1. A 13-year-old girl complains of periodic prickly pain in the heart region. Percussion revealed no changes of cardiac borders. Auscultation revealed arrhythmic enhanced heart sounds, extrasystole at the 20-25 cardiac impulse. ECG showed the sinus rhythm, impaired repolarization, single supraventricular extrasystoles at rest. What is the most likely diagnosis?
2. A 7-year-old boy had complained of headache, nausea, fatigue for 3 weeks. His condition gradually deteriorated, headache and general weakness progressed. The boy had bronchitis at the age of 3. His father has a history of pulmonary tuberculosis. Objectively: body temperature 37,5oC, conscious, lies supine, with the hip and knee flexed to 90 degrees, nuchal rigidity +6 cm, partial ptosis of the right eyelid, the dilated right pupil. General hyperalgesia is present. Liquor: transparent, pressure - 400 mm of water column, protein - 1,5%, cytosis - 610/3 with predominant lymphocytes, sugar - 1,22 mmol/l, chlorides - 500 mmol/l. What is the most likely diagnosis?
3. A 13-year-old girl has a 5-year histrory of pain in the right hypochondrium irradiating to the right shoulder blade. The pain attacks are usually associated with diet violations, they are short and can be easily relieved by antispasmodic drugs. During a pain attack, palpation of the abdomen is painful, the pain is most intensive in the projection of the gallbladder. What is the most likely diagnosis?
4. A 12-year-old boy has a 6-year hi- story of insulin-dependent diabetes. The disease is labile. Since recently there have been periodical rises in blood pressure. Microalbuminuria test gave positive results. The patient’s condition corresponds with the following stage of diabetic nephropathy:
5. A 9-month-old child presents with fever, cough, dyspnea. The symptoms appeared 5 days ago after a contact with a person having ARVI. Objectively: the child is in grave condition. Temperature of 38oC, cyanosis of nasolabial triangle is present. RR- 54/min, nasal flaring while 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 rales predominating on the right. What is the most likely diagnosis?
6. An 8-year-old child complains of fever up to 38,8oC, throat pain when swallowing, skin rash. Objectively: lacunar tonsillitis, circumscribed hyperaemia and enanthema of soft palate, pinointsized skin rash, mostly in the folds and on the flexor surfaces of the extremities, pale nasolabial triangle. Which antibiotic should be administered in the first place?
7. A 16-year-old girl had had polyuria, polydipsia for 2 months. She had lost 8 kg with a good appetite. The patient was urgently hospitalized for abdominal pain and nausea. Examination revealed glycemia at the rate of 18 mmol/l, glycosuria at the rate of 24 g/l. Insulin and infusion of isotonic solutions of sodi- um chloride and glucose eliminated these problems, including thirst. What is the most likely diagnosis?
8. A boy was born at 32 weeks gestation. 2 hours after birth he developed respiratory distress. The RD severity assessed by Silverman score was 5. The respiratory disorders progressed, respiratory failure couldn’t be eliminated by Martin-Bouyer CPAP (continuous positive airway pressure). Ro-gram of lungs shows reticular and nodular pattern, air bronhogram. What is the most likely cause of respiratory distress syndrome?
9. An 8-year-old child with a 3-year history of diabetes was hospitalized in hyperglycemic coma. Specify the initial dose of insulin to be administered:
ExplanationInitial intravenous administration of 10 to 14 units of short-acting insulin has to be prescribed for the patient during the first hour. Continuous intravenous infusion of insulin in a dose 0,1 unit/kg/hour in 0,9 % sodium chloride infusion has to be given after that.
10. A 12-year-old girl undergoes regular gastroenterological check-ups for duodenal ulcer, biliary dyskinesia. What is the recommended frequency of anti- relapse treatment?
11. Examination of a 13-year-old girl revealed acute glomerulonephritis, nephritic syndrome at the initial stage without renal dysfunction. What is the main drug of choice for the basic therapy of this patient?
12. A 6-year-old child complains of frequent liquid stool and vomiting. On the 2nd day of desease the child presented with inertness, temperature rise up to 38, 2oC, Ps- 150 bpm, scaphoid abdomen, palpatory painful sigmoid colon, defecati- on 10 times a day with liquid, scarce stool with mucus and streaks of green. What is a provisional diagnosis?
13. A 13-year-old boy complains of pain in the upper third of his left thigh, body temperature rise up to 39oC. There is a swelling in the upper third of thigh and inguinal fold smoothness. The extremity is in a half bent position. Active and passive movements are not possible because of the sharp pain. What is the most likely diagnosis?
14. An 8-month-old baby has decreased appetite, pale skin, enlarged right side of abdomen. Palpation the right side of abdomen reveals a dense elastic tumour like formation 10x7 cm large. There is a positive ballotement sign. What is the most likely diagnosis?
15. An infant is 3 weeks old. Since birth there has been observed periodical vomiting within a few minutes after feeding. The amount of vomitive masses does not exceed that of previous feeding. The infant has age appropriate body weight. What is the most likely cause of this symptom?
16. A 13-year-old girl complains of fever up to 37,4oC during the last 2 months after recovering from ARVI. Objectively: malnutrition, diffuse grade II enlargement of the thyroid gland feeling dense on palpation, exophthalmos, tachycardia. What kind of pathological syndrome is it?
17. On the 2nd day of life a full-term boy developed mild jaundice of skin and mucous membranes, the general condition of the child is normal. Blood test results: indirect hyperbilirubinemia - 120 mmol/l. The child’s blood group is A(II) Rh(+), his mother’s blood group - B(III) Rh(+). What is the doctor’s tactics of choice?
18. From urine of a 14-year-old boy with the exacerbation of secondary obstructive pyelonephritis Pseudomonas aeruginosa was isolated with a titer of 1000000 microbes per 1 ml. Which antibiotic is most advisable to be administered in this case?
19. A 14-year-old boy with a history of chronic tonsillitis and sinusitis has developed a feeling of heart irregularities and additional pulse. HR- 83/min. ECG results: regular impulses with no visible P wave that occur every two sinus contractions, QRS complex is dramatically deformed and prolonged to over 0,11 s, T wave is discordant followed by a complete compensatory pause. Specify the arrhythmia type:
20. An 8-year-old girl periodically has sudden short-term heart pain, sensation of chest compression, epigastric pain, dizziness, vomiting. Objectively: the patient is pale, respiratory rate - 40/min, jugular pulse is present. Ps- 185 bpm, of poor volume. AP- 75/40 mm Hg. ECG taken during an attack shows ectopic P waves, QRS wave is not deformed. At the end of an attack a compensatory pause is observed. The most likely cause of the attack is:
21. A baby is 3 months old. The mother consulted a pediatrician about lack of breast milk. After several test weighings it was found that the child had to receive supplementary feeding. What is the opti- mal milk formula for this child?
22. Examination of a newborn revealed skin redness that appeared immediately after birth and reached the maximum intensity on the second day of life. What is your provisional diagnosis?
23. A 10-year-old patient has a history of mild bronchial asthma. During a regular check up the patient should be recommended:
ExplanationBronchial asthma is a medical condition classified under type 1 hypersensitivity ( IgE mediated); it is a chronic inflammatory pulmonary disease that is characterized by periodic cough, wheezing, tachypnea, dyspnea, hypoxemia, increased production of mucus which blocks the airways. Triggers include stress, allergens, viral upper respiratory infections, cold air etc. On objective examination, Tachypnoe, audible wheezing, hyperinflated chest and hyper resonant sound on percussion are observed. Curshman’s spirals ( shed epithelium in mucus plugs) and Charcot leyden crystals ( broken down eosinophils) are key findings morphologically.
