Cholecystectomy, drainage of the common bile duct (for removing stones)

 

#twenty

*! A man, 35 years old, complains of pain in the lower third of his right shoulder. According to him, during the arm wrestling competition I felt a sharp pain, in connection with which, I was delivered to the emergency room after 15 minutes. On examination: pathological mobility in the lower third of the right shoulder, there is no active extension of the hand and abduction of 1 finger.

Is the MOST optimal treatment tactic considered?

+ surgical treatment and drug treatment

 

# 21

*! A woman, 78 years old, was taken by ambulance to the emergency room with complaints of pain in the right shoulder joint. From the anamnesis: I received an injury 3 days ago, I did not apply for medical help immediately after the injury. On examination: holds the shoulder with a healthy hand, bruising in the upper third of the shoulder. An adduction fracture of the surgical neck is determined on the P-grams of the shoulder joint.

Is the MOST optimal treatment tactic considered?

+ functional method

 

 

# 22

*! A woman, 42 years old, complains of pain in the elbow joint, aggravated by attempts at movements in the elbow joint. It was delivered to the emergency room 30 minutes after falling to the right elbow. On examination: significant swelling of the soft tissues of the joint, Gueter's triangle is broken. On the P-grams of the joint, a T-shaped fracture of the condyles of the shoulder is determined.

The MOST optimal treatment tactic is?

+ open metal osteosynthesis

 

# 23

*! A man, 40 years old, complains of chest pain on the right, difficulty breathing. He was injured when falling into the sewer manhole. Objectively: local chest pain, there is no breathing in the lower parts of the lung on the right, as well as blunting of percussion sound, starting from the 7th rib in the lower parts. On the P-gram, the fracture of the ribs and the fluid level in the projection of the 7th rib are determined.

Which intercostal space and which line are the MOST optimal for needle insertion during pleural puncture?

+8, rear axillary

 

# 24

*! The doctor at the factory first-aid post turned out to be an unwitting witness to the accident: the worker inadvertently spilled concentrated sulfuric acid on his hand. MOST first aid for this type of burn:

+ rinsing with water for 10 minutes

 

# 25

*! Man, 40 years old. After the operation of resection of the head of the radial bone, it can not straighten the brush, take the I finger of the brush.

MOST probable diagnosis?

* + intraoperative damage to the radial nerve

 

 

# 26

*! A child, 4 years old, complains of pain in the elbow joint. Pain appeared after the child's father restrained him from falling by his raised arm. Locally: cannot raise the right hand, the hand hangs along the body.

MOST probable diagnosis?

+ pronational subluxation of the radial head

 

# 27

*! A man, 47 years old, fell on his hand in the position of flexion of the forearm in the elbow joint. When examining the forearm is relatively shortened, there are no active movements in the elbow joint, when trying to passive movements in the joint, springy resistance is determined.

MOST probable diagnosis?

+ posterior forearm dislocation

 

 

# 28

*! A man, 65 years old, complains of pain in the elbow joint. According to the patient, during a sharp extension of the forearm and considerable effort, I heard a crack and felt severe pain on the back surface of the elbow joint. On examination: retraction of soft tissues above the ulnar process, there is no active extension of the forearm in the elbow joint, active flexion in full, painful.

MOST probable diagnosis?

+ tendon rupture with the 3rd head of the shoulder muscle

 

 

# 29

*! A man, 40 years old, was taken to the emergency room with complaints of pain, lack of movement in the left shoulder joint. According to the patient, during the detention by the police a "police" seizure was applied to him. On examination, the acromial process of the scapula is seen to stand, soft tissues are stuck under the process, and springy resistance is observed when trying to passively move the joint.

The MOST probable diagnosis will be?

+ front shoulder dislocation

 

#thirty

*! After the operation of restoration of dislocation of the acromial end of the clavicle, the immobilization of the limb MOST appropriate to appoint during?

+ 5 weeks

# 31

*! A man, 36 years old, was delivered with complaints of pain in the shoulder area. After the examination, the diagnosis was made: Closed transverse fracture of the middle third of the shoulder with a shift.

The MOST optimal type of latch in this case is?

+ lockable pin

 

# 32

*! Patient O., was admitted in an emergency with a gunshot wound to the chest. A preliminary diagnosis is made: Penetrating chest wound. MOST likely sign of open pneumothorax?

