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Internal Medicine Complex(2005,2006,2007)

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internal Medicine (Internal Medicine) Quiz on Internal Medicine Complex(2005,2006,2007), created by yogesh mandavi on 22/05/2017.
yogesh mandavi
Quiz by yogesh mandavi, updated more than 1 year ago
yogesh mandavi
Created by yogesh mandavi over 7 years ago
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Question 1

Question
A patient with unstable angina pectoris was given the following complex treatment: anticoagulants, nitrates, /alpha-adrenoblockers. However on the third day of treatment the pain still romains. Which investigation shoud be carried out to establish diagnosis?
Answer
  • Test with dosed physical exercises
  • Stress-echocardiogram
  • Coronarography
  • Esophageal electrocardiac stimulator
  • Myocardial scintigraphy

Question 2

Question
A 64 y.o. patient has developed of squeering substernal pain which had appeared 2 hours ago and irradiated to the left shoulder, marked weakness. On examination: pale skin, cold sweat. Pulse- 108 bpm, AP- 70/50 mm Hg, heart sound are deaf, vesicular breathing, soft abdomen, painless, varicouse vein on the left shin, ECG: synus rhythm, heart rate is 100 bmp, ST-segment is sharply elevated in II, III aVF leads. What is the most likely disorder?
Answer
  • Cardiogenic shock
  • Cardiac asthma
  • Pulmonary artery thromboembolia
  • Disquamative aortic aneurizm
  • Cardiac tamponade

Question 3

Question
A patient had macrofocal myocardial infarction. He is overweight for 36%, AP is 150/90 mm Hg, blood sugar- 5,9 mmol/L, general cholesterol- 4,9 mmol/L, uric acid- 0,211 mmol/L. Which risk factor should be urgently eradicated during the secondary prevention?
Answer
  • Arterial hypertension
  • Obesity
  • Hyperglycemia
  • Hypercholesterolemia
  • Hyperuricemia

Question 4

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

Question 5

Question
A 40 y.o. patient of rheumatic heart disease complains of anorexia, weakness and loss of weigth, breathless and swelling of feet. On examination: t 0- 390C, pulse is 100/min. As ucultation: diastolic murmur in the mitral area. Petechical lesion a round clavicle; spleen was palpable, tooth extraction one month ago.
Answer
  • Aortic stenosis
  • Mitral stenosis
  • Subacute bacteria endocarditis
  • Thrombocytopenia purpure
  • Recurrence of rheumatic fever

Question 6

Question
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, 7 ∗109/L, sedimentation rate- 21 mm/hour. What is the most probable diagnosis?
Answer
  • Hypertrophic cardiomyopathy
  • Ichemic heart disease, angina pectoris
  • Climacteric myocardiodystrophia
  • Rheumatism, mitral insufficiency
  • Acute myocarditis

Question 7

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

Question 8

Question
A 35 y.o. male patient suffers from chronic glomerulohephritis and has been on hemodialysis for the last 3 years. He has developed irregularities in the heart activity, hypotension, progressive weakness, dyspnea. On ECG: bradycardia, 1st degree atrioventicular block, high sharpened T-waves. Before he had severely disturbed the drinking and diet regimen. What is the most likely cause of these changes?
Answer
  • Hypokaliemia
  • Hyperkaliemia
  • Hyperhydratation
  • Hypernatremia
  • Hypocalcemia

Question 9

Question
A 37 y.o. woman is suffering from squeezing substernal pain on physical exertion. On examination: AP- 130/80 mm Hg, heart rate=pulse rate 72 bpm, heart boarders are dilated to the left side, aortic systolic murmur. ECG- signs of the left venticle hypertrophy. What method of examination is the most informative in this case?
Answer
  • Coronarography
  • Sphygmography
  • Phonocardiography
  • Echocardiography
  • X-ray

