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Tests for fifth-year students of medical faculty




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Tests for fifth-year students of medical faculty


Case 1. The child was born from the mother suffering from chronic cholecystitis and acute respiratory infection at 6th month of pregnancy. There was long waterless period at labour. Birth weight  - 3100g. Umbilical cord has fallen off at 7th day. The child has been discharged from delivery house at 8th day. Since 10th day infant became lethargic, sucked badly, eructed. Body weight at 17th day – 3150g, skin is grey, pus secrets from umbilicus. A stool is green and watery. Which most probable pathology causes these symptoms?

  1. Sepsis of newborn.

  2. Purulent omphalitis.

  3. Hypotrophia (malnutrition).

  4. Enterocolitis.

  5. Intrauterine hepatitis.

 

Case 2. Increase of right mamma was appeared at 7 days old child. The gland is firm under palpation, the child cries. The skin is hyperemic in area of infiltration. The appetite is reduced. Pus discharges from mamilla at pressing. Which most authentic pathology causes such symptoms?

  1. Mastitis of newborn.

  2. Sclerema.

  3. Necrotic phlegmon.

  4. Sepsis.

  5. Sexual crisis.

 

Case 3. The child was born from the mother suffering from chronic pyelonephritis and respiratory infection before labour. Delivery was term, with long waterless period. It has appeared erythematous rash at 2nd day, then - vesicles by the size over 1 сm filled with serous – purulent contents. Nikolskiy symptom is positive. There are erosions after bursting. The child is lethargic. Temperature is subfebrile. Which diagnosis can be made?

  1. Pemphigus of newborn.

  2. Vesiculopustulosis.

  3. Pseudofurunculosis.

  4. Sepsis.

  5. Ritter’s dermatitis.

 

Case 4. 3 days old infant suffered from hemolytic disease of newborn was not undergone to replacement blood transfusion. He has rigidity of occipital muscles, positive Grefe symptom, abnormally high excitement. Serum bilirubin level 380 mcmol/L. The most probable complication is?

  1. Bilirubinous encephalopathy.

  2. Meningitis.

  3. Encephalitis.

  4. intracranial hemorrhage.

  5. Bile thickening syndrome.

 

Case 5. The child was born from ІІ pregnancy at the woman of 35 years which suffers from hypertonic disease. Delivery ІІ, amniotic fluid contents meconium. Umbilical cord was wound round the neck. Apgar score on 1 minute - 2 balls. The breathing is not present. The newborn requires primary reanimation. Which operation carries out earlier?

  1. Suck out the mucus and tracheal contents under the visual control.

  2. Artificial lung ventilation with bag and mask.

  3. Artificial lung ventilation through intubation.

  4. Inhalation of 100 % oxygen.

  5. Catheterization of umbilical vein.

 

Case 6. Newborn has gestational age of 38 weeks. Signs: skin is pink, pure, elastic, subcutis and turgor are not changed, two dysembryogenic stigmas are revealed. Body weight – 2700g, growth - 49 сm, head circumference -33 cm, thorax circumference -31сm. The hypoplastic type of IUGR was diagnosed. Select the most informative method of an evaluation of somatometric parameters.

  1. Centile tables.

  2. Weight / growth ratio.

  3. Visual evaluation.

  4. Dysembryogenic stigmas.

  5. Sigmal tables.

 

Case 7. Newborn has birth weight of 2000g. Gestational age - 30 weeks. In three hours after birth it has appeared dyspnea, acrocyanosis. RR - 80 per 1 min, expiratory murmurs, HR - 186 per 1 min. There is shortening of sound under lung percussion, crepitation under auscultation. The doctor has suspected a respiratory distress-syndrome. What investigation will confirm the diagnosis?

