1

Classification of GERD by clinical forms:

2
A common mechanism for the development of gastroesophageal reflux disease:
<variant>Impaired barrier function of the lower esophageal sphincter
<variant>Violation of gastric peristalsis
<variant> XElicobacter pylori
<variant>Dysfunction of the upper esophageal sphincter
<variant>Antroduodenal coordination disorder

3
The following research methods are used to diagnose gastroesophageal reflux disease:
<variant>Esophagoduodenofibrogastroscopy, pH-metry
<variant>Determination of the activity of proteolytic enzymes in gastric juice
<variant>R-diagnostics, urea breath test
<variant>Detection of Helicobacter pylori, Bernstein test
<variant>Definition of the secretory function of the esophagus and stomach

4
A sign NOT characteristic of Gastroesophageal Reflux Disease:
<variant>Shortening of the length of the esophagus, revealed by endoscopic examination
<variant>The presence of erosions on the mucous membrane of the distal esophagus.
<variant>Hyperemia of the mucous membrane of the distal esophagus.
<variant>Regurgitation of gastric contents into the esophagus during radiographic examination with contrast of the
esophagus in the Trendelenburg position
<variant>Gaping or incomplete closure of the cardiac sphincter

5
When performing the Bernstein and Baker test to diagnose gastroesophageal reflux disease, a solution is used:
<variant>Hydrochloric acid
<variant>Sulfuric acid
<variant>Acetic acid
<variant>Malic acid
<variant>Baking soda

6
In gastroesophageal reflux disease, the main pathogenetic drugs are:
<variant>Proton pump inhibitors (PPIs) and H2-histamine receptor blockers
<variant>Antacid and enzyme preparations
<variant>Antispasmodics and calcium channel blockers
<variant>Prokinetic and adsorbent drugs
<variant>Proton pump inhibitors (PPIs) and gastric acid stimulants

7
For non-erosive and erosive stage 1 gastroesophageal reflux disease, treatment is carried out for 4 weeks using the
following drugs:
<variant>Proton pump inhibitor (PPI) + prokinetic agent
<variant>Proton pump inhibitor (PPI) + antacid
<variant>Prokinetic agent + antacid drug
<variant>Prokinetic agent + mucocytoprotector
<variant>Antispasmodics + calcium channel blockers

1
8
In the erosive form of gastroesophageal reflux disease stages 2 and 3, pharmacotherapy is carried out using the
following drugs:
<variant>PPI + prokinetic agent + antacid drug
<variant>PPI + antacid drug + mucocytoprotector
<variant>PPI + antacid
<variant>prokinetic agent + mucocytoprotector
<variant>antispasmodics + calcium channel blockers

9
Duration of the main course of treatment for the erosive form of gastroesophageal reflux disease stage 2-3:
<variant>8 weeks
<variant>6 weeks
<variant>4 weeks
<variant>10 weeks
<variant>12 weeks

10
For stage 4 GERD, surgery is performed:
<variant>Fundoplasty
<variant>Resection of the stomach and lower third of the esophagus
<variant>Excision of the affected area of the esophagus
<variant>Extramucosal myotomy
<variant>Plastic surgery of the esophageal opening of the diaphragm

11
H.pylori produced enzymes that are directly related to the pathogenesis of peptic ulcer disease:
<variant>Urease, mucinase
<variant>Acid phosphatase, lipase
<variant>Phospholipase, hydrochloric acid
<variant>Amylase, urease
<variant>Phosphatase, amylase

12
H.pylori adheres to the epithelial cells of the gastric antral mucosa with the help of:
<variant>Adhesin proteins
<variant>Eyelashes
<variant>Suckers
<variant>Mucinases
<variant>Products of a special adhesive substance of protein nature

13
H.pylori initially most often affects the following part of the stomach:
<variant>Antral
<variant>Subcardial
<variant>Cardiac
<variant>Fundamental
<variant>Body of the stomach

14
The decisions of the European H.pylori Study Group on how to diagnose it, how and whom to treat are called:
<variant>Maastricht Consensus
<variant>The Hague Convention
<variant>Berlin Council
<variant>Postdam Agreement
<variant>Moscow summit

2
15
If first-line eradication therapy is ineffective, the following steps must be taken according to the Maastricht
Agreement:
<variant>Prescribing second-line therapy
<variant>Using the same regimen with double the dose of drugs
<variant>Purpose of the backup circuit
<variant>Prescribing the same treatment regimen for 14 days
<variant>Prescribing any other first-line regimen within 14 days

16
In cases of unsuccessful eradication when using second-line therapy (quadruple therapy), the following is used:
<variant>"Rescue Therapy".
<variant>"Therapy of despair."
<variant>"Therapy on demand."
<variant>"Therapy on demand".
<variant>"Fractional diet therapy".

17
The leading etiological factor in ulcerative disease of the duodenal bulb is considered to be:
<variant>H. pylori (HP)
<variant>Alcohol consumption
<variant>E. coli
<variant>Smoking
<variant>Hereditary factor

18
The leading pathogenetic link in the development of peptic ulcer disease with ulcer localization in the duodenum is:
<variant>Pronounced acid-peptic factor
<variant>Bile reflux
<variant>Weakening of the protective factors of the duodenal mucosa
<variant>Immunological factors
<variant>Violation of the motor function of the gastrointestinal tract

19
The leading pathogenetic link in peptic ulcer disease with ulcer localization in the body of the stomach is:
<variant>Decreased protective properties of the gastric mucosa
<variant>Acid-peptic factor
<variant>Bile reflux
<variant>Violation of the motor-evacuation function of the gastrointestinal tract
<variant>Immunological factors

20
Early (30-60 minutes after eating) pain in the epigastric region and behind the sternum is characteristic of the
localization of an ulcer defect:
<variant>In the cardiac and subcardial regions of the stomach
<variant>In the bulb of the duodenum
<variant>In the retrobulbar part of the duodenum
<variant>In the pyloric canal
<variant>In the antral part of the stomach

21
Late, hungry and night pains in the epigastrium are characteristic of the localization of the ulcer defect:
<variant>In the duodenum
<variant>In the antral part of the stomach
<variant>On the lesser and greater curvature of the stomach
<variant>In the cardiac region of the stomach
<variant>In the subcardial region of the stomach
22

3
Simulation of symptoms of hepatobiliary pathology and frequent complication of penetration into the pancreas are
characteristic of the ulcer localization:
<variant>On the back wall of the bulb
<variant>On the posterior wall of the antrum of the stomach
<variant>Ulcers on the anterior wall of the antrum of the stomach
<variant>On the front wall of the bulb
<variant>In the pyloric canal

23
Complications that are not typical for peptic ulcer disease:
<variant>Cardiospasm
<variant>Bleeding
<variant>Perforation
<variant>Penetration
<variant>Malignancy

24
Symptom indicating ulcer perforation:
<variant>Zhober
<variant>Bergman
<variant>Murphy
<variant>Eisenberg - I
<variant>Eisenberg - II

25
Treatment of patients with HP-negative peptic ulcer disease should include:
<variant>Complex therapy
<variant>Monotherapy with any one drug
<variant>Only 7-10 days eradication therapy
<variant>One antisecretory agent
<variant>One reparant

26
Preferred first-line regimen for eradication therapy of HP-positive peptic ulcer disease:
<variant>Omeprazole + amoxicillin + clarithromycin, 12-14 days
<variant>Omeprazole + Trichopolum + Clarithromycin, 7-10 days
<variant>Pantaprazole + amoxicillin + trichopolum, 7-10 days.
<variant>Pantaprazole + tetracycline + trichopolum, 7-10 days.
<variant>Omez + de-nol + metronidazole, 10-12 days.

27
When prescribing diuretics for the treatment of edematous-ascitic syndrome in patients with liver cirrhosis, the
level of ... is taken into account.
<variant>Potassium
<variant>Chlorine
<variant>Calcium
<variant>Fluorine
<variant>Sodium

28
Marker that is NOT detected in serum in hepatitis B:
<variant>HBc Ag
<variant>HBs Ag
<variant>HBeAg
<variant>Anti-HBe IgG
<variant>Anti-HBeIgM

29
Of the listed symptoms, the following does NOT apply to hepatic encephalopathy:
4
<variant>Hyperbilirubinemia
<variant>"Flapping" tremor
<variant>Increased ammonia levels in the blood
<variant>Memory loss
<variant>Liver odor from the mouth

30
The early clinical sign of primary biliary cirrhosis is usually:
<variant> Skin itching
<variant> Ascites
<variant> Varicose veins
<variant> Jaundice
<variant> Splenomegaly

31
Chronic hepatitis is an inflammatory disease of the liver that continues without improvement for at least
<variant> 6 months
<variant> 2 months
<variant> 3 months
<variant> 4 months
<variant> 1 year

32
An indicator of active replication of the B virus is a serological marker:
<variant> HBeAg
<variant> Anti-HBs
<variant> Anti-HBcIgG
<variant> Anti-HBe
<variant> Antinuclear antibodies

33
Patient25 years old, complains of a feeling of fullness in the epigastric region after eating a normal amount of food,
early satiety. These complaints appeared 4 months ago. Your preliminary diagnosis:
<variant> Functional dyspepsia, postprandial form
<variant> Functional dyspepsia, painful form
<variant> Gastroesophageal reflux disease
<variant> Gastritis type A
<variant> Gastritis type B

34
A 64-year-old man came to see a doctor complaining of frequent heartburn, almost after every meal and at night.
Informative diagnostic method:
<variant> Esophagogastroduodenoscopy
<variant> Ultrasound examination
<variant> X-ray examination
<variant> Electrocardiography
<variant> Fluorography

35
A 59-year-old man. He came with complaints of frequent heartburn, almost after every meal and at night. EGDS
revealed swelling and hyperemia of the distal esophagus, multiple erosions occupying almost the entire
circumference of the esophagus. Your preliminary diagnosis:
<variant> Gastroesophageal reflux disease
<variant> Functional dyspepsia, painful form
<variant> Chronic gastritis in the acute stage
<variant> Gastric ulcer
<variant> Achalasia of the cardia
36

5
Patient S., 28 years old, complains of a feeling of fullness in the epigastric region after eating a normal amount of
food, early satiety. These complaints appeared 4 months ago. Group of drugs to improve gastrointestinal motility:
<variant> Prokinetics
<variant> Digestive enzymes
<variant> Proton pump inhibitors
<variant> H2-histamine receptor blockers
<variant> Gastroprotectors

37
Patient M., 24 years old, complains of a feeling of fullness in the epigastric region after eating a normal amount of
food, early satiety. These complaints appeared 4 months ago. A drug to improve gastrointestinal motility:
<variant> Itomed
<variant> Creon
<variant> De-nol
<variant> Gastal
<variant> Hofitol

38
A 40-year-old patient was admitted to the emergency room complaining of weakness, dizziness, two-time vomiting
of "coffee grounds", loose tarry stools, sweating, and thirst. History: epigastric pain for 1 year, relieved by taking
soda, the current deterioration in health occurred in the morning after lifting weights. Objectively: pale, BP 100/65
mm Hg, HR 105 bpm, weak pulse. No symptoms of peritoneal irritation. According to the clinical protocol, the
following is optimal for stopping bleeding:
<variant> Aminocaproic acid
<variant> Nitrendipine
<variant> Omeprazole
<variant> Novoseven
<variant> Hemotransfusions

39
Patient V., 38 years old, complains of pain in the right hypochondrium, mild jaundice, arthralgia. Examination
revealed hepatomegaly, normochromic anemia, leukopenia, thrombocytopenia, LE cells ++. ELISA revealed
antibodies to smooth muscles (SMA) and antinuclear antibodies (ANA). According to the clinical protocol, your
preliminary diagnosis is:
<variant> Autoimmune hepatitis
<variant> Primary sclerosing cholangitis
<variant> Overlap syndrome
<variant> Primary biliary cirrhosis of the liver
<variant> Secondary biliary cirrhosis of the liver

40
Patient R., 36 years old, complains of jaundice, skin erythema, heaviness in the right hypochondrium, loss of
appetite, weakness, arthralgia. Objectively: the liver is +2 cm from under the costal margin, the spleen is not
palpable. CBC: Hb - 100 g / l, erythrocytes - 3.0x1012 / l, leukocytes - 3.0x109 / l, thrombus - 100x109 / l, ESR 32
mm / h. ELISA: antibodies to liver-renal microsomes (ALKM-1) were detected. According to the clinical protocol,
the probable diagnosis is:
<variant> Autoimmune hepatitis
<variant> Primary sclerosing cholangitis
<variant> Overlap syndrome
<variant> Primary biliary cirrhosis of the liver
<variant> Secondary biliary cirrhosis of the liver

41
A patient with heaviness in the right hypochondrium, jaundice, hepatomegaly, during examination, bilirubin is 60
mmol / l, direct - 35 mmol / l, ALT - 2.0 μkat / l, AST - 1.5 μkat / l. ELISA: HBsAg +, HBeAg +, HBcAb +, DNA
HBV +. According to the clinical protocol, serological markers indicate:
<variant> HBV in the replication stage
<variant> Immunity after HBV
<variant> HBV carrier
6
<variant> Immunity after vaccination
<variant> HBV in the integration stage

42
A patient with heaviness in the right hypochondrium, jaundice, hepatomegaly, during examination, bilirubin is 60
mmol / l, direct - 35 mmol / l, ALT - 2.0 μkat / l, AST - 1.5 μkat / l. ELISA: HBsAg +, HBeAg +, HBcAb +, DNA
HBV +. According to the clinical protocol, your drug tactics:
<variant> Specific antiviral therapy
<variant> Symptomatic therapy
<variant> Pathogenetic therapy
<variant> Glucocorticoid therapy
<variant> Antifibrotic therapy

43
A patient with jaundice, hepatomegaly, moderate increase in transferases, ELISA revealed: HBsAg +, HBcAb class
IgG +, HBV DNA-. According to the clinical protocol, serological markers indicate:
<variant> HBV in the integration stage
<variant> HBV in the replication stage
<variant> Immunity after HBV
<variant> HBV carrier
<variant> Immunity after vaccination

44
A patient with mild scleral icterus, poor tolerance of fatty foods, heaviness in the right hypochondrium, moderate
increase in aminotransferases, ELISA revealed: HBsAg -, HBeAb +, HBcAb class IgG+, HBV DNA-. According
to the clinical protocol, serological markers indicate:
<variant> Immunity after HBV
<variant> HBV in the replication stage
<variant> HBV carrier
<variant> Immunity after vaccination
<variant> HBV in the integration stage

45
Patient K., 35 years old, was admitted to hospital with gastric bleeding. For 6 years, he has been observed by a
therapist for ulcerative disease of the duodenum (DU); ulcers are poorly amenable to standard therapy and often
recur. EGD: multiple ulcers of the duodenal mucosa. According to the clinical protocol, your diagnosis is:
<variant> Zollinger-Ellison syndrome
<variant> Postprandial distress syndrome
<variant> Epigastric pain syndrome
<variant> Gastric dyspepsia syndrome
<variant> Mallory-Weiss syndrome

46
Patient K., 35 years old, was admitted to hospital with gastric bleeding. For 6 years, he has been observed by a
therapist for ulcerative disease of the duodenum (DU); ulcers are poorly responsive to standard therapy and often
recur. EGD: multiple ulcers of the duodenal mucosa. According to the clinical protocol, the following diagnostic
method to clarify the diagnosis:
<variant> Determination of the level of gastrin in the blood
<variant> X-ray contrast study of the stomach
<variant> Coprological examination
<variant> Biopsy of the duodenal mucosa
<variant> Determination of calcitonin levels in the blood

47
A 40-year-old patient with persistently recurrent duodenal ulcer disease that is poorly responsive to standard
therapy with antisecretory drugs and antibiotics is suspected of having Zollinger-Ellison syndrome. According to
the clinical protocol, your diagnostic tactics
<variant> Determination of the level of gastrin in the blood
<variant> Determination of basal acid production (BAP)
7
<variant> Determination of maximum acid production (MAO)
<variant> Determination of the VAO/MAO ratio
<variant> Performing the Hollander test

48
Patient A., 42 years old, complains of jaundice, pain in the right hypochondrium, ossalgia, myalgia. Objectively:
liver + 2.5 cm from under the costal margin, spleen 6x8 cm. CBC: normochromic anemia, leukopenia,
thrombocytopenia. LE cells ++. ELISA revealed antibodies to smooth muscles (SMA) and antinuclear antibodies
(ANA). According to the clinical protocol, your subsequent drug therapy is:
<variant> Azathioprine + prednisolone
<variant> Ursodeoxycholic acid + cholestyramine
<variant> Heptral + Essentiale-Forte
<variant> Desferal + LIV-52
<variant> D-penicillamine + carsil

49
Patient K., 30 years old, complains of yellowing of the skin, heaviness in the right hypochondrium, loss of appetite,
weakness, arthralgia. Objectively: liver +2 cm from under the costal margin, spleen 6x8 cm. Hb - 100 g / l, er. -
3.0x1012 / l, leuk. 3.0x109 / l, thrombus. - 100x109 / l, ESR 32 mm / h. ELISA: antibodies to soluble liver antigen
(SLA) and soluble liver-pancreatic antigen (LP) were detected. According to the clinical protocol, your preliminary
diagnosis is:
<variant> Autoimmune hepatitis type 3
<variant> Autoimmune hepatitis type 1
<variant> Autoimmune hepatitis type 2
<variant> Primary biliary cirrhosis of the liver
<variant> Secondary biliary cirrhosis of the liver

50
Patient V., 43 years old, complains of dull pain in the right hypochondrium, yellowing of the skin, darkening of the
urine. Objectively: the skin is icteric, hyperemia of the palms, gynecomastia. The tongue is bright red, moist. The
abdomen is soft, painful in the right hypochondrium. Liver + 2.5 cm from under the edge of the costal arch.
ELISA: HBeAg+, anti-HBc IgM+, HBV DNA+. According to the clinical protocol, your diagnosis is:
<variant> Chronic hepatitis B
<variant> Chronic hepatitis C
<variant> Chronic hepatitis A
<variant> Chronic hepatitis D
<variant> Chronic hepatitis G

51
A 52-year-old patient complained of weakness, nausea, insomnia at night and drowsiness during the day,
abdominal distension, and pain in the right hypochondrium. The pain intensifies after eating fatty and spicy foods
and is accompanied by loose stools. The edge of the liver protrudes 6 cm from under the costal arch, is dense, and
painful on palpation. The spleen is not palpable, its dimensions are 10x12 cm. Percussion reveals dullness in the
lower abdomen. Hb 115 g/l, WBC 4.8 thousand in 1 μl, ESR 28 mm/h. ALT 1.75 mmol/l, AST 1.45 mmol/l. Total
bilirubin 46 μmol/l, albumins 30 g/l, PTI 60%. According to the clinical protocol, your preliminary diagnosis is:
<variant> Liver cirrhosis, decompensation stage
<variant> Liver cirrhosis, compensation stage
<variant> Liver cirrhosis, subcompensation stage
<variant> Autoimmune hepatitis type 1
<variant> Autoimmune hepatitis type 2

52
A 45-year-old man who has been drinking alcohol for a long time is bothered by pain in the right hypochondrium.
Objectively: the skin is icteric, the liver protrudes 2 cm from the hypochondrium, and is painful upon palpation.
Laboratory findings: macrocytic anemia, moderate leukocytosis, AST/ALT ratio > 2, increased GGT. Your
diagnosis:
<variant> Alcoholic liver disease
<variant> Chronic pancreatitis
<variant> Chronic hepatitis
8
<variant> Biliary-dependent pancreatitis
<variant> Fatty hepatosis

53
A 45-year-old man who has been drinking alcohol for a long time is bothered by pain in the right hypochondrium.
Objectively: the skin is icteric, the liver protrudes 2 cm from the hypochondrium, and is painful upon palpation.
Laboratory parameters: macrocytic anemia, moderate leukocytosis, AST/ALT ratio> 2, increased GGT. Drug
therapy:
<variant> Glutargin, B vitamins
<variant> Gastroprotectors, vitamin C
<variant> Enzyme preparations, multivitamins
<variant> Proteolytic enzymes, vitamin B12
<variant> Essential phospholipids, probiotics

54
In diet therapy for peptic ulcer disease, the inclusion of protein foods in fractional meals will lead to:
<variant> Reducing the acidity of gastric contents
<variant>Increased acidity of gastric contents
<variant>Increasing the level of pepsin in the gastric contents
<variant> Decreased pepsin levels in gastric contents
<variant> Reduction of secretin levels

55
A young woman of 18 years old developed dysphagia, a feeling of a "lump" behind the breastbone, after emotional
stress. Dysphagia recurred later with excitement, fatigue. Appetite is preserved, weight has not been lost. Physical
examination revealed no pathology. The most probable cause of dysphagia is:
<variant> Esophagospasm
<variant> Esophageal cancer
<variant> Peptic ulcer of the esophagus
<variant> Axial hernia of the esophageal opening of the diaphragm
<variant> Herpetic lesion of the esophagus

56
A 49-year-old patient underwent surgery for ulcerative bleeding with perforation 5 years ago. He notes pain similar
to the previous ones, ulcerative, but localized in the left epigastric region, vomiting at the height of the pain and
weight loss. Conservative treatment is ineffective. Gregersen reaction in stool (+++). According to the clinical
protocol, your diagnosis is:
<variant> Peptic ulcer of anastomosis
<variant> Hypoglycemia syndrome
<variant> Agastric asthenia
<variant>Afferent loop syndrome
<variant> Dumping syndrome

57
A 26-year-old man consulted a doctor with the following complaints: epigastric pain occurring 1-1.5 hours after
eating, belching, heartburn. On examination: the tongue is moist, coated with a white coating, the abdomen is soft,
moderate pain in the epigastrium. FGDS: diffuse hyperemia of the gastric mucosa, superficial defects of the
mucous membrane of the antral part of the stomach up to 0.5 cm in size. According to the clinical protocol, your
diagnosis is:
<variant> Chronic non-atrophic gastritis, with erosions
<variant> Chronic atrophic gastritis
<variant> Gastric ulcer
<variant> Reflux gastritis
<variant> Functional non-ulcer dyspepsia

58
A 76-year-old man complains of a feeling of heaviness and fullness in the epigastrium after eating, belching food,
nausea, an unpleasant taste in the mouth; flatulence; rumbling and pouring in the abdomen. During FGDS: the
mucous membrane is pale and mottled, the folds are smoothed out, the submucosal vascular pattern is visible.
9
Morphologically (in biopsies from the body and antrum of the stomach) there is atrophy, lymphoplasmacytic
infiltration, moderate intestinal metaplasia. According to the clinical protocol, your diagnosis is:
<variant> Chronic atrophic pangastritis
<variant> Chronic autoimmune pangastritis
<variant> Chronic H. Pillory antral gastritis
<variant> Chronic antral reflux gastritis
<variant> Chronic hyperplastic gastritis

59
The patient was diagnosed with hepatomegaly, hyperglycemia, skin hyperpigmentation, and elevated serum iron
levels. This symptom complex is typical for:
<variant> Hemochromatosis
<variant> Chronic hepatitis of viral etiology
<variant> Liver cirrhosis
<variant> Hyperfunction of the adrenal glands
<variant> Wilson-Konovalov disease

60
Mesenchymal inflammation syndrome is characterized by an increase in the blood:
<variant> Gamma globulins
<variant> Cholesterol
<variant> Alkaline phosphatase
<variant> Bilirubin
<variant> Albumin

61
28-year-old male, injection drug user. Chronic fatigue and AST elevation 4 times, ALT 5 times higher than normal,
positive anti-HCV. According to the clinical protocol, your diagnosis is:
<variant> Hepatitis C
<variant> Hepatitis B
<variant> HepatitisA
<variant> HepatitisE
<variant> Hepatitis G

62
A blood test revealed hepatitis "B" in the patient. The most reliable laboratory test distinguishing chronic carrier
status from chronic active hepatitis "B" is:
<variant>Human body surface antigen (HBSAg)
<variant> Nuclear antigen (anti-HBc, IgM)
<variant> Serum smooth muscle antibodies
<variant> Antinuclear factor (ANF)
<variant> Serum AFP (a-fetoprotein)

63
A 58-year-old woman with stage 2 obesity was diagnosed with autoimmune hepatitis. A six-fold increase in serum
ALT was noted. First-line drug:
<variant> Azathioprine
<variant> Prednisolone
<variant> D-penicillamine
<variant> Essential phospholipids
<variant> Ademetionine

64
An increase in the serum IgM content and the appearance of autoantibodies to mitochondrial components in
patients with jaundice and hepatosplenomegaly most often indicates:
<variant> Primary biliary cirrhosis
<variant> Drug-induced hepatitis
<variant> Viral hepatitis
<variant> Alcoholic hepatitis
10
<variant> Hemochromatosis

65
Patient Z., 54 years old, dentist, complains of weakness, bleeding gums, weight loss, itchy skin. At the age of 38,
she was operated on for uterine fibroids. Undernutrition, the skin and visible mucous membranes are icteric, spider
veins, palmar erythema. The liver is 5 cm enlarged at the expense of the left lobe, dense, the spleen is 3 cm below
the left costal arch. The abdomen is slightly enlarged in volume, the venous network is along the lateral surfaces of
the abdomen; there is no edema in the legs. In the blood serum, ELISA revealed: HBsAg (+); anti HB cor IgG (+).
In the general blood test - Hb 107 g / l; Er 2, 9x1012 / l, L 3, 4x109 / l, platelets 93 thousand. According to the
clinical protocol, your diagnosis is:
<variant> Liver cirrhosis as a result of viral hepatitis
<variant> Decompensated cryptogenic liver cirrhosis
<variant> Hepatocellular carcinoma
<variant> Primary biliary cirrhosis
<variant> Chronic viral hepatitis

66
Patient M., 48 years old, complains of periodic pain in the right hypochondrium, itchy skin, weakness, weight loss,
darkening and dry skin. Denies viral hepatitis, was treated by a dermatologist and an allergist without success.
Objectively: skin hyperpigmentation, dryness, traces of scratching, hyperkeratosis, xanthomas and xanthelasmas.
The liver and spleen are enlarged, the edge of the liver is pointed and dense. There is no edema. Ultrasound shows
hepatomegaly, changes in the echo density of the parenchyma: extrahepatic bile ducts, gallbladder, and pancreas
are intact. In the blood, antimitochondrial antibodies are detected and the IgM level is increased. According to the
clinical protocol, your diagnosis is:
<variant> Primary biliary cirrhosis of the liver
<variant> Primary sclerosing cholangitis
<variant> Hemochromatosis
<variant> Wilson-Konovalov disease
<variant> Secondary biliary cirrhosis of the liver

67
Patient M., 48 years old, complains of periodic pain in the right hypochondrium, itchy skin, weakness, weight loss,
darkening and dry skin. Denies viral hepatitis, was treated by a dermatologist and an allergist without success.
Objectively: skin hyperpigmentation, dryness, traces of scratching, hyperkeratosis, xanthomas and xanthelasmas.
The liver and spleen are enlarged, the edge of the liver is pointed and dense. There is no edema. Ultrasound shows
hepatomegaly, changes in the echo density of the parenchyma: extrahepatic bile ducts, gallbladder, and pancreas
are intact. In the blood, antimitochondrial antibodies are detected and the IgM level is increased. According to the
clinical protocol, your treatment tactics are:
<variant> Methotrexate, ursofalk
<variant> Prednisolone, Creon
<variant> Omeprazole, Ursosan
<variant> Gepabene, questran
<variant> Hofitol, Ursodex

68
Multiple ulcers in the stomach and duodenum in combination with a hyperacid state and persistent pain in the
epigastrium that is not relieved by antacids are most likely associated with:
<variant>Gastrinoma
<variant> Stomach cancer
<variant> Portal gastropathy
<variant> Gallstone disease
<variant> Persistence of H.pylori

69
Patient S., 45 years old, consulted a doctor complaining of burning pain behind the breastbone, not clearly related
to physical activity and occurring immediately after eating, and heartburn. The pain is not relieved by taking
nitroglycerin. Objectively: increased nutrition. The skin is of normal color, clean. Blood pressure 125/85 mm Hg.
Pulse 74 beats per minute, rhythmic. Heart sounds are muffled, rhythmic. There is no pathology in the lungs. The

11
tongue is moist, slightly coated with a whitish coating. The abdomen is soft, moderately painful on palpation in the
epigastric region. According to the clinical protocol, your preliminary diagnosis is:
<variant> Gastroesophageal reflux disease
<variant> Gallstone disease
<variant> Ischemic heart disease
<variant> Peptic ulcer
<variant> Chronic pancreatitis

70
Multiple ulcers of the duodenum (DU) complicated by frequent bleeding, diarrhea, resistant to treatment in middle-
aged people are most typical for:
<variant> Zollinger-Ellison syndrome
<variant> Ulcers-cancer of the duodenum
<variant> Hyperparathyroidism
<variant>NSAID-induced duodenopathy
<variant> Mallory-Weiss syndrome

71
According to the clinical protocol, encephalopathy, a sweetish smell from the mouth, and a "flapping" tremor of
the fingers of outstretched hands in a patient with liver cirrhosis indicate:
<variant> Hepatocellular insufficiency
<variant> Portal hypertension
<variant> Hepatorenal syndrome
<variant> Mesenchymal inflammation
<variant> Cholestasis syndrome

72
According to the clinical protocol, gastrointestinal bleeding that develops in a patient with liver cirrhosis most
likely indicates the presence of:
<variant> Portal hypertension
<variant> Hepatocellular insufficiency
<variant> Hepatorenal syndrome
<variant> Mesenchymal inflammation
<variant> Cholestasis syndrome

73
According to the clinical protocol, the specific criterion for acute hepatitis is:
<variant> Increase in ALT and AST levels by 10 > times
<variant> Increase in thymol test by 2-3 times
<variant> Decreased albumin levels < 40 g/l
<variant> Increased gamma globulin levels > 27 g/l
<variant> Increase in alkaline phosphatase level by 3 or > times

74
A 28-year-old patient complained of epigastric pain occurring 1.5-2 hours after eating; belching. On EGD: the
mucosa in the pyloric and antral sections of the stomach is hyperemic. According to the clinical protocol, your
further diagnostic tactics are:
<variant> Helicobacter pylori test
<variant> Chromoendoscopy
<variant> X-ray of the stomach
<variant> Intragastric pH-metry
<variant> Electrogastrographic method

75
Patient A., 47 years old, complains of severe skin itching. She worked in a chemical laboratory for 25 years.
Objectively: the skin is brownish, xanthelasma on the face. The liver protrudes 4 cm from under the costal margin.
CBC: Hb - 100 g / l, erythrocytes - 3.5x1012 / l, leukocytes - 6.5x109 / l, ESR 28 mm / h. UAN: bilirubin ++.
BAC: total bilirubin 185 g / l, direct - 94 g / l, cholesterol - 12.6 mmol / l, ALT - 2.52 mmol / l, AST - 1.98 mmol /

12
l, albumins - 34 mmol / l, PTI - 45%. IgA - 20 IU / ml. According to the clinical protocol, to verify the diagnosis it
is most appropriate to carry out:
<variant> Short-term elastography
<variant> Esophagogastroduodenoscopy
<variant> Endoscopic retrograde cholangiopancreatography
<variant> Ultrasound of abdominal organs
<variant> Computed tomography of abdominal organs

76
A 46-year-old patient complains of weakness, nausea, heaviness in the right hypochondrium, and unstable stool.
The edge of the liver protrudes 3 cm from under the costal arch, is dense, and painful on palpation. The spleen is
not palpable, dimensions are 8x10 cm. Hb 125 g/l, leukocytes 5.2 thousand in 1 μl, ESR 28 mm/h. ALT 1.75
mmol/l, AST 1.45 mmol/l. Total bilirubin 32 μmol/l, albumins - 40 g/l, PTI 65%. Ultrasound: portal vein diameter -
1.3 cm, splenic vein - 1.0 cm. According to the clinical protocol, your preliminary diagnosis is:
<variant> Liver cirrhosis, compensation stage
<variant> Liver cirrhosis, subcompensation stage
<variant> Liver cirrhosis, decompensation stage
<variant> Autoimmune hepatitis
<variant> Cruveilhier-Baumgarten disease

77
Patient K., 28 years old, complained of gait and speech disorders, muscle rigidity. Objectively: the skin is icteric, a
green ring is determined along the periphery of the cornea. Liver + 3 cm from under the edge of the costal arch,
spleen 10x12 cm. Total bilirubin - 45 μmol / l, albumins 0.40 g / l, PTI - 65%, serum ceruloplasmin - 0.1 g / l.
According to the clinical protocol, the probable diagnosis is:
<variant> Hepatolenticular degeneration
<variant> Primary biliary cirrhosis of the liver
<variant> Secondary biliary cirrhosis of the liver
<variant> Hemochromatosis
<variant> Liver carcinoma

78
According to the clinical protocol, with hepatic vein thrombosis the following develops:
<variant> Budd-Chiari syndrome
<variant> Mallory-Weiss syndrome
<variant> Cruveilhier-Baumgarten syndrome
<variant> Zollinger-Ellison syndrome
<variant> Dumping syndrome

79
According to the clinical protocol, a simultaneous increase in the blood levels of bilirubin and cholesterol indicates
that the patient has the syndrome:
<variant> Cholestasis
<variant> Cytolysis
<variant> Mesenchymal inflammation
<variant> Hepatocellular insufficiency
<variant> Portal hypertension

80
According to the clinical protocol, the indication for antiviral therapy for chronic hepatitis B is the determination
by ELISA of:
<variant> HBsAg
<variant> Anti-HBcor IgG
<variant> Anti-НBсоrIgM
<variant> HBeAgr
<variant> anti-HBеAg
81

13
A patient with jaundice and moderate hepatomegaly had a biochemical study that revealed total protein of 60 g/l,
gamma globulins of 28 g/l, CRP ++, thymol test of 6 units, and ESR of 26 mm/h. According to the clinical
protocol, the following syndrome should be considered:
<variant> Mesenchymal inflammation
<variant> Cytolysis
<variant> Cholestasis
<variant> Hepatocellular insufficiency
<variant> Hepatic blood flow bypass

82
A patient with hepatosplenomegaly and ascites showed an increase in residual nitrogen and urea during
biochemical testing, and elevated levels of indole, skatole and phenols in the urine. According to the clinical
protocol, one should consider the development of the syndrome:
<variant> Hepatocellular insufficiency
<variant> Cytolysis
<variant> Cholestasis
<variant> Mesenchymal inflammation
<variant> Hepatic blood flow bypass

