A ((rounded well-defined shadow)) was found in the costo-vertebral angle on the chest roentgenogram of an otherwise healthy 9 year old girl. Make a preliminary diagnosis:
Ganglioneuroma
A surgical department admitted a newborn boy with foamy discharges from nose and mouth, cyanosis attacks. X-ray examination: ((blind end of esophagus is at the level of the II thoracic vertebra, gastric air bubble is under the left cupula of diaphragm.)) What is the most probable diagnosis?
Esophagus atresia, tracheo-esophageal fistula
A 37-year-old woman complains of headaches, nausea, vomiting, spasms. The onset of the disease occurred the day before due to her overexposure to cold. Objectively: fever up to 40oC; somnolence; rigid neck; Kernig’s symptom is positive on the both sides; general hyperesthesia. Blood test: leucocytosis, increased ESR. Cerebrospinal fluid is turbid, yellow-tinted. What changes of the cerebrospinal fluid are most likely?`
neutrophilic pleocytosis
A 75 y.o. woman with coronary heart disease constantly takes warfarin. She was taken to the acute care department with complaints of sudden sensation of weakness in the left half of her body and eyeball deviation to the left. What examination of the patient will be a primary task?
computer tomography of the brain
A female 28 years old patient became depressed, her mood is melancholic; this state is accompanied by hypobulia, hypokinesia, slow speed of thinking. Her attitude towards her past, present and future is pessimistic. The pathogenetic mechanism of this state is supposed to involve dysfunction in the:
Hypothalamus
A 44-year-old patient complains about difficult urination, sensation of incomplete urinary bladder emptying. Sonographic examination of the urinary bladder near the urethra entrance revealed an oval well-defined hyperechogenic ((formation 2x3 cm large that was changing its position during the examination)). What conclusion can be made?
Concrement
A 65 y.o. patient has acute ((pain, paresthesia, paleness)) of his left extremity. (Pulse in the a. dorsalis pedis is absent). There is skin coldness and paleness that gradually spreads upwards. These symptoms are most likely to be the evidence of:
arterial occlusion
The treatment of choice for duodenal obstruction caused by secondary duodenal hematoma that developed a few days after blunt abdominal injury is:
Nasogastric decompression and parenteral alimentation
A 28-year-old patient consulted a surgeon about pain, edema and hyperemia of the left side of his face, weakness, fever up to 39oC. These manifestations has been present for three days. Objectively: there is an inflammatory infiltrate of the left nasolabial fold 4x4 cm large with a necrotic core in the center, the pronounced edema of the left side of face, moderate nuchal rigidity. What treatment is needed?
Hospitalization, antibiotics, anticoagulants, rest
A 35 y.o. patient was admitted to the local hospital a week after a road accident with clinical picture of clotted hemothorax. What is the most appropriate treatment tactic for prevention of acute pleural empyema?
surgical removal of clotted hemothorax
A full-term child survived antenatal and intranatal hypoxia, it was born in asphyxia (2-5 points on Apgar score). After birth the child has progressing excitability, there are also vomiting, ((nystagmus, spasms, strabismus)), spontaneous Moro’s and Babinsky’s reflexes. What localization of intracranial hemorrhage is the most probable?
Subarachnoid hemorrhage
A child is 12 years old. He complains of a dull aching pain in the epigastrium and right hypochondrium, that is getting worse after taking fatty or fried food, headache, weakness, nausea, lowgrade fever. Abdominal palpation reveals a marked resistance of muscles in the right hypochondrium, positive Kerr’s, Ortner’s, Murphy’s symptoms. What is the most likely diagnosis?
