Medicine 2
問題一覧
1
A triad of symptoms ("stearing spot", "terminal film", "blood dew") has been revealed on examination of a patient. What disease should you think about?
Psoriasis
2
A 45-year-old patient complains of some painless nodular elements tending to peripheral growth and fusion. He has a 2-year history of this disease. Aggravation takes place mainly in spring. In anamnesis: the patient's father had similar skin lesions. Objectively: pathological elements looke like guttate and nummular nodules, plaques covered with white scales. What is your provisional diagnosis?
Psoriasis
3
A 28 y.o. woman consulted a doctor with the complaints of enlargening in size of an inborn pigment nevus, it was also wetting and itching. What test should not be used for diagnostics in this case?
Incision biopsy
4
A 23 year old patient fell ill 3 weeks ago when she noticed a very painful induration in her axillary crease. 4-5 days later it burst and discharged a lot of pus. After that some new infiltrations appeared around the affected area. The patient has never suffered from skin diseases before. What is the most probable diagnosis?
Hydradenitis
5
A 26-year-old male patient complains of a rash on the upper lip skin, which arose on a background of influenza with high-grade fever and is accompanied by pain and burning. The rash has been present for 3 days. Objectively: the skin of the upper lip is edematic and erythematous, grouped vesicles are filled with serous fluid and have a rough surface. What is the most likely diagnosis?
Herpetic vesicular dermatitis
6
Psoriasis of the nails A 41-year-old patient cosulted a dermatologist about discoloration, thickening, brittleness of toenails. These symptoms have been present for about five years. Objectively: nail plates in all toes are thickened, of dirty yellow color, lustreless, crumble over the edge. Microscopy of the nail plate material treated with alkali revealed mycelial filaments. Material inoculation onto Sabouraud medium resulted in growth of the Trichophyton rubrum colony. What is the most likely diagnosis?
Rubromycosis of toenails
7
A 38-year-old female suddenly developed acute inflammatory rash in form of roseolas, papules, vesicles that are scattered on the skin of trunk in irregular and predominantly focal manner. The rash appeared a few hours after visiting a restaurant. The patient complains of itching skin. What is the most likely diagnosis?
Toxicodermatosis
8
A 30 y.o. patient has got multiple body skin rash consisting of small paired elements that are scattered on the skin diorderly and mostly focally, they are accompanied by itch. The rash appeared a few days after attending sport centre and sauna. What is the most probable diagnosis?
Scab
9
The 28 y.o. woman applied to doctor because of limited loss of the hair. In the anamnesis - she had frequent headache indisposition, arthromyalgia, fever, irregular casual sexual life, drug user. RW is negative. What examination must be done first?
Examination for HIV
10
A female patient consulted a dermatologist about the rash on the trunk and extremities. Objectively: interdigital folds, flexor surfaces of wrists and navel region are affected with pairs of nodulo-cystic eruptions and crusts. The rash is accompanied by skin itch that is getting stronger at night. What external treatment should be administered?
20¥% benzyl benzoate emulsion
11
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?
Rubromycosis
12
A 51 y.o. women was taken to the emergency department in convulsive status epilepticus. The first means of medical management should be:
Ensuring that the airway is open and the patient is oxygenating
13
A 14-year-old victim was drawn out of the water in winter after 15 minutes of being in the water. The victim shows no vital signs. What measures are to be taken?
To release respiratory tract from water, to create drain position and to take on measures to restore respiration and blood circulation
14
Explosion of a tank with benzene at a chemical plant has killed and wounded a large number of people. There are over 50 victims with burns, mechanical injuries and intoxication. Specify the main elements of medical care and evacuation of population in this situation:
Sorting, medical assistance, evacuation
15
A 20 y.o. man has a stab knife wound in the left half of thorax close to nipple. AP is 90/60 mm Hg, Ps- 130/min, BR- 32/min. During inspiration there is increase of pulse wave in the region of jugular vein, decrease of peripheral arterial pulse and reduction of AP. Respiratory murmurs are unchanged. X-ray pattern of thorax organs has no pecularities. After introduction of 2 l of isotonic solution the AP stayed low, CVP raised up to 32 cm of water column. The first step in further treatment of the patient will be:
Echocardiogram
16
A 48 y.o. patient has been staying in the emergency department for 2 days on account of acute anteroseptal myocardial infarction. In the course of examination he suddenly "snored". There was a tonic contraction of skeletal muscles; eye pupils dilatated. Pulse on a.carotis is absent. What is the immediate tactics?
Electric defibrillation
17
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 respiration above lungs, sibilant rales. What drug group should be administered in the first place?
Glucocorticoids
18
A 50 y.o. male patient was taken to the emergency department with diffuse abdominal pain and signs of cardiovascular collapse. On arrival he had BP- 95/60 mm Hg, Ps- 120/min, diuresis - 20 ml/h, HgB- 100 g/L, RBC- 2,1*1012/L. The patient needs introduction of:
Crystalloid and colloid
19
A patient who takes diuretics has developed arrhythmia as a result of cardiac glycoside overdose. What is the treatment tactics in this case?
Increased potassium concentration in blood
20
In a cold weather, the emergency room admitted a patient pulled out of the open water. There was no respiratory contact with the water. The patient is excited, pale, complains of pain, numbness of hands and feet, cold shiver. Respiratory rate is 22/min, AP - 120/90 mm Hg, Ps - 110/min, rectal temperature is 34,5oC. What kind of warming is indicated for this patient?
Passive warming
21
The family doctor examined a patient and diagnosed an acute bleeding of an intestine. What is the doctor's professional tactics in this situation?
The urgent hospitalization in to the surgical department
22
A 38-year-old woman experiences episodic increases in arterial pressure up to 240/120 mm Hg, which is accompanied by nausea, vomiting, tachycardia, increased sweating, hyperglycemia. The attack is usually followed by the excessive urination. Renal sonography reveals an additional formation adjacent to the upper pole of the right kidney and possibly belonging to the adrenal gland. What laboratory test will allow to clarify the diagnosis?
Determination of urinary excretion of catecholamines and vanillylmandelic acid
23
A 45-year-old female patient complaining of general weakness, nausea and vomiting hass been delivered to a hospital by the ambulance. Recently there has been a lack of appetite, weight loss. Objectively: hyperpigmentation of skin, blood pressure at the rate of 70/45 mm Hg, bradycardia. Additional studies revealed the reduced concentration of aldosterone and cortisol in blood, decreased excretion of 17-ketosteroids and 17-oxyketosteroids in the urine, hyponatremia, chloropenia, hypokalemia. What therapeutic measures are required?
To administer glucocorticoids, mineralocorticoids, and a diet with a high content of cooking salt
24
A 38 y.o. patient was urgently admitted to the hospital with complaints of sudden weakness, dizziness, loss of consciousness, body weight loss, nausea, vomiting, severe pain in epigastric area, diarrhea, skin hyperpigmentation. What is the most probable diagnosis?
Addisonic crisis
25
Which of the following IS NOT TYPICAL for Addison's disease?
High serum Na+
26
A 58 y.o. woman had voluminous bleeding from the ruptured varicous node on the left crus. What first aid should be provided?
Heightened position of extremity, compressive sterile bandage
27
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 significantly weakened, heart rate - 60/min, AP- 80/40 mm Hg. The abdomen is slightly painful in the epigastrial region. In blood: WBCs - 8,1*109 /l, glucose - 3,0 millimole/l. What is the most likely diagnosis?
Chronic adrenal insufficiency. Addisonian crisis
28
A 34 y.o. patient has been suffering from pulmonary tuberculosis for 7 years; he complains of muscle feebleness, weight loss, diarrheas, increased frequency of urination. Objectively: hyperpigmentation of skin, gums, internal cheek surfaces. AP is 90/58 mm Hg. Blood count: erythrocutes - 3,11012/L, Hb- 95 g/L, C.I.- 0,92; leukocytes - 9,4109 /L, eosinophils - 7, segmentonuclear leukocytes - 45, stab neutrophils - 1, lymphocytes - 40, monocytes - 7, Na+ - 115 mmole/L, К+ - 7,3 mmole/L. What is the preliminary diagnosis?
