internal state 2
問題一覧
1
Accumulation of blasts in extramedullary lesions (eg, bones, central nervous system, lymph nodes, skin), blast counts in blood or bone marrow ≥ 20% in
Blast crisis in CML
2
Hyperplastic syndrome in acute leukemia includes
infiltration of organs and tissues by tumor cells
3
Intoxication syndrome in acute leukemia includes
Fever, pain, lethargy, sweating
4
Hemorrhagic syndrome in acute leukemia includes
Various kinds of hemorrhage
5
Immunodeficiency syndrome in acute leukemia includes
Decrease in the level of neutrophils, which is manifested by the development of infectious processes
6
The first step in the ACS diagnostic algorithm is
Collection of anamnesis and complaints
7
When the diagnosis of ACS is unlikely?
Trends of troponin levels are normal
8
It is less likely to confuse chest pain in ACS with the following condition
rib fracture
9
Which characteristic of chest pain is most consistent with exertional angina
Pain caused by exercise
10
What type of medications is not first line therapy in patients with coronary heart disease and hypertension
Metabolic drugs
11
The presence of typical chest pain corresponding to angina pectoris FC 3, reduced effectiveness of antianginal therapy, the presence of episodes of ST segment depression during daily ECG monitoring is an indication for
Elective coronary angiography
12
Target LDL-C for patients after myocardial revascularization
Less than 1.4 mmol/L
13
The main mechanism for the development of ACS is
Destabilization of atherosclerotic plaque
14
At the appointment, the patient, a man, 48 years old, smoking experience 20 years. BMI 31 kg/m2. Levels of total cholesterol 5.6 mmol/l, LDL cholesterol-4.0 mmol/l. In the last month, he notes an increase in blood pressure to 160/90 mm Hg. associated with stress at work. Estimate the level of total cardiovascular risk
High
15
At the appointment, the patient, a man, 48 years old, smoking experience 20 years. BMI 31 kg/m2. Levels of total cholesterol 5.6 mmol/l, LDL cholesterol-4.0 mmol/l. In the last month, he notes an increase in blood pressure to 160/90 mm Hg. associated with stress at work. Doctor's tactics:
Recommendations for lifestyle modification + pharmacological treatment
16
Prescribe the optimal pharmacological treatment for a 60-year-old patient with arterial hypertension of the 3rd degree, a history of coronary artery disease, gout:
ACE inhibitors/ARBs, beta-blockers, Calcium channel blockers, statins, ASAs
17
ESCardio recommends that most hypertensive patients should start treatment with
ACE inhibitor/ARB +Calcium channel blockers or diuretic
18
The SECURE study investigated a secondary prevention treatment
strategy using a polypill (combination tablet) containing
Aspirin, ramipril and atorvastatin
19
At the appointment, a patient with arterial hypertension, high pulse pressure, diastolic murmur in the projection of the aortic valve. Laboratory tests normal. On the ECG, a double-humped p wave, high-voltage R waves in V5, V6.
Echocardiography
20
Choose the optimal combination for the treatment of resistant hypertension according to the ESCardio recommendations:
ACE inhibitor/ARB+Calcium channel blockers + diuretic+spironolactone or B-blocker
21
Prescribe the optimal pharmacological treatment for a 35-year-old patient with grade 1 arterial hypertension, with one risk factor:
ACE inhibitor/ARB monotherapy
22
In a patient with a persistent form of atrial fibrillation, taking warfarin at a dose of 2.5 mg (1 tablet), the INR when measured is 2.5. Doctor's tactics:
Continue same dosage
23
In a 20-year-old patient, during an annual screening examination and ECG recording, a single premature atrial contraction was registered, he does not have complaints. Doctor tactics:
In most of cases, premature atrial contractions do not require special treatment
24
With the progression of atrioventricular block in a patient with an existing AV block of the 2nd degree, it is possible to develop
Complete heart block
25
When examining young patients with rhythm disturbances, firstly necessary to exclude:
Thyroid disease
26
During a screening preventive examination of a young athlete, 1st degree AV block was detected on the ECG. Doctor's tactics:
Does not require further examination
27
With long-term use of the antiarrhythmic drug amiodarone, it is necessary to monitor
Thyroid hormones
28
CHF with low EF corresponds to
LV EF less than 40%
29
CHF with preserved EF corresponds to
LV EF more than 50%
30
Paroxysmal nocturnal dyspnea (PND) is most commonly associated with…:
Chronic heart failure
31
Chronic heart failure (CHF) is most commonly associated with…:
Left ventricle dilation
32
Bendopnea is
appearance of shortness of breath when bending forward
33
III class CHF (NYHA classification) matches with the following distance in 6 min walking test
301-425 m
34
One of the objective signs of heart dysfunction in CHF is cardiomegaly, while the cardiothoracic index is
More than 50%
35
One of the goals of treatment for terminal stage of CHF is
<variant> Preparation for myocardial revascularization
Improve quality of life
36
The indication for heart transplantation in CHF is
CHF III-IV FC, with LV EF less than 30%, OMT ineffectiveness within 3 months
37
A 60-year-old man has his appointment with GP with complaints on SoB, pitting edema. Patient and family history: Q wave-MI 2 years ago, smoker for a 20years, T2DM, mother has diabetes, father died from myocardial infarction at age 54. On physical examination his BMI=31 kg/m2. Measured BP 150/90 mm Hg, HR100 bpm, peripheral edema. Skin is pale. On ECG -signs of LVH. Choose most appropriate cause of his complaints:
CHF
38
A 26-month-old boy who presented with neutropenia associated with anemia and thrombocytopenia. There was no history of any hematological disorder. On examination: the patient had pallor and splenic enlargement. Physical examination was otherwise unremarkable. The patient had been suffering from recurrent febrile episodes and nocturnal sweats with weakness and fatigue. Peripheral blood smear examination showed normocytic normochromic red blood cells including few nucleated red blood cells, white blood cells showed left, shift with significant number of blasts. The leukocyte differential count was eosinophils 5%, lymphocytes 62%, and neutrophils 31% and band forms 1%. Bone marrow aspiration and biopsy showed increased abnormal megakaryocytic, Monolobated and multinucleated megakaryocytic with hyper chromatic and pleomorphic nuclei were seen and showed the leukemic cells were positive for CD13, CD33, CD42. What is the diagnosis?
