Pulmonolgy
2 Уровень
1
*!A woman, 42 years old, admitted with the fever 39.2ºC and cough with purulent sputum excretion. Objectively: HR 106, BP 110/60 mmHg, RR 32 per minute. Conscious, oriented in time and space. pO2 – 85% of norm. In blood: leukocytes 13×109/l, urea 8.5 mmol/l. Chest radiography: infiltration in the lower lobe of right lung. Which variant from below-listed is correct result according to CURB-65?
*5 points, lethality 27.8%, high risk
*1 point, lethality 2.7%, low risk
*2 points, lethality 6.8%, moderate risk
*3 points, lethality 14%, moderate risk
*4 points, lethality 27.8%, high risk
2
*!A man, 67 years old, admitted in severe condition with mental confusion. Respiration rate 30 per minute, BP 100/55 mmHg. In blood: leukocytes 7,8×109/l, Urea 9,2 mmol/l. Which is this patient's evaluation according to CURB-65 scale?
*1 point, out-patient treatment
*2 points, out-patient treatment
*2 points, treatment in the intensive care unit
*4 points, treatment in the intensive care unit
*4 points, treatment in a profile unit
3
*!A man, 36 years old, after catching cold notes body temperature increase to 38.7C, productive cough with yellow-green sputum, sweeting, general weakness. Which is the most probable diagnosis, based on chest radiography data?
*infiltrative tuberculosis
*exogenic alveolitis
*community-acquired pneumonia
*exudative pleuritis
*focal pulmonary tuberculosis
4
*!A 28-year old woman is bothered during 5 days by attack-like cough with small amount of white sputum, attacks mostly in the early morning. In lung auscultation, on the background of rough breathing, diffuse wheezings are heard.
Which of listed examination methods is MOST informative with the aim of disease diagnostics?
*Spirometry
*Peak-flow metry
*Chest radiography
*Pleural cavities sonography
*Bronchoscopy
5
*! The14-year old schoolboy admitted with complaints: body T – 38,6ºC, dyspnea, severe attack-like cough, pains in muscles, headaches, weakness. He became acutely ill after overcooling. Auscultation: in lungs rough breathing, on the left in the underscapular area crepitation. Which changes can be detected in chest radiograph of patient?
*infiltrative shadows in the lower lobe of the left lung
*atelectasis in the lower lobe of the left lung
*focal infiltrative modifications in segment 1-2-3-4
*picture of cellular lung (dull glass symptom)
*enlarging of bronchial roots of lungs, intensive vessel picture
6
*!A man, 72 years old, is located in the intensive care unit due to acute myocardial infarction. On the 6th day hospitalization, body temperature increased to 38ºС, cough with mucous purulent sputum, hyperhydrosis appeared. In the auscultation fine crackles are heard in lower areas of both lungs.
Which of listed diagnoses is MOST probable?
*Lung edema
*Community-acquired pneumonia
*Left-ventricular failure
*Hospital-acquired pneumonia
*Dressler's syndrome
7
*!A man, 35 year old. Complaints: pains in the right half of chest linked with breath, increased body temperature, dry cough. He became ill after overcooling. Objectively: chest of usual form, in the lower lobe of the right lung – dull percussion sound. In auscultation in lower part of the right lung, breathing is significantly weak.
Which of listed diagnoses is MOST probable?
*Community-acquired pneumonia of lower lobes
*Aspiration pneumonia on the right
*Dry pleurisy on the right
*Exudative pleurisy on the right
*Hospital-acquired pneumonia of upper lobes
8
*!Man, 72 years old, with complaints – headache, fever, dyspnea, cough with purulent sputum. The acute weakness, dizziness, sweeting appeared. Objectively: pale, evident acrocyanosis, cold clammy sweat, HR – 120 per min, thready pulse, dull cardiac tones, BP – 80/50 mmHg.
Cause of sharp worsening of his condition is MOST probably the development of:
*sepsis
*cardiogenic shock
*infectious toxic shock
*pulmonary embolism
*acute respiratory distress syndrome
9
*!Pleural fluid analysis: specific weight – 1020, color – muddy, protein – 30 g/l, Rivalt's reaction positive; microscopy: leukocytes completely in the field of vision, atypical cells – none, tuberculosis mycobacteria - none.
Which of listed diagnoses is MOST probable based on pleural fluid analysis?
*Dry pleurisy
*Exudative pleurisy
*Tuberculous pleurisy
*Pleurisy in heart failure
*Tumorous pleurisy
10
*!A man, 42 years old, after severe overcooling notes dyspnea, pain in the right half of the chest,
related to breathing, body temperature increase to 39C, chill, severe cough, hyperhidrosis, sputum purulent – 80 ml. Which is the most diagnosis, based on chest radiograph data?
