9110636
Descrição
Quiz por yogesh mandavi, atualizado more than 1 year ago
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Criado por yogesh mandavi
mais de 7 anos atrás
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|
Questão 1
Questão
A 56-year-old scientist experiences constricting retrosternal pain several times a day while
walking for 100-150 m. The pain lasts for up to 10 minutes and can be relieved by nitroglycerine.
Objectively: the patient is overweight, heart borders exhibit no abnormalities, heart sounds are
rhythmic, Ps- 78 bpm, AP- 130/80 mm Hg. ECG contains low amplitude of T wave in
V4-5. What disease might be suspected?
Responda
-
Instable stenocardia
-
Stable FC III stenocardia
-
Stable FC I stenocardia
-
Stable FC II stenocardia
-
Stable FC IV stenocardia
Questão 2
Questão
3 hours before, a 68-year-old male patient got a searing chest pain radiating to the neck and left
forearm, escalating dyspnea. Nitroglycerin failed to relieve pain but somewhat reduced
dyspnea. Objectively: there is crimson cyanosis of face. Respiratory rate is 28/min. The patient
has vesicular breathing with isolated sibilant rales. Heart sounds are muffled, with a gallop
rhythm. Ps - 100/min, AP - 100/65 mmHg. ECG shows negative T-wave in V2-V6 leads. What
drug can reduce the heart's need for oxygen without aggravating the disease?
Responda
-
Isosorbide dinitrate
-
Corinfar
-
Atenolol
-
Streptokinase
-
Aminophylline
Questão 3
Questão
A 47-year-old male patient has been lately complaining of compressing chest pain that occurs
when he walks a distane of 700-800 m. Once a week, he drinks 2 liters of beer. Rise in arterial
pressure has been observed for the last 7 years. Objectively: Ps - 74/min, AP - 120/80 mm Hg.
The bicycle ergometry performed at workload of 75 watts shows 2 mm ST-segment
depression in V4-V6 leads. What is the most likely diagnosis ?
Responda
-
Exertional stenocardia, III functional class
-
Exertional stenocardia, IV functional class
-
Exertional stenocardia, II functional class
-
Vegetative-vascular dystonia of hypertensive type
-
Alcoholic cardiomyopathy
Questão 4
Questão
A patient with unstable angina pectoris was given the following complex treatment:
anticoagulants, nitrates, α-adrenoblockers. However on the third day of treatment the
pain still romains. Which in vestigation shoud be carried out to establish diagnosis?
Responda
-
Stress-echocardiogram
-
Test with dosed physical exercises
-
Esophageal electrocardiac stimulator
-
Coronarography
-
Myocardial scintigraphy
Questão 5
Questão
A 42-year-old patient applied to hospital with complaints of pain behind the sternum with
irradiation to the left scapula. The pain appears during significant physical work, this lasts for
5-10 minutes and is over on rest. The patient is sick for 3 weeks. What is the preliminary
diagnosis?
Responda
-
IHD:Variant angina pectoris (Prinzmetal's)
-
IHD:Stable angina pectoris of effort I FC
-
IHD:Stable angina pectoris of effort IV FC
-
IHD:Progressive angina pectoris
-
IHD:First established angina pectoris
Questão 6
Questão
Thrombosis of the coronary artery caused myocardial infarction. What mechanisms of injury will
be the dominating ones in this disease?
Responda
-
Electrolytoosmotic mechanisms
-
Calcium mechanisms
-
Acidotic mechanisms
-
Protein mechanisms
-
Lipid mechanisms
Questão 7
Questão
An 18-year-old patient presents no problems. Percussion reveals that heart borders are
displaced to the right and left by 1 cm, there is a coarse systolic murmur with its epicenter within
the 4th intercostal space on the left. What is the most informative examination to confirm the
clinical diagnosis?
Responda
-
ECG
-
PCG
-
Echocardiography
-
Ventriculography
-
Polycardiography
Questão 8
Questão
A 29-year-old female patient complains of dyspnea and palpitations on exertion. According to
her mother, as a child she had heart murmur, did not undergo any examinations. Objectively: the
patient has pale skin, Ps- 94/min, rhythmic. AP- 120/60 mm Hg. In the II intercostal space on
the left auscultation reveals a continuous rasping systolodiastolic murmur, diastolic shock above
the pulmonary artery. Blood and urine are unremarkable. What is the most likely diagnosis?
Responda
-
Atrial septal defect
-
Ventricular septal defect
-
Aortarctia
-
Tetralogy of Fallot
-
Patent ductus arteriosus
Questão 9
Questão
Examination of a 35-year-old patient with rheumatism revealed that the right heart border was 1
cm displaced outwards from the right parasternal line, the upper border was on the level with
inferior margin of the 1st rib, the left border was 1 cm in from the left midclavicular line.
Auscultation revealed atrial fibrillation, loud apical first sound, diastolic shock above the
pulmonary artery. Echocardiocopy revealed abnormal pattern of the mitral valve motion. What
heart disease is characterized by these symptoms?
Responda
-
Mitral valve prolapse
-
Mitral valve insufficiency
-
Mitral stenosis
-
Aortic stenosis
-
Tricuspid valve insufficiency
Questão 10
Questão
A 67-year-old male complains of dyspnea on exertion, attacks of retrosternal pain, dizziness.
He has no history of rheumatism. Objectively: pale skin, acrocyanosis. There are rales in the
lower parts of lungs. There is systolic thrill in the II intercostal space on the right, coarse systolic
murmur conducted to the vessels of neck. AP- 130/90 mm Hg, heart rate - 90/min, regular
rhythm. The liver extends 5 cm under the edge of costal arch, shin edemata are present.
