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Krok 2 - 2023 (14 March) (General Medicine) - 1
Krok 2 - 2023 (14 March) (General Medicine) - 1
Krok 2 - 2023 (14 March) (General Medicine) - 1
me/krok2GeneralMedicine)1-
Krok 2 – 2023(General Medicine) - 14 March pressure is 80/40 mm Hg. What primary emergency
measure must be taken at the prehospital stage in this
case?
1. A 27-year-old man received an electrical injury, when
1. Administration of euphyllin (aminophylline)
he touched an exposed electrical wire with his hand,
2. Aspiration of air from the pleural cavity
after which he developed circulatory and respiratory
3. Call for a cardiology team
arrest. Resuscitation measures restored his cardiac
4. Administration of adrenaline
activity after 5 minutes. What complications are possible
5. Oxygen inhalation
in a few hours or even days after the electrical injury?
1. Pulmonary edema
6. For a month a 60-year-old patient had short-term
2. Acute renal failure
episodes of decreased strength in his limbs on the left.
3. Respiratory arrest
Later, after waking up in the morning, he developed a
4. Circulatory arrest
persistent weakness in his extremities. His blood
5. Acute liver failure
pressure is 140/90 mm Hg. He is conscious and has
central paresis of VII and XII pairs of cranial nerves on
2. Survey X-ray of the patient’s abdominal cavity has
the left. On the same side, he presents with central
shown several hemispherical areas of lucency, located
hemiparesis and hemihyperesthesia. What group of
above well-defined horizontal levels. What might be the
drugs must be chosen for the differentiated treatment of
cause of such an X-ray presentation?
this patient? (2021may,21july) 2048
1. Intestinal obstruction
1. Anticoagulants
2. Cancer of the large intestine
2. Hypotensive agents
3. Meteorism
3. Diuretics
4. Perforated ulcer
4. Corticosteroids
5. —
5. Hemostatics
3. A patient has visited the doctor at a rural outpatient
7. A 45-year-old woman with a normal body weight was
clinic twice during the calendar year (in March and in
diagnosed with diabetes mellitus for the first time.
November). In both cases, he was diagnosed with acute
Attempts to correct his blood glucose levels by means of
respiratory viral infection. How to fill in the statistical
a diet were unsuccessful. Her 24- hour glycemia varies
forms for registration of final (clarified) diagnoses, to
between 10 and 15 mmol/L. Which medicine would be
account for these morbidity cases?
optimal in this case?
1. For the first case with the (+) sign, for the second
1. Insulin
case with the (–) sign
2. Biguanides combined with sulfanilamide hypoglycemic
2. For each case separately with the (–) sign
drugs
3. For each case separately with the (+) sign
3. Sulfanilamide hypoglycemic drugs
4. The forms are not filled for either of these cases
4. Insulin combined with sulfanilamide hypoglycemic
5. For the first case with the (+) sign, for the second
drugs
case no form is necessary
5. Biguanides
4. A 55-year-old man is complaining of general
8. Fluorography of a 45-year-old patient detects a few
weakness, decreased fluid excretion, and an aching pain
foci of low intensity with blurred margins on the apex of
in his heart. For the last 15 years he has been suffering
his right lung. This sign is observed for the first time.
from chronic pyelonephritis and undergoing an inpatient
Such condition causes him no discomfort. He has a
treatment. His skin is dry and has a yellowish tinge. His
many-year history of smoking. Objectively, percussion
pulse is 80/min., rhythmic, blood pressure – 100/70 mm
produces a pulmonary sound above the lungs, the
Hg. Cardiac auscultation detects muffled heart sounds
respiration is vesicular, auscultation detects no
and a friction rub in the pericardium. Laboratory results:
wheezing. Blood test findings are normal. Make the right
creatinine – 1.1 mmol/L, glomerular filtration – 5 mL/min.
diagnosis: (2021july,06,07) 229
What treatment is indicated for this patient?
1. Eosinophilic pneumonia
1. Antibiotics
2. Peripheral lung cancer
2. Diuretics
3. Bronchopneumonia
3. Rheopolyglucin (Dextran)
4. Disseminated pulmonary tuberculosis
4. Xylit, Sorbitol
5. Focal pulmonary tuberculosis
5. Hemodialysis
9. A 54-year-old patient has been suffering from femoral
5. After lifting a heavy object, a 41-year-old man felt a
osteomyelitis for over 20 years. In the last month she
sharp pain in his chest on the right and developed
developed gradually progressing leg edemas. In the
progressing shortness of breath. The man’s condition is
urine: proteinuria – 6.6 g/L. In the blood: dysproteinemia
severe. His lips and mucosa are cyanotic, respiratory
in the form of hypoalbuminemia, increased α 2- and γ-
rate – 28/min., pulse – 122/min. Over the right half of the
globulin levels, ESR – 50 mm/hour. Make the right
chest, percussion shows tympanitis, while auscultation
diagnosis: (2006,07,11) 277
detects sharply weakened breathing. The II heart sound
1. Systemic lupus erythematosus
is accentuated over the pulmonary artery. His blood
Krok 2 - 2023- 14 March (General Medicine) (t.me/krok2GeneralMedicine)2-
2. Acute glomerulonephritis Rh(–), while the child’s blood type is A(II) Rh(+). Make
3. Secondary renal amyloidosis the right diagnosis:
4. Chronic glomerulonephritis 1. Hemolytic disease of the newborn
5. Multiple myeloma 2. Intracranial birth injury
3. Physiological jaundice
10. A 28-year-old man was hospitalized on the 9th day 4. Maldevelopment of parenchymal organs
of illness with complaints of fever of 39°C, headache, 5. Disturbed cerebral circulation
general weakness, constipation, and disturbed sleep. On
the skin of his abdomen there were isolated roseolas, his 15. The region in the Carpathian foothills is
pulse is 78/min., the liver is enlarged by 2 cm. Make the characterized with constant high atmospheric humidity
right diagnosis: (2008,09) 542 (over 80%). In the cold season, while the air temperature
1. Sepsis is moderately low, the population of this region feels
2. Brucellosis extreme cold. What type of heat transfer increases in
3. Leptospirosis such conditions? (2006,11,14) 272
4. Typhoid fever 1. Evaporation
5. Epidemic typhus 2. -
3. Convection
11. A well was dug on a rural land plot. It is located at 4. Radiation
the distance of 20 meters from the house, 10 meters 5. Conduction
from the toilet, and 15 meters from the neighbor’s house.
