Krok 2 – 2009 (General Medicine)

A woman complains of having slight dark bloody discharges and mild pains in the lower part of abdomen for several days. Last menses were 7 weeks ago. The pregnancy test is positive. Bimanual investigation: the body of the uterus indicates for about 5-6 weeks of pregnancy, it is soft, painless. In the left appendage there is a retort-like formation, 7х5 cm large, mobile, painless. What examination is necessary for detection of fetus localization?

A pregnant woman in her 40^th week of pregnancy undergoes obstetric examination: the cervix of uterus is undeveloped. The oxytocin test is negative. Examination at 32 weeks revealed: AP 140/90 mm Hg, proteinuria 1 g/l, peripheral edemata. Reflexes are normal. Choose the most correct tactics:

A 26 year old woman had the second labour within the last 2 years with oxytocin application. The child’s weight is 4080 g. After the placent birth there were massive bleeding, signs of hemorrhagic shock. Despite the injection of contractive agents, good contraction of the uterus and absence of any cervical and vaginal disorders, the bleeding proceeds. Choose the most probable cause of bleeding:

A woman of a high-risk group (chronic pyelonephritis in anamnesis) had vaginal delivery. The day after labour she complained of fever and loin pains, frequent urodynia. Specify the most probable complication:

In the woman of 24 years about earlier normal menstrual function, cycles became irregular, according to tests of function diagnostics – anovulatory. The contents of prolactin in blood is boosted. Choose the most suitable investigation:

A patient was delivered to a surgical department after a road accident with a closed trauma of chest and right-sided rib fracture. The patient was diagnosed with right-sided pneumothorax, it is indicated to perform drainage of pleural cavity. Pleural puncture should be made in:

A patient who takes diuretics has developed arrhythmia as a result of cardiac glycoside overdose. What is the treatment tactics in this case?

A 20 year old patient was delivered to the hospital in summer from the street with haemorrage from the brachial artery. First medical aid involved application of a tourniquet for provisional arrest of bleeding. What is the maximal exposure of the tourniquet?

The average body lenth of newborn boys is 50.9 cm at a sigma 1.66; and average mass – 3432 at a sigma 5.00. What criterion is necessary in order to compare degree of variability of these signs?

Indicate the registration medical document for the patient, who 21.02. was addressed to the doctor with diagnosis ARVD for the first time in this year:

Five days after a total hip joint replacement a 72 year old woman becomes acutely short of breath, diaphoretic and hypotensive. Both lung fields are clear to auscultation and percussion, but examination of the neck reveals mild jugular venous distension with prominent A waves. Heart sounds are normal. ECG shows sinus tachycardia with a new right bundle branch block and minor nonspecific ST − T wave changes. The most likely diagnosis is:

A 38 year old man, previously in good health, suddenly develops severe abdominal pain radiating from the left loin to groin and accompanied by nausea, perspiration and the need for frequent urination. He is restless, tossing in bed but has no abnormal findings. The most likely diagnosis is:

A 40 year old woman has a self-detected hard breast mass. The procedure of choice for confirming the diagnosis is:

What is the maximum duration of medical certificate in case of tuberculosis?

The student has the following devices: Geiger counter, Ebert counter, Krotov’s apparatus, Mischuk device, Ebert device. What device can he use to assess air germ pollution?

Student В. lives in the canalized house in the flat with complete set of sanitary equipment (WC, bath, shower, local water heater). How much water consumption has he got?

What guarantees against the preconceived attitude to the physician in cases of professional law violations do you know?

A 63 year old patient was diagnosed with purulent mediastinitis. What of the below listed diseases are NOT the cause of purulent mediastinitis?

A 36 year old patient was diagnosed with right-sided pneumothorax. What method of treatment is indicated to the patient?

It is suspected that a 34 year old patient has an abscess of Douglas pouches. What diagnostic method is to be chosen?

A patient has restrained umbilateral hernia complicated by phlegmon hernia, it is necessary to take following actions:

A 10 year old boy complains about pain in his left eye and strong photophobia after he had injured his left eye with a pencil at school. Left eye examination: blepharospasm, ciliary and conjunctival congestion, cornea is transparent, other parts of eyeball have no changes. Visus 0.9. Right eye is healthy, Visus 1.0. What additional method would you choose first of all?

A patient with acute purulent otitis media complicated by mastoiditis was admitted to a hospital. Roentgenogram of mastoid processes showed the shadiowing of the cellular system on the lesion, absence of bone septa was present. What are the necessary therapeutic actions at the second stage of mastoiditis?

The most available and informative diagnostic method for closed trauma of the urinary bladder is:

Female 45 year old patient was admitted to the traumatological ward with the closed fracture of the medial malleolus with its displacement up to 3 mm. The foot is to be fixed with a plaster cast in the following position:

A 3 month old infant suffering from acute segmental pneumonia has dyspnea (respiration rate – 80 per minute), paradoxical breathing, tachycardia, total cyanosis. Respiration and pulse – ratio is 1:2. The heart dullness under normal size. Such signs characterise:

A 3 year old child has been suffering from fever, cough, coryza, conjunctivitis for 4 days. He has been taking sulfadimethoxine. Today it has fever up to 39^oC and maculopapular rash on its face. Except of rash the child’s skin has no changes. What is your diagnosis?

A 2 year old girl has been ill for 3 days. Today she has low grade fever, severe catarrhal presentations, slight maculopapular rash on her buttocks and enlarged occipital lymph nodes. What is your diagnosis?

A 3 year old boy fell ill abruptly: fever up to 39^oC, weakness, vomiting. Haemorrhagic rash of various size appeared on his lower limbs within 5 hours. Meningococcemia with infective – toxic shock of the 1 degree was diagnosed. What medications should be administered?

A woman delivered a child. It was her fifth pregnancy but the first delivery. Mother’s blood group is A(II )Rh⁻, newborn’s – A(II )Rh⁺. The level of indirect bilirubin in umbilical blood was 58 micromole/l, haemoglobin – 140 g/l, RBC-3.8×10¹²/l. In 2 hours the level of indirect bilirubin turned 82 micromole/l. The hemolytic disease of newborn (icteric-anemic type, Rh-incompatibility) was diagnosed. Choose the therapeutic tactics:

Infant is 6.5 months now and is given natural feeding since birth. Body mass was 3.5 kg, with length 52 cm at birth. How many times per day the supplement (up feeding) should be given?

A 12 year old child has the ulcer disease of stomach. What is the etiology of this disease?

A nine year old child is at a hospital with acute glomerulonephritis. Clinical and laboratory examinations show acute condition. What nutrients must not be limited during the acute period of glomerulonephritis?

Examination of a 3-month-old child revealed scrotum growth on the right. This formation has elastic consistency, its size decreases during sleep and increases when the child is crying. What examination will be helpful for making a correct diagnosis?

A 52 year old patient with history of functional Class II angina complains of having intense and prolonged retrosternal pains, decreased exercise tolerance for 5 days. Angina is less responsive to nitroglycerine. What is the most probable diagnosis?

