Medicine
問題一覧
1
3 hours before, a 68-year-old male patient got a searing chest pain radiating to the neck and left forearm, escalating dyspnea. Nitroglycerin failed to relieve pain but somewhat reduced dyspnea. Objectively: there is crimson cyanosis of face. Respiratory rate is 28/min. The patient has vesicular breathing with isolated sibilant rales. Heart sounds are muffled, with a gallop rhythm. Ps - 100/min, AP - 100/65 mmHg. ECG shows negative T-wave in V2-V6 leads. What drug can reduce the heart's need for oxygen without aggravating the disease?
Isosorbide dinitrate
2
A 57-year-old male patient had an attack of retrosternal pain that lasted more than 1,5 hours. Objectively: the patient is inert, adynamic, has pale skin, cold extremities, poor volume pulse, heart rate - 120/min, AP - 70/40 mm Hg. ECG shows ST elevation in II, III, aVF leads. What condition are these changes typical for?
Cardiogenic shock
3
A patient has got a sudden attack of severe substernal pain at night. On examination: confusion, pallor of the skin, acrocyanosis, cold sweat, BP- 80/50 mm Hg, Ps- 120/min, irregular and weak pulse. What condition are these symptoms typical for?
Cardiogenic shock
4
A 58 y.o. patient developed acute myocardium infarction 4 hours ago, now he is in the acute care department. ECG registers short paroxysms of ventricular tachycardia. The most appropriate measure will be to introduct:
Lidocain
5
On the 3rd day after the acute anterior myocardial infarction a 55 y.o. patient complains of dull ache behind his breast bone, that can be reduced by bending forward, and of dyspnea. Objectively: AP- 140/180 mm Hg, heart sounds are dull. ECG results: atrial fibrillation with frequence of ventricular contractions at the rate of 110/min, pathological Q wave and S-T segment raising in the right chest leads. The patient refused from thrombolisis. What is the most probable diagnosis?
Acute pericarditis
6
A 60-year-old female patient was admitted to a hospital for acute transmural infarction. An hour ago the patient's contition got worse. She developed progressing dyspnea, dry cough. Respiratory rate - 30/min, heart rate - 130/min, AP- 90/60 mm Hg. Heart sounds are muffled, diastolic shock on the pulmonary artery. There are medium moist rales in the lower parts of lungs on the right and on the left. Body temperature - 36,4 oC. What drug should be given in the first place?
Promedol
7
A 26-year-old female patient has an 11-year history of rheumatism. Four years ago she suffered 2 rheumatic attacks. Over the last 6 months there have been paroxysms of atrial fibrillation every 2-3 months. What option of antiarrhythmic therapy or tactics should be proposed?
Prophylactic administration of cordarone
8
A 76-year-old male consulted a therapist about slow discharge of urine with a small jet. The patient reported no cardiac problems. Examination revealed atrial fibrillation with a heart rate of 72/min and without pulse deficit. There are no signs of heart failure. ECG confirms the presence of atrial fibrillation. From history we know that the arrhythmia was detected three years ago. What tactics for the treatment of atrial fibrillation in the patient should be chosen?
Does not require treatment
9
A 63-year-old male patient with persistent atrial fibrillation complains of moderate dyspnea. Objectively: peripheral edemata are absent, vesicular breathing is present, heart rate - 72/min, AP - 140/90 mm Hg. What combination of drugs will be most effective for the secondary prevention of heart failure?
Beta-blockers, ACE inhibitors
10
A 53-year-old woman complained of cardiac pain and rhythm intermissions. She had experienced these presentations since childhood. The patient's father had a history of cardiac arrhythmias. Objectively: the patient was in grave condition, Ps- 220 bpm, AP- 80/60 mm Hg. ECG: heart rate - 215/min, widening and deformation of $QRS$ complex accompanied by atrioventricular dissociation; positive $P$ wave. Some time later heart rate reduced down to 45/min, there was a complete dissociation of $P$ wave and $QRST$ complex. Which of the following will be the most effective treatment?
Implantation of the artificial pacemaker
11
Adenosine triphosphate may be expected to convert which of the following arrhythmias to sinus rhythm?
Paroxysmal supraventricular tachycardia
12
A 46-year-old patient complains of sudden palpitation, which is accompanied by pulsation in the neck and head, fear, nausea. The palpitation lasts for 15-20 minutes and is over after straining when holding her breath. What kind of cardiac disorder may be suspected?
An attack of supraventricular paroxysmal tachycardia
13
A 45-year-old male patient was admitted to the intensive care unit because of myocardial infarction. An hour later the ventricular facilitation occurred. Which of the following should be administered?
Defibrillation
14
A 46-year-old patient is to be prepared to the operation on account of stomach cancer. Preoperative preparation involves infusion therapy. It was injected up to 3,0 l of solutions into his right lunar vein. On the next day he got tensive pain in the region of his right shoulder. Examination of interior brachial surface revealed a stripe of hyperemia, skin edema and a painful cord. What complication is it?
Acute thrombophlebitis
15
A 28-year-old patient complains of periodic compressing heart pain. His brother died at the age of 34 from a cardiac disease with similar symptoms. Objectively: the patients skin is pale. Heart borders display no significant deviations. Heart sounds are loud, there is a systolic murmur above all the points with a peak above the aorta. Echocardioscopy reveals thickening of the interventricular septum in the basal parts, reduction of left ventricular cavity. What drug should be administered in order to prevent the disease progression?
Metoprolol
16
A 47-year-old male patient complains of compressive chest pain that occurs both at rest and during light physical activity; irregular heartbeat. These problems arose 3 months ago. The patient's brother died suddenly at the age of 30. Objectively: Ps - 84/min, arrhythmic, AP - 130/80 mm Hg. ECG confirms signs of left ventricular hypertrophy, abnormal Q-waves in V4-V6 leads. EchoCG reveals that interventricular septum is 1,7 cm, left ventricular wall thickness is 1,2 cm. What is the most likely diagnosis?
Hypertrophic cardiomyopathy
17
A 65 y.o. patient has acute pain, paresthesia, paleness of his left extremity. Pulse in the a. dorsalis pedis is absent. There is skin coldness and paleness that gradually spreads upwards. These symptoms are most likely to be the evidence of:
Arterial occlusion
18
A patient with a history of coronary artery disease and atrial fibrillation has the onset of sudden pain and weakness of the left leg. Examination reveals a cool, pale extremity with absent pulses below the groin and normal contralateral leg. The most likely diagnosis is:
Arterial embolism
19
A 70 y.o. patient complains of weakness, dizziness, short periods of unconsciousness, pain in the cardiac area. Objectively: HR- 40 bpm, heart sounds are rhythmic, the S1 is dull, periodically amplified. AP is 180/90 mm Hg. What is the most probable cause of hemodynamic disturbances?
Atrioventricular block type III
20
A 29-year-old female patient complains of dyspnea and palpitations on exertion. According to her mother, as a child she had heart murmur, did not undergo any examinations. Objectively: the patient has pale skin, Ps- 94/min, rhythmic. AP- 120/60 mm Hg. In the II intercostal space on the left auscultation reveals a continuous rasping systolodiastolic murmur, diastolic shock above the pulmonary artery. Blood and urine are unremarkable. What is the most likely diagnosis?
Patent ductus arteriosus
21
Five days after a total hip joint replacement a 72 year old woman becomes acutely short of breath, diaphoretic and hypotensive. Both lung fields are clear to auscultation and percussion, but examination of the neck reveals mild jugular venous distension with prominent A waves. Heart sounds are normal. ECG shows sinus tachycardia with a new right bundle branch block and minor nonspecific ST-T wave changes. The most likely diagnosis is:
Pulmonary thromboembolism
22
A 39 y.o. patient complains of having dyspnea during physical activity, crus edemata, palpitation, heart intermissions. Objectively: HR is 150 bpm, atrial fibrillation. Heart is both ways enlarged. Heart sounds are muted. Liver is 6 cm below the costal margin. Echocardiogram reveals dilatation of heart chambers (end diastolic volume of left ventricle is 6,8 cm) is 29% EF, valve apparatus is unchanged. What is the most probable diagnosis?
Dilated cardiomyopathy
23
A 32-year-old patient complains of cardiac irregularities, dizziness, dyspnea at physical stress. He has never suffered from this before. Objectively: Ps- 74 bpm, rhythmic. AP130/80 mm Hg. Auscultation revealed systolic murmur above aorta, the first heart sound was normal. ECG showed hypertrophy of the left ventricle, signs of repolarization disturbance in the I, V5 and V6 leads. Echocardiogram revealed that interventricular septum was 2 cm. What is the most likely diagnosis?
Hypertrophic cardiomyopathy
24
A 37 y.o. woman is suffering from squeezing substernal pain on physical exertion. On examination: AP- 130/80 mm Hg, heart rate=pulse rate 72 bpm, heart boarders are dilated to the left side, aortic systolic murmur. ECG- signs of the left venticle hypertrophy. What method of examination is the most informative in this case?
Echocardiography
25
An 18-year-old patient presents no problems. Percussion reveals that heart borders are displaced to the right and left by 1 cm, there is a coarse systolic murmur with its epicenter within the 4th intercostal space on the left. What is the most informative examination to confirm the clinical diagnosis?
