1 . A 29-year-old woman complains of pain in the left chest, fever up to 39 °, shortness of breath. Objective: on the left side of the lungs the vibration of the voice is weakened, the percussion sound is reduced. HR 22 times per minute, HR 100 times per minute. Which of the following methods is crucial in the diagnosis?

Chest radiography

 

2. The patient, 50 years old, complains of a dry cough, nasal congestion, fever up to 37.5 ºC. Sick 7 days ago after a cold. Auscultatory shortness of breath, scattered dry rales in all areas of the lungs, normal respiration, heart rate per minute 18. It is necessary to appoint a patient for the purpose of differential diagnosis

Chest X-ray

 

3. A sick man, 75 years old, came to the clinic complaining of palpitations, shortness of breath, general weakness. These complaints occurred a month ago, with a history of chronic coronary heart disease for 10 years. There are no P teeth on the ECG, instead large F waves are recorded up to 270 times per minute, especially visible in trailers II, III, AVF, V1, RR intervals are different, QRS complex is unchanged. What arrhythmia is detected in the patient

 atrial fibrillation, arrhythmic type

 

4. The patient is 40 years old, with a blood pressure of 220/120 mm Hg per year. Complains of fever, headache, polyuria, pain in the heart. Hypotensive drugs do not help. CT - enlargement of the right adrenal gland. Prognosis

 Conn syndrome

 

5. Patient O., 56 years old, with arterial hypertension, complains of pain in the back of the chest, which is not suppressed by izket-spray. Heart tone is closed, rhythm is normal, heart rate - 98 beats per minute, blood pressure - 110/70 mm. criticism. garden on. On the ECG: depression of the ST V2-V6 segment. Myocardial infarction is suspected. It is necessary to determine to confirm the diagnosis

 Troponin

 

6. Which drug is effective in the treatment of the first stage of bronchial asthma?

Salbutamol

 

A 7.35-year-old man has been suffering from bronchial asthma for 2 years. Asthma attacks are eliminated with berotek, hormone-dependent. The actual rate of exhalation is 66%. On examination - shortness of breath at rest, during auscultation - dry wheezing in all areas of the lungs. In the last hour he has used an inhaler with berotek three times. What treatment tactics are effective

 

30-60 mg of prednisolone intravenously

 

An 8.38-year-old man has been suffering from a small amount of sputum cough for 5 days, fever up to 380 degrees, and weakness. On the radiograph - a heterogeneous shadow with a focus on the lower part of the right lung. Which of these diagnoses is more likely?

 Focal pneumonia

 

9. Patient K., 30 years old, chest tightness, cramping pain, lasting 30 minutes, appeared early in the morning, suppressed by nitroglycerin. The ECG recorded at high pain was recorded: in the attachment V1-V6, the displacement of the ST-segment above the isoline was restored when the pain syndrome was suppressed. Your prognosis

JIA. Vasospastic angina

 

10. A patient with severe pneumonia has grade 3 respiratory failure, which corresponds to the level of saturation (Sat%)

64%

 

11. An increase in CPK-MV and troponin I (0.599 ng / ml) in the blood of a patient with intense pain in the back of the chest. What is your prognosis?

myocardial infarction

 

12. The most informative indicator in the differential diagnosis between bronchial asthma attacks and the first stage of asthmatic status

 Refractory to B2-agonists

 

13. What pathology is characteristic of the patient on the ECG before each QRS complex is the absence of P teeth, different RR intervals?

 atrial fibrillation

 

14. Patient M., 64 years old, came to the clinic complaining of burning pain in the back of the chest, lasting more than 40 minutes, the pain does not subside when taking isoket-spray. History: has been suffering from arterial hypertension for 10 years, in connection with which he is under outpatient care, taking antihypertensive drugs. At a glance: EEG 92 times per minute. AK - 130/90 mm critical. garden on. On the ECG: ST segment increased in trailers I, AVL, V3-V6. In this case, it is necessary to determine what laboratory parameters

troponin T

 

15. The patient is 54 years old. 2 weeks ago, when the patient quickly climbed to the 3rd floor, he developed chest pain and recovered at rest. After the onset of pain in the back of the chest, the pain began to develop when walking fast, climbing to the 2nd floor. What type of angina, tactics of patient management

JIA. First developed angina pectoris, hospitalization

 

16. Patient A., 52 years old, was hospitalized with transmural anterior myocardial infarction. On the 3rd day of the disease, the patient's condition worsened, on the 3rd intercostal space there was a rough systolic murmur, which spread to the left side of the chest, and the symptoms of right ventricular failure increased. What research method should be prescribed to diagnose advanced complications?

 Echocardiography at rest

 

17. The patient was taken to the clinic of acute coronary syndrome. The ECG reveals very high "coronary" T teeth with an increase in the ST segment in the II, III, AVF attachments. Troponin I is positive. What is the initial diagnosis

 JIA. Q toothless myocardial infarction

 

18. The patient was taken to the hospital with an acute transmural myocardial infarction, BP 60 and 40 mm. criticism. garden, pulse thread-like, pale skin, cold sweats, decreased heart rate, decreased diuresis. What complications of myocardial infarction did the patient develop?

cardiogenic shock

 

19. A sick man, 38 years old, complained of palpitations and palpitations, a feeling of "stagnation" of the heart, shortness of breath with little physical force. On the ECG: sinus rhythm, heart rate - 86 beats per minute. The electrical growth of the heart is normal. Polymorphic ventricular extrasystoles are often detected. During the daily ECG monitoring of the patient, 6 episodes of polymorphic ventricular extrasystoles and paired ventricular extrasystoles were recorded. Which class does this condition belong to in the Lown classification of ventricular extrasystoles?

 

IVa

A 20.75-year-old man, who smokes a lot, complains of dry cough, severe shortness of breath. Which of the following diagnoses is correct?

Chronic obstructive pulmonary disease

 

21. A patient with myocardial infarction develops a sudden attack of suffocation, shortness of breath, along with hard breathing in the lungs can be heard a lot of wet rales of various calibers. Pulse - 104 times per minute, blood pressure in the 100 and 60 mm Hg. What are the complications of myocardial infarction in this patient?

 With acute left ventricular failure, pulmonary dehydration

 

22. The patient has an irregular heart rhythm on auscultation, the first tone is weakened, the pulse is irregular, the pulse waves are of different amplitudes, the pulse deficit is about 25 times. What arrhythmia the patient may have

atrial fibrillation

 

23. A 50-year-old patient came to the ward with a severe headache in the neck, vomiting, the presence of small mosquitoes in front of the eyes. Deterioration of the patient's condition is associated with stress. The condition is severe, irritating, reddened on the surface of the skin, pulse - 100 times per minute, rhythmic, full. АК 220/110 мм.сын.бағ. on. On the ECG: a sign of left ventricular hypertrophy. Your prognosis

 Arterial hypertension grade III, crisis

 

24. In a patient with acute myocardial infarction there is an intensive angina syndrome, tachycardia, a sharp decrease in blood pressure, a thread-like pulse, pale skin, cold sticky sweat. What complications of myocardial infarction did the patient develop?

 cardiogenic shock

 

25. The patient's ECG shows a few early ventricular deformities without P-wave. What pathology is characteristic of this phenomenon?

 ventricular extrasystole

 

A 26.56-year-old patient complains of shortness of breath, a slight sputum cough, pain around the heart. Suffers from chronic obstructive pulmonary disease for a long time. Objective: swelling of the jugular veins, swollen legs, dilated heart. Scattered dry rales on auscultation, accent of the second tone in the pulmonary artery. May be the cause of the above symptoms

 Chronic pulmonary heart

 

A 27.17-year-old girl has a rare sudden onset of cough, shortness of breath and "whistle" breathing for 4 months. Respiratory discomfort disrupts sleep 1-2 times a month. The girl's mother suffers from allergic rhinitis. OFV1-82%. Which of the following diagnoses is possible?

 Bronchial asthma

 

28. The patient was diagnosed with shortness of breath at rest, hepatomegaly, anasarca. Symptoms of circulatory failure disappeared during treatment. What stage of circulatory failure do you think the patient has?

Stage II B of circulatory failure - FC III

 

29. Patient R., 58 years old, suffers from arterial hypertension for 5 years. Occasionally Captopril is taken when blood pressure rises. The following year, shortness of breath, palpitations, and wheezing in the lower part of the lungs appeared. Determine the degree of circulatory failure in the patient

Stage II A of the PES

 

30. A sick man, 62 years old, came to the clinic complaining of pain in the back of the chest, which is in a relaxed position, and the pain does not subside when taking nitroglycerin. History: had a myocardial infarction a month ago. There are no dynamic changes in the ECG. What diagnostic method should be performed on the patient

 coronary angiography

 

31. The patient was 20 years old. The pain subsides after eating during the day. Palpation of the stomach revealed pain in the pyloroduodenal region, a positive Mendel's symptom. What is the probable diagnosis

 Duodenal ulcer

 

A 32.25-year-old man complained of pain in the right half of the abdomen, liquid stools up to 6-8 times a day, weight loss of 8 kg in the last 2 years, pain in large joints, long-term disturbing subfibrillation. On examination: nodular erythema in both legs, obvious pain in the right chin on palpation; There are no symptoms of peritoneal irritation. Hb 84 g / l, color index 0.8, leukocytes 12.6 thousand per 1 μl, ESR 56 mm / h, total protein 49 g / l, albumin 39%, cholesterol 2 μmol / l, serum iron 7 μmol / l. Colonoscopy revealed deep hollow ulcers of the mucous membrane of the appendix. Possible diagnosis

Crown pain

 

34. Patient O., 32 years old, complains of pain in the pancreas, which occurs 30 minutes after alcohol or spicy food, and a strong itching sensation, which subsides after taking soda. She has been ill for 3 years and has not been treated. Objective: the tongue is covered with a white coating, a feeling of diffuse pain in the epigastrium when deeply rubbed. EFGDS: reddening, swelling of the gastric mucosa, in the antral part - one-and-a-half hemorrhage. What research method is most informative

Helicobacter pylori respiratory urease test

 

A 35.28-year-old man was diagnosed with 20 days a day of foul-smelling blood, mucus, and pus-filled stools, abdominal pain that worsens before the act of defecation and subsides after defecation, joint pain, eye pain, mouth ulcers, dizziness, and body aches. complained of fever. Which of the following diagnoses is most likely?

 Nonspecific ulcerative colitis

 

36. A man K., 42 years old, complains that his abdomen has increased in size for 2 months. Patients with hepatitis B 12 years ago, periodically take alcohol. On examination, there is a venous network in the abdomen, ascites grade 2. Which group of drugs is more appropriate to prescribe in the treatment of ascites in cirrhosis of the liver

 A group of potassium-sparing diuretics along with loop diuretics

 

37. Female A., 43 years old, has been suffering from pain under the right rib for the last 4 months, developed jaundice 2 weeks ago. History: hepatitis B virus, alcohol intake. On examination: the patient is malnourished. The skin and sclera are yellow, telangiectasia is detected. Ventilated. The liver is densely sensitive, protruding +4 cm from the wall arch. The spleen is enlarged by +3 cm, dense. In the blood: anemia, thrombocytopenia, ESR - 28 mm / h; total bilirubin - 84 μmol / l, depending on the predominant fraction. Which of the following diagnoses is most likely?

Cirrhosis of the liver

 

38. An 18-year-old woman came to the clinic complaining of pain in the left hypogastrium, which occurs during defecation, which is suppressed after defecation, periodic defecation. Appearance: palpation reveals pain in all areas of the colon. In the co-program: mucus ++++. Symptoms of dyskinesia on X-ray examination of the colon, and a tendency to spasm on colonoscopy. Which diagnosis is more likely

Irritable Bowel Syndrome

 

A 39.36-year-old man suffers from mucus, pus, blood, liquid stools, fever, ulcers in the mouth, eye pain, which occurs up to 35 times a day. Epidemiological history is no exception. Diagnosed with "nonspecific ulcerative colitis". Which of the following drugs is most effective to prescribe

Sulfasalazine

 

40. Patient D., 52 years old, came to the hospital complaining of chest pain, flatulence, weight loss of 3 kg in the last month, which occurs 20-30 minutes after a meal. During EFGDS in the small elbow of the stomach, in the middle third of which there is a star-shaped white scar with a clear contact of the folds, in the same area there is a new ulcer with swollen edges, size 6x8 mm. There is a blood clot at the bottom of the wound. Biopsy revealed Helicobacter pylori. What type of treatment should be prescribed

 Proton pump inhibitor + ampicillin + clarithromycin

 

41. Patient R., 21 years old, complains of pain of various types near the umbilicus, the pain disappears after defecation, intermittent diarrhea with constipation, constipation. Appearance: pain in all parts of the colon. Hb-123 g / l, leukocytes - 8.0x109 / l, ESR 14 mm / h. On radiological examination: symptoms of dyskinesia; on colonoscopy: prone to spasm. Which of the following treatments should be prescribed?

 Diet, stress reduction, probiotics

 

A 42.35-year-old woman is worried about swelling of her face and legs. АК 180/100 мм.сын.бағ. In the analysis of whole blood: Hb-76 g / l, erythrocytes - 2.6 x 1012 / l, leukocytes - 3.4 x 109 / l, platelets - 158 x 109 / l, ESR - 43 mm / h. Biochemical analysis of blood: total protein - 46 g / l, albumin - 28%. In the analysis of urine: protein - 14.3 g / l, epithelium 6-7 k / a, erythrocytes - 0-2 k / a. Four-component therapy is prescribed for the treatment of glomerulonephritis. Which combination of drugs is suitable for four-component therapy

 Cytostatics + corticosteroids + antiplatelets + anticoagulants

 

43. The most effective drug prescribed for urinary tract infections

 Amoxicillin

 

A 44.57-year-old man developed a sudden onset of pain in the first sole of his right foot and reddening of the skin to a bluish-red color, hot to the touch; complains of limited joint movement, fever up to 38-39 ° C, sleep disturbances, weakness, fatigue. At a glance: tofus are observed in the left eardrum and on the inner surface of the left elbow joint. Used to suppress acute gout attacks

 Colchicine

 

45. Patient K. complains of pain in the knee joints, which intensifies at the age of 50. Objective: deformed knee joints, thickening of periarticular tissues, crepitation. Dense nodules are observed in the area of the distal interphalangeal joints. STD: male - 4,2х1012 / l, lake - 5,6х109 / l, ESR - 15 mm / h, CPA - negative. Which of the following diagnoses is more likely?

Osteoarthritis

 

46. Patient O., 52 years old, suffered from sudden pain in the right elbow joint, reddening of the skin of the inflamed joint to bluish-red color, fever, swelling, limited movement, fever up to 38-39 ° C, sleep disturbances, weakness , complains of fatigue quickly. From the history of the disease: for the last 2 years he considers himself ill, at which time there was pain, swelling and redness of the first heel of the left foot, a month later these symptoms were observed in the left knee joint. Possible diagnosis

 Gouty arthritis

 

A 47.35-year-old woman was diagnosed with recurrent fever, weakness, arthralgia and myalgia, Raynaud's phenomenon, pneumonia within 5 years after severe ARVI, with bilateral pathological changes in the lungs. Later he was worried about pain and dysphagia in the heart area. Objectively - there are dense and atrophic foci on the skin. Antibodies to SCL70 were detected. Which of these drugs should be prescribed for basic therapy?

D-penicillamine

 

A 48.30-year-old woman complained of general weakness in the reception room, fever up to 38 ° C, and pain in the lower abdomen in the lower abdomen. According to the patient, these complaints have been bothering him for 5 years, and he was being treated during the exacerbation. Appearance: swollen face, pain when hitting the lumbar region. In the analysis of blood: Hb-120 g / l, erythrocyte-3,5х1012 / l, TC-1,0, leukocyte-12х109 / l, blood count - 6%, blood flow - 60%, lymph - 28%, eos - 1%, base - 0%, mon - 6%, ESR 18 mm / h. OAM: alkaline reaction, relative density 1010, leukocytes 200 k / a, erythrocytes - 0-1 k / a, bacteria ++. On ultrasound of the kidneys: the pelvic system is dilated. Possible diagnosis

 Urinary tract infection

 

49. Patient V., 37 years old, complains of pain in the lower back, frequent urination. For 10 years he noticed pain and dysuria in the lumbar region 2-3 times a year. The therapist observed, treated, and the pain intensified for a month. Objective: temperature 370C, symptoms of lumbar puncture are positive on both sides. In the analysis of blood: leukocytes - 6.1x109 / l, ESR 25 mm / h. In the analysis of urine: specific gravity - 1005, protein - 1.0 g / l, leukocytes 200 in the visual field. Nechiporenko test: erythrocyte - 2 / l, leukocyte - 6000 / l. Which of the following diagnoses is possible?

 Urinary tract infection

 

A 50.37-year-old man complains of weakness, nausea, loss of appetite, weight loss, swelling of the legs, high blood pressure. Has been suffering from diabetes for 20 years. Objective: low appetite, pale skin, dry. The face is swollen, the legs and feet are swollen. In the analysis of blood: Hb-87 g / l, erythrocytes - 3.2x1012 / l, leukocytes - 9.71x109 / l, ESR - 30 mm / h. In the analysis of urine: specific gravity - 1012, protein - 1.0 g / l, leukocytes 4-5 k / a, erythrocytes - 0 k / a. Biochemical analysis of blood: creatinine 235 μmol / l, urine 12 mmol / l. What is the next step in examining the patient

 Calculation of SFS

 

A 51.52-year-old patient complains of pain and limited movement in the interphalangeal joints of the hand. On examination: in the area of the distal interphalangeal joints revealed dense nodules up to 0.5 cm in size, slightly painful on palpation. The joints are slightly deformed, limited movement. Radiography of the wrists revealed narrowing of the joint space, osteoporosis. The most suitable treatment tactics

 ESF + chondroprotectors

 

52. Impaired renal function in patients with urinary tract infections

 Concentration

 

53. Periorbital edema with purplish-pink erythema, shortness of breath, dry cough, progressive muscle weakness, pain in the muscles of the shoulder and hips

Dermatomyositis

 

A 54.37-year-old man complains of obvious weakness, headache, loss of appetite, weight loss, edema. Suffers from kidney disease for 5 years. Objective: low body weight, pale orange skin. The face is swollen, there is swelling in the legs. АК 170/105 мм.сын.бағ. In the analysis of blood: Hb-70 g / l, epithelial cells -2.0 million, leukocytes -5.7 thousand, ESR 20 mm / h. Biochemical analysis of blood: creatinine 0.19 mmol / l (norm 0.053-0.095 mmol / l), total protein 49 g / l, blood sugar 5.4 mmol / l. In the analysis of urine: specific gravity - 1012, protein - 4.5 k / a, leukocytes - 4-5 k / a, epithelium - 5-6 k / a, hyaline cylinders - 7 in the visual field. What symptoms are typical for the diagnosis of nephrotic syndrome in a patient?

edema, hypoproteinemia, massive proteinuria

 

A 55.24-year-old man complained of weakness and loss of appetite. Has been suffering from diabetes for 15 years, taking insulin. Objective: pale, dry skin, negative symptoms on both sides of the lumbar region. АК 140/90 мм.сын.бағ. HRV per minute 80. In STDs: Hb – 116 g / l, erythrocytes -2.8 x1012 / l, leukocytes-8.2 x109 / l, ESR-18 mm / h. Urine analysis: specific gravity 1005, protein - 0.5 g / l, leukocytes - 5-6 k / a, erythrocytes - 2 k / a. Biochemical analysis of blood: creatinine 135 μmol / l, urea 8.0 mmol / l. Which treatment is effective

 IAPF nephroprotection

 

56. A 23-year-old woman complains of fever, cough and flushing until the age of 39. Taking ampicillin and paracetamol on their own was ineffective. Appearance: redness and swelling of the face, erythematous-papular rash on the chest and back, lymphadenopathy, aphthous stomatitis, focal hair loss. Heart tone is closed, rhythm is normal, heart rate is 110 beats per minute, blood pressure is 150/100 mm Hg; hepatomegaly. In the analysis of blood: erythrocytes 3.2x1012 / l, Hb-100 g / l, leukocytes 2.5x109 / l, ESR 40 mm / h. In the analysis of urine: protein - 1.9 g / l, leukocytes 6-8 k / a, erythrocytes 15-18 k / a. Possible diagnosis

 Systemic lupus erythematosus

 

57. Patient T., 30 years old, complains of inflammatory, symmetrical pain and swelling of the proximal interphalangeal, palmar-phalangeal joints, wrists, elbows; limited movement of damaged joints; morning cramps for 2 hours. Appearance: palmar bones - a slight ulnar deviation of the phalangeal joints. In the blood: er-4.5x1012 / l, Hb-130 g / l, ESR-33 mm / h; RF-32.2 UI / ml (up to 5.5 UI / ml), ADC - 147 units / ml (up to 3 units / ml). Possible diagnosis

 Rheumatoid arthritis

 

58. The woman is 45 years old. 10 years ago there was pain in the wrists, palms and phalanges, morning cramps. Objective: ulnar deviation of the palmar-phalangeal joints. Hypotrophy of the muscles of the head, limited range of motion. ESR: erythrocytes 4,5х1012 / l, Hb-130 g / l, ESR-33 mm / h. Blood BMI: RF-32.2 UI / ml (up to 5.5 UI / ml), ADC - 147 units / ml (up to 3 units / ml). What is the basic drug for the treatment of this disease

 Methotrexate

 

59. After infection, the patient was diagnosed with chronic glomerulonephritis. Name the main etiological factors of acute glomerulonephritis

 Group A B-hemolytic streptococcus

 

A 60.45-year-old woman complained of pain in the right lower back, increased urination (up to 2-3 times a night), subfebrile fever in the evening. At the age of 20 he had a urinary tract infection. Ultrasound of the kidneys: dilated pelvis of the right kidney. The most effective way to determine the outbreak of a urinary tract infection

 Bacteriological inoculation of urine

 

A 61.38-year-old woman noticed pale fingers in the cold for 10 years. In recent years, there have been increasing symptoms of arthritis of the small joints of the hands and wrists, difficulty in swallowing solid foods. In the blood test: ESR - 40 mm / h. Possible diagnosis

 Systemic scleroderma

 

62. The patient is 60 years old, complains of weakness, pain in the epigastrium. Objective: pale orange color of the skin and visible mucous membranes. The face is swollen. The tongue is "lacquered". Mild hepatosplenomegaly. In the blood: pancytopenia, macrocytosis, polysegmentality of neutrophils. Bilirubin - 38.5 μmol / l. On the myelogram: megaloblastic hematopoiesis. Which of the following diagnoses may be present?

B12-deficient anemia

 

63. The patient is 34 years old, complains of weakness, dizziness, palpitations, shortness of breath. Hemorrhoids for 2 years. Objective: pale skin and mucous membranes, colony. Heart sounds are closed, systolic murmur at the apex of the heart, tachycardia. In the blood: erythrocytes -3.7 million, Hb-92 g / l, TC -0.75, leukocytes -4.8 thousand, platelets -200 thousand, ESR-17 mm / h, anisocytosis, poikilocytosis. Serum iron is 6.4 μmol / l. What treatment should be chosen

oral ferrous sulfate

 

64. Patient V., 40 years old, complains of general weakness, sweating, weight loss, pain in the left rib cage. Objective: the skin is pale, moist. Liver protrudes 3 cm from the wall arch, spleen near the umbilicus, dense, painless. In the blood: erythrocytes - 3,0х1012 / l, leukocytes - 96х109 / l, myeloblasts - 2%, promyelocytes - 4%, metamyelocytes - 8%, rod nuclei - 12%, segment nuclei - 52%, eosinophils - 5%, basophils - 5% , lymph-12%, platelets - 200x109 / l. ESR-56 mm / h. Which diagnosis is more typical

 chronic myelogenous leukemia

 

A 65.35-year-old woman came to the reception with complaints of general weakness, dizziness and palpitations. Menstruation for 1 year for 10 days, in large quantities. Objective: pale skin and mucous membranes, brittleness and linearity of the nails, hair loss, tachycardia 100 times per minute. АК 110/60 мм.сын.бағ. In the blood: hemoglobin - 62 g / l, erythrocytes - 2.6 x 1012 / l, TC - 0.7, ESR - 36 mm / h, leukocytes - 5.8x109 / l, platelets - 420 x 109 / l. Examined by a gynecologist: uterine fibroids, 12 weeks. Surgery is recommended. Which of the following is the most effective method of patient management?

 parenteral iron preparations

 

A 66.48-year-old patient complains of weakness, weight loss, and a feeling of heaviness under the left rib. At a glance: the spleen protrudes 4 cm from the wall arch. In the blood: Hb - 128 g / l, erythrocytes 4.0 ∙ 1012 / l, leukocytes - 47 ∙ 109 / l, platelets 480 ∙ 109 / l, formula: eos-2%, base-3%, blast cells 1%, promyelocytes -2%, myelocytes -4%, young cells -10%, blood pressure - 26%, blood pressure - 34%, lymph - 12, blood pressure - 6%, ESR - 6 mm / h. On the myelogram: hyperplasia of myeloid growth cells. What research method should be prescribed to confirm the diagnosis

 identification of the Philadelphia chromosome

 

67. Changes in the myelogram characteristic of B12 deficiency anemia

type of megaloblastic hematopoiesis

 

68. A 26-year-old patient was examined by a regional doctor with a sore throat, cough and loss of appetite. Than; hyperplasia of the tonsils, enlarged lymph nodes in the neck. In the blood: Hb-100 g / l, erythrocytes-4.2 ∙ 109 / l, leukocytes - 15 ∙ 109 / l, platelets - 120 ∙ 109 / l, ESR - 25 mm / h, formula: eos-1%, t / ya-3%, c / ya-60%, lymph-24%, monocytes - 8%, blast cells - 4%. Choose the correct operation

referral of the patient to a hematologist

 

69. A patient with duodenal ulcer complains of general weakness, shortness of breath during exercise, cravings for chalk. Objective: the patient is pale, there are trophic changes in the skin. In the blood: 3.3x1012 / l; HB - 90 g / l; TC - 0.75; reticulocytes - 2%; iron in the blood - 5.6 μmol / l. What complications did the patient develop?

 iron deficiency anemia

 

70. A 70-year-old man complains of weakness, numbness of the legs, paraesthesia. History - gastric resection 7 years ago. In the blood: Hb - 70 g / l, erythrocytes 2.0x1012 / l, TC - 1.2, leukocytes - 3.0x109 / l, platelets - 140x109 / l. What caused the development of anemia

 deficiency of gastromucoprotein

 

71. A 68-year-old woman complains of general weakness, dizziness, "fluffy legs", discomfort in the epigastric region. In the blood: Hb-68 g / l, erythrocytes -2.0 x1012 / l, TC-1.02, leukocytes -3.0 x109 / l, platelets -190 x109 / l, rod nuclei-2%, segmental nuclei-64%, eosin-1%, m-6%, lymph-27%, ESR-8 mm / h. In FGDS: atrophic gastritis. What laboratory tests should be performed in the first stage?

Blood test for vitamin B12

 

A 72.28-year-old man was treated for stomatitis for 3 weeks without any results, with obvious weakness and sweating. Objective: body temperature 38.8 ˚C, pale skin, moist. Hyperplasia of the jaw, ulcerative necrotic stomatitis. Enlarged lymph nodes in the neck, painless. In the analysis of whole blood: erythrocytes - 3,0 х1012 / l., Hb - 95 g / l, TC - 0,95, leukocytes - 14,5х109 / l., Blast cells -32%, т / я-1%, segment -39%, lymph-20%, mon-8%, platelets -90 x109 / l, ESR-54 mm / h. Which of the following diagnoses is correct?

acute leukemia

 

73. The patient is 23 years old, complains of weakness, shortness of breath, palpitations. Objective: pale skin and mucous membranes. Systolic murmur at the apex of the heart, tachycardia. In the blood: erythrocytes - 3.0x1012 / l, hemoglobin - 92 g / l, leukocytes - 44.2x109 / l, platelets - 192x109 / l, ESR - 22 mm / h. Analyze blood counts

mild normochromic anemia

 

A 74.57-year-old woman complains of general weakness, dizziness, shortness of breath while walking, pain in the epigastric region. Objective: low mood, pale orange skin and visible mucous membranes, slight splenomegaly. In the blood: erythrocytes -2.1x1012 / l, Hb-89 g / l, TC-1.1, leukocytes -2.8 x109 / l, platelets-115 x109 / l, ESR-24 mm / h, macrocytosis. What changes are detected in the blood in 5-7 days of treatment of this pathology

reticulocyte crisis

 

A 75.60-year-old woman complains of general weakness, pain in the epigastric region, and nausea after eating. Objective: body temperature 36.6 ° С; TAJ- 20 / min .; pulse - 96 / min .; AK - 115/70 mm. critical Pale skin and visible mucous membranes. In the analysis of blood: erythrocytes - 2.0x1012 / l; Hb - 100 g / l; TC - 1.5; ESR - 28 mm / h. Antibodies were detected in the parietal cells of the stomach. What method is effective in the treatment of anemic syndrome in a patient

Prescribing vitamin B12

 

The patient, 76.30 years old, has been ill for 1 month, has weakness, hemorrhagic syndrome. Lymph nodes are enlarged. Temperature - 38.5C. Pale skin, intoxication. Blood test - Hb 40 g / l, erythrocytes 2.0x109 / l, leukocytes 0.8x109 / l, platelets 50 ∙ 109 / l, ESR - 41 mm / s, the formula is not calculated. Possible diagnosis

acute leukemia

 

77. Patient A., 19 years old, apparently splenomegaly. On the hemogram: leukocytes 78x10 9 / l; leukoformula: promyelocytes 3%, myelocytes 8%, metamyelocytes 12%, rod nucleus 21%, segmented neutrophils - 41%, basophils - 3%, eosinophils - 6%, lymphocytes - 6%. Platelets - 784 * 109 / l, hemoglobin - 114 g / l. Myelogram: bone marrow hypercellular, myelokaryocytes, increased megakaryocytes, all cells of the granulocyte series are detected. What is the next stage of the study?

cytogenetic study of blood

 

A 78.34-year-old man has been ill for a month, suffering from weakness, hemorrhagic syndrome, enlarged lymph nodes. Temperature - 39.5C. Pale skin, intoxication. In the blood: Hb - 36 g / l, erythrocytes - 2.2x109 / l, leukocytes - 0.8x109 / l, platelets - 50x109 / l, ESR - 41 mm / h, the formula is not counted. Select the following research method

bone marrow puncture

 

79. The patient is 19 years old, he complains of saturation of the jaws, sore throat, weakness. Objective: body temperature 39 ° С. The skin is pale, there are many petechiae and ecchymoses. The tonsils are covered with a necrotic coating. Enlarged lymph nodes in the neck. The liver and spleen protrude 2 cm from the wall arch. In the blood: erythrocytes -2.5 x1012 / l, Hb-75 g / l, TC-0.9 leukocytes -29x109 / l, blast cells - 98%, segments - 2%, platelets -28 thousand, ESR-26 mm. / h Cytochemistry: positive reaction to myeloperoxidase. It is a key symptom in the diagnosis of this disease

blastemia

 

80. Patient S., 60 years old, complains of weakness, epigastric pain, irregular bowel movements. Objective: pale orange color of the skin and visible mucous membranes. The face is swollen. The tongue is "lacquered". The liver and spleen are slightly enlarged. In the blood: erythrocytes -2,6х1012 / l, Hb-104 g / l, TC-1,2 leukocytes -2,7х109 / l, platelets -115х109 / l, ESR - 30 mm / h, macrocytosis, polysegmentality of neutrophils. Bilirubin - 38.5 μmol / l. On the myelogram: megaloblastic hematopoiesis. Which of the following diagnoses may be present?