+ there is an open hole in the chest wall

 

# 33

*! A woman, 50 years old, was admitted to the department of traumatology on the day of the injury with complaints of severe pain in the hip joint, the inability to support the lower limb. After examination, a valgus femoral neck fracture was diagnosed.

What is the best treatment?

+ closed ostiosynthesis

 

# 34

*! A woman, 55 years old, was admitted to the trauma unit on the day of the injury with complaints of pain in the hip joint, the inability to rely on the lower limb. After examination, a hip fracture was diagnosed.

Is the MOST favorable period during which an operation is necessary, from the moment of injury to osteosynthesis of the hip, considered?

+ first day

 

# 35

*! MOST likely confirming a diagnostic sign of an intraarticular fracture with a knee puncture is the presence?

* + blood with droplets of fat

 

# 36

*! THE MOST optimal period of immobilization for isolated fractures of the condyles of the tibia is considered to be during?

+6 weeks

 

# 37

*! THE MOST optimal period of immobilization for hip condyle fractures without displacement is considered to be during?

+8 weeks

 

# 38

*! Is the MOST true indication for amputation considered?

+ gangrene of the limb

 

# 39

*! When examining the bladder with a catheter, urine with blood was received, which indicates the MOST probable damage?

+ Bladder

 

 

# 40

*! THE MOST expedient method of treatment for an open fracture of the lower leg?

+ extra focal osteosynthesis

 

# 41

*! Patient D, 56 years old, was admitted with a diagnosis of shoulder dislocation. After the introduction of the anesthetic, it was decided to correct the dislocation according to the Cooper method. What manipulations are MOST characteristic for this method?

* the doctor puts the foot on the seat of the chair, and the knee in the armpit of the patient +

 

# 42

*! Patient U, 47 years old, was admitted for a traumatic dislocation of the sternal end of the clavicle. It was decided to reduce the collarbone dislocation under local anesthesia. What is most appropriate for an assistant to help a traumatologist during a dislocation?

* press the knee into the interscapular region, part the patient’s shoulders +++

 

 

# 43

*! Patient B, 24 years old, was admitted for a traumatic posterior dislocation of the forearm. When viewed along the back surface under the skin, the ulnar process will stand, the forearm is shortened. During the positioning, the assistant assistant carries out the anti-traction of the shoulder, holds the hand and produces traction along the axis of the shoulder. What are the MOST characteristic actions a traumatologist should take?

* covers the shoulder in the lower third with two hands, and the thumbs lie on the elbow process +++

 

# 44

*! Pupils of the 6th grade of high school made a bonfire on a vacant lot. One of the teenagers threw a bottle of gasoline through the fire. Gasoline in a bottle caught fire and hit one of the teenagers. The flame burned his face. Concerned about burning pain in the burn area. Objectively: the cheeks, forehead, nose and chin are hyperemic, there are bubbles filled with tissue fluid. Eyes and airways were not affected. MOST probable diagnosis?

* burn flame face I-II degree +++

 

# 45

*! One of the MOST main goals of the local conservative treatment of burns is to fight:

* with pathogenic flora ++

 

# 46

*! A patient came to the paramedic complaining of a burning pain in her right hand, on which hot water poured 20 minutes ago. On examination: the patient rushes about in pain, groans. The skin of the dorsum and half of the palmar surface of the right hand is sharply hyperemic. MOST correct

* thermal burn of I degree. 1.5% burn surface area +++

 

# 47

*! A man, 28 years old, turned to the ENT doctor with complaints of pain in the right auricle. Sick 5 days after injury. On examination, the auricle is hyperemic in the upper third, swelling with fluctuation is determined.
Which of the following is MOST appropriate for clarifying the diagnosis?

+ x-ray

 

# 48

*! A 47-year-old man complains of suppuration from the left ear, hearing loss for 15 years. In the last 5 days, a headache appeared, more in the left half of the head. On examination: marginal perforation of the eardrum on the left, overhanging of the posterior upper wall of the external auditory meatus, purulent discharge with an unpleasant odor

Which of the following is the MOST appropriate study first?

