Paed Lugansk

Крок 2 Загальна лікарська підготовка_2004-2005

3 профиль

 

№	ItemText	DistrA	DistrB	DistrC	DistrD	DistrE
1.	On the third day of disease a 10 years old child with acute respiratory infection developed productive  cough. The percussion is without pathologic features.  The auscultation reveals  bilateral  rales over the lung surface. What diagnosis should be made?	*acute bronchitis	relapsing bronchitis	obstructive bronchitis	Asthma	Pneumonia
2.	An infant aged 1 year on the third day of common cold  at night developed inspiratory stridor, hoarse voice and barking cough. Physical examination revealed  suprasternal  and intercostal chest retractions. There is a bluish skin discoloration moistly seen over the upper lip. The respiratory rate is 52 per min and pulse rate  122 per min. The body temperature is 37,50C. What disease does the infant have?	*Acute infectious croup  due to viral laryngotracheitis grade II of airway obstruction, incomplete compensation state	Acute laryngitis	Bronchopneumonia  without complications	Acute bronchiolitis with respiratory distress	Acute epiglottitis
3.	One week old male infant had one episode of vomiting yesterday and 2 episodes of spitting up with poor feeding today. There is no history of fever, diarrhea or coughing. His urine output is decreased. He was born at term weight 3.2 kg. Weight now is 3.0 kg. Laboratory data: Na 128 mmol/l, K 6.9mmol/l.  What is the most probable diagnosis?	Salt wasting form of adrenal insufficiency	Birth trauma of central nervous system	Gastroenterocolitis	Pylorospasm	Pylorostenosis
4.	A 42-week-gestational-age, 3800-g, breast-fed, female is noted to have persistent hyperbilirubinemia at 2 weeks of age. The infant has not gained weight since birth, has hoarse cry, dry skin, hypotonia, an umbilical hernia, constipation, and an anterior fontanel measuring 4 - 6 cm. What is the most likely diagnosis?	hypothyroidism	hereditary spherocytosis	neonatal hepatitis	biliary atresia	galactosemia
5.	The infant is born with perinatal asphixia.  At birth he is apneic with a heart rate 70 per minute, so bag-and- mask positive presurre ventilation with 100\% O2 was immediately instituted. After 30 sec of ventilation the heart rate is not increased. What is the most appropriate next step?	chest compression	tactile stimulation	to continue ventilation	intravenous sodium bicarbonate	intravenous epinephrine
6.	The boy is 10 years old. Two weeks ago he suffered from acute tonsillitis. Now he complains on common weakness, oedema of eyelids, ankle joints, headache, nausea. Skin is pale, appetite is reduced, daily diuresis is 600 ml. In urinalysis: protein – 0,066 g/l, WBC – 4-6, RBC – 40-45. The most probable diagnosis is?	Glomerulonephritis with nephritic syndrome	Interstitial nephritis	Pyelonephritis	Glomerulonephritis with nephrotic syndrome	Polycystic kidney disease
7.	A 1 year old boy does not walking, does not speak, not active. He holds head since 9 months. Physical examination shows pallor, oedema, saddle nose, large tongue. Skin is dry, voice is gruff. Pulse rate - 100 per 1 min. The teeth are absent. What diagnosis is the most probable?	Hypothyroidism	Hirschsprung’s disease	Rickets	Down’s syndrome	Hydrocephalus
8.	4300-g infant was born at term gestation to a poorly controlled insulin-dependent diabetic mother. Initially, the infant did well, but at 2 hours of age he was noted to be lethargic and than develop tonic-clonic seizures.  Blood glucose is 1.6 mmol/l. What is the most likely reason of seizures?	hypoglycemia	hypocalcemia	hypomagnesemia	hyponatremia	pyridoxine deficiency
9.	Phenylketonuria was diagnosed in newborn male during screening investigation. How long dietary restriction of phenylalanine must continue?	8 – 10 years	1 year	2 years	5 years	6 months
10.	A 9 year old female is referred to the hematology department with a chief complaint of acute onset of easy bruising and "rash" for 3 days. She had upper respiratory infection symptoms approximately 2 weeks ago. A diffuse petechial rash is noted on her neck, trunk, extremities and groin. CBC shows Hgb 128 g|l, Hct 38.5, WBC 6,000x. Platelet count is low at 5,000. What is the most probable diagnosis?	Idiopathic thrombocytopenic purpura	Bone Marrow Failure	Hemophilia A	Hemolytic uremic syndrome	Acute lymphoblastic leycosis
11.	Boy is 2 months old. He was born in September. Не is on breast feeding. What should a daily doze of ergocalciferol be for prophylaxis of rickets?	*400-500 IU	200-300 IU	300-400 IU	500-600 IU	100-200 IU
12.	A 10 year old boy has the history Diabetes Mellitus type I during 6 years. He has headache, nausea, sweet smell of his breath and he is breathing faster than usual. His lab studies show Na 132 mmol/l, K3.3 mmol/l, glucose 28 mmol/l.  What treatment will you prescribe?	IV fluids and short active insulin (0.1 u/kg)	IV fluids	Short active insulin (0.1 u/kg)	Combination of short active insulin and intermediate active insulin	Intermediate active insulin
13.	A 2-hour-old, 32-week-gestational-age infant develops progressive cyanosis, grunting, nasal flaring, and chest retractions. Silverman scores  were 4. The chest radiograph reveals a ground glass–air bronchogram pattern. The infant now requires oxygen therapy with continuous positive airway pressure to maintain adequate oxygenation.  What is the most likely diagnosis?	respiratory distress syndrome	intranatal asphyxia	congenital pneumonia	pneumothorax	congenital heart dis_ease.
