3 Уровень
20
*!Determine degree of severity, if asthma symptoms in a patient are observed almost daily, FEV1 42%; FVC 86%; Tiffno's index 56% of norm.
*Slight intermittent course
*Slight persistent course
*Medium-severe course
*Severe course
*Very severe course
21
*!A woman, 38 years old, was brought into admission room with complaints of distant wheezing , which was not relieved by sympatomimetics, feeling of air shortness. In physical examination, diffuse cyanosis, sitting position. In auscultation: "dumb lung". Your prelaminary diagnosis:
*Lung edema
*Asthmatic status
*Obstructive bronchitis
*Bronchial asthma, severe course
*COPD, D category
22
*!A man, 52 years old, was brought into clinic with complaints against asthma, dyspnea of expiratory character, feeling of shortness of air and chest compression. Above-mentioned symptoms occurred after intake of indometacine tablet. At examination, the condition is medium-severe, pO2 – 96%. In auscultation, on the background of weak breathing, wheezing heard in all areas. Which of listed diagnoses is MOST probable?
*Allergic type of bronchial asthma
*Aspirin asthma
*Non-allergic type of bronchial asthma
*Status asthmaticus
*COPD, C category
23
*!A man, 26 years old, yearly in the summer period is bothered by sneezing, mucous discharge from nose, redness and itching of eyes. In this August, for the first time night asthma attack was noted, paroxysmal cough, increasing when going outside the city.
Determine a treatment during the remission:
*Allergen-specific immunotherapy
*Immunotherapy using IL2
*Therapy by inhaled flunisolide
*Salt mines
*Chromoglicat dinatrium
24
*!A man, 55 years old, admitted with complaints on expiratory dyspnea, forced respiration, asthma attacks. Smokes for 30 years, 20 cigarettes per day. On day 10, on the background of performed therapy, in a patient complaints against tenderness, burning in mouth appeared. Objectively: whitish fur on the surface of lips, palate, back of tongue and on the inner side of cheeks.
Which drug of listed below could cause such complication?
*Aminophylline
*Dexamethasone i/v
*Ambroxol
*Phenoterol + Ypratropium bromide
*Budesonide inhalation
25
*!A teenager was delivered to clinic in poor condition, with complaints against shortness of breath, expiratory dyspnea. In anamnesis, seasonal pollen allergy. At the examination, perception is kept, in the sitting position he supports himself by hands on the edge of bed. Moist skin, diffuse cyanosis. Weakened respiration in lungs, wheezing over all arears. Pulse 125 bpm, correct rhythm. pO2 – 72%
Choose MOST effective drugs for necessary assistance?
*Aminophylline 10 – 20.0 parenteral until relief of symptoms
*Metylprednisolone 120-250 mg parenteral until relief of symptoms
*Anti-leukotriene drugs (Montelucast)
*Ypratropium bromide
*Salbutamol
26
*!What of the viral infections postponed at age from 1 up to 3 years increases the risk of realization of atopic constitution and development of bronchial asthma in the child?
*Respiratory syncytium virus
*Parainfluenza
*Parvovirus
*Adenovirus
*Influenza
27
*!Man 56 years old, complaints on shortness of breath, wheezes at night time (2-3 h AM), heartburn, eractation. Spirometry shows: Tiffno’s index 72%, after salbutamol – 86%.
What diagnoses MOST probable?
*GERD and cholinergetic bronchial asthma
*GERD and non-allergic bronchial asthma
*Bronchial asthma IgE-depended
*Obstructive bronchitis
*GERD and brochoobstructive syndrome
28
*!The woman of 25 years within 10 years suffers from congestion of a nose, a rhinorrhea and sneezing, itching of eyes, a nose during the period from July to October. The last 3 years at it appeared attacks of difficulty of respiration from which she get up at 4-5 in the morning, such attacks were noted in August 2-3 times a week. After a rain her condition improves. What medical tactics is most expedient during an aggravation season?
