2019 Krok Booklet From variant 52, Questions 51-100


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51. An 18-year-old young man complains of pain in his knee and elbow joints and body temperature up to 39.5°C. One week and a half earlier he developed a sore throat. On examination his body temperature is 38.5°C. Swelling of the knee and elbow joints is observed. Pulse is 106/min., rhythmic. Blood pressure is 90/60 mm Hg. Cardiac borders are unchanged, heart sounds are weakened, at the cardiac apex there is a soft systolic murmur. What factor would be the most indicative of the likely disease etiology?

A. Seromucoid
B. Rheumatoid factor
C. Creatine kinase
D. *Anti-streptolysin O
E. C-reactive protein

52. A 24-year-old pregnant woman on her 37th week of pregnancy has been brought to the maternity obstetric service with complaints of weak fetal movements. Fetal heartbeats are 95/min. On vaginal examination the uterine cervix is tilted backwards, 2 cm long, external orifice allows inserting a fingertip. Biophysical profile of the fetus equals 4 points. What tactics of pregnancy management should be chosen?

A. Urgent preparation of the uterine cervix for delivery
B. *Urgent delivery via a cesarean section
C. Doppler measurement of blood velocity in the umbilical artery
D. Treatment of placental dysfunction and repeated analysis of the fetal biophysical profile on the next day
E. Treatment of fetal distress: if ineffective, then elective cesarean section on the next day

53. A 48-year-old woman complains of disturbed menstrual cycle: her periods last for 7.9 days and are excessively profuse throughout the last half-year. She notes occasional hot flashes in her head, insomnia, irritability, and headaches. Her skin is of normal color. Blood pressure – 150/90 mm Hg. pulse – 90/min., rhythmic. The abdomen is soft and painless. Bimanual examination shows no uterine enlargement, the appendages cannot be detected. The vaginal fornices are free. What is the most likely diagnosis?

A. Uterine myoma
B. Stein-Leventhal syndrome (polycystic ovary syndrome)
C. Adrenogenital syndrome
D. Premenstrual syndrome
E. *Climacteric syndrome

54. A 38-year-old woman after physical overexertion suddenly developed palpitations, dyspnea, and a dull pain in the cardiac area. For 10 years she has been registered for regular check-ups due to rheumatism and mitral valve disease with non-disturbed blood circulation. Objectively her pulse is 96/min., of unequal strength. Blood pressure is 110/70 mm Hg, heart rate is 120/min. ECG registers small unevenly-sized waves in place of P-waves, R R intervals are of unequal length. What is the most likely diagnosis?

A. Respiratory arrhythmia
B. Paroxysmal supraventricular tachycardia
C. *Atrial fibrillation
D. Paroxysmal ventricular tachycardia
E. Atrial flutter

55. A 38-year-old woman works in flax processing, she dries fax. She came to the hospital complaining of difficult breathing, constricting sensation in her chest, and cough attacks. These signs appear on the first day of her working week and gradually diminish on the following days. What respiratory disease is likely in this case?

A. *Byssinosis
B. Asthmatic bronchitis
C. Bronchial asthma
D. Allergic rhinopharyngitis
E. Silicosis

56. At night a 2-year-old child with upper respiratory tract infection suddenly developed dyspnea with labored inspiration. Objectively the skin is pale, perioral cyanosis and slight acrocyanosis are observed. Breathing is loud, respiration rate is 32/min. Jugular, supra- and infraclavicular fossae retract during breathing Respiration is coarse on auscultation. Heart sounds are clear and sonorous, heart rate is 120/min. What condition was complicated by the development of the upper respiratory tract infection?

