Krok I Variant I

Posted: May 5, 2012 in Krok I
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Variant I

 

1.A patient who is being on long-standing treatment becouse of aortic heart defect, isexamined by now. What is the direct auscultatory sign of aortic stenosis?

A)    Accentuation of the II sound at the aorta.

B)    Accentuation of the II sound at the pulmonary artery.

C)    Systolic murmur at the 2nd intercostal space rightwards from the sternum.

D)    Systolic murmur at the xyphoid process.

E)     Systolic murmur at the 2nd intercostal space leftwards from the sternum.

2. A young man is examined by military comission. Paleness of his skin is revealed as well as pulsation of carotic, brachial arteries, rrhythmicalmovments of the head. What heart defect these signs are typical for?

A)    Mitral valve incompetence.

B)    Aortic valve incompetence.

C)    Stenosis of the mitral valve.

D)    Stenosis of the aortic rout.

E)     Trycuspid valve incompetence.

3. At examination of a 30-aged  man the folloving signs are revealed: capillary pulse, positive Musse’s sign, apex beat is diffuse and displaced. Inwhichdirection the heart borders will be displaced in this case?

A)    Upwards and rightwards.

B)    Leftwards.

C)    Leftwards and rightwards.

D)    Upwards, leftwards and rightwards.

E)     Leftwards and downwards.

4. In patient S., 23 years old, pulse rate is about 100 per min. Pulse is high and quick. Blood pressure is 160/30 mm of Hg. Weakening of the I sound at heart apex, diastolic murmur at the aorta and Botkin’s point are heard by auscultation. What heart defect these signs are typical for?

A)    Stenosis of the aortic rout.

B)    Stenosis of the mitral valve.

C)    Trycuspid valve incompetence.

D)    Aortic valve incompetence.

E)     Mitral valve incompetence.

5. Patient M., 25 years old, in physical exertion suddenly has developed dizziness, pain in the heart region, and has lost consciousness. Sharp skin paleness is visible by inspection. Thrill (symptom of “cat’s purr”) is revealed at the 2nd intercostal space rightwards from the sternum. Data of auscultation: the I sound at the heart apex and the 2nd sound at the aorta are wekened. What murmur is likely to be heard in this case?

A)    Systolic murmur at the aorta.

B)    Diastolic murmur at the aorta.

C)    Systolic murmur at the heart apex.

D)    Diastolic murmur at the pulmonary artery.

E)     Systolic murmur at the pulmonary artery.

16. Patient Yu., 30 years old,  has aortic stenosis. Ultrasound examination of the heart was performed for her. Indicate, please,  EhoCG-signs of this disease:

A)    Enlargement of the right ventricular cavity.

B)    Vibration of the mitral valve’s cusps.

C)    Thikening of the aortic valve’s cusps.

D)    Change of movements of the aortic valve’s cusps.

E)     Enlargement of the left atrial cavity.

17. Patient A., 25 years old,  has aortic incompetence. Phonocardiographic examination was performed for her. Indicate, please,  PCG-signs of this disease:

A)    Systolic murmur at the heart apex.

B)    Systolic murmur at the II intercostal space leftwards from the sternum.

C)    Diastolic murmur at the heart apex.

D)    Systolic murmur at the II intercostal space rightwards from the sternum.

E)     Systolic murmur at the xyphoid process.

18. In patient S., 18 years old,  the symptoms of  aortic stenosis were revealed. Phonocardiographic examination was prescribed for him. What  PCG-signs should you expect  to obtain in this case?

A)    Systolic murmur at the heart apex.

B)    Systolic murmur at the II intercostal space leftwards from the sternum.

C)    Diastolic murmur at the heart apex.

D)    Systolic murmur at the II intercostal space rightwards from the sternum.

E)     Systolic murmur at the xyphoid process.

19. Patient C., 18 years old,  has aortic stenosis. Electrocardiographic examination was prescribed for her. What are ECG-signs of this heart defect?

A)    Hyperthrophy of the right ventricle.

B)    Hyperthrophy of the left ventricle.

C)    Hyperthrophy of the left atrium.

D)    Hyperthrophy of the right atrium.

E)     Normogram.

20. Patient A., 28 years old,  has aortic incompetence. Electrocardiographic examination was prescribed for her. What are ECG-signs of this heart defect?

