KROK 2 Trial Quiz

198

KROK 2 Trial Quiz

1 / 100

Chief physician of a polyclinic tasked a di-strict doctor with determining the pathological prevalence of disease N in his district. What document allows to estimate the disease prevalence in the population of a medical di-strict?

2 / 100

A rounded well-defined shadow was found in the costo-vertebral angle on the chest roentgenogram of an otherwise healthy 9-year-old girl. Make a preliminary diagnosis:

3 / 100

A 58-year-old woman complains of spontaneous bruises, weakness, bleeding gums, dizziness. Objectively: the mucous membranes and skin are pale with numerous hemorrhages of various time of origin. Lymph nodes are not enlarged. Heart rate - 100/min, BP- 110/70 mm Hg. There are no changes of internal organs. Blood test results: RBC - 3,0·1012/l, ?b - 92 g/l, colour index - 0,9, anisocytosis, poi-kilocytosis, WBC - 10·109/l, eosinophiles - 2%, stab neutrophiles - 12%, segmented neutrophiles - 68%, lymphocytes - 11%, monocytes - 7%, ESR - 12 mm/h. What laboratory test should be determined additionally to make a diagnosis?

4 / 100

A 16-year-old patient with complaints of frequent pain in the abdomen was diagnosed with melanoma, examination revealed also pigmentation of the mucosa and skin, polyp in the stomach and large intestine. It is known that the patients mother has an analogous pigmentation and has been often treated for anemia. What disease is suspected?

5 / 100

A man was brought into the admission room after an overexposure to cold. He complains of sharp pain in the small of his back and elevated body temperature up to 38 C. He took some aspirin. Blood test: leukocytes - 10.5 · 1012/L, eosinophils - 5%, band neutrophils - 8%, segmented neutrophils - 51%, lymphocytes - 32%, monocytes - 4%, erythrocyte sedimentation rate - 28 mm/hour. Urinalysis: protein - 0.6 g/L, leukocytes - cover the whole vision ?eld, large amount of mucus. What is the most likely diagnosis?

6 / 100

A patient had disorder of nasal respiration, mucopurulent discharges from nose, headache for 3 weeks. At anterior rhinoscopy in middle nasal meathus the stria of pus, edema, hyperemia of the mucosa of the nose have been determined. What diagnostic method is necessary to administer first of all?

7 / 100

A full term baby born from the 1st non complicated pregnancy with complicated labour was diagnosed with cephalohematoma. On the 2nd day of life the child developed jaundice; on the 3rdday of life there appeared neurological changes: nystagmus, Graefe syndrome. Urine is yellow, feces are golden-yellow. The mother’s blood group is ? (II) Rh?, the child’s - ? (II) Rh+. On the 3rd day the results of the child’s blood test are as follows: Hb- 200 g/l, erythrocytes - 6,1·1012/l, blood bilirubin - 58 mcmol/l due to the presence of its unconjugated fraction, Ht- 0,57. In this case the jaundice is caused by:

8 / 100

A 14-year-old girl has been presenting with irritability and tearfulness for about a year. A year ago she was also found to have diffuse enlargement of the thyroid gland (II grade). This condition was regarded as a pubertal manifestation, the girl did not undergo any treatment. The girl’s irritability gradually gave place to a complete apathy. The girl developed puffy face, soft tissues pastosity, bradycardia, constipations. Skin pallor and gland density progressed, the skin developed a waxen hue. What disease can be suspected?

9 / 100

A 19-year-old girl was admitted to emergency department: unconsciousness, cyanosis, myotic pupils are present, superficial breathing is 12/min. BP is 90/60 mm Hg, Ps- 78/min. Choose the action necessary in this clinical situation:

10 / 100

A 46-year-old patient with temporarily undetermined diagnosis was prescribed pleurocentesis based on the results of the X-ray. The puncture yielded 1000 ml of a liquid with the following properties: clear, speci?c gravity - 1,010, protein content - 1%, Rivalta’s test is negative, erythrocytes - 2-3 in the ?eld of vision. What disorder are these pathologic changes characteristic of?

11 / 100

A 54-year-old female patient consulted a doctor about bloody discharges from the genital tracts after 2 years of amenorrhea. USI and bimanual examination revealed no genital pathology. What is the tactics of choice?

