Krok I Variant III

Posted: May 5, 2012 in Krok I

Variant III

 

11. The signs of aortic stenosis were revealed by examination of a patient. What indirect sign of this disease can be revealed by auscultation?

A)    Displacement of the upper border of heart dullness.

B)    Displacement of  apex beat upwards.

C)    Displacement of the left border of heart dullness.

D)    Apex beat is not displaced.

E)     Displacement of the right border of heart dullness.

12. Patient S. suffers from aortic stenosis. What cause of the disease may likely be presentin thiscase?

A)    Congenital pathology.

B)    Atherosclerosis.

C)    Rheumatic fever.

D)    Syphilis.

E)     Trauma.

13. Patient D., 40 years old, suffers from aortic incompetence coused by rheumatic fever. Roentgenologacal examination of  the chest is prescribed for the patient. What X-ray sign istypical for this disease?

A)    Mitral heart configuration.

B)    Aortic heart configuration.

C)    Normal retrocardial space.

D)    Narrowing of the ascendent part of the aorta.

E)     Narrowed retrocardial space.

14. Patient T., 40 years old, suffers from periodical pain in the heart region, dizziness at physical exwrtion. Signs of aortic stenosis are revealed by inspection. What auscultatory symptom is typical for this pathology?

A)    Presystolic murmur at the aorta.

B)    Intensification of the I sound at the aorta.

C)    Systolic murmur at the pulmonary artery.

D)    Systolic murmur at the aorta.

E)     Diastolic murmur at the aorta

15. Patient D., 17 years old,  has aortic stenosis. Ultrasound examination of the heart was performed to him. Indicate, please,  EhoCG-signs of this disease:

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

B)    Enlargement of the left ventricular cavity.

C)    Enlargement of the left atrial cavity.

D)    Thikening of the aortic valve’s cusps.

E)     Vibration of the mitral valve’s cusps.

  1. Patient M., 40 years old, suffers from cough with periodical hemopthysis, dyspnea, palpitation. At inspection specific blush and cyanosis of the face were revealed. Apex beat isn’t changed, thrill is detectible over the heart region. Dara of auscultation: loud I sound, additional sound and diastolic murmur. 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.

27. In patient V., 38 years old, mitral stenosis was verified. Indicate, please, what the main sign can you determine by auscultation of  this patient?

A)    Systolic murmur at the aorta.

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

C)    Diastolic murmur at the heart apex.

D)    Systolic murmur at the Botkin’s point.

E)     Weakening of the I sound at the heart apex.

28. In patient T., 26 years old,  trycuspid incompetence was revealed. Indicate, please, what the main sign can you determine by auscultation of  this patient?

A)    Systolic murmur at the aorta.

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

C)    Diastolic murmur at the heart apex.

D)    Systolic murmur at the heart apex.

E)     Intensification of the I sound at the heart apex.

29. Patient L., 25 years old, is on long-standing treatment becouse of attack of  rheumatic fever and decompensation of mitral incompetence. A murmur is revealed by auscultation in this patient.  Indicate actually characteristics of this murmur.

A)    Systolic murmur at the apex.

B)    Systolic murmur at the Botkin’s point.

C)    Diastolic murmur at the apex.

D)    Diastolic murmur at the Botkin’s point.

E)     Systolic murmur at the xyphoid process.

30. In patient C., 28 years old, auscultation of the heart was performed and a murmur was revealed at the heart apex. What actually murmur is typical for this heart defect?

A)    Systolic murmur at the apex.

B)    Systolic murmur at the Botkin’s point.

C)    Diastolic murmur at the apex.

D)    Diastolic murmur at the Botkin’s point.

E)     Systolic murmur at the xyphoid process.

41. Patient of 30 years old has applayed for the medical help becouse of complaints on pronounced thirst, that cannot be released by drinking even 5-6 liters of water as well as  excess urination. What pathological condition is characterized by thirst?

A)    Mixedema.

B)    Hyperthyreosis.

C)    Diabetes mellitus.

D)    Pheochromocytoma.

E)     Addison’s disease.

42. At prophylactic  examination of woman, 34 years old, thikened neck is revealed as well as protrusion of eyes, tremor of fingers and whole the body. What pathological condition these signs are typical for?

A)    Hypothyreosis.

B)    Thyrotoxicosis.

C)    Acromegaly.

D)    Diabetes mellitus.

E)     Addison’s disease.

43. At inspection of the patient which suffers from pancreatitis within recent 20 years, rubeosis is revealed (it is reddness of the skin of cheeks, supercilium and chin). Development of what disease this sign testifies about?

A)    Mixedema.

B)    Hyperthyreosis.

C)    Acromegaly.

D)    Diabetes mellitus.

E)     Addison’s disease.

44. Patient O., 36 years old,  had thyreoiditis 2 years ago.  Now she is suffering from general weakness, somnolence, inhibition,shivering. Development of what disease these signs testify about?

