Quiz

A young mother takes her infant to the pediatrician for the first time. The pediatrician notices the infant’s teeth are yellow. The antibiotic this mother most likely took during pregnancy

A patient presents with right lower-quadrant pain, fever, and diarrhea. Physical examination reveals diffuse abdominal tenderness; laboratory examination shows a moderate leukocytosis, leading to a presumptive diagnosis of acute appendicitis. Surgical exploration of the abdomen reveals mesenteric adenitis, but the appendix is normal. Which of the following organisms is most likely responsible for these signs and symptoms?

A 7-year-old boy presents to the pediatrician because his mother noticed a “smoky” color to his urine. On questioning the mother, it is revealed that the child had a sore throat several weeks ago that was left untreated. Physical examination reveals hypertension and mild generalized edema. Urinalysis is significant for red blood cell casts. Which of the following accurately describes the microorganism responsible for this child’s illness?

A 20-year-old man with stridor is brought to the emergency department by his girlfriend. He had been complaining of abdominal pain earlier in the day. Physical examination is significant for well-demarcated regions of subcutaneous edema. He has had similar episodes before, and his mother and sister have the same condition. Which of the following substances is most likely deficient in this patient?

A 69-year-old alcoholic man comes to the emergency department because of high fever, chills, and a cough. He says that he has been producing “lots of thick, bloody, gelatinous mucus” over the past 2 days. Gram staining of the sputum reveals pinkish-red bacilli. Chest x-ray shows consolidation of the upper lobes. Which of the following is found only in microorganisms with this color Gram staining?

A 4-year-old child who has had repeated infections with staphylococci and streptococci has normal phagocytic function and delayed hypersensitivity responses. Lymph node biopsy would most likely reveal:

A 2-year-old boy presents to the emergency department with pneumonia. Since the age of 6 months, he has had recurrent pneumonia and sinusitis due to Streptococcus pneumoneae and Haemophilus influenzae. Careful assessment of his immune function would likely reveal abnormal function of the:

A 35-year-old man presents to the emergency depart­ment with intense back pain. He is hydrated and given pain medication. After several hours, he passes a kidney stone. Laboratory analysis of the stone reveals that it is composed of struvite (magnesium ammonium phos­phate). Infection with which of the following organisms promotes the production of such stones?

A 24-year-old woman with a history of allergic rhinitis is involved in an automobile accident and sustains a splenic laceration. She undergoes abdominal surgery and is then transfused with 4 units of blood of the appropriate ABO and Rh type. As the transfusion progresses, she becomes rapidly hypotensive and develops airway edema, consistent with anaphylaxis. Which of the following pre-existing conditions best accounts for these symptoms?

A 3-week-old infant is found to have a particular virus. The family practitioner is especially concerned because the virus produces disease or sequelae that is/are more severe if the infection occurs at a very young age. This infant is most likely infected with which of the following viruses?

A 25-year-old Afghani immigrant presents with a confluent maculopapular rash that began on her face then spread downward over her trunk. She states that 3 days ago she started having a fever and headache, with bilateral pain associated with the front and back of her neck. She also complains of joint pain. Which of the following diseases does she most likely have?

After high-dose chemotherapy and irradiation, a 35-year-old woman with acute myeloid leukemia in remission receives a bone marrow transplant from her HLA-matched brother. One week after the graft, the patient develops a fever and a maculopapular rash over her upper extremities and back. She also notes abdominal pain and diarrhea. Laboratory examination is remarkable for elevation of alkaline phosphatase and bilirubin. Which of the following is the most likely cause of this patient’s symptoms?

A 3-week-old boy develops focal seizures, lethargy, and vomiting. Examination shows a bulging fontanelle. Which of the following organisms should he suspected?

A 54-year-old man with chronic renal failure receives a kidney transplant and is given immunosuppressive therapy with cyclosporine. Over the next 6 months, the patient’s creatinine levels progressively rise, and a needle biopsy of the kidney is performed. What is the biopsy most likely to show?

A 47 year old man presents with a nonproductive cough and rales on his chest examination. A chest x-ray film suggests atypical pneumonia. The pneumonia resolves after the treatment with azithromycin. A diagnosis of psittacosis is established by the presence of complement fixing antibodies against chlamydophila psittaci in the convalescent serum. Which of the following is the most likely occupation of this patient ?

A 58-year-old alcoholic man with multiple dental caries develops a pulmonary abscess and is treated with anti­biotics. Several days later, he develops nausea, vomiting, abdominal pain, and voluminous, malodorous, green diarrhea. Which of the following antibiotics is most likely responsible for this patient’s symptoms?

A French exchange student in a town near the Ohio River presents to the local hospital with headache, fever, malaise, and nonproductive cough. He became ill several days after cleaning and moving a chicken coop where hundreds of chickens had roosted for many years. Which of the following microorganisms is most likely responsible for his illness?

A 23-year-old woman suffers from a condition in which her antibodies react with antigens present on the surface of cells. The mechanism of action involves complement fixation by the antibody-antigen complex, which causes lysis or phagocytosis of the affected cell. Which of the following conditions is an example of this type of hypersensitivity?

A 24-year-old woman in her third trimester of preg­nancy presents with urinary frequency and burning for the past few days. She denies fever, nausea, vomiting, or chills. She takes no medications besides prenatal vita­mins and is generally in good health. Physical examina­tion is remarkable for mild suprapubic tenderness, and a urine dipstick is positive for white blood cells, protein, and a small amount of blood. Culture produces greater than 100,000 colonies of gram-negative bacilli. Which of the following attributes of this uropathogenic organ­ism is most strongly associated with its virulence?

About a month after being bitten by a bat, a man develops an influenza-like illness. He subsequently develops striking mood changes, pharyngeal spasms with drooling, and seizures, and he falls into a coma. He eventually dies of his illness. This patient’s deterioration was most likely caused by a virus from which of the following groups?

An otherwise healthy patient who has just received a prosthetic aortic valve develops postoperative fever. Blood cultures are done, and she is given broad-spectrum antibiotics. Two days later she is still febrile and clinically deteriorating. Which of the following is the most likely pathogen?

A 65-year-old man undergoes coronary artery bypass surgery that entails grafting the left internal mammary artery to the left main coronary artery to form an alter¬native conduit for blood flow. This patient received a(n)

An 18-year-old, previously healthy woman presents to the student health service with fever, vomiting, and diarrhea. On physical examination, she is hypotensive and has an erythematous, red, sunburn-like skin rash. She is currently menstruating and has. been using super-absorbent tampons. Which of the following findings from a positive culture would confirm the suspected diagnosis?

A 16-year-old boy with sickle cell disease is hospitalized for a severe infection. His spleen has autosple¬nectomized, and he has had other minor infections in the past. His symptoms include fever, chills, cough, and chest pain. Bacteria from the patient’s sputum are optochin-sensitive organisms with a positive Quellung reaction. Which of the following is the most likely pathogen?

A 33-year-old HIV-positive man complains of head­ache and blurred vision. Physical examination revels papilledema and ataxia. Head CT is normal but CSF obtained by lumbar puncture reveals encapsulated organisms’ observable with India ink. Which of the following is true concerning this organism?

After eating a dinner of leftovers that included rewarmed vegetable fried rice, a 17-year-old boy develops diarrhea and stomach pain. Which of the following is the most likely pathogen?

A 47-year-old man with a history of sickle cell dis­ease has had numerous hospitalizations requiring the placement of IV lines. The patient has poor peripheral venous access, and a catheter is placed in right sub­clavian vein. The patient subsequently develops right arm discomfort and swelling and a temperature of 40.1o C with chills. Multiple blood cultures are taken, and gram-positive cocci are isolated. The organism is catalase-positive and produces whitish colonies on mannitol salt agar. The colonies are gamma-hemolytic on sheep blood agar. Which of the following organisms is the most likely cause of this patient’s symptoms?

A 20-year-old woman presents with a 2-day history of dysuria and increased urinary frequency. She states that she was recently married and was not sexu¬ally active prior to the marriage. Physical examination reveals a temperature of 100.7°F with normal vital signs. Gynecologic examination reveals no evidence of discharge, vaginitis, or cervicitis. Urinalysis reveals 14 white blood cells per high-powered field with many grant-negative rods. Which of the following is the most appropriate pharrnacotherapy?

A 21-year-old man presents with cough, fever, and hemoptysis. Blood tests show significantly elevated BUN and creatinine. Immunofluorescent microscopy reveals a diffuse linear pattern of fluorescence along the basement membranes of. alveolar septa and glomerular capillaries. Which type of hypersensitivity is associated with this disease?

After passing his physical examination, a 19-year-old army recruit gives urine and blood samples for further testing. Serum analysis yields elevated ALT, HBsAg, anti-HBc, HBeAg, and bilirubin. All other values are normal. What is the hepatitis B status of this recruit?

A 24-year-old woman has fever, malaise, and a dry, nonproductive cough. She also complains of headache, muscle aches, and leg pain. Laboratory values arc signifi­cant for elevated cold agglutinins. Which of the following microorganisms is responsible for her symptoms?

A culture of Staphylococcus aureus bacteria is selected over many months for its ability to grow in increas­ing concentrations of penicillin. When colonies of this original culture are capable of growth on blood agar containing 400,000 IU penicillin, the colonies are picked from the agar, placed in a nutrient broth, and a lytic phage is added. The bacteria and phage are cocultured until viral maturation is complete. The culture is centrifuged, and the supernatant is added to culture tubes containing clones of penicillin-sensitive S.aureus. After 4 hours of incubation at 37.0oC, these broth cultures are poured onto blond agar Petri dishes containing 400,000 IU penicillin and incubated for 24 hours Out of 100 Petri dishes, 4 grow colonies. What Process has taken place in this experiment?