12 / 100

For the persons who live in a hot area after an accident at a nuclear object, the greatest risk within the first decade is represented by cancer of:

13 / 100

On the 4th day after recovering from a cold a patient was hospitalized with complaints of solitary spittings of mucoid sputum. On the 2nd day there was a single discharge of about 250 ml of purulent blood-streaked sputum. Objectively: the patient’s condition is moderately severe. Respiratory rate -28-30/min., Ps- 96/min., BP- 110/70 mm Hg. Respiration above the left lung is vesicular, weak above the right lung. There are various moist crackles above the lower lobe and amphoric breath near the angle of scapula. What is the most likely diagnosis?

14 / 100

Over a current year among workers of an institution 10% have not been ill a single time, 30% have been ill once, 15% - twice, 5% - 4 times, the rest - 5 and more times. What is the percentage of workers belonging to the I health group?

15 / 100

A 48-year-old woman has been hospitalized due to development of tachysystolic atrial ?brillation. She has lost 5 kg of body weight within 2 months. On palpation there is a node in the left lobe of the thyroid gland. What pathology resulted in the development of this condition?

16 / 100

A 38-year-old woman after physical overexertion suddenly developed palpitations, dyspnea, and a dull pain in the cardiac area. For 10 years she has been registered for regular check-ups due to rheumatism and mitral valve disease with non-disturbed blood circulation. Objectively her pulse is 96/min., of unequal strength. Blood pressure is 110/70 mm Hg, heart rate is 120/min. ECG registers small unevenly-sized waves in place of P-waves, R-R intervals are of unequal length. What is the most likely diagnosis?

17 / 100

A 56-year-old woman was diagnosed with stage 2 hypertension of the 2nd degree. She belongs to the group of moderate risk and has bronchial asthma. What group of drugs is CONTRAINDICATED to this patient?

18 / 100

A newborns head is of dolichocephalic shape, that is front-to-back elongated. Examination of the occipital region revealed a labour tumour located in the middle between the prefontanel and posterior fontanel. Specify the type of fetal presentation:

19 / 100

What preparations are used for prevention of fungal infection?

20 / 100

Monthly dysentery morbidity in the region given in absolute ?gures is as follows: January - 6; February - 9; March - 11; April - 10; May -16; June - 23; July - 19; August - 33; September - 58; October - 19; November - 11; December - 5. Annual total is 220 cases. What graphic presentation would provide the best visual for monthly deviations of dysentery morbidity from the average?

21 / 100

A 59 year old female patient applied to a maternity welfare clinic and complained about bloody discharges from the genital tracts. Postmenopause is 12 years. Vaginal examination revealed that external genital organs had signs of age involution, uterus cervix was not erosive, small amount of bloody discharges came from the cervical canal. Uterus was of normal size, uterine appendages were unpalpable. Fornices were deep and painless. What method should be applied for the diagnosis specification?

22 / 100

A 45-year-old woman is registered for regular check-ups due to Werlhof disease (immune thrombocytopenia). Complete blood count: ?b- 100 g/L, erythrocytes -2.8·1012/L, platelets - 90.0·109/L, leukocytes - 8.4 · 109/L, erythrocyte sedimentation rate -13 mm/hour. Examination detects a single small hematoma on the anterior surface of the thigh, developed after the patient accidentally stumbled on a table. What treatment tactics should be chosen in this case?

23 / 100

A 56-year-old patient with diffuse toxic goiter has ciliary arrhythmia, heart rate is 110-120/min., arterial hypertension, BP is 165/90 mm Hg. What drug besides Mercazolil (Thiamazole) should be prescribed in this case?

24 / 100

A young woman applied to gynecologist due to her pregnancy of 4-5 weeks. The pregnancy is desirable. Anamnesis stated that she had rheumatism in the childhood. Now she has combined mitral heart disease with the priority of mitral valve deficiency. When will she need the inpatient treatment (what periods of pregnancy)?

25 / 100

A26-year-old woman, who delivered a child 7 months ago, has been suffering from nausea, morning vomiting, and sleepiness for the last 2 weeks. She breastfeeds the child, menstruation is absent. She has not applied any contraceptives. What method should be applied in order to specify her diagnosis?