What is the minimum permissible distance between the 16. A 58-year-old patient complains of an inguinal tumor
well and the source of possible water pollution, that increases during straining and coughing. There is a
according to the sanitary norms? pulsating tumor-like formation located below and laterally
1. 20 meters to the Poupart’s ligament. The formation does not
2. 25 meters diminish during palpation. Make the right diagnosis:
3. 30 meters 1. Inguinal hernia
4. 15 meters 2. Femoral hernia
5. 10 meters 3. Neurinoma of the femoral nerve
4. Ectopic testicle
12. The ambulance has brought in the victim of an 5. Femoral aneurysm
accident, who has fallen from a height. This patient has
clinical signs of multiple fractures in both legs. The 17. A variety of lighting fixtures have been used to
patient’s condition is severe; the patient is conscious, but illuminate classrooms. What kind of lighting fixtures
mentally sluggish; the skin is pale gray; the forehead is creates the most hygienically acceptable lighting?
covered in a cold sweat. The patient’s breathing is 1. Lighting fixtures that provide direct lighting
shallow, with respiratory rate of 30/min., blood pressure 2. Lighting fixtures that provide reflected lighting
– 80/60 mm Hg, pulse – 120/min., shallow. What 3. Lighting fixtures that provide scattered lighting
complication has occurred in this person? 4. Lighting fixtures that provide semi reflected lighting
1. Syncope 5. Lighting fixtures that provide combined lighting
2. Traumatic shock, degree 1
3. Traumatic shock, degree 2 18. A victim of a car accident received multiple fractures
4. Traumatic shock, degree 3 of the limbs and pelvic bones. He has a history of
5. Traumatic shock, degree 4 hemophilia A. Objectively, hematomas form at the sites
of injury. The patient’s condition is deteriorating. The
13. A 30-year-old patient after an emotional upset blood pressure is 90/50 mm Hg. What is the optimal
developed tonic seizure that later gave place to clonic combination of infusion agents that should be given to
seizures. This condition was accompanied by loss of the patient for treatment after polyglucin (dextran) and
consciousness, foaming at the mouth, and involuntary saline solutions are administered?
urination. No focal signs were detected. Blood pressure 1. Fresh frozen plasma, albumin
is 120/60 mm Hg. Make the right diagnosis: 2. Packed erythrocytes, fresh frozen plasma
1. Stroke 3. Cryoprecipitate, packed erythrocytes
2. Syncope 4. Cryoprecipitate, glucose
3. Neurasthenia 5. Packed erythrocytes
4. Eclampsia
5. Epilepsy 19. A 40-year-old woman, gravida 6, para 3, at the 40
weeks of her pathological pregnancy (threatened
14. A full-term delivery has resulted in the birth of a live miscarriage, type I gestosis of the second half of her
full-term girl without asphyxia. The baby is inert, her skin pregnancy), gave birth to a girl with asphyxia. The
is pale with an icteric tinge, she has no edemas. The baby’s condition is severe, the weight is 2 kg, there are
abdomen is soft, the liver and spleen are enlarged. The signs of immaturity and hydrocephalus. The baby’s skin
blood tests show that the mother’s blood type is A(II) is pale, icteric, and has acrocyanosis. Heart sounds are
muffled, there is a harsh systolic murmur at all points of
Krok 2 - 2023- 14 March (General Medicine) (t.me/krok2GeneralMedicine)3-
auscultation. Abdomen is enlarged, the liver is +3 cm. 24. At a factory with harmful working conditions, a
The urine is saturated, the stool is light-colored. An complex of measures was being taken to reduce the
ophthalmologist has detected chorioretinitis in the baby. morbidity among the workers. For better effect, the
Make the right diagnosis: factory doctor was separately monitoring a group of
1. Sepsis people, who fall ill frequently and for a long time. What
2. Hemolytic disease of the newborn type of morbidity requires distinguishing such a group of
3. Congenital toxoplasmosis people?
4. Congenital heart defect 1. Morbidity with temporary disability
5. Congenital hepatitis 2. Morbidity associated with acute infections
3. General morbidity
20. A woman at 12 weeks of her pregnancy developed a 4. Morbidity associated with major non communicable
pain in her lower abdomen and mild bloody Discharge, diseases
which occurred with no apparent reason. Vaginal 5. Hospitalized morbidity
examination shows well-formed cervix with closed
external orifice. The body of the uterus is enlarged 25. A 38-year-old patient has episodes of paroxysmal
according to her term of pregnancy. Make the right hypertension that reaches 240/120 mm Hg and is
diagnosis: accompanied by nausea, vomiting, tachycardia, and
1. Imminent miscarriage excessive sweating. Hyperglycemia is observed in the
2. Anembryonic pregnancy blood during such episodes. After the episode, profuse
3. Ongoing miscarriage urination occurs. Renal sonography has shown a new
4. Threatened miscarriage formation adjacent to the upper pole of the right kidney
5. Incomplete miscarriage that might belong to the adrenal gland. What laboratory
test will help clarify the diagnosis? ~~ (2006, 2011)
21. In the demographic structure of a region, the people 248,983
aged from 0 to 14 make up 31% of the population, while 1. Blood levels of insulin and C-peptide
the 50+ age group makes up 20% of the population. 2. Blood levels of thyroxine and thyroid stimulating
What population structure characterizes such hormone
demographic situation most accurately? 3. Blood renin levels
1. Migration of the population 4. Urinary excretion of catecholamines and
2. Stationary population vanillylmandelic acid
3. Constrictive population 5. Glomerular filtration rate, measured using the
4. Emigration of the population endogenous creatinine clearance rate
5. Expansive population
26. During physical exertion, a man with a cerebral
22. A 13-year-old boy is complaining of a dry cough and artery aneurysm suddenly developed severe headache
shortness of breath. The onset of the disease was one and vomiting and fainted. The patient is agitated and
year ago. He has brief asphyxia attacks that occur 1–2 wants to run somewhere. His pulse is 62/min., rhythmic,
times per month. Objectively, the child is anxious and blood pressure – 140/90 mm Hg, the body temperature
has expiratory dyspnea, his skin is pale, his nasolabial is 37.5°C. He has nuchal rigidity and positive Kernig’s
triangle is cyanotic. His respiratory rate is 48/min. sign. Focal neurological signs are absent. Make the
Percussion produces a banbox resonance over the provisional diagnosis:
