Krok I Variant II

Posted: May 5, 2012 in Krok I

Variant II

 

6. At inspection of patient R., 29 years old, paleness of the skin and mucosa, capillary “carotide shudder” were revealed.  Data of auscultation: the I sound  at the apex and the 2nd sound at the aorta are weakened. Soft blowing protodiastolic murmur is heard. What phenomena may be revealed at patient’s femoral artery?

A)    Flint’s murmur.

B)    Doble Traube’s sound.

C)    Systolic murmur.

D)    Intermittent pulse.

E)     Paradoxic pulse.

7. Patient P., 28 years old, complains of periodical pressing pain in the heart region, accompanied by loosing of consciousness. Data of examination: skin is pale, apex beat is displaced, diffuse and resistant. Weakened I sound at the heart apex and the II sound at the aorta as well as rough systolic murmur at the aorta are heard by auscultation. How the heart borders will be displaced in this case?

A)    Leftwards.

B)    Rightwards.

C)    Upwards.

D)    Rightwards and upwards.

E)     Leftwards and upwards.

8. A patient complains of attack-like pressing pain in the heart region, dizziness, dyspnea. Paleness of the skin, pulsation of carotic arteries and positive Quinke’s symptom are revealed by inspection. Apex beat is displaced downwards and leftwards. Data of auscultation: wekened I sound at the apex and the II sound at the aorta. What murmur is likely to be heard in this case?

A)    Systolic.

B)    Presystolic.

C)    Mesodiastolic.

D)    Protodiastolic.

E)     Holodiastolic.

9. Patient O.,40 years old, complains of faints and frequent attacks of dizziness. From patient’sanamnesis: she had attack of rheumatic fever 20 years ago. The signs of aortic stenosis are revealed by examination. What kind of murmur is typical for this disease?

A)    Systolic.

B)    Presystolic.

C)    Mesodiastolic.

D)    Protodiastolic.

E)     Holodiastolic.

10. In patient P., 20 years old, which suffers from rheumatic fever within recent 5 years, sharp weakening of the II sound at the aorta is heard by auscultation as well as rough systolic murmur  at the aorta, which is transmitted towards carotic arteries. What heart defect is probably present in this case?

A)    Stenosis of the mitral valve.

B)    Mitral valve incompetence.

C)    Defect of intreventricular septum.

D)    Aortic valve incompetence.

E)     Stenosis of the aortic rout.

21. Inquireing a patient it is obviously  to determine the cause of the disease. What is the most frequent cause of mitral stenosis?

A)    Congenital pathology.

B)    Atherosclerosis.

C)    Trauma.

D)    Septic endocarditis.

E)     Rheumatic fever.

22. Inquireing a patient it is obviously  to determine the cause of the disease. What is the most frequent cause of mitral incompetence?

A)    Rheumatic fever.

B)    Atherosclerosis.

C)    Trauma.

D)    Septic endocarditis.

E)     Congenital pathology.

23. Patient P., 18 years old, within recent 3 years suffers from heart disease conducted by rheumatic fever. The following data are obtained by auscultation of the patient: weakening of the I sound and systolic murmur at the heart apex, accentuation of the II sound  at the pulmonary artery. What actually heart defect is present in the patient?

A)    Stenosis of the mitral valve.

B)    Defect of intreventricular septum.

C)    Mitral valve incompetence.

D)    Trycuspid valve incompetence.

E)     Aortic valve incompetence.

  1. In a patient, which suffers from  rheumatic fever within recent 30 years, the  following data were obtained by auscultation: loud I heart sound, weakened II sound and diastolic murmur. At the same time additional sound is heard.  What actually heart defect is present in the patient?

A)    Mitral valve incompetence.

B)    Mitral valve stenosis.

C)    Aortic valve incompetence.

D)    Stenosis of the aortic rout.

E)     Trycuspid valve incompetence.

  1. Patient A, 19 years old, suffers from periodical dyspnea, palpitation at physical loading. The patient had thore throat 3 month ago, futher he noticed edema and acute pain in joints, but he hasn’t any treatment. Data of present inspection: cyanosis of the lips, apex beat is displaced leftwards and downwards. The I heart sound is weakened, systolic murmur is registered by auscultation, which coincide to the I sound; accentuation of the II sound at the aortaispresent. How the heart borders will be displaced in this case?

A)    Will be not changed.

B)    Leftwards and downwards.