A 52 year old patient has hypervolaemic type of essential hypertension. Which of the following medications is to be prescribed either as monotherapy or in complex with other antihypertensive drugs?

A 62 year old patient complains of rest dyspnea, heart pains. 3 years ago he had myocardial infarction. Physical examination: orthopnea, acrocyanosis, swollen cervical veins. Ps – 92, total heart enlargement, the liver is enlarged by 7 cm, shin edema. What is the stage of chronic heart failure (CHF)?

A 27 year old man complains of pains in epigastrium which are relieved by food intake. EGDFS shows antral erosive gastritis, biopsy of antral mucous presents Hеlicobacter Pylori. Diagnosis is:

Prophylactic photoroentgenography examination of a 25 year old man revealed focal shadowings of small and medium intensity with irregular contours in the 1^st and 2^nd segments of the right lung. Which clinical form can be suspected?

A woman 26 years old has abused alcohol for 7 years. She has psychological dependence on alcohol, but no withdrawal syndrome. Drinks almost every day approximately 50-100 g of wine. She is in her 4^th week of pregnancy. Primary prevention of fetal alcohol syndrome requires:

The observed patient’s movements are retarded, she answers no questions. Sometimes she spontaneously stiffens in strange postures. It is possible to set her body and limbs into different positions artificially. If the psychiatrist lifts her arm or leg, so that she remains standing on the other leg, the patient can stay in such a position for quite a long time. Name the probable disorder:

The man, aged 42, applied to the therapeutist with complaints of pricking pains in scapulas area, dyspnea on physical exertion, cough with discharge of small amount of sputum. During 10 years he works in coal mining. On percussion-box-note sound in the lower parts, on auscultation- a harsh breathing. There were no changes in the heart. Possible diagnosis?

A man, aged 37, working on the collective farm on sowing, was admitted to the infectious hospital with the clinical symptoms: miosis, labored breathing, sweating.What kind of poisoning is it and what is the first aid?

The 25 year old patient was admitted on the 1^st day of the disease with complaints of double vision in the eyes, difficult respiration. The day before the patient ate home-made mushrooms. On objective examination: paleness, widened pupils, disorder of swallowing, bradycardia, constipation are marked. What is the diagnosis?

A 28 year old patient was admitted to the clinic with complaints of the temperature rise up to 39.0^oC, headache, weakness, constipation on the 9^th day of the disease. On examination: single roseolas on the skin of the abdomen are present. The pulse rate is 78 bpm. The liver is enlarged by 2 cm. What is the most probable diagnosis?

A patient has been in a hospital. The beginning of the disease was gradual: nausea, vomiting, dark urine, аcholic stools, yellowness of the skin and scleras. The liver is protruded by 3 cm. Jaundice progressed on the 14^th day of the disease. The liver diminished in size. What complication of viral hepatitis caused deterioration of the patient’s condition?

An 18 year old patient was admitted to a hospital with complaints of headache, weakness, high temperature, sore throat. Objectively: enlargement of all groups of lymph nodes was revealed. The liver is enlarged by 3 cm, spleen – by 1 cm. In blood: leukocytosis, atypical lymphocytes – 15%. What is the most probable diagnosis?

A 4 year old girl was playing with her toys and suddenly she got an attack of cough, dyspnea. Objectively: respiration rate – 45/min, heart rate – 130/min. Percussion revealed dullness of percutory sound on the right in the lower parts. Auscultation revealed diminished breath sounds with bronchial resonance on the right. X-ray picture showed shadowing of the lower part of lungs on the right. Blood analysis revealed no signs of inflammation. The child was diagnosed with foreign body in the right bronchus. What compli-cation caused such clinical presentations?

A 75 year old man who has been suffering from diabetes for the last six months was found to be jaundiced. He was asymptomatic except for weight loss at the rate of 10 pounds in 6 months. Physical examination revealed a hard, globular, right upper quadrant mass that moves during respiration. A CT scan shows enlargement of the head of the pancreas, with no filling defects in the liver. The most likely diagnosis is:

A 60 year old man with unstable angina pectoris fails to respond to heparin, nitroglycerin, beta adrenegic blockers and calcium channel antagonist. The best management includes:

A 22 year old woman complained of right subcostal aching pain, nausea, and decreased appetite. She fell ill 2 months after appendectomy when jaundice appeared. She was treated in an infectious hospital. 1 year later above mentioned symptoms developed. On exam: the subicteric sclerae, enlarged firm liver. Your preliminary diagnosis:

A 25 year old woman complained of edema on her face and legs, rise of blood pressure up to 160/100 mm Hg and weakness. She fell ill 3 weeks after recovering from angina. Urinalysis data: protein of 0.5 g/l, erythrocytes of 17-20/field, leukocytes of 2-3/field, erythrocyte casts. What treatment should be initiated after specifying the diagnosis?

A fitter of a metallurgic factory with occupational exposure to high concentrations of mercury fumes for 16 years presents instability of pulse and blood pressure, general hyperhydrosis, asymmetric innervations of facial muscles and tongue, positive subcortical reflexes, hand tremor on physical examination. A dentist revealed paradontosis and chronic stomatitis. What is the most probable diagnosis?

A 42 year old woman complains of dyspnea, edema of the legs and tachycardia during minor physical exertion. Heart borders are displaced to the left and S1 is accentuated, there is diastolic murmur on apex. The liver is enlarged by 5 cm. What is the cause of heart failure?

A 32 year old welder complains of weakness and fever. His illness started as tonsillitis a month before. On exam, BT of 38.9^oC, RR of 24/min, HR of 100/min, BP of 100/70 mm Hg, hemorrhages on the legs, enlargement of the lymph nodes. CBC shows Hb of 70 g/l, RBC of 2.2×10 ¹²/l, WBC of 3.0×10⁹/l with 32% of blasts, 1% of eosinophiles, 3% of bands, 36% of segments, 20% of lymphocytes, and 8% of monocytes, ESR of 47 mm/h. What is the cause of anemia?

A male patient, 60 years old, tobacco smoker for 30 years, alcoholic, has dysphagia and weight loss since 4 months. Suggested diagnosis?

Which of the following symptoms would occur only if a total-body acute radiation exposure exceeded 5.000 rad (50 Gy)

In the 43rd week of gestation a long, thin infant was delivered. He is apneic, limp, pale, and covered with “pea soup”amniotic fluid. The first step in the resuscitation of this infant at delivery should be:

25 children at the age of 2-3 years who don’t attend any child welfare institutions should be observed by a district pediatrician within the current year. How many initial visits of this group of children should be planned?

A 25 year old patient complains of pain in the I finger on his right hand. On examination: the finger is homogeneously hydropic, in bent position. On attempt to unbend the finger the pain is getting worse. Acute pain appears during the probe in ligament projection. What decease is the most likely?

A 26 year old manual worker complained of 3 weeks history of fevers and fatigue, weight loss with no other symptoms. Physical findings: Temperature 37.6^oC, Ps- 88 bpm, blood pressure 115/70 mm Hg, superficial lymph nodes (occipital, submental, cervical, axillary) are enlarged, neither tender nor painful. Rubella-like rash on the trunk and extremities. Herpes simplex lesions on the lips. Candidosis of oral cavi-ty. What infectious disease would you suspect?