*Budesonid of 300-400 mkg/days
*Beclomethasone Dipropionas of 400-600 mkg/days
*Chromoglikat of sodium on 2 doses 2 times in days are inhalation
*Theophylline of 200 mg 2 times a day
*Salmeterol 2 doses 2 times a day
29
*!The man of 35 years. Complaints to attacks with shortness of breathing, cough with a plentiful sputum of serous character. The relapse period is provoked by a acute viral infection therefore aggravation is observed during the autumn and winter period. For last year 2 times it was hospitalized because of development of the asthmatic status. Attacks up to 5-6 times a day, night attacks – 3-4 times a week. The attack is removed Salbutamolum, but at least 2 times a month he called the ambulance that made Prednisolonum and an Euphyllinum i.v.
What basic therapy is most expedient?
*Budesonid + phenoterol
*Beclomethasone Dipropionas
*Chromoglikat of sodium + salmeterol
*Diprospan in \m, further budesonid
*Prednisolonum orally
30
*! The man of 36 years shows complaints to attacks of short breathing, cough with a plentiful sputum of serous character. The relapse period is provoked by acute respiratory infection therefore aggravation is observed during the autumn and winter period. Has acute viral infections of 3-4 times to a year. Dyspnea attacks during aggravation up to 2-3 times a day, night attacks – 1-2 times a week. The attack is removed Salbutamolum, sometimes passes spontaneously. What examination should be conducted to the patient for specification of the diagnosis?
*Test with β-mimetic
*Test of 8-minute run
*Test of inhalation of a metacholine
*Scarification test
*The skin test with Histaminum
31
*!A woman, 67 years old, with complaints on cough with persistent sputum, dyspnea at light physical activity. From anamnesis: in last 10 years he notes persistent cough in the morning and sputum discharge. She smokes for 30 years. Objectively: chest with barrel form, vesiculotympanic resonance. In auscultation, breathing is weakened, expiration is prolonged, dry diffuse rhonhi are heard.
Which of listed diagnoses is MOST probable?
*IHD, asthmatic type
*Chronic fibrotic alveolitis
*Chronic heart failure
*Bronchial asthma
*Chronic obstructive pulmonary disease
32
*!A man, 69 years old, suffers from bronchopulmonary pathology for more than 15 years. In the last years he begun to feel heaviness in right hypochondrium, edema on feet. On ECG – appearance in the lead V1 of QRS complex type rSR of increased R V1,2, S V5, 6 waves amplitude, at that, amplitude RV1 > 7 mm or RV1 + S V5,6 > 10.5 mm. Which condition has most probably developed in this patient?
*Chronic cor pulmonale, compensation stage
*IHD, cardioclerosis, right bundle-branch block
*Postinfarction cardiosclerosis
*IHD, stable angina pectoralis
*IHD, progressive angina pectoralis
33
*!In a patient with trombophlebitis of deep veins in lower limbs, suddenly asthma has developed, cough with blood streaks, palpitation. Which condition most probably has developed in this patient?
*spontaneous pneumothorax
*bronchial asthma attack
*foreign body in airways
*gas pulmonary embolism
*thromboembolism of pulmonary artery branches
34
*!A patient, 45 years old, miner, was brought into department by the ambulance car with complaints against acute dyspnea, increasing at any physical activity. He became ill 2 hours before at work. When he lifted a load, acute pain in the left half of the chest, cough occurred. In percussion – tympanitis over the whole surface of the left half of the chest. No breathing on the left is heard. On chest radiograph – dexiocardia. Pulse 120 bpm. Your MOST probable diagnosis?
*Left-side pressure spontaneous pneumothorax. RF stage 3
*COPD. Pulmonary emphysema. Chronic cor pulmonale. RF stage 2
*Asthmatic status. RF stage 3
*Pulmonary embolism
*Acute respiratory distress syndrome
35
*!In a man, 65 years old, treated in the intensive care unit with diagnosis of COPD, in determination of the gas blood composition was found выявлено: РаО2 35 mmHg, saturation 72%. Which condition most probably developed in this patient?
*1st stage of respiratory failure
*2nd stage of respiratory failure
*3rd stage of respiratory failure
*no respiratory failure
*4th stage of respiratory failure
36
*!Patient W., 67 years old, complains of pains in the left half of chest, cough with sputum having blood streaks, dyspnea, weakness. On chest radiograph on the left – intensive infiltration of the lower lobe of the lung, with unclear contours, with atelectasis, there is the small hydrothorax. SYFRA enlarged.
