Krok 2 – 2010 (General Medicine)

A 40-year-old patient complains of colic pains in the lower abdomen and profuse bloody discharges from the genital tracts. Over the last 2 years she has been having menses for 15-16 days, profuse, with clots, painful. In anamnesis there are 2 medical abortions. On bi-manual investigation: in the canal of the uterine cervix some fibromatous nodes are palpable, they are 3 cm in diameter, on the thin crus. Discharges are bloody, moderate. Choose the correct treatment tactics:

13 months after the first labor a 24-year-old patient complained of amenorrhea.Pregnancy ended  in  Caesarian  section  because of  premature  detachment of normally positioned placenta which resulted in blood loss at the rate of 2000 ml owing to disturbance of blood clotting. Choose the most suitable investigation:

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?

Head of a department and a trade-union group have appealed to the head of a hospital about dismissal of the senior nurse who has 17 year record of service. The facts of charge were confirmed and recognized by the nurse herself. This nurse lives with a daughter (who is divorced and unemployed) and a 9-month-old grandson. Make an administrative decision:

25 unorganized children in the age 2-3 year will be observed on a pediatric district it in the current year. What scheduled number of initial visitations will make to this group of children?

A patient with high temperature came to a first-aid post in the evening. The fact of temporary disability was established. Indicate the order of examination in this case:

An 8-year-old boy fell ill acutely: he presents with fever, weakness, headache, abdominal pain, recurrent vomiting, then diarrhea and tenesmus. Stools occur 12 times daily, are scanty, contain a lot of mucus, pus, streaks of blood. His sigmoid gut is tender and hardened. What is your diagnosis?

An infant was born with body mass 3 kg and body length 50 cm. Now he is 3 years old. His brother is 7 years old, suffers from rheumatic fever. Mother asked the doctor for a cardiac check up of the 3-year-old son. Where is the left relative heart border located?

A  14-year-old  boy  has  rheumatism. Over  the  last  2  years  he  has  had 3 rheumatic attacks. What course of rheumatism does the patient have?

The patient with aquired heart failure has diastolic pressure of 0 mm Hg. What heart failure does the child have?

An 18-month-old child was taken to a hospital on the 4-th day of the disease. The disease began acutely with temperature 39, weakness, cough, breathlessness. He is pale, cyanotic, has had febrile temperature for over 3 days. There are crepitative fine bubbli-ng rales on auscultation. Percussion sound is shortened in the right infrascapular region. X-ray picture shows non-homogeneous segment infiltration 8-10 mm on the right, the intensification of lung pattern. Your diagnosis:

A baby was born at 36 weeks of gestation. Delivery was normal, by natural way. The baby has a large cephalohematoma. The results of blood count are: Hb- 120g/l, Er- 3, 5 · 10¹²/l, total serum bilirubin – 123 mmol/l, direct bili-rubin – 11 mmol/l, indirect – 112 mmol/l. What are causes of hyperbilirubinemia in this case?

A 4-month-old girl with blond hair and blue eyes has “mousy”odor of sweat and urine, delayed psychomotoric development. The most typical laboratory data for this disorder is:

A man, aged 25, presents with facial edema, moderate back pains, body temperature of 37, 5^oC, BP- 180/100 mm Hg, hematuria (up to 100 in v/f), proteinuria (2,0 g/l), hyaline casts – 10 in v/f, specific gravity – 1020. The onset of the disease is probably connected with acute tonsillitis 2 weeks ago. The most likely diagnosis is:

A 62-year-old patient has DM-2. Diabetes is being compensated by diet and Maninilum. Pаtient has to undergo an operation for inguinal hernia. What tactics of hypoglycemic therapy should be chosen?

A neonate is 5 days old. What vaccination dose of BCG vaccine (in мg) is necessary for vaccination of this child?

Patient, male, 16 years old was behind other children in development since early childhood and still has moderate mental retardation. He is short, has dismorphic body, his face is round, flattened, his eyes are narrow and slanted, and there are epicantial folds in the corners of his eyes. There is only one transversal flexor line on his palms. What is the probable etiology of this state?

A patient who works as a nightman was diagnosed with of chronic arsenious intoxication. What form of anemia is characteristic for this disease?

A patient, aged 52, works as a street cleaner. He has been suffering from pneumoconiosis for 2 years. What treatment should be recommended?

A 28-year-old patient was hospitalized with preliminary diagnosis “influenza”. Roseolous-petechial rash appeared on the 5th day of disease on the trunk. The temperature is 41^oC. Hyperemia of face, reddening of scleras, tremor of tongue, tachycardia, splenomegaly are present. What is the most likely diagnosis?

The diagnostics of the AIDS epidemic initially was made in the USA by means of:

A 20-year-old woman has a 3-4 month history of bloody diarrhoea; stool examination proved negative for ova and parasites; stool cultures negative for clostridium, campylobacter and yersinia; normal small bowel series; edema, hyperemia and ulceration of the rectum and sigmoid colon seen on sigmoidoscopic examination. Select the most likely diagnosis:

A 36-year-old alcoholic patient has cirrhosis and pancreatic insufficiency due to recurrent pancreatitis. He complains of night blindness, decreased ability to taste food, and dry skin with hyper pigmentation. These complaints suggest deficiency of:

A 60-year-old woman, mother of 6 children, developed a sudden onset of upper abdominal pain radiating to the back, accompanied by nausea, vomiting, fever and chills. Subsequently, she noticed yellow discoloration of her sclera and skin. On physical examination the patient was found to be febrile with temp. of 38, 9^oC, along with right upper quadrant tenderness. The most likely diagnosis is:

A 30-year-old patient with complai-nts of occipital headache, disturbed sleep with nightmares came to a policlinic. BP was 150/95 mm Hg. He was diagnosed wi-th hypertensic crisis. The patient should be registered in the following dispensary group for arterial hypertension surveillance:

A young patient who came to a poli-clinic was diagnosed with the 1 stage of hypertension. How often should he undergo the medical check-up?

A 45-year-old male patient was admitted to the intensive care unit because of myocardial infarction. An hour later the ventricular facilitation occurred. Which of the following should be administered?

A 47-year-old obese man complained of periodic attacks of acute arthritis in the st left tarsophalangeal joint. Lab exam revealed increased serum rate of uric acid. What is the diagnosis?

A 40-year-old woman who has worked in weaving branch for 10 years complains of frequent headache, sleeplessness, irritability, fatigue, tiredness. Physical examination revealed instability of blood pressure, internal organs are without changes. What is the most likely diagnosis?

