Pediatrics 2
問題一覧
1
A 10-year-old girl consulted a doctor about thirst, frequent urination, weight loss. She has been observing these symptoms for about a month. Objectively: no pathology of internal organs was revealed. What laboratory analysis should be carried out in the first place?
Blood glucose analysis on an empty stomach
2
During the first home visit to a full-term boy after his discharge from the maternity hospital a pediatrician revealed a symmetrical swelling of mammae without skin changes over them, swelling of the scrotum. The body temperature was of 36,5oC. The baby was calm, sucked the mother's breast actively. What condition should you think of?
Hormonal crisis of the newborn
3
A 3-year-old child has been diagnosed with type I diabetes mellitus, hyperosmolar coma. The laboratory confirmed the diagnosis. Which laboratory findings are characteristic for such condition?
High hyperglycemia without ketonemia
4
A 6 y.o child complains of thirst, polyuria, increased appetite for 2 months with weight loss for 3 kg. There has been nocturnal enuresis during last week. On examination: hyperglycemia 14 mol/L. The diagnosis is diabetis mellitus I type. What is the genesis of this disease?
Autoimmune
5
A 9 year old boy has been suffering from diabetes mellitus for a year. He gets insulin injections (humulin R, NPH), the dose makes up 0,4 units per 1 kg of body weight a day. Insulin is untroduced subcutaneously (into the shoulder) by means of a syringe. What measures should be taken in order to prevent lipodystrophy?
To change point of introduction
6
A 5-year-old girl has had thirst, polyuria, increased appetite for two months. At the same time, there is a 3 kg decrease in body weight. During the last week, these presentations got accompanied by nocturnal enuresis. Examination revealed hyperglycemia at the rate of 14 mmol/l. The child has been diagnosed with type I diabetes. What is the most likely genesis of this disease?
Autoimmune
7
An 8-year-old child with a 3-year history of diabetes was hospitalized in hyperglycemic coma. Specify the initial dose of insulin to be administered:
0,1-0,2 U/kg of body weight per hour
8
A 10-year-old girl consulted a doctor about thirst, frequent urination, weight loss. She has been observing these symptoms for about a month. Objectively: no pathology of internal organs was revealed. What laboratory analysis should be carried out in the first place?
Blood glucose analysis on an empty stomach
9
A 6-year-old boy was brought to the emergency room with a 3-hour history of fever up to 39,5oC and sore throat. The child looks alert, anxious and has a mild inspiratory stridor. You should immediately:
Prepare to establish an airway
10
A 7 d.o. boy is admitted to the hospital for evaluation of vomiting and dehydration. Physical examination is otherwise normal except for minimal hyperpigmentation of the nipples. Serum sodium and potassium concentrations are 120 meq/L and 9 meq/L respectively. The most likely diagnosis is:
Congenital adrenal hyperplasia
11
A 9 year old boy had acute respiratory viral infection. After it there appeared polydipsia, polyuria, weakness, nausea. Examination revealed the following symptoms: mental confusion, dry skin, soft eyeballs, Kussmaul's respiration, acetone smell from the mouth, muffled heart sounds, soft and painless abdomen. Blood sugar was 19 millimole/l. What acute condition is it?
Ketoacidotic coma
12
A child is 2 days old. He was born with a weight of 2900 kg, body length of 50 cm. On examination the skin is intensely red, elastic, with preserved turgor. Puerile respiration is present. Respiration rate - 40/min, cardiac sounds are rhythmic, sonorous. HR- 138/min. The abdomen is soft. The liver extends 2 cm below the costal margin. Diuresis is sufficient. Stool is in form of meconium. What is the most likely diagnosis?
Physiological erythema of the newborn
13
Mother of a newborn child suffers from chronoc pyelonephritis. She survived acute respiratory viral infection directly before labour. Delivery was at term, the period before discharge of waters was prolonged. On the 2-nd day the child got erythematous rash, later on - vesicles about 1 cm large with seropurulent content. Nikolsky's symptom is positive. Dissection of vesicles results in erosions. The child is inert, body temperature is subfebrile. What is the most probable diagnosis?
