Modul 2 Symptoms and syndromes in diseases of internal organs Text test

Situations real-life

1. 
   Data of percussion of patient’s heart are as follows: the borders of relative heart dullness- the right is on 2,5 cm laterally from the right edge of the sternum, the left one is on 1.5 cm medially from midclavicular line, the upper one is at the upper edge of the III rib. What a reason and which symptoms are possible to find out in this patient?
   
   1. 
      Left ventriclular dilatation, cardiac asthma
      
   2. 
      * Right ventriclular dilatation, edema on legs
      
   3. 
      Left atrial dilatation, atrial fibrillation
      
   4. 
      No complaints
      
   5. 
      Left ventriclular dilatation, dyspnea in phyical load
      
2. 
   Data of percussion of patient’s heart are as follows: the borders of relative heart dullness: the right one is on 1 cm laterally from the right edge of the sternum, the left one is on 3.5 cm laterally from the left midclavicular line, the upper one is at the upper edge of the III rib. What a reason and which complaints are possible to find out in this patient?
   
   1. 
      * Left ventriclular dilatation, cardiac asthma
      
   2. 
      Right ventriclular dilatation, edema on legs
      
   3. 
      Left atrial dilatation, atrial fibrillation
      
   4. 
      No complaints
      
   5. 
      Right ventriclular dilatation, dyspnea in phyical load
      
3. 
   Data of percussion of patient’s heart are as follows: the borders of relative heart dullness- the right is on 1 cm laterally from the right edge of the sternum, the left one is on 1.5 cm medially from midclavicular line, the upper one is at the upper edge of the II rib. What heart chamber is enlarged?
   
   1. 
      Left ventricle
      
   2. 
      Right ventricle
      
   3. 
      * Left atrium
      
   4. 
      No any chamber
      
   5. 
      Right ventricle
      
4. 
   During examination of patient S. mitral stenosis was revealed. The patient complains of dyspnea, by inspection edema are visible, the liver lower border is 3 cm below the costal arch. How the heart borders are changed?
   
   1. 
      Displacement of right border of relative cardiac dullness rightward
      
   2. 
      Displacement of the left heart border of relative cardiac dullness leftward
      
   3. 
      Displacement of the upper heart border of relative cardiac dullness upward
      
   4. 
      Displacement of the left heart border of relative cardiac dullness leftward, the right border – rightward and the upper one – upward
      
   5. 
      * Displacement of the right heart border of relative cardiac dullness rightward and the upper one – upward
      
5. 
   Patient N., 20 years old, was hospitalized to the therapeutic department of a hospitаl. His complaints are: pain in heart area and above the large joints wich migrates from one joint to other, edema of whole the body. Body temperature is 38 °С. From anamnesis it is known that the patient had periodical tonsillites in childhood. The patient had experienced heavy thore throat 2 weeks ago. What is more probable origin of present patological condition?
   
   1. 
      Mitral stenosis
      
   2. 
      Aortal stenosis
      
   3. 
      Septic endocarditis
      
   4. 
      * Rheumatic fever
      
   5. 
      Hypertonic crisis
      
6. 
   A patient who is being on long-standing treatment because of mitral heart defect, is examined with auscultation at the moment. What is the direct auscultatory sign of mitral stenosis?
   
   1. 
      * Intensification of 1st heart sound at the apex.
      
   2. 
      Systolic murmur at heart apex.
      
   3. 
      Systolic murmur at the 2nd intercostal space rightwards from the sternum.
      
   4. 
      Systolic murmur at the xyphoid process.
      
   5. 
      Systolic murmur at the 2nd intercostal space leftwards from the sternum.
      
7. 
   A patient who is being on long-standing treatment because of mitral heart defect, is examined with auscultation at the moment. What is the direct auscultatory sign of mitral incompetence?
   
   1. 
      Intensification of 1st heart sound at the apex.
      
   2. 
      * Systolic murmur at heart apex.
      
   3. 
      Systolic murmur at the 2nd intercostal space rightwards from the sternum.
      
   4. 
      Systolic murmur at the xyphoid process.
      
   5. 
      Systolic murmur at the 2nd intercostal space leftwards from the sternum.
      
8. 
   A patient who is being on long-standing treatment because of aortic heart defect, is examined with auscultation at the moment.. What is the direct auscultatory sign of aortic incompetence?
   
   1. 
      Intensification of 1st heart sound at the apex.
      
   2. 
      Accentuation of the II sound at the pulmonary artery.
      
   3. 
      * Systolic murmur at the 2nd intercostal space rightwards from the sternum.
      
   4. 
      Systolic murmur at the xyphoid process.
      
   5. 
      Systolic murmur at the 2nd intercostal space leftwards from the sternum.
      
9. 
   A patient who is being on long-standing treatment because of aortic heart defect, is examined with auscultation at the moment. What is the direct auscultatory sign of aortic incompetence?
   
   1. 
      Intensification of 1st heart sound at the apex.
      
   2. 
      Accentuation of the II sound at the pulmonary artery.
      
   3. 
      * Systolic murmur at Botkin-Erb’s point.
      
   4. 
      Systolic murmur at the xyphoid process.
      
   5. 
      Systolic murmur at the 2nd intercostal space leftwards from the sternum.
      
10. 
    At auscultation of a heart the first sound at heart apex is intensified, second sound at pulmonary artery is amplified. Adventitious sound is heard after te second sound.. At the apex is recorded the diastolic descendo murmur merging with the second heart sound and protodiastolic mumur. Murmur intensifies in position of the patient on the left side and it is conducted towards axillary region. What heart defect this phenomena are typical for?
    
    1. 
       * Stenosis of mitral orifice
       
    2. 
       Stenosis of aortic orifice
       
    3. 
       Aortic incompetence
       
    4. 
       Stenosis of pulmonary artery
       
    5. 
       Tricuspid valve incompetence
       
11. 
    At auscultation of a heart the first sound at heart apex is weakened, second sound at pulmonary artery is amplified. At the apex it is recorded the diastolic murmur merging with the first heart sound. The murmur occupies all the systole, intensifies in position of the patient on the left side and is conducted towards axillary region. What heart defect this phenomena are typical for?
    
    1. 
       * Stenosis of mitral orifice
       
    2. 
       Stenosis of aortic orifice
       
    3. 
       Aortic incompetence
       
    4. 
       Stenosis of pulmonary artery
       
    5. 
       Tricuspid valve incompetence
       
12. 
    At inspection of patient R., 29 years old, paleness of the skin and mucosa, capillary “carotide shudder” were revealed. Data of auscultation: the I sound at the apex and the 2nd sound at the aorta are weakened. Soft blowing protodiastolic murmur is heard at the 2nd intercostal space rightwards of the sternum. Which heart defect are these data typical for?
    
    1. 
       Stenosis of mitral orifice
       
    2. 
       Stenosis of aortic orifice
       
    3. 
       * Aortic incompetence
       
    4. 
       Stenosis of pulmonary artery
       
    5. 
       Tricuspid valve incompetence
       
13. 
    At inspection of patient R., 29 years old, who complains of dizziness and periodical faints, paleness of the skin and mucosa is revealed. Data of percussion show shift of the right border of relative heart dullness to the anterior axillary line. By auscultation: the I sound at the apex and the 2nd sound at the aorta are weakened. Rough rasping systolic murmur is heard at the 2nd intercostal space rightwards of the sternum. Which heart defect are these data typical for?
    
    1. 
       Stenosis of mitral orifice
       
    2. 
       * Stenosis of aortic orifice
       
    3. 
       Aortic incompetence
       
    4. 
       Stenosis of pulmonary artery
       
    5. 
       Tricuspid valve incompetence
       
14. 
    During examination of a patient’s heart the following auscultation picture was revealed: the heart sounds are weakened, tachycardia, tripple rrhythm is heard at the apex which is better auscultated when the patient is lying on the left side. Which pathological condition are these data typical for?
    
    1. 
       * Stenosis of mitral orifice
       
    2. 
       Stenosis of aortic orifice
       
    3. 
       Aortic incompetence
       
    4. 
       Stenosis of pulmonary artery
       
    5. 
       Tricuspid valve incompetence
       
15. 
    In patient C. with aortal incompetence systolic thrill in the ІІ intercostal space rightward of the sternum was determined. Indicate, please, expected changes of the heart borders position.
    
    1. 
       Displacement of right border of relative cardiac dullness rightward,
       
    2. 
       * Displacement of the left heart border of relative cardiac dullness leftward
       
    3. 
       Displacement of the upper heart border of relative cardiac dullness upward,
       
    4. 
       Displacement of the left heart border of relative cardiac dullness leftward, the right border – rightward,
       
    5. 
       Displacement of the right heart border of relative cardiac dullness rightward and the upper one – upward.
       
16. 
    Patient M., 72 years old, suffers with atherosclerosis. He complains of headache and periodical dizziness. By inspection it is possible to see movements of his head in anterioposterior direction and pulsation of carotic arteries. Aortal incompetence is diagnosed by auscultation and ultrasound examination. Which data of auscultation is it possible to reveal?
    