A 45-year-old driver was admitted to the hospital with 5 hour substernal pain. Nitroglycerin is not effective. He is pale, heart sounds are regular but weak. HR – 96 per minute, BP of 100/60 mm Hg. What is the most likely diagnosis?

A 33-year-old man with a history of rheumatic fever complains of fever up to 38 − 39^oC, abdominal pain, dyspnea, tachycardia. Heart borders are displaced to the left by 2 cm, systolic and diastolic murmurs above aorta, BP of 160/30 mm Hg. Petechial rash occurs after measurement of blood pressure. Liver is enlarged by 3 cm, spleen is palpable. Urine is brown-yellow. What is the most likely diagnosis?

A 30-year-old patient complains of breathlessness, pain in the right rib arc region, dry cough and the edema of legs. He is ill for 2 months. He had been treated for rheumatic fever without any effect. On exam: cyanosis, edema of legs, BT of 36, 6^oC, RR of 28/min, HR of 90/min, BP of 110/80 mm Hg, crackles above low parts of both lungs, heart borders are displaced to the left and to the right, weak sounds, systolic murmur above the apex. What is the preliminary diagnosis?

A full term infant was born after a normal pregnancy, delivery, however, was complicated by marginal placental detachment. At 12 hours of age the child, although appearing to be in good health, passes a bloody meconium stool. For determining the cause of the bleeding, which of the following diagnostic procedures should be performed first?

A newborn infant has mild cyanosis, diaphoresis, poor peripheral pule, hepatomegaly and cardiomegaly. Respiratory rate is 60 breaths per minute, and heart rate is 230 beats per minute. The child most likely has congestive heart failure caused by:

A 6-year-old boy was brought to the emergency room with a 3-hour history of fever up to 39, 5^oC and sore throat. The child looks alert, anxious and has a mild inspiratory stridor. You should immediately:

For a patient with a stab injury to the femoral artery, the treatment of choice is:

Which of the following best summarizes indications for operation on an abdominal aortic aneurysm?

Which of the following symptoms is the most typical for the adenoid hypertrophy?

A 30-year-old woman complains of nasal blockage, sneezing, watery nasal discharges. The body temperature is normal. Objectively – edema of nasal mucous membrane on both sides, especially of the lower turbinate (with cyanosis). Blood test data – mild leukocytosis and eosinophilia. What is the diagnosis?

A 27-year old patient with malaria caused by P. falciparum was treated with Chloroquine (600 mg base followed by 300 mg base in 6 hours, then 300 mg base a day for 2 days) without clinical and parasitologic responses to the treatment. What is the most likely reason for the failure to respond to the therapy?

Ten hours before initial observation patient had frequent feces and vomiting. Fecal and vomiting masses looked like rice-water. Nausea and abdominal pain weren’t observed. Hiccup and convulsions of lower limbs, temperature 35, 4^oC, hoarse voice, greyish wry face, acrocyanosis were observed. Respiratory rate 40/min, threadlike pulse 120/min, blood pressure 40/0 mm/Hg, abdomen is drawn. What treatment measures should be taken first of all?

A nurse of the kindergarten was taken to the hospital with complaints of accute pain in parumbilical region, convulsions of lower limbs, multiple bile vomiting, frequent watery foul feces of green colour in huge amounts. At the same time all the staff in the kindergarden got ill. Two days ago all of them ate cottage cheese with sour cream. General condition of patients is of moderate severity. Temperature 38, 2^oC. Heart tones: rhythmic and muted. Heart rate 95/min, arterial pressure: 160 mm/Hg. Abdomen is slightly swollen, painful. Liver +2 cm. What is the most likely diagnosis?

A 45-year-old woman, mother of four children, comes to the emergency room complaining of a sudden onset of the epigastric and right upper quadrant pain, radiating to the back, accompanied by vomiting. On examination, tenderness is elicited in the right upper quadrant, bowel sounds are decreased, and laboratory data shows leukocytosis, normal serum levels of amylase, lipase, and bilirubin. The most likely diagnosis is:

A 50-year-old man comes to the emergency room with a history of vomiting of 3 days’ duration. His past history examination reveals that for about 20 years he has been suffering from epigasric pain lasting for 2 to 3 weeks, during early spring and autumn. He remembers getting relief from pain by taking milk and antacids. Physical examination showed a fullness in the epigastric area with visi-ble peristalsis, absence of tenderness, and normal active bowel sounds. The most likely diagnosis is:

A 24-year-old law student is brought to the emergency room complaining of severe abdominal pain of 6-8 hours durati-on. He had been to a party the night before. The pain is in the epigastrium radiating to the back and is accompanied by nausea. The patient had vomited twice prior to coming to the emergency room. Clinical examination revealed that the young man was anxious, with acute condition, with a regular pulse rate of 100/min, blood pressure of 100/68 mm Hg, and body temperature of 38, 1^oC. The most likely diagnosis is:

In which of the following disorders does the pathophysiology of portal hypertension involve presinusoidal intrahepatic obstruction?

A 25-year-old man was admitted to a hospital with a 2 month history of cough and fever. A chest x-ray showed extensive left upper lobe disease with a 2 cm cavity. All three points were strongly positive on direct smear and grew M. Tuberculosis, fully sensitive to all first-line drugs. Patient must be treated with:

A 5-year-old boy was progressively getting worse compared to the previous 2 months. A chest x-ray has shown right middle lobe collapse. A tuberculin skin test was strongly positive. What is the most characteristic finding in primary tuberculosis?

A 50-year-old man was examined in the clinic for persistent cavitation and sputum. He was treated with rifampicin, isoniazid, ethambuthol. The most common toxic effect of ethambutol is:

 A  3-year-old  child  has  been  admitted to a hospital because of ostealgia and body temperature rise up to 39^oC. Objectively: the patient is in grave condi-tion, unable to stand for ostealgia, there is apparent intoxication, lymph nodesare enlarged up to 1,5 cm. Liver can be palpated 3 cm below the costal margin, spleen – 2 cm below the costal margin. In blood: RBCs – 3, 0·10¹²/l, Hb- 87 g/l, colour index – 0,9, thrombocytes – 190 · 10⁹/l, WBCs – 3, 2 · 10⁹/l, eosinophils – 1, stab neutrophils – 1, segmented neutrophils – 0, lymphocytes – 87, monocytes – 2, ESR – 36 mm/h. What examination should be conducted in order to specify the diagnosis?

