1. A 38-year-old male works within the range of ionizing radiation. At a routi- ne medical examination he presents no problems. In blood: RBCs - 4, 5·1012/l, Hb- 80 g/l, WBCs - 2, 8 · 109/l, thrombocytes - 30 · 109/l. Decide if this person can work with sources of ionizing radiation:
2. A 50-year-old patient has worked at a chemical plant for 15 years. His work involved using xylene solvent. The patient was hospitalized with suspected chronic intoxication. He was found to have anemic syndrome. What is the first- priority measure of secondary anemia prevention?
3. Explosion of a tank with benzene at a chemical plant has killed and wounded a large number of people. There are over 50 victims with burns, mechanical traumas and intoxication. Specify the main elements of medical care and evacuation of population in this situation:
Explanation
In this case, A Triage system is to be followed. Triage is a procedure followed in a medical emergency. It involves the sorting of and allocation of treatment to patients and especially battle and disaster victims according to a system of priorities designed to maximize the number of survivors
These individuals should be allocated into categories such as: Minor, Deceased, Immediate and delayed. Those in the immediate category require instant medical assistance. Lastly, all 50 victims should be evacuated from the site of explosion.
4. It is planned to build a multi- disciplinary hospital with 500 beds in a town. Specify the location of a polyclinic within the medical centre:
5. Survey radiograph of a 52-year-old worker of an agglomeration plant (28 years of experience, the concentration of metal dust is 22-37 mg/m3) shows mildly pronounced interstitial fibrosis with di- ffused contrast well-defined small nodular shadows. The patient has no complaints. Pulmonary function is not compromised. What is the provisional diagnosis?
6. A 45-year-old female patient has worked as a painter for 14 years. Contacts with synthetic paint result in face skin redness, swelling, intense itching, oozi- ng lesions. The symptoms disappear after the exposure to chemical agents, but recur even at the smell of paint. The symptom intensity progresses with relapses. Make a provisional diagnosis:
7. During the periodic medical examination an assembly fitter (works on soldering details) didn’t report any health problems. Closer examination revealed signs of asthenic-vegetative syndrome. Blood included red blood cells with basophilic aggregations and a somewhat higher number of reticulocytes, urine had a high concentration of delta-aminolevulinic acid. The complex of symptoms indicates the initial stage of chronic intoxication with:
8. 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:
9. A patient is on the sick leave for 4 months continuously from the date of injury. The treatment is going to last for 1-2 months more. Who has the right to extend the duration of medical certificate for this patient?
10. A rural hospital serves 6200 people. Preventive examinations were planned for 560 farm workers with different risk factors. 400 workers underwent preventi- ve examination. 120 individuals were found to have cardiovascular problems, 90 of them were registered with a di- spensary department for health care mai- ntenance. Which indicator should be used to assess the organization of health care maintenance at the hospital?
11. A family consists of 5 persons. The husband is a stope miner. His spouse is a housewife. Their 20-year-old daughter works as a kindergarten teacher. Their 18-year-old son is a student. The grandmother is a pensioner, she has diabetes. Which member of this family can be primarily classed among the group of persons with a high risk of tuberculosis in the planning of preventive examinations for tuberculosis?
Explanation
Generally, persons at high risk for developing TB disease fall into two categories:
Persons in the second group include individuals with the following diseases; HIV infection (the virus that causes AIDS), Substance abuse, Silicosis, Diabetes mellitus, Severe kidney disease, Low body weight, Organ transplants, Head and neck cancer, Medical treatments such as corticosteroids or organ transplant, Specialized treatment for rheumatoid arthritis or Crohn’s disease
12. During medical monitoring of labor and professional training of 6th grade schoolchildren the school doctor found that lessons in carpentry workshop are held on Friday as the fourth and fifth lesson of a total of 90 minutes, the motor density at the first lesson is 69%, and 65% at the second. Does the lesson organizati- on meet the hygienic requirements?
13. During coal extraction in a mine the concentration of coal dust in the working area is 450 mg/m3 (MPC is 10 mg/m3). What occupational respiratory disease may develop in miners?
14. The share of circulatory diseases was 15% in the total of registered diseases among city population. What statistic indicator is it?
15. During a regular medical examination at a metallurgical plant 20% of workers were found overweight (body weight was 5-14% higher than normal), and had early signs of obesity (grade I-II) with Quetelet index from 26 to 30. What products share must be reduced in the diet of this group of people in the first place in order to normalize their body weight?
16. Chief physician of a polyclinic encharged 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?
17. In an urban settlement situated on the riverbank an outbreak of hepatitis A was registered. The disease might have water origin. This assumption can be confirmed by growth of the following indicators of water quality:
18. The institutions which take part in medical examinations can be prevention and treatment facilities, medical board of Ministry of Defense, medical board of Ministry of Home Affairs, medico-social expert commissions, forensic medical boards etc. What institutions are responsi- ble for temporary disability examination?
19. A city somatic hospital with 300 beds consists of the main building which houses the therapeutic and surgical departments. Several separate buildings house the maternity, pediatric and radiologic departments that are connected to the main building by underground walkways and above-ground covered skybridges. Specify the building system of the hospital:
20. Sanitary examination of the burns unit for adults revealed that 4-bed wards had an area of 28 m2. What is the minimally required ward area for this department?
21. An employee was on a business trip to another city, where he fell ill and was hospitalized. The sick leave certificate can be issued:
22. In order to reduce weed growth on agricultural land, some herbicides have been used for a long time. In terms of environmental stability these herbicides are rated as stable. Specify the most likely route of their entry into the human body:
23. A selective population research study was aimed at exploring the effect of air emissions from a metallurgical plant on the obstructive bronchitis morbidity in a city. The calculated correlation coefficient was +0,79. Evaluate the strength and direction of the relationship:
Explanation
The Spearman's Rank Correlation Coefficient is used to discover the strength of a link between two sets of data. This example looks at the strength of the link between the effect of air emissions from a metallurgical plant on obstructive bronchitis morbidity.
Correlation is a bivariate analysis that measures the strength of association between two variables and the direction of the relationship. In terms of the strength of relationship, the value of the correlation coefficient varies between +1 and -1. A value of ± 1 indicates a perfect degree of association between the two variables. As the correlation coefficient value goes towards 0, the relationship between the two variables will be weaker. A correlation coefficient of zero indicates that no relationship exists between the variables. The direction of the relationship is indicated by the sign of the coefficient; a + sign indicates a positive/direct relationship and a – sign indicates a negative relationship.
An inverse correlation, also known as negative correlation, is a contrary relationship between two variables such that when the value of one variable is high then the value of the other variable is probably low.
The value of the correlation coefficient ‘r’ can range from 0.0, indicating no relationship between the two variables, to positive or negative 1.0, indicating a strong linear relationship between the two variables.