24. A 10-year-old child has been admitted to a hospital with a closed crani- ocerebral injury with suspected cerebral edema. The patient is in grave condition, unconscious. The dyspnea, tachycardia, hypertension are present. Muscle tone is increased, there is nystagmus, pupillary and oculomotor reactions are disturbed. The mandatory component of intensive care is dehydration. What diuretic is adequate in this case?
25. A baby born after fast labour has palsy of hand muscles. Grasp reflex is absent, as well as hand-to-mouth reflex. Hand sensitivity is absent. What is the most likely diagnosis?
26. A child is 12 years old. He complains of a dull aching pain in the epigastrium and right hypochondrium, that is getting worse after taking fatty or fried food, headache, weakness, nausea, low- grade fever. Abdominal palpation reveals a marked resistance of muscles in the right hypochondrium, positive Kerr’s, Ortner’s, Murphy’s symptoms. What is the most likely diagnosis?
27. A 3-month-old girl presents with rhinitis, dyspnea, dry cough. These manifestations has been observed for two days. Objectively: the child has pale skin, acrocyanosis, shallow respiration at the rate of 80/min. Percussion reveals handbox resonance over the whole surface of lungs, massive fine rales. What is the most likely diagnosis?
28. A newborn (mother’s I pregnancy) weighing 3500 g presents with jaundice, lethargy, reduced reflexes. Objectively: second grade jaundice of skin with saffron tint, liver - +2cm, spleen - +1 cm. Urine andfecesareyellow.Bloodcount:Hb-100 g/l, RBCs - 3, 2 · 1012/l, WBCs - 18, 7 · 109/l, mother’s blood type - 0(I) Rh(+), baby’s blood type - А(II) Rh(-), bilirubin - 170 mmol/l, indirect fraction. ALT, AST rates are normal. What disease is the child most likely to have?
29. A 15-year-old boy feels pain in the region of the left knee joint. Objectively: the soft tissues in the affected region are infiltrated, the joint function is limited. Radiography reveals a focus of bone destruction in the distal metaepiphysial segment of the left femur. The destruction is accompanied by periosteal detachment and a defect formed within cortex of Codman triangle bone. X-ray of chest shows multiple microfocal metastases. What is the most likely pathology?
30. 10 days after birth a newborn developed a sudden fever up to 38,1oC. Objectively: the skin in the regi- on of navel, abdomen and chest is erythematous; there are multiple pea- sized blisters with no infiltration at the base; single bright red moist erosions wi- th epidermal fragments on the periphery. What is your provisional diagnosis?
ExplanationEpidemic pemphigus of newborn or Pemphigus Neonatorum is a disease of the newborn, in which vesicles or blebs, usually flat on the top, appear with or without fever, on a perfectly normal or reddened skin with pin-head size vesicle elevation, which rapidly develops into a large bleb. As the disease progresses, relapses may occur, yet the infant may recover promptly after a single outbreak of but few blebs. In some cases these blebs show a marked tendency to peripheral extension, which finally dry, leaving a thin brown crust. Staphylococcus aureus have been implicated as the causative agent. The distinction between Pemphigus and syphilis in the newborn may be determined by the localization of the eruption. Syphilis will be localized to the palms of the hands and soles of the feet, as well as by the associating symptoms of syphilis. Impetigo commonly presents with honey crusted vesicles and papules. Atopic dermatitis is an allergic reaction and patient most often have other allergic conditions or family history of asthma, allergic rhinitis, eczema etc.
31. A 13-year-old girl was admitted to the gynecological department with heavy bleeding, which appeared after a long delay of menstruation. Shortly before, the girl suffered a serious psychotrauma. Her menarche occurred at the age of 11, she has a 30-day cycle with 5 to 6 days of moderate, painless bleeding. The patient is somatically healthy, of normosthenic constitution with height of 160 cm, weight of 42 kg. The patient is pale. Rectoabdominal examination revealed that the uterus was of normal size and consistency, anteflexio-versio, the appendages were not changed. What is the most likely diagnosis?
32. A 2-year-old child in a satisfactory condition periodically presents with moderate proteinuria, microhematuria. USI results: the left kidney is undetectable, the right one is enlarged, there are signs of double pyelocaliceal system. What study is required to specify the diagnosis?
33. An 8-year-old boy has a 2-year hi- story of blotchy itchy rash appearing after eating citrus fruit. The first eruption occurred at the age of 6 months after the introduction of juices to the baby’s diet. Father has a history of bronchial asthma, mother that of allergic rhinitis. What is the most likely diagnosis?
Explanation
Chiefly, we can notice a trend of allergic diseases running in the family tree. Parental history of allergic conditions are strong risk factors for atopic dermatitis in the child. Atopic dermatitis is an inflammatory skin disease that is characterised by itching, redness, and scaling of the skin, predominantly in the skin creases. This patient is allergic to citrus fruits. Atopic dermatitis is a systemic chronic allergic disease that occurs in people with an inherited predisposition to atopy and characterized by typical morphological changes of the skin with itching, lesions of the central and autonomic nervous system, endocrine and immune systems with hyper IgE. Essential criteria for diagnosis: itch, rash elements`, typical morphology and localization (flexor surface of extremities in adults (lichenification), extensor surfaces and face in children (eczema)), chronic recurrent course, atopic diseases in personal and family anamnesis (bronchial asthma, allergic rhinitis).
34. A 22-day-old infant had developed red subcutaneous nodules from 1,0 to 1,5 cm large on the scalp. Later the nodules suppurated, body temperature rose up to 37, 7oC, there appeared symptoms of intoxication, the regional lymph nodes grew bigger. Blood test results: anemia, leukocytosis, neutrophilia, accelerated ESR. What is the most likely diagnosis?
35. A 10-year-old patient complains of skin itch that occurs at night. Objectively: multiple paired papules, burrow tracks in the interdigital skin folds, on the anterolateral surfaces of abdomen and buttocks. Specify the period of regular medical check-up for pupils of the class where the patient learns:
36. A 7- y e a r - o l d f e m a l e c h i l d h a s developed an acute condition. She complains of a headache, two onsets of vomiting. Objectively: deferred reactions, body temperature - 39, 3oC, pronounced hyperesthesia, nuchal rigidity, positive superior and inferior Brudzinski’s signs, symmetric Kernig’s sign. What is the provisional diagnosis?
37. A 7-year-old child complains of itching, papular erythematous rash, dry skin. Objectively: there is lichenification in the popliteal fossae and antecubital spaces. What immunologic indicator if found in the blood serum will verify the diagnosis (atopic dermatitis)?
38. A 7-year-old patient presents with body temperature rise up to 39oC, dry cough, pain in the lateral abdomen. Objectively: there is cyanosis of the nasolabial triangle, inspiratory dyspnea with accessory muscle recruitment. Percussion reveals pulmonary dullness; among auscultation findings there are diminished breath sounds, crepitant rales. Respiratory rate is of 50/min, HR- 120/min. Evaluate the grade of respiratory failure in the patient:
39. An 8-year-old boy was brought to the admission department by his parents. Parents report that he has had pain in the right knee for the last 9 months, recently mother has noti- ced some limitation of motion in his right leg, and morning stiffness that doesn’t last till the evening. What is the most likely diagnosis?