Acute lymphocytic leukemia
39
A 26-month-old boy who presented with neutropenia associated with anemia and thrombocytopenia. There was no history of any hematological disorder. On examination: the patient had pallor and splenic enlargement. Physical examination was otherwise unremarkable. The patient had been suffering from recurrent febrile episodes and nocturnal sweats with weakness and fatigue. Peripheral blood smear examination was done. What is the next step in diagnosing?
Bone marrow aspiration and biopsy
40
A 70-year-old man presented to his primary care physician with 2 months of fatigue and 10-kg weight loss. He noted a general sense of malaise and feeling poor. On physical examination, the clinician was able to palpate the spleen 4 cm below the costal margin (splenomegaly) but noted no palpable lymphadenopathy. Family history was noncontributory. CBC: WBC-39 180 /cmm, RBC- 4.37 M/cmm, Hemoglobin-13 g/dL, HCT 40%, MCV 92 fL, MCH 29.7 pg, MCHC 32.5 g/dL, RDW-CV-13.1%, PLT-216,000/cmm. Automated Differential Count: Neutrophils-67%, Bands-9%, Lymphocytes-7%, Monocytes 2%, Eosinophils-3%, Basophils-4%, Metamyelocytes-5%, Myelocytes-3%. Make the preliminary diagnosis
Chronic Myeloid Leukemia
41
A patient who had a myocardial infarction a year ago applied for an appointment, at the same time an emergency PCI was performed, followed by stenting of the LAD. During the year there were no angina pectoris, he feels well, he receives basic therapy (bisoprolol 2.5 mg, acetylsalicylic acid 75 mg, clopidogrel 75 mg, atorvastatin 10 mg, lisinopril 2.5 mg) came to the dispensary examination. In the analyzes: blood glucose-4.9 mmol/l, blood creatinine-68 µmol/l, total cholesterol-5.5 mmol/l, LDL cholesterol-2.6 mmol/l. Coagulogram within normal limits. Doctor’s tactics:
Stop clopidogrel, increase statin dose
42
In a patient with chronic coronary artery disease, angina attacks became more frequent regardless therapy. Patient also complaints on knees pain for which the patient constantly takes ibuprofen. Choose the correct doctor's tactics:
Refer the patient for a consultation with a rheumatologist to select the therapy for osteoarthritis, optimize the medical treatment of coronary artery disease, and if ineffective, refer the patient to a planned coronary angiography
43
A 36-year-old male patient came to the appointment for a preventive examination. In the family history, the father has early coronary artery disease (under the age of 55 years). Smokes electronic cigarettes, works in a bank, travels mainly by car, BMI 29 kg/m2. Laboratory and instrumental examinations without pathology. Doctor's tactics:
Give advice on lifestyle changes – quit smoking, increase physical activity, reduce body weight, get enough sleep, avoid stress
44
A 58-year-old woman came to the appointment with complaints of ankle edema, no other complaints. From the anamnesis it is known that she is hypertensive, receives basic therapy, does not remember the name. Physical examination: BP 125/75 mm Hg. Heart rate 68 beats per minute. Heart sounds are normal, regular. ECG normal. Echocardiogram showed normal ejection fraction, global and local myocardial contractility is normal, heart chambers are not dilated, valves are intact. Which medication is most likely associated with ankle edema in this patient?
Amlodipine
45
A 58-year-old woman visit her doctor with complaints of dry cough, no other complaints. From the anamnesis it is known that she is hypertensive, takes constant basic therapy, does not remember the name. Physical examination: BP 125/75 mm Hg. Heart rate 68 beats per minute. Heart sounds are normal, rhythmic. Vesicular breathing in the lungs. ECG without features. X-ray of the lungs without pathology. Spirometry showed no abnormalities. Which drug is most likely associated with cough in this patient?
Lisinopril
46
A 58-year-old woman came to the doctor with complaints of pain in the knee joints. From the anamnesis it is known that she is hypertensive, takes constant basic therapy: lisinopril, hydrochlorothiazide, amlodipine, atorvastatin, bisoprolol. In laboratory data, the level of uric acid is increased (510 µmol/l). Which drug of the named should be discontinued?
Hydrochlorothiazide
47
A 52-year-old man came to the doctor with complaints of a feeling of interruptions, "fading" in the heart area. Previously, according to the words, he suffered from rhythm disturbance, he does not receive basic therapy. Last year, he suffered an ischemic stroke, with transient left-sided hemiparesis. The doctor ordered an ECG. What pathology is more likely to be diagnosed in a patient?
Atrial fibrillation
48
A 52-year-old man came to the doctor with complaints of a feeling of interruptions, "fading" in the heart area. Previously, he had rhythm disorder, he does not receive basic therapy. Last year, he suffered an ischemic stroke, with transient left-sided hemiparesis. Select the optimal list of pharmacological therapy, taking into account the most likely diagnosis and patient history:
Beta blockers, ACE inhibitors, oral anticoagulants
49
A patient with a permanent form of atrial fibrillation came to the appointment. The patient takes basic therapy. Recently, episodes of nosebleeds have become more frequent. What medication is this complication associated with?