A. *Stenosing laryngotracheitis
B. Bronchiolitis
C. Bronchial asthma
D. Airway foreign body
E. Obstructive bronchitis

57. A 62-year-old woman was brought into the admission room with complaints of severe burning retrosternal pain and asphyxia. She has a 10-year-long history of essential hypertension. Objectively her condition is moderately severe. She presents with skin pallor, cyanotic lips, and vesicular respiration over her lungs. The II heart sound is accentuated over the aorta. Blood pressure – 210/120 mm Hg, heart rate (pulse) – 76/min. ECG shows elevation of ST segment in the leads I. AVL, and V5-V6. What is the most likely diagnosis?
A. Hypertensive crisis complicated with acute left ventricular failure
B. Hypertensive crisis complicated with unstable angina pectoris
C Uncomplicated hypertensive crisis
D. Pulmonary embolism
E. *Hypertensive crisis complicated with acute myocardial infarction

58. A child is 1 year old. After solid food was introduced into the diet, within the last several months the child developed loss of appetite, diarrhea with large amount of feces, and occasional vomiting. Body temperature remains normal. Body weight is 7 kg. The child is very pale, has leg edemas and an extremely distended abdomen. Feces analysis detects high levels of fatty acids and soups. Diagnosis of celiac disease was made and gluten-free diet was prescribed. What should be excluded from the diet in this case?

A. Milk and dairy products
B. Easily digestible carbohydrates
C. *Cereals – wheat, oats
D. Animal protein
E. Fruits

59. A 35-year-old woman complains of high body temperature and pain in the upper outer quadrant of her right buttock, which developed after an injection. She has been presenting with this condition for 3 days. At the site of injection the skin is hyperemic, there is a painful infiltrate with an area of softening in its center. The woman is diagnosed with a post injection abscess of the right buttock. What tactics should the surgeon choose in this case?

A. *Abscess incision, sanation and drainage of the cavity
B. Hospitalization, prescription of antibiotics, UHF
C. Antipyretic agents, massage, and application of dry heat to the right buttock
D. Abscess puncture, pus removal followed by application of antiseptics
E. 10-15 minutes of low-intensity laser radiation directed at the right buttock

60. A 57-year-old woman during a regular ultrasound examination presented with a space-occupying heterogeneous lesion in the right kidney. What is the most informative method of renal tumor diagnostics?
A. Radioisotope renography
B. *Spiral computed tomography
C. Three glass urine test
D. Excretory urography
E. Retrograde pyelography

61. A 23-year-old man has accidentally swallowed brake fluid. After that he has been presenting with anuria for 5 days already: his creatinine levels elevated up to 0.569 mmol/L. What treatment tactics should be chosen in this case?

A. Antidotal therapy
B. Diuretics
C. Detoxication therapy
D. Plasmapheresis
E. *Hemodialysis

62. A 35-year-old man suffers from insulin dependent diabetes mellitus and chronic cholecystitis. He takes NPH insulin: 20 units in the morning and 12 units in the evening. After a meal he developed pain in the right subcostal area, nausea, vomiting, sleepiness. and increased polyuria. What prehospital measures will be the most effective for prevention of crisis within the next several

A. *Change insulin regimen
B. Decrease carbohydrates in the diet
C. Take analgesics
D. Exclude fats from the diet
E. Take cholagogues

63. A 7-year-old boy has been an inpatient for 1.5 months. He had been brought to the hospital with complaints of edemas all over his body, low urine output, and headache. Clinical urinalysis: proteins – 71 g/L 1-2 in the vision
leukocytes – field, erythrocytes. 3-4 in the vision field. During the course of treatment the edemas gradually dissipated, headache abated, diuresis normalized. Daily urine proteins – 3 L. Biochemical blood test: total protein – 43.2 g/L, urea – 5.2 mmol/L, cholesterol – 9.2 mmol/L. What glomerulonephritis syndrome is the most likely to be present in the patient?