Primary insufficiency of adrenal cortex
29
After a holiday in the Crimea, a 49-year-old male patient with a history of lung tuberculosis felt increased weakness, periodic dizziness, easing bowel movements with abdominal pain, the need for additional salting his meals. The patient has noted that his condition improves after some sweet tea and validol taken sublingually. Objectively: there is an intense darkening of skin, AP- 70/50 mm Hg, glycemia is 3,0 mmol/l. What is the possible cause of health deterioration:
Chronic adrenal insufficiency
30
After having the flu, a 39-year-old male patient with a history of Addison's disease developed a condition manifested by weakness, depression, nausea, vomiting, diarrhea, hypoglycemia. AP75/50 mm Hg. Blood test results: low corticosterone and cortisol, 13-oxycorticosteroids, 17-oxycorticosteroids levels. What condition developed in the patient?
Acute adrenal insufficiency
31
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 millimole/l, K - 5,8 millimole/l. Development of this complication is primarily caused by the deficit of the following hormone:
Cortisol
32
A 38 y.o. woman suffers from paroxysmal AP rises up to 240/120 mm Hg accompanied by nausea, vomiting, tachycardia, excessive sweating. During the onset blood is hyperglycemic. After the onset there is voluminous urination. Kidneys sonography revealed accessory mass bordering upon the upper pole of the right kidney, presumably it belongs to the adrenal gland. What laboratory test will allow to make a more precise diagnosis?
Estimation of catecholamine and vanillylmandelic acid excretion with urine
33
A 54-year-old patient complains of weakness, weight loss despite the unchanged appetite, frequent urination, skin itch for six months. Some time ago the patient underwent treatment for furunculosis. She hasn't been examined recently. Objectively: malnutrition, dry skin with signs of scratching. Small lymph nodes can be palpated in the axillary regions. Changes in the internal organs are absenr. What testing must be administered in the first place?
Blood sugar test on an empty stomach
34
A 49-year-old female patient has type 1 diabetes of moderate severity. The disease is complicated by retinopathy and polyneuropathy. Besides that, repeated analyses of the daily urinary excretion of albumin revealed microalbuminuria (200-300 mg/day). Glomerular filtration rate is 105 ml/min. Blood pressure is within normal range. Normalization of the following indicator should be the first-priority task in the secondary prevention of diabetic nephropathy:
Glycosylated hemoglobin
35
A 40-year-old female patient complain of headache, dizziness, muscle weakness, sometimes - cramps in the extremities. She has been taking antihypertensive medications for 10 years. AP- 180/100 mm Hg. Blood potassium - 1,8 millimole/l, sodium - 4,8 millimole/l. In urine: alkaline reaction, the relative density - 1012, protein and sugar are not found, WBCs - 3-4 in the field of vision, RBCs - 1-2 in the field of vision. Conn's syndrome is suspected. Which drug should be chosen for the treatment of arterial hypertension?
Spironolactone
36
During examination a patient is unconscious, his skin is dry and hot, face hyperemia is present. The patient has Kussmaul's respiration, there is also smell of acetone in the air. Symptoms of peritoneum irritation are positive. Blood sugar is at the rate of 33 millimole/l. What emergency actions should be taken?
Intravenous infusion of short-acting insulin
37
A 13 year old patient is suffering from an acute disease with the following symptoms: thirst, polyuria, weakness. Objectively: his general condition is satisfactory, there is no smell of acetone. Glucose concentration in blood on an empty stomach is 32 micromole/l, in urine - 6%, acetone +. What treatment should be administered?
Short-acting insulin
38
A 23 y.o. woman who suffers from insulin-dependent diabetes was admitted to the acute care department with mental confusion, inadequate anxious behaviour, hyperhidrosis, excessive salivation, tachycardia. What examination will be a primary task?
Blood test for sugar
39
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?
Insulinemia on an empty stomach
40
A 35-year-old man was operated on peptic ulcer of the stomach. Mass deficit of the body is 10 kg. The level of glucose after operation in the undiluted cellular blood on an empty stomach is 6,7 mmol. During repeated examination - 11,1 mmol (after meal), level of HbA1c - 10%. Could you please make an interpretation of the given data?
Diabetes mellitus
41
A 33 y.o. patient with first time detected diabetes mellitus keeps the diet and maintains glycemia at the level of 10,0 mmol/L after meal. He keeps himself from insulinotherapy. What examination is the most important for differentiation of the 1st (insulin-dependent) and the 2nd (insulin-independent) types of diabetes?
Determination of insular cells antibodies
42
A 33 y.o. woman has been suffering from DM (diabetes mellitus) for 5 years. For the last 3 years she has been taking more than 100 units of insulin per day. Body weight has increased up to 10 kg. Fasting blood glucose is 13 mmol/L, glucoseuria - 3%. Generalized microangiopathy. By increasing the dose of insulin the parameters of glycemia do not change. The diagnosis is:
DM 1st type, severe form, decompensation, insulin resistant
43
A 62 year old patient suffers from DM-2. Diabetes is being compensated by diet and Maninilum. The patient has to undergo an operation on inguinal hernia. What tactics of hypoglycemic therapy should be chosen?
Prescribe fast-acting insulin
44
A 58-year-old patient has a 3-year history diabetes mellitus type II. He has been keeping to a diet and regularly taking glyburide. He has been delivered to a hospital on an emergency basis for acute abdomen. Objectively: the patient is of supernutrition type. The skin is dry. In the lungs vesicular breathing can be auscultated. Heart sounds are regular, 90/min. AP- 130/70 mm Hg. The symptom of "wooden belly" is visible. Blood sugar - 9,8 millimole/l. The patients has indication for laparotomy. What is the most appropriate way of further treatment of diabetes?
To administer short insulin
45
Preventive examination of a 55 year old patient revealed diabetes mellitus. The patient hasn't received treatment for it. Objectively: height is 170 cm, weight is 106 kg, skin humidity is normal. Ps is 76 bpm, rhythmic, left border of relative heart dullness is deviated by 1 cm to the left from the middle clavicular line, heart sounds are quiet, AP is 140/80 mm Hg. Glycemia on an empty stomach is 6,9 millimole/l. Glucose rate in the daily urine is 0,5%, diuresis makes up 2,5 l. What treatment tactics should be chosen?
To administer dietotherapy
46
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:
To replace maninil with insulin
47
A 24 year old patient complained about putting on weight, limosis. Objectively: the patient's constitution is of hypersthenic type, body weight index is 33,2 kg/m2 , waist circumference is 100 cm. Correlation of waist circumference to the thigh circumference is 0,95. What is the most probable diagnosis?
Alimentary constitutional obesity of the I stage, abdominal type
48
A 39-year-old female patient complains of dyspnea when walking, palpitation, edemata in the evening. The patient's height is 164 cm, weight - 104 kg. Objectively: overnutrition. Heart sounds are weak, and tachycardia is present. The menstrual cycle is not broken. Blood sugar is 5,6 mmol/l, ACTH-response tests revealed no alterations. X-ray of the Turkish saddle revealed no pathology. What disease is it?
Alimentary obesity
49
An unconscious patient presents with moist skin, shallow breathing. There are signs of previous injection on the shoulders and hips. BP- 110/70 mm Hg. Tonus of skeletal muscles and reflexes are increased. Cramps of muscles of the extremities are seen. What is the most likely disorder?
Hypoglycemic coma
50
A patient of 32 y.o. complains of severe weakness, tremor of extremities. Objective examination: body weight loss, wet and warm skin. The thyroid gland is enlarged up to the 3-rd degree, painless, elastic. Ps- 108/min. BP- 160/55 mm Hg. There are no other abnormalties. The diagnosis is:
Diffuse toxic goiter of the 3-rd degree, thyrotoxicosis of the average degree
51
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?
Gland scanning
52
A 26 y.o. male patient with postoperative hypothyroidism take thyroxine 100 mg 2 times a day. He has developed tachycardia, sweating, irritability, sleep disorder. Determine further treatment tactics.
