A 65 y.o. man who has problems with urination as a result of benign prostate gland adenoma

dveloped fever and chill, hypotension, sinus tachycardia. Skin is warm and dry. Clinical blood

analysis revealed absolute granulocytopenia. These hemodynamic changes are most likely to

be caused by:

A 60 y.o. man complains of sense of heaviness in the region of scrotum. Objectively: scrotum

edema in the left part. Testicle is of normal size, but there is a soft, scrotum limited edema over

it that can be pressed and disappears when the patient lies down. What is the preliminary

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 40 year old woman has changes of mammary gland. What are the most often symtomps that

precede the malignization?

Name a statistical observation unit for determination of influence amount of bloodsugar on the

healing of wound's surface in a postoperative period:

A 20-year-old patient was delivered to the hospital in summer from the street with haemorrage

from the brachial artery. First medical aid involved application of a tourniquet for provisional

arrest of bleeding. What is the maximal exposure of the tourniquet?

A 9 y.o. child with diagnosis "chronic tonsillitis" stands dispanserization control. Within 1 year of

observation there was one exacerbation of disease. Physical condition is satisfactory. The

general state is not infringed. Define group of health:

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 40 year old woman has a self-detected hard breast mass. The procedure of choice for

confirming the diagnosis is:

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:

The treatment of choice for duodenal obstruction caused by secondary duodenal hematoma

that developed a few days after blunt abdominal injury is:

An anestesiologist gives narcosis to the patient, he uses a non-reversive contour. Anesthetic is

halothane. Air temperature in the operation room is 21^oС, humidity 50%, level of noise 30 dB. What occupational hazard is the principal one under these conditions?

A patient suddenly felt an acute chest pain irradiating to the left arm. Objectively: the patient is

excited, with pale skin. Breathing rate - 38/min, AP - 180/110 mm Hg. Later the patient lost

consciousness and fell down. Pulse on the great vessels was absent, the pupils were equally

dilated. What is the most likely diagnosis?

A 37-year-old patient has come to clinic being wounded in the area of umbilicus an hour ago.On

physical exam, there is a prick and cut painful wound of about 0,5x1 cm around umbilicus on

the abdominal skin with slight bleeding.How would you help this patient?

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

A 34-year-old patient was bitten by a dog 3 hours ago.There is a wound by dog teeth without

bleeding in the left arm. What surgical help would you provide to this patient?

Purulent mediastinitis is diagnosed at a 63-year-old patient. What diseases from the stated

below CANNOT cause the purulent mediastinitis?

A 63 year old patient was diagnosed with purulent mediastinitis. What of the below listed

diseases are NOT the cause of purulent mediastinitis?

A 36 year old patient was diagnosed with right-sided pneumothorax. What method of treatment

is indicated to the patient?

The diagnosis of a right-sided pneumothorax is made to a 36- year-old patient. What method of

treatment is indicated to the patient?

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?

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?

It is suspected that a 34 year old patient has an abscess of Douglas pouches. What diagnostic

method is to be chosen?

A patient has restrained umbilateral hernia complicated by phlegmon hernia, it is necessary to

take following actions:

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?

For the persons who live in a hot area after an accident at a nuclear object, the greatest risk

within the first decade is represented by cancer of:

A 10 year old boy complains about pain in his left eye and strong photophobia after he had

injured his left eye with a pencil at school. Left eye examination: blepharospasm, ciliary and

conjunctival congestion, cornea is transparent, other parts of eyeball have no changes. Visus

0,9. Right eye is healthy, Visus 1,0. What additional method would you choose first of all?

A patient had disorder of nasal respiration, mucopurulent discharges from nose, headache for 3

weeks. At anterior rhinoscopy in middle nasal meathus the stria of pus, edema, hyperemia of

the mucosa of the nose have been determined. What diagnostic method is necessary to

administer first of all?

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 35-year-old woman was admitted to resuscitation department in asthmatic status. What is the

most trustworthy criterion of breath effectiveness?

During dynamic investigation of a patient the increase of central venous pressure is combined

with the decrease of arterial pressure. What process is proved by such combination?

