Internal Med Final Mcqs .pdf

ALL THE BEST GUYZ..!GROUP 5/107 GM..! REGARDS: MIDHAT, AALIJA, SHERLY and RAIHAN..! 1. What investigation is most optimal for the pneumonia diagnosis: Sputum test Chest X-ray Bronchoscopy Spirometry Complete blood count 2. What local percussion sound characteristics are typical for the pneumonia: Clear pulmonary sound Mosaic sound Tympanic sound Dull pulmonary sound Hyperresonance on percussion 3. The “first-line” antimicrobial drugs for empirical therapy in patients with community-acquired pneumonia are: Streptomycin and gentamicin Penicillin, azithromycin Ceftriaxone, cefuroximum Ciprofloxacin, ofloxacin Lincomycin and levomycetin 4. Nosocomial pneumonia is defined as: Pneumonia in previously hospitalized patients Pneumonia develops in a patient hospitalised for ≥ 48 hours Pneumonia in elderly and frail patient Pneumonia in patients 5-7 days after discharge from hospital Pneumonia in a patient who requires hospital treatment 5. The main long-term treatment for moderate asthma is: A long-acting beta2 -agonist bronchodilators (LABA) Inhaled corticosteroids (ICS) Xanthine derivatives (theophylline) A short-acting beta2 -agonist bronchodilators (SABA) Oral corticosteroids 6. A 33 years old woman occasionally has nighttime coughs and wheezing. These complaints are a typical clinical onset of: Community-acquired pneumonia (CAP) COPD TB (tuberculosis) Asthma Emphysema 7. The main goal of COPD treatment: full recovery and rehabilitation of the patient slow down progression of bronchitis reverse development of pulmonary emphysema elimination of bacterial excretion with sputum preparation of the patient for surgical treatment of bronchitis 8. The most common causative agent of hospital acquired pneumonia is: chlamydia pneumococcus klebsiella mycoplasma herpes simplex virus 9. Cor pulmonale associated with: left atrial dilation and right ventricular hypertrophy hypertrophy of the left and right ventricles hypertrophy and dilation of the right heart chambers right ventricular dilation and left atrial hypertrophy thickening of the interventricular septum and right atrium 10. Which of the following is most effective for the treatment of chronic cor pulmonale anticoagulants bronchodilators oxygen therapy antibiotics glucocorticoids 11. Which of the following additional methods of examination is the most reliable for establishing the diagnosis of pneumonia? complete blood analysis radiological examination spirometry general sputum analysis bronchoscopy 12. What objective study is used to determine the severity of chronic obstructive bronchitis? comparative percussion of lungs X-ray examination spirometry lung auscultation bronchography ~ 13. What local features of percussion sound are typical for pneumonia? clear lung sound tympanic sound dullness of percussion sound vGPT box percussion sound 2nd File mosaic sound - from 14. What is the most effective method of slowing the progression of COPD? spa treatment mode of work and rest smoking cessation prophylactic antibiotic treatment long-acting bronchodilators 15. The drugs of choice for empiric therapy in patients with communityacquired pneumonia are: lincomycin and chloramphenicol ceftriaxane, cefuroxime amoxicillin, azithromycin ciprofloxacin, ofloxacin streptomycin and gentamicin 16. According to the International Consensus, the following gradations have been introduced into the classification of pneumonia: congenital, acquired, acute, protracted, chronic allergic, gasoline, post-traumatic acute, sub acute, protracted, chronic community acquired pneumonia, hospital acquired pneumonia, in immunocompromised patients, aspirational recurrent, non-recurrent, in the elderly 17. To identify the type of acute leukemia, you must perform: reticulocyte count puncture of the lymph node sternal puncture puncture of the spleen immunochemiluminescent analysis 18. Treatment for chronic lymphocytic leukemia is determined by: stage of disease and clinical form stage of the disease age and gender of the patient results of trephine biopsy results of cytochemical reactions 19. The most characteristic clinical manifestation of hemophilia: ~ hemarthrosis - ~ GPT 9 petechial hemorrhagic rash telangiectasia of the lips varicose veins of the esophagus nasal bleedings X 2nd Fire 20. In the differential diagnosis of hypoplastic anemia and immune thrombocytopenia, the main study is: complete blood count ultrasound of the abdominal organs trephine biopsy coagulogram bone radiography 21. Autoimmune hemolytic anemia develops due to: production of antibodies against altered erythrocyte antigens disruption of immunological tolerance deficiency of erythrocyte enzymes ineffective erythropoiesis erythrocyte membrane defect 22. Megaloblastic type of hematopoiesis, increased levels of ferritin in the blood, neurological symptoms are characteristic of autoimmune hemolytic anemia anemia of Wwski-Choffard iron deficiency anemia B12- deficiency anemia aplastic anemia 23. Acute onset, jaundice, splenomegaly, reticulocytosis is characteristic of iron deficiency anemia Minkowski-Choffard anemia Autoimmune hemolytic anemia B12-deficiency anemia aplastic anemia 24. Hypochromic anemia, a decrease level of ferritin in the blood serum, hyperplasia of the erythroid germ are characteristic of B12-deficiency anemia Minkowski-Choffard anemia iron deficiency anemia Aplastic anemia Autoimmune hemolytic anemia 25. A 57 years old patient complains of shortness of breath, cough with sputum in the morning. On x-ray: hyperinflation, flattened diaphragm, increased retrosternal space, and hypovascularity of lung parenchyma. What pathology should the doctor think about: Community-acquired pneumonia Spontaneous pneumothorax Pulmonary hemorrhage COPD Tuberculosis 28. Patient D., 52 years old, complains of cough with mucopurulent sputum, dyspnea on slight physical exertion. Past medical history: smoker, cough for 15 years, he is under follow up a general practitioner, last worsening within a week. Objectively: breathing with prolonged expiration, scattered rhonchi and wheezing on auscultation. Your clinical diagnosis: Chronic heart failure Bronchiectasis Chronic obstructive pulmonary disease Pulmonary tuberculosis Asthma 29. A 66 years old man has been suffering from COPD for 10 years and works as a road worker. What tests should be ordered to determine the severity of COPD: Bronchography Chest X-ray Respiratory function testing Electrocardiography Sputum test 26. A 56 years old patient has been suffering from COPD for 10 years and works as a road builder. What tests should be ordered to determine the severity of COPD: Complete blood count Bronchography ECG Respiratory function testing CT (computer tomography) 30. A 63 years old man complains of cough with a small amount of mucous sputum. He has been suffering for many years, for the last few months he has had a prolonged cough, dyspnea on climbing up to the third floor and walking quickly. Objectively: breathing with prolonged expiration, scattered rhonchi. What preliminary diagnosis is more likely: Bronchiectasis Pulmonary fibrosis COPD Community-acquired pneumonia (CAP) Asthma 27. A 22 years old patient complained on fever up to 39°C, cough with a small amount of yellow sputum, general weakness. Objectively, he had a moderate severity condition, respiratory rate is 21 per minute, dullness to percussion and decreased breath sounds below the angle of the right scapula. What is your preliminary diagnosis: Exacerbation of asthma Pneumonia in the lower lobe of the right lung Exacerbation of chronic obstructive bronchitis Infiltrative tuberculosis in the lower lobe of the right lung Bronchiectasis 31. A 32 years old women has occasional episodes of expiratory dyspnea, less than once a week, for which she uses ventolin inhalation. During the attack wheezing are heard in the lungs. On examination the FEV1 is 83% of normal. What is the most likely diagnosis: Mild asthma COPD, mild COPD, moderate, exacerbation Severe asthma Moderate asthma 32. A woman complained of fever up to 38.7°C, cough with a small amount of mucopurulent sputum, general weakness. Objectively: moderate severity, respiratory rate is 22 per minute, dullness to percussion and decreased breath sounds below the angle of the left scapula. What is your preliminary diagnosis: Tuberculosis in the lower lobe of the left lung Pneumonia in lower lobe of left lung Chronic obstructive pulmonary disease, exacerbation Bronchiectasis Asthma, exacerbation 33. On computed tomography: bilateral fibrosis and bilateral ‘ground glass' changes are most common in: Lobular bilateral pneumonia Lung miliary tuberculosis Pulmonary amyloidosis Fibrosing alveolitis Pulmonary sarcoidosis 34. What disease is characterized by acute course, breath weakening, wheezing on auscultation, medium-intensity infiltrative shadows in the lungs, positive dynamics with treatment: Pulmonary fibrosis 2nd File Bronchopneumonia ~ Lobular pneumonia a from Tuberculosis Bronchiectasis apF > - "Right answer 35. A 67 years old man complains on severe dyspnea, little cough with a small amount of mucous sputum. On examination: patient is very thin with a barrel chest. Breathing is assisted by pursed lips and use of accessory respiratory muscles. On auscultation there is weakened breathing, wheezing are heard. What is your preliminary diagnosis? Pneumothorax Emphysema Pneumonia Pulmonary fibrosis Asthma 36. A 54 years old man has repeated pneumonia in the same right segment over the course of a year. He has been a smoker for many years. He suffers from fatigue, weakness, coughing, weight loss, sometimes streaks of blood in the sputum. What is your preliminary diagnosis? Right lung cancer COPD Right lung tuberculosis Bronchopneumonia Pleural effusion 37. Patient complains on cough with a small amount of colorless sputum, dyspnea with moderate exertion. Сough usually worsens in the mornings. He is smoker for over 25 years. He has been coughing for many years, last worsening within a week. On examination: breath with prolonged expiration, scattered rhonchi. What is your diagnosis? Asthma Pulmonary fibrosis Bronchiectasis COPD, exacerbation Emphysema 38. Patient 33 years old, complains on wheeze, shortness of breath, chest tightness and cough up to 3 times a month, symptoms are worsens at night not more than 2 times a month. He has had asthma for several years. Define the degree of asthma: Moderate asthma Severe persistent asthma Severe hormone-independent asthma Severe hormone-dependent asthma Mild asthma 39. A 58-year-old patient complains of cough with sputum in the morning, shortness of breath. On the X-ray: the lungs are hyper lucent, intercostal spaces are enlarged, flattening of the diaphragm. What kind of pathology should the doctor think about? tuberculosis of the lungs community-acquired pneumonia spontaneous pneumothorax pulmonary bleeding emphysema 40. A 36-year-old woman, smoked for 11 years, BMI 32 kg/m2, has been taking oral contraceptives for more than 2 years. She fell ill acutely, complains of shortness of breath, fever up to 37.5°C, cough with blood-streaked sputum, weakness, pain in the left half of the chest. Preliminary diagnosis? bronchiectasis mitral heart disease exacerbation of chronic bronchitis Focal pneumonia PE (pulmonary embolism) 41. A man visited a GP with complaints of sudden onset of shortness of breath, chest pain, tachycardia, hemoptysis, and pleural rub. First of all, the doctor should suspect in the patient: transmural myocardial infarction pulmonary embolism status asthmaticus aspiration pneumonia spontaneous pneumothorax 42. A 44-year-old man came to a family doctor with complaints of cough with mucus sputum that occurs periodically. He has been sick for several years, for the last 4 months the cough has become more prolonged, shortness of breath has appeared when climbing to the 3rd floor and walking fast. Smoker's index 25. Objectively: breathing with prolonged exhalation, scattered single dry rales. What is your preliminary diagnosis? Bronchiectasis Community-acquired pneumonia Sarcoidosis of the lungs Chronic obstructive pulmonary disease Asthma 43. Patient X., 61 years old, complains of cough with mucopurulent sputum that is difficult to cough out, shortness of breath, aggravated by physical exertion, fever up to 38°C. He fell ill acutely, after hypothermia. Smoker for many years, 1 pack a day. Auscultatory: the breathing is weak with prolonged exhalation, scattered