A 32-year-old female presents to the office with fever and chills of 2 weeks’ duration. She also noticed blood in her urine this morning. She has a history of recent treatment for Lyme disease while visiting her daughter in upper New York State. Although she finished the course of doxycycline prescribed by her physician, she says she does not feel better. As part of her workup, peripheral blood smear stained with Wright-Giemsa identifies red blood cells. Which of the following is most likely causing her current symptoms?

A formula-fed, 1-month-old boy is exposed to his sister, who has chickenpox. He does not develop signs of varicella. His mother had the infection 5 years ago. Which class of immunoglobulins did he acquire from his mother in utero that protected him from this virus?

A culture of smooth Streptococcus agalactiae bacteria is grown in nutrient broth and allowed to incubate until the culture enters the decline phase of the growth curve. An extract of this process is added to a culture of rough S. agalactiae the logarithmic phase of the growth curve and incubated for 24 hours under appropriate culture conditions. The resulting culture develops some smooth and some rough strains of S. agalactiae. Purified DNase is then added to the flask and the culture is agitated gently lit 2 hours at 37°C. Afterward only rough strains of S. agalactiae are isolated from the culture. Which of the following processes would achieve the production of encapsulated S. agalactiae in this system?

A 20 year old college student presents to the university health clinic with sore throat, fever, and fatigue. Physical exam is significant for cervical lymphadenopathy and mild hepatomegaly. Heterophile antibody tests are negative. Microscopic examination of fibroblasts would be expected to reveal:

Following a barbecue hosted by a hunter who served “bear hamburgers,” several guests develop abdominal pain and diarrhea; their condition progresses about a week later to fever, myalgia, periorbital edema, and petechial hemorrhages in the conjunctiva. A peripheral blood smear shows an increased eosinophil count. Which of the following is the most likely cause of these symptoms?

A 34-year-old primigravid woman at 32 weeks gestation comes to the emergency department complaining of fever chills, dysuria, and back pain. The symptoms started 6 days ago with burning on urination and have progressively worsened. Her temperature is 39.1o C. Physical examination shows left costovertebral angle tenderness. Urinalysis is positive for leukocytes and nitrites, Which of the following interleukins is being produced by macrophages and is stimulating fever production by its action on this patient’s hypothalamic cells ??

A baby born at 32 weeks’ gestation with Apgar scores of 2 and 7 was placed in the neonatal intensive care unit. She developed a fever and leukocytosis; lumbar puncture revealed pleocytosis with increased protein, decreased glucose, and grain-positive rods. Which of the following organisms was most likely isolated from the CSF?

A 27-year-old woman conies to the physician because of a 4-week history of lethargy and fatigue. She is gener­ally healthy and, except for a red, annular lesion on her right buttock 4 weeks ago, she has no other complaints. She does not smoke cigarettes and does not drink alco­hol. She proudly says that she goes for an afternoon jog 5 days a week in the woods by her home. Physical examination shows diffuse muscle tenderness and stiff­ness of the joints. Global eradication of this disease is unlikely in the foreseeable future because the causative organism:

A 23-year-old woman with a history of sickle cell disease presents with fever and severe bone pain localized to her left tibia. An x-ray film reveals a lytic lesion, and blood cultures reveal infection. A bone culture grows gram-negative rods. Which of the following best describes the infecting organism?

A 5-year-old child who has not had routine pediatric care develops a febrile disease with cough and a blotchy rash, and is brought to the emergency department On physical examination, there is cervical and axillary lymphadenopathy. Also noted is an erythematous, maculopapular rash behind the cars and along the hairline, involving the neck and, to a lesser extent, the trunk. Examination of this patient’s oropharynx would likely reveal which of the following lesions?

Which of the following cell surface markers is required for lysis of IgG-coated target cells (antibody-dependent, cell-mediated cytotoxicity, or ADCC) by natural killer cells?

A 68-year-old patient with alcoholic cirrhosis is hospitalized with ascites and esophageal varices. The patient’s temperature is 38.3oC (101.0o F). Paracentesis reveals a polymorphonuclear cell count of 300/mm. Which of the following is the most likely infecting organism?

A 53-year-old engineer with diabetes mellitus comes to the employee health center for an annual examina­tion. She has no complaints at this time. A review of her chart reveals that she is due for a few vaccinations, including the influenza A vaccine. She questions the physician about the necessity of the vaccine because she just received one a year ago. The physician should respond that last year’s influenza vaccine may be ineffective today because influenza A:

A 3-year-old boy presents with a 1-day history of loose stools, fever, abdominal cramping, headache, and myalgia. He has no blood in the stool. A careful history reveals that he has several pet turtles. Which of the following is the most likely pathogen?

A 3-year-old girl presents with recurrent subcutaneous abscesses and furuncles. She has a history of pneumonia due to Serratia marcescens. Which of the following enzymes is most likely deficient in her neutrophils?

A 7-month-old child presents with a 4-day history of fever, deepening cough, and dyspnea. A chest x-ray film shows multiple interstitial infiltrates and hyperinflation of the lungs. Multinucleated giant cells with cytoplasmic inclusion bodies are seen when a nasal wash is inoculated into tissue culture. The most appropriate therapy includes administration of which of the following drugs?

A 60-year-old woman comes to the physician because of fever, chills, and a cough for the past 2 weeks. She lives at home with her husband, has no chronic medical conditions, and has not traveled recently. She does not smoke cigarettes or drink alcohol Her temperature is 38.2°C (100.8oF). Physical examination reveals altered breath sounds. Chest x-ray is abnormal. Which of the following is the most likely causal organism?

A 28 year old woman and a 25 year old man present for generic counselling. Both are white and have one sibling affected with cystic fibrosis. Which of the following is the most appropriate method for assessing the risk of cystic fibrosis transmission to the child ?

A college student goes to a fraternity party and consumes large quantities of beer. The alcohol in the beer is metabolized by the liver, with almost half the alcohol being oxidized to acetaldehyde. In which of the following sites does this reaction occur?

Liver cells in culture were kept at 0o C (32.0oF) and treated with trypsin to digest the receptors on the cell surface. The temperature was then raised to 37.0oC (98.6oF), and radioactive LDL was added to the culture media. Several hours later, the labeled LDL was found to be inside the cells. Which of the following represents the process of LDL uptake by hepatocytes?

A 5 year old mentally retarded boy is brought to the city from a rural community for evaluation. A careful history reveals mental retardation in a number of other family members, especially the males. Physical examination is remarkable for a long face with large ears, a large jaw, and bilateral enlargement of the testes. This presentation is suggestive of

A genetics researcher is trying to identify a potential gene from a gene signature/motif that encodes a seven-helix transmembrane domain. Which of the following is most likely the protein encoded by the researchers’ target gene?

When a cloned DNA fragment is used as a probe, a restriction fragment length polymorphism (RFLP) is revealed in the region adjacent to the centromere of chromosome 21. Four haplotypes exist: A, B. C, and D. An AB woman and a CD man have an ACC child with trisomy 21. Nondisjunction most likely occurred during which of the following?

A newborn vomits after each feeding of milk-based formula and does not gain weight. Biochemical testing reveals a severe deficiency of galactose- 1 -phosphate uridyltransferase, consistent with homozygosity. If this condition goes untreated, which of the following is the likely outcome for this patient?

A 22-year-old woman presents with a fusiform swelling of the Achilles tendon, which, when biopsied, shows cholesterol-laden macrophages (foam cells) dispersed among the collagen fibers. She had been troubled with joint pains for several years. Both her mother and father developed arthritis associated with production of xanthomas, but their first symptoms occurred in middle age. She was referred to a nutritionist and treated with an enzyme inhibitor. Which of the following is most likely elevated in the blood of this woman?

A 58 year old woman is admitted to the hospital with fever, abdominal cramps, and severe watery diarrhea. The symptoms began one day after attending a banquet. She was treated with ciprofloxacin, but her condition did not improve. PCR amplification and analysis of a gene region in the bacteria isolated from the patient revealed a missense mutation that conferred resistance to ciprofloxacin. The missense mutation is most likely in the gene encoding an enzyme essential for which of the following functions ?

Methotrexate is used as therapy for rheumatoid arthritis, but has many side effects related to competitive inhibition of the enzyme dihydrofolate reductase. These side effects can be decreased without interfering with the efficacy of methotrexate by ingestion of additional folate. If patients treated with methotrexate are given sufficient folate, which of the following would most likely occur?

The pregnant mother of a 6-year-old son with glucose¬6-phosphate dehydrogenase deficiency is very worried that her female fetus will have the disease. The father and mother are clinically normal. Which of the following is true about her baby?

A 50-year-old chronic alcoholic presents with dementia, paralysis of lateral gaze, and difficulty walking. The vitamin deficient in this patient is required as a cofactor for which of the following enzymes?

A patient with short stature presents with hypoglycemia, hepatomegaly, bleeding diathesis, hepatic adenomas, and enlarged kidneys. Laboratory evaluation reveals the presence of increased lactate, cholesterol, triglyceride, and uric acid. This patient most likely has a deficiency of which of the following enzymes?

A 2-year-old boy has a past medical history significant for mental retardation, hepatosplenomegaly, foam cells in the bone marrow, and neurologic deficits. The boy dies by the age of 3. Which of the following enzymes was most likely deficient in this child?