C)    Leftwards and upwards.

D)    Rightwards and downwards.

E)     Rightwards and upwards.

36.In patient A., 40 years old, mitral stenosis was verified. 15 years ago the patient had attack of rheumatic fever. What is the main X-ray sign of this pathology?

A)    Hyperthrophy of the left ventricle.

B)    Hyperthrophy of the right ventricle.

C)    Aortic heart configuration.

D)    Mitral heart configuration.

E)     Enlargement of the aortic arch.

37. Patient A., 54 years old, suffers from rheumatic attacks within recent 25 years. Displacement of his heart dullness borders upwards and rightwards was revealed by percussion caused by hyperthrophy of the left atrium and right ventricle. What ECG-signs of left atrial hyperthrophy do you know?

A)    Rising of P wave amplitude.

B)    Rising of R wave amplitude.

C)    Decreasing of R wave amplitude.

D)    Duration of P wave is not  changed.

E)     Appearance of byphasic P wave.

38. Patient F., 36 years old, complains of dyspnea, palpitation at physical exertion, hemopthysis. The patient had attack of rheumatic fever in childhood. Data of inspection: acrocyanosis, pronounced cyanotic blush of the cheeks. Examination of the heart has revealed symptoms of mitral stenosis. How this specific appearance of patient’s face is called?

A)    Facies febrilis.

B)    Korvisar’s face.

C)    Nephrotic face.

D)    Mixedematous face.

E)     Mitral face.

  1. Patient Ya., 27 years old, suffers from dyspnea, weakness, cough with periodical hemopthysis. In  anamnesis data about rheumatic attack and narrowing of the left atrioventricular aperture are present. What pulse is typical for this heart defect?

A)    Not changed.

B)    Hard.

C)    Mild.

D)    Equal.

E)     Different on both arms.

  1. In patient E,  30 years old mitral valve incompetence was verified.  What pulse is typical for this pathology?

A)    Not changed.

B)    Hard.

C)    Mild.

D)    Equal.

E)     Different on both arms.

51. By inspection of a patient it was established that skin colour is normal, multiple white stria are observed on the skin of abdominal wall and thighs. Patient’s body weight is about 117 kg, height is 164 cm. Skin of the abdominal wall looks like an apron.  Determine, please, the stage of obesity in the patient.

A)    I degree – +10-29 % of B.W.

B)    II degree – +30-49 % of B.W.

C)    III degree – +50-99 % of B.W.

D)    IV degree – over 100 % of B.W.

E)     Obesity is abcent.

52.A patient is suffering from numbness and weakness in the lower limbs, thirst; periodicalrising of lucose lever in the blood up to 7,1 mmol/l. Indicate, please, what  disease may be the reason of development of polyneuritis in this case?

A)    Hypothyreosis.

B)    Hyperthyreosis.

C)    Acromegaly.

D)    Adison’s disease.

E)     Diabetes mellitus.

53. A patient with diabetes mellitus has developed intensive thirst, polyuria, headache, skin itching. He didn’t use unsulin within recent 3 days. Data of inspection: aeton smell from the mouth, the patient is excted, his skin is dry. The lever of glucose in the blood is 25,4 mmol/l. What indicies of urine analysis  are necessary  to obtaine?

A)    Protein.

B)    Ketone bodies.

C)    Leukocytes.

D)    Bile pigments.

E)     Casts.

54. A student suffers from diabetes mellitus within recent 5 years.  After routine administration of insulin she has developed sweating, tremor in the body, excitation. What emergency care measures should be rendered for the patient?

A)    To give her heart drops.

B)    To administer cordiamin.

C)    To administer caffeine.

D)    To administer glucose.

E)     To administer ammonia alkohol.

55. In apatient F.  has been examined in the out-patient department, glucose lever in the blood isabout 7,4 mmol/l and low amount of sugar in the urine is revealed. What diet should you recommend for the patient?

A)    № 1.

B)    № 15.

C)    № 7.

D)    № 7.

E)     № 9.

66. Patient M., 45 years old, is reffered to the admissions department by ambulance. The patient complains of general weakness, dizziness, flickering before eyes, hum in the ears. From the anamnesis: the patient suffers from hypertension within recent  2 years. What typeof hypertonic crisis dies the patient have?