 B12-deficient anemia

 

81. What is the clinical syndrome of B12 deficiency anemia?

funicular myelosis

 

82. Patient K., 24 years old, complains of severe weight loss (9 kg per month), dry mouth, thirst, frequent urination, loss of appetite. Appearance: dry skin, yellow palms, boils. In the analysis of urine: sugar - 2.9% and acetone. In this case, which of the following drugs is more effective

short-acting insulin

 

83. The patient is 17 years old, complains of dry mouth, thirst, weight loss of 7 kg per month. There is no heredity for diabetes. Appearance: hyperglycemia 13 mmol / l, glycosylated Hb -7%. Your diagnosis

Diabetes mellitus type 1

 

84. The patient is 32 years old, restless, anxious, has a lot of hyperactivity, mental agitation, poor sleep, weight loss with high appetite, diarrhea. Appearance: tremors of the fingers, positive eye symptoms. Heart sounds are loud, a systolic murmur is heard at the apex of the heart. AK - 150/70 mm. critical. GHG - 110 times per minute. The thyroid gland is enlarged, visible when swallowed. Blood test: Hb - 100 g / l. Lake - 8.0 * 109 / l, ESR - 12mm / h. Blood glucose is 6.8 mmol / l. Choose the right initial diagnosis

feeding diffuse toxins

 

An 85.42-year-old man complains of overweight, high blood pressure, dry mouth and increased diuresis due to high appetite. Appearance: height - 174 cm, weight - 100 kg. Fasting glycemia ranges from 9.9 to 10.7 mmol / l. Which of the following drugs is more effective?

biguanides

 

A 86.38-year-old woman complains of weight gain, fatigue and headaches. Height - 180 cm, weight - 108 kg. Waist size - 110 cm. The distribution of subcutaneous fat is of the android type, papillary-pigmentary dystrophy of the skin (acanthosis nigricans), blood pressure 140/80 mm Hg. In this case, which of the following drugs is more effective?

metformin

 

A 87.48-year-old woman complains of weight gain, headache, back pain, facial growths (facial hair), shortness of breath, depression. Height -160 cm, weight 98 kg. The tips of the face are reddish-brown, the abdomen is enlarged, the limbs are thin and thin. АК 180/100 мм.сын.бағ. On the radiograph: osteoporosis of the spine and pelvis. On CT of abdominal organs: unilateral hyperplasia of the adrenal glands. Blood and urine cortisol levels were slightly elevated, ACTH was decreased. Which of the following diagnoses is more likely?

Itsenko-Cushing syndrome

 

A 88.29-year-old patient was diagnosed with diffuse toxicity (ultrasound, hormonal spectrum, puncture biopsy) a year ago. Thyrostatic treatment with mercazolyl 20-30 mg / day without results (treatment stability is not high). Grade 2 malnutrition (WHO), overt ophthalmopathy, tachycystolic atrial fibrillation, underweight and high free T4 levels persist. Which of the following indicates the severity of thyrotoxicosis?

A 62-year-old woman was admitted to the surgical unit with a wet gangrene of the first toe, which developed after a minor injury. Appearance: dry skin and mucous membranes, redness on the surface. Obvious obesity, decreased vision, vague symptoms of varicose veins. Mother and aunt: diabetes. Fasting glycemia is 6.2 mmol / l. Your first diagnosis

 Diabetes mellitus type 2 with macroagiopathy

 

A 89.22-year-old woman had a heart attack,

complains of emotional lability, irritability, weight loss of 8 kg in 2 months. The patient has asthenic, cystitis, diffuse hyperhidrosis of the skin, general tremor - a symptom of the "telegraph pole". YYYY 120 times / min. Moderately exophthalmos with uniformly enlarged thyroid gland. Which of the following groups of drugs should be prescribed first?

thyrostatics

 

A 90.26-year-old man after a viral infection developed thirst up to 6 liters per day, frequent and excessive urination, weight loss of 3 kg in the last month, general weakness. What could be the disease

 diabetes mellitus

 

91. What is the indicator that determines the degree of compensation for diabetes during the dynamic examination?

 glycosylated hemoglobin

 

In an overweight woman aged 92.50 years, 2 elevations of fasting blood glucose were found to be 6.9 and 12.2 mmol / l. Which of the following diagnoses is possible?

Type 2 diabetes

 

In a 93.42-year-old patient with clinical signs of hypothyroidism, the thyroid gland was enlarged to grade 2. Elevated antibodies to TG and TPO, TSH in the blood. Choose a drug

 levothyroxine

 

94. A 33-year-old woman complains of fatigue and weakness. History: subtotal thyroid resection, L-thyroxine 50 mcg. In Karaganda: swollen face, closed heart sounds. EEG 54 times per minute, BP - 100/70 mm. critical ECHO: There is fluid in the pericardial cavity. Which of the research methods to prescribe treatment is informative

Determination of TSH, free T4 level

 

95. A 42-year-old patient came to the endocrinologist. Complains of obvious weakness, edema leading to weight gain and volume, pronounced shortness of breath during light exercise. History: strumectomy for multinodular euthyroidism. BP 70/40 mm., HR - 56 times per minute. Heart sounds are closed, cardiomegaly. In echocardiography: a small amount of fluid is observed in the pericardial cavity. Fasting glycemia is 3.5 mmol / l. What hormones are needed to determine the diagnosis

TTG, T4 bos

 

96. A 30-year-old man is 170 cm tall and weighs 105 kg. on the surface and thanks to many vulgar pimples. AK 150/90 - 165/110 mm class. steadily rising. Cortisol level is 1050 nmol / l (normal 101-535 nmol / l). Fasting glycemia 12 mmol / l, urine sugar 1%, urine reaction to acetone is negative. Determine the type of diabetes

 steroids

 

97. Choose the principle of treatment in the elderly with hypothyroidism in case of dual functional classic angina pectoris

 Start with a small amount of L-thyroxine

 

98. The patient was diagnosed with an increase in thyroid gland to the 2nd degree. Ultrasound: the structure is not uniform, the echogenicity is changed, in the right part there is a non-uniform focal formation with a "hollow" structure with indistinct edges. Right lymphadenopathy. Which of the following diagnoses is more likely?

diffuse feeding

 

99. The patient was diagnosed with a 2nd degree enlargement of the thyroid gland. Ultrasound: irregular structure, increased echogenicity, no foci. Which of the following is not included in the diagnostic algorithm

determination of total T3 level

 

A 100.44-year-old patient suffers from weight gain, weakness, facial swelling, dry skin, constipation, amenorrhea. The skin is dry and cool. The thyroid gland is not palpable. AO 90/60 mm. critical pulse - 52 times per minute. T3, T4 decreased, TSH - increased. High in cholesterol and triglycerides. What is the initial diagnosis

primary hypothyroidism

 

Patient K, 101.53 years old, lost 8 kg of weight in one month and complained of loss of appetite. History of iron deficiency anemia for 2 years. He received occasional treatment from a local therapist at the place of residence. In the last month there has been a worsening of the condition due to loss of appetite and progressive weight loss. In HAC: Hb - 52 g / l, erythrocytes - 2.1%, Ht - 22%, leukocytes - 6.7x109 / l, ESR - 45 mm / h. On general examination of the patient on palpation in the right iliac region of the abdomen reveals a dense round formation with a diameter of up to 20.0 cm, painlessly shifts to the surrounding tissue. Perifocal vibration is observed on palpation. Colonoscopy: the formation of a dense tubular exophyte up to 20.0 cm in diameter in the area of the growing colon, the growth of the tumor in the intestine, which significantly deforms it, bleeding from contact. A biopsy was obtained. Histological findings - adenocarcinoma. What diagnostic method is needed to detect possible hematogenous metastases

 liver ultrasound

 

102. The main clinical sign that allows to distinguish esophageal cancer from cardiospasm

 

103. Progressive dysphagia

The best way to prevent malignancy in chronic esophagitis is:

endoscopic biopsy

 

Patient Z., 104.48 years old. He was admitted to the general treatment department with severe abdominal pain. This pain lasted for about 6 hours, and he took a painkiller with a temporary effect. An hour after admission, the pain resumed and intensified. History: lost 27 kg in 3 months. On examination: positive peritoneal symptoms in all fields, pain on palpation. In the context of general asthenia through the anterior wall of the abdomen in the patient revealed a dense formation of irregular shape in the left side of the abdomen with a diameter of up to 20.0 cm. What are the tactics of further treatment

 GDP surgery, in case of cancer - a biopsy can be performed on the operation.

 

Patient K, 105.76 years old, lost 12 kg of weight in 2 months due to weakness, dizziness. was hospitalized with complaints of loss of appetite. History of iron deficiency anemia for 4 years. He received occasional treatment from a local therapist at the place of residence. In the last 2 months, he complained of worsening condition due to lack of appetite and rapid weight loss. In HAC: Hb - 45 g / l, erythrocytes - 2.7%, Ht - 22%, leukocytes - 6.7x109 / l, ESR - 45 mm / h. A round tube with a dense tube up to 20.0 cm is detected, painlessly shifting relative to the surrounding tissue. Perifocal vibration is observed on palpation. In this case, what diagnostic method is recommended to check the diagnosis?

colonoscopy

 

Patient B., 106.56 years old, was hospitalized with persistent pain in the epigastric region, weight loss of 10 kg in three months, weakness, aversion to meat, vomiting, loss of appetite. For 7 years he suffered from peptic ulcer. He was treated several times in hospitals and outpatient clinics. He said that the situation has deteriorated sharply over the past six months. He has just sought medical help. Blood test: erythrocytes - 3.7 cm 1012, Hb - 85 g / l, leukocytes - 7.7 x 109, ESR - 35 mm / h. Biochemical analysis of blood: total protein - 52 g / l, total bilirubin - 8.6 μmol / l, AST - 22 units / l, ALT - 25 units / l, creatinine - 65 μmol / l, urea - 3.2 mmol / l l. What disease can be predicted in the patient

 Stomach cancer

 

107. Patient B, 47 years old, complained of weakness, decreased ability to work, pain in the epigastric region, a feeling of heaviness after eating, vomiting after eating. He was ill for 2 months and treated on his own. he took no-SPU and analgin. The first was when the pain subsided after taking the drug. In recent days, the pain has become more frequent, of an unknown nature (like coffee color), vomiting has occurred. She has lost 10 kg in the last two months. In the general analysis of blood: erythrocytes - 4,7, Hb - 97 g / l, leukocytes - 6,5х109, ESR - 45 mm / h. Biochemical analysis of blood: total protein - 62 g / l., Total bilirubin - 9.6 μmol / l., AST - 25 units / l., ALT - 30 units / l., Creatinine - 75 μmol / l., Urea - 5.2 mmol / l. The result of X-ray examination of the gastrointestinal tract: gastric deformity and the presence of a filling defect in the lower third of the stomach. What disease can be predicted in the patient

Stomach cancer

 

108. What are the specific symptoms of malignancy in chronic esophagitis:

dysphagia

 

109. Patient N., 65 years old, was admitted to the clinic with complaints of weight loss of 8 kg in three months, general weakness, periodic pain in the epigastric region. The patient underwent radiological examination and gastroscopy. An exophytic formation measuring 6 × 4 cm was found in the lower curvature of the stomach, the edges of which are roller-shaped and the central part is covered with a gray coating. Morphological conclusion: moderately differentiated adenocarcinoma. This morphological manifestation is characteristic of any disease

Stomach cancer

 

Patient I, 110.65 years old, was admitted to the therapeutic hospital for a year with alternating constipation and diarrhea, lost 11 kg of weight in a month, complained of loss of appetite, periodic subfebrile fever. For many years there was constipation for 5-7 days. D-report for 8 years in the district therapist due to colon polyposis. Over the past month, the situation has worsened due to progressive weight loss. In HAC: Hb - 95 g / l, erythrocytes - 4.7 1012 / l, Ht - 42%, leukocytes - 6.9x109 / l, ESR - 65 mm / h. On palpation: the abdomen is soft, painless in all parts, in the left half of the abdomen in the projection of the lower colon there is perifocal vibration, local muscle weakness. What kind of specialist does the patient need?

oncologist

 

111. A 25-year-old patient was examined by an annual doctor. From the anamnesis of menarche 13 years. Menstruation for 5 days, every 28 days, normal, painless. Ж-1, Б-1, А-0, Т-0. Eliminates gynecological diseases. Objective: the abdomen is soft and painless. On gynecological examination: the cervix is clean, cylindrical. On recto-vaginal examination, the uterus is not enlarged, mobile, painless, 6 cm rounded on the right, dense-elastic consistency, mobile, painless. SA-125 - 8 IU / ml. The most common benign ovarian cancer in young women

dermoid cyst

 

112. A 45-year-old patient was examined by an annual doctor. From the anamnesis of menarche 13 years. Menstruation 3 days, irregular, painless. Ж-2, Б-, А-1, Т-0. Eliminates gynecological diseases. Objective: the abdomen is soft and painless. On gynecological examination: the cervix is clean, cylindrical. On recto-vaginal examination, the uterus is not enlarged, mobile, painless, rounded to the right 9 cm, dense-elastic consistency, mobile, painless. SA-125 - 13 IU / ml. A test to determine if there is cancer in the ovaries

 intraoperative histological examination

 

113.Patient V. A 64-year-old man was diagnosed with left breast cancer a year ago and has not been seen by a doctor. He was sent to the oncology center, where he was diagnosed with "breast cancer, stage IV, tumor rupture." The cause of complications

 failure to see a doctor in time

 

A 114.45-year-old woman complained to the oncologist at the clinic about vaginal bleeding. There are no hereditary diseases. History of pregnancy, 3 deliveries. He was last seen by a gynecologist five years ago. In the anamnesis of cervical erosion treated in the mirror: a woman who gave birth to a vagina, the cervix is hypertrophied, on the anterior lip there is a small bump-like tumor 2x3 cm, bleeding on contact. The uterus and uterine appendages are no different. Rectal examination revealed no infiltrate in the lower pelvis. Further tactics of the doctor

 Referral to an oncologist after cyto-histological examination

 

115. During the screening, a 67-year-old patient was diagnosed with I St (T1N0M0) cancer of the upper outer quadrant of the right breast. Radical mastectomy was performed. The cancer is highly sensitive to the hormone IGH. The type of treatment for the next stage

hormone therapy

 

A 116.60-year-old woman has been complaining of genital bleeding for six months. The last menstruation was 10 years ago. Under the supervision of an obstetrician-gynecologist: the cervix is clean, on bimanual examination before the uterus, slightly enlarged, dense, painless, without enlargement on both sides without appendages, painless. The patient underwent a detailed diagnostic scraping, histological findings - adenocarcinoma. - Atypical hyperplasia. First of all, what expert advice is needed

 oncologist

 

A 117.51-year-old woman complains of a week-long discharge from the genital tract. Her last period was at the age of 49. Specify the most appropriate diagnostic test tactics

 detailed diagnostic grinding / hysteroscopy

 

118. A 27-year-old patient was examined by an annual doctor. From the anamnesis of menarche 11 years. Menstruation for 5 days, every 29 days, normal, painless. Ж-0, Б-0, А-0, Т-0. Eliminates gynecological diseases. Objective: the abdomen is soft and painless. On gynecological examination: the cervix is clean, cylindrical. On recto-vaginal examination, the uterus is not enlarged, mobile, painless, rounded 7 cm on the right, dense-elastic consistency, mobile, painless. SA-125 - 8 IU / ml. Treatment of benign ovarian cancer in young women

surgical

 

A 119.67-year-old patient complained to a mammologist of pain in the left breast for a month. On examination, the left mammary gland is small, dense, heavy, the skin is like a "turtle shell", drawn into the pelvis. The skin is dense, in some places carved, scaly, pigmented. Dense lymph nodes under the left armpit. Specify the type of breast cancer

 shell

 

A 120.20-year-old patient was diagnosed with breast cancer and examined by a mammologist. On examination and palpation: up to 2 cm in the outer square, rounded, painless, elastic, mobile in the breast tissue, clear border formation. Kenig's symptom is positive. Name the prognosis

fibroadenoma

 

121. A 52-year-old patient was diagnosed with a tumor in the right breast and was examined by a mammologist. On examination, the right mammary gland is up to 1.5 cm in the inner square, rounded, painless, indistinct, stone-like dense, convex surface, immobile in the breast tissue. The broad symptom is positive. Specify the prognosis

cancer

 

122. The patient is 50 years old and is examined by an annual doctor. From the anamnesis of menarche 13 years. Menstruation 3 days, irregular, painless. Ж-2, Б-, А-1, Т-0. Eliminates gynecological diseases. Objective: the abdomen is soft and painless. On gynecological examination: the cervix is clean, cylindrical. On recto-vaginal examination, the uterus is not enlarged, mobile, painless, irregular 6 cm on both sides, stone-like consistency, limited movement, painless. SA-125 - 15 IU / ml. What diagnostic method should be used to rule out Crookenberg's cancer?

VGDS + colonoscopy

 

In a prophylactic examination of a 123.65-year-old patient, the therapist identified IIIa St (T3N1M0) cancer, a nodule in the upper outer quadrant of the right breast. The diagnosis was made histologically. Cancer is highly sensitive to IGH hormones. Type of treatment

complex therapy

 

124. A 44-year-old patient has been complaining of genital bleeding for 2 months from 16 to 22 of the menstrual cycle. Menstruation 3-4 days, every 27 days. On gynecological examination: the cervix is clean, on bimanual examination the uterus is forward, enlarged, dense, painless. The appendages are not enlarged on both sides, without pain. What test method is needed to confirm the diagnosis

 detailed diagnostic grinding / hysteroscopy

 

A 125.65-year-old patient complains of an enlarged left breast within a month. On examination of the left breast, the mammary gland is enlarged, dense, the thesis is like a "lemon peel", the areola is enlarged, the uterus is inward. Dense conglomerate of lymph nodes under the left armpit. Indicate the type of breast cancer

 tumor-infiltrative

 

A 126.35-year-old woman was diagnosed with cervical erosion. History of 3 pregnancies, all of which ended in childbirth. Unexamined, last visited a gynecologist three years ago. History of cervical erosion. Looking in the mirror: a woman who gave birth to a vagina, the cervix is eroded, the uterus and uterine appendages are indistinguishable. Rectal examination revealed no infiltrate in the lower pelvis. A biopsy of the cervix was performed. Histological conclusion - "carcinoma in situ". What is the best treatment?

electroexcision of the cervix

 

127. A 60-year-old patient complains to a gynecologist about pain in the lower abdomen, enlarged abdomen, vomiting, weight loss of 10 kg in 1.5 months. Objective: the abdomen is soft and painless. On gynecological examination: the cervix is clean, atrophic. On recto-vaginal examination, the conglomerate in the lower pelvis is 10 cm, stone-like, immobile, with a rough surface. SA-125 - 2356 IU / ml. Prognosis

ovarian cancer

 

128. A 32-year-old patient complains to a mammologist about bleeding from the right ventricle for a month. On examination, both breasts are the same shape, soft, homogeneous, in the center of the uterus, on the right side of the upper quadrant, when you press the areola points, there is a bloody discharge from the uterus. Specify the prognosis

Intracranial papilloma

 

129. A 45-year-old patient was examined by an annual doctor. From the anamnesis of menarche 13 years. Menstruation 3 days, irregular, painless. Ж-2, Б-, А-1, Т-0. Eliminates gynecological diseases. Objective: the abdomen is soft and painless. On gynecological examination: the cervix is clean, cylindrical. On recto-vaginal examination, the uterus is not enlarged, mobile, painless, rounded to the right 9 cm, dense-elastic consistency, mobile, painless. SA-125 - 13 IU / ml. The most common benign ovarian cancer in premenopausal women

ovarian cystadenoma

 

130. The patient is 65 years old. Complaints have been observed for a year. There are obvious side effects: decompensated diabetes mellitus, diabetic foot, coronary heart disease, myocardial infarction in 2017, encephalopathy, arterial hypertension grade 3, CKD FC3. There are no hereditary diseases. History of 3 pregnancies, 1 delivery, 2 medical abortions. She was last seen by a gynecologist seven years ago. Looking in the mirror: the vagina is shortened. The crater in the cervix is covered with a necrotic layer. It was released from the vagina like a "meat wash". Vaginal examination: 2/3 of the vaginal wall is infiltrated. In the lower pelvis, a dense tumor conglomerate is found, which extends to both sides of the pelvis, immobile and painful. On rectal examination: the rectal mucosa is immobile. Infiltrate reaching the pelvic wall on both sides in the parameter. There is blood on the finger. CT scan of the abdomen revealed metastases in the liver. The patient was diagnosed with cervical cancer, stage IV. Type of treatment

symptomatic treatment

 

131. The patient is 44 years old

Complains of bleeding from 16 to 22 of the menstrual cycle. Menstruation 3-4 days, every 27 days. On gynecological examination: the cervix is clean, on bimanual examination the uterus is forward, enlarged, dense, painless. The appendages are not enlarged on both sides, without pain. The patient underwent a detailed diagnostic scraping, histological findings - adenocarcinoma. What diagnostic method is needed to look for possible hematogenous metastases

 Ultrasound of the abdomen, chest radiography

 

132. A 55-year-old patient complains to a gynecologist about pain in the lower abdomen, enlarged abdomen, vomiting, weight loss of 8 kg in 1.5 months. Objective: enlarged abdomen, tense. On gynecological examination: the cervix is clean, tilted back. On recto-vaginal examination, the conglomerate in the lower pelvis is stone-like, immobile, with a rough surface. SA-125 - 2356 IU / ml. An important test to determine the diagnosis

puncture through the posterior dome of the vagina or laparocentesis with cytological examination

 

A 133.51-year-old woman was diagnosed with stage I cervical cancer. The tumor extended to 2 cm at the base of the uterus and invaded to a depth of 3 mm. The tumor is highly differentiated, the receptor is positive. Indicate the best treatment tactics

 Surgery + hormone therapy

 

134. A 55-year-old patient complains of bloody discharge from the genital tract against menopause for 2 months. On gynecological examination: the cervix is clean, on bimanual examination before the uterus, enlarged, dense, painless. No enlargement on both sides, no pain. What verification method is needed to see the process

 hysteroscopy

 

A 135.33-year-old woman complained to the oncologist at the clinic about periodic bleeding from the genitals. There are no hereditary diseases. Currently, the woman is registered as a gynecologist at 34-35 weeks of pregnancy. History of 1 birth, this is the second pregnancy. When looking in the mirror: the vaginal mucosa is covered with serous secretions, clean, the cervix is hypertrophied, on the anterior lip there is a 2x3 cm cabbage-like tumor with small bumps, bleeding on contact. The uterus is enlarged according to the gestational age, uterine appendages are no exception. Rectal examination revealed no infiltrate in the lower pelvis. Infectious oncocytology - squamous cell carcinoma. Diagnosed with cervical cancer, IB T1bNxM0, 34-35 weeks of pregnancy. Indicate the tactics of patient management

 cesarean section, extended extirpation with uterine appendages, postoperative radiation therapy

 

A 136.45-year-old woman complained to the oncologist at the clinic about intermittent bleeding from the genital tract. There are no hereditary diseases. History of 3 pregnancies, 1 delivery, 2 medical abortions. He was last seen by a gynecologist five years ago. When looking in the mirror: the vaginal mucosa is covered with serous secretions, clean, the cervix is hypertrophied, on the anterior lip there is a 2x3 cm cabbage-like tumor with small bumps, bleeding on contact. The uterus is not enlarged, oval, mobile, painless. Uterine appendages are no exception. Rectal examination revealed no infiltrate in the lower pelvis. What test method should be used to confirm the diagnosis

The method of cytological + histological examination of the cervix

 

A 137.45-year-old woman complained to the oncologist at the clinic about periodic bleeding from the genitals. There are no hereditary diseases. History of 3 pregnancies, 1 delivery, 2 medical abortions. He was last seen by a gynecologist five years ago. When looking in the mirror: the vaginal mucosa is covered with serous secretions, clean, the cervix is hypertrophied, on the anterior lip there is a 2x3 cm cabbage-like tumor with small bumps, bleeding on contact. The uterus is not enlarged, oval, mobile, painless. Uterine appendages are no exception. Rectal examination revealed no infiltrate in the lower pelvis. Prognosis of the doctor

 cervical cancer IB T1bNxM0, exophytic type

 

A 138.37-year-old woman complained to the oncologist at the clinic about a watery, foul-smelling discharge from the genitals. There are no hereditary diseases. History of 3 pregnancies, 3 births. He was last seen by a gynecologist two years ago. History of cervical erosion, untreated. When looking in the mirror: the vaginal mucosa is covered with serous secretions, clean, the cervix is hypertrophied, bleeding on contact. The uterus is not enlarged, oval, mobile, painless. Uterine appendages are no exception. Rectal examination revealed no infiltrate in the lower pelvis. Histological examination of cervical biopsy - squamous cell carcinoma. Diagnosis: Cervical cancer IB T1bNxM0. What method of treatment is used

 Wertheim surgery

 

A 139.68-year-old patient has been complaining of genital bleeding for the past year. The last menstruation was 20 years ago. Decompensated type 2 diabetes. On gynecological examination: the cervix is clean, on bimanual examination before the uterus, increased in size up to 8 weeks, without tight, bumpy pain. No enlargement on both sides, no pain. The patient underwent a detailed diagnostic scraping, histological findings - adenocarcinoma. Ultrasound of the abdomen revealed 2 metastases in the hepatic portal. The patient was diagnosed with stage IV uterine cancer and liver metastasis. What treatment tactics should be used for the patient

 symptomatic treatment

 

140. A 55-year-old patient complains to a gynecologist about pain in the lower abdomen, enlarged abdomen, vomiting, weight loss of 8 kg in 1.5 months. Objective: enlarged abdomen, tense. On gynecological examination: the cervix is clean, tilted back. On recto-vaginal examination, the conglomerate in the lower pelvis is stone-like, immobile, with a rough surface. SA-125 - 2356 IU / ml. Laparocentesis was performed, 6 liters of straw yellow serous fluid was obtained. Cytological conclusion - carcinoma cells. No exceptions for other members. What is the prognosis of cancer?

 III

 

141. The patient is 20 years old, complains of liquid stools with mucus and blood 10 times a day, fever. There is sharp pain before the act of defecation. Epidemiological history: the disease was associated with eating meatballs in the kitchen. The probable diagnosis was shigellosis. Which of the following drugs should be prescribed?

 ciprofloxacin

 

142. The patient is 38 years old, acutely ill. The body temperature rose to 38.7 °, there was weakness, nausea, vomiting twice, liquid stools. By 3 days, the liquid stools increased up to 15 times, the left side of the abdomen had a seizure, and the stools looked like rectal saliva. Appearance: the patient is pale, bruised under the eyes, BP 130/70 mm Hg, heart rate 100 beats per minute. Constipation, spasm of the sigmoid colon , a small amount of stool, mixed with mucus and blood clots. What research method do you prescribe to confirm the diagnosis?

bacteriological examination of feces

 

143. The patient is 47 years old and complains of nausea, recurrent vomiting, diarrhea and abdominal pain. The stool is liquid, foamy, green. It hurts for 2 days. He associates his illness with eating raw eggs. Objective: moderate, the abdomen is sensitive to palpation along the intestine. What is the most informative research method

bacteriological examination of feces

 

144. The patient is 38 years old and fell ill 4.5 months after the operation. Blood was transfused during the operation. In recent days, weakness, pain in the knees, lower back and elbows, loss of appetite are worrying. Examination: normal body temperature, yellowing of the skin and sclera. The liver is dense, enlarged by 4 cm from the wall arch, the spleen is not enlarged. Urine is black, discolored stools. Serological data: HbsAg positive, anti-HBcor IgM negative, anti-HBcor Ig G positive, anti-HAV IgM negative. What is the prognosis?

chronic viral hepatitis B

 

A 145.25-year-old man complains of jaundice, weakness, fever up to 37.5 C and loss of appetite. He was on a business trip, where he regularly drank raw water. Serological data: HbsAg negative, anti-HBs negative, anti-HBcor IgM negative, anti-HBcor Ig G negative, anti-HAV IgM positive. What is the prognosis?

viral hepatitis A

 

A 146.30-year-old patient complained of nausea, vomiting, frequent fluid, large amounts of mucus and blood in the stool, and abdominal pain prior to the act of defecation. The disease is associated with drinking raw milk. Objective: the condition is moderate, there is pain on palpation in the small intestine. In the co-program: liquid consistency, a lot of mucus, muscle fibers (+), neutral fat (+), fatty acids (-), soap (+), leukocytes - 30-50, erythrocytes - 10-15, worm eggs were not found. Which of the following diagnoses is most likely?

shigellosis

 

A 147.21-year-old patient complains of nausea, vomiting, fever up to 37.5 C. After 4 days, the sclera and skin became yellow and the body temperature dropped. Objective: general condition is satisfactory, the skin and sclera are yellow. The abdomen is soft, painless, the liver is enlarged + 0.5 cm below the wall. ELISA for hepatitis: HbsAg negative, anti-HBs negative, anti-HBcor IgM negative, anti-HAV IgM floor. In the biochemical analysis of blood: ALT - 550 Me / ml, AST - 430 IU / ml. Which of the following treatments should be prescribed?

 diet, detoxification therapy

 

148. Patient K., 27 years old, was hospitalized with complaints: fever up to 39.0 ° C, chills, pain in the lower abdomen, tenesmus, up to 10 times bloody stools. Objective: temperature 38.8 ° С. Weak, with sigmoid intestinal pain, in the form of a dense wire. Bacteriological examination of feces revealed Salmonella spp. What antibacterial drugs are most suitable for this patient

fluoroquinolones

 

A 149.29-year-old man complains of jaundice, heaviness in the right hypochondrium, dark urine. On examination: icteric. The abdomen is soft, there is pain under the right rib, the liver is enlarged to 3.0 cm from the lower edge of the rib cage. The prognosis was "acute viral hepatitis B." What changes occur in the biochemical blood test of the patient

 Elevated ALT, elevated total bilirubin

 

A 150.35-year-old woman was hospitalized on the 6th day of illness. Complaints: headache, weakness, loss of appetite, pain in the right hypochondrium and epigastric region, nausea, vomiting. Objective: moderate, orange skin and sclera. The abdomen is soft, there is pain under the right rib, the liver is enlarged to 2.0 cm from the lower edge of the rib cage, painful on palpation. See urine. Epidemiological history: relatives in Uzbekistan, bathed in a ditch, drank unboiled water, ate fruit. ELISA for hepatitis: HbsAg negative, anti-HBs otr, anti-HBcor IgM negative, anti-HEV IgM positive. What is the prognosis?

 hepatitis E.