A)    Hyperthrophy of the right ventricle.

B)    Hyperthrophy of the right atrium.

C)    Hyperthrophy of the left ventricle.

D)    Hyperthrophy of the left atrium.

E)     Normogram.

31. Patient R. is on the long-standing treatment in rheumatological department of a hospital becouse of mitral stenosis. Ultrasound examination of his heart was performed. What EchoCG-signs are typical for this heart defect?

A)    Enlargement of the right atrial cavity.

B)    Enlargement of the right ventricular cavity.

C)    Enlargement of the right ventriclular and left atrial cavities.

D)    Enlargement of the left ventriclular and left atrial cavities.

E)     Enlargement of both atrial cavities.

32. Patient M., 30 years old, which has signs of mitral incompetence, was examined by ultrasound method if diagnostics. What EchoCG-signs are typical for this heart defect?

A)    Enlargement of the right atrial cavity.

B)    Enlargement of the right ventricular cavity.

C)    Enlargement of the right ventriclular and right atrial cavities.

D)    Enlargement of the left ventriclular and left atrial cavities.

E)     Enlargement of both atrial cavities.

33. Patient L., 25 years old, is on the long-standing treatment becouse of mitral incompetence. Phonocardiographic examination was prescribed for her. What PCG-signs should you expect tobeobtained in this case?

A)    Weakening of the I sound at the apex.

B)    Intensification of the I sound at the apex.

C)    Prolongation of P-Q-interval.

D)    Abcense of systolic murmur.

E)     Change of Q-to-I sound interval.

34. In patient C.,48 years old, mitral stenosis was verified and phonocardiographic examination was prescribed for him. What PCG-signs should you expect in this case?

A)    Intensification of the I sound.

B)    Weakening of the I sound at the apex.

C)    Prolongation of T-to-II-sound interval.

D)    Abcense of diastolic murmur.

E)     Shortening of Q-to-I-sound interval.

35. Patient H.,36 years old, had atack of  rheumatic fever in childchood and since that time mitral incompetence had developed. X-ray examination of the patient’s heart was performed. What is the main roentgenological sign of this heart defect?

A)    Aortic heart configuration.

B)    Mitral heart configuration.

C)    Enlargement of the aortic rout.

D)    Hyperthrophy of the right ventricle.

E)     Hyperthrophy of the left ventricle.

46. Patient E., 17 years old, is reffered to the hospital by ambulance. She is suffering from sharp rising of blood pressure till 180/110 mm Hg, thirst, discharging of excess volume of urine. Symptoms typical for pheochromocytoma are revealed by physical examination. What additional method of examination is the most important in diagnostics of the disease?

A)    General blood analysis.

B)    Urine analysis.

C)    Roentgenography of bones.

D)    Ultrasound examination.

E)     Computer tomography.

47. Patient of 18 years old suffers from weakness in muscles, decreasing of blood pressure. At inspection a physitian has revealed signs of adrenal insufficiency. What colour of skin is typical for this case?

A)    Usual.

B)    Hyperaemud.

C)    Pale.

D)    Cyanotic.

E)     Bronse.

48. During inspection of patient T., 30 years old, rough voice, dryness of the skin and edematous face were detected. The patient was treated becouse of thyreoiditis in the past. What pathological condition reevealed signs are typical for?

A)    Hypothyreosis.

B)    Thyrotoxycosis.

C)    Acromegaly.

D)    Obesity.

E)     Diabetes mellitus.

49. Asigns of diffuse toxic goitre of the II-III degree were revealed in pregnant woman of 19 years old, by physical examination. Prescribe, please, the main additional method of examination for the patient, which will help to estimate function of the thyroid gland:

A)    Scanogram.

B)    Roentgenogram of the neck.

C)    Ultrasound examination of the thyroid gland.

D)    Determination of TTH, T3, T4 concentration in the blood.

E)     Determination of adrenaline, noradrenaline  concentration in the blood.

50. In the patient with adrenal insufficiency blood pressure has sharply lowered during pleurocentesis and the patient has loosed consciousness. What measures of emergency care should be performed for the patient?

A)    Injection of insulin.

B)    Injection of adrenaline.

C)    Injection of large doses of corticesteroids.

D)    Injection of mesatone.