83
A patient with a decrease in liver size, vascular asterisks, gynecomastia, bleeding, laboratory tests revealed blood
albumin - 35 g / l, PTI - 40%, total bilirubin 5 mmol / l. According to the clinical protocol, one should think about
the development of the syndrome:
<variant> Hepatocellular insufficiency
<variant> Cytolysis
<variant> Cholestasis
<variant> Mesenchymal inflammation
<variant> Hepatic blood flow bypass

84
A patient with severe jaundice, itchy skin, dark urine and light stool has laboratory findings of total bilirubin 120
mmol/l, cholesterol 8.5 mmol/l, beta-lipoproteins 5 mmol/l, alkaline phosphatase 235 IU/l. According to the
clinical protocol, one should think about the development of the syndrome:
<variant> Cholestasis
<variant> Cytolysis
<variant> Mesenchymal inflammation
<variant> Hepatocellular insufficiency
<variant> Hepatic blood flow bypass

85
A patient with hepatosplenomegaly and jaundice was diagnosed with grade 1 encephalopathy; ascites, amenable to
treatment with veroshpiron; total serum bilirubin - 38 mmol/l, PTI 48%, serum albumin level - 30 g/l. According to
the clinical protocol, your preliminary diagnosis is:
<variant> Liver cirrhosis, decompensated (K 74)
<variant> Liver cirrhosis, compensated (K 74
<variant> Liver cirrhosis, subcompensated (K 74)
<variant> Chronic liver failure (K 72)
<variant> Portal hypertension (K 76.6)

86
A 27-year-old patient was admitted to the emergency room with acute abdominal pain that had developed 1 hour
ago. There was no vomiting or stool. Objectively: muscular defense in the epigastrium, percussion - disappearance
of liver dullness. According to the clinical protocol, your subsequent diagnostic tactics are:
<variant> Performing a survey radiography of the abdominal organs
<variant> Determination of hemoglobin, hematocrit, erythrocyte levels
<variant> Conducting esophagogastroduodenoscopy
<variant> Platelet count
<variant> Performing a gastric X-ray with barium
87
14
Patient A., 47 years old, complained of itchy skin and weakness. She worked in a chemistry lab for 25 years.
Objectively: brownish skin color, xanthomas on the face. CBC: Hb - 100 g/l, EBC - 3.5x1012/l, WBC - 6.5x109/l,
ESR 28 mm/h. Urea: color - brown, relative density - 1029. Bilirubin 185 g/l, cholesterol - 12.6 mmol/l, ALT - 2.52
mmol/l, AST - 1.98 mmol/l, PTI - 45%. IgA - 20 IU/ml. Ultrasound: hepatosplenomegaly, dilation of intrahepatic
bile ducts, d v.porta - 16 mm, v.lienalis - 13 mm. In the abdominal cavity - 900 ml of fluid. According to the
clinical protocol, your preliminary diagnosis is:
<variant> Toxic liver injury with cirrhosis (K71.7)
<variant> Alcoholic liver cirrhosis (K70.3)
<variant> Primary biliary cirrhosis (K74.3)
<variant> Secondary biliary cirrhosis (K74.4)
<variant> Toxic hepatitis (K71)

88
According to the clinical protocol, localization of pain in ulcers of the pyloric part of the stomach and duodenum:
<variant> In the epigastrium to the right of the midline
<variant> In the epigastrium under the xiphoid process
<variant> Behind the sternum
<variant> In the epigastrium to the left of the midline
<variant> In the umbilical region

89
According to the clinical protocol, the marker of recovery from acute viral hepatitis B is:
<variant> HBcAb class Ig G
<variant> HBeAg
<variant> HBcAb class Ig M
<variant> HBV DNA
<variant> HBsAg

90
Patient R., 27 years old, complained of cramping pain in the right hypochondrium, decreasing after the passage of
gases and defecation; instability of stool. The tongue is moist, clean. The abdomen is soft, sensitive to palpation in
the right hypochondrium. The liver and spleen are not enlarged. Bilirubin 20 mmol / l, ALT - 0.68 mmol / l, AST -
0.45 mmol / l. Ultrasound: the gallbladder is of normal size, wall thickness 0.3 cm. Your preliminary diagnosis:
<variant> Dyskinesia of the biliary tract
<variant> Pancreatitis in the acute stage
<variant> Chronic cholecystitis in the acute stage
<variant> Irritable bowel syndrome
<variant> Chronic hepatitis

91
Patient M., 58 years old, suffering from osteoarthritis, has been taking non-steroidal anti-inflammatory drugs for 3
years. According to the clinical protocol for the prevention of NSAID-induced gastric ulcers, it is advisable to
prescribe:
<variant> Omeprazole + misoprostol
<variant> Omeprazole + tetracycline
<variant> Omeprazole + domperidone
<variant> Omeprazole + famotidine
<variant> Omeprazole + Allochol

92
Patient S., a loader, complains of heartburn, chest pain, which intensifies after eating and during physical exertion.
Taking Almagel brings relief. On EGD: the esophageal mucosa is loose, the lesion of the mucosa is more than 5
mm long, limited to the fold of the mucosa, gaping of the lower esophageal sphincter. According to the clinical
protocol, your preliminary diagnosis is:
<variant> GERD stage II
<variant> GERD stage I
<variant> GERD stage III
<variant> GERD stage IV
<variant> GERD stage V
15
93
Patient S., 60 years old, complains of weakness, paresthesia in the feet, unsteadiness of gait; loss of appetite, rotten
belching, diarrhea. Objectively: the skin is pale with a yellowish tint. The tongue is "varnished". The abdomen is
soft, painless. Liver + 2 cm from under the costal arch. Spleen - 12x7 cm. Hb - 80 g / l, er. - 2.0x1012 / l, , leuk. -
3.3x109 / l; thrombus. - 100x109 / l, ESR 26 mm / h. Total bilirubin 40 g / l, direct - 4 g / l, ALT - 0.68 mmol / l,
thymol, test - 5.0 units. EGD: the gastric mucosa in the antral section is pale, the folds are weakly expressed, the
relief is smoothed. Your diagnosis:
<variant> Atrophic antral gastritis
<variant> Hypertrophic gastritis
<variant> Granulomatous gastritis
<variant> Bile reflux gastritis
<variant> Chronic active gastritis without erosions

94
A 56-year-old patient was admitted to the emergency room complaining of weakness and dizziness. , two-time
vomiting of "coffee grounds", loose tarry stools, sweating, thirst. From the anamnesis: taking antiplatelet agents,
epigastric pain for 1 year, relieved by taking soda; the current deterioration in health appeared in the morning after
lifting weights. Objectively: pale, blood pressure 100/65 mm Hg, heart rate 105 per minute, weak pulse, signs of
orthostatism. There are no symptoms of peritoneal irritation. According to the clinical protocol, your preliminary
diagnosis is:
<variant> Symptomatic gastric ulcer, bleeding
<variant> Peptic ulcer of the duodenum, bleeding
<variant> Acute hemorrhagic gastritis, bleeding
<variant>Perforation of gastric ulcer
<variant> Goodpasture's syndrome, gastric bleeding

95
Patient M., 40 years old, was admitted to the gastroenterology department with complaints of itching of the skin,
jaundice, heaviness in the right hypochondrium, weakness. Objectively: the skin is icteric, traces of scratching, the
liver +5 cm, the spleen 5x7 cm. In the blood: alkaline phosphatase - 208 IU / l, total bilirubin - 120 μmol / l,
cholesterol - 8.0 mmol / l. The leading syndrome in the patient:
<variant> Cholestatic
<variant> Hepatosplenic
<variant> Cytolytic
<variant> Mesenchymal-inflammatory
<variant> Hepatocellular insufficiency

96
Patient M., 40 years old, was admitted to the gastroenterology department with complaints of itching of the skin,
jaundice, heaviness in the right hypochondrium, weakness. Objectively: the skin is icteric, traces of scratching, the
liver +5 cm, the spleen 5x7 cm. In the blood: alkaline phosphatase - 208 IU / l, total bilirubin - 120 μmol / l,
cholesterol - 8.0 mmol / l. To reduce cholestasis syndrome, it is necessary to prescribe:
<variant> Ornithine aspartate
<variant> Diphenhydramine
<variant> Cholestyramine
<variant> Hofitol
<variant> Essliver-forte

97
The patient has verified chronic viral hepatitis B, the ALT level in the blood is 410 U/l. According to the clinical
protocol, the degree of activity of the process:
<variant> moderate
<variant> minimum
<variant> low
<variant> high
<variant> is determined by the level of bilirubin in the blood, not ALT

98

16
The patient has verified chronic viral hepatitis C, the level of total bilirubin in the blood is 85.5 μmol/l. According
to the clinical protocol, the degree of activity of the process:
<variant> The degree of activity is determined by the level of ALT, not bilirubin
<variant> The degree of activity is determined by the level of alkaline phosphatase, not bilirubin
<variant> Minimal, since the degree of activity is determined by the level of bilirubin
<variant> Moderate, since the degree of activity is determined by the level of bilirubin
<variant> Expressed, since the degree of activity is determined by the level of AST

99
A 23-year-old patient consulted a gastroenterologist with the following biochemical test results: total blood
bilirubin 79.5 mmol/l, conjugated 4.5 mmol/l, ALT 25 U/l. According to the clinical protocol, the clinical signs
equivalent to these laboratory tests are:
<variant> Icterus of the skin, weakness
<variant> Jaundice, itchy skin, darkening of urine due to bile pigments
<variant> Jaundice, itchy skin, acholic stool
<variant> Hepatomegaly, itchy skin, darkening of urine due to bile pigments,
<variant> Jaundice, darkening of urine due to free bilirubin

100
According to the clinical protocol, localization of pain in ulcers of the body of the stomach:
<variant> In the epigastrium to the left of the midline
<variant> Xiphoid process
<variant> Behind the sternum
<variant> In the epigastrium to the right of the midline
<variant> Around the navel

101
According to the clinical protocol, the marker of HCV replication is:
<variant> HCV RNA
<variant>HCV DNA
<variant> HCVAb class Ig M
<variant> HCVAb class Ig G
<variant> HDV Ag

102
A 27-year-old patient was admitted to the emergency room with acute abdominal pain that had developed 1 hour
ago. There was no vomiting or stool. Objectively: muscular defense in the epigastrium, percussion - disappearance
of liver dullness. According to the clinical protocol, your preliminary diagnosis is:
<variant>Perforation of gastric ulcer
<variant> Penetration of gastric ulcer
<variant> Gastric bleeding
<variant> Acute cholecystitis
<variant> Acute pancreatitis

103
A young man has been complaining of heartburn, nausea, and epigastric pain for two years, which subsides after
eating. The pains occurred mainly at 2-3 a.m., and subsided after taking Almagel. Recently, the pains have become
constant. According to the clinical protocol, the change in the clinical picture indicates the following complication:
<variant> Penetrations
<variant>Perforations
<variant> Pyloric stenosis
<variant> Bleeding
<variant> Malignancies

104
A patient with gastric ulcer complains of a feeling of fullness and pain in the epigastrium, vomiting of foul-
smelling food eaten the day before, and weight loss. There is a splashing sound and visible peristalsis in the
stomach area. According to the clinical protocol, your diagnosis is:
<variant> Gastric ulcer complicated by pyloric stenosis
17
<variant>Peptic ulcer of the duodenum
<variant> Gastric ulcer complicated by penetration
<variant> Gastric ulcer complicated by perforation
<variant> Gastric ulcer complicated by bleeding

105
According to the clinical protocol, varicose veins of the esophagus are a sign of the syndrome:
<variant> Portal hypertension
<variant> Liver failure
<variant> Mesenchymal inflammation
<variant> Obstipation
<variant> Malabsorption

106
According to the clinical protocol, gynecomastia, hyperemia of the palm, and a raspberry-colored "varnished"
tongue are characteristic of:
<variant> Liver cirrhosis
<variant> Pancreatitis
<variant> Gallstone disease
<variant> Celiac disease
<variant> Cystic fibrosis

107
According to the clinical protocol for diffuse liver diseases, the following therapeutic diet is recommended:
<variant> #5
<variant> #1
<variant> #2
<variant> #6
<variant> #7

108
According to the clinical protocol, localization of pain in ulcers of the cardiac part of the stomach:
<variant> Xiphoid process
<variant> Behind the sternum
<variant> In the epigastrium to the left of the midline
<variant> In the epigastrium to the right of the midline
<variant> Around the navel

109
In a patient with gastroesophageal reflux disease, during esophagogastroduodenoscopy, a lesion of the esophageal
mucosa was detected, spreading over several folds, occupying 50% of the esophagus circumference. According to
the clinical protocol, your drug treatment tactics are:
<variant> Proton pump inhibitor + prokinetic
<variant> Antacid + glucocorticosteroid
<variant> Antibiotic + gastroprotector
<variant> Antispasmodic + calcium channel antagonist
<variant> Anticholinergic + antacid

110
In a patient with gastroesophageal reflux disease, during esophagogastroduodenoscopy, a lesion of the esophageal
mucosa was detected, spreading over several folds, occupying 50% of the esophagus circumference. According to
the clinical protocol, the degree of reflux esophagitis:
<variant> C
<variant> A
<variant> In
<variant> D
<variant> E
111

18
In a patient with gastroesophageal reflux disease, during esophagogastroduodenoscopy, a lesion of the esophageal
mucosa was detected, spreading over several folds, occupying 50% of the esophagus circumference. According to
the clinical protocol, the duration of the course of treatment:
<variant> 6-8 weeks
<variant> 4-6 weeks
<variant> 6 months
<variant> 1 year
<variant> 26 weeks

112
The patient complains of profuse vomiting with a foul odor, occurring 4-6 hours after eating. Over the past month,
he has lost 5 kg. According to the clinical protocol, your preliminary diagnosis is:
<variant> Pyloric stenosis
<variant> Achalasia of the cardia
<variant> Diffuse esophageal spasm
<variant> Pylorospasm
<variant> Gastritis

113
A 46-year-old patient complains of aching pain, a feeling of heaviness in the epigastrium an hour after eating; sour
belching, a sharp decrease in appetite. Has been ill for 2 years. Objectively: deep palpation reveals pain in the
epigastrium. Blood test: Hb - 100 g / l, erythrocyte sedimentation rate - 4.2x1012 / l, total protein - 54 g / l. EGDS:
the relief of the gastric mucosa resembles cerebral convolutions. According to the clinical protocol, your
preliminary diagnosis is:
<variant> Chronic gastritis type A
<variant> Stomach cancer
<variant> Chronic atrophic gastritis
<variant> Chronic gastritis type C
<variant> Giant hypertrophic gastritis

114
A 46-year-old patient complains of aching pain, a feeling of heaviness in the epigastrium an hour after eating; sour
belching, a sharp decrease in appetite. Has been ill for 2 years. Objectively: deep palpation reveals pain in the
epigastrium. Blood test: Hb - 100 g / l, erythrocyte sedimentation rate - 4.2x1012 / l, total protein - 54 g / l. EGDS:
the relief of the gastric mucosa resembles cerebral convolutions. According to the clinical protocol, conservative
treatment:
<variant> Antisecretory drugs, antispasmodics
<variant> Digestive enzymes, pain relievers
<variant> Antibiotics, antispasmodics
<variant> Gastroprotectors, prokinetics
<variant> Glucocorticoids, bismuth preparations

115
Patient A., 19 years old, complained of intermittent pain in the epigastric region associated with food, as well as
occurring on an empty stomach; a feeling of fullness in the epigastrium after eating. These symptoms appeared 3
months ago due to nervous and mental overstrain. On EGD: the esophagus is freely passable, cardiac insufficiency
of 1 degree, the gastric mucosa is pink, folds are pronounced, HP - not detected. Your preliminary diagnosis:
<variant> Functional dyspepsia
<variant> Gastroesophageal reflux disease
<variant> Gastritis type A
<variant> Gastritis type B
<variant> Gastritis type C

116
Patient P., 46 years old, complains of weakness, dyspeptic disorders, heaviness in the lower abdomen. Objectively:
liver + 2 cm from under the costal arch, spleen is not palpable, dimensions are 8x14 cm. Ultrasound: diameter of
v.porta - 16 mm, v. lienalis - 12 mm, in the abdominal cavity - 900 ml of free fluid. Laparocentesis yielded straw-
yellow fluid. According to the clinical protocol, your preliminary diagnosis is:
<variant> Liver cirrhosis
19
<variant> Heart failure
<variant> Pancreatitis
<variant> Peritoneal tuberculosis
<variant> Infectious peritonitis

117
A 32-year-old female patient complains of epigastric pain that occurs 2 hours after eating; sour belching, heartburn.
EGD: the mucous membrane in the antrum of the stomach is sharply hyperemic, with isolated erosions. According
to the clinical protocol, the optimal drug therapy is:
<variant> Amoxicillin + clarithromycin + nolpaza
<variant> Domperidone + Almagel + De-nol
<variant> Maalox + famotidine + domperidone
<variant> Omeprazole + amoxicillin + trichopolum
<variant> Amoxiclav + metronidazole + bismuth subcitrate

118
A 32-year-old patient was admitted to the emergency room with acute abdominal pain that had developed 1 hour
earlier. There was no vomiting or stool. Objectively: the patient is lying on his right side; when attempting to lie on
his back or get up, the pain increases. Palpation reveals sharp pain and tension in the abdominal muscles in the
epigastric region. Plain radiography revealed air in the right hypochondrium. The patient has a history of gastric
ulcer. According to the clinical protocol, your preliminary diagnosis is:
<variant> Ulcer perforation
<variant> Ulcerative bleeding
<variant> Penetration of ulcer into the lesser omentum
<variant> Ulcer penetration into the pancreas
<variant> Pyloric stenosis

119
With the help of ... enzyme, conjugated (bound) bilirubin is formed in liver cells.
<variant> Glucuronyl transferases
<variant> Leucine aminopeptidases
<variant> Acid phosphatase
<variant> Nucleotidase
<variant> Amylases

120
Patient A., 32 years old, was admitted to the clinic with complaints of pain in the epigastrium, heartburn, nausea,
dizziness and tinnitus, which worsen in an upright position, black stool. Objectively: general condition of moderate
severity, pale skin. Auscultation: vesicular breathing in the lungs, no wheezing. Heart sounds are muffled, the
rhythm is regular. BP 110/70 mm Hg. The abdomen is soft, painful in the epigastrium. The liver is along the edge
of the costal arch, the edge is soft, painless. According to the clinical protocol, your diagnosis is:
<variant> Gastric ulcer complicated by bleeding
<variant> Gastric ulcer complicated by penetration
<variant> Decompensated cicatricial pyloric stenosis
<variant> Malignization of gastric ulcer
<variant> Mallory-Weiss syndrome

121
The effectiveness of vaccination and treatment with vaccines is considered proven
in relation to hepatitis type:
<variant> In
<variant> C
<variant> D
<variant> A
<variant> E

122
The patient, 21 years old, suffers from chronic gastroduodenitis. Heredity is burdened - duodenal ulcer on the
paternal side. Two years ago, he received a course of eradication therapy with effect. Due to a repeated
20
exacerbation of the disease, he was examined for the presence of Helicobacter pylori. The result is positive.
According to the clinical protocol, in this case we can think about:
<variant> Relapse of the underlying disease
<variant> Helicobacter pylori re-invasion
<variant> Development of duodenal ulcer
<variant> Functional dyspepsia
<variant> Development of gastric ulcer

123
The patient suffers from postprandial distress syndrome. She complains of heaviness and a feeling of fullness in
the epigastric region after eating, nausea, and vomiting. The drug of first choice in therapy in this case is:
<variant> Prokinetic
<variant> Antacid
<variant> Proton pump inhibitor
<variant> H2 blocker
<variant> Antispasmodic

124
The patient received the second course of eradication therapy (quadruple therapy) due to duodenal ulcer of
Helicobacter etiology. According to the clinical protocol, the time period for control eradication is:
<variant> In 4 weeks
<variant> In 2 weeks
<variant> Immediately after completion of treatment
<variant> In a year
<variant> During treatment

125
According to the clinical protocol, an important study in the differential diagnosis of peptic ulcer disease and
stomach cancer:
<variant> Endoscopic examination with biopsy
<variant> X-ray examination
<variant>Study of gastric secretion with histamine;
<variant> Fecal occult blood test
<variant> Ultrasound of abdominal organs

126
The main mechanism of development of gastroesophageal reflux disease:
<variant> Impaired barrier function of the lower esophageal sphincter
<variant> Helicobacter pylori
<variant> Dysfunction of the upper esophageal sphincter
<variant> Spasm of the sphincter of Oddi
<variant> Impaired gastric peristalsis

127
According to the clinical protocol, early (30-60 minutes after eating) pain in the epigastric region and behind the
sternum is characteristic of the localization of an ulcer defect:
<variant> In the cardiac and subcardial regions of the stomach
<variant> For all combined gastroduodenal ulcers
<variant> In the bulb of the duodenum
<variant> In the postbulbar part of the duodenum
<variant> In the pyloric canal

128
According to the clinical protocol for the treatment of edematous-ascitic syndrome in liver cirrhosis, it is necessary
to follow the rule: the volume of excreted fluid should not exceed the volume drunk on:
<variant> 400-500 ml
<variant> 1000-1500 ml
<variant> 1500-1800 ml
21
<variant> 1800-2500 ml
<variant> 200-300 ml

129
According to the clinical protocol, the most important sign of the transition of chronic hepatitis to cirrhosis is the
appearance of the syndrome:
<variant> Portal hypertension
<variant> Jaundice
<variant> Asthenovegetative
<variant> Arterial hypertension
<variant> Circulatory failure

130
Recently, a patient with gastric ulcer and duodenal ulcer has had his clinical picture change: heaviness after eating,
nausea, profuse vomiting of food in the afternoon, bad breath, weight loss.
Possible complication:
<variant> Organic pyloric stenosis
<variant> Functional stenosis
<variant> Malignization of ulcer
<variant> Ulcer penetration
<variant> Ulcer perforation

131
A 38-year-old businessman complains of an increase in the volume of the abdomen, yellowing of the skin and
mucous membranes, dark urine, bloating, unstable stool, severe general weakness, fatigue, periodic disorientation
in time and space, memory loss, handwriting impairment, sleep inversion (sleepiness during the day, insomnia at
night). From the anamnesis: in childhood - hepatitis A. For the last 7 years, he has been abusing alcohol. This
deterioration over the course of 2 weeks is associated with errors in diet and frequent alcohol consumption.
Most likely diagnosis:
<variant> Liver cirrhosis
<variant> Gallstone disease
<variant> Chronic hepatitis
<variant> Chronic pancreatitis
<variant>Pancreatic cancer

132
A 65-year-old patient, a pensioner, complains of heaviness in the right hypochondrium, increasing with physical
exertion, slight swelling of the shins and feet by the end of the day, dark urine. He has been abusing alcohol for
many years. On examination: apathetic, unsteady gait, icteric skin, sclera, isolated "vascular" stars, "liver" palms,
raspberry tongue, ascites, slight swelling of the shins, feet. Your diagnosis:
<variant> Liver cirrhosis
<variant> Chronic hepatitis
<variant> Acute hepatitis
<variant> Chronic cholecystitis
<variant> Chronic pancreatitis

133
A 52-year-old patient has had a long-term history of asthenic complaints, periodically, of a feeling of heaviness in
the right hypochondrium, nausea, and slight jaundice. At this time, biochemical indices of liver function are
impaired: alanine transferase, bilirubin, sublimate test, thymol test, protein fractions. Relapses are associated with
infections. Working capacity is maintained.
The clinical syndrome and laboratory data are consistent with the diagnosis:
<variant> Chronic persistent hepatitis
<variant> Portal cirrhosis of the liver
<variant> Biliary cirrhosis of the liver
<variant> Chronic active hepatitis
<variant> Pseudocirrhosis of the liver

134
22
 A 32-year-old patient complains of acute "stabbing" pain in the epigastric region. From the anamnesis: for the last
three years he has suffered from a duodenal ulcer with frequent relapses. The reaction to therapy with H2-histamine
blockers is positive. A blood transfusion was performed. After four weeks of ranitidine therapy, the ulcer healed.
According to the clinical protocol, further treatment tactics:
<variant> Clarithromycin + amoxicillin + omeprazole
<variant> Tetracycline + metronidazole + omeprazole
<variant> Clarithromycin + metronidazole + quamatel
<variant> Amoxicillin+de-nol+omeprazole
<variant> Amoxicillin + metronidazole + quamatel

135
Patient A., 48 years old, was admitted to the emergency department complaining of pain in the right
hypochondrium, jaundice, and general weakness. History: alcohol abuse, a week ago there was bleeding from
varicose veins of the esophagus. On examination: the skin and sclera are icteric, telangiectasias, the abdomen is
distended, hepatosplenomegaly. In the blood: anemia, thrombocytopenia, ESR - 44 mm/h. Total bilirubin - 68
μmol/l, mainly due to the direct fraction.
It is necessary to assign:
<variant> Heptral + fresh frozen plasma + vitamins C, K
<variant> Prednisolone + hepabene + Creon
<variant> Heptral + erythromass + creon
<variant> Prednisolone + Heptral + Vit C
<variant> Ferrum-lek + prednisolone + heptral

136
A 45-year-old man is bothered by chest pain that occurs during meals and after physical exertion, heartburn,
belching of eaten food, a feeling of difficulty swallowing food. Examination: electrocardiogram: no pathology;
endoscopic fibrogastroduodenoscopy: the lower esophageal sphincter does not close, hyperemia, edema of the
esophageal mucosa, isolated erosions.
According to the clinical protocol, the appropriate combination of drugs is:
<variant> Domperidone + Rabeprazole
<variant> Maalox + ampicillin
<variant> Omeprazole + smecta
<variant> Omeprazole + Maalox
<variant> Omeprazole + no-spa

137
A 37-year-old woman was admitted to the hospital complaining of pressing pain in the epigastric region that occurs
at night, on an empty stomach, and subsides after eating. History: has suffered from peptic ulcer disease for 5 years.
This exacerbation has been going on for 2 weeks. Objectively: the tongue is coated with a white coating, there is
diffuse pain in the epigastrium. The liver and spleen are not enlarged. Blood and urine tests show no pathology.
Endoscopic fibrogastroduodenoscopy: the esophagus is passable, the gastric mucosa is hyperemic, the folds are
hypertrophied, there is an ulcerative defect of 0.5 x 0.7 cm on the anterior wall of the duodenal bulb.
An appropriate combination of drugs:
<variant> Clarithromycin + Flemoxin + Pariet
<variant> Omeprazole + de-nol + maalox
<variant> Metronidazole + de-nol + almagel
<variant> Tetracycline+omeprazole+quamatel
<variant> Clarithramycin + metronidazole + phosphalugel

138
Patient K., 34 years old, was admitted to hospital with complaints of "night" and "hunger" pains in the epigastrium,
which appeared within 2 weeks. During endoscopic examination, an ulcer on the anterior wall of the duodenum
measuring 1.2 cm was first detected. Helicobacter pylori was found in the biopsy.
According to the clinical protocol, the appropriate combination of drugs is:
<variant> Omeprazole + ampicillin + clarithromycin
<variant> Omeprazole + metronidazole + ampicillin
<variant> Quamatel + de-nol + tetracycline
<variant> Omeprazole + gastrocepin + tetracycline
<variant> De-nol + ampicillin + almagel
23
139
A 48-year-old patient was admitted with complaints of weakness, increased fatigue, headache, nausea, heaviness in
the right hypochondrium, and bleeding gums. History: 10 years ago, he was treated for chronic liver disease. In the
following years, he felt well and did not follow a diet. Objectively: the skin and sclera are icteric, "liver" palms,
spider veins on the upper half of the chest, hepatosplenomegaly. Blood test: anemia, increased ESR,
hyperbilirubinemia with a predominant increase in the direct fraction, a 3-fold increase in ALT and AST. Hepatitis
markers: all markers of viral hepatitis C are positive.
According to the clinical protocol, the following drugs should be prescribed:
<variant> Intron+heptral
<variant> Essentiale + Creon
<variant> Heptral+ursosan
<variant> Heptral+creon
<variant> Prednisolone + Essentiale

140
A 50-year-old man, a heavy smoker, complains of asthma attacks, burning pain in the lower third of the sternum,
and sour belching. The condition worsens when taking theophylline drugs. ECG: no ischemic changes are
registered. According to the clinical protocol, the next step in diagnostics is:
<variant> EGDS
<variant> EchoCS
<variant>X-ray of the stomach
<variant>Chest X-ray
<variant> Spirography

141
A 45-year-old man suffering from a peptic ulcer came to the emergency room complaining of constant pain in the
epigastric region, radiating to the back, not associated with food intake, not relieved by antacids and
antispasmodics, nausea, vomiting, loose stools, and an increase in body temperature to subfebrile numbers. An X-
ray examination reveals a deep "niche" and low mobility of the ulcer zone; FGDS visualizes a deep ulcer, a steep
crater, high edges, in the form of a rampart. The cause of the above condition:
<variant> Ulcer penetration into the pancreas
<variant> Ulcer perforation
<variant> Periduodenitis
<variant> Penetration of ulcer into the lesser omentum
<variant> Ulcerative bleeding

142
A 43-year-old man who uses drugs complains of general weakness, rapid fatigue, weight loss, nausea, bitterness in
the mouth, a feeling of heaviness in the right hypochondrium, periodic increase in body temperature to subfebrile
numbers, itchy skin, bleeding gums, dark urine, light-colored feces. Objectively: hepatomegaly, jaundice,
xanthomas on the upper eyelids. According to the clinical protocol, the diagnostic method for verifying the
pathology variant:
<variant> Determination of markers of viral infection
<variant>Biochemical blood test
<variant> Coprological examination
<variant> Determination of ferritin concentration
<variant> Determination of ceruloplasmin concentration

143
A 45-year-old man with a history of alcohol abuse complains of vomiting blood. Objectively: lethargic, slurred
speech, ascites, varicose veins of the anterior abdominal wall, splenomegaly, BP-80 and 60 mm Hg, HR-110 per
minute. The next step in patient management tactics:
<variant> Esophageal balloon tamponade
<variant> Fresh frozen plasma transfusion
<variant> Antibiotic therapy
<variant> Administration of vasopressin
<variant> Endoscopic vein ligation
144

24
 A 50-year-old man, a heavy smoker, complains of asthma attacks, burning pain in the lower third of the sternum,
and sour belching. The condition worsens when taking theophylline drugs. ECG: no ischemic changes are
registered. Peak flowmetry revealed a slight decrease in peak expiratory flow rate. The most likely diagnosis:
<variant> Gastroesophageal reflux disease
<variant> Chronic gastritis
<variant> IHD. Angina pectoris
<variant> Bronchial asthma
<variant> Chronic obstructive pulmonary disease

145
A 30-year-old man complains of periodic hunger pains in the epigastric region, heartburn, nausea, and sour
belching. Objectively: localized pain in the pyloroduodenal region. FGDS reveals hyperemia and edema of the
mucous membrane of the antral section, hyperplasia of the folds, and antral spasm. According to the clinical
protocol, a research method that allows establishing the etiology of the pathological process.
<variant> Urease test
<variant> Intragastric pH-metry
<variant> Complete blood count
<variant>X-ray of the stomach
<variant> Duodenal intubation

146
A 55-year-old man with a diagnosis of: Ulcer disease of the duodenal bulb associated with HP, relapsing course.
As a result of combination therapy, including a proton pump inhibitor (PPI), clarithromycin and amoxicillin,
complete remission and eradication of HP were achieved. According to the clinical protocol, further tactics of
patient management:
<variant> PPI maintenance therapy
<variant> Intermittent H2 blocker therapy
<variant> Maintenance therapy with antibiotics
<variant>Enzyme replacement therapy
<variant> Course therapy with cytoprotectors

147
A 43-year-old man who uses drugs complains of general weakness, rapid fatigue, weight loss, nausea, bitterness in
the mouth, a feeling of heaviness in the right hypochondrium, periodic increase in body temperature to subfebrile
numbers, itchy skin, bleeding gums, dark urine, light-colored feces. Objectively: hepatomegaly, jaundice,
xanthomas on the upper eyelids. The most likely diagnosis:
<variant> Chronic viral hepatitis
<variant> Chronic cholecystitis
<variant> Chronic pancreatitis
<variant> Chronic renal failure
<variant> Hemolytic anemia

148
Increased activity of γ-glutamyl transpeptidase, 5-nucleotidase, alkaline phosphatase, hypercholesterolemia,
hyperbilirubinemia due to the direct fraction are biochemical manifestations of the syndrome:
<variant> Cholestasis
<variant> Mesenchymal-inflammatory
<variant> Cytolysis
<variant> Portocaval shunting
<variant> Hepatocellular insufficiency

149
A 75-year-old man complains of a feeling of heaviness, fullness in the epigastrium, dull pain in the epigastric
region, unpleasant taste in the mouth, nausea, loss of appetite, belching, unstable stool. Palpation of the abdomen
reveals diffuse tension in the anterior abdominal wall and pain in the epigastrium. FGDS reveals pallor, flattening,
thinning in the body and antrum of the stomach, translucence of blood vessels, increased vulnerability,
hypotension, hypokinesia, bile reflux. The above picture is typical for:
<variant> Chronic atrophic gastritis
<variant>Antral non-atrophic gastritis
25
<variant> Peptic ulcer
<variant>Non-specific ulcerative colitis
<variant> Malignant tumor of the stomach

150
A 47-year-old man is bothered by pain in the epigastrium, left and right hypochondrium, of a girdle-like nature,
occurring after eating fatty foods, and stool instability.
According to the clinical protocol for enzyme replacement therapy, it is necessary to include:
<variant> Proton pump inhibitors
<variant>Antacids
<variant> Prokinetics
<variant> Anticholinergic drugs
<variant> H2 - histamine receptor blockers

151
A 50-year-old woman complains of general weakness, a feeling of heaviness in the right hypochondrium, bleeding
gums, and itchy skin. She had icteric hepatitis 2 years ago. Obvious: the skin is icteric and dry. The liver protrudes
2 cm from the edge of the costal arch and is sensitive to palpation. In the blood: moderate anemia,
hyperbilirubinemia due to the direct fraction; PCR for viruses B and C are negative, the alpha-fetoprotein level is
20 U/L.
The most reliable research method:
<variant> Histological
<variant> Immunological
<variant> Morphometric
<variant> Morphofunctional
<variant> Immunohistochemical

152
A 28-year-old woman with autoimmune hepatitis has periodic aching pain in the right hypochondrium and slight
weakness. Ob-no: the liver is palpated at the edge of the costal arch. In the blood: increased levels of antibodies to
TPO. Markers for hepatitis viruses are negative. According to the clinical protocol, it is necessary to prescribe:
<variant> Prednisolone
<variant> Legalon
<variant> Clarithromycin
<variant> Zefix
<variant> Lamivudine