    1. 
       * Diastolic murmur at heart apex
       
    2. 
       Systolic murmur at heart apex
       
    3. 
       Diastolic murmur at aorta
       
    4. 
       Diastolic murmur at pulmonary trunk
       
    5. 
       Systolic murmur at aorta
       
17. 
    A patient suffers from dyspnoe, pain in the heart region, feeling of heart intermissions. On the phonocardiogram Q-to-first sound pause is more then 0,06 seconds. What disease is possible in the patient?
    
    1. 
       Aortal incompetence,
       
    2. 
       Mitral incompetence
       
    3. 
       Aortal stenosis
       
    4. 
       * Mitral stenosis
       
    5. 
       Tricuspidal stenosis
       
18. 
    A patient who is being on long-standing treatment because of aortic heart defect, now is examined with auscultation. What is the direct auscultatory sign of aortic stenosis?
    
    1. 
       Intensification of ist heart sound at the apex.
       
    2. 
       Accentuation of the II sound at the pulmonary artery.
       
    3. 
       * Systolic murmur at the 2nd intercostal space rightwards from the sternum.
       
    4. 
       Systolic murmur at the xyphoid process.
       
    5. 
       Systolic murmur at the 2nd intercostal space leftwards from the sternum.
       
19. 
    At auscultation of a heart the first sound at heart apex is weakened, second sound at a pulmonary artery is amplified. At the apex it is recorded the systolic murmur merging with the first heart sound. The murmur occupies all the systole, intensifies in position of the patient on the left side and is conducted towards axillary region. What heart defect this phenomena are typical for?
    
    1. 
       * Stenosis of mitral orifice
       
    2. 
       Stenosis of aortic orifice
       
    3. 
       Aortic incompetence
       
    4. 
       Stenosis of pulmonary artery
       
    5. 
       Tricuspid valve incompetence
       
20. 
    At inspection of patient R., 29 years old, paleness of the skin and mucosa, capillary “carotide shudder” were revealed. Data of auscultation: the I sound at the apex and the 2nd sound at the aorta are weakened. Soft blowing protodiastolic murmur is heard. What phenomena may be revealed at patient’s femoral artery?
    
    1. 
       * Flint’s murmur, doble Traube’s sound.
       
    2. 
       Kumb's murmur
       
    3. 
       Systolic murmur.
       
    4. 
       Intermittent pulse.
       
    5. 
       Paradoxic pulse.
       
21. 
    Data of an echocardiogram: considerable enlagrement of sizes aorta, abnormal systolic movements of its walls, decreased diameter of aortic orifice at the moment of separation of cusps. What disease is possible in the patient?
    
    1. 
       Aortal incompetence,
       
    2. 
       * Aortal stenosis
       
    3. 
       Aortitis
       
    4. 
       Aortoclerosis
       
    5. 
       Calcinosis
       
22. 
    Data of an echocardiogram: hypertrophy of the left ventricle and atrium, deformation of mitral valve cusps, unidireted movement of cusps in separation phase. What disease is possible in the patient?
    
    1. 
       Mitral incompetence,
       
    2. 
       * Mitral stenosis
       
    3. 
       Aortal stenosis
       
    4. 
       Prolapse of the mitral valve
       
    5. 
       Tricuspidal stenosis
       
23. 
    In patient P., 20 years old, which is suffering from rheumatic fever within recent 5 years, marked weakening of the II sound at the aorta is heard by auscultation as well as rough systolic murmur at the aorta, which is transmitted towards carotic arteries. What heart defect is probably present in this case?
    
    1. 
       Stenosis of the mitral valve.
       
    2. 
       Mitral valve incompetence.
       
    3. 
       Defect of intreventricular septum.
       
    4. 
       Aortic valve incompetence.
       
    5. 
       * Stenosis of the aortic rout.
       
24. 
    A patient with exacerbation of rheumatic fever is undergone ultrasound examination of his heart. Which data of EchoCG may be expected in mitral stenosis?
    
    1. 
       considerable enlagrement of aorta sizes, abnormal systolic movements of its walls, decreased diameter of aortic orifice at the moment of separation of its cusps
       
    2. 
       * hypertrophy of the left atrium, deformation of mitral valve cusps, equal direction of movement of cusps in separation phase
       
    3. 
       hypertrophy of the left atrium and ventricle, deformation and shrivering of mitral valve cusps, incomplete closure of its cusps
       
    4. 
       Prolapse of the mitral valve,
       
    5. 
       considerable enlagrement of the left ventricle, incomplete closure of aortic valve cusps.
       
25. 
    A patient with exacerbation of rheumatic fever is undergone ultrasound examination of his heart. Which data of EchoCG may be expected in mitral incompetence?
    
    1. 
       considerable enlagrement of aorta sizes, abnormal systolic movements of its walls, decreased diameter of aortic orifice at the moment of separation of its cusps
       
    2. 
       hypertrophy of the left atrium, deformation of mitral valve cusps, equal direction of movement of cusps in separation phase
       
    3. 
       * hypertrophy of the left atrium and ventricle, deformation and shrivering of mitral valve cusps, incomplete closure of its cusps
       
    4. 
       Prolapse of the mitral valve,
       
    5. 
       considerable enlagrement of the left ventricle, incomplete closure of aortic valve cusps.
       
26. 
    A patient with exacerbation of rheumatic fever is undergone ultrasound examination of his heart. Which data of EchoCG may be expected in aortic stenosis?
    
    1. 
       considerable enlagrement of aorta sizes, abnormal systolic movements of its walls, decreased diameter of aortic orifice at the moment of separation of its cusps
       
    2. 
       hypertrophy of the left atrium, deformation of mitral valve cusps, equal direction of movement of cusps in separation phase
       
    3. 
       * hypertrophy of the left atrium and ventricle, deformation and shrivering of mitral valve cusps, incomplete closure of its cusps
       
    4. 
       Prolapse of the mitral valve,
       
    5. 
       considerable enlagrement of the left ventricle, incomplete closure of aortic valve cusps.
       
27. 
    A patient with exacerbation of rheumatic fever is undergone ultrasound examination of his heart. Which data of EchoCG may be expected in aortic incompetence?
    
    1. 
       considerable enlagrement of aorta sizes, abnormal systolic movements of its walls, decreased diameter of aortic orifice at the moment of separation of its cusps
       
    2. 
       hypertrophy of the left atrium, deformation of mitral valve cusps, equal direction of movement of cusps in separation phase
       
    3. 
       hypertrophy of the left atrium and ventricle, deformation and shrivering of mitral valve cusps, incomplete closure of its cusps
       
    4. 
       Prolapse of the mitral valve,
       
    5. 
       * considerable enlagrement of the left ventricle, incomplete closure of aortic valve cusps.
       
28. 
    A patient with rheumatic fever suffers with dyspnoe, pain in the heart region, feeling of heart intermissions. A doctor supposes mitral stenosis in the patient. Which data of phonocardiogram lets to asses degree of stenosis?
    
    1. 
       Intensity of I heart sound
       
    2. 
       Intensity of II heart sound at pulmonary artery
       
    3. 
       diastolic murmur
       
    4. 
       * Q-to-first heart sound pause
       
    5. 
       all of them
       
29. 
    Data of an echocardiogram: hypertrophy of the left ventricle and atrium, deformation of mitral valve cusps, equal direction of movement of cusps in separation phase. What disease is possible in the patient?
    
    1. 
       Mitral incompetence,
       
    2. 
       * Mitral stenosis,
       
    3. 
       Aortal stenosis,
       
    4. 
       Prolapse of the mitral valve,
       
    5. 
       Tricuspidal stenosis.
       
30. 
    Data of echocardiogram: considerable enlagrement of aorta sizes, abnormal systolic movements of its walls, decreased diameter of aortic orifice at the moment of separation of its cusps. What disease is it possible in the patient?
    
    1. 
       Aortal incompetence,
       
    2. 
       * Aortal stenosis,
       
    3. 
       Aortitis,
       
    4. 
       Aortoclerosis,
       
    5. 
       Calcinosis.
       
31. 
    Data of phonocardiographic examination: widening of aortic rout, sickness and calcification of its walls. What disease is it possible in the patient?
    
    1. 
       Aortitis,
       
    2. 
       * Atherosclerotic aortosclerosis,
       
    3. 
       Myocarditis,
       
    4. 
       Syphilitic mesaortitis,
       
    5. 
       Calcinosis.
       
32. 
    A 20- year-old patient with a history of preceding streptococcal infection complains of malaise, headache, anorexia, subfebrile fever. On exam, mild generalized edema, blood pressure is 150/90 mm Hg, heart rate is 100/min, respiratory rate is 20/min, the urinalysis showed increased protein, red cells casts and hyaline casts. What is your diagnosis?
    
    1. 
       * Acute glomerulonephritis
       
    2. 
       Acute pyelonephritis
       
    3. 
       Rheumatic fever
       
    4. 
       Essential hypertension
       
    5. 
       Bacterial endocarditis
       
33. 
    A man, aged 25, presents with facial edema, moderate back pains, body temperature of 37,5 С, blood pressure is 180/100 mmHg, hematuria [ up to 100 in v/f], proteinuria [2,0 g/L], hyaline casts - 10 in v/f., urine specific gravity -1020. The onset of the disease is probably connected with acute tonsillitis 2 weeks ago. The most likely diagnosis is:
    
    1. 
       * glomerulonephritis
       
    2. 
       pyelonephritis
       
    3. 
       Cancer of the kidney
       
    4. 
       Urolithiasis
       
    5. 
       Renal failure
       
34. 
    Patient T., 48 years old, has an attack of kidney eclampsia. What will not be characteristically for this state?
    