 

151. It is used locally in case of pain

 ichthyol oil

 

152. The Balzer test is positive

 in the form of iron

 

153. Subjective feelings in STIs

 itching

 

154. In syphilis there is a severe chancre

in the first stage

 

155. Used to justify the diagnosis of pemphigoid

 Nikolsky's symptoms

 

156. Symptoms of terminal membrane are typical

psoriasis

 

157. Indicate the clinical signs of nodules in STDs

umbilical cavity

 

158. The element of a rash characterized by a change in skin color

 spot

 

159. Candidiasis of the cream layer is called something else

 oral poisoning

 

160. Lichenification is described

with thickening of the skin, the definition of the skin image

 

161. Immunoglobulin E:

 is a class of antibodies in allergic reactions

 

162. Immunoglobulin M:

is a class of antibodies in acute infections

 

163. Immunoglobulin A:

 is a class of local immune antibodies in the mucous membranes

 

164. Immunoglobulin A:

is a class of local immune antibodies in the mucous membranes

 

165. The level of T-helpers and immunization index (IRI) in HIV indicates the stage and severity of the disease. On the analysis form, this compliance indicator is:

CD4, CD4 / CD8

 

A 166.2-year-old child may have a congenital immunodeficiency characterized by recurrent infections, dermatitis, and thrombocytopenic hemorrhage and arthritis:

 Viscot-Aldrich syndrome

Immunoglobulin G:

 

167. is a class of antibodies in chronic infections

A patient with allergic diseases should identify the allergen that caused the symptoms. To do this, the causative agent is identified using a set of allergens:

Determination of allergen-specific immunoglobulin E levels

 

168. Cytokines are:

low molecular weight proteins released by activated lymphocytes and macrophages, which are mediators of inflammation and the immune response

 

169. Pathological, manifested by the formation of new tissue and accompanied by changes in the genetic apparatus of the cell, leading to a violation of the sequence of its growth and differentiation:

cancer

 

170. Anti-inflammatory cytokines:

 limits the synthesis of free radicals in phagocytes

 

171. The nature of cerebrospinal fluid cytosis in tuberculous meningitis

 lymphocytic

 

172. Characteristics of spinal fluid in tuberculous meningitis

mysterious

 

173. It is considered to be the most effective anti-tuberculosis drug

 isoniazid and rifampicin

 

Name the anti-tuberculosis drug of group 174.2

prothionamide

 

175. What is the inflammatory reaction in miliary tuberculosis of the lungs?

Productive

 

176. Name the main group of anti-tuberculosis drugs

 isoniazid

 

177. Peripheral lymph nodes are often damaged by tuberculosis

 cervical lymph nodes

 

178. The composition of the primary tuberculosis complex

 primary affect, lymphangitis, regional lymphadenitis

 

179. The nature of the exudate characteristic of tuberculous pleurisy

lymphocytic

 

180. The size of the papule in the case of a positive reaction of the TB Mantoux test

 5 mm and above

 

181. Indicate the diseases characterized by paraspecific reactions

 all types of primary tuberculosis

 

182. The method of laboratory tests to confirm the diagnosis of tuberculosis

 Detection of sputum for Mycobacterium tuberculosis

 

183. X-ray signs of individual focal shadows in the lungs

Shades up to 1 cm

 

184. How many portions of sputum from a patient with tuberculosis are collected in order to determine the effectiveness of treatment?

2 servings

 

185. Primary tuberculosis often occurs in the period of liming of the complex

 Gon hearth

 

186. It is usually detected in cavernous tuberculosis

one cavern

 

187. How many portions of sputum samples are collected from a patient with tuberculosis for diagnostic purposes?

 3 servings

 

188. X-ray method of general examination for tuberculosis

 fluorographic method

 

189. Often suffers from bone tuberculosis

lumbar spine

 

190. The nature of the Mantoux reaction of 2TB in primary tuberculosis

hyperergic

 

191. At the 35th week of pregnancy, a pregnant woman came to the reception with cramping pain in the lower abdomen. Convulsions every 4-5 minutes, 25-30 seconds. During the vaginal examination, the cervix is recorded, the edges are of medium thickness, the opening of the cervix is 2 cm. What is the most likely diagnosis

35 weeks of pregnancy. The first stage of labor

 

192. Pregnant woman O., 32 years old. At 17-18 weeks of pregnancy she complained to the district gynecologist about cramps in the lower abdomen and lower back. From the anamnesis: Birth parity: 5/2. The third and fourth pregnancies were terminated by early medical abortion without complications. During the vaginal examination: the length of the cervix is 2.5 cm, in the middle of the pelvis. The core of the cervix passes one horizontal finger, the uterus is enlarged according to the gestational age, there is a small amount of mucus secreted from the genital tract. The most probable diagnosis of the gynecologist of the clinic

 17-18 weeks of pregnancy. AAA.

Risk of late termination of pregnancy

 

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

climax

 

194. R., 32 years old, was admitted to a gynecological hospital due to an exacerbation of chronic inflammatory diseases of the uterine appendages. Before going home, she asked a gynecologist for advice on contraception. The woman is married and has 2 children. In the last 3 years he has been treated twice for exacerbation of chronic inflammatory diseases of the uterine appendages. Which of the contraceptive methods can be recommended to this woman?

combined oral contraception

 

195. A re-pregnant woman, 36 years old, had swelling in her calves at 32 weeks of gestation. AK - 140/90 mm h. b., 150/100 mm s. b., protein in urine 0.033 g / l. Which of these antihypertensive drugs is the most appropriate to prescribe

 dopegit

 

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

postpartum endometritis

 

197. K., a 29-year-old pregnant woman, came to the gastroenterology department at 35-36 weeks of pregnancy with complaints of pain and vomiting in the stomach. The disease is associated with poor nutrition. The department clears the stomach, and then there is a headache. Transferred to the maternity hospital. Examination revealed: pale skin, obvious swelling in the calves, blood pressure 160/100 mm Hg. Urine analysis: urine density 1018, leukocytes 3-4 in the eye area, protein 4 g / l, hyaline cylinders, zernist 4-5 in the eye area. Preliminary diagnosis

35-36 weeks of pregnancy.

 

197. Severity of preeclampsia

The patient was 23 years old and had tuberculosis as a child. "D" is not registered in the tuberculosis dispensary. Sometimes abdominal pain is a concern. Married for 2 years, no pregnancy and no contraception. The first menstrual period was 13 years old, the last 3 years were short and small, but the 28-day cycle was preserved. No pathological changes were detected during the special gynecological examination. Which research method clarifies the diagnosis of this patient

hysterosalpingography

 

A 198.32-year-old woman gave birth to a girl 2 weeks ago. The baby was immediately placed on his chest. The early postpartum period was no exception. She was released with her child in 4 days. He is currently complaining of a fever of 38 degrees and shivering. The general condition of the body is moderate due to poisoning. The skin over the mammary glands is hot, hard on palpation, painful. Milk is secreted from the udder. Insignificant, mysterious secretions from the genital tract. During the vaginal examination, the uterus is normal in size, painless, mobile, the outer cervical vertebrae pass through the fingertips. What is the most likely diagnosis

 lactostasis

 

A 199.26-year-old sick woman complained of stiffness and swelling of the mammary glands and calves, constipation, irritability, sweating. Has been ill for 3 years. These symptoms appear in the second phase of the menstrual cycle and stop after the next menstrual period. The severity of symptoms did not increase from year to year. Gynecological examination revealed no pathology. What kind of premenstrual syndrome can occur in this case?

Swollen

 

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

cerebral cortex, hypothalamus, adenohypophysis, ovaries, target organs and tissues

 

201. A woman came to the district doctor of the Women's Council complaining of delayed menstruation (the last one was 7 weeks ago), nausea and vomiting, which sometimes occurs once in the morning, and does not cause odors. She considers herself pregnant, the pregnancy is undesirable. Somatically healthy. She has a history of 3 births (live children) and 2 medical abortions. There were no gynecological and venereological diseases. Vaginal examination revealed: vaginal mucosa is clearly bruised, the cervix is formed, the external cervix is closed. The body of the uterus is hyperanteflexed, soft, but compacted on palpation, enlarged to 7 weeks of gestation. The fragments are mysterious. What are the tactics of the gynecologist

Clinical and laboratory examination and referral for termination of pregnancy

 

202. Patient L., 28 years old, came to the gynecological department with acute inflammation of the uterine appendages. The test showed a positive reaction to HIV. In which case, HIV infection can be considered laboratory-proven

 ELISA test twice positive + immunoblot

 

A 203.18-year-old patient complains of itching of the external genitalia, irritability during urination. For a week he considered himself ill, before that he had a purulent rash, in connection with which he took ampicillin. The general condition is satisfactory, body temperature is normal, somatic is healthy. At the entrance to the vagina, there are redness, swelling, white cheese-like discharge, which is easily rubbed with a cotton swab. Which is the most likely diagnosis

Candidiasis colpitis

 

The study of a 204.27-year-old patient revealed: vaginal pH 5.2, hyperemia of the vaginal mucosa, a positive amine test, microscopic examination of the vaginal discharge revealed "key cells". The most likely diagnosis

bacterial vaginosis

 

205. By 8-9 weeks of pregnancy, a pregnant woman has vomiting, pain up to 22 times a day, hypotension, heart rate 110 beats per minute, decreased diuresis, increased residual nitrogen and creatinine, urine acetone-4 +. Diagnosis

Vomiting in pregnant women, severe form

 

206. A 29-year-old pregnant woman came to the Women's Council complaining of pain in the lower abdomen and lower back. Gestation period is 15-16 weeks. History: one childbirth and three medical abortions. During the vaginal examination: the length of the vaginal part of the cervix is 2.5 cm, the outer cervix is concave, the cervical canal is closed, the uterus is enlarged according to the stage of pregnancy, the mucous secretions from the genital tract are small. Which of the following diagnoses is appropriate?

risk of miscarriage

 

207. It is used as much as possible for the hormonal treatment of dysfunctional uterine bleeding in the perimenopausal period of a woman

progestogens

 

208. A 27-year-old woman was delivered by ambulance to the maternity hospital with a premature pregnancy, complaining of amniotic fluid leakage. There is no maternity service. From the anamnesis: Parity 2/1. Her first pregnancy ended 2 years ago with an emergency caesarean section due to fetal complications. The postpartum period was complicated by endometritis and was treated. Doctor's tactics

 solution of labor by cesarean section

 

209. A woman with a newborn child came to the maternity hospital. She gave birth at home two hours ago. She was examined by a gynecologist during her pregnancy. Condition is satisfactory. No complaints. What to do in the reception

 check the integrity of the birth canal and introduce anticonvulsant serum

 

210. Vaginal examination of a woman revealed that 2/3 of the inner surface of the joint and the upper half of the octagon were filled with the head. 4-5 octopus vertebrae and sciatic bone are freely defined. The bow-shaped seam is on the right diagonal. Determine the plane of the pelvis where the head of the fetus is

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

 

A 211.45-year-old sick woman came to the hospital with pancreatic fibroids. Vaginal examination: the cervix is hypertrophied, the structure is changed, the uterus is enlarged at 9-10 weeks of gestation, dense, painless. Spare parts have not changed. What is the optimal volume of the operation

 extirpation of the uterus without appendages

 

212. A sick woman K., 35 years old, complains of rapid hirsutism, cessation of menstruation. For 8 months she considers herself ill, because from that time menstruation began to slow down, hair growth appeared on the face (beard, mustache). Her last period was 3.5 months ago. At examination: height -150 cm, weight - 59 cm. Explicit hirsutism. The mammary glands are atrophied. There are no secretions from the mammary glands. Vaginal examination: the cervix is cylindrical, the nape is closed. The uterus is not enlarged. The left appendages are unchanged. A dense formation measuring 6.5x5.5x4.0 cm was found in the right appendages. The most likely diagnosis

 Hormonal cancer of the ovaries

 

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

 uterine atony, bleeding

 

A 214.40-year-old woman was admitted to the gynecological department with bleeding and cramping pain in the lower abdomen. For the last 1.5 years, menstruation has been prolonged and painful since the menstrual period. The last menstrual period is periodic and lasts for 10 days. History: one childbirth and 3 abortions, without complications. This condition is characterized by menstrual disorders

 hyperpolymenorrhea

 

A 215.25-year-old woman complains of purulent discharge from the genital tract for 5 days and a feeling of irritability when urinating, normal body temperature. Sex life is irregular, there is no regular partner. Examination in the mirror revealed reddening of the vagina and cervix, a large number of purulent-mucous secretions in the form of "purulent tape". In bimanual examination: the uterus and appendages are not enlarged, painless. What research allows to determine the cause of the disease

crop method

 

216. Patient A., 24 years old, complained of pain in the lower abdomen and bloody discharge from the genital tract, delayed menstruation for 2 weeks. SAR 100/60 mm Hg, pulse rate 90 beats per minute. Looking in the mirror: cervical mucus is bruised, bloody discharge, dark. РV: the uterus is slightly enlarged, mobile, in the right appendages there is a dough-like, painful formation. The posterior dome is thick and painful. What is the most likely diagnosis

ectopic pregnancy

 

217. In a pregnant woman, a second ultrasound examination of the fetus revealed a low position of the placenta. Low placental abruption is the most characteristic clinical symptom

 recurrent bloody discharge from the genital tract

 

A 218.20-year-old patient was admitted to the gynecological department on the 13th day of the menstrual cycle, complaining of pain in the lower abdomen. AK 100/60 mm critical range. The pulse rate is 90 beats per minute. The skin is pale. The abdomen is soft, there is pain in the lower parts. There are no symptoms of irritability. Looking in the mirror: the cervix is clean, the discharge is mixed with mucous blood. PV: the uterus is normal in size, uterine appendages are not detected due to tension in the anterior abdominal wall, the domes are deep, painful. Which is the most likely diagnosis

ovarian apoplexy

 

Sick woman 219.52 years old, hot flashes on the head 8 times a day, pain in the heart area, shortness of breath, BP-150/90 mm Hg. complains of a transient increase to. Has been postmenopausal for 2 years. PV: The genitals develop backwards with age. What is the most likely diagnosis

 Mild climacteric syndrome

 

220. What criteria are used to diagnose severe preeclampsia?

 Diastolic blood pressure> 110mmHg Systolic blood pressure> 160mmHg, with proteinuria of 300mg or more

 

A 221.26-year-old sick woman came to the gynecologist complaining of pain in the left labia. The body temperature rose to 37 C. Examination of the external genitalia revealed hyperemia and swelling of the left labia. Palpation reveals a formation in the depth of the left labia, size 5x4 cm, with softened parts in the middle. Which diagnosis is the most correct

 Bartolin gland abscess

 

222. Sick woman N., 24 years old, several

complains of worsening of the condition 4-5 days before the onset of menstruation throughout the year. Complaints: edema, weight gain, tension and pain in the mammary glands, irritability, mood swings, headache, flatulence. As soon as menstruation begins, the above symptoms disappear. No pathological changes were detected during gynecological examination. Which hormone is a key factor in the etiology of this condition

 progesterone

 

223. A postpartum woman, 28 years old, weighing 4100.0 g. After the birth of the baby, the placenta was secreted, a small amount of bloody discharge from the genital tract. Examination of the birth canal revealed a rupture of the posterior wall of the vagina and the muscles and skin under it to the anus. The most probable diagnosis

II degree of intermediate rupture

 

224. A pregnant woman came to the reception with a gestation period of 37 weeks. Leopold-Levitsky's second method revealed that a large, dense, mobile part of the fetus was palpated on the right side of the uterus. What is the most likely diagnosis

 Fetal lying horizontally, 2 positions

 

225. In the 22nd week of pregnancy a woman is at risk of premature birth. Examination revealed blood type A (II) in the mother, rhesus factor (-), blood group AB (IV), rhesus factor (+) in the father. What could be the reason for not being able to conceive?

 Antibody to Rh factor in the mother

 

226. The patient is 23 years old, due to primary infertility, hysterosalpingography was performed to determine the cause. In the photo: the uterine cavity is T-shaped, the fallopian tubes are shortened, rigid, the ampullary part is as wide as the head of the pin, the contrast fluid passed into the abdomen was not observed. What kind of disease is characterized by such a change

genital tuberculosis

 

227. A mature boy is born spontaneously. 5 minutes later, with the tactic of actively conducting the third stage of labor, the sperm was separated. Examination of the placenta revealed: placenta size 22x18x3 cm, placental tissue defect 2x2.5 cm, complete membranes. What will be the doctor's tactics next?

 Immediately inspect the uterine cavity by hand and remove the rest of the placenta

 

228. A 26-year-old woman who gave birth for the first time complains of breast pain on the 3rd day after giving birth. t = 38.2ºC, heart rate 86 beats per minute. On palpation, the mammary gland was found to be uniformly enlarged, hard and sensitive. In this case, a rational tactic

squeezing and releasing breast milk

 

A 229.25-year-old patient was admitted to a gynecological hospital complaining of pain in the lower abdomen, which appeared immediately after physical exertion. He says that he had nausea, vomiting and dry mouth. Vaginal examination revealed: the uterus is dense, painless, of normal size. Left appendages indeterminate, round to the right of the uterus, elastic consistency, limited mobility, immediately painful on palpation, 7x8x6 cm. dimensional formation is determined. The pulse rate is 120 beats per minute. In the analysis of blood leukocytes 12.3. What is the diagnosis?

 Torsion of the right ovarian cyst

 

A 230.23-year-old woman gave birth 5 hours after the onset of labor with bleeding. Fetal heart rate - 132 beats per minute. She is in good condition. The opening of the cervix is 8-9 cm. What to do

 amniotomy

 

A 231.26-year-old patient complained of mood swings 5 days before menstruation: edema, weight gain, breast tenderness and pain, irritability, depression, and headache. All these complaints are eliminated with the onset of menstruation. Gynecological examination revealed no pathological changes. What is the pathology of this condition

menstrual syndrome

 

232.F., 33 years old, complains of rapid progressive hirsutism, cessation of menstruation. She considers herself ill for 6 months, at first she noticed a delay in menstruation and hair growth on her face. Her last period was 4 months ago. Examination revealed: height - 152 cm, weight 57 kg, obvious hirsutism, atrophy of the mammary glands. There are no secretions from the mammary glands. PV: the cervix is cylindrical, the nape is closed. The uterus is not enlarged. The left accessory area is no exception. Solid formation in the area of the right appendages, size 5.5x4.5x5.0 cm. palpated. What is the most likely diagnosis

Hormone-producing cancer of the ovaries

 

A pregnant woman, 233.19 years old, was taken to the maternity hospital by ambulance. According to the ambulance crew, the pregnant woman had seizures at home. His condition is serious and inadequate. Pregnancy is periodic. Birth parity is 1/0. The skin and visible mucous membranes are pale, there is obvious swelling in the legs. Blood pressure 170/110 mm Hg, pulse rate 96 beats per minute. What are the best tactics for driving a pregnant woman

Resolve childbirth no later than 12 hours after complex therapy

 

234. Postpartum woman, 24 years old. She gives birth in 5 hours. There was an immediate pain in the abdomen, uterine hypertension, inability to relax between contractions, insignificant bloody discharge from the genital tract. Preliminary diagnosis: premature rupture of the normal placenta. What research method is most effective in correctly diagnosing this condition

ultrasound examination

 

235. Early signs of ovarian dysfunction

changes in the duration of the menstrual cycle

 

236. The volume of surgery for bleeding as a result of trauma to the birth canal and soft tissues

suturing of torn soft tissues

 

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

Beginning with the beginning, I position

 

238. What causes desquamation of the functional layer of the endometrium?

 Decreased levels of estrogen and progesterone in the blood

 

239. A postpartum woman complains of pain and irritation of the labia and intercostal space 4 days after delivery, complicated by a rupture of the labia. On examination: redness of the wound surface, swollen tissues, purulent discharge. The wound bleeds easily. What is the most likely diagnosis

postpartum ulcer

 

240. A week ago a pregnant woman with severe rubella was examined by an obstetrician-gynecologist at the Infectious Diseases Hospital. Gestation period is 9-10 weeks. How can this disease affect the development of the embryo

 may lead to developmental defects in the baby

 

A 241.17-year-old girl was rushed to the hospital with a complaint of excessive uterine bleeding. Menstruation occurs at the age of 13 years, irregularly, with a delay of up to 1.5 months, followed by bleeding. Taking a course of oral contraception, to no avail. Having sex for 6 months, avoids unwanted pregnancies by abortion. What treatment can be recommended

shaving of the uterine cavity

 

A 242.19-year-old patient complained of pain in the lower abdomen, fever up to 37.5C and the discharge of purulent discharge from the genitals, accompanied by painful urination. Examination revealed: redness of the urethra, hyperemia of the cervix in the mirror, erosion, mucous-purulent discharge. Vaginal examination: the uterus is not enlarged, painful on palpation, both appendages are thickened, painful. Bacterioscopy of the infection revealed gonococci inside and outside the cell. What is the most likely diagnosis

fresh fresh gonorrhea

 

243. In case of juvenile hemorrhage from menarche, it should be ruled out in the first place

blood diseases

 

244. A woman with a periodic pregnancy gives birth for 7 hours, contractions every 3-4 minutes for 30-35 seconds. History: third pregnancy, previous two pregnancies ended in medical abortion, the latter was complicated by endometritis. He began to complain of a slight bleeding from the genitals. Vaginal examination revealed: the cervix is inscribed, the opening is 7-8 cm, the amniotic sac is intact, the left edge is loose tissue. What are your tactics?

 Perform amniotomy and continue childbirth naturally

 

245.20 years old woman giving birth, III stage of childbirth. When observed from the umbilical cord for 30-40 seconds (no signs of placental abruption), the placenta does not fall down. It is considered expedient how to carry out the third stage of labor

wait for the next good contraction of the uterus and resume traction from the umbilicus

 

246. Which of the following medical and diagnostic operations is more effective in menopausal bleeding?

Diagnostic shaving of the uterine cavity

 

247. A., a 25-year-old woman who gave birth again, was admitted to the maternity hospital with a complaint of premature ejaculation of amniotic fluid 7 hours earlier and the start of regular labor 5 hours earlier. Vaginal examination revealed a complete opening of the cervix, no fetal sac, the fetal head with a small segment adjacent to the entrance to the pelvis. The most probable diagnosis

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

 

248. The patient is 16 years old and complains of absence of menstruation for 2 years since menarche. Height 150 cm, weakly developed secondary sexual characteristics, female type, small uterus, no appendages. Estrogen-progesterone test was performed for differential diagnosis - gave a positive result. What type of amenorrhea is most likely?

 ovaries

 

249.25 years old sick woman, abdomen

She was admitted to a gynecological hospital with complaints of lower back pain, bloody discharge from the genital tract and fever up to 38 C. He considers himself ill for 3 days, these symptoms appeared after the introduction of an intrauterine device. She has a history of menstruation, 1 childbirth, 3 abortions. The general condition is satisfactory, the abdomen is soft on palpation, there is a slight pain in the upper abdomen. In bimanual examination: the uterine body is slightly enlarged, dough-like consistency, painful, no appendages. What is the most likely diagnosis

Endometritis

 

250.Baby child. Born a day, weighs 4 kg. Nourished naturally. Not taking vitamin D. The mother complains of sleep disorders, anxiety, sweating during breastfeeding. On examination: the skin is moist, red dermographism, baldness of the neck area. Weak muscular hypotension with a soft edge of 1.5 x 1.5 cm. There are no changes in the skeleton and internal organs. What research should be done to confirm the diagnosis

calcium, phosphorus, alkaline phosphatase

 

251. The child was born from the 5th pregnancy, weighing 3000 g at the time, height 50 cm. Yellowing of the skin at birth, weakness, weak voice. Poor breastfeeding, loxidia, enlarged liver and spleen. Your preliminary diagnosis

hemolytic disease of the baby

 

252. A 20-day-old boy was admitted to the Department of Neonatal Pathology with complaints of "fountain" vomiting, which began 5-6 days ago and intensified. Bile is not mixed with vomit masses, the volume of vomit is increasing in the dynamics. The child is not passionate, but does not gain weight, there is a deficiency. Decreased urination frequency, redness in the urine. What pathology to think about

 pylorostenosis

 

253. A child is born at 40 weeks of gestation and weighs 3750 g. The shout was instantaneous. She was breastfed for 1 day, received good breastfeeding, active breastfeeding. Weighs 3600 grams in 3 days of life. Papular pink rash on the chest, abdomen and limbs. Define the transition period

 transient weight loss, toxic erythema

 

254.3 a child born during pregnancy. History of 2 medical abortions. Jaundice appeared 9 hours after birth. + 1.5 cm from the edge of the liver wall arch. Hemoglobin 158 g / l, total bilirubin 99.8 μmol / l, indirect - 91.6 μmol / l, direct - 8.2 μmol / l, thymol test - 2 units. Make a preliminary diagnosis according to the classification

 Hemolytic disease of the newborn, a form of jaundice

 

255. An obstetrician talked to a 20-year-old pregnant woman about antenatal prophylaxis (36 weeks). Doctor's recommendation: eat foods rich in vitamins, take frequent walks in the fresh air, follow a daily routine. Which recommendation applies to the special prevention of rickets

Taking group D vitamins

 

256. The baby is from the 1st pregnancy, delivery is fast, birth weight is 2900 g, is breastfed, body temperature is normal, condition is satisfactory. Released from the maternity hospital on the 4th day, weighing 2850 g. When the pediatrician came to see the child, he was diagnosed with "low gestational age." According to the classification, the baby weighs less

Below 2500 g

 

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

 Against tuberculosis and viral hepatitis B.

 

258. During the examination, the child's head is slightly bent at the chest, arms and legs are bent, elbow joints are attached to the chest, arms are clenched into fists, legs are bent at the knees and hips. Determine the condition of the baby

flexor posture

 

259. A low birth weight child, from the 1st pregnancy, the 1st delivery, the pregnancy was unchanged, jaundice appeared 12 hours after birth. At 36 hours of life, bilirubin is 180 μmol / l, hemoglobin is 125 g / l, reticulocyte count is 9%. Occurs in many nuclear erythrocytes and individual spherocytes. There is no comparative diagnosis of any of the following diseases

Rhesus is a mismatch

 

260. Mild bruising of the oral triangle is observed during breastfeeding. On auscultation: The child is 26 days. He was born with a low birth weight of 2000 grams. Mother's milk is not enough in natural nutrition. Adds weight well. Not sick. Appearance: satisfactory condition, pale skin. In the analysis of blood: er - 3.1 x 10 | 2 / liter, Hb - 90 g / l, color index - 0.82. There is no change in white blood cells. Your preliminary diagnosis

premature anemia

 

261. A newborn baby is 5 days old. Pregnancy with mild toxicosis in the 1st half, emergency delivery. Body weight at birth is 3200 g, body length is 52 cm. 8/9 points on the Apgar scale. Immediately screamed and put on the chest 1 hour after birth. In the later days of his life, his condition was satisfactory. She lost weight in the first days, on the 4th day she weighed 2950 g. On the 5th day of examination, the condition is satisfactory, well absorbed, active, body weight 3000 g, physiological reflexes, muscle tone satisfactory. The mammary glands enlarge to 1.5 cm on both sides, white-milk fluid is released when pressed; The umbilical ulcer is clean. Respiration in the lungs is puerile, heart sounds are clear. The abdomen is soft, painless, the liver is 1 cm from the edge of the wall arch, with a normal density, the spleen is not palpable. ESR: HH - 187 g / l, Er - 5.5 x 1012 / l, c. n. - 0.9, Lake - 6.3 x 109 / l, n / a - 5%, c - 42%, e - 1%, l - 45%, m - 7%, ESR - 2 mm / h. APF: color - straw - yellow, reaction - acid, specific gravity - 1003, no protein

 physiological weight loss and sexual crisis

 

262. The baby, from the 2nd pregnancy, birth weight 3200, height 49 cm, 6 - 7 points on the Apgar scale. According to the anamnesis, the mother was infected with a viral infection at 36-37 weeks. His voice was immediate and loud. 10 minutes after birth. Shortness of breath, respiratory rate 70 times per minute, cyanosis in the nasopharynx. General muscular hypotension, hyporeflexia. On auscultation - small bubbly crepitated rales, a decrease in percussive sound in the lower part of the lungs during percussion. The boundaries of the heart are enlarged, the tones are silent, the heart rate is 160 beats per minute. Your preliminary diagnosis

intra-abdominal bronchopneumonia

 

During the examination of a 28-day-old child, the doctor recommended for the prevention of rickets: 1) massage; 2) walk in the fresh air; 3) UFO № 15. Which recommendation applies to non-specific measles prevention

mode, massage, walking

 

263. Yellowing of the skin was observed on the 1st day after birth. Child 4 - pregnancy, 2 - emergency delivery. 1 - and 2 - pregnancies - medical abortions, 3 - pregnancies - childbirth, 4 - pregnancies - current. The child's mother has blood type A (II), rhesus - negative. During the current pregnancy, the titer of anti-Rh antibodies is 1/68. Total blood test of the child: Hb 140 g / l. Er - 4.5 * 1012l. Once. - 26%. Leukocyte 10 * 109l. Э - 2%, т / я - 1%, с - 62%, л - 27%, м - 8%. Normoblasts per 100 2. In the biochemical analysis: the level of indirect bilirubin in the umbilical cord blood is 80 μmol / l, total bilirubin 6 hours after birth - 165 μmol / l, indirect - 158.4 μmol / l, direct - 6.6 μmol / l . The child's blood type is B (III) third, rhesus is positive. The direct Coombs test is positive.

Select the direction of further driving

 replacement blood transfusion

 

264. The baby was 2 weeks old, in contact with a mother with ARVI, body temperature 37.3 C, catarrhal changes, cough. During the examination, the pediatrician assessed his condition as moderate, respiratory rate 40 beats per minute. There is no puerile breathing in the lungs, no wheezing. Which of the following drugs is not prescribed

 antibiotic

 

265. The following complications of pneumonia are more common in underweight children, except for one

arthritis

 

266.2 - week-old baby, unvaccinated, sleeps 18 hours a day, weighs 3.5 kg, feeds 60 ml of breast milk 4 times a day, lacks iron and vitamins after other meals. Why are you skeptical?

