<question1>A patient with acute pancreatitis, on 15 days after the onset of disease epigastric palpated elastic unpainful tumor. What are the most possible diagnosis

<variant>omentobursit ++

<variant>etroperitoneal abscess

<variant>retroperitoneal hematoma

<variant>acute obstructive cholecystitis

<variant>interloop abscess

 

<question1>Choose the drug, that has antienzyme activity

<variant>contrycal

<variant>gemodez

<variant>fluorouracil ++

<variant>cordiamin

<variant>dimedrolum

<question3>35 years old female entered with complaints to sharp pain attack in upper right quadrant, nausea, single vomiting with green colored masses. Contracted sharply at night. The onset of disease binds to reception of fatty food. Increase supply excess of 15 kg. Positive Kehr, Murphy, Obraztsov signs. What is your diagnosis?

<variant>acute cholecystitis++

<variant>acute pancreatitis

<variant>ectopic pregnancy

<variant>perforative gastric ulcer

<variant>acute appendicitis

<question2>During cholecystectomy from minimal access the surgeon found a tumor of pancreas. What palliative operation may be done

<variant>external drainaging of gallbladder

<variant>cholecystectomy

<variant>cholecysotenteroanastomosis

<variant>choledohotomy ++

<variant>choledohoenteroanastomosis

<question2>While elective surgery for acute calculous cholecystitis in 67 years old patient the expansion of the common bile duct upon 1.6 cm was found. The palpable single stione having size 0.9 cm was found in the lumen of choledoh. What is the plane of operation

<variant>bringing stone down into duodenum ++

<variant>stone crushing

<variant>cholecystectomy, choledohotomy, drainaging of the choledoh

<variant>choledohoenteroanastomosis

<variant>external drainaging of extrahepatical bile ways through the skin

<question1>Stones in the common bile duct in most patients fall out

<variant>gallbladder ++

<variant>liver

<variant>duodenal

<variant>pancreas

<variant>stomach

 

<question1>The complication of cholelithic disease is not

<variant>duodenitis ++

<variant>purulent cholangitis

<variant>gallbladder empyema

<variant>mechanical jaundice

<variant>hydrops of the gallbladder

<question2>When any form of intestinal obstruction and there are signs of obstruction and strangulation

<variant>invaginated

<variant>strangulation ++

<variant>obturation tumor

<variant>spastic

<variant>paralytic

<question2>The patient 70 years, with a circulatory unefficiency of the II-III degree has a picture of diffuse peritonitis of the 5th daily prescription. What medical tactics an immediate surgery immediately after establishment of the diagnosis with correction of a

<variant>circulatory unefficiency to an operation campaign

<variant>urgent operation after 24-hour preparation ++

<variant>an immediate surgery after administration of cardiacs

<variant>an immediate surgery after short-term 2-3-hour infusional therapy

<variant>operation after complete elimination of deficiency of components BV, protein electrolytes

<question2>The hemorrhagic exudate in an abdominal cavity isn't observed at

<variant>acute cholecystitis ++

<variant>acute pancreatitis

<variant>mesenteric thrombosis

<variant>embolisms of mesenteric vessels

<variant>intestinal obstruction

<question2>At the patient, 46 years, after appendectomy concerning an acute gangrenous appendicitis for the 5th day appeared dull aches in the bottom of a stomach, cramps, pains at a defecation, small bleach at an emiction. Temperature to 37,8 – 38,5 Pages increased. Your presumable diagnosis

<variant>abscess of a Duglas space++

<variant>acute proctitis

<variant>acute hemorrhoids

<variant>diffuse peritonitis

<variant>acute cystitis

 

<question1>Is the most frequent reason of peritonitis

<variant>acute appendicitis

<variant>perforated ulcer ++

<variant>salpingitis

<variant>strangulation of a small bowel

<variant>carcinoma of the stomach

<question3>For the 6th days at the patient A., 35 years, after a laparotomy concerning appendicular peritonitis appeared pains in the lower half of a stomach, a cramps, micturition disorders. Temperature 39,5, with broad strokes, cold fits. Tongue is wet, a stomach soft, moderately morbid over a pubis. At a rectal research through a forward wall of a rectum big, sharply morbid infiltrate with a ramollissement is palpated. Your diagnosis

<variant>abscess of a small pelvis++

<variant>pylephlebitis

<variant>periappendicular abscess

<variant>interloopback abscess

<variant>sepsis

<question3>The patient later after the beginning of a disease arrived days. Pains began in an anticardium. Then went down in 6 hours to the right ileal area. Complains of delicacy, pains on all stomach. It is acyanotic. Tachycardia to 100 in a minute. Tongue dry. The stomach superficially participates in the act of respiration, is intense. Blyumberg's symptom positive in all departments. It is rectal – morbidity of a forward wall of a rectum. In a blood a leukocytosis with shift of neutrophils. Your presumable diagnosis

<variant>appendicitis, peritonitis ++

<variant>cholecystitis, peritonitis

<variant>intestinal obstruction, peritonitis

<variant>interintestinal abscess, peritonitis

<variant>ruptured ulcer, peritonitis

<question1>What clinical stage are characteristic of acute peritonitis

<variant>reactive, toxic, terminal ++

<variant>prodromal, reactive

<variant>subacute, terminal

<variant>toxic, reactive, subacute

<variant>terminal, prodromal, reactive

<question2>Diffuse purulent peritonitis may be a consequence of all these diseases, except

<variant>stenosis of the major duodenal papilla ++

<variant>Meckel diverticulum perforation

<variant>destructive appendicitis

<variant>Richter hernia infringement

<variant>acute intestinal obstruction

<question3>The patient At., 47 years came to clinic with complaints to pains in right hypochondrium, nausea, vomiting, body temperature 38,3. Was ill after reception of greasy food 3 days ago. Pulse 112 in min. Tongue dry. Skin and yellowish skin and sclera. In right the hypochondrium is defined sharply morbid, intense spherical formation of 12х8х6 cm Ortner, Murphy, Kerr's symptoms are positive. Shchetkin-Blyumberg's symptom is positive on all stomach. Your preliminary diagnosis

<variant>acute cholecystitis, peritonitis ++

<variant>courvoisier symptom

<variant>obstructive icterus

<variant>cirrhosis

<variant>pancreatitis

<question1>Pathognomonic reactive stage of peritonitis

<variant>tension of the muscles of the anterior abdominal wall ++

<variant>vomiting

<variant>abdominal pain

<variant>bloody stools

<variant>delay stool and gas

<question1>For what hernia characterized by a double urination

<variant>for sliding inguinal ++

<variant>for oblique inguinal

<variant>for direct inguinal

<variant>for strangulated inguinal

<variant>for femoral

<question3>The patient, 70 years handled the restrained inguinal hernia, caused the therapist on the house. Prescription of infringement of 10 hours. There are signs of an intestinal obstruction, a dermahemia over a hernial diverticulum. Actions of the doctor examining the patient

<variant>the emergency hospitalization in a surgical hospital ++

<variant>diaplasis of hernia

<variant>diaplasis of hernia after an injection of narcotics

<variant>cold on area of hernia, analgetics, antibiotics

<variant>the direction on consultation to the surgeon

<question1>Typical signs of congenital inguinal hernia

<variant>in the hernial sac is testicle ++

<variant>more common in children

<variant>protrusion passes through the medial inguinal fossa

<variant>protrusion located lateral of the elements of the spermatic cord

<variant>the contents of the hernia sac descends into the scrotum

<question2>In the differential diagnosis between the inguinal-scrotal hernia and dropsy shells testes should resort to

<variant>transillumination and palpation ++

<variant>puncture

<variant>percussion

<variant>auscultation

<variant>digital examination of the rectum

<question1>Specify early clinical implications of infringement of a small bowel at internal hernias

<variant>colicy pains in a stomach, a delay of a passage of flatus ++

<variant>diarrhea

<variant>collapse

<variant>peritoneum boring symptoms

<variant>dehydration

<question3>The patient has 80 years without rasping somatic pathology frequent infringements of inguinoscrotal hernia. What to recommend to the patient

<variant>planned operation after out-patient inspection

<variant>the conservative treatment referred on a regulation of a chair

<variant>an immediate surgery – a herniotomy  ++

<variant>hospitalization, observation in surgical unit

<variant>wearing of a bandage

<question2>The patient of 40 years in a year after operation for right-hand inguinal hernia had a hernial diverticulum again. Your actions

<variant>planned operation before development of complications or augmentation of hernia ++

<variant>observation, operation at a strangulation of a hernia

<variant>to operate at the progressing hernia augmentation

<variant>observation, exception of a serious exercise stress

<variant>wearing of a bandage

<question1>At whom femoral hernias are more often observed

<variant>at women

<variant>at men

<variant>at children's age

<variant>at teenagers ++

<variant>at advanced age at men

40 years old woman complains of coldness, drowsiness, hair loss, constipation. On examination: enlarged thyroid gland. What method is the most informative to establish the thyroid function:

- determining of TSH and free T4+++++

- thyroid scintigraphy

- determination of serum  Ca2+ level

- determining of total T3 and T4

- Thyroid ultrasound

A 35-year-old woman had stabbing pains in the heart, irritability, weakness, trembling in the body. The symptoms appeared after emotional stress On examination: severe weakness, hyperhidrosis, inlarged thyroid gland (of 2 degree). Heart sounds are of loud sonority, heart rate is 120 beats/min, arterial blood pressure is 150/70 mm Hg Underline the leading syndrome of this patient:

- syndrome of hyperthyroidism ++++++

- syndrome of arterial hypertension 

- astheno-neurotic syndrome

- syndrome of cardialgia

- syndrome of hypothyroidism 

25 years old female patient complains of weight loss on the background of increased appetite, rapid heartbeat, nervousness, irritability, intolerance to hot weather, discomfort in the eyeballs, blurred vision, general weakness. On examination: moderate exophthalmos, the lag of the upper eyelid when the eyeball moves downwards, and an enlargement of the thyroid gland (2 degrees). What laboratory changes can be expected, considering the patient’s current condition?

- decreased TSH level, increased free fractions of T3 and T4+++++

- decreased TSH level, decreased free fractions of T3 and T4

- increased TSH level, increased free fractions of T3 and T4

- increased TSH level, decreased  total T3 and T4

- increased TSH level, decreased free fractions of T3 and T4

 

27 years old woman complaines of pain in the neck, radiating to the ears, lower jaw, difficulty in swallowing. The deterioration of the condition is attributed to the previous respiratory viral infection. On examination: the state of moderate severity, body temperature is 38C. The skin is moist and hot on palpation. The thyroid gland is enlarged to 2d degree, dense, painful on palpation. Pulse - 98 per minute, arterial blood pressure - 130/80 mm Hg. CBC: leukocytes  9.8 * 109/l, ESR  38 mm/h. Thyroid status: TSH 0.03 µIU/ml, T4 free 54 pmol/l. What is the most likely diagnosis:

- subacute thyroiditis+++++

- diffuse toxic goiter

- fibroid thyroiditis

- autoimmune thyroiditis

- acute purulent thyroiditis

20-year-old woman complains of rapid mood changes, weight gain, drowsiness, menstrual disorders, memory loss. Her mother had nodular goiter. Thyroid gland is enlarged, heterogeneous, painless on palpation. What is the preliminary diagnosis.

- thyrotoxicosis+++++++

- neurocirculatory dystonia

- hypothyroidism

- nodular goiter

- subacute thyroiditis

 

The patient is suspected of thyroid adenoma. What is the best investigation to confirm the diagnosis?

- Thyroid scintigraphy with I 131++++

- determination of the TSH level and T3 and T4 fractions

- determination of anti thyroid peroxidase antibodies

- free T3 

- total T4 

 

Male patient with type 1 diabetes and nosocomial peumoniacomplains of thirst, frequent urination, severe general weakness. On examination: patient is unconscious, pupils are constricted. The skin is dry, turgor is reduced, the smell of acetone from the mouth. Glucose level is 19.6 mmol/l, acetone in urine is detected. What is the most diagnosis:

- ketoacidotic coma++++

- hyperosmolar coma

- hypoglycemic coma

- hyperlactacidemic

- infectious toxic shock

 

A 52-year-old man came to regular follow-up visit to an endocrinologist. Medical history: 5 years ago he was diagnosed with diabetes. Diet therapy and glucose-lowering drugs are used to correct carbohydrate metabolism. On examination: body temperature is 36.7 ° C, arterial blood pressure is 140/85 mm Hg, heart rate is 72 in per min,  Respiration rate is 18 in per min. Fasting plasma glucose is 5.9 mmol / l;  What is the most informative test for assessing the compensation of diabetes in this patient?

- determination of glycated hemoglobin+++++

- determination of ketone bodies in urine

- glycemic profile determination

- definition of carbohydrate tolerance

- definition of C-peptide

 

A 46-year-old woman complaints of thirst, dry mouth, numbness of the finger tips and toes, loss of memory. Childbirth -3, the weight of children at birth - 4500, 4700, 5100g. BMI 31.5 kg/m2. Blood pressure is 150/90 mm Hg. Blood glucose - 9.1 mmol/l. What is the most likely diagnosis?

- type 2 diabetes mellitus+++++

- type 1 diabetes mellitus

- abdominal obesity

- fasting palsma glycose

- impaired glucose tolerance

 

A 20 years old woman suffers from diabetes for 5 years and receives insulin therapy. During a physical exercises at the class she lost consciousness, with short-term convulsions. On examination: pale skin, severe hyperhidrosis, trembling in the body, mydriasis. Arterial blood pressure 140/90 mm Hg. What is the most likely diagnosis?

- hypoglycemic coma+++++ 

- hyperosmolar coma

- lactoacidic coma

- ketoacidotic coma

- collapse

 

18 years old male patient performed with the loss of consciousness 1 hour ago. On examination: unconsciousness; Kussmaul's breath; hyperemia of face; dry skin; crimson tongue,; soft eyeballs; scattered dry rales on auscultation; liver is 3 cm lower costal margin. From the patient comes a distinct smell of acetone. Medical history: postponed influenza, complaints of thirst for 2–3 weeks, frequent urination; weight loss with a satisfactory appetite; lethargy, loss of appetite in the last 2 days, nausea and vomiting few hours before admission. What is the preliminary diagnosis:

- ketoacidotic coma+++++ 

- hypoglycemic coma

- hyperosmolar coma

- lactoacidotic coma

- collapse

 

A 60-year-old woman was delivered to the emergency room unconscious. According to the relatives, she suffer from diabetes and hypertension. Symptoms in the last 2 days: vomiting, multiple liquid stools, decreased urine convulsive jerking in the muscles of the arms and legs. She does not respond to external stimuli. Pupils are dilated. The skin is dry, turgor is reduced. Eyeballs are soft. Respiration rates is 22 per min, arterial blood pressure - 60/40 mm Hg.. HR - is 110 per minute with interruptions. CBC: erythrocytes-6.5 * 1012/l, leukocytes-12.8 * 109/l, ESR - 8 mm/h. Blood glucose - 45 mmol/l. What pathogenetic factor is most important in the development of this coma?

- dehydration++++++ 

- hypoxia

- intoxication

- oliguria

- acidosis

 

22-year-old patient complaints of thirst, frequent urination, loss of weight. Symptoms started after influenza. Glycemic level is 20.5 mmol/l, glycosuria 52 g/l, keton bodies +++. What is most likely diagnosis?

- type 1 diabetes mellitus+++++

- type 2 diabetes mellitus

- gestational diabetes mellitus

- other specific types of diabetes

- renal glucosuria

 

35 years old woman, complains of high weight, reduced exercise tolerance. She gained weight 5 years ago. Height is 165cm, weight is  90 kg. Waist circumflex is 102 cm. What formula should calculate body mass index?

- Body weight (in kg)/height (in m)) 2+++++

- Body weight (in kg)/height (in cm)

- Height (in cm) / body weight (in kg)

- Height (cm)/body weight (kg)/3.4

- Height (cm) - 100

 

45 years old woman complains of  decreased tolerance to physical activity, headaches and general weakness. On examination: overweight, waist circumference is 105 cm, BMI 45 kg/m2. What is the preliminary diagnosis according WHO classification

- obesity grade 3+++++

- overweight

- obesity grade 1

- obesity grade 2

- obesity grade 4

 

 

A 27-year-old female patient notes an increase in body weight, muscular weakness, and menstrual disorders during the year. The face is of moon-shape, Purple striae on the skin of the body, abdomen, mammary glands. Arterial blood pressure - 140/90 mm Hg. Oral glucose tolerance test: Fasting - 4.5 mmol/l; 2 hours after glucose loading - 8.6 mmol/l. According to computed tomography: hyperplasia of both adrenal glands. The level of cortisol in the blood at 8.00  is 1060 ng/l (normal range is 260-720 ng /l), at 14.00 -1250 ng/l. ACTH is 2000 (normal range 5,0-1250 pg/ml) Specify the most likely diagnosis:

- Itsenko-Cushing's disease++++

- cerebral obesity

- syndrome of exogenous hypercortisolism

- hypothalamic syndrome

- Cushing syndrome

 

A patient with an elevation of blood pressure up to 260/130 mm Hg was delivered to the emergency room of the hospital. The episod was accompanied by tachycardia, polydipsia, muscle tremors, fear, sweating. Blood tests shows increased glucose level up to 15 mmol/l. What the most likely diagnosis:

Pheochromocytoma+++++

diffuse toxic goiter

Cushing's syndrome

essential arterial hypertension

secondary hyperaldosteronism

 

47 years old female complains of increased body weight over the last 1.5-2 years, dry mouth, headache, irregular menstruation. On examination: height is 160 cm, weight is 130 kg; subcutaneous fatty tissue is distributed in a dysplastic type, purple striae on the skin of the abdomen. Arterial blood pressure is 170/110 mm Hg. Glucose is 7.05 mmol/l. Wat is the leading syndrome in this patient:

- syndrome of hypercorticism ++++

- syndrome of arterial hypertension 

- syndrome of chronic hyperglycemia 

- climacteric syndrome

- insipidary syndrome

 

A 19-year-old female was taken to the hospital with syndrome of multiple vomiting. She was previously noted with decreased appetite, a change in the character of stool, weight loss. Medical history: tuberculosis. Clinical signs of exsiccosis without an increase in temperature,   skin with brown hyperpigmentation, arterial blood pressure is 80/50 mm.Hg. serum glucose -3.5 mmol/l, no glucosuria, acetone in urine is positive (+). What is the preliminary diagnosis

- adrenal insufficiency+++++

- hypoglycemic state

- food poisoning

- acetonemic vomiting

- diabetic ketoacidosis

 

35 years old female complains of episodes of sharp headache with nausea and vomiting. On examination: sweating, pallor of the skin, tremors, tachycardia, increased blood pressure 230/140 mm. Laboratory tests: hyperglycemia, glycosuria, proteinuria, leukocytosis. What is the preliminary diagnosis:

- pheochromocytoma++++++

- diabetes mellitus

- Cushing's disease

- hyperal dexterity

- hypothalamic syndrome

 

The patient has a syndrome of hypercoticism. ACTH is reduced, cortisol is high in the morning and evening. What research needs to verify the diagnosis?

- CT of adrenal glands with contrast enhancement+++++ 

- Adrenal ultrasound

- Roentgenography of the skull

- Abdominal ultrasound

- Spine Radiography

 

Patient K.(male), 47 years old  was hospitalized at the endocrinology department with complaints of muscle weakness, fatigue, and dizziness. Height 180 cm, weight 70 kg. arterial blood pressure is 85/55 mm.Hg. Skin is clean, areola nipples and palmar lines are of brown colour. Complete blood count: Hb-111g/l, Eritrocyte - 3,6 * 1012/l. Plasma glucose - 3.8 mmol/l. What is the preliminary diagnosis.

- chronic adrenal insufficiency+++++

- hypercortisolism

- vascular dystonia

- iron deficiency anemia

- pigment papillary dystrophy of the skin

 

The patient undergo subtotal strumectomy 3 days ago. Shecomplains of muscle cramps of the limbs, face and diaphragm, severe paresthesia and numbness of the limbs. There were a single episode of syncope, daily epileptiform seizures, low blood pressure. What is the the first diagnostic step?

- investigation of blood calcium levels+++++

- electroencephalography

- investigation of TSH and free T4

- 24 hours blood pressure monitoring

- investigation of plasma cortisol level

 

Three days after total strumectomy for diffuse toxic goiter, the patient developed short-term seizures, paresthesias in the limbs 3-4 times a day. On examination: The skin is moist. Heart sounds are regular, pulse is 76 per minute, blood pressure - 130/70 mm Hg. The positive symptoms of Khvostek, Trusso, Schlesinger. What is the most likely diagnosis?

- hypoparathyroidism++++

- epilepsy

- hyperthyroidism

- hypothyroidism

- hyperparathyroidism

 

3 years old girl suffers from weakness, change of gait, loss of appetite, jerking of hands and body. According to her mom, the girl began to choke while drinking, breathing difficulties appeared, and she received outpatient treatment for laryngitis a month ago. A week later, attacks of clonic-tonic convulsions is started, prescribed anticonvulsant therapy was established as non-effective. The blood test revealed a low level of calcium. On examination respiration rate-30 per min. heart rate - 96  per  min. Arterial blood pressure – 95/55 mm. Hg. Endocrine status: Height is 89 cm, weight is 12 kg. Positive symptom of Khvostek. Lab tests: ionized calcium 0.59 mmol/l (normal 1.05-1.35 mmol/l); phosphorus 3.4 mmol/l (norm 0.87-1.45 mmol/l); alkaline phosphatase 196 U/l; (norm 142 - 335 U/l), parathyroid hormone 2.5 pg/ml (norm 12 - 95 pg/ml). Specify the preliminary diagnosis:

- hypoparathyroidism++++++

- somatotropic insufficiency

- chorea

- epilepsy

- hyperparathyroidism

 

The girl is 15 years old of short stature, lack of secondary sexual characteristics, pterygoid neck, nipple hypertelorism, gothic palate. What is the most likely diagnosis:

- Turner syndrome++++

- family short stature

- Cushing syndrome

- congenital hypothyroidism

- constitutional stunted growth and puberty

 

What karyotype is most likely in a 16-year-old patient with short stature, lack of secondary sexual characteristics, absence of ovaries and uterus?

- 45 XO++++

- 46ХХ

- 46XU

- 47ХХУ

- 46 ХХ / 47ХХУ

 

A 28-year-old female patient after delivery with massive blood loss does complains of absence of lactation, severe weakness, weight loss, dry skin, anemia, amenorrhea, low blood pressure. On examination: ESR is 40 mm/hour. What is the preliminary diagnosis?

- Sheehan syndrome++++ 

- Anemia after blood loss

- Dyscirculatory encephalopathy

- Chronic inflammation of the uterus

- Chronic adrenal insufficiency

 

A young 24 years old man was hospitalized with complaints of increased in the mammary glands, a decrease in potency. Medical history: the period of puberty began late. Height 190 cm, weight 78 kg. There is no hair growth on the face. Long legs, high waist. Breast is enlarged. The testicles are small. The penis is reduced. Hair growth of female character. What is the preliminary diagnosis?

- Klinefelter syndrome++++

- Marfan cider

- Kalman's syndrome

- Willie-Prader syndrome

- Shereshevsky-Turner syndrome

 

A 28-year-old man complained of a decrease in potency., He suffered from parotitis in childhood. Height is 185cm, weight is 62 kg. Physical condition is eunuchoid, no hair growth on the face. Hairs on  pubic are scanty, small testicles, small penis. Bone age is on 15-16 years. Karyotype is 46XY. What is the preliminary diagnosis.

- primary hypogonadism++++

- Klinefelter syndrome

- secondary hypogonadism

- tertiary hypogonadism

- Marfan syndrome

 

 

The child is 4 years old.  Complaints: low appetite and pain in the umbilical cord, not associated with food intake.  The pain disappears quickly and spontaneously.  Objective: the situation is satisfactory.  Nutrition is normal.  The tongue is covered with a white coating.  Painless on palpation of the abdomen.  Defecation is normal, no signs of dysuria.  No worms were found in the large stool.  What is the correct diagnosis?

 

 

 

Choose one answer:

 

a.  -functional disorders of the stomach ++

 

b.  -enterobiosis

 

c.  -dybacteriosis

 

d.  -simple dyspepsia

 

e.  -acute gastritis

 

 

 

A 10-year-old girl, after a bite, suddenly became ill, symmetrical, papular-hemorrhagic rash appeared on the knees and elbows.  Such rashes appeared on the inner thighs and sides.  The abdomen is soft, there is pain in the stomach and colon.  There is pink blood in the stool.  The temperature is 37.30C.  What is the correct diagnosis?

 

 

 

Choose one answer:

 

a.  -hemolytic anemia

 

b.  -thrombocytopenic purpura

 

c.  -atopic dermatitis

 

d.  -hemophilia

 

e.  -hemorrhagic vasculitis ++

 

 

 

A 5-year-old boy suddenly fell ill.  On admission: temperature 37.20C, frequent dry cough, respiratory rate 28, percussion lung sounds, shortness of breath on auscultation, dry rales, rhythmic heart sounds.  Blood test unchanged.  On the radiograph of the lungs - an enhanced image of the lungs.  Which of the following diagnoses are possible?

 

 

 

Choose one answer:

 

a.  - bronchial asthma

 

b.  -obstructive bronchitis

 

c.  -acute simple bronchitis ++

 

d.  -repeated bronchitis

 

e.  -chronic pneumonia

 

The patient had the following symptoms: bruising of the face, acrocyanosis, dilated veins, positive venous pulse, systolic murmur on auscultation, swollen upwards and to the right, increased respiration, decreased exhalation.  The liver is enlarged, on palpation there is a pulsation in the liver, which is synchronous with the ventricular systole, the P wave is high on the ECG, on the radiograph the shadow of the heart is triangular, which is associated with enlargement of the right atrium and ventricle.  What a problem to think about

 

 

 

Choose one answer:

 

a.  - stenosis of the mitral valve

 

b.  - Insufficiency of the mitral valve

 

c.  - stenosis of the tricuspid valve

 

d.  - Insufficient three-way gate ++

 

e.  - Stenosis of the aortic valve

 

 

 

3-year-old child.  Complaints: excessive swelling, weakness, decreased diuresis, appeared 1 week ago.  He had a history of food allergies several times.  In general: the condition is serious, there is obvious swelling on the face, legs, ascites.  Heart tones are clear.  AK-90/50 mm etc.  Liver - 4 cm from the wall arch.  In the clinical history of urine: protein - 20 g / l, leukocytes.  In the analysis of blood: hypoproteinemia, hypoalbuminemia, hyperlipidemia.  Daily diuresis 200 ml.  What is this syndrome?

 

 

 

Choose one answer:

 

a.  - Nephrotic syndrome ++

 

b.  -hypertensive syndrome

 

c.  -Berge syndrome

 

d.  - nephritic syndrome

 

e.  -hematurgical syndrome

 

 

 

The newborn has no respiratory symptoms, pale, does not react to irritants, heart rate 84 beats per minute, legs slack.  Which of the following diagnoses are possible?

 

 

 

Choose one answer:

 

a.  - moderate severity of asphyxia

 

b.  - mild degree of asphyxia

 

c.  -dead birth

 

d.  -respiratory distress syndrome

 

e.  - Severe asphyxia ++

 

The child was born at 40 weeks of gestation, body weight 3750g.  The shout was immediate.  She was breastfed for 1 day, her breasts were well received, breastfeeding is active.  Weight 3600g in 3 days of life.  Papular pink rash on the chest, abdomen and limbs.  Define the transition period:

 

 

 

Choose one answer:

 

a.  -transient weight loss, heart attack, melena

 

b.  -sexual crisis, physiological erythema, transient weight loss

 

c.  -transient weight loss, toxic erythema ++

 

d.  -transient weight loss, oliguria, tremors

 

e.  - Physiological erythema, transient weight loss, oliguria

 

 

 

The child is from 1 pregnancy, the course of pregnancy is normal, 1 delivery is at 38 weeks.  Birth weight - 2900 g, height - 49 cm.  Blood group A (II), Rh (+) in women, blood group AB (IV), Rh (-) in children.  7-8 points on the Apgar scale.  At 3 days of life, the skin turns yellow.  The condition is normal.  Active breastfeeding, no vomiting.  Congenital automatic reflexes are actively called.  In the biochemical analysis of blood: bilirubin - due to the indirect fraction of 90 μmol / l, transaminase is normal.  What vaccinations are given to the baby in the maternity hospital according to the immunization schedule:

 

 

 

Choose one answer:

 

a.  - Against tuberculosis and viral hepatitis B. ++

 

b.  - Vaccination against hepatitis B and polio

 

c.  - Vaccination against diphtheria, tetanus, pertussis, polio

 

d.  - Against tuberculosis, polio

 

e.  - Vaccination against polio, measles, tuberculosis

 

 

 

Spontaneous component movements are observed in the newborn, which is a consequence of the predominance of extrapyramidal motility regulation.  Please tell, what reflex is determined by spontaneous motor activity:

 

 

 

Choose one answer:

 

a.  -Babinsky

 

b.  -Our

 

c.  -Babkin

 

d.  –Bauer ++

 

e.  -Robinson

 

 

 

During the examination, the child's head was slightly bent at the chest, arms and legs were bent, elbow joints were pressed to the chest, arms were clenched, legs were bent at the knees and hips.  Determine the condition of the baby:

 

 

 

Choose one answer:

 

a.  - Spontaneous muscle activity

 

b.  -preparation to try

 

c.  - Weakening of muscle tone

 

d.  -opistotonus

 

e.  -flexor posture ++

 

 

A 25-year-old patient was admitted to a gynecological hospital complaining of pain in the lower abdomen, which appeared immediately after physical exertion.  He says that he had nausea, vomiting and dry mouth.  Vaginal examination revealed: the uterus is dense, painless, of normal size.  Left appendages indeterminate, round to the right of the uterus, elastic consistency, limited mobility, immediately painful on palpation, 7 cm x 8 cm x 6 cm.  dimensional formation is determined.  The pulse rate is 120 beats per minute.  In the analysis of blood leukocytes 12.3.  What is the diagnosis:

 

Choose one answer:

 

a.  Right-sided acute salpingo-oophoritis

 

b.  Cyst of the right ovary

 

c.  Right ovarian apoplexy

 

d.  Torsion of the right ovarian cyst ++

 

e.  Ectopic pregnancy with a right disorder

 

 

 

A 25-year-old woman complains of purulent discharge from the genital tract for 5 days and a feeling of irritability when urinating, normal body temperature.  Sex life is chaotic, there is no regular partner.  Examination in the mirror revealed reddening of the vagina and cervix, a large number of purulent-mucous secretions in the form of "purulent tape".  In bimanual examination: uterus and appendages are not enlarged, painless.  What research allows to determine the cause of the disease:

 

Choose one answer:

 

a.  crop method

 

b.  bacterioscopic examination ++

 

c.  colposcopy

 

d.  Ultrasound examination of the lower pelvic organs

 

e.  bacteriological examination

 

 

 

A 45-year-old patient came to the hospital with uterine fibroids.  Vaginal examination: the cervix is ​​hypertrophied, the structure is changed, the body of the uterus is enlarged at 9-10 weeks of pregnancy, dense, painless.  Spare parts have not changed.  What is the optimal volume of the operation?

 

- pangisterectomy

 

- Vaginal amputation without uterine appendages

 

- conservative myomectomy

 

+ extirpation of the uterus without appendages ++

 

- incision of the uterus

 

 

 

What criteria are used to diagnose severe preeclampsia:

 

Choose one answer:

 

a.  Diastolic blood pressure> 90mmHg Systolic blood pressure> 140mmHg, with proteinuria of 200mg or more

 

b.  Diastolic blood pressure = 80 mmHg Systolic blood pressure = 120 mmHg, with proteinuria of 300 mg or more

 

c.  Diastolic blood pressure> 110mmHg Systolic blood pressure> 160mmHg, 300mg or more with proteinuria ++

 

d.  Diastolic blood pressure> 90mmHg Systolic blood pressure> 140mmHg, without proteinuria

 

e.  Diastolic blood pressure> 100mmHg Systolic blood pressure> 160mmHg, without proteinuria

 

 

 

Postpartum woman, 30 years old.  On the 3rd day after delivery, she complains of pain in the lower abdomen, general weakness, chills, headache, fever of 39.20 C.  Due to the retention of 2/3 of the placenta during childbirth, a manual examination of the uterine cavity was performed.  Birth parity: 4/2, two medical abortions.  Chronic cholecystopancreatitis, chronic pyelonephritis, "D" are not registered by specialists.  The mammary glands are slightly hardened.  Possible diagnosis:

 

Choose one answer:

 

a.  postpartum endometritis ++

 

b.  uterine subinvolution, lochimetry

 

c.  exacerbation of chronic pyelonephritis

 

d.  acute respiratory diseases

 

e.  infiltrative mastitis

 

 

 

 

 

Determine the pathology of the early postpartum period by looking at the following clinical picture: the condition is relatively satisfactory, BP 100/70, PS = 98 beats per minute, the skin is normal, uniform bloody discharge from the genital tract, reached 300 ml and continues.  When looking at the birth canal - there are no tears, the placenta is intact, all the shells.  When the uterus is rubbed externally, the uterus contracts well and soon relaxes again.  What is the most likely diagnosis:

 

Choose one answer:

 

a.  uterine rupture, bleeding

 

b.  residue of placental tissue in the uterine cavity

 

c.  The physiological bleeding, so there is no clinic for pathological conditions

 

d.  Disorders of the coagulation system of the female blood

 

e.  uterine atony, bleeding ++

 

 

 

 

 

A woman in the 21st week of her second pregnancy was at risk of premature birth.  Examination revealed blood type A (II) in the mother, rhesus factor (-), blood group AB (IV), rhesus factor (+) in the father.  What can cause pregnancy:

 

Choose one answer:

 

a.  Formation of antibodies to the father's rhesus factor in the fetus

 

b. In the mother, the fetus produces antibodies to rhesus factor ++

 

c.  Blood group mismatch between paternal and maternal agglutinogen

 

d.  Blood group mismatch between father and mother's agglutinin

 

e.  Formation of antibodies to rhesus factor in the fetus

 

 

 

The boy was born spontaneously.  5 minutes later, with the tactic of actively conducting the third stage of labor, the placenta was separated.  Examination of the placenta revealed: the size of the placenta 22x18x3 cm, a defect in the placental tissue 2x2.5 cm, all the membranes.  Here are the doctor's tactics:

 

Choose one answer:

 

a.  Thorough monitoring of the general condition, the amount of blood loss, manual examination of the uterine cavity, removal of the remnants of the placenta in case of increased blood loss

 

b.  Immediately examine the uterine cavity by hand and remove the rest of the placenta ++

 

c.  The woman should be asked to strain, if there is no separation of the placental remnant, then manually examine the uterine cavity and remove the remaining remnant

 

d.  external massage of the uterus, followed by removal of placental abruption by the method of Krede-Lazarevich

 

e.  dynamic monitoring of the postpartum woman, assessment of vital functions, manual examination of the uterine cavity, if necessary

 

 

 

External obstetric examination revealed that the uterus of the fetus is long, the head is above the entrance to the pelvis, the back of the fetus faces the left wall of the uterus.  Specify the place of birth and position of the fetus:

 

Choose one answer:

 

a.  Coming with the head, the previous type of position

 

b.  Coming with hips, I position

 

c.  Arriving at the beginning, I position ++

 

d.  Coming with the head, the back view of the position

 

e.  Arrival at the beginning, position II

 

 

 

Desquamation of the functional layer of the endometrium is caused by:

 

Choose one answer:

 

a.  Decreased levels of estrogen and progesterone in the blood ++

 

b.  Elevated estradiol levels

 

c.  The "peak" of luteotropin release

 

d.  Decreased levels of prolactin in the blood

 

e.  The "peak" of follitropin release

 

 

 

A., a 25-year-old woman who gave birth again, was admitted to the maternity hospital complaining about the discharge of amniotic fluid 7 hours before the due date and the start of the regular delivery 5 hours earlier.  Vaginal examination revealed that the opening of the cervix is ​​complete, there is no amniotic sac, the fetal head with a small segment is attached to the entrance to the pelvis.  The most likely diagnosis:

 

Choose one answer:

 

a.  The second stage of childbirth, the discharge of amniotic fluid before childbirth

 

b.  The first stage of childbirth, the discharge of amniotic fluid before childbirth ++

 

c.  The first stage of childbirth, premature ejaculation

 

d.  The second stage of labor, delayed discharge of amniotic fluid

 

e.  The second stage of childbirth, premature ejaculation

 

 

 

A., a 25-year-old woman who gave birth again, was admitted to the maternity hospital complaining about the discharge of amniotic fluid 7 hours before the due date and the start of the regular delivery 5 hours earlier.  Vaginal examination revealed that the opening of the cervix is ​​complete, there is no amniotic sac, the fetal head with a small segment is attached to the entrance to the pelvis.  The most likely diagnosis:

 

Choose one answer:

 

a.  The second stage of childbirth, the discharge of amniotic fluid before childbirth

 

b.  The first stage of childbirth, the discharge of amniotic fluid before childbirth

 

c.  The first stage of childbirth, premature ejaculation ++

 

d.  The second stage of labor, delayed discharge of amniotic fluid

 

e.  The second stage of childbirth, premature ejaculation

 

 

 

 

 

In order to correctly assess the clinical endocrine disorders of the female body and, accordingly, to determine the principles and methods of their pathogenetic therapy, it is necessary to know the unbroken regulation of the reproductive system - is:

 

Choose one answer:

 

a.  The cerebral cortex, hypothalamus, neurohypophysis, ovaries, uterus

 

b.  cerebral cortex, hypothalamus, neurohypophysis, ovaries, target organs and tissues

 

c.  cerebral cortex, hypothalamus, adenohypophysis, ovaries, target organs and tissues ++

 

d.  external environment, hypothalamus, neurohypophysis, ovaries, target organs and tissues

 

e.  hypothalamus, neurohypophysis, adrenal glands, ovaries, target organs and tissues

 

 

 

Vaginal examination of the woman revealed that 2/3 of the inner surface of the esophageal sphincter and the upper half of the eye socket were filled with the head.  4-5 octopus vertebrae and sciatic bone are freely defined.  The bow-shaped seam is diagonal to the right.  Determine the position of the fetal head in the pelvis:

 

Choose one answer:

 

a.  The head is at the entrance to the lower pelvis with a large segment

 

b.  The head is at the exit from the pelvis

 

c.  The head is located in the narrow part of the pelvis

 

d.  The head is located in a wide part of the lower pelvis ++

 

e.  The head is located at the entrance to the lower pelvis with a small segment

 

 

 

The physiological period in which the involutionary processes predominate in the reproductive system as a result of changes in a woman's age is called ...:

 

Choose one answer:

 

a.  surgical menopause

 

b.  early menopause

 

c.  premature menopause

 

d.  cycle failure

 

e.  climax ++

 

 

 

 

 

She complained to the women's doctor of the women's council about delayed menstruation (the last one was 7 weeks ago), nausea and vomiting, which sometimes occur once in the morning, and the absence of odors.  She considers herself pregnant, the pregnancy is undesirable.  Somatically healthy.  She had a history of 3 births (live children) and 2 medical abortions.  There were no gynecological and venereologicaldiseases.  Vaginal examination revealed: vaginal mucosa is clearly bruised, the cervix is ​​formed, the external cavity is closed.  The body of the uterus is hyperanteflexed, softened, but compacted on palpation, enlarged to 7 weeks of gestation.  The fragments are mysterious.  What are the tactics of the gynecologist:

 

Choose one answer:

 

a.  Clinical and laboratory examination and dispensary control

 

b.  Clinical and laboratory examination and referral for termination of pregnancy ++

 

c.  Referral for termination of pregnancy

 

d.  Clinical and laboratory examination

 

e.  Clinical and laboratory examination and ultrasound of the uterus

 

 

 

 

 

The pregnant woman was referred for 30 years, with complaints of periodic pain in the lower abdomen and lower back.  The gestation period is 12-13 weeks.  A week ago, the account was examined, an ultrasound examination - pathology was not found.  In the anamnesis of 2 births, one medical abortion.  In a bimanual study: the cervix is ​​2.5 cm, the external cervix is ​​closed, the uterus is increased accordingly to the term of pregnancy, the secretions from the genital tract are small in size.  Tactics of a female doctor:

 

Choose one answer:

 

a.  Hospitalize in hospital

 

b.  Psychotherapy with a control loop through the week ++

 

c.  For the purpose of preservation of pregnancy prescribe hormonal therapy

 

d.  Refer to a day hospital for tocolytic therapy

 

e.  Refer to a repeat ultrasound to determine the condition of the fruit

 

 

1) Resolution of the Minister of Health of the Republic of Kazakhstan dated 23.10.2020  № In accordance with Order 149, dynamic monitoring of people with chronic diseases is also carried out under the Disease Management Program (DMP).  The criteria for the selection of patients for ABB are:

 

- Patients with uncomplicated primary hypertension, patients with type 2 diabetes mellitus, patients with chronic heart failure and left ventricular diastolic dysfunction of NYHA class II-IV according to echocardiography with a fraction of less than 40% or a fraction of more than 40%.

 

 

 

- Patients with uncomplicated primary hypertension, patients with compensated and decompensated type 2 diabetes mellitus, patients with chronic heart failure and left ventricular diastolic dysfunction of class II-IV on NYHA with an output fraction of less than 40% or an output fraction of more than 40% according to echocardiography

 

- All patients with chronic non-communicable diseases

 

.- Compensated patients with type 2 diabetes mellitus, patients with chronic heart failure and left ventricular diastolic dysfunction of NYHA class II-IV according to echocardiography, the output fraction is less than 40% or the output fraction is more than 40%

 

-.  Patients with uncomplicated primary hypertension, patients with compensated and decompensated type 2 diabetes mellitus, patients with chronic heart failure and left ventricular diastolic dysfunction of NYHA class NYHA with a fraction of less than 40% or a fraction of more than 40% according to echocardiography ++

 

 

 

2. The patient is 28 years old, has pain in the lumbar region, fever 390C, chills, sweating, thirst, fever from very high during the day to subfebrile. The condition is moderate. The skin is moist. The lungs are vesicular.  , UR 110/min, BP 90/60 mm Hg, palpation. There is pain in both kidneys. Urine analysis shows a large number of leukocytes. Blood analysis shows leukocytes with a shift to the left of 15 * 10 12 \ l.  Up to 139 \ min tachycardia, decreased blood pressure, sudden decrease in urine volume, hemorrhage on the skin. Predicted diagnosis?

 

- Ultrasound of the thyroid gland

 

-Acute glomerulonephritis

 

-Acute pyelonephritis ++

 

- renal tuberculosis

 

-Acute pyelonephritis with infectious-toxic shock

 

3. The woman developed bleeding in the postmenopausal period.  Diagnostic curettage was performed.  Histological findings - glandular structures with pronounced cellular atypicality.  Your diagnosis

 

- uterine polyp

 

Leiomyosarcoma of the uterus 

 

- adenocarcinoma of the uterine body ++

 

-Uterine leiomyoma

 

-Fibromyoma

 

 

 

4. Pregnant N, 24 years old, complained of leakage of amniotic fluid for 15 minutes and was examined by a gynecologist.  In the anamnesis III / II, 1 pregnancy ended in a timely delivery without complications, the next pregnancy was terminated at 18 weeks.  №746 According to the zoning order, at what level the woman should be referred to the hospital

 

 

 

Level I.

 

-II level

 

-III level  ++

 

-IV level

 

-V level

 

5. An obstetrician-gynecologist was visited a week ago by a pregnant woman who was treated for a severe form of measles at the Infectious Diseases Hospital.  The gestation period is 9-10 weeks.  Medical tactics

 

-Vitamin therapy

 

- Prolongation of pregnancy

 

- Prescribing hormone therapy with continued dispensary control

 

- Termination of pregnancy ++

 

-.  Termination of pregnancy in case of fetal developmental defects

 

6. The patient is 45 years old, for 2 months complains of a cough with sputum in the morning, shortness of breath during exercise.  He has been smoking 20 cigarettes a day for 20 years and is a heavy drinker.  During the examination, the deformation of the thoracic cavity - "shoemaker's chest" (boots' breasts).  Which of the following is a major risk factor for lung disease in a patient?

 

-Decrease in IgM production

 

- alcohol abuse

 

- Primary pulmonary hypertension

 

-active and low smoking ++

 

- Deviations in the structure of the chest

 

7. Patient C ..., 45 years old. 14.03.2021.  The miller of the molding plant felt bad in the middle of the shift: pain in the occipital region, nausea, noise in the ears.  He applied to the medical center: paramedic JSC 180/100 mm Hg.  registered, provided assistance and issued a certificate of release before the end of the shift.  The next day he went to the clinic.  Doctor with a diagnosis of hypertension 3, risk 4. In case of hypertensive crisis, a list of temporary disability is opened.  In this case, what are the features of the examination of the UES?

 

- 14.03.2021  on opening a list of temporary incapacity for work, ie until the end of the work shift on 14.03.2021.  Certificate issued by the paramedic of the medical center – justification ++

 

-.  medical evidence only to extend the certificate of temporary incapacity for work

- There are no medical indications for opening a list of temporary disability and extension of the certificate of temporary disability

 

-15.03.2021  opening a list of temporary disability

 

- There are no medical indications for opening a list of temporary disability

 

8. A 7-day-old boy.  From the anamnesis: the first pregnancy, the mother was 18 years old, the mother had a bad obstetric history with bad habits, the risk of miscarriage.  Stimulated delivery, the anhydrous period of 8 hours, was born with a single rotation of the umbilical cord around the neck.  There is no hereditary burden.  The child does not.  What health group does the child belong to?

 

-IV health group

 

- Health group II ++

 

-I health group

 

-attention group

 

-III health group

 

9. A 37-year-old patient with bronchial asthma is registered by a family doctor.  Seizures occur 1-2 times a week, nocturnal asthma symptoms 2-3 times a month.  Regularly inhale fenoterol. Which of the following flow options is most likely?

 

- light flow of persistent bronchial asthma ++

 

-severe course of persistent bronchial asthma

 

-.  moderate persistent bronchial asthma

 

- Exacerbation of chronic obstructive bronchitis

 

10. A 68-year-old woman complains of headache, blinking eyes, sleep disturbances. For the first time 6 years ago there was an increase in blood pressure to 160/100 mm Hg. There are signs of heredity in cardiovascular disease, hypodynamics.  index - 31 kg. Heart tones are closed, 2 tone accent in the aorta.  BP 175/105 mm Hg. Pulse 68 \ min, tension. \ X- dyslipoproteinemia.  STDs, STDs - without deviations. Which of the following diagnoses is most likely?

 

-.  Arterial hypertension II st, risk 4

 

-.  Arterial hypertension III, risk 3

 

-Arterial hypertension II st, risk 3 ++

 

-Arterial hypertension III, risk 2

 

-Arterial hypertension II st, risk 1

 

11. A 45-year-old patient with complaints of difficulty swallowing, regurgitation, periodic pain in the back of the sternum, X-ray contrast examination of the esophagus was performed.  There was a delay in the mass of barium in the esophagus, a significant dilation of the esophagus with constriction in the cardiac region, the lack of peristalsis.  The most likely diagnosis

 

-III degree GERB

 

-Ahalasia cardiac ++

 

-diffuse esophagospasm

 

-II degree GERB

 

-II degree GERB

 

- esophageal cancer

 

12. A 70-year-old patient is monitored for 10 years for antralulcers.  He refused surgical treatment.  Has not undergone regular outpatient treatment and examination.  For the last 3 months, pain in the epigastric region is a constant concern, accompanied by general weakness, emaciation.  Further surgical tactics

 

- planned operation. ++

 

- periodic operation

 

-operation depending on vital signs

 

- FGDS with peptic ulcer biopsy

 

- Conservative treatment of peptic ulcer

 

13. A pregnant woman, who was treated for severe measles a week ago at the Infectious Diseases Hospital, went to the obstetrician-gynecologist.  The gestation period is 9-10 weeks.  Medical tactics

 

- Termination of pregnancy ++

- Termination of pregnancy in case of fetal developmental defects

- Prescribing hormone therapy with continued dispensary control

- Prolongation of pregnancy

-Vitamin therapy

 

14. Frequency of medical examination of school-age children in accordance with the epicrisis period

 

-2 times a year

 

-quarterly

 

-monthly

 

2 times a year

 

-every year ++

 

15. A woman at 12 weeks of gestation came to the ICU with complaints of nausea, vomiting, fever, weakness and fatigue.  The shock symptom is negative.  For two days he noticed a darkening of the urine.  Preliminary diagnosis:

 

--virus hepatitis ++

 

-acute pyelonephritis

 

- pneumonia

 

-pregnancy gestosis

 

-acute respiratory disease

 

16. In a patient with hypertrophic cardiomyopathy, diagnosed several years ago, there were moments of unconsciousness. Compared to the ECG performed 6 months ago, there was no dynamics in the current ECG.

 

-corona angiography

 

-.  echocardiography

 

-.  study of blood enzymes

 

- Computed tomography of the brain

 

- Daily ECG monitoring ++

 

17. The baby is 2 months old.  She refuses to breastfeed.  Chest tightness is observed during the examination.  What is your approach according to the ICSID?

 

-Antibiotics are not required, control at home

 

-.  Give the first dose of antibiotics, leave under the supervision of a doctor

 

- Give the first dose of antibiotic, send for testing

 

- Give the first dose of antibiotic, send for re-examination in two days

 

- Give the first dose of antibiotics, send to the hospital immediately ++

 

18. An 8-month-old girl at the reception.  According to the mother, the child often gets sick, and constipation lasts for 4 months.  Objective examination revealed looseness of the articular-ligamentous apparatus, delay in the development of static and motor functions, square-shaped head, rickets "bracelets" and deformity of the sternum, hepatomegaly.  No teeth.  What is your preliminary diagnosis?

 

- Rickets of the II degree (rickets), fever, acute course

 

- II degree rickets (rickets), fever, acute course

 

-II degree rickets, initial stage, acute course

 

-3 rickets, exacerbation, acute course ++

 

19. 9-month-old baby at the reception.  According to the mother, the child has been receiving anticonvulsant therapy for a long time.  Later, he began to sweat often, became restless and slept poorly.  After the examination, the doctor diagnosed rickets II, acute, feverish.  What drug contributed to the development of rickets?

 

-Calcium gluconate

 

-Actiferrina

 

-Penicillin

 

-Phenobarbital ++

 

-Diazepam

 

20. In accordance with the standards of organization of pediatric care in the Republic of Kazakhstan (Order of the Minister of Health of the Republic of Kazakhstan dated 29.12.2017 № 1027), the integration of childhood diseases is aimed at:

 

-Provide quality medical care, reduce morbidity, mortality and disability of children under 5 years, as well as improve their physical, psychosocial and emotional development

 

- Reducing the incidence of children under 5 years, as well as improving their physical, psychosocial and emotional development

 

-.  providing timely and quality medical care, as well as improving their physical, psychosocial and emotional development

 

-.  timely and quality medical care, reducing morbidity, mortality and disability of children under 5 years, as well as improving their physical, psychosocial and emotional development ++

 

- Reducing morbidity, mortality and disability of children under 5 years, as well as improving their physical, psychosocial and emotional development

 

 

 

21. Eosinophilia, Charcot-Leyden crystals, Kurshman's spirals were detected in the sputum of a patient with an asthma attack.  Prognosis ::

 

- pulmonary tuberculosis

 

-lung cancer

 

.  chronic obstructive bronchitis

 

-bronchiectasis

 

- bronchial asthma ++

 

 

 

22. A 69-year-old woman complains of headaches, especially in the neck, tinnitus, prickly pain in the heart, swelling of the ankles. In 10 years she noticed an increase in blood pressure to 160/100 mm Hg. Height - 164, weight - 82 kg  .  Heart tones are closed, 2 tone accent in the aorta.  АК 180 \ 115 мм.сын.бағ.  Pulse 88 \ min. Any of the following conditions may occur in a given patient

 

- Myocardial infarction, stroke, heart failure ++

 

- Ischemic heart disease

 

- Atherosclerosis of the carotid arteries

 

- Overweight, atrial fibrillation (atrial fibrillation)

 

-Metabolic syndrome, chronic kidney disease

 

23. The minimum level of fasting blood glucose diagnosed with diabetes

 

- fasting blood glucose level 6.1 mmol / l ++

 

- fasting blood glucose level 5.5 mmol / l

 

- fasting blood glucose level 5.8 mmol / l

 

- fasting blood glucose level 6.7 mmol / l.

 

- fasting blood glucose level 7.8 mmol / l

 

 

 

23. Upon completion of the screening study, the following groups of dynamic control are identified:

 

- Group 1 - practically healthy: people with a history of acute and chronic disease for the last 2 years, group 2 - patients: people in need of dynamic monitoring, treatment and rehabilitation.

 

- Group 1 - healthy people with risk factors: people in need of control and preventive intervention, risk factors identified, borderline condition, group 2 - practically healthy: people with a history of acute and chronic disease without complications for the last 2 years  , Group 3 - patients: people in need of dynamic monitoring, treatment and rehabilitation

 

-1A group - healthy people without risk factors, group 1B - healthy people with risk factors: people with borderline conditions, requiring control and preventive intervention, group 2 - practically healthy: no complications in the anamnesis for the last 2 years  people with acute and chronic diseases, group 3 patients: people in need of dynamic monitoring, treatment and rehabilitation. ++

 

-1-group - practically healthy: people with a history of acute and chronic disease without complications for the last 2 years, group 2 - patients: people in need of dynamic monitoring, treatment and rehabilitation.

 

- Group 1 - healthy without risk factors, Group 2 - healthy people with risk factors: people in borderline conditions, requiring control and preventive intervention, risk factors identified, Group 3 - patients: dynamic control, treatment and  people in need of rehabilitation.

 

24. In the women's clinic, the patient is 17-18 weeks pregnant.  The patient has an intermittent diastolic pressure of 90 mm Hg.  Art.  and more.  Examination revealed 0.06 g / l proteinuria, headache during overwork.  The most likely diagnosis is chronic hypertension with mild preeclampsia

 

- gestational hypertension

 

-severe preeclampsia

 

-severe preeclampsia

 

-chronic hypertension ++

 

25. The baby is 3 months old.  Complains of fever 38.50C, liquid stools.  There are no general signs of danger.  The child's diarrhea lasted for 3 days, there was no blood in the stool.  The child is restless and very angry, not thirsty.  His eyes are not dirty.  The skin folds slowly smooth out.  How much fluid does Plan B provide for an average dehydrated infant under 4 months of age in the first 4 hours?

 

-700-1000 ml

 

-50-100 ml.

 

-100-200ml.

 

- 400-700ml

 

-.  200-400ml ++

 

26. The patient is suspected of cancer of the ampullary part of the rectum.  Tumors cannot be created by examining the finger.  What diagnostic manipulations should be used

 

- colonoscopy

 

-laparoscopy

 

- rectoromanoscopy ++

 

-irrigoscopy

 

- Ultrasound of the abdomen

 

27. The main indication for the appointment of glucocorticoids in pneumonia

 

-slow distribution of infiltrate

 

- Presence of bronchospastic syndrome ++

 

-.  severe flow with obvious poisoning

 

- obvious hyperthermia

 

- The appearance of a lump in the pleural cavity

 

28. A patient complained to the doctor of obvious weakness, dull skin, poor appetite, constant craving for salty foods, unstable stools.  I have lost 8 kg in the last 6 months.  Objective: body weight 52 kg, height 166 cm, significant diffuse pigmentation of the skin, especially the neck, shoulders, palms, intestinal tract, mucous membranes of the lips.  AD-80/60 mm Hg  YYYY-98 1 min.  What examination should the patient perform to confirm the diagnosis?

 

- thyroid hormones, ultrasound examination of the thyroid gland

 

- CT of the kidney with plasma cortisol, adrenal glands ++

 

-fibrogastroduodenoscopy

 

- Computed tomography of the abdomen, kidneys

 

- Ultrasound examination of the abdomen, kidneys

 

 

 

29. The patient was 52 years old, at rest there was a general weakness, dark spots under the eyes, diarrhea, black stools.  AK-100/60 mm.s.b.  Heart rate 90 beats per minute.  There is no history of ulcers.  The method of information diagnosis of this condition

 

- Review radiography of the abdomen

 

-FGDS ++

 

- Computed tomography.

 

-irrigoscopy

 

- Ultrasound of the abdomen

 

 

 

30. Ultrasound may show non-insulin dependent diabetes mellitus

 

- The liver never changes

 

- hepatic fibrosis

 

-cirrhosis of the liver

 

- Focal changes in the liver

 

- Fatty infiltration of the liver ++

 

31. A 3-month-old baby is seen by a district pediatrician.  From the anamnesis: from the third week of life due to mastitis of the mother the baby is fed mixed.  The child has hyperemia in the abdomen, neck and armpits, despite careful care.  There is redness, swelling, cracks, milky crusts on the surface.  The child is restless, sleep is restless.  What is your preliminary diagnosis?

 

 

 

-Streptoderma

 

-Smooth skin mycosis

 

-.  Atopic dermatitis ++

 

- Herpes form eczema

 

- Allergic dermatitis

 

 

 

32. Typical of type 1 diabetes

 

- slow onset, weight loss, exophthalmos ++

 

- young, acute onset, predisposition to ketoacidosis, absolute insulin deficiency

 

- Acute onset, overweight, relative insulin deficiency

 

- Acute onset of dryness, dryness, bradycardia, constipation

 

- Over 40 years old, gradually invisible initiative, insulin is not vital

 

 

 

33. A 46-year-old woman presented to the clinic with complaints of prolonged, heavy menstruation, weakness and reduced ability to work.  On examination: pale skin, pulse 78 beats / min, rhythmic.  BP 125/80 mm Hg, hemoglobin level 80 g / l, during bimanual examination by mirrors: the cervix is ​​unchanged, the uterus is increased to the size corresponding to 16-17 weeks of pregnancy, mobile, painless.  Uterine appendages are not detected.  What is the end of the scope of surgery

 

- With salpingoectomy

 

-.  Excision of the uterus without attachments

 

-.  With the removal of the cervix

 

- Amputation of the uterus without appendages ++

 

-.  Conservative myomectomy

 

34. The patient is 38 years old.  Complaints of fever up to 38.4 ° C, cough with low sputum production, shortness of breath, general weakness appeared in the last 24 hours.  In the lower corner of the shoulder, on the right side of the lungs, the intensity of respiratory sounds is reduced, the area of ​​moist small bubbles is limited.  HR 24 times per minute, HR - 102 per minute, BP 110/70 mm Hg. In the blood test - leukocytes up to 16x109 / l.

 

Which of the following studies should be done first?

 

-Sput analysis

 

-Blood test for antibiotic susceptibility

 

- Biochemical blood test

 

-Determination of arterial blood gas

 

- Chest radiography ++

 

 

 

35. The patient is 62 years old, has been suffering from rheumatoid arthritis for 23 years, is taking prednisolone and nonsteroidal anti-inflammatory drugs, has swelling of the legs.  Which diagnosis is most likely?

 

- Membranous nephropathy

 

- Kidney cancer

 

-.  Secondary amyloidosis ++

 

- Nephropathy due to the reception of SCR

 

- Acute tubulonecrosis rheumatoid vasculitis

 

 

 

36. A 6-month-old child at the GP.  From 2.5 months on artificial feeding due to hypogalactia of the mother.  After switching to "Bread", "Comfort 1" mixture on the forehead of the child appeared red spots, itchy wrinkles with elements of microvesicles.  From the age of 4 months, there were frequent changes in milk formula, as a result of which the symptoms of skin diseases intensified and began to spread to the arms and legs, body and buttocks.  Family history: mother suffers from eczema (currently in exacerbation), father suffers from pollinosis.  Your preliminary diagnosis

 

- Allergic dermatitis

 

- Superficial pseudomycosis

 

- Herpes form eczema.

 

- Atopic dermatitis ++

 

- Smooth skin mycosis

 

37.  The patient complains of pink bleeding from the circulation.  What research methods should be used first

 

- Rectal examination with a finger ++

 

 

 

38. A 48-year-old patient complained of heavy menstruation and weakness for 3 years.  Registered for uterine fibroids (uterine volume 7-8 weeks).  In the last year, he did not see a doctor.  During the vaginal examination: the uterus is enlarged to 11-12 weeks of pregnancy, dense, uneven surface.  What may be the recommended treatment

 

- Symptomatic treatment

 

-.  Surgical treatment ++

 

- Anti-anemic treatment

 

-.  Hormone therapy with androgens

 

- Hormone treatment with progestogens

 

- Patient K., 36 years old, fell to work, getting a sprained ankle and back.  For two days he turned to a neurologist with complaints that he "does not feel the earth under his feet."  During the examination, there is a deep feeling of sensitivity to the type of conductor on the right leg.  When the structure of the nervous system is affected, the following symptoms are possible: Goll's beam ++

 

 

 

- Patient K., 40 years old, has a D-account with a neurologist with a diagnosis of "Structural (post-traumatic) focal epilepsy."  Periodically in the background of the reception of antiepileptic drugs are marked clonic convulsions of the left leg, beginning with the foot.  Later, spastic paresis of the left leg was added, preferably in the distal compartments.  Specify the localization of the process.

 

51. The patient has a clonic seizure in the left leg, starting from the foot.  Recently, spastic paresis has been added, which occurs mainly in the distal region of the left leg.  Topical diagnosis:

 

A. the upper region of the anterior central spinal cord in the right hemisphere;

 

B. the lower region of the anterior central spinal cord in the left hemisphere;

 

C. the upper region of the anterior central spinal cord in the left hemisphere; ++

 

D. right visual cortex;

 

E. inner capsule.

 

 

 

 

 

- At the age of 32, patients complain of low vision, headaches, menstrual irregularities.  During MRI of the brain with contrast, a tumor of the pituitary gland is detected, causing compression of the cross-section of the optic nerve.  What symptom will be noted when squeezing the visual chiasm?

 

<<<<< bitemporal hemianopsia / vision impairment ++

 

 

 

- Patient K., 68 years old, delivered in a resting place with complaints of violation of swallowing and phonation.  Examination by a neurologist revealed: dysarthria, paresis of the soft palate and lack of the pharyngeal reflex.  No paresis, tendon reflexes with extremities are caused normally.  What clinical syndrome is speech?

 

bulbar syndrome  ++

 

- Patient I., 49 years old, was delivered in an emergency room by ambulance with complaints of numbness and weakness in the left extremities.  When examined by a neurologist, hyperreflexiaof the left, smoothness of the left nostril, the strength of the muscles in the left extremities is reduced to 3.0 points.  What structure of the nervous system is damaged?

 

forehead share right?  ++

 

 

 

 

 

- At the age of 25 years, suddenly, on the background of full health, the sharpness of vision decreased to 0, there was a general weakness, irritability, insecurity and joy when walking, "drunk walking", in connection with which he turned.  What structure of the CNS can be suspected on the basis of the complaints?

 

cerebellum  ++

 

 

Patient K., 31 years old, is registered with a neurologist for epilepsy, regularly receives antiepileptic drugs.  The focus of the lesion of the brain on this MRI is localized in the occipital lobe.  In this patient before seizures convulsions can wait for recurrences:

 

 

 

<<<<< visual hallucinations ++

 

 

 

- Sick K., 20 years old, delivered in an unconscious state after the accident.  Evaluation on the scale of Glasgow - 7 points: the patient closes his eyes and pathologically bends to the end in response to pain, irritation.  To what level of cognition does this correspond?

 

<<<<< Coma 1 ++

 

 

 

 

 

- Patient Z., 33 years old, a housewife, suffers from shooting pains in the left half of the face after the transmission of labial herpes a week ago, for the treatment of which she took acyclovir.  Pain in turkey (trigger) zones and hyperesthesia in one

 

half of a person's face is damaged for the following nerves:

 

triple  ++

 

 

 

- The mother of the child for 7 years called the carriage to help with headaches, fever and vomiting in the child.  The boy was immediately delivered to an infectious hospital with suspicion of viral meningitis.  Indicate the main indications for serous viral meningitis by lumbar puncture results:

 

lymphocytic pleocytosis  ++

 

 

 

- The condition of the patient K., located in the pulmonology department, sharply deteriorated: significantly increased general brain symptoms, appeared meningeal symptoms.  In the cerebrospinal fluid expressed neutrophilic pleocytosis, in the blood leukocytosis, elevated ESR.  In the anamnesis of prolonged time suffers from bronchiectasis.  Preliminary diagnosis:

 

41. The condition of the patient K. in the pulmonology department has sharply deteriorated: the general symptoms of the brain have significantly increased, there are meningeal symptoms.  Clear neutrophilic pleocytosis in the cerebrospinal fluid, leukocytosis in the blood, high ESR.  He has a long history of bronchiectasis.  Can I doubt it?

 

A. secondary purulent meningitis ++

 

B. subarachnoid hemorrhage

 

C. tuberculous meningitis

 

D. pneumococcal meningitis

 

E. lymphocytic meningitis

 

 

 

- Patient, 35 years old, was delivered to the reception of the clinic by ambulance.  From the anamnesis on the background of high blood pressure suddenly appeared vomiting, psychomotor agitation, inadequate behavior.  Objectively: the condition is severe, the face is hyperemic, meningeal symptoms are positive, there are no paresis.  Preliminary diagnosis:

 

34. The patient is 35 years old, vomiting on the background of high blood pressure after stress, psychomotor agitation, inadequate gait, ptosis, loss of vision and mydriasis of the right eye, positive meningeal symptoms.  Initial diagnosis:

 

A. cerebral infarction

 

B. heart attack

 

C. subarachnoid-parenchymal hemorrhage ++

 

D. meningitis

 

E. encephalitis

 

 

 

 

 

- A woman of 69 years suddenly felt herself unwell, felt the spillage of liquid food through the right corner of the mouth, knocked a spoon out of the right hand.  After 25 minutes, these symptoms regressed independently.  It is known that 4 weeks ago he had an acute myocardial infarction.  Called the ambulance.  Preliminary diagnosis:

 

40. A 69-year-old woman suddenly felt unwell, felt liquid spilling from the right corner of her mouth and took a spoon from her right hand.  After 25 minutes, the symptoms disappeared on their own.  It is known that he had an acute myocardial infarction 4 weeks ago.  He called an ambulance.  Preliminary diagnosis:

 

A. Transient ischemic attack in the left middle cerebral artery basin ++

 

B. Ischemic stroke in the left middle cerebral artery

 

C. Subarachnoid hemorrhage

 

D. Parenchymal hemorrhage

 

E. Ischemic stroke in the anterior cerebral artery basin

 

 

 

- At the age of 65 years, objectively: the lumbar lordosis is flattened, the movements in the lumbar spine are restricted due to the back pain and on the side.  Symptoms of Wasserman and Matskevich right.  Hypesthesia on the inner and front surfaces of the right hip.  Reduction of the right knee reflex.  Specify what syndromes are present in the patient?

 

root L2-L4, peripheral  ++

 

 

 

 

 

- A man with 60 years of experience with smoking and hypertension, in the morning after sleep appeared numbness and weakness in the lower lower extremities.  In the evening the weakness in the leg increased and gradually joined the awkwardness in the proximal branch of the left upper extremity.  Topical diagnosis:

 

49. A 60-year-old man with prolonged smoking and hypertension, after sleeping in the morning, developed clotting and weakness of the lower leg.  In the evening, the weakness of the legs increased, and the discomfort in the proximal part of the left upper extremity gradually increased.  The main diagnosis:

А.  Anterior right cerebral artery pool ++

В.  The basin of the left posterior cerebral artery

С.  Basin of the right middle cerebral artery

D. The basin of the left anterior cerebral artery

E. The basin of the right cerebral artery

 

 

 

- At 42 years of age, men showed strong belching pain in the left half of the sternum, ECG and biochemical analysis of blood did not reveal cardiac pathology.  For two days in the left half of the sternum, at the level of the pacifier, in the zone appeared more rashes in the form of blisters.  A neurologist's examination revealed a zone of hypoesthesia in this area.  Preliminary diagnosis:

 

63. A 42-year-old man developed severe lumbar pain in the left side of the chest, ECG examination and biochemical analysis of blood did not reveal heart pathology.  Two days later, blisters appeared on the left side of the chest, at the level of the nipple, in the area of ​​pain in the form of blisters.  On examination, the neurologist identified an area of ​​hypoesthesia in this area.  Preliminary diagnosis:

 

A. herpetic ganglionitis ++

 

B. intercostal neuralgia

 

C. atypical dermatitis

 

D. angina pectoris

 

E. panic attack

 

 

 

- Daughter brought a 78-year-old mother to see a neurologist.  The mother does not complain, but the daughter told that the last year the mother stopped to perform the usual daily work at home, recently forgot to turn off the gas on the stove, and yesterday went out of the house and was found in a neighboring street.  With the words of daughters violations of memory are marked in the flow of 5-6 years, she lost interest in the surrounding world.  During the examination, the doctor found gross violations of memory, signs of pseudobulbar syndrome and mild disorders of balance.  Preliminary diagnosis:

 

56. The daughter brought her 78-year-old mother to a neurologist.  The mother does not complain, but the daughter said that for the last year her mother stopped doing simple chores at home, forgot to turn off the gas on the stove a few days ago, and left home yesterday and was found 2 hours later on a neighboring street.  According to her daughter, she has been unconscious for 5-6 years, she has lost interest in life. During the examination, the doctor found a clear disorder of the mind, symptoms of pseudobulbar syndrome and mild imbalance.  Prognosis:

 

A. Dyscirculatory encephalopathy II ++

 

B. Acute cerebrovascular accident

 

C. Vascular dementia

 

D. Hypertensive crisis

 

E. Encephalitis

 

 

 

- A man 54x years called an ambulance, suddenly broke his vision in the right eye, and caused weakness and numbness in the left extremities.  At the moment of arrival, an ambulance (in 20 minutes), pleas passed.  At objective inspection: the general condition is satisfactory;  vision of both eyes in the norm.  In neurological status: deep reflexes S> = D, other neurological symptoms were not detected.  Preliminary diagnosis:

 

57. A 54-year-old man called an ambulance, his right eye was impaired in the village, his left limb was weak and numb.  By the time the ambulance arrived (20 minutes later), the complaints were dismissed.  On objective examination: general condition is satisfactory, both eyes are normal.  In neurological status: deep reflexes S> = D, no other neurological symptoms.  Prognosis:

 

A. Hypertensive crisis type 1

 

B. Transient ischemic attack ++

 

C. Optico-chiasmal arachnoiditis

 

D. Multiple sclerosis

 

E. Encephalitis

 

 

 

- Men, 62 years old, suffering from chronic purulent otitis, on the background of another exacerbation (pain in the ear, purulent discharge), appeared the strongest headache, dizziness, photophobia and phonophobia, positive.  The analysis of cerebrospinal fluid revealed: turbid, cytosis-800 in ml, predominant neutrophils, protein-0.66 g / l. Preliminary diagnosis:

 

A 62-year-old man has chronic purulent otitis, on the background of another exacerbation (ear pain, purulent discharge), severe headache, dizziness, photophobia and phonophobia, positive meningeal symptoms.  The analysis of cerebrospinal fluid revealed: turbidity, 800 ml of cytosis, predominance of neutrophils, protein 0.66 g / l.  Choose the most probable diagnosis:

 

A. primary meningococcal meningitis

 

B. secondary otogenic purulent meningitis ++

 

C. viral meningitis

 

D. brain abscess

 

E. encephalitis

 

 

 

- Больная М.  58 years, delivered by ambulance brigade.  With complaints of sharp head pain, dizziness, nausea, monotonous vomiting, numbness of the tongue, weakening of motor function of the hands and feet from the left side, urinary incontinence. Objectively: AD 180/100 mm.D.  in min, uneven hemiparesis and hemihypesthesia, deviation of the left tongue, left-sided apraxia, hyperkinesis of the face and hands, violation of tone.  Topical diagnosis:

 

35. The patient was 58 years old and was taken to hospital by ambulance.  Complains of severe headache, dizziness, nausea, vomiting, numbness of the tongue, impaired motor function of the left limb, urinary incontinence.  Objective: BP 180/100 mm Hg, HR 80, HR 22 times per minute, uneven hemiparesis and hemipigesthesia are clearly visible in the distal parts, left shift of the tongue, left apraxia, hyperkinesis of the face and hands, olfactory disorders.  Topical diagnosis:

 

A. circulatory disorders in the middle cerebral artery ++

 

B. circulatory disorders in the anterior cerebral artery

 

C. circulatory disorders in the posterior cerebral artery

 

D. Circulatory disorders in the vertebral arteries

 

E. Obstruction of the main artery

 

 

 

- The student, 18 years old, suddenly fell, observed tonic-clonicconvulsions, involuntary urination.  During the examination: consciousness is lost, the saliva is isolated from the mouth with a small amount of blood.  The convulsions stopped in 2 minutes, after which the patient fell asleep.  With the words of the mother: narcotic substances, alcohol is not consumed, head injuries, neuroinfections are not tolerated.  In childhood, short episodes of disabling consciousness (several seconds) and stagnation in a certain position were observed.  The patient's sister suffers from epilepsy since childhood.  Preliminary diagnosis:

 

52. An 18-year-old student suddenly fell, had tonic-clonicconvulsions, involuntary urination.  On examination: loss of consciousness, a small amount of bloody saliva in the mouth.  The convulsions stopped after 2 minutes, after which the patient fell asleep.  According to his mother: he does not use drugs, does not drink alcohol, has never had a head injury or neuroinfection.  Short-term episodes of unconsciousness (a few seconds) and signs of stagnation were observed in the child at a young age.  The patient's sister has had epilepsy since childhood.  Preliminary diagnosis:

 

A. symptomatic epilepsy

 

B. idiopathic epilepsy ++

 

C. traumatic brain injury

 

D. brain cancer

 

E. multiple sclerosis

 

 

 

- The patient is 23 years old, suffers from weakness in the arms and legs, numbness in the wrists and feet, walking while walking.  Two weeks ago, with the words of the patient, marked flu-like condition.  When examining the muscle tone is reduced to the extremities, the strength of the muscle cysts and the stop is reduced to 1 point, the reduction of all types of sensitivity in the form of "socks and gloves", carporadial and Achilles reflexes do not cause convulsions.  The cerebrospinal fluid is colorless, translucent, cytosis of 10 lymphocytes, protein -20 grams per liter.  Preliminary diagnosis:

 

Patient U, 23 years old, complains of weakness in the arms and legs, onemia of the arms and legs, paralysis while walking. According to the patient, two weeks ago he had a flu-like condition.  During the examination, the muscle tone of the limbs decreased, the strength of the muscles of the wrists and ankles decreased to 1 point, all types of sensitivity in the form of "socks and gloves" decreased, carporadial and Achilles reflexes were not called, the skin color of the limbs changed.  The cerebrospinal fluid is colorless, transparent, cytosis of 10 lymphocytes, 20 grams of protein per liter.  Preliminary diagnosis:

 

A. encephalomyelitis

 

B. myelitis

 

C. spinal cancer

 

D. polyneuropathy (Guillaume-Barre syndrome) ++

 

E. alcoholic polyneuropathy

 

 

 

- A 24-year-old patient complains of a violation of the menstrual cycle, the patient undergoes treatment at a gynecologist with a diagnosis of primary infertility.  The level of prolactin in the blood is sharply elevated.  The patient was referred to a neurologist.  In neurological status without exceptions.  Preliminary diagnosis:

 

44. The patient is 24 years old, complains of menstrual disorders, the patient is treated by a gynecologist for primary infertility.  Elevated prolactin in the blood.  The patient was referred to a neurologist.  Neurological status unchanged.  Prognosis:

 

A. multiple sclerosis

 

B. pituitary adenoma ++

 

C. toxoplasmosis of the brain

 

D. oval brain cancer

 

E. brain abscess

 

 

 

 

 

a.  - Sick 24 years.  Autumn traveled to relatives in Russia (forest, taiga).  After the visit, a few days ago there was a sharp headache, nausea, vomiting.  There was an increase in temperature to 39 °, chills, pain in the neck area.  He thought that ARVI was treated independently.  But the condition worsened, and in the last 2-3 days there was a weakness in the arms and muscles of the neck.  In neurological status: severe paresis of the musculoskeletal system.  Preliminary diagnosis: tick-borne encephalitis +++

 

 

 

89. The patient is 24 years old.  In the fall he visited his relatives in Russia (forest, taiga).  Several days after the trip, severe headaches, nausea and vomiting appear.  Up to 39 ° fever, chills, pain in the neck.  He thought it was self-inflicted with ARVI.  But his condition worsens, and in the next 2-3 days there is weakness in the muscles of the neck and arms.  In neurological status: weak paresis of the muscles of the arms and neck.  Diagnostic principles:

 

A. lumbar puncture, clinical and serological examination

 

B. STDs

 

C. AIDS

 

D. UDDG b / c column

 

E. Lumbar MRI

 

 

 

- After the injury of the anterior region of the forearm, the patient has atrophy of the muscles of the big toe with flattening of the palm ("monkey cyst"), hyperesthesia with hyperpathy in the area of ​​the palmar surface, pain in the palate 1,2,3 fingers.  Topical diagnosis:

 

57. After the injury in the anterior region of the forearm there is atrophy of the muscles of the big toe with the flattening of the palm ("monkey hand"), hyperpathy with hyperesthesia of the palms of the fingers 1, 2, 3 and the corresponding part of the palm, burning pain.  Signs of damage:

 

A. middle nerve ++

 

B. radiating nerve

 

C. the ulnar nerve

 

D. lower tibial nerve

 

E. motor nerve of the eye

 

 

 

- Больная С.  10 years.  Sick in the morning, about 10 hours ago.  Initially there was a headache, chills, the day was joined by vomiting.  In the evening, the condition deteriorated sharply, against the background of high temperatures the body came to a state of unconsciousness, there was a recurrence of vomiting.  Temperature of the body 39.5 ° The skin is moist, the face is hyperemic.  On the lips of herpes.  Hemorrhagic rash on the skin of the hip.  Spontaneous horizontal nystagmus, dilated crooked eyes.  Trismus chewing muscles.  Tendon reflexes are right above.  On both sides caused pathological reflexes of Babinski, Oppenheim.  Stiffness of the back of the muscle - 4 transverse fingers, a symptom of Kernig with both sides positive at an angle of 90 °.  Lumbar puncture: cerebrospinal fluid flows under elevated pressure, turbid, protein — 2.6 g / l, cytosis is not given to the account (neutrophils 98%), sugar — 1.7 mmol / l, chlorine — 183.3 mmol / l.  Diplococci were found in the native drug.  Clinical diagnosis:

 

55. 10-year-old S.  A patient named.  He was taken from home by ambulance. He fell ill at about 10 o'clock in the morning.  Initially, there was a headache, chills, and vomiting during the day.  In the evening, against the background of high body temperature, there was a sharp decline in consciousness, vomiting and recurrence.  At examination: at the level of unconsciousness.  Body temperature 39.5 °.  The skin is moist, the surface is hyperemic.  Herpes on the lips. Hemorrhagic rash on the skin of the thighs.  Spontaneous horizontal nystagmus, outward curvature.  Trismus of the masticatory muscles.  Tendon reflexes predominate on the right.  Pathological Babinsky, Oppenheim reflexes on both sides.  Muscle stiffness in the neck - 4 horizontal fingers, Kernig's symptom 90 °, positive on both sides.  Lumbar puncture: cerebrospinal fluid flows under high pressure, opaque, protein - 2.6 g / l, cytosis can not be determined (neutrophils 98%), sugar - 1.7 mmol / l, chlorine - 183.3 mmol / l.  Diplococci were detected in the native drug.  Clinical diagnosis:

 

A. staphylococcal infection, serous meningomyelitis

 

B. meningococcal infection, purulent meningoencephalitis ++

 

C. infectious-allergic meningitis

 

D. diphtheria infection, viral encephalomeningitis

 

E. enterovirus infection, purulent meningoencephalitis

 

 

 

- An 18-year-old boy after a transplanted acute respiratory viral infection (ARI) felt tingling in his ankle joints.  Over the course of two days, weakness developed in the benders of the foot, and by the end of the week he had difficulty walking.  Urination and defecation were not violated.  During the week, the weakness progressed and the need for artificial ventilation of the lungs arose.  Tetraplegia developed during the movement of the eyeballs.  Increased protein content in the cerebrospinal fluid (above 10 g! L) in normal cytosis, without erythrocytosis

 

A 72.18-year-old man experienced a concussion in the ankle after experiencing an acute respiratory viral infection (ARI).  For two days he developed weakness during flexion of the foot, and in the last week he had difficulty walking.  No urination and defecation disorders.  During the week, fatigue increased and artificial lung ventilation developed.  Tetraplegia develops with the preservation of the movement of the eyeball.  Prognosis: Guillain-Barre polyradiculomyeloneuropathy. ++

 

Diagnostic principles:

 

A. CT of the abdomen

 

B. X-ray of the foot

 

C. genetic analysis

 

D. MRI of the brain, analysis of cerebrospinal fluid

 

E. neurosonography

 

 

 

- 72-year-old male coma.  The temperature has risen.  Prior to admission, the patient had an attack of generalized tonicoclonicconvulsions.  For a week before the action there was drowsiness and coughing, and vomiting.  Alcohol and drug poisoning are excluded.  In the cerebrospinal fluid: protein - 4.5 g / l, sugar - 3.4 mmol / l, leukocytes - 150 in 1 μl, erythrocytes - 3 μl, cerebrospinal fluid.  Pressure 200 mm of water, external type of milk, fibrin film leaked.

 

63. Coma in a 72-year-old man.  The temperature is high.  Prior to admission, he had a widespread tonic-clonic seizure.  A week ago there was drowsiness, cough and vomiting.  There was no alcohol or drug poisoning.  In the cerebrospinal fluid: protein - 4.5 g / l, sugar - 1.4 mmol / l, leukocytes - 150 in 1 μl, erythrocytes - 3 μl, cerebrospinal fluid pressure - 200 mm Hg, formed a milky, fibrinous membrane.  Preliminary diagnosis:

 

A. arachnoiditis

 

B. tuberculous meningitis ++

 

C. acute bacterial meningitis

 

D. cerebral aneurysm

 

E. cerebral cyst

 

 

 

 

 

- Больной А.  For 50 years he was ill.  Being behind the wheel of a car, he unexpectedly complained to the driver that he felt a "hot blow" in the area of ​​the back of the head.  Immediately there was an intense headache, nausea.  He tried to stop the car, tried to get out, caused a lot of vomiting, lost consciousness.  The brigade "ambulance" was delivered to the reception.  At review: consciousness is preserved, but there is a state of deafness.  In contact comes with labor.  It moans, it hurts, it hurts, it hurts.  Horizontal nystagmus, not bringing the eyeballs to the side.  The rigidity of the muscle of the occiput is 4 transverse fingers.  With both sides, the Kernig symptom is at an angle of 90 °, the lower symptom is Brudzinski.  lumbar puncture: fluid leaks under elevated pressure, intensely, evenly stained with blood.  Preliminary diagnosis:

 

34. Patient A.  50 years old, acutely ill.  While driving, he told his neighbors that he felt a "hot shock" in the neck area.  Immediately began a clear headache and nausea.  When he tried to stop the car and tried to get out, he vomited several times and fainted.  He was taken to the emergency department by ambulance.

