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

108. A 45-year-old patient consulted a GP in ambulatory with complaints of constricting chest pain that arose at night, lasting more than 20 minutes, which were not relieved by nitroglycerin. On the ECG complex QS. The doctor diagnosed IHD. Acute posterior myocardial infarction. Localization of myocardial infarction is diagnosed based on changes in leads:

109. A 65-year-old patient has weakness, shortness of breath, legs pitty edema. From the anamnesis: 6 years ago he had a myocardial infarction. On physical examination: heart sounds are muffled, rhythmic, heart rate-82 per minute. In the lower parts of the lungs, moist rales are heard. On the ECG: scar changes in the anterior wall of the LV and the septum. On echocardiography: left ventricle is enlarged to 5.8 cm, the wall is thickened to 1.2 cm, anterior wall akinesia. EF 42%. What is the patient’s diagnosis:

110. Which ECG changes are observed at an attack of stable (exertional) angina:

111. What is the most significant risk factor for coronary heart disease?

112. A patient with arterial hypertension is disturbed by constant dry cough while taking pharmacological therapy for hypertension. What group of drugs can cause this side effect?

113. In the diet of a patient with arterial hypertension you should restriction the intake of:

114. A patient complains of dyspnea and palpitations during minor physical activity. According to the New York Heart Association (NYHA) classification, what functional class of chronic heart failure does his condition correspond to:

115. Which of the following drugs is more reasonable to prescribe as basic therapy for the 59 years old patient with Arterial hypertension degree 3, high risk, Chronic heart failure, functional class I?

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

117. The most common cause of death in acute myocardial infarction is:

118. What drug should you prescribe to a patient with arterial hypertension and bradycardia?

119. The most sensitive biomarker of myocardial infarction is:

120. There are compelling contraindication to the use of these drugs for the patients with arterial hypertension and bilateral renal artery stenosis:

121. 1st degree AV block is characterized by ECG signs: • only ventricular contractions are registered

122. The duration of chest pain in stable (exertional) angina is:

123. Contraindication to the use of ACE inhibitors is:

124. In which following leads are there ECG changes in inferior myocardial infarct of the left ventricle:

126. A 50 years old man has been complaining for 3 months of retrosternal pressing pain, occurring when walking up to 500 meters or when climbing stairs to the third floor. This case of angina pectoris can be classified as:

127. A 35 years old patient complains of attacks of pressing pains in the chest. He woke up early in the morning with pain, and the several painful attacks occur in the form of alternating series of 10-15 minutes. ECG shows ST-segment elevation during the attack, after the attack ST-segment on baseline. What is your most likely diagnosis?

128. Women, 59 years old, after intensive work in the garden, felt severe chest pain, crushing pain in the left arm, shortness of breath, weakness, sweating. She took nitroglycerin three times, but severe chest pain didn't relieve. Objectively: she is very anxious, frightened, skin pale and moist. Heart sounds were muffled, arrhythmia, heart rate 90 per minute, BP 145/75 mm Hg. What is your most likely diagnosis?

129. A 53 years old woman follow up at the family doctor with the diagnosis: Сoronary heart disease. Angina pectoris functional class 2. Сhronic heart failure, functional class I. On the EchoCG: diastolic dysfunction of the left ventricle. What drug is reasonable to use for treatment this patient?

130. A 22 years old women has blood pressure 175/125 mm Hg for more than 1 year, refractory to hypotensive therapy. Also she has frequent attacks of abdominal pain. On examination a systolic murmur is heard above the umbilicus. What is your most likely diagnosis?

131. A 54 years old woman has been suffering from arterial hypertension and angina pectoris for 13 years. The correct scheme of drugs therapy for this patient is:

132. A 49 years old men with overweight, without bad habits, notes the occurrence of transient chest pains during excessive physical exertion, when climbing up to the 5th floor; the pains go away on their own by rest. On the ECG: no changes. What is your most likely diagnosis?

133. A 48 years old men suffering from coronary heart disease, angina pectoris, II functional class, has constant tachycardia with heart rate up to 100 per 1 minute. Which drug is considered reasonable in this case?