Ventriculography
26
A 24-year-old female teacher complains of dizziness and heart pain irradiating to the left nipple. Pain is not associated with physical activity and cannot be relieved by nitroglycerin, it abates after taking Valocordin and lasts an hour or more. The patient has a nearly 2-year history of this disease. Objectively: Ps- 76 bpm. AP- 110/70 mm Hg. Heart borders are normal, heart sounds are clear. The ECG shows respiratory arrhythmia. Radiograph of the cervicothoracic spine shows no pathology. Lungs, abdomen are unremarkable. What changes in blood formula can be expected?
No changes
27
A 57-year-old male patient complains of dyspnea on exertion, heaviness in the right hypochondrium and shin edemata towards evening. Objectively: temperature - $38,1^oC$, HR20/min, HR=Ps=92/min, AP- 140/90 mm Hg. There is apparent kyphoscoliosis. In the lungs single dry rales can be auscultated. Heart sounds are muffled, rhythmic. ECG: Rv1+Sv5=15 mm. X-ray picture shows the bulging of pulmonary artery cone, right ventricle enlargement. What is the most likely cause of this condition?
Pulmonary heart
28
A 30-year-old patient complains of breathlessness, pain in the right rib arc region, dry cough and the edema of legs. He is ill for 2 months. He had been treated for rheumatic fever without any effect. On exam: cyanosis, edema of legs, BT of 36,6oC, RR of 28/min, HR of 90/min, BP of 110/80 mm Hg, crackles above low parts of both lungs, heart borders are displaced to the left and to the right, weak sounds, systolic murmur above the apex. What is the preliminary diagnosis?
Dilated cardiomyopathy
29
A 56 year old man complains of fatigue, dyspnea on exertion and palpitations. He has had a murmur since childhood. Examination reveals a lift at the left sternal border, split S1, and fixed splitting of S2. There is a grade 3/6 midsystolic pulmonic murmur and a 1/6 middiastolic tricuspid murmur at the lower left sternal border. Chest x-ray shows right ventricular enlargement and prominent pulmonary arteries. ECG demonstrates atrial fibrillation with a right bundle branch block. The most likely diagnosis is:
Arterial septal defect
30
During examination at a military commissariat a 15-year-old teenager was found to have interval sysolic murmur on the cardiac apex, diastolic shock above the pulmonary artery, tachycardia. Which of the suuplemental examination methods will be the most informative for the diagnosis specification?
Echocardiography
31
A 52-year-old male patient complains about attacks of asphyxia, pain in his right side during respiration. These manifestations turned up all of a sudden. It is known from his anamnesis that he had been treated for thrombophlebitis of the right leg for the last month. In the admission ward the patient suddenly lost consciousness, there was a sudden attack of asphyxia and pain in his side. Objectively: heart rate - 102/min, respiratory rate - 28/min, AP- 90/70 mm Hg. Auscultation revealed diastolic shock above the pulmonary artery, gallop rhythm, small bubbling rales above the lungs under the scapula on the right, pleural friction rub. What examination method will be the most informative for a diagnosis?
Angiography of pulmonary vessels
32
A 62 year old patient complains of rest dyspnea, heart pains. 3 years ago he had myocardial infarction. Physical examination: orthopnea, acrocyanosis, swollen cervical veins. Ps - 92, total heart enlargement, the liver is enlarged by 7 cm, shin edema. What is the stage of chronic heart failure (CHF)?
CHF- 2 B
33
Generalized low voltage on an ECG (QRS deflection < 5 mm in limb leads and < 10 mm in precordial leads) may be a marker for all of the following disorders EXCEPT:
Hyperthyroidism
34
A 20-year-old patient complains of breath shortness, continuous dull heart pain, irritability. Objectively: general condition is satisfactory, the pulse is labile, AP- 130/60 mm Hg. ECG shows repolarization disorder. The patient has been diagnosed with cardiac-type neurocirculatory dystonia. The patient should receive treatment under the following conditions:
Outpatient treatment
35
A patient has chronic heart failure of the II stage. He takes furosemide regularly three times a week. He had developed bronchopneumonia and had been administered combined pharmacotherapy. On the fifth day of therapy the patient complained of hearing impairment. What drug coadministered with furosemide might have caused the hearing loss?
Gentamicin
36
Heart auscultation of a 16 y.o. boy without clinical symptoms revealed accent of the S II and systolic murmur above the pulmonary artery. Heart sounds are resonant, rhythmic. What is the most probable diagnosis?
Functional murmur
37
Routine examination of a 16-year-old boy revealed the presence of three heart sounds on auscultation. The third sound is low and occurs in early diastole, there is no additional murmur. In history: pneumonia six months ago. The patient presents no problems. Examination revealed hyposthenia, underdevelopment of muscles. Laboratory and instrumental studies reveald no peculiarities. What is the origin of the additional heart sound?
Physiological III sound
38
During the preventive examination a 17-year-old young man reports no health problems. Objectively: the patient is undernourished, asthenic; blood pressure is 110/70 mm Hg, Ps - 80/min. Heart borders are within normal range. Auscultation reveals three apical heart sounds, murmurs are absent. ECG shows no pathological changes, PCG registers the S3 occurring 0,15 seconds after the S2. How can you interpret these changes?
Physiologic S3
39
A 60-year-old patient complains about asphyxia, palpitation, rapid fatiguability. He has 8 year history of essential hypertension. Objectively: the left cardiac border is 2 cm deviated to the left from the medioclavicular line, heart sounds are rhythmic and weak; there is diastolic shock above aorta. AP- 170/100 mm Hg. Liver - +2 cm; shin pastosity is present. ECG shows deviation of cardiac axis to the left, left ventricle hypertrophy. Ejection fraction - 63%. What type of cardiac insufficiency is observed?
Diastolic
40
A 57-year-old man complains of shortness of breath, swelling on shanks, irregularity in cardiac work, pain in the left chest half with irradiation to the left scapula.Treatment is uineffective. On physical exam: heart's sounds are diminished, soft systolic murmur on the apex. Ps - 100/min, arrhythmical, BP - 115/75 mm Hg. The liver is +2 cm, painful. Roentgenoscopy: enlargement of heart shadow to all sides, pulsation is weak. Electrocardiogram (ECG): leftventricled extrasystolia, decreased voltage. What method of investigation is necessary to do to determine the diagnosis?
Echocardiography
41
During dynamic investigation of a patient the increase of central venous pressure is combined with the decrease of arterial pressure. What process is proved by such combination? During dynamic investigation of a patient the increase of central venous pressure is combined with the decrease of arterial pressure. What process is proved by such combination?
Increase of bleeding speed
42
During preventive examination a 16 year old patient presented no problems. Objectively: the patient has signs of malnutrition, he is asthenic, AP is 110/70 mm Hg, Ps is 80 bpm, cardiac border is normal, auscultation above the cardiac apex reveals three sounds, cardiac murmur is absent. ECG shows no pathological changes, phonocardiogram shows that the third sound comes 0,15 s after the second one above the apex. How are these changes called?
III physiological sound
43
A 18 y.o. female student complains of dyspnea during the intensive exertion. The condition became worse half a year ago. On examination: pulse rate is 88 bpm, accelerated, AP180/20 mm Hg, pale skin, heart borders are dilated to the left and up. There is systolic-diastolic murmur in the 2hd intercostal space, S2 at pulmonary artery is accentuated. ECG has revealed both ventricles hypertrophy. Thoracic X-ray has revealed pulsation and protrusion of the left ventricle, lung trunk. What doctor's tactics should be?
Cardiosurgeon consultation
44
A 58-year-old female patient complains about periodical headache, dizziness and ear noise. She has been suffering from diabetes mellitus for 15 years. Objectively: heart sounds are rhythmic, heart rate is 76/min, there is diastolic shock above aorta, AP is 180/110 mm Hg. In urine: OD- 1,014. Daily loss of protein with urine is 1,5 g. What drug should be chosen for treatment of arterial hypertension?
Ihibitor of angiotensin converting enzyme
45
A 74 y.o. patient has been suffering from hypertension for 20 years. He complains of frequent headache, dizziness, he takes enalapril. Objectively: accent of the SII above aorta, Ps- 84 bpm, rhythmic, AP- 180/120 mm Hg. What group of hypotensive medications could be additionally prescribed under consideration of the patient's age?
Thiazide diuretics
46
A 60 y.o. woman has had increased BP up to 210/110 mm Hg for the last 7 years. On examination: heart apex is displaced to the left. There are signs of left ventricular hypertrophy on ECG. What is the most probable diagnosis?
Essential hypertension, 2nd stage
47
A 52 year old patient has hypervolaemic type of essential hypertension. Which of the following medications is to be prescribed either as monotherapy or in complex with other antihypertensive drugs?
Hypothiazid
48
A 58-year-old patient complains of a headache in the occipital region, nausea, choking, opplotentes. The presentations appeared after a physical exertion. Objectively: the patient is excited. Face is hyperemic. Skin is pale. Heart sounds are regular, the 2nd aortic sound is accentuated. AP- 240/120 mm Hg, HR- 92/min. Auscultation reveals some fine moisr rales in the lower parts of the lungs. Liver is not enlarged. ECG shows signs of hypertrophy and left ventricular overload. What is the most likely diagnosis?
Complicated hypertensic crisis
49
A 67-year-old female patient with hypertensive crisis has asthma, cough with expectoration of frothy pink sputum, moist rales in the lungs. The patient stays in sitting position, respiratory rate is 40/min, AP- 214/136 mm Hg, heart rate - 102/min. What is the most rational tactics of this patient management?