    1. 
       Convulsions
       
    2. 
       * Eyeballs are soft
       
    3. 
       Swellings of neck veins
       
    4. 
       Pupils are dilated and irresponsive on light
       
    5. 
       Smell from a mouth
       
35. 
    A patient complains of gingival bleedings,incraesed body temperature till 38`C,marked general weakness.He feels himself sick for the recent 2weeks.Data of objective examination,petectnia on the skin,by palpation enlarged submandibular axillary and femoral lymph nodes.Data of CBC: thrombocytes-120000/l, Le-18,6 .10`9/l, blast cels-80%, ESR-36 mm/hr. Acute leukaemia is diagnosed. What is the main treatment for this disease?
    
    1. 
       corticosteroides
       
    2. 
       radiotherapy
       
    3. 
       * chemiotherapy
       
    4. 
       surgical therapy
       
    5. 
       immunostimulators
       
36. 
    A patient complains of pain in the lumbar region, dark urine, weakness, dizziness. These symptoms arise after usage of aspirin and ampicillin. Data of objective examination: skin pallor, subicteric sclera. Ps-90 per min, liver +2cm, spleen +3cm, painful in palpation. Data of CBC :er-2,2.10 9/l, Hb-60g/l.CI-0,5, Le-9,4.10`9/l,basophil-0,5%,e-3%,stub-6%,lymph-25%,mon-7%, ESR-38mm/hr, reticulocytes-24%. Biochemical blood study: bilirubin common-38mmol/l. Which preparation is it necessary to prescribe to prevent renal failure?
    
    1. 
       Isotonic saline solution
       
    2. 
       * 4% sodium solution
       
    3. 
       glucose solution
       
    4. 
       7% potassium solution
       
    5. 
       transfusion of blood.
       
37. 
    A 25-year-old woman complained of fatigue, hair loss, and brittle nails. On exam, pallor of skin, pulse rate 94/min, blood pressure 110/70 mm Hg. CBC: Hb 90 g/L, RBC 3.5•1012/L, color index 0.7, ESR 20 mm/h. Serum iron level 8.7 mcmol/L. What treatment would you initiate?
    
    1. 
       * Ferrous sulfate orally
       
    2. 
       Iron dextrin injections
       
    3. 
       Vitamin B12 intramuscularly
       
    4. 
       Blood transfusion
       
    5. 
       Packed RBCs transfusion
       
38. 
    A 47-year-old obese man complained of periodic attacks of acute arthritis in the 1st left tarsophalangeal joint. Lab exam revealed increased serum level of uric acid. What is the diagnosis?
    
    1. 
       * Gout arthritis
       
    2. 
       Reiter’s disease
       
    3. 
       Rheumatoid arthritis
       
    4. 
       Rheumatic arthritis
       
    5. 
       Osteoarthritis
       
39. 
    A 47-year-old obese man complained of periodic attacks of acute arthritis in the 1st left tarsophalangeal joint. Lab exam revealed increased serum level of uric acid. What is the diagnosis?
    
    1. 
       * Gout arthritis
       
    2. 
       Reiter’s disease
       
    3. 
       Rheumatoid arthritis
       
    4. 
       Rheumatic arthritis
       
    5. 
       Osteoarthritis
       
40. 
    A patient of 32 years old complains of severe weakness, tremor of extremities. Objective examination\: body weight loss, wet and warm skin. The thyroid gland is enlarged up to the 3rd degree, painless, elastic. Pulse\: 108. BP- 160\55 mmHg. Everything else is normal. Which pathological condition are these data typical for:
    
    1. 
       * Diffuse toxic goiter
       
    2. 
       Diffuse euthyroid goiter
       
    3. 
       Hypothyreosis
       
    4. 
       Chronic fibrous thyroiditis
       
    5. 
       Vegetovascular dystonia
       
41. 
    A patient of 31 years old complains of severe weakness, tremor of extremities. Objective examination: body weight loss, wet & warm skin. The thyroid gland is enlarged up to the 3rd degree, painless, elastic. Pulse rate is 108 per min, blood pressure 160/55 mmHg. No any other pathological changes are found out. Which pathological condition are these data typical for?
    
    1. 
       * Diffuse toxic goiter, thyrotoxicosis
       
    2. 
       Diffuse euthyroid goiter
       
    3. 
       Hypothyreosis
       
    4. 
       Myocardial infarction
       
    5. 
       Essential hypertension
       
42. 
    A patient who suffers from postheamorrhagic anemia was treated with tardiferon. Now erythrocytes and hemoglobin contents are normal. How long treatment with iron preparation should last?
    
    1. 
       11-5 months
       
    2. 
       3-4 weeks
       
    3. 
       5-6 weeks
       
    4. 
       * 2-3 months
       
    5. 
       7-8 months
       
43. 
    A patient who suffers from postheamorrhagic anemia was treated with tardiferon. Within five weeks. Now erythrocytes and hemoglobin contents correspond to norm. Is it necessary to continue treatment?
    
    1. 
       no
       
    2. 
       * yes if serum iron and indexes of its metabolism are lower than normal
       
    3. 
       yes but choose another drug
       
    4. 
       all answers are wrong
       
    5. 
       it is necessary to check other criteria’s of CBC
       
44. 
    A wonan , 57 y . o . suffers from weakness, absence of appetite, liquid feces. She has these problems for 2 years. Data of objective examination: paleness of skin, sclera are yellowish, the tongue is bright-red with fissures. Lymph nodes are enlarged. P ulse is 100 per min . Blood pressure 100 per min. Liver + 3 cm. spleen is not enlarged . Data of CBC: Hb 56 g / l , er . 1,2 х10 12/ l , color index - 1,4 , macrocites, leuk . 2 , 5 х10 9/ l , eozyn. 1 %, juvenile 1 %, metamyelocites 1 %, stub neutroph. 8 %, segmented neutroph. 47 %, lymphocites 38 %, monocites 4 % , reticulocites 0,1 %. ESR 20 mm per hr, thrombocites 100x10 9/l, Which treatment is it necessary to prescribe?
    
    1. 
       Folic acid
       
    2. 
       Iron preparations
       
    3. 
       * Vitamin B12
       
    4. 
       Glucocorticoids
       
    5. 
       All mentioned
       
45. 
    A wonan, 38 y.o. suffers from menorrhagias. She complains of flickering before eyes, dizziness, skin dryness, loosing of hairs. Data of ovjective exaiation: paleness of skin and mucosa . Pulse is 100 per min , rrhythmic . Liver and spleen are not enlarged . Data of CBC: Hb 90 g / l , er . 3,3х10 9/ l , CI - 0,7, reticulocites .1,2%, leuk .4,8х10 9/l , eosyn .2%, stub 3%, segmented 70%, lymphocites 25%, monocites 10%. Serum iron 4,2 mkmol / l . Which treatment is it necessary to prescribe?
    
    1. 
       Folic acid
       
    2. 
       * Iron preparations
       
    3. 
       Vitamin B12
       
    4. 
       Glucocorticoids
       
    5. 
       All mentioned
       
46. 
    In patient who suffers from duodenal ulcer complains of general weakness, dyspnoe in insignificant physical load and desire to eat a chalk. Data of objective examination: skin paleness, throphic changes of skin. CBC: erythrocytes 3,3.1012/l Hb 90g/l Ci-0,75, reticulocytes-2%, serum iron-5,6 micmol/l. Which diet will you prescribe for the patient?
    
    1. 
       low fat diet
       
    2. 
       * enriched with meat and fruits
       
    3. 
       enriched with milk products
       
    4. 
       enriched with vegetables
       
    5. 
       restriction of salt intake
       
47. 
    On the second postoperative day after a subtotal thyroidectomy, the patient tells the doctor that he feels numbness and tingling around the mouth. What a doctor may suspect in the patient?
    
    1. 
       Thyrotoxic crisis.
       
    2. 
       Hypothyreoid coma
       
    3. 
       * Disfunction of parathyroid glands
       
    4. 
       Brain stroke
       
    5. 
       Hypertonic crisis
       
48. 
    Patient L., 46 years old, a woman, is inspected by a doctor. Data of inspection\: the face is of intensive red colour, round (like Moon), hair growth is present on patient's chin and under the upper lip. Which disease this facial expressionis typical for?
    
    1. 
       * Itsenko-Kushing's syndrome
       
    2. 
       Thyrotoxicosis
       
    3. 
       Mixedema
       
    4. 
       Sclerodermia
       
    5. 
       No any answer is correct.
       
49. 
    Patient L., 46 years old, a woman, is inspected by a doctor. Data of inspection\: the face is of intensive red colour, round (like Moon), hair growth is present on patient's chin and under the upper lip. Which disease this facial expressionis typical for?
    