 

On examination: unconscious, in a state of shock.  It is very difficult to make contact.  Complains of nausea, headache, nausea.  Horizontal nystagmus, inability to move the eyeball.  4 transverse finger stiffness of the neck muscles.  Bilateral 90-degree Kernig's symptom, lower Brudzinski's symptom, lumbar puncture: fluid comes out with high pressure, intense, evenly stained with blood.  Prognosis:

 

A. Spinal infarction

 

B. Spinal cord hemorrhage

 

C. Subarachnoid hemorrhage ++

 

D. Spinal cord cancer

 

E. Concussion

 

 

 

- A 52-year-old patient with an overweight body, suffering from hypertensive disease, IBS, type II diabetes, suffers from "burning" in the legs.  Examination revealed a reduction of deep reflexes in the hands and feet.  Hypesthesia in the distal branches of the foot.  During the examination revealed elevated levels of glucose in the blood.  Preliminary diagnosis:

 

43. A 52-year-old patient suffers from overweight, hypertension, coronary heart disease, type II diabetes mellitus, complains of fever in the soles of the feet.  Examination revealed a decrease in deep reflexes in the legs and arms.  Hypesthesia in the distal part of the leg.  The study revealed an increase in blood glucose levels.  Prognosis:

 

А.  Diabetic polyneuropathy ++

 

В.  Varicose veins of the lower extremities

 

С.  The spinal cord is dry

 

D. Spinal cord cancer

 

Е.  Stroke

 

 

 

- The patient is 28 years old - the temperature has risen to 39 degrees.  During the 3rd week there was an marked weakness, cough.  In the anamnesis: another friend was diagnosed with mild tuberculosis 3 months ago.  Alcohol and drug poisoning are excluded.  In the cerebrospinal fluid: protein - 4.5 g / l, sugar - 1.4 mmol / l, leukocytes - 150 in 1 μl, erythrocytes - 3 μl, cerebrospinal fluid.  Pressure 200 mm of water, external type of milk, fibrin film leaked.  Clinical diagnosis:

 

56. The patient is 28 years old - fever 39 C.  At 3 weeks there was a pronounced weakness, cough.  History: a friend was diagnosed with pulmonary tuberculosis 3 months ago.  There were no alcohol or drug poisonings.  In the cerebrospinal fluid: protein - 4.5 g / l, sugar - 1.4 mmol / l, leukocytes - 150 per 1 μl, erythrocytes - 3 μl, pressure 200 mm Hg, milky appearance, fibrinous membrane is formed.  Clinical diagnosis:

 

A. Arachnoiditis

 

B. Acute bacterial meningitis

 

C. Cerebral aneurysm

 

D. Tuberculous meningitis ++

 

E. A brain cyst

 

 

 

- The patient was delivered to the hospital with complaints of an intense headache, which occurred 2 hours ago.  AD— 190/100 Frozen.  The right eye socket is already on the left.  The left nostril is smooth.  Hemiparesis, hypertension in the muscles of the left extremities, high tendons and the presence of pathological reflexes on the left leg.  Preliminary diagnosis:

 

59. The patient was taken to the hospital with a complaint of severe headache, which began 2 hours ago.  AK - 190/100, delayed.  Smoothing of the left nasal lip fold.  Hemiparesis, hypertension of the left extremity, the presence of pathological reflexes in the upper extremities and the left extremity. Prognosis:

 

А.  Hemorrhagic stroke in the left anterior cerebral artery basin

 

В.  Ischemic stroke in the right middle carotid artery basin

 

С.  Hemorrhagic stroke in the carotid pool

 

D. Ischemic stroke in the right posterior carotid artery basin ++

 

Е.  Ischemic stroke in the vertebro-basilar basin

 

 

 

- A man, 38 years old, went to the clinic with complaints of headaches, weight loss, general weakness, increased fatigue.  In neurological status: concomitant hoarseness, diplopia, stiffness of the back of the neck.  From the anamnesis: a year ago transferred to mild tuberculosis.  Principle of diagnosis:

 

88. A 38-year-old man was admitted to the clinic with a headache, weight loss, general weakness and fatigue.  Neurological status: concomitant squinting, diplopia, neck muscle spasm.  In the anamnesis: a year ago he had pulmonary tuberculosis.  Diagnostic principle:

 

A. Lumbar puncture ++

 

B. EEG

 

C. EchoEG

 

D. UZDG vessels

 

E. MRI of the neck

 

 

 

- 72-year-old male coma.  The temperature has risen.  Prior to the onset of the disease was marked by an attack of generalized tonic-clonic convulsions.  For a week before the action there was drowsiness and coughing, and vomiting.  Alcohol and drug poisoning are excluded.  Preliminary diagnosis: tuberculous meningitis.  The principle of etiological treatment:

 

94. A 72-year-old man is in a coma.  The temperature has risen.  Prior to admission, the patient had a generalized tonic-clonicseizure.  Within a week before falling, there was drowsiness, cough and vomiting.  Alcohol and drug poisoning were not detected.  Prognosis: tuberculous meningitis.  The principle of etiological treatment:

 

A. penicillin, ceftriaxone

 

B. summed, lincomycin

 

C. isoniazid, streptomycin ++

 

D. ceftazidime, ampicillin

 

E. chloridine, kanamycin

 

 

 

- A man of 46 years, suffers from morning headaches, attacks, accompanied by convulsions in the right extremities (start in the right leg, spread on the right arm).  Consciousness does not lose.  The attacks are repeated 1-2 times a day, first appearing 3 months ago.  From the anamnesis it is known that 4 years ago he received a closed craniocerebral trauma - a brain injury.  According to CT: external and internal hydrocephalus.  On the EEG: complex "acute slow wave" in the frontal-temporal region of the left hemisphere.

 

Principles of treatment:

 

72. A 46-year-old man complains of a headache in the morning, seizures with right arm pull (starts with the right leg, spreads to the right arm).  Does not lose consciousness.  Seizures recur 1-2 times a day, first appeared 3 months ago. 4 years before the anamnesis it is known that he had a closed craniocerebral trauma - brain compression.  According to CT data: external and internal hydrocephalus.  On the EEG: "sharp slow wave" complexes in the anterior-inferior region of the left hemisphere.  Principle of treatment:

 

A. preparations of valproic acid ++

 

B. magnesium and potassium preparations

 

C. sedatives

 

D. Nootropics

 

E. Neuroprotectors

 

 

 

- A man of 32 years turned to the doctor with complaints about the pain in the cervical spine, irradiating the shoulder, on the radiating edge of the forearm, to the big finger of the right hand.  Examination revealed weakness and malnutrition of the biceps, tenara, reduction of the biceps reflex.  Hyposthesia in the area of ​​the radiating edge of the forearm.  Topical diagnosis:

 

49. A 32-year-old man came to the doctor with the following complaints: pain in the neck, shoulders, old bone of the forearm, thumb of the right hand.  The examination revealed weakness and malnutrition of the two main muscles of the shoulder, decreased tenar, biceps reflex on the right.  Hypesthesia on the old bony edge of the forearm.  Root C 6 right ++

 

 

 

- A 28-year-old woman in a few days began to notice the instability of walking and awkwardness in the hands, began to "uncomfortably" print on a computer.  In the neurological status: nystagmus, intentional tremor during the performance of the finger and knee-heel test, increased tone in the lower extremities of the spastic type, a bilateral symptom of Babinski.  During the examination of the eye sole: whitening of the temporal lobes of the discs of the visual nerve.  During the three-day review, the expression of the coordinator's violations was significantly reduced.  Preliminary diagnosis:

 

57. A 28-year-old woman became unstable, uncomfortable in her hands, and uncomfortable typing on a computer during a few days of walking.  Neurological status: nystagmus, intentional tremor when testing the right toe and nose and knees, increased spastic tone in the legs, bilateral Babinski's symptom.  When looking at the fundus: whitening of the parotid discs.  Preliminary diagnosis:

 

A. Encephalopolyradiculoneuritis

 

B. Tumor of the forehead

 

C. Meningococcal meningitis

 

D. Multiple sclerosis ++

 

E. Glaucoma

 

 

 

- A woman, 58 years old, an accountant, suffering from diabetes, suffers from pain in the lower extremities, there was a feeling of tenderness and coldness, "crawling ants", intensifying at night.  Objectively: the skin of the foot is dry, peeling, on the sole of the right foot there is no sore ulcer.  Knee reflexes are suppressed, Achilles tendons are not caused.  Decreased pain and temperature sensitivity in the distal extremities of the extremities.

 

Your preliminary diagnosis:

 

62. A 58-year-old woman, an accountant, suffers from diabetes, complains of pain in her legs, a feeling of numbness and chills at night, "physical irritation".  Objective: the skin of the foot is dry, flaky, there is a painless ulcer under the right foot.  Knee reflexes are reduced, axillary reflexes are not called.  Decreased sensitivity to pain and temperature in the distal regions of the limbs.  Preliminary diagnosis:

 

A. Polyneuropathy of Guillaume - Barre

 

B. Diabetic polyneuropathy ++

 

C. Raynaud's disease

 

D. Atherosclerotic vascular damage

 

E. Thrombophlebitis of the right leg

 

 

 

- A man, 87 years old, complained of headaches, vomiting, weakness and numbness in the right extremities, speech disorders, which developed suddenly, in the morning, on the background of elevated blood pressure to 220/120 mm Hg.  Art.  Objectively: constricted, severe condition, meningeal syndrome.  Central paresis of facial muscles of the face and tongue right, hemihypesthesia and hemiparesis right with increased tone and reflexes.  Principle of diagnosis:

 

81. Male, 87 years old, morning blood pressure 220/120 mm.s.b.  He complained of sudden headaches, vomiting, weakness and paralysis of the right limbs, speech disorders.  Objective: delayed, severe, positive meningeal syndrome.  Central paresis of the facial muscles and tongue on the right side, right hemihypesthesia and hemiparesis with increased tone and reflexes.  Principles of diagnosis:

 

A. CT of the brain

 

B. MRI of the brain ++

 

C. Ultrasound of the cervical veins

 

D. EEG

 

E. EMG

 

 

 

- The patient was delivered to the hospital in a critical condition for 64 years.  According to relatives, more than 20 years suffer from hypertensive disease.  In the morning, getting up from bed, suddenly lost consciousness, fell.  There was a place of vomiting.  When reviewing, the consciousness is missing.  The skin of the face, breasts, and extremities are hyperemic.  AD — 220/100.  Pulse 96 beats per minute, strained.  Breathing Chain-Stokes.  The head and eyeballs are turned to the left.  Mouth half-open.  Rigidity of the occipital muscles.  With both sides a symptom of Kernig.  Pupils are expanded.  The right nostril is flattened.  The right foot is rotated outside.  Tendon reflexes are absent.  Does not react to injections.  The reflexes of Babinski, Rossolimo, Gordon are rightly called.  Lumbar puncture: cerebrospinal fluid pressure 180 mm Hg, cerebrospinal fluid intensively stained with blood.  During computed tomography of the brain, a zone of increased density of spherical shape in the left temporal-temporal region, the displacement of the medial structure to the left to the right by 10 mm.  Clinical diagnosis

 

34. A 64-year-old patient was taken to the hospital in critical condition.  According to his relatives, he has been suffering from hypertension for more than 20 years. After waking up in the morning, he suddenly fainted.  Vomiting before.  He lost consciousness during the examination.  Hyperemia of the skin of the face, chest, limbs. AK-220/100.  Pulse 96 beats per minute, tense.  Cheney-Stokes breath.  Head and eyeballs facing left.  The mouth is half open. Muscle spasms in the neck.  Kernig'ssymptom is positive on both sides.  The pupils are dilated.  The right nasolabial fold is flattened. The right sole is rotated outwards. There are no tendon reflexes.  Does not affect needle punctures.  Babinsky, Rossolimo, Gordon reflexes are called from the right.  Lumbar puncture: cerebrospinal fluid pressure 180 mm Hg, cerebrospinal fluid is actively stained with blood.  Computed tomography of the brain revealed a spherical area of ​​increased density in the left temporal lobe, the middle structure is shifted by 10 mm from left to right.  Clinical diagnosis:

 

A. hemorrhagic stroke in the basin of the left central cerebral artery ++

 

B. ischemic stroke in the basin of the right central cerebral artery

 

C. hemorrhagic stroke in the carotid basin

 

D. ischemic stroke in the basin of the right posterior cerebral artery

 

E. ischemic stroke in the vertebrobasilar basin

 

 

 

 

 

- The patient suffers from stiffness in movement, abundant secretion of saliva, difficulty speaking (the word is pronounced slowly), constant trembling in the hands of the hand.  Objectively: the face is amicable, the head is slightly tilted forward, the arms and legs are slightly bent in all joints, active movements are performed slowly.  Rhythmic trembling in the fingers of the hand, with a small amplitude, in the form of "rolling the pill."  The tone in the hands and feet is evenly elevated, there is the phenomenon of "toothed wheel".  Tendon reflexes are lively, uniform.  There are no pathological reflexes.  Sensitivity is not upset.  He walks with small steps.  There are friendly movements.  Topical diagnosis:

 

45. The patient complains of obstruction of movement, excessive salivation, difficulty speaking (speaks slowly), constant vibration of the fingers.  On objective examination: the face is amygdala, the head is slightly tilted forward, slightly bent at all joints of the arms and legs, slowly performs active movements.  Vibration in the fingers is uniform, low-amplitude, like "drug rotation".  There is a phenomenon of "toothed circle" in the limbs with a steady increase in tone.  Tendon reflexes are active, smooth.  No pathological reflexes.  Sensitivity is not disturbed.  Follows in small steps.  There is no coordination of movements.  Topical diagnosis:

 

lesion of the palliative system (pale ball, black substance)  ++

 

 

 

A. black matter, especially pale ball damage ++

 

B. Damage to the four bumps, especially the pale ball

 

C. black matter, especially damage to the central anterior fold

 

D. Damage to the four bumps, especially the inner capsule

 

E. especially lesions of the hypothalamic-pituitary system

 

 

 

- A man, an 49-year-old electrician, came to the clinic for emergency assistance.  When acting: consciousness is depressed, the pain opens the eyes to irritation.  Neurological status: stiffness of the back of the neck, a positive symptom of Kernig.  The conjoined eyeball.  The right nostril is flattened, the tongue is tilted to the right.  Tonus and reflexes are elevated to the right.  Lymphocytic pleocytosis in cerebrospinal fluid.  Your preliminary diagnosis:

 

85. A 49-year-old electrician was taken to the clinic by ambulance.  Upon arrival: unconscious, opens the eyes to pain irritants.  Neurological status: muscle stiffness, Kernig'ssymptom is positive.  Joint action.  The right nasopharynx is flattened, the tongue is tilted to the right.  Tonus and reflexes are high on the right.  Lymphocytic pleocytosis in the cerebrospinal fluid.  Your preliminary diagnosis:

 

A. meningitis

 

B. meningoencephalitis ++

 

C. meningomyelitis

 

D. dryness of the spine

 

E. progressive paralysis

 

 

 

- The patient is 68 years old with complaints of awkwardness and numbness at the left extremities.  Sick of the morning, when the above-mentioned complaints appeared.  Arterial pressure, 170/90 mm Hg.  Art.  In the anamnesis of ischemic heart disease, three years ago was transferred to an extensive transmural myocardial infarction, complicated by a persistent form of atrial fibrillation.  When reviewing: Medium gravity condition.  In consciousness.  There are no generalized and meningeal symptoms.  Central paresis of the facial and sublingual nerves to the left, left hemiparesis with a decrease in muscle strength up to 3 points, a symptom of Babin's left.  Left hemihypesthesia.  In the lumbar puncture: colorless, translucent cerebrospinal fluid, pressure 160 mm Hg, cytosis - 3 lymphocytes, protein - 0.33 mg%.  On MRI on the 4th day after the disease in the right temporal-temporal region is determined by the zone with a signal of increased and decreased signal intensity of the T1 and T2-weighted images, respectively.

 

Preliminary diagnosis:

 

49. A 68-year-old patient complains of numbness and discomfort in the left limb.  In the morning there was an acute illness, that is, the above complaints.  AO 170 / 90mm.  History of coronary heart disease, a persistent complication of atrial fibrillation, 3 years ago suffered a large transmural infarction.  In general: central paralysis of the facial and temporal nerves on the left, left hemiparesis, decreased muscle strength to 3 points, on the left Babinsk's symptom is positive.  Left hemihypesthesia.  In lumbar puncture: cerebrospinal fluid colorless, transparent, pressure 160 mmHg, cytosis - 3 lymphocytes, protein - 0.33 mg%.  MRI reveals an area of ​​increased and decreased intensity in the right temporal lobe for 4 days after the disease.  Prognosis: Ischemic stroke in the right hemisphere, presumably due to thromboembolism of the left ventricle ++

 

 

 

A. ischemic stroke in the right hemisphere of the brain ++

 

B. hemorrhagic stroke in the left hemisphere of the brain

 

C. parenchymal-subarachnoid hemorrhage

 

D. acute hypertensive encephalopathy

 

E. Chronic cerebrovascular accident

 

 

 

- When obsledovanïï bolnogo vıyavlenı otswtstvïe movement in nogax, povışenïe from the tone of the mışeçnogo NIH, povışenïekolennıx and axïllovıx refleksov both side, patologïçeskïeDuplex Watermarks Babïnskogo and Rossolimo, otswtstvïebryuşnıx refleksov, nalïçïe zaşçïtnıx refleksov and klonwsovstop and nadkolennïkov both side.  There is a violation of pain and temperature sensitivity from the level of the nipples and below, a violation of deep sensitivity in the legs, involuntary urination, lying in the area of ​​the sacrum and heel.

 

Topical diagnosis:

 

59. Examination of the patient showed a lack of movement in the legs, increased muscle tone, positive pathological Babinskyand Rosslimo symptoms in both legs, absent abdominal reflexes, defensive reflex, bilateral foot and knee clonus.  There is sensitivity, involuntary urination, ulcers in the eyes and soles of the feet.  Topical diagnosis:: Nodal periarthritis with damage to the peripheral nervous system and muscles ++

 

 

 

A. Complete transverse spinal cord injury at the level of Th4-Th5

 

B. Complete transverse spinal cord injury at the level of Th1-Th2

 

C. Complete transverse spinal cord injury at the level of Th3-Th4

 

D. Complete transverse spinal cord injury at the level of Th10-Th11

 

E. Complete transverse spinal cord injury at the level of Th7-Th8

 

 

 

- Patient N.  20 years.  Complaints of a sharp headache, lightheadedness, an increase in body temperature to 39-40 degrees, nausea, vomiting.  Neurological status: psychomotor agitation, stiffness of the back of the neck, positive symptoms of Kernig, Brudzinski.  Principle of diagnosis:

 

71. Patient N.  20 years old.  Complaints: headache, inability to see the light, fever up to 39-40 degrees, nausea, vomiting.  Neurological status: psychomotor agitation, stiff neck muscles, positive Kernig and Brudzinski symptoms.  Diagnosis:

 

A. diagnostic lumbar puncture ++

 

B. ELISA for parasite detection

 

C. X-ray of the lungs

 

D. PCR of urine analysis

 

E. CT scan of the abdomen

 

 

 

- Sick K, 25 years, delivered "soon" in the reception room BSMP with complaints of headaches, weakness in the right extremities.  From the anamnesis: an hour ago there were unknown people on the street after the blow on the head lost consciousness;  the length of the loss of consciousness is not known.  Objectively: in consciousness, contact, language deviates correctly, in Barre's test hang the right end, the dry reflexes D> S, the reflex of Babin's right.  There are no meningeal signs.  Principles of diagnosis: CT, MRI? ++

 

 

 

 

 

- A 38-year-old man, an engineer, went to the clinic with complaints about a sharp reduction of memory and attention, "failed thoughts", "violent thinking", with subsequent loss of consciousness and convulsions with a duration of 3-4 minutes (so).  Begins to mark the last 4 months, after a head injury and a brain injury 2 years ago.  In neurostatosis minimal scattered neurological symptoms.  Principle of diagnosis:

 

95. The patient, 38 years old, an engineer, came to the hospital with complaints of sudden loss of attention and memory, "loss of consciousness", "forced thinking", then loss of consciousness and seizures (according to his wife) lasting 3-4 minutes.  He has been experiencing similar symptoms for the last 4 months after suffering a head injury and a stroke 2 years ago.  Minimal scattered neurological symptoms in neurological status.  Diagnostic principles:

 

A. Echo-encephalography

 

B. Ultrasound of cerebral blood vessels

 

C. rheoencephalography

 

D. electroencephalography ++

 

E. electroneuromyography

 

 

 

- Больной К.  38 years June 24 delivered from the district hospital by plane on the 4th day of illness.  The statement from the history of the disease indicates: works pastuhom, fell ill.  Illness began with chills, fever up to 39 °, headache, vomiting, confusion, delirium.  On the third day, there was a violation of the movement in the hands, there was a persistent disorder of breathing.  At examination: delirium, excitement, hallucinations.  The body temperature is 38 °.  Pupils are moderately narrowed.  Dysarthria is suppressed during swallowing.  Sharply restricted movements in the arms.  Decreased muscle tone of the shoulder girdle.  Tendon reflexes with upper extremities are not triggered, knee and achilles are revived.  On both sides is determined by the pathological reflex of Babinski.  Stiffness of the muscle of the occiput 2 transverse fingers, symptom of Kernig at an angle of 90 °. Lumbar puncture: cerebrospinal fluid, translucent, colorless, drains;  protein - 1.32 g / l, cytosis - 200 (lymphocytes - 93%), sugar - 4.44 mol / l, chlorine - 211.5 mmol / l.  Preliminary diagnosis

 

33. Patient K.  The 38-year-old was taken to the district hospital by helicopter on the 4th day of June 24.  Shown in a copy of the medical history: works as a shepherd, acutely ill.  The disease began with chills, fever up to 39 °, headache, vomiting, shock, dizziness.  On the third day, there was a movement disorder in the hands, there was a permanent respiratory disorder.  At examination: delirium, agitation, hallucinations.  Body temperature 38 °.  The pupil is slightly constricted.  Dysarthria, scattered during swallowing.  Accelerated manual deceleration.  Decreased muscle tone in the shoulder girdle.  Tendon reflexes are not triggered manually, knee and Achilles reflexes are activated.  The Babinsk pathological reflex is detected on both sides.  Tension in the neck muscle is equal to 2 horizontal fingers, Kernig's symptom at an angle of 90 °.  Lumbar puncture: cerebrospinal fluid is transparent, colorless, effervescent;  protein - 1.32 g / l, cytosis - 200 (lymphocytes - 93%), sugar - 4.44 mol / l, chlorine - 211.5 mmol / l.  Prognosis

 

A. tick-borne encephalitis (meningoencephalitis)

 

B. tick-borne encephalitis (paralytic type)

 

C. Japanese mosquito encephalitis

 

D. chronic stage of tick-borne encephalitis

 

E. chronic stage of lethargic encephalitis

 

 

 

- A sick 58-year-old in the morning suffers from tremors in the hands and feet, rapid fatigue, change of speech, frequent urination, difficulty moving.  Similar complaints bother the last 3 years.  From the anamnesis it is known that the account in the psychoneurological dispensary, for a long time adopts neuroleptics.  Upon examination: fine tremor in the scales on the type of "coin count", fine tremor of the foot, decreasing with movement, perioral tremor, quiet, monotonous speech, tonus of the muscle increased by type.  Preliminary diagnosis:

 

37. The patient is 58 years old.  In the morning he complains of trembling fingers and toes, fatigue, speech disorders, frequent urination, initial movement disorders.  Such complaints have been a concern for the last 3 years.  It is known from his anamnesis that he is registered in a psychoneurologicaldispensary and has been taking neuroleptics for a long time.  During the examination: small vibrations of the "coin count" type, small vibrations at the end, decreased during movement, perioral vibration, silent, monotonous speech, increased muscle tone by extrapyramidal type.  Prognosis: Secondary parkinsonism ++

 

 

 

A. Parkinson's syndrome

 

B. vascular dementia

 

C. Economo encephalitis

 

D. Brain cancer

 

E. epilepsy

 

 

 

- In the course of 5 months, the pain disturbs the gradually growing headache, intensifying in the morning, the last time there was vomiting, reduction of vision in both eyes and walking on the left.  No side pathology of the cranial nerves has been identified.  The tone is reduced to the left extremities, the coordinate tests are poorly performed by the left extremities (intentional tremor, mimicry).  During the examination by an ophthalmologist revealed congestive discs of the optic nerve with two sides.  Topical diagnosis:

 

43. The patient has a constant headache for 5 months, increased in the morning, recent vomiting, decreased visual acuity in both eyes and swaying to the left while walking.  No pathology of the cranial nerves was detected.  Decreased tone in the left limb, poor coordination with the left limb (intentional vibration, inadvertent fall).  Examination by an ophthalmologist revealed stagnation of the optic disc on both sides.  Topical diagnosis: Left hemisphere cerebellum ++

 

A. The right cerebral hemisphere?

 

B. right frontal area

 

C. left temporal region

 

D. thalamus area

 

E. right roof area

 

 

 

- The patient is 27 years old.  Half a year ago there were general epileptic seizures, initially rare, and now 3-4 times a month.  Some seizures were preceded by deception - "burning smell".  He complained of a headache.  Later, it became worse to see, there were two in front of the eyes, as well as weakness of the left hand and legs.  Ptosis of the upper eyelid of the right eye.  Pupils are round, right and left.  The outer clasp of the right eye, the restriction of its movements up and down.  The left nostril is smooth.  The awkwardness of the left hand, the muscular force in it is reduced.  When walking and when examining Romberg's symptoms, he walks lightly to the left.  Tendon reflexes are above the left.  Clonus of the left foot.  Symptoms of Babinski and Oppenheim left.  Computed tomography of the head of the brain: displacement of the ventricular system to the right, the central department of the left lateral ventricle presses the knizuand knaruzhi.  On the angiogram, the displacement of the right upper middle cerebral artery and the medial siphon of the right sonic artery.  Clinical diagnosis:

 

44. The patient is 27 years old.  Half a year ago, general epileptic seizures appeared, initially rare, now 3-4 times a month.  Some seizures had a deceptive odor, such as a "burning odor."  Complained of a headache.  Recently, he had poor eyesight, double vision, as well as weakness in the legs and arms. Ptosis of the right eyelid.  The pupils are rounded, the right new is wider than the left.  External stiffness of the right eye, upper and lower limitation of its movement.  The left nasolabial fold is flattened.  Discomfort of the left hand.  There is a decrease in muscle strength.  Slightly deviates to the left while walking and studying Romberg's symptoms.  Tendon reflexes - increased on the left.  A clone of the left foot.  On the left, Babinsk and Oppenheim's symptoms are positive. On computed tomography of the brain: the ventricular system is shifted from right to left, the central left ventricular compartment is compressed from below and from the outside.  The angiogram reveals a high displacement of the right middle cerebral artery and a high displacement of the medial siphon of the right carotid artery.

 

Clinical diagnosis:

 

A. cancer of the right temporal region

 

B. cancer of the left frontal region

 

C. tumor of the right occipital region ++

 

D. worm cancer

 

E. Cataract

 

 

 

- A man, 57 years old, delivered to NSO with complaints of headaches, vomiting, weakness and numbness in the right extremities, speech disorders that developed suddenly, on the background of elevated AD up to 220/120 mm Hg.  Art.  Objectively: tightened, rigidity of the muscle of the occiput on 3 transverse fingers.  The right nostril is flattened, the tongue is tilted to the right.  Tonus and reflexes are elevated to the right.  All types of sensitivities are reduced to the right ends.  CT scan of the brain - the focus of increased density, dilated cerebellum.  What is the most probable diagnosis?

 

90. A 57-year-old man was admitted to the NSO during the day with a sudden development of 220/120 mm.  On the background of the rise complained of headache, vomiting, weakness and numbness of the right limbs, speech disorders objectively: delayed, muscle rigidity 3 horizontal fingers.  The right nasopharynx is flattened, the tongue is tilted to the right.  Tonus and reflexes are high on the right.  All types of sensitivity in the right leg are reduced.  CT-high-density foci of the brain, dilated ventricles.  What is the most likely diagnosis?

 

A. cerebral infarction

 

B. parenchymal-subarachnoid hemorrhage ++

 

C. circulatory disorders of the spine

 

D. subarachnoid hemorrhage

 

E. serous meningitis

 

 

 

- A 16-year-old girl went to the polyclinic with complaints about episodes of disabling consciousness.  Knows about these episodes from acquaintances and relatives: during the conversation the silence closes, in a few seconds does not react to the spoken speech.  Falling, convulsions, loss of urine denies.  Such attacks can be repeated up to several tens of times a day, lasting 10-20 seconds.  Similar seizures are noted in the sick father.  CT of the brain did not reveal pathology.  Preliminary diagnosis:

 

Idiopathic epilepsy, generalized seizures (typical absences). ++

 

 

 

- The patient is 36 years old.  There were seizures that began with a turn of the head and eyes to the left, after which appeared clonic convulsions of the left arm and legs.  Consciousness is not lost.  The seizure lasted 2-3 minutes.  Now it became worse to see, "fog appears before the eyes", weakened the left arm and leg.  Before entering the clinic it became difficult to walk.  Became apathetic, ceased to be interested in work, family, not disturbed by his illness.  In review: Predictive broad, reaction to light and convergence sluggish.  Movement of the eye is not limited, but there is instability of vision to the left.  Reporting smoothness of the left nostril.  Left hemiparesis.  Tendon reflexes are higher than the right.  Symptoms of Babinsky and Rossolimo left.  The grasping reflex of the left cyst.  Shaking of the left cyst.  The palmar-chin reflex is obtained with the left hand.  Kernig's symptom with both sides.  Angiography: dislocation down into the arterial phase in the frontal-polar branch of the anterior cerebral artery and the anterior branch of the middle cerebral artery.  Clinical diagnosis:

 

65. The patient is 36 years old.  Seizures occur, the head turns and the eye begins to tilt to the left, followed by clonic seizures in the left leg and hand.  The mind is clear.  The seizure lasts 2-3 minutes.  Then he sees poorly, "there is a fog in front of his eyes", his left arm and leg are weakened.  It was difficult to wash before going to the clinic.  He has lost interest in work and family, does not worry about his illness.  On examination: dilated pupils, weak reaction to convergence and light.  Eye movement is not limited, but left eye vision is unstable.  The left side of the nose and lips are flattened.  Left hemiparesis.  Tendon reflexes are higher on the left than on the right.  Left Babinsk and Rossolimo symptom is positive.  On the left, the pull-up reflex is positive.  The left finger is shaking.  Palm-chin reflex in the left hand.  Kernig's symptom is positive on both sides.  Angiography: Dislocation of the middle cerebral artery and anterior anterior artery in the lower part of the anterior-polar branch.

 

Clinical diagnosis:

 

A. cancer of the right forehead ++

 

B. brain worm cancer

 

C. cancer of the right temporal lobe

 

D. Corneal bridge tumor

 

E. tumor of the left occipital lobe

 

 

 

- The patient is 39 years old, is on the street in an unconscious state.  Objectively: the skin is moist, pale, the eyes are moderately extended D = S.  The tone of the muscles is reduced to the extremities.  Inhaled air smells of alcohol.  In light vesicular breathing, there is no snoring.  Tones of the heart are muffled, tachycardia 108 per min.  AD 110/70 mm Hg  There are no focal symptoms.  Meningeal symptoms are negative.  On the skin of the face of the saddle.  Your preliminary diagnosis:

 

66. The patient is 39 years old, lying unconscious on the street.  Objective: the skin is moist, pale, the pupils are slightly dilated D = S.  Decreased muscle tone of the limbs.  The smell of alcohol on exhalation.  There is no vesicular breathing, wheezing in the lungs.  Heart rate is low, tachycardia is 108 minutes.  АК110 / 70 мм рт.ст.  No focal symptoms.  Meningeal symptoms are negative.  Scars on the skin of the face.  Prognosis:

 

A. hypoglycemic coma

 

B. alcoholic coma ++

 

C. drug coma

 

D. acute myocardial infarction

 

E. Acute cerebrovascular accident

 

 

 

- An 18-year-old boy after a transplanted acute respiratory viral infection (ARI) felt tingling in his ankle joints.  Over the course of two days, weakness developed in the benders of the foot, and by the end of the week he had difficulty walking.  Urination and defecation were not violated.  During the week, the weakness progressed and the need for artificial ventilation of the lungs arose.  Tetraplegia developed during the movement of the eyeballs.  Preliminary diagnosis: polyradiculomyeloneuropathyGuillaume-Barre.  Principle of diagnosis:

 

A 72.18-year-old man experienced a concussion in the ankle after experiencing an acute respiratory viral infection (ARI).  For two days he developed weakness during flexion of the foot, and in the last week he had difficulty walking.  No urination and defecation disorders.  During the week, weakness increased and the need for artificial ventilation of the lungs developed.  Tetraplegia develops with the preservation of the movement of the eyeball.  Prognosis: Guillain-Barre polyradiculomyeloneuropathy. ++

 

Diagnostic principles:

 

F. CT of the abdomen

 

G. X-ray of the foot

 

H. genetic analysis

 

I. MRI of the brain, analysis of cerebrospinal fluid

 

J. neurosonography

 

 

 

- At the subway station, a young man of 20 years suddenly felt bad, grabbed his head and fell.  The doctor who came to the rescue found the patient unconscious and determined positive meningeal symptoms.  The girl of the young man said that before she was absolutely healthy and never complained about anything.  Principle of diagnosis:

 

73. At the metro station, a 20-year-old man immediately felt unwell, grabbed his head and fell.  When the ambulance arrived, the doctor determined that the patient was unconscious and had positive meningeal symptoms.  The young man's daughter says she has never been sick before and is healthy.  Diagnostic principles:

 

A. electroencephalogram

 

B. lumbar puncture, MRI of the brain ++

 

C. UDDG of brachiocephalic vessels

 

D. X-ray of the skull

 

E. electromyography

 

 

 

- The patient suffers from attacks of clonic convulsions.  The attack begins with pulling the right leg, then the convulsions cover the entire right half of the body.  The attack lasts 1-2 minutes.  The patient does not lose consciousness.  Examination reveals an easy revival of deep reflexes.  Make a topical diagnosis:

 

15. A sick woman complained of clonic seizures.  The seizure begins with the pull of the right foot, and then the seizure covers the entire right side of the body.  The seizure lasts 1-2 minutes.  Does not lose consciousness.  During the examination, light deep reflexes are awakened from the right side.  Topical diagnosis:

 

A. In the thickening of the neck of the left spine

 

B. The level of irritation is the level of the left upper posterior central spinal cord

 

C. The source of irritation is at the level of the right inner capsule

 

D. The source of irritation is at the level of the brainstem

 

E. The level of irritation is the level of the left upper anterior central spin ++

 

 

 

- In women, 35 years, atrophy of the muscles of the upper extremities, reduction of tendon reflexes, muscle strength and fibrillar support in the muscles of the hand.  The gait has changed, while walking "pulls" the legs.  A sharp increase in tendon reflexes in the legs, pathological reflexes of Babinski and Oppenheim with both sides.  Topical diagnosis:

 

58. A 35-year-old woman with atrophy of the arm muscles, decreased tendon reflexes, muscle strength and fibrillar tremors in the arm muscles.  His gait has changed, he "drags" his legs while walking.  Rapid increase in tendon reflexes in the legs, Babinsky and Oppenheim pathological reflexes on both sides.  Topical diagnosis:

 

A. Injury in the chest

 

B. Injury is less than neck thickening

 

C. Injury is greater than neck thickening

 

D. The lesion is at the level of neck thickening ++

 

E. Injury at the level of lumbar thickening

 

 

 

- After lifting weights, men have been suffering from severe pain in the lower back with irradiation of the outer surface of the thighs and ankles for 40 years, reaching up to the big toe of the left foot.  When reviewing: tension of the muscles of the lumbar region, weakness of the flexors I finger.  Reflexes on the legs are preserved, symmetrical.  Lassega's symptom is a positive left at 40 degrees.  Principle of diagnosis:

 

83. After lifting weights, a 40-year-old man developed severe pain in the back of the thighs and calves with irradiation, the pain reaches the big toe of the left foot.  On examination: tension in the muscles of the lumbar region, weakness of the writing of 1 finger.  Leg reflexes are preserved, symmetrical.  Lasseg's symptom is 40 degrees positive on the left.  Diagnosis method:

 

А.  MRI of the thoracic spine

 

В.  MRI of the cervical spine

 

С.  MRI of the lumbar and pancreatic spine ++

 

D. MRI of the craniovertebral passage

 

Е.  MRI of the left pelvic joint

 

 

 

The patient was 48 years old, complained of excessive menstruation at the age of 3 years, weakness.  Consists of uterine fibroids (uterine sizes 7-8 weeks).  In the last year, doctors were not consulted.  In vaginal examination: the uterus is increased to 11-12 weeks of pregnancy, dense, with an uneven surface.  What can be the recommended treatment?

 

 

 

Choose one answer:

 

a.  Hormonal treatment with progestogens

 

b.  Anti-anemic treatment

 

c.  Hormonal treatment with androgens

 

d.  Symptomatic treatment

 

e.  Operational treatment ++

 

Bolnoy K., 28 years old.  Complaints of intense pain in the lumbar region and the right half of the abdomen, irradiating in the groin and right thigh.  Frequent urges to urinate.  A year ago there was a similar attack, called "ambulance", the pain was stopped by analgesics, but after the attack there was red urine.  Objectively: temperature 36.4 ° С.  The patient is restless, looking for a comfortable position to relieve pain.  There is no pathology of the organs of respiration and the cardiovascular system.  Pulse 76 in min.  AD 120/60 mm Hg  The abdomen is soft, painful on palpation in the right hemisphere.  A symptom of Pasternak's sharp positive positive.  What is the most likely diagnosis? 

 

 

 

Choose one answer:

 

a.

 

glomerulonephritis

 

b.

 

amyloidosis of the kidneys

 

c.

 

urolithiasis ++

 

d.

 

kidney cancer

 

e.  pyelonephritis

 

The patient has 59 years of elevated nutrition, during which 20 hours of pain are held in the right subcutaneous, irradiating in the lumbar region, under the shoulder blade.  Toshnota, repeated vomiting, chills, temperature 38 degrees C.  In this clinical picture it is necessary to assume the diagnosis:

 

 

 

Choose one answer:

 

a.

 

proboscis ulcer of the stomach

 

 

 

b.  acute cholecystitis ++

 

c.  acute intestinal obstruction

 

d.  acute pyelonephritis

 

e.  acute appendicitis

 

The patient was treated for 35 years with complaints of burning pain at the base of the urethra with irradiation in the area of ​​the heart, recovered and intensified after half an hour.  They are not completely cut almagelem.  Also marked bellows air, bumps, coughs.  On FGDS: Mucous food is moderately hyperemic, covered with areas of fibrin.  Smooth, smooth, shiny.  In the cardiac department a moderately expanded light.  Cardia shrinks sluggishly, not completely, freely penetrates into the esophagus.  Everything listed allows you to suspect

 

 

 

Choose one answer:

 

a.  Bronchial asthma

 

b.

 

Cancer of the esophagus

 

c.

 

Chronic gastritis

 

d.

 

GERB  ++

 

e.  Chronic cholecystitis

 

Male 25 years.  Complaints about pain in the right hip.  The general state of the average gravity.  Upon examination - the affected limb is increased in volume, it is determined to increase the inguinal lymph nodes.  On palpation there is a sharp painful, immobile, hot on the palate without sharp edges.  The skin is worn over it.  The movements are painful, the pain is also intensified when changing the position of the body, so the patient tries to move as little as possible.  Which diagnosis is most likely

 

 

 

Choose one answer:

 

a.

 

boil

 

b.  abscess

 

c.  phlegmon ++

 

d.

 

genital inflammation

 

e.

 

gangrene

 

In the women's consultation at the dispensary registration the patient is 17-18 weeks pregnant.  Patients periodically increase diastolic pressure to 90 mm Hg.  and more.  During the examination, proteinuria was found to be 0.06 g / l, when exhausted, restless head pain.  The most probable diagnosis

 

 

 

Choose one answer:

 

a.  Gestational hypertension

 

b.  Preeclampsia is ineffective

 

c.

 

Chronic hypertension with concomitant ineffective preeclampsia

 

d.  Chronic hypertension ++

 

e.

 

Preeclampsia is severe

 

For 64 years, the patient called a general practitioner at home with complaints of dizziness, weakness, trembling in the hands, flickering in front of the eyes.  She suffers from type II diabetes due to which she takes glibenclamide (maninil).  At home, you determine the blood sugar level of 3.1 mmol / l by the express method and find out that for two days before relapse she began to take aspirin from pain in the knee joint.  In addition to events, in this situation, your recommendations should include:

 

 

 

Choose one answer:

 

a.  More strict adherence to diet

 

b.  Add to the diet of potatoes or pasta once a day

 

c.  Increase the dose of aspirin

 

d.

 

Lowering the dose of glibenclamide (during the treatment of arthritis) ++

 

<variant> More strict adherence to diets

 

e.  Consultation with a rheumatologist

 

At the age of 80 years, during the ultrasound examination, a cyst was found on the right side of the liver in the size of 8x8 cm with the same level of fluidity.  In the blood of eonozophilia.  The Katsoni test is positive.  Which operation was shown to the patient

 

Choose one answer:

 

a.

 

resection of liver

 

b.

 

echinococcectomy 

 

c.  puncture cysts under ultrasound control ++

 

d.

 

captainship on Delbe

 

e.

 

marsupialization cysts

 

At the age of 12, during the exams, a strong itch appeared on all skin.  Examination: in the area of ​​the elbow and ankle joints, radial joints of the foci of hyperemia with infiltration, lichenization, multiple linear and point excision.  The skin of the face is hyperemic, cheilitis, angular stomatitis.  From the anamnesis it is known that similar rashes appear annually in the autumn-winter period, in childhood there was diathesis.  With what illness you will not be able to make a differential diagnosis

 

Choose one answer:

 

a.  ichthyosis is common

 

b.

 

neurodermatitis 

 

c.  psoriasis

 

d.  seborrheic dermatitis ++

 

e.

 

contact dermatitis

 

A 39-year-old patient was admitted to the polyclinic with complaints of morning stiffness during the day, pain in the joints of the upper and lower extremities, swelling, restriction of movement, especially in the interphalangeal and lumbar vertebrae.  Objectively: interphalangeal, radiating joints of the hand are swollen, thickened, deformed.  Atrophy of the intercostal muscles.  With sides of internal organs without exceptions.  Your preliminary diagnosis?

 

Choose one answer:

 

a.

 

Osteoarthritis

 

b.  Gout

 

c.  brucellosis polyarthritis

 

d.  Rheumatoid arthritis ++

 

e.

 

Rheumatic polyarthritis

 

The child has 2 months of hypersensitivity, hyperesthesia, chin tremor, irritated scream, tachycardia, high tendon reflexes, marked tonic cramps.  Blood glucose level - 5.5 mmol / l, calcium - 0.9 mmol / l, magnesium - 0.92 mmol / l.  What is listed is the most probable explanation of convulsions in a child

 

Choose one answer:

 

a.  Hypoglycemia

 

b.  Hypomagnesaemia

 

c.  Hypermagnesemia

 

d.  Hyperglycemia

 

e.  Hypocalcemia ++

 

At the age of 45 years there are recurrent hemorrhages in the course of one year.  Which of the listed methods of treatment should be prescribed to the patient

 

Choose one answer:

 

a.  symptomatic treatment

 

b.  operative treatment

 

c.  aspiration biopsy

 

d.  hormonal treatment

 

e.

 

separate diagnostic excision of the uterine cavity  ++

 

The obstetrician-gynecologist was referred to a pregnant woman who was discharged from the infectious hospital a week ago, where she was in a severe form of root red.  The gestation period is 9-10 weeks.  Medical tactics:

 

 

 

Choose one answer:

 

a.  When the defects of the development of the fetus to prevent pregnancy

 

b.  Interruption of pregnancy ++

 

c.  Prolongation of pregnancy

 

d.  Prescribe hormone therapy and continue dispensary observation

 

e.  Take vitamin therapy

 

Choose a method of treatment for patients with rheumatoid arthritis, if there is an increase in temperature, viscera and vasculitis, there is a protrusion in the knee joints, ESR 35 mm / h, the duration of the disease does not exceed 6 months

 

 

 

Choose one answer:

 

a.

 

combination of NPVP with intravenous introduction of kenaloga  ++

 

b.

 

only NPVP

 

c.  preparations of gold

 

d.

 

D-penicillamine

 

e.  Cytostatics

 

 

 

Women with 50 years of excess body weight have been found to have an elevated blood glucose level of 6.9 and 7.2 mmol / l.  Which of the above diagnoses is most likely?

 

 

 

Choose one answer:

 

a.

 

Type 2 diabetes  ++

 

b.  Diabetes mellitus type 1

 

c.  Violation of glycemia on an empty stomach

 

d.  Obesity

 

e.

 

Impairment of glucose tolerance

 

The doctor at the reception of the patient K., 28 years, suffers from pain in the lumbar region, an increase in body temperature to 390C, chills, sweating, thirst, the temperature at the end of the day is very high with chills before subfebrile.  The condition of the middle degree of gravity.  The skin is wet.  In light vesicular breathing.  Tones of the heart are deaf, rhythmic, heart rate 110 beats per minute, blood pressure 90/60 mm.  рт.  Art.  On palpation, the disease is in the area of ​​both kidneys.  In the analysis of urine a large number of leukocytes.  In the analysis of blood leukocytes 15x10 12 / l with a shift to the left.  On this background, tachycardia appeared to 139 per minute, blood pressure decreased, the amount of urine decreased sharply, hemorrhage appeared on the skin.  Your preliminary diagnosis

 

 

 

Choose one answer:

 

a.  Acute pyelonephritis with infectious-toxic shock

 

b.  Kidney tuberculosis

 

c.  Lumbar-sacral radiculitis

 

d.  Acute glomerulonephritis

 

e.  Acute pyelonephritis ++

 

The girl is 1.5 years old.  The mother complains about the presence of rashes on the skin of the child, expressed skin itching, sleep disorders.  Up to 3 months of life, the child was breastfed to improve lactation by drinking tea with condensed milk, honey.  From 3 months the child is transferred to artificial insemination.  Prikorm entered in 6 months: semolina on cow's milk, eggs, cow's milk.  The rashes appeared on the skin for the first time in 6 months of life.  When inspecting the skin, dry skin.  In the area of ​​the cheeks, neck, external surface of the upper and lower extremities, elbow and ankle grooves, buttocks skin hyperemia, edema, covered with microvesicles.  Wet, multifaceted erosions and crusts are observed.  On internal organs without peculiarities.  The stool is porridge-shaped, with uncooked lumps of food.  Your preliminary clinical diagnosis.

 

 

 

Choose one answer:

 

a.  atopic dermatitis, subacute period, moderate, widespread

 

b.  atopic dermatitis, juvenile stage, puberty, middle age

 

c.  atopic dermatitis, juvenile stage, puberty, common

 

d.  atopic dermatitis, juvenile stage, puberty, moderate, common

 

e.  atopic dermatitis, juvenile stage, subacute period, erythematous-squamous form, moderate, widespread ++

 

The woman is 69 years old, suffers from headaches, more in the occipital region, noise in the ears, stabbing pains in the heart area, swelling of the ankles.  Over the course of 10 years marks an increase in blood pressure to 160/100 mm Hg.  Art.  Growth 164, weight 82 kg.  Tones of the heart are muffled, accent 2 tones over the aorta.  AD 180/115 mm Hg  Pulse 88 beats per minute.  Which of the listed conditions can be recovered in this patient?

 

Choose one answer:

 

a.  Atherosclerosis of the carotid arteries

 

b.  Myocardial infarction, cerebral stroke, cardiac insufficiency ++

 

c.

 

Metabolic syndrome, chronic kidney disease

 

d.

 

Excess body mass, Mercury arrhythmia

 

e.  Ischemic heart disease

 

The child was born 7 months ago in asphyxia.  During the examination - moderately increased vascular pattern in the area of ​​the transplant, the forehead, the large umbilical cord is closed, CHMN - without pathology.  The child is restless, disturbed in sleep, jumps down for 2 hours after feeding "curdled milk".  What kind of food from the above is the most acceptable

 

 

 

Choose one answer:

 

a.  Belactose-free mixture

 

b.

 

Milk mixture on a goat's milk

 

c.

 

Milk mixture "Comfort 4"

 

d.

 

Milk mixture with a thickener

 

e.  Acidic mixture ++

 

The boy is 2.5 months old.  From the second pregnancy on the background of gestosis II half.  Born with a mass of 3600g., Growth 53cm.  With 3.5 weeks of frequent sprains.  Objectively: Pale skins, pale with "marble" pattern.  Subcutaneous fat layer is thinned, turgor tissue is reduced, muscular hypotension.  On internal organs without pathology.  Weight of the child at inspection 4300g.  Your diagnosis.

 

Choose one answer:

 

a.  Pylorostenosis

 

b.

 

Pylorospasm 

 

c.  BEN II degree ++

 

d.

 

BEN III degree

 

e.

 

BEN I degree

 

 

 

At the age of 51, women experience long-lasting pain and a feeling of rupture in the right pelvis.  When examining jaundice, there is no positive symptom of Kera, Ortner, subfebriletemperature, hemogram SOE-30 mm / h.  What is the most likely diagnosis?

 

 

 

Choose one answer:

 

a.

 

chronic pancreatitis in the phase of exacerbation

 

b.

 

chronic hepatitis in the phase of exacerbation

 

c.  ulcerative colitis in the phase of exacerbation

 

d.  chronic cholecystitis in the phase of exacerbation ++

 

e.  cirrhosis of the liver in the stage of decompensation

 

 

 

At the reception of the child 9 months.  With the words of the mother of the child for a long time received anti-vascular therapy.  The latter often sweats, became restless, sleeps poorly.  After examination, the doctor diagnosed: Rickets II, subacute, period of exacerbation.  What drug helped to develop rickets?

 

 

 

Choose one answer:

 

a.  Actiferrin

 

b.  Penicillin

 

c.

 

Calcium gluconate

 

d.  Diazepam

 

e.  Phenobarbital ++

 

The patient was admitted to the clinic at the age of 39 with complaints of morning stiffness during the day, pain in the joints of the upper and lower extremities, swelling, restriction of movement, especially in the interphalangeal and radial lobes.

 

Objectively: interphalangeal and radial joints of the hand are swollen, thickened, deformed.  Atrophy of the intercostal muscles with the exception of internal organs without features.  Blood leukocytes 14 ∙ 10 9 ∕ l, neutrophilia, soy - 42 mm / h;  fibrinogen-7g / l.  СРБ +++ р-я.  Rose of the Rose 1: 64 ∙ R-gr ​​1 saline joints - peripheral osteoporosis.  The doctor's further tactics

 

 

 

Choose one answer:

 

a.  hospitalization in rheumatology department ++

 

b.  treatment in a day hospital

 

c.  treatment in polyclinic conditions

 

d.  inpatient organization at home

 

e.

 

the treatment is not needed

 

A woman complained to the precinct doctor about the delay in menstruation (the last was 8 weeks ago), nausea and sometimes a single vomiting in the morning, intolerance to odors.  During vaginal examination, there is a "softening" of the uterus.  The uterus has a soft consistency, becomes more dense on palpation, increased to the size of a "goose egg".  Painless.  The appendages are not enlarged, painless.  Pregnancy is not desirable.  Tactics doctor

 

 

 

Choose one answer:

 

a.

 

Guide to interruption of pregnancy

 

b.

 

Conduct clinical and laboratory examination and referral for interruption of pregnancy ++

 

c.  Conduct a clinical and laboratory examination and send home

 

d.

 

Conduct clinical and laboratory examination and ultrasound of the uterus

 

e.

 

Carry out clinical and laboratory examination and put on dispensary observation

 

The patient for 70 years complained of pain in the right subcutaneous area of ​​the epigastric region, radiating in the back, under the left shoulder blade, nausea, single vomiting.  During the examination, the surgeon suspected a sharp myocardial infarction.  What diagnostic method allows you to differentiate the onset of biliary colic from acute myocardial infarction?

 

 

 

Choose one answer:

 

a.

 

troponin test ++

 

b.

 

determination of cholesterol levels in the blood

 

c.

 

РХПГ

 

d.  review R-graph organs of the peritoneal cavity

 

e.

 

coronary angiography

 

The patient complains of 26 years of coagulation and swelling of the mammary glands and ankles, bloating, irritability, sweating.  Sick for 3 years.  The prescribed symptoms appear in the second phase of the menstrual cycle and stop after the next menstruation.  Over the years, the severity of symptoms does not increase.  No gynecological examination revealed pathology.  What form of premenstrual syndrome is likely in this case?

 

 

 

Choose one answer:

 

a.  Crisis

 

b.  Swelling ++

 

c.  Nervous-mental

 

d.  Cephalgic

 

e.  Atypical

 

The mother of the child N, 2018, went to the polyclinic at the place of residence with complaints of high temperature in the daughter, chills, pain in the throat, the presence of pus on the tonsils.  Diagnosed: Purulent angina.  Mom works as a weaver in a printing house.  Does the mother have the right to a sick leave for the child, and for what period?

 

 

 

Choose one answer:

 

a.

 

Upon departure for a sick child, a sheet or certificate of temporary incapacity is issued and extended to the period in which it is required to leave, but not more than twelve calendar days.

 

b.  For the care of a sick child, a sheet about temporary incapacity is issued and extended to the period in which he needs to leave, but not more than ten calendar days ++

 

c.  For the care of a sick child, a sheet or certificate of temporary incapacity is issued and extended for the period in which it is needed for care, but not more than six calendar days

 

d.

 

For the care of a sick child, a sheet or certificate of temporary incapacity is issued and extended for the period in which he needs care, but not more than five calendar days.

 

e.  For the care of a sick child is issued only a certificate of temporary incapacity for a period not exceeding 10 calendar days

 

The patient has been calling a doctor at home for 35 years due to acute pain in the epigastric region, vomiting with blood, weakness, dizziness.  From the anamnesis 2 months ago was treated for ulcerative colitis.  Objectively: pale skin.  On palpation there is a sharp pain in the epigastric region.  A chair of black color.  What complication can be suspected?

 

Choose one answer:

 

a.

 

Malignancy

 

b.

 

Penetration

 

c.

 

Perforation

 

d.  Stenosis

 

e.  Bleeding ++

 

Women with a positive pregnancy test on January 12, 2020.  She had a regular 28-day cycle, the last menstruation was from 8 to 11 December 2019.  Assumed term of birth:

 

 

 

Choose one answer:

 

a.

 

January 22, 2020

 

b.

 

October 12, 2020

 

c.  September 8, 2020

 

d.  September 1, 2020

 

e.  September 15, 2020 ++

 

What is the main task of obstetricians and gynecologists?

 

Choose one answer:

 

a.  indication of active and passive patronage

 

b.  indication of inpatient care for pregnant and gynecological patients

 

c.

 

identification of risk group for maternal and perinatal mortality

 

d.

 

reduction of maternal and perinatal morbidity and mortality ++

 

e.

 

reduction of extragenital pathology

 

What research method is the most informative for the diagnosis of nonspecific ulcerative colitis?

 

 

 

Choose one answer:

 

a.  X-ray examination of the small intestine

 

b.  coprology

 

c.  colonoscopy ++

 

d.  sow kala on the microflora

 

e.

 

gastrotomy 

 

 

 

 

 

The mother of a monthly child turned to the baby with anxiety.  From the anamnesis: intervals between feedings 3.5 hours.  After each feeding, the mother strains 20-30 ml of milk.  For a month added 300 gr.  During the control suckling sucked 100.0 breast milk. What is listed below is to recommend in this case

 

 

 

Choose one answer:

 

a.  Continue feeding

 

b.  Docorm with ground milk

 

c.

 

Translation to free feeding mode  ++

 

d.

 

Drug stimulation of milk

 

e.

 

Translation into mixed frying

 

 

 

The child is 1 month old, is in natural feeding, supplementation is 800 g per month, calm, stool with birth of yellow porridge 3-4 times a day, when studying kala on dysbiosis revealed staphylococcus aureus 103 KE.  Staphylococcus epidermal 245 colonies were found in 1 ml of milk at the time of milking.  Your recommendations:

 

 

 

Choose one answer:

 

a.  translate into artificial feeding

 

b.  prolong breastfeeding, prescribe probiotics mother and child ++

 

c.  forbid breastfeeding

 

d.  prolong breastfeeding, prescribe antibiotics to mother and child

 

e.  to feed skimmed, pasteurized breast milk

 

Patient K., with insulin-dependent diabetes mellitus in the unconscious state, pupils dilated.  The tone of the eyeballs is elevated.  The temperature is normal.  Leather covers wet.  There is no smell of acetone.  In light vesicular breathing, there is no snoring.  CHDD 20 per minute.  Tones of the heart are muffled, the rhythm is wrong with the CCS- 90 per minute.  AD - 90/60 mm Hg.  (+) Babinski's symptom.  An express study (glucose test) was conducted.  Indicate the cause of the symptom complex.

 

 

 

Choose one answer:

 

a.  Lactacidemic coma

 

b.

 

Hypothalamic - pituitary coma

 

c.  Ketoacidotic coma

 

d.  Hyperosmolar coma

 

e.

 

Hypoglycemic coma ++

 

The woman is 68 years old, suffers from headaches, flaking of ants in front of the eyes, a bad dream.  For the first 6 years ago, an increase in AD to 160/100 mm Hg was detected.  Heredity of SSZ is aggravated, hypodynamics Index mass of the body - 31 kg.  Tones of the heart are muffled, accent 2 tones over the aorta.  AD 175/105 mm Hg  Pulse 68 beats per minute, tense.  B \ x - dyslipoproteinemia.  In OAK, OAM without pathology.  Which of the above diagnoses is most likely?

 

 

 

Choose one answer:

 

a. Arterial hypertension IIIst, risk 4

 

b. Arterial hypertension IIIst, risk 3

 

c. Arterial hypertension IIIst, risk 2

 

d. Arterial hypertension II st, risk 1

 

e. Arterial hypertension II st, risk 3 ++

 

The teenager was referred to the family doctor for 15 years, with complaints of severe weakness, nausea.  Nakanune and today morning the boy had a black degteobrazny chair.  Examination: skin and visible mucous membranes sharply pale, cold sweat, heart rate 120 beats per minute, BP 80/30 mm Hg.  HAC hemoglobin 60 g / l.  Your diagnosis:

 

Choose one answer:

 

a.  gastric-intestinal bleeding ++

 

b.  crack in the anterior passage

 

c.  malabsorption syndrome

 

d.  cholestasis syndrome

 

e. ulcerative nonspecific colitis

 

 

 

Sick 51 years.  Complaints of frequent seizures, headache, hyperhidrosis, pain in the heart.  History: hypertensive disease.  P / m was 3.5 months ago, painless.  During the gynecological examination of the pathology was not identified.  Your diagnosis

 

 

 

Choose one answer:

 

a.  Climacteric syndrome ++

 

b.  Myocarditis

 

c.  Algodysmenorrhea

 

d.  Hypertensive crisis

 

e.  Angina pectoris

 

The woman went to the clinic for 46 years with complaints of excessive prolonged menstruation, weakness, reduced ability to work.  Examination: pale skin, pulse 78 beats / min, rhythmic.  AD 125/80 mm Hg.  st., hemoglobin level 80 g / l.  In bimanual research and with the help of a mirror: the cervix is ​​not changed, the uterus is increased in size, corresponding to 16-17 weeks of pregnancy, mobile, painless.  The appendages are not defined.  What is the end of the volume of operational interference?

 

 

 

Choose one answer:

 

a.  Conservative myomectomy

 

b.  Amputation of the uterus without appendages ++

 

c.  Salpingoectomy

 

d.  Extirpation of the uterus without appendages

 

e.  Removal of the cervix

 

Child 1 year.  Found in natural vskarmlivanii, in the corresponding

 

terms of introduced dishes and prikorma products.  Determine the one-time volume of food.

 

 

 

Choose one answer:

 

a.  300 ml

 

b.  200 ml ++

 

c.  400 ml

 

d.  350 ml

 

e.  250 ml

 

In accordance with the order of the Minister of Health of the Republic of Kazakhstan № 149 from 23.10.2020, a dynamic observation is carried out for people with chronic diseases and within the framework of disease management programs (PUZ).  Criteria for the selection of patients participating in the PUZ are:

 

Choose one answer:

 

a.  patients with CD 2 type only compensated, patients with chronic heart failure class II-IV with NYHA with a fraction of less than 40% or with a fraction of more than 40% and diastolic esophageal dysfunction of the left ventricle

 

b.  patients with primary hypertension uncomplicated, patients with chronic heart failure class II-IV with NYHA with a fraction of less than 40%

 

c.  all patients with chronic non-infectious diseases

 

d.  patients with primary hypertension uncomplicated, patients with type 2 CD, patients with chronic heart failure class II-IV with NYHA with a fraction of ejaculation less than 40% or with a fraction of ejaculation more than 40% and diastolic echocardiography.

 

e. patients with primary hypertension uncomplicated, patients with CD 2 type compensated and decompensated, patients with chronic heart failure grade II-IV according to NYHA with fraction of disc herniation eradicated less than 40% or more fraction of the disease. ++

 

Loss of ability to memorize, fixate current events. Is called

+fixation amnesia

 

During a final exam, a worried college student suddenly experiences perioral tingling, carpo-pedal spasms, and feelings of derealization. Choose the appropriate vignette

+ Hyperventilation episode

 

The members of the medical team carring for a young woman admitted for her third overdose are uncharacteristically arguing over the best way to address the patient’s increasingly emanding attitude. The nurses see her as manipulative and exploitative, while the male resident is much more willing to justify her behavior on the basis of the patient’s history of abuse and neglect. What personality disorder does this scenario suggest

+Borderline

 

27-years-old microbiology technician has had three bouts of purulent arthritis and several subcutaneous abscesses in a six-month period. She does not seem upset or worried; on the contrary, her mood brightens when her medical condition worsens. She has several scars on her abdomen and she is missing two toes on her left foot. She does not want her new, puzzled physician to obtain her past medical records. What is the most likely diagnosis

+Factitious disorder

 

37-years-old male with a history of alcohol abuse is hospitalized for dehydration and pneumonia. While being treated, he becomes acutely confused and agitated. He cannot move his eyes upward or to the right and he staggers when he tries to walk. Choose the appropriate vignette +Wernicke’s encephalopathy   60-years-old man with alcoholism is brought to the emergency department by his family after they notice a decline in memory. On examination the patient’s remote memory is intact as verified by the family, but his recent recall is severely impaired. The patient provides verbose but erroneous answers in response to questions testing recent recall. This condition is called + anterograde amnesia   35-yearsattachedattached-old woman presents with episodic anxiety and complains of the occasional feeling that she has heard or perceived things prior to actually hearing them. She expresses her concern that she is “going crazy.” You assure her that this can occur in anxiety disorders. This condition is called + déjà entendu   86-years-old woman in the intensive care unit awakes at night and mistakes her intravenous (IV) pole for a family member coming for a visit. She calls the nurses to ask them to have the visitor leave until morning. This condition is called +illusion   22-year-old man is brought to the emergency department 2 weeks after a motor vehicle accident in which he suffered significant head trauma. His parents are concerned because, although the patient recognizes them on the telephone and responds appropriately, when he sees them face-to-face, he believes them to be imposters who have replaced his real parents. He agrees that these people look like his real parents but is convinced that they are indeed imposters. The diagnosis is   +Capgras syndrome     72-years-old retired English professor with a long history of hypertension has been having difficulties with tasks he used to find easy and enjoyable, such as crossword puzzles and letter writing, because he cannot remember the correct words and his handwriting has deteriorated. He has also been having difficulties remembering the events of previous days and he moves and thinks at a slower pace. Subsequently, he develops a mild right facial hemiparesis and slurred speech. Choose the appropriate disorder + Multi-infarct dementia   A patient reports to you that for the past week or two he has had the belief that his intestines and his heart have been removed. When asked about his lack of getting out in the world, he responds “What is world There is no world!” The diagnosis is +Cotard syndrome   The focus and degree of concentration on the object and activities is called +attention   32-years-old woman with a chronic psychiatric disorder is greatly concerned because her breasts have started leaking a whitish fluid. What is the most likely cause of this symptom +Haloperidol   Patient K., male 39 years old was brought to the psychiatric hospital by an ambulance. Two days ago became anxious and restless. It seemed to him that his room was full of people, different voices shouted from outside through the wall that they were going to kill him, threatened him, suggested to go and have a drink. At night he couldn't sleep, saw mice with their tails cut off, then a goblin appeared and ordered the patient to gather gold from the floor. He saw all these creatures and objects as if they were real, picked up golden coins and felt them in his hands. At the inpatient department the patient is excited, his state worsens in the evening and at night. The contact with him is formal. Knows his name and age, but doesn't understand where he is. The syndrome is +Delirious syndrome

Symptoms of withdrawal first appear in chronic users within 24 hours. Withdrawal is most pronounced for the first 10 days and can last up to 28 days. The syndrome is +Marihuana withdrawal     The cognitive functions of an elderly man have deteriorated significantly during the previous month. He has become easily distractible, apathetic, and uncharacteristically unconcerned about his appearance. His gait shows a shortened stride length and step height. In copying a complex picture, he makes many mistakes and ignores details. He has also become incontinent of urine. What is the cause of this reversible dementia +Normal pressure hydrocephalus     A maladaptive pattern of substance use that leads to clinically significant impairment or distress +substance abuse     50-yeasr-oId woman is admitted to the hospital with complains that she is dead. She believes that her flesh is rotting and that she is able to smell the rancid odor. This condition is called +Cotard syndrome

15-years-old boy with a urine toxicology screen positive for cocaine. The diagnosis is

+conduct disorder

 

 

This drug is the milky latex fluid contained in the un-ripened seed pod of the poppy. As the fluid is exposed to air, it hardens and turns black in color. This dried form is typically smoked, but can also be eaten. What is it about

+Opium

 

 

21-years-old woman diagnosed with panic disorder comes to the outpatient mental health clinic with increased frequency of panic attacks and complains of feeling as if her surrounding environment is unreal and strange. As a result of the increasing frequency of her attacks and this new symptom, she has been unwilling to leave her apartment for several weeks. This condition is called

+derealization

 

 

Manic episodes, Panic Disorder, and Generalized Anxiety Disorder can cause a clinical picture similar to Disorder. The Disorder is

+Caffeine Intoxication

 

 

Intelligence disorders include

+mental retardation and dementia

 

Unreal flashbacks about events, which weren’t in right period of time, but they happened or could happen in the past. This condition is called

+Pseudoreminiscence

 

A 36-year-old man presents to the emergency department after being found without clothing in the street. He has multiple excoriations all over his body and states that bugs are crawling all over him. His toxicology screen is positive for cocaine. This condition is called

+formication

 

 

22-years-old woman is admitted to the hospital because of right-hand anesthesia that developed after an argument with her brother. She is in good spirits and seems unconcerned about her problem. There is no history of physical trauma. The neurologic examination is negative except for reduced sensitivity to pain in a glove-like distribution over the right hand. Her entire family is in attendance and is expressing great concern and attentiveness. She ignores her brother and seems unaware of the chronic jealousy and rivalry described by her family. The most likely diagnosis is

+Conversion disorder

 

45-years-old man is constantly sleepy and fatigued. At night he partially wakes up many times gasping for breath. His wife reports that he does not snore but she has noticed that he frequently stops breathing while he sleeps. Choose the appropriate vignette

+Central sleep apnea

 

 

40-years-old woman’s cognitive functions have progressively deteriorated for several years, to the point of needing nursing home– level care. She is depressed, easily irritated, and prone to aggressive outbursts, a dramatic change from her premorbid personality. She also presents with irregular, purposeless, and asymmetrical movements of her face, limbs, and trunk, which worsen when she is upset and disappear in sleep. Her MRI shows atrophy of the caudal nucleus and the putamen. Match each vignette with the appropriate disorder

+Huntington’s disease

 

 

21-years-old man is noted to be restless and constantly moving. He states that he feels as if he has to be moving all the time and is uncomfortable if he sits still. This sensation is known as

+akathisia

 

 

34-years-old man recurrently perceives the smell of rotten eggs. This kind of hallucination is relatively rare and is most commonly encountered in patients with

+Partial complex seizures

 

 

A false belief inappropriate to the patient's socio-cultural background and firmly held in the face of logical argument or evidence to the contrary. It is not modified by experience or reason. The symptom is

+Delusion

 

 

45-years-old man with a chronic psychotic disorder is interviewed after being admitted to a psychiatric unit. He mimics the examiner’s body posture and movements during the interview. The symptom is

+Echopraxia

 

 

14-years-old boy with an IQ of 68. The diagnosis is

+mild mental retardation

 

 

13-years-old girl with a bald patch on the back of her head and an otherwise normal physical and laboratory examination. The diagnosis is

+trichotillomania

 

 

When asked about his level of education, 48- years-old man with a history of schizophrenia describes his high school grounds, friends he had at the time, clubs he joined, and his high school graduation. He concludes by saying, “And that was the end of my schooling.” This answer demonstrate

+circumstantiality

 

 

A man being given a placebo for abatement reports 30 minutes later that the pain has disappeared. The most appropriate conclusion is that the man

+Responds to placebos

 

Q. Child today has been in contact with measles patients, and therefore, it was made intramuscularly gamma globulin. Indicate the expected duration of the possible development of the child have measles:-

+from 9 to 21 day from the moment of contact

 

Q. Choose the disease which is a result of the new disease infecting by the same agent ?

+reinfection

 

The child is 5 years old, was admitted to the hospital complaining of physical developmental delay. The child works badly Objectively: in mental development is not falling behind, there is excessive development of the shoulder girdle. The lower part of the body, limbs weak, hypomyotonia; heart borders extended to the left by 2 cm; cardiac impulse and the first tone amplified. Systolic murmur in the 2nd intercostal space on the right. The liver is not increased. Pulse on the feet is not defined. Blood pressure at the hands of 150/90 mmHg. The most likely diagnos is:

+aortic coarctation

 

Child 3 years was ill acutely with the fever up to 39, 8° c, headache, 4-told vomiting, loose stool up to 16 times per day with mucus streaked blood. Objectively: by palpation abdomen is sensitive, there is soreness in the left iliac region, and spasm sigmoid colon is tenesmus. The suitable diagnosis is:

+AEI, with a syndrome of a colitis, serious severity

 

The disease which differentiate pyelonephritis is:

+Tuberkulez of kidneys

Child 3 years old Against the background of full health the child had an attack of convulsive tussis, dyspnea ,anxietywhich passes in a dream. The mother noted that the child played with fine objects. On examination ,there is an expiratory dyspnea. On percussion lungs: a sound with a bandbox shade, respiration in lungs on auscultation - rigid, the single dry whistling rhonchuses.GBT without changes. On R-gram of a thorax inflations of the pulmonary drawing become perceptible. The most probable diagnosis:

+ debride

The child is 1 year old. The examination revealed: Percussion, increase in heart size do the left and right rough auscultation systolic murmur along the left sternal edge with a maximum in the IV m / d. On the electrocardiographic hypertrophy of both ventricles of the heart. X-ray: increased pulmonary pattern, the increase in heart size due to right and left heart departments. The diagnoses is :

+defect of intraventricular septum

 

Tolochinov-Roget's illness is:

+VSD in a muscular part

The patient 5 years old. Complaints of temperature up to 39,4 °C, dyspnea, tussis. Become ill sharply.On examination integuments and visible mucous acyanotic, are pure. Lag of the right half of a thorax in the act of respiration, restriction of mobility of bottom edge of the right lung was observed. The shorting of a percussion sound in lower parts became perceptible on the right. Roentgenogram of a thorax: the infiltrative shadow occupying the lower share of the right lung is taped. The diagnosis is right-side lung fever. What etiology of a disease is necessary to think first of all in the described clinical case?

+pneumococcus

 

The child with stomatopharynx diphtheria in 3 days from an onset of the illness had following symptoms: the rasping barking tussis, stenotic respiration, changes of a voice up to an aphonia. The most probable process which developed in the child:

+ diphtheritic croup

The child at the age of 8 months comes to a hospital with fever up to 37,40C, clinic of paroxysmal tussis with reprises to 10 times a day. Hemorrhages in scleras of eyes, a tongue bridle anguish become perceptible. Percussionly over lungs a bandbox sound. On auscultation: not plentiful dry rhonchuses. Preliminary diagnosis: Whooping cough. The laboratory and instrumental methods for differential diagnosis is:

+the general blood test, a method of the tussive plates, R-gram of a thorax, IFA with definition of antibodies to Bordetella pertussis

 

Vova, 5 year old, got sick sharply, moderate edemas on the face and legs. The BP is raised, urine of color of meat slops. Blood test: the general protein and cholesterin are normal GBT – a moderate leukocytosis, an eosinophilia, in the analysis of urine – protein of 2 g/l, a gross hematuria, a cylindruria. The diagnosis is:

+glomerulonephritis with a nephritic syndrome

 

The child has 5 years, being in somatic unit with the diagnosis: bronchial asthma, for the 10th day of stay in a hospital raised temperature to 38C, pain at a mastication developed, a headache, repeated vomiting, an abdominal pain. On examination the doctor found the tumescence in parotid areas on both sides shining and morbid at palpation, depression of sialosis, the skin is not hyperemic. The presumptive diagnosis is:

+parotitis infection

 

The immunoglobulins are defined in child in the end of an infectious disease:

+G immunoglobulins

 

The boy R., 12 years old was admitted came to unit with complaints of delicacy, nausea, vomiting, temperature increase, onychalgias. The real aggravation of symptoms became perceptible 10 days ago when temperature was upto 39,3 °C increased, submandibular lymph nodes were enlarged. In out-patient blood test the hyperleukocytosis is taped 200×109/l . Submandibular, cervical lymph nodes by the sizes to 1,5 cm, mobile, painless are palpated; axillary, inguinal lymph nodes to 1,0 cm in the diameter. The liver +4,0 cm, a lien +2,0 cm is lower than edge of a costal arch. Most acceptable following step in diagnostics?

+myelogram + cytogenetics

 

The pollen allergens belongs to :

+fleabane

 

The child is 2 years old. Body temperature is 38,5 C. Flaccid. Appetite is reduced. Wet tussis disturbs. BR 48 per minute. Shorting of a pulmonary sound on the right in infrascapular area. Weakening of respiration and wet small bubbling rale. The diagnosis "Community-acquired right-hand focal pneumonia" is previously established. What is "the gold standard" of diagnostics of this disease:

+R-graphy thorax organs

 

In new born child with the difficult intranatal period and on asphyxia at the birth in blood is found metabolic disturbances. On a neurosonography - an arachnoid cyst settling down in a web cover. The most probable syndrome is possible in this child:

+ convulsive syndrome

A 6-months child premature, bottle-fed from birth. Supplemental feeding are not given.At the dispensary examination there is revealed anemia. Hb -. 90 g / l, er - 3,8h10 12 / l. The diagnois is:

+Iron deficiency anemia of mild severity

 

ECG in congenital fibroelastosisshows:

+low voltage QRS complexes

 

The child is 2,5 months old, complaints of concern, the increased sweating, fearfulness. From the anamnesis since the birth he is on artificial feeding, receives cow's milk since the birth, was born prematurely prophylaxis of Vit D2 wasn't carried out,do not go outside. On examination the head is brachycephalous form, at palpation it is soft, edges of BR pliable and soft, a craniotabes, lambdoid suture and posterior parts of parietal bones have softening areas up to 1,5-2cm, when pressing the feeling of soft parchment appears. Hypomyotonia.The level P is decreased and the ALP level is high in biochemistery. Make the clinical diagnosis on classification:

+rachitis 1 acute current

 

The child 3,5month old, has weight is 4500gr, length 59 cm, 8 days in hospital with the diagnosis Dystrophia as an oligotrophy of 2 degree, an initial stage, the admixed etiology. On artificial feeding, weight at the birth is 3400, length is 51 cm. The stages of a fiding forto the child:

+intermediate stage

 

At histological examination of the lungs, it was found that in most cases the lung areas taken on the radiograph for the thickening of the interstitial tissue consisted of sleeping alveoli, micro-ateleclactasis. Changes which are characteristic for pneumonia:

+Interstitial

 

At high VSD is auscultatory auscultated:

+systolic hum in the III-IV intercostal space to the left of a breast bone.

 

Child , 10 years old, is on hospitalization because of pneumonia. On thorax X-ray: Pulmonary pattern is mesh, from roots of lungs strips spindle-shapedly proceed, there are accurately outlined shadows. The changes in X-Ray are characteristic of:

+interstitial

 

The child came to a hospital where DS was exposed: ORL activity of the II degree, myocarditis, failure of the mitral valve, polyarthritis. HF 1 degree is the most acceptable pharmacotherapy:

+Indomethacinum

 

A boy 11 years old with duodenal ulcer, the complicated bleeding level of red blood cells– 2,1х1012/l, hemoglobin-57g/l. Which method of treating anemia is required in this situation?

+intravenous maintenance eritrocitarnamass

Childbirth are considered preterm birth:

+32-36 week

 

The girl, 5 years old, was brought to clinic with plentiful nasal bleeding and multiple ecchymoses on a body. Objectively: paleness, on skin a large number ecchymomas and petechias. Hemorrhages are available on mucous of the mouth and eyelid, on an eye conjunctiva. Cardiac sounds are muffled. Ps – 110 per min. The lien is 1 cm lower than a costal arch. Symptoms of a pinch, a garrot, mallear are positive. Blood test RBC - 4,2*1012, Hb – 115g/l/½ Color index- 0,9, Le - 7*109, Eosinocytes - 1%, Monocytes - 9%, an ESR-18mm/ch, thrombocytes - 30*109, an anisocytosis of thrombocytes. The retraction of a bloody clot didn't occur. Duration bleeding is 8 min. Marrow punctate: a red and white sprout aren't changed. The megakaryocytic sprout is angry. Release of thrombocytes is enlarged. After carried out treatment she is written out in satisfactory condition with quantity of thrombocytes 180*109. The diagnosis. Is:

+Werlhof's disease

 

The patient has a dysuric disorder, pain with an act of urination. There is no abnormality in the blood. The temperature is normal. In the analysis of urine: leucocyturia. Diagnosis:

+cystitis

 

The girl 4 years old, applied to a hospital with complaints of Fruises on the legs, nasal bleeding. On examination: girl of subnutrition, acyanotic. Lymphonoduses aren't enlarged. There are numerous Fruises on legs.On body: single elements of a petechial eruption.Positive symptom of a pinch, garrot.On mucous of the mouth and on eyelid there are numerous hemorrhages.Internals without changes.Hb – 110g/l/½ ages - 4,2*1012, color index - 0,9, leucocytes - 8*109, eosinocytes - 1%,lymphocytes - 44%, monocytes - 9%, an ESR - 8mm/h, thrombocytes - 70*109. Duration of bleeding is 6 min., coagulability of a blood on Morovitsa - to the first is 2 min.,the last- 4 min. Marrow punctate: the red and white sprout isn't changed. The quantity of megacaryocytes is a little increased, but the release of thrombocytes is lowered. Treatment within a month with Prednisolonum and aminocapronic acid didn't lead to improvement. The right diagnosis is:

+angiohemophilia

 

The child 3 years old, is hospitalized with the diagnosis of ARVI. For the 3rd day the patient had a dyspnea, sharp delicacy, thready pulse, frequent tussis with a foamy sputum at a mouth. At auscultation in lower parts of lungs on both sides fine moist rales. Cardiac sounds are muffled, tachycardia. On the roentgenogram: an alveolar fluid lungs, there are no focal shadows. On ECG: depression of function of a left ventricle. Possible complication is:

+acute left ventricular heart failure

 

The patent ductus arteriosus is:

+between descending arch of the aorta and the pulmonary artery in its bifurcation

 

A boy 10 years old with duodenal ulcer, the complicated bleeding level of red blood cells -2,2х1012/l, Нв-54g/l. Which method of treating anemia is required in this situation?

+intravenous maintenance eritrocitarna mass

 

The child at the age of 6 months with complaints of a dyspnea, tussis, temperature increase came to DGB. The child got sick sharply. State is moderate severity. Integuments are acyanotic, a periorbital cyanosis. A thorax is expanded has barrel-shaped Percussionly: bandbox sound. On auscultation: respiration is rigid, abundance the fine moist rales in upper parts of lungs. The diagnosis is: Acute obliterating bronchiolitis. The lesion of lungs on a roentgen reminds "a wadded lung". With what diseases it is necessary to differentiate, considering these changes on a roentgen of lungs:

+Tuberculosis lungs

 

General condition of the child (1year) heavy. Skin pale waxy shade, dry. The eyelids and feet slightly swollen. There have perleches, cracks in the mucosa of the portion of the lips, angular stomatitis. Laxity muscles. The liver and spleen were significantly increased. In the rest position, tachycardia, dyspnea, systolic heart murmur. Appetite is greatly reduced, there was repeated vomiting and diarrhea. HB - 66 g / l, er - 2,3h1012 / L, CPS - 0.5. Anisocytosis +++ +++ poikilocytosis. 9 ESR mm / hour. Leukocyte formula without pathology. The diagnosis…

+hemolytic anemia

 

The following stages of congenital heart defects relate to the stages of compensatory hyperfunction of the heart:

+Emergency phase, hypertrophy, Cardiosclerosis stage

 

Misha, 8 years old, acute viral hepatitis. Choose the correct marker to confirm the diagnosis:

+anti HAV Ig M

 

The congenital defects proceeds with a small circle of a blood circulation:

+Fallo's tetrad

 

Vitya, 15 days, got sick acute, the petechial hemorrhagic eruption, ecchymoses, are appeared on the body nasal bleeding, bleeding from mucous a mouth, a black feces. Was born from the I pregnancy, normal births in time. Weight at the birth 3500. Cried at once, suckled actively. Mother of the child has Verlgof's illness (an autoimmune form) from 18 years. During pregnancy there was an exacerbation which proceededeasily, there was only a hemorrhagic eruption on the body. Blood test of mother: Ayr - 4*1012, Hb - 140ú/½/½, color index - 0,9, WBC - 15*109, E - 5%, p.b. - 1%, with / I am 22%, l - 67%, m - 5%, an ESR - 15mm/h, Tr 50*109. Bleeding duration according to Duca 6 min., blood coagulation: beginning-2 and-4min, retraction of a bloody clot 1/8. Autoantibodies to thrombocytes are found in blood serum of the child. Choose the right diagnosis.

+Werlhof's disease

 

The child 1 year 3 months old, has weight 2100, arrived in a serious state. 3 days in clinic with the diagnosis: Protein-energy malnutrition (​https:​/​​/​www.multitran.ru​/​c​/​m.exe?t=4569244_1_2&s1=%E1%E5%EB%EA%EE%E2%EE-%FD%ED%E5%F0%E3%E5%F2%E8%F7%E5%F1%EA%E0%FF%20%ED%E5%E4%EE%F1%F2%E0%F2%EE%F7%ED%EE%F1%F2%FC​) of 3 degree, an initial stage, etiology. Weight at the birth is 3000. child is on artificial feeding. The stages of a dietetics which is given to the child:

+minimum-unloading and minimal food nutrition

 

Child 9 months hospitalized with diagnosis : A.R.V.I., acute laryngotracheitis. Laryngeal stenosis I degree. What is your tactics of the IMCI for removing stenosis?

+warm excessive drinking

 

The most effective drug is most effective in the treatment of typical pneumonia is:

+Clarithromycin

 

14 years old child,with symtoms, which was found after the postponed several attacks of rheumatic fever: intensifying and infraplacement of an apical jerk, small expansion of the left border, existence of the blowing systolic hum on an apex with a rigid timbre. Sonority of the I tone on an apex is reduced, the II tone on a pulmonary artery is increased. On ECG signs of a hypertrophy of a left ventricle. On R-gram heart is enlarged to the left, the waist is maleficiated. The defect is:

+failure of the mitral valve

 

Girl of 10 l. Complaints of a hemorrhagic eruption on the lower extremities. Their anamnesis: the eruption appeared after the postponed viral infection. Objectively: On a skin of anticnemions the hemorrhagic fine spotty and papular eruption symmetric. Dermal and joint system without visible deformations. The stomach is soft, moderately morbid in the field of a belly-button. A liver and a lien at edge of a costal arch. The diagnosis a hemorrhagic vasculitis is exposed. What from listed is the most acceptable pharmacotherapy?