A patient complains about strong dyspnea that is getting worse during physical activity. Presentations appeared suddenly 2 hours ago at work: acute chest pain on the left, cough. The pain was abating, but dyspnea, dizziness, pallor, cold sweat and cyanosis were progressing. Vesicular respiration is absent, X-ray picture shows a shadow on the left. What pathology might be suspected?

Which of the methods of examination is the most informative in the diagnostics of a tube infertility?

A 38 year old man worked at roofing and drain pipes production for 15 years. He seeks medical help for expiratory breathlessness on exertion, and dry cough. On exam, wheezes above both lungs, grayish warts on fingers are seen. Factory physician has diagnosed asbestosis. What method is the most important for this diagnosis?

A patient has got pain in the axillary area, rise of temperature developed 10 hours ago. On examination: shaky gait is evident, the tongue is coated with white deposit. The pulse is frequent. The painful lymphatic nodes are revealed in the axillary area. The skin over the lymph nodes is erythematous and glistering. What is the most probable diagnosis?

Examination of a 9 month old girl revealed skin pallor, cyanosis during excitement. Percussion revealed transverse dilatation of cardiac borders. Auscultation revealed continuous systolic murmur on the left from the breastbone in the 3-4 intercostal space. This murmur is conducted above the whole cardiac region to the back. What congenital cardiac pathology can be suspected?

A 32 year old patient complains about cardiac irregularities, dizziness, dyspnea at physical stress. He has never suffered from this before. Objectively: Ps- 74 bpm, rhythmic. AP- 130/80 mm Hg. Auscultation revealed systolic murmur above aorta, the first heart sound was normal. ECG showed hypertrophy of the left ventricle, signs of repolarization disturbance in the I , V₅ and V₆ leads. Echocardiogram revealed that interventricular septum was 2 cm. What is the most probable di-agnosis?

An 8 year old boy suffering from haemophilia was undergoing transfusion of packed red cells. Suddenly he got pain behind the breastbone and in the lumbar area, dyspnea, cold sweat. Objectively: pale skin, heart rate – 100/min, AP- 60/40 Hg; oliguria, brown urine. For treatment of this complication the following drug should be administered:

A maternity hospital registered 616 live births, 1 stillbirth, 1 death on the 5^th day of life over a 1 year period. What index allows the most precise estimation of this situation?

After objective clinical examination a 12 year old child was diagnosed with mitral valve prolapse. What complementary instrumental method of examination should be applied for the diagnosis confirmation?

A 28 year old parturient complains about headache, vision impairment, psychic inhibition. Objectively: AP-200/110 mm Hg, evident edemata of legs and anterior abdominal wall. Fetus head is in the area of small pelvis. Fetal heartbeats is clear, rhythmic, 190/min. Internal investigation revealed complete cervical dilatation, fetus head was in the area of small pelvis. What tactics of labor management should be chosen?

A patient complained about problems with pain and tactile sensitivity, pain in the nail bones at the end of the working day. He works at a plant with mechanical devices. What pathology can be suspected?

A 25 year old patient complains about weakness, dizziness, haemorrhagic skin rash. She has been suffering from this for a month. Blood count: erythrocytes: 1.0×10¹²/l, Hb- 37 g/l, colour index – 0.9, leukocytes – 1.2×10⁹/l, thrombocytes – 42×10⁹/l. What diagnostic method will be the most effective?

A 68 year old female patient complains about temperature rise up to 38.3^oC, haematuria. ESR- 55 mm/h. Antibacterial therapy turned out to be ineffective. What diagnosis might be suspected?

A 48 year old female patient complains about contact haemorrhage. Speculum examination revealed hypertrophy of uterus cervix. It resembles of cauliflower, it is dense and can be easily injured. Bi-manual examination revealed that fornices were shortened, uterine body was nonmobile. What is the most probable diagnosis?

A 34 year old female patient has been suffering from anxious depression accompanied by panic attacks for 2 years. She has been a patient of a psychotherapist. Treatment resulted in incomplete remission. The patient had to break off psychotherapy because of moving to a new place of residence. Soon after this her condition grew significantly worse, she was almost permanently anxious, panic attacks turned up 5-6 times a day and were accompanied by palpitation, dyspnea, cold sweat, thanatophobia. What drug group is the most appropriate for medicamental therapy?

1.5 hour after start of gullet bougienage a 48 year old patient suffering from corrosive stricture felt acute abdominal pain. Previously he had been suffering from duodenal ulcer. Examination revealed that abdomen was very tense and painful; Ps- 110 bpm, painful sialophagia, skin pallor. What is the most probable diagnosis?

A healthy 75 year old woman who leads a moderately active way of life went through a preventive examination that revealed serum concentration of common cholesterol at the rate of 5.1 millimole/l and HDL (high-density lipoproteins) cholesterol at the rate of 70 mg/dl. ECG reveals no pathology. What dietary recommendation is the most adequate?

A parturient complains about pain in the mammary gland. Palpation revealed a 3х4 cm large infiltration, soft in the centre. Body temperature is 38.5^oC. What is the most probable diagnosis?

A 52 year old patient was admitted to a hospital because of high hemorrhagic diathesis of mucous membranes, massive skin haemorrhages in form of ecchymoses and spots, nasal and stomachal haemorrhages. After clinical examinations her illness was diagnosed as thrombocytopenic purpura. What is the most probable cause of this disease?

A 37 year old patient applied to a local therapeutist. As a result of exacerbation of chronic obstructive bronchitis the patient had been temporarily disabled for 117 days within 1 year. What tactics will be legally correct?

A 54 year old male patient complains about permanent dull pain in the mesogastral region, weight loss, dark blood admixtures in the feces, constipations. He put off 10 kg within a year. In blood: erythrocytes: 3.5×10¹²/l, Hb- 87 g/l, leukocytes – 12.6×10⁹/l, stab neutrophil shift, ESR- 43 mm/h. What is the most probable diagnosis?

A 10 month old boy has been ill for 5 days after consumption of unboiled milk. Body temperature is 38 − 39^oC, there is vomiting, liquid stool. The child is pale and inert. His tongue is covered with white deposition. Heart sounds are muffled. Abdomen is swollen, there is borborygmus in the region of ubbilicus, liver is enlarged by 3 cm. Stool is liquid, dark-green, with admixtures of mucus, 5 times a day. What is the most probable diagnosis?

Examination of a 22 year old man suffering from polyarthralgia and high fever revealed right-sided exudative pleuritis. X-ray picture showed a homogenous shadow below the IV rib on the right. In the II segment there were single dense focal shadows. Mantoux test with 2 TU resulted in formation of a papula 16 mm large. Pleural liquid has increased protein concentration, Rivalta’s reaction is positive, there was also increased number of leukocytes with prevailing lymphocytes. What is the most probable etiology of pleuritis?

At year-end hospital administration has obtained the following data: annual number of treated patients and average annual number of beds used for patients’ treatment. What index of hospital work can be calculated on the base of this data?

