Therapy 1-151 Lugansk

№	ItemText	DistrA	DistrB	DistrC	DistrD	DistrE
1.	The patient, 52 years, show complaints on a retrosternal burning pain, appearing at physical loading and disappearing after it. Objectively: a condition of the patient is satisfactory, pulse beat - 86 times a minute, during auscultation the tones of heart are rhythmical, are muffled. The arterial pressure - 130/80. On the electrocardiogram a pathological changes are not revealed.  What is yours preliminary diagnosis?	*Stenocardia stable  on exertion	Stenocardia unstable	Myocarditis	Q miocardial infarction	Cardiomyopathy
2.	Patient p, 45y.o. was delivered by an ambulance with complaints of pain in the epigastrium, vomit at the height of pain with impurity of blood; heartburn, weakness, dizziness, “black” stool in the morning. He has been ill for 10 years, nutrition is irregular. What complication has developed in the patient?	Gastric bleeding	Intestinal bleeding	Bleeding from esophageal veins	Bleeding from hemorrhoidal veins	Thrombocytopenia
3.	A 65 year old patient was admitted in the hospital with a complains of fatigue,feeling of “cotton like “legs,loss of sensitivitiy of toes. On examination pale of the skin,subecteric sclera.. Heart sounds of low intensity,systolic murmur heard over the heart area ,liver +2cm,painless,spleen not enlarged.Blood analysis: Hb 58mg/l, E- 1.3 x10 12/l, color index-1.3, reticulocytes-0.2\%. ESR 30mm/hr, megaloblasts-2:100, macrocytosis. Jolly bodies, кebots ring. Most informative method of investigation	Serum B-12 and folic  acid  level	Endoscopic examination of the stomach	X ray of abdomen	Osmotic resistance of erythrocytes	Iron content of serum
4.	The 63y.o. patient’s complaints are dyspnea during physical exercise, palpitation and swelling of the ankles. He had a transmural myocardial infarction a year ago. Objectively: T –36.5(C, BR – 22 pm, Ps – 96 bpm, AP – 110/70. Acrocyanosis. Vesicular respiration is evident; it is raised in the lower areas with single faint rales. Left cardiac bound is 1.5cm inward of lin. medioclavicularis. Cardiac tones raised, rhythm is correct, Liver – 2cm below arcus costalis. What is the mechanism of tachycardia:	Raised function of parasympathetic nervous system	Hypertrophy of myocardium	Frank-Starling’s mechanism	Vasoconstriction	Activation of renin-angiotensine-aldosterone system
5.	A 56y.o. teacher consulted a department therapist about a corresponding diet. Complaints: frequent constipations [defecation once in 2-3 days], flatulence and unpleasant aftertaste; blunt pain in the lower half of abdomen after intake of ice cream or soda drinks. At 17-20 she was treated for duodenal ulcer. Objectively: height – 164cm, weight – 62kg. Abdomen is oval, palpation doesn’t detect pathological changes. What diet is necessary for prevention of transition of chronic disease into acute?	Table #4 by Pevzner	Table #4a by Pevzner	General table	Table #2 by Pevzner	Table #9 by Pevzner
6.	A 30y.o. patient complains of local pressing heartache, dyspnea during physical exercise, memory aggravation and constipation for 3 months. Menstruation is small. Objectively: Skin is dry and pale. T- 35.4(C. Expressive edema of face and limbs. Tones are dull, rhythmic. Ps – 52 bpm, AP – 90/60. Hemogram: RBC – 2.8T/l, Hb – 92G/l, ESR – 10 mm/hour. I2-absorbtion is15( in 24 hours. What medication would you prescribe to the patient?	Thyroxin	Mercazolin	Digoxin	Furosemid	Ferroplex
7.	A 35y.o. patient has been admitted to nephrology department of OCH with chronic pyelonephritis with frequent recurrences. It is necessary to send a patient to a sanatorium in 1-2 months after treatment for prevention of recurrences. What health resort is best for the peatient?	Truskavets	Yalta	Morshen	Esentuki	Shoyani
8.	A 48yr old obse diadetic with impariment of visin for 3 weeks .on examintaion he is found to show evidence of peripheral neuropathy and grade of  II diabetic retinopathy.His blood pressure 160 to 250mm hg ,blood sugar 10to 250mg\%,while taking 5mg glibenclamide 3 time daily ,urine examination shows sugar +urine ,ni ablumin excretion ans acteone .urine excretion druning 24hrs is 400mg.whch is following mangment is approprirate?	Enalapril and insulin	Phetenoforminand enalapril	Nefidipine and phenoformin	Nefidipine and insulin	Insulin and phenoformin
9.	A 50yrs ols male has had precaridal pain for 4 hrs. on examintion his BP 110/80mmhg.pulse 10beats /mint anf respiratory rate is 206/min. His ECG maked S-T  segement elvation and left ventricle ectopies.The initial therepeutoc modilaties in his case would include.	Lignocaine,streptokinaseand morphine	Lignocanineand streptokineases	Morphineand dobtutamine	Streptokineases and morphine	Nitoglcine +Digoxine
10.	A 60 year old woman mother of 6 children developed sudden onset of  upper abdominal pain radiating to back,associtated with nausea,vomiting ,fever and chills.She noticed yellow  discoloration of her sclera and skin.On physical examination the patient was found to be febril with temperature of 38.9C, along with right upper quadrant tenderness	Choledocholithiasis	Infectious hepatitis	Hemoytic jaundice	Choledochal cyst	Ascariasis
11.	A 40 year old male pesents with headache and convulisons.His blodd pressure is 120\140 mmhg. Fundus examination revelas papillooedema.Which  of the following drug examination will be most suitable for this patient?	Nitropruside+Furosemide	Diazoxide+trimaterence	Nitroprusside+Triamterence	Resaprine	Captopril
12.	A 75 year old man who had developed diabetes within last 6 months was found to be jaundiced.He has remained asymptomatic,expect for weight loss   about10 pounds in 6 months.On physical examination he is found to have  a non- tender ,globular ,right upper quadrant mass that moves with respiration.A CT scan shows enlargement of the head of the pancreas, with no filling defects in the liver	Carcinoma of the head of the pancreas	Metastatic disease of the liver	Pancreatitis	Choledocholithiasis	Hemolytic jaundice
13.	First patient A. 35 years old with Acute Viral Respiratory Infection complains of pain in the cardiac region, palpitation, dyspnea. Objective: acrocyanosis, heart sounds are reduces, systolic noise above the apex, extrasystole, blood pressure 90/60 mm Hg. Which among the following is true?	*All the given below.	Electrophysiological test.	Laboratory test.	Hospitalisation.	None of the above.
14.	A 55 years old man complaints with chest pain for a duration of 25 min. With radiation to the left side which took place 3 days ago at rest and dissapeared without any medical treatment. The last day attack took place for 5-6 times per day with  increases in pain  intensity. The results of laboratory test: Troponin-0,17ng/mg, L-5,6 (109 /l, alaninaminotransferase-100 mmol/l, Lactat Dehydrohenase-350 mmol/l. Which disease do you suggested?	*Non-stable sternocardia.	Stable sternocardia.	Myocarditis.	Q-Myocardial Infarction.	Cardiomyopathy.