Value of r
|
Indications
|
0.0
|
No linear relationship between the two variables
|
+1.0
|
Strong positive linear relationship; as X increases in value, Y increases in value also; or as X decreases in value, Y decreases also.
|
-1.0
|
Strong inverse linear relationship; as X increases in value, Y decreases in value; or as X decreases in value, Y increases in value.
|
Therefore, a value of +0.79 is very close to +1.0 and that will give us a strong positive/direct relationship.
24. A general practitioner visited a 2-year-old child and diagnosed him with measles. The child attends a nursery, has a 5-year-old sister. What document must be filled in for the effective antiepidemic measures in the given health locality?
25. Hygienic expertise of a sample taken from the batch of grain revealed that 2% of grains were infected with microscopic Fusarium fungi. On the ground of laboratory analyses this batch of grain should be:
26. Factory’s sectorial doctor chooses a group of chronically ill people. He takes into account the duration of etiologically related cases with a temporary disability over the last year in each of the workers. The employees will fall into this group if the duration is:
27. 6 people live in a modern flat with the total area of 60 m2. There are TV-video equipment, radios, microwave ovens, computer. The residents of the flat complain of bad health, occasional headaches, arrhythmia, conjunctivitis. What is the most likely cause of this condition?
28. A man abused alcohol, drank away the property and wages thus getting hi- mself, his wife and two underage children into deep financial problems. He was regi- stered in a local drug abuse clinic. His wife asked a family doctor, what kind of petiti- on she could file in court:
29. Analysis of organization of medi- cal care in a regional centre has shown that every year about 12% of patients receive inpatient care for diseases that don’t require round-the-clock monitori- ng and intensive care. What are the most appropriate organizational changes requi- red to address this problem?
30. Doctors of a polyclinic conduct a statistical research of the disease outcomes in two groups of patients (those registered with dispensary departments and unregistered ones), depending on age and level of hygiene. What type of statistical tables would be most suitable for profound analysis of the interrelation between the above-mentioned variables?
31. Head of a department and a trade-union group have appealed to the head of a hospital about dismissal of the senior nurse who has 17-year record of service. The facts of charge were confirmed and recognized by the nurse herself. The nurse lives with a daughter (who is divorced and unemployed) and a 9-month-old grandson. Make an administrative decision:
32. Within a year, in a maternity hospital there were 616 livebirths, one stillbirth, one infant died on the 5th day of life. What index can most accurately describe this situation?
33. In one of the surgical departments the quality assurance testing of sterilization of surgical instruments was performed. After an instrument had been treated with 1% phenolphthalein, the solution turned pink. This indicates that the instrument has:
34. Study of natural illumination for a workplace in a secondary school classroom revealed that the angle of sunlight incidence was 25*, window opening angle - 3*, window-to-floor area ratio - 1:4, daylight ratio - 0,5%, depth ratio - 2. What indicators do not meet hygienic standards?
35. Bakers at bread production work in conditions of high temperature and high heat radiation. What is used to increase the body’s resistance to the unfavorable effects of these harmful work environment factors?
36. A study of the structure of death causes in the urban population revealed that cardiovascular diseases accounted for 55,0% of all deaths. What statistic value represents these data?
37. A 51-year-old female is a weaving factory worker with 15 years of service record. During a regular preventive examination she complained of frequent headaches, poor sleep, tingling in the heart, irritability, rapid fatigability, hearing impairment. For years, the noise level has exceeded the maximum allowable concentration by 10-15 dB. A year ago, the patient underwent a course of treatment for essential hypertension. Specify the most likely diagnosis:
38. Some of the population of a city distri- ct have uneven teeth color. The individuals have white spots, transverse brown stripes on the incisors. Occurrence of these symptoms is associated with the quality of drinking water from a deep well. Which of the following components of water can be the cause of the disease?
39. A 48-year-old male in-patient undergoes treatment for essential hypertension of II- B stage. It is known from history that he works in a design engineering office. His job involves neuro-emotional stress. Which of these foodstuffs do not stimulate the central nervous system and can be recommended for the patient?
40. Two years ago, a 46-year-old patient was diagnosed with stage I silicosis. Currently the patient complains of escalating dyspnea, pain in the infrascapular regions. Radiograph shows a diffuse enhancement and distorti- on of lung markings, as well as multiple nodular shadows 2-4 mm in diameter. There is interlobar pleural density on the right. Dense shadows are found in the hilar regions. Specify the form of radiographic pulmonary fibrosis in this case:
41. During dressing of a poorly-granulating wound Pseudomonas aeruginosa infection was revealed. What medication would be optimal for the wound d-bridement?
42. Examination of a dead man who died from hanging revealed that cadaver spots disappeared when pressed upon and restored after 50 seconds, rigor mortis was moderately expressed only in the masticatory muscles and the muscles of neck and fingers. Body temperature was 31*C. Specify the time of death:
43. An employee of a petrol station with 15 years of service record having contact with ethylated gasoline presents with memory impairment, bradycardia, sensation of having a hair in the mouth, skin paresthesia. In this case, one can assume intoxication with the following substance:
Explanation
From anamnesis, this patient has been exposed to Ethylated gasoline for the nature of his Job. Tetraethyl Lead is a lead compound found in Ethylated gasoline. On chronic exposure, individuals present with memory loss, neurological problems, insomnia, psychosis, tremors etc.
Patients with organophosphate poisoning usually present with Salivation, Lacrimation, Urination, Defecation, Gastric cramps, Emesis (SLUDGE) symptoms.
44. A 38-year-old female suddenly developed acute inflammatory rash in form of roseolas, papules, vesicles that are scattered on the skin of trunk in irregular and predominantly focal manner. The rash appeared a few hours after visiting a restaurant. The patient complains of itching skin. What is the most likely diagnosis?
Explanation
Toxicodermatosis is a disease of the skin caused by a poison or by an allergen. The causative agents may be such chemical substances as antibiotics, sulfanilamides, and bromine, iodine, arsenic, and mercury compounds, or such food products as berries, cheese, or fish. As described in this scenario, the rash appeared after visiting a restaurant. Toxicoderma can also occur as a metabolic disorder or an occupational disease.
The causative agent enters the body through the respiratory organs or the digestive tract, during injections, or by direct contact with the skin. The primary manifestation of toxicoderma is a rash, which is generally symmetrical; it can take the form of inflamed or hemorrhagic maculae, papule, or vesicles (blisters). In severe cases, widespread areas of the skin are affected (erythroderma) and the patient manifests fever, cardiovascular disorders, or symptoms of anaphylactic shock.
With the removal of the allergen the symptoms of toxicoderma rapidly disappear, although relapses (usually severe) may occur with subsequent repeated exposure to the causative agent. Treatment consists in avoiding contact with the suspected allergen or toxic agent, as well as in the use of desensitizing agents and of expectant treatment.
Atopic dermatitis is a chronic condition that requires symptom management. It’s characterized by an itchy, red rash that usually appears at joints in your body, such as knees or elbows, and even around the neck. This condition occurs in flare-ups or bouts, meaning that it gets worse and improves in irregular cycles.
