Крок 2 Medicine D Ventricular extrasystole

E Atrial tachycardia
Note. Correct option is A for all tests.
4. A 64 y.o. patient has developed of
1. On the 3rd day after the acute anterior squeering substernal pain which had
myocardial infarction a 55 y.o. patient appeared 2 hours ago and irradiated to the
complains of dull ache behind his breast left shoulder, marked weakness. On
bone, that can be reduced by bending examination: pale skin, cold sweat. Pulse-
forward, and of dyspnea. Objectively: AP- 108 bpm, AP- 70/50 mm Hg, heart sound
140/180 mm Hg, heart sounds are dull. are deaf, vesicular breathing, soft abdomen,
ECG results: atrial fibrillation with painless, varicouse vein on the left shin,
frequence of ventricular contractions at the ECG: synus rhythm, heart rate is 100 bmp,
rate of 110/min, pathological Q wave and ST-segment is sharply elevated in II, III
S-T segment raising in the right chest leads. aVF leads. What is the most likely
The patient refused from thrombolisis. disorder?
What is the most probable diagnosis? A Cardiogenic shock
A Acute pericarditis B Cardiac asthma
B Pulmonary embolism C Pulmonary artery thromboembolia
C Tietze's syndrome D Disquamative aortic aneurizm
D Dissecting aortic aneurysm E Cardiac tamponade
E Dressler's syndrome
5. A 28-year-old patient complains of
2. A patient with unstable angina pectoris periodic compressing heart pain. His
was given the following complex treatment: brother died at the age of 34 from a cardiac
anticoagulants, nitrates, beta- disease with similar symptoms.
adrenoblockers. However on the third day Objectively: the patients skin is pale. Heart
of treatment the pain still remains. Which borders display no significant deviations.
investigation shoud be carried out to Heart sounds are loud, there is a systolic
establish diagnosis? murmur above all the points with a peak
A Coronarography above the aorta. Echocardioscopy reveals
B Stress-echocardiogram thickening of the interventricular septum in
C Test with dosed physical exercises the basal parts, reduction of left ventricular
D Esophageal electrocardiac stimulator cavity. What drug should be administered
E Myocardial scintigraphy in order to prevent the disease progression?
A Metoprolol
3. A 67 y.o. patient complains of B Digoxin
palpitation, dizziness, noise in ears, feeling C Nitroglycerin
of shortage of air. Objectively: pale, damp D Captopril
skin. Vesicular respiration, respiratory rate- E Furosemide
22 per min, pulse- 200 bpm, AP 100/70 mm
Hg. On ECG: heart rate 200 bmp, 6. A 37 y.o. woman is suffering from
ventricular complexes are widened, squeezing substernal pain on physical
deformed, location of segments ST and of exertion. On examination: AP- 130/80 mm
wave T is discordant. The wave Р is not Hg, heart rate=pulse rate 72 bpm, heart
changed, superimposes QRST, natural boarders are dilated to the left side, aortic
conformity between Р and QRS is not systolic murmur. ECG-signs of the left
present. What kind of arrhythmia is venticle hypertrophy. What method of
present? examination is the most informative in this
A Paroxismal ventricular tachycardia case?
B Sinus tachycardia A Echocardiography
C Atrial flutter B Phonocardiography
1
C Coronarography
D Sphygmography 10. A 52 y.o. woman complains of
E X-ray weakness, painful itching after washing
and bathing, sensation of heaviness in the
7. A 42-year-old patient applied to hospital head. On examination: hyperemia of skin of
with complaints of pain behind the sternum face, neck, extremities. АP- 180/100 mm
with irradiation to the left scapula. The pain Hg. Speeln is 4 cm below the rib arch edge.
appears during significant physical work, What is the most probable diagnosis?
this lasts for 5-10 minutes and is over on A Erythremia
rest. The patient is sick for 3 weeks. What B Essential hypertension
is the preliminary diagnosis? C Dermatomyositis
A IHD:First established angina pectoris D Allergic dermatitis
B IHD:Variant angina pectoris E Systemic sclerodermia
(Prinzmetal's)
C IHD:Stable angina pectoris of effort I FC 11. A 57-year-old man complains of
D IHD:Stable angina pectoris of effort IV shortness of breath, swelling on shanks,
FC irregularity in cardiac work, pain in the left
E IHD:Progressive angina pectoris chest half with irradiation to the left
scapula. Treatment is uneffective. On
8. A 56-year-old scientist experiences physical exam: heart's sounds are
constricting retrosternal pain several times a diminished, soft systolic murmur on the
day while walking for 100-150 m. The pain apex. Ps - 100/min, arrhythmical, BP -
lasts for up to 10 minutes and can be 115/75 mm Hg. The liver is +2 cm, painful.
relieved by nitroglycerine. Objectively: the Roentgenoscopy: enlargement of heart
patient is overweight, heart borders exhibit shadow to all sides, pulsation is weak.
no abnormalities, heart sounds are Electrocardiogram (ECG): leftventricled
rhythmic, Ps- 78 bpm, AP- 130/80 mm Hg. extrasystolia, decreased voltage. What
ECG contains low amplitude of $T$ wave method of investigation is necessary to do
in $V_{4-5}$. What disease might be to determine the diagnosis?
suspected? A Echocardiography
A Stable FC III stenocardia B Veloergometria
B Instable stenocardia C X-ray kymography
C Stable FC I stenocardia D ECG in the dynamics
D Stable FC II stenocardia E Coronarography
E Stable FC IV stenocardia
12. A 60-year-old female patient had been
9. A 58-year-old female patient complains admitted to a hospital for acute transmural
about periodical headache, dizziness and infarction. An hour later the patient's
ear noise. She has been suffering from contition got worse. She developed
diabetes mellitus for 15 years. Objectively: progressing dyspnea, dry cough.
heart sounds are rhythmic, heart rate is Respiratory rate - 30/min, heart rate -
76/min, there is diastolic shock above aorta, 130/min, AP- 90/60 mm Hg. Heart sounds
AP is 180/110 mm Hg. In urine: OD- 1,014. were muffled, there was also diastolic
Daily loss of protein with urine is 1,5 g. shock on the pulmonary artery. The patient
What drug should be chosen for treatment presented with medium moist rales in the
of arterial hypertension? lower parts of lungs on the right and on the
A Ihibitor of angiotensin converting enzyme left. Body temperature - $36,4^oC$.
