1. A 76 y.o. woman complains of progressing swallowing disorder, mostly she has had problems with solid food for the last 6 weeks. Sometimes she has regurgitation of solid masses. Swallowing is not painful. She lost 6 kg. 10 years ago she had myocardial infarction, she takes constantly aspirin and prolonged nitrates. She consumes alcohol in moderate proportions, smokes. Objectively: icteric skin, neck has no peculiarities, lymph nodes are not enlarged. Thorax has no changes, cardiovascular system has no evident changes. Liver is +3 cm. What is the preliminary diagnosis

 
 
 
 
 

2. A 65 y.o. man who has problems with urination as a result of benign prostate gland adenoma developed fever and chill, hypo-tension, sinus tachycardia. Skin is warm and dry. Clinical blood analysis revealed absolute granulocytopenia. These hemodynamic changes are most likely to be caused by:

 
 
 
 
 

3. A 60 y.o. man complains of sense of heaviness in the region of scrotum. Objectively: scrotum edema in the left part. Testicle is of normal size, but there is a soft, scrotum limited edema over it that can be pressed and disappears when the patient lies down. What is the preliminary diagnosis?

 
 
 
 
 

4. A patient was delivered to a surgical department after a road accident with a closed trauma of chest and right-sided rib fracture. The patient was diagnosed with right-sided pneumothorax, it is indicated to perform drainage of pleural cavity. Pleural puncture should be made in:

 
 
 
 
 

5. A 40 year old woman has changes of mammary gland. What are the most often symtomps that precede the malignization?

 
 
 
 
 

6. Name a statistical observation unit for determination of influence amount of Blood sugar on the healing of wounds surface in a postoperative period:

 
 
 
 
 

7. A 20-year-old patient was delivered to the hospital in summer from the street with hemorrhage from the brachial artery. First medical aid involved application of a tourniquet for provisional arrest of bleeding. What is the maximal exposure of the tourniquet?

 
 
 
 
 

8. A 38 year old man, previously in good health, suddenly develops severe abdominal pain radiating from the left loin to groin and accompanied by nausea, perspiration and the need for frequent urination. He is restless, tossing in bed but has no abnormal findings. The most likely diagnosis is:

 
 
 
 
 

9. A 40 year old woman has a self-detected hard breast mass. The procedure of choice for confirming the diagnosis is:

 
 
 
 
 

10. During investigation for chronic, severe, epigastric pain, a 40 year old alcoholic man is found to have multiple areas of narrowing alternating with dilatation (“chain of lakes” appearance) of the main pancreatic duct. The operation of choice is:

 
 
 
 
 

11. Treatment of choice for duodenal obstruction caused by secondary duodenal hematoma that developed a few days after blunt abdominal injury is:

 
 
 
 
 

12. An anesthesiologist gives narcosis to the patient, he uses a non-reversible contour. Anesthetic is halothane. Air temperature in the operation room is 21°C, humidity 50%, level of noise 30 dB. What occupational hazard is the principal one under these conditions?

 
 
 
 
 

13. A patient suddenly felt an acute chest pain irradiating to the left arm. Objectively: the patient is excited, with pale skin. Breathing rate – 38/min, AP – 180/110 mm Hg. Later the patient lost consciousness and fell down. Pulse on the great vessels was absent, the pupils were equally dilated. What is the most likely diagnosis?

 
 
 
 
 

14. A 37-year-old patient has come to clinic being wounded in the area of umbilicus an hour ago. On physical exam, there is a prick and cut painful wound of about 0,5×1 cm around umbilicus on the abdominal skin with slight bleeding. How would you help this patient?

 
 
 
 
 

15. If a child has adherent fingers on his right hand, then what will be your diagnosis?

 
 
 
 
 

16. A 34-year-old patient was bitten by a dog 3 hours ago. There is a wound by dog teeth without bleeding in the left arm. What surgical help would you provide to this patient?

 
 
 
 
 

17. Purulent mediastinitis is diagnosed at a 63-year-old patient. What diseases from the stated below CANNOT cause the purulent mediastinitis?

 
 
 
 
 

18. A 36 year old patient was diagnosed with right-sided pneumothorax. What method of treatment is indicated to the patient?

 
 
 
 
 

19. The diagnosis of a right-sided pneumothorax is made to a 36- year-old patient. What method of treatment is indicated to the patient?

 
 
 
 
 

20. A 16 year old patient with complaints of frequent pain in the abdomen was diagnosed with melanoma, examination revealed also pigmentation of the mucosa and skin, polyp in the stomach and large intestine. It is know that the patients mother has an analogous pigmentation and has been often treated for anemia. What disease is suspected?

 
 
 
 
 

21. A 41 year old patient was admitted to the intensive care unit with hemorrhagic shock due to gastric bleeding. He has a history of hepatitis B during the last 5 years. The source of bleeding are esophageal veins. What is the most effective method for control of the bleeding?

 
 
 
 
 

22. It is suspected that a 34 year old patient has an abscess of Douglas pouches. What diagnostic method is to be chosen?

 
 
 
 
 

23. A patient has restrained umbilical hernia complicated by phlegmon hernia, it is necessary to take following actions:

 
 
 
 
 

24. A 52 year old man has recurrent transient ischemic attacks. Auscultation of the carotid arteries detected murmur. What diagnostic method is to be applied in the first place?

 
 
 
 
 

25. For the persons who live in a hot area after an accident at a nuclear object, the greatest risk within the first decade is represented by cancer of:

 
 
 
 
 

26. A 10 year old boy complains about pain in his left eye and strong photophobia after he had injured his left eye with a pencil at school. Left eye examination: blepharospasm, ciliary and conjunctiva congestion, cornea is transparent, other parts of eyeball have no changes. Visus 0,9. Right eye is healthy, Visus 1,0. What additional method would you choose first of all?

 
 
 
 
 

27. A patient had disorder of nasal respiration, mucopurulent discharges from nose, headache for 3 weeks. At anterior rhinoscopy in middle nasal meathus the stria of pus, edema, hyperemia of the mucosa of the nose have been determined. What diagnostic method is necessary to administer first of all?