 The less you eat, the less energy you get from food

 

267. Mild bruising of the oral triangle is observed during breastfeeding. On auscultation, the newborn has no respiratory symptoms, pale, does not react to irritants, heart rate 84 beats per minute, legs slack. Which of the following diagnoses is possible?

severity of asphyxia

 

268. Newborn N., 8 days old, was admitted to the neonatal pathology department at home on the referral of a district pediatrician. The child is from 1 pregnancy, delivery - 1, 39 weeks, urgent, physiological. During pregnancy: 1st half of pregnancy - toxicosis at 6-7 weeks, 2nd half of pregnancy - purulent sinusitis at 36 weeks, inpatient treatment. At birth the condition is satisfactory. Birth weight 3550 g, length 52 cm. 8/9 points on the Apgar scale. She is breastfed in the first 2 hours of life and is actively breastfed. In the early neonatal period, physiological jaundice, toxic erythema were observed. On the 3rd day she was discharged from the maternity hospital in satisfactory condition. On the 8th day, under the patronage of the district pediatrician, bubbles were found all over the body, and the child was sent to the hospital. The condition is moderate, inactive, weakly sucked chest, loxidy, body temperature 37.5 - 37.7 ° C. The skin layers have a pale pink marble pattern. On the skin of the body, there are polymorphic bubbles up to 2 cm in diameter on the infiltrated base, surrounded by a hyperemic vein, the inside is serous - filled with pus. In place of the perforated elements - erosive surfaces with remnants of the epidermis at the edges. The navel is clean. Respiration in the lungs is puerile. Heart tones are rhythmic and clear. The abdomen is soft, the liver protrudes 1.5 cm from the wall, the spleen is not palpable. The stools are yellow, like porridge. GVA: Hb - 181 g / l, Er - 5.6 x 1012 / l, c. n. - 0.9, thrombus - 272 x 109 / l, lake - 17.5 x 109 / l, metamyelocytes - 3% p / i - 13%, c - 57%, l - 24%, m - 3% ESR - 9 mm / s. APF: color - straw - yellow, reaction - acid, specific gravity - 1004, protein - slice, squamous epithelium - 0 - 1 p / zr, leukocytes - 2 - 3 p / z, erythrocytes - 0, cylinders - 0. get a preliminary diagnosis

baby bladder

 

269. A premature baby is born from the 1st pregnancy without complications. 3 days of life in the body Boy, 4 days. Child from 1 pregnancy, pregnancy without complications, delivery 38. Birth weight - 2900 g. height - 49 cm. Maternal blood group A (P) Rh (+) - positive. The child's blood type is AB (IV), Rh (-). 7-8 points on the Apgar scale. On the 3rd day, the child developed jaundice on the skin. I am in a good mood. Active breastfeeding, no nausea. Automation of innate reflexes is active. In the biochemical analysis of blood: bilirubin 170 μmol / l, transaminase is normal. Your preliminary diagnosis

Physiological jaundice

 

270. The doctor classified the child: no pneumonia, asthmatic breathing. Which drug do you prescribe to the child under the ICU program?

inhalation of salbutamol

 

271. The child was born 8 days, weighing less than 1000 g. What vaccinations can be given to the baby in the maternity hospital

The vaccine is not made

 

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

severity of asphyxia

 

273. The child was born from the 5th pregnancy, weighing 3000 g at the time, height 50 cm. Yellowing of the skin at birth, weakness, weak voice. Poor breastfeeding, loxidia, enlarged liver and spleen. Your preliminary diagnosis

hemolytic disease of the baby

 

274. A premature baby, from the 1st pregnancy, without complications. On the 3rd day of life on the body, limbs appeared 1 - 1.5 cm red rash with a dense round white paula in the middle. The general condition is good. Your medical tactics

 does not require treatment

 

275. Spontaneous component movements are observed in the newborn, which is a consequence of the predominance of regulation of extrapyramidal motility. Tell me at what reflex spontaneous motor activity is determined

Bauer

 

276. When looking at the head of a newborn, there is a tumor-like fluctuation in the area of the left skull, on palpation, there is no pain, no pulsation. Make a preliminary diagnosis

cephalohematoma

 

277. Mild bruising of the oral triangle is observed during breastfeeding. On auscultation: the first tone is unchanged, the accent of the second tone over the pulmonary artery. Systole - diastolic murmur is heard in 2 intercostal spaces. How does blood flow during such a congenital heart defect?

From the aorta to the pulmonary artery

 

278. A newborn baby is 14 days old. Poor breastfeeding, nausea, unstable stools. The skin is hyperemic, flaky, seborrheic folds on the scalp. Hyperemia with maceration in the axillary and groin area, diaper rash is observed. Preliminary diagnosis

seborrheic dermatitis

 

279. The child is 7 years old. He was hospitalized in critical condition. Complaints. Repeated "coffee" -like vomiting, nausea, pain, polydipsia, weakness, dizziness, impaired vision. Objective: severe, weak, sleep disorders, the smell of acetone in the mouth. Redness on the tip of the face, dry tongue, sores in the corners of the mouth. Pulse 120 times per minute, weak. The boundaries of the heart are normal. The sound of the heart is rhythmic and weak. That's the breath (Kussmaul). There are no changes in pulmonary percussion and auscultation. The abdomen is soft, the upper part of the abdomen is painful on palpation. Defecation is normal. The temperature is 35.8 °. Which diagnosis is correct

diabetic ketoacidosis

 

280. The child is 3 years old. Complaints: frequent diarrhea, poor appetite, weight gain. In the anamnesis: the child was born from 1 pregnancy, weighing 3400 g, height 51 cm. From the first day, a large stool is unstable. It is assessed as staphylococcal enterocolitis or dysbacteriosis. At the age of 11 months he had enterocolitis. Weighs 8700 g in one year, 10 kg in 2 years, 10.5 kg in 3 years. Received enzymes and biologics.

His father does not like milk. At a glance: the general condition is satisfactory. Soft tissue turgor is low, the skin is pale. Dryness of the abdomen is observed. On palpation there is a snoring of the colon. Liver + 1.5 cm. What diagnosis to think about

 lactose intolerance

 

A doctor called a 281.10-year-old boy home. I was sick for 2 days. Body temperature is 39.0 ° C. Pain in the lower back, headache. The skin is pale and clean. Does not urinate for some time. Your preliminary diagnosis

acute pyelonephritis

 

282. The child is 11 years old. Complaints: mild pain in the epigastric region, appeared after eating, sore throat, a feeling of heaviness in the epigastric region. In the anamnesis: these complaints have been troubling since the age of 2. His mother has chronic gastritis. Objective: the child's condition is satisfactory. There are no changes in the respiratory and cardiovascular systems. On palpation of the abdomen - unexplained pain in the epigastric region, normal bowel movements. What disease can be compared with the diagnosis

with chronic gastroduodenitis

 

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

functional disorders of the stomach

 

284. The child is 2 years old. Complaint. O-shaped deformity of the leg. Development is normal. She was breastfed until she was 8 months old, and received prophylaxis in the form of UFS. It is in the fresh air for 3 hours a day. After a year, the child began to walk, at which time there was a curvature of the legs, recently there was a sudden increase in deformity, changes in gait, received special treatment for rickets. In laboratory tests: hypophosphatemia, hyperphosphaturia, normal calcium in the blood and urine. What diagnosis to think about

phosphate diabetes

 

285. A 10-year-old child. Complaints: nosebleeds, skin bleeding. The condition is satisfactory during the inspection. Bleeding of different sizes on the body, face, legs. The joints have not changed. In the blood test: er. - 3.8 x 1012, HB - 100 g / l, thrombus - 3.0 x 109 / l, ESR - 24 mm per hour. Bleeding time 18 min. bleeding rate 2 min., end - 7 min. There is no blood clotting retraction. Diagnosis: Werlhof's disease. What is the danger of this disease

bleeding

 

286. A 5-year-old boy. The child is from the 2nd pregnancy (nephropathy in the mother). In the anamnesis, the child was weak and inactive for 1.5 months after stress. It was found that he drank a lot of fluids and had frequent bowel movements. The child was taken to the intensive care unit in critical condition, unconscious. Noisy breathing (Kussmaul type), reduced skin and Achilles reflexes, dry skin, low soft tissue turgor, hyperemia of the skin. Pulse - 140 beats per minute, blood pressure 75/40 mm Hg. Art. The tongue is covered with a white coating. The mouth smells of acetone. What kind of coma is this?

hyperglycemic coma

 

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

nephrotic syndrome

 

288. 8-year-old child. Complains of a wet cough and fever. Objective: pale skin. Hard breathing in the lungs, dry rales, can be heard all over the lungs. On X-ray: the image of the lungs is intensified at the base of the lungs. In the peripheral blood: L - 5.0 x 10 / l (p. - 8%, s. - 51%, l. - 39%, m. - 6%); ESR - 6 mm / h. Which of the following diagnoses is correct?

just bronchitis

 

289. Boy I., 11 years old. It is known from his anamnesis that he had scarlet fever 2.5 months ago. He is in critical condition. The child is blistering, restless, tired quickly, words are not clear, does not perform the coordination test correctly, muscular hypotension. Breathing in the lungs is vesicular, no wheezing. The heart is unchanged. Boundaries of the heart: the right side - in the right part, the top - in the III wall, the left side - in the middle - 1 cm inward along the clavicle. Heart sounds are slightly weak, systolic murmur is heard at the apex of the heart. The abdomen is soft, deeply palpable, the liver and spleen are not enlarged. Diagnosis: Rheumatism 1. What is the primary treatment prescribed to the patient

 bicillin

 

290. The girl is 6 years old, her growth and development are age-appropriate. He received preventive vaccinations according to the vaccination schedule. He first had a Mantoux reaction at the age of four. The result is a papule of 12 cm. There was a "tuberculosis", in connection with which he received chemoprophylaxis for 3 months. What vaccinations should be given to this child at the age of 6?

 ADS, JKV - 2 (against corn)

 

A 291.9-year-old boy complains of changes in urine analysis and hearing loss. The child with toxicosis from the 2nd pregnancy, the 2nd childbirth (the first child - a boy, died at the age of 11 from kidney failure, from the age of 3 - deaf). Upon admission to the clinic: moderate condition, pale skin, no swelling, blood pressure 105/55 pp. The embryogenesis is determined by stigmas. On examination - APF-protein - 0.9%, leukocytes - 6 - 7 k / a, erythrocytes - in large quantities, density - 1007. Zimnitsky's observation: fluctuations in urine density 1002 - 1008; day diuresis - 250 ml, night diuresis - 500 ml. In audiometry: hearing loss. Under the supervision of an ophthalmologist: cataract I degree, myopia. What is the best syndrome for a child?

Alport syndrome

 

An ambulance was called for a 292.6-year-old boy with bronchial asthma. From the anamnesis it was found that D was under control with bronchial asthma from the age of 4 years. Consulted by an allergist, sensitive to house dust and food. The seizure was not self-limiting. Condition is moderate, pale. Additional muscles are involved in expiratory breathing and respiration. Breathing 1 minute - 40 times. You hear a crack in the distance. Percussion lung sound is accompanied by a "box" sound. Weak rest, widespread dry scratching. What treatment is mandatory

salbutamol

 

293.5 years old child. Complaints: pain in the right knee joint. History: frequent bleeding from the nose, bleeding into the joints and skin after injury. Objective: the condition is moderate. The skin is pale. The diameter of ecchymosis in the body is 6 cm. The right knee joint is spherical, there is an immediate inhibition of movement. In the joint fluid - hemolyzed blood. In the blood test: er. - 3,6 х 1012, НЬ - 100 g / l, ESR - 20 mm / h, thrombus. - 200 x 10%, Lee - White blood clotting time 18 min. Recalculation time 450 min. Recalculation was restored after donor plasma transfusion. Which of the following diagnoses is correct?

A hemophilia

 

294. The patient has the following symptoms: bruising, acrocyanosis, dilated veins, positive venous pulse, systolic murmur on the auscultation of the sword, transmitted upwards and to the right, increased respiration, decreased respiration. The liver is enlarged, on palpation there is a pulsation in the liver, which is synchronous with the ventricular systole. What a problem to think about

 Insufficiency of three-way gates

 

A 295.9-year-old boy complains of changes in urine analysis and hearing loss. The child with toxicosis from the 2nd pregnancy, the 2nd childbirth (the first child - a boy, died at the age of 11 from kidney failure, from the age of 3 - deaf). Upon admission to the clinic: condition - moderate, pale skin, no swelling, blood pressure 105/55, etc. The embryogenesis is determined by stigmas. APF - protein - 0.9%, leukocytes - 6 - 7 k / a, erythrocytes - in large quantities, density - 1007. Zimnitsky's observation: fluctuations in urine density 1002 - 1008; day diuresis - 250 ml, night diuresis - 500 ml. In audiometry: hearing loss. Under the supervision of an ophthalmologist: cataract I degree, myopia. What is this syndrome?

Alport syndrome

 

296.10 years old child. Complaints: persistent cough, cream in the morning - the separation of purulent sputum. Shortness of breath while running, weakness, loss of appetite. At the age of 2 he was diagnosed with acute pneumonia. Since then he has been suffering from pneumonia or bronchitis every year. Appearance: moderate condition, t - 37.3 °, pale skin, stunted physical development. On percussion: in the area of the 4th - 5th wall, the sound of the lungs is reduced, breathing is hard, wet rales of different calibers are heard. After coughing, the wheezing does not change. Which diagnosis is correct

chronic pneumonia

 

297. A 7-year-old patient was admitted to the hospital with the following complaints: pain in the knees, ankles, ankles and arms. Joint syndrome persists for the last 6 months and is accompanied by an increase in ESR. Apparently, he is in critical condition, exhausted, uses crutches when walking. In large joints, local fever is high, joint function is reduced. In the analysis of whole blood: Hb - 90 g / l, Lake. - 15.0 x 109 / l, sticks - 4%, p. - 42%, e. - 2%, l. - 49%, m. - 3%, ESR - 50 mm / h, rheumatoid factor "+". Diagnosis: Juvenile rheumatoid arthritis. At the beginning of the pathological process it is necessary to differentiate the disease from the differential diagnosis

Reiter symptoms

 

298. A 5-year-old child. Complaints: pain in the right knee joint. History: frequent bleeding from the nose, bleeding into the joints and skin after the injury. Objective: the condition is moderate. The skin is pale. The diameter of ecchymosis in the body is 6 cm. The right knee joint is spherical, there is an immediate inhibition of movement. In the joint fluid - hemolyzed blood. In the analysis of blood: er - 3.6 x 1012, Hb - 100 g / l, ESR - 20 mm / h, thrombus. - 200 x 10%, Lee - White blood clotting time 18 min. Recalculation time 450 min. Recalcification was restored after donor plasma transfusion. Which diagnosis is correct?

A hemophilia

 

The 299.8-year-old child has been stunted since birth, has been sitting for 12 months, and has been walking since the age of 1.5. Height corresponds to 4 years, bone age - 2 years, disproportionate physique. Mental retardation, facial swelling, constipation, bradycardia. Your prognosis

congenital hypothyroidism

 

A 300.10-year-old girl, after a bee sting, suddenly developed a symmetrical papular-hemorrhagic rash on the knees and elbows. Such rashes appeared on the inner thighs and buttocks. Soft abdomen, pain in the stomach and colon, red blood in the stool, temperature 37.30C. What is the correct diagnosis

hemorrhagic vasculitis

 

301. The child is 11 years old, his grandmother brought him to the hospital when he lost consciousness. History: diabetes, insulin. Last insulin for 1.5 hours. previously accepted. According to the grandmother, the child immediately turned pale, sweated and lost consciousness. Appearance: pale, moist skin; Muscle tone is normal, no acetone odor, heart rate 110 beats per minute, satisfactory. AK - 90/60 mm; breathing is normal, the abdomen is soft, the liver is not enlarged, the temperature is 36.4 °. Which diagnosis is correct

 hypoglycemic coma

 

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

acute simple bronchitis

 

303. 7-year-old child. Acutely ill, body temperature 400C. Appearance: severe condition, headache, dry cough. The skin is pale, with a "marble" pattern. The neck is hyperemic. Emergency - 32 per minute. The chest is stretched, the right side is out of breath. Percussion: shortened under the shoulder in the right lung. On auscultation: shortness of breath, weakened at the site of contraction, no rales. Heart sounds loud, no noise. 120 battles per minute. The abdomen is soft and painless. Total blood test: HB - 115 g / l, Lake. - 18.0 x 109 / l, sticks - 10%, p. - 57%, e. - 1%, l. - 23%, m. - 9%, ESR - 28 mm / h. On radiography: there is intense darkening in the right lung in segments VIII and IX. Diagnosis: right segmental pneumonia. What pulmonary complications can the patient have

 pyopneumothorax

 

304. The child is 7 years old. History: grandmother suffers from bronchial asthma, has been allergic to citrus since 6 months. At the age of 3 he had acute urticaria. 1 hour ago, there was a cough, difficult noisy breathing. Objective: pale skin, cyanosis of the nasolabial triangle, expiratory dyspnea 50 times per minute, shortness of breath, dry wheezing, box-like sound in the lungs on percussion. What to think about the disease

bronchial asthma

 

305. The child is 11 years old and is registered with diabetes. Complaints: thirst, increased urination, pain around the umbilicus, nausea, vomiting, dizziness, impaired vision. He was ill for 2 days. Objective: the mucous membrane is dry, clear, there are cracks in the corners of the mouth, the tongue is covered with a coating, there is redness on the skin of the cheekbones. What are the complications of the underlying disease in the patient

Diabetic ketoacidosis grade 1

 

306. The child is 13 years old. Complaints: pain in the abdomen at night and in the stomach, varying intensity, pain when eating, itching, wheezing, nausea, prone to constipation. History: has been ill since the age of 10, diagnosed with gastroduodenitis, periodic exacerbations. Does not follow a diet. His mother and grandfather have ulcers. Objective: the child's condition is satisfactory, physical development is average. The tongue is covered with a white coating. Pain in the epigastric and pyloroduodenal region on palpation of the abdomen, Mendel's symptom is positive. The liver is not enlarged. Which diagnosis is correct

12 peptic ulcer

 

307.4-year-old boy, acutely ill: fever 38.5 ° C, cough, runny nose. At a glance: the condition is moderate. The skin is pale, the mouth is bruised. Cough is moist, emergency 40 times per minute. The intercostal space is inhaled, nasal congestion is observed. Percussion: The percussion sound is tympanic. Auscultatory: severe, there is a slowing of breathing under the shoulders of the left lung, where there are small bubbles of wet rales. Diagnosis: right-sided pneumonia. What changes can occur in the biochemical analysis of blood

SRB «positive

 

A 308.9-year-old girl was referred to an endocrinologist. The appearance of fever and sweating is disturbing. She lost 5 kg in 3 months. On objective examination: emotionally unstable, irritable, blistering. Increased physical activity - a slight tremor of the fingers. The skin is moist and hot to the touch. Gref's symptom is positive. The thyroid gland is diffusely enlarged, has a dense elastic consistency, vascular noise is heard above the gland. At rest, the tachycardia, the boundaries of the heart widen to the left. Frequent stools. Your preliminary diagnosis

diffuse - toxic goiter

 

309. The child is 2 years old, immediately developed a severe cough, shortness of breath, anxiety, 1 hour ago the child ate fish. Objective: moderate condition, inspiratory dyspnea, shortness of breath. History: the child had several skin rashes. Neurodermatitis in the mother of the child. Which disease is characterized by these clinical manifestations

allergic laryngotracheitis

 

A 310.14-year-old child was admitted to the clinic with a blood pressure of 180-200 mm. He complained of a rise in blood pressure, nosebleeds and headaches. When checking the disproportionate development of the child: the upper part of the body is well developed, the lower part is weak (pain and weakness in the legs when walking), blood pressure in the hands is 180 mm. 90 mm at the end. What changes in R-grams correspond to this patient

enlargement of the left side of the heart, 3 - 8 pairs on the lower edge of the walls «excuses

 

311. The patient is 7 years old. In the general analysis of urine: volume - 70.0 ml, color - red, reaction - alkaline, density - 1023, erythrocytes - in large quantities, leukocytes - 2 - 3 in the visual field. protein 0.99%. Diagnosis: acute glomerulonephritis, referred to the nephrology department. Indicate the duration of follow-up of the patient after discharge from the hospital

5 years

 

312. The child is 3 years old. Complaints: fever 38.8 C, whooping cough, shortness of breath. Objective: moderate condition, pale, expiratory dyspnea. The sound of "box" in the lungs. During auscultation, breathing is hard, whistling and wet rales of various calibers. Your preliminary diagnosis

obstructive bronchitis

 

LE cells were tested in the blood of a 313.14-year-old boy with high titers of anti-DNA antibodies to antinuclear factor. Which of the following diagnoses is possible?

system red dot

 

314. The child is 7 years old, acutely ill after a cold, body temperature 39.0 C, dry cough, headache. After examination, he was diagnosed with right-sided pneumonia and was sent to hospital for treatment. How long will the child be monitored at the clinic after recovery?

1 year

 

315.4 years old child. Complains of epileptic pain, recurrent vomiting. The disease begins acutely. Two weeks ago I had ARVI. Appearance: severe condition, pale skin. Papular - hemorrhagic rash in the area of symmetrical flexion of the calf, the joints are not changed. Soft abdomen, pain in the colon in the epigastric region, temperature - 37.6 C. Blood in the stool. What to think about the disease

 hemorrhagic vasculitis

 

316. The child is 6 years old. Complaints: pain in the knees, ankles, body temperature up to 37.6 °. Objective: the condition is satisfactory, there is swelling of both knees, pain when moving. With the buttock area, there are symmetrical hemorrhagic rashes on all joints. Diagnosed with hemorrhagic vasculitis. What is the danger of this disease

with gastrointestinal bleeding

 

A 317.4-year-old boy is hospitalized with polysegmental pneumonia. On the 6th day, the child's general condition worsened, weakness, shortness of breath, tachyarrhythmia, an increase in the horizontal boundary of the heart, an increase in heart sounds, especially 1 tone, the appearance of functional, systolic murmurs. What is the cause of the deterioration of this child's condition?

 with myocarditis

 

318.7 years old girl. Complaints: epileptic cough, wheezing. In the family - recurrent rash on the mother. At the age of 1-4 years in May, the child develops shortness of breath outside the city. When he arrived in the city, he was suppressed on his own. This seizure occurs after chocolate. Appearance: general condition is moderate, pale skin, wheezing, audible from a distance, prolonged exhalation. TJ - 1 min. - 28 times. Percussion sound in the lungs, like a "box". On auscultation, dry rales all over the lungs. In the blood test: e. - 14%, radiographs of the lungs - intensified, no foci. Diagnosed with bronchial asthma. What is the main mechanism of obstructive sleep apnea?

bronchospasm

 

319. The patient had an acute onset of fever, a sudden rise in body temperature to 40 ° C, complained of severe headache, recurrent vomiting, pain in the joints of the fingers. Objectively revealed: irregular star-shaped hemorrhagic rash on the limbs and hips with necrotic center, which does not disappear when pressed. Meningeal symptoms are positive. What research method should be used to make a diagnosis?

lumbar puncture

 

320. What should be checked for a child with a fever under the ICSID program?

neck muscle contraction

 

321. What are the general signs of danger included in the ICSID program?

 whether the child can drink or not drink fluids

 

322. The child is 2 years and 7 months old. The body temperature rose to 39.400C, there was repeated vomiting and abdominal pain. The stool is initially fecal in nature, then reduced in size and diluted, containing a mixture of blood and mucus. On the second day of the disease, the body temperature was 380C, stools were liquid, the frequency could not be counted - there was mucus, blood, pus, tenesmus. The anus is open. Your diagnosis

dysentery

 

323. Misha, 8 years old, suffers from acute VGA. Which marker should be determined to confirm the diagnosis

anti HAV Ig M

 

324. The child was brought to the reception with a diagnosis of tuberculosis. Objective: a sweet-smelling odor in the mouth, a slight redness in the pharynx, light-gray coating on the tonsils, difficult to remove with a spatula, bleeding. The analysis of BL smears from the anus is positive. Your first treatment tactic for this patient

introduction of anti-diphtheria serum

 

325. One of the 2nd grade students of the boarding school was diagnosed with smallpox. What measures should be taken against the epidemic

refer to Meltzer boxes

 

326.Таня В. A 7-month-old baby was hospitalized on March 8 with paresis of the right arm. In the anamnesis, on March 1, the girl was revaccinated with a live polio vaccine. In the morning, 7 days later, the mother noticed that her daughter's right arm was paralyzed. The general condition has not changed, the body temperature is normal. The doctor sent him to the hospital for treatment. After 5 days, the movement of the right arm was restored, but the recovery of tone lasted for a month. Your prognosis.

vaccine-associated poliomyelitis

 

327. Masha, 4 years old, acute pain, T - 38.0 C, abdominal pain. Stools are liquid, orange, watery, mixed with mucus. A tank of feces. E. coli found in sowing. The titer of antibodies against the detected pathogen TEGAR (indirect hemagglutination reaction) - 1:40, after 7 days - 1: 160. What is the minimum minimum titer of antibody growth confirms the diagnosis?

 4-fold increase in antibody titer

 

Diagnosis of a 328.9-month-old child at the hospital: ARVI, acute laryngotracheitis. I degree stenosis of the pharynx. This is a tactic for the treatment of stenosis in children

Drink warm liquids

 

329. The child is 5 years old. On the face, on the writing surfaces of the skin there are rashes of pink color, not connected to each other, enlarged lymph nodes in the neck. What diagnosis can be made

 rubella

 

330. The child is 1 year and 6 months old, acute pain, body T 37.6 0 C, excessive vomiting, abdominal pain, flatulence, sound and stools, large amounts of water, bubbles, yellow. A tank of feces. The spray is negative. What is your prognosis?

rotavirus gastroenteritis

 

331. Today the child was in contact with a patient with measles, in connection with which he was injected with gamma globulin. Indicate the period in which this child may develop measles

From 9 to 21 days

 

332. Which rash does not disappear when pressed with a fingertip

 spot

 

333. A 5-year-old child with mumps has the following symptoms - abdominal pain, vomiting, diarrhea, which indicates an organ damage

pancreas

 

334. Select the option from the list that does not belong to the specified non-specific protection factors

 blood

 

A 335.10-year-old boy was hospitalized with an infectious disease with a diagnosis of salmonellosis. On the 2nd day after hospitalization, the doctor suspected that the child had acute appendicitis. The doctor should determine what symptoms are suspected in a child with acute appendicitis

Schetkin-Blumberg symptom

 

336. The child is 5 years old. On the face, on the writing surfaces of the skin there are rashes of pink color, not connected to each other, enlarged lymph nodes in the neck. What diagnosis can be made

rubella

 

A 337.5-year-old boy became seriously ill, had a fever, vomiting, sore throat, and a few hours later developed a rash. The rash lasted for 3-7 days. The doctor examined the pharynx and found a follicular lesion, the tongue is covered with a thick orange-gray coating. After 3 days, the tip of the tongue began to clear on all sides, and the nipples became enlarged and bright red. After the rash returned, peeling was observed. In the blood - neutrophilic leukocytosis shifted to the left, increased ESR. What could be the diagnosis

scarlet fever

 

338. Scarlet fever rash

small dots

 

Pediatrician for a child aged 339.12 years

diagnosed with infection, 2-sided mumps and right-sided orchitis. Prescribe the necessary treatment for a child with mumps

Wear a suspension

 

340. Measles is a pathogenic symptom

 Belsky-Filatov-Koplik spots

What cells are found in the blood in infectious mononucleosis .

atypical mononuclear

 

341. The causative agent of scarlet fever

 Group A β -hemolytic streptococcus

 

A 342.5-year-old boy became seriously ill, developed fever, vomiting, sore throat, and a few hours later developed a rash. The rash lasted for 3-7 days. The doctor examined the pharynx and found a follicular lesion, the tongue is covered with a thick orange-gray coating. After 3 days, the tip of the tongue began to clear on all sides, and the nipples became enlarged and bright red. After the rash returned, peeling was observed. In the blood - neutrophilic leukocytosis shifted to the left, increased ESR. What could be the diagnosis

scarlet fever

 

343. What part of the respiratory system is most often damaged during adenovirus infection?

 nasopharynx

 

344. Prognosis of the child: Hepatitis A virus. Methods of laboratory tests to determine the etiology of the diagnosis

enzyme-linked immunosorbent assay

 

345. What is a diphtheria membrane?

 fibrin

 

346. In a 3-year-old child diagnosed with oral and pharyngeal diphtheria, swelling of the eyes and legs in the morning was observed, a general urinalysis revealed: proteinuria, hematuria, cylindruria, positive shock symptoms. The doctor should first think about the complications of this disease

glomerulonephritis

 

347. To what department should a child with chickenpox be admitted?

boxed

 

348. Symptoms of intestinal obstruction

 absence of stool and pathological vomiting

 

349. The radiograph revealed the presence of two large gas bubbles and a liquid at the horizontal level. What is your prognosis?

 High congenital intestinal obstruction

 

350. In the case of anus atresia, Wangestin's invertogram is examined several hours after birth.

 18

 

351. It is a congenital upper intestinal obstruction

12- atresia of the intestine

 

352..Name the differential-diagnostic symptoms characteristic of coprostasis or invasive intestinal colic?

absence of leukocytosis, absence of abdominal muscle spasm

 

353. A newborn baby has a sudden dilation of the abdomen. What research method clarifies the diagnosis?

Abdominal radiography

Radiographic signs of lower intestinal obstruction.

multi-level fluid levels

 

A 354.2-year-old boy was brought with suspicion of acute appendicitis. The child resists looking, cries and stiffens. What are the surgeon's tactics when the child refuses to be examined?

 Physiological or pharmacological examination during sleep

 

355. From the moment of birth the baby has a lot of bubbly saliva. Breathing is also impaired. The abdomen is slightly puffy and soft. The origin of meconium. Which of the following diagnoses is correct?

 Esophageal atresia with tracheal esophagus

 

356. From the moment of birth the baby has a lot of bubbly saliva. The abdomen is slightly puffy and soft. The origin of meconium. Suspicion of esophageal atresia. What is the best test to use first to confirm the diagnosis?

 Oesophageal catheterization, esophagography

 

357. The etiological factor of pyloric stenosis is the pathology of pylorostenosis

genetic defect

 

An 358.6-month-old child developed anxiety, refusal to eat, and a stroke. Separation like raspberry jelly during rectal examination. What is the preliminary diagnosis?

Intestinal intussusception

 

359. A 5-year-old boy was brought to the reception with complaints of abdominal pain and incontinence for up to 3 days. Physical examination revealed no pathology in the thoracic cavity. The abdomen is soft, pain on palpation, no symptoms of irritation. What is your diagnosis?

coprostasis

 

360. A one-month-old baby has been ill for 2 weeks. Vomiting like 4-5 fountains per day, decreased urination. The child is inactive, his voice is weak, and visual peristalsis is detected in the epigastric region. Prognosis?

Pylorostenosis

 

361. Children have the most reliable symptoms of acute appendicitis

 abdominal muscles

passive stress and local disease

 

362. What disease should be considered when a child has a stomach ache?

 acute appendicitis

 

363. Congenital pylorostenosis is not diagnosed by methods.

X-ray diagnosis in the Trendelenburg position

 

364. What can be considered, except for appendicitis, when a child has abdominal pain in an acute respiratory infection, the pain on palpation is located in the right sternum, umbilical region and left hypochondrium?

 mesadenitis

 

365. On the radiograph of the abdomen of a newborn - gas bubbles level 2 in the upper part of the abdomen, silent abdomen in the lower part. Which prognosis is correct?