153
A 53-year-old man with alcohol abuse was admitted with bleeding from esophageal varices. A week ago, he
developed pain in the right hypochondrium and jaundice. Ob-no: the skin and sclera are icteric, telangiectasias. The
abdomen is distended. The liver protrudes 3 cm from under the costal margin, dense, painful. Splenomegaly. In the
blood: anemia, thrombocytopenia, ESR-36 mm/h. Total bilirubin 56 μmol/l, direct fraction - 12.2 μmol/l.
Your diagnosis.
<variant> Alcoholic liver cirrhosis
<variant> Cryptogenic liver cirrhosis
<variant> Chronic alcoholic hepatitis
<variant> Chronic cryptogenic hepatitis
<variant> Chronic drug-induced hepatitis

154
A man with liver cirrhosis developed severe edematous-ascitic syndrome. Bed rest, a salt-free diet, and limiting
fluid intake to 1000 ml per day for 3 days did not reduce the edema.
According to the clinical protocol, an effective drug for further treatment tactics:
<variant> Veroshpiron
<variant> Lasix
<variant> Uregit
<variant> Triampur
<variant> Hypothiazide
155
26
 A 27-year-old man complains of epigastric pain occurring 1.5-2 hours after eating, "night" pain; sour belching,
nausea. Objectively: undernourished, tongue is moist, coated with a white coating at the root, painful in the
epigastrium upon palpation. According to the clinical protocol, the most informative method of examination is:
<variant> Gastroscopy
<variant> Irrigoscopy
<variant> Esophagomanometry
<variant>X-ray of the stomach
<variant> Ultrasound examination of abdominal organs

156
A 47-year-old man complains of constant aching pain in the epigastric region, a feeling of heaviness and
distension in the epigastrium, weight loss of 15 kg over the past six months. Objectively: poor nutrition, pale skin,
swelling of the lower extremities; pain in the epigastrium upon palpation. In the blood - erythrocytes 3.2 million,
Hb 112 g / l, ESR 10 mm / h; total protein 49 g / l. On EGDS - the folds of the gastric mucosa are sharply thickened
according to the "cerebral convolutions" type, there are small-point erosions.
The most appropriate tactics:
<variant> Surgical treatment
<variant> Sanatorium and resort treatment
<variant> Symptomatic treatment
<variant> Replacement therapy
<variant> Diet therapy

157
A 52-year-old woman complains of a feeling of heaviness and discomfort in the right hypochondrium, arising after
eating, a feeling of bitterness in the mouth, and occasional vomiting. Objectively - increased nutrition, skin of
normal color, sensitivity is determined at the point of projection of the gallbladder upon palpation.
According to the clinical protocol, the most informative research method is:
<variant> Ultrasound examination of abdominal organs
<variant> Gastroscopy
<variant> Irrigoscopy
<variant> Duodenal intubation
<variant> Liver puncture biopsy

158
A 38-year-old man complains of weakness and rapid fatigue, significant weight loss, darkening of the skin and
mucous membranes. Ob-no: skin is slate-gray with a brown tint; swelling and soreness of large joints. Blood shows
hyperglycemia. Desferal test is positive. Probable diagnosis:
<variant> Primary hemochromatosis
<variant> Autoimmune hepatitis
<variant> Dubin-Johnson syndrome
<variant> Marchiafava-Micheli disease
<variant> Wilson-Konovalov disease

159
A 35-year-old man with chronic viral hepatitis B had the following laboratory tests: bilirubin 55 mmol/l, thymol
test 8 units, ALT 1.5 mmol/l, AST 1.2 mmol/l; serological testing revealed HbsAg+, HBeAg+ and HBcAbIgM+.
An effective drug in the treatment of this pathology:
<variant> Interferon
<variant> Creon
<variant> Duphalac
<variant> Essentiale
<variant> Vitamins of group E

160
A 38-year-old woman complains of moderate pain in the right hypochondrium, heaviness in the epigastrium,
frequent nosebleeds, severe weakness, and drowsiness. Ultrasound revealed a diffuse increase in liver echo density
and an increase in sagittal dimensions. Blood tests: 3.9 million red blood cells, 2.4 thousand white blood cells, 145
thousand thrombus cells, 106 g/l Hb, 22 mm/hour ESR, 19.0 thymol test, 76% PTI. Total protein: 76 g/l, albumins:
40%, alpha-1: 4%, alpha-2: 10%, beta: 16%, gamma globulins: 30%, albumin/globulin ratio: 0.67.
27
Indicator associated with an increase in the thymol test:
<variant> Gamma globulin
<variant> Albumin
<variant> Bilirubin
<variant> Fibrinogen
<variant> Alpha globulin

161
A 65-year-old man, a surgeon, complains of severe itching of the skin, weakness, daytime drowsiness, and
insomnia at night. Obvious: the skin is icteric, there are traces of scratching on the skin, spider veins; the liver
protrudes 4 cm from under the right costal arch, the spleen measures 14 x 10 cm upon percussion. In the blood:
total bilirubin 68 mmol/l, direct 52 mmol/l, alkaline phosphatase 925 units (normal range up to 85 units), ALT 2.48
mmol/l, AST 16 mmol/l. EGD reveals esophageal varices.
According to the clinical protocol, it is advisable to prescribe:
<variant> Ornithine
<variant> Essentiale
<variant> Vancomycin
<variant> Pyridoxine chloride
<variant> Ascorbic acid

162
A 68-year-old man complains of aching pain in the epigastrium, occurring on an empty stomach and subsiding
after eating. History: gastric ulcer for 12 years. Objectively: satisfactory nutrition, moderate pain in the epigastrium
upon palpation. EGD - along the lesser curvature, an ulcerative defect of irregular shape measuring 1.5 x 2 cm with
uneven edges and a bumpy bottom covered with a grayish coating was found.
Most likely diagnosis:
<variant> Malignization of ulcer
<variant> Ulcer penetration
<variant> Ulcer perforation
<variant> Bleeding from an ulcer
<variant> Pyloric stenosis

163
A 42-year-old man complains of general weakness, weight loss, and an increase in abdominal volume. Upon
examination, he is undernourished, the skin is icteric, the abdomen is enlarged due to ascites, and the liver
protrudes from under the costal arch by 4 cm. The blood shows accelerated ESR, increased activity of alkaline
phosphatase and gamma-glutamyl transpeptidase. According to the clinical protocol, the most informative method
of examination is:
<variant> Liver elastography
<variant> Retrograde cholecystography
<variant> Duodenal intubation
<variant> Cholangiopancreatography
<variant> Duodenoscopy

164
Taking the following medications may cause ulcerative lesions of the gastrointestinal mucosa:
<variant> Aspirin
<variant> Metronidazole
<variant> Clarithromycin
<variant> Sucralfate
<variant> Amoxicillin

165
When the ulcer is localized in the stomach and does not heal for a long time, the following are indicated first:
<variant> Repeat esophagogastroscopy with tissue biopsy from the ulcer edges
<variant> Repeated X-ray examination
<variant> Conducting a course of hyperbaric oxygenation
<variant>Continuation of the course of antiulcer therapy
<variant>Continuation of the course of symptomatic therapy
28
166
In liver diseases, heptral is prescribed for the purpose of:
<variant> Hepatoprotective, antioxidant, regenerating
<variant> Proteolytic, antisecretory, eubiotic
<variant> Hepatoprotective, prokinetic, antispasmodic
<variant> Choleretic, antiviral, cytoprotective
<variant> Litholytic, eradication, anti-inflammatory

167
According to the clinical protocol for varicose veins of the esophagus, in order to prevent bleeding, it is indicated:
<variant>Endoscopic ligation
<variant> Laparocentesis
<variant> Balloon tamponade
<variant>Endoscopic sclerotherapy
<variant> Pneumocardiodilation

168
According to the clinical protocol, drug therapy for hepatic encephalopathy is aimed at reducing:
<variant> Hyperammonemia
<variant> Hypercholesterolemia
<variant> Hyperazotemia
<variant> Hyperbilirubinemia
<variant> Hypoalbuminemia

169
According to the clinical protocol, in case of hepatorenal failure and the development of refractory ascites that
occurs against the background of diuretic therapy, the following should be done:
<variant> Stop diuretics, perform laparocentesis
<variant> Combine diuretic regimen
<variant> Continue diuretics at maximum doses
<variant> Stop diuretics, prescribe glucocorticoids
<variant> Cancel laparocentesis, conduct massive diuretic therapy

170
Precancerous changes in the gastric mucosa that require follow-up observation, including control histological
studies during fibrogastroduodenoscopy, include:
<variant> Atrophic gastritis with epithelial metaplasia
<variant> Gastric ulcer, H.R.- associated
<variant> Chronic gastritis, non-atrophic
<variant> Reflux gastritis of the gastric stump
<variant> NSAIDs - gastropathy

171
According to the clinical protocol, the optimal combination of drugs for the treatment of duodenal ulcer N.r.(+):
<variant> Omeprazole + amoxicillin + clarithromycin
<variant> Rabeprazole + bismuth subcitrate + ofloxacin
<variant> Domperidone + Rabeprazole + Famotidine
<variant> Maalox + famotidine + ciprofloxacin
<variant> Lansoprazole + Trichopolum + Tetracycline

172
According to the clinical protocol, the optimal combination of drugs for the treatment of acute gastric ulcers
associated with the use of NSAIDs, N.r.(-):
<variant> Omeprazole + bismuth subcitrate
<variant> Domperidone + Rabeprazole
<variant> Maalox + famotidine
<variant> Omeprazole + amoxicillin
<variant> Omeprazole + Trichopolum

29
173
Patient I., 47 years old, complains of pain behind the sternum, occurring immediately after eating, increasing in a
horizontal position, regurgitation of eaten food, sour, a sensation of a "foreign body" in the middle third of the
esophagus. Objectively: no pathology. Radiologically: the esophagus is passable, the exit of the cardia into the
posterior mediastinum and the reflux of contrast mass from the stomach into the esophagus are noted. Necessary
research method:
<variant> EGDS
<variant> Irrigoscopy
<variant> Gastrography
<variant> Colonoscopy
<variant> Tomography of the mediastinum

174
The development of esophageal stricture can lead to:
<variant> Peptic ulcer of the esophagus
<variant> Peptic ulcer
<variant> Achalasia of the cardia
<variant> Catarrhal reflux esophagitis
<variant> Hiatal hernia

175
Indications for the use of ursodeoxycholic acid:
<variant> Alkaline esophagitis
<variant> Erosive esophagitis
<variant>Reflux esophagitis 1 st.
<variant>Reflux esophagitis 2nd stage.
<variant> Atrophic esophagitis

176
A 45-year-old female patient was admitted with complaints of dull, aching pain in the epigastric region, not
associated with food intake, and nausea. Objectively: the abdomen is soft, slightly painful in the epigastric region.
Blood, urine, and stool tests are normal. EGD - in the lower third of the body and antrum of the stomach along the
greater curvature - multiple polyps from 0.5 to 1.0 cm, round in shape. The necessary research to clarify the
diagnosis:
<variant> Cytological examination of biopsy material
<variant> Daily pH-metry
<variant> Fractional study of gastric juice
<variant>Content of hydrochloric acid in gastric juice
<variant> X-ray of the stomach

177
A 32-year-old female patient complains of pressing pain in the epigastric region after eating spicy food or alcohol
30 minutes after eating, excruciating heartburn that subsides after taking soda. She has been ill for 3 years, has not
been treated. Objectively: the tongue is coated with a white coating, with deep palpation there is diffuse pain in the
epigastrium. EGD: the gastric mucosa is hyperemic, edematous, in the antral section there are single hemorrhages.
According to the clinical protocol, to clarify the diagnosis, it is necessary to prescribe:
<variant> Helicobacter pylori test
<variant> 24-hour pH-metry of the esophagus
<variant> Study of gastric secretions by the gastrotest method
<variant> Coprological examination
<variant> Bacteriological examination of feces

178
Patient Zh., 39, complains of pressing pain and a feeling of heaviness in the epigastrium 40-60 minutes after
eating, sour belching, air, weakness, irritability. Has been ill for 3-4 years. A year ago, he was offered surgical
treatment for a polyp found radiographically. Objectively: pain in the epigastrium during deep palpation. Blood
test: hypochromic anemia, hypoproteinemia. Radiologically: along the greater curvature and in the sinuses of the
stomach - giant folds with their prolapse into the pylorus. Preliminary diagnosis:
<variant> Giant hypertrophic gastritis
30
<variant> Chronic erosive gastritis, exacerbation
<variant> Chronic atrophic gastritis
<variant> Stomach cancer
<variant> Multiple small hyperplastic polyps of the stomach

179
Patient S., 34, is bothered by pressing pain and a feeling of heaviness in the epigastrium an hour after eating, sour
belching, irritability. Has been ill for 2-3 years. Two years ago, surgical treatment was proposed for a gastric polyp
found radiographically. Objectively: pain in the epigastrium during deep palpation. Blood tests: hypochromic
anemia, hypoproteinemia. Radiographically: giant folds with their prolapse into the pylorus along the greater
curvature of the stomach. Drug of choice:
<variant> Almagel
<variant> Methyluracil
<variant> Acidin - pepsin
<variant> Amoxicillin
<variant> De-nol

180
A 64-year-old female patient was admitted with complaints of constant dull pain and a feeling of heaviness in the
epigastric region, increasing weakness, and loss of appetite. She has suffered from gastric ulcer for 8 years. Over
the past 3-4 months, the nature of the pain has changed: paroxysmal pain associated with eating has changed to
dull. Ob-no: moderate pain in the epigastric region. Radiologically: in the lower third of the stomach on the lesser
curvature, an ulcer niche of 1.5 x 0.8 cm. After a course of antiulcer therapy, the ulcer doubled in size, the pain did
not stop. Your diagnosis:
<variant> Ulcer - stomach cancer
<variant> Gastric ulcer
<variant> Gastric polyp
<variant> Penetrating gastric ulcer
<variant> Menetrier's disease

181
Patient Sh., 54, complains of constant dull pain and a feeling of heaviness in the epigastric region, increasing
weakness, and loss of appetite. Has suffered from gastric ulcer for 5 years. In the last six months, paroxysmal pain
associated with food intake has changed to dull pain, and she has lost 8 kg. On examination: undernutrition.
Moderate pain in the epigastrium is noted. Radiologically: ulcer niche on the lesser curvature of the stomach 1.8 x
1.5 cm. Antiulcer therapy is ineffective. Optimal intervention:
<variant> Surgical treatment
<variant> Antibacterial therapy
<variant> Non-narcotic analgesics
<variant> Antispasmodics - anticholinergics
<variant> Insoluble antacids

182
The nature of pain in duodenal ulcer:
<variant> "Late" and "hunger" pains in the epigastric region
<variant> Acute pain in the right hypochondrium after eating fatty foods
<variant> Constant, dull, pressing pain in the epigastric region, not associated with food intake
<variant> Girdle pains that occur after drinking alcohol and eating fatty foods
<variant> Pain in the lumbar region not associated with food intake

183
Giant gastric ulcers include ulcers of the following sizes:
<variant> 3.0- 3.5 cm
<variant> 0.6 - 0.9 cm
<variant> 1.0 - 1.5 cm
<variant> 0.3 – 0.5 cm
<variant> 1.6 – 1.9 cm

184
31
ESR value in healthy individuals mm/hour:
<variant> 5-15
<variant> 1-5
<variant> 5-20
<variant> 1-20
<variant>more than 20

185
Normal red blood cell count in women:
<variant> 3.4 – 5.0 x 1012 \l
<variant> 1.0 – 3.0 x 1012 \l
<variant> 2.0 – 5.0 x 1012 \l
<variant> 1.0 – 2.5 x 1012 \l
<variant> 2.5 – 5.5 x 1012 \l

186
Normal red blood cell count in men:
<variant> 4.0 – 5.6 x 1012 \l
<variant> 3.0 – 4.8 x 1012 \l
<variant> 1.0 – 3.0 x 1012 \l
<variant> 1.0 – 2.5 x 1012 \l
<variant> 2.5 – 5.5 x 1012 \l

187
Normal white blood cell count:
<variant> 3.2 – 11.3 x 109 \l
<variant> 3.0 – 5.0 x 109 \l
<variant> 3.0 – 10.0 x 109 \l
<variant> 2.0 – 9.0 x 109 \l
<variant> 1.0 – 8.0 x 109\l

188
Normal platelet count:
<variant> 180 – 320 x 109 \l
<variant> 50.0 – 180.0 x 109 \l
<variant> 250.0 – 400.0 x 109 \l
<variant> 350.0 – 450.0 x 109 \l
<variant> 150.0 – 200 x 109 \l

189
An increase in platelet count is:
<variant> thrombocytosis
<variant> thrombopathy
<variant> thrombopenia
<variant> thromboembolism
<variant> thrombocytopenic purpura

190
"Thrombocytopenia" is:
<variant> decrease in platelet count
<variant> platelet hypofunction
<variant> increase in platelet count
<variant> platelet hyperfunction
<variant> decrease in platelet and red blood cell count

191
Increased white blood cell count:
<variant> leukocytosis
<variant> leukopenia
32
<variant> cytopenia
<variant> pancytopenia
<variant> cytopenia, leukoplakia

192
Decreased white blood cell count:
<variant> leukopenia
<variant> leukocytosis
<variant> cytopenia
<variant> pancytopenia
<variant> cytopenia, leukoplakia

193
Indicators that are NOT related to a general clinical blood test:
<variant> amount of protein in the blood
<variant> hemoglobin content
<variant> platelet count
<variant> white blood cell count
<variant> number of red blood cells in the blood

194
Increase in the number of red blood cells in the blood:
<variant> erythrocytosis
<variant> anisocytes
<variant> poikilocytosis
<variant> macrocytosis
<variant> microcytosis

195
This hemoblastosis has the following clinical picture: malaise, fever, bone pain, frequent infections, pale skin,
purpura, gingival hyperplasia, splenomegaly, pancytopenia, blastemia, and increased ESR in the blood
<variant> acute leukemia
<variant> subleukemic myelosis
<variant> chronic myelogenous leukemia
<variant>chronic lymphocytic leukemia
<variant> erythremia

196
Chronic lymphocytic leukemia is:
<variant>Lymphoproliferative disorder
<variant> Inflammatory disease
<variant>Myeloproliferative disease
<variant>Degenerative disease
<variant> Immunoinflammatory disease

197
Chronic myelogenous leukemia is:
<variant>Myeloproliferative disease
<variant> Inflammatory disease
<variant>Lymphoproliferative disorder
<variant>Degenerative disease
<variant> Immunoinflammatory disease

198
This laboratory indicator may indicate the presence of B12-deficiency anemia:
<variant> Erythrocyte macrocytosis
<variant> Decrease in the number of red blood cells
<variant> Thrombocytosis
<variant> Neutrophilic left shift
33
 <variant> Decreased serum iron content
199
Patient S., 22 years old, complains of increasing weakness that appeared 3 months ago, periodic increase in body
temperature and appearance of bruises without apparent cause. Objectively: pale skin, hemorrhages on the mucous
membrane of the cheeks, soft palate. Enlarged, painful lymph nodes, splenomegaly. In the complete blood count:
Hb - 80 g / l, erythrocytes - 2.0x1012 / l, leukocytes - 29.8x109 / l, blast cells - 55%, platelets - 560x109 / l. What is
your diagnosis?
<variant> Acute leukemia
<variant> Hypoplastic anemia
<variant> Agranulocytosis
<variant> Infectious mononucleosis
<variant> Chronic myelogenous leukemia

200
Patient A., 27 years old, consulted a doctor complaining of weakness, sweating, weight loss, and a sensation of a
foreign body in the left side of the abdomen. Objectively: the skin and mucous membranes are pale, the lymph
nodes are not enlarged. The liver and spleen are enlarged and painful. In the complete blood count: Hb - 110 g / l,
erythrocytes - 3.5x1012 / l, CI - 0.9, leukocytes - 2.3x109 / l, platelets - 380x109 / l, eosinophils - 9%,
promyelocytes - 2%, myelocytes - 22%, megamyelocytes - 20.5%, p / y - 15%, s / y - 12%, lymphocytes - 8.5%,
ESR - 20 mm / hour. What is your diagnosis?
<variant> Chronic myelogenous leukemia
<variant> Chronic lymphocytic leukemia
<variant> Infectious mononucleosis
<variant> Tuberculosis
<variant> Lymphogranulomatosis

201
A 20-year-old patient has been experiencing increasing weakness, bleeding (skin hemorrhages, nosebleeds), and
subfebrile body temperature for 2 months. The lymph nodes, liver, and spleen are not enlarged. In the complete
blood count: Hb - 50 g / l, erythrocytes - 1.65x1012 / l, CP - 1.0, leukocytes - 1.8x109 / l, platelets - 30x109 / l,
eosinophils - 1%, p / y - 1%, s / y - 38%, lymphocytes - 55%, monocytes - 5%, ESR - 60 mm / hour. What is your
diagnosis?
<variant> Aplastic anemia
<variant> Acute leukemia
<variant> Iron deficiency anemia
<variant> Hemolytic anemia
<variant> B12-deficiency anemia

202
Patient V., 40 years old, complains of weakness, sweating, weight loss, dull pain in the left hypochondrium.
Objectively: the skin is pale, moist. The lymph nodes are not enlarged. The liver protrudes from under the costal
margin by 3 cm, the spleen is at the level of the navel, dense, painless. In the blood: erythrocytes - 3.0 million,
leukocytes - 96 thousand, myeloblasts - 2, promyelocytes - 4, metamyelocytes - 8, pal - 12, segment - 52, eosin - 5,
basoph - 5, lymph - 12, thrombus - 200 thousand, ESR - 56 mm / h. Your diagnosis:
<variant> chronic myelogenous leukemia
<variant> acute myeloid leukemia
<variant> leukemoid reaction of myeloid type
<variant> chronic lymphocytic leukemia
<variant> thrombophlebitic splenomegaly

203
The "rabbit eyes" symptom, "flaming pharynx", Cooperman's symptom, erythromelalgia and plethoric syndrome
are characteristic of:
<variant> Erythremia
<variant> Myeloma disease
<variant> Waldenstrom's disease
<variant> Chronic lymphocytic leukemia
<variant> Chronic myelogenous leukemia

34
204
A 48-year-old patient complains of subcutaneous nodules, heaviness in the hypochondrium, and itchy skin after a
shower. Examination revealed severe hepatosplenomegaly. In the complete blood count: erythrocytes - 4.1x109/l,
hemoglobin - 128 g/l, leukocytes - 58x109/l, platelets - 168x109/l, ESR - 28 mm/h, a sharp neutrophilic shift to the
left to metamyelocytes, "basophilic-eosinophilic association". The most likely diagnosis is:
<variant> Chronic myelogenous leukemia
<variant> Chronic lymphocytic leukemia
<variant> Myelofibrosis
<variant> Erythremia
<variant> Myeloma disease

205
A 27-year-old patient complains of hemorrhagic rashes on the skin and bleeding gums. The patient has been
experiencing this condition for 2 weeks and associates it with a previous infection. The complete blood count
shows a decrease in the platelet count to 32x109/l. Therapy should begin with:
<variant> Splenectomy
<variant> Glucocorticosteroids 1-2 mg per kg of body weight per day
<variant> Cyclophosphamide 200 mg per day
<variant> Plasmapheresis
<variant> Platelet transfusions

206
Mandatory method for diagnosing and determining the stage of acute leukemia:
<variant> Bone marrow puncture
<variant> Hemogram
<variant> Coagulogram
<variant> Iliac bone trephine biopsy
<variant>Ultrasound examination of the liver and spleen

207
A 42-year-old patient was admitted to the orthopedic department due to an injury. Examination revealed enlarged
axillary lymph nodes up to the size of a pea. Complete blood count: hemoglobin-107 g/l, erythrocytes-3.4x1012/l,
platelets-172x109/l, leukocytes-45x109/l, segmented-5%, prolymphocytes-3%, monocytes-2%, lymphocytes-90%.
Probable diagnosis:
<variant> Chronic lymphocytic leukemia
<variant> Lymphosarcoma
<variant> Agranulocytosis
<variant> Bone tuberculosis
<variant> Lymphocytic leukemoid reaction

208
A 22-year-old man was admitted with complaints of general weakness, bleeding gums, sore throat, and enlarged
cervical lymph nodes. In the blood: hemoglobin - 54 g / l, erythrocytes - 2 x 1012 / l, leukocytes - 76 x 109 / l,
platelets - 50 x 109 / l, ESR - 64 mm / hour, blast cells - 47%, segmented - 29%, lymphocytes - 18%, monocytes -
6%. A diagnosis of acute leukemia was made. The diagnosis is confirmed by the detection in the blood of:
<variant> Blastemia
<variant>Anemia
<variant> Thrombocytopenia
<variant> Leukocytosis
<variant> Leukocytopenia

209
A 30-year-old man has been ill for a month, complaining of general weakness, nosebleeds and gum bleeding.
Objectively: pale skin and mucous membranes, intoxication, temperature - 38.5 C. In the general blood test,
hemoglobin is 40 g / l, erythrocytes - 2 x 1012 / l, leukocytes - 0.8 x 109 / l, platelets - 50 x 109 / l, ESR - 41 mm /
hour, the leukocyte formula cannot be calculated. To clarify the diagnosis, it is necessary to carry out:
<variant> Sternal puncture
<variant> Blood test for sterility
<variant>Schilling test
35
<variant> Serum iron test
<variant> Iliac bone trephine biopsy

210
A 26-year-old man was admitted with complaints of weakness, bleeding gums, and nosebleeds. On examination:
enlarged cervical and axillary lymph nodes, moderate splenomegaly. In the blood: blast cells - 47%, segmented
leukocytes - 29%, lymphocytes - 18%, monocytes - 6%. Positive cytochemical reaction to glycogen. The next step
in diagnosis will be
<variant> Sternal puncture
<variant> Coagulogram
<variant>Schilling test
<variant> Coombs test
<variant> Iliac bone trephine biopsy

211
The patient is 26 years old, has severe anemia, persistent jaundice, hepatosplenomegaly, trophic ulcers of the shins.
On examination, the patient is short, has a "tower skull", and a "Gothic palate". The complete blood count shows
normochromic anemia with a decrease in hemoglobin to 79 g / l, microspherocytosis, reticulocytosis, moderate
increase in ESR 25 mm / h. BAC: an increase in total bilirubin due to the indirect fraction. Choose the optimal
method of therapy:
<variant> Splenectomy
<variant> Transfusion of red blood cells
<variant> Splenectomy, glucocorticoids
<variant> Glucocorticoids
<variant> Cytostatics

212
Patient Z., 19, complains of bleeding gums, sore throat, weakness. Objectively: body temperature is 39 degrees.
The skin is pale, there are multiple petechiae and ecchymoses. There is necrotic plaque on the tonsils. The
submandibular lymph nodes are enlarged. The liver and spleen protrude from under the edge of the costal arch by 2
cm. In the blood: erythrocytes - 2.5 million, Hb - 75 g / l, CP - 0.9 leukocytes - 29 thousand, blasts - 98%, segments
- 2%, thrombus - 28 thousand, ESR - 26 mm / h. Cytochemistry: the reaction to myeloperoxidase is positive. The
decisive symptom in the diagnosis of this disease is:
<variant>blastemia
<variant> leukocytosis
<variant> increased ESR
<variant> anemia
<variant> thrombocytopenia

213
A 20-year-old young man developed progressive weakness, fever, and nosebleeds after an acute respiratory viral
infection. Objectively: the skin is pale, there are petechial-spotted rashes on the abdomen, back, and pelvis. Heart
sounds are clear, tachycardia. The spleen is moderately enlarged. In the blood: Erythrocytes - 2.5 x 1012, Hb - 82
g / l, CP - 0.9, Leukocytes - 11.8 x109, blast cells - 25%, n - 5%, segm - 38%, eosinophils - 1%, lymphocytes -
25%, thrombus - 53 x109, ESR - 42 mm / hour. The next step in diagnostics will be:
<variant> Bone marrow puncture
<variant> Hemogram
<variant> Coagulogram
<variant> Iliac bone trephine biopsy
<variant>Ultrasound examination of the liver and spleen

214
A 21-year-old female patient complains of weakness, headaches, palpitations, and bruises on the body. Objectively:
the general condition is severe. Multiple hemorrhages on the skin and mucous membranes of the mouth, pallor.
Complete blood count: hemoglobin-60 g/l, erythrocytes-2.0x1012/l, platelets-75x109/l, leukocytes-87x109/l,
leukocyte formula: blasts 60%, segmented - 27%, lymphocytes - 13%, erythrocyte sedimentation rate-60 mm/h.
The next step in diagnostics will be:
<variant> Iliac bone trephine biopsy
<variant> Cytogenetic analysis
36
<variant> Coagulogram
<variant>Ultrasound examination of the liver
<variant> Ultrasound examination of the spleen

215
Bone marrow changes in B12-deficiency anemia:
<variant> megaloblastic type of hematopoiesis
<variant> normoblastic type of hematopoiesis
<variant> decrease in the number of megakaryocytes
<variant> lymphocyte predominance
<variant> leukocyte predominance

216
In hemophilia the following are observed:
<variant> increase in APTT
<variant> increase bleeding time
<variant> hypoprothrombinemia
<variant> blood clot retraction disorder
<variant> decrease in APTT

217
In thrombocytopenic purpura the following are observed:
<variant> increase in bleeding duration
<variant> decrease in APTT
<variant> leukocyturia
<variant> thrombocytosis
<variant> hemarthrosis

218
According to the clinical protocol, the first objective criterion for the effectiveness of iron therapy is:
<variant> reticulocyte crisis on the 7th day of therapy
<variant> decrease in general weakness
<variant> increase in red blood cell count
<variant>reduction in the severity of sideropenic syndrome
<variant> increase in hemoglobin

219
Characteristic picture of bone marrow in iron deficiency anemia:
<variant> decrease in the number of sideroblasts
<variant> lymphocyte predominance
<variant> decrease in the number of megakaryocytes
<variant>megaloblastosis
<variant> myeloid metaplasia

220
Diagnostic sign of hemophilia:
<variant> prolongation of blood clotting time
<variant> decreased fibrinogen levels
<variant> prolongation of bleeding time
<variant> shortening of prothrombin time
<variant>clot retraction failure

221
Patient S., 60, complains of weakness, epigastric pain, unstable stool. Objectively: the skin and visible mucous
membranes are pale with a subicteric tint. The face is puffy. The tongue is "varnished". The liver and spleen are
moderately enlarged. In the blood: erythrocytes-2.6 million, Hb-104 g / l, CP-1.2, leukocytes-2.7 thousand,
thrombus-115 thousand. ESR-30 mm / h, macrocytosis, polysegmentation of neutrophils. Bilirubin - 38.5 μmol / l.
Myelogram: megaloblastic hematopoiesis. The patient developed:
<variant> B12 deficiency anemia
37
<variant> Aplastic anemia
<variant> Marchiafava-Micheli disease
<variant> Iron deficiency anemia
<variant>Autoimmune hemolytic anemia

222
Patient K., 26 years old, complains of increasing weakness, fever up to 38 degrees. Has been ill for 2 months.
Objectively: skin and visible mucous membranes are pale, petechiae and ecchymoses are on the skin of the chest,
abdomen, thighs. Lymph nodes, liver, spleen are not enlarged. In the blood: erythrocytes - 1.8 million, Hb - 56 g / l,
CI - 0.93, leukocytes - 2.6 thousand, platelets - 30 thousand, ESR - 50 mm / hour. In the sternal puncture -
predominance of fatty bone marrow over effective. Diagnosis:
<variant> aplastic anemia
<variant> Marchiafava-Micheli disease
<variant> acute leukemia
<variant> thrombocytopenic purpura
<variant> hemolytic anemia

223
Bleeding from the nose and gums, hemorrhages on the skin and mucous membranes. In the blood: er. - 1.8 million,
Hb - 54 g / l, CP - 0.9 leuk - 2.4 thousand, pal - 6, segm - 58, eosin - 2, lymph - 34, thrombus - 44 thousand, ESR -
52 mm / h, bleeding duration - 20 minutes. According to the clinical protocol, the picture is characteristic of:
<variant> Aplastic anemia
<variant> Acute leukemia
<variant> Autoimmune thrombocytopenic purpura
<variant> Marchiafava-Micheli diseases
<variant> B12-deficiency anemia

224
The most typical picture for a myelogram of a patient with B12-deficiency anemia is:
<variant> megaloblastic type of hematopoiesis
<variant> depleted bone marrow
<variant> unchanged bone marrow
<variant> hyperplasia of all hematopoietic germs
<variant> normoblastic type of hematopoiesis with irritation of the erythroid germ

225
A 32-year-old female patient complains of profuse bleeding that occurred immediately after tooth extraction.
History of nosebleeds. Objectively: petechiae and ecchymoses on the skin. In the blood: Erythrocytes - 2.9
thousand, Hb - 77 g / l, Ci - 0.8, Leukocytes - 4.2 thousand, Thrombus - 28 thousand, ESR - 17 mm / h. Duration of
bleeding - 24 minutes, clotting time - 4 minutes. Myelogram: impaired detachment of thromboplastins from
megakaryocytes. The most likely diagnosis:
<variant> immune thrombocytopenia
<variant> hemophilia
<variant> acute leukemia
<variant> aplastic anemia
<variant> Rendu-Osler disease

226
A 60-year-old female patient complains of weakness and epigastric pain. Objectively: the skin and visible mucous
membranes are pale with a subicteric tint, the face is puffy, the tongue is "varnished". Moderate
hepatosplenomegaly. In the blood: pancytopenia, macrocytosis, polysegmentation of neutrophils. Bilirubin - 38.5
μmol/l. Myelogram: megaloblastic type of hematopoiesis. The most likely diagnosis:
<variant> B12 deficiency anemia
<variant> Iron deficiency anemia
<variant> Autoimmune hemolytic anemia
<variant> Aplastic anemia
<variant> Thalassemia

227
38
 A 19-year-old patient complains of bleeding gums, sore throat, and weakness. Objectively: body temperature is
39˚. The skin is pale, there are multiple petechiae and ecchymoses. There is necrotic plaque on the tonsils. The
submandibular lymph nodes are enlarged. The liver and spleen protrude from under the costal margin by 2 cm. In
the blood: erythrocytes - 2.5 million, Hb - 75 g / l, CP - 0.9 leukocytes - 29 thousand, blasts - 98%, segments - 2%,
thrombus - 28 thousand, ESR - 66 mm / h. Cytochemistry: the reaction to myeloperoxidase is positive. The most
informative indicator for verifying the diagnosis:
<variant> blastemia
<variant> anemia
<variant> leukocytosis
<variant> thrombocytopenia
<variant> acceleration of ESR