  1. X-ray examination of chest.

  2. Analysis of blood.

  3. Evaluation on a Silverman score.

  4. Evaluation on a Apgar score.

  5. Electrocardiography.


Case 8. The child of 4 years old has basic metabolism level 28%, cholesterol level in blood 8,6 mmol/l, absorbtion of radioactive iodine in thyroid gland in 6 hours -2,1%, in 24 h.-3,0%, in 48 h.-3,5%. Which disease characterises with such laboratory indexes?

  1. Hyperthyroidism.

  2. Hypothyroidism.

  3. Diseases of metabolism.

  4. Diabetes mellitus.

  5. Hypophysic nanism.

 

Case 9. The child of 10 years old has basic metabolism level + 48 %, cholesterol level in blood 2,6 mmol/l, absorbtion of radioactive iodine in thyroid gland in 6 hours -78%, in 24 h.-62%, in 48 h.-50%. Which disease characterises with such laboratory indexes?

  1. Diffuse-toxic goiter.

  2. Hypothyroidism.

  3. Cushing’s disease.

  4. Acromegaly.

  5. Diabetes mellitus.

 

Case 10. The child is 1,5 years old. His activity is reduced, does not walking, does not talking. Signs: skin is pale, dry, оedema, large tongue, saddle nose, voice is gruff, rough, hairs are thick and rough. Large fontanel 3,0x 3,0 cm, teeth are absent. Of which diagnosis it is possible to think?

  1. Rickets.

  2. Down’s syndrome.

  3. Hypothyroidism.

  4. Hypophysic nanism.

  5. Diabetes mellitus.

 

Case 11. The girl of 13 years old has complaints on irritability, palpitation, reduction of weight, fatigue,  increased perspiration. Signs: shivering of extremities, Grefe, Koher’s, Libits symptoms, HR –126 per 1 min., systolic murmur. Of which diagnosis it is possible to think?

  1. Thyrotoxicosis.

  2. Myocarditis.

  3. Tuberculosis.

  4. Vegeto-vessel dystonia.

  5. Neurosis.

 

Case 12. The child is 6 years old. His mother notices that the child is walking in a toilet some times at night, drinks a lot of water, has grown thin, periodically complains on abdomen pain for last 2 weeks. At inspection: skin is pale, dry, scaled on soles, blush on cheeks. Lips and tongue are brightly red, dry. Internal organs are without pathological changes. An odor of an acetone goes from a mouth. Glycemia level - 12 mmol/l. The diagnosis of diabetes mellitus is made. Which therapy is most expedient in near future?

  1. Insulin of mean duration.

  2. Prolonged insulin.

  3. Biguanids.

  4. Diet.

  5. Simple insulin.

 

Case 13. The child is 1 year old. He does not walking, sits unstable, does not speak, not active. He holds head since 10 months. Child was born from the 1st normal delivery, birth weight 4300g. Signs: pallor, oedema, saddle nose, large tongue. Skin is dry, voice is gruff. Pulse rate - 100 per 1 min. The teeth are absent. Internal organs are without pathological changes. A stool is 1 time in 2-3 days. Which is the most authentic pathology stipulates such signs?

  1. Hypothyroidism.

  2. Hirschsprung’s disease.

  3. Rickets.

  4. Down’s syndrome.

  5. Children's cerebral palsy.


Case 14. The child of 8 years with acute lymphoblastic leukaemia after clinico-laboratory remission within 3 years had relapse of leukemia. Indicate the main method of treatment of relapse of acute lymphoblastic leukaemia

  1. Course of monochemotherapy.

  2. Course of polychemotherapy.

  3. Antibiotics.

  4. Glucocorticoids.

  5. Hemotransfusion.

 

Case 15. There is a fever, pallor of skin, hemorrhagical rash, increased of axillar lymphatic nodes, which are soft, painless; liver and spleen are not increased at the patient of 10 years after ARVI (2 months ago). The analysis of blood: Нв-100 g/l, RBC –3 Т/l, colour index -1.0, WBC -3,2 G/l, blasts - 32%, neutrofill myelocytes 0,5%, methamyelocytes -0,5%, banded cells -5 %, segmented cells -35%. What is the diagnosis?