Question 10

Question
A 18 y.o. male patient complains of pain in knee and ankle joints, temperature elevation to 39, 50C. He had a respiratory disease 1,5 week ago. On examination: temperature- 38, 50C, swollen knee and ankle joints, pulse- 106 bpm, rhythmic, AP- 90/60 mm Hg, heart borders without changes, sounds are weakened, soft systolic apical murmur. What indicator is connected with possible etiology of the process?
Answer
  • 1-antitrypsine
  • Antistreptolysine-0
  • Creatinkinase
  • Rheumatic factor
  • Seromucoid

Question 11

Question
A 17 y.o. patient complains of acute pain in the knee joint and t 0 – 3 80C. He was ill with angina 3 weeks ago. Objectively: deformation and swelling of the knee joints with skin hyperemia. Small movement causes an acute pain in the joints. Which diagnose is the most correct?
Answer
  • Systemic lupus eritematodes
  • Reactive polyarthritis
  • Infectious-allergic polyarthritis
  • Rheumatism, polyarthritis
  • Rheumarthritis

Question 12

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

Question 13

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

Question 14

Question
3 weeks ago the patient was ill with tonsillitis. Clinical examination reveals edema, arterial hypertension, hematuria, proteinuria (1,8 g/per day), granular and erythrocital casts. What is the preliminary diagnosis?
Answer
  • Glomerulonephritis
  • Cystitis
  • Pyelonephritis
  • Intestinal nephritis
  • Renal amyloidosis

Question 15

Question
A male patient presents with swollen ankles, face, eyelids, elevated AP- 160/100 mm Hg, pulse- 54 bpm, daily loss of albumine with urine- 4g. What therapy is pathogenetic in this case?
Answer
  • Antibiotics
  • Calcium antagonists
  • Corticosteroids
  • NSAID
  • Diuretics

Question 16

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

Question 17

Question
47 y.o. patient complains of intensive skin itching, jaundice, bone pain. The skin is hyperpigmentated. There is multiple xanthelasma palpebrae. The liver is +6 cm enlarged, hard with acute edge. The blood analysis revealed total bilirubin 160 mkmol/L, direct – 110 mkmol/L, AST (asparate aminotransferase)- 2,1 mmol/L per hour, ALT – 1,8 mmol/L, alkaline phosphotase- 4,6 mmol/L per hour, cholesterol – 9,2 mmol/L, antimitochondrial antibodies M2 in a high titer. What is the probable diagnosis?
Answer
  • Alcoholic liver cirrhosis
  • Chronic viral hepatitis B
  • Acute viral hepatitis B
  • Primary biliary liver cirrhosis
  • Primary liver cancer

Question 18

Question
A 51 y.o. woman complains of dull pain in the right subcostal area and epigastric area, nausea, appetite decline during 6 months. There is a history of gastric peptic ulcer. On examination: weight loss, pulse is 70 bpm, AP is 120/70 mm Hg. Diffuse tenderness and resistance of muscles on palpation.There is a hard lymphatic node 1x1cm in size over the left clavicle. What method of investigation will be the most useful?
Answer
  • pH-metry
  • Ultrasound examination of abdomen
  • Esophagogastroduodenoscopy with biopsy
  • Ureatic test
  • Stomach X-ray

Question 19

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

Question 20

Question
A 61 y.o. man complained of sneezing and substernal pain on exertion. In the last 2 weeks such pain appeared at rest, with increased frequency, and couldn’t be suppressed by 1 tablet of nitroglycerin. What is the most likely diagnosis?
Answer
  • Angina pectoris of a new onset
  • Myocarditis
  • Stable angina pectoris of the III functional class
  • Unstable angina pectoris
  • Radiculitis

Question 21

Question
A 52 y.o. male patient suffers from squeezing pain attacks in substernal area which irradiates to the left hand and occurs occasionally and on physical exercises. He has had it for 1 year. On examination: heart borders are enlargement to the left side, sounds are muffled, Ps- 76 bpm, rhythmic, AP- 155/80 mm Hg, ECG: the left type, the rest signs are normal. What additional examination is necessary to confirm the diagnosis?
Answer
  • Lipoprotein test
  • Veloergometry
  • Echocardiography
  • General blood count
  • Transaminases

