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1.

You are a doctor on duty. A patient after a successful resuscitation (drowning) was delivered to an admission room. BP is 90/60 mm Hg, heart rate is 120/min., respiration rate i26/min. The patient is unconscious,  pupils are moderately dilated,  general  clonic and  toniconvulsions are observed. Make the diagnosis:

2.

32-year-old  welder  complains  of weaknesand fever. His illness initially presented as tonsillitis one month  earlier.  On examination: BT- 38, 9o C , RR-  24/min., HR-100/min.,  BP-  100/70 mm  Hg,  hemorrhages on the legs, enlargement of the lymph nodesCBC  shows  Hb-  70  g/l,  RBC-  2, 2 · 1012 /l, WBC-  3, 0 · 109 /l with 32%  of blasts,  1%  of eosinophiles, 3% of bands, 36% of segments20of lymphocytes,  an8%  of monocytes, ESR-   47  mm/hour What   is  the   cause   of anemia?

3. A  regional  cardiologist  is tasked  with the development of a plan for medioprophylactic measures aimed at decrease of cardiovascular mortality.  What  measures should  be planned for secondary prevention?
4. A  woman  complains  of muscle  weakness and   genera fatigue dyspnea vertigo brittlenes of  her  hair  and  nails,  an  urge  to eat  chalk.  Anamnesis states  uterine fibroid. Commo blood  analysis:  erythrocytes -  2,8  

Т/l, Hb- 80 g/l, color index - 0,78, anisocytosispoikilocythemia,  seru iron  -  10  mcmol/l.What diagnosis is most likely?

5.

A 24-year-old patient visited a doctor complaining  of enlargement of his submaxillar lymp nodes Objectively:    submaxillary axillar an inguina lymp nodes are enlarged. Chest X-ray shows: enlarged lymph nodes of mediastinum. Blood test: erythrocytes - 3, 4 · 1012 /l, Hb- 100 g/l, blood colour  index  -  0,88,  platelets  -  190 · 109 /l, leucocytes - 7, 5·109 /l, eosinophiles - 8%, band neutrophiles - 2%,  segmented neutrophiles - 67%, lymphocytes  - 23%, ESR-  22 mm/hour. What  test  must  be  prescribed to  verify  the

cause of lymphadenopathy?
6. An 8-year-old boy developed a temperature of 37, 5o C  two  days  after  his recovery  from the case of URTI. He complains  of suffocation, heart  painObjectively:  the  skin is pale, tachycardia, the  I heart  sound  is weakened, short  systolyc murmur in th4th intercostal area  near  the  left  edge  othe  breastbone. What  heart  disorder succlincal presentation is characteristic of?
7. A 32 year old patient complains  of cardiac irregularities, dizziness,  dyspnea  aphysical exertion. He has never suffered from such condition before.  Objectively:  Ps- 74/min., rhythmic BP-  130/80  mm  Hg.  Auscultation  revealed  systolic  murmur  above   aorta, th first   hear soun wa normal ECG showed  hypertrophy of thleft ventricle,  signs of repolarization disturbance in the I , V5 and  V6  leadsEchocardiogram revealed that interventricular septum  was 2 cm. What is the most probable diagnosis?
8. A 35-year-old patients wound with suppurative  focu was   surgicall cleaned. On  th8th day after  the  surgerthe  wound cleared  froits purulo-necrotic content and granulations appeared. However, against  the bacground of antibacterial therapy thbody temperature keeps  at 38,5-39,5oC . There  are chills, excessive sweating, euphoria, heart rate is 120/min. Whacomplication of local pyoinflammatory process can it be?
9. A  60-year-ol woma has  bee sufferinfrom  arterial hypertension for  15 years. After  recurrent stroke  she started complaining of unmotivated bad mood,  problems with attention concentration; shforgets  to  close the  entrancdoor,  canno recall  event of the  past  day.  Computetomography shows areas of postinfarction changes in the cortical postfrontal areasWhat  is the most probable diagnosis?
10. Clinic of a research instutute for occupational diseases  examined  a worker  who works at  a concentration plant  and  diagnosed him with chronic dust bronchitis. The case is investigated by  a  commission  including  the representatives  of:  the   plant clinic,  local SES,  department oSocial  Insurance Fund, trade  unionAccording to the regulation on investigation of. . . , the commission should be headed by the representative of the following authority:
11. A 37-year-old woman complains of headaches,  nausea vomiting spasms.   The onset  of the disease  occurred  thday before due  to  her  overexposurto  cold.  Objectively:  fever  up  to  40o C ;  somnolence;  rigid neck;  Kernigs  symptom   is  positive  on  the both sides; generahyperesthesia. Blood test: leucocytosis,   increase ESR.   Cerebrospinal fluid is turbidyellow-tinted. What changes of the cerebrospinal fluid are most likely?
12. A  48-year-old  woman  complains  of pain i th thoraci spine sensitivit disorder in  the  lower  body,  disrupted moto function  of  th lowe limbs,  body   temperature rise  up  to  37, 5o C .  She  has  been  suffering from  this  condition for  3  years.  Treatment by various specialists was ineffective. X-ray reveals  destruction  of  adjacensurfaces  of the VIII and IX vertebral bodies. In the right paravertebral area at the level of lesion there is an additional soft tissushadow.  What  diagnosis is most likely?
13. A pregnant woman is 28 years old. Anamnesis: accelerated labor complicated by the  II  degree  cervical  rupture. The  following two  pregnancies resulted in spontaneous abortions at  the  terms  of 12 and  14 weeks. On  mirro examination:  the  uterine cervix is scarred  froprevious  ruptures at 9 and  3 hours,  the  cervicacanal  is gaping.  On  vaginal examination: thcervix is 2 cm long, the externaorifice is open 1 cm wide, the internal orifice is half-open;  thuterus  is enlarged to the 12th week of pregnancysoft, mobile, painless,  the  appendages are  without   changes. What diagnosis would you make?
14.