Specify the assumed valvular defect:
Responda
-
Pulmonary artery stenosis
-
Mitral insufficiency
-
Aortic stenosis
-
Ventricular septal defect
-
Tricuspid regurgitation
Questão 11
Questão
A 18 y.o. female student complains of dyspnea during the intensive exertion. The condition
became worse half a year ago. On examination: pulse rate is 88 bpm, accelerated, AP- 180/20
mm Hg, pale skin, heart borders are dilated to the left and up. There is systolic-diastolic murmur
in the 2hd intercostal space, S2 at pulmonary artery is accentuated. ECG has revealed both
ventricles hypertrophy. Thoracic X-ray has revealed pulsation and protrusion of the left
ventricle, lung trunk. What doctor's tactics should be?
Responda
-
Cardiosurgeon consultation
-
Dispensary observation
-
Administration of therapeutic treatment
-
Continuation of investigation
-
Exemption from physical exercises
Questão 12
Questão
A female rheumatic patient experiences diastolic thoracic wall tremor (diastolic thrill),
accentuated S1 at apex, there is diastolic murmur with presystolic intensification, opening
snap, S2 accent at pulmonary artery. What rind of heart disorder is observed?
Responda
-
Aortic valve insufficiency
-
Pulmonary artery stenosis
-
Mitral valve insufficiency
-
Mitral stenosis
-
Opened arterial duct
Questão 13
Questão
A 60-year-old patient has been admitted to a hospital with complaints of dyspnea, tightness in
the right subcostal area, abdomen enlargement. These presentations have been progressing
for a year. Heart auscultation reveals presystolic gallop rhythm. Objectively: swelling of the neck
veins, ascites, palpable liver and spleen. What disease requires differential diagnostics?
Responda
-
Hepatocirrhosis
-
Lung cancer with invasion to the pleura
-
Chronic pulmonary heart
-
Pulmonary embolism
-
Constrictive pericarditis
Questão 14
Questão
On the 3rd day after the acute anterior myocardial infarction a 55 y.o. patient complains of dull
ache behind his breast bone, that can be reduced by bending forward, and of dyspnea.
Objectively: AP- 140/180 mm Hg, heart sounds are dull. ECG results: atrial fibrillation with
frequence of ventricular contractions at the rate of 110/min, pathological Q wave and S-T
segment raising in the right chest leads. The patient refused from thrombolisis. What is the most
probable diagnosis?
Responda
-
Pulmonary embolism
-
Tietze's syndrome
-
Acute pericarditis
-
Dissecting aortic aneurysm
-
Dressler's syndrome
Questão 15
Questão
A 43-year-old female patient complains of dyspnea, swelling of legs, abdomen enlargement,
pricking heart pain. She has a history of tuberculous bronchadenitis, quinsies. The patient's
condition deteriorated 6 months ago. Objectively: cyanosis, bulging neck veins, vesicular
breathing. Heart borders are not displaced. Heart sounds are muffled, Ps is 106/min, liver is +4
cm, ascites is present. Low voltage on the ECG has been revealed. Radiograph shows a thin
layer of calcium deposits along the left contour of heart. What treatment should be
recommended to the patient?
Responda
-
Treatment by a cardiac surgeon
-
Digitalis preparations
-
Anti-TB drugs
-
Diuretics
-
Vasodilators, nitrates
Questão 16
Questão
A 28-year-old patient complains of periodic compressing heart pain. His brother died at the age
of 34 from a cardiac disease with similar symptoms. Objectively: the patients skin is pale. Heart
borders display no significant deviations. Heart sounds are loud, there is a systolic murmur
above all the points with a peak above the aorta. Echocardioscopy reveals thickening of the
interventricular septum in the basal parts, reduction of left ventricular cavity. What drug should
be administered in order to prevent the disease progression?
Responda
-
Digoxin
-
Metoprolol
-
Nitroglycerin
-
Captopril
-
Furosemide
Questão 17
Questão
A 37 y.o. woman is suffering from squeezing substernal pain on physical exertion. On
examination: AP- 130/80 mm Hg, heart rate=pulse rate 72 bpm, heart boarders are dilated to
the left side, aortic systolic murmur. ECG- signs of the left venticle hypertrophy. What method of
examination is the most informative in this case?
Responda
-
Phonocardiography
-
Coronarography
-
Sphygmography
-
Echocardiography
-
X-ray
Questão 18
Questão
A 57-year-old man complains of shortness of breath, swelling on shanks, irregularity in cardiac
work, pain in the left chest half with irradiation to the left scapula. Treatment is uineffective. On
physical exam: heart's sounds are diminished, soft systolic murmur on the apex. Ps - 100/min,
arrhythmical, BP - 115/75 mm Hg. The liver is +2 cm, painful. Roentgenoscopy: enlargement of heart shadow to all sides, pulsation is weak. Electrocardiogram (ECG): left ventricled extrasystolia, decreased voltage. What method of investigation is necessary to do to determine the diagnosis?
Responda
-
Echocardiography
-
Veloergometria
-
X-ray kymography
-
ECG in the dynamics
-
Coronarography
Questão 19
Questão
A 56-year-old patient with diffuse toxic goiter has ciliary arrhythmia with pulse rate of 110 bpm,
arterial hypertension, AP- 165/90 mm Hg. What preparation should be administered along with
mercazolil?
Responda
-
Propranolol
-
Radioactive iodine
-
Procaine hydrochloride
-
Verapamil
-
Corinfar
Questão 20
Questão
171
A 43 y.o. woman complains of shooting heart pain, dyspnea, irregularities in the heart activity,
progressive fatigue during 3 weeks. She had acute respiratory disease a month ago. On
examination: AP- 120/80 mm Hg, heart rate 98 bpm, heart boarders +1,5 cm left side, sounds
are muffled, soft systolic murmur at apex and Botkin's area; sporadic extrasystoles. Liver isn't
palpated, there are no edema. Blood test: WBC- 6,7x109/L, sedimentation rate- 21 mm/hour. What is the most probable diagnosis?
