Surgery 2
問題一覧
1
A patient is staying in the hospital with the diagnosis of abdominal typhus. During the 3-d week from the beginning of the disease the patient stopped keeping diet and confinement to bed. As a result the body temperature and rapid pulse decreased and melena appeared. What kind of complications should we think about first of all?
Intestinal haemorrhage
2
If a child has adherent fingers on his right hand, then what will be your diagnosis?
Syndactyly
3
The complications of acute cholecystitis which require surgical intervention are as follows EXCEPT:
Jaundice
4
A 75-year-old male patient complains of slight pain in the right iliac region. The abdominal pain arose 6 days ago and was accompanied by nausea. Surgical examination revealed moist tongue, Ps- 76 bpm. AP- 130/80 mm Hg. Abdomen was soft, slightly painful in the right iliac region on deep palpation, the symptoms of the peritoneum irritation were doubtful. In blood: RBCs - $4,0¥cdot10^{12}$/l, Hb- 135 g/l, WBCs - $9,5¥cdot10^9$/l, stab neutrophils - 5¥%, segmentonuclear - 52¥%, lymphocytes - 38¥%, monocytes - 5¥%, ESR - 20 mm/h. Specify the doctor's further tactics:
Emergency operation for acute appendicitis
5
A 38 y.o. woman was hospitalized to the surgical unit with acute abdominal pain irradiating to the spine and vomiting. On laparocentesis hemmorhagic fluid is obtained. What disease is suspected?
Acute pancreatitis
6
3 hours ago a 65-year-old female patient felt sharp abdominal pain irradiating to the right scapula, there was a single vomiting. She has a history of rheumatoid arthritis. Objectively: pale skin, AP- 100/60 mm Hg, Ps- 60/min. Abdomen is significantly painful and tense in the epigastrium and right subcostal areat, there are positive symptoms of parietal peritoneum irritation over the right costal arch, that is tympanitis. What is the tactics of an emergency doctor?
To take the patient to the surgical hospital
7
An hour before an elective surgery, a 56-year-old patient of the surgical department got a dramatic increase in blood pressure, tachycardia, hand tremor. The patient is confused, anxious, depressed, fearful, is pessimistic about the operation outcome, refuses the surgery. What tactics should be chosen by a surgeon?
Start the surgery after correction of blood pressure
8
Plan radiography of the patient's abdominal cavity reveals some hemispherical lucent areas situated above distinct horizontal levels. What is the cause of such X-ray picture?
Intestinal obstruction
9
A patient has restrained umbilateral hernia complicated by phlegmon hernia, it is necessary to take following actions:
Herniotomy by Mayo-Sapezhko
10
A patient complains of pathological lump, appearing in the right inguinal region on exercise. The lump is round-shaped, 4 cm in diameter, on palpation: soft elastic consistency, is positioned near the medial part of Poupart's ligament. The lump is situated inwards from the spermatic cord. What is the most probable preliminary diagnosis?
Right-sided direct inguinal hernia
11
Half an hour ago a 67-year-old patient with a hernia picked up a heavy object, which caused acute pain in the region of hernia protrusion, the hernia couldn't be reduced. Objectively: the hernia in the right inguinal region is roundish, tight, moderately painful; during palpation it was reduced back to the cavity, the pain was gone. Specify the further medical tactics:
Inpatient surveillance
12
A young man has painful indurations in the peripapillary regions of both mammary glands. The most reasonable action will be:
To leave these indurations untouched
13
30 y.o. woman, had mild trauma of 5th finger of the left hand 15 days ago. She has treated her self at home. She presents to the hospital due to deterioration of the condition and temperature rise. Objectively: hyperemia and swelling on the ventral surface of finger. Restricted movements of the finger. X-ray of the left hand: an early stage of оsteomyolitis of the fifth finger could not be excluded. The diagnosis: panaris of 5th finger of the left hand. What form of panaris has occurred in the patient?
Bony
14
A 25 year old patient complains of pain in the I finger on his right hand. On examination: the finger is homogeneously hydropic, in bent position. On attempt to unbend the finger the pain is getting worse. Acute pain appears during the probe in ligament projection. What decease is the most likely?
Thecal whitlow (ligament panaritium)
15
It is suspected that a 34 year old patient has an abscess of Douglas pouches. What diagnostic method is to be chosen?
Digital examination of rectum
16
14 days ago a 49-year-old patient was operated on for perforated appendicitis and disseminated fibrinopurulent peritonitis. The postoperative period was uneventful. On the 9th day the patient presented with low-grade fever, abdominal pain, frequent liquid stools. USI of the left mesogastrium reveals a fluid formation 9x10 cm large. In blood: leukocytosis with the left shift. What is your provisional diagnosis?
Interloop abscess
17
A 74 y.o. patient complains of abdomen pain and sweling, nausea. She suffers from ischemic heart disease, postinfarction and atherosclerotic cardiosclerosis. Objectively: the patient is in grave condition, abdomen is swollen, abdominal wall doesn't take active part in respiration. Laparoscopy revealed a small amount of muddy effusion in abdominal cavity, one of the loops of small intestine is dark-cyan. What is the most probable diagnosis?
Thrombosis of mesenteric vessels
18
A 37-year-old patient was delivered to a hospital in unconscious state. He got a closed abdominal injury. He is suspected to have internal haemorrhage, intraabdominal injury. He is being prepared an emergency operation. By means of standard sera a physician determined his blood group and got the following results: 0(І) - no agglutination, А(ІІ) - no agglutination, В(ІІІ) - no agglutination. What is the patient's blood group?
0(І)
19
To replace the blood loss replacement 1000 ml of the same group of Rhesus-compatible donated blood was transfused to the patient. The blood was conserved by sodium citrate. At the end of hemotransfusion there appeared excitement, pale skin, tachycardia, muscles cramps in the patient. What complication should be suspected?
Citrate intoxication
20
A 42-year-old patient with acute haemorrhage and class III blood loss underwent blood transfusion and got 1,8 l of preserved blood and erythromass of the same group and Rh. After the transfusion the patient complained of unpleasant retrosternal sensations, his arterial pressure dropped to 100/60 mm Hg, there appeared convulsions. Blood serum calcium was at the rate of 1,7 millimole/liter. What is the mechanism of this complication development?
Citrate binds calcium ions, hypocalcemia impairs myocardial function
21
Blood typing resulted in positive isohemagglutination reaction with standard sera of A(II) and B(III) groups and negative reaction with sera of 0(I) and AB(IV) groups. What is this result indicative of?
Faulty standard sera
22
A 26-year-old patient complains of experiencing pain in the right hand for 4 days. The pain arose at the site of corns on the palmar surface at the base of the II and III fingers. Some time later the dorsum of hand became edematic. I and III fingers are half-bent in the interphalangeal joints, the hand looks like "rake". What is the most likely diagnosis?
Phlegmon of the second interdigital space of the right hand
23
A 19 year old patient was admitted to a hospital with acute destructive appendicitis. He suffers from hemophilia of B type. What antihemophilic medications should be included in pre- and post-operative treatment plan?
Fresh frozen plasma
24
A 15 y.o. patient has developmental lag, periodical skin yellowing. Objectively: spleen is 16х12х10 cm large, holecistolithiasis, skin ulcer on the lower third of his left crus. Blood count: erythrocytes - 3,0*1012/L, Hb- 90 g/L, C.I.- 1,0, microspherocytosis, reticulocytosis. Blood bilirubin - 56 mmole/L, indirect bilirubin - 38 mmole/L. Choose the way of treatment:
Splenectomy
25
A 40-year-old woman with acute gastrointestinal hemorrhage was transfused 400 ml of the preserved blood after having conducted all compatibility tests. After hemotransfusion the condition of the patient became worse. She started having headache, muscles pain, her temperature has risen up to 38,8OC. What is the reason for such condition of the patient?
Pyrogenic reaction of medium severity
26
A 19 year old boy was admitted to a hospital with closed abdominal trauma. In course of operation multiple ruptures of spleen and small intestine were revealed. AP is falling rapidly, it is necessary to perform hemotransfusion. Who can specify the patient's blood group and rhesus compatibility?