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 74 y.o. patient has been ill with benign prostate hyperplasy for the last 5 years. 4 days ago,

after alcochol consumption, there was an acute retention of urination. At the pre-admission

stage his urinary bladder was catheterized with metallic catheter. Examination revealed: right

epididymis is enlarged, thick and painful, there are purulent discharges from urethra. What way

of emergency care must be chosen?

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 4 y.o. child attends the kindergarten. Complains of poor appetite, fatigue. Objective

examination: skin and mucous membrane are pale, child is asthenic. In the hemogram:

hypochromatic anemia 1st, leucomoide reaction of the eosinophile type. What pathology must

be excluded first of all?

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 - 2,5x10¹²/l. The reduction of blood volume averages:

action necessary in this clinical situation:

What preparations are used for prevention of fungal infection?

What developes most often after accidental intake of Hydrochloric acid?

30 y.o. woman, had mild trauma of 5th finger of the left hand 15 days ago. She has treated her

self at home. She presents to the hospital due to deterioration of the condition and temperature

rise. Objectively: hyperemia and swelling on the ventral surface of finger. Restricted movements

of the finger. X-ray of the left hand: an early stage of оsteomyolitis of the fifth finger could not

be excluded. The diagnosis: panaris of 5th finger of the left hand. What form of panaris has

occurred in the patient?

A 36 y.o. patient is diagnosed with right sided pneumothorax. What method of treatment is

indicated to the patient?

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 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 22 y.o. man complains of acute throat pain, increasing upon swallowing during 3 days. Body

temperature 38,3^oС, neck lymph nodules are slightly enlarged and painful. Pharyngoscopically - tonsilar hyperemia, enlargement and edema, tonsils are covered by round yellow fibrinous patches around crypts openings. Beta-haemolytic streptococcus in swab analysis. What is the diagnosis?

A patient is staying in the hospital with the diagnosis of abdominal typhus. During the 3-d week

from the beginning of the disease the patient stopped keeping diet and confinement to bed. As a

result the body temperature and rapid pulse decreased and melena appeared. What kind of

complications should we think about first of all?

A 45-year-old woman, mother of four children, comes to the emergency room complaining of a

sudden onset of the epigastric and right upper quadrant pain, radiating to the back,

accompanied by vomiting. On examination, tenderness is elicited in the right upper quadrant,

bowel sounds are decreased, and laboratory data shows leukocytosis, normal serum levels of

amylase, lipase, and bilirubin. The most likely diagnosis is:

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:

A 50 year old woman with a 2-year history of mild, diffuse, tender thyroid enlargement complains

of 10 pound weight gain and fatigue. What is the most probable diagnosis?

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?

A 38 y.o. woman was hospitalized to the surgical unit with vomiting and acute abdominal pain

irradiating to the spine. On laparocentesis hemmorhagic fluid is obtained. What disease should

be suspected?

The 67 y.o. patient had 5 recurrent fractures of the lower extremities without considerable

cause within 5 years. O-shaped deformity of the legs in the knee joints has appeared. The skull,

pelvis and lower extremities X-Ray shows the thickening of flat bones. In the long bones there is

a hyperostosis along the bone axis.The blood test has not revealed any inflammation activity.

Serum calcium is normal. What disease do you consider in this case?

A 33 y.o. patient was admitted to the reception room of the Central District Hospital. He

complains of a severely painful swelling localized on posterior neck, fever up to 38,4^oC and

general weakness. In anamnesis: diabetes mellitus within 5 years. On physical examination on

the posterior neck surface there is an infiltrate elevated above surrounding skin. The tissues

affected by swelling are tense and blue reddish discoloration in central area. There are also

several purulent necrotic pustules which are connected with each other and form a large skin

necrosis. A thinned necrotic skin of this swelling has holes looking like sieve, pus discharges

through out. What disease should a doctor consider first of all?

A 19 y.o. man was admitted to the reception department in 20 minutes after being wounded with

the knife to the left chest. The patient is confused. The heart rate is 96 bpm and BP- 80/60 mm

Hg. There are the dilated neck veins, sharply diminished apical beat and evident heart

enlargement What kind of penetrative chest wound complications has developed in patient?