    1. 
       * Itsenko-Kushing's syndrome
       
    2. 
       Thyrotoxicosis
       
    3. 
       Mixedema
       
    4. 
       Sclerodermia
       
    5. 
       No any answer is correct.
       
50. 
    Patient S. 40 years old, is on the long-standing treatment in endocrinologial department. Data of inspection: the face is puffy, amimic, eye slits ate narrowed, hair is abcent on the external parts of eyebroves, the nose and lips are enlarged, skin is pallid. Which disease is this facial expression typical for?
    
    1. 
       Thyrotoxicosis
       
    2. 
       Quinke's edema
       
    3. 
       Acromegalia
       
    4. 
       * Hypothyreosis
       
    5. 
       No any answer is correct.
       
51. 
    Patient S. 40 years old, is on the long-standing treatment in endocrinologial department. Data of inspection: the face is puffy, amimic, eye slits ate narrowed, hair is abcent on the external parts of eyebroves, the nose and lips are enlarged, skin is pallid. Which disease is this facial expression typical for?
    
    1. 
       Thyrotoxicosis
       
    2. 
       Quinke's edema
       
    3. 
       Acromegalia
       
    4. 
       * Hypothyreosis
       
    5. 
       No any answer is correct.
       
52. 
    Patient В.45 years old, a woman, was admitted to a hospital with complaints on palpitation, tremor of her hands. Data of examination: expression of fair on patient's face, eye sleats are widened, eyes are protruded. Which facial expression is observed in the patient?
    
    1. 
       facies mitralis
       
    2. 
       facies Hippocraticа
       
    3. 
       * facies Basedovica
       
    4. 
       facies febrilis
       
    5. 
       No any answer is correct
       
53. 
    Patient В.45 years old, a woman, was admitted to a hospital with complaints on palpitation, tremor of her hands. Data of examination\: expression of fair on patient's face, eye sleats are widened, eyes are protruded. Which facial expression is observed in the patient?
    
    1. 
       facies mitralis
       
    2. 
       facies Hippocraticа
       
    3. 
       * facies Basedovica
       
    4. 
       facies febrilis
       
    5. 
       No any answer is correct
       
54. 
    In a patient of 48 y.o. during examination in admissious department pneumonia was diagnosed in the middle lobe of the right lung. Which data of palpation will be?
    
    1. 
       Barrel-shaped chest
       
    2. 
       Paralytic chest
       
    3. 
       Pain in one interspace
       
    4. 
       * Increased resistance of the affected part of the chest
       
    5. 
       Thoracic type of breathing
       
55. 
    Patient A. 63 y.o., is on long-standing treatment because of thrombophlebitis of the lower limbs veins. Suddenly he has developed sharp pain in the right part of the chest. It intensifies in inspiration, is followed with cough and expectoration of bloody sputum. Besides the patient has marked dyspnea, severe wekness, dizziness. In examination geleral condition is severe. Skin pallor, cyanosis of the face and neck. Respiratory rate is 36 per min. Which disease should you suspect?
    
    1. 
       Croupous pneumonia
       
    2. 
       * Pulmonary thrombembolism
       
    3. 
       Lung cancer
       
    4. 
       Exacerbation of bronchiectatic disease
       
    5. 
       Rupture of pulmonary abscess into a bronchus
       
56. 
    Patient H. is diagnosed acute catarrhal bronchitis. The patient suffers of shills, cough with expectoration of mucous sputum. Which data of percussion should be expected ower the chest?
    
    1. 
       Bandbox sound
       
    2. 
       Dull sound
       
    3. 
       Dull-to-thympany sound
       
    4. 
       * Clear pulmonary (resonant) sound
       
    5. 
       Slight dullness
       
57. 
    A patient complains of fever, dry cough, progressing inspiratory dyspnea. Data of auscultation and percussion lets to attending doctor to suspect pleurisy with effusion. Which forced position is typical for such patients?
    
    1. 
       Sitting
       
    2. 
       * Lying on the affected side
       
    3. 
       Lying on healthy side
       
    4. 
       The patient is sitting, declining forward, supporting with hands on the window-steel
       
    5. 
       The patient is restless
       
58. 
    Patient V. on 4th day after operation because of ovarial cystoma had developed sharp pain in the right part of the chest and expectoration of pink sputum, dyspnea. Percussion of lungs showed dullness in the lower parts of both lungs. Which complication is possible?
    
    1. 
       Lung abscess
       
    2. 
       Pneumonia
       
    3. 
       * Lung infarction (pulmonary artery thrombembolism)
       
    4. 
       Pleurisy with effusion
       
    5. 
       Pneumothorax
       
59. 
    A patient with pleural exudation was undergone pleurocentesis and 1 liter of fluid was obtained. In the same time ultrasound examination showed that there were 2 litres of fluid in the pleural cavity. How data of percussion will change after the puncture?
    
    1. 
       The sound will become tympanic
       
    2. 
       The sound will stay dull
       
    3. 
       The sound will become bandbox
       
    4. 
       The sound will become resonant
       
    5. 
       * The intensity and square of dullness will decrease
       
60. 
    Data of inspection of a chest: the lover part of its sternum is depressed into the chest, the chest is narrow, costoarticular junctions are enlarged and resemble beads. What type of a chest is present in this patient?
    
    1. 
       Paralytic
       
    2. 
       * Rachitic
       
    3. 
       Lordosis
       
    4. 
       Emphysematous
       
    5. 
       Normal
       
61. 
    Data of inspection of a chest of a patient with tuberculosis: its anterior-posterior diameter is decreased, the chest is not symmetrical, scapulas are separated from it like wings, intercostal spaces, supra- and subclavicular fossa are elevated. What type of a chest is present in this patient?
    
    1. 
       * Paralytic
       
    2. 
       Rachitic
       
    3. 
       Lodosis
       
    4. 
       Emphysematous
       
    5. 
       Normal
       
62. 
    During inspection of a chest it was revealed that spinal cord is curved backward and rightward in its thoracic part. How is this deformation called?
    
    1. 
       Kyphosis
       
    2. 
       Scoliosis
       
    3. 
       Lordosis
       
    4. 
       * Kyphoscoliosis
       
    5. 
       Kypholordosis
       
63. 
    During inspection of a chest it was revealed that spinal cord is curved backwards in its thoracic part more than in norm. How is this deformation called?
    
    1. 
       * Kyphosis
       
    2. 
       Scoliosis
       
    3. 
       Lordosis
       
    4. 
       Kyphoscoliosis
       
    5. 
       Kypholordosis
       
64. 
    During inspection of a chest it was revealed that spinal cord is curved leftwards in its thoracic part more than in norm. How is this deformation called?
    
    1. 
       Kyphosis
       
    2. 
       * Scoliosis
       
    3. 
       Lordosis
       
    4. 
       Kyphoscoliosis
       
    5. 
       Kypholordosis
       
65. 
    During inspection of the patient’s chest the last one is revealed to be diminished in anterio-posterior and lateral diameters, the chest is narrow and flat. Epigastric angle is less than 90 degrees. What is the type of the chest?
    
    1. 
       * Asthenic
       
    2. 
       Normosthenic
       
    3. 
       Hypersthenic
       
    4. 
       Emphysematous
       
    5. 
       Foveated
       
66. 
    During prophylactic examination of adolescent person it was revealed by percussion that the lungs apexes rise above the clavicles up to 3 cm. How to assess revealed signs?
    
    1. 
       Pulmonary emphysema
       
    2. 
       Bronchial obstruction
       
    3. 
       Consolidation of pulmonary tissue
       
    4. 
       * Norm
       
    5. 
       Right-sided hydrothorax
       
67. 
    In the patient ill with croupous pneumonia in the stage of hepatization of pulmonary tissue cough will be … and vocal fremitus will be …
    
    1. 
       * Moist cough, intensified vocal fremitus
       
    2. 
       Dry cough, weakened vocal fremitus
       
    3. 
       Moist cough, weakened vocal fremitus
       
    4. 
       Moist cough, absent vocal fremitus
       
    5. 
       Cough is absent, weakened vocal fremitus
       
68. 
    A patient developed sufficient intensification of vocal fremitus in the lower part of the right lung. Which percussion sound should you expect in the patient?
    
    1. 
       Resonant
       
    2. 
       Tympanic
       
    3. 
       * Dull
       
    4. 
       Bandbox
       
    5. 
       Flat
       
69. 
    Patient R. is on long-standing treatment because of pleurisy with effusion. Typical complaint in this disease on the stage of stabilization of exudation is:
    
    1. 
       Pain in the chest at inspiration
       
    2. 
       Chocking over in swallowing
       
    3. 
       * Feeling of heaviness and tension in lower part of the chest on the affected side
       
    4. 
       Dry cough
       
    5. 
       Hemopthysis
       
70. 
    Patient R. is on long-standing treatment because of lung disease. In the morning he usually develop cough with expectoration for about 200 ml of purulent sputum. Which pathological condition is it typical for?
    