A doctor of any speciality
27
A 37-year-old male patient has a histrory of diabetes of moderate severity. On the left side of face the patient has a carbuncle. What severe complication might have occurred in the patient?
Cavernous sinus thrombosis
28
A 30 year old patient undergoes treatment because of Werlhof's disease. Objectively: the patient is pale, there are petechial haemorrhages on the extension surfaces of forearms. Ps is 92 bpm, AP is 100/60 mm Hg. The lower edge of spleen is at a level with umbilicus. Blood count: erythrocytes: 2,81012/l, Hb - 90 g/l, Ht - 0,38, thrombocytes - 30109 /l. The patient is being prepared for splenectomy. What transfusion medium should be chosen in the first place for the preoperational preparation?
Thrombocytic mass
29
A 34 year old patient complains of profuse sweating at night, skin itching, weight loss (9 kg within the last 3 months). Examination revealed malnutrition, skin pallor. Palpation of neck and inguinal areas revealed dense elastic lymph nodes for about 1 cm in diameter, nonmobile, non-adhering to skin. What is the most probable diagnosis?
Lymphogranulomatosis
30
What preparations are used for prevention of fungal infection?
Fluconozol, Orungol, Nisoral
31
A 42-year-old builder consulted a doctor about a foot injury with a nail that he got in the morning of the same day. The wound was washed with water. Three years ago he was vaccinated against tetanus. Examination established satisfactory condition of the patient. The left foot was slightly edematic, there was a stab wound on the sole. In order to prevent tetanus it is primarily required to:
Give an intravenous injection of 0,5 ml of tetanus anatoxin
32
A female patient has been suffering from pain in the right subcostal area, bitter taste in the mouth, periodical bile vomiting for a month. The patient put off 12 kg. Body temperature in the evening is $37,6^oC$. Sonography revealed that bile bladder was 5,5х2,7 cm large, its wall - 0,4 cm, choledochus - 0,8 cm in diameter. Anterior liver segment contains a roundish hypoechoic formation up to 5 cm in diameter and another two up to 1,5 cm each, walls of these formations are up to 0,3 cm thick. What is the most likely diagnosis?
Alveolar echinococcus of liver
33
A 32-year-old patient lives in an area endemic for echinococcosis. In the last 6 months hereports of pain in the right subcostal area, fever. He is suspected to have liver echinococcosis. What study would be the most informative in this case?
USI
34
A 4 y.o. child attends the kindergarten. Complains of poor appetite, fatigue. Objective examination: skin and mucous membrane are pale, child is asthenic. In the hemogram: hypochromatic anemia 1st, leucomoide reaction of the eosinophile type. What pathology must be excluded first of all?
Helminthic invasion
35
On the 5th day after a surgery for colon injury a patient complains of bursting pain in the postoperative wound, weakness, drowsiness, headache, fever up to $40^oC$. Objectively: the skin around the wound is swollen, there is gas crepitation. The wound discharges are scarce foul-smelling, of dark-gray colorl. What is the most likely diagnosis?
Anaerobic clostridial wound infection
36
A 42-year-old female patient complains of a dull pain in her left side, low-grade fever, accelerated painful urination in small portions. These presentations have been observed for three years. For a long time, the patient has had cystitis with frequent exacerbations, there is pulmonary tuberculosis in the past history. Urinalysis results: microscopic hematuria, leukocyturia. What is the most likely provisional diagnosis?
Renal tuberculosis
37
A man with a stab-wound of the right foot applied to doctor. He stepped on the board with nail two hours ago. In the patient medical chart it is stated that 3 years ago he passed the whole course of vaccination against tetanus. What is the tactics of doctor to prevent tetanus in this case?
Do not conduct specific prophylaxis
38
A 40-year-old patient underwent an operation for a lumbar phlegmon. Body temparature rose again up to 38oC, he got intoxication symptoms, there was an increase of leukocyte number in blood. The wound that was nearly free from necrotic tissues and full of granulations started to discharge pus, the granulations turned pale. What complication dveloped in this patient?
Sepsis
39
A patient operated for acute paraproctitis undergoes antibacterial and detoxification therapy, the local course of the disease has the positive dynamics. Since the operation the patient has had chills, pyrexia, tachycardia, euphoria for five days. The doctor suspected sepsis. What study will confirm the diagnosis?
Blood culture for a pathogen
40
A 66-year-old female patient has been admitted to a hospital for massive gross hematuria with release of shapeless blood clots, frequent painful urination. The patient also reports a moderate weight loss within 3-4 months. Gross hematuria that was not accompanied by pain and dysuria first occurred three months ago for no apparent reason, and after a few days the bleeding subsided independently. What is the most likely diagnosis?
Bladder tumor
41
A 74 y.o. patient has been ill with benign prostate hyperplasy for the last 5 years. 4 days ago, after alcochol consumption, there was an acute retention of urination. At the pre-admission stage his urinary bladder was catheterized with metallic catheter. Examination revealed: right epididymis is enlarged, thick and painful, there are purulent discharges from urethra. What way of emergency care must be chosen?
Trocar or open epicystostomy
42
A 78-year-old patient complains of severe pain in the lower abdomen, perineum and rectum; intense urge to urinate and inability to urinate without assistance. Abdomen palpation reveals a moderately painful globular formation above the pubis, there is percussion dullness over the formation. What is the most likely diagnosis?
Acute urinary retention
43
A 77-year-old male patient complains of inability to urinate, bursting pain above the pubis. The patient developed acute condition 12 hours before. Objectively: full urinary bladder is palpable above the pubis. Rectal prostate is enlarged, dense and elastic, well-defined, with no nodes. Interlobular sulcus is distinct. Ultrasonography results: prostate volume is 120 cm3 , it projects into the bladder cavity, has homogeneous parenchyma. Prostate-specific antigen rate is of 5 ng/ml. What is the most likely disease that caused acute urinary retention?
Prostatic hyperplasia
44
X-ray picture of chest shows a density and an abrupt decrease in the upper lobe of the right lung. The middle and lower lobe of the right lung exhibit significant pneumatization. The right pulmonary hilum comes up to the dense lobe. In the upper and middle parts of the left pulmonary field there are multiple focal shadows. In the basal region of the left pulmonary field there are clear outlines of two annular shadows with quite thick and irregular walls. What disease is this X-ray pattern typical for?
Fibro-cavernous pulmonary tuberculosis
45
A 50 y.o. patient was admitted to the hospital with complaints of blood in urine. There was no pain or urination disorders, hematuria has lasted for 3 days. Objectively: kidneys are not palpable, suprapubic region has no pecularities, external genitals have no pathology. Rectal examination revealed: prevesical gland is not enlarged. Cytoscopy revealed no changes. What disease would you think about first of all?
Cancer of kidney
46
A 20-year-old patient complains of pain in the left lumbar region, arterial pressure rise up to 160/110 mm Hg. USI revealed that the structure and size of the right kidney were within age norms, there were signs of 3 degree hydronephrotic transformation of the left kidney. Doppler examination revealed an additional artery running to the lower pole of the kidney. Excretory urogram shows a narrowing in the region of ureteropelvic junction. Specify the therapeutic tactics:
Surgical intervention
47
A 25-year-old patient complains of burning and pain during urination, purulent discharges from the urethra that turned up 2 days ago. Objectively: the urethral labia are edematic, hyperemic, there are profuse purulent discharges from the urethra. Provisional diagnosis: recent acute gonorrheal urethritis. What supplemental data of clinical examinations will alow to specify the diagnosis?
Microscopy of the urethral discharges
48
A 66-year-old female patient has been admitted to a hospital for massive gross hematuria with release of shapeless blood clots, frequent painful urination. The patient also reports a moderate weight loss within 3-4 months. Gross hematuria that was not accompanied by pain and dysuria first occurred three months ago for no apparent reason, and after a few days the bleeding subsided independently. What is the most likely diagnosis?
