Krok 2 – 2020 (General Medicine)

During examination of a patient, the doctor detected in him disorders of the eyes (hemeralopia, Bitot’s spots), skin and skin appendages, mucosa, ang gastrointestinal tract. He was provisionally diagnosed with Prasad’s syndrome. What causes the development of this pathology?

A 45-year old man with thrombophlebitis of the deep veins in his legs suddenly after physical exertion developed sharp pain in his thorax on the right, dyspnea, and hemoptysis. Objectively his condition is severe; he presents with acrocyanosis, shortening of pulmonary percussion sound on the right, and weakened respiration. Respiration is 30/min, blood pressure is 110/80mm Hg. ECG shows sinus tachycardia, his heart rate is 120/min, the electrical axis of the heart deviates to the right. S1-Q3. What is the most likely diagnosis?

A 37-year old woman received an occupational trauma that resulted in a severe vision impairment. Now she needs to be trained for another occupation. What type of rehabilitation should be doctor choose for the patient in this case?

A 22-year old post parturient woman on the 12^th day after the normal childbirth informs of fever up to 39 degree C for the last three days and pain in her right mammary gland. The right mammary gland is enlarged, hot to touch, tense, hyperemic, and painful. Palpation reveals there a dense infiltration 8*8 cm with a fluctuation in its center. What is the most likely diagnosis?

A 38-year-old woman has been suffering from glomerulonephritis for 20 years. For approximately 16 years she has been presenting with progressing renal parenchymal arterial hypertension that became refractory and accompanied by leg edemas. She receives a combination of 100mg losartan and 20mg lercanidipine with insufficient antihypertensive effect. What medicine can she be recommended for intensification of the antihypertensive effect of her therapy?

A 45-year old man has been suffering from ankylosing spondylitis for 15 years. For the last 3 years he has been noticing facial swelling and edemas of the limbs. Objectively he assumes a “beggar’s” position. X-ray shows “bamboo spine” changes in the thoracic and lumbar segments. Heart ultrasound shows aortic regurgitation. Complete blood count: Hb-106g/L; leukocytes- 8.9 x 10⁹ /L; ESR-40mm/hour. Daily proteinuria-9.6 grams per 24 hours. Blood creatinine-230 mcmol/L. What is the cause of kidney failure in this case?

A patient was brought into the pulmonology department with complaints of inspiratory dyspnea and dry cough at the highest point of inhalation. On the examination the following is observed: pale skin, cyanotic lips, “Hippocratic fingers”. Auscultation detects Velcro-type crackles (like opening a Velcro fastener). X- ray shows a “ground glass opacity” pattern. What is the most likely diagnosis?

A 45-year old man came to the hematologist with complaints of general weakness, elevated body temperature, excessive sweating, enlarged cervical lymph nodes. Objectively, his body temperature is 37.5 C, the skin is pale and dry, the posterior cervical lymph nodes are dense and elastic, upto 2 cm in diameter, mobile. There are no peculiarities in the patient’s heart and lungs. Hepatosplenomegaly was detected. What examination is necessary to determine the scope of pathologic process?

A 65-year old man underwent a left hemicolectomy due to a malignant tumor in the descending colon. On the 4^th day after the surgery he developed pain and edema in his left shin. The Homans sign is positive on the left. What postoperative complication developed in this patient?

 A 35-year old forestry officer was delivered to the hospital on the 7^th day after the onset of the disease. He complains of chills, elevated body temperature up to 40.0 C, sharp headache, and myalgias. On examination his face is puffy and hyperemic, the tongue is dry, “chalk-dusted”. In the left inguinal area, a sharply painful conglomeration of enlarged lymph nodes can be palpated. The skin over the conglomeration is hyperemic and tense. What etiotropic therapy should be prescribed to this patient?

Examination detected vesicles with seropurulent content on the neck, back of the head, and buttocks of an infant on the 4^th day of life. The patient’s condition is satisfactory, the child is active, all newborn reflexes can be fully induced, the umbilical cord is at the stage of mummification, the umbilical area is without any peculiarities. What disease can be suspected?

A 65-year old man with acute anterior myocardial infarction developed an asphyxia attack. Examination detected diffuse cyanosis. In the lungs there are numerous heterogenous wet crackles. Heart rate is 100/min. Blood pressure is 120/100 mm Hg. What complication occurred in this patient?

A 13-year- old girl for a month has been complaining of fatigability, dull pain in her right subcostal area, abdominal distension, and constipations. Abdominal palpation reveals positive Kehr, Murphy, and Ortner signs, while Desjardins and Mayo-Robson points are painless. Total bilirubin is 14.7 mcmol/L, predominantly indirect, ALT-20 U/L, AST- 40 U/L, amylase – 6.3 mmol/L. Echo cholecystography shows practically no contraction of the gallbladder. Make the provisional diagnosis:

A 48-year old woman has been hospitalized due to development of tachysystolic atrial fibrillation. She has lost 5 kg of body weight within 2 months. On palpation there is a node in the left lobe of the thyroid gland. What pathology resulted in the development of this condition?

A 58-year old man complains of weakness and tumor-like formations that appeared on the anterior surface of his neck and in the inguinal region. Palpation detects soft painless mobile cervical and inguinal lymph nodes up to 2cm in diameter. The liver protrudes by 2cm from the edge of the costal margin, the lower splenic pole is at the umbilical level. In blood: erythrocytes- 3.5 x 10¹²/L, Hb- 88 g/L, leukocytes- 86 x 10⁹/L, band neutrophils- 1%, segmented neutrophils-10%, lymphocytes- 85%, eosinophils-2%, basophils-0%, monocytes-2%, erythrocyte sedimentation rate- 15 mm/hour, Gumprecht shadows. What is the most likely diagnosis?