A 56-year-old patient complains of pain in thepigastrium after  eating,  eructation, loss of  appetite, slight  losof  weight,  fatigability. The  patient smokesno excessive alcohol consumption. Objectively:  pale  mucosa,  BP-110/70 mm  Hg.  The  tongue   is  lacquered. The  abdomen is  soft,  sensitive  in  the  epigastric area. Blood test: erythrocytes - 3,0 T/l, Hb-  110 g/l, coloindex  - 1,1; macrocytosis; leukocytes  - 5,5 g/l, ESR-  13 mm/hour On fibrogastroduodenoscopy: atrophy   of  fundic mucosa. What pathogenesis does this disorder have?

15.

A 26-year-olsecundipara at 40 weeks of gestation   arrived  at  a  maternity ward  after the  beginning  of  labor  activity.  The  bursting  of  water occurred  2  hour prior.   The fetus  was in a longitudinal lie witcephalic presentation. Abdominal circumference was 10cm,  fundal  height  -  42  cm.  Contractions  occurre every  4-5 minute and  laste25 seconds each. Internal obstetric examination revealed cervical effacement, opening by 4cm. Fetal bladder was absent.  Fetal head was pressed against the pelvic inlet. What complication arose in the childbirth?

 
16. Bacterial analysis of air in a living space in winter period by means of Krotovs apparatus revealed that total number of microorganisms in 1 m3  of air was 7200. Whais the allowed number of microorganisms for the  aito  be characterized as ”pure?
17. A    24-year-old     patient    received     a puncture injury below the Pouparts ligament accompanied by intense arterial bleeding. The best method  to temporarily stop the bleeding in the patient would be:
18. A 42-year-old  womahas beehospitalized  with  complaints  of intense  pain  attacks in  the  lumbar   and  right  iliac  areas,  which irradiate to the vulvar lips, frequent urination, nausea.  The  pain  onset  waacute.  Objectively:  the  abdomen isoft,  moderately painful in the right subcostal area, costovertebral angltenderness on the  rightCommon  urinanalysis: specific gravity  - 1016, traces  of protein, leukocytes  - 6-8 in the  vision  field, erythrocytes - 12-16 in the vision field, fresh. What diagnosis can be made?
19. A    29-year-old    patien works    a a motor  mechanic.  Anamnesis shows frequent exposure to cold, exacerbation of chronic bronchitis  attended  by  coug with   relativly small  amount   omucopurulent sputum, subfebrility,  sometimes joineby hemoptysis and pain in the right side of chest. Breathing is vesicular.  X-ray  shows shadows  ansharp decrease in size of the lower lobe distinctly visible on the X-ray image as a streak 2-3 cm wide situated at the angle from lung root to the frontal  costodiaphragmatic recessThe  most likely diagnosis is:
20. A 62-year-old  patient has beehospitalized  with  complaint of  pain  in  the  thorax othe  right  during  breathing, dyspnea,  dry cough. Ten days ago he slipped  and fell hitting his right  side.  On  examintaion: the  patient lies on the left side. The right side of the thora lags  during  breathing.  On  the  right there are crepitation and pain in the III-IV ribs. Dullnesof percussion  sound and sharply diminished   breath sounds  can  be  observed. On X-ray: signs of exudate, fracture of the III- IV ribs. On pleurocentesis: blood is detected. Choose the further tactics:
21.