Impetigo neonatorum
14
Examination of a 4 month old child revealed some lemon-yellow squamae with fatty crusts on the scalp. What is the most probable diagnosis?
Gneiss
15
A child is 2 m.o. Inguinofemoral folds contain acutely inflamed foci with distinct borders in form of spots that are slightly above the surrounding areas due to skin edema. The rash has appeared during the week. Vesiculation and wetting are absent. What is the most probable diagnosis?
Napkin-area dermatitis
16
10 days after birth, a newborn developed a sudden fever up to 38,1oC. Objectively: the skin in the region of navel, abdomen and chest is erythematous; there are multiple pea-sized blisters with no infiltration at the base; single bright red moist erosions with epidermal fragments on the periphery. What is your provisional diagnosis?
Epidemic pemphigus of newborn
17
A 12 y.o. girl took 2 pills of aspirine and 4 hours later her body temperature raised up to 39-400С. She complains of general indisposition, dizziness, sudden rash in form of red spots and blisters. Objectively: skin lesions resemble of second-degree burns, here and there with erosive surface or epidermis peeling. Nikolsky's symptom is positive. What is the most probable diagnosis?
Acute epidermal necrolisis
18
A mother of a newborn child suffers from chronic pyelonephritis. She had acute respiratory viral disease before the labor. Labor in time, with prolonged period without waters. A child had erythematous eruption on the 2 day, then there were seropurulent vesicles for about 1cm large. Nikolsky's symptom is positive. Erosions have occured after vesicle rupture. The child is flabby. The temperature is subfebrile. What is the most probable diagnosis?
Newborn pemphigus
19
On the 6th day of life a child got multiple vesicles filled with seropurulent fluid in the region of occiput, neck and buttocks. General condition of the child is normal. What disease should be suspected?
Vesiculopustulosis
20
A child was taken to a hospital with focal changes in the skin folds. The child was anxious during examination, examination revealed dry skin with solitary papulous elements and ill-defined lichenification zones. Skin eruption was accompanied by strong itch. The child usually feels better in summer, his condition is getting worse in winter. The child has been artificially fed since he was 2 months old. He has a history of exudative diathesis. Grandmother by his mother's side has bronchial asthma. What is the most likely diagnosis?
Atopic dermatitis
21
Examination of a newborn revealed skin redness that appeared immediately after birth and reached the maximum intensity on the second day of life. What is your provisional diagnosis?
Simple erythema
22
A full-term infant is 3 days old. On the different parts of skin there are erythemas, erosive spots, cracks, areas of epidermis peeling. The infant has scalded skin syndrome. Nikolsky's symptom is positive. General condition of the infant is grave. Anxiety, hyperesthesia, febrile temperature are evident. What is the most probable diagnosis?
Exfoliative dermatitis
23
A 13 y.o. patient was treated in dermatological hospital for atopic dermatitis exacerbation. He was discharged in the condition of clinical remission. What recommendations should the doctor give to prevent exacerbations?
Use of neutral creams to protect skin
24
A full-term infant is 3 days old. On the different parts of skin there are erythemas, erosive spots, cracks, areas of epidermis peeling. The infant has scalded skin syndrome. Nikolsky's symptom is positive. General condition of the infant is grave. Anxiety, hyperesthesia, febrile temperature are evident. What is the most probable diagnosis?
Exfoliative dermatitis
25
A 10-year-old boy underwent treatment in cardiological department for rheumatism, I acute attack of rheumatic fever, active phase, II degree. The patient was discharged in satisfactory condition. Which drug should be chosen for prevention of rheumatism recurrence?
Bicillinum-5
26
An 11-year-old boy complains of general weakness, fever up to 38,2oC, pain and swelling of the knee joints, feeling of irregular heartbeat. 3 weeks ago, the child had quinsy. Knee joints are swollen, the overlying skin and skin of the knee region is reddened, local temperature is increased, movements are limited. Heart sounds are muffled, extrasystole is present, auscultation reveals apical systolic murmur that is not conducted to the left inguinal region. ESR is 38 mm/h. CRP is 2+, antistreptolysin O titre - 400. What is the most likely diagnosis?