+dezagregant therapy, heparin

 

The number of times when a nurse of outpatient clinic carry out a prenatal casework:

+2 times

 

A three- month- old child has the multiple pustules on examination which are settling down generally in natural folds with skin hyperaemia around an element, infiltrate basis are noted. The preliminary diagnosis is:

+vesicopustulesis

 

.4 months old. Child Complaints of tussis, disturbance of health of the child, loss of appetite, increase T 37,5. Objectively: the complicated noisy respiration,  perioral (​https:​/​​/​www.multitran.ru​/​c​/​m.exe?a=118&t=3649721_1_2​) cyanosis, frequent, dry excruciating tussis, emphysematous blown up thorax, frequency of respiration up to 68-70 per min., respiration in lungs rigid with the extended exhalation, abundance of the dry whistling and crepitantrhonchuses. The preliminary diagnoses is the most probable to be:

+obliterating bronchiolitis

 

The nurse and physician of outpatient clinic carry out postpartal casework after releasing from the maternity hospital:

+during the first 3 days

 

The boy 11 months old entered the hospital with complaints of lag in physical development (body weight 7.0 kg), the appearance of dyspnea and cyanosis with physical and emotional stress. On examination the skin with a diffuse cyanotic shade. A symptom of "drumsticks" and "watch glass". The boundaries of relative cardiac dullness: left on the left middle-clavicular line, right on the right parasternal line. Upper 2m / p. Heart rate is 150 per min. A rough systolic noise is heard along the left edge of the sternum, 2 tons weakened at 2 m / r on the left. The most likely diagnosis is:

+tetrad of Fallot

 

Amount of protein excreted in the urine over 24 hours in nefroticescom syndrome:

+3,0 and more

The child of 2 months. The mother has complains of resistant "whooping" cough from the first weeks of life. 

The weight does not increase on breastfeeding. Over the lungs percussion sound with shortening sites, auscultation - mixed wet and dry rales on both sides. Stool copious, foul-smelling, viscous with shiny lumps up to 8 times per day. The preliminary diagnosis is:

+mixed form of cystic fibrosis

 

A child get hospitlised with suspected meningitis, were observed headache, repeated vomiting. When viewed from the positive meningeal symptoms: stiff neck and symptom Kernig. Spent a lumbar puncture: cell count 1800 cells, lymphocytes - 25% neutrophils - 75%, Pandy’s reaction ++ Nonne-Apelt ++. The clinical diagnosis is:

+subarachnoid hemorrhage

 

1 month old child was released from maternitg home. With satisfactory state. However at the age of 17 days on a skin the punctate hemorrhagic rash and single ecchymoses appeared. On examination on a body and mucous there were petechial hemorrhagic eruption and single ecchymomas. Cardiac sounds are pure, rhythmical 130 per min. The abdomen is soft, the liver is 3 cm lower than a costal arch, a lien on 2 cm. FBT: Ayr - 4,2*1012, Hb – 115g/l/½ color index - 0,9, Le - 10*109, an ESR - 12mm/h, thrombocytes 210*109. Bleeding duration according to Duca 6 min. Coagulability 2 min. In the blood of child there was platelet antigen of PLA found In mother’s blood this antigen isn't found. In blood serum of the child there are isoantibodies to thrombocytes. In punctate of marrow there is no pathology. Correct diagnosis is:

+Werlhof's disease

 

characterstics of cough in bronchial asthma:

+attack-like

 

10 years old child is diagnosed : Acute rheumatic fever, a carditis with a lesion of the mitral valve, a polyarthritis , The etiological therapy of this situation:

+Benzylpenicillinum of 50-100 thousand PIECES/kg of weight within 10 days

 

The examine done by specialist at the age of 3-years old is called:

+surgeon, dentist

 

Childbirth are considered late childbirth:

+42–45 week

 

During duodenal sounding is revealed slow allocation (less 25 min.) big V (less 60 ml) "B, bile about "B" is intensively painted. On holetsistogramma the gall bladder is increased, the emptying, which is slowed down, diameter of a gall bladder was reduced by 20%.Choose the correct diagnosis:

+biliary dyskinesia on hypotonic

 

Which of the following congenital malformations does go with the enrichment of the pulmonary circulation?

+tetralogy of Fallot

 

Child, 3 years old Against the background of full health the child had an attack of convulsive tussis, a dyspnea at concern which passes in a dream. Mother says that child played with fine objects. At examination there is an expiratory dyspnea. On percution lung sound with a bandbox shade, respiration in lungs at auscultation - rigid, the single dry whistling rhonchuses. Blood Analysis without changes. The methods of diagnosis :

+broncho-scopy

 

The child 3 years old was admitted, parents have complaints of lag in physical development: the child badly goes. Objectively: mental development answers age norms, excessive development of a shoulder girdle becomes perceptible. Lower body, extremities weak, hypomyotonia. Borders of heart are expanded to the left on 2 cm. The cordial jerk strengthened 1 tone increased. Systolic hum in 2 intercostal spaceon the right. The liver isn't enlarged. The clinical signs most confirms an aorta coarctation:

+The ABP is higher on arms, than on legs

 

The child 5 years old. There were eruption of pink color of spotty character extensor surfaces of the face skin the augmentation of occipital lymph nodes doesn't merge, becomes perceptible. Your diagnosis:

+rubella

 

The child of 12 years, is sick with ARVI. For the 5th day of illness there was bradycardia, pulse 59 per 1 min., extrasystoles. The child is referred for ECG, FCG, blood tests and urine. For the 8th day of illness the child had a dyspnea, sharp delicacy, thready pulse, frequent tussis with a foamy sputum at a mouth. At auscultation – of lungs in lower parts on both sides wet rhonchuses. What complication development ?

+acute left ventricular heart failure

 

Morphological characteristics of early carditis:

+infiltration

 

In child of 5 years old the doctor saw purulent plaques in lacunas of tonsils. Suggest what laboratory research will allow to specify a disease etiology:

+a smear from a fauces on flora

 

A child was admitted with a diagnosis of purulent tonsillitis.Objectively: sugary sweet breath, moderate hyperemia Oropharynx, tonsils white-gray patina, badly removed by tongue depressor , after removing the surface of the tonsil it is bleeding.A positive analysis of smear inoculation on BL. The treatment for this patient is:

+introduction of antidiphtherial serum

 

Drug which belongs to absorbentsis is?

+Hylakforte

 

The child suffered from angina, treated with Acetylsalicylic acid and Sulfadimizinom. After 2 weeks ecchymosis and petechiae appeared on hands and feet, and then there was nasal bleeding, which ceased after the on / in the aminocaproic acid and the use of cold in the nose. Positive symptom of pinch, harness and mallear. The internal organs have no deviations from the norm. Platelet count is 46 * 10 9. Retraction of the blood clot does not occur. The duration of the bleeding 10 minutes. The patient was discharged after a month in a satisfactory condition, the platelets are 180 * 10 9. The clinical diagnosis is:

+Thrombocytopenic purpura.

 

8-years-old child was admitted to hospital with complaints of bleeding in the skin, nose, black stool. Child has been ill for 3 years. The disease appeared after suffering for the first time. Each exacerbation accompanied by bleeding in the skin and nasal bleeding. On examination, the child skin is pale and has numerous petechiae and bruises.On the oral mucosa hemorrhage. The gums bleed. In the nose, bloody scabs. Heart sounds are muffled, tachycardia up to 110 beats per minute, vesicular breathing. The abdomen was soft. The spleen 1 cm below the costal arch. Blood test: Er - 3.1 x 10 12, of . Hb - 78g / l, Color.i - 0.8, leukocytes - 12 x 10 9 eosinophils - 5%, Young - 1% n / n-3%, c / I-50% lymphocytes - 36% monocytes - 5%, ESR-15 mm / h, platelets - 20 x 10 9 / l. The duration of bleeding by Duque - 12 minutes, the index of retraction of blood clot-1/0. Bone marrow puncture: red and white germ has not changed, megakaryocytic germ is annoyed number of megakaryocytes is 1 250 ml of 3 punctate but platelet broken. The correct answer is :

+Thrombocytopenic purpura

 

The Child of 5 months. He got sick within 1 week. The disease began with temperature up to 38 °C, after feeding appeared regurgitations the stool became frequent to 8 times, watery, orange color, with white undigested lumps. In recent days joined persistent vomiting, the stool became frequent till 12-15 times. On presentation the state of moderate severity, skin is pale, the turgor and an elastance are a little lowered, the big fontanel is executed. The abdomen is blown up, sigma has not a spasm ova on the intestine course. The fundament doesn't gape. The presumptive diagnostic is:

+esherihioz

 

Child of 6 months. Complaints of frequent tussis, dyspnea. Objectively: the condition ofmoderate severity, dyspnea of expiratory character. RR 45 per minute, the HR 120 per minute, T 38,2, the use of accessory muscles of respiration (​https:​/​​/​www.multitran.ru​/​c​/​m.exe?t=4553939_1_2&ifp=1&s1=the%20use%20of%20accessory%20muscles%20of%20respiration​). Percussion: box sound, bubbling rales on the background of a weavened breathing.Preliminary diagnosis: acute bronchiolitis. The additional methods of a research need to be carried out for specification of the diagnosis:

+X-ray lungs

 

Renin secreted in

+Juxtaglomerular apparatus of renal

 

Parents of the child 3 months old came to hospital with complaints of a dyspnea during feeding, cyanosis, poor weight gain On examination: border of heart are expanded to the right, the 2nd tone over a pulmonary artery is weakened, along the left edge of a breast bone rasping systolic hum with a maximum in 2-3 m/ruble R-grafiya of heart is auscultated: heart in the form of "boot", an arch of a pulmonary artery sinks down. ECG hypertrophy of a right ventricle. What of the listed diagnoses is most probable:

+Fallo’stetrada

 

In a newborn baby, the umbilical cord is swollen and hyperemic. The diagnosis for these symptoms:

+omphalitis

 

The child is 6 years old, complaints of fever up to 39.8 °, headache, shortness of breath up to 80, cyanosis of nasolabial triangle Objectively: critical condition, frequent painful cough, pale, t -39,2 °, restless child, with no appetite. On Percussion: lungs timpanists, low standing lung edges, narrowing of boundaries of the relative cardiac dullness. On auscultation- single unstable dry wheezing. Abdominal palpation is soft, painless. On chest X-ray:Pulmonary mesh pattern, from the roots of the lungs come fusiform band has fat stranding, clearly defined shadows. The most likely diagnosis:

+interstitial pneumonia

 

the child at the age of 3 years old,become ill. On presentation temperature was 37.5 C, catarrhal changes of the upper respiratory tract. The general satae of moderate severity, BR-28 per minute. On percussion – box tone of pulmonary sound, on auscultation- in the background of elongated exhalation large amount of dry wheezing. In the X Ray low standing of flattened dome of the diaphragm and increasing the transparency of the lung fields.  The diagnosis is:

+obstructive bronchitis

 

Patient M., 4 years 9 months. Cardiac symptoms: pale skin, expressed pulsation of neck vessels. On crying and worrying marked cyanosis of the lower body, disappearing immediately after exercise interruption. Palpatory :increased apical impulse, shifted to the left and downward diffuse nature. In II intercostal space at the left sternal determined systolic tremor. Pulse is high and accelerated. Percussion displacement of relative dullness to the left. On Auscultation there is determined systolic-diastolic "machine" noise with punctum maximum in II intercostal space left along the sternum; Noise is held in the left subclavian region and interscapulum. Over the pulmonary artery has been a sharp increase in II tone. The symptoms characterized by:

+ductus arteriosus

 

The 2 major syndromes are characterized the primary acute Glomerulonephritis?

+hypertensive, hydropic

A child 3 years old diagnosed with diphtheria oropharyngeal noted puffiness under your eyes and lower extremities in the morning, when the survey in general urine analysis found: proteinuria, hematuria, cylindruria, positivesymptom effleurage. What complications of thisdoes disease the doctor must think first and foremost?

+glomerulonephritis

 

A symptom characteristic of meningitis in children up to 6 months of life:

+Le Sage's symptom

 

A boy of 7 years suffered from angina, treated with amokcicilini, paracetamoli. After 2 weeks on hands and feet appeared ecchymosis and petechiae, then nosebleeds, which ceased after the on / in the aminocaproic acid and the use of cold in the nose. Positive symptoms of pinch and harness. The internal organs have no deviations from the norm. The blood test : Hb 110g / L, platelets 46 * 10 9. Retraction of the blood clot does not occur. The duration of the bleeding 10 minutes. The patient was discharged after a month in a satisfactory condition. The correct diagnosis is:

+thrombocytopenicpurpura

 

The child is 2 years 11 months old, was ill sharply were Independently given at home Paracetamolum, "Panadolum". Arrived with complaints of frequent wet tussis, fever up to 39, a fatigue a loss of appetite. At survey ChD 44 intoxication symptoms in a minute, a dyspnea of the admixed character, paleness of integuments are expressed. The voice tremor is strengthened on the right, percussion below a scapula angle, a shorting of a pulmonary sound on the right. In the same part against the background of the weakened respiration constant fine moist rales are auscultated. In the general blood test a leukocytosis, a neutrophilia with shift to the left, enlarged by an ESR. On R-gram of a thorax – on the right in a lower part focal shadows. Your most probable diagnosis:

+bronchial pneumonia

 

7 months old child Weight 3500g at birth, height 50 cm. Breastfeeding up to 2 months 1.5 months,with visit receives irregularly apple juice,from 7 months.eats vegetable puree, reluctantly, not every day. He had dyspepsia, and ARV on examination there were revealed a large paleness, dryness of skin, tachycardia, heart murmur. Liver + 2 cm from under the costal arch, spleen 1 cm below the costal margin, the body weight of 8 kg. HB - 80 g / l, er. - 3,5h10 12 / L, CPU - 0.6, there is esinophils, leukocytosis, ESR - 10 mm / hour. The diagnosis is:

+Iron deficiency anemia of mild severity

 

The boy 14 years old suffers from a peptic ulcer 12perstnoy intestines of a helikobakterny etiology. Heredity is burdened – the father has a peptic ulcer. A year ago received a course of eradikatsionny therapy. Inspection taped a disease exacerbation with positive tests for Helicobacter pylori. What your tactics?

+it is necessary to carry out eradication therapy to the child.

 

A 6-months child admitted to the hospital, Mother complaints of shortness of breath, difficulty in feeding, retarded physical development, vomiting, recurrent colds, and groans at night. Mother suffered flu at 8 months pregnancy. These complaints are from 3 months. The child's state is critical due to heart failure, pallor, weakness, swelling of the face and feet. Shortness of breath at rest, tachycardia. Cardiac deaf, arrhythmia. Liver + 5-6cm. On radiographs - cardiomegaly. The ECG - atrioventricular block of I degree. On US - dilatation of the cavities of the heart, myocardial hypokinesis.The diagnosis is:

+Congenital late carditis

 

Boy 13 years old received a second course of eradication therapy (quadrotherapy) with duodenal ulcer of helicobaсter pylori etiology. Terms of monitoring of eradication?

+through 4 weeks

 

The drug which belongs to nitrofuran is:

+Furadonin

 

15 years old,child had several times attacks of rheumatic fever . The skin is acyanotic. The apical jerk is strengthened and displaced from top to bottom, the left border of heart is enlarged. On auscultation: the flowing diastolic hum at the left edge of a breast bone which is auscultated after the 2 tone. On ECG: a hypertrophy of a left ventricle.On R-gram heart in the form of "boot".Signs of hypertrophy of a left ventricle. What is the diagnoses:

+failure of the aortal valve

 

The term of a fetal stage from the impregnation till the birth is:

+270 days

 

Girl 13 yearsold complains of rise of a body temperature to 38,7S, loss of appetite, frequent painful urination, smallportions. The urine is cloudy, with bunches of fresh blood.In urinalysis: leukocytosis, traces of protein, squamous epithelium. The urine culture:was found conditionally pathogenic flora. The diagnosis is:

+cystitis

 

Inflammation of an umbilical cord is:

+omphalitis

 

In a child with diphtheria of the oropharynx 3 days after the onset of the disease, the following symptoms appeared: a rough barking cough, stenotic breathing, changes in the voice up to aphonia. Indicate the most likely process that has developed in a child:

+diphtheria croup

 

Criterion of the response to glucocorticoid therapy at nephritic syndrome according to which hormonresistanse nephrotic syndrome is diagnosed?

+Had full clinical laboratory remission at treatment by Prednisolonum of 2 mg/kg / with

 

The child has an acute disease. Temperature - 37,2, disturbs frequent dry tussis, appetite is kept. On examination the voice tremor isn't changed, BR-28 per minute. On percussion: pulmonary sound, an auscultation of lungs: respiration is rigid, dry scattered rhonchuses, moist rale. Cor tones loud, rhythmical. In GBA-there are no changes. On thorax R-gram, there is intensifying of the pulmonary drawing. The most probable diagnosis:

+acute simple bronchitis

 

Thrombasthenia lack of a complex of glycoproteins 2b/3a is of the heart of the pathogenesis of a thrombotsitopaty of defect in the functional activity of thrombocytes. With what from listed below blood elements thrombocytes have no ability to be bound?

+fibrinogen

 

Denis, 5 years,old admitted with complaints of change in urine color, which appeared 2 days after an upper respiratory infection. On examination: no swelling, no hypertension, urine color of meat slops. The diagnosis is:

+IgA nephropathy

 

The child is 10 months old. Complaints of delicacy, sweating, loss of appetite, lag in physical development. The child on artificial feeding about 1,5 months, was born in winter time, receives 5% semolina porridge since the birth, doesn't receive feedings up, on the street isn't. In 5 months the diagnosis was for the first time exposed: The rickets 2, received Vit D2, but mother didn’t regularly. on examination the head is square, the thorax is pressed through from sides, there are "Rickets beads", the lower extremity "O" figurative, carious teeth, a pot-belly, a liver and a lien are enlarged. In X-Ray of zones of body height - several strips of a calcification in metaphyses. The clinical diagnosis on classification:

+rickets 2nd subacute current,

 

The simple form of omphalitis is:

+"a soaked belly-button"

 

The syndrome causes serious condition at Acute bronchiolitis:

+respiratory distress

 

Sasha S. 2 years old became ill Acutely. The body temperature is 38.8 ° C, pale and apathetic. abundant mucus from nose,the cough is dry. Cervical lymph nodes are enlarged to the size III. Conjunctivitis from the right side. Pharynx is hyperemic, tonsils enlarged to size II, no raids, follicular hyperplasia of posterior pharyngeal wall. In the lungs breathing hard, dry, scattered wheezes.Liver +2.5 cm from under the costal arch, spleen +1,0 cm. The general analysis of blood: leukopenia, lymphocytosis. The presumptive diagnosis is:

+Adenovirus infection

 

Tania B. 7 months old became ill. She admitted to the hospital on the 8 th of March ,with paresis of the right hand. From history we found out that on March was held revaccination against st ofpoliomyelitis by live vaccine. After 7 days, mother noticed in the the morning no active movement in the right hand of her daughter. The general condition does not suffer, the temperature was normal. After going to the doctor was sent to hospital treatment. After 5 days, the movement in her right hand restored, but decreased muscle tone held within one month. Your prospective diagnosis is:

+vaccine-associated polio

 

Which drug is contributed to closure of patent ductus arteriosus in children?

+Indometacin

 

10 years old,child is ill within 2 days when the following complaints appeared: T up to 39 C, a rhinitis, herpetic rashes on labiums, a fatigue, a loss of appetite, a headache. mother independently gave Paracetamol, Antigrippin, without effect. On examination a state of moderate severity, paleness, temperature is 38,7 C, pulse is 110, respiration - 44 per minute. Tussis and pains in the left side amplifying at deep respiration. On percussion the sound shorting at the left from top to bottom from a scapula angle becomes perceptible, respiration in this zone is weakened. The most probable diagnosis is:

+left-side lung fever

 

Drug injected for fits to child by intramuscular injection for convulsion:

+25% Magnesium sulfate

 

Bleeding in patients with idiopathic thrombocytopenic purpura is caused by quantitative (thrombocytopenia) and qualitative (thrombocytopathy) inferiority. The most acceptable link of hemostasis:

+platelet hemostasis

 

Forms of chronic Glomerulonephritis are distinguished by:

+Nephrotic, haematurica, mixed

 

Sick Boy 9 years old, was admitted to hospital with complaints of increased body temperature to febrile digits, pain in the lumbar region. There is pasty face, blue and dark circles under the eyes, pale skin, dry. The child was not surveyed. From history we know that his mother and grandmother have Chr. pyelonephritis. The preliminary diagnosis is:

+pyelonephritis.

 

The boy R., 12 years,old came to hospital with complaints to delicacy, nausea, vomiting, temperature increase,pain in legs.The real aggravation of symptoms became perceptible 10 days ago when temperature increase upto 39,3 °C submandibular lymph nodes were enlarged. In out-patient blood test the hyper leukocytosis is taped to 200×109/l with suspicion on a chronic leukosis the boy was hospitalized. Submandibular, cervical lymph nodes by the sizes to 1,5 cm, mobile, painless are palpated; axillary, inguinal lymph nodes to 1,0 cm in the diameter. The liver of +4,0cm, a lien of +2,0 cm is lower than edge of a costal arch. The most probable diagnosis is:

+acute limfoblast leukosis

 

In most cases arterial duct in newborns closes:

+At the first hours and days of birth

 

The patient has acute illness began suddenly with the appearance of the T up to 40 0 C, the complaints of severe headache, repeated vomiting, pain in the joints of the fingers.Objectively found: on the legs and buttocks purpura in a wrong star-shaped with necrosis in the center. During pressing disappears. The positive meningeal signs. The method of research is needed to put the diagnosis:

+lumbar puncture

 

2 years old, child is ill within 4 days. Complaints of rising of a fever, frequent respiration, tussies, food refusal, fatigue. State of moderate severity. On percussion of lungs: it shortening sound under a scapula on the right. Respiration is rigid, in shorting part - weakened against the background of which fine moist rales are listened, chest retraction. On thorax R-gram intensifying of the pulmonary drawing, on the right irregular shape, fine focal shadows. What diagnosis is most probable in this situation?

+acute focal pneumonia

 

The child was treated by a Parainfluenza on an outpatient basis within 7 days. At repeated visit of the district doctor symptoms remained in the form of the residual phenomena increased fatigue, sweating, headache. Define the period of infectious process in child:

+convalescences

 

The drugs effective in acute pyelonephritis is:

+antibiotic therapy

 

A child of 14 years, old suffering from chronic tonsillitis/ angina: after 2 weeks noticed eyelid edema, weakness, decreased performance. Swelling of eyelids occasionally observed throughout the year. After 1.5 years there was shortness of breath, swelling of the face, waist, hydrothorax on the background of a viral infection. Deaf heart sounds. BP 135/80 mmHg Tot en common urine analysis: uD.ves 1021, Protein 9 g / l, RBC15-20 in n / sp, gial. 2-4 in the preparation. The primary diagnosis is:

+exacerbation of chronic glomerulonephritis, mixed form

 

The child of 2 months, body weight- 4200, and height- 56cm. At birth weight was 3500, the height of 53cm. Fatness index is 10-15, the flabby fold of skin, decreased tissue tension and decreased muscle tone. There is a tendency to posseting (regurgitation). The mother has no milk. Degree of Protein-energy malnutrition (​https:​/​​/​www.multitran.ru​/​c​/​m.exe?t=4569244_1_2&s1=%E1%E5%EB%EA%EE%E2%EE-%FD%ED%E5%F0%E3%E5%F2%E8%F7%E5%F1%EA%E0%FF%20%ED%E5%E4%EE%F1%F2%E0%F2%EE%F7%ED%EE%F1%F2%FC​):

+Protein-energy malnutrition (​https:​/​​/​www.multitran.ru​/​c​/​m.exe?t=4569244_1_2&s1=%E1%E5%EB%EA%EE%E2%EE-%FD%ED%E5%F0%E3%E5%F2%E8%F7%E5%F1%EA%E0%FF%20%ED%E5%E4%EE%F1%F2%E0%F2%EE%F7%ED%EE%F1%F2%FC​)of 2 degree

 

The following referred to the phases of development of pulmonary hypertension:

+Hypervolemic, mixed, sclerotic

 

Choose the drug which belongs to Proton pump inhibitors?

+Almagel

During the medical examination of the child has no complaints. In the biochemical analysis of blood parameters of total bilirubin and its fractions in the normal range; Immunophenotyping of blood detected anti-HAV Ig G and anti-HBcor Ig M. What's the diagnosis?

+hepatitis B , anicteric form , transferred viral hepatitis A

 

The hypoallergenic diet excluded:

+honey

 

In somatic ward the 1-year-old child with a diagnosis of "pneumonia" was detected in case of salmonellosis. The patient was hospitalized in the infectious diseases hospital.Survey, in your opinion, you need to spend in office at the contact of children is:

+stool culture

 

2 months old.child On exaMINATION: the palpatorno-apical jerk rising, diffuse, is displaced from top to bottom. On Percussion: borders of heart are expanded to the left. Auscultation: in 2m/r to the left of a breast bone rasping systolodiastolic hum, accent 2 tones over a pulmonary artery. Radiological:by protrusion a pulmonary artery arch, augmentation of the sizes of heart to the left. ECG: hypertrophy of the left departments of heart. Which of the listed diagnoses is most probable?

+ PDA

 

The child wasw admitted with complaints of pain, restriction of the movement, puffiness of knee joints, temperatureincrease to subfebrile digits. About 3 weeks suttered from an angina. The disease began with puffiness, morbidity in ankle joints, then in these joints puffiness, morbidity decreased, knee joints were involved in process. Borders of heart are expanded in the diameter. Tones are muffled, systolic hum on an apex, in the V point. The most acceptable pharmacotherapy:

+Indomethacinum and Prednisolonum

 

The cause of iron-deficiency anemia in children?

+lack of neonatal iron stocks

 

The newborn child at the age of 5 days has ochrodermia, which appeared 2 days ago (on Kramer 3 td zone). Wellbeing does not suffer, suckling actively, assimilate food. The level of total bilirubin 162 mkmol/l. Clinicallyhealthy. Physiological excretions in normal. The preliminary diagnosis is:

+transient jaundice (hyperbilirubinemia)of newborn

 

The form of child development maintains card in the outpatient clinic is:

+112form

 

Childbirth are considered emergency childbirth:

+37–41 week

 

Generalized meningococcal infection with a meningococcaemiain in children drug of choice is:

+Laevomycetin

 

Mary, 4, at acutely ill, T - 38.0 C, cramping abdominal pain. A stool is liquid, orange, watery, with mucus. The stool culture isolated E. coli. The IHA titer of antibodies to the selected pathogen - 1:40, 7 days - 1: 160. Minimum increase in antibody titers confirms the diagnosis of the disease:

+antibody titer rise to 4 times

 

The child of 12 years arrives with complaints of back pains, a headache, fatique, deterioration in vision. On examination there were edemas hematuria and massive proteinuria in urine, hypertonia and anemia . Borders of heart are expanded to the left. On examination of eyeground there were signs of a hypertensive angioretinopaty .The diagnosis:

+Chronic GN, the admixed form

 

Patient with ARF diagnosed the following symptoms : The CARDIAC CONTRACTIONS RATE is higher than norm for 40%, the frequency of respiration is higher than norm for 50%, there is no edema of a lung, the liver acts from under edge of a costal arch on 2-3 cm. The most acceptable pharmacotherapy:

+Digoksin

 

Forms of an omphalitis are:

+simple, phlegmonous, necrotic

 

The child of 3 months old has weight 4200, body length 55 cm, a birth weight was 3000, length 50см. 4 days In the clinic with a diagnosis : Protein-energy malnutrition - Degree of Protein-energy malnutrition

+Protein-energy malnutrition of 2 degree

 

The child at the age of three weeks, since the birth on exclusively breastfeeding. At the time of examination mother shows complaints to concern of the child, infrequent emictions, the body weight increase in 3 weeks made 250 grams. What is the reason of such state of the child?

+hypogalactia

 

The boy is 12 years old. State is severe Complains of dyspnea, thorax pains at tussis and a deep inspiration.Acyanotic.The expressed Crocq's disease. The exercise stress causes intensifying of a dyspnea. The right half of a thorax lags behind in respiration, intercostal spaces are maleficiated. Lower than the level 4 ribs is defined an obtusion of a pulmonary sound, find Grokko-Raukhfus's triangles, Garland, in the same place respiration at auscultation isn't listened. On X-ray of organs of a thorax blackout lower share of the right lung, shift of a mediastinum to the left side is revealed. In GBT: Нв 110 g/l, leucocytes 16 x 10, p.b. of 15%, with / I am 60%, e/1%, m / 5%, l / 19%, an ESR of 30 mm/h. The complication of pneumonia:

+pleuritis

 

Diphtheria toxin causes: + Paralysis respiratory muscles, myocarditis

A woman, 30 years old. Complaints of acute abdominal pain, radiating to anus, general weakness, dizziness. Acutely ill 30 minutes ago, when the above mentioned complaints appeared. In anamnesis: 1 medical abortion without complications, irregular menstruation. Last menstruation 2 months ago. Objectively: patient is pale, flabby, pulse is 120/min, BP - 85/50 mm Hg, abdomen is soft, painful in hypogastrium. Symptom of Shchetkin-Blumberg sharply positive, minor bleeding from genital tract. Your strategy + infusion therapy and emergency hospitalization

This coma is characterized by vomit, mydriasis, ptozis, strabismus + Traumatic

«Hoop» headache, impairment of consciousness, inspiratory dyspnea, vomiting, cherry colour of mucous coat and skin integument feature inhalation poisoning with: + carbon monoxide

 

Type of acute myocardial infarction occurs with minimal complains + Asymptomatic

 

For acute asthmatic attack use: + Salbutamol

The most characteristic sign of pulmonary hemorrhage: + scarlet, foamy sputum

A woman, 32 years old, pregnancy 38 weeks + 3days - second pregnancy, second delivery. At inspection: regular contractions, intense, bursting amniotic fluid. Bearing down period started during transportation and fetus hand came out. EMA team tactics in this situation: + to impose a napkin on perineum and deliver to the nearest labor hospital

 

Location of damage of left ventricle’s wall which can cause vomi9ting reflex + On the inferior-posterior

 

A young woman of 32 years old, considers herself pregnant for about 5 weeks, during the last 3 days there are pains in the lower abdomen, cramping, gradually increasing every day, there is non-permanent spotting from genital tract, increase in body temperature up to 37.5. Your preliminary diagnosis: + tubal abortion

 

6 years old child. According to his mother's words: sick for 3 days, runny nose, low-grade fever. On the eve there was cough with labored sonorous exhalation, audible in a distance. Objectively: the child is excited, temperature - 37,2 C, BH - 36 per minute, PS - 128 per minute. Throat hyperemia. Percussion: there is box sound over the lungs. Auscultation: breathing is hard, extended exhalation, dry wheezing over the lungs surface. Cardiac tones are clear, rhythmic. Abdomen is soft. Stool, urine output is normal. Your preliminary diagnosis. + acute obstructive bronchitis

 

Name the main cause of infectious-toxiс shock: + Sepsis

 

Full AV-blockade is an indication for conducting: + pacemakers 

A girl, 20 years old. She was outside and suddenly had sharp pain in the left upper quadrant, lost consciousness shortly. Upon EMA arrival: blood pressure is 90/60 mm. Hg Pulse 100 beats/ min, weak filling. Abdomen is soft, moderately painful in the left side channel, there is also dullness and doubtful symptoms of peritoneal irritation. Your preliminary diagnosis: + spleen rupture.

Forced position is characteristic in the patient with myocardial infarction  + Constantly changes the position 

The most common causes of acute upper airway obstruction in children: + inflammation of upper respiratory tract

Analgesics used in myocardial infarction is: + morphine

 

Man, 28 years old. Complaints of pain in the left arm. From anamnesis: he got hit his left forearm by wooden beam. Objectively: on the external volar surface of the lower third of left forearm there is a subcutaneous hematoma. Palpation of the injury is painful, there is crepitus of bone fragments. When there is load on forearm axis there is pain in the injury place. Pronation and supination are difficult, attempt to make these movements causes sharp pain. Distal part of the forearm and hand are in pronation position. Your preliminary diagnosis: + Fracture of the left radial bone diaphysis in the lower third

In case two resuscitator give resuscitation to an adult without intubation of trachea ratio between the closed-chest cardiac massage and artificial respiration is + 30:2

Toxic pulmonary edema is developed in case of acute poisoning with: + irritant asphyxiating gas

A 47 years old man complains on strong arching pain in the chest, which have appeared suddenly about 20-25 minutes ago, dyspnea, vertigo, pain in the right hypochondrium, abdominal distension, vomitus, severe weakness. Present state: general state – severe, manifest “cast iron” color cyanosis of skin of the upper half of the body, expanded neck veins, pulsing in epigastrium, edema on legs. Respiration is rare, arrhythmic. Auscultation: respiration diminished on the right. Cardiac tones muffled, second tone accented and split, systolic hum on the pulmonary artery. Arterial pressure – 70/50 mm Hg, heart rate – 120 per minute. Abdomen is distended, right hypochondrium is painful, liver enlarged on 4 cm, painful. Medicine dangerous to use in this clinical case is: + Lidokain

Time from the beginning of myocardial infarction in the subacute stage + From 10th day to end of 4-8 week

What leads to the development of ketoacidotic coma + discontinuation of insulin therapy

Name the form of epileptic attack: a child had been writing, suddenly become still, “freeze”, sometimes dropped pen, after 20-30 minutes state normalized:+ Minor (petit mal)

Ambulance call. 1.5 years old child. According to his mother’s words, he became suddenly ill with increase of body temperature up to 38.2 ° C, running nose, mild catarrhal signs. Hoarse voice appeared at night, "barking" cough, noisy breath in agitation. BR is 42 per minute, heart rate is 140 per minute. Your preliminary diagnosis. + ARVI. Acute laryngotracheitis. Larynx stenosis I degree

69 years old male complains on sharp pain in the chest, dyspnea, manifest weakness. Anamnesis morbi: yesterday during physical activity suddenly arose dyspnea and pain in the chest. In anamnesis: decompensated thrombophlebitis of right lower extremity. Present state: general state is severe, consciousness is clear, anxious, diffuse cyanosis. Auscultation: in the right side on the level of scapula – crepitation defined. Respiration rate is 26 per minute. Cardiac tones muffled, rhythm is regular, heartrate is 120 per minute. Arterial pressure is 110/80 mm Hg. Abdomen is soft, painless. On the ECG: rhythm is regular, sinus, P-pulmonale in the leads II, III, avF, blockade of the right branch of bundle of His. Your diagnosis + Pulmonary artery thromboembolism

As an antidote in case of poisoning with arsenic and salts of heavy metal the following is used: + unitiol

1 year old child, according to his mother became restless, refuses to take breast. There was a single vomiting, abdomen bloating. The state is moderate, pale wet skin, baby cries, pullsknees towards stomach. 37.10 C temperature, respiratory rate 38 / min. HR - 140 / min, pulse - 140 / min. Stool is with mucus and blood. Palpation of the abdomen: there is a palpable f ormation, smooth, soft and supple, right iliac area is empty. Vaal symptom is positive. Your preliminary diagnosis: + intussusception

For acute asthmatic attack use: + Salbutamol

58 years old male complains on a sense of lack of air, dyspnea at rest, cough with a lot of foamy, pink colored sputum, sense of anxiety, weakness. Anamnesis: he has been suffering from arterial hypertension during 10 years, doesn’t get regularly antihypertensive treatment. Duting last 3 hours state is worsened. General state severe, consciousness is clear, patient is anxious. Face is hyperemic. Percussion of lungs: pulmonary sound, auscultation of lungs: a lot of wet large- and small-caliber rales on all of the lung’s fields. Respiratory rate is 30 per minute. Cardiac tones muffled, rhythm is regular, heart rate is 100 per minute. Arterial pressure – 210/100 mm Hg. Abdomen is soft, painless. Liver is normal sized. On the ECG: rhythm is regular, sinus. Signs of hypertrophy left ventricle. Diagnosis: + Arterial hypertension 3 degree. Risk 3. Hypertensive crisis 1 type. Pulmonary edema.

Hemianesthesia is absence of sensitivity in: + One half of the body

42 years old female complains on gasp, dyspnea, unendurable skin pruritus, manifest general weakness, vertigo, heartbeat. Anamnesis morbi: suffers from polyvalent drug allergy. Half an hour ago she was stung by a wasp into upper lip. Present state: general state - extremely severe, clouding of consciousness. Manifest motor restlessness. Skin is hyperemic, covered with sticky sweat. Lips and eyelids are swollen. Auscultation of lungs: respiration is vesicular, a lot of dry, whistling rales on all of the lung’s fields. Respiratory rate is 30 per minute. Cardiac tones muffled, rhythm is regular, heart rate is 140 per minute. Arterial pressure – 40/0 mm Hg. Abdomen is normal. Pathology has developed in this patient: + Anaphylactic shock

 

In diabetic coma they administer this medicine at a prehospital stage + 0.9% solution of sodium chloride

 

Priority maneuver for bleeding from a limb wound + applying a tourniquet

 

In case of poisoning with methylene alcohol, ethanol is injected every 3 hours in the following dosage: + 50 ml 30% solution

 

On the ECG: elevation of segment ST in the leads I, avL, V1-V6. There are some extraordinary deformed complexes QRS. Localization of myocardial damage: + Anterior septal and lateral wall of left ventricle

 

A woman, 22 years old. Complaints of cramping abdominal pain, dark bloody discharge from genital tract, worse state for the last 2-3 hours. Delay of menstruation is 15 days. Signs of pregnancy are not noted. In anamnesis: chronic salpingo-oophoritis, irregular menstruation. OBJECTIVELY: wet tongue, abdomen of usual form, involved in respiration, moderately tense, painful in suprapubic and right iliac area. Symptom of Shchetkin-Blumberg is doubtful. Discharge from genital tract is dark smearing. Your preliminary diagnosis:+ ectopic pregnancy

 

Haemodynamic abnormalities in case of hemorrhagic shock are conditioned by + initial decrease in the circulating blood volume

 

Male 32 years old, mechanic. An hour ago, he injured his right eye with a piece of iron. The injured eye immediately lost the sight. Examination: shaped vision of the right eye is absent, but the patient sees light and correctly indicates its direction. Severe corneal syndrome. Bright mixed injection of eyeball conjunctiva. At the point of 3 o’clock, 4 mm from limbus, there is a lacerated wound of cornea, size 2 to 4 mm, its edges are swollen. Between the edges dark brown amorphous tissue is infringed. The front camera is absent. Iris is of dark brown color, tightened to the wound. Eye is painful at palpation. Your preliminary diagnosis: + penetrating corneal injury with prolapsus of right eye iris

 

In case of poisoning with atropine, hyoscyasmus and other anti-cholinesterases as an antidote the following is applied during the pre-hospital stage: + proserine

 

45 year old female, complains on headache, vertigo, heartbeat, tremors throughout the body, sense of anxiety, weakness. Anamnesis morbi: has been suffering from arterial hypertension during 6 years, maximum increase of arterial pressure to 200/120 mm Hg. She takes Arifon, Kapoten but irregularly. Complains appeared 2-3 years after psychoemotional overstrain. General state moderate severe, consciousness is clear. Skin is hyperemic, dry. Respiration is vesicular, no rales. Respiratory rate is 20 per minute. Cardiac tones muffled, second tone accented on aorta, rhythm is regular, heart rate is 110 per minute, pulse tension. Arterial pressure is 220/120 mm Hg. Focal neurological symptoms weren’t determine. On the ECG: rhythm is regular, sinus. Signs of hypertrophy left ventricle. Diagnosis: + Arterial hypertension 3 degree. Risk 3. Hypertensive crisis 2 type.

 

In case of severe heat apoplexy the following is observed + postural hypotension

 

Miscarriage of tubal pregnancy in type of tubal abortion most often occurs in the term of pregnancy: + 4-6 weeks

 

Type of myocardial infarction in which there are no anamnestic or instrumental signs of having myocardial infarction in the past + Primary myocardial infarction

 

Man, 36 years old. According to relatives, he is sick for 4 days, about 7 hours ago he’s got shortness of breath, sharp chills, increased weakness and pain in the chest, decreased body temperature to 35.70 C. Objectively: the state is heavy, lethargic, respiratory rate - 30, cyanosis, pulse thready, 104 per minute, blood pressure of 60/40 mm. Hg. In lungs: breathing шы hard, crackles are in all lung areas. Cardiac tones muted, heart rate - 104 min. Urine output is reduced. Determine complication developed in a patient: + infectious-toxic shock

 

The triple Safar method should be limited to a double method in: + suspicion of the possible cervical spine damage

 

A woman, 29 years old, complaints of sudden abdominal pain, radiating to the right shoulder blade, right supraclavicular region, acute weakness, short-term loss of consciousness. Your preliminary diagnosis: + impaired ectopic pregnancy

 

30 years old female complains on the sense of heartbeat, interruption in the heart, dyspnea, weakness. Present state: general state moderate severe, consciousness is clear. Skin is pale. Respiration is vesicular, no rales. Respiratory rate – 18 per minute. Cardiac tones muffled, arrhythmic. Pulse - low filling, rhythm is irregular, 68-90 per minute. Arterial pressure – 90/60 mm Hg. On the ECG: rhythm is irregular, atrial fibrillation, signs of complete atrioventricular blockade. Syndrome characterized by these ECG- signs: + Frederic

 

Emergency room admitted a patient with closed abdominal trauma, pelvis and spine. On the forehead there is a contused wound, size 3 to 4 cm What type of injury. + polytrauma

Man, 35 years old. Slipping on the ice, he has strongly hit the pubis, and then got a strong pain in the area of ​​injury. Due to this fact he called an ambulance. At examination: in the pubic area to the right there is swelling and sharp pain. The most likely diagnosis: A. + fracture of the pubic bone

Name causative agent of alimentary toxic-infection: + Salmonella

Woman, 28 years old. Complaints of severe pain in the abdomen, radiating to anus, which appeared after lifting a heavy water tank. Objectively: pale, cold sticky sweat, retching and urge to defecation. What sign is usually absent in ovarian apoplexy, unlike pregnant pipe rupture: + bleeding from uterus

Patient, 76 years old. Complaints: sharp girdle pain in the upper abdomen. Pains appear suddenly after eating fatty foods. Pains intolerable, repeated vomiting, which does not give relief, weakness, profuse sweating. In anamnesis: cholelithiasis, ischemic heart disease, arterial hypertension. Objectively: serious condition, skin covered with cold sweat, body temperature is 37.2. Pulse 125 beats/ min. arrhythmic, blood pressure 140/90 mm Hg. Vesicular breathing. Tongue dry, coated with white deposit. Abdominal palpation: moderately distended, soft, painful epigastric. Symptoms of irritation of the peritoneum negative. Your preliminary diagnosis: + Acute pancreatitis

Woman, 25 years old. Complaints of acute abdominal pain radiating to the anus, general weakness, dizziness. Acutely ill, 30 minutes ago. From anamnesis: irregular menstrual cycle. Last menstrual period - 2 months ago. Objectively: the patient is pale, flabby. Pulse 120/ min., HR 120/ min., BP 85/50 mm Hg Stomach is painful in hypogastric area. Positive symptom of Shchetkin-Blumberg. There is minor bleeding from genital tract. Your preliminary diagnosis: + ectopic pregnancy by pipe rupture type

Stethoparalysis is developed in case of poisoning with: + phosphoorganic substances

34 years old female, pregnancy 38-39 weeks - the third pregnancy, the third labor. Suddenly appeared contractions, regular, intense. There is development of good labor, bursting amniotic fluid. It was decided to bring her to the labor hospital. Bearing down period started during transportation. EMA team actions in this situation: + to stop the transport and deliver a baby

The most common causes of acute upper airway obstruction in children: + inflammation of upper respiratory tract

Poisoning with dichloroethane declare itself with the following set of symptoms: + impairment of consciousness, repeated vomit, unformed stool, icteritiousness of skin and sclerum, arterial hypertension

In case of broncho-obstructive syndrome the following is contraindicated + beta-blocking agents

The most common cause of bleeding in the third stage of labor is: + decrease in uterine activity

2 years old girl. Anamnesis: she fell down from horizontal bar. There was brief loss of consciousness, single vomiting. BP 65/20, HR 140 / min, BH: 38 / min. Body temperature 36,7 ° C. Increased muscle tonus. The skin is pale. Auscultation: no lung pathology, heart tones are good. In the occipital area there is a hematoma of 3x4 cm. there is no conjunctival reflex, gag reflex is present. There is mydriasis on the right side with decreased reaction to light. Oculocephalic reflex is positive. Reflexes of Brudzinskiy and Kernig are negative. Babinsky reflex is positive on the left. Your preliminary diagnosis: + brain contusion

Define stage of labor: shortening, smoothing and full disclosure of the cervix: + I

Criteria of effectivity of cardiopulmonary resuscitation + Appearance of diuresis

In diabetic coma they administer this medicine at a prehospital stage + 0.9% solution of sodium chloride

Girl, 3 years old. According to her mother 10 minutes ago a girl got burned with hot oil. At examination: the child is conscious, inhibited, crying a bit. Skin of face, neck, front surface of the chest and right hand has areas of hyperemia. Some places got marks of epidermis necrosis with formation of bubbles. BR – 40/ min, heart rate – 160/min. Determine shock degree: + burn shock II degree

In case of narcotic analgesics intake + respiration depth is increased

The triple Safar method should be limited to a double method in: + suspicion of the possible cervical spine damage

A 43 years old man complains of pain in the chest, profuse sweating, dyspnea. Anamnesis morbi: night attack of pain appeared for the first time, nitroglycerine was ineffective. Called the ambulance. Present state: general state – severe. Skin is pale and wet. Cyanosis of the lips. Man lies without a pillow. Respiration is superficial, no rales. Respiratory rate – 28 per minute. Cardiac tones muffled, rhythm is irregular, heart rate – 100-110 per minute. Pulse 100-110 per minute, low filling with extrasystoles. Arterial pressure – 80/40 mm Hg. Abdomen is soft, unpainful. The liver is on 3 cm out of the edge of the costal arch. Doesn’t urinated. On the ECG: elevation of segment ST in the leads III, aVF, V5-V6. There are extraordinary deformed complexes QRS. Localization of myocardial damage Right ventricle + The posterolateral wall of left ventricle

Emergency assistance to the patient in a state of status asthmaticus: + oxygen inhalation, intravenous infusion of fluids, hormones

45 years old male complains on cough with muco-purulent sputum, dyspnea, weakness. Anamnesis morbi: smoking for 30 years. Has been suffering from dry cough in the morning for 12-15 years. Doesn’t been examined, doesn’t get treatment. Complains appeared yesterday after overcooling. Present state: cyanosis of nasolabial triangle. Body temperature is 37,5°С. Respiratory rate is 26 per minute. Auscultation: respiration is rough, dry and wet large-caliber rales. Percussion: pulmonary sound with bandbox tone. Your preliminary diagnosis: + Chronic obstructive bronchitis’s exacerbation

Causes of intussusception in children: + high excitability of intestinal muscles

During vaginal examination of patient with suspicion of extrauterine pregnancy were determined: external fauces slightly opened, red, bloody discharge from the cervical canal, uterus enlarged to 8 week of pregnancy, adnexa uteri weren’t determined, fornixes of vagina are free. Diagnosis: + the violated uterine pregnancy

Man, 58 years old, slipped outside and fell on the bent knee. He has severe pain in the knee when moving tibia forward. Knee joint thickened, fluid is determined in the joint. Trying to find a symptom of "balloting" patella causes sharp pain. The patient cannor raise his straight leg. Your preliminary diagnosis: + fracture of the patella

46 years old male complains on whining, contracting pain behind sternum, arose after fast walking. Anamnesis morbi: has been suffering from coronary artery disease for about 5 years, about 5-6 weeks ago was treated from acute coronary syndrome. Present state: general state moderate severe, consciousness is clear, skin colored normally. Respiration is vesicular, no rales. Cardiac tones muffled, rhythm is regular. Arterial pressure – 130/90 mm Hg. Heart rate, pulse – 86 per minute. On the ECG: rhythm is regular, sinus, heart's electrical axis is normal. In the leads I, aVL, V1-V2 – pathological Q-wave and negative T-wave. Stage of myocardial infarction presented in this case: + Subacute

Anginal pain at myocardial infarction often irradiates in these fingers of left hand + 4,5

Patient, 76 years old. Complaints: sharp girdle pain in the upper abdomen. Pains appear suddenly after eating fatty foods. Pains intolerable, repeated vomiting, which does not give relief, weakness, profuse sweating. In anamnesis: cholelithiasis, ischemic heart disease, arterial hypertension. Objectively: serious condition, skin covered with cold sweat, body temperature is 37.2. Pulse 125 beats/ min. arrhythmic, blood pressure 140/90 mm Hg. Vesicular breathing. Tongue dry, coated with white deposit. Abdominal palpation: moderately distended, soft, painful epigastric. Symptoms of irritation of the peritoneum negative. Your preliminary diagnosis: + Acute pancreatitis

Full AV-blockade is an indication for conducting: + pacemakers

Male 32 years old, mechanic. An hour ago, he injured his right eye with a piece of iron. The injured eye immediately lost the sight. Examination: shaped vision of the right eye is absent, but the patient sees light and correctly indicates its direction. Severe corneal syndrome. Bright mixed injection of eyeball conjunctiva. At the point of 3 o’clock, 4 mm from limbus, there is a lacerated wound of cornea, size 2 to 4 mm, its edges are swollen. Between the edges dark brown amorphous tissue is infringed. The front camera is absent. Iris is of dark brown color, tightened to the wound. Eye is painful at palpation. Your preliminary diagnosis: + penetrating corneal injury with prolapsus of right eye iris

Labor at home: first delivery period lasts for 20 minutes. There is bloody discharge from genital tract. What pathology should be excluded first of all? + placental abruption

What medicine is used at pulmonary bleeding? + Etamzilat sodium 2,0 ml, intravenous

Haemodynamic abnormalities of the first phase of infectious-toxic shock are conditioned by + initial vasodepression

The amount of prehospital aid in ear bleeding: + auditory canal tamponade with dry sterile gauze turunda

Analgesics used in myocardial infarction is: + morphine

First aid at obstructive bronchitis in children includes: + salbutamol, prednisolone

The most common cause of bleeding in the third stage of labor is: + decrease in uterine activity

A male patient, 35 years old. Complaints about sharp girdling pain in his upper abdomen, repeated vomit. The pain occurred after alcohol and fat food ingestion 6 hours ago. Moderately grave condition. Pulsus is 110 beats per minute. ABP – 100/60 mm Hg. The abdomen is sharply painful in its upper parts, where you can determine muscular rigidity in the anterior abdominal wall. There is dullness of percussion sound in the abdomen slopes. The peristalsis is weak. There were no intestinal habit, gases are removed. Your preliminary diagnosis: + acute pancreatitis

55 years old man. Complaints of weakness, malaise, dizziness, which occurred suddenly. There was a single vomiting of "coffee grounds" type. The sate is moderate, the skin is pale and moist. There is cyanosis of lips. Vesicular breathing, no wheezing. Heart area is not changed, heart sounds clear, no noise. Respiratory rate 23 / min. BP 120/80 mmHg, HR - 98 / min, pulse - 98 / min. In anamnesis: peptic ulcer. Your preliminary diagnosis: + gastrointestinal bleeding

 

Strident breathing features + upper airway obstruction

 

What is characterized to Siberian plague (anthrax)? + Black crust in the center of damaging

 

Asthmatic status is: + Prolonged attack of bronchial asthma, not resolved by bronchodilators and accompanied by acute respiratory failure +

 

Define the labor period: uterus volume decreases, uterus and vagina cavity is the birth canal, presenting part descends to the pelvic bottom: + II

 

Meningeal syndrome is + Rigid of occipital muscles

 

Notion «exposure» in case of acute poisoning is time from + poison intake till start of remedial measures

 

Causes of intussusception in children: + high excitability of intestinal muscles

 

Denge’s hemorrhagic fever is: + endemic-trophic infectious with articular syndrome

 

Man, 36 years old. According to relatives, he is sick for 4 days, about 7 hours ago he’s got shortness of breath, sharp chills, increased weakness and pain in the chest, decreased body temperature to 35.70 C. Objectively: the state is heavy, lethargic, respiratory rate - 30, cyanosis, pulse thready, 104 per minute, blood pressure of 60/40 mm. Hg. In lungs: breathing шы hard, crackles are in all lung areas. Cardiac tones muted, heart rate - 104 min. Urine output is reduced. Determine complication developed in a patient: + infectious-toxic shock

 

Character of anginal pain in myocardial infarction + Burning

 

Use of the gastric tube at the pre-hospital stage in case of poisoning with catheresis poisons is: + indicative after intake of analgesics and spasmolytics

 

Acceleration chest trauma does not lead to: + formation of TELA

 

Typical signs of laryngostenosis: + inspiratory dyspnea, barking cough

 

Patient L. in a state of intoxication at work fell and received a fracture of the ankle of the right lower leg. What document will be issued to certify temporary disability:

+ form help 094 / y

The international classification of diseases :

+rubric system in which individual pathological conditions are included in accordance with established criteria

The system automatically selects women of fertile age in the 3rd group according to the following parameters, indicate the correct option:

+ gender = female, age = from 15 to 49 inclusive, are registered according to the diagnoses of N60-N64, N70-N77, N80-N98, N99, attached to the current MO

In order to add laboratory tests to a medical record, it is necessary

+ in the line "Laboratory studies" click on the "Add" button

Male, 58 years old, consists of a dispensary with a diagnosis of "coronary artery disease, angina FC III." During the last week, anginal attacks have become frequent, have lasted up to 7-9 minutes, for the relief of which one has to take several nitroglycerin tablets. What tactic is most appropriate?

+ Refer for inpatient treatment

Which group setting is carried out only in manual mode, the “Woman of fertile age” module?

+5

A 50-year-old patient turned for a routine physical examination. No complaints. On examination: HELL 160/100 mm Hg, heart rate 72 per 1 minute, regular rhythm, increased apical impulse, body temperature is normal. A study of the fundus vessels reveals a narrowing of the arterioles and a crimpiness of the vascular pattern. Chest without features. The rest of the physical signs without features. On ECG: left ventricular hypertrophy. There are no changes in electrolyte and creatinine analyzes. Your tactics:

+ prescribe antihypertensive therapy and eliminate symptomatic hypertension

Which of the integrated medical information system (IMIS) services allows you to make an appointment with a doctor without contacting the registry?

+ IMIS. Self-service terminal

What is included in the development process of the CPG?

+Problem definition, collection of objective medical information, preparation of a manual together with all interested parties

A pregnant woman with chronic glomerulonephritis without an exacerbation in the period of 5-6 weeks got into the antenatal clinic. The most likely tactic:

+ hospitalization in a specialized department

Patient A., 35 years old, has suffered from bronchial asthma for 2 years. Asthma attacks stop by berotek, hormone-dependent. Peak expiratory flow rate - 66%. At the time of inspection - shortness of breath at rest, with auscultation - whistling dry rales in all pulmonary fields. The patient in the last hour applied an inhaler with a berotek three times. What tactics of the patient is most appropriate?

+ prednisone / in a dose of 30-60 mg

In which of the IMIS modules does a single card of a dispensary patient form, taking into account all its diseases for which it is observed by D-counting?

+“IMIS. Prevention

A patient, 63 years old, is in the dispensary account with a diagnosis of CHD, angina FC III. During the last week, anginal attacks have become frequent, have lasted up to 7-9 minutes, for the relief of which one has to take several nitroglycerin tablets. Which of the following options is correct in the tactics of the district doctor in this situation?

+ send to in-patient department for cardiology department

At the doctor's appointment, patient N., 30 years old, complaining of sudden attacks of heartbeat, accompanied by nausea, abdominal distention, sweating and ending with heavy urination. Attacks appeared for the first time about 3 months ago, did not go to the doctors. When viewed from the pathology of the internal organs are not identified. HELL 110/80 mm Hg, heart rate 78 beats. in 1 min. On the ECG, the shortening of the PQ interval, the broadening and deformation of the QRS complex, the front knee of the QRS in the form of a “ladder”, the discordant shift of the ST interval. What rhythm disorder did this patient develop?

+ WPW syndrome with paroxysmal atrial tachycardia

What additional features does the advanced use of the site by the patient include?

+“create your own personal medical archive

Which of the listed specialists has the right to issue documents certifying temporary disability?

+ Hospital admissions doctor

Mother is on sick leave from 6.12 to 15.12 due to illness. 12.12 she had a sick child who needed care until 20.12. What document and from what date can a mother be issued for the ca

+ sick leave certificate from 16.12

Child K., 3 years old. During the holidays, the mother suffered ARVI and needed care from 17 to 23.03. What document is issued to the mother and is her leave extended by the numb

+ document is not issued and leave is not extended

To receive a patient, you must:

+“select an entry from the calendar (click on it with the left mouse button) and select“ Patient Accepted ”from the menu

A 47-year-old man complains of squeezing pain behind the sternum during two months when walking at an average pace after 500 meters, or when climbing the stairs to the 3rd floor. Occasionally pains appear and alone. This case of angina can be classified as

+ stable exertional angina II FC

Screening for the early detection of circulatory system diseases in individuals who are not registered at the dispensary for arterial hypertension, ischemic heart disease, is carried out by

+1 time in 2 years

A patient of 35 years old, complains of weakness, sweating, weight loss, dull pain in the left hypochondrium. Objectively: the skin is pale and moist. Lymph nodes are not enlarged. The liver protrudes from under the costal margin 4 cm, the spleen at the level of the navel, thick, painless. B blood: er. - 3.2x1012 / l, watering. - 85.0х109 / l, myeloblasts - 2%, promyelocytes - 4%, metamyelocytes - 8%, fell. - 12% segment. - 52%, eosin. - 4%, basoph. - 5%, limf. - 12%, blood clot. - 185x109 / l, ESR - 46 mm / h. By what laboratory indicator will you evaluate the effectiveness of the treatment?

+ peripheral blood leukocytes

Which of the sections is NOT included in the IMIS module of the doctor's office?

+ fluoroscopy plan

Patient R. was on the sick-list from July 10 to July 12 about acute bronchitis. 12.07 came to the reception while intoxicated. VN due to bronchitis continues, alcohol intake did not complicate the course of the disease. How further should make sure VN:

+ continues to issue a sick leave with a mark of violation of the regime

Patient J. due to an exacerbation of gastric ulcer, released from work from 15.08 (reference form 094 / y). Aug. 17, brought to the surgical department in connection with the perforation of gastric ulcers. What document must certify temporary disability

+ sick leave from 17.08

At the reception, the patient is 26 years old, a nurse, with complaints of an increase in body temperature to 38-390Сwithin 5 days. Ill acutely. Start with heat with torrential sweats. Independently received cefazolin at 1.0 x 3 r / d i / m, but without effect. When viewed revealed an increase in the cervical lymph nodes on the left, hyperemia and enlarged tonsils. KLA: Hb 90 g / l, er. 3.3х1012 / l, CPU 0.9; Lake 13.0x109 (eosinophils-6%, basophils -2%, p / nuclear - 14%; seg./toxic - 67%, lymphocytes - 1%, monocytes - 10%), ESR 60 mm / hour. When conducting sternal puncture in the bone marrow Berezovsky-Reed-Sternberg cells were detected. Make a diagnosis.

+ lymphogranulomatosis

Certificate form No. 094/y is not issued in the following cases:

+ Intoxication

When registering a pregnant woman, the general practitioner fills out the “Individual card of the pregnant woman and the puerperal woman” form:

+111/y

A 50-year-old patient with frequent exacerbations of a bronchitis smoker this night for the first time in his life had a burning sensation behind the sternum unrelated to breathing and radiating to the neck for 2-3 hours, severe weakness and sweating. He is at your reception. What should you think about first?

+ myocardial infarction

At the reception of the family doctor, patient B., 48 years old with complaints, feeling of bitterness in the mouth in the morning, weakness, malaise, loss of appetite, nausea, nagging pain in the right hypochondrium. An objective examination revealed a positive Kerr symptom and a slight resistance of the muscles of the anterior abdominal wall in the right hypochondrium. Which of the following diagnoses is suitable for this

+ chronic non-calculous cholecystitis in the acute stage with biliary dyskinesia of hypokinetic type

A patient approached a family doctor who complained of nausea, vomiting that suddenly appeared this morning. Objectively: the tongue is dry, white coated, the temperature is 380C, on palpation, sharp abdominal soreness and diffuse muscle tension of the anterior abdominal wall are determined. HELL 90/70 mm.rt.st. HR 100 rpm. Which of the following options is a priority in the further management of the patient?

+ emergency hospitalization in the surgical department

A 45-year-old man complains of weakness, frequent nasal hemorrhages, fatigue, loss of appetite. Especially concerned about the feeling of heaviness and pain in the abdomen. For many years, consume alcoholic beverages. On examination, palmar erythema and vascular "stars" were detected. Palpable liver enlarged, dense, uneven, nodular. A symptom of "wave" is defined as a sign of ascites. Your diagnosis:

+ alcoholic cirrhosis, micronodular, portal hypertension, stage 2, ascites.

A child needs hospitalization, but cannot be hospitalized due to the quarantine imposed on the child). What document is issued:

+ hospital certificate is issued

Patient M., 63 years old, complains of sudden complaints of sudden bouts of severe dizziness with loss of consciousness, which appeared after infectious myocarditis 3 years ago. Recently, an increase in seizures up to 2-3 times a month. HELL 110/70 mm Hg, heart rate 57 beats. in 1 min. ECG prolongation of the PQ interval, regular periods of Samoilov-Wenckebach. What is the best treatment for this patient?

+ introducing an artificial pacemaker

 

Patient K., merchandiser. Regarding ankle sprain from 10 to 13.02 released from work. On 12.02, a physician called in diagnosed follicular sore throat. As certified in this case, temporar

+ sick leave from 14.02

In the case of a favorable outcome, convalescents of acute pneumonia consist in dispensary registration:

+6 months

Patient K., 38 years old, has been suffering from asthma and expiratory dyspnea for a long time. Asthma attacks stop by berotek, take prednisone 10 mg per day for 2 years. Peak expiratory flow rate - 65%. What is the most appropriate basic therapy for a patient?

+ Beclomethasone

A child of two years was in contact with a patient with scarlet fever, in connection with which he was quarantined and he was not allowed into nurseries. What document and for how long will be issued to the mother who is caring for a healthy child:

+ form help 138 / y for receiving leave without content

A patient L, 25 years old, came to the polyclinic doctor with complaints of weakness, headache, pain in the lumbar region, swelling on the face, legs, hands, rare urination. Often sick with colds. On examination, edema in the eyelids, swelling of the scrotum, pastosity of the legs was revealed. Heart sounds are muffled, rhythmic, HR-72 beats in one minute. HELL -170 / 100mm.rt.st. Daily diuresis 400ml / day. In OAM red blood cells 60 in the field of view, leukocytes 20-25 in the field of view, granular and hyaline cylinders 2-4 in the field of view. Diagnose:

+ acute glomerulonephritis, developed current, chronic renal failure 0

The acute complications of peptic ulcer include:

+Perforation

A 19-year-old patient has a fever, edema such as anasarki, oliguria, and an urticarial rash on the skin. Ill for 3 months. In the urine protein 3.3 g / l, red blood cells and protein in large quantities, in the blood urea 25 mmol / l. HELL 200/120 mm Hg Renal biopsy - thickening of the capillary walls, dystrophy of the basement membrane. Specify the most probable cause of the indicated symptom complex:

+ systemic lupus erythematosus

In the state of hangover Sh. did not go to work and turned to the clinic. What document to justify absenteeism can be issued:

+ document is not issued

What is the genesis of cardialgia with hypertrophic cardiomyopathy?

+ relative coronary insufficiency

A 33-year-old patient came to the clinic with complaints of chest pain, a feeling of spreading in this area. The night before, I ate fish and choked. Objectively: difficulty swallowing, body temperature 37.3 ° C, swelling in the neck and lower half of the face, crepitus is noted during palpation of the neck. On the chest radiograph - the expansion of the shadow of the mediastinum with gas layers, located paravertebral. Doctor tactic

+ to hospitalize immediately in the surgical department

Concerning the worsening of his condition a patient M., 68 years old, came to the family doctor, who is observed with a diagnosis of IHD. Postinfarction cardiosclerosis. Hypertension II, risk IV. NKIIB. Complaints of weakness, headache, nausea, recurrent abdominal pain, double vision. He takes medication regularly. HELL 150/90 mm Hg, heart rate 50 beats. in 1 min. ECG: PQ interval of 0.24 s, QRS complex is deformed, in almost all leads there is a “trough-like” shift of the ST interval below the isoelectric line, ventricular extrasystoles by the type of bigeminia. Specify the most probable cause of the patient's condition deterioration

+ glycosidic intoxication

During the period of maternity leave without pay for child care up to 2.5 years, the second child of 4 years fell ill. What document will be issued to the mother for the care of the second

+ document is not issued

A 38-year-old woman, a driver, flatly refused to be sent to MSEQ. The disability certificate shows the date of referral to MSEQ - 25.01 and made a note about violation of the regime from 25.01 “Refusal to send to MSQ”. Documents of the patient were sent to the expert committee and registered on 28.01. The patient for examination at MSEQ was only 15.02., Where she was recognized as a disabled person of group III. Specify the number of medical institutions that must close the disability certificate in this case:

+ Recognized as Group III disabled 28.01

At the reception of the family doctor, patient B., 48 years old with complaints, feeling of bitterness in the mouth in the morning, weakness, malaise, loss of appetite, nausea, nagging pain in the right hypochondrium. An objective examination revealed a positive Kerr symptom and a slight resistance of the muscles of the anterior abdominal wall in the right hypochondrium. Which of the following diagnoses is suitable for this

+ chronic non-calculous cholecystitis in the acute stage with biliary dyskinesia of hypokinetic type

The IMIS module allows you to receive electronic services: make an appointment with a doctor and call a doctor at home.

+ IMIS. Patient's room

Patient A. was voluntarily hospitalized in a dispensary for the treatment of xr. alcoholism. What expert document will be issued for the period of hospital stay

+form help 094 / y

 

Patient S. is 35 years old. Complaints of marked general weakness, jaundice, itching, insomnia, apathy, persistent headache, nausea. From the anamnesis: a year ago blood was transfused. On examination: the liver is enlarged, painful on palpation. Palpated edge of the spleen. In the study: total bilirubin -145.1 µmol / l, straight line 80.6 µmol / l. Thymol test - 2.6 units ALT 0.85mkkat / l, AST 0.95 катkat / l. HBsAg positive. Make

+ chronic hepatitis B, icteric form, moderate severity

 

Patient K., 38 years old, notes an increase in weight, a decrease in sweating, and a pasty face. Suffer from chronic tonsillitis. Objectively: height is 158 cm, weight is 89 kg. Striae no, pronounced hyperkeratosis. Face pasty, with swollen palpebral fissures. HR-56 per minute AD-100/60 mmHg Art. In the blood: blood glucose - 3.3 mmol / l, iodine associated with serum proteins - 300 mmol / l. What tactics of the patient is most

+therapy with thyroid drugs

Patient S., 42 years old, has been seen by a family doctor about type 2 diabetes mellitus for the past 3 years. Complies with all recommendations of the doctor. The sugar level is 6.1 mmol / l. Within 4 months, frequent headaches began to bother. On examination, an increase in blood pressure to 150/100 mm Hg was found. When you re-measure after 15 minutes and in the next admission figures of blood pressure are saved. Is a blood pressure reduction recommended for the patient and why?

+ yes, because it will improve the patient’s life expectancy

 

The IMIS Fluorotek Module allows you to:

+automatically form the plans for fluorosurverage and a card index of the results, including the images themselves from digital fluorography

 

Child P., 5 years old, was discharged from the hospital in good condition, where he was without a mother, but because of the quarantine imposed on the kindergarten, was not allowed into the group. All family members work. Will the mother be released from work and on the basis of which document:

+ form help 138 / y for registration of leave without content

 

A rural doctor who works at the site alone can issue a sick-list:

+ for 2 months

 

What are the approximate periods of incapacity for work with non-community-acquired pneumonia?

+15 days

 

Patient V., at a family doctor, complains of nausea, vomiting, which appeared suddenly this morning. On examination, the patient’s tongue is dry, coated, the temperature is 37.7 ° C, abdominal tenderness and diffuse tension of the muscles of the anterior abdominal wall are determined on palpation. HELL 100/70 mm Hg Heart rate 97 v / min What is your tactic?

+ emergency delivery to the surgical department

 

To establish the group of disability, citizens of the Republic of Kazakhstan are carried out in accordance with the Rules for conducting medical and social expertise, approved by government resolution and patients have the right to register disability and all related benefits. What is the date and time of the document?

+ Government Regulation No. 750 of July 20, 2005

 

A 43 years old man, a bus driver, complains of a feeling of heaviness in the epigastrium, loss of appetite, nausea, vomiting, and burping air. When conducting FGDs, atrophy of the gastric

+ chronic atrophic gastritis associated with H.pylori

 

A 36-year-old patient has complaints of burning epigastric pains that occur and increase half an hour after eating, with physical exertion and body bending, which are not alleviated by Almagel. Sour eructations, choking attacks, coughing are also noted. What is the most informative research method in this case?

+ esophagus daily pH metry

 

A 40-year-old man was issued a disability certificate with a diagnosis of Acute Respiratory Viral Infection from 18.10 to 20.10 indicating to attend a doctor's appointment 20.10. The patient came to the reception only 25.10, as he left the city without the permission of the doctor. When viewed diagnosed with pneumonia. How should the disability sheet be drawn up

+ Extended from 25.10, indicating “violation of the regime”

 

A 55-year-old patient is worried about pains in his right shoulder, previously provoked by brisk walking, disappearing after stopping, today have arisen after dinner and have been go

+ acute myocardial infarction

 

A 23-year-old patient complains of weakness, fatigue. In childhood he often had sore throat. On examination: the pulse is small, slow, dancing carotid. On auscultation: weakening of 1 tone at the apex of the heart and 2 tones on the aorta, systolic murmur on the aorta and at the Botkin-Erb point; noise is better heard on the aorta, radiating to the carotid arteries and in interscapular space. Your diagnosis?

+ Chronic rheumatic heart disease, aortic stenosis, H IIB

 

What medical documentation is filled in by the general practitioner when an adult patient is admitted according to the order of the. Of the Minister of Health of the Republic of Kazakhstan of November 23, 2010 No. 907 “On approval of forms of primary medical documentation of health organizations”?

+ Form 025

 

What types of assets are NOT represented in the IMIS Doctor's Office?

+ assets of the sanatorium

 

At the reception of the family doctor, patient K., 28 years old, complains of choking, paroxysmal dry cough. Twice in the last week of the night I woke up from the choking that was stopped by a berotek. Takes prednisone 10 mg daily. When viewed from the NPV - 22 per minute. Peak expiratory flow rate - 68%. What is the most likely diagnosis?

+ bronchial asthma, moderate, exacerbation, hormone-dependent form, DN II

 

According to the classification of arterial hypertension, WHO-MOG experts (1999), hypertension of I degree include the following values:

+140/95

 

To assess the physical development of a child in primary health care conditions, use

+ head volume

 

There are two children of 3 and 5 years old in the family, who both get measles and need care from 24.03 to 17.04. How much sick leave and for how long should the mother be given

+14 days sick leave

 

A 40-year-old woman applied for a preventive examination. Periodically notes the rare short stitching pains in the region of the heart. Weight 90 kg and height 170 cm, smokes 1 pack a day for 5 years, does not exercise. The last survey was 6 years ago. Mother suffered myocardial infarction at the age of 45 years. Physical examination revealed no pathology. What diagnostic examination should be carried out first?

+serum cholesterol

 

 

Who are family members who are given a sick leave for child care up to 3 years with outpatient treatment:

+ mother or other family member living together if the mother cannot care for a good reason

 

 

At the reception, the patient is 26 years old, a nurse, with complaints of an increase in body temperature to 38-390Сwithin 5 days. Ill acutely. Start with heat with torrential sweats. Independently received cefazolin at 1.0 x 3 r / d i / m, but without effect. When viewed revealed an increase in the cervical lymph nodes on the left, hyperemia and enlarged tonsils. KLA: Hb 90 g / l, er. 3.3х1012 / l, CPU 0.9; Lake 13.0x109 (eosinophils-6%, basophils -2%, p / nuclear - 14%; seg./toxic - 67%, lymphocytes - 1%, monocytes - 10%), ESR 60 mm / hour. When conducting sternal puncture in the bone marrow Berezovsky-Reed-Sternberg cells were detected. Make a diagnosis.

+lymphogranulomatosis

 

How is it possible to delete erroneously entered diagnoses in the IMIS Module "Prevention"?

+ you need to select a diagnosis or group of diagnoses (by holding down the ctrl key and noting

A 35-year-old patient turned to a family doctor with complaints of squeezing chest pains lasting up to 3 hours or more, which arose after psycho-emotional stress at work and persisted over the last 2 weeks. HR - 82 beats in min., HELL 130/80 mm Hg Choose the most appropriate next step in managing the patient.

+ electrocardiogram removal in place

 

To study the average rate of coco-day, the effectiveness of the pharmacotherapy conducted by an expert doctor of this medical institution, an audit was conducted of the work of the therapy department. Type of audit:

+ Internal audit

 

Patient 26 years of social risk. Complaints of weakness, malaise, fatigue, weight loss, coughing, night sweats. Sick in the last 2-3 months, very often working on the night shift. It was

+ sputum analysis for BC

 

Patient K., 46 years old at a family doctor's appointment with complaints of vomiting, acidic contents, belching air after eating, epigastric discomfort, bloating. Palpation revealed tenderness in the epigastric region. What instrumental study is necessary for the patient?

+ Fibrogastroduodenoscopy

 

In what two modes does the IMIS patients site operate, allowing to receive electronic services?

+"advanced" and "non-advanced" patients

 

A 62-year-old patient complained of pain in the right knee joint, morning stiffness of the joint for 2 hours, and a crunch in the joint during movement. From the anamnesis: the disease began 5 years ago, pains in this joint appeared. On examination: the deflection of the right knee joint, restriction of mobility in the affected joint, swelling, hot to the touch. Blood test: Erit. 4,0х1012 / l, leukots. 9x109 / l, total protein 75 g / l, ESR 1

+ OA, secondary gonoarthrosis, FN II Art.

 

 

Which heart rhythm disorder effectively eliminates transesophageal electrical stimulation of the heart?

+ atrioventricular heart block II degree

 

In case of a general disease, the sick leave is issued to the maximum:

+ up to 4 months

 

To work with the patient archive, you must

+ patient resolution

 

A 38-year-old patient complains of intense chest pains, lasting up to 20 minutes, which predominantly arise from physical exertion, which have intensified in the last 2 days, are poorly controlled by nitroglycerin. On ECG: ST segment offset by 2 mm, negative T wave. What diagnostic test will allow to verify the diagnosis?

+ enhancement of cardiospecific enzymes

 

The choice of which antianginal drug is preferable when a patient has type 2 diabetes?

+ cardio selective beta blockers

 

A 32-year-old man complained of a decrease in temperature of 38.4 ° C and indisposition. From the anamnesis for 2 years he worked as a shepherd. Blood test: leukocytes 3,2x109 / l

+ wavy

 

Patient J. due to an exacerbation of gastric ulcer, released from work from 15.08 (reference form 094 / y). Aug. 17, brought to the surgical department in connection with the perforation of gastric ulcers. What document must certify temporary disability

+ sick leave from 17.08

 

Who of family members caring for a child up to 3 years in the hospital may be given a sick leave:

+ to any caregiver

 

 

At the reception of a family doctor, patient F., 55 years old, complains of periodic asthma attacks, marked shortness of breath, cough with mucous mucous sputum. Attacks are repeated 2-3 times a week. On examination: positive symptoms of "drum sticks" and "watch glasses", barrel-shaped chest. When percussion is determined pulmonary sound with a box shade, auscultatory - weakened vesicular breathing. What pathology

+ pulmonary emphysema

 

Determine temporary disability in acute pulmonary pneumonia:

+13-15 days

 

Patient I., aged 60, received treatment for a trophic ulcer with no effect. During the year gets maninil. The skin is dry, no edema. HELL - 135/80 mm Hg HR - 82 per minute Status lokalis: the right foot is hyperemic, moderately edematous, on the back surface there is an irregularly shaped ulcer measuring 4.5 x 6.1 cm. The pulsation of the peripheral vessels on the right foot is weakened. Blood sugar - 15 mmol / l, daily glucosuria

+ switching to insulin

 

Who can be given a sick leave if a child is temporarily living with a grandmother in another locality at the time of illness:

+ grandmother

 

Which antianginal drug is preferred when a patient has chronic obstructive bronchitis

+ calcium antagonists

 

 

Schedules for admission of doctors and offices with flexible customization options are presented in the module:

+ IMIS. Registry

 

What are the main socially significant non-communicable diseases:

+ cardiovascular diseases, chronic respiratory diseases, oncological diseases

 

Repeatedly 28 years old, in full-term, applied to FA with complaints of nagging pain in the lower abdomen. History 2 Cesarean section in the lower uterine segment. MOST justified tactics

+ send to level 3 maternity hospital

 

A 2-year-old child temporarily lives with her grandmother. In connection with a serious illness, he was hospitalized in a hospital together with his mother, who came from another locality. What document will be issued to the mother for the period of caring for a sick child in the hospital:

+ free form help

 

Form of a certificate of temporary disability of a student, college student, vocational school, illness, quarantine and other reasons for the absence of a child attending school, children's pre

+095/y

 

 

A baby-boy child with acute nephritis cannot be transported to the hospital due to off-road. The family has a healthy grandmother, who usually takes care of the child. What document

+ sick leave on a general basis

A disabled person of 3 groups, asthma attacks 2-3 times a week, works in lightened conditions, after an acute respiratory viral infection there was a temporary disability. Specify the type of disability, which should be listed in the sick-list of this patient?

+ General disease

 

A patient of 35 years old, complains of weakness, sweating, weight loss, dull pain in the left hypochondrium. Objectively: the skin is pale and moist. Lymph nodes are not enlarged. The liver protrudes from under the costal margin 4 cm, the spleen at the level of the navel, thick, painless. B blood: er. - 3.2x1012 / l, watering. - 85.0х109 / l, myeloblasts - 2%, promyelocytes - 4%, metamyelocytes - 8%, fell. - 12% segment. - 52%, eosin. - 4%, basoph. - 5%, limf. - 12%, blood clot. - 185x109 / l, ESR - 46 mm / h. By what laboratory indicator will you evaluate the effectiveness of the treatment?

+ peripheral blood leukocytes

 

A 23-year-old man is calling for a temperature of 38 ° C for 4 days, cough with yellow-green sputum, weakness, sweating. From the anamnesis: the disease is associated with hypothermia. Objectively: NPV is 20 min., It is the skin of the perussion sound, auscultatively finely humid rales. The best treatment for this patient?

+ azithromycin 0.5x1 p / d by mouth for 5 days

 

 

A 32-year-old patient complains of pressure, prolonged pain behind the sternum, without irradiation, decreasing in a sitting position, low-grade fever. The disease is associated with hypothermia. Which of the following data is most likely for this disease?

+ ST in all leads shifted up from the isoline

 

A patient is under treatment for 2.5 months for a fracture of the lower third of the bones of the leg. When the control x-ray examination incomplete regeneration of the fracture. The doctor continued the treatment. How long can a patient be on a sick leave?

+ up to 4 months

 

What is the validity period of the tests (complete blood count, urinalysis, biochemical analysis, bacterial culture) during the planned hospitalization of the patient in the framework of the GABPM according to the Government of the Republic of Kazakhstan Decree No. 1464 of December 5, 2011 “On Approval of the Inpatient Care Rules The most probable?

+ Should not exceed 10 calendar days

 

A patient has a high risk of developing coronary artery disease. Should I train the patient?

+yes, to perform non-drug measures to control risk factors

 

 

A 25-year-old patient complained of epigastric pain with a pronounced circulatory-hypoxic syndrome. A history of gastric ulcer. Pale skin. Blood test: Hb - 85 g / l, E - 3.8 x 1012 / l, Cp - 0.8, platelets - 165.0x109 / l, reticulocytes - 0.5%. bilirubin - 15 µmol / l, serum iron - 4.5 mmol / l. Gregersen's reaction is positive. Your intended diagnosis:

+ iron deficiency anemia

 

A 25-year-old patient complained of epigastric pain with a pronounced circulatory-hypoxic syndrome. A history of gastric ulcer. Pale skin. Blood test: Hb - 85 g / l, E - 3.8 x 1012 / l, Cp - 0.8, platelets - 165.0x109 / l, reticulocytes - 0.5%. bilirubin - 15 µmol / l, serum iron - 4.5 mmol / l. Gregersen's reaction is positive. Your

+ iron deficiency anemia

 

A 43 years old man, a bus driver, complains of a feeling of heaviness in the epigastrium, loss of appetite, nausea, vomiting, and burping air. When conducting FGDs, atrophy of the gastric

+ chronic atrophic gastritis associated with H.pylori

 

The outpatient clinic (Family Health Center) is:

+ independent legal entity or a department of a polyclinic providing primary health care (pre-medical, qualified)

 

Patient V., at a family doctor, complains of nausea, vomiting, which appeared suddenly this morning. On examination, the patient’s tongue is dry, coated, the temperature is 37.7 ° C, abdominal tenderness and diffuse tension of the muscles of the anterior abdominal wall are determined on palpation. HELL 100/70 mm Hg Heart rate 97 v / min What is your tactic?

+ emergency delivery to the surgical department

 

 

The documents certifying temporary disability do not include:

+ form 088/y

 

 

Till how long can the attending physician be able to individually extend a disability certificate?

+up to 6 days

 

 

Patient K., after cholecystectomy, was sent from the hospital for follow-up care at a rehabilitation sanatorium, what document and for how long will it be issued in connection with aftercare

+ sick leave for the entire period of treatment in a sanatorium

 

 

Which of the sections is NOT included in the IMIS module of the doctor's office?

+ making an appointment with a doctor

 

 

The PHC center is:

+ medical organization providing primary health care

 

A 34-year-old man, a bank manager, was hospitalized with a diagnosis of "Community-acquired pneumonia." The patient on his own insistence is discharged from the hospital still disabled. For how long does a hospital doctor have the right to extend the disability list?

+ Not more than 10 days

 

 

At a GP reception, a child has 6 months of life with abnormalities in neuropsychic development for 1 epicrizable period, with a history of perinatal CNS damage. With which group of health and with which criterion of KSZ (complex assessment of health status) do these data relate:

+ II B gr., 1st criterion

 

Patient M., 60 years old, has been complaining of recurrent headaches and dizziness during the last year. Repeatedly noted an increase in blood pressure to 170/100 mm Hg. Art., especially during periods of headaches. The survey found that the mother had high blood pressure, died at 57 years after a stroke. A patient of increased nutrition, smokes a lot, loves fatty foods and beer. What is the patient's likely diagnosis?

+ hypertension, grade II, risk III

 

 

A 30-year-old patient who had previously received treatment for pulmonary tuberculosis had edema and proteinuria up to 2.5 g. per day. What kidney damage is most likely?

+ secondary amyloidosis

 

Patient M., 41, came to the family doctor for a routine checkup. Is under observation with a diagnosis of CHD. Angina voltage II FC. Arterial hypertension II, risk III, NK0. At the time of inspection no complaints. HELL 130/80 mm Hg, heart rate 72 beats. in 1 min. On an ECG, rare ventricular extrasystoles are recorded. An additional chord has been identified on Echo CG. Is it necessary to prescribe anti-arrhythmic therapy to

+ No, since the patient’s arrhythmia is subjectively well tolerated

 

 

Patient Yu, 56 years old, went to the doctor with complaints of weakness, fatigue, fever up to 380 ° C, nagging pain in the lumbar region. In the history of chronic pyelonephritis. On examination, the general condition of moderate severity. Pale skin. HELL -150 / 100mm.rt.st. Symptom of Pasternack positive on both sides. In the study of urine revealed an increase in diuresis, a decrease in specific weight, proteinuria, leukocyturia. When ultrasound of the kidneys revealed a pronounced compaction of the parenchyma, reducing the size of the kidney. Your tactics:

+ moderate mode limitation, employment

 

Patient V., 50 years old, came to the family doctor with complaints of intense chest pain. When examined by a doctor, no visible changes in the heart and lungs were detected. HELL 120/85 mm Hg, heart rate - 88 beats. In 1 minute. The doctor reassured the patient and sent him home, with recommendations to lie down at home and come back tomorrow. Is the doctor's tactic correct?