A 22-year-old girl has been complaining of having itching rash on her face for 2 days. She associates this disease with application of cosmetic face cream. Objectively: apparent reddening and edema of skin in the region of cheeks, chin and forehead; fine papulovesicular rash. What is the most likely diagnosis?

Apgar test done on a newborn girl at 1st and 5th minute after birth gave the result of 7-8 scores. During the delivery there was a short-term difficulty with extraction of shoulder girdle. After birth the child had the proximal extremity dysfunction and the arm couldn’t be raised from the side. The shoulder was turned inwards, the elbow was flexed, there was also forearm pronation, obstetric palsy of brachial plexus. What is the clinical 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 27-year-old patient with a history of ronchial asthma was stung by a bee. He had a sensation of chest compression, breath shortage, difficult expiration, sense of heat in the upper half of body, dizziness, apparent itch, convulsions. Objectively: noisy wheezing breath, AP – 90/60 mm Hg, Ps- 110 bpm. Auscultation revealed weak rhythmic heart sounds, rough respi-ration above lungs, sibilant rales. What drug group should be administered in the first place?

A 32-year-old patient complains of 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 likely diagnosis?

On the 21 day after appearance of vesiculous chickenpox rash a 7-year-old child developed ataxia, nystagmus, intention tremor, muscle hypotonia. Liquor analysis shows insignificant lymphocytic pleocytosis, slightly increased protein rate. What complication is it?

Clinic of a research institute for occupational diseases examined a worker who works at a concentration plant and diagnosed him with chronic dust bronchitis. The case is investigated by a commission including the representatives of: the plant, clinic, territorial SES, department of Social Insurance Fund, trade union. According to the “regulation on investigation of. . . “, the commission should be headed by the representative of the following authority:

Basing upon the data of laboratory assessment  of  sanitary state of soil  in a  certain  territory,  the soil was found to be low-contaminated according to the sanitary indicative value; contami-nated according to the coli titer; low-contaminated according to the anaerobe titer (Cl. Perfringens). This is indicative of:

A 28-year-old patient underwent endometrectomy as a result of incomplete abortion. Blood loss was at the rate of 900 ml. It was necessary to start hemotransfusion. After transfusion of 60 ml of erythrocytic mass the patient presented with lumbar pain and fever which resulted in hemotransfusion stoppage. 20 minutes later the patient’s condition got worse: she developed adynamia, apparent skin pallor, acrocyanosis, profuse perspiration. t^o– 38, 5^oC, Ps-110/min, AP- 70/40 mm Hg. What is the most likely diagnosis?

A painter working at a motorcar plant was diagnosed with acute intoxication with amide compounds of benzene, moderate severity grade. The in-patient treatment resulted in considerable health improvement. What expert decision should be made in this case?

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

A   44-year-old patient complains  about  difficult urination,sensation of incomplete urinary bladder emptying. Sonographic examination of the urinary bladder near the urethra entrance revealed an oval well-defined hyperechogenic formation 2×3 cm large that was changing its position during the examination. What conclusion can be made?

An emergency team has delivered to a hospital an unconscious patient found lying in the street in winter. Objectively: the patient is pale, with superficial respiration; bradycardia with heartrate 54/min, t^o– 35, 0^oC. AP- 100/60 mm Hg. Palpation of chest and abdomen revealed no peritoneal symptoms. There is a smell of alcohol from the patient’s mouth. What is the most likely diagnosis?

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 examination revealed complete cervical dilatation, fetus head was in the area of small pelvis. What tactics of labor management should be chosen?

A 35-year-old patient complains about pain and morning stiffness of hand joints and temporomandibular joints that lasts over 30 minutes. She has had these symptoms for 2 years. Objectively: edema of proximal interphalangeal digital joi-nts and limited motions of joints. What examination should be administered?

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?

Bacterial analysis of air in a living space in winter period by means of Krotov’s apparatus revealed that total number of microorganisms in 1m³ of air was 7200. What is the allowed number of microorganisms for the air to be characterized as “pure”?

A patient who has been consuming refined foodstuffs for a long time complains about headache, fatiguability, depression, insomnia, irritability. Objectively: muscle asthenia, pain and cramps in the gastrocnemius muscles, during walking the patient lands onto his heel first, then on the external edge of foot. Cardiovascular system exhibits tachycardia, hypoxia, dystrophic changes of myocardium. There are also gastrointestinal di-sorders. What is the most likely diagnosis?

A 9-year-old boy has been suffering from bronchoectasis since he was 3. Exacerbations occur quite often, 3-4 times a year. Conservative therapy results in short periods of remission. The disease is progressing, the child has physical retardation. The child’s skin is pale, acrocyanotic, he has “watch glass”nail deformation. Bronchography revealed saccular bronchiectases of the lower lobe of his right lung. What is the further treatment tactics?

A 46-year-old patient once took part in elimination of breakdown at an atomic power plant. Currently he is being treated at an in-patient hospital. He was diagnosed with progressing vegetative insufficiency. This disease relates to the following group of ionizing radiation effects:

A child is 4 years old, has been ill for 5 days. There are complaints of cough, skin rash, t^o– 38, 2^oC, face puffiness, photophobia, conjunctivitis. Objectively:there is bright, maculo-papulous, in some areas confluent rash on the face, neck, upper chest. The pharynx is hyperemic. There are seropurulent discharges from the nose. Auscultation revealed dry rales in lungs. What is the most likely diagnosis?

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 likely 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 3,0 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 a stri-pe of hyperemia, skin edema and a painful cord. What complication is it?

A children’s health camp received a party of tinned food. External examination of the tins revealed that they had deep dents; formed a concavity when pressed and didn’t immediately return to the initial state; rust was absent; the tins were greased with inedible fat. Specify the bloat type:

In autumn a 25-year-old patient developed stomach ache that arose 1,5-2 hours after having meals and at night. He complains about pyrosis and constipation. The pain is getting worse after consuming spicy, salty and sour food, it can be relieved by means of soda and hot-water bag. The patient has been suffering from this disease for a year. Objectively: furred moist tongue. Abdomen palpation reveals epigastrial pain on the right, resistance of abdominal muscles in the same region. What is the most likely diagnosis?

On the 4th day after suturing the perforative stomach ulcer a patient with pulmonary emphysema developed spontaneous pneumothorax. What is the best place for pleural drainage?

A 32-year-old male patient has been suffering from pain in the sacrum and coxofemoral joints, painfulness and stiffness in the lumbar spine for a year. ESR – 56 mm/h. Roentgenography revealed symptoms of bilateral sacroileitis. The patient is the carrier of HLA B27 antigen. What is the most likely diagnosis?