40. A 13-year-old girl was admitted to the gynecology department for having a significant bleeding from the genital tract for 10 days. The patient has a history of irregular menstrual cycle since menarche. Menarche occurred at the age of 11. Recto-abdominal examination revealed no pathology. What is the provisional diagnosis?
41. A 3-year-old girl has had an increase in body temperature up to 38,5oC for four days. The child refuses to eat. Over the last two days, nose and mouth breathing has become difficult. Mesopharyngoscopy reveals hyperthermia and enlargement of tonsils, as well as hyperemia and bulging of the posterior wall of the oropharynx, which significantly narrows the oropharyngeal lumen. What complication of quinsy occurred in the patient?
42. A 9-year-old patient has measles. On the 6th day after the rash appeared, the boy developed a condition manifested by dyspnea, barking cough, stenotic respiration. Objectively: the rash on the face, neck and torso turned brown. There is a branny desquamation. Respiratory rate is 22/min. What complication should be diagnosed?
43. A 13-year-old boy with hypertrophic cardiomyopathy complains of dyspnea on minimal exertion. EhoCG reveals asymmetric left ventricular hypertrophy, signs of pulmonary hypertension, dilatation of the left atrium. EF is 64%. The revealed alterations are indicative of:
44. A 6-year-old boy complains of paroxysmal pain that occurs after a mental stress, consumi- ng cold drinks or ice cream. After clinical and instrumental examination the boy has been di- agnosed with hypertensive biliary dyskinesia. The drugs of the following groups should be administered in the first place:
45. A 15-year-old patient consulted a dermatologist about a painful lump in the armpit. Objectively: there is a walnut sized node, lymphadenitis, infiltration of the surrounding tissues. The patient has been diagnosed with hidradenitis. What is the most likely causative agent of this disease?
46. Mother of a 10-month-old baby reports significant pallor, poor appetite, enlarged abdomen in the baby. As a neonate, the child underwent treatment in the inpatient hospital for jaundice and anemia. Objectively: the skin is pale and jaundiced, teeth are absent, abdomen is enlarged, spleen is palpable. Blood test results: Hb- 90 g/l, RBC- 3, 0·1012/l, color index -0,9,microspherocytosis, reticulocytosis up to 20%, serum bilirubin - 37mmol/l, unconjugated bilirubin - 28 mmol/l. What type of anemia has occurred in the patient?
47. A lumbar puncture was performed for a newborn suspected of having an intracranial birth injury. Bloody cerebrospinal fluid was obtained. What hemorrhage occurred in this case?
48. An infant is 2 days old. He was born full-term with signs of intrauterine infection, and therefore receives antibiotics. Neonates should be given antibiotics at longer intervals and lower doses compared to older children and adults because:
49. Examination of a full-term 6-day-old infant revealed that different areas of skin had erythemas, flaccid bubbles, eroded surface, cracks, peeling of the epidermis looking like being scalded with boiling water. There was positive Nikolsky’s symptom. General condition of the child was serious. The child was restless, hypersensitive, febrile. What is the most likely diagnosis in this case?
50. A 5-year-old girl has had thirst, polyuria, increased appetite for two months. At the same time, there is a 3 kg decrease in body weight. During the last week, these presentations got accompanied by nocturnal enuresis.. Examination revealed hyperglycemia at the rate of 14 mmol/l. The child has been diagnosed with type I diabetes. What is the most likely genesis of this disease?
51. A 17-year-old male patient consulted a therapist about malaise, chills, runny nose, aching muscles and joints, nausea and diarrhea. The patient asks to prescribe him a lot of painkillers and sedatives (tramadol or solpadein that help the best, and diazepam). Pharyngeal mucosa is pale pink, clean. Auscultation reveals vesicular breathing. Tachycardia is present. The pupils are dilated, there is sluggish response to light. There are injection marks on the forearm skin. During examination, the patient’s manner is vulgar, irritable, rude and untruthful. Make a diagnosis:
Explanation
Opioids, sometimes called narcotics, are a type of drug. They include strong prescription pain relievers, such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid. They are commonly used to treat moderate to severe or refractory pain. Examples of opioids include:
-Full agonist: Morphine, Heroin, Meperidine, Methadone, Codeine, Fentanyl
-Partial agonists: Buprenorphine
-Mixed agonist/antagonist: Pentazocine-Antagonist: Naloxone, Naltrexone
Treat toxicity with Naloxone (competitive opioid receptor antagonist) and prevent relapse with Naltrexone. The risks of using prescription opioids include dependence and addiction. Dependence means feeling withdrawal symptoms when not taking the drug. Addiction is a chronic brain disease that causes a person to compulsively seek out drugs, even though they cause harm. Common Signs of Opioid Addiction: The inability to control opioid use; Uncontrollable cravings; Drowsiness; Frequent flu-like symptoms; Isolation from family or friends; Stealing from family, friends or businesses; New financial difficulties. This patient has injection marks on the forearms and cravings for Tramadol in addition to showing signs of opioid withdrawal - sweating, dilated pupils, rhinorrhea, lacrimation, nausea, stomach cramps, diarrhea (“flu-like” symptoms), piloerection (“cold turkey”). Flu-like symptoms here include - malaise, chills, runny nose, aching muscles and joints. Even though Solpadein contains both Paracetamol and Caffeine which are Pain killers, the best choice here is Opioid addiction due to the signs of withdrawal manifested by this patient.
52. A 4-year-old boy had untimely vaccination. He complains of painful swallowing, headache, inertness, fever. Objectively: the child is pale, has enlarged anterior cervical lymph nodes, swollen tonsils with cyanotic hyperemia, tonsils are covered with gray-white pellicles which cannot be easily removed. When the pellicles are forcibly removed, the tonsils bleed. What is the most likely diagnosis?
53. A 9-year-old girl has been admitted to a hospital for an elevated body temperature (39, 8oC), painful dry cough, abdominal pain on the right. Examination reveals dullness on percussion on the right, diminished breath sounds, crepitus. What study is required to make a diagnosis?
54. A newborn has purulent discharges from the umbilical wound, the skin around the navel is swollen. The baby’s skin is pale, with a yellow-gray tint, generalized hemorrhagic rash is present. What is the most likely diagnosis?
Explanation
Sepsis is a medical condition caused by the body’s reaction to an infection. Neonatal sepsis can be caused by organisms such as E. coli, listeria, Group B streptococcus, Herpes simplex virus etc. Conditions that increase the risk of neonatal sepsis include: Preterm birth, early rupture of membrane, chorioamnionitis etc.Key signs include: Fever, vomiting, diarrhea, pale skin with yellow and white tint ( jaundice), irritability, difficulty in breathing and feeding etc. Hemorrhagic disease of newborn occurs as a result of deficiency in vitamin K or essential blood clotting factors, trauma. It is characterised by excessive bleeding. Hemolytic disease of newborn occurs due to ABO incompatibility or Rhesus Incompatibility between mother and child ( mother -ve, child +ve).
55. A 10-year-old child with a history of nonrheumatic carditis has periodic attacks manifested by heart pain, dyspnea, pallor, high blood pressure, a dramatic increase in heart rate up to 180/min. What drug would be most effective to treat this patient?
56. A 10-year-old child has been admitted to a hospital with a closed craniocerebral injury with a suspected cerebral edema. The patient is in grave condition, unconscious. The dyspnea, tachycardia, hypertension are present. Muscle tone is increased, there is nystagmus, pupillary and oculomotor reactions are impaired. The mandatory component of intensive care is dehydration. What diuretic is adequate in this case?
57. An 11-year-old girl has been immunized according to her age and in compliance with the calendar dates. What vaccinations should the children receive at this age?
