internal disease

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問題一覧

1. What investigation is most optimal for the pneumonia diagnosis:

• Chest X-ray

2. What local percussion sound characteristics are typical for the pneumonia:

• Dull pulmonary sound

3. The “first-line” antimicrobial drugs for empirical therapy in patients with community-acquired pneumonia are:

• Penicillin, azithromycin

4. Nosocomial pneumonia is defined as:

• Pneumonia develops in a patient hospitalised for ≥ 48 hours

5. The main long-term treatment for moderate asthma is:

• Inhaled corticosteroids (ICS)

6. A 33 years old woman occasionally has nighttime coughs and wheezing. These complaints are a typical clinical onset of:

• Asthma

7. The main goal of COPD treatment:

• slow down progression of bronchitis

8. The most common causative agent of hospital acquired pneumonia is:

• klebsiella

9. Cor pulmonale associated with:

• hypertrophy and dilation of the right heart chambers

10. Which of the following is most effective for the treatment of chronic cor pulmonale

• oxygen therapy

11. Which of the following additional methods of examination is the most reliable for establishing the diagnosis of pneumonia?

• radiological examination

12. What objective study is used to determine the severity of chronic obstructive bronchitis?

• spirometry

13. What local features of percussion sound are typical for pneumonia

• dullness of percussion sound

14. What is the most effective method of slowing the progression of COPD?

• smoking cessation

15. The drugs of choice for empiric therapy in patients with community-acquired pneumonia are:

• amoxicillin, azithromycin

16. According to the International Consensus, the following gradations have been introduced into the classification of pneumonia:

• community acquired pneumonia, hospital acquired pneumonia, in immunocompromised patients, aspirational

17. To identify the type of acute leukemia, you must perform:

• sternal puncture

18. Treatment for chronic lymphocytic leukemia is determined by:

• stage of disease and clinical form

19. The most characteristic clinical manifestation of hemophilia:

• nasal bleedings

20. In the differential diagnosis of hypoplastic anemia and immune thrombocytopenia, the main study is:

• trephine biopsy

21. Autoimmune hemolytic anemia develops due to:

• production of antibodies against altered erythrocyte antigens

22. Megaloblastic type of hematopoiesis, increased levels of ferritin in the blood, neurological symptoms are characteristic of

• B12- deficiency anemia

23. Acute onset, jaundice, splenomegaly, reticulocytosis is characteristic of

• Autoimmune hemolytic anemia

24. Hypochromic anemia, a decrease level of ferritin in the blood serum, hyperplasia of the erythroid germ are characteristic of

• iron deficiency anemia

25. A 57 years old patient complains of shortness of breath, cough with sputum in the morning. On x-ray: hyperinflation, flattened diaphragm, increased retrosternal space, and hypovascularity of lung parenchyma. What pathology should the doctor think about:

• COPD

26. A 56 years old patient has been suffering from COPD for 10 years and works as a road builder. What tests should be ordered to determine the severity of COPD:

• Respiratory function testing

27. A 22 years old patient complained on fever up to 39°C, cough with a small amount of yellow sputum, general weakness. Objectively, he had a moderate severity condition, respiratory rate is 21 per minute, dullness to percussion and decreased breath sounds below the angle of the right scapula. What is your preliminary diagnosis:

• Pneumonia in the lower lobe of the right lung

28. Patient D., 52 years old, complains of cough with mucopurulent sputum, dyspnea on slight physical exertion. Past medical history: smoker, cough for 15 years, he is under follow up a general practitioner, last worsening within a week. Objectively: breathing with prolonged expiration, scattered rhonchi and wheezing on auscultation. Your clinical diagnosis:

• Chronic obstructive pulmonary disease

29. A 66 years old man has been suffering from COPD for 10 years and works as a road worker. What tests should be ordered to determine the severity of COPD:

• Respiratory function testing

30. A 63 years old man complains of cough with a small amount of mucous sputum. He has been suffering for many years, for the last few months he has had a prolonged cough, dyspnea on climbing up to the third floor and walking quickly. Objectively: breathing with prolonged expiration, scattered rhonchi. What preliminary diagnosis is more likely:

• COPD

31. A 32 years old women has occasional episodes of expiratory dyspnea, less than once a week, for which she uses ventolin inhalation. During the attack wheezing are heard in the lungs. On examination the FEV1 is 83% of normal. What is the most likely diagnosis:

• Mild asthma

32. A woman complained of fever up to 38.7°C, cough with a small amount of mucopurulent sputum, general weakness. Objectively: moderate severity, respiratory rate is 22 per minute, dullness to percussion and decreased breath sounds below the angle of the left scapula. What is your preliminary diagnosis:

• Pneumonia in lower lobe of left lung

33. On computed tomography: bilateral fibrosis and bilateral ‘ground glass' changes are most common in:

• Fibrosing alveolitis

34. What disease is characterized by acute course, breath weakening, wheezing on auscultation, medium-intensity infiltrative shadows in the lungs, positive dynamics with treatment:

• Lobular pneumonia

35. A 67 years old man complains on severe dyspnea, little cough with a small amount of mucous sputum. On examination: patient is very thin with a barrel chest. Breathing is assisted by pursed lips and use of accessory respiratory muscles. On auscultation there is weakened breathing, wheezing are heard. What is your preliminary diagnosis?

• Emphysema

36. A 54 years old man has repeated pneumonia in the same right segment over the course of a year. He has been a smoker for many years. He suffers from fatigue, weakness, coughing, weight loss, sometimes streaks of blood in the sputum. What is your preliminary diagnosis?

• Right lung cancer

37. Patient complains on cough with a small amount of colorless sputum, dyspnea with moderate exertion. Сough usually worsens in the mornings. He is smoker for over 25 years. He has been coughing for many years, last worsening within a week. On examination: breath with prolonged expiration, scattered rhonchi. What is your diagnosis?

• COPD, exacerbation

38. Patient 33 years old, complains on wheeze, shortness of breath, chest tightness and cough up to 3 times a month, symptoms are worsens at night not more than 2 times a month. He has had asthma for several years. Define the degree of asthma:

• Mild asthma

39. A 58-year-old patient complains of cough with sputum in the morning, shortness of breath. On the X-ray: the lungs are hyper lucent, intercostal spaces are enlarged, flattening of the diaphragm. What kind of pathology should the doctor think about?

• emphysema

40. A 36-year-old woman, smoked for 11 years, BMI 32 kg/m2, has been taking oral contraceptives for more than 2 years. She fell ill acutely, complains of shortness of breath, fever up to 37.5°C, cough with blood-streaked sputum, weakness, pain in the left half of the chest. Preliminary diagnosis?

• PE (pulmonary embolism)

41. A man visited a GP with complaints of sudden onset of shortness of breath, chest pain, tachycardia, hemoptysis, and pleural rub. First of all, the doctor should suspect in the patient:

• pulmonary embolism

42. A 44-year-old man came to a family doctor with complaints of cough with mucus sputum that occurs periodically. He has been sick for several years, for the last 4 months the cough has become more prolonged, shortness of breath has appeared when climbing to the 3rd floor and walking fast. Smoker's index 25. Objectively: breathing with prolonged exhalation, scattered single dry rales. What is your preliminary diagnosis?

• Chronic obstructive pulmonary disease

43. Patient X., 61 years old, complains of cough with mucopurulent sputum that is difficult to cough out, shortness of breath, aggravated by physical exertion, fever up to 38°C. He fell ill acutely, after hypothermia. Smoker for many years, 1 pack a day. Auscultatory: the breathing is weak with prolonged exhalation, scattered dry rales are heard on both sides, on the left in the subscapular region - moist finely bubbling rales, there is also dullness of percussion sound. X-ray: in the lower lobe of the left lung - infiltrative shadow. Leukocytes–15*109/l, ESR-22mm/h. Which of the following diagnoses is most likely?