14.	A 7 year old male presents to physician with the chief complaint of dark "cola colored" urine, facial puffiness and abdominal pain for the past 2 days. 14 days ago he had a sore throat and fever. He has had abdominal pain.  His urine is dark. Urine analysis shows an increased specific gravity, RBCs are too numerous to count.   What is the most probable diagnosis?	Glomerulonephritis. Nephritic Syndrome	Glomerulonephritis. Nephrotic Syndrome	Acute heart failure	Acute infection of urinary tract	Hemolytic uremic syndrome
15.	A 4 year old female has been limping with swelling of her right knee for several months. Physical examination demonstrates swelling of her right knee, flexion contracture of 10 degrees and flexion to 120 degrees. Lab. data: WBC 8 g/l,  with 45\% neutr., 47 lymphs\%, 8\% mon. Hgb 120 g/l. ESR 20mm/h. Rheum. factor neg., ANA 1:640 speckled. What is the most probable diagnosis?	Juvenile Rheumatoid Arthritis	Rheumatism	Lupus	Osteomyelitis	Infection Arthritis
16.	The laboratory data of patient's hemoglobin as 70 g/l, and the reticulocyte count as 1\%. The published normal value for the reticulocyte count is 0.7\% to 2.0\%, so the reticulocyte count is within the laboratory's normal range. How would you interpret this reticulocyte count?	This reticulocyte count value is normal for a patient with a normal hemoglobin, but for a severely anemic patient, the reticulocyte count should be high.	This reticulocyte count is normal, so the patient's bone marrow is making RBCs adequately.	This reticulocyte count is low.	This reticulocyte count is too high.	This reticulocyte count is depend from hemoglobin level
17.	Mother of a previously healthy 4 year old male complains of cough and wheeze. Boy had playing with a small toy. During examination the right side of a chest show hyperresonance, diminished vocal resonance and poor air entry.  What is the most probable diagnosis?	Foreign body aspiration	Asthma	Pneumonia	Bronchitis	Bronchiolitis
18.	A previously healthy 14 year old female complains of a fast heart rate, weight loss, and fatigue over the past 2 months. Her family history is significant for a grandmother and aunt with Hashimoto thyroiditis. During examination she has mild tachycardia without murmurs or gallop and mild tremor. Hyperthyroidism (Graves disease) was diagnosed.  What treatment will you prescribe?	Propylthiouracil	Surgical treatment	L-thyroxine	Prednizolone	Iodinated salt
19.	1 month old female presents to the intensive care unit with severe cyanosis, congestive heart failure, normal first sound, single second sound and an insignificant one to two ejection systolic murmur. The electrocardiogram shows right axis deviation and right ventricular hyperthrophy. The thoracic roentgenogram shows cardiomegaly with narrow base and plethoric lung fields.  What is the most probable diagnosis?	Congenital heart disease, right to left shunt	Congenital heart disease, left to right shunt	Pneumonia	Congenital lung malformation	Bronchiolitis
20.	16 month old female presents  with an acute onset of her hands and feet "drawing up.Both her hands are flexed at the wrists with hyperextended fingers at the proximal and distal interphalangeal joints and flexion at the metacarpophalangeal joints. Neurologic exam reveals symmetric hyperreflexia, decreased muscle strength and tone. Lab.data: Ca 0,9 mmol/l, P 0.4 mmol/l. What is the most probable diagnosis?	Vitamin D deficiency, spasmophylia	Epilepsy	Acute infection of central nervous system	DiGeorge syndrome	Glycogenosis
21.	A 7 month old male delayed in psycho-motor development from 6 month. He developed pursuant to age up to 3 mo. His hair is lighter than in parents, eyes are blue. There are periodically cramps. It is marked the specific "mouth-like" odor of urine. The diagnosis of phenilketonuria is made. What is necessary to exclude from child diet?	Phenilalanin	Metionin	Galactose	Glucose	Maltose
22.	A 8 year old boy has symptoms of polyuria, nocturia during 2 mo. He began to lose weight over this same period. He has a noticeably sweet smell to his breath. His skin is warm to his wrists and ankles. A urine  shows 4+ glucose and 2+ ketones. His initial lab studies show Na 132 mmol/, K3.3 mmol/l, glucose 23 mmol/l. A urine analysis shows 4+ glucose and 2+ ketones.  What is the most probable diagnosis?	Diabetes Mellitus, Type I, diabetic ketoacidosis	Acute infection of urinary tract	Diabetes Mellitus, Type II	Enuresis	Chronic lymphocytic thyreoiditis