26 / 100

A 41-year-old patient, a hunter, complains of heaviness in the right subcostal area. No other complaints recorded. Anamnesis states causeless urticaria and skin itching that occurred 1 year ago. Objectively: liver margin is rounded, painless, and can be palpated 3 cm below the costal arch. No other pathology was detected during physical examination of the patient. Body temperature is normal. X-ray reveals a hemispherical protrusion in the right cupula of the diaphragm. What disease can be suspected in the given case?

27 / 100

A 2-year-old girl has a medical history of recurrent obstructive pneumonia. In the lungs various moist and dry crackles can be auscultated, breath sounds are diminished. Sputum is thick, viscous and dif?cult to expectorate. Drumstick ?ngers and physical developmental retardation are observed. What preliminary diagnosis can be made?

28 / 100

A 30-year-old woman complains of pain in the heart area (”aching, piercing pain”) that arises primarily in the morning hours in autumn and spring. Pain irradiates into the neck, back, abdomen and is attended by rapid heart rate and low vital tonus. This condition occurs independently from physical exertion. In the evening her condition improves. Somatic and neurologic state and ECG have no pathologies. What pathology is likely to result in such clinical presentation?

29 / 100

A 32-year-old woman complains of dizziness, headache, palpitation, tremor. For the last several months she has been under outpatient monitoring for increased arterial pressure. Recently such attacks have become more frequent and severe. Objectively: skin is covered with clammy sweat, tremor of the extremities is present. Heart rate - 110/min, BP - 220/140 mm Hg. Heart sounds are weakened. In blood: WBCs – 9.8 · 109/l, ESR - 22 mm/h. Blood glucose – 9.8 millimole/l. What disease is the most likely cause of this crisis?

30 / 100

A 27-year-old woman presents at the maternity welfare centre because of infertility. She has had sexual life in marriage for 4 years, doesnt use contraceptives. She hasnt get pregnant. On examination: genital development is without pathology, uterine tubes are passable, basal (rectal) temperature is one-phase during last 3 menstrual cycles. What is the infertility cause?

31 / 100

A 26 year old woman who delivered a child 7 months ago has been suffering from nausea, morning vomiting, sleepiness for the last 2 weeks. She suckles the child, menstruation is absent. She hasnt applied any contraceptives. What method should be applied in order to specify her diagnosis?

32 / 100

A 32-year-old woman complains of episodes of intense fear that occur without visible cause and last for 10-20 minutes; the episodes are characterized by rapid pulse, sweating, labored breathing, and vertigo. Specify the likely diagnosis:

33 / 100

A 14-year-old girl has been presenting with irritability and tearfulness for about a year. A year ago she was also found to have diffuse enlargement of the thyroid gland (II grade). This condition was regarded as a pubertal manifestation, the girl did not undergo any treatment. The girl’s irritability gradually gave place to a complete apathy. The girl got puffy face, soft tissues pastosity, bradycardia, constipations. Skin pallor and gland density progressed, the skin got a waxen hue. What disease may be assumed?

34 / 100

A 35-year-old woman was admitted to resuscitation department in asthmatic status. What is the most trustworthy criterion of breath effectiveness?

35 / 100

A secundipara has regular birth activity. Three years ago she had cesarean section for the reason of acute intrauterine hypoxia. During parodynia she complains of extended pain in the area of postsurgical scar. Objectively: fetus pulse is rhythmic - 140 bpm. Vaginal examination shows 5 cm cervical dilatation. Fetal bladder is intact. What is the tactics of choice?

36 / 100

A 9-month-old child presents with fever, cough, dyspnea. The symptoms appeared 5 days ago after a contact with a person having URTI. Objectively: the child is in grave condition. Temperature of 38 C, cyanosis of nasolabial triangle is present. Respiration rate - 54/min, nasal ?aring while breathing. There was percussion dullness on the right below the scapula angle, and tympanic sound over the rest of lungs. Auscultation revealed bilateral ?-ne moist rales (crackles) predominating on the right. What is the most likely diagnosis?