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 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 child was taken to a hospital with focal changes in the skin folds. The child was anxious during examination, examination revealed dry skin with solitary papulous elements and ill-defined lichenification zones. Skin eruption was accompanied by strong itch. The child usually feels better in summer, his condition is getting worse in winter. The child has been artificially fed since he was 2 months old. He has a history of exudative diathesis. Grandmother by his mother’s side has bronchial asthma. What is the most likely diagnosis?

2 weeks after recovering from angina an 8-year-old boy developed edemata of face and lower limbs. Objectively: the patient is in grave condition, AP- 120/80 mm Hg. Urine is of dark brown colour. Oliguria is present. On urine analysis: relative density – 1,015, protein – 1,2 g/l, RBCs are leached and cover the whole vision field, granular casts – 1-2 in the vision field, salts are represented by urates (big number). What is the most likely diagnosis?

A 60-year-old female patient was admitted to a hospital for acute transmural infarction. An hour ago the patient’s contition got worse. She developed progressing dyspnea, dry cough. Respiratory rate – 30/min, heart rate – 130/min, AP- 90/60 mm Hg. Heart sounds are muffled, diastolic shock on the pulmonary artery. There are medium moist rales in the lower parts of lungs on the right and on the left. Body temperature – 36, 4^oC. What drug should be given in the first place?

A 52-year-old male patient complains about attacks of asphyxia, pain in his right 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 side. Objectively: heart rate – 102/min, respiratory rate – 28/min, AP- 90/70 mm Hg. Auscultati-on 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 primagravida in her 20th week of gestation complains about pain in her lower abdomen, blood smears from the genital tracts. The uterus has an increased tonus, the patient feels the fetus movements. Bimanual examination revealed that the uterus size corresponded the term of gestation, the uterine cervix was contracted down to 0,5 cm, the external orifice was open by 2 cm. The discharges were bloody and smeary. What is the most likely diagnosis?

On the 4th day after recovering from a cold a patient was hospitalized with complaints of solitary spittings of mucoid sputum. On the 2nd day there was a single discharge of about 250 ml of purulent blood-streaked sputum. Objectively: the patient’s condition is moderately severe. Respiratory rate – 28-30/min, Ps- 96 bpm, AP- 110/70 mm Hg. Respiration above the left lung is vesicular, weak above the right lung. There are moist rales of different types above the lower lobe and amphoric breath near the angle of scapula. What is the most likely diagnosis?

350 workers of a mettalurgical plant had to undergo a yearly preventive examination. A territorial polyclinic carried out preventive examination of 325 workers. As a result of it, 1 worker was recognized as temporarily disabled, 15 workers underwent further rehabilitation at an after-work sanatorium, 10 workers were provided with diet meal. What index characterizing the preventive work of the polyclinic should be applied in this case?

A 14-year-old girl has been presenting with irritability and tearfulness for about a year. A year ago she was also found to have diffuse enlargement of the thyroid gland (II grade). This condition was regarded as a pubertal manifestation, the girl didn’t undergo any treatment. The girl’s irritability gradually gave place to a complete apathy. The girl got puffy face, soft tissues pastosity, bradycardia, constipations. Skin pallor and gland density progressed, the skin got a waxen hue. What disease may be assumed?

A newborn’s head is of doli-chocephalic shape, that is front-to-back elongated. Examination of the occipital region of head revealed a labour tumour located in the middle between the prefontanel and posterior fontanel. The delivery took place with the following type of fetus head presentation:

A 56-year-old patient with diffuse toxic goiter has ciliary arrhythmia with pulse rate 110 bpm, arterial hypertension, AP- 165/90 mm Hg. What preparation should be administered along with mercazolil?

Over a current year among workers of an institution 10% haven’t been ill a single time, 30% have been ill once, 15% – twice, 5% – 4 times, the rest – 5 and more times. What is the percentage of workers relating to the I health group?

A 16-year-old boy was admitted to the hospital for the reason of intractable nasal haemorrhage and intolerable pain in the right cubital articulation. Objectively: the affected articulation is enlarged and exhibits defiguration and skin hyperaemia. There are manifestations of arthropathy in the other articulations. Ps- 90 bpm; colour index – 1,0, WBC – 5, 6 · 10⁹/l, thrombocytes- 220 · 10⁹/l, ESR – 6 mm/h. Lee-White coagulation time: start – 24’, fi-nish – 27’10”. What drug will be the most effective for this patient treatment?

A 42-year-old woman complains about bruises on her both legs and prolonged menstruation; general weakness, tinnitus cerebri. Objectively: multiple macular haemorrhages on the legs and body. The patient presents with tachypnoe, tachycardia, systolic murmur in all auscultatory points. AP- 75/50 mm Hg. Blood count: RBC – 1, 9 · 10¹²/l, Нb- 60 g/l, colour index – 0,9, WBC – 6, 5 · 10⁹/l, thrombocytes – 20 · 10⁹/l, ESR- 12 mm/h. Duke bleeding time – 12 minutes. Bone marrow analysis revealed plenty of juvenile immature forms of megacaryocytes without signs of thrombocyte pinch-off. What is the most likely diagnosis?

A 43-year-old man who often contacts with ethyl gasoline was admitted to a hospital with complaints of general weakness, dizziness, memory impairment, sleepiness at daytime and insomnia at night, sense of hair in the mouth, colicky pains in the right subcostal region. What is the most likely diagnosis?

A 30-year old woman taken by influenza has empty stomach glycemia at the rate of 11,3 millimole/l, glucosuria at the rate of 25 g/l. The patient is 168 cm tall and weighs 67 kg. What test would be the most informative for the diagnosis specification?

A 52-year-old male patient has an 18 year history of diabetes mellitus. One year ago he had cystitis. The patient takes 0,005 g of maninil thrice a day. Objectively: height – 176 cm, weight – 82 kg. Glycemia variability on an empy stomach is at the rate of 10,3-12,4 millimole/l. Analyses revealed proteinuria at the rate of 0,033 g/l. The most efficient way to prevent diabetic nephropathy progress will be:

A 34-year-old female patient complains about weakness, 12 kg weight loss within 6 months, sweating, palpitation, irritability. Objectively: III grade thyroid gland is elastic, diffuse enlargement is present, there is also a node in the right lobe. Cervical lymph nodes are not enlarged. What treatment tactics would be the most rational?

