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1. Терапевтичний профіль

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Крок 2 Medicine

1. Терапевтичний профіль


A 47 y.o. woman complains of having paroxysmal headaches for the last 5 years. The pain is

one-sided, intense, localised in frontal region of head, accompanied by nausea and stomach

discomfort, begins one of a sudden. Onset is usually preceded by vision reduction.

Anamnesis gives evidence of periodical AP rise, but at the moment the woman doesn't take

any medicines. Inbetween the onsets of headache her state is satisfactory. Objectively:

high-calorie diet (body weight index - 29), AP- 170/95 mm Hg. Neurologic state has no

pecularities. What is the most probable diagnosis?

A Migraine

B Chronic subdural hematoma

C Epilepsy

D Benign intracranial hypertension

E Hypertensive encephalopathy


A 7 y.o. boy suddenly felt pain in his right knee, it became edematic. The day before he took

part in a cross-country race. Family anamnesis has no data about hemophilia and bleeding

sickness. Objectively: body temperature is $37,5^0С$. The knee is painful, hot to the touch,

edematic with local tissue tension over it. Blood count: Нb- 123 g/L, leukocytes -

$5,6*10^9$/L, thrombocytes - $354*10^9$/L, prothrombin time - 12 seconds (normally 10-15

seconds), partly activated thromboplastin time - 72 seconds (normally 35-45 seconds).

Hemorrhage time is normal, VIII:C factor is 5\% of norm. What is the most probable


A Hemophilia A

B Hemophilia B

C Schoenlein-Henoch disease

D Vitamin K deficiency

E Thrombocytopenia


On the 3rd day after the acute anterior myocardial infarction a 55 y.o. patient complains of dull

ache behind his breast bone, that can be reduced by bending forward, and of dyspnea.

Objectively: AP- 140/180 mm Hg, heart sounds are dull. ECG results: atrial fibrillation with

frequence of ventricular contractions at the rate of 110/min, pathological Q wave and S-T

segment raising in the right chest leads. The patient refused from thrombolisis. What is the

most probable diagnosis?

A Acute pericarditis

B Pulmonary embolism

C Tietze's syndrome

D Dissecting aortic aneurysm

E Dressler's syndrome


A 54 y.o. man was admitted to the hospital with complaints of sudden intense headache in

occipital region and vomiting. In the medical hystory: moderate arterial hypertension, the

patient was taking hydrochlorothiazide. Three days ago he consulted a therapeutist about

intense headache that was suppressed by an analgetic. Objectively: consciousness is

confused, left pupil is mydriatic. Evident photophobia and tension of neck muscles. Left-side

hemiparesis with increased muscle tonus and reflexes. Body temperature is low, rash is

absent. AP- 230/130 mm Hg, Ps- 50 bpm, BR- 12/min. What is your preliminary diagnosis?

A Acute subdural hematoma

B Myasthenia

C Disseminated sclerosis

D Migraine

E Acute bacterial meningitis


A 51 y.o. women was taken to the emergency department in convulsive status epilepticus.

The first means of medical management should be:

A Ensuring that the airway is open and the patient is oxygenating

B Inserting a tongue blade

C Administering an instravenous bolus of 50\% dextrose

D Injecting 5 mg of diazepam followed by a loading dose of phenytoin

E Inducing pentobarbital coma


A 38 y.o. man complains of having occasional problems with swallowing of both hard and

fluid food for many months. Sometimes he feels intense pain behind his breast bone,

epecially after hot drinks. There are asphyxia onsets at night. He has not put off weight.

Objectively: his general condition is satisfactory, skin is of usual colour. Examination revealed

no changes of gastrointestinal tract. X-ray picture of thorax organs presents esophagus

dilatation with level of fluid in it. What is the preliminary diagnosis?