23.	The child is 6 years old. He suffers from  nervous – arthritic diathesis. What period is critical for development of this diathesis?	* School	Preschool	Infancy	Neonatal	Perinatal
24.	Child is 2 months old. He is premature infant. What should a daily doze of ergocalciferol be for prophylaxis of rickets?	*1000-1200 IU	800-1000 IU	1200-1500 IU	400-500 IU	1300-1500 IU
25.	Girl is 4 months old. She was born in October. She is on breast feeding. To what age should prophylaxis of rickets carry out?	*1,5 years	2 years	2,5 years	1 year	6 months
26.	Boy is 4 months old. Не is on breast feeding. Determine a remedy for primary prophylaxis of spasmophilia.	* Ergocalciferol	Calcium gluconate	Calcium  chloride	Natrium chloride	Calcium  pantothenate
27.	Boy is 3 months old. He has signs of local manifestation of exudative catarrhal diathesis. From what age should preventive inoculations do to this child?	*From  3  months	From  6 months	From  8 months	From  10 months	From  12 months
28.	Girl is 4 years old. She suffers from recurring bronchitis. Through what time should prophylactic medical supervision of this child at absence of recurrences stop?	*2 years	1 year	2,5 years	1,5 years	3 years
29.	Child is 3 months old. At investigation in a polyclinic rickets was diagnosed. The basic process characteristic for rickets is infringement of a metabolism.	* Calcium and phosphorus	Calcium and potassium	Calcium and magnesium	Calcium and sodium	Calcium and zinc
30.	The child is three months old. He suffers from rickets. What acid does the important role play in an exchange of phosphorus and calcium, influences on action of calciferol, function of parathyroid glands?	* Citric	Acetic	Hydrochloric	Phosphoric	Sulfuric
31.	The child is 7 months old. He suffers from spasmophilia. What infringement of a kind of an exchange is a pathogenic part at spasmophilia?	*Phosphoric-calcic	Phosphoric-potassic	Phosphoric-sodium	Phosphoric-magnesion	Phosphoric-zinc
32.	A 6-year-old boy with asthma has had mild wheezing only four times since you began treating him 3 months ago with Cromolyn inhalation twice each day. For the past 2 days, he has again had mild coughing and wheezing. What should you recommend to treat acute attack of asthma?	inhalation Salbutamol	inhalation corticosteroids	Loratadine	Aspirin	Theophylline
33.	The child is 6 months old. He suffers from lymphatic-hypoplastic diathesis. What is the main pathogenic marker at this diathesis?	*Lymphocytosis	Lymphopenia	Neutrophylosis	Neutropenia	Monocytosis
34.	Full term newborn has developed jaundice at 10 hours of age. Hemolytic disease of newborn due to Rh-incompatibility was diagnosed. 2 hours later the infant has indirect serum bilirubin level increasing 14 mmol/L. What is most appropriate for treatment hyperbilirubinemia in this infant?	exchange blood transfusion	phototherapy	phenobarbital	intestinal sorbents	infusion therapy
35.	7 -year-old boy with chronic cinusitis and reccurent pulmonary infections has chest a x-ray demonstrating a right-sided cardiac silhouette. What is the most likely diagnosis?	Kartagener syndrome	cystic fibrosis	bronhiolitis obliterans	laryngotracheomalacia	(-antitrypsin deficiency
36.	Parents of 3-year-old girl complain of rectal prolapse and failure to gain weight in spite of a good appetite. Patient has a history of recurrent prolonged respiratory infections and frequent, bulky, greasy stools. Sweet chloride is 126 mmol/l. What is the diagnosis?	cystic fibrosis	(-antitrypsin deficiency	Kartagener syndrome	celiac disease	Hirschprung’s disease
37.	2-year-old previously healthy boy had eaten peanuts and suddenly presents with an acute onset of cough, choking, and respiratory distress. Physical examination reveals a RR of 45 and wheezing, body temperature is normal. There is no history of asthma or allergic reactions, and no one at home is ill.  What is the most likely diagnosis?	foreign body aspiration	acute bronchiolitis	attack of asthma	acute laryngitis	angioedema
38.	A 6-year-old girl has had a dry cough without sputum for 2 months. The cough is getting worse after exercises and at night. Family history revealed that the parents have eczema. On physical examination, you hear a wheeze in both lung fields. She has none of the signs of chronic lung disease. What is the most likely diagnosis?	bronchial asthma	pertussis	foreign body aspiration	bronchiectasis	interstitial pneumonia