+ x-ray

 

 

# 49

*! A young woman, 25 years old, complains of fever up to 38.4 ° C, sore throat. Sick 2nd day after hypothermia. With pharyngoscopy - hyperemia, swelling of the tonsils, on the surface of the tonsils there are islands of a whitish-yellowish coating, which is easily removed, the surface under it does not bleed.
Which research method, of the following, is MOST suitable for clarifying the diagnosis?

* + M throat from BL to BL

 

# 50

*! Young woman L., 25 years old, complains of fever up to 38.4 ° C, sore throat. Sick 2nd day after hypothermia. With pharyngoscopy - hyperemia, swelling of the tonsils, on the surface of the tonsils there are islands of a whitish-yellowish coating, which is easily removed, the surface under it does not bleed.
Which of the following is MOST appropriate to be included in the treatment plan:
* + P gargling pharynx with infusions of herbs

 

# 51

*! A 6-month-old boy is anxious, cries, chokes when eating, nasal breathing is difficult, his voice is nasal. Pharyngoscopy: hyperemia of the mucosa of the posterior pharyngeal wall; a spherical protrusion with fluctuation is determined on the posterior wall.

Which of the following is the most appropriate treatment?

* + opening of the pharyngeal space

 

# 52

*! A 67-year-old woman was delivered to the clinic with nosebleeds. With rhinoscopy: bleeding from the rear of the nasal cavity.

Which method of stopping bleeding from the following is MOST appropriate?

+ P erednyaya tamponade

 

# 53

*! A 29-year-old man was hospitalized in a clinic with a diagnosis of acute purulent frontal sinusitis on the right, ethmoiditis complicated by phlegmon of the orbit. On the first day of hospitalization, tremendous chills, exophthalmos on the left, chemosis, immobility of the left eyeball, soreness with pressure on the eyeballs did not appear.

Which of the following drugs is MOST appropriate to include in your treatment plan?

* + And nticoagulants (cavernous sinus thrombosis)

 

# 54

*! A boy of 4 years old complained of a barking cough and shortness of breath. Got sick

in cool, T-38 ° C. Marked retraction of the sternum and supraclavicular fossa,

The pulse is quickened, the skin is pale, the lips are cyanotic. With rhinoscopy and pharyngoscopy:

Hyperemia of the mucosa. Laryngoscopic narrowing of the glottis is noted. Due to infiltration and edema of the underfold space up to 3 mm.

What type of emergency assistance from the following is MOST appropriate?

* + N lower tracheostomy

 

# 55

*! A 17-year-old man complains of hemoptysis, pain in the area of ​​the thyroid cartilage, difficulty breathing after a fight. Inspection: the volume of the neck is increased, the contours are smoothed, with palpation soreness and crepitus. Laryngoscopy: narrowing of the lumen of the larynx, mucous pale, swollen.

Which of the following tools are MOST appropriate to use for further actions?

* + With calpel, single-tooth hook, Trusso expander, tracheocanula

 

# 56

1Man, 35 years old, was admitted to the clinic with pains over the bosom, ishuria. It turned out that 3 hours ago he received a blow to the suprapubic area. He was drinking alcohol the day before. Forced situation, sitting. The symptom of "vanka-vstanka" is expressed. With percussion in the abdomen, free fluid is determined.

Select the MOST probable diagnosis from the following?

* + bladder rupture

 

# 57

*! A 75-year-old man was admitted with complaints of difficulty urinating with a sluggish stream, with a feeling of incomplete emptying of the bladder, nocturia up to 5-6 times. Dysuria has been increasing over the past 6 months. Over the past 4-5 days, he was unable to urinate, with the exception of urine dropwise. The patient complains of pain in the lower abdomen, radiating to the perineum, drowsiness, fatigue, nausea and vomiting.

The MOST probable diagnosis of the following?

* + BPH 3 tbsp. Chronic complete urinary retention. Chronic renal failure.

 

# 58

*! A 27-year-old man complained of pain in the lumbosacral region

and perineum of a aching nature, discharge from the urethra in the morning of the mucous membrane

character, as well as frequent urination with moderate pain at the end

act of urination. A history of irregular sex life.

Which of the following diagnoses is MOST probable?