15.	A 20y.o. student fell ill with acute glomerulonephritis. He was ill with angina a week ago. Objectively: skin and mucous layers pallor, edema of face, limbs and trunk. AP – 180/110. Urogram: protein – 6.6 g/l, RBC – 100-120 in f/v, hyaline cylinders – 2-3 in f/v, oligoanuria. What infection had in important part in development of disease?	Streptococcus	Virus	Staphylococcus	Blue-purulent bacillus	Intestinal bacillus
16.	The patient has peptic ulcer of stomach with frequent recurrences. Courses of anti-recurrent therapy must be:	Once in 3 months	Twice a year	Each year	Each month	After each recurrence
17.	A 65y.o. patient is in the reanimation department with transmural myocardial infarction. He complains of abdominal pain, flatulence and constipation. Objectively: Abdomen is algestic in the region of colon, with continent inflation; its lower part is full. What is the main mechanism of this condition?	Hypodynamia	Failure of nervous regulation	Non-adequate alimentation	Colon abnormality	Failure of aqueous-saline exchange
18.	A patient complains of resting dyspnea, high temperature and chest pain. Objectively: The right half of chest is behind in the act of respiration. During percussion a blunt sound is evident. Sounds are absent in lungs during auscultation. X-ray: a homogenous opacity 2/3 of right lung. The most informative for diagnosis is:	Punction of pleural cavity	Bronchoscopy	Bronchography	Pneumotachometria	Spirography
19.	A 62y.o. patient is ill with chronic obstructive bronchitis. He has smoked for 20 years. Point out the non-medicamentous prevention of recurrences in this pathology:	All measures	Training of respiratory muscles	Refusal from smoking	Optimization of microclimate	Balanced alimentation
20.	A 53y.o. woman is suffering from essential arterial hypertension of the I degree combined with obesity of the II degree. Which of the following methods assist an accurate decrease of EAH progression risk?	Therapeutic diet	Psychotherapy	Physical therapy	Rodone baths	Collar zone massage
21.	A 34y.o. patient has been admitted to clinic with complaints of heaviness in the right subrib, nausea and emesis after intake of fried pork; dark urine and light feces. He was ill with viral hepatitis half a year ago, but wasn’t on a diet. Objectively: Scleras are subicteric. Abdomen is with continent inflation. Liver is +2cm of costal arc margin on lin. medioclavicularis dextra. Its surface is smooth and it has an elastic consistence. What disease would you think about?	Chronic hepatitis	Cirrhosis of liver	Active hepatitis	Chronic cholecystitis	Chronic pancreatitis
22.	A 40 year pateint of rhenmatic heart disease complains of anoxeria,weaknessand loss of weigth,breathlessnesss and swelling of feet . on examination temp 39C pu;lse is 100/mint .Asucultation distolic murmur in the mitral area.Petchical lesion round clavicle and spleen was palpable,Tooth extraction one month ago.	Subacute bacteria endocardidtis	Recurrence of rheumatic fever	Throbocytopenia purpure	Mital stenosis	A ortic stenosis
23.	If  a 55year male presents with normotension, nephroticsyndrome, azotemia, collateral abdominal veins with upward flow and there is history of gross, painless haematuria 6 months back, the mostly likely diagnosis is	Hypernephroma	Amyloidosis	Papillary necrosis	Periarteritis	Liver Cirrhosis
24.	A 70  yrs old women is admitted to the hospital with icreasiing fatigabality and dyspone for the several month. Physical examintaion heat rate 100/min regular rhythm and BP of 150/100mmhg engorged neck veins ,third heart sound and rales over lung fields.Skigram on chest show and prominent vascular markings .This patient is likely to be having	Cngestive cardiac failure	Adult respiratory distress syndrome	A trial fribrillation	Rebound hypertensive crisis	Pulumonary edema
25.	A 45yrs old executive who is a heavy smoker, had severe retrostrenal discomfort while going to the toilet at 7.00 a.m .ECG done immediately showed that S-T segement elevation in the infrrioe leads which normalised within an hour. This  likely mostly diagnosis is	Prinzmetal s angina	Acute myocardial infraction	Dissecting aneurysm of arota	Acute pericarditis	Stable angina pectilors
26.	A 50 year  old patient previously in good health and sudden onset of right anterior chest pain without chills,feveror cough.On examintion he has tanchypneic.Over the right lower rib cage there was an inspiratory rub.Chest X –ray was negative.Which statement is correct	Pulmonary embolus must be cosidered promptly	Pneumococcal pneumonia is mostly ans penicilline should be given	Bronchogenic carcinoma is most likely	Bronchoscopy needs to be done promptly	Viral pnenumonia is most likely diagnosis
27.	A 43 year old man begins to wheeze.There is no way to tell whether this is bronchial asthma or cardiac asthmaThe best drug to be use would be	Aminophylline	Digitalis	Cortisone	Epinephrine	Salbutarole
28.	A middle –aged patient presents with  ashort history of hight fever and rigors.On examination the pulse rate is 140/min and there are signs of toxaemia.Chest examination shows restriction of movement over left infraclavicular region and there is dullness on percussion. Vocal resonance is increased with low pitched bronchial breath sounds over the above area.The mostly likely diagnosis	Lobar pneumonia	Lung abscess	Bronchial pneumonia	Plerual effusion	Acute bronchitis
29.	A 48 year-old man presnets with arthralagia,abdominal pain,diarrhoea ,progressive weight loss,low-grade fever,confusion,memoryloss and opthalamoplegia.Investigation reveal steatorrhoea,imparied xyloseobsorption,abnormal samll- bowel X rays hypoalbuminaemia and anemia.The mostly likely diagnosis	Whipple s disease	Coeliac disease	Inflammatory bowel disease	Tropical sprue	Chronic enterocolitis
30.	An indian adult who has neve travelled abroad come with a history of high fever,headache,jaundice,marked oliguria,heptospleenomegaly and   shock with TLC of 16,000/cumm.The mostly likely diagnosis is	Leptospirosis{weil s disease}	Viral hepatitis	Yellow fever	Haemolytic uraemic syndrome	Haemolytic jaundice
31.	A patient is noted to have paroxysmal episodes of hypertension,tremors,weakness and sweating.Physical examination reveals tachycardia and hypertension.The urinary catecholamines and their metabolites are elevated and a computerised tomography scan detects a mass within the adrenal gland.Which is the most likely diagnosis	Pheocromocytoma	Cushing syndrome	Conns disease	Essential hypertension.Crisis conditions	Cushing disease
32.	A 76-year old woman presents with  an acute myocardial infarction.Her symptoms stared 4 hrs before admission and resolved  after 1 sublingual nitroglycerine.She has history of hypertension,pulse is 104beats/min and BP is 180/106mmHg.A third heart sound is present.No venticular ectopy is observed druning ECG monitoring.Appropriate initial therapy may include	Metoprolol	Lidocaine	Procaineamide	Digoxin	Diltiazem
33.	A 40  year old woman in good gernal health experiences sudden chest pain,fever and shortness of breath.She is heavy smoker and takes takes no medication except oral contraceptives.Tachypnea and temperature of 38C are found on physical examination. Chest auscultation,percussion and radiographic findings are normal.Which of the following diagnosis is likely	Pulmonary embolus	Atypical pneumonia	Tracheobronchitis	Bacterial pneumonia	Lung cancer
34.	A 17y.o. patient complains of acute pain in the knee joint and T – 38(C. He was ill with angina 3 weeks ago. Objectively: Deformation and swelling of the knee joints with skin hyperemia. Small movement causes and acute pain in the joints. Which diagnose is the most correct?	Rheumatism, polyarthritis	Systemic lupus eritematodes	Reactive polyarthritis	Infectious-allergic polyarthritis	Rheumarthritis
35.	A 12- year old boy had sever vomiting and diarrhoea.He was brought to the hosptial because of severe oliguria.He was give IV fluids and furosemide without any diuresis.Blood biochemistry revealed : Urea 120 mg\% and serum creatinine 4mg\%.The most likely diagnosis is	Prerenal azotemia	Haemolytic uremic syndrome	Acute glomerulonephritis	Acute tubular necrosis	Acute pyelonephritis
36.	A 56 year old woman has an elevated serum calicum level of 12.2mg/dl.She has no history of any illness,or treatment associated with hypercalcemia.Which of the following studies would be most helpful in making diagnosis of primary hyperparathyriodism	Serum para thyroid hormone	Serum ionized calcium	Serum phosphate	CT scan of the neck	24 hrs urine calcium excretion
37.	A 13 year old girl with sickle cell anemia presents with pallor,tachycardia,hypotension and massive splenomegaly.The most likely explanation is	Splenic sequestration	Hemorragic shock	Septic shock	Cardiogenic shock	Hypovolemic shock
38.	A 30 year old 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	Carpal tunnel syndrome	Atlanto-axial sublaxation of cervical spine	Sensory peripheral neuropathy	Rheumatoid vacultis	Rheumatoid arthrits without complication
39.	A 27 year old woman presents with muscle weakness,ptosis,has been  receiving gentamicin injections for the last 7 days for a urinary infection.Thyroid function tests,serum creatine kinase, eletromyogram and musle biopsy are noraml.I/V administration of edrophoniumresults isn adramtic improvements in the pateints muscle strength.Which of the following is most likely diagnosis	Myasthenia gravis	Toxic {drug induced}myopathy	Duchenne musclar dystrophy	Peripheral neuropathy	None of the above
40.	A 56 year old woman is admitted after 2 weeks of frequent vomiting.She is dehydrated.Work –up showss complete gastric outlet due to longstanding peptic ulcer disease.Her serum dueto longstanding peptic ulce disease.Her serum chloride is 90mEq/dl {low},sodium 134mEq/dl [low},bicarbonate 35mEq/dl [high},and her urine PH is low {acidic}	Severe Crohns disease	Sigmoid colectomy	Splenectomy	Segmental jejunal resection	Sigmoid colectomy
41.	A 47-year old man presents to his physician with progressive abdominal swelling.On examination he is found to have ascites and a tender,erlarged liver.If the patient describes the ascites as having  been of abrupt onset and preceded by trauma, tha most likely diagnosis is	Thrombosis of the hepatic vein {Budd-Chiari syndrome}	Congestive hear failure	Portal vein thrombosis	Chronic hepatitis
42.	A 60 year old woman was admitted in ths hospital  with abdominal cramps,watery diarrhea and flushing with episodes of wheezing.Select the appropriate  diagnosis	Carcinoid syndrome	Gastroenteritis	Uclerative colitis	Lactose intolerance	Short gut syndrome
43.	A 20- year old woman with 3-4 months history of bloody diarrhea ,stool examination negative for a ova and parasites,stool culutre negative for Clostridium,Campylobacter and Yersinia,normal bowel series edema,hypermia and ulceration of rectum and sigmoid colon seen on sigmoidoscopic examination	Ulcerative colitis	Gastroenteritis	Carcinoid syndrome	Granulomatous colitis	Lactose intolerance
44.	An 80-year old woman with a history of Congestive Heart Faliure develops angina pectoris.Her medications are adjusted to include furosemide,digoxin,nitroglycerine and potassium supplements.Shortky there after develops intermittent frontal throbbing headache.Which of the following should the physician do frist?	Discontinue nitroglycerin	Perform a temporal artery biopsy	Begin propranolol	Begin sublingual ergotamine	Obtain a brain CT scan
45.	A patient 54 years old, admitted in hospital with intensive and tremendous retrosternal pain without radiation, pain lasted for 40 minutes, no changes were observed after taking nitroglycerin. Objectively : pale face, sweatting, hypotonia (pulse rate 108/min), “gallop”rythm. ECG: elevation of  ST to 6 mm at III and AVF leads. Read the above given information and select the correct diagnose from the following:	*Troponin I and T.	Activity of the alaninaminotrasferasa.	Activity of the aspartataminotrasferasa.	Activity of the general lactactdehydrogenase.	Activity of the general creatinphospokenase
46.	A patient 60 years old with ischemic heart disease, post infract cardiosclerosis. After physical exercise, there is  weakness, breathlessness at rest, strong heart beat, sputum is reddish in colour, cyanotic skin, patient is half seated, half lying , cold sweat. Breathing rate is 30/min, heart rate 100/min, blood pressure 100/60 mm.hg., different kinds of  rattling, hummid sounds in lungs and heart murmurs. Which mechanism leads to development of acute heart failure?	*Increase of hydrostatic pressure in small circulating blood vessels.	Decrease of oncotic pressure in the blood plasma.	Raise in activity of sympathoadrenergic system.	Increase in volume of circulating blood.	Retention of water and sodium in the organism.