 Congenital duodenal obstruction

 

366. Symptoms of pylorospasm

regurgitation with milk from birth

 

367. What is the cause of constipation?

 from cancer

 

368. What is pandactylitis?

it is a purulent inflammation of the finger that spreads to all tissues

 

369. Which cracks are characterized by a multi-chamber light pocket?

postoperative

 

370. Choose the method of instrumental examination in acute cholecystitis

 Ultrasound

 

371. What is a phlegmon?

 widespread inflammation of the subcutaneous mucosa

 

372. What is Mallory-Weiss syndrome?

 longitudinal rupture of the mucous membrane of the cardiac part of the stomach

 

373. Indications for gastrostomy are

esophageal cancer that cannot be operated on

 

374. What are the most common symptoms of Crohn's disease?

diarrhea

 

375. Not used in acute intestinal obstruction

angiography of the iliac artery

 

376. Acute thinning is an early and persistent symptom of opacity

abdominal cramps

 

377.What is characteristic of a Wall symptom

clearly limited elongated intestinal loop, which is detected by palpation of the abdomen

 

378. What is peritonitis?

acute inflammation of the intestines, manifested by general and local symptoms, accompanied by dysfunction of vital organs and joints

 

379. The thorax is observed during ballot:

closed pneumothorax

 

380. Indicate the symptoms of acute appendicitis

Kocher's symptom

 

381. There are no complications of gallstones

duodenitis

 

382. Oral is not a symptom of burns in the pharynx and esophagus

dry mouth

 

383. The most common cause of peritonitis

 perforated appendicitis

 

384. The most common cause of peritonitis

acute appendicitis

 

385. What is peritonitis?

 acute inflammation of the intestines, manifested by general and local symptoms, accompanied by dysfunction of vital organs and joints

 

386. What are the symptoms of acute appendicitis?

Kocher's symptom

 

387. Nonspecific ulcer is a characteristic symptom of colitis

frequent bloody discharge

 

388. What is the name of the symptom of lack of pulsation as a result of compression of the aorta by a swollen pancreas?

 Resurrection symptoms

 

389. The main cause of acute cholecystitis

 biliary tract disorders

 

390. It is called an abscess

limited accumulation of pus in the tissues and body

 

391. What research method is not used in the diagnosis of acute appendicitis?

irrigoscopy

 

392. The most common cause of acute pancreatitis

pain in the upper abdomen

 

393. The patient complains that he always feels a dark spot in front of his left eye and can not see in this area. Define this symptom

Absolutely positive scotoma

 

394. The patient suddenly had a tumor on the right upper eyelid, the base of the eyelashes was purulent, local hyperemia, there was sharp pain. Which of the following diagnoses is most likely?

denied

 

395. The patient's eyelids

complained of increased itching, redness, exfoliation of the base of the lashes, after the weight of the edges on the eyes. Which of the following diagnoses is most likely?

blepharitis

 

396. From the words of a teenager, while cutting wires, something caught his eye. Nothing was detected by simple methods. What additional research methods are needed

radiography of the eye

 

397. Indicate the drug as a first aid in acute glaucoma. Mechanism of action.

pilocarpine narrows the pupil by pulling the root of the iris from the anterior trunk

 

A 398.5-year-old boy had acute corneal syndrome. The face is swollen. On examination - pericorneal injection of the eyeball, superficial darkening of the cornea. Which of the following diagnoses is most likely?

flictenulosis keratitis

 

399. In spring and summer a teenager has a sharp tingling and tearing. Objectively - the conjunctiva of the upper eyelid has nipples reminiscent of a "paved street". Which of the following diagnoses is most likely?

spring row

 

400. A 14-year-old girl who came to the reception complained that her right eyelid was sore, red, swollen and hot. Objective: acute swelling of the eyelids, closed eyes, pain, redness of the upper eyelid. The anamnesis revealed that he had his eyebrows removed 3 days ago. Which of the following diagnoses is most likely?

 abscess

 

401. After a woman dyes her eyebrows and eyelashes at the hairdresser's, there is a sharp itching and swelling of the eyelids and vesicular rash. Which of the following diagnoses is most likely?

Toxicity of the eyelids

 

A man 402.30 years old. He noticed that he had blindness in his right eye due to endocarditis. When determining visual acuity, the ophthalmologist found blindness in the right eye and visual acuity of the left eye was 1.0. An increase in blood pressure (150/90 mm Hg) was observed. Which of the following diagnoses is most likely?

Acute occlusion of the central retinal artery

 

403. What is common in patients with acute glaucoma and iridocyclitis?

pain, redness of the eyes

 

404. The patient has an asymmetry of facial expressions on the right after a cold, the right eye is always open, there is no blinking movement. Which of the following diagnoses is most likely?

lagophthalmos

 

405. The patient is 4 years old. The right eye complained of the presence of a gradually growing, painless growth under the skin of the eyelid 4 months ago: VIS OD = 1, O VIS OS = 1, O Objective: OD - a dense growth the size of a pea under the skin, which does not change in the middle third visible, visible on the fingers, painless, not covered with skin. The eyelid conjunctiva around the growth is hyperemic, small nipples are spread. The eyeball is calm, the center is transparent, the fundus is normal. Which of the following diagnoses is most likely?

chalazion

 

406. The child has difficulty breathing through the nose, occasional purulent discharge from the nose, high body temperature. Two days ago there was severe pain in the right eye and a forward shift of the eyeball. Objective: OD - swelling and redness of the eyelids and conjunctiva, limited movement of the eyeball, exophthalmos. The most likely diagnosis

orbital phlegmon

 

The patient complained of narrowing of the eyes, feeling like sand under the eyelids, and the same separation in both eyes. Diagnosis: the eyelids are slightly swollen and reddened, the conjunctiva of the eyelids is sharply hyperemic, velvety, no images of cartilage glands. Easily removed gray film on the conjunctiva of the eyelid. Numerous hemorrhages in the conjunctiva of the sclera. Your diagnosis

pneumococcal conjunctivitis

 

407. During the inspection of the eye of the victim of the explosion, you found a piece of wire protruding from the source with a length of 10 mm. Your action

 wire removal, dripping of disinfectants, binocular dressing

 

408. The patient is 72 years old. For 2 days he complained of severe pain in his right eye and a rapid decrease in vision in the last three weeks. He was previously diagnosed with neonatal cataracts. Vis OD = sees light, correctly determines the direction, Vis OS = 1,0. ODC OD = 40 mm. sn. бг КИК OS = 20 mm. sn. bg Ob: OD eye is evenly narrowed, clearly visible stagnant injection of the eyeball, the cornea is swollen, no anterior chamber, the pupil is enlarged to 6 mm, the pupil is evenly blurred gray light, there is no fundus reflex. OS unchanged. What is the most likely diagnosis?

phacomorphic glaucoma

 

409. The patient is 55 years old. He complained of decreased visual acuity, difficulty reading, and the appearance of metamorphosis. During ophthalmoscopy: in the macular area there are large, indistinct edges, intertwined foci - druses. What is the most likely diagnosis?

maculodystrophy

 

410. The eyelids of a 2-day-old baby are sharply swollen. Objective: the eyelids are closed, the eyelids are sharply swollen, there is a tightness when pressed with a finger, when you try to open the eyelids, fluid-like fluid flows from the eye sockets. The first thing to think about is what disease.

gonococcal conjunctivitis

 

411.Patient K. He was admitted to the emergency room with the following symptoms: swelling of the eyelids and hematoma, narrowing of the orbit, exophthalmos, restricted movement of the eyeball down and to the nose, ptosis, subcutaneous emphysema with crepitation. The most likely diagnosis.

fracture of the eye wall

 

A 412.52-year-old patient complained of pain in his right eye and a gradual decrease in vision. Objective: visus OD = 0.7 is not corrected. OD: the eye is calm, the cornea is transparent, the anterior cortex is at a moderate depth, when examined by transient light, a wire-like dark haze is visible in the pupil; The fundus is slightly foggy, without features. Your diagnosis

The first cataract in the cortex

 

413. After a blow to the patient's eye

The pupil turned gray and complained of decreased vision. Give a reason why it is possible.

darkening of the eyeballs

 

414. After 6 hours, a man working with a quartz lamp complained of severe tears and fear of light. Examination revealed OU-blepharospasm, conjunctival hyperemia and small vesicular elevation of the corneal epithelium. The most likely diagnosis.

electroophthalmia

 

415. Patient S., 45 years old, was taken to the hospital with acute vision loss, left eye, left temporal lobe and upper skull, was examined by a neurologist, dentist, ophthalmologist. The patient has never had an eye disease. It turned out that 4 hours before the onset of the seizure he was given an intramuscular injection of atropine due to complications of peptic ulcer disease. Which of the following diagnoses is most likely?

seizures of closed-angle glaucoma

 

A 416.14-year-old boy complained of occasional redness, pain and vision loss in both eyes. The patient was examined by a dentist for stomatitis and dermatologist for cutaneous lesions. Objectively detected by the organs of vision: pericorneal injection, hypopyon, posterior synechia, opacity of the vitreous. Which of the following diagnoses is most likely?

uveitis, Behcet's disease

 

A 417.45-year-old patient with conjunctival syndrome and a combined injection of the eyeball revealed a horseshoe-like infiltrate with an epithelial defect in the lower segment of the cornea. The sensitivity of the cornea is not impaired. Which of the following diagnoses is most likely?

ulcer of the cornea

 

A 418.5-year-old boy complained of fever, sore throat, redness of the right eye and discharge from it, fever 37.8 °. The child is bored, immobile, the pharynx is hyperemic, the tonsils are swollen, covered with a dark brown-gray film. OD-eyelids are swollen, the conjunctiva of the eyelid is sharply hyperemic, velvety, it has a gray film, difficult to remove, followed by bleeding. Which of the following diagnoses is most likely?

conjunctival diphtheria

 

A 419.25-year-old woman, 36 weeks pregnant, was referred to an obstetrician-gynecologist for an eye examination. The child wears glasses with a high degree of near vision, 12.0 diopters with a scattering lens, in which the visual acuity in both eyes is 0.3. Stronger lenses do not improve vision. Large staphyloma at the base of the eye, multiple dystrophic foci in the retina and choroid. What abortion procedure do you recommend

to avoid a period of tension

 

Aphasia in both eyes in a 420.8-year-old boy. Regularly use glasses correction OU (in both eyes) + 9.0 diopters. The lens feels uncomfortable wearing glasses and often breaks them. What adjustment would you recommend to improve the quality of life?

 insert an artificial bean

 

421. The patient is worried about severe pain, nausea and vomiting in the right half of the head in OD. After a nervous breakdown in the morning, the eyes suddenly began to ache. Objective: OD - delayed injection, pupil wide, anterior chamber shallow. During gonioscopy, the anterior chamber angle of the OD is closed. KIC 41 mm.sn.bg. Which of the following diagnoses is most likely?

seizures of closed-angle glaucoma

 

A 422.32-year-old patient complains of severe pain in the left side of the head, which is especially disturbing in recent days. There is no appetite, vomiting is not associated with eating. He has been suffering from hearing loss for about 15 years. Periodic exacerbation of the purulent process is noted. The last exacerbation was observed half a year ago, during which a sharp decline in hearing developed, which continues to this day. The skin is pale gray, with an earth tint. The tongue is covered. Pulse 48 times per minute. The patient is inactive, retarded, blisters. Cannot execute simple commands, does not understand the sentence, can not remember the names of the specified objects. He talks a lot, mispronounces individual words, can't compose sentences correctly. Slight stiffness of the neck muscles was detected, a positive increase in the right Babinski reflex and a deep increase in the right deep reflexes. On the right otoscopy reveals purulent discharge from the ear canal. After hygienic cleaning of the ear, a wide marginal defect of the tympanic membrane is visible, filled with swollen granulations. The projection of the nipple-like growth is slightly painless. The spinal fluid is cloudy and comes out under pressure. Make a diagnosis

Exacerbation of chronic otitis media complicated by otogenic abscess of the frontal lobe of the brain.

 

423. Patient K, 23 years old, complains of nasal congestion, hearing loss, tinnitus. History of ARVI 1 week ago. Appearance: AD- AS Mt- weak purple, hammer handle vascular injection. SS - 4 m, the nasal mucosa is red, swollen, creamy-purulent. What is the diagnosis:

Bilateral tubotympanitis

 

424. The patient complained to the doctor about severe pain in his right ear. From the anamnesis he was acutely ill after ARA. The pain in the ear appeared at night under the feet, and was transmitted to the pharynx and other. The pain was excruciating. On otoscopy: AD-AS- auditory canal is empty, Mt- gray on the left, the eardrum on the right is clearly red, swollen. Rhinoscopy: the nasal mucosa is swollen, there is a creamy-purulent discharge in the general nasal passage. Diagnose:

Acute otitis media

 

425. Patient S., 45 years old, applied to the ENT department with complaints of hoarseness, hoarseness, itching in the throat. He has a history of smoking for 25 years. Swallowing is painless, mouth opening is free. During indirect laryngoscopy: the pear-shaped sinus is loosely symmetrical, the surface of the larynx is mobile. The larynx is empty, there is a lack of vocal folds in the middle third during phonation. In the intervertebral space of the mucous membrane there are dense cone-shaped growths. Diagnose:

Pachidermal laryngitis

 

426. The patient complained to the ENT doctor of the clinic with a blockage of the period after a nose injury. The patient complained: if he lies on the right side, the right side of the nose is blocked, or if he lies on the left side, the left side is blocked. On rhinoscopy: the nasal septum is tilted to the right, the nasal passages are narrowed, the lower nasal congestion is enlarged, the mucous membrane is pale purple.

Vasamotor rhinitis, nasal curvature

 

427. A 45-year-old patient came to the ENT department complaining of hoarseness, itchy throat and irritability. A smoker with 25 years of experience. Swallowing is painless, the mouth is free to open. In indirect laryngoscopy: pear-shaped sinuses are empty, symmetrical, the larynx is mobile. The larynx is empty, the phonation is not easily connected in the middle third of the vocal cords. Diagnose:

Pachidermal laryngitis.

 

428. Patient S. Referred to the ENT department: difficulty swallowing, suffocation with liquid food. According to the patient, he did not eat for the third day, his body temperature was 39.5 degrees, his skin was moist, his voice was trembling, his breathing was free, and his mouth was empty. Hyperemia when looking at the pharynx, tonsils are moderately swollen, loose. In indirect laryngoscopy, the pear-shaped sinuses are filled with saliva, the lingual space is narrowed, the lining is thickened, infiltrated, limited mobility, the larynx is difficult to see, empty. The vocal folds close. Diagnose:

Auxiliary abscess

 

429. A 25-year-old woman complained to the doctor that she often had typhoid fever, subfibrillation and periodic arthralgia. On examination, the tonsils are scarred, connected with the arch, immobile during rotation, the anterior palate is swollen, red, there are caseous plugs in the lacuna. Enlarged lymph nodes are palpated in the corner of the jaw. Diagnose:

Decompensated stage of chronic tonsillitis .

 

430. A sick woman complains of severe pain in the right ear, nasal congestion, headache, fever. In the anamnesis - 2 days of illness. The onset of the disease is associated with runny nose. On otoscopy: AD-auditory canal is empty, the skin is not changed, Mt-redness, swelling, swelling. Decreased hearing in the right ear SS-2m, in Weber's test the sound is directed to the right. Diagnose:

 Right-sided acute otitis media.

 

431. The patient complains of severe pain in the left ear, which is transmitted to the forehead and forehead, accelerates when chewing, the temperature rises to 37.7 ° C. On otoscopy: a cone-shaped bump is detected on the anterior wall of the AS-auditory canal. The skin on it is red. In the middle of the formation - pus, narrowed auditory canal. The lymph node in front of the eardrum is enlarged. Diagnose:

Anterior wall of the external auditory canal.

 

432. What is typical of the disease: difficulty breathing through the nose, periodic nosebleeds, closed nasal passages, examination of the fingers, a posterior rhinoscopy reveals a tumor-like formation with a flat surface.

nasopharyngeal angiofibroma

 

433. A 45-year-old patient came to the hospital with complaints of hearing loss and purulent discharge from the right ear with an unpleasant odor. History of periodic purulent discharge from the right ear for 20 years, untimely treatment. Otoscopy: purulent discharge with an unpleasant odor in the external auditory canal, peripheral defects of the eardrum, masses such as white powder. Make a diagnosis:

 chronic purulent epithymponitis, complicated by cholestatoma

 

434. The patient came to the reception with a complaint of severe pain in the ear. He considers himself ill for 3 days, after the onset of symptoms of ARVI. On otoscopy: AS - the auditory canal is empty, Mt - gray on the left, AD - the auditory canal in the bony part is narrowed by a bulging bulge, which consists of hemorrhagic substance and is located on the posterior wall of the auditory canal and passes into the eardrum. Diagnose:

 Bullous otitis .

 

435. A 10-year-old girl came to the reception with a sore throat, fever and weakness. He was ill 3 days before his anamnesis. Objective: moderate condition, body temperature 40 ° С, moist skin. On pharyngoscopy: the mucous membrane of the pharynx is hyperemic, the tonsils are covered with a white coating, the lymph nodes of the neck are enlarged in the area of the lower jaw and jaw. An enlargement of the inguinal and axillary lymph nodes was detected. In the analysis of blood: leukocytes - 13 * 10 ^ 9 g / l Segmental nuclear neutrophils - 23% Rod nucleus - 0% Lymphocytes - 50% Eosonophils - 0% Monocytes - 26%. Diagnose:

 Monocyte printing .

 

436. The patient complains of cough, hoarseness, fever, ie after drinking cold beer two days ago. Today, these symptoms have intensified. At a glance: the general condition is satisfactory, the temperature is 37.5C. There are no inflammatory changes in the pharynx and nasal cavity. Laryngoscopy: reddening of the mucous membrane of the larynx. The vocal folds are pink, slightly infiltrated, and the vocal folds are wide for breathing. Other ENT members unchanged. What is the diagnosis?

 acute catarrhal laryngitis

 

437. Patient G complained to the doctor of obstruction of the left ear, hearing loss, tinnitus, watery feeling, autophony. On otoscopy: AD-AS-auditory canal is empty, Mt-gray on the right. On rhinoscopy: the nasal mucosa is slightly subatrophic, the nasal septum is tilted to the right at the level of the lower nasal passages. Diagnose:

 Acute otitis media

 

438. The patient is 32 years old, smokes and complains of hoarseness for a year. He only whispers when he has a cold. The general condition is satisfactory. There are no changes in the nasal cavity and pharynx. Laryngoscopy: the creamy layer of the larynx is red, slightly swollen, the vocal folds are red, thickened, the larynx is large enough to breathe. Diagnosis?

 chronic hypertrophic laryngitis

 

439. Patient S. The 25-year-old came to the ENT hospital with a sore throat and difficulty swallowing. History of tonsillectomy 5 years ago. On examination, there is a discharge of saliva, the protrusion of the tongue is painful. When the back of the tongue was pressed with a spoon, the pain syndrome became unbearable. Intermittent hyperemia. On examination of the larynx and pharynx, there are one-and-a-half gray dots in the projection of the base of the tongue. Diagnose:

 Language publishing.

 

440. A 25-year-old patient came to the ENT hospital and complained of sore throat, hyperthermia and weakness. According to the patient, he was seriously ill and was associated with drinking cold juice. History: often suffers from typhoid fever. On pharyngoscopy: slightly asymmetrical, with a clear tumor in the posterior pharyngeal arch, the left tonsil is displaced inward and forward. Diagnose:

Left posterior paratonsillitis.

 

441. The patient came to the ENT hospital with complaints of difficulty breathing through the nose, weakness. Anterior rhinoscopy revealed pale gray, motile formations, purulent discharge from the common nasal passage. Diagnose:

 Polyposis rhinosinusitis.

 

442. A 25-year-old patient complained to the ENT doctor of a headache, weakness, nasal congestion and purulent discharge. According to him, he fell ill immediately after catching a cold. On examination, the nasal mucosa is red, slightly swollen, there is pus in the nasal passages. The radiograph shows fluid levels along with peripheral hyperplasia of the maxillary sinuses. Make a diagnosis.

Exacerbation of bilateral chronic sinusitis

 

443. The patient complained to the ENT department: difficulty swallowing, splashing with liquid food. According to the patient, on the 3rd day he did not eat, his body temperature was 39.5 ° С, his skin was moist, his voice was hoarse, his mouth was open. On examination: widespread hyperemia, slightly swollen tonsils, loose. Indirect laryngoscopy: pear-shaped sinuses are full of mucus, the area of the lingual-laryngeal valve is narrowed, the laryngeal valve is thickened, infiltrated, limited mobility, the larynx is difficult to see, empty. The voice layer is activated. Diagnose:

Laryngeal abscess.

 

444. A patient came to the otolaryngologist complaining of severe itching of the ears and occasional pain. He had a history of multiple exacerbations of otitis externa. On otoscopy, the AD-AS- external auditory canal is filled with dry epidermal plates, fused together in some places. After removing them, Mt- turned gray, as if slightly covered with wool on the outside. Diagnosis:

 

External otitis media

 

445. During the professional examination of the patient, dense plugs were found on the surface of the tonsils. Examination of the root of the tongue revealed similar formations in the area of projection of the tonsils of the tongue. The plugs are conical, bulge over the mucous membrane and are difficult to remove. Diagnose:

Pharyngomycosis.

 

446. A patient with chronic purulent otitis complains of a headache on the left side, which increases when the head is turned to the right. Body temperature 38 ° C, bradycardia. The patient cannot name familiar objects. What is the diagnosis?

 abscess of the frontal lobe of the brain

 

447. A sick woman complains of pain in the ears, creamy-purulent discharge. Does not notice hearing loss. Condition is satisfactory, fever is subfebrile. The disease appeared 1 week ago, the behavior is associated with the removal of the hairpin and the injury. He was treated at home on his own, to no avail. On otoscopy: AD-AS-narrowed auditory canal, full of creamy-purulent secretions, after cleaning, only with a thin groove Mt- gray on the right, muddy, on the left - faint purple. Diagnose:

Bilateral external diffuse otitis.

 

448. A 20-year-old patient complained to the emergency department of pain and weakness in the throat, which increased when swallowing and speaking. Body temperature 38 ° C, there is swelling in the lower jaw and chin. Palpation of the mandible reveals an infiltrate that spreads to the anterior and left lateral surfaces of the neck, the skin is hyperemic. It is difficult to open the mouth, there is a bad smell, the tongue is raised. Examination reveals a tight hyperemia, thickening of the soft tissues at the bottom of the oral cavity. Acute pain after extraction of carious teeth. Diagnose:

Phlegmon of the bottom of the mouth

 

449. A 16-year-old patient complained of nasal congestion, nasal congestion and right-sided hearing loss. 2 years ago for the first time he noticed signs of nasal congestion and difficulty breathing through the nose. Objective: on the right in the posterior part of the nasal cavity there is a bright red formation. Nasal breathing is not detected on the right. In the nasopharynx, the nostrils are completely covered with a smooth, dense structure. The radiograph reveals a darkening of the soft tissue that completely covers the nasopharyngeal cavity, wedge-shaped cavity and spreads to the nasal cavity. The bone surfaces surrounding the formation have clear edges. What is your diagnosis?

Cancer of the nasopharynx

 

450. A 23-year-old patient called a doctor at home and complained of fever up to 38oC for 4 days, yellow-green sputum cough, weakness, sweating. The disease is associated with a cold. Objective: pale skin, respiratory rate 20 minutes, on the right there is a dark focus of percussion sound below the corner of the scapula, auscultatory small bubbles of wet rales. What treatment is effective for this patient?

Azithromycin 0.5 x1 r / d orally for 5 days.

 

451. A 59-year-old woman with type II diabetes often complains of heart attack, headache, dizziness, pain in the right leg. On examination: tachycardia, BP 85/50 mm, thrombophlebitis - glycemia 55 mmol / l. No ketoacidosis. Leukocytosis. Hyperazotemia. How to explain the absence of ketone bodies in a patient with precoma?

endogenous secretion of insulin

preservation of endogenous insulin secretion

 

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

Arterial hypertension II st, risk 3

 

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

light flow of persistent bronchial asthma

 

454. A 22-year-old patient was admitted to the emergency department with drowsiness, severe weakness, weight loss, thirst and increased urination. The above symptoms have been bothersome for the last 2-3 weeks. Objective: confusion, dry skin, decreased turgor of the skin, muscle hypotension. Frequent breathing (up to 20 per minute), noisy, blood pressure 90/60 mm Hg, HR = 98 per minute. The mouth smells of acetone. Specify the probable diagnosis

 Diabetes first diagnosed. ketoacidotic precoma

 

455. Patient P., 40 years old, has been suffering from hypothyroidism for 10 years. She has been taking thyroid medication at a daily dose of 125 mcg for a long time. The patient has dry skin, constipation, impaired memory in the dynamics, drowsiness. In the analysis: increased levels of thyrotropic hormone. What to change in the doctor's way

Increasing the dose of thyroid drugs

 

456. A 42-year-old woman complained of weakness, headache, pain in the right lower back, fever up to 38.5 ° C, chills. She began to feel sick after a cold. Temperature 38 ° С, pulse 88 \ min, BP 140/80, 145/85 mm Hg. garden The abdomen is soft, there is pain in the urinary tract. Painful urination. Urine analysis: turbid, density 1017, protein 0.066 g / l, a large number of leukocytes and bacteria in the visual field, oxalates. What is the most likely treatment?

Ceftriaxone

 

457. A 40-year-old patient complains of stabbing pain in the right hypochondrium, fever up to 37, weakness, and fatigue after dietary errors. The seizures lasted for 3 years. The general condition is moderate. Pale skin, increased nutrition. The tongue is covered with a yellow coating. Respiratory and circulatory system without pathology. AK 110/70 mm sb. On palpation of the abdomen, the right subcostal muscle was tense, Kera, Ortner's symptom was positive. On the edge of the liver. Stools are prone to constipation. Urination is free and painless. Your prognosis

Chronic cholecystitis, complication

 

458. The patient is 68 years old, 2 years ago he had a myocardial infarction. For the last 6 months, pain in the back of the chest, heart palpitations during moderate exercise, asthma, swelling of the legs in the evening. BP at the level of 140/90 mm Hg, HR 84 times per minute. On the ECG - transmural infarction in the anterior wall at the stage of scarring, ventricular extrasystole. The patient takes aspirin (100 mg), corinfar retard (20 mg), perindopril (5 mg), furosemide periodically. Make adjustments to the treatment:

removal of corinfar, prescribing beta-blockers, increasing the dose of perindopril to 10 mg, prescribing mineralocorticoid receptor antagonists (spironolactone 50 mg). If necessary, prescribe long-lasting (prolonged) nitrates

 

459. In a 32-year-old woman with chronic rheumatic heart disease: orthopnea, acrocyanosis; silent wet rales in the lower and lateral parts; gross pansystolic murmur in the axillary region; tachyarrhythmia, enlarged liver, edema of the legs. Which group of drugs should be prescribed first?

Diuretics

 

460. A 64-year-old patient called a general practitioner with complaints of dizziness, weakness, tremors in the hands, blinking eyes. He suffers from type II diabetes and is taking glibenclamide (maninnil). At the patient's home, you quickly determine your blood sugar level of 3.1 mmol / l and find out that two days before the onset of the complaint, he started taking aspirin to relieve pain in his knee joint. In this case, in addition to the measures of the ambulance service, your recommendations should include:

Reduction of glibenclamide (in the treatment of arthritis)

 

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

Daily ECG monitoring

 

462. A 50-year-old overweight woman was found to have twice an increase in fasting glucose levels to 6.9 and 7.2 mmol / l. Which of the following diagnoses is MOST likely?

 Type 2 diabetes

 

463. Patient D., 28 years old, complains of palpitations, shortness of breath when walking fast. Registered with a rheumatologist. Objective: increased, leftward oscillation; mitral configuration of the heart; weakening of the upper tone I; vocal systolic murmur at the tip of the armpit. Your prognosis

 Chronic rheumatic heart disease, mitral valve insufficiency. СЖЖI

 

464. After the operation of subtotal resection of the thyroid gland, the patient developed convulsions in the legs, tails symptom, Trusso's symptom. What complications did the patient develop?

Hypoparathyroidism

 

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

Chest radiography

 

466. A 69-year-old woman complains of headaches, especially in the neck area, tinnitus, prickly pain in the heart area, swelling of the ankles. . Heart tones are closed, 2 tone accent in the aorta. АК 180 \ 115 мм.сын.бағ. Pulse 88 \ min. Any of the following conditions may occur in a given patient

 Myocardial infarction, stroke, heart failure

 

467. Patient A., 20 years old, complained to the doctor of significant weight loss, dry mouth, thirst, frequent urination, nausea, loss of appetite. Objective: dry skin, orange palms and soles, boils. Urine analysis revealed the presence of sugar - 3.5% and acetonuria (++). What is the probable diagnosis

 Diabetes mellitus type I, decompensation, ketoacidosis

 

468. A 49-year-old man complains of abdominal pain and vomiting up to 6 times a day after dietary errors. From the anamnesis it was found that abdominal pain is intermittent, the intensity of which gradually increases. Not on a diet. Not considered. On examination, the tongue is covered with a white coating. From the heart, from the lungs - no pathology. AK 130/80 mm sb. Abdominal pain on palpation, pain in the epigastric region, Mayo-Robson point. Along the liver wall arch. The stools are like porridge, 4 times a day. Your preliminary diagnosis

Chronic pancreatitis in the complication stage

 

469. Patient M., 44 years old, complains of pain in the right hypochondrium, bitter taste in the mouth, itching, nausea, fever up to 37.5 C, constipation. These complaints have been a source of concern for the past 5 years. On examination: the patient's nutrition is high. Objective: normal skin color, scratches on the inside and back. From the heart, from the lungs - no pathology. AK - 130/80 mm sb. Art. Moist tongue, covered with yellow flowers at the roots. On palpation, the abdomen is soft, there is pain in the right hypochondrium, Murphy's symptom is positive. On the edge of the liver. There was no stool for 2 days. Make a preliminary diagnosis

 Chronic cholecystitis in the complication stage. Dyskinesia of the biliary tract of the hypertensive type

 

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

 bronchial asthma

 

471. Patient K with insulin-dependent diabetes mellitus is unconscious, dilated pupils. Increased eye tone. The body temperature is normal. The skin is moist. Acetone is odorless. There is vesicular breathing in the lungs, no wheezing. Heart rate per minute 20. Heart sounds are blocked, irregular rhythm 90 times per minute. АК - 90/60 мм сн.бғ. (+) Babinsky's symptoms. An emergency examination (glucotest) was performed. Indicate the cause of the symptomatic complex.

 Hypoglycemic coma

 

472. A 48-year-old patient was admitted to hospital for the first time with complaints of weakness, thirst and itchy skin. Deterioration is observed within 1.5 months. After ARVI, thirst increased sharply, appetite was disturbed, and abdominal pain appeared. Objective: pale skin, dry skin and eyeballs. Hyperemia in the facial arch, chin, forehead. Subfebrile fever. АК - 90/50 мм сн.бғ. Decreased diuresis. TAJ - 28 times per minute. Kussmaul's breath, the smell of acetone. What are the causes of existing symptoms and the results of a rapid examination of the patient (glucotest)?