* + congestive prostatitis

# 59

*! The clinic asked a woman 37 years with complaints about the conductive weakness, aching pain in the right lower back. Two hours ago, re carried sided attack of renal colic, accompanies Xia raising the temperature to 38.5, chills followed Snack eye reduction temperature, pouring sweat and the disappearance of back pain. At the time of examination, the symptom of Parsnip is slightly positive on the right, the kidneys are not palpated, urination is not impaired, the urine is clear, body temperature is 37.2C.

Select of the following MOST've royatny diagnosis:

* + stone of the right ureter, acute serous pyelonephritis

 

# 6 0

*! A 37-year-old woman came to the clinic with complaints of general weakness, aching

lower back pain on the right. Two hours ago suffered a right-sided kidney attack

colic, accompanied by fever, chills, followed by a rapid decrease in temperature, torrential sweat and the disappearance of lower back pain. At the time of examination, the thumping symptom is slightly positive on the right, the kidneys are not palpated, urination is not impaired, the urine is clear, the temperature is 37.2.

The MOST probable doctor tactics in this case include:

* + urgent hospitalization

 

# 61

*! A 47-year-old patient was admitted with complaints of dull lower back pain on the right. Sick for 3 days, noted an increase in temperature to 37.8-38.5 C. There is no history of urological disease. Shortly before the present disease, there was an abscess on the skin, which squeezed out on its own. The kidneys are not palpable. The area of ​​the right kidney is painful on palpation. The symptom of striking on the right is positive. Muscle tension of the lower back and anterior abdominal wall is absent. In the OAK - leukocytosis with a shift to the left, acceleration of ESR, in the OAM - leukocyturia. Ultrasound-hypoechoic formation of the right kidney, 2 x 4 cm in size.

Select the MOST probable diagnosis from the following?

* + kidney carbuncle

 

# 62

*! The patient complains of paroxysmal pains in the region of the right kidney, radiating along the ureter to the right, nausea. Body temperature 36.6 C. Urination is not impaired, painless. In the KLA - moderate leukocytosis, accelerated ESR, in the OAM - hematuria, leukocyturia. On ultrasound - the expansion of the abdominal elements of the right kidney, in / 3 of the right ureter.

Select them from the following. MOST probable diagnosis?

* + stone of the upper third of the right ureter, renal colic on the right.

# 63

*! The patient complains of acute pain in the perineum, giving to the sacrum and suprapubic region. Body temperature increased to 39.5 C. Urination difficult, painful.

In OAK - leukocytosis, acceleration of ESR, in OAM - leukocyturia. The secret of the prostate is 30 leukocytes in half-vision.

Select the MOST probable diagnosis from the following?

* + acute prostatitis

 

 

# 64

*! A 46-year-old woman complains of pain during urination, a spray of urine during urination. From the anamnesis, 2 years ago she was examined by a gynecologist, a consultation of a urologist was recommended. Dysuria for 2 years, for 3 months with aggravation.

Select the MOST probable diagnosis from the following?

* + urethral polyp

 

# 65

*! A man, 45 years old, complained of a painless education in the upper eyelid region, which appeared 5 months ago. Within a month notes an increase in education. Objectively: in the middle third of the century, 3 mm from the edge there is a painless formation of approximately 4 mm in diameter; the skin above it is mobile, not changed. Moderate conjunctival hyperemia over education. The remaining parts of the eye are unchanged. VOD = 1.0; VOS = 1.0.

What is the most appropriate treatment tactic?

* + surgical treatment

 

# 66

*! A man, 36 years old, turned to an ophthalmologist with complaints of decreased vision, redness and pain in his right eye. Sick for a week. Recently had the flu. On examination: visual acuity OD = 0.4 does not correct. The eye is irritated, pericorneal injection, precipitates on the endothelium, the pupil is narrow, there are no other changes. The left eye is healthy.

What treatment is MOST appropriate to prescribe first?

* + mydriatics

 

# 67

*! A man, 56 years old, turned to an ophthalmologist with complaints of flickering “flies” and periodic pain in his right eye. On examination: visual acuity OD = 0.7; OS = 0.9. The field of view of the right eye is narrowed in the upper-inner quadrant by 15 °, the left eye is normal. With gonioscipia, the area of ​​the trabecula is not visible on the right. On the fundus of OD, excavation of the optic nerve disc is 0.5-0.6. Intraocular pressure OD = 28 mmHg, OS = 17 mmHg

Which drug is most appropriate to prescribe?