E)     Injection of cordiaminum.

61. In the patient K., 42 years old,  mild hypertension was determined. Indicate criteria of this disease.

A)    Systolic blood pressure is 120-130 mm of Hg.

B)    Systolic blood pressure is 130-135 mm of Hg.

C)    Systolic blood pressure is 136-140 mm of Hg.

D)    Systolic blood pressure is 140-159 mm of Hg.

E)     Systolic blood pressure is 160-179 mm of Hg.

62. Patient D., 38 years old, suffers from hypertension within recent 6 years. Blood pressure violates within the limit 160/100-180/110 mm of Hg. How to evaluate this type of hypertension according to the lever of blood presure?

A)    Mild hypertension.

B)    Border hypertension.

C)    Moderate hypertension.

D)    Isolated systolic hypertension.

E)     Severe  hypertension.

63. In patient Z., 35 years old, hypertension of the II degree was established. Indicate signs typical for this degree of hypertension.

A)    High stable hypertension.

B)    Hyperthrophy of the left ventricle.

C)    Generalized narrowing of retinal vessels.

D)    Microalbuminuria.

E)     All above mentioned.

64. In patient N., 40 years old, blood pressure violates within the limit 140-149/90/94 mm of Hg. Indicate the most probable origin of hypertension in this case:

A)    Renal.

B)    Cardiovascular.

C)    Renovascular.

D)    Primary.

E)     Renoparenchimatous.

65. Patient M., 48 years old, has applied for medical advise to admissions department with complains on dizziness, headache, dull boring pain in lumbar region, high blood pressure:160/90-190/110 mm Hg, clinical  effect  after administration of hypotensive preparations is abcent. Indicate signs typical for vasorenal hypertension present in this patient:

A)    Hypertension of II-III degree.

B)    Resistance for hypotensive therapy.

C)    Pain in lumbar region.

D)    Patient’s age.

E)     All above mentioned.

76. A patient of 47 years old is on long-standing treatment with complaints on high temperature, pain in the back, swellingof the face, red colouring of urine. 1 month ago he was suffering from thore throat. Data of inspection: paleness of the skin, swelling of the face, edema in paraorbital zones of the face. Blood pressure is 200/130 mmof Hg. What is the type of hypertension in the patient?

A)    Renovascular.

B)    Renoparenchimatous.

C)    Adrenal.

D)    Hypophysary.

E)     Cardiovascular.

77. Patient of 77 years old complains of quick increasing of body weight, headache, elevation of blood pressure, enlargement of brists. Data of inspection: the face is round with deep-red  blush on the cheeks, obesity of the upper part of the body, gynaecomastia. Blood pressure is about 210/130 mm Hg. Whay disease these signs are typical for?

A)    Thyrotoxycosis.

B)    Cushing’s pituitary baasophilism.

C)    Konn’s disease.

D)    Pheochromocytoma.

E)     Hypertonic disease.

78. A patient  of 17 years old is reffered to the hospital by ambulance. Periodical sharp rising of blood pressure, hyperglycaemia and glucosuria are revealed in the patient. At attacks blood pressure rises up to 210/140 mm Hg, patient feels headache, vomits. What is the type of hypertension in the patient?

A)    Renovascular.

B)    Renoparenchimatous.

C)    Adrenal.

D)    Hypophysary.

E)     Cardiovascular.

79. The patient, 32 years old, has visited a policlinic becouse of complaints on headache and derangement of vision. Data of inspection: excessive body weight +30kg, face is moon-like with cyanotic blush, fat depoisition pattern is mostly on the upper part of the body. Blood pressure is 190/120 mm Hg. What substance in patient’s urine should you obtaine for definition of diagnosis?

A)    aldosteron

B)    vinilinmygdal acid

C)    noradrenaline

D)    ketosteroids

E)     creatitine

80. The patient A., 47 years old, suffers during recent 20 years from bronchial asthma with is characterized by  frequent attacks; she takes 3 tables of prednisolon per day permanently. The patient has noticed rising of blood pressure last time. How to characterize this change of blood pressure?

A)    essential hypertension

B)    medicamentous one

C)    adrenal hypertension

D)    thyreoid hypertension

E)     neurogenic one.

91. In patient T., 30 years old, iron-defficiency anemia is proved by laboratiry examination of blood. Indicate the most typical complaint for deffificency of iron.

