Download A 21 y.o. man complains of having morning pains in his back for the

1. A 21 y.o. man complains of having morning pains in his back for the last three
months. The pain can be relieved during the day and after physical exercises.
Physical examination revealed reduced mobility in the lumbar part of his spine,
increase of muscle tonus in the lumbar area and sluch during moving. X-ray
pattern of spine revealed bilateral sclerotic changes in the sacrolumbal part. What
test will be the most necessary for confirming a diagnosis?
A. Rheumatoid factor
B. Antinuclear antibodies
C. Uric acid in blood plasma
D. HLA-B27 *
E. ESR
2. A 38 y.o. patient lifted a heavy object that resulted in pain in the lumbar part of
spine irradiating to the posterior surface of his left leg. The pain increases during
changing body position and also in the upright position. Examination revealed
positive symptoms of tension. What is the preliminary diagnosis?
A. Myelopathy
B. Polyneuritis
C. Pathology of intercostal disks *
D. Spinal cord tumor
E. Arachnomyelitis
3. A 47-year-old obese man complained of periodic attacks of acute arthritis in the
1st left tarsophalangeal joint. Lab exam revealed increased serum level of uric
acid. What is the diagnosis?
A. Gout arthritis *
B. Reiter’s disease
C. Rheumatoid arthritis
D. Rheumatic arthritis
E. Osteoarthritis
4. A 42-year-old woman complains of dyspnea, edema of the legs, and tachycardia
during small physical exertion. Heart borders are displaced to the left and S1 is
accentuated, there is protodiastolic murmur on xiphoid process. The liver is
enlarged by 5 cm. What is the cause of heart failure?
A. Mitral stenosis *
B. Mitral regurgitation
C. Tricuspid stenosis
D. Tricuspid regurgitation
E. Aortic stenosis
5. Woman age 40,ill on rheumatic disease with composite mitral disease with
prevalence of the stenosis of left venous foramen.Complainse on the
palpitation,fatigability progressing dyspnea,attacks of a dyspnea and
hemoptysis.Now she can not execute even the mild activities.What tactics is the
most expedient?
A. Mitral comissurotomia. *
B. Conduction of current bicilino-prophilaxis.
C. Assiging of anticoagulants.
D. Assiging of venous vasodilatators .
6. A 48 year-old man presnets with arthralagia,abdominal pain,diarrhoea ,progressive
weight loss,low-grade fever,confusion,memoryloss and
opthalamoplegia.Investigation reveal steatorrhoea,imparied
xyloseobsorption,abnormal samll- bowel X rays hypoalbuminaemia and
anemia.The mostly likely diagnosis
A. Whipple s disease *
B. Coeliac disease
C. Inflammatory bowel disease
D. Tropical sprue
E. Chronic enterocolitis
7. A 17y.o. patient complains of acute pain in the knee joint and T – 38 C. He was ill
with angina 3 weeks ago. Objectively: Deformation and swelling of the knee joints
with skin hyperemia. Small movement causes and acute pain in the joints. Which
diagnose is the most correct?
A. Rheumatism, polyarthritis *
B. Systemic lupus eritematodes
C. Reactive polyarthritis
D. Infectious-allergic polyarthritis
E. Rheumarthritis
8. A 41-year-old woman complains of weakness, fatigue, fever up to 38°C, rash on
the face skin, pain in the wrists and the elbows. On physical exam, erythematous
rash on the cheeks with “butterfly” appearance, the wrists and elbow joints are
involved symmetrically, swollen, tender on motions, friction rub over the lungs,
the heart sounds are weak, regular, HR of 88/ minute, BP of 160/95 mm Hg. CBC
shows anemia, leucopenia, lymphopenia; on urinalysis: proteinuria, leukocyturia,
casts. What is the main mechanism of disease development?