B $\beta$-blocker What drug should be given in the first
C Calcium channel antagonist place?
D Thiazide diuretic A Promedol
E $\alpha$-blocker B Aminophylline
2
C Dopamine edemata, abdomen enlargement due to
D Heparin ascites. He has a 20-year history of chronic
E Digoxin bronchitis. For the last 3 years he has been
disabled (group II) because of cardiac
13. A 62-year-old male has been changes. Objectively: mixed cyanosis,
hospitalized in the intensive care unit with a edemata. Ps - 92/min, rhythmic, AP -
continuous attack of retrosternal pain that 120/70 mm Hg, respiration rate - 24/min.
cannot be relieved by nitroglycerin. There is accentuation of the second sound
Objectively: AP- 80/60 mm Hg, heart rate - above the pulmonary artery. Auscultation
106/min, breathing rate - 22/min. Heart reveals the box resonance above the lungs.
sounds are muffled, a gallop rhythm is There are also dry rales over the entire
present. How would you explain the AP surface of lungs. What is the mechanism
drop? of heart changes development in this
A Reduction in cardiac output patient?
B Reduction in peripheral resistance A Euler-Liljestrand reflex
C Blood depositing in the abdominal cavity B Kitaev's reflex
D Adrenergic receptor block C Bainbridge reflex
E Internal haemorrhage D Cardiovascular reflex
E Respiratory reflex
14. A 56-year-old patient with diffuse toxic
goiter has ciliary arrhythmia with pulse rate 17. A 60 y.o. patient experiences acute air
of 110 bpm, arterial hypertension, AP- insufficiency following of the venoectomy
165/90 mm Hg. What preparation should be due to subcutaneous vein thrombophlebitis
administered along with mercazolil? 3 days ago. Skin became cianotic, with grey
A Propranolol shade. Marked psychomotor excitement,
B Radioactive iodine tachypnea, substernal pain. What
C Procaine hydrochloride postoperative complication has occured?
D Verapamil A Thromboembolia of pulmonary artery
E Corinfar B Hemorrhagia
C Hypostatic pneumonia
15 A 18 y.o. female student complains of D Myocardial infarction
dyspnea during the intensive exertion. The E Valvular pneumothorax
condition became worse half a year ago. On
examination: pulse rate is 88 bpm, 18. A female rheumatic patient experiences
accelerated, AP- 180/20 mm Hg, pale skin, diastolic thoracic wall tremor (diastolic
heart borders are dilated to the left and up. thrill), accentuated $S_1$ at apex, there is
There is systolic-diastolic murmur in the diastolic murmur with presystolic
2hd intercostal space, $S_2$ at pulmonary intensification, opening snap, $S_2$ accent
artery is accentuated. ECG has revealed at pulmonary artery. What rind of heart
both ventricles hypertrophy. Thoracic X-ray disorder is observed?
has revealed pulsation and protrusion of the A Mitral stenosis
left ventricle, lung trunk. What doctor's B Aortic valve insufficiency
tactics should be? C Pulmonary artery stenosis
A Cardiosurgeon consultation D Mitral valve insufficiency
B Dispensary observation E Opened arterial duct
C Administration of therapeutic treatment
D Continuation of investigation 19. A 60-year-old patient has been admitted
E Exemption from physical exercises to a hospital with complaints of dyspnea,
tightness in the right subcostal area,
16. A 49-year-old male patient complains abdomen enlargement. These presentations
of dyspnea of combined nature, cough, shin have been progressing for a year. Heart
3
auscultation reveals presystolic gallop holding her breath. What kind of cardiac
rhythm. Objectively: swelling of the neck disorder may be suspected?
veins, ascites, palpable liver and spleen. A An attack of supraventricular paroxysmal
What disease requires differential tachycardia
diagnostics? B An attack of ventricular paroxysmal
A Constrictive pericarditis tachycardia
B Hepatocirrhosis C An attack of atrial flutter
C Lung cancer with invasion to the pleura D An attack of ciliary arrhythmia
D Chronic pulmonary heart E An attack of extrasystolic arrhythmia
E Pulmonary embolism
23. A 43 y.o. woman complains of shooting
20. A 40 y.o. man complains of headache in heart pain, dyspnea, irregularities in the
occipital area. On physical examination: the heart activity, progressive fatigue during 3
skin is pale; face and hand edema, BP- weeks. She had acute respiratory disease a
170/130 mm Hg. On EchoCG: concentric month ago. On examination: AP- 120/80
hypertrophy of the left ventricle. Ultrasound mm Hg, heart rate 98 bpm, heart boarders
examination of the kidneys reveals thinned +1,5 cm left side, sounds are muffled, soft
cortical layer. Urine analysis shows systolic murmur at apex and Botkin's area;
proteinuria of 3,5 g/day. What is the sporadic extrasystoles. Liver isn't palpated,
probable diagnosis? there are no edema. Blood test: WBC-
A Essential arterial hypertension $6,7*10^9$/L, sedimentation rate- 21
B Chronic pyelonephritis mm/hour. What is the most probable
C Chronic glomerulonephritis diagnosis?
