Actual problems of infectious diseases and hiv infection
Partial intestinal uncommunicating
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Partial intestinal uncommunicating Acute calculary cholecystitis Choledocholithiasis Cholecystitis Sick, 37 years, acted on stationary treatment with complaints of bad feel, headache, increase of temperature upto to 39.5 °С, edema, pains in muscles of eyes, tongues, lower extremities. 2 weeks prior to beginning of disease used raw pork fat. Objectively: edema present. In a blood test: Leucocytes – 18.5*109 L, eosynophils – 22 %, basophils – 2 %, neutrophils – 56 %, stab neutrophils – 16 %, monocytes – 4 %. It is no pathological changes in urine. What is most probable diagnosis? Leptospirosis Acute nephritis *Trichinosis Quinke’s edema Dermatomyositis Patient 35 years old, was entered to the clinic with complaints of grumbling in a stomach, propensity to diarrhea, that are already present during 2 months. After the last two weeks at the act of defecation noticed moving snatches of flat struture. Has habit to use in a meal the raw stuffing from meat of home animal with spices. At colonoscopy there are numerous lateral folds which fills almost all segment.What is the drug of choice for treatment? Mebendazol Combantrin Albendazol *Phenasalum Medamin Patient A., 17 years old, complaints of headache, stomachache, nausea, enhanceable fatigue ability, insignificant pain and sometimes diarrheA. He was sick during 4 months. Day prior he was addressed to the hospital in incandescence noticed a round worm length 15cm. What will be the best treatment for him? Levomycitin *Decaris Akrikhin Ftalazol Furazolidon Patient, 27 years old, complaints of itching in perianal area, which is present in evening before sleep. It continues for 1-3 days and disappears independently, but reconvolense afterwards. Most probable diagnose will be: Trichinosis *Enterobiosis Ascaridosis Helminthosis Cystitis Patient, 27 years, complaints of weakness, irritation, pain of muscles, fever, dry cough, pain in thorax, shortness of breath. In lung - dry and moist rales and wheezes are determined without dulling of percutory sound. In sputum are еosinophil, crystals of Charkot-Leyden with admixtures of blood. On the repeated X-ray of lungs shows plural еosinophilic infiltrations of different sizes which change a form and localization (Leffler syndrome). Tuberculosis of lungs Acute pneumonia Bronchitis AIDS *Ascaridosis Patient A, 29 years old, complaints of the decline of appetite, nausea, vomiting, stomach-ache, diarrhea, pain in the chest, weakness, dizziness, parahypnosis.There is present hypochromic anaemiA. Periodically used raw and half cooked raw pork. What most probable diagnosis? Teniarinhosis Difilobotriosis *Teniosis Trichinellosis Ascaridosis Patient, 37 years old, complaints of pain in the chest, nausea, vomitting, periodic attacks of Grand-mal epilepsy and memory became worse. Papule rash in a skin. What most probable diagnosis? Teniarinhosis Difilobotriosis Teniosis Trichinellosis *Ascaridosis Patient, 27 years, complaints of nausea, heaviness in epigastrium, stomach-ache, diarhoea and general weakness. An increase in appetite, mass of body is decreased. In blood moderate anaemia and high eosinophiliA. Noticed creeping out of segments with excrement. She likes to use raw meat. What is the most probable diagnosis? *Teniarinhosis Difilobotriosis Teniosis Trichinellosis Ascaridosis Patient 30 years old, complaints of weakness, increasing of temperature up to 39.2 °C, pain in muscles, fatigue, edema present. 2 weeks ago he was used pork with the flab of meat. Edema is present,an enlarged liver is palpable. The BP is 90/60 mm of Hg. In blood analysis: leucocytes – 12,4*109, eos – 19 %, young neutrophills – 2 %, neutrophills – 59 %, lymphocytes– 16 %, mon – 4 %. Specify the most probable diagnosis. Leptospirosis Flu *Trichinosis Typhoid fever Spotted fever Sick, 45 years old was sick for 17days, lives in a village. The sick grumbles about strong stomach-ache, frequent 15 times and more on a day emptying, nausea, vomit, headache and fever. Objectively: person is pale, eyes are hollow, the turgor of skin is sharply decreased.Tongue is dry assessed white coating, stomach is sharply blown away, at palpation pain takes place in the area of colons. Liver is moderately enlarged. At hemanalysis leucocytosis 16*109 L, eosinophills 1 %, ESR – 7mm/hr. Change of leucocyte formula takes place. Emptying with addition of bloods, has a pungel smell. At rectoscopy at the area sigmoid and bowels was found deep ulcers with undetermined edges. What most probable pathology which predetermines such picture? Amebiasis *Balantidiasis Nonspecific ulcerous colitis Tumour of rectum Food poisoning A sick child 8 years old complaints of itching in the perinium areA. Child creaks teeth during sleeping, sleeps bad. Objectively: sufficient nourishment, pallor of skin, tongue is insignificantly covered with white patches, stomach is soft, accessible for palpationis painless. The lowering of haemoglobin level takes place. What is most probable pathology which predetermines such picture? *Enterobiasis Salmonellosis Ascaridosis Giardiasis Trichinosis A sick 26 years appeared to the therapeutic department with complaints of the itching of skin, weakness, liquid emptying diarhoea 1-2 times a day. Objectively: sufficient nourishment. On the skin has pouring out red color as “hives” which has linear character. In blood eosinophilic reaction of blood – 28 %. Lives in rural area What is the most probable pathology which predetermines such picture? Salmonellosis *Strongyloidosis Food poisoning Giardiasis Trihocephallosis A sick 20 years arrived from Western Siberia complaint of pain in the area of liver and gall-bladder, bitter taste in mouth. Objectively: abdomen is soft, accessible for palpation, at palpation pain takes place in an area of bilious system. At blood analysis еosinophills – 23 %. She had eaten fish. What is the most probable pathology which predetermines such picture? *Opistorhosis Ascaridosis Trihocephallosis Giardiasis Trichinosis Patient 28 years old, complaints of an increased appetite, weakness, decreased physical activity tolerance, pain in stomach. Objectively: colour of skin is pale, signs of meteorism,and glossitis. In blood thereis diminished amount of red cells, leucocytes, thrombocyte and hypochromic anaemiA. It is known from epideminological anamnesis, that the patient had spent 4th months on Volga river and had eaten the salted fish and caviar. What is the most probable pathology which predetermines such picture? Teniosis Anaemia *Difilobotriosis Opisthorchosis Helminthosis A 5 years old girl complaints of headache, decreased appetite, weakness, nausea, vomiting, bitter taste in mouth, stomach-ache and periodic diarrheA. Objectively: decreased nourishment status, on her tongue there is white coating observed. The stomach is soft, accessible for palpation, and painful in the area of gall-bladder. No Change in blood analysis was found. According to the mother the same symptoms were observed with her son a month ago. What is the most probable pathology which predetermines such picture? Amebiasis Balantidiasis Intestinal trichomonosis *Giardiasis Dysbacteriosis A 23 years old patient complaints of weakness, nausea, periodic presence of segments of helminth in the stool. In anamnesis the patient had eaten undercooked meat. Faeces were sent for microscopic examination. The bovin solitaire was found in the stool. What would be the drug of choice? *Biltritsid Pyrantelum Piperazinum Decaris Fazizhin A 24 years old engineer from Donetsk, has spent one month in India where he drunk unboiled water. After arriving home he has become ill. He appeared to the doctor with complaints of fever, weakness, pain in stomach, diarrhea - 12-15 times a day with mucous and blood (like raspberry jelly stool). Objectively: the state is relatively satisfactory, appetite became worse, tongue is coated with white patches.On deep palpation of abdomen patient complaints of pain especially in his right half and hypochodrium areA. Liver and spleen are not changed. No change was found in blood analysis. On rectoscopy clear mucous and hyperemia of mucous membrane in rectum with ulceration in sigmoid colon were found. The stool test gave the growth of pathogenic florA. What most probable pathology which predetermines such picture? Strongyloidosis *Amebiasis Ulcerative colitis Balantidiasis Food poisoning Patient K., 30 years old, came with complaints of nausea, vomiting, pain in epigastrium and paraumbilical areA. High body temperature, pale skin, dry. tongue covered with whitish-gray coating. Quick pulse, low blood pressure. 2 hours before the onset of symptoms of the disease he ate in cafe. What is the diagnosis most likely. Cholera Shigellosis Thypoid fever *Salmonellosis Meningitis Disease started acutely with the complaints of watery diarrhea, vomiting, cramps in the lower extremities. Objectively: slow voice, shunken eyes, quick pulse, low blood pressure, decrease of urination, weak cardiac sounds. In liver and spleen no changes. Put the correct diagnosis. Salmonellosis Dysentery Food poisoning *Cholera Typhoid fever A Pakistani, 30 years old, severly ill: with the complaints of frequent diarrhea like rice water. Objectively: body temperature 35,4 °C, skin of peripheral parts of the body cold to the touch, acrocyanosis, xerostomia, sharply decreased skin elasticity and turgor. What should be done to assess the degree of dehydration. Measurement of central venous pressure Determination of urea and creatinine in blood *Funduscopy Plain X-ray film of abdomen Determination of specific gravity of blood plasma Patient N., 30 years old, works in a restaurant, admitted to the hospital complaining of unbearable pain in the abdomen, increase of temperature 38,8 °C, nausea, vomiting, diarrhea of dark-green colour, He took eggs, mushrooms, canned food. Objective state: general condition is moderately sever, skin and mucous membranes are dry, pain in epigastric region. Name the disease. Shigellosis Yersiniosis *Salmonellosis Cholera Rotaviral infection Patient 35 years old with complaints of increasing of temperature to 39 °C with chill, vomiting, pain in epigastric region, diarrhea with foul smell, abdominal cramps. 6 hours before onset of the disease ate raw eggs, fried potatoes with grinded meat, drank juice. To clarify the diagnosis of serological diagnostic methods often used RNGA with the salmonella groupdiagnostic tools and RA (Vidal test) . When blood should take for the diagnostic procedures? In the first day of illness At the end of the first month In 1st week in 3-4 days *At the end of the 1st week from 7-10 days During admission to the hospital A patient was hospitalised after 4 hours of consumption of raw eggs, complaining frequent vomiting, abdominal pain, mostly in the right iliac area and umbilical areA. Objectively pale skin, dry tongue with gray coating, hypotension, tachycardiA. What tests should be carried out to confirm the diagnosis. General blood analysis Parasitological examinations Microscopic examination of stool Biological test *Coproculture Patient G., 22 years old, was hospitalised in an infectious department complaining of chills, stabing pain in epigastrium, diarrhea, temperature increased up to 39,6 °C, repeated vomiting. Feces copious, watery, without pathological changes. 4 hours before the onset of symptoms ate the meat, salad. What is the most appropriate drug to be prescribe. Antidiarrheal drugs Flouroquinolone group of antibiotics Sulfanilamide group of antibiotics Desintoxication therapy *Enterosorbents Patient K., 40 years old, was hospitalised with the diagnosis of intestinal infection. Complaints of general weakness, headache and diarrheA. Symptomes appeared suddenly 2 hours after consumption of cake with custard. Suddenly there were chills, nausea, profuse repeated vomiting, frequent diarrhea, abdominal pain and short-term loss of consciousness, temperature increased to 38,6 °C. The preliminary dianosis? Salmonellosis, localized form, gastroenteritis type *Salmonellosis, localized form gastroenterocolitis type Salmonellosis, localized form enterocolitis type Salmonellosis, generalized form Salmonellosis, nosoparasitic Patient K., 40 years old, hospitalised with the diagnosis of salmonellosis, with symptoms of rise of body temperature to 40 °C, repeated vomiting, diarrheA. Objectively: AP 60/20 mm Hg, pulse 120/minute, pale face, increased intestinal peristalsis, enlarged liver and spleen. What is the best treatment. *Glucocorticoids, desintoxication, antibacterial therapy Diuretic, desintoxication therapy, antibacterial drugs Enterorsorbents, diuretic, detsintoxication therapy Glucocorticoids, diuretic, desintoxication therapy, antibacterial drugs Glucocorticoids, diuretic, antibacterial drugs Patient P., 36 years old, a farmer is seriously ill, with high temperature, having chills, headache, flatulence, nauseA. At present he is complaining of severe abdominal pain, diarrhea up to 15 times a day stool is liquid, smelly, with impurities mucous and blood. His eyes are sunken. The tongue is covered with white coating. On palpation- painful colon, increased liver. In blood – neutropil leukocytosis with a shift formula the left anemiA. On rectomanoscopy deep ulcers with irregular edges are observed, including along the folds. What is the diagnosis. Shigellosis *Balantidiasis Nonspecific ulcerous colitis Amoebiasis Colon tumor A 29 years old patient T. Has been working on a pig farm. She was hospitalized with symptoms of balantidiasis. What would be the drug of choice. Benzylpenicillin Gentamycin Chloramphenicol *Monomycin Timogen Patient C., 35 years old, the disease has started severe chills, raising the temperature to 39 oC, vomiting, pain in epigastric region, diarrhea with water-smelly bowel movement. Over 6 hours after eating raw eggs, potatoes with braised meat, drank juice. What kind of agent is likely to cause this condition. *Salmonella Vibrio cholera Enteric stick Campylobacter Shigella Patient 25 years, received complaints of double vision of the eyes, a decline of view, shortness of breath. Before the disease eat mushrooms home preservation. Objective: pallor, wide pupils with a weak reaction to light, dry mouth, a violation of swallowing, flatulence, delay of stool. What is preliminary diagnosis. Leptospirosis Yersinioz *Botulism Giardiasis Salmonellosis Patient C., 22 years old, hospitalized in an infectious department complaining of chills, temperature increase to 38,5 oC, vomiting, pain in epigastrii, frequent stool. 7 hours before the disease, ate raw eggs, potatoes with braised meat, drink tomato juice. What kind of organism most likely to cause disease. Enterovirus *Salmonella Enteric stick Staphylococcus C. perfringens Emergency ambulance delivered in infectious hospital girl N., 17 years old, complaining of headaches, expressed general weakness, pain in epigastrium, repeated vomiting, diarrhea to 8 times a day greenish color. She was used 2 raw chicken eggs. Body temperature 39 °C, the tongue covered with white coat, moderately cramps, pain in abdomen and sigmoid areA. What is the most likely diagnosis. Acute appendicitis Crohn’s disease Shigellosis Viral gastroenteritis *Salmonellosis Patient L., 32 years old, was admitted to the infectious office complaining of chills, headache, expressed general weakness, cutting pain in epigastrii, diarrheA. The temperature of 39 °C, repeated vomiting. Excrement abundant, greenish color, without pathological impurities. Over 4 hours to illnesses used the meat salad in the factory canteen. Which drugs will be most effective for the treatment of this patient. Antibotulism serum Salt and colloid solutions Sulfanilamides *Antibiotics Enterosorbent Patient B., 55 years old, was hospitalized in an infectious hospital with complaints of frequent vomiting, liquid excrements, abdominal pain, mainly in the right iliac area and epigastrium. Pale skin, dry tongue with a touch of gray, hypotension, tachycardiA. The doctor was suspected salmonellA. What laboratory test is need to perform. General blood analysis Parasytoscopy of blood smear Microscopy of stool *Coproculture Biological test Patient C., 30 years old, was hospitalized with a preliminary diagnosis of salmonellosis. Body temperature – 40 °C, repeated vomiting, profused diarrheA. Hypotension (BP 55/30 mm Hg), expressed tachycardia (pulse to 120/min), face pale, pain mainly in right iliac area and epigastrium, hepatosplenomegaly were found. What treatment tactic will be most effective in this case. Glucocorticoids, crystalloid solutions, antibiotics, diuretics Cardiac glycosides, colloid solutions, antibiotics Sorbents, diuretics, desintoxication Dopamine, colloid solutions, antibacterial *Glucocorticoids, crystalloid solutions, antibiotics Patient F., 25 years old, was hospitalized in the infectious hospital with complaints of frequent vomiting, liquid stool, abdominal pain in epigastrium. Pale skin, dry tongue with a grey cover, hypotension, tachycardiA. The doctor was suspected salmonellA. What serologic study is need to perform. Microprecipitation reaction RA (Widal) *RIGA with Salmonella diagnosticum RIGA with Shigella diagnosticum and RA (Widal) with paired serum RKC Patient N., 22 years old, was admitted to the infectious office complaining of chills, headache, expressed general weakness, cutting pain in sigmoid area, diarrheA. The temperature of the body of 39,3 °C, vomiting. Faces watery. Patient was used the salad with sausage and eggs. For further diagnosis doctor was prescribed RIGA with salmonella diagnosticums. When it’s necessary to take blood for the investigation. At the 1st and 2nd days of illness Once in recovering period *At the end of the 1st week and after 7-10 days At the end of the 1st week and after 3-4 days Once in acute period Patient B., 32 years old, an employ of poultry was hospitalized with complaints of pain in abdomen, mostly in sigmoid area, fever up to 38,8 oC, nausea, vomiting, diarrhea with dark-green colour of stool, without any pathological changes. Skin and mucous membranes are dry, moderate tension in epigastric region and pain in the right iliac areA. The most likely diagnosis. Acute appendicitis Cholera Dysbacteriosis *Salmonellosis Rotavirus gastroenteritis 3 patients were delivered with symptoms of fever, diarrhea and vomiting. Excrements dark-green, without any pathological changes. All patients together took part in the preparation of food and have used eggs, meat salad. The most likely diagnosis. Cholera Botulism Dysbacteriosis *Salmonellosis Shigellosis Patient L., 33 years old, was admitted to the hospital with the complaints of untolarable pain in the abdomen, mostly in sigmoid region, fever up to 38,8 oC, nausea, vomiting , diarrhea of dark-green colour in every1-1,5 hour, without admixture of blood and mucus. The condition progressively deteriorated, increasing hypotension, paleness, weak cardiac sounds, decreased intestinal peristalsis with moderate tension in epigastric region and pain in the right iliac region. What tactics of treatment? Glucocorticoids, infusion of salt solutions, antibiotics intravenously, diuretic Cardiac glycosides, infusion colloidal solution, antibacterial drugs Enterosorbents, diuretic, desintoxication therapy Mezaton 1% / in drops, infusion of salt solutions, antibacterial drugs orally *Glucocorticoids, infusion of salt solutions, antibiotics intravenously Patient 45 years old, became ill within 10 hours after consumption of grinded meat. Complaints of vomiting, pain in epigastric region, diarrhea of green color, increasing of temperature up to to 39 °C. During objective examination revealed that: patients general condition is sever, pain in the muscles of the lower limbs, pale face, acrocyanosis. Pulse 130 per min,. B.P 70/40 mm Hg. weak cardiac sounds, dry tongue, brown-whitecovering . abdomen cramps, painful iliac and epigastric regions. What is the most likely diagnosis. Shigellosis Cholera *Salmonellosis Viral gastroenteritis Eshericiosis 5 patients during 15 hours were admited In a hospital. All of them have similiar complaints of mild diarrhea and vomiting developed ,diplopia, midriasis, visual disturbance, difficult swallowing, dry mouth, difficulty in breathing. All patients together joined in a dinner party, used different dishes, including meat, salad, canned mushroom. The most likely diagnosis. Cholera *Botulism Typhoid fever Salmonellosis Rotaviral gastroenteritis Patient G., 24 years old, 6 hours after taking his breakfast with boiled eggs, a cup of coffee appeared chill, fever up to 38,8 °C, pain in left inguinal area, nausea,vomiting, rumbling in the stomach, then frequent diarrhea, feces copious, watery, mudy-green. What is the most likely diagnosis. Cholera Botulism *Salmonellosis Typhoid fever Shigellosis Patient U., who was arrived from the Crimea, diarrhea appeared in an intervel of 1-1.5 hour. with copious watery increments, without admixtures of mucous and blood. He was admitted in an infectious dipartment with the diagnosis of “acute intestinal infection”. What laboratory tests are necessary to confirm the etoilogical diagnosis. General blood analysis Bacteriological blood analysis Microscopical analysis of stool *Coprogram The biological examination in mice Patient C with complaints of diarrhea with mucous, stabing pain in epigastric area, rumbling in the stomach, fever. According to his anamnesis he took preserved milk, eggs, salad of fresh vegetables. What is the disease most likely. Shigellosis Yersiniosis *Salmonellosis Cholera Botulism Patient B., 38 years old, came to the admission department with the complaints of fever up to 38 °C, vomiting 4 times in a day, diarrhea up to 6 times in a day. Durin objective examination revealed that BP 125/75 mm Hg, pulse 80 per min, abdomen is soft,painful in the right iliac and epigastric area .According to anamnesis he took salad of boiled eggs and sausage. What treatment should be started first. Antibotulism serum Intravenous antibiotics Washing of the stomach and intestine, rehydration therapy , glucocorticoids *Gastric lavage and washing of intestine, rehydraton therapy enterosorbents Treatment after getting of the laboratory test results Patient 27 years old, complaints of headaches, weakness, pain in epigastric area, vomiting, diarrhea (9 times in a day; huge excrement, greenish colour). Before the appearance of disease he consumed raw eggs. Objectively: body temperature 38,8 °C. Tongue is white, pain in epigastric and umbilical region. The most likely diagnosis. *Salmonellosis Cholera Dysentery Viral gastroenteritis Acute appendicitis Patient K., 30 years old, came with complaints of nausea, vomiting, pain in epigastrium and paraumbilical areA. High body temperature, pale skin, dry. tongue covered with whitish-gray coating. quick pulse, low blood pressure. 2 hours before the onset of symptoms of the disease he ate in cafe. What is the diagnosis most likely. Cholera Shigellosis Thypoid fever *Salmonellosis Meningitis Disease started acutely with the complaints of watery diarrhea, vomiting, cramps in the lower extremities. Objectively: slow voice, shunken eyes, quick pulse, low blood pressure, decrease of urination, weak cardiac sounds. In liver and spleen no changes. Put the correct diagnosis. Salmonellosis Dysentery Food poisoning *Cholera Typhoid fever A Pakistani, 30 years old, severly ill: with the complaints of frequent diarrhea like rice water. Objectively: body temperature 35,4 °C, skin of peripheral parts of the body cold to the touch, acrocyanosis, xerostomia, sharply decreased skin elasticity and turgor. What should be done to assess the degree of dehydration. Measurement of central venous pressure Determination of urea and creatinine in blood Funduscopy X-rays examination of abdomen *Determination of specific gravity of blood plasma Patient N., 30 years old, works in a restaurant, admitted to the hospital complaining of unbearable pain in the abdomen, increase of temperature 38,8 oC, nausea, vomiting, diarrhea of dark-green colour, He took eggs, mushrooms, canned food. Objective state: general condition is moderately sever, skin and mucous membranes are dry, pain in epigastric region. Name the disease. Shigellosis Yersiniosis *Salmonellosis Cholera Rotaviral infection Patient 35 years old with complaints of increasing of temperature to 39 °C with chill, vomiting, pain in epigastric region, diarrhea with foul smell, abdominal cramps. 6 hours before onset of the disease ate raw eggs, fried potatoes with grinded meat, drank juice. To clarify the diagnosis serological diagnostic methods often used. When blood should be taken for the diagnostic procedures? In the first day of illness At the end of the first month In 1st week in 3-4 days *At the end of the 1st week from 7-10 days During admission to the hospital A patient 20 years old, had treated himself concerning an acute respiratory disease for 5 days, but marked no displays of respirator syndrome. Last 2 days temperature has been normal, appetite disappeared, however, appeared pain in epigastrium with nausea, and urine turned dark. About what illness is it possible to think? Hepatitis B Infectious mononucleosis Pseudotuberculosis Leptospirosis *Hepatitis A A patient 28 years old, an injection drug addict, complaints of dull pain in right subcostal region, weakness, decline of appetite, pain in joints. The symptoms have been present for 2 weeks. At examination: the icterus of skin and scleras observed. The liver and spleen are enlarged. Urine is dark, excrements are discoloured. What is preliminary diagnosis? Hepatitis A *Hepatitis B Chronic cholecystitis Toxic hepatitis HIV-infection A patient 25 years old got sick suddenly after chills and temperature increase up to 38,0 °C. There was vomiting 2 times. Moderate pharyngeal pain appeared at swallowing with stomach discomfort. Signs of bursitis observed on knee and elbow joints. The light icterus of sclera and skins of joints on 4th day, on the skin of lateral surfaces of trunk, forehead and lower extremities. The small bright red papular rash appeared, more concentrated in natural folds.Liver is enlarged, the tongue is raspberry like appearence. Preliminary diagnosis would be: Hepatitis A Hepatitis B *Pseudotuberculosis Scarlet fever Infectious mononucleosis A 19 years old patient was diagnosed with hepatitis B. After violation of diet and nervous stress the condition of patient got worse: increasing of icterus intensity , pulse 110/min, BP 80/50 mm Hg. «Coffee-grounds» vomiting . Decreasing of the liver size, pain during palpation. What complication would you think about? Infectious-toxic shock Acute kidneys insufficiency Acute adrenal insufficiency Hemolitic icterus *Acute hepatic insufficiency A patient C., 43 years old, has been treated for 5years . During the last hospitalization a liver-biopsy was conducted. Histologicaly there is bulb dystrophy and necrosis of hepatocytes, with leucocyts infiltration, and pericellular fibrosis. What diagnosis is most credible in this case? *Alcohol liver cirrhosis Viral hepatitis B Viral hepatitis C Cryptogenic hepatitis Fatty dystrophy of liver Patient B., 23 years old. Objectively: skin is yellow, icterus of sclerA. Pulse 66/min, BP 120/80. Indexes of AlAT, AsAT, and Tymol tests are normal. General billirubin is 34 mmol/l due to indirect fraction. Specify the most credible diagnosis. Chronic toxic hepatitis Chronic cryptogenic hepatitis Chronic hepatitis C *Zhilber’s syndrome Chronic B hepatitis A nurse got sick on 16.09: general weakness, nausea, vomiting, pain in joints appeared. 21.09 urine turned dark, and skin yellow. 21.09 she was hospitalized. Objectively: general status worse, temperature 38,2 °C, expressed skin and mucous membranes jaundice. Liver palpated 3 cm below the costal arc. 26.09 stomach-aches and increased sleepiness with disorientation in time and place were appeared. 27.09 haematomas in the places of injections also appeared. Hepatic breath was noticed. Light edema of feet and lumbar region were observed. The liver was not palpable. Development of what syndrome can be? Meningoencephalitis *Hepatic encephalopathy Acute nephrosonephritis Pancreatitis IDS syndrom A patient B., 52 years old, for 3 month complaints of nausea, periodic vomiting, swelling of stomach, weakness, loss of weight up to 12 kg, consistency of stool is chainging. During some days consciousness is entangled, somnolence, allolalia, general weakness are expressed. Temperature of body 37,4 °C. Icterusis on the skin. Tremor of brushes and nystagmus is marked. Pupils are narrowed, with a slow reaction on light, increase of tendon reflexes. Ps 112/min, unrhythmical. BP 90/65 mm Hg. A liver is dense +2. Laboratory tests: Hb 86 g/L, Leuc 4,2*109/L, ESR 18 mm/hour, glucose 3,4 mmol/l, general bilirubin 56,7 mm/L, albumen 52 g/L, K+ 3,2 mmol/l, AsAT 0,62; AlAT 0,84; prothrombin index-58 %; рН blood 7,3. What is previous diagnosis? Hepatocirrhosis Vilsona-Konovalov disease Cancer of liver *Endogenous hepatic encephalopathy Meygs disease A patient, 17 years, complaints of a weakness, worsening of appetite, nausea, painfull in right subcostal area, dull ache in the body, dark color of urine, temperature to 37,8 °C. She stood in contact with sick on icterusis 1,5 months ago. Objectively: yellow colour of the skin and visible mucous membranes. The liver is increased to 1,5 cm. Unsignificant enlargment of spleen. What is your preliminary diagnosis? Viral hepatitis B Infectious mononucleosis *Viral hepatitis A Leptospirosis Pseudotuberculosis Before the appearance of jaundice in a patient 16 years old, during 2 days there were an increasing of the body temperature (38,5 °C), headache, dull ache disturbed whole body. Name the variant of pre-icteric period of viral hepatitis for this patient? *Influenza-like Astenovegetative Artralgic Dyspeptic Allergic A patient T., 28 years, appilled due to worsening of common status at the seventh day to the infectious department concerning viral hepatitis. Nausea and vomiting were present, hepatic smell appeared, increasing of the liver sizes. What biochemical index does allow to suspect complication in the patient? Increasing activity of AlAT Increasing of bilirubin, increasing activity of AlAT Increasing timol test Decreasing of protrombin, increasing of bilirubin *Decreasing of AlAT A sick P., 54 years old, complaints of dull pain in right subcostal area, bad taste in the mouth, itching of the skin, increasing of abdomen. After the liver puncture fatty dystrophy of hepatocytes, eccentric placing of veins in a hepatic lobule were found. What laboratory index are most characteristic in this case? Alkaline phosphotase Hemodiastase *Level of transaminases Glucose of blood Creatinphosphokinase Direct bilirubin is increased , in urine there is significant increase of bilirubin and urobilin, increasing of stercobilin of excrements. What is the type of icterus? Haemolitic *Parenhimatous Transport Extraliver Mechanical On the average 15 to 30 % of all population of the planet suffer from some pathology of liver. Prevalence of hepatitis and cirrhosis in the European countries is about 1 % of adults. Annually in the world there are about 2 million people with acute viral hepatitis. What % of all cases will develop chronic form. 100 % 50 % 25 % *10 % 1 % A patient, 24, complaints of pains in right subcostal area, increasing after-meal, nausea, increase temperature of body to 37,7 °C, icterus, pains in large joints. He is ill from 8 months. Suffers a nonspecific ulcerative colitis. Hepatosplenomegaly. ESR 47 mm/hr, general bilirubin level is 86,1mmol/lt, direct-42,3 mmol/lt. In blood found out antibodies against smooth muscles. General albumen of 62 gram/lt, albumin б. 40 %, globulin. 60 %, gamma globulins 38 %. Not found out the markers of viral hepatitis. On USD diameter of portal vein is 1 cm What will be your diagnosis? Primary biliary cirrhosis Zhilber syndrome Viral hepatitis Hemochromatosis *Autoimmune hepatitis Woman of 22 years old, in the 7th month of pregnancy felt ill acutely in 3 weeks after arrival from Turkmenistan. An icterus, untraceable vomiting, pain in right subcostal region, hemmorhaeges on the skin, appeared after three-day fever. Most probable diagnosis will be: Acute fatty hepatosis of pregnancy Cholestatic hepatosis of pregnant *Viral hepatitis of A Viral hepatitis B Acute sepsis Weakness appeared in a patient, decrease in an appetite, began pains in the joints of extremities, felling of weight in right subcostal region, vomiting. Urine became dark in 12 days, and in a day – sclera and skin turned yellow. It was discovered in an immunogram: antuIgG -HAV (+), HBsAg (+), antiIgМ -НBcorAg (+), anti-НCV (–), anti-НDV (–). To the patient 3 months back was extracted a tooth. Most probable diagnosis? *Viral hepatitis B Viral hepatitis A Viral hepatitis C Viral hepatitis D Viral hepatitis E A patient 42 years, radiologist, entered surgical department with bleeding from the mouth, was admitted to the gastroenterological departments . He considered himself healthy. 