Responda
-
Climacteric myocardiodystrophia
-
Ichemic heart disease, angina pectoris
-
Rheumatism, mitral insufficiency
-
Acute myocarditis
-
Hypertrophic cardiomyopathy
Questão 21
Questão
A 47-year-old male patient complains of compressive chest pain that occurs both at rest and
during light physical activity; irregular heartbeat. These problems arose 3 months ago. The
patient's brother died suddenly at the age of 30. Objectively: Ps - 84/min, arrhythmic, AP -
130/80 mm Hg. ECG confirms signs of left ventricular hypertrophy, abnormal Q-waves in V4-V6
leads. EchoCG reveals that interventricular septum is 1,7 cm, left ventricular wall thickness is
1,2 cm. What is the most likely diagnosis?
Responda
-
Exertional angina
-
Neurocirculatory asthenia
-
Hypertrophic cardiomyopathy
-
Myocarditis
-
Pericarditis
Questão 22
Questão
A 55-year-old male had been treated at the surgical department for acute lower-extremity
thrombophlebitis. On the 7th day of treatment he suddenly developed pain in the left part of
chest, dyspnea and cough. Body temperature was 36,1oC, respiratory rate - 36/min. The
patient was also found to have diminished breath sounds without wheezing. Ps- 140/min,
thready. AP- 70/50 mm Hg. The ECG shows QІІІ-S1 syndrome. What is the most likely
diagnosis?
Responda
-
Myocardial infarction
-
Pulmonary embolism
-
Cardiac asthma
-
Bronchial asthma
-
Pneumothorax
Questão 23
Questão
A 49-year-old male patient complains of dyspnea of combined nature, cough, shin edemata,
abdomen enlargement due to ascites. He has a 20-year history of chronic bronchitis. For the
last 3 years he has been disabled (group II) because of cardiac changes. Objectively: mixed
cyanosis, edemata. Ps - 92/min, rhythmic, AP - 120/70 mm Hg, respiration rate - 24/min. There
is accentuation of the second sound above the pulmonary artery. Auscultation reveals the box
resonance above the lungs. There are also dry rales over the entire surface of lungs. What is
the mechanism of heart changes development in this patient?
Responda
-
Kitaev's reflex
-
Bainbridge reflex
-
Cardiovascular reflex
-
Respiratory reflex
-
Euler-Liljestrand reflex
Questão 24
Questão
A 60 y.o. patient experiences acute air insufficiency following of the venoectomy due to
subcutaneous vein thrombophlebitis 3 days ago. Skin became cianotic, with grey shade. Marked
psychomotor excitement, tachypnea, substernal pain. What postoperative complication has
occured?
Responda
-
Hemorrhagia
-
Hypostatic pneumonia
-
Thromboembolia of pulmonary artery
-
Myocardial infarction
-
Valvular pneumothorax
Questão 25
Questão
181
A 57-year-old male patient complains of dyspnea on exertion, heaviness in the right
hypochondrium and shin edemata towards evening. Objectively: temperature - 38,1oC, HR-
20/min, HR=Ps=92/min, AP- 140/90 mm Hg. There is apparent kyphoscoliosis. In the lungs
single dry rales can be auscultated. Heart sounds are muffled, rhythmic. ECG: Rv1+Sv5=15
mm. X-ray picture shows the bulging of pulmonary artery cone, right ventricle enlargement. What
is the most likely cause of this condition?
Responda
-
Atherosclerotic cardiosclerosis
-
Dilatation cardiomyopathy
-
Mitral stenosis
-
Pulmonary heart
-
Primary pulmonary hypertension
Questão 26
Questão
A 67 y.o. patient complains of palpitation, dizziness, noise in ears, feeling of shortage of air.
Objectively: pale, damp skin. Vesicular respiration, respiratory rate- 22 per min, pulse- 200 bpm,
AP- 100/70 mm Hg. On ECG: heart rate- 200 bmp, ventricular complexes are widened,
deformed, location of segments ST and of wave T is discordant. The wave Р is not changed,
superimposes QRST, natural conformity between Р and QRS is not present. What kind of
arrhythmia is present?
Responda
-
Sinus tachycardia
-
Paroxismal ventricular tachycardia
-
Atrial flutter
-
Ventricular extrasystole
-
Atrial tachycardia
Questão 27
Questão
A 76-year-old male consulted a therapist about slow discharge of urine with a small jet. The
patient reported no cardiac problems. Examination revealed atrial fibrillation with a heart rate of
72/min and without pulse deficit. There are no signs of heart failure. ECG confirms the presence
of atrial fibrillation. From history we know that the arrhythmia was detected three years ago.
What tactics for the treatment of atrial fibrillation in the patient should be chosen?
Responda
-
Verapamil
-
Digoxin
-
Obzidan
-
Ajmaline
-
Does not require treatment
Questão 28
Questão
A 46-year-old patient complains of sudden palpitation, which is accompanied by pulsation in the
neck and head, fear, nausea. The palpitation lasts for 15-20 minutes and is over after straining
when holding her breath. What kind of cardiac disorder may be suspected?
Responda
-
An attack of supraventricular paroxysmal tachycardia
-
An attack of ventricular paroxysmal tachycardia
-
An attack of atrial flutter
-
An attack of ciliary arrhythmia
-
An attack of extrasystolic arrhythmia
Questão 29
Questão
A 26-year-old female patient has an 11-year history of rheumatism. Four years ago she
suffered 2 rheumatic attacks. Over the last 6 months there have been paroxysms of atrial
fibrillation every 2-3 months. What option of antiarrhythmic therapy or tactics should be proposed?
Responda
-
Immediate hospitalization
-
Prophylactic administration of cordarone
-
Defibrillation
-
Lidocaine administration
-
Heparin administration
Questão 30
Questão
A 53-year-old female patient complains of cardiac pain and rhythm intermissions. She has
experienced these presentations since childhood. The patient's father had a history of cardiac
arrhythmias. Objectively: the patient is in grave condition, Ps- 220 bpm, AP- 80/60 mm Hg. ECG
results: heart rate - 215/min, extension and deformation of QRS complex accompanied by
atrioventricular dissociation; positive P wave. Some time later heart rate reduced down to
45/min, there was a complete dissociation of P wave and QRST complex. Which of the
following will be the most effective treatment?
