2020-06-29
256
#twenty
*! A man, 35 years old, complains of pain in the lower third of his right shoulder. According to him, during the arm wrestling competition I felt a sharp pain, in connection with which, I was delivered to the emergency room after 15 minutes. On examination: pathological mobility in the lower third of the right shoulder, there is no active extension of the hand and abduction of 1 finger.
Is the MOST optimal treatment tactic considered?
+ surgical treatment and drug treatment
# 21
*! A woman, 78 years old, was taken by ambulance to the emergency room with complaints of pain in the right shoulder joint. From the anamnesis: I received an injury 3 days ago, I did not apply for medical help immediately after the injury. On examination: holds the shoulder with a healthy hand, bruising in the upper third of the shoulder. An adduction fracture of the surgical neck is determined on the P-grams of the shoulder joint.
Is the MOST optimal treatment tactic considered?
+ functional method
# 22
*! A woman, 42 years old, complains of pain in the elbow joint, aggravated by attempts at movements in the elbow joint. It was delivered to the emergency room 30 minutes after falling to the right elbow. On examination: significant swelling of the soft tissues of the joint, Gueter's triangle is broken. On the P-grams of the joint, a T-shaped fracture of the condyles of the shoulder is determined.
The MOST optimal treatment tactic is?
+ open metal osteosynthesis
# 23
*! A man, 40 years old, complains of chest pain on the right, difficulty breathing. He was injured when falling into the sewer manhole. Objectively: local chest pain, there is no breathing in the lower parts of the lung on the right, as well as blunting of percussion sound, starting from the 7th rib in the lower parts. On the P-gram, the fracture of the ribs and the fluid level in the projection of the 7th rib are determined.
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Which intercostal space and which line are the MOST optimal for needle insertion during pleural puncture?
+8, rear axillary
# 24
*! The doctor at the factory first-aid post turned out to be an unwitting witness to the accident: the worker inadvertently spilled concentrated sulfuric acid on his hand. MOST first aid for this type of burn:
+ rinsing with water for 10 minutes
# 25
*! Man, 40 years old. After the operation of resection of the head of the radial bone, it can not straighten the brush, take the I finger of the brush.
MOST probable diagnosis?
* + intraoperative damage to the radial nerve
# 26
*! A child, 4 years old, complains of pain in the elbow joint. Pain appeared after the child's father restrained him from falling by his raised arm. Locally: cannot raise the right hand, the hand hangs along the body.
MOST probable diagnosis?
+ pronational subluxation of the radial head
# 27
*! A man, 47 years old, fell on his hand in the position of flexion of the forearm in the elbow joint. When examining the forearm is relatively shortened, there are no active movements in the elbow joint, when trying to passive movements in the joint, springy resistance is determined.
MOST probable diagnosis?
+ posterior forearm dislocation
# 28
*! A man, 65 years old, complains of pain in the elbow joint. According to the patient, during a sharp extension of the forearm and considerable effort, I heard a crack and felt severe pain on the back surface of the elbow joint. On examination: retraction of soft tissues above the ulnar process, there is no active extension of the forearm in the elbow joint, active flexion in full, painful.
MOST probable diagnosis?
+ tendon rupture with the 3rd head of the shoulder muscle
# 29
*! A man, 40 years old, was taken to the emergency room with complaints of pain, lack of movement in the left shoulder joint. According to the patient, during the detention by the police a "police" seizure was applied to him. On examination, the acromial process of the scapula is seen to stand, soft tissues are stuck under the process, and springy resistance is observed when trying to passively move the joint.
The MOST probable diagnosis will be?
+ front shoulder dislocation
#thirty
*! After the operation of restoration of dislocation of the acromial end of the clavicle, the immobilization of the limb MOST appropriate to appoint during?
+ 5 weeks
# 31
*! A man, 36 years old, was delivered with complaints of pain in the shoulder area. After the examination, the diagnosis was made: Closed transverse fracture of the middle third of the shoulder with a shift.
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The MOST optimal type of latch in this case is?