On the next day after being taken by influenza a 46-year-old woman presented with intensified headache, dizziness, nausea. Objectively: the patient is conscious, psychomotor excitement is present; there is general hyperesthesia, moderate meningeal syndrome, nystagmus. Tendon teflexes are higher on the right, right extremities display muscle weakness, right-sided pathological Babinski’s sign is present. Liquor is transparent, pressure is 220 mm of water column; cytosis is 46/3 with prevailing lymphocytes. What is the most likely diagnosis?

After examination a 46-year-old patient was diagnosed with left breast cancer T2N2M0, cl. gr. II-a. What will be the treatment plan for this patient?

A 34-year-old male patient was delivered to the neurological department with complaints of intense headache, double vision, light and noise intolerance. The attack came suddenly while load lifting. Objectively: torpor, moderate divergent strabismus, diplonia. Bilateral Kernig’s symptoms. No paresises. Bloody liquor. What medication should be administered in the first line?

A patient suffering from acute posttraumatic pain received an injection of morphine that brought him a significant relief. Which of the following mechanisms of action provided antishock effect of morphine in this patient?

After supercooling a 38-year-old woman developed muscle pain, body temperature rise up to 39^oC, headache, dysuria, positive Pasternatsky’s symptome. In the urine: leukocyturia, bacteriuria. In blood: Decrease in Hb rate down to 103 g/l, left shift leukocytosis, ESR acceleration up to 32 mm/h. Blood urea – 6,0 millimole/l. What is the most likely diagnosis?

A 50-year-old patient complains about having pain attacks in the right subcostal area for about a year. He pain arises mainly after taking fattening food. Over the last week the attacks occurred daily and became more painful. On the 3rd day of hospitalization the patient presented with icteritiousness of skin and scleras, light-colored feces and dark uri-ne. In blood: neutrophilic leukocytosis – 13, 1 · 10⁹/l, ESR – 28 mm/h. What is the most likely diagnosis?

A 30-year-old gravida consulted a gynecologist about bright red bloody discharges from the vagina in the 32 week of gestation. She was hospitalized with suspi-cion of placental presentation. Under what conditions is it rational to conduct the internal examination for the diagnosis specification?

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 likely diagnosis?

A 30-year-old patient presented with body temperature rise up to 38, 5^oC, pain in the small articulations of hands; face edemata and erythema. In blood: RBCs – 2, 6 · 10¹²/l; Hb- 98 г/л; WBCs – 2 · 10⁹/l; ESR – 58 mm/h. In the urine: protein – 3,1 g/l; RBCs – 10-15 in the vision field. What disease can be suspected in this case?

A 5-grade pupil complains about extensive skin rash accompanied by intensive itch, especially at night. Objectively: there are small red papules set mostly in pairs in the region of interdigital folds on both hands, on the flexor surface of radicarpal articulations, abdomen and buttock skin as well as internal surface of thighs. In the centre of some papules vesicles or serohaemorrhagic crusts can be seen. There are multiple excoriations. What is the most likely diagnosis?

A 43-year-old female patiet complai-ns of eruption on her right leg skin, pain, weakness, body temperature rise up to 38^oC. The disease is acute. Objectively: there is an edema on the right leg skin in the region of foot, a well-defined bright red spot in form of flame tips which feels hot. There are isolated vesicles in focus. What is your provisional diagnosis?

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 35-year-old patient was admitted to the in-patient psychiatric facility for the first time. He was diagnosed with paranoid schizophrenia. What is the most rational treatment method?

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

A patient came 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 fi-ngers 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?

A patient was delivered to the admission ward 40 minutes after a minor trauma   with complaints of pain  in the  thoracic spine.  He has a history of pulmonary tuberculosis. Roentgenography results: suspected compression fracture of the VIII and IX thoracic vertebrae. What pathological process in spine might have stimulated pathological fracture of vertebral bodies?

On the next day after esophagoscopy and biopsy a 44-year-old female patient developed emphysema of both supraclavicular regions, deglutition pain and pain behind the breastbone, cyanosis. Body temperature – 39^oC. In blood: WBCs – 16 · 10⁹/l, left shift in the neutrophils. X-ray picture shows a limited shadow of the posterior mediastinum at a level with trachea bifurcation. The patient was diagnosed with esophagus rupture. What treatment tactics would be the most rational?

A 30-year-old woman with a long hi-story of chronic pyelonephritis complains about considerable weakness, sleepiness, decrease in diuresis down to 100 ml per day. AP- 200/120 mm Hg. In blood: creatinine – 0,62 millimole/l, hypoproteinemia, albumines – 32 g/l, potassium – 6,8 milli-mole/l, hypochromic anemia, increased ESR. What is the first step in the patient treatment tactics?

A 10-year-old girl consulted a doctor about thirst, frequent urination, weight loss. She has been observing these symptoms for about a month. Objectively: no pathology of internal organs was revealed. What laboratory analysis should be carried out in the first place?

A 19-year-old patient complains about skin rash that appeared 2 days ago after eating smoked fish. The rash disappears after 4-6 hours but then turns up again. It is accompanied by itch. Objectively: trunk and upper limbs are covered with multiple pink blisters as big as a pea or a bean. What is the most likely diagnosis?

A 68-year-old  patient  consulted a  doctor about  a  tumour  in  her  left breast. Objectively: in the upper internal quadrant of the left breast there is a neoplasm up to 2,5 cm in diameter, dense, uneven, painless on palpation. Regional lymph nodes are not enlarged. What is the most likely diagnosis?

A 40-year-old female patient has been observing profuse menses accompanied by spasmodic pain in the lower abdomen for a year. Bi-manual examination performed during menstruation revealed a dense formati-on 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 likely diagnosis?

A 65-year-old patient complains about pain in the lumbar spine, moderate disuria. He has been suffering from these presentations for about half a year. Prostate volume is 45 cm³ (there are hypoechogenic nodes in both lobes, capsule invasion). Prostate-specific antigen is 60 ng/l. Prostate biopsy revealed an adenocarcinoma. Which of the supplemental examination methods will allow to determine the stage of neoplastic process in this patient?

A 44-year-old man has been working in coke industry for 16 years. Dust concentration at his workplace is 5-10 times higher 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?

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 worker who undergoes regular medical check-up for duodenal ulcer received a subsidized 24-day sanatorium voucher from his plant. The term of annual leave of a worker is 24 calender days, it will take 4 days more to get to the sanatorium and back home. What is the procedure of obtaining a 4-day sick-leave?