A 29-year-old female patient complains of dyspnea,  heaviness  anchest pain  on the  right, body temperature rise up to 37, 2o C . The disease is associated with a chest trauma received 4 days ago. Objectively:  skin is pale and moist.  Ps- 90/min., regular.  Palpation reveals a dull sound on the right, auscultation reveals significantly   weakened  vesicula breathing. In  blood:  RBCs-  2, 8 · 1012 /l, colour  index  0,9, Hb-  100 g/l, WBCs-  8, 0 · 109 /l, ESR-  17 mm/hour.  What results of diagnostic puncture of the pleural cavity can be expected?

22. Cariemorbidity rate  is 89% among residents  of a community. Iis determined that fluorine  content in  water  is 0,1 mg/lWhat preventive measures should be taken?
23.

Examination of a grouof persons  living on the  samterritory revealed the  following common  symptomsdark-yellow  pigmentation of the  tooth  enamel,  diffuse  osteoporosis of bone  apparatus, ossification  oligaments and joints, functional disorders of the central nervous system. This condition may be caused by the excessive concentration of the following microelement in food or drinking water:

 
24. In a pre-school educational establishment the menu consists of the following dishes: milk porridge from buckwheat, pastwith minced meat, cucumber salad, kissel (thin berry jelly), rye bread. What dish should be excluded from the menu?
25.

An infant has been born at the 41st week of gestation.  The pregnancwas complicated witsevere  gestosis  of the  second  semester. The weight of the baby is 2400 g, the height i50 cm. Objectively: the skin is flabby, the layer of  subcutaneous fat  is  thin,  hypomyotonia, neonatal  reflexe ar weak Th internal organs  are  without  pathologic changes.  Thinewborn can be estimated as a:

26. A    patien suffering    from    infiltrative pulmonary tuberculosis was prescribed streptomycin, rifampicin,  isoniazid, pyrazinamidevitamin C. One month  after the beginning  othe  treatment the  patient started complaining  of reduced hearing  and tinnitus. What drug has such a side effect?
27.

A womahas developed sudden  thoracic pain  on  the  right  with  expectoration of  pink sputum  and  body  temperature rise up t37, 7o C  on  the  4tday after  the  surgery  for cystoma of the right ovary. On lung examination: dullness  of the  lung sound  on the  lower right is observed. Isolated moist crackles can be auscultated in the same area. What complication is the most likely?

28. A 58-year-old  patient was delivered to an admission room with complaints  of pain in the thorax  on  the  left.  On  clinical  examination: aside  from  tachycardia (102/min.)  nother changes.  On  ECG:  pathologic wave  Q  in I, аVL, QS in V1, V2, V3 leads and domed’ ST elevation with negative  T. What  diagnosiis most likely?
29. A 48-year-old  woman  has thermal burns oboth  hands.  The  epidermis  of  the  palms and backs of her hands is exfoliatingand blisters filled with serous liquid are forming. The forearms arintact.  What  diagnosis  is most likely?
30. A 39-year-old patient complains of morning headache, appetite loss, nausea,  morning vomiting,  periodic  nasahaemorrhages. The patient had a case of acutglomerulonephritis at the age of 15. Examination revealed rise of arterial pressure up to 220/130 mm Hg, skin haemorrhages on his arms and legs, palloof skin and mucous membranes. What biochemical parameter is mosimportant for making diagnosis in this case?
31. A     30-year-old     patient,    who     has been suffering from headaches, suddenly developed extreme headache after  lifting  a heavy  load,  aif he  had  been  hit  over  the head Nausea vomiting an slight   dizziness are observed. In a day he developed pronounced meningeal   syndrome and  body temperature up to 37, 6o C . A doctor  suspects subarachnoid hemorrhage.  What   additional examination is necessary  tconfirm  thidiagnosis?
32.

