1 Level
51
*!A woman of 68 years came to a doctor complaining of cough with sputum, shortness of breath, chest pain associated with breathing, fever, sweating and weakness. Felt ill after exposure to cold. Objectively: shortening of percussion sound in the lower part of right lung. Wet small bubbling wheezes are listened there during the auscultation.
Which of the following diagnoses is MOST likely?
*+Community-acquired pneumonia of the lower lobe of the right lung
*Chronic obstructive bronchitis
*Asthma
*Chronic obstructive pulmonary disease
*Aspiration pneumonia
52
*!A 52 years old man complained of shortness of breath, cough, weakness, subfebrile body temperature. A blood test for HIV is positive. Auscultation: wet small bubbling wheezes are listened in all parts of both lungs.
Which of the following diagnoses is MOST likely?
*Community-acquired pneumonia
*Pleural effusion
*+Immunodeficiency pneumonia
*Aspiration pneumonia
*Asthma
53
*!A man of 65 years appealed to the therapist with complaints of cough with mucopurulent sputum, increase in body temperature to 38°C, shortness of breath. Which of the following descriptions BETTER fits the provided chest X-ray?
*+Inflammatory infiltration in the lower lobe of the right lung
*Destruction of the cavity in the lower lobe of the right lung
*Focal lesions in the lower lobe of the right lung
*Double sided dissemination
*Bilateral increase in lung roots
54
*!A man of 54 years old with complaints of chest pain with a deep breath, wheezing, fever, marked weakness, dry cough. Objectively: the chest of the usual form, dull percussion sound in the lower lobe of the left lung. Auscultation: sharply weakened respiration in the lower left lung.
Which of the following diagnoses is MOST likely?
*Community-acquired low lobar pneumonia
*Aspiration pneumonia at right
*Dry pleurisy at right
*+Pleurisy at the right
*Nosocomial top lobar pneumonia
55
*!Analysis of pleural fluid: specific weight – 1020, color - cloudy, protein – 30g\l, Rivalt’s reaction +; Microscopy: leucocytes entirely in sight, atypical cells - no, Mycobacterium tuberculosis - no.
Which of the following diagnoses is MOST likely characterized by the result of this pleural fluid analysis?
*Dry pleurisy
*+Pleural effusion
*Tuberculosis pleurisy
*Pleurisy in heart failure
*Tumor pleurisy
56
*!Male 25 years old complains of weakness, dry cough for 2 days, pain behind the breastbone, rising body temperature to 37,0˚C, which appeared after hypothermia. In the anamnesis: frequent SARS. Do not smoke. Percussion is determined by clear lung sounds. Auscultation: hard breathing.
Which of the following diagnoses is MOST likely?
*Spontaneous pneumothorax
*Pleural effusion
*Lung Cancer
*Community-acquired pneumonia
*+Acute bronchitis
57
*!A 29 years old woman complains of a feeling of rawness and burning in the chest, dry cough, weakness. In the anamnesis: frequent SARS. On examination indicated pale skin. Percussion determined pulmonary sound. Auscultation auscultated hard breathing, no wheezing.
Which of the following diagnoses is MOST likely?
*Spontaneous pneumothorax
*+Acute bronchitis
*Lung Cancer
*Aspiration pneumonia
*Dry pleurisy
58
*!A man 48 years old complains of cough with mucopurulent sputum for a long time, the body temperature rising up to 37,8oC, weakness, malaise that emerged after hypothermia. Objective: cyanosis of the nasolabial triangle, thickening of the nails. Auscultation auscultated hard breathing with crepitate wheezing.
Which of the following diagnoses is MOST likely?
*+Chronic Bronchitis
*Pleural effusion
*Fibrosing alveolitis
*Community-acquired pneumonia
*Acute bronchitis
59
*!The man of 52 years complaints of cough with difficult separated sputum, dyspnea during the rest, increasing at physical stress. From the anamnesis: constant cough in the mornings and excretion of the sputum in the period of the last 10 years. Smokes within 30 years Objectively: a thorax of a barrel form, percutory pulmonary sound with a bandbox shade. Auscultation: respiration is weakened, the exhalation is extended, dry scattered rales are listened.
What of the listed diagnoses is MOST probable?