 
 
 
 
 

28. A patient with acute purulent otitis media complicated by mastoiditis was admitted to a hospital. Roentgenogram of mastoid processes showed the shadowing of the cellular system on the lesion, absence of bone septa was present. What are the necessary therapeutic actions at the second stage of mastoiditis?

 
 
 
 
 

29. A 35-year-old woman was admitted to resuscitation department in asthmatic status. What is the most trustworthy criterion of breath effectiveness?

 
 
 
 
 

30. During dynamic investigation of a patient the increase of central venous pressure is combined with the decrease of arterial pressure. What process is proved by such combination?

 
 
 
 
 

31. A 22 year old patient was admitted to trauma center with complaints of pain in the left ankle joint that was getting worse during moving and weight bearing. On the clinical examination it was found that the patient had the closed fracture of medial malleolus without displacement. In which position should the foot be fixed in plaster cast?

 
 
 
 
 

32. A 74 y.o. patient has been ill with benign prostate hyperplasy for the last 5 years. 4 days ago, after alcohol consumption, there was an acute retention of urination. At the pre-admission stage his urinary bladder was catheterized with metallic catheter. Examination revealed: right epididymis is enlarged, thick and painful, there are purulent discharges from urethra. What way of emergency care must be chosen?

 
 
 
 
 

33. A rounded well-defined shadow was found in the costo-vertebral angle on the chest roentgenogram of an otherwise healthy 9 year old girl. Make a preliminary diagnosis:

 
 
 
 
 

34. A 4 y.o. child attends the kindergarten. Complains of poor appetite, fatigue. Objective examination: skin and mucous membrane are pale, child is asthenic. In the hemogram: hypochromatic anemia 1st, leucomoide reaction of the eosinophile type. What pathology must be excluded first of all?

 
 
 
 
 

35. A 33 year old male patient was brought to Emergency Department with the signs of cardiovascular collapse: BP – 60/30 mm Hg, Ps – 140 bpm, the skin is pale and moist, diuresis 20 ml/h, Hb – 80 g/l, red blood cell count – 2,5×1012/l. The reduction of blood volume averages: A. 30-40% à stage 3 Hypovolumic shock

 
 
 
 
 

36. A 19 year old girl was admitted to emergency department: unconsciousness, cyanosis, myotic pupils are present, superficial breathing is 12/min. BP is 90/60 mm Hg, Ps- 78/min. Choose the action necessary in this clinical situation:

 
 
 
 
 

37. What preparations are used for prevention of fungal infection?

 
 
 
 
 

38. 30 y.o. woman, had mild trauma of 5th finger of the left hand 15 days ago. She has treated her self at home. She presents to the hospital due to deterioration of the condition and temperature rise. Objectively: hyperemia and swelling on the ventral surface of finger. Restricted movements of the finger. X-ray of the left hand: an early stage of osteomyolitis of the fifth finger could not be excluded. The diagnosis: panaris of 5th finger of the left hand. What form of panaris has occurred in the patient?

 
 
 
 
 

39. A 30 year old man complains of acute pain in his right ear, hearing loss, high temperature for three days. Objectively: right ear whispering language – 0,5 mm, external ear is intact, otoscopically – eardrum protrusion, hyperemia and swelling, loss of landmarks. What disease is it?

 

 

 

 

 

 
 
 
 
 

40. A patient is staying in the hospital with the diagnosis of abdominal typhus. During the 3-d week from the beginning of the disease the patient stopped keeping diet and confinement to bed. As a result the body temperature and rapid pulse decreased and melena appeared. What kind of complications should we think about first of all?

 
 
 
 
 

41. A 45-year-old woman, mother of four children, comes to the emergency room complaining of a sudden onset of the epigastric and right upper quadrant pain, radiating to the back, accompanied by vomiting. On examination, tenderness is elicited in the right upper quadrant, bowel sounds are decreased, and laboratory data shows leukocytosis, normal serum levels of amylase, lipase, and bilirubin. The most likely diagnosis is:

 
 
 
 
 

42. During an operation for presumed appendicitis the appendix was found to be normal; however, the terminal ileum is evidently thickened and feels rubbery, its serosa is covered with grayish-white exudate, and several loops of apparently normal small intestine are adherent to it. The most likely diagnosis is:

 
 
 
 
 

43. A 50 year old woman with a 2-year history of mild, diffuse, tender thyroid enlargement complains of 10 pound weight gain and fatigue. What is the most probable diagnosis ?

 
 
 
 
 

44. The 67 y.o. patient had 5 recurrent fractures of the lower extremities without considerable cause within 5 years. O-shaped deformity of the legs in the knee joints has appeared. The skull, pelvis and lower extremities X-Ray shows the thickening of flat bones. In the long bones there is a hyperostosis along the bone axis. The blood test has not revealed any inflammation activity. Serum calcium is normal. What disease do you consider in this case?

 
 
 
 
 

45. A 33 y.o. patient was admitted to the reception room of the Central District Hospital. He complains of a severely painful swelling localized on posterior neck, fever up to 38,4°C and general weakness. In anamnesis: diabetes mellitus within 5 years. On physical examination on the posterior neck surface there is an infiltrate elevated above surrounding skin. The tissues affected by swelling are tense and blue reddish discoloration in central area. There are also several purulent necrotic pustules which are connected with each other and form a large skin necrosis. A thinned necrotic skin of this swelling has holes looking like sieve, pus discharges through out. What disease should a doctor consider first of all?

 
 
 
 
 

46. A 19 y.o. man was admitted to the reception department in 20 minutes after being wounded with the knife to the left chest. The patient is confused. The heart rate is 96 bpm and BP- 80/60 mm Hg. There are the dilated neck veins, sharply diminished apical beat and evident heart enlargement What kind of penetrative chest wound complications has developed in patient?

 
 
 
 
 

47. A 35 y.o. patient complains of a difficult swallowing, pain behind the breastbone. He can eat only liquid food. While swallowing sometimes he has attacks of cough and dyspnea. Above mentioned complaints are progressing. It is known that the patient has had a chemical burn of esophagus one month ago. What complication does the patient have?