A Esophagus achalasia

B Myastenia

C Cancer of esophagus

D Esophagus candidosis

E Gastroesophageal reflux


A 35 y.o. woman consulted a doctor about occasional pains in paraumbilical and iliac region

that reduce after defecation or passage of gases. Defecation takes place up to 6 times a day,

stool is not solid, with some mucus in it. Appetite is normal, she has not put off weight. First

such symptoms appeared 1,5 year ago, but colonoscopy data reveals no organic changes.

Objectively: abdomen is soft, a little bit painful in the left iliac region. Blood and urine are

normal. What is the preliminary diagnosis?

A Irritable bowels syndrome

B Celiac disease

C Crohn's disease

D Pseudomembranous colitis

E Dispancreatism


The physician must undertake measures for primary prophylaxis of iron deficiency anemia.

Which of the following categories of patient are subject to such primary prophylactic


A Pregnant women

B Patients after 60

C All children

D Patients after operation

E Workers of industrial enterprises


A patient with unstable angina pectoris was given the following complex treatment:

anticoagulants, nitrates, $/alpha$-adrenoblockers. However on the third day of treatment the

pain still romains. Which in vestigation shoud be carried out to establish diagnosis?

A Coronarography

B Stress-echocardiogram

C Test with dosed physical exercises

D Esophageal electrocardiac stimulator

E Myocardial scintigraphy


The 28 y.o. woman applied to doctor because of limited loss of the hair. In the anamnesis -

she had frequent headache indisposition, arthromyalgia, fever, irregular casual sexual life,

drug user. RW is negative. What examination must be done first?

A Examination for HIV

B Examination for neuropathology

C Examination for gonorrhea

D Examination for fungi

E Examination for trichomoniasis


A 35 y.o. woman was admitted to thoracic surgery department with fever up to $40^0C$, onset

of pain in the side caused by deep breathing, cough with considerable quantity of purulent

sputum and blood with bad smell. What is the most likely diagnosis?

A Abscess of the lung

B Complication of liver echinococcosis

C Bronchiectatic disease

D Actinomycosis of lungs

E Pulmonary tuberculosis


A 67 y.o. patient complains of palpitation, dizziness, noise in ears, feeling of shortage of air.

Objectively: pale, damp skin. Vesicular respiration, respiratory rate- 22 per min, pulse- 200

bpm, AP- 100/70 mm Hg. On ECG: heart rate- 200 bmp, ventricular complexes are widened,

deformed, location of segments ST and of wave T is discordant. The wave Р is not changed,

superimposes QRST, natural conformity between Р and QRS is not present. What kind of

arrhythmia is present?

A Paroxismal ventricular tachycardia

B Sinus tachycardia

C Atrial flutter

D Ventricular extrasystole

E Atrial tachycardia


Male 30 y.o., noted growing fingers and facial scull, changed face. Complains of poor

eyesight, weakness, skin darkening, loss of body weight. X-ray shows broadening of sella

turcica, thinning of tuberculin sphenoidale, signs of increased intracranial pressure. What

diagnosis can you make?

A Adenoma of hypophysis

B Encephalitis of truncus

C Optico - hiasmatic arachnoiditis

D Adrenal gland tumor

E Tumor of pondo-cerebellar corner


A patient complains of a tormental (agonizing) cough with expectoration of up to 600 ml/daily

purulent chocolatecolor sputum with a decay smell. Onset of illness was abrupt, $t^0$-

$39^0C$, fever of irregular type. There is the area of darkening with a cavity in a center on

X-ray film, with irregular contours and level of liquid. What disease is the question?

A Gangrene of lung

B Tuberculosis

C Bronchiectatic illness

D Pneumonia complicated by an abscess

E Lobar pneumonia


A 24 y.o. patient complains of nausea, vomiting, headache, shortness of breath. He had an

acute nephritis being 10 y.o. Proteinuria was found out in urine. Objectively: a skin is

grey-pale, the edema is not present. Accent of II tone above aorta. BP 140/100-180/100 mm

Hg. Blood level of residual $N_2$- 6,6 mmol/L, creatinine- 406 mmol/L. Day's diuresis- 2300

ml, nocturia. Specific density of urine is 1009, albumin- 0,9 g/L, WBC- 0-2 in f/vis. RBC.- single

in f/vis., hyaline casts single in specimen. Your diagnosis?

