Days before and 3-5 days after vaccination

 

# 137

*! Mom with a 5-year-old girl applied for an admission to the children's clinic. The child has weakness, abdominal pain, loss of appetite, in the evenings - a rise in temperature to 37.9 ° C. Mother noticed that the girl often urinates, the urine is cloudy. The tongue is dry, coated with a white coating. In the lungs, vesicular breathing, heart sounds are muffled. The abdomen is soft, painless.

Liver, spleen not enlarged.

What changes in the blood test are MOST likely for this disease? Leukocytosis, ESR acceleration

 

# 138

*! A 5-year-old boy with complaints of weakness, fever, pain in the lower extremities. From the anamnesis it is known that within 3 months the boy quickly gets tired, his appetite decreased. The deterioration appeared 10 days from an increase in body temperature to 39.3 C, an increase in lymph nodes. On examination, the condition is serious, symptoms of intoxication. Hemorrhagic syndrome is expressed on the lower extremities and mucous membranes of the oral cavity. Palpable submandibular, cervical, inguinal lymph nodes up to 1 cm in size, dense, painless. Liver + 4 cm, spleen + 2 cm below the costal arch. In the analysis of peripheral blood, hyperleukocytosis up to 200,000 / μl, blasts 76%, anemia, thrombocytopenia. In the myelogram: blasts 96%, erythroid germ, neutrophilic germ 3%, no megakaryocytes.

Which of the following is the MOST probable diagnosis? Acute leukemia

 

# 139

*! The boy 7 years last month began a stubborn fever with evening rise t to 38,5-39 ⁰ .Rebenok blednyy..Nemnogochislennaya petechial-spotted type of hemorrhagic rash on the skin of the trunk and to the extremities. Hepatomegaly, splenomegaly + 2cm, an increase in cervical and axillary lymph nodes are noted. Blood test: HBG -74 g / l, RBC - 2.4 x 10 ¹² / l., Reticulocytes - 0.4%; WBC - 2.2 x 10 ⁹ / l, stab-1%; segmented-11%; eosinophils-2%; monocytes-5%. lymphocytes-81%; PLT –30x10 ⁹ / l.; ESR – 52 mm / hour.

Which of the following is the MOST probable diagnosis? Acute lymphoblastic leukemia? (symptoms and lymphocytes are enlarged). But there are no blasts as such. Therefore, there is a suspicion of aplastic anemia.

 

# 140

*! Patient P... 12 years old was admitted to the department with nosebleeds. From the anamnesis it is known that 2 weeks before the present disease suffered an ARVI. after which, in various parts of the body, without a certain localization, ecchymoses of various sizes and a small-point hemorrhagic rash appeared. Upon admission, the child's condition is serious. When viewed With reference is ample attention to themselves in the form of hemorrhagic syndrome ekhimo call various sizes and old, on the face, neck and hands petechial elements. Blood swabs in the nasal passages. Peripheral skie lymph nodes are small, movable. Liver, spleen are not palpable. General blood test: Hb - 101 g / l. Er - 3.2x10 g / l;. Thromb. 10 * 10 ^ 12 / l., Lake - 6.4x10 / l, s / n - 2%, s - 59%. e - 3%. l - 28%. m - 8%. ESR 5 mm hour.

Which of the following is the MOST probable diagnosis? Itp - idiopathic thrombocyte purple

 

# 141

*! What are the most likely main criteria for the diagnosis of hereditary Minkowski-Shoffar anemia in children? Anemic syndrome (promised symptom complex), icteric syndrome, splenomegaly, hepatomegaly

 

# 142

*! Boy 3 years old. The parents of the child consulted a doctor with complaints of swelling in the face and legs, and abdominal pain. From the anamnesis: the boy often has colds, and 2 weeks ago suffered a sore throat. Home treatment: biseptol, pharyngosept. On examination: pallor of the skin, swelling of the face, swelling on the legs. From the side of the heart and lungs, pathology was not detected. Moderate soreness during palpation of the abdomen. The liver and spleen are not enlarged.