 
 
 
 
 

48. A patient operated for acute paraproctitis undergoes antibacterial and detoxification therapy, the local course of the disease has the positive dynamics. Since the operation the patient has had chills, pyrexia, tachycardia, euphoria for five days. The doctor suspected sepsis. What study will confirm the diagnosis?

 
 
 
 
 

49. A 44-year-old patient has been admitted to a hospital with complaints of dull, aching pain in the left lumbar region, the admixture of pus in the urine. Examination revealed a grade II staghorn calculus on the left. What method of treatment is indicated for this patient?

 
 
 
 
 

50. An emergency team has delivered to a hospital an unconscious patient found lying in the street in winter. Objectively: the patient is pale, with superficial respiration; bradycardia with heart rate 54/min, to- 35°C. AP- 100/60 mm Hg. Palpation of chest and abdomen revealed no peritoneal symptoms. There is a smell of alcohol from the patients mouth. What is the most likely diagnosis ?

 
 
 
 

51. A 48-year-old patient got a job-related injury of a hypodermic varicose vein on his shin that was accompanied by the intensive phleborrhagia. Choose the optimal variant of first aid:

 
 
 
 
 

52. A 24-year-old patient got a puncture injury below the Pouparts ligament accompanied by intense arterial bleeding. The best method to temporarily stop the bleeding in the patient would be :

 
 
 
 
 

53. While making a round, a doctor had noticed the edema of the right shoulder of a 26-day-old child with diagnosis of “umbilical sepsis”. Active movements in the shoulder joint were absent, right hand was hanging down. Mother stated that her childs condition had worsened for the last 24 hours what resulted in childs refusal to be breast-fed, restlessness, weeping while swaddling, rise in body temperature up to 38,8°C. What is the most probable preliminary diagnosis?

 
 
 
 
 

54. A 65-year-old patient complains of dull pain in the rectum during and after defecation, discharge of mucus and small amount of blood mixed up with mucus and feces. The discharged blood is of dark red color, sometimes with small amount of clots. The patient is sick for 8 months, has lost some weight.On digital examination, there is a round constriction of the rectum with infiltrate at a height of 4-5 cm from the anus. What is the most probable diagnosis?

 
 
 
 
 

55. A 52 y.o. patient fell from 3 m height on the flat ground with the right lumbar area. He complains of pain in this area. There is microhematuria in the urea. Excretory urography revealed that kidneys functioning is satisfactory. What is the most probable diagnosis?

 
 
 
 
 

56. A female patient has been suffering from pain in the right subcostal area, bitter taste in the mouth, periodical bile vomiting for a month. The patient put off 12 kg. Body temperature in the evening is 37,6°C. Sonography revealed that bile bladder was 5,5 x 2,7 cm large, its wall – 0,4 cm, choledochus – 0,8 cm in diameter. Anterior liver segment contains a roundish hypoechoic formation up to 5 cm in diameter and another two up to 1,5 cm each, walls of these formations are up to 0,3 cm thick. What is the most likely diagnosis?

 
 
 
 
 

57. A 36-year-old woman applied to doctor with complaints of the enlargement of the right mammary gland. On physical exam: the right mammary gland is enlarged, hardened; nipple with areola is pasty and hydropic, looks like “lemon peel”. There palpates a lymph node in the right axilla, 1,5 cm in diameter, dense consistence, not mobile. What is the most probable diagnosis?

 
 
 
 
 

58. A 43 year old patient had cholecystectomy 6 years ago because of chronic calculous cholecystitis. Lately he has been suffering from pain in the right subcostal area and recurrent jaundice. Jaundice hasn’t gone for the last 2 weeks. Stenosing papillitis 0,5 cm long has been revealed. What is the best way of treatment?

 
 
 
 
 

59. A 49-year-old male patient who had been scheduled for a surgery for gastric cancer underwent preoperative infusion therapy. Up to 3,0 liters of liquid was introduced into the right cubital vein. The following day, he felt a dragging pain in the right shoulder. Objectively: on the inner surface of the shoulder there is a longitudinal hyperemic zone, edema of skin, a tender cord. What complication occurred in the patient?

 
 
 
 
 

60. A 54-year-old patient applied with complaints of acute pain in the shoulder joint. 10 minutes earlier he fell in the street with his arms stretched. Doctor of the traumatological unit noticed an acute deformation of the right shoulder joint, the impossibility of active movement in the right extremity. Roentgenologically: uncoincidence of articulating surfaces. What is the most probable diagnosis?

 
 
 
 
 

61. A 62-year-old patient has been delivered to the surgical department with complaints of sudden pain in the umbilical region irradiating to the back and groin, which was accompanied by a syncope. Objectively: the patient is in grave condition, umbilical region is tender on palpation, bowel sounds are diminished. AP drop is present. USI reveals: free fluid in the abdomen, thickening of the wall of the abdominal aorta. The most likely diagnosis is:

 
 
 
 
 

62. Parents of a 2-year-old boy applied to clinic complaining of right testicle absence in the scrotum of a boy. While examining the boy, hypoplasia of the right half of the scrotum was revealed, absence of the testicle. Testicle is miniaturized, it palpitates along the inguinal canal but it could not be moved down to scrotum. What is the most probable diagnosis?

 
 
 
 
 

63. A patient suffers from suddenly arising crampy pain in the right loin area. 2 hours after the pain had started, hematuria took place. Loin X-ray: no pathological shadows. Ultrasound: pyelocaliectasis on the right, the left part is normal. What is the most probable diagnosis?

 
 
 
 
 

64. A patient complains of an extremely intense pain in epigastrium. He has peptic ulcer disease of duodenum for 10 years. The patient is in the forced position being on the right side with legs abducted to stomach. Abdomen has acute tenderness in the epigastrium. Guarding contraction of the abdominal wall muscles is observed. What is the preliminary diagnosis?

 
 
 
 
 

65. A 30-year-old patient complains of pain, hyperemia along subcutaneous veins, rise in body temperature. While examining the large shin subcutaneous vein, there is hyperemia, pain by pressing. Homanss and Lusess symptoms are negative. What is the preliminary diagnosis?