• COPD, moderate severity, exacerbation. Pneumonia in the lower lobe of the left lung

44. A 23-year-old girl, sometimes has attacks of expiratory gasp, less than once a week, for which she uses salbutamol inhalations to stop them. During an attack, dry whistling rales are heard in the lungs. On examination: between asthma attacks, FEV1 was 80-85% of the predicted value. What is the most likely diagnosis?

• asthma, light intermittent

45. Patient P., aged 65, complains of a persistent cough with sputum with an unpleasant odor, especially in the morning, shortness of breath on moderate exertion, and weakness. On auscultation: moist rales on both sides. These symptoms are typical for

• bronchiectasis

46. A 55-year-old woman lost consciousness on the street and was taken by an ambulance to the hospital. Objectively: tachycardia 123 beats per minute, severe hypotension. Plain X-ray of the lungs: total darkening of the right lung. What complication of pneumonia should be considered in the first place:

• infectious-toxic shock

47. During an outpatient visit, a 19-year-old student complains of attacks of dry cough, "whistling in the chest", subfebrile temperature, sweating. She fell ill a few days ago, was not treated, this was not observed before. Percussion: clear pulmonary sound, hard breathing, scattered few dry rales on both sides. The sputum could not be collected. X-ray of the lungs without abnormalities. What disease can a GP think of?

• acute bronchitis

48. A 23-year-old patient complained of fever up to 39°C, cough with a small amount of viscous yellowish sputum, and general weakness. Objectively: the state of moderate severity, respiratory rate 22 per minute, increased voice trembling and dullness of percussion sound below the angle of the right scapular angle. Preliminary diagnosis?

• focal pneumonia in the lower lobe of the right lung

49. Which disease for is more typical: acute course, moist rales on auscultation, infiltrative shadows of medium intensity in the lower parts of the lungs on the X-ray, rapid positive dynamics during treatment

• focal pneumonia

50. Woman A., 37 years old, suffers from asthma for 5 years. Gasp attacks are stopped by berodual. Peak expiratory flow rate is 66%. At the time of examination - shortness of breath at rest, during auscultation - whistling dry rales in all lung fields. The patient used the berodual inhaler three times in the last hour. What tactics of management is most favorable in this situation?

• prednisolone 60 mg IV drip

51. A 53-year-old patient has febrile fever with severe intoxication syndrome, myalgia, arthralgia, cough, abdominal pain, and diarrhea. Often goes on business trips, stays in hotels, boarding houses, where there are air conditioners, showers. CBC: leukocytosis with lymphocytopenia, ESR 50 mm/hour. What type of pneumonia are these signs typical of?

• legionella

52. Patient E., 46 years old. Complaints: temperature increase up to 39oC, chills, stabbing pains in the left chest, dry cough. During the act of breathing, the left half of the chest lags behind. Heart rate 102 bpm per minute, BP 120/60 mm Hg. On the chest X-ray - a homogeneous darkening with an oblique upper line on the left, the mediastinal organs are displaced to the right. What is the diagnosis?

• exudative pleurisy

53. A 43-year-old patient was admitted to the orthopedic department because of an injury. The examination revealed: an increase in axillary lymph nodes up to the size of a pea. CBC: Hb-107 g/l., erythrocytes - 3.4x1012/l, platelets - 172x109 / l, leukocytes - 45.8x109/l, segmented neutrophils-5%, prolymphocytes - 3%, monocytes - 2%, lymphocytes -90%. Which of the diagnoses is the most likely?

• chronic lymphocytic leukemia

54. A 19-year-old patient complains of multiple hemorrhages on the body, nasal bleedings. From the anamnesis: fell ill after the flu. Objectively: there are multiple bruises on the skin, with different shades, peripheral lymph nodes are not enlarged, the liver and spleen are within normal limits. CBC: Hb-122 g / l., erythrocytes - 4.1x1012 / l, platelets - 20x109 / l, leukocytes - 6.8x109 / l. Which of the diagnoses is the most likely?