lungs; auscultation detects weakened breathing with 1. Ischemic stroke
bilateral dry wheezing. Forced expiratory volume is 80% 2. Hypertensive crisis
of the normal. What medicine should be prescribed to 3. Subarachnoid hemorrhage
this boy? 4. Meningitis
1. Prednisolone 5. Brain hemorrhage
2. Euphyllin (Aminophylline)
3. Salbutamol 27. A 14-year-old boy developed a sympatho-adrenal
4. Indomethacin crisis. What medicine was indicated for crisis relief in this
5. Suprastin (Chloropyramine) case?
1. Digoxin
23. A patient with rheumatism presents with diastolic 2. Propranolol
tremor of the chest wall («cat’s purr»), heart sound I that 3. Thiopental sodium
is amplified at the apex, diastolic murmur with presystolic 4. Euphyllin (Aminophylline)
amplification, a mitral opening sound, and an accent of 5. Drotaverine
the II heart sound over the pulmonary artery. What heart
defect was observed in this patient? 28. In the morning, an 8-year-old child started
1. Stenosis of the left atrioventricular orifice complaining of general weakness and pain during
2. Mitral valve insufficiency swallowing. At noon, her parents called for a doctor,
3. Patent ductus arteriosus because the girl’s weakness was progressing and she
4. Pulmonary artery stenosis developed a bilateral swelling slightly below and in front
5. Aortic valve insufficiency of her ears. Make the right diagnosis:
Krok 2 - 2023- 14 March (General Medicine) (t.me/krok2GeneralMedicine)4-
The baby is inert and has a subfebrile body temperature. 4. Kidney cancer
Make the diagnosis: 5. Tuberculosis of the urinary bladder
1. Sepsis
2. Vesiculopustulosis 42. A 28-year-old patient complains of chills in his feet
3. Neonatal pemphigus and fingers and pain in his legs during walking. The
4. Ritter’s disease of the newborn disease onset was one year ago. The skin of his legs is
5. Pseudofurunculosis pale and cold; low turgor and hypotrichosis are
observed. Pulsation over the femoral and popliteal
38. A 34-year-old patient has been suffering from arteries is weakened, on the pedal arteries it is palpable
pulmonary tuberculosis for the last 7 years. He after a nitroglycerin test. Rheographic index is <1. Make
complains of muscle weakness, weight loss, diarrhea, the right diagnosis:
and frequent urination. His skin, gums, and buccal 1. Chronic thrombophlebitis
mucosa are hyperpigmented. His blood pressure is 2. Obliterating endarteritis
12
90/58 mm Hg. In the blood: erythrocytes – 3.1×10 /L, 3. Wegener vasculitis
9
Hb – 95 g/L, color index – 0.92; leukocytes – 9.4×10 /L, 4. Arteriosclerosis obliterans
eosinophils – 7%, segmented neutrophils – 45%, band 5. Raynaud syndrome
neutrophils – 1%, lymphocytes – 40%, monocytes – 7%,
Na+ – 115 mmol/L, K+ – 7.3 mmol/L. Make the 43. A 20-year-old woman complains of amenorrhea.
diagnosis: She has hirsutism and obesity with predominant
1. Pheochromocytoma distribution of adipose tissue on the face, neck, and
2. Primary hyperaldosteronism upper torso. On her face she has acne vulgaris, on her
3. Congenital hyperplasia of the adrenal cortex skin there are stretch marks. The blood pressure is
4. Primary insufficiency of the adrenal cortex 170/100 mm Hg. Her mental development and
5. Diabetes insipidus intelligence are not impaired. Gynecological status
shows moderate hairiness of the external genitalia and
39. A 35-year-old woman has red swollen areas on the acute hypoplasia of the vagina and uterus. Make the
dorsal surface of her hands after a severe nervous right diagnosis:
strain, which was followed by formation of small inflamed 1. Turner syndrome
nodules, vesicles, and later erosions with significant 2. Stein-Leventhal syndrome
discharge of a serous fluid. This process was 3. Cushing syndrome
accompanied by severe itching. Make the right 4. Sheehan syndrome
diagnosis: 5. Babinski-Froehlich syndrome
1. Allergic dermatitis
2. Microbial eczema 44. A 48-year-old patient was hospitalized with
3. Toxicoderma complaints of headache, nausea, wet cough,
4. Simple contact dermatitis problematic breathing, impaired vision, excessive
5. True eczema sweating, and salivation. He worked in a team that
treated gardens with organophosphorus pesticides. In
12
40. A 48-year-old patient, whose blood test has resulted his blood: erythrocytes – 4.1×10 /L, Hb – 136 g/L, color
9
in positive Wasseman and sedimentation reactions index – 0.9, leukocytes – 13.0×10 /L, ESR – 17
thrice, came to a doctor. His treponema pallidum mm/hour. He was diagnosed with acute intoxication
immobilization test was positive as well. Examination caused by organophosphorus pesticides. What is the
has shown no clinical manifestations of syphilis in the most important diagnostic criterion of this pathology?
patient’s skin, internal organs or nervous system. Make 1. Thrombocytopenia
the right diagnosis: 2. Reticulocytosis
1. Latent recurrent syphilis 3. Leukocytosis
2. Early latent syphilis 4. Decreased cholinesterase levels
3. Tertiary syphilis 5. Anemia
4. Seropositive primary syphilis
5. Recurrent secondary syphilis 45. A 55-year-old man on the 3rd day after an acute
anterior myocardial infarction complains of shortness of
41. A 50-year-old man was hospitalized with complaints breath and a dull pain behind the sternum that
of blood in the urine. There are no pain or urination decreases when he leans forward. His blood pressure is
disorders. Hematuria is observed for the last 3 days. The 140/80 mm Hg and his heart sounds are muffled. ECG
kidneys are not palpable, the suprapubic area is normal, has shown atrial fibrillation with the ventricular rate of
the external genitalia have no pathology. Rectal 110/min., pathological Q wave, and ST segment
examination detects no prostatic enlargement. elevation in the right-sided chest leads. Make the right
Cystoscopy detects no changes. What disease is diagnosis:
suspected first? 1. Acute pericarditis
1. Varicocele 2. Dressler syndrome
2. Renal dystopia 3. Tietze syndrome
3. Necrotizing papillitis 4. Pulmonary embolism
Krok 2 - 2023- 14 March (General Medicine) (t.me/krok2GeneralMedicine)6-
localized in the center of his chest. It does not irradiate 5. Decrease in conjugated bilirubin levels
to other areas, nor does it intensify with changes in the
position of the body. The pain was accompanied by 67. A 58-year-old patient has undergone an urgent
nausea without vomiting. No respiratory symptoms are cholecystectomy and drainage of the abdominal cavity.
observed. The man has a history of essential In the postoperative period, she was prescribed heparin
hypertension and takes angiotensin-converting-enzyme and developed hemorrhagic syndrome. What medicine
inhibitors. Objectively, his skin is pale and moist. His must be used to eliminate the side effects of heparin in
pulse is 115/min., respiratory rate – 20/min. ECG shows this case?