    1. 
       Tuberculosis
       
    2. 
       * Bronchiectatic disease
       
    3. 
       Focal pneumonia
       
    4. 
       Empyema pleurae
       
    5. 
       Bronchial asthma
       
71. 
    Patient K., 20 y.o., after overcooling developed chills, pain in the right part of the chest, general weakness. In the evening of the same day his body temperature rose up to 40 ºC, cough with expectoration of small amount of sputum developed. Present data of examination: condition of the patient is of moderate severity, skin pallor, sweat. Respiratory rate 24 per min. Retardation of the right part of the chest in respiration, by percussion – dull sound below of scapular angle on the same side. Which pathological mechanism lies in the basis of this condition?
    
    1. 
       * Inflammatory consolidation of pulmonary tissue
       
    2. 
       Obstruction of fine bronchi
       
    3. 
       Bronchial tumour
       
    4. 
       All mentioned
       
    5. 
       No any of them
       
72. 
    A patient, 37 y.o., complains of dyspnea, cough with expectoration of small amount of sputum. Several times she developed attacks of suffocation, these attacks disaper after expectoration of sputum. The patient suffers of chronic obstructive pulmonary disease for 5 years. During the last 2 month she noticed aggravation of her condition after grippe. Present examination data: during percussion hyperresonant sound is heard over all the lungs. Lower lungs borders mobility is decreased. Which changes are possible to find above lungs apexes?
    
    1. 
       Bilateral diminishing
       
    2. 
       Unilateral diminishing
       
    3. 
       * Bilateral enlargement
       
    4. 
       Unilateral enlargement
       
    5. 
       No changes
       
73. 
    A patient, 42 y.o., suffers of bronchial asthma for years. Now she is urgently transported to a clinics with prolonged asthma attack. Data of examination: condition is severe. The patient is excited, skin is pale-grey, moist. Respiration is frequent, superficiall. By auscultation a doctor cannot hear any respiratory sounds. What is the cause of this condition?
    
    1. 
       * Gross spasm of fine bronchi with following ineffective pulmonary ventilation
       
    2. 
       Pleural effusion
       
    3. 
       Pulmonary tissue consoldation
       
    4. 
       Block of the trachea
       
    5. 
       No any answer is correct
       
74. 
    A patient, 28 y.o., complains of dyspnea in rest, dull pain in the right part of the chest, dry cough, fever 38,5 ºC, weakness, sweating. He is ill for the last weak. Received treatment because of grippe. 1 day ago the patient developed pain in the right chest, dry painful cough and dyspnea. Data of examination: general condition is of moderate severity, acrocyanosis, respiratory rate 36 per min, the right part of the chest retardation in respiration. Data of percussion: from the middle of the right scapula and downwards dull percussion sound is heard which shifts to complete dullness. Which pathological condition is possible to supect?
    
    1. 
       * Croupous pneumonia located in the right lower lung lobe
       
    2. 
       Right-sided pleurisy with effusion
       
    3. 
       Tumour of the right lung
       
    4. 
       Echinococcus cyst of the lung
       
    5. 
       Tuberculosis
       
75. 
    A patient applies to a doctor with complaints on pain in the right part of the chest in deep inspiration, dry cough, general weakness. A doctor after examination suspected dry pleurisy in him. Which data of objective examination wil be helpful in diagnostics of this disease?
    
    1. 
       Low grade fever
       
    2. 
       Dull-to-thympany sound below the right scapula
       
    3. 
       * Pleural friction sound in the right part of the chest below the scapula in inspiration and expiration
       
    4. 
       Decreased lower lung border mobility on the right side
       
    5. 
       External signs of dyspnea
       
76. 
    A patient applies to a doctor with complaints on pain in the right part of the chest in deep inspiration, dry cough, general weakness. A doctor after examination suspected pleurisy with effusion in him.Which character of pain is typical for this disease?
    
    1. 
       Cutting and permanent
       
    2. 
       Stubbing, appears in inspiration, cough
       
    3. 
       * Feeling of heaviness and tension on the affected side
       
    4. 
       Pressing, occurs in physical load
       
    5. 
       Pain is absent
       
77. 
    A patient applies to a doctor with complaints on pain in the right part of the chest in deep inspiration, dry cough, general weakness. A doctor after examination suspected pleurisy with effusion on the right side of the chest in him.Which changes of topographic percussion should be expected?
    
    1. 
       Decreased lower lung border mobility on the opposite side
       
    2. 
       Bilateral decrease of lower lung border mobility
       
    3. 
       * The zone of transition of clear pulmonary (resonant) sound to the dull one is located above the expected normal position of the left lower lung border
       
    4. 
       Widened Kroenig’s area
       
    5. 
       No changes
       
78. 
    A patient applies to a doctor with complaints on pain in the right part of the chest in deep inspiration, dry cough, general weakness. A doctor after examination suspected right-sided dry pleurisy in him. What is the character of pain in this case?
    
    1. 
       Cutting permanent
       
    2. 
       * Stubbing, appears in inspiration or cough
       
    3. 
       Feeling of heaviness and tension on the affected side
       
    4. 
       Pressing, occurs in physical load
       
    5. 
       Pain is absent
       
79. 
    In patient T., 42 y.o., who is ill with right-sided dry pleurisy, on the 4th day of the disease pain in the chest had decreased, but the patient developed heaviness in the right part of the chest, progressive dyspnea, general weakness and fever about 37,8 ºC. A doctor suspect pleurisy with effusion in him. Which changes will be in objective examination?
    
    1. 
       In dynamic inspection of the chest there will be retardation of affected part in respiration
       
    2. 
       Enlargement of the right part of the chest
       
    3. 
       Weakened vocal fremitus on the right side
       
    4. 
       Dullness above the lower part of the right side of the chest with oblique upper border
       
    5. 
       * All mentioned
       
80. 
    A patient applies to a doctor with complaints on pain in the right part of the chest in deep inspiration, dry cough, general weakness. A doctor after examination suspected right-sided pleurisy with effusion in him. Which changes of topographic percussion should be expected?
    
    1. 
       Bilateral decrease of lower lung border mobility
       
    2. 
       The zone of transition of clear pulmonary (resonant) sound to the dull one is displaced downwards
       
    3. 
       The zone of transition of clear pulmonary (resonant) sound to the dull one is displaced upwards
       
    4. 
       * Widened Kroenig’s area
       
    5. 
       No changes
       
81. 
    A patient of 45 y.o. complains of paroxysmal attacks of expiratory dyspnea, severe dry cough. He is ill for 5 years. Attacks occur mostly at night, suddenly, last for 2-3 hours, than the patient start to expectorate viscous mucous sputum and an attack disappear. Data of examination: forced position – sitting, supporting on a table with hands. Participation of adventitious respiratory muscles in breathing. Respiration is shallow, with whistling sounds. The chest is widened, lower lungs borders are displaced downward. Which changes of lung apexes is it possible to find out?
    
    1. 
       Bilateral decrease of heighth of lungs apexes
       
    2. 
       Unilatreral decrease of heighth of lungs apexes
       
    3. 
       * Bilateral increase of heighth of lungs apexes
       
    4. 
       Unilatreral inecrease of heighth of lungs apexes
       
    5. 
       No changes
       
82. 
    A patient of 45 y.o. complains of attack of expiratory dyspnea, severe dry cough. He is ill for 5 years. Attacks occur mostly at night, suddenly, last for 203 hours, than the patient start to expectorate viscous mucous sputum and an attack disappear. Data of examination: forced position – sitting, supporting on a table with hands. Participation of adventitious respiratory muscles in breathing. Respiration is shallow, with whistlings, borders are displaced downward. The chest is widened. Which disease is it possible to diagnose?
    
    1. 
       Pleurisy with effusion
       
    2. 
       Exacerbation of non-obstructive chronic bronchitis
       
    3. 
       * Bronchial asthma
       
    4. 
       Bronchiectatic disease
       
    5. 
       Croupous pneumonia
       
83. 
    Patient A. complains of dry cough followed by pain in the right part of the chest, fever 39-40° C, sweating, dyspnea. During objective examination croupous pneumonia was diagnosed. Which provoking factor of this disease do you know?
    
    1. 
       Viral infection
       
    2. 
       Tobacco dust inhalation
       
    3. 
       * Overcooling
       
    4. 
       Overheating
       
    5. 
       Eating of spoiled food
       
84. 
    Patient A. complains of dry cough followed by pain in the right part of the chest in deep breathing and cough, fever 39-40 ºC, sweating, dyspnea. During objective examination croupous pneumonia was diagnosed. Which anatomical structure affection causes cough in this disease?
    
    1. 
       Tracheal mucous membrane
       
    2. 
       Bronchial mucous membrane
       
    3. 
       Lungs parenchyma
       
    4. 
       * Pleura
       
    5. 
       Lymph nodes
       
85. 
    Patient B. was hospitalized in pulmonological department with pneumonia of the right lower lung lobe. Data of examination: retardation of affected side of the chest in breathing, by palpation – decreased elasticity of the chest on affected side. Which percutorial sound is it possible to listen to in this area?
    
    1. 
       Clear pulmonary (resonant)
       
    2. 
       Tympanic
       
    3. 
       * Dull
       
    4. 
       Bandbox
       
    5. 
       Dull-to-thymppany
       
86. 
    26. Patient Z. complains of permanent pain in the chest, cough with expectoration of bloody sputum, diffusely mixed with mucus. Sputum looks like strawberry jelly. Which disease is it typical for?
    