Warfarine
50
A 52-year-old man came to the doctor with complaints of a feeling of interruptions, "fading" in the heart area. Previously, according to the words, he suffered from rhythm disturbance, he does not receive basic therapy. Last year, he suffered an ischemic stroke, with transient left-sided hemiparesis. The doctor ordered an ECG. What pathology is more likely to be diagnosed in a patient?
Atrial fibrillation
51
A 52-year-old man came to the doctor with complaints of a feeling of interruptions, "fading" in the heart area. Previously, he had rhythm disorder, he does not receive basic therapy. Last year, he suffered an ischemic stroke, with transient left-sided hemiparesis. Select the optimal list of pharmacological therapy, taking into account the most likely diagnosis and patient history:
Beta blockers, ACE inhibitors, oral anticoagulants
52
A patient with a permanent form of atrial fibrillation came to the appointment. The patient takes basic therapy. Recently, episodes of nosebleeds have become more frequent. What medication is this complication associated with?
Warfarine
53
A 60-year-old man has his appointment with GP with complaints on SoB, pitting edema. Patient and family history: Q wave-MI 2 years ago, smoker for a 20years, T2DM, mother has diabetes, father died from myocardial infarction at age 54. On physical examination his BMI=31 kg/m2. Measured BP 150/90 mm Hg, HR100 bpm, peripheral edema. Skin is pale. On ECG -signs of LVH. Choose most appropriate cause of his complaints:
CHF
54
A 60-year-old man has his appointment with GP with complaints on SoB, pitting edema. Patient and family history: Q wave-MI 2 years ago, smoker for a 20years, T2DM, mother has diabetes, father died from myocardial infarction at age 54. On physical examination his BMI=31 kg/m2. Measured BP 150/90 mm Hg, HR100 bpm, peripheral edema. RR 21, Skin is pale. On ECG -signs of LVH. His BNP level is 600 pg/mL. On TTE- LV EF is 42%. Choose most appropriate drugs combination for this patient:
b-blockers+SGLTi+sakubitril/valsartan+loop diuretic
55
A 60-year-old man has his appointment with GP with complaints on SoB, pitting edema. Patient and family history: Q wave-MI 2 years ago, smoker for a 20years, T2DM, mother has diabetes, father died from myocardial infarction at age 54. On physical examination his BMI=31 kg/m2. Measured BP 150/90 mm Hg, HR100 bpm, peripheral edema. Skin is pale. On ECG -signs of LVH. Choose next step in patient management:
TTE and BNP/pro-BNP level
56
The three main symptoms of acute pyelonephritis are:
fever, low back pain, urinary changes
57
Inflammatory diseases of the urogenital system leading to chronic renal failure:
chronic pyelonephritis
58
The most characteristic changes in the blood in chronic renal failure:
progressive azotemia
59
The main focus of the chronic renal failure diet:
a low-protein diet
60
Method of treating end-stage chronic renal failure
hemodialysis
61
An exacerbation of chronic glomerulonephritis is characterised by:
Increased edema, proteinuria and hematuria
62
The morphological variant of chronic glomerulonephritis can be determined reliably:
renal puncture biopsy
63
Indicate the correct sequence of pathogenesis of nephrotic edema:
massive proteinuria, hypoalbuminemia, decrease in intracapillary oncotic pressure, fluid transfer into interstitial space, decrease in circulating blood volume, activation of renin-angiotensin system
64
The low specific gravity of urine observed over a 24-hour period is called:
isohypostenuria
65
The main sign of nephrotic syndrome:
Proteinuria
66
A group of metabolic diseases characterized by hyperglycaemia resulting from defects in insulin secretion, insulin action, or both”:
diabetes mellitus
67
One of the long-term consequences of diabetes includes:
neuropathy
68
Type 1 diabetes mellitus should be treated
insulin with diet therapy
69
Which indicator is the most reliable criterion for the degree of compensation of diabetes mellitus in the follow-up examination?
glycosylated haemoglobin
70
A possible cause of hypoglycaemia in diabetes mellitus is:
high dose of insulin
71
Type 1 diabetes mellitus is characterised by:
acute onset, young age, tendency to ketoacidosis, absolute insulin deficiency
72
What is the secretion of thyroid hormone in diffuse toxic goiter:
abnormal
73
A set of disorders that involve excess synthesis and secretion of thyroid hormones by the thyroid gland, which leads to the hypermetabolic condition:
Hyperthyroidism
74
A disorder resulting from deficiency of thyroid hormone:
Hyporthyroidism
75
Therapy with antithyroid drugs is recommended for the following conditions:
Hyperthyroidism
76
Therapy with levothyroxine is recommended for the following conditions:
Hyporthyroidism
77
A chronic recurrent disease due to impaired gastro-esophageal motorevacuation function, characterised by spontaneous or regularly recurrent aspiration of gastric or duodenal contents into the oesophagus, leading to the development of inflammatory changes in the distal oesophagus and/or characteristic clinical symptoms:
GERD
78
A chronic disease morphologically characterised by inflammatory and dystrophic processes in the gastric mucosa and a variety of clinical signs:
Gastritis
79
A chronic relapsing disease, with alternating periods of exacerbation and remission, the leading manifestation of which is the formation of a defect (ulcer) in the stomach wall:
gastric ulcer
80
The occurrence of pain syndrome in the epigastric region immediately after eating is characteristic of:
cardiac ulcer
81
The occurrence of pain syndrome in the epigastric region 2-3 hours after eating, hunger pains, night pains are characteristic of:
duodenal ulcer
82
In urine test the specific gravity is 1026, protein - traces, WBC up to 100, RBC - 2-3, bacteria +++, mucus +++. This urine test is most characteristic for which of the following diseases:
acute pyelonephritis
83
A young woman consulted a doctor with complaints of weakness, fever up to 39.2 °C, pain in the lumbar region, frequent and painful urination in small quantities. Past medical history: considers herself ill since the age of 15 years, when she first noted the occurrence of the above complaints, was treated. In the next 2 years she was repeatedly hospitalised with similar complaints. At the age of 17 years the patient was offered sanatorium treatment, which gave positive results. Condition worsened about 2 weeks ago, when after hypothermia she experienced chills, fever up to 39°С, severe intermittent pains in the lumbar region, which radiated downwards to the abdomen, accompanied by frequent painful urination.