A 35 y.o. patient complains of a difficult swallowing, pain behind the breastbone. He can eat only

liquid food. While swallowing sometimes he has attacks of cough and dyspnea. Above

mentioned complaints are progressing. It is known that the patient has had a chemical burn of esophagus one month ago. What complication does the patient have?

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 patient operated for acute paraproctitis undergoes antibacterial and detoxification therapy, the local course of the disease has the positive dynamics. Since the operation the patient has had chills, pyrexia, tachycardia, euphoria for five days. The doctor suspected sepsis. What study will confirm the diagnosis?

A 44-year-old patient has been admitted to a hospital with complaints of dull, aching pain in the left lumbar region, the admixture of pus in the urine. Examination revealed a grade II staghorn calculus on the left. What method of treatment is indicated for this patient?

An emergency team has delivered to a hospital an unconscious patient found lying in the street in winter. Objectively: the patient is pale, with superficial respiration; bradycardia with heartrate 54/min, t^o- 35^oC. AP- 100/60 mm Hg. Palpation of chest and abdomen revealed no peritoneal symptoms. There is a smell of alcohol from the patient's mouth. What is the most likely diagnosis?

A 48-year-old patient got a job-related injury of a hypodermic varicose vein on his shin that was

accompanied by the intensive phleborrhagia. Choose the optimal variant of first aid:

A 24-year-old patient got a puncture injury below the Poupart's ligament accompanied by intense arterial leeding. The best method to temporarily stop the bleeding in the patient would be:

While making a round, a doctor had noticed the edema of the right shoulder of a 26-day-old child with diagnosis of "umbilical sepsis". Active movements in the shoulder joint were absent, right hand was hanging down. Mother stated that her child's condition had worsened for the last 24 hours what resulted in child's refusal to be breast-fed, restlessness, weeping while swaddling, rise in body temperature up to 38,8^oC. What is the most probable preliminary diagnosis?

A 65-year-old patient complains of dull pain in the rectum during and after defecation, discharge of mucus and small amount of blood mixed up with mucus and faeces. The discharged blood is of dark red color, ometimes with small amount of clots. The patient is sick for 8 months, has lost some weight. On digital examination, there is a round constriction of the rectum with infiltrate at a height of 4-5 cm from the anus. What is the most probable diagnosis?

A 52 y.o. patient fell from 3 m height on the flat ground with the right lumbar area. He complains of pain in this area. There is microhematuria in the urea. Excretory urography revealed that kidney's functioning is satisfactory. What is the most probable diagnosis?

A female patient has been suffering from pain in the right subcostal area, bitter taste in the mouth, periodical bile vomiting for a month. The patient put off 12 kg. Body temperature in the evening is 37,6^oC. Sonography revealed that bile bladder was 5,5х2,7 cm large, its wall - 0,4 cm, choledochus - 0,8 cm in diameter. Anterior liver segment contains a roundish hypoechoic formation up to 5 cm in diameter and another two up to 1,5 cm each, walls of these formations are up to 0,3 cm thick. What is the most likely diagnosis?

A 36-year-old woman applied to doctor with complaints of the enlargement of the right mammary gland. On physical exam: the right mammary gland is enlarged, hardened; nipple with areola is pasty and hydropic, looks like "lemon peel". There palpates a lymph node in the right axilla, 1,5 cm in diameter, dense consistence, not mobile. 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?

A 49-year-old male patient who had been scheduled for a surgery for gastric cancer underwent preoperative infusion therapy. Up to 3,0 liters of liquid was introduced into the right cubital vein. The following day, he felt a dragging pain in the right shoulder. Objectively: on the inner surface

of the shoulder there is a longitudinal hyperemic zone, edema of skin, a tender cord. What complication occurred in the patient?

A 54-year-old patient applied with complaints of acute pain in the shoulder-joint. 10 minutes earlier he fell in the street with his arms stretched. Doctor of the traumatological unit noticed an acute deformation of the right shoulder-joint, the impossibilty of active movement in the right extremity. Roentgenologically: uncoincidence of articulating surfaces. What is the most probable diagnosis?