+ no, you need to assign an urgent ECG study

 

 

A 12-year-old child has a cough for three weeks amid symptoms of intoxication. For early detection of tuberculosis in a child, should GP be prescribed?

+ Mantoux test and chest fluorography

 

The diagnostic method "gold standard" is otherwise called referent

+ absolute

 

Patient D in a state of acute alcohol intoxication was taken to hospital. Which document will certify VN:

+ form help 094 / y

 

Patient M., a typist. Regarding the acute respiratory disease was on a sick-list from 4 to 6.01, she received a fracture of the right radial bone in everyday life. When viewed 6.01 catarrhal phenomena are gone. Body temperature returned to normal. How further temporary disability is made:

+ Continued sick leave

 

 

 

The system automatically selects women of childbearing age in group 1 by the following parameters, select the correct option:

+ is entered only manually

 

Can a sick leave certificate be issued for the care of an adult family member in the hospital and for how long:

+ sick leave not issued

 

  

A 29-year-old patient complains of pains of an indefinite nature in the region of the heart, constant weakness, drowsiness, interruptions in the heart, sweating during exercise. In the evenings, there is an increased body temperature up to 37.3 ° C. In addition to the colds suffered last month, no more sick. An elderly unemployed person suffering from tuberculosis lives in the apartment. Blood test, urine test normal. Above the heart, systolic murmur is heard, heart rate 100 in 1 min. On the ECG: PQ 0,26s. Intraventricular conduction. The most likely diagnosis:

+ myocarditis

 

Patient Yu, 56 years old, went to the doctor with complaints of weakness, fatigue, fever up to 380 ° C, nagging pain in the lumbar region. In the history of chronic pyelonephritis. On examination, the general condition of moderate severity. Pale skin. HELL -150 / 100mm.rt.st. Symptom of Pasternack positive on both sides. In the study of urine revealed an increase in diuresis, a decrease in specific weight, proteinuria, leukocyturia. When ultrasound of the kidneys revealed a pronounced compaction of the parenchyma, reducing the size of the kidney. Your tactics:

+moderate mode limitation, employment

 

 

A 20-year-old patient turned to a GP doctor with complaints of fever up to 38 * C, weakness, headaches, catarrhal symptoms, loss of appetite. From the anamnesis: 4 days ago, the urine

+ A 20-year-old patient turned to a GP doctor with complaints of fever up to 38 * C, weakness, headaches, catarrhal symptoms, loss of appetite. From the anamnesis: 4 days ago, the urine

 

severity, the skin and sclera of moderate icteric color, clean. Pulse 72 min. HELL 100/60 mm Hg, the tongue is coated with a grayish bloom. The abdomen is soft, painful in the right hypochondrium, the liver and spleen are palpated. The chair is discolored by urine in the color of "beer." Laboratory data: total bilirubin 64.0, straight 52.0 μmol / l, indirect 22.0 μmol / l, thymol test 8.3. ALT 0.83mkkat / l, AST 0.87 катkat / l. HB

+ acute viral hepatitis A, icteric form, moderate severity

 

A patient of 27 years old, complained of pain in the metacarpophalangeal knee joints, swelling of these joints, restriction of movements in them. In the morning, notes stiffness in the affected joints until 12 o'clock in the afternoon. On examination: the configuration of the metacarpophalangeal and knee joints. Blood test: Erit. 3.2 x1012 / l, hemogl. 105 g / l, leukots. 12x109 / l, ESR 36 mm / h. Radiography of the hands: signs of periarticular osteoporosis in the area of ​​the metacarpophalangeal joint, narrowing of the joint space, multiple Uzuras. Based on the data obtained, formulate a diagnosis.

+ RA, polyarthritis, slowly progressive course, II degree of activity, RS III

 

A mother and child arrived on a weekend in another locality. On Monday, a local doctor was called, who diagnosed a child with a serious illness. What document can be issued to the

+ sick leave with the permission of the head physician

 

 

What additional features does the advanced use of the site by the patient include?

+“keep a diary of monitoring your health

 

Loss of ability to memorize, fixate current events. Is called?

+ Fixation amnesia

During a final exam, a worried college student suddenly experiences perioral tingling, carpo-pedal spasms, and feelings of derealization. Choose the appropriate vignette?

+ Hyperventilation episode

The members of the medical team carring for a young woman admitted for her third overdose are uncharacteristically arguing over the best way to address the patient’s increasingly emanding attitude. The nurses see her as manipulative and exploitative, while the male resident is much more willing to justify her behavior on the basis of the patient’s history of abuse and neglect. What personality disorder does this scenario suggest?

+ Borderline

27-years-old microbiology technician has had three bouts of purulent arthritis and several subcutaneous abscesses in a six-month period. She does not seem upset or worried; on the contrary, her mood brightens when her medical condition worsens. She has several scars on her abdomen and she is missing two toes on her left foot. She does not want her new, puzzled physician to obtain her past medical records. What is the most likely diagnosis?

+ Factitious disorder

37-years-old male with a history of alcohol abuse is hospitalized for dehydration and pneumonia. While being treated, he becomes acutely confused and agitated. He cannot move his eyes upward or to the right and he staggers when he tries to walk. Choose the appropriate vignette?

+ Wernicke’s encephalopathy

60-years-old man with alcoholism is brought to the emergency department by his family after they notice a decline in memory. On examination the patient’s remote memory is intact as verified by the family, but his recent recall is severely impaired. The patient provides verbose but erroneous answers in response to questions testing recent recall. This condition is called?

+ anterograde amnesia

35-yearsattachedattached-old woman presents with episodic anxiety and complains of the occasional feeling that she has heard or perceived things prior to actually hearing them. She expresses her concern that she is “going crazy.” You assure her that this can occur in anxiety disorders. This condition is called?

+déjà entendu

70-years-old male with a dementing disorder dies in a car accident. During the previous five years, his personality had dramatically changed and he caused much embarrassment to his family due to his intrusive and inappropriate behavior. Pathological examination of his brain shows fronto-temporal atrophy, gliosis of the frontal lobes’ white matter, characteristic intracellular inclusions, and swollen neurons. Amyloid plaques and neurofibrillary tangles are absent. Choose the correct diagnosis?

+ Pick’s disease

The psychologic effects of using this psychoactive substance are similar to those produced by cocaine and include alertness, euphoria, and feelings of competence and power. The psychoactive substance is?

+Amphetamines

A child often appears distracted and inattentive. His parents have noticed that frequently he “spaces out” for 10 to 20 seconds at a time. His EEG shows a spike and wave pattern. Choose the appropriate vignette?

+ Absence seizures

The patient experiences his surroundings as unreal. An office or a bus or a street seems like a large stage set with actors rather than real people going about their ordinary business. Everything seems colourless, artificial and dead. What is the most suitable diagnosis?

+ Derealisation

The role of the neurotransmitter in the pathogenesis of drug dependence belongs to?

+ Dopamine

The process of accumulation, retention and reproduction of information is called?

+memory

When an examiner asks a patient to count backward by 7, starting with 100 (referred to as serial sevens), what is principally being tested?

+ concentration

While the majority of women do not experience significant side effects when taking oral contraceptives, for those who do, the most commonly encountered psychological problem is?

+ Depression

The term "drug" substance includes three criteria?

+ medical, social, legal (juridical)

A young male with a history of IV drug abuse has experienced over the course of several months a progressive loss of memory and difficulty concentrating. He has lost interest in his friends, his work and has difficulty with abstract thoughts and solving minor everyday problems. He has also become withdrawn and depressed. Choose the appropriate vignette?

+ AIDS dementia

6-years-old girl who had reached normal early development milestones now does not speak in school or at home. The diagnosis is?

+ Rett disorder

The first stage of hashish addiction is characterized by?

+ obsessive desire

Alcoholic psychosis usually arises?

+ as clinical manifestations of withdrawal syndrome

A healthy 62-year-old male undergoes a corneal transplant. Three months later, he is profoundly demented and his EEG shows periodic bursts of electrical activity superimposed on a slow background. Choose the appropriate disorder?

+ Creutzfeldt-Jakob disease

14-years-old boy with an IQ of 34. The diagnosis is?

+ severe mental retardation

When patients hear voices which are critical of them. What are these experiences called?

+ auditory hallucinations

6-years-old girl whose parents are going through a divorce will not speak during school. The diagnosis is?

+ selective mutism

The second stage of hashish addiction is characterized by?

+ physical dependence

The patient complains that he was unjustly transferred to a lower position at work with smaller salary. He thinks that this happened because his boss overheard his conversation with his colleague, in which the patient criticised the boss. In his new position he behaves extremely carefully, in the actions of his colleagues he "sees" bad attitude towards him. The patient is full of thoughts about "persecution" and "overhearing of conversations." Thinks that in this way the administration is getting rid of disagreeable employees. The syndrome is?

+ Paranoial syndrome

53-years-old woman who has consumed approximately half a pint of sweet liquor every day for the past 24 years presents with severe memory problems. Her amnestic disorder is likely to be characterized by?

+ Both anterograde and retrograde memory deficits

A person is sitting alone and behaving as if listening intently, then suddenly begins to nod and mutter aloud. This person most likely is experiencing?

+ hallucination

86-years-old woman in the intensive care unit awakes at night and mistakes her intravenous (IV) pole for a family member coming for a visit. She calls the nurses to ask them to have the visitor leave until morning. This condition is called?

+ illusion

Integrative mental function, which includes ability to knowledge, learning new things, level of knowledge and ability to use them. This is called?

+ Intelligence

22-year-old man is brought to the emergency department 2 weeks after a motor vehicle accident in which he suffered significant head trauma. His parents are concerned because, although the patient recognizes them on the telephone and responds appropriately, when he sees them face-to-face, he believes them to be imposters who have replaced his real parents. He agrees that these people look like his real parents but is convinced that they are indeed?

+Capgras syndrome

72-years-old retired English professor with a long history of hypertension has been having difficulties with tasks he used to find easy and enjoyable, such as crossword puzzles and letter writing, because he cannot remember the correct words and his handwriting has deteriorated. He has also been having difficulties remembering the events of previous days and he moves and thinks at a slower pace. Subsequently, he develops a mild right facial hemiparesis and slurred speech. Choose the appropriate disorder?

+ Multi-infarct dementia

A patient reports to you that for the past week or two he has had the belief that his intestines and his heart have been removed. When asked about his lack of getting out in the world, he responds “What is world There is no world!” The diagnosis is?

+ Cotard syndrome

The focus and degree of concentration on the object and activities is called?

+ attention

32-years-old woman with a chronic psychiatric disorder is greatly concerned because her breasts have started leaking a whitish fluid. What is the most likely cause of this symptom?

+ Haloperidol

Patient K., male 39 years old was brought to the psychiatric hospital by an ambulance. Two days ago became anxious and restless. It seemed to him that his room was full of people, different voices shouted from outside through the wall that they were going to kill him, threatened him, suggested to go and have a drink. At night he couldn't sleep, saw mice with their tails cut off, then a goblin appeared and ordered the patient to gather gold from the floor. He saw all these creatures and objects as if they were real, picked up golden coins and felt them in his hands. At the inpatient department the patient is excited, his state worsens in the evening and at night. The contact with him is formal. Knows his name and age, but doesn't understand where he is. The syndrome is?

+ Delirious syndrome

Symptoms of withdrawal first appear in chronic users within 24 hours. Withdrawal is most pronounced for the first 10 days and can last up to 28 days. The syndrome is?

+ Marihuana withdrawal

The cognitive functions of an elderly man have deteriorated significantly during the previous month. He has become easily distractible, apathetic, and uncharacteristically unconcerned about his appearance. His gait shows a shortened stride length and step height. In copying a complex picture, he makes many mistakes and ignores details. He has also become incontinent of urine. What is the cause of this reversible dementia?

+ Normal pressure hydrocephalus

A maladaptive pattern of substance use that leads to clinically significant impairment or distress?

+ substance abuse

50-yeasr-oId woman is admitted to the hospital with complains that she is dead. She believes that her flesh is rotting and that she is able to smell the rancid odor. This condition is called?

+ Cotard syndrome

15-years-old boy with a urine toxicology screen positive for cocaine. The diagnosis is?

+ conduct disorder

This drug is the milky latex fluid contained in the un-ripened seed pod of the poppy. As the fluid is exposed to air, it hardens and turns black in color. This dried form is typically smoked, but can also be eaten. What is it about?

+ Opium

21-years-old woman diagnosed with panic disorder comes to the outpatient mental health clinic with increased frequency of panic attacks and complains of feeling as if her surrounding environment is unreal and strange. As a result of the increasing frequency of her attacks and this new symptom, she has been unwilling to leave her apartment for several weeks. This condition is called?

+ derealisation

Manic episodes, Panic Disorder, and Generalized Anxiety Disorder can cause a clinical picture similar to Disorder. The Disorder is?

+ Caffeine Intoxication

Intelligence disorders include?

+ mental retardation and dementia

Unreal flashbacks about events, which weren’t in right period of time, but they happened or could happen in the past. This condition is called?

+ Pseudoreminiscence

A 36-year-old man presents to the emergency department after being found without clothing in the street. He has multiple excoriations all over his body and states that bugs are crawling all over him. His toxicology screen is positive for cocaine. This condition is called?

+ formication

22-years-old woman is admitted to the hospital because of right-hand anesthesia that developed after an argument with her brother. She is in good spirits and seems unconcerned about her problem. There is no history of physical trauma. The neurologic examination is negative except for reduced sensitivity to pain in a glove-like distribution over the right hand. Her entire family is in attendance and is expressing great concern and attentiveness. She ignores her brother and seems unaware of the chronic jealousy and rivalry described by her family. The most likely diagnosis is?

+ Conversion disorder

45-years-old man is constantly sleepy and fatigued. At night he partially wakes up many times gasping for breath. His wife reports that he does not snore but she has noticed that he frequently stops breathing while he sleeps. Choose the appropriate vignette?

+ Central sleep apnea

40-years-old woman’s cognitive functions have progressively deteriorated for several years, to the point of needing nursing home– level care. She is depressed, easily irritated, and prone to aggressive outbursts, a dramatic change from her premorbid personality. She also presents with irregular, purposeless, and asymmetrical movements of her face, limbs, and trunk, which worsen when she is upset and disappear in sleep. Her MRI shows atrophy of the caudal nucleus and the putamen. Match each vignette with the appropriate disorder?

+ Huntington’s disease

21-years-old man is noted to be restless and constantly moving. He states that he feels as if he has to be moving all the time and is uncomfortable if he sits still. This sensation is known as?

+ akathisia

34-years-old man recurrently perceives the smell of rotten eggs. This kind of hallucination is relatively rare and is most commonly encountered in patients with?

+ Partial complex seizures

A false belief inappropriate to the patient's socio-cultural background and firmly held in the face of logical argument or evidence to the contrary. It is not modified by experience or reason. The symptom is?

+ Delusion

45-years-old man with a chronic psychotic disorder is interviewed after being admitted to a psychiatric unit. He mimics the examiner’s body posture and movements during the interview. The symptom is?

+ Echopraxia

14-years-old boy with an IQ of 68. The diagnosis is?

+ mild mental retardation

13-years-old girl with a bald patch on the back of her head and an otherwise normal physical and laboratory examination. The diagnosis is?

+ trichotillomania

When asked about his level of education, 48- years-old man with a history of schizophrenia describes his high school grounds, friends he had at the time, clubs he joined, and his high school graduation. He concludes by saying, “And that was the end of my schooling.” This answer demonstrate?

+ circumstantiality

A man being given a placebo for abatement reports 30 minutes later that the pain has disappeared. The most appropriate conclusion is that the man?

+ Responds to placebos

35-years-old postal worker has been getting lost in familiar places he has known for years. He has been moody and irritable and “irrational”. His family members have noticed that he “makes bad decisions.” His 42-year-old sister is in a hospice, due to a chronic neurodegenerative disorder. His father died 10 years earlier, due to the same condition. What is method of patient’s assessment?

+MRI

26-years-old man with narcolepsy explains that he has episodes of brief paralysis without any loss of consciousness or other deficits. These attacks are usually precipitated by laughter or anger. This is phenomenon known as?

+ cataplexy

 

What combination of big and small diagnostic criteria can be used to diagnose acute rheumatic fever?

++ 2 major criteria and 1 minor criterion + episode about previous streptococcal infection

 

Man, 35 years old came to a doctor with following complains: swelling of legs, shortness of breath during physical activity. In urine analysis proteinuria (3,5 grams per day) appeared. Also low serum albumin level are noticed. Choose a possible syndrome for the patient:

++Nephrotic syndrome

 

Type II respiratory failure occurs in clinical settings as:

++Brainstem injury, sleep-disordered breathing, severe hypothyroidism

 

Freshly oxygenated blood returns to the heart via which of the following blood vessels

++Pulmonary vein

 

Which of the following patients would be the best candidate for the administration of nitroglycerin

++A woman with arrhythmia

 

Nephritic syndrome is

++hematuria, proteinuria < 3.5g/d, hypertension

 

Which of the following is least likely to be a cause of unstable angina:

++Hyperthyroidism

 

Indications for renal replacement therapy don’t include:

++ Anemia with level of Hb≤75 g/L

 

Cystic folds around the small mouth can be at:

++systemic scleroderma

 

A 78 year old male with a history of hypertension, diabetes, dyslipidemia and atrial fibrillation presents to the emergency department with altered mental status and generalized body aches. His temperature is 37.2 C, blood pressure 110/70, heart rate 80, respirations 20 and oxygen saturation 95% on room air. Physical examination reveals normal pupils, he is alert and oriented to person only, normal jugular venous pressure, normal breath sounds and heart sounds, and a non-tender/non-distended abdomen. A CBC is normal. Urinalysis shows large blood, negative nitrite, negative leukocyte esterase,  no WBCs and no RBCs. Electrolyte studies are below. Sodium 149, Potassium 6.2, Chloride 110, CO2 16, BUN 52, Creatinine 2.8, Glucose 90, Calcium 6.2, Magnesium 2.0, Phosphorus 5.1. Which of the following medications most likely caused his current presentation

++Simvastatin

 

Nocturia is:++ frequent urinary at night, urine volumes maybe large or small

Which of the following is NOT a typical description of angina

++ Sudden onset substernal chest pressure radiating to the left arm

 

Rheumatic fever is usually started after

++ pharyngitis or tonsillitis

 

In addition to oxygen therapy; the most effective way to minimize the detrimental effects associated with cardiac compromise is to

++ Nitroglycerin Reassure the patient and provide prompt transport

 

Which of the following causes of respiratory failure is recognized to have the highest mortality rate?

++ Acute respiratory distress syndrome (ARDS)

 

What is the most detrimental effect that tachycardia can have on a patient experiencing cardiac compromise

++ Increased oxygen demand

 

A big diagnostic criteria for rheumatic fever include ... ... ...

++ all of the above is true

 

Patient 75 years old smokes during last 40 years came to the pulmonologist with following complains: weight loss (10 kg for last 2 month), increased shortness of breath, cough with hemoptysis, pain in the right shoulder region radiating toward the axilla and scapula. Complains appears 2 month ago. The most likely diagnose in this case is:

++ lung cancer

 

Alveolar flooding may be a consequence of:

++Pulmonary edema, pneumonia, alveolar hemorrage

 

The side effects of long-term therapy with prednisone does NOT include:

++ Cough

 

Nephrotic-range proteinuria is

++ the loss of 3 grams or more per day of protein into the urine

 

Woman, 46 years old came to a doctor with following complains: swelling of legs, shortness of breath during physical activity. In urine analysis proteinuria (4 grams per day) appeared. Also low serum albumin level are noticed. Choose a possible syndrome for the patient:

++ Nephrotic syndrome

 

Which of the following parametrs in blood serum is the most represantative for the chronical kidney disease`s stage:

++ creatinin

 

Which of the following best describes the most common pathophysiologic mechanism present during ST segment elevation myocardial infarction

++ Coronary plaque rupture

 

Which of the following is an indication for the use of calcium channel blockers in patients with unstable angina

++ Vasospastic angina

 

Face without facial expression with shiny skin is typical for:

++ systemic scleroderma

 

The proper use of sublingual nitroglycerine is

++ Use one sublingual tablet when angina occurs. If still present in 3-5 minutes, call ambulance and use a second tablet

 

How many electrodes are used in Holter monitor

++5 Electrodes

 

Which of the following are side effects of nitroglycerin

++ Headache

 

Which of the following describes a patient with a myocardial infarction that is Killip Class II

++ Findings of mild to moderate heart failure (S3 gallop, rales < half-way up lung fields or elevated jugular venous pressure)

 

The myocardium receives its blood supply from the coronary arteries that branch directly from the

++ Aorta

 

Patients with central or endobronchial growth of the primary tumor may present with

++ Cough, hemoptysis, stridor, and dyspnea

 

What is the name of the syndrome, which is manifested by pain in the joints, their defiguration and deformation, restriction of movements in the joints, changes in the tendon-ligamentous apparatus of the joints and surrounding muscles?

++ Articular syndrome

 

A 56 year old male with a history of hypertension presents to the emergency room with acute onset chest pains. His temperature is 37.0, blood pressure 190/70 in the left arm and 150/70 in the right arm, heart rate 110, respirations 22, and oxygen saturation 94% on room air. Physical examination reveals normal lung sounds, elevated jugular venous pressures and a II/IV early diastolic murmur at the right upper sternal border. ECG shows normal sinus rhythm and left ventricular hypertrophy. Which of the following is the most likely diagnosis

++ Aortic dissection

 

Choose structural and functional unit of the kidney:

++ nephron

 

Which of the following ECG patterns is consistent with those seen in the setting of unstable angina or non-ST elevation myocardial infarction

++ All of the above

 

Which of the following diagnoses should be considered in the differential diagnosis of unstable angina

++ All the above

 

A 23-year-old turned to a doctor. Complaints of high blood pressure and discoloration of urine (red colour). In clinical urine analysis: proteinuria, cylindruria and gross hematuria

++ Glomerulonephritis

 

The heart pumps

++ At a usual rate of 60-100 beats per minute

 

A 72 year old male with no cardiac history, but a history of leukemia actively receiving chemotherapy is admitted to the hospital with a low grade fever and weakness. He suddenly has the acute onset of palpitations and mild shortness of breath. His ECG reveals atrial fibrillation with an uncontrolled ventricular response. His respiratory rate is 20, blood pressure 100/60, heart rate 145 and oxygen saturation 98% on room air. What is the appropriate next step in management

++ Intravenous diltiazem or metoprolol

 

Which of the following ECG characteristics distinguishes atrial flutter from other atrial dysrhythmias  

++ The "saw tooth" or "picket fence" appearance of waveforms before QRS 

 

A 45-year-old patient has Raynaud's syndrome, including necrotic changes in the fingers, impaired swallowing, pulmonary hypertension, difficulty in flexing the fingers, thickening the skin in the area of the hands, shortening the terminal phalanges of the fingers. What pathology about should think?

++ systemic scleroderma

 

Intravenous diltiazem is administered to the patient and the heart rate remains 140 beats per minute in atrial fibrillation, however the blood pressure decreases to 80/40 and the patient becomes dizzy and confused. A fever of 102.2 F develops. Laboratory evaluation is available revealing a white blood cell count of 0.9 thousand/mm3. What is the next step in management for his

++ Intravenous amiodarone

 

Repolarization of the myocardial cells is determined mostly by which current

++ Outgoing potassium

 

As you are assessing an elderly man who is complaining of chest pain, the patient suddenly loses consciousness. Your first step should be to

++ Open the airway

 

What is the most common location of joint damage in OSTEOARTHROSIS?

++ Knee joints

 

Which component of the cardiac cycle is most responsible for LV filling

++ Transmitral pressure gradient

 

Type I respiratory failure occurs in clinical settings as:

++ Sepsis, gastric aspiration, pneumonia

 

A 74 year old male underwent coronary artery bypass surgery in 1978. He has been experiencing chest pains and a treadmill ECG stress test was ordered. After 1 minute on the treadmill he develops typical anginal chest pains and there is 2 mm of ST depression in leads V5 and V6. Since the chest pain is not limiting to him he continues to exercise. The chest pains resolve as does the ST depressions. Which of the following is the best explanation

++ Opening of coronary collateral circulation

 

Within the first 24 hours of hospitalization the patient recovers quickly until there are no apparent neurologic deficits. She provides no additional history and reports no symptoms prior to the cardiac arrest. What is the next step in her management

++ Single-chamber ICD

 

A 85 year old male has undergone bypass surgery on three occasions. All of his saphenous vein grafts are occluded and he has anginal symptoms with minimal exertion. He is not considered to be a revascularization candidate. He is afebrile, heart rate 55 beats per minute, respirations 20, and blood pressure 110/70. He is taking isosorbide mononitrate 480 mg PO daily, atenolol 100 mg PO daily, amlodipine 10 mg PO daily, ranolazine 1000 mg PO bid, aspirin and simvastatin. Which of the following is the next most appropriate course of action

++ Enhanced external counterpulsation

 

As you are attempting to resuscitate an adult man with cardiac arrest, you receive an "o shock advised" message from the automated external defibrillator (AED). What

++ Check for a pulse

 

Nephrotic syndrome is

++ the combination of nephrotic-range proteinuria with a low serum albumin level and edema

 

Which of the following statements is true

++ A critical hemodynamic coronary stenosis is a prerequisite of an acute coronary syndrome

 

Most patients with slowly progressive chronic kidney disease are asymptomatic until GFR falls below

++30 mL/min/1.73 m2

 

Which of the following is an indication for stress testing

++ Evaluation of chest pain in a patient with normal baseline ECG

 

Type III respiratory failure (perioperative respiratory failure) is a result of:

++ Lung atelectasis

 

The ECG characteristics in Myocardial Ischemia includes

++ Changes in the ST segment and T waves

 

The extensive list of potential etiologic agents in community-acquired pneumonia includes:

++ bacteria, fungi, viruses, protozoa

 

X-ray signs of rheumatoid arthritis include everything except:

++ bone growths, osteophytes

 

The ‘atypical’ microorganisms that cause pneumonia include:

++ Mycoplasma pneumoniae, respiratory viruses

 

The PR interval of a first degree heart block

++ Constant and greater than 0.20 second in duration

 

The best choice for treatment of acute rheumatic fever is

++ benzylpenicillin

 

A 59 year old male is undergoing a treadmill ECG stress test for evaluation of chest pains. After 6 minutes on a Bruce protocol he develops substernal chest pain radiating to his left arm and there is 4 mm of ST depression in lead V5 and V6.  His vital signs are stable. Which of the following would you expect to find on his physical examination

++ An S4 heart sound and a holosystolic murmur at the cardiac apex

 

The drug which is given to relief pain and anxiety in MI patient's

++ Morphine

 

Which of the following alterations of heart sounds would likely be heard in a patient presenting with unstable angina or a non-ST elevation myocardial infarction active myocardial ischemia

++ The presence of an S4 heart sound

 

A 45-year-old patient has Raynaud's syndrome, including necrotic changes in the fingers, difficulty in flexing the fingers, thickening the skin of the face and hands, and a dysphagia of swallowing solid foods. Your diagnosis:

++ systemic scleroderma

 

Glomerular filtration rate typical for terminal stage of the chronical kidney disease:

++10 ml/min

 

A big diagnostic criteria for rheumatic fever include ... ... ...

++all of the above is true

 

Diuretic therapy, particularly the use of loop diuretics, is mainstay therapy for symptomatic heart failure. Which of the following is incorrect regarding loop diuretics in heart fa

++ diuretics Does not require higher dosing in renal insufficiency or heart failure

 

A pregnant woman, 27 years old, with a pregnancy period of 20-22 weeks suffering from chronic glomerulonephritis, has a gradual increase in proteinuria from 0.33 g to 5 g / l, red blood cells - 0-1 in sight; in the blood - creatinine 75 өmol / l. Physical examination: blood pressure 110/80 mm Hg. Fetal ultrasound: fetal size conform to the gestation period. What further tactic

++ Prescription of prednisone

 

A 65 year old female with a history of hypertension and otherwise healthy presents for evaluation for palpitations. Her vital signs are normal and a 12-lead electrocardiogram is normal. An ambulatory ECG monitor confirms that her palpitations correlated with paroxysmal atrial fibrillation with heart rates of 140 beats per minute. She is started in long acting diltiazem. Which of the following would be an additional appropriate recommendation

++ Either C or D is reasonable

 

Cardiac arrest in the adult population most often is the result of

++ A cardiac arrhythmia

 

Nitroglycerin possesses which of the following effects when administered to patients with suspected cardiac chest pain

++ Vasodilation and increased myocardial oxygen supply

 

The most common side effect when the patient takes Nitroglycerin to relieve Angina

++ Headache

 

A 42 year old male with no cardiovascular past medical history comes to the emergency room with a complaint of shortness of breath and lower extremity edema for 1 month. He is afebrile, heart rate 160 beats per minute, respirations 20 and blood pressure 140/90. Oxygen saturation 92% on room air. His jugular venous pressure is markedly elevated. Lung exam reveals diffuse rales. A II/VI systolic ejection murmur is appreciated at the right upper sternal border. An S3 heart sound is present and the PMI is laterally displaced. No S4 is heard. There is 3+ pitting edema up to his knees. His ECG confirms atrial fibrillation with an uncontrolled ventricular rate. What is the most appropriate initial management

++ Intravenous diltiazem or metoprolol

 

What combination of big and small diagnostic criteria can be used to diagnose acute rheumatic fever?

++2 major criteria and 1 minor criterion + episode about previous streptococcal infection

 

A 17-year-old male presents to you after a screening ECG was performed for a sports physical that demonstrated pre-excitation. What is the next step in his evaluation

++ Echocardiogram

 

A 45 year old female has coronary artery disease and asthma. She underwent coronary artery bypass grafting for left main coronary stenosis. She is taking diltiazem CD 120 mg PO daily and pravastatin 10 mg PO qhs. She is allergic to aspirin. Which of the following is the best course of action

++ Add clopidogrel

 

Atrial flutter (AF) is characterized by which of the following

++ All of the above

 

Type IV respiratory failure is a result of:

++ Hypoperfusion of respiratory muscles in patient in shock

 

For differential diagnosis in articular syndrome, the following should be considered:

+ All of the answers are right

 

What is the most common location of joint damage in GOUT?

++1 metatarsophalangeal joint

 

A 85 year male is experiencing substernal chest pressure radiating to his left arm with exertion relieved with rest. There is associated shortness of breath. His physical examination reveals an S4 heart sound. There is a III/VI late-peaking systolic ejection murmur at the right upper sternal border with a soft S2 heart sound. There is also a III/VI holosystolic murmur at the apex. His ECG is below (show LVH with strain). A coronary angiogram shows only minimal non-obstructive coronary artery disease. What is the likely explanation for this patients anginal symptoms

++ Increased wall stress

 

Repolarization of the myocardial cells is determined mostly by which current

++ Outgoing potassium

 

Which of the following questions would be most appropriate to ask when assessing a patient with chest pain

++ What does the pain feel like

 

What is the most common location of joint damage in RHEUMATOID ARTHRITIS?

+ Brush Joints

 

A 39-year-old man underwent radiofrequency ablation in the RA for medically refractive symptomatic atrial tachycardia. He was dismissed on aspirin 325mg/day. Six days following the procedure he developed left-sided persistent chest pain and mild dyspnea. His exam is notable only for tachycardia with a HR of 110 bpm. An ECG discloses sinus tachycardia. What is the

+ Arterial blood gas, D-Dimer

 

 

Which of the following tests is useful in late diagnosis of myocardial infarction

+ Creatine kinase (CK-MB) test

 

 

A 68 year old female with uncontrolled hypertension has atrial fibrillation which as been adequately rate controlled with a combination of diltiazem and atenolol. She complains of intermittent palpitations, mild exertional dyspnea and fatigue. An echocardiogram reveals an ejection fraction of 65% as well as a septal and posterior wall thickness of 1.6 cm. Her left atrium is moderately enlarged with a left atrial volume index of 46 cc/m3. Which of the following management strategies would NOT be appropriate

+ Initiation of sotalol

 

 

The best choice for treatment of acute rheumatic fever is

++ benzylpenicillin

 

A 85 year female with coronary artery disease begins to experience her exertional angina which has occurred after moderate exertion for years. She rests and the symptoms do not immediately resolve so she uses one sublingual nitroglycerin. After 5 minutes the pain is still present. She should

++ Call an ambulance, then take a second sublingual nitroglycerin tablet

 

 

Which of the following chambers of the heart has the thickest walls:

++ Left ventricle

 

Which of the following approaches to medical therapy is appropriate during unstable angina or non-ST elevation myocardial infarction

 

+Dihydropyridine calcium channel blockers are recommended as a substitute for beta-blockers in patients with severe asthma and unstable angina or non-ST elevation     A 69 year old male with a history of coronary artery bypass surgery has increasing exertional anginal symptoms. Angiography shows an occluded vein graft to his obtuse marginal branch. The vessel is not able to be opened up percutaneously and medical therapy for his angina is recommended. He uses a nitroglycerin patch at 0.6 mg/hr, metoprolol succinate 100 mg PO daily, amlodipine 10 mg PO daily, aspirin and pravastatin. He is afebrile, heart rate 55, respirations 18, blood pressure 120/70. Which of the following is the most appropriate course of action to improve his anginaA 69 year old male with a history of coronary artery bypass surgery has increasing exertional anginal symptoms. Angiography shows an occluded vein graft to his obtuse marginal branch. The vessel is not able to be opened up percutaneously and medical therapy for his angina is recommended. He uses a nitroglycerin patch at 0.6 mg/hr, metoprolol succinate 100 mg PO daily, amlodipine 10 mg PO daily, aspirin and pravastatin. He is afebrile, heart rate 55, respirations 18, bloodpressure 120/70. Which of the following is the most appropriate course of action to improve his angina ++ Add ranolazine     Duration of cough for chronic bronchitis ++ At least 3 months in a year for 2 previous years     A 45-year-old patient has Raynaud's syndrome, including necrotic changes in the fingers, impaired swallowing, pulmonary hypertension, difficulty in flexing the fingers, thickening the skin in the area of the hands, shortening the terminal phalanges of the fingers. What pathology about should think? ++ systemic scleroderma   Which of the following best describes “walk-through angina” ++ Angina that occurs upon exertion that resolves when physical activity is continued or increased.

Which of the following statements is true regarding enhanced external counterpulsation (EECP)

++ EECP reduces the time to 1 mm ST depression on treadmill ECG testing

 

 

Which one of the following antiarrhythmic agents does not prolong the QT interval

++ Lidocaine

 

 

Polyuria is:

++ significant increase in 24-hour urine volume, roughly defined as exceeding 3L

 

Etiology of acute rheumatic fever is

++ B-hemolytic streptococcus group A

 

 

Which of the following medications is not associated with a survival benefit in systolic heart failure patients

++ Digoxin

 

 

Which of the following antiarrhythmic agents may promote AF

++ Adenosine

 

 

Patient N., 18 years old, complained of swelling on the face, headache, aching back pain, a decrease in urination. Ill for 3 days. 2 weeks ago had tonsillitis. Physical examination: temperature 37.7 ° C. Swelling of the face, feet and legs. Pale skin. Heart sounds are rhythmic, muffled. Pulse 84 per minute, blood pressure 165/100 mm Hg. What diagnosis do you suspect?

++ Acute glomerulonephritis

 

A 46-year-old woman calls emergency medical service (EMS) because of severe chest pain. When you arrive, she advises you that she has taken two of her husband's nitroglycerin tablets without relief. What is your most appropriate course of action

++ Apply supplemental oxygen and transport the patient to the hospital without delay

 

 

Man, 65 years old came to a doctor with following complain: painful urination, frequent urinary. Painful urination is not typical for:

++ diabetes

 

How long does it take for cardiac troponins to appear in the blood after a myocardial infarction

++3-6 hours

 

What is the effect on venous return to the heart seen with performing the valsalva maneuver

++ The valsalva increases intrathoracic pressure, thus inhibiting venous return to the right heart

 

 

The most effective treatment for lung cancer is:

++ Surgical

 

A 72 yr old patient has a history of on-off chest pain. His resting ECG is normal. It is decided to put him through an exercise  stress test. Which of the following:

++150 bpm

 

 

Which of the following describes a patient with a non-ST elevation myocardial infarction

++Acute onset rest angina with a normal ECG and elevated cardiac biomarkers

 

 

A 46 year old male with coronary artery disease also has erectile dysfunction and is requesting medications. He takes ASA 81 mg PO daily, metoprolol tartrate 25 mg PO bid, lisinopril 10 mg PO daily, atorvastatin 80 mg PO daily and sublingual nitroglycerine as needed. You tell him

++ Sildenafil can be used as long as separated by nitrates by 24 hours

 

 

A 59 year old female has known coronary artery disease and has been experiencing substernal chest pains typical for her angina with minimal exertion. Angiography reveals diffuse coronary disease and medical therapy for angina is recommended. She is taking atenolol 25 mg PO daily, diltiazem CD 480 mg PO daily, isosorbide mononitrate 480 mg PO daily, aspirin and atorvastatin. Her blood pressure is 110/70, heart rate 80, respirations 16 and oxygen saturation normal. Laboratory evaluation is normal including a CBC and BMP. Which of the following is the most appropriate course of action

++ Increase atenolol to 50 mg PO daily

 

 

For differential diagnosis in articular syndrome, the following should be considered:

+++ All of the answers are right

 

 

A 79 year old female with chronic hypertension presents with palpitations and dizziness. She is found to be in atrial fibrillation with an uncontrolled ventricular response (heart rate 160 beats per minute). Blood pressure is 132/82, respirations 18 and she is afebrile. Physical examination is normal except for the irregularly irregular heart rhythm and tachycardia. Which of the following is the appropriate next step in management

+++ Intravenous diltiazem or metoprolol

 

 

A 57 year old female has known coronary artery disease and has been experiencing substernal chest pains typical for her angina with minimal exertion. Angiography reveals diffuse coronary disease and medical therapy for angina is recommended. She is taking atenolol 25 mg PO daily, diltiazem CD 480 mg PO daily, isosorbide mononitrate 480 mg PO daily, aspirin and atorvastatin. Her blood pressure is 110/70, heart rate 80, respirations 16 and oxygen saturation normal. Laboratory evaluation is normal including a CBC and BMP. Which of the following is the most appropriate course

+++Increase atenolol to 50 mg PO daily

 

 

The most frequent causative agent of acute bronchitis

++ virus

 

 

Pancoast syndrome includes

++ Pain in the shoulder region radiating toward the axilla and scapula, often with radiologic destruction of the first and second ribs

 

 

A 89 year old male with a history of coronary artery disease has increasing anginal symptoms and prefers medical management over invasive management. He is afebrile, heart rate 60 beats per minute, respirations 12 and blood pressure 140/70. He is currently taking isosorbide dinitrate 120 mg PO tid, carvedilol 25 mg PO bid, aspirin and rosuvastatin. Which of the following is the appropriate course of action

+++Add amlodipine

 

 

The ECG characteristics in Myocardial Ischemia includes

++Changes in the ST segment and T waves

 

 

Woman, 19 years old came to a doctor with following complain: painful urination, frequent urinary. In urine test leucocyturia appears. CBC test is normal. Choose the possible diagnosis:

++cystitis

 

 

Which of the following scenarios would be a good indication for ranolazine use in a patient with persistent anginal symptoms

++A patient with angina taking aspirin, a beta-blocker (heart rate 60 beats per minute), a calcium channel blocker and long acting nitrates.

A 78 year old female has severe diffuse coronary disease not amenable to percutaneous revascularization and she refuses coronary artery bypass grafting. She has been using a nitroglycerine patch 0.2 mg/hr, atenolol 50 mg PO daily and amlodipine 5 mg PO daily for her angina with good success. Her angina begins to increase and so she decides to double her nitroglycerine patch by applying one in the morning and evening. Her angina then worsens and she presents to the emergency room. She is afebrile, heart rate 60, blood pressure 120/80, respirations 12. Her ECG is normal. Laboratory evaluation is normal including cardiac enzymes. Which of the following is the most appropriate course of action

++Increase nitroglycerine patch to 0.4 mg/hr and apply once in the morning and off at night

 

 

Which of the following therapies is not indicated in patients with angina from coronary vasospasm

++Beta-blockers (atenolol, metoprolol)

 

 

What is the most common mechanism involved in clinically important cardiac arrhythmias

++ Reentry

 

 

A 57 year old female with a history of hypertension, dyslipidemia, and asthma presents for a routine clinic visit without any specific complaints. Her medications include amlodipine, simvastatin, and albuterol. Vital signs and physical examination are normal. Her laboratory studies are below  Total protein - 6.8 g/dL Albumin  - 4.0 g/dL AST (SGOT) – 60 U/L  (10-37 U/L) ALT (SGPT) – 120 U/L  (10-65 U/L) Total bilirubin - 1.0 mg/dL Alkaline phosphatase – 100 U/L Which of the following is the most appropriate course of action

+++ Observation

 

 

What is the name of the syndrome, which is manifested by pain in the joints, their defiguration and deformation, restriction of movements in the joints, changes in the tendon-ligamentous apparatus of the joints and surrounding muscles?

+++Articular syndrome

 

 

A 29 year old male with no cardiovascular risk factors complains of exertional chest pressure that is squeezing in nature, radiating to his left jaw and left arm, occurs upon exertion and is relieved with rest,  and nitroglycerine. It associated with shortness of breath and diaphoresis. Physical examination and a 12-lead ECG is normal. He exercised 16 minutes on a Bruce protocol, had a normal exercise ECG and exercise echocardiogram. The chest pain was reproduced during the test. He continues to have chest pains and investigations into non-cardiac causes is unrevealing. A coronary angiogram is done which demonstrated normal coronary arteries and no chest pain reproduced with ergonovine infusion. Which of the following is the most likely diagnosis

+++Da Costa’s syndrome

 

1 What is the most common cause of peritonitis? -ruptured appendix 2 The most often localization of synechias in abdominal cavity - right iliac fossa 3 What is the most frequent localization of the hydatid cyst? - liver 4 Which of the following ways of reposition of the dislocated shoulder is based on the repetition in reverse dislocation mechanism elements? - Kocher 5 Where is radiating pain of acute cholecystitis? - right shoulder girdle 6 What are subjective symptoms, specific for corneal syndrome? - tearing, photophobia, foreign body sensation under upper eyelid 7 What is the most frequent localization of the hydatid cyst? - liver 8 How to determine the differential diagnosis of pelvic peritonitis from peritonitis? - by the boundary, defining the pelvic peritoneum 9 What is not included in treatment of superficial thrombophlebitis? - transfusion of fresh frozen plasma 10 What is enough to spend for the diagnosis of acute subcutaneous paraproctitis? -inspection and palpation of the perianal area, digital examination of the anal canal and rectum   11 Name the main clinical syndrome of obliterating diseases of the lower limbs? - intermitted claudication 12 What is the main method of diagnosis of esophageal diverticulum? -contrast radiography   13 How does echinococcus spread in the human body? - through the blood and lymphatic vessels 14 What promotes thrombophlebitis of varicose veins less? - hypervolemia   15 What is name of sinusitis after odothopathy? -odontogenic   16 What is the most useful for diagnosing of pylephlebitis? - ultrasound of the portal vein and liver 17 In case of trichiasis should be done? - diathermocoagulation of eyelashes 18 Catheterization of a bladder is used to? - assistance at a sharp delay of an urination 19 What type of strangulated hernia does not exist? - Т"- figurative 20 Determination of peritonitis - body reaction to conflict of pathogenic agent (usually infectious substantiated) with peritoneum 21 What kind of neсessary immobilization for fracture of lower third of cnemis? - posterior plaster bar until upper third of cnemis 22 On the basis of what can be done the differential diagnosis between cancer of the anal canal and the anal fissure? - cytological studies 23 Which method of research is urgently needed to apply a patient with ulcerative colitis suspected perforation of ulcers? - overview abdominal X-rays 24 What is an obligate precancerous diseases of colon? - family polyposis colon 25 What cannot cause obturation intestinal obstruction? - mesentery strangulation 26 What usually develops in the deep vein thrombosis limbs? - soft tissue swelling 27 What is the indication for irrigoscopy in the diagnosis of "anal fissure"? - mucocutoneous bleeding from the anus 28What type of blockade is used as a therapeutic activity in acute intestinal obstruction? - perirenal blockade by Wishniewski 29 List the main clinical symptoms of acute pancreatitis? - encircling abdominal pain, uncontrollable vomiting, dynamic ileus 30 What is the most common complication of cholelithiasis? - cholecystitis 31 Which disease would be considered in the differential diagnostic of hernia of white line of abdomen? - benign neoplasm of anterior abdominal wall 32 What are reliable symptoms of the pterygoid blades? - the medial border of one scapula moves away from the rear part of the thorax 33 What examination method is the most informative of obliterating diseases of the lower limbs? - ultrasonic Doppler examination 34 Which diseases are caused of secondary varicose veins of the lower extremities? - postthrombophlebitic syndrome 35 Radical surgery for liver alveococcosis: - liver resection 36 What is not used in treatment of pylephlebitis? - thrombectomy of portal vein 37 Where is Lamblia mainly found? - in the duodenum 38 What is orbital cavity’s phlegmon? - diffuse purulent inflammation of retrobulbar tissue 39 Which of the forms of atresia of the esophagus occurs most often? - atresia with blind top and bottom ends 40 The method of choice in the surgical treatment of syndrome Leriche is? - aorto-femoral bifurcation shunt 41 Which drug should be included in acute pancreatitis therapy for knocking enzyme toxemia? - protease inhibitors 42 What are the characteristic features of congenital inguinal hernia? - the testicle located in the hernial sac   43 By which investigating method can you diagnose dumping syndrome? - control the passage of barium in the intestines 44 Name the correct treatment of the barley in infiltration stage: - аntibacterial drops, antibacterial ointment, dry heat or high wave treatment 45 Catheterization of a bladder which is contraindicated at a sharp delay of urine, is caused by? - rupture of an urethra 46 What test is used to detect failure of valves of the superficial veins? - Troyanov-Trendelenburg 47 What is crucial meaning in the differential diagnosis of tumors and suppurative lung disease belongs? - endoscopic, radiological methods of investigation 48 Which operation is the most often used in varicocele? - operation Ivanisevich-Erokhina 49 What clinical features do not characterize the surface thrombophlebitis? - lower limb edema 50 What is the objective characteristic feature of keratitis? - infiltrate in the cornea with fuzzy boundaries 51 At what level of limb will be amputated if proximal part of the foot is destructed? - at lower third of tibia 52 Shlange-Grekov’s symptom during acute enterostasis is? - visible peracute intestinal motility 53 Name pathognomonic symptom of reactive stage of peritonitis? - voltage abdominal muscles 54 What refers to the Leriche syndrome? - atherosclerotic occlusion of abdominal aortic bifurcation 55 What can be an absolute indication for surgical treatment of acute superficial thrombophlebitis? - spreading of thrombophlebitis in the proximal direction 56 What is the most common functional postgastroectomy syndrome? - dumping syndrome   57 What is the name of the absence of urine excretion under intense urge to urination? - acute urinary retention 58 Choose the indication for emergency surgery of acute pancreatitis? - peritonitis 59 What disease is most often differentiated by acute cholecystitis? - acute pancreatitis, perforated ulcer, acute appendicitis 60 Select the method of instrumental diagnosis of acute cholecystitis - ultrasonic study 61 The characteristic of common symptom for acute cystitis is - ailment, depression 62 What clinical symptom is not related to acute thrombophlebitis of deep veins of lower extremities? - increased body temperature 63 The most commonly used surgery for liver echinococcosis - echinococcectomy without cavity opening 64 What should be done primarily to clarify the diagnosis of bleeding stomach ulcers? - gastroscopy 64 What never includes appendicular infiltrate? - gastrohepatic omentum 65 What is the most frequent cause of acute thrombosis of arteries of lower extremities? - atherosclerosis 66 Which atypical location of appendix is characterized by pain in the lumbar region? - retro peritoneum 67 What is the name of violation of urination? - dysuria 68 What symptom is common to all types of intestinal obstruction? - persistent constipation and gas 69 What is the most common sign of acute appendicitis? - painfullness in the right iliac region   70 What causes the disappearance of hepatic dullness in the perforated ulcer of stomach? - free gas in abdominal cavity 71 What is the leading role in the development of acute pancreatitis? - autolysis 71 When deciding on the urgency of surgical intervention in patients with acute cholecystitis, the first thing to focus on - the severity of peritoneal symptoms 72 What causes progression of varicose veins in lower limbs? -violation of the valvular apparatus veins   73 What is an indication for immediate examination of the entire colon with the presence of acute anal fissure? - blood and mucus discharge from the anus 74 Which method is effective in the treatment of congenital glaucoma? - surgical 75 What symptom does acute gangrenous appendicitis characterize? -"toxic scissors" 76 When are secondary varicose veins of the lower extremities diagnosed? - data arteriography 77 Denote foremost role for etiology of congestive optic papilla? - atherosclerosis 78 What defect of anatomic formations plays in the leading role formation of spinal hernia? - vertebral arches 79 What is the difference between ozena and atrophic rhinitis? - damage of osmesis because of olfactory region’s atrophy 80 What is primarily changed during straight inguinal hernia? - posterior wall of abdominal canal 81 Specify the study, that allows to identify the source of hematuria - three-glass test   82 What is the main cause of Douglas abscess after typically appendectomy on the first day of phlegmonous appendicitis? - poor sanitation of the abdominal cavity during surgery 83 What is sufficient for approval to conduct a diagnosis of anal fissure? - anoscopies 84 Specify the clinical picture of fracture of the extensor Collis? - stylobata deformity of the wrist joint 85 The patient with the symptoms of acute appendicitis was taken to surgery. Choose the most rational method of treatment of the stump of the appendix - bandaging with a catgut and immersion in the purse string suture 86 The cecal appendage found on the short mesentery behind the cecum. What is a type of atypical location of cecal appendage? - retrocecum 87 What area is affected in pelvioperitonitis? - pelvic 88 What are the most commonly affected vessels in obliterating thromboangitis? - crural artery 89 What does of irreducible hernia cause? - adhesions between organs in the hernial sac and the wall of hernial sac 90 At what version of esophageal dyskinesia, spasm of limited areas of esophagus will be observed? - segmental esophageal spasm or "nutcracker esophagus" 91 Specify selective localizations of echinococcus in humans? - lung, brain, liver 92 Which immobilization is used when gunshot fractures of the shoulder joint? - immobilization Cramer 93 How do you call a symptom - definition of fluid levels on radiograph? - Kloyber’s bowl 94 What is fundamental in the diagnosis of postresection peptic ulcer? - study of gastric secretion   95 What is Lerish’s syndrome? - atherosclerotit occlusion of bifurcation of abdominal aorta 96 Reason of renal form of anutia is? - acute glomerulonephritis 97 Specify changes of the anterior eye in acute attack of wide glaucoma - corneal edema, small anterior chamber, dilated pupil 98 To clarify the source of macro hematuria the most appropriate is to begin examination? - with cystoscopy 99What is the nature of pain of acute appendicitis? - paroxysmal 100 What is the main place of gallstones formation? - gallbladder 101 What vessels are more prone to varicose? - veins of the lower limbs 102 Which blockades are most justified in acute pancreatitis? - blockade by Roman-Stolyar 103 What is the main reason for the formation of inguinal hernias in children? - violation of obliteration of vaginal process of the peritoneum 104 That is not typical for the second stage of diffuse widespread peritonitis - increased pain in the abdomen 105 What is the most important in the diagnosis of Douglas abscess? - digital examination of the rectum 106The basic pathogenetic link of total pancreonecrosis is   - endotoxicosis 107 What are the crucial research methods for the diagnosis of "Acute ileus "? - review Ro-scopy of abdomen, study barium passage through the intestine 108 What instrument is used to remove foreign bodies from the nose? -hook   109 What pain is most typical for the beginning of acute pancreatitis? - constant strong encircling upper abdominal 110 What causes atherosclerosis of lower limb? - gangrene 111 Specify the most characteristic localization of intussusception in children - thin-colonic 112 Name the character of pain in acute urological diseases - cutting, cramping 113 Where does pathological process of appendicitis start? - from the mucosa of appendix 114 What distinguishes acute ischemia in thrombosis from is ischemia in embolism? - the clinic is not as bright as embolism has 115 Absolute contraindication for bougienage during cicatrical stenosis of esophagus is - cicatrical stenosis complicated esophago-bronchical fissure 116 What is not used in diagnosis of esophageal foreign bodies? - esophageal intubation 117 What type of research is the most informative for the diagnosis of hemorrhoids? - sigmoidoscopy 118 What disease of the rectum does often localize on the back semicircle of anus? - anal fissure 119 What does term varicocele mean? - widening of the plexus 120 What is the most effective method of immunological diagnosis of echinococcosis and alveococcosis? -latex-agglutination   121 Modern tool used for embolectomy is - Fogarty balloon catheter 122 What vertebrae are true? -cervical, thoracic, lumbar 123 Name absolute indication to surgery of peptic ulcer - penetrating ulcers forming pathological fistula between organs 124 What clinical stage does acute peritonitis characterize? - reactive, toxic, terminal 125 What complication can cause on echinococcal cyst located near the gates of the liver? - obstructive jaundice

 

126 Specify the method that promotes the outflow of pus from suppurative lung cavities? - postural drainage 127 To clarify the source of macro hematuria the most appropriate is to begin examination? - with cystoscopy 128 At what damage occurs fracture like the "duck beak ”? - calcaneus 129 What complication can occur in fractures of the surgical neck of the shoulder? - damage of the neurovascular bundle 130 In what position of the patient extension in the hip joint is measured? - lay on the abdomen 131 What is used in the diagnosis of acute appendicitis in children? - laparoscopy and electromyography of the anterior abdominal wall 132 What is obligatory etiologic factor for the occurrence of acute paraproctitis? - blockage of the excretory duct of the anal glands and inflammation 133 Which atypical location of appendix is characterized by pain in the right upper quadrant? - subhepatic The pregnant woman came to the admission department on the 35th week of pregnancy, with painful pain in the lower part of the abdomen. Nappy every 4-5 minutes, 25-30 seconds. In the case of anesthesia, the uterus is cervix, the extremities are in the middle, the uterine wound is 2 cm. What is the most likely diagnosis? +35 weeks of pregnancy. Stage I   Correct description of the Crookenberg Cancer: +it affects both ovaries   Postpartum or abortion occurs most frequently in the mucous membrane of the uterus: +placenta polyp   Patient A., 24 years old, complained of pain in the lower limbs and bleeding from the genital tract to the extremity of the menstrual period for 2 weeks. 90/60 mm Hg, 90% per minute pulse wave. According to the mirror: uterus cervical mucus, bloody and dark. RV: a slightly increased uterus, movable, and smooth consistency of the dough, consistent with the consistency of the right ruminants. The back dome is thick and painful. What is the most likely diagnosis? +uterine pregnancy   A 40-year-old woman was admitted to the gynecological department with bleeding and pelvic pain in her lower back. During the past 1.5 years, the menstrual period has been prolonged and suffered from a large number of disintegration. The last menstrual cycle is periodic and continues for 10 days. Anamnesis: one birth and 3 abnormal abortions, without anesthesia. What is the disturbance of the menstrual activity? +hyperpolimenorea   What is breast cancer? +inflammation of the tissue at the bottom of the developing, born part   What is the tactics of the treatment of the reproductive age with breast cancer? +Planned laparotomy, ovarian resection   What follows is the displacement of the functional layer of the endometrium +Decreased levels of estrogen and progesterone in the blood   The woman was diagnosed during vaginal examination: 2/3 of the inner surface of the vein and the upper half of the aperture is full of head. 4-5 The vertebral vertebrae and the inferior bone are freely identified. The shoulder-shaped jaws are in the right-angle size. Determine where the pelvic head is located on the pelvis: +head, small pelvis   What is the main clinical symptom of bacterial vaginosis? +Breakdown with unpleasant fish smell   In the form of a stem, connective tissue feet in the mucous membrane of a cervix or cervix, a multi-layer flat or cylindrical epithelial is compatible with the glandular structure: +cervix polyps   The woman was at the active maternity stage at the maternity hospital, the boiling water was gone two hours ago. In the cardiogram, the infant's RMS is slowly reducing to the basic level, slowing down without the wristwatch, and with a good variability. How would you describe this slowing down? +explosion of a pile of cache   Metallurgical Combine 10   There are about 4,000 people in the world. What is the calculation of the organization of personal hygiene at this enterprise: +Depending on the number of women employed at the enterprise   The maximum concentration of chlorion gonadotropin in the blood is recorded at the time of pregnancy: +8-10 weeks   A 30-year-old woman was admitted to the emergency room with an ambulance, 8th pregnancy, 26 weeks. An hour later, in the lower abdomen, sudden pain lasted for 2-3 minutes. Subsequently, small brown spots were detected. Your forecast: +premature scrolling of a normal baby boyfriend   During the first 30 weeks of pregnancy, for the first time in pregnant women - 140/90 and 130/90 mm. upgrading. Following appropriate clinical and laboratory tests, the following diagnosis was made: Gestational hypertension. Which of the following explanations corresponds to gestational hypertension: +Hypertension that occurs after 20 weeks of pregnancy, which is recovered within 6 weeks after delivery   24-year-old puerperal woman, 4 days after birth. At the end of the third day, the body temperature was increased to 37.3 ° C, and the general weakness, headache, vomiting and vaginal discharge occurred. The cervix's bottom is 3 horizontally lower than the umbilical cord, the uterus is dense and painless. The suture on the wound in the interval is covered with porous cover, the tissues around it are reddened, swollen, and palpable. What is the most likely diagnosis and tactic? +absorption of stitches in the interval, removing the wound, cleaning the wound, antibacterial therapy   When does the postpartum period begin ?: +begins with a 6-8 weeks after the baby is separated   The woman was ready to give birth in a room, very painful. Until this time no analgesia or anesthesia was performed. The baby's head is visible at an intermediate level when intensified. Choose the type of anesthesia: +blocking of the genital nerve   The next pregnancy biomechanism relates to the type of headache: the head of the small pelvis, the backward incision of the head, the back of the head, the back of the head, the head of the head: +rear type of lying   A 22-year-old woman came to the doctor to choose a method of contraception with a family planning questionnaire, a trichomonate cocktail in the anamnesis, and several sexual partners. In this case, what method of contraception should be given to the mechanism of action: +Barrier Effect   A 20-year-old woman, who thought she was pregnant for 10 days, came to the women's council. It was detected during examination: the condition was satisfactory, intestine soft, painless, AK-120/80 mm, pulse 72 shots per minute. In gynecologic examination: mucous membranes of the vagina, increased lymph nodes, increased right artery beds. This clinic corresponds to the following diagnoses: +Progressive Tuberculosis Pregnancy   In a 48-year-old patient, right anterior cervix was removed due to the circumference of the right anterior ovarian tumor. Histological - cystadenocarcinoma serosity. How We Treat: +Relaparotomy + polyhythmias   The following major changes occur in the body during puberty: +activation of hormonal function of ovarian gland   A 17-year-old girl complained to a obstetrician-gynecologist that she had not had an epilepsy. It was found out that the tests were a real amenorrhea. What may be the result of genuine (pathological) amenorrhea: +Syndrome of tectonic feminization   Symptoms of HELLP syndrome ...: +Increased liver transaminases   Within 38 weeks + 5 days, the baby born first pregnant was assessed by 4-5 points on the Apgar stomach, during 5 days, the muzzle of the bubble triangle was detected and systolic noise was heard during auscultation of the tone of the heart. What you can think about: +Braking of embryonic closure   A 26-year-old woman complained about a 5-day delay in her menstrual cycle, including swelling, weight gain, mammary glands, pain, irritation, depression, and headaches. All of these complaints will be eliminated by the beginning of the next menstrual cycle. There were no pathological changes in gynecological examination. What is the pathology of this condition: +The sweat was getting dirty   During the 21st week of the second pregnancy, the woman had premature birth. When analyzing the blood group, the blood (II) blood group, (-) Rhesus factor, AB (IV) blood group and (+) Rhesus factor were identified. What Cause Can Cause pregnancy: +Antibodies to the rhesus factor in the fetus The pregnant woman complained about swelling of her legs for 2 weeks with a 36-37 week pregnancy. In the general urine analysis, no protein, AK - 120/80 mm. What is the most likely diagnosis? +36-37 week of pregnancy. Swelling of pregnancy   What is the location of the umbilical cord when it is missing a fetal cervix below the fetal part? +umbilical cord   In the diagnostics of external genital endometriosis, the most common information about the instrument test is: +laparoscopy, biopsy pathomorphological examination   A 25-year-old man has been identified as a cabbage bubble. A year after the removal of the bubble, the body has not increased in gynecologic examination. Torium of chorionic gonadotropin - 1000, without bleeding. What to present to a patient: +Monochymotherapy   A 32-year-old woman who gave birth to a child 2 weeks ago has given birth. The baby is immediately referred to his chest. An early postpartum period without exception. She was taken home with her son for 4 days. At present, she is complaining about an increase in body temperature by 38 degrees, fever. The overall condition is moderate gravity. The skin over the breasts is hot, palpable and painful. Milk is extracted from the seeds. Small, germinating subcutaneous. In vaginal examination, the uterus is normal in size, painless, movable, and cervical externally. Which is the most likely diagnosis. +lactostasis   A 20-year-old woman, who thought she was pregnant for 10 days, came to the women's council. It was detected during examination: the condition was satisfactory, intestine soft, painless, AK-120/80 mm, pulse 72 shots per minute. Gynecological examination revealed: mucous membrane of the vagina, the uterus did not grow, the right uterine joints were increased. Ultrasound examination of the small pelvis was suspected of progressive tubular pregnancy. What's the doctor's tactics of the Women's Council: +Urgent hospitalization of the patient   Early diagnostic symptoms of ovarian function: +Changes in the duration of the menstrual cycle   The 9-year-old girl started breast cancer growth. How to assess this situation: +Normal pubertat   Changes in the age of the woman are the dominant physiological stage of involutionary processes in the reproductive system ...: +Climax   According to ECG data, a newborn was detected in the newborn, the standard bend of the wound was high, the negative on the right, and the R wave low. What kind of process do you see from the ECG? +Normal electrocardiogram   A pregnant woman, 23, complained of abortion to the pathology department at weekly pregnancy, 30-31 weeks, with fatigue, thirst, hunger, and drinking liquids 5-6 liters a day. The woman is angry at the skin, and urinary tension is a problem. The first pregnancy ends 27-28 weeks before the end of the delivery with dead fetus, the second pregnancy increases 30-31 weeks according to the pregnancy, the fetus has longitudinal head. The heartbeat is clear, rhythmic. Blood sugar content is 10.2 mmol / l. 5 μmol / l of urine. Diagnosis: +diabetes mellitus   A 49-year-old woman was taken to a surgical department with a rapidly growing uterus. Vaginal examination: The uterine body has been increased to 12 weeks of pregnancy, and the stomach is lower than the uterus. What is the optimal amount of operation: +Extinction of the uterus   Breastfeeding after labor. Prevention is: +infectious diseases   Woman is 25 years old, pregnancy is 14-15 weeks. The abdomen is often called an ambulance due to frequent pains. Your predicted diagnosis: +Danger of abortion   A 24-year-old woman. Diagnosis: An incomplete abortion. Specify the amount of assistance: +Removal of the egg residue by means of instruments, infusion and antibacterial treatment   A 26-year-old woman who complains about the pain of breast cancer on the 3rd day of postpartum period. t = 38,2 ° C, pulse makes 86 per minute. The mammary gland has a uniform increase, palpation, and sensitivity. In this case rational tactics: +exhalation of milk in breast milk   Repeatedly pregnant at 36-37 on pregnancy. Result negative. The titles of the conflicts are 1:32. Things To Do: +By amniotomy, breastfeeding   Which is the most recognized, effective and safe method for treating preeclampsia / eclampsia, which is a method of selective treatment: +magnesium therapy   Determine the pathology of the postpartum puerperium next to the clinical picture: the condition is relatively satisfactory, the acne is 100/70, PS = 98 per minute, the skin has an ordinary color, uniform blood splits, up to 300 ml. When you look at the puerperium - there are no tears, the child is the whole and the shells are all. At the outer umbrella of the uterus, it is well cluttered and soon re-relaxed. What is the most likely diagnosis? +uterine hypotension and bleeding   The District Council of Women complained that the menstrual cycle (the last was 7 weeks earlier), and the luncheon and the mornings sometimes did not cause odors or odors. She thinks she is pregnant, unwanted pregnancy. Somatic healthy. There were 3 births (children live) and 2 medical abortions. There were no gynecological and venereal diseases. Vaginal examination revealed that: vaginal mucosa was clearly moldy, uterus cervical, and external mood was closed. The uterus is sealed in hyperantheplexia, softening, but palpation, increased to 7 weeks of pregnancy. Cuttings of clay. What's the doctor's tactics of the Women's Council: +Clinical and laboratory tests and referral to pregnancy   A 25-year-old woman was admitted to a gynecologic hospital complaining of pain in the lower part of her body, bloody separation from the genital tract and elevation to 38C. She has been diagnosed with illness since 3 days, these symptoms appeared after intravenous spiral introduction. There were 1 neoplasms and 3 abortions in the anesthesia. The overall condition is satisfactory, the palpation is mild in the palate, the pain is a little painful. In the study of bimanal: a slightly increased uterine body, doughy consistency, pain, and joints are not detected. What is the most likely diagnosis? +Endometritis   Patient L., 28 years old, underwent acute inflammation of the gynecological department. It was found out that positive responses to HIV were found during the test. In some cases, HIV infection can be considered as laboratory-proven: +The IFA reaction is positive + immunoblot   Adolescents are selective for the treatment of genital endometriosis: +KOC   Transplantation, posterior abdominal wall, AD = 160/110 mmHg, urine at 1.65 g / l in urine during pregnancy at 28 weeks pregnancy. Diagnosis: +severe preeclampsia   What does a driver say: +The point where the first pelvis enters the entrance and is the first seen through the groove   Specify high risk factors for cesarean section surgery: +chorionamniotitis   His mother noticed a 3-year-old girl, an omentum and anus. The girl is awakened at night, crying out because she is very disturbed and has a severe pain in the rectum. The appetite has diminished. What is the most likely diagnosis? +enterobiosis   The first pregnant woman was re-pregnant at the maternity home, complaining of four days before her pregnancy, 4 weeks of pregnancy, 4 hours before the fetal drainage, and an hour's pain in her lower part. Nutrition every 10 to 15 seconds every 6-7 minutes. What is the most likely diagnosis? +37 weeks of pregnancy + 4 days. Stage I. Pre-delivery fertility water. Obstetric anamnesis is severe   When juvenile bleeding occurs, it is necessary to eliminate the following: +blood diseases   What is the main feature of the two-phase cycle: +Ovulation   A 25-year-old patient came to the gynecologic hospital complaining about the pain in the lower part of the body that emerged immediately after physical violence. Vomit, vomiting, and mouthwheck tell him he is dry. Vaginal examination revealed that: uterus is dense, painless, moderate. Left spacers are not detectable, rounded to the right from rib, elastic consistency, limited movement, immediately palpation, 7 cm x 8 cm x 6 cm. dimensional formation is determined. The pulse wave was 120 pounds per minute. Leucocytes in the blood test were 12.3. We can talk about the diagnosis: +Twitching of the right ovary cyst   The 45-year-old patient was diagnosed with ovarian cancer and extracorporeal omentectomy. In histological study - borderline type cystadenoma with no symptoms. It needs: +control   A 40-year-old woman complained of bloody ulcers in her pupillary pain and genital tract. She is ill for 4 years. Over the last 3 years, he has anemia. In vaginal examination: bloody, large quantities. From the cervix's neck there is a myomax nodule in the thin end with a diameter of 3 cm. The uterus is a little bit dense and painful. No backups are detected. What is the doctor's tactic: +Remove the nose and then slaughter the uterus   During pregnancy 8-9 weeks of pregnancy, 22 pregnancies, pains, hypotonia, pulse rate of 110 times per minute, diuresis decreases, residual nitrogen and creatinine increase in acetone-4 + in the urine. Diagnosis: +pregnancy, severe form   A 52-year-old patient complains of general anxiety, 10 times a day, decreased work capacity, sleep disorders, depression, fear, anxiety, irritation, crying. The last drop was 10 months ago. Diagnosis: +Climacteric syndrome   A 56-year-old woman complained about the pain in her lower limbs and lumbar region, and the separation of liquids from the genital tract, and sometimes with her bleeding. In this case, what is the clinical symptom of cervical cancer? +Contact with bleeding   The pediatrician is 25 years old, 2 hours in the first delivery period. The genitals began to bleed. The most likely pathology: +diseased placenta   The pregnant woman, who was 29 years old, complained to the women's council about the pain of the lower leg and back pain. Pregnancy period is 15-16 weeks. There were one birth and three medical abortions. In vaginal examination: the vaginal dislocation of the cervix is ​​2.5 cm in length, it is surrounded by cervical spinal cord, it increases according to the duration of uterus, separated from the mucosa, in small quantities. Which of the following diag- noses corresponds to: +The risk of self-disability   During pregnancy 8-9 weeks of pregnancy, 22 cases of vomiting, pain, hypotension, pulse decreases 110 times per minute, diuresis decreases, residual nitrogen and creatinine increase, acetone in the urine -4+. Doctor Tactics: +hospitalization, termination of complex treatment   One of the most important steps to minimize perinatal mortality is: +(Timely diagnosis of the fetal state of the fetus   A 17-year-old girl was taken to the hospital immediately with large numbers of uterine bleeding. The mother is 13 years old, chronic, with hindrances of up to 1.5 months and ends with bleeding. The oral contraceptive course is ineffective. It has been sexually active since 6 months, and is maintained by sexually abused intercourse. What kind of treatment can you offer? + killing the uterus   A 38-year-old woman after Colskopia had a biopsy of the cervix's mucous membrane without pathological changes (the result of biopsy negative); and atypical cells were detected from the cervical core (the result was positive). What further action should be taken: +Maintenance of cervical neck   A pregnant woman was observed during her 37-week pregnancy: at 140/90 mm in the general urine analysis - 0.35 g / day protein. What is the most likely diagnosis? +The lightweight degree of preeclampsia   A pregnant woman has developed clinical and toxic attempts to overcome the severe gestosis. What causes the complication? +Eclampsia   The woman is pregnant for 7 hours with a periodic pregnancy and she is 30-35 seconds each 3-4 minutes. In the history: the third pregnancy, the previous two pregnancies ended with a medical abortion, the latter was complicated by endometritis. She started complaining about a small bleeding from the genital tract. Vaginal examination revealed: cervix, discovery 7-8 cm, fetal sachet whole, left loose fibrous tissue. What is your tactic: +make amniotomy and continue the delivery naturally   The perinatal mortality rate is calculated as follows: +(Number of infant deaths in the first 168 hours following birth) / (number of live and non-living births) 1000   The pregnant woman, 24, was delivered to the maternity hospital with a term of 39-40 weeks of pregnancy. Height is 152 cm, weight is 60 kg. Hip size: 23-25-28-17.5 cm, Solovyov index - 15 cm, Circulation - 105 cm, Head height - 39 cm. The Michaeley rhombus is 10x9 cm. The fetal heart rate is clear, rhythmic, 140 beats per minute, vertical size of the fetal head - 12 cm. Vaginal examination: The cervix is ​​"ripe," the head is moving , at the entrance to the small pelvis, moving. The diagonal conjugate is 11.5 cm. What is the most likely diagnosis? +39-40 weeks of pregnancy. The same degree of generalized hip, I degree. Large fetus   An unwanted pregnant woman was brought to the maternity hospital. According to relatives, 6 days before influenza. She complained about headaches, swelling of her legs. In the morning there was a fight. In general, it is severe and inaccessible. JSC = 130 / 80s. and AK = 120/80 hp, pregnancy 31-32 weeks. The fetus is at the head. The heartbeat is 140 milligrams per minute, the urinary catheter is 10 ml. In urine analysis, 3.5 g / l. Diagnosis: +31-32 weeks of pregnancy. Eclampsia, coma   A 4-5-point infant born on the Apgar pillar revealed unsteady thermoregulation in the first hour of life, including twice the incision syndrome, marble of the skin, and cramps of nerve-reflex excitation. What kind of symptom coincides with: +To the average degree of asphyxia   A 26-year-old woman complained about fatigue and swelling of the breasts and mucous membranes, scratching, irritation, sweating. He has been ill for three years. These symptoms appear in the second phase of the menstrual cycle and stop after the next menstrual cycle. Year-to-year symptoms did not increase. There was no pathology in gynecological examination. In this case, what type of menstrual syndrome may be: +Conducted   Patient, 32 years old, with a rapidly growing uterine uterine myomaly without amniotic fluid abnormalities. Histologically - proliferative leiomyoma. What is the doctor's tactics: +Control   A 52-year-old woman suffers 8 cases per day, headaches in the head, pain in the heart, respiratory tract, -150 / 90 mm. up to transistor upgrades. Postmenopause for 2 years. PV: The genitals are backward developing according to their age. What is the most likely diagnosis? +Easy degree of climacteric syndrome   There was a birthday. She was born in the age of 4200.0 and she was 52 cm in height. The boy's friend was separated individually. Then there were bloody dividing lines from the outer genitals. Effective methods of stopping conservative bleeding. Total bleeding was 800 ml. 90 / 50cb of bullet wound, 100 horsepower per minute. Nb - 90 g / l, erythrocytes 2,8 * 10 12 / l, Nt-30 percent. Put Diagnose: +early postnatal period. Hemorrhagic shock II degree Atonic Bleeding   Whenever the fetal death rate is included in an antenatal mortality rate: +22-42 weeks of pregnancy   36 weeks of pregnancy complained about an hour before fetal drainage. The situation is satisfactory. BP and vascular warfare are normal. The heartbeat of the fetus is choking and rhythmic, with 140 shots per minute. The ostrich is in the norm. On the back of the mirror the translucent pulse was found on the back dome. What is the most likely diagnosis? +36 weeks of pregnancy. Prevents premature fertility.   U, 26 years old, suffered medical abortions and complained that she had not had a menstrual period for 4 months after the end of her uterine cavity resuscitation. In the expected menstrual period, the lower part of the abdomen appears. RV: The uterus is increased by 6 to 7 weeks of pregnancy, consistency. The Enable area is unchanged. Which diagnosis is most likely to occur: +anemia of the amenorrhea, the atresia of the neck core   Patient N., 30 years old, obstetrician-gynecologist in family №2, for 3 months was treated with complaints of absence of menstruation, nausea, lack of appetite, and sometimes vomiting. During the objective examination, cyanosis of the cervix and vaginal mucosa was detected, and a large number of white spots were detected. In vaginal examination, the "softening" of the neck is determined. The cord consistency is soft, coated with palpation, increased to the size of the goose eggs. Do not worry. Companions do not grow and do not pain. Your diagnosis: +Pregnancy 8 weeks   The death of a woman during pregnancy or childbirth, within 42 days of pregnancy, which is related to pregnancy or due to any cause, but is not connected to a cause or accident, is: +Maternal mortality   At the reception center of the maternity ward with a woman who had a baby. 2 hours before birth at home. During pregnancy, she was registered at a local gynecologist, she was undergoing a full test. The situation is satisfactory. There is no claim. What steps should be taken in the admission department? +Looking at the way of labor and injecting yellow water to the antiperspirant.   In the reanimant woman, the fetus is lying on the thigh, with a predicted weight of 3200.0 + -200, at the end of the first stage of delivery, the drowsiness is repeated every 20 to 25 seconds every 4-5 minutes. The heartbeat of the fetus is clear, rhythmic, 136 hits per minute. What is the tactic of the doctor: +To initiate intravascular administration of oxytocin   A woman complained to the reception center of the maternity hospital that she had painful pains every 10 to 15 seconds every 6 to 7 minutes. The circulation is 108 cm, the height of the uterus is 39 cm, and the hips are 24-26-29-19 cm. What is the most likely diagnosis? +Mature pregnancy. Stage I. Generalized stroke I degree. Large fetus   A 20-year-old patient was admitted to the gynecological department on 13th day of the menstrual cycle complaining of the pain in the lower part of the body. 100/60 mm or more. The pulse wave was 90 shots per minute. The skin is pale. The abdomen is soft and there is pain in the lower parts. There is no symptom of irritation. According to the mirror: cervix is ​​clean and the mucosa is mucous. PV: The uterus is normal in size, the joints of the anterior abdominal wall are not detectable, the dome is deep, painful. What is the most likely diagnosis? +apoplexy of the ovary   Infection of the fetal membrane during pregnancy and childbirth ... +chorionamnionite   What is the main obstacle to obstetrician-gynecology? +reducing maternal and childhood morbidity and mortality         A 26-year-old woman complained about fatigue and swelling of the breasts and mucous membranes, scratching, irritation, sweating. He has been ill for three years. These symptoms appear in the second phase of the menstrual cycle and stop after the next menstrual cycle. Year-to-year symptoms did not increase. There was no pathology in gynecological examination. In this case, what treatment is not recommended: +double oral contraceptives   Many 35-year-old pediatricians complained of bleeding from the genital tract and lack of fetal movement. Excluding: BD 60/30 mm hp pulse - 110 min. The fetus is precisely defined under the hands of a doctor, does not hear a heart attack, tactics: +Drainage of the abdomen   The re-pregnant woman was taken to the reception center of the maternity ward for 38 weeks + 5 days of pregnancy, 6 hours after complaining of painful pain in the lower part of her umbilical cord, she washed for 25-30 seconds every 4 to 5 minutes, and 1.5 hours before fetal drainage . From anamnesis: The previous delivery was 13 months ago. What is the most likely diagnosis? +38 weeks of pregnancy + 5 days. Stage I. Early splenic fertility. Often delivery   Patient K., 24 years old. The reason for the call: pain in the abdomen. At arrival, the patient complains of pain in the lower part of the abdomen, bleeding from the genital tract. From anamnesis: The patient considers himself a person for 24 hours. It can not link anything with anything. Received No Boogie. Gynecological anamnesis: menstrual period is delayed for 2 weeks. Objective: The condition is moderate. Heart tones are clear, rhythm is correct. JSC 120 and 80 mm.s. Tuberculosis 100 times per minute. The belly is soft, slightly bloated. Bleeding from the genital tract. Feces and diuresis are normal. Which of the following diagnoses coincide: +uterine pregnancy   What major changes take place in the body during puberty: +Activation of hormonal function of ovaries   In case of cervical cancer 1 stage, the following treatment method is used: +Consolidated   Which of the following diseases is at the minimum risk for the development of atypical hyperplasia of endometrium: +Acute endometritis   In the normal case, the vaginal part of the cervix is ​​covered by: +Multi-layered flat non-epithelium   A 43-year-old woman was diagnosed with prophylaxis and subsequent follow-up, with the following diagnosis: "Dysplasia of the cervical neck". What does not use for treating this pathology: +Dithermocoagulation     Bleeding outcome as a result of injury to the uterus and soft tissue: +sewing soft tissue   Formation of the phytoplasmic system, basically ends: +By the 16th week of pregnancy   A pregnant woman complained of bleeding from her genitals during her 30-week pregnancy. From the anamnesis: Pregnancy - 4, the first delivery is ahead, bloody separations from the genital tract have been occurring in the 21st and 27th weeks of pregnancy. What is the most likely diagnosis? +Low placenta placement   The ultrasonography of the hernia was found to be low placenta. In the case of the Women's Council, recommendations were given. For the first time in a low placenta, bleeding often occurs at the time of pregnancy: +28-32 weeks   The 26-year-old midwife was taken to the maternity home after an ambulance, after the eclampsia stroke at home. Pregnancy life is 36-37 weeks. Sense of consciousness is slow. Skin coat pellets, anassaras, PA 170 \ 100 mm. What is the tactics of driving? +Creating a caesarean section after intensive care for 2-3 hours   The main indicator of the effectiveness of prophylactic gynecological examination of working women is: +The number of women surveyed is a part of gynecological patients   An overweight woman was at the age of 26 years pregnant with eclampsia during her 34-week pregnancy. He was taken to a maternity hospital by an ambulance. At the time of occurrence: consciousness delay is delayed, 180/110 and 170/100 mm. What is the load dose for magnetic therapy? +5 grams of dry matter or 20 ml of 25% MgSO4   What is the mechanism of contraceptive action of the barrier method? +cessation of entering the cervix through the uterine cervix   The first day of the newly infected baby has been described as follows: Nv - 220 g / l, color value is 1.2, leucocyte formula is left, neutrophil leukocytosis, blood suction time is 5 minutes, duration of breath is 5 minutes. What is the condition of this newborn baby, the image of this blood? +The image of blood is normal   By the end of pregnancy, what is determined by hemostasis: +fibrinogen, decline of prothrombin index, increase of fibrinogen degradation products   The 19-year-old patient complained of pain in the lower part of the body, increased body temperature up to 37.5C, and the removal of purulent cuttings from the genitals, pain in the urine. It was revealed that urethra is red, uterine cervix with hyperemia, erosion, and mucous membranes. In vaginal examination: it does not increase the uterus, it is painful in palpation, duplicate joints become thicker and painful. At best bacterioscopy, the gonococcus, located inside and outside the cell, was detected. What is the most likely diagnosis? +gentleman fresh gonorrhea   The negative result of the functional test with double estrogenic receptor tells us about the type of amenorrhea: +Umbrella At the age of 35, an endometrial hyperplasia was detected in the histologic examination of the wound hexagonal intestinal helix. What you need to do: +Control   Clinical forms of self-abortion: +dangerous, initiated, complete and incomplete abortion   During an external obstetric study, it was detected during palpation of the abdomen: from the length of the fetus, to the entrance to the small pelvis, and the back of the fetus to the left wall of the uterus. Specify the position and position of the fetus: +Headrest, Position I   An obstetrician-gynecologist had a pregnant woman who had been lying in the infectious hospital a week earlier with a heavy rubella. Pregnancy is 9 to 10 weeks. How can this disease affect the development of the embryo? +it can lead to the development of the baby   The pregnant woman came to the reception, the pregnancy was 37 weeks. The second method of Leopold-Levitsky was determined: large, dense, moving part of the fetus is palpable on the right side of the uterus. What is the most likely diagnosis? +Horizontal laying of the fetus, position 2   A 23-year-old nurse came out with bleeding after 5 hours after the onset. Sick heartbeat - 132 times / min. The situation is good. The cervix is ​​8-9 cm. what to do: +amniotomy   A 45-year-old woman was hospitalized because of mucous membrane uterus. Vaginal examination: uterine cervix is ​​hypertrophied, structure has changed, the uterus is 9-10 weeks pregnant, dense and painless. The squirrels have not changed. What is the optimal amount of operation: +extruding without iritation supplements   An ambulance was examined for 5 days after delivery. Complaints: permanent pain in the lower part of the abdomen, an increase in body temperature by 390 °, chills. Excess pain in palpation, unpleasant odor. What is the clinical symptom after endometrial endometrial surgery? +hyperthermia, with unpleasant odors   Reproductive woman is breastfed for 12 hours. Seed water is whole. Suddenly, the spleen began to ache, and the skin coated. The heartbeat of the fetus is bradycardia. In vaginal examination: full uterine cerebral opening, fertilization stomach, stem cell small pelvis. What is your tactic: +to open the fetal sac and to build obstetric clamps   In the delivery of women, 10 minutes after the baby was born, bleeding from the genitals appeared. There are signs of childhood divorce. Blood loss 250.0. What is the attitude of obstetrician-gynecologist? +isolation of the child using external methods   The growth rate of breast cancer and bleeding from the genital tract up to the age of the baby is considered a hormonal disorder and does not require treatment: +3 weeks     What is vulvit? +inflammation of external genitalia   The first child of 24 years, the second stage of labor continues for 40 minutes, weakened head, large segment of the head with small pelvis, should be fitted during vaginal examination, no narrow hip. The fetal condition is good. Things To Do: +introduction of oxytocin   How to determine the degree of uterine contractility: +Look at the height of the uterus   Common complications during puberty pregnancy: +Early childbirth   A 26-year-old female patient complained to the gynecologist on the pain of the right upper lip. Body temperature was raised to 37 C. When examining the exogenous genitals, hyperemia and swelling of the left breast lip were detected. At palpation, the depth of the left align is 5х4 cm in the center, with a smooth surface in the middle. Which diagnosis is most appropriate: +Bartole's gland abscess          65-year-old patient suffering from arterial hypertension developed asphyxiation and inspiratory dyspnea. The patient is in a forced sitting position. In the lungs, multiple mixed wet rales are heard. BP is normal, tachycardia.Preliminary diagnosis--cardiogenic pulmonary edema    60-year-old patient complaints of general weakness, fatigue, dizziness. From anamnesis: frequent fainting. Objective: conscious, pale, heart rate is 40 per 1 min., BP is 115/70 mm Hg. The drug of choice for emergency care:--atropine 0.1% -0.5 ml i/v.   45-year-old patient with some drug poisoning reveals the following symptoms: psychomotor agitation, mydriasis, accommodation paralysis, tachycardia, decreased salivary gland secretion, dry skin. The most likely drug, as the cause of poisoning—atropine   37-year-old patient who had deep vein thrombophlebitis of the lower extremities in anamnesis, had shortness of breath suddenly, acute chest pain, a cough with streaks of blood, palpitations The most likely cause of this condition--thromboembolism of the branches of the pulmonary artery    45-year-old woman complaints of an itchy rash all over the body, difficulty breathing, swelling of the lips, eyelids. From anamnesis: due to a strong cough after ARVI, she independently took intramuscular ceftriaxone. The group of antibacterial agents that can cause a similar reaction in a patient—cephalosporins Patient S., 56 years old, was delivered from the fire site. During extinguishing the fire, a brief loss of consciousness was observed, then replaced by agitation and convulsions. BP is 180/100 mm Hg, HR is100 beats per min. Emergency medical service:-- oxygen therapy, glucose + ascorbic acid I /V  Patient G., 16 years old. A reason for call: unconscious lying on the street. Anamnesis could not be determined. Objectively: the state is extremely critical, unconscious. The pupils are narrow, “punctate”, do not react to light. On the forearms there are multiple traces of old and fresh injections. There are single respiratory movements - 5-6 per 1 minute. Heart sounds are loud, rhythmic. Heart rate is 64 per 1 min., BP is 90/60 mm Hg.A drug that can rescue a patient out of a coma.--naloxone    --50-year-old woman suddenly in the morning for the first time, for no particular reason, had an attack of frequent heartbeat. The attack was accompanied by a feeling of fear, general and severe weakness, a sense of lack of air, and unpleasant sensations in the heart area. Objectively: the general state is of moderate severity. The patient is agitated, trembling. The skin is a normal color. In the lungs: vesicular breathing, no wheezing, BR is 20 beats per minute. Heart sounds are loud, rhythmic. Pulse is 170 beats per minute, rhythmic, small filling. BP is 120/70 mm Hg. ECG: rhythm is correct, heart rate is 170 beats per minute. QRS complexes are narrow. No focal changes noted.An effective drug for this heart rhythm disorder.--isoptin    tourist was bitten by a tarantula, he has intense pain, skin flushing, marked edema and paresthesia at the bite area.First aid:--desensitization therapy    35-year-old man with a complaint of headache, severe abdominal pain, nausea, vomiting and a acute deterioration in vision was brought to the emergency room in critical state. From anamnesis: abuses alcohol, on the eve he drank technical alcohol with his friend. Objectively: the state is critical. The skin is pale, dry. Heart sounds are loud, tachycardia is 100 beats per 1 min., BP is 140/90 mm Hg. Antidote for this poisoning--ethyl alcohol    The reason for EMS call: chest pain. Complaints: acute pain behind the sternum radiating to the back, feeling of lack of air. State deterioration is during an hour, and nitroglycerin intake did not improve the state. From anamnesis: the patient is registered in "D" account with diagnosis: CHD. Exertional angina. Objectively: heart sounds are deaf, regular rhythm, heart rate is 80 per 1 min., BP is 90/60 mm. ECG: sinus rhythm, correct, 80 in 1 min. Elevation of the ST segment, pathological Q in the II, III, aVFlead.Priority emergency service: --- oxygen therapy, i /v 200.0 ml 0.9% solution of NaCl, dopamine i/v, by drop infusion, morphine, aspirin, thrombolysis    72-year-old female patient complains of a headache, dizziness, stitching pains in the heart area without irradiation, an increase in blood pressure. Deterioration is noted within 3 hours. Anamnesis: coronary artery disease, hypertension for more than 10 years with infrequent rises in blood pressure up to 180/110 mm Hg. Objectively: general state is of moderate severity. Pulse is 80 beats per min., BP is 180/100 mm Hg.First aid medicine:.-- captopril   reason for EMS call: a 40-year-old patient woke up in the middle of the night because of pain in the heart area, feeling of lack of air. ECG: transient arc-shaped rise of the ST segment convexity upwards. From anamnesis: previously he noted similar night attacks, but he did not call the doctor. He took 1 tabl. of nitroglycerin. There was no effect.The drug of choice for emergency service:-- nfedipine   At a pedestrian crossing an accident occurred - a car hit a pedestrian. An ambulance arrived in 5 minutes. A man was lying on the carriageway with multiple closed fractures of the right lower limb. The victim was agitated, pale, covered with cold sweat, moaning from pain, asking for help. BP is 100/80 mmHg, pulse is 110 per 1 min.Algorithm of emergency medical service:-- adequate analgesia, transport immobilization, infusion therapy, hospitalization    60-year-old man called an ambulance because of severe weakness and dizziness. From anamnesis: suffers from diabetes for many years. Objectively: the skin is moist, tremor of the fingers. In lungs: vesicular breathing. Heart sounds have weak sonority, rhythmic. HR is 90 beats per min. BP is 160/100 mm Hg. When conducting glucometer: blood glucose is 2.5 mmol / l. Emergency medical service:-- intravenous bolus 40-60ml 40% solution of glucose   48-year-old female patient complaints of a heart attack that arose this morning after breakfast, severe weakness, constricting pain in the heart area, feeling of fear, shortness of breath. Attack couldn’t be stopped independently. She called an ambulance. Objectively: pale skin. In the lungs - vesicular breathing, without wheezing, BR is 24 per 1min. Heart sounds are loud, rhythmic, without noise. Pulse is 190 per 1 min., rhythmic, small filling. BP is 105 / 70mm Hg (the usual pressure is 120/70 mm Hg). The abdomen is soft, painless. Liver at the edge of the costal arch. Emergency medicine:--isoptin   62-year-old patient upon arrival of EMS team complains of suffocation, a feeling of lack of air, severe chest pain, a sense of fear of death. Deterioration occurred suddenly at night. Objectively: the state is critical. Consciousness is clear. The skin is pale, moist. Orthopnoye. Breathing is noisy, bubbling. In the lungs: the mass of moist rales of different sizes. Heart sounds are deaf, rhythmic. Heart rate is 110 per 1 minute, blood pressure is 160/100 mm Hg First-line drug in emergency service:-- morphine   Patient I. is 60 years old. He complaints of general weakness, fatigue, dizziness. From anamnesis: frequent fainting. Objectively: conscious, pale, heart rate is 45 per 1min., BP is 100/70 mm. Most acceptable screening test—ecg   56-year-old male patient upon arrival of EMS team complained of pain behind the sternum, in epigastrium. This pain is pressing, there is general weakness, a sense of fear of death. ECG: low voltage of the R wave in II, III, AVF, depression of ST interval in II, III, AVF. Type of examination at the EMS stage--cardiospecific enzymes    45-year-old female patient called an ambulance due to pills poisoing. She complains of headache, nausea, repeated vomiting. According to patient; 1 hour before the ambulance arrived she took 10 tablets for sucicidal purpose (unknown medicine). Objectively; the patient is agitated, restless, marked hyperhidrosis, tachycardia 120 per 1mint, shortness of breath 25 per1 mint, BP is 160/100 mmHg+++ Ephedrine    A 10 year old patient…. A positive mendels symptom. The diagnosis is+++Blcedenal ulcer A patient has dysuric disorder……;leucocyturia. Diagnosis is+++cystits A 2-year old child ill within 4 days…….most probable in this situation+++acute focal and pneumonia Parents of a 3-month old child….maximum 2-3m/r, R-grafiya of the heart……on ECG hypertrophy of the right ventrical. The most probable diagnosis is+++teratology of falat A 5- year old Vova got sick sharpy………protein of 2g/l gross hematuria, cylinduria. The diagnosis is+++nephritic syndrome with glomerulonephritic A12- year old child arrives……..signs of a hypertensive angioretinopathy. The diagnosis is+++ The basis of functional dyspepsia is+++Functional Dyspepsia (FD). Organic causes include peptic ulcer disease, medication effects, endocrine disorders, hepatocellular carcinoma, gallstones, parasitic infestation, and pancreatico-biliary disorder What is functional dyspepsia+++is a term for recurring signs and symptoms of indigestion that have no obvious cause. Dyspeptic disorders in functional dyspepsia may be caused by++++intestinal microbiome changes. infection. the bacterium Helicobacter pylori. above-normal acid secretion. To violations of gastroduodenal mortality in children with functional dyspepsis is listed+++ Decreed motor activity For functional dyspepsia is characterized by the following symptoms+++troublesome early satiety, fullness, or epigastric pain or burning. It can easily be overlooked as the symptoms overlap with gastro-oesophageal reflux disease and irritable bowel syndrome. The immediate cause of the rapid development of atrophy in autoimmune gastritis is+++T-cell lymphocytes infiltrate the gastric mucosa and contribute to the epithelial cell destruction and resulting gastric atrophy. One of the main morphological criteria of chronic gastritis is+++Artheroclerosis Name the factors of the lead to biliary tract moprtility disorders+++ including altered bile composition, cholesterol supersaturation of bile, gallbladder dysmotility, and loss of duodenal induced stimulation of gallbladder emptying. Gold standard diagnosis of infection is HP+++ureas breath test  Which of the following symptoms typical for acute pyelonefritis+++P.urea The basic and most common mechanism of acute glomerulonephritis+++immune-mediated, in which both humoral as well as cell-mediated pathways are active.  A child of 5 year old... 5th day…shortness of breath persists. What changes should be made first in the treatment+++Anemia [jaundice] The child is 2 year old,…..HB 83g/l Er 3, 5h012. What is the most likely diagnosis+++iron deficiency anemia The patient has the following symptoms; facial cyanosis…….which vicc can you think off+++tricuspid insuficiency Dasha, 10 year old. The day before….OAM- proteinuria 6g/l in b / x blood…….what is the main type of pathogenetictherapy+++preclnisilndom The patient has dysuric disorders,….in the analysis of urine; leukocyturia. Your preliminary diagnosis+++cystitis The child is 12years old, the condition…..temperature is 38.7C a positive symptom of pounding……Pelvic system. Your preliminary diagnosis+++Acute pylonephritis    A  -1year old child condition is severe……………HB-66g/l, er-2.3h1012/l, pcs-0.5………………the  diagnosis      is.++++ hemolytic  anemia A3-months-old child has multiple…….A preliminary diagnosis is++++ Vascular pustolosis A  5 day old new born …………………….bowel and bladder habit are normal……….pre..diagnosis is- +++ neonatal  jaundice the basis of function dyspepsia  is………………….. +++ neutriational  factors dyspeptic disorders……………..may be caused by +++++ neurophysiological  factor for functional dyspepsia…………………… the following symptoms+++ lack of increase of complation,error in diet,ofnight pain which of the following reason……………….a shortage of neonatal  stocks  Fe. +++ deficiency of carbohydrate diet in pregnant women which material does not………………..the absorption of Fe.+++ calcium 9.mauriac’s  syndrome occurs.+++ some children and adolescents with type 1 diabetes irrespective of their glycemic control.type 1 diabetes characterized by extreme liver enlargement due to glycogen deposition, along with growth failure and delayed puberty. 10.the clinic picture of hypothyroidism in infants.+++ snotingbreathing 11. hypothyroidism should be differentiated.+++ down syndrome 12. the new born at birth has no sign…………the pulse is about 84 beats / minute …….your primary diagnosis.+++ hypotoniaya asphyxia 13. the child is 9 years old ……….blood test er-ZxU/2 liter, HB-70g/l,CP-0.7……………..changes in the blood test.+++++ iron deficiency anemia 14. a child of 8 months……………..high temperature of 39C……………..which group of cephalosparins  does this antibiotic belong to ?++++3rd generation 15. what changes in peripheral ………of whooping cough.+++ all cytosis 16.omphalitis may be accompanied by.++++Omphalitis is a condition characterized by infected yolk sacs, often accompanied by unhealed navels in young fowl. 17.  relationship between the epidermis and dermis of newborn is.++++The neonatal dermis (the thick layer of tissue below the epidermis) also contains fewer collagen and elastin fibres and structural proteins. This affects the strength of the skin, making it more fragile than adult skin. 18.the child of 1.5 month old……..body weight of 2100 gram………..er-3,1x10/2/liter, Hb-90g/l,cp-0.82…… your primary diagnosis.+++++ anemia of premature 19.the child is 1 month old………………first month added 300 gram………..weight 3500 gram…….primary diagnosis.+++++ congenital  pyro neurosis/ pylo stenosis 20. the child is 2 months old…………..born weight 3400g.height of 51cm. and currently weight 400g.height 55cm………. your primary diagnosis.++++pyloric stenosis ciliac  disease, pylora  spasm 21. enxiety, weeping and hyperemia……………child 5 months is identified.+++++ 22. after examining a 2 months old child……….Ufa no.15……….prevention of rickets.++++ massage and walking 23.the child ids 6 months old……..oil solution of vitamin D for 500 ME 4 times a day . ………………. The child condition…+++ 24.the obstetrician conducted a conversation………….what are the doctors recommended for specific prevention of rickets……..+++++ vitamins of group D 25. a 3 months old child has multiple pustules…………..a primary diagnosis is..+++++ 26.Newborn are characterized by ………..of extra pyramidal regulation of motor skills………..motor activity is determined.+++++++++ 28. hemorrhagic  rash typical of.+++++ meningococcal  toximea 29.the  newborn at birth has  no  sign of breathing………84 beats /min…… your primary diagnosis.++++++ 30.triad Grega  comprises of itself following anomalieas of the developments..++++