Intravenous administration of furosemide
50
A 42-year-old male patient wth essential hypertension presents with headache, palpitations, unexplained fear. Objectively: Ps- 100/min, AP- 200/100 mm Hg, the left border of cardiac dullness is displaced by 1,5 cm to the left, vesicular breathing is present. ECG shows sinus tachycardia, signs of left ventricular hypertrophy. What drug should be administered as an emergency?
Obzidan
51
A 46 year old woman who has been suffering from hypertension for 5 years was diagnosed with hypertensive crisis. She complains about palpitation, sense of head pulsation; heart rate is 100/min, AP is 190/100 mm Hg (haemodynamics is of hyperkinetic type). What medication should be the medication of choice?
β-adrenoceptor blocker
52
A 67-year-old female patient suffering from the essential hypertension suddenly at night developed headache, dyspnea that quickly progressed to asphyxia. Objectively: the patient is pale, with sweaty forehead, AP- 210/140 mm Hg, heart rate - 120/min, auscultation revealed solitary dry rales and moist rales in the lower parts. The shins are pastose. What kind of emergency aid would be the most efficient in this case?
Nitroglycerin and furosemide intravenously
53
After myocardial infarction, a 50-year-old patient had an attack of asthma. Objectively: bubbling breathing with frequency of 32/min, cough with a lot of pink frothy sputum, acrocyanosis, swelling of the neck veins. Ps- 108/min, AP- 150/100 mm Hg. Heart sounds are muffled. Mixed moist rales can be auscultated above the entire lung surface. What drug would be most effective in this situation?
Nitroglycerin intravenously
54
A female rheumatic patient experiences diastolic thoracic wall tremor (diastolic thrill), accentuated S1 at apex, there is diastolic murmur with presystolic intensification, opening snap, S2 accent at pulmonary artery. What rind of heart disorder is observed?
Mitral stenosis
55
A 42 year old woman complains of dyspnea, edema of the legs and tachycardia during minor physical exertion. Heart borders are displaced to the left and S1 is accentuated, there is diastolic murmur on apex. The liver is enlarged by 5 cm. What is the cause of heart failure?
Mitral stenosis
56
A 40 y.o. woman is ill with rheumatic disease with composite mitral disease with prevalence of the stenosis of left venous foramen.Complains of palpitation, fatigability, progressing dyspnea, attacks of dyspnea and hemoptysis. Now she cannot be engaged even in the easy activities. What tactics is the most expedient?
Mitral comissurotomia
57
A 42-year-old patient applied to hospital with complaints of pain behind the sternum with irradiation to the left scapula. The pain appears during significant physical work, this lasts for 5-10 minutes and is over on rest. The patient is sick for 3 weeks. What is the preliminary diagnosis?
IHD:First established angina pectoris
58
A 33-year-old man with a history of rheumatic fever complains of fever up to 38-39oC, abdominal pain, dyspnea, tachycardia. Heart borders are displaced to the left by 2 cm, systolic and diastolic murmurs above aorta, BP of 160/30 mm Hg. Petechial rash occurs after measurement of blood pressure. Liver is enlarged by 3 cm, spleen is palpable. Urine is brown-yellow. What is the most likely diagnosis?
Infectious endocarditis
59
Thrombosis of the coronary artery caused myocardial infarction. What mechanisms of injury will be the dominating ones in this disease?
Calcium mechanisms
60
A patient had macrofocal myocardial infarction. He is overweight for 36%, AP is 150/90 mm Hg, blood sugar- 5,9 mmol/L, general cholesterol- 4,9 mmol/L, uric acid- 0,211 mmol/L. Which risk factor should be urgently eradicated during the secondary prevention?
Obesity
61
A patient has got acute macrofocal myocardial infarction complicated by cardiogenic shock. The latter is progressing under conditions of weak general peripheric resistance and decreased cardiac output. What antihypotensive drug should be injected to the patient in the first place?
Dopamine
62
A 30 year old woman ill with influenza felt palpitation and dull cardiac pain during moderate physical exercise. Objectively: Ps - 96 bpm, AP - 100/60 mm Hg. The first sound is quiet above the apex, soft systolic murmur is present. What complication is indicated by these clinical presentations?
Acute viral myocarditis
63
A 64 y.o. patient has developed of squeering substernal pain which had appeared 2 hours ago and irradiated to the left shoulder, marked weakness. On examination: pale skin, cold sweat. Pulse- 108 bpm, AP- 70/50 mm Hg, heart sound are deaf, vesicular breathing, soft abdomen, painless, varicouse vein on the left shin, ECG: synus rhythm, heart rate is 100 bmp, ST-segment is sharply elevated in II, III aVF leads. What is the most likely disorder?
Cardiogenic shock
64
A 45-year-old driver was admitted to the hospital with 5 hour substernal pain. Nitroglycerin is not effective. He is pale, heart sounds are regular but weak. HR - 96 per minute, BP of 100/60 mm Hg. What is the most likely diagnosis?
Acute myocardial infarction
65
A 50 year old woman complains about dull cardiac pain, asphyxia, body temperature rise up to 38oC. She had influenza a week ago. Objectively: Ps - 100 bpm, dropped-beat pulse during inspiration. AP - 100/70 mm Hg, heart sounds are muffled. ECG: reduced voltage, ST segment is above the isoline in all leads. X-ray picture shows extensively enlarged cardiac silhouette. Palmus is of small amplitude. What is the most probable diagnosis?
Exudative pericarditis
66
A 60-year-old patient has been admitted to a hospital with complaints of dyspnea, tightness in the right subcostal area, abdomen enlargement. These presentations have been progressing for a year. Heart auscultation reveals presystolic gallop rhythm. Objectively: swelling of the neck veins, ascites, palpable liver and spleen. What disease requires differential diagnostics?
Constrictive pericarditis
67
A 43-year-old female patient complains of dyspnea, swelling of legs, abdomen enlargement, pricking heart pain. She has a history of tuberculous bronchadenitis, quinsies. The patient's condition deteriorated 6 months ago. Objectively: cyanosis, bulging neck veins, vesicular breathing. Heart borders are not displaced. Heart sounds are muffled, Ps is 106/min, liver is +4 cm, ascites is present. Low voltage on the ECG has been revealed. Radiograph shows a thin layer of calcium deposits along the left contour of heart. What treatment should be recommended to the patient?
Treatment by a cardiac surgeon
68
A 43 y.o. woman complains of shooting heart pain, dyspnea, irregularities in the heart activity, progressive fatigue during 3 weeks. She had acute respiratory disease a month ago. On examination: AP- 120/80 mm Hg, heart rate 98 bpm, heart boarders +1,5 cm left side, sounds are muffled, soft systolic murmur at apex and Botkin's area; sporadic extrasystoles. Liver isn't palpated, there are no edema. Blood test: WBC- 6,7*109 /L, sedimentation rate- 21 mm/hour. What is the most probable diagnosis?
Acute myocarditis
69
A 25 year old patient had pharyngitis 2 weeks ago. Now he complains about body temperature rise up to 38oC, general weakness, dyspnea during walking, swelling and shifting pain in the articulations. Objectively: cyanosis of lips, rhythmic pulse of poor volume - 100 bpm. Left cardiac border deviates outwards from the mediaclavicular line by 1 cm. The first heart sound is weakened on the apex, auscultation revealed systolic souffle. What is the most probable aetiological factor that caused this pathological process?
β-haemolytic streptococcus
70
A 45-year-old man was brought to clinic with complaints of the pain that started suddenly in the left chest part and epigastric area, shortness of breath, nausea, one-time vomiting. The acute pain started after weight-lifting. On physical exam: shallow breathing, RR - 38/min, left chest part is behind during respiration, by percussion - tympanitic sound, respiration is not ausculated. Ps - 110 bpm, of weak filling. BP - 100/60 mm Hg, insignificant displacement of heart to the right, sounds are dull. What examination is the most expedient to do first?
Roentgenography
71
A 55-year-old male had been treated at the surgical department for acute lower-extremity thrombophlebitis. On the 7th day of treatment he suddenly developed pain in the left part of chest, dyspnea and cough. Body temperature was $36,1^oC$, respiratory rate - 36/min. The patient was also found to have diminished breath sounds without wheezing. Ps- 140/min, thready. AP- 70/50 mm Hg. The ECG shows QІІІ-S1 syndrome. What is the most likely diagnosis?
Pulmonary embolism
72
A healthy 75 year old woman who leads a moderately active way of life went through a preventive examination that revealed serum concentration of common cholesterol at the rate of 5,1 millimole/l and HDL (high-density lipoproteins) cholesterol at the rate of 70 mg/dl. ECG reveals no pathology. What dietary recommendation is the most adequate?
Any dietary changes are necessary
73
After a long periode of subfebrility a patient registered increase of dyspnea, pain in the right hypochondrium, leg edemata. Objectively: neck veins are edematic. Ps is 120 bpm, sometimes it disappears during inspiration. Heart sounds are very weakened. ECG showed low-voltage waves of ventricular complex. A month ago there was raise of ST V1-V4 segment. Cardiac silhouette is enlarged, roundish. What is the most probable diagnosis?
Exudative pericarditis
74
A 56-year-old scientist experiences constricting retrosternal pain several times a day while walking for 100-150 m. The pain lasts for up to 10 minutes and can be relieved by nitroglycerine. Objectively: the patient is overweight, heart borders exhibit no abnormalities, heart sounds are rhythmic, Ps- 78 bpm, AP- 130/80 mm Hg. ECG contains low amplitude of $T$ wave in $V_{4-5}$. What disease might be suspected?