D Polycystic disease of the kidneys A Acute myocarditis
E Cushing's disease B Climacteric myocardiodystrophia
C Ichemic heart disease, angina pectoris
21. A 38-year-old woman experiences D Rheumatism, mitral insufficiency
episodic increases in arterial pressure up to E Hypertrophic cardiomyopathy
240/120 mm Hg, which is accompanied by
nausea, vomiting, tachycardia, increased 24. A patient had macrofocal myocardial
sweating, hyperglycemia. The attack is infarction. He is overweight for 36\%, AP is
usually followed by the excessive urination. 150/90 mm Hg, blood sugar- 5,9 mmol/L,
Renal sonography reveals an additional general cholesterol- 4,9 mmol/L, uric acid-
formation adjacent to the upper pole of the 0,211 mmol/L. Which risk factor should be
right kidney and possibly belonging to the urgently eradicated during the secondary
adrenal gland. What laboratory test will prevention?
allow to clarify the diagnosis? A Obesity
A Determination of urinary excretion of B Arterial hypertension
catecholamines and vanillylmandelic acid C Hyperglycemia
B Blood test for insulin and C-peptide D Hypercholesterolemia
C Estimation of glomerular filtration rate by E Hyperuricemia
measuring endogenous creatinine clearance
D Blood test for thyroxine and thyrotrophic 25. While staying in a stuffy room a 19-
hormone year-old emotionally labile girl developed
E Blood test for renin level severe weakness, dizziness, blackout,
nausea and loss of consciousness without
22. A 46-year-old patient complains of convulsions. Objectively: the patient is
sudden palpitation, which is accompanied unconscious, the skin is pale, extremities
by pulsation in the neck and head, fear, are cold. AP - 90/60 mm Hg, Ps- 96/min,
nausea. The palpitation lasts for 15-20 deficient, breathing is shallow. Pupillary
minutes and is over after straining when and tendon reflexes are present. There are
4
no pathological signs. What is the most dominating ones in this disease?
likely diagnosis? A Calcium mechanisms
A Syncope B Electrolytoosmotic mechanisms
B Vegetovascular paroxysm C Acidotic mechanisms
C Epileptic attack D Protein mechanisms
D Hysterical neurosis E Lipid mechanisms
E Transient ischemic attack
29. During dynamic investigation of a
26. A 40-year-old female patient complain patient the increase of central venous
of headache, dizziness, muscle weakness, pressure is combined with the decrease of
sometimes - cramps in the extremities. She arterial pressure. What process is proved by
has been taking antihypertensive such combination?
medications for 10 years. AP- 180/100 mm A Increase of bleeding speed
Hg. Blood potassium - 1,8 millimole/l, B Developing of cardiac insufficiency
sodium - 4,8 millimole/l. In urine: alkaline C Shunting
reaction, the relative density - 1012, protein D Depositing of blood in venous channel
and sugar are not found, WBCs - 3-4 in the E Presence of hypervolemia
field of vision, RBCs - 1-2 in the field of
vision. Conn's syndrome is suspected. 30. A 58-year-old patient complains of a
Which drug should be chosen for the headache in the occipital region, nausea,
treatment of arterial hypertension? choking, opplotentes. The presentations
A Spironolactone appeared after a physical exertion.
B Propanolol Objectively: the patient is excited. Face is
C Enalapril hyperemic. Skin is pale. Heart sounds are
D Hydrochlorothiazide regular, the 2nd aortic sound is accentuated.
E Clonidine AP- 240/120 mm Hg, HR- 92/min.
Auscultation reveals some fine moisr rales
27. A 53-year-old woman complained of in the lower parts of the lungs. Liver is not
cardiac pain and rhythm intermissions. She enlarged. ECG shows signs of hypertrophy
had experienced these presentations since and left ventricular overload. What is the
childhood. The patient's father had a history most likely diagnosis?
of cardiac arrhythmias. Objectively: the A Complicated hypertensic crisis
patient was in grave condition, Ps- 220 B Acute myocardial infarction, pulmonary
bpm, AP- 80/60 mm Hg. ECG: heart rate - edema
215/min, widening and deformation of C Bronchial asthma exacerbation
$QRS$ complex accompanied by D Uncomplicated hypertensic crisis
atrioventricular dissociation; positive $P$ E Community-acquired pneumonia
wave. Some time later heart rate reduced
down to 45/min, there was a complete
dissociation of $P$ wave and $QRST$ 31. A 14 year old patient complains of chest
complex. Which of the following will be pain, temperature up to 38,5oC,
the most effective treatment? breathlessness. He had acute tonsillitis 2
A Implantation of the artificial pacemaker weeks ago. He is in grave condition. The
B $\beta$-adrenoreceptor blocking agents skin is pale. Heart borders are dilated, heart
C Cholinolytics sounds are quiet. Above total heart area you
D Calcium antagonists can hear pericardium friction sound.
E Cardiac glycosides Electrocardiogram: the descent of QRS
voltage, the inversion T. The liver is
28. Thrombosis of the coronary artery enlarged by 3 cm. ESR - 4 mm/h, ASL - 0 -
caused myocardial infarction. What 1260, C-reactive protein +++. Your
mechanisms of injury will be the diagnosis:
5
A Rheumatic pancarditis examination: orthopnea, acrocyanosis,
B Rheumatic pericarditis swollen cervical veins. Ps - 92, total heart
C Rheumatic myocarditis enlargement, the liver is enlarged by 7 cm,
D Rheumatic endocarditis shin edema. What is the stage of chronic
E Septic endocarditis heart failure (CHF)?