*Pneumonia of the lower lobe of the left lung
*Tuberculoma
*Bronchiectasis of the lower lobe of the left lung
*Lung abscess
*Lung cancer
11
In a student, 20 years old, scratching in throat, dry cough, headache, chill, myalgia. At the examination: pale wet skin. At the auscultation: in lungs – rough respiration, on the both lungs – weakness of auscultation sounds, in lower section – fine crackles.
Choose a combination of drugs, which is MOST effective for the treatment of this female patient?
*Acyclovir + Gentamycin
*Oseltamivir + Rifampicin
*Ribavirin + Metronidazole
*Ribavirin + Ofloxacine
*Oseltamivir +Ceftriaxon
12
*!In a 26-year old woman, disease started with pains in the throat when swallowing, headache, body temperature raise to 37.5C. Few days later she applied to polyclinic with suspicion to pneumonia, received treatment with amoxicillin 500 mg 2 times a day for 3 days. On third day of treatment temperature grows to 38 – 39C, ineffective cough, dyspnea. On radiograph, inhomogeneous infiltration in the middle lobe of the right lung and in the lower love of the left lung will be determined.
Which further treatment tactics is MOST reasonable?
*to increase amoxicillin dose
*to replace amoxicillin by roxytromycine
*to replace amoxicillin by ceftriaxon
*to replace amoxicillin by levofloxacin
*to add moxifloxacine to the treatment
13
*!A woman, 25 years old, complains of cough with purulent sputum, shortness of breath, fever - 39C in the evening. She became acutely ill after overcooling. At lung percussion – on the left, under the angle of scapula on both sides dullness of percussion sound, in auscultation, at the same place, fine crackles are heard.
Which changes you are expecting to see on the plan chest radiograph of this patient?
*lung pattern improvement more on the left
*roots of the lungs expansion
*increased pulmonary tissue transparency
*infiltrative focuses
*lung pattern depletion
14
*!A woman, 33 years old, was delivered to admission room unconscious. According to her mother, she had flu, on day 4 her condition suddenly get worse. BP 60/40 mmHg, HR 112 per minute. On chest radiogram bilateral infiltrative shadows.
Which assistance should be provided in the first place?
*Dopamine
*Oseltamivir
*Metylprednisolone intravenously
*Ceftriaxone
*Adrenaline
15
*!A man, 48 years old, applied with complaints against cough with excretion of green sputum with the "full mouth". He was ill for 2 weeks after strong overcooling with fever up to 39.5C, chilling, dyspnea, general weakness, fatigue. He use paracetamol and ampicilline himself, didn't applied to doctor. Today in the morning, after just another cough attack, sputum in the amount about 100 ml was discharged, after that his condition improved, temperature decreased.
Which examination method is most reasonable?
*Peak-flowmetry
*Spirometry
*Pleural cavities sonography
*Chest organs CT
*Bronchography
16
*! Woman, 35 years old after acute respiratory infection the cough with mucus-purulent sputum, chilling and fever up to 37,5-38С in evening, sweeting and fatigue are appeared. At examination: in right lower areas shortness of auscultation sounds, focal crepitation. RR 20 per min. BP 120/80 mm Hg, HR 95 per min. In blood: leukocytes 9,5x109/l, erythrocytes – 3,9x1012/l., Нв-120 g/l, ESR 20 mm/h.
Treatment tactic:
* hospitalization and levofloxacine
*out-patient treatment with gentamycine
*out-patient treatment with amoxicilline
* hospitalization and clindamycine
* hospitalization and rovamycine
17
HIV-positive patient after overcooling chilling, fever, dyspnea and dry cough developed. X-ray – lung vessels picture expression and multifocal infiltration in both lungs. CD4+ cells – 156 in ml.
What etiology of pneumonia MOST possible?
*Streptococcus pneumonia
*Mycoplasma pneumonia
*Chlamydia pneumonia
*Pneumocystis carinii
*Candida albucans
18
Pregnant woman in 29 years old, pregnancy on 6-8 weeks. Complaints on fever, dyspnea, fever 38,8°С; cough with mucus sputum. Auscultation: fine crackles in left lower areas. In blood: leukocytes 10,5x109/l, erythrocytes – 3,9x1012/l., Нв-120 g/l, ESR 45 mm/h.
What preparation must be included in treatment plan?
*levofloxacine
*azitromycine
*cyprofloxacine
*doxycycline
*ofloxacine
19
*!A woman, 28 years old, with complaints on attacks of shortness of breath up to 6 – 8 times a day, absence of any effect of salbutamol inhalations, which he received 12 times during the last day. At the examination, orthopnoe, RR – 28 times per minute. Breathing is weakened, in some places isn't heard. РаО2 45 mmHg, saturation– 78%.
Your MOST probable diagnosis:
*Bronchial asthma, severe course, exacerbation. RF I
*Bronchial asthma, medium-severe course, exacerbation. RF II
*Bronchial asthma, intermittent course, exacerbation. RF I
*Chronic obstructive bronchitis, exacerbation. RF III
*Status asthmaticus, RF III