A female patient has been suffering from pain in the right subcostal area, bitter taste in the mouth, periodical bile vomiting for a month. The patient put off 12 kg. Body temperature in the evening is 37.6^oC. Sonography revealed that bile bladder was 5.5х2.7 cm large, its wall – 0.4 cm, choledochus – 0.8 cm in diameter. Anterior liver segment contains a roundi-sh hypoechoic formation up to 5 cm in diameter and another two up to 1.5 cm each, walls of these formations are up to 0.3 cm thick. What is the most probable diagnosis?

A 3 year old child with weight deficiency suffers from permanent moi-st cough. In history there are some pneumonias with obstruction. On examination: distended chest, dullness on percussion over the lower parts of lungs. On auscultation: a great number of different rales. Level of sweat chloride is 80 millimol/l. What is the most probable diagnosis?

A 14 year old girl complains of profuse bloody discharges from genital tracts during 10 days after suppresion of menses for 1.5 month. Similiar bleedings recur since 12 years on the background of disordered menstrual cycle. On rectal examination: no pathology of the internal genitalia. In blood: Нb – 70 g/l, RBC-2.3×10¹²/l, Ht – 20. What is the most probable diagnosis?

A 46 year old patient is to be prepared to the operation on account of stomach cancer. Preoperative preparation involves infusion therapy. It was injected up to 3 l of solutions into his right lunar vein. On the next day he got tensive pain in the region of his right shoulder. Examination of interior brachial surface revealed an oblong area of hyperemia, skin edema and painful cord. What complication is it?

A 58 year old female patient complains about periodical headache, dizziness and ear noise. She has been suffering from diabetes mellitus for 15 years. Objectively: heart sounds are rhythmic, heart rate is 76/min, there is diastolic shock above aorta, AP is 180/110 mm Hg. In urine: OD- 1.014. Daily loss of protein with urine is 1.5 g. What drug should be chosen for treatment of arterial hypertension?

A 25 year old patient had pharyngitis 2 weeks ago. Now he complains about body temperature rise up to 38^oC, general weakness, dyspnea during walking, swelling and shifting pain in the articulations. Objectively: cyanosis of lips, rhythmic pulse of poor volume – 100 bpm. Left cardiac border deviates outwards from the mediaclavicular line by 1 cm. The first heart sound is weakened on the apex, auscultation revealed systolic souffle. What is the most probable aetiological factor that caused this pathological process?

A 50 year old locksmith was diagnosed with typhoid fever. The patient lives in a separate apartment with all facilities. Apart of him there are also 2 adults in his family. What actions should be taken about persons communicating with the patient?

A 39 year old patient complained about morning headache, appetite loss, nausea, morning vomiting, periodic nasal haemorrhages. The patient had acute glomerulonephritis at the age of 15. Examination revealed rise of arterial pressure up to 220/130 mm Hg, skin haemorrhages on his arms and legs, pallor of skin and mucous membranes. What biochemical index has the greatest diagnostic importance in this case?

A 43 year old patient was admitted to the infectious diseases hospital with high body temperature and intense headache. The iIlness has lasted for 2 days. Examination revealed a carbuncle on his forearm. The area around it was apparently edematic and slightly painful. Regional lymphadenitis and hepatoli-enal syndrome were also present. It is known from the anamnesis that the patient works at a cattle-breeding farm. What disease should be suspected in the first place?

Study of morbidity with temporary disability among workers of a machine building plant revealed that average duration of a case was 20 days. What diseases influenced upon the index value?

A 14 year old child suffers from vegetovascular dystonia of pubertal period. He has got sympathoadrenal atack. What medicine should be used for attack reduction?

A 52 year old male patient complains about attacks of asphyxia, pain in his left side during respiration. These manifestations turned up all of a sudden. It is known from his anamnesis that he had been treated for thrombophlebitis of the right leg for the last month. In the admission ward the patient suddenly lost consciousness, there was a sudden attack of asphyxia and pain in his left side. Objectively: heart rate – 102/min, respiratory rate – 28/min, AP- 90/70 mm Hg. Auscultation revealed diastolic shock above the pulmonary artery, gallop rhythm, small bubbling rales above the lungs under the scapula on the right, pleural friction rub. What examination method will be the most informative for a diagnosis?

A 4 month old child fell seriously ill: body temperature rose up to 38.5^oC, the child became inert and had a single vomiting. 10 hours later there appeared rash over the buttocks and lower limbs in form of petechiae, spots and papules. Some haemorrhagic elements have necrosis in the centre. What is the most probable disease?

A 13 year old girl was admitted to the cardiological department because of pain in the muscles and joints. Examination of her face revealed an edematic erythema in form of butterfly in the region of nose bridge and cheeks. What is the most probable diagnosis?

A 15 year old girl suddenly got arthralgia, headache, nausea, vomiting; pain and muscle tension in the lumbar area; body temperature rose up to 38 − 39^oC. Pasternatsky’s symptom was distinctly positive on the right. In the urine: bacteriuria, pyuria. What is the most probable diagnosis?

A 19 year old patient was admitted to a hospital with acute destructive appendicitis. He suffers from hemophilia of B type. What antihemophilic medications should be included in pre- and post-operative treatment plan?

A 59 year old female patient applied to a maternity welfare clinic and complained about bloody discharges from the genital tracts. Postmenopause is 12 years. Vaginal examination revealed that external genital organs had signs of age involution, uterus cervix was not erosive, small amount of bloody discharges came from the cervical canal. Uterus was of normal size, uterine appendages were unpalpable. Fornices were deep and painless. What method should be applied for the diagnosis specification?

A 26 year old woman who delivered a child 7 months ago has been suffering from nausea, morning vomiting, sleepiness for the last 2 weeks. She suckles the child, menstruation is absent. She hasn’t applied any contraceptives. What method should be applied in order to specify her diagnosis?

A boy is 1 year old. Previously he had purulent otitis. After that he started complaining about pain in the upper third of his left thigh, body temperature rose up to 39^oC. Objectively: the thigh is swollen in its upper third, inguinal fold is smoothed. Extremity is in half-bent position. Active and passive movements are impossible because of acute pain. What is the most probable diagnosis?

A 2 month old full-term child was born with weight 3500 g and was on the mixed feeding. Current weight is 4900 g. Evaluate the current weight of the child:

A woman consulted a doctor on the 14^th day after labour about sudden pain, hyperemy and induration of the left mammary gland, body temperature rise up to 39^oC, headache, indisposition. Objectively: fissure of nipple, enlargement of the left mammary gland, pain on palpation. What pathology would you think about in this case?

A 32 year old patient suffering from chronic viral hepatitis complains about dull pain in the right subcostal area, nausea, dry mouth. Objectively: liver dimensions are 13-21-11 cm (according to Kurlov), spleen is by 2 cm enlarged, aspartate ami-notransferase is 3.2 micromole/l·h, alani-ne aminotransferase – 4.8 millimole/l·h. Serological study revealed HBeAg, high concentration of DNA HBV . What drug should be chosen for treatment of this patient?