Responda
-
$\beta$-adrenoreceptor blocking agents
-
Cholinolytics
-
Implantation of the artificial pacemaker
-
Calcium antagonists
-
Cardiac glycosides
Questão 31
Questão
A 64 y.o. patient has developed of squeering substernal pain which had appeared 2 hours ago
and irradiated to the left shoulder, marked weakness. On examination: pale skin, cold sweat.
Pulse- 108 bpm, AP- 70/50 mm Hg, heart sound are deaf, vesicular breathing, soft abdomen,
painless, varicouse vein on the left shin, ECG: synus rhythm, heart rate is 100 bmp,
ST-segment is sharply elevated in II, III aVF leads. What is the most likely disorder?
Responda
-
Pulmonary artery thromboembolia
-
Cardiac asthma
-
Disquamative aortic aneurizm
-
Cardiogenic shock
-
Cardiac tamponade
Questão 32
Questão
A 54-year-old drowned man was rescued from the water and delivered to the shore. Objectively:
the man is unconscious, pale, breathing cannot be auscultated, pulse is thready. Resuscitation
measures allowed to save the patient. What complications may develop in the near future?
Responda
-
Pulmonary edema
-
Respiratory arrest
-
Encephalopathy
-
Cardiac arrest
-
Bronchospasm
Questão 33
Questão
A 60-year-old female patient had been admitted to a hospital for acute transmural infarction. An
hour later the patient's contition got worse. She developed progressing dyspnea, dry cough.
Respiratory rate - 30/min, heart rate - 130/min, AP- 90/60 mm Hg. Heart sounds were muffled,
there was also diastolic shock on the pulmonary artery. The patient presented with medium
moist rales in the lower parts of lungs on the right and on the left. Body temperature -
$36,4^oC$. What drug should be given in the first place?
Responda
-
Aminophylline
-
Promedol
-
Dopamine
-
Heparin
-
Digoxin
Questão 34
Questão
A 62-year-old male has been hospitalized in the intensive care unit with a continuous attack of
retrosternal pain that cannot be relieved by nitroglycerin. Objectively: AP- 80/60 mm Hg, heart
rate - 106/min, breathing rate - 22/min. Heart sounds are muffled, a gallop rhythm is present.
How would you explain the AP drop?
Responda
-
Reduction in peripheral resistance
-
Reduction in cardiac output
-
Blood depositing in the abdominal cavity
-
Adrenergic receptor block
-
Internal haemorrhage
Questão 35
Questão
After myocardial infarction, a 50-year-old patient had an attack of asthma. Objectively: bubbling
breathing with frequency of 32/min, cough with a lot of pink frothy sputum, acrocyanosis, swelling
of the neck veins. Ps- 108/min, AP- 150/100 mm Hg. Heart sounds are muffled. Mixed moist
rales can be auscultated above the entire lung surface. What drug would be most effective in
this situation?
Responda
-
Nitroglycerin intravenously
-
Pentamin intravenously
-
Strophanthin intravenously
-
Dopamine intravenously
-
Aminophylline intravenously
Questão 36
Questão
A 58-year-old patient complains of a headache in the occipital region, nausea, choking,
opplotentes. The presentations appeared after a physical exertion. Objectively: the patient is
excited. Face is hyperemic. Skin is pale. Heart sounds are regular, the 2nd aortic sound is
accentuated. AP- 240/120 mm Hg, HR- 92/min. Auscultation reveals some fine moist rales in
the lower parts of the lungs. Liver is not enlarged. ECG shows signs of hypertrophy and left
ventricular overload. What is the most likely diagnosis?
Responda
-
Acute myocardial infarction, pulmonary edema
-
Complicated hypertensic crisis, pulmonary edema
-
Bronchial asthma exacerbation
-
Uncomplicated hypertensic crisis
-
Community-acquired pneumonia
Questão 37
Questão
A 57-year-old male patient had an attack of retrosternal pain that lasted more than 1,5 hours.
Objectively: the patient is inert, adynamic, has pale skin, cold extremities, poor volume pulse,
heart rate - 120/min, AP - 70/40 mm Hg. ECG shows ST elevation in II, III, aVF leads. What
condition are these changes typical for?
Responda
-
Arrhythmogenic shock
-
Perforated gastric ulcer
-
Cardiogenic shock
-
Acute pericarditis
-
Acute pancreatitis
Questão 38
Questão
A 67-year-old female patient with hypertensive crisis has asthma, cough with expectoration of
frothy pink sputum, moist rales in the lungs. The patient stays in sitting position, respiratory rate
is 40/min, AP- 214/136 mm Hg, heart rate - 102/min. What is the most rational tactics of this
patient management?
Responda
-
Intravenous administration of furosemide
-
Urgent pneumography
-
Bed rest, lying position
-
Intravenous administration of a β-blocker
-
Tactics can be determined after ECG and chest radiography
Questão 39
Questão
A 63-year-old male patient with persistent atrial fibrillation complains of moderate dyspnea.
Objectively: peripheral edemata are absent, vesicular breathing is present, heart rate - 72/min,
AP - 140/90 mm Hg. What combination of drugs will be most effective for the secondary
prevention of heart failure?
Responda
-
Beta-blockers, ACE inhibitors
-
Beta-blockers, cardiac glycosides
-
Cardiac glycosides, diuretics
-
Cardiac glycosides, ACE inhibitors
-
Diuretics, beta-blockers
Questão 40
Questão
In the development of the inflammation processes glucocorticoids reduce the level of certain
most important active enzyme. It results also in the reducing of the synthesis of prostaglandins
and leucotrienes which have a key role in the development of inflammation processes. What is
the exact name of this enzyme?