20 years ago had haemotransfusion. Fibrogastroduodenoscopy shows venous dilation of the oesophagus of the III degree. Most probable etiologic reason of disease: Autoantibodies against hepatocytes Viral hepatitis A X-ray irradiation *Viral of hepatitis B Defficiency of antitrypsin A patient during half of the year got frequent parenterally injections concerning bronchial asthmA. There was decrease in appetite gradually, started to feel weakness, arthralgia, dark coloured urine, the icterus of skin appeared. Objectively: temperature of 37 °C, pulse 68/min BP 115/70 mm of Hg Liver +4 cm, spleen +1 cm, skin and sclera is yellow coloured In the general blood analysis: amount of leucocytes: 3,6 109,among them 52 % lymphocytes, ESR 6 mm/hr, activity of ALAT is increased in 10 times. which information will be more credible than all in blood of patient? Anti-HBs antibodies Anti-HAV IgM antibodies *Anti-HBV antibodies Anti-HCV IgG antibodies Anti-HEV IgM antibodies Patient 34 years old complaints of fatigue, decreasing of appetite, nausea, feeling of weight in a epigastric region, bitter taste in to the mouth. Objectively: Pulse is 76/min , temperature 37,2 °C. Skin is pale, with single vascular “asterisks” present on thorax. Liver is enlarged with 2 cm below the costal arch . In blood: bilirubinn :36 mmol/lt , ASAT :2,5 mmol/lt, ALAT :2,8 mmol. HBeAg, anti-HBc (–), HBsAg and anti-HBe (+). What will be the diagnosis of the patient? *Chronic hepatitis, phase of integration, activity is poorly expressed Chronic hepatitis, phase of replication, activity is poorly expressed Chronic hepatitis, phase of integration, high activity Chronic hepatitis, phase of replication, activity is poorly expressed Chronic hepatitis, phase of replication, moderate activity A patient of 34 years complaints of fatigue, decreasing of appetite, nausea, feeling of weight in a epigastric region, bitter taste in the mouth. Objective examination : Pulse 76/min, temperature 37,2 °C. Skin is pale, single vascular star-like rash on the thorax. Liver is 2 cm below the costal arch. In blood: bilirubin level is 36 mmol/lt, ASAT 2,5, ALAT 2,8 . Anti-HBc (–), HBsAg and HBeAg (+). What therapeutic tactic is expedient in this case? Therapy by hepatoprotectors *Antiviral therapy by lamivudine Antiviral therapy by ribavirin Therapy by corticosteriods Therapy by immunostimulators Man 30 years, drug addict, takes drugs intravenously. Has been taking drugs for 12 years Complaints of weakness, moderate icterus, weight in right subcostal region. The state was worsened gradually. Biochemical indexes: general bilirubin 28,2 mmol/lt; ALAT 1,0, ASAT 0,8 . Will you define a diagnostic method which it is expedient to conduct for establishment of etiologic diagnosis? Biopsy of liver *Polymerase chain reaction (PCR) Enzymes of liver Computer tomography Immunological tests Patient B., 51 years, a lot of years used an alcohol. Complaints of nausea, liquid stools, icterus of skin. Objectively: skin and sclera is yellow coloured, atrophy of muscles, subfebrile temperature. Liver 3 cm below the costal arch, painful on palpation What method of diagnostics most informing in this case? Activity of cytolysis (AsAT, AlAT) Proteinogram *Biopsy of liver Markers of viral hepatitis Violation of cellular immunity (T4,T8) Patient of B., 64 years old, has been sick with chronic hepatitis. Complaints of pain in the liver, growth retardation. Objectively: his skin is dry, erythemic, atrophy of muscles, telangiectasis on shoulders, hyperemia of hands, abdomen is enlarged. The liver below the costal arc on 3 cm, painful, dense, spleen on 1 cm below the costal arch, positive symptom of fluctuation. Laboratory investigation: hypergammaglobulinaemia, increasing of AsAT activity, AlAT is highly increased. What drug of choice for the patient? Lactulose *Hepatoprotectors Antibiotics Glucocorticoids Alpha interferon A patient 48 years old, complaints of attacks pains in right subcostal area after the physical loading. Periodically marks more light excrement, darkening of urine. Objectively: skin and mucous membranes high icteric. General bilirubin 36,8 mm/L, direct fraction - 26,4. Ultrasound of gall-bladder: thickness of wall 4 mm, there is a lot of bile in the ducts. It is necessary to prescribe with a lytolitic purpose: Choleretics *Ursofalk Cholekinetics Spasmolytics Cytostatics During annual inspection increasing of a liver to 4 cm of 23 years old patient was found, increasing of bilirubin level in 2 times, AlAT in 2,5 time. He has been often sick with genital herpes. It was discovered RNA of hepatitis C virus. What is etiologic treatment *Interferons Essencial phosphotides Choleretics Cholekinetics Ursodesoksihole acids A woman of 22 years old, on the 7th month of pregnancy, fell ill suddenly after 3 weeks arrival from Turkmenistan. An icterus, incessant vomiting, pain in right subcostal area, skin haemorrhages, were appeared after 7-daily fever. What is most credible diagnosis: *Hepatitis A Hepatitis B Acute fatty hepatosis of pregnant Cholestatic hepatosis of pregnant Cholecystitis A patient 28 years old, injection drug addict, complaints of dull pain in the right subcostal area, weakness, decline of appetite, pain in joints, which disturbs during 2 weeks. At examination: icterus of the skin and sclera, enlargement of the liver and spleen, dark urine, excrement is discoloured. What is preliminary diagnosis? HIV-infecion Hepatitis B Hepatitis C *Toxic hepatitis Hepatitis A At inspection of a 8 weeks term pregnant woman HBsAg was found. Level of bilirubin of blood and activity of ALAT were normal. What is necessary to do? *To save pregnancy and conduct the inoculation to newborn against hepatitis B Termination of pregnancy Termination of pregnancy and conduct treatment by interferon To save pregnancy and conduct treatment by lamivudin To save pregnancy and ultrasonic inspection of the fetus Student 20 years, treated oneself on an occasion of ARVI (increasing of temperature to 38,2 °C during 3 days). He complaints of worsening of appetite, increasing fatigue at a normal temperature and absence of the catarrhal phenomena of upper respiratory tracts. A doctor found out an increasing and moderate sickliness of liver. There were cases of hepatitis A in a student’s group. What method of investigation will allow? Ultrasound scanning of the liver Determination of bilirubin level of the blood Determining the amount of beta-lipoproteins *Determination of activity of аminotransferases of the blood Immunofluorescent research of the nasal smears A patient I., 25 years old, appealed to the internist with complaints of a general weakness, loss of appetite, pain in the right hypochodrium. Treated himself on an occasion of ARVI ambulatory 3 days. Became acute worsening of fealling: nausea, pain in right hypochondrium, ochrodermia of sclera, darkening of urine, appeared. Objectively: breathing superficial, cardiac tone is rhythmic. Abdomen is soft, painfull in right hypochondrium, a liver is megascopic, a spleen not palpable. What is most credible diagnosis? *Hepatitis A Leptospirosis Cholecystitis Influenza Pseudotuberculosis A patient 42 years old, complaints of dull pain in a right hypochondrium, weakness, decline of appetite, itching of skin, icterus. Disease began 1 month ago from protracted аrthralgia, disgust for a meal, strong weakness. An icterus which now increased considerably appeared three weeks ago. Temperature 36,0 °C. Pulse 56 per 1 min. A tongue is assessed with white cover. A stomach is soft, sickly in right hypochondrium. A liver +3 cm, spleen is not megascopic. Common analysis of blood: leukopenia, relative lymphomonocytosis, ESR 3 mm/hour. What diagnosis is most credible? Cancer of head of a pancreas *Hepatitis B Hepatitis A Cirrhosis of liver Chronic cholecystitis For a patient 35 years after 4-months of treatment by isoniaside - аdynemia, icterus, pain in right hypochondric were appeared. A liver is megascopic. In blood activity of enzymes of AlAT is enhanceable in three times, AsAT in two times. Bilirubin of blood of 122 gm/ml (conjugated – 82, unconjugated – 40). НBs-аntigen is not found out. What is the diagnos? Calculary cholecystitis Hepatocirrhosis Acute viral hepatitis Chronic active hepatitis *Toxic hepatitis A patient 75 years old. Complaints of a subfibrile temperature, general weakness, pharyngalgia, conjunctivitis. A child in family an acute adenoviral disease is ill. A patient considers itself a patient the second day. At examination discovered sign of acute pharyngitis. Lymphatic nodes are megascopic: neck front and back, arm-pits and inguinal, to 1 cm in a diameter, soft, not soldered between itself and with a surrounding tissue. Hyperemia of pharynx and tonsills. Wheezes are not present in lungs. Breathing clean. Tones of heart are muffled. BP - 140/80 mm Hg, Ps - 80 per 1 min. Stomach soft. Palpatory- megascopic liver and spleen, 3 cm below the costal arc, soft, painless. Choose the most credible diagnosis: Flu, to middle weight Limfogranulomatosis *Adenoviral infection Infectious mononucleosis Hepatitis A A patient 35 years old, complaints of aching pain in right hypocostal area, nausea, decline of appetite. Beginning of disease binds to appendicitis. After it in 2 months an icterus appeared first. Treated oneself in an infectious department. In 1 began to notice aching pain in right hypocostal area, in analyses is an increase of level of bilirubin. Your diagnosis? Calculary cholecystitis Zhil'ber disease Acute viral hepatitis Chronic cholangitis *Chronic hepatitis The patient T., 35 years, operating trained nurse, appealed to the doctor on the 8th day of gradual development of illness with complaints of a general weakness, rapid fatigueability, dark color of urine. In the morning noticed the icterus. On examination temperature of body 36,8 °C. Found out the increase of liver -+3 sm The changes of what laboratory index most informing at this illness? *AlAT Hemodiastases Protrombin index Cholesterol Alkaline phosphatase 23-years old patient during 6 months gets diabetes mellitus in a policlinic the injections of insulin. A weakness, arthalgia, grew gradually, an appetite disappeared, then dull pain appeared in an epigastrium after-meal. In 2 weeks from the beginning of illness noticed the dark color of urine, and afterwards – icterus on a background which the general state continues to be worsened. Temperature of body 36,5°C, Ps 58 per 1 min Liver +5 sm, spleen +1 sm What from hemanalysis is it needed to appoint for confirmation of diagnosis? Activity of alkaline phosphatase Activity of lactatdehydrogenase *Activity of ALAT Activity of creatinphosphokinase Activity of amylase 42-years old patient got blood transfusion two months ago. A weakness was gradually increased, an appetite was worsened, arthalgia, small nausea appeared. On a 12th day noticed an insignificant icterus, appealed to the doctor. At examination is the general state fully satisfactory. The temperature of body is normal, Ps 60 per 1 min, BP 100/70 mm Hg.A liver and spleen is moderate megascopic, a stomach at palpatory is not sickly. Anti-HCV IGM is found in blood. What from changes in the global analysis of blood most probably? Neutrocytosis *Leykopeniya Lymphopenia Speed-up ESR Aneozinofiliya A 17-years-old patient during 4 days suddenly had headackes, myalgias, fever of permanent type. From a 5th day is a normal temperature of body, the general state was considerably improved, an appetite appeared, nausea, general weakness, disappeared, but an icterus became noticeable. The general state is satisfactory, liver +3 cm, spleen +1 cm, Ps 56 per 1 mins Peripheral lymphatic knots, amygdales are not megascopic, hyperemia of pharynx is not present. At research of global analysis of blood is leykopenia with a relative lymphocytosis, 3 % virocytis, ESR normal. Activity of ALAT of blood is increase in 5 times. What diagnos is most credible? *Hepatitis A Infectious mnonucleosis Citomegaloviral infection Hepatitis B Hepatitis C On the 15th day of illness in a 17-years-old patient with hepatitis anti-HBs is found in blood. The condition of patient was considerably worsened the day before. There was excitation, a nose-bleed, a hemorragic rash appeared on a skin, diminished and became sickly at palpatory liver. Ps 106 per 1 min, BP of 110/ 70 mm Hg, the temperature of body subfebrile. What changes of blood indexes is most credible? Growth of alkalinephosphatase Growth of Fibrinogenum Growth of indirect bilirubinum *Decline of protrombin index Growth of albumin 25-years old woman during a year got numerous injections concerning bronchial asthmA. An appetite disappeared gradually, a weakness, arthalgia grew, urine became dark in two weeks, through three – an icterus on a background which the general condition continues to be worsened appeared. The temperature of body is normal, Ps 62 per 1 min. Moderate sickliness in the area of pancreas, positive symptom of Voskresensky, liver +4 cm, spleen +2 cm. What markers of viral hepatitis more credible will be positive for a patient? *Anti-HBc IGM ANTI-HEV IGM ANTI-CMV IGM HBsAg ANTI-HAV IGM 26-years old man during 6 days marks gettings up temperatures with a strong chill. 6 months ago there were alike attacks of fever during a trip to Afghanistan, from where returned 4 months ago. Temperature of body 36,4°C, Ps 94 per 1 min. The moderate increasing of spleen and liver is marked. A diuresis suffices, without pathological changes. What disease can be suspected for a patient? Leptospirosis Hemorragic fever *Malaria Viral hepatitis Sepsis A 16-years-old patient in a month after returning from Crimea had headackes, myalgias appear suddenly, strong weakness with a fever to 39°C during 3 days. The general condition was considerably improved farther, a bad appetite and nausea, dull pain, was saved only in right hypocostal area, became dark urine, an excrements became white. On a 6th day a moderate icterus appeared. Liver +4 cm, spleen +1 cm. In the general blood analysis is leykopenia, relative limphomonocytosis, ESR 4 mm/hour. General bilirubin of blood 89 mmol/L, the direct prevails, activity of ALAT is increase in 4 times, ASAT – in 3 times. What is most credible diagnoses? Hepatitis B *Hepatitis A Opisthorchiasis Hemolitic icterus Acute cholecystitis Patient A., 19 years, became sick acutely – the temperature of body rose to 39 °C, a weakness, nausea, appeared. Vomiting, a stomach-ache are not present. A temperature reposed on high numbers 2 days, then went down to normal. Urine became dark on the 6th day of illness, subicterus noticed on 5th. To this time condition of patient was improved, nausea, weakness, disappeared. Objectively: moderate icterus of skin and sclera, a rash is not present. Pulse 66 per 1 min, BP 110/70 mm Hg. Abdomen is soft, painless in all of parts, liver + 2,5 cm, the spleen was palpitated. What is the reason of changes in the pre-icteric period of the disease? *Toxicemiya Bacterialemiya Pancreatitis Viremia Cholecystitis 40-years old patient during 2th days marks absence of appetite, nausea, general weakness. A year ago carried acute hepatitis B, avoided a clinical supervision. Objectively: the temperature of body is normal, skin and sclera are icteric, liver + 3 cm. A spleen is not megascopic. Urine is moderate dark colouring. ALAT of blood 4,0. What is most credible diagnosis? Chronic viral hepatitis, minimum activity Chronic cholecystitis *Chronic viral hepatitis, moderate activity Hepatocirrhosis Chronic viral hepatitis, high activity A man, 37 years, injection drug addict, alcoholic, complaints of a general weakness, dull pain in right hypocostal area, increasing of abdomen, shortness of breath. He was sick by chronic hepatitis during 10 years. Objectively: temperature of body 37,1°C, an expressed icterus. Liver +6 cm. Free liquor in abdomen. Positive symptom of fluctuation. What complication present? Exacerbation of chronic hepatitis C Acute hepatic insufficiency Hepatocarcinoma Exacerbation of chronic hepatitis B *Hepatocirrhosis A patient is 59 years, suffers from chronic viral hepatitis with development of cirrhosis, hospitalized with a diagnosis: “bleeding from the veins of esophagus”. Acute pallor of skin covers. BP 80/40 mm Hg, pulse 100 per 1 min, the temperature of body is normal. On a front abdominal wall a venous net is extended. What preparation is it necessary to begin therapy from? Albumen Plasma Neogemodez *Blood Glucose Patient 20 years, treated oneself on an occasion ARVI during 5 days, but marked no displays of respirator syndrome. Last a temperature is normal 2 days, an appetite disappeared however, pain appeared in an epigastrium, nausea, urine had darked. About what illness is it possible to think? Acute hepatitis B Infectious mononucleosisз Pseudotuberculosis Leptospirosis *Hepatitis A In 2 months after returning from India, where often drank unboiled water, the 23-years-old pregnant nauseated, strong general weakness, head pain, later the temperature of body rose to 38,6°, which stuck to within a week. An icterus appeared on a 6th day, the general state continued to be worsened. On the 12th day of illness the general state heavy. EuphoriA. Vomiting at night. Complete fastidium. Bright icterus, signs of hemorragic syndrome, tachycardiA. BP 110/60 mm Hg, temperature of body of 37,8°C. A liver is insignificantly megascopic, soft, painfull, spleen +2 sm There is neutrophilic leykocytosis in the global analysis of blood. General bilirubinum of blood of 570, to the line – 300, activity of ALAT is enhanceable in 100 times, timol test of 26 units., urea – 2,1 mmol/l. With most probability for a patient: *Hepatitis A Malignant icterus of pregnant Typhoid Mechanical icterus Leptospirosis A patient is 25 years, appealed to the internist with complaints of a general weakness, worsening of appetite, feeling of weight in right hypocostal areA. Treated oneself on an occasion ARVI ambulatory 3 days. A feel was worsened, nausea, pain in right hypocostal arrea, ochrodermia of sclerotica, darkening of urine, appeared. Objectively: breathing normal, cardiac tones are rhythmic. A stomach is soft, sickly in right hypocostal area, a liver is megascopic, a spleen is not megascopic. What is the most credible diagnosis? *Hepatitis A Leptospirosis Calculary cholecystitis Flu Pseudotuberculosis A patient 20 years old, had treated himself concerning an acute respiratory disease for 5 days, but marked no displays of respirator syndrome. Last 2 days temperature has been normal, appetite disappeared, however, appeared pain in epigastrium with nausea, and urine turned dark. About what illness is it possible to think? Hepatitis B Infectious mononucleosis Pseudotuberculosis Leptospirosis *Hepatitis A A patient 28 years old, an injection drug addict, complaints of dull pain in right subcostal region, weakness, decline of appetite, pain in joints. The symptoms have been present for 2 weeks. At examination: the icterus of skin and scleras observed. The liver and spleen are enlarged. Urine is dark, excrements are discoloured. What is preliminary diagnosis? Hepatitis A *Hepatitis B Chronic cholecystitis Toxic hepatitis HIV-infection A patient 25 years old got sick suddenly after chills and temperature increase up to 38,0 °C. There was vomiting 2 times. Moderate pharyngeal pain appeared at swallowing. with stomach discomfort. Signs of bursitis observed on knee and elbow joints. The light icterus of sclera and skins of joints on 4th day, on the skin of lateral surfaces of trunk, forehead and lower extremities. The small bright red papular rash appeared, more concentrated in natural folds.Liver is enlarged, the tongue is raspberry like appearence. Preliminary diagnosis would be: Hepatitis A Hepatitis B *Pseudotuberculosis Scarlet fever Infectious mononucleosis A 19 years old patient was diagnosed with hepatitis B. After violation of diet and nervous stress the state of patient got worse: intensity of ichterus was increased, pulse 110/min, BP 80/50 mm Hg. Also there was vomiting by «coffee-grounds». The size of liver has decreased, the liver on palpation was painful. What complication would you think about? Infectious-toxic shock Acute kidneys insufficiency Acute adrenal insufficiency Hemolitic icterus *Acute hepatic insufficiency A patient C., 43 years old, has been treated for 5years . During the last hospitalization a liver-biopsy was conducted. Histologicaly there is bulb dystrophy and necrosis of hepatocytes, with leucocyts infiltration, and pericellular fibrosis. What diagnosis is most credible in this case? *Alcoholic liver cirrhosis Viral hepatitis B Viral hepatitis C Cryptogenic hepatitis Fatty dystrophy of liver Patient B., 23 years old. Objectively: skin is yellow, icterus of sclerA. Pulse 66/min, BP 120/80 . Indexes of AlAT, AsAT, and Tymol tests are normal. General billirubin is 34 mmol/l due to indirect fraction. Specify the most credible diagnosis. Chronic toxic hepatitis Chronic cryptogenic hepatitis Chronic hepatitis C *Zhilber’s syndrome Chronic B hepatitis A trained nurse got sick on 16.09: general weakness, nausea, vomiting, pain in joints appeared. 21.09 urine turned dark, and skin yellow. 21.09 she was hospitalized. Objectively: general status satisfactory, temperature 38,2 °C, expressed skin and mucous membranes jaundice. Liver palpated 3 cm below the costal arc. 26.09 stomach-aches and increased sleepiness with disorientation in time and place were appeared. 27.09 haematomas in the places of injections also appeared. Hepatic breath was noticed. Light edema of feet and lumbar region were observed. The liver was not palpable. Development of what syndrome can be forecast? Meningoencephalitis Hepatic encephalopathy Acute nephrosonephritis Pancreatitis *ID syndrom A patient B., 52 years old, for 3 month complaints of nausea, periodic vomiting, swelling of stomach, weakness, loss of weight up to 12 kg, consistency of stool is chainging. During some days consciousness is entangled, somnolence, allolalia, general weakness are expressed. Temperature of body 37,4 °C. Icterusis on the skin. Tremor of brushes and nystagmus is marked. Pupils are narrowed, with a slow reaction on light, increase of tendon reflexes. Ps 112/min, unrhythmical. BP 90/65 mm Hg. A liver is dense +2. Laboratory tests: Hb 86 g/L, Leuc 4,2*109/L, ESR 18 mm/hour, glucose 3,4 mmol/l, general bilirubin 56,7 mm/L, albumen 52 g/L, K+ 3,2 mmol/l, AsAT 0,62; AlAT 0,84; prothrombin index-58 %; рН blood 7,3. What is previous diagnosis? Hepatocirrhosis Vilson-Konovalov disease Cancer of liver *Endogenous hepatic encephalopathy Meygs disease A patient, 17 years, complaints of a weakness, worsening of appetite, nausea, painfull in right subcostal area, dull ache in the body, dark color of urine, temperature to 37,8 °C. She stood in contact with sick on icterusis 1,5 months ago. Objectively: yellow colour of the skin and visible mucous membranes. The liver is increased to 1,5 cm. Unsignificant enlargment of spleen. What is your preliminary diagnosis? Viral hepatitis B Infectious mononucleosis *Viral hepatitis A Leptospirosis Pseudotuberculosis Before the appearance of jaundice in a patient 16 years old, during 2 days there were an increasing of the body temperature (38,5 °C), headache, dull ache disturbed whole body. Name the variant of pre-icteric period of viral hepatitis for this patient? *Influenza-like Astenovegetative Artralgic Dyspeptic Allergic A patient T., 28 years, appilled due to worsening of common status at the seventh day to the infectious department concerning viral hepatitis. Nausea and vomiting were present, hepatic smell appeared, increasing of the liver sizes. What biochemical index does allow to suspect complication in the patient? Increasing activity of AlAT Increasing of bilirubin, increasing activity of AlAT Increasing timol test *Decreasing of protrombin, increasing of bilirubin Decreasing of AlAT A sick P., 54 years old, complaints of dull pain in right subcostal area, bad taste in the mouth, itching of the skin, increasing of abdomen. After the liver puncture fatty dystrophy of hepatocytes, eccentric placing of veins in a hepatic lobule were found. What laboratory index are most characteristic in this case? Alkaline phosphotase Hemodiastase *Level of transaminases Glucose of blood Creatinphosphokinase A patient, 24, complaints of pains in right subcostal area, increasing after-meal, nausea, increase temperature of body to 37,7 °C, icterus, pains in large joints. He is ill from 8 months. Suffers a nonspecific ulcerative colitis. Hepatosplenomegaly. ESR 47 mm/hr, general bilirubin level is 86,1mmol/lt, direct-42,3 mmol/lt. In blood found out antibodies against smooth muscles. General albumen of 62 gram/lt, albumin б. 40 %, globulin. 60 %, gamma globulins 38 %. Not found out the markers of viral hepatitis. On USD diameter of portal vein is 1 cm What will be your diagnosis? Primary biliary cirrhosis Zhilber syndrome Viral hepatitis Hemochromatosis *Autoimmune hepatitis Woman of 22 years old, in the 7th month of pregnancy felt ill acutely in 3 weeks after arrival from Turkmenistan. An icterus, untraceable vomiting, pain in right subcostal region,, hemmorhaeges on the skin, appeared after three-day fever. Most probable diagnosis will be: Acute fatty hepatosis of pregnancy Cholestatic hepatosis of pregnant *Viral hepatitis of A Viral hepatitis B Acute sepsis Weakness appeared in a patient, decrease in an appetite, began pains in the joints of extremities, felling of weight in right subcostal region, vomiting. Urine became dark in 12 days, and in a day – sclera and skin turned yellow. It was discovered in an immunogram: antuIgG -HAV (+), HBsAg (+), antiIgМ -НBcorAg (+), anti-НCV (–), anti-НDV (–). To the patient 3 months back was extracted a tooth. Most probable diagnosis? *Viral hepatitis B Viral hepatitis A Viral hepatitis C Viral hepatitis D Viral hepatitis E A patient 42 years, radiologist, entered surgical department with bleeding from the mouth, was admitted to the gastroenterological departments . He considered himself healthy. 20 years ago had haemotransfusion. Fibrogastroduodenoscopy shows venous dilation of the oesophagus of the III degree. Most probable etiologic reason of disease: Autoantibodies against hepatocytes Viral hepatitis A X-ray irradiation *Viral of hepatitis B Defficiency of antitrypsin A patient during half of the year got frequent parenterally injections concerning bronchial asthmA. There was decrease in appetite gradually, started to feel weakness, arthralgia, dark coloured urine, the icterus of skin appeared. Objectively: temperature of 37 °C, pulse 68/min BP 115/70 mm of Hg Liver +4 cm, spleen +1 cm, skin and sclera is yellow coloured In the general blood analysis: amount of leucocytes: 3,6 109,among them 52 % lymphocytes, ESR 6 mm/hr, activity of ALAT is increased in 10 times. which information will be more credible than all in blood of patient? Anti-HBs antibodies Anti-HAV IgM antibodies *Anti-HBV antibodies Anti-HCV IgG antibodies Anti-HEV IgM antibodies Patient 34years old complaints , about fatigue, decreasing of appetite, nausea, feeling of weight in a epigastric region, bitter taste in to the mouth. Objectively: Pulse is 76/min , temperature 37,2 -°C. Skin is pale, with single vascular “asterisks” present on thorax. Liver is enlarged with 2 cm below the costal arch . In blood: bilirubinn :36 mmol/lt , ASAT :2,5 mmol/lt, ALAT :2,8 mmol. HBeAg, anti-HBc (–), HBsAg and anti-HBe (+). What will be the diagnosis of the patient? *Chronic hepatitis B, phase of integration, activity is poorly expressed Chronic hepatitis B, phase of replication, activity is poorly expressed Chronic hepatitis B phase of integration, high activity Chronic hepatitis C, phase of replication, activity is poorly expressed Chronic hepatitis C phase of replication, moderate activity A patient of 34 years complaints of fatigue, decreasing of appetite, nausea, feeling of weight in a epigastric region, bitter taste in the mouth. Objective examination : Pulse 76/min, temperature 37,2 °C. Skin is pale, single vascular star-like rash on the thorax. Liver is 2 cm below the costal arch. In blood: bilirubin level is 36 mmol/lt, ASAT 2,5, ALAT 2,8 . Anti-HBc (–), HBsAg and HBeAg (+). What therapeutic tactic is expedient in this case? Therapy by hepato-protectors *Antiviral therapy by lamivudine Antiviral therapy by ribavirin Therapy by corticosteriods Therapy by immunostimulators Man 30 years, drug addict, takes drugs intravenously. Has been taking drugs for 12 years Complaints of weakness, moderate icterus, pain in right subcostal region. The state was worsened gradually. Biochemical indexes: general bilirubin 28,2 mmol/lt; ALAT 1,0, ASAT 0,8 . Will you define a diagnostic method which it is expedient to conduct for establishment of etiologic diagnosis? Biopsy of liver *Polymerase chain reaction (PCR) Enzymes of liver Computer tomography Immunological tests Patient B., 51 years, a lot of years used an alcohol. Complaints of nausea, liquid stools, icterus of skin. Objectively: skin and sclera is yellow coloured, atrophy of muscles, subfebrile temperature. Liver 3 cm below the costal arch, painful on palpation What method of diagnostics most informing in this case? Activity of cytolysis (AsAT, AlAT) Proteinogram *Biopsy of liver Markers of viral hepatitis Violation of cellular immunity (T4,T8) Patient of B., 64 years old, has been sick with chronic hepatitis. Complaints of pain in the liver, growth retardation. Objectively: his skin is dry, erythemic, atrophy of muscles, telangiectasis on shoulders, hyperemia of hands, abdomen is enlarged, look like “jelly-fish head”. The liver below the costal arc on 3 cm, painful, dense, spleen on 1 cm below the costal arch, positive symptom of fluctuation. Laboratory investigation: hypergammaglobulinaemia, increasing of AsAT activity, AlAT is highly increased. What drug of choice for the patient? Lactulose *Hepatoprotectors Antibiotics Glucocorticoids Alpha interferon A patient 48 years old, complaints of attacks pains in right subcostal area after the physical loading. Periodically marks more light excrement, darkening of urine. Objectively: skin and mucous membranes high icteric. General bilirubin 36,8 mm/L, direct fraction - 26,4. Ultrasound of gall-bladder: thickness of wall 4 mm, there is a lot of bile in the ducts. It is necessary to prescribe with a lytolitic purpose: Choleretics *Ursofalk Cholekinetics Spasmolytics Cytostatics During annual inspection increasing of a liver to 4 cm of 23 years old patient was found, increasing of bilirubin level in 2 times, AlAT in 2,5 time. He has been often sick with genital herpes. It was discovered RNA of hepatitis C virus. What is etiologic treatment *Interferons Essencial phosphotides Choleretics Cholekinetics Ursodesoksihole acids A patient, 19 years old, with hepatitis B. After violation of diet and nervous stress the state of the patient became worse: increasing of intensity of jaundice, pulse 110 per 1 min, BP 80/50 mm Hg, vomiting with “coffee-grounds”, decreasing of the liver size. What complication is it possible to think about? *Acute liver insufficiency Infectious-toxic shock Acute kidney insufficiency Acute extrarenal insufficiency Hemolytic A woman of 22 years old, on the 7th month of pregnancy, fell ill suddenly after 3 weeks arrival from Turkmenistan. An icterus, incessant vomiting, pain in right subcostal area, skin haemorrhages, were appeared after 7-daily fever. What is most credible diagnosis: *Hepatitis A Hepatitis B Acute fatty hepatosis of pregnant Cholestatic hepatosis of pregnant Cholecystitis A patient, 25 years old, fell ill suddenly: after a chill temperature rose up to 38,0 °C, 2 times vomiting, moderate pharyngalgias at swallowing, pain in the stomach, knee and elbow joints. Non intensive jaundice of scleras and skin at 4th day of disease were appiared, urine became dark; on the lateral surfaces of trunk, overhead and lower extremities small spot bright red rash appeared. Liver is increased, tongue is assessed, “raspberry”, increased lymphonodes. What is preliminary diagnosis? Hepatitis A *Pseudotuberculosis Allergodermia Scarlet fever Infectious mononucleosis A patient 21 years old, complaints of increasing of temperature to 39,2 °C, weakness, headache, pharyngalgia, pain in the muscles, joints and stomach, nausea, vomiting once. On the 3rd day stomach-ache increased and began to be expressly localized in the right iliac areA. The patient was hospitalised in a surgical department with a diagnosis “appendicitis”. At examination: hyperemia of mucous of nasopharynges, subicteroses, liver +2. At operation changed appendix and packages of mesenterial lymphonodes has been found. What is preliminary diagnosis: Typhoid fever Adenoviral infection Hepatitis A *Pseudotuberculosis Enteroviral infection Animal technician 57 years, on the 3th day of illness appealed to the doctor with complaints of headacke, high temperature, pain in gastrocnemius muscles, dark urine and diminishing of its amount. Objectively: temperature 38,1 °C, injection of the sclera vessels, petechial rash on upper part of the thorax, hepatosplenomegaly. What is most credible preliminary diagnosis? Pseudotuberculosis Brucellosis Viral hepatitis *Leptospirosis Influenza A patient 28 years old, injection drug addict, complaints of dull pain in the right subcostal area, weakness, decline of appetite, pain in joints, which disturbs during 2 weeks. At examination: icterus of the skin and sclera, enlargement of the liver and spleen, dark urine, excrement is discoloured. What is preliminary diagnosis? HIV-infecion Hepatitis B Hepatitis C *Toxic hepatitis Hepatitis A At inspection of a 8 weeks term pregnant woman HBsAg was found. Level of bilirubin of blood and activity of ALAT were normal. What is necessary to do? *To save pregnancy and conduct the inoculation to newborn against hepatitis B Termination of pregnancy Termination of pregnancy and conduct treatment by interferon To save pregnancy and conduct treatment by lamivudin To save pregnancy and ultrasonic inspection of the fetus A patient I., 26 years old, delivered in a hospital on the 4th day of disease with complaints of fever, headache, pain in gastrocnemius muscles. Works as a specialist in land-reclamation. Has a lot of sexual contacts. Objectively: temperature – 39,7 °C. Severe common condition. Expressed icterosis of skins and sclerA. Hemorrhages in conjunctiva and sclerA. There is a hemorragic rash on a skin. A liver increased on 3 see below the costal arc, edge of spleen, the Day's diuresis 300 ml. The etiologic factor of disease most for certain is: Rickettsia Virus *Leptospira Spirocheta Chlamidia Patient 43, miner, on the 7th day of disease complaints of acute weakness, high temperature, pain in the muscles of feet and back, icterus, dark color of urine, headache. Fell ill sharply from a chill, temperature 40,2 °, there was a nose-bleed. A diuresis 200 ml. What is a credible diagnosis? Sepsis Typhoid Viral hepatitis *Leptospirosis Malaria 36 years old man, during 8 days marks increasing of temperature with a strong chill, which end with abundant sweating and repeat oneself regularly in a day. There were alike attacks of fever in Afghanistan, from where returned 4 months ago. Temperature 39,2 °, pulse 94 after 1 mins A stomach during palpation is not sickly. There is a moderate increase of spleen and liver, insignificant icterus. What diagnosis is most credible? Viral hepatitis Typhoid Sepsis *Malaria Tuberculosis Patient 40 years old, in a week after returning from Ethiopia on a motherland disturb the periodic attacks of fever. The icterus of sclera and skin covers, hepatospleenomegaly, is marked. What from the transferred diagnoses most credible? Sepsis *Malaria Hepatitis A Hemolitic anaemia Leptospirosis Patient 45 years, hospitalized on the 7th day of fever. Objectively: temperature 39,8 °C, somnolence (at night insomnia), dormancy, аdynemia, pallor of skin covers, pulse 78 per 1 min, BP 105/70 mm of Hg. The tangue is thickly assessed with a grey cover with the imprints of a teeth. A stomach is swollen, liver and spleen megascopic, in a right iliac area rumbling and hyperemia of skin. Stool is absent 2 days. What investigation is it neccessary to perform for clarification of diagnosis? *Bacteriologic examination of blood Spinal puncture Myelogram Colonoscopy Analysis on the markers of viral hepatitis Patient 52 years old, suffering sharply from a chill and headache, fever to 40,5 °C. On a 3rd day of disease nausea, vomiting, dark urine appeA. On a 4th day temperature falls down to 37,2 °C, but an icterus appeared and the amount of urine decreased to 600 ml. What disease such symptoms develop from? Sepsis Hemorrhagic fever with a kidney syndrome Hepatitis A *Leptospirosis Acute glomerulonephritis A patient, 35 years, suffering sharply, complaints of a headache, pain in the muscles of lower extremities, increasing of temperature to 39,3 °C. Objectively on the 4th day of disease: the state is severy, hyperemic face, icterosis of skin and sclerA. Enlargment of liver and spleen. A diuresis is mionectic. What is most credible diagnosis? Trichinosis Hepatitis A Yersiniosis Infectious mononucleus *Leptospirosis Student 20 years, treated oneself on an occasion of ARVI (increasing of temperature to 38,2 °C during 3 days). He complaints of worsening of appetite, increasing fatigue at a normal temperature and absence of the catarrhal phenomena of upper respiratory tracts. A doctor found out an increasing and moderate sickliness of liver. There were cases of hepatitis A in a student’s group. What method of investigation will allow? Ultrasound scanning of the liver Determination of bilirubin level of the blood Determining the amount of beta-lipoproteins *Determination of activity of аminotransferases of the blood Immunofluorescent research of the nasal smears For a patient, workwoman of a pig farm, on a background of complete health a chill appeared suddenly, a temperature rose to 39,9 °C, there was a headache, nauseA. On the next day marked pains in the muscles of lower extremities, nose-bleeding began. On the 3rd day of illness, state became more severy. Face is hyperemic, scleritis, hyperemic scleritis. Liver +3 cm. Daily diuresis 700 ml. What is previous diagnosis? Yersiniosis Hepatitis A Hemorrhagic fever with a kidney syndrome Flu *Leptospirosis A patient Z., 33 years old, miner, entered clinic of infectious diseases on the 7th day of disease with complaints of a acute weakness, high temperature, pain in the muscles of feet and back, icterus, dark color of urine, headache. Became sick sharply from a chill, temperature rises up to 40,1 °C. On a 4th day there is an icterus, nose-bleeding, hemorrhages in sclerA. Duration of fever 6 days. Diuresis is 200 ml. What is credible diagnosis? Typhoid fever *Leptospirosis Hepatitis A Sepsis Influenza A patient is disturbed by attacks of fever which repeated every third day. The icterus of sclera and skin, hepatospleenomegaly were marked. What is most credible diagnosis? Viral hepatitis Sepsis *Malaria Influenza Leptospirosis A patient Y., 25 years old, entered infectious department on the 3rd day of disease with complaints of headache, pain in the back, gastrocnemius muscles, high fever, chill. State is moderate. Icteruses of the scleras. Mucous membrane of soft palate is hyperemic. Tongue is dry, assessed with brown cover. The abdomen is swollen. Liver +2 cm, spleen is not megascopic. Painfull muscles, especially gastrocnemius. Urine is dark, excrements ordinary color. What is the most credible diagnosis? Infectious moneuclious Hepatitis A Malaria *Leptospirosis Yersiniosis On the 3rd day of illness the sick is delivered in a severy condition with complaints of a suddenly arising up high temperature, headache, repeated nose-bleed, pains in gastrocnemius muscles. Objectively: moderate icterus of sclera and skins, hepatospleenomegaly, оliguriA. What is most credible diagnosis? *Leptospirosis Viral hepatitis Influenza Infectious mononucleosis Malaria A patient S., 45 years old, suffering suddenly from appearance of chill and increasing of temperature to 39,2 °C. In the evening pain appeared in a stomach and gastrocnemius muscles. In 2 days noticed the ochrodermia of skin and sclerA. Objectively: the state is severy, temperature 39,9 °C. The tongue is covered. Moderate jaundice of the skin and sclerA. There is plural petachiae on a trunk. Superficial breathing 20 times per 1 min, pulse 102 per 1 min, AP 100/60 mm of Hg. A stomach is soft, sickly in epigastrium, a liver on 3 cm comes from a costal arc. Daily diuresis 300 mm, urine is sad-coloured. What is preliminary diagnosis? Sepsis *Leptospirosis Influenza Hepatitis B Infectious mononucleus A patient I., 25 years old, appealed to the internist with complaints of a general weakness, loss of appetite, pain in the right hypochodrium. Treated himself on an occasion of ARVI ambulatory 3 days. Became acute worsening of fealling: nausea, pain in right hypochondrium, ochrodermia of sclera, darkening of urine, appeared. Objectively: breathing superficial, cardiac tone is rhythmic. Abdomen is soft, painfull in right hypochondrium, a liver is megascopic, a spleen not palpable. What is most credible diagnosis? *Hepatitis A Leptospirosis Cholecystitis Influenza Pseudotuberculosis A patient 42 years old, complaints of dull pain in a right hypochondrium, weakness, decline of appetite, itching of skin, icterus. Disease began 1 month ago from protracted аrthralgia, disgust for a meal, strong weakness. An icterus which now increased considerably appeared three weeks ago. Temperature 36,0 °C. Pulse 56 per 1 min. A tongue is assessed with white cover. A stomach is soft, sickly in right hypochondrium. A liver +3 cm, spleen is not megascopic. Common analysis of blood: leukopenia, relative lymphomonocytosis, ESR 3 mm/hour. What diagnosis is most credible? Cancer of head of a pancreas *Hepatitis B Hepatitis A Cirrhosis of liver Chronic cholecystitis For a patient 35 years after 4-months of treatment by isoniaside - аdynemia, icterus, pain in right hypochondric were appeared. A liver is megascopic. In blood activity of enzymes of AlAT is enhanceable in three times, AsAT in two times. Bilirubin of blood of 122 gm/ml (conjugated – 82, unconjugated – 40). НBs-аntigen is not found out. What is the diagnos? Calculary cholecystitis Hepatocirrhosis Acute viral hepatitis Chronic active hepatitis *Toxic hepatitis A patient is 35 years, grumbles about aching pain in right hypocostal area, nausea, decline of appetite. Beginning of disease binds to appendicitis. After it in 2 months an icterus appeared first. Treated oneself in an infectious department. In 1 began to notice aching pain in right hypocostal area, in analyses is an increase of level of bilirubin. Your diagnosis? Calculary cholecystitis Illness of Zhil'bera Sharp viral hepatitis Chronic cholangitis *Chronic hepatitis The patient T., 35 years, operating trained nurse, appealed to the doctor on the 8th day of gradual development of illness with complaints of a general weakness, rapid fatigueability, dark color of