A 62-year-old patient has been delivered to the surgical department with complaints of sudden pain in the umbilical region irradiating to the back and groin, which was accompanied by a syncope. Objectively: the patient is in grave condition, umbilical region is tender on palpation,

bowel sounds are diminished. AP drop is present. USI reveals: free fluid in the abdomen, thickening of the wall of the abdominal aorta. The most likely diagnosis is:

Parents of a 2-year-old boy applied to clinic complaining of right testicle absence in the scrotum of a boy. While examining the boy, hypoplasia of the right half of the scrotum was revealed, absence of the testicle. Testicle is miniaturized, it palpitates along the inguinal canal but it could not be moved down to scrotum. What is the most probable diagnosis?

A 62-year-old patient complains of the pain behind the sternum, bad passing of solid and liquid food, bad breath, increased salivation weight, loss of 15 kg during the period of 2 months. Appetite is retained. On physical exam: face features are sharpened. The skin is pale, with sallow tint, its turgor is decreased. The liver is not enlarged. Blood Hb - 86g/L. Gregersen reaction is positive. What kind of pathology caused the given clinical situation?

A patient suffers from suddenly arising crampy pain in the right loin area. 2 hours after the pain had started, hematuria took place. Loin X-ray: no pathological shadows. Ultrasound:

pyelocaliectasis on the right, the left part is normal. What is the most probable diagnosis?

A patient complains of an extremely intense pain in epigastrium. He has peptic ulcer disease of duodenum for 10 years. The patient is in the forced position being on the right side with legs abducted to stomach. Abdomen has acute tenderness in the epigastrium. Guarding contraction

of the abdominal wall muscles is observed. What is the preliminary diagnosis?

A 30-year-old patient complains of pain, hyperemia along subcutaneous veins, rise in body temperature. While examining the large shin subcutaneous vein, there is hyperemia, pain by pressing. Homanss and Luses's symptoms are negative. What is the preliminary diagnosis

A 30-year-old man has suffered from traffic accident. Consciousness is absent. Pulse on the carotid artery is undeterminable, no respiration. There is a wide leather belt on man's waist. What measures are to be taken?

An emergency team deliverd a 83-year-old patient complaining of inability of her right leg to support the body after falling on her right side. Objectively: the patient lies on a gurney, her right leg is rotated outwards, the outside edge of foot touches the bed. There is positive straight leg raising sign. What is your provisional diagnosis?

A 50-year-old patient complains of bursting pain in the left lower limb that is getting worse on exertion, swelling in the region of shin and foot. Objectively: left shin and foot are doughy, skin of the lower shin is indurated and has a bronze tint, subcutaneous veins are dilated, there is an ulcer with necrotic masses. What is the most likely diagnosis?

3 days ago a 29-year-old patient presented with pulsating pain in the region of rectum, fever, general weakness. Objectively: local tenderness in the anal region in the 6 o'clock position. Digital investigation of rectum revealed a painful infiltration reaching the pectinate line. What is

the most likely diagnosis?

A 65-year-old patient complains of gradual worsening of the left eye vision during 10 months. On physical examination: acuty of vision of the left eye is 0,01, not correctable. The eye is quiet, pupil of the eye is grayish, reflex from the eye-ground is absent. Intraocular pressure is 18 mm/Hg. What is the most probable preliminary diagnosis?

A 36 y.o. patient was admitted to the hospital with sharp pain in substernal area following occasional swallowing of a fish bone. On esophagoscopy the foreign body wasn't revealed. The pain increased and localized between scapulas. In a day temperature elevated, condition became worse, dysphagia intensified. What complication has developed?

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 post-operative treatment plan?

On the 4th day after recovering from a cold a patient was hospitalized with complaints of solitary spittings of mucoid sputum. On the 2nd day there was a single discharge of about 250 ml of purulent blood-streaked sputum. Objectively: the patient's condition is moderately severe.

Respiratory rate - 28-30/min, Ps- 96 bpm, AP- 110/70 mm Hg. Respiration above the left lung is vesicular, weak above the right lung. There are moist rales of different types above the lower lobe and amphoric breath near the angle of scapula. What is the most likely diagnosis?