sinus tachycardia. Chest X-ray shows a darkening in the 1. 1% solution of protamine sulfate
upper left and lower right segments. His cardiac enzyme 2. 10% solution of calcium chloride
levels are normal. Make the right diagnosis: 3. 1% solution of vicasol (menadione)
1. Acute pericarditis 4. 1% solution of calcium chloride
2. Myocarditis 5. 5% solution of aminocaproic acid
3. Strangulated hiatal hernia
4. Dissecting aortic aneurysm 68. A 20-year-old young man was brought to a clinic on
5. Acute myocardial infarction the 7th day of his illness with complaints of icteric skin
and sclerae, dark urine, one episode of vomiting, low
o
64. When playing football, a 20-year-old man squatted appetite, and fever of 38 C throughout the last 2 days.
sharply on his right leg with a simultaneous turn to the Three weeks ago he went fishing with friends, during
o
left. This movement resulted in a sharp pain in his right which they all shared the same tableware. He is inert, t
o
knee, after which he was brought to a first-aid station. – 36.8 C, his skin and sclerae are icteric, the liver
The range of movements in the right knee joint is 100– protrudes from under the edge of the costal arch by 3 cm
o
150 , there is no lateral mobility in the knee. Make the and is tender on palpation; the spleen cannot be
right diagnosis: palpated. Patient’s urine is dark, his feces are partially
1. Tense hemarthrosis of the knee joint acholic. Make the right diagnosis:
2. Subluxation of the patella, possibly habitual 1. Hemolytic anemia
3. Damage to the medial collateral ligament 2. Intestinal yersiniosis
4. Damage to the internal meniscus 3. Viral hepatitis A
5. Damage to the anterior cruciate ligament 4. Infectious mononucleosis
5. Leptospirosis
65. An 18-year-old young man was brought into to the
hematology department with complaints of a headache, 69. A 30-year-old man is complaining of intense pain,
o
general weakness, loss of appetite, fever of 39°C, and a skin redness, swollen ankle, and fever of 39 C. The
swelling on his neck. His, t° – 38°С, the skin and onset of the disease was sudden. In the past, he had
mucosa are markedly pale, the cervical lymph nodes on similar episodes that lasted 5–6 days without changes in
both sides are up to 1 cm in size and painless. The liver the joint. The skin over the ankle joint is hyperemic,
is +1 cm and painless, the spleen is +0.5 cm. In the without clear margins or an infiltrative bank on the
12
blood: Hb – 98 g/L, erythrocytes – 2.9×10 /L, periphery. Make the right diagnosis:
9
leukocytes – 32×10 /L, blast neutrophils – 0%, (2005,06,06,07,08,09) 177
segmented neutrophils – 28%, monocytes – 2%, 1. Erysipelas
lymphocytes – 39%, blasts – 31%, reticulocytes – 31%, 2. Osteoarthrosis
9
platelets – 120×10 /L , ESR – 36 mm/hour. Specify the 3. Rheumatoid arthritis
form of the patient’s leukemia: 4. Gout
1. Acute lymphoblastic leukemia 5. Infectious arthritis
2. Chronic lymphocytic leukemia
3. Undifferentiated leukemia 70. A 7-year-old boy has been receiving treatment for a
4. Chronic myelogenous leukemia month. At the time of hospitalization, he had marked
5. Acute myeloblastic leukemia edemas, proteinuria of 7.1 g/L, and daily urine protein of
4.2 g. Biochemical blood test has shown persistent
66. A 16-year-old teenager complains of weakness, hypoproteinemia (43.2 g/L) and hypercholesterolemia
dizziness, and heaviness in the left subcostal region. (9.2 mmol/L ). What leading glomerulonephritis
The skin and visible mucosa are icteric. The tower skull syndrome is most likely in this patient? (2006,11)
syndrome is observed. The liver is +2 cm. The lower 238,1004
edge of the spleen is at the level of the navel. The blood 1. Hematuric
12
has: erythrocytes – 2.7×10 /L, Hb – 88 g/L, leukocytes 2. Mixed
9
– 5.6×10 /L, ESR – 15 mm/hour. What is the most likely 3. Isolated urinary
change in the bilirubin levels in this patient? 4. Nephritic
1. Increase in conjugated bilirubin levels 5. Nephrotic
2. Decrease in unconjugated bilirubin levels
3. Increase in unconjugated bilirubin levels 71. A 65-year-old man complains of asphyxia, cough
4. Increase in unconjugated and conjugated bilirubin with pink foaming sputum, sensation of lack of air, and
levels fear of death. He has orthopnea, pale skin, and
Krok 2 - 2023- 14 March (General Medicine) (t.me/krok2GeneralMedicine)9-
acrocyanosis and is covered in cold sticky sweat. His masticatory muscles and muscles of neck and fingers.
respiration is harsh, in the lower posterior segments The body temperature is 31.0°C. What is the time of
there are wet finely vesicular and moderately vesicular death is likely in this case? (2006,11,14) 318
crackles on both sides. His respiratory rate is 40/min. 1. 1–2 hours
The heart sounds are markedly muffled. At the cardiac 2. 6–7 hours
apex, the gallop rhythm is observed. Make the right 3. 8–10 hours
diagnosis: 4. 10–18 hours
1. Infarction pneumonia 5. 16–24 hours
2. Pulmonary embolism
3. Pulmonary edema 76. A child has suddenly developed a respiratory arrest,
4. Status asthmaticus cyanotic skin, and pinpoint pupils. There is no pulse on
5. Croupous pneumonia the great blood vessels. What measures must be taken
first in this case?