47.	A patient 28 years old, during 10 years diagnosis of reumatism, failure of aortic valve, admitted in the clinic with cardiac deficiency  at the II B stage. Which of the following hemodynamics is of  importance in the diagnosis of systolic dysfunction?	*Dillation of the heart and decrease in heart output.	Hypertrophy of the heart and decrease in heart output.	Increase in minute volume of blood.	Decrease in minute volume of blood.	Decrease of heart output.
48.	The patient has had the non-specific hecoid colitis for many years. He is in remission now. During dispanserisation the doctor must prescribe colonoscopy to him:	Each year	Twice a year	Each month	Once in 3 months	Once in 2 years
49.	Throughout the year after an attack of acute myocardial infection, a patient complains of periodic pain in the heart area. At the time of observation of the electrocardiogram  except pathological Q in II, III and AVF leads other changes were not  observed. Which investigation is the most apropriate in order to diagnose and treat the patient?	*Hollter’s monitering electrocardiogram.	Investigation of  electrolytes in blood.	Coronarography.	Physical test.	Stress-echocardiography.
50.	A patient with unstable stenocardia was given a complex treatment of the following : anticoagulants, lyins nitrates, (-adrenoblockers. But on the third day of treatment the pain was continous, which tests are carried out on this patient to get the proper diagnosis?	*Coronarography	Stress-ecocardiogram.	Test with doses of physical exercises.	Oesophageal electrocardio stimulator.	Myocardial syncitigraphy.
51.	The patient who after ‘Q’ positive myocardial infarction of left ventricle: experienced dyspnea, edema and  hepatomegalia. Echocardiograph: Increase in end diastole  volume & intraventricular pressure of left ventricle. What is the main reason of congestive heart failure of the patient?	*Disease + low cardiac output + accumulation of liquid.	Disease + high cardiac output + increased vascular resistance.	Low cardiac out put + accumlation of  Na+1 + accumulation of liquid.	Increased resistance of vesseles + increased activity of sympatho adrenergic system.	Increased activity of sympathoadrenegic system + increased activity of renin – angiotensin – aldosteron system.
52.	A patient with hypertension in 2nd stage, has inspiratory breathelessness, cough, weakness after physical exercise. Echo cardigraphy revealed: hypertrophy of left ventricle myocardium. There is a decrease of final diastolic volume with a fraction of excreation  of  58\%.  Destrution of heamodynamic regulation is the main cause of failure of :	*Diastolic function of the left ventricle.	Systolic function of the left ventricle.	Diastolic function of the right ventricle.	Systolic function of the right ventricle.	Systolic – diastolic function of the heart.
53.	A patient 57 years old, admitted in hospital with small focal myocardial infraction from the past 3 months is reported to have cardiac insufficiency of first stage functional class 1 (Fc1). At present he complains dyspnea, fatigue, palpitation in normal physical maintinance. Which of the following is the best method of prophylaxis for the given patient?	*Treatment of the basic disease.	Treatment of the cardiac insufficiency.	Diet with controlled amount of liquid, salt and animal fats.	Satisfactory climatic treatment.	Control of physical tolerance.
54.	The patient aged 58 suddenly had headache, syncope, nausea, fear, “net” glimmering in  the visual field, palpitation, cardiac pain. He has been suffering from hypertension for 18 years. Clinical examination revealed   cardiac rate 96 per 1 min., BP = 210/115 mm Hg. What preparation should be prescribed to this patient most currently?	* Corinfar	Adelfan	Analgin	Cristepin	Egilok
55.	A 26 years old patient was admitted to the hospital with complains of pain in the right chest, fever up to 38-40 C and cough with purulent sputum discharge. Before  he has been ill within  2 weeks with common cold  and lower lobe pneumonia on the right. He was treated as a out-patient but 3 days ago his general condition was worsened  and above mentioned complaints was appeared.  On physical examination the patient is  asthenic, exhausted, with pale grey skin.  An unpleasant smell  from the mouth is noted. On auscultation: the air entering in the lower  right lobe is diminished.  In other chest there is crapitation. On percussion: there is dullness over  the lower lobe on the right. CBC  reveals high WBCs count (leucocytosis) with the formula band shift and low RBCs count (anemia). On the X-Ray graph  the right middle and low lung fields are very dense. In the lower lobe there is intrapulmonary  destructive cavity with horizontal fluid level surrounded by inflammatory wall. Haw could you define the chest disease?	* Lobar  pneumonia complicated by  acute abscess of lung	Lung gangrene	Non complicated pneumonia	Lobar  pneumonia complicated by  chronic abscess of lung	Chronic lung abscess
56.	What kind of cereals mentioned doesn’t produce worsening the course of celiac disease (non-tropical sprue):	*rice	wheat	oats	rye	barley
57.	A 19 years old patient  complains of long-term bleeding started after tooth extraction. It is known from the case history that he has had large haematomas in the childhood. His uncle from mother’s side  died from bleeding.	What clinical diagnosis is the most probable?	*Hemophilia	Hemorrhagic vasculitis	Iron deficiency anemia	Aplastic anemia
58.	A man aged 32 yr notes general weakness, elevation of the body t°, pains in the throat while swallowing. He is ill 2 months and treated from tonsillitis by antibiotics without any effect. The main clinical features are body t° 38,4 °C, RR (respiratory rate) 22 per min; pulse  108, BP (blood pressure)  100/60 mm of Hg. The skin is pale. There are purpura (hemorrhagic rash) on extremities, systemic  enlargement of lymphatic nodes and hepatosplenomegaly. In CBC RBC are 2,2*1012/l, Hb  70 g/l; WBC (leuc.) 13,5*109/l;  atypical cells (blastocytes) 32\%; metamyelocytes  1\%; stab neutrophils  3\%; segm. neutr. – 35\%; lymph. – 20\%; monocytes – 8\%; thrombocytes  37*109/l; ESR – 30mm/hour. What clinical diagnosis is the most probable?	*Acute leukosis	Chronic lympholeukosis	Chronic myeloleukemia	Aplastic anemia	Thrombocytopenic purpura
59.	A men, 25 years, appealed to the policlinic concerning a quinsy. Appointed soulfanilamidi and aminoglicozidi. On 5-those day an urinary syndrome turned out, arterial hypertension was not present. A to 15 day an infection ended and an urinary syndrome gradually vanished. What diagnosis must it be?	*Infection-tocsical bud.	Sharp glomerulonephrit.	Sharp pyelonephrit.	Sheynleyn’s – Genoh’s illness.	Berger’s illness.