A)    Water-salt

B)    Neuro-vegitative

C)    Diencephalic

D)    Convulsive

E)     Cardial

67. Patient A., 48 years old, complains of severe headache, hum in the ears. Attacks with manifestation of the same symptoms are observed within recent  2 years after phychical overstrains. Blood pressure is about 190/120 mm Hg. What syndrome has developed in the patient?

A)    The syndrome of acute heart insufficiency.

B)    Hypotensive syndrome.

C)    Hypertensive syndrome.

D)    The syndrome of acute vascular insufficiency.

E)     The syndrome of coronary insufficiency.

68. A student, which the first time has entered an operating room, sharply has developed wekness, dizziness, clinking in the ears; immediatelly  nausea has followed as well as numbness in the limbs, darkness in the eyes. Patient’s skin is covered with cold sweating, pulse is rare, respiration is frequent, superficial, pupills are widened, their responce on light is preserved. What measures of emergency care should be performed for the patient?

A)    Injection of 0,3 ml of 1 % mesaton solution.

B)    Injection of cordiaminum for quick restoration of consciousness..

C)    To call on an emegrency team.

D)    To put the patient  down in recumbent position and to remove clothes from his chest

E)     To put the patient down in recumbent position with head downwards and lowered limbs, to take her to inhale ammonia alcohol.

69. Patient A., 45 years old, complains of the pain in the back of the head, general weakness, periodical occurence of edema on the legs till the evening. The patient  considers himself to be ill during the last year, when diagnosis of hypertension of the I degree was established. What should lie down in the basis of patient’s therapeutical diet?

A)    Water limitation.

B)    Limitation of fats.

C)    Limitation of salt.

D)    Limitation of carbohydrates.

E)     Limitation of protein.

70. In patient K., 43 years old, at routine prophylactic examination rising of blood pressure till 140-149/90-94  mm of Hg was revealed. What is the type of hypertension in this patient?

A)    Isolated systolic hyertension.

B)    Mild hypertension.

C)    Moderate hypertension.

D)    Border hypertension.

E)     Severe  hypertension.

86. Patient C., 28 years old, complains of weakness, dizziness, hum in the ears, decreasing of appetite. Skin paleness is revealed by inspection. Patient’s hear is thin, easly folls down, nales a flate and brittle. Specific smeel is felt from the mouth, alweolar pyorrhea is present. What disease the last sign is typical for

A)    pernicious anemia

A)    iron-defficiency anemia

B)    hemolytic anemia

C)    acute leucosis

D)    erythremia

87. In woman K.. pronounced metrorrhagias are observed. Signs of hypochromic anemia are observed. What examination is necessary for diagnostics?

A)    erythrocytes sedimentation rate

B)    determination of blood proteins

C)    determination of reticuloci\ytes

D)    estimation of erythrocytes shape

E)     determination of serum iron.

88. During prophylactic examination of an adolescent preson  the foloowing blood formula was obtained: juvenile leukocytes– 3 %, stab leukocytes – 10 %. Which formof granulocytes are present in blood in norm?

A)    juvenile

B)     stab

C)     myelocytes

D)    promyelocytes

E)     metamyelocytes

89. A patient complains of high body temterature, enlargement of lymph nodes and sore throat. Signs of necrotic angina are revealed by inspection as well as hemorragic rash, enlargement of lymph nodes, liver and spleen. Puncture biopsy of bone marrow was prescribed for diagnostics. Indicate, please, puncture of which bone usually is necessary to perform:

A)    femoral bone

B)    sternum

C)    skull bones

D)    iliac bone

E)     ribs

90. Patient N., 19 years old, complains of weakness, fever, nasal bleeding. Objective signs of acute leucosis were revealed by examination. Laboratory tests are necessary for diagnostics. Which method is the most fine for diagnostics of leucosis?

A)    general blood analysis

B)    myelogram

C)    spleen puncture biopsy

D)    puncture biopsy of lymph nodes

E)     cytochemical method

  1. Patient P., 40 years old, suffers from diabetes mellitus within recent 20 years. Now he is hospitalized into a clinic in unconscious condition. From wife’s words the patient felt weakness, nausea, vomiting, polyuria during recent weak. Data of inspection: skin is dry, its turgor is decreased. The tone of eyebulbs is decreased, Kussmaul’s respiration is obcerved. Acetone smell is felt from patient’s mouth. What should a physitian suspect in this case?