• immune thrombocytopenic purpura

55. A 40-year-old patient complains of dizziness, fatigue, shortness of breath, paresthesia in the extremities and a tendency to diarrhea. On examination, the skin is yellowish in color, smoothness of the papillae of the tongue, signs of glossitis. The patient underwent gastrectomy 3 years ago. Hyperchromic anemia is noted. Puncture of the bone marrow: megaloblastic type of hematopoiesis. An increase in the level of ferritin in the blood was revealed. What is the preliminary diagnosis?

• B12 deficiency anemia

56. A 23-year-old patient has visited a family doctor with complaints of pain in the ankle joints, subfebrile temperature, symmetrical hemorrhagic rashes on the skin of the lower leg and hips. From the anamnesis: she fell ill for the first time, a week ago she had flu. Your preliminary diagnosis:

• Scheinlein-Henoch disease

57. Patient Y., 29 years old, changes revealed in the CBC: leukocytes 78x109/l; leukocyte formula: promyelocytes-3%, myelocytes-8%, metamyelocytes-12%, stab neutrophils-21%, segmented neutrophils-41%, basophils-3%, eosinophils-6%, lymphocytes-6%. Platelets - 784x109 / l, hemoglobin - 114 g / l., hypercellular bone marrow, the content of myelokaryocytes and megakaryocytes is increased, all elements of the granulocytic series are determined. Diagnosis:

• chronic stable phase of chronic myelogenous leukemia

58. For a patient with hypochromic microcytic anemia and chronic enteritis, the prescribed oral sorbifer has no effect. Tactics of the doctor in this case:

• prescribe parenteral iron medications

59. In whish disease can the following symptoms occur: burning sense in the tongue, dyspeptic disorders (decreased appetite, nausea), impaired well-being, numbness and paresthesia of the extremities, the appearance of neurological symptoms:

• Vitamin B-12 deficiency anemia

60. Patient L., 31 years old, came to the clinic at the place of residence with complaints of weakness, sweating, stomatitis. From the anamnesis: sick for 3 weeks, treatment without effect. The skin is pale, moist. Objectively: body temperature is 38.8°C, gingival hyperplasia, ulcerative necrotic stomatitis. Submandibular lymph nodes are enlarged, painless. In the blood: RBC.-2.9x1012/l, Hb-94g/l, CI-0.95, leukocytes-13.5x109/l, blasts-32%, stab neutrophils-1%, segm-39%, lymph -20%, mon-8%, platelets-90.0x109/l. ESR-24 mm/h. Cytochemical study: the reaction to peroxidase is positive. Your diagnosis:

• acute myeloid leukemia

61. A 40-year-old man complains of general weakness, sweating, weight loss, dull pain in the left hypochondrium. Objectively: the skin is pale, moist. Lymph nodes are not enlarged. The liver protrudes from under the costal margin by 3 cm, the spleen is at the level of the navel, dense, painless. CBC: RBC-3.0x1012/l, leukocytes-94x109/l, myeloblasts-2%, promyelocytes-4%, metamyelocytes-8%, stab neu-12%, segment.neu-52%, eosin.-5%, basof -5%, lymph.-12%, platelets-200.0x109/l. ESR-53 mm/h. Treatment of this condition is carried out under the control of the level:

• leukocytes

62. A 23-year-old girl suffers from menorrhagia for a long time. Hemoglobin-79 g / l, CI-0.69, leukocytes 3.8x109 / l, formula without changes, serum iron 5.2 mmol / l. What is the proposed treatment?