Responda
-
Phospholipase A2
-
Arachidonic acid
-
Lipoxygenasе
-
Cyclooxygenase – 1
-
Cyclooxygenase – 2
Questão 41
Questão
A 18 y.o. male patient complains of pain in knee and ankle joints, temperature elevation to
39,5oC. He had a respiratory disease 1,5 week ago. On examination: temperature-
38,5oC, swollen knee and ankle joints, pulse- 106 bpm, rhythmic, AP- 90/60 mm Hg, heart
borders without changes, sounds are weakened, soft systolic apical murmur. What indicator is
connected with possible etiology of the process?
Responda
-
1-antitrypsine
-
Antistreptolysine-0
-
Creatinkinase
-
Rheumatic factor
-
Seromucoid
Questão 42
Questão
After a holiday in the Crimea, a 36-year-old female patient presents with severe pain in the
elbow joints, dyspnea and weakness. The body temperature is of 37,6oC, the skin is pale,
there is erythema of cheeks and nose, lower lip ulceration. Visual inspection reveals no
changes in the joints, the right elbow movement is limited. There is murmur and pleural friction in
the lungs below the right angle of the scapula. Cardiac sounds are muffled, there is tachycardia,
gallop rhythm, Ps- 114/min. AP- 100/60. What is the most likely diagnosis?
Responda
-
Rheumatic heart disease
-
Rheumatoid arthritis
-
SLE
-
Infectious allergic myocarditis
-
Dry pleurisy
Questão 43
Questão
A 58-year-old patient complains about sensation of numbness, sudden paleness of II-IV fingers,
muscle rigidness, intermittent pulse. The patient presents also with polyarthralgia, dysphagia,
constipations. The patient's face is masklike, solid edema of hands is present. The heart is
enlarged; auscultation revealed dry rales in lungs. In blood: ESR- 20 mm/h, crude protein - 85/l,
γ-globulines - 25%. What is the most likely diagnosis?
Responda
-
Dermatomyositis
-
Rheumatoid arthritis
-
Systemic lupus erythematosus
-
Systemic scleroderma
-
Raynaud's disease
Questão 44
Questão
A 39-year-old male patient complains of moderate pain and weakness in the shoulder, back and
pelvic girdle muscles, that has been progressing for the last 3 weeks; great difficulty in getting
out of bed, going up and down the stairs, shaving. Dermatomyositis has been suspected. Blood
test results: Hb- 114 g/l, WBC- 10,8*109/l, eosinophils - 9%, ESR -22 mm/h, C-reactive
protein - (++). The alteration in the following laboratory value wil be of decisive diagnostic
significance:
Responda
-
Ceruloplasmin
-
Sialic acids
-
dsDNA antibodies
-
Gamma-globulins
-
Creatine phosphokinase
Questão 45
Questão
A 38-year-old patient is under observation having polyneuritic syndrome with considerable loss
of weight, fever, rise in BP. Blood test:: considerable inflammatory changes. What examination
is the most expedient to make the diagnosis?
Responda
-
Determination of antinuclear antibodies
-
Electromyography
-
Muscular biopsy with histological investigation of the material
-
Blood culture
-
Determination of HLA antigens
Questão 46
Questão
A 32-year-old patient has a 3-year history of asthma attacks, that can be hardly stopped with
berotec. Over a few last months he has experienced pain in the joints and sensitivity disorder of
legs and feet skin. Ps - 80/min, AP - 210/100 mm Hg. In blood: eosinophilia at the rate of 15%.
What disease can be suspected in this case?
Responda
-
Systemic lupus erythematosus
-
Systemic scleroderma
-
Dermatomyositis
-
Wegener's disease
-
Periarteritis nodosa
Questão 47
Questão
A 30 y.o. female with rheumatoid arthritis of five years duration complains of pain in the frist
three fingers of her right hand over past 6 weeks. The pain seems especially severe at night
often awakening her from sleep.The most likelly cause is?
Responda
-
Carpal tunnel syndrome
-
Atlanto-axial sublaxation of cervical spine
-
Sensory peripheral neuropathy
-
Rheumatoid vasculitis
-
Rheumatoid arthritis without complication
Questão 48
Questão
A 35-year-old patient complains about pain and morning stiffness of hand joints and
temporomandibular joints that lasts over 30 minutes. She has had these symptoms for 2 years.
Objectively: edema of proximal interphalangeal digital joints and limited motions of joints. What
examination should be administered?
Responda
-
Complete blood count
-
Roentgenography of hands
-
Rose-Waaler reaction
-
Immunogram
-
Proteinogram
Questão 49
Questão
A patient has an over a year-old history of fast progressive rheumatoid arthritis. X-raying
confirms presence of marginal erosions. What basic drug would be the most appropriate in this
case?
Responda
-
Chloroquine
-
Methotrexate
-
Prednisolone
-
Diclofenac sodium
-
Aspirin
Questão 50
Questão
A 60-year-old female patient complains of recurrent pain in the proximal interphalangeal and
wrist joints, their periodic swelling and reddening that have been observed for 4 years. X-ray
picture represents changes in form of osteoporosis, joint space narrowing and single usuras.
What is the most likely diagnosis?
Responda
-
Rheumatoid arthritis
-
Osteoarthritis
-
Gout
-
Pseudogout
-
Multiple myeloma
Questão 51
Questão
A 58-year-old woman complains of osteoarthrosis of knee-joint. For 2 weeks she had been
receiving an in-patient medical treatment. She was discharged from the hospital in satisfactory
condition with complaints of minor pain after prolonged static work. Local hyperemia and
exudative effects in the area of joints are absent. What further tactics is the most expedient?