Bladder tumor
49
A children's surgical unit admitted a 1-month-old boy who had been prenatally diagnosed with the left-sided pyelectasis. Such studies as drip infusion urography, cystography and USI allowed to reveal initial hydronephrosis. There is no information confirming the secondary pyelonephritis. What tactics of this patient management is most advisable?
6-month surveillance
50
A 65-year-old patient complains about pain in the lumbar spine, moderate disuria. He has been suffering from these presentations for about half a year. Prostate volume is 45 cm3 (there are hypoechogenic nodes in both lobes, capsule invasion). Prostate-specific antigen is 60 ng/l. Prostate biopsy revealed an adenocarcinoma. Which of the supplemental examination methods will allow to determine the stage of neoplastic process in this patient?
Computer tomography of pelvis
51
A patient complains of nycturia, constant boring pain in perineum and suprapubic region, weak urine jet, frequent, obstructed and painful urination. He has been ill for several months, pain in perineum appeared after getting problems with urination. Rectal examination revealed that prostate is enlarged (mostly owing to the right lobe), dense, asymmetric, its central sulcus is flattened, the right lobe is dense, painless, tuberous. What disease can it be?
Cancer of prostate
52
An 80-year-old patient complains of constantly urinating small amounts, a feeling of pressure in the lower abdomen. Objectively: there is a suprapubic spherical bulging with percussion dullness over it. What syndrome occurred in the patient?
Paradoxical ischuria
53
A patient, aged 81, complains of constant urinary excretion in drops, feeling of fullness in the lower abdomen. On examination: above pubis there is a spherical protrusion, over which there is a dullness of percussion sound, positive suprapubic punch. What symptom is observed in this patient?
Paradoxal ischuria
54
The most available and informative diagnostic method for closed trauma of the urinary bladder is:
Retrograde cystography
55
A 60 y.o. man complains of sense of heaviness in the region of scrotum. Objectively: scrotum edema in the left part. Testicle is of normal size, but there is a soft, scrotum limited edema over it that can be pressed and disappears when the patient lies down. What is the preliminary diagnosis?
Varicocele
56
A 45-year-old patient with urolithiasis had an attack of renal colic. What is the mechanism of the attack development?
Disturbed urine outflow from the kidney
57
A patient suffers from suddenly arising crampy pain in the right loin area. 2 hours after the pain had started, hematuria took place. Loin X-ray: no pathological shadows. Ultrasound: pyelocaliectasis on the right, the left part is normal. What is the most probable diagnosis?
Stone of the right kidney, renal colic
58
A 38 year old man, previously in good health, suddenly develops severe abdominal pain radiating from the left loin to groin and accompanied by nausea, perspiration and the need for frequent urination. He is restless, tossing in bed but has no abnormal findings. The most likely diagnosis is:
Leftsided renal colic
59
A 10-year-old child has been admitted to a hospital with a closed craniocerebral injury with suspected cerebral edema. The patient is in grave condition, unconscious. The dyspnea, tachycardia, hypertension are present. Muscle tone is increased, there is nystagmus, pupillary and oculomotor reactions are disturbed. The mandatory component of intensive care is dehydration. What diuretic is adequate in this case?
Furosemide
60
A patient came to the traumatology centre and complained about a trauma of the lower third of the volar forearm surface caused by cut on a piece of glass. Objectively: flexion of the IV and V fingers is impaired, sensitivity of the interior dorsal and palmar surface of hand as well as of the IV finger is reduced. What nerve is damaged?
Ulnar
61
A victim of the car crash was brought to neurosurgery due to craniocerebral trauma. During examination symptoms of focused injury of the cerebrum are found, cerebrum contusion is suspected. What method of examination is to be used?
Computed tomography of the cerebrum
62
A 65 y.o. man who has problems with urination as a result of benign prostate gland adenoma dveloped fever and chill, hypotension, sinus tachycardia. Skin is warm and dry. Clinical blood analysis revealed absolute granulocytopenia. These hemodynamic changes are most likely to be caused by:
Endotoxemia with activation of complement system
63
A 44-year-old patient has been admitted to a hospital with complaints of dull, aching pain in the left lumbar region, the admixture of pus in the urine. Examination revealed a grade II staghorn calculus on the left. What method of treatment is indicated for this patient?
Surgery
64
1 day ago a 19-year old male patient got a trauma after a fall from 1,5 m height when he "bestrode" a wooden beam. Urination is extremely difficult, there is macrohematuria, urethrorrhagia. There is a hematoma in the perineum and on the scrotum. Urethrography revealed flowing of contrast medium into the membranous part of urethra. What is the treatment tactics of choice?
Epicystostomy
65
A rounded well-defined shadow was found in the costo-vertebral angle on the chest roentgenogram of an otherwise healthy 9 year old girl. Make a preliminary diagnosis:
Ganglioneuroma
66
A 72 year old patient complains about pain and bleeding during defecation. Digital rectal investigation revealed a tumour of anal canal. After verification of the diagnosis the patient was diagnosed with squamous cell carcinoma. The secondary (metastatic) tumour will be most probably found in:
Lungs
67
For the persons who live in a hot area after an accident at a nuclear object, the greatest risk within the first decade is represented by cancer of:
Skin
68
A 17-year-old patient complains of pain in the area of the left knee joint. Soft tissues of thigh in the affected region are infiltrated, joint function is limited. X-ray picture of the distal metaepiphysis of the left femur shows a destruction focus with periosteum detachment and Codman's triangle found at the defect border in the bone cortex. X-ray of chest reveals multiple small focal metastases. What treatment is indicated?
Palliative chemotherapy
69
An anestesiologist gives narcosis to the patient, he uses a non-reversive contour. Anesthetic is halothane. Air temperature in the operation room is 210С, humidity 50%, level of noise 30 dB. What occupational hazard is the principal one under these conditions?
Air pollution with anesthetic
70
A patient aged 18 with a cranial injury was in comatose state during several hours. In post-comatose period gets tired quickly, non-productive in dialog - in the beginning answers 2-3 questions, then gets tired and can not understand the point of the question. Which psychotropic should be given to the patient to prevent psychoorganic syndrome?
Nootropics
71
A 9-year-old boy fell from a tree and hit the occipital region, there was a momentary loss of consciousness. Objectively: the child's condition is satisfactory, he complains of the headache and dizziness. The X-ray of skull reveals a comminuted depressed fracture of occipital bone in the region of inion. What treatment is indicated for the patient?
Surgical intervention
72
A 55-year-old patient complains of severe itching, burning and pain in the eyes, skin redness in the outer corners of the palpebral fissure. Objectively: skin around the outer corners of the palpebral fissure is macerated, eczematous, there are single moist cracks. Palpebral conjunctiva is hyperemic, quaggy. There are minor discharges in form of stringing mucus. What is the most likely diagnosis?
Chronic conjunctivitis
73
A 65-year-old patient complains of gradual worsening of the left eye vision during 10 months. On physical examination: acuty of vision of the left eye is 0,01, not correctable. The eye is quiet, pupil of the eye is grayish, reflex from the eye-ground is absent. Intraocular pressure is 18 mm/Hg. What is the most probable preliminary diagnosis?
Senile cataract
74
A patient complains of impaired far vision. Previously his eyes often turned red and hurt. Objectively: the eyes are not irritated, the cornea is transparent, anterior chambers are median deep, their liquid is transparent. The iris of the right eye has not changed in colour, its pattern is unchanged. The pupil is of irregular shape, scalloped. Biomicroscopy of the crystalline lens reveals the areas of opacity and vacuoles. Make a diagnosis:
Complicated cataract of the right eye
75
A 72 year old female patient has been treated for urolithiasis in the urological department. After atropine injection she got acute pain in her left eye and abrupt vision impairment. Objectively: visual acuity of the left eye is 0,01, the eye is dense but painful on palpation, cornea is opaque, there is cyanotic induration of eyeball vessels. What is the most probable diagnosis?