Рreliminary diagnosis:
Chronic pyelonephritis
84
A young woman complains of lumbar pain and fever for the past two days. She has been having pains when urinating for the last week and the pronounced pain and fever occurred yesterday. The pain was predominantly localized to the right side of the lower back, it was constant, blunt and without irradiation. She took 400mg ibuprofen last night for sleep, but the pain persisted and she decided to go and see the GP in the morning. Patient is married and has regular menstrual periods, last one week ago. She uses an intrauterine device as contraception. She denies genital tract discharge. Urination 5-7 times a day, urine is excreted in usual amounts, cloudy and frothy over the last two days. Objectively: body temperature 38.3° C, heart rate 112 per minute, BP 120/70 mmHg, respiratory rate 15 per minute. On palpation of the right rib-vertebral angle there is pronounced painfulness, tapping in the renal area is sharply painful on the right side. There is no swelling. Physical examination reveals no other abnormalities.Рreliminary diagnosis:
Acute pyelonephritis
85
In urine test: colour turbid, specific gravity - 1008, protein - 0.066g/l, white blood cells – a lot, red blood cells - 3-6, bacteria++++, renal epithelial cells - 2-3. This urine test is most characteristic for which of the following diseases:
acute pyelonephritis
86
A young woman came to her doctor for pain in the lumbar region. Urinalysis showed crystals. A radiograph shows multiple, slightly contrasting homogeneous concrements in the abdominal projection. On an excretory urogram the stones are visualised as filling defects. What disease can be suspected:
urolithiasis
87
A young woman, a housewife, complained of aching pain in the lumbar region, which persisted after taking antispasmodics and analgesics. Her urine was constantly alkaline (pH above 7.0), protein 0.06-0.3, leukocytes 8-12, erythrocytes 30-40, bacteria+++. An excretory urogram shows a coral stone in the left kidney.
What kind of disease can be suspected:
urolithiasis
88
A middle-aged woman complained of fever up to 38°C, frequent painful urination, dull aching pain in the right lumbar region without irradiation, headache, weakness and chills. Past medical history: 20 years ago, during pregnancy she had urine abnormalities (leucocytes and protein), but was not examined afterwards. Preliminary diagnosis:
Chronic pyelonephritis, exacerbation
89
A middle-aged woman from the age of 25 has been in repeatedly treated for chronic pyelonephritis. In addition to medical treatment, what dietary recommendations would you suggest:
reduce salt intake, increase vegetables and fruit
90
A young woman consulted her GP with complaints of weakness, rapid fatigue, weight loss of 5 kg. Past medical history: she became ill 3 months ago when the above complaints appeared, edema appeared in the face and lower extremities, blood pressure increased to 150/95 mmHg. Examination: massive swelling of the lower legs, lumbar region. Urinalysis: specific gravity - 1015, waxy and hyaline cylinders, erythrocytes - 15-20, protein - 6 g/day. Preliminary diagnosis:
Acute glomerulonephritis
91
A woman complains of urine the colour of meat slop, discomfort in the lumbar region, headache. Daily urine output is 1.2 litres. Past medical history: the above complaints appeared 6 weeks ago after an acute respiratory infection. Examination: pastous legs, BP 140/95 mmHg. Tapping symptom is positive on both sides. In the urinalysis: red blood cells - 30-45, cylinders waxy, protein -2.8 g/l.
Acute glomerulonephritis
92
A middle-aged female presented to her GP complains of puffiness of face in the morning, also she noticed some blood in urine (or sometimes brown urine) moreover, she started urinating less than usual, and sometimes the increase in blood pressure occurs. Your tactic in this case:
carry out an examination, recommend a CBC, biochemical blood test, renal ultrasound and an X-ray
93
Urinalysis: urine’s amount – 150 ml, color – brown, specific gravity – 1000, protein- 3,8 g, erythrocytes- 11-12, leukocytes – 9. Indicate a possible diagnosis:
glomerulonephritis
94
Urine analysis: specific gravity 1006, reaction - alkaline, urine colour – dark brown, protein - 3g / l, erythrocytes 10-12, granular cylinders (+).Indicate a possible diagnosis:
glomerulonephritis
95
A middle-aged man from the age of 24 has been in repeatedly treated for chronic glomerulonephritis. He has been suffering from high blood pressure for many years. In addition to the main medical treatment, what treatment for high blood pressure would you suggest:
angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers
96
A middle-aged woman from the age of 20 has been in repeatedly treated for chronic glomerulonephritis. In addition to medical treatment, what dietary recommendations would you suggest:
reduce salt and protein intake, increase vegetable intake
97
A middle-aged patient has been suffering from chronic glomerulonephritis for a long time. His GFR is 65. Define the stage of chronic kidney disease:
Stage 2- mild loss of kidney function
98
A middle-aged patient has been suffering from chronic glomerulonephritis. His GFR is 92. Define the stage of chronic kidney disease:
Stage 1- normal kidney function
99
A middle-aged patient has been suffering from chronic glomerulonephritis for a long time. His GFR is 50. Define the stage of chronic kidney disease:
Stage 3a- mild to moderate loss of kidney function
100
A middle-aged patient has been suffering glomerulonephritis for a long time. His GFR is 37. Define the stage of chronic kidney disease:
Stage 3b- moderate to severe loss of kidney function
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100問 • 1年前問題一覧
1
Accumulation of blasts in extramedullary lesions (eg, bones, central nervous system, lymph nodes, skin), blast counts in blood or bone marrow ≥ 20% in
Blast crisis in CML
2
Hyperplastic syndrome in acute leukemia includes
infiltration of organs and tissues by tumor cells
3
Intoxication syndrome in acute leukemia includes
Fever, pain, lethargy, sweating
4
Hemorrhagic syndrome in acute leukemia includes
Various kinds of hemorrhage
5
Immunodeficiency syndrome in acute leukemia includes
Decrease in the level of neutrophils, which is manifested by the development of infectious processes
6
The first step in the ACS diagnostic algorithm is
Collection of anamnesis and complaints
7
When the diagnosis of ACS is unlikely?