Acute rheumatic fever
27
Examination of a full-term 6-day-old infant revealed that different areas of skin had erythemas, flaccid bubbles, eroded surface, cracks, peeling of the epidermis looking like being scalded with boiling water. There was positive Nikolsky's symptom. General condition of the child was serious. The child was restless, hypersensitive, febrile. What is the most likely diagnosis in this case?
Ritter's exfoliative dermatitis
28
After objective clinical examination a 12 year old child was diagnosed with mitral valve prolapse. What complementary instrumental method of examination should be applied for the diagnosis confirmation?
Echocardiography
29
An infant was born with body mass 3 kg and body length 50 cm. Now he is 3 years old. His brother is 7 years old, suffers from rheumatic fever. Mother asked the doctor for a cardiac check up of the 3-year-old son. Where is the left relative heart border located?
1 cm left from the left medioclavicular line
30
A 12-year-old child had three attacks of acute rheumatic fever accompanied by carditis. Examination revealed the symptoms of chronic tonsillitis, mitral insufficiency, carious teeth. What is the optimal method of secondary prophylaxis?
Year-round bicillin prophylaxis till the age of 25
31
A 10-year-old girl was admitted to a hospital with carditis presentations. It is known from the anamnesis that two weeks ago she had exacerbation of chronic tonsillitis. What is the most likely etiological factor in this case?
Streptococcus
32
A child with chronic cardialtis, cardial insufficiency ІІА that is being treated with digoxin has got progressing bradycardia, nausea, vomiting. dizziness, sleep disorders. ECG results: extrasystole, PQ- 0,18. What is the most probable cause of this condition?
Cardiac glucosides overdose or intolerance
33
A child with tetralogy of Fallot is most likely to exhibit:
Increased pressure in the right ventricle
34
The patient with aquired heart failure has diastolic pressure of 0 mm Hg. What heart failure does the child have?
Aortal insufficiency
35
Routine examination of an otherwise healthy child with a history of bronchial asthma reveals AP of 140/90 mm Hg. The most likely cause of the hypertension is:
Renal disease
36
A newborn infant has mild cyanosis, diaphoresis, poor peripheral pule, hepatomegaly and cardiomegaly. Respiratory rate is 60 breaths per minute, and heart rate is 230 beats per minute. The child most likely has congestive heart failure caused by:
Paroxysmal atrial tachycardia
37
An 8-year-old girl has been admitted to the cardiology department. Objectively: there is a skin lesion over the extensor surfaces of joints with atrophic cicatrices, depigmentation, symmetrical affection of skeletal muscles (weakness, edema, hypotrophy). What disease are these changes most typical for?
Dermatomyositis
38
The condition of a 3-year-old child with acute non-rheumatic myocarditis has suddenly deteriorated: he presents with anxiety, acrocyanosis, peripheral edemata, dyspnea. Auscultation of lungs reveals fine moist rales on both sides mainly in the lower parts. AP- 65/40 mm Hg. HR- 150/min, heart sounds are muffled, arrhythmic (extrasystole). Liver is +4 cm. Oliguria is present. The child has been diagnosed with acute heart failure. Which method of examination is most informative for assessing the child's status dynamics?
Echocardiography
39
A 5 y.o. child with stigmas of dysembryogenesis (small chin, thick lips, opened mouth,hyperthelorismus) has systolic murmur in the second intercostal to the right of the sternum. The murmur passes to the neck and along the sternum left edge. The pulse on the left brachial artery is weakened. BP on the right arm is 110/60 mm Hg, on the left - 100/60 mm Hg. ECG results: hypertrophy of the right ventricle. What defect is the most probable?
Aortic stenosis
40
The doctors in maternity hospital made a newborn boy the following diagnosis: congenital heart disease (interventricular septal defect). At the age of 2 months the boy has got a dyspnea. Objectively: BR- up to 60/min, tachycardia up to 170/min, liver is 3 cm below the costal margin. What medicines must be immediately prescribed?
Cardiac glycosides
41
Examination of a 9-month-old girl revealed skin pallor, cyanosis during excitement. Percussion revealed transverse dilatation of cardiac borders. Auscultation revealed continuous systolic murmur on the left from the breastbone in the 3-4 intercostal space. This murmur is conducted above the whole cardiac region to the back. What congenital cardiac pathology can be suspected?