• sorbifer Durules in tablets

63. Neurological symptoms in the form of funicular myelosis, gastroenterological symptoms, pernicious, hyperchromic anemia and megalocytosis in the peripheral blood are characteristic of:

• B12 deficiency anemia

64. Patient P., 65 years old, was admitted with complaints of epistaxis and weakness. In the blood: total protein 100 g/l, M-gradient is determined. The craniogram showed no changes in the bones of the skull. In the myelogram: plasma cells - 5%. Presumptive diagnosis:

• multiple myeloma

65. Patient A., aged 54, a livestock specialist by profession, was admitted with severe splenomegaly. In CBC: RBC-3.1x1012/l; Hb-95 g / l, CI-0.9, leukocytes 124x109 / l, promyelocytes - 12%, myelocytes - 10%, stab neu - 12%, segm neut - 32%, lymph. – 19%, basophils – 7%, eosinophils – 8%. ESR–42 mm/h. Reactions of Wright and Heddelson are negative. Your diagnosis:

• chronic myeloid leukemia

66. Patient Zh., aged 20, complains of fever, periodic epistaxis, gingival bleeding, weakness, shortness of breath. Objectively: the patient is in a serious condition, the skin is pale, there are bruises all over the body, the peripheral lymph nodes are not enlarged. The rest of the organs are unremarkable. CBC: Hb-60 g/l; RBC 2.0x1012/l; CI-0.9; WBC - 1.5x109 / l; platelets 20х109/l. In the myelogram: the ratio of fatty bone marrow to the effective 90%: 10% in favor of fat. What is the most likely diagnosis?

• aplastic anemia

The patient complains of an increase in body temperature up to 390C, fatigue, palpitations, shortness of breath during exercise. The skin is pale, the edge of the liver is palpable, the spleen is enlarged, dense. In analyses: Hb-95g/l; CI 0.92; WBC -52x109/l, shift of the leukocyte formula to the left to promyelocytes, myelocytes and myeloblasts, ESR 78 mm/h. What is the preliminary diagnosis?

• chronic myeloid leukemia

68. The patient complains of dizziness, constant fatigue, shortness of breath, paresthesia in the limbs and a tendency to diarrhea. Objectively: the skin is yellowish in color, smoothness of the papillae of the tongue, signs of glossitis. A few years ago, a gastrectomy was performed. Hyperchromic anemia is noted. Puncture of the bone marrow: megaloblastic type of hematopoiesis. An increase in the level of ferritin in the blood was revealed. Determine the diagnosis?

• B12 deficiency anemia

70. A 43 years old patient complains on a persistent, mornings, cough with a small amount of colorless sputum, dyspnea on exertion. Past medical history: smoker for over 20 years. Objectively: tachypnea, barrel-shaped chest, use of accessory respiratory muscles and paradoxical indrawing of lower intercostal spaces. Vocal trembling is attenuated on both sides. Hyperresonance on percussion. Prolonged expiration. Coarse crackles. What examination has the greatest diagnostic value in this disease:

• Spirometry

71. A 33 years old patient had a local dullness in the lower lobe of the right lung during a physical examination. The medical history revealed that the patient had recently experienced weakness, cough with mucous sputum, tingling in the chest on the right side. Complete blood count: Hb - 128 g/l, WBC - 9.8x109/l, ESR - 21 mm/hour. Choose the most informative method for differential diagnosis between pneumonia and lung cancer:

• CT (computer tomography)

72. What pneumonia is characterized by anamnesis - use of air conditioning, showers in hotels; febrile fever with marked intoxication, myalgia, arthralgia, cough, abdominal pain, diarrhea; blood test - leukocytosis with lymphocytopenia, ESR - 50 mm/hour:

• Legionella

A 65-year-old patient with COPD has increased dyspnea, cough, increased volume of yellow-green sputum, subfebrile body temperature. Objectively: pulse rate-28, heart rate-92. On auscultation: the lung breathing is rigid, dry whistling rales are heard. Which of the following drugs should be prescribed in this case?