+ lockable pin
# 32
*! Patient O., was admitted in an emergency with a gunshot wound to the chest. A preliminary diagnosis is made: Penetrating chest wound. MOST likely sign of open pneumothorax?
+ there is an open hole in the chest wall
# 33
*! A woman, 50 years old, was admitted to the department of traumatology on the day of the injury with complaints of severe pain in the hip joint, the inability to support the lower limb. After examination, a valgus femoral neck fracture was diagnosed.
What is the best treatment?
+ closed ostiosynthesis
# 34
*! A woman, 55 years old, was admitted to the trauma unit on the day of the injury with complaints of pain in the hip joint, the inability to rely on the lower limb. After examination, a hip fracture was diagnosed.
Is the MOST favorable period during which an operation is necessary, from the moment of injury to osteosynthesis of the hip, considered?
+ first day
# 35
*! MOST likely confirming a diagnostic sign of an intraarticular fracture with a knee puncture is the presence?
* + blood with droplets of fat
# 36
*! THE MOST optimal period of immobilization for isolated fractures of the condyles of the tibia is considered to be during?
+6 weeks
# 37
*! THE MOST optimal period of immobilization for hip condyle fractures without displacement is considered to be during?
+8 weeks
# 38
*! Is the MOST true indication for amputation considered?
+ gangrene of the limb
# 39
*! When examining the bladder with a catheter, urine with blood was received, which indicates the MOST probable damage?
+ Bladder
# 40
*! THE MOST expedient method of treatment for an open fracture of the lower leg?
+ extra focal osteosynthesis
# 41
*! Patient D, 56 years old, was admitted with a diagnosis of shoulder dislocation. After the introduction of the anesthetic, it was decided to correct the dislocation according to the Cooper method. What manipulations are MOST characteristic for this method?
* the doctor puts the foot on the seat of the chair, and the knee in the armpit of the patient +
# 42
*! Patient U, 47 years old, was admitted for a traumatic dislocation of the sternal end of the clavicle. It was decided to reduce the collarbone dislocation under local anesthesia. What is most appropriate for an assistant to help a traumatologist during a dislocation?
* press the knee into the interscapular region, part the patient’s shoulders +++
# 43
*! Patient B, 24 years old, was admitted for a traumatic posterior dislocation of the forearm. When viewed along the back surface under the skin, the ulnar process will stand, the forearm is shortened. During the positioning, the assistant assistant carries out the anti-traction of the shoulder, holds the hand and produces traction along the axis of the shoulder. What are the MOST characteristic actions a traumatologist should take?
* covers the shoulder in the lower third with two hands, and the thumbs lie on the elbow process +++
# 44
*! Pupils of the 6th grade of high school made a bonfire on a vacant lot. One of the teenagers threw a bottle of gasoline through the fire. Gasoline in a bottle caught fire and hit one of the teenagers. The flame burned his face. Concerned about burning pain in the burn area. Objectively: the cheeks, forehead, nose and chin are hyperemic, there are bubbles filled with tissue fluid. Eyes and airways were not affected. MOST probable diagnosis?
* burn flame face I-II degree +++
# 45
*! One of the MOST main goals of the local conservative treatment of burns is to fight:
* with pathogenic flora ++
# 46
*! A patient came to the paramedic complaining of a burning pain in her right hand, on which hot water poured 20 minutes ago. On examination: the patient rushes about in pain, groans. The skin of the dorsum and half of the palmar surface of the right hand is sharply hyperemic. MOST correct
* thermal burn of I degree. 1.5% burn surface area +++
# 47
*! A man, 28 years old, turned to the ENT doctor with complaints of pain in the right auricle. Sick 5 days after injury. On examination, the auricle is hyperemic in the upper third, swelling with fluctuation is determined.
Which of the following is MOST appropriate for clarifying the diagnosis?
+ x-ray
# 48
*! A 47-year-old man complains of suppuration from the left ear, hearing loss for 15 years. In the last 5 days, a headache appeared, more in the left half of the head. On examination: marginal perforation of the eardrum on the left, overhanging of the posterior upper wall of the external auditory meatus, purulent discharge with an unpleasant odor
Which of the following is the MOST appropriate study first?