* + pilocarpine

 

# 68

*! A woman, 50 years old, complained of decreased vision in her left eye gradually over the past 3 years, painlessly. Visual acuity of the left eye of 0.1 is not corr. Objectively: subatrophy of the iris stroma; on the fundus, the ratio of excavation to the optic nerve disc is 0.8-0.9; In the field of view, the peripheral border in the upper-inner quadrant is 15 degrees from the fixation point. Intraocular pressure OD / OS = Maklakov 16/29 mm Hg With gonioscopy, all the identification zones of the anterior chamber angle are visible.

Which drug is most appropriate to prescribe?

* + timolol 0.5%

 

# 69

*! In a 50-year-old man, four months after cataract phacoemulsification with IOL implantation, vision on the operated eye decreased. Objectively: the cornea is transparent; anterior chamber of medium depth, moisture transparent; IOL position is correct; the back capsule is cloudy; deeper lying departments are not visible. Diagnosed with secondary cataract.

Which of the following treatment methods is MOST appropriate?

* + laserdiscision of the posterior capsule

 

# 70

*! A man, 65 years old, complains of a gradual decrease in vision in both eyes, more on the left. Objectively: Vis OD = 0.9; IOP = 19 mmHg Vis OS = 0.09 n / a; IOP = 18 mmHg Art.

OU: the cornea is transparent, the anterior chamber is of medium depth. The iris in color is not changed. After dilating the pupil on the left, clouding of the central and lower parts of the crystalline lens was revealed; on the periphery, the fundus reflex is clearly visible. Visible fundus without pathology.

Which operation is most appropriate?

+ cataract phacoemulsification

 

# 7 1

*! In a 43-year-old man, one year after receiving a penetrating wound of the right eye, electrophysiological examination revealed signs of sympathy of the left eye.

What is the most appropriate treatment for the prevention of patient blindness?

+ enucleation of the injured eye

 

# 72

*! A 46-year-old woman complained of lacrimation, photophobia, pain in the left eye. From the anamnesis: during the repair of the house a drop of lime got into the eye. Immediately washed my eye with running water. On examination: Vis OD = 1, 0. Vis O S = 0, 1 n / a; Objectively: severe blepharospasm; with biomicroscopy, mixed injection, conjunctiva of the eyelids hyperemic, edematous; the cornea is edematous, in the center-paleoscopic, opaque.. At instillation of 0, 1% fluorescein solution, the area of ​​the cornea turned green. The anterior chamber is of medium depth, uniform.

What is the most likely diagnosis?

* + corneal erosion

 

# 73

*! A 67-year-old man complained of a gradual decrease in vision in both eyes, more on the left. Objectively: Vis OD = 0.9; IOP = 19 mmHg Vis OS = 0.02 n / a; IOP = 18 mmHg Biomicroscopy: the cornea is transparent, the anterior chamber is of medium depth. The iris in color is not changed. After dilating the pupil on the left, diffuse opacification of the lens was revealed; the fundus is not ophthalmoscopically.

Which study is MOST likely to evaluate the functional prognosis of the planned operation?

* + electrophysiological

Test tasks

for students of 5 courses in the specialty "OM"

discipline "Infectious diseases in the work of GP" module "Basics of infectology"

* Infectious diseases in the work of GPs * 1 * 5 *

#1

*! What is the primary action the physician should take when an infectious disease is suspected?

Send emergency notice

# 2

*! What population is subject to follow-up after salmonellosis? Food Service Workers

# 3

*! What is the most common transmission route for brucellosis infection: Alimentary and contact routes

# 4

*! What part of the respiratory tract is affected mainly with influenza? Trachea

# 5

*! Does it refer to a localized form of meningococcal infection? Nasopharyngitis, pneumonia, meningococcal congestion

* Infectious diseases in the work of GPs * 2 * 23 *

#1

*! Man, 31 years old, he fell ill acutely, with fever up to 39 ^of the C, the appearance of fever, pain in the frontal and retro-orbital areas, aches in the muscles, bones and joints, pain and sore throat, dry cough, nasal congestion. On examination, on the 2nd day of the disease, hyperemia and puffiness of the face, vascular injection of the sclera were noted. In the oropharynx: bright hyperemia of the palatine arches, tonsils are not enlarged, no deposits, granularity of the posterior pharyngeal wall.