Those symptoms is MOST typical to:
*Tuberculous pleuritis
*Pneumonia complicated by pleuritis
*Lung cancer
*Chronic heart failure
*Pleural empyema
37
*!A patient, 47 years old, was admitted with complaints against manifested asthma, cough with blood streaks and chest pain. These symptoms appeared about 3 months ago. Fiber-optic bronchoscopy: Left: central lung cancer (exophytic form), lumen of the left upper lobar bronchus covers vermilion tumor with smooth surface. What risk factor is most typical in this pathology?
*Smoking
*Alcogol abuse
*Obersity
*Frequent viral infection
*COPD
38
*!A man, 64 years old, complains on fever, cough with of mucous-purulent sputum, dyspnea, weakness, sweeting, which appeared after overcooling. Smokes 25 cigarettes per day for 45 years. Radiology detected lung tissue infiltration on the left in lower lobe. Treatment with ceftriaxone and levofloxacine was began. In the sputum on the 3rd day, pneumococci were found. TLC – 72%, FEV1 – 67%
What preparations must added to treatment plan:
*metronidazole, acetylcysteine
*amoxiclav, bromhexine
*prednisolone, aminophilline
*ambroxol, salbutamol
*ambroxol, ypratropium bromide
39
*!In a 65-year old man, suffering from chronic bronchitis for 20 years, smoker for 40 years, dyspnea at light physical load, cough with discharge of small amount of sputum, heaviness in the right hypochondrium are noted. Objectively: moderate acrocyanosis, jugular veins swelling, pulsation in epigastric area, tone II accent on pulmonary artery, tachycardia, hepatomegaly.
Choose MOST expected changes on ECG in this patient?
*axis of heart deviation to the right, enlarged waves R V1,2, deep wave S V5,6
*axis of heart deviation to the right, ST segment elevation in leads III, AVF, V1, V2;
*axis of heart deviation to the right, ST depression in I, AVL, V5, V6;
*axis of heart deviation to the left, ST segment elevation in V2 lead; negative T wave in leads I, AVL, V2.
*axis of heart deviation to the left, increased wave Rv4,5, deep wave S III,V1,2
40
*!In a 55-year old woman, suffering from asthma for 20 years, cough with discharge of small amount of sputum, heaviness in the right hypochondrium and feet edema are noted. Objectively: moderate acrocyanosis, jugular veins swelling, pulsation in epigastric area, tone II accent on pulmonary artery, tachycardia, hepatomegaly.
Choose MOST expected changes on ECG in this patient?
*axis of heart deviation to the right, ST segment elevation in leads III, AVF, V1, V2;
*axis of heart deviation to the right, ST depression in I, AVL, V5, V6;
*axis of heart deviation to the right, deep wave S V5,6, S, wave S in all V leads
*axis of heart deviation to the left, ST segment elevation in V2 lead; negative T wave in leads I, AVL, V2.
*axis of heart deviation to the left, increased wave Rv4,5, deep wave SIII,V1,2
41
*!A man, 65 years old, heavy smoker, complains of dyspnea with mixed nature, attack-like cough with persistent sputum, palpitation. At physical examination, moderate acrocyanosis. At auscultation: tone II accent and splitting over the pulmonary artery. BP 150/90 mmHg, HR 96 bpm.
What preparations have CONTRAINDICATION in those patients?
*Angiotensin receptor antagonists
*ACE inhibitors
*β2-adrenoblockers
*Cardiac glycosides
*Calcium channels antagonists
42
*!A man, 52 years old, applied with complaints against cough with persistent sputum, dyspnea at rest, which increases at light physical activity. From anamnesis: in the last 10 years he notes consistent cough in the morning and sputum discharge. He smokes for 30 years. Objectively: barrel chest, in the percussion, pulmonary resonance with box note. In auscultation, respiration is weakened, expiration prolonged, dry diffuse rhonhi are heard.
What will be most probably detected in spirometry?
* LVC – 85%, FEV1 – 95%
* LVC – 75%, FEV1 – 86%
* LVC – 65%, FEV1 – 60%
* LVC – 55%, FEV1 – 75%
* LVC – 45%, FEV1 – 85%
43
*!A patient, 45 years old, miner, was delivered to department by ambulance with complaints against acute dyspnea, which increases at any slightest physical activity. He became ill 2 hours before, at work. When he lifted a load, acute pain in the left half of chest appeared, cough. At the percussion, tympanitis over the whole surface of the left half of chest. Respiration on the left is not heard. Pulse 120 bpm.