60.	Which of the diseases doesn’t trigger cancer of the rectum:	*amebiasis	diffusive family polyposis	Crohn's disease	ulcerative colitis	immunodeficiency
61.	The arterial hypertensive patient aged 30 during last 5 years  has had a constant BP index 170/100 – 200/120 mm Hg. On objective examining systolic murmur is heard above the navel in the right. What’s the reason of hypertension?	*reno-vascular hypertension	hypertension disease	polycystic kidney	coarctation of aorta	glomerulonephritis
62.	The patient aged 30 complains of headache, general weakness, nocturia. Proteinuria has been noted  5 years and arterial hypertention  2 years ago.  Heart rate is 88 beats per min, blood pressure – 150/100 mm Hg, creatinine – 0.23 mkmole/l, urea – 9,1 mlmole/l, glomerular filtration  rate 50 ml/min. Diagnosis?	*chronical renal insufficiency 1 stage	chronical renal insufficiency 2 stage	Heart failure 3 stage	chronical renal insufficiency 4 stage	acute renal insufficiency 1 stage
63.	The patient aged 31, called in with complaints of headache, nausea, vomiting. Diagnosis of chronical glomerulonephritis with renal failure  was made in stationary. What medical drug again high  blood urea nitrogen  would you recommend to the patient?	*Polysorb	Furosemid	Hypothiazid	Guttalax	Verapamil
64.	A sick man, who is 43, started to complain to his therapeutist about the heaviness in the stomach after a meal, bad belch, vomiting with food, he had eaten the day before. He has suffered from ulcer of duodenum for 10 years. He has applied to the doctor (therapeutist) two times but he started to feel worse last month. What pathology must it be?	*Ulcerous stenosis of the exit part of the gullet	Gullet cancer	Stomach cancer	Ahalaziya of the gullet	Reactive pancreatitis.
65.	The patient, aged 65 rising to the first floor have felt  pain behind the sternum  lasting nearly 5 – 8 minutes  radiated  to the left shoulder and blade. For the next 10 days the attacks of pain have become more frequent.  A feeling as if he lacks air to breathe (breathleeness) was appeared.  The pain didn’t cease after taking one nitroglycerin tablet. What is the most probable diagnosis?	* Progressive stenocardia	Prinzmetal’s angina	Angina on exertion III funct.class	Myocardial infarction	Acute myocarditis
66.	Patient after over cooling complained about continuos fever up to 38?C, cough with small amount of serous sputum.   Was under treatment at district policlinic, in ten days hectic fever appeared in spite of treatment. In three days after this suddenly expectorated sputum with “full mouth” and very bad smell. Amphoric respiration was auscultated over middle part of the upper lobe from the right side. About what disease is it necessary to think?	*Pulmonary abscess.	Bronchiectatic illnes.	Lobar pneumonia.	Pulmonary tuberculosis..	Cancer of a lung.
67.	The patient aged 25 yr has  dyspnea, cyanotic skin pallor occurred suddenly.  Cardiac rate is 130 beats per  minute. BP is 85/50 mm. Hg. The heart sounds are significantly quiet. On ECG there are polytopic premature bites,  diffuse myocardial  changes. On X-ray there is a cardiomegaly. The onset of illness the patient connects with analgin intake  adverse reaction occurred 15 days ago. What is the most probable diagnosis?	* Abramov – Fiedler’s idiopathic myocarditis	Hypertrophic cardiomyopathy	Exudative pericarditis	Endocardial fibroelastosis	Mitral stenosis.
68.	A patient aged 26 years complains of the enlargement of cervical, subclavicular,  grain lymphatic nodes, skin itching, considerable sweating at night, fever up to 390C. In CBC there are leukocytosis, lymphopenia, high  ESR. What clinical diagnosis is the most probable?	* lymphogranulomatosis	chronic lymphatic leukemia	acute lymphoblastic leukosis	infectious mononucleosis	leukomoidal reaction
69.	A 42 years old man  suddenly felt worsening of his general condition and complains of dizziness, weakness and   appetite loss. From the clinical history it is known that the patient  suffers from the duodenal ulcer disease within  15 years and it is written down in his individual medical file. In CBC erythrocytes(RBC) are 1,9*1012/l , Hb 57g/l , KP 0,9, reticulocytes 1\% , thromb. 2,1*109/l ,  WBC (leuc.) 11,5*109/l , eosinophils-1\%; stabneutrophils-10\%; seg.neutrophils-65\%; lymph/-19\%; mon.-5\%; ESR-35 mm/hour. What clinical diagnosis is the most probable?	*post-hemorrhagic anemia	hemolytic anemia	hypoplastic anemia	DVC – syndrome	pernicious anemia
70.	The therapeutist must prescribe to patients primary prophylaxis iron deficiency anemia to prevent its development. Whо is adminested this prophylaxis?	*Pregnant women	Patients after 60	All children	Patients after operation	Workers of industrial interprises.
71.	The man os 25 years complains of periodic epigastralgia. At inspection the chronic gastritis with the increased acidity is revealed. Treatment is lead. What preparation is expedient for using for primary preventive maintenance of a stomach ulcer?	*Famotidin	Cerucal	Vicalinum	Maalox	Gastropharm*Famotidin
72.	A 21 years old patient with history of multiple pneumonias   complains of malaise, breathlessness, palpitation, fillings of noisy  ears and  “flies”  in front of  eyes. The patient is ill within one month. On physical examination the skin is pale.  In the mouth  there is ulceretive  necrotizing stomatitis. Also purpura in the  femoral and  abdominal skin areas is noted. The  peripheral lymphatic nodes are not enlarged. CBC:  RBC are 1,8*1012/l,   Hb 56g/l   K.P-0,9 , WBC 2,3*109/l; eosinohyils-2\% , stub neutrophils 3\%, segmented neutrophils 65\%, lymphocyes 22\%,  monocytes 8\%, thrombocytes 16*109/l , ESR 25mm/h.  In  urine analysis the macrohaematuria is revealed. What clinical diagnosis is the most probable?	*aplastic anemia, hemorrhagic syndrome	hemolytic anemia	iron-deficiency anemia	B12-dificiency anemia	acquired hypoplastic anemia
73.	A 70 year old patient has got an unhospital pneumonia of the second category. Prescribe the empiric therapy that is most appropriate for this case.	*Spiramycin in combination with doxycycline per os.	Penicillin intramusculary	Ampicillin 0,5 6 times a day	Etazol endovenous.	None of the variants is right.
74.	Patient P., age 52 has IHD (ischemic heart disease) for 5 years. He is worried about the retrosternal pain that occurs after  physical exerxises. The pain lasts for  7-8 minutes and stops indepently at rest. The patient doesn’t use nitrats now. There are no pathologic changes of segment ST and wave T on the ECG at rest; during the coronary angiography, decrease in diameter of the left coronary arteria by 50\% was found. What is the pathogenesis of retrosternal pain development of the patient in this case?	*The incapacity of injuried coronary arteria to increase its opening on when  oxygen in needed.	The presence of the spasm in injured coronary arteria.	Pathological adhession and aggregation of the thrombocytes with the extraction of vasoactive substanses.	Hemodynamic factors of blood flow in the time of efforts in aorta.	The breach of the coronary blood flow on account of arteritis.