228
Erythromelalgia is:
<variant> sharp burning pain in the fingertips
<variant> palpable nodules along the vessels
<variant> dilation of scleral vessels
<variant> pain and numbness in feet
<variant> tonsil hypertrophy

229
A 48-year-old patient reports fever, sweating, general weakness, and enlarged lymph nodes. On examination:
peripheral lymph nodes are enlarged to the size of a "walnut", painless on palpation, mobile, moderate
splenomegaly. In the blood: Hb-80 g / l, leuk-72x109 / l, tr-110x109 / l, in the formula - lymphocytosis 79%, ESR
32 mm / h. According to the clinical protocol, the most likely diagnosis is:
<variant> chronic lymphocytic leukemia
<variant> chronic myelogenous leukemia
<variant> erythremia
<variant> essential thrombocytosis
<variant> chronic myelofibrosis

230
A 48-year-old female patient complains of general weakness, dizziness, and palpitations. For 1 year, menstruation
lasts 10 days, and is heavy. Objectively: pale skin and mucous membranes, striated and brittle nails, hair loss. In the
blood, hemoglobin is 42 g / l, erythrocytes are 1.9 x 1012 / l, color index is 0.7, ESR is 36 mm / hour, leukocytes
are 5.8 x 109 / l, basophils are 1%, eosinophils are 2%, band neutrophils are 4%, segmented neutrophils are 69%,
lymphocytes are 18%, monocytes are 6%, platelets are 420 x 109 / l. According to the clinical protocol, the next
step in diagnostics is:
<variant> serum iron determination
<variant> coagulogram study
<variant> conducting the Schilling test
<variant> sternal puncture
<variant> iliac cranial bone biopsy

231
A 20-year-old female patient has been periodically eating clay and chalk since childhood. Three months ago,
dizziness, tinnitus, and brittle nails increased. An objective examination revealed pale skin and visible mucous
membranes, normal liver and spleen. Blood test: Hb-58 g/l, Er.2.9x1012/l, L-8x109/l, white blood cell count is
normal. Reticulocytes 1.2%, platelets 200x109/l. Blood bilirubin is 14 mmol/l, iron is 6.24 μmol/l. The most likely
diagnosis is:
<variant> Iron deficiency anemia
<variant> Hemolytic anemia
<variant> B-12 deficiency anemia
<variant> Hypoplastic anemia
<variant> Folate deficiency anemia

232
An 82-year-old patient complains of sudden progressive weakness and severe pain in the tips of the tongue. Ob-no:
The skin is pale, with an icteric tinge. The liver and spleen are not palpable. Body temperature is 39 C. Blood test:
39
Hb-77 g/l, erythrocytes-2.1x1012/l, leukocytes-3.8x109/l, basophils-0%, eosinophils-2%, T/nucleus-2%, S/nucleus-
62%, lymphocytes-30%, M-4%, platelets 92x109/l. ESR 58 mm/h. The most likely diagnosis:
<variant> B12 deficiency anemia
<variant> Sepsis
<variant> Hypoplastic anemia
<variant> Myeloma disease
<variant> Acute leukemia

233
A 19-year-old female patient has periodically noticed yellowing of the skin since childhood. Three months ago, the
yellowing increased. During an objective examination, the liver and spleen are palpable. Blood test: Hb-81/l,
Er.2.9x1012/l, L-8x109/l, leukocyte formula is normal. Reticulocytes 24%, platelets 182x109/l. Osmotic resistance
of erythrocytes: beginning 0.6% NaCl, end - 0.4% NaCl. Blood bilirubin 134 mmol/l, direct -12 mmol/l, iron -24
μmol/l. The most likely diagnosis:
<variant> Hemolytic anemia
<variant> Folate deficiency anemia
<variant> Hypoplastic anemia
<variant> Iron deficiency anemia
<variant> B-12 deficiency anemia

234
The most common cause of iron deficiency anemia is:
<variant> blood loss
<variant> helminthic invasion
<variant> congenital iron deficiency
<variant> avitaminosis
<variant> radiation

235
Patient S., 22 years old, complains of: increasing weakness that appeared a month ago, periodic increase in body
temperature and the appearance of bruises without apparent cause. Objectively: pale skin, hemorrhages on the
mucous membrane of the cheeks, soft palate. Enlarged, painful lymph nodes, splenomegaly. In the complete blood
count: Hb - 80 g / l, erythrocytes - 2.4x1012 / l, leukocytes - 59x109 / l, blast cells - 55%, platelets - 56x109 / l. The
most likely diagnosis:
<variant> Acute leukemia
<variant> Chronic lymphocytic leukemia
<variant> Infectious mononucleosis
<variant> Tuberculosis
<variant> Lymphogranulomatosis

236
According to the protocol, the mandatory research method in the diagnosis and clarification of the stage of acute
leukemia:
<variant> bone marrow puncture
<variant> hemogram
<variant> coagulogram
<variant> iliac cranial bone biopsy
<variant> ultrasound examination of the liver and spleen

237
A 21-year-old female patient complains of weakness, headaches, palpitations, fleeting pains in the joints, "bruises"
on the body. From the anamnesis: has been ill for 2 weeks. Objectively: general condition is severe. Multiple
hemorrhages on the skin, mucous membranes of the mouth, pallor. Lymph nodes up to the size of a bean, painless.
Heart sounds are muffled, tachycardia up to 100 beats/min. Moderate hepatosplenomegaly. Complete blood count:
hemoglobin - 99 g/l, erythrocytes - 3.0x1012/l, platelets - 57x109/l, leukocytes - 87x109/l, leukocyte formula:
blasts 60%, segmented - 27%, lymphocytes - 13%, erythrocyte sedimentation rate - 60 mm/h. The most accurate
diagnosis:
<variant> Acute leukemia
<variant> Aplastic anemia
40
<variant> Thrombocytopenic purpura
<variant> Chronic lymphocytic leukemia
<variant> Systemic lupus erythematosus

238
Botkin-Gumprecht shadows are:
<variant> lymphocyte nuclei destroyed during smear preparation
<variant> neutrophils phagocytosed nuclear substance
<variant> myelokaryocytes
<variant> lymphoblasts
<variant> destroyed monoblasts

239
A 32-year-old patient has a hematoma type of bleeding with damage to the musculoskeletal system, which
appeared in early childhood, an increase in activated partial thromboplastin time, and the absence of factor VIII.
The most likely diagnosis is:
<variant> Hemophilia A
<variant> Rosenthal's disease
<variant> Von Willebrand disease
<variant> Stuart-Prower disease
<variant> Hereditary dysfibrinogenemia

240
Patient, 18 years old, complains of: multiple hemorrhages on the body, nosebleed. From the anamnesis: fell ill
after suffering from the flu. Objectively: there are multiple bruises on the skin, with different shades, peripheral
lymph nodes are not enlarged, the liver and spleen are within normal limits. Complete blood count: hemoglobin-
122 g / l., erythrocytes-4.1x1012 / l, platelets-8x109 / l, leukocytes-6.8x109 / l. The most likely diagnosis:
<variant> Immune thrombocytopenic purpura
<variant> Thrombocytopathy
<variant> Acute leukemia, advanced stage
<variant> Disseminated intravascular coagulation syndrome, hypocoagulation phase
<variant> Aplastic anemia

241
An 18-year-old female patient has had bleeding gums and nosebleeds, and skin hemorrhages in the thigh area for
the past 4 months. On examination: pale skin and visible mucous membranes with a slight icteric tint, lymph nodes
are not enlarged, the liver and spleen are not palpable. Blood test: Hb-72 g/l, Er-2.1x1012/l, L-2.0x109/l, P-1%, S-
40%, L-53%, M-6%, Tr-40x109/l, ESR-48 mm/h. Presumptive diagnosis:
<variant> aplastic anemia
<variant> hemolytic anemia
<variant> iron deficiency anemia
<variant>B12-deficiency anemia
<variant> thrombocytopenic purpura

242
A 33-year-old female patient complains of profuse bleeding that occurred immediately after tooth extraction.
History of nosebleeds. Objectively: petechiae and ecchymoses on the skin. In the blood: erythrocytes - 2.9
thousand, Hb - 77 g / l, CP - 0.8, leukocytes - 4.2 thousand, thrombus - 28 thousand, ESR - 17 mm / h. Duration of
bleeding - 24 minutes, clotting time - 4 minutes. Myelogram: impaired detachment of thromboplastins from
megakaryocytes. The most likely diagnosis:
<variant> Immune thrombocytopenia
<variant> Hemophilia
<variant> Acute leukemia
<variant> Aplastic anemia
<variant> Rendu-Osler disease

243
A female patient, 18 years old, complains of multiple hemorrhages on the body, nosebleeds. From the anamnesis:
she fell ill after having the flu. Objectively: there are multiple bruises on the skin, with different shades, peripheral
41
lymph nodes are not enlarged, the liver and spleen are within normal limits. General blood test: hemoglobin - 122 g
/ l., erythrocytes - 4.1x1012 / l, platelets - 22x109 / l, leukocytes - 6.8x109 / l. Probable diagnosis:
<variant> Immune thrombocytopenic purpura
<variant> Thrombocytopathy
<variant> Acute leukemia, advanced stage
<variant> Disseminated intravascular coagulation syndrome, hypocoagulation phase
<variant> Aplastic anemia

244
A 32-year-old female patient complains of general weakness, fatigue, dizziness, "flickering spots" before the eyes,
shortness of breath, brittle nails. History: 7 pregnancies, including 4 miscarriages, menstruation lasts 5-7 days,
heavy. Objectively: the skin and visible mucous membranes are pale, dry, clean. The nails are soft, break easily.
There are cracks in the corners of the mouth. Complete blood count: hemoglobin - 62 g / l, erythrocytes - 2.6 x
1012 / l, platelets - 180 x 109 / l, leukocytes - 4.9 x 109 / l, erythrocyte sedimentation rate - 30 mm / h. Serum iron -
7.2 μmol / l, serum ferritin - 10.82 ng / ml. Select a drug for treatment:
<variant> Sorbifer-Durules
<variant> Vitamin B12
<variant> Folic acid
<variant> Ascorbic acid
<variant> Erythropoietin

245
A 21-year-old patient complains of sudden general weakness, dizziness, shortness of breath, and an increase in
body temperature to 37-380C. Objectively: the skin and visible mucous membranes are pale, with a lemon-yellow
tint. Heart sounds are clear, tachycardia, and systolic murmur in the apex region. Moderate hepatosplenomegaly is
noted. Complete blood count: hemoglobin 55 g/l, erythrocytes 1.6x1012/l, reticulocytes 15%, platelets 180x109/l,
leukocytes 9.9x109/l, erythrocyte sedimentation rate 25 mm/h. Blood biochemistry: total bilirubin 41 μmol/l, direct
4.9 μmol/l, indirect 37.1 μmol/l, Coombs reaction +++. For first-line treatment, the most effective are:
<variant> Prednisolone
<variant> Amoxiclav
<variant> Gepadif
<variant> Folic acid
<variant> Sorbifer Durules

246
A 71-year-old female patient complains of loss of appetite, heaviness in the epigastric region after eating, pain and
burning in the tongue, general weakness, shortness of breath, a crawling sensation in the legs, and numbness in the
legs. History: has suffered from gastritis for many years. Objectively: pale, icteric skin, smooth, varnished tongue,
glossitis. Complete blood count: hemoglobin 80 g/l, erythrocytes 2.2x1012/l, platelets 160x109/l, leukocytes
7.1x109/l. The hemogram contains macrocytes, megalocytes, erythrocytes contain Jolly bodies and Cabot rings.
The myelogram shows megaloblastic type of hematopoiesis. Esophagogastroduodenoscopy: diffuse atrophic
gastritis. The most effective drug for the treatment of:
<variant> Vitamin B12
<variant> Folic acid
<variant> Sorbifer-Durules
<variant> Floodara
<variant> Mezim-forte

247
A 68-year-old man consulted a doctor due to frequent upper respiratory tract infections. Examination revealed
lymphadenopathy, splenomegaly, hepatomegaly, absolute lymphocyte count in the blood is 14 x 109/l, lymphocyte
count in the myelogram is 35%, coexpression of CD5, CD19, CD23, but CD20 is weakly expressed. Probable
diagnosis:
<variant> Chronic lymphocytic leukemia
<variant> Lymphoma of the spleen
<variant> Lymphosarcoma of peripheral lymph nodes
<variant> Lymphogranulomatosis
<variant> Tuberculosis of the lymph nodes
248
42
 A 22-year-old man was admitted with complaints of general weakness, bleeding gums, sore throat, and enlarged
cervical lymph nodes. In the blood: hemoglobin - 54 g / l, erythrocytes - 2 x 1012 / l, leukocytes - 76 x 109 / l,
platelets - 50 x 109 / l, ESR - 64 mm / hour, blast cells - 47%, segmented - 29%, lymphocytes - 18%, monocytes -
6%. A diagnosis of acute leukemia was made. The diagnosis is confirmed by the detection in the blood:
<variant> Blastemia
<variant>Anemia
<variant> Thrombocytopenia
<variant> Leukocytosis
<variant> Leukocytopenia

249
A 47-year-old woman was admitted to the emergency room complaining of general weakness, dizziness, and
palpitations. For 1 year, menstruation lasts 10 days, heavy. Objectively: pale skin and mucous membranes, striated
and brittle nails, hair loss, tachycardia up to 100 per minute, blood pressure 110/60 mm Hg. In the blood:
hemoglobin - 62 g / l, erythrocytes - 2.6 x 1012 / l, color index - 0.7, ESR - 36 mm / hour, leukocytes - 5.8 x 109 / l,
platelets - 420 x 109 / l. Further tactics of patient management:
<variant> Parenteral iron preparations
<variant> Parenteral vitamin B12
<variant> Folic acid per os
<variant> Parenteral ascorbic acid
<variant> Transfusion of red blood cells

250
A 68-year-old man was admitted to the emergency room with severe general weakness, shortness of breath,
palpitations, and a feeling of "cottony" legs. Six years ago, a gastric resection was performed for a peptic ulcer.
Objectively: pale skin and mucous membranes with a jaundiced tint. In the blood: hemoglobin - 46 g / l,
erythrocytes - 1.3 x 109 / l, leukocytes - 2.3 x 109 / l, color index - 1.1, ESR - 41 mm / hour, basophils - 1%,
eosinophils - 4%, band neutrophils - 6%, segmented neutrophils - 65%, lymphocytes - 16%, monocytes - 8%,
platelets - 110 x 109 / l. In the myelogram: megaloblastic type of hematopoiesis. Further tactics for patient
management:
<variant> Vitamin B12 preparations
<variant> Iron preparations
<variant> Prednisolone
<variant> Desferal
<variant> Ascorbic acid

251
A 15-year-old patient has severe anemia, persistent jaundice, hepatosplenomegaly, and trophic ulcers of the shins.
On examination, the patient is short, with a "Mongoloid" facial type, "tower skull," and "Gothic palate." The CBC
shows normochromic anemia with a decrease in hemoglobin to 79 g/l, microspherocytosis, reticulocytosis, and a
moderate increase in ESR of 25 mm/h. BAC: increased total bilirubin due to the indirect fraction. Ultrasound:
hepatosplenomegaly, multiple gallstones. Optimal therapy:
<variant> cholecystectomy, splenectomy
<variant> transfusion of red blood cells, glucocorticoids
<variant> splenectomy, glucocorticoids
<variant> cholecystectomy, red blood cell transfusion
<variant> cytostatics, antioxidants

252
Congenital absence of receptors for vitamin B12 in the small intestine is characteristic of the disease:
<variant> Immerslund-Gresbeck
<variant> Goshe
<variant> Marchiafava-Micheli
<variant> Di-Guglielmo
<variant> Vaqueza

253
The clinical picture of patients with chronic myelogenous leukemia is dominated by:
<variant> splenomegaly
43
<variant> lymphadenopathy
<variant> cutaneous leukemic infiltrates
<variant>hemorrhagic rash
<variant> hepatomegaly

254
Anemia in chronic renal failure is caused by:
<variant> decreased synthesis of erythropoietins
<variant> iron deficiency
<variant> vitamin B12 deficiency
<variant> autoimmune hemolysis
<variant>folate deficiency

255
The most common type of acute leukemia in adults:
<variant> myeloblastic
<variant> undifferentiated
<variant> promyelocytic
<variant>lymphoblastic
<variant> monoblastic

256
Patient D., 28, underwent 3-week treatment for stomatitis without effect, with increasing weakness and sweating.
Objectively: body temperature 38.8 degrees, skin is pale and moist. Gingival hyperplasia, ulcerative necrotic
stomatitis. Submandibular lymph nodes are enlarged and painless. In the blood: erythrocytes - 3.0 million, Hb - 95
g / l, CI - 0.95, leukocytes - 14.5 thousand, blasts - 32%, pal - 1%, segments - 39%, lymph - 20%, mon - 8%,
thrombus - 90 thousand, ESR - 24 mm / h. Cytochemical study: reaction to glycogen is positive. After 3 days -
headaches, nausea, vomiting, paresis of the lower extremities. What is your diagnosis?
<variant> acute lymphoblastic leukemia
<variant> acute myeloid leukemia
<variant> acute undifferentiated leukemia
<variant>acute monoblastic leukemia
<variant> acute low-grade leukemia

257
Patient K., 19 years old, complains of weakness, bone pain, nosebleed. He fell ill acutely. Objectively: pale skin,
hemorrhagic rash on the body. The liver protrudes from the hypochondrium by 4 cm, has a soft elastic consistency,
the spleen is palpable.
In the general blood test: Hb - 86 g/l, Er. - 1.5x1012/l, WBC - 25x109/l, myeloblasts - 60%, S/Y - 20%, L - 12%,
monocytes - 8%. Your clinical diagnosis:
<variant> Acute myeloid leukemia
<variant> Acute leukemia
<variant> Chronic lymphocytic leukemia
<variant> Infectious mononucleosis
<variant> Hypoplastic anemia

258
The following laboratory parameters may suggest the presence of B12 deficiency anemia:
<variant> Erythrocyte macrocytosis
<variant> Decrease in the number of red blood cells
<variant> Thrombocytosis
<variant> Neutrophilic left shift
<variant> Decreased serum iron content

259
A 61-year-old female patient complains of weakness and epigastric pain. Objectively: the skin and visible mucous
membranes are pale with a subicteric tint, the face is puffy, the tongue is "varnished". Moderate
hepatosplenomegaly. In the blood: pancytopenia, macrocytosis, polysegmentation of neutrophils. Bilirubin - 38.5
μmol/l. Myelogram: megaloblastic type of hematopoiesis. The most likely diagnosis:
44
<variant> B12 deficiency anemia
<variant> Iron deficiency anemia
<variant> Autoimmune hemolytic anemia
<variant> Aplastic anemia
<variant> Thalassemia

260
Bleeding from the nose and gums, hemorrhages on the skin and mucous membranes. In the blood: er.-1.8 million,
Hb-54 g / l, CP - 0.9 leuk-2.4 thousand, pal-6, segm-58, eos-2, lymph-34, thrombus-44 thousand. ESR-52 mm / h,
bleeding duration - 20 minutes. In the trephine - a large amount of fat. According to the clinical protocol, the
picture is characteristic of:
<variant> Aplastic anemia
<variant> Acute leukemia
<variant> Autoimmune thrombocytopenic purpura
<variant> Marchiafava-Micheli diseases
<variant> B12-deficiency anemia
261
A 56-year-old woman complained of a tumor in her right cheek. Five years ago, she felt "sand in her eyes" and dry
mouth, which began to intensify. She has multiple dental caries. Diffuse arthralgia developed three months before
her visit. Examination revealed dry eyes and oral mucosa, a swollen parotid salivary gland on the right. Blood tests
showed 3.2 thousand leukocytes, ESR - 60 mm/hour. Positive tests for RF (titer 1:600) and antinuclear antibodies
(titer 1:256). What disease can we think about:
<variant>Sjogren's syndrome
<variant>Cystic fibrosis
<variant>Viral conjunctivitis
<variant>Sharp's syndrome
<variant>Rheumatoid arthritis

262
The most characteristic symptom of dermatomyositis is
<variant>hypotension of the upper third of the esophagus
<variant>myocarditis
<variant>rheumatoid arthritis-like hand disease
<variant>diffuse pulmonary interstitial tissue damage
<variant>progressive weight loss

263
According to the clinical protocol, when treating dermatomyositis with cytostatics, the drug of choice is
<variant>methotrexate
<variant>captopril
<variant>omeprazole
<variant>ranitidine
<variant>chlorbutin

264
Patient S., 33 years old, was diagnosed with: Primary dermatomyositis, acute course, activity grade 3, manifest
period with lesions of the skin of the face (erythema of the eyelids), muscles of the neck, upper limbs, pharynx and
esophagus. According to the clinical protocol, the daily dose of prednisolone:
<variant>2 mg/kg
<variant>60 mg/kg
<variant>40 mg/kg
<variant>20 mg/kg
<variant>10 mg/kg

265
According to the clinical protocol, Idiopathic dermatomyositis must first be differentiated from:
<variant>tumor dermatomyositis
<variant>malignant myasthenia
<variant>rheumatic polymyalgia
45
<variant>infectious myopathy
<variant>toxic myopathy in chronic alcoholism

266
The most valuable laboratory criterion confirming the diagnosis of dermatomyositis is
<variant>increased creatine phosphokinase activity
<variant>increased ESR
<variant>detection of antinuclear factor in the blood
<variant>detection of rheumatoid factor in the blood
<variant>detection of antibodies to muscle antigens

267
A 16-year-old female patient complains of fever up to 40C, shortness of breath, cough, pain in the small joints of
the hands. History: spontaneous miscarriage a month ago. Objectively: malnutrition, lymphadenopathy, erythema
of the cheeks and bridge of the nose, "livedo reticularis" on the skin of the shins; signs of pleurisy, pericarditis,
nephritis. In the blood: erythrocytes - 2.4 million, Hb-70 g / l, leukocytes - 2.2 thousand, ESR-70 mm / hour. In the
urine analysis: protein - 5.2 g / s, erythrocytes - 20-30 in the field of vision. Antibodies to double-stranded DNA are
positive. The most informative research method:
<variant> Determination of antibodies to cardiolipin
<variant>Bacteriological blood culture
<variant> Rheumatoid factor determination
<variant> Determination of the titer of antistreptococcal antibodies
<variant> Enzyme immunoassay for urogenital infection

268
A 28-year-old female patient was admitted to the hospital. She fell ill 9 years ago and was diagnosed with systemic
lupus erythematosus. She constantly takes prednisolone (maximum dose 40 mg/day, maintenance dose 10-15
mg/day), against this background, epigastric pain and black stool appeared. This patient has a complication.
<variant>steroid ulcer with bleeding
<variant>Itsenko-Cushing syndrome
<variant>mesenteric vascular thrombosis
<variant>splenic infarction
<variant>steroid diabetes

269
A 42-year-old woman has had Raynaud's syndrome for 15 years. Over the past year, signs of arthritis of the small
joints of the hands and wrists, thickening of the skin of the face, and difficulty swallowing solid food have
appeared. Blood ESR is 32 mm/hour, and there are isolated lupus cells. According to the clinical protocol, your
preliminary diagnosis is:
<variant>systemic scleroderma
<variant>esophageal tumor
<variant>systemic lupus erythematosus
<variant>dermatomyositis
<variant>rheumatoid arthritis

270
A 45-year-old female patient has Raynaud's syndrome, including necrotic changes in the fingers, swallowing
disorder, pulmonary hypertension, difficulty bending the fingers, thickening of the skin in the area of the hands,
and shortening of the fingers due to lysis of the terminal phalanges. According to the clinical protocol, your
diagnosis is:
<variant>systemic scleroderma
<variant>systemic lupus erythematosus
<variant>rheumatoid arthritis
<variant>periarteritis nodosa
<variant>thromboangiitis Burger

271
A 35-year-old female patient consulted a doctor complaining of numbness and tingling in the fingertips of both
hands. When in contact with cold water, the hands turn noticeably pale, followed by a bluish tint to the skin.
46
Raynaud's syndrome was diagnosed and systemic scleroderma was suspected. According to the clinical protocol,
the signs that are most likely to confirm the diagnosis are:
<variant>thickening of the skin on the fingers and hands
<variant>erythema on the cheeks
<variant>deformation of small joints
<variant>signs of interstitial nephritis
<variant>numbness, tingling in the fingertips

272
Skin lesion that can exclude suspicion of systemic scleroderma:
<variant>erythematous rash
<variant>isolated foci of skin fibrosis
<variant>calcinosis cutis
<variant>telangiectasia
<variant>fibrosis of the skin of the neck, trunk

273
In systemic scleroderma, the following blood vessels are predominantly affected:
<variant>arterioles and capillaries
<variant>medium caliber vessels
<variant>vessels of any diameter
<variant>large vessels
<variant>venules and veins

274
The patient is 31 years old, diagnosed with systemic scleroderma, diffuse form. According to the clinical protocol,
the patient's skin is affected mainly in the following areas of the body:
<variant>face, chest, abdomen and symmetrical parts of the limbs
<variant>face, fingers and feet
<variant>trunk and proximal parts of the limbs
<variant>head, chest and abdomen
<variant>symmetrical areas of the upper limbs

275
The development of scleroderma nephropathy is caused by a primary lesion
<variant>arterioles
<variant>balls
<variant>tubules
<variant>renal pelvis and calyces system
<variant>renal parenchyma

276
The patient was diagnosed with Raynaud's syndrome - a symmetrical paroxysmal spasm of the digital arteries,
cutaneous arterioles and arteriovenous shunts, induced by cold or emotional stress, characterized by a sequential
change in the color of the skin of the fingers. The first phase of the syndrome is manifested by:
<variant>"whitening" of the fingers and toes
<variant>reactive hyperemia of the skin of the fingers and toes
<variant>cyanosis of the distal extremities
<variant>paresthesias throughout the arm and leg
<variant>the appearance of telangiectasia

277
Patient B., 42 years old, complains of increasing stiffness in her hands over the course of a year, numbness, cold
fingers and toes, difficulty swallowing solid food, dry cough, shortness of breath during exertion. Ob-no: upon
palpation, the skin of the hands and feet is dense, cold, cyanotic. In the lungs, breathing is weakened, moist rales of
various sizes. Heart sounds are muffled, the rhythm is regular. In the blood: erythrocytes-3.2 million, hemoglobin -
117 g / l, leukocytes-7.4 thousand, ESR-38 mm / hour. According to the clinical protocol, the following should be
prescribed as antifibrotic therapy:
<variant>D-penicillamine
47
<variant>Cyclophosphamide
<variant>Azathioprine
<variant>Curantil
<variant>Prednisolone

278
Patient D., 35 years old, is being observed by a rheumatologist with a diagnosis of systemic scleroderma.
According to the clinical protocol, the indication for prescribing D-penicillamine is:
<variant>increasing severity of skin compaction
<variant>pronounced laboratory indicators of disease activity
<variant>high titer of antinuclear factor
<variant>scleroderma renal crisis
<variant>progressive pulmonary hypertension

279
A 45-year-old female patient has Raynaud's syndrome, swallowing disorder, pulmonary hypertension, pain in the
joints of the hands, and thickening of the skin in the area of the hands. According to the clinical protocol, your
diagnosis is:
<variant>Systemic scleroderma
<variant>Systemic lupus erythematosus
<variant>Rheumatoid arthritis
<variant>Polyarteritis nodosa
<variant>Burger's thrombangiitis

280
A 44-year-old female patient was admitted with complaints of cold fingers, difficulty chewing and opening the
mouth, and decreased amount of saliva. She has been ill for about 6 months. Objectively: Weight is maintained.
Lymph nodes are not enlarged. The face is amemic. There are no forehead folds, the skin of the forehead and
cheeks does not fold. The tongue is dry. There are no pathologies from the side of the internal organs. The skin of
the hands is cyanotic, the fingers are swollen. Complete blood count: Hb 136 g/l, leukocytes 6.4*109/l, E - 1%,
platelets 210*109/l, ESR 42 mm/h. Your diagnosis according to the clinical protocol:
<variant>Systemic scleroderma
<variant>Systemic lupus erythematosus
<variant>Sjogren's disease
<variant>Raynaud's disease
<variant>Dermatomyositis

281
A 42-year-old female patient complained of cold fingers, toes and skin discoloration, especially when air
temperature drops and in cool water: initially whitening, then cyanosis followed by soft tissue edema. These
complaints have been present for ≈ 2 years. For six months, she began to notice difficulty swallowing - a "lump"
sensation, arthralgia, and cardialgia. On examination: the face is amimic, the skin does not fold well. Heart: normal
boundaries, muffled, arrhythmic tones, systolic murmur, heart rate 98 beats per minute, blood pressure 100/60 mm
Hg. According to the clinical protocol, the patient should be prescribed prednisolone at a dose of
<variant>15-20 mg/day
<variant>1-2mg/kg
<variant>20-40 mg/day
<variant>in the form of pulse therapy
<variant>90-120 mg/day

282
A 35-year-old woman in her third trimester of pregnancy complains of unilateral pain in the hip joint that
developed a month ago. The pain is aching, constant, does not go away at rest or when lying on her back. An
unsteady gait, pain when bending and internal rotation are noted. Reflexes are normal. Laboratory tests are normal,
except for ESR - 50 mm / h. The correct treatment option:
<variant>X-ray examination of the hip joint with fetal shielding
<variant>Rest prescribed, acetaminophen taken
<variant>Monitoring throughout pregnancy, without diagnostic interventions
<variant>Prescribing NSAIDs in normal doses until pain is relieved
48
<variant>Computed tomography to rule out osteonecrosis of the femoral head
283
A woman suffering from SLE with active lupus nephritis wants to have a child. She receives prednisolone at a dose
of 20 mg/day. You will recommend her, according to the clinical protocol:
<variant>Pregnancy is undesirable, as there is a high probability of the disease becoming active.
<variant>Increase the dose of prednisolone. It is possible to get pregnant against this background
<variant>Allow pregnancy; if renal function worsens, prescribe cyclophosphamide
<variant>Continue treatment until remission occurs and then plan pregnancy.
<variant>Allow pregnancy, if condition worsens, terminate early

284
A 30-year-old woman with severe lupus nephritis and end-stage CRF is referred for consultation to decide on a
kidney transplant. She has been on hemodialysis for 5 years. She is currently concerned that lupus will destroy the
donor kidney. The correct judgment regarding the patient's concern is:
<variant>transplant rejection problems are no different from those seen in people with other diseases
<variant>After transplantation, the risk of exacerbation of SLE increases significantly
<variant>high risk of recurrence of lupoid nephritis in the transplanted kidney
<variant>60% of patients die after transplantation
<variant>After the transplant, complete recovery occurs

285
A 25-year-old woman with SLE is taking prednisolone at a dose of 5 mg per day. The last few years have been in
remission. The patient wants to have a child. According to the clinical protocol, the patient can be given the
following advice:
<variant>remission period (6 months before conception) is the optimal time for pregnancy planning
<variant>the presence of SLE is an absolute contraindication for pregnancy
<variant>It is necessary to stop prednisolone and then plan pregnancy
<variant>planning a pregnancy is possible only after the disease has been completely cured
<variant>it is necessary to increase the dose of prednisolone during pregnancy

286
A 26-year-old woman came to see a doctor about polyarthritis of the small joints of her hands and wrists for 6
months. She started losing her hair 2 months ago, and recently after a trip to the sea, an erythematous rash appeared
on her face. Temperature 38°C. Blood pressure 140/100 mm Hg. Proteinuria in the urine. According to the clinical
protocol, your diagnosis is:
<variant>Systemic lupus erythematosus
<variant>Dermatomyositis
<variant>Acute nephritis
<variant>Systemic scleroderma
<variant>Rheumatoid arthritis

287
A 45-year-old man complains of acute pain in the area of the big toe of the left foot, swelling of the joint, redness
of the skin of the dorsum of the foot, an increase in body temperature to 390C. Swelling of the first
metatarsophalangeal joint of the left foot, limited motion. Joint X-ray: "punch" symptom. Blood: leukocytes 10
thousand, ESR - 45 mm/hour, urea 15 mmol/l. Urine analysis: specific gravity 1014, erythrocytes 5-7 in the field of
vision, urates. According to the clinical protocol, it is advisable to prescribe from the listed drugs:
<variant>allopurinol, as it inhibits the enzyme xanthine oxidase, suppressing the formation of urates in the blood
serum
<variant>methotrexate, as it has an antifolate effect, suppressing cellular mitosis
<variant>Plaquenil, as it affects the metabolism of immunocompetent cells and connective tissue
<variant>prednisolone, as it inhibits the activity of phospholipase A2 and hyaluronidase
<variant>indomethacin, as it is a strong inhibitor of prostaglandin biosynthesis

288
A 25-year-old female patient with SLE with joint and kidney damage (with nephrotic syndrome) has been receiving
prednisolone at a dose of 60 mg/day for the third month due to an exacerbation of the disease. Which of the
following complications may develop:
49
<variant>femoral head necrosis
<variant>thrombocytopenia
<variant>Raynaud's syndrome
<variant>erythema on the cheeks
<variant>blood protein content 55 g/l

289
A 17-year-old girl has developed a fever, symmetrical migrating pain in large joints, stabbing pain in the heart, and
palpitations. In the anamnesis, she had acute tonsillitis 10 days ago. On examination, there is annular erythema on
the skin. The examination revealed dynamically increasing titers of antistreptolysin-O. Benzylpenicillin was
prescribed. In accordance with the clinical protocol, it is advisable to additionally include it in the drug treatment
program.
<variant>diclofenac to inhibit COX and suppress RGE2 synthesis
<variant>digoxin as an improvement in myocardial contractile function
<variant>amlodipine as a calcium channel blocker
<variant>metoprolol as a beta-blocker
<variant>spilactone to enhance the cardiotonic effect of cardiac glycosides

290
According to the clinical protocol, the manifestation of SLE (systemic lupus erythematosus) requiring the use of
high doses of glucocorticosteroids:
<variant>lupus nephritis
<variant> lupusarthritis
<variant>skin rashes
<variant>presence of LE cells in the blood
<variant>high ESR

291
True LE cells are:
<variant>segmented leukocytes containing nuclei of other cells
<variant>segmented leukocytes containing lymphocytes
<variant>monocytes containing nuclei of other cells
<variant>monocytes forming "rosettes" with erythrocytes
<variant>hematoxylin bodies