A 5-year-old boy has temporary weakness and cramping of skeletal muscle after exercise. He has normal mental development. This child most likely has a deficiency of which of the following enzymes?

A lethal mutation occurs in a bacterium, rendering it incapable of replicating its chromosome. Because of this mutation, DNA synthesis produces many short fragments of DNA that have RNA sequences at their 5′ ends. The mutation is most likely in a gene encoding which of the following?

A 36-year old Greek man with viral pneumonia has a self-limiting episode of hemolysis. Over the next week, he as an increased rate of reticulocytosis. Which of the following serves as a precursor in a pathway that allows the newly matured erythrocytes to participate in oxygen transport ?

A researcher is trying to identify a specific protein within a mixture. He subjects the mixture to gel electrophoresis and then transfers the separation to nitrocellulose filters. The filters are incubated with antibody to the specific protein, and the excess antibody is washed off. The antibody-protein complex is then incubated with a radiolabelled protein that hinds to the antibody. Autoradiography is performed to detect the presence of the protein. Which of the following is the technique being carried out by the researcher?

A rapid way to purify proteins that are targeted to lysosomes would be to use affinity chromatography. An appropriate antibody to use on an affinity chromatography column would be one directed against:

Following the ingestion of glyburide, a type 2 diabetic patient begins to experience anxiety, diaphoresis, and hunger. The patient subsequently ingests a health food bar containing glucose. Which of the following is required to initiate the process of energy production from the ingested glucose?

A previously normal child begins deteriorating developmentally at about 6 months of age. She is seen by an ophthalmologist because she no longer responds to visual stimuli. A cherry-red spot on the macula is noted on ophthalmologic examination. The enzyme that is deficient in this child normally carries out which of the following functions?

A 12-year-old boy has a particular genetic disease. His mother is a carrier of the mutated gene, but his father is not clinically affected and is not a carrier. The man has four siblings: a sister and 2 brother who are not clinically affected and are not carriers; a sister who is a carrier but is not clinically affected-and a brother who is clinically affected. This inheritance pattern is consistent with which of the following diseases?

A neonate with ambiguous genitalia and microcephaly is suspected of having a genetic disease characterized by failure to metabolize 7-dehydrocholesterol to cholesterol. Which of the following is the most likely diagnosis?

A 30-year-old vegetarian presents to his physician complaining of diminished sensation in his lower extremities. He has not eaten meat for the past 15 years. A complete blood count reveals hypersegmented neutrophils and elevated mean corpuscular volume. Which of the following findings would be expected on urinalysis?

A 7 year old is brought to the emergency department by her parents with a complaint of severe polyuria and polydipsia. Laboratory examination reveals ketones in her urine. Which of the following is the most likely source of the ketones ?

Pseudogenes are homologues of functional genes that lack promoters and are therefore part of the unexpressed DNA. It is thought that at least some of these pseudogenes were produced by reverse transcription of mRNA and insertion of the resultant cDNA into a chromosome by a virus. In addition to lacking a promoter and other regulatory elements, a pseudogene produced in this manner will also differ from the authentic gene in which one of the following ways ?

A 23-year-old, single, unemployed woman in her eighth month of pregnancy is seen in a volunteer-staffed obstetrics clinic. Her first child, born at home and exclusively breast-fed, had prolonged diarrhea and died from an intracranial hemorrhage at 1 month of age. To help prevent a similar problem in this pregnancy, the resident gives her a free prescription for a vitamin and advises her to take one 20-mg tablet each day. He also informs her that the infant should receive an injection of this vitamin soon after birth. The vitamin prescribed is required as a coenzyme by which of the following enzymes?

A 26-year-old pregnant woman complains of persistent, dry, ulcerated skin over her knees and elbows. Examination of her eyes reveals small, gray plaques on the conjunctiva. Which of the following is the most likely diagnosis?

A patient with acute lymphocytic leukemia is treated appropriately with antineoplastic therapy. Inhibition of which of the following enzymes will help prevent side effects of this therapy?

A 45-year-old man is diagnosed with cancer of the proximal portion of the colon. His father died of colon cancer at the age of 52. He has three siblings. His 55-year-old brother has not been diagnosed with cancer, but his 57-year-old sister has an endometrial carcinoma, and his other sister died of ovarian cancer. A diagnosis of hereditary nonpolyposis colorectal cancer (HNPCC) is made. Which of the following types of mutations most likely occurred in this family?

A 62 year old man is prescribed a pharmaceutical agent that inhibits the activity of the enzymes HMF-CoA reducatase. This patient most likely has which of the following conditions ?

A 4-year-old retarded child hurls himself into walls and bites his fingertips so severely that they must be heavily bandaged. This child most likely has a deficiency of which of the following enzymes?

A 24-year-old woman with phenylketonuria (PKU) gives birth to her first child. Although there is no history of PKU in the father’s family, the couple could not afford genetic testing of the father or consistent prenatal care. At birth, the child is small, microcephalic, and has elevated blood phenylalanine. What is the most likely explanation for this neonate’s symptoms?

A 4-year-old boy is brought to the paediatrician because of gastroenteritis for 3 days, followed by a brief generalized seizure that left him semicomatose. The blood glucose level at admission is 18 mg/dL (0.10 mM) and urine is negative for glucose and ketones, but positive for a variety of organic dicarboxylic acids. Intravenous administration of glucose improves his condition within 10 minutes. Following diagnosis of an enzyme deficiency, his parents are cautioned to make sure he rats frequently. Which of the following is the most likely diagnosis?

A 30-year-old man has been fasting for religious reasons for several days. His blood glucose level is now about 60% of its normal value, but he does not feel lightheaded because his brain has reduced its need for serum glucose by using which of the following substances as an alternate energy source?

Several members of a family have an autosomal recessive disease characterized by intellectual deterioration, weakness, ataxia, seizures, and death at a young age. Special studies demonstrate a deficiency of cytochmme C oxidase activity. Which of the following subcellular organelles is defective in affected members of this family?

A gene product thought to be involved in the down-regulation of fetal hemoglobin expression is being investigated. Samples of primary tissue cultures of fetal, neonatal, and adult liver and bone marrow, as well as adequate amounts of a DNA probe believed to contain the studied gene, are provided. Which of the following techniques is the best for determining the tissue culture sample that is expressing the gene of interest?

A 69-year-old edentulous alcoholic man, who lives alone, is admitted to the hospital for evaluation of a shoulder wound that is not healing well. On physical examination, numerous ecchymoses are noted on the posterior aspect of his legs and thighs. Careful examination of the man’s skin reveals minute hemorrhages around hair follicles and splinter hemorrhages in the nail beds. Laboratory examination is remarkable for a hemoglobin of 10 g/dL; no other hematologic abnormalities are noted. Which of the following is the most appropriate therapy for this disorder?

A newborn presents with severe acidosis, vomiting, hypotonia, and neurologic deficits. Laboratory analysis reveals elevated levels of lactate and alanine. These observations suggest a deficiency of which of the following enzymes?

A 17-year-old high-school student comes to the school health clinic. She has missed her last menstrual period and is worried about being pregnant. In the past history, it is noted that she has sickle cell trait and mild asthma but is otherwise healthy. She has never been pregnant before and is sexually active with one boyfriend. They use barrier contraception on an irregular basis. She reports that her boyfriend once told her that he too had sickle cell trait. She is determined to continue with the pregnancy if the urine pregnancy test turns out to be positive. Her main concern is whether her child will have sickle cell anemia. At this stage, it is appropriate to counsel her that in cases where both parents have sickle cell trait the risk of having a baby born with sickle cell anemia is which of the following?

A 2-year-old boy is diagnosed with a biochemical defect involving hexosaminiclase A. The patient’s condition would be most appropriately categorized as belonging to which of the following general classes of defects?

A prokaryotic operon codes for two enzymes and one regulatory protein. The operon is expressed only in the presence of a particular sugar. Initial mapping of the operon has differentiated the nontranscribed sequences from the transcribed sequences. Deletion of 10 nucleotides from one of the nontranscribed sequences results in transcription of the operon in both the presence and absence of the sugar. Which of the following sequences was most likely affected?

On physical examination, a newborn is found to have micrognathia, a prominent occiput, low-set ears, and rocker-bottom feet. There is very little mental development during the first months of life, and the infant dies of cardiac complications after 8 months. A complete karyotype of this child would show which of the following?

A 27-year-old medical student is unable to eat lunch and dinner during her clinical rotation. Which of the following enzymes is responsible for helping to maintain blood glucose levels by releasing glucose from its storage form in the liver?

A surgeon performing an appendectomy makes an incision through the ventrolateral abdominal wall. The layers of the abdominal wall are shown below 1. Internal oblique 2. External oblique 3. Peritoneum 4. Transversus abdominis. Which of the following corresponds to the order of penetration of the layers of the abdominal wall ?

A 43-year-old woman is diagnosed with a condition that causes excruciating pain near her nose and mouth. The involved nerve innervates which of the following branchial arches?

A neonate has a prominent defect at the base of his spine through which his meninges and spinal cord protrude. A failure of which of the following processes is the most common cause of this type of defect?

A 45-year-old man with a history of stable angina presents to the emergency department with an episode of chest pain that is not relieved by rest or nitroglycerin. After stabilization in the telemetry unit for 2 days, he undergoes a thallium stress test. The results show reduced perfusion of the lateral wall of the left ventricle. Which artery is most likely occluded?

A 54 year old man has cirrhosis, with obstruction of the portal circulation within the liver. Portal blood could still be conveyed to the caval system via which of the following ?