Trends of troponin levels are normal
8
It is less likely to confuse chest pain in ACS with the following condition
rib fracture
9
Which characteristic of chest pain is most consistent with exertional angina
Pain caused by exercise
10
What type of medications is not first line therapy in patients with coronary heart disease and hypertension
Metabolic drugs
11
The presence of typical chest pain corresponding to angina pectoris FC 3, reduced effectiveness of antianginal therapy, the presence of episodes of ST segment depression during daily ECG monitoring is an indication for
Elective coronary angiography
12
Target LDL-C for patients after myocardial revascularization
Less than 1.4 mmol/L
13
The main mechanism for the development of ACS is
Destabilization of atherosclerotic plaque
14
At the appointment, the patient, a man, 48 years old, smoking experience 20 years. BMI 31 kg/m2. Levels of total cholesterol 5.6 mmol/l, LDL cholesterol-4.0 mmol/l. In the last month, he notes an increase in blood pressure to 160/90 mm Hg. associated with stress at work. Estimate the level of total cardiovascular risk
High
15
At the appointment, the patient, a man, 48 years old, smoking experience 20 years. BMI 31 kg/m2. Levels of total cholesterol 5.6 mmol/l, LDL cholesterol-4.0 mmol/l. In the last month, he notes an increase in blood pressure to 160/90 mm Hg. associated with stress at work. Doctor's tactics:
Recommendations for lifestyle modification + pharmacological treatment
16
Prescribe the optimal pharmacological treatment for a 60-year-old patient with arterial hypertension of the 3rd degree, a history of coronary artery disease, gout:
ACE inhibitors/ARBs, beta-blockers, Calcium channel blockers, statins, ASAs
17
ESCardio recommends that most hypertensive patients should start treatment with
ACE inhibitor/ARB +Calcium channel blockers or diuretic
18
The SECURE study investigated a secondary prevention treatment
strategy using a polypill (combination tablet) containing
Aspirin, ramipril and atorvastatin
19
At the appointment, a patient with arterial hypertension, high pulse pressure, diastolic murmur in the projection of the aortic valve. Laboratory tests normal. On the ECG, a double-humped p wave, high-voltage R waves in V5, V6.
Echocardiography
20
Choose the optimal combination for the treatment of resistant hypertension according to the ESCardio recommendations:
ACE inhibitor/ARB+Calcium channel blockers + diuretic+spironolactone or B-blocker
21
Prescribe the optimal pharmacological treatment for a 35-year-old patient with grade 1 arterial hypertension, with one risk factor:
ACE inhibitor/ARB monotherapy
22
In a patient with a persistent form of atrial fibrillation, taking warfarin at a dose of 2.5 mg (1 tablet), the INR when measured is 2.5. Doctor's tactics:
Continue same dosage
23
In a 20-year-old patient, during an annual screening examination and ECG recording, a single premature atrial contraction was registered, he does not have complaints. Doctor tactics:
In most of cases, premature atrial contractions do not require special treatment
24
With the progression of atrioventricular block in a patient with an existing AV block of the 2nd degree, it is possible to develop
Complete heart block
25
When examining young patients with rhythm disturbances, firstly necessary to exclude:
Thyroid disease
26
During a screening preventive examination of a young athlete, 1st degree AV block was detected on the ECG. Doctor's tactics:
Does not require further examination
27
With long-term use of the antiarrhythmic drug amiodarone, it is necessary to monitor
Thyroid hormones
28
CHF with low EF corresponds to
LV EF less than 40%
29
CHF with preserved EF corresponds to
LV EF more than 50%
30
Paroxysmal nocturnal dyspnea (PND) is most commonly associated with…:
Chronic heart failure
31
Chronic heart failure (CHF) is most commonly associated with…:
Left ventricle dilation
32
Bendopnea is
appearance of shortness of breath when bending forward
33
III class CHF (NYHA classification) matches with the following distance in 6 min walking test
301-425 m
34
One of the objective signs of heart dysfunction in CHF is cardiomegaly, while the cardiothoracic index is
More than 50%
35
One of the goals of treatment for terminal stage of CHF is
<variant> Preparation for myocardial revascularization
Improve quality of life
36
The indication for heart transplantation in CHF is
CHF III-IV FC, with LV EF less than 30%, OMT ineffectiveness within 3 months
37
A 60-year-old man has his appointment with GP with complaints on SoB, pitting edema. Patient and family history: Q wave-MI 2 years ago, smoker for a 20years, T2DM, mother has diabetes, father died from myocardial infarction at age 54. On physical examination his BMI=31 kg/m2. Measured BP 150/90 mm Hg, HR100 bpm, peripheral edema. Skin is pale. On ECG -signs of LVH. Choose most appropriate cause of his complaints:
CHF
38
A 26-month-old boy who presented with neutropenia associated with anemia and thrombocytopenia. There was no history of any hematological disorder. On examination: the patient had pallor and splenic enlargement. Physical examination was otherwise unremarkable. The patient had been suffering from recurrent febrile episodes and nocturnal sweats with weakness and fatigue. Peripheral blood smear examination showed normocytic normochromic red blood cells including few nucleated red blood cells, white blood cells showed left, shift with significant number of blasts. The leukocyte differential count was eosinophils 5%, lymphocytes 62%, and neutrophils 31% and band forms 1%. Bone marrow aspiration and biopsy showed increased abnormal megakaryocytic, Monolobated and multinucleated megakaryocytic with hyper chromatic and pleomorphic nuclei were seen and showed the leukemic cells were positive for CD13, CD33, CD42. What is the diagnosis?