urine. In the morning noticed the icterus. On examination temperature of body 36,8 °C. Found out the increase of liver -+3 sm The changes of what laboratory index most informing at this illness? *AlAt Hemodiastases Protrombin index Cholesterol Alkaline phosphatase Diagnosed a patient: chronic hepatitis in the stage of integration. What markers will be in patient in this stage disease? HBeAg Antibodies to HBeAg DNA OF HBV Viral DNA-polimerase *HBsAg, anti-НBе 23-years old patient during 6 months gets diabetes mellitus in a policlinic the injections of insulin. A weakness, arthalgia, grew gradually, an appetite disappeared, then dull pain appeared in an epigastrium after-meal. In 2 weeks from the beginning of illness noticed the dark color of urine, and afterwards – icterus on a background which the general state continues to be worsened. Temperature of body 36,5°C, Ps 58 per 1 min Liver +5 sm, spleen +1 sm What from hemanalysis is it needed to appoint for confirmation of diagnosis? Activity of alkaline phosphatase Activity of lactatdehydrogenase *Activity of ALAT Activity of creatinphosphokinase Activity of amylase 42-years old patient got blood transfusion two months ago. A weakness was gradually increased, an appetite was worsened, arthalgia, small nausea appeared. On a 12th day noticed an insignificant icterus, appealed to the doctor. At examination is the general state fully satisfactory. The temperature of body is normal, Ps 60 per 1 min, BP 100/70 mm Hg.A liver and spleen is moderate megascopic, a stomach at palpatory is not sickly. Anti-HCV IGM is found in blood. What from changes in the global analysis of blood most probably? Neutrocytosis *Leykopeniya Lymphopenia Speed-up ESR Aneozinofiliya A 17-years-old patient during 4 days suddenly had head pains, myalgias, fever of permanent type. From a 5th day is a normal temperature of body, the general state was considerably improved, an appetite appeared, nausea, general weakness, disappeared, but an icterus became noticeable. The general state is satisfactory, liver +3 sm, spleen +1 sm, Ps 56 per 1 mins Peripheral lymphatic knots, amygdales are not megascopic, hyperemia of pharynx is not present. At research of global analysis of blood is leykopenia with a relative lymphocytosis, 3 % virocytis, ESR normal. Activity of ALAT of blood is enhanceable in 5 times. What from diagnoses most credible for a patient? *Hepatitis A Infectious mnonucleosis Citomegaloviral infection Hepatitis B Hepatitis C On the 15th day of illness for a 17-years-old patient by hepatitis In anti-HBs is found in blood. The state of patient was considerably worsened the day before. There was excitation, there was a nose-bleed, a hemorragic rash appeared on a skin, diminished and became sickly at palpatory liver. Ps 106 per 1 min, BP of 110/ 70 mm Hg, the temperature of body subfebrile. What changes of indexes blood will a patient have most credible? Growth of alkalinephosphatase Growth of Fibrinogenum Growth of indirect bilirubinum *Decline of protrombin index Growth of albumin 25-years old woman during a year got numerous injections concerning bronchial asthmA. An appetite disappeared gradually, a weakness, arthalgia grew, urine became dark in two weeks, through three – an icterus on a background which the general state continues to be worsened appeared. The temperature of body is normal, Ps 62 after 1 mins Moderate sickliness in the area of pancreas, positive Voskresensky symptom, liver +4 cm, spleen +2 cm What from the markers of viral hepatitis more credible will be positive for a patient? *Anti-HBc IGM ANTI-HEV IGM ANTI-CMV IGM HBsAg ANTI-HAV IGM 26-years old man during 6 days marks the 6-8-sentinel gettings up temperatures with a strong chill, which end with abundant then and repeat oneself regularly in a day. 6 months ago there were alike attacks of fever during a stay in Afghanistan, from where returned 4 months back. Temperature of body 36,4°C, Ps 94 per 1 min. The moderate increase of spleen and liver is marked. A diuresis suffices, wetting without pathological changes. What disease can be suspected for a patient? Leptospirosis Hemorragic fever *Malaria Viral hepatitis Sepsis 40-years old patient during 2th days marks absence of appetite, nausea, general weakness. A year ago was treated due to acute hepatitis B, avoided a clinical supervision. Objectively: the temperature of body is normal, icterus of skin and sclera, increasing of liver 3 cm. A spleen is not megascopic. Urine moderatory dark colouring. ALAT of blood 4,0. What is most credible diagnosis? Chronic viral hepatitis, minimum activity Chronic cholecystitis *Chronic viral hepatitis, moderate activity Hepatocirrhosis Chronic viral hepatitis, high activity A man, 37 years, injection drug addict, practises upon an alcohol, grumbles about a general weakness, dull pain in right hypocostal area, increase of stomach, shortness of breath. It is ill chronic hepatitis on an extent 10 years. Objectively: temperature of body 37,1°C, an icterus is expressed. Liver +6 sm. In an abdominal region is a free liquid. Positive symptom of fluctuation. What complication did arise up for a patient? Intensifying of chronic hepatitis C Acutehepatic insufficiency Hepatocarcinoma Intensifying of chronic hepatitis B *Hepatocirrhosis A patient is 59 years, suffers chronic viral hepatitis with development of cirrhosis, hospitalized with a diagnosis: “bleeding from the veins of gullet”. Sharp pallor of skin covers. BP 80/40 mm Hg, pulse 100 per 1 min, the temperature of body is normal. On a front abdominal wall a venous net is extended. What preparation is it necessary to begin therapy from? Albumen Plasma Neogemodez *Blood Glucose 24 years old patien is bothered by pharyngalgia, general weakness. Objectively: temperature 38,0 °C. pulse 96 per min, hyperemia of otopharynx, enlargment of tonsills. Neck and submandibular lymphatic nodes are palpated, spleenomegaly present. Polymorhyc spots on the skin of trunk. What disease is most probable? Scarlet fever Acute respiratory disease Follicle tonsillitis Typhoid fever *Infectious mononucleosis 17 years old patient has a temperature of 38,2 °C, generalized lymphadenopathy (neck lymphatic nodes which are located along m. sternocleidomastoideus, mild icterus, hepatospleenomegaly. What is the preliminary diagnosis? Tuberculosis of lymphatic nodes Bacterial tonsillitis Diphtheria *Infectious mononucleosis Megacaryoblastoma Sick, 24 years old, is bothered by pharyngalgia, general weakness. Objectively: temperature – 38 °C. Pulse – 96 per min., increasing and huperemia of tonsills. Also increasing of neck and submandibular lymphatic nodes, spleenomegaly. What disease is most probable? Measles Follicular tonsillitis Typhoid fever *Infectious mononucleosis Acute respiratory infection Sick girl 8 years, entered permanent establishment with complaints of a general weakness, increasing of temperature, pharyngalgiA. Objectively: the mucous of otopharynx is bright red, on tonsills are white raids, is taken off easily. Increasing of all groups of lymphonodes, 1-3 cm in a diameter, dense, elastic, littlesickly, not soldered between itself. A liver is megascopic, spleen – on +1 cm. Leycocytosis, plasmatic cells – 20 %. What is the possible diagnosis? Acute lympholeycosis *Infectious mononucleosis Tonsillitis Diphtheria Adenoviral infection At a child with the catarrhal phenomena increasing of submandibular and back neck lymphatic nodes, hyperplasia of tonsills, presence of the single roseol-papular rash, increasing of liver it was found. What is the possible diagnosis. *Infectious mononucleosis Adenoviral infection Scarlet fever Measles Flu In a policlinic 18 years old patient complaints of a moderate pharyngalgia, headacke, general weakness, high temperature of 38,9 °C. He was sick during three days. Objectively it was found: increasing of back neck, and inguinal lymphatic nodes, hepatospleenomegaly, subicterus of scleras and skin, changes in a throat, characteristic for a quinsy. Lymphomonocytosis in a general blood analysis. What is the possible diagnosis? *Infectious mononucleosis Follicular tonsillitis Adenoviral infection Flu Viral hepatitis In a policlinic the patient C., 18 years old, appealed with complaints of a moderate pharyngalgia, head pain, general weakness fervescence, to 38,9 °C. It is ill already three days. Objectively: it is found out megascopic back neck, and inguinal lymphatic knots, hepatospleenomegaly, subicterus scleroticas and skin, changes in a throat, characteristic for a quinsy. At the hemanalysis – lymphomonocytosis. What are the principles of treatment? Antibiotics, hepar protective preparations, antihistaminic Antiherpetic preparations, hepar protective preparations, antihistaminic *Antibiotics, preparations of interferon, hepar protective preparations Antibiotics, Antiherpetic preparations , antihistaminic Antibiotics, preparations of interferon, vitamins At a patient, 17 years: quinsy, temperature 38,2 °C, generilized lymphadenopathy (the first multiplied neck lymphatic nodeswhich are located along m. sternocleidomastoideus), small icterus hepatospleenomegaly. What exciter causes this disease? Herpesvirus I type Herpesvirus ІІ type Herpesvirus ІІІ type *Herpesvirus ІV type Herpesvirus V type Sick, in 24, disturbs a pharyngalgia, general weakness. Objectively: temperature – 38 °C. Pulse 96 shots per min, dermahemia mucus of otopharynx bloodshot, tonsills are megascopic in sizes, loose. Palpated megascopic back neck and submandibular lymphatic knots., a spleen comes forward from under the edge of costal arc of to 1 sm. What methods of diagnostics is it possible to confirm the diagnosis? Reaction of Paul-Bynnel, Right-Heddlson, Goffa-Bauer *Reaction of Paul-Bynnel, Lovrik-Volner, Goffa-Bauer Reaction of Paul-Bynnel, Right-Heddlson, Lovrik-Volner Reaction of Paul-Bynnel, Goffa-Bauer Reaction of Paul-Bynnel, Goffa-Bauer, Right-Heddlson, Lovrik-Volner Patient P, 17 years old, has got ill gradually. General weakness, fatigue, painful throat, and nausea were marked. He was hospitalized on the 5th day of illness. Objectively: temperature is 38 °C. Objectively: skin and sclera are yellowish, neck, anticubital and subclavian lymph nodes are enlarged. Not numerous mculo-papular elements of rash on a trunk are found. The tongue is covered with white coat. The tonsils covered with white yellowish patches.On palpation of stomach enlarged spleen and liver are found. In blood there is leucocytosis with neutophylic shift, atypical mononuclears-10 %, plasmatic cells- 10 %. What would be the diagnosis? Scarlet fever *Infectious mononucleosis Typhoid fever Iersiniosis Lacunar tonsilitis The boy 12 years old, with catarrhal phenomena seen an increase of all the lymph nodes, sclera, hyperplasia of tonsils white layers on them as islands, existing single maculo-papular rash, increased liver and spleen size. What additional research should be done? Reaction of passive heamaglutination(RPG) with influenza viruses Ultrasound of the abdomen Puncture of the lymph nodes, with following microscopy Inoculation of blood *Blood test for atypical mononuclears Sick C., 17 years old fell ill gradually. Disturbed by general weakness, fatigue, sore throat, abdominal pain, nauseA. Hospitalized at 5th day of illness. Examination: body temperature 38,0 °C, increasing of the neck, shaped inframaxillary lymph nodes. Skin and eye sclera were subicteric. Macula-papular rash on the trunk. Raids on tonsils thick, white, yellow, white furred tongue stomach is moderately swollen, hepatosplenomegaly. In blood analyses: leukocytosis, microphage with the left shift, atypical mononuclear – 10 %, plasma cells – 10 %. What is the preliminary diagnosis? *Infectious mononucleosis Yersyniosis Lacunar tonsillitis Viral hepatitis A Typho-paratyphoid disease Patient 18 years, entered permanent establishment with complaints of head pain, general weakness increase of temperatures, to 37,5–38,2 °C during 6 days, pharyngalgiA. Objectively: all groups of lymphonoduses, 1-3 cm in a diameter, elastic, are megascopic, little sickly, not soldered between itself. A liver is megascopic on 3 sm, spleen – on 1 sm. In a blood is leycocytosis, plasmatic mews – 15 %. What group of herpes does the exciter of this illness belong to? Alpha Beta *Gamma Delta Teta Patient A., 18 years old, is complaining of headache, weakness, high temperature, sore throat. Objectively: general lymphadenopaty,with lymph nodes 1-3 cm in diameter, dense, elastic not painful and not combined between themselves. Hepatospleenomegaly was noticed. In blood there is leucocytosis, monocytes – 15 %. What is the diagnosis? *Infectious mononucleosis Adenoviral infection Tonsillitis Diphtheria Acute leukemia An 18 years old patient, entered the hospital with complaints of headache, general weakness, raising the temperature to 37,5-38,0 °C for 6 days, a sore throat. Objective examination: increasing of all lymph nodes, 1-3 cm in diameter, flexible, megaloblastic not soliter together. Increasing of the liver size till 3 cm, spleen – 1 cm. Common blood analysis: leukocytosis, plasma cells – 15 %. What is the preliminary diagnosis? Diphtheria Adenovirul infection Lacunar tonsillitis *Infectious mononucleosis Acute lympholucosis Patient D., 20 years old, fell ill and went to infectious polyclinic cabinet with complaints of moderate pain in the throat, headache, general weakness, increased body temperature of 38.9 °C. Fells bed during three days. At examination: increasing of inguinal lymph nodes, hepatosplenomegaly, subicteric sclera and skin, changes in the throat are typical for sore throats. In the blood – lymphogranulomatosis. The principles of treatment are? *Antibiotics, interferons, hepatoprotectors Antihypertensives hepatoprotectors, antihistamines Antibiotics, hepatoprotectors, antihistamines Antibiotics, antihypertensives, antihistamine Antibiotics, interferones, vitamins A patient D., 20 years old came to the infectious polyclinic with complaints of moderate pain in the throat, headache, general weakness, increasing of body temperature to 38.9 °C. He fells sick during 3 days. Objective examination: increasing inguinal lymph nodes, hepatosplenomegaly, subicteric sclera and skin, changes in the throat are typical for sore throats were found. Blood analysis – lymphogranulomatosis. What is the probable diagnosis? *Infectious mononucleosis Tonsillitis Adenovirus infection Influenza Viral hepatitis The patients, 20 years old, with 5 days fever, pain in the throat during swallowing, pain in muscles. During review – there is thick, congested tonsils with purulent layers that are easily removed, enlarged neck, and inframaxillary lymph glands, liver + 1.5 cm possible palpation of edge of spleen. What additional research should be done? Puncture of the lymph nodes, followed by microscopy Ultrasound of the abdominal cavity *Blood test for atypical mononuclear Inoculation of blood Reaction of passive heamoglutination(RPH) influenza A viruses In children with catarrhal phenomena revealed an increase of inframaxillary lymph nodes, tonsil hyperplasia with whitish soft touch on them in the form of points and islands, the presence of rare maculo-papular bulging out, increased liver and spleen. Identify the likely diagnosis? *Infectious mononucleosis Acute leukemia Measles Scarlet fever Chicken pox Patient A., 35 years old, came to the clinic on the third day of disease with complaints of drowsiness, sweat, headache, fever up to 38.5 °C. Reviewing physician found sore throat, splenomegaly, enlarged lymph nodes. Liver not enlarged. Blood analysis – leukocytosis, lymphomonocytosis. What is the treatment for the patient? *Antibiotic, drugs interferon, hepatoprotectors Antihistamin, antiherpetic preparations hepatoprotectors Antibiotic, hepatoprotector, antihistamine Antibiotics, antihistamine, antiherpatic drugs Vitamins, antibiotics, drugs interferon 35 years old patient A., came to the clinic on the third day of illness with complaints of drowsiness, sweat, headache, fever up to 38.5 °C. Reviewing physician found sore throat, splenomegaly, enlarged lymph nodes. Liver is not enlarged. Blood analysis – leukocytosis, lymphocytosis. What additional test should hold the patient for infectious mononucleosis? Byurne and Wright-Hadulson’s reaction ELISA-test, bacteriological test for tularemia Bacteriological test for diphtheria and typhoid fever *ELISA-test, bacteriological test for diphtheria Paul-Bunnel’s reaction and lymph node puncture Patient L., 38 years old, complaints of recurrent attacks of fever with severe chills and heavy then. Epemiologically found that he had recently returned from IndiA. When parazitoscopii blood found erythrocytic schizonts. Vector of the disease is: Fly *Mosquitoes Flea Bee Pliers Patient G., 28 years old, sailor, joined the 18-day illness, complaining of high fever, headache, weakness. Disease began as a chills during an hour, then the temperature had risen to 39,8 °C. In next 5-6 days, chills repeated every day in the middle of the day, after which the temperature rose to 40-41 °C, such attacks fever occur every other day. Face is hyperemic, herpes, vascular injection of sclerA. Tons of the heart muted, rhythmic, pulse 140 for 1 min, AD 140 and 60 mm RT. Art. Liver is normal, spleen +2 sm. Which method of diagnosing is the most valuable in this situation? *Smear and thick drop of blood for malaria An overall analysis of blood Bilirubin in the blood, ALaT culture of blood Immunological Methods Patient G., 28 years old, sailor, has been ill in 18-day illness, complaining of high fever, headache, weakness. Disease began as a chills during an hour, then the temperature had risen to 39,8 °C. In next 5-6 days, chills repeated every day in the middle of the day, after which the temperature rose to 40-41 °C, such attacks fever occur every other day. Face is hyperemic, herpes, vascular injection of sclerA. Tons of the heart muted, rhythmic, pulse 140 for 1 min, AD 140 and 60 mm RT. Art. Liver is normal, spleen +2 sm. What you need to start treatment? *Primaquine Fansidar Metakelfin Quinine Tetracycline A citizen of Nigeria, 19 years old, came to study in Ukraine. After 10 days of appeared a strong chill, which lasted about 1 hour and changed the feeling of heat. There has been a headache, slice, nagging pain in the muscles. Attack of such clinical symptoms rapid again after 2 days. OBJECTIVE: body temperature 39,6 °C, sclera subicterich, appeared lips herpes. Spleen significantly increased, dense, the liver is a normal. What investigation needs to be done? *Microscopy of peripheral blood Microscopy of centrifuge of urine Lumbar puncture Observation of oculi USD abdomen The patient concerned about attacks of fever, which are repeated every third day. There are jaundice of sclera and skin, hepatosplenomegali. Which of the diagnoses most likely? Sepsis *Malaria viral hepatitis Hemolytic anemia Leptospirosis Patient G., 20 years old, six months ago returned from AfricA. A month later he introduced the three-day clinical symptoms of malariA. Is it necessary to carry out epidemic contacts that the patient had? You do not need because there is no vector You need because there is vector *You do not need because reconvalence not cause It should be, because rekonvalence allocates cause You do not need because epidemic activities inefficient A patient G., 42 years old, for a week every 48 hours had attacks of chills, which followed by heat. Body temperature rises to 40 °C, in 3-4 hours was a severe sweat. Worsened appetite, a common weakness. Skin pale. Hepatosplenomegaly. What are the most effective method for verification of the diagnosis. *Microscopy and a thick smear of blood drops Microscopy hanging drops An overall analysis of blood Bacteriological method Enzyme multiplied immunoassay Citizen B. travelling in the summer as a tourist to resort, disadvantaged malariA. How to prevent malaria infection? Follow the rules of personal hygiene Do not drink raw water Make vaccine *Hold chemoprophylaxis Conduct heat treatment of food Patient A., 25, treated at a hospital about malariA. The latest attack was the day before. Assign etiotropic treatment. Antibiotics Serum transfer Delagil Primaquine *Delagil + Primaquine A patient 20 years old, had treated himself concerning an acute respiratory disease for 5 days, but marked no displays of respirator syndrome. Last 2 days temperature has been normal, appetite disappeared, however, appeared pain in epigastrium with nausea, and urine turned dark. About what illness is it possible to think? Hepatitis B Infectious mononucleosis Pseudotuberculosis Leptospirosis *Hepatitis A A patient 28 years old, an injection drug addict, complaints of dull pain in right subcostal region, weakness, decline of appetite, pain in joints. The symptoms have been present for 2 weeks. At examination: the icterus of skin and scleras observed. The liver and spleen are enlarged. Urine is dark, excrements are discoloured. What is preliminary diagnosis? Hepatitis A *Hepatitis B Chronic cholecystitis Toxic hepatitis HIV-infection A patient 25 years old got sick suddenly after chills and temperature increase up to 38,0 °C. There was vomiting 2 times. Moderate pharyngeal pain appeared at swallowing. with stomach discomfort. Signs of bursitis observed on knee and elbow joints. The light icterus of sclera and skins of joints on 4th day, on the skin of lateral surfaces of trunk, forehead and lower extremities. The small bright red papular rash appeared, more concentrated in natural folds.Liver is enlarged, the tongue is raspberry like appearence. Preliminary diagnosis would be: Hepatitis A . Hepatitis B *Pseudotuberculosis Scarlet fever Infectious mononucleosis A 19 years old patient was diagnosed with hepatitis B. After violation of diet and nervous stress the state of patient got worse: intensity of ichterus was increased, pulse 110/min, BP 80/50 mm Hg. Also there was vomiting by «coffee-grounds». The size of liver has decreased, the liver on palpation was painful. What complication would you think about? Infectious-toxic shock Acute kidneys insufficiency Acute adrenal insufficiency Hemolitic icterus *Acute hepatic insufficiency A patient C., 43 years old, has been treated for 5years . During the last hospitalization a liver-biopsy was conducted. Histologicaly there is bulb dystrophy and necrosis of hepatocytes, with leucocyts infiltration, and pericellular fibrosis. What diagnosis is most credible in this case? *Alcoholic liver cirrhosis Viral hepatitis B Viral hepatitis C Cryptogenic hepatitis Fatty dystrophy of liver Patient B., 23 years old. Objectively: skin is yellow, icterus of sclerA. Pulse 66/min, BP 120/80 . Indexes of AlAT, AsAT, and Tymol tests are normal. General billirubin is 34 mmol/l due to indirect fraction. Specify the most credible diagnosis. Chronic toxic hepatitis Chronic cryptogenic hepatitis Chronic hepatitis C *Gilbert’s syndrome Chronic B hepatitis A trained nurse got sick on 16.09: general weakness, nausea, vomiting, pain in joints appeared. 21.09 urine turned dark, and skin yellow. 21.09 she was hospitalized. Objectively: general status satisfactory, temperature 38,2 °C, expressed skin and mucous membranes jaundice. Liver palpated 3 cm below the costal arc. 26.09 stomach-aches and increased sleepiness with disorientation in time and place were appeared. 27.09 haematomas in the places of injections also appeared. Hepatic breath was noticed. Light edema of feet and lumbar region were observed. The liver was not palpable. Development of what syndrome can be forecast? Meningoencephalitis *Hepatic encephalopathy Acute nephrosonephritis Pancreatitis IDS syndrom A patient B., 52 years old, for 3 month complaints of nausea, periodic vomiting, swelling of stomach, weakness, loss of weight up to 12 kg, consistency of stool is chainging. During some days consciousness is entangled, somnolence, allolalia, general weakness are expressed. Temperature of body 37,4 °C. Icterusis on the skin. Tremor of brushes and nystagmus is marked. Pupils are narrowed, with a slow reaction on light, increase of tendon reflexes. Ps 112/min, unrhythmical. BP 90/65 mm Hg. A liver is dense +2. Laboratory tests: Hb 86 g/L, Leuc 4,2*109/L, ESR 18 mm/hour, glucose 3,4 mmol/l, general bilirubin 56,7 mm/L, albumen 52 g/L, K+ 3,2 mmol/l, AsAT 0,62; AlAT 0,84; prothrombin index-58 %; рН blood 7,3. What is previous diagnosis? Hepatocirrhosis Vilson-Konovalov disease Cancer of liver *Endogenous hepatic encephalopathy Meygs disease A patient, 17 years, complaints of a weakness, worsening of appetite, nausea, painfull in right subcostal area, dull ache in the body, dark color of urine, temperature to 37,8 °C. She stood in contact with sick on icterusis 1,5 months ago. Objectively: yellow colour of the skin and visible mucous membranes. The liver is increased to 1,5 cm. Unsignificant enlargment of spleen. What is your preliminary diagnosis? Viral hepatitis B Infectious mononucleosis *Viral hepatitis A Leptospirosis Pseudotuberculosis Before the appearance of jaundice in a patient 16 years old, during 2 days there were an increasing of the body temperature (38,5 °C), headache, dull ache disturbed whole body. Name the variant of pre-icteric period of viral hepatitis for this patient? *Influenza-like Astenovegetative Artralgic Dyspeptic Allergic A patient T., 28 years, appilled due to worsening of common status at the seventh day to the infectious department concerning viral hepatitis. Nausea and vomiting were present, hepatic smell appeared, increasing of the liver sizes. What biochemical index does allow to suspect complication in the patient? Increasing activity of AlAT Increasing of bilirubin, increasing activity of AlAT Increasing timol test *Decreasing of protrombin, increasing of bilirubin Decreasing of AlAT A sick P., 54 years old, complaints of dull pain in right subcostal area, bad taste in the mouth, itching of the skin, increasing of abdomen. After the liver puncture fatty dystrophy of hepatocytes, eccentric placing of veins in a hepatic lobule were found. What laboratory index are most characteristic in this case? Alkaline phosphotase Hemodiastase *Level of transaminases Glucose of blood Creatinphosphokinase Direct bilirubin is increased , in urine there is significant increase of bilirubin and urobilin, increasing of stercobilin of excrements. What is the type of icterus? Haemolitic *Parenchimatous Transport Extraliver Mechanical On the average 15 to 30 % of all population of the planet suffer from some pathology of liver. Prevalence of hepatitis and cirrhosis in the European countries is about 1 % of adults. Annually in the world there are about 2 million people with acute viral hepatitis. What % of all cases will develop chronic form. 100 % 50 % 25 % *10 % 1 % A patient, 24, complaints of pains in right subcostal area, increasing after-meal, nausea, increase temperature of body to 37,7 °C, icterus, pains in large joints. He is ill from 8 months. Suffers a nonspecific ulcerative colitis. Hepatosplenomegaly. ESR 47 mm/hr, general bilirubin level is 86,1mmol/lt, direct-42,3 mmol/lt. In blood found out antibodies against smooth muscles. General albumen of 62 gram/lt, albumin б. 40 %, globulin. 60 %, gamma globulins 38 %. Not found out the markers of viral hepatitis. On USD diameter of portal vein is 1 cm What will be your diagnosis? Primary biliary cirrhosis Gilbert syndrome Viral hepatitis Hemochromatosis *Autoimmune hepatitis Woman of 22 years old, in the 7th month of pregnancy felt ill acutely in 3 weeks after arrival from Turkmenistan. An icterus, untraceable vomiting, pain in right subcostal region,, hemmorhaeges on the skin, appeared after three-day fever. Most probable diagnosis will be: Acute fatty hepatosis of pregnancy Cholestatic hepatosis of pregnant *Viral hepatitis of A Viral hepatitis B Acute sepsis Weakness appeared in a patient, decrease in an appetite, began pains in the joints of extremities, felling of weight in right subcostal region, vomiting. Urine became dark in 12 days, and in a day – sclera and skin turned yellow. It was discovered in an immunogram: antuIgG -HAV (+), HBsAg (+), antiIgМ -НBcorAg (+), anti-НCV (–), anti-НDV (–). To the patient 3 months back was extracted a tooth. Most probable diagnosis? *Viral hepatitis B Viral hepatitis A Viral hepatitis C Viral hepatitis D Viral hepatitis E A patient 42 years, radiologist, entered surgical department with bleeding from the mouth ,was admitted to the gastroenterological departments . He considered himself healthy. 20 years ago had haemotransfusion. Fibrogastroduodenoscopy shows venous dilation of the oesophagus of the III degree. Most probable etiologic reason of disease: Autoantibodies against hepatocytes Viral hepatitis A X-ray irradiation *Viral hepatitis B Defficiency of antitrypsin A patient during half of the year got frequent parenterally injections concerning bronchial asthmA. There was decrease in appetite gradually, started to feel weakness, arthralgia, dark coloured urine, the icterus of skin appeared. Objectively: temperature of 37 °C, pulse 68/min BP 115/70 mm of Hg Liver +4 cm, spleen +1 cm, skin and sclera is yellow coloured In the general blood analysis: amount of leucocytes: 3,6 109,among them 52 % lymphocytes, ESR 6 mm/hr, activity of ALAT is increased in 10 times. which information will be more credible than all in blood of patient? Anti-HBs antibodies Anti-HAV IgM antibodies *Anti-HBV antibodies Anti-HCV IgG antibodies Anti-HEV IgM antibodies A patient of 34 years complaints of fatigue, decreasing of appetite, nausea, feeling of weight in a epigastric region, bitter taste in the mouth. Objective examination : Pulse 76/min, temperature 37,2 °C. Skin is pale, single vascular star-like rash on the thorax. Liver is 2 cm below the costal arch. In blood: bilirubin level is 36 mmol/lt, ASAT 2,5, ALAT 2,8 . Anti-HBc (–), HBsAg and HBeAg (+). What therapeutic tactic is expedient in this case? Therapy by hepato-protectors *Antiviral therapy by lamivudine Antiviral therapy by ribavirin Therapy by corticosteriods Therapy by immunostimulators Man 30 years, drug addict, takes drugs intravenously. Has been taking drugs for 12 years Complaints of weakness, moderate icterus, weight in right subcostal region. The state was worsened gradually. Biochemical indexes: general bilirubin 28,2 mmol/lt; ALAT 1,0, ASAT 0,8 . Will you define a diagnostic method which it is expedient to conduct for establishment of etiologic diagnosis? Biopsy of liver *Polymerase chain reaction (PCR) Enzymes of liver Computer tomography Immunological tests Patient B., 51 years, a lot of years used an alcohol. Complaints of nausea, liquid stools, icterus of skin. Objectively: skin and sclera is yellow coloured, atrophy of muscles, subfebrile temperature. Liver 3 cm below the costal arch, painful on palpation What method of diagnostics most informing in this case? Activity of cytolysis (AsAT, AlAT) Proteinogram *Biopsy of liver Markers of viral hepatitis Violation of cellular immunity (T4,T8) Patient of B., 64 years old, has been sick with chronic hepatitis. Complaints of pain in the liver, growth retardation. Objectively: his skin is dry, erythemic, atrophy of muscles, telangiectasis on shoulders, hyperemia of hands, abdomen is enlarged, look like “jelly-fish head”. The liver below the costal arc on 3 cm, painful, dense, spleen on 1 cm below the costal arch, positive symptom of fluctuation. Laboratory investigation: hypergammaglobulinaemia, increasing of AsAT activity, AlAT is highly increased. What drug of choice for the patient? Lactulose *Hepatoprotectors Antibiotics Glucocorticoids Alpha interferon A patient 48 years old, complaints of attacks pains in right subcostal area after the physical loading. Periodically marks more light excrement, darkening of urine. Objectively: skin and mucous membranes high icteric. General bilirubin 36,8 mm/L, direct fraction - 26,4. Ultrasound of gall-bladder: thickness of wall 4 mm, there is a lot of bile in the ducts. It is necessary to prescribe with a lytolitic purpose: Choleretics *Ursofalk Cholekinetics Spasmolytics Cytostatics During annual inspection increasing of a liver to 4 cm of 23 years old patient was found, increasing of bilirubin level in 2 times, AlAT in 2,5 time. He has been often sick with genital herpes. It was discovered RNA of hepatitis C virus. What is etiologic treatment *Interferons Essencial phosphotides Choleretics Cholekinetics Ursodesoksihole acids A patient, 19 years old, with hepatitis B. After violation of diet and nervous stress the state of the patient became worse: increasing of intensity of jaundice, pulse 110 per 1 min, BP 80/50 mm Hg, vomiting with “coffee-grounds”, decreasing of the liver size. What complication is it possible to think about? *Acute liver insufficiency Infectious-toxic shock Acute kidney insufficiency Acute extrarenal insufficiency Hemolytic A patient 28 years old, injection drug addict, complaints of dull pain in the right subcostal area, weakness, decline of appetite, pain in joints, which disturbs during 2 weeks. At examination: icterus of the skin and sclera, enlargement of the liver and spleen, dark urine, excrement is discoloured. What is preliminary diagnosis? HIV-infection Hepatitis B Hepatitis C *Toxic hepatitis Hepatitis A At inspection of a 8 weeks term pregnant woman HBsAg was found. Level of bilirubin of blood and activity of ALAT were normal. What is necessary to do? *To save pregnancy and conduct the inoculation to newborn against hepatitis B Termination of pregnancy Termination of pregnancy and conduct treatment by interferon To save pregnancy and conduct treatment by lamivudin To save pregnancy and ultrasonic inspection of the fetus Student 20 years, treated oneself on an occasion of ARVI (increasing of temperature to 38,2 °C during 3 days). He complaints of worsening of appetite, increasing fatigue at a normal temperature and absence of the catarrhal phenomena of upper respiratory tracts. A doctor found out an increasing and moderate sickliness of liver. There were cases of hepatitis A in a student’s group. What method of investigation will allow? Ultrasound scanning of the liver Determination of bilirubin level of the blood Determining the amount of beta-lipoproteins *Determination of activity of аminotransferases of the blood Immunofluorescent research of the nasal smears A patient I., 25 years old, appealed to the internist with complaints of a general weakness, loss of appetite, pain in the right hypochodrium. Treated himself on an occasion of ARVI ambulatory 3 days. Became acute worsening of fealling: nausea, pain in right hypochondrium, ochrodermia of sclera, darkening of urine, appeared. Objectively: breathing superficial, cardiac tone is rhythmic. Abdomen is soft, painfull in right hypochondrium, a liver is megascopic, a spleen not palpable. What is most credible diagnosis? *Hepatitis A Leptospirosis Cholecystitis Influenza Pseudotuberculosis A patient 42 years old, complaints of dull pain in a right hypochondrium, weakness, decline of appetite, itching of skin, icterus. Disease began 1 month ago from protracted аrthralgia, disgust for a meal, strong weakness. An icterus which now increased considerably appeared three weeks ago. Temperature 36,0 °C. Pulse 56 per 1 min. A tongue is assessed with white cover. A stomach is soft, sickly in right hypochondrium. A liver +3 cm, spleen is not megascopic. Common analysis of blood: leukopenia, relative lymphomonocytosis, ESR 3 mm/hour. What diagnosis is most credible? Cancer of head of a pancreas *Hepatitis B Hepatitis A Cirrhosis of liver Chronic cholecystitis For a patient 35 years after 4-months of treatment by isoniaside - аdynamia, icterus, pain in right hypochondric were appeared. A liver is megascopic. In blood activity of enzymes of AlAT is enhanceable in three times, AsAT in two times. Bilirubin of blood of 122 gm/ml (conjugated – 82, unconjugated – 40). НBs-аntigen is not found out. What is the diagnos? Calculary cholecystitis Hepatocirrhosis Acute viral hepatitis Chronic active hepatitis *Toxic hepatitis A patient 75 years old. Complaints of a subfibrile temperature, general weakness, pharyngalgia, conjunctivitis. A child in family an acute adenoviral disease is ill. A patient considers itself a patient the second day. At examination discovered sign of sharp pharyngitis. Lymphatic nodesare megascopic: neck front and back, arm-pits and inguinal, to 1 sm in a diameter, soft, not soldered between itself and with a surrounding cellulose. A pharynx is bloodshot, amygdales are hypertrophied and hyperaemiA. In lights wheezes are not present. Breathing clean. Tones of heart are muffled. BP - 140/80 mm Hg, Ps - 80 per 1 min. Stomach soft. Palpatory- megascopic liver, salient on 3 sm below than costal arc, and spleen, soft, painless. Choose the most credible diagnosis from offered: Flu, to middle weight Limfogranulomatosis *Adenoviral infection Infectious mononucleosis Hepatitis A A patient is 35 years, grumbles about aching pain in right hypocostal area, nausea, decline of appetite. Beginning of disease binds to appendicitis. After it in 2 months an icterus appeared first. Treated oneself in an infectious department. In 1 began to notice aching pain in right hypocostal area, in analyses is an increase of level of bilirubin. Your diagnosis? Calculary cholecystitis Zhil'ber disease Sharp viral hepatitis Chronic cholangitis *Chronic hepatitis The patient T., 35 years, operating trained nurse, appealed to the doctor on the 8th day of gradual development of illness with complaints of a general weakness, rapid fatigueability, dark color of urine. In the morning noticed the icterus. On examination temperature of body 36,8 °C. Found out the increase of liver -+3 sm The changes of what laboratory index most informing at this illness? *AlAT Hemodiastases Protrombin index Cholesterol Alkaline phosphatase 23-years old patient during 6 months gets diabetes mellitus in a policlinic the injections of insulin. A weakness, arthalgia, grew gradually, an appetite disappeared, then dull pain appeared in an epigastrium after-meal. In 2 weeks from the beginning of illness noticed