292
Patient Z., aged 19, fell ill acutely three months ago, when sharp pains appeared in the right shoulder and wrist
joints, a feeling of stiffness in them, an increase in body temperature to 38°C. Antibacterial therapy was ineffective.
Objectively: lymphadenopathy. There is bright erythema on the skin of the cheeks and bridge of the nose. Pulse is
100 per minute, rhythmic. BP is 120/70 mm Hg. Complete blood count: hemoglobin 95 g / l, erythrocytes 4.2
million, leukocytes 11 thousand. ESR 37 mm / h. Uroam: protein 5 g / day, leukocytes 6-8 in the field of view,
erythrocytes 20-25 in the field of view, hyaline casts 3-5 in the field of view. According to the clinical protocol, a
specific immunological research method should be prescribed:
<variant>Antibodies to double-stranded DNA
<variant>Anti-cyclic citrullinated peptide antibodies
<variant>Anti-topoisomerase antibodies
<variant>Antinuclear cytoplasmic antibodies
<variant>Anticentromere antibodies

293
Patient V., 16 years old, was admitted with complaints of pain and stiffness in the joints of the hands and knees,
muscle pain, fever up to 380C, cough with mucous sputum, weakness, malaise, and facial flushing. Objectively: the
skin is pale, there is erythema in the form of a "butterfly" on the face. In the lungs, breathing is harsh, with moist
fine-bubble rales. Heart sounds are muffled, rhythmic, pulse is 110 beats per minute. Blood pressure is 140/90 mm
Hg. Radiologically: there is a non-homogeneous decrease in pulmonary transparency. There is fluid in the pleural
cavity on the right. According to the clinical protocol, the patient has:
<variant>systemic lupus erythematosus
<variant>rheumatoid arthritis
<variant>systemic scleroderma
50
<variant>sarcoidosis
<variant>dermatomyositis
294
A 29-year-old female patient was admitted with complaints of joint pain, fever with chills, and weakness. Three
years ago, weakness and arthralgia developed after childbirth. Over the course of a year, joint pain has increased,
with frequent fever, erythematous rash on the skin, and weight loss. Objectively: there is a pale pink rash on the
chest and forearms. There is swelling and pain in the elbow, wrist, and knee joints with decreased mobility. The
cervical and axillary lymph nodes up to 1 cm in size are palpable. Complete blood count: Hb 95 g/l, ESR 54
mm/hour. Urea: relative density 1012, protein 2.6 g/l, erythrocytes 20-30 in the field of vision, hyaline and granular
cylinders. Your tactics according to the clinical protocol:
<variant>Methylprednisolone pulse therapy
<variant>hydroxychloroquine in combination with NSAIDs
<variant>prednisolone 0.1-0.2 mg/kg
<variant>prednisolone 0.5 mg/kg
<variant>cyclophosphamide pulse therapy

295
According to the clinical protocol, when conducting pulse therapy with glucocorticosteroids in patients with
systemic lupus erythematosus, the following is used:
<variant>methylprednisolone
<variant>prednisolone
<variant>dexamethasone
<variant>Diprospan
<variant>triamcinolone

296
In a patient with systemic lupus erythematosus receiving cyclophosphamide, the white blood cell count dropped to
2.9 thousand. According to the clinical protocol, the appropriate tactics are:
<variant>cancel cyclophosphamide, prescribe prednisolone at a dose of 1 mg/kg
<variant>cancel cyclophosphamide
<variant>replace cyclophosphamide with azathioprine
<variant>reduce the dose of cyclophosphamide, start a course of plasmapheresis
<variant>do not change the dose of cyclophosphamide, but simultaneously prescribe prednisolone

297
Patient A., 50 years old, complained of pain in the joints of her legs, which intensified in the evening. From the
anamnesis: arthralgia has been bothering her for about 7 years, beginning with moderate pain in the knee joints
with periodic swelling. She treated herself with folk remedies. Objectively: Subcutaneous fat is excessively
developed. There are dense nodules on the lateral surfaces of the distal interphalangeal joints of the III-IV fingers
of both hands. "Crunching" when moving the knee joints. Swelling with local hyperthermia of the left knee joint. In
accordance with the clinical protocol, the drug used as a chondroprotective therapy for this disease is:
<variant>chondroxide
<variant>delagil
<variant>prednisolone
<variant>cyclophosphamide
<variant>allopurinol

298
A 25-year-old patient was diagnosed with systemic lupus erythematosus a year ago. She took prednisolone at a
dose of 60 mg / day, against this background she noted a weight gain of 17 kg, blood pressure increased to 180/110
mm Hg. Attempts to reduce the dose of prednisolone caused weakness, increased skin changes, increased edema,
and an increase in body temperature. On examination, obesity, bright hyperemia of the skin of the face, pustular
rash on the skin of the back and shoulders, striae on the abdomen, edema of the shins. Blood pressure 175 / 105
mm Hg. Blood tests: ESR 47 mm / h, anti-ds DNA titer ≥ 30 IU / ml. Your tactics according to the clinical
protocol:
<variant>refer for hospitalization for belimumab therapy
<variant>increase the dose of prednisolone
<variant>continue outpatient treatment with the addition of fosinopril
<variant>refer for hospitalization for rituximab therapy
51
<variant>refer to day hospital for pulse therapy
299
A 26-year-old woman has fever, arthralgia, and has had ulcers on the oral mucosa for the past two weeks. She
recently returned from the subtropics, but there are no signs proving an infectious disease. You suspect the
diagnosis:
<variant>Systemic lupus erythematosus
<variant>Acute rheumatic fever
<variant>Rheumatoid arthritis
<variant>Behcet's disease
<variant>Reiter's disease

300
A 30-year-old female patient has suffered from systemic lupus erythematosus since she was 28. She has been
taking a maintenance dose of 10 mg of prednisolone for a year. According to the clinical protocol, patients
receiving prednisolone at a dose of ≥5 mg per day are recommended to use:
<variant>calcium (1500 mg per day) and vitamin D (800 IU per day)
<variant>calcium (1500 mg per day)
<variant>vitamin D (800 IU per day)
<variant>calcium (1000 mg per day) and vitamin D (800 IU per day)
<variant>calcium gluconate 1500 mg per day

301
A 23-year-old woman developed a diffuse erythematous rash on her face, pleurisy, and fever up to 38.50. She had
episodes of leukopenia in the past. She had been receiving novocainamide for several years due to a heart rhythm
disorder. Laboratory testing revealed a moderate increase in the concentration of antibodies to DNA, urine tests
showed erythrocyturia and proteinuria 2.5 g/day. According to the clinical protocol, your diagnosis is:
<variant>drug-induced lupus
<variant>discoid lupus erythematosus
<variant>systemic lupus erythematosus
<variant>systemic scleroderma
<variant>systemic lupus erythematosus, unspecified

302
A 35-year-old patient, works in a pasture, was admitted to the nephrology department with nephrotic syndrome and
arthralgia. According to the clinical protocol, a reliable diagnostic method is:
<variant>kidney biopsy
<variant>determination of urea
<variant>Determination of daily protein loss
<variant>ultrasound examination of the kidneys
<variant>creatinine determination

303
According to the clinical protocol, in the acute course of systemic lupus erythematosus, the period from the onset of
the disease to the development of multiple organ damage is
<variant>3-6 months
<variant>6-12 months
<variant>more than 12 months
<variant>1-2 months
<variant>2-3 years

304
According to the clinical protocol, the development of lupus syndrome is possible when taking:
<variant>novocainamide
<variant>metoprolol
<variant>lidocaine
<variant>etacizine
<variant>verapamil

305
52
A 21-year-old patient complains of intense pain and stiffness in the lower back and hip joints. Radiography
revealed uneven contours and narrowing of the sacroiliac joints. According to the clinical protocol, laboratory
testing is required to verify the diagnosis:
<variant>HLA-B27
<variant>HLA-DR4
<variant>HLA-B52
<variant>Antinuclear factor
<variant>Rheumatoid factor

306
A 30-year-old patient. Admitted to the clinic with complaints of constant pain in the spine, mainly in the lumbar
region, limited movement. The pain first appeared 5 years ago, accompanied by subfebrile temperature, and
subsequently the temperature did not rise. He was treated with thermal procedures. A year later, the stiffness in the
spine increased. On examination: pale, poor nutrition. Movement in the spine is sharply limited, severe atrophy of
the back and thigh muscles. Vesicular breathing, no wheezing. RR 20 per minute. HR 66 per minute. BP 110/60
mm Hg. Liver, spleen are not enlarged. Your presumptive diagnosis:
<variant>Bechterew's disease
<variant>Osteochondrosis of the spine
<variant>Brucellosis
<variant>Tuberculous spondylitis
<variant>Rheumatoid arthritis

307
Bechterew's disease (ankylosing spondylitis) most often affects:
<variant>teenagers and young men (15-30 years)
<variant>children
<variant>women in menopause
<variant>young girls
<variant>old people

308
According to the clinical protocol, in Bechterew's disease (ankylosing spondylitis) the following most often occurs:
<variant>aortic insufficiency
<variant>mitral stenosis
<variant>mitral valve insufficiency
<variant>aortic stenosis
<variant>tricuspid valve insufficiency

309
In laboratory diagnostics of Bechterew's disease, according to the clinical protocol, with a clinical assumption, the
decisive confirmation of the diagnosis will be:
<variant>Detection of HLA B27 antigens
<variant>Long-term increase in ESR
<variant>Hypochromic anemia
<variant>Increased CRP and globulin fractions in blood serum
<variant>Increased activity of lysosomal enzymes

310
A 35-year-old patient. Complains of constant pain in the spine, mainly in the lumbar region, limited movement.
The pain first appeared 4 years ago, accompanied by subfebrile temperature. He was treated with massage and
thermal procedures. A year later, the stiffness in the spine increased. On examination: pale, poor nutrition.
Movement in the spine is sharply limited, smoothing of physiological curves, pronounced atrophy of the back and
hip muscles. CBC: erythrocyte sedimentation rate 4.0 million, l 5.7 thousand, ESR 26 mm / h, CRP 25 mg / l.
According to the clinical protocol for diagnosing the disease, the following is mandatory:
<variant>anteroposterior pelvic radiograph
<variant>X-ray of the lumbar spine
<variant>magnetic resonance imaging
<variant>computed tomography
<variant>X-ray densitometry
53
311
A patient who has been experiencing lower back pain and stiffness for 7 months, which are relieved by physical
exercise, is diagnosed with a restriction of the respiratory excursion of the chest. According to the clinical protocol,
in order to reduce pain and stiffness in the spine, the following is prescribed:
<variant>aceclofenac
<variant>prednisolone
<variant>methotrexate
<variant>infliximab
<variant>etanercept

312
A 23-year-old patient complains of intense pain and stiffness in the lower back and hip joints at rest, which
decreases with physical activity. Radiography revealed uneven contours and narrowing of the sacroiliac joints on
both sides. According to the clinical protocol, the symptoms identified are a criterion for:
<variant>Ankylosing spondylitis
<variant>Psoriatic arthritis
<variant>Reactive spondyloarthritis
<variant>Rheumatoid arthritis
<variant>Lumbosacral osteochondrosis

313
The patient was found to have pain in the sacroiliac joints with long-term recurrent monoarthritis of a large joint of
the axial skeleton. This is more indicative of:
<variant>Bechterew's disease
<variant>Lumbosacral osteochondrosis
<variant>Rheumatoid arthritis
<variant>Lyme Diseases
<variant>Psoriatic arthritis

314
The most common side effect of sulfasalazine, a basic drug for ankylosing spondylitis, is
<variant>nausea and vomiting
<variant>skin rash
<variant>agranulocytosis
<variant>fever
<variant>ulcerations of the oral mucosa

315
A 64-year-old patient complains of limited mobility in the distal interphalangeal joints of both hands, which arose
about 12 years ago and is gradually progressing. During examination, nodular thickenings in the area of the distal
interphalangeal joints of both hands are noticeable, the fingers are deformed, mobility in them is limited. No
pathology was found on the part of the internal organs. Blood and urine tests are within normal limits. According to
the clinical protocol, the following diagnosis can be made:
<variant>Osteoarthritis of the joints of the hands
<variant>Rheumatoid polyarthritis
<variant>Rheumatoid arthritis
<variant>Reactive arthritis
<variant>Tuberculous arthritis

316
A 50-year-old woman reports swelling and stiffness of the distal interphalangeal joints of her hands. Otherwise
unremarkable. Probable diagnosis:
<variant>osteoarthritis
<variant>rheumatoid arthritis
<variant>systemic lupus erythematosus
<variant>scleroderma
<variant>gout
317

54
A 53-year-old female patient complains of pain in the small joints of the hands, limited mobility. On examination,
there are dense, symmetrical, nodular thickenings in the area of the distal interphalangeal joints of the hands. X-
rays reveal marginal growths of the bone tissue of the terminal phalanges of the fingers. Name of the nodular
formations:
<variant>Heberden's nodes
<variant>Bouchard's nodes
<variant>tofus
<variant>rheumatoid nodules
<variant>xanthomas

318
A 64-year-old female patient has been taking medications for 2 weeks due to exacerbation of primary
osteoarthrosis and heart failure. Blood tests show a decrease in the number of leukocytes to 3.0 thousand/ml. Which
of the following medications could have caused leukopenia:
<variant>naproxen
<variant>Kenalog
<variant>hypothiazide
<variant>digoxin
<variant>enalapril

319
A 48-year-old woman was hospitalized with complaints of pain and limited motion in the interphalangeal joints of
the hands, mainly on the right. On examination, the distal interphalangeal joints were deformed, in the area of the
third proximal interphalangeal joint, dense nodules measuring 0.5 cm were found, moderately painful on palpation.
The joints were slightly deformed, and their motion was limited. X-ray examination of the joints revealed a
narrowing of the joint space, compaction of the marginal plate, and the presence of exophytes. According to the
clinical protocol, the detected nodules were:
<variant>Bouchard's knots
<variant>Heberden's nodes
<variant>Rheumatoid nodules
<variant>Rheumatic nodules
<variant>Tofus

320
A 47-year-old female patient complained of pain and crunching in the knee joints, which intensify with physical
activity. Upon examination, the joints were unchanged. Laboratory tests: ESR-12 mm/hour, CRP-neg. RF (+). The
radiograph of the joints showed a narrowing of the joint space, compaction of the marginal plate, osteophytes in the
patella area. Your tactics according to the clinical protocol:
<variant>Ostenil intra-articularly
<variant>Alflutop intravenously
<variant>Diprospan intra-articular
<variant>Methodject subcutaneously
<variant>Methotrexate intramuscularly

321
The initial sign of osteoarthritis of the knee joint is
<variant>Patellofemoral joint lesion (based on radiographic data)
<variant>pain on palpation of the knee joint
<variant>crunching sound when moving the knee joint
<variant>osteophytes (according to radiograph data)
<variant>it hurts when walking up the stairs

322
The leading pathogenetic mechanism of osteoarthritis progression is:
<variant>Articular cartilage degeneration
<variant>Synovitis
<variant>Calcium pyrophosphate crystal deposition
<variant>Bone tissue remodeling
<variant>Atrophy of nearby muscle groups
55
323
A characteristic sign of severe bilateral coxarthrosis is
<variant>"duck walk"
<variant>violation of internal and external rotation of the hips
<variant>limitation of hip abduction and adduction
<variant>hip muscle wasting
<variant>lameness

324
Patient K., 55 years old. Has a body mass index of 32. Complains of pain in the knee joints, which intensifies when
walking, and crunching when moving the joints. Ultrasound examination of the joints shows signs of cartilage
thinning, synovial fluid is within normal values. According to the clinical protocol, from non-drug methods, you
would advise the patient first of all:
<variant>diet and physiotherapy
<variant>just a diet
<variant>physical exercise
<variant>Diet and exercise
<variant>joint immobilization

325
A 64-year-old patient complains of limited mobility in the distal interphalangeal joints of both hands, which arose
about 12 years ago and is gradually progressing. During examination, nodular thickenings in the area of the distal
interphalangeal joints of both hands are noticeable, the fingers are deformed, mobility in them is limited. No
pathology was found on the part of the internal organs. Blood and urine tests are within normal limits. According to
the clinical protocol, treatment tactics:
<variant>teraflex 500/400mg
<variant>methotrexate 2.5 mg
<variant>methylprednisolone 8 mg
<variant>prednisolone 30 mg
<variant>alflutop 20 mg

326
A 52-year-old female patient has been reporting knee joint pain and morning stiffness for up to half an hour for 2
years. Objectively: the knee joints are deformed, there are compactions of the periarticular tissues, mild
hyperthermia, and palpable crepitus. Complete blood count: erythrocytes 4.0 million, leukocytes 5.7 thousand, ESR
16 mm/h, CRP is negative, the Waaler-Rose reaction is 1:8. According to the clinical protocol, the main diagnostic
test for establishing a diagnosis is:
<variant>X-ray of the knee joints
<variant>densitometry
<variant>knee joint puncture
<variant>Magnetic resonance imaging of the knee joints
<variant>arthroscopy

327
The most vivid clinical picture of synovitis with frequent exacerbations is observed in osteoarthritis:
<variant>knee joint
<variant>hip joint
<variant>distal interphalangeal joints of the hands
<variant>I metatarsophalangeal joint
<variant>proximal interphalangeal joints

328
A 24-year-old man complained of pain and swelling of the knee, and scabs on the sole. These symptoms appeared
2 months ago, after diarrhea. According to the clinical protocol, differential diagnostics should first be carried out
with
<variant>infectious arthritis
<variant>idiopathic ankylosing spondylitis
<variant>arthritis in Crohn's disease
<variant>psoriatic arthritis
56
<variant>juvenile ankylosing spondylitis
329
A 30-year-old patient with symptoms of arthritis of the right ankle and knee joints and urethritis was admitted to
the clinic. Based on the clinical examination, he was diagnosed with Reiter's syndrome. According to the clinical
protocol, the main diagnostic procedure in the hospital is:
<variant>ELISA for sexually transmitted infections
<variant>Ultrasound of the prostate, bladder
<variant>PCR for sexually transmitted infections
<variant>Bacteriological examination of urine
<variant>Urologist consultation

330
A 36-year-old man complains of sharp pain in the left knee joint with reddening of the skin, swelling, and limited
mobility. Upon questioning, it turns out that about a month ago he was treated by a urologist he knows for
"urethritis". According to the clinical protocol, the patient should be prescribed:
<variant>Smear for gn and Bordet-Gengou reaction
<variant>X-ray of the knee joint and blood test
<variant>Blood test and urine test
<variant>Consultation with a rheumatologist
<variant>Knee joint puncture with corticosteroid administration

331
A 27-year-old man, a construction worker, complained of pain and swelling in the right ankle. These symptoms
appeared 2 months ago. There were no previous ankle injuries. When questioning the patient, it was established
that 3 weeks ago there was a short episode of red eyes, and 2 times there was pain when urinating. The patient is
sexually active, has several partners. Body temperature is 38.2 ° C. The ankle joint is swollen, hot to the touch, the
skin under the joint is hyperemic, movement is limited due to pain. The toes of the right foot are diffusely swollen
and painful. There is hyperemia on the head of the penis and in the area of the opening of the urethra. Your
diagnosis:
<variant>reactive arthritis
<variant>rheumatoid arthritis
<variant>psoriatic arthritis
<variant>gout
<variant>Behcet's disease

332
A 28-year-old woman was admitted to the hospital with a two-day history of joint pain. Initially, it arose in the
right ankle, then migrated to the left knee, then to the right wrist. The patient had a fever, several hemorrhagic
rashes appeared on the skin of the upper and lower extremities. The patient is sexually active. The menstrual cycle
began 3 days ago. In the tests - leukocytes in the blood 13.5x109 / l, 93% neutrophils and 5% band forms. Your
diagnosis:
<variant>disseminated gonococcemia
<variant>rheumatoid arthritis
<variant>rheumatoid arthritis
<variant>reactive polyarthritis
<variant>Reiter's syndrome

333
A 60-year-old patient, a smoker for over 30 years, complains of persistent, long-term arthralgia in the knee, ankle,
and hip joints. The joints sometimes swell, movement becomes limited, but does not last long. He lost 8 kg in 3
months, and is concerned about decreased appetite, weakness, lethargy, and poor sleep. The tests show anemia and
accelerated ESR. Your tactics:
<variant>Examination to detect tumor process
<variant>Just an observation
<variant>Examination to detect specific joint pathology
<variant>Screening for tuberculosis
<variant>Testing to detect blood disease

334
57
A patient developed acute arthritis of the knee joint 3 months after a kidney transplant. The current treatment
includes cyclosporine, azothioprine, prednisolone. The specialist believes that taking cyclosporine caused acute
gouty arthritis. What treatment should be given to this patient:
<variant>inject diprospan intra-articularly
<variant>prescribe high doses of NSAIDs
<variant>prescribe colchicine
<variant>prescribe systemic hormone therapy
<variant>prescribe methotrexate

335
A patient with sarcoidosis has bilateral adenopathy of the pulmonary roots and erythema nodosum. What joint
changes are most common:
<variant>Painful periarthritis and tenosynovitis of the elbow and knee joints
<variant>Monoarticular arthritis of the wrist
<variant>Oligoarticular arthritis with effusion into the knee joint cavity
<variant>Asymptomatic cysts of the heads of the phalanges
<variant>Bilateral sacroiliitis

336
A 60-year-old woman suddenly developed pain in the knee joints, as well as a feeling of heat and effusion. This
occurred 24 hours after a hysterectomy due to a benign ovarian cyst. The anamnesis includes episodes of bilateral
knee pain. T-37°C, BP-140/80 mmHg. The most likely diagnosis is:
<variant>Pseudogout
<variant>Septic arthritis
<variant>Gout
<variant>Acute rheumatoid arthritis
<variant>Ruptured Baker's Cyst

337
According to the clinical protocol, in a patient with damage to the distal interphalangeal joints, one can notice:
<variant>Psoriatic nail disease
<variant>HLA B27
<variant>Asymmetrical sacroiliitis
<variant>Rheumatoid factor
<variant>No joint involvement

338
One of the rarest signs of psoriatic arthritis is
<variant>symmetrical sacroiliitis
<variant>arthritis of the distal interphalangeal joints
<variant>"sausage-shaped" configuration of toes
<variant>paraarticular phenomena that adequately reflect the activity of arthritis
<variant>close connection with the course of skin syndrome

339
Required for psoriatic arthritis is:
<variant>erosive process in the distal interphalangeal joints
<variant>the presence of an inflammatory process in the joints and/or spine
<variant>latent course of the inflammatory process in the spine
<variant>ankylosis of intervertebral joints
<variant>the first signs of the disease are skin

340
The most typical symptom of psoriatic arthritis is
<variant>intra-articular osteolysis of the distal interphalangeal joints
<variant>the relationship between the development of aortitis and aortic heart disease and activity
peripheral arthritis
<variant>the relationship between amyloid nephropathy and the nature of skin lesions
<variant>pronounced atrophy of the muscles adjacent to the affected joints
58
<variant>arthritis combined with symmetrical sacroiliitis

341
A patient with arthritis of the hand joints was diagnosed with psoriatic arthritis. According to the clinical protocol,
the basic drug is:
<variant>methotrexate
<variant>cuprenil
<variant>prednisolone
<variant>diclofenac
<variant>azothioprine

342
Prevention of osteoporosis development is most effective to begin in the following period:
<variant>After 45 years, approximately 3-5 years before menopause
<variant>At any age
<variant>After 35 years
<variant>After menopause
<variant>5 years after menopause

343
"Favorite" localization of osteoporotic fractures in Itsenko-Cushing's disease:
<variant>Ribs and vertebral bodies
<variant>Flat bones
<variant>Neck of the femur and shoulder
<variant>Medial malleoli of the legs
<variant>Radial bones in the "typical location"

344
A 58-year-old woman is visiting you. She has had 2 fractures in the last 3 years. She notes a 2 cm decrease in
height. From questioning, it was possible to find out that her mother had a hip fracture. Menopause within 10 years.
According to the clinical protocol, your diagnosis is:
<variant>Postmenopausal osteoporosis
<variant>Post-traumatic osteoarthritis
<variant>Osteodystrophy
<variant>Osteomalacia
<variant>Bone metastases

345
A 58-year-old woman is visiting you. A year ago, she suffered a fracture of the right radius. She has no special
complaints. Her height has decreased by 4 cm. Menopause has been going on for 10 years. Examination reveals
pronounced kyphoscoliosis. Questioning revealed that her mother had a femoral neck fracture. Serum calcium
levels are normal. According to the clinical protocol, the following informative examination method should be
prescribed:
<variant>X-ray densitometry
<variant>ultrasound densitometry
<variant>bone sonometry
<variant>magnetic resonance imaging of the spine
<variant>X-ray of the lumbar spine

346
A 60-year-old woman has come to you. She reported that her mother and grandmother had a hip fracture. Her daily
diet contains almost no dairy products. You explain that her daily calcium requirement is:
<variant>1500 mg
<variant>1000 mg
<variant>1200 mg
<variant>850 mg
<variant>1300 mg

347
59
A 15-year-old female patient complains of a rise in body temperature to 37°C, weakness, anxiety, involuntary
movements of the arms and head, and slurred speech. Examination revealed isolated pale pink ring-shaped rashes
on the shins, body temperature 38.2°C. Blood test: leukocytes 8.5 thousand, ESR 29 mm/h. Your diagnosis:
<variant>acute rheumatic fever
<variant>systemic lupus erythematosus
<variant>temporal arteritis
<variant>polyarteritis nodosa
<variant>non-specific aortoarteritis

348
A 78-year-old patient has been diagnosed with senile osteoporosis. According to the clinical protocol, the following
is prescribed:
<variant>alendronic acid
<variant>calcitonin
<variant>estrogens
<variant>calcium preparations
<variant>Vitamin D preparations

349
Over the past 3 years, patient S., 66, has lost 3 cm of height. She has no fractures, but has a kyphotic deformity of
the spine. X-ray examination revealed a wedge-shaped ThXII vertebra. Bone mineral density according to the T
criterion for the vertebra is -2.8, for the femur -2.1. According to the clinical protocol, your diagnosis is:
<variant>osteoporosis
<variant>osteopenia
<variant>osteochondrosis
<variant>osteoarthritis
<variant>osteomalacia

350
A 45-year-old man was admitted to the department complaining of severe pain in the ankle joint ("sheet pain"),
fever up to 37.5C. The attack began suddenly at night. The joint area is swollen, hyperemic, painful. A month ago,
he had a similar attack with damage to the first metatarsophalangeal joint, which resolved spontaneously. In
accordance with the clinical protocol, it is advisable to prescribe the drug.
<variant> indomethacin
<variant> clarithromycin
<variant> prednisolone
<variant> sirdaluda
<variant> tramadol

351
Patient D., 45, has suffered from bronchial asthma since childhood. For many years, she took systemic
glucocorticoids. Currently, her condition is stable. She is concerned about the possible side effects (especially on
bones) of long-term glucocorticoid use. According to the clinical protocol, the patient is recommended to undergo a
study once a year:
<variant>densitometry
<variant>ultrasound examination of joints
<variant>X-ray of bones
<variant>bicycle ergometry
<variant>bronchoprovocation test

352
Such phenomena as fever, polyneuritis, arterial hypertension, broncho-obturator syndrome are most characteristic
of:
<variant>periarteritis nodosa
<variant>systemic lupus erythematosus
<variant>dermatomyositis
<variant>acute rheumatic fever
<variant>infective endocarditis

60
353
The patient's blood pressure in the upper limbs differs by 50 mm Hg. Two years ago he was treated for
tonsillogenic sepsis. The examination revealed noises in the femoral and right carotid arteries. According to the
clinical protocol, pressure asymmetry in the upper limbs is a diagnostic criterion:
<variant>non-specific aortoarteritis
<variant>coarctation of the aorta
<variant>atherosclerotic stenosis of the right carotid artery
<variant>polyarteritis nodosa
<variant>Marfan syndrome

354
On examination of the patient in the emergency room: the general condition is relatively satisfactory. Body
temperature is 37.20C, in the area of the shins there are symmetrically located small-point hemorrhagic rashes,
moderate pain in the ankle joints. The diagnosis is: hemorrhagic vasculitis. The severity of the process:
<variant>Easy
<variant>Medium level
<variant>Heavy
<variant>Extremely difficult
<variant>Relatively satisfactory

355
On examination of the patient in the emergency room: Body temperature 38.80C, in the area of the shins, buttocks,
abdomen there are symmetrically located, in places merged small-point hemorrhagic rashes, swelling and pain in
the knee and ankle joints. When palpating the abdomen, there is pain throughout the abdomen. Tarry feces, urine
the color of "meat slops". Diagnosis: hemorrhagic vasculitis. Severity of the process:
<variant>Heavy
<variant>Medium level
<variant>Easy
<variant>Extremely difficult
<variant>Satisfactory

356
A 20-year-old man fell ill 2 weeks after an acute respiratory viral infection: his body temperature rose to 37.50C, a
small-point rash appeared on his lower limbs, and joint pain. Objectively: symmetrical papular rash on his lower
limbs, pain in the knee and ankle joints. In the blood: leukocytes 9 thousand, ESR 25 mm/h. Your diagnosis:
<variant>hemorrhagic vasculitis
<variant>allergic dermatitis
<variant>polyarteritis nodosa
<variant>thromboangiitis obliterans
<variant>erythema nodosum

357
Patient T., 22 years old. Became ill about 7 months ago: pain in large joints, subfebrile body temperature, dizziness,
headache, sharp decrease in visual acuity in the left eye. On examination: joints are unchanged; systolic murmur is
heard at all points of cardiac auscultation, over the vessels of the neck, abdominal aorta. Pulsation in the left radial
artery is sharply weakened. BP on the right arm is 230/130 mm Hg, on the left 150/130 mm Hg, on the legs
220/110 mm Hg. According to the clinical protocol, the diagnostic criterion for this disease is:
<variant>weakening of pulsation in the radial artery
<variant>increased blood pressure
<variant>decreased visual acuity
<variant>age over 40 years
<variant>arthritis of large joints

358
A 42-year-old patient visits a general practitioner. He is bothered by arthralgia, muscle pain in the lower
extremities, and numbness in the feet. From the anamnesis, it was possible to find out that a month ago the patient
consulted a urologist about pain in the scrotum. He lost 6 kg. BP 180/120 mm Hg. There is a pinkish-reticular
pattern on the skin of the thighs. Blood tests show ESR 40 mm/h; creatinine 520 mmol/l; the HBS antigen test is
positive. According to the clinical protocol, your tactics are:
61
<variant>plasmapheresis in combination with glucocorticoids
<variant>plasmapheresis in combination with intravenous immunoglobulin
<variant>pulse therapy with cytostatics
<variant>glucocorticoids in combination with cytostatics
<variant>pulse glucocorticoid therapy
359
A 42-year-old patient visits a general practitioner. He is bothered by arthralgia, muscle pain in the lower
extremities, and numbness in the feet. From the anamnesis, it was possible to find out that a month ago the patient
consulted a urologist about pain in the scrotum. He lost 6 kg. BP 180/120 mm Hg. There is a pinkish-reticular
pattern on the skin of the thighs. Blood tests show ESR 40 mm/h, urea 50 mg%; the HBS antigen test is positive.
Your diagnosis according to the clinical protocol:
<variant>periarteritis nodosa
<variant>systemic scleroderma
<variant>brucellosis
<variant>Reiter's disease
<variant>Wegener's granulomatosis

360
A 69-year-old woman complained of severe headaches with episodes of vision loss in the right eye for 3 years. The
patient also noted pain and cramps in the jaw muscles when chewing, arthralgia, subfebrile temperature, weight
loss of 2-3 kg. On examination, pain was noted during palpation of the head and both temporal arteries. Noise was
heard over the left carotid artery. In the blood, leukocytes are 11.5 thousand, platelets are 520 thousand. ESR is 50
mm / hour. Your diagnosis:
<variant>Giant cell arteritis
<variant>Rheumatoid arthritis
<variant>Fibromyalgia
<variant>Thrombosis of cerebral vessels
<variant>Migraine

361
A 25-year-old female patient was hospitalized with a severe angina attack. Examination revealed asymmetry of
pulse and blood pressure, stenotic noise in the carotid arteries. Your preliminary diagnosis:
<variant>Takayasu's disease
<variant>Raynaud's disease
<variant>Reiter's disease
<variant>Henoch-Scheinlen disease
<variant>Horton's disease

362
A 40-year-old man complains of loss of appetite, weakness, weight loss, shortness of breath, cough with sputum.
Examination revealed palpable purpura. Radiologically persistent focal infiltrates. According to the clinical
protocol, the identified symptoms are a criterion:
<variant>periarteritis nodosa
<variant>chronic heart failure
<variant>lung cancer
<variant>pulmonary tuberculosis
<variant>microscopic polyarteritis

363
A 50-year-old man was hospitalized due to edema, dyspnea, weight loss, and subfebrile condition. History: severe
hypertension, stroke, myocardial infarction, repeated surgeries for intestinal obstruction. Urine analysis: proteinuria
2.6 g/l, erythrocyturia. HBsAg detected. Your diagnosis according to the clinical protocol:
<variant>periarteritis nodosa
<variant>acute glomerulonephritis
<variant>cirrhosis
<variant>microscopic polyarteritis
<variant>non-specific aortoarteritis

364
62
A 40-year-old patient is being examined in the nephrology department for rapidly progressing glomerulonephritis.
The blood contains p-ANCA, which, according to the clinical protocol, is most often detected in:
<variant>Wegener's granulomatosis
<variant>polyarteritis nodosa
<variant>Churg-Strauss syndrome
<variant>microscopic polyarteritis
<variant>non-specific aortoarteritis

365
A 40-year-old patient has been suffering from hay fever for a long time. He was hospitalized due to an asthma
attack. Radiologically, there is an infiltrate in the upper lobe on the right. According to the clinical protocol, the
characteristic laboratory sign of the disease is:
<variant>eosinophilia
<variant>leukocytosis
<variant>increased ESR
<variant>hypocomplementemia
<variant>lymphocytosis

366
A 28-year-old patient, who suffered a myocardial infarction against the background of high arterial hypertension,
gastrointestinal bleeding due to a duodenal ulcer over the past two years, developed an attack of suffocation,
accompanied by a cough with viscous sputum. On examination: sharply reduced nutrition. Expressed symmetrical
sensory disturbances in the feet. In the blood test, leukocytosis up to 26 * 109 / l, p / y 2%, segments 52%, eosinus
18%, mon 4%, lymph 24%. In the urine test, protein 1.26%0, blood creatinine level is within normal limits. Your
diagnosis according to the clinical protocol:
<variant>Churg-Strauss syndrome
<variant>Wegener's granulomatosis
<variant>periarteritis nodosa
<variant>microscopic polyarteritis
<variant>bronchial asthma