Many doctors use the terms “atopic dermatitis” and “eczema” interchangeably. They are both generic terms for “inflammation of the skin.” Eczema usually starts in early infancy, but also affects a substantial number of adults. It is commonly associated with elevated levels of immunoglobulin E (IgE) and a series of allergic diseases—including food allergy, asthma, and allergic rhinitis.
Contact Dermatitis occurs when your skin has a reaction to something it’s come in contact with. This can include bleach, soap, poison ivy, certain metals, or other irritants. The rash is typically red and may itch or burn.
45. Public nurseries are designed as a single or several one- or two-storey buildings linked by covered walkways. Planning the structure of preschool instiutions is based upon the following principle:
46. A 50-year-old male in a grave condition has been admitted to the intensive care unit. It is known from life history that the patient works in agriculture, and 3 hours ago was engaged into insecticide treatment of crops for control of colorado potato beetle. Condition on admission: acrocyanosis, bronchorrhea, tachypnea, AP- 100/60 mm Hg, Ps- 44/min. What method of efferent therapy would be most appropriate at this stage?
Explanation
Hemosorbtion: Removal of toxins or metabolites from the circulation by the passing of blood, within a suitable extracorporeal circuit, over semipermeable microcapsules containing adsorbents (e.g., activated charcoal) or enzymes, or other adsorbents (e.g., various resins, albumin-conjugated agarose).
Hemodialysis: A medical procedure to remove fluid and waste products from the blood and to correct electrolyte imbalances. This is accomplished using a machine and a dialyzer, also referred to as an "artificial kidney."
Hemodialysis is used to treat both acute (temporary) and chronic (permanent) kidney failure.
Plasmapheresis (PP) is the removal of whole blood from the patient, its separation by machine into component parts, and then the return of certain of those components to the patient. Indications include Gulliane-barre syndrome, good pasture syndrome, chronic demyelinating disorders , Thrombotic thrombocytopenic purpura etc.
47. Carpathian region is characterized by permanently high (over 80%) air humidity. In the cold season the population of this region feels very cold at moderately low temperatures. This is due to an increase in the heat transfer by:
48. An employee has been diseased for 4 months, further treatment is necessary, the patient is incapacitated. Who is authorized to provide further disability examination of this patient?
49. A factory’s sectorial doctor selects a group of persons who often fall ill for thorough monitoring. At the same time he takes into consideration the number of etiologically related cases with temporary disability in each of the employees over the last year. An employee falls into this group if the number of sickness cases is:
50. A family lives in the town situated within the zone of radiation pollution. A 6-year-old child had been ill with ARVI for 19 days. The child was undergoing outpatient treatment and was nursed by his mother, a cafe worker. Specify the order of disability examination:
51. It is planned to organize a rural outpati- ent clinic. The patients will be able to visit the doctors of the following specialities:
Explanation
52. A 12-year-old girls has minor functi- onal and morphological abnormalities: 1,0 D myopia, reduced body resistance. The patient has no history of chronic diseases. Over the last year, there were 4 cases of respiratory di- seases. The girl belongs to the following health group:
53. A hospital nutrition unit received a batch of beef. Sanitation physician examined the meat and revealed the presence of 5 bladder worms per 40 cm2 of meat. Give the hygienic assessment of meat:
54. An emergency physician arrived to provide medical care for a hangman taken out of the loop by his relatives. The doctor revealed no pulse in the carotid arteries, lack of consciousness, spontaneous breathing and corneal reflexes; cadaver spots on the back and posterior parts of extremities. A person can be declared dead if the following sign is present:
Explanation
Forensic pathologists are essentially required to estimate the time since death (TSD) to assist in death investigation. The early post-mortem phase is most frequently estimated using the classical triad of post-mortem changes – rigor mortis, algor mortis and livor mortis.
Algor Mortis: Humans are warm-blooded organisms, which means that we maintain a constant internal temperature, regardless of the outside environment. The brain is our thermostat and the circulatory system is the main heat dissipator. However, within seconds of death, the brain cells begin to die and the heart stops pumping blood. Without the brain and and the blood distributing heat, the corpse eventually starts to match the outside temperature.
Rigor mortis is the post-mortem stiffening of muscles, caused by the depletion of adenosine triphosphate (ATP) from the muscles.
Livor Mortis: This is the final stage of death. When the heart stops beating, the blood is now at the mercy of gravity. It tends to collect at certain parts of the body. Depending on the position of the body, these parts would vary. For instance, if the person was flat on their back when they died, the blood would collect in the parts that are touching the ground (just as in this patient - cadaver spots were on the back and posterior parts of the extremities). If the person was hanging, it would collect in their fingertips, toes, and earlobes. Lividity starts with the skin where the blood has settled developing a bright red color. After a few hours, the color changes from red to bluish-purple. The bluish coloring of the skin is called livor mortis or cadaver spots.
55. A 69-year-old male patient has been hospitalized with hypothermia. Objectively: the patient is pale, has shallow breathing. AP- 100/60 mm Hg, Ps- 60/min. Palpation of the abdomen and chest reveals no pathological signs. The body temperature is of 34.8*C. The patient’s breath smells of alcohol. Give treatment recommendations:
Explanation
Hypothermia is a severe condition in which the body temperature drops to an abnormally low level. It occurs when the body is unable to produce enough heat to counter the heat that it is losing. Under healthy conditions, the body maintains a relatively stable temperature of around 98.6˚F or 37˚C.
The following techniques can help treat hypothermia:
Passive external rewarming: This uses the individual’s heat-generating ability. It involves removing their cold, wet clothing, ideally replacing it with adequately insulated, dry clothing, and moving them to a warm environment.
Active external rewarming: This involves applying warming devices, such as hot-water bottles or warmed forced air, externally to truncal areas of the body. For example, the individual could hold a hot-water bottle under each arm.
Active core rewarming: This uses warmed, intravenous fluids to irrigate body cavities, including the thorax, peritoneum, stomach, and bladder. Other options include getting the individual to inhale warm, humidified air, or applying extracorporeal rewarming by using a heart-lung machine.
Do not give a person alcohol if they have signs of hypothermia, and avoid giving any drinks to an unconscious person.
Considering the critical condition of this patient, active core warming by using warmed intravenous fluids which gets into the system immediately and will bring the most desired result at the shortest time possible is by far the best treatment recommendation.
56. Examination of an electric welder with 15 years of service record revealed dry rales in the lower lung fields. Radiograph shows diffuse nodules sized 3-4 mm in the middle and lower lung fields. What disease can be suspected?
57. Evaluation results of sanitary and hygiene
conditions in a 4-bed ward were as follows: ward area - 30 m2, height - 3,2 m, temperature - 20o C , humidity - 55%, air velocity - 0,1 m/s, window-to-floor area ratio - 1:5, daylight ratio - 0,6%, concentration of carbon dioxide in the air - 0,1%. Which of the given indicators does not meet hygienic requirements?