A)    loosing of tactile sensation

B)     greyness of hear

C)     brittleness of nales

D)    fissures in the angles of the mouth

E)     deranged taste

92. During examination of 17-yeared patient  signs of hematologic disease are revealed. In blood analysis leucocitosis is present up to 36х109/l as well as ESR is 58 mm/hour. In which disease ESR is significantly increased?

A)    Erythremia

B)    Anemia

C)    Acute leucosis

D)    Hemophylia

E)     Myelomatosis

93. Patient A., 63 years old, is suffering from chronic myeloleucosis within recent 5 years. Exacerbations of the disease have became more frequent last year. What symptom is typical for chronic myeloleucosis?

A)    enlargement of liver

B)     hemorragic syndrome

C)     enlargement of lymph nodes

D)    enlargement of spleen

E)     all mentioned above

  1. A physitian  suspects acute leucosis in the patient with heavy necrotic angina. What canges in blood analysis indicate on acute leucosis?

A)    diminishing of amount of erythrocytes

B)    rising of leucocytes amount

C)    diminishing of leucocytes amount

D)    blast cells

E)     thrombocytopenia

  1. The longitudinal diameter of a spleen obtained bypercussion in patient M. is equal to 10,5 cm. What should be this diameter in norm?

A)    4-6 cm

B)    6-8 cm

C)    8-10 cm

D)    10-12 cm

E)     more than 12 cm

106. A man, 52 years old, was applaying for medical help becouse of complaints on frequent urination, thirst, increased appetite, pain in lower limbs, fatique. Data of objective examination: excessive body weight, dryness of skin, excoriations on the skin. Pulse is 78 per min, of satisfactory properties. Blood pressure is 150/90 mm Hg. There aren’s data about pathological changes in another internal organs. What disease is more likey  to be present in the patient?

A)    diabetes mellitus, type I

B)    diabetes mellitus, type II

C)    diabetes incipidus

D)    chronic pyelonephritis

E)     essential hypertesion

107. A man, 52 years old, was applaying for medical help becouse of complaints on frequent urination, thirst, increased appetite, pain in lower limbs, fatique. Data of objective examination: excessive body weight, dryness of skin, excoriations on the skin. Pulse is 78 per min, of satisfactory properties. Blood pressure is 150/90 mm Hg. There aren’s data about pathological changes in another internal organs. What examinations should be performed to define a diagnosis?

A)    glycemic profile and profile of glucose concentration in urine

B)    general blood analysis and biochemical blood analysis

C)    determination of sugar content in the blood and its presence in the urine

D)    determination of sugar content in the blood, coagulogram

E)     determination of insuline content in the blood.

108. Patient K., 42 years old, is suffering from diabetes mellitus, type I,  within recent 16 years. Rising of blood pressure was recorded in him last 2 months as well as pufiness of the face in the morning, dryness in the mouth, pain in the lower limbs. What  complication among following is probably present in the patient?

A)    essential hypertension

B)    diabetic nephropathy

C)    diabetic polyneuropathy

D)    diabetic angiopathy

A)    chronic pyelonephritis

109. In patient N., 20 years old, thirst, frequent urination were observed within recent 2 weeks as well as loosing of body weight while his appetite is increased, general and muscular weakness, abdominal pain, vomiting. Hyperaemia of cheeks, dryness of skin sre obcerved by inspection. Pulse is 90 per min, blood pressure is 125/85 mm Hg. There aren’t data about pathological changes in another internal organs. What disease is more likey  to be present in the patient?

A)    diabetes mellitus, type I

B)    diabetes mellitus, type II

C)    diabetes incipidus

D)    acute appendicitis

E)     difuse toxic goitre

110. In patient N., 20 years old, thirst, frequent urination were observed within recent 2 weeks as well as loosing of body weight while his appetite is increased, general and muscular weakness, abdominal pain, vomiting. Hyperaemia of cheeks, dryness of skin sre obcerved by inspection. Pulse is 90 per min, blood pressure is 125/85 mm Hg. There aren’t data about pathological changes in another internal organs. What examinations should be performed in the first order to define a diagnosis?