Question 22

Question
A 58 y.o. man complained of severe inspiratory dyspnea and expectoration of frothy and bloodtinged sputum. He has been suffering from essential hypertension and ischemic heart disease. On examination: acrocyanosis, "bubbling"breathing, Ps- 30/min, BP- 230/130 mm Hg, bilateral rales. Choose medicines for treatment.
Answer
  • Cordiamine, isoproterenol
  • Albuterol, atropine, papaverine
  • Theophylline, prednisolon
  • Morphine, furosemide, nitroprusside sodium
  • Strophanthine, potassium chloride, plathyphylline

Question 23

Question
A patient has got a sudden attack of severe substernal pain at night. On examination: confusion, pallor of the skin, acrocyanosis, cold sweat, BP- 80/50 mm Hg, Ps- 120/min, irregular and weak pulse. What condition are these symptoms typical for?
Answer
  • Acute right-side heart failure
  • Acute left-side heart failure
  • Cardiogenic shock
  • Radicular syndrome
  • Acute vascular insufficiency

Question 24

Question
The doctors in maternity hospital made a newborn boy the following diagnosis: congenital heart disease (interventricular septal defect). At the age of 2 months the boy has got a dyspnea. Objectively: BR- up to 60/min, Krok 1 Medicine 2006 19 tachycardia up to 170/min, liver is 3 cm below the costal margin. What medicines must be immediately prescribed?
Answer
  • β-adrenoceptor bloockers
  • Potassium preparations
  • Nonsteroidal antiinflammatory drugs
  • Cardiac glycosides
  • Glucocorticoids

Question 25

Question
A 40 y.o. patient with rheumatic heart disease complains of anorexia, weakness and loss of weigth, breathlessness and swelling of feet. The patient had tooth extraction one month ago. On examination: t 0- 390C, Ps- 100/min. Auscultation: diastolic murmur in the mitral area. Petechial lesion are round of clavicle; spleen was palpable.
Answer
  • Recurrence of rheumatic fever
  • Thrombocytopenia purpura
  • Aortic stenosis
  • Mitral stenosis
  • Subacute bacteria endocarditis

Question 26

Question
A 40 y.o. woman is ill with rheumatic disease with composite mitral disease with prevalence of the stenosis of left venous foramen.Complains of palpitation, fatigability, progressing dyspnea, attacks of dyspnea and hemoptysis. Now she cannot be engaged even in the easy activities. What tactics is the most expedient?
Answer
  • Conduction of current bicilinoprophilaxis
  • Mitral comissurotomia
  • Prescription of anticoagulants
  • Prescription of venous vasodilatators

Question 27

Question
On the 3rd day after the acute anterior myocardial infarction a 55 y.o. patient complains of dull ache behind his breast bone, that can be reduced by bending forward, and of dyspnea. Objectively: AP- 140/180 mm Hg, heart sounds are dull. ECG results: atrial fibrillation with frequence of ventricular contractions at the rate of 110/min, pathological Q wave and S-T segment raising in the right chest leads. The patient refused from thrombolisis. What is the most probable diagnosis?
Answer
  • Acute pericarditis
  • Pulmonary embolism
  • Dissecting aortic aneurysm
  • Tietze’s syndrome
  • Dressler’s syndrome

Question 28

Question
A 35 y.o. male patient suffers from chronic glomerulonephritis and has been treated with hemodialysis for the last 3 years. He has got irregularities in the heart activity, hypotension, progressive weakness, dyspnea. On ECG: bradycardia, 1st degree atrioventricular block, high sharpened T-waves. Some time before he had seriously broken the water consumption and dietary pattern. What is the most likely cause of these changes?
Answer
  • Hyperhydratation
  • Hypokaliemia
  • Hyperkaliemia
  • Hypernatremia
  • Hypocalcemia

Question 29

Question
A 70 y.o. patient complains of weakness, dizziness, short periods of lossof consciousness, pain in the region of heart. Objectively: HR- 40/min, sounds are rhytmic, the 1st sound is dull, occasionally very intensive. AP- 180/90 mm Hg. What is the most probable reason of hemodynamic disorders?
Answer
  • I degree atrioventricular heart block
  • Bradysystolic form of the atrial fibrillation
  • Sinus bradycardia
  • III degree atrioventricular heart block
  • Complete block of the left branch of His bundle