58. The outpatient department of a city hospital works also as a 60-bed day hospital for somatic patients. The department operates in a single-shift mode. What specialist selects patients for admission to the day hospital?
59. Within the structure of the population the share of persons aged 0 to 14 years is 25%, the share of persons aged 50 years and older is 30%. What concept most accurately describes this demographic situation?
60. During examination of a patient, the doctor detected in him disorders of the eyes (hemeralopia, Bitot\'s spots), skin and skin appendages, mucosa, and gastrointestinal tract. He was provisionally diagnosed with Prasad\'s syndrome. What causes the development of this pathology?
61. A 37-year-old woman received an occupational trauma that resulted in a severe vision impairment. Now she needs to be trained for another occupation. What type of rehabilitation should the doctor choose for the patient in this case?
62. A 28-year-old man, a teacher, after an emotional stress developed painful muscle spasms in his right hand that occur during writing; now he has to hold the pen between the second and third fingers. He has no problems with typing or writing on the blackboard; no other motor disturbances or neurological pathologies are detected. What is the most likely diagnosis?
63. The director of a medical facility draws up a financial plan for the next year. To improve the economic well-being of his establishment, he decided to increase the amount of medical services provided. How will it change the fixed cost per unit of service?
64. 40% of the workers, who polish the art glass, using an abrasive disk, and have a long record of employment, are diagnosed with ulnar neuritis, 21% - with vegetative polyneuritis, and 12% - with vegetomyofascitis of the upper limbs. These pathologies are associated with the following harmful factor:
65. After a long drive with the window open a man developed a facial asymmetry; he cannot close his right eye, his right nasolabial fold is smoothed out, movements of expression are absent on the right, there is a disturbance of taste sensation in the tongue on the right. No other neurological abnormalities were detected. What disease can be provisionally diagnosed in this case?
66. A 30-year-old woman made an appointment with the family doctor for scheduled vaccination of her 2-year-old child. What type of healthcare provides such medical services?
Explanation
According to levels of specialization, types of medical care include: Emergency, Primary, Secondary, Tertiary, palliative, medical rehabilitation and dentistry.
Primary medical care: involves care given by nurses, midwives, general physicians, family doctors, in polyclinics etc. One major aspect of primary health care is preventive medicine - these include vaccination, teaching on methods for good living etc.
Secondary medical care: When your primary care provider refers you to a specialist, you are then in secondary care. Secondary care simply means you will be taken care of by someone who has more specific expertise eg cardiologist, endocrinologist etc
Tertiary Medical Care: Once a patient is hospitalized and needs a higher level of specialty care within the hospital, he may be referred to tertiary care. Tertiary care requires highly specialized equipment and expertise.
67. A patient is 45 years old. He was referred for a consultation with a psychiatrist due to complaints of abdominal pain and discomfort that occur in emotionally straining situations. Objectively no changes of the gastrointestinal tract were detected. The complaints emerged over 10 years ago against the background of severe alcohol poisoning. The patient has been repeatedly visiting gastroenterologists, who were unable to find any significant changes in the patient. The prescribed therapy was ineffective. What is the likely conclusion?
Explanation
In Somatoform Autonomic dysfunction, the symptoms are presented by the patient as if they were due to a physical disorder of a system or organ that is largely or completely under autonomic innervation and control, i.e. the cardiovascular, gastrointestinal, respiratory, and urogenital systems. Clinical and instrumental examination revealed no organic alterations in any system therefore indicating a somatoform autonomic dysfunction.
Organic brain syndrome is defined as a state of diffuse cerebral dysfunction associated with a disturbance in consciousness, cognition, mood, affect, and behavior in the absence of drugs, infection, or a metabolic cause
68. Forensic autopsy of the body of a 59-year-old man, who died suddenly at home without signs of violent death, shows pink skin and mucosa, liquid bright-red blood, and bright-red plethoric internal organs. Forensic toxicology testing detected 1.44°/00 of ethanol in the blood and carboxyhemoglobin levels of 55%. What is the cause of death?
69. For 20 years the role of excessive weight in ischemic heart disease development among the working age male population over 40 was studied. It was determined that overweight men developed ischemic heart disease more often. What type of epidemiological study is it?
70. In a pediatric clinic, located in a rural area, there are 9 children, who simultaneously fell ill. The following signs were detected: low physical activity, acrocyanosis of the nasolabial triangle and fingertips, mucosal cyanosis, tachycardia, dyspnea. It was determined that all the sick children were fed with a formula that was dissolved in the water taken from a dug well. Laboratory analysis revealed high levels of methemoglobin in the blood of the children. These signs can be caused by increased content of a certain element in the water. Name this element:
71. When planning treatment of a patient, it was decided to use a medicine with evidence level A. What trials produce the evidence that allows to classify the medicine as level A?
72. A 57-year-old man, a miner, complains of a pain in his chest, dyspnea on physical exertion, excessive sweating, constant subfebrile tempeature, and cough that produces blood-streaked sputum. He has been smoking for approximately 40 years (2 packs a day) and frequently has ’’pneumonias” Survey chest X-ray shows a triangular shadow in the middle lobe of the right lung. One of the apices of the shadow points to the lung root. Cardiac and mediastinal shadows are displaced toward the affected area. Make the provisional diagnosis:
73. A district doctor has diagnosed one of his patients with dysentery What accounting document reflects this type of morbidity?
74. What modern organzational method can provide the patients in the remote settlements with timely access to quality medical aid and such medical services as consulting, diagnostics, and treatment, especially in the situations when time and distance are crucial?
75. A man works in casting of nonferrous metals and alloys for 12 years. In the air of working area there was registered high content of heavy metals, carbon monoxide, and nitrogen. During periodic health examination the patient presents with asthenovegetative syndrome, sharp abdominal pains, constipations, pain in the hepatic area. In urine: aminolevulinic acid and coproporphyrin are detected. In blood: reticulocytosis, low hemoglobin level. Such intoxication is caused by:
76. On laboratory investigation of a pork sample there is 1 dead trichinella detected in 24 sections. This meat should be:
77. Employees work in conditions of high dust concentration. Certain chemical (silicon dioxide content) and physical properties of dust aerosols contribute to the development of occupational dust-induced diseases. What is the main physical property of dust aerosols?
78. A 39-year-old man, a battery attendant, suddenly developed weakness, loss of appetite, non-localized colicky abdominal pains, and nausea. Objectively his skin is gray; there is a pink-gray stripe on his gums; the abdomen is soft and sharply painful. Blood test detected erythrocytes with basophilic stippling and anemia. The patient has a history of peptic ulcer disease of the stomach. Constipations occur each 3-4 days. What is the most likely provisional diagnosis?