39.	You are called to the delivery of a boy at 42 weeks' gestational age with thick meconium stained fluid. The obstetrician rapidly delivers the infant and hands him to you for care. The boy is hypotonic, cyanotic, apneic, and bradycardic. What is the most appropriate next step?	intubate the trachea and apply aspiration	stimulate the infant to breathe	administer epinephrine	provide bag-and-mask ventilation	intubate the trachea and provide positive pressure ventilation
40.	Baby was born by vaginal delivery follow_ing a term gestation. Apgar score was 5 and 7. Physical examination reveals scaphoid abdomen, slow respiration and reduced chest movement. Breezing sounds are absent in a lower part of left lung. Chest radiograph reveal shift of mediastinum to right side, intestinal shadow on left side. What is the most likely diagnosis?	diaphragmatic hernia	respiratory distress syndrome	congenital bronhiectasis	congenital pneumonia	(- cystic fibrosis
41.	A 2.9-kg term male infant is born to a mother who developed polyhydramnios at 34 weeks' gestation. At birth, the Apgar scores were 9 and 9. The infant develops choking and cyanosis with the first feed. In addition, is unable to place a nasogastric tube. What is the most likely diagnosis?	esophageal atresia	choanal atresia	laryngomalacia	tracheal atresia	respiratory distress syndrome
42.	A 2-hour-old, 32-week-gestational-age infant develops respiratory distress syndrome with progressive cyanosis, grunting, and chest retractions. The infant now requires oxygen therapy with continuous positive airway pressure ventilation to maintain adequate oxygenation. Antibiotics are administered. What you should prescribe to infant?	endotracheal surfactant	intravenous dexamethasone	intravenous epinephrine	intravenous sodium bicarbonate	endotracheal ambroxol
43.	A 3 month child has vomiting, poor feeding, fever up to 38°C for the 2 days. His  stool is frequent, with slime. Infant has lost 250 g of weight. He is pale, mucous are dry, fontanel is “fallen”, turgor is reduced, the abdomen is moderately inflated. The diagnosis of enterocolitis was made, dehydratation of 2nd degree. What solution is necessary to prescribe for rehydratation?	Rehydron	5 \% glucose solution	Boiled water	Tea	Broth of a camomile (medical)
44.	The child is 11 months old. He suffers from nervous – arthritic diathesis. The increased synthesis of what acid is pathogenically at nervous- arthritic diathesis?	* Uric acid	Acetic acid	Phosphoric acid	Hydrochloric acid	Sulfuric acid
45.	What anatomic - physiologic feature of lungs  structure in the first years of life infants causes exactly segmental pneumonias?	*Segments removing with soft connective tissue	Left  bronchus deviation at right angles	Wide right bronchus which is trachea’s extension	Elastic tissue hypoplasia	Reduced aeration and secretion evacuation
46.	The child of 7 months old who is suffering from tetralogy of Fallot has admitted to hospital with attack of dyspnoea and cyanosis. The respiration rate is 55 per minute, the heart rate – 120 per minute. What is the treatment of this condition?	IV promedol, anaprilin; oxygen supply	IV strophantin, glucose	IV euphyllin, prednisone	IV prednisone, furosemide	IV furosemide, albumine
47.	A 2.5 month girl has frequent vomiting irrespective of eat period, growing thin, weakness during last 1,5 months. She was born with bodyweight 3400. Present weight - 2900. Girl is pale, has penis-like clitor, subcutaneous fat is absent. The laboratory studies show K - 9.4 mmol/l, sodium - 86 mmol/l. What is the most probable diagnosis?	Adrenogenital syndrome (virilised  and salt-wasting form)	Pylorostenosis	Pylorospasmus	Enterocolitis	Partial intestinal ileus
48.	The girl is 3 years old. She has admitted to hospital with the parents’ complaint on poorly walking. The excessive development of shoulder muscles is noticed, the lower extremities are poor developed, muscle hypotonia. The borders of relative heart dullness are extended to the left on 2 cm. There is systolic murmur in 2nd intercostal interspace on the right side of the sternum. Blood pressure on arms – 100/70, on legs – 40/20. Which diagnosis could be suspected?	Coarctation of aorta	Ventricle septal defect	Atrium septal defect	Tetralogy of Fallot	myocarditis
49.	A mother consults her 3 years old daughter by pediatrician. The child complains  of hoarse voice, barking cough, laboured breathing with difficult inspiration. The infectious croup due to acute  laryngitis is diagnosed. What anatomical feature predisposes a child to  laryngeal stridor?	*Narrow vocal slit	Wide laryngeal lumen	Watering-pot form of the larynx	Poor vascularization of the mucous membrane	Diaphragmatic type of respiration
