Internal Medicine Complex (Krok 2014)

Description

internal Medicine (Internal Medicine) Quiz on Internal Medicine Complex (Krok 2014), created by yogesh mandavi on 27/05/2017.
yogesh mandavi
Quiz by yogesh mandavi, updated more than 1 year ago
yogesh mandavi
Created by yogesh mandavi almost 7 years ago
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Resource summary

Question 1

Question
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 V4-5. What disease might be suspected?
Answer
  • Instable stenocardia
  • Stable FC III stenocardia
  • Stable FC I stenocardia
  • Stable FC II stenocardia
  • Stable FC IV stenocardia

Question 2

Question
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?
Answer
  • Isosorbide dinitrate
  • Corinfar
  • Atenolol
  • Streptokinase
  • Aminophylline

Question 3

Question
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 ?
Answer
  • Exertional stenocardia, III functional class
  • Exertional stenocardia, IV functional class
  • Exertional stenocardia, II functional class
  • Vegetative-vascular dystonia of hypertensive type
  • Alcoholic cardiomyopathy

Question 4

Question
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?
Answer
  • Stress-echocardiogram
  • Test with dosed physical exercises
  • Esophageal electrocardiac stimulator
  • Coronarography
  • Myocardial scintigraphy

Question 5

Question
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?
Answer
  • IHD:Variant angina pectoris (Prinzmetal's)
  • IHD:Stable angina pectoris of effort I FC
  • IHD:Stable angina pectoris of effort IV FC
  • IHD:Progressive angina pectoris
  • IHD:First established angina pectoris

Question 6

Question
Thrombosis of the coronary artery caused myocardial infarction. What mechanisms of injury will be the dominating ones in this disease?
Answer
  • Electrolytoosmotic mechanisms
  • Calcium mechanisms
  • Acidotic mechanisms
  • Protein mechanisms
  • Lipid mechanisms

Question 7

Question
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?
Answer
  • ECG
  • PCG
  • Echocardiography
  • Ventriculography
  • Polycardiography

Question 8

Question
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?
Answer
  • Atrial septal defect
  • Ventricular septal defect
  • Aortarctia
  • Tetralogy of Fallot
  • Patent ductus arteriosus

Question 9

Question
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?
Answer
  • Mitral valve prolapse
  • Mitral valve insufficiency
  • Mitral stenosis
  • Aortic stenosis
  • Tricuspid valve insufficiency

Question 10

Question
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:
Answer
  • Pulmonary artery stenosis
  • Mitral insufficiency
  • Aortic stenosis
  • Ventricular septal defect
  • Tricuspid regurgitation

Question 11

Question
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, AP- 180/20 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?
Answer
  • Cardiosurgeon consultation
  • Dispensary observation
  • Administration of therapeutic treatment
  • Continuation of investigation
  • Exemption from physical exercises

Question 12

Question
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?
Answer
  • Aortic valve insufficiency
  • Pulmonary artery stenosis
  • Mitral valve insufficiency
  • Mitral stenosis
  • Opened arterial duct

Question 13

Question
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?
Answer
  • Hepatocirrhosis
  • Lung cancer with invasion to the pleura
  • Chronic pulmonary heart
  • Pulmonary embolism
  • Constrictive pericarditis

Question 14

Question
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?
Answer
  • Pulmonary embolism
  • Tietze's syndrome
  • Acute pericarditis
  • Dissecting aortic aneurysm
  • Dressler's syndrome

Question 15

Question
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?
Answer
  • Treatment by a cardiac surgeon
  • Digitalis preparations
  • Anti-TB drugs
  • Diuretics
  • Vasodilators, nitrates

Question 16

Question
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?
Answer
  • Digoxin
  • Metoprolol
  • Nitroglycerin
  • Captopril
  • Furosemide

Question 17

Question
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?
Answer
  • Phonocardiography
  • Coronarography
  • Sphygmography
  • Echocardiography
  • X-ray

Question 18

Question
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): left ventricled extrasystolia, decreased voltage. What method of investigation is necessary to do to determine the diagnosis?
Answer
  • Echocardiography
  • Veloergometria
  • X-ray kymography
  • ECG in the dynamics
  • Coronarography