the dark color of urine, and afterwards – icterus on a background which the general state continues to be worsened. Temperature of body 36,5°C, Ps 58 per 1 min Liver +5 sm, spleen +1 sm What from hemanalysis is it needed to appoint for confirmation of diagnosis? Activity of alkaline phosphatase Activity of lactatdehydrogenase *Activity of ALAT Activity of creatinphosphokinase Activity of amylase 42-years old patient got blood transfusion two months ago. A weakness was gradually increased, an appetite was worsened, arthalgia, small nausea appeared. On a 12th day noticed an insignificant icterus, appealed to the doctor. At examination is the general state fully satisfactory. The temperature of body is normal, Ps 60 per 1 min, BP 100/70 mm Hg.A liver and spleen is moderate megascopic, a stomach at palpatory is not sickly. Anti-HCV IGM is found in blood. What from changes in the global analysis of blood most probably? Neutrocytosis *Leucopenia Lymphopenia Increased ESR Aneozinophilia A 17-years-old patient during 4 days suddenly had head pains, myalgias, fever of permanent type. From a 5th day is a normal temperature of body, the general state was considerably improved, an appetite appeared, nausea, general weakness, disappeared, but an icterus became noticeable. The general state is satisfactory, liver +3 cm, spleen +1 sm, Ps 56 per 1 mins Peripheral lymphatic knots, amygdales are not megascopic, hyperemia of pharynx is not present. At research of global analysis of blood is leykopenia with a relative lymphocytosis, 3 % virocytis, ESR is normal. Activity of ALAT of blood is enhanceable in 5 times. What from diagnoses most credible for a patient? *Hepatitis A Infectious mnonucleosis Cytomegaloviral infection Hepatitis B Hepatitis C In 2 months after returning from India, where often drank unboiled water, a 23-years-old expectant mother nauseated, strong general weakness, head pain, later the temperature of body rose to 38 °, and stuck to week. An icterus appeared on a 6th day, the general state continued to be worsened. On a 12th day illnesses are the general state heavy. EiforiyA. At night there was vomiting. Complete fastidium. Bright icterus, signs of hemorragic syndrome, tachycardiA. BP 110/60, temperature of body 37,8 °C. A liver is insignificantly megascopic, soft, sickly, spleen +2 cm There is neutrophilic leycocytosis in the global analysis of blood. General bilirubin of blood is 570 to the line 300, ALAT is enhanceable in 100 times, timol test of 26 units., urea – 2,1 mmol/l. What is the most probable diagnosis for this patient: Malignant icterus of pregnant Mechanical icterus Typhoid fever *Acute Hepatitis Leptospirosis On the 15th day of illness for a 17-years-old patient by hepatitis In anti-HBs is found in blood. The state of patient was considerably worsened the day before. There was excitation, there was a nose-bleed, a hemorragic rash appeared on a skin, diminished and became sickly at palpatory liver. Ps 106 per 1 min, BP of 110/ 70 mm Hg, the temperature of body subfebrile. What changes of indexes blood will a patient have most credible? Increasing of alkalinephosphatase Increasing of fibrinogen Increasing of indirect bilirubinum *Decline of protrombin index Increasing of albumin 25-years old woman during a semiyear got numerous injections concerning bronchial asthmA. An appetite disappeared gradually, a weakness, arthalgia grew, urine became dark in two weeks, through three – an icterus on a background which the general state continues to be worsened appeared. The temperature of body is normal, Ps 62 per 1 min. Moderate sickliness in the area of pancreas, positive Voskresensky symptom, liver +4 cm, spleen +2 cm What markers of viral hepatitis will be positive in such case? *Anti-HBc IGM ANTI-HEV IGM ANTI-CMV IGM HBsAg ANTI-HAV IGM 26-years old man during 6 days marks the 6-8-sentinel gettings up temperatures with a strong chill, which end with abundant then and repeat oneself regularly in a day. 6 months ago there were alike attacks of fever during a stay in Afghanistan, from where returned 4 months back. Temperature of body 36,4 °C, Ps 94 per 1 min The moderate increase of spleen and liver is marked. A diuresis suffices, wetting without pathological changes. What disease can be suspected for a patient? Leptospirosis Hemorragic fever *Malaria Viral hepatitis Sepsis For a 16-years-old patient in a month after return from Crimea did head pain, myalgias appear suddenly, strong weakness with a simultaneous fervescence to 39°C, which stuck to 3 days. The general state was considerably improved, a bad appetite and nausea, dull pain, was saved only in right hypocostal area, became dark wetting, white is an excrement. On a 6th day is a moderate icterus, an appetite appeared, a general weakness diminished. Liver +4 cm, spleen +1 cm. Leykopenia in the general blood analysis, relative limphomonocytosis, ESR 4 mm/hour. General bilirubinum of blood of 89, the direct prevails, activity of ALAT is enhanceable in 4 times, ASAT – in 3 times. What from diagnoses most credible? Hepatitis B *Hepatitis A Opisthorchiasis Hemolitic icterus Sharp calculary cholecystitis Patient of A., 19 years, had ill acutely – the temperature of body rose to 39°C, a weakness, nausea, appeared. Vomiting and stomach-ache was not present. A temperature reposed on high numbers 2 days, then went down to normal. Urine became dark on the 6th day of illness, subicterus noticed on 5th. To this time the feel of patient was improved, nausea, weakness, disappeared. Objectively: moderate icterus of skin and sclerotica, a rash is not present. Pulse 66 per 1 min, BP 110/70 mm Hg.A stomach is soft, painless in all of departments, a liver on 2,5 cm comes forward from under a costal arc, the edge of spleen was palpitated. Is there what reason of fervescence in the pre-icteric period of this disease? *Toxicemia Bacteriaemia Pancreatitis Viremia Cholecystitis 40-years old patient during 2th days marks absence of appetite, nausea, general weakness. A year ago carried sharp hepatitis B, avoided a clinical supervision. Objectively: the temperature of body is enhanceable, skin and sclerotica are icterus, the megascopic palpatory, to the moderate closeness, sickly liver, salient from under the edge of costal arc on 3 sm. A spleen is not megascopic. Wetting moderatory dark colouring. The sickliness of joints is marked at motions. ALAT of blood 4,0. What most credible diagnosis? Chronic viral hepatitis, minimum activity Chronic cholecystitis *Chronic viral hepatitis, moderate activity Hepatocirrhosis Chronic viral hepatitis, high activity A man, 37 years, injection drug addict, practises upon an alcohol, grumbles about a general weakness, dull pain in right hypocostal area, increase of stomach, shortness of breath. It is ill chronic hepatitis on an extent 10 years. Objectively: temperature of body 37,1°C, an icterus is expressed. Liver +6 cm. In an abdominal region is a free liquid. Positive symptom of fluctuation. What complication did arise up for a patient? Intensifying of chronic hepatitis C Sharp hepatic insufficiency Gepatokarcinoma Intensifying of chronic hepatitis B *Hepatocirrhosis A patient is 59 years, suffers chronic viral hepatitis with development of cirrhosis, hospitalized with a diagnosis: “bleeding from the veins of gullet”. Sharp pallor of skin covers. BP 80/40 mm Hg, pulse 100 per 1 min, the temperature of body is normal. On a front abdominal wall a venous net is extended. What preparation is it necessary to begin therapy from? Albumen Plasma Neogemodez *Blood Glucose Patient A., 37 years old, entered to infectious hospital on the third days of disease in the severe condition. He complaints of the high fever with chills and sweat, general weakness, pain in right under a rib. Objectively: temperature of body 41 °С, icterus of skin, liver +2 cm, pain at palpation in abdomen, positive symptoms of Ortner and Mussy, a spleen is normal, tachycardiA. What is the previous diagnosis? Malaria *Cholangitis Viral hepatitis Sepsis Leptospirosis Patient W., 38 years old, entered to infectious hospital on the 5th days of disease in the severe condition. He complaints of the high fever with chills and sweat, general weakness, pain in sacrum. Objectively: temperature of body of 41 °С, tachycardia, positive symptom of Pasternacky, liver and spleen not is normal. Previous diagnosis? Malaria Cholangitis *Pyelonephritis Sepsis Leptospirosis Patient D., 39 years old, entered to infectious hospital on the second week days of disease in the severe condition. Local habitant, nowhere arrived. She is complaints for the high fever with chills and sweat, general weakness. Attacks of fever without correct periodicity. Objectively: the temperature of body – 41 °С, subicterus of sclera, tachycardia, Pasrernacky‘s symptom positive, liver + 2 cm, spleen + 2 cm. What is the previous diagnosis? Malaria Cholangitis Pyelonephritis *Sepsis Leptospirosis Patient D., 39 years old, entered to infectious hospital on the second week days of disease in the severe condition. She is complaints for the high fever with chills and sweat, general weakness, pharyngalgia at swallowing. Objectively: temperature of body 37,7 °С, hyperemia of mucus of pharynx, tonsils are enlarged, loose, festering raid in lakuns, enlarged submandibula, neck, axilars lymphonodules, icterus of sclera and skin, bradycardia, liver + 2 cm, spleen + 1 cm. Urine is color of beer, an excrement is discolored. What is the previous diagnosis? Malaria Infectious mononucleosis Viral hepatitis *Sepsis Leptospirosis Patient of 52 years, fell ill sharply from a chill and head pain, fevers to 40°C. On a 3th day illnesses are nausea and vomiting, dark urine. On a 4th day a temperature went down to 37 °, but an icterus appeared and the amount of urine diminished to 600 ml. What disease is such development of symptoms characteristic for? Hepatitis A Hemorragic fever with a kidney syndrome *Leptospirosis Sepsis Acute glomerulonephritis Sick, 24 years old, complaints on a pain in a throat, general weakness. Objectively: temperature 38,0 °C. pulse 96 shots per a min., dermahemia mucus of otopharynx bloodshot, tonsils are enlarged in sizes, loose. During palpation-enlarged posterior cervical and submandibular lymph nodes, a spleen comes forward from under the edge of costal arc on 1 cm. About what disease it is necessary to think? Scarlet fever Acute respirator disease Follicle tonsillitis Typhoid fever *Infectious mononucleosis At a patient, 17 years: anginA. Temperature 38,2 °C, generilised lymphadenopathy (the first multiplied neck lymphatic nodeswhich are located along m. sternocleidomastoideus), small icterus, hepatospleenomegaly. Previous diagnosis? Tuberculosis of lymphatic knots Bacterial quinsy Diphtheria *Infectious mononucleosis Megacaryoblastoma A girl, 6 years old, admitted to hospital with complaints on general weakness, increase of temperature, pain in a throat. Objectively: observed oropharyngeal mucous membrane is bright red, on tonsils – white covering, can take off easily and enlarged all groups of lymph nodes 1-3 cm in a diameter, dense and elastic in consistancy, not very painfull, are not soldered between themselves. Liver is enlarged till 3 cm, spleen - till 1 cm. In bloods - leykocytosis, plazmocytes – 20 %. What will be the credible diagnosis? Acute lympholeycosis *Infectious mononucleosis Angina Diphtheria Adenoviral infection In children with catarrhal phenomena revealed an increase of inframaxillary lymph nodes, tonsil hyperplasia with whitish soft touch on them in the form of points and islands, the presence of rare maculo-papular bulging out, increased liver and spleen. Identify the likely diagnosis? *Infectious mononucleosis Acute leukemia Measles Scarlet fever Chicken pox At a child with the catarrhal phenomena it is found out the increase of submandibular and back neck lymphatic knots, hyperplasia of tonsils with the magnificent raid of gum-blush on them as points and aits, presence of the single roseol-papular pouring out, increase of liver. Name a credible diagnosis. *Infectious mononucleosis Adenoviral infection Scarlet fever Measles German measles In a policlinic the patient C., 18 years old, appealed with complaints of a moderate pharyngalgia, head pain, general weakness fervescence, to 38,9 °C. It is ill already three days. Objectively: it is found out megascopic back neck, and inguinal lymphatic knots, hepatospleenomegaly, subicterus scleroticas and skin, changes in a throat, characteristic for tonsils. At the hemanalysis – lymphomonocytosis. Credible diagnosis? *Infectious mononucleosis Follicle quinsy Adenoviral infection Flu Viral hepatitis In a policlinic the patient C., 18 years old, appealed with complaints of a moderate pharyngalgia, head pain, general weakness fervescence, to 38,9 °C. It is ill already three days. Objectively: it is found out megascopic back neck, and inguinal lymphatic knots, hepatospleenomegaly, subicterus scleroticas and skin, changes in a throat, characteristic for tonsils. In general blood analysis – lymphomonocytosis. Principles of treatment? Antibiotics, hepar protective preparations, antihistaminic Antiherpetic preparations, hepar protective preparations, antihistaminic *Antibiotics, preparations of interferon, hepar protective preparations Antibiotics, Antiherpetic preparations , antihistaminic Antibiotics, preparations of interferon, vitamins At a patient, 17 years: tonsils, temperature 38,2 °C, generilized lymphadenopathy (the first multiplied neck lymphatic nodeswhich are located along m. sternocleidomastoideus), small icterus hepatospleenomegaly. What exciter causes this disease? Herpesvirus I type Herpesvirus ІІ type Herpesvirus ІІІ type *Herpesvirus ІV type Herpesvirus V type Sick, in 24, disturbs a pharyngalgia, general weakness. Objectively: temperature – 38 °C. Pulse 96 shots per min, dermahemia mucus of otopharynx bloodshot, tonsills are megascopic in sizes, loose. Palpated megascopic back neck and submandibular lymphatic knots, a spleen comes forward from under the edge of costal arc of to 1 sm. What methods of diagnostics is it possible to confirm a diagnosis by? Reaction of Paul-Bynnel, Right-Heddlson, Goffa-Bauer *Reaction of Paul-Bynnel, Lovrik-Volner, Goffa-Bauer Reaction of Paul-Bynnel, Right-Heddlson, Lovrik-Volner Reaction of Paul-Bynnel, Goffa-Bauer Reaction of Paul-Bynnel, Goffa-Bauer, Right-Heddlson, Lovrik-Volner Patient P, 17 years old, has got ill gradually. General weakness, fatigue, painful throat, and nausea were marked. He was hospitalized on the 5th day of illness. Objectively: temperature is 38 °С. Objectively: skin and sclera are yellowish, neck, anticubital and subclavian lymph nodes are enlarged. Not numerous maculo-papular elements of rash on a trunk are found. The tongue is covered with white coat. The tonsils covered with white yellowish patches.On palpation of abdomen enlarged spleen and liver are found. In blood there is leucocytosis with neutophylic shift, atypical mononuclears-10 %, plasmatic cells- 10 %. What would be the diagnosis? Scarlet fever *Infectious mononucleosis Typhoid fever Yersiniosis Lacunar tonsillitis The boy 12 years old, with catarrhal phenomena seen an increase of all the lymph nodes, sclera, hyperplasia of tonsils white layers on them as islands, existing single maculo-papular rash, increased liver and spleen size. What additional research should appoint? Reaction of passive heamaglutination(RPG) with influenza viruses Ultrasound of the abdomen Puncture of the lymph nodes, with following microscopy Inoculation of blood *Blood test for atypical mononuclears Patient A., 17 years old, became ill gradually. A general weakness, fatigue, pain in throat, abdomen-ache, nausea, was marked. He was hospitalized on the 5th day of illness. Objectively: body temperature 38 °C, increased cervical, cubital and axillary lymph nodes. Subecteric skin and sclerA. Observed elements of spot-papul rash on a trunk. Raids on tonsils are loose, yellow, tongue coated by white covering, a abdomen is moderately swollen, hepatospleenomegaly. In general blood – leucocytosis, neutrophyle shift to left, atypical mononuclears – 10 %, plasmatic cells – 10 %. What is preliminary diagnosis? *Infectious mononucleosis Yersyniosis Lacunar tonsillitis Viral hepatitis A Typho-paratyphoid disease Patient 18 years, entered permanent establishment with complaints of headacke, general weakness increase of temperatures, to 37,5–38,2 °C during 6 days, pharyngalgiA. Objectively: all groups of lymphonoduses, 1-3 cm in a diameter, elastic, are megascopic, little sickly, not soldered between itself. A liver is megascopic on 3 cm, spleen – on 1 cm. In a blood is leycocytosis, placmatic mews – 15 %. What group of herpes does the exciter of this illness belong to? Alpha Beta *Gamma Delta Teta Patient A., 18 years old, is complaining about headache, weakness, high temperature, soar throat. Objectively: general lymphadenopaty,wit lymph nodes 1-3 cm in diameter, dense, elastic not painful and not combined between themselves. Hepatospleenomegaly was noticed. In blood there is leucocytosis, monocytes – 15 %. What is the diagnosis? *Infectious mononucleosis Adenoviral infection Tonsillitis Diphtheria Acute leukemia An 18 years old patient, entered the hospital with complaints of headache, general weakness, raising the temperature to 37,5-38,0 °C for 6 days, a sore throat. Objective examination: increasing of all lymph nodes, 1-3 cm in diameter, flexible, megaloblastic not soliter together. Increasing of the liver size till 3 cm, spleen – 1 cm. Common blood analysis: leukocytosis, placma cells – 15 %. What is preliminary diagnosis? Diphtheria Adenovirul infection Lacunar tonsillitis *Infectious mononucleosis Acute lympholucosis Patient D., 20 years old, fell ill and went to infectious polyclinic cabinet with complaints of moderate pain in the throat, headache, general weakness, increased body temperature of 38.9 °C. Fells bed during three days. At examination: increasing of inguinal lymph nodes, hepatosplenomegaly, subicteric sclera and skin, changes in the throat are typical for sore throats. In the blood – lymphogranulomatosis. The principles of treatment are? *Antibiotics, interferons, hepatoprotectors Antihypertensives hepatoprotectors, antihistamines Antibiotics, hepatoprotectors, antihistamines Antibiotics, antihypertensives, antihistamine Antibiotics, interferones, vitamins A patient D., 20 years old came to the infectious polyclinic with complaints of moderate pain in the throat, headache, general weakness, increasing of body temperature to 38.9 °C. He fells sick during 3 days. Objective examination: increasing inguinal lymph nodes, hepatosplenomegaly, subicteric sclera and skin, changes in the throat are typical for sore throats were found. Blood analysis – lymphogranulomatosis. What is probable diagnosis? *Infectious mononucleosis Tonsillitis Adenovirus infection Influenza Viral hepatitis The patients, 20 years old, with 5 days fever, pain in the throat during swallowing, pain in muscles. During review – there is thick, congested tonsils with purulent layers that are easily removed, enlarged neck, and inframaxillary lymph glands, liver + 1.5 cm possible palpation of edge of spleen. What additional research should be done? Puncture of the lymph nodes, followed by microscopy Ultrasound of the abdominal cavity *Blood test for atypical mononuclear Inoculation of blood Reaction of passive heamoglutination(RPH) influenza A viruses Patient A., 35 years old, came to the clinic on the third day of disease with complaints of drowsiness, sweat, headache, fever up to 38.5 °C. Reviewing physician found sore throat, splenomegaly, enlarged lymph nodes. Liver not enlarged. Blood analysis – leukocytosis, lymphomonocytosis. What is treatment for the patient? *Antibiotic, drugs interferon, hepatoprotectors Antihistamine, antiherpetic preparations hepatoprotectors Antibiotic, hepatoprotector, antihistamine Antibiotics, antihistamine, antiherpatic drugs Vitamins, antibiotics, drugs interferon 35 years old patient A., came to the clinic on the third day of illness with complaints of drowsiness, sweat, headache, fever up to 38.5 °C. Reviewing physician found sore throat, splenomegaly, enlarged lymph nodes. Liver is not enlarged. Blood analysis – leukocytosis, lymphocytosis. What additional test should hold the patient for infectious mononucleosis? Byurne and Wright-Hadulson’s reaction ELISA-test, bacteriological test for tularemia Bacteriological test for diphtheria and typhoid fever *ELISA-test, bacteriological test for diphtheria Paul-Bunnel’s reaction and lymph node puncture A female M., 24 years old came to the doctor with long-lasting fever, night sweat. Over the past three months, weight reduced by 7 kg. Low intention for sex. Objective examination found an increasing of all lymph nodes, hepatolienal syndrome. In the blood: Leucocyte – 2,2?109. What disease should be suspected? *HIV infection B. Lymphogranulomatosis C. Tuberculosis D. Infectious mononucleosis E. Sepsis A patient, 13 years old, complaints on pain in a throat, body temperature rise till 38 °C. Objectively: hyperemia of skin, hyperpigmentation of oropharyngeal mucous , tonsils are enlarged in size, marked suppuration of follicles. During palpation enlarged posterior cervical and submandibular lymph nodes. Pulse 96 times/minute, spleen – under the edge of costal arc on 1 cm. About what disease it is necessary to think? *Infectious mononucleosis Follicular tonsillitis Typhoid fever Measles Acute respiratory disease During the examination of a patient, 17 years old, observe tonsilitis, body temperature 38,2 °C, generalized lymphadenopathy (cervical ltmph nodes, located along the m. sternocleidomastoideus), mild jaundice, hepatospleenomegaly. What is preliminary diagnosis? Tuberculosis of lymph nodes Bacterial tonsillitis Diphtheria *Infectious mononucleosis Lymphogranulematosis Patient C., 16 years old, consulted to the infectious hospital on the 2nd day of diseases with complaints for a pain in throat at swallowing, increase of temperature. Objectively: body temperature 38,6 °C, hyperemia to the pharynx, edematous and loose tonsils, on both sides – purulent covering which can be taken off easily by spatulA. By palpation painful enlarged submandibular lymph nodes. Pulse 114 times/minute. From epidemic anamnesis it is clear that the same symptoms had her boyfriend. Changes in other organs didn’t observe. What preliminary diagnosis can be suspected? *Lacunar tonsillitis Diphtheria of pharynx. Infectious mononucleosis. Influenza Scarlet fever A 17 years old boy, got ill suddenly: the temperature rose up-to 40,3 °С, extremely sharp headache, makes him to yell. The patient is agitated and vomits frequently. Tremor of fingers of extremities is observed. The star like hemorrhagic rash of different form and sizes appeared, mainly on buttocks, thighs, shins, and trunk. Meningeal signs are positive. What is the most credible diagnosis? Encephalitis Flu with a hemorrhagic syndrome * Meningococcal infection Measles Leptospirosis A 19-years-old patient became ill 5 days ago: subfebrile temperature, acquired voice, dry cough weakness. After hospitalization: t - 37,1 °C, but general condition is serious, pallor, expressed weakness, aphonia, noisy stenotic breathing, inciters indrawings of intercostal intervals, pulse 110 per min, frequency of breathings 36 per min., cyanosys of lips and nailes. Tonsills is covered by the greyish dense raid. Define strategy of intensive therapy: Tracheotomy, AVL, antitoxin Tracheotomy, AVL, toxoid, desintoxic therapy * Sedative, intubation, antitoxin, dexametazon, desintoxic therapy intubation, sedative, toxoid, penicillinum, desintoxic therapy sedative, oxygenotherapy, antitoxin i/v A girl, 6 years old, admitted to hospital with complaints of general weakness, increase of temperature, pain in a throat. Objectively: observed oropharyngeal mucous membrane is bright red, on tonsils - white covering, can take off easily and enlarged all groups of lymph nodes 1-3 cm in a diameter, dense and elastic in consistancy, not very painfull, are not soldered between themselves. Liver is enlarged till 3 cm, spleen - till 1 cm. In bloods - leykocytosis, plazmocytes - 20 %. What will be the credible diagnosis? Acute lympholeycosis *Infectious mononucleosis Angina Diphtheria Adenoviral infection A new born child on 10th day of life became worse: Temperature 39.2 °C, frequent vomiting, generalized cramps, violations of consciousness, spastic paresis of left extremities. Month prior to his birth herpes virus was present in the mother, which she did not treat. What disease is most possible? * Herpetic encephalitis Meningococcal meningitis Subarechnoid hemorrhage Cerebral abscess Violation of blood cerebral circulation A patient 17 years old, became suddenly ill: .Temperature rose to 40,3 °C. Severe headache, motive excitation, frequent vomiting, tremor of fingers of extremities. Hemorrhagic spots of round form and different sizes, more frequently as stars, mainly on buttocks and trunk. Meningeal signs are positive. What is the most possible diagnosis? Encephalitis Flu with a hemorrhagic syndrome * Meningococcal infection Measles Leptospirosis A patient 21 years old 4th day grumbles about a general weakness, moderate pharyngalgia fervescence, to 39 °C. Did not treat oneself. Objectively: edema and cyanosys of mucous of otopharynx of left tonsill rough fibrinose raid which goes out on a palatal handle and tongue. Bloodstreaks appear at the attempt of removal by his spatulA. Submandibular lymphatic nodesare megascopic, more on the left side. What diagnosis is most credible? Paratonsill abscess Lacunar quinsy Quinsy of Vensan-Symanovskiy * Diphtheria of otopharynx Infectious mononucleosis A patient 60 years old for 2 days has disturbed severe pain in a right arm. On 3rd day appeared blisters, pouring out as a chain on the skin of shoulder, forearm and brush. Sensitiveness in the area of pouring out is mionectic. What disease can be diagnosed? Dermatitis * Herpetic ganglionitis Neck-pectoral redicals Psoriasis Allergy A patient A., 23 years old, hospitalized on the 2th day of disease with complaints of a weakness, pharyngalgias, that increase at swallowing, chill. State is moderate, temperature of body - 38.3 °C, a moderate hyperemia with cyanosys of mucous of the throat, tonsills is megascopic, covered by the pellicles raids which spread on a wall pharynx and tongue. Increasing of neck lymphonodes. Pulse - 88 per 1 min, BP 120/60 mm of Hg. A liver and spleen are not megascopic. What is previous diagnosis: * Diphtheria of oropharynx Mycotic tonsillitis Simanovsky-Vensent's tonsillitis Infectious mononucleosis Acute leucosis A patient became ill sharply. Severe pain of head, frequent vomits appeared in the morning. Temperature of body rose to 39,9 °C. Adopted febrifuge, however much the state got worse. Till the evening patient lost consciousness. Excited, sharply expressed meningeal signs. What is most reliable diagnosis? Status typhosus in typhoid fever Viral meningoencephalitis Sepsis, infectious-toxic shock * Meningococcal infection, meningitis Status typhosus in epidemic typhus A patient C., 25 years old, fell suddenly ill. Every morning severe headache, frequent vomiting, temperature of the body is 39,9 °C. Adopted fatigue, then state got much worse. In the evening lost of consciousness. Expressed muscles pains of back and head. Positive Кеrning's symptom. Leukocytes - 18,0*109/L. What is the most reliable diagnosis? Flu Epidemic typhus, typhus state Viral menigoencephalitis Sepsis, infectious-toxic shock * Bacterial menigoencephalitis A patient came with complaints of erosions of his penis. From anamnesis frequent appearance of similar rashes during a year is found out. Objectively: on a balanus are the grouped blisters and erosions of polycyclic outlines, with clear margin, soft during palpation. What is your diagnosis? * Recurrent congenital herpes Pemphigus vulgaris Primary syphillis Pyodermia Scabies A patient came with complaints of sickly erosions on his penis. From anamnesis frequent appearance of similar rashes is found out during a year. Objectively: on a balanus are the grouped blisters and erosions, soft on palpation. What is your diagnose? * Recurrent herpes of ІІ type Vulvar pemphigus Primary syphyllis Shankoform pyoderma Recurrent herpes of ІІІ type A patient D., 20 years old came to the infectious polyclinic with complaints of moderate pain in the throat, headache, general weakness, increasing of body temperature to 38.9 °C. He fells sick during 3 days. Objective examination: increasing inguinal lymph nodes, hepatosplenomegaly, subicteric sclera and skin, changes in the throat are typical for sore throats were found. Blood analysis - lymphogranulomatosis. What is probable diagnosis? * Infectious mononucleosis Tonsillitis Adenovirus infection Influenza Viral hepatitis A patient D., yesterday in the evening delivered in the hospital due to high temperature of body, increasing pharyngalgia, pain lockjaw of masseters, nausea, vomits. At nasopharhyngoscopy by an otolaryngologist the moderate expressed hyperemia, edema, cyanosys of mucous membrane of left palatal tonsil, oral cavity and nasopharynx were found out. The surface of tonsil is covered by the raid of dirty-grey color pellicle which goes beyond his borders (in nasopharynx). Increasing of left submandibular lymphatic node of dense consistency was also found. The edema of hypoderm of neck reaches to the collar-bone. What is the described disease? * Hypertoxic diphtheria of nasopharynx Localized diphtheria of nasopharynx Subtoxic diphtheria of nasopharynx Widespread diphtheria of nasopharynx Lacunar tonsillitis A patient has herpetic meningitis. What preparation of specific therapy for viral neuro infection should be given? * Acyclovir Cefataxime Ceftriaxone Gentamycin Furazolidon A patient is hospitalized in infectious permanent establishment: sharp beginning of disease, temperature 39,9 °C, moderate pharyngalgia, takes place edema, insignificant hyperemia with cyanosys of mucuses shells of otopharynx, on tonsills dense, brilliant, greyish color the raids placed as continuous pellicle, is heavily taken off, bare a surface, that bleeds. Submandibular lymphonoduss are moderatory megascopic. A patient must immediately do: Strokes with tonsills, nose or other areas for the exposure of diphtherial stick IFA * Microscopy (painting for Neyser) Haemoculture RDHA with a diphtherial diagnosticum A patient is sick with meningococcal meningitis. He take a massive dose of penicillin. 4 days temperature of body 36,6-36,8 °C. Meningeal signs are negative. When is it possible to stop the antibiotic therapy. * At a cytosis in a CSF 100 and less, lymphocytes prevail After 10 days from the beginning antibiotic therapy After 7 days from the beginning antibiotic therapy At a cytosis 100 and less, neutrophil prevail From 6 days from the beginning antibiotic A patient N., 45 years old, complaints of headache, general weakness increasing of temperature, to 37.4 °C. In 2 days pain appeared in the pectoral region of spine with an irradiation in a right between scapular regions. After some time skin in this region turned red as a strip from a spine to the subarmpit line, and in 2 days red knots which through the set time grew into blisters with transparent maintenance appeared in this place. What is your diagnosis? * Herpes zoster Thoracal rediculopathy Neurology of intercostal nerves Neurology of superscapular nerve Herpetiform dermatitis A patient sharply had a chill, headacke, vomits, temperature of body up to 38,5 °C. Till evening rigidity of muscles, Kernig symptom appeared. Herpetic blisters are marked on mucouse of lips and nose. Neurological symptoms is not found out expressed. What disease will you suspect? Subarachnoiditis hemorrhage Herpetic encephalitis Abscess of brain Hemorrhage in a brain * Meningococcal meningitis A patient was delivered in a hospital on the 2th day of illness with the symptoms of expressed toxicosis. Objectively: found out the severe condition, hemorrhagic rash of wrong form of different size on a skin, hemorrhages in the scleras of both eyes. Extremities are cold. AP 60/20 mm/hg, pulse - 120 per minute. Previous diagnosis? * Meningococcemia Hemorrhagic fever with a kidney syndrome Leptospirosis Typhoid fever Pseudotuberculosis A patient with meningococcal meningitis gets penicillin during 7 days. The temperature of body is normal 4 days. Meningeal signs are negative. When is it possible to stop the antibiotic therapy. In default of leucocytosis displacement in blood * At a cytosis in a neurolymph 100 and less, lymphocyte prevail At a cytosis in a neurolymph 100 and less, neutrophil prevail At a cytosis in a neurolymph 150, lymphocyte prevail At once immediately A patient X., 25 years old, was examined by a otolaryngologist on the 4th day of illness. Temperature of body - 38.1 °C. Complaints of indisposition, moderate pain in the throat. Objectively: a mouth opens fully. Mucous of a soft palate, tongue were swollen, insignificant hyperemia with cyanosis. Increasing of tonsills, covered by the grey dense raid. The raid is taken off hard. The edema of neck is not present. Increasing of submandibular lymph nodes. What is most credible diagnosis? Lacunar tonsillitis Infectious mononucleosis Simanovsky-Vensent's tonsillitis * Diphtheria of oropharynx Follicular tonsillitis A patient, 13 years old, complaints of pain in a throat, body temperature rise till 38 °C. Objectively: hyperemia of skin, hyperpigmentation of oropharyngeal mucous , tonsils are enlarged in size, marked suppuration of follicles. During palpation enlarged posterior cervical and submandibular lymph nodes. Pulse 96 times/minute, spleen - under the edge of costal arc on 1 cm. About what disease it is necessary to think? * Infectious mononucleosis Follicular tonsillitis Typhoid fever Measles Acute respiratory disease A patient, 20 years old, during few days complaints of pharyngalgias. After supercooling the state became worse : sudden chills, increase of temperature to 40,6 °C, headache. On skin of low extremities, trunk and buttocks there are a lot of different sizes hemorragic spots, acrocyanosis. Consiouness is preserved. Meningeal signs are absent. What is the previous diagnosis? * Meningococcal infection Flu Epidemic typhus Hemorrhagic fever Leptospirosis A patient, 22 years old, became ill sharply. History showed fever up to 38.2 °C with headache, repeated vomiting, olfactory and tastes hallucinations. Quickly got complex of meningeal symptoms, pyramidal paresis. The general epileptic attack and comatose state also developed. Neurolymph is with mixed lymphocytosis, cytochrome, single red corpuscles. What is previous diagnosis? Brain abscess Subdural empyema * Herpetic encephalitis Tumor of brain Encephalopathy A pregnant woman, 27 years (pregnancy ІІ, 8-10 weeks.), temperature of body increased. At the inspection on a TORCH-infection antibodies are found to the herpes virus, ІІ types of class IGM. What we must recommend to pregnant women? * To cut pregnancy To prolong the supervision Treatment with acyclovir Symptomatic treatment Appoint of alpha-fetoprotein A sick 3 years old child came to the doctor with symptoms of the fever, languor, waiver of meal. A boy is capricious, temperature of body 37.9 °C. On the mucous of soft palate, cheeks are single vesicle, hypersalivation. What is the diagnosis? * Herpetic stomatitis Candidosis of oral cavity Leucoplacia Follicular tonsillitis Lacunar tonsillitis A sick person, 65 years old, complaints of rash, pain in a subscapular region. Objectively: on a skin surface of the subscapular region present the arcwise rose-red filling out hearths some infiltrative, with clear scopes. On-the-spot hearths grouped vesicles with transparent maintenance. What preparation he should take? Suprastyn Prednisolone Biseptolum-480 Loratidin * Laferon A woman 65 years old the disease had beginning sharply from increase of temperature to 39.0 °C, weakness, and pain in the left part of thorax that increased with breathing motions. On 3rd day of disease vesicular breathing appeared after motion of rib on the left on a hyperemic background. Together with sick a grandchild lives 4 years. What measures of prophylaxis of disease need to be adopted? Vaccination Final disinfection Reception of specific immunoprotein * Isolation of patient Acyclovir administration A woman C., during 3 days complaints of a general weakness, headache increasing of temperature to 39-40 °C, insignificant pharyngalgiA. Her husband is sick with tonsillitis. Objectively: a skin is pale, cyanosis of lips. Hyperemia of mucous of oropharynx, increasing of tonsils. On the spot of tonsils there are continuous dense accented mother-of-pearl raids, which are taken off with great effort with bleading. Increasing of submandibular lymphatic nodes. Edema of the neck. AP 105/65 mm Hg. What is most credible diagnosis? Acute leucosis Lacunar tonsillitis Infectious mononucleosis * Diphtheria of oropharynx Adenoviral infection After the disease which was accompanied by the fever and pharyngalgias, there were an odynophagia, dysarthria, weakness and violation of motions in hands and feet, hyporeflexia, violation of sensitiveness in extremities to the polyneurotic type. What disease does it follow to think about above all things? Neuropathy of hypoglossus * Diphtherial polyneuropathy Neuropathy of glossopharyngeus nerve Trunk encephalitis Pseudobulbar syndrome Among the students of PTU 2 cases of generalized form of meningococcal infection are registered. What preparation does it follow to enter to the contact persons with the purpose of urgent prophylaxis? Normal immunoglobulin Leukocytic interferon * Meningococcal vaccine Meningococcal anatoxin Bacteriophage An 18 years old patient, entered the hospital with complaints of headache, general weakness, raising the temperature to 37,5-38,0 °C for 6 days, a sore throat. Objective examination: increasing of all lymph nodes, 1-3 cm in diameter, flexible, megaloblastic not soliter together. Increasing of the