72. In April, during medical examination of the 1. Artificial pulmonary ventilation, closed chest cardiac
population, 27% of the examined people were massage
complaining of their decreased working ability and high 2. Intracardiac injection of adrenaline
fatigability. Examination revealed swollen loose gums 3. Intravenous injection of euphyllin (aminophylline)
that markedly bleed when pressed. On the skin, follicular 4. Gastric lavage
hyperkeratosis is observed against the background of 5. Oxygen therapy
normal skin moisture. What pathology is most likely
cause of this condition? (2018,19) 1825 77. For the last 2 years, a 51-year-old woman has been
1. Periodontosis experiencing a dull pain with periodical exacerbations in
2. Hypovitaminosis A her right subcostal region. The pain was associated with
3. Hypovitaminosis C eating fatty foods. The woman is complaining of
4. Hypovitaminosis B1 bitterness in her mouth in the morning, constipations,
o o
5. Polyhypovitaminosis and flatulence. She is overeating, t – 36.9 C, the tongue
is coated near its root, the abdomen is moderately
73. A 37-year-old woman complains of shortness of distended and painful at the point of gallbladder
breath and constricting retrosternal pain. One week ago projection. What study would be the most useful for
she had a flu. She has acrocyanosis, her heart rate is making a diagnosis? (2018,19,20) 1728
98/min., blood pressure – 90/75 mm Hg, respiratory rate 1. Abdominal ultrasound
– 26/min. The cardiac borders are expanded to the left 2. Cholecystography
and right by 3 cm. The heart sounds are muffled, above 3. Duodenoscopy
the cardiac apex there are a protodiastolic gallop rhythm 4. Liver scan
and a systolic murmur. Hb – 100 g/L, ESR – 25 5. Duodenal sounding
mm/hour. Make the right diagnosis:
1. Infectious-allergic myocarditis 78. A 17-year-old girl was hospitalized into the
2. Ischemic heart disease, angina pectoris gynecological department with complaints of profuse
3. Exudative pericarditis bloody discharge from her genital tracts and a cramping
4. Myocardial dystrophy pain in her lower abdomen. The last menstruation was
5. Dilated cardiomyopathy 10 weeks ago. Her blood pressure is 100/60 mm Hg,
pulse is 90/min.. Vaginal examination has shown that the
74. A 25-year-old multipara was hospitalized at the first external orifice of the uterine cervix allows inserting one
period of labor with moderately strong contractions. This finger. The uterus is painless and enlarged to 6 weeks of
is her third pregnancy. She has a history of one pregnancy. The uterine appendages cannot be detected,
cesarean section due to clinically narrow pelvis and one the fornices are free. Make the right diagnosis:
artificial abortion. Suddenly she developed severe 1. Imminent miscarriage
abdominal pain and weakness. The blood pressure 2. Incomplete miscarriage
dropped to 90/50 mm Hg. Moderate bloody discharge 3. Threatened miscarriage
appeared from the vagina. The fetal heartbeat cannot be 4. Complete miscarriage
auscultated. The labor activity has ceased. Make the 5. Anembryonic pregnancy
right diagnosis:
1. Amniotic fluid embolism 79. A 53-year-old woman complains of an aching pain in
2. Inferior vena cava syndrome the lower abdomen, a significant abdominal distention
3. Placental abruption within the last 5 months, weight loss, and weakness. The
4. Placenta previa cervix is clean, the uterus is not enlarged, painless, and
5. Uterine rupture immobile. On the both sides, there are dense
mildlymobile tumors 10x13 cm in size with an uneven
75. Examination of the corpse of a man, who died by surface. Abdominal percussion detects a fluctuation.
hanging, reveals that the spots of livor mortis disappear Make the right diagnosis:
when pressed and then reappear 50 seconds later. The 1. Endometriosis
rigor mortis is moderate and observed only in the 2. Floating kidney
Krok 2 - 2023- 14 March (General Medicine) (t.me/krok2GeneralMedicine)10
-
4. Work at a high altitude He does not smoke and is not a heavy drinker.
5. Infrasound Previously, due to gastric dyspepsia he was taking
antacids and proton pump inhibitors, but recently these
98. A pregnant woman was registered with a maternity drugs have stopped bringing him relief. He is
consultancy at the term of 11 weeks and was monitored undereating, a lymph node can be palpated in his left
throughout the whole normal course of her pregnancy. supraclavicular fossa. The liver is not enlarged. Make
What document will be given by the doctor to this the right diagnosis:
woman for hospitalization to a maternity clinic? 1. Diaphragmatic hernia
1. Hospitalization referral 2. Esophageal tumor
2. Medical sertificate issued by a sanitary and 3. Gastric carcinoma
epidemiological station 4. Gastric ulcer
3. Temporary disability certificate 5. Pylorostenosis
4. Personal medical record of the pregnant woman
5. Exchange medical record 103. For the last 2 months, a 29-year-old woman has
been complaining of chest pain on the left, cough,
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99. A 63-year-old man complains of weakness without shortness of breath, and fever of 39.6 C. The left half of
an obvious cause, fatigability, loss of appetite, and a her chest lags behind in the act of breathing, her
feeling of disgust towards meat products. Two weeks vesicular respiration is weakened, and there is a
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ago he had a gastric bleeding. Objectively, t – 37.5 C, shortening of the percussion sound on the left. X-ray has
respiratory rate – 20/min., pulse – 96/min., blood shown a round shadow in the lower lobe of the left lung.
pressure – 110/75 mm Hg. Epigastric palpation detects Make the right diagnosis:
pain and muscle tension. In the blood: Hb – 82 g/L, ESR 1. Purulent pleurisy
– 35 mm/hour. What study will be the most useful for 2. Lung abscess
making a diagnosis? 3. Chronic pneumonia
1. Endoscopy 4. Lung cancer
2. X-ray 5. Pleural empyema
3. Cytology
4. Stool test 104. A 28-year-old man is undergoing a treatment for
5. Gastric contents analysis pulmonary tuberculosis. He has complains of shortness
of breath and a sharp chest pain on the right that
100. A medical committee consists of a therapist, appeared suddenly. Percussion detects a bandbox
dermatologist, traumatologist, ophthalmologist, resonance over the right lung, auscultation detects no
neurologist, immunologist, surgeon, otolaryngologist, breathing there. X-ray has shown that the right lung is
and hematologist was called in for the regular medical collapsed to its root by 1/2 of its volume, the heart and
examination of the workers at a chemical factory that mediastinal organs are shifted to the left. What
produces chromium- and nickel-containing mineral complication has developed in this patient?
compounds. Name the minimum composition of such a 1. Exudative pleurisy
committee, taking into account the characteristics of the 2. Pulmonary infarction
products manufactured by this factory: 3. Spontaneous pneumothorax
1. Therapist, ophthalmologist, neurologist 4. Dry pleurisy
2. Therapist, dermatologist, traumatologist 5. Pleural empyema
3. Therapist, immunologist, surgeon
4. Therapist, hematologist, ophthalmologist 105. A 76-year-old woman is complaining of a
5. Otolaryngologist, therapist, dermatologist progressive swallowing disorder, predominantly when
she eats solid foods. This sign is observed over the past
101. A 70-year-old patient complains of weakness, 6 weeks. Sometimes she notes episodes of vomiting
dizziness, brief episodes of nuconsciousneus, and pain with solid vomitus. Swallowing is painless. She has lost
in the cardiac region. His heart rate is 40/min., heart 6 kg. Ten years ago she had a myocardial infarction.
sounds are rhythmic, the first heart sound is muffled and She permanently takes aspirin and long-acting nitrates,
significantly intensifies from time to time. Blood pressure drinks alcohol in moderation, and smokes. Her skin is
is 180/90 mm Hg. What is most likely the cause of these icteric, her neck is normal, the lymph nodes are not
hemodynamic disorders? enlarged. The chest is normal. The cardiovascular
1. Third-degree AV block system shows no marked changes. The liver is +3 cm.
2. First-degree AV block Make the right diagnosis:
3. Sinus bradycardia 1. Diffuse esophageal narrowing
4. Bradysystolic form of ciliary arrhythmia 2. Diaphragmatic hernia
5. Complete block of the His left bundle branch 3. Myasthenia
4. Esophageal achalasia
102. A 76-year-old man has complains of epigastric pain 5. Esophageal cancer
and periodical vomiting throughout the past 2 months.