A surgeon tells a medical student to tap the side of the face of a patient who just had thyroid surgery. The surgeon is most worried about damage to which of the following vessels?

During a routine physical examination, a 71 -year-old man is found to have a 7-cm pulsatile mass deep in the abdomen, between the xiphoid and the umbilicus. He has a history of untreated hypertension. The endothelial lining of the affected structure is composed of which of the following tissue types?

A 49 year old Vietnamese man is diagnosed with tuberculosis. On physical examination, large flocculent masses are noted over the lateral lumbar back, and a similar mass is located in the ipsilateral groin just medial to the anterior superior iliac spine. This pattern of involvement strongly suggests an abscess tracking along which of the following muscles?

A 6-year-old boy is brought to the office for evaluation of a neck mass. His mother reports that he first developed the mass 3 days ago, and it has not resolved. Further questioning reveals that he has recently recovered from a viral upper respiratory infection. He is otherwise healthy and is up to Gate on all recommended vaccinations. Physical examination shows a 2-cm neck mass in the midline immediately above the thyroid cartilage notch. The mass elevates when he sticks his tongue out of his mouth. Which of the following is the most likely diagnosis?

A 36-year-old woman ts hospitalized for treatment of a stomach ulcer that has been getting progressively worse over several months. Radiographic studies reveal the site of involvement to be along the greater curvature. approximately 4 cm away iron, the pyloric sphincter. That night, Me ulcer perforates, and there is considerable, intra-abdominal bleeding. Surgery reveals that the ulcer has eroded through the stomach wall and has damaged the rtery supplying the involved region of the stomach. Which artery was likely involved?

A 45-year-old man comes into the emergency department with abdominal pain that has progressively worsened since the previous night. He also notes nausea and vomiting, but is afebrile. Upper gastrointestinal radiographic studies reveal that a loop of small intestine has passed through the epiploic foramen into the omental bursa and is constricted by the margins of the foramen as the intestine fills. The constriction should not be surgically relieved by opening the epiploic foramen because this procedure would risk cutting the:

An infant is born with an abnormally developed falciform ligament. The hepatogastric and hepatoduodenal ligaments are also malformed. These developmental anomalies are most likely due to abnormal development of the:

A resident physician is performing a pelvic examination on a young woman. The fingers of one of her hands are in the patient’s vagina, palpating the cervix. The other hand is pressing on the abdomen. With the palm of this hand, the physician feels a bony structure in the lower midline. This structure is most likely the

Brunner’s glands secrete an alkaline product that helps achieve optimal pH for the activity of pancreatic enzymes. Where are these glands located?

A neuroscientist decides to perform a study that requires him to increase the concentration of norepinephrine in the cortex of an animal subject. He does this by electri­cally stimulating a nucleus in the brain. Which of the following nuclei is the most important source of norad­renergic innervation to the cerebral cortex?

A patient is transported to the emergency department with a knife wound to the right fifth intercostal space at the midaxillary line. Which of the following structures is likely to have been damaged?

A 26-year-old man is stabbed in the left chest during a bar brawl. Several days after he is treated, he returns to the physician complaining of decreased function in his left arm. Physical examination reveals a winged left scapula and an inability to raise his left arm above the horizontal. Which of the following nerves is most likely affected?

A newborn male is found to have urethral openings along the ventral surface of the penis. The physician explains to the parents that the bilateral structures that should have fused in the midline failed to fuse completely, and this resulted in the defect. The parents are very concerned. but the physician reassures them that this can easily be surgically corrected. Which of the following structures in a female normally develop from the same structures that failed to fuse in this boy?

A 34 year old man is examined in the prison infirmary after sustaining a superficial stab wound to the superolateral aspect of the thoracic wall at the level of the third rib. There is little bleeding and no difficulty breathing; However, the medical boarder of the scapula on the injured side pulls away from the body wall when the arm is raised . In addition, the arm cannot be abducted above the horizontal. Which of the following muscles is paralyzed?

A woman who recently gave birth has elevated prolasl in levels The gland responsible for secretion of this hormone is derived from which of the hallowing structures?

The femoral triangle is bounded superiorly by the inguinal ligament. Which of the following structures form the lateral and medial borders of the femoral triangle?

A 57-year-old man has hematuria and left-sided flank pain. Diagnostic studies show a left-sided renal mass with extension into the renal vein. A radical nephrectomy is performed, and the specimen is sent for pathologieevaluation. Which of the following structures present in this patient’s specimen is lined with epithelium derived from mesoderm of the ureteric bud?

A 2 year old boy is brought to the pediatrician by his mother because he has had several episodes of rectal bleeding. Evaluation with a technetium-99m perfusion scan reveals a 3cm ileal outpouching located 60 cm from the ileocecal value. This structure most likely contains which of the following types of ectopic tissue?

A patient presents with sudden onset of violent involuntary flinging movements of the left upper limb. The movements are jerky and irregular. This patient’s condition can best be described as a loss of:

A 4-day-old boy is brought to the pediatric clinic because of breathing difficulties and poor feeding. He coughs, chokes, and spits up milk very soon after beginning to suckle. Physical examination and radiographs reveal the presence of the most common type of tracheoesophageal fistula. The infant’s defect likely resulted from

A 47 year old man presents to his neurologist with an unsteady, broad-based gait and slow, slurred speech. Neurologic examination reveals dysdiadochokinesia, intention tremor, hypotonia, and nystagmus. The patient’s lesion is in a brain structure that derives from which of the following embroyonic structures?

A 15-year-old girl with a history of chronic rlrinitis, allergy, asthma, and nasal polyposis presents with fever and dental pain. She is diagnosed with maxillary sinusitis. Mucopurulent exudate would be most likely to drain through an ostium in the

A surgeon is first on the scene after a serious automobile accident. He finds a passenger bleeding profusely from the neck and correctly surmises that the bleeding is from the carotid artery. To control the bleeding, the surgeon can compress the carotid artery against the anterior tubercle of which of the following vertebrae?

A 75-year-old man with a 40-pack.year history of Smoking and hypercholesterolemia is diagnosed with severe atherosclerosis. Atherosclerotic occlusion of which of the following arteries would result in insufficient perfusion of the urinary bladder ?

A 23-year-old woman wearing high-heeled shoes inverts and sprains her ankle while running down a Bight of stairs. Which of the following ligaments did she most likely injure?

A 34-year-old woman bursts through the doors of the emergency department. She is straining to take a breath but can only mouth the phrase: “I can’t br—” before collapsing. She is placed on a stretcher. Her tongue is swollen and protruding from her mouth. ‘the patient has only minimal air movement with bag-mask ventilation. Oxygen saturation is approximately 80%. Attempts at oral intubation are unsuccessful due to massive soft tissue edema of her pharynx. A decision is made to perform a cricothyrotomy. The necessary instrument tray is collected, and the patient’s neck is quickly prepped. After palpating the neck to identify the appropriate landmarks, an incision should be made at which of the following locations?

When removing an impacted mandibular third molar, the oral surgeon must warn the patient of possible lasting numbness of the tip of the tongue. This loss of general sensation is due to damage to the

A 24 year old man is stabbed in the neck. Neurologic examination reveals left-sided hemiparesis. There is complete loss of discriminatory joint position and vibration sensation below C8 on the left side. On the right side, there is loss of pain and temperature sensation below C8. It can be expected that an MRI of the cervical spinal cord will show which of the following findings?

A histologist is examinig cells arrested at various stages of oogenesis. He discovers a follicle whitin the stroma of the ovary that has developed an antrum. This follicle would be classified as :

A 24-year-old man presents with pain in his right wrist that resulted when he fell hard on his outstretched hand. Radiographic studies indicate an anterior dislocation of a proximal row carpal bone that articulates with the most lateral proximal row carpal bone. Which of the following bones was dislocated?

A couple comes to the physician for advice about contraception and family planning. The physician provides advice about various methods of birth control. While discussing the option of using an intrauterine device. a discussion of the process of implantation comes up. At what stage of embryonic development does an embryo normally begin to implant in the endometrium?

One week following a sexual encounter at a ski resort in Colorado, a young woman develops a painful, swollen knee joint. The emergency department physician suspects gonococcal arthritis and wants to confirm this by sending joint fluid for bacterial culture. lie uses the standard suprapatellar approach and passes a needle from the lateral aspect of the thigh into the region immediately proximal to the patella. Through which of the following muscles does the needle pass?

Air infant born to an alcoholic mother had microcephaly and cardiac abnormalities and died despite resuscitative efforts. During which of the following periods of pregnancy is alcohol most teratogenic?

A 19 year old woman comes to the emergency department after falling while on roller-blades. There is a 3 cm laceration over the lateral aspect of the knee penetration so deep that the head of the fibula is apparent. A radiograph of the leg is negative for any fractures. A noticeable foot-drop occurs while the patient walks. Further examination reveals inability to dorsiflex or evert of the foot. Which of the following best explains her injury?

A resident physician is demonstrating tire correct technique for inserting a subclavian central venous line. He has a medical student palpate the clavicle, then the chest wall below it. The first bonystructurc that can be palpated below the inferior margin of the medial portion of the clavicle is the

A patient presents to the physician complaining of “something wrong with her foot” that causes her to trip and fall. Physical examination reveals an inability to dorsiflex (extend) the foot and a loss of sensation between the first and second toes. There is no other motor or sensory loss. Which of the following nerves was most likely injured?

A 40-year-old man complains of loss of sensation over the right scrotum and on the medial right thigh. Damage to which of the following nerves would result in such symptoms?

