Rheumatology
2 Уровень
1
*!Female patient, 45 years old, applied to clinic with complaints against itching, manifested dryness of cutaneous coverlets, dryness in eyes and mouth for three months. In the questioning of patient was found that she is more than one year bothered bychill hands and fingertips which turn blue in cold. Schirmer's test positive.
What most possible diagnosis?
*Scleroderma systematica
*Raynaud's disease
*Systemic lupus erythematosus
*Sjögren’ sicca syndrome
*Sjögren’ disease
2
*!Female patient, 45 years old, applied with complaints against feeling of skin constriction, hair loss, dry mouth, chill of hands and legs. Objectively: foci of hyperpigmentation over whole body, telangiectasia on face. In lungs: rough breathing, crepitation in lower parts. 2 tone accent on 3rd auscultation point.
What 1st diagnosis should be considered?
*Scleroderma systematica
*Primary pulmonary hypertension
*Idiopathic fibrosing alveolitis
*Systemic lupus erythematosus
*Sjögren’disease
3
*!What vasculitis associated hepatitis B virus in half cases?
*Purpura rheumatica
*Non-specific aortoarteriitis
*Periarteritis nodosa
*Temporal arteritis
*Wegener's granulomatosis
4
*!Woman, 22 years old, complains of numbness of the left half of body, dizziness when raising her hand, disturbed vision, cardialgia. BP in the right hand 90/60 mmHg, in the left hand – 60/40 mmHg, in both legs – 125/80 mmHg. Pulse in both hands is weakly palpable. Angiographic signs of stenosis of the left brachial and radial arteries. Echocardiography determined aortic valve insufficiency. In blood: ESR – 55 mm/h, Hb - 92 mg/l, ANCA – positive.
Which diagnosis is most probable?
*Wegener's granulomatosis
*Systemic lupus erythematosus
*Periarteritis nodosa
*Non-specific aortoarteriitis
*Chronic rheumatic heart disease
5
*!At the consultation of physician, there is a 16-year old girl, accompanied by her mother, body temperature 38.4º, complaints against migrating pains in large joints. Her mother thinks that disease started about three weeks ago and started with swelling and skin redness of the left knee joint. Last winter and spring, girl three times had tonsillitis and few times acute respiratory diseases, therefore she didn't visited the school. During current examination, she is bothered by pains in right knee joint and left wrist, skin over them is slightly hyperemic, swelled; temperature above joints is increased; joint movements are limited. On chest skin, dull pink spots with clarifications in center.
Which diagnosis of listed below is most probable?
*Infectious-allergic polyarthritis
*Rheumatic arthritis
*Lyme disease
*Rheumatoid arthritis
*Scleroderma
6
*!A young man, 18 years old, complains of dyspnea after insignificant physical exertion, swelling of legs, pains in heart area. 3 weeks before he suffered acute tonsillitis. Auscultation: on the apex I tone is weaken and systolic murmur, ІІ tone accent on the pulmonary artery. Heart rate – 105 per minute. Arterial pressure – 110/70 mmHg.
For which defect listed below are most typical the auscultative signs?
*Mitral regurgitation
*Mitral stenosis
*Aortic valve regurgitation
*Tricuspid valve regurgitation
*Pulmonary artery stenosis
7
*!A boy, 14 years old, complains of pains in knee joints, sub febrile fever. In case history: 20 days ago he suffered acute tonsillitis. Then, handwriting changes were detected. Shortly after, his mother begun to note in the boy twitching of facial muscles, movements inaccuracy during dressing or food intake. Neurological disturbances grew: grimacing manifestations increased, boy needed assistance in dressing. Objectively: borders of relative heart dullness are widened. Heart sounds are clear, rhythm is regular. In bloood: Hb – 115 g/l, ESR – 42 mm/h, leukocytes – 12 *109/l, fibrinogen – 6.2 g/l, antistreptolysine "O" 1:1200 units. On ECG – sinus rhythm, heart rate – 72 per minute.
Which disorder from the list below is most probable?