A 5 month old boy was born prematurely, he didn’t suffer from any disease at the infant age and later on. Examination at an outpatient’s hospital revealed paleness of skin, sleepiness. Blood count: Hb – 95 g/l, erythrocytes – 3.5×10¹²/l, reticulocytes – 9⁰/₀₀, colour index – 0.7, osmotic stability of erythrocytes – 0.44-0.33%, serum iron – 4.9 micromole/l. What is the most probable cause of anemia?

A 45 year old woman complains about unbearable pain attacks in the left part of face lasting 1-2 minutes. Such attacks are provoked by mastication. These symptoms appeared 2 months ago after exposure to cold. Objectively:the pain is localized in the ending points of trigeminus on the left. A touch near nose wing provokes another pain attack and tonic spasm of face muscles. What is the most probable diagnosis?

A 38 year old man was delivered to the hospital in unconscious state. The symptoms of illness turned up a day before: headache, nausea, vomiting, t^o-38.5^oC, dizziness, delusion. For the last 4 days he had been complaining of pain and hearing loss in the left ear. Objectively: sopor, rigidity of occipital muscles, bilateral Kernig’s symptom, general hyperesthesia, purulent discharges from the left ear. What is the most probable diagnosis?

A 70 year old man is suffering from coronary heart disease. His mood is evidently depressed, anxious. As a result of continious sleeplessness he has got fears, suicidal thoughts. He would sit for a long time in the same pose, answer after a pause, in a low, monotonous voice. His face has a look of suffering, pain, fear. What is the main psychopathologic syndrome?

A 23 year old female patient complains about periodical chill and body temperature rise up to 40^oC, sense of heat taking turns with profuse sweating. The patient has had already 3 attacks that came once in two days and lasted 12 hours. She has lived in Africa for the last 2 months. Liver and spleen are enlarged. In blood: erythrocytes – 2.5×10¹²/l. What is the most probable diagnosis?

A 39 year old patient suffering from hypertension suddenly got intense headache in the region of occiput; there appeared recurrent vomiting. These presentations has been lasting for 5 hours. Objectively: Ps – 88 bpm, AP – 205/100 mm Hg, painfulness of occipital points, rigidity of occipital muscles are present. Kernig’s symptom is bilaterally positive. Subarachnoid haemorrhage is also suspected. What diagnostic method will be of the greatest importance for confirmation of provisional diagnosis?

Immediately after delivery a woman had haemorrhage, blood loss exceeded postpartum haemorrhage rate and was progressing. There were no symptoms of placenta detachment. What tactics should be chosen?

A 33 year old patient was delivered to the infectious diseases department on the 7^th day of disease. He complained about great weakness, high temperature, pain in the lumbar area and leg muscles, icteritiousness, dark colour of urine, headache. The acute disease started with chill, body temperature rise up to 40^oC, headache, pain in the lumbar area and sural muscles. Icterus turned up on the 4th day, nasal and scleral haemorrhages came on the 5^th day. Fever has lasted for 6 days. Diuresis – 200 ml. What is the most probable diagnosis?

A 72 year old male patient complains about itch in his left shin, especially around a trophic ulcer. Skin is reddened and edematic, there are some oozing lesions, single yellowish crusts. The focus of affection is well-defined. What is the most probable diagnosis?

A 29 year old female patient complains about periodical right-sided headache that is usually provoked by strong smells or excitement. The patient’s mother suffers from the same disease. Objectively: examination of internal organs revealed no pathology. During the attack there are general hyperesthesia and nausea, at the end of the attack polyuria is observed. Palpation of the right temporal artery during the attack revealed tension and painfulness of the artery. Complete blood count and urine analysis reveale dno pecularities. What is the most probable diagnosis?

A 52 year old woman complains about face distortion. It turned up 2 days ago after supercooling. Objectively: body temperature is 38.2^oC. Face asymmetry is present. Frontal folds are flattened. Left eye is wider than right one and doesn’t close. Left nasolabial fold is flattened, mouth corner is lowered. Examination revealed no other pathology. Blood count: leukocytes – 10×10⁹/l, ESR – 20 mm/h. What is the most probable diagnosis?

A 10 year old boy suffers from chronic viral hepatitis type B with maximal activity. What laboratory test can give the most precise characteristic of cytolysis degree?

Examination of a 12 year old child revealed diffuse thyroid enlargement of the II degree. Heart auscultation revealed dullness of heart sounds, heart rate was 64/min. The child has frequent constipations, anemia. Concentration of thyreoglobulin antibodies is increased. What disease might have caused such symptoms?

A 13 year old patient is suffering from an acute disease with the following symptoms: thirst, polyuria, weakness. Objectively: his general condition is satisfactory, there is no smell of acetone. Glucose concentration in blood on an empty stomach is 32 micromole/l, in urine – 6%, acetone +. What treatment should be administered?

Surgical department admitted a 37 year old patient with a big crushed wound of his left thigh 4 hours after he got this trauma. What is the main provision for successful prevention of gaseous gangrene?

A 40 year old patient was bitten by a stray dog for about an hour ago. The bite can be seen on the patient’s left shin in form of a wound 4х2х0.5 cm large. What kind of aid would be recommended in this case?

A patient has got acute macrofocal  myocardial infarction complicated by cardiogenic shock. The latter is progresi-ng under conditions of weak general peripheric resistance and lowered cardiac output. What antihypotensive drug should be injected to the patient in the first place?

A patient applied to the traumatology centre and complained about a trauma of the lower third of the volar forearm surface caused by cut on a piece of glass. Objectively: flexion of the IV and V fingers is impaired, sensitivity of the interior dorsal and palmar surface of hand as well as of the IV finger is reduced. What nerve is damaged?

It was noticed that a 7 year old pupil had been innattentive several times during the lessons. The teacher also noticed that the child had been smacking his lips and had vacant look. There were no falls and convulsions. During such short periods of absence the child didn’t react to calling his name. His mother notic such phenomena before but didn’t pay much attention to them thinking that the child was deep in thought. What type of epileptic attack (according to the standard classification) is it?

A 41 year old woman has suffered from nonspecific ulcerative colitis for 5 years. On rectoromanoscopy: evident inflammatory process of lower intestinal parts, pseudopolyposive changes of mucous membrane. In blood: WBC-9.8×10⁹/l, RBC- 3.0×10¹²/l, ESR – 52 mm/hour. What medication provides pathogenetic treatment of this patient?

A 38 year old female patient complains about body stiffness in the morning, especially in the articulations of her upper and lower limbs, that disappears 30-60 minutes later after active movements. She has also arthritis of metacarpophalangeal and proximal phalangeal articulations, subfebrile temperature. ESR- 45 mm/h. Roentgenography revealed osteoporosis and erosion of articular surface of small hand and foot articulations. What is the most probable diagnosis?

A child was born with body weight 3250 g and body length 52 cm. At the age of 1.5 month the actual weight is sufficient (4350 g), psychophysical development corresponds with the age. The child is breast-fed, occasionally there are regurgitations. What is the cause of regurgitations?

Three weeks after acute angina the patient is still weak, inert, subfebrile, his retromaxillary lymph nodes are enlarged. Tonsils are flabby, stick together with arches, there are purulent plugs in lacunae. What is the most probable diagnosis?