Ketoacidot coma

 

473. A 39-year-old patient came to the clinic in the morning with complaints of retardation, pain in the joints of the arms and legs, swelling, limited mobility, especially in the interphalangeal, wrist and knee joints. Objective: inter-articular, wrist joints are swollen, thickened, deformed. Interstitial muscle atrophy. There are no differences in the internal organs. In the blood - leukocytes 14 ∙ 10 9 ∕ l, neutrophilia, soe - 42 mm / h; fibrinogen-7g / l. СРБ +++ р-я. Voleva Roza 1: 64 ∙ R-gr 1 saline joints - intervertebral osteoporosis. Further approach of the doctor

referral to the rheumatology department

 

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

Acute pyelonephritis

 

475. The patient is 28 years old, severe pain in the lumbar region and the right side of the abdomen radiates to the groin and right thigh. There is a feeling of frequent urination. 1 year ago there was a similar seizure. An ambulance was called, an injection was given, the pain disappeared, but after this seizure the urine turned red. Objective: temperature 36.40C. The general condition is moderate. There is no pathology of the respiratory and cardiovascular systems. Pulse 76 \ min, rhythmic. Blood pressure 120/60 mm Hg.

Urinary stone disease, renal colic

 

476. A 34-year-old patient complains of a slight sputum cough, which occurs when lying down after a meal, which decreases with changes in body position. What diagnostic tests are required for differential diagnosis?

 fibroesophageal gastroduodenoscopy

 

477. A 32-year-old woman complained to a general practitioner of palpitations, weakness, irritability, sweating and weight loss. Ill for more than a year. Objective. Anxious. His eyes are shining. In the Romberg position, the tremors of the fingers are not constant. Hyperhidrosis. Vesicular respiration in the lungs. Heart: tachycardia, pulse 110 beats per minute, 1 min, BP 150/30, 160/40 mm Hg Feces - prone to diarrhea. What is your prognosis?

hyperthyroidism

 

478. A 49-year-old man complains of headache and tinnitus. There is an increase in blood pressure in several volumes, aortocardiosclerosis. Objective: an increase in the boundaries of the heart to the left, the heart sounds closed. GHG 95 \ min.AQ 180 \ 90 mm.class. Which of the following groups of drugs is most likely?

 ACE inhibitors, thiazide diuretics, betablockers, statins

 

479. Choose a method of treatment for a patient with rheumatoid arthritis, if there is no fever, visceritis and vasculitis, exudate in the knee joints, ESR 35 mm / h, the duration of the disease is 6 months, if not previously treated

 Introduction of kenalog into the joint is a combination of NSAIDs

 

480. A 27-year-old pregnant woman under the care of a general practitioner, 16-17 weeks. Complaints: headache, especially in the occipital region, dizziness, slight nausea. The complaints first appeared three days ago. No chronic diseases. On physical examination, he is conscious, his feet are swollen, his heartbeat is blocked, he is rhythmic. Blood pressure 160/100 mm Hg, pulse rate 90 beats per minute. In the analysis of whole blood, biochemical analysis (AST, ALT, bilirubin, creatinine, platelet levels) are normal. In the urine - proteinuria less than 0.1 g / l, the condition of the fetus in the uterus is satisfactory. What is your prognosis?

Gestational hypertension.

 

481. A 35-year-old patient complains of burning pain at the base of a sword-like growth that spreads to the heart area, appearing and intensifying half an hour after a meal. Pain is not completely relieved with almagel. Heartburn, suffocation and coughing are also observed. In FGDS: the mucous membrane of the esophagus is moderately hyperemic, covered with areas of fibrin. Smooth, shiny. The gap in the heart is moderately enlarged. The cardia closes slowly, not completely, and enters the esophagus freely. All of the above are typical of any disease

GERA

 

482. A 27-year-old man suddenly felt pain in the epigastric region and under the right rib "like a dagger". After a few hours the pain subsided. Objective: dry tongue, constricted, tense abdominal muscles. AK 90/60 mm sb. Art., Root War 120 beats / min. Prognosis:

Gastric ulcer, ulcer perforation 12 p.m.

 

483. A 27-year-old patient 3 days ago had a sudden chills, dry cough, pain in the right side, fever rose to 38.7o C. TAJ 22 / min. YYYY 88 / min. When breathing, the right half of the chest is left behind. Percussion: from the anterior 3rd intercostal space to the middle of the posterior intercostal space - a closed sound, breathing is weakened in this area. Estimated time to prescribe antibiotics in this case?

 constant normal body temperature for 4-5 days

 

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

Secondary amyloidosis

 

485. A 32-year-old patient with bronchial asthma is regularly examined by a GP and a pulmonologist.

According to the dynamic control plan, it is recommended to conduct once every 6 months:

Spirography

 

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

 active and less smoking

 

487. A 39-year-old patient came to the clinic in the morning with complaints of retardation, pain in the joints of the arms and legs, swelling, limited mobility, especially in the interphalangeal, wrist and knee joints. Objective: inter-articular, wrist joints are swollen, thickened, deformed. Interstitial muscle atrophy. There are no differences in the internal organs. What is your prognosis?

 Rheumatoid arthritis

 

488. Patient I., 53 years old, has uncomplicated pneumonia of the lower right side. Sent to work. In this case, what are the dynamic control periods for recovery from acute pneumonia?

6 months

 

489. A 48-year-old patient complains of low-sputum cough, shortness of breath, weakness, fever up to 38.50C. Amoxicillin was taken 3 times a day for 3 days. Which of the following is a sign of the effectiveness of antibacterial therapy?

 Decreased body temperature and reduction of poisoning

 

490. The version of the RES flow due to the lack of protein-calorie nutrition in young children in tropical countries

 kvashiorkor

 

491. What health group does a 2-year-old child belong to: physical development - low weight; hemoglobin level - 95 g / l; history of atopic dermatitis.

third

 

492. A mother sits in the reception with her 3-month-old son, weighing 6000 g and 63 cm tall. When assessing the physical development of the child, the GP paid attention to the following parameters; body length +1 according to age, body weight according to length + 3, body weight according to age + 3, DSI +3 depending on age. How to analyze the physical development of a child identified by GP?

disharmonious development, excess

weight

 

493. The child is 6 months old and came for a preventive examination. During the examination, the GP noticed pale skin. The liver and spleen are not enlarged. The analysis of whole blood showed HB 100 g / l, erythrocytes 3.3 x 1012, CP 0.8, anisocytosis. What kind of anemia can occur in this case?

 iron deficiency

 

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

 Atopic dermatitis

 

495. A 2.5-month-old boy. Against the background of the second half of gestosis from the second pregnancy. Birth weight 3600 g, height 53 cm. Frequent vomiting from 3.5 weeks. Objective: the skin is pale, dry, "marble" color. Thin layer of fat under the skin, decreased tissue turgor, muscle hypotension. There is no pathology of the internal organs. At the time of examination, the child weighed 4300 g. What is your diagnosis?

 II degree RES

 

496. A 3.5-month-old girl has mild sweating, muscular hypotension, hair loss on the back of the head, mild oral cyanosis. What changes may occur in this patient on the radiograph

 No changes

 

497. The girl is 6 years old. Height 124 cm (8th centile interval), weight 24.6 kg (7th centile). Chest circumference 55 cm. determine the compatibility of physical development.

very high, harmonious development

 

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

 give the first dose of antibiotic, send to the hospital immediately

 

499. A 7-month-old girl was discharged from the hospital with a clinical diagnosis of rickets grade II, fever, acute current, iron deficiency anemia grade I. How to continue to treat children with grade II rickets?

For 3 years

 

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

 200-400ml

 

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

 Atopic dermatitis

 

502. The child is 7 months old, born with asphyxia. On examination - on the forehead, bridge of the nose, the vascular image is moderately amplified, the work is closed, BMN (CHMN) - without pathology. The child is restless, sleep deprived, vomiting "cheese milk" 2 hours after feeding. Which of the following foods is best?

 Milk formula with thickener

 

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

annually

 

504. Complaints about a 5-month-old child with a rise in body temperature to 38.80 C. During the examination, the GP noted that the child could not drink or breastfeed, and had stiff neck muscles. The GP classifies the child's condition according to the ICSID

 very severe febrile illness

 

505. The child is 1 year old. In natural nutrition, snacks and complementary foods were introduced at the appropriate time. Determine the amount of food

200 ml

 

506. The baby is 6 months old. Weight 8000 g. Preliminary examination of the GP revealed moderate pale palms. In the analysis of whole blood HB 100 g / l, erythrocytes 3.3 x 1012, CP 0.8. 1.25 ml of iron syrup (syrup) was prescribed in accordance with IVBDV (BSHAI). What recommendations should be given for the use of the drug

 One dose of iron per day for 14 days

 

507. A mother came to the reception with her 4-year-old son. She complains about her child's poor appetite. From the anamnesis: the mother often eats porridge, sometimes does not like cereals, meat and vegetables. Weight 14000 g. The skin is pale on examination, moderate humidity when held, the mucous membranes are pale pink. Heart sounds are rhythmic, heart rate is 102 beats per minute, systolic murmur in the upper part of the heart. In the analysis of whole blood: Hb 76 g / l, er.- 3, 9x1012 / l, CP 0.6, ESR 6 mm / h. MCV 77 JT, MSN 264 pg, MSNS 320 g / l), RDW 14%. Your preliminary clinical diagnosis.

moderate iron deficiency anemia

 

508. During the examination, a 12-year-old boy developed severe itching on all skin. On examination: pits of the elbow and knee, foci of hyperemia with infiltration in the area of the forearm joints, lichenization, multiple linear and point extractions. Facial hyperemia, cheilitis, angular stomatitis. The anamnesis shows that such rashes appear every year in the autumn-winter period, and in childhood there is diathesis. You do not make a differential diagnosis of any disease

 seborrheic dermatitis

 

509. A mother came to the reception with her 4-year-old son. She complains about her child's poor appetite. From the anamnesis: the mother often eats porridge, sometimes does not like cereals, meat and vegetables. Weight 14000 g. The skin is pale on examination, moderate humidity when held, the mucous membranes are pale pink. Heart sounds are rhythmic, heart rate is 102 beats per minute, systolic murmur in the upper part of the heart. In the analysis of whole blood: Hb 76 g / l, er.- 3, 9x1012 / l, CP 0.6, ESR 6 mm / h. MCV 77 JT, MSN 264 pg, MSNS 320 g / l), RDW 14%. What is the therapeutic dose of the drug recommended by trivalent iron hydroxide-polymaltose complex

5 mg / kg per day per os

 

510. The development of a 6-month-old child corresponds to age. At the age of 6 months after the introduction of the first supplement - 80-100.0 g, weight loss, stools - 2-3 times a day, periodically up to 5 times, often, there is an odor. Which of the following is appropriate?

Agglutine diet

 

511. A 9-month-old baby at the reception. According to the mother, the child has been receiving anticonvulsant therapy for a long time. Later he sweats a lot, becomes restless and sleeps poorly. After the examination, the doctor diagnosed rickets II, acute, feverish. What drug contributed to the development of rickets?

Phenobarbital

 

512. The child is 1 year old. In natural nutrition, snacks and complementary foods were introduced at the appropriate time. Determine the amount of food

 200 ml.

 

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

Grade III rickets (rickets), exacerbation, acute course

 

514. A 12-month-old child is admitted. No complaints. Physical development is harmonious. Neuropsychological development corresponds to age. He has a history of ARVI 3 times. Determine this child's resistance.

 average

 

515. A 2-month-old child has hyperexcitability, hyperesthesia, tremors, sharp irritated screams, tachycardia, high tendon reflexes, tonic convulsions. Blood glucose level - 5.5 mmol / l, calcium - 0.9 mmol / l, magnesium - 0.92 mmol / l. Which of the above is the most likely explanation for a child's convulsions?

Hypocalcemia

 

516. A mother with a 2-month-old child came to the pediatrician with a complaint of a rash on the face, gneiss on the head, rash on the skin folds, anxiety. From the anamnesis: the child does not breastfeed. According to the mother, after eating sweets and oranges, the child developed a rash on the skin. It is known from the anamnesis that the maternal grandmother and brother suffer from bronchial asthma and are under the dynamic supervision of an allergist. Objective examination: general condition is satisfactory. The skin and mucous membranes are pale, there are erythematous-papular rash on the face, facial redness, rash on the abdomen and armpits, gneiss in the beginning. Vesicular respiration in the lungs. The heartbeat is rhythmic. The language is wet, "geographical language". The yawning is quiet. The abdomen is soft. Liver +1.0 cm, + 1.0 + 0.5 cm. The spleen is not enlarged. According to his mother, the stool is diluted 4-5 times a day. Sits freely on the toilet.

 Atopic dermatitis, neonatal type, acute stage, light flow, limited, predominant food sensitization.

 

517. The child was 1 month old, on a natural diet, added 800 g per month, calm, stools yellow from birth 3-4 times a day, examination of feces for dysbiosis revealed Staphylococcus aureus, 103 COE / g of stool. Epidermal staphylococcus with 245 colonies in 1 ml of breast milk was detected during breastfeeding. Your suggestions:

 continuing breastfeeding, prescribing probiotics to mother and child

 

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

Health group II

 

519. A 12-year-old girl complains of fatigue, drowsiness, tinnitus and dizziness at the general practitioner's office. Objective: pale skin, visible mucous membranes, cleft palate. Auscultatory: attenuation of heart sounds, systolic murmur in the upper part, UR 105. Choose a test option to clarify the clinical diagnosis?

study of iron metabolism

 

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

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

 

521. 2018 t. The child's mother complained to the clinic at the place of residence about her daughter's fever, chills, sore throat, and the presence of purulent discharge from the tonsils. Diagnosed with purulent tonsillitis. His mother works as a bookbinder in a printing house. Does the mother have the right to receive a childcare certificate and for how long?

A sick leave certificate is issued for the care of a sick child and is extended for a period that requires care, but not more than ten calendar days .

 

522. A 24-year-old woman working as a nurse is 27 weeks pregnant. The course of pregnancy is uncomplicated. In this case, how to conduct a temporary disability examination?

 During the normal course of pregnancy, the list of temporary disability for pregnancy and childbirth is issued for one hundred and twenty-six calendar days (seventy calendar days before delivery and fifty-six calendar days after delivery) from the thirtieth week of pregnancy after the conclusion of the VCC.

 

523. Patient A, 44 years old, driver of a heavy truck in December 2020 with a blood pressure of 180/100 mm Hg Due to the increase in GDP, History: suffers from arterial hypertension for many years, is registered by a cardiologist for hypertension and endocrinologist for type 2 diabetes "D". Objective: left hemiplegia, constantly in need of help from another person: he can not move on his own, does not eat, goes to the toilet, conducts hygiene measures, wears clothes, wears shoes. The patient has signs of disability. What are the restrictions on survival and what is the severity of this condition and to which group of disability does it correspond?

 In this case, the patient has a disorder of the 3rd degree: self-service, employment, which corresponds to the first group of disabilities

 

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

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

 

525. M, a 25-year-old patient working as a nurse in a regional tuberculosis dispensary, was diagnosed with tuberculosis for the first time, with recurrence and extensive drug resistance. In this case, what is the duration of the patient's temporary disability?

In accordance with paragraph 78 of the Minister of Health of the Republic of Kazakhstan dated 18.11.2020. 3 of the Rules of temporary incapacity for work approved by the order №198 The duration of temporary incapacity for work in this case is 15 months

 

526. A 34-year-old unemployed patient received a domestic injury in March 2021: fracture of the upper third of the right shoulder, complicated by osteomyelitis of the humerus, resulting in amputation of the right arm. What group of disabilities does the patient have symptoms of and for how long?

 third group of disability Minister of Health and Social Development 31.03.2015 №44 without an expiration date for re-examination due to anatomical defects in accordance with Annex 3 to paragraph 5 of the Rules of medical and social examination, approved by order 44.

 

527. Patient A, 44 years old, driver of a heavy truck, in December 2020, had a blood pressure of 180/100 mm Hg. bg due to the increase in the number of History: suffers from arterial hypertension for many years, is registered by a cardiologist for hypertension and endocrinologist for type 2 diabetes "D". Objective: left hemiplegia, always needs someone's help: he can not move on his own, does not eat, goes to the toilet, takes care of hygiene, wears clothes, wears shoes. The patient has signs of disability. When to send a patient to the ITU

In accordance with paragraphs 5, 41 and Annex 3 to the Rules of medical and social examination, approved by the Order of the Minister of Health and Social Development dated 31.03.2015 №44, not earlier than four months from the date of diagnosis of persons temporarily disabled or unemployed.

 

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

 Group 1A - healthy people without risk factors, Group 1B - healthy people with risk factors: people with borderline conditions, requiring control and preventive intervention, group 2 - practically healthy: history of complications for the last 2 years without complications and people with chronic diseases, group 3 patients: dynamic control, people in need of treatment and rehabilitation.

 

529. A 5-year-old girl was admitted to a local clinic due to an exacerbation of a chronic illness in which she was diagnosed with a disability 3 years ago. According to the results of the examination, the child was sent to the hospital through the portal. His mother works as a teacher at the school. In this case, for how long should the mother be issued a certificate of temporary incapacity for child care?

Temporary disability certificate for child care is issued to the mother for the entire period of hospitalization according to the results of the DCC, because the child has a category of disabled child

 

530. An 18-year-old patient complains of itching of the external genitalia, burning sensation when urinating. He became ill a week ago, before that he had a purulent discharge and was taking ampicillin. Condition is satisfactory, temperature N, somatically healthy. There is redness, swelling, white discharge at the entrance to the vagina, which can be easily removed with a cotton swab. What is the probable diagnosis

 Candidiasis colpitis

 

531. A 29-year-old pregnant woman complained of pain in the lower abdomen and lower back. Gestation period is 15-16 weeks. History of 1 delivery and 3 meds. abortion. During the vaginal examination: the cervix is 2.5 cm long, the external cavity is open, the cervical canal is closed, the uterus is enlarged according to the gestational age, mucous secretions from the genital tract, moderate. What is the probable diagnosis

There is a risk of miscarriage

 

532. Bleeding in a woman in the postclimatic period. Diagnostic scraping was performed. At slaughter - atypical glandular structures with obvious cellular atypia. Your diagnosis

 adenocarcinoma of the uterine body

 

533. At 27 weeks of gestation, a woman came to the IAS with complaints of weakness and fatigue. Blood test showed fasting hyperglycemia 7.1 mmol / l, no signs of ketosis. Your diagnosis

Gestation 27 weeks. Diabetes mellitus I degree

 

534. The patient is 51 years old. Often complains of fever (headache), headache, hyperhidrosis, heart pain. History: hypertension. S / e (P / m) was 3.5 months ago, painless. Gynecological examination revealed no pathology. Your diagnosis is

Climacteric Syndrome

 

535. A 26-year-old patient complains of stiffness and swelling of the mammary glands and legs, bloating, irritability, sweating. Has been ill for 3 years. These symptoms appear in the second phase of the menstrual cycle and stop after the end of the next menstruation. Symptoms do not increase over the years. Gynecological examination revealed no pathology. In this case, what form of premenstrual syndrome can be?

 Swelling

 

536. When a woman went to the doctor on 12 January 2020, her pregnancy test was positive. It has a regular 28-day cycle, the last menstruation of which took place from 8 to 11 December 2019. Expected delivery time:

 September 15, 2020

 

537. What is the main task of obstetricians and gynecologists:

reduction of maternal and perinatal morbidity and mortality

 

538. A week ago, a pregnant woman discharged from an infectious diseases hospital went to an obstetrician-gynecologist with severe measles. Gestation period - 9-10 weeks. Medical approach

termination of pregnancy

 

539. A 12-week-old pregnant woman complained of nausea, vomiting, fever, weakness and fatigue. The symptoms of pneumonia are negative. For two days he noticed that the urine was darker in color. Prognosis

 viral hepatitis

 

540. A woman with a gestational age of 17-18 weeks came to the women's clinic. The patient has an intermittent diastolic pressure of 90 mm Hg. b. increases and higher. Examination revealed 0.06 g / l proteinuria, headache during overwork. The most likely diagnosis

 chronic hypertension

 

541. A 26-year-old patient complained to a gynecologist about pain in the area of the left labia. He notes that his body temperature rose to 37.80 C. Examination of the external genitalia revealed swelling and redness of the left labia. Palpation reveals a softening area of 5x4 cm in the thickness of the left labia, in the middle. What is the most accurate diagnosis

 barolin gland abscess

 

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

 emergency treatment

 

543. A woman complained to the district doctor of the women's counseling department about delayed menstruation (the last one was 8 weeks ago), nausea and sometimes vomiting in the morning, and intolerance to odors. Vaginal examination reveals a "softening" of the uterine isthmus. The uterus has a soft consistency, is dense on palpation, increased to the size of a "goose egg". It doesn't hurt. Spare parts are not enlarged, painless. Pregnancy should not be planned. The doctor's way

Clinical and laboratory examination and termination of pregnancy

 

544. A pregnant woman with severe measles, who was discharged from an infectious disease hospital a week ago, came to the obstetrician-gynecologist. Gestation period is 9-10 weeks. Medical approach

 Termination of pregnancy

 

545. A 45-year-old patient has a recurrence of bleeding for a year. Which of the following treatments should be prescribed to the patient?

 Separate diagnostic cleaning of the uterine cavity

 

546. A 17- to 18-week-old patient was registered at the women's clinic. The patient's diastolic pressure is periodically 90 mm Hg. and above. The examination revealed 0.06 g / l proteinuria, headache during overwork. Prognosis

 Chronic hypertension

 

547. Which of the following symptoms indicates the severity of toxicosis in the first half of pregnancy?

 presence of acetone in urine

 

548. A 46-year-old woman complained to the clinic about excessive menstruation, weakness and reduced ability to work. On examination: pale skin, pulse 78 beats / min, rhythmic. AK 125/80 mm Hg during bimanual examination and with the help of mirrors: the cervix is unchanged, the uterus is enlarged to the size corresponding to 16-17 weeks of pregnancy, mobile, painless. Applications are not detected. What is the outcome of the surgery?

Amputation of the uterus without appendages

 

549. A 24-year-old woman was taken to the gynecologist. The pregnant woman came, the gestation period is 30 weeks, complains of leakage of fluid in the pelvis for 15 minutes. Pregnancy from the anamnesis - 3, in which 1 pregnancy ended in premature birth, the child is alive, the next pregnancy was terminated at 18 weeks. According to the zoning order, the woman should be referred to what level of inpatient care

 Level III

 

550. A 51-year-old woman feels pain and right subcostal support for a long time. No jaundice on examination Kera, Ortner positive symptom, subfebrile temperature, hemogram ESR-30 mm / h. What is the most likely diagnosis?

 chronic cholecystitis in the exacerbation phase

 

551. A 22-year-old patient underwent fibrogastroduodenoscopy with the following changes: slight erythema and loosening of the mucous membrane of the abdominal esophagus, vibration of the esophageal mucosa 1.5-2.0 cm during short-term excitation, a marked decrease in the tone of the lower esophageal sphincter. Which of the following endoscopic signs corresponds to:

 light from the esophageal compartment of the diaphragm

 

552. A 35-year-old patient called a doctor with complaints of acute pain in the epigastric region, vomiting of blood, weakness, dizziness. Two months before the anamnesis, he was treated for a stomach ulcer. Objective: pale skin. On palpation there is a sharp pain in the epigastric region. The stool was black. What complications can be suspected?

 bleeding

 

553. Patient K., 28 years old. Complains of severe pain in the lumbar region and the right half of the abdomen, groin and right pelvis. Frequent urination A year ago there was such a seizure, an "ambulance" was called, the pain was stopped by analgesics, but after the seizure appeared red urine. Objective: temperature 36.4 ° C. The patient is calm, looking for a comfortable position to relieve pain. There is no pathology of the respiratory and cardiovascular systems. Pulse 76 per minute. BP 120/60 mm Hg. The abdomen is soft, the right half is painful on palpation. Pasternak's symptom is sharply to the right. What is the most likely diagnosis?

 urinary tract disease

 

554. A 25-year-old patient was admitted to a general practitioner. Complains of nausea, taste in the mouth, pain in the epigastric region of the spine. Because the pain is at night, the patient wakes up at night and drinks a glass of cold milk. Pain on palpation in the right epigastric region, Mendel's symptom is positive. What is your prognosis?

 Ulcer of the duodenum

 

555. A 70-year-old patient complained of pain in the right hypochondrium, spread from the epigastric region to the back, left shoulder, nausea and vomiting. During the examination, the surgeon suspected an acute myocardial infarction. What diagnostic method allows to distinguish biliary colic from acute myocardial infarction?

 troponin test

 

556. To ensure free permeability of the patient's airways:

 put a roller under the shoulder, tilt the head back, move the lower side forward

 

557. A 46-year-old patient presented to a family doctor with complaints of upper abdominal pain, diarrhea and weight loss. From the anamnesis: used alcohol for 10 years. Objective: underweight, dry skin, small red spots on the skin of the chest and abdomen that do not disappear when pressed. There is pain on palpation. The stools are oily and shiny, 3 times a day. What is your preliminary diagnosis?

 chronic pancreatitis

 

558. At the general practitioner's office, a 68-year-old man complains of pathological discharge from the intestine in the form of blood and mucus, a feeling of a foreign body in the rectum, constipation, constipation, pain in the anus. Examination of the rectum with a finger palpates the rigidity of the intestinal wall with the presence of dense exophytic nodules, raised edges like a shaft, the presence of ulcers with an uneven surface and narrowing of the intestinal orifice. What is your diagnosis?

 Immunochemical examination of fecal occult blood.

 

559. Patient P., 27 years old, complained to the general practitioner of severe pain in the right forearm, redness, swelling, general weakness in this area, fever up to 38 degrees. Four days ago, he scratched the back of his right forearm. Examination of the back of the right forearm reveals a dense inflammatory infiltrate with hyperemia and hyperthermia. Palpation of the infiltrate is associated with severe pain. Fluctuation symptom is positive. What is your prognosis?

Phlegmon of the right forearm

 

560. A 20-year-old patient complains of pain in the lower abdomen, mostly on the right side. The pain appeared at night and intensified in the morning. He noted nausea and once had a bowel movement. The day before menstruation ended. Married. Voskresensky, Razdolsky, Bartomie-Michelson signs are positive. Your diagnosis

acute appendicitis

 

561. What type of instrumental examination is the most informative for the diagnosis of hemorrhoids?

rectoromanoscopy

 

562. What research method is the most informative for the diagnosis of non-specific ulcerative colitis?

colonoscopy

 

563. Ultrasound examination of an 80-year-old patient revealed a right liver cyst with a fluid level of 8x8 cm. Eonozophilia in the blood. The Cazoni test is positive. What operation was performed on the patient

Ultrasound-guided cyst puncture

 

564. The woman is 36 years old. He complained of pain in the left hypochondrium and back, nausea, vomiting, constipation, weakness, dry mouth, chills. The disease is associated with physical activity. Objective: Sighing. The skin is pale. Abdominal pain and left under the left rib. The shock symptom is positive. Pain on palpation of the kidneys. Blood test: 3.4x1012 / l erythrocytes, hemoglobin 100 g / l, leukocytes 9.5x109 / l, erythrocyte sedimentation rate 18 mm / h. In the general analysis of urine there are 10-15 erythrocytes in the visual field. Which of the above preliminary diagnoses is possible?

 urinary tract disease

 

565. Patient S. 53 3 hours after the onset of the disease, acute epigastric pain, short-term loss of consciousness, cold sweats, vomiting were reported. From the anamnesis: stomach ulcer for 10 years. On examination, pale skin, heart rate 100 beats per minute, blood pressure 100/70 mm Hg. The radiograph showed an empty gas under the right dome of the diaphragm. Your preliminary diagnosis

perforated ulcer

 

566. What are the following symptoms: "dagger" pain in the abdomen, vomiting, high fever, "board-like" abdomen, absence of the hepatic duct?

 gastric ulcer

 

567. The man is 25 years old. Complained of pain in the right pelvis. The general condition is average. Examination revealed an increase in the size of the affected limb, an increase in the inguinal lymph nodes. On palpation, there is severe pain, immobile, hot touch without clear boundaries. Its upper layers of skin shine. There is pain during movement, the pain increases when the body position changes, so the patient tries to move as little as possible. What diagnosis is possible

 phlegmon

 

568. A 59-year-old patient is malnourished and has pain in the right subcostal space from the lumbar region to the groin for 20 hours. Nausea, recurrent vomiting, chills, temperature 38 degrees C. What diagnosis should be predicted by this clinical picture:

acute cholecystitis

 

569. A 15-year-old boy complained of severe weakness and nausea to a family doctor. Yesterday and this morning the child had black stools. On examination: the skin and visible mucous membranes are pale, cold sweat, heart rate 120 beats per minute, blood pressure 80/30 mm Hg. HR hemoglobin is 60 g / l. Your diagnosis:

 gastrointestinal bleeding

 

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

 hemorrhagic stroke in the left central cerebral artery

 

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

 The level of irritation is the level of the upper left anterior central spinal cord

 

572. The patient is 40 years old, with a diagnosis of "Structural (post-traumatic) focal epilepsy" in the D-report of a neurologist. The patient periodically develops clonic seizures, starting from the soles of the feet, under the influence of antiepileptic drugs. Recently, spastic paresis has been observed in the distal parts of the left leg. Specify the localization of the process.

 upper part of the anterior middle fold of the right hemisphere;

573. Patient K., located in the pulmonology department. The cases worsened sharply: the general cerebral symptoms increased significantly and meningeal symptoms appeared. Significant neutrophilic pleocytosis, leukocytosis in the blood, increased ESR in the cerebrospinal fluid. Has been suffering from bronchiectasis for a long time. Preliminary diagnosis:

 Secondary purulent meningitis

 

574. A 16-year-old girl was admitted to the clinic with a complaint of unconsciousness. He knows about these episodes from acquaintances: he is silent during speech, does not speak the language for a few seconds. Eliminates falls, convulsions, lack of urine. Such seizures can be repeated ten times a day, lasting 10-20 seconds. Such seizures occurred in the patient's father. CT scan of the brain revealed no pathology. Prognosis:

idiopathic epilepsy (absences).