dry rales are heard on both sides, on the left in the subscapular region - moist finely bubbling rales, there is also dullness of percussion sound. X-ray: in the lower lobe of the left lung - infiltrative shadow. Leukocytes–15*109/l, ESR-22mm/h. Which of the following diagnoses is most likely? COPD, mild, exacerbation. Pneumonia in the lower lobe of the right lung COPD, severe, exacerbation. Respiratory insufficiency 1 degree asthma, moderate severity, exacerbation. Respiratory insufficiency 2 degrees COPD, moderate severity, exacerbation. Pneumonia in the lower lobe of the left lung asthma, moderate. Pneumonia in the lower lobe of the right lung 44. A 23-year-old girl, sometimes has attacks of expiratory gasp, less than once a week, for which she uses salbutamol inhalations to stop them. During an attack, dry whistling rales are heard in the lungs. On examination: between asthma attacks, FEV1 was 80-85% of the predicted value. What is the most likely diagnosis? asthma, moderately persistent COPD, mild severity. Respiratory insufficiency I asthma, light intermittent asthma, mild persistent COPD, moderate, exacerbation 45. Patient P., aged 65, complains of a persistent cough with sputum with an unpleasant odor, especially in the morning, shortness of breath on moderate exertion, and weakness. On auscultation: moist rales on both sides. These symptoms are typical for lung cancer bronchiectasis chronic bronchitis pulmonary tuberculosis bronchial asthma 46. A 55-year-old woman lost consciousness on the street and was taken by an ambulance to the hospital. Objectively: tachycardia 123 beats per minute, severe hypotension. Plain X-ray of the lungs: total darkening of the right lung. What complication of pneumonia should be considered in the first place: ans & distress syndrome T acute respiratory failure parapneumonic pleurisy - infectious-toxic shock acute cor pulmonale > 2nd File -Right For - 47. During an outpatient visit, a 19-year-old student complains of attacks of dry cough, "whistling in the chest", subfebrile temperature, sweating. She fell ill a few days ago, was not treated, this was not observed before. Percussion: clear pulmonary sound, hard breathing, scattered few dry rales on both sides. The sputum could not be collected. X-ray of the lungs without abnormalities. What disease can a GP think of? asthma bronchiectasis chronic obstructive bronchitis fibrosing alveolitis acute bronchitis 48. A 23-year-old patient complained of fever up to 39°C, cough with a small amount of viscous yellowish sputum, and general weakness. Objectively: the state of moderate severity, respiratory rate 22 per minute, increased voice trembling and dullness of percussion sound below the angle of the right scapular angle. Preliminary diagnosis? infiltrative tuberculosis in the lower lobe of the right lung bronchiectasis of the lungs focal pneumonia in the lower lobe of the right lung exacerbation of chronic obstructive bronchitis exacerbation of asthma 49. Which disease for is more typical: acute course, moist rales on auscultation, infiltrative shadows of medium intensity in the lower parts of the lungs on the X-ray, rapid positive dynamics during treatment pneumoconiosis focal pneumonia sarcoidosis of the lungs miliary tuberculosis lung cancer 50. Woman A., 37 years old, suffers from asthma for 5 years. Gasp attacks are stopped by berodual. Peak expiratory flow rate is 66%. At the time of examination - shortness of breath at rest, during auscultation - whistling dry rales in all lung fields. The patient used the berodual inhaler three times in the last hour. What tactics of management is most favorable in this situation? ventolin via nebulizer continue inhaling berodual prednisolone 60 mg IV drip theophylline tablets per os eufillin 2.4% -10 ml IV bolus 51. A 53-year-old patient has febrile fever with severe intoxication syndrome, myalgia, arthralgia, cough, abdominal pain, and diarrhea. Often goes on business trips, stays in hotels, boarding houses, where there are air conditioners, showers. CBC: leukocytosis with lymphocytopenia, ESR 50 mm/hour. What type of pneumonia are these signs typical of? pneumococcal// chlamydial// mycoplasma // legionella// staphylococcal 52. Patient E., 46 years old. Complaints: temperature increase up to 39 oC, chills, stabbing pains in the left chest, dry cough. During the act of breathing, the left half of the chest lags behind. Heart rate 102 bpm per minute, BP 120/60 mm Hg. On the chest X-ray - a homogeneous darkening with an oblique upper line on the left, the mediastinal organs are displaced to the right. What is the diagnosis? pulmonary tuberculosis exudative pleurisy focal pneumonia lobar pneumonia gangrene of the lung 53. A 43-year-old patient was admitted to the orthopedic department because of an injury. The examination revealed: an increase in axillary lymph nodes up to the size of a pea. CBC: Hb-107 g/l., erythrocytes - 3.4x1012/l, platelets 172x109 / l, leukocytes - 45.8x109/l, segmented neutrophils-5%, prolymphocytes - 3%, monocytes - 2%, lymphocytes -90%. Which of the diagnoses is the most likely? leukemoid reaction chronic myeloid leukemia bone tuberculosis chronic lymphocytic leukemia lymphosarcoma 54. A 19-year-old patient complains of multiple hemorrhages on the body, nasal bleedings. From the anamnesis: fell ill after the flu. Objectively: there are multiple bruises on the skin, with different shades, peripheral lymph nodes are not enlarged, the liver and spleen are within normal limits. CBC: Hb122 g / l., erythrocytes - 4.1x1012 / l, platelets - 20x109 / l, leukocytes 6.8x109 / l. Which of the diagnoses is the most likely? acute leukemia, advanced stage DIC syndrome, hypocoagulation phase aplastic anemia immune thrombocytopenic purpura hemorrhagic vasculitis 55. A 40-year-old patient complains of dizziness, fatigue, shortness of breath, paresthesia in the extremities and a tendency to diarrhea. On examination, the skin is yellowish in color, smoothness of the papillae of the tongue, signs of glossitis. The patient underwent gastrectomy 3 years ago. Hyperchromic anemia is noted. Puncture of the bone marrow: megaloblastic type of hematopoiesis. An increase in the level of ferritin in the blood was revealed. What is the preliminary diagnosis? iron deficiency anemia aplastic anemia B12 deficiency anemia autoimmune hemolytic anemia congenital hemoglobinopathies 56. A 23-year-old patient has visited a family doctor with complaints of pain in the ankle joints, subfebrile temperature, symmetrical hemorrhagic rashes on the skin of the lower leg and hips. From the anamnesis: she fell ill for the first time, a week ago she had flu. Your preliminary diagnosis: Rendu-Osler disease Werlhof disease Scheinlein-Henoch disease hemophilia acute leukemia 57. Patient Y., 29 years old, changes revealed in the CBC: leukocytes 78x109/l; leukocyte formula: promyelocytes-3%, myelocytes-8%, metamyelocytes-12%, stab neutrophils-21%, segmented neutrophils-41%, basophils-3%, eosinophils-6%, lymphocytes-6%. Platelets - 784x109 / l, hemoglobin - 114 g / l., hypercellular bone marrow, the content of myelokaryocytes and megakaryocytes is increased, all elements of the granulocytic series are determined. Diagnosis: blast crisis of chronic myelogenous leukemia chronic stable phase of chronic myelogenous leukemia essential thrombocythemia idiopathic myelofibrosis polycythemia vera 58. For a patient with hypochromic microcytic anemia and chronic enteritis, the prescribed oral sorbifer has no effect. Tactics of the doctor in this case: transfuse RBC mass prescribe parenteral iron medications increase the dose of sorbifer refer the patient for a consultation with a hematologist refer the patient for a consultation with a gastroenterologist 59. In whish disease can the following symptoms occur: burning sense in the tongue, dyspeptic disorders (decreased appetite, nausea), impaired wellbeing, numbness and paresthesia of the extremities, the appearance of neurological symptoms: hemolytic anemia aplastic anemia iron deficiency anemia anemia due to bleeding Vitamin B-12 deficiency anemia 60. Patient L., 31 years old, came to the clinic at the place of residence with complaints of weakness, sweating, stomatitis. From the anamnesis: sick for 3 weeks, treatment without effect. The skin is pale, moist. Objectively: body temperature is 38.8°C, gingival hyperplasia, ulcerative necrotic stomatitis. Submandibular lymph nodes are enlarged, painless. In the blood: RBC.2.9x1012/l, Hb-94g/l, CI-0.95, leukocytes-13.5x109/l, blasts-32%, stab neutrophils-1%, segm-39%, lymph -20%, mon-8%, platelets-90.0x109/l. ESR-24 mm/h. Cytochemical study: the reaction to peroxidase is positive. Your diagnosis: acute myeloid leukemia acute lymphoblastic leukemia acute undifferentiated leukemia acute monoblastic leukemia acute promyelocytic leukemia 61. A 40-year-old man complains of general weakness, sweating, weight loss, dull pain in the left hypochondrium. Objectively: the skin is pale, moist. Lymph nodes are not enlarged. The liver protrudes from under the costal margin by 3 cm, the spleen is at the level of the navel, dense, painless. CBC: RBC-3.0x1012/l, leukocytes-94x109/l, myeloblasts-2%, promyelocytes-4%, metamyelocytes-8%, stab neu-12%, segment.neu-52%, eosin.-5%, basof 5%, lymph.-12%, platelets-200.0x109/l. ESR-53 mm/h. Treatment of this condition is carried out under the control of the level: reticulocytes erythrocytes leukocytes ESR platelets 62. A 23-year-old girl suffers from menorrhagia for a long time. Hemoglobin79 g / l, CI-0.69, leukocytes 3.8x109 / l, formula without changes, serum iron 5.2 mmol / l. What is the proposed treatment? folic acid by mouth vitamin B 12 i/m - sorbifer Durules in tablets - & ferrus Lek i/m from confirm re tile "Ind apt RBC transfusion 63. Neurological symptoms in the form of funicular myelosis, gastroenterological symptoms, pernicious, hyperchromic anemia and megalocytosis in the peripheral blood are characteristic of: autoimmune hemolytic anemia B12 deficiency anemia IDA Minkowski-Choffard anemia aplastic anemia 64. Patient P., 65 years old, was admitted with complaints of epistaxis and weakness. In the blood: total protein 100 g/l, M-gradient is determined. The craniogram showed no changes in the bones of the skull. In the myelogram: plasma cells - 5%. Presumptive diagnosis: a confirm acute leukemia thrombocytopenic purpura ~ multiple myeloma ~ chronic myeloid leukemia File Waldenström's disease correct > - 2nd - from answer 65. Patient A., aged 54, a livestock specialist by profession, was admitted with severe splenomegaly. In CBC: RBC-3.1x1012/l; Hb-95 g / l, CI-0.9, leukocytes 124x109 / l, promyelocytes - 12%, myelocytes - 10%, stab neu 12%, segm neut - 32%, lymph. – 19%, basophils – 7%, eosinophils – 8%. ESR–42 mm/h. Reactions of Wright and Heddelson are negative. Your diagnosis: chronic brucellosis acute leukemia chronic myeloid leukemia chronic lymphocytic leukemia erythremia 66. Patient Zh., aged 20, complains of fever, periodic epistaxis, gingival bleeding, weakness, shortness of breath. Objectively: the patient is in a serious condition, the skin is pale, there are bruises all over the body, the peripheral lymph nodes are not enlarged. The rest of the organs are unremarkable. CBC: Hb-60 g/l; RBC 2.0x1012/l; CI-0.9; WBC - 1.5x109 / l; platelets 20х109/l. In the myelogram: the ratio of fatty bone marrow to the effective 90%: 10% in favor of fat. What is the most likely diagnosis? ENT acute myeloid leukemia acute erythromyelosis chronic myeloid leukemia aplastic anemia thrombocytopenic purpura 67. The patient complains of an increase in body temperature up to 39 0C, fatigue, palpitations, shortness of breath during exercise. The skin is pale, the edge of the liver is palpable, the spleen is enlarged, dense. In analyses: Hb-95g/l; CI 0.92; WBC -52x109/l, shift of the leukocyte formula to the left to promyelocytes, myelocytes and myeloblasts, ESR 78 mm/h. What is the preliminary diagnosis? sepsis erythremia acute leukemia chronic myeloid leukemia chronic lymphocytic leukemia 68. The patient complains of dizziness, constant fatigue, shortness of breath, paresthesia in the limbs and a tendency to diarrhea. Objectively: the skin is yellowish in color, smoothness of the papillae of the tongue, signs of glossitis. A few years ago, a gastrectomy was performed. Hyperchromic anemia is noted. Puncture of the bone marrow: megaloblastic type of hematopoiesis. An increase in the level of ferritin in the blood was revealed. Determine the diagnosis? aplastic anemia B12 deficiency anemia iron deficiency anemia autoimmune hemolytic anemia congenital hhemoglobinopathies 69. A 47 years old patient complains on productive cough, fever, chest pain and dyspnea. On examination the X-ray showed certain changes. What disease is characterized for this radiological picture: 72. What pneumonia is characterized by anamnesis - use of air conditioning, showers in hotels; febrile fever with marked intoxication, myalgia, arthralgia, cough, abdominal pain, diarrhea; blood test - leukocytosis with lymphocytopenia, ESR - 50 mm/hour: Staphylococcus aureus Chlamydia Mycoplasma Legionella Pneumococcal - TB (tuberculosis) Sarcoidosis Pleural effusion Community-acquired pneumonia Lung cancer -and File 73. A 30-year-old patient presented with a fever of up to 38°C, a non-productive cough, and general weakness. He had been acutely ill for 3 days. He had no bad habits. X-ray examination revealed changes. 