A CHF- 2 B
32. A 40 y.o. patient with rheumatic heart B CHF- 1
disease complains of anorexia, weakness C CHF- 2 А
and loss of weight, breathlessness and D CHF- 0
swelling of feet. The patient had tooth E CHF- 3
extraction one month ago. On examination:
t0- 390C, Ps- 100/min. Auscultation:
diastolic murmur in the mitral area. 36. A patient, aged 49, complains of fever
Petechial lesion around the clavicle; spleen of 37,5oC, heart pain, dyspnea. S1 is
was palpable. clapping; S2 is accentuated in the aortic
A Subacute bacteria endocarditis area; opening snap, presystolic murmur can
B Recurrence of rheumatic fever be auscultated. What is the most efficient
C Thrombocytopenia purpura examination for valvular disorder
D Mitral stenosis assessment?
E Aortic stenosis A Echocardiography+Doppler-
Echocardiography
B Phonocardiography
33. A 52 year old patient with history of C Ballistocardiogram
functional Class II angina complains of D Chest X-ray
having intense and prolonged retrosternal E ECG
pains, decreased exercise tolerance for 5
days. Angina is less responsive to 37. A 60 y.o. asthmatic man comes for a
nitroglycerine. What is the most probable check up and complains that he is having
diagnosis? some difficulty in "starting to urinate".
A IHD. Unstable angina Physical examination indicates that the man
B Cardialgia due to spine problem has blood pressure of 160/100 mm Hg, and
C IHD. Functional Class II angina a slight enlarged prostate. Which of the
D Myocarditis following medications would be useful in
E Myocardial dystrophy treating both of these conditions:
A Doxazosin
B Labetalol
34. A 52 year old patient has hypervolaemic C Phetolamine
type of essential hypertension. Which of the D Propranolol
following medications is to be prescribed E Isoproterenol
either as monotherapy or in complex with
other antihypertensive drugs? 38. A 60 year old man with unstable angina
A Hypothiazid pectoris fails to respond to heparin,
B Dibazol nitroglycerin, beta adrenegic blockers and
C Clonidine calcium channel antagonist. The best
D Kapoten management includes:
E Nifedipin A Coronary artery bypass grafting
B Intravenous streptokinase
C Excercise testing
35. A 62 year old patient complains of rest D Oral aspirin
dyspnea, heart pains. 3 years ago he had E Antihypertensive therapy
myocardial infarction. Physical
6
39. A 40 y.o. woman is ill with rheumatic B Acute left-side heart failure
disease with composite mitral disease with C Acute right-side heart failure
prevalence of the stenosis of left venous D Radicular syndrome
foramen.Complains of palpitation, E Acute vascular insufficiency
fatigability, progressing dyspnea, attacks of
dyspnea and hemoptysis. Now she cannot 43. A 61 y.o. man complained of sneezing
be engaged even in the easy activities. What and substernal pain on exertion. In the last 2
tactics is the most expedient? weeks such pain appeared at rest, with
A Mitral comissurotomia increased frequency, and couldn't be
B Conduction of current bicilino- suppressed by 1 tablet of nitroglycerin.
prophilaxis What is the most likely diagnosis?
C Prescription of anticoagulants A Unstable angina pectoris
D Prescription of venous vasodilatators B Angina pectoris of a new onset
E- C Myocarditis
D Radiculitis
40. A 45-year-old male patient was E Stable angina pectoris of the III
admitted to the intensive care unit because functional class
of myocardial infarction. An hour later the
ventricular facilitation occurred. Which of 44. A 45-year-old driver was admitted to
the following should be administered? the hospital with 5 hour substernal pain.
A Defibrillation Nitroglycerin is not effective. He is pale,
B External chest compression heart sounds are regular but weak. HR - 96
C Lidocaine injection per minute, BP of 100/60 mm Hg. What is
D Adrenalin injection the most likely diagnosis?
E Cardiac pacing A Acute myocardial infarction
B Stable angina
41. A 58 y.o. man complaines of severe C Pulmonary embolism
inspiratory dyspnea and expectoration of D Acute myocarditis
frothy and blood-tinged sputum. He has E Acute left ventricular failure
been suffering from essential hypertension
and ischemic heart disease. On 45. A 19 y.o. girl admitted to the hospital
examination: acrocyanosis, "bubbling" complained of pain in the knee and fever of
breathing, Ps- 30/min, BP- 230/130 mm 38,60C. She is ill for 2 weeks after acute
Hg, bilateral rales. Choose medicines for tonsillitis. On exam, hyperemia and
treatment. swelling of both knees, temperature is
A Morphine, furosemide, nitroprusside 37,40C, HR- 94/min, BP- 120/80 mm Hg,
sodium and heart border is displaced to the left; S1
B Theophylline, prednisolon is weak, systolic murmur is present. Total
C Albuterol, atropine, papaverine blood count shows the following: Hb- 120
D Strophanthine, potassium chloride, g/L, WBC- 9,8*109/L, ESR of 30 mm/L.
plathyphylline ECG findings: the rhythm is regular, PQ =
E Cordiamine, isoproterenol 0,24 sec. What is a causative agent of the
disease?