To decrease thyroxine dosage
53
A 47-year-old woman underwent a thyroid gland resection on ccount of nodular euthyroid goiter. What preparations are most likely to prevent the disease recurrence?
Thyroid hormones
54
A 24-year-old male patient had been diagnosed with class III diffuse toxic goiter. There is moderate hyperthyroidism. A surgery was suggested, and the patient agreed to it. What preoperative measures should be taken for prevention of thyrotoxic crisis in the postoperative period?
Administration of antithyroid drugs
55
Male 30 y.o., noted growing fingers and facial scull, changed face. Complains of poor eyesight, weakness, skin darkening, loss of body weight. X-ray shows broadening of sella turcica, thinning of tuberculin sphenoidale, signs of increased intracranial pressure. What diagnosis can you make?
Adenoma of hypophysis
56
A 49 year old female patient was admitted to a hospital with acute attacks of headache accompanied by pulsation in temples, AP rose up to 280/140 mm Hg. Pheochromocytoma is suspected. What mechanism of hypertensive atack does this patient have?
Increase of catecholamine concentration
57
A 32-year-old female complains of dizziness, headache, palpitation, tremor. For the last several months she has been under outpatient observation for the increased arterial pressure. Since recently such attacks have become more frequent and severe. Objectively: skin is covered with clammy sweat, tremor of the extremities is present. HR- 110/min, AP- 220/140 mm Hg. Heart sounds are muffled. Blood test results: WBCs - $9,8¥cdot10^9$/l, ESR - 22 mm/h. Blood glucose - 9,8 millimole/l. What disease is the most likely cause of this crisis?
Pheochromocytoma
58
Examination of a hanged man's corpse revealed the following: livores mortis disappear when pressed, restore in 50 seconds, rigor mortis is moderately evident only in masseteric muscles, neck muscles and fingers. Body temperature is 31,00С. What is the prescription of death coming?
6-7 hours
59
A 37-year-old patient was brought to resuscitation unit. General condition of the patient is very serious. Sopor. The skin is grey, moist. Turgor is decreased. Pulse is rapid, intense. BP - 160/110 mm Hg, muscle tonus is increased. Hyperreflexia. There is an ammonia odor in the air. What is the presumptive diagnosis?
Uraemic coma
60
A female patient consulted a doctor about gain in weight, chill, edemata, dry skin, sleepiness, problems with concentration. Objectively: the patient's height is 165 cm, weight is 90 kg, gynoid body proportions, to - 35,8oC, ESR- 58/min, AP- 105/60 mm Hg. Heart sounds are weakened, bradycardia is present. Other internal organs have no changes. Thyroid gland is not palpable. Mammary glands ooze milk droplets. Hormonal study revealed rise of TSH and prolactin concentration, reduction of T4. What factor caused obesity?
Primary hypothyroidism
61
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?
Operation after antithyroid therapy
62
A 63 y.o. patient was operated on account of big multinodular euthyroid goiter. Despite of techical difficulties a forced subtotal resection of both parts of the thyroid gland was performed. On the 4-th day after the operation the woman had cramps of face muscles and upper extremities, stomach ache. Positive Chvostek's and Trousseau's signs. What is the most probable cause of such condition?
Insufficiency of parathyroid glands
63
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?
Propranolol
64
In morgue there are dead bodies with the following causes of death: electrotrauma; rupture of the spleen with acute anemia. There is one unknown person; one ethyl alcohol poisoned person and one drowned man. What dead body should the blood group be determined for?
All dead bodies of the unknown persons
65
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:
Choledocholithiasis
66
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 urine. In blood: neutrophilic leukocytosis - 13,1*109 /l, ESR - 28 mm/h. What is the most likely diagnosis?
Chronic calculous cholecystitis
67
47 y.o. patient complains of intensive skin itching, jaundice, bone pain. The skin is hyperpigmentated. There are multiple xanthelasma palpebrae. The liver is +6 cm enlarged, solid with acute edge. The blood analysis revealed total bilirubin -160 mkmol/L, direct - 110 mkmol/L, AST- 2,1 mmol/L, ALT- 1,8 mmol/L, alkaline phosphotase - 4,6 mmol/L, cholesterol- 9,2 mmol/L, antimitochondrial antibodies M2 in a high titer. What is the probable diagnosis?
Primary biliary liver cirrhosis
68
A 28 y.o. man fell seriously ill, he feels chill, has got a fever, body temperature raised up to 38,5 0С, paroxysmal pain in the left iliac region, frequent defecation in form of fluid bloody and mucous mass. Abdomen palpation reveals painfulness in its left half, sigmoid colon is spasmed. What is the most probable diagnosis?
Acute dysentery
69
A 75 y.o. man has acute pain in the paraumbilical region accompanied by vomiting and feeling of abdominal swelling in approximately 30 minutes after meals. He lost 10 kg during the last months because he doesn't eat in order to avoid pain. Abdomen examination reveals no changes in the periods between pain attacks. Above the right femoral artery a murmur can be auscultated, peripheral pulsation in the lower extrimities is weak. X-ray examination of stomach and colonoscopy reealed no changes. What is the leading factor of his pathogenesis?
Ischemia
70
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 38,9oC, along with right upper quadrant tenderness. The most likely diagnosis is:
Choledocholithiasis
71
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?
Aluminium-bearing antacid
72
A 50-year-old patient was hospitalized in severe condition with complaints of chills, high grade temperature, dryness in the mouth, multiple vomiting, pain in the epigastrium, frequent watery, foamy, dirty green color stool of unpleasant odor. The tongue and the skin are dry. BP - 80/40 mm Hg. What first aid is necessary for the patient?
Intravenous injection of sodium solutions
73
A 37-year-old patient has sudden acute pain in the right epigastric area after having fatty food. What method of radiological investigation is to be used on the first stage of examining the patient?
Ultrasonic
74
A 51 y.o. woman complains of dull pain in the right subcostal area and epigastric area, nausea, appetite decline during 6 months. There is a history of gastric peptic ulcer. On examination: weight loss, pulse is 70 bpm, AP is 120/70 mm Hg. Diffuse tenderness and resistance of muscles on palpation.There is a hard lymphatic node 1x1cm in size over the left clavicle. What method of investigation will be the most useful?
Esophagogastroduodenoscopy with biopsy
75
A 54 year old male patient complains about permanent dull pain in the mesogastral region, weight loss, dark blood admixtures in the feces, constipations. He put off 10 kg within a year. In blood: erythrocytes: 3,51012/l, Hb- 87 g/l, leukocytes - 12,6109 /l, stab neutrophil shift, ESR- 43 mm/h. What is the most probable diagnosis?
Cancer of transverse colon
76
A 40 y.o. patient was admitted to the gasteroenterology with skin itching, jaundice, discomfort in the right subcostal area, generalized weakness. On examination: skin is jaundice, traces of scratches, liver is +5 cm, splin is 6x8 cm. In blood: alkaline phosphatase- 2,0 mmol/(hour*L), general bilirubin - 60 mkmol/L, cholesterol - 8,0 mmol/L. What is the leading syndrome in the patient?
Сholestatic
77
A patient complains of retrosternal pain, difficult swallowing, over 10 kg weight loss within three months, general weakness. In blood: hypochromic anaemia, neutrophilic leukocytosis. In feces: weakly positive Gregersen's reaction. On esophagram a filling defect with ill-defined serrated edges shows up along a large portion of the esophagus. What is the most likely diagnosis?
Esophageal carcinoma
78
A 49-year-old male patient complains of retrosternal pain, heartburn, weight loss of 8 kg over the last year, constipation, weakness. The patient has been a smoker for 20 years, and has a 10-year history of gastroesophageal reflux disease. The patient is asthenic, has dry skin. EGD revealed an ulcer in the lower third of the esophagus and esophageal stricture accompanied by edema, hyperemia and multiple erosions of the mucosa. What study is required for more accurate diagnosis?