Question 30

Question
A 60 y.o. woman has had increased BP up to 210/110 mm Hg for the last 7 years. On examination: heart apex is displaced to the left. There are signs of left ventricular hypertrophy on ECG. What is the most probable diagnosis?
Answer
  • Essential hypertension, 1st stage
  • Essential hypertension, 2nd stage
  • Ischemic heart diseas
  • Cardiomyopathy
  • Symptomatic hypertension

Question 31

Question
A 17 y.o. patient complains of acute pain in the knee joint and t 0- 380C. He was ill with angina 3 weeks ago. Objectively: deformation and swelling of the knee joints with skin hyperemia. Small movement causes an acute pain in the joints. Which diagnose is the most correct?
Answer
  • Infectious-allergic polyarthritis
  • Systemic lupus erythematodes
  • Reactive polyarthritis
  • Rheumatism, polyarthritis
  • Rheumatoid arthritis

Question 32

Question
A 10 y.o. boy was ill with angina 2 weeks ago, has complaints of joint pain and stiffness of his left knee and right elbow. There was fever (38, 50) and ankle disfunction, enlargement of cardiac dullness by 2 cm, tachycardia, weakness of the 1st sound, gallop rhythm, weak systolic murmur near apex. What diagnosis corresponds with such symptoms?
Answer
  • Acute rheumatic fever
  • Systemic lupus erythematosis
  • Juvenile rheumatoid arthritis
  • Reiter’s disease E. Reactive arthri

Question 33

Question
A patient has complained of great weakness for 6 years. He fell seriously ill, the illness is accompanied by body temperature rise, indisposition, pain in joints and along the legs muscles. Objectively: violet-bluish erythema around eyes and over knee joints. HR- 120/min, heart sounds are weak. Blood count: leukocytes - 12 ∗109/L, ESR- 40 mm/h. What is themost probable diagnosis?
Answer
  • Systemic lupus erythematosus
  • Dermatomyositis
  • Rheumathoid arthritis
  • Atopic dermatitis
  • Reactivepolyarthritis

Question 34

Question
A 41 y.o. woman complains of weakness, fatigue, fever up to 380C, rash on the face skin, pain in the wrists and the elbows. On physical examination: erythematous rash on the cheeks with "butterfly"look, the wrists and elbow joints are involved symmetrically, swollen, sensitive, friction rub over the lungs, the heart sounds are weak, regular, HR- 88/min, BP- 160/95 mm Hg. CBC shows anemia, leucopenia, lymphopenia; on urine analysis: proteinuria, leukocyturia, casts. What is the main mechanism of disease development?
Answer
  • Production of myocytes antibodies
  • Production of antibodies to endothelial cells
  • Production of antibodies to doublestranded DNA
  • Production of myosin antibodies
  • Productionofantimitochondrialantibodies

Question 35

Question
A 31 y.o. patient has been suffering from systemic scleroderma for 14 years. She has been treated in hospital many times. She complains of occasional dull pain in the heart region, palpitation, dyspnea, headache, eye-lid edemata, weight loss and deformation of extremities joints. What organ affection worsens the disease prognosis?
Answer
  • Gastrointestinal tract
  • Heart C. Lungs
  • Skin and joints
  • Kidneys

Question 36

Question
A 60 y.o. patient complains of pain in interphalangeal joints of hand that gets worse during working. Objectively: distal and proximal joints of the II-IV fingers aredefigured, with Heberden’s and Bouchard’s nodes, painful, stiff. X-ray picture of joints: joint spaces are constricted, there are marginal osteophytes, subchondral sclerosis. What is the most probable diagnosis?
Answer
  • Osteoarthritis
  • Reiter’s disease
  • Bechterew’s disease
  • Rheumaticarthritis
  • Psoriaticarthritis