42. A patient has got a sudden attack of A Beta-hemolytic streptococci
severe substernal pain at night. On B Viral-bacterial association
examination: confusion, pallor of the skin, C Autoimmune disorder
acrocyanosis, cold sweat, BP- 80/50 mm D Staphylococci
Hg, Ps- 120/min, irregular and weak pulse. E Ricchetsia
What condition are these symptoms typical
for? 46. A 42 year old woman complains of
A Cardiogenic shock dyspnea, edema of the legs and tachycardia
7
during minor physical exertion. Heart C Gastrin level in blood
borders are displaced to the left and S1 is D Examination of stomach secretion
accentuated, there is diastolic murmur on E Examination of stomach motor function
apex. The liver is enlarged by 5 cm. What is
the cause of heart failure? 50. A 30-year-old patient complains of
A Mitral stenosis breathlessness, pain in the right rib arc
B Mitral regurgitation region, dry cough and the edema of legs. He
C Tricuspid stenosis is ill for 2 months. He had been treated for
D Tricuspid regurgitation rheumatic fever without any effect. On
E Aortic stenosis exam: cyanosis, edema of legs, BT of
36,6oC, RR of 28/min, HR of 90/min, BP of
47. A 33-year-old man with a history of 110/80 mm Hg, crackles above low parts of
rheumatic fever complains of fever up to both lungs, heart borders are displaced to
38-39oC, abdominal pain, dyspnea, the left and to the right, weak sounds,
tachycardia. Heart borders are displaced to systolic murmur above the apex. What is
the left by 2 cm, systolic and diastolic the preliminary diagnosis?
murmurs above aorta, BP of 160/30 mm A Dilated cardiomyopathy
Hg. Petechial rash occurs after B Infectious endocarditis
measurement of blood pressure. Liver is C Acute myocarditis
enlarged by 3 cm, spleen is palpable. Urine D Rheumatic fever, mitral stenosis
is brown-yellow. What is the most likely E Acute pericarditis
diagnosis?
A Infectious endocarditis 51. A patient with a history of coronary
B Rheumatic fever artery disease and atrial fibrillation has the
C Acute hepatitis onset of sudden pain and weakness of the
D Acute nephritis left leg. Examination reveals a cool, pale
E Aortic regurgitation extremity with absent pulses below the
groin and normal contralateral leg. The
48. A 60 y.o. woman has had increased BP most likely diagnosis is:
up to 210/110 mm Hg for the last 7 years. A Arterial embolism
On examination: heart apex is displaced to B Arterial thrombosis
the left. There are signs of left ventricular C Acute thrombophlebitis
hypertrophy on ECG. What is the most D Cerebrovascular accident
probable diagnosis? E Dissecting aortic aneurysm
A Essential hypertension, 2nd stage
B Essential hypertension, 1st stage 52. A 32-year-old patient complains of
C Symptomatic hypertension cardiac irregularities, dizziness, dyspnea at
D Cardiomyopathy physical stress. He has never suffered from
E Ischemic heart disease this before. Objectively: Ps- 74 bpm,
rhythmic. AP-130/80 mm Hg. Auscultation
49. A 39 y.o. woman complaines of revealed systolic murmur above aorta, the
squeezed epigastric pain 1 hour after meal first heart sound was normal. ECG showed
and heartburn. hypertrophy of the left ventricle, signs of
She had been ill for 2 years. On palpation, repolarization disturbance in the I, V 5 and
there was moderate tenderness in V6 leads. Echocardiogram revealed that
pyloroduodenal area. Antral gastritis was interventricular septum was 2 cm. What is
revealed on gastroscopy. What study can the most likely diagnosis?
establish genesis of the disease? A Hypertrophic cardiomyopathy
A Revealing of Helicobacter infection in B Aortic stenosis
gastric mucosa C Essential hypertension
B Detection of autoantibodies in the serum D Myocardium infarction
8
E Coarctation of aorta the SII above aorta, Ps- 84 bpm, rhythmic,
AP- 180/120 mm Hg. What group of
53. A 64 y.o. patient has developed of hypotensive medications could be
squeering substernal pain which had additionally prescribed under consideration
appeared 2 hours ago and irradiated to the of the patient's age?
left shoulder, marked weakness. On A Thiazide diuretics
examination: pale skin, cold sweat. Pulse- B Loop diuretics
108 bpm, AP- 70/50 mm Hg, heart sound C $\beta$-adrenoceptor blockers
are deaf, vesicular breathing, soft abdomen, D $\alpha$-adrenoceptor blockers
painless, varicouse vein on the left shin, E Central sympatholytics
ECG: synus rhythm, heart rate is 100 bmp,
ST-segment is sharply elevated in II, III
aVF leads. What is the most likely 57. A 37 y.o. woman is suffering from
disorder? squeezing substernal pain on physical
A Cardiogenic shock exertion. On examination: AP- 130/80 mm
B Cardiac asthma Hg, heart rate=pulse rate 72 bpm, heart
C Pulmonary artery thromboembolia boarders are dilated to the left side, aortic
D Disquamative aortic aneurizm systolic murmur. ECG- signs of the left
E Cardiac tamponade ventricle hypertrophy. What method of
examination is the most informative in this
54. A healthy 75 year old woman who leads case?
a moderately active way of life went A Echocardiography
through a preventive examination that B Phonocardiography
revealed serum concentration of common C Coronarography
cholesterol at the rate of 5,1 millimole/l and D Sphygmography
HDL (high-density lipoproteins) cholesterol E X-ray
at the rate of 70 mg/dl. ECG reveals no
pathology. What dietary recommendation is 58. A 42-year-old patient applied to
the most adequate? hospital with complaints of pain behind the
A Any dietary changes are necessary sternum with irradiation to the left scapula.
B Decrease of cholesterol consumption The pain appears during significant
C Decrease of saturated fats consumption physical work, this lasts for 5-10 minutes
D Decrease of carbohydrates consumption and is over on rest. The patient is sick for 3
E Increase of cellulose consumption weeks. What is the preliminary diagnosis?