+ x-ray
# 49
*! A young woman, 25 years old, complains of fever up to 38.4 ° C, sore throat. Sick 2nd day after hypothermia. With pharyngoscopy - hyperemia, swelling of the tonsils, on the surface of the tonsils there are islands of a whitish-yellowish coating, which is easily removed, the surface under it does not bleed.
Which research method, of the following, is MOST suitable for clarifying the diagnosis?
* + M throat from BL to BL
# 50
*! Young woman L., 25 years old, complains of fever up to 38.4 ° C, sore throat. Sick 2nd day after hypothermia. With pharyngoscopy - hyperemia, swelling of the tonsils, on the surface of the tonsils there are islands of a whitish-yellowish coating, which is easily removed, the surface under it does not bleed.
Which of the following is MOST appropriate to be included in the treatment plan:
* + P gargling pharynx with infusions of herbs
# 51
*! A 6-month-old boy is anxious, cries, chokes when eating, nasal breathing is difficult, his voice is nasal. Pharyngoscopy: hyperemia of the mucosa of the posterior pharyngeal wall; a spherical protrusion with fluctuation is determined on the posterior wall.
Which of the following is the most appropriate treatment?
* + opening of the pharyngeal space
# 52
*! A 67-year-old woman was delivered to the clinic with nosebleeds. With rhinoscopy: bleeding from the rear of the nasal cavity.
Which method of stopping bleeding from the following is MOST appropriate?
+ P erednyaya tamponade
# 53
*! A 29-year-old man was hospitalized in a clinic with a diagnosis of acute purulent frontal sinusitis on the right, ethmoiditis complicated by phlegmon of the orbit. On the first day of hospitalization, tremendous chills, exophthalmos on the left, chemosis, immobility of the left eyeball, soreness with pressure on the eyeballs did not appear.
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Which of the following drugs is MOST appropriate to include in your treatment plan?
* + And nticoagulants (cavernous sinus thrombosis)
# 54
*! A boy of 4 years old complained of a barking cough and shortness of breath. Got sick
in cool, T-38 ° C. Marked retraction of the sternum and supraclavicular fossa,
The pulse is quickened, the skin is pale, the lips are cyanotic. With rhinoscopy and pharyngoscopy:
Hyperemia of the mucosa. Laryngoscopic narrowing of the glottis is noted. Due to infiltration and edema of the underfold space up to 3 mm.
What type of emergency assistance from the following is MOST appropriate?
* + N lower tracheostomy
# 55
*! A 17-year-old man complains of hemoptysis, pain in the area of the thyroid cartilage, difficulty breathing after a fight. Inspection: the volume of the neck is increased, the contours are smoothed, with palpation soreness and crepitus. Laryngoscopy: narrowing of the lumen of the larynx, mucous pale, swollen.
Which of the following tools are MOST appropriate to use for further actions?
* + With calpel, single-tooth hook, Trusso expander, tracheocanula
# 56
1Man, 35 years old, was admitted to the clinic with pains over the bosom, ishuria. It turned out that 3 hours ago he received a blow to the suprapubic area. He was drinking alcohol the day before. Forced situation, sitting. The symptom of "vanka-vstanka" is expressed. With percussion in the abdomen, free fluid is determined.
Select the MOST probable diagnosis from the following?
* + bladder rupture
# 57
*! A 75-year-old man was admitted with complaints of difficulty urinating with a sluggish stream, with a feeling of incomplete emptying of the bladder, nocturia up to 5-6 times. Dysuria has been increasing over the past 6 months. Over the past 4-5 days, he was unable to urinate, with the exception of urine dropwise. The patient complains of pain in the lower abdomen, radiating to the perineum, drowsiness, fatigue, nausea and vomiting.
The MOST probable diagnosis of the following?
* + BPH 3 tbsp. Chronic complete urinary retention. Chronic renal failure.