Biopsy of the esophageal mucosa
79
A 38 y.o. man complains of having occasional problems with swallowing of both hard and fluid food for many months. Sometimes he feels intense pain behind his breast bone, epecially after hot drinks. There are asphyxia onsets at night. He has not put off weight. Objectively: his general condition is satisfactory, skin is of usual colour. Examination revealed no changes of gastrointestinal tract. X-ray picture of thorax organs presents esophagus dilatation with level of fluid in it. What is the preliminary diagnosis?
Esophagus achalasia
80
A 49-year-old patient complains of deglutition problems, especially with solid food, hiccups, voice hoarseness, nausea, regurgitation, significant weight loss (15 kg within 2,5 months). Objectively: body weight is reduced. Skin is pale and dry. In lungs: vesicular breathing, heart sounds are loud enough, heart activity is rhythmic. The abdomen is soft, painless on palpation. Liver is not enlarged. What study is required to make a diagnosis?
Esophageal duodenoscopy along with biopsy
81
A 23-year-old patient complains of a dull ache, sensation of heaviness and distention in the epigastrium immediately after meals, foul-smelling eructation; dry mouth, empty stomach nausea, diarrhea. Objectively: the skin is pale, the patient is of thin build. Abdomen is soft on palpation, there is epigastric pain. The liver does not extend beyond the costal arch. In blood: Hb - 110 g/l, RBCs - $3,4¥cdot10^{12}$/l, WBC count is normal. ESR - 16 mm/h. What is the most informative study that will allow make a diagnosis?
Esophageal gastroduodenoscopy
82
A 27 y.o. man complained of aching epigastric pain right after meal, heartburn and nausea. Stomach endoscopy revealed a large amount of mucus, hyperemia and edema of mucous membrane in gastric fundus with areas of atrophy. Make a diagnosis.
Chronic gastritis of type A
83
A 27 year old man complains of pains in epigastrium which are relieved by food intake. EGDFS shows antral erosive gastritis, biopsy of antral mucous presents Hеlicobacter Pylori. Diagnosis is:
Gastritis of type B
84
Gastric juice analysis of a 42-year-old male patient revealed absence of free hydrochloric acid at all stages. Endoscopy revealed pallor, thinning of gastric mucosa, smoothed folds. Microscopically the atrophy of glands with intestinal metaplasia was found. What disease is this situation typical for?
Chronic type A gastritis
85
A 63-year-old female complains of general weakness, a feeling of heaviness, compression in the epigastrium, postprandial fullness, nausea, belching after meals. These symptoms have been observed for about 15 years. Objectively: body temperature is 36,4oC, respiratory rate - 20/min, Ps - 88/min, blood pressure - 115/75 mm Hg. Skin and mucous membranes are pale. Blood test results: RBC - 2,0x1012/l, Hb - 100 g/l. Tests revealed parietal-cell antibodies. What is the most likely reason for the development of anemia in this patient?
Production of antibodies to intrinsic factor
86
A 50 year old woman complained of attacks of right subcostal pain after fatty meal she has been suffering from for a year. Last week the attacks repeated every day and became more painful. What diagnostic study would you recommend?
Ultrasound examination of the gallbladder
87
A patient complains of feeling heaviness behind his breast bone, periodical sensation of food stoppage, dysphagy. During the X-ray examination barium contrast revealed a single saccular outpouching of anterodextral esophagus wall with regular contours and rigidly outlined neck. What is the most probable diagnosis?
Esophageal diverticulum
88
A 63 y.o. woman complains of motiveless weakness, rapid fatigability, loss of appetite, aversion to meat. Two days ago she had stomach bleeding. Objectively: temperature - 37,50С, BR- 20/min, Ps- 96/min, AP- 110/75 mm Hg. On palpation in epigastrium - pain and muscle tension. Blood count: Hb- 82 g/L, ESR- 35 mm/h. What examination will allow to make a diagnosis?
Cytologic
89
A 43-year-old male patient undergoing treatment for peptic ulcer complains of weakness, dizziness, coffee-ground vomiting, melena. After administration of haemostatics the patient's condition has not improved, fresh blood has shown up in the vomit, skin bruises of different sizes have appeared. In blood: thrombocytes - $50¥cdot10^9$/l, Lee-White clotting time - 35 minutes, APTT - 80 seconds. In this case it is most rational to administer the following preparation:
Fresh frozen plasma
90
A male patient complains of heartburn which gest stronger while bending the body, substernal pain during swallowing. There is a hiatus hernia on X-ray. What disoeder should be expected at gastroscopy?
Gastroesophageal reflux
91
A 35-year-old patient complains of heartburn, sour eructation, burning, compressing retrosternal pain and pain along the esophagus rising during forward bending of body. The patient hasn't been examined, takes Almagel on his own initiative, claims to feel better after its taking. Make a provisional diagnosis:
Gastroesophageal reflux disease
92
A 28-year-old male patient complains of sour regurgitation, cough and heartburn that occurs every day after having meals, when bending forward or lying down. These problems have been observed for 4 years. Objective status and laboratory values are normal. FEGDS revealed endoesophagitis. What is the leading factor in the development of this disease?
Failure of the lower esophageal sphincter
93
A 43-year-old female patient complains of unstable defecation with frequent constipations, abdominal swelling, headache, sleep disturbance. Body weight is unchanged. What disease are these clinical presentations typical for?
Irritable colon syndrome
94
A 33-year-old female complains of escalating spastic pain in the abdomen after the psycho-emotional stress. The patient has intermittent bowel movements, that is 2-3 bowel movements after waking up alternate with constipation lasting for 1-2 days. Objectively: body weight is unchanged, there is moderate pain on palpation of the sigmoid colon. Hb- 130 g/l, WBC- 5,2*109 /l, ESR- 9 mm/h. Proctosigmoidoscopy causes pain due to spastic bowel condition, intestinal mucosa is not changed. In the lumen there is a lot of mucus. What is the most likely diagnosis?
Irritable bowel syndrome
95
A 51-year-old female patient complains of frequent defecation and liquid blood-streaked stools with mucus admixtures, diffuse pain in the inferolateral abdomen, 6 kg weight loss over the previous month. Objectively: body temperature - $37,4^oC$, malnutrition, skin is pale and dry. Abdomen is soft, sigmoid is painful and spasmodic, makes a rumbling sound. Liver is dense, painful, extends 3 cm below the costal margin. What is the most likely diagnosis?
Non-specific ulcerative colitis
96
A 45-year-old female patient complains of frequent liquid stools with a lot of mucus, pus and blood; pain across the abdomen, loss of 7 kg within 6 months. She has a 1-year history of non-specific ulcerative colitis. What group of drugs should be preferred for this patient?
Corticosteroids
97
A 47-year-old female patient has an 8-year history of ulcerative colitis, has been treated with glucocorticoids. She complains of cramping pain in the umbilical region and left iliac region which has significantly increased during the past 2 weeks, diarrhea with mucus and blood 4-6 times a day, elevated body temperature up to 38-39oC, headache and pain in the knee joints. Objectively: the patient is in moderate condition, Ps - 108/min, AP - 90/60 mm Hg; heart and lungs are unremarkable; the tongue is moist; abdominal muscle tone is significantly decreased; peristaltic noises are absent. What complication developed in the patient?
Toxic dilatation of the colon
98
A 40-year-old man is ill with autoimmune hepatitis. Blood test: А/G ratio 0,8, bilirubin - 42μmol/L, transaminase : ALT- 2,3 mmol g/L, АSТ - 1,8 mmol g/L. What is the most effective means in treatment from the given below?
Glucocorticoids, cytostatics
99
A 42 y.o. woman suffers from micronodular cryptogenic cirrhosis. During the last week her condition has been worsening: she had spasms, consciousness aberration, jaundice. What examination may account for the worsening of the patient's condition?
Estimation of serum ammonia
100
A 43 y.o. male complains of stomach pain, which relieves with defecation, and is accompanied by abdominal winds, rumbling, the feeling of incomplete evacuation or urgent need for bowel movement, constipation or diarrhea in alternation. These symptoms have lasted for over 3 months. No changes in laboratory tests. What is the most likely diagnosis?