Question 37

Question
A man, aged 30, complains of intense pain, reddening of skin, edema in the ankle-joint area, fever up to 390_. There was acute onset of the illness. In the past there were similar attacks lasting 5-6 days without residual changes in the joint. The skin over the joint is hyperemic without definite borders and without infiltrative bank on the periphery. What is the most likely diagnosis?
Answer
  • Infectional arthritis
  • Rheumatoid arthritis
  • Gout
  • Erysipelatousinflammation
  • Osteoarthritis

Question 38

Question
A 54 y.o. patient has been suffering from osteomyelitis of femoral bone for over 20 years. In the last month there appeared and gradually progressed edemata of lower extremities. Urine analysis: proteinuria - 6,6 g/L. Blood analysis: disproteinemia in form of hypoalbuminemia, increase of α2- and γ- globulins, ESR- 50 mm/h. What is the most probable diagnosis?
Answer
  • Chronic glomerulonephritis
  • Myelomatosis
  • Acute glomerulonephritis
  • Secondary renal amyloidosis
  • Systemic lupus erythematosus

Question 39

Question
3 weeks ago a patient was ill with tonsillitis. Clinical examination reveals edema, arterial hypertension, hematuria, proteinuria (1,8 g/per day), granular and erythrocital casts. What is the preliminary diagnosis?
Answer
  • Cystitis
  • Glomerulonephritis
  • Pyelonephritis
  • Intestinal nephritis
  • Renal amyloidosis

Question 40

Question
A 29 y.o. woman is critically ill. The illness is presented by high fever, chills, sweating, aching pain in lumbar area, discomfort during urination and frequent voiding. Pasternatsky’s sign is positive in both sides. On lab examination: WBC- 20 ∗ 109/L; on urine analysis: protein - 0,6g/L, leukocyturia, bacteriuria. Your preliminary diagnosis.
Answer
  • Nephrolithiasis
  • Exacerbation of chronic pyelonephritis
  • Acute glomerulonephritis
  • Acute cystitis
  • Acute pyelonephritis

Question 41

Question
A 32 y.o. woman has been suffering for 5 months from pain in lumbar region, low grade fever, frequent urination. Urine analysis: moderate proteinuria, leukocytes occupy the whole field of sight, bacteriuria. Blood analysis: leukocytosis, increased ESR. What is the most probable diagnosis?
Answer
  • Acute glomerulonephritis
  • Chronic glomerulonephritis
  • Acute pyelonephritis
  • Chronic pyelonephritis
  • Urolithiasis

Question 42

Question
A 50 y.o. woman who suffers from chronic pyelonephritis was prescribed a combination of antibiotics for the period of exacerbation - gentamicin (80 mg 3 times a day) and biseptol (960 mg twice a day). What consequences may be caused by such a combination of antibiotics?
Answer
  • Acute renal insufficiency
  • Glomerulosclerosis
  • Chronic renal insufficiency
  • Antibiotic combination is optimal and absolutely safe
  • Acute suprarenal insufficiency

Question 43

Question
A 28 y.o. woman consulted a doctor about edematic face, moderate legsedemata; occasionally her urine hascolour of "meat slops". When she was a teenager she often fell ill with angina. Objectively: skin is pallor, body temperature is 36, 80_, Ps- 68/min, rhythmic. AP- 170/110 mm Hg. What urine changes are the most probable?
Answer
  • Increase of relative density, hematuria, bacteriuria
  • Decrease of relative density, proteinuria, some urinary sediment
  • Proteinuria, hematuria, cylindrouria
  • Erythrocyturia and urinozuria
  • Decrease of relative density, proteinuria

Question 44

Question
A 7 y.o. boy has been treated in a hospital for a month. At the time of admission he had evident edemata, proteinuria - 7,1 g/L, protein content in the daily urine- 4,2 g. Biochemical blood analysis reveals permanent hypoproteinemia (43,2 g/L), hypercholesterolemia (9,2 mmol/L). What variant of glomerulonephritis is the most probable?
Answer
  • Nephritic
  • Isolated urinary
  • Nephrotic
  • Hematuric
  • Mixed