?Patient P, 48 years old. He is admitted to the hospital again. The disease developed gradually. A few days before he was admitted to the hospital, he became withdrawn, isolated. During the conversation with the doctor, he said that"green radio waves are emitted from the neighboring house with the help of a special transmitter." He hears the voices of women, men, and children. From the content of the voices, he knew that this was a spy group. Voices speak of the need to kill people, to burn houses. He believes that at the order of the voices, his wife put poison in his food. Preliminary diagnosis

+ paranoid schizophrenia

- catatonic schizophrenia

- hebephrenic schizophrenia

- undifferentiated schizophrenia

- simple schizophrenia

 

?Patient P, 48 years old. He is admitted to the hospital again. The disease developed gradually. A few days before he was admitted to the hospital, he became withdrawn, isolated. During the conversation with the doctor, he said that"green radio waves are emitted from the neighboring house with the help of a special transmitter." He hears the voices of women, men, and children. From the content of the voices, he knew that this was a spy group. Voices speak of the need to kill people, to burn houses. He believes that at the order of the voices, his wife put poison in his food. Leading syndrome

+ paranoid syndrome

- hebephrenic syndrome

- paraffin syndrome

- manic syndrome

- delirious syndrome

 

?Patient P, 48 years old. He is admitted to the hospital again. The disease developed gradually. A few days before he was admitted to the hospital, he became withdrawn, isolated. During the conversation with the doctor, he said that"green radio waves are emitted from the neighboring house with the help of a special transmitter." He hears the voices of women, men, and children. From the content of the voices, he knew that this was a spy group. Voices speak of the need to kill people, to burn houses. He believes that at the order of the voices, his wife put poison in his food. Treatment tactics

+ neuroleptics

- anticonvulsants

- antidepressants

- nootrops

- vitamins

 

?Patient S. 78 years old, was hospitalized in a psychiatric hospital due to the fact that she began to hear numerous "voices"through the wall. She is sure that next to her room there is a " pre-trial detention center "in which the" bird people " work. Over time, she began to see these "bird people" in her home, she fed them, treated them, talked to them. She believed that some birds were chasing her, and others were helping her. I'm sure they exist, they seem to come to visit her in the hospital. Treatment tactics

+ neuroleptics

- anticonvulsants

- antidepressants

- nootropics

- vitamins

 

?Patient S. 78 years old, was hospitalized in a psychiatric hospital due to the fact that she began to hear numerous "voices"through the wall. She is sure that next to her room there is a " pre-trial detention center "in which the" bird people " work. Over time, she began to see these "bird people" in her home, she fed them, treated them, talked to them. She believed that some birds were chasing her, and others were helping her. I'm sure they exist, they seem to come to visit her in the hospital. Leading syndrome

+ paranoid syndrome

- hebephrenic syndrome

- paraphrenic syndrome

- manic syndrome

- delirious syndrome

 

?Patient S. 78 years old, was hospitalized in a psychiatric hospital due to the fact that she began to hear numerous "voices"through the wall. She is sure that next to her room there is a " pre-trial detention center "in which the" bird people " work. Over time, she began to see these "bird people" in her home, she fed them, treated them, talked to them. She believed that some birds were chasing her, and others were helping her. I'm sure they exist, they seem to come to visit her in the hospital.

+ paranoid schizophrenia

- catatonic schizophrenia

- hebephrenic schizophrenia

- undifferentiated schizophrenia

- simple schizophrenia

 

?Patient K, 36 years old, previously he was repeatedly hospitalized in a psychiatric clinic, he claims that he was abducted by a "flying saucer" and traveled to the stars on it. The patient talks about extraterrestrials, transmits conversations that he still hears from outer space. He is filledwith a sense of self-esteem and superiority, since he is the only one on the whole earth who communicates with the cosmos. Treatment tactics

+ neuroleptics

- anticonvulsants

- antidepressants

- nootrops

- vitamins

 

?Patient K, 36 years old, previously he was repeatedly hospitalized in a psychiatric clinic, he claims that he was abducted by a "flying saucer" and traveled to the stars on it. The patient talks about extraterrestrials, transmits conversations that he still hears from outer space. He is filledwith a sense of self-esteem and superiority, since he is the only one on the whole earth who communicates with the cosmos. Preliminary diagnosis

+ paranoid schizophrenia

- catatonic schizophrenia

- hebephrenic schizophrenia

- undifferentiated schizophrenia

- simple schizophrenia

 

?Patient K, 36 years old, previously he was repeatedly hospitalized in a psychiatric clinic, he claims that he was abducted by a "flying saucer" and traveled to the stars on it. The patient talks about extraterrestrials, transmits conversations that he still hears from outer space. He is filledwith a sense of self-esteem and superiority, since he is the only one on the whole earth who communicates with the cosmos. Leading syndrome

+ paraphrenic syndrome

- paranoid syndrome

- hebephrenic syndrome

- manic syndrome

- delirious syndrome

 

?The patient is talkative to the point of hoarseness, he tries to talk to any of the patients, but without listening to the latter, he enthusiastically recites poems to another. Seeing that the nurse is trying to clean the floor, rushes to her aid, but soon, abandoning what he started, gives advice to patients playing chess. He is inexhaustible in his activities, speaks rapidly, and his mood is elevated. Leading syndrome

+ manic syndrome

- paranoid syndrome

- catatonic syndrome

- paraphrenic syndrome

- delirious syndrome

 

?The patient is 27 years old. Hospitalized for the first time in his life, became acutely ill 2 days ago. Before that, during the week, his condition changed: he became distracted, did not understand the essence of the questions, and answered after a long pause. Gradually, inhibition increased, muscle tone increased, froze in uncomfortable poses, stopped answering questions at all, there was greasiness of the skin of the face, rare blinking, when trying to transplant the patient, resisted, when trying to feed, compressed his lips, when the spoon was removed from the mouth – opened his mouth. Leading syndrome

+ catatonic syndrome

- manic syndrome

- paranoid syndrome

- paraphrenic syndrome

- delirious syndrome

 

?The patient is 27 years old. Hospitalized for the first time in his life, became acutely ill 2 days ago. Before that, during the week, his condition changed: he became distracted, did not understand the essence of the questions, and answered after a long pause. Gradually, inhibition increased, muscle tone increased, froze in uncomfortable poses, stopped answering questions at all, there was greasiness of the skin of the face, rare blinking, when trying to transplant the patient, resisted, when trying to feed, compressed his lips, when the spoon was removed from the mouth – opened his mouth. Preliminary diagnosis

+ catatonic schizophrenia

- paranoid schizophrenia

- hebephrenic schizophrenia

- undifferentiated schizophrenia

- simple schizophrenia

 

?The patient is 27 years old. Hospitalized for the first time in his life, became acutely ill 2 days ago. Before that, during the week, his condition changed: he became distracted, did not understand the essence of the questions, and answered after a long pause. Gradually, inhibition increased, muscle tone increased, froze in uncomfortable poses, stopped answering questions at all, there was greasiness of the skin of the face, rare blinking, when trying to transplant the patient, resisted, when trying to feed, compressed his lips, when the spoon was removed from the mouth – opened his mouth. Treatment tactics

+ neuroleptics

- anticonvulsants

- antidepressants

- nootrops

- vitamins

 

?The patient is 26 years old, graduated from medical school, does not work, entered a psychiatric hospital for the first time. He was brought to the ward on a stretcher, he lies motionless, his head does not touch the pillow, his raised arm remains in this position, there is a symptom of a "gear wheel". He does not answer questions, does not respond to instructions. His gaze is fixed, blank, fixed on a single point. The patient is dirty, unshaven, unshaven. While trying to wash it, he suddenly hit the nurse in the face with his fist and froze again. Leading syndrome

+ catatonic syndrome

- manic syndrome

- paranoid syndrome

- paraphrenic syndrome

- delirious syndrome

 

?The patient is 26 years old, graduated from medical school, does not work, entered a psychiatric hospital for the first time. He was brought to the ward on a stretcher, he lies motionless, his head does not touch the pillow, his raised arm remains in this position, there is a symptom of a "gear wheel". He does not answer questions, does not respond to instructions. His gaze is fixed, blank, fixed on a single point. The patient is dirty, unshaven, unshaven. While trying to wash it, he suddenly hit the nurse in the face with his fist and froze again. Treatment tactics

+ neuroleptics

- anticonvulsants

- antidepressants

- nootrops

- vitamins

 

?During the examination, the patient is motorically inhibited, verbal contact is not available. At times, she spontaneously freezes in a strange pose. You can artificially give an unnatural position: raise her arm or leg so that she remains standing on the other leg, then the patient remains in this position for a long time. Leading syndrome

+ catatonic syndrome

- manic syndrome

- paranoid syndrome

- paraphrenic syndrome

- delirious syndrome

 

?During the examination, the patient is motorically inhibited, verbal contact is not available. At times, she spontaneously freezes in a strange pose. You can artificially give an unnatural position: raise her arm or leg so that she remains standing on the other leg, then the patient remains in this position for a long time. Preliminary diagnosis

+ catatonic schizophrenia

- paranoid schizophrenia

- hebephrenic schizophrenia

- undifferentiated schizophrenia

- simple schizophrenia

 

?During the examination, the patient is motorically inhibited, verbal contact is not available. At times, she spontaneously freezes in a strange pose. You can artificially give an unnatural position: raise her arm or leg so that she remains standing on the other leg, then the patient remains in this position for a long time. Treatment tactics

+ neuroleptics

- anticonvulsants

- antidepressants

- nootrops

- vitamins

 

?The patient notices that others constantly hint at his bad qualities. When people meet him, they lower their eyes, cough, and start laughing. The drivers specially light up its windows. The newspapers published an article titled "20 days left". This implies that he has 20 days left to live. Leading syndrome

+ paranoid syndrome

- hebephrenic syndrome

- paraphrenic syndrome

- manic syndrome

- delirious syndrome

 

?The patient notices that others constantly hint at his bad qualities. When people meet him, they lower their eyes, cough, and start laughing. The drivers specially light up its windows. The newspapers published an article titled "20 days left". This implies that he has 20 days left to live. Preliminary diagnosis

+ paranoid schizophrenia

- catatonic schizophrenia

- hebephrenic schizophrenia

- undifferentiated schizophrenia

- simple schizophrenia

 

?The patient notices that others constantly hint at his bad qualities. When people meet him, they lower their eyes, cough, and start laughing. The drivers specially light up its windows. The newspapers published an article titled "20 days left". This implies that he has 20 days left to live. Treatment tactics

+ neuroleptics

- anticonvulsants

- antidepressants

- nootrops

- vitamins

 

?Patient N, 40 years old, disabled person of group 2 for mental illness. She's lying in bed, talking to herself. It was found out that the patient "hears" the voices of a large group of people who are "attached" to her head with the help of a complex technique. The heads of these people are connected to her head, she can exchange thoughts with them, follow their instructions. These phenomena change her mood, suppress her will, turn her into a robot. The patient is sure that her thoughts are known to the neighbors. Preliminary diagnosis

+ paranoid schizophrenia

- catatonic schizophrenia

- hebephrenic schizophrenia

- undifferentiated schizophrenia

- simple schizophrenia

 

?Patient N, 40 years old, disabled person of group 2 for mental illness. She's lying in bed, talking to herself. It was found out that the patient "hears" the voices of a large group of people who are "attached" to her head with the help of a complex technique. The heads of these people are connected to her head, she can exchange thoughts with them, follow their instructions. These phenomena change her mood, suppress her will, turn her into a robot. The patient is sure that her thoughts are known to the neighbors. Leading syndrome

+ paranoid syndrome

- hebephrenic syndrome

- paraphrenic syndrome

- manic syndrome

- delirious syndrome

 

?Patient N, 40 years old, disabled person of group 2 for mental illness. She's lying in bed, talking to herself. It was found out that the patient "hears" the voices of a large group of people who are "attached" to her head with the help of a complex technique. The heads of these people are connected to her head, she can exchange thoughts with them, follow their instructions. These phenomena change her mood, suppress her will, turn her into a robot. The patient is sure that her thoughts are known to the neighbors. Treatment tactics

+ neuroleptics

- anticonvulsants

- antidepressants

- nootrops

- vitamins

 

?Patient N, 29, an engineer, after suffering an episode of schizophrenia, was discharged from the hospital without productive psychotic symptoms. However, she did not return to work, as she could not bring herself to act actively. She became indifferent not only to the work she had previously admired, but also to communicating with people. I paid little attention to my child and family. Over time, she almost stopped taking care of herself, washed and combed her hair only after she was reminded. I spent most of the day in bed. Leading syndrome

+ apato-abulic syndrome

- depressive syndrome

- paranoid syndrome

- catatonic syndrome

- asthenic syndrome

 

?Patient N, 29 years old, an engineer, after suffering an episode of schizophrenia, was discharged from the hospital without productive psychotic symptoms. However, she did not return to work, as she could not bring herself to act actively. I became indifferent not only to the work that I had previously admired, but also to communicating with people. I paid little attention to my child and family. Over time, she almost stopped taking care of herself, washed and combed her hair only after she was reminded. I spent most of the day in bed. Treatment tactics

+ neuroleptics

- anticonvulsants

- antidepressants

- nootropics

- vitamins

 

?Patient K. Became ill at the age of 30, suffered from atypical depression, and was treated on an outpatient basis. A month later, he was hospitalized in a state of psychomotor agitation: cheerful, with a mischievous smile on his face, easily comes into contact with others. The speech is fast, often does not finish the phrase. He does not express delusional ideas. Deceptions of perception are not noted. During the treatment, the mental state returned to normal. Leading syndrome

+ manic syndrome

- paranoid syndrome

- catatonic syndrome

- paraffin syndrome

- delirious syndrome

 

?Patient M. 49 years old, a teacher, is admitted to a psychiatric hospital for the fifth time. She complains of boredom, boredom, "a heavy heart." She walked slowly into the doctor's office, sat on the edge of a chair, and hardly changed her position. Her expression is sad, she speaks slowly, in a low, low-modulated voice, and answers questions after a pause. He feels no interest in anything. She considers herself a failure, accuses herself of having a bad attitude towards children. Physical complaints: constipation, palpitations. Leading syndrome

+ depressive syndrome 

- paranoid syndrome 

- catatonic syndrome 

- apato-abulic syndrome 

- asthenic syndrome

 

?Patient M. 49 years old, a teacher, is admitted to a psychiatric hospital for the fifth time. She complains of boredom, boredom, "a heavy heart." She walked slowly into the doctor's office, sat on the edge of a chair, and hardly changed her position. Her expression is sad, she speaks slowly, in a low, low-modulated voice, and answers questions after a pause. He feels no interest in anything. She considers herself a failure, accuses herself of having a bad attitude towards children. Physical complaints: constipation, palpitations. Preliminary diagnosis

+ depressive episode

- catatonic schizophrenia

- bipolar-affective disorder

- hysterical personality disorder

- simple schizophrenia

 

?Patient M. 49 years old, a teacher, is admitted to a psychiatric hospital for the fifth time. She complains of boredom, boredom, "a heavy heart." She walked slowly into the doctor's office, sat on the edge of a chair, and hardly changed her position. Her expression is sad, she speaks slowly, in a low, low-modulated voice, and answers questions after a pause. He feels no interest in anything. She considers herself a failure, accuses herself of having a bad attitude towards children. Physical complaints: constipation, palpitations. Treatment tactics

+ antidepressants

- neuroleptics

- anticonvulsants

- nootropics

- vitamins

 

?Patient D, 35 years old. During the last month, she was very tired, she did not sleep much due to the child's illness. Her mood worsened, and she felt a sense of longing, as if facing some kind of disaster. A week ago, she stopped sleeping, barely ate, and didn't go to work. Everything around her seemed bleak, life meaningless. Most of the time she lies in bed, sometimes walking around the room, wringing her hands. She does not communicate with anyone, and in a conversation with a doctor, she begs to save her. She doesn't take care of her appearance, eats with compulsion, and has a shallow sleep. Leading syndrome

+ depressive syndrome 

- paranoid syndrome 

- catatonic syndrome 

- apato-abulic syndrome 

- asthenic syndrome

 

?Patient D, 35 years old. During the last month, she was very tired, she did not sleep much due to the child's illness. Her mood worsened, and she felt a sense of longing, as if facing some kind of disaster. A week ago, she stopped sleeping, barely ate, and didn't go to work. Everything around her seemed bleak, life meaningless. Most of the time she lies in bed, sometimes walking around the room, wringing her hands. She does not communicate with anyone, and in a conversation with a doctor, she begs to save her. She doesn't take care of her appearance, eats with compulsion, and has a shallow sleep. Preliminary diagnosis

+ depressive episode

- catatonic schizophrenia

- bipolar-affective disorder

- hysterical personality disorder

- simple schizophrenia

 

?Patient D, 35 years old. During the last month, she was very tired, she did not sleep much due to the child's illness. Her mood worsened, and she felt a sense of longing, as if facing some kind of disaster. A week ago, she stopped sleeping, barely ate, and didn't go to work. Everything around her seemed bleak, life meaningless. Most of the time she lies in bed, sometimes walking around the room, wringing her hands. She does not communicate with anyone, and in a conversation with a doctor, she begs to save her. She doesn't take care of her appearance, eats with compulsion, and has a shallow sleep. Treatment tactics

+ antidepressants

- neuroleptics

- anticonvulsants

- nootropics

- vitamins

 

?A 36-year-old woman went to see a psychiatrist. Outwardly, she looks tired, depressed, and untidy . She complains of headaches and persistent insomnia, increased blood pressure, decreased appetite, lack of strength. She is dejected by the fact that she can not take care of her daughter for 7 years. She claims that she has lost all interest in life. Refuses the help of family and friends, asks to leave her alone. Treatment tactics

+ antidepressants

- neuroleptics

- anticonvulsants

- nootropics

- vitamins

 

?A 36-year-old woman went to see a psychiatrist. Outwardly, she looks tired, depressed, and untidy . She complains of headaches and persistent insomnia, increased blood pressure, decreased appetite, lack of strength. She is dejected by the fact that she can not take care of her daughter for 7 years. She claims that she has lost all interest in life. Refuses the help of family and friends, asks to leave her alone. Preliminary diagnosis

+ depressive episode

- catatonic schizophrenia

- bipolar-affective disorder

- hysterical personality disorder

- simple schizophrenia

 

?A 36-year-old woman went to see a psychiatrist. Outwardly, she looks tired, depressed, and untidy . She complains of headaches and persistent insomnia, increased blood pressure, decreased appetite, lack of strength. She is dejected by the fact that she can not take care of her daughter for 7 years. She claims that she has lost all interest in life. Refuses the help of family and friends, asks to leave her alone. Leading syndrome

+ depressive syndrome 

- paranoid syndrome 

- catatonic syndrome 

- apato-abulic syndrome 

- asthenic syndrome

 

?Patient S, 48 years old. It is received repeatedly. Previous hospitalizations alternated between depression and mania. The intermissions are long. Mental status at the time of examination: anxious, agitated. She blames herself for the fact that her whole "life consists of continuous mistakes and has been lived in vain." The speech is monotonous, the facial expressions are suffering. She usually notes the deterioration of her condition in the morning. In the evening, it becomes more active. Treatment tactics

+ antidepressants

- neuroleptics

- anticonvulsants

- nootropics

- vitamins

 

?Patient S, 48 years old. It is received repeatedly. Previous hospitalizations alternated between depression and mania. The intermissions are long. Mental status at the time of examination: anxious, agitated. She blames herself for the fact that her whole "life consists of continuous mistakes and has been lived in vain." The speech is monotonous, the facial expressions are suffering. She usually notes the deterioration of her condition in the morning. In the evening, it becomes more active. Leading syndrome

+ depressive syndrome 

- paranoid syndrome 

- catatonic syndrome 

- apato-abulic syndrome 

- asthenic syndrome

 

?Patient S, 48 years old. It is received repeatedly. Previous hospitalizations alternated between depression and mania. The intermissions are long. Mental status at the time of examination: anxious, agitated. She blames herself for the fact that her whole "life consists of continuous mistakes and has been lived in vain." The speech is monotonous, the facial expressions are suffering. She usually notes the deterioration of her condition in the morning. In the evening, it becomes more active. Preliminary diagnosis

+ bipolar-affective disorder, depressive episode

- catatonic schizophrenia

- bipolar-affective disorder, manic episode

- catatonic schizophrenia

- simple schizophrenia

 

?Patient B, 45 years old. Anamnesis: 2 years ago, she had a traumatic brain injury. Her mental state changed 2 years ago: she ran the farm, is untidy, stopped going to work, as she "could not figure out what to do for what". Her beliefs are primitive, she tries to be witty, but her jokes are flat. She can't name the current date, remember where she put things, what she did the day before. To others, she sticks with inappropriate advice. Basic skills are preserved, more complex operations are lost. Leading syndrome

+ dementia syndrome

- paranoid syndrome

- amnesic syndrome

- psycho-organic syndrome

- delirious syndrome

 

?Patient L, 12 years old, brought to the reception by his mother. Born in asphyxia. I started walking at the age of 3, and talking at the age of 5. Objectively: short stature, mouth half-open, hyperglossia, epicanthus, one furrow missing on the palms. The questions are answered in monosyllables, the thinking is subject-specific. It can't perform the simplest arithmetic operations. He believes that the difference between an airplane and a bird is that " the bird wants to eat." Leading syndrome

+ intellectual disability syndrome

- amnesic syndrome

- dementia syndrome

- hyperactivity syndrome

- attention deficit syndrome

 

?The child is 13 years old. From early childhood, he was inferior to his peers in mental development. With difficulty, he graduated from the first grade of school. He learned to copy words, and wrote individual words under dictation. The account is mechanical up to a hundred, the reverse account is difficult. It performs arithmetic operations within 20, subtraction-requires outside help. The child knows what a bed, a chair, a table is, but he cannot generalize them into one concept. He's diligent. He has a good mechanical memory. Outwardly, it is neat. Emotionally, he is adequate. Leading syndrome

+ intellectual disability syndrome

- amnesic syndrome

- dementia syndrome

- hyperactivity syndrome

- attention deficit syndrome

 

?The child is 13 years old. From early childhood, he was inferior to his peers in mental development. With difficulty, he graduated from the first grade of school. He learned to copy words, and wrote individual words under dictation. The account is mechanical up to a hundred, the reverse account is difficult. It performs arithmetic operations within 20, subtraction-requires outside help. The child knows what a bed, a chair, a table is, but he cannot generalize them into one concept. He's diligent. He has a good mechanical memory. Outwardly, it is neat. Emotionally, he is adequate. Preliminary diagnosis

+ intellectual disability syndrome

- amnesic syndrome

- dementia syndrome

- hyperactivity syndrome

- attention deficit syndrome

 

?The patient is 36 years old, for the last few days he felt extremely anxious, could not sleep, constantly walked around the rooms: it seemed that someone was in the house. When I opened the bathroom door, I could clearly see a man with a gray beard, wearing a turban and a long oriental robe, standing at the door. I grabbed it, but found that I was holding a bathrobe. I went to the bedroom and saw the same Oriental man at the window, rushed to him, but realized that it was a curtain. I lay down, but I couldn't sleep. I noticed that the flowers on the wallpaper became convex, and the walls began to grow. Leading syndrome

+ withdrawal syndrome with delirium

- withdrawal syndrome

- acute intoxication

- pathological intoxication

- mental dependence syndrome

 

?The patient is 36 years old, for the last few days he felt extremely anxious, could not sleep, constantly walked around the rooms: it seemed that someone was in the house. When I opened the bathroom door, I could clearly see a man with a gray beard, wearing a turban and a long oriental robe, standing at the door. I grabbed it, but found that I was holding a bathrobe. I went to the bedroom and saw the same Oriental man at the window, rushed to him, but realized that it was a curtain. I lay down, but I couldn't sleep. I noticed that the flowers on the wallpaper became convex, and the walls began to grow. Leading syndrome

+ delirious

- manic

- paranoid

- alcohol intoxication

- acute intoxication

 

?Patient D, 26, who was found lying on the sidewalk. He was taken to the hospital on a stretcher. The contact is unavailable. It lies motionless, does not react to external and painful stimuli. From the mouth-the smell of alcohol. In the oral cavity – the remains of vomit. The skin is pale, cyanotic. The skin is moist. Temperature 35 C, blood pressure-90/50 mmHg, shallow breathing, rare (8-10 per minute). The reaction of the pupils to light, tendon and skin reflexes are absent. There are tonic convulsions of the masticatory and occipital muscles. Leading syndrome

+ Severe alcohol intoxication

- Withdrawal syndrome

- Mild alcohol intoxication

- Moderate alcohol intoxication

- Pathological intoxication

 

?Patient D, 26, who was found lying on the sidewalk. He was taken to the hospital on a stretcher. The contact is unavailable. It lies motionless, does not react to external and painful stimuli. From the mouth-the smell of alcohol. In the oral cavity – the remains of vomit. The skin is pale, cyanotic. The skin is moist. Temperature 35 C, blood pressure-90/50 mmHg, shallow breathing, rare (8-10 per minute). The reaction of the pupils to light, tendon and skin reflexes are absent. There are tonic convulsions of the masticatory and occipital muscles. Qualify the patient's condition

+ Severe alcohol intoxication

- Heroin overdose

- Alcohol withdrawal

- Hashish intoxication

- Cocaine overdose

 

?The doctor of the ambulance team records the patient's tremor, dilated pupils, runny nose, frequent sneezing, coughing and excessive lacrimation. The patient is restless, anxious, tries to massage the muscles of the extremities, complains of pulling pains in the joints of the extremities, stool disorder, insomnia. When examined in the area of the elbow bends along the course of the veins, there are numerous seals and small hemorrhages in places. Leading syndrome

+ Withdrawal syndrome

- Phobic Syndrome

- Neurosis-like syndrome

- Psychopathic Syndrome

- Anxiety-depressive syndrome

 

?During the examination, the patient after using the drug notes the appearance of sensations of waves of heat in the body, dry mouth, itching of the skin of the face against the background of general peace, peace, an influx of dreams, bright pictures, ending in sleep for 3-4 hours. Qualify the patient's condition

+ hashish intoxication

- heroin intoxication

- opium intoxication

- cocaine intoxication

- alcohol intoxication

 

?M, 39 years old, has been abusing alcohol for 5 years, and has been getting drunk for the last 2.5 years. On the background of a mild cold for 3 days,He used vodka. Then, after stopping drinking (the patient had to go to work), he suddenly had a disturbed sleep, there was anxiety, anxiety, fear. In the evening, closing his eyes, he began to see flies, spiders, "some other vile insects." The next day he felt better, but in the evening he began to see flies and spiders again, this time with his eyes open, he felt them crawling on his skin, biting him, after a while he was surprised to notice that chickens and mice appeared in the room, which began to chase him. He hid, ran, shouted, decided to hang himself, but could not figure out how to do it better. Qualify the patient's condition

+ Alcoholic delirium

- Acute alcoholic hallucinosis

- Acute alcoholic paranoid

- Acute infectious psychosis

- Symptomatic psychosis

 

?Patient M, 36 years old, complains of insomnia for 8 months. As prescribed by doctors, he took sleeping pills periodically, then constantly. The patient himself notes that without sleeping pills, he feels constant fatigue, irritability, "a feeling of heaviness". While when they are used, there is a feeling of a surge of energy, increased activity, efficiency. He hadn't noticed that the dose of sleeping pills had increased, but without the hypnotic effect. He decided to stop taking these sleeping pills, but the next day the patient had an inexplicable anxiety, fear. There were tremors in the limbs, muscle twitching, general weakness, dizziness, nausea, vomiting. Later, 2convulsive seizures developed. Preliminary diagnosis

+ Mental and behavioral disorders due to the use of barbiturates

- Mental and behavioral disorders due to cocaine use

- Mental and behavioral disorders due to amphetamine use

- Mental and behavioral disorders due to the use of phencyclidine

- Mental and behavioral disorders due to the use of haloperidol

 

?Patient M, 36 years old, complains of insomnia for 8 months. As prescribed by doctors, he took sleeping pills periodically, then constantly. The patient himself notes that without sleeping pills, he feels constant fatigue, irritability, "a feeling of heaviness". While when they are used, there is a feeling of a surge of energy, increased activity, efficiency. He hadn't noticed that the dose of sleeping pills had increased, but without the hypnotic effect. He decided to stop taking these sleeping pills, but the next day the patient had an inexplicable anxiety, fear. There were tremors in the limbs, muscle twitching, general weakness, dizziness, nausea, vomiting. Later, 2convulsive seizures developed. Leading syndrome

+ withdrawal syndrome

- acute intoxication

- withdrawal syndrome with delirium

- pathological intoxication

- mental dependence syndrome

 

?Woman, 50 years old, widow, does not work, often drinks with her husband. Binge drinking up to 10 days, the last alcohol consumption-2 days ago. She complains of poor sleep, headache with nausea and dizziness, weakness, sweating, poor appetite, thirst. She looks older than her age, her hair is matted, her face is swollen, and her clothes are dirty. There is an increase in blood pressure, tachycardia, tremor of the fingers, hyperacusis; she experiences anxiety, fear, and is depressed. Leading syndrome

+ withdrawal syndrome

- withdrawal syndrome with delirium

- psychotic disorder

- amnesic syndrome

- acute intoxication syndrome

 

?The patient is 37 years old, disoriented in time and environment, believes that he is not in the hospital, but in the garage, calls others by the names of his friends. He makes movements with his hands, as if shaking insects from his clothes. According to the accompanying persons, he has been abusing alcohol for 10-12 years, has been intoxicated for 4 years, and the last alcohol consumption was 3 days ago. Leading syndrome

+ withdrawal syndrome with delirium

- withdrawal syndrome

- alcoholic paranoid

- amnesic syndrome

- acute intoxication syndrome

 

?The patient is 37 years old, disoriented in time and environment, believes that he is not in the hospital, but in the garage, calls others by the names of his comrades. He makes movements with his hands, as if shaking insects from his clothes. According to the accompanying persons, he has been abusing alcohol for 10-12 years, has been intoxicated for 4 years, and the last alcohol consumption was 3 days ago. Treatment tactics

+ haloperidol

- noofen

- pantocalcin

- amitriptyline

- fevarin

 

?Patient D, 23 years old, suffers from heroin addiction, during the last 3 days she was forced to stop taking the drug. When examined by a narcologist, she complains of sharp pains throughout the body, unpleasant sensations in the heart and stomach, nausea and diarrhea. She is in a state of motor activity, answers questions rudely, irritably, constantly asks to give her a drug or sleeping pills. Leading syndrome

+ withdrawal syndrome

- withdrawal syndrome with delirium

- psychotic disorder

- amnesic syndrome

- acute intoxication syndrome

 

?Patient D, 23 years old, suffers from heroin addiction, during the last 3 days she was forced to stop taking the drug. When examined by a narcologist, she complains of sharp pains throughout the body, unpleasant sensations in the heart and stomach, nausea and diarrhea. She is in a state of motor anxiety, answers questions rudely, irritably, constantly asks to give her a drug or sleeping pills. Treatment tactics

+ Psychopharmacotherapy

- Acupuncture

- Psychotherapy

- Electroconvulsive therapy

- Heroin substitution therapy

 

?The 19-year - old boy in the emergency room did not recognize others, did not know where he was, spoke about "aliens", but it was not possible to collect more detailed information. According to the mother, it is known that he has recently changed in behavior-he became secretive, sometimes came home cheerful, excited, laughed for no apparent reason, but did not notice the smell of alcohol. Increased appetite. Pupils are narrow, gait is unstable, blood pressure is 90/60 mmHg, temperature is normal. In the morning, after a drug-induced sleep and sedation, he was completely focused, told about the experience on the eve of the episode. In the evening, while in the company, he used a substance, after which he became cheerful, laughed, and then felt that he was "either on a flying saucer, or in a rocket and was in space, as if there was a blue sky and bright stars around". He doesn't remember how they brought him to the hospital. Determine the patient's condition

+ Hashish oneiroid

- Cocaine delirium

- Heroin withdrawal

- Amphetamine intoxication

- Cyclodol withdrawal

 

?Patient K, 68 years old, after interrupting an alcoholic binge, he began to see crumbling castles on the wall, he was surrounded by people with terrible faces and tried to strangle him. At the same time, he saw several flying UFOs. He ran away from home and hid in the woods. When hospitalized, the patient said that he was staying with a friend who had died a few years ago. He misspelled the year and time of year, and got the dates wrong. There's a look of horror on his face. Leading syndrome

+ withdrawal syndrome with delirium

- withdrawal syndrome

- paranoid syndrome

- amnesic syndrome

- acute intoxication syndrome

 

?The patient is 40 years old, from the age of 20 he abuses alcohol, gets drunk. A week before admission, he had a binge for 3 days. Going to work, two days after the binge, he heard the voice of an old friend who called him to go get drunk, then the voice began to "laugh", mock the patient. The patient ran to the home of a friend to sort things out, the patient.he was agitated, aggressive. The wife of a friend called a special team. He hears men's voices taunting him, threatening him. He feels fear, afraid that he will be dealt with. Leading syndrome

+ withdrawal syndrome with delirium

- withdrawal syndrome

 

A 38-year-old man for 5 days is worried about a cough with a small amount of sputum, a fever up to 38, weakness. On the roentgenogram - a focal heterogeneous shadow in the lower lobe of the right lung. Which of the following diagnoses is most likely

focal pneumonia

 

A 75-year-old man was admitted with complaints of palpitations, shortness of breath, general weakness. These complaints have been disturbing for about a month, with a history of chronic ischemic heart disease for about 10 years. On the ECG, the P wave is not recorded. There are atrial large F waves with a frequency of 270 per minute, the same in length, shape and height, consist of a steep ascending and gently sloping descending knee (saw teeth), clearly visible in leads II, III, avF, V1. The RR intervals are different. The QRS complex is not changed. What is the rhythm disturbance in the patient

atrial flutter, irregular shape

 

Patient C, on the 20th day of acute transmural infarction, developed intense chest pains associated with breathing, accompanied by severe weakness and sweating.

Objectively: subfebrile condition - 37.8 ° C, auscultatory hard breathing in the lungs, pleural friction noise is heard in the lower lateral parts. Heart sounds are muffled, pericardial friction noise is heard over the area of ​​absolute cardiac dullness. Which group of drugs is more appropriate to prescribe for this complication of acute myocardial infarction

non-steroidal anti-inflammatory

 

On auscultation: irregular rhythm, different volume of I tone, arrhythmic pulse, pulse waves of different amplitudes, pulse deficit of about 25 beats. What rhythm disturbance is most likely in the patient

atrial fibrillation

 

At the first stage of treatment of bronchial asthma, it is MOST advisable to prescribe: salbutamol

The patient, against the background of acute myocardial infarction, developed an attack of suffocation, shortness of breath appeared and increased, a large number of moist rales of various sizes were heard in the lungs against the background of hard breathing. Pulse 104 beats', BP 100 and 60 mm Hg. Your opinion about the complication

acute left ventricular failure, pulmonary edema

 

Male M, 64 years old, complained of burning pains behind the breastbone, lasting more than 40 minutes, which was not relieved by taking an isoket spray. From the anamnesis: Arterial hypertension for 10 years, observed on an outpatient basis, takes antihypertensive drugs. On examination: heart rate - 92 per minute. BP - 130/90 mm Hg. ECG: elevation of the ST segment in leads I, AVL, V3-V6.

What laboratory indicator must be determined in this situation troponin T

A patient with severe pneumonia has grade 3 respiratory failure, which corresponds to the saturation level (Sat%)

64%

A 29-year-old woman complains of chest pain on the left, fever up to 39 °, increasing shortness of breath. Objectively: weakening of vocal tremor on the left, shortening of percussion sound. The number of breaths is 22 per minute, heart rate is 100 beats per minute. Which of the following methods is decisive in making a diagnosis?

Chest x-ray

 

A 56-year-old patient complains of severe shortness of breath, cough with scanty sputum, pain in the heart. Has been suffering from chronic obstructive pulmonary disease for a long time. Objectively: swelling of the cervical veins, edema of the lower extremities, expansion of the borders of the heart. On auscultation, scattered dry rales, the emphasis of the second tone on the pulmonary artery. What is the most likely cause of the above symptoms

Chronic cor pulmonale

 

On the ECG, single deformed premature ventricular complexes without a previous P wave are recorded. What pathology can you think of?

ventricular premature beats

 

A 38-year-old man complained of interruptions in the work of the heart, a feeling of "fading", shortness of breath during normal physical exertion. ECG: sinus rhythm, heart rate 86 per minute. Normal EOS. Frequent polymorphic ventricular premature beats. Daily ECG monitoring was performed: polymorphic ventricular extrasystoles, 6 episodes of paired ventricular extrasystoles were revealed. What class according to the Lown classification belong to the patient's extrasystoles

IVa

 

A blood test in a patient with intense pressing pains behind the sternum revealed a high level of MV-CPK and troponin I (0.599 ng / ml). What's your diagnosis

myocardial infarction

 

A 75-year-old man, a hard-core smoker, complains of a dry hacking cough with hard-to-separate mucous sputum, severe shortness of breath. Which of the following diagnoses is correct

chronic obstructive pulmonary disease

 

Patient M., who was in the cardiology department for acute myocardial infarction, had a systolic murmur in the apex of the heart in dynamics, the 1st tone was weakened. What characteristic changes in ECHOKS do you expect to see in this situation?

mitral regurgitation

 

A patient with myocardial infarction has an intense anginal syndrome, tachycardia, a sharp decrease in blood pressure, a threadlike pulse, pallor of the skin, cold sweat. What complication developed in this patient

cardiogenic shock

 

The patient was admitted to the clinic for acute transmural myocardial infarction, blood pressure 60 and 40 mm Hg, thready pulse, pale cold skin, heart sounds are sharply weakened, urine output is reduced. Identify a possible complication

cardiogenic shock

The patient has dyspnea at rest, hepatomegaly, anasarca; during treatment, there is a slight regression of the phenomena of heart failure. What is your opinion on the degree of circulatory failure

CHS II B - FC III

 

The patient was admitted to the clinic for acute coronary syndrome. On the ECG, there is an elevation of the ST segment with a transition to a high coronary T wave in II, III, AVF. Troponin I is positive. Preliminary diagnosis

Ischemic heart disease. Myocardial infarction without Q wave

 

A 35-year-old man has been suffering from bronchial asthma for 2 years. Asthma attacks are relieved by berotek, hormone-dependent. The peak expiratory flow rate is 66%. At the time of examination - shortness of breath at rest, with auscultation - wheezing dry rales throughout the pulmonary fields. In the last hour, I have used an inhaler with berotek three times. What tactics are appropriate

prednisolone IV at a dose of 30-60 mg +

 

Patient R., 58 years old, has been suffering from arterial hypertension for 5 years. Occasionally, with an increase in blood pressure, he takes captopril. During the year, notes shortness of breath manifested during exercise, palpitations, small bubbly unsonic rales in the lower parts of the lungs. Determine the stage of NDT

NK II A stage

 

A 50-year-old patient complains of dry cough, nasal congestion, fever up to 37.5 ° C. She fell ill 7 days ago after hypothermia. Auscultatory breathing is hard, scattered dry rales throughout the pulmonary fields, exhalation is normal, NPV is 18 per minute. For the purpose of differential diagnosis, the patient must be assigned

Chest x-ray

 

A 55-year-old patient was admitted to the hospital with complaints of palpitations, a feeling of faintness and a tendency to fainting, dizziness. Auscultation: I and II tones are weakened, systolic-diastolic murmur at Botkin's point and II intercostal space on the right, murmurs are conducted into the jugular fossa and carotid arteries. ECG changes in ST segment and (-) T in I, AVL, V5-V6. ECHOKG: signs of aortic stenosis and diastolic aortic regurgitation. The most likely diagnosis in the patient

a combination of aortic stenosis and aortic insufficiency

 

A 17-year-old girl has rare sudden attacks of coughing, shortness of breath and wheezing for 4 months. Respiratory discomfort interrupts sleep 1–2 times a month. The girl's mother suffers from allergic rhinitis. FEV1 - 82%. Which of the following diagnoses is likely

bronchial asthma

 

On examination, the patient has a blush on the cheeks. Palpation at the top of the "cat's purr". Auscultation: diastolic murmur, I flapping tone, mitral valve opening tone, arrhythmia. Heart rate - 110 / min., Pulse deficit. In the lungs, in the lower parts, moist, unsonic wheezing. NPV - 21-22 per minute. Chest x-ray: flattening the waist of the heart,

deviation of the esophagus along an arc of a small radius. ECG: left atrial and right ventricular hypertrophy. The defeat of which valve is observed in the patient

mitral stenosis

 

A 62-year-old man complained of pressing pains behind the breastbone, arising at rest, not relieved by taking nitroglycerin. From the anamnesis: a month ago he had a myocardial infarction. There are no dynamic changes on the ECG. What diagnostic method is necessary for the patient

coronary angiography

 

In the patient on the 3rd day of myocardial infarction, the ECG shows the absence of the P wave in front of the QRS and different RR distances, what kind of heart rhythm disturbance developed in the patient in the postinfarction period

atrial fibrillation

 

An ECG in a patient with a history of arterial hypertension revealed an R wave in leads V5, V6, corresponding to 25 mm. What pathology is most likely in the patient?

left ventricular hypertrophy

 

The main method of pathogenetic therapy for patients with myocardial infarction arriving in the first 4-6 hours after the onset of the disease is

thrombolytic therapy

 

When conducting a differential diagnosis between an attack of bronchial asthma and the first stage of status asthmaticus, the most reliable symptom is

refractoriness to B2 agonists

 

A 20-year-old patient was admitted to the hospital with complaints of severe paroxysmal pain of a cutting, stabbing character in the epigastric region, more often at night. In the daytime, the pain subsides after eating. On palpation of the abdomen, there is pain in the pyloroduodenal zone, a positive Mendel's symptom. What is the alleged diagnosis

Duodenal ulcer

 

An 18-year-old woman came to the clinic with complaints of pain in the left hypogastrium during the act of defecation, disappearing after stool discharge; periodically loosening of the stool.

Objectively: pain on palpation of all parts of the colon. In the general analysis of blood: no pathology. Coprogram slime ++++. X-ray examination of the large intestine: signs of dyskinesia; at colonoscopy: tendency to spasms. What is the most likely diagnosis

Irritable bowel syndrome

 

A 25-year-old patient complains of aching pains in the right side of the abdomen; loose stools up to 6-8 times a day, losing weight by 8 kg over the past 2 years; pain in large joints, prolonged subfebrile condition. On examination: erythema nodosum on both legs, severe pain in the right iliac region; there are no symptoms of peritoneal irritation. In the UAC: HB 84 g / l, CP 0.8; watering can. - 12.6 thousand in 1 μl, ESR - 56 mm / h, total protein 49 g / l, albumin 39%, cholesterol 2 μmol / l, serum iron 7 μmol / l. Colonoscopy revealed slit-like deep ulcers of the mucous membrane of the cecum. Most likely diagnosis

Crohn's disease

 

Patient R., 21 years old, complains of pain around the navel of varying intensity, disappearing after stool discharge, periodically constipation with diarrhea, bloating.

Objectively: pain in all parts of the colon. In the general analysis of blood: HB-123 g / l, leukocytes - 8.0x109 / l., ESR - 14 mm / h. X-ray examination of the large intestine: signs of dyskinesia; at colonoscopy: tendency to spasms. Which plan of the listed treatment measures is most appropriate to prescribe?

Diet, stress reduction, probiotics

 

Male K., 42 years old, complains of an increase in the abdomen in volume, within 2 months. He suffered from hepatitis B disease about 12 years ago and occasionally drank alcohol. On examination

- a noticeable venous network on the abdomen, grade 2 ascites. The most appropriate group of drugs in the treatment of ascites in liver cirrhosis

Potassium-sparing diuretic in combination with a loop diuretic

 

A 36-year-old man is worried about frequent loose stools mixed with mucus, pus, blood up to 35 times a day; fever; the appearance of painful ulcerations in the mouth; cramps and pain in the eyes.

Epidemiological history was unremarkable. A preliminary diagnosis of ulcerative colitis was made. Which of the following drugs is most appropriate to prescribe

Sulfasalazine

 

Woman A., 43 years old over the past 4 months began to worry about pain in the right hypochondrium, 2 weeks ago developed jaundice. History of viral hepatitis B, alcohol abuse. On examination: a patient with reduced nutrition. The skin and sclera are icteric, with telangiectasias. The belly is swollen. The liver is +4 cm protruding from under the edge of the costal arch, dense, sensitive.

The spleen is enlarged by +3 cm, dense. In the blood: anemia, thrombocytopenia, ESR - 28 mm / hour; total bilirubin - 84 μmol / l, mainly due to the direct fraction. Which of the following diagnoses is most likely

Cirrhosis of the liver

 

Patient D., 52 years old, was admitted to the clinic with complaints of pain in the epigastric region arising 20-30 minutes after a meal, belching with air, and a decrease in body weight by 3 kg over the last month. With EFGDS: on the lesser curvature, in its middle third, there is a stellate whitish scar with a distinct convergence of folds. There is also a fresh ulcer with edematous, inflammatory changes in the edges, measuring 6x8 mm. There is a blood clot deep in the ulcer.

A biopsy of the mucous membrane from the edges of the ulcer was performed. Helicobacter pylori was found in the biopsy. What is the most appropriate therapy regimen

Proton pump inhibitor + ampicillin + clarithromycin

 

Patient O., 32 years old, complains of pressing pain in the epigastric region after spicy food or alcohol 30 minutes after eating, excruciating heartburn, which decreases after taking soda. Ill for 3 years, not treated. Objectively: the tongue is coated with a white coating, with deep palpation, diffuse soreness in the epigastrium. EFGDS: the gastric mucosa is hyperemic, edematous, in the antrum - single hemorrhages. What is the most informative examination method

Respiratory urease test for Helicobaster pylori

 

A 28-year-old man complains of loose stools up to 20 times a day mixed with blood, mucus, pus with a fetid odor, cramping abdominal pain, aggravated before the act of defecation and weakened after stool; joint pain; lacrimation, pain and cramps in the eyes; the appearance of sores in the mouth; dizziness, flashing of flies before the eyes; fever. Which of the following diagnoses is most likely

Nonspecific ulcerative colitis

 

Patient V., 37 years old, complains of pain in the lumbar region, frequent urination. Within 10 years, 2-3 times a year, noted pain in the lower back, dysuria. She was observed by a therapist, received treatment, within a month the pain intensified. Objectively: temperature 370C. The symptom of tapping of the lumbar region is positive on both sides. In the blood: leukocytes - 6.1 thousand, ESR - 20 mm / hour. Urine analysis: beats. weight -1005, protein - 1.0 g / l, leukocytes completely cover the field of view. Nechiporenko's test: erythrocytes - 2 / l, leukocytes - 6000 / l. Which of the following diagnoses is most likely

urinary tract infections

 

Patient O., 52 years old, with complaints of sudden pain in the right elbow joint, redness of the skin over the inflamed joint up to a bluish-purple color, hot to the touch, swelling, impaired mobility, increased body temperature up to 38-39 ° C, violation sleep, weakness, fatigue. From the anamnesis of the disease: considers himself ill during the last 2 years, when pain, swelling and redness appeared in the first metatarsophalangeal joint of the left foot, a month later the same symptoms in the left knee joint. Presumptive diagnosis

Gouty arthritis

 

Periorbital edema with purple-purple erythema, shortness of breath, dry cough, increasing muscle weakness, pain in the muscles of the shoulder and pelvic girdle are most common for

dermatomyositis

 

In a patient with urinary tract infection, renal function is primarily impaired.

Which drug is most appropriate for urinary tract infection amoxicillin

Patient T. 30 years old, with complaints of pain and swelling of the proximal interphalangeal, metacarpophalangeal, wrist joints, elbow joints; symmetrical, inflammatory, limitation of mobility in the affected joints; morning stiffness for 2 hours. On examination: moderate ulnar deviation of the metacarpophalangeal joints. In the blood: er-4.5x1012 / l, HB-130 g / l, ESR-33 mm / hour. RF - 32.2 UI / ml (up to 5.5 UI / ml), ADCP - 147 U / ml (up to 3 U / ml). Presumptive diagnosis

rheumatoid arthritis

 

After the transferred infection, the patient was diagnosed with chronic glomerulonephritis. What is the main etiological factor of acute glomerulonephritis

B-hemolytic streptococcus group A

 

Patient K., 50 years old, complains of pain in the knee joints, aggravated by walking. Objectively: the knee joints are deformed, there are seals of the periarticular tissue, crepitus. Dense nodules were found in the distal interphalangeal joints. UAC: er - 4.2x1012 / l, watering can - 5.6x109 / l, ESR - 15 mm / hour, CRP - negative. Which of the following diagnoses is most likely

osteoarthritis

 

A 35-year-old woman is worried about swelling of the face and lower extremities. BP 180/100 mm Hg In the blood: HB - 76 g / l, er - 2.6 million, leuke - 3.4 thousand, thrombus - 158 thousand, ESR - 43 mm / h, total protein - 46 g / l, albumin - 28 %. Urine analysis: protein - 14.3 g / l, leuke 6-7 in field of vision, er - 0-2 in field of vision. Prescribed a four-component therapy for the treatment of glomerulonephritis. Which drug combination corresponds to the quadruple therapy

cytostatics + corticosteroids + antiplatelet agents + anticoagulants

 

A 45-year-old woman complained of aching pains in the lumbar region on the right, frequent urination (up to 2-3 times at night), subfebrile temperature in the evening. At the age of 20, he notes UTI, exacerbation 2-3 times a year. On ultrasound of the kidneys - expansion of the cups, pelvis of the right kidney. To confirm the diagnosis of exacerbation of urinary tract infection, it is most advisable to carry out

urine culture

 

A 24-year-old man is worried about weakness, decreased appetite. Ill for 15 years, diabetes mellitus, receiving insulin. Objectively: pale, dry skin, a symptom of tapping of the lumbar region is negative on both sides. BP - 140/90 mm Hg. Heart rate - 80 beats / min. In the blood: HB — 116 g / l, erythrocytes — 2.8 million, leukocytes — 8.2 thousand, ESR — 18 mm / h. Urine analysis: beats. weight - 1005, protein - 0.5 g / l, leukocytes - 5-6 in field of vision, erythe - 2 in field of vision. Biochemical blood test: creatinine 135 μmol / l, urea 8.0 mmol / l. Which treatment is most appropriate

Nephroprotection with ACE inhibitors

 

In a 35-year-old woman, within 5 years after severe acute respiratory viral infection, relapses of fever, severe weakness, arthralgia and myalgia, Raynaud's phenomenon, bilateral pathological changes in the lungs, which were regarded as pneumonia, appear. Later, pain in the region of the heart, dysphagia appeared. Objectively - there are foci of compaction and atrophy on the skin. Antibodies to SCL70 have been identified. The appointment of which of the listed drugs is advisable for basic therapy

D-penicillamine

 

A woman, 30 years old, was admitted to the emergency room with complaints of general weakness, an increase in body temperature up to 380 C, pain in the lumbar region, aching in nature, with irradiation to the lower abdomen. According to the patient, these complaints were treated for 5 years, with an exacerbation. On examination: pasty face, soreness when tapping the lumbar region. On examination: UAC: HB-120g / l, erythrocytes - 3.5x1012 / l, CP-1.0, leukocytes 12x109 / l, p / i - 6%, s / i - 60%, lim -28%, eos - 1%, base - 0%, mon - 6%, ESR-18mm / hour. OAM: alkaline reaction, relative density-1010, leukocytes - all over, erythrocytes - 0-1 in field of vision, bacteria ++. On ultrasound of the kidneys: expansion of the PCS. What is the most likely diagnosis

urinary tract infections

 

A 37-year-old man complains of weakness, nausea, decreased appetite, weight loss, swelling in the legs, increased blood pressure. Diabetes mellitus for 20 years. About-but: low nutrition, the skin is pale, dry. Puffiness of the face; swelling of the legs and feet. Blood test: HB-87 g / l, erythrocytes-3.2x1012 / l, leukocytes-9.71x109 / l, COE-30 mm / h. Urine analysis: specific weight-1012, protein-1.0 g / l, leukocytes-4-5 in field of vision, erythrocytes - 0 in field of vision. Biochemical blood test: creatinine 235 mmol / l, urea 12 mmol / l. What is the next step in examining a patient

GFR calculation

 

Woman 45 years old. 10 years ago, there were pains in the wrist, metacarpophalangeal joints, morning stiffness. Objectively: ulnar deviation of the metacarpophalangeal joints. Muscle hypotrophy of the dorsum of the hands, limitation of range of motion. In the blood: er-4.5x1012 / l, HB-130 g / l, ESR-33 mm / hour. RF - 32.2 UI / ml (up to 5.5 UI / ml), ADCP - 147 U / ml (up to 3 U / ml). The basic drug for the treatment of this disease is

methotrexate

 

A 52-year-old patient complains of pain and limitation of movement in the interphalangeal joints of the hands. Examination in the area of ​​the distal interphalangeal joints revealed dense nodules up to 0.5 cm in size, moderately painful on palpation. The joints are slightly deformed, the movement in them is limited. X-ray of the joints of the hands revealed a narrowing of the joint space, osteoporosis. The most expedient tactic

NSAIDs + chondroprotectors

 

A 38-year-old woman has had painful whitening of her fingers in the cold for 10 years. Over the past year, it has become more pronounced, there are signs of arthritis of the small joints of the hands and wrists, difficulty in swallowing solid food. Blood test: ESR

- 40 mm / h. Most likely diagnosis Systemic scleroderma

A 23-year-old woman complains of fever up to 39, sore throat, coughing, facial flushing. She took ampicillin and paracetamol on her own without effect. On examination: hyperemia and swelling of the face; on the chest, back, erythematous-papular rash, lymphadenopathy, aphthous stomatitis, local hair loss. Heart sounds are muffled, the rhythm is correct, heart rate is 110 per minute, blood pressure is 150/100 mm Hg. Art .; hepatomegaly. In the blood: er-3.2x1012 / l, HB-100 g / l, leukocytes - 2.5x109 / l, ESR-40 mm / hour. In the analysis of urine: protein - 1.9 g / l, lei - 6-8 in field of vision, er-15-18 in field of vision.

Most likely diagnosis. systemic lupus erythematosus

A 57-year-old man, complaints of sudden pain in the 1st joint of the right foot, redness of the skin over the inflamed joint up to bluish-purple color, hot to the touch; tension, impaired mobility in the joint, an increase in body temperature to 38-39 ° C, sleep disturbance, weakness, fatigue. On examination: Tophus in the concha of the left ear, in the extensor part of the left elbow joint. To relieve an acute attack of gout, use

colchicine

A 37-year-old man complains of severe weakness, headache, decreased appetite, weight loss, edema. He has been suffering from kidney disease for 5 years. About-but: reduced nutrition, the skin is pale with an icteric tinge. Puffiness of the face; swelling of the legs and feet. HELL 170/105 mm Hg Blood test: HB-70 g / l, er-2.0 million, leik-5.7 thousand, COE-20 mm / h. Biochemical blood test: creatinine 0.19 mmol / l (norm 0.053-0.095 mmol / l), total protein 49 g / l, blood sugar 5.4 mmol / l. Urine analysis: specific weight-1012, protein-4.5 g / l, leuke-4-5 in the field of vision, eryth-5-6 in the field of vision, hyaline cylinders-7 in the field of view. What combination of symptoms is typical for the diagnosis of nephrotic syndrome in a patient?

edema, hypoproteinemia, massive proteinuria

 

Patient A., 19 years old, on examination, has splenomegaly. In the hemogram: leukocytes 78 ∙ 109 / l; leukocyte formula: promyelocytes 3%, myelocytes 8%, metamyelocytes 12%, stab

neutrophils 21%, segmented neutrophils - 41%, basophils - 3%, eosinophils - 6%, lymphocytes - 6%. Platelets - 784 ∙ 109 / L, hemoglobin - 114 g / L, bone marrow is hypercellular, the content of myelokaryocytes and megakaryocytes is increased, all elements of the granulocytic series are determined. What is the next stage of the survey

cytogenetic blood test

 

A 57-year-old woman complains of general weakness, dizziness, shortness of breath when walking, pain in the epigastric region. Objectively: decreased nutrition, skin and visible mucous membranes are pale with an icteric tinge, moderate splenomegaly. In the blood: er-2.1x1012 / l, HB- 89 g / l, CP-1.1, leuke-2.8x109 / l, platelets-115x109 / l, ESR-24 mm / h, macrocytosis. What changes in the hemogram on the 5-7th day of treatment are characteristic of the alleged pathology

reticulocytic crisis

 

Patient D., 28 years old, was treated for 3 weeks for stomatitis without effect with increasing weakness, sweating. Objectively: the body temperature is 38.8ные, the skin is pale, moist. Gingival hyperplasia, ulcerative necrotizing stomatitis. Submandibular lymph nodes are enlarged, painless. In the blood: er-3.0x1012 / l, HB-95 g / l, CP - 0.95, leuke - 14.5x109 / l, blasts-32%, pal-1%, segm-39%, lymph-20 %, mon-8%, thrombus-90x109 / l. ESR-54 mm / h.

Which of the following diagnoses is most likely for acute leukemia?

A man, 70 years old, was admitted with complaints of weakness, chilliness of the legs, parasthesia. In the anamnesis, 7 years ago there was a resection of the stomach. In the blood: HB- 70 g / l, erythrocytes 2.0 ∙ 1012 / l, CP- 1.2, leuke- 3.0 ∙ 109 / l, platelets - 140 ∙ 109 / l. What is the reason for the development of this anemia

deficiency of gastromucoprotein

 

A 23-year-old patient complains of weakness, shortness of breath, palpitations. Objectively: the skin and mucous membranes are pale. Systolic murmur at the apex, tachycardia. In the blood: erythrocytes - 3.0x1012 / l., Hemoglobin - 92 g / l, leukocytes - 4.2x109 / l., Platelets - 192x109 / l, ESR - 22 mm / h. The most accurate interpretation of a blood test

mild normochromic anemia

 

A 68-year-old woman, complaints of severe general weakness, dizziness, “wobbling of the legs”, discomfort in the epigastric region. In the hemogram: HB-68 g / l, erythr-2.0 x1012 / l, CP-1.02, leuke-3.0 x109 / l, thrombus-190 x109 / l, n-2%, s-64% , e-1%, m-6%, lim-27%, ESR-8 mm / hour. At FGDS:

atrophic gastritis. What laboratory research should be carried out at the initial stage

blood test for vitamin B12

 

Patient V., 40 years old, complains of weakness, sweating, weight loss, dull pain in the left hypochondrium. Objectively: the skin is pale, moist. The liver protrudes from under the costal margin by 3 cm, the spleen is at the level of the navel, dense, painless. In the blood: er-3.0 x1012 / l, leuke-96 x109 / l, myeloblasts-2%, promyelocytes-4%, metamyelocytes-8%, pal-12%, segment-52%, eosin-5%, basof -5%, lymph-12%, thrombus-200x109 / l. ESR-56 mm / h. What is the most likely diagnosis

chronic myeloid leukemia

 

A 48-year-old patient complains of weakness, weight loss, heaviness in the left hypochondrium. On examination, the edge of the spleen protrudes 4 cm from the edge of the arch. In the blood: Нb- 128g / l, er 4.0 ∙ 1012 / l, leuke- 47 ∙ 109 / l, tr 480 ∙ 109 / l, formula: eos-2%, base-3%, blasts 1%, prom -2%, myel-4%, young-10%, p / i-26%, s / i-34%, lymph-12, mon-6%, ESR-6 mm / h. In the myelogram - hyperplasia of the cells of the myeloid lineage.

What research needs to be done to clarify the diagnosis definition of the Philadelphia chromosome

A woman, 60 years old, complains of general weakness, a feeling of heaviness in the epigasgral area,

Belching after eating. Objectively: body temperature 36.6 ° C; NPV - 20 / min; pulse - 96 / min.; HELL

- 115/70 mm. rt. Art. The skin and visible mucous membranes are pale. Blood test: Erythrocytes - 2.0x1012 / l; Hb - 100 g / l; CPU - 1.5; ESR - 28 mm / hour. Revealed antibodies to parietal cells of the stomach. The most preferred tactics for the treatment of anemic syndrome in a patient

Prescribe vitamin B12

 

Changes in the myelogram characteristic of B-12 deficiency anemia megaloblastic type of hematopoiesis

What clinical syndrome is most typical for B12-deficiency anemia? Funicular myelosis

Patient S., 60 years old, complains of weakness, epigastric pain, unstable stool. Objectively: the skin and visible mucous membranes are pale with a subicteric shade. The face is puffy. The tongue is "lacquered". The liver and spleen are moderately enlarged. In the blood: er-2.6x1012 / l, HB-104 g / l, CP-1.2 leuke-2.7x109 / l, thrombus-115x109 / l ESR-30 mm / h, macrocytosis, polysegmentation of neutrophils. Bilirubin-38.5 μmol / L. Myelogram: megaloblastic type of hematopoiesis.

Which of the following diagnoses is most likely? B12-deficiency anemia

Patient 30 years old, ill for a month, weakness, hemorrhagic syndrome. Swollen lymph nodes. Temperature - 38.5C. Pallor of the skin, intoxication. In the blood: HB- 40 g / l, er- 2 ∙ 109 / l, leuke- 0.8 ∙ 109 / l, tr- 50 ∙ 109 / l, ESR - 41 mm / hour, the formula is not calculated.

Select the presumptive diagnosis of acute leukemia

A 34-year-old patient complains of weakness, dizziness, palpitations, shortness of breath. He has been suffering from hemorrhoids for 2 years. Objectively: pallor of the skin and mucous membranes, koilonychia. Tones

muffled, systolic murmur at the apex, tachycardia. In the blood: er-3.7 million, HB-92 g / l, CP-0.75, leuke-4.8 thousand, thrombus-200 thousand ESR-17 mm / h, anisocytosis, poikilocytosis. Serum iron - 6.4 μmol / l. The most expedient tactic

oral ferrous sulfate

 

A 19-year-old patient complains of bleeding gums, sore throat, weakness. Objectively: body temperature 39 ° C. Pale skin, multiple petechiae and ecchymosis. On the tonsils - necrotic plaque. Submandibular lymph nodes are enlarged. The liver, spleen protrude from under the edge of the costal arch by 2 cm.In the blood: er-2.5 x1012 / l, HB-75 g / l, CP-0.9 leuke-29x109 / l, blasts-98%, segm -2%, thrombus-28 thousand, ESR-26 mm / h. Cytochemistry: the reaction to myeloperoxidase is positive. The decisive symptom in the diagnosis of this disease is

blastemia

 

A 60-year-old patient complains of weakness, epigastric pain. Objectively: the skin and visible mucous membranes are pale with a subicteric shade, the face is puffy, the tongue is "lacquered". Moderate hepatosplenomegaly. In the blood: pancytopenia, macrocytosis, polysegmentation of neutrophils. Bilirubin - 38.5 μmol / l. Myelogram: megaloblastic type of hematopoiesis. Most likely diagnosis

B12 deficiency anemia

 

A patient with duodenal ulcer complains of general weakness, shortness of breath with little exercise, desire to eat chalk. Objectively: the patient is pale, trophic changes in the skin are revealed. Blood test: erythrocytes - 3.3x1012 / l; Hb - 90 g / l; CPU - 0.75; reticulocytes - 2%; blood iron - 5.6 μmol / l. What complication has developed in the patient

Iron-deficiency anemia

 

A 34-year-old man, ill for a month, weakness, hemorrhagic syndrome. Swollen lymph nodes. Temperature - 39.5C. Pallor of the skin, intoxication. In the blood: HB - 36 g / l, er - 2.2 ∙ 109 / l, leuke - 0.8 ∙ 109 / l, tr - 50 ∙ 109 / l, ESR - 41 mm / hour, the formula is not calculated. What should be the next method of examining a patient

bone marrow puncture

 

A 35-year-old woman was admitted to the emergency room with complaints of general weakness, dizziness, palpitations. Within 1 year, menstruation for 10 days, profuse. Objectively: pallor of the skin and mucous membranes, striated and brittle nails, hair loss, tachycardia up to 100 per minute, BP 110/60 mm Hg. In the blood: hemoglobin - 62 g / l, erythrocytes - 2.6 x 1012 / l, color index - 0.7, ESR - 36 mm / hour, leukocytes - 5.8x109 / l, platelets - 420 x 109 / l. Consulted by a gynecologist: Uterine fibroids, 12 weeks. Surgical treatment is recommended. Which of the following is the most appropriate management of the patient

parenteral iron preparations

 

A 26-year-old patient consulted a local doctor. Complaints of sore throat, cough, loss of appetite. On examination, hyperplasia of the tonsils, enlargement of the cervical lymph nodes. In the blood: HB-100 g / l, er-4.2 ∙ 109 / l, leuke-15 ∙ 109 / l, tr-120 ∙ 109 / l, ESR - 25 mm / h, formula: eos-1%, p / i-3%, s / i-60%, lymph-24%, monocytes - 8%, blast cells - 4%. What is the most correct tactic

refer the patient to a hematologist

A 48-year-old patient complains of weight gain, headaches, back pain, facial hair growth, shortness of breath, depression. Height-160 cm, weight 98 kg. A face with a crimson-red blush on the cheeks, an enlarged belly, weight loss of arms and legs. BP 180/100 mm Hg On radiographs: osteoporosis of the bones of the spine and pelvic bones, on CT of the abdominal cavity, unilateral adrenal hyperplasia. Moderate increase in the level of cortisol in the blood and urine, decrease in ACTH. Which of the following diagnoses is most likely

Itsenko-Cushing's syndrome

 

A 33-year-old woman notes weakness, fatigue. History: subtotal resection of the thyroid gland, took 50 μg of L-thyroxine. Objectively: the face is pasty, the heart sounds are muffled. Heart rate 54 per minute. BP - 100/70 mm Hg. Art. With echocardiography, the presence of fluid in the pericardial cavity is noted. Which of the following research methods is the most informative for determining treatment tactics

determination of the level of TSH, T4 free

 

A 30-year-old man, height 170 cm, body weight 105 kg, fat deposition prevails in the trunk area, purple striae on the skin of the inner surface of the shoulders and thighs, multiple acne vulgaris on the face and back. Blood pressure is steadily increased at the level of 150/90 - 165/110 mm Hg. Art. The cortisol level is 1050 nmol / l (the norm is 101-535 nmol / l). Fasting glycemia 12 mmol / l, urine sugar 1%, urine reaction to acetone is negative. Determine the type of diabetes

steroid

 

A 29-year-old patient has a diffuse toxic goiter verified a year ago (ultrasound, hormonal spectrum, puncture biopsy). Thyrostatic therapy with mercazolil in doses of 20-30 mg per day with insufficient effect (adherence to therapy is low). Goiter II degree (WHO), severe ophthalmopathy, tachysystolic atrial fibrillation, body weight deficiency and a high level of free T4 persist. Which of the following signs reflects severe thyrotoxicosis

tachysystolic atrial fibrillation

 

A 44-year-old patient is worried about weight gain, weakness, facial swelling, dry skin, memory impairment, constipation, amenorrhea. The skin is dry and cold. The thyroid gland is not palpable. BP -90/60 mm Hg, pulse - 52 beats per minute. T3, T4 are reduced, TSH is increased. High cholesterol and triglycerides. Your preliminary diagnosis

primary hypothyroidism

 

A 42-year-old man complains of excess weight against the background of increased appetite, increased blood pressure, dry mouth, increased urine output. Objectively: Height - 174 cm, weight - 100 kg. Fasting glycemia in the range of 9.9-10.7 mmol / l. Which of the following drugs is most appropriate

biguanides

 

In a 42-year-old patient with clinical signs of hypothyroidism, the thyroid gland is enlarged to the 2nd degree, dense, but homogeneous. In the blood, the level of antibodies to TG and TPO and TSH is increased. Choose a drug for treatment

Levothyroxine

What is the principle of treatment of hypothyroidism in old age in combination with angina pectoris 2

functional class

 

start treatment with low doses of L-thyroxine

 

The patient has an enlargement of the thyroid gland of the 2nd degree. Ultrasound data: the structure is heterogeneous, echogenicity is increased, focal formations were not identified. Which of the following is not included in the diagnostic algorithm

determination of the level of general T3

 

The patient has an enlargement of the thyroid gland of the 2nd degree. Ultrasound data: the structure is heterogeneous, echogenicity is not changed, focal formation in the right lobe of a heterogeneous structure with indistinct contours without "halo". Lymphadenopathy on the right. Which of the following diagnoses is most likely

diffuse goiter

 

A 32-year-old patient is fussy with a lot of excessive movements, is mentally excitable, does not sleep well, has lost weight with increased appetite, diarrhea. Objectively: tremor of the fingers, positive eye symptoms. Heart sounds are loud, rhythm is correct, systolic murmur at the apex. HELL

- 150/70 mm Hg, heart rate - 110 per min. The thyroid gland is enlarged, visible when swallowing. General blood analysis: HB - 100 g / l. Lake - 8.0 * 109 / l, ESR - 12mm / h. Blood glucose - 6.8 mmol / l. What is the most likely preliminary diagnosis

diffuse toxic goiter

 

An overweight 50-year-old woman was twice found to have an increase in the level of fasting glucose up to 6.9 and 12.2 mmol / l. Which of the following diagnoses is most likely

type 2 diabetes mellitus

 

A 22-year-old woman complained of palpitations, emotional lability, aggressiveness, 8 kg weight loss in 2 months. The woman is asthenic, whiny, diffuse hyperhidrosis of the skin, general tremor - a symptom of a "telegraph pole". HR-120 / min. The thyroid gland is evenly enlarged, exophthalmos is moderately expressed. Which group of drugs from the listed is most advisable to prescribe in the first place?

thyrostatics

 

What indicator is the most reliable criterion for the degree of compensation of diabetes mellitus during dynamic examination?

glycosylated hemoglobin

 

A 42-year-old patient consulted an endocrinologist. Complaints of severe weakness, dense pronounced edema that led to an increase in body weight and volume. Disturbed by severe shortness of breath with little physical exertion. History of stumectomy for many nodular euthyroid goiter. BP 70/40 mm Hg, HR-56 beats per minute. with severe deafness of heart sounds and cardiomegaly. Echox shows a small amount of fluid in the pericardium. Fasting glycemia 3.5 mmol / l. What hormones are needed to verify the diagnosis

TSH, T4 free

A 17-year-old patient complains of dry mouth, thirst, has lost 7 kg within a month. Diabetes mellitus heredity is not burdened. Examination revealed hyperglycemia of 13 mmol / l, GlyNv -7%. Your diagnosis

Diabetes mellitus type 1

 

A 38-year-old patient complains of increased body weight, fatigue, headaches. Height - 180 cm, weight 108 kg. FROM - 110 cm. The distribution of subcutaneous fat according to the android type, papillary-pigmentary dystrophy of the skin (acanthosis nigricans), blood pressure 140/80 mm Hg .. Which of the following drugs is most appropriate in this case

metformin

 

Patient K., 24 years old, turned to the local doctor with complaints of significant weight loss (within a month by 9 kg), dry mouth, thirst, frequent urination, nausea, poor appetite. Objectively: the skin is dry, palms and soles with a yellowish tinge, there is furunculosis. In the analysis of urine, sugar is 2.9% and acetone. Which of the following drugs is most appropriate in this case

short-acting insulin

 

A 62-year-old woman was admitted to the surgical department with signs of wet gangrene of the first toe of the right foot, which appeared after a minor injury. Objectively, there is dryness of the skin and mucous membranes, flushing of the cheeks. Severe obesity, decreased vision, not pronounced signs of varicose veins. Mother and aunt have diabetes. Fasting glycemia 6.2 mmol / l. What is the most likely preliminary diagnosis?

type 2 diabetes mellitus with macroangiopathy

 

A 26-year-old boy, after a viral infection, developed a pronounced thirst up to 6 liters per day, frequent and profuse urination, weight loss by 3 kg for a month, and general weakness. What disease is possible

diabetes insipidus

 

Patient B., 56 years old, was admitted to the hospital with complaints of constant aching pain in the epigastric region, weight loss by 10 kg in three months, weakness, aversion to meat food, recurrent vomiting of undigested and eaten food the day before, lack of appetite. For 7 years he has been suffering from gastric ulcer. She was repeatedly treated in hospitals and outpatients. In the past six months, she has noted a sharp deterioration in her condition. She applied for medical help just now. Blood test: erythrocytes -3.71012, Hb-85 g / l, leukocytes - 7.7x109, ESR-35 mm / h. Biochemical blood test: Total protein - 52 g / l, total. bilirubin-8.6 μmol / l, AST-22 u / l., ALT-25 u / l., creatinine-65 μmol / l., urea-3.2 mmol / l. What disease can be assumed in the patient?