70. A 43 years old patient complains on a persistent, mornings, cough with a small amount of colorless sputum, dyspnea on exertion. Past medical history: smoker for over 20 years. Objectively: tachypnea, barrel-shaped chest, use of accessory respiratory muscles and paradoxical indrawing of lower intercostal spaces. Vocal trembling is attenuated on both sides. Hyperresonance on percussion. Prolonged expiration. Coarse crackles. What examination has the greatest diagnostic value in this disease: CT (computer tomography) Chest X-ray Spirometry Sputum test Bronchoscopy 71. A 33 years old patient had a local dullness in the lower lobe of the right lung during a physical examination. The medical history revealed that the patient had recently experienced weakness, cough with mucous sputum, tingling in the chest on the right side. Complete blood count: Hb - 128 g/l, WBC 9.8x109/l, ESR - 21 mm/hour. Choose the most informative method for differential diagnosis between pneumonia and lung cancer: Immunological blood test Sputum test for atypical cells Chest X-ray CT (computer tomography) Bronchography Which antibacterials are first-line drugs in the treatment of this patient? 3rd generation cephalosporins fluoroquinolones Aminoglycosides Aminopenicillins Macrolides 74. A 65-year-old patient with COPD has increased dyspnea, cough, increased volume of yellow-green sputum, subfebrile body temperature. Objectively: pulse rate-28, heart rate-92. On auscultation: the lung breathing is rigid, dry whistling rales are heard. Which of the following drugs should be prescribed in this case? ventolin inhaled gentamicin i/m amoxicillin per os inhalation seretide inhaled 75. Male, 28 years old. Complaints of weakness, malaise, fatigue, weight loss, coughing, night sweats. He has been ill for the last 2-3 months and very often works night shifts. On fluorogram: an infiltrative shadow in the upper lobe of the right lung with a pathway to the root. Your tactic: referral for antituberculosis treatment refer to pulmonology department refer for consultation to a phthisiatrician give antimicrobial treatment refer for sputum analysis for Mycobacterium tuberculosis. community-acquired lower lobe pneumonia, left lung abscess, inpatient treatment in a pulmonology department community-acquired lower left lobe pneumonia, exudative pleuritis, inpatient treatment in a pulmonology department community-acquired lower lobe pneumonia of the left lung, left-sided pleuritis, referral for inpatient treatment in a day care centre left-sided exudative pleuritis, treat with day-care 77. A 62-year-old patient complains of cough with sputum, fever up to 38°C. Worsening of condition for 4 days after hypothermia. The patient has been referred for examination. The radiograph revealed the following changes: 76. A 47-year-old patient consulted a general practitioner with complaints of cough with retractable (retching) sputum, fever up to 38° C and chest pain in the left side of the chest. He works as a specialist in an office. Worsened condition for 10 days after hypothermia, took paracetamol, gentamicin, no improvement. Outpatient clinic doctor examined the patient and ordered an examination. The radiograph showed the following changes: Your conclusion and further tactic: community-acquired middle lobe pneumonia of the right lung, right-sided pleuritis, inpatient treatment in a day hospital community-acquired right middle lobe pneumonia, exudative pleuritis, inpatient treatment in a pulmonology department right lung abscess, for inpatient treatment in a pulmonology department community-acquired middle-lobe pneumonia of the right lung, moderate severity, prescribe treatment in a day hospital exudative right-sided pleuritis, inpatient treatment in a pulmonology department Your conclusion and further tactics: out-of-hospital lower lobe pneumonia of the left lung, prescribe treatment at home, follow-up at home A 49-year-old patient complains of weakness, dizziness, decreased appetite, weight loss, sweating, prolonged (about 1.5 months) non-productive cough. On examination: relatively satisfactory condition. The skin was grayish, pale and moist. Breathing is rigid, and wet wheezing are heard in the upper parts of the left lung. The doctor's diagnostic tactic: immuno-blood test lung radiography sputum examination general blood analysis biochemical blood analysis 78. Patient, 60 years old with a CBC: Hb-78g/l; color index-1.3; erythrocytes2.3x1012/l; macrocytosis. Past medical history: suffers from chronic gastric and intestinal disease for a long time. What treatment should be administered to a patient with this disease? treatment with sorbifer durules for a long time folic acid intake fercaine injections with courses cyanocobalamin injections on a regular basis transfusion of red cell mass according to indications 79. A 24-year-old patient presents with a fever of up to 40°C, headache and pain in the throat when swallowing. He had an acute illness 3 days ago. On the first examination: hyperemia of the pharynx, enlarged submandibular lymph nodes. Examination: CBC- Hb 90 mmol/l, erythrocytes 2.2×1012/l, Leucocytes-2.3×109/l, ESR-45 mm/h. Myelogram: blast cells 65%. Your preliminary diagnosis and further tactic: patient has chronic myeloleukaemia, anaemic syndrome. patient has acute leukaemia, as the bone marrow shows blastosis. patient is anaemic, with a decrease in haemoglobin and erythrocytes in the blood. patient with acute leukaemia due to suppression of all hematopoietic sprouts in the bone marrow patient has chronic lymphatic leukaemia, haemorrhagic syndrome 80. A 25-year-old woman has come a general practitioner with the diagnosis: Repeated pregnancy 10-11 weeks, moderate degree of iron deficiency anaemia. Treatment tactics for identified iron deficiency anaemia: parenteral administration of iron preparations before delivery and during the whole lactation period, per os intake of iron preparations the intake of apples and pomegranates, red fish transfusion of red blood cells daily consumption of 300 grams of chopped liver 81. A 46-year-old patient presented with a productive yellow-green cough, raised body temperature to 39°, dyspnoea at rest and chest pain. The patient underwent radiological examination. Determine the correct tactics of the GP. patient has community-acquired right-sided lower lobe pneumonia, moderate severity, treatment with broad spectrum antibiotics at home patient has community-acquired bilateral lower lobe pneumonia, moderate severity, treated as an outpatient with two antibiotics patient with right-sided pleuritis, emergency admission to the pulmonology department patient has nosocomial bilateral lower lobe pneumonia, severe, emergency admission to the pulmonology department patient with COPD, exacerbation treated with broad-spectrum antibiotics in day hospital 82. A 54-year-old patient presenting with cough, shortness of breath 3-4 times a week, nocturnal attacks up to once a week. Smoker's index is 20. Spirography revealed forced expiratory volume1-58%, after inhalation of salbutamol the airway improved by 10%. What diagnosis has the patient been given by the doctor? mild to moderate obstructive chronic lung disease asthma with a moderate persistent course chronic obstructive pulmonary disease of moderate severity asthma with a persistent, mild course bronchial asthma with a mild intermittent course 83. A 36-year-old patient is seen by a doctor in a rural outpatient clinic. He has been on the registry for 7 years with a diagnosis of chronic enteritis. He complains of weakness, dizziness, sometimes pains near the navel and in the epigastrium, sore throat, irregular stools. On examination in general blood analysis Hb - 110g/l, er - 3.8×1012, microcytosis, anisocytosis. Diagnose the patient and decide on further treatment tactics: B12 deficiency anemia, chronic enteritis, chronic gastritis, prescribe fibrogastroduodenoscopy, vitamin B12 treatment iron deficiency anaemia, medium degree of severity, red blood cell mass transfusion intermediate iron deficiency anaemia, chronic enteritis, determine ferritin, treatment with iron supplements intermediate iron deficiency anaemia, chronic enteritis, administer parenteral iron supplements chronic enteritis, chronic gastritis, prescribe diet, proton pump inhibitors 84. Patient T., 65 years old, has been suffering from asthma for several years, complains of persistent cough, shortness of breath, and frequent attacks of gasps at night. On examination: PEF - 55%, FEV1 - 50%. Specify the severity of this clinical picture: 2nd level of asthma 3rd level of asthma 1st level of asthma 4th level of asthma 5th level of asthma 85. Patient I., 57 years old, economist. He is under the follow up with a diagnosis of coronary artery disease: Angina pectoris FC 2, CHF (NYHA 1). At the GP’s appointment, community-acquired focal pneumonia was diagnosed, mild of severity. Determine the doctor's tactics for the treatment of this patient: treatment in the pulmonology department treatment in the cardiology department treatment a hospital at home treatment in a day time clinic outpatient treatment in a polyclinic 86. In progressive angina pectoris usually seen: Chest pain occurs at night The presence of a Q wave, negative t wave on the ECG Increased frequency and duration of chest pain Persistent increase in blood pressure The appearance of chest pain with a deep breath 87. The main sign of transmural myocardial infarction on the ECG is: Multi-lead ST segment depression Right bundle branch block The appearance of a QS complex in two or more leads Tall T waves Heart rhythm disorder 88. Choose the optimal complex of drugs for the treatment of chronic heart failure stage II NYHA: send file ans - Diuretics, glycosides, and lidocaine Calcium channel blockers and glycosides Diuretics, glycosides a Diuretics and ACE inhibitors β-blockers and glycosides - varified from GPT 89. The most effective drug for the treatment of ventricular paroxysmal tachycardia is: Verapamil Ivabradine Novocainamide Enalaprili Amiodarone 90. The most common complication in the first hours of acute myocardial infarction is: Acute aneurism Cardiogenic shock Rhythm disorder Pulmonary edema Myocardial rupture 91. A contraindication for the prescribing of ACE inhibitors is: Diabetes mellitus Raynaud's syndrome Heart failure Pregnancy Gout 92. What drug from the followings can cause dry cough? Atorvastatine Berotec Nedocromil Captopril Amlodipine 93. A patient was admitted for the treatment with complaints of dull, pressing pains in the chest. Woke up with pain, a few hours after sleep. From the anamnesis: The attacks are usually in the form of a series, alternating one after another for 10-15 minutes. The ECG shows an elevation of the ST segment during the attack. What is your most likely diagnosis? Angina pectoris 3 FC Angina pectoris 4 FC Prinzemetal’s angina Angina pectoris 2 FC Acute myocardial infarction 94. Patient M., 20 years old, complains of stitching pain in the heart area, palpitations, weakness, malaise. From the anamnesis: 3 weeks ago he had the flu. On physical examination, the heart borders are expanded to the left, a systolic murmur is heard over the entire heart area, without irradiation, heart rate is 90 beats per minute. Temperature 37.7 0C. A laboratory study reveals leukocytosis, increased ESR, C-reactive protein (+). On the ECG: repolarization abnormality and slowing of