Responda
-
Repeated in-patient treatment
-
Conducting arthroscopy
-
Refferral to MSEC
-
Orthopedist consultation
-
Outpatient treatment
Questão 52
Questão
A 36-year-old female patient complains of intense pain in the knee joints and neck. In the
morning she experiences pain in the interscapular region and leg joints; pain subsides after
warm-up gymnastics. The patient is overnourished, there is a clicking sound in the knees when
squatting, the knees are somewhat disfigured, painful on palpation. Blood test results: ESR- 18
mm/h, WBC- 8,0*109/l. Radiography reveals subchondral sclerosis in the left knee.
What is the basis of this pathology?
Responda
-
Autoimmune process in the synovium
-
Degenerative processes in cartilage
-
Deposition of urates (tophi) in the articular tissues
-
Beta-haemolytic streptococcus
-
Hemarthrosis
Questão 53
Questão
A 53-year-old male has been admitted to a hospital for an attack of renal colic which has
repeatedly occurred throughout the year. Objectively: in the region of auricles and the right
elbow some nodules can be seen that are covered with thin shiny skin. Ps- 88/min, AP- 170/100
mm Hg. There is bilateral costovertebral angle tenderness (positive Pasternatsky's symptom).
The patient has been scheduled for examination. What laboratory value would be most helpful
for making a diagnosis?
Responda
-
Uric acid
-
Rheumatoid factor
-
ESR
-
Urine sediment
-
Lactic acid
Questão 54
Questão
A patient, aged 40, has been ill during approximately 8 years, complains of pain in the lumbar
part of the spine on physical excertion, in cervical and thoracal part (especially when coughing),
pain in the hip and knee joints on the right. On examination: the body is fixed in the forward
inclination with head down, gluteal muscles atrophy. Spine roentgenography: ribs osteoporosis,
longitudinal ligament ossification. What is the most likely diagnosis?
Responda
-
Tuberculous spondylitis
-
Ancylosing spondyloarthritis
-
Psoriatic spondyloarthropatia
-
Spondyloarthropatia on the background of Reiter's disease
-
Spread osteochondrosis of the vertebral column
Questão 55
Questão
A 32-year-old male patient has been suffering from pain in the sacrum and coxofemoral joints,
painfulness and stiffness in the lumbar spine for a year. ESR- 56 mm/h. Roentgenography
revealed symptoms of bilateral sacroileitis. The patient is the carrier of HLA B27 antigen. What
is the most likely diagnosis?
Responda
-
Coxarthrosis
-
Rheumatoid arthrit
-
Reiter's disease
-
Ankylosing spondylitis
-
Spondylosis
Questão 56
Questão
A 35-year-old patient has been admitted to a hospital for pain in the left sternoclavicular and
knee joints, lumbar area. The disease has an acute character and is accompanied by fever up
to 38oC. Objectively: the left sternoclavicular and knee joints are swollen and painful. In
blood: WBCs - 9,5x109/l, ESR - 40 mm/h, CRP - 1,5 millimole/l, fibrinogen - 4,8 g/l, uric
acid - 0,28 millimole/l. Examination of the urethra scrapings reveals chlamydia. What is the most
likely diagnosis?
Responda
-
Rheumatic arthritis
-
Gout
-
Bechterew's disease
-
Rheumatoid arthritis
-
Reiter's syndrome
Questão 57
Questão
A 26-year-old male patient complains of pain in the right knee, which is getting worse in the
morning. Two weeks before, he consulted an urologist about prostatitis. Objectively:
conjunctivitis is present. There is also periarticular edema of the knee joint, redness of the
overlying skin. Rheumatoid factor was not detected. Until further diagnosis is specified, it would
be reasonable to start treatment with the following antibiotic:
Responda
-
Cephalosporins
-
Penicillins
-
Aminoglycosides
-
Tetracyclines
-
Lincosamides
Questão 58
Questão
A 24 y.o. patient complains of nausea, vomiting, headache, shortness of breath. He had an
acute nephritis being 10 y.o. Proteinuria was found out in urine. Objectively: a skin is grey-pale,
the edema is not present. Accent of II tone above aorta. BP 140/100-180/100 mm Hg. Blood
level of residual N2- 6,6 mmol/L, creatinine- 406 mmol/L. Day's diuresis- 2300 ml, nocturia.
Specific density of urine is 1009, albumin- 0,9 g/L, WBC- 0-2 in f/vis. RBC.- single in f/vis.,
hyaline casts single in specimen. Your diagnosis?
Responda
-
Chronic nephritis with violation of kidney function
-
Feochromocitoma
-
Hypertensive illness of the II degree
-
Stenosis of kidney artery
-
Nephrotic syndrome
Questão 59
Questão
A 25-year-old man has facial edema, moderate back pains. His temperature is 37,5oС, BP
180/100 mm Hg, hematuria [up to 100 in v/f], proteinuria [2,0 g/L], hyaline casts - 10 in v/f., specific gravity -1020. The onset of the disease is probably connected with acute tonsillitis that started 2 weeks ago. What is the most probable diagnosis?
Responda
-
Acute pyelonephritis
-
Cancer of the kidney
-
Urolithiasis
-
Acute glomerulonephritis
-
Chronic glomerulonephritis
Questão 60
Questão
A 26-year-old patient undergoes a course of treatment due to chronic glomerulonephritis. The
treatment was successful, normalization of all the characteristics was recorded. What
sanitorium and health resort treatment could be recommended?
Responda
-
Morshyn
-
Not recommended
-
Myrhorod
-
Truskavets
-
The south coast of the Crimea
Questão 61
Questão
2 weeks after recovering from angina a 29-year-old patient noticed face edemata, weakness,
decreased work performance. There was gradual progress of dyspnea, edemata of the lower
extremities, lumbar spine. Objectively: pale skin, weakening of the heart sounds, anasarca. AP-
160/100 mm Hg. In urine: the relative density - 1021, protein - 5 g/l, erythrocytes - 20-30 in the
field of vision, hyaline cylinders - 4-6 in the field of vision. What is the most likely diagnosis?
