1 Level

61

*!At the man of 58 years old after a year, after the postponed extensive myocardial infarction appears orthopnea, night cough, tachycardia more than 120 in the min. At examination swelling of cervical veins, a hepatomegalia, legs edemas. On EchoCG: cardiomegaly. The refractivity to therapy is noted.

Specify what stage of ChHF developed at the patient:

*0 class

*I class

*IIA class

*IIB class

*+III class

62

*!Woman of 35 years old having rheumatic heart disease complains of dyspnea, heartbeat, leg's edema. At examination congestive changes in lungs, a hepatomegalia and hypostases are revealed.

For an assessment of function of a left ventricle of the patient should be carried out:

*a cycleergometry

*+the echocardiography

*an elecyrocardiography

*a coronaroangiography

*Holterov's monitoring of an ECG

63

*!During carrying out cycle ergometric test at the woman of 47 years old on a second stage of loading (50 W) had anginous pains and a depression of an interval of ST to 1 mm in V3-V4 assignments. To what degree an ischemia corresponds results of a cycle ergometry?

*Slight (mild)

*+ Moderately the expressed

*Expressed

*Far come

*Ischemia is not revealed

64

*!Man 39 years old, abusing alcohol complains to the pains in heart of the pressing character, which is not bound with exercise stress; dyspnea, intermissions. Objectively: paleness of integuments, Dyupiitren's contracture. Borders of heart are increased to the medial-clavicular line, tones are considerably muffled, a ciliary arrhythmia. A BP - 100/60 mm of mercury. The liver is increased by 4 cm, swelling on lower leg. ECG: an atrial fibrillation with a frequency of ventricular reductions of 125 - 140 per min. The interval of QT is extended. TV2-V6 is negative.

OBLIGATORY condition of therapy of this patient is:

*vitamin therapy

*+the complete abstinence

*diuretic therapy

*metabolic therapy

*antiarrhytmic therapy

65

*!Man 45 years old complains of febrile fever with cold fits; cough, pneumorrhagia; joint pains, lumbar area. In the anamnesis - a furunculosis. At examination: integuments of "coffee with milk" color, on the lower extremities – petechial rashes; symptoms of "drum sticks" and "clock glasses" are revealed. At analyses: eryth - 2,9 thousand, Hb – 92 g/l, leuc – 22 thousand, an ESR – 46 mm/hour, a disproteinemia, a proteinuria. On the roentgenogram - a clinoid shadow in the right lung.

What method of examination is the MOST advisable to appoint for specification of the diagnosis?

*a bronchoscopy

*a scintigraphy

*+the echocardiography

*roentgenography of joints

*computer tomography of lungs

66

*!Young man of 16 years old complains of periodically arising attacks of heartbeat and syncopal states. On an ECG of rest - changes are not present. A computer tomography of a brain without pathology. An echocardiography within norm.

Which of the listed research techniques are MOST advisable to appoint for diagnostics of syncope?

*Ventriculography

* Transesophageal echocardiography

*+Cholterov's monitoring of the ECG

*Transesophageal electrostimulation of heart

*Endocardiac electrophysiological research

67

*!Young man of 25 years complains of the pulsing headache, nasal bleedings, increase of a BP. Objectively: an intensive pulsation of vessels of a neck, collaterals in intercostal space, weakening of a pulsation of an abdominal aorta, intensive systolic noise in the II intercostal space to the left of a sternum. A BP on hands – 230/110, standing – 150/90 mm of Hg.; erosion of rip edges.

What of the listed diagnoses is MOST probable?

*Nonspecific an aorto-arteritis

*Primary a hyperaldosteronism

*Disease of an Icenko-Kushings

*+Coarctation of the aorta

*Pheochromocytoma

68

*!Woman of 30 years complains to the heartbeat attacks which are followed by dyspnea, sometimes with a short-term loss of consciousness. In the anamnesis frequent catarrhal diseases. On an ECG: syndrome WPW signs. EchoCG: expansion of a cavity of a left ventricle, valves are intacted, diffuse hypokinesis of interventricular septa, contractive and pump functions of a myocardium of a left ventricle are moderately reduced.

What of the listed examination methods are the MOST INFORMATIVE in diagnostics of syncopal states:

*Coronarography

*Echocardiography

*Ventriculography

*Electrocardiography

*+24-houred monitoring of the ECG

69

*!At the woman of 31 years old revealed fever, the pricking pains in heart, weakness after the postponed acute respiratory viral infection. In blood: An ESR – 32 mm/hour. On an ECG – atrioventricular blockade of the I degree. EchoCG – fraction of emission – 48%, liquid in a pericardium.

What of the listed groups of preparations is MOST advisable to appoint?

*Metabolics

*Antibiotics

*Anticoagulants

*Cardiac glycosides

*+Glucocorticosteroid

70

*!Woman of 58 years is hospitalized with an attack of the inspiratory dyspnea amplifying in horizontal situation. In lungs multiple wet rales. Cardiac tones are dulled, tachycardia, emphasis of the II tone on a pulmonary artery. In the anamnesis: arterial hypertension, diabetes mellitus. On an ECG: QS and elevation of STV2-V6; ventricular extrasystoles.

What therapy is necessary to appoint FIRST OF ALL?

*An antiarrhytmic

*+Thrombolytic

*Antiagregants

*Oxygenotherapies

*Metabolics

71

*!Man of 49 years suffering from a chronic glomerulonephritis is brought in a serious condition. Complains of suddenly arisen dyspnea and cough with a foamy pink sputum. At examination: the orthopnea, respiration noisy, bubbling, on all pulmonary fields are listened mixed wet rales, respiration rate - 28 in min. Cardiac tones are dulled, tachycardy-120 beat in a min. BP - 240/140 mm hg.

Which listed preparations is the MOST EXPEDIENT for emergency care:

*Captopril

*Nifedipine

*+Furosemid

*Propranololum

*Sulphate of a magnesium

72

*!At the man of 64 years after the postponed myocardial infarction developed the signs of a congestive heart failure. During the examination: a cholesterol – 4,2 mmol/l. ECG: fibrillation of auricles with a frequency of reduction of ventricles of 110 beats/min. EchoCG: fraction of emission - 35%.

Which listed preparations is the MOST advisable for treatment of an arrhythmia:

*Nitrates

*Statins

*Diuretics

*angiotensin receptor anatagonists

*+b-adrenoblocker

73

*! The patient with congestive heart failure owing to dilated cardiomyopathy reapplied a after a month of the beginning of therapy by ACE inhibitor with complaints to constant dry cough.

What tactics is the MOST expedient to the patient?

* to revoke ACF inhibitor

* to replace to other ACE inhibitor

* to prescribe antitussive therapy

* to continue to apply ACE inhibitor

* + to replace ACC inhibitor to A II - receptors blocker

74

*! Specify the MOST probable indication for purpose of daily monitoring of an ECG?

*assessment of dynamics of a myocardial infarction

*diagnosis of stable stenocardia

*diagnostics of aсute coronary syndrome

*monitoring of the progressing stenocardia treatment

*heart rhythm assessment at patients with the increased risk of sudden cardiac death

75

*! What of the listed MOST tests is possibly appointed for determination of tolerance to an exercise stress?

*with Dobutaminum

* with ergometrine

* cycle ergometry

* with dipiridamol

* with nitroglycerine