intraventricular conduction. Indicate the most likely diagnosis Cardiomyopathy Myocarditis Pericarditis Myocardial dystrophy Myocardial infarction 95. Patient’s ECG revealed the following changes: the rhythm is irregular, the absence of P waves before the ventricular complex, different amplitude oscillations of the baseline: The doctor interpreted it as: Ectopic rhythm Sinus tachycardia Atrial fibrillation Atrial premature beats Ventricular premature beats 96. At a patient with myocardial infarction a sudden deterioration of his condition occurs, the following ECG changes were revealed: chaotic irregular rhythm, QRS complexes and T waves are absent. What condition is it typical for? Ventricular premature beats Atrial fibrillation Ventricular fibrillation Atrial premature beats Ectopic rhythm 97. A 58-year-old woman, after intensive work in the garden, felt severe pressing chest pain, irradiating in her left shoulder, shortness of breath, weakness, sweating. She took nitroglycerin twice, but her condition did not improve. Examination: agitated, scared, the skin is pale, moist. Heart sounds are muffled, arrhythmia, blood pressure 145/75 mm Hg, heart rate 90 per minute. Likely diagnosis: Idiopathic myocardiopathy Hypertension Acute myocardial infarction Acute myocarditis Intercostal neuralgia 98. A patient with cardiac arrhythmias has the following symptoms: short-term loss of consciousness after tachybradycardia, absence of breathing, pulse, pressure, pallor of the skin, convulsions, involuntary urination and defecation, rapid self-recovery to the initial health condition. What is the reason for these symptoms? Hyperglycemic condition Status epilepticus Ventricular fibrillation Adams–Stokes syndrome Orthostatic collapse 99. A patient with arterial hypertension with concomitant bronchial asthma should be prescribed an antihypertensive drug. Which of the proposed drugs is contraindicated in this situation? Amlodipine Candesartan Indapamide Anaprilin Lisinopril 100. The choice of which antianginal drug is preferable if the patient has concomitant COPD? Beta blockers Nitrates (as monotherapy) Diuretics Calcium channel blockers ACE inhibitors 101. A 55-year-old patient is complaining for the right shoulder pain, previously provoked by brisk walking, disappearing in rest, today arose after dinner and continued for 20 minutes. For which of the following conditions the pain is typical? Myocarditis Cervical ostheochondrosis Acute myocardial infarction Angina pectoris Prinzmetal’s angina 102. Patient K., 68 years old, who had an acute myocardial infarction 2 months ago, complains on chest pain on the left side, on auscultationweakening of breath sounds on left side, fever, pericardial friction noise, increased ESR. ECG dynamics were unremarkable. Your conclusion: Fibrinous pleurisy Left side lower lobe pneumonia Dressler syndrome The spread of the myocardial affected area Idiopathic pericarditis 103. A patient was admitted for the treatment with complaints of dull, pressing pain in the chest. Woke up with pain, a few hours after sleep. From the anamnesis: The attacks are usually in the form of a series, alternating one after another for 10-15 minutes. The ECG shows an elevation of the ST segment during the attack. What is your most likely diagnosis? Prinzmetal’s angina Angina pectoris 2 FC Angina pectoris 3 FC Angina pectoris 4 FC Acute myocardial infarction 104. A 47-year-old patient had pain in the lower part of the sternum 2 weeks ago when he run to the 4th floor, Stopped in rest. Such pains appeared for the first time. Later, such pains began to appear when walking fast, going up the 2nd floor. Determine the form of angina pectoris. Choose your tactics: Ischemic heart disease. First-onset angina pectoris. Send for hospitalization, prescribe antianginal therapy Ischemic heart disease. Exertional angina FC 2. Prescribe antianginal therapy Ischemic heart disease. Progressive angina pectoris. Send for hospitalization Cardialgia may be due to a non-coronary disease. Perform a work up Ischemic heart disease. Prinzmetal's angina. Prescribe antianginal therapy 105. Patient N., 67 years old, suffers from high blood pressure for 10 years, smokes for 15 years, suffers from type 2 diabetes mellitus for 4 years, takes glucophage 850 mg per day. Body mass index 29, cholesterol level 5.9 mmol / L. ECG: signs of left ventricular hypertrophy. During the examination, the blood pressure was 190/110 mm Hg. Your diagnosis: HTN 3. Very high risk HTN 3. Moderate risk HTN 2. High risk HTN 3. High risk HTN 2. Very high risk 106. Patient M., 63 years old, complains of periodic sudden attacks of severe dizziness with loss of consciousness, which appeared after infectious myocarditis 3 years ago. Recently, there has been an increase in relapses up to 2-3 times a month. BP 110/70 mm Hg, heart rate 57 beats per minute. ECG: lengthening of the PQ interval duration, regular Wenckebach periods. What treatment is most optimal for a given patient? Heart pacemaker implantation CABG (coronary artery bypass graft) M-cholinoblockers Calcium channel blockers Beta-blockers 107. A 47-year-old patient had pain in the lower part of the sternum 2 weeks ago when he run to the 4th floor, stopped in rest. Such pains appeared for the first time. Later, such pains began to appear when walking fast, going up the 2nd floor. Determine the form of angina pectoris. Choose your tactics: Ischemic heart disease. First-onset angina pectoris. Send for hospitalization Prescribe antianginal therapy Ischemic heart disease. Exertional angina FC 2. Prescribe antianginal therapy Cardialgia may be due to a non-coronary disease. Perform a work up Ischemic heart disease. Progressive angina pectoris. Send for hospitalization Ischemic heart disease. Prinzmetal's angina. Prescribe antianginal therapy 108. A 45-year-old patient consulted a GP in ambulatory with complaints of constricting chest pain that arose at night, lasting more than 20 minutes, which were not relieved by nitroglycerin. On the ECG complex QS. The doctor diagnosed IHD. Acute posterior myocardial infarction. Localization of myocardial infarction is diagnosed based on changes in leads: II, III, aVF I, aVL, V3,V4 I, aVL, V1-V6 V5, V6, III, aVF I, aVL, V1-V3 109. A 65-year-old patient has weakness, shortness of breath, legs pitty edema. From the anamnesis: 6 years ago he had a myocardial infarction. On physical examination: heart sounds are muffled, rhythmic, heart rate-82 per minute. In the lower parts of the lungs, moist rales are heard. On the ECG: scar changes in the anterior wall of the LV and the septum. On echocardiography: left ventricle is enlarged to 5.8 cm, the wall is thickened to 1.2 cm, anterior wall akinesia. EF 42%. What is the patient’s diagnosis: Pulmonary embolism Dilated cardiomyopathy Bilateral lower lobe pneumonia Chronic heart failure Exacerbation of COPD 110. Which ECG changes are observed at an attack of stable (exertional) angina: deep, wide Q wave in III and AVF deep, broad Q wave in V1-V3 ST segment horizontal depression Q wave, negative T wave in all leads ST segment elevation 111. What is the most significant risk factor for coronary heart disease? arterial hypertension alcohol consumption smoking physical inactivity moderate obesity 112. A patient with arterial hypertension is disturbed by constant dry cough while taking pharmacological therapy for hypertension. What group of drugs can cause this side effect? ACE inhibitors CCBs (calcium channel blockers) beta-blockers ARBs (angiotensin receptor blockers) thiazides diuretics 113. In the diet of a patient with arterial hypertension you should restriction the intake of: sodium (cooking salt) potassium fats carbohydrates protein 114. A patient complains of dyspnea and palpitations during minor physical activity. According to the New York Heart Association (NYHA) classification, what functional class of chronic heart failure does his condition correspond to: and file answer > functional class IV functional class 0 - functional class III functional class II functional class I ~ correct 115. Which of the following drugs is more reasonable to prescribe as basic therapy for the 59 years old patient with Arterial hypertension degree 3, high risk, Chronic heart failure, functional class I? ACE inhibitors calcium channel blockers diuretics digoxin beta-blockers 116. The most common complication in the first hours of acute myocardial infarction is: acute aneurysm rhythm disturbance acute pulmonary edema cardiogenic shock heart rupture 117. The most common cause of death in acute myocardial infarction is: сardiogenic shock complete AV block arrhythmias left ventricular failure pericarditis 118. What drug should you prescribe to a patient with arterial hypertension and bradycardia? hydrochlorothiazide amlodipine lisinopril bisoprolol spironolactone 119. The most sensitive biomarker of myocardial infarction is: LDH (lactate dehydrogenase) ALT (alanine aminotransferase) Cardiac troponin I AST (aspartate aminotransferase) CK (creatine phosphokinase) 120. There are compelling contraindication to the use of these drugs for the patients with arterial hypertension and bilateral renal artery stenosis: ACE inhibitors 2nd > File answer beta-blockers calcium antagonists (dihydropyridines) calcium antagonists (verapamil, diltiazem) diuretics 122. The duration of chest pain in stable (exertional) angina is: 1 to 15 minutes 5 to 10 minutes 15 to 30 minutes less than 1 minute up to 60 minutes 123. Contraindication to the use of ACE inhibitors is: pregnancy diabetes mellitus asthma heart failure gout 124. In which following leads are there ECG changes in inferior myocardial infarct of the left ventricle: II, III, aVF aVL, V1-V4 aVL, V1-V2 I, aVL, V5-V6 V1-V6 125. A 45-year-old man complains at sharp and spasmodic chest pains. Objectively his condition was satisfactory. Heart sounds were clear, rhythm was irregular, PS 76 in 1 minute, BP 125/60 mm Hg. On ECG: ectopic atrial contraction, followed by normal QRS complex. PQ interval was 0.12-0.20 sec. - - 121. 1st degree AV block is characterized by ECG signs: only ventricular contractions are registered PQ interval is prolonged independent appearance of atrial and ventricular complexes sinus bradycardia is detected only atrial contractions are registered What is your conclusion on the patient's ECG: ventricular extrasystole atrial extrasystole atrial flutter ventricular fibrillation atrial fibrillation 126. A 50 years old man has been complaining for 3 months of retrosternal pressing pain, occurring when walking up to 500 meters or when climbing stairs to the third floor. This case of angina pectoris can be classified as: Stable angina pectoris III functional class Stable angina pectoris II functional class Stable angina pectoris I functional class Stable angina pectoris IV functional class It is impossible to determine the functional class 127. A 35 years old patient complains of attacks of pressing pains in the chest. He woke up early in the morning with pain, and the several painful attacks occur in the form of alternating series of 10-15 minutes. ECG shows ST-segment elevation during the attack, after the attack ST-segment on baseline. What is your most likely diagnosis? Prinzmetal's angina angina pectoris functional class III angina pectoris functional class I angina pectoris functional class II Acute myocardial infarction 128. Women, 59 years old, after intensive work in the garden, felt severe chest pain, crushing pain in the left arm, shortness of breath, weakness, sweating. She took nitroglycerin three times, but severe chest pain didn't relieve. Objectively: she is very anxious, frightened, skin pale and moist. Heart sounds were muffled, arrhythmia, heart rate 90 per minute, BP 145/75 mm Hg. What is your most likely diagnosis? acute myocardial infarction climacteric myocardiopathy arterial hypertension acute myocarditis intercostal neuralgia 129. A 53 years old woman follow up at the family doctor with the diagnosis: Сoronary heart disease. Angina pectoris functional class 2. Сhronic heart failure, functional class I. On the EchoCG: diastolic dysfunction of the left ventricle. What drug is reasonable to use for treatment this patient? aldosterone antagonists nonglycoside inotropic drugs loop diuretics digitalis glycosides selective beta-blockers 130. A 22 years old women has blood pressure 175/125 mm Hg for more than 1 year, refractory to hypotensive therapy. Also she