37 / 100

Full-term pregnancy. Body weight of the pregnant woman is 62 kg. The fetus has the longitudinal position; the fetal head is pressed against the pelvic inlet. Abdominal circumference is 100 cm. Fundal height is 35 cm. What is the approximate weight of the fetus?

38 / 100

An 18-year-old patient always obeys others and adapts his needs to the demands of the people on whom he depends. He excessively defers to their wishes and makes them responsible for his wellbeing, cannot defend his interests and needs support from other people. Such psychic pro?le has been formed in the childhood, remains unchanged, and hinders adaptation. What psychic disorder is observed in this patient?

39 / 100

A gravida with 7 weeks of gestation is referred for the artificial abortion. On operation while dilating cervical canal with Hegar dilator No.8 a doctor suspected uterus perforation. What is immediate doctors tactics to confirm the diagnosis?

40 / 100

A 47 y.o. woman complains of having paroxysmal headaches for the last 5 years. The pain is one-sided, intense, localized in frontal region of head, accompanied by nausea and stomach discomfort, begins one of a sudden. Onset is usually preceded by vision reduction. Anamnesis gives evidence of periodical AP rise, but at the moment the woman doesn’t take any medicines. In-between the onsets of headache her state is satisfactory. Objectively: high-calorie diet (body weight index - 29), AP- 170/95 mm Hg. Neurologic state has no peculiarities. What is the most probable diagnosis?

41 / 100

A 52-year-old woman complains of face distortion. It appeared 2 days ago after exposure to cold. Objectively: body temperature is 38.2 C. Face asymmetry is present. Frontal folds are ?attened. Left eye is wider than the right one and cannot close. Left nasolabial fold is ?attened, mouth corner is lowered. Examination revealed no other pathology. Blood count: leukocytes - 10 · 109/l, ESR - 20 mm/h. What is the most probable diagnosis?

42 / 100

Several hours before, a 28-year-old patient suddenly developed acute headache and repeated vomiting, then lost consciousness. Objectively: focal neurological symptoms were not found. Pronounced meningeal symptoms were revealed. BP - 120/80 mm Hg. According to clinical and liquorological ?ndings the patient was diagnosed with subarachnoid haemorrhage. After administration of dehydrants the patient’s condition somewhat improved. What is the main component of further emergency care?

43 / 100

A 33-year-old male patient was brought to Emergency Department with the signs of cardiovascular collapse: BP - 60/30 mm Hg, Ps - 140 bpm, the skin is pale and moist, diuresis 20 ml/h, Hb - 80 g/l, red blood cell count - 2,5×1012/l. The reduction of blood volume averages:

44 / 100

A 52-year-old man has recurrent transient ischemic attacks. Auscultation of the carotid arteries detected murmur. What diagnostic method is to be applied in the first place?

45 / 100

A primagravida in her 20th week of gestation complains about pain in her lower abdomen, blood smears from the genital tracts. The uterus has an increased tonus, the patient feels the fetus movements. Bimanual examination revealed that the uterus size corresponded the term of gestation, the uterine cervix was contracted down to 0,5 cm, the external orifice was open by 2 cm. The discharges were bloody and smeary. What is the most likely diagnosis?

46 / 100

A 13 year old girl consulted the school doctor on account of moderate bloody discharge from the genital tracts, which appeared 2 days ago. Secondary sexual characters are developed. What is the most probable cause of bloody discharge?

47 / 100

What develops most often after accidental intake of Hydrochloric acid?

48 / 100

A 39-year-old man suffers from chronic adrenal insuf?ciency and receives replacement glucocorticoid therapy (hydrocortisone - 15 mg/day). He is to undergo elective surgery for calculous cholecystitis. What medication adjustment should be made on the day of the surgery to prevent the development of acute adrenal insuf?ciency?

49 / 100

A 43 y.o. woman complains of contact hemorrhages during the last 6 months. Bimanual examination: cervix of the uterus is enlarged; its mobility is reduced. Mirrors showed the following: cervix of the uterus is in the form of cauliflower. Chrobak and Schiller tests are positive. What is the most probable diagnosis?

50 / 100

A patient has been provisionally diagnosed with pheochromocytoma at the stage of intermission. BP is within norm, there is a tendency towards tachycardia. No urine pathologies. The decision has been made to perform a provocative test with histamine. What drug should be kept close at hand for emergency aid in case of positive test result?