75.	The atrial flutter  with  heart rate up to 130 per min firstly appeared in a woman aged 28 yr considered before healthy. Physical examination reveals  pale  bluish  cheeks. The respiratory rate is 24 per min. Cardiac auscultation  is difficult because of high rate but S1  tone is loud. The chest is free and  abdomen is soft and painless. ECG revealed right ventricle hypertrophy and atrial flutter. This woman was not  consulted by any doctor because  she lives in a small village. What is the most probable diagnosis?	*Mitral stenosis	Myocarditis	Thyrotoxicosis	Artherosclerotic cardiosclerosis	Myocardiodistrophy
76.	In the patient, aged 45 after physical exertion burning pain near the heart, fear of death, sweating occurred. On the ECG there are the QS wave,  cupola – like  ST elevation  and negative T in I, AVL, V1 – V3 leads.  What is the most probable diagnosis?	* Acute myocardial infarction of the anterior wall of left ventricle	Progressive stenocardia	Acute myocarditis	Lung artery thromboembolism	Aortic dissection
77.	Patient A. Complains about the shortness of breath, pains in area of heart, sense of widespread pulsation. In anamnesis - frequent quinsies (tonsillitis). Objectively: skin covers are pale; positive capillary pulse, “dance of carotids”, dome-shaped apex beat displaced downward and to the left, a pulse is quick, high. The left border of heart is displaced to the left. Weakening I and II tones, diastolic murmur over aorta. BP - 180/40 mm Hg. ECG: signs of hypertrophy of left ventricle. What most credible preliminary diagnosis?	*Insufficiency of aortic valve	Feochromocytoma	Chronic nephritis	Hypertensive illness	Coarctation of aorta
78.	Patient 47 years is delivered at a clinic due to the attack of difficulty in breathing. Objectively: skin is pallid-cyanotic. Position abed – semisitting. Breathing is bubbling, 36 per a minute. The heart sounds are dull, accent of II tone above an aorta. Above lungs different moist rales are hearing to. The WBC–10,5G/l; ESR 4 mm/hour; AST 1,8 mkmol/l; ALT 1,2 mkmol/l; KFK 2,8 mkmol/l. Set a diagnosis:	*Acute myocardial infarction	Attack of bronchial asthma	Acute bronchopneumonia	Acute pleuropneumonia	Pneumothorax
79.	Patient 28 years complains about the suddenly appearing strong and frequent blows of heart. In anamnesis the cardiac diseases are not present, was much nervous. Objectively: a patient is excited, pulse 160 in a minute, BP-150/30 of mm Hg, contractions of heart are rhythmic, sounds loud, clear. ECG:  heartbeats 160 per a minute, the QRS complex is stored, the P wave is not determined. In the chest leads the voltage of the T wave is megascopic. Your diagnosis:	*Paroxysmal tachycardia	Atrial flutter	Atrial fibrillation	Atrioventricular block of the III digree	Respiratory arrhysmia
80.	The ECG of 10 years old child demonstrates high cardiac rate up 180 per minute. Р wave  is accumulated on Т and deforms it. The PQ interval is slightly prolonged.   QRS complex doesn’t changed.  What cardiac disorder   has this child?	*Narrow complex supraventricular tachycardia	Atrial hypertrophy	Ventricular hypertrophy	WPW (Wolf – Parkinson – White) syndrome	Premature bites
81.	Patient 50 years, after heavy physical loading substernal pain of cutting character appears suddenly. BP-140/80 of mm Hg; pulse-80 in a minute. The rhythm of heart regular, heart sounds clear. Pain disappeared in 10 minutes independently. It is known from anamnesis, that except attack of ARVI a patient was nothing ill. About what is it necessary to think?	*First arising angina pectoris up	Diaphragmal hernia	Prinzmetal’s angina pectoris	Myocardial infarction	Acute pericarditis
82.	At a patient 58 years, 2 years being ill of stable angina pectoris of tension, the character of clinical displays of angina pectoris changed suddenly, more often and making of attacks heavier appeared, began anymore to accept nitroglycerine, an effect from acceptance diminished. About what is it necessary to think?	*Progressive angina pectoris	First arising angina pectoris up	Stable angina pectoris of tenssion	Myocardial infarction	Acute myocarditis
83.	A patient 56 years is at a clinic concerning the acute myocardial infarction the third week. He complains about the increase of temperature, pains in area of heart of a different intensity and character, pains in area of humeral joint and defeat of skin. There is leukocytosis in a blood, eosinophiliya, the ESR, level of (-2 and (-globulin, C-reactive protein increased. About what is it necessary to think?	*Heart postinfarction syndrome of Dressler	Heart postinfarction cardiac insufficiency	Tromboemboliya of pulmonary artery	Aneurysm of heart	Pleurisy
84.	A patient 65 years during a few days disturbs pain in an epigastric region, once or twice was vomiting. Appealed to the doctor. It was diagnosed acute gastritis. Got medical treatment. However much being of patient continued to get worse – weakness, pallor of skin covers, sticky sweat, BP-80/50 mm Hg, heart sounds very dull.  About what it is necessary to think:	*Diaphragmal myocardial infarction	Peptic ulcer	Acute  gastritis	Solyarit	Diaphragmal hernia
85.	Patient 30 years with complaints about the expressed shortness of breath and palpitation during the last year. On X-ray of the chest considerable expansion of heart is exposed. On an electrocardiogram – decline of amplitude of the R wave in all leads and negative T.  On echocardiogram – dilatation of ventricles of heart with the decline of fraction of the ejection to 35 \%. A valvular apparatus not changed. It is possible to suppose:	*Dilated (congestive) cardiomyopathy	Insufficiency of aortic valve	Insufficiency of mitral valve	Myocarditis	Innate heart disease
86.	Woman, 32 years, during 2 years was treated by internist because of neurocyrculatory dystonya and by gynecologist because of menorrhagia. Complaints about the promoted fatigability, muscular weakness, predilection for strong smells (petrol, ether), the desires eat chalk. Common analysis of blood: RBC- 3,5 T/l; Hb – 105 g/l; C.i. – 0,8; hypochromiya, anisocytosis; WBC. - 6,8 g/l; B-0\%; E-2\%; St-4\%; S-60\%; L-26\%; M-8\%; ESR 12mm/ch. Whey iron 7-8 mkm/l. What is it necessary to appoint?	*Peroral preparations of iron	Vitamins of B group	Folic acid	Parenteral preparationsof iron	Vitamin C
87.	The woman aged 30, is suffering from polycystic kidney. She was admitted to the hospital because of weakness thirst, nocturia. Diuresis was about 1800 ml per day. Blood pressure 200/100mm Hg. Blood test: erythrocytes: 1,8*109. Hg-68 g/l. Urine specific gravity is 1005, leucocytes- 50-60, erythrocytes in microscopic fild - 3-5, creatinine- 0,82 mmole/l, potassium – 6,5 mmole/l, provision urine filtration rate 10 ml/min. What’s the immediate task in the case treatment?	*Hemodialysis	antibacterial therapy	sorbents	blood transfusion	Hypotensive therapy
88.	A patient is 60 years. In anamnesis - hypertensive illness, angina pectoris. Felt off suddenly palpitation, heaviness in area of heart, difficult breath appeared. At examination: it is pale, it is all of a cold sweat, lips are cyanotic.  A pulse is frequent, it is difficult to count up. BP 100/50 mm Hg. The heart sounds are dull. A patient is quickly hospitalized. How do you think, with what diagnosis?	*Myocardial infarction	Hypertensive crisis	Attack of angina pectoris	Fainting-fit	Cardiac asthma
89.	The sick man aged 40  has been suffering from glomerulonephritis. He complains of vomiting, muscle cramps in the distal extremity. Blood pressure 180/120 mm Hg, creatinine in blood serum – 770 mkmole/l, glomerular filtration – 5 ml/min. What treatment methods are indicated to this patient ?	* hemodialisis	sorbents	hemo – absorption	plasmapheresis	hemofiltration
90.	A patient 55 years complains about pain, slight swelling in the joints of brushes, long constraint at mornings, limitation of mobility. 1 year is ill. Treated oneself with ibuprofen with a small effect. Objectively: swelling of metacarpal-phalange, proximal interphalange joints of the II-III fingers of both brushes with pain limitation of mobility. ESR 37 mm/hour. What researches are most informing for clarification of diagnosis of rheumatoid arthritis?	*Rheumatoid factor, X-ray of brushes joints	Determination of uric acid in blood	Titers of antichlamidias antibodies	Presence of LE-cells	Determination of blood lipids level
91.	A patient 24 years complains about nausea, vomiting, headache, shortness of breath. In 10 years had an acute nephritis. Proteinuria was found out in urine. Objectively: a skin is grey- pale, the edema is not present. Accent of II tone above an aorta. BP 140/100 - 180/100 mm Hg. Blood level of residual N2 6,6 mmol/L, creatinine 406 µmol/L. Day's diuresis 2300 ml, nicturia. Spac.  gravity.  of urine  is1009, albumen 0,9 g/L, WBC-0-2 in f/vis. RBC.-sin. in f/vis., hyaline casts single in specimen. Your diagnosis?	*Chronic nephritis with violation of kidney function	Feochromocitoma	Hypertensive illness of the II degree	Nephrotic syndrome	Stenosis of kidney artery
92.	A patient 70 years suffers of hypertensive illness more than 20 years. Woke up at night due a suddenly arised attack of shortness of breath with difficult inhalation. Objectively: orthopnoe. Pulse 108 per/min, rhythmic. The heart sounds are dull, on an apex the rhythm of gallop. In the lower parts of lungs moist wheezes. What complication of hypertensive illness arose up at a patient?	*Cardiac asthma	Myocardial infarction	Acute violation of cerebral blood circulation	Fainting-fit	Pulmonary edema
93.	Patient M., 52 years. Complains about headache, palpitation. About 5 years suffers of hypertension. Had the myocardial infarction one year ago, 6 months ago - cerebral stroke. Objectively: being of middleweight. The left border of heart is displaced laterally on 2,5 sm. Accent of II tone on an aorta, systole murmur on an apex. Ps - 96 in a minute, arrhythmic.  BP 190/105 mm Hg.  Your diagnosis?	*Hypertensive illness of the III degree	Stenosis of bulb of aorta	Insufficiency of aortic valve	Coarctation of aorta	Atherosclerosis of aorta
94.	Man 40 years complains about gradually increasing headache, nausea, inclinations to vomiting, somnolence, pains in a heart, fog before eyes. Suffers with hypertensive illness 12 years. Closing dates much worked, got tired. Objectively: it is pale, a face is puffy, Ps-62 /min, is hard. BP 200/120 mm Hg. The left border of heart is displaced to the left on 2 cm. Accent of II tone above an aorta, slight edema of shins. Specific gravity of the urine is 1015. WBC - single in f/vision. ECG: signs of hypertrophy of left ventricle. Your diagnosis?	*Hypertensive illness of the II degree, crisis	Ishemic heart disease	Chronic pyelonephritis	Itsenko-Kushing Illness	Coarctation of aorta
95.	Patient I., 50 years, complains about headache, flashing of beauty spot before eyes, excitation, trembling in all body. Suffers of hypertensive illness 5 years. Arterial pressure 140/90 - 180/100 mm Hg. Objectively: skin covers are moist, red color. Ps is tense, 96 per/min. BP - 190/105 mm Hg. Left border of cardiac dullness - 1 cm laterally from a left middle clavicular line. Accent of II tone on an aorta. ECG has the signs of hypertrophy of the left ventricle. Spec. grav. of urine 1019. WBC. - 2-4 in f/vis. RBC. - 0-1 in f/vis.  Your diagnosis?	*Hypertensive illness of the II degree, crisis	Feochromocitoma	Acute glomerulonephritis	Atherosclerosis of aorta	Insufficiency of aortic valve
96.	A patient has complaints about a tormental (agonizing) cough with expectoration to 600-ml/daily purulent chocolate color of sputum with a decay smell. Onset of illness was abrupt, temperature 39(C, 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?	*Gangrene of lung .	Tuberculosis.	Bronchiectatic illness.	Abcetic pneumonia.	Lobar pneumonia.