has frequent attacks of abdominal pain. On examination a systolic murmur is heard above the umbilicus. What is your most likely diagnosis? renal artery stenosis aneurysm of renal artery coarctation of the aorta atherosclerosis of abdominal aorta pheochromocytoma 131. A 54 years old woman has been suffering from arterial hypertension and angina pectoris for 13 years. The correct scheme of drugs therapy for this patient is: diuretics + nitrates calcium channel blockers + digitalis glycosides beta-blockers + calcium channel blockers ACE inhibitor monotherapy digitalis glycosides + nitrates 132. A 49 years old men with overweight, without bad habits, notes the occurrence of transient chest pains during excessive physical exertion, when climbing up to the 5th floor; the pains go away on their own by rest. On the ECG: no changes. What is your most likely diagnosis? acute myocardial infarction stable angina pectoris functional class I Prinzmetal's angina stable angina pectoris functional class II acute coronary syndrome 133. A 48 years old men suffering from coronary heart disease, angina pectoris, II functional class, has constant tachycardia with heart rate up to 100 per 1 minute. Which drug is considered reasonable in this case? bisoprolol 5 mg once a day nitroglycerin under the tongue without restriction cardiket 20 mg 2 times a day thromboAss 100 mg once daily atorvastatin 10 mg once daily 134. A 58 years old patient suffering from coronary heart disease with rhythm disturbances and grade II arterial hypertension should start drug therapy with: beta-blockers diuretics calcium channel blockers ACE inhibitors nitrates 135. A 45 years old patient with acute myocardial infarction. On the ECG: polytopic group of ventricular extrasystoles. In this case the patient should be administered with: diltiazem bisoprolol lidocaine verapamil adenosine 136. Seven weeks after acute myocardial infarction, a patient was presented with chest pain and fever. Examination revealed pericarditis and pleurisy. What is your most likely diagnosis? Dressler's syndrome cardiomyopathy viral myocarditis esophageal hernia neurocirculatory dystonia 137. A patient has an acute myocardial infarction and high blood pressure. Which drug is preferred to reduce high blood pressure in this case? ~ nitroglycerin and File * ACE inhibitors angiotensin receptor blockers calcium channel blockers diuretics answer rect 138. Which drug is inadvisable to use in an attack of Prinzmetal angina? verapamil diltiazem nitrates beta-blockers nifedipine 139. Select the ECG sign that is absolutely significant for acute myocardial infarction: negative T wave decreased R wave amplitude QS combined with ST elevation ST segment depression T wave inversions 140. A 68 years old patient with grade III arterial hypertension is disturbed by dyspnea and palpitations at rest. According to the New York Heart Association (NYHA) classification, what functional class of chronic heart failure does his condition correspond to? II functional class I functional class IV functional class III functional class 0 functional class 141. Choose the best drugs to treat a patient with coronary heart disease and concomitant COPD? nitrates ACE inhibitors calcium channel blockers beta-blockers angiotensin receptor blockers 142. A 73 years old woman has arterial hypertension and angina pectoris for many years. Choose the optimal combination of drugs for treatment: beta-blockers + calcium channel blockers ACE inhibitors + nitrates ACE inhibitor (monotherapy) thiazide diuretics + nitrates calcium channel blockers + angiotensin receptor blockers 143. A 62-year-old female patient with functional class II angina pectoris is constantly suffering from tachycardia up to 100 beats per minute. What drug is most effective for this condition// long acting oral nitrates (isosorbide mononitrate) calcium channel blockers (nifedipine) antiplatelet therapies (aspirin in maintenance dose of 75 mg/day) beta-blockers (metoprolol) short acting oral nitrates (nitroglycerine) 144. A 15 years old adolescent has increased blood pressure to 175/115 mmHg, complains of occasional numbness in the legs. Objectively: Welldeveloped thorax, narrow pelvis and thin legs. Differential blood pressure between upper and lower extremities was noted. On chest x-ray: bilateral rib notching. What is your most likely diagnosis? atherosclerosis of the aortic arch fibrosing alveolitis coarctation of the aorta Cushing's syndrome Takayasu's disease patient has chronic heart failure patient has bilateral lower lobe pneumonia patient has dilated cardiomyopathy 145. Which of the instrumental tests is the most informative to detect left ventricular hypertrophy: ECG (electrocardiography) Chest X-ray EchoCG (echocardiography) Heart percussion Heart auscultation 149. A 36 years old patient complains of sharp pains in the heart region after stress. Objectively: satisfactory condition, BP 120/60 mm Hg. Heart sounds are muffled, arrhythmia. On the ECG: 146. A 40 years old patient suffering from grade II arterial hypertension, grade I chronic heart failure and type I diabetes mellitus. Her primary care physician prescribed bisoprolol as maintenance therapy for arterial hypertension. Instead of bisoprolol, doctor should prescribe this drug: thiazide-type diuretic calcium channel blocker ACE inhibitor loop diuretic potassium-sparing diuretic What is your conclusion about the patient's ECG? ventricular fibrillation atrial extrasystole ventricular extrasystole atrial fibrillation sinus rhythm 147. A 20 years old patient complains of sharp pains in the heart region after stress. He suffers from congenital heart defect (atrial septal defect). On ECG: each P wave corresponds to a QRS complex. P wave 0.08 sec, PQ interval 0.28 sec, QRS interval 0.10 sec, ST 0.30 sec, ST is on the baseline, T wave is positive. What is your conclusion about the patient's ECG? no arrhythmias and conduction disturbances ~ Gpi answer atrial fibrillation on X AV block sinoatrial block File ventricular extrasystole m e m missing 148. A 65 years old patient complains of weakness, shortness of breath, edema in the legs. Past medical history: he suffered acute myocardial infarction 6 years ago. He takes bisoprolol and thromboass (aspirin). Objectively: Heart sounds are muffled, rhythmic, heart rate 82 per minute. Pulmonary crepitations were heard in lower lobes of both lungs. On ECG: scars changes on the posterior wall of the left ventricle and septum. On the EchoCG: akinesia zones on the posterior wall. LVEF (left ventricular ejection fraction) is 42%. What caused the appearance of these symptoms in this patient? patient has an exacerbation of chronic obstructive bronchitis patient has pulmonary embolism 2nd 150. A 36 years old woman had a severe influenza, she was treated as an outpatient and refused hospitalization. After 2 weeks, constant pain in the heart area, irregular heartbeat, dyspnea on slight physical exertion, and edemas in the legs appeared. On examination: body temperature 37.3°C, acrocyanosis, heart sounds are muffled, arrhythmic with heart rate 100 per minute, BP 100/80 mm Hg, single moist wheezing in lower lungs, BR 20 per minute. The liver was 1 cm below the edge of the rib arch, ankle swelling. ECG showed decreased wave voltage of the all leads. What flu complication in this case is there? acute myocardial infarction pneumothorax myocarditis cardiomyopathy valve disease 151. A 46 years old man had pain in the lower third of his sternum two weeks ago while climbing up to the 4th floor very quickly, which passed at rest. Such pains occurred for the first time. Later on, they began to appear during fast walking, climbing up to the 2nd floor. Choose most likely diagnosis and management tactic: Coronary heart disease, progressive angina pectoris. Referral for hospitalization. ouaptanswer may be its correct Coronary heart disease, stable angina pectoris II functional class. Prescribe antianginal therapy. Myocarditis, may be due to non-coronary disease. Perform heart auscultation. Coronary heart disease, the first onset angina pectoris. Refer for admission to the hospital. Coronary heart disease, Prinzmetal's angina. Prescribe nitrates. O und File answer 152. A 56 years old man suddenly had pain in the lower third of his sternum in the morning. Such pain occurred for the first time. The patient was examined by an ambulance doctor, the patient's ECG showed myocardial infarction: Choose most likely ECG conclusion: Scarring myocardial infarction of posterior wall of left ventricle Acute myocardial infarction of anterior wall of left ventricle Acute myocardial infarction of posterior wall of right ventricle Acute myocardial infarction of posterior wall of left ventricle Acute myocardial infarction of anterior wall of right ventricle 153. A 56 years old patient was examined at home with complaints of intense pressure chest pains and pains in the epigastrium. These complains began after physical exertion, took nitroglycerin, but the pains were not relieved. ECG showed the following picture. Choose your most likely ECG conclusion: Posterior septal wall myocardial infarction of the left ventricle Anteroseptal wall myocardial infarction of the left ventricle Anterolateral wall myocardial infarction of the left ventricle Anteroseptal and Anterolateral wall myocardial infarction of the left ventricle Posterior basal wall myocardial infarction of the left ventricle 154. A 40 years old man complains of palpitations and pressure chest pains, accompanied by loss of consciousness. Objectively: Heart sounds are slightly muffled, rhythmic, heart rate 88 per minute. BP 90/60 mm Hg. On the ECG: ST segment elevation in V2-V3. Troponin T was in normal ranges. What tests should be done the first of all? coronaroangiography electroencephalography echoCG ventriculography ECG monitoring 155. In which disease does haematuric syndrome most often develop? chronic glomerulonephritis acute pyelonephritis renal artery stenosis renal vein thrombosis diabetes mellitus 156. What is the most common cause of nephrotic syndrome? renal artery stenosis acute pyelonephritis chronic glomerulonephritis renal vein thrombosis chronic pyelonephritis 157. Which of the following signs is mandatory in chronic glomerulonephritis: edema changes in urine tests arterial hypertension pollakiuria dysuria 158. Which kidney disease is characterised by oedema, hypoproteinemia? glomerulonephritis polycystic disease pyelonephritis diabetic nephropathy urolithiasis 159. What tests are prescribed by a general practitioner in primary care when there is a suspicion of thyrotoxicosis? blood tests for TSH, T3 and T4 thyroid scan x-ray of the neck with barium swallow thyroid ultrasound magnetic resonance imaging of the thyroid gland 160. The most informative method for detecting thyroid cancer is: thyroid scintigraphy thyroid palpatory examination fine-needle aspiration biopsy of the thyroid gland thyroid ultrasonography computed tomography of the thyroid gland 161. Type 1 diabetes mellitus should be treated starvation insulin with diet therapy nutritional therapy sulfonamide medication biguanides 162. Which indicator is the most reliable criterion for the degree of compensation of diabetes mellitus in the follow-up examination? daily mean glycaemia glycosylated haemoglobin C-peptide average amplitude of glycemic fluctuations blood insulin level 163. A possible cause of hypoglycaemia in diabetes mellitus is: high dose of insulin insufficient physical activity excessive bread units missed insulin injection insufficient insulin dose 164. In a typical diffuse-toxic goiter, thyrotropic hormone secretion is: normal suppressed elevated may vary depends on the size of thyroid gland 165. In primary hypothyroidism, blood shows:// TTH test is of no diagnostic significance reduced TTH level normal TTH level elevated TTH level no TTH 166. The presence of goiter in a significant number of individuals living in a particular region is defined as: epidemic goiter endemic goiter sporadic goiter de Curwen's goiter diffuse toxic goiter 167. Which hormone profile variant is characteristic of primary hypothyroidism? TTH decreased, T3 and T4 increased TTH elevated, T3 and T4 elevated TTH is normal, T3 and T4 are elevated TTH elevated, T3 and T4 decreased TTH, T3 and T4 are normal 168. Which type of hormonal profile is characteristic of diffuse toxic goiter? TTH elevated, T3 and T4 elevated TTH is normal, T3 and T4 are