A patient has a tumor in the pterygopalatine fossa. The tumor is enlarging and moving through the pterygo­maxillary fissure. The tumor is entering what region of the skull?

A 49-year-old woman comes to the emergency department because of right upper quadrant pain, nausea, vomiting, and fever. She also complains of pain in her right shoulder. A right upper quadrant ultrasound reveals multiple gallstones and pericholecystic fluid. Which of the following dermatomes is most likely involved in her shoulder pain?

An autopsy is performed on a man who died of an unknown cause. The pathologist discovers that the man lids a small atrial septa! defect. The defect is seen in the portion of the atrial septum near the upper border of the fossa ovalis. Which of the following was the likely functional manifestation of this defect during life?

MRI reveals that a 62-year-old man has a brain tumor growing in his interhemispheric fissure at the level of the central sulcus. The tumor produces neurologic dysfunction of the cerebral cortex on either side of the tumor. A neurologic examination of this patient would most likely reveal:

A 67-year-old man has an abnormal neurologic exam. An electroencephalogram is subsequently performed and reveals delta waves over his left frontal lobe. Which of the following was the most likely abnormal finding on his neurologic exam?

A 47-year-old woman with a history of rheumatic fever is examined by her physician. Physical examination is significant for a low-pitched, rumbling, diastolic mur­mur preceded by an opening snap. The affected valve can be best evaluated by auscultation at which of the following locations?

An intravenous pyclogram is performed on a patient to evaluate the function and structure of her kidneys. Examination of the resulting radiographs reveals that the left kidney is normal but that there is a duplication of the ureter and renal pelvis on the right side. Further testing reveals that kidney function is normal. This variation is a result of abnormal development of which of the following structures?

A woman consulted a doctor on the 14th day after labour about sudden pain, hyperemy and induration of the left mammary gland, body temperature rise up to 39oC, headache, indisposition. Objectively: fissure of nipple, enlargement of the left mammary gland, pain on palpation. What pathology would you think about in this case?

Examination of a 3-month-old child revealed scrotum growth on the right. This formation has elastic consistency, its size decreases during sleep and increases when the child is crying. What examination will be helpful for making a correct diagnosis?

A 52 year old patient was admitted to a hospital because of high hemorrhagic diathesis of mucous membranes, massive skin haemorrhages in form of ecchymoses and spots, nasal and stomachal haemorrhages. After clinical examinations her illness was diagnosed as thrombocytopenic purpura. What is the most probable cause of this disease?

An excited patient constantly tries to look into the next room because he is sure of his friends’ presence. He claims to hear his friends and other people talking although no-one is there. He tries to persuade his doctor that people in the next room are disputing about "his punishment", repeats aloud phrases he has allegedly heard from the next room. What state is it?

A 28 year old woman was admitted to the emergency room with a slightly reddened, painful "knot"8 cm above the medial malleolus. Examination in the standing position demonstrates a distended vein above and below the mass. There are no other abnormalities on physical examination. The most likely diagnosis is:

A 42 year old woman complains of dyspnea, edema of the legs and tachycardia during minor physical exertion. Heart borders are displaced to the left and S1 is accentuated, there is diastolic murmur on apex. The liver is enlarged by 5 cm. What is the cause of heart failure?

A healthy 75 year old woman who leads a moderately active way of life went through a preventive examination that revealed serum concentration of common cholesterol at the rate of 5,1 millimol/l and HDL (high-density lipoproteins) cholesterol at the rate of 70 mg/dl. ECG reveals no pathology. What dietary recommendation is the most adequate?

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

Preventive examination of a 55 year old patient revealed diabetes mellitus. The patient hasn’t received treatment for it. Objectively: height is 170 cm, weight is 106 kg, skin humidity is normal. Ps is 76 bpm, rhythmic, left border of relative heart dullness is deviated by 1 cm to the left from the middle clavicular line, heart sounds are quiet, AP is 140/80 mm Hg. Glycemia on an empty stomach is 6,9 millimole/l. Glucose rate in the daily urine is 0,5%, diuresis makes up 2,5 l. What treatment tactics should be chosen?

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

A fitter of a metallurgic factory with occupational exposure to high concentrations of mercury fumes for 16 years presents instability of pulse and blood pressure, general hyperhydrosis, asymmetric innervations of facial muscles and tongue, positive subcortical reflexes, hand tremor on physical examination. A dentist revealed paradontosis and chronic stomatitis. What is the most probable diagnosis?

A 3 year old child has been suffering from fever, cough, coryza, conjunctivitis for 4 days. He has been taking sulfadimethoxine. Today it has fever up to 39oC and maculopapular rash on its face. Except of rash the child’s skin has no changes. What is your diagnosis?

A patient has got pain in the axillary area, rise of temperature developed 10 hours ago. On examination: shaky gait is evident, the tongue is coated with white deposit. The pulse is frequent. The painful lymphatic nodes are revealed in the axillary area. The skin over the lymph nodes is erythematous and glistering. What is the most probable diagnosis?

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

Survey radiograph of chest of a 62 year old smoker who often suffers from "pneumonias"showed a triangle shadow in the right lung, its vertex is pointing towards the lung root. It also showed deviation of heart and mediastinum shadows towards the lesion. What is the most probable diagnosis?

A 25 year old patient was admitted on the 1st day of the disease with complaints of double vision in the eyes, heavy breathing. The day before the patient ate home-made mushrooms. On objective examination: paleness, mydriatic pupils, difficult diglutition, bradycardia, constipation. What is the diagnosis?

A 50 year old patient has been admitted to the clinics with atrophic gastritis. Blood count: erythrocytes 3,8 · 1012/l, Hb - 68 g/l, c.i. - 1, macroanisocytosis, poikilocytosis. There is megaloblastic type of haemopoesis. A number of leukocytes, reticulocytes and thrombocytes is lreduced. Which pathology is suspected?

A 5 month old boy was born prematurely, he didn’t suffer from any disease at the infant age and later on. Examination at an outpatient’s hospital revealed paleness of skin, sleepiness. Blood count: Hb - 95 g/l, erythrocytes - 3,5 · 1012/l, reticulocytes - 90/00, colour index - 0,7, osmotic stability of erythrocytes - 0,44-0,33%, serum iron - 4,9 micromole/l. What is the most probable cause of anemia?

A 13 year old girl consulted the school doctor on account of moderate bloody discharge from the genital tracts, which appeared 2 days ago. Secondary sexual characters are developed. What is the most probable cause of bloody discharge?

A 60 year old man complains of fever, significant weight loss, bone and joint pain, bleeding gums. Examination revealed paleness, lymphadenopathy, hepato- and splenomegaly. CBC: WBC - 270 · 109/l with 13% lymphocytes, 1% monocytes, 21% basophiles, 29% neutrophils, 9% blasts, 12% promyelocytes, 12% myelocytes, 2% metamyelocytes, 1% eosinophils. ESR 22 mm/h. Name the drug for treatment:

A 27 year old man complains of pains in epigastrium which are relieved by food intake. EGDFS shows antral erosive gastritis, biopsy of antral mucous presents Hеlicobacter Pylori. Diagnosis is:

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

A 70 year old man is suffering from coronary heart disease. His mood is evidently depressed, anxious. As a result of continious sleeplessness he has got fears, suicidal thoughts. He would sit for a long time in the same pose, answer after a pause, in a low, monotonous voice. His face has a look of suffering, pain, fear. What is the main psychopathologic syndrome?

A patient, aged 48, complains of heaviness in the right hypochondrium, itching of the skin. Repeatedly he had been treated in infectious diseases hospital because of icterus and itch. Objectively: meteorism, ascitis, dilation of abdominal wall veins, protruding navel, spleen enlargement. Diagnosis is:

On the first day after labour a woman had the rise of temperature up to 39oC. Rupture of fetal membranes took place 36 hours before labour. Examination of the bacterial flora of cervix of the uterus revealed hemocatheretic streptococcus of A group. The uterus body is soft, tender. Discharges are bloody, with admixtures of pus. Specify the most probable postnatal complication:

A 24 year old patient complained about putting on weight, limosis. Objectively: the patient’s constitution is of hypersthenic type, body weight index is 33,2 kg/m2, waist circumference is 100 cm. Correlation of waist circumference to the thigh circumference is 0,95. What is the most probable diagnosis?

A triad of symptoms ("stearing spot", "terminal film", "blood dew") has been revealed on examination of a patient. What disease should you think about?

A 23 year old man complains about face edemata, headache, dizziness, reduced urination, change of urine colour (dark-red). These presentations appeared after pharyngitis. Objectively: face edemata, pale skin, temperature 37,4oC; heart rate - 86/min, AP - 170/110 mm Hg. Heart sounds are muffled, the II sound is accentuated above aorta. What etiological factor is probable in this case?

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

A 26 year old man was admitted to the hospital because of stabbing back pain on inspiration and dyspnea. Examination results: BT of 37oC, Ps of 24/min, HR of 92/min, vesicular breath sounds. There is a dry, grating, low-pitched sound heard on both expiration and inspiration in the left inferior lateral part of the chest. What is the most likely diagnosis?

A female 28 years old patient became depressed, her mood is melancholic; this state is accompanied by hypobulia, hypokinesia, slow speed of thinking. Her attitude towards her past, present and future is pessimistic. The pathogenetic mechanism of this state is supposed to involve dysfunction in the:

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

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

A 26 year old woman who delivered a child 7 months ago has been suffering from nausea, morning vomiting, sleepiness for the last 2 weeks. She suckles the child, menstruation is absent. She hasn’t applied any contraceptives. What method should be applied in order to specify her diagnosis?