A Chronic nephritis with violation of kidney function

B Feochromocitoma

C Hypertensive illness of the II degree

D Nephrotic syndrome

E Stenosis of kidney artery


A 33 y.o. male patient was admitted to a hospital. A patient is pale, at an attempt to stand up

he complains of strong dizziness. There was vomiting like coffee-grounds approximately hour

ago. BP- 90/60 mm Hg., pulse- 120 b/min. In anamnesis, a patient has suffered from ulcer of

the stomach, painless form during 4 years. An ulcer was exposed at gastrofiberoscopy. Your


A Ulcer of stomach, complicated with bleeding

B Ulcer of duodenum, complicated with bleeding

C Erosive gastritis

D Acute pleurisy

E Acute myocardial infarction, abdominal form


A 48-year-old patient complains of heaviness in the right hypochondrium, itching of the

skin.He had been treated in infectious diseases hospital repeatedly due to icterus and itch.

On physical exam: meteorism, ascitis, dilation of abdominal wall veins, protruded umbilicus,

spleen enlargement. What can be diagnosed in this case?

A Liver cirrhosis

B Cancer of the liver

C Cancer of the head of pancreas

D Gallstones

E Viral hepatitis B


A 25-year-old man has facial edema, moderate back pains. His temperature is $37,5^OС$,

BP 180/100 mm Hg,

hematuria [up to 100 in v/f], proteinuria [2,0 g/L], hyaline casts - 10 in v/f., specific gravity -1020.

The onset of the disease is probably connected with acute tonsillitis that started 2 weeks

ago. What is the most probable diagnosis?

A Acute glomerulonephritis

B Acute pyelonephritis

C Cancer of the kidney

D Urolithiasis

E Chronic glomerulonephritis


In the development of the inflammation processes glucocorticoids reduce the level of certain

most important active enzyme. It results also in the reducing of the synthesis of

prostaglandins and leucotrienes which have a key role in the development of inflammation

processes. What is the exact name of this enzyme?

A Phospholipase A2

B Arachidonic acid

C Lipoxygenasе

D Cyclooxygenase – 1

E Cyclooxygenase – 2


A 30 y.o. female with rheumatoid arthritis of five years duration complains of pain in the frist

three fingers of her right hand over past 6 weeks. The pain seems especially severe at night

often awakening her from sleep.The most likelly cause is?

A Carpal tunnel syndrome

B Atlanto-axial sublaxation of cervical spine

C Sensory peripheral neuropathy

D Rheumatoid vasculitis

E Rheumatoid arthritis without complication


A 19-year-old man has suffered from moderate mental retardation since childhood. The

patient is illiterate, can take care of himself, do simple household work and other kinds of

easy work under supervision. What does his rehabilitation [tertiary prevention] require?

A All the above mentioned

B Supervision of a social worker

C Physical work under supervision

D Supervision of relatives (if any)

E None of the above mentioned


A 38 y.o. patient was urgently admitted to the hospital with complaints of sudden weakness,

dizziness, loss of consciousness, body weight loss, nausea, vomiting, severe pain in

epigastric area, diarrhea, skin hyperpigmentation. What is the most probable diagnosis?

A Addisonic crisis

B Acute gastroenteritis

C Meningoencephalitis

D Scleroderma

E Pellagra


An unconscious patient presents with moist skin, shallow breathing. There are signs of

previous injection on the shoulders and hips. BP- 110/70 mm Hg. Tonus of skeletal muscles

and reflexes are increased. Cramps of muscles of the extremities are seen. What is the most

likely disorder?

