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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 is 26/min. The patient is unconscious, pupils are moderately dilated, general clonic and tonic convulsions are observed. Make the diagnosis:
A 32-year-old welder complains of weakness and 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 nodes. CBC 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 segments, 20% of lymphocytes, and 8% of monocytes, ESR- 47 mm/hour. What is the cause of anemia?
Т/l, Hb- 80 g/l, color index - 0,78, anisocytosis, poikilocythemia, serum iron - 10 mcmol/l.What diagnosis is most likely?
A 24-year-old patient visited a doctor complaining of enlargement of his submaxillary lymph nodes. Objectively: submaxillary, axillary and inguinal lymph 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
A 56-year-old patient complains of pain in the epigastrium after eating, eructation, loss of appetite, slight loss of weight, fatigability. The patient smokes; no 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, color index - 1,1; macrocytosis; leukocytes - 5,5 g/l, ESR- 13 mm/hour. On fibrogastroduodenoscopy: atrophy of fundic mucosa. What pathogenesis does this disorder have?
A 26-year-old secundipara at 40 weeks of gestation arrived at a maternity ward after the beginning of labor activity. The bursting of waters occurred 2 hours prior. The fetus was in a longitudinal lie with cephalic presentation. Abdominal circumference was 100 cm, fundal height - 42 cm. Contractions occurred every 4-5 minutes and lasted 25 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?
A 29-year-old female patient complains of dyspnea, heaviness and chest 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 vesicular 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?
Examination of a group of persons living on the same territory revealed the following common symptoms: dark-yellow pigmentation of the tooth enamel, diffuse osteoporosis of bone apparatus, ossification of ligaments 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:
An infant has been born at the 41st week of gestation. The pregnancy was complicated with severe gestosis of the second semester. The weight of the baby is 2400 g, the height is 50 cm. Objectively: the skin is flabby, the layer of subcutaneous fat is thin, hypomyotonia, neonatal reflexes are weak. The internal organs are without pathologic changes. This newborn can be estimated as a:
A woman has developed sudden thoracic pain on the right with expectoration of pink sputum and body temperature rise up to 37, 7o C on the 4th day 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?
A worker of a blowing shop complains of headache, irritability, sight impairment - he sees everything as if through a ”net”. Objectively: hyperemic sclera, thickened cornea, decreased opacity of pupils, visual acuity is 0,8 in the left eye, 0,7 in the right eye. The worker uses no means of personal protection. What diagnosis is most likely?
A 48-year-old patient was found to 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 this case?
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 graphic presentation would provide the best visual for
monthly deviations of dysentery morbidity from the average?
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/min., BP- 110/70 mm Hg. Respiration above the left lung is vesicular, weak above the right lung. There are various moist crackles above the lower lobe and amphoric breath near the angle of scapula. What is the most likely diagnosis?
In a maternity hospital a 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 had 2 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?
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?
A 67-year-old man complains of dyspnea on exertion, attacks of retrosternal pain, dizziness. He has no history of rheumatism. Objectively: pale skin, acrocyanosis. There are crackles in the lower lungs. There is systolic thrill in the II intercostal space on the right, coarse systolic murmur conducted to the vessels of neck. BP- 130/90 mm Hg, heart rate - 90/min., regular rhythm. The liver extends 5 cm from under the edge of costal arch, shin edemas are present. Specify the suspected valvular defect:
A 24-year-old female teacher complains of dizziness and heart pain irradiating to the left nipple. Pain is not associated with physical activity and cannot be relieved by nitroglycerin, it abates after taking Valocordin 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. Heart borders are normal, heart sounds are clear. The ECG shows respiratory arrhythmia. Radiograph of the cervicothoracic spine reveals no pathology. Lungs, abdomen are unremarkable. What changes in blood formula can be expected?
Chief physician of a polyclinic charged a district doctor with a task to determine the pathological prevalence of disease N in his district. What document allows to estimate the disease prevalence in the population of a medical district?
A 32-year-old woman complains of dizziness, headache, palpitation, tremor. For the last several months she has been under outpatient observation for increased arterial pressure. Since recently such attacks have become more frequent and severe. Objectively: the skin 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 most likely cause of this crisis?
A 58-year-old woman complains of spontaneous bruises, weakness, 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%, stab neutrophiles - 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?
A 9-month-old child presents with fever, cough, dyspnea. The symptoms appeared 5 days ago after a contact 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 crackles predominating on the right. What is the most likely diagnosis?
A 27-year-old woman complains of bleeding gums, nasal hemorrhages, multiple hematomas on the skin of her limbs and on the front of her torso, 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?
A child is 10 years old. The weight is 46 kg. Since birth the child has been gaining excessive weight. The parents are full-bodied. The child has undergone the following tests: carbohydrate tolerance, level of 17-ketosteroids, blood electrolytes, US of adrenal glands, cranium X-ray. The tests revealed no pathologies.The diagnosis of exogenic constitutive obesity has been made. What direction of therapy should be prioritized?