A 39 year old patient suffering from hypertension felt suddenly intense headache in the region of occiput; there appeared recurrent vomiting. These presentations has been lasting for 5 hours. Objectively: Ps - 88 bpm, AP - 205/100 mm Hg, painfulness of occipital points, rigidity of occipital muscles are present. Kernig’s symptom is bilaterally positive. Subarachnoid haemorrhage is also suspected. What diagnostic method will be of the greatest importance for confirmation of provisional diagnosis?

A 29 year old patient underwent surgical treatment because of the benign serous epithelial tumour of an ovary. The postoperative period has elapsed without complications. What is it necessary to prescribe for the rehabilitational period:

A 3 year old boy fell ill abruptly: fever up to 39oC, weakness, vomitng. Haemorrhagic rash of various size appeared on his lower limbs in 5 hours. Meningococcemia with infective - toxic shock of the 1 degree was diagnosed. What medications should be administered?

Clinical and statistical study was devoted to the effect of a new pharmacological medication upon the patients with coronary heart disease. What parametric criterion (coefficient) can be used for estimation of results validity?

A 54 year old woman complains of increasing fatigue and easy bruising of 3 weeks’ duration. Physical findings included pale, scattered ecchymoses and petechiae and mild hepatosplenomegaly. Blood count: RBC- 2,5 · 1012/l; Hb - 73 g/l; Ht - 20%; PLT- 23 · 109/l; and WBC162·109/l with 82% blasts, that contained Auric rods; peroxidase stain was positive. What is the most probable diagnosis?

A 40 year old patient complains of yellowish discharges from the vagina. Bimanual examination revealed no pathological changes. The smear contains Trichomonas vaginalis and blended flora. Colposcopy revealed two hazy fields on the frontal labium, with a negative Iodine test. Your tactics:

A 10 year old girl complains about abdominal pain that is arising and getting worse after eating rough or spicy food. She complains also about sour eructation, heartburn, frequent constipations, headache, irritability. She has been suffering from this for 12 months. Objectively: the girl’s diet is adequate. Tongue is moist with white deposit at the root. Abdomen is soft, painful in its epigastric part. What study method will help to make a diagnosis?

A pregnant woman in her 40th week of pregnancy undergoes obstetric examination: the cervix of uterus is undeveloped. The oxytocin test is negative. Examination at 32 weeks revealed: AP 140/90 mm Hg, proteinuria 1 g/l, peripheral edemata. Reflexes are normal. Choose the most correct tactics:

A pregnant woman may be diagnosed with hepatitis if it is confirmed by the presence of elevated:

A 75 year old man who has been suffering from diabetes for the last six months was found to be jaundiced. He was asymptomatic except for weight loss at the rate of 10 pounds in 6 months. Physical examination revealed a hard, globular, right upper quadrant mass that moves during respiration. A CT scan shows enlargement of the head of the pancreas, with no filling defects in the liver. The most likely diagnosis is:

A 23 year old patient fell ill 3 weeks ago when she noticed a very painful induration in her axillary crease. 4-5 days later it burst and discharged a lot of pus. After that some new infiltrations appeared around the affected area. The patient has never suffered from skin diseases before. What is the most probable diagnosis?

A 24 year old patient complains about general weakness, dizziness, body temperature rise up to 37,5oC, sore throat, neck edema, enlargement of submaxillary lymph nodes. Objectively: mucous membrane of oropharynx is edematic and cyanotic, tonsils are enlarged and covered with films that spread beyond the tonsils and cannot be easily removed. What is the leading mechanism of this illness’ development?

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

A patient has been in a hospital. The beginning of the disease was gradual: nausea, vomiting, dark urine, аcholic stools, yellowness of the skin and scleras. The liver is protruded by 3 cm. Jaundice progressed on the 14th day of the disease. The liver diminished in size. What complication of viral hepatitis caused deterioration of the patient’s condition?

A 25 year old woman complained of edema on her face and legs, rise of blood pressure up to 160/100 mm Hg and weakness. She fell ill 3 weeks after recovering from angina. Urinalysis data: protein of 0,5 g/l, erythrocytes of 17-20/field, leukocytes of 2-3/field, erythrocyte casts. What treatment should be initiated after specifying the diagnosis?

A 37 year old farmer complains about general weakness, spastic pain in the lower parts of his abdomen, mainly in the left iliac area, frequent defecations up to 18 times a day, feces contain admixtures of mucus and blood. The illness began abruptly 3 days ago with chill, fever, headache. General condition is moderately severe, body temperature is 37,8oC. Sigmoid colon is spasmed and painful. What is the most probable diagnosis?

The highest risk of congenital anomalies probably occurs when human embryos or fetuses are exposed to ionizing radiation. At what stage of gestational period does it occur?

A nine year old child is at a hospital with acute glomerulonephritis. Clinical and laboratory examinations show acute condition. What nutrients must not be limited during the acute period of glomerulonephritis?

A 56 year old patient has worked at the aluminium plant over 20 years. Within 3 last years he has been experiencing loosening of teeth, bone and joint pains, piercing pains in heart region, vomiting. The provisional diagnosis is:

A 35 year old woman consulted a doctor about affection of arm skin and lower third of forearm in form of a large edema, hyperemia, vesiculation and maceration. The disease developed after using a laundry detergent "Lotos". The patient has been using it for a month. She hasn’t suffered from dermatological diseases before. What is the most probable diagnosis?

At year-end hospital administration has obtained the following data: annual number of treated patients and average annual number of beds used for patients’ treatment. What index of hospital work can be calculated on the base of this data?

Adenosine triphosphate may be expected to convert which of the following arrhythmias to sinus rhythm?

A 52 year old patient with history of functional Class II angina complains of having intense and prolonged retrosternal pains, decreased exercise tolerance for 5 days. Angina is less responsive to nitroglycerine. What is the most probable diagnosis?

A 50 year old woman complained of attacks of right subcostal pain after fatty meal she has been suffering from for a year. Last week the attacks repeated every day and became more painful. What diagnostic study would you recommend?

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

15 minutes after the second vaccination with diphteria and tetanus toxoids and pertussis vaccine a 4 month old boy manifested symptoms of Quincke’s edema. What medication should be applied for emergency aid?

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

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

A primagravida with pregnancy of 3738 weeks complains of headache, nausea, pain in epigastrium. Objective: the skin is acyanotic. Face is hydropic, there is short fibrillar twitching of blepharons, muscles of the face and the inferior extremities. The look is fixed. AP- 200/110 mm Hg; sphygmus of 92 bpm, intense. Respiration rate is 32/min. Heart activity is rhythmical. Appreciable edemata of the inferior extremities are present. Urine is cloudy. What medication should be administered?

Prophylactic photoroentgenography examination of a 25 year old man revealed focal shadowings of small and medium intensity with irregular contours in the 1st and 2nd segments of the right lung. Which clinical form can be suspected?

The average body lenth of newborn boys is 50,9 cm at a sigma 1,66; and average mass - 3432 at a sigma 5,00. What criterion is necessary to compare degree of variability of these signs?

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

A 34 year old woman fell ill 3 months ago after cold exposure. She complained of pain in her hand and knee joints, morning stiffness and fever up to 38oC. Interphalangeal, metacarpophalangeal and knee joints are swollen, hot, with reduced ranges of motions; ESR of 45 mm/h, CRP (+++), Vaaler-Rouse test of 1:128. What group of medicines would you recommend the patient?

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

A severely traumatized patient who has been receiving prolonged parenteral alimentation develops diarrhea, mental depression, alopecia and perioral and periorbital dermatitis. Administration of which of the following trace elements is most likely to reverse these complications?

An 18 year old patient was admitted to a hospital with complaints of headache, weakness, high temperature, sore throat. Objectively: enlargement of all groups of lymph nodes was revealed. The liver is enlarged by 3 cm, spleen - by 1 cm. In blood: leukocytosis, atypical lymphocytes - 15%. What is the most probable diagnosis?

After delivery and revision of placenta there was found the defect of placental lobule. General condition of woman is normal, uterus is firm, there is moderate bloody discharge. Speculum inspection of birth canal shows absence of lacerations and raptures. What action is necessary?

A patient with acute respiratory viral infection (3rd day of disease) complains of pain in lumbar region, nausea, dysuria, oliguria. Urinalysis - hematuria (100-200 RBC in eyeshot spot), specific gravity 1002. The blood creatinin level is 0,18 millimole/l, potassium level - 6,4 millimole/l. Make the diagnosis:

The observed patient’s movements are retarded, she answers no questions. Sometimes she spontaneously stays in strange postures. It is possible to set her body and limbs into different positions artificially. If the psychiatrist lifts her arm or leg, so that she remains standing on the other leg, the patient can stay in such a position for quite a long time. Name the probable disorder:

A 9 year old girl with a history of intermittent wheezing for several years is brought to the pediatrician. The child has been taking no medications for some time. Physical examination reveals agitation and perioral cyanosis. Intercostal and suprasternal retractions are present. The breath sounds are quiet, and wheezing is audible bilaterally. The child is admitted to the hospital. Appropriate interventions might include all of the following EXCEPT:

A 3 month old child has occiput alopecia, anxious sleep, excessive sweating. What disease might be suspected?

A 12 year old girl complains about abrupt weakness, nausea, dizziness, vision impairment. The day before she ate home-made stockfish, beef. Examination revealed skin pallor, a scratch on the left knee, dryness of mucous membranes of oral pharynx, bilateral ptosis, mydriatic pupils. The girl is unable to read a simple text (mist over the eyes). What therapy would be the most adequate in this case?

