A *Cererbrovascular dementia



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1

Woman of 60-th years, about 15-th years suffers by arterial hypertention After the repeated stroke grumbles about the amotivational decline of mood, weight of concentration of attention, forgets to close entrance doors, does not remember the event of past day. On CT - areas of poststrokes changes are in crust postfrontal areas. What diagnosis is most reliable at patient?

A *Cererbrovascular dementia

B Illness of Al'cgeymer’s

C Illness of Gentington’s

D Peak illness

E Dissociativ amnesia
2

Patient of 68-th years, office worker. There are about two years disorders of memory had began : patient is helpless in work and way of life, did not get along at official duties. Gradually began to forget the names of relatives, names of objects, became helpless, speech was violated. Lost skills of letter, reading, care of itself. At CT research: atrophy of cortex of large hemispheres of brain. What diagnosis is most reliable ?

A *Illness Al'cgeymer’s

B Peak illness

C Atherosclerotic dementia

D Senil'naya dementia

E Progressive paralysis
3

Patient of 31 years, economist, from youth age suffers epilepsy with large convulsive attacks, constantly accepted anticonvulsive treatment. Entered in hospital with the considerable becoming more frequent of attacks. In a separation there are serial attacks between which a patient does not come in consciousness. What measures is it most expedient to use?

A *Inta venois infusion of cybazon’s.

B Parenteral'noe introduction of aminazin.

C To increase doses of medicine usually used by patients.

D Introduction of camphorae.

E Elektro - shocking therapy.
4

A woman of 56 years on a background a climax have attacks which are characterized great head pain, by the increase of arterial pressure to 180/ 100 мм of Hg, tachycardia, the shortness of breath, general shaking. Duration of attack 30-40 min. An attack ends with urination. What type of crysis is it more possible?

A * Simpato-adrenalin’s crysis

B Vago-insulin’s crysis

C Low blood pressure crysis

D Hypertensive crysis

E Epileptic attack
5

A girl of 18 years got illnes sharply: there is a cold, cough, stomach-aches, temperature of 38,5С. To the third day the catarrhal phenomena diminished, temperature of 36,6С. On a fourth day of illnesses are a weakness in a right foot. Objectively: active motions absent in a leg, passive – sickly. The muscles of thigh are languid, sickliness on motion nervous barrels. Knee and axilles reflex on a right foot not caused, the symptom of “triangle” is positive. In blood leuc. - 4,2*109., SFE – 6 mm/min. Credible diagnosis?

A *Poliomyelitis, spinal form

B Poliomyelitis, pontine form

C Sausage-poisoning

D Encephalomielit

E Tick encephalitis
6

The attacks of twitches of right foot, which spread on all of leg and lasted during a few minutes, appeared for a patient. Not lost consciousness. At examination: paresis of right foot after an attack, deep reflexes on a right foot are promoted, symptom of Babinskogo on the right. Specify the type of attack:

A *Jeckson’s epilepsy

B Kozhevnikovskiy epilepsy

C Miokloniya

D Genaral tonico-clonic attack

E Absans
7

A man of 35 years worked 13 years a bulldozerman. Grumbles about dizziness, head pain at the end of working day, numbness of fingers and pain in the muscles of feet at night. At an inspection violations of pain and tactil sensitiveness are exposed on a peripheral type, sickliness of sural muscles, pulsation on and dorsalis pedis is stored. What disease most probably?

A *Vibration illness

B Illness of Reyno

C Siringomieliya

D Vegetative (ANS) polyneuripathy

E Obliterating atherosclerosis
8

The patient of 22 years grumbles about sudden palenaess of finger-tips, developing at cooling. At warming fingers acquire at first cyanosis, and then purple colouring. Preparation of choice for treatment of this syndrome is:

A *Nifedipin

B Dipiridamol

C No-shpa

D Aspirin

E Nitrates
9

A man is neat in the street in the unconscious state and delivered in hospital. With small intervals he have the repeated attacks of tonic and clonic cramps of hands and feet. Consciousness is lost, pupils are wide, irresponsive on light. In language are biting tracks. There was involuntary urination. Signs of hearth defeat of cerebrum it is not exposed. AP - 140/ 90 мм Hg. The head of patient can be freely resulted to the breast. you will define the most credible pathology.