A. Isolated urinary
B. Nephritic
C. *Nephrotic
D. Mixed
E. Hematuric

64. A chronic alcoholic was hospitalized into the therapeutic inpatient unit due to pneumonia. On the day 5 of his hospitalization he became disoriented in time and space, developed fear-inducing visual hallucinations and motor agitation. Full body tremor and tremor of the limbs are observed. X-ray and physical examinations detect the signs of his convalescence from pneumonia. What tactics should be chosen regarding this patient?

A. Discharge from the hospital
B. *Transfer into the inpatient narcology department
C. Continue the treatment in the therapeutic department
D. Transfer into the neuro resuscitation department
E Compulsory medical treatment for alcoholism

65. A 34-year-old man on the 3rd day of ceftriaxone treatment for acute otitis (daily dosage – 2 grams) developed diarrhea occurring 5-6 times per day. Feces are without mucus or blood admixtures. Temperature is 36.6°C. The Gregersen reaction (occult blood in feces) is negative. Stool culture detected no pathogenic germs. What is the most likely cause of diarrhea in this case?

A. *Antibiotic-associated diarrhea
B. Crohn’s disease (regional enteritis)
C. Ulcerative colitis
D. Bacterial overgrowth syndrome
E. Intestinal dysbiosis

66. A 5-year-old child was brought to the ENT department by an ambulance. The child presents with cough and difficult respiration From the patient’s history it is known that the child was playing with a toy construction set, when suddenly started coughing and developed labored breathing Examination detects periodical cough, labored expiration, and respiratory lag in the left side of the child’s thorax. Auscultation: diminished respiration on the left. Percussion: tympanitis. X-ray shows a displacement of the mediastinal organs to the right. Make the diagnosis:
A. A foreign body in the left bronchus, complete bronchostenosis
B. A foreign body in the trachea
C. A foreign body in the right bronchus, valvular bronchostenosis
D. *A foreign body in the left bronchus, valvular bronchostenosis
E. A foreign body in the right bronchus, partial bronchostenosis

67. On laboratory investigation of a pork sample there is 1 dead trichinella detected in 24 sections. This meat should be:

A. *Sent for technical disposal
B. Processed for boiled sausage production
C. Allowed for sale with no restrictions
D. Processed and sold through public catering network
E. Frozen until the temperature of -10°C is reached in the deep layers, with subsequent exposure to cold for 15 days

68. A 22-day-old infant developed subcutaneous red nodes from 1.0 to 1.5 cm in size on the scalp: later the nodes suppurated. Temperature increased up to 327°C intoxication symptoms appeared. regional lymph nodes enlarged. Complete blood count: anemia, leukocytosis. neutrocytosis, increased ESR. What diagnosis can be made?

A. –
B. Pemphigus
C. Scalp phlegmon
D. Vesiculo Pustulosis
E. *Pseudo Furunculosis

69. A 9-month-old infant presents with delayed tooth eruption and fontanel closure, weakness, and excessive sweating. What type of hypovitaminosis is the most likely in this child?

A. Hypovitaminosis A
B. Hypovitaminosis B1
C. Hypovitaminosis B6
D. *Hypovitaminosis D
E. Hypovitaminosis C

70. A 58-year-old woman came to the gynecological clinic. She complains of bloody discharge from her genital tracts. Menopause is 8 years. Gynecological examination: the uterus is slightly enlarged, dense to touch. with limited mobility: the uterine appendages cannot be detected; parametrium is free. Fractional curettage of the uterine cavity yields a significant amount of medullary substance in the scrape. What is the most likely diagnosis?
A. Adenomyosis
B. *Uterine corpus cancer
C. Choriocpithehoma
D. Hormone-producing ovarian tumor
E. Uterine cervix cancer

71. A 72-year-old man diagnosed with ischemic heart disease presents with diffuse cardiosclerosis, permanent tachysystolic atrial fibrillation, heart failure lla, FCI Objective examination of vital signs blood pressure is 135/80 mm Hg, heart rate is 160/min., pulse is 125/min. Left ventricular ejection fraction is 32%. What drug is indicated in this case and should be prescribed to the patient?