• amoxicillin per os

75. Male, 28 years old. Complaints of weakness, malaise, fatigue, weight loss, coughing, night sweats. He has been ill for the last 2-3 months and very often works night shifts. On fluorogram: an infiltrative shadow in the upper lobe of the right lung with a pathway to the root. Your tactic:

• refer for sputum analysis for Mycobacterium tuberculosis.

• A 49-year-old patient complains of weakness, dizziness, decreased appetite, weight loss, sweating, prolonged (about 1.5 months) non-productive cough. On examination: relatively satisfactory condition. The skin was grayish, pale and moist. Breathing is rigid, and wet wheezing are heard in the upper parts of the left lung. The doctor's diagnostic tactic:

• lung radiography

78. Patient, 60 years old with a CBC: Hb-78g/l; color index-1.3; erythrocytes-2.3x1012/l; macrocytosis. Past medical history: suffers from chronic gastric and intestinal disease for a long time. What treatment should be administered to a patient with this disease?

• cyanocobalamin injections on a regular basis

79. A 24-year-old patient presents with a fever of up to 40°C, headache and pain in the throat when swallowing. He had an acute illness 3 days ago. On the first examination: hyperemia of the pharynx, enlarged submandibular lymph nodes. Examination: CBC- Hb 90 mmol/l, erythrocytes 2.2×1012/l, Leucocytes-2.3×109/l, ESR-45 mm/h. Myelogram: blast cells 65%. Your preliminary diagnosis and further tactic:

• patient has acute leukaemia, as the bone marrow shows blastosis.

80. A 25-year-old woman has come a general practitioner with the diagnosis: Repeated pregnancy 10-11 weeks, moderate degree of iron deficiency anaemia. Treatment tactics for identified iron deficiency anaemia:

• before delivery and during the whole lactation period, per os intake of iron preparations

82. A 54-year-old patient presenting with cough, shortness of breath 3-4 times a week, nocturnal attacks up to once a week. Smoker's index is 20. Spirography revealed forced expiratory volume1-58%, after inhalation of salbutamol the airway improved by 10%. What diagnosis has the patient been given by the doctor?

• chronic obstructive pulmonary disease of moderate severity

83. A 36-year-old patient is seen by a doctor in a rural outpatient clinic. He has been on the registry for 7 years with a diagnosis of chronic enteritis. He complains of weakness, dizziness, sometimes pains near the navel and in the epigastrium, sore throat, irregular stools. On examination in general blood analysis Hb - 110g/l, er - 3.8×1012, microcytosis, anisocytosis. Diagnose the patient and decide on further treatment tactics:

• intermediate iron deficiency anaemia, chronic enteritis, administer parenteral iron supplements

84. Patient T., 65 years old, has been suffering from asthma for several years, complains of persistent cough, shortness of breath, and frequent attacks of gasps at night. On examination: PEF - 55%, FEV1 - 50%. Specify the severity of this clinical picture:

• 3rd level of asthma

85. Patient I., 57 years old, economist. He is under the follow up with a diagnosis of coronary artery disease: Angina pectoris FC 2, CHF (NYHA 1). At the GP’s appointment, community-acquired focal pneumonia was diagnosed, mild of severity. Determine the doctor's tactics for the treatment of this patient:

• treatment in a day time clinic

86. In progressive angina pectoris usually seen:

• Increased frequency and duration of chest pain

87. The main sign of transmural myocardial infarction on the ECG is:

• The appearance of a QS complex in two or more leads

88. Choose the optimal complex of drugs for the treatment of chronic heart failure stage II NYHA:

• β-blockers and glycosides

89. The most effective drug for the treatment of ventricular paroxysmal tachycardia is:

• Verapamil

90. The most common complication in the first hours of acute myocardial infarction is:

• Rhythm disorder

91. A contraindication for the prescribing of ACE inhibitors is:

• Pregnancy

92. What drug from the followings can cause dry cough?

• Captopril

93. A patient was admitted for the treatment with complaints of dull, pressing pains in the chest. Woke up with pain, a few hours after sleep. From the anamnesis: The attacks are usually in the form of a series, alternating one after another for 10-15 minutes. The ECG shows an elevation of the ST segment during the attack. What is your most likely diagnosis?