Stable FC III stenocardia
75
A 47-year-old male patient has been lately complaining of compressing chest pain that occurs when he walks a distane of 700-800 m. Once a week, he drinks 2 liters of beer. Rise in arterial pressure has been observed for the last 7 years. Objectively: Ps - 74/min, AP - 120/80 mm Hg. The bicycle ergometry performed at workload of 75 watts shows 2 mm ST-segment depression in V4-V6 leads. What is the most likely diagnosis ?
Exertional stenocardia, II functional class
76
A 62-year-old male has been hospitalized in the intensive care unit with a continuous attack of retrosternal pain that cannot be relieved by nitroglycerin. Objectively: AP- 80/60 mm Hg, heart rate - 106/min, breathing rate - 22/min. Heart sounds are muffled, a gallop rhythm is present. How would you explain the AP drop?
Reduction in cardiac output
77
A 40 y.o. patient with rheumatic heart disease complains of anorexia, weakness and loss of weight, breathlessness and swelling of feet. The patient had tooth extraction one month ago. On examination: t0 - 390C, Ps- 100/min. Auscultation: diastolic murmur in the mitral area. Petechial lesion around the clavicle; spleen was palpable.
Subacute bacteria endocarditis
78
A 18 y.o. male patient complains of pain in knee and ankle joints, temperature elevation to 39,50C. He had a respiratory disease 1,5 week ago. On examination: temperature38,50C, swollen knee and ankle joints, pulse- 106 bpm, rhythmic, AP- 90/60 mm Hg, heart borders without changes, sounds are weakened, soft systolic apical murmur. What indicator is connected with possible etiology of the process?
Antistreptolysine-0
79
Examination of a 35-year-old patient with rheumatism revealed that the right heart border was 1 cm displaced outwards from the right parasternal line, the upper border was on the level with inferior margin of the 1st rib, the left border was 1 cm in from the left midclavicular line. Auscultation revealed atrial fibrillation, loud apical first sound, diastolic shock above the pulmonary artery. Echocardiocopy revealed abnormal pattern of the mitral valve motion. What heart disease is characterized by these symptoms?
Mitral stenosis
80
A 67-year-old male complains of dyspnea on exertion, attacks of retrosternal pain, dizziness. He has no history of rheumatism. Objectively: pale skin, acrocyanosis. There are rales in the lower parts of lungs. There is systolic thrill in the II intercostal space on the right, coarse systolic murmur conducted to the vessels of neck. AP- 130/90 mm Hg, heart rate - 90/min, regular rhythm. The liver extends 5 cm under the edge of costal arch, shin edemata are present. Specify the assumed valvular defect:
Aortic stenosis
81
A 61 y.o. man complained of sneezing and substernal pain on exertion. In the last 2 weeks such pain appeared at rest, with increased frequency, and couldn't be suppressed by 1 tablet of nitroglycerin. What is the most likely diagnosis?
Unstable angina pectoris
82
A 60 year old man with unstable angina pectoris fails to respond to heparin, nitroglycerin, beta adrenegic blockers and calcium channel antagonist. The best management includes:
Coronary artery bypass grafting
83
A 52 year old patient with history of functional Class II angina complains of having intense and prolonged retrosternal pains, decreased exercise tolerance for 5 days. Angina is less responsive to nitroglycerine. What is the most probable diagnosis?
IHD. Unstable angina
84
A patient with unstable angina pectoris was given the following complex treatment: anticoagulants, nitrates, α-adrenoblockers. However on the third day of treatment the pain still romains. Which in vestigation shoud be carried out to establish diagnosis?
Coronarography
85
During the ultrasound study of carotid and vertebral arteries a 74-year-old patient developed a condition manifested by dizziness, weakness, nausea, transient loss of consciousness. Objectively: pale skin, AP- 80/60 mm Hg, Ps- 96/min of poor volume. ECG shows sinus tachycardia, left ventricular hypertrophy. Focal neurological symptoms were not found. What is the provisional diagnosis?
Carotid sinus syncope
86
A 49-year-old male patient complains of dyspnea of combined nature, cough, shin edemata, abdomen enlargement due to ascites. He has a 20-year history of chronic bronchitis. For the last 3 years he has been disabled (group II) because of cardiac changes. Objectively: mixed cyanosis, edemata. Ps - 92/min, rhythmic, AP - 120/70 mm Hg, respiration rate - 24/min. There is accentuation of the second sound above the pulmonary artery. Auscultation reveals the box resonance above the lungs. There are also dry rales over the entire surface of lungs. What is the mechanism of heart changes development in this patient?
Euler-Liljestrand reflex
87
A patient, aged 49, complains of fever of 37,5oC, heart pain, dyspnea. S1 is clapping; S2 is accentuated in the aortic area; opening snap, presystolic murmur can be auscultated. What is the most efficient examination for valvular disorder assessment?
Echocardiography+Doppler-Echocardiography
88
A welder at work got the first-degree burns of the middle third of his right shin. 5 days later the skin around the burn became edematic and itchy. Objectively: on a background of a well-defined erythema there is polymorphic rash in form of papules, vesicles, pustules, erosions with serous discharge. What is the most likely diagnosis?
Microbal eczema
89
A male, 50 y.o., has a black flat mole on the skin of the leg for 10 years. Since 4 months ago the shapes of the mole become irregular. What diagnostic methods should be used?
Excision biopsy
90
A 35 year old woman consulted a doctor about affection of arm skin and lower third of forearm in form of a large edema, hyperemia, vesiculation and maceration. The disease developed after using a laundry detergent "Lotos". The patient has been using it for a month. She hasn't suffered from dermatological diseases before. What is the most probable diagnosis?
Allergic dermatitis
91
A 32 y.o. man is divorced, has an irregular sexual life. He complains of falling out of hair in the region of eyelashes, eyebrows, scalp. Objectively: diffuse alopecia is observed, eyebrow margin is absent, eyelashes are stair-like (Pinkus' sign). What examination should be carried out first of all?
Wasserman test, IFT
92
A 72-year-old male patient complains about itch in his left shin, especially around a trophic ulcer. Skin is reddened and edematic, there are some oozing lesions, single yellowish crusts. The focus of affection is well-defined. What is the most likely diagnosis?
Microbial eczema
93
A 35 y.o. patient experienced a strong nervous stress that resulted in formation of reddened and edematic areas on the back surface of her hands with further formation of small inflammated nodules, vesicles and then erosions accompanied by profuse discharge of serous liquid. The process is also accompanied by intense itching. What is the most probable diagnosis?
Common eczema
94
A 32-year-old female patient consulted a doctor about a skin affection of her body, face and extremities which turned up after peroral intake of biseptol. The patient was diagnosed with drug toxicoderma. What treatment methods would be the most effective for this patient?
Extracorporal therapy
95
A patient complains of skin painfullness and reddness of the right gastrocnemius muscle. Objectively: body temperature is 38,50С, enlarged and painful inguinal lymph nodes on the right. Skin of extremity is edematic, hyperemic, covered with eruption in form of vesicles containing dark fluid; its palpation is painful. There is distinct border between normal and hyperemic skin. What is the most probable diagnosis?
Erysipelas, hemorrhagic form
96
Medical examination of a man revealed "geographic tongue". This microsymptom is the evidence of the following vitamin deficiency:
Vitamins of B group
97
A patient at a doctor complains of temperature rise up to 38,20С, edema in the region of his upper lip. Objectively: upper lip is evidently edematic, in the middle of edema there is a cone-shaped swelling. Skin and mucous membrane over it are dark-red. Diagnosis: labial furuncle. A surgeon cut the furuncle, treated the wound with hydrogen peroxide solution and applied a bandage with hypertensive solution. What therapeutic regimen should be recommended?
In-patient treatment with common regimen
98
A 43-year-old female patiet complains of eruption on her right leg skin, pain, weakness, body temperature rise up to 38oC. The disease is acute. Objectively: there is an edema on the right leg skin in the region of foot, a well-defined bright red spot in form of flame tips which feels hot. There are isolated vesicles in focus. What is your provisional diagnosis?
Erysipelas
99
A 26-year-old male patient complains of a rash on the upper lip skin, which arose on a background of influenza with high-grade fever and is accompanied by pain and burning. The rash has been present for 3 days. Objectively: the skin of the upper lip is edematic and erythematous, grouped vesicles are filled with serous fluid and have a rough surface. What is the most likely diagnosis?