liver size till 3 cm, spleen - 1 cm. Common blood analysis: leukocytosis, placma cells - 15 %. What is preliminary diagnosis? Diphtheria Adenovirul infection Lacunar tonsillitis * Infectious mononucleosis Acute lympholucosis A 17 years old boy, after tick bite got ill suddenly: the temperature rose up-to 40,3 °С, extremely sharp headache, makes him to yell. The patient is agitated and vomits frequently. Tremor of fingers of extremities is observed. Meningeal signs are positive. What is the most credible diagnosis? *Viral meningoencephalitis Leptospirosis Measles Meningococcal infection Flu with a hemorrhagic syndrome A citizen of Nigeria, 19 years old, came to study in Ukraine. After 10 days a strong chill appeared. There has been a headache, slice, nagging pain in the muscles. OBJECTIVE: body temperature 39,6 °C, sclera subicteric, herpes of lips. Symptoms of bronchitis were present. Spleen is significantly increased, dense, the liver is normal. What investigation is necessary to do? USI of abdomen Lumbar puncture *Microscopy of tissue slades Microscopy of peripheral blood Observation of oculi A patient B., 62 years old, became ill suddenly. Severe pain of head, frequent vomiting appeared in the morning. Temperature of body rose to 39,9 °C. Adopted febrifuge, however much the state got worse. Till the evening patient lost consciousness. Excited, expressed meningeal signs present. What is most probably diagnosis? Status typhosus in epidemic typhus Status typhosus in typhoid fever *Viral meningoencephalitis Sepsis, infectious-toxic shock Meningococcal infection, meningitis Patient B., 62 years old, became ill suddenly. Severe pain of head, frequent vomiting appeared in the morning. Temperature of body rose to 39,9 °C. Adopted febrifuge, however much the state got worse. Till the evening patient lost consciousness. Excited, expressed meningeal signs present. What is most probably diagnosis? Meningococcal infection, meningitis Status typhosus in typhoid fever Sepsis, infectious-toxic shock Status typhosus in epidemic typhus *Viral meningoencephalitis A patient became ill sharply. Severe pain of head, frequent vomits appeared in the morning. Temperature of body rose to 39,9 °C. Adopted febrifuge, however much the state got worse. Till the evening patient lost consciousness. Excited, sharply expressed meningeal signs. What is most reliable diagnosis? *Viral meningoencephalitis Meningococcal infection, meningitis Status typhosus in epidemic typhus Sepsis, infectious-toxic shock Status typhosus in typhoid fever A patient became sick 2 days ago suddenly. Temperature of body rose to 41°С, headache, vomit, positive Kernig’s and Brudzinsky’s symptoms appeared. In cerebrospinal liquid: cytosis 7 000 in 1 mkl, 90 % are lymphocytes, some increasing of protein, sugar, chlorides. What is clinical diagnosis? Endocarditis *Meningeal form of viral encephalitis Infectious-toxic shock Meningococcemia Meningicm A patient C., 25 years old, fell suddenly ill. Every morning severe headache, frequent vomiting, temperature of the body is 39,9 °C. Adopted fatigue, then state got much worse. In the evening lost of consciousness. Expressed muscles pains of back and head. Positive Кеrning’s symptom. Leukocytes – 8,0*109. What is the most reliable diagnosis? Epidemic typhus, typhus state Flu *Viral menigoencephalitis Bacterial menigoencephalitis Sepsis, infectious-toxic shock A patient is disturbed by attacks of fever. The icterus of sclera and skins is observed, hepatosplenomegaly is found on palpation. What is possible diagnosis accept? Leishmaniosis Leptospirosis *Sepsis Malaria Viral hepatitis A patient sharply had a chill, head pain, vomits, temperature of body rose up to 38,5 °C. Till evening rigidity of muscles, Kernig’s symptom appeared. Herpetic blisters are marked on mucous of lips and nose. Neurological symptoms is not found out expressed. What disease will you suspect? Herpetic encephalitis Abscess of brain *Meningoencephalitis Hemorrhage in a brain Subarachnoid hemorrhage A patient became sick 2 days ago suddenly. Temperature of body rose to 41°С, headache, vomit, positive Kernig’s and Brudzinsky’s symptoms appeared. In cerebrospinal liquid: cytosis 7 000 in 1 mkl, 90 % are lymphocytes, some increasing of protein, sugar, chlorides. What is clinical diagnosis? Endocarditis Meningococcemia Infectious-toxic shock * Meningeal form of viral encephalitis Meningicm A patient C., 25 years old, fell suddenly ill. Every morning severe headache, frequent vomiting, temperature of the body is 39,9 °C. Adopted fatigue, then state got much worse. In the evening lost of consciousness. Expressed muscles pains of back and head. Positive Кеrning’s symptom. Leukocytes – 8,0*109. What is the most reliable diagnosis? Epidemic typhus, typhus state Bacterial menigoencephalitis Flu Sepsis, infectious-toxic shock *Viral menigoencephalitis At a patient with meningoencephalitis 44 years old, rose up general clonic-tonic cramps, abundant sweat, hyperemia of the face, bradycardia quickly changed on tachycardia, violation of breathing (Cheyne-Stokes type). What complication develop? Swelling and edema of cerebrum *Wedging of cerebrum in the cervical channel Hypovolemic shock Waterhause-Friedrichsen syndrome Infectious toxic shock In a patient, 27 y.o., after tick biting, headache which accompanied by nausea, repeated vomits, hyperesthesia, photophobia appear. At a review: feet are bended to the trunk, expressed rigidity of muscles of the back of head, positive symptoms of Kerning’s, Brodzinsky’s. It is not found out paresises. Select a basic neurological syndrome. Root syndrome *Meningeal syndrome Syndrome of liquor hypertension Vegetative crisis Syndrome of liquor hypotension Patient B., 38 years, delivered by emergency doctor, anamnesis is unknown. However, according to neighbours, patient 2 days ago was healthy. At a review: consciousness is absent, motion of left overhead and lower extremities is absent, increasing of muscular tone is marked in the same extremities. Periodically are clonic-tonic cramps in right extremities. Expressed asymmetry of person. Sharply expressed rigidity of muscles of the back of head, positive Кеrnig symptom, positive overhead and lower Brudzinsky symptom. Acrocyanоsis is marked, temperature of body 38,8 °С. Breathning 36/min, unrhythmical. Vesicular breathing during auscultation. Pulse 72/min, weak filling and tension. Heart tones are muffled, AP 80/50 mm/hg. Tongue is dry, assessed by the white raid. Physiology sending in a norm. Your diagnosis? Epidemic typhys Hemorrhagic fever Typhoid fever *Viral meningoencephalitis Leptospirosis Patient D., 30 y.o., teacher, have been examined by the doctor of first-aid and delivered to a clinic on the 2nd day of illness. Fell ill acutely, temperature 40 °C, severy headacke, repeated vomits, photophobiA. The general condition is severe, consciousness is darkened. Sharply expressed rigidity of neck muscles, positive Kernig symptom. Pulse 100 min, weak; tones of heart deaf, AP 60/30 mmHg. What is your diagnosis? Crimean hemorrhagic fever Disease of blood Flu, toxic form Hemorrhagic stroke *Viral meningoencephalitis Patient D., 53 years, have been examined by doctor on the 2th day of illness. Fell ill suddenly, temperature 40 °С, acute headache, repeated vomiting, photophobiA. The common state is severe, consciousness is darkened, expressed rigidity of cervical muscles, positive Kernig’s symptom. Pulse 110/min, weak. BP 60/30 mm/hg. What is your diagnosis? Hemorrhagic stroke Leptospirosis Flu, toxic form *Viral meningoencephalitis Marburg hemorrhagic fever Patient K., 21 y.o., the disease began from the increasing of temperature to 39,0 °C, headache, chill, repeated vomit. Objectively: temperature of 39,3 °C, pulse 76. Rigidity of muscles of the back of head. The tendon reflexes are expressed. Analysis of liquor: 84 % lymphocytes, 16 % neutrophiles, liquid is turbid, flows out under the promoted pressure. What disease is most reliable? Second festering meningitis *Viral meningoencephalitis Meningococcal infection: serous meningitis Infectious mononucleosis Meningococcal infection: purulent meningitis Patient L., 38 years old, complaints of attacks of fever with chill and common sickness. Epemiologically was found that he had recently returned from IndiA. Leishmania donovani was found under a microscopy. What is the vector of the disease: Bee Pliers Flea *Mosquitoes Fly Person 16 years entered permanent establishment on 6 day of illness. Illness began after tick bite. Temperature 37,7 °C. The state became worse: severe head pain, frequent vomits unconnected with a meal appeared. The common state is heavy. Pupils are extended, photoharmose is not present. Positive meningeal symptoms. General hyperesthesiA. Tones of heart are deaf, BP 100/50 mm/hg. What reliable diagnosis? Meningococcal meningitis Influenza *Viral meningoencephalitis Typhoid fever Infectious mononucleosis Patient, 15 y.o., back from Japane, became ill 3 days ago. Complaints of headache, temperature of 37,4 °C. After next days: headache increased, a temperature rise to 38,3 °C, repeated vomits. Objectively: a skin is pale, without rash. Mucous membrane of posterior wall of the throat is normal. Pulse 86, satisfactory filling. Meningeal signs are positive. What investigation is necessary to perform: Intracutaneous allergic test Biological test on white mice *Cerebrospinal puncture Hemoculture Vidal test Patient, 16 y.o., during 3 days stood with high temperature at home. 10 days ago been bited by tick. Next 2 days felt better. A temperature became normal. There was a chill on a 6th day, a temperature rose to 40 °C again, intensive, quickly increased headache, during 3 hours – repeated vomiting. The state is severe, consciousness is absent, psychomotor violations expressed meningeal signs. Meningitis is suspected. What is his etiology? Tubercular Meningococcal Enteroviral Postinfluenzal *Viral meningoencephalitis Patient, 23 y.o., suddenly experienced intensive headacke, nausea, pain in a neck and lumbar areA. Temperature of body 39,2 °C. Expressed meningeal symptoms. Light, tactile, pain hyperesthesiA. Blood: leucocytes – 17 000 /l, ESR-29 mm/hour. What method of investigation is most informative? Echoencephalography Transcranial dopplerography Electroencephalography *Lumbar puncture Computer tomography Sick 15 year old, became ill 3 days ago. Disturbed| headache, temperature of 37,4 °C. During next days: headackeache increased, a temperature had rose to 38,3 °C, repeated vomiting. Objectively: a skin is pale, without rash. Pulse 86/min satisfactory filling. Meningeal signs positive. It is needed to conduct for the selection of exciter. Endermic test Bioassay on mice *Bacteriological examination of CSF Widal test Cultivation on bilious clear soup Sick, 54 years old, hospitalized in an infectious department in a severy condition. Complaint about the expressed headache, mainly in frontal and temporal areas, superciliary arcs, origin of vomit on height of pain, pain at motions by eyeballs, in muscles and joints. Objectively: a patient is excited, temperature of body 39 °C, BP 100/60 mm Hg. Bradycardia changed by tachycardiA. There were tonic cramps. Doubtful meningeal signs. From anamnesis it is known that at home a woman is ill. What preparations must be entered? Aspirin, analgin, d, dimedrol Lasix, analgin, ampicillin Mannitol, acetophene, prednisolone *Mannitol, lasix, prednisolone, euphylin, suprastin Veroshpiron, euphylin, prednisolone, dimedrol Worker, 22 y.o., became ill sharply: t 39°C, severe pain of head, frequent vomits. Objectively: the condition is severe, psychomotor excitation, moans due to the great pain of head, expressed rigidity of neck muscles. Sharply positive symptoms of Brudzinsky’s and Kernig’s, general hyperesthesiA. What’s necessary to do for clarification of diagnosis? Computer tomography of cerebrum *General blood analysis and liquor analysis X-ray of skull in two projections Analysis of the excrement and urine for a pathological flora General blood analysis and blood sterility Patient A., 23 years suddenly experienced intensive head pain, nausea, pain in a neck, and lumbar. Examination is delivered in a clinic. Objectively: temperature 40,2 °C. Expressed meningeal symptoms. Light, haptic, pain hypesthesiA. Blood: leucocytes – 5 thousand/l, ERS-19 mm/hr. A neurolymph under high pressure, turbid, lymphocytosis, some increasing of protein, chlorides. What is your diagnosis? Meningococcal meningitis *Viral meningitis Tubercular meningitis Staphylococcus meningitis Pneumoccocal meningitis In a patient, 35 y.o., came back from China one week ago, sharp beginning of disease have happened. Hyperthermia to 39,5 °C, headache, which is accompanied with vomits, myalgias, scleritis; rigidity of cervical muscles, Kernig’s and Brudzinsky’s symptoms are positive, neutrophilic leukocytosis in common blood analisis. What is most credible diagnosis? Yersiniosis Leptospirosis *Viral meningoencephalitis Thrombocytopenic purpura Typhoid fever In permanent establishment on the 2nd day of illness a patient is delivered with the symptoms of expressed toxicosis. Have been visited Japan. Objectively: the general condition is severe, hemorrhages in sclera of both eyes. Extremities are cold. AP is 60\20 mmHg, pulse – 120. What is previous diagnosis? Typhoid fever Hemorrhagic fever with a renal syndrome Meningococcemia *Viral meningoencephalitis Crimean hemorrhagic fever At a patient, 35 years, after the trip to Japan sharp beginning of disease happened. Body temperature – 39,5 °С, head ache, which is accompanied with vomits, myalgias. Hemorrhagic rash, that are localized on scleras. Rigidity of cervical muscles, Kernig and Brudzinsky symptoms are expressed. Spinal liquor without changes. What is most credible diagnosis? Meningococcal infection Leptospirosis Epidemic typhus Typhoid fever * Viral meningoencephalitis For the treatment of acidosis in viral meningoencephalitis is better to use. 10 % chloride solution 10-20 % glucose solution *4 % sodium bicarbonate solution Concentrated dry placma Patient, 35 years was hospitalized with diagnosis localized diphtheria of pharynx. What is the first dose of antitoxic antidyphtherial serum? *30 000 AU XX. 50 000 AU 80 000 AU 120 000 AU AAA. 150 000 AU What laboratory examination is compulsory to do for the patient with signs of tonsillitis? Isolation of hemolytic streptococcus from the throat mucosa Biochemical blood analysis X-ray examination *Cmear from nose and pharynx Immune-enzyme analysis In preschool the registered case of diphtheriA. What from the measures adopted below does not conduct to the contact children? *Introduction of antidiphterial whey Non-permanent is stroke from a pharynx and nose for the bacteriologic examination Daily is supervision during 7 days Determination of titres of specific antibodies At the repeated cases of disease is extraordinary revaccination diphtheria At a patient the dense darkly-grey raid covers tonsils is considerably megascopic and spreads for their scopes. Mucus shell bloodshot accented cyanochroic, was considerably swollen. Immediate medical measure: Ultraviolet irradiation of throat Punction of peritonsillar space Section of peritonsillar space *Introduction of antidiphterial serum Compress on a neck A boy 6 years was in the close touch with a patient with diphtheriA. What treatment-prophylactic measures need to be conducted, if vaccine anamnesis is unknown? Introduction of AWDT vaccine Antibacterial therapy Introduction of ADT-м to the toxoid *Antibacterial therapy and double introduction of ADT toxoid Antibacterial therapy and introduction of immunoprotein At a girl, 22 years old, severy form of diphtheria of otopharynx have happened. Specific treatment begun only on a 5th day from the beginning of disease. What complication of diphtheria is potentially dangerous? Stenotic laryngotracheitis Pneumotorax Meningoencephalitis Septicopyemia *Infectious-toxic shock What remedy is most effective for treatment of dyphtheria should be used immediately? Antibiotics Oxygenotherapy *Antitoxic antidyphtherial serum Antipyretic drugs Sulfanilamides At sick L, 35 years old, a diagnosis is set is diphtheria of pharynx, noncommunicative form. What first dose of antitoxic antidiphtheria whey is it necessary to appoint? 120 thousand of AО 80 thousand of AО *30 thousand of AО 50 thousand of AО 150 thousand of AО A child 2 years carries a diphtherial croup. There was the stop of breathing on 2nd days of whey therapy. What was the reason of asphyxia? *Mechanical obturation by tapes Stenosis of larynx Anaphylaxis shock Whey illness Paresis of respiratory musculature When patient refered to the doctor with such complaints: prodromal respiratory illness, sore throat, fever, headache, stiff neck, vomiting, confusion, irritability. What is previous diagnosis? What main methods can confirm the diagnosis? Epidemic typhys. ELISA-test Hemorrhagic fever. ELISA-test Leptospirosis. Lumbar puncture. Typhoid fever. ELISA-test *Meningococcal infection. Lumbar puncture A patient is sick with meningococcal meningitis. He take a massive dose of penicillin. 4 days temperature of body 36,6-36,8 °C. Meningeal signs are negative. When is it possible to stop the antibiotic therapy. *At a cytosis in a CSF 100 and less, lymphocytes prevail After 10 days from the beginning antibiotic therapy After 7 days from the beginning antibiotic therapy At a cytosis 100 and less, neutrophil prevail From 6 days from the beginning antibiotic In patients with intensive head acke, nausea, pain in a neck and lumbar area, expressed meningeal symptoms; light, tactile, pain hyperesthesia what method of inspection is most informing? *Lumbar puncture Computer tomography Electroencephalography Transcranial dopplerography Echoencephalography Among the students of school 2 cases of generalized form of meningococcal infection are registered. What preparation does it follow to enter to the contact persons with the purpose of urgent prophylaxis? Normal immune globulin Leukocytic interferon *Meningococcal vaccine Meningococcal anatoxin Bacteriophage In the kindergarden a child had a meningococcal infection. She was immediately hospitalized. After clinical convalescence in child sowed meningococcus. To which category can the carrier (child) of pathogen belongs? Convalescent, chronic *Convalescent, acute Healthy Immune in vaccinated Immune in those, that had infection A patient with meningococcal meningitis gets penicillin during 7 days. The temperature of body is normal 4 days. Meningeal signs are negative. When is it possible to stop the antibiotic therapy. In default of leucocytosis displacement in blood *At a cytosis in a neurolymph 100 and less, lymphocyte prevail At a cytosis in a neurolymph 100 and less, neutrophil prevail At a cytosis in a neurolymph 150, lymphocyte prevail At once immediately At a patient the dense darkly-grey raid covers tonsills is considerably megascopic and spreads for their scopes. Mucus shell bloodshot accented cyanochroic, was considerably swollen. Immediate medical measure: *Antidiphterial serum Punction of peritonsillar space Section of peritonsillar space Microscopic research of stroke from under tape Bacteriologic examination of stroke from under pallatum In an epidemic focusl rationally to organize verification of the state of immunity. The Use of RIHA allows to find out persons unimmune to diphtheria during a few hours. What minimum protective titre? 1:10 1:20 *1:40 1:80 1:160 At a child 4 years on the third day of disease the widespread form of diphtheria of nasopharynx is diagnosed. Preparation of specific therapy: Macrolids per os Penicillin i/m Cortycosteroid *Antidiphterial serum i/v Antitoxic therapy At maintenance of call on a house a district pediatrician put to the sick 5 years old child diagnosis “Acute lacunar tonsillitis”. Specify, who must carry out the laboratory inspection of patient and in what terms. Worker of SES upon receipt report A district medical sister is at once after determination of diagnosis Doctor pediatrician in 5 hours *Doctor pediatrician at once after determination of diagnosis District medical sister on a next day At a patient with meningococcal meningitis 44 years old, rose up general clonic-tonic cramps, abundant sweat, hyperemia of person, bradycardia quickly changed on tachycardia, violation of breathing (Cheyne-Stokes type). What complication develop? Infectious toxic shock *Wedging of cerebrum in the cervical channel Encephalitis Swelling and edema of cerebrum Waterhause-Friedrichsen syndrome At a patient with meningococcal meningitis, in 52, there was the syndrome of cerebral hypotension on the 6th day of illness. Objectively: expressed toxicosis and dehydration of organicm, meningial symptoms disappeared, muscles tones was low and areflexia developed. What complication arose up? * Infectious toxic shock Wedging of cerebrum in the cervical channel Encephalitis D. Swelling and edema of cerebrum Waterhause-Friedrichsen syndrome Patient D., 30 years, have been examined by emergency doctor and delivered in a clinic on the 2th day of illness. Fell ill sharply, temperature 40 °С, sharp head pain, repeated vomits, photophobiA. The common state is severe, consciousness is darkened. Star-like shape rashes at the skin of abdomen, buttocks and lower extremities appeared. Sharply expressed rigidity of cervical muscles, positive Kernig symptom been present. Pulse 100/min, weak, tones of heart seak, BP 60/30 mm/hg. Your diagnosis? * Meningococcal infection Flu, toxic form Marburg hemorragic fever Leptospirosis Hemorrhagic fever Patient Н., 21 year, entered hospital on the 7th day of disease with complaints of the expressed weakness, pains in muscles and joints, head pain, nauseA. The disease began with irritation on the throat, chill, general weakness. After 2 days the state became worse, temperature increased to 39-40°С. Objectively: patient adynamic, consciousness is stored. Temperature of body 37,5 °С, the state as severe, pale skin, lips and nail phalanxes cyantic, hemorrhagic rashes on the skin of trunk and hands, the scopes of heart are extended to the left on 1,5 cm, tones deaf, pulse 130/min, weak filling, BP 80/40 mm/hg. Vesicular breathing. Tongue is assessed, moist, phenomena of pharyngitis present. Inlargement of neck lymphonodes. Meningeal symptoms are not present. OliguriA. What is previous diagnosis? Hemorrhagic fever Leptospirosis Epidemic typhus *Meningococcal infection Typhoid fever Patient B., 38 years, delivered by emergency doctor, anamnesis is unknown. However, according to neighbours, patient 2 days ago was healthy. At a review: consciousness is absent, motion of left overhead and lower extremities is absent, increasing of muscular tone is marked in the same extremities. Periodically are clonic-tonic cramps in right extremities. Expressed asymmetry of person. Sharply expressed rigidity of muscles of the back of head, positive Кеrnig symptom, positive overhead and lower Brudzinsky symptom. On the skin of overhead and lower extremities, buttocks, trunk abundant hemorrhagic rashes “star shape” character with necrosis in a center. Acrocyanоsis is marked, temperature of body 38,8 °С, hyperemia of pharynx Breathning 36/min, unrhythmical. Vesicular breathing during auscultation. Pulse 72/min, weak filling and tension. Heart tones are muffled, AP 80/50 mm/hg. Tongue is dry, assessed by the white raid. Physiology sending in a norm. Your diagnosis? Epidemic typhys Hemorrhagic fever Leptospirosis Typhoid fever *Meningococcal infection At a patient with meningococcal nasopharynsitis in 2 days from the beginning of illness the temperature of body rose to 41°С, head pain, vomit, positive Kernig and Brudzinsky symptoms appeared. In cerebrospinal liquid: cytosis 15 000 in 1 mkl, 90 % are neutrophils. What diagnosis? Chronic meningococcemia *Meningitis Endocarditis Infectious-toxic shock Meningicm A patient was delivered in permanent establishment on the 2th day of illness with the symptoms of expressed toxicosis. Objectively: found out the severe condition, hemorrhagic rash of wrong form of different size on a skin, hemorrhages in the scleras of both eyes. Extremities are cold. AP 60/20 mm/hg, pulse – 120 per minute. Previous diagnosis? *Meningococcemia Hemorrhagic fever with a kidney syndrome Leptospirosis Typhoid fever Pseudotuberculosis At a patient with nasopharyngitis after 2 days from the beginning of illness the temperature of body rose up to 41°С, head pain, vomit, positive Kernig and Brudinsky symptoms appeared. Cerebrospinal liquid: cytosis 15000 in 1 mcl, 90 % are neutrophils. Diagnosis? Chronic meningococcemia Endocarditis *Meningitis Meningicm Meningococcal nasopharyngitis A patient sharply had a chill, head pain, vomits, temperature of body rose up to 38,5 °C. Till evening rigidity of muscles, Kernig symptom appeared. Herpetic blisters are marked on mucouse of lips and nose. Neurological symptoms is not found out expressed. What disease will you suspect? Subarachnoiditis hemorrhage Herpetic encephalitis Abscess of brain Hemorrhage in a brain *Meningococcal meningitis Patient A., 23 years suddenly experienced intensive head pain, nausea, pain in a neck, and lumbar. Examination is delivered in a clinic. Objectively: hemorrhagic rashes on a body. Temperature 40,2 °C. Expressed meningeal symptoms. Light, haptic, pain hypesthesiA. Blood: leucocytes – 25 thousand/l, ERS-29 mm/hr. A neurolymph is turbid, neutrophilic erythrocytosis, meningococci. What is your diagnosis? Staphylococcus meningitis Tubercular meningitis *Meningococcal meningitis Viral meningitis Pneumoccocal meningitis Person 16 years entered permanent establishment on 6 day of illness. Illness began from a cold and cough. Temperature 37,7 °C. The state became worse: severe head pain, frequent vomits unconnected with a meal appeared. The common state is heavy. Pupils are extended, photoharmose is not present. Positive meningeal symptoms. General hyperesthesiA. Tones of heart are deaf, BP 100/50 mm/hg. What reliable diagnosis? Infectious mononucleosis *Meningococcal meningitis Toxic food-born infection Influenza Typhoid fever At a patient, 35 years, acute beginning of disease happened. Symptoms of nasopharyngitis. Body temperature – 39,5 °С, head ache, which is accompanied with vomits, myalgias. Hemorrhagic rash, that are localized on scleras, brushes, feet, buttocks. Rigidity of cervical muscles, Kernig and Brudzinsky symptoms are expressed. Neutrophilic leucocytosis in common blood analisis.What is most credible diagnosis? *Meningococcal infection Typhoid fever Yersiniosis Leptospirosis Epidemic typhus A 17 years old boy, got ill suddenly: the temperature rose up-to 40,3 °С, extremely sharp headache, makes him to yell. The patient is agitated and vomits frequently. Tremor of fingers of extremities is observed. The star like hemorrhagic rash of different form and sizes appeared, mainly on buttocks, thighs, shins, and trunk. Meningeal signs are positive. What is the most credible diagnosis? Encephalitis Flu with a hemorrhagic syndrome *Meningococcal infection Measles Leptospirosis Patient S., 20 years old refered to the doctor with such complaints: prodromal respiratory illness, sore throat, fever, headache, stiff neck, vomiting, confusion, irritability. Previous diagnosis. What main methods can confirm the diagnosis? Epidemic typhys. ELISA-test Hemorrhagic fever. ELISA-test Leptospirosis. Lumbar puncture. Typhoid fever. ELISA-test *Meningococcal infection. Lumbar puncture Sick, 54, hospitalized in an infectious department in a severy condition. Complaint about the expressed headache, mainly in frontal and temporal areas, superciliary arcs, origin of vomit on height of pain, pain at motions by eyeballs, in muscles and joints. Objectively: a patient is excited, temperature of body 39 °C, BP 100/60 mm Hg. Bradycardia changed by tachycardiA. There were tonic cramps. Doubtful meningeal signs. From anamnesis it is known that at home a woman is ill. What preparations must be entered? *Mannitol, lasix, prednisolone, euphylin, suprastin Mannitol, acetophene Lasix, analgin, ampicillin Veroshpiron, euphylin, dimedrol Aspirin, analgin, dimedrol A patient, 20 years old, during few days complaints of pharyngalgias. After supercooling the state became worse : sudden chills, increase of temperature to 40,6 °C, headache. On skin of lower extremities trunk and buttocks there are a lot of different sizes of hemorragic spots, acrocyanosis. Consiouness is preserved. Meningeal signs are absent. What is the previous diagnosis? *Meningococcal infection Flu Epidemic typhus Hemorrhagic fever Leptospirosis A patient C., 25 years old, fell suddenly ill. Every morning severe headache, frequent vomiting, temperature of the body is 39,9 °C. Adopted fatigue, then state got much worse. In the evening lost of consciousness. Expressed muscles pains of back and head. Positive Кеrning’s symptom. Leukocytes – 18,0*109. What is the most reliable diagnosis? Flu Epidemic typhus, typhus state Viral menigoencephalitis Sepsis, infectious-toxic shock *Bacterial menigoencephalitis A patient 17 years old, became suddenly ill: .Temperature rose to 40,3 °C. Severe headache, motive excitation, frequent vomiting, tremor of fingers of extremities. Hemorrhagic spots of round form and different sizes, more frequently as stars, mainly on buttocks and trunk. Meningeal signs are positive. What is the most possible diagnosis? Encephalitis Flu with a hemorrhagic syndrome *Meningococcal infection Measles Leptospirosis In permanent establishment on the 2nd day of illness a patient is delivered with the symptoms of expressed toxicosis. Objectively: the general condition is severe, on skin hemorrhagic rash of different form and sizes, hemorrhages in sclera of both eyes. Extremities cold. AP is 60\20 mmHg., pulse – 120. Previous diagnosis? *Meningococcemia Crimean hemorrhagic fever Hemorrhagic fever with a renal syndrome Typhoid fever ECНО-eczanthema Patient, 16 y.o., during 3 days there was a increase of temperature to 38 °C, першіння in a throat, indisposition. Next 2 days felt better. A temperature was normal. There was a chill on a 6th day, a temperature rose to 40 °C, intensive, quickly increased headache, through 3 hours – repeated vomits. The state is heavy, consciousness is absent, psychomotor violations expressed meningeal signs. Meningitis is suspected. What is his etiology? Tubercular Enteroviral Postinfluenzal * Meningococcal Lymphocytic choreomeningitis Patient D., 30 y.o., teacher, examined by the doctor of first-aid and delivered to a clinic on the 2nd day of illness. Fell ill sharply, temperature 40 °C, sharp head pain, repeated vomits photophobiA. The general condition is severe, consciousness is darkened. On the skin of abdomen, buttocks and lower extremities is зірчаста rash. Sharply expressed rigidity of neck muscles, positive Kernig symptom. Pulse 100 min, weak; tones of heart deaf, AP 60/30 mmHg. Your diagnosis? Flu, toxic form Crimean hemorrhagic fever Disease of blood Hemorrhagic stroke *Meningococcal infection, meningococcemia Worker, 22 y.o., became ill acutely: t 39°C, severy headacke, frequent vomits. Objectively: the condition is severe, psychomotor excitation, moans due to the great pain of head, expressed rigidity of neck muscles. Sharply positive symptoms of Brudzinsky’s and Kernig’s, general hyperesthesiA. What needs to be done for clarification of diagnosis? * General blood analysis and liquor analysis General blood analysis and blood sterility Computer tomography of cerebrum X-ray of skull in two projections Analysis of the excrement and urine for a pathological flora A patient with meningococcal meningitis gets penicillin during 7 days. Last 4 days temperature of body is normal. Meningeal signs are absent. When is it possible to abolish an antibiotic? *At cytosis in liquor 100 and less, lymphocytes prevails At absence of leukocytosis and stab-nucleus shift in a blood At cytosis in liquor 100 and more less, neutrophils prevails At cytosis in liquor 150, lymphocytes prevails At once Among the students of university 2 cases of generalized form of meningococcal infection are registered. What preparation does it follow to enter to the contact persons with the purpose of urgent prophylaxis? Normal immunoglobulin Leukocytic interferon *Meningococcal vaccine Meningococcal anatoxin Bacteriophage Patient K., 21 y.o.., the disease began from the increase of temperature to 39,0 °C, headache, chill, repeated vomit. Objectively: temperature of 39,3 °C, pulse 76. Rigidity of muscles of the back of head. The tendon reflexes are expressed. Analysis of liquor: cytosis 1237 in 1 ml, from them: 84 % neutrophiles, 16 % lymphocytes, reaction to Panda ++, albumen 0,66 g/l, liquid is turbid, flows out under the promoted pressure. Bacterioscopy found out in liquor gram(-) cooks morphologically similar with meningococcus. What disease is most reliable? Serous meningitis Infectious mononucleosis *Meningococcal meningitis Tuberculosis meningitis Purulent meningitis In the kindergarden a child had a meningococcal infection. She was immediately hospitalized. After clinical convalescence in child sowed meningococcus. To which category can the carrier (child) of pathogen belongs? Convalescent, chronic *Convalescent, acute Healthy Immune in vaccinated Immune in those, that had infection In a patient, 27 y.o., on the 5th day of respirator disease, there was sharp head pain, that was accompanied by nausea, repeated vomits, hyperesthesia, photophobiA. At a review: lies with the neglected head, feet are bended to the trunk, expressed rigidity of muscles of the back of head, positive symptoms of Kerning’s, Brodzinsky’s. It is not found out paresises. Select a basic neurological syndrome. Meningeal syndrome *Syndrome of liquor hypertension Syndrome of liquor hypotension Root syndrome Vegetative crisis Patient, 23 y.o., suddenly experienced intensive head pain, nausea, pain in a neck and lumbar areA. He was delivered to the clinic. Objectively: on a body hemorrhagic rash. Temperature of body 39,2°C. Expressed meningeal symptoms. Light, tactile, pain hyperesthesiA. Blood: leucocytes-25x10 9/l, ESR-29 mm/hour. What method of inspection is most informing? *Lumbar puncture Computer tomography Electroencephalography Transcranial dopplerography Echoencephalography Patient, 15 y.o., became ill 3 days ago. Complaints of headache, running nose, pain in a throat, temperature of 37,4°C. Next days : headache increased, a temperature risen to 38,3°C, repeated vomits. Objectively: a skin is pale, without rash. Mucous membrane of posterior wall of throat is moderately hyperemic, swollen. Pulse 86, satisfactory filling. Meningeal signs are positive. What is needed to conduct the selection of pathogen: * Bacteriological research of liquor Biological test on mice Intracutaneous test Reaction of Vidala’s Cmear of the blood on bilious bullion In a patient, 35 y.o., sharp beginning of disease, preceding nasopharyngitis, t° 39,5°C, headache, which is accompanied with vomits, myalgias, hemorrhagic rash, that is localized on sclera, fists, feet, buttocks; rigidity of cervical muscles, symptoms of Kering’s and Brudzinsky’s are positive, expressed neutrophilic leukocytosis. What is most credible diagnosis? Typhoid fever Yersiniosis Leptospirosis *Meningococcal infection Thrombocytopenic purpura Sick C., 8 years, appealed to the infectious hospital on the second day of disease with complaints of a pharyngalgia at swallowing, increase of temperature. Objectively: temperature 38,6 °C, hyperemia of soft palate, tonsills, filling out, loose, on both there are festering stratifications which are taken off by a spatulA. Megascopic sickly submandibular lymphonoduses are palpated. Pulse – 114 per a min. Present roseol-papular pouring out on all body. Pastia‘s symptom is positive. It is known from epidemogical anamnesis, that its comrade had alike symptoms. It is not found out the change from the side of other organs. What previous diagnosis can be suspected? Lacunar quinsy Diphtheria of pharynx *Scarlet fever Flu Infectious mononucleosis A 4 years old child complaints of: cough, temperature of body 38,1 °C. Skin without rashes. Conjunctiva hyperemic. Exanthema on skin. On mucous of cheeks there are points of hyperemia gum blushs. In lungs difficult breathing. What is the most possible diagnosis? Scarlet fever Rubella *Measles Enteroviral infection Flu Sick C., 8 years, appealed to the infectious hospital on the second day of disease with complaints of a pharyngalgia at swallowing, increase of temperature. Objectively: temperature of body – 38,6 °C, sharp hyperemia of soft palate, tonsills, filling out, loose, on both there are festering stratifications which are taken off by a spatulA. Palpated megascopic, sickly submandibular lymphonoduses. Pulse – 114 per min. Present roseol-papular pouring out on all body. Pastia symptom is positive. It is known from epid anamnesis, that at its comrade were alike symptomes. It is not found out the change from the side of other organs. What previous diagnosis can be suspected? Lacunar tonsillitis Diphtheria of pharynx Infectious mononucleosis Flu *Scarlet fever Patient A. , 27 years old, was admited on the 4th day of illness with the diagnosis of viral ARVI, and allergic dermatitis. The patient felt ill suddenly with increase of temperature up-to 38 °C, headache, sore throat, and intensive cough. On the 3d day rash appeared on the skin of neck and face. Patient was taking aspirin in order to decrease the temperature. Objectively: temperature of body 38,8 °C. The face of patient looks puffy. Signs of conjunctivitis, and renitis were observed. On the skin of neck face and chest there was intensive papular rash, without itch. Mucous membrane of oropharynx was brightly hyperemic. Submandibular and frontal neck lymph nodes were enlarged. The liver and spleen were not palpable. What is the diagnosis? *Measles Allergic dermatitis Infectious mononucleosis Rubella Scarlet fever A child 10 years old presents with temperature 38 °C, renitis, conjunctivitis, moist cough. On the mucous membrane of cheeks, lips, gums