    1. 
       Bronchial asthma
       
    2. 
       Chronic bronchitis
       
    3. 
       Pulmonary tuberculosis
       
    4. 
       Pneumonia
       
    5. 
       * Lung cancer
       
87. 
    A patient is ill with acute bronchitis. He complains of cough with easy expectoration of small amount of white transparent sputum, easly diacharged. How is this sputum called?
    
    1. 
       Serous
       
    2. 
       * Mucous
       
    3. 
       Mucopurulent
       
    4. 
       Purulent
       
    5. 
       Glass-like
       
88. 
    A patient is ill with croupous pneumonia. He complains of chills, general weakness, dryness in the mouth, headache, sweating, pain in muscles. Body temperature is 39,2 ºC. Which syndrome do these data indicate on?
    
    1. 
       Mucociliary insufficierncy
       
    2. 
       * Endogenous intoxication
       
    3. 
       Respiratory failure
       
    4. 
       Pulmonary tissue consolidation
       
    5. 
       Bronchial obstruction
       
89. 
    A patient with chronic bronchitis complains of dry cough, pierching sensations behind the sternum at the moments when the patient leaves warm room and goes to the cold as well as when he breathes with tobacco dust. Which anatopmical system affection does cause this sensation?
    
    1. 
       Pharynx
       
    2. 
       * Mucosa of trachea and large bronchi
       
    3. 
       Lung parenchyma
       
    4. 
       Pleura
       
    5. 
       Lymph nodes
       
90. 
    Patient E. 48 y.o., 3 days ago was undergone resection of one lung because of destructive tuberculosis. Which data of inspection will be?
    
    1. 
       Barrel-shaped chest
       
    2. 
       Pigeon chest
       
    3. 
       * In dynamic inspection of the chest there will be retardation of affected part in respiration
       
    4. 
       Collapse of the affected part of the chest
       
    5. 
       Wide intercostal spaces on the affected side
       
91. 
    Patient P. is hospitalized with diagnosis “bronchial asthma, severe exacerbation. Pulmonary emphysema, respiratory failure of II degree”. Which position of lower lung border will be in this case?
    
    1. 
       Displaced downward on one side
       
    2. 
       Displaced upward on one side
       
    3. 
       * Displaced downward on both sides
       
    4. 
       Displaced upward on both sides
       
    5. 
       No changes
       
92. 
    Patient complains of periodical attacks of expiratory dyspnea which occur after contact with animal’s foeter. They may be stopped with salbutamol inhalations and finish with expectoration of sputum. Which sputum is it typical for this diseas?
    
    1. 
       Serous
       
    2. 
       Mucous
       
    3. 
       * Glass-like mucous
       
    4. 
       Mucopurulent
       
    5. 
       Purulent
       
93. 
    Patient P. is hospitalized with diagnosis “bronchial asthma, severe exacerbation. Pulmonary emphysema, respiratory failure of II degree”. How will mobility of lungs lower borders will change in this case?
    
    1. 
       Decrease on one side
       
    2. 
       Increase on one side
       
    3. 
       * Decrease on both sides
       
    4. 
       Increase on both sides
       
    5. 
       No changes
       
94. 
    A patient complains of dyspnea in rest, heaviness in the head and deranged sleep. Data of examinations: diffuse cyanosis, respiratory rate is 34 per min. Which syndrome are these data typical for?
    
    1. 
       Mucociliary insufficiency
       
    2. 
       Bronchial obstruction
       
    3. 
       * Respiratory failure
       
    4. 
       Pulmonary tissue consolidation
       
    5. 
       Pulmonary tissue hyperpneumatization
       
95. 
    A patient complains of acute intensive pain in the right part of the chest. The pain has occurred suddenly 30 min ago. By percussion on the anterior side of the chest on the level of 3-5 ribs tympanic sound is heard. Which syndrome are these data typical for?
    
    1. 
       Mucociliary insufficiency
       
    2. 
       Bronchial obstruction
       
    3. 
       * Presence of air in pleural cavity
       
    4. 
       Pulmonary tissue consolidation
       
    5. 
       Pulmonary tissue hyperpneumatization
       
96. 
    A patient with bronchial asthma suffers from periodical attacks (1-2 times per day) which may be released with salbutamol inhalations. Between attacks he feel himself quite well, physical activity is not restricted. How to evaluate patient’s condition?
    
    1. 
       Satisfactory
       
    2. 
       * Moderate severity
       
    3. 
       Severe
       
    4. 
       Very severe
       
    5. 
       Agony
       
97. 
    A patient of 26 y.o. developed a disease suddenly 2 days ago. The disease started sharply with headache, weakness, cough whith “rusty” sputum. Data of examinations: face is hyperemic, respiratory rate 36 per min. By percussion above the lungs – dull sound is heard rightward from the right scapula angle, vocal fremitus is absent there. Boby temperature is 38 ºC Which preliminary diagnosis is the most probable?
    
    1. 
       Pulmonary tuberculosis
       
    2. 
       Bronchiectatic disease
       
    3. 
       Acute bronchitis
       
    4. 
       Pleurisy with effusion
       
    5. 
       * Pneumonia
       
98. 
    A patient of 38 y.o. developed a disease 2 weeks ago when he felt cough, weakness, body temperature elevation up to 38 ºC. His condition sharply worsened till the end of 1st week, when he developed chills, excess sweating, fever 39 ºC. 2 days before hospitalization during cough the patient expectorated 600 ml of bed smelling sputum and then patient’s condition benefited. Now respiratory rate is 20 per min, temperature – 37,6 ºC. In which disease is possible to discharge sputum in such a way?
    
    1. 
       Spontaneous pneumothorax
       
    2. 
       * Lung abscess
       
    3. 
       Pulmonary infarction
       
    4. 
       Pneumonia
       
    5. 
       Pleurisy with effusion
       
99. 
    A patient 38 y.o. complains of attack-like cough with expectoration of small amount of “rusty" sputum, pain in the right side in deep breathing and cough. Onset of the disease was acute after overcooling. Data of examination: body temperature 39,2 C, respiratory rate 22 per min. Skin is moist, hyperemia of cheeks. Which diagnosis is the most probable?
    
    1. 
       Pleurisy with effusion
       
    2. 
       Bronchiectatic disease
       
    3. 
       Pulmonary tuberculosis
       
    4. 
       Acute bronchitis
       
    5. 
       * Pneumonia
       
100. 
     A patient of 40 y.o. complains of attack-like cough with brownish sputum, pain in the right side in deep breathing, sweating. He is ill for 6 days after overcooling. Data of examination: body temperature 39,6 C, respiratory rate 26 per min. By percussion in lower parts of right lung – dull sound, by palpation – vocal fremitus is absent. Which disease is the most probable?
     
     1. 
        * Fibrinous pleurisy
        
     2. 
        Lung abscess
        
     3. 
        Empyema pleurae
        
     4. 
        Spontaneous pneumothorax
        
     5. 
        Lung athelectasis
        
101. 
     In a patient of 48 y.o. during examination in admissious department pneumonia was diagnosed. The inflammatory focus is located in the lower lobe of the right lung. Which data of inspection of the chest will be?
     
     1. 
        Barrel-shaped chest
        
     2. 
        Paralytic chest
        
     3. 
        * In dynamic inspection of the chest there will be retardation of affected part in respiration
        
     4. 
        Collapse of the affectedt part of the chest
        
     5. 
        Thoracic type of breathing
        
102. 
     A patient of 40 y.o. complains of attack-like cough with brownish sputum, pain in the right side in deep breathing, sweating. He is ill for 6 days after overcooling. Data of examination: body temperature 39,6 ºC, respiratory rate is 26 per min. During percussion in lower parts of right lung dull sound is heard. Which changes of vocal fremitus will be?
     
     1. 
        Intensified above the upper part of affected lung
        
     2. 
        Decreased upper part of affected lung
        
     3. 
        * Absent on affected side
        
     4. 
        Not changed
        
     5. 
        No any answer is correct
        
103. 
     A patient of 60 y.o. complains of dyspnea with difficult expiration, which intensifies in physical load, on cough with expectoration of small amount of mucopurulent sputum, especially in the morning. He suffers from COPD for years. What is the mechanism of dyspnea in this disease?
     
     1. 
        Hypercapnia
        
     2. 
        *Bronchial obstruction (at the level of fine and median bronchi)
        
     3. 
        Bronchospasm
        
     4. 
        Obstruction of upper airways
        
     5. 
        Accumulation of sputum
        
104. 
     A patient of 64 y.o. was a worker in the staliness factory in the past. He was ill with chronic bronchitis for years. Now he is hospitalized with complaints on acute pain in the right part of the chest and dyspneawhich developed suddenly 2 hors beore. Data of examination: cyanosis, swelling of neck veins. Respiratory rate is 2 per min. One part of the chest is enlarged. During percussion tympanic sound on the right side of the chest is heard. Which pathological condition is it possible to suspect?
     