51 / 100

A 23-year-old woman, who works as a milk and dairy inspector, after the miscarriage suffers from high fever up to 38,6 C, recurring chills, excessive sweating. Objectively: polyadenitis, pain in the lumbosacral spine, swollen left knee joint, enlarged liver and spleen. What diagnosis is most likely?

52 / 100

A 25-year-old patient was delivered to an infectious diseases unit on the 3rd day of illness with complaints of headache, pain in lumbar spine and gastrocnemius muscles, high fever, chill. Objectively: condition of moderate severity. Scleras are icteric. Pharynx is hyperemic. Tongue is dry with dry brown coating. Abdomen is distended. Liver is enlarged by 2 cm. Spleen is not enlarged. Palpation of muscles, especially gastrocnemius muscles, is painful. Urine is dark in colour. Stool is normal in colour. The most likely diagnosis is:

53 / 100

A 34-year-old patient after vacation in Crimea has developed severe pain in her elbow joints, dyspnea and weakness. Body temperature is 37.6 C, skin pallor and erythema on the cheeks and bridge of nose are observed, lip mucosa is ulcerated. The joints are not visibly deformed, movement of the right elbow joint is restricted. Pleura friction sound is detected in the lungs on the right side below the angle of scapula. Heart sounds are dull, tachycardia, gallop rhythm, heart rate -114/min, BP - 100/60 mm Hg. The most likely diagnosis is:

54 / 100

A 26-year-old man complains of chills, rhinitis, dry cough, and fever up to 38 C. Examination shows him to be in a moderately severe condition; there are small pale pink non-merging spots on the skin of his back, abdomen, and extremities. Palpation reveals enlarged occipital and axillary lymph nodes. No information about vaccination history could be obtained. What is the likely etiology of this disease?

55 / 100

A woman in the first half of pregnancy was brought to clinic by an ambulance. Term of pregnancy is 36 weeks. She complains of intensive pain in the epigastrium, had vomiting for 2 times. Pain started after the patient had eaten vinaigrette. Swelling of lower extremities. BP - 140/100 mm Hg. Urine became curd after boiling. What is the most probable diagnosis?

56 / 100

A 45-year-old man with thrombophlebitis of the deep veins in his legs suddenly after physical exertion developed sharp pain in his thorax on the right, dyspnea, and hemoptysis. Objectively his condition is severe; he presents with acrocyanosis, shortening of pulmonary percussion sound on the right, and weakened respiration. Respiration is 30/min, blood pressure is 110/80 mm Hg. ECG shows sinus tachycardia, heart rate is 120/min., electrical axis of the heart deviates to the right, S –Q. What is the most likely diagnosis?

57 / 100

A 33-year-old man developed multiple rashes on the skin of his torso and extensor surfaces of his upper and lower limbs. The rashes itch and occasionally fuse together and form plaques. The elements of rash are covered with silver-white ?ne scales that easily ?ake off when scratched. Grattage test results in three sequential phenomena: stearin spot, terminal ?lm, and punctate hemorrhage. What diagnosis can be suspected?

58 / 100

The dermatologist has an appointment with a 30-year-old man that complains of severely itching rashes that especially disturb him at night. The rashes developed 2 weeks ago, after he had returned from a travel. Objectively on the lateral surfaces of his ?ngers, hands, wrists, elbows, lower abdomen, genitals, and thighs there are paired papulovesicles, single pustules, and scratch marks. What disease can be suspected?

59 / 100

A 22 year old patient was admitted to trauma center with complaints of pain in the left ankle joint that was getting worse during moving and weight bearing. On the clinical examination it was found that the patient had the closed fracture of medial malleolus without displacement. In which position should the foot be fixed in plaster cast?

60 / 100

A 27-year-old man complains of pain in his leg joints, purulent discharge from the eyes, and painful burning sensations during urination. Disease onset was acute. He has a history of in?uenza. The patient smokes and drinks alcohol in excess. In his line of work, he is often away on business trips. What is the most likely etiological factor of this disease?