Acute attack of primary glaucoma of the left eye
76
A 60 y.o. man complains of significant pain in the right eye, photophobia, lacrimation, reduced vision of this eye, headache of the right part of the head. Pain occured 2 days ago. On examination: Vis OD- 0,03, congested injection of the eye ball, significant cornea edema, front chamber is deep, pupil is narrow, athrophic iris, there is optic nerve excavation on the eye fundus, intraocular pressure- 38 mm Hg. Vis OS- 0,8 unadjustable. The eye is calm, healthy. Intraoccular pressure- 22 mm Hg. What is the most probable diagnosis?
Acute glaucoma attack
77
A neonatologist examining a full-term mature baby revealed the shortening and external rotation of the newborn's lower extremity. Clinical examination revealed positive Ortolani sign, symptom of non-vanishing pulse, additional skin folds on the internal surface of thigh. What is the most likely diagnosis?
Congenital hip dislocation
78
The 67 y.o. patient had 5 recurrent fractures of the lower extremities without considerable cause within 5 years. O-shaped deformity of the legs in the knee joints has appeared. The skull, pelvis and lower extremities X-Ray shows the thickening of flat bones. In the long bones there is a hyperostosis along the bone axis.The blood test has not revealed any inflammation activity. Serum calcium is normal. What disease do you consider in this case?
Paget's disease
79
A 10 year old boy complains about pain in his left eye and strong photophobia after he had injured his left eye with a pencil at school. Left eye examination: blepharospasm, ciliary and conjunctival congestion, cornea is transparent, other parts of eyeball have no changes. Visus 0,9. Right eye is healthy, Visus 1,0. What additional method would you choose first of all?
Staining test with 1% fluorescein
80
After contusion of the right eye a patient complains of sudden loss of vision with remaining light perception. Objectively: the eye is not irritated. The cornea is transparent. Pupil reacts to light. The pupil area is black. The fundus reflex is absent. What is the most likely cause of vision loss?
Hemophthalmia
81
A 57 year old patient abruptly lost the sight of one eye. Examination revealed that his sight made up 0,02 excentrically, eye fundus has haemorrhages of different forms and sizes ("squashed tomato" symptom). Disc of optic nerve is hyperemic. In anamnesis general vascular pathology is recorded. Direct-acting anticoagulants were administered. What is the most probable diagnosis?
Thrombosis of central vein of retina
82
A 40-year-old female patient has a history of rheumatism. She complains about acute pain in her left eye, especially at night, vision impairment, photophobia, lacrimation. The patient cannot suggest any reasons for the disease. Objectively: weak pericorneal injection, flattening of iris relief, iris discoloration. What is the most likely diagnosis?
Iridocyclitis
83
Which of the following symptoms is the most typical for the adenoid hypertrophy?
Nasal obstruction
84
10 years ago a patient had a fracture in the middle one-third of his left femoral bone, and during the last 7 years he has been having acute inflammation in the area of old fracture accompanied by formation of a fistula through which some pus with small fragments of bone tissue is discharged. After a time the fistula closes. What complication of the fracture is it?
Chronic osteomyelitis
85
After an accident a patient complains of pain in the hip joint. Objectively: the leg is in the position of flexion, adduction and internal rotation, significantly contracted. There is elastic resistance to passive adduction or abduction of the extremity. Major trochanter is located high above the Roser-Nelaton line. A significant lordosis is present. What is your provisional diagnosis?
Iliac dislocation of hip
86
A patient with acute purulent otitis media complicated by mastoiditis was admitted to a hospital. Roentgenogram of mastoid processes showed the shadiowing of the cellular system on the lesion, absence of bone septa was present. What are the necessary therapeutic actions at the second stage of mastoiditis?
Mastoidotomy
87
A 30-year-old woman complains of nasal blockage, sneezing, watery nasal discharges. The body temperature is normal. Objectively - edema of nasal mucous membrane on both sides, especially of the lower turbinate (with cyanosis). Blood test data - mild leukocytosis and eosinophilia. What is the diagnosis?
Allergic rhinitis
88
A 3-year-old girl has had an increase in body temperature up to 38,5oC for four days. The child refuses to eat. Over the last two days, nose and mouth breathing has become difficult. Mesopharyngoscopy reveals hyperthermia and enlargement of tonsils, as well as hyperemia and bulging of the posterior wall of the oropharynx, which significantly narrows the oropharyngeal lumen. What complication of quinsy occurred in the patient?
Retropharyngeal abscess
89
A patient complains of intense pressing pain in the pharynx, mainly to the right, impossibility to swallow even liquid food. The illness started 5 days ago. The patient's condition is grave. Body temperature - 38,90C, speech is difficult, voice is constrained, difficulties in opening the mouth. Submaxillary glands to the right are painful, enlarged. What is the most probable diagnosis?
Peritonsillar abscess
90
A 26-year-old male patient consulted a doctor abut sore throat, fever up to 38,2oC. A week before, the patient had quinsy, didn't follow medical recommendations. On examination, the patient had forced position of his head, trismus of chewing muscles. Left peritonsillar region is markedly hyperemic, swollen. What is the provisional diagnosis?
Left-sided peritonsillar abscess
91
A 30 year old man complains of acute pain in his right ear, hearing loss, high temperature for three days. Objectively: right ear whispering language - 0,5 mm, external ear is intact, otoscopically - eardrum protrusion, hyperemia and swelling, loss of landmarks. What disease is it?
Acute purulent otitis media
92
A 22 y.o. man complains of acute throat pain, increasing upon swallowing during 3 days. Body temperature 38,30С, neck lymph nodules are slightly enlarged and painful. Pharyngoscopically - tonsilar hyperemia, enlargement and edema, tonsils are covered by round yellow fibrinous patches around crypts openings. Beta-haemolytic streptococcus in swab analysis. What is the diagnosis?
Acute membranous tonsilitis
93
A patient had disorder of nasal respiration, mucopurulent discharges from nose, headache for 3 weeks. At anterior rhinoscopy in middle nasal meathus the stria of pus, edema, hyperemia of the mucosa of the nose have been determined. What diagnostic method is necessary to administer first of all?
An X-ray of paranasal sinuses
94
An 8-month-old baby has had problems with nasal breathing and muco-purulent discharge from the nose for a week. Examination reveals a rhinedema, muco-purulent discharges from the middle nasal meatus as well as on the back of pharynx. What disease are these symptoms most typical for?
Ethmoiditis
95
A 36-year-old male patient complains of having headache, obstructed nasal breathing, purulent nasal discharge for 2 weeks. A month before, he had his right maxillary premolar filled. Radiolography revealed an intense opacity of the right maxillary sinus. Diagnostic puncture revealed a large amount of thick malodorous crumbly pus. What is the most likely diagnosis?
Chronic suppurative odontogenic sinusitis
96
Three weeks after acute angina the patient is still weak, inert, subfebrile, his retromaxillary lymph nodes are enlarged. Tonsils are flabby, stick together with arches, there are purulent plugs in lacunae. What is the most probable diagnosis?
Chronic tonsillitis
97
A 22 y.o. man complains of acute throat pain, increasing upon swallowing during 3 days. Body temperature 38,30С, neck lymph nodules are slightly enlarged and painful. Pharyngoscopically - tonsilar hyperemia, enlargement and edema, tonsils are covered by round yellow fibrinous patches around crypts openings. Beta-haemolytic streptococcus in swab analysis. What is the diagnosis?
Acute membranous tonsilitis
98
In course of herniotomy of a 12 y.o. patient doctors revealed a testicle in the hernial sac. What type of hernia is it?
Congenital oblique inguinal hernia
99
It has been suspected that a newborn has congenital diaphragmatic hernia (asphyctic incarceration). What study will allow to confirm the diagnosis?