A driver had been fixing a car in a closed garage and afterwards complained about headache, dizziness, nausea, muscle asthenia, sleepiness. Objectively: pulse and respiratory rate elevation, excitement, hypertension, delirium of persecution. What is the most likely diagnosis?

The total area of a ward at the therapeutical department is 28 m². What is the maximum number of beds that can be exploited in this ward?

2 days ago a patient presented with acute pain in the left half of chest, gneral weakness, fever and headache. Objectively: between the 4 and 5 rib on the left the skin is erythematous, there are multiple groups of vesicles 2-4 mm in diameter filled with transparent liquid. What diease are these symptoms typical for?

A 27-year-old military servant was delivered to the regimental aid post 1,5 hour after getting an abdominal injury with an aerial bomb splinter. Objectively: the patient is in grave condition, pale, Ps-132/min, AP- 80/60 mm Hg. Subcostal area has a bandage on from the first-aid pack, the bandage is soaked with blood. The abdomen is tense. Percussion revealed dullness in flat parts that changes its location with the change of body position. There are symptoms of peritoneal irritation. What department of the regimental aid post should provide medical care?

A sergeant got injured with a shell splinter in the left subcostal region. He was bandaged by his fellow soldiers with an individual field dressing. Afterwards he was delivered to the regimental medical station. The patient complains of dizziness, weakness, thirst, abdominal pain. His general condition is grave, he is pale, Ps- 120 bpm. The abdomen is painful, soft on palpation. The dressing is well-fixed but slightly soaked with blood. The victim should be evacuated to the collecting battalion with the following type of transport and in the following turn:

On the 5th day after labor body temperature of a 24-year-old parturient suddenly rose up to 38, 7^oC. She complai-ns 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 likely diagnosis?

An 11-yearold girl was taken by an acute disease: she got pain in the lumbar region, nausea, vomiting, frequent urination, body temperature 39^oC. Objectively: the abdomen is soft, painful on palpation in the lumbar region. Common urine analysis revealed considerable leukocyturia, bacteriuria. The urine contained colibacilli. What is the most likely diagnosis?

A patient is active, lively, fussy. He opposes the examination. His speech is fast and loud, his statements are spontaneous and inconsequent. Specify the psychopathological state of this patient:

A surgeon examined a 42-year-old patient and diagnosed him with right forearm furuncle, purulo-necrotic stage. The furuncle was lanced. At the hydration stage the wound dressing should enclose the following medication:

A 37-year-old patient was delivered to a hospital in unconscious state. He got a closed abdominal injury. He is suspected to have internal haemorrhage, intraabdominal injury. He is being prepared an emergency operation. By means of standard sera a physician determined his blood group and got the following results: 0(I) – no agglutinati-on, А(II) – no agglutination, В(III) – no agglutination. What is the patient’s blood group?

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 gestation underwent an operation on account of acute phlegmonous appendicitis. In the postoperative period it is necessary to take measures for prevention of the following pregnancy complication:

A 30-year-old patient presents with sudden loss of consciousness, tonoclonic spasms, AP- 150/100 mm Hg, heart rate – 100/min. Before the attack he felt di-zziness, sense of irreality, inexplicable fear. After the attack the patient failed to remember it. What is the most likely diagnosis?

A 26-year-old male patient complains of piercing pain during breathing, cough, dyspnea. Objectively: t^o– 37, 3^oC, respiration rate – 19/min, heart rate=Ps – 92/min; AP- 120/80 mm Hg. Vesicular respiration. In the inferolateral parts of chest auscultation in both inspiration and expiration phase revealed noise that was getting stronger at phonendoscope pressing and can be still heard after cough. ECG showed no pathological changes. What is the most likely diagnosis?

HIV displays the highest tropism towards the following blood cells:

In terms of megacalorie (1000 kcal 4184 kJ) the ration of an adult includes 30 g of proteins, 37 g of fats, 137 g of carbohydrates, 15 mg of vitamin C, 0,6 mg of thiamine (vitamin B₁). The ration is UNBALANCED as to the contents of:

A 22-year-old patient is a clerk. His working day runs in a conditioned room. In summer he was taken by an acute disease with the following symptoms: fever, dyspnea, dry cough, pleural pain, myalgia, arthralgia. Objectively: moist rales on the right, pleural friction rub. X-ray picture showed infiltration of the inferior lobe. In blood: WBC – 11 · 10⁹/l, stab neutrophiis – 6%, segmented neutrophils – 70%, lymphocytes – 8%, ESR – 42 mm/h. What is the ethiological factor pneumonia?

A 47-year-old patient complains about cough with purulent sputum, pain in the lower part of the left chest, periodical body temperature rise. She has been suffering from these presentations for about 10 years. Objectively: “drumstick”distal phalanges. What examination would be the most informative for making a diagnosis?

A heat station working on solid fuel is located in a residential district. On cloudy foggy days in december there was an increase in diseases with upper airway affection and signs of general intoxication. There were also mortal cases among the elderly people. What is the most likely factor that provoked toxic effect?

A 32-year-old female patient consulted a doctor about a skin affection of her body, face and extremities which turned up after peroral intake of biseptol. The patient was diagnosed with drug toxi-coderma. What treatment methods would be the most effective for this patient?

A 42-year-old woman has had hyperpolymenorrhea and progressing algodismenorrhea for the last 10 years. Gynecological examination revealed no changes of uterine cervix; discharges are moderate, of chocolate colour, uterus is slightly enlarged and painful, appendages are not palpable, the fornices are deep and painless. What is the most likely diagnosis?

On the tenth day after discharge from the maternity house a 2-year-old patient consulted a doctor about body temperature rise up to 39^oC, pain in the right breast. Objectively: the mammary gland is enlarged, there is a hyperemized area in the upper external quadrant, in the same place there is an ill-defined indurati-on, lactostasis, fluctuation is absent. Lymph nodes of the right axillary region are enlarged and painful. What is the most likely 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?

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?

A 26-year-old woman complains of having bloody discharges from the genitals for the last 14 days, abdominal pain, general fatiguability, weakness, weight loss, body temperature rise, chest pain, obstructed respiration. 5 weeks ago she underwent induced abortion in the 6-7 week of gestation. Objectively: the patient is pale and inert. Bimanual examination revealed that the uterus was enlarges up to 8-9 weeks of gestation. In blood: Hb- 72 g/l. Urine test for chorionic gonadotropin gave the positive result. What is the most likely diagnosis?