Which of the following diagnoses is the most likely? Flu

# 2

*! A young man of 18 years old, turned to a local therapist with complaints for 3 days, there was chills, headache, aching all over the body, low-grade fever, sore throat and along the trachea, a rough barking cough. On examination, mild hyperemia of the pharynx, tonsils behind the damsels, no raids, rapid and labored breathing, profuse serous discharge from the nose, hoarseness of the voice. Heart sounds are muffled by the rhythm correct heart rate 82 beats / min, blood pressure 100/60 mm Hg The abdomen is soft, painless. Urinates adequately.

Which of the following diagnoses is the most likely? Parainfluenza

#4

*! A young man of 17 years old, was admitted to the hospital. Complaints of fever up to 37.7С, headache, sore throat and along the trachea, a rough barking cough. On examination: moderate hyperemia of the mucous membrane of the oropharynx, tonsils are not enlarged. Rapid and labored breathing, profuse serous discharge from the nose, hoarseness of the voice. Heart sounds are muffled, pulse 82 beats / min, blood pressure 100/60 mm Hg The abdomen is soft, painless. Urinates adequately.

Which part of the upper respiratory tract is affected by parainfluenza? Larynx

#5

*! A man of 28 years old, became acutely ill with a headache in the frontal region and orbits of the eyes, body aches, in bones and joints, sore throat, nasal congestion, hospital. When viewed on the 2nd day of the disease: in the oropharynx - bright hyperemia, hyperemia and puffiness of the face, vascular injection of the sclera, nose is blocked. In the lungs - hard breathing, no wheezing. Cardiac tones are muffled, tachycardia, heart rate 98 beats / min, blood pressure 100/60 mm Hg Abdomen soft painless, increase in body temperature up to 39 ^of the C. I took teraflu and paracetamol on my own, but without effect. Caused BSMP, delivered to the infectious

What syndrome is predominant in the clinical picture? Intoxication

# 6

*! A woman, 30 years old, went to the doctor on the 1st day of illness. She became ill sharply, the temperature increased with chills up to 39.5 ° C, there was a headache in the frontal region, in the eye sockets, nasal congestion, sore throat and sore throat, dry cough, muscle pain, photophobia. Epidemiological history: 3 days ago a child was ill. On examination: a moderate condition, the face is hyperemic, vascular injection of the sclera. The pharynx is brightly hyperemic. The nose is blocked, breathing through the mouth. Pulse 108 beats. in minutes HELL 100/60 mm Hg The abdomen is soft, painless.

MOST probable diagnosis? Flu

# 7

*! A girl of 19 years old, became acutely ill with the appearance of malaise, headache, nasal congestion, a feeling of dryness and a feeling of soreness in the nasopharynx. Soon there appeared profuse serous, and then mucous discharge from the nose, frequent sneezing. Objectively: Body temperature - 37.4C. With rhinoscopy: hyperemia and swelling of the nasal mucosa, profuse rhinorrhea. At the nasal openings, the skin is macerated. Heart sounds are muffled, the rhythm is correct. Heart rate - 80 bpm, blood pressure - 110/60 mm Hg The abdomen is soft, painless. Urinates adequately.

Which of the following is the most likely diagnosis? Rhinovirus infection

# 8

*! A woman, 20 years old, became ill gradually with the appearance of malaise, headache, nasal congestion and tickle in the nasopharynx. On the 2nd day, the condition worsened, body temperature increased to 38.5 ° C, the cough intensified and became paroxysmal in nature, sputum joined. Objectively: a serious condition. Acrocyanosis. In the throat: the mucous membrane is hyperemic, granular. Heart sounds are muffled, rhythmic. NPV - 20 per min. With percussion of the lungs, areas with a boxy tint of sound, alternating with areas of blunting, are noted. During auscultation, breathing is tough; dry and small-bubble moist rales are heard.