Herpetic vesicular dermatitis
Surgery
Surgery
Reshma Shaji · 100問 · 2年前Surgery
Surgery
100問 • 2年前Surgery 2
Surgery 2
Reshma Shaji · 100問 · 2年前Surgery 2
Surgery 2
100問 • 2年前Surgery 3
Surgery 3
Reshma Shaji · 90問 · 2年前Surgery 3
Surgery 3
90問 • 2年前Pediatrics 3
Pediatrics 3
Reshma Shaji · 87問 · 2年前Pediatrics 3
Pediatrics 3
87問 • 2年前Hygiene 1
Hygiene 1
Reshma Shaji · 100問 · 2年前Hygiene 1
Hygiene 1
100問 • 2年前Medicine 2
Medicine 2
Reshma Shaji · 100問 · 2年前Medicine 2
Medicine 2
100問 • 2年前Medicine 3
Medicine 3
Reshma Shaji · 81問 · 2年前Medicine 3
Medicine 3
81問 • 2年前Gynecology 1
Gynecology 1
Reshma Shaji · 92問 · 2年前Gynecology 1
Gynecology 1
92問 • 2年前Hygiene 2
Hygiene 2
Reshma Shaji · 94問 · 2年前Hygiene 2
Hygiene 2
94問 • 2年前Gynecology 2
Gynecology 2
Reshma Shaji · 100問 · 2年前Gynecology 2
Gynecology 2
100問 • 2年前Pediatrics 1
Pediatrics 1
Reshma Shaji · 100問 · 2年前Pediatrics 1
Pediatrics 1
100問 • 2年前Pediatrics 2
Pediatrics 2
Reshma Shaji · 51問 · 2年前Pediatrics 2
Pediatrics 2
51問 • 2年前問題一覧
1
3 hours before, a 68-year-old male patient got a searing chest pain radiating to the neck and left forearm, escalating dyspnea. Nitroglycerin failed to relieve pain but somewhat reduced dyspnea. Objectively: there is crimson cyanosis of face. Respiratory rate is 28/min. The patient has vesicular breathing with isolated sibilant rales. Heart sounds are muffled, with a gallop rhythm. Ps - 100/min, AP - 100/65 mmHg. ECG shows negative T-wave in V2-V6 leads. What drug can reduce the heart's need for oxygen without aggravating the disease?
Isosorbide dinitrate
2
A 57-year-old male patient had an attack of retrosternal pain that lasted more than 1,5 hours. Objectively: the patient is inert, adynamic, has pale skin, cold extremities, poor volume pulse, heart rate - 120/min, AP - 70/40 mm Hg. ECG shows ST elevation in II, III, aVF leads. What condition are these changes typical for?
Cardiogenic shock
3
A patient has got a sudden attack of severe substernal pain at night. On examination: confusion, pallor of the skin, acrocyanosis, cold sweat, BP- 80/50 mm Hg, Ps- 120/min, irregular and weak pulse. What condition are these symptoms typical for?
Cardiogenic shock
4
A 58 y.o. patient developed acute myocardium infarction 4 hours ago, now he is in the acute care department. ECG registers short paroxysms of ventricular tachycardia. The most appropriate measure will be to introduct:
Lidocain
5
On the 3rd day after the acute anterior myocardial infarction a 55 y.o. patient complains of dull ache behind his breast bone, that can be reduced by bending forward, and of dyspnea. Objectively: AP- 140/180 mm Hg, heart sounds are dull. ECG results: atrial fibrillation with frequence of ventricular contractions at the rate of 110/min, pathological Q wave and S-T segment raising in the right chest leads. The patient refused from thrombolisis. What is the most probable diagnosis?
Acute pericarditis
6
A 60-year-old female patient was admitted to a hospital for acute transmural infarction. An hour ago the patient's contition got worse. She developed progressing dyspnea, dry cough. Respiratory rate - 30/min, heart rate - 130/min, AP- 90/60 mm Hg. Heart sounds are muffled, diastolic shock on the pulmonary artery. There are medium moist rales in the lower parts of lungs on the right and on the left. Body temperature - 36,4 oC. What drug should be given in the first place?
Promedol
7
A 26-year-old female patient has an 11-year history of rheumatism. Four years ago she suffered 2 rheumatic attacks. Over the last 6 months there have been paroxysms of atrial fibrillation every 2-3 months. What option of antiarrhythmic therapy or tactics should be proposed?
Prophylactic administration of cordarone
8
A 76-year-old male consulted a therapist about slow discharge of urine with a small jet. The patient reported no cardiac problems. Examination revealed atrial fibrillation with a heart rate of 72/min and without pulse deficit. There are no signs of heart failure. ECG confirms the presence of atrial fibrillation. From history we know that the arrhythmia was detected three years ago. What tactics for the treatment of atrial fibrillation in the patient should be chosen?
Does not require treatment
9
A 63-year-old male patient with persistent atrial fibrillation complains of moderate dyspnea. Objectively: peripheral edemata are absent, vesicular breathing is present, heart rate - 72/min, AP - 140/90 mm Hg. What combination of drugs will be most effective for the secondary prevention of heart failure?
Beta-blockers, ACE inhibitors
10
A 53-year-old woman complained of cardiac pain and rhythm intermissions. She had experienced these presentations since childhood. The patient's father had a history of cardiac arrhythmias. Objectively: the patient was in grave condition, Ps- 220 bpm, AP- 80/60 mm Hg. ECG: heart rate - 215/min, widening and deformation of $QRS$ complex accompanied by atrioventricular dissociation; positive $P$ wave. Some time later heart rate reduced down to 45/min, there was a complete dissociation of $P$ wave and $QRST$ complex. Which of the following will be the most effective treatment?
Implantation of the artificial pacemaker
11
Adenosine triphosphate may be expected to convert which of the following arrhythmias to sinus rhythm?
Paroxysmal supraventricular tachycardia
12
A 46-year-old patient complains of sudden palpitation, which is accompanied by pulsation in the neck and head, fear, nausea. The palpitation lasts for 15-20 minutes and is over after straining when holding her breath. What kind of cardiac disorder may be suspected?
An attack of supraventricular paroxysmal tachycardia
13
A 45-year-old male patient was admitted to the intensive care unit because of myocardial infarction. An hour later the ventricular facilitation occurred. Which of the following should be administered?
Defibrillation
14
A 46-year-old patient is to be prepared to the operation on account of stomach cancer. Preoperative preparation involves infusion therapy. It was injected up to 3,0 l of solutions into his right lunar vein. On the next day he got tensive pain in the region of his right shoulder. Examination of interior brachial surface revealed a stripe of hyperemia, skin edema and a painful cord. What complication is it?
Acute thrombophlebitis
15
A 28-year-old patient complains of periodic compressing heart pain. His brother died at the age of 34 from a cardiac disease with similar symptoms. Objectively: the patients skin is pale. Heart borders display no significant deviations. Heart sounds are loud, there is a systolic murmur above all the points with a peak above the aorta. Echocardioscopy reveals thickening of the interventricular septum in the basal parts, reduction of left ventricular cavity. What drug should be administered in order to prevent the disease progression?
Metoprolol
16
A 47-year-old male patient complains of compressive chest pain that occurs both at rest and during light physical activity; irregular heartbeat. These problems arose 3 months ago. The patient's brother died suddenly at the age of 30. Objectively: Ps - 84/min, arrhythmic, AP - 130/80 mm Hg. ECG confirms signs of left ventricular hypertrophy, abnormal Q-waves in V4-V6 leads. EchoCG reveals that interventricular septum is 1,7 cm, left ventricular wall thickness is 1,2 cm. What is the most likely diagnosis?
Hypertrophic cardiomyopathy
17
A 65 y.o. patient has acute pain, paresthesia, paleness of his left extremity. Pulse in the a. dorsalis pedis is absent. There is skin coldness and paleness that gradually spreads upwards. These symptoms are most likely to be the evidence of:
Arterial occlusion
18
A patient with a history of coronary artery disease and atrial fibrillation has the onset of sudden pain and weakness of the left leg. Examination reveals a cool, pale extremity with absent pulses below the groin and normal contralateral leg. The most likely diagnosis is:
Arterial embolism
19
A 70 y.o. patient complains of weakness, dizziness, short periods of unconsciousness, pain in the cardiac area. Objectively: HR- 40 bpm, heart sounds are rhythmic, the S1 is dull, periodically amplified. AP is 180/90 mm Hg. What is the most probable cause of hemodynamic disturbances?
Atrioventricular block type III
20
A 29-year-old female patient complains of dyspnea and palpitations on exertion. According to her mother, as a child she had heart murmur, did not undergo any examinations. Objectively: the patient has pale skin, Ps- 94/min, rhythmic. AP- 120/60 mm Hg. In the II intercostal space on the left auscultation reveals a continuous rasping systolodiastolic murmur, diastolic shock above the pulmonary artery. Blood and urine are unremarkable. What is the most likely diagnosis?
Patent ductus arteriosus
21
Five days after a total hip joint replacement a 72 year old woman becomes acutely short of breath, diaphoretic and hypotensive. Both lung fields are clear to auscultation and percussion, but examination of the neck reveals mild jugular venous distension with prominent A waves. Heart sounds are normal. ECG shows sinus tachycardia with a new right bundle branch block and minor nonspecific ST-T wave changes. The most likely diagnosis is:
Pulmonary thromboembolism
22
A 39 y.o. patient complains of having dyspnea during physical activity, crus edemata, palpitation, heart intermissions. Objectively: HR is 150 bpm, atrial fibrillation. Heart is both ways enlarged. Heart sounds are muted. Liver is 6 cm below the costal margin. Echocardiogram reveals dilatation of heart chambers (end diastolic volume of left ventricle is 6,8 cm) is 29% EF, valve apparatus is unchanged. What is the most probable diagnosis?
Dilated cardiomyopathy
23
A 32-year-old patient complains of cardiac irregularities, dizziness, dyspnea at physical stress. He has never suffered from this before. Objectively: Ps- 74 bpm, rhythmic. AP130/80 mm Hg. Auscultation revealed systolic murmur above aorta, the first heart sound was normal. ECG showed hypertrophy of the left ventricle, signs of repolarization disturbance in the I, V5 and V6 leads. Echocardiogram revealed that interventricular septum was 2 cm. What is the most likely diagnosis?