  1. Acute leulemia.

  2. Sepsis.

  3. Chronic myeloleukosis.

  4. Trombocytopenic purple.

  5. Lymphogranulomathosis.

 

Case 16. The boy of 12 years fallen ill in acute way: fever up to 39, excess of sweat, chill. The doctor has revealed the increase of cervical lymphatic nodes at the left side with dense consistence, hyperemia and hyperplasia of tonsills. Which method is the most informative for confirmation of the diagnosis?

  1. Punction of spleen.

  2. Radio-isotope research of lymphatic system.

  3. Punction of node.

  4. Leukocyte formula of blood.

  5. Byopsia of node.

 

Case 17. The patient has increased pain, weakness, hemorrhages (on skin, nose bleedings), fever for the last 2 months. Lymphatic nodes, liver and spleen are not increased. НЬ – 50 g/l, RBC - 1.5 Т/l, colour index - 1.0, WBC- 1.8 G/l, banded -1%, segmented-38%, eos.-1%, lymph.-55%, mon. -5 %, ESR – 60 mm/hour, platelets – 30 G/l. Which is the diagnosis?

  1. Aplastic anemia.

  2. Iron- deficiency anemia.

  3. Hemolytic anemia.

  4. Acute leukaemia.

  5. В12- deficient anemia.

  

Case 18. The boy of 12 years fallen ill in acute way: fever, temperature 39, excess of sweat, chill. The doctor has revealed the increase of cervical lymphatic nodes at the left side with dense consistence, hyperemia and hyperplasia of tonsills. Blood analysis крови- Hb-95 g/l, RBC-3,0 Т/l, CI-0,9, WBC-12,5 G/l, bas.-2%,eos.-6,  banded-10,  segm.-64, lymph.-8, mon.-10, ESR-60 mm/h. Which diagnosis can be assumed?

  1. Lymphogranulomathosis.

  2. Bacterial endocarditis.

  3. Acute leukaemia.

  4. Lympadenopathy.

  5. Reactive lymphadenitis.

 

Case 19. The patient of 11 years notices frequent nose bleedings within the last year, periodic skin echimoses . State of health of the child is good. At examination: pale, extensive echimoses. Internal organs without pathological features. The blood analysis -Нb-90 g/l, RBC-4, 2 Т/l, CI-0.64, WBC- 7.2 G/l, eos.-2%, banded-3 %,  segm.-67 %, lymph.-23, mon.-5, ESR-15 mm/h.. Which diagnosis can be assumed?

  1. Aplastic anemia.

  2. Trombocytopenic purpure.

  3. Hemorrhagic vasculitis.

  4. Iron- deficiency anemia.

  5. Hemophilia.

 

Case 20. The girl of 7 years is sick for idiopathic trombocytopenic purple has addressed with extensive hemorrhagic syndrome, bleeding from mucous membrane, and single platelets in blood. Prescribe the therapy.

  1. Prednisolone 2 mg/kg per day, dicinon, vitamin С and Р.

  2. Dicinon, vitamins C, Р, salts of calcium.

  3. Prednisolone 1 mg/kg per day, vit. C and Р.

  4. Heparine 300-400 U/kg per day, prednisone 2 mg/kg per day.

  5. Dicinone, heparine 600 U/kg per day, vitamins C and Р.

 

Case 21. Which clinical symptom is the most typical for hemorrhagic disorders?

  1. Haemorrhage.

  2. Weakness.

  3. Fever.

  4. Pain in joints.

  5. Increase of liver.

 

Case 22. The haemorrhagic and abdominal syndrome are expressed at the child with the heavy form of haemorrhagic vasculitis, renal bleeding. Which therapy it is necessary to prescribe?