What is the most likely diagnosis in this clinical case? RCI

# 9

*! A 26-year-old man turned to a district doctor on the 3rd day of illness. The disease began gradually with the appearance of a runny nose and cough, slight sore throat. Low-grade fever lasts all days. Epigastric pains are noted, 1-2 times there was a loose stool. On examination: facial hyperemia, vascular injection of the sclera and conjunctiva, moderate hyperemia and granularity of the mucosa of the posterior pharyngeal wall. Cervical, submandibular lymph nodes are enlarged slightly. Unilateral conjunctivitis.

Which of the following diagnoses is MOST probable?

Adenovirus infection

# 10

*! A man, 20 years old, was admitted to an infectious diseases hospital. He became acutely ill with the appearance of chills, headache, vomiting, fever up to 39C. The next day, an abundant hemorrhagic rash appeared on the skin of the lower extremities. On examination: body temperature 39.0C. In the pharynx: the mucous membrane is hyperemic, the follicles of the posterior pharyngeal wall are hypertrophied. The skin is pale. In the region of the legs, feet of both legs - a hemorrhagic rash of a star-shaped form. Heart sounds are muffled, rhythmic. HELL - 100/60 mm Hg White blood cells in the KLA - 21.5x10 ⁹ / L.

What form of the disease is MOST likely in this clinical case? meningococcemia

# 11

*! A student of 20 years entered February 2 on the 2nd day of illness. Complaints: an increase in body temperature to 40.0 ° C, stubborn headache, vomiting that does not bring relief. On examination: serious condition. In the mind, lies with his eyes closed. In the pharynx diffuse hyperemia and granularity of the posterior pharyngeal wall. The skin is hot to the touch. On palpation, moans due to pain. On the skin of the lower extremities is an abundant petechial rash. In the KLA: lake-25 × 10 ⁹ / l, semi-neutral neutr. - 18%, secondary neutr.-72%, lymph. - 5%, mon.-5%.

What is the most likely diagnosis? Meningococcal infection, meningitis, meningococcemia

# 12

*! A man, 25 years old, fell ill acutely with fever up to 39-40 ° C, severe headache, vomiting once, loss of appetite, weakness, body aches. On examination: clear consciousness, in the throat-slight hyperemia, tonsils behind the arches, no raids. On the skin of the feet is a single hemorrhagic rash. HELL 100/60 mm Hg, pulse 100 beats / min. The local doctor diagnosed SARS, prescribed outpatient treatment, leaving the patient at home.

What symptom should alert the local doctor about meningococcemia?

Hemorrhagic rash

#thirteen

*! A girl, 19 years old, fell ill on March 15, acutely, in full health. Complaints of fever up to 38 ⁰ C, headache, weakness, nasal congestion, sore throat. The state of moderate severity. In the throat: hyperemia of the mucosa, hypertrophy of the follicles of the posterior pharyngeal wall, mucopurulent deposits on the posterior wall. Heart sounds are muffled, pulse -88 beats / min., Blood pressure - 110/70 mm Hg. In the hemogram: white blood cells - 15.0x10 ⁹ / l., ESR - 20 mm / hour. A culture of N was isolated from nasopharyngeal mucus. meningitidis.

What is the MOST correct diagnosis for this patient? Meningococcal infection, nasopharyngitis

14

*! A man, 20 years old, fell ill acutely with fever up to 40 ° C, headache, vomiting, weakness, body aches. On the same day, a hemorrhagic rash appeared on the feet, lower leg, and thighs. The skin is pale. Stiff neck. HELL 90/60 mm Hg, pulse 100 beats / min. In the hemogram: leukocytes - 20x10 ⁹ / l., Leukoformula: myelocytes - 2, s / I - 14, s / I - 78, monocytes -2, lymphocytes - 4, ESR - 40 mm / hour. Cerebrospinal fluid: turbid, flowing out under pressure, Pandy reaction (+++), cytosis of 1500 cells in 1 μl due to neutrophils (95%).

What is the patient’s form of meningococcal infection? Meningococcal infection, mixed form

# 15

*! A girl, 16 years old, a student of the Lyceum, was admitted to the clinic on the 1st day of illness. The disease began acutely with a sudden increase in temperature to 40 ° C, a sharp headache, vomiting, which does not bring relief. At admission: general condition is extremely serious, stupor. Pupils dilated, photoreaction saved. Rigidity of the occipital muscles sharply "+", Kernig symptom "+". General hyperesthesia is noted. In the lungs, vesicular breathing. Heart sounds are deaf, pulse is 130 beats per minute, blood pressure is 100/50 mm Hg.