134. A 58 years old patient suffering from coronary heart disease with rhythm disturbances and grade II arterial hypertension should start drug therapy with:

135. A 45 years old patient with acute myocardial infarction. On the ECG: polytopic group of ventricular extrasystoles. In this case the patient should be administered with:

136. Seven weeks after acute myocardial infarction, a patient was presented with chest pain and fever. Examination revealed pericarditis and pleurisy. What is your most likely diagnosis?

137. A patient has an acute myocardial infarction and high blood pressure. Which drug is preferred to reduce high blood pressure in this case?

138. Which drug is inadvisable to use in an attack of Prinzmetal angina?

139. Select the ECG sign that is absolutely significant for acute myocardial infarction:

140. A 68 years old patient with grade III arterial hypertension is disturbed by dyspnea and palpitations at rest. According to the New York Heart Association (NYHA) classification, what functional class of chronic heart failure does his condition correspond to?

141. Choose the best drugs to treat a patient with coronary heart disease and concomitant COPD?

142. A 73 years old woman has arterial hypertension and angina pectoris for many years. Choose the optimal combination of drugs for treatment:

143. A 62-year-old female patient with functional class II angina pectoris is constantly suffering from tachycardia up to 100 beats per minute. What drug is most effective for this condition//

144. A 15 years old adolescent has increased blood pressure to 175/115 mmHg, complains of occasional numbness in the legs. Objectively: Well-developed thorax, narrow pelvis and thin legs. Differential blood pressure between upper and lower extremities was noted. On chest x-ray: bilateral rib notching. What is your most likely diagnosis?

145. Which of the instrumental tests is the most informative to detect left ventricular hypertrophy:

146. A 40 years old patient suffering from grade II arterial hypertension, grade I chronic heart failure and type I diabetes mellitus. Her primary care physician prescribed bisoprolol as maintenance therapy for arterial hypertension. Instead of bisoprolol, doctor should prescribe this drug:

147. A 20 years old patient complains of sharp pains in the heart region after stress. He suffers from congenital heart defect (atrial septal defect). On ECG: each P wave corresponds to a QRS complex. P wave 0.08 sec, PQ interval 0.28 sec, QRS interval 0.10 sec, ST 0.30 sec, ST is on the baseline, T wave is positive. What is your conclusion about the patient's ECG?

148. A 65 years old patient complains of weakness, shortness of breath, edema in the legs. Past medical history: he suffered acute myocardial infarction 6 years ago. He takes bisoprolol and thromboass (aspirin). Objectively: Heart sounds are muffled, rhythmic, heart rate 82 per minute. Pulmonary crepitations were heard in lower lobes of both lungs. On ECG: scars changes on the posterior wall of the left ventricle and septum. On the EchoCG: akinesia zones on the posterior wall. LVEF (left ventricular ejection fraction) is 42%. What caused the appearance of these symptoms in this patient?

150. A 36 years old woman had a severe influenza, she was treated as an outpatient and refused hospitalization. After 2 weeks, constant pain in the heart area, irregular heartbeat, dyspnea on slight physical exertion, and edemas in the legs appeared. On examination: body temperature 37.3°C, acrocyanosis, heart sounds are muffled, arrhythmic with heart rate 100 per minute, BP 100/80 mm Hg, single moist wheezing in lower lungs, BR 20 per minute. The liver was 1 cm below the edge of the rib arch, ankle swelling. ECG showed decreased wave voltage of the all leads. What flu complication in this case is there?

151. A 46 years old man had pain in the lower third of his sternum two weeks ago while climbing up to the 4th floor very quickly, which passed at rest. Such pains occurred for the first time. Later on, they began to appear during fast walking, climbing up to the 2nd floor. Choose most likely diagnosis and management tactic:

154. A 40 years old man complains of palpitations and pressure chest pains, accompanied by loss of consciousness. Objectively: Heart sounds are slightly muffled, rhythmic, heart rate 88 per minute. BP 90/60 mm Hg. On the ECG: ST segment elevation in V2-V3. Troponin T was in normal ranges. What tests should be done the first of all?