Irritable bowel syndrome
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51問 • 2年前問題一覧
1
A triad of symptoms ("stearing spot", "terminal film", "blood dew") has been revealed on examination of a patient. What disease should you think about?
Psoriasis
2
A 45-year-old patient complains of some painless nodular elements tending to peripheral growth and fusion. He has a 2-year history of this disease. Aggravation takes place mainly in spring. In anamnesis: the patient's father had similar skin lesions. Objectively: pathological elements looke like guttate and nummular nodules, plaques covered with white scales. What is your provisional diagnosis?
Psoriasis
3
A 28 y.o. woman consulted a doctor with the complaints of enlargening in size of an inborn pigment nevus, it was also wetting and itching. What test should not be used for diagnostics in this case?
Incision biopsy
4
A 23 year old patient fell ill 3 weeks ago when she noticed a very painful induration in her axillary crease. 4-5 days later it burst and discharged a lot of pus. After that some new infiltrations appeared around the affected area. The patient has never suffered from skin diseases before. What is the most probable diagnosis?
Hydradenitis
5
A 26-year-old male patient complains of a rash on the upper lip skin, which arose on a background of influenza with high-grade fever and is accompanied by pain and burning. The rash has been present for 3 days. Objectively: the skin of the upper lip is edematic and erythematous, grouped vesicles are filled with serous fluid and have a rough surface. What is the most likely diagnosis?
Herpetic vesicular dermatitis
6
Psoriasis of the nails A 41-year-old patient cosulted a dermatologist about discoloration, thickening, brittleness of toenails. These symptoms have been present for about five years. Objectively: nail plates in all toes are thickened, of dirty yellow color, lustreless, crumble over the edge. Microscopy of the nail plate material treated with alkali revealed mycelial filaments. Material inoculation onto Sabouraud medium resulted in growth of the Trichophyton rubrum colony. What is the most likely diagnosis?
Rubromycosis of toenails
7
A 38-year-old female suddenly developed acute inflammatory rash in form of roseolas, papules, vesicles that are scattered on the skin of trunk in irregular and predominantly focal manner. The rash appeared a few hours after visiting a restaurant. The patient complains of itching skin. What is the most likely diagnosis?
Toxicodermatosis
8
A 30 y.o. patient has got multiple body skin rash consisting of small paired elements that are scattered on the skin diorderly and mostly focally, they are accompanied by itch. The rash appeared a few days after attending sport centre and sauna. What is the most probable diagnosis?
Scab
9
The 28 y.o. woman applied to doctor because of limited loss of the hair. In the anamnesis - she had frequent headache indisposition, arthromyalgia, fever, irregular casual sexual life, drug user. RW is negative. What examination must be done first?
Examination for HIV
10
A female patient consulted a dermatologist about the rash on the trunk and extremities. Objectively: interdigital folds, flexor surfaces of wrists and navel region are affected with pairs of nodulo-cystic eruptions and crusts. The rash is accompanied by skin itch that is getting stronger at night. What external treatment should be administered?
20¥% benzyl benzoate emulsion
11
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?
Rubromycosis
12
A 51 y.o. women was taken to the emergency department in convulsive status epilepticus. The first means of medical management should be:
Ensuring that the airway is open and the patient is oxygenating
13
A 14-year-old victim was drawn out of the water in winter after 15 minutes of being in the water. The victim shows no vital signs. What measures are to be taken?
To release respiratory tract from water, to create drain position and to take on measures to restore respiration and blood circulation
14
Explosion of a tank with benzene at a chemical plant has killed and wounded a large number of people. There are over 50 victims with burns, mechanical injuries and intoxication. Specify the main elements of medical care and evacuation of population in this situation:
Sorting, medical assistance, evacuation
15
A 20 y.o. man has a stab knife wound in the left half of thorax close to nipple. AP is 90/60 mm Hg, Ps- 130/min, BR- 32/min. During inspiration there is increase of pulse wave in the region of jugular vein, decrease of peripheral arterial pulse and reduction of AP. Respiratory murmurs are unchanged. X-ray pattern of thorax organs has no pecularities. After introduction of 2 l of isotonic solution the AP stayed low, CVP raised up to 32 cm of water column. The first step in further treatment of the patient will be:
Echocardiogram
16
A 48 y.o. patient has been staying in the emergency department for 2 days on account of acute anteroseptal myocardial infarction. In the course of examination he suddenly "snored". There was a tonic contraction of skeletal muscles; eye pupils dilatated. Pulse on a.carotis is absent. What is the immediate tactics?
Electric defibrillation
17
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 respiration above lungs, sibilant rales. What drug group should be administered in the first place?
Glucocorticoids
18
A 50 y.o. male patient was taken to the emergency department with diffuse abdominal pain and signs of cardiovascular collapse. On arrival he had BP- 95/60 mm Hg, Ps- 120/min, diuresis - 20 ml/h, HgB- 100 g/L, RBC- 2,1*1012/L. The patient needs introduction of:
Crystalloid and colloid
19
A patient who takes diuretics has developed arrhythmia as a result of cardiac glycoside overdose. What is the treatment tactics in this case?
Increased potassium concentration in blood
20
In a cold weather, the emergency room admitted a patient pulled out of the open water. There was no respiratory contact with the water. The patient is excited, pale, complains of pain, numbness of hands and feet, cold shiver. Respiratory rate is 22/min, AP - 120/90 mm Hg, Ps - 110/min, rectal temperature is 34,5oC. What kind of warming is indicated for this patient?
Passive warming
21
The family doctor examined a patient and diagnosed an acute bleeding of an intestine. What is the doctor's professional tactics in this situation?
The urgent hospitalization in to the surgical department
22
A 38-year-old woman experiences episodic increases in arterial pressure up to 240/120 mm Hg, which is accompanied by nausea, vomiting, tachycardia, increased sweating, hyperglycemia. The attack is usually followed by the excessive urination. Renal sonography reveals an additional formation adjacent to the upper pole of the right kidney and possibly belonging to the adrenal gland. What laboratory test will allow to clarify the diagnosis?
Determination of urinary excretion of catecholamines and vanillylmandelic acid
23
A 45-year-old female patient complaining of general weakness, nausea and vomiting hass been delivered to a hospital by the ambulance. Recently there has been a lack of appetite, weight loss. Objectively: hyperpigmentation of skin, blood pressure at the rate of 70/45 mm Hg, bradycardia. Additional studies revealed the reduced concentration of aldosterone and cortisol in blood, decreased excretion of 17-ketosteroids and 17-oxyketosteroids in the urine, hyponatremia, chloropenia, hypokalemia. What therapeutic measures are required?
To administer glucocorticoids, mineralocorticoids, and a diet with a high content of cooking salt
24
A 38 y.o. patient was urgently admitted to the hospital with complaints of sudden weakness, dizziness, loss of consciousness, body weight loss, nausea, vomiting, severe pain in epigastric area, diarrhea, skin hyperpigmentation. What is the most probable diagnosis?
Addisonic crisis
25
Which of the following IS NOT TYPICAL for Addison's disease?
High serum Na+
26
A 58 y.o. woman had voluminous bleeding from the ruptured varicous node on the left crus. What first aid should be provided?
Heightened position of extremity, compressive sterile bandage
27
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 significantly weakened, heart rate - 60/min, AP- 80/40 mm Hg. The abdomen is slightly painful in the epigastrial region. In blood: WBCs - 8,1*109 /l, glucose - 3,0 millimole/l. What is the most likely diagnosis?
Chronic adrenal insufficiency. Addisonian crisis
28
A 34 y.o. patient has been suffering from pulmonary tuberculosis for 7 years; he complains of muscle feebleness, weight loss, diarrheas, increased frequency of urination. Objectively: hyperpigmentation of skin, gums, internal cheek surfaces. AP is 90/58 mm Hg. Blood count: erythrocutes - 3,11012/L, Hb- 95 g/L, C.I.- 0,92; leukocytes - 9,4109 /L, eosinophils - 7, segmentonuclear leukocytes - 45, stab neutrophils - 1, lymphocytes - 40, monocytes - 7, Na+ - 115 mmole/L, К+ - 7,3 mmole/L. What is the preliminary diagnosis?