Hypertrophic cardiomyopathy
24
A 37 y.o. woman is suffering from squeezing substernal pain on physical exertion. On examination: AP- 130/80 mm Hg, heart rate=pulse rate 72 bpm, heart boarders are dilated to the left side, aortic systolic murmur. ECG- signs of the left venticle hypertrophy. What method of examination is the most informative in this case?
Echocardiography
25
An 18-year-old patient presents no problems. Percussion reveals that heart borders are displaced to the right and left by 1 cm, there is a coarse systolic murmur with its epicenter within the 4th intercostal space on the left. What is the most informative examination to confirm the clinical diagnosis?
Ventriculography
26
A 24-year-old female teacher complains of dizziness and heart pain irradiating to the left nipple. Pain is not associated with physical activity and cannot be relieved by nitroglycerin, it abates after taking Valocordin and lasts an hour or more. The patient has a nearly 2-year history of this disease. Objectively: Ps- 76 bpm. AP- 110/70 mm Hg. Heart borders are normal, heart sounds are clear. The ECG shows respiratory arrhythmia. Radiograph of the cervicothoracic spine shows no pathology. Lungs, abdomen are unremarkable. What changes in blood formula can be expected?
No changes
27
A 57-year-old male patient complains of dyspnea on exertion, heaviness in the right hypochondrium and shin edemata towards evening. Objectively: temperature - $38,1^oC$, HR20/min, HR=Ps=92/min, AP- 140/90 mm Hg. There is apparent kyphoscoliosis. In the lungs single dry rales can be auscultated. Heart sounds are muffled, rhythmic. ECG: Rv1+Sv5=15 mm. X-ray picture shows the bulging of pulmonary artery cone, right ventricle enlargement. What is the most likely cause of this condition?
Pulmonary heart
28
A 30-year-old patient complains of breathlessness, pain in the right rib arc region, dry cough and the edema of legs. He is ill for 2 months. He had been treated for rheumatic fever without any effect. On exam: cyanosis, edema of legs, BT of 36,6oC, RR of 28/min, HR of 90/min, BP of 110/80 mm Hg, crackles above low parts of both lungs, heart borders are displaced to the left and to the right, weak sounds, systolic murmur above the apex. What is the preliminary diagnosis?
Dilated cardiomyopathy
29
A 56 year old man complains of fatigue, dyspnea on exertion and palpitations. He has had a murmur since childhood. Examination reveals a lift at the left sternal border, split S1, and fixed splitting of S2. There is a grade 3/6 midsystolic pulmonic murmur and a 1/6 middiastolic tricuspid murmur at the lower left sternal border. Chest x-ray shows right ventricular enlargement and prominent pulmonary arteries. ECG demonstrates atrial fibrillation with a right bundle branch block. The most likely diagnosis is:
Arterial septal defect
30
During examination at a military commissariat a 15-year-old teenager was found to have interval sysolic murmur on the cardiac apex, diastolic shock above the pulmonary artery, tachycardia. Which of the suuplemental examination methods will be the most informative for the diagnosis specification?
Echocardiography
31
A 52-year-old male patient complains about attacks of asphyxia, pain in his right side during respiration. These manifestations turned up all of a sudden. It is known from his anamnesis that he had been treated for thrombophlebitis of the right leg for the last month. In the admission ward the patient suddenly lost consciousness, there was a sudden attack of asphyxia and pain in his side. Objectively: heart rate - 102/min, respiratory rate - 28/min, AP- 90/70 mm Hg. Auscultation revealed diastolic shock above the pulmonary artery, gallop rhythm, small bubbling rales above the lungs under the scapula on the right, pleural friction rub. What examination method will be the most informative for a diagnosis?
Angiography of pulmonary vessels
32
A 62 year old patient complains of rest dyspnea, heart pains. 3 years ago he had myocardial infarction. Physical examination: orthopnea, acrocyanosis, swollen cervical veins. Ps - 92, total heart enlargement, the liver is enlarged by 7 cm, shin edema. What is the stage of chronic heart failure (CHF)?
CHF- 2 B
33
Generalized low voltage on an ECG (QRS deflection < 5 mm in limb leads and < 10 mm in precordial leads) may be a marker for all of the following disorders EXCEPT:
Hyperthyroidism
34
A 20-year-old patient complains of breath shortness, continuous dull heart pain, irritability. Objectively: general condition is satisfactory, the pulse is labile, AP- 130/60 mm Hg. ECG shows repolarization disorder. The patient has been diagnosed with cardiac-type neurocirculatory dystonia. The patient should receive treatment under the following conditions:
Outpatient treatment
35
A patient has chronic heart failure of the II stage. He takes furosemide regularly three times a week. He had developed bronchopneumonia and had been administered combined pharmacotherapy. On the fifth day of therapy the patient complained of hearing impairment. What drug coadministered with furosemide might have caused the hearing loss?
Gentamicin
36
Heart auscultation of a 16 y.o. boy without clinical symptoms revealed accent of the S II and systolic murmur above the pulmonary artery. Heart sounds are resonant, rhythmic. What is the most probable diagnosis?
Functional murmur
37
Routine examination of a 16-year-old boy revealed the presence of three heart sounds on auscultation. The third sound is low and occurs in early diastole, there is no additional murmur. In history: pneumonia six months ago. The patient presents no problems. Examination revealed hyposthenia, underdevelopment of muscles. Laboratory and instrumental studies reveald no peculiarities. What is the origin of the additional heart sound?
Physiological III sound
38
During the preventive examination a 17-year-old young man reports no health problems. Objectively: the patient is undernourished, asthenic; blood pressure is 110/70 mm Hg, Ps - 80/min. Heart borders are within normal range. Auscultation reveals three apical heart sounds, murmurs are absent. ECG shows no pathological changes, PCG registers the S3 occurring 0,15 seconds after the S2. How can you interpret these changes?
Physiologic S3
39
A 60-year-old patient complains about asphyxia, palpitation, rapid fatiguability. He has 8 year history of essential hypertension. Objectively: the left cardiac border is 2 cm deviated to the left from the medioclavicular line, heart sounds are rhythmic and weak; there is diastolic shock above aorta. AP- 170/100 mm Hg. Liver - +2 cm; shin pastosity is present. ECG shows deviation of cardiac axis to the left, left ventricle hypertrophy. Ejection fraction - 63%. What type of cardiac insufficiency is observed?
Diastolic
40
A 57-year-old man complains of shortness of breath, swelling on shanks, irregularity in cardiac work, pain in the left chest half with irradiation to the left scapula.Treatment is uineffective. On physical exam: heart's sounds are diminished, soft systolic murmur on the apex. Ps - 100/min, arrhythmical, BP - 115/75 mm Hg. The liver is +2 cm, painful. Roentgenoscopy: enlargement of heart shadow to all sides, pulsation is weak. Electrocardiogram (ECG): leftventricled extrasystolia, decreased voltage. What method of investigation is necessary to do to determine the diagnosis?
Echocardiography
41
During dynamic investigation of a patient the increase of central venous pressure is combined with the decrease of arterial pressure. What process is proved by such combination? During dynamic investigation of a patient the increase of central venous pressure is combined with the decrease of arterial pressure. What process is proved by such combination?
Increase of bleeding speed
42
During preventive examination a 16 year old patient presented no problems. Objectively: the patient has signs of malnutrition, he is asthenic, AP is 110/70 mm Hg, Ps is 80 bpm, cardiac border is normal, auscultation above the cardiac apex reveals three sounds, cardiac murmur is absent. ECG shows no pathological changes, phonocardiogram shows that the third sound comes 0,15 s after the second one above the apex. How are these changes called?
III physiological sound
43
A 18 y.o. female student complains of dyspnea during the intensive exertion. The condition became worse half a year ago. On examination: pulse rate is 88 bpm, accelerated, AP180/20 mm Hg, pale skin, heart borders are dilated to the left and up. There is systolic-diastolic murmur in the 2hd intercostal space, S2 at pulmonary artery is accentuated. ECG has revealed both ventricles hypertrophy. Thoracic X-ray has revealed pulsation and protrusion of the left ventricle, lung trunk. What doctor's tactics should be?
Cardiosurgeon consultation
44
A 58-year-old female patient complains about periodical headache, dizziness and ear noise. She has been suffering from diabetes mellitus for 15 years. Objectively: heart sounds are rhythmic, heart rate is 76/min, there is diastolic shock above aorta, AP is 180/110 mm Hg. In urine: OD- 1,014. Daily loss of protein with urine is 1,5 g. What drug should be chosen for treatment of arterial hypertension?
Ihibitor of angiotensin converting enzyme
45
A 74 y.o. patient has been suffering from hypertension for 20 years. He complains of frequent headache, dizziness, he takes enalapril. Objectively: accent of the SII above aorta, Ps- 84 bpm, rhythmic, AP- 180/120 mm Hg. What group of hypotensive medications could be additionally prescribed under consideration of the patient's age?
Thiazide diuretics
46
A 60 y.o. woman has had increased BP up to 210/110 mm Hg for the last 7 years. On examination: heart apex is displaced to the left. There are signs of left ventricular hypertrophy on ECG. What is the most probable diagnosis?
Essential hypertension, 2nd stage
47
A 52 year old patient has hypervolaemic type of essential hypertension. Which of the following medications is to be prescribed either as monotherapy or in complex with other antihypertensive drugs?