Explanation
It is recommended that diphtheria, tetanus, and acellular pertussis vaccination be administered across the lifespan. Children younger than 7 years of age receive DTaP or DT, while older children and adults receive Td. D- Diphtheria; T- Tetanus; P- Pertussis (Whooping cough); aP- acellular pertussis vaccine.
- Give infants and children 5 doses of DTaP. Give one dose at each of these ages: 2 months, 4 months, 6 months, 15 through 18 months, and 4 through 6 years.
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Give adolescents a single dose of Tdap, preferably at 11 to 12 years of age.
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Give pregnant women a single dose of Tdap during every pregnancy, preferably during the early part of gestational weeks 27 through 36.
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Give adults who have never received Tdap a single dose of Tdap. This can be given at any time, regardless of when they last got Td. This should be followed by either a Td booster every 10 years.
58. A 3-month-old infant has occipital alopecia, restless sleep, excessive sweating. What disease can you think of?
59. It has been suspected that a newborn has congenital diaphragmatic hernia (asphyctic incarceration). What study will allow to confirm the diagnosis?
60. During the first home visit to a full-term boy after his discharge from the maternity hospital a pediatrician revealed a symmetrical swelling of mammae without skin changes over them, swelling of the scrotum. The body temperature was of 36, 5oC. The baby was calm, sucked the mother’s breast actively. What condition should you think of?
61. A 12-year-old boy presents with nausea, frequent repeated vomiting that first occurred after eating canned vegetables. Objectively: the patient has dry mucous membranes, muscular hypotonia, anisocoria, mydriasis, dysphagia and dysarthria. What is the most likely diagnosis?
62. A full-term neonate weighing 4500 g was born asphyxiated with Apgar score of 4-6 points. During the delivery shoulder dystocia occurred. Neurologic assessment revealed non-focal neurologic symptoms, total flaccid paresis of the upper extremities since the arm was atonic and pronated. Grasping, Babkin’s and Moro’s reflexes were absent. What segments of spinal cord had been affected?
63. A 5-year-old boy has a history of repeated pneumonia, frequent acute respiratory viral diseases. Objectively: exertional dyspnea, minor fatigabilty. There is a systolic murmur having its epicenter in the IV intercostal space on the left. Left relative dullness is found along the midclavicular line. According to the findings of instrumental methods of examination (electrocardiography, echocardiography), the patient has been diagnosed with ventricular septal defect, subcompensation stage. What is the main method of treatment?
64. At the first minute of life a full-term infant born with umbilical cord entangled around his neck has total cyanosis, apnea,HR- 80/min, hypotonia and areflexia. There are no signs of meconium aspiration. After the airway suctioning the newborn did not start breathing. What is the next action of the doctor?
65. Examination of an 11-year-old boy revealed frequent nosebleeds, fatigue when walking, underdevelopment of the lower half of the body, increased blood pressure in the upper extremities and decreased pressure in the lower ones, extension of the left heart border, blowing systolic murmur in the interscapular region. ECG shows the horizontal axis of heart. Radiography reveals left cardiomegaly, costal usuration. What is the most likely diagnosis?
66. During the preventive examination a 17-year-old young man reports no health problems. Objectively: the patient is undernourished, asthenic; blood pressure is 110/70 mm Hg, Ps- 80/min. Heart borders are within normal range. Auscultation reveals three apical heart sounds, murmurs are absent. ECG shows no pathological changes, PCG registers the S3 occurring 0,15 seconds after the S2. How can you interpret these changes?
67. A 12-year-old boy periodically has short episodes (10-15 seconds) of a brief loss of awareness with a dazed look and eyes stare in an upright position, blank expression of face, absence of motions and subsequent amnesia. Specify the described state:
68. A 6-year-old boy had had a quinsy. 9 days later, there appeared edemata of the face, extremities and trunk, general health condition deteriorated. Urine became turbid. Objectively: expressive edemata, ascites. AP-100/55 mm Hg, diuresis - 0,2 l of urine per day. Results of the biochemical blood analysis: total protein - 50 g/l, cholesterol - 11,28mmol/l, urea - 7,15 mmol/l, creatinine - 0,08mmol/l. Urinalysis results: leukocytes - 3-5 per HPF, red blood cells are absent. What is the provisional diagnosis?
69. A 13-year-old boy has had abdominal pain, bloating, nausea, liquid fatty gray stool with putrid smell for the last 3 years. Palpation reveals epigastric tenderness, as well as tenderness in the Desjardins’ pancreatic point, Chauffard’s triangle; there is positive Mayo- Robson’s sign. Failure of exocrine pancreatic function has been suspected. What is the most informative method for evaluating the state of exocrine pancreatic function?
Explanation
Apart from the endocrine function of the pancreas ( production of hormones such as insulin, glucagon, somatostatin etc), the Pancreas also possess exocrine function ie, it produces enzymes that aid in in food digestion eg amylase for the digestion of carbohydrate, lipase for the breakdown of fats and trypsin and chymotrypsin for proteins, elastase. Notice that this patient has an issue with digestion revealed by the presence of bloating, liquid, gray and smelly stool.
Pancreatic fecal elastase-1 (FE-1) has become the first-line test of pancreatic function. FE-1 is well documented in quantitative studies to be stable during intestinal transit and studies demonstrate significant correlation between fecal elastase and levels of other pancreatic enzymes such as duodenal lipase, amylase, trypsin, and bicarbonate concentration. Fecal elastase is concentrated in human feces compared with pancreatic juice and is a simple, non-invasive and inexpensive test.
70. An 8-year-old child was hospitalized for fever up to 39, 8oC, inertness, moderate headache, vomiting. Examination revealed meningeal symptoms. Lumbar puncture was performed. The obtained fluid had raised opening pressure, it was transparent, with the cell count of 450 cells per 1 mcL (mainly lymphocytes - 90%), glucose level of 2,6mmol/l. What causative agent might have caused the disease in the child?
71. An 11-year-old boy complains of general weakness, fever up to 38, 2oC, pain and swelling of the knee joints, feeling of irregular heartbeat. 3 weeks ago, the child had quinsy. Knee joints are swollen, the overlying skin and skin of the knee region is reddened, local temperature is increased, movements are limited. Heart sounds are muffled, extrasystole is present, auscultation reveals apical systolic murmur that is not conducted to the left inguinal region. ESR is 38 mm/h. CRP is 2+, anti streptolysin O titre - 400. What is the most likely diagnosis?
72. A 51-year-old man complains of vomiting with blood. He has been drinking alcohol excessively. Health disorder has been observed since he was 40, when he first developed jaundice. On examination the skin and visible mucosa are icteric, with a stellate vascular pattern. The patient is malnourished and presents with abdominal distension, umbilical hernia, and ascites. The edge of the liver is tapered and painless, +3 cm, the spleen is +2 cm. Blood test: Hb - 80 g/L, leukocytes -3∙109/L, platelets - 85∙109/L. What is the cause of portal hypertension in this patient?
73. During an outdoors school event in hot weather, a 10-year-old girl lost her consciousness. Body temperature - 36.7°C. Objectively her skin is pale and cold to touch, her pupils are dilated. Blood pressure - 90/50 mm Hg. Heart rate - 58/min. What pathology occurred in this case?