Plan radiography of the chest cavity
100
During investigation for chronic, severe, epigastric pain, a 40 year old alcoholic man is found to have multiple areas of narrowing alternating with dilatation ("chain of lakes" appearance) of the main pancreatic duct. The operation of choice is:
Lateral pancreaticojejunostomy
Surgery
Surgery
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51問 • 2年前問題一覧
1
A patient is staying in the hospital with the diagnosis of abdominal typhus. During the 3-d week from the beginning of the disease the patient stopped keeping diet and confinement to bed. As a result the body temperature and rapid pulse decreased and melena appeared. What kind of complications should we think about first of all?
Intestinal haemorrhage
2
If a child has adherent fingers on his right hand, then what will be your diagnosis?
Syndactyly
3
The complications of acute cholecystitis which require surgical intervention are as follows EXCEPT:
Jaundice
4
A 75-year-old male patient complains of slight pain in the right iliac region. The abdominal pain arose 6 days ago and was accompanied by nausea. Surgical examination revealed moist tongue, Ps- 76 bpm. AP- 130/80 mm Hg. Abdomen was soft, slightly painful in the right iliac region on deep palpation, the symptoms of the peritoneum irritation were doubtful. In blood: RBCs - $4,0¥cdot10^{12}$/l, Hb- 135 g/l, WBCs - $9,5¥cdot10^9$/l, stab neutrophils - 5¥%, segmentonuclear - 52¥%, lymphocytes - 38¥%, monocytes - 5¥%, ESR - 20 mm/h. Specify the doctor's further tactics:
Emergency operation for acute appendicitis
5
A 38 y.o. woman was hospitalized to the surgical unit with acute abdominal pain irradiating to the spine and vomiting. On laparocentesis hemmorhagic fluid is obtained. What disease is suspected?
Acute pancreatitis
6
3 hours ago a 65-year-old female patient felt sharp abdominal pain irradiating to the right scapula, there was a single vomiting. She has a history of rheumatoid arthritis. Objectively: pale skin, AP- 100/60 mm Hg, Ps- 60/min. Abdomen is significantly painful and tense in the epigastrium and right subcostal areat, there are positive symptoms of parietal peritoneum irritation over the right costal arch, that is tympanitis. What is the tactics of an emergency doctor?
To take the patient to the surgical hospital
7
An hour before an elective surgery, a 56-year-old patient of the surgical department got a dramatic increase in blood pressure, tachycardia, hand tremor. The patient is confused, anxious, depressed, fearful, is pessimistic about the operation outcome, refuses the surgery. What tactics should be chosen by a surgeon?
Start the surgery after correction of blood pressure
8
Plan radiography of the patient's abdominal cavity reveals some hemispherical lucent areas situated above distinct horizontal levels. What is the cause of such X-ray picture?
Intestinal obstruction
9
A patient has restrained umbilateral hernia complicated by phlegmon hernia, it is necessary to take following actions:
Herniotomy by Mayo-Sapezhko
10
A patient complains of pathological lump, appearing in the right inguinal region on exercise. The lump is round-shaped, 4 cm in diameter, on palpation: soft elastic consistency, is positioned near the medial part of Poupart's ligament. The lump is situated inwards from the spermatic cord. What is the most probable preliminary diagnosis?
Right-sided direct inguinal hernia
11
Half an hour ago a 67-year-old patient with a hernia picked up a heavy object, which caused acute pain in the region of hernia protrusion, the hernia couldn't be reduced. Objectively: the hernia in the right inguinal region is roundish, tight, moderately painful; during palpation it was reduced back to the cavity, the pain was gone. Specify the further medical tactics:
Inpatient surveillance
12
A young man has painful indurations in the peripapillary regions of both mammary glands. The most reasonable action will be:
To leave these indurations untouched
13
30 y.o. woman, had mild trauma of 5th finger of the left hand 15 days ago. She has treated her self at home. She presents to the hospital due to deterioration of the condition and temperature rise. Objectively: hyperemia and swelling on the ventral surface of finger. Restricted movements of the finger. X-ray of the left hand: an early stage of оsteomyolitis of the fifth finger could not be excluded. The diagnosis: panaris of 5th finger of the left hand. What form of panaris has occurred in the patient?
Bony
14
A 25 year old patient complains of pain in the I finger on his right hand. On examination: the finger is homogeneously hydropic, in bent position. On attempt to unbend the finger the pain is getting worse. Acute pain appears during the probe in ligament projection. What decease is the most likely?
Thecal whitlow (ligament panaritium)
15
It is suspected that a 34 year old patient has an abscess of Douglas pouches. What diagnostic method is to be chosen?
Digital examination of rectum
16
14 days ago a 49-year-old patient was operated on for perforated appendicitis and disseminated fibrinopurulent peritonitis. The postoperative period was uneventful. On the 9th day the patient presented with low-grade fever, abdominal pain, frequent liquid stools. USI of the left mesogastrium reveals a fluid formation 9x10 cm large. In blood: leukocytosis with the left shift. What is your provisional diagnosis?
Interloop abscess
17
A 74 y.o. patient complains of abdomen pain and sweling, nausea. She suffers from ischemic heart disease, postinfarction and atherosclerotic cardiosclerosis. Objectively: the patient is in grave condition, abdomen is swollen, abdominal wall doesn't take active part in respiration. Laparoscopy revealed a small amount of muddy effusion in abdominal cavity, one of the loops of small intestine is dark-cyan. What is the most probable diagnosis?
Thrombosis of mesenteric vessels
18
A 37-year-old patient was delivered to a hospital in unconscious state. He got a closed abdominal injury. He is suspected to have internal haemorrhage, intraabdominal injury. He is being prepared an emergency operation. By means of standard sera a physician determined his blood group and got the following results: 0(І) - no agglutination, А(ІІ) - no agglutination, В(ІІІ) - no agglutination. What is the patient's blood group?
0(І)
19
To replace the blood loss replacement 1000 ml of the same group of Rhesus-compatible donated blood was transfused to the patient. The blood was conserved by sodium citrate. At the end of hemotransfusion there appeared excitement, pale skin, tachycardia, muscles cramps in the patient. What complication should be suspected?
Citrate intoxication
20
A 42-year-old patient with acute haemorrhage and class III blood loss underwent blood transfusion and got 1,8 l of preserved blood and erythromass of the same group and Rh. After the transfusion the patient complained of unpleasant retrosternal sensations, his arterial pressure dropped to 100/60 mm Hg, there appeared convulsions. Blood serum calcium was at the rate of 1,7 millimole/liter. What is the mechanism of this complication development?
Citrate binds calcium ions, hypocalcemia impairs myocardial function
21
Blood typing resulted in positive isohemagglutination reaction with standard sera of A(II) and B(III) groups and negative reaction with sera of 0(I) and AB(IV) groups. What is this result indicative of?
Faulty standard sera
22
A 26-year-old patient complains of experiencing pain in the right hand for 4 days. The pain arose at the site of corns on the palmar surface at the base of the II and III fingers. Some time later the dorsum of hand became edematic. I and III fingers are half-bent in the interphalangeal joints, the hand looks like "rake". What is the most likely diagnosis?
Phlegmon of the second interdigital space of the right hand
23
A 19 year old patient was admitted to a hospital with acute destructive appendicitis. He suffers from hemophilia of B type. What antihemophilic medications should be included in pre- and post-operative treatment plan?
Fresh frozen plasma
24
A 15 y.o. patient has developmental lag, periodical skin yellowing. Objectively: spleen is 16х12х10 cm large, holecistolithiasis, skin ulcer on the lower third of his left crus. Blood count: erythrocytes - 3,0*1012/L, Hb- 90 g/L, C.I.- 1,0, microspherocytosis, reticulocytosis. Blood bilirubin - 56 mmole/L, indirect bilirubin - 38 mmole/L. Choose the way of treatment:
Splenectomy
25
A 40-year-old woman with acute gastrointestinal hemorrhage was transfused 400 ml of the preserved blood after having conducted all compatibility tests. After hemotransfusion the condition of the patient became worse. She started having headache, muscles pain, her temperature has risen up to 38,8OC. What is the reason for such condition of the patient?