Defect of interventricular septum
42
A 4 y.o. boy was admitted to the hospital with complaints of dyspnea, rapid fatigability. His anamnesis registers frequent respiratory diseases. On percussion: heart borders are dilatated to the left and upwards. On auscultation: amplification of the SII above pulmonary artery, a harsh systolodyastolic "machine" murmur is auscultated between the II and the III rib to the left of breast bone, this murmur is conducted to all other points including back. AP is 100/20 mm Hg. What is the most probable diagnosis?
Opened arterial duct
43
A 7 y.o. boy was admitted to the hospital. He complains of unpleasant sensations in the heart region, pain in the epigastrium, dizziness, vomiting. Objectively: evident paleness of skin, dyspnea, jugular pulse. Heart borders are within the normal range. Heart sounds are clear, HR- 170/min, small pulse. AP- 90/50 mm Hg. EKG showed: paroxysm of ventricular tachycardia. The paroxysm can be suppressed by:
Lidocain
44
A 13-year-old boy with hypertrophic cardiomyopathy complains of dyspnea on minimal exertion. EhoCG reveals asymmetric left ventricular hypertrophy, signs of pulmonary hypertension, dilatation of the left atrium. EF is 64%. The revealed alterations are indicative of:
Diastolic heart failure
45
A 10-year-old child has been folowed-up for the dilated cardiomyopathy. The child presents with dyspnea, cardialgia. There are dense, nonmobile edemata on the lower extremities and sacrum. Ps- 120/min. The cardiac borders are extended transversely. Heart sounds are muffled, there is blowing systolic murmur at the apex and over the xiphoid process. Liver is 3 cm enlarged, urine output is reduced. The blood total protein - 58.6 g/l. In urine: protein - 0,025 g/l, WBCs - 2-4 in the field of vision, RBCs - 2-3 in the field of vision. What is the main mechanism of edema syndrome development:
Venous congestion of greater circulation
46
Examination of an 11-year-old boy revealed frequent nosebleeds, fatigue when walking, underdevelopment of the lower half of the body, increased blood pressure in the upper extremities and decreased pressure in the lower ones, extension of the left heart border, blowing systolic murmur in the interscapular region. ECG shows the horizontal axis of heart. Radiography reveals left cardiomegaly, costal usuration. What is the most likely diagnosis?
Aortarctia
47
Examination of a 9-month-old girl revealed skin pallor, cyanosis during excitement. Percussion revealed transverse dilatation of cardiac borders. Auscultation revealed continuous systolic murmur to the left of the breastbone in the 3-4 intercostal space. This murmur is conducted above the whole cardiac region to the back. What congenital cardiac pathology can be suspected?
Defect of interventricular septum
48
A 14-year-old boy with a history of chronic tonsillitis and sinusitis has developed a feeling of heart irregularities and additional pulse. HR- 83/min. ECG results: regular impulses with no visible $P$ wave that occur every two sinus contractions, $QRS$ complex is dramatically deformed and prolonged to over 0,11 s, $T$ wave is discordant followed by a complete compensatory pause. Specify the arrhythmia type:
Trigeminal extrasystole
49
An 8-year-old girl periodically has sudden short-term heart pain, sensation of chest compression, epigastric pain, dizziness, vomiting. Objectively: the patient is pale, respiratory rate - 40/min, jugular pulse is present. Ps- 185 bpm, of poor volume. AP- 75/40 mm Hg. ECG taken during an attack shows ectopic $P$ waves, $QRS$ wave is not deformed. At the end of an attack a compensatory pause is observed. The most likely cause of the attack is:
Paroxysmal atrial tachycardia
50
A 5-year-old child had an attack of palpitation with nausea, dizziness, generalized fatigue. On ECG: tachycardia with heartbeat rate of 220/min. Ventricle complexes are deformed and widened. P wave is absent. What medication is to be prescribed to provide first aid?
Lidocaine
51
A 10-year-old child with a history of nonrheumatic carditis has periodic attacks manifested by heart pain, dyspnea, pallor, high blood pressure, a dramatic increase in heart rate up to 180/min. What drug would be most effective to treat this patient?