Question 19

Question
A 56-year-old patient with diffuse toxic goiter has ciliary arrhythmia with pulse rate of 110 bpm, arterial hypertension, AP- 165/90 mm Hg. What preparation should be administered along with mercazolil?
Answer
  • Propranolol
  • Radioactive iodine
  • Procaine hydrochloride
  • Verapamil
  • Corinfar

Question 20

Question
171 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- 6,7x109/L, sedimentation rate- 21 mm/hour. What is the most probable diagnosis?
Answer
  • Climacteric myocardiodystrophia
  • Ichemic heart disease, angina pectoris
  • Rheumatism, mitral insufficiency
  • Acute myocarditis
  • Hypertrophic cardiomyopathy

Question 21

Question
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?
Answer
  • Exertional angina
  • Neurocirculatory asthenia
  • Hypertrophic cardiomyopathy
  • Myocarditis
  • Pericarditis

Question 22

Question
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 36,1oC, 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?
Answer
  • Myocardial infarction
  • Pulmonary embolism
  • Cardiac asthma
  • Bronchial asthma
  • Pneumothorax

Question 23

Question
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?
Answer
  • Kitaev's reflex
  • Bainbridge reflex
  • Cardiovascular reflex
  • Respiratory reflex
  • Euler-Liljestrand reflex

Question 24

Question
A 60 y.o. patient experiences acute air insufficiency following of the venoectomy due to subcutaneous vein thrombophlebitis 3 days ago. Skin became cianotic, with grey shade. Marked psychomotor excitement, tachypnea, substernal pain. What postoperative complication has occured?
Answer
  • Hemorrhagia
  • Hypostatic pneumonia
  • Thromboembolia of pulmonary artery
  • Myocardial infarction
  • Valvular pneumothorax

Question 25

Question
181 A 57-year-old male patient complains of dyspnea on exertion, heaviness in the right hypochondrium and shin edemata towards evening. Objectively: temperature - 38,1oC, HR- 20/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?
Answer
  • Atherosclerotic cardiosclerosis
  • Dilatation cardiomyopathy
  • Mitral stenosis
  • Pulmonary heart
  • Primary pulmonary hypertension

Question 26

Question
A 67 y.o. patient complains of palpitation, dizziness, noise in ears, feeling of shortage of air. Objectively: pale, damp skin. Vesicular respiration, respiratory rate- 22 per min, pulse- 200 bpm, AP- 100/70 mm Hg. On ECG: heart rate- 200 bmp, ventricular complexes are widened, deformed, location of segments ST and of wave T is discordant. The wave Р is not changed, superimposes QRST, natural conformity between Р and QRS is not present. What kind of arrhythmia is present?
Answer
  • Sinus tachycardia
  • Paroxismal ventricular tachycardia
  • Atrial flutter
  • Ventricular extrasystole
  • Atrial tachycardia

Question 27

Question
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?
Answer
  • Verapamil
  • Digoxin
  • Obzidan
  • Ajmaline
  • Does not require treatment

Question 28

Question
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?
Answer
  • An attack of supraventricular paroxysmal tachycardia
  • An attack of ventricular paroxysmal tachycardia
  • An attack of atrial flutter
  • An attack of ciliary arrhythmia
  • An attack of extrasystolic arrhythmia

Question 29

Question
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?
Answer
  • Immediate hospitalization
  • Prophylactic administration of cordarone
  • Defibrillation
  • Lidocaine administration
  • Heparin administration

Question 30

Question
A 53-year-old female patient complains of cardiac pain and rhythm intermissions. She has experienced these presentations since childhood. The patient's father had a history of cardiac arrhythmias. Objectively: the patient is in grave condition, Ps- 220 bpm, AP- 80/60 mm Hg. ECG results: heart rate - 215/min, extension 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?
Answer
  • $\beta$-adrenoreceptor blocking agents
  • Cholinolytics
  • Implantation of the artificial pacemaker
  • Calcium antagonists
  • Cardiac glycosides

Question 31

Question
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?
Answer
  • Pulmonary artery thromboembolia
  • Cardiac asthma
  • Disquamative aortic aneurizm
  • Cardiogenic shock
  • Cardiac tamponade