A 24 y.o. male patient was transferred to the chest surgery department from general surgical department with acute post-traumatic empyema of pleura. On the X-ray: wide level horizontal of fluid on the right. What method of treatment should be prescribed?

A patient complains of intense pressing pain in the pharynx, mainly to the right, impossibility to swallow even liquid food. The illness started 5 days ago. The patient's condition is grave. Body temperature - 38,9^oC, speech is difficult, voice is constrained, difficulties in opening the mouth. Submaxillary glands to the right are painful, enlarged. What is the most probable diagnosis?

In a 65 y.o. female patient a tumor 13х8 сm in size in the umbilical area and above is palpated, mild tenderness on palpation, unmovable, pulsates. On ausculation: systolic murmur. What is the most probable diagnosis?

An hour before an elective surgery, a 56-year-old patient of the surgical department got a dramatic increase in blood pressure, tachycardia, hand tremor. The patient is confused,

anxious, depressed, fearful, is pessimistic about the operation outcome, refuses the surgery. What tactics should be chosen by a surgeon?

A patient with suspicion of pelvic bones fraction is under examination conducted by the doctor

who presses alae ilii in medial direction with his both hands. What causes painful syndrome of

the patient?

A 30-year-old man was injured in a fire and got thermic burns of III-A and III-B degree that affected 20% of the total skin. AP - 110/70 mm Hg, heart rate -120/min. What transfusion means should be used for blind infusion before transportation?

A 48-year-old male patient complains of pain in the lower extremities, especially when walking,

intermittent claudication, numbness in the fingers, cold extremities, inability to walk more than

100 meters. Sleeps with his leg lowered. The patient has been a smoker since he was 16,

abuses alcohol, has a history of CHD. The left lower extremity is colder than the right one, the

skin of extremities is dry, pedal pulse cannot be palpated, femoral pulse is preserved. What is

the most likely diagnosis?

A 24 y.o. woman consulted a doctor about continued fever, night sweating. She lost 7 kg within the last 3 months. She had casual sexual contacts. Objectively: enlargement of all lymph nodes, hepatolienal syndrome. Blood count: leukocytes - 2,2x10⁹/L. What disease can be suspected?

Development of chronic venous insufficiency of lower extremities depends on the functional condition of so-called musculovenous pump. This term refers to the following group of muscles:

A 27-year-old patient was brought to clinic with a crashed wound of the posterior surface of the right shin in 2 hours after the accident happened. During surgical treatment pieces of dirty clothes and gravel were removed. What actions from the given below are the decisive ones to

prevent an anaerobic infection?

A 32-year-old patient lives in an area endemic for echinococcosis. In the last 6 months he reports of pain in the right subcostal area, fever. He is suspected to have liver echinococcosis. What study would be the most informative in this case?

In morgue there are dead bodies with the following causes of death: electrotrauma; rupture of the spleen with acute anemia. There is one unknown person; one ethyl alcohol poisoned person and one drowned man. What dead body should the blood group be determined for?

A 50 y.o. patient was admitted to the hospital with complaints of blood in urine. There was no pain or urination disorders, hematuria has lasted for 3 days. Objectively: kidneys are not palpable, suprapubic region has no pecularities, external genitals have no pathology. Rectal

examination revealed: prevesical gland is not enlarged. Cytoscopy revealed no changes. What

disease would you think about first of all?

A patient complains of nycturia, constant boring pain in perineum and suprapubic region, weak urine jet, frequent, obstructed and painful urination. He has been ill for several months, pain in perineum appeared after getting problems with urination. Rectal examination revealed that prostate is enlarged (mostly owing to the right lobe), dense, asymmetric, its central sulcus is flattened, the right lobe is dense, painless, tuberous. What disease can it be?

The patient complains of a painful swelling in the chin region, malaise, headache. Examination reveals an acutely inflamed cone-shaped dense node. The skin over it is tense, red. In the center of the node there is an ulcer with overhanging edges and a necrotic core of a dirty-green

colour. Submandibular lymph nodes on the right are enlarged and painful. What is the most likely

diagnosis?