A. Production of antibodies to double-stranded DNA. *
B. Production of antibodies to myocytes.
C. Production of antibodies to endothelial cells.
D. Production of antibodies to myosin.
E. Production of antimitochondrial antibodies.
9. A 14 year old patient. He complains of chest pain, temperature 38,5,
breathlessness. He had acute tonsillitis2 weeks ago. He is in a bad state. The skin is
pale. Heart borders are widened, the tones are weakened. Above all heart area you
can hear pericardium friction sound. Electrocardiogramm: the descent of voltage
QRS, the inversion T. The liver is 3 sm enlarged. ESR – 4mm/h, ASL – 0 – 1260,
C-reaction protein +++. Your diagnosis:
A. Rheumatic pancarditis *
B. Rheumatic pericarditis
C. Rheumatic myocarditis
D. Rheumatic endocarditis
E. Septic endocarditis
10.A 47-year-old obese man complained of periodic attacks of acute arthritis in the
1st left tarsophalangeal joint. Lab exam revealed increased serum level of uric
acid. What is the diagnosis?
A. Gout arthritis *
B. Reiter’s disease
C. Rheumatoid arthritis
D. Rheumatic arthritis
E. Osteoarthritis
11.A 25 -year-old woman complained of edema on the face and legs, elevation in
blood pressure up to 160/100 mm Hg, and weakness. She fell ill 3 weeks after sore
throat. On urinalysis, protein of 0.5 g/L, erythrocytes of 17 – 20/field, leukocytes
of 2 – 3/field, erythrocyte casts. What treatment should be initiated after
establishing of the
A. Penicillin OS *
B. Heparin
C. Ceftriaxone
D. Dipyridamole
E. Ciprofloxacine
12.A 19-year-old girl admitted to the hospital complained of pain in the knee and
fever of 38.6°C. She is ill for 2 weeks after acute tonsillitis. On exam, hyperemia
and swelling of both knees, BT of 37.4°C, HR of 94/min, BP of 120/80 mm Hg,
and heart border is displaced to the left; S1 is weak, systolic murmur is present.
Total blood count shows the following: Hb – 120 g/L, WBC – 9.8•109/L, ESR of
30 mm/L. ECG findings: the rhythm is regular, PQ = 0.24 sec. What is a causative
agent of the disease?
A. Beta-hemolytic streptococci. *
B. Viral-bacterial association.
C. Autoimmune disorder.
D. Staphylococci.
E. Ricchetsia.
13.A 42-year-old woman complains of dyspnea, edema of the legs, and tachycardia
during small physical exertion. Heart borders are displaced to the left and S1 is
accentuated, there is protodiastolic murmur on xiphoid process. The liver is
enlarged by 5 cm. What is the cause of heart failure?
A. Mitral stenosis *
B. Mitral regurgitation
C. Tricuspid stenosis
D. Tricuspid regurgitation
E. Aortic stenosis
14.A 33-year-old man with a history of rheumatic fever complains of fever up to 38 39°, abdominal pain, dyspnea, tachycardia. Heart borders are displaced to the left
by 2 cm, systolic and diastolic murmurs above aorta, BP of 160/30 mm Hg.
Petechial rash occurs after measurement of blood pressure. Liver is enlarged by 3
cm, spleen is palpable. Urine is brown-yellow. What is the most probable
diagnosis?
A. Infectious endocarditis *
B. Rheumatic fever
C. Acute hepatitis
D. Acute nephritis
E. Aortic regurgitation
15.Woman age 40,ill on rheumatic disease with composite mitral disease with
prevalence of the stenosis of left
venous foramen.Complainse on the
palpitation,fatigability progressing dyspnea,attacks of a dyspnea and
hemoptysis.Now she can not execute even the mild activities.What tactics is the
most expedient?
A. Mitral comissurotomia. *
B. Conduction of current bicilino-prophilaxis.
C. Assiging of anticoagulants.
D. Assiging of venous vasodilatators .
16.A patient 55 years complains about pain, slight swelling in the joints of brushes,
long constraint at mornings, limitation of mobility. 1 year is ill. Treated oneself
with ibuprofen with a small effect. Objectively: swelling of metacarpal-phalange,
proximal interphalange joints of the II-III fingers of both brushes with pain
limitation of mobility. ESR 37 mm/hour. What researches are most informing for
clarification of diagnosis of rheumatoid
A. Rheumatoid factor, X-ray of brushes joints *
B. Determination of uric acid in blood
C. Titers of antichlamidias antibodies
D. Presence of LE-cells
E. Determination of blood lipids level
17.The atrial flutter with heart rate up to 130 per min firstly appeared in a woman
aged 28 yr considered before healthy. Physical examination reveals pale bluish
cheeks. The respiratory rate is 24 per min. Cardiac auscultation is difficult
because of high rate but S1 tone is loud. The chest is free and abdomen is soft and
painless. ECG revealed right ventricle hypertrophy and atrial flutter. This woman
was not consulted by any doctor because she lives in a small village. What is the
most probable diagnosis?