A. Verapamil
B. *Digoxin
C. Ivabradine
D. Procainamide (Novocainamide)
E. Isadrine (Isoprenaline)

72. A pregnant woman is 28 years old. Anamnesis: accelerated labor complicated by the II degree cervical rupture. The following two pregnancies resulted in spontaneous abortions at the terms of 12 and 14 weeks. On mirror examination: the uterine cervix is scarred from previous ruptures at 9 and 3 hours, the cervical canal is gaping. On vaginal examination: the cervix is 2 cm long, the external orifice is open 1 cm wide, the internal orifice is half-open: the uterus is enlarged to the 12th week of pregnancy, soft, mobile, painless, the appendages are without changes. What diagnosis can be made?

A. *Isthmico-cervical insufficiency, habitual non carrying of pregnancy
B. Threatened spontaneous abortion
C. Cervical pregnancy, 12 weeks
D. Cervical hysteromyoma. habitual non carrying of pregnancy
E. Incipient abortion, habitual noncarrying of pregnancy

73. A 40-year-old victim of a traffic accident sustained the following injuries: closed diaphyseal femur fracture, brain concussion, multiple rib fractures. hemopneumothorax degloving shin injuries. What injuries ress the most urgent attention?

A. Brain concussion
B. Degloving shin injuries
C. All injuries are equivalent
D. Closed diaphyseal femur fracture
E. *Multiple rib fractures, hemopneumothorax

74. A 16-year-old girl has primary amenorrhea, no pubic hair growth, normally developed mammary glands: her genotype is 46 XY, uterus and vagina are absent. What is your diagnosis?

A. Cushing disease
B. Mayer-Rokitansky-Kuster-Hauser syndrome
C. *Testicular feminization syndrome
D. Sheehan syndrome
E. Cushing syndrome

75. A 10-year-old boy with symptoms of arthritis and myocarditis was brought to a hospital. Based on clinical examination the provisional diagnosis of juvenile rheumatoid arthritis was made. What symptom is the most contributive for the diagnostics of this disease?

A. Affection of the large joints
B. *Reduced mobility of the joints in the morning
C. Enlarged heart
D. Regional hyperemia of the joints
E. Increased heart rate

76. An 11-year-old boy for a month has been presenting with increasing pain in the right femur. In the painful area there is a nonmobile painful tumor with unclear margins. The child complains of general indisposition, weakness, increased body temperature up to 39°C. X-ray shows widened medullary cavity small foci of cancellous bone destruction, and onion-like lameliar exfoliation of the cortical layer. What is the most likely pathology resulting in such clinical presentation?

A. Juxtacortical sarcoma
B. Fibrosarcoma
C. *Ewing sarcoma
D. Chondrosarcoma
E. Osteogenic sarcoma

77. At night a 63-year-old woman suddenly developed an asphyxia attack. She has a 15year-long history of essential hypertension and had a myocardial infarction 2 years ago. Objectively her position in bed is orthopneic, the skin is pale, the patient is covered with cold sweat, acrocyanosis is observed. Pulse – 104/min. Blood pressure – 210/130 mm Hg, respiration rate – 38/min. Pulmonary percussion sound is clear, with slight dullness in the lower segments, throughout the lungs single dry crackles can be heard that become bubbling and non-resonant in the lower segments. What is the most likely complication in this patient?

A. Paroxysmal tachycardia
B. Pulmonary embolism
C. Acute right ventricular failure
D. Bronchial asthma attack
E. *Acute left ventricular failure

78. A 27-year-old man complains of pain in his leg joints, purulent discharge from the eyes, and painful burning sensations during urination. Disease onset was acute. He has a history of influenza. The patient smokes and drinks alcohol in excess. In his line of work he is often away on business trips. What is the most likely etiological factor of this disease?