On the 5th day after a surgery for colon injury a patient complains of bursting pain in the

postoperative wound, weakness, drowsiness, headache, fever up to 40^oC. Objectively: the

skin around the wound is swollen, there is gas crepitation. The wound discharges are scarce

foul-smelling, of dark-gray colorl. What is the most likely diagnosis?

A children's surgical unit admitted a 1-month-old boy who had been prenatally diagnosed with the left-sided pyelectasis. Such studies as drip infusion urography, cystography and USI allowed to reveal initial ydronephrosis. There is no information confirming the secondary pyelonephritis. What tactics of this patient management is most advisable?

A 60 y.o. man complains of significant pain in the right eye, photophobia, lacrimation, reduced vision of this eye, headache of the right part of the head. Pain occured 2 days ago. On examination: Vis OD- 0,03, congested injection of the eye ball, significant cornea edema, front chamber is deep, pupil is narrow, athrophic iris, there is optic nerve excavation on the eye fundus, intraocular pressure- 38 mm Hg. Vis OS- 0,8 unadjustable. The eye is calm, healthy.

Intraoccular pressure- 22 mm Hg. What is the most probable diagnosis?

A 54-year-old female patient has been admitted to a hospital 12 days after the beginning of acute pancreatitis. Objectively: the patient is in grave condition. The body temperature is hectic. Ps - 112 bpm. The abdomen is swollen. Epigastrium palpation reveals a very painful infiltration falling in the localization of pancreas. Abdominal cavity contains fluid. There is an edema of the left lumbar region. In blood: WBCs – 18x10⁹/l. What is the required tactics of the patient's treatment?

A 37-year-old male patient has a histrory of diabetes of moderate severity. On the left side of face the patient has a carbuncle. What severe complication might have occurred in the patient?

To replace the blood loss replacement 1000 ml of the same group of Rhesus-compatible donated blood was transfused to the patient. The blood was conserved by sodium citrate. At the end of hemotransfusion there appeared excitement, pale skin, tachycardia, muscles cramps in the patient. What complication should be suspected?

A 20 y.o. patient suddely felt ill 12 hours ago. There was pain in epigactric area, nausea, sporadic vomiting. He had taken alcohol before. In few hours the pain localized in the right iliac area. On examination: positive rebound tenderness symptoms. WBC- 12,2x10⁹/L. What is the most probable diagnosis?

A patient, aged 58, was fishing in the winter. On return home after some time felt some pain in the feet. Consulted a doctor. On examination: feet skin was pale, then after rewarming became red, warm to the touch. Edema is not significant, limited to the toes. All types of sensitivity are preserved. No blisters. What degree of frostbite is observed?

After an accident a patient complains of pain in the hip joint. Objectively: the leg is in the position of flexion, adduction and internal rotation, significantly contracted. There is elastic resistance to passive adduction or abduction of the extremity. Major trochanter is located high above the

Roser-Nelaton line. A significant lordosis is present. What is your provisional diagnosis?

Three weeks after acute angina the patient is still weak, inert, subfebrile, his retromaxillary lymph nodes are enlarged. Tonsils are flabby, stick together with arches, there are purulent plugs in lacunae. What is the most probable diagnosis?

A 43 year old patient had right-sided deep vein thrombosis of iliofemoral segment 3 years ago. Now he is suffering from the sense of heaviness, edema of the lower right extremity. Objectively: moderate edema of shin, brown induration of skin in the lower third of shin, varix dilatation of superficial shin veins are present. What is the most probable diagnosis?

A child undergoes in-patient treatment for acute staphylococcal destruction of the right lung.

Unexpectedly he develped acute chest pain on the right, dyspnea, cyanosis. The right side of

chest lags behind in the respiratory act. Percussion reveals dullness in the lower parts on the

right, bandbox resonance in the upper parts. Borders of the relative cardiac dullness are shifted

to the left. What complication has most likely developed?