What are the most likely symptoms for the diagnosis to be MOST likely for this disease? Proteinuria, hypoproteinemia, decreased GFR

 

# 143

*! Boy 3 years old. Parents of a child consulted a doctor with complaints of lethargy, swelling in the face and legs, decreased appetite, and abdominal pain. From the anamnesis: the boy often has colds, and suffered a sore throat two weeks ago. Home Treatment: Biseptol, Pharyngosept,

multivitamins. On examination: pallor of the skin, swelling in the face and legs. From the side of the heart and respiratory system, no pathology was detected. Moderate soreness during palpation of the abdomen. The liver and spleen are not enlarged.

What changes in urine analysis are MOST likely for this disease? Proteinuria, hematuria

 

# 144

*! Girl 9 years old. Parents of a child consulted a doctor with complaints of abdominal pain and

lumbar region, increased urination. History: a girl from I pregnancy,

proceeding with toxicosis of the first half. The child often has ARVI. This disease started 4 days ago (against the background of hypothermia) with abdominal pain, hyperthermia up to 39 ° C. On examination: the skin is pale, no swelling. Sim ptom Pasternatskogo positive on both sides. US: ehoplotnosti increase in both kidneys, a suspicion of a doubling of the left SMOs ki.

What changes in urine analysis are MOST likely for this disease? leukocyturia

 

# 145

*! Girl 13 years old. The disease began 2 weeks ago after suffering an ARI. The local doctor began treatment for cystitis. History: 8 years old, the girl suffered scarlet fever, against the background of which traces of protein, macrohematuria, leukocyturia were found. Further urine tests were not controlled. Despite the therapy, lethargy was growing, nausea, pastes of the eyelids, and a decrease in diuresis began to be noted. In the analysis of urine: protein - 0.66% ₀ , red blood cells - 25-30 in n / a. The girl was hospitalized in a specialized department.

What is the most likely blood pressure indicator for this disease? Here the blood pressure will be increased, for example 140/90 and higher

 

# 146

*! Boy 4 years old. After discharge from the hospital and completion of the course of treatment for the diagnosis of Acute glomerulonephritis, the child is taken to “D”.

What is the most appropriate number of examinations of narrow specialists in the first year of the dispensary observation of this child? 1 time in 3 months - nephrologist, 2 times a year - ENT, Dentist, Optometrist

 

# 147

*! The boy is 5 years old. The child, after the 1st stage of treatment regarding the diagnosis of "Acute post-streptococcal glomerulonephritis", was discharged from the hospital at maintenance doses of a corticosteroid. Given the duration of hormone therapy, an antacid agent is additionally prescribed.

Which antacid drug is MOST suitable for this

baby? Almagel A

 

# 148

*! The girl is 8 months old, complaints from her mother's words about pallor, lethargy, loss of appetite. AT

history: a child from IV full-term pregnancy with anemia, the threat of miscarriage, bronchopneumonia, II urgent delivery. The girl has been on artificial feeding since 3 months. Objectively: the girl is moody, active. For organs without pathology. In the general analysis of blood: hemoglobin 90 g / l, red blood cells 3.5x10 ¹² / l, color indicator 0.87; MCV -70 fL, MCH -25 pg, MCHC -29%, anisocytosis +, poikilocytosis +, hypochromia +, reticulocytes - 10%.

Which drug is MOST likely to be used at the outpatient stage of medical care? Actiferrin

 

# 149

*! A girl of 5 months, complaints from the words of her mother about pallor, lethargy, loss of appetite. A child from II pregnancy, proceeding against the background of anemia, the threat of miscarriage, II urgent birth. The girl has been on artificial feeding since 1 month. Objectively: the girl is moody, active. The skin is pale, clean. For organs without pathology. In the general analysis of blood: hemoglobin 95 g / l, red blood cells 3.7x10 ¹² / l, color indicator 0.82; MCV -70 fL, MCH -26 pg, MCHC -29%, anisocytosis +, poikilocytosis +, hypochromia +, reticulocytes - 11%, ESR - 6 mm / h.

What is the MOST probable period of follow-up for this child?

* 1-2 months

* 3-5 months.

* + 6-12 months.

* 13-18 months.