Acute lymphocytic leukemia
39
A 26-month-old boy who presented with neutropenia associated with anemia and thrombocytopenia. There was no history of any hematological disorder. On examination: the patient had pallor and splenic enlargement. Physical examination was otherwise unremarkable. The patient had been suffering from recurrent febrile episodes and nocturnal sweats with weakness and fatigue. Peripheral blood smear examination was done. What is the next step in diagnosing?
Bone marrow aspiration and biopsy
40
A 70-year-old man presented to his primary care physician with 2 months of fatigue and 10-kg weight loss. He noted a general sense of malaise and feeling poor. On physical examination, the clinician was able to palpate the spleen 4 cm below the costal margin (splenomegaly) but noted no palpable lymphadenopathy. Family history was noncontributory. CBC: WBC-39 180 /cmm, RBC- 4.37 M/cmm, Hemoglobin-13 g/dL, HCT 40%, MCV 92 fL, MCH 29.7 pg, MCHC 32.5 g/dL, RDW-CV-13.1%, PLT-216,000/cmm. Automated Differential Count: Neutrophils-67%, Bands-9%, Lymphocytes-7%, Monocytes 2%, Eosinophils-3%, Basophils-4%, Metamyelocytes-5%, Myelocytes-3%. Make the preliminary diagnosis
Chronic Myeloid Leukemia
41
A patient who had a myocardial infarction a year ago applied for an appointment, at the same time an emergency PCI was performed, followed by stenting of the LAD. During the year there were no angina pectoris, he feels well, he receives basic therapy (bisoprolol 2.5 mg, acetylsalicylic acid 75 mg, clopidogrel 75 mg, atorvastatin 10 mg, lisinopril 2.5 mg) came to the dispensary examination. In the analyzes: blood glucose-4.9 mmol/l, blood creatinine-68 µmol/l, total cholesterol-5.5 mmol/l, LDL cholesterol-2.6 mmol/l. Coagulogram within normal limits. Doctor’s tactics:
Stop clopidogrel, increase statin dose
42
In a patient with chronic coronary artery disease, angina attacks became more frequent regardless therapy. Patient also complaints on knees pain for which the patient constantly takes ibuprofen. Choose the correct doctor's tactics:
Refer the patient for a consultation with a rheumatologist to select the therapy for osteoarthritis, optimize the medical treatment of coronary artery disease, and if ineffective, refer the patient to a planned coronary angiography
43
A 36-year-old male patient came to the appointment for a preventive examination. In the family history, the father has early coronary artery disease (under the age of 55 years). Smokes electronic cigarettes, works in a bank, travels mainly by car, BMI 29 kg/m2. Laboratory and instrumental examinations without pathology. Doctor's tactics:
Give advice on lifestyle changes – quit smoking, increase physical activity, reduce body weight, get enough sleep, avoid stress
44
A 58-year-old woman came to the appointment with complaints of ankle edema, no other complaints. From the anamnesis it is known that she is hypertensive, receives basic therapy, does not remember the name. Physical examination: BP 125/75 mm Hg. Heart rate 68 beats per minute. Heart sounds are normal, regular. ECG normal. Echocardiogram showed normal ejection fraction, global and local myocardial contractility is normal, heart chambers are not dilated, valves are intact. Which medication is most likely associated with ankle edema in this patient?
Amlodipine
45
A 58-year-old woman visit her doctor with complaints of dry cough, no other complaints. From the anamnesis it is known that she is hypertensive, takes constant basic therapy, does not remember the name. Physical examination: BP 125/75 mm Hg. Heart rate 68 beats per minute. Heart sounds are normal, rhythmic. Vesicular breathing in the lungs. ECG without features. X-ray of the lungs without pathology. Spirometry showed no abnormalities. Which drug is most likely associated with cough in this patient?
Lisinopril
46
A 58-year-old woman came to the doctor with complaints of pain in the knee joints. From the anamnesis it is known that she is hypertensive, takes constant basic therapy: lisinopril, hydrochlorothiazide, amlodipine, atorvastatin, bisoprolol. In laboratory data, the level of uric acid is increased (510 µmol/l). Which drug of the named should be discontinued?
Hydrochlorothiazide
47
A 52-year-old man came to the doctor with complaints of a feeling of interruptions, "fading" in the heart area. Previously, according to the words, he suffered from rhythm disturbance, he does not receive basic therapy. Last year, he suffered an ischemic stroke, with transient left-sided hemiparesis. The doctor ordered an ECG. What pathology is more likely to be diagnosed in a patient?
Atrial fibrillation
48
A 52-year-old man came to the doctor with complaints of a feeling of interruptions, "fading" in the heart area. Previously, he had rhythm disorder, he does not receive basic therapy. Last year, he suffered an ischemic stroke, with transient left-sided hemiparesis. Select the optimal list of pharmacological therapy, taking into account the most likely diagnosis and patient history:
Beta blockers, ACE inhibitors, oral anticoagulants
49
A patient with a permanent form of atrial fibrillation came to the appointment. The patient takes basic therapy. Recently, episodes of nosebleeds have become more frequent. What medication is this complication associated with?