A newborn has a round red formation in the suprapubic region. Examination shows that urine is being discharged in pulses from the two orifices located in the lower part of this formation. Name this developmental anomaly:

A 28-year old man, a teacher, after an emotional stress developed painful muscle spasms in his right hand that occur during writing; now he has to hold the pen between the second and the third fingers. He has no problems with typing or writing on the black board, no other motor disturbances or neurological pathologies are detected. What is the most likely diagnosis?

A 45-year old woman was hospitalized with complaints of periodical severe headaches against the background of elevated blood pressure up to 180/90 mmHg, muscle weakness, and frequent urination (at night as well). Her anamnesis states that despite combining various antihypertensive drugs and adjusting the dosage her arterial hypertension cannot be corrected with drugs. The patient’s blood serum potassium levels are 2.0 mmmol/L, blood serum sodium level are 160mmmol/L. Ultrasound imaging detects three dimensional formations approximately 1.0 cm in diameter in the both adrenal glands. Selective endovascular blood sampling from the suprarenal vein was performed which revealed significant increase of cortisol and aldosterone levels. Make the diagnosis:

A pregnant woman at 32 weeks of gestation with the risk of preterm labor undergoes a treatment to prevent fetal respiratory distress syndrome. What medicine was she prescribed?

A 45-year old man underwent a cardiac surgery one week ago. His general state has been deteriorating since then: dyspnea at rest, retrosternal pain that irradiates to the neck, marked weakness. Objectively, his body temperature is hectic. His cardiac borders are expanded, apical beat is weakened. Auscultation detects pericardial friction rub. What is the most likely diagnosis?

The director of a medical facility draws up a financial plan for the next year. To improve the economic well-being of his establishment, he decided to increase the amount of medical services provided. How will it change the fixed cost per unit of service?

A woman with the pregnancy term of 8 weeks complains of elevated temperature up to 37.6 C, skin rash that can be characterized as macular exanthema, enlargement of posterior cervical and occipital lymph nodes, small amount of bloody discharge from the genital tracts. She was examined by the infectious diseases specialist and diagnosed with rubella. What tactics should be obstetrician- gynecologist choose?

A surgery unit received a person with an incised stab wound on the upper third of the right thigh. Examination detects an incised stab wound 3.0×0.5×2.0 cm in size on the inner surface of the upper third of the right thigh. Bright red blood flow from deep within the wound in a pulsing stream. Characterize this type of bleeding:

A 23-year old woman without visible cause developed a conflicting behavior at the work place. She accused the management of underestimating her, claimed that she can be a deputy director, because she speaks four languages, is very attractive, and can make useful connections for the company. She has been dressing extravagantly, flirting with her colleges, and singing loudly in her office. Infact, she has only the training of a computer operator and speaks no foreign languages. What is the likely clinical diagnosis?

A 45-year old woman undergoes an inpatient treatment. She complains of elevated body temperature up to 39.0 C, pain in her right lumbar area, turbid urine with blood. CT scan shows an area of low density within the parenchyma, no difference between the cortical and medullary layers, an increased density of the perinephric fat due to edema. What is the diagnosis?

A 25-year old man was hospitalized with complaints of pain in his lower abdomen and right lumbar area that appeared one hour ago. The patients general state is moderately severe. Body temperature- 38.2C, heart rate-102/min. The tongue is dry. The abdomen is painful on deep palpation j the right iliac area and in the petit triangle. Aure-Rozanov and Gabay signs are positive. Make the provisional diagnosis:

A 56-year old woman was diagnosed with stage 2 hypertension of the 2^nd degree. She belongs to the group of moderate risk and has bronchial asthma. What group of drugs is CONTRAINDICATED to this patient?

A 68-year old woman with congestive heart failure and left ventricular ejection fraction of less than 40% receives the following pharmacotherapy scheme: ramipril, torasemide, bisoprolol, clopidogrel and digoxin. During one of her regular examination, frequent polymorphic ventricular extrasystole were detected in the patient. What medicine should be removed from her therapy scheme?

A 35-year old woman had acute onset of the disease that started with fever up to 39.0C and cough. 3days later a dyspnea at rest increased to 35/minute. Downward from her right shoulder blade angle, percussion detects a dull sound. No vocal fremitus, respiratory sounds cannot be auscultated. What is the treatment tactics?

After playing with” mosaics”, a two-year-old child suddenly developed cough, stridorous respiration, urges to vomit, and cyanosis against the background of relative stomatic health. What should the doctor suspect first when examining the child?

40% of workers who, who polish the art glass, using an abrasive disk, and have a long record of employment, are diagnosed with ulnar neuritis, 21%- with vegetative polyneuritis, and 12% – with vegetomyofascitis of the upper limbs. These pathologies are associated with the following harmful factor:

After a long drive with the window open a man developed a facial asymmetry; he cannot close his right eye, his right nasolabial fold is smoothed out, movements of expression are absent on the right, there is a disturbance of taste sensation in the tongue on the right. No other neurological abnormalities were detected. What disease can be provisionally diagnosed in this case?

A 6-year-old girl complains of body temperature up to 39 C, rhinitis, dry cough, dyspnea. She has been presenting with these signs for 5 days already. On examination her condition is of moderate severity. Her dyspnea is of mixed genesis. Respirations are 28/min. Percussion produces a dull sound in the right lower segments; in the same area auscultation detects weakened respiration and fine vesicular wet crackles; coarse respiration can be detected on the left. Make the provisional diagnosis:

A full-term newborn (born with the body weight of 3900 g at gestational age of 39 weeks) on the first day of his life developed respiratory disturbances: dyspnea, arrhythmic respiration, cyanosis attacks. On examination there is paradoxical respiration observed and left side of the chest lags behind in the act of breathing. On auscultation the respiration is weakened in the lungs on the left. Neurologist diagnosed the patient with left- sided Erb-Duchenne palsy. Complete blood count shows no changes. What is the most likely diagnosis?