Obsidan
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100問 • 2年前問題一覧
1
A 10-year-old girl consulted a doctor about thirst, frequent urination, weight loss. She has been observing these symptoms for about a month. Objectively: no pathology of internal organs was revealed. What laboratory analysis should be carried out in the first place?
Blood glucose analysis on an empty stomach
2
During the first home visit to a full-term boy after his discharge from the maternity hospital a pediatrician revealed a symmetrical swelling of mammae without skin changes over them, swelling of the scrotum. The body temperature was of 36,5oC. The baby was calm, sucked the mother's breast actively. What condition should you think of?
Hormonal crisis of the newborn
3
A 3-year-old child has been diagnosed with type I diabetes mellitus, hyperosmolar coma. The laboratory confirmed the diagnosis. Which laboratory findings are characteristic for such condition?
High hyperglycemia without ketonemia
4
A 6 y.o child complains of thirst, polyuria, increased appetite for 2 months with weight loss for 3 kg. There has been nocturnal enuresis during last week. On examination: hyperglycemia 14 mol/L. The diagnosis is diabetis mellitus I type. What is the genesis of this disease?
Autoimmune
5
A 9 year old boy has been suffering from diabetes mellitus for a year. He gets insulin injections (humulin R, NPH), the dose makes up 0,4 units per 1 kg of body weight a day. Insulin is untroduced subcutaneously (into the shoulder) by means of a syringe. What measures should be taken in order to prevent lipodystrophy?
To change point of introduction
6
A 5-year-old girl has had thirst, polyuria, increased appetite for two months. At the same time, there is a 3 kg decrease in body weight. During the last week, these presentations got accompanied by nocturnal enuresis. Examination revealed hyperglycemia at the rate of 14 mmol/l. The child has been diagnosed with type I diabetes. What is the most likely genesis of this disease?
Autoimmune
7
An 8-year-old child with a 3-year history of diabetes was hospitalized in hyperglycemic coma. Specify the initial dose of insulin to be administered:
0,1-0,2 U/kg of body weight per hour
8
A 10-year-old girl consulted a doctor about thirst, frequent urination, weight loss. She has been observing these symptoms for about a month. Objectively: no pathology of internal organs was revealed. What laboratory analysis should be carried out in the first place?
Blood glucose analysis on an empty stomach
9
A 6-year-old boy was brought to the emergency room with a 3-hour history of fever up to 39,5oC and sore throat. The child looks alert, anxious and has a mild inspiratory stridor. You should immediately:
Prepare to establish an airway
10
A 7 d.o. boy is admitted to the hospital for evaluation of vomiting and dehydration. Physical examination is otherwise normal except for minimal hyperpigmentation of the nipples. Serum sodium and potassium concentrations are 120 meq/L and 9 meq/L respectively. The most likely diagnosis is:
Congenital adrenal hyperplasia
11
A 9 year old boy had acute respiratory viral infection. After it there appeared polydipsia, polyuria, weakness, nausea. Examination revealed the following symptoms: mental confusion, dry skin, soft eyeballs, Kussmaul's respiration, acetone smell from the mouth, muffled heart sounds, soft and painless abdomen. Blood sugar was 19 millimole/l. What acute condition is it?
Ketoacidotic coma
12
A child is 2 days old. He was born with a weight of 2900 kg, body length of 50 cm. On examination the skin is intensely red, elastic, with preserved turgor. Puerile respiration is present. Respiration rate - 40/min, cardiac sounds are rhythmic, sonorous. HR- 138/min. The abdomen is soft. The liver extends 2 cm below the costal margin. Diuresis is sufficient. Stool is in form of meconium. What is the most likely diagnosis?
Physiological erythema of the newborn
13
Mother of a newborn child suffers from chronoc pyelonephritis. She survived acute respiratory viral infection directly before labour. Delivery was at term, the period before discharge of waters was prolonged. On the 2-nd day the child got erythematous rash, later on - vesicles about 1 cm large with seropurulent content. Nikolsky's symptom is positive. Dissection of vesicles results in erosions. The child is inert, body temperature is subfebrile. What is the most probable diagnosis?