Pyrogenic reaction of medium severity
26
A 19 year old boy was admitted to a hospital with closed abdominal trauma. In course of operation multiple ruptures of spleen and small intestine were revealed. AP is falling rapidly, it is necessary to perform hemotransfusion. Who can specify the patient's blood group and rhesus compatibility?
A doctor of any speciality
27
A 37-year-old male patient has a histrory of diabetes of moderate severity. On the left side of face the patient has a carbuncle. What severe complication might have occurred in the patient?
Cavernous sinus thrombosis
28
A 30 year old patient undergoes treatment because of Werlhof's disease. Objectively: the patient is pale, there are petechial haemorrhages on the extension surfaces of forearms. Ps is 92 bpm, AP is 100/60 mm Hg. The lower edge of spleen is at a level with umbilicus. Blood count: erythrocytes: 2,81012/l, Hb - 90 g/l, Ht - 0,38, thrombocytes - 30109 /l. The patient is being prepared for splenectomy. What transfusion medium should be chosen in the first place for the preoperational preparation?
Thrombocytic mass
29
A 34 year old patient complains of profuse sweating at night, skin itching, weight loss (9 kg within the last 3 months). Examination revealed malnutrition, skin pallor. Palpation of neck and inguinal areas revealed dense elastic lymph nodes for about 1 cm in diameter, nonmobile, non-adhering to skin. What is the most probable diagnosis?
Lymphogranulomatosis
30
What preparations are used for prevention of fungal infection?
Fluconozol, Orungol, Nisoral
31
A 42-year-old builder consulted a doctor about a foot injury with a nail that he got in the morning of the same day. The wound was washed with water. Three years ago he was vaccinated against tetanus. Examination established satisfactory condition of the patient. The left foot was slightly edematic, there was a stab wound on the sole. In order to prevent tetanus it is primarily required to:
Give an intravenous injection of 0,5 ml of tetanus anatoxin
32
A female patient has been suffering from pain in the right subcostal area, bitter taste in the mouth, periodical bile vomiting for a month. The patient put off 12 kg. Body temperature in the evening is $37,6^oC$. Sonography revealed that bile bladder was 5,5х2,7 cm large, its wall - 0,4 cm, choledochus - 0,8 cm in diameter. Anterior liver segment contains a roundish hypoechoic formation up to 5 cm in diameter and another two up to 1,5 cm each, walls of these formations are up to 0,3 cm thick. What is the most likely diagnosis?
Alveolar echinococcus of liver
33
A 32-year-old patient lives in an area endemic for echinococcosis. In the last 6 months hereports of pain in the right subcostal area, fever. He is suspected to have liver echinococcosis. What study would be the most informative in this case?
USI
34
A 4 y.o. child attends the kindergarten. Complains of poor appetite, fatigue. Objective examination: skin and mucous membrane are pale, child is asthenic. In the hemogram: hypochromatic anemia 1st, leucomoide reaction of the eosinophile type. What pathology must be excluded first of all?
Helminthic invasion
35
On the 5th day after a surgery for colon injury a patient complains of bursting pain in the postoperative wound, weakness, drowsiness, headache, fever up to $40^oC$. Objectively: the skin around the wound is swollen, there is gas crepitation. The wound discharges are scarce foul-smelling, of dark-gray colorl. What is the most likely diagnosis?
Anaerobic clostridial wound infection
36
A 42-year-old female patient complains of a dull pain in her left side, low-grade fever, accelerated painful urination in small portions. These presentations have been observed for three years. For a long time, the patient has had cystitis with frequent exacerbations, there is pulmonary tuberculosis in the past history. Urinalysis results: microscopic hematuria, leukocyturia. What is the most likely provisional diagnosis?
Renal tuberculosis
37
A man with a stab-wound of the right foot applied to doctor. He stepped on the board with nail two hours ago. In the patient medical chart it is stated that 3 years ago he passed the whole course of vaccination against tetanus. What is the tactics of doctor to prevent tetanus in this case?
Do not conduct specific prophylaxis
38
A 40-year-old patient underwent an operation for a lumbar phlegmon. Body temparature rose again up to 38oC, he got intoxication symptoms, there was an increase of leukocyte number in blood. The wound that was nearly free from necrotic tissues and full of granulations started to discharge pus, the granulations turned pale. What complication dveloped in this patient?
Sepsis
39
A patient operated for acute paraproctitis undergoes antibacterial and detoxification therapy, the local course of the disease has the positive dynamics. Since the operation the patient has had chills, pyrexia, tachycardia, euphoria for five days. The doctor suspected sepsis. What study will confirm the diagnosis?
Blood culture for a pathogen
40
A 66-year-old female patient has been admitted to a hospital for massive gross hematuria with release of shapeless blood clots, frequent painful urination. The patient also reports a moderate weight loss within 3-4 months. Gross hematuria that was not accompanied by pain and dysuria first occurred three months ago for no apparent reason, and after a few days the bleeding subsided independently. What is the most likely diagnosis?
Bladder tumor
41
A 74 y.o. patient has been ill with benign prostate hyperplasy for the last 5 years. 4 days ago, after alcochol consumption, there was an acute retention of urination. At the pre-admission stage his urinary bladder was catheterized with metallic catheter. Examination revealed: right epididymis is enlarged, thick and painful, there are purulent discharges from urethra. What way of emergency care must be chosen?
Trocar or open epicystostomy
42
A 78-year-old patient complains of severe pain in the lower abdomen, perineum and rectum; intense urge to urinate and inability to urinate without assistance. Abdomen palpation reveals a moderately painful globular formation above the pubis, there is percussion dullness over the formation. What is the most likely diagnosis?
Acute urinary retention
43
A 77-year-old male patient complains of inability to urinate, bursting pain above the pubis. The patient developed acute condition 12 hours before. Objectively: full urinary bladder is palpable above the pubis. Rectal prostate is enlarged, dense and elastic, well-defined, with no nodes. Interlobular sulcus is distinct. Ultrasonography results: prostate volume is 120 cm3 , it projects into the bladder cavity, has homogeneous parenchyma. Prostate-specific antigen rate is of 5 ng/ml. What is the most likely disease that caused acute urinary retention?
Prostatic hyperplasia
44
X-ray picture of chest shows a density and an abrupt decrease in the upper lobe of the right lung. The middle and lower lobe of the right lung exhibit significant pneumatization. The right pulmonary hilum comes up to the dense lobe. In the upper and middle parts of the left pulmonary field there are multiple focal shadows. In the basal region of the left pulmonary field there are clear outlines of two annular shadows with quite thick and irregular walls. What disease is this X-ray pattern typical for?
Fibro-cavernous pulmonary tuberculosis
45
A 50 y.o. patient was admitted to the hospital with complaints of blood in urine. There was no pain or urination disorders, hematuria has lasted for 3 days. Objectively: kidneys are not palpable, suprapubic region has no pecularities, external genitals have no pathology. Rectal examination revealed: prevesical gland is not enlarged. Cytoscopy revealed no changes. What disease would you think about first of all?
Cancer of kidney
46
A 20-year-old patient complains of pain in the left lumbar region, arterial pressure rise up to 160/110 mm Hg. USI revealed that the structure and size of the right kidney were within age norms, there were signs of 3 degree hydronephrotic transformation of the left kidney. Doppler examination revealed an additional artery running to the lower pole of the kidney. Excretory urogram shows a narrowing in the region of ureteropelvic junction. Specify the therapeutic tactics:
Surgical intervention
47
A 25-year-old patient complains of burning and pain during urination, purulent discharges from the urethra that turned up 2 days ago. Objectively: the urethral labia are edematic, hyperemic, there are profuse purulent discharges from the urethra. Provisional diagnosis: recent acute gonorrheal urethritis. What supplemental data of clinical examinations will alow to specify the diagnosis?
Microscopy of the urethral discharges
48
A 66-year-old female patient has been admitted to a hospital for massive gross hematuria with release of shapeless blood clots, frequent painful urination. The patient also reports a moderate weight loss within 3-4 months. Gross hematuria that was not accompanied by pain and dysuria first occurred three months ago for no apparent reason, and after a few days the bleeding subsided independently. What is the most likely diagnosis?