A 30-year-old woman made an appointment with the family doctor for scheduled vaccination of her 2-year-old child. What type of healthcare provides such medical services?

A 3-year-old child has been brought to a hospital with pain in the legs, fever, and loss of appetite. Objectively: pale skin and mucosa, hemorrhagic rash. Lymph nodes are enlarged, painless, dense and elastic, not matted together. Bones, joints and abdomen are painful. The liver and spleen are enlarged. Hemogram: Hb-88g/L, color index- 1.3, platelets- 80 x 10⁹/L, leukocytes- 25.8 x 10⁹/L, lymphoblasts- 70%, ESR-52 mm/hour. Make the provisional diagnosis:

After semolina was introduced into the diet, a1-year old child for 2 months has been presenting with loss of appetite, irritability, loss of body mass, and loss of previously learned skills. The feces are copious and foul smelling. The skin is pale and dry, the hair is brittle. The abdomen is distended, while the limbs are thin. Stool test shows high levels of fatty acids. What is the most likely diagnosis?.

A 73-year-old woman came to the family physician for one of her regular follow-up examinations. Three months ago she was found to have type 2 diabetes mellitus. She was keeping to her diet and exercise plan and taking Phyto preparations. On examination her fasting glucose was within the range of 7.8-8.6mmol/L,HbA1c- 7.9%. height –164cm, weight –83kg. What blood glucose controlling medicine should be prescribed first in the course of her pharmacological therapy?

A patient has gradually lost his consciousness. The skin is pale and dry. There is smell of ammonia from the mouth. Respiration is deep and noisy. Heart sound muffled, pericardial friction rub are present, blood pressure is 180/130mmHg. Blood test  : Hb – 80g/l, leukocytes- 12 x 10⁹/l , blood glucose-6.4mmol/l  ,urea – 50mmol/l, creatine- 1200mmol/l, blood osmolarity – 350 mOsmol/kg H2O.No urinary excretion. Make the diagnosis:

A 10-year-old boy came to the polyclinic with complaints of stuffy nose. It is known that these signs occur in the child periodically (in spring and autumn). He has  a history of atopic dermatitis. The father of the child had bronchial asthma. Objectively, the boy’s face is pale and slightly swollen. Respirations are 22/min. Auscultation detects vesicular respiration over the lungs. Rhinoscopy shows swollen and pale nasal mucosa. What disease can be suspected?

Disease onset was acute. A child developed general weakness, pain in the joints, and fever. Later these signs became accompanied by itching skin rash manifested as erythematous spots 2-5 mm in size. The rash gradually turned hemorrhagic. Large joints are painful and swollen ;pain attacks periodically occur in paraumbilical area; there are signs of intestinal hemorrhage. What is the most likely diagnosis?

A 34-year-old multipara was brought to the labor ward with regular labor activity. Her pelvic size 26-29-32-22 cm. Vaginal examination shows 6 cm cervical dilation, the amniotic sac is unbroken. The fetus is in the breech presentation, with buttocks pressed to the entrance into the lesser pelvis. The promontory cannot be reached, no exostoses. Feta heart rate is 140/min, expected fetal weight is 2800g. What labor tactics should be chosen?

A 54-year-old woman complains of fogged vision in her right eye, rainbow circles in her vision, headache, and nausea. Within the last month she twice experienced a similar condition, but back the all the signs eventually disappeared and her sight was restored. Currently, all the signs have beed persisting for over 2 days. Objectively, the patient has eyelid edema, congestive injection of the eyeball, corneal opacity, shallow anterior chamber of the eye, and dilated pupil that is unresponsive to the light. Her intraocular pressure is 48mmHg. Make the diagnosis:

A 3-month-old child with sighs of rickets presents with positive Chvostek, Trousseau, and Maslov signs. One days ago, the parents witnessed a cyanotic attack in their child- the child broke into a cold sweat, the eyes bulged, and respiratory arrest occurred. One minute later the child drew in a loud breath and child’s condition normalized again. What is the cause the described signs of the disease?

After eating shrimps, a 25-year old man suddenly developed skin itching, some areas of his skin became hyperemic or erupted into vesicles. Make the diagnosis:

A 35-year-old woman came to the family doctor with complaints of profuse menstruations that last up to 10 days. Gynecological examinations shows that the uterine cervix is without changes, the uterus  is in anterflexio, has normal size , is mobile and painless. The uterine appendages on the both sides are without peculiarities. The family doctor made the provisional diagnosis of the abnormal uterine bleeding. What instrumental method of examination needs to be performed first to diagnose this pathology?

A 19-year-old young man was diving and hit his head on the bottom of the pool. He complains of pain in the neck, head movements are limited and painful. During examination his head is bowed forward and to the right and the patient supports it with his hands. Palpation detects tense neck muscles and protruding spinous process of the IV cervical vertebra(C4). When pressure is applied to this process and to the head (axial load), the pain intensifies. Make the provisional diagnosis:

A patient is 45 year old. He was referred for a consultation with a psychiatrist due to complains of abdominal pain and discomfort that occur in emotional staining situation. Objectively, no changes of the gastrointestinal tract was detected. The complaints emerged over 10 years ago against the background of severe alcohol poisoning. The patient has been repeatedly visiting gastroenterologists, who were unable to find any significant changes in the patient. The prescribed therapy was ineffective. What is the likely conclusion?