A Epilepsy, epileptic status

B Brain hemorrhage

C Ishemic stroke

D Stupor


E Sharp meningoencephalitis
10

7- years schoolboy during lessons to on once or twice became inattentive, began to smack lips. During short "absence" he did not respond to the name. Falling and cramps at this time were not observed. A mother noticed such phenomena and before, but did not attach a significance them, considering that a child was thoughtful. What most reliable diagnosis ?

A Absans

B Generalized myoclonick attack

C Adversive attack

D Complex partial attack

E Dzhekson’s partial attack

11

At a 25-years-old woman the attack of the following character developed on a background the signs of vegetative dystonia: pains appeared in area of heart, feeling of difficulty in breathing, nausea, dizziness, redness of person, the loss of consciousness, lasting about minute, came after. ABP is 80/60 мм of Hg. Frequency of pulse - 56 /min. Vagoinsulyar crysis is diagnosed, syncopes. What Is basic direction of therapy?



A Simpatomimetic preparations

B Simpatolytic preparations

C Kholinomimetic preparations

D Vasjactive

E Degidrative
12

In patient of 17 years a disease arose up very sharply and developed stormily: chill, increase of temperature to 40,0 With, intensive poured out head pain, vomiting, the loss of consciousness came afterwards . Objectively: menigeal signs. SCF (liquor) turbid. Cells - 4600 /mm3., an albumin is 1680 mgs/l, sugar - 2,5 mml/l, chlorides -100 mml/l, neutrophils - 98 %, lymfocytes - 2 %. What Is the most credible diagnosis?

A Meningococcal meningitis

B Tubercular meningitis

C Limphocyte choriomeningitis

D Enterovirus meningitis

E Parotitis meningitis

13

A girl of 17 years got electro-trauma. After conducting of reanimation there was hospitalized. Which from the followings complications, dangerous for life, possible through a few clock or days after it:



A Fibrillation of ventricles

B Stop of breathing

C pulmonary edema

D Comatose state

E Violation of neuro-muscular conductivity
14

The woman of 45-th years complains on sudden unbearable pain in the left half of face by duration 1-2 minutes. Attacks are provoked mastication. Start of illness two months back after supercooling. Objectively: pain in points the output of trigeminal nerve on the left. A touch near the wing of nose on the left causes a next attack with the tonic cramp of muscles of face. What from this diagnoses is most reliable?

A Tic douloureux

B Neuralgia of n.glosssofarineus

C Arthritis of low jaw joint

D Facial migraine

E Antritis
15

The man of 38-th years entered hospital in the unconscious state. Start of problem was yesterday:

head pain, nausea, vomiting, appeared T 38,5 C, there was disorientation, delirium, . During the last 4 days grumbled about pain and decline of ear on a left ear. Objectively: state of sopor, rigidity of cervical muscles, symptom of Kernig’s on either side, general hyperaesthesia, suppuration from a left ear. What is from this diagnoses most reliable?

A Second festering meningitis

B Primary festering meningitis

C Tubercular meningitis

D Subarachnoidite hemorrhage

E Brain hemorrhage


16

At a woman 46 years old through one day after the beginning of flu head pain increased, appeared disorientation, nausea. Objectively: consciousness is stored, psychomotorical excitation; general hyperaesthesia, midle meningale syndrome. Nistagm. Tendon reflexes on the right is higher, force of muscles is reduced in right extremities, on the right side is pathological reflexes of Babinskiy. CCF: transparent, pressure 220 мм. item, cytosis - 46,3, mainly lymphocytis. What from diagnoses is most reliable ?

A Influenzal meningoencephalitis

B Bacterial meningoencephalitis

C Subarachnoidal hemorrhage

D Brain hemorrhage

E Ischemic stroke
17

Girl of 15-th years during a day once or twice suddenly hardens on 5-15 sec, erecting a look upwards, irresponsive on an address to it. After an attack does not realize that happened with it. For the last year for a girl memory was worsened, success went down at school. On EEG convulsive activity is registered by frequency of 3/sec. What diagnosis is most reliable?