Impetigo neonatorum
14
Examination of a 4 month old child revealed some lemon-yellow squamae with fatty crusts on the scalp. What is the most probable diagnosis?
Gneiss
15
A child is 2 m.o. Inguinofemoral folds contain acutely inflamed foci with distinct borders in form of spots that are slightly above the surrounding areas due to skin edema. The rash has appeared during the week. Vesiculation and wetting are absent. What is the most probable diagnosis?
Napkin-area dermatitis
16
10 days after birth, a newborn developed a sudden fever up to 38,1oC. Objectively: the skin in the region of navel, abdomen and chest is erythematous; there are multiple pea-sized blisters with no infiltration at the base; single bright red moist erosions with epidermal fragments on the periphery. What is your provisional diagnosis?
Epidemic pemphigus of newborn
17
A 12 y.o. girl took 2 pills of aspirine and 4 hours later her body temperature raised up to 39-400С. She complains of general indisposition, dizziness, sudden rash in form of red spots and blisters. Objectively: skin lesions resemble of second-degree burns, here and there with erosive surface or epidermis peeling. Nikolsky's symptom is positive. What is the most probable diagnosis?
Acute epidermal necrolisis
18
A mother of a newborn child suffers from chronic pyelonephritis. She had acute respiratory viral disease before the labor. Labor in time, with prolonged period without waters. A child had erythematous eruption on the 2 day, then there were seropurulent vesicles for about 1cm large. Nikolsky's symptom is positive. Erosions have occured after vesicle rupture. The child is flabby. The temperature is subfebrile. What is the most probable diagnosis?
Newborn pemphigus
19
On the 6th day of life a child got multiple vesicles filled with seropurulent fluid in the region of occiput, neck and buttocks. General condition of the child is normal. What disease should be suspected?
Vesiculopustulosis
20
A child was taken to a hospital with focal changes in the skin folds. The child was anxious during examination, examination revealed dry skin with solitary papulous elements and ill-defined lichenification zones. Skin eruption was accompanied by strong itch. The child usually feels better in summer, his condition is getting worse in winter. The child has been artificially fed since he was 2 months old. He has a history of exudative diathesis. Grandmother by his mother's side has bronchial asthma. What is the most likely diagnosis?
Atopic dermatitis
21
Examination of a newborn revealed skin redness that appeared immediately after birth and reached the maximum intensity on the second day of life. What is your provisional diagnosis?
Simple erythema
22
A full-term infant is 3 days old. On the different parts of skin there are erythemas, erosive spots, cracks, areas of epidermis peeling. The infant has scalded skin syndrome. Nikolsky's symptom is positive. General condition of the infant is grave. Anxiety, hyperesthesia, febrile temperature are evident. What is the most probable diagnosis?
Exfoliative dermatitis
23
A 13 y.o. patient was treated in dermatological hospital for atopic dermatitis exacerbation. He was discharged in the condition of clinical remission. What recommendations should the doctor give to prevent exacerbations?
Use of neutral creams to protect skin
24
A full-term infant is 3 days old. On the different parts of skin there are erythemas, erosive spots, cracks, areas of epidermis peeling. The infant has scalded skin syndrome. Nikolsky's symptom is positive. General condition of the infant is grave. Anxiety, hyperesthesia, febrile temperature are evident. What is the most probable diagnosis?
Exfoliative dermatitis
25
A 10-year-old boy underwent treatment in cardiological department for rheumatism, I acute attack of rheumatic fever, active phase, II degree. The patient was discharged in satisfactory condition. Which drug should be chosen for prevention of rheumatism recurrence?
Bicillinum-5
26
An 11-year-old boy complains of general weakness, fever up to 38,2oC, pain and swelling of the knee joints, feeling of irregular heartbeat. 3 weeks ago, the child had quinsy. Knee joints are swollen, the overlying skin and skin of the knee region is reddened, local temperature is increased, movements are limited. Heart sounds are muffled, extrasystole is present, auscultation reveals apical systolic murmur that is not conducted to the left inguinal region. ESR is 38 mm/h. CRP is 2+, antistreptolysin O titre - 400. What is the most likely diagnosis?