Question 32

Question
A 54-year-old drowned man was rescued from the water and delivered to the shore. Objectively: the man is unconscious, pale, breathing cannot be auscultated, pulse is thready. Resuscitation measures allowed to save the patient. What complications may develop in the near future?
Answer
  • Pulmonary edema
  • Respiratory arrest
  • Encephalopathy
  • Cardiac arrest
  • Bronchospasm

Question 33

Question
A 60-year-old female patient had been admitted to a hospital for acute transmural infarction. An hour later 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 were muffled, there was also diastolic shock on the pulmonary artery. The patient presented with 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?
Answer
  • Aminophylline
  • Promedol
  • Dopamine
  • Heparin
  • Digoxin

Question 34

Question
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?
Answer
  • Reduction in peripheral resistance
  • Reduction in cardiac output
  • Blood depositing in the abdominal cavity
  • Adrenergic receptor block
  • Internal haemorrhage

Question 35

Question
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?
Answer
  • Nitroglycerin intravenously
  • Pentamin intravenously
  • Strophanthin intravenously
  • Dopamine intravenously
  • Aminophylline intravenously

Question 36

Question
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 moist 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?
Answer
  • Acute myocardial infarction, pulmonary edema
  • Complicated hypertensic crisis, pulmonary edema
  • Bronchial asthma exacerbation
  • Uncomplicated hypertensic crisis
  • Community-acquired pneumonia

Question 37

Question
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?
Answer
  • Arrhythmogenic shock
  • Perforated gastric ulcer
  • Cardiogenic shock
  • Acute pericarditis
  • Acute pancreatitis

Question 38

Question
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?
Answer
  • Intravenous administration of furosemide
  • Urgent pneumography
  • Bed rest, lying position
  • Intravenous administration of a β-blocker
  • Tactics can be determined after ECG and chest radiography

Question 39

Question
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?
Answer
  • Beta-blockers, ACE inhibitors
  • Beta-blockers, cardiac glycosides
  • Cardiac glycosides, diuretics
  • Cardiac glycosides, ACE inhibitors
  • Diuretics, beta-blockers

Question 40

Question
In the development of the inflammation processes glucocorticoids reduce the level of certain most important active enzyme. It results also in the reducing of the synthesis of prostaglandins and leucotrienes which have a key role in the development of inflammation processes. What is the exact name of this enzyme?
Answer
  • Phospholipase A2
  • Arachidonic acid
  • Lipoxygenasе
  • Cyclooxygenase – 1
  • Cyclooxygenase – 2

Question 41

Question
A 18 y.o. male patient complains of pain in knee and ankle joints, temperature elevation to 39,5oC. He had a respiratory disease 1,5 week ago. On examination: temperature- 38,5oC, 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?
Answer
  • 1-antitrypsine
  • Antistreptolysine-0
  • Creatinkinase
  • Rheumatic factor
  • Seromucoid

Question 42

Question
After a holiday in the Crimea, a 36-year-old female patient presents with severe pain in the elbow joints, dyspnea and weakness. The body temperature is of 37,6oC, the skin is pale, there is erythema of cheeks and nose, lower lip ulceration. Visual inspection reveals no changes in the joints, the right elbow movement is limited. There is murmur and pleural friction in the lungs below the right angle of the scapula. Cardiac sounds are muffled, there is tachycardia, gallop rhythm, Ps- 114/min. AP- 100/60. What is the most likely diagnosis?
Answer
  • Rheumatic heart disease
  • Rheumatoid arthritis
  • SLE
  • Infectious allergic myocarditis
  • Dry pleurisy

Question 43

Question
A 58-year-old patient complains about sensation of numbness, sudden paleness of II-IV fingers, muscle rigidness, intermittent pulse. The patient presents also with polyarthralgia, dysphagia, constipations. The patient's face is masklike, solid edema of hands is present. The heart is enlarged; auscultation revealed dry rales in lungs. In blood: ESR- 20 mm/h, crude protein - 85/l, γ-globulines - 25%. What is the most likely diagnosis?
Answer
  • Dermatomyositis
  • Rheumatoid arthritis
  • Systemic lupus erythematosus
  • Systemic scleroderma
  • Raynaud's disease