A Absanse

B Adversive attacks

C Sinkope

D Neuroticlike state

E Transitory ischemic attack
18

The man of 74 years complains of periodic disorientation, violation of speech, loss of memory on current events, slow gait. It is ill about 5 years. Objectively: speech with dysarthria, mimic is poore, hunched carriage. Tendon reflexes is S>D, symptom Babinskogo from 2th sides, symptoms of oral automatism, muscular tone is promoted on a plastic type. In a pose Romberg’s is unsteady, nistagm is horizontal. What diagnosis is most reliable ?

A Dyscirculatory encephalophaty

B Illness of Parkinson’s

C Meningoencephalitis

D Encephalomielitis

E --
19

A man is 57 years old delivered in a neurological department with complaints on the weakness of left arm, feet, head pain, prolapsus of right age, doubling. Problem start gradually during some the times after nervous overloads. Objectively: stunning, speech is stored, going away cross-eye of left eye, ptosis of right eyelid, diplopia. Force of muscles in left extremities is reduced. Tendon reflexes on the left higher. What from the transferred diagnoses is most reliable ?

A Ischemic stroke

B Brain hemorrhage

C Meningoencephalitis

D Miasteniya

E Sausage-poisoning

20
Male 34 years was delivered to the neurological department with complaints of severe headache, double vision when looking straight, intolerance of light, noise. Fell ill with acute attack developed in weightlifting. OBJECTIVE: stunning, mild exotropia (divergent strabismus), double vision. Kernig's symptom on both sides. No paresis. Liquor bloody. Which drug should appoint the first place? 
A Epsilon-aminocaproic acid 
B Acetyl-salicylic acid 
C Heparin  
D nicotinic acid 
E glutamic acid 


21 
Male 25 years old, who is sick for 4 years with multiple sclerosis, complaining about increased unsteadiness, weakness of lower extremities, urine retention. OBJECTIVE: Central tetraparesis. Cerebellar ataxia, dysfunction of pelvic organs. What is the most useful therapy in this case? 
A Glucocorticoid 
B Antibiotics 
C Nootropics 
D desensitization 
E Vitamins 

22 
In 70-year-old man during moderate headache for two days appeared and intensified speech disturbances, weakness in the right extremities. In the history of: myocardial infarction, arrhythmia suffers. In the neurological status: elements of motor aphasia, central paresis of the VII and XII of pairs of cranial nerves on the right, on the same side of hemiparesis on the central type and gemigiperesteziya. What is the most likely diagnosis? 
A Ischemic stroke 
B Hemorrhagic stroke 
C transient ischemic attack 
D Epidural hematoma 
E brain tumor 

23 
The patient aged 39, suffering from hypertension suddenly developed severe headache in the neck, nausea, repeated vomiting. Condition lasts five hours. OBJECTIVE: Ps-88/min., AD-205/100 mmHg, occipital pain points, stiff neck. Symptom Kernig positive on both sides. There is a suspicion of subarachnoid hemorrhage. Which of the following methods of examination is crucial to confirm the preliminary diagnosis? 


A lumbar puncture 
B Examination of fundus 
C Ultrasonic Doppler 
D  EEG
E CT 

24 
Polisher Combine Works 50 years turned to the shop physicians with complaints of general weakness, numbness phalanges and severe pain in them. OBJECTIVE: pale skin fingers. In the study of pain, tactile, and temperature sensitivity revealed minor violations. From other organs and systems are no deviations. What disease is most likely? 


A Vibration disease 
B polyneuritis 
C Raynaud's disease 
D Syringomyelia 
E Deforming arthrosis 

25
The patient D., 48 years on the second day after surgery for perforated ulcers night developed right-sided central hemiparesis, gemigipesteziya and speech disorders.What paraclinical methods of examination can verify the diagnosis? 