74. 10 hours after birth a child developed jaundice, hypotonia, hyporeflexia, and moderate hepatosplenomegaly. Feces and urine are of normal color. Umbilical cord blood bilirubin is 51cmol/L due to unconjugated bilirubin levels. In venous blood: erythrocytes - 3.5∙1012/L, Hb - 140g/L, reticulocytes - 1.5%, bilirubin - 111 mcmol/L, conjugated - 11 mcmol/L, ALT - 40 U/L, AST - 30U/L. Mother’s blood group is A(II) Rh(-), child’s blood group is A(II) Rh(+). What laboratory test can confirm the diagnosis?
75. A 15-year-old girl complains of dizziness and sensation of lack of air that she develops in emotionally straining situations. Relief occurs after she takes corvalol. Objectively: hyperhidrosis and marble-like pattern of the skin of her palms and feet. Clinical and instrumental examination revealed no organic changes in the central nervous, cardiovascular, and respiratory systems. What provisional diagnosis can be made?
76. The 5-year-old child has been ill for 2 weeks. Cough attacks developed first and were then followed by reprises. During coughing the child’s face turns red and cervical veins bulge. The cough attacks induce vomiting. X- ray shows intensified bronchial pattern. Blood test: leukocytes-16∙109/L , lymphocytes - 72%, erythrocyte sedimentation rate - 4 mm/hour. What is the most likely diagnosis?
77. A 6-month-old child on breastfeeding is hospitalized in the inpatient department. After the child recovers, the doctor recommends the mother to start introducing solid food to the child’s diet. What products should be introduced to the child’s diet first?
78. A 16-year-old girl has primary amenorrhea, no pubic hair growth, normally developed mammary glands; her genotype is 46 XY; uterus and vagina are absent. What is your diagnosis?
79. A 17-year-old girl has made an appointment with the doctor. She plans to begin her sex life. No signs of gynecological pathology were detected. In the family history the patient’s grandmother had cervical cancer. The patient was consulted about the maintenance of her reproductive health. What recommendation will be the most helpful for prevention of invasive cervical cancer?
80. An 11-year-old boy for a month has been presenting with increasing pain in the right femur. In the painful area there is a non mobile painful tumor with unclear margins. The child complains of general indisposition, weakness, increased body temperature up to 39°C. X-ray shows widened medullary cavity, small foci of cancellous bone destruction, and onion-like lamellar exfoliation of the cortical layer. What is the most likely pathology resulting in such clinical presentation?
81. During medical examination of high and middle school students, the doctors vere assessing correlation between biological and calendar age of the school students based on the following criteria: height growth rate per year, ossification of the carpal bones, the number of permanent teeth. What additional development criterion should be assessed at this age?
82. A 3-week-old infant developed large, flaccid vesicles with purulent contents on the skin of chest and abdomen. The vesicles rupture quickly. Make the provisional diagnosis:
83. A child is 1 year old. After solid food was introduced into the diet, within the last several months the child developed loss of appetite, diarrhea with large amount of feces, and occasional vomiting. Body temperature remains normal. Body weight is 7 kg. The child is very pale, has leg edemas and extremely distended abdomen. Feces analysis detects high levels of fatty acids and soaps. Diagnosis of celiac disease was made and gluten-free diet was prescribed. What should be excluded from the diet in this case?
84. A 10-year-old boy with symptoms of arthritis and myocarditis was brought to a hospital. Based on clinical examination the provisional diagnosis of juvenile rheumatoid arthritis was made. What symptom is the most contributive for the diagnostics of this disease?
85. A 14-year-old girl came to the general practitioner with complaints of weakness, loss of appetite, headache, rapid fatigability. Her last menstruation was profuse and lasted for 14 days after the previous delay of 2 months. Objectively: the skin is pale, heart rate is 90/min., BP is 110/70 mm Hg,Hb is 88 g/L. Rectal examination: the uterus and its appendages are without changes, no discharge from the genital tracts. What complication occurred in the patient?
86. A 7-year-old boy has severe pulmonary mucoviscidosis (cystic fibrosis). He complains of dyspnea and blood expectoration. Objectively he presents with lagging physical development, acrocyanosis, hepatomegaly, drumstick fingers, and nail plates resembling a ”clock face”. Provisional diagnosis of chronic pulmonary heart disease is made. What examination would be the most informative for diagnosis confirmation?
Explanation
A doppler echocardiography is a diagnostic method for heart related issues. It is a combination of an echocardiogram (which uses sound waves to create an image of the heart) and a doppler technology ( which shows the velocity ie, speed and direction of blood flow in cardiac tissues). An Electrocardiography shows the electrical activity of the heart. In patients with cystic fibrosis (CF), continuous pulmonary infection and inflammation with thickened secretions cause airways obstruction and hyperinflation. As the disease progresses, these patients develop disabling lung disease and eventually respiratory failure and pulmonary hypertension (PH). PH is considered to be a consequence of several mechanisms that either raise the pressure downstream of the pulmonary capillaries, induce vasoconstriction, increase blood flow to the lung, or obstruct the pulmonary vessels either by embolism or in situ fibrosis. The echocardiogram is an integral part of the evaluation of a patient with PH. Common echocardiographic findings in PH includes right atrial and right ventricular (RV) enlargement, reduced RV function, displacement of the intraventricular septum to the left, and tricuspid regurgitation that permits the estimation of the pulmonary artery systolic pressure (PASP). Therefore, Doppler echocardiography will be the best choice to evaluate a patient with a chronic pulmonary heart disease.
87. A 10-year-old boy, who was outdoors in windy and cold weather, developed moderate pain and tingling in his fingers and toes. When he had returned home, his parents noticed that the tips of his fingers and toes were white and their sensitivity was lost. The affected areas are warming up, the fingers are tingling and in pain. Skin pallor changed into redness, tingling stopped, slight itching and swelling of the fingers appeared. Determine the frostbite degree in this child
88. A 12-year-old boy with hypertrophic cardiomyopathy complains of dyspnea caused by the slightest physical exertion. Echocardiography detected asymmetrical left ventricularhM hypertrophy, signs of pulmonary hypertension,aM and left ventricular dilatation, its ejection fraction is 59%. These developments are indicative of
89. A 9-month-old infant presents with delayed tooth eruption and fontanel closure, weakness, and excessive sweating. What type of hypovitaminosis is the most likely in this child?
90. A 10-year-old girl exhibits high level of physical development ( + 3σ), her body length increased by 10 cm within a year (which is double the norm for her age group), the number of permanent teeth corresponds with the age norm (20), the development of her secondary sex characteristics is three years ahead of her age (Ма, Р, Ах, Menarche). Development rate ahead of her biological age can occur due to:
91. 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 50cm. 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 assessed as a:
92. A 16-year-old adolescent living in a rural area has been bitten in the shin by a stray dog. The wound is superficial. Regular vaccination against tetanus was received 3 months ago. What treatment tactics would be the most advisable in this case?
93. During examination a 4-month-old child with meningococcemia presents with acrocyanosis, cold extremities, tachypnea, and thready pulse, blood pressure of 30/0 mm Hg, anuria, and sopor. What clinical syndrome is it?
94. The right arm of a newborn is stretched along the torso with all its joints extended; the shoulder is rotated inwards, while the forearm is pronated, the hand is in the position of palmar flexion. Spontaneous movements are absent in the shoulder and elbow joints, passive movements are painless. What is the most likely diagnosis?
95. A 1-year-old child with a case of URTI suddenly developed noisy respirations with difficult inspiration, intercostal retractions, and barking cough on the 2nd night after the disease onset. What is the most likely diagnosis?