A worker  of a blowing shop complainof headache, irritability,   sight  impairment - he sees everything  as if through  a ”net.  Objectively: hyperemic sclera, thickened cornea, decreased opacity  of  pupils,  visual  acuity  i0,8 in the  lefeye, 0,7 in the  right  eye. The worker uses no means of personal protection. What diagnosis is most likely?

33. A 45-year-old woman is undergoing treatment foactive  rheumatism, combined mitral valve failure. During her morning procedures shsuddenly  sensed  pain  in the left handwhich was followed  by numbness. Pain  and  numbness continued taggravate. Objectively:  thskin of thleft hand  is pale and comparatively cold. Pulse in the hand arteries  is  absen along  the   whole  length. What treatment tactics is most efficient?
34. A 10-year-old boy had a case of viral hepatitis type B four years ago. Currently the assumption was made abouthe formation of hepatic  cirrhosis  in thpatient. What  additional investigation can clarify the diagnosis?
35. A  40-year-ol patient  has  acut onset odisease  caused  boverexposure to  cold. Temperature  ha increased    u t 39o C . Foul-smellin sputum   is  expectorated during coughig. Various moist crackles can be auscultated abovthe 3rd segment  on the right. Blood test: leukocytes  - 15, 0 · 109 /l, stab neutrophils - 12%, ESR-  52 mm/hour.  On X- ray: in the 3rd segmenon the right there  is a focus of shadow 3 cm in diameter, low density, with fuzzy smooth  margins  and  a clearing  in its center.  What  disease  is moslikely in the given case?
36. An  electro-gas   welding  operator working at a machinworkshop performs welding and  cutting  of metal,  which  is accompanied by intense  UV-radiation. His welding station is equipped witefficient  mechanical ventilation Wha occupational  disease   is  most likely  to  develop  in  an  electro-ga weldinoperator?
37.

A 48-year-old  patient was founto have diffuse enlargement of the thyroid  gland, exophthalmia, weight loss of 4 kg in 2 months, sweating Objectively HR 105/min. BP - 140/70  mm  Hg.  Defecation  act  is  normal. What kind of therapy is recommended in thicase?

38. A womaaddressed a doctor  with complaints  of increased  body temperature up to 37, 8o C and moderately sore throat for the last  3 days.  Objectively mandibulalymph nodes are enlarged up to 3 cm. Palatine tonsils are hypertrophied, coverewith grey coating that  spreads  to the uvula and anterior pillars of the fauces. What diagnosis is most likely?
39. A 48-year-olman complainof constant pain  ithe  upper  abdomen, predominantly on the left, which aggravates after eating, diarrhea,  loss  of  weight.   Th patient  has alcohol  use  disorder. Two  years  ago  he  had a  case  of acute  pancreatitis. Blood  amylase is 4 g/hour·l. Feces analysis: steatorrhea, creatorrhea. Blood sugar is 6,0 mmol/l. What treatment should be prescribed?
40. In  10  hours  after  eating  canned mushrooms  a  27-year-ol patienhas develope diplopia,    bilatera ptosis,    disrupted swallowingshallow  breathing with respiratory rate 40/min., muscle weakness, enteroparesis. What measure should be taken first?
41. A 32-year-old patient complains of reddening, burning, and sensatioof a foreign body in the right eye. The disease is acute. On examination: visual  acuity  of  the  both  eyes is 1,0. In  the  right  eythere  are  hyperemy and  swelling  othe  conjunctiva, superficial injection.  There  is purulent discharge  in the conjunctival sac. The cornea is clear. The color and pattern of the iris are uncanged,  the pupil is mobile. What diagnosis is most likely?
42. A patient is on the sick leave for 4 months continuously from the date of injury. The treatment is going to last for another 1-2 months Who  has  the  right  to  extend   the duration of medical  certificate  for  thipatient?
43.

Monthly dysentery morbidity in the region given in absolute figures is as follows: January - 6; February - 9; March - 11; April - 10; May - 16; June - 23; July - 19; August - 33; September - 58; October - 19; November - 11; December - 5. Annual total  is 220 cases. What  graphipresentation would provide the best visual for

monthl deviations  of  dysentery  morbiditfrom the average?