Responda
-
Essential hypertension
-
Acute pyelonephritis
-
Acute glomerulonephritis
-
Infectious allergic myocarditis
-
Myxedema
Questão 62
Questão
A 54-year-old patient has an over 20-year history of femoral osteomyelitis. Over the last month
she has developed progressing edemata of the lower extremities. Urine test reveals: proteinuria
at the rate of 6,6 g/l; in blood: dysproteinemia in form of hypoalbuminemia, increase in
α2- and γ-globulin rate, ESR - 50 mm/h. What is the most likely diagnosis?
Responda
-
Acute glomerulonephritis
-
Secondary renal amyloidosis
-
Myelomatosis
-
Chronic glomerulonephritis
-
Systemic lupus erythematosus
Questão 63
Questão
2 weeks after having quinsy, a 26-year-old male patient got facial edemata, moderate pain in the
sacrum. Objectively: body temperature is 37,5oC, AP- 100/80 mm Hg. Urinalysis results:
RBC- up to 100 fresh cells in per HPF, protein - 2,2 g/l, hyaline cylinders - up to 10 per HPF,
relative density - 1002. What is the most likely diagnosis?
Responda
-
Nephroma
-
Acute pyelonephritis
-
Urolithiasis
-
Acute glomerulonephritis
-
Chronic glomerulonephritis
Questão 64
Questão
A 54-year-old male patient complains of aching pain in the lumbar region, that is getting worse
after standing in an upright position, physical exercise, supercooling. The patient also reports of
experiencing weakness in the afternoon. Pain in the lumbar region, said about 10 years old.
Objectively: pale skin, to- 37,2oC, AP- 180/100 mm Hg, minor costovertebral angle
tenderness (Pasternatsky symptom). In blood: RBCs - 3,5x1012/l, WBCs - 6,5x109/l, ESR - 22 mm/h. In urine: the relative density - 1010, leukocytes - 12-15 in the field of vision, erythrocytes - 2-3 in the field of vision. Urine bacterial count - 100000 in 1 ml. What is the most likely diagnosis?
Responda
-
Nephrolithiasis
-
Chronic pyelonephritis
-
Polycystic renal disease
-
Chronic glomerulonephritis
-
Amyloidosis
Questão 65
Questão
A 72-year-old patient after operation due to holecystectomia was prescribed gentamicin (80 mg
every 8 hours) and cephalothin (2 g every 6 hours) due to fever. In 10 days there was an
increase of creatinine up to 310 mu*mol/L. BP - 130/80 mm Hg, daily quantity of the urine is
1200 mL. Urine tests are without pathology. Ultrasound: the size of kidneys is normal.
What is the most probable reason for renal failure?
Responda
-
Nephrotoxity of gentamicin
-
Acute glomerulonephritis
-
Unequal infusion of the liqiud
-
Cortical necrosis of kidneys
-
Hepatorenal syndrome
Questão 66
Questão
A 37-year-old patient was brought to resuscitation unit. General condition of the patient is very
serious. Sopor. The skin is grey, moist. Turgor is decreased. Pulse is rapid, intense. BP -
160/110 mm Hg, muscle tonus is increased. Hyperreflexia. There is an ammonia odor in the air.
What is the presumptive diagnosis?
Responda
-
Alcoholic coma
-
Uraemic coma
-
Hypoglycemic coma
-
Hyperglycemic coma
-
Cerebral coma
Questão 67
Questão
A 35-year-old patient has been in the intensive care unit for acute renal failure due to crush for
4 days. Objectively: the patient is inadequate. Breathing rate - 32/min. Over the last 3 hours
individual moist rales can be auscultated in lungs. ECG shows high T waves, right ventricular
extrasystoles. CVP - 159 mm Hg. In blood: the residual nitrogen - 62 millimole/l, K+- 7,1
millimole/l, Cl- - 78 millimole/l, Na+- 120 millimole/l, Ht - 0,32, Hb - 100 g/l, blood creatinine
- 0,9 millimole/l. The most appropriate method of treatment would be:
Responda
-
Hemosorption
-
Plasma sorption
-
Hemodialysis
-
Plasma filtration
-
Ultrafiltration
Questão 68
Questão
A 28-year-old woman has a 12-year history of chronic glomerulonephritis with latent course.
Over the past six months she has developed general weakness, loss of appetite, low work
performance, nausea. The patient complains of headache, pain in the joints. On examination:
anemia, blood urea - 34,5 millimole/l, blood creatinine - 0,766 millimole/l, hyperkalemia. What
complication has developed?
Responda
-
Nephrotic syndrome
-
Acute renal insufficiency
-
Renal amyloidosis
-
Pyelonephritis
-
Chronic renal insufficiency
Questão 69
Questão
177
A patient has chronic heart failure of the II stage. He takes furosemide regularly three times a
week. He had developed bronchopneumonia and had been administered combined
pharmacotherapy. On the fifth day of therapy the patient complained of hearing impairment.
What drug coadministered with furosemide might have caused the hearing loss?
Responda
-
Linex
-
Gentamicin
-
Nystatin
-
Tavegil
-
Mucaltin
Questão 70
Questão
A 30-year-old woman with a long history of chronic pyelonephritis complains about considerable
weakness, sleepiness, decrease in diuresis down to 100 ml per day. AP- 200/120 mm Hg. In
blood: creatinine - 0,62 millimole/l, hypoproteinemia, albumines - 32 g/l, potassium - 6,8
millimole/l, hypochromic anemia, increased ESR. What is the first step in the patient treatment
tactics?
Responda
-
Enterosorption
-
Antibacterial therapy
-
Haemosorption
-
Haemodialysis
-
Blood transfusion
Questão 71
Questão
A 41-year-old male patient was delivered to a hospital unconscious. During the previous 7 days
he had been taking large doses of biseptolum for a cold. The night before, he began complaining
of dyspnea, especially when lying down, swollen legs, 2-day urinary retention. In the morning he
had seizures and lost consciousness. Objctively: noisy breathing at the rate of 30/min,
edematous legs and lumbar region, Ps- 50/min. Plasma creatinine is 0,586 mmol/l, plasma
potassium - 7,2 mmol/l. What treatment is necessary for this patient?