A 23 year old patient fell ill 3 weeks ago when she noticed a very painful induration in her axillary crease. 4-5 days later it burst and discharged a lot of pus. After that some new infiltrations appeared around the affected area. The patient has never suffered from skin diseases before. What is the most probable diagnosis?

A 28 year old woman has bursting pain in the lower abdomen during menstruation; chocolate-like discharges from vagina. It is known from the anamnesis that the patient suffers from chronic adnexitis. Bimanual examinati-on revealed a tumour-like formation of heterogenous consistency 7х7 cm large to the left from the uterus. The formation is restrictedly movable, painful when moved. What is the most probable diagnosis?

As a result of prophylactic medical examination a 35 year old woman was diagnosed with alimentary and constitutive obesity of the III degree. It is known from her anamnesis that the patient doesn’t observe rules of rational nutrition: she often overeats, the last food intake is usually 10-15 minutes before going to bed, prefers fattening and rich in carbohydrates food. What is the main alimentary risk factor of obesity development?

A 40 year old female patient has been observing excessive menstruation accompanied by spasmodic pain in the lower abdomen for a year. Bi-manual examination performed during menstruation revealed a dense formation up to 5 cm in diameter in the cervical canal. Uterus is enlarged up to 5-6 weeks of pregnancy, movable, painful, of normal consistency. Appendages are not palpable. Bloody discharges are profuse. What is the most probable diagnosis?

A child is 1 day old. During delivery there had been problems with extraction of shoulders. Body weight is 4300 g. Right arm hangs down along the body, hand is pronated, movement in the arm is absent. “Scarf”symptom is positive. What is the most probable diagnosis?

A 42 year old man applied to a hospital 10 minutes after he got stung by a bee and complained about face edema and difficult respiration. Objectively: Ps- 98 bpm, AP- 130/80 mm Hg. A doctor on duty injected him 1 ml of 1% dimedrol solution intramuscularly and recommended to apply to his local therapeutist on the next day. What tactics of treatment should be chosen for this patient?

Study of morbidity rate in a city N revealed that population of different administrative districts differed in age structure. What statistic method allows to eliminate influence of this factor upon morbidity indices?

A 44 year old man has been working in coke industry for 16 years. Dust concentration at his workplace is 5-10 times more than maximum permissible concentration. Roentgenography of lungs revealed changes that are typical for pneumoconiosis. What is the most probable type of pneumoconiosis in this case?

An outbreak of food poisoning was recorded in an urban settlement. The illness was diagnosed as botulism on the grounds of clinical presentations. What foodstuffs should be chosen for analysis in the first place in order to confirm the diagnosis?

A 72 year old female patient has been treated for urolithiasis in the urological department. After atropine injection she got acute pain in her left eye and abrupt vision impairment. Objectively: visual acuity of the left eye is 0.01, the eye is dense but painful on palpation, cornea is opaque, there is cyanotic induration of eyeball vessels. What is the most probable diagnosis?

Administration of a plant producing red lead paint intends to form a group of medical specialists for periodical medical examinations. What specialist must be obligatory included into this group?

A 42 year old man works in a boiler room. He complains about girdle headache and recurring vomiting. There was also short-term consciousness loss. Objectively: increase of tendon reflexes, spontaneous myofibrillations. AP is 150/80 mm Hg, Ps- 104 bpm. Visible mucous membranes and cutaneous surfaces have crimson colouring. What is the most probable diagnosis?

The amount of ultraviolet radiation dose was measured in minutes. What device was applied for measurement of the biodose?

A 63 year old patient complained about pain in the lumbar area. He underwent a course of physiological treatment on account of radiculitis but this led to no improvement of his condition. R-graphy of spinal column and pelvic bones revealed osteoporosis and serious bone defects. Blood analysis revealed moderate normochromic anaemia, urine analysis revealed proteinuria. Whole blood protein made up 10.7 g/l. What disease should be suspected?

A sergeant was injured by a shell splinter in the left subcostal area. He was bandaged with a first-aid pack on a battlefield. The patient was delivered to the regiment medical aid station. He complains about dizziness, weakness, thirst, abdominal pain. General condition is grave, the patient is pale. Ps is 120 bpm. Abdomen is soft, painful on palpation. The bandage is well fixed but a little bit soaked with blood. The patient should be evacuated to the medical battalion with the following transport and in the following turn:

On the 5th day after labor body temperature of a parturient suddenly rose up to 38.7^oC. She complains about  weakness, headache, abdominal pain, irritability. Objectively: AP- 120/70 mm Hg, Ps- 92 bpm, t^o– 38.7^oC. Bimanual examination revealed that the uterus was enlarged up to 12 weeks of pregnancy, it was dense, slightly painful on palpation. Cervical canal lets in 2 transverse fingers, discharges are moderate, turbid, with foul smell. In blood: skeocytosis, lymphopenia, ESR- 30 mm/h. What is the most probable diagnosis?

A 19 year old boy was admitted to a hospital with closed abdominal trauma. In course of operation multiple ruptures of spleen and small intestine were revealed. AP is falling rapidly, it is necessary to perform hemotransfusion. Who can specify the patient’s blood group and rhesus compatibility?

A 36 year old man was delivered to the surgical department an hour after a road accident. His condition is getting worse: respiratory insufficiency is progressing, there are cardiac abnormalities. Clinical and roentgenological investigations revealed mediastinal displacement. What process has caused this complication?

An 18 year old primigravida in her 27-28 week of pregnancy underwent an operation on account of acute phlegmonous appendicitis. In the postoperative period it is necessary to take measures for prevention of the following pegnancy complication:

It is planned to make complete isolation boxes in the infectious department in order to prevent nosocomial airborne infections. The boxes consist of a tambour, a ward and a lock chamber. What structure should be also included in a complete isolation box?

A 3 year old boy has petechial eruption. Examination revealed no other pathological changes. Thrombocyte number is 20×10⁹g/l; haemoglobin and leukocyte concentration is normal. What is the most probable diagnosis?

Indices that characterize population health include demographic indices. What environment is used for calculation of these indices?

An infant is full-term. Delivery was pathological, with breech presentation. Examination of the infant revealed limited abduction of the right leg to 50^o, positive “clicking”symptom on the right, asymmetric inguinal folds. What is the most probable diagnosis?

A 30 year old man complains of intense pain, reddening of skin, edema  in the ankle-joint area, fever up to 39^oC. There was an acute onset of the illness. In the past there were similar attacks lasting 5-6 days without residual changes in the joint. The skin over the joint is hyperemic and ill-defined, without infiltrative bank on the periphery. What is the most likely diagnosis?

The results of 5 year monitoring allowed to estimate the level of environmental influence upon health indices of population. What statistic method should be chosen?

A 37 year old miner has lifted significant loads and afterwards felt pain in the lumbar area irradiating to his left leg. He walks slowly and carefully. Lumbar lordosis is flattened. There is also left-sided scoliosis and tension of paravertebral muscles. Neri’s and Dejeri-ne’s symptoms are positive, there is Lasegue’s sign on the left from the angle of 350. What method will help to specify the diagnosis?