A 1,5-year-old child was taken by an acute disease: body temperature up to 39^oC, frequent vomiting up to 5 times. Nervous system tests revealed positive Kernig’s and Brudzinski’s signs. The given symptoms relate to:

A pediatrician had a conversation with 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?

1 day ago a 19-year old male patient got a trauma after a fall from 1,5 m height when he “bestrode”a wooden beam. Urination is extremely difficult, there is macrohematuria, urethrorrhagia. There is a hematoma in the perineum and on the scrotum. Urethrography revealed flowing of contrast medium into the membranous part of urethra. What is the treatment tactics of choice?

A 40-year-old patient underwent an operation for a lumbar phlegmon. Body temparature rose again up to 38^oC, he got intoxication symptoms, there was an increase of leukocyte number in blood. The wound that was nearly free from necrotic tissues and full of granulations started to discharge pus, the granulations turned pale. What complication dveloped in this patient?

A 40-year-old female patient has a hi-story of rheumatism. She complains about acute pain in her left eye, especially at night, vision impairment, photophobia, lacrimation. The patient cannot suggest any reasons for the disease. Objectively: weak pericorneal injection, flattening of iris relief, iris discoloration. What is the most likely diagnosis?

Three days ago a boy underwent removal of a foreign body from under a nail plate. 2 days later he felt acute pulsating pain at the end of the nail bone which was getting worse at pressing. Nail fold became hyperemic, body temperature rose up to 37, 5^oC, there was a change in nail plate colour. What is the most likely diagnosis?

Statistic of patients of common medical practice displays constant increase in elderly and old people number. What kind of pathology is expected to prevail in the morbidity structure of population in question?

A 30-year-old patient consulted a doctor about menstruation absence for 2 years after labour, loss of hair, body weight loss. The labour was compli-cated by a haemorrhage caused by uterus hypotonia. Objectively: the patient is asthenic, external genitals are hypoplastic, the uterus body is small and painless. The appendages are not palpaple. What is the most likely diagnosis?

A 25-year-old patient complains of burning and pain during urination, purulent discharges from the urethra that turned up 2 days ago. Objectively: the urethral labia are edematic, hyperemic, there are profuse purulent discharges from the urethra. Provisional diagnosis: recent acute gonorrheal urethritis. What supplemental data of clinical examinations will allow to specify the diagnosis?

A 28-year-old patient has been admitted to the gynecological department three days after a casual coitus. She complains about pain in her lower abdomen and during urination, profuse purulent discharges from the vagina, body temperature rise up to 37, 8^oC. The patient was diagnosed with acute bi-lateral adnexitis. Supplemental examination revealed: the 4th degree of purity of the vaginal secretion, leukocytes within the whole visual field, diplococcal bacteria located both intra- and extracellularly. What is the etiology of acute adnexitis in this patient?

A boy is 8 year old. His physical development is compliant with his age. The child has had cardiac murmur since birth. Objectively: skin and visible mucous membranes are of normal colour. AP- 100/70 mm Hg. Auscultation revealed systolo-diastolic murmur and diastolic shock above the pulmonary artery. ECG shows overload of the left heart. Roentgenoscopy shows coarsening of the lung pattern, heart shadow of normal form. What is the most likely diagnosis?

A 45-year-old patient with urolithiasis had an attack of renal colic. What is the mechanism of the attack development?

A 25-year-old woman came 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 likely diagnosis?

A  32-year-old  gravida  complains about episodes of unconsciousness, spontaneous syncopes that are quickly over after a change of body position. A syncope can be accompanied byquickly elapsing bradycardia. There are no other complications of gestation. What is the most likely reason for such condition?

A 49-year-old woman complains about headache, head and neck going hot, increased perspiration, palpitation, arterial pressure rise up to 170/100 mm Hg, irritability, insomnia, tearfulness, memory impairment, rare and scarce menses, body weight increase by 5 kg over the last half a year. What is the most likely diagnosis?

The correlation between the service record and eosinophil concentration in blood was studied in workers at dyeing shops of textile factories. What index will be the most informative for the analysis of this data?

A 38-year-old patient complains about inertness, subfebrile temperature, enlargement of lymph nodes, nasal haemorrhages, ostealgia. 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 neutrophi-ls – 2%, segmented neutrophils – 12%, lymphocytes – 83%, lymphoblasts – 2%, smudge cells; ESR- 57 mm/h. What is the most likely diagnosis?

A 58-year-old patient complains about sensation of numbness, sudden paleness of II-IV fingers, muscle rigidness, intermittent pulse. The patient presents also with polyarthralgia, dysphagia, constipations. The patient’s face is masklike, solid edema of hands is present. The heart is enlarged; auscultation revealed dry rales in lungs. In blood: ESR – 20 mm/h, crude protein – 85/l, γ-globulines – 25%. What is the most likely diagnosis?

A 36-year-old female patient complains of general weakness, edemata of her face and hands, rapid fatiguability during walking, difficult diglutition, cardiac irregularities. These symptoms turned up 11 days after a holiday at the seasi-de. 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 millimole/h·l, aldolase – 9,2 IU/l, creatine phosphokinase – 2,5 millimole 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 a transfusion of donor erythrocyte mass of AB(IV )Rh⁺ group. An hour later the patient became anxi-ous, 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 compli-cation is it?

A 45-year-old man has been exhibiting high activity for the last 2 weeks, he became talkative, euphoric, had little sleep, claimed being able “to save the humanity”and solve the problem of cancer and AIDS, gave money the starangers. What is the most likely diagnosis?

A 67-year-old female patient suffering from the essential hypertension suddenly at night developed headache, dyspnea that quickly progressed to asphyxia. Objectively: the patient is pale, with sweaty forehead, AP- 210/140 mm Hg, heart rate – 120/min, auscultation revealed solitary dry rales and moist rales in the lower parts. The shins are pastose. What kind of emergency aid would be the most efficient in this case?

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

A 26-year-old patient complains about considerable muscle weakness, dizziness, extended abdominal pain, nausea and vomiting giving no relief. The disease has been gradually developing within 6 months. There was progress of general weakness, skin darkening. The patient fell into grave condition after an ARD: there appeared abdominal pain and frequent vomiting. Objectively: the skin is dry with diffuse pigmentation. Heart sounds are si-gnificantly weakened, heart rate – 60/min, AP- 80/40 mm Hg. The abdomen is sli-ghtly painful in the epigastrial region. In blood: WBCs – 8, 1 · 10⁹/l, glucose – 3,0 millimole/l. What is the most likely di-agnosis?