*Community-acquired pneumonias
*Chronic bronchitis
*Pleuritis
*Bronchial asthmas
*+Chronic obstructive pulmonary disease
60
*!The man of 52 years comes because of complaints of the cough with difficult separated sputum, dyspnea during the rest increasing at physical stress. From the anamnesis: constant cough in the mornings and an excretion of the sputum during the last 10 years. Smokes within 30 years. Objectively: a thorax of a barrel form, percutory pulmonary sound with a bandbox shade. At auscultation: respiration is weakened, the exhalation is extended, dry dispelled rattles are listened.
What of the listed methods of examination is MOST reasonable to make the diagnosis?
*+Spirometry
*Peakflowmetries
*Pulsoxymetries
*Roentgenography of a thorax's organ
*Computer tomographies
62
*!The man of 62 years is a driver, smokes for 40 years. Complaints of dyspnea, cough with a mucous sputum during the day. Auscultation of lungs: weakened respiration, dry whistling rales in all fields. Primary diagnosis: Chronic obstructive pulmonary disease. The spirometry is carried out.
What of the listed indexes of a spirometry will MOST possibly be decreased?
*Vital capacity
*Minute volume of a heart 25
*Maximal ventilation
*Respiratory volume
*+Index of the Tiffno
65
*!The man of 62 years is a driver, smokes for 40 years. Complaints of dyspnea, cough with a mucous sputum during the day. Objectively: a thorax of a barrel form, percutory pulmonary sound with a bandbox shade. At auscultation respiration is weakened, the exhalation is extended, dry dispelled rattles are listened. The diagnosis is exposed: Chronic obstructive pulmonary disease.
What of the listed below changes of the chest X-ray picture is MOST characteristic for this patient?
*Homogeneous intensive blackout with a slanting upper bound
*Intensive infiltrative blackout of a spherical form
*A cavity of a spherical form with a smooth internal contour
*Focal-infiltrative changes with an indistinct, irregular contours
*+The increased lightness of pulmonary tissue, low standings of the diaphragm
66
*!Student 19 years old with a diagnosis of acute bronchitis received outpatient treatment for 7 days. On re-admission he had no complaints, condition was satisfactory. Auscultation: vesicular breathing, no wheezing.
What tactics of prevention of such disorders is MOST advisable?
*Purpose b-2 agonists, long-acting
*The appointment of a number of different antibiotics
*Nebulizer therapy with a corticosteroid
*+Vaccination against influenza
*Appointment of b-2 agonists, short-acting
67
*! The student 2 courses of the medical university, 19 years, the resident of Almaty, studies here. Denies chronic diseases. Within the last year was not ill. At the time of survey the health estimates as excellent. There are no complaints to the moment of survey. Objective survey of special pathology did not reveal. The blood serum research on antibodies to Herpes virus, CMV and Epstein-Barre's virus showed existence of AT IgG to antigens of a virus of herpes, CMV in average levels. Wants to receive treatment. What can be recommended?
*+No treatment is required
*Acyclovir
*Gancyclovir
*Poludanum
*Derinat
68
*! At the patient the herpetic infection relapses 8 times a year. What of immunotherapy methods most efficiently in this situation from the point of view of evidential medicine?
*Gancyclovir the long-lived courses
*UV radiation of blood
*Intravenous laser exposure of blood
*Recombinant granulo-macrophagal growth factor
*+Immunogram and by its results the choice of a method of an immunotherapy
69
*! The patient of 42 years with nonspecific aortoarteriitis of Takayasu, with well controlled course of a disease, receiving Prednisolonum in a maintenance dose. What can you recommend from the most rational and effective measures for decrease in risk of infectious complications to this patient?
*+Vaccination against flu every year
*Wearing a mask in the period of SARS epidemic
*To use in an interferon in a nose at each exit to the street
*Quenching and moderate physical activity
*The regular reception of adaptogens – echinacea, eleuterococcus
70
*! The patient with a rheumatoid arthritis, with Kaplan's syndrome, receives basic therapy of the micophenolat mofetil. What preventive measure for prevention of a respiratory infection is necessary in this case?
*Wearing a mask in cold season
*Vaccination from Haemophilus influenzae
*+Vaccination by pneumococcal vaccine
*Preventive antibacterial therapy
*Rybomunil application
ENDOCRINOLOGY