79. During regular medical examination a lyceum student presents with signs of cheilitis that manifests as epithelial maceration in the area of lip seal. The lips are bright-red, with single vertical cracks covered with brown-red scabs. These clinical signs are most likely caused by insufficient content of the following in the diet:
80. Children from a certain township present with brittle teeth, malocclusion, dental enamel erosions, and dental pigmentation that looks like yellow-brown spots. What is the likely cause of this presentation?
81. An unconscious patient was delivered to a hospital by an ambulance. Objectively his body temperature is 39°C, he presents with convulsions and red dry skin. It is known that the patient works as a stoker in the boiler room. What is the likely diagnosis?
Explanation
From anamnesis, we observe that this patient works in a very hot/steaming environment; the signs shown by this patient i.e. a red dry skin and a temperature of 39℃ indicates the effect of heat on the patient.
Heat stroke is a form of hyperthermia in which the body temperature is elevated dramatically. The cause of heat stroke is an elevation in body temperature, often accompanied by dehydration.
The most common symptoms of CO (carbon monoxide) poisoning are headache, dizziness, weakness, upset stomach, vomiting, chest pain, and confusion on the background of inhalation of fumes from cars, generators etc.
Acute food poisoning will often present with vomiting, nausea and diarrhea.
82. A 56-year-old woman has been working as a disinfector for 19 years. She complains of general weakness, nausea, bitter taste in her mouth, heavy sensation in her right subcostal area, and rapid fatigability Objectively her body temperature is 37°C, the sclerae are icteric, and the liver is enlarged, total bilirubin is 40 mcmol/L. What is the likely diagnosis?
83. A middle school teacher with 4-year-long record of work was issued a medical certificate for pregnancy and childbirth leave. What amount of pay will she receive for the duration of her leave in this case?
84. In the inpatient gynecological unit within a year 6500 women underwent treatment. They spent there a total of 102000 bed-days. What indicator of the gynecological unit work can be calculated based on these data?
85. At the railroad crossing a passenger train collided with a bus. In this collision 26 bus passengers died, another 18 passengers received mechanical injuries of varying severity. Where will be professional medical aid provided for the victims of this accident? Who will provide this aid?
86. A 42-year-old man, a dispatcher, suffers from peptic ulcer disease of the duodenum. The disease is of moderate severity. He wants to be assigned a disability group. Make the conclusion regarding his working ability:
87. In the air of the feed kitchen at the poultry factory, at the area where formula feed is being mixed, the dust concentration reaches 200 mg/m3. Air microflora is represented predominantly by Asperqillus and Mucor fungi. What effect determines pathogenic properties of the dust?
88. 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?
Explanation
Celiac disease is an immune reaction to eating gluten, a protein found in wheat, barley and rye. Sometimes called celiac sprue or gluten-sensitive enteropathy. When people with celiac disease eat gluten (a protein found in wheat, rye and barley), their body mounts an immune response that attacks the small intestine. These attacks lead to damage on the villi, small fingerlike projections that line the small intestine, that promote nutrient absorption. When the villi get damaged, nutrients cannot be absorbed properly into the body.
Celiac disease is hereditary, meaning that it runs in families. People with a first-degree relative with celiac disease (parent, child, sibling) have a 1 in 10 risk of developing celiac disease.
Celiac disease can develop at any age after people start eating foods or medicines that contain gluten.
Oats contain avenin, which is a protein similar to gluten. Research has shown that most people with coeliac disease can tolerate gluten free oats with no problems. The issue is that sometimes oats are produced in the same place as wheat, barley and rye, and then become contaminated with these other grains.
89. A regional cardiologist is given a task to develop a plan for preventive measures aimed at decreasing cardiovascular mortality rates. What measures should be planned for secondary prevention?
90. 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:
91. Caries morbidity rate is 89% among residents of a community. It is determined that fluorine content in water is 0.1 mg/L. What preventive measures should be taken?
92. A 39-year-old man, a battery attendant, suddenly developed weakness, loss of appetite, nonlocalized colicky abdominal pains, and nausea. Objectively his skin is gray; there is pink-gray stripe on his gums; the stomach is soft and sharply painful. Blood test detected erythrocytes with basophilic stippling and anemia. The patient has a history of peptic ulcer disease of the stomach. There is tendency to constipation. What is the most likely provisional diagnosis?
93. The inpatient surgery unit has introduced the method of laparoscopic cholecystectomy into its practice. As the result the average duration of postoperative care provided to the patients could be reduced to 3.4±0.8 days compared to 7.3±1.1 days that were required after non-laparoscopic cholecystectomy. What method of medical statistics can confirm the statistical significance of the difference between these two estimates?
94. A 37-year-old worker during a fire ended up in the area of high CO concentration. He was delivered to a hospital in unconscious state. Objectively: the skin of his face and hands is crimson. Respiration rate is 20/min. ECG: alterations specific for hypoxic myocardium. Hourly diuresis is 40 ml. Blood test: erythrocytes -4.5·1012/L, Нb- 136 g/L, color index - 0.9, ESR-3 mm/hour, carboxyhemoglobin - 5%. What criterion allows determining the severity of the patient’s condition?
95. In April during the medical examination of various population groups, 27% of individuals presented with low working ability and rapid fatigability. The following symptoms were observed in the affected individuals: swollen friable gingiva that bleeds when pressed, hyperkeratosis follicularis not accompanied by skin dryness. These symptoms most likely result from the following pathology:
96. A man works in casting of nonferrous metals and alloys for 12 years. In the air of working area there was registered high content of heavy metals, carbon monoxide, and nitrogen. During periodic health examination the patient presents with asthenovegetative syndrome, sharp pains in the stomach, constipations, pain in the hepatic area. In urine: aminolevulinic acid and coproporphyrin are detected. In blood: reticulocytosis, low hemoglobin level. Such intoxication is caused by:
97. Due to introduction of a new treatment method, average duration of therapy in the experimental group was 12.3±0.2 days compared to 15.4±0.4 days in the control group that was treated by the old method. What calculations should be made to estimate the statistical significance of the difference in the results?
98. Establishments participating in medical examinations include: medical and preventive treatment facilities, hygiene and preventive treatment facilities, sociomedical expert committees, Ministry of Defence medical committees, Ministry of Domestic Affairs medical committees, forensic medicine agency, etc. Specify what service deals with sociomedical assessment of temporary disability:
99. In the process of hiring, a prospective employee has undergone preventive medical examination and was declared fit to work in this manufacturing environment. What type of preventive medical examination was it?
100. An employee has been sick for 4 months, further treatment is necessary, the patient is unable to work. Who is authorized to provide further disability examination of this patient?
101. A population of a small town often presents with registered cases of juvenile cardiomyopathy, atherosclerosis, hypertension, endocrinopathy, chronic dermatitis, and arthralgia - signs of Keshan disease. What is the most likely cause of this pathology?
102. To assess the effectiveness of medical technologies and determine the power and direction of their effect on the public health indicators, the research was conducted to study the immunization rate of children and measles incidence rate by district. What method of statistical analysis should be applied in this case?