97.	A female patient complains of weakness, dizziness, breathlessness on physical exertion and, diarrhea. In history the patient started to be ill   3 years ago after operative stomach resection by B-II done against a chronic gastric ulcer disease complicated with   severe bleeding. On physical examination the skin is pale and tongue brightly “lacquered”   red. The CBC reveals a low HB and hyperchromic enlarged in size  RBCs, their degenerative forms and poikilocytosis, Zholy’s intra cell inclusions. She was treated by iron preparations and vitamin B12 and then her condition became much better. What is the type of anemia?	* Anemia due to gastricectomy	Iron deficient anemia	В12 – folic acid deficient anemia	Coexistence of Iron deficient anemia with hereditary В12 – folic acid deficient anemia	Aplastic anemia
98.	Disease began abruptly with shaking chills, severe headache and fever up to 39-40?C. Pain appears from the left side of the chest in 4 hours during respiration. Cough at once was dry, but in 4 days rusty sputum was expectorated. Percussion revealed hip sound over left low lobe, vocal fremitus was intensified, during auscultation was listened bronchial respiration over affected lobe. What percussion sound will be over space of Traube?	* Tympanic sound.	Bandbox sound	Clear lung sound.	Dull-tympanic.	Hip sound.
99.	Patient C., age 32, is admitted in a hospital for a long time due to toxico-allergic myocorditis. There is  dyspnea at rest, heart rate 104 per min, arrhythmia was also observed. The pulsation of cervical veins occured in bed. There is an edema in the lower limbs, the skin is pale, and cold  palpation on skin. The cap-shaped depression disappears in  2 minutes. What is the main pathogenic mechanism of the edema in this case?	*Decrease of difference between the oncotic and the venous hydrostatic pressure. Secondary hyperaldosteronism.	Decrease of difference between the oncotic and the venous hydrostatic pressure. Primary hyperaldosteronism.	Exceeding hydrostatic over the oncotic pressure in arterioles. Secondary hyperaldosteronism.	Exceeding hydrostatic over the oncotic pressure in arterioles. Primary hyperaldosteronism.	Increase of the left ventrical of the heart filling pressure. Primary hyperaldosteronism.
100.	Woman, 56 years, complaints about the skin itching, sweating, subfebrile fever with the periodic increases of temperature to 38-39 C(, loss of weight, heaviness in right and left hypochondria, dyspeptic disorders. Objectively: a skin is pale, some icteric. A liver palpate at the level of umbilicus, a spleen on 2 cm is below than umbilicus, dense consistency. Common analysis of blood: RBC -3,0 T/L, Hb-110 g/L, C.I.-0,8; WBC-28 G/L, bas. – 4\%, eos.-5, myel.-6, St.-8, seg.-70, L-5, M-3, trom.180g/L,ESR mm/hour. Your diagnosis:	*Chronic myeloleucosis (subleucemic form)	Chronic myeloleucosis (leucemic form)	Chronic myeloleucosis (Aleucemic form)	Acute myeloblastic leucosis	Chronic lympholeucosis
101.	Rectoromanoscopy showed a 1 cm polyp in the patient. On histological examination there was found an adenomatous polyp. The further reasonable step in treating this patient can be?	*irrigoscopy	rectum resection	endoscopy polypectomy	repeated analysis of the occult blood in feces	repeated rectoromanoscopy
102.	The patient, 45 years, show complaints on severe retrosternal pains, not decreasing after usage of nitroglycerine. Objectively: integument’s are pale, there is cold perspiration, the respiration is vesicular and weakened, the tones of heart are rhythmical, pulse beat - 78, arterial pressure - 110/70. On the electrocardiogram: a rhythm is right sinus, there is pathological wave Q in the V1-V4, depression of segment ST in III AVF. What is your preliminary diagnosis?	*Acute miocardial infarction anterior-septal-apex.	Attack of a stenocardia.	Thromboembolism of the pulmonary artery.	Acute miocardial infarction of posterior wall of the left ventricular.	Acute pericarditis.
103.	Of the patient of nephrological department, who is ill on chronic glomerulonephritis, changed for the worse. The patient is delayed, it is impossible to get in touch with him, painful sensitivity is kept, integument’s are pale and dry, the face is swollen, there is a fibrillary twitching of muscles, pupils are narrowed, the respiration is vesicular and weakened, the tones of heart are rhythmical, pulse beat - 96, arterial pressure - 190/115. The blood test: creatinine - 0,352 mmol/liters. What condition was developed at the patient?	*Uremic coma.	Hyperosmotic coma.	Toxic coma.	Coma, which conditioned by damage of central nervous system.	Hepatic coma.
104.	Patient C aged 47 yr complains of intensive skin itching, jaundice, bone pain. The skin is  hyperpigmentated. There is multiple xanthelasma palpebrarum. The liver is +6 cm enlarged, hard with  acute edge. The  blood analysis revealed total bilirubin 160 mkmol/l, direct – 110 mkmol/l, AST (asparate aminotransferase) 2,1 mmol/l per hour, ALT – 1.8 mmol/l, alkaline phosphotase 4,6 mmol/l per hour, cholesterol – 9,2 mmol/l, antimitochondrial antibodies M2 in a high titer. What is the probable diagnosis?	*primary biliary liver cirrhosis	primary liver cancer	chronic viral hepatitis B	acute viral hepatitis B	alcoholic liver cirrhosis
105.	The patient  aged 60 yr  feels dyspnea  on a even slight physical exertion and complains of lower limbs swelling in the daytime. He is suffering from Ischemic Heart Disease and persistent atrial flutter within 2 years. On physical examination the patient appears  acrocyanotic.  Heart rate is 120 per  min., PS   68, BP 105/63 mm Hg. Heart sounds are loud, arrhythmic. Chest auscultation reveals moist rales in the lower lung regions. What treatment  is the most advisable for this patient?	* Digoxin	Egilok	Isoptine	Corinfar	Preductal
106.	The complications of acute cholecystitis which require surgical intervention are as follows except:	*Jaundice	Empyema  of the gall-bladder	Emphysematous gall-bladder	Gall-bladder perforation	Cholangitis conditioned by the presence of stones in the bile tract
107.	The serologic profile of the patient having been inoculated with recombinant  vaccine against hepatitis B (HBV includes the positive result of the test for:	*anti-НВс	HBsAg	anti-HBe	anti--HBs	anti - HBc and  anti -HBs
108.	Which of the following substances (drugs) can cause granulomatous hepatitis?	*allopurinolum	alchohol	paracetamol	methyldopha	cordaron
109.	The patient is 36. For a few years he has complained of heaviness and a dull ache in the abdomen. The liver is enlarged, hard and has an uneven surface. CT (computer tomography) has shown multiple pathological changes in the organs of  abdominal cavity. The correct diagnosis is:	*polycystosis of the liver;	cirrhosis of the liver;	multiple metastases of liver cancer;	echinococcosis of the liver;	acute hepatitis.
110.	In the patient with the pulsating formation in the epigastrium where systolic murmur has been heard a sudden acute pain in the abdomen has occurred. After the shock condition with  loss of consciousness was developed.  The diagnosis is:	*aneurysm rupture	ulcer perforation	acute appendicitis	peritonitis	acute pancreatitis
111.	The 48 years old patient  has the left ventricle wall hypertrophy  according to the data of echocardiography. What disease has no such a symptom ?	*Dilatative cardiomyopathy	Ischemic heart disease	Hypertonic disease	Hypertrophic cardiomyopathy	Myocarditis
112.	Splenomegaly, the low RBC (red blood cells) count, the high content of urobilinogen in feces of the patient with jaundice are the symptoms of:	*hemolytic jaundice	extrahepatic cholestasia	intrahepatic cholestasia	sepsis	mechanical jaundise
113.	The patient, 32 years, complains of a constant aching lumbar pains, frequent painful urination, subfibrile temperature, a headache. Urine test: relative density - 1015, protein - 0,066 gr/liters, leukocytes on all field of vision, erythrocytes - 4-5, oxalates. On the roentgenogram: expansion of kidney plelois. What is your preliminary diagnosis?	*Chronic pyelonephritis.	Acute pyelonephritis.	Acute glomerulonephritis.	Chronic glomerulonephritis.	Paranephritis.