Responda
-
Large doses of verospiron
-
Hemodialysis
-
Plasma volume expanders
-
Glucocorticosteroids
-
Heparin
Questão 72
Questão
A 40 y.o. patient was admitted to the gasteroenterology with skin itching, jaundice, discomfort in
the right subcostal area, generalized weakness. On examination: skin is jaundice, traces of
scratches, liver is +5 cm, splin is 6x8 cm. In blood: alkaline phosphatase - 2,0 mmol/(hour*L),
general bilirubin - 60 mkmol/L, cholesterol - 8,0 mmol/L. What is the leading syndrome in the
patient?
Responda
-
Сholestatic
-
Сytolytic
-
Mesenchymal inflammatory
-
Asthenic
-
Liver-cells insufficiency
Questão 73
Questão
A 40-year-old man is ill with autoimmune hepatitis. Blood test: А/G ratio 0,8, bilirubin – 42 mu*mol/L, transaminase: ALT- 2,3 mmol g/L, АSТ - 1,8 mmol g/L. What is the most effective means in treatment from the given below?
Responda
-
Antibacterial medication
-
Hepatoprotectors
-
Glucocorticoids, cytostatics
-
Antiviral medications
-
Hemosorbtion, vitamin therapy
Questão 74
Questão
A 42-year-old female patient suffers from micronodular cryptogenic cirrhosis. Over the last
week her condition has deteriorated: she developed convulsions, mental confusion, progressing
jaundice. What study may give reasons for such aggravation?
Responda
-
Determination of cholesterol ethers
-
Determination of alpha-phetoprotein
-
Determination of ALAT and ASAT
-
Determination of serum ammonia
-
Determination of alkaline phosphatase
Questão 75
Questão
The complications of acute cholecystitis which require surgical intervention are as follows
EXCEPT:
Responda
-
Empyema of the gall-bladder
-
Emphysematous gall-bladder
-
Gall-bladder perforation
-
Cholangitis conditioned by the presence of stones in the bile tract
-
Jaundice
Questão 76
Questão
A 37-year-old patient has sudden acute pain in the right epigastric area after having fatty food.
What method of radiological investigation is to be used on the first stage of examining the
patient?
Responda
-
Roentgenological
-
Radionuclid
-
Magnetic-resonance
-
Ultrasonic
-
Thermographic
Questão 77
Questão
150
A 50-year-old patient complains about having pain attacks in the right subcostal area for about a
year. He pain arises mainly after taking fattening food. Over the last week the attacks occurred
daily and became more painful. On the 3rd day of hospitalization the patient presented with
icteritiousness of skin and scleras, light-colored feces and dark urine. In blood: neutrophilic
leukocytosis - 13,1x109/l, ESR- 28 mm/h. What is the most likely diagnosis?
Responda
-
Chronic recurrent pancreatitis
-
Chronic calculous cholecystitis
-
Fatty degeneration of liver
-
Chronic cholangitis, exacerbation stage
-
Hypertensive dyskinesia of gallbladder
Questão 78
Questão
A 55 y.o. patient complains of distended abdomen and rumbling, increased winds evacuation,
liguid foamy feces with sour smell following the diary products consumption. What is the correct
name of this syndrome?
Responda
-
Syndrome of decayed dyspepsia
-
Syndrome of fatty dyspepsia
-
Dyskinesia syndrome
-
Malabsorption syndrome
-
Syndrome of fermentative dyspepsia
Questão 79
Questão
A 48-year-old male patient complains of constant pain in the upper abdomen, mostly on the left,
that is getting worse after taking meals; diarrhea, weight loss. The patient is an alcohol abuser. 2
years ago he had acute pancreatitis. Blood amylase is 4 g/h*l. Coprogram shows steatorrhea, creatorrhea. Blood glucose is 6,0 mmol/l. What treatment is indicated for this patient?
Responda
-
Panzinorm forte
-
Insulin
-
Gastrozepin
-
Contrycal
-
No-spa
Questão 80
Questão
4 hours after having meals a patient with signs of malnutrition and steatorrhea experiences
stomach pain, especially above navel and to the left of it. Diarrheas take turns with constipation
lasting up to 3-5 days. Palpation reveals moderate painfulness in the choledochopancreatic
region. The amylase rate in blood is stable. X-ray reveals some calcifications located above
navel. What is the most likely diagnosis?
Responda
-
Duodenal ulcer
-
Chronic gastroduodenitis
-
Zollinger-Ellison syndrome
-
Chronic pancreatitis
-
Chronic calculous cholecystitis
Questão 81
Questão
A 56 y.o. man, who has taken alcoholic drinks regularly for 20 years, complains of intensive
girdle pain in the abdomen. Profuse nonformed stool 2-3- times a day has appeared for the last
2 years, loss of weight for 8 kg for 2 years. On examination: abdomen is soft, painless. Blood
amylase - 12g/L. Feces examination-neutral fat 15 g per day, starch grains. What is the most
reasonable treatment at this stage?
Responda
-
Contrykal
-
Aminocapron acid
-
Pancreatine
-
Levomicytine
-
Imodium
Questão 82
Questão
A 64-year-old male patient has a 35-year history of chronic pancreatitis. In the last 5 years, he
claims to observe the pain abatement, bloating, frequent bowel movements up to 3-4 times a
day, grayish, glossy stool with undigested food rests, the progressive loss of body weight.
Change of symptoms in the patient is due to overlay of:
Responda
-
Exocrine pancreatic insufficiency
-
Endocrine pancreatic insufficiency
-
Lactase deficiency syndrome
-
Irritable bowel syndrome
-
Chronic enterocolitis
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