61 / 100

A patient has restrained umbilateral hernia complicated by phlegmon hernia, it is necessary to take following actions:

62 / 100

In a maternity hospital a newborn had been presenting with cough attacks after eating. The child was discharged from the hospital on the 18th day due to a case of pneumonia. During the further 1.5 months the child had 2 cases of pneumonia. Periodically there are cough attacks after eating, especially if the child lies on the left side. Objectively: the II degree hypotrophy, isolated moist crackles, dyspnea. Stool and diuresis are not disrupted. What diagnosis is most likely?

63 / 100

A 74 y.o. patient has been ill with benign prostate hyperplasia for the last 5 years. 4 days ago, after alcohol consumption, there was an acute retention of urination. At the pre-admission stage his urinary bladder was catheterized with metallic catheter. Examination revealed: right epididymis is enlarged, thick and painful, there are purulent discharges from urethra. What way of emergency care must be chosen?

64 / 100

After a case of purulent otitis a 1-year-old boy has developed pains in the upper third of the left thigh, body temperature up to 39 C. Objectively: swelling of the thigh in its upper third and smoothed out inguinal fold. The limb is in semi ?exed position. Active and passive movements are impossible due to severe pain. What diagnosis is most likely?

65 / 100

After examination a46-year-old patient was diagnosed with left breast cancer T2N2M0, clinical group II-A. What will be the treatment plan for this patient?

66 / 100

A 41-year-old patient was admitted to the intensive care unit with haemorrhagic shock due to gastric bleeding. He has a history of hepatitis B during the last 5 years. The source of bleeding are esophageal veins. What is the most effective method for control of the bleeding?

67 / 100

A pregnant woman in her 8th week was admitted to the hospital for artificial abortion. In course of operation during dilatation of cervical canal of uterus by means of Hegars dilator No.8 the doctor suspected uterus perforation. What is the immediate tactics for confirmation of this diagnosis?

68 / 100

A 73-year-old woman came to the family physician for one of her regular follow-up examinations. Three months ago she was found to have type 2 diabetes mellitus. She was keeping to her diet and exercise plan and taking phytopreparations. On examination her fasting glucose was within the range of 7.8-8.6 mmol/L, Hb?1? - 7.9%. Height - 164 cm, weight - 83 kg. What blood sugar-controlling medicine should she be prescribed ?rst in the course of her pharmacological therapy?

69 / 100

A 26-year-old woman gave birth to a child 6 months ago. She applied to gynecologist complaining of menstruation absence. The child is breast-fed. Vagina exam: uterus is of normal form, dense consistence. What is the most probable diagnosis?

70 / 100

A 10-year-old boy complains about pain in his left eye and strong photophobia after he had injured his left eye with a pencil at school. Left eye examination: blepharospasm, ciliary and conjunctival congestion, cornea is transparent, other parts of eyeball have no changes. Visus 0,9. Right eye is healthy, Visus 1,0. What additional method would you choose first of all?

71 / 100

After a long drive with the window open a man developed facial asymmetry; he cannot close his right eye, his right nasolabial fold is smoothed out, movements of expression are absent on the right, there is a disturbance of gustatory sensation in the tongue on the right. No other neurological pathologies were detected. What disease can be provisionally diagnosed in this patient?

72 / 100

A 59-year-old female patient attended a maternity welfare clinic with complains of bloody discharge from the genital tracts. Postmenopause is 12 years. Vaginal examination revealed that external genital organs had signs of age involution, uterus cervix was not erosive, small amount of bloody discharge came from the cervical canal. Uterus is of normal size, uterine appendages are unpalpable. Fornices were deep and painless. What method should be applied for the diagnosis speci?cation?

73 / 100

A child is 1 month 10 days old ”Gushing” vomiting has been observed since the age of 3 weeks. The vomit volume exceeds the volume of the previous feeding. Objectively: the child is inert. Skin elasticity and tissue turgor are decreased. Hour-glass deformity sign is positive. The preliminary diagnosis is pyloric stenosis. What treatment tactics should be chosen?

74 / 100

The diagnosis of a right-sided pneumothorax is made to a 36- year-old patient. What method of treatment is indicated to the patient?