A)    hyperosmolar coma

B)    hypercetonemic coma

C)    hyperlactacidemic coma

D)    hypoglycemic coma

E)     diabetic encephalopathy

  1. Patient P., 40 years old, suffers from diabetes mellitus within recent 20 years. Now he is hospitalized into a clinic in unconscious condition. From wife’s words the patient felt weakness, nausea, vomiting, polyuria during recent weak. Data of inspection: skin is dry, its turgor is decreased. The tone of eyebulbs is decreased, Kussmaul’s respiration is obcerved. Acetone smell is felt from patient’s mouth. What examination should be performed first of all?

A)    blood analysis for sugar content determination, general blood analysis.

B)    ECG, blood analysis for determination of sugar content

C)    determination of blood sugar content, concentration of acetone in urine

D)    electroencephalography, determination of blood sugar content

E)     biochemical blood analysis, common urine analysis.

  1. In a patient diabetes incipidus is present. Cetoaciditas is diagnosed in him. What changes will be observed concerning patient’s skin?

A)    skin is moist, its turgor is preserved

B)    skin is moist, its turgor is decreased

C)    diabetic rubeosis

D)    skin is dry, its turgor is decreased

E)     xantosis and lupoid necrobiosis.

  1. Patient C., 38 years old, is suffering from diabetes mellitus, type I,  within recent 15 years. Stable rising of blood pressure is obcerven in the patient. Data of inspection: skin paleness, puffiness of the face. Data of biochemical blood analysis: cholesterol content – 6,5 mmol/l, total protein – 58 g/l, common lipids – 5,4 g/l, urea – 8,0 mcmol/l. Leucosytes in urine – 8-10 in one vision field. What patological condition is more likey  to be present in the patient?

A)    diabetic nephropathy

B)    chronic pyelonephritis

C)    chronic pyelocystitis

D)    essential hypertension

E)     symptomatic arterial hypertension

105. Patient C., 38 years old, is suffering from diabetes mellitus, type I,  within recent 15 years. Stable rising of blood pressure is obcerven in the patient. Data of inspection: skin paleness, puffiness of the face. Data of biochemical blood analysis: cholesterol content – 6,5 mmol/l, total protein – 58 g/l, common lipids – 5,4 g/l, urea – 8,0 mcmol/l. Leucosytes in urine – 8-10 in one vision field. What syndrome is more likey  to be present in the patient

A)    uric

B)    nephritic

C)    nephrotic

D)    renal arterial hypertension

E)     renal  failure

116. In a patient dull percutory sound is obtained by percussion from the right side of the chest downwards from scapular angle. Bronchial breathing, sonorous fine bubbling rales and bronchophonia are revealed here by auscultation. What disease is likelly to be present in the patient?

A)    Lung abscess

B)    dry pleurisy

C)    pleurisy with effusion

D)    lobar pneumonia in the IInd stage

E)     lung emphyzema

117. In a patient weakened vesicular breathing is heard by auscultation as well as additional respiratory sound is  heard both during expiration and inspiration, the sound can change and disappear. What is this sound?

A)    initial crepitation

B)     final crepitation

C)     moist fine-bubbling rales

D)    pleural friction

E)     dry rales.

118. A patient was admitted to the hospital with attack of dyspnea. During inspection bundbox perkutory sound was revealed as well as weakened vesicular breathing and multiply disseminated dry whistling sounds. Data of examination of sputum: glass-like consistance, eosinophylia, Kurshman’s spirals, Charcot-Leuden’s cristals. What disease presented signs are typical for?

A)    chronic bronchitis

B)    lung emphyzema

C)    bronchial asthma

D)    dry pleurisy

E)     lung cancer

119. A patient expectorates 300 ml of sputum every morning. The sputum is of purulent character and has unpleasant smell. Data of microscopic examination: great amount of leukocytes, elastic fibers, cristals of cholesterol, hematoidin and fat acids. What disease this characterof sputum is typical for?

A)    chronic bronchitis

B)    lung cancer

C)    bronchial asthma

D)    lung abscess

E)     lobar pneumonia

120. A patient expectorates with cough a few amount of “rasty” sputum. Presence of erythrocytes, leukocytes, alveolar epithelial cells, fibrinous cloths and pneumococci in the sputum was established by microscopic examination. What disease this sputum is typical for?