A. Mitral stenosis *
B. Myocarditis
C. Thyrotoxicosis
D. Artherosclerotic cardiosclerosis
E. Myocardiodistrophy
18.The patient, 32 years old, came to the doctor with complaints for the increase of
body temperature up to 38 degrees Celsius, pain in his joints, conjunctivitis. He
felt ill acute after the accidental sexual contact. During the examination the skin
over the right ankle joint, the left knee joint and the right hip joint was hyperemic,
hot to
A. Reyter’s disease *
B. Psoriatic arthritis
C. Behterev’s disease
D. Lupus aerytematosis
E. Arthritis rheumatoidis
19.A 4 year old female has been limping with swelling of her right knee for several
months. Physical examination demonstrates swelling of her right knee, flexion
contracture of 10 degrees and flexion to 120 degrees. Lab. data: WBC 8 g/l, with
45\% neutr., 47 lymphs\%, 8\% mon. Hgb 120 g/l. ESR 20mm/h. Rheum. factor
neg., ANA 1:640 speckled. What is the most probable diagnosis?
A. Juvenile Rheumatoid Arthritis *
B. Rheumatism
C. Lupus
D. Osteomyelitis
E. Infection Arthritis
20.The child aged 12 yr complains of slight fever up to 38.0(C, knee joints pain, a
day before ankle pain, tenderness in active and passive movements, common
weakness and cardiac pain. It is known he was ill with acute tonsillitis two weeks
ago. Physical examination reveals left heart border external shift, non frequent
cardiac premature bites. What disease should be suspected?
A. Rheumatic fever *
B. Now-rheumatic carditis
C. Rheumatoid arthritis.
D. Systemic lupus erythematosus
E. Reactive arthritis
21.10-year old girl was admitted to the department with symptoms of carditis. Well
known that the exacerbation of chronic tonsillitis was occurred 2 weeks ago. What
etiological trigger of carditis is the most possible in this case?
A. streptococcus *
B. staphylococcus
C. pneumococcus
D. klebsiele
E. proteus
22.The boy of 9 years old. He is ill for 3 days. He has complaints on pain and
restriction of movements in right knee and left elbow joints, dyspnoea. He was
suffered from acute tonsillitis 2 weeks ago. There are fever (38,5 C), oedema of
joints, extension of the borders of cordial dullness on 2 cm left, HR - 110 per 1
min, weakness of 1st sound, "soft" systolic murmur on an apex. What diagnosis
should be suspected?
A. Acute rheumatic fever *
B. systemic lupus erythematodes
C. juvenile rheumatoid arthritis
D. Reiter’s disease
E. reactive arthritis
23.A 17y.o. patient complains of acute pain in the knee joint and T – 38(C. He was ill
with angina 3 weeks ago. Objectively: Deformation and swelling of the knee joints
with skin hyperemia. Small movement causes and acute pain in the joints. Which
diagnose is the most correct?
A. Rheumatism, polyarthritis *
B. Systemic lupus eritematodes
C. Reactive polyarthritis
D. Infectious-allergic polyarthritis
E. Rheumarthritis
24.The atrial flutter with heart rate up to 130 per min firstly appeared in a woman
aged 28 yr considered before healthy. Physical examination reveals pale bluish
cheeks. The respiratory rate is 24 per min. Cardiac auscultation is difficult
because of high rate but S1 tone is loud. The chest is free and abdomen is soft and
painless. ECG revealed right ventricle hypertrophy and atrial flutter. This woman
was not consulted by any doctor because she lives in a small village. What is the
most probable diagnosis?
A. Mitral stenosis *
B. Myocarditis
C. Thyrotoxicosis
D. Artherosclerotic cardiosclerosis
E. Myocardiodistrophy
F.