Question 44

Question
A 39-year-old male patient complains of moderate pain and weakness in the shoulder, back and pelvic girdle muscles, that has been progressing for the last 3 weeks; great difficulty in getting out of bed, going up and down the stairs, shaving. Dermatomyositis has been suspected. Blood test results: Hb- 114 g/l, WBC- 10,8*109/l, eosinophils - 9%, ESR -22 mm/h, C-reactive protein - (++). The alteration in the following laboratory value wil be of decisive diagnostic significance:
Answer
  • Ceruloplasmin
  • Sialic acids
  • dsDNA antibodies
  • Gamma-globulins
  • Creatine phosphokinase

Question 45

Question
A 38-year-old patient is under observation having polyneuritic syndrome with considerable loss of weight, fever, rise in BP. Blood test:: considerable inflammatory changes. What examination is the most expedient to make the diagnosis?
Answer
  • Determination of antinuclear antibodies
  • Electromyography
  • Muscular biopsy with histological investigation of the material
  • Blood culture
  • Determination of HLA antigens

Question 46

Question
A 32-year-old patient has a 3-year history of asthma attacks, that can be hardly stopped with berotec. Over a few last months he has experienced pain in the joints and sensitivity disorder of legs and feet skin. Ps - 80/min, AP - 210/100 mm Hg. In blood: eosinophilia at the rate of 15%. What disease can be suspected in this case?
Answer
  • Systemic lupus erythematosus
  • Systemic scleroderma
  • Dermatomyositis
  • Wegener's disease
  • Periarteritis nodosa

Question 47

Question
A 30 y.o. female with rheumatoid arthritis of five years duration complains of pain in the frist three fingers of her right hand over past 6 weeks. The pain seems especially severe at night often awakening her from sleep.The most likelly cause is?
Answer
  • Carpal tunnel syndrome
  • Atlanto-axial sublaxation of cervical spine
  • Sensory peripheral neuropathy
  • Rheumatoid vasculitis
  • Rheumatoid arthritis without complication

Question 48

Question
A 35-year-old patient complains about pain and morning stiffness of hand joints and temporomandibular joints that lasts over 30 minutes. She has had these symptoms for 2 years. Objectively: edema of proximal interphalangeal digital joints and limited motions of joints. What examination should be administered?
Answer
  • Complete blood count
  • Roentgenography of hands
  • Rose-Waaler reaction
  • Immunogram
  • Proteinogram

Question 49

Question
A patient has an over a year-old history of fast progressive rheumatoid arthritis. X-raying confirms presence of marginal erosions. What basic drug would be the most appropriate in this case?
Answer
  • Chloroquine
  • Methotrexate
  • Prednisolone
  • Diclofenac sodium
  • Aspirin

Question 50

Question
A 60-year-old female patient complains of recurrent pain in the proximal interphalangeal and wrist joints, their periodic swelling and reddening that have been observed for 4 years. X-ray picture represents changes in form of osteoporosis, joint space narrowing and single usuras. What is the most likely diagnosis?
Answer
  • Rheumatoid arthritis
  • Osteoarthritis
  • Gout
  • Pseudogout
  • Multiple myeloma

Question 51

Question
A 58-year-old woman complains of osteoarthrosis of knee-joint. For 2 weeks she had been receiving an in-patient medical treatment. She was discharged from the hospital in satisfactory condition with complaints of minor pain after prolonged static work. Local hyperemia and exudative effects in the area of joints are absent. What further tactics is the most expedient?
Answer
  • Repeated in-patient treatment
  • Conducting arthroscopy
  • Refferral to MSEC
  • Orthopedist consultation
  • Outpatient treatment

Question 52

Question
A 36-year-old female patient complains of intense pain in the knee joints and neck. In the morning she experiences pain in the interscapular region and leg joints; pain subsides after warm-up gymnastics. The patient is overnourished, there is a clicking sound in the knees when squatting, the knees are somewhat disfigured, painful on palpation. Blood test results: ESR- 18 mm/h, WBC- 8,0*109/l. Radiography reveals subchondral sclerosis in the left knee. What is the basis of this pathology?
Answer
  • Autoimmune process in the synovium
  • Degenerative processes in cartilage
  • Deposition of urates (tophi) in the articular tissues
  • Beta-haemolytic streptococcus
  • Hemarthrosis