A 21-year-old man was hospitalized on the 2^nd day of the disease. His general condition is severe, body temperature is 39C. On his skin there are numerous irregular-shaped hemorrhghic elements. The diagnosis of meningococcemia was made. The next day his body temperature suddenly decreased, blood pressure was 80/40mmHg, pulse was 120/min. Acrocyanosis was detected. What complication did the patient develop?

Forensic autopsy of a body of a 59-year-old man, who died suddenly at home without signs of violent death, shows pink skin and mucosa, liquid bright-red blood, and bright-red plethoric internal organs. Forensic toxicology testing detected 1.44% of ethanol in the blood and carboxyhemoglobin levels of 55%. What is the cause of death?

A  45-year-old man with a history of myocardial infarction developed a brief attack of palpitation, accompanied by the sensations of lack of air, fear, and vertigo. His blood pressure is 90/60mmHg. ECG during the attack shows extended QRS complex (0.13 seconds) with heart rate of 160/min, discordant shift of ST segment and T wave, dissociation of atrial and ventricular rhythm. What disturbances of cardiac rhythm it is?

For 20 years the role of excessive weight in ischemic heart disease development among the working age male production over 40 was studied. It was determined that overweight men developed ischemic heart disease more often. What type of epidemiological study is it?

A 20-year-old woman complains of headaches, vertigo, tearfulness, vomiting, pain in the area of the heart, and tachycardia. The signs appear 6-7 days before menstruation and disappear in the first days of menstruation. Make the diagnosis

A woman came to the gynecologist to plan her pregnancy. She was advised to increase her intake of the products rich in folic acid, particularly soy beans, bread made of coarsely ground flour, fruits, leafy green vegetables. Such changes in her diet will work toward the prevention of:

A 48-year-old woman complains of disturbed menstrual cycle; her periods last for 7-9 days and are excessively profuse throughout the last half-year. She notes occasional hot flashes in her head, insomnia, irritability, and headaches. Her skin is of normal color. Blood pressure – 150/90mmHg, pulse –90/min, rhythmic. The abdomen is soft and painless. Bimanual examination shows no uterine enlargement, the appendages cannot be detected. The vaginal fornixes are free. What is the most likely diagnosis?

A pregnant woman of 32 weeks of gestation underwent dopperometry of umbilical circulation, which revealed a reverse diastolic component. Objectively, the height of the uterus is 27 cm above the pubic bone, head of the fetus is mobile and located above the entrance to the lesser pelvis. Fetal heartbeat is 136/min. Vaginal examination shows that the uterine cervix is closed, its length is 3 cm. What tactics should the obstetrician choose?

A 26-year-old woman was hospitalized into the gynecological department with the complains of body temperature up to 38.2 C, fever, general weakness, and dirty-red blood discharge from her genital tracts. She is hemodynamically stable. Two days ago, she underwent a medical abortion on the 8^th week of pregnancy. Ultrasound detects the remains of the fertilized egg in her uterine cavity. What are the tactics of the patient management in this case?

A 23-year-old woman with type 1 diabetes mellitus during the 2^nd week of community-acquired pneumonia developed nausea and vomiting. In the evening she has lost her consciousness and was hospitalized. Objectively, the patient’s skin is pale and dry. Her respiration is long, the tongue is dry, with brown deposit. Her heart rate is 129/min, blood pressure is 85/50mmHg. Palpation of the patient’s abdomen provokes no response. the liver is +3 cm. Acetone test is markedly positive, blood glucose is 26 mmol/l. Make the provisional diagnosis:

On the 5^th day after giving birth a post parturient woman complains of a pain in her left mammary gland and body temperature up to 38.1C. Examination shows that her mammary gland is enlarged  and painful on palpation, the nipple is edematous and has fissures, the upper external quadrant of the gland is hyperemic. Name the measures that would have prevented the development of this complication in the patient

On ultrasound of the thyroid gland. A 47-year-old woman presents with a hypoechoic node 1.6 cm in diameter with blurred margins and intranodular hypervascularization. The doctor suspects thyroid carcinoma. What method should be used to verify the diagnosis?

In a pediatric clinic, located in a rural area, there are 9 children, who simultaneously fell ill. The following signs were detected: low physical activity, acrocyanosis of the nasolabial triangle and fingertips, mucosal cyanosis, tachycardia, dyspnea. It was determined that all the sick children were fed with a formula that was dissolved in the water taken from a dug well. Laboratory analysis revealed high levels of methemoglobin in the blood of the children. These signs can be caused by increased content of a certain element in the water. Name this element:

A 20-year old man suffers from headache, general weakness, and face edema that appears in the morning. 18 days earlier he had a case of tonsillitis. Objectively, his skin is pale, there are edema under his eyes. Hear rate is 60/min, blood pressure is 185/100 mmHg. The sign of costovertebral angle tenderness (punch sign in the lumbar region) is negative. Urinalysis: color of “meat slops”, protein-4.5 g/, altered erythrocytes- 40-45 in the vision field, leukocytes- 5-6 in the vision field. 24-hour diuresis is 400 mL. What is the most likely diagnosis?

An 18-year old patient always obeys others and adapts his needs to the demands of the people on whom he depends. He excessively defers to their wishes and makes them responsible for his wellbeing, cannot defend his interests and needs support from other people. Such psychic profile has been formed in the childhood, remains unchanged, and hinders adaptation. What psychic disorder is observed in this patient?

A 35-year old woman complaints of a pain in her right axillary region. She has been suffering from this condition for a week. Her body temperature is 38 C. in the right axillary region there are 2 formations, 2 cm in size each. The skin over the formations is dark red and thin, palpation produces a yellow-white discharge from the fistular openings. What is the most likely diagnosis?