Bladder tumor
49
A children's surgical unit admitted a 1-month-old boy who had been prenatally diagnosed with the left-sided pyelectasis. Such studies as drip infusion urography, cystography and USI allowed to reveal initial hydronephrosis. There is no information confirming the secondary pyelonephritis. What tactics of this patient management is most advisable?
6-month surveillance
50
A 65-year-old patient complains about pain in the lumbar spine, moderate disuria. He has been suffering from these presentations for about half a year. Prostate volume is 45 cm3 (there are hypoechogenic nodes in both lobes, capsule invasion). Prostate-specific antigen is 60 ng/l. Prostate biopsy revealed an adenocarcinoma. Which of the supplemental examination methods will allow to determine the stage of neoplastic process in this patient?
Computer tomography of pelvis
51
A patient complains of nycturia, constant boring pain in perineum and suprapubic region, weak urine jet, frequent, obstructed and painful urination. He has been ill for several months, pain in perineum appeared after getting problems with urination. Rectal examination revealed that prostate is enlarged (mostly owing to the right lobe), dense, asymmetric, its central sulcus is flattened, the right lobe is dense, painless, tuberous. What disease can it be?
Cancer of prostate
52
An 80-year-old patient complains of constantly urinating small amounts, a feeling of pressure in the lower abdomen. Objectively: there is a suprapubic spherical bulging with percussion dullness over it. What syndrome occurred in the patient?
Paradoxical ischuria
53
A patient, aged 81, complains of constant urinary excretion in drops, feeling of fullness in the lower abdomen. On examination: above pubis there is a spherical protrusion, over which there is a dullness of percussion sound, positive suprapubic punch. What symptom is observed in this patient?
Paradoxal ischuria
54
The most available and informative diagnostic method for closed trauma of the urinary bladder is:
Retrograde cystography
55
A 60 y.o. man complains of sense of heaviness in the region of scrotum. Objectively: scrotum edema in the left part. Testicle is of normal size, but there is a soft, scrotum limited edema over it that can be pressed and disappears when the patient lies down. What is the preliminary diagnosis?
Varicocele
56
A 45-year-old patient with urolithiasis had an attack of renal colic. What is the mechanism of the attack development?
Disturbed urine outflow from the kidney
57
A patient suffers from suddenly arising crampy pain in the right loin area. 2 hours after the pain had started, hematuria took place. Loin X-ray: no pathological shadows. Ultrasound: pyelocaliectasis on the right, the left part is normal. What is the most probable diagnosis?
Stone of the right kidney, renal colic
58
A 38 year old man, previously in good health, suddenly develops severe abdominal pain radiating from the left loin to groin and accompanied by nausea, perspiration and the need for frequent urination. He is restless, tossing in bed but has no abnormal findings. The most likely diagnosis is:
Leftsided renal colic
59
A 10-year-old child has been admitted to a hospital with a closed craniocerebral injury with suspected cerebral edema. The patient is in grave condition, unconscious. The dyspnea, tachycardia, hypertension are present. Muscle tone is increased, there is nystagmus, pupillary and oculomotor reactions are disturbed. The mandatory component of intensive care is dehydration. What diuretic is adequate in this case?
Furosemide
60
A patient came to the traumatology centre and complained about a trauma of the lower third of the volar forearm surface caused by cut on a piece of glass. Objectively: flexion of the IV and V fingers is impaired, sensitivity of the interior dorsal and palmar surface of hand as well as of the IV finger is reduced. What nerve is damaged?
Ulnar
61
A victim of the car crash was brought to neurosurgery due to craniocerebral trauma. During examination symptoms of focused injury of the cerebrum are found, cerebrum contusion is suspected. What method of examination is to be used?
Computed tomography of the cerebrum
62
A 65 y.o. man who has problems with urination as a result of benign prostate gland adenoma dveloped fever and chill, hypotension, sinus tachycardia. Skin is warm and dry. Clinical blood analysis revealed absolute granulocytopenia. These hemodynamic changes are most likely to be caused by:
Endotoxemia with activation of complement system
63
A 44-year-old patient has been admitted to a hospital with complaints of dull, aching pain in the left lumbar region, the admixture of pus in the urine. Examination revealed a grade II staghorn calculus on the left. What method of treatment is indicated for this patient?
Surgery
64
1 day ago a 19-year old male patient got a trauma after a fall from 1,5 m height when he "bestrode" a wooden beam. Urination is extremely difficult, there is macrohematuria, urethrorrhagia. There is a hematoma in the perineum and on the scrotum. Urethrography revealed flowing of contrast medium into the membranous part of urethra. What is the treatment tactics of choice?
Epicystostomy
65
A rounded well-defined shadow was found in the costo-vertebral angle on the chest roentgenogram of an otherwise healthy 9 year old girl. Make a preliminary diagnosis:
Ganglioneuroma
66
A 72 year old patient complains about pain and bleeding during defecation. Digital rectal investigation revealed a tumour of anal canal. After verification of the diagnosis the patient was diagnosed with squamous cell carcinoma. The secondary (metastatic) tumour will be most probably found in:
Lungs
67
For the persons who live in a hot area after an accident at a nuclear object, the greatest risk within the first decade is represented by cancer of:
Skin
68
A 17-year-old patient complains of pain in the area of the left knee joint. Soft tissues of thigh in the affected region are infiltrated, joint function is limited. X-ray picture of the distal metaepiphysis of the left femur shows a destruction focus with periosteum detachment and Codman's triangle found at the defect border in the bone cortex. X-ray of chest reveals multiple small focal metastases. What treatment is indicated?
Palliative chemotherapy
69
An anestesiologist gives narcosis to the patient, he uses a non-reversive contour. Anesthetic is halothane. Air temperature in the operation room is 210С, humidity 50%, level of noise 30 dB. What occupational hazard is the principal one under these conditions?
Air pollution with anesthetic
70
A patient aged 18 with a cranial injury was in comatose state during several hours. In post-comatose period gets tired quickly, non-productive in dialog - in the beginning answers 2-3 questions, then gets tired and can not understand the point of the question. Which psychotropic should be given to the patient to prevent psychoorganic syndrome?
Nootropics
71
A 9-year-old boy fell from a tree and hit the occipital region, there was a momentary loss of consciousness. Objectively: the child's condition is satisfactory, he complains of the headache and dizziness. The X-ray of skull reveals a comminuted depressed fracture of occipital bone in the region of inion. What treatment is indicated for the patient?
Surgical intervention
72
A 55-year-old patient complains of severe itching, burning and pain in the eyes, skin redness in the outer corners of the palpebral fissure. Objectively: skin around the outer corners of the palpebral fissure is macerated, eczematous, there are single moist cracks. Palpebral conjunctiva is hyperemic, quaggy. There are minor discharges in form of stringing mucus. What is the most likely diagnosis?
Chronic conjunctivitis
73
A 65-year-old patient complains of gradual worsening of the left eye vision during 10 months. On physical examination: acuty of vision of the left eye is 0,01, not correctable. The eye is quiet, pupil of the eye is grayish, reflex from the eye-ground is absent. Intraocular pressure is 18 mm/Hg. What is the most probable preliminary diagnosis?
Senile cataract
74
A patient complains of impaired far vision. Previously his eyes often turned red and hurt. Objectively: the eyes are not irritated, the cornea is transparent, anterior chambers are median deep, their liquid is transparent. The iris of the right eye has not changed in colour, its pattern is unchanged. The pupil is of irregular shape, scalloped. Biomicroscopy of the crystalline lens reveals the areas of opacity and vacuoles. Make a diagnosis:
Complicated cataract of the right eye
75
A 72 year old female patient has been treated for urolithiasis in the urological department. After atropine injection she got acute pain in her left eye and abrupt vision impairment. Objectively: visual acuity of the left eye is 0,01, the eye is dense but painful on palpation, cornea is opaque, there is cyanotic induration of eyeball vessels. What is the most probable diagnosis?