  1. Heparin , prednisolone 1.5-2 mg/kg per day.

  2. Prednisolone 1.5-2 mg/kg per day.

  3. Heparin 400 Un/kg per day, antihistaminic drugs, vikasol.

  4. Antihistaminic drugs, prednisolone 1.5-2 mg/kg per day.

  5. Haemotransfusions, aminocapronic acid, antihistaminic drugs.


Case 23. The most typical course of haemophilia is:

  1. Illness from childhood.

  2. The illness has arisen after an infection.

  3. Acute course with spontaneous remission.

  4. Illness connected to radial therapy.

  5. The illness has arisen after reception of antibiotics.

 

Case 24. Child of 5 months has admitted to hospital with the complaints on jaundice and pallor of skin, bad appetite, increase of temperature up to 37,3. The child was born from the first pregnancy and delivery, group of blood of the mother B (ІІІ) Rh+, child - O(I), Rh+. The mother is healthy, father has reticulocytosis. Objective - condition is severe, expressed jaundice, pallor, anxiety. The abdomen is increased, liver +3 cm, spleen +4 cm from rib arc. Urine is dark, the stool is not changed. Which is the most probable diagnosis?

  1. Lucey’s jaundice.

  2. Acute leukaemia.

  3. Hepatitis.

  4. Haemolytic disease of newborn.

  5. Inherent haemolytic anemia.

 

Case 25. Child is 4 years of age. He is ill for the first time. He complains of weakness, tiredness. There are multiple haematoms in different stage on pale skin, gingival bleeding. In blood: Нb-73 g/l, RBC -2,1 Т/l, plat.-100 G/l, WBC-24,0 G/l, eos-2, band-2, segm-20, lymph.-55, mon.-10, blasts-11. In myelogramm- 91% of blast cells. Make the diagnosis.

  1. Acute lymphoblast leukaemia.

  2. Acute myeloblast leukaemia.

  3. Chronic lymphoblast leukaemia.

  4. Hodgkin’s disease.

  5. Leukemoid reaction.

 

Case 26. The boy suffering from haemophilia A has massive bleeding in 8 hours after a falling from alveola of dropped tooth. Indicate the main method of therapy of the child?

  1. Cryoprecipitate.

  2. Dicinone.

  3. Transfusion of erythrocytes.

  4. Vicasol.

  5. Transfusion of fresh refrigerated plasma.

 

Case 27. Child is 14 years old. He complains to slackness, weakness, increase of lymphatic nodes in all groups, increase of liver up to 5 cm. In blood: blast cells - 2 %, in myelogramm – blast cells 90%. The diagnosis of acute lymphoblasic leukaemia was made. Select an optimum method of therapy?

  1. Course of polychemotherapy.

  2. Radial therapy.

  3. Course of monochemotherapy.

  4. Glucocorticoids.

  5. Antibiotics.

 

Case 28. The Hodgkin’s disease is suspended at the child of 10 years. Which is the most typical clinical symptom of this disease?

  1. Increase of cervical lymphatic nodes.

  2. Fever.

  3. Anemia.

  4. Increase of spleen.

  5. Bleeding.

 

Case 29. The child of 4 years has complaints on haemorrhages on legs and hands after scheduled vaccination. The diagnosis: haemorrhagic vasculitis, skin form. Which is the most typical character of haemorrhages at this disease?

  1. Vasculitic-purple.

  2. Angiomatous.

  3. Haematomous.

  4. Petechial-macular.

  5. Microcirculatory-haematomous.

 

Case 30. The Hodgkin’s disease is suspected at the child of 14 years with increase of cervical nodes, night itch, fever, loss of weight. Which method is most informative for confirmation) of the diagnosis?

  1. Biopsy of node.

  2. Punction of node.

  3. Punction of spleen.

  4. Leukocytes formula of blood.

  5. Radio-isotope research of lymphatic system.


Test answers


1

A

2

A

3

A

4

A

5

A

6

A

7

A

8

B

9

A

10

C

11

A

12

E

13

A

14

B

15

A

16

E

17

A

18

A

19

B

20

A

21

A

22

A

23

A

24

E

25

A

26

A

27

A

28

A

29

A

30

A

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