there are greyish-white points, reminding a farinA. What is the diagnosis? *Measles Adenoviral infection URTI Enteroviral infection Infectious mononucleosis In a newborn, the septic state was accompanied with the increase of temperature to 40 oC which developed on 5th day, with pneumonia expressed intoxication: pallor, vomiting, shortness of breath, disturbance, cramps. Appeared rash (blisters with hemorrhages) on skin, mucous membrane of mouth cavity, throat and conjuctivA. The child suffers with congenital herpes. Lungs: difficult breathing and vesicular wheezing. Mild enlargement of liver. What is the most reliable diagnosis? *Herpetic infection Cytomegaloviral infection Chicken pox Rubella AIDS A new born child on 10th day of life became worse: Temperature 39.2 °C, no frequent vomiting, generalized cramps, violations of consciousness, spastic paresis of left extremities. Month prior to his birth herpes virus was present in the mother, which she did not treat. What disease is most possible? *Herpetic encephalitis Meningococcal meningitis Subarechnoid hemorrhage Cerebral abscess Violation of blood cerebral circulation A patient has herpetic meningitis. What preparation of specific therapy for viral neuro infection should be given? *Acyclovir Cefataxime Ceftriaxone Gentamycin Furazolidon A patient, 22 years old, became ill sharply. History showed fever up to 38.2 °C with headache, repeated vomiting, olfactory and tastes hallucinations. Quickly got complex of meningeal symptoms, pyramidal paresis. The general epileptic attack and comatose state also developed. Neurolymph is with mixed lymphocytosis, cytochrome, single red corpuscles. What is previous diagnosis? Brain abscess Subdural empyema *Herpetic encephalitis Tumor of brain Encephalopathy A boy 11 years old, complaints of sickness at mastication, increasing of temperature to 37.1 °C, enlargment of parotid salivary glands . At the age of 8 years carried a paraflu infection. Objectively: in the region of right parotid salivary gland tubular sickly at palpation, a skin above it is not changed. A pharynx is moderate hyperemic, tonsils are not coated. What is your previous diagnosis? *Cytomegaloviral syaloadenitis Lymphadenitis Parotitis Infectious mononucleosis Cholylithiasis At junior nurse, who works in child’s infectious department, herpes simplex was found. What should manager of department must do? *Create a quarantine in the department To appoint an immunoprotein to the children Discharge all children from the department To appoint immunomodulators with a prophylactic purpose To inspect a junior nurse on a staphylococcus A woman 65 years old the disease had beginning sharply from increase of temperature to 39.0 °C, weakness, and pain in the left part of thorax that increased with breathing motions. On 3rd day of disease vesicular breathing appeared after motion of rib on the left on a hyperemic background. Together with sick a grandchild lives 4 years. What measures of prophylaxis of disease need to be adopted? Vaccination Final disinfection Reception of specific immunoprotein *Isolation of patient Acyclovir administration Patient 60 years old complain of pains in right hand which last for 2 days. On the 3rd day appeared vesicular chain-like rash on the skin of arm, forearm and fist. Sensitivity in the rash area is decreased. Which disease can be diagnosed? Dermatitis *Herpetic ganglionitis Neck-thorax radiculitis Psoriasis Allergy A patient 60 years old for 2 days has disturbed severe pain in a right arm. On 3rd day appeared blisters, pouring out as a chain on the skin of shoulder, forearm and brush. Sensitiveness in the area of pouring out is mionectic. What disease can be diagnosed? Dermatitis *Herpetic ganglionitis Neck-pectoral redicals Psoriasis Allergy The patient, 58 years old, was hospitalised in the infectious department with complaints of pain in the left half of thorax, fever. At a review: temperature of body 37.5 °C, in XI-XII intercostal area the grouped shallow blisters on a hyperemic-filling background are filled by transparent maintenance. Preparation of choice for treatment of this patient is: Suprastin Prednisolone Biseptolum-480 Semavin *Laferon Patient C., 60 years old during one year has 4th relapse of Herpes zoster. Recommended treatment and relapses prophylaxis? *Valcyclovir Acyclovir Herpevir Proteflazid Cycloferon A pregnant woman, 27 years (pregnancy ІІ, 8-10 weeks.), temperature of body increased. At the inspection on a TORCH-infection antibodies are found to the herpes virus, ІІ types of class IGM. What we must recommend to pregnant women? *To cut pregnancy To prolong the supervision Treatment with acyclovir Symptomatic treatment Appoint of alpha-fetoprotein Patient, 25 years old, came to the physician on the 3rd day of disease with complaints of rash on the mouth, external nose and ears, which are itching and painful. Objectively: T-37,7 °C. On the not changed skin of mouth, nose and ear auricle there are vesicles with size of 1-2 mm grouped localization. About what disease you can think? Erysipelas, bulbous form Anthrax *Herpetic infection Eczema Streptodermic infection Sick patient, 25 years old, was consulted by a doctor on the third day of illness with complaints of pouring out on lips, wings of nose and ears, pain and swelling in the places of these pouring out. Objectively: temperature of body – 37.7 °C, unchanged skin of overhead lip, wings of nose, auricles, there is vesicular scars 1-2 mm with the group location. What disease you may think about? Erysipelas, bullous form Anthrax *Herpetic infection Anthrax, skin form Chicken pox Sick A., complaints of turning red rash and edema on a right cheek. During a review: temperature of body – 38.7 °C, submandibular lymph nodes enlarged and painful, border between turning red and healthy skin is clear, there are blisters with a dark liquid inwardly, palpation is painful. What is your previous diagnosis? *Erysipelas, hemorrhagic form Anthrax, skin form Herpetic infection Chicken pox Phlegmon of cheek In patient R., 34 years old with general intoxication and increased body temperature up to 38 °C, appear pain in region of right auditory canal and next day distortion of face to the left side. Review: softening of frontal and nasal-mouth skin folds, right eyelid cleft is wider than left, mouth cavity turned left, right eyebrow doesn’t move upwards and cheek is strenght. Right xerophthalmia, xerotomia and disordered taste sensation on the surface of right anterior 2/3 half of tongue. Herpetic vesicles in right exterior auditory canal and auricle. What is the most possible diagnosis? Rossolimo-Melkerson-Rozental’s syndrome right side Postherpetic neuralgia of I-st and II-nd branch of right trigeminal nerve Postherpetic neuralgia of all 3 branches of right trigeminal nerve Sluder’s syndrome right side *Hant’s syndrome A 32 years old patient appealed to a doctor on a background of fever and increase of temperature to 38.0 °C, pain in the right ear area, left side “deviation” appear during the next day. On examination: right side cmoothed out frontal and occipital skinning folds, right eyelids fissure is wider than left, a mouth is overtighten to the left, a right eyebrow does not rise upwards, and a cheek “hyperemia”, xerostomia and violation of taste receptors on front 2/3 right halves of tongue. Herpetic blisters in right external auditory canal and auricle. What is the most possible diagnosis? *Hunt’s syndrome Post herpetic neuralgia of the I- and II- branches of right trifacial nerve Post herpetic neuralgia of all branches of right trifacial nerve Sludder’s syndrome Rosolimo-Меlkerson-Rozantalia syndrome A 40 years old scientist, became ill sharply with chill, temperature of body – 39.8 °C, severe headache, vomiting, pain in muscles. Did not went to the doctor, the state had become worse, hyperemia of sclera, appeared, on lips herpes with hemorrhagic maintenance, the nose-bleeding, skin and sclera, became icteric, urine color is of strong tea, diuresis 200 ml, an anacholia was not present. What is the most reliable source of infection? *Rats Cats Infected people Bacillocarrier Mosquito A patient came with complaints of erosions of his penis. From anamnesis frequent appearance of similar rashes during a year is found out. Objectively: on a balanus are the grouped blisters and erosions of polycyclic outlines, with clear margin, soft during palpation. What is your diagnosis? *Recurrent congenital herpes Pemphigus vulgaris Primary syphillis Pyodermia Scabies Sick 65 years old patient, complaints of pain in a subscapular region. Objectively: on a skin surface of subscapular region the placed arcwise rose-red filling out hearths some infiltrative, with clear scopes was present. On-the-spot hearths grouped vesicles with transparent maintenance. What is the diagnosis? Impetigo Herpes simplex Erysipelas Allergodermia *Herpes zoster A sick person, 65 years old, complaints of rash, pain in a subscapular region. Objectively: on a skin surface of the subscapular region present the arcwise rose-red filling out hearths some infiltrative, with clear scopes. On-the-spot hearths grouped vesicles with transparent maintenance. What preparation he should take? Suprastyn Prednisolone Biseptolum-480 Loratidin *Laferon A patient N., 45 years old, complaints of headache, general weakness increasing of temperature, to 37.4 °C. In 2 days pain appeared in the pectoral region of spine with an irradiation in a right between scapular regions. After some time skin in this region turned red as a strip from a spine to the subarmpit line, and in 2 days red knots which through the set time grew into blisters with transparent maintenance appeared in this place. What is your diagnosis? *Herpes zoster Thoracal rediculopathy Neurology of intercostal nerves Neurology of superscapular nerve Herpetiform dermatitis A 37 years old patient, 2 days ago a spot on a hand appeared, which for days grew into pustule with a black bottom, painless at touch, with the crown of daughters vesicles on periphery. There are painless edema on a hand and shoulder. Temperature rise to 39.0 °C, dizziness appeared. Pulse – 100 beats per min, AP – 95/60 mm Hg. BR – 30 per a minute. What is the most possible diagnosis? *Anthrax Plague Tularemia Brucellosis Herpes A 70 years old sick person, after supercooling severy pain in the left half of head in the area of forehead and left eye appeared. 3 days ago the temperature of body increased to 37,6 °C, the blister of pouring out at the head and left overhead eyelid appeared. What disease can be diagnosed? *Herpetic ganglionitis Encephalitis Allergy Dermatitis Trifacial neuritis A sick 3 years old child came to the doctor with symptoms of the fever, languor, waiver of meal. A boy is capricious, temperature of body 37.9 °C. On the mucus shell of soft palate, cheeks are single vesicle hypersalivation. What is the diagnosis? *Herpetic stomatitis Candidosis of oral cavity Leucoplacia Follicular tonsillitis Lacunar tonsillitis Sick, 49 years old, came to the doctor with complaints of pain. On the 3rd day he became ill, first marked heartburn and pain in thorax, yesterday is pouring out. At examination: temperature of body 37,8 °C, after motion of the V-VI intercostals intervals on a hyperemic skin group of the blisters filled by transparent maintenance. What is the diagnosis? *Herpes zoster Chicken pox Erysipelas, erythematous-bulous form Allergic dermatitis Myositis Patient K., 56 years old, during last 5 days has Herpes zoster with localization of the process on the right cheek and paraauricular region. Treating with herpevir. Today pain in the right eye appeared. During examination present of edema of eyelid and hyperemia of conjunctivA. What is the action of a physician? Prescribing eye drops (оphtan, аlbucid and other) Prolonged treatment with herpevir *Immediately consultation of ophthalmologist Intensify treatment with antiviral drugs Prescribe warm compress To the infectious diseases department was admitted patient M. 58 years old, with complaints of pain in left part of thorax, fever. During a review: body temperature 37,5 °C, on the level of XI–XII intercostals spaces on hyperemic-edemous shadow grouped cmall vesicles with transparent content. Preparation of choice for treatment of this patient? Suprastyn Prednisolon Biseptol-480 Cymeven *Laferon A patient appealed to the doctor with complaints of difficulties in opening of the mouth. Two weeks ago fell down and head was hurt, did not have medication. At a review mouth opens on 1.5 cm, moderate expressed pain of muscles at the back of head. The paralysis of muscles of person, eyeballs, are more prominent. In a temporal area dry bloody crusts in the place of traumA. What are your diagnosis? Neuritis of facial nerve Throat abscess *Facial paralytic stupor of Rоsе Bulbar encephalitis Herpetic ganglionitis of knot of trifacial A patient came with complaints of sickly erosions on his penis. From anamnesis frequent appearance of similar rashes is found out during a year. Objectively: on a balanus are the grouped blisters and erosions, soft on palpation. What is your diagnose? *Recurrent herpes of ІІ type Vulvar pemphigus Primary syphyllis Shankoform pyoderma Recurrent herpes of ІІІ type Patient A., complaints of redness of the skin and edema on the right cheek. During a review: body temperature 38,7 °C, enlarged and painful right submandibular lymphatic nodes, the border between red and normal skin is sharp, present vesicles with dark content, palpation is painful. Your primary diagnosis? *Erysipelas, hemorrhagic form Anthrax, skin form Herpetic infection Varicella (chickenpox) Phlegmone of the cheek At a patient G., 41 years old, was a high temperature during 8 days, severe headache, constipation. Objectively: temperature of body 39,5 °C, pale, languid. Pulse 82 per a min, a tongue is dry, assessed by the brown coat. An abdomen is moderato exaggerated, painful in a right ileac areA. A liver + 2 cm. What is the most credible diagnosis? *Typhoid fever Epidemic typhus Flu Appendicitis Yersiniosis Patient L., 20 years old, had appendectomy on the 5th day of disease. During operation was found an appendix with the signs of catarrhal inflammation and hyperplasia of lymphatic nodes of mesentery. After a day his state became severe: temperature – 40 °C, with hallucinations, hepatosplenomegaly. Single roseols elements appeared on the skin of abdominal on a 10th day. The tongue is great, covered with grey coating, with the imprints of teeth, wound is in normal. In the analysis of blood is leucopenia, relative lympho- and monocytosis. In anamnesis was contact with a patient with typhoid fever. What is the most credible diagnosis? *Typhoid fever, atypical form: appendicotyphoid Epidemic typhus Yersiniosis Pseudotuberculosis Flu Patient L., 20 years old, had appendectomy on the 5th day of disease. During operation was found an appendix with the signs of catarrhal inflammation and hyperplasia of lymphatic nodes of mesentery. After a day his state became severe: temperature – 40 °C, with hallucinations, hepatosplenomegaly. Single roseols elements appeared on the skin of abdominal on a 10th day. The tongue is great, covered with grey coating, with the imprints of teeth, wound is in normal. In the analysis of blood is leucopenia, relative lympho- and monocytosis. In anamnesis was contact with a patient with typhoid fever. By which method is it possible to diagnostic this disease? Urinocultura Coproculture Bilicultura *Hemocultura Reaction of Vidal Pain in abdomen appeared at a patient with typhoid fever on the 19th day of disease, and was during 4 hours. Pulse – 100 per a min, rhythmic. A tongue is dry, assessed by wait coat. The abdomen is tense, does not take part in the act of breathing. Stool and urine was absent. About what complication is it necessary to think? Appendicitis Infectiously-toxic shock Bleeding *Perforation Urolithiasis At the patient B., 25 years old, was diagnosed typhoid fever. On the 17th day of disease the temperature of body critically went down to the norm, a pallor color of skin increased. Consciousness is stored. Pulse 120 per a min, rhythmic. On the top of heart is systolic noise. Constipation. About what complication is it necessary to think? *Bleeding Perforation Infectious-toxic shock Infectious-allergic myocarditis Pneumonia A sick person, 23 years old, appealed to the hospital on 6th day with gradual development of illness and complaints of severe headache, pain at the back of his head, sleep disturbance and fever. Objectively: Т-39,7 °C, Рs-84/min. His face is pale, tongue is dry, near the root covered by a grey covering. The abdomen is flatulent. A percutory sound is heard in the right iliac areA. The liver and spleen are enlarged. Which day does rash appear on the skin in this illness? On 12 day On 4 days On 5 day On 6 day *On 8 day In a 42 y.o. annual explorers the temperature of body rose to 39 °C. At reception the patient is pale, tongue is edematous and covered by a dirty-brown raid, with clean edges and tag, and on the sides imprints of teeth, protrusion of the tongue is impaired and he trembles finely, he has an ammonia breath. On anterior surface of the abdomen are found monomorphic single roseollas. In his mouth cavity are hyperplasic lymphatic follicles of soft palate especially in front, appeared symmetric flat superficial oval form of ulcer, diameter up to 5 mm. Such ulcers are on tonsils. In case of such disease the convalescents are discharge after: Triple bacteriological research of blood, excrement, urine, bile *Triple bacteriological research of excrement, urines and once of the bile Triple bacteriological research of excrement, urines and once of the blood Triple bacteriological research of excrement, urine, bile Triple bacteriological research of blood, urine, bile and once excrement To the reception of the infectious hospital a patient came with complaints of high fever – 38-40 °C In 3 weeks, headache, weakness and insomniA. She didn’t get a doctors consultation She took antipyretic drugs, seduxen. Objectively: Т 35,7 °C, Рs – 140/min., BP-80/50 mm Hg. Her general condition is severe. Skin and mucous membranes are pale. The tongue is thickened with the imprints of teeth, with a dirty-brown covering, apex and edges of the tongue are clean. her abdomen is flatulent. her liver and spleen are moderately enlarged. Her stool on admission was mixed with fresh blood. Why was there a decrease of temperature and an increase in pulse? Poisoning by the drugs Infectious-toxic shock Hemorrhoid bleeding *Intestinal bleeding Endometriosis of colon Patient Н., 28 years old, came to the clinic on the ninth day of illness with complaints of increased Т to 39,0 °C, headache, general weakness, delay of voiding, sleep disturbance. At inspection: the skin of abdomen had single roseollas, the tongue is covered with a brown covering, Ps. 78 beats per min. and rhythmic, the liver is enlarged to 2сm. What changes will be seen in the cardio-vascular system? Bradycardia, dicrotic pulse, muffling of cardiac tones, hypotension Tachycardia, dicrotic pulse, muffling of cardiac tones, hypotension Tachcardia, dicrotic pulse, muffling of cardiac tones, hypertension *Relative bradycardia, dicrotic pulse, muffling of cardiac tones, hypotension Dicrotic pulse, muffling of cardiac tones, hypotension A 30 y/o patient is seen on the 9th day of illness. The symptoms of illness has been building –up gradually with increase in temperature and intoxication. Roseolar rash has appeared on his abdomen. His skin is pale, temperature is 40 °C, pulse 80 /1 min., BP 100/65 mmHg. His tongue is covered with sediments and his abdomen is swollen. Spleen and liver are palpable. What symptom will be positive for this patient? Symptom of Botkin *Symptom of Padalka Symptom of Kyl'dyshevsky Symptom of Ortner Symptom of Pasternacky A sick woman, 32 years, complaints of diarrhea, headache, severe weakness, insomnia and a dull pain in her right iliac areA. It is the 8th day of her illness. At a review: Т-39,8 °C, Рs – 86/min., AP – 90/60 mm Hg. Pulse is dictoric. Skin is pale. Single roseollas are on the abdomen. Tongue is dry, assessed by the coverings, with the imprints of teeth on a lateral surface. Soft, dulling of percutory sound is observed in the illeocaecal area of her abdomen. Hepatosplenomegaly, positive Blumberg’s symptom, neutrophilic leukocytosis. What changes will be at roentgenologic examination? No changes *Presence of air under a diaphragm Presence of the exaggerated loops of intestine Enlarged liver and spleen Signs of impassability of intestine Patient with the diagnosis “typhoid fever” is hospitalized in an infectious hospital. He lives in an isolated apartment with a woman and two children. What preparations is the mean defense against typhoid fever for people in contact with the patient? Vaccine Antibiotic Immunoglobulin Antitoxin *Bacteriophage A district doctor suspected typhoid fever in a patient M., 15 y.o. To make the patient safe as the sources of infection, which of the following measures should be taken? except: *Introduction to the patient of antityphoid monovaccine Hospitalization in the infectious department during 3-6 hours Introduction etiotropic antibacterial treatment Conducting of controls bacteriological researches of excrement and urine (triply) and bile before the discharge Clinical supervision after the discharge during 3 months Patient 24 y.o., was hospitalized in the infectious department on the 10th day of disease with complaints of general weakness, headache, poor appetite and cough. Objectively: body temperature is 39,5 °C, pallor of skin. Adynamicm. Single roseolas are present on the skin of anterior wall of the abdomen, thorax. Liver is palpable + 1 cm below the rib angle on the midclavicular line, spleen is not significantly palpated. What is the most probable diagnosis? *Typhoid fever Flu Typhoid rash Brucellosis Pneumonia A patient A., 43 years old, is ill for 2 weeks. The disease started as an increase in temperature to 37,2 °C, headache, decline of appetite and weakness. Then the temperature got to 39-40 °C. Objectively: his condition is severe, he responds slowly to questions. AdynamiA. Pulse 80 in a min. BP is 100/60 mmHg. An abdomen is painless, flatulence, hepatosplenomegaly. Stool is of green color. How long is it necessary to look after people who were in contact with this patient? 35 days 1 month *21 days 1 week 12 days A plumber, 45 y.o., is hospitalized on the 7th day of fever. Objectively: t – 39,8 °C, somnolence (at night insomnia), adynamia, pallor of skin, Ps 78/min, BP 105/70 mmHg. Tongue is thickly assessed by the grey raid with the imprints of teeth. Palpation: the abdomen is distended, the liver is enlarged to 2 cm, and spleen to 1 cm below costal arc, in the right iliac area – the crepitating grumbling and hyperesthesia of skin. Defecation is absent for 2 days. What additional research should be performed for clarification of diagnosis? Spinal puncture *Bacteriological research of blood Analysis of myelogram Colonoscopy Research of blood for the markers of viral hepatitis Patient S., 23 years old, became ill at the end of the summer, His temperature rose to 37,2 °C, insignificant headache and weakness appeared. For 7 days of the illness he was treated ambulatorily as ARI (acute respiratory infection). His state became worse, he was hospitalized in the permanent establishment. Temperature – 40 °C, pale, weakness. Pulse 96 per a min, BP 110/70 mm Hg. Tongue with the imprints of teeth, abdomen soft, distended, hepatosplenomegaly. Stool is not present. There is hyperemia and hyperplasia of palatine tonsils, on the surface of right palatine tonsils are ulcers. What disease is comes to your mind? Angina of Simonovsky Herpes angina Ulcerative-necrotic angina Infectious mononucleosis *Angina of Diuge Patient L., 43 years old, entered to the clinic of infectious diseases with a diagnosis „fever of idiopathic etiology”. He has been ill for 15 days: temperature of body – 39,3 °C. Skin is pale. Pulse – 86 per a min, satisfactory properties. BP is 110/70 mm Hg. Tongue is dry, assessed by the coverings, with the imprints of teeth on a lateral surface. On a abdomen are 10-12 roseolas to 5 mm in a diameter. A liver and spleen is enlarged. What is the most credible diagnosis? Yersiniosis *Typhoid fever Brucellosis Epidemic typhus Sepsis A patient K., 26 years old, come to the permanent establishment on the 5th day of the disease with complaints of a high temperature, chill and a dry cough. The disease began suddenly from getting up of temperature to 38,8 °C, chill, then a dry cough. Treated himself as ARI, took analgin and dimedrol. Objectively: moderate severity, on his abdomen single roseollas, hepatosplenomegaly, diarrhea up to 4 times without admixtures. The most informative methods of diagnostics for this disease are: Cmear from a pharynx for a virus Passive hemaglutination reaction with О-, Н- and Vi-antigens Clinical blood test Reaction of Vidal *Hemoculture Sick person, 18 years old, became ill suddenly, when appeared chill, increased of temperature to 39,6 °C, weakness, headache. On the 2nd day of illness appeared diarrhea up to 10 times per day, without admixtures. A few days ago ate beef. On the 5th day of illness appeared maculous-papulous rash on his body. Pulse was 100 per a min., BP 110/60 mmHg. Abdomen is soft, painful in the epigastrium and mesogastrium. Liver +1 cm. Watery diarrhea 5 time per days. Choose the most reliable diagnosis: Typhoid fever Yersiniosis *Paratyphoid fever B Sepsis Paratyphoid fever A In a patient 30 years old, on the 9th day of illness disease began gradually, with slow progression of fever and intoxication, appeared unabundant roseollar rash on the skin of abdomen. Skin was pale, Т-40 °C, pulse-80 per a min, BP-100/65 mm Hg. The tongue is assessed, abdomen is distended, the spleen is enlarged, and the liver is palpable. What symptom will be positive? Botkin’s symptom *Padalka’s symptom Kildushevsky‘s symptom Оrtner’s symptom Pasternatsky‘s symptom A patient R., 23 years old, was hospitalized on the 4th day of disease, he had contact with a patient with typhoid fever. During hospitalization body temperature – 37,8 °C, severe headache. A tongue is covered wit a yellow coverings. The abdomen is soft, painless, rumbling in an ileocecal corner. Liver +1 cm. Defecation is absent during 3 days. Hospitalized for an inspection on typhoid fever. What examination (laboratory diagnosis) do you suggest for this patient? Urinoculture Coproculture *Hemoculture Biliculture Positive reaction with a typhoid antigen 1:200 In a patient A., 33 years old, with the diagnosis of typhoid fever, on the 5th day of normal temperature appeared tachycardia and roseol rash on the middle and lateral surfaces of the abdomen. About what is it necessary to consider? Measles Bleeding Perforation *Relapse of typhoid fever Infectiously-allergic myocarditis In the induction centre of ian nfectious hospital a patient came in with a three weeks history of high fever 38-40 °C, head pain, weakness, insomniA. He couldn’t speak to the doctor, accepted antipyretics. Objectively: body temperature is 35,7 C, pulse 140 per 1 mines, BP 80/50 mm Hg. General condition is severe. Skin and mucous membranes are pale. The tongue has teeth imprints, with a dirty-brown raid, a tag and edges of the tongue is clean. The abdomen is swollen. The liver and spleen are enlarged. There was defecation on reception, in the excrement was fresh blood. Why the increase in body temperature and decrease in pulse? Perforation Acute poisoning medications Infectiously toxic shock Endometriosis of colon *Bleeding The patient O., 23 years old, appealed to the hospital on the 6th day of gradual development of illness, with complaints of severe headache (pain at the back of head)and fever. Objectively: temperature of body 39,7 °C, pulse 84 per a min The face is pale, tongue is dry, near a root covered a grey raid. abdomen is swollen. Dulling of percutic sound is observed in a right iliac areA. His liver and spleen are palpated. What day does rash appear on in this illness? *On a 8th day On a 2tnd day On a 4th day On a 5th day On a 14th day A patient, 23 years old, appealed to the hospital on the 6th day of gradual development of illness, with complaints of severe head pain at the back of his head, parahypnosis and fever. Objectively: temperature 39,7 °C, Ps 84 per min. His face is pale, tongue is dry, near the root is covered with a grey raid. A abdomen is swollen. Dulling of percutory sound is observed in a right iliac areA. The liver and spleen are palpated. What day does rash appear in this illness? On a 12th day On a 4th day On a 5th day On a 6th day *On a 8th day A woman D., 41 years, complaints on diarrhea, headache, severe weakness, insomnia, dull pain in a right iliac areA. It is a 8th day of illness. At a review: Т-39,8 °C, Рs – 86/min., AP – 90/60 mm Hg. Pulse is dicotic. Skin is pale. Single roseollas are on the abdomen. Tongue is dry, assessed by the coverings, with the imprints of teeth on a lateral surface. Soft, dulling of percutory sound is determined in a illeocaecal area of abdomen. Hepatosplenomegaly, positive Blumberg’s symptom, neutrophilic leukocytosis. What diagnosis is most reliable? *Typhoid fever Epidemic typhus Sepsis Megakaryoblastoma Tuberculosis Patient R., 35 years old, entered to the clinic on the ninth day of illness with complaints of increased Т to 39,0 °C, headache, general weakness, delay in voiding, sleep disturbance At a review: on the skin of abdomen are single roseollas, a tongue is assessed by the brown covering, Ps. 78 shots in a min., rhythmic, liver is enlarged for 2сm. What is reliable diagnosis? *Typhoid fever Leptospirosis Brucellosis Sepsis Tuberculosis A vagabond 45 years old is hospitalized on the 7th day of fever. Objectively: t – 39,8 °C. He complaints of headache and insomniA. The patient is excited, talkative. Face is hyperemic. Rash mainly on the lateral surfaces of trunk, abundant, roseollar-patechial. Pulse is rapid. Enlarged liver and spleen. What is the preliminary diagnosis? Typhoid fever *Epidemic typhus Paratyphoid B Leptospirosis Scarlet fever A patient, 24 y/o, was hospitalized in infectious department on the 10th day of illness with complaints of weakness, headache, bad appetite and cough. Objectively: temperature of body 39,5 °C, pallor of skin. On the abdomen, and chest some roseolas were found. There is hard breathing over the lungs with no wheezes. RR 20 / min. Pulse 80 /1 min. The liver edge is palpable to 1 cm. below the costal arc. The spleen is not enlarged. What is the diagnosis? *Typhoid fever Flu Spotted fever Brucellosis Pneumonia Patient P., 45 years old, entered on consultation with a diagnosis „fever of idiopathic etiology”. He has been ill 8 days. The disease developed gradually, then appeared headache, insomnia, adynamiA. Temperature – 39,5 °C, skin is pale. Pulse – 88 per a min. The center of the tongue was covered with a thick grey coat. The abdomen is exaggerated, grumbles in a right iliac region. The liver and spleen are enlarged on 2 cm. What is the most probable diagnosis? *Typhoid fever Yersiniosis Epidemic typhus Adenoviral infection Sepsis At the inspection of persons who had contact with a patient with typhoid fever, stick of typhoid fever was found in urine. The reaction of Widal was negative. The patient considers himself healthy. What is your preliminary diagnosis? Typhoid fever, latent period Typhoid fever, relapse Transitory bacteriocarriers of stick of typhoid fever *Chronic bacteriocarriers of stick of typhoid fever Any of the enumerated diagnoses is possible A 39 years old train conductor, is hospitalized on the 4th day of illness with complaints of headache, weakness, dizziness, increased perspiration, insomnia, chills. Hyperemia of face with edema, and conjunctivitis have been observed. On a transitional fold a conjunctiva are not numerous petechias. On the skin of trunk, thorax, abdomen, extremities intensive roseolopetechial rash was found. On exam there was tachycardia BP – 100/60 mm of Hg tremor of tongue were marked. The liver, and spleen, are enlarged. Patient is constipated for 3 days. Most credible diagnosis is: *Epidemic typhus Typhoid fever Flu Meningococcemia Leptospirosis A patient V., 23 years old, acted to permanent establishment on the 6th day of the disease with complaints for a high temperature, chill, dry cough. The disease began suddenly with a rise of temperature to 39,7 °C, chill, then dry cough. Treated oneself as ARI, took an analgin, dimedrol. Objectively: state of moderate severity, on an abdomen single roseollas, hepatosplenomegaly, diarrhea up to 4 times without admixtures. What is the preliminary diagnosis? Yersiniosis Typhoid fever Brill‘s disease Meningococcemia *Epidemic typhus Patient I., 28 years old, hospitalized on the 9th day of illness with complaints of increase of temperature to 39,2 °C, headache, general weakness and absence of defecation. There are singles roseolas on the abdomen, pulse 78 per a min, a liver + 2 cm. What is probable diagnosis? Sepsis Spotted fever *Typhoid fever Brucellosis Leptospirosis At sick, 32 years, on the 9th day of illness which began gradually, from slow rise of fever and intoxication, appeared 3 roseols on the skin of abdomen. Objectively: skin is pale, temperature – 40,4 °C, pulse 80 per a min, BP 100/65 mm Hg. The tongue is assessed, an abdomen is swollen, and the spleen and liver are palpable. Inspection of which disease is needed above all the options? Spotted fever *Typhoid fever Measles Scarlet fever Sepsis A child, 8 years old, has been ill for 9 days. Complaints of weakness, headache and insomniA. A temperature to – 38,5-39,5 °C. Skin is pale. There are 3 roseolas on the abdomen. A tongue is assessed. Liver and spleen are enlarged. What disease is the most probable? Sepsis Yersiniosis Infectious mononucleosis *Typhoid fever Leptospirosis At sick P., 40 years old, the high temperature of the body is marked during 8 days, severe headache. Objectively: temperature – 39,5 °C, the patient is pale, languid, adynamic. Pulse 82 per a min. Tongue is dry, assessed a brown raid, on the skin of abdomen singles roseolas. A liver + 2 cm. What is the most probable diagnosis? *Typhoid fever Spotted fever Sepsis Tuberculosis Brucellosis Patient B., 36 years old, complaints of a great headache, general weakness, insomnia, fever to 39,7 °C. Fell ill gradually. Objectively: skin is pale, on a abdomen are singles roseolas. A tongue with the imprints of teeth and white raid, edges and tag is clean. Flatulence. A liver and spleen are enlarged. Dulling of percussive sound is in a right iliac areA. Pulse 70 per a min, BP 100/60 mm Hg. In lights there are the dissipated dry wheezes, hard breathing. Blood test: leycocytosis 3,1?109/l, RSE 25 mm/hour, eos. 0 %, n/n 9 %, s/n 51 %, lymphs. 31 %, monocyts 5 %. What is the most credible diagnosis? *Typhoid fever Epidemic typhus Pneumonia Leptospirosis Sepsis Patient K, 32 years old, of no fixed residence went to see a doctor for 5-days illness with complaints of fever, severe headache, insomniA. On body temperature 40 °C, pulse 110/min. The patient is excited and talkative. Hyperemic, scleritis. At whole over the body there is pink petehial rashes. Positive Govorova-Godele‘s symptom. Enlarged liver and spleen. What do you need to find out the epidemic status? *The existence of head lice Use of poor food Availability of parenteral interventions Contact with rodents Drinking water from unhygienic sources A patient L., 32 years old, who complaints of severe headache and fever, the 6-day illness positive agglutination test with rickettsia reaction. Vector of the disease is: Flea Fly Mosquitoes Bee *Lice A patient L, 72 years old, who complaints of severe headache and fever, the 6-day illness positive agglutination test with rickettsia reaction. Past sick sick was typhus. Vector of the disease is: Flea Fly Mosquitoes Lice *Carrier does not need A patient 29 years, a few days ago, a chill, the temperature for 2-3 days increased to 39-40 °C. There hyperemia and edema person,significant sclera like "drunk" person and "rabbit" eyes. On the third day of illness – on mucuos of soft palate, parenthesis bright red enantema is seen. At 3-4-day patient when trying to protrude the tongue, there was hypermovement, tremor, rejecting it to the side. Diagnosis: epidemic typhus. Which disease is likely in a patient? *Epidemic typhus Typhoid fever Brill disease Paratyphoid A Paratyphoid B A patient at the 4-day fever has profuse rosy-petehia exanthema predominantly located on the lateral surface of the torso and limbs flexion surfaces. Hyperemic, vascular conjunctivitis, petehii transition of anterior fold conjunctivA. What kind of illness can think? Typhoid fever *Epidemic typhus Measles Haemorrhagic fever with renal syndrome Crimean hemorrhagic fever Patient B., complaints of headaches, delirium. When inspection: a body temperature of 39 °C, initiated, a person hyperemic, positive symptom Govorova-Godele, petehia rash on the trunk, limbs, tachycardia, hypotension, hepatosplenomegaly. Drunker, drug user, living in the basement room type. What is your preliminary diagnosis? AIDS infection Influenza Leptospirosis *Epidemic typhus Alcohol psychosis A patient 28 years old, of no fixed abode, hospitalized with a preliminary diagnosis «flu», a 5-day illness appeared rosy-petehia rashes on the body and interior surfaces of the extremities. The temperature of 41 °C, euphoria, hyperemia person, redness sclera, tongue tremor, tachycardia, enlarged spleen; excitement. What is the likely diagnosis? Typhoid fever Leptospirosis Alcohol deliry Measles *Epidemic typhus The watchman 42 years old, complaining of?desperately ill. Entered the 6-day illness with fever 39,7 °C, severe headaches, noise in the ears, insomniA. OBJECTIVE: instituted, euphoric, talkative. Face red, his eyes shining, sclera and conjunctiva enhanced vascular pattern. On the inside shoulder and the side surfaces of chest rosy-petehia rash. Found head lice and nits. Reaction Vidal 1:40. What is diagnosis? Brill disease Malaria *Epidemic typhus Typhoid fever Q-fever A patient 28 years at the 4-day fever has profuse rosy-petehia exanthema predominantly located on the lateral surface of the torso and limbs flexion surfaces. An individual patient hyperemic expressed vessels conjunctival injection, petehies transition to fold conjunctivA. Analysis of urine protein single hyaline and granular cylinders. What kind of illness can think? Typhoid fever Haemorrhagic fever with renal syndrome Crimean hemorrhagic fever Measles *Epidemic typhus For patients 78 years of acute illness began, which is characterized by fever with chilling, rash dominated rosy petehia elements. The condition of the patient violated moderately. Agent and the source of infection is not detected, but it is known that 45 years ago patient had severe typhus. What is your diagnosis? Yersiniozis * Brill‘s disease Typhoid fever Drug allergy Food Allergies The patient, a train conductor, 39 years old, hospitalized for a 4-day illness with complaints of headache, weakness, dizziness, sweating, insomnia, fever. Hyperemic, edema, conjunctivitis. At the transition fold conjunctiva – single petehies. At the skin torso, chest, abdomen, limbs abundance rosy-petehia rash. TachycardiA. AD 100 and 60. Tremor of the tough. Palpable liver, spleen. Stool arrested. What is the most likely diagnosis? Leptospirosis Typhoid fever Influenza Meningoccemia *Epidemic typhus A patient 30 years on 9th day of illness that began gradually, the slow rise of fever and intoxication, a painless rosy rashes on the skin of the abdomen. OBJECTIVE: pale, temperature 40 ° C, pulse 80/min, AD 100 and 65 mm RT. Art. Language is coached, abdomen bubbles, enlarged spleen and liver. For what disease you can suggest in the first place? *Typhoid fever Epidemic typhus Measles Scarlet fever Sepsis Patient 20 years, complained about the high temperatures of up to 39 ° C, headache in the frontal area, pain in the eyeball, photophobia, pain in muscles, dry cough. Acutely ill the day before. Objective: condition serious, hyperaemic, eyes shining, vascular injection sclerA. Pulse 96/min, rhythmical. Tone heart weakened. In the lungs scattered dry bubbling rale. Faces hyperemic, granular. Meningeal symptoms are not present. Blood tests: Leu. 3?109, eoz. 1 %, yang neu. 6 %, neu. 51 %, lymph. 