75 / 100

A 32-year-old patient complains of reddening, burning, and sensation of a foreign body in the right eye. The disease is acute. On examination: visual acuity of the both eyes is 1.0. In the right eye there are hyperemy and swelling of the conjunctiva, super?cial injection. There is purulent discharge in the conjunctival sac. The cornea is clear. The color and pattern of the iris are unchanged, the pupil is mobile. What diagnosis is most likely?

76 / 100

A 25-year-old woman complains of profuse foamy vaginal discharges, foul, burning and itching in genitalia region. She has been ill for a week. Extramarital sexual life. On examination: hyperemia of vaginal mucous, bleeding on touching, foamy leucorrhea in the urethral area. What is the most probable diagnosis?

77 / 100

A 42-year-old man has undergone gastric analysis. Free hydrochloric acid is absent at all phases. On endoscopy: pallor, gastric mucosa loss, gastric folds are smoothed out. On microscopy: glands atrophy with intestinal metaplasia. What disease can be characterized by such presentation?

78 / 100

A 24-year-old woman, teacher by profession, complains of dizziness and heart pain irradiating to the left nipple. Pain is not associated with physical activity and cannot be relieved by nitroglycerin, it abates after taking Valocordin and lasts for an hour or more. The patient has a nearly 2-year history of this disease. Objectively: Heart rate - 76 bpm. BP - 110/70 mm Hg. Heart borders are normal, heart sounds are clear. The ECG shows respiratory arrhythmia. X-ray of the cervicothoracic spine shows no pathology. Lungs, abdomen are unremarkable. What changes in blood formula can be expected?

79 / 100

During dynamic investigation of a patient the increase of central venous pressure is combined with the decrease of arterial pressure. What process is proved by such combination?

80 / 100

A 45-year-old patient complains of pain in the epigastric region, left subcostal area, abdominal distension, diarrhea, loss of weight. He has been suffering from this condition for 5 years. Objectively: tongue is moist with white coating near the root; deep palpation of abdomen reveals slight pain in the epigastric region and ???? Robson’s point. Liver is painless and protrudes 1 cm from the costal arch. Spleen cannot be palpated. What disease can be primarily suspected?

81 / 100

Several hours before, a 28-year-old patient suddenly developed acute headache and repeated vomiting, then lost consciousness. Objectively: focal neurological symptoms were not found. Pronounced meningeal symptoms were revealed. BP- 120/80 mm Hg. According to clinical and liquorologi-cal ?ndings the patient was diagnosed with subarachnoid haemorrhage. After administration of dehydrants the patient’s condition somewhat improved. What is the main component of further emergency care?

82 / 100

A woman consulted a doctor on the 14th day after labour about sudden pain, hyperemy and induration of the left mammary gland, body temperature rise up to 39°C, headache, indisposition. Objectively: fissure of nipple, enlargement of the left mammary gland, pain on palpation. What pathology would you think about in this case?

83 / 100

A 27 y.o. gravida with 17 weeks of gestation was admitted to the hospital. There was a history of 2 spontaneous miscarriages. On bimanual examination: uterus is enlarged to 17 weeks of gestation, uterus cervix is shortened, isthmus allows to pass the finger tip. The diagnosis is isthmico-cervical insufficiency. What is the doctors tactics?

84 / 100

A 7 y.o. boy suddenly felt pain in his right knee, it became edematic. The day before he took part in a cross-country race. Family anamnesis has no data about hemophilia and bleeding sickness. Objectively: body temperature is 37,5°C. The knee is painful, hot to the touch, edematic with local tissue tension over it. Blood count: Hb- 123 g/L, leukocytes - 5,6×109/L, thrombocytes - 354×109/L, prothrombin time - 12 seconds (normally 10-15 seconds), partly activated thromboplastin time - 72 seconds (normally 35-45 seconds). Hemorrhage time is normal, VIII:C factor is 5% of norm. What is the most probable diagnosis?

85 / 100

A patient suffering from acute posttraumatic pain received an injection of morphine that brought him a signi?cant relief. Which of the following mechanisms of action provided for antishock effect of morphine in this patient?

86 / 100

A 48-year-old woman developed insomnia, depressive mood, anxiety, fears and suicidal thoughts after the death of her husband that occurred one month ago. During her stay in the hospital she speaks in a low voice, is depressed, anxious, avoids sleeping, refuses to eat. What medications should be prescribed in this case?