He has no dysphagia or «coffee grounds» vomiting. 106. A girl was born with the weight of 3250 g and the
During this period, he has lost 5 kg, his appetite is low. body length of 52 cm. At the age of 1.5 months, the
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child’s actual body weight is sufficient (4350 g) and the be palpated 1 cm below the costal margin. His ALT
psychophysical development corresponds with the levels are 220 units. How this condition can be
child’s age. The child is on breastfeeding. Periodical interpreted?
regurgitation is observed. What may cause regurgitation 1. Residual effects of hepatitis B
in this child? (2006,07,08,09) 201 2. Biliary dyskinesia
1. Aerophagia 3. Development of hepatic cirrhosis
2. Pylorostenosis 4. Development of chronic hepatitis
3. Esophageal atresia 5. Recurrence of viral hepatitis B
4. Acute gastroenteritis
5. Pylorospasm 111. A 78-year-old woman complains of lumbar pain.
The pain increases during movements, decreases at
107. A 12-year-old girl took two aspirin tablets. 4 hours rest, and does not irradiate to other areas. Her
later her body temperature increased to 39–40°C. She is temperature is normal, the body weight remains
complaining of general indisposition, dizziness, and unchanged. Her peripheral joints are normal, she has
spontaneous development of red spots and blisters on moderate obesity, the mobility of the lumbar spine is
her skin. The skin lesions resemble burns of the second limited. A local tension is observed in the soft tissues
degree, in some places there are erosions or exfoliation over the L2 vertebra. In the blood: Hb – 147 g/L,
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of the epidermis. The Nikolsky sign is positive. Make the leukocytes – 8.8×10 /L, platelets – 222×10 /L, ESR – 5
+ + 2+
right diagnosis: (2005,06) 119 mm/hour, Na – 140 mmol/L, K – 4.2 mmol/L, Ca –
1. Acute epidermal necrolysis 2.35 mmol/L. Make the right diagnosis:
2. Pemphigus vulgaris 1. Osteoporosis with a pathological fracture
3. Bullous dermatitis 2. Amyloidosis
4. Erythema multiforme exudativum 3. Secondary hyperparathyroidism
5. Duhring dermatitis herpetiformis 4. Sciatica
5. Multiple myeloma
108. On the fifth day after a full-term birth, a
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postparturient woman developed a fever of 38.8 C, 112. A 39-year-old patient undergoes treatment in the
abdominal pain, and general weakness. Her blood surgical department for acute cholecystitis. He was
pressure is 120/80 mm Hg, pulse is 100/min. The transferred to the therapy department due to an increase
breasts are moderately distended. The abdomen is soft in blood pressure to 180/120 mm Hg, protein excretion
and participates in the act of breathing. The uterine with urine, and persistent fever. This persistent
fundus is located three finger-widths below the navel. subfebrile body temperature was resistant to antibiotic
Vaginal examination shows that the cervix allows therapy. 10 days after the treatment, the patient had an
inserting one finger; the uterus is soft, painful, and asphyxia attack with difficult expiration. Later, he
enlarged to 13 weeks of pregnancy. There is a developed arthralgias and erythematous skin lesions.
seropurulent foul-smelling discharge from the genital Eosinophil levels in the blood are 18%. What disease
tracts. Make the right diagnosis: might be suspected in this patient?
1. Uterine subinvolution 1. Systemic lupus erythematosus
2. Lactostasis 2. Nonspecific aortoarteritis
3. Postpartum purulent metroendometritis 3. Hemorrhagic vasculitis (Henoch-Schoenlein purpura)
4. Septic shock 4. Polyarteritis nodosa
5. Postpartum endometritis 5. Acute glomerulonephritis
109. A surgical department has received a boy on the 113. A 74-year-old man has been suffering from benign
first day of his life. He produces a foaming discharge prostate hyperplasia for the last 5 years. 4 days ago,
from his nose and mouth and has cyanosis attacks. X- after drinking alcohol, an acute urinary retention
ray has shown the esophagus that ends in a blind-ended occurred. At the prehospital stage, his bladder was
pouch at the level of the Th2 vertebra and the gastric air catheterized with a metallic catheter twice a day. The
bubble that is located under the left dome of the examination has shown enlarged, dense, and painful
diaphragm. Make the right diagnosis: epididymis of the right testicle. There is purulent
1. Esophageal atresia without fistula discharge from the urethra. What kind of emergency aid
2. Bronchoesophageal fistula must be provided in this case? (2006) 301
3. Paraesophageal hernia of the esophageal hiatus of 1. Transurethral resection or prostatectomy
the diaphragm 2. Trocar or open epicystostomy
4. Total esophageal atresia 3. Transurethral microwave thermotherapy of the
5. Esophageal atresia, tracheoesophageal fistula prostate
4. Installation of a permanent urethral catheter
110. One year ago an 8-year-old boy had a case of 5. Installation of an intraprostatic stent
hepatitis B. For the last two months he has been
complaining of fatigability, disturbed sleep, loss of 114. The people living in a radiation contaminated area
appetite, and nausea, especially in the morning. His skin were recommended to include pectin in their diet for
is not icteric, the liver and spleen are painless and can
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removal of radionuclides from the body. What products during work. The distal and proximal joints of her fingers
can be the main source of pectin? II-IV are defigured, painful, have Heberden and
1. Milk Bouchard nodes, and their mobility is limited. X-ray of
2. Meat the joints has shown narrowed joint spaces, marginal
3. Pasta osteophytes, and subchondral sclerosis. Make the right
4. Bread diagnosis:
5. Vegetables and fruits 1. Reiter disease (reactive arthritis)
2. Psoriatic arthritis
115. A 25-year-old woman is complaining of fever of 3. Bekhterev disease (ankylosing spondylitis)
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37 C, pain in her lower abdomen, and vaginal discharge. 4. Osteoarthrosis deformans, nodular form
Three days ago, at 10 weeks of pregnancy, an artificial 5. Rheumatic arthritis
abortion was performed. The cervix is clean, the uterus
is slightly enlarged and painful. The uterine appendages 120. A 19-year-old young man was admitted to the
cannot be detected. The fornices are deep and painless. surgical inpatient department with a closed abdominal
Sanguinopurulent discharge is being produced from the injury. During the surgery, multiple ruptures of the spleen
vagina. Make the right diagnosis: and small intestine were detected. The patient’s blood
1. Uterine perforation after an abortion pressure is progressively decreasing. Blood transfusion
2. Postabortion metroendometritis is required. Who can determine the patient’s blood type
3. Pelvioperitonitis and rhesus factor? (2005,06,07,08,09) 159
4. Hematometra 1. Surgeon
5. Parametritis 2. Traumatologist
3. Anesthesiologist
116. A 72-year-old woman has been hospitalized with a 4. Doctor of any specialty
nosebleed. Within the last 6 years, her blood pressure 5. Medical laboratory scientist
had spikes up to 180/100 mm Hg. Her skin is pale, the
heart sounds are quite sonorous, the second heart 121. A 2-month-old boy was born with body weight of
sound is accentuated over the aorta, there is an audible 5100 g. The baby has jaundice, hoarse cry, umbilical
systolic murmur. Blood pressure – 150/80 mm Hg. In the hernia, and a delay in physical development. The liver is
12
blood: Hb – 92 g/L, erythrocytes – 2.7×10 /L. In the +2 cm, the spleen is not enlarged. The umbilical cord
urine: specific gravity – 1022, leukocytes – 3–7 in the separation was delayed in the baby. In the blood: Hb –
12
vision field, erythrocytes – 0–2 in the vision field. What is 120 g/L, erythrocytes – 4.5×10 /L, ESR – 3 mm/hour.