* 19-24 months

# 150

*! A girl of 6 months, according to the mother, the child complains of pallor, lethargy, loss of appetite. From the anamnesis: a child from IV full-term pregnancy, II urgent delivery. Pregnancy

proceeded against a background of placental insufficiency. It has been on artificial feeding since 3 months. Objectively: The girl is capricious, active. The skin is pale, clean. For organs without pathology. In the general analysis of blood: hemoglobin 90 g / l, red blood cells 3.1x10 ¹² / l, color indicator 0.8; MCV -70 fL, MCH -25 pg, MCHC -29%, anisocytosis +, poikilocytosis +, hypochromia +, reticulocytes - 10%.

What are the MOST significant antenatal causes of this disease in a child?

* fetal hypoxia

*bronchopneumonia

* threatened abortion

* burdened obstetric history

* + placental insufficiency

 

 

# 151

*! A boy aged 1 year 2 months, my mother went to the doctor with complaints about a decrease in the child’s appetite, lethargy, eating toothpaste, raw dough, and chalk. From the anamnesis: the child is from a second pregnancy, proceeding against the background of anemia. It is on artificial feeding from 2 months. Objectively: the skin is pale, clean, dull, brittle, capricious, lethargic hair. For organs without pathology. In a general blood test: hemoglobin (Hb) - 85 g / l, red blood cells - 3.0x10 ¹² / l, color indicator - 0.71; reticulocytes - 1.9%, leukocytes - 7.2x10 ⁹ / l, stab - 2%, segmented - 20%, eosinophils - 4%, lymphocytes - 64%, monocytes - 10%, ESR - 6 mm / hour. In a biochemical blood test: serum iron 9.1 μmol / L.

What are the most appropriate patient management tactics?

* the appointment of a complete and balanced diet with the main ingredients

* transfusion of red blood cells at the rate of 10-15 ml / kg of weight

* + appointment of hemofer orally in a daily dose of 25 drops

* the appointment of ferrum Lek parenterally in 0.5 ml every other day

* whole blood transfusion in a volume of 150 ml

# 152

*! A girl of 6 months, according to the mother, the child complains of pallor, lethargy, loss of appetite. A child from IV full-term pregnancy, II birth. From the anamnesis: pregnancy proceeded against a background of placental insufficiency. Delivery was urgent, but there was a late cord ligation. The girl has been on artificial feeding since 3 months. Objectively: the girl is moody, active. The skin is pale, clean. For organs without pathology. In the general analysis of blood: hemoglobin 90 g / l, red blood cells 3.0x10 ¹² / l, color indicator 0.8; MCV -70 fL, MCH -25 pg, MCHC -29%, anisocytosis +, poikilocytosis +, hypochromia +, reticulocytes - 10%.

What are the MOST significant intranatal causes of this disease in a child?

* urgent delivery

*bronchopneumonia

* + late umbilical cord dressing

* burdened obstetric history

* placental insufficiency

# 153

*! A boy at the age of 1 year 2 months, my mother went to the doctor with complaints of decline

appetite, lethargy, eating toothpaste, raw dough, chalk. From the anamnesis: a child from the second full-term pregnancy, the second birth. Objectively: The skin is pale, hair is dull, brittle. Cor tones are loud, rhythmic, functional noise at the apex of the heart. For other organs without pathology. AT

general blood test: Hb - 85 g / l, red blood cells - 3.1x1012 / l, CP - 0.71; reticulocytes - 1.9%,

leukocytes - 7.2x109 / l, stab - 2%, segmented - 20%, eosinophils - 4%,

lymphocytes - 64%, monocytes - 10%, ESR - 6 mm / hour. In a biochemical blood test: serum iron 9.1 μmol / L.

Which of the laboratory tests most accurately confirms the diagnosis in this patient?

* desferal test

*general blood analysis

* serum ferritin

* + whey iron

* transferrin saturation coefficient

 

# 154

*! A district doctor came to the I patronage of a newborn girl for 8 days. Is situated on

breastfeeding. There are no complaints. From the anamnesis: a child from І pregnancy, І urgent birth. Objectively: the skin is clean. Zev is calm. For organs without pathology. Complete blood count: erythrocytes - 4.4 x 10 ¹² / l, HB - 120 g / l, color indicator - 0.95, leukocytes - 9.8 x 10 ⁹ / l, stab - 2, segmented - 25, lymphocytes - 66, monocytes - 3, eosinophils - 4, ESR - 5 mm / hour. The local doctor gave recommendations.