155. In which disease does haematuric syndrome most often develop?

156. What is the most common cause of nephrotic syndrome?

157. Which of the following signs is mandatory in chronic glomerulonephritis:

158. Which kidney disease is characterised by oedema, hypoproteinemia?

159. What tests are prescribed by a general practitioner in primary care when there is a suspicion of thyrotoxicosis?

160. The most informative method for detecting thyroid cancer is:

161. Type 1 diabetes mellitus should be treated

163. A possible cause of hypoglycaemia in diabetes mellitus is:

162. Which indicator is the most reliable criterion for the degree of compensation of diabetes mellitus in the follow-up examination?

164. In a typical diffuse-toxic goiter, thyrotropic hormone secretion is:

165. In primary hypothyroidism, blood shows:

166. The presence of goiter in a significant number of individuals living in a particular region is defined as:

167. Which hormone profile variant is characteristic of primary hypothyroidism?

168. Which type of hormonal profile is characteristic of diffuse toxic goiter?

169. Which disease most often contributes to the development of nephrotic syndrome?:

170. Which examination is reliable to confirm thyrotoxicosis?

171. Type 1 diabetes mellitus is characterised by:

172. Chronic kidney disease 4 (CKD) is characterised by a decrease in GFR to:

What treatment should be given to an elderly patient with severe hypothyroidism?

174. Acute nephritic syndrome is characterised by:

175. A 67-year-old female patient has been suffering from urolithiasis for several years and underwent surgery 5 years ago. She has been suffering from urolithiasis for several years and underwent surgery 5 years ago. CBC: Hb-110g/l, red blood cells-3.0 mln, colour index-0.8, sedimentation rate-20 mm/hour, blood urea-8.8 mmol/l, creatinine 200.0 µmol/l. What is the diagnosis of the patient?

176. A 63-year-old patient has been suffering from urolithiasis for 15 years and underwent surgery 3 years ago. His blood pressure has constantly increased to 165/105 mmHg, last year to 00/110 mmHg, he has facial oedema. Blood tests: Hb-105g/l, erythrocytes-3.0 million, colour index 0.8, sedimentation rate -20 mm/hour, blood urea-9.0 mmol/l, creatinine 242.0 µmol/l. What complication did this patient develop?

178. Patient T., 20-year-old in general urine analysis: specific gravity 1.030, protein-3.1 g/l, leukocytes 8-10, erythrocytes 20-30, cylinders (hyaline) 7-10. Which disease is characterised by the following?

180. Student Y., 16 year-old 2.5 weeks after a sore throat, complains of headache and redness of urine. She was previously healthy. Face pale, puffy, BP-165/100 mm Hg. Suspected acute glomerulonephritis. What's very important at the start of treatment?

181. A man is registered with an outpatient clinic for diabetes, insulin dependent, severe course, diabetic angiopathy, stage 3 nephropathy. Which spas can be referred to:

182. Patients with what diagnosis is spa treatment indicated?

183. A 55-year-old patient with a history of urolithiasis who underwent surgery 5 years ago. His blood pressure was 155/95 mmHg, last year it was 185/100 mmHg, he had facial oedema. Blood count: Hb-110 g/l, erythrocytes-3.0, color index-0.7 sedimentation rate-20 mm/hour, blood urea-8.8 mmol/l, creatinine 200.0 µmol/l. What is the diagnosis of the patient?

184. During a physical examination of patient O., 21 years old, the following was found in his OM: specific gravity 1.028, protein-3.0 g/l, leukocytes 8-10, erythrocytes 20-30, cylinders (hyaline) 7-10. Which disease is characterised by the following?

185. A 57-year-old patient diagnosed with urolithiasis. What is a contributing factor for urinary tract stone formation:

186. A 25-year-old female patient complained of headache and redness of urine 10 days after a sore throat. She was previously healthy. Her face was pale, puffy, BP-155/95 mmHg. Acute glomerulonephritis is suspected. Which of the following is important at the beginning of treatment?