 
 
 
 
 

66. A 30-year-old man has suffered from traffic accident. Consciousness is absent. Pulse on the carotid artery is undeterminable, no respiration. There is a wide leather belt on mans waist. What measures are to be taken?

 
 
 
 
 

67. 3 days ago a 29-year-old patient presented with pulsating pain in the region of rectum, fever, general weakness. Objectively: local tenderness in the anal region in the 6 oclock position. Digital investigation of rectum revealed a painful infiltration reaching the pectinate line. What is the most likely diagnosis?

 
 
 
 
 

68. A 65-year-old patient complains of gradual worsening of the left eye vision during 10 months. On physical examination: acuity of vision of the left eye is 0,01, not correctable. The eye is quiet, pupil of the eye is grayish, reflex from the eye-ground is absent. Intraocular pressure is 18 mm/Hg. What is the most probable preliminary diagnosis?

 
 
 
 
 

69. A 36 y.o. patient was admitted to the hospital with sharp pain in substernal area following occasional swallowing of a fish bone. On esophagoscopy the foreign body wasnt revealed. The pain increased and localized between scapulas. In a day temperature elevated, condition became worse, dysphagia intensified. What complication has developed?

 
 
 
 
 

70. A 19 year old patient was admitted to a hospital with acute destructive appendicitis. He suffers from hemophilia of B type. What antihemophilic medications should be included in pre- and post-operative treatment plan?

 
 
 
 
 

71. On the 4th day after recovering from a cold a patient was hospitalized with complaints of solitary spitting of mucoid sputum. On the 2nd day there was a single discharge of about 250 ml of purulent blood-streaked sputum. Objectively: the patients condition is moderately severe. Respiratory rate – 28-30/min, Ps- 96 bpm, AP- 110/70 mm Hg. Respiration above the left lung is vesicular, weak above the right lung. There are moist rales of different types above the lower lobe and amphoric breath near the angle of scapula. What is the most likely diagnosis?

 
 
 
 
 

72. A patient complains of intense pressing pain in the pharynx, mainly to the right, impossibility to swallow even liquid food. The illness started 5 days ago. The patients condition is grave. Body temperature – 38,9°C, speech is difficult, voice is constrained, difficulties in opening the mouth. Submaxillary glands to the right are painful, enlarged. What is the most probable diagnosis?

 
 
 
 
 

73. In a 65 y.o. female patient a tumor 13×8 cm in size in the umbilical area and above is palpated, mild tenderness on palpation, unmovable, pulsates. On auscultation: systolic murmur. What is the most probable diagnosis?

 
 
 
 
 

74. An hour before an elective surgery, a 56-year-old patient of the surgical department got a dramatic increase in blood pressure, tachycardia, hand tremor. The patient is confused, anxious, depressed, fearful, is pessimistic about the operation outcome, refuses the surgery. What tactics should be chosen by a surgeon?

 
 
 
 
 

75. A patient with suspicion of pelvic bones fraction is under examination conducted by the doctor who presses alae ilii in medial direction with his both hands. What causes painful syndrome of the patient?

 
 
 
 
 

76. A 30-year-old man was injured in a fire and got thermic burns of III -A and III-B degree that affected 20% of the total skin. AP – 110/70 mm Hg, heart rate -120/min. What transfusion means should be used for blind infusion before transportation?

 
 
 
 
 

77. A 48-year-old male patient complains of pain in the lower extremities, especially when walking, intermittent claudication, numbness in the fingers, cold extremities, inability to walk more than 100 meters. Sleeps with his leg lowered. The patient has been a smoker since he was 16, abuses alcohol, has a history of CHD. The left lower extremity is colder than the right one, the skin of extremities is dry, pedal pulse cannot be palpated, femoral pulse is preserved. What is the most likely diagnosis?

 
 
 
 
 

78. A 24 y.o. woman consulted a doctor about continued fever, night sweating. She lost 7 kg within the last 3 months. She had casual sexual contacts. Objectively: enlargement of all lymph nodes, hepatolienal syndrome. Blood count: leukocytes – 2,2×109/L. What disease can be suspected?

 
 
 
 
 

79. Development of chronic venous insufficiency of lower extremities depends on the functional condition of so-called musculovenous pump. This term refers to the following group of muscles:

 
 
 
 
 

80. A 27-year-old patient was brought to clinic with a crashed wound of the posterior surface of the right shin in 2 hours after the accident happened. During surgical treatment pieces of dirty clothes and gravel were removed. What actions from the given below are the decisive ones to prevent an anaerobic infection?

 
 
 
 
 

81. A 32-year-old patient lives in an area endemic for echinococcosis. In the last 6 months he reports of pain in the right subcostal area, fever. He is suspected to have liver echinococcosis. What study would be the most informative in this case?

 
 
 
 

82. In morgue there are dead bodies with the following causes of death: electrotrauma; rupture of the spleen with acute anemia. There is one unknown person; one ethyl alcohol poisoned person and one drowned man. What dead body should the blood group be determined for?

 
 
 
 
 

83. A 50 y.o. patient was admitted to the hospital with complaints of blood in urine. There was no pain or urination disorders, hematuria has lasted for 3 days. Objectively: kidneys are not palpable, suprapubic region has no peculiarities, external genitals have no pathology. Rectal examination revealed: prevesical gland is not enlarged. Cytoscopy revealed no changes. What disease would you think about first of all?

 
 
 
 
 

84. A patient complains of nycturia, constant boring pain in perineum and suprapubic region, weak urine jet, frequent, obstructed and painful urination. He has been ill for several months, pain in perineum appeared after getting problems with urination. Rectal examination revealed that prostate is enlarged (mostly owing to the right lobe), dense, asymmetric, its central sulcus is flattened, the right lobe is dense, painless, tuberous. What disease can it be?

 
 
 
 
 

85. On the 5th day after a surgery for colon injury a patient complains of bursting pain in the postoperative wound, weakness, drowsiness, headache, fever up to 40°C. Objectively: the skin around the wound is swollen, there is gas crepitation. The wound discharges are scarce foul-smelling, of dark-gray colorl. What is the most likely diagnosis?