# 58
*! A 27-year-old man complained of pain in the lumbosacral region
and perineum of a aching nature, discharge from the urethra in the morning of the mucous membrane
character, as well as frequent urination with moderate pain at the end
act of urination. A history of irregular sex life.
Which of the following diagnoses is MOST probable?
* + congestive prostatitis
# 59
*! The clinic asked a woman 37 years with complaints about the conductive weakness, aching pain in the right lower back. Two hours ago, re carried sided attack of renal colic, accompanies Xia raising the temperature to 38.5, chills followed Snack eye reduction temperature, pouring sweat and the disappearance of back pain. At the time of examination, the symptom of Parsnip is slightly positive on the right, the kidneys are not palpated, urination is not impaired, the urine is clear, body temperature is 37.2C.
Select of the following MOST've royatny diagnosis:
* + stone of the right ureter, acute serous pyelonephritis
# 6 0
*! A 37-year-old woman came to the clinic with complaints of general weakness, aching
lower back pain on the right. Two hours ago suffered a right-sided kidney attack
colic, accompanied by fever, chills, followed by a rapid decrease in temperature, torrential sweat and the disappearance of lower back pain. At the time of examination, the thumping symptom is slightly positive on the right, the kidneys are not palpated, urination is not impaired, the urine is clear, the temperature is 37.2.
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The MOST probable doctor tactics in this case include:
* + urgent hospitalization
# 61
*! A 47-year-old patient was admitted with complaints of dull lower back pain on the right. Sick for 3 days, noted an increase in temperature to 37.8-38.5 C. There is no history of urological disease. Shortly before the present disease, there was an abscess on the skin, which squeezed out on its own. The kidneys are not palpable. The area of the right kidney is painful on palpation. The symptom of striking on the right is positive. Muscle tension of the lower back and anterior abdominal wall is absent. In the OAK - leukocytosis with a shift to the left, acceleration of ESR, in the OAM - leukocyturia. Ultrasound-hypoechoic formation of the right kidney, 2 x 4 cm in size.
Select the MOST probable diagnosis from the following?
* + kidney carbuncle
# 62
*! The patient complains of paroxysmal pains in the region of the right kidney, radiating along the ureter to the right, nausea. Body temperature 36.6 C. Urination is not impaired, painless. In the KLA - moderate leukocytosis, accelerated ESR, in the OAM - hematuria, leukocyturia. On ultrasound - the expansion of the abdominal elements of the right kidney, in / 3 of the right ureter.
Select them from the following. MOST probable diagnosis?
* + stone of the upper third of the right ureter, renal colic on the right.
# 63
*! The patient complains of acute pain in the perineum, giving to the sacrum and suprapubic region. Body temperature increased to 39.5 C. Urination difficult, painful.
In OAK - leukocytosis, acceleration of ESR, in OAM - leukocyturia. The secret of the prostate is 30 leukocytes in half-vision.
Select the MOST probable diagnosis from the following?
* + acute prostatitis
# 64
*! A 46-year-old woman complains of pain during urination, a spray of urine during urination. From the anamnesis, 2 years ago she was examined by a gynecologist, a consultation of a urologist was recommended. Dysuria for 2 years, for 3 months with aggravation.
Select the MOST probable diagnosis from the following?
* + urethral polyp
# 65
*! A man, 45 years old, complained of a painless education in the upper eyelid region, which appeared 5 months ago. Within a month notes an increase in education. Objectively: in the middle third of the century, 3 mm from the edge there is a painless formation of approximately 4 mm in diameter; the skin above it is mobile, not changed. Moderate conjunctival hyperemia over education. The remaining parts of the eye are unchanged. VOD = 1.0; VOS = 1.0.
What is the most appropriate treatment tactic?
* + surgical treatment
# 66
*! A man, 36 years old, turned to an ophthalmologist with complaints of decreased vision, redness and pain in his right eye. Sick for a week. Recently had the flu. On examination: visual acuity OD = 0.4 does not correct. The eye is irritated, pericorneal injection, precipitates on the endothelium, the pupil is narrow, there are no other changes. The left eye is healthy.