During a regular examination, an 8-year old girl with type 1 diabetes mellitus presents with a swelling on the anterior surface of her hip. The swelling is 3 cm in diameter, dense, painless on palpation. The skin over this formation has normal color and temperature. Localization of the swelling matches the place where the girl usually receives her insulin injections. What is the most likely cause of this clinical presentation?

A 52-year-old woman has been suffering for 2 years from dull, occassionally exacerbating pain in her right subcostal area, occuring after eating high-fat foods, bitter taste in her mouthin the morning, constipations, and flatulence. Objectively, she is obese, her body temperature is 36.9 C; there is a coating on the root of her tongue; abdomen is moderately distended and painful in the area of the gallbladder projection. What examination would be most helpful for diagnosis making?

A family doctor performed an external obstetrical examination on a pregnant woman and determined that her uterine fundus is located at the level of the navel. What is the most likely term of pregnancy in this woman?

What should be prescribed as secondary prevention drugs for a patient with atrial fibrillation after an ischemic stroke caused by cardiac embolism?

A 55-year old woman complaints of thyroid gland enlargement that can be observed throughout the last two years and a discomfort during swallowing. Objectively, she has signs of hypothyroidism. The thyroid gland on palpation is dense, non-fused with the surrounding tissues and mobile on swallowing. The regional lymph nodes are not enlarged. In the serum there are antithyroid antibodies detected. What is the most likely diagnosis?

A 12-year-old girl after a case of respiratory infection developed dyspnea at rest, paleness of skin. Heart rate is 110/min, BP is 90/55 mmHg. Heart sounds are muffled. Borders of relative heart dullness: right- the left parasternal line, upper- the III rib, left- 1,0 cm outwards from the midclavicular line. Make the provisional diagnosis:

A 19-year-old young man complains of cough with expectoration of purulent sputum in amount of 100 ml per day, hemoptysis, dyspnea, increased body temperature up to 37.8 C, general weakness, weight loss. The patients condition lasts for 4 years. Exacerbations occur 2-3 times a year. The patient presents with malnutrition, pale skin, cyanosis of the lips, drumstick (clubbed fingers). Tympanic percussion sound in the lungs, weakened respiration, and various numerous moist crackles in the lower pulmonary segments on the left can be observed in this patient. in blood:  erythrocytes-3.2 x 10¹²/L, leukocytes- 8.4 x 10⁹/L, ESR-56 mm/hour. On X-ray: lung fields are emphysematous, the left pulmonary root is deformed and dilated. What is the most likely diagnosis?

A patient 1 year had a Q wave myocardial infarction of the posterior wall of the left ventricle. For the last 2 weeks he has been suffering from daily attacks of atrial fibrillation and bradycardia episodes, accompanied by bouts of vertigo. What tactics is the most advisable in this case?

A 58-year old woman has type2 diabetes mellitus that is compensated with diet and metformin. She prepares for cholecystectomy. Objectively, her height is 164 cm, weight is 90 kg, heart rate is 72/min, blood pressure is 130/80 mmHg. Her abdomen is soft, painful in the right subcostal region. The liver is not enlarged. Fasting glucose-6.2 mmol/L. Glycated hemoglobin- 6.5%. what further tactics of sugar lowering therapy should be chosen in this case?

A 23-year-old woman came to the gynecological clinic. she complains of pain, itching, and burning in her vulva, general weakness, indisposition, elevated body temperature up to37.2 C, and headache. On examination in the vulva there are multiple vesicles up to 2-3 mm in diameter with clear contents against the background of hyperemia and mucosal edema. Make the provisional diagnosis:

A 5-year-old child had acute onset of the disease that manifested in body temperature up to 39.5 C, marked chills, weakness, inertness, skin pallor, and headache. 8 hours later a hemorrhagic rash developed on the skin of the buttocks and les. The child is sluggish, the body temperature has dropped, blood pressure is 80/40, respirations are 28-30/min, diuresis is decreased. Make the provisional diagnosis:

A 43-year old man complains of facial edema, dyspnea, and difficult swallowing that appeared 3 hours after he was stung by an insect. Objectively, the skin of his eyelids, cheeks and lips is acutely hyperemic and edematous. What medicines should he be prescribed for emergency aid?

When planning treatment of a patient, it was decided to use a medicine with evidence level A. what trials produce the evidence that allows to classify the medicine level as A?

After the pregnant woman’s water broke, it was noted that they are significantly contaminated with meconium. Upon birth, the baby is not breathing, remains inert, the skin is cyanotic and covered in meconium, heart rate is 98/min. What resuscitation measures should be taken after the baby is born?

The 5-year old child has been ill for 2 weeks. Cough attacks developed first and were then followed by reprises. During coughing the child’s face turns red and cervical veins bulge. The cough attacks induce vomiting. X-ray shows intensified bronchial pattern. Blood test: leukocytes-16 x 10⁹/L, lymphocytes-72%, erythrocyte sedimentation rate-4mm/hour. What is the most likely diagnosis?

A 48-year old woman was delivered into the surgical unit with wounds in her thigh. On examination the wound surface has a dirty-gray coating with unpleasant sweet smell. The wound content resembles a raspberry jelly. Skin tissues around the wound are glossy and turgid. Palpation reveals moderate crepitation in the tissues. What bacteria is the most likely to cause such inflammation?

A patient underwent suture plication of the perforated duodenal ulcer. On the 3^rd day after the operation he started producing a large amount of discharge from the abdominal drain tube. The discharge contains bile and has high amylase levels. What complication occurred in the patient?