A CT 
B Contrast angiography 
C Ultrasonic Doppler 
D Survey of coagulating properties of blood 
E Ehoentsefaloskopiya 

26
Patient S., aged 25, fell ill with acute: in the morning appeared, severe headache, vomiting, reusable, body temperature rose to 39.9 C. Took fever, but condition worsened. Evening and lost consciousness. OBJECTIVE: pronounced muscular rigidity neck, Kernig sign. Leukocytosis blood -18,0 X10 * 9 / liter. What is the most likely diagnosis in the patient? 


A Bacterial meningitis 
B Typhus, typhoid mill 
C Viral meningoencephalitis 
D sepsis, an infectious-toxic shock 
E Influenza, gipertoksicheskaya form 

27 
After lifting the weight 38 year old Steve suddenly felt an unbearable headache, tinnitus, he began to vomit. There was a convulsive fit with involuntary urination. OBJECTIVE: the patient disoriented, complained of pain in the neck, back, photophobia. Total hyperesthesia, psychomotor agitation. Paresis of course not. Muscular rigidity neck.Ptosis and divergent strabismus, anisocoria. Pulse - 52/min. AD-180/110 mmHg At the fundus of the eye: dilated veins, tortuous, optic disk was edematous. Liquor on day 5 of illness: xanthosis, cells 372 / 3, protein - 4,2%. What is the most likely diagnosis? 

A Subarachnoid hemorrhage 
B Acute meningitis 
C Acute meningoencephalitis 
D Intracerebral Hemorrhage 
E Subdural hematoma 

  

28 


Female 52 years complains of bias to the right person. Pain in 2 days ago after hypothermia. The temperature rose to 38.2 C. OBJECTIVE: marked facial asymmetry.Left frontal folds smoothed. The left palpebral fissure wider than the right and not closed.Flattened left nasolabial fold. Omitted corner of his mouth. Another pathology was not detected. In the blood: Leuk .- 10,0 x10 * 9 / L, ESR - 20 mm / hour. What is the most likely diagnosis? 
A * Neuritis of the facial nerve 
B prosoponeuralgia 
C Gemikraniya (migraine) 
D Ischemic stroke 
E brain tumor 

29 
The patient was 43 years complains of recurrent bouts of pain in the right half of the face. During the attack marked spasm of mimic muscles of the right half face, the skin on that side of his face redden. Analysis of blood without pathology. Was diagnosed with trigeminal neuralgia on the right. Which drug is most expedient to appoint? 
A * Finlepsin 
B Prednisolone 
C Actovegin 
D Analgin 
E Indomethacin 

30 
Woman 62 years after the lifting felt a sharp pain in the lumbar region, buttocks, posterior-lateral surface of the right thigh, the outer surface of the right lower leg and dorsum of the foot. Objective: weak tibialis anterior muscle, long extensor muscle of thumb, short extensor muscle of fingers of the right foot. Reduced ankle reflex on the right. Positive symptom Lassega. What is the most informative research methods for the diagnosis of discogenic compression of L5 root?: 
A * Magnetic Resonance Imaging 
B X-ray of the spine 
C Electromyography 
D Angiography 
E Lumbar puncture 

31 
Asked the man to the hospital with complaints that after lifting heavy weight felt a sharp pain. From anamnesis it was reported that more than 10 years the patient suffers from chronic sciatica. What additional LIMITED survey method must be kidding? 


A CT scan of the lumbar spine 
B X-ray of the pelvic bones 
C Lumbar puncture 
D Elektromiografiya 
E Ultrasound kidney 

 32 
Patient 25 years old, who is being treated in hospita,lsuddenly developed an attack, which was accompanied by impaired consciousness, spasms of limbs, biting tongue, foam from his mouth. Diazepam was introduced intravenously, but the attack does not cropped. After 15 minutes of the re-introduction of the drug also proved to be ineffective. What is the state of emergency has developed in a patient? 