Question 45

Question
An 8 y.o. boy was ill with B hepatitis one year ago. In the last 2 months he has complaints of undue fatiguability, sleep disorder, appetite loss, nausea, especially in the mornings. Skin isn’t icterious, liver and spleen are 1 cm below the costal margins, painless. Alanine aminotransferase activity is 2,2 mcmol/L. How can this condition be estimated?
Answer
  • Recurrance of viral hepatitis type B
  • Development of chronic hepatitis
  • Biliary dyskinesia
  • Residual effects of old viral hepatitis type B
  • Development of liver cirrhosis

Question 46

Question
A 16 y.o. teenager complains of weakness, dizziness, sense of heaviness in the left hypochondrium. Objectively: skin and visible mucous membranes are icteric. Steeple skull. Liver +2 cm, the lower pole of spleen is at the level of navel. Blood test: RBC- 2, 7 ∗ 1012/L, Hb- 88 g/L, WBC- 5, 6 ∗ 109/L, ESR- 15 mm/h. What is the most probable reason of bilirubin level change?
Answer
  • Decrease of unconjugated bilirubin
  • Decrease of conjugated bilirubin
  • Increase of conjugated bilirubin
  • Increase of unconjugated and conjugated bilirubin
  • Increase of unconjugated bilirubin

Question 47

Question
47 y.o. patient complains of intensive skin itching, jaundice, bone pain. The skin ishyperpigmentated. There are multiple xanthelasmapalpebrae. The liver is +6 cm enlarged, solid with acute edge. The blood analysis revealed total bilirubin - 160 mkmol/L, direct - 110 mkmol/L, AST- 2,1mmol/L, ALT- 1,8 mmol/L, alkaline phosphotase - 4,6 mmol/L, cholesterol- 9,2mmol/L, antimitochondrial antibodies M2 in a high titer. What is the probable diagnosis?
Answer
  • Acute viral hepatitis B
  • Primary liver cancer
  • Chronic viral hepatitis B
  • Alcoholiclivercirrhosis
  • Primary biliary liver cirrhosis

Question 48

Question
A 60 y.o. woman complains of unbearable pains in the right hypochondrium. In the medical hystory: acute pancreatitis. Body temperature is 38, 20. Objectively: sclera icteritiousness. No symptoms of peritonium irritation arepresent. There are positive Ortner’s and Hubergrits-Skulski’s symptoms. Urine diastase is 320 g/h. What diagnosis is the most probable?
Answer
  • Cancer of pancreas
  • Acute cholangitis
  • Chronic pancreatitis
  • Chronic cholecystitis
  • Acute cholecystitis

Question 49

Question
A52 y.o. patient with previously functional Class II angina complains of 5 days of intensified and prolonged retrosternal pains, decreased exercise tolerance. Angina is less responsive to Nitroglycerinum. Which of the following diagnosis is most likely?
Answer
  • Myocardial dystrophy
  • Myocarditis
  • IHD. Functional Class II angina
  • IHD. Unstable angina
  • Cardialgia due to spine problem

Question 50

Question
A 58 y.o. patient developed acute myocardium infarction 4 hours ago, now he is in the acute care department. ECG registers short paroxysms of ventricular tachycardia. The most appropriatemeasure will be to introduct:
Answer
  • Flecainid
  • Lidocain
  • Amyodaron
  • Propafenone
  • Veropamil

Question 51

Question
A 40 y.o. patient with rheumatic heart disease complains of anorexia, weakness and loss of weight, breathlessness and swelling of feet. The patient had tooth extraction one month ago. On examination: t0- 390C, Ps- 100/min.Auscultation: diastolic murmur in the mitral area. Petechial lesion around the clavicle; spleen was palpable.
Answer
  • Recurrence of rheumatic fever
  • Subacute bacteria endocarditis
  • Aortic stenosis
  • Mitral stenosis
  • Thrombocytopenia purpura

Question 52

Question
A42 y.o. woman complains of dyspnea, edema of the legs, and tachycardia during small physical exertion. Heart borders are displaced to the left and S1 is accentuated, there is diastolic murmur on apex. The liver is enlarged by 5 cm. What is the cause of heart failure?
Answer
  • Mitral stenosis
  • Mitral regurgitation
  • Tricuspid stenosis
  • Tricuspid regurgitation
  • Aortic stenosis