Your tactics for necessary assistance to this patient?
Your treatment tactics in this situation?
*Draining puncture in II intercostal area
*Parenteral application of aminophylline
*Application of large prednisolone doses
*Draining puncture in VII intercostal area
*Salbutamol inhalation
44
*!A man, 50 years old, mining industry worker, has admitted to department with complaints against severe asthma, increasing at any slightest physical activity. This started 1.5 hours before, at work. When he lifted a load, sudden pain in the left half of the chest and cough appeared. At the percussion, tympanitis over the whole surface of the right half of chest. Respiration on the right is not heard. Pulse 122 bpm.
What could be seen on X-ray this situation?
*air at right pleural cavity, collapse of right lung
*dislocation of the heart to right
*total density of lung picture at left half of chest
*atelectasis of right lung
*total pleurisy at right half of chest
45
*!The woman of 35 years at application of Cefazolinum began to complain of feeling of heat, nausea, shortness of breath. Skin – hyperemia changed by pale color; in lungs - distant wheezing, pulse frequent, weak.
What preparation must be used after applying of adrenaline?
*Salbutamolum
*Prednisolonum
*Dopamine
*Suprastinum
*Euphyllinum
46
*!Woman 23 years old at application of amoxycilline complains on weakness, nausea, itching, urticaria on neck, back, chest, hands, edema and hyperemia of the face. BP– 70/50 mm Hg
What preparation must be used immediately?
*Budesonide
*Prednisolonum
*Dopamine
*Adrenaline
*Euphyllinum
47
*!The patient of 42 years suffering from bronchial asthma receives flunisolid in a dose 400 mkg/days with phenoterol. After overcooling a week ago day symptoms become more often, night attacks appeared, she used Salbutamolum 8 times per day for the last days.
What further tactics is most expedient?
*To lower a dose of a flunosolid and to add claritromycine
*To increase a dose of a flunisolid and to add levofloxcine
*To add Prednisolonum orally to treatment
*To add an Euphyllinum to treatment
*Hospitalization also to begin Prednisolonum course i.v.
48
*!The woman of 32 years within 2 years suffers from nose congestion, difficulty of respiration, attacks of dry cough, wheezes. Symptoms can appear at any time, but are especially expressed when cleaning and at the village. Flunisolid 400 mkg/days recommended.
What research will allow to estimate effectiveness of the carried-out therapy?
*Spirometry - once at every month
*Daily peakflowmetry – daily lability less than 20%
*Common blood test – disappearance of an eosinophilia
*Tolerance for physical activity
*The analysis of a sputum – disappearance of eosinocytes
49
*!The 72-year-old patient with a diabetes mellitus is transfered from surgical department after cholecystectomia. Bilateral pneumonia of a heavy current is diagnosed. Temperature – 35.6ºC, amplified shortness of breath, the HR – 102 beats/min, BP – 105/90. CBA – Erythrocytes – 3,2x1012/l, a hemoglobin – 94 g/l, leukocytes 15x109/l, young – 2%, stabe neutrophils -14%, segmented neutrophils -72%, lymphocytes – 10%, monocytes of-2%, a toxic graininess of neutrophils. What complication perhaps developed at the patient?
*parapneumonic exudative pleurisy
*infectious and toxic shock
*subhepatic abscess
*peritonitis
*sepsis
50
The man admitted in sever condition at intensive care unit, the body temperature 39,8ºC, dyspnea at rest, RR 30 in a minute, a BP – 90/55 mm Hg in a serious condition came to. A bad smell from a mouth, a plentiful sputum green - chocolate color with black crumbs in a sublayer. On the roentgenogram – in the left-hand lung extensive intensive infiltration of pulmonary infiltration with a focal destruction in average departments in a radical zone. On the right – infiltrative shadows of drain character in average and lower departments against the background of the reinforced pulmonary picture.
What diagnosis is most probable at the patient?
*Lung cancer in destruction stage
*Lung abscess
*Lung gangrene
*Superlobar pneumonia
*Bronchoectatic disease