Question 53

Question
A 53-year-old male has been admitted to a hospital for an attack of renal colic which has repeatedly occurred throughout the year. Objectively: in the region of auricles and the right elbow some nodules can be seen that are covered with thin shiny skin. Ps- 88/min, AP- 170/100 mm Hg. There is bilateral costovertebral angle tenderness (positive Pasternatsky's symptom). The patient has been scheduled for examination. What laboratory value would be most helpful for making a diagnosis?
Answer
  • Uric acid
  • Rheumatoid factor
  • ESR
  • Urine sediment
  • Lactic acid

Question 54

Question
A patient, aged 40, has been ill during approximately 8 years, complains of pain in the lumbar part of the spine on physical excertion, in cervical and thoracal part (especially when coughing), pain in the hip and knee joints on the right. On examination: the body is fixed in the forward inclination with head down, gluteal muscles atrophy. Spine roentgenography: ribs osteoporosis, longitudinal ligament ossification. What is the most likely diagnosis?
Answer
  • Tuberculous spondylitis
  • Ancylosing spondyloarthritis
  • Psoriatic spondyloarthropatia
  • Spondyloarthropatia on the background of Reiter's disease
  • Spread osteochondrosis of the vertebral column

Question 55

Question
A 32-year-old male patient has been suffering from pain in the sacrum and coxofemoral joints, painfulness and stiffness in the lumbar spine for a year. ESR- 56 mm/h. Roentgenography revealed symptoms of bilateral sacroileitis. The patient is the carrier of HLA B27 antigen. What is the most likely diagnosis?
Answer
  • Coxarthrosis
  • Rheumatoid arthrit
  • Reiter's disease
  • Ankylosing spondylitis
  • Spondylosis

Question 56

Question
A 35-year-old patient has been admitted to a hospital for pain in the left sternoclavicular and knee joints, lumbar area. The disease has an acute character and is accompanied by fever up to 38oC. Objectively: the left sternoclavicular and knee joints are swollen and painful. In blood: WBCs - 9,5x109/l, ESR - 40 mm/h, CRP - 1,5 millimole/l, fibrinogen - 4,8 g/l, uric acid - 0,28 millimole/l. Examination of the urethra scrapings reveals chlamydia. What is the most likely diagnosis?
Answer
  • Rheumatic arthritis
  • Gout
  • Bechterew's disease
  • Rheumatoid arthritis
  • Reiter's syndrome

Question 57

Question
A 26-year-old male patient complains of pain in the right knee, which is getting worse in the morning. Two weeks before, he consulted an urologist about prostatitis. Objectively: conjunctivitis is present. There is also periarticular edema of the knee joint, redness of the overlying skin. Rheumatoid factor was not detected. Until further diagnosis is specified, it would be reasonable to start treatment with the following antibiotic:
Answer
  • Cephalosporins
  • Penicillins
  • Aminoglycosides
  • Tetracyclines
  • Lincosamides

Question 58

Question
A 24 y.o. patient complains of nausea, vomiting, headache, shortness of breath. He had an acute nephritis being 10 y.o. Proteinuria was found out in urine. Objectively: a skin is grey-pale, the edema is not present. Accent of II tone above aorta. BP 140/100-180/100 mm Hg. Blood level of residual N2- 6,6 mmol/L, creatinine- 406 mmol/L. Day's diuresis- 2300 ml, nocturia. Specific density of urine is 1009, albumin- 0,9 g/L, WBC- 0-2 in f/vis. RBC.- single in f/vis., hyaline casts single in specimen. Your diagnosis?
Answer
  • Chronic nephritis with violation of kidney function
  • Feochromocitoma
  • Hypertensive illness of the II degree
  • Stenosis of kidney artery
  • Nephrotic syndrome