50.	The positive urine glucose test due to so-called  physiological  glucosuria was revealed in a healthy 1 month old infant on routine examination.. What feature of urinary system in infant predisposes to this phenomenon?	* Immaturity of  glucose reabsorbtion in kidney	Big  daily urine output	Transitory low  urine specific gravity	Small volume  capacity of  bladder	Rather low position  of the kidney
51.	A 10 years old child is ill with spastic cerebral palsy. Supported on trying to walk the child has his legs flexed  in hip and knee joints and spastically scissored.  The upper extremities movements aren’t disturbed. What type of spasticity distribution is there?	*Lower paraplegic	Tetraplegic	Hemiplegic	Athetosis	Monoplegic
52.	A newborn  aged 3 days with hyperbilirubinemia (428 mkmol/l) developed followed disorders. From beginning there were severe jaundice with poor suckling, hypotomia and hypodynamia. Little bit later periodical excitation, neonatal convulsions and neonatal primitive reflexes loss are noted. Now physical examination reveals convergent squint, rotatory nystagmus and setting sun eye sign.  How to explain   this condition?	* Encephalopathy due to hyperbilirubinemia	Skull injury	Brain tumour	Hydrocephalus	Spastic  cerebral palsy
53.	A 1.5 month male infant has frequent vomiting, weight loss during last 3 weeks. X-ray examination shows the extension of stomach, high level of fluid, the delay of contrast substance in a stomach for a long time (8 hours), which does not disappear after atropin injection. What is  the most probable diagnosis?	Pylorostenosis	Atresia of esophagus	Cystic fibrosis	Sepsis	Hirshprung’s disease
54.	A girl aged 8 month has a large head with the circumference up to 48 cm corresponded a value over 95 percentile and big non bulged non pulsed  fontanel. The preliminary diagnosis is  hydrocephalus. What  cerebral spinal fluid findings do you wait for in this case?	* Cells 2-3 in 1 mkl, protein 0,2-0,4 g/l	Cells 200-300 in 1 mkl, protein 1,0-2,0 g/l	Lymphocytes cells  500-600 in 1 mkl, protein  2,5-4,0 g/l	PMNL (polymorphonuclear leukocytes) cells  50-100 in 1 mkl, protein 4,5-6,0 g/l	PMNL cells  100-200 in 1 mkl, protein 5,0-6,0 g/l
55.	The child is 3 months old. He has admitted to hospital to diagnose the reason for cardiac murmur. Complaints of parents: low weight gain, attacks of dyspnoea and cyanosis which amplify at a physical load. Systolic murmur in 3rd intercostal interspace on the left side, systolic murmur under 2nd intercostals interspace on the right side of the sternum, hypertrophia of right ventricle. What diagnosis should be suspected?	Tetralogy of Fallot	infectious endocarditis	ventricular septal defect	hypertrophyc cardiomyopathy	atrial septal defect
56.	The child aged 12 yr complains of slight fever  up to 38.0(C, knee joints pain, a day before  ankle pain, tenderness in active and passive movements, common weakness and cardiac pain. It is known he was ill with acute tonsillitis  two weeks ago. Physical examination reveals left heart border external shift, non frequent cardiac premature bites. What disease should be suspected?	* Rheumatic fever	Now-rheumatic carditis	Rheumatoid arthritis.	Systemic lupus erythematosus	Reactive arthritis
57.	A 7 years old boy is admitted to the hospital with complains of  thirst and  polyuria. He is ill with diabetes mellitus within 5 years. In the clinical history there are 3 times happened diabetic comas. Blood glucose is 15.54 mmol/l and in urine 5\%. The retinal angiopathy signs  has been revealed by an ophtalmologist. What dose of insulin will be administered to this child more likely?	*1,5 units/kg.	0,25 unit/ kg	0,5 unit/  kg	1,0 unit/ kg	2,0 units/ kg
58.	A  12 years old girl suffers with  diabetes mellitus since 2 years of age. Clinical  examination reveals the considerably enlarged abdomen. The slightly tender liver is palpated 6cm lower of the costal margin. The child has also Cushing  type of obesity, short stature, and pubertal delay.  Blood glucose is 17 mmol/l, glucosa in urine 4 \%. There are an increased levels of blood cholesterol and ketoacidemia. What is the suggested diagnosis?	*diabetes mellitus I type, Mauriac’s syndrome	Diabetes mellitus I type, Nobecurs syndrome.	Diabetes mellitus I type, ketoacidotic coma.	Cushing’s disease.	Cushing’s syndrome.