A. Adenovirus
B. *Chlamydia
C. Staphylococci
D. Streptococci
E. Candida

79. The 5-year-old child has been ill for 2 weeks. Cough attacks developed first and were then followed by reprises. During coughing the child’s face turns red and cervical veins bulge. The cough attacks induce vomiting, Xray shows intensified bronchial pattern. Blood test: leukocytes – 16 . 10°/L . lymphocytes • 72%, erythrocyte sedimentation rate – 4 mm/hour. What is the most likely diagnosis?

A. Adenovirus infection
B. Pneumonia
C. Foreign body
D. *Pertussis
E. Obstructive bronchitis

80. During medical examination a cadet in the naval college was detected to have a painless dense ulcer 1.5×0.5 in size in his perianal area at the 2 o’clock position. The ulcer floor resembles “old fat” What is the provisional diagnosis?

A. Rectal fissure
B. Anal cancer
C. Rectal fistula
D. Anal crypt suppuration
E. *Hard syphilitic chancre of the rectum

81. A 53-year-old man complains of general weakness, loss of appetite, and painful vesicles appearing on his skin. The disease onset occurred suddenly, after hyperinsolation one week ago. Examination detects isolated vesicles with wrinkled opercula and occasional painful erosions on the skin of the patient’s torso and limbs. The Nikolsky sign is positive. What is the most likely diagnosis?

A. Non Acantholytic pemphigus
B. *Acantholytic pemphigus
C. Toxicodermia
D. Duhring’s disease (dermatitis herpetiformis)
E. Herpes

82. A 23-year-old man complains of severe pain in his left knee joint. Objectively the left knee joint is enlarged with hyperemic skin, painful on palpation. Complete blood count: erythrocytes – 3.8. 101/L, HD-122 L leukocytes – 74-10P/L. platelets – 183 10 IL Erythrocyte sedimentation rate – 10 mm/hour. Bleeding time (Duke method) – 4 min., Lee White coagulation time. 24 min. Partial thromboplastin time (activated) – 89 seconds Rheumatoid factor – negative. What is the most likely diagnosis?

A. Rheumatoid arthritis
B. Werlhof disease (immune thrombocytopenia)
C. Hemorrhagic vasculitis (Henoch-Schonlein purpura), articular form
D. Thrombocytopathy
E. *Hemophilia, hemarthrosis

83. A 32-year-old woman complains of episodes of intense fear that occur without visible cause and last for 10-20 minutes, the episodes are characterized by rapid pulse. sweating, labored breathing, and vertigo. Specify the likely diagnosis:

A. *Panic disorder
B. Simple schizophrenia
C. Paranoid syndrome
D. Claustrophobia
E. Manic syndrome

84. During medical examination of high and middle school students, the doctors vere assessing correlation between biological and calendar age of the school students based on the following criteria: height growth rate per year, ossification of the carpal bones, the number of permanent teeth. What additional development criterion should be assessed at this age?

A. Vital capacity of lungs
B. Hand strength
C. Chest circumference
D. Body mass
E. *Development of secondary sex characteristics

85. During an outdoor school event in hot weather, a 10-year-old girl lost consciousness. Body temperature – 36.7°C. Objectively her skin is pale and cold to touch, her pupils are dilated. Blood pressure – 90/50 mm Hg. Heart rate – 58/min. What pathology occurred in this case?

A. Sunstroke
B. Paralytic collapse
C. Sympathicotonic collapse
D. –
E. *Syncope

86. A 78-year-old man with a prostate adenoma underwent a herniotomy for a direct inguinal hernia. After the surgery he presents with absent urination. Enlarged urinary bladder is detectable above the patient’s pubis. What measures should be taken in this case?