114.	A patient K. aged  35 years complains of weakness, dizziness, headache, palpitation, attacks of pain in umbilical, sacral areas, fever up to 38,20C, urine discoloration   resembled smoky brown and normal stool. The condition started after bee  sting. On clinical examination the jaundice is noted. BP (blood pressure) is 100/60 mm of Hg, spleen is enlarged. RBC (  erythrocytes) are  2,3 * 1012/l, НB  72 g/l, K - 0,9, reticulocytes  13,1\%, WBC (leucocytes) 6,2 * 109/l, ESR -25 mm/hour. In urine  urobilin reaction is strongly  positive, bilirubin pigments are absent. The total bilirubin is  60 mkmol/l, indirect 40 mkmol/l. Serum iron  is  20,4 mkmol/l. What clinical diagnosis is the most probable?	* Acquired hemolytic anemia	Acute liver insufficiency	Iron-deficiency anemia	В12- deficiency anemia	Viral hepatitis
115.	A 30 years old woman complains of dizziness, weakness, increased nails fragility, alopecia and pica. On clinical examination body t° is 36,7°, the skin is pale, RR (respiration rate) is 20 per min; Ps  98, BP (blood pressure)  100/60 mm of Hg. In CBC erythrocytes are 2,8*1012/l, Hemoglobin (Hb) 85 g/l, KP-0,9, reticulocytes-2\%; WBC (leucocytes) 4,7*109/l; eosinophils-2\%; stub neutrophils-3\%, segmented neutrophils-62\%, lymphacytes-26\%, monocytes-5\%, ESR-20mm/hour. Serum iron is 6,8 mkmol/l. What preparation is necessary to prescribe to a patient?	*Iron per os	Fresh blood	Erythrocytal mass	Iron pareuterally	Vitamin B12-intramuscularly
116.	Patient P  34 years old was diagnosed long-lasting bronchial asthma  3rd type and 3rd type of exacerbation. Pulmonary  insufficiency is of the I type. What therapy  should be administered in this  case?	*beclometasone 1000 mkg/day and at night, salmeterol 100 mkg/day and at night, if necessary  short acting ?2-antagonist but not more than 3-4 times per day and at night	?2-antagonist of the short action during the attack of breathlessness	beclometasone 500 mkg /day, salmeterol 50 mkg /day.	beclometasone 2000 mkg/day, oral  prednisolon 10 mg/day, salmeterol 100 mkg/day.	?2-antagonist of the short action 6 times per day, oral  prednisolon 20 mg/day (2 times in the morning).
117.	A patient aged  43 years was admitted to  the hospital. She has been suffering from the bronchial asthma for 7 years. The main clinical features are following.  The patient`s position is orthopnoic and she speaks only with separate words. The additional muscles take part in the act of respiration. Respiratory rate is 32 per min. Wheezes are heard  in all lung’s surface. The heart rate  125 per min. Expiratory peak volume  after short acting  B2 antagonists intake  is 55\% from the normal value. PaO2 is 58 mm of Hg, PaCO2 42 mm Hg, SaO2 – 90\%. Haw should be classified   the bronchial asthma  observed in this case?	*sever	Moderate to severe	mild	Moderate	Life threatening
118.	A 52 years old hard smoker patient  complains of  persistent  cough with purulent sputum  discharge especially in  mornings, dyspnea provoked even by slight physical exertion, wheezing  chest, tahypnoe, general weakness. He considers himself to be ill during 12 years. The overwritten conditions appear 3-4 times per year  usually after common cold and have tendency to progress. About what disease do you think  first of all?	*Chronic obstructive lung disease	Bronchial asthma	Mucoviscidosis	Bronchoectatic disease	Aspergillosis
119.	Patient P. aged 62 yr was diagnosed non-hospital bilateral localized in lower lobes  pneumonia group III and risk class IV with exacerbated  chronic obstructive lung disease in III stage. What antibacterial preparation should be chosen for this patient for treating in the in-patient department?	*Protected aminopenicillin intravenously or cephalosporin of the II-III generation plus macrolid	Fluoroquinolones of the III-IV generation intravenously	Aryfromycin or quarithromycin	Clindamycin	Amycacin
120.	Patient F. aged 23 yr complains of the BT elevation up to 380 C, marked itching of the skin , an appearance of rash on the whole body. She ate strawberries in the evening. What preparations should be administered first of all?	*Antihistamine preparations of the 3-rd generation.	Antibiotics	Histaglobulin.	Autoserum.	Antipyretic drugs.
121.	A boy aged  15 yr periodically has been complaining of the epigastric  pains, nausea and heartburn. Gastroduodenoscopy revealed the sings of gastroduodenitis and ulcer impairment of the duodenal mucous membrane. What drug will be the most effective in the treatment of this patient ?	*De-nol	Nos-pa	Papaverin	Atropin	Almagel
122.	3 weeks ago the patient was ill with tonsillitis. Clinical examination revealed edema, arterial hypertension, hematuria, proteinuria (1,8g/per day) granular and erythrocital casts. What is the suggestive  diagnosis?	*Glomerulonephritis	Cystitis	Pyelonephritis	Intestinal nephritis	Renal amyloidosis
123.	The 52 years old patient has been admitted to the hospital. He complains of vomiting, soft  black repeated stools (melena)  during the day. Such cases have never been before. The pulse rate is 96 beats per minute, the blood pressure  100/70 mm Hg. On finger examination of the rectum there was found black feces. The appropriate examining is:	*esophagogastroduodenoscopy	rectoromanoscopy	irrigoscopy	roentgenoscopy of the stomach	laparoscopy
124.	The 58 years old patient  complains of the burning pain behind her breastbone which appears when she walks more then   300 m of distance and when she rises  on the second floor. The stereotype pain propagated  into the left shoulder disappears within 1-2 minutes after sublingual nitroglycerin intake.  Identify the functional class of ischemic heart disease:	*ІІ	І	ІІІ	IV	Progressive ischemic heart disease
125.	A patient T. 33 years was admitted to a hospital. A patient is pale, at an attempt to stand up complains about strong dizziness. There was approximately hour ago vomiting like coffee-grounds. BP - 90/60 mm Hg., pulse - 120 b/min. It is known from anamnesis, that a patient during 4 years suffers with ulcerous illness of the stomach, painless form. An ulcer was exposed at gastrofiberoscopy. Your diagnosis:	*Ulcerous illness of stomach, complicated with bleeding	Ulcerous illness of duodenum, complicated with bleeding	Erosive  gastritis	Acute pleurisy	Acute myocardial infarction, abdominal form
126.	Patient T., 48 years. Complaints about the decline of appetite, heaviness in an epigastria region after a meal, pains in right hypochondria, aching character, increasing after a meal, especially fat. Disturbs nausea, flatulence, disorders of stool, loss of weight. At examination – jaundice of skin, vascular spiders, gynecomastia, ascites, “caput medusae”. A liver at palpation is painless, dense, an edge is sharp, a spleen is enlarged. Your preliminary diagnosis:	*Liver cirrhosis	Chronic active  hepatitis	Acute hepatitis A	Acute cholecystitis	Acute pancreatitis
127.	Patient complains about significant dyspnoe. During inspection has forced posture (orthopnea). Percussion of the lungs revealed hip dullness to the 2-nd rib (backside) with upper boundary as parabolic line on the left side.    Respiratory sounds and vocal fremitus over dullness are absent. What breathing will be in the area of dullness?	*Will be absent.	Amphoric.	Vesicular.	Bronchial..	Cogwheel.