103. The objective of a statistical research was to find out to what extent the population peruses the available medical services. For this purpose 300 residents of the area were interviewed. Information was collected by means of a special questionnaire. What method of collecting information was used by the researchers?
104. Estimation of community health level involved analysis of a report on diseases registered among the population of district under charge (reporting form 12). What index is calculated based on this report?
105. The body of a 24-year-old woman with probable signs of poisoning has been found on the street. Forensic medical examination was requested by an investigator during examination of the site and the body. According to the criminal Procedure Code currently in force in Ukraine, forensic medical examination is required when it is necessary to determine the:
106. An excavator operator with 20 years of work experience at the opencast ore mine undergoes regular medical examination. He presents with signs of pneumoconiosis. What type of pneumoconiosis is the most likely in this case?
107. A 52 year old man came to see his family physician complaining of pain in the chest. After taking history and performing physical exam the doctor decided to direct the patient to cardiologist for a consultation. What level of medical care is being proposed to the patient?
Explanation
According to levels of specialization, types of medical care include: Emergency, Primary, Secondary, Tertiary, palliative, medical rehabilitation and dentistry.
Primary medical care: involves care given by nurses, midwives, general physicians, family doctors, in polyclinics etc. Primary healthcare is the first contact a person has with the health system when they have a health problem.
Secondary medical care: When your primary care provider refers you to a specialist, you are then in secondary care. Secondary care simply means you will be taken care of by someone who has more specific expertise eg cardiologist, endocrinologist etc
Tertiary Medical Care: Once a patient is hospitalized and needs a higher level of specialty care within the hospital, he may be referred to tertiary care. Tertiary care requires highly specialized equipment and expertise.
At this level, you will find procedures such as coronary artery bypass surgery, renal or hemodialysis, and some plastic surgeries or neurosurgeries.
108. A 30-year-old woman made an appointment with the family doctor for scheduled vaccination of her 2-year-old child. What type of healthcare provides such medical services?
Explanation
According to levels of specialization, types of medical care include: Emergency, Primary, Secondary, Tertiary, palliative, medical rehabilitation and dentistry.
Primary medical care: involves care given by nurses, midwives, general physicians, family doctors, in polyclinics etc. Primary healthcare is the first contact a person has with the health system when they have a health problem. For example, Immunizations/Vaccinations, health education on benefits of exercise, healthy diet etc., are some of the responsibilities of a primary health care system.
Secondary medical care: When your primary care provider refers you to a specialist, you are then in secondary care. Secondary care simply means you will be taken care of by someone who has more specific expertise eg cardiologist, endocrinologist etc
Tertiary Medical Care: Once a patient is hospitalized and needs a higher level of specialty care within the hospital, he may be referred to tertiary care. Tertiary care requires highly specialized equipment and expertise.
109. A 38-year-old woman has been working as a milker for 15 years. She made an appointment with the doctor due to development of red rashes on her hands, predominantly in the interdigital space. The rashes are weeping, itching, and expanding on her skin. Examination of her hands shows her nail plates to be yellow and brittle. These presentations aggravate during work. Make the provisional diagnosis:
110. 40-50 minutes after the completion of repair works conducted in a closed garage, with car engine running, the repair workers developed severe headache in the temporal area, nausea, tinnitus, vertigo, etc. These symptoms are characteristic of acute poisoning with:
111. A 37-year-old man working as a typesetter in a print shop complains of rapid fatigability, paroxysmal attacks of stomachache, weak drooping hands. Examination of neurological status revealed hypotrophy of the forearm muscles. Carporadial reflexes are sharply weakened. Sensitivity is not disturbed. Gums present with dark blue border. What neurological pathology is it?
112. A 32-year-old pregnant woman at the term of 5-6 weeks was vaccinated against influenza along with her whole family. At that time she was not aware of her pregnancy. The pregnancy is wanted. The woman needs an advice from the family doctor regarding the maintenance of her pregnancy, namely whether there is a risk of fetal malformations because of received vaccination. What advice should the doctor give in this case?
113. 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?
114. A 45-year-old woman has been suffering from rheumatoid arthritis for 10 years and takes methotrexate twice a week. What statement regarding vaccination against pneumococci (23-valent vaccine) would conform to the recommendations for the management of rheumatoid arthritis issued by the European league Against Rheumatism in 2010?
115. A 65-year-old woman was diagnosed with the following: chronic rheumatic heart disease, l degree of rheumatic activity; combined mitral heart disease with prevalence of III degree stenosis; heart failure IIA with retained left ventricular ejection fraction, functional class lII (NYHA). What tactics of vaccination against respiratory infections should be chosen to provide secondary prevention of exacerbations and to avoid heart failure decompensation in this patient?
116. A 60-year-old man presents with subcompensated viral liver cirrhosis (HCV), Child-Pugh class B. What tactics should be chosen regarding the vaccination against influenza in this case?
117. A 20-year-old student was brought to the first-aid center. He has a closed fracture of the left forearm and a contused lacerated wound on his left shin. After the patient received initial wound management, he presented the documents confirming that he has received all the necessary preventive vaccination as scheduled. What should the doctor do to prevent tetanus in this patient?
118. A 40-year-old man developed fever up to 37.5*C and macular rash 10 days after the first dose of MMR (Measles-Mumps-Rubella) vaccine was administered. The vaccination was considered necessary as there was a measles outbreak in the city and the patient had not received MMR vaccination in his childhood. Is revaccination with MMR vaccine possible?
Explanation
Side effects from MMR vaccines that can occur 7 to 10 days after vaccination include:
-
fever (can be more than 39.4 °C), lasting two to three days
-
faint red rash (not infectious)
-
head cold, runny nose, cough or puffy eyes
-
drowsiness or tiredness
-
swelling of salivary glands
-
localised pain, redness and swelling at the injection site.
2 doses of the MMR vaccine provide the best protection against measles, mumps and rubella. The above listed side effects are expected in a small percentage of the population. Once the first dose is given, if any of the above listed side effects should occur, it is not a contraindication for the second dose as these side effects are expected.
So, it is possible, as the patient in question, only had low grade fever and a macular rash.
However, it is important to note that uncommon and rare side effects like serious allergic reaction (anaphylaxis) might require a course of glucocorticoids treatment or given together with antihistamines. Thrombocytopenia, which is bleeding caused by insufficient blood platelets might be a contraindication for a revaccination. But that is not the case in this question. 119. A 26-year-old man is undergoing a regular check-up. One year ago he had a case of tonsillar diphtheria complicated with myocarditis. Presently his condition is satisfactory, no signs of cardiovascular failure; ECG shows first-degree atrioventricular block. What vaccine was administered to this man according to his age?
Explanation
This patient had Diphtheria a year ago but currently, his condition is satisfactory. The question wants to know which vaccine was given to him a year ago that helped in managing the disease.