Stomach cancer

 

Indicate the most characteristic and specific symptom indicating malignancy in chronic esophagitis:

dysphagia

 

Patient I., 65 years old, was admitted to a therapeutic hospital with complaints of the alternation of constipation and diarrhea during the year, weight loss by 11 kg within a month, lack of appetite,

periodic low-grade fever. History of constipation up to 5-7 days for many years. Registered for 8 years with a local therapist for polyposis of the large intestine. In the last month, she noted a deterioration in her condition due to progressive weight loss. In the UAC: Нb - 95 g / l, erythrocytes - 4.71012 / l, Нt - 42%, leukocytes - 6.9x109 / l, ESR-65 mm / h. On palpation: the abdomen is soft, painless in all parts, in the left half of the abdomen in the projection of the descending colon, there is perifocal rumbling, local muscular defense. Which specialist is the most important for the patient to consult?

Oncologist

 

Patient K., 76 years old, was admitted to the hospital with complaints of constant weakness, dizziness, weight loss by 12 kg in 2 months, lack of appetite. History of iron deficiency anemia for 4 years. Occasionally received treatment from a local therapist at the place of residence. In the last 2 months, she noted a deterioration in her condition due to a lack of appetite and progressive weight loss. In the UAC: Нb - 45 g / l, erythrocytes - 2.71012 / l, Нt - 22%, leukocytes - 6.7x109 / l, ESR-45 mm / h. During a general examination of the patient, palpation of the abdomen in the right iliac region reveals a dense, lumpy, rounded formation up to 20.0 cm in diameter, painless, displaced relative to the surrounding tissues. On palpation, perifocal rumbling is noted. What diagnostic method is appropriate in this case to verify the diagnosis?

Colonoscopy

 

Patient V., 47 years old, was admitted with complaints of weakness, decreased performance, dull, aching pain in the epigastric region, feeling of heaviness after eating, vomiting of food eaten. Ill for 2 months, he was treated independently: he took no-shpa and analgin. At first, after taking medication, the pain was less disturbing. In recent days, the pains have become more frequent and vague, vomiting like "coffee grounds" has appeared. I have lost about 10 kg in weight in the last two months. In the general analysis of blood: erythrocytes -4.71012, Hb-97 g / l, leukocytes - 6.5x109, ESR-45 mm / h. Biochemical blood test: Total protein - 62 g / l., Total. bilirubin-9.6 μmol / l., AST-25 u / l., ALT-30 u / l., creatinine-75 μmol / l., urea-5.2 mmol / l. The result of X-ray examination of the gastrointestinal tract: deformation of the stomach and the presence of a filling defect in the lower third of the stomach. What disease can be assumed in the patient?

Stomach cancer

 

Patient N., 65 years old, was admitted to the clinic with complaints of weight loss by 8 kg in three months, general weakness, recurrent cramping pain in the epigastrium. The patient underwent X-ray examination and gastroscopy. On the lesser curvature of the stomach, an exophytic formation measuring 6 × 4 cm with ridged edges and a sunken central part covered with a gray bloom was found. Morphological conclusion: moderately differentiated adenocarcinoma. What disease is this morphological picture most typical for?

Stomach cancer

 

Patient K., 53 years old, with complaints of 8 kg weight loss within a month, lack of appetite. History of iron deficiency anemia for 2 years. Occasionally received treatment from a local therapist at the place of residence. In the last month, she noted a deterioration in her condition due to a lack of appetite and progressive weight loss. In the UAC: Нb - 52 g / l, erythrocytes - 2.11012 / l, Нt - 22%, leukocytes - 6.7x109 / l, ESR-45 mm / h. During a general examination of the patient, with

palpation of the abdomen in the right iliac region is determined by a dense rounded formation up to 20.0 cm in diameter, painless, displaced relative to the surrounding tissues. On palpation, perifocal rumbling is noted. Colonoscopy: in the region of the ascending colon, a dense, lumpy exophytic formation up to 20.0 cm in diameter, growing into the lumen of the intestine and significantly deforming it, bleeds in contact. A biopsy was taken. The histological conclusion is adenocarcinoma. What diagnostic method is necessary to search for possible distant hematogenous metastases?

Liver ultrasound

 

Patient Z. 48 years old was urgently admitted to the emergency room of the general medical network with acute pains throughout the abdomen. These complaints within 6 hours, independently took painkillers, with a temporary effect. An hour after taking the pain, the pain resumed and intensified. Anamnesis: weight loss of 27 kg in 3 months. On examination: positive peritoneal symptoms in all fields, palpation is painful, difficult, but possible. Against the background of general asthenization of the patient through the anterior abdominal wall in the left lateral region of the abdomen, a dense formation of irregular shape up to 20.0 cm in diameter is determined. What will be the further tactics?

Operate on AIO, in the presence of education - intraoperative biopsy

 

The leading clinical sign that distinguishes esophageal cancer from cardiospasm is:

increasing dysphagia

 

To exclude malignancy in chronic esophagitis, the best method is: endoscopic with biopsy

A 45-year-old woman consulted a gynecological oncologist at a polyclinic with complaints of recurrent bleeding from the genital tract. Heredity is not burdened. There were three pregnancies, one childbirth and two honey. abortion. The last time I had a gynecologist was 5 years ago. Examination in the mirrors: vaginal mucosa uvlvzhnenv serous discharge, clean; the cervix is ​​hypertrophied: on the front lip there is a small-bumpy swelling in the form of "cauliflower" 2x3 cm, bleeding on contact. The uterus is not enlarged, oval in shape, mobile, painless. The areas of the appendages were normal. When rectal examination in the small pelvis, infiltrates are not determined. What needs to be done to confirm the diagnosis

cytological + histological examination of cervical biopsy

 

A 60-year-old woman has noted periodic bloody discharge from the genital tract for six months. Last menses 10 years ago. During a gynecological examination by a district obstetrician-gynecologist: the cervix is ​​clean, with a bimanual examination, the uterus is anteriorly, slightly enlarged, dense, painless. The appendages on both sides are not defined.

The patient underwent separate diagnostic curettage, the histological conclusion was atypical hyperplasia. Indicate in the consultation which specialist the patient needs in the first place

Oncogynecologist

 

A 67-year-old female patient was diagnosed with cancer of the right breast St I (T1N0M0), a nodular form of the upper outer quadrant during screening. Performed radical mastectomy, IHC tumor is highly hormone-sensitive. Indicate the next stage of treatment

hormone therapy

 

A woman, 33 years old, consulted a gynecological oncologist with complaints of recurrent bleeding from the genital tract for a week. Heredity is not burdened. At the moment, the patient is registered with a gynecologist for pregnancy at 34-35 weeks. History of one childbirth, this pregnancy is the second. Examination in the mirrors: the vagina of the giving birth, the cervix is ​​hypertrophied. On her front lip there is a small-bumpy swelling in the form of "cauliflower" 2x3 cm, bleeding when touched. The uterus is enlarged according to the gestational age, the appendages are b \ features. When rectal examination in the small pelvis, infiltrates are not determined. Oncocytology smear - squamous cell carcinoma. Diagnosed with cervical cancer, IB T1bNxM0, pregnancy 34-35 weeks. Specify the tactics of patient management

cesarean section, extended extirpation of the uterus with appendages, postoperative radiation therapy

A 37-year-old woman consulted a gynecological oncologist at a polyclinic with complaints of watery discharge from the genital tract with an unpleasant odor. Heredity is not burdened. There were three pregnancies, three births. We did not observe, the last time I had a gynecologist was 2 years ago. History of cervical erosion, not treated. Examination in the mirrors: the vagina of the parturient woman, the cervix is ​​hypertrophied, bleeding on contact. Uterus and appendages b \ features. When rectal examination in the small pelvis, infiltrates are not determined. Histological examination of cervical biopsy - squamous cell carcinoma. Diagnosis: Cervical cancer IB T1bNxM0.

What method of treatment is indicated for Wertheim's operation

A 55-year-old patient within 2 months began to identify bleeding from the genital tract against the background of menopause. Gynecological examination: the cervix is ​​clean, with a bimanual examination, the uterus is anteriorly, slightly enlarged, dense, painless. The appendages on both sides are not enlarged, painless. What diagnostic method is appropriate in this case to visualize the process

Hysteroscopy

 

A 65-year-old female patient complains of liquid serous-yellow discharge with an unpleasant odor from the vagina, sometimes mixed with blood. These complaints are valid for 1 year. Severe concomitant pathology: decompensated diabetes mellitus, diabetic foot, encephalopathy, ischemic heart disease, PIM 2017, grade 3 arterial hypertension, CHF FC3.

Heredity is not burdened. There were three pregnancies, one childbirth, two abortions. The last time I had a gynecologist was 7 years ago. Examination with mirrors: the vagina is shortened. In its dome, in place of the cervix, a crater with necrotic plaque is visible. Vaginal discharge is colored

"Meat slops." Vaginal examination: the walls of the vagina for 2/3 of it are infiltrated. In the small pelvis, a conglomerate of a tumor of a dense consistency is determined, reaching the walls of the pelvis from both sides, motionless, painful. Rectal examination: rectal mucosa is motionless. In the parametria, infiltrates reaching the walls of the pelvis are noted on both sides. There is blood on the finger being tested. Based on CT scan of the abdominal cavity, liver metastases are noted. The patient was diagnosed with Stage IV cervical cancer. Treatment tactics

symptomatic treatment

A patient, 60 years old, consulted a gynecologist with complaints of pain in the lower abdomen, an increase in the volume of the abdomen, nausea, weight loss of up to 10 kg in 1.5 months. Objectively: the abdomen is soft, painless. At a gynecological examination: the cervix is ​​clean, atrophic. During rectovaginal examination, a conglomerate up to 10 cm, stony consistency, motionless, with a bumpy surface is determined in the small pelvis. CA-125 - 2356 IU / ml. Your presumptive diagnosis

Ovarian cancer

 

A 55-year-old female patient complained of lower abdominal pain, abdominal enlargement, nausea, weight loss up to 8 kg in 1.5 months. Objectively: the abdomen is enlarged and tense. At a gynecological examination: the cervix is ​​clean, rejected posteriorly. During rectovaginal examination, a conglomerate of stony consistency, motionless, with a bumpy surface is determined in the small pelvis. CA-125 - 2356 IU / ml. Sawed out laparocentesis, received 6 liters of straw-yellow serous fluid. The cytological conclusion is carcinoma cells. On other organs and systems without features. laparocentesis with cytological examination. Presumptive stage of the tumor process

III

 

A 44-year-old patient within 2 months began to identify spotting from the genital tract from 16 to 22 days of the menstrual cycle. Menses for 3-4 days, after 27 days. Gynecological examination: the cervix is ​​clean, with a bimanual examination, the uterus is anteriorly, slightly enlarged, dense, painless. The appendages on both sides are not enlarged, painless. What diagnostic method is appropriate in this case to verify the diagnosis

Separate diagnostic curettage / hysteroscopy

 

The patient, 45 years old, consulted a gynecologist for an annual examination. Anamnesis: Menarche at 13

years. Menses for 3 days, moderate, painless, irregular. B-2, R-1, A-1, B-0. Denies gynecological diseases. Objectively: the abdomen is soft, painless. At gynecological examination: the cervix is ​​clean, cylindrical. At recto-vaginal examination, the uterus is not enlarged, mobile, painless, behind it on the right is defined a formation of up to 9 cm, rounded, tight-elastic consistency, mobile, painless. CA-125 - 13 IU / ml. The most common benign ovarian tumors in women during perenopause

Ovarian cystadenoma

 

A 44-year-old patient within 2 months began to identify spotting from the genital tract from 16 to 22 days of the menstrual cycle. Menses for 3-4 days, after 27 days. Gynecological examination: the cervix is ​​clean, with a bimanual examination, the uterus is anteriorly, slightly enlarged, dense, painless. The appendages on both sides are not enlarged, painless. The patient underwent separate diagnostic curettage, the histological conclusion - adenocarcinoma. What diagnostic method is needed to search for possible distant hematogenous metastases in this case?

Abdominal ultrasound, chest x-ray

 

The patient, 50 years old, consulted a gynecologist for an annual examination. Anamnesis: Menarche at 13

years. Menses for 3 days, moderate, painless, irregular. B-2, R-1, A-1, B-0. Denies gynecological diseases. Objectively: the abdomen is soft, painless. When

gynecological examination: the cervix is ​​clean, cylindrical. At recto-vaginal examination, the uterus is not enlarged, mobile, painless, behind it on both sides are determined formations up to 6 cm, irregular shape, stony consistency, limited mobile, painless.

CA-125 - 15 IU / ml. What methods should be used to supplement the diagnostic search to exclude the Krukenberg tumor

VGDS + colonoscopy

 

Woman, 51 years old, complaining of spotting spotting from the genital tract for a week. Last menstrual period at 49 years old. Indicate the most appropriate diagnostic tactics in this situation

Separate diagnostic curettage / hysteroscopy

 

Patient V. 64 years old, a year ago discovered a tumor in the left mammary gland, did not go to doctors. Sent to an oncological dispensary, where the diagnosis was made: Cancer of the left breast, stage IV. Breakdown of the tumor. The reason for neglect

untimely access to a doctor

 

A 65-year-old female patient consulted a mammologist complaining of an enlargement of the left breast in volume within a month. On examination, the left mammary gland is enlarged, dense, heavy, the skin is in the form of a "lemon crust", the areola is expanded, the nipple is retracted. In the left axillary region there is a conglomerate of dense lymph nodes. Indicate the type of breast cancer

edematous infiltrative

 

A woman, 68 years old, notes periodic bloody discharge from the genital tract during the year. Last menses 20 years ago. Decompensated type 2 diabetes mellitus. Gynecological examination: the cervix is ​​clean, with a bimanual examination, the uterus is anteriorly enlarged up to 8 weeks, dense, bumpy, painless. The appendages on both sides are not defined. The patient underwent separate diagnostic curettage, the histological conclusion - adenocarcinoma. On ultrasound of the abdominal cavity - 2 metastases at the gate of the liver. Revealed the diagnosis: cancer of the body of the uterus, stage IV with metastases to the liver. Indicate the most appropriate treatment tactics for this patient

Symptomatic treatment

 

A 65-year-old female patient, during a preventive examination by a therapist, revealed cancer of the right breast St IIIa (T3N1M0), the nodal form of the upper outer quadrant. The diagnosis was verified histologically, the IHC tumor is highly hormone-sensitive. Specify type of breast cancer treatment

complex therapy

 

A 32-year-old patient consulted a mammologist with complaints of bloody discharge from the nipple of the right breast within a month. On examination and palpation: mammary glands of the same shape, soft, homogeneous, nipples in the center, on the right, when pressing on a point along the edge of the areola on the border of the upper quadrants from the nipple, bloody discharge. Indicate the preliminary diagnosis

intraductal papilloma

A 51-year-old woman has stage I cancer of the uterine body. The formation is localized in the area of ​​the fundus of the uterus up to 2 cm in diameter, the depth of invasion is 3 mm. The tumor is highly differentiated, receptor-positive. What is the most appropriate treatment strategy for this patient?

Operation + hormone therapy

 

A 55-year-old female patient complained of lower abdominal pain, abdominal enlargement, nausea, weight loss up to 8 kg in 1.5 months. Objectively: the abdomen is enlarged and tense. At a gynecological examination: the cervix is ​​clean, rejected posteriorly. During rectovaginal examination, a conglomerate of stony consistency, motionless, with a bumpy surface is determined in the small pelvis. CA-125 - 2356 IU / ml. Possible way to verify the diagnosis at the moment

Puncture of the abdominal cavity through the posterior vaginal fornix or laparocentesis with cytological examination

The patient, 27 years old, consulted a gynecologist for an annual examination. Anamnesis: menarche at 11

years. Menses for 5 days, moderate, painless, after 29 days. B-0, P-0, A-0, B-0. Denies gynecological diseases. Objectively: the abdomen is soft, painless. At gynecological examination: the cervix is ​​clean, cylindrical. At a recto-vaginal examination, the uterus is not enlarged, mobile, painless, behind it on the right is a formation of up to 7 cm, round in shape, tight-elastic consistency, mobile, painless. CA-125 - 8 IU / ml. Treatment of benign ovarian tumors in young women

Surgical

 

Woman, 35 years old, during a preventive examination revealed erosion of the cervix. There were three pregnancies, all ended in childbirth. We did not observe, the last time I had a gynecologist was 3 years ago. History of cervical erosion, not treated. Examination in the mirrors: the vagina of the parturient woman, the cervix is ​​eroded. The uterus and appendages were normal. When rectal examination in the small pelvis, infiltrates are not determined. A biopsy of the cervix was taken. The histological conclusion is "carcinoma in situ". What is the most advisable method of treatment

electro excision of the cervix

 

The patient, 25 years old, consulted a gynecologist for an annual examination. Anamnesis: Menarche at 13

years. Menses for 5 days, moderate, painless, after 28 days. B-1, R-1, A-0, B-0. Denies gynecological diseases. Objectively: the abdomen is soft, painless. At gynecological examination: the cervix is ​​clean, cylindrical. At a recto-vaginal examination, the uterus is not enlarged, mobile, painless, behind it on the right is a formation of up to 6 cm, rounded, tight-elastic consistency, mobile, painless. CA-125 - 8 IU / ml. Most common benign ovarian tumors in young women

Dermoid cyst

 

A 52-year-old female patient independently discovered a tumor in the right mammary gland and consulted a mammologist. On examination and palpation: formation on the border of the inner quadrants of a rounded shape up to 1.5 cm in diameter, painless, stony density, with a fuzzy border, a bumpy surface, motionless in the gland tissue, Koenig's symptom is positive. Indicate the preliminary diagnosis

cancer

A 67-year-old patient consulted a mammologist with complaints of pain in the left breast for a month. On examination, the left mammary gland is reduced in volume, dense, heavy, the skin is in the form of a "tortoise shell", the nipple is retracted. The skin is thickened, in places with ulceration, covered with crusts, pigmented. There is a dense lymph node in the left axillary region. Indicate the type of breast cancer

armored

 

A 45-year-old woman consulted a gynecological oncologist at a polyclinic with complaints of recurrent bleeding from the genital tract. Heredity is not burdened. There were three pregnancies, one childbirth and two honey. abortion. The last time I had a gynecologist was 5 years ago. Examination in the mirrors: vaginal mucosa uvlvzhnenv serous discharge, clean; the cervix is ​​hypertrophied: on the front lip there is a small-bumpy swelling in the form of "cauliflower" 2x3 cm, bleeding on contact. The uterus is not enlarged, oval in shape, mobile, painless. The areas of the appendages were normal. When rectal examination in the small pelvis, infiltrates are not determined. Doctor's preliminary diagnosis

Cervical cancer IB T1bNxM0, exophytic form

 

The patient, 45 years old, consulted a gynecologist for an annual examination. Anamnesis: Menarche at 13

years. Menses for 3 days, moderate, painless, irregular. B-2, R-1, A-1, B-0. Denies gynecological diseases. Objectively: the abdomen is soft, painless. At gynecological examination: the cervix is ​​clean, cylindrical. At a recto-vaginal examination, the uterus is not enlarged, mobile, painless, behind it on the right is a formation of up to 9 cm, rounded, tight-elastic consistency, mobile, painless. CA-125 - 13 IU / ml. By what method is it possible to determine for sure the presence or absence of a malignant tumor in a cyst

intraoperative histological examination

 

A 20-year-old patient independently discovered a tumor in the mammary gland and consulted a mammologist. On examination and palpation: formation on the border of the outer quadrants of a rounded shape up to 2 cm in diameter, painless, elastic consistency, with a clear border, smooth surface, mobile in the gland tissue, Koenig's symptom is positive. Indicate the preliminary diagnosis

fibroadenoma

 

A 45-year-old woman consulted a gynecologist in a polyclinic with complaints of contact spotting from the genital tract. Heredity is not burdened. There were three pregnancies, three births. We did not observe, the last time I had a gynecologist was 5 years ago. History of cervical erosion, not treated. Examination in the mirrors: the vagina of the giving birth, the cervix is ​​hypertrophied. On her front lip there is a small-bumpy swelling in the form of a "cauliflower" 2x3 cm, bleeding when touched. The uterus and appendages were normal. When rectal examination in the small pelvis, infiltrates are not determined. Further tactics of the doctor

after cyto-histological examination, refer to a gynecological oncologist

 

A 35-year-old woman went to the hospital on the 6th day of illness with complaints of headache, weakness, loss of appetite, pain in the right hypochondrium and epigastrium, nausea, and a single vomiting. On examination: a state of moderate severity, the skin and sclera are icteric. The abdomen is soft, painful in the right hypochondrium, the liver protrudes from under the lower edge of the costal arch up to 2.0 cm, painful on palpation, the edge is even. Dark urine. From the epidemic history: had

relatives in Uzbekistan, bathed in a ditch, drank raw water, ate fruit. ELISA for hepatitis: HBsAg neg, anti-HBs neg, anti-HBcor IgM neg, anti-HEV IgM sex. Which of the following diagnoses is most likely

hepatitis E

 

A 30-year-old patient complained of nausea, vomiting, frequent liquid, profuse stools more than 15 times, of a non-fecal character with a large amount of mucus and blood streaks, spasmodic abdominal pain before the act of defecation. The disease is associated with the use of raw milk.

Objectively: the condition is moderate, the abdomen is painful on palpation in the ileum. Coprogram: liquid consistency, mucus - a large amount, muscle fibers (+), neutral fat (+), fatty acids (-), soaps (+), leukocytes - 30-50 f / s, erythrocytes - up to 10-15 v p / s, eggs of worms - not found. Which of the following diagnoses is most likely

shigellosis

 

A 20-year-old man, complaints of frequent loose stools mixed with mucus, streaks of blood up to 10 times a day, fever. The appearance of sharp pains before the act of deformation. Epidemiological history: considers himself ill within 12 hours after eating meat patties in the dining room.

A preliminary diagnosis of shigellosis has been made. Which of the following drugs is most appropriate to prescribe

ciprofloxacin

 

A 25-year-old man, was on a business trip, where he constantly drank raw water, complains of yellowness of the skin, weakness, an increase in body temperature to 37.5 C and a decrease in appetite.

Serological data: HbsAg neg, anti-HBs neg, anti-HBcor IgM neg, anti-HBcor Ig G neg, anti-

HAV IgM gender What is the most likely diagnosis of viral hepatitis A?

A 38-year-old woman fell ill 4.5 months after the operation. During the operation, blood was transfused. During the last days worried about weakness, pain in the knee and elbow joints, lower back, decreased appetite. On examination: the temperature is normal, the skin and sclera are icteric, single traces of scratching. The liver is of a dense consistency, protrudes from under the edge of the costal arch by 4 cm. The spleen is not enlarged. Dark urine, discolored stools.

Serological data: HbsAg positive, anti-HBcor IgM negative, anti-HBcor Ig G positive, anti-HAV IgM negative. What is the most likely diagnosis

chronic viral hepatitis B

 

A 47-year-old patient complained of nausea, repeated vomiting, frequent liquid, profuse stools, frothy, green, diffuse abdominal pain. Ill for 2 days. The disease is associated with the consumption of raw eggs. Objectively: a state of moderate severity, the abdomen is sensitive to palpation along the intestines. What is the most informative examination method

stool culture

 

Patient K., 27 years old, was admitted with complaints of an increase in body temperature up to 39.0 ° C, chills, cramping pains in the lower abdomen, false urge to defecate, scanty stools up to 10 times streaked with blood. Objectively: temperature 38.8 ° C. Flaccid, scaphoid abdomen, sigma

painful, in the form of a dense cord. Into the tank. sowing feces, Salmonella spp was found. What antibacterial drugs are most appropriate for this patient

fluoroquinolones

 

A 21-year-old patient complains of nausea, single vomiting, an increase in body temperature to 37.5 C. After 4 days, yellowness of the sclera and skin appeared, and the body temperature dropped.

Objectively: the condition is relatively satisfactory, yellowness of the skin and sclera. The abdomen was soft, painless, the liver was enlarged by + 0.5 cm from under the costal margin. ELISA for hepatitis: HBsAg neg, anti-HBs neg, anti-HBcor IgM neg, anti-HAV IgM sex. In a biochemical blood test: ALT - 550 IU / ml, AST - 430 IU / ml. Which plan of the listed treatment measures is most appropriate to prescribe

diet, detoxification therapy

 

A 38-year-old patient, acutely ill with an increase in temperature to 38.70C, weakness, nausea, 2-fold vomiting, liquid watery stools, which gradually increased up to 15 times by the 3rd day, became scanty in the form of "rectal spitting", which was accompanied by excruciating drawing pains in the left abdomen. Objectively: the patient is pale, blue under the eyes, blood pressure 130/70, pulse 100 beats per minute. The abdomen is pulled in, a painful sigma in the form of a cord is palpable. Stool examined: scanty, mucus, streaks of blood. What research method should be prescribed to the patient to confirm the diagnosis

tank sowing feces

 

A 29-year-old man complains of yellowness of the skin, heaviness in the right hypochondrium, darkening of urine. On examination: a state of moderate severity, the skin and sclera are icteric. The abdomen is soft, painful in the right hypochondrium, the liver protrudes from under the edge of the costal arch up to 3 cm. A preliminary diagnosis was made: "Acute viral hepatitis B".

What changes in the biochemical blood test will this patient have with an increase in ALT, an increase in total bilirubin

Mucosal candidiasis is otherwise called thrush

Name the element of the rash, which is characterized by a discoloration of the skin.

With furunculosis, ichthyol ointment is used externally

To confirm the diagnosis with pemphigoid, Nikolsky's symptom

Specify the clinical signs of papules in LPL umbilical depression

The terminal film symptom is characteristic of psoriasis.

Chancre with syphilis appears in the primary

Lichenification is an increase in the skin pattern

What are the subjective sensations with lichen planus itching?

Balzer's test is positive for pityriasis versicolor

A pathological process, represented by a newly formed tissue, in which changes in the genetic apparatus of cells lead to a violation of the regulation of their growth and differentiation:

tumor

 

The level of T-helpers and the immunoregulatory index (IRI) in HIV reflects the stage and progression of the disease. In the analysis form, this corresponds to:

CD4, CD4 / CD8

 

Anti-inflammatory cytokines

 

limit the synthesis of free radicals in phagocytes

 

A 2-year-old child has been diagnosed with congenital immunodeficiency characterized by recurrent infections, dermatitis, arthritis, and bleeding caused by thrombocytopenia. This could be:

Wiskott-Aldrich syndrome Immunoglobulin M:

is a class of antibodies of acute infection Immunoglobulin A:

is a class of mucosal local immunity antibodies Immunoglobulin E:

is a class of antibodies of an allergic reaction Cytokines are:

low molecular weight proteins secreted by activated lymphocytes and macrophages, which are mediators of inflammation and the immune response

The allergic patient needs to identify the causative allergen that is causing the symptoms. To do this, use a set of probable allergens and use them to determine:

level of allergen-specific immunoglobulin E

Immunoglobulin G:

 

is a class of antibodies in chronic infection The nature of cytosis in tuberculous pleurisy lymphocytic

The main method of radiation diagnostics used to detect pulmonary tuberculosis is fluorography

With cavernous tuberculosis, usually one cavity is found

X-ray signs of a single focal shadow shadow up to 1 cm in size

The result of the Mantoux test in primary tuberculosis complex is hyperergic

The size of the positive reaction of the Mantoux test with 2 TE

 

5 mm or more

 

Name the main line drug isoniazid

The nature of the cerebrospinal fluid in tuberculous meningitis serous

A couple of specific reactions are characteristic of all forms of primary tuberculosis.

Laboratory research confirming the diagnosis of tuberculosis, sputum analysis on the office

Of all groups of peripheral lymph nodes, tuberculosis most often affects the cervical

What reaction of inflammation prevails in miliary tuberculosis of the lungs productive

Most often, with bone tuberculosis, the vertebrae of the lumbar spine are affected.

With the healing of the pulmonary focus in the primary tuberculosis complex, the Gona focus is more often formed

Isoniazid and rifampicin are considered the most effective anti-TB drugs.

Name the drug of the 2nd line prothionamide

How many portions of sputum is collected from a tuberculosis patient in order to determine the effectiveness of treatment

2  samples

 

The cellular composition of the cerebrospinal fluid in tuberculous meningitis is lymphocytic

How many portions of sputum for Mycobacterium tuberculosis are collected from a patient for diagnostic purposes

3  samples

 

Primary tuberculosis complex consists of

 

primary affect, lymphangitis, regional lymphadenitis

 

A 25-year-old patient was admitted to a gynecological hospital, complaining of sharp pains in the lower abdomen, which arose suddenly, after physical exertion. Notes nausea, vomiting, dry mouth. Vaginal examination: the uterus is dense, painless, of normal size. On the left, the appendages are not determined, to the right of the uterus, the formation of a round shape, elastic consistency, limited mobile, sharply painful on palpation in the amount of 7x8x6 cm is determined. Pulse is 120 beats / min. In the analysis of blood leukocytes 12.3. What pathology are we talking about?

Torsion of the ovarian cyst on the right

 

As a result, there is a desquamation of the functional layer of the endometrium Decrease in the level of estrogen and progesterone in the blood

In primiparous, 26 years old, on the 3rd day of the postpartum period, she complains of pain in the mammary glands. t = 38.2ºC, pulse 86 beats per minute. The mammary glands are evenly enlarged on palpation, rough, sensitive. Rational tactics in this situation

emptying the breast by expressing

 

A 52-year-old patient has complaints of hot flashes up to 8 times a day, pain in the heart area, shortness of breath, a transient increase in blood pressure up to 150/90 mm Hg. Postmenopause 2 years. Vaginal examination: the genitals in a state of age-related involution. What is the most likely diagnosis

Mild climacteric syndrome

 

The patient is 16 years old, complaints of the absence of menstruation for 2 years from the period of menarhe. Height 150

cm, secondary sexual characteristics are poorly developed, according to the female type, the uterus is small, the appendages are not

palpable. For the purpose of differential diagnosis, an estrogen-progesterone test was performed - positive. The most likely form of amenorrhea

ovarian

 

Which of the diagnostic and treatment operations is the most appropriate for menopausal bleeding

diagnostic curettage of the uterine cavity

 

Determine the pathology of the early postpartum period according to the following clinical picture: the condition is relatively satisfactory, blood pressure 100/70, PS = 98 beats. per minute, the skin of the usual color, from the genital tract, moderate spotting reached 500 ml and continues. When examining the birth canal, there are no ruptures, the afterbirth is intact, the membranes are all. With external massage of the uterus, the uterus is toned and after a while relaxes. What is the most likely diagnosis

uterine atony, bleeding

 

A 23-year-old patient underwent hysterosalpingography for primary infertility. In the picture: the uterine cavity is T-shaped, the fallopian tubes are shortened, rigid, with clavate extensions in the ampullar regions, the release of the contrast agent into the abdominal cavity is not observed. What disease are these changes most typical for?

genital tuberculosis

 

A 18-year-old patient complains of itching of the external genital organs, burning sensation when urinating. She fell ill a week ago, before that she had a purulent sore throat, for which she received ampicillin. The condition is satisfactory, the temperature is normal, somatically healthy. In the area of ​​the entrance to the vagina, there is hyperemia, swelling, white cheesy discharge, which can be easily removed with a cotton swab. What is the most likely diagnosis

Colpitis

 

Pregnant K., 29 years old with a pregnancy of 35-36 weeks, was admitted to the gastroenterology department with complaints of pain in the stomach, vomiting. The disease is associated with the intake of low-quality food. The department underwent gastric lavage, after which headaches appeared. Transferred to the maternity hospital. Examination revealed: pale skin, pronounced swelling of the legs, blood pressure 160/100 mm Hg urine analysis: urine density 1018, leukocytes 3-4 in the field of view, protein 4 g / l, hyaline cylinders, granular 4-5 in the field of view.

Preliminary diagnosis

 

pregnancy 35-36 weeks. Severe preeclampsia

 

 

A 29-year-old pregnant woman came to the antenatal clinic with complaints of aching pains in the lower abdomen and lower back. The gestation period is 15-16 weeks. History of 1 childbirth and 3 honey. abortion. Vaginal examination: the cervix is ​​2.5 cm long, the external yaw is gaping, the cervical canal is closed, the uterus is enlarged according to the gestational age, the discharge from the genital tract is mucous, moderate. What is the most likely diagnosis

threatening spontaneous miscarriage

A 28-year-old woman in labor, gave birth to a baby weighing 4100 g, after the birth of the fetus, bloody discharge from the genital tract appeared in moderate quantities. When examining the birth canal, there is a rupture of the posterior wall of the vagina and the underlying muscles, the skin of the perineum to the anus. Most likely diagnosis

grade II perineal rupture

 

With a vaginal examination of a woman, it is determined: 2/3 of the inner surface of the pubic articulation and the upper half of the sacral cavity are occupied by the head of the fetus. 4-5 sacral vertebrae and ischial bones are freely probed. The sagittal suture is in the right oblique dimension. Determine in which plane of the pelvis the head is located

the head in the wide part of the pelvic cavity

 

A pregnant woman came to an obstetrician-gynecologist, who was discharged from the infectious diseases hospital a week ago, where she was being treated for a severe form of measles rubella. The gestation period is 9-10 weeks. What effect can the disease have on the development of the embryo?

high likelihood of fetal malformations

 

A 26-year-old patient consulted a gynecologist with complaints of pain in the left labia. Marks a rise in body temperature up to 37.80C. Examination of the external genitalia revealed swelling and hyperemia of the left labia. On palpation, a 5x4 cm formation in the thickness of the left labia with a softening area in the center is determined. What is the most correct diagnosis

Bartholin gland abscess

 

A pregnant woman is admitted to the emergency room, at the gestational age of 35 weeks with complaints of cramping pains in the lower abdomen. Contractions for 25-30 seconds, after 4-5 minutes. At vaginal examination, the cervix is ​​smoothed, the edges are of medium thickness, the opening of the uterine pharynx is 2.0 cm.What is the most probable diagnosis

Pregnancy 35 weeks. 1st stage of labor

 

Patient L., 28 years old, was admitted to the gynecological department with acute inflammation of the uterine appendages. The examination revealed a positive reaction to HIV. When can HIV infection be considered laboratory-confirmed?

double positive reaction ELISA reaction + immunoblot

 

A 26-year-old patient complains of worsening of her condition 5 days before menstruation: edema, weight gain, feeling of tension and soreness of the mammary glands, irritability, bad mood, headache. With the onset of the next menstruation, the complaints disappear. Gynecological examination revealed no pathological changes. What pathology is this condition caused by?

Premenstrual syndrome

 

The woman in labor O. is 20 years old, ІІІ - the period of childbirth. Within 30-40 seconds, with controlled stretching of the umbilical cord with abduction of the uterus in the opposite direction (i.e., there are no signs of separation of the placenta), the placenta does not descend. What further tactics of management of the III - period of labor is the most expedient

wait for another good contraction of the uterus and repeat the stretching of the umbilical cord

 

An external obstetric examination with palpation of the abdomen established: the position of the fetus is longitudinal, the head is presented above the entrance to the small pelvis, the back of the fetus is facing the left wall of the uterus. Indicate presentation and position of the fetus

Head presentation, I position

 

Spontaneous childbirth occurred with a full-term male baby. After 5 minutes, with the help of active management of the third stage of labor, the placenta was isolated. Examination of the placenta revealed: the placenta measuring 22x18x3cm, there is a defect in the placental tissue measuring 2x2.5 cm, all the membranes. Further tactics of the doctor

immediately proceed to manual examination of the uterine cavity and removal of the retained placenta lobe

Examination of the patient revealed: pH of vaginal discharge more than 5.2 hyperemia of the vaginal mucosa, positive amine test, "key cells" during microscopic examination of vaginal discharge. Most likely diagnosis

bacterial vaginosis

 

Pregnant O., 32 years old. The local gynecologist complained of aching pains in the lower abdomen and lower back in the gestation period of 17-18 weeks. Anamnesis: Labor parity 5/2. The 3rd and 4th pregnancies ended in early medical abortion without complications. On vaginal examination, the cervix is ​​2.5 cm long in the center of the small pelvis. The cervical canal is passable for 1 transverse finger, the uterus is enlarged according to the gestational age, mucous discharge from the genital tract, in moderation. The most likely diagnosis of a gynecologist in a polyclinic

pregnancy 17 - 18 weeks. OAA. Threatened late abortion

 

A 20-year-old patient was admitted to the gynecological department with complaints of pain in the lower abdomen on the 13th day of the menstrual cycle. BP 100/60 mm Hg Pulse 90 beats per minute. The skin is pale. The abdomen is soft, painful in the lower parts. There are symptoms of peritoneal irritation. On the mirrors: the cervix is ​​clean, the discharge is mucous and bloody. PV: the uterus is of normal size, the appendages are not defined due to pain and tension of the anterior abdominal wall, the vaults are deep, painful. What is the most likely diagnosis

ovarian apoplexy

 

Patient 26 years old, complaints of engorgement and swelling of the mammary glands and legs, bloating, irritability, sweating. Ill for 3 years. These symptoms appear in the second phase of the menstrual cycle and stop after the next menstruation. Symptoms do not increase in severity over the years. Gynecological examination revealed no pathology. What form of premenstrual syndrome is likely in this case?

Edematous

 

With a repeated pregnancy, a woman at 22 weeks was at risk of premature birth. When examined in the mother, blood group A (II) is Rh factor negative, in the father - AB

(IV) group, Rh factor is positive. What cause can contribute to miscarriage

Formation of maternal antibodies to the Rh factor of the fetus

 

The pregnant woman was diagnosed with placenta previa at the second screening ultrasound of the fetus.

The most characteristic clinical symptom of placenta previa is repeated bleeding from the genital tract.

A woman with a full-term pregnancy is in labor for 7 hours, contractions for 30-35 seconds, after 3-4 minutes. From the anamnesis: pregnancy 3 previous two ended in abortion honey, the latter was complicated by endometritis. The woman began to complain of minor bleeding from the genital tract. During vaginal examination, the cervix is ​​smoothed, the opening of the uterine pharynx is 8 cm, the fetal bladder is intact, spongy tissue is determined on the left along the edge. What is the tactic

make an amniotomy, continue to lead the birth through the natural birth canal, make an amniotomy, apply obstetric forceps

Patient A., 24 years old, was admitted with complaints of pain in the lower abdomen and spotting from the genital tract with delayed menstruation for 2 weeks. BP 100/60 mm Hg, pulse 90 beats / min. In the mirrors: cyanosis of the mucous membrane of the cervix, bloody, dark discharge. PV: the uterus is slightly enlarged, mobile, on the right in the region of the appendages, a formation is determined, painful, doughy consistency. The posterior fornix is ​​flattened, painful. What is the most likely diagnosis

ectopic pregnancy

 

Patient K., 35 years old, complains of rapidly progressing hirsutism, cessation of menstruation. Considers himself sick for 8 months, when menstruation delays first began to be noted, facial hair growth (beard, mustache) appeared. Last menstruation 3.5 months ago. On examination: height - 150 cm, weight 59 kg. Severe hirsutism. The mammary glands are atrophic. There is no discharge from the nipples. Vaginal examination: the cervix is ​​cylindrical in shape, the pharynx is closed. The uterus is not enlarged. The area of ​​the left appendages was normal. On the right, in the area of ​​the appendages, a dense formation measuring 6.5x5.5x4.0 cm is palpable.The most probable diagnosis

hormone-producing ovarian tumor

 

A 19-year-old patient complained of pain in the lower abdomen, fever up to 37.5C ​​and purulent discharge from the genital tract, painful urination. On examination: the urethra is infiltrated, in the mirrors - the cervix is ​​hyperemic, eroded, abundant mucopurulent discharge. Vaginal examination: the uterus is not enlarged, painful on palpation, the appendages on both sides are thickened, painful. With bacterioscopy of smears - gonococci located extra- and intracellular. What is the most likely diagnosis

fresh acute ascending gonorrhea

 

The postpartum woman is 30 years old, on the 3rd day after childbirth complains of pain in the lower abdomen, general weakness, chills, headache, fever up to 39.20 C. In childbirth due to a defect in 2/3 of the placenta membrane, a manual examination was performed uterine cavity. Birth parity: 4/2 pregnancy, two medical abortions. Chronic cholecystopancreatitis, chronic pyelonephritis, is not registered on "D". The mammary glands are moderately coarse.

What is the most likely diagnosis of postpartum endometritis?

F., 34 years old, complains of rapidly progressing hirsutism, cessation of menstruation (3 months). Considers himself ill for 6 months, when menstruation delays began to be noted for the first time, facial hair growth appeared. On examination: height 152 cm, weight 57 kg. Severe hirsutism. The mammary glands are atrophic. There is no discharge from the nipples. PV: the cervix is ​​cylindrical and the pharynx is closed. The uterus is not enlarged. The area of ​​the left appendages was normal. On the right, in the area of ​​the appendages, a dense formation measuring 5.5x4.5x5.0 cm is palpable.What is the most probable diagnosis

hormone-producing ovarian tumor

 

A 30-year-old pregnant woman came to the antenatal clinic with complaints of recurrent pain in the lower abdomen and lower back. The gestation period is 12-13 weeks. A week ago I got registered, underwent an ultrasound examination - no pathology was revealed. History of 2 births, one medical abortion. In a bimanual examination: the cervix is ​​2.5 cm, the external pharynx is closed, the uterus is enlarged according to the gestational age, there is a small amount of mucous discharge from the genital tract. The tactics of the doctor of the antenatal clinic

Psychotherapy with control attendance after a week

 

A 17-year-old girl was admitted urgently to the hospital with profuse uterine bleeding. Menstruation from 13 years old, the cycle is irregular, delays up to 1.5-2 months, followed by bleeding. Received a course of oral contraceptives, without a lasting effect. Lives sexually for 6 months, is protected by interrupted intercourse. What can be the recommended treatment

scraping of the uterine cavity

 

For a correct clinical assessment of neuroendocrine disorders in a woman's body and, accordingly, determining the principles and methods of their pathogenetic therapy, it is necessary to know the five-link regulation of the reproductive system - this is

cerebral cortex, hypothalamus, adenohypophysis, ovaries, target organs and tissues

 

A 25-year-old woman complains of purulent discharge from the genital tract, cramps when urinating for 5 days, body temperature is normal. Lives sexually irregularly, does not have a permanent partner. On the mirrors: the vagina and cervix are hyperemic, abundant purulent-mucous discharge in the form of "purulent tape". Bimanual examination: the uterus and appendages are not enlarged, painless. What studies can identify the etiology of the disease

cultural method

 

A 40-year-old patient was admitted to the gynecological department with bleeding and cramping pains in the lower abdomen. Sick for 1.5 years, when menstruation became longer and more abundant. The last menstruation began on time and lasts 10 days. History: one childbirth and 3 artificial abortions, without complications. What is the nature of menstrual dysfunction

hyperpolymenorrhea

 

Woman, 32 years old. Two weeks ago, a live full-term female fetus was born. The baby is immediately attached to the breast. The early postpartum period was uneventful.

Discharged on the 4th day. At the moment, she is complaining about an increase in body temperature up to

38 degrees, chills. The general condition is moderate due to intoxication. The skin over the mammary glands is hot, the glands are dense, painful on palpation. Milk is released from the nipples. Scanty serous discharge from the genital tract. During vaginal examination, the uterus is of normal size, painless, mobile, the external pharynx passes the dome of the finger. What is the most likely diagnosis

lactostasis

 

A postpartum woman with a child was delivered to the emergency room of the maternity hospital. The birth took place 2 hours ago at home. During pregnancy, the woman was registered with a gynecologist and was examined. The condition is satisfactory. No complaints. What actions need to be taken in an emergency room

examine the birth canal for ruptures, inject anti-tetanus serum

 

Multiparous 23 years old, with full-term pregnancy, 5 hours after the onset of contractions, bloody discharge from the genital tract appeared, fetal heartbeat 132 beats / min. The condition does not suffer. The opening of the uterine pharynx is 8-9 cm. The fetal bladder is intact. What to do

make an amniotomy

What criteria are used to diagnose severe preeclampsia diastolic blood pressure> 110mmHg Systolic blood pressure

> 160mmHg with 300mg proteinuria or more

 

Pregnant Zh., 19 years old, was taken to the maternity hospital by ambulance. According to the ambulance team, the pregnant woman had a seizure at home. The condition is serious, the consciousness is inadequate. Full-term pregnancy. Gender parity is 1 \ 0. The skin and visible mucous membranes are pale, marked edema is noted on the lower extremities. HELL 170 \ 110 mm Hg. Art., pulse 96 beats per minute. The most correct tactics for managing a pregnant woman

delivery after complex intensive care no later than 12 hours

 

The physiological period of a woman's life, during which, against the background of age-related changes in the body, involutional processes in the reproductive system dominate, is called

climacteric

 

A pregnant woman, 37 weeks gestation, was admitted to the emergency room. When Leopold Levitsky's 2nd technique is performed, a large, dense, ballot part of the fetus is palpated on the right side. What is the most likely diagnosis

Transverse position of the fetus, 2 position

 

On the 4th day after childbirth, which were complicated by rupture of the labia, there were complaints of pain, burning sensation in the area of ​​the outer labia, perineum. On examination, hyperemia, tissue edema, purulent discharge on the surface of the wound. The wound bleeds easily. What is the most likely diagnosis

postpartum ulcer

 

The volume of surgery performed for postpartum hemorrhage due to soft tissue injuries of the birth canal

suturing soft tissue tears

 

A 36-year-old woman who was re-pregnant, 32 weeks of gestation developed swelling on the legs. BP - 140/90 mm Hg, 150/100 mm Hg, urine protein 0.033 g / l. The appointment of which antihypertensive drug from the listed is most appropriate

will finish

 

For the purpose of hormonal treatment of dysfunctional uterine bleeding in the perimenopausal period, women probably use

gestagens

 

Patient N., 24 years old, for several years complains of worsening of her condition 4-5 days before the onset of the next menstruation: edema, weight gain, feeling of tension and soreness of the mammary glands, irritability, bad mood, headache, flatulence. With the onset of menstruation, the above complaints disappear. Gynecological examination revealed no pathological changes. What hormone is the key factor in the etiology of this condition

progesterone

 

The patient, 23 years old, suffered from tuberculosis in childhood. He is not registered with the tuberculosis dispensary. Periodically disturbed by pain in the abdomen. In marriage for 2 years, pregnancy does not occur, did not protect herself. Menarche from the age of 13, the last 3 years of menstruation have become short and scanty, but the cycle has been maintained for 28 days. A special gynecological examination revealed no pathological changes. Which study will confirm the diagnosis in this patient?

hysterosalpingography

 

Re-pregnant A., 25 years old, at full-term pregnancy was admitted to the maternity hospital with complaints of the outpouring of light amniotic fluid 7 hours ago and the beginning of regular contractions 5 hours ago. A vaginal examination revealed: the opening of the uterine pharynx is complete, there is no fetal bladder, the head is presented, a small segment is fixed at the entrance to the small pelvis.

Most likely diagnosis

 

second stage of labor, prenatal rupture of amniotic fluid

 

Woman in labor K., 24 years old. In childbirth within 5 hours. Suddenly there were pains in the abdomen, the uterus is in hypertonicity, does not relax between contractions, moderate bleeding from the genital tract. Presumptive diagnosis: Premature detachment of the normally located placenta. What research method is most likely to diagnose premature detachment of a normally located placenta

ultrasound procedure

 

A 45-year-old patient was admitted to the hospital for submucous uterine fibroids. Vaginal examination: the cervix is ​​hypertrophied, deformed, the body of the uterus is enlarged up to 9-10 weeks of pregnancy, dense, painless. The appendages are not changed. What is the optimal amount of surgery

extirpation of the uterus without appendages

In an ambulance car, multiparous A., 27 years old, with a full-term pregnancy was admitted to the maternity hospital with amniotic fluid poured out. There is no generic activity. Anamnesis: Parity 2/1. The first pregnancy 2 years ago ended with an emergency caesarean section due to the threatening condition of the fetus.

The postpartum period was complicated by endometritis. Doctor's tactics delivery by caesarean section

A 25-year-old patient was admitted to a gynecological hospital with complaints of pain in the lower abdomen, spotting from the genital tract, fever up to 38 C. She considers herself a patient for 3 days, these symptoms appeared after the introduction of the IUD. Menstruation is regular, childbirth 1, abortion 3. The condition is satisfactory, the abdomen is soft, moderately painful above the bosom.

Bimanual examination: the body of the uterus is slightly enlarged, doughy consistency, painful, the appendages are not determined. What is the most likely diagnosis

Endometritis

 

The earliest symptoms of decreased ovarian function are Menstrual irregularities

A pregnant woman with a period of 8-9 weeks of pregnancy vomiting up to 22 times a day, loses weight, hypotension, pulse 110 per minute, urine output is reduced, residual nitrogen and creatinine are increased, acetone in urine - 4 plus.

Diagnosis

 

vomiting of pregnant women, severe

 

R., 32 years old, was in a gynecological hospital due to exacerbation of chronic inflammation of the uterine appendages. Before discharge, the patient consulted the gynecologist with a request to advise on the method of contraception. The woman is married and has 2 children. During the last 3 years, she was twice treated by a gynecologist for an exacerbation of the inflammatory process of the uterine appendages. Which contraceptive method suits her best?

Combined oral contraceptives

 

After birth, a full-term newborn was laid out on the mother's abdomen, and early breastfeeding was initiated. 2 hours after giving birth, he was transferred to a joint stay, was on exclusively HB. By the end of the first days after birth, the baby had regurgitation after each feeding, bloating. The child is restless, there is hyperesthesia, body temperature within 36.7C - 37.1C. The mother has not observed a bowel movement in the baby since birth. In the KLA: leukocytes - 18,000, e. - 5 B. - 3%, p. - 7%, p. - 32%, l. - 37%, m. - 16. Leukocyte index - 0.18. Evaluate the diagnostic value of the described clinical symptoms and the given laboratory data, make a preliminary diagnosis

intestinal obstruction

 

When carrying out the third postpartum patronage to a newborn of 3 weeks of age, the district pediatrician notes that the recommendations for 1 and 2 patronage to the newborn did not work and the mother lost milk, tk. she has aggravated hay fever and constantly stressful situations at home. The mother began to feed the child with the infant formula "Malyutka". On day 3, the child became restless, regurgitation, bloating, and undigested stools were noted. Hyperemia appeared on the cheeks, gneiss on the scalp and eyebrows. The local pediatrician found a clear intolerance to cow's milk proteins and recommended formula

nutramigen, Pregestimil

 

The child is 27 days old. She is breastfed. When visiting a child at home, the district pediatrician assesses the neuropsychic development of the child and notes that the child smoothly traces the moving red ball, listens to the doctor's voice, smiles, lying on his stomach tries to raise and hold his head, makes separate sounds in response to the mother's conversation with him ... How the doctor will assess the neuropsychic development of the child

normal development

 

In a 2-week-old child, elements of a pustular rash appeared on the scalp in the area of ​​the hair follicle orifices, surrounded by a weakly expressed corolla of hyperemia. Moderate symptoms of intoxication are noted, the temperature has risen to 37.3 C. In the KLA - anemia, leukocytosis, neutrophilia, accelerated ESR. Your preliminary diagnosis

pseudofurunculosis

 

An hour after a newborn girl, stained with meconium after birth, was ventilated under positive pressure in the delivery room, she had a decrease in hemoglobin oxygen saturation and a weakened breathing on one side of the chest. Your preliminary diagnosis

pneumothorax

 

A 2-week-old child who had contact with a mother with ARVI had a fever up to 37.3C, catarrhal manifestations in the nasopharynx, and a cough. When examined by a local doctor, the condition was assessed as moderate, the number of breaths 40 per minute. Above the lungs, puerile breathing is heard, no wheezing. Which of the drugs is not indicated for the appointment

antibiotics

 

A child of 8 days old, premature, was born with a weight of 1000 g. What vaccinations can a newborn be given in a maternity hospital

not subject to vaccination

 

An absolute indication for a replacement blood transfusion in a full-term child with HDN on the first day of life is

hourly increase in bilirubin of more than 6.8 μmol / h in the first day of life

 

The mother of a 2-week-old child turned to the local doctor with complaints of engorgement of the mammary glands, discharge from the genitals. On examination, the child's condition is assessed as satisfactory, the temperature is within normal limits, and is gaining weight. Your preliminary diagnosis

sexual crisis

 

A child from I pregnancy, which proceeded without features, I delivery at 38 weeks. Birth weight

- 2900 gr., Height - 49 cm. A woman has A (II), Rh (+) blood, a child - AB (IV), Rh (-) blood. Score on the Apgar scale 7-8 points. On the 3rd day, the child developed icteric staining of the skin. The state of health is not disturbed. Sucks actively, does not regurgitate. Reflexes of innate automatism are actively evoked. In a biochemical blood test: bilirubin 90 μmol / l for

the account of the indirect fraction, transaminase is normal. According to the vaccination schedule, a newborn child in the maternity hospital is

vaccination against tuberculosis, viral hepatitis B

 

Newborns are characterized by a choreatic component in movements, which is a consequence of the predominance of extrapyramidal motor control. Specify the reflex in which spontaneous motor activity is determined

Bauer

 

In a full-term newborn with a birth weight of 3400 g, 10 hours after birth, moderate respiratory disturbances appeared, body temperature increased to 38.2C, and he refused to breastfeed. In the KLA: leukocytes - 4500, e. - 5 B. - 0%, Yu. - 3%, p. - 10%, p. - 32%, l. - 38%, m. - 12%. Leukocyte index - 0.29. Evaluate the diagnostic value of the described clinical symptoms and the given laboratory data. Your preliminary diagnosis

severe bacterial infection

 

A newborn child has shortness of breath, tachycardia, cyanosis of the nasolabial triangle, increasing with anxiety, when sucking the breast. On auscultation, the heart sounds are significantly muffled, there is no noise, over the area of ​​the lungs - vesicular breathing, no wheezing. The borders of the heart are expanded. It is known from the anamnesis that when the pregnancy was 6 months, the mother had a severe viral infection. Your preliminary diagnosis

late congenital carditis

 

The girl was born on time (full-term), the birth went well. After giving birth, the newborn screamed and began to breathe spontaneously. On physical examination 1 hour later, she was completely normal. Light yellowness was noticed after 2 days. The mother's blood was of the first group, Rh-positive, the child's blood was of the second group, Rh-positive.

HDN on the AVO system

 

A premature baby, whose weight is 950 g, is fed with undiluted breast milk, he receives 120 kcal / kg per day. After a few weeks, the baby is most likely to develop

hypocalcemia

 

At birth, a newborn has no signs of breathing, he is pale, does not respond to irritation, the pulse is about 84 beats per minute, the limbs hang down. Your preliminary diagnosis

severe asphyxia

 

Child at the age of 2 weeks. He became acutely ill when catarrhal manifestations appeared in the nasopharynx. On the 2nd day of illness, the condition worsened: intoxication increased, the temperature rose to 390, shortness of breath appeared. On examination, the child's condition is assessed as serious. Respiratory rate up to 70 per minute, expiratory shortness of breath, frequent wet cough, unproductive. Above the lungs, a mass of different-sized wet rales is heard, as well as dry and wheezing rales. Your preliminary diagnosis

bronchiolitis

During the third postpartum patronage of the newborn, the mother of the child complained to the district pediatrician that 2 hours ago her temperature had risen to 37.5C, there was a painful compaction on palpation on the left breast, slight hyperemia. When expressing, milk is of normal color, without mucus and blood. Actions of the local pediatrician

continue to breastfeed with the obligatory expression of the remaining milk after feeding

A 2-week-old child is not vaccinated, sleeps 18 hours a day, weighs 3.5 kg, receives 60 ml of breast milk 4 times a day, does not receive solid food, iron and vitamins. What worries you the most

infrequent feedings, insufficient energy intake from food

 

A premature baby born from the 1st pregnancy, 1st birth, proceeding without features, turned yellow 12 hours after birth. The mother's vaccination and transfusion history is not burdened. At the age of 36 hours, the bilirubin content was 180 μmol / L, the hemoglobin level was 125 g / L, and the reticulocyte count was 9%. Differential diagnosis should be carried out with all of the following diseases, except

Rhesus - incompatibility

 

The baby was born at 40 weeks of gestation with a weight of 3750 g. He cried out at once. Applied to the breast on the first day, took the breast well, sucked actively. On the third day of life, the body weight is 3600 g. On the skin of the chest, abdomen, extremities, a spotty-papular rash of pink color is noted. Reveal transient stances

transient weight loss, toxic erythema

 

The boy is 7 days old, examined by the district pediatrician. From the anamnesis: the first pregnancy, the mother's age is 18 years, the mother smokes, the pregnancy proceeded with toxicosis of the first and second half. Stimulated labor, anhydrous period of 8 hours, was born with a single cord entanglement around the neck. Mom did not work, is not married, lives with her parents, social and living conditions are satisfactory. Heredity is not burdened. The baby is breastfed. What health group will the child be classified to?

health group II A

 

When viewed in a child, the head is slightly brought to the chest, the arms are bent at the elbow joints and pressed against the lateral surface of the chest, the hands are clenched into fists, the legs are bent at the knees and hip joints. Determine the condition of the newborn

flexor pose

 

Child 10 days old. Was born at a period of 34-35 weeks, from the 3rd difficult pregnancy, with a body weight of 2200, height 44 cm. The mother has chronic pyelonephritis, obesity. He screamed at once, hypothermia occurs, 3 days after birth, diffuse seals of the skin and subcutaneous fat appeared in the area of ​​the thighs, buttocks, upper extremities. The skin is pale in color with a slight icteric tint, cool to the touch, body temperature 35.6 C, the child's physical activity is reduced, the face is amimic. There are no pathological seals on the palms and soles. When pressing on the affected area of ​​the skin, the depression does not remain. From the side of the lungs - no pathology, heart sounds are moderately muffled. The liver and spleen are not enlarged. Your preliminary diagnosis

sclera of a newborn

 

Child N., a newborn, was born from 2 full-term pregnancies with a body weight of 3200, a length of 49 cm, an Apgar score of 6 - 7 points. The mother has a history of a viral infection transferred at 36 to 37 weeks. Shouted at once, the scream is not loud. In 10 minutes. shortness of breath appeared, respiratory rate 70 per minute, became lethargic, increased cyanosis of the nasolabial triangle. General muscle hypotension, hyporeflexia. On auscultation - fine bubbling crepitant rales, with percussion in the lower parts of the lungs and basal zones, shortening of the percussion sound.

The borders of the heart are expanded in diameter, the tones are muffled, the heart rate is 160 per minute. Your preliminary diagnosis

intrauterine bronchopneumonia

 

Child at the age of 2 weeks. He became acutely ill when catarrhal manifestations appeared in the nasopharynx. On the 2nd day of illness, the condition worsened: intoxication increased, the temperature rose to 39.0C, shortness of breath appeared. On examination, the child's condition is assessed as serious. Respiratory rate up to 70 per minute, expiratory shortness of breath, frequent wet cough, unproductive. Above the lungs, a mass of different-sized wet rales is heard, as well as dry and wheezing rales. Your preliminary diagnosis

bronchiolitis

 

Child 6 days old, weight 1500 grams. Hypothermia occurred during the transfer to stage 2 of nursing. Examination of the thighs, buttocks, and upper extremities revealed diffuse seals of the skin and subcutaneous fat. When pressing on the affected area of ​​the skin, the depression does not remain. The skin is pale in color with a slight icteric tint, cool to the touch, body temperature 35.6C, the child's physical activity is reduced. On the part of the internal organs without any peculiarities. The predisposing factor for this condition is

hypothermia

 

The most common complications of pneumonia in premature babies, all of the above, except arthritis

Patronage examination of a newborn for 7 days gave the following picture: bubbles in the lower abdomen, on the extremities, in folds at different stages of development (sizes from 0.5 to 1.5 cm in diameter, filled with serous-purulent contents, the base of the bubbles is somewhat infiltrated against the background erythematous spots). Nikolsky's symptom is negative. After opening the bubbles, erosion remains. No crusts are formed at the site of the former bubbles. The general condition of the child is not disturbed. Body temperature is subfebrile. Your preliminary diagnosis

Pemphigus (pemphigus of a newborn

 

Child M., 10 days old, was born from the 4th pregnancy, proceeding with severe toxicosis, with a period of 35 - 36 weeks. Previous pregnancies ended in abortions, and the third in miscarriage. An ultrasound scan for a period of 27 weeks established a characteristic posture of a "buddha" fetus, a significant increase in the mass of the placenta. Body weight at birth 3200, length 44 cm. The skin is sharply pale, with an icteric tinge, edema over the entire surface of the body, a barrel-shaped abdomen is sharply increased in volume, hepatosplenomegaly. The borders of the heart are expanded in diameter, the tones are muffled, the heart rate is 98 per minute. On palpation of the abdomen - fluctuation. In a biochemical blood test -

hyperbilirubinemia. In the UAC - er. 2.5 x 1012 / l, hemoglobin - 70 g / l, CPK 0.75, platelets 100

thousand Your preliminary diagnosis of HDN, edematous form

The child is 2 years old. Complaints about O-shaped deformity of the legs. Developed satisfactorily. Until 8 months he was breastfed, received rickets prophylaxis in the form of UFO. It is open for 3 hours daily. After a year, when the child began to walk, a curvature of the legs appeared, recently the deformity has increased sharply, and the gait has changed. In laboratory studies: hypophosphatemia, hyperphosphaturia with normocalcemia, normocalciuria. Your preliminary diagnosis

phosphatic diabetes

 

Child 7 years old. Admitted to the hospital in serious condition with complaints of repeated vomiting

"Coffee grounds", nausea and abdominal pain, polydipsia, weakness, dizziness, visual impairment. Objectively: a serious condition, lethargic, drowsy, the smell of acetone from the mouth. On the cheeks in the area of ​​the zygomatic arches there is a blush, the tongue is dry, in the corners of the mouth there are cracks. Pulse 120 beats per minute, weak filling. The boundaries of the heart are within normal limits. The tones are rhythmic, slightly muffled. Noisy breathing (Kussmaul). There are no changes in the lungs during percussion and auscultation. The abdomen is soft, painful on palpation in the upper half. The chair was decorated. Temperature 35.8 °.

Your preliminary diagnosis of diabetic ketoacidosis

The child is 13 years old. Complaints of fasting and nocturnal abdominal pain, of varying intensity and duration, disappear after eating, heartburn, belching, nausea, stool with a tendency to constipation. Anamnesis: sick since 10 years old, gastroduodenitis was diagnosed, seasonality of exacerbations is noted. Does not adhere to a diet. Mother and grandfather have peptic ulcer disease. Objectively: the child's condition is satisfactory. Physical development is average. Tongue coated with white bloom. On palpation of the abdomen, pain in the epigastric region, in the pyloroduodenal zone. Mendel's symptom is positive. The liver is not enlarged. Your preliminary diagnosis

duodenal ulcer

 

The child is 2 years old, the general condition is closer to satisfactory, but there is pallor, dryness of the skin. There are seizures in the corners of the mouth, the hair is dull and brittle. Thinning, brittleness of nails is noted. Recently, there has been imbalance in behavior, decreased appetite, eats chalk. In organs: systolic murmur at the apex of the heart, moderate enlargement of the liver. HB - 83 g / l Er. - 3.5 x 1012. What is the most likely diagnosis

moderate iron deficiency anemia

 

The child is 3 years old. Complaints of frequent diarrhea, poor appetite, weight loss. From the anamnesis: born from the first pregnancy, birth weight 3 kg 400 g. From the first days of life, unstable stool was noted, which was regarded as staphylococcal enterocolitis and dysbiosis. At the age of 11 months he suffered colienteritis. At the age of one year, he had a mass of 8 kg 700 g; at two years old - 10 kg; at three years old - 10.5 kg. Does not tolerate dairy products. Received enzymes and biological products. The father does not tolerate milk. Objectively: the child's condition is satisfactory. Decreased nutrition, tissue turgor is reduced. Pale. The abdomen is swollen, palpation is determined by rumbling along the colon. The edge of the liver + 1.5 cm.Your preliminary diagnosis

lactose intolerance

 

A 5-year-old child is on inpatient treatment on the 5th day with a diagnosis of acute focal right-sided pneumonia, uncomplicated. Receives penicillin i / m from the 1st day of illness. The general condition of the child during the period of treatment was unchanged, the child continues to periodically fever. Intoxication symptoms persist, appetite does not improve, shortness of breath persists.

What changes need to be made in the first place in the treatment to replace the antibiotic

The patient has the following symptoms: facial cyanosis, acrocyanosis, varicose veins, positive venous pulse. With auscultation under the xiphoid process, a blowing systolic murmur is heard, which is carried up and to the right, intensifies during a deep inhalation and weakens during exhalation. The liver is enlarged. When it is palpated, pulsation of the liver is felt, synchronous with the systole of the ventricles. On the ECG there are high, pointed teeth P. On the roentgenogram, the shadow of the heart is triangular in shape due to an increase in the right ventricle and atrium, expansion of the superior vena cava. What vice can you think

tricuspid valve failure

 

A 4-year-old child is being treated in a hospital for polysegmental pneumonia. On the fifth day of hospitalization, the state of health sharply deteriorated due to severe respiratory failure. Objectively: the condition is severe, the skin is pale with a grayish tinge, cyanosis of the nasolabial triangle is pronounced. The auxiliary muscles are involved in the act of breathing, the left half of the chest lags behind when breathing. With percussion: dulling of the pulmonary sound over the lower parts of the left lung, the Garland triangle and the Rauchfus triangle are percussed. Voice tremor is weakened on the left. What is the reason for the deterioration of the child's condition

pyopneumothorax

 

A child of 12 years old, a state of moderate severity due to symptoms of intoxication. The temperature is 38.7 C, a positive beating symptom. In OAM - leukocyturia, bacteriuria. Ultrasound signs of inflammatory changes in the PCS. Your preliminary diagnosis

complicated IMS (acute pyelonephritis

 

The patient has the following symptoms: facial cyanosis, acrocyanosis, varicose veins, positive venous pulse. With auscultation under the xiphoid process, a blowing systolic murmur is heard, which is carried up and to the right, intensifies during a deep inhalation and weakens during exhalation. The liver is enlarged. When it is palpated, pulsation of the liver is felt, synchronous with the systole of the ventricles. On the ECG there are high, pointed teeth P. On the roentgenogram, the shadow of the heart is triangular in shape due to an increase in the right ventricle and atrium, expansion of the superior vena cava. What vice can you think

tricuspid valve failure

 

Child 3 years old. Complaints about fever, wet cough, shortness of breath. Objectively: a state of moderate severity, pale, expiratory dyspnea. Above the lungs there is a boxy shade of percussion sound. On auscultation against the background of hard breathing, dry and variegated moist rales are heard. Your preliminary diagnosis

acute obstructive bronchitis

Patient K., 4 years old. He fell ill acutely. Complaints of fever up to 39.4 ° C, painful cough with a small amount of viscous, vitreous sputum, severe chills, pain in the right side. On examination, the boy is inhibited, pale skin with a pronounced blush on the cheeks (especially on the right), pallor of the nail beds, dyspnea at rest of a mixed character with retraction of the compliant places of the chest. The child was lying on his right side with bent legs. There was a limitation in the mobility of the lower edge of the right lung. There was a shortening of the percussion sound in the lower parts of the right. No wheezing was heard.

The ratio of pulse to respiration rate was 2: 1. General blood test: Hb - 124 g / l, Er. - 4.8 x 1012 / l, Lake. - 16.2 x 109 / l, young neurophilia - 2%, p / i - 8%, p. - 64%, l. - 24%, m. - 8%, ESR - 22 mm / hour. Chest X-ray: an infiltrative shadow is revealed that occupies the lower lobe of the right lung. Which of the following is most likely when interpreting a CBC

leukocytosis, neutrophillosis with a shift to the left lymphocytopenia, accelerated ESR

 

An 11-year-old girl is visiting a neurologist. A month before going to the doctor, I had a sore throat. Recently, she began to get tired, study worse, irritability, tearfulness, twitching of facial muscles, unsteadiness of gait appeared, handwriting changed. Objectively: expansion of the borders of the heart, tachycardia, systolic murmur at the apex of the heart, in addition, decreased muscle tone and tendon reflexes, impaired coordination tests.

The doctor diagnosed with acute rheumatic fever (chorea minor). What is the etiology of the disease

streptococcal infection

 

The medical worker classified the child as having no pneumonia, asthmoid breathing. Which drug will you choose to treat a child under the IMCI program?

inhalation with salbutamol

 

Boy 3., 13 years old, was admitted for examination with complaints of poly - arthralgia within the last 4 months, prolonged subfebrile condition, increased fatigue. Anamnesis of the disease: the onset of this disease is associated with a previous acute respiratory viral infection, which proceeded with high fever. On admission: a state of moderate severity. The skin is pale. There are pale-colored erythematous - desquamatous elements on the face, mainly on the cheeks and the bridge of the nose. There are joint changes in the form of swelling and moderate pain in the joints. Heart sounds are somewhat muffled, rhythmic, no murmurs. Stool and urine output are normal. Complete blood count: Hb - 100 g / l, Er. - 4.2 x 1012 / l, Thrombus. - 90 x 109 / l, Lake. - 1.5 x 109 / l, p / i - 2%, p. - 62%, e. - 2%, l. - 31%, m. - 3%, ESR - 50

mm / hour Biochemical blood test: total protein - 83 g / l, albumin - 46%, globulins: a2 - 12

%, gamma - 32%, seromucoid - 0.8 (normal - up to 0.2), ALT - 32 U / L, ACT - 25 U / L, urea - 4.5 mmol / L, creatinine - 98 mmol / L ... Diagnosed with Systemic lupus erythematosus. What is the degree of activity of the patient

Grade 3

 

Dasha, 10 years old. The day before she had a follicular sore throat, a week later there were pronounced edema on the face, legs, ascites, oliguria. In OAM - proteinuria 6 g / l, in b / x blood tests - hypoproteinemia, hyperlipidemia. What type of pathogenetic therapy is the main

prednisone

Patient R., 1 year 3 months old, was admitted to the department with complaints of vomiting, abdominal pain, fatigue, weight loss. Within 5 days (runny nose, cough), at the same time, loose stools were noted, the temperature was 37.5 ° C for 2 days. Since that time, the boy became lethargic, vomiting was periodically noted, mainly at night there were bouts of anxiety, a wet cough. I got tired. Appetite decreased significantly. On the eve of the boy's condition sharply worsened: he was extremely restless, there was repeated vomiting, hepatomegaly was revealed up to + 7 cm from under the costal arch. On admission, the condition was serious. The skin is pale, cyanosis of the nasolabial triangle, edema on the legs. In the lungs, harsh breathing, in the lower parts - moist rales. BH - 60 per minute. The boundaries of relative cardiac dullness are extended to the left to the anterior axillary line. Dull tones systolic murmur at the apex, heart rate - 160 beats per minute. Diagnosed with non-rheumatic carditis. Presumably, what is the etiology of this disease

viral etiology

 

The child is 4 years old, taken to the hospital by an ambulance. He fell ill acutely, 3 days ago. The disease began with a cough, an increase in temperature to 37.7. Not treated. Child from II pregnancy - II delivery. Birth weight 3400 height 55 cm, screamed at once. Breastfed for up to 1 year. After a year, an allergy in the form of a rash to citrus fruits. From 6 months 2 times a year ARVI. Mom has bronchial asthma, father is healthy. Which of the following is the most aggravating factor

burdened allergic history

 

The child is 9 years old, with prof. examination at school in the analysis of urine revealed hematuria, low blood pressure. In the family, the mother has nephropathy, hearing loss. Your preliminary diagnosis

hereditary nephritis

 

The child is 4 years old. Complaints about a deterioration in appetite and recurrent pain around the navel, not related to the intake and nature of food. The pains are short-lived and go away on their own. Objectively: the condition is satisfactory. Normal food. The tongue is coated. The abdomen is painless on palpation, the liver is not enlarged. On the part of other internal organs without features. The stool was formed regular, feces on I / worm were negative, there were no dysuric phenomena. Your preliminary diagnosis

functional stomach disorders

 

Child 10 years old. Complaints of persistent cough, discharge of mucopurulent sputum in the morning; shortness of breath when running, lethargy, poor appetite. At the age of 2, he suffered acute destructive pneumonia. Since then, he annually suffers from pneumonia and bronchitis. Objectively: a state of moderate severity, t - 37.3 °. Pale, below average physical development.

Micropolyadenitis. When percussion over the lungs, shortening in front in the region of 4 - 5 ribs. Breathing is hard, various moist rales are heard. After coughing, their intensity does not decrease. Your preliminary diagnosis

chronic pneumonia

 

The patient has dysuric disorders, pain during the act of urination. There is no deviation from the norm in the blood. The temperature is normal. In the analysis of urine: leukocyturia. Your preliminary diagnosis

cystitis

Patient R., 6 years old, is admitted to the hospital with complaints of pain in the knee, ankle, wrist and hip joints, morning stiffness of the joints. The articular syndrome persisted for 6 months and was accompanied by an increase in ESR. On examination, the girl's condition is serious. Child of undernutrition. She uses crutches for hip joints. There is an increase in local temperature, an increase in volume and a significant limitation of movements in the knee, ankle and radial joints. In the general analysis of blood: Hb - 90 g / l, Lake. - 15.0 x 109 / l, p / i - 4%, p. - 42%, e. - 2%, l. - 49%, m. - 3%, ESR - 50 mm / hour, rheumatoid factor "+". Diagnosed with juvenile rheumatoid arthritis. What diseases is it necessary to carry out a differential diagnosis at the beginning of the process

Reiter's symptom

 

An 11-year-old boy was admitted to the hospital unconscious, accompanied by his grandmother. It is known from the anamnesis that he suffers from diabetes mellitus and receives insulin. The last time the insulin was injected was 1.5 hours ago. According to his grandmother, the boy suddenly turned pale, covered with sweat, lost consciousness. On examination: the skin is pale, moist; muscle tone is normal; there is no smell of acetone; pulse 110 beats per minute, satisfactory filling; HELL - 90/60 mm Hg; breathing is normal; the abdomen is soft, the liver is not enlarged; temperature 36.4 °. Your preliminary diagnosis

hypoglycemic coma

 

The child is 3 years old. Complaints of lethargy, refusal to eat, vomiting, sharp abdominal pain. Episodes like the one described above were repeated many times. The child in the maternity hospital had lingering jaundice unrelated to Rh - conflict and incompatibility in the ABO blood system. Objectively: a serious condition, pronounced icterus of the skin and sclera; the borders of the heart are expanded, tachycardia. The liver protrudes from under the costal margin by 6 cm, the spleen by 4 cm. The urine is dark, the stool is colored. In the blood test: Er. - 2.4 x 1012 / liter, microspherocytes prevail, HB - 40 g / l, reticulocytes 5%; ESR - 45 mm per hour. What anemia are these changes most typical for?

Minkowski-Shafar anemia

 

Child 7 years old. He fell ill acutely, temperature 400C. On examination: a serious condition, complaints of headache, dry cough. The skin is pale, with a "marble" pattern. The pharynx is hyperemic. Grunting breath. BH - 32 in 1 minute. The chest is swollen, the right half is lagging behind in breathing. Percussion: on the right, below the scapula, the area of ​​dullness of the percussion sound is determined. Auscultatory: hard breathing, weakened over the dull area, no wheezing. Heart sounds are loud, no noise, heart rate 120 beats per minute. The abdomen is soft and painless. Complete blood count: Hb - 115 g / l, Lake. - 18.0 x 109 / l, p / i - 10%, p. - 57%, e. - 1%, l. - 23%, m. - 9%, ESR - 28 mm / hour Chest X-ray: there is intense darkening in the VIII and IX segments of the right lung. Diagnosed with right-sided segmental pneumonia.

pyopneumothorax

 

A 10-year-old girl fell ill acutely; after a bumblebee bite, a rash in the form of nodules appeared on the extensor surfaces of the elbow and knee joints. The same rash appeared on the inner thighs, buttocks. Symptoms of the pinch and tourniquet are negative. There are no pathologies on the part of the internal organs. Temperature 37.3C. Your preliminary diagnosis

hemorrhagic vasculitis

Patient A., 12 years old, was admitted to the department with complaints of epistaxis. Upon admission, the child's condition is serious. The temperature is subfebrile. The skin and visible mucous membranes are pale. There are numerous petechial elements on the skin and mucous membranes of the oral cavity, there is a slight bleeding from the gums. Heart sounds are quickened, a gentle systolic murmur is heard at the apex. The abdomen is soft, painless, the liver and spleen are not palpable. Urine of normal color. General blood test: Hb - 72 g / l, Er. - 2.8 x 1012 / l, Retic. - 0.2%, Thrombus. - single, Lake. - 1.3 x 109 / l, p / i - 1%, p. - 4%, l. - 95%, ESR - 35 mm / hour. Myelogram: bone marrow is poor in cellular elements, blast cells are absent, granulocytic lineage - 11%, erythroid lineage - 8%, megakaryocytes - not found. Diagnosed with: Acquired aplastic anemia. Explain the pathogenesis of hemorrhagic syndrome

suppression of the platelet lineage

 

The child is 11 years old. Complaints of moderate pain in the epigastrium around the navel that occurs after eating food, belching, a feeling of heaviness in the epigastric region. In the anamnesis: such complaints have been disturbing for 2 years, the seasonality of the disease is not observed. The mother has chronic gastritis. Objectively: the child's condition is satisfactory. Developed by age. There are no changes in the respiratory and cardiovascular system. On palpation of the abdomen - slight pain in the epigastrium, otherwise unremarkable. The chair is decorated. What diseases should a differential diagnosis be made with?

chronic gastroduodenitis

 

The child is 8 years old. Complaints of tearfulness, irritability, sweating. These complaints have been troubling for 2 years. On examination, the child has bulging eyes, shine in the eyes, a positive symptom of Gref, Kocher, Rosenbach. In what disease are these symptoms characteristic?

diffusely toxic goiter

 

Boy I., 11 years old. From the anamnesis it is known that 2.5 months ago he had scarlet fever. On admission, the condition was serious. The boy is whiny, irritable, gets tired quickly, there is a chanting of speech, inaccurate performance of coordination tests, muscle hypotonia. In the lungs, vesicular breathing, no wheezing. The region of the heart is not visually changed. Borders of the heart: right - along the right edge of the fudina, upper - along the III rib, left - 1 cm inward from the middle

- clavicular line. The heart tones are moderately muffled, a coarse systolic murmur is heard at the apex, occupying 1/6 of the systole, is not performed. The abdomen is soft, deep palpation is available, the liver and spleen are not enlarged. Diagnosed with Rheumatism 1. What initial treatment should be given to the patient?

bicillin

 

A 5-year-old child became acutely ill. On admission, the temperature is 37.2 C, frequent, dry cough worries, appetite is preserved, voice tremor is not changed, RR - 28, percussion - pulmonary sound, breathing is hard, single dry wheezing, cor - loud, rhythmic tones. There are no changes in the blood test. On the R - gram of the group, the strengthening of the pulmonary pattern Your preliminary diagnosis

acute simple bronchitis

 

On the 3rd day of illness, the parents consulted a doctor due to the deterioration of the child's condition 1.5

years. Complaints about fever, rapid breathing, cough, refusal to eat, lethargy. The child's condition is moderate. With percussion of the lungs, there is a shortening of the percussion

sound on the right under the scapula. Breathing is hard, in the area of ​​shortening it is weakened, against the background of which fine bubbling moist rales are heard. On the P - gram of the chest there is an increase in the pulmonary pattern, on the right of an irregular shape, small focal shadows. Specify the morphological form of acute pneumonia

focal

 

A 7-year-old boy had a sore throat, was treated with aspirin, sulfadimezin. After 2 weeks, ecchymosis and petechiae appeared on the arms and legs, then epistaxis, which stopped after intravenous administration of aminocaproic acid and application of cold to the nose. Positive symptoms of pinching and tourniquet. Internal organs without deviations from the norm. In the analysis of blood Hb - 110 g / l, platelets - 96 x 10. Retraction of the blood clot did not occur. Duration of bleeding 12 min. Diagnosed with ITP. What drugs should be prescribed to the patient

aminocaproic acid

 

Girl 6 years old. Complaints of paroxysmal cough, wheezing. Family history: mother has recurrent urticaria. At the age of 3 and 4 years, in May, outside the city, the girl had attacks of suffocation, which were independently stopped when moving to the city.