Warfarine
50
A 52-year-old man came to the doctor with complaints of a feeling of interruptions, "fading" in the heart area. Previously, according to the words, he suffered from rhythm disturbance, he does not receive basic therapy. Last year, he suffered an ischemic stroke, with transient left-sided hemiparesis. The doctor ordered an ECG. What pathology is more likely to be diagnosed in a patient?
Atrial fibrillation
51
A 52-year-old man came to the doctor with complaints of a feeling of interruptions, "fading" in the heart area. Previously, he had rhythm disorder, he does not receive basic therapy. Last year, he suffered an ischemic stroke, with transient left-sided hemiparesis. Select the optimal list of pharmacological therapy, taking into account the most likely diagnosis and patient history:
Beta blockers, ACE inhibitors, oral anticoagulants
52
A patient with a permanent form of atrial fibrillation came to the appointment. The patient takes basic therapy. Recently, episodes of nosebleeds have become more frequent. What medication is this complication associated with?
Warfarine
53
A 60-year-old man has his appointment with GP with complaints on SoB, pitting edema. Patient and family history: Q wave-MI 2 years ago, smoker for a 20years, T2DM, mother has diabetes, father died from myocardial infarction at age 54. On physical examination his BMI=31 kg/m2. Measured BP 150/90 mm Hg, HR100 bpm, peripheral edema. Skin is pale. On ECG -signs of LVH. Choose most appropriate cause of his complaints:
CHF
54
A 60-year-old man has his appointment with GP with complaints on SoB, pitting edema. Patient and family history: Q wave-MI 2 years ago, smoker for a 20years, T2DM, mother has diabetes, father died from myocardial infarction at age 54. On physical examination his BMI=31 kg/m2. Measured BP 150/90 mm Hg, HR100 bpm, peripheral edema. RR 21, Skin is pale. On ECG -signs of LVH. His BNP level is 600 pg/mL. On TTE- LV EF is 42%. Choose most appropriate drugs combination for this patient:
b-blockers+SGLTi+sakubitril/valsartan+loop diuretic
55
A 60-year-old man has his appointment with GP with complaints on SoB, pitting edema. Patient and family history: Q wave-MI 2 years ago, smoker for a 20years, T2DM, mother has diabetes, father died from myocardial infarction at age 54. On physical examination his BMI=31 kg/m2. Measured BP 150/90 mm Hg, HR100 bpm, peripheral edema. Skin is pale. On ECG -signs of LVH. Choose next step in patient management:
TTE and BNP/pro-BNP level
56
The three main symptoms of acute pyelonephritis are:
fever, low back pain, urinary changes
57
Inflammatory diseases of the urogenital system leading to chronic renal failure:
chronic pyelonephritis
58
The most characteristic changes in the blood in chronic renal failure:
progressive azotemia
59
The main focus of the chronic renal failure diet:
a low-protein diet
60
Method of treating end-stage chronic renal failure
hemodialysis
61
An exacerbation of chronic glomerulonephritis is characterised by:
Increased edema, proteinuria and hematuria
62
The morphological variant of chronic glomerulonephritis can be determined reliably:
renal puncture biopsy
63
Indicate the correct sequence of pathogenesis of nephrotic edema:
massive proteinuria, hypoalbuminemia, decrease in intracapillary oncotic pressure, fluid transfer into interstitial space, decrease in circulating blood volume, activation of renin-angiotensin system
64
The low specific gravity of urine observed over a 24-hour period is called:
isohypostenuria
65
The main sign of nephrotic syndrome:
Proteinuria
66
A group of metabolic diseases characterized by hyperglycaemia resulting from defects in insulin secretion, insulin action, or both”:
diabetes mellitus
67
One of the long-term consequences of diabetes includes:
neuropathy
68
Type 1 diabetes mellitus should be treated
insulin with diet therapy
69
Which indicator is the most reliable criterion for the degree of compensation of diabetes mellitus in the follow-up examination?
glycosylated haemoglobin
70
A possible cause of hypoglycaemia in diabetes mellitus is:
high dose of insulin
71
Type 1 diabetes mellitus is characterised by:
acute onset, young age, tendency to ketoacidosis, absolute insulin deficiency
72
What is the secretion of thyroid hormone in diffuse toxic goiter:
abnormal
73
A set of disorders that involve excess synthesis and secretion of thyroid hormones by the thyroid gland, which leads to the hypermetabolic condition:
Hyperthyroidism
74
A disorder resulting from deficiency of thyroid hormone:
Hyporthyroidism
75
Therapy with antithyroid drugs is recommended for the following conditions:
Hyperthyroidism
76
Therapy with levothyroxine is recommended for the following conditions:
Hyporthyroidism
77
A chronic recurrent disease due to impaired gastro-esophageal motorevacuation function, characterised by spontaneous or regularly recurrent aspiration of gastric or duodenal contents into the oesophagus, leading to the development of inflammatory changes in the distal oesophagus and/or characteristic clinical symptoms:
GERD
78
A chronic disease morphologically characterised by inflammatory and dystrophic processes in the gastric mucosa and a variety of clinical signs:
Gastritis
79
A chronic relapsing disease, with alternating periods of exacerbation and remission, the leading manifestation of which is the formation of a defect (ulcer) in the stomach wall:
gastric ulcer
80
The occurrence of pain syndrome in the epigastric region immediately after eating is characteristic of:
cardiac ulcer
81
The occurrence of pain syndrome in the epigastric region 2-3 hours after eating, hunger pains, night pains are characteristic of:
duodenal ulcer
82
In urine test the specific gravity is 1026, protein - traces, WBC up to 100, RBC - 2-3, bacteria +++, mucus +++. This urine test is most characteristic for which of the following diseases:
acute pyelonephritis
83
A young woman consulted a doctor with complaints of weakness, fever up to 39.2 °C, pain in the lumbar region, frequent and painful urination in small quantities. Past medical history: considers herself ill since the age of 15 years, when she first noted the occurrence of the above complaints, was treated. In the next 2 years she was repeatedly hospitalised with similar complaints. At the age of 17 years the patient was offered sanatorium treatment, which gave positive results. Condition worsened about 2 weeks ago, when after hypothermia she experienced chills, fever up to 39°С, severe intermittent pains in the lumbar region, which radiated downwards to the abdomen, accompanied by frequent painful urination.