Hypothiazid
48
A 58-year-old patient complains of a headache in the occipital region, nausea, choking, opplotentes. The presentations appeared after a physical exertion. Objectively: the patient is excited. Face is hyperemic. Skin is pale. Heart sounds are regular, the 2nd aortic sound is accentuated. AP- 240/120 mm Hg, HR- 92/min. Auscultation reveals some fine moisr rales in the lower parts of the lungs. Liver is not enlarged. ECG shows signs of hypertrophy and left ventricular overload. What is the most likely diagnosis?
Complicated hypertensic crisis
49
A 67-year-old female patient with hypertensive crisis has asthma, cough with expectoration of frothy pink sputum, moist rales in the lungs. The patient stays in sitting position, respiratory rate is 40/min, AP- 214/136 mm Hg, heart rate - 102/min. What is the most rational tactics of this patient management?
Intravenous administration of furosemide
50
A 42-year-old male patient wth essential hypertension presents with headache, palpitations, unexplained fear. Objectively: Ps- 100/min, AP- 200/100 mm Hg, the left border of cardiac dullness is displaced by 1,5 cm to the left, vesicular breathing is present. ECG shows sinus tachycardia, signs of left ventricular hypertrophy. What drug should be administered as an emergency?
Obzidan
51
A 46 year old woman who has been suffering from hypertension for 5 years was diagnosed with hypertensive crisis. She complains about palpitation, sense of head pulsation; heart rate is 100/min, AP is 190/100 mm Hg (haemodynamics is of hyperkinetic type). What medication should be the medication of choice?
β-adrenoceptor blocker
52
A 67-year-old female patient suffering from the essential hypertension suddenly at night developed headache, dyspnea that quickly progressed to asphyxia. Objectively: the patient is pale, with sweaty forehead, AP- 210/140 mm Hg, heart rate - 120/min, auscultation revealed solitary dry rales and moist rales in the lower parts. The shins are pastose. What kind of emergency aid would be the most efficient in this case?
Nitroglycerin and furosemide intravenously
53
After myocardial infarction, a 50-year-old patient had an attack of asthma. Objectively: bubbling breathing with frequency of 32/min, cough with a lot of pink frothy sputum, acrocyanosis, swelling of the neck veins. Ps- 108/min, AP- 150/100 mm Hg. Heart sounds are muffled. Mixed moist rales can be auscultated above the entire lung surface. What drug would be most effective in this situation?
Nitroglycerin intravenously
54
A female rheumatic patient experiences diastolic thoracic wall tremor (diastolic thrill), accentuated S1 at apex, there is diastolic murmur with presystolic intensification, opening snap, S2 accent at pulmonary artery. What rind of heart disorder is observed?
Mitral stenosis
55
A 42 year old woman complains of dyspnea, edema of the legs and tachycardia during minor physical exertion. Heart borders are displaced to the left and S1 is accentuated, there is diastolic murmur on apex. The liver is enlarged by 5 cm. What is the cause of heart failure?
Mitral stenosis
56
A 40 y.o. woman is ill with rheumatic disease with composite mitral disease with prevalence of the stenosis of left venous foramen.Complains of palpitation, fatigability, progressing dyspnea, attacks of dyspnea and hemoptysis. Now she cannot be engaged even in the easy activities. What tactics is the most expedient?
Mitral comissurotomia
57
A 42-year-old patient applied to hospital with complaints of pain behind the sternum with irradiation to the left scapula. The pain appears during significant physical work, this lasts for 5-10 minutes and is over on rest. The patient is sick for 3 weeks. What is the preliminary diagnosis?
IHD:First established angina pectoris
58
A 33-year-old man with a history of rheumatic fever complains of fever up to 38-39oC, abdominal pain, dyspnea, tachycardia. Heart borders are displaced to the left by 2 cm, systolic and diastolic murmurs above aorta, BP of 160/30 mm Hg. Petechial rash occurs after measurement of blood pressure. Liver is enlarged by 3 cm, spleen is palpable. Urine is brown-yellow. What is the most likely diagnosis?
Infectious endocarditis
59
Thrombosis of the coronary artery caused myocardial infarction. What mechanisms of injury will be the dominating ones in this disease?
Calcium mechanisms
60
A patient had macrofocal myocardial infarction. He is overweight for 36%, AP is 150/90 mm Hg, blood sugar- 5,9 mmol/L, general cholesterol- 4,9 mmol/L, uric acid- 0,211 mmol/L. Which risk factor should be urgently eradicated during the secondary prevention?
Obesity
61
A patient has got acute macrofocal myocardial infarction complicated by cardiogenic shock. The latter is progressing under conditions of weak general peripheric resistance and decreased cardiac output. What antihypotensive drug should be injected to the patient in the first place?
Dopamine
62
A 30 year old woman ill with influenza felt palpitation and dull cardiac pain during moderate physical exercise. Objectively: Ps - 96 bpm, AP - 100/60 mm Hg. The first sound is quiet above the apex, soft systolic murmur is present. What complication is indicated by these clinical presentations?
Acute viral myocarditis
63
A 64 y.o. patient has developed of squeering substernal pain which had appeared 2 hours ago and irradiated to the left shoulder, marked weakness. On examination: pale skin, cold sweat. Pulse- 108 bpm, AP- 70/50 mm Hg, heart sound are deaf, vesicular breathing, soft abdomen, painless, varicouse vein on the left shin, ECG: synus rhythm, heart rate is 100 bmp, ST-segment is sharply elevated in II, III aVF leads. What is the most likely disorder?
Cardiogenic shock
64
A 45-year-old driver was admitted to the hospital with 5 hour substernal pain. Nitroglycerin is not effective. He is pale, heart sounds are regular but weak. HR - 96 per minute, BP of 100/60 mm Hg. What is the most likely diagnosis?
Acute myocardial infarction
65
A 50 year old woman complains about dull cardiac pain, asphyxia, body temperature rise up to 38oC. She had influenza a week ago. Objectively: Ps - 100 bpm, dropped-beat pulse during inspiration. AP - 100/70 mm Hg, heart sounds are muffled. ECG: reduced voltage, ST segment is above the isoline in all leads. X-ray picture shows extensively enlarged cardiac silhouette. Palmus is of small amplitude. What is the most probable diagnosis?
Exudative pericarditis
66
A 60-year-old patient has been admitted to a hospital with complaints of dyspnea, tightness in the right subcostal area, abdomen enlargement. These presentations have been progressing for a year. Heart auscultation reveals presystolic gallop rhythm. Objectively: swelling of the neck veins, ascites, palpable liver and spleen. What disease requires differential diagnostics?
Constrictive pericarditis
67
A 43-year-old female patient complains of dyspnea, swelling of legs, abdomen enlargement, pricking heart pain. She has a history of tuberculous bronchadenitis, quinsies. The patient's condition deteriorated 6 months ago. Objectively: cyanosis, bulging neck veins, vesicular breathing. Heart borders are not displaced. Heart sounds are muffled, Ps is 106/min, liver is +4 cm, ascites is present. Low voltage on the ECG has been revealed. Radiograph shows a thin layer of calcium deposits along the left contour of heart. What treatment should be recommended to the patient?
Treatment by a cardiac surgeon
68
A 43 y.o. woman complains of shooting heart pain, dyspnea, irregularities in the heart activity, progressive fatigue during 3 weeks. She had acute respiratory disease a month ago. On examination: AP- 120/80 mm Hg, heart rate 98 bpm, heart boarders +1,5 cm left side, sounds are muffled, soft systolic murmur at apex and Botkin's area; sporadic extrasystoles. Liver isn't palpated, there are no edema. Blood test: WBC- 6,7*109 /L, sedimentation rate- 21 mm/hour. What is the most probable diagnosis?
Acute myocarditis
69
A 25 year old patient had pharyngitis 2 weeks ago. Now he complains about body temperature rise up to 38oC, general weakness, dyspnea during walking, swelling and shifting pain in the articulations. Objectively: cyanosis of lips, rhythmic pulse of poor volume - 100 bpm. Left cardiac border deviates outwards from the mediaclavicular line by 1 cm. The first heart sound is weakened on the apex, auscultation revealed systolic souffle. What is the most probable aetiological factor that caused this pathological process?
β-haemolytic streptococcus
70
A 45-year-old man was brought to clinic with complaints of the pain that started suddenly in the left chest part and epigastric area, shortness of breath, nausea, one-time vomiting. The acute pain started after weight-lifting. On physical exam: shallow breathing, RR - 38/min, left chest part is behind during respiration, by percussion - tympanitic sound, respiration is not ausculated. Ps - 110 bpm, of weak filling. BP - 100/60 mm Hg, insignificant displacement of heart to the right, sounds are dull. What examination is the most expedient to do first?
Roentgenography
71
A 55-year-old male had been treated at the surgical department for acute lower-extremity thrombophlebitis. On the 7th day of treatment he suddenly developed pain in the left part of chest, dyspnea and cough. Body temperature was $36,1^oC$, respiratory rate - 36/min. The patient was also found to have diminished breath sounds without wheezing. Ps- 140/min, thready. AP- 70/50 mm Hg. The ECG shows QІІІ-S1 syndrome. What is the most likely diagnosis?
Pulmonary embolism
72
A healthy 75 year old woman who leads a moderately active way of life went through a preventive examination that revealed serum concentration of common cholesterol at the rate of 5,1 millimole/l and HDL (high-density lipoproteins) cholesterol at the rate of 70 mg/dl. ECG reveals no pathology. What dietary recommendation is the most adequate?