96. A 10-year-old boy with symptoms of arthritis and myocarditis was delivered into a hospital. Based on clinical examination the preliminary diagnosis of juvenile rheumatoid arthritis was made. What symptom is the most contributive for the diagnostics of this disease?
97. A 7-year-old boy has been an inpatient for 1.5 months. He had been delivered to the hospital with complaints of edemas all over his body, low urine output, and headache. Clinical urinalysis: proteins - 7.1 g/L, leukocytes - 1-2 in the vision field, erythrocytes - 3-4 in the vision fi- eld. During the course of treatment the edemas gradually dissipated, headache abated, diuresis normalized. Daily urine proteins - 3 g/L. Biochemical blood test: total protein - 43.2 g/L,urea - 5.2 mmol/L, cholesterol - 9.2 mmol/L. What glomerulonephritis syndrome is the most likely to be present in the patient?
98. The mother of a 3-month-old child came to a family doctor with complaints of her child being physical underdeveloped and suffering from cough attacks and dyspnea. Anamnesis: the child is the result of the second full-term pregnancy with the risk of miscarriage (the first child died of pulmonary pathology at the age of 4 months, according to the mother). Body mass at birth is 2500 g. Cough attacks were observed from the first days of life, twice the child was treated for bronchitis. Considering the severity of the child’s condition the doctor made the referral for hospitalization. What diagnosis was most likely stated in the referral?
99. A 5-year-old child that contacts with viral hepatitis in the kindergarten presents with increased body temperature up to 38oC, weakness, low appetite, single case of vomiting, dull pain in the subcostal area on the right. The child is provisionally diagnosed with viral hepatitis. What examination would be the most informative for diagnosis confirmation?
100. An infant is 2.5 months old. The onset of the disease was gradual, the child had normal body temperature but presented with slight cough. Within a week the cough intensified, especially at night; on the 12th day the child developed cough fits occurring up to 20 times per day and followed by vomiting. There was one instance of respiratory arrest. Make the diagnosis:
101. A 14-year-old boy presents with moderate bronchial asthma in its exacerbation period. What drug should be prescribed to stop an acute attack of expiratory dyspnea?
102. A newborn with gestational age of 31 weeks presents with hypotonia and depressed consciousness. Hematocrit is 35%, general cerebrospinal fluid analysis shows increased content of erythrocytes and protein, and low glucose. These data correspond with the clinical presentation of:
103. A 16-year-old girl has primary amenorrhea, no pubic hair growth, normally developed mammary glands; her genotype is 46 ХY; uterus and vagina are absent. What is your diagnosis?
104. Mother of an 8-year-old girl complains that the child is too short and has excessive body weight. Objectively: obesity with fat deposits on the torso and face (round moon-like face), acne, striae on the thighs and lower abdomen, hirsutism. What hormone can cause such symptoms, when in excess?
105. A 9-year-old girl complains of fever up to 38.5oC, headache, inertness, weakness, loss of appetite, stomachache, and frequent painful urination. Provisional diagnosis of acute pyelonephritis is made. Clinical urine analysis: specific gravity - 1016, no protein, leukocytes- 10-15 in the vision field. What investigation method can verify the diagnosis of urinary tract infection?
106. A newborn has Apgar score of 9. When should the infant be put to the breast?
107. A woman with blood group B(III) Rh(+) gave birth to a full-term healthy boy. Examination on the 3rd day of the infant’s life shows him to have icteric tint to his skin. The child has no problems with suckling, sleep is nondisturbed. The abdomen is soft, the liver protrudes by 2 cm from under the costal margin. Complete blood count: hemoglobin -200 g/L, erythrocytes - 5.5 · 1012/L, total bilirubin - 62 mcmol/L, indirect bilirubin - 52mcmol/L. What condition can be suspected?
108. A 3-day-old infant with hyperbilirubinemia (428 mcmol/L) developed disturbances manifesting as periodical excitation and convulsions against the background of inertness, hypotension, hypodynamia, and inhibition of unconditioned reflexes, convergent strabismus, rotational nystagmus, and setting sun eye phenomenon. What is the most likely cause of such symptoms?
109. A 15-year-old adolescent girl came the gynecologist with complaints of painful menstruations that are accompanied by nausea, vomiting, and dizziness. Her menarche was at 12. Menstruations became painful since she was 14, remain regular. What treatment should be prescribed in this case?
110. A 3-year-old child presents with sharp deterioration of his general condition. He has a history of purulent otitis. His temperature is now 38.5oC. The left leg is pressed to the torso, active movements are absent, the lower third of the thigh and knee joint are thickened, hyperemic, with localized fever. Axial load leads to acute discomfort of the patient. What is the most likely diagnosis?
111. A 1.5-month-old child on breastfeeding presents from birth with daily vomiting, irregular liquid foamy feces, and flatulence, which are resistant to antibacterial and probiotic therapy; no increase of body mass is observed. The child’s condition improved, when breastmilk was substituted. What pathology is it?
112. During regular examination of a 2-year-old boy, he presents with enlarged left kidney, painless on palpation. The right kidney was undetectable on palpation. Excretory urography shows no contrast on the right. Cytoscopy detected hemiatrophy of the urinary bladder trigone, the right ureteral orifice is not detected. What pathology is it?
113. A 5-year-old child has body temperature risen up to febrile numbers, suffers from inertness, weakness. Examination revealed hemorrhage on the skin of limbs and torso. Enlargement of cervical and axillary lymph nodes can be detected. The liver is 4 cm below the costal arch; the spleen is 6 cm below the costal arch. Blood test: erythrocytes- 2.3 · 1012/L, Hb- 60 g/L, platelets - 40 · 109/L, leukocytes - 32.8 · 109/L, eosinophiles - 1%,band neutrophiles - 1%, segmented neutrophiles - 12%, lymphocytes - 46%, monocytes - 1%, blasts - 40%, Duke’s bleeding time test result is 9 min. What examination is necessary to make the diagnosis?
114. A 22-day-old infant developed subcutaneous red nodes from 1.0 to 1.5 cm in size on the scalp; later the nodes suppurated. Temperature increased up to 37.7oC, intoxication symptoms appeared, regional lymph nodes enlarged. Complete blood count: anemia, leukocytosis, neutrocytosis, increased ESR. What diagnosis will you make?
115. An 8-year-old girl with complaints of painful urination, frequent low volume urination, and leukocyturia was diagnosed with acute cystitis. 10 days before the disease onset she was treated by the gynecologist for acute vulvitis. 5 days ago she presented with mild catarrhal symptoms. Her mother ascribes the child’s disease to her overexposure to cold. Specify the most likely infection route:
116. A 5-year-old boy complains of severe dyspnea and sensation of lack of air. Objectively the child assumes orthopneic position, presents with marked peripheral cyanosis, drumstick fingers, nail plates resembling a \\\"clock face”, the borders of cardiac dullness are bilaterally extended; coarse systolic murmur can be detected over the whole surface of the heart and is especially pronounced in the II inter costal area on the left near the sternum. What disease can be characterized by such presentations?
117. A 10-year-old boy is delivered into a polytrauma unit after he received a blunt trauma of the thorax, having fallen from the bicycle. Upon hospitalization his blood pressure is 110/80 mm Hg, heart rate is 96/min. Chest X-ray is noncontributive to the diagnosis. Echocardiogram shows free liquid in the pericardial cavity, in the amount of up to 100ml. In an hour after the hospitalization the patient started to develop increasing signs of heart failure: jugular venous distention, decreased blood pressure down to 90/70 mmHg, tachycardia up to 120/min. On auscultation muffled heart sounds. What would be the primary tactics of a physician?