• Prinzemetal’s angina

94. Patient M., 20 years old, complains of stitching pain in the heart area, palpitations, weakness, malaise. From the anamnesis: 3 weeks ago he had the flu. On physical examination, the heart borders are expanded to the left, a systolic murmur is heard over the entire heart area, without irradiation, heart rate is 90 beats per minute. Temperature 37.70C. A laboratory study reveals leukocytosis, increased ESR, C-reactive protein (+). On the ECG: repolarization abnormality and slowing of intraventricular conduction. Indicate the most likely diagnosis

• Myocarditis

97. A 58-year-old woman, after intensive work in the garden, felt severe pressing chest pain, irradiating in her left shoulder, shortness of breath, weakness, sweating. She took nitroglycerin twice, but her condition did not improve. Examination: agitated, scared, the skin is pale, moist. Heart sounds are muffled, arrhythmia, blood pressure 145/75 mm Hg, heart rate 90 per minute. Likely diagnosis:

• Acute myocardial infarction

98. A patient with cardiac arrhythmias has the following symptoms: short-term loss of consciousness after tachybradycardia, absence of breathing, pulse, pressure, pallor of the skin, convulsions, involuntary urination and defecation, rapid self-recovery to the initial health condition. What is the reason for these symptoms?

• Adams–Stokes syndrome

99. A patient with arterial hypertension with concomitant bronchial asthma should be prescribed an antihypertensive drug. Which of the proposed drugs is contraindicated in this situation?

• Anaprilin

100. The choice of which antianginal drug is preferable if the patient has concomitant COPD?

• Calcium channel blockers

101. A 55-year-old patient is complaining for the right shoulder pain, previously provoked by brisk walking, disappearing in rest, today arose after dinner and continued for 20 minutes. For which of the following conditions the pain is typical?

• Acute myocardial infarction

102. Patient K., 68 years old, who had an acute myocardial infarction 2 months ago, complains on chest pain on the left side, on auscultation- weakening of breath sounds on left side, fever, pericardial friction noise, increased ESR. ECG dynamics were unremarkable. Your conclusion:

• Dressler syndrome

103. A patient was admitted for the treatment with complaints of dull, pressing pain in the chest. Woke up with pain, a few hours after sleep. From the anamnesis: The attacks are usually in the form of a series, alternating one after another for 10-15 minutes. The ECG shows an elevation of the ST segment during the attack. What is your most likely diagnosis?

• Prinzmetal’s angina

104. A 47-year-old patient had pain in the lower part of the sternum 2 weeks ago when he run to the 4th floor, Stopped in rest. Such pains appeared for the first time. Later, such pains began to appear when walking fast, going up the 2nd floor. Determine the form of angina pectoris. Choose your tactics:

• Ischemic heart disease. First-onset angina pectoris. Send for hospitalization, prescribe antianginal therapy

105. Patient N., 67 years old, suffers from high blood pressure for 10 years, smokes for 15 years, suffers from type 2 diabetes mellitus for 4 years, takes glucophage 850 mg per day. Body mass index 29, cholesterol level 5.9 mmol / L. ECG: signs of left ventricular hypertrophy. During the examination, the blood pressure was 190/110 mm Hg. Your diagnosis:

• HTN 3. Very high risk

100

106. Patient M., 63 years old, complains of periodic sudden attacks of severe dizziness with loss of consciousness, which appeared after infectious myocarditis 3 years ago. Recently, there has been an increase in relapses up to 2-3 times a month. BP 110/70 mm Hg, heart rate 57 beats per minute. ECG: lengthening of the PQ interval duration, regular Wenckebach periods. What treatment is most optimal for a given patient?

• Heart pacemaker implantation

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