Any dietary changes are necessary
73
After a long periode of subfebrility a patient registered increase of dyspnea, pain in the right hypochondrium, leg edemata. Objectively: neck veins are edematic. Ps is 120 bpm, sometimes it disappears during inspiration. Heart sounds are very weakened. ECG showed low-voltage waves of ventricular complex. A month ago there was raise of ST V1-V4 segment. Cardiac silhouette is enlarged, roundish. What is the most probable diagnosis?
Exudative pericarditis
74
A 56-year-old scientist experiences constricting retrosternal pain several times a day while walking for 100-150 m. The pain lasts for up to 10 minutes and can be relieved by nitroglycerine. Objectively: the patient is overweight, heart borders exhibit no abnormalities, heart sounds are rhythmic, Ps- 78 bpm, AP- 130/80 mm Hg. ECG contains low amplitude of $T$ wave in $V_{4-5}$. What disease might be suspected?
Stable FC III stenocardia
75
A 47-year-old male patient has been lately complaining of compressing chest pain that occurs when he walks a distane of 700-800 m. Once a week, he drinks 2 liters of beer. Rise in arterial pressure has been observed for the last 7 years. Objectively: Ps - 74/min, AP - 120/80 mm Hg. The bicycle ergometry performed at workload of 75 watts shows 2 mm ST-segment depression in V4-V6 leads. What is the most likely diagnosis ?
Exertional stenocardia, II functional class
76
A 62-year-old male has been hospitalized in the intensive care unit with a continuous attack of retrosternal pain that cannot be relieved by nitroglycerin. Objectively: AP- 80/60 mm Hg, heart rate - 106/min, breathing rate - 22/min. Heart sounds are muffled, a gallop rhythm is present. How would you explain the AP drop?
Reduction in cardiac output
77
A 40 y.o. patient with rheumatic heart disease complains of anorexia, weakness and loss of weight, breathlessness and swelling of feet. The patient had tooth extraction one month ago. On examination: t0 - 390C, Ps- 100/min. Auscultation: diastolic murmur in the mitral area. Petechial lesion around the clavicle; spleen was palpable.
Subacute bacteria endocarditis
78
A 18 y.o. male patient complains of pain in knee and ankle joints, temperature elevation to 39,50C. He had a respiratory disease 1,5 week ago. On examination: temperature38,50C, swollen knee and ankle joints, pulse- 106 bpm, rhythmic, AP- 90/60 mm Hg, heart borders without changes, sounds are weakened, soft systolic apical murmur. What indicator is connected with possible etiology of the process?
Antistreptolysine-0
79
Examination of a 35-year-old patient with rheumatism revealed that the right heart border was 1 cm displaced outwards from the right parasternal line, the upper border was on the level with inferior margin of the 1st rib, the left border was 1 cm in from the left midclavicular line. Auscultation revealed atrial fibrillation, loud apical first sound, diastolic shock above the pulmonary artery. Echocardiocopy revealed abnormal pattern of the mitral valve motion. What heart disease is characterized by these symptoms?
Mitral stenosis
80
A 67-year-old male complains of dyspnea on exertion, attacks of retrosternal pain, dizziness. He has no history of rheumatism. Objectively: pale skin, acrocyanosis. There are rales in the lower parts of lungs. There is systolic thrill in the II intercostal space on the right, coarse systolic murmur conducted to the vessels of neck. AP- 130/90 mm Hg, heart rate - 90/min, regular rhythm. The liver extends 5 cm under the edge of costal arch, shin edemata are present. Specify the assumed valvular defect:
Aortic stenosis
81
A 61 y.o. man complained of sneezing and substernal pain on exertion. In the last 2 weeks such pain appeared at rest, with increased frequency, and couldn't be suppressed by 1 tablet of nitroglycerin. What is the most likely diagnosis?
Unstable angina pectoris
82
A 60 year old man with unstable angina pectoris fails to respond to heparin, nitroglycerin, beta adrenegic blockers and calcium channel antagonist. The best management includes:
Coronary artery bypass grafting
83
A 52 year old patient with history of functional Class II angina complains of having intense and prolonged retrosternal pains, decreased exercise tolerance for 5 days. Angina is less responsive to nitroglycerine. What is the most probable diagnosis?
IHD. Unstable angina
84
A patient with unstable angina pectoris was given the following complex treatment: anticoagulants, nitrates, α-adrenoblockers. However on the third day of treatment the pain still romains. Which in vestigation shoud be carried out to establish diagnosis?
Coronarography
85
During the ultrasound study of carotid and vertebral arteries a 74-year-old patient developed a condition manifested by dizziness, weakness, nausea, transient loss of consciousness. Objectively: pale skin, AP- 80/60 mm Hg, Ps- 96/min of poor volume. ECG shows sinus tachycardia, left ventricular hypertrophy. Focal neurological symptoms were not found. What is the provisional diagnosis?
Carotid sinus syncope
86
A 49-year-old male patient complains of dyspnea of combined nature, cough, shin edemata, abdomen enlargement due to ascites. He has a 20-year history of chronic bronchitis. For the last 3 years he has been disabled (group II) because of cardiac changes. Objectively: mixed cyanosis, edemata. Ps - 92/min, rhythmic, AP - 120/70 mm Hg, respiration rate - 24/min. There is accentuation of the second sound above the pulmonary artery. Auscultation reveals the box resonance above the lungs. There are also dry rales over the entire surface of lungs. What is the mechanism of heart changes development in this patient?
Euler-Liljestrand reflex
87
A patient, aged 49, complains of fever of 37,5oC, heart pain, dyspnea. S1 is clapping; S2 is accentuated in the aortic area; opening snap, presystolic murmur can be auscultated. What is the most efficient examination for valvular disorder assessment?
Echocardiography+Doppler-Echocardiography
88
A welder at work got the first-degree burns of the middle third of his right shin. 5 days later the skin around the burn became edematic and itchy. Objectively: on a background of a well-defined erythema there is polymorphic rash in form of papules, vesicles, pustules, erosions with serous discharge. What is the most likely diagnosis?
Microbal eczema
89
A male, 50 y.o., has a black flat mole on the skin of the leg for 10 years. Since 4 months ago the shapes of the mole become irregular. What diagnostic methods should be used?
Excision biopsy
90
A 35 year old woman consulted a doctor about affection of arm skin and lower third of forearm in form of a large edema, hyperemia, vesiculation and maceration. The disease developed after using a laundry detergent "Lotos". The patient has been using it for a month. She hasn't suffered from dermatological diseases before. What is the most probable diagnosis?
Allergic dermatitis
91
A 32 y.o. man is divorced, has an irregular sexual life. He complains of falling out of hair in the region of eyelashes, eyebrows, scalp. Objectively: diffuse alopecia is observed, eyebrow margin is absent, eyelashes are stair-like (Pinkus' sign). What examination should be carried out first of all?
Wasserman test, IFT
92
A 72-year-old male patient complains about itch in his left shin, especially around a trophic ulcer. Skin is reddened and edematic, there are some oozing lesions, single yellowish crusts. The focus of affection is well-defined. What is the most likely diagnosis?
Microbial eczema
93
A 35 y.o. patient experienced a strong nervous stress that resulted in formation of reddened and edematic areas on the back surface of her hands with further formation of small inflammated nodules, vesicles and then erosions accompanied by profuse discharge of serous liquid. The process is also accompanied by intense itching. What is the most probable diagnosis?
Common eczema
94
A 32-year-old female patient consulted a doctor about a skin affection of her body, face and extremities which turned up after peroral intake of biseptol. The patient was diagnosed with drug toxicoderma. What treatment methods would be the most effective for this patient?
Extracorporal therapy
95
A patient complains of skin painfullness and reddness of the right gastrocnemius muscle. Objectively: body temperature is 38,50С, enlarged and painful inguinal lymph nodes on the right. Skin of extremity is edematic, hyperemic, covered with eruption in form of vesicles containing dark fluid; its palpation is painful. There is distinct border between normal and hyperemic skin. What is the most probable diagnosis?
Erysipelas, hemorrhagic form
96
Medical examination of a man revealed "geographic tongue". This microsymptom is the evidence of the following vitamin deficiency:
Vitamins of B group
97
A patient at a doctor complains of temperature rise up to 38,20С, edema in the region of his upper lip. Objectively: upper lip is evidently edematic, in the middle of edema there is a cone-shaped swelling. Skin and mucous membrane over it are dark-red. Diagnosis: labial furuncle. A surgeon cut the furuncle, treated the wound with hydrogen peroxide solution and applied a bandage with hypertensive solution. What therapeutic regimen should be recommended?
In-patient treatment with common regimen
98
A 43-year-old female patiet complains of eruption on her right leg skin, pain, weakness, body temperature rise up to 38oC. The disease is acute. Objectively: there is an edema on the right leg skin in the region of foot, a well-defined bright red spot in form of flame tips which feels hot. There are isolated vesicles in focus. What is your provisional diagnosis?
Erysipelas
99
A 26-year-old male patient complains of a rash on the upper lip skin, which arose on a background of influenza with high-grade fever and is accompanied by pain and burning. The rash has been present for 3 days. Objectively: the skin of the upper lip is edematic and erythematous, grouped vesicles are filled with serous fluid and have a rough surface. What is the most likely diagnosis?
Herpetic vesicular dermatitis