87 / 100

A patient was admitted to the hospital with complaints of periodical pain in the lower part of abdomen that gets worse during menses, weakness, malaise, nervousness, dark bloody smears from vagina directly before and after menses. Bimanual examination revealed that uterus body is enlarged, appendages cannot be palpated, posterior fornix has tuberous surface. Laparoscopy revealed: ovaries, peritoneum of rectouterine pouch and pararectal fat have "cyanotic eyes". What is the most probable diagnosis?

88 / 100

Examination of a just born placenta reveals defect 2x3 cm large. Hemorrhage is absent. What tactic is the most reasonable?

89 / 100

A patient is on the sick leave for 4 months continuously from the date of injury. The treatment is going to last for another 1-2 months. Who has the right to extend the duration of medical certi?cate for this patient?

90 / 100

A 54-year-old patient complains of weakness, weight loss despite the unchanged appetite, frequent urination, skin itch for six months. Sometime ago the patient underwent treatment for furunculosis. She has not been examined recently. Objectively: mal-nutrition, dry skin with scratch marks. Small lymph nodes can be palpated in the axillary regions. Changes in the internal organs are absent. What test must be performed in the ?rst place?

91 / 100

A 46-year-old woman complains of pain attacks in the right lumbar area, which irradiate to the lower abdomen, and nausea. This kind of pain attacks has never been detected in the patient before. Survey X-ray of the abdominal cavity reveals no pathologic shadows. Ultrasonic scan detects a hyperechogenic growth 1.5 cm in diameter, which re?ects sound wave, in the enlarged right renal pelvis. What diagnosis is most likely?

92 / 100

It is suspected that a 34-year-old patient has an abscess of Douglas pouches. What diagnostic method is to be chosen?

93 / 100

A 4 y.o. child attends the kindergarten. Complains of poor appetite, fatigue. Objective examination: skin and mucous membrane are pale, child is asthenic. In the hemogram: hypochromatic anemia 1st, leucomoide reaction of the eosinophile type. What pathology must be excluded first of all?

94 / 100

In river-side urban community there was an outbreak of hepatitis type A possibly spread by water. What indexes of river water quality can con?rm this theory?

95 / 100

A 46-year-old woman has diarrhea with abdominal distension, loss of body mass, and large amounts of porridge-like foul-smelling stool without blood streaks or tenesmus. Objective examination detects moderate tenderness in the mesogastrium and left abdominal ?ank. Feces analysis detects steatorrhea with neutral fat and creatorrhea. What prescription would be the most advisable in this case?

96 / 100

A patient with acute purulent otitis media complicated by mastoiditis was admitted to a hospital. Roentgenogram of mastoid processes showed the shadowing of the cellular system on the lesion, absence of bone septa was present. What are the necessary therapeutic actions at the second stage of mastoiditis?

97 / 100

A 38-year-old woman developed a medical condition 7 days after her return from Bangladesh. Periodical elevation of temperature was accompanied by chills and excessive sweating. She was diagnosed with tropical malaria. Next day her condition further deteriorated: body temperature - 38 C, inertness, periodical loss of consciousness, generalized seizures, tachycardia, hypotension, and icteric skin. What complication can be suspected in this case?

98 / 100

A 26-year-old woman, who gave birth 7 months ago, has been suffering from nausea, morning sickness, somnolence for the last 2 weeks. The patient breastfeeds; no menstruation. She has been using no means of contraception. What method would be most ef?cient in clari?cation of the diagnosis?

99 / 100

A50-year-old patient complains about having pain attacks in the right subcostal area for about a year. The pain arises mainly after taking fatty 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-coloured faeces and dark urine. In blood: neutrophilic leukocytosis - 13,1 · 109/l, ESR - 28 mm/h. What is the most likely diagnosis?

100 / 100

A 24-year-oldmanhas developed increasing headaches, vertigo, diplopia, paresis of the facial muscles on the right, choking during swallowing. The signs appeared on the 5th day of respiratory disorder. He was diagnosed with acute viral encephalitis. Determine the main direction of emergency therapy:

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