kr 2003

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2003 ? A 38-year-old patient has been treated in a hospital. A fever of 39C, chest pain which is worsened by breathing, cough, brownish sputum appeared on the 7th day of the treatment. Chest X-ray shows left lower lobe infiltrate. Which of the following is the treatment of choice for this patient? +Cephalosporins of the III generation -Erythromycin -Streptomycin -Penicillin -Tetracycline ? A 32-year-old woman developed the Laiel's syndrome after taking the biceptol. What immunotrope remedies are indicated in this situation? +Steroid immune depressants -Interferons -Non-specific immune modulators -Non-steroid immune depressants -Specific immune modulators ? An 18-month-old child is taken to hospital on the 4-th day of the disease. The disease began acutely with temperature 39C, weakness, cough, reathlessness. He is pale has cyanosis, febrile temperature for more than 3 days. There are crepitative fine bubbling rales at the auscultation. Percussion sound is shortened in right under scapula area. X-ray picture: unhomogenius segment infiltration 810 in the right, the increase of vascular picture, unstructural rools. What is the most likely diagnosis? +Segmentary pneumonia -Bronchitis -Bronchiolitis -Interstitial pneumonia -Grippe ?

A 43-year-old male presents with stomach pain, which relieves with defecation, is accompanied with a feeling of abdominal winds, incomplete evacuation or urgent need for bowel movement, constipation or diarrhea. These symptoms have been lasting for over 3 months. No changes in laboratory tests. What is the most likely diagnosis? +Irritable bowel syndrome -Chronic enterocolitis, exacerbation phase -Spastic colitis -Colitis with hypertonic type dyskinesia -Atonic colitis ? A 62-year-old man presents with the pain in mesogastral area that irradiates to back, general weakness, poor appetite, weight loss. Oh physical examination the patient is of decreased nutrition, skin and eyeballs are light-yellow. Stomach is soft. Enlarged painless gallbladder is palpated in the right hypochondrium. Urine is dark. Stool is colourless. What is the most likely diagnosis? +Cancer in the head of pancreas, mechanic icterus' -Hemolytic icterus -Liver cirrhosis -Parenchimatosus icterus -Gallbladder disease, mechanic icterus ? A 5-year-old child had an attack of palpitation with nausea, dizziness, generalized fatigue. On ECG: tachycardia with HR of 220/min. Ventricle complexes are deformed and widened. P wave is absent. What medication should be given for emergent care? +Lydocain -Seduxen -Strophantin -Isoptin -Novocainamides

? A 43-year-old woman complains of contact hemorrhages during the last 6 months. Bimanual exam: cervix of the uterus is enlarged, restricted in mobility. Mirrors showed the following: cervix of the uterus is in the form of cauliflower. Chrobak and Schiller tests are positive. What is the most probable diagnosis? +Cancer of cervix of the uterus -Cervical pregnancy -Leukoplakia -Nascent fibroid -Polypus of the cervis of the uterus ? A 43-year-old woman complains of severe pain in the right side, fever, dryness and bitterness in the mouth. There was multiple vomiting without relief. Patient relates pain to taking of fat and fried meal. Physical examination: Patient lies on the right side. Pale. Dry tongue. Tachycardia. Right side of abdomen is painful upon palpation and somewhat tense in right hypochondrium. What is the most likely diagnosis? +Acute cholecystitits -Perforative ulcer -Acute appendicitis -Acute bowel obstruction -Right-sided renal colic ? A 20-year-old patient is known as using to clash with teachers and classmates in school, to shout, to be able to throw with fists. He was detained several times for fighting and was convicted. He has changed several places of work due to conflicts and aggression. Psychiatric status: he is focused correctly, answers loudly, using obscene words. He demands "to leave him in rest "because "he does not control himself". In department he shows aggression for the most insignificant


reasons. What is your preliminary diagnosis? +Maniacal-depressive psychosis -Explosive psychopathy -Hysterical psychopathy -Hysterical neurosis -Schizophrenia ? A 52-year-old male is under gastroenterologist supervision due to chronic autoimmune gastritis for 10 years. He presents with some nausea, feeling of weight in epigastrium after meal. Last exacerbation of disease was 6 month ago. He adheres to a diet, smokes 10 cigarettes per day, and uses alcohol moderately. What measures to prevent stomach cancer are necessary? +Cancellation of smoking and alcohol use qA . Taking antacids periodically -Taking H2-blokers periodically -Taking antihelycobacter medications periodically -Taking gastrocepin periodically ? A 26-year-old woman gave birth to a child 6 months ago. She applied to gynecologist complaining of menstruation absence. The child is breast-fed. Vagina exam: uterus is of normal form, denseconsistence. What is the most probable diagnosis? +Physiological amenorrhea -Pseudoamenorrhea -Gestation -Sheehan's syndrome -Asherman's syndrome ? A 28-year-old woman comes to the Emergency Room with a slightly reddened, painful "knot, 8 cm above the medial malleolus. Examination in the standing position demonstrates a distended vein above and below the mass. There are no other abnormalities on physical