128.	A patient is ill 20 years with chronic bronchitis, complains about cough with purulent sputum up to 200-300 ml/daily. Lately discharge about 2 liters of purulent sputum per day with the biggest amount of sputum in a morning time, fingers as “drumsticks”, nails have type of “watch glasses”. About what disease is it necessary to think?	*Bronchiectatic illness	Abscess of lung	Pulmonary tuberculosis	Lobar pneumonia	Gangrene of lungs
129.	Patient L., 38 years. Complaints about dull, aching pains in area of right hypochondria, permanent or arising up in 1-3 hours after the reception of abundant and especially fat food and fried dishes. Pain radiates upwards, in the region of right shoulder and neck. In addition, often disturbs feeling of bitter taste and metallic taste into the mouth, belch with air, flatulence. At palpation of abdomen tenderness in area of projection of gall bladder. A liver is not enlarged, a spleen not palpate. Your preliminary diagnosis:	*Chronic cholecystitis	Cirrhosis of liver	Acute  hepatitis	Chronic hepatitis	Acute cholecystitis
130.	The 62 year old patient complains of the 10 kg weight loss within last  2 months, some times dark red urine voiding occurs and  pain in the middle back. The patient is feverish up to 390C. On palpation there is the left kidney tenderness. In blood: hemoglobin is 90 g/l, erythrocytes – 2,8*1012/l, leukocytes – 8,8*109/l, erythrocytes sedimentation rate – 42mm/h. In urine: specific gravity is 1018, protein – 0,.66 g/l, mycroerytrocyturia . The previous diagnosis is:	*kidney tumor	kidney carbuncle	kidney tuberculosis	acute glomerulonephritis	urolithic disease
131.	The patient aged 38 within 2 weeks fills   pain in the upper one third part of the sternum that occurs usually when he rises to the 2nd floor. The pain lasts up to 5-10 minutes. BP is 120/80 mm Hg. ECG T-waves are smoothed out in V1- V4. What is the most probable diagnosis?	* The first attack of angina	Myocardial infarction	Angina on exertion III ph. class	Angina on exertion IV ph. class	Vegetative vascular dystonia
132.	A patient aged 45 yr long time suffers with mitral stenosis and arrhythmia joined it last year. Acute burning pains in the epigastrical region, weakness, dizziness appeared suddenly 2 hours ago. The main clinical features of the case are following. The patient’s general condition is severe. Pulse is 120 beats per minute and weak. BP (blood pressure) is 90/40 mm Hg).  Abdomen is paifull and rigid (does not take part in respiration). The symptoms of peritoneum irritation are observed. Peristaltic sounds are not heard.  Usual percussive liver’s dullness is preserved. But there is not dullness in the sloping  parts  of  abdomen. The plane abdomen  X-ray does not  reveal disorders.  What is the diagnosis?	*Thromboembolism of superior mesenteric artery	Perforated duodenal ulcer	Acute pancreatitis	Acute cholecystitis	All mentioned above
133.	Point out the sign which is not a criterion for the cessation of a physical load test in patients suffering from cardiovascular pathology:	*Increasing the cardiovascular frequency more than 30\% as compared with the initial value	The segment ST depression more than 2 mm from the midline	The development of the ECG compete  or partial heart block	The paroxysmal  ventricular tachycardia development	The signs of  inadequate cerebral blood supply
134.	A 70 year old patient is on residential follow-up with the diagnosis: ischemic heart disease, stable angina of effort, II functional class. Ciliary arrhythmia, tachysystolic form. Сhronic heart failure II. Secondary diagnosis: diabetes mellitus, type II.	*Antagonists Ca++, verapamil group	Antagonists Ca++, nifedipine group	Nitrates of durable action	(-adrenoreceptor blocking agents, selective	(-adrenoreceptor blocking agents, with intrinsic sympathomimetic activity.
135.	Which of the following antiarhythmic preparations is contraindicated in  treatment of  ventricular premature bites:	*verapamil	metoprolol	ethacizine	amyodaron	propaphenon
136.	The patient, 67 years, shows complaints on palpitation, dizziness, noise in ears, feeling of shortage of air. Objectively:  the patient is pale, integument’s are damp, respiration is vesicular, frequency of respiratory movements - 22, pulse beat - 200 times a minute, arterial pressure - 100/70. On the electrocardiogram: frequency of heart beat - 200, ventricular complexes are widened, deformed, the arrangements of segments ST and of wave T is discordant. The wave Р is not changed accumulates on QRST, conformity to natural laws between Р and QRS is not present. What infringement of a rhythm was developed at the patient?	*Paroxismal ventricular tachycardia.	Sinus tachycardia.	Thimmer arrythmia.	Ventricular extrasystole.	Atrial tachycardia.
137.	The patient, 32 years, complains of the general weakness, loss of appetite, thirst, dryness in a mouth, a headache, decrease of urinary excretion, aching lumbar pains, edema on legs and the face. Arterial pressure - 165/80. The blood test: creatinine - 0,18 mmol/liters, hypoalbuminemia, hyperlipidemia. Urine test: density - 1026, protein - 3, 5 gr/liters. Daily proteinuria - 4. What clinical syndrome conducting at the given patient?	*Nephrotic.	Uric.	Acute nephritic.	Hypertensive.	Edematous.
138.	The patient, 40 years, with combined mitral defect with prevalence of a stenosis suddenly felt a sharp retrosternal pain, difficulty of  breath (dyspnea). Objectively: a condition of the patient is grave, cyanosis, swelling of cervical veins, tachipnea - 40 times a minute, vesicular respiration, tachycardia - 120 times a minute, arterial pressure - 80/50 . On the roentgenogram: an enlightenment of pulmonary fields on the limited site, expansion of a shadow top of superior cava. What is yours preliminary diagnosis?	*Thromboembolism of the pulmonary artery	Acute miocardial infarction.	Attack of bronchial asthma.	Attack of heart asthma.	Attack paroxysmal tachycardias.
139.	The 46 years old patient complains of the anginous attacks development  at  night chiefly from 3 to 4 AM without apparent cause. Within valoergometric examination at time  of 50 w physical load the slight cardiac pain was noted by the patient  and this pain disappeared at 75 w load moment. Make a diagnosis :	*Prinzmetal’s angina	Progressive stenocardia	Early postinfarction stenocardia	Angina on exertion	Angina at rest
140.	The patient aged 60 had myocardial infarction 10 years ago. He has been suffering from arterial hypertension for about 15 years. Now he  feels palpitation and pain behind the breastbone. BP is 190/100 mm Hg, heart rate  100 per min. On  ECG there are supraventricular  premature bites, left ventricular hypertrophy and scar on the posterior myocardial wall. PQ interval longs 0,18 s. What preparation is indicated to the patient?	* Egilok	Corinfal	Clophelin	Triampur	Prazozin.
141.	The patient complains of syncope (unconsciousness fits) that started to occur after myocardial infarction which he  had 6 months ago. On clinical examination the  heart sounds are quiet, heart  rate is 40 per min. and  BP  110/70 mm Hg. On Holter ECG monitoring second degree Mobitz type 2 (3:1, 4:1) A – V block was established. Asystolic  periods long up to 3-4 sec. What is current  treatment?	*artificial pacemaker implantation	prescription of nitrates	atropine regular intake	prescription of preductal	neopinephrine regular intake
142.	The female patient aged 28 had had a flu. Two  weeks later she felt pain behind the breastbone. On clinical examination there are  hoarse voice,  neck vein’s swelling,  absence of relative cardiac dullness. ECG voltage is low and segment ST rises above the midline in all leads. What is the most probable diagnosis?	* Pericarditis	The second myocardial infarction	Acute muocarditis	Idiopathic cardiomyopathy	Angina Pectoris
143.	The female patient aged 25 had had a flu. Two weeks later severe weakness, mild fever, breathlessness and constant aching cardiac pain there occurred. On clinical examination  the first heart sound (S1) is quite (s1). Body temperature  is 37,30 C. The  ECG voltage is low and first   degree AV block noted.  ESR is  30 mm/h. What is the most probable diagnosis?	* Acute myocarditis	Pneumonia	Dilatation cardiomyopathy	Infectious endocarditis	Unstable stenocardia
144.	According to the New-York Cardiologists Association Recommendations the 55 years old patient  has been made the diagnosis ischemic heart disease, angina on exertion  functional class II, heart failure  functional class I, arterial hypertension of the second degree, hypertensive heart. Point out the preparation of choice in treatment of this case:	*metoprolol	clophelinum	doxasozine	nitroglycerin	indapamide
145.	The 42 years old woman suffers from viral hepatitis B. On examination there has been determined the absence of comprehensive  contact, confusion (patient`s disorientation in place and time), the mild smell of acetone out of the mouth. What is your immediate action?	* admission to the intensive care unit (ICU)	the blood prothrombin  control	the aminocapronic acid preparation infusion	the  antibiotics prescribe	the dynamic observation  of vital functions
146.	In a 6 year-old child infiltrate of 18 mm in diameter was detected as a result of the Montoux test. A 1 year ago Montoux test  showed infiltrate of 10 mm. Determine the result of Montoux test.	Hyperergic	Hypoergic	Normergic	Anergic	Postvaccinal allergy
147.	18 years old patient complains of cramping abdomen pain, weakness, body temperature up to 38,5 for 2 days, scanty portions of stool with mucous up to 10 times per day.  The patient`s tongue is white coated and dry. The abdomen is painful in the left iliac region. Sigma is spasmodic. What is the suspected diagnosis?	* Shigellosis	Thyphoid fever	Food toxicoinfection	Salmonellosis	Escherichiosis
148.	19 years old patient has an acute onset of  disease. The body temperature is 36. He complains of weakness, vomiting without  any nausea and abdomen pain. The large amounts of stool like  rice-water with smell of grated potatoes is the feature of this case . Diagnosis?	* Cholera	Shigellosis	Campilobacteriosis	Botulism	Salmonellosis
149.	Within  20 days the 20 years old man has had a fever and productive  cough. By auscultation there has been detected bilateral diminished air entry and moist  rales. The X-Ray   showed volatile (migrants)  infiltrates. Point out the diagnosis:	* ascaridiasis	bronchitis	bronchial asthma	embolism of pulmonary artery	lobar  pneumonia
150.	The 19 years old patient was admitted  in the in-patient department with viral hepatitis B. On the 5th day of the disease the patient become to be excited, speaks much. The jaundice is deteriorating.  There is tachycardia. The size of liver is decreasing up to  2.5 cm per day. The total serum bilirubin increased 2 times comparison with day of admission  and  ALAT (alanine aminotranspherase) fall from 8.0 mmole/l to 3.8 mmole/l. What cause  triggered the  patient’s deterioration?	* acute encephalopathy	joining of the secondary infection	biliary ducts obstruction	acute hemolytic anemia	infective toxic shock