*Rheumatoid arthritis
*Recurring rheumatic fever, mitral incompetence, NK IIА
*Non-rheumatic myocarditis, subacute course. NK І
*Acute rheumatic fever, chorea
*Systemic lupus erythematosus, polyarthritis, carditis, NK І
8
*!A youth, 15 years old, became ill after overcooling. He had body temperature increase to 38.8º, dyspnea, shooting pains in heart area, pains and swelling in the left ankle joint, weakness, and palpitation attacks. At heart auscultation: sounds are subdued, tachycardia. HR 120 bpm. Blood analysis: Hb – 120 g/l, leukocytes 14 × 109/l, ESR – 35 mm/h. C-reactive protein – 34 mg/l, ASL-O – 1:750. On ECG: sinus tachyarrhythmia, P-Q interval prolongations.
Which diagnosis is MOST probable?
*Reactive arthritis
*Congenital heart disease
*Non-rheumatic myocarditis
*Dilated cardiomyopathy
*Acute rheumatic fever
9
*!In a patient, 48 years old, with suspected CRHD, at the auscultation, a systolic murmur at xiphoid process and in III and IV intercostal space near right edge of breastbone was heard, which increased in breath-holding at top of inhalation.
For which condition, such noise picture is most typical:
*mitral stenosis
*aortic regurgitation
*mitral regurgitation
*tricuspid valve regurgitation
*aortic stenosis
10
*!Female patient А., 14 years old, with complaints against dyspnea, palpitations, pains in elbow and ankle joints. Objectively: body temperature 38.2ºC. On the skin of body and hips, ring-shaped eruptions of pale pink color, not soaring over skin surface and turning white under pressure. Left ankle joint is swollen. RR 24 per minute. Borders of heart are not changed. Heart sounds are muffled, 98 bpm. On heart apex, I tone is muffled, systolic murmur is heard, which is conducted into the left axillary region and strengthening after physical exercises. BP 110/60. Liver borders are not changed.
Which examination tests from the list below will allow confirming diagnosis?
*ECG, EchoCG, ASL-O, inoculation from throat
*Chest roentgenography, blood inoculation for hemoculture
*CBA, CUA, coagulogram
*Joints roentgenography, C-reactive protein, rheumofactor
*ECG, thyroid hormones
11
*!In a man, 60 years old, hypersthenic person, at scheduled physical examination, diastolic murmur in III intercostal space on the left of sternum was found, BP change (180/50 mmHg). X-ray examination found aortic walls calcification, on EchoCG: root dilatation and aneurism of ascending part of aorta, manifested regurgitation on aortic valve.
Which is most probable cause of valve disorders in this patient?
*rheumatism
*syphilis
*infectious endocarditis
*Marfan's syndrome
*atherosclerosis
12
*!Patient 42 years old with complaints against constricting, gripping pains in cardiac area, under physical stress, coronarography was made, which hasn't detected any signs of coronary arteries damage. Systolic murmur on 2nd intercostal space right to breastbone auscultated. Choose most probable reason from listed below:
*Mitral stenosis
*Mitral insufficiency
*Stenosis of pulmonary artery orifice
*Subaortic stenosis
*Mitral valve prolapse
13
*!A woman, 32 years old, ill for more than 6 years, complaints against pains and swelling and disfiguration of small hand joints, wrist, elbow, metacarpophalangeal and metatarsophalangeal joints, feeling of decrease of mobility until the noon.
Your provisional diagnosis?
*Rheumatoid arthritis
*Psoriatic arthritis
*Jaccoud's syndrome
*Reactive arthritis
*Gouty arthritis
14
*!A woman, 35 years old, ill for more than 5 years, complaints against pains and swelling and deformation of small hand joints, radiocarpal, elbow, metacarpophalangeal and metatarsophalangeal joints, feeling of stiffness until the noon.
Determine X-ray stage of this disease?
*Steinbrocker stage 0
*Steinbrocker stage I
*Steinbrocker stage II
*Steinbrocker stage III
*Steinbrocker stage IV
15
*!A man, 34 years old, complains of acute pains in the right knee joint with swelling, skin redness, limited mobility. Life history: he is single, has few sex partners. In last two months he felt unsteady itch or burning in the urinary tract, noticed slight mucous-serous excretions from urinary tract. About a month before he was treated by urologist from "urethritis".
Which examination is most informative to verify diagnosis?
*Knee joint arthrogram
*Swab for presence of gonococci and Bordet-Gengou test
*Blood and urine analysis
*Antibodies to extracellular enzymes of streptococcus
*Knee joint puncture with introduction of corticosteroids