What non-specific prophylaxis is MOST likely prescribed by a doctor?

* walks, pine baths, massage

* walks, mud baths, massage

* walks, salt baths, massage

* + walks, hygienic baths, massage

* walks, a series of baths, massage

 

# 155

*! A mother and a child aged 2 months came to a preventive clinic. Is breastfed. There are no complaints. From the anamnesis: a child from the first pregnancy, the first birth at 35-36 weeks. She was born with body weight - 2800 g, height - 48 cm, screamed right away, Apgar score - 7-8 points. Objectively: the skin is clean. Zev is calm. For organs without pathology. Complete blood count: red blood cells - 4.4 x 10 ¹² / l, HB - 120 g / l, CP - 0.9, white blood cells - 9.8 x 10 ⁹ / l,

stab - 2, segmented - 25, lymphocytes - 66, monocytes - 3, eosinophils - 4, ESR - 5 mm / hour. The local doctor diagnosed and prescribed health measures.

What medical prophylaxis is MOST likely prescribed by a doctor?

* transfusion of red blood cells at the rate of 10 ml / kg of body weight once

* Aloe syrup with iron orally 2.5 ml 3 times a day for 3 months

* + actiferrin 5 drops 3 times a day orally for 3 months

* ferrum Lek 0.5 ml intramuscularly after 2 days for 2 months

* fercyle 1 ml intramuscularly after 2 days for 5 months

 

 

# 156

*! A girl of 5 months, complaints from the words of her mother about pallor, lethargy, loss of appetite. From the anamnesis: a child from II pregnancy, II urgent delivery. The girl has been on artificial feeding since 1 month. Objectively: the girl is moody, active. The skin is pale, clean. Zev is calm. For organs without pathology. In the general analysis of blood: hemoglobin 95 g / l, red blood cells 3.7x10 ¹² / l, CP 0.82; MCV -70 fL, MCH -26 pg, MCHC -29%, anisocytosis +, poikilocytosis +,

hypochromia +, reticulocytes - 11%, ESR - 6 mm / h.

What is the most appropriate appointment for the patient?

* transfusion of red blood cells at the rate of 10 ml / kg of weight

* balanced by the main ingredients diet

* + hemofer orally in a daily dose of 16 drops

* ferrum lek parenterally 0.3 ml every other day

* transfusion of whole blood in a volume of 100 ml

 

# 157

*! A boy aged 1 year 2 months, my mother went to the doctor with complaints of decreased appetite, lethargy, eating toothpaste, raw dough, chalk. From the anamnesis: a child from ІІ pregnancy, ІІ urgent birth. Objectively: the skin is pale, clean, dull, brittle hair. Cor tones are loud, rhythmic, functional noise at the apex of the heart. For other organs without pathology. AT

general blood test: Hb - 85 g / l, red blood cells - 3.1x10 ¹² / l, CP - 0.71; reticulocytes - 1.9%, leukocytes - 7.2x10 ⁹ / l, stab - 2%, segmented - 20%, eosinophils - 4%, lymphocytes - 64%, monocytes - 10%, ESR - 6 mm / hour. In a biochemical blood test: serum iron 9.1 μmol / L.

What is the MOST probable diagnosis?

* Vitamin B12 - deficiency anemia, II degree

* iron deficiency anemia of the III degree

* + iron deficiency anemia, II degree

* folic deficiency anemia of the first degree

* iron deficiency anemia of the first degree

 

# 158

*! Mom with a girl aged 2.5 years went to the doctor with complaints of decreased appetite, pallor, lethargy, red urine. Complaints appeared 2-3 weeks ago, red urine this morning, on the eve of eating beetroot salad. From the anamnesis of life: a child from II pregnancy, II urgent delivery. The girl was called a breastfed up to 1 month. Objectively: the skin is pale, clean. For organs without pathology. In the general analysis of blood: hemoglobin 95 g / l, red blood cells 3.7x10 ¹² / l, color indicator 0.8; MCV -70 fL, MCH -26 pg, MCHC -29%, anisocytosis +, poikilocytosis +, hypochromia +, reticulocytes - 11%, ESR - 6 mm / h.

What symptom is one of the MOST rare symptoms in a given disease?