Question 59

Question
A 25-year-old man has facial edema, moderate back pains. His temperature is 37,5oС, BP 180/100 mm Hg, hematuria [up to 100 in v/f], proteinuria [2,0 g/L], hyaline casts - 10 in v/f., specific gravity -1020. The onset of the disease is probably connected with acute tonsillitis that started 2 weeks ago. What is the most probable diagnosis?
Answer
  • Acute pyelonephritis
  • Cancer of the kidney
  • Urolithiasis
  • Acute glomerulonephritis
  • Chronic glomerulonephritis

Question 60

Question
A 26-year-old patient undergoes a course of treatment due to chronic glomerulonephritis. The treatment was successful, normalization of all the characteristics was recorded. What sanitorium and health resort treatment could be recommended?
Answer
  • Morshyn
  • Not recommended
  • Myrhorod
  • Truskavets
  • The south coast of the Crimea

Question 61

Question
2 weeks after recovering from angina a 29-year-old patient noticed face edemata, weakness, decreased work performance. There was gradual progress of dyspnea, edemata of the lower extremities, lumbar spine. Objectively: pale skin, weakening of the heart sounds, anasarca. AP- 160/100 mm Hg. In urine: the relative density - 1021, protein - 5 g/l, erythrocytes - 20-30 in the field of vision, hyaline cylinders - 4-6 in the field of vision. What is the most likely diagnosis?
Answer
  • Essential hypertension
  • Acute pyelonephritis
  • Acute glomerulonephritis
  • Infectious allergic myocarditis
  • Myxedema

Question 62

Question
A 54-year-old patient has an over 20-year history of femoral osteomyelitis. Over the last month she has developed progressing edemata of the lower extremities. Urine test reveals: proteinuria at the rate of 6,6 g/l; in blood: dysproteinemia in form of hypoalbuminemia, increase in α2- and γ-globulin rate, ESR - 50 mm/h. What is the most likely diagnosis?
Answer
  • Acute glomerulonephritis
  • Secondary renal amyloidosis
  • Myelomatosis
  • Chronic glomerulonephritis
  • Systemic lupus erythematosus

Question 63

Question
2 weeks after having quinsy, a 26-year-old male patient got facial edemata, moderate pain in the sacrum. Objectively: body temperature is 37,5oC, AP- 100/80 mm Hg. Urinalysis results: RBC- up to 100 fresh cells in per HPF, protein - 2,2 g/l, hyaline cylinders - up to 10 per HPF, relative density - 1002. What is the most likely diagnosis?
Answer
  • Nephroma
  • Acute pyelonephritis
  • Urolithiasis
  • Acute glomerulonephritis
  • Chronic glomerulonephritis

Question 64

Question
A 54-year-old male patient complains of aching pain in the lumbar region, that is getting worse after standing in an upright position, physical exercise, supercooling. The patient also reports of experiencing weakness in the afternoon. Pain in the lumbar region, said about 10 years old. Objectively: pale skin, to- 37,2oC, AP- 180/100 mm Hg, minor costovertebral angle tenderness (Pasternatsky symptom). In blood: RBCs - 3,5x1012/l, WBCs - 6,5x109/l, ESR - 22 mm/h. In urine: the relative density - 1010, leukocytes - 12-15 in the field of vision, erythrocytes - 2-3 in the field of vision. Urine bacterial count - 100000 in 1 ml. What is the most likely diagnosis?
Answer
  • Nephrolithiasis
  • Chronic pyelonephritis
  • Polycystic renal disease
  • Chronic glomerulonephritis
  • Amyloidosis

Question 65

Question
A 72-year-old patient after operation due to holecystectomia was prescribed gentamicin (80 mg every 8 hours) and cephalothin (2 g every 6 hours) due to fever. In 10 days there was an increase of creatinine up to 310 mu*mol/L. BP - 130/80 mm Hg, daily quantity of the urine is 1200 mL. Urine tests are without pathology. Ultrasound: the size of kidneys is normal. What is the most probable reason for renal failure?
Answer
  • Nephrotoxity of gentamicin
  • Acute glomerulonephritis
  • Unequal infusion of the liqiud
  • Cortical necrosis of kidneys
  • Hepatorenal syndrome