Acute rheumatic fever
27
Examination of a full-term 6-day-old infant revealed that different areas of skin had erythemas, flaccid bubbles, eroded surface, cracks, peeling of the epidermis looking like being scalded with boiling water. There was positive Nikolsky's symptom. General condition of the child was serious. The child was restless, hypersensitive, febrile. What is the most likely diagnosis in this case?
Ritter's exfoliative dermatitis
28
After objective clinical examination a 12 year old child was diagnosed with mitral valve prolapse. What complementary instrumental method of examination should be applied for the diagnosis confirmation?
Echocardiography
29
An infant was born with body mass 3 kg and body length 50 cm. Now he is 3 years old. His brother is 7 years old, suffers from rheumatic fever. Mother asked the doctor for a cardiac check up of the 3-year-old son. Where is the left relative heart border located?
1 cm left from the left medioclavicular line
30
A 12-year-old child had three attacks of acute rheumatic fever accompanied by carditis. Examination revealed the symptoms of chronic tonsillitis, mitral insufficiency, carious teeth. What is the optimal method of secondary prophylaxis?
Year-round bicillin prophylaxis till the age of 25
31
A 10-year-old girl was admitted to a hospital with carditis presentations. It is known from the anamnesis that two weeks ago she had exacerbation of chronic tonsillitis. What is the most likely etiological factor in this case?
Streptococcus
32
A child with chronic cardialtis, cardial insufficiency ІІА that is being treated with digoxin has got progressing bradycardia, nausea, vomiting. dizziness, sleep disorders. ECG results: extrasystole, PQ- 0,18. What is the most probable cause of this condition?
Cardiac glucosides overdose or intolerance
33
A child with tetralogy of Fallot is most likely to exhibit:
Increased pressure in the right ventricle
34
The patient with aquired heart failure has diastolic pressure of 0 mm Hg. What heart failure does the child have?
Aortal insufficiency
35
Routine examination of an otherwise healthy child with a history of bronchial asthma reveals AP of 140/90 mm Hg. The most likely cause of the hypertension is:
Renal disease
36
A newborn infant has mild cyanosis, diaphoresis, poor peripheral pule, hepatomegaly and cardiomegaly. Respiratory rate is 60 breaths per minute, and heart rate is 230 beats per minute. The child most likely has congestive heart failure caused by:
Paroxysmal atrial tachycardia
37
An 8-year-old girl has been admitted to the cardiology department. Objectively: there is a skin lesion over the extensor surfaces of joints with atrophic cicatrices, depigmentation, symmetrical affection of skeletal muscles (weakness, edema, hypotrophy). What disease are these changes most typical for?
Dermatomyositis
38
The condition of a 3-year-old child with acute non-rheumatic myocarditis has suddenly deteriorated: he presents with anxiety, acrocyanosis, peripheral edemata, dyspnea. Auscultation of lungs reveals fine moist rales on both sides mainly in the lower parts. AP- 65/40 mm Hg. HR- 150/min, heart sounds are muffled, arrhythmic (extrasystole). Liver is +4 cm. Oliguria is present. The child has been diagnosed with acute heart failure. Which method of examination is most informative for assessing the child's status dynamics?
Echocardiography
39
A 5 y.o. child with stigmas of dysembryogenesis (small chin, thick lips, opened mouth,hyperthelorismus) has systolic murmur in the second intercostal to the right of the sternum. The murmur passes to the neck and along the sternum left edge. The pulse on the left brachial artery is weakened. BP on the right arm is 110/60 mm Hg, on the left - 100/60 mm Hg. ECG results: hypertrophy of the right ventricle. What defect is the most probable?
Aortic stenosis
40
The doctors in maternity hospital made a newborn boy the following diagnosis: congenital heart disease (interventricular septal defect). At the age of 2 months the boy has got a dyspnea. Objectively: BR- up to 60/min, tachycardia up to 170/min, liver is 3 cm below the costal margin. What medicines must be immediately prescribed?
Cardiac glycosides
41
Examination of a 9-month-old girl revealed skin pallor, cyanosis during excitement. Percussion revealed transverse dilatation of cardiac borders. Auscultation revealed continuous systolic murmur on the left from the breastbone in the 3-4 intercostal space. This murmur is conducted above the whole cardiac region to the back. What congenital cardiac pathology can be suspected?