59.	The girl aged 14 years old complains of sleep disturbances, body weight loss, palpitations, cardialgias, fatigue. 2nd degree thyroid gland hyperplasia and exophthalmus were noted by physical examination. What  hormone level are the most characteristic for this disease?	* Free thyroxine and total serum triiodothyronine excess .	Free thyroxine  deficiency	Serum thyroid-stimulating  hormone excess	Radioactive iodine uptake excess test	serum triiodothyronine deficiency
60.	1 years old infant developed the signs of folic acid deficiency  anemia. What features of CBC are characteristic for this pathology?	* hyperchromic and macrocytic RBC (red bood cells),  reticulocytopenia, thrombocytopenia, leukopenia	hyperchromic and microcytic RBC (red bood cells),  reticulocytopenia, thrombocytopenia, leukopenia	hyporchromic and microcytic RBC (red bood cells), anisocytosis, reticulocytosis, thrombocytosis;	normochromic and normocytic RBC (red bood cells),   thrombocytosis, leukocytosis;	All answers are true.
61.	1,5 years old infant has revealed iron deficiency. What is the duration of  treatment with oral iron preparations?	*2-3 months	2 weeks	21 days	3-4 weeks	6 months
62.	What is the most important suggestive clinical feature of CBC (complete blood count)  and bone marrow examination which make it possible to suspect myelodysplastic syndrome in children?	*The high blood leukocyte count accompanied by low platelet and RBC (red blood cells) counts associated with disorders of maturation bone marrow-derived cells	High platelet   and  RBC (red blood cells) counts associated with bone marrow hyperfunction	High WBC count in peripheral blood normal or depressed bone  marrow function	Low RBC, WBC and platelet counts associated wiht disorders of maturation bone marrow-derived cells	Low RBC, WBC and platelet counts associated wiht  bone marrow hyperfunction
63.	8 years old girl had had  a rheumatic fever manifested  with  chorea and  carditis 6 months ago. She was treated in-patient department within 1,5 months. Now she is under long term observation by the rheumocardiologist in children out-patient department. The  prevention therapy of rheumatic fever relapse  foresees:	*The administration of bicillin-5 every month during 5 years	The administration of bicillin-5 every month during a year	The administration of bicillin-5 every month during 3 years	The administration of bicillin-3 every month during a year	The administration of bicillin-3 every month during 3 years
64.	2 years old child has simple dyspepsia with nausea and vomiting.  There are not signs of dehydration. The prevention of pathological fluid losses consists in the following administration:	* Oral rehydration  solution (ORS)	Intravenous infusion 5\% glucose in water solution	Starvation during 12 hours	Antibacterial therapy	Gastric  lavage
65.	The child aged 12 yr complains of cramping pain in the right hypochondrium which is easily controlled with antyspasmotic  preparations. During attacks  nausea and less often vomiting occur. Palpation of the abdomen reveals tenderness in the gallbladder projection point. The liver is not enlarged. What additional method of clinical investigation is the most informative in this case?	*Ultrasound  examination	Esophagogastroduedenoendoscopy	CBC (complete blood count)	X-Ray upper Gastrointestinal (GI) series	Coprologic examination
66.	10-year old girl was admitted to the department with symptoms of carditis. Well known that the exacerbation of chronic tonsillitis was occurred 2 weeks ago. What etiological trigger of carditis is the most possible in this case?	*streptococcus	staphylococcus	pneumococcus	klebsiele	proteus
67.	A 11 month female has poor appetite, stool with plenty of faeces, periodically vomiting after introduction of solid food during last months. Temperature is normal. Bodyweight is 7 kg. On physical exam there are pale, oedema on legs, enlargement of abdomen. Coprogram shows a lot of greasy acids. The diagnosis of celiac disease was made, the aglutenic diet was prescribed. What is necessary to exclude from child diet?	Cereals	Milk products	Meat	Egg	Easy absorbed carbohydrates
68.	A 1 month male infant has symptoms of excitation. His head circumference is - 37 cm, the size of large fontanel is 2x2 cm. The child regurgitates after feeding by small portions of milk (changed and unchanged); stool is normal. Muscle tonus is normal. What is the most probable diagnosis?	Pylorospasmus	Meningitis	Pylorostenosis	Microcephaly	Craniostenosis