Рreliminary diagnosis:
Chronic pyelonephritis
84
A young woman complains of lumbar pain and fever for the past two days. She has been having pains when urinating for the last week and the pronounced pain and fever occurred yesterday. The pain was predominantly localized to the right side of the lower back, it was constant, blunt and without irradiation. She took 400mg ibuprofen last night for sleep, but the pain persisted and she decided to go and see the GP in the morning. Patient is married and has regular menstrual periods, last one week ago. She uses an intrauterine device as contraception. She denies genital tract discharge. Urination 5-7 times a day, urine is excreted in usual amounts, cloudy and frothy over the last two days. Objectively: body temperature 38.3° C, heart rate 112 per minute, BP 120/70 mmHg, respiratory rate 15 per minute. On palpation of the right rib-vertebral angle there is pronounced painfulness, tapping in the renal area is sharply painful on the right side. There is no swelling. Physical examination reveals no other abnormalities.Рreliminary diagnosis:
Acute pyelonephritis
85
In urine test: colour turbid, specific gravity - 1008, protein - 0.066g/l, white blood cells – a lot, red blood cells - 3-6, bacteria++++, renal epithelial cells - 2-3. This urine test is most characteristic for which of the following diseases:
acute pyelonephritis
86
A young woman came to her doctor for pain in the lumbar region. Urinalysis showed crystals. A radiograph shows multiple, slightly contrasting homogeneous concrements in the abdominal projection. On an excretory urogram the stones are visualised as filling defects. What disease can be suspected:
urolithiasis
87
A young woman, a housewife, complained of aching pain in the lumbar region, which persisted after taking antispasmodics and analgesics. Her urine was constantly alkaline (pH above 7.0), protein 0.06-0.3, leukocytes 8-12, erythrocytes 30-40, bacteria+++. An excretory urogram shows a coral stone in the left kidney.
What kind of disease can be suspected:
urolithiasis
88
A middle-aged woman complained of fever up to 38°C, frequent painful urination, dull aching pain in the right lumbar region without irradiation, headache, weakness and chills. Past medical history: 20 years ago, during pregnancy she had urine abnormalities (leucocytes and protein), but was not examined afterwards. Preliminary diagnosis:
Chronic pyelonephritis, exacerbation
89
A middle-aged woman from the age of 25 has been in repeatedly treated for chronic pyelonephritis. In addition to medical treatment, what dietary recommendations would you suggest:
reduce salt intake, increase vegetables and fruit
90
A young woman consulted her GP with complaints of weakness, rapid fatigue, weight loss of 5 kg. Past medical history: she became ill 3 months ago when the above complaints appeared, edema appeared in the face and lower extremities, blood pressure increased to 150/95 mmHg. Examination: massive swelling of the lower legs, lumbar region. Urinalysis: specific gravity - 1015, waxy and hyaline cylinders, erythrocytes - 15-20, protein - 6 g/day. Preliminary diagnosis:
Acute glomerulonephritis
91
A woman complains of urine the colour of meat slop, discomfort in the lumbar region, headache. Daily urine output is 1.2 litres. Past medical history: the above complaints appeared 6 weeks ago after an acute respiratory infection. Examination: pastous legs, BP 140/95 mmHg. Tapping symptom is positive on both sides. In the urinalysis: red blood cells - 30-45, cylinders waxy, protein -2.8 g/l.
Acute glomerulonephritis
92
A middle-aged female presented to her GP complains of puffiness of face in the morning, also she noticed some blood in urine (or sometimes brown urine) moreover, she started urinating less than usual, and sometimes the increase in blood pressure occurs. Your tactic in this case:
carry out an examination, recommend a CBC, biochemical blood test, renal ultrasound and an X-ray
93
Urinalysis: urine’s amount – 150 ml, color – brown, specific gravity – 1000, protein- 3,8 g, erythrocytes- 11-12, leukocytes – 9. Indicate a possible diagnosis:
glomerulonephritis
94
Urine analysis: specific gravity 1006, reaction - alkaline, urine colour – dark brown, protein - 3g / l, erythrocytes 10-12, granular cylinders (+).Indicate a possible diagnosis:
glomerulonephritis
95
A middle-aged man from the age of 24 has been in repeatedly treated for chronic glomerulonephritis. He has been suffering from high blood pressure for many years. In addition to the main medical treatment, what treatment for high blood pressure would you suggest:
angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers
96
A middle-aged woman from the age of 20 has been in repeatedly treated for chronic glomerulonephritis. In addition to medical treatment, what dietary recommendations would you suggest:
reduce salt and protein intake, increase vegetable intake
97
A middle-aged patient has been suffering from chronic glomerulonephritis for a long time. His GFR is 65. Define the stage of chronic kidney disease:
Stage 2- mild loss of kidney function
98
A middle-aged patient has been suffering from chronic glomerulonephritis. His GFR is 92. Define the stage of chronic kidney disease:
Stage 1- normal kidney function
99
A middle-aged patient has been suffering from chronic glomerulonephritis for a long time. His GFR is 50. Define the stage of chronic kidney disease:
Stage 3a- mild to moderate loss of kidney function
100
A middle-aged patient has been suffering glomerulonephritis for a long time. His GFR is 37. Define the stage of chronic kidney disease:
Stage 3b- moderate to severe loss of kidney function