elevated TTH elevated, T3 and T4 decreased TTH, T3 and T4 are normal TTH is decreased, T3 and T4 are elevated 169. Which disease most often contributes to the development of nephrotic syndrome?: chronic pyelonephritis chronic glomerulonephritis acute pyelonephritis renal vein thrombosis diabetes mellitus 170. Which examination is reliable to confirm thyrotoxicosis? blood T3 and T4 tests neck radiograph with barium swallow thyroid ultrasound thyroid scan thyroid MRI 171. Type 1 diabetes mellitus is characterised by: gradual onset, middle age, excessive weight gain, relative insulin deficiency acute onset, mainly female, rapid weight loss, increased appetite, exophthalmus gradual and imperceptible onset, age over 40 years, insulin is not vital acute onset, young age, tendency to ketoacidosis, absolute insulin deficiency gradual onset, dry skin, bradycardia, constipation, facial swelling, weight gain 172. Chronic kidney disease 4 (CKD) is characterised by a decrease in GFR to: 89-60 ml/min 60-30 ml/min less than 15 ml/min/ over 90 ml/min 29 -15 ml/min 173. What treatment should be given to an elderly patient with severe hypothyroidism? refer to a sanatorium for balneotherapy prescribe high-dose L-thyroxine treatment with glucocorticoids prescribe low-dose L-thyroxine treatment prescribe glucocorticosteroids refuse treatment for hypothyroidism 174. Acute nephritic syndrome is characterised by: edema, hypo- and dysproteinemia, hypercholesterolemia arterial hypertension, hypercholesterolemia proteinuria, edema, hypo- and dysproteinemia arterial hypertension, proteinuria, haematuria arterial hypertension, azotemia, anaemia 175. A 67-year-old female patient has been suffering from urolithiasis for several years and underwent surgery 5 years ago. She has been suffering from urolithiasis for several years and underwent surgery 5 years ago. CBC: Hb-110g/l, red blood cells-3.0 mln, colour index-0.8, sedimentation rate-20 mm/hour, blood urea-8.8 mmol/l, creatinine 200.0 µmol/l. What is the diagnosis of the patient? chronic tubulointerstitial nephritis chronic renal failure acute renal failure acute interstitial nephritis acute urinary retention 176. A 63-year-old patient has been suffering from urolithiasis for 15 years and underwent surgery 3 years ago. His blood pressure has constantly increased to 165/105 mmHg, last year to 00/110 mmHg, he has facial oedema. Blood tests: Hb-105g/l, erythrocytes-3.0 million, colour index 0.8, sedimentation rate -20 mm/hour, blood urea-9.0 mmol/l, creatinine 242.0 µmol/l. What complication did this patient develop? chronic renal failure acute renal failure acute interstitial nephritis acute urinary retention chronic tubulointerstitial nephritis 177. A man has severe oedema syndrome, oliguria. After the examination the diagnosis is acute glomerulonephritis, nephrotic syndrome. Choose the correct treatment tactics: non-steroidal anti-inflammatory drugs quinidine derivatives gold medications glucocorticosteroid drugs antibacterials 178. Patient T., 20-year-old in general urine analysis: specific gravity 1.030, protein-3.1 g/l, leukocytes 8-10, erythrocytes 20-30, cylinders (hyaline) 7-10. Which disease is characterised by the following? acute pyelonephritis chronic pyelonephritis acute glomerulonephritis chronic renal failure chronic glomerulonephritis 179. Patient X., 54 year-old in general urine analysis: specific gravity 1.003, protein - 3.0 g/l, leukocytes 5-7, erythrocytes 10-15, hyaline cylinders 1-2. What disease are these changes characteristic for? acute pyelonephritis chronic pyelonephritis urolithiasis file chronic glomerulonephritis -~ and answer answer Cup corret from confirm a polycystic kidney disease 180. Student Y., 16 year-old 2.5 weeks after a sore throat, complains of headache and redness of urine. She was previously healthy. Face pale, puffy, BP-165/100 mm Hg. Suspected acute glomerulonephritis. What's very important at the start of treatment? penicillin intramuscular oral curantil bed regime salt restriction oral prednisolone 181. A man is registered with an outpatient clinic for diabetes, insulin dependent, severe course, diabetic angiopathy, stage 3 nephropathy. Which spas can be referred to: seaside resorts spa treatment is contraindicated any resort area spas in the forest-steppe zone any resort in the pine forest zone 182. Patients with what diagnosis is spa treatment indicated? chronic glomerulonephritis, hypertensive, acute stage, CRF1. bilateral chronic pyelonephritis in the phase of exacerbation, recurrent course of chronic renal failure 0 (CRF0) bilateral pyelonephritis, symptomatic hypertension of CRF II chronic pyelonephritis in remission chronic glomerulonephritis with nephrotic syndrome in the acute phase of CRF 1 183. A 55-year-old patient with a history of urolithiasis who underwent surgery 5 years ago. His blood pressure was 155/95 mmHg, last year it was 185/100 mmHg, he had facial oedema. Blood count: Hb-110 g/l, erythrocytes-3.0, color index-0.7 sedimentation rate-20 mm/hour, blood urea-8.8 mmol/l, creatinine 200.0 µmol/l. What is the diagnosis of the patient? acute renal failure acute interstitial nephritis chronic tubulointerstitial nephritis acute urinary retention chronic renal failure 184. During a physical examination of patient O., 21 years old, the following was found in his OM: specific gravity 1.028, protein-3.0 g/l, leukocytes 8-10, erythrocytes 20-30, cylinders (hyaline) 7-10. Which disease is characterised by the following? acute pyelonephritis chronic pyelonephritis chronic renal failure acute glomerulonephritis chronic glomerulonephritis 185. A 57-year-old patient diagnosed with urolithiasis. What is a contributing factor for urinary tract stone formation: hypoparathyroidism age gender hyperurecaemia antibiotic treatment 186. A 25-year-old female patient complained of headache and redness of urine 10 days after a sore throat. She was previously healthy. Her face was pale, puffy, BP-155/95 mmHg. Acute glomerulonephritis is suspected. Which of the following is important at the beginning of treatment? penicillin intramuscular oral curantil salt restriction// bed regime oral prednisolone 187. Define a direct indication for spa treatment bilateral chronic pyelonephritis in the acute phase, relapsing course of CRF0 chronic glomerulonephritis, hypertensive form in acute stage, CRFI bilateral pyelonephritis, symptomatic hypertension CRFII chronic pyelonephritis in remission chronic glomerulonephritis with nephrotic syndrome in the acute phase of CRF1 188. Patient K., 18 years old, has been suffering from diabetes for 6 years, receiving insulin therapy. During a physical education lesson she fainted and had brief convulsions. Her skin was moist. Which of the following complications is most likely? hyperosmolar coma lactacidotic coma ketoacidotic coma acute pulmonary heart failure hypoglycemic coma 189. Patient is 55 years old. Suffers from insulin-independent diabetes mellitus. Diabetes is compensated by diet and gluconil. The patient is about to undergo surgery for calculous cholecystitis. What is the tactics of hypoglycemic therapy? maintaining the same treatment regimen withdraw gluconil add prednisolone insulin prescription maninil regimen 190. What treatment should be given to an elderly man with severe hypothyroidism: refer him to a health resort for balneotherapy start treatment with high doses of L-thyroxine with glucocorticoids prescribe diuretics start treatment with low doses of L-thyroxine stop treatment of hypothyroidism 191. Patient diagnosed with diffuse toxic goiter of grade 2. Treatment was started with mercazolil 10 mg 3 times a day, anapriline 20 mg 3 times a day, phenozepam 1 mg 2 times a day. The patient's condition improved considerably, but pronounced leukopenia developed. What is the cause of the leukopenia: phenozepam administration high anapriline dose further progression of the disease mercazolid treatment not related to these medications 192. Patient K., 29 years old, complains of right lower back pain, headaches, fever up to 38°C, frequent urination. The patient had been treated for more than 4 years. Exacerbation of the condition occurred after overcooling of the legs. On the face: puffy, pale, puffiness around the eyes. Positive kidney punch symptom. Blood count: HB-114 g/l, leukocyties - 9.8x109/l; sedimentation rate - 34 mm/hour. Urinalysis: specific gravity - 1025, protein -0.99 g/l, leukocyties- all over the place; hyaline cylinders -2-4. What investigation is necessary to clarify the diagnosis? Zimnitsky's function test urine culture for Mycobacterium tuberculosis Rehberg-Tareyev test immunological blood test bacteriological examination of urine 193. Patient is a 56 year old, accountant. She has increasing weakness, dry skin, headaches and pain in the kidney area. Chronic kidney disease and arterial hypertension for many years. CBC: Hb-104g/l, color index-0.82, red blood cells-3.8x1012/l, Leucocyties-6.3x109/l, sedimentation rate-18 mm/h. Urine analysis: urea-10 mmol/l, creatinine-119mmol/l, total protein-61g/l. Zimnitsky's test: isohypostenuria. What is your diagnosis and what examinations should be further prescribed to the patient? chronic glomerulonephritis, determine glomerular filtration rate chronic glomerulonephritis, Nechiporenko urine test chronic glomerulonephritis, hypertensive form, additional prescription ECG chronic pyelonephritis, determine glomerular filtration rate chronic pyelonephritis, no need for evaluation 194. Patient, 32 years old, he is a lawyer. He has weakness, dry skin, headaches, facial swelling, suffers from kidney disease. CBC: HB-104g/l; erythrocyties-3.8x1012/l; Leucocyties -6.3x109/l; sedimentation rate-28 mm/hour. Urine analysis: specific gravity -1.003; protein-1.65g/l; hyaline casts -1-3; Leucocyties -1-2, erythrocyties -10-15. Zimnitsky's testisohypostenuria. Biochemical blood test: creatinine-140 µmol/l; total protein-63 g/l; cholesterol-5.0 mmol/l. GFR - 42 ml/min. Diagnosis?: chronic renal disease, stage 2. chronic glomerulonephritis, mixed form chronic renal disease, stage Chronic glomerulonephritis, haematuric form chronic renal disease, stage 3. Chronic glomerulonephritis, haematuric form chronic renal disease, stage 3.Chronic glomerulonephritis, nephrotic form. chronic renal disease, stage 3. Chronic glomerulonephritis, hypertensive form 195. Patient I., 48, complains of headaches, leg swelling, shortness of breath when walking, weakness, poor appetite, kidney disease for 10 years. Objectively: pale skin, swollen feet. Blood count: Hb-96 g/l; erythrocyties 2.8x1012/l; Leucocyties -8.8x109/l; sedimentation rate -35 mm/h. Urea-16 mmol/l, creatinine 250 µmol/l. Urine analysis: specific gravity -1005; protein -4.5 g/l; Leucocyties 6-10; erythrocyties -20-25; hyaline cylinders 2-. What examination is necessary to clarify the clinical diagnosis? glomerular filtration test Bens-Jones protein determination urine bacteriological examination urine culture for Mycobacterium tuberculosis Nechiporenko test 196. Patient J., 50 years old, has suffered from kidney disease for many years. On general examination there is a slight pastosity of the face and eyelids. Elevated BP. Kidneys were painful on palpation. Urine analysis: hypostenuria 1004-1007, leukocyturia, microhematuria. Ultrasound: the kidneys are enlarged, contours are uneven, cavities up to 2x3 cm in diameter are detected in both kidneys. Diagnosis: urolithiasis chronic pyelonephritis chronic glomerulonephritis renal tuberculosis polycystic kidney disease 197. A 28-year-old man was admitted to the hospital with complaints of weakness, headache, lower back pain, swelling in the face, upper and lower extremities, and swelling in the scrotal area. Past medical history: 3 weeks ago he had an acute respiratory infectious disease, within 4 days his temperature was 38-39°С. Objectively: Swelling of eyelids, shins, scrotum. Heart tones muffled, rhythmic, heart rate 58 per minute. BP160/90 mm Hg. Daily urine output 400 ml. On the CBC: leukocytosis, eosinophilia, anemia, accelerated ESR. The daily diuresis was dirty pink in colour, protein-3 g/l; red blood cells-60, white blood cells-15-18, renal epithelium, hyaline, granular cylinders. What is the diagnosis to think about? chronic glomerulonephritis in the acute phase acute glomerulonephritis nephritis interstitialis in the acute phase chronic exacerbation phase pyelonephritis renal amyloidosis 198. A 22-year-old man complains of