A status epilepticus 
B epileptic seizure 
C epileptic reaction 
D vegetative crises 
E syncopal attack 

33 
Patient 28 years transported to the hospital in an unconscious state, with repeated 15-20 min generalized seizures. During transport the patient was administered twice sibazon, sulphate of magnesia, but the level of consciousness is not restored. Which department should provide emergency care? 


A Intensive care unit 
B Neurology department 
C Surgery department 
D Therapeutic department 
E Psychiatric Unit 

34 
Man 45 years old, longshoreman, complains of back pain and right leg. These symptoms persist 2 months and after a course of conservative therapy has not diminished. OBJECTIVE: motion in the lumbar spine is limited, symptom Lasegue positive right. Knee-jerk D = S, alive. Achilles: S> D, right sharply reduced. What a survey should be executed for the patient the diagnosis? 


A * Magnetic Resonance Imaging 
B X-ray of the spine 
C Electromyography feet 
D Reovasography feet 
E - 
 
35 
Patient 37 years old hospitalized in the intensive care unit due to the repeated every half hour tonic-clonic seizures. Patient between seizures in mind did not come. BP- 120/90 mm. Hg, PS-100/min.Yesterday evening he was at a wedding, drinking alcohol. 5 years ago suffered a closed head injury, brain contusion, and then appeared single seizures with loss of consciousness, but the patient did not take anti-epileptic medication. Which drug should first be introduced for first aid? 
A * Diazepam 
B Magnesium sulfate 
C Oxybutyrate sodium 
D Aminazin 
E Thiopental sodium 

36 
In patient S., aged 35, during an ultrasound examination of carotid and vertebral arteries arose dizziness, weakness, nausea, difficulty breathing and lost consciousness for 20 seconds. OBJECTIVE: skin is pale, BP - 90/60 mm Hg, HR - 96 beats / min. Reduced reaction to light. Focal neurological symptoms are observed. EEG and echoencephalogram pathological changes were observed. Your preliminary diagnosis? 


A * syncope 
B epileptic seizure 
C Minor ischemic stroke 
D Transient ischemic attack 
E Vagoinsulyarny crisis 

 37 
Patient D., aged 23, at the doctor suddenly stopped and froze for several seconds, eyes glazed, simultaneously raising both hands, sobbing, muscles of the body is tensed, then relaxed for 3 min. And then, after incontinent he fell asleep for 20 minutes.Patient developed amnesia on this attack. What is needed to conduct a survey after the attack?

A Electroencephalography 
B Rheoencephalography 
C MRI 
D X-ray of the skull bones 
E Axial CT 

38 
The patient was 52-years, the secretary-typist, worked for 30 years. Complains of cramps in the right hand at work, the impossibility of printing and writing. The load on the hand - up to 80% of the working time.The patient is sick for 2 years. Objective data: the right hand tight, muscle tone is increased, while trying to write there are seizures. In a study of pathological manifestations of the CNS was not found. Your preliminary diagnosis. 


A * convulsive form of coordination neurosis

B neuralgic form of coordination neurosis
C paretic form of coordination neurosis
D hysterical neurosis 
E chronic manganese intoxication 

39 
The patient 52 years with common spinal osteochondrosis, after heavy lifting, there was backache, and pain along the left sciatic nerve. Objective: to the left positive symptom Lassega and reduced ankle reflex. Which drug belongs to the pathogenetic therapy?


A Diclofenac 
B Aspirin 
C Analgin 
D Novocaine 
E Spazmalgon 

40 
A woman 35 years there was an attack, during which appeared heartbeat, chills, fear of death. Revealed pale skin, increased blood pressure. Attack ended with the release of large amounts of urine. What kind of character attack should be considered? 


A * sympathoadrenal crisis (panic attacks) 
B vago insular crisis 
C hypotonic crisis 
D hyperglycemic coma 
E epileptic seizure 
41
Patient had resection of the stomach. During the operation, the left upper extremity patient was assigned and fixed to the operating table for anesthetic management.Postoperatively, the patient developed a dysfunction of the upper extremity in the form of "hanging" brush. Violation of any anatomical structure led to the emergence of this symptom?
A radial nerve
B axillary nerve
C ulnar nerve
D median nerve
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