The real attack occurred after eating chocolate. On examination: a state of moderate severity. The skin is pale, blue under the eyes. Breathing wheezing, audible from a distance. The exhalation is lengthened. BH - 28 in 1 minute. Above the lungs, there is a percussion sound with a box shade, auscultatory: a mass of dry wheezing over the entire surface of the lungs. In a general blood test: e. - 14% Chest X-ray: pulmonary fields of increased transparency, increased bronchopulmonary pattern in the basal zones, no focal shadows. Diagnosed with:

Bronchial asthma. What is the main mechanism of obstructive syndrome in a child? Bronchospasm

A 9-year-old boy was admitted to the department with complaints of changes in urine tests, hearing loss. A child from a second pregnancy with toxicosis, second birth (the first child, a boy, died at the age of 11 from kidney failure, suffered from hearing loss from the age of 3). On admission, the patient was in moderate severity. The skin is pale. No edema, no pastiness. BP 105/55 mm Hg. Art. There are stigmas of dysembryogenesis. In the study: in the general analysis of urine: protein - 0.9% o, leukocytes - 6 - 7 in the field of view, erythrocytes - cover the entire field of view, relative density - 1.007. Test according to Zimnitsky: fluctuations in relative density from

1.002 to 1.008; daytime diuresis - 250 ml, nighttime diuresis - 500 ml. Audiometry: revealed a decrease in hearing at high frequencies. Ophthalmologist's consultation: diagnosed with grade I cataract, myopia. Your preliminary diagnosis

Alport syndrome

 

A 14-year-old patient has LE cells, antinuclear factor and antibodies to DNA in high titers in the blood. Your preliminary diagnosis

systemic lupus erythematosus

 

The child is 10 years old. Complaints about frequent nosebleeds and skin hemorrhages. Objectively: the condition is satisfactory. On the skin of the trunk, face, limbs there are hemorrhages of various sizes and age. The joints are not changed. In the clinical analysis of blood: er. - 3.8 x 1012, Hb - 100 g / l, thrombus - 3.0 x 109 / l, ESR - 24 mm per hour. Bleeding time 18 min.

Blood clotting 2 min., End - 7 min. There is no retraction of the blood clot. Diagnosed with Werlhof's disease. Why is this disease dangerous?

bleeding

 

Child M., 2.5 years old, the disease began acutely with an increase in body temperature to 40 C, headache, loss of appetite, single vomiting, muscle pain. A day later, there were moderate catarrhal phenomena in the form of nasal congestion, sore throat. In the oropharynx, there is moderate hyperemia of the tonsils and the posterior pharyngeal wall. The skin is pale, clear of rash. For other organs without pathology. Stool and urine output are normal. What drug should be prescribed to a child to lower the temperature

paracetamol

 

The child is 4 years old. Complaints of cramping abdominal pain, repeated vomiting. The disease began acutely. Two weeks ago I had an acute respiratory infection. Objectively: a serious condition, pallor of the skin, suffering facial expression. On the symmetrical extensor areas of the legs, there are single elements of papular-hemorrhagic rash, the joints are not changed. The abdomen is soft, painful in the epigastrium and along the colon. Temperature - 37.6. There is fresh blood in the stool. Your preliminary diagnosis

hemorrhagic vasculitis

 

A child of 9 months was admitted to a hospital with a diagnosis of acute respiratory viral infections, acute laryngotracheitis. Grade I laryngeal stenosis. What is your tactics for managing this child with IMCI to relieve stenosis

warm plentiful drink

 

Which department is it necessary to hospitalize a child with chickenpox boxed

A child with a diagnosis of purulent tonsillitis was admitted to the emergency room. Objectively, a sweetish-cloying odor from the mouth, moderate hyperemia of the oropharynx is determined, on the tonsils a white-gray plaque, poorly removable with a spatula, after removal, the surface of the tonsil bleeds. Throat swab positive for BL. What is your initial treatment strategy for this patient

administration of anti-diphtheria serum

 

A 3-year-old child with a diagnosis of diphtheria of the oropharynx showed swelling under the eyes and lower extremities in the morning; upon examination, a general urine analysis revealed proteinuria, hematuria, cylindruria, and a positive effusion symptom. What complication of this disease the doctor should think about, first of all

glomerulonephritis

 

The basis of the diphtheria film is fibrin

Misha, 8 years old, suffers from acute HAV. Choose the most appropriate marker to confirm the diagnosis

anti HAV Ig M

The child today was in contact with a measles patient, and therefore, he was given intramuscular gammaglobulin. What is the expected time frame for this child to develop measles?

from 9 to 21 days from the moment of contact

 

What cells are found in the blood during infectious mononucleosis? Atypical mononuclear cells

Child 5 years old. On the skin of the face, extensor surfaces, a pink rash of a spotty nature does not merge, an increase in the occipital lymph nodes is noted. Which of the following is the most likely diagnosis?

rubella

 

In a 5-year-old child, the disease began acutely, body temperature increased, vomiting and sore throat appeared, and a few hours later, a rash. The rash lasted 3-7 days. In the oropharynx, the doctor found follicular sore throat, the tongue was thickly coated with a gray-yellow coating. After 3 days, the tongue began to peel at the edges and tip, and became bright red with pronounced papillae. After the rash disappeared, peeling was noted. In the blood - leukocytosis of neutrophilic nature with a shift to the left, increased ESR. Which of the following is the most likely diagnosis?

scarlet fever

 

Child 1y. 6 months, acutely ill, body temperature 37.6 ° C, profuse vomiting, abdominal pain, loud passing of stool and gas. The stool is spluttering, profuse, watery, frothy, yellow in color without pathological impurities. Tank. stool culture is negative. What is your presumptive diagnosis

rotavirus gastroenteritis

 

The doctor diagnosed a 12-year-old boy with mumps infection, 2-sided mumps and orchitis on the right. Choose the right treatment for a sick child with mumps orchitis

suspensor imposition

 

Which of the following parts of the respiratory system is predominantly affected by adenovirus infection

nasopharynx

 

The child has a preliminary diagnosis of Viral hepatitis A. To confirm the etiology of the diagnosis, it is necessary to conduct a laboratory research method

linked immunosorbent assay

 

In a 5-year-old child, the disease began acutely, body temperature increased, vomiting and sore throat appeared, and a few hours later, a rash. The rash lasted 3-7 days. In the oropharynx, the doctor found follicular sore throat, the tongue was thickly coated with a gray-yellow coating. After 3 days, the tongue began to peel at the edges and tip, and became bright red with pronounced papillae. After the rash disappeared, peeling was noted. In the blood - leukocytosis of neutrophilic nature with a shift to the left, increased ESR. Which of the following is the most likely diagnosis?

scarlet fever

A sick child 5 years old with mumps infection developed the following symptoms - abdominal pain, vomiting, diarrhea, which indicates involvement in the process

pancreas

 

The patient's disease began acutely, suddenly with the onset of T up to 40 ° C, complaints of severe headache, repeated vomiting, pain in the joints of the fingers. Objectively found on the limbs and buttocks hemorrhagic rash in the form of an irregular stellate shape with necrosis in the center. does not disappear when pressed. Positive meningeal signs. What research method is necessary to carry out in order to diagnose

lumbar puncture

 

Masha, 4 years old, acutely ill, T - 38.0 C, cramping abdominal pain. The stool is liquid, orange, watery, with mucus. Into the tank. inoculation of feces, E. coli was isolated. In RNGA, the titer of antibodies to the isolated pathogen is 1 40, after 7 days - 1 160. Specify the minimum increase in antibody titers confirms the diagnosis of the disease

4-fold increase in antibody titer

 

Nonspecific factors of protection are all listed, except for blood

Child 2 years 7 months, acutely ill, in the evening. The temperature rose to 39,400C, repeated vomiting and abdominal pains appeared. The stool was initially fecal in nature, later scanty, liquid, with mucus and streaks of blood. On the second day of illness, the temperature was up to 380C, the stool became liquid, without counting - mucus, blood, pus in the stool, tenesmus appeared. The anus gapes. Your diagnosis

dysentery

 

Tanya V. 7 months. was admitted to the clinic on March 8 for paresis of the right hand. From the anamnesis it was found that on March 1 the girl was given a revaccination against poliomyelitis with a live vaccine. After 7 days in the morning, the mother noticed that the girl had no active movements in her right hand. The general condition did not suffer, the temperature was normal. After consulting a doctor, she was referred for inpatient treatment. After 5 days, the movements in the right arm recovered, but the decreased muscle tone persisted for one month.

vaccine-associated poliomyelitis

 

One of the pupils of the 2nd grade of the boarding school was diagnosed with moderately severe chickenpox. What anti-epidemic measures are most correct

hospitalize the patient in the Meltzer box

 

A 10-year-old child was admitted to an infectious diseases hospital with a diagnosis of salmonellosis. On the 2nd day of hospitalization, the doctor suspected acute appendicitis in the child. What symptom should a doctor detect in a child with suspected acute appendicitis?

Schetkin-Blumberg symptom Scarlet fever is characterized by a small-point rash

Child 5 years old. On the skin of the face, extensor surfaces, a pink rash of a spotty nature does not merge, an increase in the occipital lymph nodes is noted. Which of the following is the most likely diagnosis?

rubella

 

Which rash does not disappear when petechiae is pressed with a fingertip

What are the common danger signs in the IMCI program can the baby drink or suckle?

Pathognomonic symptom in measles is Belsky-Filatov-Koplik spots

In an infant with a fever in the IMCI program, it is imperative to check the stiffness of the neck muscles

The causative agent of scarlet fever is

 

β-hemolytic streptococcus group A

 

Audible peristaltic noises in the early period of the disease are characteristic of mechanical intestinal obstruction.

What distinguishes acute appendicitis and ulcer perforation

 

lack of pronounced tension of the abdominal wall in the first hours of the disease Name the symptoms characteristic of intestinal obstruction

Valya, Obukhovskaya hospital

 

The earliest and most persistent symptom of acute small bowel obstruction is cramping abdominal pain

The main symptom of peritonitis is muscle tension in the anterior abdominal wall.

Most often, the cecum and bladder are involved in the formation of a sliding hernia.

Which hernia is characterized by a double act of urination for a sliding inguinal

The most common cause of peritonitis is acute appendicitis.

For appendicitis complicated by diffuse peritonitis, use the lower-median access

Note the indication for emergency surgery in acute pancreatitis peritonitis

What symptom is characteristic of peritonitis Blumberg symptom

What symptom is the least characteristic of intestinal obstruction; periodic discharge of fetid gas

Indicate a common symptom of Crohn's disease diarrhea

What complaint is not typical for pancreatitis; vomiting, bringing relief

What is the main cause of acute cholecystitis, impaired outflow of bile

Specify the most common parasitic lesion of the liver echinococcosis

What is the nature of pain typical for acute appendicitis?

Pain syndrome with intestinal obstruction is characterized by severe cramping pain

What is the leading syndrome in acute cholecystitis pain

Feces in the form of raspberry jelly are characteristic of intussusception.

The most characteristic vomiting in acute pancreatitis is repeated, does not bring relief Question371

What is not typical for the gangrenous form of appendicitis, increased pain in the right iliac region

What is peritonitis

acute inflammation of the peritoneum, accompanied by both local and general symptoms, serious dysfunctions of the most important organs and systems

What explains the positive phrenicus symptom in acute pancreatitis by an increase in the volume of the head of the gland

The leading symptom of acute appendicitis? abdominal pain

With atresia of the anus, the study according to Wangensteen is reliable after how many hours from birth

 

eighteen

 

on the general X-ray of the abdominal cavity, two large gas bubbles with a horizontal liquid level are determined. Preliminary diagnosis?

high congenital intestinal obstruction

 

On the roentgenogram of the abdominal cavity, there are 2 levels of the gas bubble of the abdominal cavity in the upper sections, and in the lower part of the dumb belly. What is the MOST probable preliminary diagnosis?

congenital obstruction of the duodenum

 

The child had no stool for 2 days, and had abdominal pain. No pain after enema What is your diagnosis? coprostasis

Congenital pyloric stenosis is not diagnosed by X-ray methods in the Trendelenburg position

A 2-year-old child resists examination, cries, strains his stomach. What is the surgeon's tactics? examine during natural or medication sleep

Suspected esophageal atresia. What is the MOST probable study to clarify the diagnosis?

insertion of the probe into the esophagus, esophagography

 

The leading signs of congenital intestinal obstruction are the absence of stool and vomiting with pathological contents.

a 21 day old child with vomiting with a fountain shows a huge gas bubble with a liquid level on X-ray of the abdominal organs

pyloric stenosis

 

A 6-month-old child, against the background of complete well-being, developed bouts of severe anxiety, refusal to eat. Rectal examination revealed discharge like "raspberry jelly".

What is the MOST probable preliminary diagnosis? intestinal intussusception

Pylorospasm is manifested by symptoms

regurgitation of milk from birth

 

The most reliable signs of acute appendicitis in children are passive tension of the muscles of the abdominal wall and local pain

a 12-year-old boy has local pain in the right iliac region, passive tension of the muscles of the anterior abdominal wall, and a positive peritoneal symptom. What is your presumptive diagnosis?

acute appendicitis

 

the child is 21 days old, vomiting is noted with a fountain. Presumptive diagnosis? pyloric stenosis

Low bowel obstruction is characterized by x-ray symptoms; multiple fluid levels

Congenital high intestinal obstruction includes duodenal atresia

What X-ray sign is characteristic of congenital high intestinal obstruction?

two levels of fluid in the upper half of the abdominal cavity The etiological factor of pyloric stenosis is the pathology of the pylorus genetic defect

From birth, the newborn had a profuse release of frothy saliva with signs of respiratory failure. What is the MOST probable preliminary diagnosis?

esophageal atresia with tracheoesophageal fistula

 

The patient turned to the ophthalmic emergency room with the following symptoms: edema and hematoma of the eyelids, exophthalmos, limited mobility of the eyeball downwards and towards the nose, ptosis, subcutaneous emphysema with crepitus in the left eyelids. Which of the following is the most likely diagnosis?

fracture of the walls of the orbit

 

What spectacle correction does a myopic 2 diopters need at the age of 50?

 

-2.0 diopters for distance Question396

Here are two newborns with slightly cloudy corneas. When instilling a hypertonic solution (40% glucose solution) in one of them, the cornea became transparent. What is your diagnosis?

congenital glaucoma

According to the teenager, he was chopping the wire and something got into the eye. Nothing was found by conventional inspection methods. What additional research methods need to be carried out

orbital radiography

 

The child was discharged from the hospital with symptoms of dacryocystitis and the lack of effect from the massage of the lacrimal sac. Your tactics

lavage, probing of the lacrimal passages

 

The young man received a blow to the eye with his fist. Complaints about blurred vision, "spots" in front of the eye. On examination, the anterior segment of the eye was without pathology. In transmitted light, against the background of a weakened reflex, floating opacities of a dark color are visible from the fundus of the eye. What is the most likely diagnosis, tactics

traumatic hemophthalmos; hemostatics, osmotherapy

 

A 14-year-old boy turned to an ophthalmologist with complaints of recurrent redness of both eyes, pain, decreased vision. The patient consulted a dentist for stomatitis and a dermatologist for skin ulceration. Objectively, the organ of vision revealed: pericorneal injection, hypopyon, posterior synechiae, opacities in the vitreous body. Which of the following is the most likely diagnosis?

uveitis, Behcet's disease

A 14-year-old boy turned to an ophthalmologist with complaints of recurrent redness of both eyes, pain, decreased vision. The patient consulted a dentist for stomatitis and a dermatologist for skin ulceration. Objectively, the organ of vision revealed: pericorneal injection, hypopyon, posterior synechiae, opacities in the vitreous body. Which of the following is the most likely diagnosis?

uveitis, Behcet's disease

 

The cause of decreased vision in hypertensive retinopathy

 

the appearance in the macular area of ​​plasmorrhages, yellowish-white foci forming

"Star shape"

 

A nurse, a few hours after washing the floor in the dressing room, while working with quartz lamps, complained of photophobia, lacrimation, and blepharospasm. What is the most likely diagnosis? Your tactics

electrophthalmia, cold lotions, antibacterial drops

 

The child has some difficulty in nasal breathing, periodically purulent nasal discharge, high temperature. Two days ago, there were pains in the right orbit and protrusion of the eyeball. Objectively: OD - edema and hyperemia of the eyelids and conjunctiva, limitation of eyeball movements, exophthalmos. Which of the following is the most likely diagnosis?

phlegmon orbit

 

In a 18-year-old boy, the right eye corrects to 1.0 with glass - 2.0 D, the left - with glass - 8.0 D. Which of the following diagnoses is the most probable? Your tactics.

anisometropia; contact correction or surgical treatment

 

A patient consulted an ophthalmologist with complaints of sharp pains, lacrimation, photophobia, redness, decreased vision of the right eye. History of chronic tonsillitis with frequent exacerbations. Objectively: pronounced pericorneal injection of the eyeball, hypopyon, gray exudate in the pupil area, posterior synechiae. Which of the following is the most likely diagnosis and what is the emergency?

acute iridocyclitis, prescribe mydriatics

 

Patient G. 69 years old suddenly lost vision in his left eye. Previously, he was troubled by bouts of short-term transient blindness. Registered with a therapist for hypertension. Objectively: YisOD / OS = 1.0 / 0; OS - on the fundus: the optic disc is pale pink, the borders are slightly veiled due to edema of the surrounding retina, which has a milky white color. The blood flow in the vessels is segmental. Against the background of the edematous retina, the central fossa of the macular region looks brighter. Which of the following is the most likely diagnosis?

PMC in CAC

 

The teacher is 40 years old. Complaints of eye fatigue when reading, especially in the evening in the last 2-3 months. VIS OD = 1.0 VIS OS = 1.0 Objectively: OU - calm eyes, transparent optical media, fundus without pathology. According to the tables for determining near vision, each eye reads font N 8, with glass (+) 1.0 D font N 2. Which of the following diagnoses is the most probable?

presbyopia

 

A 5-year-old child has complaints of fever, sore throat, redness and discharge from the right eye, body temperature 37.8 C. The child is lethargic, adynamic, the throat is hyperemic, the tonsils are swollen, covered with dirty gray films. The eyelids are edematous, the conjunctiva of the eyelids is sharply hyperemic, loosened and velvety, it has gray films that can be removed with difficulty with subsequent bleeding. Your diagnosis.

conjunctival diphtheria

 

Patient K., 22 years old, consulted an ophthalmologist with a complaint of decreased vision in both eyes. The examination revealed: YisOD / OS = 0.7 / 0.6 not corr .; bitemporal bias of visual field narrowing. Increased blind spot. In the fundus of both eyes there are stagnant discs. History - frequent headaches, associated with repeated CCI. What is the most appropriate action plan in this situation?

consultation with a neurologist

 

Patient S., 45 years old, was taken to the hospital by an ambulance due to an acute decrease in vision, an attack of pain in the left eye, left temple and upper jaw and was examined by a neurologist, dentist, ophthalmologist. The patient has never suffered from eye disease. As it turned out, 4 hours before the attack, she was given an intramuscular injection of atropine due to an exacerbation of gastric ulcer. Which of the following is the most likely diagnosis?

acute attack of glaucoma

 

A 34-year-old patient with a corneal ulcer was diagnosed with chronic dacryocystitis during examination.

What type of treatment is indicated in the first place dacryocystorhinostomy.

A 27-year-old man consulted a doctor, who a year ago suffered an injury to his left eye with damage to the lens. The cataract was removed. What treatment can restore the patient's binocular vision and work capacity?

contact correction or IOL

 

After orbitotomy, the patient developed ptosis. Name the reason the levator was cut

A patient after a traumatic brain injury began to complain of diplopia. Objectively: the eye is deviated inward, the visual acuity of both eyes is 1, O. Which of the following is the most likely diagnosis?

paralytic strabismus

 

The patient has a feeling of itching of the edges of the eyelids in both eyes, redness, peeling at the root of the eyelashes, which intensifies after visual stress. Which of the following is the most likely diagnosis?

blepharitis

 

After hypothermia, the patient developed asymmetry of mimic movements on the right, the right eye is constantly slightly open, and there are no blinking movements. Your diagnosis, tactics

lagophthalmos, temporary adhesive bandage

 

A child who has had measles again had a moderate increase in body temperature, swelling of the upper eyelid in the outer half, an S-shaped eye slit. On palpation in the area of ​​the upper-outer segment of the orbit under the orbital edge, a painful dense formation is palpated. Which of the following is the most likely diagnosis?

dacryoadenitis

 

A 25-year-old woman, 36 weeks of gestation, was referred for a fundus examination by an obstetrician-gynecologist. High myopia since childhood, wears glasses with 12.0 diopters of diffusing lenses, in which visual acuity is 0.3 in both eyes. Stronger lenses do not improve vision. An extensive staphyloma, multiple dystrophic foci in the retina and choroid were found on the fundus. What tactics for the management of labor do you recommend?

exclude the period of hard work

 

The child was hit in the eye with a branch. Complaints about lacrimation, photophobia. On examination, a mixed injection was found, corneal edema, in one area there was no shine. What is the most likely diagnosis? Tactics

traumatic corneal erosion; korneregel, tobrex

 

Surgeon's tactics in the presence of a piece of wire sticking out in the eye

 

remove, drip antibacterial drops, apply a binocular bandage, inject tetanus toxoid according to Bezredka according to indications

A 23-year-old patient complained of pain and sensation of a foreign body in both eyes, sticking of the eyelids in the morning. Ill for 2 days. first the right eye hurt, and then the left. Objectively: dried yellowish crusts on the eyelashes, the conjunctiva of the eyelids is hyperemic, velvety, the pattern of the meibomian glands of the cartilage is not visible. Moderately pronounced conjunctival injection of the sclera. Your diagnosis, tactics

acute bacterial conjunctivitis, tobrex drops

 

The patient has right-sided homonymous hemianopsia. Specify the localization of the lesion lesion left optic tract

A 14-year-old girl came to the appointment complaining of pain, redness, swelling, a feeling of heat in the upper eyelid on the right. Objectively: a sharp edema of the eyelid, the eye is closed, soreness, hyperemia of the upper eyelid. From the anamnesis it was established - 3 days ago she plucked her eyebrows.

abscess

 

A 16-year-old patient has complaints about the absence of nasal breathing, a feeling of congestion and hearing loss on the right. Two years ago, I first noticed nasal congestion and difficulty in nasal breathing. Objectively: on the right, in the posterior parts of the nasal cavity, a bright red formation is determined. There is no nasal breathing on the right. The nasopharyngeal cavity is occupied by a smooth, dense formation that almost completely covers the choanas. On the roentgenogram of the nasopharynx, the shadow of a soft tissue formation is determined, which fills the nasopharyngeal cavity, the sphenoid sinus and is introduced into the nasal cavity. Bone walls surrounding the formation, with clear contours. What is your diagnosis?

malignant tumor of the nasopharynx

 

Patient S. turned to the ENT department with complaints of: difficulty swallowing, choking on liquid food. According to the patient, he does not eat for the third day, the body temperature is 39.5 degrees, the skin is moist, the voice is hoarse, breathing is free, opening the mouth is not difficult. On examination, diffuse hyperemia in the pharynx, tonsils moderately edematous, loose. With indirect laryngoscopy, the piriform sinuses are filled with saliva, the lingual-epiglottis space is narrowed, the epiglottis is thickened, infiltrated, limited in mobility, the larynx lumen is hardly visible, free. The vocal folds are closed. Make a diagnosis:

Epiglottis abscess

 

A 32-year-old patient complains of severe pain in the left side of the head, which is especially troubling in recent days. There is no appetite, notes bouts of vomiting not associated with food intake. For about 15 years he has been suffering from middle ear disease with hearing loss.

Periodically notes an exacerbation of the process, accompanied by suppuration. The last exacerbation was observed six months ago, during which a sharp decrease in hearing developed, which still persists. The skin is pale gray in color, with an earthy tint. The tongue is coated. Pulse 48 beats per minute. The patient is lethargic, inhibited, watery. She cannot carry out the simplest commands, does not understand the speech addressed to her, cannot remember the name of the objects shown to her. She is verbose, mispronounces individual words, does not build sentences correctly. A slight stiffness of the occipital muscles was determined, a positive Babinski reflex and a slight increase in deep reflexes on the right were revealed. With an otoscopy on the right, a purulent discharge in the ear canal is determined. After the toilet, an extensive marginal defect of the tympanic membrane is visible, filled with swelling granulations. The projection of the mastoid is slightly painless. Cloudy cerebrospinal fluid flows out under pressure. Revealed stagnant fundus papilla. Establish a diagnosis

Exacerbation of chronic otitis media complicated by an otogenic abscess of the temporal lobe of the brain.

The patient turned to the ENT doctor of the polyclinic with complaints of: periodic nasal congestion, which appeared after a nose injury. The patient presented quite characteristic complaints: if he was lying on his right side, he was laying the right half of the nose, if on the left side, then he was laying the left half of the nose. When rhinoscopy: the nasal septum is bent to the right, the nasal passage on the right is narrowed, the inferior turbinates are moderately hypertrophied, the nasal mucosa is pale pink. Make a diagnosis:

Vasomotor rhinitis, curvature of the nasal septum.

 

A 25-year-old patient was admitted to the emergency room of the ENT department with complaints of difficulty in nasal breathing, swelling and soreness in the vestibule of the nose, and an increase in body temperature up to 38º. According to the patient, about two weeks ago, he received an injury to the external nose - an accidental blow with his hand during a sports game. There was no bleeding. There was nasal congestion, which did not bother me much. The last two, three days the nose was "swollen", there were pains, the body temperature rose to 38.5 °. With anterior rhinoscopy, the nasal septum in the cartilaginous region is symmetrically enlarged, the edematous mucosa is sharply hyperemic. Make a diagnosis:

Suppurative hematoma of the nasal septum Question 429

A 25-year-old patient was admitted to the emergency room of an ENT hospital with complaints of sore throat, hyperthermia, and weakness. According to the patient, he fell ill acutely, the onset of the disease is associated with the intake of a cold drink. History: frequent tonsillitis. Pharyngoscopy: the pharynx is asymmetric, infiltration of the posterior palatopharyngeal arch is expressed, the amygdala on the left is displaced inward and anteriorly.

Make a diagnosis:

 

Posterior paratonsillitis on the left

 

Patient K., 23 years old, complains of nasal congestion, hearing loss, tinnitus. She had a history of ARVI about a week ago. On examination: AD –AS Mt slightly pink, injection of vessels along the handle of the malleus. ShR -4m, nasal mucosa is hyperemic, edematous, discharge of a mucopurulent nature. What is the diagnosis:

2-sided tubotympanitis

 

Patient S., 45 years old, turned to the ENT department with complaints of hoarseness, tickling, itching in the throat. History of a smoker with 25 years of experience. Swallowing is painless, mouth opening is free. With indirect laryngoscopy: the pear-shaped sinuses are free symmetrical, the epiglottis is mobile. The lumen of the larynx is free, during phonation there is a slight inadequacy of the glottis in the middle third. In the inter-scallop space on the surface of the mucous membrane there are cone-shaped dense outgrowths. Make a diagnosis:

Pachydermic laryngitis Q432

A 25-year-old patient consulted an ENT doctor with complaints of headache, weakness, malaise, nasal congestion, purulent discharge. According to the patient, she fell ill acutely after suffering hypothermia. On examination, the nasal mucosa is hyperemic, moderately edematous, purulent discharge in the common nasal passage. On the roentgenogram against the background of parietal hyperplasia of the maxillary sinus mucosa - the level of fluid. Make a diagnosis:

Exacerbation of chronic bilateral sinusitis Question 433

The patient went to the doctor with complaints of severe pain in the right ear. From the anamnesis, she became ill acutely after suffering from ARZ. Ear pains appeared at night and suddenly gave to the throat, to the head. The ear pain was unbearable. On otoscopy: AD –AS - the auditory canals are free, Mt is gray on the left, Mt is bulging on the right, there are no identifying points, the eardrum is sharply hyperemic. Rhinoscopy: Nasal mucosa is moderately edematous, mucopurulent discharge in the common nasal passage. What is the diagnosis:

Acute otitis media Q434

The patient went to the emergency room with complaints of severe pain in the ear. Considers himself sick within 3 days after the onset of ARVI symptoms. When otoscopy: AS - the auditory canal - free, Mt - gray on the left, AD - the auditory meatus is narrowed in the bony section due to a bulging bullous formation filled with hemorrhagic contents, localized on the posterior wall of the ear canal with the transition to the tympanic membrane.

What is the diagnosis:

Bullous otitis media Q435

Patient G. turned to the doctor with complaints of a feeling of ear congestion on the left, hearing loss, tinnitus (low-frequency nature), a feeling of fluid transfusion in the ear, autophony. When otoscopy: AD –AS - auditory canals - free, Mt-gray on the left slightly protrudes. SHR-3m. Mt is gray on the right. Rhinoscopy: The nasal mucosa is somewhat subatrophic, the nasal septum is bent to the right, in the form of a ridge at the level of the lower nasal passage. What is the diagnosis:

Acute otitis media Q436

Patient S., 45 years old, turned to the ENT department with complaints of hoarseness, tickling, itching in the throat. History of a smoker with 25 years of experience. Swallowing is painless, mouth opening is free. With indirect laryngoscopy: the pear-shaped sinuses are free symmetrical, the epiglottis is mobile. The lumen of the larynx is free, during phonation there is a slight inadequacy of the glottis in the middle third. In the inter-scallop space on the surface of the mucous membrane there are cone-shaped dense outgrowths. Make a diagnosis:

Pachydermic laryngitis Q437

What disease is characterized by: difficulty in nasal breathing, recurrent nosebleeds, closed nasalism, with digital examination, posterior rhinoscopy, a tumor-like transformation with a smooth surface?

angiofibroma of the nasopharynx Question438

A 20-year-old patient came to the emergency room with complaints: pain in the throat, aggravated by swallowing and talking, weakness and malaise. Increase in body temperature up to 38º, swelling in the submandibular and submental areas. On palpation in the submental area, an infiltrate extending to the anterior and left lateral surfaces of the neck, the skin is hyperemic. It is difficult to open the mouth, the tongue is raised, and ichorous odor from the mouth. On examination, the pharynx is hyperemic, the compaction of the soft tissues of the floor of the mouth is determined. Acutely ill after extraction of a carious tooth. Make a diagnosis:

Phlegmon of the oral cavity Question439

The patient complains of severe pain in the right ear, radiating to the temple, ear congestion, headache, fever up to 38 degrees. From the anamnesis - sick for 2 days. The onset of the disease is associated with a runny nose. During otoscopy: AD- the auditory canal is free, the skin is not changed, Mt-hyperemic, infiltrated, bulging, there are no identifying points. Hearing in the right ear is reduced ШР-2m, laterization of sound in Weber's experiment to the right.

What is the diagnosis:

 

Right-sided acute otitis media Question440

A 10-year-old girl was admitted to the emergency room with complaints of sore throat, fever, weakness, and malaise. From the anamnesis she fell ill three days ago. Objectively: The patient's condition is assessed as moderate, body temperature is 40º, the skin is moist. Pharyngoscopy: The mucous membrane of the pharynx is hyperemic, the tonsils are covered with a white coating, an increase in the lymph nodes of the neck, submandibular and maxillary region is determined. An increase in lymph nodes in the axillary and inguinal region was revealed. Blood tests: leukocytes-13 x 109 g / l Segmented neutrophils -23% Stab -0% Lymphocytes-50% Eosinophils-0% Monocytes-26. Make a diagnosis:

Monocytic tonsillitis.

 

Q441

 

The patient complains of pain in the ears, discharge of a mucopurulent character. Hearing loss is not noted. The condition and state of health are satisfactory, the temperature is subfebrile.

The disease started about a week ago. The onset of the disease is associated with the traumatic removal of sulfur deposits (hairpin). She was treated independently at home, but without effect. During otoscopy: AD-AS - the lumens of the auditory canals are narrowed, filled with mucopurulent discharge, after the toilet it was only possible to enter a narrow funnel. Mt-right-gray, cloudy, left-slightly pink. What is the diagnosis:

2-sided external diffuse otitis media Question442

Patient S. turned to the ENT department with complaints of: difficulty swallowing, choking on liquid food. According to the patient, he does not eat for the third day, the body temperature is 39.5 degrees, the skin is moist, the voice is hoarse, breathing is free, opening the mouth is not difficult. On examination, diffuse hyperemia in the pharynx, tonsils moderately edematous, loose. With indirect laryngoscopy, the piriform sinuses are filled with saliva, the lingual-epiglottis space is narrowed, the epiglottis is thickened, infiltrated, limited in mobility, the larynx lumen is hardly visible, free. The vocal folds are closed. Make a diagnosis:

Epiglottis abscess Question443

The patient went to the emergency room with complaints of pain in the auricle area. A pronounced sensation of heat, burning in the auricle, fever and a feeling of general malaise. Five days before the onset of the disease, the patient accidentally scratched the auricle with a pin. Three days before going to the emergency room, reddening of the skin of the auricle appeared, it increased in size, swollen, and a headache appeared. The patient's condition gradually worsened, a temperature appeared. On examination, the skin of the auricle is sharply hyperemic, infiltrated. The process extends to the parotid region, the skin of the ear canal. Hyperemic areas are surrounded by a demarcation line.

There is no pathological discharge from the ear canal, the eardrum is not changed. Establish a diagnosis

Erysipelas of the skin of the auricle Q444

A 45-year-old patient was admitted to the ENT hospital. with complaints of hearing loss and purulent discharge with unpleasant odors from the right ear. History of periodic suppuration from the right ear, within 20 liters. was not treated regularly. Otoscopy: purulent discharge with an unpleasant odor in the ear canal, marginal defect b / p, tiny white masses. Define d / z:

chronic purulent epithymponitis complicated by cholestatoma Question445

A 32-year-old patient, smokes, complains of hoarseness for a year. After hypothermia, he speaks in a whisper. On examination, the general condition is satisfactory. There is no change in the nasal cavity or pharynx. Laryngoscopy: the mucous membrane of the larynx is hyperemic, edematous, the vocal folds are hyperemic, hypertrophied, the glottis is sufficient for breathing. Diagnosis?

chronic hypertrophic laryngitis Q446

The patient went to the ENT hospital with complaints of shortness of nasal breathing, weakness. Anterior rhinoscopy revealed pale gray mobile formations, purulent discharge in the general nasal passage. Make a diagnosis:

Polypoid rhinosinusitis Q447

A patient with chronic purulent otitis media complains of pain on the right side of the head, aggravated by turning the head. Body temperature 38 C, bradycardia. The patient cannot name objects familiar to him. What is the diagnosis?

abscess in the temporal part of the brain Q448

The patient complains of severe pain in the ear on the left, radiating to the temporal and parietal regions, aggravated by chewing, on an increase in temperature to 37.7 ° C. During otoscopy: AS - in the ear canal on the anterior wall, a cone-shaped eminence is determined, the skin on its surface is hyperemic. In the center of education there is a purulent head, the lumen of the ear canal is narrowed Mt- immensely. An enlarged lymph node is palpated in front of the auricle. What is the diagnosis:

Furuncle of the anterior wall of the external auditory canal. Q449

A patient consulted an otorhinolaryngologist with complaints of severe itching in the ears, periodically turning into a feeling of pain. A history of several times exacerbation in the form of external diffuse otitis media. When otoscopy: AD –AS - the auditory canals are filled with plates of dry epidermis, in places exfoliating in the form of casts. After their removal, Mt is gray on both sides without identifying points, as if slightly covered with "fluff". What is the diagnosis:

Fungal otitis externa Question450

A 25-year-old patient has consulted a doctor for frequent tonsillitis, low-grade fever, periodic arthralgia. When viewed in the pharynx: tonsils are scar-altered, welded to the arches, not mobile during rotation, the anterior palatine arches are infiltrated, hyperemic, caseous plugs in the lacunae. In the maxillary region, enlarged lymph nodes are palpable. Make a diagnosis:

Chronic tonsillitis decompensated form Question451

The patient complains of cough, hoarseness, fever, binds after drinking cold beer 2 days ago. Today these symptoms have worsened. Objectively: the general condition is satisfactory, the body temperature is 37.5 C. There are no signs of inflammation in the cavity of the pharynx and nose. Laryngoscopy: the larynx mucosa is hyperemic.

The vocal folds are pink, somewhat infiltrated, the glottis for breathing is wide. Other ENT organs were normal. Diagnosis?

acute catarrhal laryngitis Q452

Patient S., 25 years old, came to the emergency room of the ENT clinic with complaints of sore throat, difficulty swallowing. She had a history of tonsillectomy 5 years ago. On examination, salivation is noted, sticking out the tongue is painful. When pressed with a spatula on the posterior third of the tongue, the pain syndrome increases to unbearable. In the pharynx there is diffuse hyperemia. On examination of the laryngopharynx, single point formations of gray-yellow color in the projection of the tongue root.

Make a diagnosis:

 

Lingual sore throat Q453

The patient during the prof. examination revealed dense plugs on the surface of the tonsils. Examination of the tongue root revealed similar formations at the site of the projection of the lingual tonsil. The plugs have a conical shape, rise above the surface of the mucous membrane, and are removed with great difficulty. Make a diagnosis:

Pharyngomycosis Question454

Patient M., 44 years old, with complaints of pain in the right hypochondrium, bitterness in the mouth, belching, nausea, fever up to 37.5 C, constipation. According to the words, they have been disturbed from time to time over the past 5 years. On examination: a patient with increased nutrition. Objectively: the skin is of a normal color with traces of scratching on the abdomen and back. From the side of the heart, lungs - no pathology was revealed. BP - 130/80 mm Hg. Art. Tongue moist, coated at the root with a yellow bloom. The abdomen on palpation is soft, painful in the right hypochondrium, positive Murphy's symptom. Liver on the edge. There was no chair for 2 days. Establish a preliminary diagnosis

Chronic cholecystitis in the acute stage. Hypertensive type biliary dyskinesia

Q455

A 22-year-old patient was admitted to the emergency department with complaints of drowsiness, severe weakness, weight loss, thirst and increased urination. The above symptoms have been troubling for the last 2-3 weeks. Objectively: the consciousness is confused, the skin is dry, the turgor of the skin is reduced, muscle hypotonia is noted. Breathing quickened (up to 20 per minute), noisy, blood pressure 90/60 mm Hg, heart rate = 98 per minute. The smell of acetone from the mouth. Indicate the presumptive diagnosis

Newly diagnosed diabetes mellitus, ketoacidotic precoma Question456

A 35-year-old patient complained of burning pains at the base of the xiphoid process with irradiation to the heart region, arising and intensifying half an hour after eating. They are not completely stopped by Almagel. Belching with air, attacks of suffocation, coughing are also noted. On FGDS: The mucous membrane of the esophagus is moderately hyperemic, covered with areas of fibrin. Smooth, smooth, shiny. In the cardiac section, the lumen is moderately expanded. The cardia closes sluggishly, not completely, freely prolapses into the esophagus. All of the above allows one to suspect

GERD

 

Q457

 

After the operation of subtotal resection of the thyroid gland, the patient developed convulsions in the extremities, Khvostek's symptom, Trousseau's symptom. What complications have developed in the patient

Hypoparathyroidism Q458

A 32-year-old patient is regularly observed by a GP and a pulmonologist for bronchial asthma. In accordance with the follow-up plan, once every 6 months, he is recommended to carry out:

Spirography Question459

A 32-year-old woman consulted a general practitioner complaining of palpitations, weakness, irritability, sweating, and weight loss. Ill for over a year. Objectively. Fidgety. Eyes shine. Tremor of the fingers, in the Romberg position is not stable. Hyperhidrosis. Vesicular respiration in the lungs. Heart: tachycardia, pulse 110 in 1 min, blood pressure 150/30, 160/40 mm Hg. Stool - a tendency to diarrhea. What is your preliminary diagnosis?

hyperthyroidism Q460

The patient, 37 years old, is registered with a family doctor for bronchial asthma. Attacks 1-2 times a week, nocturnal asthma symptoms more often 2-3 times a month. Regularly uses inhalation of fenoterol Which of the following options for the course is the most likely?

persistent bronchial asthma mild course Question461

At the appointment with a general practitioner, a 27-year-old pregnant woman, 16-17 weeks. Complaints of headaches, especially in the occipital region, dizziness, periodic nausea. Complaints first appeared three days ago. Chronic diseases are denied. On physical examination, conscious, pasty feet, muffled heart sounds, rhythmic. BP 160/100 mm Hg, heart rate 90 in 1 min. In the general blood test, biochemical analysis (AST, ALT, bilirubin, creatinine, platelet count) are normal. In urine - proteinuria less than 0.1 g / l The state of the fetus is satisfactory. What is your preliminary diagnosis?

Gestational hypertension. Question462

The patient is 38 years old. Complaints of an increase in body temperature up to 38.4 ° C, a cough with the discharge of a small amount of sputum, shortness of breath, general weakness - arose during the last 24 hours. On the right, in the lungs below the angle of the scapula, there is a weakening of the intensity of respiratory noise, a limited area of ​​moist fine bubbling rales. NPV 24 per minute, heart rate - 102 per minute, blood pressure 110/70 mm Hg. In the analysis of blood - leukocytes up to 16x109 / l. Which of the following studies should be done first?

Chest X-ray Question463

A 49-year-old man with complaints of abdominal pain of a girdle nature that appeared after an error in the diet, vomiting up to 6 times a day. From the anamnesis it is known that abdominal pains disturb periodically, the intensity of which gradually increased. I did not follow the diet. Was not examined. On examination, the tongue is coated with a white coating. From the side of the heart, lungs - no pathology was revealed. BP 130/80 mm Hg. Art. The abdomen is straining on palpation, painful in the epigastric region, Mayo-Robson's point. Liver along the edge of the costal arch. Stool 4 times a day, mushy with a greasy sheen. Your preliminary diagnosis

Chronic pancreatitis in the acute stage Question464

An overweight 50-year-old woman was twice found to have an increase in the level of fasting glucose up to 6.9 and 7.2 mmol / l. Which of the following diagnoses is the most likely?

Type 2 diabetes mellitus Q465

Patient A., 20 years old, consulted a doctor with complaints of significant weight loss, dry mouth, thirst, frequent urination, nausea, poor appetite. Objectively: the skin is dry, palms and soles with a yellowish tinge, furunculosis. In the analysis of urine: found the presence of sugar - 3, 5% and acetonuria (++). What is the preliminary diagnosis?

Type I diabetes mellitus, decompensation, ketoacidosis Question466

Choose a treatment method for a patient with rheumatoid arthritis, if she does not have fever, visceritis and vasculitis, there is effusion in the knee joints, ESR 35 mm / hour, the duration of the disease is 6 months, has not been previously treated

combination of NSAIDs with intra-articular administration of kenalog Question467

Patient I., 53 years old, suffered from right-sided lower lobe pneumonia without complications. Discharged to work. What are the terms of follow-up recommended for the convalescent of acute pneumonia in this situation?

6 months Question468

A 48-year-old patient was hospitalized for the first time with complaints of weakness, thirst, itching. Deterioration is noted within 1.5 months. After ARVI, thirst sharply increased, appetite was disturbed, and abdominal pains appeared. Objectively: Pale skin, dry skin and eyeballs. Hyperemia in the area of ​​the zygomatic arches, chin, forehead. Subfebrile temperature. BP - 90/50 mm Hg Diuresis is reduced. NPV - 28 per min. Breath of Kussmaul, the smell of acetone. What is the cause of the existing symptoms and the result of a rapid study (glucotest) in a patient?

Ketoacidotic coma Question469

Patient K., 28 years old, consulted a doctor. Complaints of severe pain in the lumbar region and the right half of the abdomen, radiating to the groin and right thigh. Has frequent urge to urinate. A year ago, there was a similar attack for the first time. They called an ambulance, gave injections and the pain went away, but after this attack there was red urine. Objectively: temperature 36.40C. General condition of moderate severity. The patient is restless, looking for a comfortable position to relieve pain. There is no pathology on the part of the respiratory system and the cardiovascular system. Pulse 76 bpm, rhythmic, BP 120/60 mm Hg. The abdomen is soft, painful on palpation in the right half. Pasternatsky's symptom is sharply positive on the right. Your preliminary diagnosis

Urolithiasis, an attack of renal colic Q470

Patient K, with insulin-dependent diabetes mellitus, was unconscious, pupils were dilated. The tone of the eyeballs is increased. The temperature is normal. The skin is moist.

There is no acetone smell. There is vesicular breathing in the lungs, no wheezing. NPV 20 per minute. The heart sounds are muffled, the rhythm is wrong with a heart rate of 90 per minute. BP - 90/60 mm Hg (+) Babinsky's symptom. An express study (glucotest) was carried out. Indicate the reason for the existing symptom complex.

Hypoglycemic coma Q471

A 62-year-old patient, suffering from rheumatoid arthritis for 23 years, receiving prednisolone and NSAIDs via this wire, developed edema on the lower extremities. On examination: ESR

- 50 mm / hour, hypoalbuminemia, proteinuria 6 g / day, creatinine - 0.14 mmol / L. What is the most likely diagnosis?

Secondary amyloids Question472

A 49-year-old man complains of headaches, tinnitus. For several years, he noted an increase in blood pressure, aortocardiosclerosis. Objectively: an increase in the borders of the heart to the left, the heart sounds are muffled. Heart rate 95 beats per minute. BP 180/90 mm Hg Which group of drugs from the listed is most appropriate?

ACE inhibitors, thiazide diuretics, beta-blockers, statins Question473

A 48-year-old patient complains of cough with unproductive sputum, shortness of breath, unmotivated weakness, fever up to 38.50C. Took amoxicillin 0.5 g 3 times a day for 3 days. Which of the following is considered a criterion for the effectiveness of antibiotic therapy

Decrease in body temperature and decrease in intoxication Question474

A 39-year-old patient came to the clinic with complaints of morning stiffness during the day, pain in the joints of the upper and lower extremities, swelling, restriction of movement, especially in the interphalangeal, wrist and knee. Objectively: interphalangeal, wrist joints of the hands are swollen, thickened, deformed. Atrophy of the interosseous muscles. On the part of the internal organs without any peculiarities. What is your preliminary diagnosis?

Rheumatoid Arthritis Question475

A 42-year-old woman complained of weakness, headache, right lower back pain, fever up to 38.5 ° C, chills. She fell ill after hypothermia. On examination: the skin is clean, pale, hot. Temperature 38 ° С, pulse 88 per minute, blood pressure 140/80, 145/85 mm Hg. Art.

The abdomen is soft, painful along the ureters. Urination is painless. Urine analysis: turbid, specific weight 1017, protein 0.066 g / l, leukocytes and bacteria completely in the field of view, oxalates. What is the most appropriate treatment strategy?

Ceftriaxone Q476

Patient 45 years old, complaints of cough with mucous sputum in the morning, within 2 months, shortness of breath on exertion. Smokes 20 cigarettes a day for 20 years, abuses alcohol. On examination - deformation of the chest - "shoemaker's chest". Which of the following is a major risk factor for a patient developing lung disease

Active and passive smoking Question477

A 69-year-old woman complains of headaches, more in the occipital region, tinnitus, stitching pains in the heart, swelling of the legs. Within 10 years, he noted an increase in blood pressure to 160/100 mm Hg. Art. Height 164, weight 82 kg. Muffled heart sounds, accent 2 tones above the aorta. HELL

180/115 mm Hg Pulse 88 beats per minute. Which of the following conditions can occur in this patient?

Myocardial infarction, Cerebral stroke, Heart failure Q478

A 59-year-old female patient suffers from type II NIDDM, complained of palpitations, headache, dizziness, pain in the right lower extremity. On examination: tachycardia, blood pressure 85/50 mm, thrombophlebitis phenomena - glycemia 55 mmol / l. There is no ketoacidosis. Leukocytosis.

Hyperazotemia. How to explain the absence of ketone bodies in a patient in a state of precoma? preservation of endogenous insulin secretion

Q479

 

A 32-year-old woman with chronic rheumatic heart disease has: orthopnea, acrocyanosis; inaudible wet wheezing in the lower-lateral sections; at the apex there is a rough pansystolic murmur, conducted into the axillary region; tachyarrhythmia, enlarged liver, edema in the lower extremities. Which group of drugs is most appropriate to prescribe in the first place?

Diuretics Q480

A 23-year-old patient called a doctor at home complaining of an increase in body temperature up to 38 ° C for 4 days, a cough with yellow-green sputum, weakness, sweating. The disease is associated with hypothermia. Objectively: the skin is pale, the respiratory rate is 20 min., On the right below the angle of the scapula, there is a focus of dullness of the percussion sound, auscultatory fine bubbling moist rales. What treatment is optimal for a given patient

Azithromycin 0.5 x1 r / d inside for 5 days. Question481

A patient with hypertrophic cardiomyopathy diagnosed several years ago developed fainting. No dynamics appeared on the ECG, compared to the ECG six months ago.

It is necessary to appoint:

 

24-hour ECG monitoring Question482

A patient with asthma attacks revealed eosinophilia, Charcot-Leiden crystals, Kurshman's spirals in the sputum. Preliminary diagnosis:

bronchial asthma Q483

Patient P., 40 years old, has been suffering from hypothyroidism for 10 years. She has been taking thyroid medications for a long time at a daily dosage of 125 mcg. The patient has dry skin, constipation, memory impairment in dynamics, drowsiness. In the analyzes: an increase in the level of thyroid-stimulating hormone. What needs to be changed in the doctor's tactics

Increase the dose of thyroid medications Question484

At the doctor's appointment, patient K., 28 years old, complains of pain in the lumbar region, an increase in body temperature of 39 ° C, chills, sweating, thirst, the temperature during the day ranges from very high with chills to subfebrile. Condition of moderate severity. The skin is damp. Vesicular respiration in the lungs. Heart sounds are muffled, rhythmic, heart rate 110 per minute, blood pressure 90/60 mm. rt. Art. On palpation, pain in the region of both kidneys. In the analysis of urine, a large number of leukocytes. In the analysis of blood leukocytes 15x10 12 / l with a shift to the left. Against this background, tachycardia appeared up to 139 per minute, blood pressure decreased, the amount of urine sharply decreased, hemorrhages appeared on the skin. Your preliminary diagnosis

Acute pyelonephritis Q485

Patient 68 years old, suffered myocardial infarction 2 years ago. For the last 6 months, chest pains, interruptions in the heart that appear with moderate physical exertion began to bother me, shortness of breath increased, in the evening there are swelling on the legs. Hell at the level of 140/90 mm Hg, heart rate 84 per minute. On the ECG - transmural infarction on the anterior wall in the stage of the scar, supraventricular extrasystole. The patient receives aspirin (100 mg), corinfar retard (20 mg), perindopril (5 mg), periodically furosemide. Correct the treatment:

cancel corinfar, prescribe beta-blockers, increase the dose of perindopril to 10 mg, mineralocorticoid receptor antagonists (spironolactone 50 mg). Prolonged nitrates if necessary

Question486

 

Patient D., 28 years old, complains of palpitations, shortness of breath when walking fast. Registered with a rheumatologist. Objectively: increased, diffuse, left-sided apical impulse; mitral configuration of the heart; weakening of the I tone at the apex; holosystolic murmur at the apex radiating to the axillary region. Your preliminary diagnosis

Chronic rheumatic heart disease, mitral valve insufficiency. CHF I

 

Question487

 

A 34-year-old female patient complains of a cough, with scanty sputum that occurs after a heavy meal in the supine position, decreases with a change in body position. What diagnostic study is necessary for differential diagnosis

Fibroesophagogastroduodenoscopy Question488

A 39-year-old patient came to the clinic with complaints of morning stiffness during the day, pain in the joints of the upper and lower extremities, swelling, restriction of movement, especially in the interphalangeal, wrist and knee. Objectively: the interphalangeal and wrist joints of the hands are swollen, thickened, deformed. Atrophy of the interosseous muscles from the side of internal organs was unremarkable. An blood - leukocytes 14 ∙ 10 9 ∕ l, neutrophilia, soe - 42 mm / hour; fibrinogen-7g / l. CRB +++ district. Volleva rose 1: 64 ∙ R-gr ​​1 of saline joints - periarticular osteoporosis. Further tactics of the doctor

hospitalization in the rheumatology department Question489

A 27-year-old man suddenly felt "dagger" pain in the epigastrium and in the right hypochondrium. After a few hours, the pain subsided. Objectively: the tongue is dry, the abdomen is pulled in, the muscles of the abdominal wall are tense. BP 90/60 mm Hg. Art., pulse 120 beats / min. Presumptive diagnosis:

Peptic ulcer, ulcer perforation 12 p.c. Question490

A 40-year-old patient complains of aching pain in the right hypochondrium, which appeared after an error in the diet, an increase in body temperature to 37, weakness, rapid fatigue. According to the words, attacks occur within 3 years. On examination, the general condition of moderate severity. Pale skin, increased nutrition. The tongue is coated with a yellow coating. Respiratory and circulatory organs without pathology. BP 110/70 mm Hg. Art. On palpation of the abdomen, muscle tension in the right hypochondrium is determined, a positive symptom of Kera, Ortner.

Liver on the edge. Stool with a tendency to constipation. Free, painless urination. Your preliminary diagnosis

Chronic cholecystitis, exacerbation stage Question 491

A 27-year-old patient 3 days ago suddenly developed a chill, dry cough, pain in the right side, fever up to 38.7o C. NPV 22 / min. Heart rate 88 / min. The right half of the chest lags behind when breathing. Percussion from the 3rd intercostal space in front and from the middle of the interscapular space behind - a dull sound, breathing in this area is weakened. Tentative timing of antibiotic prescription in this situation?

up to 4-5 days of persistently normal body temperature Question 492

A 64-year-old patient called a general practitioner at home with complaints of dizziness, weakness, trembling in her hands, flickering before her eyes. She suffers from type II diabetes mellitus for which she is taking glibenclamide (maninnil). At the patient's home, you use the express method to determine the blood sugar level of 3.1 mmol / l and find out that two days before the onset of complaints, she began to take aspirin for pain in the knee joint. In addition to ambulance activities, in this situation, your recommendations should include:

Reducing the dose of glibenclamide (for the period of arthritis treatment) Question 493

A 68-year-old woman complains of headaches, flashing of flies in front of her eyes, poor sleep. For the first time 6 years ago, an increase in blood pressure up to 160/100 mm Hg was revealed. Heredity for CVD is burdened, lack of exercise Body mass index - 31 kg. Muffled heart sounds, accent 2 tones above the aorta. BP 175/105 mm Hg Pulse 68 beats per minute, tense. B \ x - dyslipoproteinemia. In the UAC, OAM without pathology. Which of the following diagnoses is the most likely?

Arterial hypertension stage II, risk 3

Q494

 

A 7-month-old girl was discharged from the hospital with a clinical diagnosis of Rickets II degree of severity, a peak period, acute course, iron deficiency anemia of I degree of severity. What is the further management of children who have had rickets of the II degree.

for 3 years.

 

Question495

 

The baby is 6 months old. Weight 8000 g. During the routine examination, the GP noted moderate pallor of the palms. In the general analysis of blood HB 100 g / l, erythrocytes 3.3 x 1012, CP 0.8. Prescribed iron syrup 1.25 ml, according to IMCI. What recommendations should be given on the use of the drug

one dose of iron supplement daily for 14 days Question496

A mother with a 4-year-old child at the reception with complaints about the child's poor appetite. From the anamnesis: my mother mainly feeds with cereals, rarely cereal soups, does not like meat, vegetables. Weight 14000 g. On examination, the skin is pale, of moderate moisture to the touch, visible mucous membranes of a pale pink color. Rhythmic heart sounds, heart rate 102 per minute, systolic murmur at the apex of the heart. In the general analysis of blood: Hb 76 g / l, e. - 3.9x1012 / l, CP 0.6, ESR 6 mm / hour. MCV 77 fl, MCH 264 pg, MSCS 320 g / l), RDW 14%. Your preliminary clinical diagnosis.

moderate iron deficiency anemia Question497

The child is 6 months old, undergoing a routine examination. When examining the GP, he drew attention to the pallor of the skin. The liver and spleen are not enlarged. In the general analysis of blood HB 100 g / l, erythrocytes 3.3 x 1012, CP 0.8, anisocytosis is expressed. What anemia occurs in this case

Iron deficiency Question498

At the reception of the district pediatrician, the child is 3 months old. From the anamnesis: from three weeks of life, due to mastitis in the mother, the child is on mixed feeding. Despite careful care, the child has hyperemia in the groin areas, on the neck, in the armpits. On the cheeks, hyperemia, swelling, cracks, milk crusts. The child is restless, sleep is disturbing. What is your preliminary diagnosis?

Atopic Dermatitis Q499

The child is 12 months old at a prophylactic appointment. No complaints. Physical development is harmonious. Neuropsychic development is age appropriate. He had ARVI 3 times in the anamnesis. Determine the resistance of this child

Average

Question500

 

The baby is 3 months old. Complaints about an increase in body temperature of 38.50C, loose stools. There are no general signs of danger. The child's diarrhea lasts 3 days, there is no blood in the stool. The child is restless and painfully irritable, he has no thirst. Eyes not sunken. The fold of the skin straightens slowly. What amount of fluid is recommended according to plan B in the first 4 hours with moderate dehydration for a child under 4 months

200-400ml

 

Question501

 

A 12-year-old boy developed severe itching all over his skin during examinations. On examination: in the area of ​​the elbow and popliteal fossa, wrist joints, foci of hyperemia with infiltration, lichenization, multiple linear and punctate excoriation. Facial skin is hyperemic, cheilitis, angular stomatitis. From the anamnesis it was found that similar rashes appear annually in the autumn-winter period, in childhood there was a diathesis. What disease will you not carry out differential diagnostics with?

seborrheic dermatitis Q502

The boy is 2.5 months old. From the second pregnancy against the background of preeclampsia of the second half. Was born with a weight of 3600g., Height 53cm. Frequent regurgitation from 3.5 weeks. Objectively: The skin is pale, dryish with a "marble" pattern. The subcutaneous fat layer is thinned, tissue turgor is reduced, muscle hypotension. Internal organs without pathology. The child's weight at the examination is 4300g. Your diagnosis

PEN II degree Question503

A 2-month-old child has hyperexcitability, hyperesthesia, chin tremor, a piercing irritated cry, tachycardia, high tendon reflexes, tonic convulsions are noted. The blood glucose level is 5.5 mmol / l, calcium - 0.9 mmol / l, magnesium - 0.92 mmol / l. Which of the following is the most likely explanation for the child's seizure

Hypocalcemia Q504

The baby is 2 months old. Refuses to breast. On examination, chest retraction is noted. Your tactics according to IMCI?

give the first dose of antibiotic, send urgently to the hospital Question505

At the reception there is a mother with a boy of 3 months, weight 6000 g, height 63 cm. When assessing the physical development of the GP noted the following parameters; length-for-age +1, weight-for-length + 3, weight-for-age + 3, BMI-for-age +3. How to interpret the physical development of the child, as identified by the GP

disharmonious development, overweight

Question506

 

Boy, 6 months old at the GP. From 2.5 months on artificial feeding due to hypogalactia in the mother. After switching to the mixture "Nan" "Comfort 1", the boy had areas of redness on the skin of his cheeks with elements of microvesicles, with the formation of itchy crusts. From the age of 4 months, there was a frequent change of milk mixtures, against the background of which the skin manifestations of the disease intensified, involving the upper and lower extremities, trunk, buttocks. Family history: the mother suffers from eczema (currently in an acute stage), the father suffers from hay fever. Your preliminary diagnosis

Atopic Dermatitis Q507

Girl 6 years old. Height 124 cm (8th centile interval), weight 24.6 kg (7th centile). Chest circumference 55 cm. Determine the harmony of physical development.

very high, harmonious development Q508

A child of 5 months, complaints of an increase in body temperature up to 38.80C. During the examination, the GP noted that the child could not drink or suckle the breast, there was a stiff neck.

The GP classifies the child's condition, according to IMCI, as a very severe febrile illness

Question509

 

A child under 6 months of age develops accordingly. After the introduction of the first complementary foods at 6 months - semolina porridge, low weight gains of 80-100.0 g began to be observed, stool - 2-3 times a day, periodically up to 5 times, abundant, fetid. Which of the following is the most acceptable food?

Gluten Free Diet Question510

The child is 1 month old, is breastfed, an increase of 800 g per month, calm, yellow mushy stool from birth 3-4 times a day, in the study of feces for dysbiosis revealed staphylococcus aureus 103 CFU / g feces. Staphylococcus epidermidis of 245 colonies in 1 ml of milk was revealed in the mother when sowing milk. Your recommendations:

continue breastfeeding, administer probiotics to mother and baby Question511

At the reception, a girl of 8 months. According to the mother, the child is often ill, constipation worries for 4 months. During an objective examination, laxity of the articular-ligamentous apparatus, a delay in the development of static and motor functions, a square head, rickets were revealed.

"Bracelets", "rosary" and deformation of the sternum, hepatomegaly. No teeth. Your preliminary diagnosis

Rickets III degree, high period, subacute course

Question512

 

At the reception, the child is 9 months old. According to the mother, the child received anticonvulsant therapy for a long time. Recently, he often sweats, became restless, sleeps poorly. After examination, the doctor diagnosed Rickets II, subacute course, the peak period. What drug contributed to the development of rickets?

Phenobarbital Q513

A 3.5-month-old girl has mild sweating, muscle hypotension, baldness in the occiput, and mild oral cyanosis. What changes on the roentgenogram are most likely in this patient

There are no changes. Question514

The child is 7 months old, was born in asphyxiation. On examination, the vascular pattern in the region of the bridge of the nose and forehead was moderately enhanced, the large fontanelle was closed, and the PMN was without pathology. The child is restless, sleep disturbed, spits up 2 hours after feeding with "curdled milk". Which of the following is the most appropriate food

Milk mixture with thickener Q515

The child is 1 year old. She is naturally fed, meals and complementary foods were introduced at the appropriate time. Determine the one-time amount of food

200 ml.

 

Question516

 

The mother of a one-month-old baby came in contact with the anxiety of the baby. From the anamnesis: the intervals between feedings are 3.5 hours. After each feeding, the mother expresses 20-30 ml of milk. For a month I added 300 grams. Sucked breast milk 100.0 during control feeding.Which of the following should be recommended in this case

Transfer to free feeding mode Question 517

A variant of the course of PEM in young children in tropical countries, due to protein-caloric malnutrition:

Kwashiorkor Q518

Girl 1.5 years old. The mother complains about the child's skin rash, severe itching, sleep disturbance. Up to 3 months of life, the child was breastfed, to improve lactation she drank tea with condensed milk and honey. From 3 months, the child was transferred to artificial feeding. Complementary foods were introduced at 6 months: semolina porridge with cow's milk, egg, cow's milk. Skin rashes first appeared at 6 months of age. On examination

the skin is dry. In the area of ​​the cheeks, neck, outer surface of the upper and lower extremities, elbow and popliteal fossa, buttocks, the skin is hyperemic, edematous, covered with microvesicles. Weeping, multiple erosion and crusts are observed. The internal organs were normal. The stool is mushy, with undigested lumps of food. Your preliminary clinical diagnosis.

atopic dermatitis, infantile stage, subacute period, erythematous-squamous form, moderate, common

Question519

 

A mother with a 4-year-old child at the reception with complaints about the child's poor appetite. From the anamnesis: my mother mainly feeds with cereals, rarely cereal soups, does not like meat, vegetables. Weight 14000 g. On examination, the skin is pale, of moderate moisture to the touch, visible mucous membranes of a pale pink color. Rhythmic heart sounds, heart rate 102 per minute, systolic murmur at the apex of the heart. In the general analysis of blood: Hb 76 g / l, e. - 3.9x1012 / l, CP 0.6, ESR 6 mm / hour. MCV 77 fl, MCH 264 pg, MSCS 320 g / l), RDW 14%. What is the therapeutic dose of the drug, represented by the hydroxide-polymaltose complex of ferric iron

5 mg / kg per day per os

 

Question520

 

At the pediatrician's appointment, a mother with a 2-month-old baby complains of rashes on the face, gneiss on the head, diaper rash in the skin folds, anxiety. Anamnesis: A breastfed baby. According to the mother, after she ate sweets and an orange, the child developed a rash on the skin of the face. From the anamnesis it is known that on the mother's side, the grandmother and uncle suffer from bronchial asthma and are monitored by an allergist. Objective examination: General condition is satisfactory. The skin and mucous membranes are pale, on the face there is erythematous - papular rashes, hyperemia of the cheeks, diaper rash is noted in the region of the inguinal and armpits, and gneiss on the head. Vesicular respiration in the lungs. Heart sounds are rhythmic. The language is wet, "geographic language". The pharynx is calm. The abdomen is soft. Liver +1.0 cm,

+ 1.0 + 0.5cm. The spleen is not enlarged. According to the mother, liquefied stool, 4-5 times a day. Peeing freely

Atopic dermatitis, infant form, acute stage, mild course, limited, mainly with food sensitization.

Question521

 

Boy 7 days old. From the anamnesis: the first pregnancy, the mother's age is 18 years, the mother has bad habits, the pregnancy proceeded with the threat of termination, a burdened obstetric history. Stimulated labor, anhydrous period of 8 hours, was born with a single cord entanglement around the neck. Heredity is not burdened. The baby is breastfed. What health group will the child be classified into?

health group II

 

Question522

 

At the reception of a general practitioner, a 12-year-old girl complaining of fatigue, drowsiness, tinnitus, dizziness. Objectively: pallor of the skin, visible mucous membranes,

"Seizures" in the corners of the mouth. Auscultation: weakening of heart sounds, systolic murmur at the apex, heart rate 105. Choose the option of examination to confirm the clinical diagnosis?

study of iron metabolism Question523

Which health group should a 2-year-old child belong to: physical development - low weight; hemoglobin level - 95 g / l; a history of atopic dermatitis.

Third Question524

Patient M, 25 years old, working as a nurse in the regional TB dispensary, was first diagnosed with a tuberculous process with subsequent relapse and with extensive drug resistance. How long is the patient's temporary disability in this case?

in accordance with clause 78, clause 3 of the Rules for temporary incapacity for work

approved by the Order of the Minister of Health of the Republic of Kazakhstan No. 198 dated 11/18/2020, the duration of temporary disability in this case is 15 months

Question525

 

Patient S., 34 years old, unemployed, in March 2021 received a domestic trauma at home: a multi-fragment fracture of the upper third of the right shoulder, complicated by osteomyelitis of the humerus, as a result of which the right upper limb was amputated. What group of disabilities does the patient have, and for how long?

The third group of disability without a period of re-examination in connection with an anatomical defect in accordance with Appendix 5, clause 3 of the Rules for conducting medical and social examination, approved by Order No. 44 of the Minister of Health and Social Development of 03/31/2015.

Question526

 

At the end of the screening study, the following follow-up groups are determined

Group 1A - healthy without risk factors, Group 1B - healthy with risk factors: persons with identified risk factors, borderline conditions, requiring observation and preventive intervention, group 2 - practically healthy: persons with a history of acute and chronic disease without exacerbations in during the last 2 years, group 3 - patients: persons in need of dynamic observation, treatment and rehabilitation

Question527

 

A 24-year-old woman working as a nurse had 27 weeks of pregnancy. Pregnancy without complications. How the examination of temporary disability should be carried out in this case

A certificate of temporary disability due to pregnancy and childbirth in the normal course of pregnancy is issued after the conclusion of the VKK from thirty weeks of pregnancy for one hundred twenty six calendar days (seventy calendar days before delivery and fifty six calendar days after childbirth) with normal childbirth.

Question528

 

Patient A, 44 years old, a driver of a heavy-duty car in December 2020 with BP 180/100 mm. rt. Art. suffered ONMK. Anamnesis: suffering from arterial hypertension for many years, is registered with a cardiologist for hypertension and with an endocrinologist for type 2 diabetes. Objectively: left-sided hemiplegia, constantly needs outside help: cannot move independently, eat food, go to the toilet, carry out hygiene measures, dress, put on shoes. The patient has signs of disability. What categories of disabilities and what degree of severity take place in this case, and which disability group does this correspond to?

in this case, the patient has an impairment of the ability of the 3rd degree: self-service movement, work activity, which corresponds to the first group of disability

Question529

 

In accordance with the order of the Minister of Health of the Republic of Kazakhstan No. 149 dated October 23, 2020, dynamic observation of persons with chronic diseases is carried out within the framework of the disease management program (DMP). The criteria for the selection of patients participating in the HSP are

patients with uncomplicated primary hypertension, patients with type 2 diabetes, compensated and decompensated, patients with chronic heart failure of NYHA classes II-IV with an ejection fraction of less than 40% or with an ejection fraction of more than 40% and left ventricular diastolic dysfunction according to echocardiography.

Question530

 

Patient C, 45 years old, a milling machine operator at the molding products plant on 03/14/2021, in the middle of the shift, felt unwell: pain in the occipital region, nausea, tinnitus appeared. I went to the first-aid post: a paramedic recorded a blood pressure of 180/100 mm Hg, provided assistance and issued a certificate of release until the end of the shift. The next day he went to the clinic. A doctor diagnosed with AH 3, risk 4. Hypertensive crisis opened a list of temporary disability. What is the peculiarity of the VN examination in this case?

opening of a sheet of temporary incapacity for work from 03/14/2021, i.e. backdating,

basis - a certificate issued by the paramedic of the medical center on 03/14/2021 about the release until the end of the work shift

Question531

 

The mother of child N, born in 2018, turned to the local polyclinic with complaints of high fever in her daughter, chills, sore throat, and the presence of purulent plaque on the tonsils. Diagnosed with purulent tonsillitis. Mom works as a bookbinder in a printing house. Does a mother have the right to sick leave for childcare, and for how long

For caring for a sick child, a temporary disability certificate is issued and extended for the period during which he needs care, but not more than ten calendar days.

Question532

Patient A, 44 years old, a driver of a heavy-duty car in December 2020 with BP 180/100 mm. rt. Art. suffered ONMK. Anamnesis: suffering from arterial hypertension for many years, is registered with a cardiologist for hypertension and with an endocrinologist for type 2 diabetes. Objectively: left-sided hemiplegia, constantly needs outside help: cannot move independently, eat food, go to the toilet, carry out hygiene measures, dress, put on shoes. The patient has signs of disability. When should a patient be referred to ITU

In accordance with clause 5, clause 41 and Appendix 3 of the Rules for conducting medical and social

expert examinations approved by Order No. 44 of the Minister of Health and Social Development of March 31, 2015, no earlier than four months after the onset of temporary disability or diagnosis of unemployed persons.

Question533

 

The woman went to the local polyclinic for an exacerbation of a chronic disease in her 5-year-old daughter, about which 3 years ago the child was assigned the category of disabled child. Based on the examination results, the child was sent to the hospital through the portal. Mom works as a teacher at the school. For how long should a certificate of temporary incapacity for work to take care of a child be issued to a mother in this case?

a sheet of temporary disability for caring for a child is issued to this mother for the entire period of stay in the hospital according to the conclusion of the VKK, since the child has a category of disabled child

Question534

 

A woman came to the local doctor of the antenatal clinic with complaints of delayed menstruation (the last one was 8 weeks ago), nausea and sometimes single vomiting in the morning, odor intolerance. At vaginal examination, there is a "softening" of the isthmus of the uterus. The uterus has a softish consistency, becomes more dense on palpation, enlarged to the size of a "goose egg". Painless. The appendages are not enlarged, painless.

Pregnancy is not desired. Doctor's tactics

 

Conduct clinical and laboratory examination and send for termination of pregnancy Question535

A 26-year-old patient complains of engorgement and swelling of the mammary glands and legs, bloating, irritability, sweating. Ill for 3 years. These symptoms appear in the second phase of the menstrual cycle and stop after the next menstruation. Symptoms do not increase in severity over the years. Gynecological examination revealed no pathology. What form of premenstrual syndrome is likely in this case?

Edematous Question536

Which of the following symptoms indicates the severity of toxicosis in the first half of pregnancy

presence of acetone in urine Q537

A woman with a 12-week pregnancy came to SVA with complaints of nausea, vomiting, fever, weakness, and fatigue. The tapping symptom is negative.

Notices a darkening of the color of urine within two days. Preliminary diagnosis of viral hepatitis

Question538

 

Pregnant N, 24 years old, consulted a antenatal clinic with complaints of leakage of amniotic fluid within 15 minutes, at a gestational age of 30 weeks. From the anamnesis pregnancy - 3, where 1 pregnancy ended in premature birth, the child is alive, the subsequent pregnancy was terminated at 18 weeks. To what level of inpatient care a woman should be directed according to the order of regionalization

Level III Question539

A 29-year-old pregnant woman came to the antenatal clinic with complaints of aching pains in the lower abdomen and lower back. The gestation period is 15-16 weeks. History of 1 childbirth and 3 honey. abortion. Vaginal examination: the cervix is ​​2.5 cm long, the external yawning gapes, the cervical canal is closed, the uterus is enlarged according to the gestational age, mucous discharge from the genital tract is moderate. What is the probable diagnosis

threatening spontaneous miscarriage Q540

A 45-year-old patient has recurrent bleeding within one year. Which of the following treatment methods should be prescribed to the patient

separate diagnostic curettage of the uterine cavity Question541

A pregnant woman came to an obstetrician-gynecologist, who was discharged from the infectious diseases hospital a week ago, where she was with severe rubella. The gestation period is 9-10 weeks. Medical tactics

Termination of pregnancy Question542

A 46-year-old woman came to the clinic with complaints of heavy, prolonged menstruation, weakness, and decreased ability to work. On examination: pale skin, pulse 78 beats / min, rhythmic. HELL 125/80 mm Hg. Art., the level of hemoglobin 80 g / l. Bimanual examination and using mirrors: the cervix is ​​not changed, the uterus is enlarged to the size corresponding to 16-17 weeks of pregnancy, mobile, painless. The appendages are not defined. How does the volume of surgery end

Amputation of the uterus without appendages Question543

What is the main task of obstetricians and gynecologists?

decrease in maternal and decrease in perinatal morbidity and mortality Question 544

In the antenatal clinic, a patient with a gestational age of 17-18 is registered at the dispensary

weeks. The patient's diastolic pressure periodically rises to 90 mm Hg. and more. The examination revealed a proteinuria of 0.06 g / l, with overwork, the headache worries. Most likely diagnosis

Chronic hypertension Q545

A pregnant woman came to an obstetrician-gynecologist, who was discharged from the infectious diseases hospital a week ago, where she was with severe rubella. The gestation period is 9-10 weeks. Medical tactics

Termination of pregnancy Question546

In the antenatal clinic, a patient with a gestational age of 17-18 is registered at the dispensary

weeks. The patient's diastolic pressure periodically rises to 90 mm Hg. and more. The examination revealed a proteinuria of 0.06 g / l, with overwork, the headache worries. Most likely diagnosis

Chronic hypertension Q547

A postmenopausal woman developed bleeding and underwent diagnostic curettage. Scraping - atypical glandular structures with pronounced cellular atypism. Your diagnosis

Adenocarcinoma of the body of the uterus Q548

A 18-year-old patient complains of itching of the external genital organs, burning sensation when urinating. She fell ill a week ago, before that she had a purulent sore throat, for which she received ampicillin. The condition is satisfactory, the temperature is N, somatically healthy. In the area of ​​the entrance to the vagina, there is hyperemia, swelling, white cheesy discharge, which can be easily removed with a cotton swab. What is the probable diagnosis

Candidal colpitis Question549

A 26-year-old patient consulted a gynecologist with complaints of pain in the left labia. Marks a rise in body temperature up to 37.80C. Examination of the external genitalia revealed swelling and hyperemia of the left labia. On palpation, a 5x4 cm formation in the thickness of the left labia with a softening area in the center is determined. What is the most correct diagnosis

barolin gland abscess

Question550

 

A 48-year-old patient complained of heavy menstruation for 3 years, weakness. Registered for uterine fibroids (uterine size 7-8 weeks). During the last year, she did not see a doctor. Vaginal examination: the uterus is enlarged up to 11-12 weeks of pregnancy, dense, with an uneven surface. What can be the recommended treatment

Surgical treatment Question551

A woman with 27 weeks of pregnancy came to SVA with complaints of weakness and fatigue. In the blood test, fasting hyperglycemia of 7.1 mmol / l, there are no signs of ketosis. Your diagnosis

Pregnancy 27 weeks. Diabetes mellitus I degree Question552

When a woman visits a doctor on January 12, 2020, a pregnancy test is positive. She has a regular 28-day cycle, her last period was December 8-11, 2019.

Estimated due date:

 

15 September 2020

 

Question553

 

Patient 51 years old. Complaints about frequent hot flashes, headaches, hyperhidrosis, pain in the heart. History: hypertension. P / m was 3.5 months ago, painless. Gynecological examination revealed no pathology. Your diagnosis

Climacteric syndrome Question554

In an 80-year-old patient, ultrasound examination revealed a cyst of the right lobe of the liver measuring 8x8 cm with a fluid level. Eonosophilia in the blood. Katsoni's test is positive. What kind of surgery is indicated for the patient

puncture of the cyst under ultrasound control Question555

At the appointment with a general practitioner, a 25-year-old patient with complaints of nausea, taste in the mouth, pain in the epigastric region radiating to the spine. The pain occurs at night, and the patient wakes up at night and drinks a glass of cold milk. Objectively pain on palpation in the right epigastric region, a positive Mendel's symptom. What is your preliminary diagnosis?

Duodenal ulcer. Question556

A 15-year-old teenager turned to the family doctor with complaints of severe weakness and nausea. The boy had black tarry stools the day before and this morning. On examination: the skin and visible mucous membranes are sharply pale, cold sweat, pulse 120 per minute, blood pressure 80/30 mm Hg. In the KLA, hemoglobin is 60 g / l. Your diagnosis:

gastrointestinal bleeding Q557

To ensure free airway patency of the patient, it is necessary:

 

put a roller under the shoulder blades, tilt the head backward, push the lower jaw forward Question 558

What research method is the most informative for the diagnosis of ulcerative colitis

colonoscopy Question559

Woman 36 years old. Complaints of pain in the lower back and in the left hypochondrium, nausea, vomiting, stool retention, weakness, dry mouth, chills. The disease is associated with physical activity.

Objectively: Moans. The skin is pale. The abdomen is painful and tense in the left hypochondrium. The tapping symptom is positive. Palpation of the kidney is painful. Blood test: erythrocytes 3.4x1012 / l, hemoglobin 100 g / l, leukocytes 9.5x109 / l, erythrocyte sedimentation rate 18 mm / hour. In the general analysis of urine, erythrocytes are 10-15 in the field of view. Which of the following preliminary diagnoses is most likely

urolithiasis Q560

Male 25 years old. Complaints of pain in the right hip. General condition of moderate severity. On examination

- the affected limb is increased in volume, an increase in the inguinal lymph nodes is determined. Palpation reveals a sharply painful, motionless, hot to the touch formation without clear boundaries. The skin above it shines. The movements are painful, the pain also increases with a change in body position, so the patient tries to move as little as possible. What is the most likely diagnosis

phlegmon Question561

A 35-year-old patient called a doctor at home about sharp pains in the epigastric region, vomiting mixed with blood, weakness, dizziness. From the anamnesis 2 months ago she was treated for peptic ulcer disease. Objectively: the skin is pale. On palpation, there is a sharp pain in the epigastric region. The chair is black. What complication can you suspect?

Bleeding Question562

What type of instrumental research is the most informative for the diagnosis of hemorrhoids sigmoidoscopy

Question563

A 20-year-old patient came to the GP with complaints of pain in the lower abdomen, mostly on the right. The pains appeared at night, intensified in the morning. She notes nausea, there was a single bowel movement. A day ago, my period ended. Married. A positive symptom of Voskresensky, Razdolsky, Bartomier-

Michelson. Your diagnosis of acute appendicitis Question564

At the appointment with a general practitioner, a 68-year-old man with complaints of recurrent pathological discharge from the intestine in the form of blood and mucus, a feeling of a foreign body in the rectum, constipation, bloating, pain in the anal canal. On digital examination of the rectum, an exophytic node of dense consistency is palpated, the presence of ulcerations with roller-like raised edges, with an uneven surface and rigidity of the intestinal wall with narrowing of the intestinal lumen. What examination will confirm your diagnosis?

Immunochemical study of feces for occult blood. Question565

A 46-year-old patient consulted a family doctor about pain in the upper abdomen of a surrounding nature, diarrhea, weight loss. From the anamnesis: he has been abusing alcohol for 10 years. Objectively: underweight, dry skin, small red spots on the skin of the chest and abdomen that do not disappear when pressed. Soreness on palpation. The stool is mushy with a greasy sheen, up to 3 times a day. What is your preliminary diagnosis?

Chronic pancreatitis Question 566

In a 22-year-old patient, the following changes were revealed during fibrogastroduodenoscopy: moderate erythema and looseness of the mucous membrane of the abdominal esophagus, short-term provoked subtotal prolapse of the esophageal mucosa by 1.5-2.0 cm, a pronounced decrease in the tone of the lower esophageal sphincter. These endoscopic signs are typical for:

Hernia of the esophageal diaphragm Question567

A 59-year-old patient has increased nutrition, for 20 hours pain persists in the right hypochondrium, radiating to the lumbar region, under the scapula. Nausea, repeated vomiting, chills, temperature 38 degrees C. With this clinical picture, a diagnosis should be assumed:

acute cholecystitis Question568

A 70-year-old patient was admitted with complaints of pain in the right hypochondrium of the epigastric region radiating to the back, under the left shoulder blade, nausea, and a single vomiting. On examination, the surgeon suspected acute myocardial infarction. What diagnostic method will allow to differentiate an attack of biliary colic from acute myocardial infarction?

troponin test

Question569

 

Patient K., 28 years old. Complaints of intense pain in the lumbar region and the right half of the abdomen, radiating to the groin and right thigh. Frequent urge to urinate. A year ago there was a similar attack, an ambulance was called, the pains were relieved by analgesics, but after the attack there was red urine. Objectively: temperature 36.4 ° C. The patient is restless, looking for a comfortable position to relieve pain. There is no pathology on the part of the respiratory system and the cardiovascular system. Pulse 76 / min. BP 120/60 mm Hg The abdomen is soft, painful on palpation in the right half. Pasternatsky's symptom is sharply positive on the right. What is the most likely diagnosis?

urolithiasis Q570

A 51-year-old woman has prolonged pain and a feeling of fullness in the right hypochondrium. On examination, there was no jaundice, a positive symptom of Kera, Ortner, subfebrile temperature, in the hemogram ESR-30 mm / h. What is the most likely diagnosis?

chronic cholecystitis in the acute phase Question571

In what pathology do the following symptoms occur: "dagger" abdominal pain, vomiting, high fever, "board-like" abdomen, absence of hepatic dullness:

perforated stomach ulcer Q572

Patient S. 53 years old, was admitted urgently after 3 hours from the moment of illness with complaints of acute pain in the epigastrium, short-term loss of consciousness, cold sweat, single vomiting. From the anamnesis: for 10 years suffering from gastric ulcer. On examination, pallor of the skin is noted, the pulse is 100 beats per minute, the blood pressure is 100/70 mm Hg. An overview X-ray shows free gas under the right dome of the diaphragm. Your preliminary diagnosis

perforated ulcer Q573

Patient P., 27 years old, consulted a general practitioner with complaints of severe pain in the right forearm, edema, hyperemia in this area, general weakness, malaise, an increase in body temperature to 38. Four days before that, she received an abrasion on the back of the right forearms. When examining the dorsum of the right forearm, a dense inflammatory infiltrate with edema, hyperemia and hyperthermia is determined. Palpation of the infiltrate is associated with severe pain. The fluctuation symptom is positive. What is your preliminary diagnosis?