 

575. The patient is 58 years old. In the morning he complains of trembling of the toes and fingers, fatigue, speech disorders, frequent urination, initial movement disorders. Such complaints have been a concern for the last 3 years. It is known from the anamnesis that he is registered in a psychoneurological dispensary and has been taking neuroleptics for a long time. On examination: fine-grained vibration of the "coin count" type, fine-grained vibration at the end, decreases during movement, perioral vibration, silent, monotonous speech, increased muscle tone by extrapyramidal type. Prognosis:

 Parkinson's syndrome

 

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

Diabetic polyneuropathy

 

577. A 68-year-old patient complains of numbness and discomfort in the left limb. In the morning he became seriously ill, that is, he had the above complaints. АК 170 / 90мм.сын.бағ. History of coronary heart disease with persistent complications of atrial fibrillation, 3 years ago suffered a large transmural infarction. In general: central paralysis of the left facial and lingual nerve, left hemiparesis, decreased muscle strength to 3 points, left Babinsk symptom is positive. Left hemihypesthesia. In lumbar puncture: cerebrospinal fluid colorless, transparent, pressure 160 mmHg, cytosis - 3 lymphocytes, protein - 0.33 mg%. MRI reveals an area of increased and decreased intensity in the right temporal lobe 4 days after the onset of the disease. Prognosis:

 ischemic stroke in the right hemisphere of the brain

 

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

 Circulatory disorders in the middle cerebral artery

circulatory disorders in the anterior cerebral artery

 

579. Patient K., 20 years old, was taken to the emergency department after a traffic accident. Coma -7 points on the Glasgow scale. What level of consciousness does it correspond to?

coma

 

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

Diabetic polyneuropathy

 

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

Tuberculous meningitis

 

582. On examination of the patient there is a lack of movement in the legs, increased muscle tone, pathological Babinsky and Rosslimo symptoms in both legs are positive, abdominal reflexes are eliminated, protective reflex, bilateral foot and knee clonus are observed. There is sensitivity, involuntary urination, ulcers in the eye area and soles of the feet. Topical diagnosis:

Complete transverse lesion of the spinal cord at the level of Th4-Th5

 

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

 The damage is at the level of neck thickening

 

584. A 33-year-old housewife complains of a sharp pain in the left side of the face after taking acyclovir a week ago for the treatment of labial herpes. Pain in the trigger areas and hyperesthesia on one side of the face are associated with which nerve damage?

 triangular

 

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

The right cerebral hemisphere

 

586. Patient K., 25 years old, came to the emergency department of the emergency department with a headache and weakness in his right limb. From the anamnesis: 1 hour ago on the street unknown people hit him, he fainted after being hit in the head, the time of unconsciousness is unknown. Objectively: conscious, in contact, the tongue is tilted to the right, in the Barre test the right limb is drooping, tendon reflexes D> S, Babinski reflex on the right. No meningeal symptoms. Diagnostic principles:

 CT or MRI of the brain

 

After an anterior shoulder injury, the patient has muscle atrophy, elevation of the thumb with flattening of the palm ("monkey wrist"), hyperesthesia and hyperpathy of the palms of the fingers 1,2,3, and burning pain in those areas. Topical diagnosis:

 Of the middle nerve

 

587. The patient was 25 years old and, despite the absence of any health problems, came to the neurologist with complaints of sudden decrease in visual acuity to 0, general weakness, irritability, swaying while walking, "drunk walking". Based on these complaints, which structure of the central nervous system can be suspected of damage?

 optic nerve, cerebellum

 

588. The patient was 68 years old and came to the reception with complaints of swallowing and phonation disorders. Examination by a neurologist revealed dysarthria, paresis of the soft palate and the absence of a bronchial reflex. There are no paresis, tendon reflexes of limbs are not disturbed. What clinical syndrome is described?

bulbar

 

589. Male, 87 years old, morning blood pressure 220/120 mm.s.b. Sudden onset of headache, vomiting, weakness and paralysis of the right limb, speech disorders. Objective: delayed, severe condition, positive meningeal syndrome. Central paresis of the right facial muscles and tongue, right hemigipesthesia and hemiparesis with increased tone and reflexes. Principles of diagnosis:

CT of the brain

 

590. A 72-year-old man is in a coma. The temperature has risen. Prior to hospitalization, the patient had a generalized tonicoclonic seizure. A week before admission to the hospital there was drowsiness and cough, vomiting. No alcohol or drug poisoning. In the cerebrospinal fluid: protein - 4.5 g / l, sugar - 3.4 mmol / l, leukocytes150 in 1 μl, erythrocyte - 3 μl, cerebrospinal fluid pressure 200 mm Hg, milky appearance, fibrin film.

Tuberculous meningitis

 

591. A 32-year-old man complained of pain in the cervical spine, shoulder, along the old bone, which is transmitted to the thumb of the right hand. Examination revealed weakness and malnutrition of the skeletal muscle of the shoulder, torso, decreased right biceps reflex. There is hypostasis along the old shoulder bone. Topical diagnosis:

 C6 root on the right

 

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

 black matter, especially pale ball damage

 

593. Patient A. 50 years old, acutely ill. While driving, he told those around him that he felt a "hot shock" in the neck area. Immediately began a clear headache and nausea. When he tried to stop the car and tried to get out, he vomited several times and fainted. He was taken to the emergency department by ambulance. On examination: unconscious, in a state of shock. It is very difficult to make contact. Complains of nausea, headache, nausea. Horizontal nystagmus, inability to move the eyeball. 4 transverse finger stiffness of the neck muscles. Bilateral 90-degree Kernig's symptom, lower Brudzinsky's symptom, lumbar puncture: fluid comes out with high pressure, intense, evenly stained with blood. Prognosis:

 Subarachnoid hemorrhage

 

594. Patient U., 23 years old, complains of weakness of limbs, numbness, swaying while walking. 2 weeks ago, according to the patient, there was a flu-like condition. During the examination, the muscle tone of the limbs decreased, the strength of the limbs decreased to 1 point, all sensations decreased, such as "socks and gloves", there were no carporadial and Achilles reflexes, the skin color of the limbs changed. The cerebrospinal fluid is colorless, transparent, cytosis is 10 lymphocytes, protein -20 grams per liter. Prognosis:

polyneuropathy (Guillain-Barre syndrome)

 

595. A 49-year-old electrician was admitted to an ambulance. On arrival: unconsciousness, pain, irritability. Neurological status: neck muscle spasm, Kernig's symptom is positive. It's a weird thing to do. The right nasopharynx is flattened, the tongue is tilted to the right. Tonus and reflexes are high on the right. In the cerebrospinal fluid - lymphocytic pleocytosis. Your preliminary diagnosis:

meningoencephalitis

 

596. A 28-year-old woman became unstable, uncomfortable in her hands and uncomfortable typing on a computer during a few days of walking. Neurological status: nystagmus, intentional tremor when testing the fingers, nose and right knee, increased spasticity in the legs, bilateral Babin's symptom. When looking at the fundus: whitening of the frontal lobes of the optic nerve discs. Preliminary diagnosis:

Multiple sclerosis

 

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

tumor of the right frontal lobe

 

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

Ischemic stroke in the right middle carotid artery basin

 

599. A 32-year-old patient has a tumor of the pituitary gland, which causes compression of the visual system. What are the symptoms of compression of the visual chiasm?

 heteronymous hemianopsia

 

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

electroencephalography

 

601. The patient is 24 years old. In the fall he went to Russia to visit relatives (forest, taiga). A few days after arrival, there were headaches, nausea and vomiting. There was a rise in body temperature to 39 °, chills, pain in the neck. He thought he had ARVI and was treated on his own. But his condition worsened, and in the last 2-3 days there was weakness in the muscles of the arms and neck. Neurological status: passive paresis of the muscles of the neck and arms. Prognosis:

 tick-borne encephalitis

 

602. A 7-year-old boy was hospitalized with suspected meningitis with complaints of headache, fever and vomiting. According to the results of lumbar puncture, indicate the main symptoms of serous viral meningitis:

 lymphocytic cytosis of the cerebrospinal fluid

 

603. Patient N. 20 years old. Complains of severe headache, fear of light, fever up to 39-40 degrees Celsius, nausea and vomiting. Neurological status: psychomotor agitation, cervical muscle spasm, positive Kernig, Brudzinsky symptoms. Principles of diagnosis:

diagnostic lumbar puncture

 

604. A 62-year-old man suffers from chronic purulent otitis, with severe headache, dizziness, photophobia and phonophobia, positive meningeal symptoms. In the analysis of cerebrospinal fluid: cloudy, 800 ml of cytosis, predominance of neutrophils, protein 0.66 g / l. Initial diagnosis:

secondary otogenic purulent meningitis

 

605. A 54-year-old man called an ambulance. By the time the ambulance arrived (20 minutes later), the complaints were dismissed. On objective examination: the general condition is satisfactory, both eyes are normal. In neurological status: deep reflexes S> = D, no other neurological symptoms. Prognosis:

Transient ischemic attack

 

606. A man, 57 years old, complains of headache, vomiting, clotting and weakness in the right limbs, speech disorders, daytime blood pressure 220/120 mm. garden developed immediately, ie during the rise. Objective: pause, neck muscle tension is equal to 3 horizontal fingers. The right nasolabial fold is flattened, the tongue is tilted to the right. Increased tone and reflexes on the right. All types of sensitivity in the right limb are reduced. CT of the brain - the focus is highly compacted, the ventricles of the brain are dilated. Prognosis:

parenchymatous-subarachnoid hemorrhage

 

607. A 35-year-old patient was taken to hospital by ambulance. From the anamnesis on the background of high blood pressure there was a sudden appearance of vomiting, psychomotor agitation, impatient behavior. Objective: severe condition, hyperemia, positive meningeal symptoms, no paresis. Preliminary diagnosis:

 Subarachnoid hemorrhage

 

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

cancer of the right temporal region

 

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

lumbar puncture, brain MRI

 

610. An 18-year-old boy experienced an ankle sprain after experiencing acute respiratory viral infection (ARI). For two days he was weak in flexion of the foot, and at the end of the week it was difficult for him to walk. Urination and defecation are not disturbed. Within a week, weakness intensified and, if necessary, artificial ventilation of the lungs. Tetraplegia developed when the movement of the eyeball was preserved. Increased protein content in the cerebrospinal fluid (above 10 g / l) during normal cytosis, without erythrocytosis.

 Guillain-Barré syndromes;

 

611. 10-year-old S. A patient named. He got sick at about 10 o'clock in the morning. Initially, there was a headache, chills and vomiting during the day. In the evening, against the background of high body temperature, there was a sharp decline in mood, vomiting again. On examination: unconscious. Body temperature 39.5 °. The skin is moist, the surface is hyperemic. Hemorrhagic rash on the skin of the thigh. Spontaneous horizontal nystagmus, outward curvature. Trismus of the masticatory muscles. Tendon reflexes predominate on the right. Pathological Babinsky, Oppenheim reflexes on both sides. Muscle stiffness in the neck - 4 horizontal fingers, Kernig's symptom is 90 °, both sides are positive. Lumbar puncture: cerebrospinal fluid flows under high pressure, opaque, protein - 2.6 g / l, cytosis can not be determined (neutrophils 98%), sugar - 1.7 mmol / l, chlorine - 183.3 mmol / l. Diplococci were detected in the native drug. Clinical diagnosis:

 meningococcal infection, purulent meningoencephalitis

 

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

MRI of the lumbar spine

 

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

 tick-borne encephalitis (meningoencephalitis)

 

614. A 42-year-old man developed severe lumbar pain in the left side of the chest, ECG examination and biochemical analysis of blood did not reveal heart pathology. Two days later, a blister-like rash appeared on the left side of the chest, at the level of the nipple, in the area of pain. A neurologist diagnosed hypoesthesia in this area. Prognosis:

Herpes ganglionitis

 

615. The student is 18 years old, fell down immediately, there were tonic-clonic seizures, involuntary urination. On examination: unconscious, slightly bloody saliva from the mouth. The seizures stopped after 2 minutes, after the patient fell asleep. According to his mother, he does not take drugs or alcohol, has not suffered from head injuries and neuroinfections. As a child, he lost consciousness for several seconds and froze in one position. The patient's sister has been suffering from epilepsy since childhood. Prognosis:

 idiopathic epilepsy

 

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

pituitary adenoma

 

617. An 18-year-old boy suffered a concussion in the ankle joint after an acute respiratory viral infection (ARI). Weakness developed during the two days of leg flexion, and in the last week it became difficult to walk. No urination and defecation disorders. During the week, weakness increased and artificial lung ventilation developed. Tetraplegia develops with the preservation of the movement of the eyeball. Prognosis: Guillain-Barre polyradiculomyeloneuropathy. Diagnostic principles:

 MRI of the brain, analysis of cerebrospinal fluid

 

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

Vascular dementia

 

619. The patient is 31 years old, is registered with a neurologist in connection with epilepsy, regularly takes antiepileptic drugs. According to the results of MRI, the lesion of the brain is located in the neck. In this patient, seizures may occur before:

visual hallucinations

 

620. The patient was 49 years old and was taken to the emergency department by the ambulance crew with a complaint of anesthesia and weakness of the left limb. As a result of the neurologist's examination, left hyperreflexia, flattening of the nasolabial folds, decreased strength of the muscles of the left limb to 3.0. Which structure of the nervous system is damaged?

the right hemisphere of the brain

 

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

Lumbar puncture

 

622. The patient is 36 years old. He fell at work and suffered a concussion in the back and neck. Two days later, a neurologist came to the doctor and complained that he "did not feel the ground under his right leg." Examination revealed a conductive type of deep sensitivity in the right leg. Which of the following is a symptom of a nervous system disorder:

of the spine

 

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

 isoniazid, streptomycin

 

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

Anterior right cerebral artery basin

 

625. A 69-year-old woman complains of discomfort under the feet, leakage of liquid food from the right corner of the mouth, taking a spoon from the right hand № After 25 minutes, these symptoms return to normal. The patient says that he had a myocardial infarction 4 weeks ago. An ambulance was called. Initial prognosis:

Acute ischemic attack of the left middle cerebral artery

 

626. In a 65-year-old patient, objective: lumbar lordosis, lumbar movement is limited to the back and side due to pain. Wasserman and Matskevich's symptoms are on the right. Hypesthesia on the inner and outer surface of the positive number. Decreased right knee reflex. What syndromes does the patient have?

 root L2-L4

 

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

 alcoholic coma

628. A 46-year-old man complained of morning headache, seizures, right limb movement (starting from the right leg and spreading to the right arm). He did not lose consciousness. . In the anamnesis, 4 years ago he had a closed brain injury - a brain tumor. On CT: external and internal hydrocephalus. EEG: "sharp slow wave" complex in the frontal lobe of the left hemisphere. Treatment:

anticonvulsants

 

629. Patient M., 68 years old. After getting a new apartment, he fell ill. Unable to adjust to the new environment, he waited for the worst. Sleep, appetite worsened. He stopped doing housework. Fear intensified, and in this connection he was referred to a psychiatric hospital. He can't find a place to walk around the room. He was in a low mood, always on the beach, as if something had happened at home. Name the syndrome

 panic-depressive

 

630. Relatives of the patient come for advice. They say that the patient has grown up in a satisfactory condition since childhood. One year ago, at the age of 25, he changed his behavior, became silent and closed the door of his room all day. The patient's diary revealed that "people from a secret criminal organization wanted to kill him." During the interview with the patient, it was found that some perceptual processes were disrupted. The patient is protected. Only during a long conversation did it become clear that the patient's neighbors were following him, that they were members of the new organization. How to diagnose a patient

paranoid schizophrenia

 

631. Patient M., 30 years old. He is in a psychiatric hospital. For 3 days he did not talk at all, he walks by himself in the ward without interacting with anyone. Patient number 1110 "All the people and I were lying down, everything was in the yellow fog." People all over the world speak the language of the sea. It was scary, but interesting. It's a pity I came back from there. In this summer, which group of drugs will help the patient better

neuroleptics

 

632. Patient K. The 29-year-old complains of fear of sharp, sharp and piercing objects. He is afraid to catch them. He asks his mother to cut the fruit. It happens both at work and at home. What is the leading syndrome in the patient

phobic syndrome

 

633. Patient M., 30 years old. He is in a psychiatric hospital. For 3 days he did not talk at all, he walks by himself in the ward without interacting with anyone . Patient number 1110 "All the people and I were lying down, everything was in the yellow fog." People all over the world speak the language of the sea. It was scary, but interesting. It's a pity I came back from there. Name the syndrome

 oneroid syndrome

 

634. A 14-year-old boy wakes up at night and walks around the apartment. He even opens a window or a closed door and tries to go outside. It is impossible to go to bed. etc. resists, is aggressive, does not say a word. After a while it became conquering. In the morning he complains of pain, he does not remember what happened. Symptoms of epileptic seizures were observed at an early age. School performance has deteriorated. Enuretic episodes were clearly marked at night

 somnambulism

 

635. The patient is 62 years old, retired and is being treated in a psychiatric hospital. Does not socialize with anyone, sits alone, always in a low mood. He spends most of his time in bed, but does not sleep and often sighs deeply. During the conversation with the doctor, he became very nervous and his hands trembled a little. He pulls the hem of his shirt with his hands, full of tears. Complains of lack of mood, insomnia, various anxious thoughts. He thinks, "I don't need anyone, I'm lonely, I don't need to live." Although her son, who was born yesterday, came to visit, all his relatives believe that he died. What is the leading syndrome in the patient

 depressive syndrome

 

636. Relatives of the patient come for advice. They say that the patient has grown up in a satisfactory condition since childhood. One year ago, at the age of 25, he changed his behavior, became silent and closed the door of his room all day. The patient's diary revealed that "people from a secret criminal organization wanted to kill him." 637. During the conversation with the patient it was found out that some reception process was disturbed. The patient is protected. Only during a long conversation did it become clear that the patient's neighbors were following him, that they were members of the new organization. How to diagnose a patient

paranoid schizophrenia

 

638. Relatives of the patient come for advice. They say that the patient has grown up in a satisfactory condition since childhood. One year ago, at the age of 25, he changed his behavior, became silent and closed the door of his room all day. The patient's diary revealed that "people from a secret criminal organization wanted to kill him." During the interview with the patient, it was found that some perceptual processes were disrupted. The patient is protected. Only during a long conversation did it become clear that the patient's neighbors were following him, that they were members of the new organization. How to diagnose a patient

paranoid schizophrenia

 

639. The patient is 18 years old. It hurts right away. At work he began to look around in fear. He said something nonsensical and fled into the woods. When he was found, he stood in the doorway and did not answer questions. In the hospital: does not say a word, does not sit on a chair after a call. Neglected, active negativism is revealed. There are no internal defects. The nervous system is unchanged. A drug that works well for the patient

haloperidol

 

640. A 14-year-old boy speaks with a speech impediment, his vocabulary is immediately limited, his speech is stereotyped, stereotyped. He was psychophysiologically retarded as a child. The child did not go to kindergarten. The first speech was made at the age of 3. Can't read extra school, but can hardly count to 10, but can name individual letters. Interest is limited to meet physiological needs. IQ-48, VQ-39. Determine the degree of mental retardation in this patient

intermediate degree

 

641. Patient M., 30 years old. He is in a psychiatric hospital. For 3 days he did not talk at all, he walks by himself in the ward without interacting with anyone. Patient number 1110 "All the people and I were lying down, everything was in the yellow fog." People all over the world speak the language of the sea. It was scary, but interesting. It's a pity I came back from there. A drug that works well for the patient

haloperidol

 

642. Patient A. suffers from pneumonia, in the high fever at night he sees large spiders and other scary insects on the walls and ceiling of the room, that is, they fell and ran around. Out of fear, he shouted for help and tried to hide. In the conversation with the paramedic, he said his name and age correctly, but did not understand where he was, and called those around him his friends or relatives. What is the leading syndrome in the patient

 delirium syndrome

 

643. At the reception the patient said to his mother: “My daughter has been behaving like this since April. At first, he talked to himself, then laughed, and for some reason rubbed his ears. He tells me that you are not my mother, because a magician told him so. According to my daughter, the magician forces her to refuse food and laugh. She explains that she met him one day at a worship meeting and that he has been influencing her in various ways ever since. For example, he can communicate with the TV announcer and force him to go to bed early. " What syndrome is being talked about

 Kandinsky-Clerambo syndrome

 

644. Patient A became ill at the age of 15. Feeling exceptionally relieved, he seemed to be able to do anything. After 2 weeks, these scenes disappeared. At the age of 20, this situation was repeated: there was fun, faster thinking and increased mobility. He was hospitalized in a psychiatric hospital and spent the whole day singing and composing poems. Find the leading syndrome in the patient.

 manic syndrome

 

645. A 23-year-old man was detained by police for promptness and immoral behavior. He invented it, ran away from the pursuers, shouted and attacked the policeman. On the way to the clinic he regained consciousness. At the reception it was found that there was an odor of alcohol in the mouth. The orientation is correct (address, time, in person). No psychoproductive symptoms were detected during the conversation. Parents of the situation

 Dark state of consciousness

 

646. Patient A., 32 years old. For several weeks he was completely motionless, his knees bent inwards. Does not speak, does not answer questions. There are no facial expressions and saliva flows from the mouth. If the patient stands in any position, he can stay in that position for 10-15 minutes. Symptoms of air cushion are observed at bedtime. Nasological diagnosis

 Catatonic schizophrenia

 

647. The patient is 18 years old. It hurts right away. At work he began to look around in fear. He said something nonsensical and fled into the woods. When he was found, he stood in the doorway and did not answer questions. In the hospital: does not say a word, does not sit on a chair after a call. Neglected, active negativism is revealed. There are no internal defects. The nervous system is unchanged. What is the leading syndrome in the patient

 catatonic syndrome

 

648. While repairing the patient's house, he held a paintbrush in his hands under his feet, and then the paint fell off. It lasted for a few seconds. After that, the patient became confused, could not concentrate immediately, had complete amnesia.

abscess

 

649. The patient says that green herbs affect his thinking. The game is poisonous and the patient introduces uncharacteristic thoughts ». Identify the syndrome

 Kandinsky-Clerambo syndrome

 

650. Identify the disorder: the patient is 82 years old, has failed to recognize his children and acquaintances. She "recognizes" her daughter as her birth mother. She considers herself 18 years old and "prepares for marriage". I remember the events of my early childhood, but I do not remember the recent events. There is an amnesty orientation. Ushkalak goes out at night and in the evening, gathers his clothes and tries to leave the house. The mood is sometimes kind, sometimes angry. Parents of the situation

dementia

 

651. The patient is 29 years old and works as an electrician at the plant. No bad habits. He noticed that his condition worsened for about a month. Complains of feeling like his shoulders are squeezing all the time. He admits that he is in an awkward situation, but he can't do anything. Find the leading syndrome in the patient

 obsessive-compulsive disorder

652. The patient is 29 years old and works as an electrician at the plant. No bad habits. He noticed that his condition worsened for about a month. Complains of feeling like his shoulders are squeezing all the time. He admits that he is in an awkward situation, but he can't do anything. Find the leading syndrome in the patient

 obsessive-compulsive disorder

 

653. Patient M., 30 years old. He is in a psychiatric hospital. For 3 days he did not talk at all, he walks by himself in the ward without interacting with anyone. Patient number 1110 "All the people and I were lying down, everything was in the yellow fog." People all over the world speak the language of the sea. It was scary, but interesting. It's a pity I came back from there. A drug that works well for the patient

haloperidol

 

654. The patient is frightened, has difficulty breathing, red face, sweating. He sees small animals (rats, small cows, black spiders) walking on them. He shakes his hands, looks under the bed and shouts. Cannot clearly define the environment (the hospital is considered a pub). He knows the environment clearly, he is sane. Name the syndrome

 delirium

 

655. A 16-year-old patient complained that he did not want to go to school. Then he breaks up with his friends, sits at home and sings a song in a rude way. When he arrives at the hospital, the ward continues to sing this song despite the warning. His face looks like a fool, sometimes with meaningless smiles, throwing food, snatching other patients' food and not listening to the medical staff. Find the leading syndrome in the patient

hebephrenic syndrome

 

656. A 15-year-old boy was taken to the reception. He answers questions with a big smile and a whistle. He takes impressive punches, scolds the doctor, frowns. He jumps up from his chair and starts dancing. He cries, but there he says that he will play everything. What is the leading syndrome in the patient

hebephrenic

 

657. The patient says that he uses a video camera to monitor his neighbor's movements and speech. He avoids going outside, saying that "the rays reach quickly". What is the leading syndrome in the patient

 Kandinsky-Clerambo syndrome

 

658. Patient D., 30 years old, history of epilepsy. For 2 days she and her husband waited for their flight at the airport, the flight was repeatedly postponed. Suddenly he disappeared. According to the patient, at home. In fact, he stretched 10 km from the airport, broke the knee of the kindergarten and fell asleep there. The moon tells the year exactly, and the question "what day?" My husband left somewhere and thinks that he has returned from a trip. Name the situation

 Oneiroid

 

659. After experiencing IMS, the patient became naughty and naughty. Noise makes noise at home and at work for no reason. He can't stand the heat, he feels nauseous while driving. He is intelligent, criticizes his behavior, and regrets that shouting is the cause of the noise. Expresses high sensitivity to sounds, light, tactile sensations. The main syndrome

Cerebrastenic

 

660. A 14-year-old boy speaks with a speech impediment, his vocabulary is immediately limited, his speech is stereotyped, stereotyped. He was psychophysiologically retarded as a child. The child did not go to kindergarten. The first speech was made at the age of 3. Can't read extra school, but can hardly count to 10, but can name individual letters. Interest is limited to meet physiological needs. IQ-48, VQ-39. Determine the degree of mental retardation in this patient

intermediate degree

 

661. The patient is in a very high mood, everything is perceived "as a pink color". The patient is selfish, but does not pay attention to negative emotions, overestimates his capabilities. The pace of thinking has accelerated, the conversation is anxious, this situation lasted for 2 weeks. What is the leading syndrome in the patient

manic

 

662. The patient complained that the police of the whole country followed him in the hospital - there are a lot of "spies". In the process, they are trying to take his money and remove him from office. Disorders of consciousness. Lack of criticism. His behavior is in line with his concerns: he wants justice to be done, he writes a complaint, he asks the "spies" to distance himself from him. Name the leading syndrome of the patient

 paraphrenic

 

663. The patient says that he uses a video camera to monitor his neighbor's movements and speech. In this summer, which group of drugs will help the patient better

anticonvulsant

 

664. The patient is 62 years old, retired and being treated in a psychiatric hospital. Does not socialize with anyone, sits alone, always in a low mood. He spends most of his time in bed, but does not sleep and often sighs deeply. During the conversation with the doctor, he became very nervous and his hands trembled a little. He pulls the hem of his shirt with his hands, full of tears. Complains of lack of mood, insomnia, various anxious thoughts. He thinks, "I don't need anyone, I'm lonely, I don't need to live." Although her son, who was born yesterday, came to visit, all his relatives believe that he died. " In this summer, which group of drugs will help the patient better

 antidepressants

 

665. The patient is not interested in the environment, does not respond emotionally to events, nothing entertains or depresses the patient. Identify psychopathological symptoms

Apathy

 

666. A 12-year-old girl suffers from infectious mononucleosis. For 2 days her body temperature rose to 40 degrees. She was lying in bed and worried. that is, he brought her homework. ”Against the background of constant fear and panic, he begins to fix the blanket with his fingers, his eyes wide and open, as if surprised, the autonomic reaction is obvious. Anxiety reaches its maximum in the evening and at night. What is the leading syndrome in the patient

 delirium syndrome

 

667. The patient is 18 years old. It hurts right away. At work he began to look around in fear. He said something nonsensical and fled into the woods. When he was found, he stood in the doorway and did not answer questions. In the hospital: does not say a word, does not sit on a chair after a call. Neglected, active negativism is revealed. There are no internal defects. The nervous system is unchanged. What is the leading syndrome in the patient

catatonic syndrome

 

668. The patient looks in the mirror and says: “I don't understand! My face is mine, but my soul is not the same as before. " A drug that works well for the patient

tryptazine

 

669. It is said that a patient monitors his neighbor's movements and speech with the help of a video camera. He avoids going outside, saying that "the rays reach quickly". In this summer, which group of drugs will help the patient better

neuroleptics

 

670. The patient has been suffering from somatic disease for a long time. Against the background of the progression of somatic disorders, the following situation has developed: the patient's orientation is impaired (address, time, personality). Sometimes he shouts something, or repeats other people's words or short phrases many times. He looks confused, sometimes his face is tense, he hits something with his hands. Recently, there has been a chaotic movement in bed. The main syndrome

Oneiroids

 

671. Patient M., 30 years old. He is in a psychiatric hospital. For 3 days he did not talk at all, he walks by himself in the ward without interacting with anyone. Patient number 1110 "All the people and I were lying down, everything was in the yellow fog." People all over the world speak the language of the sea. It was scary, but interesting. It's a pity I came back from there. In this summer, which group of drugs will help the patient better

neuroleptics

 

672. The patient is 18 years old. It hurts right away. At work he began to look around in fear. He said something nonsensical and fled into the woods. When he was found, he stood in the doorway and did not answer questions. In the hospital: does not say a word, does not sit on a chair after a call. Neglected, active negativism is revealed. There are no internal defects. The nervous system is unchanged. In this summer, which group of drugs will help the patient better

neuroleptics

 

673. Patient Z. was taken to the reception of the narcological dispensary. The patient was taken from the street. When the patient is agitated, he becomes frozen. He was taken to the hospital on a stretcher. He does not answer the question. There is an odor of alcohol in the mouth. There is vomit in the mouth. The skin is gray, cyanotic. The skin is moist. Body temperature 35 C, blood pressure - 90/50 mm Hg, shallow breathing, frequent (8-10 minutes). Pupil reaction to light, tendon and skin reflexes are not observed. Muscle and masticatory tonic spasms are observed in the neck. Determine the therapeutic tactics

Severe alcohol intoxication

 

674. The patient has been suffering from epilepsy for 5 years. According to his relatives, he was in the dark at the same time, did not move in one place, his eyes were closed and his order was normal. fell asleep. Parent of the leading syndrome

obscurity of consciousness

 

675. A 25-year-old man is convinced that for 4 months "bad people want to put bad thoughts in his head and use it for their own purposes." He looks for evidence in the news and in the newspapers. There is fear and excitement. Emotions are not adequate, they are always smiling during the conversation. Physical examinations are close to the norm. Prognosis

Schizophrenia

 

676. Patient A., 32 years old. For several weeks he was completely motionless, his knees bent inwards. Does not speak, does not answer questions. There are no facial expressions and saliva flows from the mouth. If the patient stands in any position, he can stay in that position for 10-15 minutes. Symptoms of air cushion are observed at bedtime. What is the leading syndrome in the patient

 Catatonic syndrome

 

677. Patient A., 32 years old. For several weeks he was completely motionless, his knees bent inwards. Does not speak, does not answer questions. There are no facial expressions and saliva flows from the mouth. If the patient stands in any position, he can stay in that position for 10-15 minutes. Symptoms of air cushion are observed at bedtime. A drug that works well for the patient

haloperidol

 

678. Patient K., 68 years old, after drinking alcohol, began to see the walls of the fortifications, which were surrounded by scary people and tried to strangle him. Simultaneously saw the series "Flying BUN (UFO)." He ran away from home and hid in the woods. He said that he was at his friend's house during the hospitalization, that his friend died a few years ago, that he misrepresented the year and the season, and that the dates were wrong. She looks terrified. Prescribe treatment

Neuroleptics

 

679. Patient A. suffers from pneumonia, in the high fever at night he sees large spiders and other scary insects on the walls and ceiling of the room, that is, they fall and run around. Out of fear, he shouted for help and tried to hide. In the conversation with the paramedic, he said his name and age correctly, but did not understand where he was, and called those around him his friends or relatives. What is the leading syndrome in the patient

delirium syndrome

 

680. The patient talks a lot, tries to talk to any of the patients, and eagerly reads a poem to someone else before listening to the latter. When he sees the nurse washing the floor, he wants to help her, but he immediately leaves her unfinished and starts giving advice to those who are playing chess. His energy is flowing, he speaks fluently, he is in a good mood. The main syndrome

Manic

 

681. The doctor of the ambulance crew fixed the patient's tremor, dilated pupils, runny nose, frequent sneezing, coughing and a lot of tears. The patient is restless, anxious, trying to massage the muscles of the legs, complains of pain in the limbs, bowel movements, insomnia. Numerous thickened and small hemorrhages are observed along the veins in the area of the elbow flexion. Make a prognostic diagnosis

 Abstinence syndrome

682. The patient looks in the mirror and says: “I don't understand! My face is mine, but my soul is not the same as before. "

depersonalization

 

683. A condition accompanied by activity, anxiety, sometimes tremors, internal stress, tachycardia, high blood pressure

Fear

 

684. Patient A., 32 years old. For several weeks he was completely motionless, his knees bent inwards. Does not speak, does not answer questions. There are no facial expressions and saliva flows from the mouth. If the patient stands in any position, he can stay in that position for 10-15 minutes. Symptoms of air cushion are observed at bedtime. In this summer, which group of drugs will help the patient better

neuroleptics

 

685. Patient M., 68 years old. After getting a new apartment, he fell ill. Unable to adjust to the new environment, he waited for the worst. Sleep, appetite worsened. He stopped doing housework. Fear intensified, and in this connection he was referred to a psychiatric hospital. He can't find a place to walk around the room. He was in a low mood, always on the beach, as if something had happened at home. Name the syndrome

panic-depressive

 

686. Patient M., 30 years old. He is in a psychiatric hospital. For 3 days he did not talk at all, he walks by himself in the ward without interacting with anyone. Patient number 1110 "All the people and I were lying down, everything was in the yellow fog." People all over the world speak the language of the sea. It was scary, but interesting. It's a pity I came back from there. Name the syndrome

oneroid syndrome

 

687. The patient is 62 years old, retired and being treated in a psychiatric hospital. Does not socialize with anyone, sits alone, always in a low mood. He spends most of his time in bed, but does not sleep and often sighs deeply. During the conversation with the doctor, he became very nervous and his hands trembled a little. He pulls the hem of his shirt with his hands, full of tears. Complains of lack of mood, insomnia, various anxious thoughts. He thinks, "I don't need anyone, I'm lonely, I don't need to live." Although her son, who was born yesterday, came to visit, all his relatives believe that he died. " A drug that works well for the patient

amitrite

 

688. The patient says that green herbs affect his thinking. The game is poisonous and the patient introduces uncharacteristic thoughts ». In this case, which group of drugs will help the patient better

neuroleptics

 

689. The patient says that he uses a video camera to monitor his neighbor's movements and speech. He avoids going outside, saying that "the rays reach quickly". A drug that works well for the patient

tryptazine

 

690. Female, 30 years old. Complains of palpitations, cardiac arrest, shortness of breath, weakness. Objective: average condition, sane. The skin is pale. Normal breathing in the lungs, no wheezing. TAJ - 18 times a minute. Heart tones are closed, arrhythmic. Weak pulse, irregular rhythm, 68-90 beats per minute. BP 90/60 on the ECG: irregular rhythm, atrial fibrillation, complete blockade of the AV. Which syndrome is characterized by these ECG changes?