A 47 year old male patient got a flame burn of trunk and upper extremities and was delivered to the hospital. The patient is in grave condition, confused mental state, with fever. AP- 80/50 mm Hg, Ps- 118 bpm. It was locally stated that the patient got III B degree burns with total area of 20%. What medical actions should be taken?

A 54 year old female patient was admitted to the hospital with evident acrocyanosis, swollen cervical veins, enlarged liver, ascites. Cardiac borders are dilated. Heart sounds cannot be auscultated, apical beat is undetectable. AP is 100/50 mm Hg. X-ray picture of chest shows enlarged heart shadow in form of a trapezium. What pathology might have caused these symptoms?

15 minutes after the second vaccination with diphteria and tetanus toxoids and pertussis vaccine a 4 month old boy manifested symptoms of Quincke’s edema. What medication should be applied for emergency aid?

A 16 year old female patient underwent an operation on account of diffuse toxic goiter of the III-IV degree 12 years ago. Now she has recurrence of thyrotoxicosis. The patient was offered operative intervention, but it is necessary first to localize the functioning gland tissue. What method should be applied for this purpose?

Examination of a 26 year old female patient revealed a node in the right lobe of thyroid gland. The node appeared no earlier than 3 months ago. The patient associates this node with stress. She doesn’t complain either about pain or enlargement of the node. Ultrasonic  scanning revealed a 2×2.5 cm large node in the inferior part of the right lobe of thyroid gland. What treatment should be administered?

During examination a patient is unconscious, his skin is dry and hot, face hyperemia is present. The patient has Kussmaul’s respiration, there is also smell of acetone in the air. Symptoms of peritoneum irritation are positive. Blood sugar is at the rate of 33 millimole/l. What emergency actions should be taken?

A patient complains about evaginations in the region of anus that appear during defecation and need to be replaced. Examination with anoscope revealed 1×1 cm large evaginations of mucosa above the pectineal line. What is the most probable diagnosis?

A 34 year old patient was delivered to the hospital because of follicular tonsillitis characterized by high temperature. The patient has been abusing alcohol for 12 years. In the evening on the day of hospitalization he became anxious, couldn’t stay in bed, left his ward several times and applied to the staff on duty with different complaints. He reported about seeing alot of spiders and flies in his ward as well as about hearing threats from the corridor. He was exasperated by the fact that other patients didn’t hear them. He lost also spatial orientation. What psychopathological syndrome is it?

On the third day of life an infant’s skin got icteric colouring. The child was born with body weight of 3200 g, body length of 52 cm. The child is active. There is puerile respiration above the lungs. Respiratory rate is 36/min, heart sounds are rhythmic, heart rate is 130/min. Abdomen is soft, liver comes out from the edge of costal arch by 2 cm, spleen is not palpable. Feces are in form of meconium. What is the most probable diagnosis?

A pediatrician talked to a mother of a 7 month old breast-fed boy and found out that the child was fed 7 times a day. How many times should the child of such age be fed?

In order to study impact of micro climate upon the human organism it is necessary to make systematic observation of air temperature over 3 days. Choose a device that will allow to make the most precise temperature records:

A prematurely born girl is now 8 months old. She has dyspnea, tachycardia, hepatosplenomegaly, physical developmental lag, limb cyanosis. There is also parasternal cardiac hump, auscultation revealed systolodiastolic murmur in the II intercostal space on the left. AP is 90/0 mm Hg. What disease should be suspected?

A 72 year old patient complains about pain and bleeding during defecation. Digital rectal investigation revealed a tumour of anal canal. After verification of the diagnosis the patient was diagnosed with squamous cell carcinoma. The secondary (metastatic) tumour will be most probably found in:

A 52 year old patient complains about headache, weakness of his upper left extremity. Neurological symptoms become more intense during physical stress of the left extremity. Pulsation on the arteries of the left extremity is sharply dampened but it remains unchanged on the carotid arteries. What is the most probable diagnosis?

A 25 year old woman applied to a maternity welfare clinic and complained about being unable to conceive within 3 years of regular sexual life. Examination revealed weight gain, male pattern of hair distribution on the pubis, excessive pilosis of thighs. Ovaries were dense and enlarged, basal temperature was monophase. What is the most probable diagnosis?

A woman consulted a therapeutist about fatigability, significant weight loss, weakness, loss of appetite. She has had amenorrhea for 8 months. A year ago she born a full-term child. Haemorrhage during labour made up 2 l. She got blood and blood substitute transfusions. What is the most probable diagnosis?

A 35 year old female patient suffering from cholelithiasis has broken her diet, and this caused an acute pain attack in the right subcostal are. The pain eased off on the third day, but the patient got progressing jaundice. What non-invasive diagnostic method should be applied?

A 68 year old patient complains about acute pain in his right foot, toe edema and darkening of skin of the IV toe. He has been suffering from diabetes mellitus for 15 years, doesn’t receive regular treatment. What complication of diabetes mellitus is it?

A plot of land with total area of 2.0 hectare was intended for building of a hospital. The maximal capacity of the hospital will be:

A 26 year old woman complains about edemata, swelling and painfulness of mammary glands, headache, tearfulness, irritability. These signs turn up 5 days before menstruation and disappear after its start. What clinical syndrome is it?

A 27 year old patient suffers from haemophilia. He was admitted to the hospital with melena and skin pallor. Objectively: Ps- 110 bpm, AP- 100/60 mm Hg. In blood: Hb- 80 g/l, erythrocytes – 2.8×10¹²/l. What medication should be administered in the first place?

A 38 year old patient complains about inertness, subfebrile temperature, enlargement of lymph nodes, nasal haemorrhages, bone pain. Objectively: the patient’s skin and mucous membranes are pale, palpation revealed enlarged painless lymph nodes; sternalgia; liver was enlarged by 2 cm, spleen – by 5 cm, painless. In blood: erythrocytes  –  2.7×10¹²/l,  Hb-  84  g/l, leukocytes – 58×10⁹/l, eosinophils – 1%, stab neutrophils – 2%, segmented neutrophils – 12%, lymphocytes – 83%, lymphoblasts – 2%, smudge cells; ESR-57 mm/h. What is the most probable di-agnosis?

A 36 year old female patient complains about general weakness, edemata of her face and hands, rapid fatigability during walking, difficult diglutition, cardiac irregularities. These symptoms turned up 11 days after holi-day at the seaside. Objectively: face erythema, edema of shin muscles. Heart sounds are muffled, AP is 100/70 mm Hg. In blood: ASAT activity is 0.95 millimole/h·l, ALAT – 1.3 micromole/h·l, aldolase – 9.2 IU/l, creatine phosphoki-nase – 2.5 micromole Р/g·l. What method of study would be the most specific?

A 33 year old patient has acute blood loss (erythrocytes – 2, 2·10¹²/l, Hb- 55 g/l), blood group is A(II )Rh⁺. Accidentally the patient got transfusion of donor packed red blood cells of AB(IV )Rh⁺ group. An hour later the patient became anxious, got abdominal and lumbar pain. Ps- 134 bpm, AP- 100/65 mm Hg, body temperature – 38.6^oC. After catheterization of urinary bladder 12 ml/h of dark-brown urine were obtained. What complication is it?