187. Define a direct indication for spa treatment

188. Patient K., 18 years old, has been suffering from diabetes for 6 years, receiving insulin therapy. During a physical education lesson she fainted and had brief convulsions. Her skin was moist. Which of the following complications is most likely?

189. Patient is 55 years old. Suffers from insulin-independent diabetes mellitus. Diabetes is compensated by diet and gluconil. The patient is about to undergo surgery for calculous cholecystitis. What is the tactics of hypoglycemic therapy?

190. What treatment should be given to an elderly man with severe hypothyroidism:

191. Patient diagnosed with diffuse toxic goiter of grade 2. Treatment was started with mercazolil 10 mg 3 times a day, anapriline 20 mg 3 times a day, phenozepam 1 mg 2 times a day. The patient's condition improved considerably, but pronounced leukopenia developed. What is the cause of the leukopenia:

192. Patient K., 29 years old, complains of right lower back pain, headaches, fever up to 38°C, frequent urination. The patient had been treated for more than 4 years. Exacerbation of the condition occurred after overcooling of the legs. On the face: puffy, pale, puffiness around the eyes. Positive kidney punch symptom. Blood count: HB-114 g/l, leukocyties - 9.8x109/l; sedimentation rate - 34 mm/hour. Urinalysis: specific gravity - 1025, protein -0.99 g/l, leukocyties- all over the place; hyaline cylinders -2-4. What investigation is necessary to clarify the diagnosis?

193. Patient is a 56 year old, accountant. She has increasing weakness, dry skin, headaches and pain in the kidney area. Chronic kidney disease and arterial hypertension for many years. CBC: Hb-104g/l, color index-0.82, red blood cells-3.8x1012/l, Leucocyties-6.3x109/l, sedimentation rate-18 mm/h. Urine analysis: urea-10 mmol/l, creatinine-119mmol/l, total protein-61g/l. Zimnitsky's test: isohypostenuria. What is your diagnosis and what examinations should be further prescribed to the patient?

194. Patient, 32 years old, he is a lawyer. He has weakness, dry skin, headaches, facial swelling, suffers from kidney disease. CBC: HB-104g/l; erythrocyties-3.8x1012/l; Leucocyties -6.3x109/l; sedimentation rate-28 mm/hour. Urine analysis: specific gravity -1.003; protein-1.65g/l; hyaline casts -1-3; Leucocyties -1-2, erythrocyties -10-15. Zimnitsky's test-isohypostenuria. Biochemical blood test: creatinine-140 µmol/l; total protein-63 g/l; cholesterol-5.0 mmol/l. GFR - 42 ml/min. Diagnosis?:

195. Patient I., 48, complains of headaches, leg swelling, shortness of breath when walking, weakness, poor appetite, kidney disease for 10 years. Objectively: pale skin, swollen feet. Blood count: Hb-96 g/l; erythrocyties -2.8x1012/l; Leucocyties -8.8x109/l; sedimentation rate -35 mm/h. Urea-16 mmol/l, creatinine 250 µmol/l. Urine analysis: specific gravity -1005; protein -4.5 g/l; Leucocyties 6-10; erythrocyties -20-25; hyaline cylinders - 2-. What examination is necessary to clarify the clinical diagnosis?

197. A 28-year-old man was admitted to the hospital with complaints of weakness, headache, lower back pain, swelling in the face, upper and lower extremities, and swelling in the scrotal area. Past medical history: 3 weeks ago he had an acute respiratory infectious disease, within 4 days his temperature was 38-39°С. Objectively: Swelling of eyelids, shins, scrotum. Heart tones muffled, rhythmic, heart rate 58 per minute. BP-160/90 mm Hg. Daily urine output 400 ml. On the CBC: leukocytosis, eosinophilia, anemia, accelerated ESR. The daily diuresis was dirty pink in colour, protein-3 g/l; red blood cells-60, white blood cells-15-18, renal epithelium, hyaline, granular cylinders. What is the diagnosis to think about?

A 22-year-old man complains of significant weight loss, dry mouth, thirst, frequent urination, nausea. Objectively: dry skin, yellowish palms and soles, furunculosis on the body. In urinalysis: glucose-3.5%; acetone (++). What is the preliminary diagnosis?