A)    general blood analysis, determination of sugar content in the blood

B)    biochemical blood analysis, common urinalysis

C)    determination of sugar content in the blood, determination of sugar and acetone presence in the urine

D)    coagulogram, biochemical blood analysis

E)     Analysis of urine by Nechiporenko, biochemical blood analysis

121. In a patient rising of body temperature up to 38,5-39 °C was established. The morning amount of discharged sputum is insignificant, its character is mucous, smell is unpleasant, sometimes blood streaks are present in the sputum. “Ditrich plagues” are revealed by microscopic examination. What disease of respiratory system this sputum is typical for?

A)    bronchial asthma

B)    chronic bronchitis

C)    bronchiectatic disease

D)    lobar pneumonia

E)     lung emphyzema

122. By objective examination of a patient the following data were revealed: vocal fremitus is intensified downwards from the left scapular angle, percutory sound is dull, bronchial breathing and bronchophony are present here. What syndrome these symptoms are typical for?

A)    The syndrome of pulmonary tissue consolidation

B)    The syndrome of fluid accumulation in the pleural cavity

C)    The syndrome of air overfeeling of lungs

D)    The syndrome of air accumulation in the pleural cavity

E)     The syndrome of bronchial obstruction.

123. By objective examination of a patient the following data are revealed: lagging of the right  part of the chest in respiration, vocal fremitus and bronchophony are abcent  from thisside, dull percutory sound is heard, respiration is not heard. What syndrome these symptoms are typical for?

A)    The syndrome of pulmonary tissue consolidation

B)    The syndrome of presence of cavity in the lungs

C)    The syndrome of fluid accumulation in the pleural cavity

D)    The syndrome of air overfeeling of lungs

E)     The syndrome of bronchial ectasia.

124. By objective examination of a patient the following data are revealed:  accesory muscles take part in respirationthe character of  percutory sound is clear lung sound, respiration is harsh vesicular with prolonged expiration, multiply disseminated dry whistling sounds are heard. What syndrome these symptoms are typical for?

A)    The syndrome of bronchial obstruction

B)    The syndrome of fluid accumulation in the pleural cavity

C)    The syndrome of pulmonary tissue consolidation

D)    The syndrome of air overfeeling of lungs

E)     The syndrome of air accumulation in the pleural cavity

125. By objective examination of a patient the following data are revealed over the entire surface of the chest: equal weakening of vocal fremitus, bundbox percutory sound, weakening of vesicular breathing, absence of bronchophonia. What syndrome these symptoms are typical for?

A)    The syndrome of pulmonary tissue consolidation

B)    The syndrome of air overfeeling of lungs

C)    The syndrome of fluid accumulation in the pleural cavity

D)    The syndrome of air accumulation in the pleural cavity

E)     The syndrome of bronchial obstruction

136. During deep palpation of an abdomen it was established that sigmoid intestine is enlarged and of solid consistence, its surface is tuberous. Which methods of examination will help to define a disagnosis?

A)    Plain  X-ray examination of intestine

B)    colonoscopy

C)    irigoscopy

D)    rectoromanoscopy

E)     coprogram

137. During microscopic examination of feces considerable amount of neutral fats and changed muscular fibers were revealed as well as mass of extracellular starch, soaps and significant amount of cristals of fatty acids. What coprological syndrome these data are typical for?

A)    colic

B)    cholecystitis

C)    pancreatitis

D)    peptic ulcer

E)     enteritis

138. A patient complains of periodical pain in the right hypohondrium, nausea, bitter taste in the mouth, belching, decreasing of appetite. Diseases of which organs should you suspect in this case?

A)    liver and bile  ducts

B)     stomach

C)     intestine

D)    pancreas

E)     esophagus

139. A patient was reffered to a hospital with complaints on sharp pain in the right hypochondrium and vomiting. Pain has developed after intake of fatty and spicy food. Tenderness and pain in the right hypochondrium are revealed by palpation. What pathological condition should you suspect in this case?

A)    billiary colic

B)    exacerbation of peptic ulcer

C)    exacerbation of chronic pancreatitis

D)    exacerbation of chronic colitis

E)     exacerbation of chronic enteritis

140. A patient complains of pain in the right hypochondrium. The upper border  of liver dullness is not changed. The lower liver endge is 5 cm downwards from the costal arch by palpation. The liver margin is solid, arounded, painful, liver surface is smooth. What may be the causes of presented changes of liver margin?