D- Diphtheria; T- Tetanus; P- Pertussis (Whooping cough); aP- acellular pertussis vaccine.
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. Therefore, in this patient who is older than 7 years (26 year old man), he was given a diphtheria and Tetanus 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.
-
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.
120. A patient received flame burns of both hands. On the dorsal and palmar surface of the hands there are blisters filled with serous fluid. The wrist joint region is hyperemic. The forearms were not injured. What is the provisional diagnosis?
Explanation
Rule of “nines” – area of different areas of the body is proportional: anterior surface of the trunk – 18 %, posterior – 18 %, lower limb – 18 %, external genitals – 1 %);
Rule of “palm”. It is used if burns are limited and located on different areas of the body.
According to the rule of palm takes 1 % of the skin surface.
Division of the burns on superficial (I, II, IIIA st.) and deep (IIIB-IV st.)
I stage – hyperemia of the skin
II stage – separation of epidermis with formation of bullas
III A stage – necrosis of superficial layers of the skin with saving of bulbs hair, sweat glands and sebaceous glands.
IIIB stage – necrosis of all the derma
IV stage – necrosis of the skin and underlying tissues.
Palmar surface - 1%; Dorsal surface - 1%, that's 2% for one hand and that will be 4% for both hands.
Blisters (bullae) - Stage II
121. During the periodic medical examination an assembly fitter (works on soldering details) didn’t report any health problems. Closer examination revealed signs of asthenic vegetative syndrome. Blood included red blood cells with basophilic aggregations and a somewhat higher number of reticulocytes, urine had a high concentration of delta aminolevulinic acid. The complex of symptoms indicates the initial stage of chronic intoxication with:
122. 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:
123. 45-year-old man complains of cough fits and tickling in his nasopharynx. He had been staying for 10 days in the polluted area created by the Chornobyl nuclear power plant accident. Rhinoscopy shows signs of severe nasopharynx irritation. What radionuclide is the cause of this irritation?
124. A 28-year-old man complains of skin rash and itching on the both of his hands. The condition persists for 1,5 years. The exacerbation of his condition he ascribes to the occupational contact with formaldehyde resins. Objectively: lesion foci are symmetrically localized on both hands. Against the background of erythema with blurred margins there are papulae, vesicles, erosions, crusts, and scales. What is the most likely pathology?
125. During assessment of work conditions at the mercury thermometer manufacture, content of mercury vapors in the air of working area is revealed to exceed maximum concentration limit. Specify the main way of mercury penetration into the body:
126. During health assessment of car drivers and police officers on point duty, the physicians detected carboxyhemoglobin in the blood of the patients, weakened reflex responses, disturbed activity of a number of enzymes. Revealed professional health disorders are most likely to be associated with the effect of
127. On laboratory investigation of a pork sample there is 1 dead trichinella detected in 24 sections. This meat should be:
128. Examination of a 43-year-old man objectively revealed pallor of skin and mucous membranes, loss of tongue papillae, transverse striation of fingernails, cracks in the mouth corners, tachycardia. Blood test results: Hb- 90 g/l, anisocytosis, poikilocytosis. The most likely causative factor of this condition is the inadequate intake of:
129. A 47-year-old man is employed at the weaving workshop, has 15-year-long record of service at this factory; his work conditions are associated with high frequency and high-intensity noise. During periodical examination he was diagnosed with occupational deafness. What are the grounds for making such a diagnosis?
130. 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?
131. Clinic of a research institute 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 of Social Insurance Fund, trade union. According to the ”regulation on investigation of. . . ”, the commission should be headed by the representative of the following authority:
132. Bacterial analysis of air in a living space in winter period by means of Krotov’s apparatus revealed that total number of microorganisms in 1 m3 of air was 7200. What is the allowed number of microorganisms for the air to be characterized as ”pure”?
Explanation
Air cleanness estimation according to indexes of bacteriological research in different year periods.
Air estimation
|
Microorganisms Contents in 1m3 of air.
|
|
Generally
|
Streptococcus hemolyticus
|
Generally
|
Streptococcus hemolyticus
|
|
Summer period
|
Winter period
|
Clean
|
less 1500
|
less 16
|
less 4500
|
less 36
|
Moderately muddy
|
1500 - 2500
|
16-35
|
4500-7000
|
36-125
|
Muddy
|
more 2500
|
more 35
|
more 7000
|
more 125
|
133. 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?
134. A 48-year-old woman has thermal burns of both hands. The epidermis of the palms and backs of her hands is exfoliating, and blisters filled with serous liquid are forming. The forearms are intact. What diagnosis is most likely?
135. An electro-gas welding operator working at a machine workshop performs welding and cutting of metal, which is accompanied by intense UV-radiation. His welding station is equipped with efficient mechanical ventilation. What occupational disease is most likely to develop in an electro gas welding operator?
136. Monthly dysentery morbidity in the regiongiven 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?
137. A 50-year-old man, who works as a polisher at a combine building factory, addressed the factory’s sectorial doctor with complaints of general fatigue, sensations of 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?
138. A worker, who was involved in fire fighting inside the building that stored 2 kg of mercury, has been delivered to a hospital with complaints of emotional expansiveness, palpitations, excessive sweating, body tremor, heart pain. Within one day his condition aggravated. Objectively: the skin is pale and moist. The patient is depressed. Permanent red dermographism, erethism, unstable BP are observed. What drug is the serum in this case?
139. During meat testing Trichinella was detected in diaphragm crura in one of the two muscular tissue samples. What tactics should a doctor choose regarding this meat?
140. The following indicators were calculated to analyse population health and treatment quality in a cardiological hospital: primary cardiovascular morbidity - 62%; total cardiovascular morbidity - 483,55%; cardiovascular mortality - 10,9%; proportion of cardiovascular mortality within total mortality -67,0%; primary disablement caused by cardiovascular diseases - 16,2 per 10.000 population. What indicator is an extensive value?
141. After a lengthy march an army regiment has set camp for 3 days near a settlement. Sanitary hygienic investigation detected several water sources. Choose the source that would satisfy the demands for potable water the most under the given field conditions:
142. Clinical statistical investigation was performed to determine efficiency of a new pharmacological preparation for patients with ischemic heart disease. What parametric test (coefficient) can be used to estimate reliability of the results?
143. A planner designs a heating system for a pre-school educational establishment. The highest air temperature should be in the following room:
144. An emergency situation at a chemical plant caused acute occupational intoxication. A doctor who revealed the case of ”acute occupational disease (intoxication)” must notify the following authority:
145. The process of open-cut mining requires drilling and blasting operations, rock and ore excavation, transportation of ore to fragmentation and sorting factories and transportation of barren rock to slag-heaps, road building and maintenance, repair works. What factor of production is most important for miner’s health?