A puerpera is 25 years old, it is her second day of postpartum period. It was her first labour, it took place at full term. The lochia should be:

A 32-year-old patient consulted a doctor about being inable to get pregnant for 5-6 years. 5 ago the primipregnancy ended in artificial abortion. After the vaginal examination and USI the patient was diagnosed with endometrioid cyst of the right ovary. What is the optimal treatment method?

A 20-year-old man complains about pain arising in the lower third of femoral bone under stress and at rest. He denies having a trauma. Objectively: the skin is of normal colour, deep palpation reveals pastosity and pain, knee joint motions are limited. X-ray picture of the meta-epyphisis of distal femur shows a destruction zone and spicules. In blood: immature cell forms, no signs of inflammation. What is the most likely diagnosis?

A 10-year-old girl was admitted to a hospital with carditis presentations. It is known from the anamnesis that two weeks ago she had exacerbation of chronic tonsi-llitis. What is the most likely etiological factor in this case?

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

Workers of a laboratory producing measuring devices (manometers, thermometers etc) complain about a mettalic taste in mouth, stomatitis, dyspepsia, sleep disturbance, unsteady walk, abrupt decrease in cardiac activity. These presentations must have been caused by the intoxication with the following substance:

A full-term infant has respiratory rate of 26/min, heart rate of 90/min, blue skin, muscle hypotonia. During catheter suction of mucus and amniotic fluid from the nose and mouth the child reacted with a grimace. Low reflexes. Auscultation revealed weakened vesicular respiration above lungs. Heart sounds are loud. After 5 minutes the respiration became rhythmic, at the rate of 38/min, heart rate of 120/min. What is the most likely 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 35-year-old man complains about intense lumbar pain irradiating to the inguinal area, external genitalia, thigh; frequent urination, chill, nausea, vomiting. Objectively: positive Pasternatsky’s symptom. Urine analysis revealed that RBCs and WBCs covered the total fi-eld of microscope; the urine exhibited hi-gh protein concentration. These clinical presentations were most likely caused by the following pathology:

Head circumference of a 1-month-old boy with signs of excitement is 37 cm, prefontanel is 2×2 cm large. After feeding the child regurgitates small portions of milk; stool is normal in its volume and composition. Muscle tone is within norm. What is the most likely diagnosis?

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”is confirmed, then bacteriological study of urethral discharges will reveal:

As a result of load lifting a 68-year-old female felt acute pain in the lumbar region, in a buttock, posterolateral surface of her right thigh, external surface of the right shin and dorsal surface of foot. Objectively: weakness of the anterior tibial muscle, long extensor muscle of the right toes, short extensor muscle of the right toes. Low Achilles reflex on the right. Positive Lasegue’s sign. What examination method would be the most effective for specification of the diagnosis of discogenic compression of L₅ root?

A hospital admitted a patient with coarse breathing (obstructed inspiration), skin cyanosis, tachycardia and arterial hypertension. He has a histrory of bronchial asthma. An hour ago he was having salbutamol inhalation and forgot to remove a cap that was aspired while taking a deep breath. What measures should the doctor take?

A 28-year-old patient was delivered to the admission ward in the unconscious state with generalized epileptic attacks taking place every 15-20 minutes. During transportation the patient was given two injections of diazepam, magnesia sulphate, but they failed to bring the patient to consciousness. What department should render emergency aid?

On the second day after preventive vaccination a 2-year-old boy presented with 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 likely diagnosis?

On the 6th 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 60-year-old patient complains about asphyxia, palpitation, rapid fatiguability. He has 8 year history of essential hypertension. Objectively: the left cardiac border is 2 cm deviated to the left from the medioclavicular line, heart sounds are rhythmic and weak; there is diastolic shock above aorta. AP- 170/100 mm Hg. Liver – +2 cm; shin pastosity is present. ECG shows deviation of cardiac axis to the left, left ventricle hypertrophy. Ejecti-on fraction – 63%. What type of cardiac insufficiency is observed?

A 3-year-old male patient consulted a family doctor 2 months after he had been operated for an open fracture of brachial bone. Objectively: the patient’s condition is satisfactory, in the region of the operative wound there is a fistula with some purulent discharge, redness, fluctuation. X-ray picture shows brachial bone destruction with sequestra. What complication arose in the postoperative period?

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 49-year-old patient undergoes regular medical check-up for uterine fibromyoma. Within the last year the uterus has enlarged up to 20 weeks of gestation. What is the rational way of treatment?

A patient is being prepared for the operation on account of varix dilatation of lower extremities veins. Examination of the patient’s soles revealed flour-like desquamation along the skin folds. All the toenails are greyish-yellow, thickened and partially decayed. What dermatosis should be suspected?

A 46-year-old patient was issued a 10-day sick list because of exacerbation of chronic cholecystitis. The patient’s general condition got better, but the clinical manifestations of the disease are still present. What authority is entitled to extend the sick list?

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 decreased. Heart sounds are muffled, rapid. AP- 60/40 mm Hg, heart rate – 96/min. In blood: Na – 120 mi-llimole/l, K – 5,8 millimole/l. Development of this complication is primarily caused by the deficit of the following hormone:

Forensic medical expertise of corpse of a newborn revealed: body weight 3500 g, body length 50 cm, the umbilical cord was smooth, moist, glossy, without any signs of drying. Hydrostatic tests were posi-tive. The test results are the evidence of:

A maternity house has admitted a primagravida complaining of irregular, intense labour pains that have been lasting for 36 hours. The woman is tired, failed to fall asleep at night. The fetus is in longitudinal lie, with cephalic presentation. The fetus heartbeat is clear and rhythmic, 145/min. Vaginal examination revealed that the uterine cervix was up to 3 cm long, dense, with retroflexion; the external orifice was closed; the discharges were of mucous nature. What is the most likely diagnosis?

A 52-year-old patient works as a secretary and has 30 year record of service. She complains of spasms in her right hand during working and inability to type and write. Up to 80% of her work involves hand load. The patient has been presenting with these symptoms for 2 years. Objectively: the right hand is tense, there is an increase in muscle tone, attempts to write cause spasms. Examination revealed no pathological changes of CNS. What is the most likely diagnosis?

During examination at a military commissariat a 15-year-old teenager was found to have interval sysolic murmur on the cardiac apex, diastolic shock above the pulmonary artery, tachycardia. Which of the suuplemental examination methods will be the most informative for the diagnosis specification?

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. Objectively: 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?