A 98 y.o. male patient complains of pain in the left lower limb which intensifies on walking, feeling of cold and numbness in both feet. He has been ill for 6 years. On examination: pale dry skin, hyperkeratosis. Hairy covering is poorly developed on the left shin. "Furrow symptom " is

positive on the left. Pulse on foot arteries and popliteal artery isn't palpated, on the femoral artery it's weak. On the right limb the artery pulsation is reserved. What is the most probable diagnosis?

Examination of a dead man who died from hanging revealed that cadaver spots disappeared when pressed upon and restored after 50 seconds, rigor mortis was moderately expressed only in the masticatory muscles and the muscles of neck and fingers. Body temperature was 31^oC. Specify the time of death:

Examination of the corpse of a man who died from hanging reveals: death spots disappear when pressed upon and restore after 50 seconds, rigor mortis is moderately expressed only in the masticatory muscles as well as neck and finger muscles, body temperature is of 31^oC. The time of death:

After contusion of the right eye a patient complains of sudden loss of vision with remaining light perception. Objectively: the eye is not irritated. The cornea is transparent. Pupil reacts to light. The pupil area is black. The fundus reflex is absent. What is the most likely cause of vision loss?

A 65-year-old patient complains of pain in the lumbar spine, moderate disuria. He has been suffering from these presentations for about half a year. Prostate volume is 45 cm³ (there are hypoechogenic nodes in both lobes, capsule invasion). The rate of prostate-specific antigen is 60 ng/l. Prostate biopsy revealed an adenocarcinoma. Which of the supplemental examination methods will allow to determine the stage of neoplastic process in this patient?

X-ray picture of chest shows a density and an abrupt decrease in the upper lobe of the right lung. The middle and lower lobe of the right lung exhibit significant pneumatization. The right pulmonary hilum comes up to the dense lobe. In the upper and middle parts of the left pulmonary field there are multiple focal shadows. In the basal region of the left pulmonary field there are clear outlines of two annular shadows with quite thick and irregular walls. What disease is this

X-ray pattern typical for?

A patient complains of impaired far vision. Previously his eyes often turned red and hurt. Objectively: the eyes are not irritated, the cornea is transparent, anterior chambers are median deep, their liquid is transparent. The iris of the right eye has not changed in colour, its pattern is unchanged. The pupil is of irregular shape, scalloped. Biomicroscopy of the crystalline lens reveals the areas of opacity and vacuoles. Make a diagnosis:

A 26-year-old patient complains of experiencing pain in the right hand for 4 days. The pain arose at the site of corns on the palmar surface at the base of the II and III fingers. Some time later the dorsum of hand became edematic. I and III fingers are half-bent in the interphalangeal joints, the hand looks like "rake". What is the most likely diagnosis?

A 30-year-old patient had deep burn covering 30% of body 30 days ago. Now he presents with continued fever, loss of appetite, night sweats. Burned surface weakly granulates. What is the stage of burn disease?

A 29 y.o. patient was admitted to the hospital with acute girdle pain in epigastric area, vomiting in 1 hour after the meal. On examination: pale, acrocyanosis. Breathing is frequent, shallow. Abdominal muscles are tensed, positive Schotkin-Blumberg's symptom. What is the maximal term to make a diagnosis?

A surgeon examined a 42-year-old patient and diagnosed him with right forearm furuncle at the purulo-necrotic stage. The furuncle was lanced. At the hydration stage the wound dressing should enclose the following medication:

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: 2,8x1012/l, Hb - 90 g/l, Ht - 0,38, thrombocytes – 30x109/l. The patient is being prepared for splenectomy. What transfusion medium should be chosen in the first place for the preoperational preparation?

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?

A 36-year-old man was delivered to the surgical department an hour after a road accident. His

condition is getting worse: respiratory insufficiency is progressing, there are cardiac

abnormalities. Clinical and roentgenological investigations revealed mediastinal displacement.

What process has caused this complication?

A victim of the car crash was brought to neurosurgery due to craniocerebral trauma. During examination symptoms of focused injury of the cerebrum are found, cerebrum contusion is suspected. What method of examination is to be used?