118. An 8-year-old child presents with blood pressure up to 180/100 mm Hg in the upper limbs accompanied by headaches, tinnitus, occasional nosebleeds, and high fatigability. On examination there is no pulse over the leg arteries. ECG shows left ventricular hypertrophy. MRI-scan shows aortic narrowing to 5 mm in the typical place. Coarctation of aorta is diagnosed. What kind of treatment should be prescribed in this case?
119. A 6-year-old girl arrived to the in-patient unit with complaints of enlargement of the lower third of her right thigh. According to the case history, she has been stepping carefully on her right leg and limping for 6 months. Blood test detected anemia. X-ray of the right thigh shows a round bone defect with clear margins resembling melting sugar in the distal metaphysis. What provisional diagnosis can be made in this case?
120. A 15-year-old girl suffers from systemic lupus erythematosus and has been receiving prednisolone therapy in the daily dosage of 2mg/kg for the last 6 weeks. The plans are made to gradually lower the dosage of the medicine. No clinical signs of her disease are observed. Previously she has received no immunization against measles. Due to measles outbreak it is necessary to develop the immunity against this infection in the patient. When can she be vaccinated?
121. A healthy child 1 year and 5 months of age is being vaccinated against hepatitis B. The child did not receive the first dose of the vaccine previously, while in the maternity hospital. The doctor makes an individual vaccination schedule for this child and plans the administration of the next dose of the vaccine. What is the minimum interval between doses of vaccine in this case?
122. A 6-month-old infant is not vaccinated. The physician recommends a DPT (diphtheria, pertussis, tetanus) vaccination but the mother is absolutely against this procedure. Choose the most substantial argument in favor of vaccination:
123. During administration of planned DPT vaccination the child suddenly developed acute anxiety, signs of pain response, dyspnea, grunting respirations, cutis marmorata, cold sweat. Objectively the child’s consciousness is disturbed, heart rate is 150/min., blood pressure is 60/40 mm Hg, heart sounds are muffled. The child was diagnosed with anaphylactic shock. What drug should be administered first?
124. Among first-year schoolchildren there was a case of measles registered. A 7-year-old boy from the same group was not vaccinated against measles due to refusal of his parents. His clinical history has no cases of measles in the past and is not contraindicatory to immunobiological agents. Choose the most rational tactics of measles prevention in this schoolboy:
125. An 8-year-old boy developed a temperature of 37, 5oC two days after his recovery from the case of URTI. He complains of suffocation, heart pain. Objectively: the skin is pale, tachycardia, the I heart sound is weakened, short systolyc murmur in the 4th intercostal area near the left edge of the breastbone. What heart disorder such clincal presentation is characteristic of?
126. A 9-year-old boy has been suffering from multiple bronchiectasis since he was 3 years old. Exacerbations occur frequently (3-4 times a year), after conservative therapy there are short remission periods. The disease progresses, the child is physically underdeveloped, presents with pale skin, acrocyanosis, deformed nail plates in the shape of ”clock-face”. Bronchography reveals saccular bronchiectases in the lower lobe of the right lung. What further treatment tactics should be chosen?
127. A 9-month-old child presents with fever, cough, dyspnea. The symptoms appeared 5 days ago after a contact with a person with URTI. Objectively: the child is in grave condition. Temperature is 38oC, cyanosis of nasolabial triangle is present. RR- 54/min, nasal flaring during breathing is observed. There was percussion dullness on the right below the scapula angle and tympanic sound over the other areas of lungs. Auscultation revealed bilateral fine moist crackles predominating on the right. What is the most likely diagnosis?
128. A boy was born at 32 weeks of gestation. 2 hours after the birth he developed respiratory distress (RD). The RD severity assessed by Silverman score was 5. The respiratory disorders progressed, respiratory failure could not be eliminated by Martin-Bouyer CPAP(continuous positive airway pressure). X-ray of lungs shows reticular and nodular pattern, air bronchogram. What is the most likely cause of respiratory distress syndrome?
129. An infant is 3 weeks old. Since birth there has been observed periodical vomiting within a few minutes after feeding. The amount of vomitive masses does not exceed the volume of previous feeding. The infant has age-appropriate body weight. What is the most likely cause of this symptom?
130. From urine of a 14-year-old boy with the exacerbation of secondary obstructive pyelonephritis Pseudomonas aeruginosa was isolated with a titer of 1000000 microbes per1 ml. What antibiotic is the most advisable in this case?
131. A 3-year-old girl is being treated at a resuscitation unit with diagnosis ”acute kidney failure, oligoanuric stage”. ECG: high T wave, extended QRS complex, displacement of S-T interval downwards below the isoline. What electrolyte imbalance is it?
132. On the 3rd day of life a newborn, who had suffered birth asphyxia, developed hemorrhage from the umbilical wound. Laboratory analysis reveals hypocoagulation, thrombocytopenia, and hypothrombinemia. What is the cause of such clinical developments?
133. Posture of an 11-year-old boy was determined during preventive examination. The child presents with curled forward rounded shoulders, the head is bowed forward, the thorax is flattened, the stomach is bulging. In the vertebral column there are deepened cervical and lumbar flexures. What posture does the child have?
134. The left hand of a newborn is extended in all its joints, stretched along the torso, and pronated in the forearm. Active movements of the shoulder joint are retained. The hand is flattened, atrophied, cold to touch, hangs passively. Grasping and Babkin’s reflexes are absent at the affected side. Hemogram indicators are normal. Make the most likely diagnosis:
135. An infant cries during urination, the foreskin swells and urine is excreted in drops. What approach to treatment should be chosen?
136. A 14-year-old patient complains of alopecia foci on his scalp. The patient has been presenting with this condition for 2 weeks. Objectively: on the scalp there are several small oval foci with blurred margins. The skin in the foci is pink-red, the hairs are broken off at 4-5 mm length or at skin level. Under Wood’s lamp there are no foci of green luminescence detected. What disease is it?
137. 10 days after birth a newborn developed sudden fever up to 38,1oC. Objectively: the skin in the region of navel, abdomen and chest is erythematous; there are multiple pea sized blisters with no infiltration at the base; isolated bright red moist erosions with epidermal fragments are observed on the periphery. What is the provisional diagnosis?
138. A 12-year-old girl after a case of respiratory infection developed dyspnea at rest, paleness of skin. Heart rate is 110/min., BP is 90/55 mm Hg. Heart sounds are muffled. Borders of relative heart dullness: right - the parasternal line, upper - the III rib, left -1,0 cm outwards from the midclavicular line. Make the provisional diagnosis:
139. A 15-year-old teenager has undergone medical examination in military recruitment center. The following was revealed: interval systolic murmur at the cardiac apex, accent of the II heart sound over the pulmonary artery, tachycardia. What additional examination method will be the most informative for determining diagnosis?
140. A 6-year-old girl came to a general practitioner with her mother. The child complains of burning pain and itching in her external genitalia. The girl was taking antibiotics the day before due to her suffering from acute bronchitis. On examination: external genitalia are swollen, hyperemic, there is white deposit accumulated in the folds. The most likely diagnosis is:
141. ECG revealed the following in a 10-year-old child: sharp acceleration of the heart rate - 240/min., P wave overlaps with T wave and deforms it, moderate lengthening of PQ interval, QRS complex is without alterations. What pathology does this child have?