Primary insufficiency of adrenal cortex
29
After a holiday in the Crimea, a 49-year-old male patient with a history of lung tuberculosis felt increased weakness, periodic dizziness, easing bowel movements with abdominal pain, the need for additional salting his meals. The patient has noted that his condition improves after some sweet tea and validol taken sublingually. Objectively: there is an intense darkening of skin, AP- 70/50 mm Hg, glycemia is 3,0 mmol/l. What is the possible cause of health deterioration:
Chronic adrenal insufficiency
30
After having the flu, a 39-year-old male patient with a history of Addison's disease developed a condition manifested by weakness, depression, nausea, vomiting, diarrhea, hypoglycemia. AP75/50 mm Hg. Blood test results: low corticosterone and cortisol, 13-oxycorticosteroids, 17-oxycorticosteroids levels. What condition developed in the patient?
Acute adrenal insufficiency
31
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 millimole/l, K - 5,8 millimole/l. Development of this complication is primarily caused by the deficit of the following hormone:
Cortisol
32
A 38 y.o. woman suffers from paroxysmal AP rises up to 240/120 mm Hg accompanied by nausea, vomiting, tachycardia, excessive sweating. During the onset blood is hyperglycemic. After the onset there is voluminous urination. Kidneys sonography revealed accessory mass bordering upon the upper pole of the right kidney, presumably it belongs to the adrenal gland. What laboratory test will allow to make a more precise diagnosis?
Estimation of catecholamine and vanillylmandelic acid excretion with urine
33
A 54-year-old patient complains of weakness, weight loss despite the unchanged appetite, frequent urination, skin itch for six months. Some time ago the patient underwent treatment for furunculosis. She hasn't been examined recently. Objectively: malnutrition, dry skin with signs of scratching. Small lymph nodes can be palpated in the axillary regions. Changes in the internal organs are absenr. What testing must be administered in the first place?
Blood sugar test on an empty stomach
34
A 49-year-old female patient has type 1 diabetes of moderate severity. The disease is complicated by retinopathy and polyneuropathy. Besides that, repeated analyses of the daily urinary excretion of albumin revealed microalbuminuria (200-300 mg/day). Glomerular filtration rate is 105 ml/min. Blood pressure is within normal range. Normalization of the following indicator should be the first-priority task in the secondary prevention of diabetic nephropathy:
Glycosylated hemoglobin
35
A 40-year-old female patient complain of headache, dizziness, muscle weakness, sometimes - cramps in the extremities. She has been taking antihypertensive medications for 10 years. AP- 180/100 mm Hg. Blood potassium - 1,8 millimole/l, sodium - 4,8 millimole/l. In urine: alkaline reaction, the relative density - 1012, protein and sugar are not found, WBCs - 3-4 in the field of vision, RBCs - 1-2 in the field of vision. Conn's syndrome is suspected. Which drug should be chosen for the treatment of arterial hypertension?
Spironolactone
36
During examination a patient is unconscious, his skin is dry and hot, face hyperemia is present. The patient has Kussmaul's respiration, there is also smell of acetone in the air. Symptoms of peritoneum irritation are positive. Blood sugar is at the rate of 33 millimole/l. What emergency actions should be taken?
Intravenous infusion of short-acting insulin
37
A 13 year old patient is suffering from an acute disease with the following symptoms: thirst, polyuria, weakness. Objectively: his general condition is satisfactory, there is no smell of acetone. Glucose concentration in blood on an empty stomach is 32 micromole/l, in urine - 6%, acetone +. What treatment should be administered?
Short-acting insulin
38
A 23 y.o. woman who suffers from insulin-dependent diabetes was admitted to the acute care department with mental confusion, inadequate anxious behaviour, hyperhidrosis, excessive salivation, tachycardia. What examination will be a primary task?
Blood test for sugar
39
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?
Insulinemia on an empty stomach
40
A 35-year-old man was operated on peptic ulcer of the stomach. Mass deficit of the body is 10 kg. The level of glucose after operation in the undiluted cellular blood on an empty stomach is 6,7 mmol. During repeated examination - 11,1 mmol (after meal), level of HbA1c - 10%. Could you please make an interpretation of the given data?
Diabetes mellitus
41
A 33 y.o. patient with first time detected diabetes mellitus keeps the diet and maintains glycemia at the level of 10,0 mmol/L after meal. He keeps himself from insulinotherapy. What examination is the most important for differentiation of the 1st (insulin-dependent) and the 2nd (insulin-independent) types of diabetes?
Determination of insular cells antibodies
42
A 33 y.o. woman has been suffering from DM (diabetes mellitus) for 5 years. For the last 3 years she has been taking more than 100 units of insulin per day. Body weight has increased up to 10 kg. Fasting blood glucose is 13 mmol/L, glucoseuria - 3%. Generalized microangiopathy. By increasing the dose of insulin the parameters of glycemia do not change. The diagnosis is:
DM 1st type, severe form, decompensation, insulin resistant
43
A 62 year old patient suffers from DM-2. Diabetes is being compensated by diet and Maninilum. The patient has to undergo an operation on inguinal hernia. What tactics of hypoglycemic therapy should be chosen?
Prescribe fast-acting insulin
44
A 58-year-old patient has a 3-year history diabetes mellitus type II. He has been keeping to a diet and regularly taking glyburide. He has been delivered to a hospital on an emergency basis for acute abdomen. Objectively: the patient is of supernutrition type. The skin is dry. In the lungs vesicular breathing can be auscultated. Heart sounds are regular, 90/min. AP- 130/70 mm Hg. The symptom of "wooden belly" is visible. Blood sugar - 9,8 millimole/l. The patients has indication for laparotomy. What is the most appropriate way of further treatment of diabetes?
To administer short insulin
45
Preventive examination of a 55 year old patient revealed diabetes mellitus. The patient hasn't received treatment for it. Objectively: height is 170 cm, weight is 106 kg, skin humidity is normal. Ps is 76 bpm, rhythmic, left border of relative heart dullness is deviated by 1 cm to the left from the middle clavicular line, heart sounds are quiet, AP is 140/80 mm Hg. Glycemia on an empty stomach is 6,9 millimole/l. Glucose rate in the daily urine is 0,5%, diuresis makes up 2,5 l. What treatment tactics should be chosen?
To administer dietotherapy
46
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:
To replace maninil with insulin
47
A 24 year old patient complained about putting on weight, limosis. Objectively: the patient's constitution is of hypersthenic type, body weight index is 33,2 kg/m2 , waist circumference is 100 cm. Correlation of waist circumference to the thigh circumference is 0,95. What is the most probable diagnosis?
Alimentary constitutional obesity of the I stage, abdominal type
48
A 39-year-old female patient complains of dyspnea when walking, palpitation, edemata in the evening. The patient's height is 164 cm, weight - 104 kg. Objectively: overnutrition. Heart sounds are weak, and tachycardia is present. The menstrual cycle is not broken. Blood sugar is 5,6 mmol/l, ACTH-response tests revealed no alterations. X-ray of the Turkish saddle revealed no pathology. What disease is it?
Alimentary obesity
49
An unconscious patient presents with moist skin, shallow breathing. There are signs of previous injection on the shoulders and hips. BP- 110/70 mm Hg. Tonus of skeletal muscles and reflexes are increased. Cramps of muscles of the extremities are seen. What is the most likely disorder?
Hypoglycemic coma
50
A patient of 32 y.o. complains of severe weakness, tremor of extremities. Objective examination: body weight loss, wet and warm skin. The thyroid gland is enlarged up to the 3-rd degree, painless, elastic. Ps- 108/min. BP- 160/55 mm Hg. There are no other abnormalties. The diagnosis is:
Diffuse toxic goiter of the 3-rd degree, thyrotoxicosis of the average degree
51
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?
Gland scanning
52
A 26 y.o. male patient with postoperative hypothyroidism take thyroxine 100 mg 2 times a day. He has developed tachycardia, sweating, irritability, sleep disorder. Determine further treatment tactics.