A. Prescribe proserin (neostigmine) intramuscularly
B. Prescribe antispasmodics subcutaneously
C. Prescribe processing of the postoperative wound with UHF field
D. *Bladder catheterization
E. Apply cold to the urinary bladder area

87. A 27-year-old woman complains of foul smelling discharge from her genital tracts, pain in her lower abdomen, and elevated temperature. The complaints arose 2 days ago. She has a history of surgical abortion at the term of 8 weeks one week ago. Mirror examination: the uterine cervix is clear, external orifice produces foul-smelling discharge. Vaginal examination: the uterus lies in anteflexion, is mobile, painful, and slightly enlarged. The appendages are without changes. Make the provisional diagnosis:

A. Appendicitis
B. Salpingo Oophoritis
C. *Postabortal endometritis
D. Acute respiratory disease
E. Enterocolitis

88. A woman with atopic bronchial asthma was found to have one allergen to dog hair +++. Carpets were removed from the apartment, the apartment was renovated, and the air conditioner was installed. However, recurrent asphyxia attacks still occur every night, despite the patient undergoing pathogenetic therapy. What long-term treatment tactics can help this patient to decrease her sensitivity to the allergen?
A. Continuation of prior treatment
B. Antihistamine therapy
C. Buteyko breathing technique
D. *Specific hyposensitization
E. Referral for speleotherapy

89. A 45-year-old man with thrombophlebitis of the deep veins in his legs suddenly after physical exertion developed sharp pain in his thorax on the right, dyspnea, and hemoptysis. Objectively his condition is severe; he presents with acrocyanosis, shortening of pulmonary percussion sound on the right, and weakened respiration. Respiration is 30/min.. blood pressure is 110/80 mm Hg ECG shows sinus tachycardia, heart rate is 120/min., electric axis of the heart deviates to the right, S-O What is the most likely diagnosis?

A. Spontaneous pneumothorax
B. Right-sided exudative pleurisy
C. *Pulmonary embolism
D. Cancer of the right lung
E. Community-acquired right-sided pneumonia

90. A 40-year-old man claims that his wife is cheating on him and presents a “proof of her infidelity. He repeatedly initiated scandals with his wife at home and at work, demanding that she confess her infidelity, insulted her, and threatened to kill her. What preventive measures should be taken against socially dangerous actions on his part?

A. Consultation with the general practitioner
B. *Consultation with the psychiatrist
C. Outpatient treatment
D. Consultation with the psychologist
E. Family counseling

91. A 1.5-month-old child on breastfeeding presents from birth with daily vomiting. irregular liquid foamy feces, and meteorism, which are resistant to antibacterial and probiotic therapy: no increase of body mass is observed. The child’s condition improved, when breastmilk was substituted with “NAN low lactose” formula. What pathology is it?

A. Drug-induced enteritis
B. Infectious enteritis
C. Functional dyspepsia
D. *Lactase deficiency
E. Intestinal lambliasis (Giardiasis)

92. A 37-year-old patient complains of pain in the spinal column, reduced mobility. The condition persists for 7 years. “Sway back” is observed, there is no movement in all spinal regions. X-ray shows “bamboo spine” vertebral column. What is the most likely diagnosis?

A. Spondylolisthesis
B. Tuberculous spondylitis
C. *Ankylosing spondyloarthritis
D. Osteochondrosis
E. Spondylitis deformans

93. After a long drive with the window open a man developed facial asymmetry, he cannot close his right eye, his right nasolabial fold is smoothed out, movements of expression are absent on the right, there is a disturbance of gustatory sensation in the tongue on the right. No other neurological pathologies were detected. What disease can be provisionally diagnosed in this patient?

A. Trigeminal ganglionitis
B. *Neuropathy of the facial nerve
C. Neuropathy of the trigeminal nerve
D. Neuropathy of the oculomotor nerve
E. Ischemic stroke

94. A man was brought into the admission room after overexposure to cold. He complains of sharp pain in the small of his back and elevated body temperature up to 38°C. He took some aspirin. Blood test: leukocytes – 10.5 1012/L, eosinophils – 5%. band neutrophils – 8%, segmented neutrophils 51%, lymphocytes – 32%, monocytes . 4% erythrocyte sedimentation rate – 28 mm/hour Urinalysis: protein – 0.6 L, leukocytes – cover the whole vision field, large amount of mucus What is the most likely diagnosis?