 
 
 
 
 

86. A childrens surgical unit admitted a 1-month-old boy who had been prenatally diagnosed with the left-sided pyelectasis. Such studies as drip infusion urography, cystography and USI allowed to reveal initial hydronephrosis. There is no information confirming the secondary pyelonephritis. What tactics of this patient management is most advisable?

 
 
 
 
 

87. A 60 y.o. man complains of significant pain in the right eye, photophobia, lacrimation, reduced vision of this eye, headache of the right part of the head. Pain occured 2 days ago. On examination: Vis OD- 0,03, congested injection of the eye ball, significant cornea edema, front chamber is deep, pupil is narrow, athrophic iris, there is optic nerve excavation on the eye fundus, intraocular pressure- 38 mm Hg. Vis OS- 0,8 unadjustable. The eye is calm, healthy. Intraoccular pressure- 22 mm Hg. What is the most probable diagnosis?

 
 
 
 
 

88. A 54-year-old female patient has been admitted to a hospital 12 days after the beginning of acute pancreatitis. Objectively: the patient is in grave condition. The body temperature is hectic. Ps – 112 bpm. The abdomen is swollen. Epigastrium palpation reveals a very painful infiltration falling in the localization of pancreas. Abdominal cavity contains fluid. There is an edema of the left lumbar region. In blood: WBCs – 18×109/l. What is the required tactics of the patients treatment?

 
 
 
 
 

89. A 37-year-old male patient has a history of diabetes of moderate severity. On the left side of face the patient has a carbuncle. What severe complication might have occurred in the patient?

 

 

 
 
 
 
 

90. To replace the blood loss replacement 1000 ml of the same group of Rhesus-compatible donated blood was transfused to the patient. The blood was conserved by sodium citrate. At the end of hemotransfusion there appeared excitement, pale skin, tachycardia, muscles cramps in the patient. What complication should be suspected?

 
 
 
 
 

91. A 20 y.o. patient suddenly felt ill 12 hours ago. There was pain in epigactric area, nausea, sporadic vomiting. He had taken alcohol before. In few hours the pain localized in the right iliac area. On examination: positive rebound tenderness symptoms. WBC- 12,2×109/L. What is the most probable diagnosis?

 
 
 
 
 

92. A patient, aged 58, was fishing in the winter. On return home after some time felt some pain in the feet. Consulted a doctor. On examination: feet skin was pale, then after rewarming became red, warm to the touch. Edema is not significant, limited to the toes. All types of sensitivity are preserved. No blisters. What degree of frostbite is observed?

 
 
 
 
 

93. After an accident a patient complains of pain in the hip joint. Objectively: the leg is in the position of flexion, adduction and internal rotation, significantly contracted. There is elastic resistance to passive adduction or abduction of the extremity. Major trochanter is located high above the Roser-Nelaton line â. A significant lordosis is present. What is your provisional diagnosis?

 
 
 
 
 

94. Three weeks after acute angina the patient is still weak, inert , subfebrile, his retro maxillary lymph nodes are enlarged. Tonsils are flabby, stick together with arches, there are purulent plugs in lacunae. What is the most probable diagnosis?

 

 

 

 

 

 
 
 
 
 

95. A 43 year old patient had right-sided deep vein thrombosis of iliofemoral segment 3 years ago. Now he is suffering from the sense of heaviness, edema of the lower right extremity. Objectively: moderate edema of shin, brown induration of skin in the lower third of shin, varix dilatation of superficial shin veins are present. What is the most probable diagnosis?

 

 

 

 

 

 
 
 
 
 

96. A child undergoes in-patient treatment for acute staphylococcal destruction of the right lung. Unexpectedly he developed acute chest pain on the right, dyspnea, cyanosis. The right side of chest lags behind in the respiratory act. Percussion reveals dullness in the lower parts on the right, bandbox resonance in the upper parts. Borders of the relative cardiac dullness are shifted to the left. What complication has most likely developed?

 

 

 

 

 

 
 
 
 
 

97. A 98 y.o. male patient complains of pain in the left lower limb which intensifies on walking, feeling of cold and numbness in both feet. He has been ill for 6 years. On examination: pale dry skin, hyperkeratosis. Hairy covering is poorly developed on the left shin. “Furrow symptom ” is positive on the left. Pulse on foot arteries and popliteal artery isnt palpated, on the femoral artery its weak. On the right limb the artery pulsation is reserved. What is the most probable diagnosis?

 

 

 

à young men , SMOKER

 

 
 
 
 
 

98. Examination of a dead man who died from hanging revealed that cadaver spots disappeared when pressed upon and restored after 50 seconds, rigor mortis was moderately expressed only in the masticatory muscles and the muscles of neck and fingers. Body temperature was 31°C. Specify the time of death:

 
 
 
 
 

99. After contusion of the right eye a patient complains of sudden loss of vision with remaining light perception. Objectively: the eye is not irritated. The cornea is transparent. Pupil reacts to light. The pupil area is black. The fundus reflex is absent. What is the most likely cause of vision loss?

 
 
 
 
 

100. A 65-year-old patient complains of pain in the lumbar spine, moderate dysuria. He has been suffering from these presentations for about half a year. Prostate volume is 45 cm3 (there are hypoechogenic nodes in both lobes, capsule invasion). The rate of prostate-specific antigen is 60 ng/l. Prostate biopsy revealed an adenocarcinoma. Which of the supplemental examination methods will allow to determine the stage of neoplastic process in this patient?

 
 
 
 
 

101. X-ray picture of chest shows a density and an abrupt decrease in the upper lobe of the right lung. The middle and lower lobe of the right lung exhibit significant pneumatization. The right pulmonary hilum comes up to the dense lobe. In the upper and middle parts of the left pulmonary field there are multiple focal shadows. In the basal region of the left pulmonary field there are clear outlines of two annular shadows with quite thick and irregular walls. What disease is this X-ray pattern typical for?