An outpatient hospital made record of 11600 diseases within one year. Among them influenza and ARD make up 5800, circulatory system diseases - 3480, digestion diseases - 1300, other diseases - 1020. What relative index can be calculated according this data?

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

During preventive examination a 16 year old patient presented no problems. Objectively: the patient has signs of malnutrition, he is asthenic, AP is 110/70 mm Hg, Ps is 80 bpm, cardiac border is normal, auscultation above the cardiac apex reveals three sounds, cardiac murmur is absent. ECG shows no pathological changes, phonocardiogram shows that the third sound comes 0,15 s after the second one above the apex. How are these changes called?

A patient complained about problems with pain and tactile sensitivity, pain in the nail bones at the end of the working day. He works at a plant with mechanical devices. What pathology can be suspected?

A 14 year old patient complains of chest pain, temperature up to 38,5oC, breathlessness. He had acute tonsillitis 2 weeks ago. He is in grave condition. The skin is pale. Heart borders are dilated, heart sounds are quiet. Above total heart area you can hear pericardium friction sound. Electrocardiogram: the descent of QRS voltage, the inversion T. The liver is enlarged by 3 cm. ESR - 4 mm/h, ASL - 0 - 1260, C-reactive protein +++. Your diagnosis:

A woman of a high-risk group (chronic pyelonephritis in anamnesis) had vaginal delivery. The day after labour she complained of fever and loin pains, frequent urodynia. Specify the most probable complication:

A 38 year old man complains about mild pain and muscle weakness of shoulder and pelvic girdles and back that has been progressing for the last 3 weeks. He has also significant problems with getting up, going up and down the stairs and shaving. It is suspected that the patient is suffering from dermatomyositis. Blood count: Hb - 114 g/l, leukocytes - 10,8 · 109/l, eosin - 9%, ESR - 22 mm/h, C-reactive protein (++). Change of the following laboratory factor will be of the greatest diagnostic importance:

A 34 year old coal miner who has been in service for 10 years was discharged from an occupational disease clinic after examination and treatment. He was diagnosed with the I stage of anthracosilicosis, peribronchitis, 0 stage of respiratory failure. What expert decision should be taken about his working capacity?

During examination a patient is unconscious, his skin is dry and hot, face hyperemia is present. The patient has Kussmaul’s respiration, there is also smell of acetone in the air. Symptoms of peritoneum irritation are positive. Blood sugar is at the rate of 33 millimole/l. What emergency actions should be taken?

A mother consulted a pediatrician about her son. Her son was born with body mass of 3 kg and length of 48 cm. He’s 1 year old now. What is the required normal mass?

A 49 year old female patient was admitted to a hospital with acute attacks of headache accompanied by pulsation in temples, AP rose up to 280/140 mm Hg. Pheochromocytoma is suspected. What mechanism of hypertensive attack does this patient have?

A 2 month old healthy infant with good appetite is given artificial feeding since he turned 1 month old. When is it recommended to start the corrective feeding (fruit juice)?

A 32 year old patient complains about pain in small joints of her hands, paresthesia at the tips of fingers, weakness, difficult diglutition. She has been suffering from this for 13 years. Objectively: face amimia, shortening of nail bones, skin indurations in the area of shoulder girdle are present. Roentgenological examination of lungs revealed basal pneumosclerosis. Fibrogastroscopy revealed esophagus constriction in its cardial part. Blood count: leukocytes - 9,8 · 109/l, ESR - 22 mm/h, γ-globulin - 22%. What is the most probable diagnosis?

In order to improve organism tolerance of boarding-school pupils a doctor developed a program. The program is based upon the following principles: graduality, consistency, individuality, coomplexity. What of the main principles of organism tempering wasn’t taken into account?

A 14 year old girl complains of profuse bloody discharges from genital tracts during 10 days after suppresion of menses for 1,5 month. Similiar bleedings recur since 12 years on the background of disordered menstrual cycle. On rectal examination: no pathology of the internal genitalia. In blood: Нb - 70 g/l, RBC- 2,3 · 1012/l, Ht - 20. What is the most probable diagnosis?

A woman born a child. It was her fith pregnancy but the first delivery. Mother’s blood group is A(II)Rh−, newborn’s A(II)Rh+. The level of indirect bilirubin in umbilical blood was 58 micromole/l, hemoglobin - 140 g/l, RBC- 3,8·1012/l. In 2 hours the level of indirect bilirubin turned 82 micromole/l. The hemolytic disease of newborn (icteric-anemic type, Rhincompatibility) was diagnosed. Choose the therapeutic tactics:

A 7 year old boy has periods of loss of attention that last 10-15 seconds and occur several times a day. During these periods he stands still in one position, doesn’t answer the questions or react when he is called by his name. Neurological examination revealed no changes. What diagnostic method should be applied to specify his diagnosis?

A military unit stopped for 3-day’s rest in an inhabited locality after a long march. The sanitary-epidemiological reconnaissance found several water sources. It is necessary to choose the source complying with the hygienic standards for drinking water in the field conditions:

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

A 56 year old woman has an acute onset of fever up to 39oC with chills, cough, and pain on respiration in the right side of her chest. On physical examination: HR - 90/min, BP- 95/60 mm Hg, RR26/min. There is dullness over the right lung on percussion. On X-ray: infiltrate in the right middle lobe of the lung. What is the diagnosis?

A woman in her 39th week of pregnancy, the second labor, has regular birth activity. Uterine contractions take place every 3 minutes. What criteria describe the beginning of the II labor stage the most precisely?

A 42 year old metalworker has been working at the turning machine for production of heavy large-size parts for 5 years. His work requires using of hand and pedal levers that involves considerable physical force. What means for osteoarthrosis prevention should be recommended?

In order to study impact of microclimate upon the human organism it is necessary to make systematic observation of air temperature over 3 days. Choose a device that will allow to make the most precise temperature records:

Among the following causes of acute renal failure, the one that would be classified as "postrenal"is:

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

A 68 year old patient complains about acute pain in his right foot, toe edema and darkening of skin of the IV toe. He has been suffering from diabetes mellitus for 15 years, doesn’t receive regular treatment. What complication of diabetes mellitus is it?

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

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

A 60 year old patient has been suffering from arterial hypertension for 15 years. After recurrent stroke she started complaining about amotivational bad mood, problems with attention concentration; she forgets to close the entrance door, cannot recall events of the last day. Computer tomography shows areas of postinfarction changes in the cortical postfrontal regions. What is the most probable diagnosis?

A 25 year old patient complains about weakness, dizziness, appearance of haemorrhagic skin rash. She has been suffering from this for a month. Blood count: erythrocytes: 1,0·1012/l, Hb- 37 g/l, colour index - 0,9, leukocytes - 1,2 · 109/l, thrombocytes - 42 · 109/l. What diagnostic method will be the most effective?

A 48 year old man complains of fatique and shortness of breath. His Ht is 32%, and Hb - 103 g/l. Peripheral blood smear reveals macrocytosis. Serum vitamin B12 level is 90 pg/ml (normal is 170 to 940); serum folate level is 6 ng/ml (normal is 2 to 14). Possible causes to consider include all of the following EXCEPT:

During hygienic examination of a hospital it was established that the area for each bed in a double ward was: in the infectious department for children - 7 2, in the infectious department for adults 8 2, in the burns department - 9 2, in the radiological department - 10 2, in the critical care department - 13 2. In which wards the area for each bed doesn’t correspond with hygienic requirements?

Esophagus wall of a 72 year old patient with severe concomitant pathology was injured during urgent fibroesophagogastroscopy. This resulted in progressing of acute respiratory failure and collapse of the left lung. What aid should be rendered?

A 26 year old woman had the second labour within the last 2 years with oxytocin application. The child’s weight is 4080 gr. After the placent birth there were massive bleeding, signs of hemorrhagic shock. Despite the introduction of contractive agents, good contraction of the uterus and absence of any cervical and vaginal disorders, the bleeding proceeds. Choose the most probable cause of bleeding:

Routine examination of an otherwise healthy child with a history of bronchial asthma reveals AP of 140/90 mm Hg. The most likely cause of the hypertension is:

A 2 year old child has been ill with acute respiratory viral infection of upper thrice a year - in February, in April and in December. How should these occurrences be recorded?

A man in grave condition was delivered to the admission ward of a hospital on the 2nd day of illness. Examination revealed body temperature of 36,1oC, sharpened features of face, dry skin that makes a fold, aphonia, convulsive twitching of some muscle groups. Acrocyanosis is present. Heart sounds are muffled, Ps is 102 bpm, AP is 50/20 mm Hg. Abdomen is soft, drawn-in, painless. Anuria is presnt. Stool is liquid in form of rice water. What is the most probable diagnosis?

A 30 year old woman ill with influenza felt palpitation and dull cardiac pain during moderate physical exercise. Objectively: Ps - 96 bpm, AP - 100/60 mm Hg. The first sound is quiet above the apex, soft systolic murmur is present. What complication is indicated by these clinical presentations?

An 8 year old girl complains about joint pain, temperature rise up to 38oC, dyspnea. Objectively: the left cardiac border is deviated by 2,5 cm to the left, tachycardia, systolic murmur on the apex and in the V point are present. Blood count: leukocytes - 20,0 · 109/l, ESR - 18 mm/h. What sign gives the most substantial proof for rheumatism diagnosis?