To decrease thyroxine dosage
53
A 47-year-old woman underwent a thyroid gland resection on ccount of nodular euthyroid goiter. What preparations are most likely to prevent the disease recurrence?
Thyroid hormones
54
A 24-year-old male patient had been diagnosed with class III diffuse toxic goiter. There is moderate hyperthyroidism. A surgery was suggested, and the patient agreed to it. What preoperative measures should be taken for prevention of thyrotoxic crisis in the postoperative period?
Administration of antithyroid drugs
55
Male 30 y.o., noted growing fingers and facial scull, changed face. Complains of poor eyesight, weakness, skin darkening, loss of body weight. X-ray shows broadening of sella turcica, thinning of tuberculin sphenoidale, signs of increased intracranial pressure. What diagnosis can you make?
Adenoma of hypophysis
56
A 49 year old female patient was admitted to a hospital with acute attacks of headache accompanied by pulsation in temples, AP rose up to 280/140 mm Hg. Pheochromocytoma is suspected. What mechanism of hypertensive atack does this patient have?
Increase of catecholamine concentration
57
A 32-year-old female complains of dizziness, headache, palpitation, tremor. For the last several months she has been under outpatient observation for the increased arterial pressure. Since recently such attacks have become more frequent and severe. Objectively: skin is covered with clammy sweat, tremor of the extremities is present. HR- 110/min, AP- 220/140 mm Hg. Heart sounds are muffled. Blood test results: WBCs - $9,8¥cdot10^9$/l, ESR - 22 mm/h. Blood glucose - 9,8 millimole/l. What disease is the most likely cause of this crisis?
Pheochromocytoma
58
Examination of a hanged man's corpse revealed the following: livores mortis disappear when pressed, restore in 50 seconds, rigor mortis is moderately evident only in masseteric muscles, neck muscles and fingers. Body temperature is 31,00С. What is the prescription of death coming?
6-7 hours
59
A 37-year-old patient was brought to resuscitation unit. General condition of the patient is very serious. Sopor. The skin is grey, moist. Turgor is decreased. Pulse is rapid, intense. BP - 160/110 mm Hg, muscle tonus is increased. Hyperreflexia. There is an ammonia odor in the air. What is the presumptive diagnosis?
Uraemic coma
60
A female patient consulted a doctor about gain in weight, chill, edemata, dry skin, sleepiness, problems with concentration. Objectively: the patient's height is 165 cm, weight is 90 kg, gynoid body proportions, to - 35,8oC, ESR- 58/min, AP- 105/60 mm Hg. Heart sounds are weakened, bradycardia is present. Other internal organs have no changes. Thyroid gland is not palpable. Mammary glands ooze milk droplets. Hormonal study revealed rise of TSH and prolactin concentration, reduction of T4. What factor caused obesity?
Primary hypothyroidism
61
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?
Operation after antithyroid therapy
62
A 63 y.o. patient was operated on account of big multinodular euthyroid goiter. Despite of techical difficulties a forced subtotal resection of both parts of the thyroid gland was performed. On the 4-th day after the operation the woman had cramps of face muscles and upper extremities, stomach ache. Positive Chvostek's and Trousseau's signs. What is the most probable cause of such condition?
Insufficiency of parathyroid glands
63
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?
Propranolol
64
In morgue there are dead bodies with the following causes of death: electrotrauma; rupture of the spleen with acute anemia. There is one unknown person; one ethyl alcohol poisoned person and one drowned man. What dead body should the blood group be determined for?
All dead bodies of the unknown persons
65
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:
Choledocholithiasis
66
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 urine. In blood: neutrophilic leukocytosis - 13,1*109 /l, ESR - 28 mm/h. What is the most likely diagnosis?
Chronic calculous cholecystitis
67
47 y.o. patient complains of intensive skin itching, jaundice, bone pain. The skin is hyperpigmentated. There are multiple xanthelasma palpebrae. The liver is +6 cm enlarged, solid with acute edge. The blood analysis revealed total bilirubin -160 mkmol/L, direct - 110 mkmol/L, AST- 2,1 mmol/L, ALT- 1,8 mmol/L, alkaline phosphotase - 4,6 mmol/L, cholesterol- 9,2 mmol/L, antimitochondrial antibodies M2 in a high titer. What is the probable diagnosis?
Primary biliary liver cirrhosis
68
A 28 y.o. man fell seriously ill, he feels chill, has got a fever, body temperature raised up to 38,5 0С, paroxysmal pain in the left iliac region, frequent defecation in form of fluid bloody and mucous mass. Abdomen palpation reveals painfulness in its left half, sigmoid colon is spasmed. What is the most probable diagnosis?
Acute dysentery
69
A 75 y.o. man has acute pain in the paraumbilical region accompanied by vomiting and feeling of abdominal swelling in approximately 30 minutes after meals. He lost 10 kg during the last months because he doesn't eat in order to avoid pain. Abdomen examination reveals no changes in the periods between pain attacks. Above the right femoral artery a murmur can be auscultated, peripheral pulsation in the lower extrimities is weak. X-ray examination of stomach and colonoscopy reealed no changes. What is the leading factor of his pathogenesis?
Ischemia
70
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 38,9oC, along with right upper quadrant tenderness. The most likely diagnosis is:
Choledocholithiasis
71
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?
Aluminium-bearing antacid
72
A 50-year-old patient was hospitalized in severe condition with complaints of chills, high grade temperature, dryness in the mouth, multiple vomiting, pain in the epigastrium, frequent watery, foamy, dirty green color stool of unpleasant odor. The tongue and the skin are dry. BP - 80/40 mm Hg. What first aid is necessary for the patient?
Intravenous injection of sodium solutions
73
A 37-year-old patient has sudden acute pain in the right epigastric area after having fatty food. What method of radiological investigation is to be used on the first stage of examining the patient?
Ultrasonic
74
A 51 y.o. woman complains of dull pain in the right subcostal area and epigastric area, nausea, appetite decline during 6 months. There is a history of gastric peptic ulcer. On examination: weight loss, pulse is 70 bpm, AP is 120/70 mm Hg. Diffuse tenderness and resistance of muscles on palpation.There is a hard lymphatic node 1x1cm in size over the left clavicle. What method of investigation will be the most useful?
Esophagogastroduodenoscopy with biopsy
75
A 54 year old male patient complains about permanent dull pain in the mesogastral region, weight loss, dark blood admixtures in the feces, constipations. He put off 10 kg within a year. In blood: erythrocytes: 3,51012/l, Hb- 87 g/l, leukocytes - 12,6109 /l, stab neutrophil shift, ESR- 43 mm/h. What is the most probable diagnosis?
Cancer of transverse colon
76
A 40 y.o. patient was admitted to the gasteroenterology with skin itching, jaundice, discomfort in the right subcostal area, generalized weakness. On examination: skin is jaundice, traces of scratches, liver is +5 cm, splin is 6x8 cm. In blood: alkaline phosphatase- 2,0 mmol/(hour*L), general bilirubin - 60 mkmol/L, cholesterol - 8,0 mmol/L. What is the leading syndrome in the patient?
Сholestatic
77
A patient complains of retrosternal pain, difficult swallowing, over 10 kg weight loss within three months, general weakness. In blood: hypochromic anaemia, neutrophilic leukocytosis. In feces: weakly positive Gregersen's reaction. On esophagram a filling defect with ill-defined serrated edges shows up along a large portion of the esophagus. What is the most likely diagnosis?
Esophageal carcinoma
78
A 49-year-old male patient complains of retrosternal pain, heartburn, weight loss of 8 kg over the last year, constipation, weakness. The patient has been a smoker for 20 years, and has a 10-year history of gastroesophageal reflux disease. The patient is asthenic, has dry skin. EGD revealed an ulcer in the lower third of the esophagus and esophageal stricture accompanied by edema, hyperemia and multiple erosions of the mucosa. What study is required for more accurate diagnosis?