199. A 50 year old overweight woman is found to have an elevated fasting glucose level of 6.9 and 7.2 mmol/l on two occasions. Which of the following diagnoses is most likely?

200. A 37-year-old patient complains of dysuria, subfebrile fever, urinalysis: specific gravity 1010, protein 0.033 g/l, leukocytes - 20-30, bacteria+++, ultrasound examination: deformity of both renal tubules and pelvis. Blood urea 7 mmol/l. Presumptive diagnosis:

177. A man has severe oedema syndrome, oliguria. After the examination the diagnosis is acute glomerulonephritis, nephrotic syndrome. Choose the correct treatment tactics:

179. Patient X., 54 year-old in general urine analysis: specific gravity - 1.003, protein - 3.0 g/l, leukocytes 5-7, erythrocytes 10-15, hyaline cylinders 1-2. What disease are these changes characteristic for?

201. Patient N., 64 years old, consulted a doctor with complaints of headache, redness of urine colour and swelling of the legs. Past medical history: suffered from angina two weeks ago. For a long time he suffered from ventricular extrasystole against the background of coronary heart disease, arterial hypertension (BP 170/100 mmHg). Objectively: edema all over the body, BP 200/110 mmHg. Examination: urinalysis: proteinuria-13.5 g/day, erythrocytes entirely covering the field of vision, CBC: Hb-124 g/l, ESR-40 mm/h, total protein-60 g/l, albumin-60 g/l. Presumptive genesis of the edema syndrome:

202. Patient S., 28 years old, on the 5th day of treatment with paracetamol due to acute respiratory infections has headache, BP 170/100 mmHg. Urine tests: hypostenuria, proteinuria. What is the most likely complication?

203. A woman with 8-10 weeks' gestation presented to the outpatient clinic with complaints of chilling, elevation of body temperature to 37.4-38.0°С, pain in the lumbar region. Past medical history: previously treated for kidney disease. Other organs showed no symptoms. Positive tapping symptom. Urine analysis: protein 0.066 g/l, leukocyturia, pyuria, erythrocytes 8-10, epithelial cells 6-8. Preliminary diagnosis:

204. Patient F., 52 years old, in the urine sample: specific gravity - 1.007, protein - 3.0 g/l, leukocytes 5-7, erythrocytes 7-10, hyaline cylinders 1-2. What disease are these changes characteristic for?

205. A 19-year-old student complains of significant dry mouth, thirst, frequent urination, weight loss, nausea. The skin is dry, palms and soles have a yellowish color, furunculosis on the body. CBC: glucose-3.5%; acetone (++). What is the diagnosis?

206. On examination in a patient with a BMI of 30, fasting glucose levels were found to rise to 6.7 and 7.4 mmol/l. Which is the correct diagnosis?

207. Patient A., 40 years old, suffers from hypertension stage II, HF stage 1, and type I diabetes mellitus (compensated). A GP doctor has prescribed bisoprolol as maintenance therapy. The patient should be prescribed:

208. A 15 year old teenager complains of thirst, frequent urination, especially at night, and itchy skin. To make a diagnosis of diabetes mellitus it is necessary to carry out:

209. A 36-year-old man with severe oedema syndrome, oliguria. After the examination the diagnosis is: acute glomerulonephritis, nephrotic syndrome. Choose the treatment tactics:

210. A 23-year-old woman with 22-23 weeks' gestation complains of chilling, elevated body temperature up to 37.4-38.0°C, pain in the lumbar region. Past medical history: previously treated for kidney disease. Other organs showed no symptoms. Tapping symptom is positive. Urine analysis: protein 0.066 g/l, leukocyturia, pyuria, erythrocytes 8-10, epithelial cells 6-8. Preliminary diagnosis:

211. A 35-year-old female patient presents with weakness and fatigue. Past medical history: subtotal thyroid resection, took 50 mcg L-thyroxine. Objectively: facial edema, heart tones are muffled. BP - 100/70 mm Hg. Echocardiogram shows fluid in the pericardial cavity. Which of the following methods of investigation is the most informative?