A Hypoglycemic coma

B Hyperglycemic coma

C Hyperosmolar coma

D Hyperlactacidotic coma

E Stroke


A patient was admitted to the hospital on the 7th day of the disease with complaints of high

temperature, headache, pain in the muscles, especially in calf muscles. Dermal integuments

and scleras are icteric. There is hemorrhagic rash on the skin. Urine is bloody. The patient

was fishing two weeks ago. What is the most likely diagnosis?

A Leptospirosis

B Yersiniosis

C Salmonellosis

D Brucellosis

E Trichinellosis


A 60-year-old woman, mother of 6 children, developed a sudden onset of upper abdominal

pain radiating to the back, accompanied by nausea, vomiting, fever and chills. Subsequently,

she noticed yellow discoloration of her sclera and skin. On physical examination the patient

was found to be febrile with temp of $38,9^oC$, along with right upper quadrant tenderness.

The most likely diagnosis is:

A Choledocholithiasis

B Benign biliary stricture

C Malignant biliary stricture

D Carcinoma of the head of the pancreas

E Choledochal cyst


A 42-year-old woman suffers from bronchial asthma, has an acute attack of bronchial

asthma. What medication from the listed below is contraindicated to render a first aid?

A Euphylinum

B Izardin

C Corazolum

D Morphinum hydrochloride

E Strophanthin hydrochloride


A 62-year-old patient complaining of enlargement of cervical, supraclavicular and axillary

lymph nodes, subfebrile temperature for the last 3 months has been admitted to a hospital. In

blood: WBCs - $64\cdot10^9$/l, lymphocytes - 72\%. What method of study should be used to

specify the diagnosis?

A Myelogram

B Lymphography

C Lymphoscintigraphy

D X-rays

E Thermography


A 38 y.o. woman complains of a purulent discharge from the left nostril. The body temperature

is $37,5^0C$. The patient has been ill for a week and associates her illness with common

cold. There are a pain and tenderness on palpation of her left cheek. The mucous membrane

in the left nasal cavity is red and turgescent. The purulent exudate is seen in the middle

meatus in maxillary. What is the most probable diagnosis?

A Acute purulent maxillary sinusitis

B Acute purulent frontitis

C Acute purulent ethmoiditis

D Acute purulent sphenoiditis

E -


The complications of acute cholecystitis which require surgical intervention are as follows


A Jaundice

B Empyema of the gall-bladder

C Emphysematous gall-bladder

D Gall-bladder perforation

E Cholangitis conditioned by the presence of stones in the bile tract


A 22-year-old girl has been complaining of having itching rash on her face for 2 days. She

associates this disease with application of cosmetic face cream. Objectively: apparent

reddening and edema of skin in the region of cheeks, chin and forehead; fine papulovesicular

rash. What is the most likely diagnosis?

A Allergic dermatitis

B Dermatitis simplex

C Eczema

D Erysipelas

E Neurodermatitis


A schizophrenic patient considers himself to be "an outstanding scientist, a brilliant

composer and an unrivalled artist". He complains that "family and friends are always jealous

of him and want to poison him". Determine the psychopathological syndrome:

A Paranoiac

B Paranoid

C Manic

D Paratrophic

E Hebephrenic


A 42-year-old patient complains of back pain, darkened urine, general weakness, dizziness

that occurred after treating a cold with aspirin and ampicillin. Objectively: the patient is pale,

with subicteric sclerae. HR - 98 bpm. Liver - +2 cm, spleen - +3 cm. In blood: RBCs -

$2,6\cdot10^{12}$/l, Hb - 60 g/l, CI - 0,9, WBCs - $9,4\cdot10^9$/l, basophils - 0,5\%,

eosinophils - 3\%, stab neutrophils - 6\% segmented neutrophils - 58\%, lymphocytes - 25\%,

monocytes - 7\%, ESR - 38 mm/hour, reticulocytes - 24\%. Total bilirubin - 38 millimole/l. What

complication occurred in the patient?

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