Question 66

Question
A 37-year-old patient was brought to resuscitation unit. General condition of the patient is very serious. Sopor. The skin is grey, moist. Turgor is decreased. Pulse is rapid, intense. BP - 160/110 mm Hg, muscle tonus is increased. Hyperreflexia. There is an ammonia odor in the air. What is the presumptive diagnosis?
Answer
  • Alcoholic coma
  • Uraemic coma
  • Hypoglycemic coma
  • Hyperglycemic coma
  • Cerebral coma

Question 67

Question
A 35-year-old patient has been in the intensive care unit for acute renal failure due to crush for 4 days. Objectively: the patient is inadequate. Breathing rate - 32/min. Over the last 3 hours individual moist rales can be auscultated in lungs. ECG shows high T waves, right ventricular extrasystoles. CVP - 159 mm Hg. In blood: the residual nitrogen - 62 millimole/l, K+- 7,1 millimole/l, Cl- - 78 millimole/l, Na+- 120 millimole/l, Ht - 0,32, Hb - 100 g/l, blood creatinine - 0,9 millimole/l. The most appropriate method of treatment would be:
Answer
  • Hemosorption
  • Plasma sorption
  • Hemodialysis
  • Plasma filtration
  • Ultrafiltration

Question 68

Question
A 28-year-old woman has a 12-year history of chronic glomerulonephritis with latent course. Over the past six months she has developed general weakness, loss of appetite, low work performance, nausea. The patient complains of headache, pain in the joints. On examination: anemia, blood urea - 34,5 millimole/l, blood creatinine - 0,766 millimole/l, hyperkalemia. What complication has developed?
Answer
  • Nephrotic syndrome
  • Acute renal insufficiency
  • Renal amyloidosis
  • Pyelonephritis
  • Chronic renal insufficiency

Question 69

Question
177 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?
Answer
  • Linex
  • Gentamicin
  • Nystatin
  • Tavegil
  • Mucaltin

Question 70

Question
A 30-year-old woman with a long history of chronic pyelonephritis complains about considerable weakness, sleepiness, decrease in diuresis down to 100 ml per day. AP- 200/120 mm Hg. In blood: creatinine - 0,62 millimole/l, hypoproteinemia, albumines - 32 g/l, potassium - 6,8 millimole/l, hypochromic anemia, increased ESR. What is the first step in the patient treatment tactics?
Answer
  • Enterosorption
  • Antibacterial therapy
  • Haemosorption
  • Haemodialysis
  • Blood transfusion

Question 71

Question
A 41-year-old male patient was delivered to a hospital unconscious. During the previous 7 days he had been taking large doses of biseptolum for a cold. The night before, he began complaining of dyspnea, especially when lying down, swollen legs, 2-day urinary retention. In the morning he had seizures and lost consciousness. Objctively: noisy breathing at the rate of 30/min, edematous legs and lumbar region, Ps- 50/min. Plasma creatinine is 0,586 mmol/l, plasma potassium - 7,2 mmol/l. What treatment is necessary for this patient?
Answer
  • Large doses of verospiron
  • Hemodialysis
  • Plasma volume expanders
  • Glucocorticosteroids
  • Heparin

Question 72

Question
A 40 y.o. patient was admitted to the gasteroenterology with skin itching, jaundice, discomfort in the right subcostal area, generalized weakness. On examination: skin is jaundice, traces of scratches, liver is +5 cm, splin is 6x8 cm. In blood: alkaline phosphatase - 2,0 mmol/(hour*L), general bilirubin - 60 mkmol/L, cholesterol - 8,0 mmol/L. What is the leading syndrome in the patient?
Answer
  • Сholestatic
  • Сytolytic
  • Mesenchymal inflammatory
  • Asthenic
  • Liver-cells insufficiency

Question 73

Question
A 40-year-old man is ill with autoimmune hepatitis. Blood test: А/G ratio 0,8, bilirubin – 42 mu*mol/L, transaminase: ALT- 2,3 mmol g/L, АSТ - 1,8 mmol g/L. What is the most effective means in treatment from the given below?
Answer
  • Antibacterial medication
  • Hepatoprotectors
  • Glucocorticoids, cytostatics
  • Antiviral medications
  • Hemosorbtion, vitamin therapy