most likely the cause of hypertension in this case? Total serum bilirubin – 28 mcmol/L, indirect bilirubin – 20
1. Aortic atherosclerosis mcmol/L, direct bilirubin – 8 mcmol/L. What disease is
2. Chronic pyelonephritis suspected first?
3. Coarctation of the aorta 1. Hemolytic anemia
4. Chronic glomerulonephritis 2. Cytomegalovirus infection
5. Essential hypertension 3. Congenital hypothyroidism
4. Congenital hepatitis
117. Medical examination of the population has revealed 5. Conjugated jaundice
and registered chronic diseases, various pathological
conditions, and abmormalities. What type of morbidity is 122. A 31-year-old woman has complains of pain and
being studied in this case? swelling in her radiocarpal and metacarpophalangeal
1. Morbidity with temporary disability joints and morning stiffness for up to 1.5 hours. These
2. Primary morbidity signs have been observed for the last 3 years. Two
3. Pathological morbidity weeks ago she developed pain, swelling, and redness in
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4. Prevalence of the disease her knee joints and fever of 37.5 C. The examination of
5. General morbidity her internal organs shows no pathological changes. She
was diagnosed with rheumatoid arthritis. What changes
118. A man has developed acute chills, headache, will most likely be visible on the X-ray scan of her joints?
o
vomiting, and fever of 38.5 C. In the evening, nuchal 1. Multiple marginal osteophytes
rigidity and positive Kernig’s sign has appeared. Herpetic 2. Narrowing of the joint space, usuras (bone lesions)
blisters are visible on the mucosa of his lips and nose. 3. Cysts in the subchondral bone
No focal neurological signs were detected. Make the 4. Osteolysis of the epiphyses
right diagnosis: 5. Narrowing of the joint space, subchondral
1. Meningococcal meningitis osteosclerosis
2. Herpesviral encephalitis
3. Brain abscess 123. A 7-year-old boy suddenly developed pain and
4. Brain hemorrhage edema in the right knee. The day before, at school, he
5. Subarachnoid hemorrhage took part in cross-country skiing. There is no family
history of hemophilia or susceptibility to bleeding. His
o
119. A 60-year-old woman is complaining of pain in the body temperature is 37.5 C. The knee is painful on
interphalangeal joints of her hands that exacerbates palpation, hot to the touch, and has edema with local
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tissue tension above it. In the blood: Hb – 123 g/L, His temperature is low. No rash is observed in the
9 9
leukocytes – 5.6×10 /L, platelets – 354×10 /L, patient. His blood pressure is 230/130 mm Hg, pulse –
prothrombin time – 12 seconds (normal range is 10–15 50/min., respiratory rate – 12/min. Make the right
seconds), activated partial thromboplastin time – 72 diagnosis: (2006) 260
seconds (normal range is 35–45 seconds). Bleeding 1. Acute subdural hematoma
time is normal, the factor VIII levels constitute 5% of 2. Myasthenia
normal value. Make the right diagnosis: (2006) 279 3. Acute bacterial meningitis
1. Hemophilia A 4. Multiple sclerosis
2. Hemophilia B 5. Migraine
3. Thrombocytopenia
4. Vitamin K deficiency 128. A 25-year-old woman at 34 weeks of pregnancy
5. Henoch-Schoenlein purpura was hospitalized in a critical condition into the maternity
clinic. She has complains of headache, vision
124. A 13-year-old girl came to a school doctor. Two impairment, and nausea. She has edemas, her blood
days ago she first developed moderate bloody discharge pressure is 170/130 mm Hg. Suddenly, the woman
from her genital tracts. Her secondary sexual developed fibrillar twitching of her facial muscles, tonic
characteristics are developed. What is most likely the and clonic seizures, and respiratory arrest. One and a
cause of the bloody discharge in this case? half minutes later her breathing resumed and blood-
(2005,06,07,08) 199 tinged foam appeared from her mouth. Her urinary
1. Endometrial cancer protein levels are 3.5 g/L. Make the right diagnosis:
2. Hemophilia (2006) 223
3. Juvenile bleeding 1. Brain edema
4. Werlhof’s disease 2. Brain hemorrhage
5. Menarche 3. Gastric ulcer
4. Epilepsy
125. For 2 hours after giving birth, the condition of the 5. Eclampsia
mother remains stable. Her uterus is dense and
spherical, its floor is at the level of the navel, there is no 129. During the study of pulmonary tuberculosis
bleeding. The clamp applied to the umbilical cord morbidity, the data on socio economic living conditions
remains at the same level. When the woman is taking a and harmful habits of the patients were obtained. What
deep breath and the edge of the palm is pressed over methods allow the assessment of the extent to which
her symphysis, the umbilical cord retracts into the these factors influence the tuberculosis morbidity?
vagina. There is no bloody discharge from the genital (2006) 208
tracts. What are the doctor’s next tactics? 1. Calculation of the agreement coefficient
1. Administer oxytocin intravenously 2. Calculation of the confidence coefficient
2. Remove the placenta manually 3. Calculation of the correlation coefficient
3. Apply the Abuladze technique 4. Calculation of the regression coefficient
4. Perform the Crede-Lazarevich maneuver 5. Calculation of standardized indicators
5. Perform the uterine curettage
130. A 2-month-old girl was being transferred to formula
126. A 28-year-old man had an acute onset of the feeding. She was born with the body weight of 3500 g.
disease. He began feeling too hot and developed chills, Now, her body weight is 3900 g. What is the normal daily
o
fever of 38.5 C, tenesmus, paroxysmal pain in his left volume of feeding for this baby?