A IHD:First established angina pectoris
55. Heart auscultation of a 16 y.o. boy B IHD:Variant angina pectoris
without clinical symptoms revealed accent (Prinzmetal's)
of the S II and systolic murmur above the C IHD:Stable angina pectoris of effort I FC
pulmonary artery. Heart sounds are D IHD:Stable angina pectoris of effort IV
resonant, rhythmic. What is the most FC
probable diagnosis? E IHD:Progressive angina pectoris
A Functional murmur
B Stenosis of pulmonary artery valve 59. A 58-year-old female patient complains
C Insufficiency of pulmonary artery valve about periodical headache, dizziness and
D Nonclosure of Botallo's duct ear noise. She has been suffering from
E Defection of interatrial septum diabetes mellitus for 15 years. Objectively:
heart sounds are rhythmic, heart rate is
56. A 74 y.o. patient has been suffering 76/min, there is diastolic shock above aorta,
from hypertension for 20 years. He AP is 180/110 mm Hg. In urine: OD- 1,014.
complains of frequent headache, dizziness, Daily loss of protein with urine is 1,5 g.
he takes enalapril. Objectively: accent of What drug should be chosen for treatment
9
of arterial hypertension? apex. Ps - 100/min, arrhythmical, BP -
A Ihibitor of angiotensin converting enzyme 115/75 mm Hg. The liver is +2 cm, painful.
B β-blocker Roentgenoscopy: enlargement of heart
C Calcium channel antagonist shadow to all sides, pulsation is weak.
D Thiazide diuretic Electrocardiogram (ECG): left ventricled
E α-blocker extrasystolia, decreased voltage. What
method of investigation is necessary to do
60. A 25 year old patient had pharyngitis 2 to determine the diagnosis?
weeks ago. Now he complains about body A Echocardiography
temperature rise up to 38oC, general B Veloergometria
weakness, dyspnea during walking, C X-ray kymography
swelling and shifting pain in the D ECG in the dynamics
articulations. Objectively: cyanosis of lips, E Coronarography
rhythmic pulse of poor volume - 100 bpm.
Left cardiac border deviates outwards from 63. After a long periode of subfebrility a
the mediaclavicular line by 1 cm. The first patient registered increase of dyspnea, pain
heart sound is weakened on the apex, in the right hypochondrium, leg edemata.
auscultation revealed systolic souffle. What Objectively: neck veins are edematic. Ps is
is the most probable aetiological factor that 120 bpm, sometimes it disappears during
caused this pathological process? inspiration. Heart sounds are very
A β-haemolytic streptococcus weakened. ECG showed low-voltage waves
B Staphylococcus of ventricular complex. A month ago there
C Pneumococcus was raise of ST V1-V4 segment. Cardiac
D Virus silhouette is enlarged, roundish. What is the
E Fungi most probable diagnosis?
A Exudative pericarditis
61. A 50 year old woman complains about B Small-focal myocardial infarction
dull cardiac pain, asphyxia, body C Postinfarction cardiosclerosis
temperature rise up to 38oC. She had D Metabolic postinfection myocardiopathy
influenza a week ago. Objectively: Ps - 100 E Primary rheumatic carditis
bpm, dropped-beat pulse during inspiration.
AP - 100/70 mm Hg, heart sounds are 64. A 60-year-old female patient was
muffled. ECG: reduced voltage, ST admitted to a hospital for acute transmural
segment is above the isoline in all leads. X- infarction. An hour ago the patient's
ray picture shows extensively enlarged contition got worse. She developed
cardiac silhouette. Palmus is of small progressing dyspnea, dry cough.
amplitude. What is the most probable Respiratory rate - 30/min, heart rate -
diagnosis? 130/min, AP- 90/60 mm Hg. Heart sounds
A Exudative pericarditis are muffled, diastolic shock on the
B Myocardium infarction pulmonary artery. There are medium moist
C Dilatation cardiomyopathy rales in the lower parts of lungs on the right
D Myocarditis and on the left. Body temperature - 36,4 oC.
E Stenocardia What drug should be given in the first
place?
62. A 57-year-old man complains of A Promedol
shortness of breath, swelling on shanks, B Aminophylline
irregularity in cardiac work, pain in the left C Dopamine
chest half with irradiation to the left D Heparin
scapula. Treatment is uineffective. On E Digoxin
physical exam: heart's sounds are
diminished, soft systolic murmur on the 65. A 52-year-old male patient complains
10
about attacks of asphyxia, pain in his right What doctor's tactics should be?
side during respiration. These A Cardiosurgeon consultation
manifestations turned up all of a sudden. It B Dispensary observation
is known from his anamnesis that he had C Administration of therapeutic treatment
been treated for thrombophlebitis of the D Continuation of investigation
right leg for the last month. In the E Exemption from physical exercises
admission ward the patient suddenly lost
consciousness, there was a sudden attack of 68. A 30 year old woman ill with influenza
asphyxia and pain in his side. Objectively: felt palpitation and dull cardiac pain during
heart rate - 102/min, respiratory rate - moderate physical exercise. Objectively: Ps
28/min, AP- 90/70 mm Hg. Auscultation - 96 bpm, AP - 100/60 mm Hg. The first
revealed diastolic shock above the sound is quiet above the apex, soft systolic
pulmonary artery, gallop rhythm, small murmur is present. What complication is
bubbling rales above the lungs under the indicated by these clinical presentations?
scapula on the right, pleural friction rub. A Acute viral myocarditis
What examination method will be the most B Acute allergic infectious myocarditis
informative for a diagnosis? C Idiopathic myocarditis
A Angiography of pulmonary vessels D Myocardiopathy
B Echocardioscopy E Neurocirculatory dystonia
C Study of external respiration function
D ECG 69. A 48 y.o. patient has been staying in the
E Coagulogram emergency department for 2 days on
account of acute anteroseptal myocardial
66. A 18 y.o. male patient complains of infarction. In the course of examination he
pain in knee and ankle joints, temperature suddenly "snored". There was a tonic
elevation to 39,5 0C. He had a respiratory contraction of skeletal muscles; eye pupils
disease 1,5 week ago. On examination: dilatated. Pulse on a.carotis is absent. What
temperature 38,50C, swollen knee and is the immediate tactics?