*lethargy

* + bitumen

*pallor

* swelling

* decreased appetite

 

# 159

*! Mom with a child aged 1.5 months turned to the clinic with complaints of sweating, anxiety, and trembling. From the anamnesis: mother during pregnancy selectively ate, walked for an hour. A child from І pregnancy occurring against the background of gestosis, І urgent delivery. The boy was born in November. It is on mixed feeding. On examination: craniotabes, baldness of the nape. On internal organs without altering th. In the biochemical analysis of blood: total phosphorus - 1.6 mmol / l, total calcium - 2.7 mmol / l, ionized calcium - 1.55 mmol / l.

What predisposing exogenous factors on the part of the mother MOST likely caused the disease in the child?

* gestosis, toxicosis, complicated labor

* young age, renal pathology, lack of exercise

* toxicosis, renal pathology, complicated labor

* + physical inactivity, insufficient insolation, nutritional defects

* gestosis, insufficient insolation, nutritional defects

 

# 160
*! Mom with a baby aged 1.5 months turned to the clinic complaining of sweating, anxiety, and trembling. From the anamnesis: a child from І pregnancy, proceeding against

preeclampsia, I urgent delivery. The boy was born in November. It is on mixed feeding. Mom with a child walk daily for 15-30 minutes. Massage and exercise therapy for the child does not hold tight swaddles. On examination: craniotabes, baldness of the occipital region. On internal organs without altering th.

What exogenous factors on the part of the child MOST likely caused this disease in him?

* immaturity, prematurity, intestinal infections, age

* large fetus, encephalopathy, mixed feeding, season of birth

* + lack of exercise therapy and massage, season of birth, tight swaddling, mixed feeding

* breastfeeding, malabsorption syndrome, season of birth, age

* age, history, tight swaddling, mixed feeding

 

 

# 161

*! Girl 13 years old. The disease began 2 weeks ago after suffering an ARI. The local doctor began treatment for cystitis. History: 8 years old, the girl suffered scarlet fever, against the background of which traces of protein, macrohematuria, leukocyturia were found. Further urine tests were not controlled. Despite the therapy, lethargy was growing, nausea, pastes of the eyelids, and a decrease in diuresis began to be noted. In the analysis of urine: protein 0.66% 0, red blood cells 25-30 in n / a. The girl was hospitalized in a specialized department.

Which of the following diagnoses is MOST probable for this disease?

Chronic glomerulonephritis

# 162

*! Boy 13 years old. Complaints of paroxysmal cough, wheezing, shortness of breath. From the anamnesis: atopic dermatitis, periodically short-term attacks of suffocation,

docked independently; father has hay fever. The real attack came in contact with a cat. On examination: dry cough, wheezing, BH 26 in 1 min, in the lungs - percussion-like shade of sound, mass of dry wheezing in all fields.
What is the MOST probable diagnosis of this patient?

Bronchial asthma

# 163

*! Mom with a child aged 10 months went to the doctor with complaints of curvature of the lower extremities. From the anamnesis: a child from І pregnancy, І urgent birth. Objectively: the skin is pale. The frontal and parietal tubercles, the “Harrison groove”, on the ribs of the “rosary”, on the wrists of the “bracelet”, varus deformity of the extremities are protruding. Muscular hypotension is noted. C heart and lungs without pathology. The abdomen is swollen, the liver protrudes 1.5 cm from under the edge of the costal arch, the edge is soft, elastic. Stool 1 time in 2-3 days, urination is normal.

What clinical symptoms are MOST likely to help the doctor in diagnosing and determining the severity of the disease in this child?

“Bracelets”, “pearl strands”, “rosary”, deformation of the upper limbs

 

# 164

*! A boy of 8 years old, diagnosed with dysfunction of the biliary tract, hypokinetic form.

What clinical symptoms will be MOST characteristic?

* + nausea, bitterness in the mouth, flatulence, constipation, aching pain in the right hypochondrium

* cramping pains in the right hypochondrium, irradiation of pain in the left shoulder blade, bitterness in the mouth

* colicky pains in the right hypochondrium, irradiation of pain on the back, nausea, vomiting, constipation

* stitching pains in the right hypochondrium, irradiation of pain in the left hypochondrium, flatulence, constipation

* aching pain in the right hypochondrium, irradiation of pain on the back, bitterness in the mouth, vomiting, heartburn

 

# 165

*! A girl of 15 years old, complaints of severe paroxysmal pain in the epigastric region, most often at night. On palpation of the abdomen, pain in the pyloroduodenal zone is noted. Preliminary diagnosis: duodenal ulcer.