A)    lung abscess

B)    lung cancer

C)    lobar pneumonia

D)    bronchial asthma

E)     chronic bronchitis

131. On the plain roentgenogram  of the patient pulmonary tissue consolidation was defined in pulmonary segments S9-10. What changes will you obtain by percussion?

A)    Thympanic soung

B)    No any changes

C)    Dull percutory sound

D)    Dull-to-thympany sound

E)     Dull sound

132. A patient complains of heaviness  in epigastric region, regurgitation and nausea. Splashing sound is heard  on the empty stomach. What this sing suggests about?

A)    About hypersecretion on the empty stomach

B)    About hyposecretion

C)    About acceleration of stomach motor function

D)    About gastroptosis.

133. Patient B., 41 years old, suffersfrom peptic ulcer of the stomach  within recent 8 years. During the last 6 months pain in epigastric region has significantly intensified. Pain appears 5-10 min after food intake independently on the kind of food, that is why the patient obstains from eating. The patient is troubled with frequent vomiting which releases patiemt’s sufferings, sometimes vomiting occurs spontaneously . The painent has lost 9 kg of boby weight last time. What complication of peptic ulcer is present in the patient?

A)    pyloroctenosis

B)    reflux-esophagitis

C)    penetration

D)    perforation

E)     intestinal bleeding.

134. Patient K., 28 years old, was admitted to a hospital with complaints on dull boring pain in epigastric region which occurs 2-2.5 hours after food intake as well as on pyrosis, acid belching, constipations.  Data of objective examination: the tongue is covered with white coating, palpation is painful in  pyloroduodenal region, Mendel’s symptom is posistsve here. What disease is present in the patient?

A)    stomach ulcer

B)     duodenal ulcer

C)    chronic cholecystitis

D)    chronic pancreatitis

E)     chronic hepatitis

135. A patient has applayed for medical advise becouse of periodic abdominal pain, intestinal flatulence and constipation. Basing on data of anamnesis and objective examination disease of intestine is suspected in the patient. Lesion of which part of the intestine  should you expect?

A)    duodenum

B)    ascendent colon

C)    small intestine

D)    rectum

E)     large intestine

146. Patient M. suffers from intensive pain in the right hypochondrium which occures after intake of spicy and fatty food. She is ill the recent 3 years. Data of objective examination: joundice is abcent, body temperature is subfebrile. Intensive pain is present at deep palpationin at the projection of gallbladder. Liver is not enlarged. What disease is possible in this patient?

A)    exacerbation of chronic cholecystitis

B)    exacerbation of chronic pancreatitis

C)    peptic ulcer

D)    chronic presistant hepatitis

A)    cholelithiasis

147. Patient K. was admitted to a clinic with complaints on pain in the upper part of the abdomen of girdling character, nausea, vomiting, abdominal flatulence, diarrhoea with discharging of significant amount of  fetid feces, loosing of body weight. These problems are observed within recent 5 years. Exacerbations develop after ignoration of the diet. Pain is present at palpation in the zone of projection of pancreas. What disease is possible in this pstient?

A)    cholecystitis

B)     pancreatitis

C)    peptic ulcer

D)    chronic hepatitis

E)     cholelithiasis

148. In a patient D., 32 years old, sudden girdling pain in the upper part of the abdomen has deveolped after intake of large amount of fatty food. The pain is accompanied by nausea and vomiting. Data of examination: skin paleness, subicteric colour of sclera. Pulse is 110 per min, rrhythmic, small. Blood pressure is 90/60 mm of Hg. The abdomen is inflated. By palpation sharp pain is revealed in epigastric region and left hypochondrium. Blumberg’s symptom is positive. Amylase concentration in the urine is 1024 Un by Volgemut. What disease is possible in this patient?

A)    chronic pancreatitis

B)    acute pancreatitis

C)    chronic cholecystitis

D)    chronic hepatitis

F)     peptic ulcer

149. A patient complains of pain in the epigastrium of girdling character, with  irradiation towards the back. What from following conditions this type of pain is typical for?

A)    gastritis

B)    duodenal ulcer

C)    pancreatitis

D)    cholecystitis

E)     irritation of abdominal plexus becouse of diseases of stomach, duodenum, gallbladder and pancreas.

150. A patient is troubled by nausea, pyrosis, acid belching and so-called “hunger pain”. What disease thesesigns are typical for?

A)    cholecystitis

B)    pancreatitis

C)    cholangitis

D)    stomach ulcer

E)     duodenal ulcer

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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