Phlegmon of the right forearm. Question574

A 38-year-old man was admitted to the clinic with complaints of headaches, weight loss, general weakness, and increased fatigue. In neurological status: convergent strabismus, diplopia,

stiff neck muscles. From the anamnesis: a year ago he had pulmonary tuberculosis. Diagnostic principle:

lumbar puncture Q575

For 5 months, the patient is worried about a gradually increasing headache, which intensifies in the morning, recently vomiting, decreased vision in both eyes and staggering when walking to the left have joined. No pathology was revealed on the part of the cranial nerves. The tone in the left extremities is reduced, coordination tests are poorly performed by the left extremities (intentional tremor, passing by). Examination by an ophthalmologist revealed stagnant optic discs on both sides. Topical diagnosis:

the left hemisphere of the cerebellum. Question576

A 68-year-old patient complains of awkwardness and numbness in the left extremities. He fell ill acutely in the morning when the above complaints appeared. Blood pressure, 170/90 mm Hg Art. He has a history of ischemic heart disease, three years ago he suffered an extensive transmural myocardial infarction, complicated by a constant form of atrial fibrillation. On examination: Condition of moderate severity. Conscious. There are no general cerebral and meningeal symptoms. Central paresis of the facial and hypoglossal nerves on the left, left-sided hemiparesis with a decrease in muscle strength to 3 points, Babinsky's symptom on the left. Left hemigipesthesia. With a lumbar puncture: CSF is colorless, transparent, pressure 160 mm water column, cytosis - 3 lymphocytes, protein - 0.33 mg%. On MRI on the 4th day after the disease in the right parietal-temporal region, a zone with a signal of increased and decreased signal intensity on T1 and T2-weighted images, respectively, is determined. Preliminary diagnosis:

Ischemic stroke in the right hemisphere of the brain Question577

A 32-year-old patient has complaints of decreased vision, headaches, menstrual irregularities. A contrast-enhanced MRI of the brain revealed a pituitary tumor causing compression of the optic chiasm. What symptom will be noted when the visual chiasm is compressed?

heteronymous hemianopsia Question578

A 72-year-old man has a coma. The temperature is high. Before admission, the patient had an attack of generalized tonic-clonic seizures. A week before admission, there was drowsiness and coughing, and vomiting. Alcoholic and drug poisoning is excluded.

Preliminary diagnosis: tuberculous meningitis. The principle of etiological treatment: isoniazid, streptomycin

Question579

 

Examination revealed a lack of movement in the legs, increased muscle tone in them, increased knee and Achilles reflexes on both sides, bilateral

pathological signs of Babinsky and Rossolimo, the absence of abdominal reflexes, the presence of protective reflexes and clonuses of the feet and patella on both sides. There is a violation of pain and temperature sensitivity from the level of the nipples and below, a violation of deep sensitivity in the legs, involuntary urination, bedsores in the sacrum and heels. Topical diagnosis:

complete damage to the diameter of the spinal cord. at the Th4-Th5 level

 

 

Question580

 

The daughter brought her 78-year-old mother to a neurologist for examination. Mom has no complaints, but her daughter said that for the last year my mother stopped doing her usual daily chores, recently forgot to turn off the gas on the stove, and yesterday she left home and was found on a nearby street 2 hours later. According to her daughter, memory impairments have been observed for 5-6 years, she has lost interest in the world around her. On examination, the doctor discovered gross memory impairments, signs of pseudobulbar syndrome and mild imbalance. Preliminary diagnosis:

vascular dementia Question581

The patient is 24 years old. In the autumn I went to visit my relatives in Russia (forests, taiga). After arrival, a few days later, there was a sharp headache, nausea, vomiting. There was an increase in temperature up to 39 °, chills, pain in the neck. I thought that ARVI was treated on my own. But the condition worsened, and in the next 2-3 days there was a weakness in the arms and muscles of the neck. In the neurological status: flaccid paresis of the muscles of the neck and arms. Preliminary diagnosis:

tick-borne encephalitis Question582

Patient K, 25 years old, was taken by ambulance to the emergency room of emergency hospital with complaints of headaches, weakness in the right extremities. From the anamnesis: an hour ago he was beaten by unknown persons in the street after being hit on the head and lost consciousness; the duration of the loss of consciousness is not known. Objectively: conscious, contact, tongue deviates to the right, right limbs sag in Barre's test, tendon reflexes D> S, Babinsky's reflex on the right. There are no meningeal signs. Diagnostic principles:

CT or MRI of the brain Question583

A 58-year-old woman, an accountant, suffering from diabetes mellitus, complains of pain in the lower extremities, a feeling of chilliness and cold snap, “creeping creeps”, intensifying at night. Objectively: the skin of the feet is dry, peeling, there is a painless ulcer on the sole of the right foot. Knee reflexes are reduced, Achilles are not triggered. Decrease in pain and temperature sensitivity in the distal extremities. Your preliminary diagnosis:

diabetic polyneuropathy Question584

A 62-year-old man suffering from chronic purulent otitis media, against the background of another exacerbation (pain in the ear, purulent discharge), developed a severe headache, dizziness, photo- and phonophobia, and positive meningeal symptoms. The analysis of cerebrospinal fluid revealed: turbid, cytosis-800 in ml, neutrophils predominate, protein-0.66 g / L. Preliminary diagnosis:

secondary otogenic purulent meningitis Question585

An 18-year-old boy, after suffering an acute respiratory viral infection (ARVI), felt a tingling sensation in the ankle joints. Within two days, he developed weakness in the extensors of the feet, and by the end of the week it became difficult for him to walk. Urination and defecation were not disturbed. During the week, the weakness progressed and there was a need for mechanical ventilation. Tetraplegia developed, while the movements of the eyeballs were preserved. Preliminary diagnosis: Guillain-Barré polyradiculomyeloneuropathy. Diagnostic principle:

MRI of the brain, analysis of cerebrospinal fluid Question586

A 69-year-old woman suddenly felt unwell, felt liquid food pouring out through the right corner of her mouth, dropped a spoon from her right hand. After 25 minutes, these symptoms self-regressed. It is known that 4 weeks ago she had an acute myocardial infarction. I called an ambulance. Preliminary diagnosis:

transient ischemic attack in the basin of the left middle cerebral artery Question587

Patient K., 38 years old, on June 24, was taken from the regional hospital by plane on the 4th day of illness. An extract from the medical history states: he works as a shepherd, he is acutely ill. The disease began with chills, fever up to 39 °, headache, vomiting, confusion, delirium. On the third day, there was a violation of movements in the hands, there was a persistent breathing disorder. On examination: delirious consciousness, agitation, hallucinations. Body temperature 38 °. The pupils are moderately constricted. Dysarthria, choking on swallowing. Hand movements are severely limited. Reduced muscle tone in the shoulder girdle. Tendon reflexes from the upper extremities are not evoked, the knee and Achilles are revitalized. The pathological Babinsky reflex is determined on both sides. Stiffness of the muscles of the occiput of 2 transverse fingers, Kernig's symptom at an angle of 90 °. Lumbar puncture: the cerebrospinal fluid is transparent, colorless, flows out in a stream; protein - 1.32 g / l, cytosis - 200 (lymphocytes - 93%), sugar - 4.44 mol / l, chlorine - 211.5 mmol / l.

Preliminary diagnosis

 

tick-borne encephalitis (meningoencephalitis form) Question 588

A 46-year-old man complains of morning headaches, seizures accompanied by twitching in the right extremities (starting in the right leg, extending to the right arm). Consciousness does not lose. The attacks are repeated 1-2 times a day, for the first time occurred 3 months ago. From the anamnesis it is known that 4 years ago he received a closed craniocerebral injury - a contusion of the brain. According to CT: external and internal hydrocephalus. EEG: complexes

"Acute slow wave" in the fronto-parietal region of the left hemisphere. Treatment principle:

anticonvulsants Question589

Patient I., 49 years old, was taken to the emergency room by an ambulance with complaints of numbness and weakness in the left extremities. Examination by a neuropathologist reveals hyperreflexia on the left, smoothness of the left nasolabial fold, muscle strength in the left extremities is reduced to 3.0 points. What structure of the nervous system is damaged?

right hemisphere of the brain Question590

The patient complains of stiffness when moving, profuse salivation, difficulty speaking (speaks words slowly), constant trembling in the hands. Objectively: the face is amimic, the head is slightly tilted forward, the arms and legs are slightly bent in all joints, he performs active movements slowly. In the fingers of the hands, rhythmic tremors, with a small amplitude, in the form

"Rolling the pills". The tone in the arms and legs is uniformly increased, there is a “cogwheel” phenomenon. Tendon reflexes are lively, uniform. There are no pathological reflexes.

Sensitivity is not upset. He walks in small steps. There are no friendly movements. Topical diagnosis:

primary lesion of the globus pallidus, substantia nigra Question591

Patient N. 20 years old. Complaints of a sharp headache, photophobia, fever up to 39-40 degrees, nausea, vomiting. Neurological status: psychomotor agitation, stiff neck muscles, positive symptoms of Kernig, Brudzinsky. Diagnostic principle:

diagnostic lumbar puncture Question592

Patient K., 20 years old, was taken to the emergency room unconscious after an accident. The Glasgow Coma Scale is 7 points: the patient opens his eyes and pathologically flexes his limbs in response to painful irritation, and occasionally groans. What level of impaired consciousness does this correspond to?

coma Question593

Patient K., 68 years old, was admitted to the emergency room with complaints of impaired swallowing and phonation. Examination by a neuropathologist revealed: dysarthria, paresis of the soft palate and the absence of a pharyngeal reflex. There are no paresis, tendon reflexes from the limbs are evoked normally. What clinical syndrome are we talking about?

Bulbarnom Question594

A 54-year-old man called an ambulance, vision in his right eye was suddenly impaired, and weakness and numbness in the left limbs arose. By the time the ambulance arrived (after 20 minutes), the complaints were gone. On objective examination: the general condition is satisfactory; vision

both eyes are normal. In the neurological status: deep reflexes S> = D, no other neurological symptoms were found. Preliminary diagnosis:

transient ischemic attack Q595

A 64-year-old patient was admitted to the hospital in an extremely serious condition. According to the story of his relatives, he has been suffering from hypertension for more than 20 years. In the morning, getting out of bed, suddenly lost consciousness, fell. Vomiting took place. On examination, there is no consciousness. The skin of the face, chest, limbs is hyperemic. AD — 220/100. Pulse 96 beats per minute, tense. Cheyne-Stokes breath. The head and eyeballs are turned to the left. The mouth is half open. Stiff neck. Kernig's symptom on both sides. The pupils are dilated. The right nasolabial fold is smoothed. The right foot is rotated outward. Tendon reflexes are absent. Does not react to injections. On the right, the reflexes of Babinsky, Rossolimo, Gordon are called. Lumbar puncture: the pressure of the cerebrospinal fluid is 180 mm of water column, the cerebrospinal fluid is intensely colored with blood.

Clinical diagnosis

 

hemorrhagic stroke in the basin of the left middle cerebral artery Question596

Patient K., 31 years old, is registered with a neurologist for epilepsy, regularly receives antiepileptic drugs. The focus of brain damage according to MRI data is localized in the occipital lobe. In this patient, before seizures, one can expect the occurrence of:

visual hallucinations Question597

Patient 36 years old. Seizures appeared that began with turning the head and eyes to the left, followed by clonic convulsions of the left arm and leg. I didn’t lose consciousness. The seizure lasted 2-3 minutes. Now I began to see worse, “a fog appears before my eyes,” my left arm and leg became weaker. Before entering the clinic, it became difficult to walk. Has become apathetic, has ceased to be interested in work, family, not alarmed by her illness. On examination: Pupils are wide, reaction to light and convergence is sluggish. Eye movements are not limited, but there is an instability of gaze to the left. Distinct smoothness of the left nasolabial fold. Left-sided hemiparesis.

Tendon reflexes on the left are higher than on the right. Symptoms of Babinsky and Rossolimo on the left. Grasp reflex of the left hand. Trembling of the left hand. The chin reflex is obtained from the left hand. Kernig's symptom on both sides. Angiography: dislocation downward in the arterial phase in the frontal-pole branch of the anterior cerebral artery and the anterior branches of the middle cerebral artery. Clinical diagnosis:

tumor of the right frontal lobe Question598

The patient is 27 years old. A year and a half ago, general epileptic seizures appeared, at first rare, and now 3-4 times a month. Some seizures were preceded by a deception of smell -

"The smell of burning." Complained of a headache. Recently, it has become worse to see, appeared

double vision, as well as weakness of the left arm and leg. Ptosis of the upper eyelid of the right eye. Pupils are round, the right one is wider than the left one. External strabismus of the right eye, limitation of its movements up and down. The left nasolabial fold is smoothed. Awkwardness of the left arm, muscle strength in it is reduced. When walking and when examining Romberg's symptom, it staggers slightly to the left.

Tendon reflexes are higher on the left. Clonus of the left foot. Symptom Babinsky and Oppenheim on the left. Computed tomography of the brain: displacement of the ventricular system from right to left, the central part of the left lateral ventricle is pressed downward and outward. On the angiogram, the upward displacement of the right middle cerebral artery and the medial siphon of the right carotid artery. Clinical diagnosis:

tumor of the right temporal lobe Q599

Patient A. 50 years old fell ill acutely. While driving a car, he suddenly complained to others that he felt a "hot blow" in the back of his head. An intense headache and nausea immediately appeared. I managed to stop the car, tried to get out, there was repeated vomiting, lost consciousness. An ambulance brigade was delivered to the emergency department. On examination: consciousness is preserved, but there is a state of stunnedness. He makes contact with difficulty.

Moans, complains of headache, nausea. Horizontal nystagmus, not bringing the eyeballs to the sides. Stiffness of the muscles of the occiput of 4 transverse digits. On both sides Kernig's symptom at an angle of 90 °, Brudzinsky's lower symptom. lumbar puncture: fluid flows out under increased pressure, intensively, evenly colored with blood. Preliminary diagnosis:

 

 

subarachnoid hemorrhage Q600

A 35-year-old woman has muscle atrophy of the upper extremities, decreased tendon reflexes, muscle strength and fibrillar twitching in the arm muscles. Changed gait when walking

"Pulls" the legs. A sharp increase in tendon reflexes on the legs, pathological reflexes of Babinsky and Oppenheim on both sides. Topical diagnosis:

at the level of the cervical thickening Q601

An 18-year-old boy, after suffering an acute respiratory viral infection (ARVI), felt a tingling sensation in the ankle joints. Within two days, he developed weakness in the extensors of the feet, and by the end of the week it became difficult for him to walk. Urination and defecation were not disturbed. During the week, the weakness progressed and there was a need for mechanical ventilation. Tetraplegia developed, while the movements of the eyeballs were preserved. An increased protein content (over 10 g! L) was found in the cerebrospinal fluid with normal cytosis, without erythrocytosis

Guillain-Barré syndrome;

 

Question602

 

A 49-year-old man, an electrician, was admitted to the clinic by ambulance. On admission: consciousness is depressed, he opens his eyes to painful irritations. Neurological status: muscle stiffness

occiput, Kernig's symptom is positive. Convergent squint. The right nasolabial fold is smoothed, the tongue is deviated to the right. The tone and reflexes are increased on the right. Lymphocytic pleocytosis in the cerebrospinal fluid. Your preliminary diagnosis:

meningoencephalitis Q603

A 42-year-old man developed severe girdle pain in the left side of the chest; ECG and biochemical blood tests did not reveal any cardiac pathology. Two days later, in the left side of the chest, at the level of the nipple, in the area of ​​pain, rashes appeared in the form of bubbles. Examination by a neurologist revealed a zone of hypesthesia in the same area. Preliminary diagnosis:

herpetic ganglionitis Q604

After lifting weights, a 40-year-old man developed severe lower back pain radiating along the outer surface of the thigh and lower leg, reaching the big toe on the left. On examination: muscle tension in the lumbar region, weakness of the extensors of the first finger. Reflexes on the legs are preserved, symmetrical. Lassegh's symptom is positive on the left by 40 degrees. Diagnostic principle:

MRI of the lumbosacral spine Question605

Patient K., 36 years old, fell at work, receiving a bruise of the back and the back of the head. Two days later, he turned to a neurologist with complaints that he "does not feel the ground under the leg on the right." On examination, there is a deep sensation disorder of the conductive type on the right leg. With the defeat of which structure of the nervous system, this symptomatology is possible:

spinal cord Q606

A 25-year-old patient suddenly, against the background of complete health, decreased visual acuity to 0, developed general weakness, irritability, uncertainty and unsteadiness when walking, "drunken gait", in connection with which he turned to a neurologist. The defeat of what structures of the central nervous system can be suspected on the basis of the complaints presented?

optic nerve, cerebellum Q607

Patient U, 23 years old, complains of weakness in the arms and legs, numbness in the hands and feet, staggering when walking. Two weeks ago, according to the patient, a flu-like condition was noted. On examination, the muscle tone in the extremities is reduced, the strength of the muscles of the hands and feet is reduced to 1 point, all types of sensitivity are reduced in the form of "socks and gloves", carporadial and Achilles reflexes are not evoked, and the color of the skin of the extremities changes. Liquor is colorless, transparent, cytosis of 10 lymphocytes, protein -20 grams per liter. Preliminary diagnosis:

polyneuropathy (Guillain-Barré syndrome.)

Q608

 

The mother of a 7-year-old child called an ambulance for the child's headache, fever and vomiting. The boy was immediately taken to the infectious diseases hospital with suspected viral meningitis. What is the main symptom of serous viral meningitis based on the results of a lumbar puncture:

Lymphocytic cytosis of cerebrospinal fluid Q609

After injury to the anterior forearm, the patient has atrophy of the muscles of the eminence of the thumb with flattening of the palm ("monkey's hand"), hypoesthesia with hyperpathy in the palmar surface of the 1, 2, 3 fingers and the corresponding part of the palm, burning pain. Topical diagnosis:

median nerve Q610

Patient Z., 33 years old, a housewife, complains of shooting pains in the left side of the face after suffering labial herpes a week ago, for the treatment of which she took acyclovir. Pain in the trigger (trigger) zones and hyperesthesia in one half of the face are characteristic of damage to the following nerve:

trigeminal question611

At the metro station, a 20-year-old young man suddenly felt unwell, grabbed his head and fell. An ambulance doctor arrived found the patient unconscious and identified positive meningeal symptoms. The young man's girlfriend said that before he was completely healthy and never complained about anything. Diagnostic principle:

lumbar puncture, MRI of the brain Q612

An 18-year-old student suddenly fell, tonic-clonic convulsions, involuntary urination were observed. On examination: consciousness is lost, saliva with a small amount of blood comes out of the mouth. The convulsions stopped after 2 minutes, after which the patient fell asleep. According to the mother: drugs, alcohol does not use, head trauma, neuroinfections previously did not tolerate. In childhood, there were short-term episodes of switching off consciousness (several seconds) and freezing in a certain position. The patient's sister has been suffering from epilepsy since childhood. Preliminary diagnosis:

idiopathic epilepsy Q613

A 57-year-old man was admitted to the NSO with complaints of headache, vomiting, weakness and numbness in the right extremities, speech disorders that developed suddenly, in the afternoon against the background of an increase in blood pressure to 220/120 mm Hg. Art. Objectively: inhibited, stiffness of the occiput muscles by 3 transverse digits. The right nasolabial fold is smoothed, the tongue is deviated to the right. Increased tone and reflexes

on right. All types of sensitivity in the right limbs are reduced. CT scan of the brain is a focus of increased density, the ventricles of the brain are enlarged. What is the MOST probable diagnosis?

parenchymal - subarachnoid hemorrhage Q614

A 16-year-old girl went to the clinic with complaints of episodes of switching off consciousness. Knows about these episodes from friends and relatives: during a conversation he becomes silent, for a few seconds he does not react to the speech addressed. Falls, convulsions, loss of urine is denied. Such attacks can be repeated up to several dozen times a day, lasting 10-20 seconds. Similar attacks are noted in the patient's father. CT scan of the brain did not reveal any pathology. Preliminary diagnosis:

idiopathic epilepsy (absences). Question615

A 60-year-old man with a long history of smoking and hypertension, in the morning after sleep, numbness and weakness appeared in the left lower extremity. In the evening, the weakness in the leg intensified and the awkwardness in the proximal part of the left upper limb gradually joined.

Topical diagnosis:

 

pool of the right anterior cerebral artery Q616

Patient K., 40 years old, is registered with a neuropathologist with a diagnosis of "Structural (post-traumatic) focal epilepsy". Periodically, the patient, while taking antiepileptic drugs, has clonic spasms of the left leg, starting from the foot. Recently, spastic paresis of the left leg has joined, mainly in the distal regions. Specify the localization of the process.

the upper part of the anterior central gyrus of the right hemisphere; Question617

A 24-year-old patient has complaints of menstrual irregularities; the patient is being treated by a gynecologist with a diagnosis of primary infertility. The level of prolactin in the blood is dramatically increased.

The patient is referred for a consultation with a neurologist. The neurological status was normal. Preliminary diagnosis:

pituitary adenoma Q618

A 38-year-old man, an engineer, was admitted to the clinic with complaints of a sharp decrease in memory and attention, "failure of thoughts", "violent thinking", followed by loss of consciousness and convulsive convulsions lasting up to 3-4 minutes (according to his wife). The beginning marks the last 4 months, after suffering a head injury and brain contusion 2 years ago. Neurostatus has minimal disseminated neurological symptoms. Diagnostic principle:

electroencephalography Question619

The patient, 35 years old, was delivered by ambulance to the emergency room of the clinic. From the anamnesis against the background of high blood pressure, vomiting, psychomotor agitation, and inappropriate behavior suddenly appeared. Objectively: the condition is serious, the face is hyperemic, the meningeal symptoms are positive, there is no paresis. Preliminary diagnosis:

subarachnoid hemorrhage Q620

The patient complains of attacks of clonic seizures. The attack begins with a twitching of the right foot, then convulsions cover the entire right half of the bodies. The attack lasts 1-2 minutes.

The patient does not lose consciousness. On examination, a slight revival of deep reflexes on the right is revealed. Make a topical diagnosis:

the focus of irritation in the upper parts of the anterior central gyrus on the left Question621

A man, 87 years old, was admitted with complaints of headache, vomiting, weakness and numbness in the right extremities, speech disorders that developed suddenly, in the morning, against the background of an increase in blood pressure to 220

/ 120 mm Hg. Art. Objectively: inhibited, severe condition, meningeal syndrome. Central paresis of the facial muscles of the face and tongue on the right, hemihypesthesia and hemiparesis on the right with increased tone and reflexes. Diagnostic principle:

CT of the brain Q622

The condition of patient K., who was in the pulmonary department, deteriorated sharply: cerebral symptoms significantly increased, meningeal signs appeared. In the cerebrospinal fluid pronounced neutrophilic pleocytosis, in the blood leukocytosis, increased ESR. In anamnesis, he suffers from bronchiectasis for a long time. Preliminary diagnosis:

secondary purulent meningitis Q623

A 39-year-old patient is on the street in an unconscious state. Objectively: the skin is moist, pale, the pupils are moderately dilated D = S. The muscle tone of the limbs is reduced. Breathe out the smell of alcohol. There is vesicular breathing in the lungs, no wheezing. Muffled heart sounds, tachycardia 108 / min. BP 110/70 mm Hg There are no focal symptoms. Meningeal symptoms are negative. There are abrasions on the skin of the face. Your preliminary diagnosis:

alcoholic coma Q624

A 65-year-old patient has objectively: lumbar lordosis is smoothed, movements in the lumbar spine are limited due to pain back and to the sides. Symptoms of Wasserman and Matskevich on the right. Hypesthesia on the inner and anterior surface of the right thigh. Decreased right knee reflex. What syndromes does the patient have?

radicular L2-L4

 

Question625

A 72-year-old man has a coma. The temperature is high. Before admission, the patient had an attack of generalized tonic-clonic seizures. A week before admission, there was drowsiness and coughing, and vomiting. Alcoholic and drug poisoning is excluded. In the cerebrospinal fluid: protein - 4.5 g / l, sugar - 3.4 mmol / l, leukocytes 150 in 1 μl, erythr - 3 μl, cerebrospinal fluid. Pressure 200 mm of water column, milky appearance, fibrin film fell out.

Tuberculous meningitis Question 626

A 32-year-old man consulted a doctor with complaints of pain in the cervical spine, radiating to the shoulder, along the radial edge of the forearm, to the thumb of the right hand. Examination revealed weakness and hypotrophy of the biceps brachii muscle, thenar, and a decrease in the biceps reflex on the right. Hyposthesia in the area of ​​the radial edge of the forearm. Topical diagnosis:

C6 spine on the right Question627

A 58-year-old patient in the morning complains of tremors in the hands and feet, rapid fatigue, changes in speech, frequent urge to urinate, difficulty starting movement. Such complaints have been troubling for the last 3 years. From the anamnesis it is known that he is registered in a neuropsychiatric dispensary, has been taking antipsychotics for a long time. On examination: small-sweeping tremor in the hands of the type of "coin counting", small-sweeping tremor of the legs, decreasing with movement, perioral tremor, quiet, monotonous speech, muscle tone increased in the extrapyramidal type. Preliminary diagnosis:

Parkinson's syndrome Q628

Patient S. 10 years old. She fell ill in the morning, about 10 hours ago. At first, there was a headache, chills, vomiting joined in the afternoon. By the evening, the condition deteriorated sharply, against the background of a high body temperature, a disorder of consciousness occurred, repeated vomiting was observed. On examination: a soporous state of consciousness. Body temperature 39.5 ° The skin is moist, the face is hyperemic.

Herpes on the lips. Hemorrhagic rash on the skin of the thighs. Spontaneous horizontal nystagmus, divergent squint. Trismus of the chewing muscles. Tendon reflexes are higher on the right. Pathological reflexes of Babinsky and Oppenheim were caused on both sides. Stiffness of the occiput muscles - 4 transverse fingers, Kernig's symptom on both sides is positive at an angle of 90 °. Lumbar puncture: cerebrospinal fluid flows out under increased pressure, turbid, protein - 2.6 g / l, cytosis cannot be counted (neutrophils 98%), sugar - 1.7 mmol / l, chlorine - 183.3 mmol / l. Diplococcus was found in the native preparation. Clinical diagnosis:

meningococcal infection, purulent meningoencephalitis Q629

A 28-year-old woman for several days began to notice instability when walking and awkwardness in her hands, it became "inconvenient" to type on a computer. In the neurological status: nystagmus, intentional tremor when performing finger-nose and knee-calcaneal tests on the right, increased tone in the lower extremities according to the spastic type, bilateral Babinsky symptom. On examination of the fundus: blanching of the temporal halves of the optic discs

nerves. On re-examination three days later, the severity of coordination disorders significantly decreased. Preliminary diagnosis:

multiple sclerosis Q630

A 52-year-old patient with overweight, suffering from hypertension, coronary artery disease, type II diabetes mellitus, complains of "burning" in the feet. Examination revealed a decrease in deep reflexes on the arms and legs. Hypesthesia in the distal legs. The examination revealed an elevated blood glucose level. Preliminary diagnosis:

diabetic polyneuropathy Question631

The patient is 28 years old - the temperature is increased to 39 degrees. Within 3 weeks, there was marked weakness, cough. History: a friend was diagnosed with pulmonary tuberculosis 3 months ago. Alcoholic and drug poisoning is excluded. In the cerebrospinal fluid: protein - 4.5 g / l, sugar - 1.4 mmol / l, leukocytes 150 in 1 μl, erythr - 3 μl, cerebrospinal fluid. Pressure 200 mm of water column, milky appearance, fibrin film fell out. Clinical diagnosis:

tuberculous meningitis Q632

Patient M., 58 years old, was delivered by an ambulance. With complaints of a sharp headache, dizziness, nausea, single vomiting, numbness of the tongue, weakening of the motor function of the arm and leg on the left side, urinary incontinence Objectively: BP 180/100 mm Hg, heart rate - 80, NPV - 22 per minute, uneven hemiparesis and hemihypesthesia, deviation of the tongue to the left, left-sided apraxia, hyperkinesis of the face and hands, impaired sense of smell. Topical diagnosis:

circulatory disorders in the anterior cerebral artery Q633

The patient was admitted to the hospital with complaints of intense headache that arose 2 hours ago. AD - 190/100 Inhibited. The right palpebral fissure is narrower than the left one. The left nasolabial fold is smoothed. Hemiparesis, hypertonicity in the muscles of the left extremities, high tendon and the presence of pathological reflexes on the left leg. Preliminary diagnosis:

 

 

ischemic stroke in the basin of the right middle cerebral artery Q634

Patient K. He fell ill at the age of 30, suffered a typical depression, was treated on an outpatient basis. A month later, he was hospitalized in a state of psychomotor agitation: cheerful, a mischievous smile on his face, easily comes into contact with others. Speech is fast, often does not finish phrases. Doesn't express crazy ideas. Deceptions of perception are not observed. In the course of treatment, the mental state returned to normal. Leading syndrome

manic

Question635

 

A 37-year-old patient, disoriented in time and his surroundings, believes that he is not in a hospital, but in a garage, and calls those around him by the names of his comrades. He makes movements with his hands, as if shaking off insects from his clothes. According to the accompanying persons, he abuses alcohol for 10-12 years, gets drunk for 4 years, the last alcohol consumption was 3 days ago. Leading syndrome

withdrawal syndrome with delirium Q636

M, 39 years old, has been abusing alcohol for 5 years, has been drunk for the last 2.5 years. Against the background of a mild colds for 3 days, I drank vodka. Then, after stopping drinking (the patient had to go to work), his sleep was suddenly disturbed, anxiety, anxiety, fear appeared. In the evening, having closed his eyes, he began to see flies, spiders, "some other nasty insects." In horror he opened his eyes, and then everything disappeared. The next day he felt better, but towards evening he again began to see flies and spiders, this time with open eyes, felt them crawling on the skin, biting him, after a while he was surprised to notice that chickens appeared in the room and mice that began to chase him. He hid, ran, shouted, decided to hang himself, but could not figure out how best to do it.

Qualify the patient's condition Alcoholic delirium

Question637

 

Patient M., 49 years old, a teacher, is admitted to a psychiatric hospital for the fifth time. Complains of melancholy, boredom, "heaviness in the heart." I entered the doctor's office slowly, sat on the edge of a chair and practically did not change my posture. The expression on his face is sad, speaks slowly, in a quiet and low-modulated voice, answers questions after a pause. Feels no interest in anything. He considers himself a failure, accuses himself of a bad attitude towards children. Physical complaints: constipation, palpitations. Presumptive diagnosis

depressive episode Q638

A 19-year-old boy in the emergency room did not recognize those around him, did not know where he was, talked about

"Aliens", but more detailed information could not be collected. From the words of the mother, it is known that recently he has changed in behavior - he became secretive, sometimes he came home cheerful, excited, laughed for no apparent reason, but did not notice the smell of alcohol. Increased appetite. The pupils are narrow, the gait is unstable, the blood pressure is 90/60 mm Hg, the temperature is normal. In the morning after medication sleep and sedation, he was fully oriented, told about his experiences on the eve of the episode. In the evening, being in the company, he used a substance, after which he felt cheerful, laughed, and then felt that he was "either on a flying saucer, or in a rocket and was in space, as if there were blue skies and bright stars around." He does not remember how they brought him to the hospital. Qualify the patient's condition

Hashish Oneiroid Question639

Patient D, 26 years old, who was found lying on the sidewalk. He was taken to the hospital on a stretcher. The contact is not available. Lies motionless, does not react to external and painful stimuli. From the mouth - the smell of alcohol. In the oral cavity - the remains of vomit. The skin is pale, cyanotic. The skin is damp. Temperature 35 C, blood pressure 90/50 mm Hg, shallow breathing, rare (8-10 per minute). Pupil reaction to light, tendon and skin reflexes are absent. Tonic cramps of the chewing and occipital muscles are noted.

Assess the psychopathological state Severe alcohol intoxication Question 640

A 36-year-old woman consulted a psychiatrist. Outwardly looks tired, depressed, dressed untidy Complains of headaches and persistent insomnia, increased blood pressure, decreased appetite, lack of strength. Dejected that she cannot look after her daughter for 7 years. She declares that she has lost all interest in life. Refuses the help of family and friends, asks to leave her alone. Leading syndrome

depressive Q641

Patient D, 35 years old. Over the past month, I was very tired, did not sleep much due to the child's illness. My mood worsened, I felt melancholy, as if before some kind of disaster. A week ago I stopped sleeping, barely ate, and did not go to work. Everything around him seemed gloomy, life - meaningless. Most of the time he lies in bed, sometimes he walks around the ward, wringing his hands. He does not communicate with anyone, in a conversation with a doctor he begs to save her. Does not monitor his appearance, eats with compulsion, shallow sleep. Presumptive diagnosis

depressive episode Q642

Patient M., 49 years old, a teacher, is admitted to a psychiatric hospital for the fifth time. Complains of melancholy, boredom, "heaviness in the heart." I entered the doctor's office slowly, sat on the edge of a chair and practically did not change my posture. The expression on his face is sad, speaks slowly, in a quiet and low-modulated voice, answers questions after a pause. Feels no interest in anything. He considers himself a failure, accuses himself of a bad attitude towards children. Physical complaints: constipation, palpitations. Leading syndrome

depressive Q643

Patient L, 58 years old, previously worked as an accountant; along with his current work he prepared extensive annual reports for companies. For the last few years, I have noted fatigue, weight loss. During the year, troubles began, he began to make mistakes in the reports, as a result, he lost a large number of funds. He began to take notes, but forgot where he left them. All these symptoms proceeded against the background of lowered mood and irritability from their failure. I arrived in another city and left my car in the central square, where I was supposed to meet with a friend. A few hours after the meeting, he forgot where he left the car, rushed in search of it. I went to a psychiatrist. On examination, he is confused, his eyes are wide and surprised. Confuses dates, definitely not

remembers how he got to this city. A distinct decrease in memory for current events and events of the last week. CT showed signs of atrophy of the posterior frontal parts of the left hemisphere, compensated hydrocephalus. Treatment tactics

Metantine Question644

During the examination, the patient after using the drug notes the appearance of sensations of heat waves in the body, dry mouth, itching of the facial skin against the background of general tranquility, peace, an influx of dreams, vivid pictures ending in sleep for 3-4 hours. Qualify the patient's condition

hashish intoxication Q645

Patient D, 35 years old. Over the past month, I was very tired, did not sleep much due to the child's illness. My mood worsened, I felt melancholy, as if before some kind of disaster. A week ago I stopped sleeping, barely ate, and did not go to work. Everything around him seemed gloomy, life - meaningless. Most of them lie in bed, sometimes walking around the ward, wringing their hands. He does not communicate with anyone, in a conversation with a doctor he begs to save her. Does not monitor his appearance, eats with compulsion, shallow sleep. Leading syndrome

Depressive Question646

Patient K, 36 years old, was previously repeatedly hospitalized in a psychiatric clinic, claims that he was abducted by a "flying saucer" and made a trip to the stars on it. Tells about aliens, conveys conversations that they still have from space. He is filled with a sense of his own dignity and superiority, as he alone on the whole earth communicates with the cosmos. Presumptive diagnosis

paranoid schizophrenia Q647

The patient is talkative to the point of hoarseness, he tries to talk to any of the patients, but without listening to the latter, he enthusiastically recites poetry to another. Seeing that the nurse is trying to clean the floor, rushes to her aid, but soon after giving up what she started, she gives advice to the sick playing chess. He is inexhaustible in his activity, he speaks quickly, the mood is high. Leading syndrome

manic Q648

A 36-year-old woman consulted a psychiatrist. Outwardly looks tired, depressed, dressed untidy Complains of headaches and persistent insomnia, increased blood pressure, decreased appetite, lack of strength. Dejected that she cannot look after her daughter for 7 years. She declares that she has lost all interest in life. Refuses the help of family and friends, asks to leave her alone. Treatment tactics

antidepressants

Q649

 

Patient D, 23 years old, suffers from heroin addiction, during the last 3 days she was forced to stop taking drugs. When examined by a narcologist, he complains of sharp pains throughout the body, discomfort in the heart and stomach, nausea and diarrhea. She is in a state of motor restlessness, answers questions rudely, irritably, constantly asks for drugs or sleeping pills. Treatment tactics

Psychopharmacotherapy Question650

A 26-year-old patient, graduated from a medical institute, does not work, was admitted to a psychiatric hospital for the first time. They brought me into the ward on a stretcher, lies motionless, the head does not touch the pillow, the raised arm remains in this position, a "cogwheel" symptom is observed. Does not answer questions, does not respond to instructions. The gaze is frozen, empty, directed to one point. The patient is dirty, not cropped, unshaven. While trying to wash him, he unexpectedly hit the nurse with his fist in the face and froze again. Treatment tactics

antipsychotics Q651

Patient N, 40 years old, a disabled person of the 2nd group for mental illness. Lies in bed, talking to herself. It was possible to find out that the patient "hears" the voices of a large group of people who "attach" to her head using a complex technique. The heads of these people are connected with her head, she can exchange thoughts with them, follow their instructions. These phenomena change her mood, suppress her will, and turn her into a robot. The patient is sure that her thoughts are known to her neighbors. Presumptive diagnosis

paranoid schizophrenia Q652

The child is 13 years old. From early childhood he was inferior to his peers in mental development. With difficulty I graduated from the first grade of school. He learned to copy words, wrote individual syllables under dictation. Mechanical counting up to one hundred, counting down is difficult. Arithmetic operations within 20, subtraction - requires outside help. Knows what a bed, a chair, a table is, but cannot summarize them into one concept. Diligent. Good mechanical memory. Outwardly neat.

Emotionally adequate. Presumptive diagnosis of debility

Q653

 

Patient P, 48 years old. Submitted again. The disease developed gradually. A few days before admission to the hospital, he became withdrawn, retired. During a conversation with a doctor, he said that "green radio waves are emitted from a neighboring house using a special transmitter."

Hears voices of women, men, children. I understood from the content of the voices that this was a spy group. Voices speak of the need to kill people, burn houses. He believes that, by order of the voices, his wife sprinkled poison on his food. Treatment tactics

Antipsychotics

Q654

 

A 40-year-old patient, from 20 years old, abuses alcohol, gets drunk. A week before admission, a binge was noted for 3 days. Going to work, two days after getting out of the binge, I heard the voice of an old friend, who called him to go get drunk, then began to "laugh", scoff at him. The patient ran to his house to sort things out, was agitated, aggressive. A friend's wife called a special brigade. He is oriented, assures that he is healthy. He hears male voices that taunt him, threaten. Feels fear, fears that he will be dealt with. Leading syndrome

withdrawal syndrome with delirium Q655

On examination, the patient is motor inhibited, verbal contact is not available. At times, spontaneously freezes in a strange position. You can artificially give an unnatural posture: raise an arm or leg so that it remains on the other leg, then the patient remains in this position for a long time. Treatment tactics

antipsychotics Q656

Patient P, 48 years old. Submitted again. The disease developed gradually. A few days before admission to the hospital, he became withdrawn, retired. During a conversation with a doctor, he said that "green radio waves are emitted from a neighboring house using a special transmitter."

Hears voices of women, men, children. I understood from the content of the voices that this was a spy group. Voices speak of the need to kill people, burn houses. He believes that, by order of the voices, his wife sprinkled poison on his food. Leading syndrome

paranoid Q657

Patient N., 29 years old, an engineer, after suffering an episode of schizophrenia, was discharged from the hospital without productive psychotic symptoms. However, she did not return to work, because she could not force herself to act actively. She became indifferent not only to work, which she previously admired, but also to communication with people. She paid little attention to her child and family. Over time, she practically stopped taking care of herself, washed, combed her hair only after she was reminded. I spent most of the day in bed. Leading syndrome

apato-abulic Question658

Patient L, 58 years old, previously worked as an accountant; along with his current work he prepared extensive annual reports for companies. For the last few years, I have noted fatigue, weight loss. During the year, troubles began, he began to make mistakes in the reports, as a result, he lost a large number of funds. I started making notes, but forgot where I left them. All these symptoms proceeded against the background of lowered mood and irritability from their failure. I arrived in another city and left my car in the central square, where I was supposed to meet with a friend. A few hours after the meeting, he forgot where he left the car, rushed in search of it. I went to a psychiatrist. On examination, he is confused, his eyes are wide and surprised. Confuses dates, does not remember exactly how he got to this city. A distinct decrease in memory for current events and events

last week. CT showed signs of atrophy of the posterior frontal parts of the left hemisphere, compensated hydrocephalus. Presumptive diagnosis

dementia in early-onset Alzheimer's disease Q659

The patient is 27 years old. Hospitalized for the first time in his life, acutely ill 2 days ago. Before that, within a week, the state changed: he became absent-minded, did not understand the essence of the questions, answered after a long pause. Lethargy gradually increased, muscle tone increased, froze in uncomfortable positions, stopped answering questions at all, facial skin greasiness, rare blinking was noted, when trying to transplant a patient, he resisted, when trying to feed he compressed his lips, when the spoon was removed from his mouth, he opened his mouth. Leading syndrome

catatonic Q660

Patient N, 40 years old, a disabled person of the 2nd group for mental illness. Lies in bed, talking to herself. It was possible to find out that the patient "hears" the voices of a large group of people who "attach" to her head using a complex technique. The heads of these people are connected with her head, she can exchange thoughts with them, follow their instructions. These phenomena change her mood, suppress her will, and turn her into a robot. The patient is sure that her thoughts are known to her neighbors. Leading syndrome

paranoid Question661

A 36-year-old patient, over the past few days, felt extremely anxious, could not sleep in any way, constantly walked around the rooms: it seemed that there was someone in the house. Opening the bathroom door, I clearly saw a man with a gray beard in a turban and a long oriental dress standing at the door. Grabbed him, but found himself holding a bathrobe. I went to the bedroom and saw the same oriental man at the window, rushed to him, but realized that it was a curtain. I went to bed, but I could not sleep. I noticed that the flowers on the wallpaper became convex, the walls began to grow. Leading syndrome

delirious Question662

Woman, 50 years old, widow, does not work, often drinks with her partner. Binge drinking up to 10 days, last drinking - 2 days ago. Complains of poor sleep, headache with nausea and dizziness, weakness, sweating, poor appetite, thirst, feeling

"Unnecessary", asks for a drink. She looks older than her age, her hair is matted, her face is swollen, and her clothes are dirty. Revealed increased blood pressure, tachycardia, tremor of the fingers, hyperacusis; experiencing anxiety, fear, suppressed. Leading syndrome

withdrawal syndrome Q663

Patient K, 68 years old, after interrupting the alcoholic binge, began to see crumbling locks on the wall, people with terrible faces surrounded him and tried to strangle him. I saw at the same time

series of flying UFOs. He ran away from home, hid in the woods. When hospitalized, he assured him that he was with his friend, who died several years ago, that he incorrectly named the year and the time of year, and was confused with dates. An expression of horror on his face. Leading syndrome

withdrawal syndrome with delirium Q664

The patient notices that others are constantly hinting at his bad qualities. When people meet him, they lower their eyes, cough, start laughing. Chauffeurs specially illuminate its windows. The newspapers published an article under the heading "20 days left." This hints that he has 20 days left to live. Presumptive diagnosis

paranoid schizophrenia Q665

Patient S., 78 years old, was admitted to a psychiatric hospital due to the fact that she began to hear numerous "voices" through the wall. I came to the conviction that next to her room there is a "pre-trial detention center" in which "people - birds" work. Over time, she began to see these "bird-people" in her dwelling, fed them, treated them, talked to them.

She believed that some birds were chasing her, while others were helping her. I'm sure they exist, they seem to come to visit her at the hospital. Leading syndrome

paranoid Question666

A 37-year-old patient, disoriented in time and his surroundings, believes that he is not in a hospital, but in a garage, and calls those around him by the names of his comrades. He makes movements with his hands, as if shaking off insects from his clothes. According to the accompanying persons, he abuses alcohol for 10-12 years, gets drunk for 4 years, the last alcohol consumption was 3 days ago. Treatment tactics

haloperidol Q667

Patient M, 36 years old, complains of insomnia for 8 months. As prescribed by doctors, he took sleeping pills periodically, then constantly. The patient himself notes that without sleeping pills he feels constant fatigue, irritability, "a feeling of heaviness." While their use gives rise to a feeling of a surge of energy, activity and efficiency increase. I did not notice how the dose of sleeping pills increased, but without the sleeping pills effect. I decided to quit taking these hypnotics, but the next day the patient developed an inexplicable anxiety and fear. There were tremors in the limbs, muscle twitching, general weakness, dizziness, nausea, vomiting .. Later, 2 convulsive seizures developed. Presumptive diagnosis

PPI due to the use of barbiturates Question668

Patient K, 36 years old, was previously repeatedly hospitalized in a psychiatric clinic, claims that he was abducted by a "flying saucer" and made a trip to the stars on it.

Tells about aliens, conveys conversations that they still have from space. He is filled with a sense of his own dignity and superiority, as he alone on the whole earth communicates with the cosmos. Treatment tactics

antipsychotics Question669

The patient is 27 years old. Hospitalized for the first time in his life, acutely ill 2 days ago. Before that, within a week, the state changed: he became absent-minded, did not understand the essence of the questions, answered after a long pause. Lethargy gradually increased, muscle tone increased, froze in uncomfortable positions, stopped answering questions at all, facial skin greasiness, rare blinking was noted, when trying to transplant a patient, he resisted, when trying to feed he compressed his lips, when the spoon was removed from his mouth, he opened his mouth. Presumptive diagnosis

catatonic schizophrenia Q670

The patient is 27 years old. Hospitalized for the first time in his life, acutely ill 2 days ago. Before that, within a week, the state changed: he became absent-minded, did not understand the essence of the questions, answered after a long pause. Lethargy gradually increased, muscle tone increased, froze in uncomfortable positions, stopped answering questions at all, facial skin greasiness, rare blinking was noted, when trying to transplant a patient, he resisted, when trying to feed he compressed his lips, when the spoon was removed from his mouth, he opened his mouth. Treatment tactics

antipsychotics Q671

The doctor of the ambulance team records the patient's tremor, dilated pupils, runny nose, frequent sneezing, coughing and profuse lacrimation. The patient is restless, anxious, trying to massage the muscles of the extremities, complains of pulling pains in the joints of the extremities, upset stools, insomnia. When viewed in the area of ​​the elbow folds along the veins, numerous seals and small hemorrhages in places. Leading syndrome

Withdrawal syndrome Phobic syndrome

Anxiety-depressive syndrome Neurosis-like syndrome Psychopathic syndrome Question672

Patient N., 29 years old, an engineer, after suffering an episode of schizophrenia, was discharged from the hospital without productive psychotic symptoms. However, she did not return to work, because she could not force herself to act actively. She became indifferent not only to work, which she previously admired, but also to communication with people. She paid little attention to her child and family. Over time, she practically stopped taking care of herself, washed, combed her hair only after she was reminded. I spent most of the day in bed. Treatment tactics

antipsychotics Q673

A 26-year-old patient, graduated from a medical institute, does not work, was admitted to a psychiatric hospital for the first time. They brought me into the ward on a stretcher, lies motionless, the head does not touch the pillow, the raised arm remains in this position, a "cogwheel" symptom is observed. Does not answer questions, does not respond to instructions. The gaze is frozen, empty, directed to one point. The patient is dirty, not cropped, unshaven. While trying to wash him, he unexpectedly hit the nurse with his fist in the face and froze again. Leading syndrome

catatonic Q674

Patient C, 48 years old. Received repeatedly. Previous hospitalizations alternately in a state of depression and mania. Long-term intermissions. Mental status at the time of examination: anxious, agitated. She accuses herself that her whole "life consists of continuous mistakes and was lived in vain." Speech is monotonous, mimicry is suffering. Worsening of the condition is usually noted in the morning. It becomes lively in the evening. Leading syndrome

depressive Q675

The patient notices that others are constantly hinting at his bad qualities. When people meet him, they lower their eyes, cough, start laughing. Chauffeurs specially illuminate its windows. The newspapers published an article under the heading "20 days left." This hints that he has 20 days left to live. Leading syndrome

Paranoid Question676

On examination, the patient is motor inhibited, verbal contact is not available. At times, spontaneously freezes in a strange position. You can artificially give an unnatural posture: raise an arm or leg so that it remains on the other leg, then the patient remains in this position for a long time. Presumptive diagnosis

catatonic schizophrenia Q677

Patient M., 49 years old, a teacher, is admitted to a psychiatric hospital for the fifth time. Complains of melancholy, boredom, "heaviness in the heart." I entered the doctor's office slowly, sat on the edge of a chair and practically did not change my posture. The expression on his face is sad, speaks slowly, in a quiet and low-modulated voice, answers questions after a pause. Feels no interest in anything. He considers himself a failure, accuses himself of a bad attitude towards children. Physical complaints: constipation, palpitations. Treatment tactics

antidepressants Q678

Patient S., 78 years old, a pensioner, was hospitalized in a psychiatric hospital due to the fact that she began to hear numerous "voices" through the wall. I came to the conviction that next to her room there is a "pre-trial detention center" in which "people - birds" work. Over time, she began to see these "bird-people" in her dwelling, fed them, treated them, talked to them. She believed that some birds were chasing her, while others were helping her. I am sure of their existence, they seem to fly to visit her in the hospital Treatment tactics

antipsychotics Q679

Patient N, 40 years old, a disabled person of the 2nd group for mental illness. Lies in bed, talking to herself. It was possible to find out that the patient "hears" the voices of a large group of people who "attach" to her head using a complex technique. The heads of these people are connected with her head, she can exchange thoughts with them, follow their instructions. These phenomena change her mood, suppress her will, and turn her into a robot. The patient is sure that her thoughts are known to her neighbors. Treatment tactics

Antipsychotics Question680

Patient B, 45 years old. History 2 years ago traumatic brain injury. The mental state changed 2 years ago: she started up the household, was untidy, stopped going to work, because “I could not figure out what to do.” Judgments are primitive, trying to joke, but the jokes are flat. The doctor turns to "you". Can't remember the current date, remember where she put things, what she did the day before. Pestering others with inappropriate advice. Elementary skills have been retained, more complex operations have been lost. Leading syndrome

dementy Question681

A 36-year-old woman consulted a psychiatrist. Outwardly looks tired, depressed, dressed untidy Complains of headaches and persistent insomnia, increased blood pressure, decreased appetite, lack of strength. Dejected that she cannot look after her daughter for 7 years. She declares that she has lost all interest in life. Refuses the help of family and friends, asks to leave her alone. Presumptive diagnosis

depressive episode Q682

The child is 13 years old. From early childhood he was inferior to his peers in mental development. With difficulty I graduated from the first grade of school. He learned to copy words, wrote individual syllables under dictation. Mechanical counting up to one hundred, counting down is difficult. Arithmetic operations within 20, subtraction - requires outside help. Knows what a bed, a chair, a table is, but cannot summarize them into one concept. Diligent. Good mechanical memory. Outwardly neat.

Emotionally adequate. Leading Intellectual Disability Syndrome Q683

The patient notices that others are constantly hinting at his bad qualities. When people meet him, they lower their eyes, cough, start laughing. Chauffeurs specially illuminate its windows. The newspapers published an article under the heading "20 days left." This hints that he has 20 days left to live. Treatment tactics

antipsychotics Question684

Patient L, 12 years old, was brought in by his mother. Born in asphyxiation. He began to walk at the age of 3, and speak at the age of 5. Objectively: short, half-open mouth, hyperglossia, epicanthus, one groove is missing on the palms. The questions are answered in monosyllables, thinking is subject-specific. It cannot perform the simplest arithmetic operations. He believes that the difference between an airplane and a bird is that "the bird wants to eat." Leading syndrome

intellectual disability Question685

Patient C, 48 years old. Received repeatedly. Previous hospitalizations alternately in a state of depression and mania. Long-term intermissions. Mental status at the time of examination: anxious, agitated. She accuses herself that her whole "life consists of continuous mistakes and was lived in vain." Speech is monotonous, mimicry is suffering. Worsening of the condition is usually noted in the morning. It becomes lively in the evening. Presumptive diagnosis Presumptive diagnosis

BAR Depressive Episode Q686

Patient D, 23 years old, suffers from heroin addiction, during the last 3 days she was forced to stop taking drugs. When examined by a narcologist, he complains of sharp pains throughout the body, discomfort in the heart and stomach, nausea and diarrhea. She is in a state of motor restlessness, answers questions rudely, irritably, constantly asks for drugs or sleeping pills. Leading syndrome

withdrawal syndrome Q687

Patient M, 36 years old, complains of insomnia for 8 months. As prescribed by doctors, he took sleeping pills periodically, then constantly. The patient himself notes that without sleeping pills he feels constant fatigue, irritability, "a feeling of heaviness." While their use gives rise to a feeling of a surge of energy, activity and efficiency increase. I did not notice how the dose of sleeping pills increased, but without the sleeping pills effect. I decided to quit taking these hypnotics, but the next day the patient developed an inexplicable anxiety and fear. There were tremors in the limbs, muscle twitching, general weakness, dizziness, nausea, vomiting. Later, 2 seizures developed. Leading syndrome

withdrawal syndrome Q688

Patient K, 36 years old, was previously repeatedly hospitalized in a psychiatric clinic, claims that he was abducted by a "flying saucer" and made a trip to the stars on it. Tells about aliens, conveys conversations that they still have from space. He is filled with a sense of his own dignity and superiority, as he alone on the whole earth communicates with the cosmos. Leading syndrome

paraphrenic Question689

Patient P, 48 years old. Submitted again. The disease developed gradually. A few days before admission to the hospital, he became withdrawn, retired. During a conversation with a doctor, he said that "green radio waves are emitted from a neighboring house using a special transmitter."

Hears voices of women, men, children. I understood from the content of the voices that this was a spy group. Voices speak of the need to kill people, burn houses. He believes that, by order of the voices, his wife sprinkled poison on his food. Presumptive diagnosis

paranoid schizophrenia Q690

Patient C, 48 years old. Received repeatedly. Previous hospitalizations alternately in a state of depression and mania. Long-term intermissions. Mental status at the time of examination: anxious, agitated. She accuses herself that her whole "life consists of continuous mistakes and was lived in vain." Speech is monotonous, mimicry is suffering. Worsening of the condition is usually noted in the morning. It becomes lively in the evening. Treatment tactics

antidepressants Q691

Patient D, 35 years old. Over the past month, I was very tired, did not sleep much due to the child's illness. My mood worsened, I felt melancholy, as if before some kind of disaster. A week ago I stopped sleeping, barely ate, and did not go to work. Everything around him seemed gloomy, life - meaningless. Most of them lie in bed, sometimes walking around the ward, wringing their hands. He does not communicate with anyone, in a conversation with a doctor he begs to save her. Does not monitor his appearance, eats with compulsion, shallow sleep. Treatment tactics

antidepressants Q692

On examination, the patient is motor inhibited, verbal contact is not available. At times, spontaneously freezes in a strange position. You can artificially give an unnatural posture: raise an arm or leg so that it remains on the other leg, then the patient remains in this position for a long time. Leading syndrome

catatonic Q693

Patient D, 26 years old, who was found lying on the sidewalk. He was taken to the hospital on a stretcher. The contact is not available. Lies motionless, does not react to external and painful stimuli. From the mouth - the smell of alcohol. In the oral cavity - the remains of vomit. Skin

pale, cyanotic. The skin is damp. Temperature 35 C, blood pressure 90/50 mm Hg, shallow breathing, rare (8-10 per minute). Pupil reaction to light, tendon and skin reflexes are absent. Tonic cramps of the chewing and occipital muscles are noted.

Assess the psychopathological state Severe alcohol intoxication Question694

Girl, 3 years old. According to the mother, about 10 minutes ago, she burned herself with hot vegetable oil. On examination: the child is conscious, somewhat inhibited, weak cry. On the skin of the face, neck, front surface of the chest and right arm, there are areas of redness. In places, there is necrosis of the epidermis with the formation of blisters. BH - 40 in 1 min, pulse - 160 beats. 1 min. Your preliminary diagnosis:

Burns of the chest and right arm II degree, burn shock II degree Question695

Male, 35 years old. Having slipped on the ice, he hit the groin area hard, after which he felt severe pain in the area of ​​the injury, and therefore caused an emergency accident. When viewed in the groin area on the right, edema and sharp soreness are determined. Most likely diagnosis:

Fracture of the pubic bone Q696

Woman, 34 years old, pregnancy 38-39 weeks - third pregnancy, third birth. Contractions suddenly appeared, regular, intense in nature. Against the background of the development of good labor, the amniotic fluid departed in the woman in labor. A decision was made to deliver the woman in labor to the hospital. During transportation in the SMP car, the woman in labor began to struggle. The tactics of the ambulance brigade in this situation:

stop the car and deliver the baby Question697

Patient, 58 years old. Complaints of paroxysmal pain in the lumbar region, bloody urination. From the anamnesis: against the background of good health, an attack of renal colic suddenly occurred. After some time, gross hematuria appeared. Objectively: a state of moderate severity. No pathology was found in the lungs and heart. What pathology should you think about?

pelvis stone Question698

Child 6 years old. According to the mother: he was ill for 3 days, had a runny nose, low-grade fever. The day before, a cough appeared with a difficult sonorous exhalation, audible from a distance. Objectively: the child is excited, temperature - 37.2 ° C, respiratory rate - 36 per minute, PS - 128 per minute. Hyperemia of the pharynx. On auscultation, breathing is hard, exhalation is lengthened, dry wheezing rales are heard over the entire surface of the lungs. Heart sounds are clear, rhythmic. The abdomen is soft. Stool, urine output are normal. Your tactics.

aerosol of salbutamol, aminophylline solution 2.4% 0.6 ml / m, transportation to the children's hospital

Question699

 

Girl 20 years old. Got into an accident. Complaints of pain in the right shoulder. Objectively, the condition is moderate. Consciousness is clear. There are no vesicular wheezing in the lungs. NPV 20 per min.

Heart sounds are clear, the rhythm is correct, heart rate is 96 per minute. BP 110/70 mm Hg The abdomen is soft and painless. There are abrasions on the face. The area of ​​the right shoulder is deformed, edematous, movement is limited, there is a sharp soreness and crunch in the area of ​​the upper 1/3 of the shoulder. Rational prehospital medical care: anesthesia, fracture immobilization, transportation to a hospital

the fastest transportation to the hospital without additional medical measures

Q700

 

Woman, 30 years old. Complaints of palpitations, interruptions in the heart, shortness of breath, weakness. Objectively: a state of moderate severity, clear consciousness. The skin is pale. In the lungs, vesicular breathing, no wheezing. NPV - 18 per min. Muffled heart sounds, arrhythmic. Pulse of weak filling, the rhythm is not correct, 68-90 beats per minute. HELL 90/60 mm Hg ECG: irregular rhythm, atrial fibrillation, signs of complete AV block. What syndrome is characterized by melon ECG changes?

Frederica Q701

Male, 36 years old. According to relatives, the patient has been ill for 4 days, about 7 hours ago, shortness of breath, a sharp chill appeared, weakness and pain in the chest increased, the body temperature dropped sharply to 35.70 C. Objectively: a serious condition, inhibited, NPV - 30, cyanosis, pulse threadlike, 104 bpm, blood pressure 60/40 mm. rt. Art. In the lungs, breathing is hard, moist rales throughout the pulmonary fields.

Deaf heart sounds, heart rate - 104 per minute. Diuresis is reduced. The development of which determines the severity of the condition:

Infectious toxic shock Q702

Male, 28 years old. The reason for calling the ambulance brigade is an accident. Objectively: a state of moderate severity, clear consciousness. The skin is pale. In the lungs, vesicular breathing, no wheezing, respiratory rate - 18 per minute. Heart sounds are loud, the rhythm is correct. HELL 90/50 mm Hg, heart rate - 100 bpm, pulse - 100 beats / min. Deformity of the left thigh, bleeding wound is locally determined.

Determine the degree of shock:

 

I

 

Q703

 

Woman 30 years old, pregnancy 36 weeks. Complaints of headaches, dizziness, nausea, vomiting, swelling in the legs. Objectively, the condition is serious, the consciousness is inhibited, clonic-tonic convulsions are noted. In the lungs, breathing is weakened, no wheezing. NPV 32 per min. The heart sounds are muffled, the rhythm is correct, the heart rate is 100 per minute. HELL 170/110 mm Hg The fetal heartbeat is preserved. Which drug will you completely exclude from the assistance program?

Polyglyukin

Q704

 

.Man, 38 years old. Complaints of pain in the epigastric region, arising after eating, vomiting of gastric contents, bringing relief. Deterioration in health for about two days, after consuming alcohol and fried food, pain resumed, vomiting joined. Objectively, the condition is moderate, clear consciousness. The skin is clean, of normal color. Tongue moist, coated with white bloom. Stable hemodynamics. The chair is irregular, without pathological impurities. Your preliminary diagnosis:

Stomach ulcer Q705

Woman, 46 years old. Complaints of paroxysmal dyspnea, cough with difficult to separate viscous sputum. History: bronchial asthma for 10 years. The deterioration of the state is associated with hypothermia. The last day of inhalation of salbutamol does not stop the attack. Objectively: the condition is serious. Orthopnea, NPV 42 / min. The skin is pale, moist, acrocyanosis. Auscultation: in the lungs, breathing is weakened, in all fields there are dry wheezing rales, in the lower parts of the “silent” lung. Heart rate 110 / min. BP 150/90 mm Hg

Urgent Care:

 

oxygen inhalation, glucocorticoids, anticoagulants, intravenous infusion of solutions, Question706

Patient 35 years old. Complaints - general weakness, rapid fatigue, loss of appetite, weight loss, temperature up to 37.4 in the second half of the day, periodic dry cough, mixed shortness of breath at rest. From the anamnesis - within six months I was on a business trip abroad. Upon arrival (10 days ago), the listed complaints appeared. I did not go to the doctor. He was treated independently. Worsening notes in the evening. On examination - normosthenic body type, reduced nutrition. The skin is dry. T-36.9. With percussion - pulmonary sound. On auscultation - vesicular breathing, single dry rales over the upper lobes.

NPV - 22 per minute. BP - 100/60 mm Hg Heart rate - 92 per minute. Provide first aid: oxygen therapy, infusion therapy

Q707

 

The young man was found unconscious on the street. On examination, there was no bodily injury. Skin with pronounced cyanosis, along the veins in the arms, traces of injections. Breathing is rare, shallow with periods of apnea, 8 - 10 in 1 minute. Muffled heart sounds, heart rate 60 in 1 minute. What drug should be administered to the patient?

Naloxone Q708

Upon the arrival of an ambulance, a woman, 40 years old, with no signs of life, was found on the call. According to relatives: she lost consciousness about 10 minutes ago, she had not been ill with anything before. Objectively: consciousness, pulse on the carotid arteries, breathing, pupil reaction to light are absent, the skin is pale, warm. Cardiopulmonary resuscitation was performed. One of the criteria for the effectiveness of cardiopulmonary resuscitation

the appearance of a pulse on the carotid artery

Q709

 

Male, 38 years old. Reason for calling the SMP: hit by a car. I did not lose consciousness. I could not get up and stand on my own feet due to severe pain in the right half of the pelvis. Objectively: a state of moderate severity. The skin is of a normal color, in the ilium and the bosom on the right, there are subcutaneous hemorrhages. Ps - 96 / min., Satisfactory filling and voltage, BP 130/80 mm Hg. Art. The abdomen is soft, painful above the bosom. Peritoneal symptoms are negative. Didn't urinate. Determine the type of transportation:

On a rigid stretcher lying on your back with legs bent at the knees Question 710

Male, 26 years old. Complaints of nausea, vomiting, growing headache. From the anamnesis: a few hours ago, during unloading work, he was injured by negligence, a wooden board fell on the parietal region of the head. I did not lose consciousness, I did not ask for help. The condition worsened sharply after 5 hours, when the above complaints appeared, in connection with which he caused an ambulance. Objectively: the condition is serious, restless, tossed about, groans because of a painful, bursting headache. Chills, convulsions are noted. Hoarse, intermittent breathing. Muffled heart sounds, bradycardia. HELL 90/60 mm Hg Pathological reflexes are revealed. What is the most likely diagnosis?

CCMT. Intracranial bleeding. Compression of the brain Q711

Patient 72 years old. Complaints of shortness of breath with difficult exhalation, cough with difficult to separate viscous sputum, dizziness, chest discomfort. From the anamnesis - ischemic heart disease, heart failure, PIM, hypertension, bronchitis, asthma, prescribed treatment takes situational. The deterioration is associated with hypothermia. I did not go to the doctor. I took only Ventolin in 2 doses, no improvement. On examination - cyanosis of the nasolabial triangle. Orthopnea. Pasty feet. The chest is emphysematous. The auxiliary muscles are involved in the act of breathing. When percussion - boxed sound over the upper lobes, dullness over the lower lobes .. Excursion of the lungs is reduced. On auscultation, hard breathing. In the lower sections, weakened, dry wheezing in the upper sections, single moist in the lower sections. NPV - 36 per minute. HELL - 150/100 mm Hg Heart rate - 90 per minute. This patient is contraindicated:

Narcotic analgesics Question712

Woman, 25 years old. Complaints of acute pain in the lower abdomen radiating to the anus, general weakness, dizziness. She fell ill acutely, 30 minutes ago. Anamnesis: irregular menstrual cycle. Last menstruation - 2 months. back. Objectively: the patient is pale, lethargic. Pulse 120 in 1 min., Heart rate 120 in 1 min., BP 85/50 mm Hg. Painful abdomen in the hypogastric region. Positive symptom of Shchetkin-Blumberg. Minor bloody discharge from the genital tract is noted. Patient management tactics:

transportation to the gynecological department Question713

Child 6 years old. Complaints of pain in the right ear. According to his mother, half an hour ago he fell on the playground and hit the edge of the sandbox. Objectively, the condition is relatively

satisfactory. Consciousness is clear. Neurological status without pathology. A small amount of blood is released from the right ear canal. The scope of prehospital care in this situation includes:

tamponade of the ear canal with dry sterile gauze turunda Question 714

The victim has multiple trauma: fracture of the left thigh and both legs. The approximate volume of blood loss based on the location of fractures is:

2000 ml Q715

Woman, 28 years old. Complaints of acute pains in the lower abdomen, radiating to the anus, which arose when lifting a heavy tank of water. History: chronic salpingo-oophoritis, last menstruation 3 weeks ago, irregular. Objectively: pale, covered with cold sticky sweat, retching and defecation. Heart rate 100 / min., BP 90/60 mm Hg. What sign is missing in this situation:

bloody discharge from the uterus Q716

A young woman with severe anaphylactic shock has severe laryngeal edema. What must be done first of all to deliver the patient alive to the hospital?

conduct a conicotomy Question717

An elderly patient suddenly developed a sharp pain behind the sternum, followed by a dry cough, dizziness. A little later, inspiratory dyspnea and cyanosis, combined with pallor of the skin, developed. Pathological pulsation in the epigastric region is visually determined. Percussion - expansion of the right border of the heart, auscultatory - the accent of the II tone and its bifurcation over the pulmonary artery. Preliminary diagnosis

TELA

 

Question718

 

Consciousness is absent. Clonic-tonic convulsions, dilated pupils with no reaction to light, spotted cyanosis. There is a rapid transition from tachypnea (heart rate 40 or more) to bradypnea (respiratory rate 8-10 per minute). A drop in blood pressure, heart rate> 140 per minute, atrial fibrillation is possible, Ra 02 is reduced to 50 mm Hg. Art., PaCO2 increases to 80-90 mm Hg. Art. and more. What stage of ARF is the above described clinical picture typical for?

III

 

Question719

 

Male, 45 years old. Complaints of cough with discharge of mucopurulent sputum, shortness of breath, weakness. Anamnesis: smokes for 30 years. For 12-15 years, intermittent dry cough in the morning worries. Was not examined, received no treatment. The above complaints appeared the day before

in the afternoon, after prolonged hypothermia. Objectively: cyanosis of the nasolabial triangle. Body temperature 37.5 ° C. NPV - 26 per min. On auscultation in the lungs, hard breathing, dry and moist large bubbling rales. When percussed, a pulmonary sound with a boxed tone. What is your preliminary diagnosis?

exacerbation of chronic obstructive bronchitis Q720

The cook turned over a thermos with freshly cooked porridge. Screams in pain, restless, excited. Objectively: on the trousers from the level of the knee joints to the ankles and on the skin of the feet, hands and left forearm, there is adhered liquid porridge, in the free areas the skin is hyperemic, edematous, exfoliated in the form of bubbles with a transparent liquid. The bottom of the opened blisters is scarlet, shiny, painful, in some places with white specks, dry. BP 110/75 mm Hg. Art, pulse 86 beats per minute, rhythmic. What is the likely degree of thermal burn?

ΙΙΙ A degree Question721

Male, 52 years old. Complaints about the feeling of palpitations, shortness of breath and discomfort in the region of the heart without irradiation. From the anamnesis: the above complaints arose 2 hours ago, after mental stress. I took a 40 mg verapamil tablet on my own, no improvement. Called the ambulance. Objectively: clear consciousness, excited. The skin is pale. In the lungs, vesicular breathing, no wheezing, NPV 22 beats. in 1 min. The heart sounds are muffled, the rhythm is correct. Pulse 180 beats. in 1 min., rhythmic, small filling. BP 100/70 mm. rt. Art. On the ECG: the rhythm is correct, ventricular tachycardia, heart rate - 180 per minute. The drug of choice in this case?

Lidocaine Q722

Male, 46 years old. Complaints about aching, squeezing pains behind the breastbone, which appeared after brisk walking. From the anamnesis: he has been suffering from coronary artery disease for about 5 years, 5-6 weeks ago he was treated for ACS. Objectively: a state of moderate severity, clear consciousness, normal color of the skin. In the lungs, vesicular breathing, no wheezing. The heart sounds are muffled, the rhythm is correct. HELL 130/90 mm Hg Heart rate and pulse - 86 beats. in min. On the ECG: the rhythm is correct, sinus, the normal position of the EOS. In leads I, aVL, V1-V2, there is a pathological Q wave and a negative T wave. What is the stage of myocardial infarction in this patient?

subacute Question723

Girl, 2 years old. From the anamnesis: fell from the horizontal bar. There was a short-term loss of consciousness, there was a single vomiting. BP 65/20, HR: 140 / min., HR: 38 / min. Body temperature 36.7 ° C. The muscle tone is increased. The skin is pale. Auscultation in the lungs no pathology, sonorous heart sounds. On the back of the head, a hematoma of 3x4 cm is revealed. The conjunctival reflex is absent, the gag reflex is preserved. There is a dilation of the pupil on the right, with a decrease in reaction to light. Oculocephalic reflex is positive. Reflexes of Brudzinsky, Kernig are negative. Babinsky's reflex is positive on the left. Your preliminary diagnosis and management of the patient:

Brain contusion, transportation to the neurological department Question 724

The cause of laryngostenosis in young children:

 

immaturity of the respiratory center Q725

The patient is 48 years old. Complaints - mixed shortness of breath, aggravated by the slightest exertion, dry cough, temperature up to 38.8. History - sick for 2 weeks, after hypothermia. I did not go to the doctor. He was treated independently. On examination: Pale skin, cyanosis of the nasolabial triangle. Zev is calm. The ribcage is cylindrical. Lagging of the left half of the chest during breathing. Percussion dullness of sound over the lower lobe on the left. On auscultation - hard breathing, single dry rales on the front surface, over the lower lobe of the left lung, breathing is not heard. NPV - 24 per minute. BP - 110/70 mm Hg Heart rate - 94 per minute. For the rest of the organs and systems without pathology. Further tactics of conducting:

Hospitalization in the thoracic department Question 726

Male, 19 years old. No complaints due to the severity of the condition. About 5 minutes ago, it was removed from the loop while trying to hang. Objectively: the condition is serious, there is no consciousness.

Spontaneous breathing, convulsions. HELL 100/70 mm Hg Pulse 120 / min. NPV 14 per min. What is the most appropriate tactic for an ambulance doctor?

introduction of an airway, administration of anticonvulsants, transportation to a hospital

Question727

 

A call to a man, 46 years old. In the middle of the night I woke up with pain in the region of my heart, feeling short of breath. There are no changes on the ECG. The anamnesis previously had the same nocturnal attacks, did not seek help. Took nitroglycerin, no effect. What drug is most acceptable for the patient to take when the next attack of pain occurs?

nifedipine Q728

Most Effective Treatment for Carbon Monoxide Poisoning: Hyperbaric Oxygenation

Question729

 

The patient is 48 years old. Complaints - mixed shortness of breath, aggravated by the slightest exertion, dry cough, temperature up to 38.8. History - sick for 2 weeks, after hypothermia. I did not go to the doctor. He was treated independently. On examination: Pale skin, cyanosis of the nasolabial triangle. The ribcage is cylindrical. Lagging of the left half of the chest during breathing. Percussion dullness of sound over the lower lobe on the left. On auscultation - hard breathing, single dry wheezing on the anterior surface, above the lower

lobes of the left lung, breathing is not heard. NPV - 24 per minute. BP - 110/70 mm Hg Heart rate

- 94 per minute. For the rest of the organs and systems without pathology. Provide first aid: oxygen therapy, antipyretics

Q730

 

Woman 35 years old. Complaints of headaches, dizziness, single vomiting, loss of consciousness. This condition is noted after a fall in altitude 3-4 hours ago. Objectively, the condition is moderate. Clouded consciousness. She is unstable in the Romberg position, does not perform a finger-nose test. There are no vesicular wheezing in the lungs. NPV 20 per min. Heart sounds are clear, the rhythm is correct, heart rate is 86 per minute. BP 110/70 mm Hg The abdomen is soft and painless.

The amount of emergency care allowed in this condition: Dehydration therapy

Question731

 

Woman, 32 years old. Complaints about itching and rashes. From the anamnesis: the appearance of a rash is associated with taking diclofenac tablets. Objectively: the skin of the neck and chest is not abundant, brightly hyperemic, large-spotted rash, traces of scratching. HELL 120/70 mm Hg, body temperature 37.50 C. Which group of drugs should be used for first aid:

Sedative Question732

Calling an ambulance team for a child 1.5 years old. According to the mother: while eating, a sudden attack of coughing developed against the background of complete health, shortness of breath appeared, aggravated by anxiety. Objectively: pale skin, cyanosis of the face, stenotic breathing, hoarseness. Your preliminary diagnosis:

foreign body of the respiratory tract Question733

Woman, 32 years old, pregnancy 38 weeks + 3 days - second pregnancy, second birth. At the time of the examination: the contractions were regular, intense, and the amniotic fluid had receded. During transportation in the SMP car, the woman in labor began to struggle and the handle fell out. The tactics of the ambulance brigade in this situation:

put a napkin on the perineum and deliver to the nearest maternity hospital Question 734

The girl is 16 years old. Complaints due to the severity of the condition. According to my mother, an hour ago, she ate a lot of citrus fruits, after which itching appeared all over the body and then the patient lost consciousness. This state is noted for the first time. Objectively, the condition is serious. Consciousness is absent. The skin is hyperemic, there is a rash all over the body, rising above the surface, merging in places. There are no vesicular wheezing in the lungs. NPV 22 per min. Heart sounds are deaf, the pulse is threadlike, blood pressure is 50/30 mm Hg. The abdomen is soft and painless. What is the applicable dosage of prednisolone in this situation:

20-25 mg / kg

Question735

 

Calling an ambulance team for a child 1.5 years old. According to the mother, he fell ill acutely, there was an increase in body temperature up to 38.2 ºС, a runny nose, moderate catarrhal phenomena. At night there was a hoarseness of voice, a "barking" cough, a noisy breath during anxiety. BH 42 per minute, heart rate 140 per minute. What is your preliminary diagnosis?

ARVI. Acute laryngotracheitis, laryngeal stenosis, I degree Q736

Male locksmith, 32 years old. An hour ago, he was injured by a piece of iron in his right eye. The injured eye immediately lost sight. During the examination, it was found that the uniform vision of the right eye is absent, but the patient sees the light and correctly indicates its direction. Severe corneal syndrome. Bright mixed injection of the conjunctiva of the eyeball. At three o'clock, 4 mm from the limbus, a lacerated wound of the cornea measuring 2 by 4 mm was found, its edges were swollen. A dark brown amorphous tissue is pinched between them. There is no front camera. The iris is dark brown, pulled up to the wound. The eye is painful on palpation. Your preliminary diagnosis:

penetrating corneal injury of the right eye Question 737

Patient 45 years old. Complaints of general weakness, malaise, decreased appetite, weight loss, dyspnea of ​​a mixed nature at rest and aggravated by the slightest exertion, pain in the right half of the chest, intermittent cough with scanty viscous sputum with a yellowish tinge. From the anamnesis - 3 years ago he was operated on for cr antrum of the stomach. Real aggravation within 4-5 months, did not go to the doctor. He took expectorant drugs himself, without improvement. On examination, there was a slight cyanosis of the nasolabial triangle. T - 37.1. Swelling of the lower extremities up to the middle 1/3 of the legs. The ribcage is cylindrical. The right half lags slightly behind the left when breathing. Percussion over the right lung in the projection of the middle lobe is dullness. On auscultation - over the middle lobe, breathing is sharply weakened, single moist rales. Excursion of the lungs on the right is reduced. NPV - 28 per minute. BP - 100/70 mm Hg Heart rate - 96 per minute. Provide first aid:

Oxygen therapy Q738

A curious one-year-old child put his hand into a bucket of boiling lime. The tactics of the ambulance brigade and the neutralization of the burn:

Application with 20% glucose solution, solution of prednisolone in / m Question 739

Patient, 76 years old. Complaints of sharp, girdling pain in the upper abdomen. The pain came on suddenly after eating fatty foods. The pain is unbearable, there is repeated vomiting, which does not give relief, weakness, profuse sweating. Anamnesis: gallstone disease, ischemic heart disease, hypertension. Objectively: the condition is severe, the skin is covered with cold sweat, the body temperature is 37.2. Pulse 125 beats. in min. arrhythmic, BP 140/90 mm Hg Breathing is vesicular. Tongue dry, coated with white bloom. The abdomen is moderately swollen on palpation, soft, painful in the epigastrium. Symptoms of peritoneal irritation are negative. Your preliminary diagnosis:

Acute pancreatitis Q740

The patient is 39 years old. Complaints - shortness of breath with difficult exhalation, dry paroxysmal cough, runny nose. From the anamnesis - I went into the bathroom at work and the smell of household chemicals started to develop shortness of breath. Before the arrival, the SMP did not take any medications. On examination: orthopnea, cyanosis of the nasolabial triangle, mucous discharge from the nose. The chest is closer to emphysematous. With percussion - box sound. The excursion of the lungs is reduced. On auscultation - against the background of hard breathing, multiple dry wheezing rales. NPV - 32 per minute. BP - 120/80 mm Hg Heart rate - 102 per minute. Further tactics of conducting:

Observation of a local doctor, pulmonologist, allergist Question741

Man, 69 years old. Complaints of sharp chest pain, shortness of breath, severe weakness. From the anamnesis: the day before, during physical activity, shortness of breath and chest pain suddenly appeared. History of decompensated thrombophlebitis of the right lower extremity. Objectively: a serious condition, clear consciousness, agitated, diffuse cyanosis. Crepitation above the lungs on the right at the level of the scapula. NPV 26 per min. The heart sounds are muffled, the rhythm is correct, the heart rate is 120 / min. BP 110/80 mm Hg The abdomen is soft and painless. ECG: the rhythm is correct, sinus, P-pulmonale in II, III, AVF, right bundle branch block. What is your diagnosis?

pulmonary embolism Q742

The most common symptom for pulmonary hemorrhage is:

 

discharge of scarlet foamy sputum Question 743

The patient is 39 years old. Complaints - shortness of breath with difficult exhalation, dry paroxysmal cough, runny nose. From the anamnesis - I was on the bus, suddenly there was a pungent smell of perfume, after which shortness of breath began. Before the arrival of the ambulance service, she did not take any medications (it was over). On examination: orthopnea, cyanosis of the nasolabial triangle, mucous discharge from the nose. The chest is closer to emphysematous. With percussion - box sound. The excursion of the lungs is reduced. On auscultation - against the background of hard breathing, multiple dry wheezing rales. NPV - 32 per minute. BP - 120/80 mm Hg Heart rate - 102 per minute. This patient is contraindicated:

Narcotic analgesics Question744

Man, 43 years old. Complaints of burning pain behind the breastbone, profuse sweat, shortness of breath. From the anamnesis: an attack of pain occurred for the first time, self-administration of analgesics is ineffective. Called the ambulance. Objectively: The condition is serious, restless. The skin is pale, moist. Cyanosis of the lips. Breathing is shallow, no wheezing. NPV 28 per min. Deaf heart sounds, irregular rhythm, heart rate 100-110 per minute. Pulse 100-110 per minute, weak filling, extrasystoles. BP 80/40 mm Hg The abdomen is soft and painless. ECG: ST elevation in III, aVF, V5-V6 leads.

There are extraordinary deformed QRS complexes. Where is myocardial injury located?

posterolateral wall of the left ventricle Q745

Male, 28 years old. Complaints of pain in the left arm. From the anamnesis: received a blow with a wooden bar on the left forearm. Objectively: there is a subcutaneous hematoma on the outer palmar surface of the lower third of the left forearm. Palpation of the injury site is painful, crepitus of bone fragments is determined. With a load along the axis of the forearm, pain appears at the site of injury. Pronation and supination are difficult, an attempt to produce these movements causes severe pain.

The distal forearm and hand are in the pronated position. Your preliminary diagnosis:

Fracture of the diaphysis of the left radial bone in the lower third Question 746

Male, 58 years old. Complaints about feeling short of breath, shortness of breath at rest, cough with the release of a large amount of foamy sputum with a pink tint, anxiety, weakness. From the anamnesis: for 10 years suffers from arterial hypertension, does not receive regular antihypertensive treatment. Worsening of the condition within 3 hours. The general condition is serious, the consciousness is clear, the patient is agitated. The face is hyperemic. In the lungs: percussion pulmonary sound, auscultatory - in all pulmonary fields a mass of moist large and small bubbling rales.

NPV 30 in 1 min. Heart sounds are muffled, the rhythm is correct, heart rate is 100 per 1 min. BP 210/100 mm Hg The abdomen is soft, painless, the liver is not enlarged. On the ECG: the rhythm is correct, sinus.

Signs of left ventricular hypertrophy. What's your diagnosis?

 

Arterial hypertension III degree Risk 3. Type I hypertensive crisis. Pulmonary edema Q747

Priority maneuver for bleeding from a wound in an extremity:

 

harness imposition Question748

Male, 50 years old. Complaints of paroxysmal dyspnea, cough with difficult mucous sputum. History: bronchial asthma. Deterioration after ARVI. The number of inhalations of Berodual was increased up to 10 times. The last 2 days, the attack does not stop completely. Objectively: the condition is serious. Orthopnea, NPV 34 / min. Noisy wheezing exhalation. The skin is pale, moist, cyanosis of the nasolabial triangle. Auscultation: in the lungs, breathing is weakened, areas of the "silent" lung. Heart rate 120 / min. BP 140/90 mm Hg How is the ineffectiveness of the berodual explained?

Development of the "Ricochet" symptom

 

Male, 58 years old. Slipped in the street and fell on a bent knee. Experiencing severe knee pain when bringing the lower leg forward. The knee joint is thickened, the presence of fluid in the joint is determined. An attempt to detect the symptom of "ballot" of the patella causes severe pain. The patient cannot lift a straightened leg. Your preliminary diagnosis:

patella fracture

Male, 53 years old. Complaints of choking, shortness of breath with difficult exhalation, a feeling of fear, pronounced general weakness. From the anamnesis: for about 15 years suffering from bronchial asthma, for 3 years receiving hormonal therapy, regularly using inhalation of salbutamol. The deterioration of the condition is noted in the morning, after the cleaning of the apartment. Before the arrival, the SMP took 4 doses of salbutamol, with an interval of 30 minutes, without improvement. Objectively: the condition is serious.

The position is orthopedic. Consciousness is clear. Severe cyanosis of the lips and nasolabial triangle, acrocyanosis, hyperemia of the face. In the lungs, breathing is hard, in all fields there are dry wheezing rales heard at a distance, expiratory dyspnea, respiratory rate - 34 per minute. Heart sounds are muffled, the rhythm is correct, heart rate and pulse - 100 per minute, blood pressure 160/100 mm Hg. What condition did this patient develop?

asthmatic status