69.	A 1 month female infant vomits frequently “by fountain” irrespective of eat period and has periodically liquid stool. She is dehydrated, exhausted. There is clitoris hypertrophy. What diagnosis is the most probable?	Adrenogenital syndrome, salt-wasting form	Pylorostenosis	Upper intestinal ileus	True hermaphroditism	Acute intestinal infection
70.	A 2 year boy has subfebrile temperature, dry, persistent, prolonged, attacked cough, frequent breathing with hindered exhalation. The breathing under auscultation is harsh, there are diffuse dry sibilant rales. X-ray lung examination shows increased transparency. There is leukopenia in blood. What diagnosis is the most probable?	Obstructive bronchitis	Pertussis	Pneumonia	Rhinitis	Bronchiolitis
71.	A 1,5 year old boy has non-productive cough with purulent sputum, dyspnea, retardation in physical development, polyfecalia, increasing of sweat chloride up to 150 mEq/l. The cystic fibrosis was diagnosed. What treatment will you prescribe?	Enzymes + antibiotics	Choleretics + adaptogens	Н2-histaminic blockaders + hepatoprotectors	Vitamins + antibiotics	Vitamins + mucolytics
72.	A 2 year old girl has symptoms of cystic fibrosis: relapsed pneumonia, secretion of a plenty purulent green sputum, dyspnea, polifecalia, retardation in physical development, increasing of sweat chloride up to 120 mEq/l. What is the most suitable method of diagnosis?	Direct detection of a gene by polymerase chain reaction	Complete blood count	Karyotype	Determination of sex chromatin	Family tree
73.	A 1,5 year old boy with poor activity does not walking, does not talking. Physical examination demonstrates pale and dry skin, оedema, large tongue, saddle nose, gruff voice. His hairs are thick and rough. Large fontanel - 3,0x 3,0 cm, teeth are absent. What diagnosis is the most probable?	Hypothyroidism	Down’s syndrome	Rickets	Growth hormone deficiency	Diabetes mellitus
74.	Boy is 3 years old. Complaints: dyspnoe, fast tiredness, frequent episodes of respiratory diseases in history. Borders of relative heart dullness are extended to the left, strengthening of the 2nd heart sound in the 2nd intercostal interspace on the left side, hard systolo-dyastolic murmur in the second intercostal interspace on the left side and above the  clavicle (“machine noise”), which is conducted on interscapular interspace. What is the most probable diagnosis?	Open arterial duct	aortal stenosis	atrial septal defect	ventricle septal defect	Isolated stenosis of arteria pulmonalis
75.	The infant aged 3 days become jaundice. The course of pregnancy and delivery is without any complications. The child was born  with  3300 g of body weight and 8 Apgar score.  The general condition of newborn is good. The infant blood group is O (I) Rh(-)ve, the mother’s blood group is A (II) Rh (+)ve. What is the most probable cause of this jaundice?	* Physioligic jaundice	Infant`s hemolytic caused by Rh-incompatibility	Infant`s hemolytic anemia  caused by ABO-incompatibility	Obstructive  jaundice	Jaundice due to septicemia
76.	The girl of 11 years old. She is ill for 1 month. She has "butterfly"-type rash on face (spots and papules), pain and swelling of small joints on arms and legs, signs of stomatitis (small-sized ulcers in mouth). CBC - Нb – 80 g/l, RBC – 2,9 T/l, WBC – 15 G/l, ESR - 40 mm/hour. Urinalysis - protein – 0,33 g/l. What is the most probable diagnosis?	systemic lupus erythematodes	juvenile rheumatoid arthritis, systemic type	periarteriitis nodosa	Acute rheumatic fever	dermatomyositis
77.	The infant aged 2 months complaints of restlessness, subcutaneous fat wasting and underweight. The    deficiency calculated from the ratio between the actual and average expected weight for his age is 14\%. The constipation and little amount of stools with undigested bits are noted. The child is in the breast feeding. The total day breast milk volume  is not known. There is not evidence of infection  in this case. What is the most  probable diagnosis:	*Hyponutrition in development	Mucoviscidosis, intestinal  form	Acute gastroenteritis	Chronic gastroduodenitis	Dehydration
78.	What kind of breathing can  be heard above  the lungs  in  healthy children aged  7 years?	*Vesicular	Puerile	Weakened vesicular	Coarse	Grunting