     1. 
        Intercostal neuralgy
        
     2. 
        Dry pleurisy
        
     3. 
        Exacerbation of bronchitis
        
     4. 
        Pneumonia
        
     5. 
        * Sponrtaneous pneumothorax
        
105. 
     A patient for several days complains of cough with expectoration of sputum, on voise hoarsness and general weakness. He leaves near earth-flax mine. Data of examination: enlarged lymph nodes above the right clavicle and in axillary region. Data of examination of otolaryngologist: paresis of the right vocal fold. Which pathological condition is it necessary to suspect?
     
     1. 
        * Cancer of the right lung
        
     2. 
        Right-sided pneumonia
        
     3. 
        Chronic bronchitis
        
     4. 
        Syphilis
        
     5. 
        Pulmonary tuberculosis
        
106. 
     Patient B. is seeking for medical advice becаuse of increased body temperatute up to 38 ?C, sweating, dry cough and general weakness. Bronchopneumonia was diagnosed in the patient. What onset is typical for bronchopneumonia?
     
     1. 
        Sharp
        
     2. 
        Acute
        
     3. 
        Prolonged
        
     4. 
        * Gradual
        
     5. 
        Dilated
        
107. 
     Patient B. is seeking for medical advice becаuse of increased body temperatute up to 39 ºC, pain in the left part of the chest. Pleuroneumonia was diagnosed in the patient. What onset is typical for pleuropneumonia?
     
     1. 
        Sharp
        
     2. 
        * Acute
        
     3. 
        Prolonged
        
     4. 
        Gradual
        
     5. 
        Dilated
        
108. 
     Patient D. complains of dry cough, hoarseness, general weakness, sweating, increase of body temperature up to 37,5 ºС. Data of physical examination: vocal fremitus is not changed, above the lungs resonant pulmonary sound is heard. What these data testify about?
     
     1. 
        Pulmonary emphysema
        
     2. 
        * Acute catarrhal bronchitis
        
     3. 
        Pneumonia
        
     4. 
        Norma
        
     5. 
        Hydrothorax
        
109. 
     Patient H. complains of acute pain in the right part of the chest, which gains more severe intensity at cough, deep breathing. What is the mechanism of development of the pain?
     
     1. 
        Distension of pleura
        
     2. 
        * Irritation of pleura because of its ruffness
        
     3. 
        Irritation of bronchial mucosa
        
     4. 
        Irritation of lung parenchyma
        
     5. 
        Pressing on the heart
        
110. 
     Patient J. complains of dyspnea, cough, night sweating. The lung apex height on the right side is equal to 1-1,5 cm, Krenig’s area is reduced. What the revealed signs specify about?
     
     1. 
        Pulmonary emphysema
        
     2. 
        * Pneumofibrosis of the apex
        
     3. 
        Pneumothorax
        
     4. 
        Norma
        
     5. 
        Right-sided hydrothorax
        
111. 
     Patient R. can’t sleep at night because of severe dyspnea, which make him to sit in a bed. How does such position of the patient in the bed is called?
     
     1. 
        Dyspnoe
        
     2. 
        * Ortopnoe
        
     3. 
        Tachypnoe
        
     4. 
        Eupnoe
        
     5. 
        Bradypnoe
        
112. 
     Patient R. complaints of feeling of air hunger and difficulties in expiration. Data of inspection: patient is staying and leaning against window-still. Respiratory rate is 28 per min, wheezes are heard on the distance What revealed signs testify about?
     
     1. 
        * Bronchial obstruction
        
     2. 
        Inflammation of pulmonary tissue
        
     3. 
        Air in the thoracic cavity
        
     4. 
        Hydrothorax
        
     5. 
        Asphyxia
        
113. 
     Patient R., aged 47, complains of severe dyspnea, cough, sweating, weakness for about recent 5 years. She explanes this disorders as a result of inhalation of dust for years. Which disease may develop in prolonged inhalation of dust?
     
     1. 
        Pneumonia
        
     2. 
        * Chronic bronchitis
        
     3. 
        Acute bronchitis
        
     4. 
        Pleurisy
        
     5. 
        Laringtis
        
114. 
     Patient S. suffers with morning cough with expectoration of large volume of greenish sputum. The sputum is better expelled in a certain position of patient’s body. Occureing of a such kind of cough is typical for:
     
     1. 
        * Bronchiectatic disease
        
     2. 
        Laryngitis
        
     3. 
        Pneumonia
        
     4. 
        Dry pleurisy
        
     5. 
        Lung cancer
        
115. 
     Patient T. complains of painful pierching sensations behind the sterrnum during coughing as well as on dry cough.This type of pain is typical for:
     
     1. 
        Bronchitis
        
     2. 
        Bronchiectatic disease,
        
     3. 
        * Tracheitis
        
     4. 
        Dry pleurisy
        
     5. 
        Exudative pleurisy
        
116. 
     Patient T. complains of sharp pain in the right part of his chest at deep breathing and cough. Such a pain is typical for:
     
     1. 
        Bronchitis
        
     2. 
        Bronchiectatic disease
        
     3. 
        Diffuse bronchitis
        
     4. 
        * Dry pleurisy
        
     5. 
        Exudative pleurisy
        
117. 
     Patient T. complains of sharp pain in the throat especially in swallowing. This type of pain is typical for:
     
     1. 
        Bronchitis
        
     2. 
        * Pharyngitis
        
     3. 
        Diffuse bronchitis
        
     4. 
        Dry pleurisy
        
     5. 
        Exudative pleurisy
        
118. 
     Patient with partial obstruction of a main bronchus by a tumour devepoted not complete atelectasis. Which percutorial sound may be obtained above the affected zone?
     
     1. 
        Resonant
        
     2. 
        Bandbox
        
     3. 
        Tympanic
        
     4. 
        * Dull
        
     5. 
        Dull-to-thympany
        
119. 
     Patient Y. was hospitalized with complaints on dry cough, chills and pain in the chest. In a hospital he started to expectorate rusty sputum. What should a doctor suppose in the patient?
     
     1. 
        Diffuse catarrhal bronchitis
        
     2. 
        Bronchiolitis
        
     3. 
        Bronchiectatic disease
        
     4. 
        Focal pneumonia
        
     5. 
        * Pleuropneumonia
        
120. 
     Patient А. Suffers of liver cirrhosis for 10 years. Now he complains of general weakness, reduction of body weight, feeling of heaviness in the left and right hypohondriums. No any pathology of thoracic cavity organs was revealed by physical examination, no liquid in abdominal cavity. The left and the right lower lungs borders are displaced upwards. What may be the cause of these findings?
     
     1. 
        Pulmonary emphysema
        
     2. 
        Pneumothorax
        
     3. 
        Norma
        
     4. 
        Bilateral hydrothorax
        
     5. 
        * High level of diaphragm, because of enlargement of the liver and spleen
        
121. 
     Patient А. complaints on cоugh with attacks of expiratory dyspnea. By palpation weakened vocal fremitus was revealled while bandbox sound was heard during percussion. What these signs indicate on?
     
     1. 
        * Pulmonary emphysema
        
     2. 
        Consolidation of pulmonary tissue
        
     3. 
        Cavity in the lungs
        
     4. 
        Liquid in the pleural cavity
        
     5. 
        Air in the pleural cavity
        
122. 
     Patient К. complains of increase of body temperature up to 37,8 ºС, pain in the chest on the right side as well as of dyspnea and cough. Vocal fremitus is amplified on the right side. By percussion dull sound is revealed. Which pathological process is present in the patient?
     
     1. 
        Pulmonary emphysema
        
     2. 
        Bronchial obstruction
        
     3. 
        * Consolidation of pulmonary tissue
        
     4. 
        Air in the pleural cavity
        
     5. 
        Hydrothorax
        
123. 
     Patient К. complains of expiratory dyspnea, general weakness. By percussion above the lungs bandbox sound is revealed, enlargement of the Krenig’s area, descendence of the lower lungs borders on both sides. How to assess revealed signs?
     
     1. 
        * Pulmonary emphysema
        
     2. 
        Bronchial obstruction
        
     3. 
        Consolidation of pulmonary tissue
        
     4. 
        Norma
        
     5. 
        Right-sided hydrothorax
        
124. 
     Patient К. is suffering from cоugh, fever up to 38,2 ºС, dyspnea. Intesified vocal fremitus was revealed by palpation of his chest while during percussion dull percussion sound was heard leftwards from the ІV to the VІ pibs. What these signs suggest about?
     
     1. 
        Pulmonary emphysema
        
     2. 
        * Consolidation of pulmonary tissue
        
     3. 
        Bronchial obstruction
        
     4. 
        Cavity in the lungs
        
     5. 
        Liquid in the pleural cavity
        
125. 
     The patient C. complaints on dyspnea. The disease has began after overcooling. At physical examination such symptoms were revealed as dyspnea, vocal fremitus above the lower part of the right lung is absent; the chest is resistent on the right side. By percussion in the lower part of the right lung dull percussion sound is revealed as well as displacement of the lower lung border on posterior axillary line up to VІ rib. What the revealed signs testify about?
     
     1. 
        Pulmonary emphysema
        
     2. 
        Bronchial obstruction
        
     3. 
        * Consolidation of pulmonary tissue
        
     4. 
        Air in the pleural cavity
        
     5. 
        Right-sided hydrothorax
        
126. 
     The patient complains of expiratory dyspnea, cough with difficult expectoration of viscous mucous sputum. He assumes forced position. Which actually position is typical for this pathological condition?
     