Explanation
Mining involves the extraction of materials/ minerals from the earth; just like the question states, it involves processes such as drilling, blasting, excavation, sorting etc. Miners are usually exposed to lots of hazards such as earth collapse, dust inhalation, noise, vibrations etc. Of all the above listed hazards, exposure to dust is the most important/frequent hazard to a miners health; depending on the type of dust, this can lead to restrictive lung diseases such as pneumoconiosis, silicosis etc.
146. The correlation between the service record and eosinophil concentration in blood was studied in workers at dyeing shops of textile factories. What index will be most informative for the analysis of this data?
147. A region attended by a central regional hospital demonstrates increased hemorrhagic stroke morbidity. Essential hypertension morbidity, however, remains at the same level and is below the average level registered within the larger area. What managerial decision should be made in this case?
148. Estimation of community health level involved analysis of a report on diseases registered among the population of district under charge (reporting form 12). What index is calculated based on this report?
149. A 45-year-old patient (14-year-long work record as a house painter) upon the contact with synthetic paint develops skin reddening, edema, severe itching and oozing lesions on her face. Symptoms disappear after the contact with this chemical substance stops but even the smell of paint alone is enough to make them reappear each time. Each recurrence is characterised by increased severity of symptoms. What provisional diagnosis can be made?
150. A 38-year-old man’s workplace is within the area of effect of ionizing radiation. During regular medical check up he expresses no complaints. Blood test: erythrocytes -4, 5 · 1012/l, Нb- 80 g/l, leukocytes - 2, 8 · 109/l, platelets - 30 · 109/l. Can this person continue to work with sources of ionizing radiation?
151. During medical examination of a group of children under 4 years carried out by a pediatric team in one of the African countries a set of similar pathological signs was detected in some of the children. The signs are as follows: growth inhibition, mental changes, muscle atrophy, swellings, changes in hair and skin pigmentation. These children were diagnosed with kwashiorkor. What food products should be added to the diet to treat this disorder?
Explanation
Kwashiorkor is a disease marked by severe protein malnutrition and bilateral extremity swelling. It usually affects infants and children. It should be differentiated from marasmus which is energy or calorie deficiency. For the correction of kwashiorkor, foods rich in protein should be taken eg, fish, meat, cereals, milk etc.
152. A patient with high temperature came to a first aid post in the evening. The fact of temporary disability was established. Indicate the measure to be taken in this case:
153. Clinic of a research institute 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, medical unit, territorial sanitation center, department of Social Insurance Fund, trade union. According to the \"regulation on investigation of. . . \", the commission should be headed by the representative of the following authority:
154. Maximum permissible concentration of carbon dioxide in the air is considered to be a sanitary index of air purity in a classroom. What concentration of carbon dioxide in the air is accepted as a permissible maximum?
155. A patient with cardiac infarction is on sick leave with his medical certificate being continuously extended for 4 months according to a standard procedure. The disease is progressing. The issue is put forward to refer the patient to the industrial injury assessment board. Who among the medical staff of medical and preventive treatment facility is authorized to do this?
156. A 46-year-old patient once took part in elimination of breakdown at an atomic power plant. Currently he is being treated at an inpatient hospital unit. He was diagnosed with progressing somatoform autonomic dysfunction. This disease relates to the following group of ionizing radiation effects:
157. Over a current year among workers of an institution 10% have not been ill a single time, 30% have been ill once, 15% - twice, 5% - 4 times, the rest - 5 and more times. What is the percentage of workers belonging to the I health group?
158. In river-side urban community there was an outbreak of hepatitis type A possibly spread by water. What indexes of river water quality can confirm this theory?
159. Establishments participating in medical examinations include: medical and preventive treatment facility, hygiene and preventive treatment facility, sociomedical expert committees, Ministry of Defence medical committees, Ministry of Domestic Affairs medical committees, forensic medicine agency, etc. Specify what service deals with sociomedical assessment of temporary disability:
160. In order to study impact of microclimate on the human organism it is necessary to make systematic observation of air temperature during the period of 3 days. Choose a device that will allow to make the most precise temperature records:
161. Various population groups mortality has been studied for a long time; territorial distribution of population and resulting changes in mortality trends are considered. What statistical method can be applied?
162. A workshop resident doctor makes a list of workers, who are often ill, for special supervision. He takes into account the number of etiologically connected cases resulting in temporary disability that occurred in the span of a year for each worker. How many such cases should a worker have to be included in this group?
163. A tractor driver with the record of service of 24 years has undergone palestesiometry test (Vibration Sensitivity Measurement). Test revealed increased vibration sensitivity threshold at the frequencies of 63-125-259Hz to 25 dB. Dynamometry is 20 kg on the right and 16 kg on the left. Cold stimulus test is positive, time of hand temperature restoration is 52 minutes. Blanching at pressure symptom is positive and equals 21. Hypesthesia of upper and lower limbs is observed and can be classified as \"gloves\" and \"socks\" polyneuritic pattern. Make the provisional diagnosis.
Explanation
According to the character of influence to the organism there is local, general and combined vibration. During the local vibration the transmission of mechanical oscillations to the body is realized through the arms. Most often this etiologic factor we can see among the face-workers, chasers, drillers. The sources of the general vibration are the vibro platform, the table vibrator, the forming and concrete-laying machines.
The combined vibration is a combination of local and general - as in this case with a tractor driver who will have both localized and generalized vibratory impact.
According to the intensity’s degree of pathologic process symbolically mark out 4 stages of disease:
I – initial (episodic finger numbness with or without tingling - Hypesthesia)
II – moderately expressed (dystrophic disorders);
III – expressed (irreversible organic changes);
IV – generalized
164. Head of a department and a trade union group have appealed to the head of a hospital about dismissal of the senior nurse who has 17 year record of service. The facts of charge were confirmed and recognized by the nurse herself. This nurse lives with a daughter (who is divorced and unemployed) and a 9-month-old grandson. Make an administrative decision:
165. Deputy of chief medical officer carried out a study of morbidity rate for population which had been served at the polyclinics within the last 5 years. What statistical values can help in calculation of morbidity rates?
166. A 50-year-old locksmith has a long term record of work under the effect of mercury vapors with concentration exceeding MPC by 5-10 times. Clinical examination revealed the lability of vasomotors of skin, pulse and arterial pressure; total hyperhydrosis; asymmetric innervation of facial and lingual muscles, positive subcortical reflexes, intention tremor. Against the background of increased emotional excitability the patient presents with lack of self-confidence, shyness. A dentist found him to have parodontosis, chronic stomatitis. What disease can be suspected?
167. A 36-year-old female patient complains of bruises on the body, gingival haemorrhage, general weakness. A month ago she had a severe domestic poisoning with some pesticide (the patient can not remember the name). She has a 7-year record of working in contact with petroleum products, particularly benzene. In blood: RBCs - 3, 2 · 1012/l, WBCs -2, 7 · 109/l, thrombocytes - 70 · 109/l. What is the most likely pathology?
168. Educational rooms are illuminated with various lighting fittings. What type of lighting fittings is the most appropriate in respect of hygienic norms?