44. A  30-year-old  woman  complains  of pain in  the  hear area  (”aching,   piercing  pain) that  arises primarily  in the morning  hourin autumn and  springPain  irradiates into  the neck, back, abdomen and is attended by rapid heart  ratand low vital tonus. This condition occurs  independentlfrom  physical  exertionIn  the  evening  her  condition improves. Somatiand neurologic  state  and ECG  have npathologies. What  pathology is likely  to result in such clinical presentation?
45.  full  ter bab bor fro th 1st noncomplicated pregnancy with complicatelabowas diagnosed with cephalohematoma. On  the  2nd  day  of life the  childeveloped jaundice; on the 3rd day of life there appeared neurological changes: nystagmus,  Graefe syndrome. Urine  is yellow, feces argolden- yellowThe  mothers  blood  group  is А  (II) Rh, the  childs - А  (II)  Rh+.  On  the  3rd day the results of the childs blood test are as follows: Hb- 200 g/l, erythrocytes - 6, 1 · 1012 /l, bloo bilirubi -  58  mcmol/ du to   the presence of its unconjugated fraction, Ht- 0,57. In this case the jaundice is caused by:
46.

On  the  4th  daafter  recovering  from  a cold a patient was hospitalized with complaints  osolitary  spittings  of  mucoid  sputum. On  the  2nd day there  was a single discharge of about  250 ml of purulent blood-streaked sputum Objectively the   patients  condition  is moderately severe.  Respiratory rate  28-30/min., Ps- 96/min., BP110/70 mHg. Respiration above  the  left  lung  is vesicularweak  above  the  right  lungThere  are  various moist crackleabove  the lower lobe and amphoric  breath near  the  angle  of  scapula. What is the most likely diagnosis?

47.  46-year-ol patient  with   temporarily undetermined diagnosis was prescribed pleurocentesis based  on the resultof the X- ray. The puncture yielded 1000 ml of a liquid witthe  following  properties: clear,  specific gravity - 1,010, protein content - 1%, Rivaltas test is negative,  erythrocytes - 2-3 in the field of vision. What  disorder are thespathologic changes characteristic of?
48. A 14-year-old girl has been presenting with irritability  and tearfulness for about  a year. A year ago she was also found to have diffuse enlargement of the  thyroid  glan(II  grade). This  condition waregarded as  a  pubertal manifestation, the  girl dinot  undergo  any treatment. The girls irritability  gradually gave place to a complete apathy. The girl developed puffy face, soft tissues pastositybradycardia, constipations. Skipallor  and  gland  density progressed, the skin developed a waxen hue. What disease can be suspected?
49.

In  a  maternity hospital  newborn had been presenting with cough attacks  after eating. The child was discharged from the hospital on the 18th day due to a case of pneumonia. During  the  further 1,5 months  the  child ha2 cases of pneumonia. Periodically  there  are cough  attacks  after  eating,  especially  if the child lies on the  left side. Objectively:  the  II degree   hypotrophy, isolated   moist  crackles, dyspnea. Stool and diuresis are not disrupted. What diagnosis is most likely?

50.  26-year-ol woman wh gave   birth  7 months  ago,  habeen  suffering  from nausea mornin sickness,   somnolence  for the  last 2 weeks.  The  patient breasfeeds; no menstruation. She has been using no means of contraception. What  method  woulbe most efficient in clarification of the diagnosis?
51. A  2-year-old  girl  has  a  medical  history orecurrent  obstructive pneumonia. In  the lungs  variou moist   an dry  crackle can be  auscultatedbreath  sound ar diminished.  Sputum  is thick,  viscous  and  difficult to expectorate. Drumstick fingers anphysical developmental retardation are  observed. What preliminary diagnosis can be made?
52. After  a case of purulent otitis a 1-year-old boy has developed pains in the upper third of the  left thigh, body temperature up to 39o C . Objectivelyswelling of the thigh in its upper third  and smoothed out inguinafold. The limb is in semiflexed position. Active and passive movements are  impossible  due  tsevere pain. What diagnosis is most likely?
53.