 
 
 
 
 

102. A 30-year-old patient had deep burn covering 30% of body 30 days ago. Now he presents with continued fever, loss of appetite, night sweats. Burned surface weakly granulates. What is the stage of burn disease?

 

 

 

 

 

 
 
 
 
 

103. A 29 y.o. patient was admitted to the hospital with acute girdle pain in epigastric area, vomiting in 1 hour after the meal. On examination: pale, acrocyanosis. Breathing is frequent, shallow. Abdominal muscles are tensed, positive Schotkin-Blumbergs symptom. What is the maximal term to make a diagnosis?

 

 

 

 

 

 
 
 
 
 

104. A surgeon examined a 42-year-old patient and diagnosed him with right forearm furuncle at the purulo-necrotic stage. The furuncle was lanced. At the hydration stage the wound dressing should enclose the following medication:

 
 
 
 

105. A 30 year old patient undergoes treatment because of Werlhofs disease. Objectively: the patient is pale, there are petechial hemorrhages on the extension surfaces of forearms. Ps is 92 bpm, AP is 100/60 mm Hg. The lower edge of spleen is at a level with umbilicus. Blood count: erythrocytes: 2,8×1012/l, Hb – 90 g/l, Ht – 0,38, thrombocytes – 30×109/l. The patient is being prepared for splenectomy. What transfusion medium should be chosen in the first place for the pre-operational preparation?

 
 
 
 
 

106. A 19 year old boy was admitted to a hospital with closed abdominal trauma. In course of operation multiple ruptures of spleen and small intestine were revealed. AP is falling rapidly, it is necessary to perform hemotransfusion. Who can specify the patients blood group and rhesus compatibility? A. A doctor of any specialty

 
 
 
 
 

107. A 36-year-old man was delivered to the surgical department an hour after a road accident. His condition is getting worse: respiratory insufficiency is progressing, there are cardiac abnormalities. Clinical and roentgenological investigations revealed mediastinal displacement. What process has caused this complication?

 

 

 

 

 

 
 
 
 
 

108. A victim of the car crash was brought to neurosurgery due to craniocerebral trauma. During examination symptoms of focused injury of the cerebrum are found, cerebrum contusion is suspected. What method of examination is to be used?

 
 
 
 
 

109. A 35 y.o. female patient was admitted to the surgical department with symptoms of ulcerative gastric hemorrhage. Its been the third hemorrhage for the last 2 years. After conservative treatment vomiting with blood stopped, hemoglobin elevated from 60 till 108 g/L. General condition became better. But profuse vomiting with blood reoccurred in 2-3- hours. Hemoglobin decreased to 93,1 g/L then to 58,1 g/L. What is the tactics of treatment?

 
 
 
 
 

110. A 39-year-old patient complains of a tumor on the anterior surface of her neck. The tumor has been observed for 2 years. It is non-mobile and has enlarged recently. The patient has a changed tone of voice, a sense of pressure. Objectively: in the left lobe of the thyroid gland a 3 cm node is palpable; it is very dense,tuberous, painless. Cervical lymph nodes are enlarged. Functional status of the thyroid gland is unchanged.What is the most likely diagnosis?

 
 
 
 
 

111. An unconscious victim in severe condition is brought to clinic. It is known that the patient touched the bare wire with his hand and during 5 minutes was under the influence of an alternating current with voltage of 220 V. Physical exam: skin is pale, cold by touch. Breath is weakened, BP – 90/50 mm Hg, Ps – 60 bpm, arrhythmical. There are fields of necrosis of the skin on the right hand and on the right foot. What is the preliminary diagnosis?

 
 
 
 

112. A 47-year-old patient complains about cough with purulent sputum, pain in the lower part of the left chest, periodical body temperature rise. She has been suffering from these presentations for about 10 years. Objectively: “drumstick” distal phalanges. What examination would be the most informative for making a diagnosis?

 
 
 
 
 

113. Blood typing resulted in positive isohemagglutination reaction with standard sera of A(II) and B(III)groups and negative reaction with sera of 0(I) and AB(IV) groups. What is this result indicative of?

 

 

 

 

 

 
 
 
 
 

114. A victim of a road accident, aged 44, is operated on account of intraperitoneal hemorrhage. In which case can the patients blood from the abdominal cavity be used for auto transfusion?

 
 
 
 
 

115. A man with a stab-wound of the right foot applied to doctor. He stepped on the board with nail two hours ago. In the patient medical chart it is stated that 3 years ago he passed the whole course of vaccination against tetanus. What is the tactics of doctor to prevent tetanus in this case?

 
 
 
 
 

116. A 42-year-old patient with acute haemorrhage and class III blood loss underwent blood transfusion and got 1,8 l of preserved blood and erythromass of the same group and Rh. After the transfusion the patient complained of unpleasant retrosternal sensations, his arterial pressure dropped to 100/60 mm Hg, there appeared convulsions. Blood serum calcium was at the rate of 1,7 millimole/liter. What is the mechanism of this complication development?

 
 
 
 
 

117. A 40-year-old woman with acute gastrointestinal hemorrhage was transfused 400 ml of the preserved blood after having conducted all compatibility tests. After hemotransfusion the condition of the patient became worse. She started having headache, muscles pain, her temperature has risen up to 38,8°C. What is the reason for such condition of the patient?

 
 
 
 
 

118. A 27-year-old patient with a knife stomach wound has been delivered to a hospital 4 hours after injury.Objectively: the patient is in grave condition. Ps- 120 bpm, weak. AP- 70/40 mm Hg. Laparotomy revealed a lot of liquid blood in the abdominal cavity. The patient has been found to have bleeding from the mesenteric vessels of the small intestine. Damage to hollow organs has not been revealed. What is the best way to restore the blood loss?

 
 
 
 
 

119. A patient presented to a hospital with a carbuncle of the upper lip. The body temperature is 39°C. There is a pronounced edema of the upper lip and eyelids. What is the surgeons tactics of choice?

 
 
 
 
 

120. A patient, aged 25, suffering from stomach ulcer. Had a course of treatment in the gastroenterological unit. 2 weeks later developed constant pain, increasing and resistant to medication. The abdomen is painful in epigastric area, moderate defence in pyloroduodenal area. Which complication development aggravated the patients state?