A parturient woman is 27 year old, it was her second labour, delivery was at term, normal course. On the 3^rd day of postpartum period body temperature is 36.8^oC, Ps – 72/min, AP – 120/80 mm Hg. Mammary glands are moderately swollen, nipples are clean. Abdomen is soft and painless. Fundus of uterus is 3 fingers below the umbilicus. Lochia are bloody, moderate. What is the most probable diagnosis?

A patient suffering from gastroesophageal reflux has taken from time to time a certain drug that “reduces acidity”for 5 years. This drug was recommended by a pharmaceutist. The following side effects are observed: osteoporosis, muscle weakness, indisposition. What drug has such following effects?

A 34 year old patient complains of profuse sweating at night, skin itching, weight loss (9 kg within the last 3 months). Examination revealed malnutrition, skin pallor. Palpation of neck and inguinal areas revealed dense elastic lymph nodes for about 1 cm in diameter, nonmobile, non-adhering to skin. What is the most probable diagnosis?

A department chief of an in-patient hospital is going to examine resident doctors as to observation of medical-technological standards of patient service. What documentation should be checked for this purpose?

A woman is 34 years old, it is her tenth labor at full term. It is known from the anamnesis that the labor started 11 hours ago, labor was active, painful contractions started after discharge of waters and became continuous. Suddenly the parturient got knife-like pain in the lower abdomen and labor activity stopped. Examination revealed positive symptoms of peritoneum irritation, ill-defined uterus outlines. Fetus was easily palpable, movable. Fetal heartbeats wasn’t auscultable. What is the most probable diagnosis?

A 22 year old female patient complains about frequent and painful urination, urge to urinate at night, enuresis, pain in the suprapubic and lumbar area. Her urine often has beer colouring. She got married a month ago. Objectively: general state is satisfactory. Lung examination revealed vesicular respiration. Heart sounds are rhythmic, heart rate is 78/min, AP- 128/68 mm Hg. Abdomen is soft, painful in the suprapubic area. Urine contains 12-18 erythrocytes and 12-15 bacteria within eyeshot. What is the most probable diagnosis?

Examination of placenta revealed a defect. An obstetrician performed manual investigation of uterine cavity, uterine massage. Prophylaxis of endometritis in the postpartum period should involve following actions:

A 9 year old boy had acute respiratory viral infection. After it there appeared polydipsia, polyuria, weakness, nausea. Examination revealed the following symptoms: mental confusion, dry skin, soft eyeballs, Kussmaul’s respiration, acetone smell from the mouth, muffled heart sounds, soft and painless abdomen. Blood sugar was 19 millimole/l. What acute condition is it?

A patient consulted a venereologist about painful urination, reddening of the external opening of urethra, profuse purulent discharges from the urethra. He considers himself to be ill for 3 days. He also associates the disease with a casual sexual contact that took place for about a week ago. If provisional diagnosis “acute gonorrheal urethritis”will be confirmed, then bacteriological study of urethral discharges will reveal:

A 30 year old patient complains about inability to become pregnant over 3 years of married life. The patient is of supernutrition type, she has hair along the median abdominal line, on the internal thigh surface and in the peripapillary area. Menses started at the age of 16, they are infrequent and non-profuse. US revealed that the uterus was of normal size, ovaries were 4х5х5 cm large and had a lot of cystic inclusions. What is the most probable diagnosis?

On the second day after preventive vaccination a 2 year old boy got abdominal pain without clear localization, body temperature rose up to 38^oC. On the third day the child got red papular haemorrhagic eruption on the extensor surfaces of limbs and around the joints. Knee joints were edematic and slightly painful. Examination of other organs and systems revealed no pathological changes. What is the most probable diagnosis?

On the 6^th day of life a child got multiple vesicles filled with seropurulent fluid in the region of occiput, neck and buttocks. General condition of the child is normal. What disease should be suspected?

A 4 month old child was admitted to a surgical department 8 hours after the first attack of anxiety. The attacks happen every 10 minutes and last for 2-3 minutes, there was also one-time vomiting. Objectively: the child’s condition is grave. Abdomen is soft, palpation reveals a tumour-like formation in the right iliac area. After rectal examination the doctor’s finger was stained with blood. What is the most probable diagnosis?

Estimation of physical development of a child involved dynamometry and estimation of body weight and length, annual gain in body length, chest circumference, number of permanent teeth, secondary sexual characters, lung vital capacity. Which of the mentioned indices relates to the physiometric ones?

During preventive examination a 16 year old patient presented no problems. Objectively: the patient has signs of malnutrition, he is asthenic, AP is 110/70 mm Hg, Ps is 80 bpm, cardiac border is normal, auscultation above the cardiac apex reveals three sounds, cardiac murmur is absent. ECG shows no pathological changes, phonocardiogram shows that the third sound comes 0.15 s after the second one above the apex. How are these changes called?

Estimation of community health level involved analysis of a report on diseases registered among the population of district under charge (reporting form 12). What index is calculated on the grounds of this report?

A 37 year old male patient was admitted to the resuscitation department because of attacks of tonoclonic spasms repeating every half an hour. Between the attacks the patient remains unconscious. AP is 120/90 mm Hg, Ps- 100 bpm. A day before the patient was at wedding and consumed alcohol. 5 years ago he had a closed craniocerebral trauma and brain contusion that later caused single convulsive attacks accompanied by loss of consciousness, but the patient didn’t undergo antiepileptic treatment. What drug should be injected for emergency aid?

A 43 year old female patient was delivered to the hospital in grave condition. She suffers from Addison’s disease. The patient had been regularly taking prednisolone but a week before she stopped taking this drug. Objectively: sopor, skin and visible mucous membranes are pigmented, skin and muscle turgor is lowered. Heart sounds are muffled, rapid. AP- 60/40 mm Hg, heart rate – 96/min. In blood: Na-120 millimole/l, K- 5.8 micromole/l. Development of this complication is primarily caused by the deficit of the following hormone:

A 67 year old female patient complains about edemata of face and legs, pain in the lumbar area that is getting worse at moving; great weakness, sometimes nasal haemorrhages, rise of body temperature up to 38.4^oC. Objecti-vely: painfulness of vertebral column and ribs on palpation. Laboratorial study revealed daily proteinuria of 4.2 g, ESR-52 mm/h. What changes of laboratory indices are to be expected?

A female patient consulted a doctor about gain in weight, chill, edemata, dry skin, sleepiness, problems with concentration. Objectively: the patient’s height is 165 cm, weight is 90 kg, gynoid body proportions, t^o– 35.8^oC, ESR-58/min, AP- 105/60 mm Hg. Heart sounds are weakened, bradycardia is present. Other internal organs have no changes. Thyroid gland is not palpable. Mammary glands ooze milk droplets. Hormonal study revealed rise of TSH and prolactin concentration, reduction of T₄. What factor caused obesity?