significant weight loss, dry mouth, thirst, frequent urination, nausea. Objectively: dry skin, yellowish palms and soles, furunculosis on the body. In urinalysis: glucose-3.5%; acetone (++). What is the preliminary diagnosis? diabetes mellitus, decompensated type II diabetes mellitus, decompensated type I diabetes mellitus, decompensated, ketoacidosis type I diabetes mellitus, subcompensated type II diabetes mellitus, subcompensated 199. A 50 year old overweight woman is found to have an elevated fasting glucose level of 6.9 and 7.2 mmol/l on two occasions. Which of the following diagnoses is most likely? metabolic syndrome type 2 diabetes mellitus type 1 diabetes mellitus high fasting glucose impaired glucose tolerance 200. A 37-year-old patient complains of dysuria, subfebrile fever, urinalysis: specific gravity 1010, protein 0.033 g/l, leukocytes - 20-30, bacteria+++, ultrasound examination: deformity of both renal tubules and pelvis. Blood urea 7 mmol/l. Presumptive diagnosis: chronic pyelonephritis acute pyelonephritis urolithiasis secondary renal amyloidosis chronic glomerulonephritis 201. Patient N., 64 years old, consulted a doctor with complaints of headache, redness of urine colour and swelling of the legs. Past medical history: suffered from angina two weeks ago. For a long time he suffered from ventricular extrasystole against the background of coronary heart disease, arterial hypertension (BP 170/100 mmHg). Objectively: edema all over the body, BP 200/110 mmHg. Examination: urinalysis: proteinuria13.5 g/day, erythrocytes entirely covering the field of vision, CBC: Hb124 g/l, ESR-40 mm/h, total protein-60 g/l, albumin-60 g/l. Presumptive genesis of the edema syndrome: circulatory insufficiency in a patient with coronary artery disease. acute glomerulonephritis exacerbation of chronic pyelonephritis symptom complex " arteriolosclerotic kidney" acute pyelonephritis, possibly suppurative nephritis 202. Patient S., 28 years old, on the 5th day of treatment with paracetamol due to acute respiratory infections has headache, BP 170/100 mmHg. Urine tests: hypostenuria, proteinuria. What is the most likely complication? acute glomerulonephritis acute pyelonephritis acute renal failure of unclear origin acute tubulo-interstitial nephritis chronic glomerulonephritis, hypertensive variant 203. A woman with 8-10 weeks' gestation presented to the outpatient clinic with complaints of chilling, elevation of body temperature to 37.4-38.0°С, pain in the lumbar region. Past medical history: previously treated for kidney disease. Other organs showed no symptoms. Positive tapping symptom. Urine analysis: protein 0.066 g/l, leukocyturia, pyuria, erythrocytes 8-10, epithelial cells 6-8. Preliminary diagnosis: acute glomerulonephritis chronic glomerulonephritis chronic cystitis chronic pyelonephritis acute pyelonephritis 204. Patient F., 52 years old, in the urine sample: specific gravity - 1.007, protein - 3.0 g/l, leukocytes 5-7, erythrocytes 7-10, hyaline cylinders 1-2. What disease are these changes characteristic for? acute pyelonephritis chronic pyelonephritis urolithiasis polycystic kidney disease chronic glomerulonephritis 205. A 19-year-old student complains of significant dry mouth, thirst, frequent urination, weight loss, nausea. The skin is dry, palms and soles have a yellowish color, furunculosis on the body. CBC: glucose-3.5%; acetone (++). What is the diagnosis? decompensated diabetes mellitus decompensated type II diabetes mellitus subcompensated type II diabetes mellitus type I diabetes mellitus with ketoacidosis subcompensated type I diabetes mellitus 206. On examination in a patient with a BMI of 30, fasting glucose levels were found to rise to 6.7 and 7.4 mmol/l. Which is the correct diagnosis? grade 1 obesity impaired glucose tolerance type 2 diabetes mellitus diabetes mellitus type 1 high fasting glucose 207. Patient A., 40 years old, suffers from hypertension stage II, HF stage 1, and type I diabetes mellitus (compensated). A GP doctor has prescribed bisoprolol as maintenance therapy. The patient should be prescribed: calcium preparations digoxin antiaplatelet ACE inhibitors potassium-spairing diuretics 208. A 15 year old teenager complains of thirst, frequent urination, especially at night, and itchy skin. To make a diagnosis of diabetes mellitus it is necessary to carry out: glucose analysis in daily urine an acetone test in the morning urine 24-hour urine glucose and acetone test blood glucose test before bedtime fasting blood glucose test 209. A 36-year-old man with severe oedema syndrome, oliguria. After the examination the diagnosis is: acute glomerulonephritis, nephrotic syndrome. Choose the treatment tactics: antibacterials glucocorticosteroid drugs non-steroidal anti-inflammatory quinidine derivatives gold preparations 210. A 23-year-old woman with 22-23 weeks' gestation complains of chilling, elevated body temperature up to 37.4-38.0°C, pain in the lumbar region. Past medical history: previously treated for kidney disease. Other organs showed no symptoms. Tapping symptom is positive. Urine analysis: protein 0.066 g/l, leukocyturia, pyuria, erythrocytes 8-10, epithelial cells 6-8. Preliminary diagnosis: acute glomerulonephritis chronic glomerulonephritis chronic cystitis chronic pyelonephritis acute pyelonephritis 211. A 35-year-old female patient presents with weakness and fatigue. Past medical history: subtotal thyroid resection, took 50 mcg L-thyroxine. Objectively: facial edema, heart tones are muffled. BP - 100/70 mm Hg. Echocardiogram shows fluid in the pericardial cavity. Which of the following methods of investigation is the most informative? ECG bacteriological blood cultures computer tomography of mediastinum organs daily Blood Pressure Monitoring TTH, T3 and T4 levels 212. A 39-year-old patient complains of acute weakness, headache, decreased appetite, weight loss, leg swelling. He has been suffering from kidney disease for 5 years. Objectively: pale skin with jaundice, pastosity of the face, edema of the legs. CBC: Hg-70 g/l, erythrocytes-2.8x1012/l, leukocytes-5.8x109/l, ESR -29 mm/h. Biochemical blood test: specific gravity-1012; protein-1.5 g/l; leukocytes-4-5; erythrocytes-5-6. What investigation is necessary to clarify the diagnosis? kidney puncture biopsy chromo-cystoscopy kidneys X-ray Bens-Jones protein test urine bacteriological examination 213. A 42-year-old woman has been suffering from hypothyroidism for more than 10 years. She has been taking euthyrox in a daily dose of 75 mcg for a long time. The patient still has dry skin, constipation, memory impairment and drowsiness. On examination: TSH level increase. What should be changed in treatment tactics? prescribe prednisolone per/os decrease thyroid medication surgical treatment increase the dose of thyroid medication prescribe cytostatics 214. A 47 year old woman, 160cm tall and weighing 84kg, is accidentally found to have an elevated fasting blood glucose of 6.9mmol/l. What to do in this case: redetermination of fasting glycemia glycaemia determination after meals weight loss carry out a glucose tolerance test insulin therapy and a hypocaloric diet 215. A 17-year-old patient complains of thirst, dry mouth, weight loss. Examination revealed blood glucose 11.5 mmol/l, blood cholesterol 6.5 mmol/l, blood creatinine above 120.5 µmol/l, signs of ketoacidosis. Examination by an ophthalmologist - cataract. Your diagnosis and further tactic: diabetes mellitus 2, hospital admission diabetes mellitus 1, increase insulin dose diabetes mellitus 2, increase control of diet diabetes mellitus 1, hospital admission endocrinologist consultation 216. A patient with type 1 diabetes mellitus, decompensated, with high glucosuria, acetone in the urine (+++) is seen. What is the doctor's tactic: outpatient treatment day-care treatment home treatment hospitalisation in an endocrinology department increase in insulin dose 217. A 52-year-old woman complains of weakness, drowsiness, decreased hearing. Dry skin, muffled heart tones, bradycardia, BP 120/90 mmHg, leg oedema. ECG: low amplitude and flattening of T wave. EchoCG: decreased cardiac output. Urine test: moderate proteinuria. What additional test should be ordered: creatinine, urea, as she has glomerulonephritis. perform an ultrasound of the thyroid gland, as the patient has a hypothyroidism syndrome determine T3, T4, TTG, since the patient has a hypothyroidism clinic prescribe stress tests as she has ischemic heart disease refer for consultation to an endocrinologist 218. A 62 year old woman, weight gain, weakness, swollen face, dry skin, constipation, amenorrhoea, memory impairment. Her skin is dry and cold. Thyroid gland is not palpable. BP - 90/60 mmHg, pulse - 52 per min. T3, T4 are decreased, TTH - increased. What treatment need to the patient? thyrostatic medications diuretics iodine preparations steroidal anti-inflammatory drugs thyroid medications 219. Patient is 65 years old. He is 160 sm tall and has a body weight of 105 kg. He has no complaints. His fasting blood glucose level is 7.0 mmol/l. Choose the management tactics for this patient: Patient is healthy and no further investigation or treatment is necessary. Glucose tolerance test is required to decide further management Patient is hypoglycaemic, history of hypoglycaemia should be carefully reviewed Diabetes mellitus patient requires diet and blood glucose control Urine glucose levels should be determined 220. Patient I. 48 years old with complaints of headaches, leg swelling, shortness of breath when walking, weakness, poor appetite. Kidney disease for 10 years. On physical examination: pale skin, swollen feet. Blood count: Hg-96 g/l; erytrocites-2.8x1012/l; WBC-8.8x109/l; ESR-35 mm/h. Urea-16 mmol/l, creatinine 250 µmol/l. The urine sample: specific gravity - 1005; protein -4.5 g/l; leuk-6-10 ; erytrocytes-20-25; hyaline casts - 2-3. What examination is necessary to clarify the clinical diagnosis? Bence-Jones protein test Urine culture Urine culture for Mycobacterium tuberculosis Glomerular filtration test Urine microscopy 221. A 29-year-old woman complains of lower back pain more on the right side, headaches, fever up to 38°C, frequent urination. She has been suffering from pain for more than 4 years, has been treated several times, she associates this aggravation with foot chill. Objectively: puffy, pale face, pastous eyelids. Positive tapping symptom. Complete blood count: Hb114g/l, WBC 9.8x109/l; ESR-34 mm/h. Urinalysis: specific gravity 1.025, protein-0.99 g/l, WBC - little amount; casts 2-4. What investigation is necessary to clarify the diagnosis? Zimnitsky's function test Urine culture for Mycobacterium tuberculosis Nechiporenko test Urine culture Immunological blood test 222. Patient I., aged 60, was treated for a trophic ulcer with no effect. He has been receiving glibenclamid for a year. Skin is dry, no oedema. BP135/80 mm Hg. Heart rate-82 per minute. Status localis: the right foot was hyperemic, moderately edematous, there was an irregularly shaped ulcer on the dorsal surface approximately 4.5x6.1 cm in size. Peripheral vascular pulsation in the right foot was impaired. Blood sugar - 15 mmol/l, daily glucosuria - 29 g/l. What is the patient's management tactic? Switch to biguanides. Increase in sulfonylurea dosage Switching to insulin Strict diet and exercise management Integrated use of secretagogues with biguanides 223. In case of gout arthritis, it is necessary to determine: rheumatoid factor anti-nucleic factor antistreptolysin-O uric acid LE cells 224. Crunch in knee joints when moving and pain when walking, passing at rest; uneven narrowing of joint slots and osteophytes are characteristic of: osteoarthritis gout rheumatoid arthritis rheumatism polyarteritis nodosa 225. What complication of peptic ulcer causes weakness, nausea, loss of appetite, constant pain in the epigastric region, weight loss? gastric outlet obstruction gastric ulcer penetration malignant ulcer microbleeding from ulcer perforated ulcer 226. In what disease is heartburn the leading symptom of? with cholecystitis with GERD with atrophic gastritis with pancreatitis with gallstone disease 227. The leading symptom of what diseases is gastric dyspepsia? chronic colitis chronic enteritis GERD chronic pancreatitis gastritis, peptic ulcer 228. What is the leading aggressive factor that contributes to the development of GERD? nitric acid, pepsin helicobacter pylori hydrochloric acid, pepsin