Chronic cholecystitis
A 54-year-old patient has been suffering from diabetes mellitus for 5 years, with diet being his only treatment. Within the last half a year he lost 7 kg of body weight, complains of thirst, vertigo when raising from bed, decrease of erectile function, frequent stool, especially at night. Objectively: malnutrition, dry skin. BP in lying position is 160/90 mm Hg; BP in standing position is 170/85 mm Hg. No edemas. Fasting plasma glucose level is 12 mmol/l. Glycated hemoglobin accounts for 11%. Albumin excreted with urine is 20 mg per day. The most likely diagnosis is:
Diabetes mellitus type 2 with visceral neuropathy
(The late onset of the disease in old age and weight loss are typical for type 2 diabetes mellitus. The symptoms of Decrease of erectile function, Vertigo when raising from bed and Frequent stool, especially at night are typical for visceral neuropathy)
A 24-year-old patient had been delivered to a thoracic department with a chest injury, fracture of the ((IV, V, VI ribs on the right)). Plan radiography showed the fluid level in the pleural cavity to be reaching the III rib on the right. ((Puncture contained blood clots)). What is the optimal treatment tactics?
Emergency thoracotomy
A 17-year-old patient complains of pain in the area of the left knee joint. Soft tissues of thigh in the affected region are infiltrated, joint function is limited. X-ray picture of the ((distal metaepiphysis)) of the left femur shows a ((destruction focus with periosteum)) detachment and Codman’s triangle found at the defect border in the bone cortex. X-ray of chest reveals ((multiple small focal metastases)). What treatment is indicated?
Palliative chemotherapy
A 48-year-old patient complains of having dull pain in the right lumbar region for over three years. USI shows that kidneys are of normal size, at the upper pole of the right kidney there is a ((fluid containing formation)) up to 12 cm in diameter. Excretory urograms show normal condition on the left, and the deformation of the superior ((renal calyces)) with satisfactory function on the right. What kind of disease can you think of?
simple cyst of the right kidney
A 30-year-old patient was in a car accident. He is unconscious, pale, has thready pulse. In the middle third of the right thigh there is an extensive laceration with ongoing profuse external arterial bleeding. What urgent actions must be taken to save the life of the patient?
Tourniquet above the wound of the right thigh
A 12-year-old boy periodically has short episodes (10-15 seconds) of a brief loss of awareness with a dazed look and eyes stare in an upright position, blank expression of face, absence of motions and subsequent amnesia. Specify the described state:
Absence seizure
A 75-year-old male patient complains of slight pain in the right iliac region. The ((abdominal pain arose 6 days ago and was accompanied by nausea)). Surgical examination revealed moist tongue, Ps- 76 bpm. AP- 130/80 mm Hg. Abdomen was soft, slightly ((painful in the right iliac region on deep palpation)), the symptoms of the peritoneum irritation were doubtful. In blood: RBCs - 4,0 · 1012/l, Hb- 135 g/l, WBCs - 9,5 · 109/l, stab neutrophils - 5%, segmentonuclear - 52%, lymphocytes 38%, monocytes - 5%, ESR - 20 mm/h. Specify the doctor’s further tactics:
Emergency operation for acute appendicitis
A surgeon examined a 42-year old patient and diagnosed him with right forearm furuncle at the purulonecrotic stage. The furuncle was lanced. At the hydration stage the wound dressing should enclose the following medication:
hypertonic solution
A child is 1 month 10 days old. ”Gushing” vomiting has been observed since the age of 3 weeks. The vomit volume exceeds the volume of the previous feeding. Objectively: the child is inert. Skin elasticity and tissue turgor are decreased. ((Hour-glass deformity sign is positive)). The preliminary diagnosis is pyloric stenosis. What ((treatment tactics should be chosen))?
surgery
After a car accident a 37-year-old patient has an acute pain and bleeding in the middle third of his right thigh. Objectively: there is a wound on the anterior surface of the right thigh with massive bleeding, abnormal mobility at the level of the middle third of the thigh. The first aid is to be started with:
Digital occlusion of the femoral artery
During a surgery on a 30-year-old patient a dark ileo-ileal conglomerate was discovered, the intussusceptum intestine was considered to be unviable. The intussuscipiens intestine was dilated to 7-8 cm, swollen, full of intestinal contents and gases. What pathology led to the surgery?
invagination (combined) obstruction
A 36-year-old woman complains of pain in her lumbar area, which irradiates to her lower right limb and increases during movements, and sensation of numbness in her limb. Objectively: palpation of the shin and thigh muscles is painful, positive stretch symptom on the right. MRI scan: (herniation of intervertebral disk) L5-S1 4 mm in size.What is the most likely diagnosis?
Vertebrogenic lumbago