367
A 53-year-old man developed sharp pains in the area of the big toe of his right foot after dinner at a restaurant at
night, and his body temperature rose to 380. Examination revealed swelling of the first metatarsophalangeal joint
and bright hyperemia of the skin around it. Touching the big toe causes a sharp increase in pain. According to the
clinical protocol, the patient should first be prescribed:
<variant>diclofenac 75 mg i/m
<variant>prednisolone 60 mg IM
<variant>Methoject 15 mg s/c
<variant>allopurinol 400mg orally
<variant>paracetamol 1 g orally

368
A 39-year-old patient had an attack of pain accompanied by swelling of the first toe of the left foot 6 months ago.
Currently, he is concerned about pain in the ankle joint of the right leg. The concentration of uric acid in the blood
serum is elevated. According to the clinical protocol, you will prescribe:
<variant>allopurinol
<variant>cyclophosphamide
<variant>basilip
<variant>methotrexate
<variant>prednisolone

369
A 39-year-old patient had two attacks of pain accompanied by swelling of the first toe of the left foot during the
year. After the acute attack was stopped with diet therapy, allopurinol was prescribed at a dose of 200 mg/day.
According to the clinical protocol, therapy is carried out under control of the level of:
<variant>uric acid
<variant>cholesterol
<variant>creatinine
63
<variant>urea
<variant>total protein
370
A 45-year-old man called an ambulance due to severe pain in his right foot, weakness, body temperature of 37.6
0C, headache. You suspect a gout attack. According to the clinical protocol, the informative method for confirming
the diagnosis is:
<variant>Polarization microscopy of synovial fluid
<variant>Analysis of daily urine for uric acid
<variant>Clinical blood test
<variant>Blood test for uric acid
<variant>X-ray of feet

371
A patient developed acute arthritis of the knee joint 3 months after a kidney transplant. The current treatment
includes cyclosporine, azothioprine, prednisolone. The specialist believes that the attack is associated with taking
cyclosporine. What caused cyclosporine:
<variant>acute gouty arthritis
<variant>rheumatoid arthritis
<variant>infectious arthritis
<variant>tuberculous arthritis
<variant>rheumatoid arthritis

372
A 47-year-old patient has the following combination of symptoms: early involvement of the metatarsophalangeal
joint of the big toe, during an exacerbation, sharp redness, joint defiguration, fever, subcutaneous nodules on the
auricles and elbows. Your diagnosis, according to the clinical protocol:
<variant>Chronic tophaceous gout
<variant>Acute gouty oligoarthritis
<variant>Rheumatoid polyarthritis
<variant>Osteoarthritis
<variant>Reactive polyarthritis

373
A 49-year-old female patient has been diagnosed with an acute attack of gout. She has been suffering from this
disease for 10 years with exacerbations 2-3 times a year. According to the clinical protocol, the radiological sign of
the disease is:
<variant>Puncher's Symptom
<variant>destructive arthritis
<variant>erosive arthritis
<variant>calcification of cartilage
<variant>calcification of periarticular tissues

374
Patient P., 40 years old, took ketonal 3 times a day for a week due to gout. Yesterday he noticed black stool. He
notes dizziness, weakness, shortness of breath. Your diagnosis:
<variant>gastrointestinal bleeding
<variant>inflammation of the hemorrhoidal node
<variant>acute renal failure
<variant>toxic hepatitis
<variant>acute heart failure

375
Patient P., 40 years old, took ketonal 3 times a day for a week due to gout. Yesterday he noticed black stool. He
notes dizziness, weakness, shortness of breath. Do you recommend:
<variant>Control
<variant>Vikasol
<variant>Prednisolone
<variant>Dicenon
<variant>Omeprazole
64
376
Patient A., 45, was admitted to the department with an attack of acute arthritis of the right ankle joint. The attack
began suddenly, in the morning. Accompanied by a rise in temperature to 37.50C. The joint area is swollen,
hyperemic, painful. A month ago, he noted a similar attack, with damage to the metatarsophalangeal joint of the
right leg, which passed on its own. According to the clinical protocol, mandatory diagnostic tests include:
<variant>serum uric acid concentration test, X-ray examination
<variant>X-ray examination, determination of rheumatoid factor
<variant>General blood and urine analysis
<variant>X-ray examination, general blood and urine analysis
<variant>joint puncture

377
A 36-year-old female patient has been diagnosed with an acute attack of gout. According to the clinical protocol,
the following should be used first:
<variant>indomethacin
<variant>allopurinol
<variant>prednisolone
<variant>aspirin
<variant>paracetamol

378
A 45-year-old man developed a relapse of acute arthritis with severe pain in the first metatarsophalangeal joint.
According to the clinical protocol, the following is used to relieve acute symptoms:
<variant>lornaxicam
<variant>allopurinol
<variant>butadion
<variant>probenecid
<variant>paracetamol

379
According to the clinical protocol, in systemic scleroderma, a drug that suppresses collagen formation:
<variant>cuprenil
<variant>delagil
<variant>azathioprine
<variant>prednisolone
<variant>cyclosporine

380
A 50-year-old female patient complains of "mechanical" pain in the knee joints, which intensifies after walking.
Objectively: deformation of the distal interphalangeal joints of the hands in the form of dense nodules and
subluxations. The knee joints are deformed, the periarticular tissues are compacted. In the blood: erythrocytes 4.2
million, leukocytes 6.6 thousand, ESR 25 mm/hour. The patient received non-steroidal anti-inflammatory drugs for
3 months, but the pain syndrome was not relieved. In accordance with the clinical protocol, the most appropriate
tactics are:
<variant>perform arthroscopy
<variant>prescribe chondroprotectors
<variant>prescribe prednisolone
<variant>prescribe colchicine
<variant>perform the Wright-Heddelson reaction

381
A 20-year-old patient was bothered by swelling and pain in the knee and ankle joints six months ago. A month ago,
pain appeared in the chest, lumbar spine, and left hip joint. Objectively, pain along the spine is determined, flexion
in the left hip joint and spine is difficult, deformation in the area of the left sternoclavicular joint; signs of iritis. In
accordance with the clinical protocol, the most appropriate tactics are:
<variant>Sulfasalazine+Arcoxia
<variant>Diclofenc+methotrexate
<variant>Prednisolone
65
<variant>D-penicillamine
<variant>Chloroquine + indomethacin ointment 10%
382
A 65-year-old female patient complains of intense headache in the frontal and parietal areas on the left, increased
body temperature to 37.2 °C, sleep disturbances, and decreased appetite. Objectively, thickening, tortuosity, and
tenderness on palpation along the left temporal artery, and redness of the skin in this area are determined. Blood
test: leukocytes 6.5 thousand, ESR 34 mm/hour; CRP +++. In accordance with the clinical protocol, the patient
should be prescribed:
<variant>Prednisolone
<variant>Movalis
<variant>D-penicillamine
<variant>Methotrexate
<variant>Azathioprine

383
A 28-year-old female patient complains of severe weakness, weight loss, fever up to 37.5°C, pain and swelling in
the ankle and wrist joints, and increased bleeding. Examination revealed discoid lesions on the skin with hyperemic
edges and depigmentation in the center, hepatosplenomegaly, and lymphadenopathy. Blood test: erythrocytes 1.5
million, leukocytes 2.5 thousand, platelets 46 thousand. According to the clinical protocol, the most appropriate
treatment is:
<variant>methylprednisolone pulse therapy
<variant>hydroxychloroquine
<variant>azathioprine
<variant>cyclophosphamide pulse therapy
<variant>methotrexate

384
A 45-year-old patient has attacks of peripheral vasospasm similar to Raynaud's syndrome, symmetrical thickening
of the skin in the area of the proximal interphalangeal joints of the fingers. EGD: reflux esophagitis. Chest X-ray:
bilateral basal pulmonary fibrosis. According to the clinical protocol, the most appropriate treatment is:
<variant>D-penicillamine
<variant>Methotrexate
<variant>Cyclophosphamide
<variant>Azathioprine
<variant>Plaquenil

385
A 28-year-old female patient reports the appearance of erythematous spots on her face, an increase in body
temperature to 39 degrees, weight loss, intense polyarthralgia, the appearance of edema and an increase in blood
pressure one month after childbirth. The examination revealed: Hb 90 g / l, ESR 50 mm / h, fibrinogen 6 g / l,
albumins 30%, LE cells 5: 1000 leukocytes. Your diagnosis:
<variant>systemic lupus erythematosus
<variant>systemic scleroderma
<variant>dermatomyositis
<variant>diffuse eosinophilic fasciitis
<variant>polymyalgia rheumatica

386
The presence of fever, polyneuritis, arterial hypertension, broncho-obstructive syndrome are most characteristic of:
<variant>periarteritis nodosa
<variant>systemic lupus erythematosus
<variant>dermatomyositis
<variant>acute rheumatism
<variant>infective endocarditis

387
A 23-year-old patient complains of intense pain and stiffness in the lower back and hip joints. Radiography
revealed uneven contours and narrowing of the joint spaces in the sacroiliac joints. According to the clinical
protocol, the most effective treatment tactics are:
66
<variant>sulfasalazine + movalis
<variant>prednisolone + diclofenac
<variant>prednisolone + metatrexate
<variant>Tauredon + Celebrex
<variant>cyclosporine + prednisolone

388
In gouty arthritis, the joint initially affected is:
<variant>1st metatarsal phalangeal
<variant>hip
<variant>knee-
<variant>radiocarpal
<variant>brachial

389
A sign that excludes the diagnosis of rheumatoid arthritis:
<variant>distal interphalangeal joint disease
<variant>morning stiffness
<variant>erosion of articular surfaces
<variant>ankylosis of joints
<variant>periarticular tissue damage
390

A 20-year-old man has joint pain, urethritis, and conjunctivitis. Probable diagnosis:
<variant>Reiter's disease
<variant>psoriatic arthropathy
<variant>Sjogren's syndrome
<variant>Felty's syndrome
<variant>sarcoidosis

391
A 24-year-old woman complains of numbness in the left half of the body, dizziness when raising her arm, visual
impairment, and stabbing pain in the heart. Angiography revealed severe stenosis of the left brachial and radial
arteries. There is an elevated level of antibodies to cardiolipin in the blood. Echocardiography shows signs of aortic
valve insufficiency. ESR is 60 mm/hour. The most likely diagnosis is:
<variant>Non-specific aortoarteritis
<variant>Systemic lupus erythematosus
<variant>Polyarteritis nodosa
<variant>Primary antiphospholipid syndrome
<variant>Raynaud's syndrome

392
A 21-year-old woman has recurrent purulent sinusitis, ulcerative necrotic tonsillitis, hemoptysis, weight loss, fever,
and arthralgia. On examination: ulcerative necrotic lesion of the wings of the nose, purulent discharge from the
eyes and nose. In the general blood test - ESR 70 mm / h, in the general urine test - erythrocytes 15-17 in the field
of vision, creatinine - 146 μmol / l. According to the clinical protocol, it is necessary to prescribe:
<variant>Cyclophosphamide
<variant>Methylprednisolone
<variant>Infliximab
<variant>Prednisolone
<variant>Methotrexate

393
A 34-year-old patient with systemic lupus erythematosus, receiving prednisolone 20 mg/day, complains of fever,
erythematous rash on the face, edema, headache, memory loss, paresthesia. Examination revealed nephrotic
syndrome, leukopenia, high levels of antibodies to native DNA. She associates the exacerbation of the disease with
a medical abortion complicated by endometritis. According to the clinical protocol, the optimal treatment tactics
are:
<variant>Methylprednisolone pulse therapy
67
<variant>increase the dose of prednisolone to 40-50 mg/day
<variant>stop prednisolone, prescribe azathioprine
<variant>stop prednisolone, prescribe cyclophosphamide
<variant>add chrysanol

394
Treatment method for a patient with rheumatoid arthritis, if she does not have fever, visceritis and vasculitis, there
is effusion in the knee joints; ESR 35 mm/h; duration of the disease is 6 months, has not been treated before:
<variant>Cytostatics in combination with nonsteroidal anti-inflammatory drugs
<variant>Non-steroidal anti-inflammatory drugs only
<variant>Only gold preparations
<variant>D-penicillamine in combination with nonsteroidal anti-inflammatory drugs
<variant>Combination of nonsteroidal anti-inflammatory drugs with intra-articular administration of kenalog

395
Rheumatoid arthritis is characterized by:
<variant>positive latex test and Vaaler-Rose reaction
<variant>presence of LE cells
<variant>high titer of antistreptolysin – O
<variant>presence of monoclonal protein
<variant>high serum uric acid levels

396
Your probable diagnosis for a 48-year-old female patient with complaints of a formation in the projection of the
parotid glands; for 5-6 weeks, she has been bothered by dry mouth, a sensation of a foreign body in the eye,
photophobia, lack of tears; subfebrile condition, periodic polyarthralgia:
<variant>Sjogren's disease
<variant>Sharp syndrome
<variant>Felty's syndrome
<variant>Whipple's disease
<variant>Takayasu's disease

397
Rheumatoid nodules are usually found in:
<variant>periarticular tissues
<variant>skin
<variant>cartilages
<variant>visceral organs
<variant>bones

398
Along with arthritis, enlargement of the spleen and peripheral lymph nodes is characteristic of:
<variant>Felty's syndrome
<variant>Sjogren's syndrome
<variant>Bechterew's disease
<variant>psoriatic arthritis
<variant>Reiter's disease

399
Early limitation of respiratory excursion of the chest is characteristic of:
<variant>Bechterew's disease
<variant>osteochondrosis of the thoracic spine
<variant>polyarteritis nodosa
<variant>systemic scleroderma
<variant>rheumatoid arthritis

400
The clinical picture of early sacroiliitis is characteristic of:
<variant>Bechterew's disease
68
<variant>rheumatoid arthritis
<variant>gout
<variant>brucellosis
<variant>rheumatism

401
Increased activity of creatine phosphokinase in the blood serum is most typical for:
<variant>dermatomyositis
<variant>rheumatoid arthritis
<variant>systemic scleroderma
<variant>polyarteritis nodosa
<variant>systemic lupus erythematosus

402
For the diagnosis of Goodpasture syndrome, it is important to identify:
<variant>circulating antibodies to the renal basement membrane
<variant>leukocytosis and increased ESR
<variant>acute phase proteins
<variant>iron deficiency anemia
<variant>increased blood creatinine

403
Chronic purulent rhinitis, otitis, arthritis with arthromyalgia, hemorrhagic vasculitis of the skin, infiltrates in the
lungs with decay are characteristic of:
<variant>Wegener's granulomatosis
<variant>polyarteritis nodosa
<variant>Takayasu's disease
<variant>Goodpasture's syndrome
<variant>scleroderma

404
With non-specific aortoarteritis the following are affected:
<variant>large arteries
<variant>medium caliber arteries
<variant>veins
<variant>small caliber arteries
<variant>capillaries

405
With scleroderma, the following parts of the gastrointestinal tract are most often damaged:
<variant>esophagus
<variant>stomach
<variant>12 duodenum
<variant>small intestine
<variant>colon

406
Heberden's nodes represent:
<variant>marginal bone growths of the epiphyses of the terminal phalanges
<variant>deposition of uric acid crystals in tendons, cartilage, synovial membrane, and bone base of the joint
<variant>infiltration of the dermis, synovial membrane by histiocytes and giant cells that contain lipids
<variant>focal necrosis of subcutaneous tissue with chronic inflammation
<variant>deposition of calcium salts in subcutaneous tissue, muscles

407
According to the clinical protocol, the drug of choice for an acute attack of gout is:
<variant>indomethacin
<variant>butadion
<variant>cyclophosphamide
69
<variant>benethazon
<variant>allopurinol

408
According to the clinical protocol, the following are preferred in the treatment of dermatomyositis:
<variant>corticosteroids
<variant>nonsteroidal anti-inflammatory drugs
<variant>aminoquinoline drugs
<variant>cytostatics
<variant>broad spectrum antibiotics

409
Long-term use of the following drug may lead to the development of erythematous skin lesions:
<variant>cuprenil
<variant>chrysanol
<variant>endoxan
<variant>Plaquenil
<variant>Andindomethacin

410
Osteolysis of the distal phalanges of the fingers is most often observed in:
<variant>scleroderma
<variant>rheumatoid arthritis
<variant>ankylosing spondylitis
<variant>intermittent dropsy of the joints
<variant>dermatomyositis

411
Malignant neoplasms most often accompany:
<variant>dermatomyositis
<variant>systemic lupus erythematosus
<variant>systemic scleroderma
<variant>polyarteritis nodosa
<variant>Behcet's syndrome

412
A 35-year-old female patient suffering from chronic rheumatic heart disease was admitted to the hospital with
symptoms of decompensated heart failure. Heart auscultation revealed a quail rhythm, accentuated second heart
sound in the pulmonary artery, and protodiastolic murmur. EchoCG revealed the area of the left atrioventricular
orifice to be 1.2 cm2. According to the clinical protocol, the patient management tactics aimed at reducing the
progression of heart failure were:
<variant>mitral commissurotomy
<variant>continuous antibacterial therapy
<variant>chronic glucocorticosteroid therapy
<variant>chronic therapy with angiotensin converting enzyme inhibitors
<variant>cardiac glycoside therapy

413
Joint damage at the onset of the disease, allowing to exclude the diagnosis of rheumatoid arthritis:
<variant>distal interphalangeal
<variant>wrist
<variant>knee
<variant>metacarpophalangeal
<variant>proximal interphalangeal

414
A 30-year-old female patient has been suffering from polyarthritis for 4 years. Lymph node enlargement and
hepatosplenomegaly have been observed for 6 months. Blood: hemoglobin 85 g/l, leukocytes 3x109/l, ESR 34
mm/h. Vaaler-Rose reaction 1:128. The most correct diagnosis is:
70
<variant>Felty's syndrome
<variant>chronic active hepatitis with systemic manifestations
<variant>systemic lupus erythematosus
<variant>osteoarthritis
<variant>Still's syndrome

415
A sign characteristic of Felty's syndrome in patients with rheumatoid arthritis:
<variant>splenomegaly
<variant> endocarditis
<variant>pericarditis
<variant>hepatomegaly
<variant>pleurisy

416
The laboratory marker that is most important in the diagnosis of early rheumatoid arthritis:
<variant>Anti-cyclic citrullinated peptide antibodies
<variant>rheumatoid factor
<variant>neutrophilic leukocytosis
<variant>anemia
<variant>thrombocytopenia

417
A 52-year-old female patient has been experiencing shortness of breath with little physical exertion and weakness
for 2 weeks. History: has suffered from rheumatoid arthritis for 10 years. Regularly takes methotrexate. Chest X-
ray shows dilated lung roots, increased pulmonary pattern, honeycomb-shaped lungs. Spirogram: decreased forced
expiratory volume. The patient developed a complication:
<variant>pulmonary fibrosis
<variant>chronic obstructive pulmonary disease
<variant>pneumonia
<variant>pneumonitis
<variant>chronic bronchitis

418
Patient K., 50, complains of pain in the knee joints, more on the right, increasing with walking; morning stiffness
for up to half an hour. Objectively: the knee joints are deformed, there are compactions of the periarticular tissue,
hyperthermia on the right, crepitus, the range of motion in the joints is preserved. Dense nodules and subluxations
of the fingers were found in the area of the distal interphalangeal joints. CBC: erythrocytes 4.2 million, leukocytes
5.6 thousand, ESR 15 mm / hour. CRP is negative, Waaler-Rose reaction 1: 8. Your diagnosis.
<variant>osteoarthritis with reactive synovitis
<variant>rheumatoid arthritis
<variant>psoriatic arthritis
<variant>reactive arthritis
<variant>gouty arthritis

419
Patient K., 50, complains of pain in the knee joints, more on the right, increasing with walking, morning stiffness
for up to half an hour. Minor pain in the joints has been bothering her for the past two years, she notes that the pain
increases after long walks. Objectively: the knee joints are deformed, periarticular tissue compactions are revealed,
hyperthermia on the right, crepitus under the arm, the range of motion is preserved. Erythrocytes 4.2 million,
leukocytes 5.6 thousand, ESR 15 mm / hour. CRP is negative, the Waaler-Rose reaction is 1: 8. In accordance with
the clinical protocol, the necessary examination to establish a diagnosis.
<variant>X-ray of joints
<variant>rheumatoid factor determination
<variant> mmagnetic resonance tomographyjoints
<variant>synovial fluid analysis
<variant>determination of uric acid levels

420
71
A syndrome characterized by damage to the salivary and lacrimal glands in rheumatoid arthritis:
<variant>Sjogren
<variant>Kaplan
<variant>Felty
<variant>Reuters
<variant>Pseudoseptic

421
Syndrome in rheumatoid arthritis with characteristic lung damage:
<variant>Kaplan
<variant>Felty
<variant>Sjogren
<variant>Reuters
<variant>Peudo-septic

422
Patient A., 30 years old, complains of pain and swelling in the joints of the hands, difficulty moving the joints in
the morning. Objectively: symmetrical defiguration of the proximal interphalangeal joints of the II-IV fingers of
both hands is noted. Movement in the specified joints, especially extension, is limited due to pain and exudative
phenomena. In the blood: erythrocytes 4 million, hemoglobin 128 g / l, leukocytes 10 thousand, ESR 41 mm / hour,
CRP - positive. Examination is necessary to clarify the diagnosis.
<variant>determination of ACCP titer
<variant>Definition of H LAB-27
<variant>Wright and Heddelson reactions
<variant>determination of titer of antistreptococcal antibodies
<variant>murexide test

423
Patient K., 19, welder. She fell ill acutely, her body temperature rose to 39C, she developed a sore throat, coughing,
and facial flushing, which she associated with a burn from welding. She took ampicillin and paracetamol on her
own. She was hospitalized due to worsening symptoms. Objectively: hyperemia and swelling of the face.
Erythematous-papular rash on the chest and back. Lymphadenopathy. BP 150/90 mmHg, HR 110 per minute.
Hepatomegaly. In the blood: erythrocytes 3.2 million, Hb 100 g / l, leukocytes 3 thousand, ESR 40 mm / hour.
Uroaminal analysis: protein - 0.9 g / l, erythrocytes 1-8 in the field of vision. Your preliminary diagnosis:
<variant>systemic lupus erythematosus
<variant>drug disease
<variant>allergic dermatitis
<variant>acute tonsillitis
<variant>agranulocytosis

424
Fever due to diffuse connective tissue involvement with histological features of nephritis with the symptom of
"wire loops", fibrinoid, hyaline thrombi and nuclear pathology indicates:
<variant>systemic lupus erythematosus
<variant>rheumatoid arthritis
<variant>Crohn's disease
<variant>polyarteritis nodosa
<variant>chronic glomerulonephritis

425
Patient T., 26, complains of fever up to 40C, shortness of breath, cough, pain in small joints of hands. History:
spontaneous miscarriage a month ago. Objectively: malnutrition, lymphadenopathy, erythema of cheeks and bridge
of nose, "livedo reticularis" on skin of extremities. Changes in internal organs - polyserositis (pleurisy,
pericarditis), carditis, nephritis. In blood: erythrocytes 2.4 million, hemoglobin 70 g / l, leukocytes 2.2 thousand
ESR 70 mm / hour. UAN: protein 5.2 g / s, erythrocytes 20-30 in the field of vision, antibodies to double-stranded
DNA - positive. In accordance with the clinical protocol, additional examination to clarify the diagnosis:
<variant>Determination of antibodies to cardiolipin
<variant>rheumatoid factor determination
<variant>determination of titer of antistreptococcal antibodies
72
<variant>bacteriological blood culture
<variant>enzyme immunoassay for urogenital infection
426
Patient T., 16, complains of fever up to 40C, dyspnea, cough, edema. Objectively: malnutrition, lymphadenopathy,
erythema of the cheeks and bridge of the nose, signs of polyserositis (pleurisy, pericarditis, perivisceritis), carditis,
nephritis. In the blood: erythrocytes 2.4 million, Hb70 g / l, leukocytes 2.2 thousand, ESR70 mm / h. UAN: protein
5.2 g / s, erythrocytes 20-30 in the field of vision, Le-cells 5: 1000. In accordance with the clinical protocol, the
dose of methylprednisolone for pulse therapy.
<variant>1000 mg
<variant>60 mg
<variant>100 mg
<variant>150 mg
<variant>500 mg

427
In accordance with the clinical protocol, the indication for the administration of cytostatics in systemic lupus
erythematosus
<variant>lupus nephritis, carditis, arthritis
<variant> thrombocytosis
<variant> arthralgia
<variant>polyserositis
<variant>cytopenia

428
Patient L., 35, has been bothered by unpleasant sensations and dull pains in the left chest and left limbs for 5 years.
Skin changes have appeared in the last 3 years. Objectively: on the left half of the body and on the left limbs there
are brownish-brown lesions of various shapes of considerable size, protruding above the skin level, with a smooth
and shiny surface, separated from the healthy skin by a narrow bluish-red border. No abnormalities were found in
the internal organs. Your preliminary diagnosis.
<variant>limited scleroderma
<variant>dermatomyositis
<variant>systemic lupus erythematosus
<variant>psoriatic arthropathy
<variant>systemic scleroderma

429
Patient I., 24 years old, complains of sharp pain in the left knee and ankle joints, swelling and limited movement in
them, an increase in temperature to 38With and painful urination. Objectively: the left knee and ankle joints are
swollen, hot to the touch, sharply painful on palpation, tendons and the right heel bone are painful. In the blood:
Hb-130 g / l, erythrocytes 3.8 million, leukocytes 10 thousand, ESR 46 mm / h, CRP (+++). RF in latex test 1:10.
In accordance with the clinical protocol, the drug required for treatment:
<variant>macrolide antibiotic
<variant>nonsteroidal anti-inflammatory drug
<variant>cytostatic
<variant>gold preparation
<variant>quinoline drug

430
Patient N., 45, complains of pain and swelling in the left knee joint and right heel. History: about a month ago he
was treated for acute dysentery. Objectively: defiguration of the left knee joint and the area of the right heel,
hyperemia of the skin. Vesicular breathing in the lungs. Heart sounds are sonorous, the rhythm is regular, pulse is
84 per minute. The abdomen is soft, painless. In the blood: erythrocytes 4.2 million, leukocytes 11 thousand, ESR
26 mm / hour. Your preliminary diagnosis.
<variant>reactive arthritis
<variant>acute rheumatic fever
<variant>rheumatoid arthritis
<variant>septic arthritis
<variant>gout

73
431
Patient G., 30, after suffering from the flu, developed muscle pain, muscle weakness, eyelid swelling, shortness of
breath with the slightest physical exertion, nasal voice, dysphagia. Objectively: awkward, hobbling gait, eyelid
swelling, erythematous rash on the upper eyelids, cheekbones, wings of the nose, in the décolleté "zone". Palpation
revealed pain in the muscles of the shoulder girdle, thighs, difficulty raising the arms upward. In the blood:
erythrocytes 4.5 million, Hb 110 g / l, leukocytes 7 thousand, ESR 66 mm / h. Sensitive and specific test for
diagnosis:
<variant>increase in creatine phosphokinase
<variant>increase in erythrocyte sedimentation rate
<variant>increase in antibodies to double-stranded DNA
<variant>high titer of rheumatoid factor
<variant>leukocytosis, with a shift in the leukocyte formula to the left

432
A 48-year-old woman complains of weakness, malaise, joint pain, abdominal distension, belching, and unstable
stool. Objectively: dry skin, foci of hyper- and hypopigmentation, pale mucous membranes, abdominal distension
due to flatulence. Ultrasound: hepatosplenomegaly, v.portae 1.5 cm. Blood: anemia, thrombocytopenia. FGDS:
grade 2 varicose veins of the lower third of the esophagus, "red spots" symptom. History of type 2 diabetes
mellitus. Blood pressure: 110/85 mm Hg. To prevent possible complications, the following should be prescribed:
<variant> carvedilol
<variant> nifedipine
<variant> bisoprolol
<variant> nitroglycerin
<variant> omeprazole

433
A 53-year-old man has a history of liver cirrhosis as a result of viral hepatitis C. In the last week after an acute
respiratory viral infection, weakness has been increasing, sleep disturbances in the form of drowsiness during the
day and insomnia at night, periods of euphoria are replaced by periods of apathy. On admission, the condition is
severe, consciousness is confused, psychomotor agitation. The liver is at the costal margin, urine is dark.
Respiration is 24 per minute, pulse is 100 beats per minute, blood pressure is 90/60 mm Hg. The main drug in the
treatment of this complication:
<variant> L-ornithine-L-aspartate
<variant> lactulose
<variant> ademetionine
<variant> ursodeoxycholic acid
<variant> rifaximin

434
A 45-year-old woman complained of jaundice, which first appeared against the background of an acute
respiratory viral infection 2 months ago. At that time, an examination revealed an increase in the level of
unconjugated bilirubin. Episodes of jaundice recurred 2 more times. Examination revealed dark skin in the folds.
An ultrasound scan a year ago showed no pathology. Current ultrasound shows stones filling ¼ of the gallbladder.
In the blood, erythrocytes 3.2×1012/l, hemoglobin 82 g/l, ESR 30 mm/h. What is most likely to be revealed in a
urine test?
<variant> hemosiderinuria
<variant> proteinuria
<variant> glycosuria
<variant> cylindruria
<variant> erythrocyturia

435
A 62-year-old man complains of pain in the right hypochondrium, jaundice, fever, and itchy skin. Objectively:
icterus of the skin, traces of scratching. The tongue is moist, coated with a yellowish coating. Palpation of the
abdomen is painful, an increase in the size of the liver is determined, its edge is rounded, the abdomen is not
bloated. It is necessary to examine first of all:
<variant> total bilirubin, alkaline phosphatase
<variant> acid phosphatase, lactate dehydrogenase
<variant> urea, creatinine
74
 <variant> total protein, albumin
<variant> creatine phosphokinase MB, myoglobin

436
A 65-year-old man suffers from type II diabetes mellitus, BMI 36.0, does not drink alcohol. Upon examination,
his condition is moderate, liver +0.5-1.0 cm, spleen +1.0-1.5 cm. In the biochemical blood test - ALT 45 U/l,
AST 60 U/l, ALP 240 U/l, total bilirubin 24.0 μmol/l, albumin 30 g/l, PTI - 65%. EGDS - grade 1 esophageal
varices. Liver elastography is 10.5 kPa (F3), IHA: HBsAg, aHCV are negative. Probable diagnosis:
<variant> liver cirrhosis as a result of non-alcoholic steatohepatitis
<variant> liver cirrhosis as a result of viral hepatitis B
<variant> cirrhosis of the liver of unknown etiology
<variant> nonalcoholic steatohepatitis
<variant> chronic hepatitis of unknown etiology

437
A 54-year-old man, N., was admitted to the department complaining of periodic "girdle-like" pain in the upper
abdomen, which intensified soon after eating and when lying on his back, repeated vomiting, frequent loose
stools (up to 3-5 times a day) with the release of copious feces with a greasy sheen and mushy consistency. Two
days before admission, the patient developed the above complaints due to a violation of his diet (eating fatty, fried
foods). On examination: Height - 169 cm, weight - 50 kg, BMI - 17 kg/m2. Tongue is moist, coated with a white
coating. The abdomen is soft, painful in the Chauffard zone. The liver is not enlarged. The following group of
drugs is the main one in the treatment of this pathology during remission:
<variant> pancreatic enzymes
<variant> probiotics
<variant> antispasmodics
<variant> proton pump inhibitors
<variant> choleretics

438
Postprandial distress syndrome is characteristic of:
<variant> Functional dyspepsia
<variant> Achalasia cardia
<variant> Gastroesophageal reflux disease
<variant> Pancreatitis
<variant> Gallstone disease

439
According to the clinical protocol, granulomatous gastritis occurs in:
<variant> Crohn's disease
<variant> Whipple's disease
<variant> Helicobacter pylori infection
<variant> Itsenko-Cushing's disease
<variant> Intestinal dysbacteriosis

440
In a patient with atrophic gastritis, the production of antibodies to the parietal cells of the stomach and Castle
factor, the first manifestation of the disease is damage to:
<variant> Central nervous system
<variant> Peripheral nervous system
<variant> Adrenal
<variant>Pancreas
<variant> Intestines

441
Autoimmune hepatitis type 1 is characterized by:
<variant> Smooth muscle antibodies (SMA)
<variant> Antibodies to liver-kidney microsomes (ALKM-1)
<variant> Antibodies to soluble liver antigen (SLA)
<variant> Antibodies to liver-pancreatic antigen (LP)
75
 <variant> Tropoisomerase antibodies (Scl-70)

442
The factors of intestinal resistance to the effects of pathological flora are:
<variant> Bifidobacteria
<variant>Lactobacilli
<variant> Enterobacter
<variant> Proteus
<variant> Klebsiella

443
According to the clinical protocol, the drug of choice for the treatment of esophageal achalasia:
<variant> Isosorbide nitrate
<variant> Verapamil
<variant> Phentolamine
<variant> Diltiazem
<variant> Domperidone

444
A 58-year-old man complains of a burning sensation and pressure under the xiphoid process, occurring 20-30
minutes after eating, with irradiation under the left shoulder blade. Radiography reveals a "niche" on the posterior
wall of the subcardial region of the stomach. According to the clinical protocol, it is advisable to prescribe the
drug:
<variant> omeprazole
<variant> cerucal
<variant> eglonil
<variant> retabolil
<variant> motilium

445
A 41-year-old woman complains of pain in the right hypochondrium that occurs after eating fatty foods.
Objectively: overnutrition, moderate pain at the projection point of the gallbladder upon palpation. In the blood -
leukocytes 6.9 thousand, ESR 12 mm / h, cholesterol 7.3 mmol / l. On ultrasound of the abdominal cavity - a
calculus 0.8 cm in diameter was found in the cavity of the gallbladder. The most appropriate drug:
<variant> chenodeoxycholic acid
<variant> flamin
<variant> holagol
<variant> ampicillin
<variant> platifillin

446
A 36-year-old woman complains of pain in the lower quadrants of the abdomen, loose mushy stools 2-3 times a
day without visible pathological impurities. On examination - malnutrition, multiple aphthae in the oral cavity,
pain along the intestines on palpation. Rectomanoscopy - anal fissures. Irrigoscopy - ulcers of various sizes and
shapes, intestinal strictures, mucous membrane of the "cobblestone" type are revealed. Your diagnosis:
<variant> Crohn's disease
<variant> chronic colitis
<variant> intestinal tuberculosis
<variant> intestinal amyloidosis
<variant> nonspecific ulcerative colitis