 
 
 
 
 

121. A 62-year-old male patient complains of intense pain in the left leg that suddenly arose three hours before, leg numbness and coldness. During the year there has been pain in the leg while walking,hypersensitivity to cooling. Objectively: the left foot and shin have marbled skin, subcutaneous veins are collapsed. The foot is cold, active movements of the foot and toes are preserved. Pulse is present only on the femoral artery. There is rough systolic murmur above the artery. Make a provisional diagnosis:

 
 
 
 
 

122. A patient complains about pyrosis and permanent pain behind his breastbone. When he bends forward after eating there appears regurgitation. Roentgenological examination revealed extrasaccular cardio functional hernia of esophageal opening of diaphragm. Esophagoscopy revealed signs of reflux esophagitis. What is the necessary treatment tactics?

 
 
 
 
 

123. A patient aged 18 with a cranial injury was in comatose state during several hours. In post-comatose period gets tired quickly, non-productive in dialog – in the beginning answers 2-3 questions, then gets tired and can not understand the point of the question. Which psychotropic should be given to the patient to prevent psychoorganic syndrome?

 
 
 
 
 

124. A 45-year-old male patient with acute abscess of the left lung has suddenly developed acute chest pain and dyspnea while coughing, tachycardia has increased. The control Ro-gram shows left lung collapse, the air in the left pleural cavity and a horizontal fluid level. What is the mechanism of this complication?

 
 
 
 
 

125. Examination of a 38-year-old patient who had been hit with a blunt object on the left side of chest revealed a fracture of the X rib with fragments displacement, parietal pneumothorax. The patient complains of pain in the left subcostal area. Objectively: the patient is pale, AP- 80/40 mm Hg, Ps- 138/min, of poor volume. USI reveals fluid in the left abdomen. Splenic rupture is present. What treatment tactics should be chosen?

 
 
 
 
 

126. On the 2nd day after a surgery for toxic mixed goiter IV a 35-year-old patient complains of heart pain. ECG shows prolonged QT intervals. Chvosteks and Trousseau symptoms cannot be clearly defined. The patient is provisionally diagnosed with latent tetany. What study will allow to confirm the diagnosis?

 
 
 
 
 

127. A patient with bilateral hydrothorax has repeatedly undergone pleural puncture on both sides. After a regular puncture the patients condition has become worse: he presents with fever, chest pain. The next day, the attending physician performing pleural puncture revealed some pus on the right. What is the mechanism of acute right-sided empyema development?

 
 
 
 
 

128. A 38 y.o. patient lifted a heavy object that resulted in pain in the lumbar part of spine irradiating to the posterior surface of his left leg. The pain increases during changing body position and also in the upright position. Examination revealed positive symptoms of tension. What is the preliminary diagnosis?

 
 
 
 
 

129. Two hours ago a 38-year-old patient got pain in his right shin. He was diagnosed with popliteal artery embolism, acute arterial insufficiency of grade I. What is the most appropriate therapeutic tactics?

 
 
 
 
 

130. A 38-year-old patient has suddenly developed pain in the left side of his chest, suffocation. Objectively: moderately grave condition, Ps- 100/min, AP-90/60 mm Hg, breath sounds on the left cannot be auscultated. Chest radiography shows the collapse of the left lung up to 1/2. What kind of treatment should be administered?

 

 

 

 

 

 
 
 
 
 

131. A 47-year-old female patient complains of leg heaviness, fatigue when standing and walking. This feeling disappears when she takes a horizontal position. Objectively: dilatation of the superficial veins of the left shin and thigh with pigmentation and trophic skin disorders. What functional test should the examination be started with?

 
 
 
 
 

132. A neonatologist examining a full-term mature baby revealed the shortening and external rotation of the newborns lower extremity. Clinical examination revealed positive Ortolani sign, symptom of non-vanishing pulse, additional skin folds on the internal surface of thigh. What is the most likely diagnosis?

 
 
 
 
 

133. A 10-year-old child has been admitted to a hospital with a closed craniocerebral injury with suspected cerebral edema. The patient is in grave condition, unconscious. The dyspnea, tachycardia, hypertension are present. Muscle tone is increased, there is nystagmus, pupillary and oculomotor reactions are disturbed. The mandatory component of intensive care is dehydration. What diuretic is adequate in this case?

 
 
 
 
 

134. A 40-year-old patient underwent an operation for a lumbar phlegmon. Body temperature rose again up to 38°C, he got intoxication symptoms, there was an increase of leukocyte number in blood. The wound that was nearly free from necrotic tissues and full of granulation started to discharge pus, the granulation turned pale. What complication developed in this patient?

 
 
 
 
 

135. After a car accident a 37-year-old patient has an acute pain and bleeding in the middle third of his right thigh. Objectively: there is a wound on the anterior surface of the right thigh with massive bleeding, abnormal mobility at the level of the middle third of the thigh. The first aid is to be started with:

 
 
 
 
 

136. A 42-year-old builder consulted a doctor about a foot injury with a nail that he got in the morning of the same day. The wound was washed with water. Three years ago he was vaccinated against tetanus. Examination established satisfactory condition of the patient. The left foot was slightly edematic, there was a stab wound on the sole. In order to prevent tetanus it is primarily required to:

 
 
 
 
 

137. 14 days ago a 49-year-old patient was operated on for perforated appendicitis and disseminated fibrinopurulent peritonitis. The postoperative period was uneventful. On the 9th day the patient presented with low-grade fever, abdominal pain, frequent liquid stools. USI of the left mesogastrium reveals a fluid formation 9×10 cm large. In blood: leukocytosis with the left shift. What is your provisional diagnosis?

 
 
 
 
 

138. A 67 y.o. patient complains of dyspnea, breast pain, common weakness. He has been ill for 5 months.Objectively: to- 37,3°C, Ps- 96/min. Vocal tremor over the right lung cannot be determined, percussion sound is dull, breathing cannot be auscultated. In sputum: blood diffusely mixed with mucus. What is the most probable diagnosis?