ankle joints, pulse 106 bpm, rhythmic, AP- A Electric defibrillation
90/60 mm Hg, heart borders without B Saphar's triple airway maneuver
changes, sounds are weakened, soft systolic C ECG record
apical murmur. What indicator is connected D Intracardiac introduction of adrenalin
with possible etiology of the process? with atropine
A Antistreptolysine-0 E Precardiac stroke
B 1-antitrypsine
C Creatinkinase 70. A 60 y.o. patient experiences acute air
D Rheumatic factor insufficiency following of the venoectomy
E Seromucoid due to subcutaneous vein thrombophlebitis
3 days ago. Skin became cianotic, with grey
67. A 18 y.o. female student complains of shade. Marked psychomotor excitement,
dyspnea during the intensive exertion. The tachypnea, substernal pain. What
condition became worse half a year ago. On postoperative complication has occured?
examination: pulse rate is 88 bpm, A Thromboembolia of pulmonary artery
accelerated, AP-180/20 mm Hg, pale skin, B Hemorrhagia
heart borders are dilated to the left and up. C Hypostatic pneumonia
There is systolic-diastolic murmur in the D Myocardial infarction
2hd intercostal space, S2 at pulmonary E Valvular pneumothorax
artery is accentuated. ECG has
revealed both ventricles hypertrophy. 71. A female rheumatic patient experiences
Thoracic X-ray has revealed pulsation and diastolic thoracic wall tremor (diastolic
protrusion of the left ventricle, lung trunk. thrill), accentuated S1 at apex, there is
11
diastolic murmur with presystolic C Bradysystolic form of ciliary arrhythmia
intensification, opening snap, S2 accent at D Sinus bradycardia
pulmonary artery. What rind of heart E Complete left bandle-branch block
disorder is observed?
A Mitral stenosis 75. A 35 year old patient who suffers from
B Aortic valve insufficiency chronic glomerulonephritis and has been
C Pulmonary artery stenosis hemodialysis-dependent for the last three
D Mitral valve insufficiency years developed intermissions of heart
E Opened arterial duct activity, hypotension, progressing
weakness, dyspnea. ECG showed
72. The doctors in maternity hospital made bradycardia, atrioventricular block type I,
a newborn boy the following diagnosis: high pointed waves T. The day before the
congenital heart disease (interventricular flagrant violation of diet took place. What is
septal defect). At the age of 2 months the the most probable cause of these changes?
boy has got a dyspnea. Objectively: BR- up A Hyperkaliemia
to 60/min, tachycardia up to 170/min, liver B Hyperhydratation
is 3 cm below the costal margin. What C Hypokaliemia
medicines must be immediately prescribed? D Hypernatriemia
A Cardiac glycosides E Hypocalciemia
B Nonsteroidal antiinflammatory drugs
C Potassium preparations 76. A 40 y.o. man complains of headache in
D $\beta$-adrenoceptor blockers occipital area. On physical examination: the
E Glucocorticoids skin is pale; face and hand edema, BP-
170/130 mm Hg. On EchoCG: concentric
73. A 52 y.o. male patient suffers from hypertrophy of the left ventricle. Ultrasound
squeezing pain attacks in substernal area examination of the kidneys reveals thinned
which irradiates to the left hand and occurs cortical layer. Urine analysis shows
occasionally and on physical exercises. He proteinuria of 3,5 g/day. What is the
has had it for 1 year. On examination: heart probable diagnosis?
borders are enlargement to the left side, A Essential arterial hypertension
sounds are muffled, Ps-76 bpm, rhythmic, B Chronic pyelonephritis
AP- 155/80 mm Hg, ECG: the left type, the C Chronic glomerulonephritis
rest signs are normal. What additional D Polycystic disease of the kidneys
examination is necessary to confirm the E Cushing's disease
diagnosis?
A Veloergometry 77. A 38 y.o. woman suffers from
B Echocardiography paroxysmal AP rises up to 240/120 mm Hg
C Lipoprotein test accompanied by nausea, vomiting,
D General blood count tachycardia, excessive sweating. During the
E Transaminases of blood onset blood is hyperglycemic. After the
onset there is voluminous urination.
74. A 70 y.o. patient complains of Kidneys sonography revealed accessory
weakness, dizziness, short periods of mass bordering upon the upper pole of the
unconsciousness, pain in the cardiac area. right kidney, presumably it belongs
Objectively: HR- 40 bpm, heart sounds are to the adrenal gland. What laboratory test
rhythmic, the S1 is dull, periodically will allow to make a more precise
amplified. AP is 180/90 mm Hg. What is diagnosis?
the most probable cause of hemodynamic A Estimation of catecholamine and
disturbances? vanillylmandelic acid excretion with urine
A Atrioventricular block type III B Estimation of insulin and C-peptide
B Atrioventricular block type I content in blood
12
C Estimation of glomerular filtration rate E Prednisolone
D Estimation of thyroxin and thyrotropic
hormon in blood 81. A 49 year old female patient was
E Estimation of renin content in blood admitted to a hospital with acute attacks of
headache accompanied by pulsation in
78. A 74 y.o. patient complains of abdomen temples, AP rose up to 280/140 mm Hg.
pain and sweling, nausea. She suffers from Pheochromocytoma is suspected. What
ischemic heart disease, postinfarction and mechanism of hypertensive atack does this
atherosclerotic cardiosclerosis. Objectively: patient have?