447
According to the clinical protocol, taking the following drugs can cause ulcerative lesions of the gastrointestinal
mucosa:
<variant> aspirin
<variant> metronidazole
<variant> clarithromycin
<variant> sucralfate
<variant> amoxicillin
76
448
According to the clinical protocol, endoscopic examination for Crohn's disease can reveal:
<variant> "cobblestone" mucous membrane
<variant> absence of vascular pattern
<variant> oblong ulcers
<variant> millet abscesses
<variant> purulent abscesses

449
A 46-year-old man complains of weakness, sleep and attention disorders, memory loss, handwriting has recently
changed, nosebleeds, bruises. The skin is dry, there are hypo- and hyperpigmentation areas, white nails,
telangiectasias on the chest and face. The liver protrudes from under the costal margin by 1 cm, it is dense. The
spleen is 15x8 cm. Free fluid is detected in the abdominal cavity. ALT - 28 IU / ml, AST - 24 IU / ml, bilirubin
143 μmol / l, PTI - 45%, total protein - 57 g / l, albumin - 32 g / l. liver elastography - 43 kPa. Result of FGDS:
<variant> dilated veins in the lower third of the esophagus, bulging into the lumen
<variant> bands of hyperemia of the gastric mucosa converging towards the cardia
<variant> hyperemia of the lower third of the esophagus
<variant> ulcerative defect along the greater curvature of the stomach
<variant> atrophic gastric mucosa with pronounced venous pattern

450
A man was admitted with complaints of an enlarged abdomen, discomfort in the right and left hypochondrium,
sleep inversion (sleepiness during the day, insomnia at night), and constipation. All these symptoms appeared 3
months ago. Ultrasound revealed hepatosplenomegaly and ascites. Over the past week, weakness has been
increasing, with an increase in temperature to subfebrile numbers, abdominal pain, and decreased diuresis. In the
complete blood count: leukocytes 9.9×109/l, p -5%, c - 75%, m - 1%, l - 19%, erythrocytes 3.5×1012/l,
hemoglobin 112 g/l, ESR 30 mm/h. The patient has a probable complication:
<variant> spontaneous bacterial peritonitis
<variant> acute liver failure
<variant> addition of intestinal infection
<variant> hepatorenal syndrome
<variant> urinary tract infection

451
A 52-year-old patient complains of difficulty swallowing, especially solid food, regurgitation, pain and a feeling
of a food lump being retained behind the breastbone, not associated with physical exertion. To facilitate
swallowing, he is forced to wash down food with a glass of warm water. The listed symptoms have been
bothering him for 5 years. The patient's general condition is not affected, weight is 70 kg with a height of 164 cm.
According to the clinical protocol, your diagnosis is:
<variant> Achalasia of the cardia
<variant> Gastroesophageal reflux disease
<variant> Esophageal cancer
<variant> Barrett's esophagus
<variant> Hiatal hernia

452
A 52-year-old patient complains of difficulty in passing food, "getting stuck" at the level of the esophagus, 2-4
seconds after the start of swallowing, especially solid food. To facilitate swallowing, he is forced to wash down
food with a glass of warm water. The listed symptoms have been bothering him for 4 years. The patient's general
condition is not affected, weight is 70 kg with a height of 164 cm. According to the clinical protocol, to relieve
symptoms, it is necessary to prescribe:
<variant> Nitrendipine 10-30 mg 30 minutes before meals sublingually
<variant> Omeprazole 20 mg 2 times a day before meals
<variant> Domperidone 10 mg 3 times a day 20 minutes before meals
<variant> Itopride 50 mg 3 times a day 15 minutes before meals
<variant> De-nol 120 mg 3 times a day after meals

453
77
 A 52-year-old patient complains of difficulty swallowing, especially solid food, regurgitation, pain and a feeling
of a food lump being retained behind the breastbone, not associated with physical exertion. To facilitate
swallowing, he is forced to wash down food with a glass of warm water. The listed symptoms have been
bothering him for 5 years. The patient's general condition is not affected, weight is 70 kg with a height of 164 cm.
According to the clinical protocol, your tactics:
<variant>Endoscopic balloon dilation
<variant>Observation in dynamics
<variant> Consultation with a surgeon
<variant> Gastroenterologist consultation
<variant> Drug therapy

454
A 30-year-old patient was admitted to the emergency room complaining of weakness, dizziness, two-time
vomiting of "coffee grounds", loose tarry stools, sweating, and thirst. The patient's condition worsened in the
morning after lifting something heavy. Objectively: pale, blood pressure 100/65 mm Hg, heart rate 105 bpm,
weak pulse. There are no symptoms of peritoneal irritation. According to the clinical protocol, your preliminary
diagnosis is:
<variant>Bleeding from acute gastric ulcers
<variant>Symptomatic gastric ulcer
<variant>Acute hemorrhagic gastritis, bleeding
<variant>Perforation of gastric ulcer
<variant>Goodpasture's syndrome, gastric bleeding

455
Patient P., 43 years old, complained of weakness, thirst, increased appetite, polyuria, dyspnea and tachycardia
with moderate exertion. Objectively: the skin is bronze in color, the liver is enlarged, of a dense consistency, the
edge is pointed. The spleen is not palpable, with percussion the size is 8-10 cm. Blood glucose is 11.2 mmol/l.
The following research method to verify the diagnosis:
<variant> Serum iron level
<variant> Serum calcium level
<variant>Serum copper level
<variant>Serum creatinine level
<variant>Serum urea level

456
A patient with increased stool frequency up to 4 times a day, slight blood in the stool, colonoscopically detected
superficial ulcers along the sigmoid, descending colon and transverse colon, according to the clinical protocol,
should be prescribed:
<variant> Sulfasalazine 2 g/day + prednisolone 20 mg/day
<variant> Sulfasalazine 1 g/day + prednisolone 20 mg/day
<variant> Sulfasalazine 2 g/day + prednisolone 40 mg/day
<variant> Sulfasalazine 2 g/day + prednisolone 60 mg/day
<variant> Sulfasalazine 1g/day + prednisolone 40 mg/day

457
Patient K., 32 years old, complained of abdominal distension, increased frequency of stools up to 4-6 times a day,
weakness, loss of appetite. These symptoms appeared 10 days after the end of an 8-week course of treatment with
antisecretory drugs and antibiotics for gastric ulcer. Cause of diarrhea:
<variant> Microbial contamination syndrome
<variant> Irritable bowel syndrome
<variant> Chronic pancreatitis
<variant> Celiac disease
<variant> Intestinal lipodystrophy

458
A 16-year-old female patient with diarrhea up to 10 times a day, steatorrhea, weight loss, signs of
polyhypovitaminosis and electrolyte disturbances, ELISA revealed antibodies (IgA) to endomysium and tissue
trans-glutaminase. Your preliminary diagnosis:
<variant> Celiac disease
78
 <variant> Pancreatitis
<variant> Whipple's disease
<variant> Crohn's disease
<variant> Giardiasis
459
A 45-year-old patient with severe girdle-like pain, weight loss, thirst, increasing weakness, loss of appetite,
fasting blood glucose level of 11.0 mmol/l. Ultrasound: replacement of a significant part of the pancreas with
connective tissue. According to the clinical protocol, your preliminary diagnosis is:
<variant>Pancreatic fibrosis, type II diabetes mellitus
<variant> Chronic obstructive pancreatitis, diabetes mellitus type I
<variant> Chronic calcifying pancreatitis, diabetes mellitus type II
<variant> Chronic parenchymatous pancreatitis, impaired glucose tolerance
<variant> Chronic pseudotumoral pancreatitis, diabetes mellitus type II

460
A 45-year-old patient with severe girdle-like pain, weight loss, thirst, increasing weakness, loss of appetite,
fasting blood glucose level of 11.0 mmol/l. Ultrasound: replacement of a significant part of the pancreas with
connective tissue. According to the clinical protocol, treatment is aimed at correcting:
<variant>Exocrine insufficiency, hyperglycemia
<variant> Endocrine insufficiency, hyperglycemia
<variant> Pancreatic insufficiency, hypoglycemia
<variant>Exocrine insufficiency, hypoglycemia
<variant> Antisecretory function, hyperglycemia

461
A 40-year-old patient, suffering from chronic cholecystitis for 8 years, developed severe girdle pain, abdominal
distension, vomiting, and scleral icterus after violating his diet. He was hospitalized in the surgical department
with a diagnosis of "Acute cholecystitis". Ultrasound showed edema of the head of the pancreas, dilation of the
Wirsung duct, increased echo density, and uneven contours. According to the clinical protocol, your diagnosis is:
<variant> Pseudotumor form of pancreatitis
<variant> Exacerbation of chronic cholecystitis
<variant>Pancreatic cancer
<variant> Gallstone disease
<variant> Sphincter of Oddi dysfunction

462
A 40-year-old female patient, suffering from chronic cholecystitis for 12 years, developed severe girdle pain,
abdominal distension, vomiting, and scleral icterus after violating her diet. She was hospitalized in the surgical
department with a diagnosis of "Acute cholecystitis." Ultrasound showed edema of the pancreatic head, dilation
of the Wirsung duct, increased echo density, and uneven contours. According to the clinical protocol, your
subsequent tactics are:
<variant> Omeprazole + Creon + Odeston
<variant> Gastrocepin + mezim-forte + maalox
<variant> Ranitidine + festal + baralgin
<variant> Famotidine + panzinorm + no-shpa
<variant> Platyphylline + Allochol + Oraza

463
During diagnostic ERCP, a patient with choledocholithiasis had the wall of the Wirsung duct damaged and biliary
pancreatitis developed. Objectively: the abdomen is tense, bloated, intestinal peristalsis is not heard; In the blood
- elevated levels of amylase and lipase. According to the clinical protocol, a drug for suppressing pancreatic
secretion:
<variant> Octreotide
<variant> Famotidine
<variant> Esomeprazole
<variant> Ranitidine
<variant> Atropine sulfate

464
79
 Patient K., 17 years old, complains of weakness, jaundice, fever up to 37.5 °C, heaviness in the left
hypochondrium. The patient's father periodically develops jaundice. The abdomen is soft, painful in the left
hypochondrium. The liver protrudes 1 cm from under the costal arch, the spleen is 14x8 cm. Hb - 90 g / l,
erythrocytes - 3.0x1012 / l, leukocytes - 8.8x109 / l; ESR 24 mm / h, reticulocytes - 25%. Total bilirubin - 40 g / l,
direct - 4 g / l, ALT - 0.68 mmol / l. Serum iron - 39.8 μmol / l. Coombs test - negative. Ultrasound: liver contours
are uneven, echostructure is heterogeneous. Portal vein - 1.2 cm. Spleen: area 45 cm2; splenic vein - 0.8 cm.
Gallbladder: shape - oval; dimensions 10.6 x 6.8 cm; wall thickness 0.5 cm. In the bladder cavity - echogenic
suspension. According to the clinical protocol, your preliminary diagnosis is:
<variant> Hereditary microspherocytosis
<variant> Autoimmune hepatitis
<variant> Chronic hepatitis
<variant> Gallstone disease
<variant> Calculous cholecystitis

465
Patient M., 22 years old, 1 week after returning from a trip to the Central Asian republics, noted an increase in
the frequency of bowel movements to 4-5 times a day. The feces are liquid, with an admixture of blood, foamy, in
large volumes. During bacteriological examination, E.coli strain 0157 was cultured in the feces. Your tactics:
<variant> Ciprofloxacin
<variant> Bactrim
<variant> Biseptol
<variant> Ceftriaxone
<variant> Flemoxin-solutab

466
A 48-year-old woman, who underwent laparoscopic cholecystectomy for cholelithiasis 6 months ago, complains
of recurrence of pain in the same location. Diagnostic data: changes in liver function tests, acholic stool, dark
urine, dilation of the bile ducts with hyperechoic inclusions detected by ultrasound scanning. It can be assumed:
<variant> Obturation of the common bile duct with a stone
<variant> Development of acute pancreatitis
<variant> Dysfunction of the sphincter of Oddi
<variant> Exacerbation of chronic hepatitis
<variant> Development of bacterial cholangitis

467
A 32-year-old man who drinks alcohol is bothered by pain to the right of the midline of the epigastrium and in
the right hypochondrium, persistent vomiting that does not bring relief. The skin is icteric, signs of mechanical
jaundice. According to the clinical protocol, your preliminary diagnosis is:
<variant> Enlargement of the head of the pancreas
<variant> Sphincter of Oddi dysfunction
<variant> Exacerbation of chronic hepatitis
<variant> Development of bacterial cholangitis
<variant>Perforation of the common bile duct

468
A 48-year-old woman, who underwent laparoscopic cholecystectomy for cholelithiasis 5 months ago, complains
of recurrence of pain in the same location. On ultrasound, the diameter of the common bile duct is more than 8
mm. Possible complication:
<variant> stenosis of the papilla of Vater
<variant> biliary-dependent pancreatitis
<variant> chronic hepatitis
<variant> dysfunction of the sphincter of Oddi
<variant> liver cirrhosis

469
A 38-year-old woman, after laparoscopic cholecystectomy for cholelithiasis, began to experience recurrent
hepatic colic 3 days later, signs of mechanical jaundice with a direct bilirubin level of up to 500 μmol/l began to
increase. Possible complication:
<variant> Common Bile Duct Stump Syndrome
80
 <variant>Perforation of the common bile duct
<variant> Biliary-dependent pancreatitis
<variant> Chronic hepatitis
<variant> Dysfunction of the biliary tract
470
A 48-year-old woman, who underwent laparoscopic cholecystectomy for cholelithiasis 4 months ago, complains
of recurrence of pain in the same location. The basal pressure of the sphincter of Oddi is over 40 mm Hg, the
common bile duct is dilated to 13 mm, functional liver tests are changed, and the contrast medium is slowly
eliminated from the bile ducts during ERCP. Possible complications:
<variant> Stenosis of the sphincter of Oddi
<variant>Perforation of the common bile duct
<variant> Biliary-dependent pancreatitis
<variant> Chronic hepatitis
<variant> Dysfunction of the biliary tract

471
A patient with a hernia of the esophageal orifice of the diaphragm and a long history of heartburn has had a
change in the clinical picture in the last 6 months: heartburn has disappeared, difficulty swallowing has appeared
when eating solid food, appetite is preserved, but the volume of food consumed has decreased, the patient has
begun to lose weight. According to the clinical protocol, the presumptive diagnosis is:
<variant> Esophageal cancer
<variant> Stomach cancer
<variant> Esophageal stricture
<variant> Achalasia of the cardia
<variant> Barrett's esophagus

472
A woman complains of significant weight loss, periodically occurring bullous rashes on the skin of the trunk,
abdomen and buttocks. Objectively, a shiny, bright, red-orange tongue, severe anemia, increased ESR,
hyperglycemia are noted. According to the clinical protocol, your diagnosis is:
<variant> Glucagonoma
<variant> Insulinoma
<variant> Diabetes mellitus
<variant> Pheochromocytoma
<variant> Vipoma

473
A 45-year-old woman with gastric outlet obstruction was on parenteral nutrition for two weeks. After that,
multiple hematomas appeared on her skin. Examination revealed no signs of gastrointestinal bleeding, the
patient's condition is stable. The reason for this condition in the patient:
<variant> Vitamin K deficiency
<variant> DIC syndrome
<variant> Sepsis
<variant> Thrombocytopenia
<variant> Calcium deficiency

474
During examination of the patient, an external fistula was found in the right iliac region. 2 months ago, he
underwent surgery due to suspected acute appendicitis. During the operation, no pathological changes in the
appendix were detected. According to the clinical protocol, your presumptive diagnosis is:
<variant> Crohn's disease
<variant> Intestinal tuberculosis
<variant> Actinomyces Israelii infection
<variant> Solitary diverticulum of the cecum
<variant> HIV infection

475
A young man of draft age was referred to a gastroenterologist from the military registration and enlistment office
with the following lab test results: total bilirubin - 47.0 μmol/l, conjugated - 4.5 μmol/l, ALT - 28.0 U/l, general
81
 blood test: erythrocytes - 5.0*1012/l, color index - 0.9, leukocytes - 5.8 * 109/l, ESR - 9 mm/h; blood test in
ELISA: HBsAg - negative, anti-HBcor IgG - positive, anti-HCV - negative. Complains of drowsiness, decreased
performance for 1-2 weeks. The sclera are icteric, no changes were found in the organs and systems. In the past,
he has no illnesses except for acute respiratory viral infections. Your conclusion:
<variant> Gilbert's syndrome after viral hepatitis B
<variant> Acute viral hepatitis B, subclinical
<variant> Chronic viral hepatitis B, low activity
<variant> Chronic viral hepatitis B, moderate activity
<variant> Gilbert's syndrome, viral hepatitis B, integration stage

476
A 33-year-old female patient consulted a doctor complaining of chest pain and a feeling of fullness in the area.
The night before she ate fish and choked. She did not consult a doctor. In the morning she complained of
difficulty swallowing, her body temperature rose to 37.3°C, and there was swelling in the neck and lower half of
the face. There was no vomiting. Crepitus was noted on palpation of the neck; chest X-ray showed widening of
the mediastinal shadow with gas layers located paravertebrally. Doctor's tactics:
<variant> immediately hospitalize in the surgical department
<variant> puncture the neck tissue and insert Dufour needles
<variant> perform esophagoscopy
<variant> prescribe antibiotics, with a recommendation to return in 2-3 days
<variant> call for consultation with an otolaryngologist

477
A 56-year-old woman has burning pain at the base of the xiphoid process radiating to the heart, occurring and
intensifying half an hour after eating, during physical exertion and when bending the body, as well as belching
air; they are not completely relieved by Almagel. X-ray examination with barium suspension shows persistent
retention of a hemispherical radiopaque mass above the diaphragm, folds of the gastric mucosa, reflux of the
contrast mass from the stomach into the esophagus. Your diagnosis:
<variant> hiatal hernia
<variant> esophageal cancer
<variant> bronchial asthma
<variant> chronic gastritis
<variant> achalasia of the cardia

478
A young woman of 18 years old developed dysphagia after emotional stress when consuming liquid cold or hot
food (solid food passes well). Dysphagia appeared later during excitement, fatigue. Appetite is preserved, weight
has not been lost. Physical examination revealed no pathology. The patient should be advised to:
<variant> treatment of neurosis
<variant> liquid nutrition
<variant> astringents and enveloping agents
<variant> physiotherapy
<variant> vitamin therapy

479
A 35-year-old patient came to the doctor complaining of periodic pain in the right half of the chest, alternating
with a burning sensation, and bad breath. Dysphagia has occasionally appeared in recent months. He often suffers
from pneumonia. To confirm the diagnosis, it is first necessary to conduct:
<variant> barium x-ray
<variant> electrocardiography
<variant> blood test for hemoglobin
<variant> gastroscopy
<variant> chest x-ray

480
A 76-year-old man complains of a feeling of heaviness and fullness in the epigastrium after eating, belching
food, nausea, an unpleasant taste in the mouth; flatulence; rumbling and pouring in the abdomen. During FGDS:
the mucous membrane is pale and mottled, the folds are smoothed out, the submucosal vascular pattern is visible.

82
 Morphologically (in biopsies from the body and antrum of the stomach) there is atrophy, lymphoplasmacytic
infiltration, moderate intestinal metaplasia. According to the clinical protocol, your treatment tactics are:
<variant> Abomin, domperidone, cyanocobalamin
<variant> Prednisolone, omeprazole, Creon
<variant> Cisapride, Almagel, Mezim-Forte
<variant> Festal, de-nol, ascorbic acid
<variant> Kvamatel, gastal, creon

481
Telangiectasias of the lips, tongue, oral mucosa and gastrointestinal tract in combination with gastric bleeding are
characteristic of:
<variant> Weber-Rendu-Osler diseases
<variant> Mallory-Weiss syndrome
<variant> Scurvy
<variant> Hemorrhagic gastritis
<variant> Werlhof's diseases

482
A 45-year-old female patient has suffered from constipation since childhood, with bowel movements once or
twice a week. Some improvement was observed during puberty. Currently, she has an independent bowel
movement once every two weeks with the release of hard feces. She is forced to use enemas. In childhood and
adolescence, she often had "two-stage bowel movements", when after one bowel movement, a second bowel
movement was observed half an hour or an hour later, and then constipation would again follow. Your diagnosis:
<variant> megadolichocolon
<variant> myxedema
<variant> intestinal endometriosis
<variant> colon cancer
<variant> irritable bowel syndrome

483
A 19-year-old boy was observed for a year with a diagnosis of chronic enteritis and was unsuccessfully treated
with intestopan, astringents and enzyme preparations. Weakness, diarrhea, weight loss, dry skin increased, leg
edema, glossitis, cheilitis appeared. Since childhood, the stool is loose, periodically foamy, there are no
indications of a previous intestinal infection. In the tests: anemia, hypoproteinemia, hypocholesterolemia,
hypocalcemia; coprogram - polyfecalia, steatorrhea. Your preliminary diagnosis:
<variant> celiac disease
<variant> intestinal dysbacteriosis
<variant> Crohn's disease
<variant> intestinal colonization syndrome
<variant> irritable bowel syndrome

484
Diverticulosis of the colon most often affects:
<variant> Sigmoid colon
<variant> Rectum
<variant> Descending colon
<variant> Transverse colon
<variant> Cecum

485
A 35-year-old woman complained of acute pain in the right hypochondrium and iliac region, subfebrile
temperature, and mushy stool. X-ray examination of the intestines revealed ulcers of varying sizes in the cecum
and ascending colon, short slit-like sinuses; alternating with areas of unchanged mucosa; a characteristic
"cobblestone" appearance. According to the clinical protocol, your diagnosis is:
<variant> Granulomatous colitis
<variant> Whipple's disease
<variant> Diverticular disease
<variant> Tuberculous ileotiphlitis
<variant> Ischemic colitis
83
486
A 43-year-old woman consulted her family doctor complaining of constipation. She almost never has an
independent bowel movement. During the conversation, it became clear that she was also bothered by cold
extremities, fatigue, and hair loss. She works as a programmer and spends a lot of time at the computer.
Examination revealed dry skin and mucous membranes. Muffled heart sounds. Blood pressure 110/70 mm Hg.
The abdomen is soft, and palpation reveals a dense sigmoid colon filled with feces. An informative diagnostic test
to determine the cause of constipation:
<variant> thyroid hormone determination
<variant> fibroesophagogastroscopy
<variant> fibrocolonoscopy
<variant> coprogram
<variant> Abdominal ultrasound

487
The patient was diagnosed with hepatomegaly, hyperglycemia, hyperpigmentation of the skin, and increased
serum iron levels. This symptom complex is characteristic of:
<variant> hemochromatosis
<variant> chronic hepatitis of viral etiology
<variant> liver cirrhosis
<variant> hyperfunction of the adrenal glands
<variant> Wilson-Konovalov disease

488
The patient is 26 years old, has been receiving D-penicillamine for Wilson's disease continuously for 2 years, the
last six months at a maintenance dose of 750 mg/day. A month ago, he began to notice a decrease in appetite,
signs of stomatitis, and periodic watery diarrhea. He noted the appearance of dandruff, was examined by a
dermatologist, and was diagnosed with seborrheic desquamative dermatitis. It is necessary to include in the
treatment program:
<variant> Pyridoxine
<variant> Mebendazole
<variant> Bifidobacterin
<variant> Pancreatin
<variant> Fluconazole

489
A patient with diabetes mellitus on insulin therapy developed an acute respiratory viral infection with a rise in
temperature to febrile numbers, gastric and intestinal dyspepsia appeared, and appetite decreased sharply. What
changes in the patient's treatment regimen should be made?
<variant> Increase doses of short-acting and long-acting insulins
<variant> Reduce doses of short-acting insulin
<variant> Stop insulin therapy until appetite is restored
<variant> Increase doses of long-acting insulin, cancel short-acting insulin
<variant> Switch to short-acting insulin only when eating food

490
A patient suffering from diabetes mellitus type 1 for 9 years, vision has deteriorated, transient hypertension up to
145/95 mm Hg has begun to be noted, persistent microalbuminuria with relative compensation of glycemia has
been detected. Which of the drugs should be added to the treatment program in the near future?
<variant> Prescribing ACE inhibitors
<variant> Centrally acting alpha agonists
<variant> Beta blockers
<variant> Low doses of diuretics
<variant> Infusions of protein preparations

491
A 25-year-old girl has been suffering from diabetes for 8 years. She takes lente insulin 38 U per day. In the last 3
weeks after an acute respiratory viral infection, her thirst, polyuria, and weakness have increased. She has lost 3

84
 kg. Objectively: dry skin, traces of scratching. Blood glucose is 19 mmol/l. What state of carbohydrate
metabolism is MOST likely?
<variant> Diabetes mellitus type 1, decompensation
<variant> Diabetes mellitus type 2, subcompensation
<variant> Diabetes mellitus type 1, subcompensation
<variant> Diabetes mellitus type 2, decompensation
<variant> Diabetes mellitus type 1, compensation
492
A 50-year-old man has been complaining of thirst, polyuria, and weakness for the past 3-4 months. Objectively:
body weight 106 kg, height 170 cm, dry skin, signs of scratching. BP 140/85 mm Hg. Urination is frequent and
painless. Glycemic profile: 9.7-14.9-12.3 mmol/l. Which drug is MOST appropriate to prescribe to the patient?
<variant> Metformin
<variant> Glibenclamide
<variant> Intermediate-acting insulin
<variant> Short-acting insulin
<variant> Long-acting insulin

493
A 30-year-old man suddenly lost consciousness at work. According to those around him, he is taking insulin.
Objectively: the skin is moist. Muscle tone is increased. Pupils are wide, do not react to light. The tongue is
moist, pink. BP - 125/80 mm Hg. Pulse - 96 beats/min. Which of the following comas is MOST likely to have
developed in the patient?
<variant> Hypoglycemic
<variant> Liver
<variant> Hyperosmolar
<variant> Ketoacidotic
<variant> Lactacidemic

494
A 47-year-old man suddenly lost consciousness after motor and mental excitement. On examination: the skin is
moist, there are traces of injections on the skin. Twitching of the facial muscles is noted, the pupils are dilated.
Respiratory rate is 32 per minute. Which drug is MOST appropriate to prescribe?
<variant> Glucagon 1 ml
<variant> Sodium chloride 0.9% solution
<variant> Sodium chloride 0.45% solution
<variant> Sodium bicarbonate 2% solution
<variant> Short-acting insulin 30 U

495
A typical complication after the use of mercazolil in the treatment of thyrotoxicosis is:
<variant> Hypokalemia
<variant> Increased levels of creatinine and urea in the blood
<variant> Decreased neutrophil count and development of agranulocytosis+
<variant> Hyperglycemia
<variant> Hypocalcemia

496
A 17-year-old female patient has polyuria with low urine specific gravity. After a fluid restriction test, the urine
specific gravity did not change. It is most likely that the patient has:
<variant> Diabetes insipidus
<variant> Psychogenic polydipsia
<variant> Diabetes mellitus
<variant> Chronic pyelonephritis
<variant> Hashimoto's goiter

497
The criteria for compensation of type 2 diabetes most likely include:
<variant> fasting blood glucose  7.0 mmol/l
<variant> HbA1c 8.0%
85
 <variant> HbA1c  9.5%
<variant> urine glucose  0.5%
<variant> cholesterol  6.0 mmol/l

498
The following metabolic shift occurs in hyperosmolar coma:
<variant> Hyperglycemia
<variant> Hyperkalemia
<variant> Hypercalcemia
<variant> Glucosuria
<variant> Hyponatremia

499
A 16-year-old girl has been suffering from diabetes for 4 years and is receiving insulin therapy. During a
physical education lesson, she lost consciousness and had short-term convulsions. The skin is moist. Which of the
following diagnoses is most likely?
<variant> hypoglycemic coma
<variant> hyperosmolar coma
<variant> lactic acidotic coma
<variant> ketoacidotic coma
<variant> acute pulmonary heart failure

500
A 62-year-old woman was admitted by an ambulance team in an unconscious state. According to
relatives, she suffers from diabetes mellitus. Over the past 5 days, vomiting, repeated loose stools, and
convulsions have been observed. The woman does not respond to external stimuli. The pupils are dilated.
The eyeballs are soft. The skin is dry, turgor is decreased. Respiratory rate is 24 per minute, blood
pressure is 50/30 mm Hg. Heart rate is 120 per minute. Blood sugar is 58 mmol / l. Serum osmolarity is
> 350 mmol / l. Acetone in the urine is negative. Which of the following comas is most likely?
<variant> hyperosmolar
<variant> liver
<variant> ketoacidotic
<variant> hypoglycemic
<variant> lactic acidotic

501
A patient with type 1 diabetes has increased thirst, polyuria, the condition has rapidly worsened, blood sugar is
19.6 mmol/l, acetone in the urine, the smell of acetone comes from the mouth. Presumptive diagnosis:
<variant> Ketoacidotic coma
<variant>Hyperosmolar coma
<variant> Hypoglycemic coma
<variant> Hyperlactacidemic
<variant> Uremic coma

502
A 35-year-old man has abdominal obesity, BMI - 35.6 kg/m2, blood pressure increases to 150/90 mm Hg. In the
biochemical blood test - cholesterol - 6.5 mmol/l, triglycerides - 3.2 mmol/l, glucose - 6.1 mmol/l. Which leads to
hypertriglyceridemia in patients with metabolic syndrome.
<variant> Hyperinsulinemia
<variant> Hypoinsulinemia
<variant> Hypogonadism
<variant> Hyperthyroidism
<variant> Hyperprolactemia

503
A 60-year-old man has been treated for a trophic ulcer without effect. He has been taking Maninil for a year. The
skin is dry, there is no edema. Blood pressure is 135/80 mm Hg. Heart rate is 82 beats per minute. Status localis:
the right foot is hyperemic, moderately edematous, there is an irregularly shaped ulcer on the dorsal surface,

86
 measuring 4.5 x 6.1 cm. Pulsation of peripheral vessels on the right foot is weakened. Blood sugar is 15 mmol/l,
daily glucosuria is 29 g/l. What is the most appropriate treatment strategy?
<variant> switching to insulin
<variant> transition to biguanides
<variant> increasing the dose of sulfonylurea drugs
<variant> strict diet and rational physical activity
<variant> complex use of secretagogues with biguanides
504
A 32-year-old woman has general weakness and fatigue. Examination revealed an asymmetrical enlargement of
the thyroid gland, palpation revealed a node with clear boundaries, a smooth surface, freely movable upon
palpation. What management tactics are most appropriate?
<variant> surgical treatment
<variant>thyreostatics
<variant> iodine preparations
<variant> thyroid hormones
<variant> anti-inflammatory drugs

505
A patient with type 1 diabetes who fell into a hypoglycemic coma was given 40% glucose intravenously, which
led to an increase in glycemia to 12.3 mmol/l. Consciousness was not restored. What actions should the doctor
take?
<variant> Prescribe measures to combat cerebral edema
<variant> Re-introduce 40% glucose
<variant> Prescribe intravenous infusion of 5% glucose
<variant> Start IV insulin infusion
<variant> Perform a spinal tap

506
A 48-year-old patient with normal body weight with verified type 2 diabetes mellitus has been taking metformin
1500 mg and glibenclamide 5 mg twice a day for 5 years. Over the past year, he has lost 4 kg. What is the
treatment correction?
<variant> Transfer to insulin therapy
<variant> Increase the dose of glibenclamide to a maximum of 15 mg per day
<variant> Increase metformin dose to 3000mg
<variant> Add pioglitazone
<variant> Increase the dose of both drugs

507
Patient 19years old notes weight gain, menstrual irregularities for a year. There are purple striae on the skin of
the thighs, abdomen, and mammary glands. Blood pressure - 140/90 mm Hg. Glucose tolerance test: fasting - 4.5
mmol/l; 2 hours after glucose load - 8.6 mmol/l. CT: hyperplasia of both adrenal glands. Blood cortisol level at 8
am -1060 ng/l (normal - 260-720 ng/l), at 2 pm -1250 ng/l. The most likely diagnosis:
<variant> Itsenko-Cushing's disease
<variant> Cerebral obesity
<variant> Hypothalamic syndrome
<variant> Stein-Leventhal syndrome
<variant> Exogenous-constitutional obesity

508
A 23-year-old patient was admitted to the hospital unconscious. Dry skin, flushed cheeks. A sharp smell of
acetone in exhaled air. Kussmaul respiration. Blood pressure 130/90 mm Hg. Pulse 102 beats per minute. Blood
sugar 28.4 mmol/l, urine 6%, reaction to acetone is sharply positive. Presumptive diagnosis:
<variant> ketoacidotic coma
<variant> renal coma
<variant> uremic coma
<variant> hyperosmolar coma
<variant> hyperlactacidemic coma

509
87
 According to the clinical protocol, the sections of the colon in which villous tumors are most often found are:
<variant> Rectum
<variant> Descending colon
<variant> Transverse colon
<variant> Ascending colon
<variant> Cecum

510
The characteristic microscopic structure of esophageal cancer is:
<variant> Squamous cell carcinoma with keratinization
<variant>Poorly differentiated cancer
<variant> Oat cell carcinoma
<variant> Signet ring cell carcinoma
<variant> Small cell carcinoma

511
A 16-year-old female patient has obesity, a moon-shaped face, wide purple striae with "minus tissue", and
increased blood pressure. A skull X-ray shows an enlarged sella turcica. What is your diagnosis?
<variant> Itsenko-Cushing's disease
<variant> Hypothalamic syndrome of puberty
<variant> Aldosteroma
<variant> Androsteroma
<variant> Exogenous-constitutional obesity

512
A 68-year-old patient complains of weakness, sweating, and weight loss of 10 kg over 2 years. The liver, spleen,
and all groups of lymph nodes are enlarged. Blood test: Hb - 85 g/l, Er -3.0 x 1012/l, WBC 135.0 x 109/l, P - 3%,
Lymph - 96%, Mon. - 1%, ESR - 28 mm/hour. Total bilirubin 45 μmol/l, direct - 11 μmol/l. Serum iron - 28
mmol/l, Coombs test is positive.
What is the reason for the patient's deterioration?
<variant>autoimmune hemolysis
<variant>blast crisis
<variant>gastrointestinal bleeding
<variant>acute hepatitis
<variant>agranulocytosis

513
Specify the measures taken to relieve DIC syndrome:
<variant>transfusion of fresh frozen plasma
<variant>introduction of phenylin
<variant>cryoprecipitate transfusion
<variant>introduction of streptokinase
<variant>red blood cell transfusion