reflux of bile duodenal secret 229. Suspicion of a complication of peptic ulcer (perforation, penetration, ulcerative pyloric stenosis, malignancy) is an indication for consultation: gastroenterologist endoscopist therapist surgeon radiologist 230. The main complaints in nonspecific ulcerative colitis: heartburn, vomiting, abdominal pain frequent loose stools with impurities, vomiting abdominal pain, frequent loose stools mixed with blood belching, pain in the left hypochondrium vomiting of food eaten the day before 231. In the treatment of mild ulcerative colitis, the drug of choice is: Prednisolone Smecta Omeprazole Sulfosalazine Trichopolum 232. In order to identify the level of exocrine pancreatic insufficiency, the most informative method is: Determination of amylase in the blood Determination of blood diastasis Determination of blood trypsin Determination of elastase 1 in feces Determination of amylase in urine 233. A high level of transaminase activity in the blood serum indicates: chronic cholecystitis cholestasis primary biliary cirrhosis viral hepatitis aminazine jaundice 234. A characteristic clinical sign of chronic pancreatitis is: the development of diabetes mellitus: jaundice increased activity of aminotransferases hepatomegaly decreased function of external secretion 235. Decisive role in the diagnosis of chronic hepatitis is: anamnesis data on the transferred viral hepatitis detection of Australian antigen in blood serum data of histological examination of the liver periodic subfebrility, pain in the right hypochondrium hyperbilirubinemia 236. An early (manifesting) sign of primary biliary cirrhosis of the liver is usually: itching of the skin ascites varicose veins jaundice splenomegaly 237. For the latent form of chronic pancreatitis, the most characteristic coprological sign is: and file a confirm steatorrhea from amylorrhea from GpT creatorrhea iodophilic flora digestible fiber corectr--v 238. The most important etiological factors of the development of cholecystitis are: Quantitative and qualitative deviations in the diet Motor-secretory disorders in the gallbladder and biliary tract system correct - Motor-secretory disorders and infection L file -Infection of the gallbladder and bile ducts Congenital malformations of the biliary tract "und anser 239. When the ulcer penetrates into the pancreas, the following increases in the blood: Lipase activity Amylase activity Glucose level Alkaline phosphatase activity Aminotransferase activity 240. What groups of drugs are used to treat chronic viral hepatitis C? Metabolic Choleretic Hepatoprotectors Interferons Corticosteroids 241. What changes in biochemical parameters are characteristic of cholestasis? Decrease in hemoglobin White blood cell count Reduced protein levels Increase in bilirubin, alkaline phosphatase Increased transaminases A disease characterized by symmetrical erosive arthritis of peripheral small joints A disease characterized by lesions of the interphalangeal joints of the hands and signs of sacroiliitis 242. Portal hypertension can be observed in: Gilbert 's syndrome Chronic hepatitis Cirrhosis of the liver Cholelithiasis Wilson-Konovalov diseases 247. For the treatment of rheumatoid arthritis, the basic drug is: non-steroidal anti-inflammatory drugs aminoquinoline preparations corticosteroids gold preparations methotrexate 243. The causative agent of acute rheumatic fever is: β-hemolytic Streptococcus Staphylococcus Coxsackie viruses Escherichia coli Group A Streptococcus 248. Which of the drugs affects the metabolism of uric acid? allopurinol ketoprofen retabolil insulin aspirin 249. Tofuses in patients with gout are located: in the sacrum area in the area of the extensor surface of the knee joints on the cartilage of the nose in the area of the extensor surface of the elbow joint in the area of the flexor surface of the shoulder joints 250. Typical radiological signs of osteoarthritis: joint erosion cystic enlightenments osteolysis subchondral sclerosis and osteophytes tophus 251. The leading pathogenetic mechanism of osteoarthritis progression is: synovitis articular cartilage degeneration calcium pyrophosphate crystal deposition bone tissue remodeling atrophy of muscles 244. An 18-year-old girl revealed systolic tremor above the apex of the heart, which is typical for: mitral valve stenosis aortic valve stenosis tricuspid valve insufficiency aortic valve insufficiency mitral valve insufficiency 245. Which of the following signs are characteristic of aortic valve stenosis: Enlargement of the right ventricle Diastolic murmur on the carotid arteries Arterial hypertension Dizziness, attacks of chest pains Hepatosplenomegaly 246. Rheumatoid arthritis is: A disease associated with the accumulation of uric acid crystals in small joints of the foot A disease characterized by a predominant lesion of the cartilaginous component of small joints A disease characterized by damage to several joints, conjunctivitis, urethritis 252. The main immune biomarkers of SLE include: leukocytosis rheumatoid factor HLA-B27 ACCP anti-dsDNA antibodies Rheumatoid arthritis Rheumatic arthritis Gonorrhoea arthritis 253. Lung injury in SLE is characterized by pleuritis 2nd file interstitial lung disease focal pneumonia a recurrent pulmonary embolism emphysema 258. A 42-year-old woman in a hospital with complaints of pain in the joints of the hands and feet, elbow, knee joints, morning stiffness, weakness. From a history: she was ill for about 2 years, did not seen to the doctors. On physical examination: ulnar deviation of the hands; ulnar, knee without deformities; feet in the form of halux valgus. Your preliminary diagnosis: Bechterev's disease (ankylosing spondilitis) Rheumatic arthritis Joint chondromatosis Rheumatoid arthritis Gout arthritis answer correct 254. What diagnostic method is important for dermatomyositis? biopsy of a musculocutaneous flap radiography ultrasound blood chemistry urine analysis 255. The main finding is thickening and tightening of the skin and inflammation and scarring of many body parts, leading to problems in the lungs, kidneys, heart, intestinal system and other areas. SLE Rheumatic arthritis Rheumatoid arthritis ~ Scleroderma > from Dermatomyositis - GPT from a f ile 2nd 260. A 26-year-old man with complaints of temperature increase to 38°C, abdominal pain, loose stool up to 8-10 times a day with an admixture of blood and mucus. He has fallen ill acutely after SARS. Upon examination, the abdomen is moderately bloated, painful in the left iliac region, and the large intestine is palpated. What disease is most likely in the patient? Acute dysentery Crohn's Disease Colorectal cancer Ulcerative colitis Whipple's Disease 256. A 43-year-old man’s body temperature increased to 38.3°C, there appeared sharp pains, swelling and redness of the thumb of the left foot. BMI=29 kg/m2. With increase in BP to 160/90 mm Hg, hydrochlorothiazid is taken by him. Most likely diagnosis is: Rheumatic arthritis Reactive arthritis Rheumatoid arthritis Gonorrhoea arthritis Gout arthritis 257. An 18-year-old patient has complaints of swelling, soreness and a local increase in temperature over the elbow joint on the right. Deterioration of the condition 2 weeks after a nasopharyngeal infection, volatility of joint pain. Your estimated diagnosis: File a for ~ Reactive arthritis from Gout arthritis and 259. A 51-year-old man was admitted to the hospital with complaints of prolonged pain and a feeling of bursting in his right hypochondrium. When examined: no jaundice, positive Ker's symptom, subfebrile temperature, ESR - 30 mm/h. What is the presumed diagnosis? Chronic pancreatitis, exacerbation Gastric ulcer, exacerbation Chronic hepatitis, exacerbation Chronic cholecystitis, exacerbation Oddi's sphincter dysfunction capt 261. A 26-year-old man with complaints of temperature increase to 38°C, abdominal pain, loose stools up to 8-10 times a day with an admixture of blood and mucus. He has fallen ill acutely after SARS. Upon examination, the abdomen is moderately bloated, painful in the left iliac region, and the large intestine is palpated. What disease is most likely in the patient? Acute dysentery Colorectal cancer Whipple's Disease Ulcerative colitis Crohn's Disease 262. A 49-year-old man with complaints of a feeling of heaviness in his right underbelly, general weakness, weight loss, joint pain. He cannot specify an exact time of deterioration. On physical examination: jaundice, telangiectasias. On the inner surface of the elbow joints there are traces of injections. The liver protrudes from under the edge of the rib arc by 2.5 cm. The spleen is not palpable. Blood chemistry: total bilirubin-32.6 mmol/l. ELISA: Australian antigen detected. What is the diagnosis? Primary biliary cirrhosis Autoimmune hepatitis Wilson’s disease Chronic hepatitis Gilbert's disease 263. A patient, suffering from gastric ulcer for a long time, complained of weakness, nausea, loss of appetite, constant pain in the epigastric area, weight loss. In this case, you can think about: gastric outlet obstruction gastric ulcer penetration microbleeding from ulcer malignant ulcer perforated ulcer 264. Patient A., 46 years old, plumber by profession, with complaints of abdominal enlargement, pain in the underarms, a sharp weight loss of 10 kg in 2 months. He has been ill for 3 years, when he first noticed the darkening of the skin. Deterioration of the condition during the last month, urine darkened, swelling appeared and the abdomen increased. Objectively: bronze-colored skin, ictericity of sclera, dark pigmentation of palm folds and soles, "vascular sprockets" on the chest, back and shoulders. Ascite. The liver and spleen are enlarged in size. What is your preliminary diagnosis? Hemochromatosis Wilson's disease Chronic hepatitis Liver amyloidosis Primary biliary cirrhosis 265. A 57-year-old patient after a plentiful dinner at night had sharp pains in the area of thumb of his left foot, a temperature of 38°C. The examination revealed swelling of 1 st metatarsal-phalangeal joint, bright hyperemia of the skin around it. Touching the finger causes a sharp increase in pain. Your diagnosis: Rheumatoid arthritis Reactive arthritis Osteoarthritis Gout arthritis Osteoporosis 266. Patient with complaints of pain in the joints of the hands and feet, morning stiffness, weakness. From anamnesis: ill for several years, not treated. Objectively: ulnar deviation of the hands, feet in the form of halux valgus. What is the preliminary diagnosis? Gout arthritis Behterev's disease(ankylosing spondylitis) Rheumatic arthritis Osteoarthritis of joints Rheumatoid arthritis 267. Patient Y., 32 years old, director of the company, went to the doctor with complaints of epigastric pain, worsening one hour after eating, without irradiation, poor appetite. From the anamnesis: SU (stomach ulcer) for 1.5 years. Abdomen: local muscle tension on the left in the epigastrium, moderate pain, the liver is not enlarged. On FGDS: the gastric mucosa is hyperemic and thinned in the pyloric section, where there is a mucosal defect 1 cm in diameter, rounded, with smooth edges, the bottom is covered with white fibrin. What is the diagnosis? chronic gastritis type A, exacerbation chronic gastritis type B, exacerbation SU, exacerbation GERD duodenal ulcer, exacerbation 268. A young girl has discomfort when swallowing liquid food. These complaints for about a year, at work are often stressful. Recently, unpleasant sensations appear with unrest and fatigue. On examination, no pathology was found. What is the diagnosis? hiatal hernia chronic esophagitis erosion of the esophagus GERD esophageal diverticulum 269. A 28-year-old patient, unemployed, complains of poor appetite, epigastric pain, aggravated one hour after eating, without irradiation. History of SU for 3 years. On palpation of the abdomen: local muscle tension on the left in the epigastrium, moderate pain, the liver is not enlarged. The results of FGDS: the gastric mucosa is hyperemic and thinned in the pyloric section, where there is a mucosal defect with a diameter of 1.5 cm, rounded in shape, with smooth edges, the bottom is covered with white fibrin. What is the diagnosis? chronic gastritis type A, exacerbation chronic gastritis type B, exacerbation SU (stomach ulcer), exacerbation GERD duodenal ulcer, exacerbation 270. As a variant of monotherapy for chronic gast

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