 
 
 
 
 

139. A 52 year old patient complains about pain in the right part of her chest, dyspnea, cough with a lot of foul-smelling albuminoid sputum in form of “meat slops”. Objectively: the patients condition is grave, cyanosis is present, breathing rate is 31/min, percussion sound above the right lung is shortened, auscultation revealed different rales. What is the most probable diagnosis?

à  .

 

 

 

:

 
 
 
 
 

140. 3 hours ago a 65-year-old female patient felt sharp abdominal pain irradiating to the right scapula, there was a single vomiting. She has a history of rheumatoid arthritis. Objectively: pale skin, AP- 100/60 mm Hg, Ps- 60/min. Abdomen is significantly painful and tense in the epigastrium and right subcostal areat, there are positive symptoms of parietal peritoneum irritation over the right costal arch, that is tympanitis. What is

the tactics of an emergency doctor?

 

 

 

 

 

 
 
 
 
 

141. A 15 year old patient suffers from headache, nasal hemorrhages, sense of lower extremity coldness.Objectively: muscles of shoulder girdle are developed, lower extremities are hypotrophied. Pulsation on the pedal and femoral arteries is sharply dampened. AP is 150/90 mm Hg, 90/60 on the legs. Systolic murmur can be auscultated above carotid arteries. What is the most probable diagnosis?

 
 
 
 
 

142. A 15 y.o. patient has developmental lag, periodical skin yellowing. Objectively: spleen is 16x12x10 cm large, holecistolithiasis, skin ulcer on the lower third of his left crus. Blood count: erythrocytes – 3,0×1012/L, Hb- 90 g/L, C.I.- 1,0, microspherocytosis, reticulocytosis. Blood bilirubin – 56 mmole/L, indirect bilirubin -38 mmole/L. Choose the way of treatment:

 

 

 

 

 

 
 
 
 
 

143. A 72-year-old patient complains of pain and bleeding during defecation. Digital rectal investigation revealed a tumor of the anal canal. After verification of the diagnosis the patient was diagnosed with squamous cell carcinoma. The secondary (metastatic) tumor will be most probably found in:

 
 
 
 
 

144. A patient with frostbite of both feet was delivered to the admission ward. What actions should be taken?

 

 

 

 

 

 
 
 
 
 

145. 10 years ago a patient had a fracture in the middle one-third of his left femoral bone, and during the last 7 years he has been having acute inflammation in the area of old fracture accompanied by formation of a fistula through which some pus with small fragments of bone tissue is discharged. After a time the fistula closes. What complication of the fracture is it?

 
 
 
 
 

146. A 21-year-old male patient got a deep cut wound in his right thigh. In the emergency room a surgeon on duty performed primary debridement of the wound and primary wound closure with a suture. After 4 days,there appeared pain, redness, edema, purulent discharge from the wound gap, body temperature rose up to 39°C. What kind of wound complication can you think of and what actions should be taken?

 
 
 
 
 

147. A patient has a stab wound on his right foot. On the fourth day after injury the patients body temperature rose up to 38°C, inguinal lymph nodes became enlarged and painful, skin over them reddened. What complication might be suspected?

 
 
 
 
 

148. A 52 year old patient complains about headache, weakness of his upper left extremity. Neurological symptoms become more intense during physical stress of the left extremity. Pulsation on the arteries of the left extremity is sharply dampened but it remains unchanged on the carotid arteries. What is the most probable diagnosis?

 
 
 
 
 

149. A 43-year-old patient had been admitted to a hospital with clinical presentations of ischiorectal periproctitis. On the 12th day of treatment the patients condition deteriorated: there was an increase in the rate of intoxication and hepatic failure, the body temperature became hectic, AP was 100/60 mm Hg. USI of liver revealed a hydrophilic formation. In blood: WBCs – 19,6×109/l, RBCs.- 3,0×1012/l, Hb- 98 g/l. What complication was developed?

 
 
 
 
 

150. A 55 year old patient felt suddenly sick in a hospital corridor, he was immediately examined by a doctor. Examination revealed that the patients skin was pale, autonomous respiration was absent, pulse on carotid arteries couldn’t be felt, pupils were mydriatic. What action should be taken at the beginning of cardiac resuscitation?

 
 
 
 
 

151. A 25-year-old victim of a road accident complains of chest pain, dyspnea. Objectively: the patient is in a grave condition, Ps- 120/min, AP- 90/70 mm Hg. There is pathological mobility of fragments of III-V ribs on the right. Percussion reveals a box sound over the right lung, breathing sounds cannot be auscultated on the right. What examination should be administered in the first place?

 

 

 

 

 

 
 
 
 
 

152. After the pneumatic dilatation of oesophageal structure a patient developed acute retrosternal pain getting worse when throwing the head back and swallowing. Objectively: dilatation of the neck veins, dropped beat pulse, signs of purulent intoxication, oliguria, emphysema of the upper portion of chest. What disease can be suspected?

 
 
 
 
 

153. A 28-year-old female patient has been admitted to a hospital. She states to be ill for 12 years. On examination she has been diagnosed with bronchiectasis with affection of the left lower lobe of lung. What is the optimal treatment tactics for this patient?

 
 
 
 
 

154. 4 weeks after myocardial infarction a 56-year-old patient developed acute heart pain, pronounced dyspnea. Objectively: the patients condition is extremely grave, there is marked cyanosis of face, swelling and throbbing of neck veins, peripheral pulse is absent, the carotid artery pulse is rhythmic, 130 bpm, AP is 60/20 mm Hg. Auscultation of heart reveals extremely muffled sounds, percussion reveals heart border extension in both directions. What is the optimal treatment tactics for this patient?

 
 
 
 
 

155. A 17-year-old patient complains of pain in the area of the left knee joint. Soft tissues of thigh in the affected region are infiltrated, joint function is limited. X-ray picture of the distal metaepiphysis of the left femur shows a destruction focus with periosteum detachment and Codmans triangle found at the defect border in the bone cortex. X-ray of chest reveals multiple small focal metastases. What treatment is indicated?