A 35 y.o. female patient was admitted to the surgical department with symptoms of ulcerative gastric hemorrhage. It's been the third hemorrhage for the last 2 years. After conservative treatment vomiting with blood stopped, hemoglobin elevated from 60 till 108 g/L. General

condition became better. But profuse vomiting with blood reoccured in 2-3- hours. Hemoglobin decreased to 93,1 g/L then to 58,1 g/L. What is the tactics of treatment?

A 39-year-old patient complains of a tumour on the anterior surface of her neck. The tumour has been observed for 2 years. It is nonmobile and has enlarged recently. The patient has a changed tone of voice, a sense of pressure. Objectively: in the left lobe of the thyroid gland a 3 cm node is palpable; it is very dense, tuberous, painless. Cervical lymph nodes are enlarged. Functional status of the thyroid gland is unchanged. What is the most likely diagnosis?

An unconscious victim in severe condition is brought to clinic. It is known that the patient touched the bare wire with his hand and during 5 minutes was under the influence of an alternating current with voltage of 220 V. Physical exam: skin is pale, cold by touch. Breath is weakened, BP - 90/50 mm Hg, Ps - 60 bpm, arrhythmical. There are fields of necrosis of the skin on the right hand and on the right foot. What is the preliminary diagnosis?

A 47-year-old patient complains about cough with purulent sputum, pain in the lower part of the left chest, periodical body temperature rise. She has been suffering from these presentations for about 10 years. Objectively: "drumstick" distal phalanges. What examination would be the

most informative for making a diagnosis?

Blood typing resulted in positive isohemagglutination reaction with standard sera of A(II) and

B(III) groups and negative reaction with sera of 0(I) and AB(IV) groups. What is this result

indicative of?

A victim of a road accident, aged 44, is operated on account of intraperitoneal haemorrhage. In which case can the patient's blood from the abdominal cavity be used for autotransfusion?

A man with a stab-wound of the right foot applied to doctor. He stepped on the board with nail two hours ago. In the patient medical chart it is stated that 3 years ago he passed the whole course of vaccination against tetanus. What is the tactics of doctor to prevent tetanus in this case?

A 42-year-old patient with acute haemorrhage and class III blood loss underwent blood transfusion and got 1,8 l of preserved blood and erythromass of the same group and Rh. After the transfusion the patient complained of unpleasant retrosternal sensations, his arterial pressure dropped to 100/60 mm Hg, there appeared convulsions. Blood serum calcium was at the rate of 1,7 millimole/liter. What is the mechanism of this complication development?

A 40-year-old woman with acute gastrointestinal hemorrhage was transfused 400 ml of the preserved blood after having conducted all compatibility tests. After hemotransfusion the condition of the patient became worse. She started having headache, muscles pain, her temperature has risen up to 38,8^oC. What is the reason for such condition of the patient?

A 27-year-old patient with a knife stomach wound has been delivered to a hospital 4 hours after injury. Objectively: the patient is in grave condition. Ps- 120 bpm, weak. AP- 70/40 mm Hg. Laparotomy revealed a lot of liquid blood in the abdominal cavity. The patient has been found to have bleeding from the mesenteric vessels of the small intestine. Damage to hollow organs has not been revealed. What is the best way to restore the blood loss?

A patient presented to a hospital with a carbuncle of the upper lip. The body temperature is 39^oC. There is a pronounced edema of the upper lip and eyelids. What is the surgeon's tactics of choice?

A patient, aged 25, suffering from stomach ulcer. Had a course of treatment in the gastroenterological unit. 2 weeks later developed constant pain, increasing and resistant to

medication. The abdomen is painful in epigastric area, moderate defence in pyloroduodenal area. Which complication development aggravated the patient's state?

A 62-year-old male patient complains of intense pain in the left leg that suddenly arose three hours before, leg numbness and coldness. During the year there has been pain in the leg while walking, hypersensitivity to cooling. Objectively: the left foot and shin have marbled skin,

subcutaneous veins are collapsed. The foot is cold, active movements of the foot and toes are preserved. Pulse is present only on the femoral artery. There is rough systolic murmur above the artery. Make a provisional diagnosis:

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 tretment tactics?