35 %, mon. 7 %. What is the most likely diagnosis? Measles *Influenza Meningococcal disease Pneumonia Typhus Often, in patient with epidemic typhus arise transition petehies in the conjunctivA. What term did it call? Symptom of Heller Conjunctivitis Symptom of Govorova-Godele *Symptom of Zorohovich-Chiari-Avtsyn Enantema Rosenberg‘s In the family of the patient with epidemic typhus, were lice in the children. With the help of any of these events could prevent the subsequent spread of the disease? *Monitoring and complete sanitation of contact in the centre The use of chemoprophylaxis The use of antibiotics Isolation contact Check-up When you can stopped etiotropic medications treatment of the patient with epidemic typhus? Immediately after the normalization of body temperature After the normalization of the liver and spleen *After a 2-day normal body temperature After the disappearance of roseola Within 10 days after the disappearance of roseola Patient K., 23 years old, hospitalized on the 3rd day of illness, which was accompanied by mild running nose, high fever to 40,2 °C, headache and hemorrhagic rash on the skin. In the 2 hours after the introduction of penicillin blood pressure dropped to 40 and 10 mm Hg. Distal pulse and meningeal signs are not defined. What is the diagnosis in a patient? *Meningoccocemia, infectious-toxic shock Epidemic Typhus, severe course Measles, severe course Scarlet fever, severe course Flu, anaphylactic shock A patient 25 years old, who returned from the Far East, suddenly has increased body temperature to 39 °C, a pain in the backbone, reddening skin type «hood», single hemorrhages on the skin. After 3 days, along with declining fever, weakness, thirst, decreased diuresis to 300 ml, decreased blood pressure. Much pronounced Pasternatskyj‘s symptom. What is the most likely diagnosis? Leptospirosis Typhus Haemorrhagic fever Crimean-Congo Acute glomerulonephritis *Haemorrhagic fever with renal syndrome Male 45 years old, fell ill after 2 weeks after returning from Afghanistan, where six months ago underwent malariA. In return were found lice. Suddenly, there were severe headache, weakness, body temperature 39 °C with a temporary decrease in the 4th day of illness, followed by general weakness, much intoxication, headache, appeared on the body abundance polymorphic rash. At the 7-day state of heavy, the phenomenon of encephalitis, excitation, hallucinations periodically. Objective – erythematos-petehial exanthemA. The temperature of the body 40,1 ?C, pulse was 136 for 1 min, blood pressure 120/70 mm RT art. Moderately enlarged liver and spleen. Paradoxical ishuriyA. In the blood analys neutrofil mild leukocytosis, eozinofilia, accelerated ESR. Which of the studies of blood will be positive? At typhoid fever At the three-day malaria Tropical malaria *Epidemic typhus At brucellosis Male 26 years old, who last month returned from Africa and was processing about lice, sick 5 days. Home was a sudden: severe headache, weakness, body temperature 38,8 °C, which persisted all day at a constant level, but at the 4th day of the disease declined for several hours. Then the patient condition has deteriorated significantly, a rash on the body, delay urine. OBJECTIVE: pulse was 110 for 1 min, blood pressure 115/70 mm RT. Art., temperature 39,7 °C. Face red, a significant injection of vascular sclera, cmall hemorrhages in the conjunctiva, mucous membrane soft palate, abundant rosy-petehialexanthema on the body. Signs interstitsial pneumonia, encephalitis. Enlarged liver and spleen. What kind of illness can you think of? *Epidemic typhus Typhoid fever Tropical malaria Leptospirosis Yellow fever Patient P., 68 years old, fell ill suddenly 7 days ago from the increase of temperature to 39,3 °C, appearances of headache and insomniA. Objectively: excited, inadequate. Face is hyperemic. The tongue is very dry, trembles at pulling out. On a trunk are polymorphic rash, tachycardia, and blood pressure low. HepatosplenomegaliA. Stool is absent. In age 10 years had epidemic typhus. What is the previous diagnosis? Yersiniosis Typhoid fever *Brill‘s disease meningococcemia Sepsis Patient P., 76 years old, complianed during 7 days for the permanent increase of temperature to 38,2-38,7 °C, headache, insomnia, horrific dreams, dry cough, myalgias, artalgias. Polymorphic rash appeared on a trunk on the 4th day of diseases. In childhood was ill by epidemic fever, three-day malariA. Temperature of body – 38,4 °C, pulse – 98 per a min, hepatolienal syndrome, bilateral pneumonia confirmed roentgenologic. In the analysis of blood moderate neutrophil leycocytosis. What is the preliminary diagnosis? *Brill‘s disease Typhoid fever Lime‘s disease Malaria Leptospirosis Patients D., 30 years old, became ill saddenly, when the temperature of body rose to 40,2 °C, appeared headache, weakness, euphoria, injection of vascular sclera, hyperemia of face, appears the positive symptom of Govorov-Godele. Reaction with Rickettsia prowazekii 1:160, IgG – 87 %. What is your diagnosis? Brill‘s disease Typhoid fever Paratyphoid A Paratyphoid B *Epidemic typhus Patients I., 78 years old, became ill saddenly, the temperature of body rose to 39,2 °C, euphoric, vessels of scleras are injection, hyperemia of face, appears enantema of Rozenberg. Reaction with Rickettsia prowazekii 1:160, IgG – 87 %. What is your diagnosis? *Brill‘s disease Typhoid fever Meningococcal infection Flu Leptospirosis At a patient with a pediculosis the temperature of body rose to 41,6 °C, appeared headache, euphoria, in 4th days from the beginning of illness – rozeola-petehial rash. Reaction with Rickettsia prowazekii 1:640, IGG – 89 %. What is your diagnosis? Flu Typhoid fever Meningococcal infection *Epidemic typhus Leptospirosis A patient’s temperature is 40 °C. There are also deep and unproductive cough, photophobia, face puffiness whitish points on the mucous membrane of cheeks opposite molar teeth. What is the most possible diagnosis? Tuberculosis Meningococcemia *Measles Enteroviral infection Staphylococcus sepsis A child after consuming food in a party complaints of vomiting and diarrhea within 1-5 hours. The diagnosis is: *Staphylococcus aureus Streptococcus Clostridium Perfringens Clostridium Botulinum Meningococcus Patient A., 37 years old, entered to infectious hospital on the third days of disease in the severe condition. He complaints of the high fever with chills and sweat, general weakness, pain in right under a rib. Objectively: temperature of body 41 °С, icterus of skin, liver +2 cm, pain at palpation in abdomen, positive symptoms of Ortner and Mussy, a spleen is normal, tachycardiA. What is the preliminary diagnosis? Malaria *Cholangitis Viral hepatitis Sepsis Leptospirosis Patient W., 38 years old, entered to infectious hospital on the 5th days of disease in the severe condition. He complaints of the high fever with chills and sweat, general weakness, pain in sacrum. Objectively: temperature of body of 41 °С, tachycardia, positive symptom of Pasternacky, liver and spleen is not normal. Preliminary diagnosis? Malaria Cholangitis *Pyelonephritis Sepsis Leptospirosis Patient D., 39 years old, entered to infectious hospital on the second week of disease in the severe condition. She complaints of high fever with chills and sweat, general weakness, pharyngalgia at swallowing. Objectively: temperature of body 37,7 °С, hyperemia of mucus of pharynx, tonsils are enlarged, loose, festering raid in lakuns, enlarged submandibula, neck, axilars lymphonodules, icterus of sclera and skin, bradycardia, liver + 2 cm, spleen + 1 cm. Urine is color of beer, an excrement is discolored. What is the previous diagnosis? Malaria Infectious mononucleosis Viral hepatitis *Sepsis Leptospirosis Patient A., 37 years old, entered to infectious hospital on the third days of disease in the severe condition. He complaints of the high fever with chills and sweat, general weakness, pain in right under a rib. Objectively: temperature of body 41 °С, icterus of skin, liver + 2 cm, pain at palpation in abdomen, positive symptoms of Ortner and Mussy, a spleen is normal, tachycardiA. What methods is it possible to confirm a previous diagnosis by? Global analysis of blood *Ultrasonic research Biochemical blood test Hemoculture Parazytoskopy of blood Patient W., 38 years old, entered the infectious hospital on the 5th days of disease in the severe condition. He complaints of the high fever with chills and sweat, general weakness, pain in sacrum. Objectively: temperature of body of 41 °С, tachycardia, positive symptom of Pasternacky, liver and spleen not is normal. What is the previous diagnosis? What methods is it possible to confirm a previous diagnosis by? General blood analysis Ultrasonic research Biochemical blood test Hemoculture *Parazytoskopy of blood Patient of 52 years, fell ill sharply from a chill and head pain, fevers to 40°C. On a 3th day illnesses are nausea and vomiting, dark urine. On a 4th day a temperature went down to 37 °, but an icterus appeared and the amount of urine diminished to 600 ml. What disease is such development of symptoms characteristic for? Hepatitis A Hemorragic fever with a kidney syndrome *Leptospirosis Sepsis Acute glomerulonephritis Animal technician 57 years, on the 3rd day of illness appealed to the doctor with complaints of head pain, high temperature, pain in gastrocnemius muscles, cmall of the back, icterus, dark urine and diminishing of its amount. Objectively: temperature 38,1 °C, injection of the sclera vessels, petechial rash on upper part of the thorax, hepatosplenomegaly. What is the most credible preliminary diagnosis? Pseudotuberculosis Brucellosis Viral hepatitis *Leptospirosis Influenza A patient I., 26 years old, delivered in a hospital on the 4th day of disease with complaints of fever, headache, pain in gastrocnemius muscles. Works as a specialist in land-reclamation. Has a lot of sexual contacts. Objectively: temperature – 39,7 °C. Severe common condition. Expressed icterosis of skins and sclerA. Hemorrhages in conjunctiva and sclerA. There is a hemorragic rash on a skin. A liver increased on 3 see below the costal arc, edge of spleen, the day's diuresis 300 ml. The etiologic factor of the disease most probable: Rikkettsia Virus *Leptospira Spirocheta Chlamidia Patient 43, miner, on the 7th day of disease grumbles about a sharp weakness, high temperature, pain in the muscles of feet and cmall of the back, icterus, dark color of urine, headache. Fell ill sharply is a chill, temperature 40,2 °, there was a nose-bleed. A diuresis 200 ml. Credible diagnosis? Sepsis Typhoid Viral hepatitis *Leptospirosis Malaria A patient, 35 years, suffering sharply, complaints of a headache, pain in the muscles of lower extremities, increasing of temperature to 39,3 °C. Objectively on the 4th day of disease: the state is severy, hyperemic face, icterosis of skin and sclerA. Enlargment of liver and spleen. A diuresis is mionectic. What is most credible diagnosis? Trichinosis Hepatitis A Yersiniosis Infectious mononucleus *Leptospirosis For a patient, workwoman of a pig farm, on a background of complete health a chill appeared suddenly, a temperature rose to 39,9 °C, there was a headache, nauseA. On the next day marked pains in the muscles of lower extremities, nose-bleeding began. On the 3rd day of illness, state became more severy. Face is hyperemic, scleritis, hyperemic scleritis. Liver +3 cm. Daily diuresis 700 ml. What is the preliminary diagnosis? Yersiniosis Hepatitis A Hemorrhagic fever with a kidney syndrome Flu *Leptospirosis On the 3rd day of illness the sick is delivered in a severe condition with complaints of sudden rise of temperature, headache, repeated nose-bleed, pain in gastrocnemius muscles. Objectively: moderate icterus of sclera and skins, hepatospleenomegaly, оliguriA. What is most credible diagnosis? *Leptospirosis Viral hepatitis Influenza Infectious mononucleosis Malaria A patient S., 45 years old, suffering suddenly from appearance of chill and increasing of temperature to 39,2 °C. In the evening pain appeared in a abdomen and gastrocnemius muscles. In 2 days noticed the ochrodermia of skin and sclerA. Objectively: the state is severy, temperature 39,9 °C. The tongue is covered. Moderate jaundice of the skin and sclerA. There is plural petachiae on a trunk. Superficial breathing 20 times per 1 min, pulse 102 per 1 min, AP 100/60 mm of Hg. A abdomen is soft, sickly in epigastrium, a liver on 3 cm comes from a costal arc. Daily diuresis 300 mm, urine is sad-coloured. What is your preliminary diagnosis? Sepsis *Leptospirosis Influenza Hepatitis B Infectious mononucleus A patient Z., 33 years old, miner, entered clinic of infectious diseases on the 7th day of disease with complaints of acute weakness, high temperature, pain in the muscles of feet and back, icterus, dark color of urine, headache. Became sick sharply from a chill, temperature rises up to 40,1 °C. On a 4th day there is an icterus, nose-bleeding, hemorrhages in sclerA. Duration of fever 6 days. Diuresis is 200 ml. What is credible diagnosis? Typhoid fever *Leptospirosis Hepatitis A Sepsis Influenza A patient Y., 25 years old, entered infectious department on the 3rd day of disease with complaints of headache, pain in the back, gastrocnemius muscles, high fever, chill. State is moderate. Icteruses of the scleras. Mucous membrane of soft palate is hyperemic. Tongue is dry, assessed with brown cover. The abdomen is swollen. Liver +2 cm, spleen is not megascopic. Painfull muscles, especially gastrocnemius. Urine is dark, excrements ordinary color. What is the most credible diagnosis? Infectious moneuclious Hepatitis A Malaria *Leptospirosis Yersiniosis Patient A., 16 years, hospitalized in an infectious department with complaints of absence of motions in lower extremities. A disease was begun 2 days back with the increase of temperature to 38 °, dyarrhea is to 3-5 times per days. Melosalgias took a place, head pain. Objectively: temperature of body 36,8 °, active motions absent in lower extremities, in the area of defeat is areflexis, low blood pressure of muscles, a sensitiveness is stored. Meningeal symptoms are poorly expressed. What disease is it needed to think of? Leptospirosis Meningococcal infection *Poliomyelitis Parainfectional encephalitis Tubercular meningo encephalitis For patient A., 25 years, which returned from Far East, suddenly the temperature of body rose to 39 °, pain appeared in cmall of the back, hyperemia of person, neck, overhead half of trunk, single haemorrages as red strips on a neck and lateral surfaces of thorax. Nose-bleeds. Through 3 days a weakness, thirst, grew together with the decline of fever, diminished to 300 ml diuresis, an arteriotony went down. Positive symptom of Pasternackogo. What diagnosis is most credible? Leptospirosis *Hemorrhagic fever with a kidney syndrome Spotted fever Hemorrhagic fever Crimea-Congo Acute glomerulonephritis Man 26 years, month ago returned from Africa, passed treatment concerning pediculosis. He is ill for 5 days. Beginning was sudden: great head pain, weakness, stationary temperature of body (38,8°C), which on a 4th day went down on a few clock. The state of patient was considerably worsened farther, a rash appeared on a trunk, coughing, uroschesis. Objectively: temperature of body 39,7°C, pulse 110 per 1 min, BP 115/70 mm Hg. Skin of person red, considerable injection of vessels of sclerotica, shallow hemorrhage on a conjunctiva, mucous membrane of soft palate, abundant roseol-petechial exanthema on a trunk. Signs of interstitial pneumonia, encephalitis. A liver and spleen is megascopic. What disease most probably? Yellow fever Typhoid fever Tropical malaria Leptospirosis * Epidemic typhus Patient A., 35 years, had ill sharply, complaints of high temperature of body, great head pain, sickliness in gastrocnemius muscles. Objectively on the 4th day of illness: the state is heavy, hyperemia of person, skin and sclerotica are icterus, a liver and spleen is megascopic. OliguriyA. What diagnosis is most credible? Yersiniosis Viral hepatitis *Leptospirosis Poisoning of tetraetyl lead Omsk hemorrhagic fever At one on holiday-makers ashore lake in 6 days did a temperature rise to 38,5 °C, headacke, pain, appeared in muscles, sweating. In 3 days there was the sickly slight swelling in an inguinal areA. At examination in an inguinal area found out a dense, mobile, moderate sickly lymphonodus to 5 cm in a diameter. The skin above him is not changed. What diagnosis is most credible? Leptospirosis Iersiniosis Infectious mononucleosis *Rabbit-fever Acute lymphadenitis Patient of 62 years, in the past had been ill with spotted fever. Fell ill sharply: fever 39,5 °C, head pain, insomniA. On a 6th day on the skin of abdomen and lateral surfaces of thorax roseol appeared rash. A liver and spleen, tachycardia, deafness of tones of heart, low blood pressure is megascopic. What diagnosis is most credible? *Illness of Brilla Typhoid Leptospirosis Sepsis Infectious mononucleosis Patient I., 21 years old, entered hospital on the 7th day of illness with complaints of a sharp weakness, pains in muscles and joints, head pain, nauseA. A disease began with sore throat, cold, general weakness. Did not measure a temperature. Last was the state worsened 2 days, a chill appeared, high temperature 39-40°C, head pain, nauseA. Objectively: patient of adynamic, consciousness is kept, temperature of body 37,5°C, the state is extremely heavy, a skin is pale, lips and nail phalanxes of cianotic, on the skin of tiptoes and hands hemorragic rash, the scopes of heart are extended to the left on 1,5 cm, tones are deaf, pulse 130 per 1 mines, weak filling, BP 80/40 mm Hg. Breathing normal. A tongue is assessed, moist, phenomena of pharyngitis. Neck lymphonodus are megascopic. Meningeal signs are absent. OliguriA. What diagnosis is most credible? Hemorrhagic fever Leptospirosis Epidemic typhus Rheumatoceils *Meningococcal infection. MeningococcemiA. Animal technician 57 years, on the 3rd day of illness appealed to the doctor with complaints of head pain, high temperature, pain in gastrocnemius muscles, cmall of the back, icterus, dark urine and diminishing of its amount. Objectively: temperature 38,2°, injection of vessels of sclerotica, petechial rash on overhead part of thorax, megascopic hepar and spleen. Most credible preliminary diagnosis? Brucellosis *Leptospirosis Viral hepatitis Pseudotuberculosis Trichinosis Patient 43, miner, on the 7th day of disease complains of a sharp weakness, high temperature, pain in the muscles of feet and cmall of the back, icterus, dark color of urine, head pain. Fell ill sharply is a chill, temperature 40°, there was a nose-bleed. A diuresis 200 ml. Credible diagnosis? Malaria Typhoid Viral hepatitis Sepsis *Leptospirosis Patient 35 years, which fell ill sharply, complains of headache myalgia, pain in the muscles of lower extremities, increase of temperature to 39 °C. Objectively on the 4th day of illness: state heavy. Face of hyperaemiA. Skin and sclera are icteric. The liver and spleen are enlarged. A diuresis is mionectic. Most credible diagnosis? Yersiniosis Hepatitis A *Leptospirosis Infectious mononucleosis Trichinosis Leptospirosis For a patient, workwoman of pig farm, on a background a complete health a chill appeared suddenly, a temperature rose to 39,9 °, there was a head myalgia, nauseA. The next day marked pains in the muscles of lower extremities, a nose-bleed began. At the reception of the permanent establishment, on the 3rd day of illness, state heavy. Face of hyperaemia, scleritis, subicterus of sclerA. Liver +3cm, a diuresis 700 ml. Preliminary diagnosis? Hemorragic fever with a kidney syndrome Hepatitis of A Yersiniosis Flu *Leptospirosis The patient 33 years, miner, entered clinic of infectious diseases on the 7th day of disease with complaints of a sharp weakness, high temperature, pain in the muscles of feet and cmall of the back, icterus, dark color of urine, head pain. Fell ill sharply from a chill, temperatures 40°. On a 4th day is an icterus, nose-bleed, hemorrhage in a scleroticA. Duration of fever 6 days. A diuresis 200 ml. Credible diagnosis? *Leptospirosis Typhoid Hepatitis A Sepsis Iersiniosis A patient is disturbed by attacks fevers which repeat oneself periodically every third day. The icterus of sclerotica and skin covers, Liver and spleen are enlarged. Which of the following diagnosis below is most correct? Viral hepatitis Sepsis *Malaria Yersiniosis Leptospirosis A patient 25 years, entered infectious separation on the 3rd day of disease with complaints of pain in gastrocnemius muscles, high fever, chill. State of middle weight. Sclera are icterus. Mucous membrane of soft palate is hyperaemiA. A tongue is dry, assessed a brown raid. A abdomen is swollen. Liver +2 cm A spleen is not megascopic. Palpation of muscles, especially gastrocnemius, painful. Wetting dark. Excrement of ordinary color. Name the most credible diagnosis: Infectious mononucleosis Viral hepatitis A Malaria *Leptospirosis Yersiniosis In receiving department of infectious separation on the 3rd day of illness the sick is delivered in a grave condition with complaints of a suddenly arising up high temperature, head pain, repeated nose-bleed, pains in gastrocnemius muscles. Objectively: moderate icterus of sclerotica and skins, liver and spleen are enlarged oliguriA. What is the most credible diagnosis? Infectious mononucleosis Viral hepatitis Yersiniosis *Leptospirosis Malaria Patient P., 45 years old, fell ill suddenly from appearance of chill and increase of temperature to 39,2 °C. In the evening myalgia appeared in a abdomen and gastrocnemius muscles. In 2 days noticed the ochrodermia of skin and scleroticA. Objectively: the state is heavy, temperature 39,9 °C. Skin and sclerotica moderate yellow. There is plural petechia on a trunk. Breathing is normal. FB-20/min, Pulse-102/min, BP 100/60 mm Hg. A abdomen is soft, sickly in an epigastrium, inreasing of liver. Daily diuresis 300 ml of urine of sad-coloured. What is preliminary diagnosis? Sepsis *Leptospirosis Yersiniosis Hepatitis B Infectious mononucleosis 76-years old patient during 7 days grumble about the permanent increase of temperature to 38-38,7 °C, moderate head pain, insomnia, horrific dreams, dry cough, myalgias, arthragiA. From the 4th day of illness – on a trunk polymorphic exanthema with predominance of roseol elements. In childhood was ill the spotted fever, three-day malariA. Temperature of body 38,4°, pulse 98 per 1 min, hepatolienal syndrome, bilateral pneumonia, confirmed roentgenological. There is moderate neutrophilic leykocytosis in the global analysis of blood, speed-up ESR. What from diagnosis is the most credible? * Brill’s disease Typhoid fever Lime disease Malaria Leptospirosis Patient P., 24 years old, hospitalized in an infectious department in a severe condition. Complaints of head acke, pain in muscles and joints, vomiting. Objectively –a patient is excited, temperature of body 39 °C. BP 90/60 mm Hg, tachycardiA. hyperaestesia of skin appeared. Doubtful meningial signs. It is known from anamnesis, that lives in a mud flow, has an economy, there are rats. What preparations must be given? Veroshpiron, euphyllinum, Dimedrolum *Mannitol, Lasixum, prednisolon, penicillin Analgin, Dimedrolum, acetophene Manitol, acetophene Lasixum, analgin, ampicillin Sick, 22 years old, hospitalized in an infectious separation with complaints of chill, fever, great head pain, pain in gastrocnemius muscles. The state is severe, hyperemia of face, skin and sclera are icteric, the iver and spleen are enlarged, oliguriA. What preparations are routinely given in this disease? Introduction of whey *Antibiotics Sulfanilamid preparations Desintoxic therapy Enterosorbtion Patient T., 40 years, hospitalized in infectious separation with complaints of chill, fever, great head pain, pain in gastrocnemius muscles. The state is severe, hyperemia of face, skin and sclera are icteric, the liver and spleen are enlarged. BP 60/20 mm Hg, pulse 120 per 1 min Optimum chart of treatment? Hormones, desintoxical therapy, antibiotics Diuretic, desintoxical therapy, antibiotics Sorbtions, diuretic, desintoxical therapy *Hormones, diuretic, desintoxical therapy, antibiotics Hormones, diuretic, antibiotics Patient A., 57 years, animal technician, on the 3rd day of illness appealed to the doctor with complaints of head pain, fever, pain in gastrocnemius muscles, cmall of the back, icterus, dark urine and diminishing of its amount; temperature of body 38,2 °C , injection of vessels of sclerotica, petechial rash on overhead part of thorax, enlarged liver and spleen. What preparations must be appointed above all things? Intravenous introduction of salt solutions Transfusion of fresh-frozen placma *Setting of antibiotics Hyperbaric oxygenetion Haemosorbtion, sympathomimetics Patient of 43 years, miner, on the 4th day of illness complains of a sharp weakness, high fever, onychalgias and cmall of the back, dark color of urine, head pain. Fell ill sharply chill, temperature 40,3°, there was a nose-bleed. A diuresis 200 ml. What preparations from the listed is necessary to use for this disease? *Specific immunoprotein Holinomimetics Spacmolysants Miorelaks Vitamins of group B A patient, 44 years, entered infectious separation with a diagnosis leptospirosis. On the 7th day of treatment his state was sharply worsened, pains appeared in cmall of the back, somnolence, languor, cramps, head pain, a diuresis diminished to 100 ml/days. In blood: red corpuscles 2,6 T/l, creatinine of 438 mcmoll/l, urea 13,0 mmol/l. What complication developed in the patient? Heart attack of buds Acute hepatic insufficiency Chronic pyelonephritis Ischemic stroke *Acute kidney insufficiency A patient 40 years complains of a sharp weakness, head pain, to pain in gastrocnemius muscles, cmall of the back, insomnia, vomiting. Fell ill sharply 4 days back, when did a chill appear, a temperature rose to 40°, myalgias, nose-bleeds, icterus. Bathed in the river, where a lot of rodents is. The state is severe, on lips is herpes, sclerotica injections, icterus. Hemorragic rash on a skin. Pulse 120 on 1 mines, BP 90/50 mm Hg. A liver and spleen is megascopic. The symptom of Pasternackogo is positive. For days selected 100 ml of urine. Specify the most credible urgent state. *Acute kidney insufficiency Infectiously-toxic shock Dehydratation shock Head cerebral edema Acute respiratory insufficiency A patient 42, animal technician, fell ill sharply: chill, temperature to 40°, head pain, megalgias, is in muscles, especially gastrocnemius. Objectively: an icterus, hemorragic rash, is expressed on a body, a liver and spleen are enlarged, positive symptom of Pasternasky. Put a preliminary diagnosis. Malaria Ku-fever *Leptospirosis Spotted fever Fever of Ebola Man 45 years, works as on a stock-raising farm a veterinary. Delivered in an induction centre with complaints of discoloration urine, diminishing of diuresis, fervescence to 39,3 °C, pain in muscles. It is ill during 5 days: the temperature of body rose suddenly, great pains appeared in the muscles of shins, head pain, rash on a skin, hemorrhage in a sclerotica, red color of urine. Pulse 56 per 1 mines, BP 90/60 mm Hg. Uranalysis: squirrel of a 0,99 gramme/l, eras. 25-30 cylinders hyalin 8-10. Urea of blood 20,5 mmol/l. What diagnosis most credible? *Leptospirosis Acute glomerulonephritis Urolithiasis Cancer of urinary bladder Rheumatoceils Sick, milkmaid diseased sharply, appeared great pain heads, broken, weakness, profuse sweats, loss of appetite, dry cough, insomnia, myalgias, pain, in a lumbar areA. A temperature from the first days rose to 39-40 °C. At a review it is found out hyperemia of face, injections of sclera vessels, hyperemia of mucous of nasopharyngs. Pulse 80 per minute. BP 90/60 mm/Hg. Lymphatic nodes are not palpable. Liver and spleen also not palpable. About what disease is it possible to think? Typhoid fever Epidemic typhus *Leptospirosis Brucellosis Flu Sick, milkmaid became sick sharply, severe head ache appeared. Weakness, profuse sweats, loss of appetite, dry cough, insomnia, myalgias, pain in a lumbar area also appeared. A temperature from the first days rise to 39-40 °C. During inspection hyperemia of skin, injections of vessels of scleras, hyperemia of mucous membranes found out. Pulse 80 per min. BP is 90/60 mm/Hg. Lymphatic nodes are not palpable. Spleen and liver are enlarged. How is it possible to confirm a credible diagnosis? Virologicaly *Bacteriologically Exposure of exciter in emptying Research of hanging drop of blood Research of thick drop of blood Sick, milkmaid diseased sharply, appeared great pain heads, broken, weakness, profuse sweats, loss of appetite, dry cough, insomnia, myalgias, pain, in a lumbar areA. A temperature from the first days rose to 39-40 °C. At a review it is found out hyperemia persons, injections of vessels of scleroticas, hyperemia of mucuse. Pulse 80/min. BP is 90/60 mm/Hg. Lymphatic nodes not palpable. Hepatoslpenomegaly. What etiotropic treatment should be given? Benzylpenicilline *Теtracyclin Acyclovir Delagilum Ftalazol 32 years sick person, appealed to the doctor on the 7th day of illness with complaints of high temperature, head pain, pain in muscles especially gastrocnemius. Skin and sclera are icteric, on a skin hemorragic rash. HematuriA. 2 weeks ago rode on fishing. Reliable diagnosis? *Leptospirosis Trichinosis Brucellosis Pyelonephritis Hemorrhagic fever with a kidney syndrome 45 years sick person, appealed to the hospital on the 5th day of illness. 8 days ago he arrived from Laos with complaints of fever, headache, general weakness. Objectively: temperature of body – 40,2 °C, skin moisture, scleroticas, subicteric, acrocyanosis, cardiac tones, deaf, increase of liver and spleen. What complication more frequent in all develops at the severe forms of this illness? Coma Edema of lungs *ID-syndrome Acute hepatic insufficiency Acute kidney insufficiency Patient A., 35 years old, became ill suddenly, complain on the high temperature, severe headache, pain in muscles of legs. Objectively (the 4th day of disease): the state is severe, hyperemia of face, skin and scleras are icterus, spleen and liver are enlarged, oligourhiA. What is the most credible diagnosis? Yersiniosis Viral hepatitis *Leptospirosis Poisoning by a tetraethyllead Omsk‘s hemorrhagic fever Farmer, 57 years old, appealed to a doctor on the 3rd day of disease with complaints on headache, high temperature, pain in the muscles, icterus of skin, dark urine and decrease quantity of urine. Objectively: temperature – 38,2 °C, injection of scleras, petehial rash on the overhead part of thorax, hepatosplenomegaliA. What is the most reliable previous diagnosis? Brucelosis *Leptospirosis Viral hepatitis Yersiniosis Trichinosis Chill appeared suddenly at the workwoman of pig farm, a temperature rose to 39,9 °C, there was a headache, nauseA. On the next day appeared pain in the muscles of lower extremities, began the nose bleeding. On the 3rd day of disease, state was severe. A face is hyperemic, scleritis, subicterous of scleras. Liver + 3 сm, diuresis – 700 ml. What is the previous diagnosis? Hemorrhagic fever with a kidney syndrome Hepatitis A Yersiniosis Flu *Leptospirosis Patient Q., 11 years old, complaints on weakness, headache, high temperature, pain in the muscles; at night suddenly the temperature of body rose to 39,5 °C, decrease level of urine. 