Acute attack of primary glaucoma of the left eye
76
A 60 y.o. man complains of significant pain in the right eye, photophobia, lacrimation, reduced vision of this eye, headache of the right part of the head. Pain occured 2 days ago. On examination: Vis OD- 0,03, congested injection of the eye ball, significant cornea edema, front chamber is deep, pupil is narrow, athrophic iris, there is optic nerve excavation on the eye fundus, intraocular pressure- 38 mm Hg. Vis OS- 0,8 unadjustable. The eye is calm, healthy. Intraoccular pressure- 22 mm Hg. What is the most probable diagnosis?
Acute glaucoma attack
77
A neonatologist examining a full-term mature baby revealed the shortening and external rotation of the newborn's lower extremity. Clinical examination revealed positive Ortolani sign, symptom of non-vanishing pulse, additional skin folds on the internal surface of thigh. What is the most likely diagnosis?
Congenital hip dislocation
78
The 67 y.o. patient had 5 recurrent fractures of the lower extremities without considerable cause within 5 years. O-shaped deformity of the legs in the knee joints has appeared. The skull, pelvis and lower extremities X-Ray shows the thickening of flat bones. In the long bones there is a hyperostosis along the bone axis.The blood test has not revealed any inflammation activity. Serum calcium is normal. What disease do you consider in this case?
Paget's disease
79
A 10 year old boy complains about pain in his left eye and strong photophobia after he had injured his left eye with a pencil at school. Left eye examination: blepharospasm, ciliary and conjunctival congestion, cornea is transparent, other parts of eyeball have no changes. Visus 0,9. Right eye is healthy, Visus 1,0. What additional method would you choose first of all?
Staining test with 1% fluorescein
80
After contusion of the right eye a patient complains of sudden loss of vision with remaining light perception. Objectively: the eye is not irritated. The cornea is transparent. Pupil reacts to light. The pupil area is black. The fundus reflex is absent. What is the most likely cause of vision loss?
Hemophthalmia
81
A 57 year old patient abruptly lost the sight of one eye. Examination revealed that his sight made up 0,02 excentrically, eye fundus has haemorrhages of different forms and sizes ("squashed tomato" symptom). Disc of optic nerve is hyperemic. In anamnesis general vascular pathology is recorded. Direct-acting anticoagulants were administered. What is the most probable diagnosis?
Thrombosis of central vein of retina
82
A 40-year-old female patient has a history of rheumatism. She complains about acute pain in her left eye, especially at night, vision impairment, photophobia, lacrimation. The patient cannot suggest any reasons for the disease. Objectively: weak pericorneal injection, flattening of iris relief, iris discoloration. What is the most likely diagnosis?
Iridocyclitis
83
Which of the following symptoms is the most typical for the adenoid hypertrophy?
Nasal obstruction
84
10 years ago a patient had a fracture in the middle one-third of his left femoral bone, and during the last 7 years he has been having acute inflammation in the area of old fracture accompanied by formation of a fistula through which some pus with small fragments of bone tissue is discharged. After a time the fistula closes. What complication of the fracture is it?
Chronic osteomyelitis
85
After an accident a patient complains of pain in the hip joint. Objectively: the leg is in the position of flexion, adduction and internal rotation, significantly contracted. There is elastic resistance to passive adduction or abduction of the extremity. Major trochanter is located high above the Roser-Nelaton line. A significant lordosis is present. What is your provisional diagnosis?
Iliac dislocation of hip
86
A patient with acute purulent otitis media complicated by mastoiditis was admitted to a hospital. Roentgenogram of mastoid processes showed the shadiowing of the cellular system on the lesion, absence of bone septa was present. What are the necessary therapeutic actions at the second stage of mastoiditis?
Mastoidotomy
87
A 30-year-old woman complains of nasal blockage, sneezing, watery nasal discharges. The body temperature is normal. Objectively - edema of nasal mucous membrane on both sides, especially of the lower turbinate (with cyanosis). Blood test data - mild leukocytosis and eosinophilia. What is the diagnosis?
Allergic rhinitis
88
A 3-year-old girl has had an increase in body temperature up to 38,5oC for four days. The child refuses to eat. Over the last two days, nose and mouth breathing has become difficult. Mesopharyngoscopy reveals hyperthermia and enlargement of tonsils, as well as hyperemia and bulging of the posterior wall of the oropharynx, which significantly narrows the oropharyngeal lumen. What complication of quinsy occurred in the patient?
Retropharyngeal abscess
89
A patient complains of intense pressing pain in the pharynx, mainly to the right, impossibility to swallow even liquid food. The illness started 5 days ago. The patient's condition is grave. Body temperature - 38,90C, speech is difficult, voice is constrained, difficulties in opening the mouth. Submaxillary glands to the right are painful, enlarged. What is the most probable diagnosis?
Peritonsillar abscess
90
A 26-year-old male patient consulted a doctor abut sore throat, fever up to 38,2oC. A week before, the patient had quinsy, didn't follow medical recommendations. On examination, the patient had forced position of his head, trismus of chewing muscles. Left peritonsillar region is markedly hyperemic, swollen. What is the provisional diagnosis?
Left-sided peritonsillar abscess
91
A 30 year old man complains of acute pain in his right ear, hearing loss, high temperature for three days. Objectively: right ear whispering language - 0,5 mm, external ear is intact, otoscopically - eardrum protrusion, hyperemia and swelling, loss of landmarks. What disease is it?
Acute purulent otitis media
92
A 22 y.o. man complains of acute throat pain, increasing upon swallowing during 3 days. Body temperature 38,30С, neck lymph nodules are slightly enlarged and painful. Pharyngoscopically - tonsilar hyperemia, enlargement and edema, tonsils are covered by round yellow fibrinous patches around crypts openings. Beta-haemolytic streptococcus in swab analysis. What is the diagnosis?
Acute membranous tonsilitis
93
A patient had disorder of nasal respiration, mucopurulent discharges from nose, headache for 3 weeks. At anterior rhinoscopy in middle nasal meathus the stria of pus, edema, hyperemia of the mucosa of the nose have been determined. What diagnostic method is necessary to administer first of all?
An X-ray of paranasal sinuses
94
An 8-month-old baby has had problems with nasal breathing and muco-purulent discharge from the nose for a week. Examination reveals a rhinedema, muco-purulent discharges from the middle nasal meatus as well as on the back of pharynx. What disease are these symptoms most typical for?
Ethmoiditis
95
A 36-year-old male patient complains of having headache, obstructed nasal breathing, purulent nasal discharge for 2 weeks. A month before, he had his right maxillary premolar filled. Radiolography revealed an intense opacity of the right maxillary sinus. Diagnostic puncture revealed a large amount of thick malodorous crumbly pus. What is the most likely diagnosis?
Chronic suppurative odontogenic sinusitis
96
Three weeks after acute angina the patient is still weak, inert, subfebrile, his retromaxillary lymph nodes are enlarged. Tonsils are flabby, stick together with arches, there are purulent plugs in lacunae. What is the most probable diagnosis?
Chronic tonsillitis
97
A 22 y.o. man complains of acute throat pain, increasing upon swallowing during 3 days. Body temperature 38,30С, neck lymph nodules are slightly enlarged and painful. Pharyngoscopically - tonsilar hyperemia, enlargement and edema, tonsils are covered by round yellow fibrinous patches around crypts openings. Beta-haemolytic streptococcus in swab analysis. What is the diagnosis?
Acute membranous tonsilitis
98
In course of herniotomy of a 12 y.o. patient doctors revealed a testicle in the hernial sac. What type of hernia is it?
Congenital oblique inguinal hernia
99
It has been suspected that a newborn has congenital diaphragmatic hernia (asphyctic incarceration). What study will allow to confirm the diagnosis?
Plan radiography of the chest cavity
100
During investigation for chronic, severe, epigastric pain, a 40 year old alcoholic man is found to have multiple areas of narrowing alternating with dilatation ("chain of lakes" appearance) of the main pancreatic duct. The operation of choice is:
Lateral pancreaticojejunostomy