A 40-year-old victim of a traffic accident sustained the following injuries: closed diaphyseal femur fracture, brain concussion, multiple rib fractures, hemopneumothorax, degloving shin injuries. What injuries require the most urgent attention?

A 20-year old woman, gravida 2, para1 has been in labor for 4 hours. Her condition is satisfactory. Moderately painful contractions occur every 3 minutes and last for 35-40 seconds. The waters have not burst yet. The fetus is in longitudinal position. Fetal heartbeats are 136/min., clear and rhythmic. Major segment of the fetal head is engaged to the pelvic inlet. Vaginal examination shows smooth cervix of 6 cm, amniotic sac is intact, sagital suture is in the left oblique diameter, occipital fontanel is on the right near the symphasis pubis. What stage of labor is it?

A 22-year-old infant developed subcutaneous red nodes from 1.0 to 1.5 cm in size on the scalp; later the nodes enlarged. Complete blood count: anemia, leukocytosis, neutrocytosis, raised ESR. What diagnosis will you make?

A 26-year-old man complains of chills, rhinitis, dry cough, and fever up to 38C. Examination shows him to be in a moderately severe condition; there are small pale pink non-merging spots on the skin of his back, abdomen, and extremities. Palpation reveals enlarged occipital and axillary lymph nodes. No information about vaccination history could be obtained. What is the likely etiology of this disease?

A 38-year-old patient has been delivered by an ambulance toa surgical department with complaints of general weakness, indisposition, black stool. On examination the patient is pale, there are dotted hemorrhages on the skin of his torso and extremities. On digital investigation there are black feces on the glove. Blood test: Hb-108g/L, thrombocytopenia. Anamnesis states that similar condition was observed I year ago. Make the diagnosis:

The body of a citizen was found at the place of his dwelling. On his face, neck, and hands there were detected irregular-shaped wounds, varying from 2×3 cm to 4×5 cm in size. The skin and underlying tissues are absent in the wounds. The margins of the wounds are uneven, with major and minor scalloping along the edges and no signs of bleeding. What is the initiating mechanism of these wounds?

A multigravida, labor II, 36-37 weeks of gestation, has gone into labor. Her waters broke 8 hours ago, the labor activity continues for the last 4 hours, it is regular, with contractions that last 35 seconds and occur every 3 –4 minutes. The child is in the cephalic presentation, with the head pressed to the entrance into the lesser pelvis. The parturient woman complains of a sudden sharp abdominal pain. Her pulse is100/min, blood pressure is 110/70- 100/70 mmHg. The uterus is tense and does not relax between the contractions. Fetal heartbeat is muffled- 100/min. The amniotic fluid is blood-colored and continues to leak. What is the most likely diagnosis?

A 45-year-old woman complains of increasing body weight throughout the last year. Examination revealed moon face syndrome, brittle hair, hirsutism, stretch marks on the abdomen, and disproportionally thin limbs. The patient’s height is 162 cm, her body weight is 94 kg, her body mass index is 35.8 kg/m². What type of obesity it?

A 2.5-year –old child is ill for the second day. The onset of the disease was associated with the temperature up to 37.8 C, a single bout of vomiting, a watery diarrhea up to 5 times per day. During the second day, vomiting occurred twice, body temperature is 38.0C, the child has low appetite, watery diarrhea continues. The treatment of the child should start with the following:

On the 3^rd day after the artificial abortion the woman was hospitalized into the gynecological department in a severe condition with signs of intoxication, abdominal pain, and purulent discharge from the vagina. Objectively, the patient’s condition is severe, her body temperature is 38.8 C, pulse is 100/min, blood pressure is 110/70 mmHg, the uterus is soft, the uterine fundus is located at the level of navel, there are positive signs of peritoneal irritation. What is the most likely diagnosis?

You witnessed a car accident. When examining the place of the accident you noticed a man of about 30 years, who was hit by the car. He is unconscious. On his neck on the left there is a profuse hemorrhage with bright-red blood. How to stop this hemorrhage?

A 27-year-old man complains of pain in his leg joints, purulent discharge from the eyes, and painful burning sensations during urination. The disease onset was acute. He has a history of influenza. The patient smokes and drinks alcohol in excess. In his line of work, he is often away on business trips.  What is the most likely etiological factor of this disease?

A 57-year-old man, a miner, complaints of a pain in his chest, dyspnea on physical exertion, excessive sweating, constant sub febrile temperature, and cough that produces blood-steaked sputum. He has been smoking for approximately 40 years (2 packs a day) and frequently has ”pneumonias”. Survey chest X-ray shows a triangular shadow in the middle lobe of the right lung. One of the apices of the shadow points to the lung root. Cardiac and mediastinal shadows are displaced toward the affected area. Make the provisional diagnosis:

A district doctor has diagnosed one of his patients with dysentery. What accounting document reflects this type of morbidity?

A 31-year-old drug-addicted person complains of a cough with bloody expectorations, dyspnea, persistent fever, and leg edemas. The jugular veins are distended. There is a coarse pansystolic murmur detected above the base of the xiphoid process and in the second intercostal space on the left, close to the edge of the sternum. Heart sounds are clear, arrythmia is detected, heart rate is 128/min, pulse-82/min, blood pressure is 100/70 mmHg. What is the most likely diagnosis?

A 7-year-old boy after a fall from a height presents with rapid and shallow breathing and cyanotic face. The right half of his thorax is distended and takes no part in the respiration. Percussion detects tympanitis in the affected area, while auscultation detects no breathing there. What pathology is the most likely cause of this clinical presentation? What instrumental examination would be most informative in this case?