A 28 year old woman had the second labour and born a girl with manifestations of anemia and progressing jaundice. The child’s weight was 3 400 g, the length was 52 cm. The woman’s blood group is B (III) Rh−, the father’s blood group is A (III) Rh+, the child’s blood group is B (III) Rh+. What is the cause of anemia?

During inspection of sanitary conditions of studying at a technical university it was necessary to evaluate the visual regimen of students, who study from 9 a.m to 3 p.m. What index of natural light will be the most informative?

A 38 year old man was admitted to a hospital from his working place on July 19 because of hip fracture. He was invalid till November 19. Requires prolongation of treatment. Who decides on the issue of further temporary invalidity?

Internal obstetric examination of a parturient woman revealed that the sacrum hollow was totally occupied with fetus head, ischiadic spines couldn’t be detected. Sagittal suture is in the straight diameter, occipital fontanel is directed towards symphysis. In what plane of small pelvis is the presenting part of the fetus?

Generalized low voltage on an ECG (QRS deflection < 5 mm in limb leads and < 10 mm in precordial leads) may be a marker for all of the following disorders EXCEPT:

It is planned to make complete isolation boxes in the infectious department in order to prevent nosocomial airborne infections. The boxes consist of a tambour, a ward and a lock chamber. What structure should be also included in a complete isolation box?

A child is 1 day old. During delivery there had been problems with extraction of shoulders. Body weight is 4300,0. Right arm hangs down along the body, hand is pronated, movement in the arm is absent. "Scarf"symptom is positive. What is the most probable diagnosis?

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

An outbreak of food poisoning was recorded in an urban settlement. The illness was diagnosed as botulism on the grounds of clinical presentations. What foodstuffs should be chosen for analysis in the first place in order to confirm the diagnosis?

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

A 57 year old patient abruptly lost the sight of one eye. Examination revealed that his sight made up 0,02 excentrically, eye fundus has haemorrhages of different forms and sizes ("squashed tomato"symptom). Disc of optic nerve is hyperemic. In anamnesis general vascular pathology is recorded. Direct-acting anticoagulants were administered. What is the most probable diagnosis?

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

A 68 year old patient has been suffering from chronic pancreatitis for 35 years. During the last 5 years he has been observing abatement of pain syndrome, abdominal swelling, frequent defecations up to 3-4 times a day (feces are greyish, glossy, with admixtures of undigested food), progressing weight loss. Change of symptom set is caused by joining of:

A 52 year old patient has hypervolaemic type of essential hypertension. Which of the following medications is to be prescribed either as monotherapy or in complex with other antihypertensive drugs?

A woman consulted a therapeutist about fatigability, significant weight loss, weakness, loss of appetite. She has been having amenorrhea for 8 months. A year ago she born a full-term child. Haemorrhage during labour made up 2 l. She got blood and blood substitute transfusions. What is the most probable diagnosis?

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

A child with tetralogy of Fallot is most likely to exhibit:

A 9 year old boy has been suffering from diabetes mellitus for a year. He gets insulin injections (humulin R, NPH), the dose makes up 0,4 units per 1 kg of body weight a day. Insulin is untroduced subcutaneously (into the shoulder) by means of a syringe. What measures should be taken in order to prevent lipodystrophy?

Researchers studied disease incidence of influenza and acute respiratory viral infection within the last 5 years. What kind of graphic presentation should be used for the best visualization of this data?

A 5 tons milk batch was sampled. The lab analysis revealed: fat content 2%, specific density - 1,04 g/cm3, acidity - 210Т, reductase probe - weak-positive. What way is the product to be used in?

A 39 year old patient complained about morning headache, appetite loss, nausea, morning vomiting, periodic nasal haemorrhages. The patient had acute glomerulonephritis at the age of 15. Examination revealed rise of arterial pressure up to 220/130 mm Hg, skin haemorrhages on his arms and legs, pallor of skin and mucous membranes. What chemestry test has the greatest diagnostic importance in this case?

A 2 year old girl has been ill for 3 days. Today she has low grade fever, severe catarrhal presentations, slight maculopapular rash on her buttocks and enlarged occipital lymph nodes. What is your diagnosis?

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

A 3 month old infant suffering from acute segmental pneumonia has dyspnea (respiration rate - 80 per minute), paradoxical breathing, tachycardia, total cyanosis. Respiration / pulse ratio is 1:2. The heart dullness under normal size. Such signs characterise:

A full-term infant is 3 days old. On the different parts of skin there are erythemas, erosive spots, cracks, areas of epidermis peeling. The infant has scalded skin syndrome. Nikolsky’s symptom is positive. General condition of the infant is grave. Anxiety, hyperesthesia, febrile temperature are evident. What is the most probable diagnosis?

A 2 month old full-term child was born with weight 3500 g and was on the mixed feeding. Current weight is 4900 g. Evaluate the current weight of the child:

A 30 year old patient complains about inability to become pregnant over 3 years of married life. The patient is of supernutrition type, she has hair along the median abdominal line, on the internal thigh surface and in the peripapillary area. Menses started at the age of 16, they are infrequent and non-profuse. US revealed that the uterus was of normal size, ovaries were 4х5х5 cm large and had a lot of cystic inclusions. What is the most probable diagnosis?

A 28 year old patient was admitted to the clinic with complaints of the temperature rise up to 39,0oC, headache, weakness, constipation on the 9th day of the disease. On examination: single roseolas on the skin of the abdomen are present. The pulse rate is 78 bpm. The liver is enlarged by 2 cm. What is the most probable diagnosis?

Maximum permissible concentration of carbon dioxide in the air is considered to be a sanitary index of air purity in a classroom. What concentration of carbon dioxide in the air is accepted as maximum permissible?

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

A 48 year old woman complains about weakness, weight loss, appetite loss, headache. The patient had acute glomerulonephritis when she was young. She has been suffering from arterial hypertension since she was 25. She didn’t undergo systematic treatment, consulted a doctor rarely. Examination revealed signs of chronic renal insufficiency of the I stage (creatinine - 0,43 millimole/l). What dietary recommendations are the most reasonable?

A 52 year old woman complains about face distortion. It appeared 2 days ago after supercooling. Objectively: body temperature is 38,2oC. Face asymmetry is present. Frontal folds are flattened. Left eye is wider than right one and doesn’t close. Left nasolabial fold is flattened, mouth corner is lowered. Examination revealed no other pathology. Blood count: leukocytes - 10 · 109/l, ESR - 20 mm/h. What is the most probable diagnosis?

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

A patient who takes diuretics has developed arrhythmia as a result of cardiac glycoside overdose. What is the treatment tactics in this case?

A 6 week old child is admitted because of tachypnea. Birth had been uneventful, although conjunctivitis developed on the third day of life and lasted for about 2 weeks. Physical examination reveals tachypnea, bilateral inspiratory crackles and single expiratory wheezing. Bilateral pneumonia is evident on chest X-ray. The child is afebrile and has no history of fever. White blood cell count is 15 · 109/l, with 28% of eosinophils. The most likely cause of this child’s symptoms is:

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

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

An 8 year old child has low-grade fever, arthritis, colicky abdominal pain and a purpuric rash llocalized on the lower extremities. laboratory studies reveal a guaiac-positive stool, urinalysis with red blood cell (RBC) casts and mild proteinuria, and a normal platelet count. The most likely diagnosis is:

A woman complains of having slight dark bloody discharges and mild pains in the lower part of abdomen for several days. Last menses were 7 weeks ago. The pregnancy test is positive. Bimanual investigation: the body of the uterus indicates for about 5-6 weeks of pregnancy, it is soft, painless. In the left appendage there is a retort-like formation, 7 х 5 cm large, mobile, painless. What examination is necessary for detection of fetus localization?

A child was born with body weight 3250 g and body length 52 cm. At the age of 1,5 month the actual weight is sufficient (4350 g), psychophysical development corresponds with the age. The child is breast-fed, occasionally there are regurgitations. What is the cause of regurgitations?

A 24 years old primipara was hospitalized with complaints about discharge of the amniotic waters. The uterus is tonic on palpation. The position of the fetus is longitudinal, it is pressed with the head to pelvic outlet. Palpitation of the fetus is rhythmical, 140 bpm, auscultated on the left below the navel. Internal examination: cervix of the uterus is 2,5 cm long, dense, the external os is closed, light amniotic waters out of it. Point a correct component of the diagnosis:

What guarantees against the preconceived attitude to the physician in cases of professional law violations do you know?

A 14 year old child suffers from vegetovascular dystonia of pubertal period. He has got sympathoadrenal atack. What medicine should be used for attack reduction?

Study of actual diet of an adult revealed the following: proteins make up 16% of energy value of daily ration, fats - 25%, carbohydrates - 59%. Evaluate compliance of protein, fat and carbohydrate share in the energy value of daily ration with the recommended shares of these nutrients?

A 3 year old child fell acutely ill, body temperature rose up to 39,5oC, the child became inert, there appeared recurrent vomiting, headache. Examination revealed positive meningeal symptoms, after this lumbal puncture was performed. Spinal fluid is turbid, runs out under pressure, protein concentration is 1,8 g/l; Pandy reaction is +++, sugar concentration is 2,2 millimole/l, chloride concentration - 123 millimole/l, cytosis is 2,35 · 109 (80% of neutrophils, 20% of lymphocytes). What is the most probable diagnosis?

A 7 year old girl has mild form of varicella. Headache, weakness, vertigo, tremor of her limbs, ataxia, then mental confusion appeared on the 5th day of illness. Meningeal signs are negative. Cerebrospinal fluid examination is normal. How can you explain these signs?