79.	The girl is 5 years old. She has been hospitalised with the complaints on generalized oedema (face, abdomen, lower extremities), reduce of daily urine volume up to 300 ml, loss of appetite. In urinalysis – protein – 3 g/l, RBC – 1-2, WBC – 6-7, specific gravity – 1027. CBC – Hb – 110 g/l, WBC – 10 G/l. What diagnosis is most probable?	Glomerulonephritis with nephrotic syndrome	Interstitial nephritis	Pyelonephritis	Polycystic kidney disease	Glomerulonephritis with nephritic syndrome
80.	The girl is 11 years old. She complains on pain in abdomen and lumbar region, headache, increase of temperature up to 39 C, vomiting, reduce of appetite. Skin is pale, hot, respiration is normal, heart rate – 100 per minute, positive Pasternatsky symptom. CBC: RBC – 3,9 T/l, WBC - 18 G/l, ESR-34 mm/hour. Urinalysis - protein 0,066 g/l, WBC – 30-40, RBC – 1-2, bacteria - a lot of. Most probable diagnosis is?	Acute pyelonephritis	Acute glomerulonephritis	Cystitis	paranephritis	Polycystic kidneys disease
81.	The girl of 12 years old is suffering from acute glomerulonephritis. Daily diuresis is 700 ml, heart rate – 100 per minute, blood pressure – 130/95, temperature – 37,3 C. In urinalysis – RBC – 30-40, WBC – 5-6, protein – 0,099 g/l. Which medicines should be prescribed in this case?	Antibiotic, hypotensive, diuretic, vitamin C	Antibiotics + prednisone	Antihistaminic + vitamins	Antiaggregants + diuretics	Sulfanilamids + cytostatics
82.	The girl is 12 years old. Yesterday she was overcooled. Now she complains on pain in suprapubic area, frequent painful urination by small portions, temperature is 37,8 C. Pasternatsky symptom is negative. Urinalysis – protein - 0,033 g/l, WBC – 20-25, RBC – 1-2. What diagnosis is most probable?	Acute cystitis	Dysmetabolic nephropathy	Acute glomerulonephritis	Acute pyelonephritis	Urolithiasis
83.	The polycystic kidney disease was diagnosed at the boy of 3 years old. Mother complaints that the boy has growth retardation, poor appetite, vomiting. Skin is pale, turgor of soft tissues is reduced, heart rate - 120 per minute, harsh breathing at auscultation, abdomen is enlarged, soft. Biochemical tests – urea – 14 mmol/l, creatinine – 0,130 mmol/l, protein – 58 g/l.  Which condition has been developed?	Chronic renal failure	Acute renal failure	Encephalopathy	Interstitial nephritis	Pyelonephritis
84.	The boy of 9 years old. He is ill for 3 days. He has complaints on pain and restriction of movements in right knee and left elbow joints, dyspnoea. He was suffered from acute tonsillitis 2 weeks ago. There are fever (38,5 C), oedema of joints, extension of the borders of cordial dullness on 2 cm left, HR - 110 per 1 min, weakness of 1st sound, "soft" systolic murmur on an apex. What diagnosis should be suspected?	Acute rheumatic fever	systemic lupus erythematodes	juvenile rheumatoid arthritis	Reiter’s disease	reactive arthritis
85.	The 7 years old boy  developed an asphyxic attack, expiratory wheezing and cough. In past history the child has had relapsing  rhinitis and red eyes syndrome. His sister suffers with atopic dermatitis. The correct diagnosis is:	* bronchial asthma;	acute bronchitis;	viral croup;	acute obstructive bronchitis;	pneumonia.
86.	The course of tonsillar diphtheria in a 2-years old child was complicated with appearance of early myocarditis. Prednisolone in a dose of 1,5 mg/kg was introduced into therapy . Which one from  expected complications is not related with prolonged glucocorticoid therapy ?	*Hyperthermic reaction	Elevation of blood pressure	Hypokalemia	Osteoporosis	Cushingoid syndrome
87.	1,5 - years old infant was inoculated with live oral polio vaccine (OPV).  On the 16th day after being asymptomatic the child suddenly developed the right low limb weakness and stopped  to walk. How to comment this event?	*Vaccine - associated poliomyelitis	Poliomyelitis	Guillain - Barre syndrome	Landry syndrome	Polyradiculoneuropathy
88.	The child  aged 3 years was admitted to the pediatric department on the 3d day of illness. The general condition is moderate. Body temperature is 38,5oC. One time of vomiting, skin pallor, lost skin  turgor, spasmodic  colon descendens are presented. The patient has stools with mucus and blood 9-10 times per  day. What is the initial diagnosis?	* Acute bacterial dysentery (Shigellesis)	Enteric fever (Salmonellosis)	Rotavirus gastroenteritis	Yersiniosis	Escherichiosis