A 55-year-old woman came to a gynecologist with complaints of leukorrhea and bloody discharge from the vagina after 5 years of menopause. Anamnesis states no pregnancies. Bimanual examination: the uterus and uterine appendages are without changes. During diagnostic curettage of the uterine cavity the physician scrapped off a sample of encephaloid matter. What is the most likely diagnosis in this case?

What modern organizational method can provide the patients in the remote settlements with timely access to quality medical aid and such medical services as consulting, diagnostics, and treatment, especially in the situations when time and distance are crucial?

A 17-year old girl has been suffering from hepatic cirrhosis for 3 years. Lately her periods of excitation have been intermittent with depression, she does not sleep enough. Objectively her condition is severe, the girl is sluggish, gives one-word responses, has tremor in her extremities, her skin is icteric, with single hemorrhagic rashes. Name the likely complication of her disease:

A man works in casting of nonferrous metals and alloys for 12 years. In the air of working area there was registered high content of heavy metals, carbon monoxide, and nitrogen. During periodic health examination the patient presents with asthenovegetative syndrome, sharp abdominal pains, constipations, pain in the hepatic area. In urine: aminolaevulinic acid and coproporphyrin are detected. In blood: reticulocytosis, low hemoglobin level. Such intoxication is caused by:

During regular examination of a 2-year old boy, he presents with enlarged left kidney, painless on palpation. The right kidney was undetectable on palpation. Excretory urography shows no contrast on the right. Cytoscopy detected hemi atrophy of the urinary bladder trigone, the right ureteral orifice is not detected. What pathology is it?

A 34-year-old woman after rapidly changing her position from horizontal to vertical suddenly paled, fell down, her skin became moist, her limbs are cold, her pupils are dilated. The pulse is rapid and thready, blood pressure is 50/25 mmHg. What condition has likely developed in the patient?

On laboratory investigation of a pork sample there is 1 dead trichinella detected in 24 sections. This meat should be:

Employees work in conditions of high dust concentration. Certain chemical (silicon dioxide content) and physical properties of dust aerosols contribute to the development of occupational dust-induced diseases. What is the main physical property of dust aerosols?

A woman complains of a severe pain in her throat on the left, difficult swallowing and mouth opening, elevated body temperature, and general malaise. The onset of the disease was 4 days ago after a case of tonsillitis. Examination detects a trismus of the masticatory muscles; the left tonsil is displaced toward the midline; the anterior palatal arch is infiltrated and protruding. The regional lymph nodes on the right are enlarged and painful on palpation. Make the diagnosis:

During winter epidemics of influenza caused predominantly by virus A/California/04/2009 (H1N1), on the 2^nd day after the disease onset a 30-year old hospitalized man presented with high fever, dry cough, myalgia, headache, and general weakness. What should be prescribed as an etiotropic treatment in this case?

A 30-year old woman complains of itching skin, predominantly in the evening and at night. The condition lasts for 2 weeks already. On the skin of interdigital folds, mammary glands, abdomen, buttocks, and thighs there are numerous fine papular and papulovesicular rashes located in pairs, excoriations. There is no rash on the face and neck. Similar rash is observed in the husband of the patient. What is the most likely diagnosis?

A 20-year old patient complains of a severe headache, double vision, weakness, fever, irritability. Objectively: body temperature is 38.1 C, the patient is reluctant to contact, sensitive to stimuli. There is ptosis of the left eyelid, exotropia, anisocoria S >D, and pronounced meningeal syndrome. On the lumbar puncture the cerebrospinal fluid flowed out under a pressure of 300 mmHg, the fluid is clear, slightly opalescent. 24 hours later there appeared a fibrin film. Protein- 1.4 g/L, lymphocytes- 600 per mm^3, glucose- 0.3 mmol/L. What is the provisional diagnosis?

3 hours after a trauma, a young man developed bradycardia of 46/min, anisocoria D >S, hemi-hyperreflexia S >D, hemi hypesthesia on the left, and a convulsive disorder. The character of this process needs to be clarified. What method of examination will be the most accurate for this purpose?

A 75-year-old man in a severe condition suffers from dyspnea at rest, marked weakness, and arrhythmia. Abdominal aortic pulsation is observed, further on is a systolic murmur detected. Palpation reveals a volumetric formation in the mesogastrium. Blood pressure is 70/40mmHg. There is no pulsation over the femoral arteries. Oliguria is detected. Which diagnosis is the correct one?

A dweller of the northern Dnieper area, a fisherman, for the last several days has been complaining of a discomfort in his right subcostal region, periodical episodes of diahhrea, intermittent with constipation, frequent skin rashes. Abdominal ultrasound shows enlarged liver and pancreatic head. Make the provisional diagnosis:

A 25-year-old woman was brought into the gynecological department with profuse bloody discharge from her genital tracts. She is 12 weeks pregnant, the pregnancy is planned. Within the last 3 days she was experiencing pains in her lower abdomen that eventually started resembling cramps, ahe developed bleeding. Her skin is pale, pulse-88/min, blood pressure-100/60mmHg, body temperature –36.8C. Vaginal examination; the uterus size corresponds to 11 weeks of gestation, the cervical canal allows inserting 1 finger and contains fragments of the fertilized ovum, the discharge is bloody and profuse. What is the most likely diagnosis?

A 39-year-old man, a battery attendant suddenly developed weakness, loss of appetite, nonlocalized colicky abdominal pains, and nausea. Objectively, his skin, its grey, there is pink-gray stripe on his gums; the abdomen is soft and sharply painful. Blood test detected erythrocytes with basophilic stippling and anemia. The patient has a history of peptic ulcer disease of the stomach. Constipations occur each 3-4 days. What is the most likely provisional diagnosis?