A  56-year-old  patient with  diffuse  toxic goiter has ciliary arrhythmia, heart rate is 110-120/min., arterial hypertension, BP is 165/90mm Hg. What  drug besides  Mercazolil  (Thiamazole) should be prescribed in this case?

54.  patient  has   bee provisionall diagnosed with pheochromocytoma at the stage of intermission. BP  is within  norm,  there  is a tendency towards  tachycardia. No urine pathologies. Thdecision  has been  made  to perform a  provocativtest  with  histamine. What  drushould  be kept  close at hand  for emergency aid in case of positive test result?
55. A 54-year-old patient complains of weakness,  weight loss despite  the unchanged appetite, frequent urination, skin itch for six months. Some time ago the patient underwent treatment for furunculosis.  She has not been examine recently.   Objectively malnutrition, dry skin with scratch marks. Small lymph nodes can be palpated in the axillary regions. Changes  in  the  internal   organs  are  absenr. What   test  must  be  performed  in  the  first place?
56. A child is 1 month  10 days old. Gushingvomiting has been observesince the age of 3 weeks. The vomit volume exceeds the volume of the previous  feeding.  Objectively:  the chi- lis inert.  Skin  elasticity  and  tissue  turgor are  decreased. Hour-glass   deformit sign  is positive.  The preliminary diagnosiis pyloric stenosis.  What   treatment tactics  should   be chosen?
57. 46-year-old  woman  complains  of pain attackin the right lumbar  area, which irradiat to   th lowe abdomen,  an nausea. This  kind  of  pain  attack has  never   been detected  in  the   patient  before Survey  X- ray of the abdominal cavity reveals no pathologic shadows.  Ultrasonic scan  detecta hyperechogenic growth  1,5 cm in diameter, which reflects sound wave, in the enlarged right renal pelvis. What diagnosis is most likely?
58. Severahours  before,  a 28-year-old  patiensuddenly  developed acute  headache and repeated vomiting,  then  losconsciousness. Objectively:    foca neurological   symptoms were not found. Pronounced meningeal symptom were   revealed.  BP-  120/80  mm Hg.  Accordinto  clinical  and  liquorological  findings  the  patient  was  diagnosed  with  subarachnoid haemorrhageAfte administration of dehydrants thpatients condition  somewhat  improved. What  is thmain component of further emergency  care?
59. A 24-year-old man has developed increasing headaches, vertigo, diplopia,  paresis of the facial muscles on the right, choking during swallowing.  The  signappeared on  the  5th day of respiratory disorder.  He was diagnosed witacute  viral encephalitis. Determine the main direction of emergency  therapy:
60. A  23-year-old  woman,  who  works  as  a miland  dairy  inspector,  after  the  miscarriage  suffers  from  high  fever  up  to  38, 6o C , recurring chills, excessivsweating.  Objectively: polyadenitis, pain in the lumbosacral spine,  swollen  lefknee  joint,  enlarged liver and spleen. What diagnosis is most likely?
61. A 16-year-old  adolescent has been  hospitalized with complaints of unceasing nasal hemorrhage and  unbearable pain  in  his  right  elbow  joint.  Objectively:  the  large  joint is  enlarged  and  defigurated,  the  skin  over the joint is hyperemic. Arthropathy signs can be  observed  in the  other  joints.  Ps- 90/min. Blood test: erythrocytes - 3, 9 · 1012 /l, Нb- 130 g/l, color  index  - 1,0, leukocytes  - 5, 6 · 109 /l, platelets  -  220  ·  109 /l,  ESR-   6  mm/hour. Lee-White coagulation time:  start-  24\\\' , end- 27\\\' 10\\\'\\\'  . What  drug would be most efficient in the treatment of this patient?
62.

A 67-year-old  macomplains  of dyspnea on exertion,  attacks  of retrosternal paindizziness. He has no history of rheumatism. Objectively: pale skin, acrocyanosis. There are crackles  in thlower  lungs. There  is systolic thrill  ithe  II  intercostal space  on  the  right, coarse systolic murmur conducted to the vessels of neck. BP- 130/90 mm Hg, heart rat- 90/min., regular  rhythm.  The liver extends  5 cm from  under  the  edge  of costal  arch,  shiedema are  present. Specify  the  suspected valvular defect:

63.