Question 74

Question
A 42-year-old female patient suffers from micronodular cryptogenic cirrhosis. Over the last week her condition has deteriorated: she developed convulsions, mental confusion, progressing jaundice. What study may give reasons for such aggravation?
Answer
  • Determination of cholesterol ethers
  • Determination of alpha-phetoprotein
  • Determination of ALAT and ASAT
  • Determination of serum ammonia
  • Determination of alkaline phosphatase

Question 75

Question
The complications of acute cholecystitis which require surgical intervention are as follows EXCEPT:
Answer
  • Empyema of the gall-bladder
  • Emphysematous gall-bladder
  • Gall-bladder perforation
  • Cholangitis conditioned by the presence of stones in the bile tract
  • Jaundice

Question 76

Question
A 37-year-old patient has sudden acute pain in the right epigastric area after having fatty food. What method of radiological investigation is to be used on the first stage of examining the patient?
Answer
  • Roentgenological
  • Radionuclid
  • Magnetic-resonance
  • Ultrasonic
  • Thermographic

Question 77

Question
150 A 50-year-old patient complains about having pain attacks in the right subcostal area for about a year. He pain arises mainly after taking fattening food. Over the last week the attacks occurred daily and became more painful. On the 3rd day of hospitalization the patient presented with icteritiousness of skin and scleras, light-colored feces and dark urine. In blood: neutrophilic leukocytosis - 13,1x109/l, ESR- 28 mm/h. What is the most likely diagnosis?
Answer
  • Chronic recurrent pancreatitis
  • Chronic calculous cholecystitis
  • Fatty degeneration of liver
  • Chronic cholangitis, exacerbation stage
  • Hypertensive dyskinesia of gallbladder

Question 78

Question
A 55 y.o. patient complains of distended abdomen and rumbling, increased winds evacuation, liguid foamy feces with sour smell following the diary products consumption. What is the correct name of this syndrome?
Answer
  • Syndrome of decayed dyspepsia
  • Syndrome of fatty dyspepsia
  • Dyskinesia syndrome
  • Malabsorption syndrome
  • Syndrome of fermentative dyspepsia

Question 79

Question
A 48-year-old male patient complains of constant pain in the upper abdomen, mostly on the left, that is getting worse after taking meals; diarrhea, weight loss. The patient is an alcohol abuser. 2 years ago he had acute pancreatitis. Blood amylase is 4 g/h*l. Coprogram shows steatorrhea, creatorrhea. Blood glucose is 6,0 mmol/l. What treatment is indicated for this patient?
Answer
  • Panzinorm forte
  • Insulin
  • Gastrozepin
  • Contrycal
  • No-spa

Question 80

Question
4 hours after having meals a patient with signs of malnutrition and steatorrhea experiences stomach pain, especially above navel and to the left of it. Diarrheas take turns with constipation lasting up to 3-5 days. Palpation reveals moderate painfulness in the choledochopancreatic region. The amylase rate in blood is stable. X-ray reveals some calcifications located above navel. What is the most likely diagnosis?
Answer
  • Duodenal ulcer
  • Chronic gastroduodenitis
  • Zollinger-Ellison syndrome
  • Chronic pancreatitis
  • Chronic calculous cholecystitis

Question 81

Question
A 56 y.o. man, who has taken alcoholic drinks regularly for 20 years, complains of intensive girdle pain in the abdomen. Profuse nonformed stool 2-3- times a day has appeared for the last 2 years, loss of weight for 8 kg for 2 years. On examination: abdomen is soft, painless. Blood amylase - 12g/L. Feces examination-neutral fat 15 g per day, starch grains. What is the most reasonable treatment at this stage?
Answer
  • Contrykal
  • Aminocapron acid
  • Pancreatine
  • Levomicytine
  • Imodium

Question 82

Question
A 64-year-old male patient has a 35-year history of chronic pancreatitis. In the last 5 years, he claims to observe the pain abatement, bloating, frequent bowel movements up to 3-4 times a day, grayish, glossy stool with undigested food rests, the progressive loss of body weight. Change of symptoms in the patient is due to overlay of:
Answer
  • Exocrine pancreatic insufficiency
  • Endocrine pancreatic insufficiency
  • Lactase deficiency syndrome
  • Irritable bowel syndrome
  • Chronic enterocolitis
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