An 18-year-old patient complains of skin rash. The patient has been suffering from this condition for 5 years. The first instance of this disease occurred after a car accident. Objectively, the patient presents with a papular rash covered in silvery scales, “thimble” sign (small pits on the nails) affected joints. What is the most likely diagnosis?

During regular medical examination a lyceum student present with signs of cheilitis that manifests as epithelial maceration in the area of lip seal. The lips are bright-red with single vertical cracks covered with brown-red scabs. These clinical signs are mostly likely caused by insufficient content of the following in the diet:

Children from a certain township presents with brittle teeth, malocclusion, dental enamel erosions, and dental pigmentation that looks like yellow- brown spots. What is the likely cause of this presentation?

An 8-day-old boy was delivered to the hospital on the second day after the onset of the disease. His parents complain of his fussiness, regurgitation, body temperature up to 38.5 C, red skin with infiltration in the lumbar area. His medical history has no peculiarities. The child is in the severe condition, inert, pale, suckles poorly. In the lumbar area, on the sacrum and buttocks there is a tense infiltration with hyperemic and cyanotic areas and with a soft spot 8×7 cm in its center. the stool is 10 times in 24 hours, with green and mucous admixtures. What is the most likely diagnosis?

A 72-year-old man with pneumonia complains of marked dyspnea, chest pain, severe cough with expectoration, temperature is 39.5-40 C, no urination for the last 24 hours. Objectively, the patient is conscious. Respiratory rate is 36/min. Percussion sound is dull over the right lower pulmonary lobe; on auscultation there is bronchial respiration and numerous moist crackles. Blood pressure is 80/60 mmHg. Heart rate is 120/min. Heart sounds are muffled, there is tachycardia. What tactics should the family doctor choose for the management for this patient?

A 48-year-old man came to a doctor with complaints of vomiting that brings no relief and a burning pain in his left subcostal region that irradiates to the left lumbar region. These signs appeared after a meal. The Ortner’s and Mayo-Robson’s signs are positive. In the blood; leukocytosis and increased ESR. In the urine; elevated diastase levels. Make the diagnosis:

A 32-year-old woman complains of general weakness, low-grade, fever persisting for 4 months, lumbar pain, and dysuria. Anamnesis includes frequent acute respiratory diseases, overexposure to cold, low-calorie diet, a case of pulmonary tuberculosis in childhood. Clinical urine analysis; pH 4.8 leukocytosis, hematuria. Complete blood count: leukocytosis, lymphocytosis, raised ESR, urography concludes; dilation of renal pelvis and calyceal system of both kidneys, foci of the calcification in the projection of right kidney parenchyma. What is the most likely diagnosis?

An unconscious patient was delivered to a hospital by an ambulance. Objectively, his body temperature is 39 C, he presents with convulsion and red dry skin. It is known that the patient works as a stoker in the boiler room. What is the likely diagnosis?

A child was born at 40 weeks of gestation with the weight of 3700g. The child’s Apgar score is 7/9. The baby was put to breast immediately after birth and suckled actively. On the 3^rd day of life, the child’s weight decreased to 3600g. What transitory condition is observed in this child?

2 hours after eating unknown mushrooms, a 28-year-old man sensed a decrease in his mobility and deterioration of his ability to focus. This condition was then followed by a state of agitation and aggression. On examination, he is disoriented and his speech is illegible. 4 hours later he developed fetor hepaticus and lost his consciousness. What syndrome can be observed in this patient?

A 17-year-old girl complains of a pain in her knee and ankle joints and body temperature up to 39c . 2 weeks ago, she had a case of acute tonsillitis. Objectively, her joints are swollen, sharply painful and their mobility is reduced. On the skin of her truck and limbs there are barely visible circle-shaped pale pink spots. Heart rate is 95/min, blood pressure is 90/60 mmHg, heart sounds are weakened, there is a soft systolic noise over the apex. Make the provisional diagnosis:

A 19-year-old girl complains of moderate, itching and hair loss on her head. Objectively, on the skin of her occipital region there is a single round erythematous focus 3 cm in diameter with clear margins. Asbestos- like scales can be observed on the surface of the lesion. The hair in the focus of the lesion is broken off at the length of 6-8 cm. What is the most likely diagnosis?

A woman complains of frequent watery stool (up to 9-10 times per day) with mucus and blood admixtures, dull pain in the hypogastrium, weight loss of 4kg within the last year. Objectively, malnutrition, dry skin, low turgor, aphthous stomatitis. The abdomen is soft, the sigmoid colon is spastic and painful on palpation. Occult blood test is positive. Fibro colonoscopy; edema, hyperemia, mucosal granulation, pseudopolyps, small ulcers with irregular edged. Make the diagnosis:

A 9-year-old boy fell off a tree and hit the back of his head. A brief loss of consciousness was observed. The child’s condition is satisfactory, he has a headache and vertigo. Skull X-ray scans shows depressed fracture of the occipital bone in the area of the external occipital protuberance. What treatment tactics is indicated for this patient?

A 16-year-old boy developed dizziness. His heart rate is 35/min, blood pressure is 85/45mmHg, heart borders are not enlarged. Heart sounds are loud and clear. ECG shows P waves disconnected from QRS complex, dissociation and different rhythm of atria and ventricles is accompanied by varying location of P wave in relation to QRST complex. This presentation is the most characteristic of the following disease:

A 56-year-old woman has been working as a disinfector for 19 years. She complains of general weakness, nausea, bitter taste in her mouth, heavy sensation in her right subcostal area, and rapid fatigability. Objectively, her body temperature is 37.1 C, the sclerae are icteric, and the liver is enlarged. Total bilirubin is 40 mcmol/L. What is the likely diagnosis?