A. *Acute pyelonephritis
B. Acute glomerulonephritis
C. Chronic pyelonephritis
D. Subacute malignant glomerulonephritis
E. Tubulointerstitial nephritis

95. A 28-year-old woman complaining of irregular menstruations and infertility came to the gynecological clinic. Menstruations occur since the age of 15, irregular, with delays up to 2 months. On examination she presents with marked hirsutism and excessive body weight. On vaginal examination the uterus is reduced in size and painless. The ovaries on both sides are dense and enlarged. Ultrasound shows microcystic changes in the ovaries, the ovaries are 5×4 cm and 4.5×4 cm in size with dense ovarian capsule. Basal body temperature is monophasic. What is the most likely diagnosis?

A. Krukenberg tumor
B. Endometrioid cysts
C. Ovarian carcinoma
D. Bilateral adnexitis
E. *Polycystic ovary syndrome

96. A newborn with gestational age of 31 weeks presents with hypotonia and depressed consciousness. Hematocrit is 35%, general cerebrospinal fluid analysis shows increased content of erythrocytes and protein, and low glucose. These data correspond with the clinical presentation of:

A. Sepsis
B. *Intracranial hemorrhage
C. Anemia
D. Meningitis
E. Intrauterine infection

97. A 25-year-old woman has been suffering from diabetes mellitus since she was 9. She was admitted into the nephrology unit with significant edemas of the face, arms, and legs. Blood pressure – 200/110 mm Hg. Hb- 90 g/L, blood creatinine – 850 mcmol/L, urine proteins – 10 g/L, leukocytes – 10-15 in the vision field. Glomerular filtration rate – 10 mL/min. What tactics should the doctor choose

A. Active conservative therapy for diabetic nephropathy
B. Transfer into the endocrinology Clinic
C. *Transfer into the hemodialysis unit
D. Dietotherapy
E. Renal transplantation

98. A 43-year-old man, a coal-face worker with a 15-year-long record of work, complains of cough, thoracic pain, and dyspnea. The cough is mild, usually dry, and occurs mostly in the morning. The pain is localized in the interscapular region and aggravates during deep intake of breath. Dyspnea occurs during physical exertion. Vesicular respiration in the lungs is weakened. Heart sounds are rhythmic. heart rate is 86/min., blood pressure is 135/80 mm Hg. The abdomen is soft and painless, Xray shows micronodular pulmonary fibrosis. Make the provisional diagnosis:

A. Berylliosis
B. Metal pneumoconiosis
C. *Carboconiosis
D. Byssinosis
E. Siderosis

99. A 26-year-old woman presents with amenorrhea. 10 months ago she gave birth for a second time. In her early postpartum period she developed a massive hypotonic hemorrhage. No breastfeeding. Lately she has been presenting with loss of weight, loss of hair, and indisposition. Gynecological examination revealed atrophy of the external genitals, the uterus is abnormally small, no uterine appendages can be detected. What is the most likely diagnosis?

A. Galactorrhea-amenorrhea syndrome
B. *Sheehan syndrome (postpartum pituitary gland necrosis)
C. Suspected progressing ectopic pregnancy
D. Stein-Leventhal syndrome (polycystic ovary syndrome)
E. Physiological amenorrhea

100. A 7-year-old girl has been twice treated with antibacterial agents for urinary tract infection. US shows no severe renal defects. The child presents with recurrence of leukocyturia and bacteriuria, elevated body temperature up to 38.5°C, and pain in her left lumbar area. What examination should be conducted first to clarify the cause of urinary infection recurrence?

A. Retrograde pyelography
B. Radioisotope renography
C. Excretory urography
D. Immunogram
E. *Micturating cystourethrography


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