     1. 
        * Orthopnoe
        
     2. 
        Tachipnoe
        
     3. 
        Bradipnoe
        
     4. 
        Eupnoe
        
     5. 
        Polypnoe
        
127. 
     The patient G. complains of dyspnea and dry cough. By percussion bandbox sound is heard. The mobility of the lower lungs border is limited. How to assess revealed signs?
     
     1. 
        * Pulmonary emphysema
        
     2. 
        Pneumofibrosis of the apex
        
     3. 
        Pneumothorax
        
     4. 
        Norma
        
     5. 
        Right-sided hydrothorax
        
128. 
     Patient P., 54 years old, suffers from bronchial asthma for 10 years. At inspection of his chest its anterior-posterior diameter is enlarged, the chest is of barrel shape. What type of a chest is present in this patient?
     
     1. 
        Paralytic
        
     2. 
        Rachitic
        
     3. 
        Lordosis
        
     4. 
        * Emphysematous
        
     5. 
        Normal
        
129. 
     Patient K., 56 y.o., is on long-standing treatment in therapeutic department because of heart disease. He is on bed regimen. Where is edema located in such cases most often?
     
     1. 
        * Lumbar region
        
     2. 
        Feets
        
     3. 
        Below eyes
        
     4. 
        On hands
        
     5. 
        On legs
        
130. 
     A patient with rheumatic fever developed pericarditis. A doctor during auscultation has found murmur in precordial region located leftwards in the third - fourth intercostal spaces between medioclavicular and anterior axillary lines, it is heard very close to the ear of the examiner. The examiner supposed pleuropericardial friction murmur in the patient. Select typical sign of pleuropericardial friction murmur:
     
     1. 
        * Corresponds to respiration and heart rate
        
     2. 
        Intensifies if the patient declines forward
        
     3. 
        Intensifies if to press the bell of the stethoscope tightly the chest wall
        
     4. 
        Intensifies if the patient rises his hands up
        
     5. 
        Intensifies if the patient performes some excersises
        
131. 
     At inspection of patient R., 29 years old, paleness of the skin and mucosa, capillary “carotide shudder” were revealed. Data of auscultation: the I sound at the apex and the 2nd sound at the aorta are weakened, protodiastolic murmur. The examiner supposes aortal incompetence in the patient. Which maneur may help in recognition of the disease?
     
     1. 
        To ask the patient to breath deeply, to inhale and stop breathing
        
     2. 
        To ask the patient to decline forward or to press the bell of the stethoscope tightly the chest wall
        
     3. 
        * To ask the patient to rise his hands up
        
     4. 
        To ask the patient to perform some excersises
        
     5. 
        No any maneur is used
        
132. 
     Data of auscultation of a heart: near the left edge of the sternum in third - fourth intercostal spaces the changeble murmur is listened. The murmur is synchronous with heart contractions. The examiner supposes pericardial friction sound in the patient. Which maneur may help in recognition of the murmur?
     
     1. 
        To ask the patient to breath deeply, to inhale and stop breathing
        
     2. 
        * To ask the patient to decline forward
        
     3. 
        To ask the patient to rise his hands up
        
     4. 
        To ask the patient to perform some excersises
        
     5. 
        No any maneur is used
        
133. 
     Data of auscultation of a heart: near the left edge of the sternum in third - fourth intercostal spaces the changeble murmur is listened. The murmur is synchronous with heart contractions. The examiner supposes pleuropericardial friction sound in the patient. Which maneur may help in recognition of the murmur?
     
     1. 
        * To ask the patient to breath deeply or to inhale and stop breathing
        
     2. 
        To ask the patient to decline forward or to press the bell of the stethoscope tightly the chest wall
        
     3. 
        To ask the patient to rise his hands up
        
     4. 
        To ask the patient to perform some excersises
        
     5. 
        No any maneur is used
        
134. 
     During examination of patient’s heart a student has felt diastolic thrill at heart apex. Diastolic thrill at heart apex is the equivalent of:
     
     1. 
        Respiratory movements
        
     2. 
        Contraction of the left ventricle
        
     3. 
        Contraction of the right ventricle
        
     4. 
        Systolic murmur in aortal stenosis
        
     5. 
        * Diastolic murmur of mitral stenosis
        
135. 
     During examination of a patient with mitral stenosis slupping Ist heart sound is heard as well as acentuation of II sound and its split at pulmonary artery, opening snup sound, diastolic murmur. Which among presented fenomena belong to tripple rrhythm?
     
     1. 
        * Slupping I sound, acentuation of II sound at pulmonary artery, opening snup sound.
        
     2. 
        Slupping I sound, opening snup sound, diastolic murmur
        
     3. 
        Acentuation of II sound pulmonary artery, opening snup sound
        
     4. 
        Slupping I sound, opening snup sound
        
     5. 
        Slupping I sound, II sound split at pulmonary artery, opening snup sound
        
136. 
     During examination of patient S. aortal incompetence was revealed. The patient complains of headache, periodical dizziness. Skin palenes is visible as well as pulsation of carotic arteries. Which auscultaroty penomenon may be heard on femoral arteries?
     
     1. 
        * Double Traube’s sound
        
     2. 
        Systolic murmur
        
     3. 
        Diastolic murmur
        
     4. 
        Musse’s sign
        
     5. 
        Tripple rrhythm
        
137. 
     During examination of patient S. aortal incompetence was revealed. The patient complains of headache, periodical dizziness, skin palenes is visible as well as carotic arteries pulsation. A doctor is listening to patient’s femoral arteries by presing femoral artery with phonendoscope. Which auscultaroty penomenon is he cheking for?
     
     1. 
        * Durosier’s murmur
        
     2. 
        Systolic murmur
        
     3. 
        Diastolic murmur
        
     4. 
        Musse’s sign
        
     5. 
        Tripple rrhythm
        
138. 
     During inspection, palpation, percussion and auscultation of a patient the congestion in his lungs is revealed, which is caused by severe left ventricular failure. Which adventitious heart sounds may be auscultated at the apex of the patient’s heart?
     
     1. 
        I heart sound,
        
     2. 
        II heart sound
        
     3. 
        Opening snup sound,
        
     4. 
        Pericardial click
        
     5. 
        * III heart sound
        
139. 
     In a patient who is being on long-standing treatment because of chronic obstructive pulmonary disease, enlargement of the right ventricle and pulmonary hypertension are revealed by ultrasound examiation of a heart. What auscultation data is it possible to expect?
     
     1. 
        Intensification of 1st heart sound at the apex.
        
     2. 
        * Accentuation of the II sound at the pulmonary artery.
        
     3. 
        Systolic murmur at Botkin-Erb’s point.
        
     4. 
        Diastolic murmur at the xyphoid process.
        
     5. 
        Systolic murmur at the 2nd intercostal space rightwards of the sternum.
        
140. 
     In patient C. mitral valvular incompetence and left ventricular hypertrophy were diagnosed. Indicate, please, expected changes of the heart borders position.
     
     1. 
        Displacement of right border of relative cardiac dullness rightward,
        
     2. 
        Displacement of the left heart border of relative cardiac dullness leftward
        
     3. 
        Displacement of the upper heart border of relative cardiac dullness upward,
        
     4. 
        * Displacement of the left heart border of relative cardiac dullness leftward, the upper heart border of relative cardiac dullness upward
        
     5. 
        Displacement of the right heart border of relative cardiac dullness rightward and the upper one – upward.
        
141. 
     In patient C. mitral valvular incompetence with right ventricular failure was diagnosed. Indicate, please, expected changes of the heart borders position.
     
     1. 
        Displacement of right border of relative cardiac dullness rightward,
        
     2. 
        Displacement of the left heart border of relative cardiac dullness leftward
        
     3. 
        Displacement of the upper heart border of relative cardiac dullness upward,
        
     4. 
        * Displacement of the left heart border of relative cardiac dullness leftward, the upper heart border of relative cardiac dullness upward, the right heart border of relative cardiac dullness rightward
        
     5. 
        Displacement of the right heart border of relative cardiac dullness rightward and the upper one – upward.
        
142. 
     In patient C. with aortal heart defect systolic thrill in the ІІ intercostal space of the right chest was determined by palpation while diastolic murmur – by auscultation. Indicate, please, data of auscultation of femoral artery.
     
     1. 
        * Flint’s murmur, doble Traube’s sound.
        
     2. 
        Kumb's murmur
        
     3. 
        Systolic murmur.
        
     4. 
        Intermittent pulse.
        
     5. 
        Paradoxic pulse.
        
143. 
     In patient S. whith mitral heart defect intensified І sound above the heart apex is heard. Signs of right ventricular failure are present in the patient (edema on lower limbs, hepatomegaly, jugular veins swelling). Which finding is it possible to hear over pulmonary artery?
     
     1. 
        Systolic murmur
        
     2. 
        Diastolic murmur
        
     3. 
        Slapping I sound
        
     4. 
        Weakened I sound
        
     5. 
        * Accentuation of ІІ heart sound or (an) its split