A  24-year-ol female   teacher  complains  of  dizziness  an hear pai irradiating t th left   nipple Pai is  no associated with  physical  activity   an canno be  relieved  by  nitroglycerin,  it  abate after   takinValocordin and  lasts  an  hour  or  more. The  patient has  a  nearly  2-year  history  of this  disease Objectively Ps-  76/min.,  BP- 110/70 mm  Hg.  Hearborders are  normal, heart sounds are clear. The ECshows respiratory  arrhythmia. Radiograph of thcervicothoracic  spine reveals no pathology. Lungs, abdomen are unremarkable. What changes in blood formula can be expected?

64. A 51-year-old female patient complains of frequent defecation and liquid blood-streaked stools with mucus admixtures, diffuse pain in the  inferolateral abdomen, 6 kg weighloss within the previoumonth.  Objectively:  body temperature - 37, 4o C , malnutrition, skin  is pale and dry. Abdomen is soft, sigmoid is painful and spasmodic, makes a rumblinsound. Liver  is dense,  painful,  extends  3 cm below the costal margin. Whais the most likely diagnosis?
65.

Chief  physician  of a polyclinic charged  district  doctor  with  a task  tdetermine the pathological prevalence of  disease  N  ihis district.  What  document allowto  estimate the disease prevalence in the population of a medical district?

66.

A 32-year-old woman complainof dizziness,  headachepalpitation,  tremor.  For the last several months she has been under outpatient  observation for  increased   arterial pressure. Since recently  such attacks  have become  more  frequent ansevere.  Objectively: thskin is covered  with clammy sweat, tremor  of  the  extremities  is  present.  HR- 110/min., BP- 220/140 mm Hg. Heart sounds are  muffled.  Blood  test  results:  WBCs-  9, 8 · 109 /l, ESR-  22 mm/hour.  Blood  glucose - 9,8 millimole/l.  What  disease  is the  moslikely cause of this crisis?

67. A  45-year-old  patient complains  of pain in the epigastric region, left subcostal area, abdominal distension,  diarrhea, loss of weight. He has been suffering from this condition for 5 years. Objectively:  tonguis moist with white coating near the root; deep palpation of abdomen revealslight pain in the epigastric region and Мауо-Robsons point. Liver is painless and protrudes 1 cm from the costal arch. Spleen cannot  be palpated. What disease can be primarily suspected?
68.

A 58-year-old woman complains of spontaneous bruisesweakness,  bleeding gums, dizziness. Objectively: the mucous membranes and skin are pale with numerous hemorrhages of various time of origin. Lymph nodes are not enlarged. Heart rate - 100/min., BP-  110/70 mm  Hg.  There   are  no  changes of internal organs.  Blood  test  results:  RBC- 3, 0 · 1012 /l,  Нb-  92 g/l, colour  index  - 0,9, anisocytosis,  poikilocytosis,  WBC - 10 · 109 /l, eosinophiles - 2%,  staneutrophiles - 12%, segmented neutrophiles - 68%,  lymphocytes - 11%,  monocytes  - 7%,  ESR-  12 mm/hour. What   index   should   be  determined  additionally by a laboratory to make a diagnosis?

69. A 49-year-old patient complains of swallowin disorder  tha intensifie during eating solid food, hiccups, hoarse voice, nausea,  regurgitation, significanweight  loss (15 kg within 2,5 months). Objectively:  body weight  is reduced;  the  skiis pale  and  dry; vesicular  respiration; heart  sounds  arsufficientlsonorous;  heart  rate  is rhythmic.  The abdomen is softno  pain  on  palpation. The liver  inot  enlarged. What  investigation  is most  necessary  for  making  the  diagnosis  in this case?
70.

A 9-month-old child presents with fever, cough dyspnea Th symptom appeared 5  days  ago  after   a  contac with  a  person suffering  from  URTI. Objectively:  the  child is in grave  condition. Temperature of 38o C , cyanosis of nasolabial  triangle  is present. Respiration rate  - 54/min., nasal flaring during breathing. There  was percussion  dullness on the right below the scapula angle, and tympanic sound over the rest of lungs. Auscultation revealed bilateral fine moist cracklepredominating on the right. What  is the most likely diagnosis?

71. A 50-year-olman, who works as a polisher at a combine-building factory, addressed the  factorys  sectorial  doctor  witcomplaints of general fatigue, sensationof numbness and  pain  in his fingers. Objectively:  the  skin of his fingers is pale. Reaction to pain, tactile and thermal stimuli was revealed to be slightly disrupted. No disruptions can be observed within the other organs and systems. What disorder is most likely?
72.