What treatment is MOST appropriate to prescribe first?
* + mydriatics
# 67
*! A man, 56 years old, turned to an ophthalmologist with complaints of flickering “flies” and periodic pain in his right eye. On examination: visual acuity OD = 0.7; OS = 0.9. The field of view of the right eye is narrowed in the upper-inner quadrant by 15 °, the left eye is normal. With gonioscipia, the area of the trabecula is not visible on the right. On the fundus of OD, excavation of the optic nerve disc is 0.5-0.6. Intraocular pressure OD = 28 mmHg, OS = 17 mmHg
Which drug is most appropriate to prescribe?
* + pilocarpine
# 68
*! A woman, 50 years old, complained of decreased vision in her left eye gradually over the past 3 years, painlessly. Visual acuity of the left eye of 0.1 is not corr. Objectively: subatrophy of the iris stroma; on the fundus, the ratio of excavation to the optic nerve disc is 0.8-0.9; In the field of view, the peripheral border in the upper-inner quadrant is 15 degrees from the fixation point. Intraocular pressure OD / OS = Maklakov 16/29 mm Hg With gonioscopy, all the identification zones of the anterior chamber angle are visible.
Which drug is most appropriate to prescribe?
* + timolol 0.5%
# 69
*! In a 50-year-old man, four months after cataract phacoemulsification with IOL implantation, vision on the operated eye decreased. Objectively: the cornea is transparent; anterior chamber of medium depth, moisture transparent; IOL position is correct; the back capsule is cloudy; deeper lying departments are not visible. Diagnosed with secondary cataract.
Which of the following treatment methods is MOST appropriate?
* + laserdiscision of the posterior capsule
# 70
*! A man, 65 years old, complains of a gradual decrease in vision in both eyes, more on the left. Objectively: Vis OD = 0.9; IOP = 19 mmHg Vis OS = 0.09 n / a; IOP = 18 mmHg Art.
OU: the cornea is transparent, the anterior chamber is of medium depth. The iris in color is not changed. After dilating the pupil on the left, clouding of the central and lower parts of the crystalline lens was revealed; on the periphery, the fundus reflex is clearly visible. Visible fundus without pathology.
Which operation is most appropriate?
+ cataract phacoemulsification
# 7 1
*! In a 43-year-old man, one year after receiving a penetrating wound of the right eye, electrophysiological examination revealed signs of sympathy of the left eye.
What is the most appropriate treatment for the prevention of patient blindness?
+ enucleation of the injured eye
# 72
*! A 46-year-old woman complained of lacrimation, photophobia, pain in the left eye. From the anamnesis: during the repair of the house a drop of lime got into the eye. Immediately washed my eye with running water. On examination: Vis OD = 1, 0. Vis O S = 0, 1 n / a; Objectively: severe blepharospasm; with biomicroscopy, mixed injection, conjunctiva of the eyelids hyperemic, edematous; the cornea is edematous, in the center-paleoscopic, opaque.. At instillation of 0, 1% fluorescein solution, the area of the cornea turned green. The anterior chamber is of medium depth, uniform.
What is the most likely diagnosis?
* + corneal erosion
# 73
*! A 67-year-old man complained of a gradual decrease in vision in both eyes, more on the left. Objectively: Vis OD = 0.9; IOP = 19 mmHg Vis OS = 0.02 n / a; IOP = 18 mmHg Biomicroscopy: the cornea is transparent, the anterior chamber is of medium depth. The iris in color is not changed. After dilating the pupil on the left, diffuse opacification of the lens was revealed; the fundus is not ophthalmoscopically.
Which study is MOST likely to evaluate the functional prognosis of the planned operation?
* + electrophysiological
Test tasks
for students of 5 courses in the specialty "OM"
discipline "Infectious diseases in the work of GP" module "Basics of infectology"
* Infectious diseases in the work of GPs * 1 * 5 *
#1
*! What is the primary action the physician should take when an infectious disease is suspected?