examination. What is the most likely diagnosis? +Superficial venous thrombosis -Subcutaneous hematoma -Early deep vein thrombosis -Cellulitis -Insect bite ? A 45-year-old man was brought to clinic with complaints of the pain that started suddenly in the left chest part and epigastric area, shortness of breath, nausea, one-time vomiting. The acute pain started after weightlifting. On physical exam: shallow breathing, RR - 38/min, left chest part is behind during respiration, by percussion - tympanitic sound, respiration is not ausculated. Ps - 110 bpm, of weak filling. BP - 100/60 mm Hg, insignificant displacement of heart to the right, sounds are dull. What examination is the most expedient to do first? +Ultrasound of the abdominal cavity -Esophagogastroscopy -Bronchoscopy -Electrocardiography -Roentgenography ? A 42-year-old man has died in a road accident after the hemorrhage on the site, due to acute hemorrhagic anemia. What minimum percent of all volume of blood could result in death at acute hemorrhage? +25-30% -15-20% -10-14% -35-50% -6-9% ? While making a round, a doctor had noticed the edema of the right shoulder of a 26-day-old child with diagnosis of "umbilical sepsis". Active movements in the shoulder joint were absent, right hand was hanging down. Mother stated that her

child's condition had worsened for the last 24 hours what resulted in child's refusal to be breast-fed, restlessness, weeping while swaddling, rise in body temperature up to 38,8C. What is the most probable preliminary diagnosis? +Epiphysial osteomyelitis of the humerus -Phlegmon of the shoulder -Traumatic brachioplexftis -Fracture of the humerus -Fracture of the clavicle ? Study of pulmonary tuberculosis provided data about social and everyday conditions of life and bad habits of patients. Which of the following methods allows assessing degree of influence of smoking on tuberculosis incidence? +Calculation of correlation coefficient, -Calculation of standardized indices -Calculation of regression coefficient -Assessment of statistical probability of differences -Analysis of dynamic row indices 17. In 2 weeks after receiving of 3 Gy doze of general 7-irradiation, the diminished number of blood cells is marked at injured man. What is the cause of such changes? +Suppression of blood cells production -Reduction of peripheral blood cells life time -Delay of blood cells in the marrow -Prolongation of blood cells growth -Increased destruction of peripheral blood cells ? A 28-year-old man is hospitalized with complaints of expiration dyspnoe after work at summer residence. Physical examination: condition of moderate severity. He sits resting his hands on the seat-


back. Ps 102 bpm, BP 140/90 mmHg. RR 32/min. Percussion reveals lung sound with box tone. Heterogeneous multiple dry rales are auscultated. Heart work is regular. Which immunoglobulin plays leading role in development of this pathological condition? +IgE -IgG -lgD -IgM -IgA ? The patient was admitted to the hospital on the 7th day of the disease with complaints of high temperature, headache, pain in the muscles, especially in calf muscles. The dermal integuments and scleras are icteric. There is hemorrhagic rash on the skin. Urine is bloody. The patient went fishing two weeks ago. What is the diagnosis? +Leptospirosis -Brucellosis -Yersiniosis -Trichinellosis -Salmonellosis ? A 26-year-old woman complains of spontaneously arising pelvic pain, irradiating to the anus, nausea, giddiness, bloody dark vaginal discharge for one week, the delay of menses for 4 weeks. Signs of peritoneal irritation are positive. Pelvic examination: borders of uterine and adnexa are not determined because of sharp morbidness. The diversion and tenderness of posterior and right lateral fornices vaginae are marked. What is the most probable diagnosis? +Broken tubal pregnancy -Acute appendicitis -Apoplexy of the ovary -Torsion of an ovarian tumour leg -Acute right-side adnexitis

? A 6-year-old asthmatic child is brought to the emergency room because of severe coughing and wheezing during the prior 24 h. The child has been taking theophylline without relief. Physical examination reveals a child who is anxious, has intercostal and suprasternal retractions, expiratory wheezing throughout all lung fields, and RR 60/min. Initial treatment may include the administration of which of the following? +Subcutaneous epinephrine -Parenteral gentamicyn -Parenteral phenobarbital -N-acetyl cysteine and cromolyn by inhaler -Intravenous fluids in the first 2 h to correct a water deficiency. ? A 76-year-old man, with