iliac region, and frequent liquid stools with blood and 1. 600 mL
mucus. Abdominal palpation is painful on the left, the 2. 650 mL
sigmoid colon is spastic. Make the right diagnosis: 3. 690 mL
(2006,07) 310 4. 730 mL
1. Malignant tumors of the large intestine 5. 750 mL
2. Amoebiasis
3. Nonspecific ulcerative colitis 131. A 33-year-old man was hospitalized with a
4. Dysentery recurrent ulcer bleeding that was stopped. During the
5. Escherichia coli infection examination he is exhausted and pale. Blood test shows
Hb of 77 g/L and Ht that equals 0.25. Due to anemia,
127. A 54-year-old man was hospitalized with complaints there were two attempts to transfuse him with the blood
of a sudden severe headache in the back of the head of his group – A(II) Rh(+). Both transfusions must be
and vomiting. He has a history of moderate hypertension stopped because of anaphylactic reaction development.
and takes hypothiazide. Three days ago he came to a What transfusion medium is indicated in this case?
therapist, complaining of an intense headache, which (2005,07) 153
was relieved with an analgesic. His consciousness is 1. Washed erythrocytes
clouded and his left pupil is dilated. He presents with 2. Fresh citrated blood
marked photophobia, tense neck muscles, and left sided 3. Erythrocyte mixture
hemiparesis with increased muscle tone and reflexes.
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leukocytes – 12×10 /L, ESR – 40 mm/hour. Make the 92/min., blood pressure – 90/60 mm Hg. His sclerae are
right diagnosis: (2006) 335 icteric. His abdomen is enlarged due to ascites and
1. Systemic lupus erythematosus hepatosplenomegaly. What is the most likely cause of
2. Reactive polyarthritis bleeding in this case?
3. Rheumatoid arthritis 1. Mallory-Weiss syndrome
4. Dermatomyositis 2. Esophageal achalasia
5. Atopic dermatitis 3. Ruptured varicose veins in the esophagus
4. Budd-Chiari syndrome
141. A 22-year-old young woman has complains of an 5. Peptic ulcer disease of the duodenum
aching pain in her right iliac region throughout the last
week, morning sickness, and taste distortions. Her 145. A 63-year-old woman has undergone a surgery for
menstruation is delayed for 3 weeks already. Her blood a large multinodular euthyroid goiter. Subtotal resection
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pressure is 110/70 mm Hg, pulse – 78/min., t – 37.0 C. of the both lobes of the thyroid gland had to be
Bimanual examination shows that her uterus is slightly performed, which was done with technical difficulties. On
enlarged, soft, mobile, and painless. Palpation of the the 4th day after the surgery, the woman developed
uterine appendages detects on the right a painful and abdominal pain and muscle spasms in her face and
moderately mobile dense-elastic formation 3x4 cm in arms. The Chvostek and Trousseau signs were positive.
size. Make the right diagnosis: (2007) 362 What is the most likely the cause of the patient’s
1. Cyst of the right ovary condition?
2. Progressing tubal pregnancy 1. Hypoparathyroidism
3. Acute appendicitis 2. Thyrotoxic crisis
4. Interrupted tubal pregnancy 3. Tracheomalacia
5. Uterine pregnancy 4. Damage to the recurrent nerve
5. Postoperative hypothyroidism
142. For the past 6 years a 37-year-old woman has been
experiencing frequent nosebleeds, severe 146. A 3-year-old child has a cough and runny nose.
metrorrhagias, and periodic bruising on her skin. 12 days Two other family members have the same signs. On the
ago, after a severe nosebleed, her weakness intensified, third day after the onset of the disease, the cough
she developed dizziness and palpitations. Her skin is intensified and became dry and persistent. The
o
pale, there are multiple petechiae and isolated temperature increased to 37.8 C. The act of breathing
ecchymoses on the anterior surface of her torso, legs, involves the auxiliary muscles. Percussion produces a
and arms. In the blood: Hb – 80 g/L, erythrocytes – banbox resonance bilaterally in the lungs. Breathing is
12 9
4.0×10 /L, color index – 0.7; leukocytes – 5.3×10 /L; harsh, expiration is prolonged, there are moderate and
band neutrophils – 2%, segmented neutrophils – 65%, large bubbling wheezes. The wheezes are diffuse and
eosinophils – 2%, lymphocytes – 24%, monocytes – 5%, mostly wet, though in some places they are dry. Make
9
platelets – 10×10 /L, ESR – 15 mm/hour. Make the right the right diagnosis:
diagnosis: 1. Acute bronchiolitis
1. Aplastic anemia 2. Acute obstructive bronchitis
2. Hemophilia 3. Bilateral bronchopneumonia
3. Hemorrhagic vasculitis 4. Stenosing laryngotracheitis
4. Idiopathic thrombocytopenic purpura 5. Bronchial asthma
5. Iron deficiency anemia
147. A 35-year-old man has complains of a chest pain
143. A patient in a state of clinical death receives closed- that persists for several months already and an
chest cardiac massage and mouth-to-mouth artificial occasionally observed bitter taste in his mouth. The pain
pulmonary ventilation. The doctor noticed that the air is localized behind the sternum, occurs at rest, and
does not enter the patient’s airways, and his head and sometimes irradiates into the neck. It doesn’t intensify
torso are at the same level. Why is the artificial during physical exertion, but may intensify after drinking
pulmonary ventilation ineffective in this case? alcohol or eating a large meal. At night, this condition
(2015,16,18) 1489 becomes worse. Swallowing is not disturbed. The body
1. Closed-chest cardiac massage weight is increased. Examination detected no changes.
2. Swallowed tongue Make the right diagnosis:
3. The volume of inhaled air is too low 1. Globus hystericus
4. The patient’s mouth is too small 2. Esophageal achalasia
5. No gastric tube 3. Gastroesophageal reflux disease
4. Esophageal tumor
144. A 54-year-old patient, a heavy drinker, who 4 years 5. Diaphragmatic hernia
ago had a case of viral hepatitis B, has been
experiencing heartburn and a burning pain retrosternal 148. A 35-year-old patient for the last 3 years is on
for the past two months. In the morning, after eating and hemodialysis due to chronic glomerulonephritis. He
lifting a heavy object, he had an episode of vomiting with developed cardiac irregularities, hypotension,
fresh dark blood. His skin is pale and moist, pulse – progressing weakness, and dyspnea. ECG has shown
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