142. A 13-year-old girl complains of fatigability, frequent headaches, cardialgia. Eight years ago she had a case of pyelonephritis. Urine analyses periodically revealed leukocyturia. The child has undergone no further treatment. On examination: increased BP up to 150/100mm Hg. Ultrasound investigation revealed significant reduction of the right kidney. What process is leading in arterial hypertension pathogenesis in this case?
143. A 3-month-old child presents with saffron-yellow coloring of the skin, sclera, and mucous membranes. The abdomen is enlarged, hepatomegaly and splenomegaly are observed. In blood there is conjugated bilirubin-induced hyperbilirubinemia. On intravenous cholangiocholecystography: opacified bile is discharged into the intestine. Transaminase activity is normal. What is the most likely diagnosis?
144. An 9-year-old child was hospitalized for fever up to 39,8oC, inertness, moderate headache, vomiting. Examination revealed meningeal symptoms. Lumbar puncture was performed. The obtained fluid was characterised by increased opening pressure, was transparent, with the cell count of 450 cells per1 mcL (mainly lymphocytes - 90%), glucose level of 3,6 mmol/l. What agent could have caused the disease in the child?
145. During examination of a healthy infant, the child takes a toy into his hands, turns from the back to the side; when lying on the stomach he can firmly prop himself up on his forearms; the child laughs and makes joyful exclamations. The age of the child is:
146. A full-term newborn (born with the body weight of 3900 g at gestational age of 39 weeks) on the first day of his life developed respiratory disturbances: dyspnea, arrhythmic respiration, cyanosis attacks. On examination there is paradoxical respiration observed and left side of the chest lags behind in the act of breathing. On auscultation the respiration is weakened in the lungs on the left. Neurologist diagnosed the patient with left-sided Erb duchenne palsy. Complete blood count shows no changes. What is the most likely diagnosis?
147. A 12-year-old child had three attacks of acute rheumatic fever accompanied by carditis. Examination revealed the symptoms of chronic tonsillitis, mitral insufficiency, and carious teeth. What is the optimal method of secondary prophylaxis?
148. A 3-year-old child has been delivered to a hospital with complaints of pain in the legs,fever, loss of appetite. Objectively: pale skin and mucosa, hemorrhagic rash. Lymph nodes are enlarged, painless, dense and elastic, not matted together. Bones, joints, and abdomen are painful. The liver and spleen are enlarged. Hemogram: Hb- 88 g/l, color index - 1,3, platelets - 80 · 109/l, leukocytes - 25, 8 · 109/l, lymphoblasts - 70%, ESR- 52 mm/hour. Make the provisional diagnosis:
149. A 14-year-old girl came to a general practitioner with complaints of weakness, loss of appetite, headache, rapid fatigability. Her last menstruation was profuse and lasted for 14 days after previous delay of 2 months. Objectively: the skin is pale, heart rate is 90/min., BP is 110/70 mm Hg, Hb is 88 g/l. Rectal examination: the uterus and its appendages are without changes, no discharge from the genital tracts. What complication occurred in the patient?
150. During last several weeks an 11-year-old girl has been complaining of dyspnea and edema of shins and feet after physical exercise. After a long rest or sleep through the night her edemas diminish significantly. On clinical examination there are enlarged liver and rasping systolic murmur over the cardiac area. Blood and urine analyses are without changes. What is the most likely cause of the child’s edema?
151. In a pre-school educational establishment the menu consists of the following dishes: milk porridge from buckwheat, pasta with minced meat, cucumber salad, kissel (thin berry jelly), rye bread. What dish should be excluded from the menu?
152. A 10-year-old boy had a case of viral hepatitis type B four years ago. Currently the assumption was made about the formation of hepatic cirrhosis in the patient. What additional investigation can clarify the diagnosis?
153. A full term baby born from the 1st non complicated pregnancy with complicated labor was diagnosed with cephalohematoma. On the 2nd day of life the child developed jaundice; on the 3rd day of life there appeared neurological changes: nystagmus, Graefe syndrome. Urine is yellow, feces are golden-yellow. The mother’s blood group is А (II)Rh−, the child’s - А (II) Rh+. On the 3rd day the results of the child’s blood test are as follows: Hb- 200 g/l, erythrocytes - 6, 1 · 1012/l, blood bilirubin - 58 mcmol/l due to the presence of its unconjugated fraction, Ht- 0,57. In this case the jaundice is caused by:
154. 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 gland (II grade). This condition was regarded as a pubertal manifestation, the girl did not undergo any treatment. The girl’s irritability gradually gave place to a complete apathy. The girl developed puffy face, soft tissues pastosity, bradycardia, constipations. Skin pallor and gland density progressed, the skin developed a waxen hue. What disease can be suspected?
155. 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?
156. A 2-year-old girl has a medical history of recurrent obstructive pneumonia. In the lungs various moist and dry crackles can be auscultated, breath sounds are diminished. Sputum is thick, viscous and difficult to expectorate. Drumstick fingers and physical developmental retardation are observed. What preliminary diagnosis can be made?
157. 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?
158. A 6-year-old child complains of frequent liquid stool and vomiting. On the 2nd day of disease the child presented with inertness, temperature rise up to 38, 2oC, Ps- 150/min., scaphoid abdomen, palpatory painful sigmoid colon, defecation 10 times a day with liquid, scarce stool with mucus and streaks of green. What is the provisional diagnosis?
Explanation
Bacterial gastroenteritis is caused by a variety of organisms, including Campylobacter, Salmonella, Shigella, Yersinia, Vibrio cholerae, Staphylococcus aureus, diarrheagenic Escherichia coli, Clostridium difficile, Clostridium perfringens, and non cholera Vibrio species. Shigellosis is also known as bacillary dysentery caused by the infection of the shiga toxin. It is characterised by High-fever, tenesmus,Profuse inflammatory, mucoid-bloody diarrhea and basically affects the large intestine. This patient experiences pain in the sigmoid colon accompanied by profuse diarrhea ( mixed with mucus)
84. The extensive statistical indicator is used to determine a structure of a disease ( in this case, how many percent ( the proportion) of the total diseased fall under cardiovascular cases) ie., it shows, what part from the general number of all diseases is made with this or that disease which enters into total.
The intensive parameter characterizes frequency or distribution. It shows how frequently the given phenomenon occurs in the given environment. 159. A 10-year-old patient has a history of mild bronchial asthma. During a regular check-up the patient should be recommended:
160. A prematurely born girl is now 8 months old. She has dyspnea, tachycardia, hepatosplenomegaly, physical developmental lag, limb cyanosis. There is parasternal cardiac hump, auscultation revealed systolodiastolic murmur in the II intercostal space on the left. BP is 90/0 mm Hg. What disease can be suspected?
161. A 3-month-old girl has rhinitis, dyspnea, dry cough. She has been sick for 2 days. Objectively: pale skin, acrocyanosis, hypopnoe; breathing rate is 80/min.; over the whole pulmonary surface there is vesiculotympanitic (bandbox) resonance observed with numerous bubbling crackles. The most likely diagnosis is:
162. A 4-month-old child was admitted to a surgical department 8 hours after the first attack of anxiety. The attacks happen every 10 minutes and last for 2-3 minutes, vomiting occurred once. Objectively: the child’s condition is grave. Abdomen is soft, palpation reveals a tumor-like formation in the right iliac area. After rectal examination the doctor’s finger was stained with blood. What is the most probable diagnosis?
163. A 2-year-old child in a satisfactory condition periodically presents with moderate proteinuria, microhematuria. US results: the left kidney is undetectable, the right one is enlarged, there are signs of double pyelocaliceal system. What study is required to specify the diagnosis?