A)    Echinococcosis.

B)     Tumor of the liver

C)    liver cirrhosis

D)    hepatitis.

151. A patient is troubled by dull boring pain in the upper part of the abdomen, instable stool, belching with ameel of rotten eggs.  What disease this belching is  typical for?

A)    stomach ulcer

B)    duodenal ulcer

C)    stomach cancer

D)    liver cyrrosis

E)     pancreatitis

152. A patient with stomach ulcer feels diminishing of abdominal pain intensity and appearance of general weakness. He is trobled by vomiting with masses like “coffee ground”. What pathological condition  such vomiting is  typical for?

A)    pylorostenosis

B)    stomach bleeding on the phone of ahylia

C)    stomach bleeding on the phone of nornochlorhydria or hyperchlorhydria

D)    coffee abuse

E)     perforation of ulser

153. Fractional testing of stomach secreation was performed to a patient with peptic ulcer. Increase acidity was defined. What changes of stool are typical for such patients?

A)    constipation

B)    diarrhoea

C)    constipation and diarrhoea consequently

D)    normal stool

E)     feces with undigested food

154. Data of ECG: rrythm is sinual, regular, heart rate is 70 per min. Voltage is preserved. Electrical axis deviation: angle a 10 0 – deviated leftwards. Disorders of myocardial repolarization. When heart rrhythm is suggested to be regular?

A)    The difference between R-R intervalsis more than 10 %

B)    The difference between R-R intervalsis not more than 0,1 sec

C)    The difference between R-R intervalsis more than 0,1 sec

D)    The difference between R-R intervalsis  more than 0,2 sec

E)     The difference between R-R intervalsis more than 0,3 sec

155. Data of ECG: rrythm is sinual, regular, heart rate is 76 per min. Voltage is preserved. Electrical axis is horizontal. Signs of hypoxia of myacardium.  What is irregular heart rrhythm?

A)    P wave is negative before each complex QRS

B)    P wave is positive before each complex QRS, duration of R-R varies within the rate 0,15-0,45 sec

C)    P wave is positive before each complex QRS, duration of R-R nears 0,10 sec

D)    P wave is of disserent amplitude  and shape  before each complex QRS

E)     P wave is present not before  each complex QRS, duration of P-Q interval varies within the rate 0,25-0,35 sec

161. During analysis of ECG a student has noticed that the wave P is negative in lead aVR, its duration is 0,08 sec. When it may be?

A)    Hyperthrophy of both atriums

B)    In norm

C)    In intraatrial block

D)    In atrial extrasystole

E)     In myocardial infarction of anterriolateral wall of the left ventracle.

162. During analysis of ECG a student has made conclusion that electrical heart axis is deviated rightwards. What signs are necessary tohave to make such a conclusion?

A)     in the I standart lead wave R is the highest while in the III the – wave S is the deepest.

B)      in the III standart lead wave R is the highest while in the I the – wave S is the deepest.

C)      wave R is the highest in the I standart lead.

D)     wave R is the highest in the II standart lead

E)      wave R is the highest in the III standart lead

163. During analysis of ECG a student has made conclusion that electrical heart axis is deviated leftwards. What signs are necessary to have to meake such a conclusion?

A)    in the I standart lead wave R is the highest while in the III tne – wave S is the deepest.

B)    in the III standart lead wave R is the highest while in the I tne – wave S is the deepest.

C)    wave R is the highest in the I standart lead.

D)    wave R is the highest in the II standart lead

E)     wave R is the highest in the III standart lead

164. During analysis of ECG a student has made conclusion that electrical heart axis is not deviated. What signs are necessary to have to meake such a conclusion?

A)    in the I standart lead wave R is the highest while in the III tne – wave S is the deepest.

B)    in the III standart lead wave R is the highest while in the I tne – wave S is the deepest.

C)    wave R is the highest in the I standart lead.

D)    wave R is the highest in the II standart lead

E)     wave R is the highest in the III standart lead

165. Analysing ECG a student has checked that wave T is negative in aVR and V1.  What does ot testify about?

A)    It may be in norm

B)    Subepicardial ischemia

C)    Subendocardial ischemia

D)    Hypoxia of myacardium

E)     About postinfarctional scar.

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