Question 53

Question
A 39 y.o. patient complains of having dyspnea during physical activity, crus edemata, palpitation, heart intermissions. Objectively: HR is 150 bpm, atrial fibrillation. Heart is both ways enlarged.Heart sounds are muted. Liver is 6 cm below the costal margin. Echocardiogram reveals dilatation of heart chambers (end diastolic volume of left ventricle is 6,8 cm) is 29% EF, valve apparatus is unchanged. What is the most probable diagnosis?
Answer
  • Thyreotoxic cardiomyopathy
  • Hypertrophic cardiomyopathy
  • Exudative pericarditis
  • Dilated cardiomyopathy
  • Restrictive cardiomyopathy

Question 54

Question
After a long periode of subfebrility a patient registered increase of dyspnea, pain in the right hypochondrium, leg edemata. Objectively: neck veins are edematic. Ps is 120 bpm, sometimes it disappears during inspiration. Heart sounds are very weakened. ECG showed lowvoltage waves of ventricular complex. A month ago there was raise of ST V1 − V4 segment. Cardiac silhouette is enlarged, roundish. What is the most probable diagnosis?
Answer
  • Metabolic postinfection myocardiopathy
  • Postinfarction cardiosclerosis
  • Exudative pericarditis
  • Small-focal myocardial infarction
  • Primary rheumatic

Question 55

Question
A 35 y.o. patient who suffers from chronic glomerulonephritis and has been hemodialysis-dependent for the last three years developed intermissions of heart activity, hypotension, increasing weakness, dyspnea. ECG showed bradycardia, atrioventricular block type I, high pointed waves T. The day before the flagrant violation of diet took place. What is the most probable cause of these changes?
Answer
  • Hyperkaliemia
  • Hyperhydratation
  • Hypokaliemia
  • Hypernatriemia

Question 56

Question
A 70 y.o. patient complains of weakness, dizziness, short periods of unconsciousness, pain in the cardiac area. Objectively: HR- 40 bpm, heart sounds are rhythmic, the S1 is dull, periodically amplified. AP is 180/90 mm Hg. What is the most probable cause of hemodynamic disturbances?
Answer
  • Complete left bandle-branch block
  • Sinus bradycardia
  • Atrioventricular block type I
  • Bradysystolic form of ciliary arrhythmia
  • Atrioventricular block type III

Question 57

Question
A 74 y.o. patient has been suffering from hypertension for 20 years. He complains of frequent headache, dizziness, he takes enalapril. Objectively: accent of the SII above aorta, Ps- 84 bpm, rhythmic, AP- 180/120 mm Hg. What group of hypotensive medications could be additionally prescribed under consideration of the patient’s age?
Answer
  • Loop diuretics
  • β-adrenoceptor blockers
  • Thiazide diuretics
  • α-adrenoceptor blockers
  • Central sympatholytics

Question 58

Question
A 58 y.o. man complaines of severe inspiratory dyspnea and expectoration of frothy and blood-tinged sputum. He has been suffering from essential hypertension and ischemic heart disease. On examination: acrocyanosis, "bubbling" breathing, Ps- 30/min, BP- 230/130mm Hg, bilateral rales. Choose medicines for treatment.
Answer
  • Theophylline, prednisolon
  • Albuterol, atropine, papaverine
  • Strophanthine, potassium chloride, plathyphylline
  • Morphine, furosemide, nitroprusside sodium
  • Cordiamine, isoproterenol

Question 59

Question
A 41 y.o. woman complains of weakness, fatigue, fever up to 380C, rash on the face skin, pain in the wrists and the elbows. On physical examination: erythematous rash on the cheeks with "butterfly"look, the wrists and elbow joints are involved symmetrically, swollen, sensitive, friction rub over the lungs, the heart sounds are weak, regular, HR- 88/min, BP- 160/95 mm Hg. Hematology shows anemia, leucopenia, lymphopenia; on urinalysis: proteinuria, leukocyturia, casts. What is the main mechanism of disease development?
Answer
  • Production of antibodies to doublestranded DNA
  • Production of antimitochondrial antibodies
  • Production of myosin antibodies
  • Production of myocytes antibodies
  • Production of antibodies to endothelial cells