A 27-year-old  womacomplains  of bleeding  gumsnasal  hemorrhages, multiple hematomas on the  skin of her  limbs and  on the  front  of hetorso,  extreme general  fatigue.  Blood  test:  Hb-  64  g/l,  erythrocytes - 2, 5 · 1012 /l,  reticulocytes -  16%,  platelets - 30 · 109 /l, ESR-  22 mm/hour.  What  approach would be most efficient for treatment of this pathology?

73. 23-year-old  patient had  taken  1 g of aspirin  to  treat   acute  respiratory infection. After  that  he developed an asthmatic  fit with  laboreexpiration that  was  arrested by introduction of aminophylline. Thpatients medical history is not burdened with allergies. Thpatient has undergone two surgeries  for nasal polyposis in the past. Whadiagnosis is most likely?
74. A 58-year-old woman undergoing chemotherapy for her oncologidisorder has developed sore throat. Examination revealed necrotic  areas  on the mucosof the pharynx and tonsils. Many of her teeth are afflicted with caries. In blood: neutrophilic granulocytes are practically  absent  against the background of leukopenia. Leukocytes are represented mainly by lymphocyteand monocytes.  What disease can be suspected in the given case?
75. A   patient  complain of  constan dull pain  ithe  perineum and  suprapubic area, weak  flow  of  urine frequendifficult  painful   urination,  nocturia.  Th patient  has been suffering from this condition for several months,  during  which urination was becoming increasingldifficult, and pain in the perineum  has  developedOn  rectal  examination: thprostate is enlarged (mainly  its right lobe),  denseasymmetrical, central  fissure is smoothed out, the right lobe is of stony density, painless, tuberous. What disease is it?
76.

A  child  is  10  years  old.  The  weight  i46  kg.  Since  birth  the  child  has  been  gaining  excessive  weight.  The  parents are  full-bodied.  The child has undergone the following   tests carbohydrate  tolerance,  leve of 17-ketosteroids,  bloo electrolytes,  US   oadrenal glands, cranium  X-ray. The tests revealed no pathologies.The diagnosis of exogenic constitutive obesithas been  made. What  direction of therapy shoulbe prioritized?

77. An  8-year-old  child with a 3-yeahistory of diabetes was hospitalized in hyperglycemic coma. Specify the initial dose of insulin to be administered:
78. A  worker,  who  was  involved  in  fire  fighting  inside  the  building  that  stored  2 kg of mercury,  has beedelivered to a hospital with complaints  of emotional expansiveness, palpitations, excessive sweating, body tremor, heart pain. Within one day his condition aggravated. Objectively:  thskin is paland moistThe  patient is depressed. Permanent red  dermographism, erethismunstable  BP are observed.  What  drug is the seruin this case?
79. During  meatesting  Trichinella  was detected in diaphragm crura in one of the two muscular  tissue samples.  What  tactics should a doctor  choose regarding this meat?
80. A 40-year-old patient was bitten by a stray dog an hour  ago. On  the  left shin there  is a bitmark  - the  wound  is 4x2x0,5 cm in size. What  surgical aid would be most  efficient in this case?
81. A 30-year-old  patient has beehospitalized  with  diagnosis  of intestinal obstruction. Thsurgery  revealed the  obstruction of the small  intestin to  be  caused  by  helminth ball. What kind of helminth is it?
82. Mother of a newborn  suffers from chronic pyelonephritis; she had a case of URTI before the  delivery.  The  delivery  is aterm,  for  a long  period   waters  were  not  breaking. On the  2nd  day  olifthe  child  developed an erythematic  rash,  later   the  rash  developed intblisters  approximately 1 cm in diameter filled with serous purulent substance.  Nikolskysymptom  is positive.  After  the  blisters had been  lancederosions  developed in their place. The child is inert. The childs body temperature is subfebrile.  What  diagnosiis most likely?
83. Three  weeks after  a case of acute tonsillitis the  patient is still weakinert,  subfebrile, his retromaxillary lymph nodes  are enlarged. Tonsils are flabby, stick together with arches, there  arpurulent plugs in lacunae.  What  is the most probable diagnosis?
84.