Frederick

 

691. Male, 26 years old. Complains of nausea, vomiting, progressive headache. In the anamnesis: a few hours before the accident, he was injured when he fell on a tree while loading. He did not lose consciousness and did not call for help. His condition began to deteriorate after 5 hours, ie with the above complaints, so he called the media. Objective: he is in a serious condition, anxious, has a severe headache and can't find a place to rest. There is trembling and trying. Breathing snoring and pausing. Heart tones are closed, bradycardia. JSC 90/60 class. Pathological reflexes are observed. What is the diagnosis?

IMS. Intracranial hemorrhage. Compression of the brain

 

692. Male, 58 years old. Complains of shortness of breath, shortness of breath, pale red sputum cough, anxiety, weakness. History: suffers from hypertension for 10 years, does not take antihypertensive drugs. His condition worsened in 3 hours. His general condition is serious, he is conscious, he is agitated. Her face is red. Clear pulmonary sounds in the lungs, auscultatory - large and small bubbly rales of moisture in the entire lung area. TAJ - 30 times a minute. Heart tones are closed, rhythm is normal, YYYY-100 1 min. AK 210/100 class. The abdomen is soft, painless, the liver is not enlarged. On the ECG: rhythmic, sinus. Left ventricular hypertrophy. Your diagnosis

Arterial hypertension III degree. Threat 3. Hypertensive crisis type I. Pulmonary edema

 

693. Male, 42 years old. Complains of palpitations, shortness of breath, dizziness. In the anamnesis: coronary heart disease for 10 years, BOMI (PIM 3 years ago). Developed after 30 minutes of physical exertion. Objective: in moderate cases, clear consciousness, pale skin, acrocyanosis. Breathing in the lungs is vesicular, no wheezing. Heart sounds are closed, arrhythmic, tachycardia, heart rate 140 min., Pulse 140 min. AO 90/50 mm. Supraventricular tachycardia on ECG. The ambulance crew performed isoptin, but the seizure was not suppressed. Further tactics of the ambulance crew:

repeated administration of isoptin

 

694. Male, 38 years old. Complaints: after eating, there is pain in the epigastric region, nausea, vomiting, vomiting in the stomach with relief, loss of appetite. Stools are normal, daily, without pathological impurities. He was ill for two days. Two days ago, after drinking alcohol and fatty foods, the pain intensified and vomiting was added. Prognosis

 gastric ulcer

 

695. The patient is 39 years old. Complaints - shortness of breath with difficulty breathing, dry cough with seizures, runny nose. In the anamnesis - shortness of breath with the smell of perfume under the feet, coming on the bus. He did not use any medicine before the arrival of the HR team. Examined: orthopnea, triangular cyanosis of the nose and lips, nasal mucosa. Chest cell emphysema. Percussion - box sound. Pulmonary excursion decreased. Auscultation - many dry wheezing on the background of hard breathing. TAJ - 32 minutes. AK - 120/80 mm.s.b. YYYY - 102 minutes. Contraindicated in this patient:

 Narcotic analgesics

 

696. Female, 28 years old. Complains of acute pain in the lower abdomen, transmitted to the rectum, the pain occurred after lifting a tank full of heavy water. Objective: pale, cold sticky sweating, vomiting and diarrhea. In the case of ovarian apoplexy, there is no sign of rupture of the fallopian tubes

 bleeding from the uterus

 

697. Female, 25 years old. Complains of acute pain in the lower abdomen, general weakness, dizziness. Acutely ill 30 minutes ago. History: irregular menstrual cycle. Last menstrual period - 2 months ago. Objective: the patient's appearance is pale, weak. Pulse 120 times per minute, HR 120 times per minute, BP 85/50 mm Hg. There is no abdominal pain in the hypogastric region. Schetkin-Blumberg symptom is positive. It was found that blood from the genital tract was mixed. Make a prognostic diagnosis

transportation to the gynecological department

 

698. Sick, 58 years old. Seizure-like pain in the lumbar region, urine mixed with blood. History: sudden onset of kidney stones. After a while, macrohematuria appeared. Objective: average condition. There are no pathological changes in the lungs and heart. What pathology to think about

 stone in a bowl

 

699. A woman, 32 years old, 38 weeks pregnant + 3 days - second pregnancy, second delivery. On examination: regular, rhythmic, progressive contractions, amniotic fluid. During the transport, in the car of the media, the labor began to intensify, and the hand of the fetus was the first to fall. Tactics of the media brigade in this case

 Delivery to the nearest maternity hospital with a napkin in the interval

 

700. Male, 69 years old. Complains of severe chest pain, shortness of breath, acute weakness. History: sudden shortness of breath and chest pain during exercise. History of decompensated thrombophlebitis of the right leg. On examination: severe, unconscious, agitated, diffuse cyanosis. Rays are heard in the right lung at shoulder level. TAJ - 26 times a minute. Heart tones are closed, rhythmic. YYYY - 120 times a minute. AO 110/80 mm. garden The abdomen is soft and painless. On the ECG: rhythmic, sinus, II, III, P-Pulmonale on AVF, blockade of the right leg of the Giss bundle. Your diagnosis

pulmonary artery thromboembolism

 

701. The most effective method of treatment of carbon monoxide poisoning:

 hyperbaric oxygenation

The child is 6 years old. According to his mother, he has been ill for 3 days, has the flu, has a low-grade fever. The day before, he had a cough and difficulty breathing. In general: the child is restless, temperature-37.2, heart rate-36, pulse-128. The neck is hyperemic. A box sound is heard in the percussion lungs. On auscultation, shortness of breath, prolonged exhalation, dry wheezing are heard in all areas of the lungs. The tone of the heart is clear and rhythmic. The abdomen is soft. Defecation and diuresis are normal. Your tactics:

 aerosol salbutamol, aminophylline early. 2.4% 0.6 ml b / w, transportation to the children's hospital

 

702. The patient is 35 years old. Complaints: general weakness, fatigue, loss of appetite, weight loss, fever 37.4 in the afternoon, periodic dry cough, shortness of breath at rest. History of being in another country for half a year. Upon arrival (10 days later) the above complaints were disturbing. Did not go to the doctor. He treated himself. The deterioration of his condition began in the evening. On examination - normosthenic type, low food intake. The skin is dry. T-36.9. Percussion - the sound of the lungs. Auscultation - vesicular breathing, occasional dry rales in the upper part of the lungs. TAJ - 22 minutes. AK - 100/60 mm.s.b. YYYY - 92 minutes. Provide first aid:

Oxygen therapy, infusion therapy

 

703. A boy was found unconscious on the street. There are no bruises on the test. There is a clear cyanosis of the skin, traces of injections along the veins in the hands. Breathing is rare, with signs of superficial apnea, 8 - 10 1 minute. Heart attacks are closed, heart rate - 60 1 minute. What drug should be administered to the patient:

 naloxone

 

704. A woman is 30 years old and 36 weeks pregnant. Complains of headache, dizziness, nausea, vomiting, swelling of the legs. Objective: general condition is severe, mental retardation, clonic-tonic convulsions. Shortness of breath in the lungs, no wheezing, heart rate 32 min. Heart rate is closed, rhythm is correct, heart rate 100min. АК 170/110 мм.сын.бағ. The fetal heartbeat is preserved. Which drug do you completely exclude from the treatment plan:

 polyglucin

 

705. In an elderly patient there was a sudden pain in the back of the chest, followed by a dry cough and dizziness. Shortly afterwards, cyanosis appeared, accompanied by inspiratory dyspnea and pale skin. Pathological pulsation is detected in the visual epigastric region. Percussion - dilation of the right side of the heart, auscultatory - the accent of the second tone and its doubling above the pulmonary artery. Prognosis

pulmonary artery thromboembolism

 

706. Female, 45 years old. Complains of headache, dizziness, palpitations, anxiety, weakness. In the anamnesis: for 6 years with arterial hypertension, blood pressure 200/120. rises up, drinks arifon, the hood is unstable. The above complaints began after 2-3 hours of psycho-emotional stress. His general condition is average, he is sane. The skin is red and dry. Vesicular breathing in the lungs, no wheezing. 20 wars in 1 minute. Heart tones are closed, aortic II tone is amplified, rhythm is normal, HR 110 1 min, pulse is strong. JSC 220/120 class. There are no focal neurological symptoms. On the ECG: rhythmic, sinus. Left ventricular hypertrophy. Your diagnosis

Arterial hypertension III degree. Danger 3. Hypertensive crisis type II

 

707. The patient is 48 years old. Complaints: mixed shortness of breath, dry cough, body temperature 38.8, exacerbated by light physical exertion. In the anamnesis - sick for 2 weeks, started after a cold. Not seen by a doctor. He treated himself. On examination: pale skin, cyanosis of the nasolabial triangle. The neck is normal. The breast is cylindrical. When you breathe, the left chest remains. Percussion sound from the left to the bottom of the percussion. On auscultation - shortness of breath, occasional dry rales on the anterior surface, no breathing in the lower part of the left lung. TAJ - 24 minutes. AK - 110/70 mm. YYYY - 94 minutes. No changes to other members or systems. Tactics for further driving:

hospitalization in the thoracic department

 

708. The girl is 16 years old. There are no complaints about the severity of his condition, according to his mother, he ate a lot of citrus fruits an hour ago, and then his body itched and fainted. This is the first case. The objective condition is serious. In a state of unconsciousness. The skin is hyperemic, with rashes protruding from the skin in all areas of the body, in some places prone to adhesions. Breathing in the lungs is vesicular, no wheezing, HR 22 min. The heart is frozen, the pulse is like a thread, blood pressure is 50/30 mm Hg. The abdomen is soft and painless. In this case, the dose of prednisolone:

20-25 mg / kg

 

709. The patient is 50 years old. Complaints: shortness of breath with a seizure, cough with difficult sputum. From the anamnesis: bronchial asthma. His condition worsened after ARVI. Berodual increased the amount of inhalation up to 10 times. The seizure has not subsided in the last 2 days. In general: the condition is serious. Orthopnea, expiratory dyspnea, HR 24 times per minute, loud wheezing on exhalation. The skin is pale, moist, cyanosis of the nasolabial triangle. On auscultation: shortness of breath in the lungs, "dumb lungs". HR 120 times per minute, anti-aircraft artillery 140/90 mm. What is the effect of berodual ineffective?

 Development of "ricochet" symptom

 

710. Female, 46 years old. Complaints: epileptic shortness of breath, cough with sputum, difficult to separate. History: bronchial asthma for 10 years. Deterioration of the condition is associated with a cold. Salbutamol inhalation during the last day does not suppress seizures. Objective: serious condition. Orthopnoe, TAJ 42 min. The skin is pale, moist, acrocyanosis. Auscultatory: shortness of breath in the lungs, dry wheezing in all areas of the lungs, areas of "dumb lungs" in the lower parts. YYYY 110 min. AK 150/90 mm critical range. Ambulance:

oxygen inhalation, glucocorticoids, anticoagulants, intravenous solution infusion

 

711. An ambulance was called for a 1.5-year-old boy. According to the mother, a healthy child suddenly develops a cough, shortness of breath while eating, and if the child is anxious, shortness of breath increases. Objective: pale skin, bruising, stridor breathing, hoarseness. Prognosis

 foreign body in the respiratory tract

 

712. A girl, 3 years old. According to the mother, 10 minutes ago the boy was burnt in hot oil. During the examination: the child is unconscious, retarded, his voice is weak. Redness of the skin of the face, neck, anterior surface of the chest and the skin of the right arm. Everywhere there is a necrosis of the epidermis with a smiling face. Emergency - 40 times per minute, pulse - 160 times per minute. Your prognosis:

chest and right arm burns of II degree, burn shock of II degree

 

713. Male, 58 years old. He fell on his knees in the field. Feels severe pain when moving the calf forward. The knee joint is enlarged, it is determined that there is fluid in the joint. Detection of symptoms of "balloting" of the patella of the knee leads to acute pain. The patient cannot lift a straight leg. Your prognosis:

fracture of the patella above the knee

 

714. Female, 32 years old. Complains of itchy skin and rashes. History: the appearance of rashes is associated with the use of diclofenac tablets. Objective: small, clearly hyperemic large spots on the skin of the neck and chest, traces of itching. BP 120/70 mm Hg, body temperature 37.50 C. Which group of drugs should be used as first aid:

sedative

 

715. Male, 28 years old. The cause of the accident was a car accident. Objective: average condition, sane. The skin is pale. Normal breathing in the lungs, no wheezing. TAJ - 18 hours. min. Heart tones are strong, rhythmic. AO 90/50 class, YYYY - 100 sog. per minute, pulse - 100 beats per minute. Local left hip deformity and bleeding wound are visible. Determine the degree of shock:

I

 

716. A one-year-old boy curiously put his hand on a boiling bucket of lime. Tactics and burn neutralization of HR team:

 Application with 20% glucose solution, prednisolone

 

717. A 40-year-old woman with no signs of life was identified when an ambulance arrived. According to his relatives, he lost consciousness ten minutes ago and had never been ill before. Objective: deaf, pulse in the carotid arteries, breathing, the effect of light on the pupils is not detected, the skin is pale, warm. Cardiopulmonary resuscitation was performed. What criteria should the emergency physician use to evaluate the effectiveness of cardiopulmonary resuscitation?

 pulse in the carotid artery

 

718. The patient is 45 years old. Complaints: general weakness, loss of appetite, weight loss, shortness of breath at rest and during light exercise, pain in the right chest, cough with sputum, which is difficult to separate from the orange viscous. In the anamnesis - surgery was performed 3 years ago due to cr in the antral part of the stomach. Deterioration of current condition 4-5 months, did not go to the doctor. He took sputum, but to no avail. On examination - a slight cyanosis of the nasolabial triangle. T - 37.1. Swelling of the legs up to the middle 1/3 of the calf. The thorax is cylindrical. Remains right when breathing. Closure in the projection of the middle part on the right percussion. Auscultation - in the middle part of the breath is markedly weakened, sparse moist rales. Pulmonary excursion decreased from the right. TAJ– 28 minutes. AK - 100/70 mm.s.b. YYYY - 96 minutes. Provide first aid:

Oxygen therapy

 

719. The woman is 39 years old. Complaints - shortness of breath with difficulty breathing, dry cough with seizures, runny nose. In the anamnesis - at work, when going to the toilet, he developed shortness of breath from the smell of household chemicals. He did not take any medication before the ambulance arrived. On examination: orthopnea, cyanosis of the nasolabial triangle, nasal mucosa. Chest cell emphysema. Percussion - box sound. Pulmonary excursion decreased. On auscultation - many dry wheezing on the background of hard breathing. TAJ - 32 minutes. AK - 120/80 mm. YYYY - 102 minutes. Tactics for further driving:

examination by a district doctor, pulmonologist, allergist

 

720. The patient is 72 years old. Complaints: shortness of breath, difficulty breathing, sputum cough, dizziness, chest discomfort. In the anamnesis: coronary heart disease, angina pectoris, PIM, hypertension, bronchitis, asthma, situational treatment. Deterioration of the condition is associated with a cold. Not seen by a doctor. Ventolin took 2 doses, no improvement. On examination: triangular cyanosis of the nose and lips. Orthopnoe. Slight swelling of the ankles. Chest cell emphysema. Additional muscles are involved in respiration. Percussion - the closure of the ship in the upper parts, in the lower parts. Pulmonary excursion decreased. On auscultation - shortness of breath, weak in the lower extremities, dry in the upper extremities, occasional moist rales in the lower extremities. TAJ - 36 minutes. AK - 150/100 mm. YYYY - 90 minutes. Contraindicated in this patient:

 Narcotic analgesics

 

721. Unconscious. Clonic-tonic convulsions, dilated pupils and their lack of reaction to light, spotted cyanosis. There is a very rapid transition from tachypnoea (TAH 40 and more) to bradypnoea (TAH 8-10 1 min.). Decreased blood pressure, heart rate> 140 1 min., There may be atrial fibrillation, critical Ra 02 - 50 mm. garden decreased to, PaC02 -80-90 mm critical. garden rise to. Which of the above clinical manifestations is associated with:

III

 

722. The girl is 20 years old. The road was in a car accident. Complains of pain in the right shoulder. Objective: the general condition is moderate. Consciousness is clear. Breathing in the lungs is vesicular, no wheezing, HR 20 min. The heartbeat is clear, the rhythm is normal, heart rate - 96 min. АК 110/70 мм.сын.бағ. No mild abdominal pain. You have scratches on your face. The right shoulder area is deformed, swollen, limited movement, there is obvious pain and tingling in the upper 1/3 of the shoulder. Rational medical care in the pre-hospital period:

anesthesia, fracture immobilization, hospitalization

 

723. Male, 43 years old. Complains of chest pain, profuse sweating, shortness of breath. In the anamnesis: for the first time such pain, nitroglycerin did not suppress the pain. Invited by the media. Objective: serious condition. The skin is pale and moist. Mold on the lips. She is without a pillow. Breathing is shallow, no scratches. TAJ- 28 times per minute. Heart tones are closed, the rhythm is irregular. 100-110 beats per minute. Heart rate -110 beats per minute, extrasystole. JSC 80/40 class. The abdomen is soft and painless. The liver protrudes +3 cm below the wall. There is no small bowel movement. On the ECG: ST elevated in attachments III, aVF, V5-V6. Extraordinary changes in the QRS complex are observed. Which part of the myocardium is damaged?

from the rear side wall of the left wall

 

724. Male, 52 years old. Complaints: discomfort in the heart area, pain does not spread, increased heart rate, shortness of breath. In the anamnesis: the above complaints began 2 hours after the trauma. Spontaneous administration of verapamil 40 mg tablets, no improvement. He called an ambulance. Objective: conscious, excited. The skin is pale. Breathing in the lungs is vesicular, no wheezing. TAZ-22 war 1 minute. Heart tones are weak, rhythm is normal. Pulse 180 beats 1 min., Rhythmic, slow. JSC 100/70 class. On the ECG: rhythm, ventricular tachycardia, UR - 180 minutes. What medicine do you choose in this case?

 Lidocaine

 

725. Female, 42 years old. Complains of suffocation, shortness of breath, unbearable itching of the skin, sudden severe weakness, dizziness, palpitations. History: polyvalent drug allergy. Half an hour ago he bit his upper lip. The objective condition is very serious, he is insane. The skin is reddish, covered with sticky skin. Swelling of the eyelids, lips. On auscultation, vesicular breathing in the lungs, numerous dry wheezing. TAZ 30 war 1 min. Heart tones are closed, rhythmic. YYYY- 140 war 1 min. АК 40/0 мм сн. garden The patient's abdomen is unchanged. What is the patient's condition and your tactics

 Anaphylactic shock, transport to the intensive care unit

 

726. Symptoms of pulmonary hemorrhage:

and red bubbly sputum

 

727. Male locksmith, 32 years old. 1 hour ago he was injured in the right eye with iron powder. Immediately lost the ability to see the injured eye. Examination revealed a lack of visual acuity of the right eye, but the patient sees the light and shows its direction correctly. Translucent membrane syndrome is obvious. A bright mixed injection of the conjunctiva of the eyeball is observed. After 3 hours, a ruptured ulcer of 2/4 mm in size was found 4 mm from the limb, the area was swollen. Among them is compressed dark gray amorphous tissue. No front camera. The iris is dark gray, close to the wound. Pain on palpation of the eye. Your prognosis

 penetrating injury of the cornea with the fall of the iris of the right eye

 

728. A 46-year-old man was summoned. He woke up in the middle of the night with pain in his heart and shortness of breath. There are no changes in the ECG. In the anamnesis: there were such seizures before, no one asked for help. Taking nitroglycerin, no results. Which drug is better to use in the development of the following pain attacks:

nifedipine

 

729. Male, 19 years old. He does not complain because his condition is very serious. He was untied 5 minutes ago in an attempt to commit suicide. At a glance: he is in critical condition, unconscious. Sudden breathing, convulsions. AO 100/70 mm. garden Pulse 120 times per minute. TAJ- 14 times per minute. What are the tactics of the ambulance doctor

introduction of air ducts, administration of anticonvulsants, delivery to the hospital

 

730. The reasons for the development of laryngostenosis in young children:

imperfection of the respiratory center

 

731. A woman, 34 years old, 38-39 weeks pregnant - third pregnancy, third childbirth. Rhythmic and intense contractions began. On the basis of good childbirth, the woman gave birth to amniotic fluid. The decision was made to take the woman to the maternity hospital. During the transportation, the labor in the media began to intensify. Tactics of the media brigade in this case

 Stop the car and start delivery

 

732. A 35-year-old woman. Complains of headache, dizziness, occasional vomiting, fainting. This condition developed after a fall from a height 3-4 hours ago. Objective: the general condition is moderate. Confused. Unstable in the Romberg position, unable to perform finger-nose sampling. Breathing in the lungs is vesicular, no wheezing, HR 20 min. Heart rate is clear, rhythm is normal, HR 86min. АК 110/70 мм.сын.бағ. The abdomen is soft and painless. The amount of emergency care in this case:

Dehydration therapy

 

733. The child is 6 years old. Complaints: pain in the right ear. According to his mother, half an hour ago, while playing, he fell and hit the edge of a sandbox. Objective: the general condition is relatively satisfactory. Consciousness is clear. Neurological status without pathology. There is a small amount of blood from the ear canal in the right ear. In this case, pre-hospital care includes:

 swab the ear canal with a dry sterile gauze tourniquet

734. The patient is 76 years old. Complaints: severe pain in the upper abdomen. Sudden pain after eating fatty foods. The pain is severe, with repeated vomiting, weakness, excessive sweating. In the anamnesis: OTA (UCA), coronary artery disease. AG. Objective: severe condition, cold sweats, body temperature 37.2. Pulse 125 beats per minute, without rhythm, BP 140/90 mm. Breathing is normal. The tongue is dry, covered with a white smear. On palpation, the abdomen is slightly dry, soft, painful in the epigastric region. Symptoms of intestinal irritation are negative. Prognosis

 acute pancreatitis

 

735. An ambulance was called to a 1.5-year-old boy. According to the mother, the disease began acutely, the body temperature rose to 38.2 ºC, there were a few catarrhal changes. At night, his voice began to change, he coughed "like a dog" and his breathing was noisy. HR 42 times per minute, HR 140 times per minute. Your prognosis

 ARVI. Acute laryngotracheitis. Throat constriction I degree

 

736. Male, 45 years old. Complains of cough, shortness of breath, weakness with mucous-purulent sputum. History: smoked for 30 years. For 12-15 years, morning dry cough worries. He was not examined and did not receive treatment. The above complaints were observed that day, after a long period of freezing. On examination: bruising in the nasolabial triangle. Body temperature is 37.5 ° C. TAJ - 26 breaths min. On auscultation, shortness of breath, dry and wet large bubbles. Pulmonary sound with a box tone on percussion. Your prognosis

 Complications of chronic obstructive bronchitis

 

737. The girl is 2 years old. From the anamnesis he fell from a horizontal bar. Short-term fainting and single vomiting were observed. АК 65/20 мм.сб, ЖЖЖ-140, ТАЖ-38, Т-36,7. Increased muscle tone. Pale skin. On auscultation there is no pathology in the lungs, the heart tone is clear. A 3x4 cm hematoma is found in the neck area. The conjunctival reflex is not detected, the vomiting reflex is preserved. The right pupil is dilated, the reaction to light is reduced. The oculacephalic reflex is positive. Brudzinsky, Kerning reflexes are negative. Babinski's reflex is positive on the left. Your prognosis

concussion, transfer to the neurological department

 

738. A 38-year-old man. The reason for calling an ambulance: the car crashed. He did not lose consciousness. He could not stand on his own due to severe pain in the right pelvis. Objective: the condition is moderate, due to pain in the right pelvis. Ps– 96 beats per minute, satisfactory filling, BP 130/80 mm Hg. The abdomen is soft, there is pain over the loins. Pain in the abdomen, pain in the groin. Peritoneal symptoms are negative. Did not go to the toilet. Specify the type of transport

 Carry on a rigid cannon, lying on your back, legs bent at the knees

 

739. First aid for bleeding from a leg wound:

 Insert a tourniquet

 

740. Male, 35 years old. The reason for calling an ambulance was that he had slipped and fallen on the ice, hit his forehead and was in severe pain. On examination, there is swelling on the right side of the skull area and immediate severe pain. Your prognosis

Fracture of the skull

 

741. In a young woman with severe anaphylactic shock there is a pronounced swelling of the larynx. What should we do first to get the patient to the hospital alive:

conicotomy

 

742. The patient is 48 years old. Complaints - shortness of breath with mixed physical exertion, dry cough, fever 38.8. Rise. History - sick for 2 weeks, after a cold. Did not go to the doctor. He treated himself. On examination: pale skin, triangular cyanosis of the nose and lips. The breast is cylindrical. Left-handed when breathing. Percussion left-hand short circuit. Auscultation - shortness of breath, occasional dry rales on the front, no breathing on the left side. TAJ - 24 minutes. AK - 110/70 mm.s.b. YYYY - for 94 minutes. There is no pathology in other organs and systems. Provide first aid:

 Oxygen therapy, antipyretics

 

743. Multiple injuries in an injured person: fractures of the right femur and bilateral calf bones. Approximate amount of blood loss, depending on the location of the bone fracture

2000 ml

 

744. Male, 46 years old. When walking fast, he complains of pain and tightness around the chest. History: coronary heart disease for 5 years, 5-6 weeks ago (acute coronary syndrome). Objective: moderate condition, sane, normal skin. There is no vesicular breathing, wheezing in the lungs. Heart tones are closed, rhythmic. JSC 130/90 class. UR and pulse - 86 beats. per minute. Rhythmic, sinus, correctly located ECG on the ECG. Pathological tooth Q and negative T tooth in I, aVL, V1-V2 attachments. What is the stage of a heart attack in this disease

acceleration

 

745. Male, 28 years old. Complains of pain in the left arm. History: He was hit in the left shoulder with a piece of wood. Objective: on the surface of the outer palm there is a subcutaneous hematoma in the lower 3/1 of the left shoulder. Pain on palpation of the injured area. Magic is detected in the bone marrow. Pain occurs at the site of injury to the axillary shoulder during exercise. Pronation and supination are difficult, which leads to rapid pain when trying to make movements. The distal part of the shoulder and fingers are located in the pronation position. Your prognosis

fracture of the diaphysis in the lower 3/1 of the left humerus

 

746. The cook poured freshly cooked porridge on himself. She screams in pain and is agitated. Objective: on the skin from the knees to the soles of the feet and on the left shoulder there is a liquid porridge, in some places there are redness, swelling, blisters with a clear liquid. The bottom of the ruptured blisters - pink, shiny, painful, with dry white spots in some places. AK 110/75 critical. garden, pulse 86 minutes, rhythmic. Any kind of thermal burns

ΙΙΙ Grade A.

 

747. Male, 36 years old. According to relatives, he was ill for 4 days, 7 hours ago shortness of breath, acute tremors, increased weakness and chest pain, acute body temperature dropped to 35.70 C. Objective: general condition is severe, delayed, heart rate - 30 minutes, cyanosis, thread-like pulse, 104 beats per minute, blood pressure - 60/40 mm. 748. Shortness of breath in the lungs, wet rales in all areas of the lungs. Heart attacks are closed, heart rate - 104 minutes. Decreased diuresis. Deterioration is associated with the development of:

 Infectious - toxic shock

 

 

 

749. A 25-year-old patient was admitted to the ENT unit with complaints of nasal congestion, swelling and pain in the nasal passages, fever of 38 °. According to the patient, 2 weeks ago he was injured during a sports game and injured his outer nose. There is no bleeding. Nasal congestion, but no effect. In the last 2-3 days, the nose "swelled", became ill and the temperature rose to 38.5 °. On anterior rhinoscopy, the cartilage of the nasal septum is symmetrically enlarged, the mucous membrane is pale red. Make a diagnosis.

 Purulent hematoma of the nasal septum

 

750.

The patient went to the reception with complaints of pain in the eardrum. Symptoms of hot flashes, fever and weakness. Five days before the onset of the disease, the patient accidentally scratched the eardrum with a pin. Three days before going to the reception, there was a reddening of the skin of the eardrum, which was enlarged, swollen and had a headache. The patient's condition gradually worsened, he developed a fever. On examination, the skin of the eardrum suddenly reddened, infiltrated. The process spreads to the area around the ear, the skin of the external auditory canal. The hyperemic areas are surrounded by a demarcation line. There are no pathological divisions in the external auditory canal, the septum is not changed. Diagnose:

 

Lingual damage to the skin of the eardrum