514
The following are agents that suppress fibrinolysis:
<variant>e-aminocaproic acid
<variant>heparin
<variant>recombinant antithrombin III
<variant>ticlid
<variant>fibrinolysin

515
Specify the cause of development of multiple organ failure in DIC syndrome:
<variant>microcirculation block
<variant>inhibition of tissue respiration by fibrinogen degradation products
<variant>thrombin damage to plasma membranes of vital organs
<variant>thrombin damage to lysosomal membranes
<variant>immune complex syndrome
88
516
Specify the mechanism of action of transfusions of fresh frozen donor plasma in DIC syndrome:
<variant>replenishment of consumed coagulation factors and natural anticoagulants
<variant>binding of fibrinogen degradation products
<variant>decreased platelet aggregation capacity
<variant>reduction of the concentration of DIC activators in the bloodstream
<variant>removal of cellular antigens
517
To relieve hemorrhagic syndrome in hemophilia A, the following is used:
<variant>cryoprecipitate
<variant>plasma
<variant>native plasma
<variant>factor IX concentrate
<variant>factor IX-enriched plasma

518
The principles of surgical treatment of patients with hemophilia include:
<variant>any surgical interventions can be performed provided adequate replacement transfusion therapy is
provided
<variant>surgical benefit is limited
<variant>orthopedic treatment is only carried out on patients with a mild form of the disease
<variant>knee joint replacements cannot be performed
<variant>hip replacement surgery is not allowed

519
Methods of treating symptomatic cytopenias include:
<variant>plasmapheresis
<variant>prednisolone
<variant>leukomax
<variant>radiation therapy
<variant>heparin

520
Treatment of reactive thrombocytosis is carried out:
<variant>correction of the disease underlying thrombocytosis and antiplatelet drugs
<variant>hydroxyurea
<variant>alpha-interferon
<variant>phenylin
<variant>heparin

521
The patient was treated for 3 weeks for stomatitis without effect with increasing weakness and sweating.
Objectively: body temperature 38.8, skin is pale, moist. Gingival hyperplasia, ulcerative necrotic stomatitis.
Submandibular lymph nodes are enlarged, painless. Blood: erythrocytes - 3.0 x 10 ^ 12 /l, Hb - 95 g /l, CI - 0.95,
leukocytes - 14.5 x 10 ^ 9 /l, blasts - 32%, pal. - 1%, segments - 39%, lymph. - 20%, mon. - 8%, thrombus - 90.0 x
10 ^ 9 /l. ESR - 24 mm /h. Cytochemical study: reaction to glycogen is positive. After 3 days - headaches, nausea,
vomiting, paresis of the lower extremities. What is your diagnosis?
<variant>acute lymphoblastic leukemia
<variant>acute myeloid leukemia
<variant>acute undifferentiated leukemia
<variant>acute monoblastic leukemia
<variant>acute promyelocytic leukemia

522
The patient was treated for 3 weeks for stomatitis without effect with increasing weakness and sweating.
Objectively: body temperature 38.8 degrees, skin is pale and moist. Gingival hyperplasia, ulcerative necrotic
stomatitis. Submandibular lymph nodes are enlarged, painless. Blood count: erythrocytes - 3.0 x 10 ^ 12 /l, Hb - 95
g /l, CP-0.95, leukocytes - 14.5 x 10 ^ 9 /l, blasts - 32%, pal. - 1%, segments - 39%, lymph. - 20%, mon. - 8%,
89
thrombus - 90.0 x 10 ^ 9 /l. ESR - 24 mm /h. Cytochemical study: reaction to glycogen is positive. After 3 days -
headaches, nausea, vomiting, paresis of the lower extremities. Events of the 3rd day should be assessed as:
<variant>neuroleukemia
<variant>progression of leukemia
<variant>meningitis
<variant>blast crisis
<variant>ischemic stroke
523
Patient L., 46, complains of nosebleeds, gum bleeding, uterine bleeding, weakness, shortness of breath.
Objectively: pale skin, bruises on the anterior thighs and abdomen, nose tamponade. Systolic murmur at the apex,
HR - 98 in 1 min, BP - 100/70 mm Hg. The liver and spleen are not enlarged. Blood tests: erythrocytes - 2.8 x 10 ^
12 /l, Hb - 76 g /l, CI - 0.81, leukocytes - 9.2 x 10 ^ 9 /l, thrombus - 32 x 10 ^ 9 /l, ESR - 22 mm / h. Bleeding
duration is 18 min. Your diagnosis:
<variant>idiopathic autoimmune thrombocytopenic purpura
<variant>von Willebrand disease
<variant>hemophilia
<variant>hemorrhagic vasculitis
<variant>Rendu-Osler disease

524
A 35-year-old patient, during an operation for chronic cholecystitis (cholecystectomy), lost 0.8 liters of blood. The
patient was prescribed transfusions:
<variant>plasma-substituting solutions
<variant>platelet mass
<variant>blood
<variant>erythrocyte mass
<variant>washed red blood cells

525
A 60-year-old man was admitted to hospital. Examination revealed a diagnosis of B12-deficiency anemia. HB level
is 60 g/l, pulse is 92 per minute, rhythmic. BP = 120/80 mm Hg. The patient is prescribed transfusions:
<variant> frozen red blood cells
<variant>fresh blood
<variant>erythrocyte mass
<variant>washed red blood cells
<variant>thawed red blood cells

526
In a patient with anemia (HB - 70 g/l) caused by chronic renal failure, it is preferable to use:
<variant>recombinant erythropoietin
<variant>fresh blood
<variant>erythrocyte mass
<variant>washed red blood cells
<variant>thawed red blood cells

527
A 21-year-old patient was admitted to hospital. A diagnosis of aplastic anemia was made. Blood tests showed HB -
50 g/l, platelet count 5.0 x 109/l, moderate hemorrhagic syndrome. The patient may be transfused with:
<variant>platelet mass and washed erythrocytes
<variant>fresh frozen plasma
<variant>cryoprecipitate
<variant>fresh blood
<variant>erythrocyte mass

528
Patient O., 46, complains of constant aching pain in the right half of the abdomen, loose stools up to 6-8 times a
day, weakness. She has been ill for 2 years, lost 8 kg in the last year, periodically has stomatitis. She was
hospitalized twice with suspected acute appendicitis. Objectively: the skin is pale, dry, the abdomen is painful in
the iliac region on the right. ESR-56 mm/h. Your diagnosis:
90
<variant> Crohn's disease
<variant> chronic nonspecific ulcerative colitis
<variant> chronic enteritis
<variant> chronic post-dysenteric colitis
<variant> acute appendicitis

529
Patient Y., 35 years old, was admitted to the clinic with complaints of pain in the epigastrium, heartburn, nausea,
dizziness and tinnitus, which worsen in an upright position, black stool. Objectively: general condition of moderate
severity, pale skin. Auscultation: vesicular breathing in the lungs, no wheezing. Heart sounds are muffled, the
rhythm is regular. BP 110/70 mm Hg. The abdomen is soft, painful in the epigastrium. The liver is along the edge
of the costal arch, the edge is soft, painless. According to the clinical protocol, your diagnosis is:
<variant> gastric ulcer complicated by bleeding
<variant> gastric ulcer complicated by penetration
<variant> decompensated cicatricial pyloric stenosis
<variant> malignancy of gastric ulcer
<variant> Mallory-Weiss syndrome

530
A young man, an asthenic, has periodic acute pains in the right hypochondrium, provoked by stressful situations,
without an increase in body temperature. During examination: according to ultrasound of the abdominal organs, the
gallbladder is reduced in size. Your diagnosis:
<variant> biliary dyskinesia of the hypermotor type
<variant> chronic cholecystitis
<variant> biliary dyskinesia of the hypomotor type
<variant> chronic pancreatitis
<variant> functional dyspepsia

531
A woman was first diagnosed with 2 stones measuring 2 and 3 mm in her gallbladder using ultrasound. Previously,
she was diagnosed with chronic cholecystitis. Duodenal intubation performed a year ago revealed the presence of
cholesterol crystals +++. Treatment tactics:
<variant> litholytic therapy
<variant> diet therapy
<variant> laparoscopic cholecystectomy
<variant> open cholecystectomy
<variant> extracorporeal lithotripsy

532
Based on complaints, anamnesis, objective data, you have made a preliminary diagnosis: Exacerbation of chronic
recurrent pancreatitis. According to the clinical protocol, the clinical and laboratory method of research confirming
your preliminary diagnosis:
<variant> determination of the level of diastase activity in blood and urine
<variant> blood sugar level determination
<variant> determination of blood cholesterol level
<variant> determination of the level of AST and ALT activity in the blood
<variant> determination of alpha-fetoprotein level in blood

533
A 44-year-old patient was admitted to the clinic complaining of pain in the epigastric region and repeated
vomiting. The patient had been drinking alcohol for 3 days. His general condition is severe, his skin is pale and dry,
his body temperature is 38.6 C. Pulse is 110 per minute. Blood pressure is 80/40 mHg. Vesicular breathing is
slightly weakened in the lower sections on both sides. The tongue is coated and dry. The abdomen is swollen, soft,
and painful in the epigastrium. Positive symptoms of Kehr, Kerte, Voskresensky. According to the clinical
protocol, your diagnosis is:
<variant> acute pancreatitis
<variant> acute gastritis
<variant> gastric ulcer and duodenal ulcer
<variant> liver cirrhosis
91
<variant> acute cholecystitis

534
Call to patient D., 33 years old, complains of pain in the epigastric region
girdle-like, vomiting that does not bring relief. From the anamnesis: fell ill acutely while on a business trip.
Objectively: pale skin, forced position of the patient with lower limbs drawn to the stomach, sharp pain in the
epigastrium with superficial palpation. The liver and spleen are not enlarged. According to the clinical protocol,
your tactics at the pre-hospital stage:
<variant> relieve pain
<variant> advise to undergo examination by a gastroenterologist
<variant> contact your local therapist
<variant> urgently hospitalize the patient in the surgical department
<variant> observation of the patient in dynamics

535
A 60-year-old man was diagnosed with a 2.5 cm gastric ulcer during an X-ray examination. According to the
clinical protocol, the following signs suggest that the ulcer is benign:
<variant> detection of convergence of gastric folds in the ulcer area
<variant> weight loss of 5 kg over the last 2 months
<variant> absence of pain in the epigastric region, despite the presence of an ulcer
<variant> localization of ulcer on the lesser curvature of the stomach
<variant> presence of hydrochloric acid in gastric juice during pH-metry

536
According to the clinical protocol, dynamic EGDS is a mandatory indication to exclude a malignant tumor:
<variant> large stomach ulcer
<variant> atrophic gastritis
<variant> pernicious anemia
<variant> duodenal ulcer
<variant> erosive gastroduodenitis

537
For a patient with gastroesophageal reflux disease in combination with COPD, the following are contraindicated:
<variant> anticholinergics
<variant> adrenergic agonists
<variant> H-2-histamine receptor blockers
<variant> liquid antacids
<variant> proton pump inhibitors

538
Metacin belongs to the group:
<variant> selective anticholinergics
<variant> non-selective anticholinergics
<variant> sympathomimetics
<variant> H-2-histamine receptor blockers
<variant> proton pump inhibitors

539
The mechanism of action of omeprazole is:
<variant> blockade of parietal cells of the stomach
<variant> blockade of the chief cells of the stomach
<variant> inhibition of prostaglandin synthesis
<variant> inhibition of gastrin synthesis
<variant> inhibition of mucin synthesis

540
Patient A., 66 years old, was admitted with complaints of pain in the right hypochondrium, radiating to the heart
area, occurring after eating fatty foods. She has been ill for 3 years. Objectively: body temperature is 36.4 °. The
abdomen is soft, painful on palpation in the projection of the gallbladder, Ortner's symptom is positive. In the blood
92
- leukocytes - 7.8 thousand, ESR - 18 mm / h. Bile examination: mucus and leukocytes in all portions. Your
diagnosis:
<variant> chronic cholecystitis, with cardiac syndrome
<variant> acute appendicitis, with cardiac syndrome
<variant> exacerbation of chronic duodenitis
<variant> angina pectoris
<variant> myocardial infarction, gastralgic variant
541
Patient L., 28, was admitted with complaints of paroxysmal pain in the right hypochondrium, bitterness in the
mouth, general weakness, moderate jaundice. Attacks of pain after a dietary error have been bothering her for 10
years. Intravenous cholangiography showed a slightly dilated common bile duct. The gallbladder is enlarged, low-
lying, filled without forming layers, with a large stone at the bottom. Your diagnosis:
<variant> exacerbation of calculous cholecystitis
<variant> exacerbation of chronic duodenitis
<variant> exacerbation of chronic acalculous cholecystitis
<variant> gallbladder tumor in the decay stage
<variant> gallbladder dyskinesia of hypomotor type

542
Patient L., 28, was admitted with complaints of paroxysmal pain in the right hypochondrium, radiating to the right
arm; vomiting with bile. During duodenal intubation, all three portions contained mucus, leukocytes, and in the
sixth portion, lamblia. According to the clinical protocol, your clinical diagnosis is:
<variant> chronic cholecystitis in the acute stage
<variant> calculous cholecystitis in the acute stage
<variant> biliary dyskinesia of the hypertensive type
<variant> chronic duodenitis in the acute stage
<variant> chronic cholangitis in the acute stage

543
Patient M., 74, was admitted with complaints of intermittent pain in the right hypochondrium, nausea, vomiting,
headaches that arose after eating fatty fried foods and radiated to the right shoulder blade. He has been ill for 3
years. Objectively: the tongue is coated with a white coating, there is pain in the gallbladder area when palpating
the abdomen. Ortner's symptoms, Frenicus symptom, Mussi's are positive. Body temperature is 37C. In the general
blood test - neutrophilic leukocytosis. Preliminary diagnosis:
<variant> chronic acalculous cholecystitis, exacerbation
<variant> community-acquired pneumonia of the lower lobe of the right lung
<variant> chronic hepatitis, minimal activity
<variant> acute appendicitis complicated by serous peritonitis
<variant> chronic duodenitis in the acute stage

544
The criterion for successful treatment of gallstone disease with Ursofalk is:
<variant> decrease stone size
<variant> weight loss
<variant> reduction of dyspeptic symptoms
<variant> normalization of cholestasis parameters - bilirubin, alkaline phosphatase
<variant> ESR normalization

545
Patient S., 48, was admitted with complaints of pain in the right hypochondrium radiating to the right arm,
vomiting with bile. The patient is 18 years old. Objectively: overnutrition, subicteric sclera, pain in the right
hypochondrium, liver is not enlarged, Ortner's symptom is positive. In the blood: leukocytes - 12 thousand, ESR -
33 mm / h. Bile analysis - in all three portions - mucus, leukocytes, in portion IV - lamblia. Etiotropic treatment:
<variant> furazolidone
<variant> allochol
<variant> liobil
<variant> atropine subcutaneously
<variant> erythromycin

93
546
According to the clinical protocol, the most informative test for diagnosing exacerbation of chronic recurrent
pancreatitis in patients is the determination in the blood of:
<variant> amylases
<variant> trypsin
<variant> elastases
<variant> alkaline phosphatase
<variant> glucose
547
A 42-year-old patient complains of excess weight, high blood pressure, thirst, and polyuria. Objectively: Height -
174 cm, weight - 100 kg. Fasting glycemia is within 9.9-10.7 mmol/l. The most appropriate prescription is:
<variant> Siofora
<variant> Amarila
<variant> Diabeton
<variant> Monopril
<variant> Sibutramine

548
A 20-year-old girl reports thirst and weight gain. Objectively: height - 162 cm, weight - 94 kg. BMI - 35.8 kg/m2.
Fasting glycemia - 5.9 mmol/l, total cholesterol - 5.2 mmol/l, triglycerides - 2.4 mmol/l. The most appropriate
prescription is:
<variant> Xenical
<variant> Maninila
<variant> Diabeton
<variant> Novonorm
<variant> Simvastatin

549
The level of glycosylated hemoglobin (HbA1), which corresponds to compensation of diabetes mellitus:
<variant> <7.5%
<variant> 7.6%
<variant> 7.8%
<variant> 7.9%
<variant> 8%

550
Severe type II diabetes mellitus is characterized by:
<variant> grade III retinopathy
<variant> compensation is achieved by diet
<variant> compensation is achieved by taking hypoglycemic drugs
<variant> retinopathy stage I
<variant> nephropathy I - II degrees

551
Name the disease that causes systolic arterial hypertension:
<variant> diffuse toxic goiter
<variant> glomerulonephritis
<variant> pyelonephritis
<variant> vasorenal hypertension
<variant> Conn's syndrome

552
A 60-year-old woman was brought to the emergency room in an unconscious state. According to relatives, she
suffers from diabetes mellitus and hypertension. In the last 2 days, she has been vomiting, has had multiple loose
stools, the amount of urine has decreased, and then convulsive twitching in the muscles of the arms and legs joined
in. On examination, the woman does not respond to external stimuli. The pupils are dilated. The skin is dry, turgor
is reduced. The eyeballs are soft. Respiratory rate is 22 per minute, blood pressure is 60/40 mm Hg. Heart rate is
110 per minute with interruptions. In the blood: erythrocytes - 6.5 million, leukocytes - 12.8 thousand, ESR - 8 mm
/ h. Blood sugar is 45 mmol / l. Which pathogenetic factor is most important in the development of this coma:
94
<variant> dehydration
<variant> hypoxia
<variant> intoxication
<variant> oliguria
<variant> acidosis

553
A 19-year-old female patient was admitted to hospital with multiple vomiting syndrome. Previously, she had noted
decreased appetite, changes in stool patterns, and weight loss. History of tuberculosis. Clinical signs of exsicosis
without fever, marked darkening of the skin, general blood analysis - thickening, glycemia -3.5 mmol/l, no
glucosuria, + acetone in urine. How can this pathological condition be assessed:
<variant> adrenal insufficiency
<variant> hypoglycemic state
<variant> food poisoning
<variant> acetonemic vomiting
<variant> diabetic ketoacidosis

554
A patient with diabetes mellitus was admitted to the emergency room in a comatose state, which developed after
food poisoning with repeated vomiting and loose stools. Clinical signs of severe dehydration with severe
hypotension and oliguria. Glycemia is 27 mmol/l, plasma osmolarity is 380 mmol/l (320 mmol/l), urine acetone test
is negative. What medications should be administered intravenously to begin emergency care:
<variant> Hypotonic solution at the rate of 1 l/hour
<variant> 20 U insulin bolus
<variant> Insulin drip 12-14 U per hour
<variant> Physiological solution at the rate of 1 l/hour
<variant> Colloidal solutions 500 ml/hour

555
A 60-year-old woman complained of thirst, polyuria, weight loss, abdominal pain, and night sweats. Blood
pressure 185/105 mm Hg. After intravenous administration of 10 mg of tropafen - 70/40 mm Hg. Daily excretion of
VMK in urine is 50 μmol/l (normal 2.5-3.8). Presumptive diagnosis
<variant> pheochromocytoma
<variant> climacteric neurosis
<variant> Itsenko-Cushing's disease
<variant> Itsenko–Cushing syndrome
<variant> vegetative-vascular dystonia

556
The cytolysis syndrome that develops with acute liver damage is characterized by:
<variant>increased activity of AST, ALT, LDH
<variant>increase in alkaline phosphatase level
<variant>decreased prothrombin levels
<variant>Changes in protein sediment samples
<variant>positive Coombs reaction

557
The following symptom appears earliest in biliary cirrhosis of the liver:
<variant>skin itching
<variant>bleeding gums
<variant>enlarged spleen
<variant>increased AST and ALT
<variant>decreased cholinesterase levels

558
A 56-year-old patient registered for liver cirrhosis as a result of viral hepatitis B, severity class B according to CTP
(8 points), underwent an ultrasound of the liver, which revealed a focal lesion with a diameter of 1.8 cm. The most
appropriate next step in patient management is:
<variant>AFP definition
95
<variant>repeat the ultrasound of the liver on another device
<variant>conducting an MRI of the abdominal cavity
<variant>definition of REA
<variant>conducting CT scan of the abdominal cavity

559
A 51-year-old man has long-term pain and a feeling of distension in the right hypochondrium. Upon examination:
no jaundice, positive Kehr's symptom, subfebrile temperature, ESR - 30 mm/h. What is the presumptive diagnosis:
<variant>chronic cholecystitis in the acute phase
<variant>chronic pancreatitis in remission
<variant>gastric ulcer in the acute phase
<variant>chronic hepatitis
<variant>other disease

560
A 35-year-old female patient complains of acute pain in the right hypochondrium and iliac region, subfebrile
temperature, frequent stools. X-ray examination of the intestines revealed ulcers of various sizes in the cecum and
ileum, short hollow sinuses similar to a "stone bridge", with inclusions of normal creamy layers. Your diagnosis:
<variant> Granulomatous colitis
<variant> Whipple's disease
<variant> Diverticular disease
<variant> Tuberculous ileotiphlitis
<variant> Ischemic colitis

561
The patient had hepatomegaly, hyperglycemia, hyperpigmentation of the skin, and increased serum iron levels.
This symptom complex is characteristic of the disease:
<variant> Hemochromatosis
<variant> Chronic viral hepatitis
<variant> Liver cirrhosis
<variant> Adrenal hyperfunction
<variant> Wilson-Konovalov disease

562
An indicator that increases in blood content in mesenchymal inflammatory syndrome
<variant> Gamma globulins
<variant> Cholesterol
<variant> Alkaline phosphatase
<variant> Bilirubin
<variant> Albumin

563
A 28-year-old man uses injection drugs. He noticed that he gets tired quickly. The serum AST level increased 4-
fold, ALT - 5-fold, anti-HCV is positive. Your diagnosis:
<variant> Hepatitis C
<variant> Hepatitis B
<variant> Hepatitis A
<variant> Hepatitis E
<variant> Hepatitis G

564
A 58-year-old woman with stage 2 obesity was diagnosed with "autoimmune" hepatitis. Serum ALT was increased
6 times. The first drug prescribed in therapy:
<variant> Azathioprine
<variant> Prednisolone
<variant> D-penicillamine
<variant> Essential phospholipids
<variant> Ademetionine

96
565
In the blood serum of a patient with jaundice and hepatosplenomegaly, an increase in the level of autoantibodies to
mitochondrial components and IgM was detected. This condition is characteristic of the disease:
<variant> Primary biliary cirrhosis
<variant> Drug-induced hepatitis
<variant> Viral hepatitis
<variant> Alcoholic hepatitis
<variant> Autoimmune hepatitis

566
Description of the microscopic structure of esophageal cancer:
<variant> Squamous cell carcinoma with keratinization
<variant>Poorly differentiated cancer
<variant> Simple cell carcinoma
<variant> Ring cancer
<variant> Small cell carcinoma

567
The clinical picture of the disease has changed in a patient with a diaphragmatic-esophageal hernia: belching and
regurgitation have disappeared, dysphagia has appeared when eating solid food, appetite has decreased, and weight
loss has occurred. Your diagnosis:
<variant> Esophageal cancer
<variant> Stomach cancer
<variant> Light compression
<variant> Liver cancer
<variant> Development of Zenker's diverticulum

568
When the patient first visited the doctor, he was diagnosed with stage 2 gastroesophageal reflux disease. This is a
method of examination that is not needed for differential diagnosis of the disease:
<variant>Serum lipidogram
<variant> Esophagogastroduodenoscopy
<variant> X-ray of the esophagus
<variant> Intraesophageal pH-metry
<variant> Electrocardiography

569
A condition that results in bleeding from the gastrointestinal tract in a patient with liver cirrhosis.
<variant> Portal hypertension
<variant> Hepatocellular failure
<variant> Hepatorenal syndrome
<variant> Mesenchymal inflammation
<variant> Cholestasis syndrome

570
According to the clinical protocol, the coprological criterion of exocrine pancreatic insufficiency has been proven:
<variant> Steatorrhea
<variant> Creatorea
<variant> Amilorea
<variant> Polyfecalia
<variant> Iodophilic flora

571
According to the clinical protocol, the syndrome that develops with hepatic vein thrombosis:
<variant> Budd-Chiari syndrome
<variant> Mallory-Weiss syndrome
<variant> Cruveilhier-Baumgarten syndrome
<variant> Zollinger-Ellison syndrome
<variant> Dumping syndrome
97
572
45-year-old G., a patient with CKD after mitral valve replacement for double mitral valve defect, takes warfarin
2.5 mg 2 tablets per day. According to the clinical protocol, the amount of the drug is adjusted according to the
following laboratory indicator:
<option> INR
<option> APTT
<option> Prothrombin index
<option> Fibrinogen
<option> Blood clotting time

573
A 52-year-old patient with rheumatic heart disease has left ventricular failure. Examination revealed: systolic and
diastolic murmur at Botkin's point in the second intercostal space on the right. A high-pitched systolic murmur is
transmitted to the jugular fossa and carotid artery; palpation reveals systolic thrill in the second intercostal space to
the right of the sternum. The first and second sounds are weakened. An associated defect has been diagnosed.
Symptoms of aortic valve insufficiency:
<variant> Diastolic murmur
<variant> Systolic murmur
<variant> Systolic murmur in the second intercostal space on the right
<variant> Weakening of the 2nd tone
<variant> Weakening of the I and II tones

574
During a clinical examination of a 15-year-old patient, a leftward shift of the apical pulse was detected, the boundaries
of relative cardiac dullness were shifted to the left and upward, and the cardiac girdle was flattened. Auscultation
revealed a weakening of the first tone at the apex, as well as a systolic murmur with an accentuation of the second tone
over the pulmonary artery. The radiograph showed an enlargement of the left chambers of the heart. Your diagnosis:
<variant> Mitral valve insufficiency
<variant> Narrowing of the left atrioventricular orifice
<variant> Aortic insufficiency
<variant> Aortic stenosis
<variant> Tricuspid valve insufficiency

575
A 28-year-old woman has limited mobility and pain in the small joints of her hands. According to the clinical
protocol, when conducting differential diagnostics between rheumatoid arthritis and systemic lupus erythematosus,
the following indicators and studies are of decisive importance for making a diagnosis:
<variant> Detection of antibodies to cyclic citrullinated peptide (anti-cyclic citrullinated peptide antibodies) and
radiography of the wrist joints
<variant> Complete blood count and x-ray of wrist joints
<variant> Magnetic resonance imaging of the wrist joints
<variant> Radiofrequency and ultrasound examination of the joints of the hand
<variant> Blood IgG, M, A and CRP

576
Which of the following metabolic changes occurs in hyperosmolar coma:
<variant> Hyperglycemia
<variant> Hyperkalemia
<variant> Hypercalcemia
<variant> Glucosuria
<variant> Hyponatremia

577
A 62-year-old woman was admitted by ambulance in an unconscious state. According to her relatives, she suffers
from diabetes. Vomiting, multiple bowel movements, and convulsions have been observed over the past 5 days.
The woman does not respond to external stimuli. The pupils are dilated. The eyeballs are soft. The skin is dry,
turgor is decreased. RR is 24/min., BP is 50/30 mmHg. HR is 120/min. Blood sugar level is 58 mmol/l. Serum
osmolarity is > 350 mmol/l. Urine acetone is negative. Which of the following is impossible?
98
<variant> Hyperosmolar
<variant> Liver
<variant> Ketoacidotic
<variant> Hypoglycemic
<variant> Lactic acidosis
578
The patient was admitted to the emergency department with a blood pressure of 300/130 mmHg. The crisis was
accompanied by tachycardia, polydipsia, muscle tremors, and a feeling of fear. Blood tests showed that the
glucose level had increased to 20 mmol/l. Possible diagnosis:
<variant> Pheochromocytoma
<variant> Conn's syndrome
<variant> Itsenko-Cushing syndrome
<variant> Essential arterial hypertension
<variant>Secondary hyperaldosteronism

579
A 45-year-old patient has persistently elevated blood pressure up to 200/110 mm Hg, muscle weakness, cramps,
and frequent urination. These symptoms have been bothering me for a year. CT scan showed an enlarged left
adrenal gland. The most appropriate appointment:
<variant> Veroshpiron
<variant> Concor
<variant> Physiotensa
<variant> Furosemide
<variant> Indapamide

580
Pheochromocytoma increases production of:
<variant> Catecholamines
<variant> Glucocorticoids
<variant> Mineralocorticoids
<variant> Growth hormone
<variant> Corticotropin

581
An 18-year-old boy developed thirst, polyuria, and general weakness during a cold. Blood sugar level was 16
mmol/l, urine sugar level was 5%, and urine acetone was positive. The patient's diabetes type was:
<variant> Insulin-dependent diabetes mellitus (type 1)
<variant> Non-insulin-dependent diabetes mellitus (type 2)
<variant> Insulin-dependent diabetes mellitus (type 2)
<variant> Type 2 Diabetes (MODY)
<variant> Recurrent diabetes

582
Symptoms of hyperlactacidemic coma:
1) Acetone smell from the mouth, 2) Cyanosis, 3) Dry skin, 4) 4 Kussmaul respirations, 5) Lower tendon reflexes.
<variant> 2,3,4,5
<variant> 1,2,3,4
<variant> 1,3,4,5
<variant> 1,2,4,5
<variant> 1,2,3,5

583
Patient B., 65, has had diabetes for a long time. He took 2 tablets of Adebit 3 times a day. A week ago, he
developed a cough after the flu. Before going down, he vomited and went to the emergency room unconscious.
The skin is dry and pale. Does not smell of acetone. Kussmaul respiration. Blood pressure is 50/30 mm Hg. Heart
rate is 120 times per minute. Blood sugar is 12 mmol / l, urine sugar is 6%, lactic acid level is 2 mmol / l. What is
your diagnosis?
<variant> diabetes mellitus type 2, lactic acidosis coma
<variant> diabetes mellitus type 2, ketoacidotic coma
99
 <variant> diabetes mellitus type 2, hyperosmolar coma
<variant> uremic coma
<variant> hepatic coma

584
A 30-year-old patient has been suffering from diabetes mellitus type 1 for 5 years. A few days after hypothermia,
a low temperature, catarrhal symptoms, decreased appetite appeared, and the patient's insulin dose was reduced.
The day before, nausea, vomiting twice, increased weakness, dry mouth and apathy appeared. Glycemia is 15
mmol/l. He was taken to the hospital by ambulance.
Which of the following is the first step in diagnosis?
<variant>Determination of acetone in urine
<variant>Glycemic profile study
<variant>Complete blood count
<variant>Determination of the level of creatinine in the blood
<variant>Determination of the amount of potassium and sodium in the blood

585
A young man was referred to a gastroenterologist at the military registration and enlistment office with the
following laboratory test results: total bilirubin - 47.0 μmol/l, conjugated bilirubin - 4.5 μmol/l, ALT - 28.0
μmol/l. In the general blood test: erythrocytes - 5.0*1012/l, color index - 0.9, leukocytes - 5.8*109/l, ESR - 9
mm/h; In the blood IPT: HBsAg - negative, anti-HBcor IgG - positive, anti-HCV - negative. Complains of
drowsiness, decreased work productivity for 1-2 weeks. The sclera are yellow, no changes in the organs and
systems are detected. Previously, he had no diseases except for acute respiratory viral infections. Your
conclusion:
<variant>Gilbert's syndrome after viral hepatitis B
<variant>Acute viral hepatitis B subclinical
<variant>Chronic viral hepatitis B, low activity
<variant>Chronic viral hepatitis B, moderate activity
<variant>Viral hepatitis B, integration period

586
The patient, 21 years old, suffers from chronic gastroduodenitis. Heredity has been determined - duodenal ulcer
on the paternal side. Two years ago, he received effective eradication treatment. Helicobacter pylori was tested
due to a relapse of the disease. The result is positive. Possible situation according to the clinical protocol:
<variant>Helicobacter pylori reinfection
<variant>Relapse of the underlying disease
<variant>Development of duodenal ulcer
<variant>Functional dyspepsia
<variant>Development of gastric ulcer

587
According to the clinical protocol, indications that should be taken into account when prescribing diuretics for
the treatment of tumor-ascites syndrome in patients with liver cirrhosis:
<variant>potassium level
<variant>calcium level
<variant>sodium level
<variant>chlorine level
<variant>hemoglobin level

588
The main mechanism of action of Omeprazole, a proton pump inhibitor:
589
gastric epithelial cell block
<variant>blockade of the main cells of the stomach
<variant>inhibition of prostaglandin synthesis
<variant>inhibition of gastrin synthesis
<variant>inhibition of mucin synthesis

590
100
 A patient with type 1 diabetes has increased thirst, polyuria, a sharp deterioration in his condition, blood sugar
19.6 mmol/l, acetone in the urine, and the smell of acetone from the mouth. Probable diagnosis:
<variant>Ketoacidotic coma
<variant>Hyperosmolar coma
<variant>Hypoglycemic coma
<variant>Hyperlactacidemic
<variant>Uremic coma

591
A patient with type 1 diabetes mellitus who fell into a hypoglycemic coma was prescribed a 40% glucose
solution, which led to an increase in glycemia to 12.3 mmol/l. What should the doctor do?
<variant>Prescribing measures against cerebral edema
<variant>Re-introduction of 40% glucose
<variant>Prescription of a drip with a 5% glucose solution
<variant>Start insulin infusion
<variant>Spinal tap

592
A patient, 48 years old, of normal body weight, with type 2 diabetes mellitus, verified 5 years ago, receives
metformin 1500 mg and glibenclamide 5 mg 2 times a day. Over the past year, he has lost 4 kg. What is the
treatment correction?
<variant>Transfer to insulin therapy
<variant>Increasing the dose of glibenclamide to 15 mg per day
<variant>Increase metformin dose to 3000 mg
<variant>Add pioglitazone
<variant>Increase the dose of two drugs

593
A 19-year-old female patient complains of weight gain over the past year and irregular menstrual cycle. There
are dark stripes on the skin of the thighs, abdomen, and chest. Blood pressure is 140/90 mm Hg. Glucose
tolerance test: fasting - 4.5 mmol/l; 2 hours after glucose administration - 8.6 mmol/l. CT: hyperplasia of both
adrenal glands. Blood cortisol level is 1060 ng/l at 8 am (normal -260-720 ng/l), 1250 ng/l at 2 pm. :
<variant> Itsenko-Cushing's disease
<variant> Cerebral obesity
<variant> Hypothalamic syndrome
<variant> Stein-Leventhal syndrome
<variant> Exogenous-constitutional obesity

594
Characteristic microscopic structure of esophageal cancer:
<variant> Squamous cell carcinoma with keratinization
<variant>Poorly differentiated cancer
<variant> Oat cell carcinoma
<variant> Ring cell carcinoma
<variant> Small cell carcinoma

101