What methods of diagnosing H. pylori MOST informative?

* biochemical blood test, bacteriological, brush cytological, biopsy

* + bacteriological, brush cytological, urease breath test, PCR

* general blood test, biochemical blood test, general urinalysis, coprogram

* enzyme immunoassay, biopsy, bacteriological, PCR

* general blood test, biochemical blood test, urease breath test, PCR

 

# 166

*! A 11-year-old boy is registered with a diagnosis of chronic gastroduodenitis, remission. Sanatorium treatment with chloride - atrium mineral waters has been prescribed.

Which hospitals in Kazakhstan are MOST likely?

* Merke, Mankent * Borovoe, Almaty

 

* + Mankent, Saryagash
* Zhanakorgan, Rakhmanov keys

* Almaty, Aksay

 

# 167 (hint, in all answers except the correct one there is hypotrophy, and a 13-year-old girl can’t put it, hypotrophy seems to be only up to 1 year old)

*! A girl of 13 years old is observed with a diagnosis of celiac disease from 3 years of age. Gluten-free diet practically does not comply. Complaints of general weakness, diarrhea, growth and weight lag, menstrual irregularities, pain in bones and joints, memory impairment, decreased attention. FGDS: atrophic duodenitis, unit, biopsy: partial and subtotal villous atrophy.

What diseases are most likely to develop in the prognosis?

* + osteoporosis, nanism, autoimmune thyroiditis, iron deficiency anemia

* chronic glomerulonephritis, malnutrition, iron deficiency anemia, dwarfism

* chronic pyelonephritis, atherosclerosis, malnutrition, gigantism

* rickets, malnutrition, atopic diathesis, autoimmune thyroiditis

* autoimmune thyroiditis, malnutrition, nanism, atopic diathesis

 

# 168

*! The girl is 13 years old, two weeks after suffering a sore throat, she was diagnosed with acute glomerulonephritis.

What changes in urine analysis are MOST likely for this child?

* uraturia, xanthuria, glucosuria

* oxaluria, hemoglobinuria, bacteriuria

* + hematuria, proteinuria, leukocyturia

* glucosuria, proteinuria, phosphaturia

* bacteriuria, hemoglobinuria, glucosuria

 

# 169

*! A girl of 5 months, complaints from the mother’s words about the pallor of the skin and mucous membranes, lethargy, loss of appetite. The local doctor put diaznoz: Iron deficiency th anemia I first degree. Girl find tons to I n and artificially m feeding and. Objectively: the skin is pale, clean. Zev is calm. For organs without pathology.

What are the MOST characteristic changes or diseases that occur in iron deficiency anemia with secondary immunodeficiency syndrome?

* + frequent pneumonia, acute respiratory infections, acute respiratory viral infections

* dysbiosis, maldigestion, decreased appetite

* fatigue, perversion of taste and smell

* hypotension, lethargy, decreased appetite

* perversion of taste, smell, pallor

 

# 170

*! A girl of 5 months, complaints from the mother’s words about the pallor of the skin and mucous membranes, lethargy, loss of appetite. The local doctor put diaznoz: Iron deficiency th anemia I first degree. Girl find tons to I n and artificially m feeding and. Objectively: the skin is pale, clean. Zev is calm. For organs without pathology.

What are the MOST probable symptoms of cardiovascular syndrome with iron deficiency anemia?

* + shortness of breath, hypotension, tachycardia, functional noise

* hypertension, clear tones, fatigue, shortness of breath

* weakening of tones, decrease in stroke volume, decrease in minute volume, bradycardia

* hypotension, fatigue, bradycardia, shortness of breath

* systolic murmur, increased stroke volume, increased minute volume, shortness of breath

 

# 171

*! A girl of 9 years old, is registered at the clinic with a diagnosis of chronic pancreatitis. Currently observed with exacerbation.

What symptoms are MOST characteristic of the disease?