the patient is in grave condition, abdomen is A Increase of catecholamine concentration
swollen, abdominal wall doesn't take active B Increase of aldosterone level in blood
part in respiration. Laparoscopy revealed a C Increase of plasma renin activity
small amount of muddy effusion in D Increase of vasopressin secretion
abdominal cavity, one of the loops of small E Increase of thyroxine secretion
intestine is dark-cyan. What is the most
probable diagnosis? 82. A patient had macrofocal myocardial
A Thrombosis of mesenteric vessels infarction. He is overweight for 36%, AP is
B Twisted bowels 150/90 mm Hg, blood sugar- 5,9 mmol/L,
C Acute intestinal obstruction general cholesterol- 4,9 mmol/L, uric acid-
D Ischemic abdominal syndrome 0,211 mmol/L. Which risk factor should be
E Erysipelas urgently eradicated during the secondary
prevention?
79. A 43 y.o. woman complains of shooting A Obesity
heart pain, dyspnea, irregularities in the B Arterial hypertension
heart activity, progressive fatigue during 3 C Hyperglycemia
weeks. She had acute respiratory disease a D Hypercholesterolemia
month ago. On examination: AP- 120/80 E Hyperuricemia
mm Hg, heart rate 98 bpm, heart boarders
+1,5 cm left side, sounds are muffled, soft 83. A 39 y.o. patient complains of having
systolic murmur at apex and Botkin's area; dyspnea during physical activity, crus
sporadic extrasystoles. Liver isn't palpated, edemata, palpitation, heart intermissions.
there are no edema. Blood test: WBC- Objectively: HR is 150 bpm, atrial
6,7*109/L, sedimentation rate 21 mm/hour. fibrillation. Heart is both ways enlarged.
What is the most probable diagnosis? Heart sounds are muted. Liver is 6 cm
A Acute myocarditis below the costal margin. Echocardiogram
B Climacteric myocardiodystrophia reveals dilatation of heart chambers (end
C Ichemic heart disease, angina pectoris diastolic volume of left ventricle is 6,8 cm)
D Rheumatism, mitral insufficiency is 29% EF, valve apparatus is unchanged.
E Hypertrophic cardiomyopathy What is the most probable diagnosis?
A Dilated cardiomyopathy
80. A patient has got acute macrofocal B Exudative pericarditis
myocardial infarction complicated by C Restrictive cardiomyopathy
cardiogenic shock. The latter is progressing D Hypertrophic cardiomyopathy
under conditions of weak general peripheric E Thyreotoxic cardiomyopathy
resistance and decreased cardiac output.
What antihypotensive drug should be 84. During dynamic investigation of a
injected to the patient in the first place? patient the increase of central venous
A Dopamine pressure is combined with the decrease of
B Noradrenaline arterial pressure. What process is proved by
C Adrenaline such combination?
D Mesatonum A Increase of bleeding speed
13
B Developing of cardiac insufficiency B Systolic
C Shunting C Combined
D Depositing of blood in venous channel D It's a norm
E Presence of hypervolemia E Unspecified

85. A 67-year-old female patient suffering 88. During preventive examination a 16

from the essential hypertension suddenly at year old patient presented no problems.
night developed headache, dyspnea that Objectively: the patient has signs of
quickly progressed to asphyxia. malnutrition, he is asthenic, AP is 110/70
Objectively: the patient is pale, with sweaty mm Hg, Ps is 80 bpm, cardiac border is
forehead, AP- 210/140 mm Hg, heart rate - normal, auscultation above the cardiac apex
120/min, auscultation revealed solitary dry reveals three sounds, cardiac murmur is
rales and moist rales in the lower parts. The absent. ECG shows no pathological
shins are pastose. What kind of emergency changes, phonocardiogram shows that the
aid would be the most efficient in this case? third sound comes 0,15 s after the second
A Nitroglycerin and furosemide one above the apex. How are these changes
intravenously called?
B Enalapril and furosemide intravenously A III physiological sound
C Digoxin and nitroglycerin intravenously B Fout-ta-ta-rou (reduplication of the 2nd
D Labetalol and furosemide intravenously sound)
E Nitroglycerin intravenously and capoten C Protodiastolic gallop rhythm
internally D Atrial gallop rhythm
E IV physiological sound
86. A 46 year old woman who has been
suffering from hypertension for 5 years was 89. During examination at a military
diagnosed with hypertensive crisis. She commissariat a 15-year-old teenager was
complains about palpitation, sense of head found to have interval sysolic murmur on
pulsation; heart rate is 100/min, AP is the cardiac apex, diastolic shock above the
190/100 mm Hg (haemodynamics is of pulmonary artery, tachycardia. Which of
hyperkinetic type). What medication should the suuplemental examination methods will
be the medication of choice? be the most informative for the diagnosis
A β-adrenoceptor blocker specification?
B Adenosine pyrophosphate inhibitor A Echocardiography
C Diuretic B Electrocardigraphy
D α-adrenoceptor blocker C Roengenography
E Dihydropyridine calcium antagonist D Phonocardiography
E Rheography
87. A 60-year-old patient complains about
asphyxia, palpitation, rapid fatiguability. He
has 8 year history of essential hypertension.
Objectively: the left cardiac border is 2 cm
deviated to the left from the
medioclavicular line, heart sounds are
rhythmic and weak; there is diastolic shock
above aorta. AP- 170/100 mm Hg. Liver -
+2 cm; shin pastosity is present. ECG
shows deviation of cardiac axis to the left,
left ventricle hypertrophy. Ejection fraction
- 63%. What type of cardiac insufficiency is
observed?
A Diastolic
14