A)    Hypothyreosis.

B)    Hyperthyreosis.

C)    Acromegaly.

D)    Diabetes mellitus.

E)     Addison’s disease.

45. Patient M., 36 years old, has applied for medical care becouse of headache, deranged vision, increasing of body weight. Data of inspection: the face is round, whith cyanotic blush. The patient is obese (+15kg of b.w.), distribution of fat tissue on the trunk, neck; gynaecomastia, elevation  of blood pressure. Pathology of what organ these data testify about?

A)    Thyroid gland.

B)    Hypophysis.

C)    Adrenal glands.

D)    Parathyroid glands.

E)     Pancreas.

56. During examination of a young person by medical comission it was established presence about 0,5 %. of sugar in patient’s urine. What from the following conditions glucosuria is typical for?

A)    Diabetes incipidus.

B)    Diabetes mellitus.

C)    Hyperthyreosis.

D)    Hypothyreosis.

E)     Adison’s disease.

57. A patient complaints of apathy, inhibition, swelling of the fsce, neck, chill. Data of objective examination: patient is inhibited, skin is dry, pale, sickened, movements are slow. Thyroid gland isn’t detectible by palpation. Indicate the sign typical for hypothyreosis.

A)    Elevation of intracellular natrium concentration.

B)    Incresaing of cholesterol concentration in patient’s blood.

C)    Incresaing of glucose concentration in patient’s blood.

D)    Anemia.

E)     Decreasing of thyroxin level.

58. At inspection of a patient, 45 years lod, signs of hypothyreosis are revealed. What facial expression  is typical for this pathology?

A)    Corvisar’s face.

B)    Acromegalic face.

C)    Facies Basedovica.

D)    Mixedematous face.

E)     Moon-like face.

59. A patient suffers from thinning of the skin, irritability, tremor of fingers and whole the body. He lives nearCarpathian mountins. At inspection Graefe’s and Mobius’s symptoms are positive. What facial expression  is typical for this pathology?

A)    Corvisar’s face.

B)    Acromegalic face.

C)    Facies Basedovica.

D)    Mixedematous face.

E)     Moon-like face.

60. At inspection of a young adolescent by military comission  in was established that patient’s neck is thickened and  enlargement of the thyroid gland is visible even by an eye. What degree doesthis enlargemend correspond to?

A)    I degree.

B)    II degree.

C)    III degree.

D)    IV degree.

E)     V degree.

71.In a young man, 28 years old, during examination by military comission rising of blood pressure was revealed. The last one  corresponds to mild hypertension.Indicate, please, what indicies of blood pressure corresponds to mild hypertension:

A)    130-139/85-89 mm of Hg.

B)    140-159/90-99 mm of Hg.

C)    160-179/100-109 mm of Hg.

D)    180-190/more than 110 mm of Hg.

E)     More than 199/115 mm of Hg.

72. A student, 20 years old, hasnotised rising of blood pressure within recent 5-6 years, but hypertonic disease is not verified by doctors. Indicate, please, the level of blood pressure corresponds to “high normal blood pressure”:

A)    130-139/85-89 mm of Hg.

B)    140-159/90-99 mm of Hg.

C)    160-179/100-109 mm of Hg.

D)    180-190/more than 110 mm of Hg.

E)     More than 199/115 mm of Hg.

73. A patient complains of headache, flickering before eyes. High blood pressure hass found in the patient and diagnosis if hypertension of the I degree is verified. Lesions of which organs are possible in this stage?

A)    Hyperthrophy of the left ventrice.

B)    Kidneys (proteinuria).

C)    Central nervous system.

D)    Narrowing of retinal vessels.

E)     Abcent.

74. In patient of 63 years old which is under medical observation within the recent 3 years blood pressure rises up to 170/95 mm of Hg. After routine examination the diagnosis of hypertension of the II degree was verified. Lesions of which organs are possible in this stage?

A)    Hyperthrophy of the left ventrice.

B)    Hypertonic nephropathy.

C)    Spasm of retinal arterioles.

D)    Increasing of serum creatinine concentration.

E)     All above mentioned.

75. A patient of 26 years old complains of sickness of the neck, rising of blood pressure, irritability, insomnia. Data of inspection: thyroid gland is enlarged, of gomogenous consistence. Protrusion of the eyes, tremor of fingers are present. Blood pressure is about 180/90 mm of Hg. What disease this hypertension is typical for?

A)    Thyrotoxycosis.

B)    Cushing’s pituitary baasophilism.

C)    Konn’s disease.

D)    Pheochromocytoma.

E)     Obesity.

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

160. Data of ECG: rrythm is sinual, regular, heart rate is 60 per min. Voltage is decreased. Electrical axis is vertical. What is the angle A in this case?

A)    0-30°
B)    30-70°
C)    71-90°
D)    91-180°
E)     0-(-30)°

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

64. 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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