Biopsy of the esophageal mucosa
79
A 38 y.o. man complains of having occasional problems with swallowing of both hard and fluid food for many months. Sometimes he feels intense pain behind his breast bone, epecially after hot drinks. There are asphyxia onsets at night. He has not put off weight. Objectively: his general condition is satisfactory, skin is of usual colour. Examination revealed no changes of gastrointestinal tract. X-ray picture of thorax organs presents esophagus dilatation with level of fluid in it. What is the preliminary diagnosis?
Esophagus achalasia
80
A 49-year-old patient complains of deglutition problems, especially with solid food, hiccups, voice hoarseness, nausea, regurgitation, significant weight loss (15 kg within 2,5 months). Objectively: body weight is reduced. Skin is pale and dry. In lungs: vesicular breathing, heart sounds are loud enough, heart activity is rhythmic. The abdomen is soft, painless on palpation. Liver is not enlarged. What study is required to make a diagnosis?
Esophageal duodenoscopy along with biopsy
81
A 23-year-old patient complains of a dull ache, sensation of heaviness and distention in the epigastrium immediately after meals, foul-smelling eructation; dry mouth, empty stomach nausea, diarrhea. Objectively: the skin is pale, the patient is of thin build. Abdomen is soft on palpation, there is epigastric pain. The liver does not extend beyond the costal arch. In blood: Hb - 110 g/l, RBCs - $3,4¥cdot10^{12}$/l, WBC count is normal. ESR - 16 mm/h. What is the most informative study that will allow make a diagnosis?
Esophageal gastroduodenoscopy
82
A 27 y.o. man complained of aching epigastric pain right after meal, heartburn and nausea. Stomach endoscopy revealed a large amount of mucus, hyperemia and edema of mucous membrane in gastric fundus with areas of atrophy. Make a diagnosis.
Chronic gastritis of type A
83
A 27 year old man complains of pains in epigastrium which are relieved by food intake. EGDFS shows antral erosive gastritis, biopsy of antral mucous presents Hеlicobacter Pylori. Diagnosis is:
Gastritis of type B
84
Gastric juice analysis of a 42-year-old male patient revealed absence of free hydrochloric acid at all stages. Endoscopy revealed pallor, thinning of gastric mucosa, smoothed folds. Microscopically the atrophy of glands with intestinal metaplasia was found. What disease is this situation typical for?
Chronic type A gastritis
85
A 63-year-old female complains of general weakness, a feeling of heaviness, compression in the epigastrium, postprandial fullness, nausea, belching after meals. These symptoms have been observed for about 15 years. Objectively: body temperature is 36,4oC, respiratory rate - 20/min, Ps - 88/min, blood pressure - 115/75 mm Hg. Skin and mucous membranes are pale. Blood test results: RBC - 2,0x1012/l, Hb - 100 g/l. Tests revealed parietal-cell antibodies. What is the most likely reason for the development of anemia in this patient?
Production of antibodies to intrinsic factor
86
A 50 year old woman complained of attacks of right subcostal pain after fatty meal she has been suffering from for a year. Last week the attacks repeated every day and became more painful. What diagnostic study would you recommend?
Ultrasound examination of the gallbladder
87
A patient complains of feeling heaviness behind his breast bone, periodical sensation of food stoppage, dysphagy. During the X-ray examination barium contrast revealed a single saccular outpouching of anterodextral esophagus wall with regular contours and rigidly outlined neck. What is the most probable diagnosis?
Esophageal diverticulum
88
A 63 y.o. woman complains of motiveless weakness, rapid fatigability, loss of appetite, aversion to meat. Two days ago she had stomach bleeding. Objectively: temperature - 37,50С, BR- 20/min, Ps- 96/min, AP- 110/75 mm Hg. On palpation in epigastrium - pain and muscle tension. Blood count: Hb- 82 g/L, ESR- 35 mm/h. What examination will allow to make a diagnosis?
Cytologic
89
A 43-year-old male patient undergoing treatment for peptic ulcer complains of weakness, dizziness, coffee-ground vomiting, melena. After administration of haemostatics the patient's condition has not improved, fresh blood has shown up in the vomit, skin bruises of different sizes have appeared. In blood: thrombocytes - $50¥cdot10^9$/l, Lee-White clotting time - 35 minutes, APTT - 80 seconds. In this case it is most rational to administer the following preparation:
Fresh frozen plasma
90
A male patient complains of heartburn which gest stronger while bending the body, substernal pain during swallowing. There is a hiatus hernia on X-ray. What disoeder should be expected at gastroscopy?
Gastroesophageal reflux
91
A 35-year-old patient complains of heartburn, sour eructation, burning, compressing retrosternal pain and pain along the esophagus rising during forward bending of body. The patient hasn't been examined, takes Almagel on his own initiative, claims to feel better after its taking. Make a provisional diagnosis:
Gastroesophageal reflux disease
92
A 28-year-old male patient complains of sour regurgitation, cough and heartburn that occurs every day after having meals, when bending forward or lying down. These problems have been observed for 4 years. Objective status and laboratory values are normal. FEGDS revealed endoesophagitis. What is the leading factor in the development of this disease?
Failure of the lower esophageal sphincter
93
A 43-year-old female patient complains of unstable defecation with frequent constipations, abdominal swelling, headache, sleep disturbance. Body weight is unchanged. What disease are these clinical presentations typical for?
Irritable colon syndrome
94
A 33-year-old female complains of escalating spastic pain in the abdomen after the psycho-emotional stress. The patient has intermittent bowel movements, that is 2-3 bowel movements after waking up alternate with constipation lasting for 1-2 days. Objectively: body weight is unchanged, there is moderate pain on palpation of the sigmoid colon. Hb- 130 g/l, WBC- 5,2*109 /l, ESR- 9 mm/h. Proctosigmoidoscopy causes pain due to spastic bowel condition, intestinal mucosa is not changed. In the lumen there is a lot of mucus. What is the most likely diagnosis?
Irritable bowel syndrome
95
A 51-year-old female patient complains of frequent defecation and liquid blood-streaked stools with mucus admixtures, diffuse pain in the inferolateral abdomen, 6 kg weight loss over the previous month. Objectively: body temperature - $37,4^oC$, malnutrition, skin is pale and dry. Abdomen is soft, sigmoid is painful and spasmodic, makes a rumbling sound. Liver is dense, painful, extends 3 cm below the costal margin. What is the most likely diagnosis?
Non-specific ulcerative colitis
96
A 45-year-old female patient complains of frequent liquid stools with a lot of mucus, pus and blood; pain across the abdomen, loss of 7 kg within 6 months. She has a 1-year history of non-specific ulcerative colitis. What group of drugs should be preferred for this patient?
Corticosteroids
97
A 47-year-old female patient has an 8-year history of ulcerative colitis, has been treated with glucocorticoids. She complains of cramping pain in the umbilical region and left iliac region which has significantly increased during the past 2 weeks, diarrhea with mucus and blood 4-6 times a day, elevated body temperature up to 38-39oC, headache and pain in the knee joints. Objectively: the patient is in moderate condition, Ps - 108/min, AP - 90/60 mm Hg; heart and lungs are unremarkable; the tongue is moist; abdominal muscle tone is significantly decreased; peristaltic noises are absent. What complication developed in the patient?
Toxic dilatation of the colon
98
A 40-year-old man is ill with autoimmune hepatitis. Blood test: А/G ratio 0,8, bilirubin - 42μmol/L, transaminase : ALT- 2,3 mmol g/L, АSТ - 1,8 mmol g/L. What is the most effective means in treatment from the given below?
Glucocorticoids, cytostatics
99
A 42 y.o. woman suffers from micronodular cryptogenic cirrhosis. During the last week her condition has been worsening: she had spasms, consciousness aberration, jaundice. What examination may account for the worsening of the patient's condition?
Estimation of serum ammonia
100
A 43 y.o. male complains of stomach pain, which relieves with defecation, and is accompanied by abdominal winds, rumbling, the feeling of incomplete evacuation or urgent need for bowel movement, constipation or diarrhea in alternation. These symptoms have lasted for over 3 months. No changes in laboratory tests. What is the most likely diagnosis?
Irritable bowel syndrome