What form of meningococcal infection should be thought of? Meningitis, generalized form

#sixteen

*! A woman of 25 years, examined on the 2nd day of illness in the emergency room of the infectious diseases hospital. Complaints about Quest shaped abdominal pain, nausea, headache, diarrhea up to 10 times a day, tenez we, false desires. On examination: body temperature - 36.0 ° C, blood pressure - 90/60 mm RT. Art. Pulse - 110 beats per minute. On palpation of the abdomen: pain in the left iliac region, whitefish movidnaya gut spasm. The stool is calcite, mucus streaked with blood. At OAK: er. - 4.0x10 ¹² / l, Hb -145 g / l, lake-11.4x10 ⁹ / l, e - 1, n - 2, s - 75, l - 18, m - 5. ESR - 17 mm /

Which of the following diagnoses is most likely? Dysentery / acute shigillosis

# 17

*! A woman, 40 years old, turned to a therapist on the 1st day of illness. Ill acutely after 4 hours after pre byvaniya visiting: epigastric pain, nausea around the navel, 4-5 times vomiting, diarrhea to 7-8 times. On admission: temperature - 38ºС. The abdomen is not swollen, palpation painful in the epigastrium and right iliac region. There is no bowel spasm. HELL - 100/60. Pulse - 90 beats per minute Urinates. The chair is plentiful, with mucus, dark greenish in color, fetid.

What is the most likely diagnosis? Acute Salmonellosis

# 18

*! A man, 30 years old, went to the clinic on the 2nd day of illness. He became acutely ill 8 hours after eating poorly fried eggs at home. They began to disturb the pain in the epigastrium, around the navel, nausea, vomiting 3-4 times, frequent loose stools up to 5-7 times a day. On admission: temperature - 38ºС. The abdomen on palpation is painful in the epigastrium and the right iliac region. HELL - 100 / 70mm Hg Urinates. The chair is plentiful, with mucus, dark greenish in color, fetid. The doctor suggested that the patient had salmonellosis.

Which of the clinical forms (variant) of salmonellosis is the most likely in this case? Gastrointestinal form

# 19

*! A student, 18 years old, lives in a dormitory, became acutely ill with an increase in body temperature to 39C, the appearance of chills, headache, and weakness. Almost simultaneously, cramping abdominal pains appeared, 1 time there was vomiting, loose stools up to 15 times a day. The abdomen is soft, painful in the left iliac region. The stool is fluid, sparse, with mucus and streaks of blood.

Which of the following diagnoses is MOST probable? Acute shigellosis

#twenty

! A man, 18 years old, was admitted on the 3rd day of illness with complaints of cramping abdominal pain, weakness, fever, loose stools up to 15 times a day, false desires. On the eve was at a party, ate a variety of foods (salads, fried mushrooms), drank alcohol. At home he drank water from the column, ate cucumbers, apples from the garden. Body temperature - 37.6ºС. AD-100/70 mm RT. Art. Pulse 90 beats. in 1 min. The stomach is soft. The sigmoid colon is spasmodic, painful on palpation. The stool is sparse, with mucus and streaks of blood. Acute shigellosis

The MOST probable diagnosis in this clinical case is:

# 21

*! A 42-year-old man was taken to the emergency room of the Mangistau Regional Hospital with complaints of temperatures up to 39-40C with tremendous chills, body aches, severe headache, pain in the armpit on the right, and wheezing. He fell ill acutely last night. 3 days ago he participated in the slaughter of a sick camel, cut his hand. The patient's condition is severe due to severe intoxication. BH-20 in 1 min. Pulse - 120 in 1 min., AD-90/60 mm / hour. In the axillary region on the right, a sharply painful, dense motionless conglomerate is palpated, the skin over which is hyperemic.

In the hemogram: white blood cells - 24 x 10 ⁹ / l, p / I neutroph. -14%, s / I neutroph - 82%, lymph. - 2%, mon. -2%. Do not urinate during the day.

What organizational event should you hold first?