Question 60

Question
A 32 y.o. patient has been suffering from systematic scleroderma for 14 years. She was repeatedly exposed to treatment in the in-patient department. Complains of periodical dull cardiac pain, dyspnea, headache, eyelid edemata, weight loss, pain and deformation of extremities joints. What organ’s lesion deteriorates the prognosis for the disease?
Answer
  • Skin and joints
  • Kidneys
  • Lungs
  • Heart
  • Gastrointestinal tract

Question 61

Question
A 21 y.o. man complains of having morning pains in his back for the last three months. The pain can be relieved during the day and after physical exercises. Physical examination revealed reduced mobility in the lumbar part of his spine, increase of muscle tonus in the lumbar area and sluch during moving. X-ray pattern of spine revealed bilateral sclerotic changes in the sacrolumbal part. What test will be the most necessary for confirming a diagnosis?
Answer
  • HLA-B27
  • ESR
  • Rheumatoid factor
  • Uric acid in blood plasma
  • Antinuclear antibodies

Question 62

Question
A 30 y.o. man complains of intense pain, reddening of skin, edema in the ankle-joint area, fever up to 390_. There was acute onset of the illness. In the past there were similar attacks lasting 5-6 days without residual changes in the joint. The skin over the joint is hyperemic without definite borders and without infiltrative bank on the periphery. What is the most likely diagnosis?
Answer
  • Infectional arthritis
  • Gout
  • Rheumatoid arthritis
  • Erysipelatous inflammation
  • Osteoarthritis

Question 63

Question
A 54 y.o. woman has been ill with osteomyelitis of femoral bone for over 20 years. During the last month there appeared and have been steadily increasing edemata of lower extremities. Urine analysis revealed: proteinuria - 6,6 g/l. Blood analysis: disproteinemia in form of hypoalbuminemia, raise of α2- and γ- globulines, ESR- 50 mm/h. What is the most probable diagnosis?
Answer
  • Systematic lupus erythematosus
  • Chronic glomerulonephritis
  • Acute glomerulonephritis
  • Myelomatosis
  • Secondary renal amyloidosis

Question 64

Question
3 weeks ago a patient was ill with tonsillitis. Clinical examination reveals edema, arterial hypertension, hematuria, proteinuria (1,8 g/per day), granular and erythrocital casts. What is the preliminary diagnosis?
Answer
  • Intestinal nephritis
  • Pyelonephritis
  • Cystitis
  • Glomerulonephritis
  • Renal amyloidosis

Question 65

Question
A 58 y.o. patient complains of weakness, leg edemata, dyspnea, anorexia. He has been suffering from chronic bronchitis for many years. During the last 5 years he has been noting intensified discharge of sputum that is often purulent. Objectively: RR- 80/min, AP- 120/80 mm Hg. Disseminated edemata, skin is dry and pale, low turgor. In urine: intense proteinuria, cylindruria. Specify the most probable pathological process in kidneys:
Answer
  • Chronic glomerulonephritis
  • Renal amyloidosis
  • Chronic pyelonephritis
  • Interstitial nephritis
  • Acute glomerulonephritis

Question 66

Question
166.Apatient with hepatic cirrhosis drank some spirits that resulted in headache, vomiting, aversion to food, insomnia, jaundice, fetor hepaticus, abdominal swelling.What complication of hepatic cirrhosis is meant?
Answer
  • Hepatocellular insufficiency
  • Portal hypertension
  • Hemorrhage from varicosely dilatated veins of esophagus
  • Acute stomach ulcer
  • Thrombosis of mesenteric vessel

Question 67

Question
A patient suffers from chronic recurrent pancreatitis with evident disturbance of exocrinous function. After intake of rich spicy food and spirits his stool becomes fatty. Reduced production of what factor is the most probable cause of steatorrhea?
Answer
  • Tripsin
  • Lipase
  • Acidity of gastric juice
  • Amylase
  • Alkaline phosphatase
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