Defect of interventricular septum
42
A 4 y.o. boy was admitted to the hospital with complaints of dyspnea, rapid fatigability. His anamnesis registers frequent respiratory diseases. On percussion: heart borders are dilatated to the left and upwards. On auscultation: amplification of the SII above pulmonary artery, a harsh systolodyastolic "machine" murmur is auscultated between the II and the III rib to the left of breast bone, this murmur is conducted to all other points including back. AP is 100/20 mm Hg. What is the most probable diagnosis?
Opened arterial duct
43
A 7 y.o. boy was admitted to the hospital. He complains of unpleasant sensations in the heart region, pain in the epigastrium, dizziness, vomiting. Objectively: evident paleness of skin, dyspnea, jugular pulse. Heart borders are within the normal range. Heart sounds are clear, HR- 170/min, small pulse. AP- 90/50 mm Hg. EKG showed: paroxysm of ventricular tachycardia. The paroxysm can be suppressed by:
Lidocain
44
A 13-year-old boy with hypertrophic cardiomyopathy complains of dyspnea on minimal exertion. EhoCG reveals asymmetric left ventricular hypertrophy, signs of pulmonary hypertension, dilatation of the left atrium. EF is 64%. The revealed alterations are indicative of:
Diastolic heart failure
45
A 10-year-old child has been folowed-up for the dilated cardiomyopathy. The child presents with dyspnea, cardialgia. There are dense, nonmobile edemata on the lower extremities and sacrum. Ps- 120/min. The cardiac borders are extended transversely. Heart sounds are muffled, there is blowing systolic murmur at the apex and over the xiphoid process. Liver is 3 cm enlarged, urine output is reduced. The blood total protein - 58.6 g/l. In urine: protein - 0,025 g/l, WBCs - 2-4 in the field of vision, RBCs - 2-3 in the field of vision. What is the main mechanism of edema syndrome development:
Venous congestion of greater circulation
46
Examination of an 11-year-old boy revealed frequent nosebleeds, fatigue when walking, underdevelopment of the lower half of the body, increased blood pressure in the upper extremities and decreased pressure in the lower ones, extension of the left heart border, blowing systolic murmur in the interscapular region. ECG shows the horizontal axis of heart. Radiography reveals left cardiomegaly, costal usuration. What is the most likely diagnosis?
Aortarctia
47
Examination of a 9-month-old girl revealed skin pallor, cyanosis during excitement. Percussion revealed transverse dilatation of cardiac borders. Auscultation revealed continuous systolic murmur to the left of the breastbone in the 3-4 intercostal space. This murmur is conducted above the whole cardiac region to the back. What congenital cardiac pathology can be suspected?
Defect of interventricular septum
48
A 14-year-old boy with a history of chronic tonsillitis and sinusitis has developed a feeling of heart irregularities and additional pulse. HR- 83/min. ECG results: regular impulses with no visible $P$ wave that occur every two sinus contractions, $QRS$ complex is dramatically deformed and prolonged to over 0,11 s, $T$ wave is discordant followed by a complete compensatory pause. Specify the arrhythmia type:
Trigeminal extrasystole
49
An 8-year-old girl periodically has sudden short-term heart pain, sensation of chest compression, epigastric pain, dizziness, vomiting. Objectively: the patient is pale, respiratory rate - 40/min, jugular pulse is present. Ps- 185 bpm, of poor volume. AP- 75/40 mm Hg. ECG taken during an attack shows ectopic $P$ waves, $QRS$ wave is not deformed. At the end of an attack a compensatory pause is observed. The most likely cause of the attack is:
Paroxysmal atrial tachycardia
50
A 5-year-old child had an attack of palpitation with nausea, dizziness, generalized fatigue. On ECG: tachycardia with heartbeat rate of 220/min. Ventricle complexes are deformed and widened. P wave is absent. What medication is to be prescribed to provide first aid?
Lidocaine
51
A 10-year-old child with a history of nonrheumatic carditis has periodic attacks manifested by heart pain, dyspnea, pallor, high blood pressure, a dramatic increase in heart rate up to 180/min. What drug would be most effective to treat this patient?
Obsidan