4 days ago swimming in a lake, injured a leg. What preparations must be appointed? Prednizolonum, hot foot-baths Febrifuge Euphyllin, vitamin C *Antibiotics Sorbents Patient E., 24 years old, was hospitalized in the infectious department in the severe condition. He complains of headache, pain in muscles, joints, vomiting. Objectively: temperature of body 39 °C. BP is 90 and 60 mm Hg, appeared tachycardia, hyperesthesia of skin. Meningeal signs are doubtful. It is known from anamnesis, that he lives in a village, has a pet, rats. What preparations must be given? Veroshpironum, euphilinum, dimedrol *Manitol, lazix, prednizolonum, penicillin Analgin, dimedrol, acetophen Manitol, acetophen Lazix, analgin, ampicillin Patient T., 22 years old, was hospitalized in the infectious department with complaints of chill, fever, severe headache, pain in the gastrocnemius muscles. The state is severe, hyperemia of face, icterus of skin and scleras, liver and spleen are enlarged, olygouriA. What preparations must be given first? Introduction of serum *Ftorchinolons preparations Sulphanilamid preparations Dethintoxikation therapy Sorbents Patient T., 22 years old, was hospitalized in the infectious department with complaints of chill, fever, severe headache, pain in the gastrocnemius muscles. The state is severe, hyperemia of face, icterus of skin and scleras, liver and spleen are enlarged, olygouriA. BP is 60 and 20 mm Hg, pulse – 120 per a min. What preparations must be given? Hormones, dethintoxikation therapy, antibacterial preparations Diuretic, dethintoxikation therapy, antibacterial preparations Sorbents, diuretic, dethintoxikation therapy *Hormones diuretic, dethintoxikation therapy, antibacterial preparations Hormones, diuretic, antibacterial preparations Patient A., 57 years old, farmer, came to the doctor on the 3rd day of illness with complaints of headache, pain in the gastrocnemius muscles, fever, icterus of skin and scleras, dark urine and decrease level of urine, temperature of body – 38,2 °C, petehial rash on overhead part of thorax, hepatosplenomegaliA. What preparations must be given? Salts solutions Transfusion of fresh-frozen placma *Antibiotics Hyperbaric oxygenation Hemosorbcion, sympathomimetics Patient K., 43 years old, miner, on the 4th day of disease complained of weakness, headache, pain in the gastrocnemius muscles, fever, icterus of skin and scleras, dark urine, temperature of body – 38,2 °C, hepatosplenomegaliA. What preparations must be entered? There was the nose-bleed. Diuresis – 200 ml. What preparations must be given? *Specific immunoglobulin Holynomimetics Spacmolytics Miorelaxants Vitamins of group B At a patient, 39 years old: disease beginning suddenly, t° – 39,5 °C, pain in muscles (especially in gastrocnemius), hepatosplenomegly, icterus, hemorrhagic rash, oligouria, rigidity of the neck muscles. What is the most credible complications? Renal insufficiency, reno-hepatic insufficiency, ІТS, ACVI, meningitis Renal insufficiency, hepatic insufficiency, ІТS, ACVI, meningitis Renal insufficiency, hepatic insufficiency, ІТS, ACVI, break of spleen *Renal insufficiency, reno-hepatic insufficiency, ІТS, ACVI, uveit Renal insufficiency, hepatic insufficiency, ІТS, ACVI, uveit Patient K, 32 years old, of no fixed residence went to see a doctor for 5-days illness with complaints of fever, severe headache, insomniA. On body temperature 40 °C, pulse 110/min. The patient is excited and talkative. Hyperemic, scleritis. At whole over the body there is pink petehial rashes. Positive Govorov-Godele‘s symptom. Enlarged liver and spleen. What do you need to find out the epidemic status? *The existence of head lice Use of poor food Availability of parenteral interventions Contact with rodents Drinking water from unhygienic sources A patient L., 32 years old, who complains of severe headache and fever, on the 6th-day illness positive agglutination test with rickettsia reaction. What is the vector of the disease?: Flea Fly Mosquitoes Bee *Lice Patient A., 37 years old, entered to infectious hospital on the third day of the disease in the severe condition. He complains of high fever with chills and sweat, general weakness, pain in right under a rib. Objectively: temperature of body 41 °С, icterus of skin, liver +2 cm, pain at palpation in abdomen, positive symptoms of Ortner and Mussy, a spleen is normal, tachycardiA. What is the previous diagnosis? Malaria *Cholangitis Viral hepatitis Sepsis Leptospirosis Patient W., 38 years old, entered to infectious hospital on the 5th days of disease in the severe condition. He complaints of the high fever with chills and sweat, general weakness, pain in sacrum. Objectively: temperature of body of 41 °С, tachycardia, positive symptom of Pasternasky, liver and spleen is not normal. Preliminary diagnosis? Malaria Cholangitis *Pyelonephritis Sepsis Leptospirosis Patient D., 39 years old, entered to infectious hospital on the second week of disease in the severe condition. Local habitant, nowhere arrived. She is complaints for the high fever with chills and sweat, general weakness. Attacks of fever without correct periodicity. Objectively: the temperature of body – 41 °С, subicterus of sclera, tachycardia, Pasrernacky‘s symptom positive, liver + 2 cm, spleen + 2 cm. What is the preliminary diagnosis? Malaria Cholangitis Pyelonephritis *Sepsis Leptospirosis Patient D., 33 years old, came to the infectious hospital on the second week of disease in the severe condition. She is complains of high fever with chills and sweat, general weakness, pharyngalgia at swallowing. Objectively: temperature of body 37,7 °С, hyperemia of mucus of pharynx, tonsils are enlarged, loose, festering raid in lacunas, enlarged submandibular, neck and axillar lymph nodes, icterus of sclera and skin, bradycardia, liver + 2 cm, spleen + 1 cm. Urine is color of beer, an excrement is discolored. What is the preliminary diagnosis? Malaria Infectious mononucleosis Viral hepatitis *Sepsis Leptospirosis Patient K, 32 years old, of no fixed residence went to see a doctor for 5-days illness with complaints of fever, severe headache, insomniA. Body temperature 40 °C, pulse 110/min. The patient is excited and talkative. Hyperemic, scleritis. The body is ocvered pink petehial rashes. Positive Govorova-Godele‘s symptom. Enlarged liver and spleen. What do you need to find out the epidemic status? *The existence of head lice Use of poor food Availability of parenteral interventions Contact with rodents Drinking water from unhygienic sources A patient L., 32 years old, who complains of severe headache and fever, on the 6th-day of illness has positive agglutination test with rickettsia reaction. What is the vector of the disease?: Flea Fly Mosquitoes Bee E. *Lice A patient L, 72 years old, who complaints of severe headaches and fever, had 6-day illness with positive agglutination test with rickettsia reaction. In the past he was sick with typhus. Vector of the disease is: Flea Fly Mosquitoes Lice *Carrier does not need a vector A patient 29 years old, few days ago, had a chill, the temperature for 2-3 days increased to 39-40 °C. There was hyperemia and edema on the person, significant sclera like "drunk" person and "rabbit" eyes. On the third day of illness – on mucous of soft palate, parenthesis bright red enanthema is seen. In 3-4-days patient tried to protrude the tongue, there was hyper movement, tremor, moving it to the side. Diagnosis: epidemic typhus. Which disease is likely in the patient? *Epidemic typhus Typhoid fever The disease Brill Paratyphoid A Paratyphoid B A patient on the 4th-day of fever has profuse rosy-petechial exanthema predominantly located on the lateral surface of the torso and limbs. Hyperemic, vascular conjunctivitis, petechial transition of anterior fold conjunctivA. What kind of illness do you think it is? Typhoid fever *Epidemic typhus Measles Hemorrhagic fever with renal syndrome Crimean hemorrhagic fever Patient B., complaints of headaches, delirium. When inspection: a body temperature of 39 °C, initiated, a person hyperemic, positive symptom Govorova-Godele, petechial rash on the trunk, limbs, tachycardia, hypotension, hepatosplenomegaly. Drunker, drug user, living in the basement room type. What is your preliminary diagnosis? AIDS infection Influenza Leptospirosis * Epidemic typhus Alcohol psychosis A patient 28 years old, of no fixed abode, hospitalized with a preliminary diagnosis «flu», a 5-day illness appeared rosy-petehia rashes on the body and interior surfaces of the extremities. The temperature of 41 °C, euphoria, hyperemia person, redness sclera, tongue tremor, tachycardia, enlarged spleen; excitement. What is the likely diagnosis? Typhoid fever Leptospirosis Alcohol deliry Measles *Epidemic typhus A watchman 42 years old, desperately ill. Entered the 6-day illness with fever 39,7 °C, severe headaches, noise in the ears, insomniA. OBJECTIVE: instituted, euphoric, talkative. Faceis red, his eyes shining, sclera and conjunctiva enhanced vascular pattern. On the inside shoulder and the side surfaces of chest rosy-petechia rash. Found on head lice and nits. Reaction Vidal 1:40. What is diagnosis? Brill disease Malaria *Epidemic typhus Typhoid fever Q-fever A patient 28 years at the 4th-day of fever has profuse rosy-petechial exanthema predominantly located on the lateral surface of the torso and limbs flexion surfaces. An individual patient hyperemic expressed vessels conjunctival injection, petechial transition to fold conjunctivA. Analysis of urine protein single hyaline and granular cylinders. What kind of illness do you think it is? Typhoid fever Hemorrhagic fever with renal syndrome Crimean hemorrhagic fever Measles *Epidemic typhus For a patients of 78 years acute illness began, which is characterized by fever with chilling, rash dominated rosy petechia elements. Agent and the source of infection is not detected, but it is known that 45 years ago patient had severe typhus. What is your diagnosis? Yersinia *The Brill‘s disease Typhoid fever Drug allergy Food Allergies The patient, a train conductor, 39 years old, hospitalized for a 4-day illness with complaints of headache, weakness, dizziness, sweating, insomnia, fever. Hyperemic, edema, conjunctivitis. At the transition fold conjunctiva – single petehies. At the skin torso, chest, abdomen, limbs abundance rosy-petechia rash. TachycardiA. AD 100 and 60. Tremor of the tongue. Palpable liver, spleen. What is the most likely diagnosis? Leptospirosis Typhoid fever Influenza Meningococcemia *Epidemic typhus A patient 30 years on 9th day of illness that began gradually, the slow rise of fever and intoxication, a painless rosy rashes on the skin of the abdomen. OBJECTIVE: pale, temperature 40 ° C, pulse 80/min, AD 100 and 65 mm RT. Art. Language is coached, abdomen bubbles, enlarged spleen and liver. For what disease you can suggest in the first place? *Typhoid fever Epidemic typhus Measles Scarlet fever Sepsis Patient 20 years old, complained about the high temperatures of up to 39 ° C, headache in the frontal area, pain in the eyeball, photophobia, pain in muscles, dry cough. Acutely ill the day before. Objective: condition serious, hyperaemic, eyes shining, vascular injection sclerA. Pulse 96/min, rhythmical. Tone heart weakened. In the lungs scattered dry bubbling rale. Faces hyperemic, granular. Meningeal symptoms are not present. Blood tests: Leu. 3?109, eoz. 1 %, yang neu. 6 %, neu. 51 %, lymph. 35 %, mon. 7 %. What is the most likely diagnosis? Measles *Influenza Meningococcal disease Pneumonia Typhus Often, in patient with epidemic typhus arise transition petechias in the conjunctivA. What term is it called? Symptom of Heller Conjunctivitis Symptom of Govorov-Godele *Symptom of Zorohovich-Chiari-Avtsyna Exanthema Rosenberg‘s Often, in patient with epidemic typhus arises petechia on mucosal soft palate. What term did it call? Symptom of Heller Conjunctivitis Symptom of Govorova-Godele Symptom of Zorohovich-Chiari *Exanthema Rosenberg‘s Often, in patient with epidemic typhus the tongue is in tremor when protruded it sticks on the lower teeth. What term did it call? Symptom of Heller Conjunctivitis *Symptom of Govorova-Godele Symptom of Zorohovich-Chiari Exanthema Rosenberg‘s A patient 29 years, a few days ago, a chill, the temperature for 2-3 days increased to 39-40 ° C. There hyperemia and edema person, significant sclera like "drunk" person and "rabbit" eyes. On the third day of illness – on mucous of soft palate, parenthesis bright red exanthema is seen. At 3-4-day patient when trying to protrude the tongue, there was hyper movement, tremor, rejecting it to the side. Diagnosis: epidemic typhus. What is the mechanicm of infection? Air-dropping Fecal-oral Contact Residential Parenteral *Vector borne Patient A., 37 years old, entered to infectious hospital on the third days of disease in the severe condition. He complaints of the high fever with chills and sweat, general weakness, pain in right under a rib. Objectively: temperature of body 41 °С, icterus of skin, liver + 2 cm, pain at palpation in abdomen, positive symptoms of Ortner and Mussy, a spleen is normal, tachycardiA. What methods is it possible to confirm a previous diagnosis by? General blood analysis *Ultrasonic research Biochemical blood test Hem culture Parasitoscopy of blood Patient W., 38 years old, entered to infectious hospital on the 5th days of disease in the severe condition. He complaints of the high fever with chills and sweat, general weakness, pain in sacrum. Objectively: temperature of body of 41 °С, tachycardia, and positive symptom of Pasternascky sign, liver and spleen not is normal. What is the previous diagnosis? What methods is it possible to confirm a previous diagnosis by? Global analysis of blood Ultrasonic research Biochemical blood test Hem culture *Parasitoscopy of blood Student of 22 years, gradually ill: hyperemia and erythema in area of right forearm, which was gradually increased to 10 cm in a diameter, appeared. Erythema has a center and raised bright red edges. The temperature of body is sub febrile, general state satisfactory. 5 days prior to beginning of illness gather mushrooms in the forest. What is our preliminary diagnosis? Erysipelas *Lime disease Ebola Erysipelas Herpetic infection Student F., 22 years old, gradually ill: hyperemia and erythema in area of right forearm, which was gradually increased to 10 cm in a diameter, appeared. Erythema has a center and raised bright red edges. The temperature of body sub febrile, general state is satisfactory. 5 days prior to beginning of illness walked in the forest after mushrooms. What laboratory methods will confirm the diagnosis? Common analysis of blood Hem culture parasitoscopy of blood RMA with leptospirosis *RIGA with borrelliea Student of 22 years, gradually ill: hyperemia and erythema in area of right forearm, which was gradually increased to 10 cm in a diameter, appeared. Erythema has a center and raised bright red edges. The temperature of body is sub febrile, general state satisfactory. 5 days prior to beginning of illness gather mushrooms in the forest. What is etiotropic therapy? *Tetracycline Metronidazole Normal immunoglobulin Glucocorticoids Enter sorbents Patient A., 28 years old, was treated in a neurological department during 2 months concerning neuritis of facial nerve. In anamnesis - 2 years ago was treated due to polyarthritis (right knee and talocrural joints). Lives in a mud flow, likes to gather mushrooms. Presence of ticks does not deny. What is laboratory and instrumental methods of research will allow specifying a diagnosis? Biological test on botulicm EEG Computer tomography of a brain RNGA with borrelliea *Lumbar puncture Patient A., 28 years old, was treated in a neurological department during 2 months concerning neuritis of facial nerve. In anamnesis - 2 years ago was treated due to polyarthritis (right knee and talocrural joints). Lives in a mud flow, likes to gather mushrooms. Presence of ticks does not deny. What is etiotropic therapy? *Benzyl penicillin Sulfanilamide’s Normal immunoglobulin Glucocorticoids Antiviral drugs Patient B., 38 years old, was treated from myocarditis in a cardiologic department. There are violations of cardiac conductivity on the type of atrioventricular blockade, tachycardiA. The temperature of body is sub febril. Arthritis of right knee-joint. Works as a forest ranger, likes to gather mushrooms and berries. What is treatment? Benzyl penicillin Nonsteroid ant inflammatory drugs Glucocorticoids Physical therapy *All above enumerated Patient P., 35 years old, was treated from myocarditis in a cardiologic department. There are violations of cardiac conductivity on the type of atrioventricular blockade, tachycardiA. The temperature of body is. Arthritis of right knee-joint. Works as a forest ranger, likes to gather mushrooms and berries. What laboratory and instrumental methods of research will allow you to specify the diagnosis? Serology ECG X-rays investigation *RIGA with borrelliea Biochemical blood test A man 28 years old was appealed to the policlinic. The day before he found a tick in the surface of his skin. He was in-field 2 days ago. He feels satisfactory. What measures of Lime disease prophylaxis? Treatment of the place of bite *Urgent antibiotic therapy Using of specific immunoglobulin Enter sorbents Vitamins Citizen A. was a participant in a business geologic expedition. Area is endemic to Lyme disease. How to prevent possible infection? *Individual protecting from ticks Urgent antibiotic prophylaxis Vaccination Using of specific immunoglobulin All above enumerated Patient of 52 years fell ill sharply from a chill and head pain, fevers to 40°C. On a 3th day illnesses are nausea and vomiting, dark urine. On a 4th day a temperature went down to 37 °, but an icterus appeared and the amount of urine diminished to 600 ml. What disease is such development of symptoms characteristic for? Hepatitis A Hemorrhagic fever with a kidney syndrome *Leptospirosis Sepsis Acute glomerulonephritis A patient L, 72 years old, who complaints of severe headache and fever, the 6-day illness positive agglutination, test with rickettsia reaction. Past sick was typhus. Vector of the disease is: Flea Fly Mosquitoes Lice *Carrier does not need A patient 29 years, a few days ago, a chill, the temperature for 2-3 days increased to 39-40 °C. There hyperemia and edema person, significant sclera like "drunk" person and "rabbit" eyes. On the third day of illness – on mucous of soft palate, parenthesis bright red enantema is seen. At 3-4-day patient when trying to protrude the tongue, there was hyper movement, tremor, rejecting it to the side. Diagnosis: epidemic typhus. Which disease is likely in a patient? *Epidemic typhus Typhoid fever The disease Brill Paratyphoid A Paratyphoid B A patient at the 4-day fever has profuse rosy-petechial exanthema predominantly located on the lateral surface of the torso and limbs flexion surfaces. Hyperemic, vascular conjunctivitis, petechial transition of anterior fold conjunctivA. What kind of illness can think? Typhoid fever *Typhus Measles Hemorrhagic fever with renal syndrome Crimean hemorrhagic fever Patient B. complaints of headaches, delirium. When inspection: a body temperature of 39 ° C, initiated, a person hyperemic, positive symptom Govorova-Godele, petechial rash on the trunk, limbs, tachycardia, hypotension, hepatosplenomegaly. Drunker, drug user, living in the basement room type. What is your preliminary diagnosis? AIDS infection Influenza Leptospirosis *Typhus Alcohol psychosis A patient 28 years old, of no fixed abode, hospitalized with preliminary diagnosis «flu», a 5-day illness appeared rosy-petechial rashes on the body and interior surfaces of the extremities. The temperature of 41 °C, euphoria, hyperemia person, redness sclera, tongue tremor, tachycardia, enlarged spleen; excitement. What is the likely diagnosis? Typhoid fever Leptospirosis Alcohol delirium Measles *Epidemic typhus A patient 28 years at the 4-day fever has profuse rosy-petechial exanthema predominantly located on the lateral surface of the torso and limbs flexion surfaces. An individual patient hyperemic expressed vessels conjunctiva injection, petechias transition to fold conjunctivA. Analysis of urine protein single hyaline and granular cylinders. What kind of illness can think? Typhoid fever Hemorrhagic fever with renal syndrome Crimean hemorrhagic fever Measles *Epidemic typhus For patients 78 years of acute illness began, which is characterized by fever with chilling, rash dominated rosy petechial elements. The condition of the patient violated moderately. Agent and the source of infection are not detected, but it is known that 45 years ago patient had severe typhus. What is your diagnosis? Lyme disease * Brill‘s disease Typhoid fever Drug allergy Food Allergies The patient, a train conductor, 39 years old, hospitalized for a 4-day illness with complaints of headache, weakness, dizziness, sweating, insomnia, fever. Hyperemic, edema, conjunctivitis. At the transition fold conjunctiva – single petechias. At the skin torso, chest, abdomen, limbs abundance rosy-petechial rash. TachycardiA. AD 100 and 60. Tremor of the tough. Palpable liver, spleen. Stool arrested. What is the most likely diagnosis? Leptospirosis Typhoid fever Influenza Meningococcemia *Epidemic typhus A patient 30 years on 9th day of illness that began gradually, the slow rise of fever and intoxication, a painless rosy rashes on the skin of the abdomen. OBJECTIVE: pale, temperature 40 ° C, pulse 80/min, AD 100 and 65 mm RT. Art. Language is coached, abdomen bubbles, enlarged spleen and liver. For what disease you can suggest in the first place? *Typhoid fever Epidemic typhus Measles Scarlet fever Sepsis Patient 20 years, complained about the high temperatures of up to 39 ° C, headache in the frontal area, pain in the eyeball, photophobia, pain in muscles, dry cough. Acutely ill the day before. Objective: condition serious, hyperemic, eyes shining, vascular injection sclerA. Pulse 96/min, rhythmical. Tone heart weakened. In the lungs scattered dry bubbling rile. Faces hyperemic, granular. Meningeal symptoms are not present. Blood tests: Leu. 3*109, eoz. 1 %, yang neu. 6 %, neu. 51 %, lymph. 35 %, mon. 7 %. What is the most likely diagnosis? Measles *Influenza Meningococcal disease Pneumonia Typhus Patient K., 23 years old., hospitalized on the 3rd day of illness, which was accompanied by mild running nose, high fever to 40,2 °C, headache and hemorrhagic rash on the skin. In the 2 hours after the introduction of penicillin blood pressure dropped to 40 and 10 mm RT. Art. Distal pulse and meningeal signs are not defined. What is the diagnosis in a patient? *Meningococcemia, infectious-toxic shock Epidemic Typhus, severe course Measles, severe course Scarlet fever, severe course Flu, anaphylactic shock A patient 25 years old, who returned from the Far East, suddenly increased body temperature to 39 °C, a pain in backbone, reddening skin type «hood», single hemorrhages on the skin. After 3 days, along with declining fever, weakness, thirst, decreased diuresis to 300 ml, decreased blood pressure. Much pronounced Pasternatsky‘s symptom. What is the most likely diagnosis? Leptospirosis Typhus Hemorrhagic fever Crimean-Congo Acute glomerulonephritis *Hemorrhagic fever with renal syndrome Male 45 years old, fell ill after 2 weeks after returning from Afghanistan, where six months ago underwent malariA. In return were found lice. Suddenly, there were severe headache, weakness, body temperature 39 ?C with a temporary decrease in the 4th day of illness, followed by general weakness, much intoxication, headache, appeared on the body abundance polymorphic rash. At the 7-day state of heavy, the phenomenon of encephalitis, excitation, hallucinations periodically. Objective – erythematos-petechial exanthemA. The temperature of the body 40,1 °C, and pulse was 136 for 1 min, blood pressure 120/70 mm RT art. Moderately enlarged liver and spleen. In the blood analys neutrofil mild leukocytosis, eozinofilia, accelerated ESR. Which of the studies of blood will be positive? At typhoid fever At the three-day malaria Tropical malaria *At epidemic typhus At brucellosis Male 26 years old, who last month returned from Africa and was processing about lice, sick 5 days. Home was a sudden: severe headache, weakness, body temperature 38,8 °C, which persisted all day at a constant level, but at the 4th day of the disease declined for several hours. Then the patient condition has deteriorated significantly, a rash on the body, delay urine. OBJECTIVE: pulse was 110 for 1 min, blood pressure 115/70 mm RT. Art., temperature 39,7 °C. Face red, a significant injection of vascular sclera, and cmall hemorrhages in the conjunctiva, mucous membrane soft palate, and abundant rosy-petechial exanthema on the body. Signs interstitial pneumonia, encephalitis. Enlarged liver and spleen. What kind of illness can think? *Epidemic typhus Typhoid fever Tropical malaria Leptospirosis Yellow fever Patient P., 68 years old, fell ill suddenly 7 days ago from the increase of temperature to 39,3 °C, appearances of headache and insomniA. Objectively: excited, inadequate. Face is hyperemic. The tongue is very dry, trembles at pulling out. On a trunk are polymorphic rash, tachycardia, and blood pressure low. Hepatosplenomegaly. Stool is absent. In age 10 years had epidemic typhus. What is the previous diagnosis? Yersiniosis Typhoid fever *Brill‘s disease meningococcemia Sepsis Patient P., 76 years old, complied during 7 days for the permanent increase of temperature to 38,2-38,7 °C, headache, insomnia, horrific dreams, dry cough, myalgia’s, arthalgias. Polymorphic rash appeared on a trunk on the 4th day of diseases. In childhood was ill by epidemic fever, three-day malariA. Temperature of body – 38,4 °C, pulse – 98 per a min, bilateral pneumonia confirmed roentgenologic. In the analysis of blood moderate neutrophil leucocytosis. What is the previous diagnosis? *Brill‘s disease Typhoid fever Lime‘s disease Malaria Leptospirosis Patients I., 78 years old, became ill saddenly, the temperature of body rose to 39,2 °C, euphoric, vessels of scleras are injection, hyperemia of face, appears enantema of Rozenberg. Reaction with Rickettsia prowazekii 1:160, IGG – 87 %. What is your diagnosis? *Brill‘s disease Typhoid fever Meningococcal infection Flu Leptospirosis Patients D., 30 years old, became ill saddenly, when the temperature of body rose to 40,2 °C, appeared headache, weakness, euphoria, injection of vascular sclera, hyperemia of face, appears the positive symptom of Govorov-Godele. Reaction with Rickettsia prowazekii 1:160, IgG – 87 %. What is your diagnosis? Brill‘s disease Typhoid fever Paratyphoid A Paratyphoid B *Epidemic typhus A patient with a pediculosis the temperature of body rose to 41,6 °C, appeared headache, euphoria, in 4th days from the beginning of illness – rose-petechial rash. Reaction with Rickettsia prowazekii 1:640, IgG – 89 %. What is your diagnosis? Flu Typhoid fever Meningococcal infection *Epidemic typhus Leptospirosis 25 years sick, which got back from Far East, suddenly temperature of body rose up to 39,9 °C, pain appeared, rash as a “jacket”, single hemorrhages on a skin. In 3 days weakness, thirst, grew together with the decline of fever, diminished to 300 ml diuresis considerably expressed Pasternatsky symptom. What is most credible diagnosis? *Hemorrhagic fever with a kidney syndrome Congo-Crimea hemorrhagic fever Epidemic typhus Glomerulonephritis Leptospirosis Person 26 years old, month ago got back from Africa and passed treatment on an occasion a pediculosis, are ill 5 days. Beginning was sudden: great head pain, a weakness, 38,8 °C, was saved all days at permanent level, but on the 4th day of illness went down on a few hours. Farther the state of patient became worse considerably, a rash, coughing, appeared on a trunk. Objectively: temperature – 39,7 °C, pulse – 110, BP - 115/70 mm/hg. The skin of person is red, considerable injection of sclera, shallow hemorrhages on a conjunctiva, mucous shell of soft palate, abundant petechial-еrythematos Signs of іnterstitial pneumonia, encephalitis. A liver and spleen is megascopic. What disease is most credible? Dengue fever Typhoid Tropical malaria Leptospirosis *Epidemic typhus Patient B., 45 years old, appealed to the hospital on the fourth day of illness with complaints of a high temperature, head pain, in muscles Two weeks ago a patient arrived from Far East. Objectively: temperature – 39,6 °C, face and neck hyperemic, vessels of the sclera’s and conjunctivitis. On a skin under collar-bones, shoulder-blades, necks, face is petechial rash in the type of chains. Pasternatsky‘s symptom is positive on both sides. What changes is characteristic for this disease in hemo gramme? *Leukocytosis neutropenia Monocytosis ESR is low Eosinophilia Sick patient, 27 age, 3th day of illness, became ill sharply. Grumbles about a chill, head myalgia, pain in muscles and joints, nausea, vomit. Objectively: hyperemia and puffiness of person, neck, thorax, petechial, “rabbit eyes”, photophobiA. Pulse – 110. Hepatomegaly. A patient arrived from Zaire. Your diagnosis? Viral hepatitis Flu Leptospirosis *Yellow fever Malaria A patient, 39 years old, became ill sharply 3 days ago after return from JamaicA. Complaints on a high temperature, severe headache, nausea, vomit by “coffee- brown”, pain in the muscles and joints. Objectively: temperature 39,9 °C, face is swollen, red, conjunctivitis, photophobiA. Rashes. Sclerotic, and skin is yellow, petechial rash, acrocyanosis. A liver is latge3 сm, painful on palpation. Tachycardia, hypotension. In hemograme are leukopenia, thrombocytopeniA. Describe the most likely diagnosis. *Yellow fever Viral hepatitis B Malaria Leptospirosis Hemorrhagic fever with a kidney syndrome At two nurses who care for the patients with fever from southern Sudan in a hospital, appeared a fever, headache, pain in muscles, joints, abdomen, general weakness and diarrheA. On the 4th day of the disease maculo-papular rash appeared on a body, on a 5th day was the bloody vomiting, melena, hypotension, and deafness of cardiac tones. The condition was extremely heavy. Put a previous diagnose. Leptospirosis Spotted fever Dengue fever *Ebola-fever Malaria A patient 26 years entered permanent establishment in 3 weeks upon termination of reaping. The state is heavy, chronotaraxis and space, high fever to 40 °C, on a skin petechial and еchimosis, on the back linear hemorrhages, sanguifluousness from a nose and gums, there was vomit by “coffee-grounds”. Pasternatsky symptom is sharply positive. At the laboratory inspection: neutrophilic leukocytosis, thrombocytes – 100 thousand in 1 ml, hematocrit – 0,55, day's amount of urine 70 ml, protienuria, еrythrocyturiA. What disease does it follow to suspect? *Hemorrhagic fever with a kidney syndrome Leptospirosis, anicteric form Salmonellosis, septic form Lassa hemorrhagic fever Crimean hemorrhagic fever A boy 12 years old is hospitalized in an infectious department. Became ill 7 days ago from appearance of a headache, hyperthermia up to 40,3 °C, pain in muscles, general weakness. In 2 days after normalization of temperature of body the appeared hemorrhagic rash on the skin and mucus’s, nasal bleeding, icterus, hepatospleenomegaly. Three weeks ago got back from rest in South AfricA. There have been repeated mosquito bites. What infectious disease does it follow to suspect above all things? Dengue fever *Yellow fever Leptospirosis Malaria Q-fever A boy 10 years of age, who lives in Transcarpathia, on the 4th day of fever appeared painless hemorrhagic petechial rushes, sometimes in the form of red and purple stripes with overwhelming localization on a neck, thorax, in the axillary, above collar-bones. On hyperemic mucus of oro-pharing point hemorrhages, bleeding from a nose. In lungs was hard breathing, tones of the heart deaf, bradycardia, swelling and abdomen-ache, enlarged a liver and spleen. Oliguria, proteinuria, hematuria, cylindruriA. In blood neutrophilic leukocytosis, thrombocytopenia, accelerated ESR. What diagnose is previous the most reliable. Meningococcal infection *Hemorrhagic fever Rheumato cells Leptospirosis Thrombocytopenic purpura In ambulance delivered a girl 14 years, which became ill 6 days ago from appearance of weakness, increase body temperature to 39,3 °C, enanthema appeared on the skin and mucous and had hemorrhagic character, icterus, nasal bleeding, increases of liver and spleen. 2 weeks ago got back from a festival in Brazil. What infectious pathology should be eliminated first? *Yellow fever Q-fever Dengue fever Malaria Viral hepatitis A 30-year-old resident of Peru brought to the hospital at the 4th day of illness, there was vomiting with blood, nose bleeding, icteric skin, petechial. In urine revealed erythrocytes protein. Volume of urine decreased. What is the preliminary diagnosis? *Yellow fever Dengue Fever Malaria Lassa fever Ebola fever Family week ago got back from the trip on AfricA. In a few days at a child 10 years the temperature of body rose to 40 °C, on a next day vomit, diarrhea with the admixtures of mucus, blood. The state gets worse gradually. On a 4th day on the skin of extremities, trunk appeared single hemorrhage, hemorrhage on a soft palate. What credible disease from will you settle tactic of conduct of patient coming? *Hemorrhagic fevers Grigoriev-Shiga dysentery Leptospirosis Meningococcal infection Salmonellosis The soldier, who arrived on vacation from Sierra Leone, was taken to hospital in connection with the febrile illness. Suspected Lassa fever. What kind of laboratory indicators is characteristic for this disease? The decline in serum indicators KFK and LDG ESR greater after 60 mm/hour Neutrophil in liquor Elevated levels of alkaline phosphatase in the serum *High proteinuria At patient, who acted to permanent establishment, on clinical epidemiological indexes of Lassa fever is suspected. What from the resulted clinical indexes are not characteristic for this disease? *Hemolytic icterus Generalized lymphadenopathy Conjunctivitis Ulcerous pharyngitis Encephalopathy At patient, who acted to permanent establishment, the especially dangerous hemorrhagic fever is suspected. For the selection of exciter can be used all materials, except for? Blood *Puncture from lymph nodes Urines Pleura liquid Swab from nasopharyngeal In a patient who is at the hospital about high fever disease, which arose up suddenly, a diagnosis of Ebola fever. The severity of the state can be attributed to the development of the following emergency conditions, except for: *Acute respiratory insufficiency Infectious-toxic shock Hypovolemic shock Hemorrhagic shock Acute kidneys insufficiency In a serviceman, who acted to permanent establishment, set previous diagnosis of especially dangerous hemorrhagic fever. What from the transferred terms of latent period does follow at determination of duration of primary disease measures? 6 days 10 days 40 days *21 day 72 hours At a patient with the hemorrhagic fever with a kidney syndrome a diuresis decreased to 300 ml, the рН of blood is 7,0; increase the level of creatinine and urea on the blood. Intensive therapy is conducted. Which of the funds should not be considered appropriate? *Hypotension drugs Heparin Introduction of entero sorbent solution Introduction 4 % solution of sodium bicarbonate Saluretics At a resident of Colombia on the 3th day of illness was a high temperature, head pain, marked pains in back and extremities appear. At the inspection: face is hyperemic, edema, scleritis. Tongue is assessed by the white coats, pulse frequent. Abdomen is soft, sickly in a еpigastric areA. 7 days ago got back from forests. What is previous diagnosis? Ebola fever Dengue fever Hemorrhagic fever with a kidney syndrome Lassa fever *Yellow fever You are flying in an airplane from the Republic of Zaire. Waitress asks to help a child 12 years old. In inspection – at the torso, limbs, palms and soles are determined multi bubbles. Parents indicate that over 4 days before the child's fever was 40 °C. Rash developed gradually, on the first day of the face, on the second day on the body, on the third day in the limbs. What is the best tactic? *The immediate message to ground air traffic controllers on the case, the suspect cmallpox Reassure parents, said that the state is a manifestation of allergic reaction Immediately enter dexamethasone Immediately begin antibiotic therapy Immediately enter vaccine To you, as to the graduating student of medical university, is possibly to work upon termination of studies in CrimeA. What endemic ticks infections is in this territory? *Crimean hemorrhagic fever, tick encephalitis, Q-fever Crimean hemorrhagic fever, malaria, epidemic typhus Tick encephalitis, Ebola fever, Lassa fever, Crimean hemorrhagic fever Q-fever, spotted fever, leptospirosis Q-fever, Crimean hemorrhagic fever, psittacosis, tick encephalitis Sick 37 years person on Crimea grumbles about a high temperature, non-permanent vomit head pain. On the 4th day of illness: the state is severe, temperature of body 38,9 °C, skin pale, mucous shells are hyperemic. On a soft palate is hemorrhagic enanthema, hemorrhages in sclera reveal. On lateral area of trunk – petechial rash. Pulse is weak, 120/min, BP – 90/50 mm/hg. Abdomen is soft, painless. What from therapeutic facilities not are prescribed in this case? Cyclopheron *Biseptol Glucocorcoids Suprastine Depiridamol Patient 25 years, which got back from Far East, suddenly temperature of body raised to a 39 °C, pain appeared in back, erubescence as “jacket”, single hemorrhage on a skin. In 3 days a weakness, thirst, grew together with the decline of fever, diminished to a 300 ml diuresis, the arteriotony went down. Considerably expressed Pasternasky symptom. What diagnosis is most credible? Typhoid fever Crimea-Congo hemorrhagic fever *Hemorrhagic fever with a kidneys syndrome Acute glomerulonephritis Leptospirosis Patient 39 years, grumbles about the high temperature, sharp pain in a head, back, muscles of extremities, photophobiA. At a review is pallor of nasolabial triangle, hyperemia of person, neck, overhead half of trunk, by the positive Pasternatsky symptom on either side. Eyeing cracks lips, injection of sclera’s. Mucous of mouth bright red with point hemorrhages. On a neck, lateral surfaces of thorax, in arm-pits fossulas, above the collar-bones of petechial rushes in the form of asterisks and forms group as red or violet strips. What diagnosis is most credible? Marburg fever Congo-Crimean hemorrhagic fever *Hemorrhagic fever with a kidney syndrome Ebola fever Lassa fever Patient complaints of the increasing body temperature up to 40,2 °C, pain in the head, joints and muscles, limbs and back, abdomen, frequent vomits. Patient is excited. Neck, overhead part of breasts are hyperemic, scleratis and conjunctivatis of both eyes. Mucous of oral cavity is hyperemic with punctulate еnanthema, soft palate is filling out. On the 2-4th day of illness on the skin of lateral surface of trunk, and arm-pits areas, on abdomen and extremities appeared petechial rushes oval form with the clear contours of darkly-cherry blossom. Simultaneously mucosal bleeding appeared from gums, nose, lights, digestive channel uterus. Liver is megascopic. Positive Pasternaskiy‘s symptom. What diagnosis is most credible? Yellow fever Congo-Crimea hemorrhagic fever *Hemorrhagic fever with a kidneys syndrome Lassa fever Ebola fever Sick person 34 years old, became ill suddenly – rose temperatures of body, vomiting. Patient disturbs pain in a head, back, joints, and bones. Hyperemia and puffiness of face and neck, eyes are poured by a blood. Patient is excited. The yellow coloring of skin and sclera’s appeared on the 3th day of illness, point hemorrhages on a skin, liver and spleen was multiplied. What diagnosis is most credible? *Yellow fever Congo-Crimea hemorrhagic fever Hemorrhagic fever with a kidneys syndrome Lassa fever Ebola fever Sick C., 33, appealed on the 5th day of illness. In second day the temperature of body was raised to 40 °C, delirium happened. An icterus grew. Vomits was dark-brown color, stool – dark (melena). Petechial and ecchymosis exanthema appeared on the skin of trunk and extremities. There was the nasal and uterine bleeding. Oliguria, blood and cylinders in urine, azotemiA. In the blood test – leukopenia – (1,5-2,0?109), neutropenia, increasing of ESR. Hyperbilirubinemia (due to both fractions of pigment), increasing of activity of aminotransferases, in urine was bilirubin, urobilin. What diagnosis is the most credible? *Yellow fever Viral hepatitis A Viral hepatitis B Viral hepatitis hepatic encephalopathy Crimean hemorrhagic fever Patient, 30 years old, lives in Egypt. Became ill sharply. A temperature with a chill rose to 39 °C and was contained next 3 days. Disturbed headache, severe muscle pain. The skin of person is hyperemic, injection of sclera and conjunctiva vessels, hyperemia of nasopharyngs mucous. Pulse – 80/min, lowered blood pressure. Increasing of lymphatic nodes. Phenomena of bronchitis in lungs, cough insignificant, not productive. Petechial rush on the skin of overhead and lower extremities. Bleeding of gums, nose-bleeds. Enlarged liver. How do to confirm a credible diagnosis? Bacteriological *Virologic Research of drop of blood in the dark field Research of hanging drop of blood Research of thick drop of blood The Patient, a hunter, lives in Russia (Ural), arrived to Ukraine 2 weeks ago. Became ill sharply. A temperature rose to 39 °C. Disturbed severe headache, pains in the back, muscles, extremities. There was vomit, photophobiA. Decline of sharpness of sight. Consciousness is some darkened. Hyperemia of face, pallor of nasolabial triangle, injection of sclera’s vessels. Petechial rush pouring out trunk as strips. Pulse 110 per 1 min. Tones of heart is hypostheniA. Tongue is dry, abdomen is blown away. Megascopic liver. Sharply positive Pasternatskiy‘s symptom. OliguriA. In urine: protein, hailing, fibrin cylinders, renal epithelium cells. About what disease is it possible to think? hemorrhagic fever Yellow fever Leptospirosis *Hemorrhagic fever with a kidneys syndrome Crimea hemorrhagic fever Sick, 35 years, habitant of CrimeA. Became ill sharply. With a chill a temperature rose to 39,5 °C. Disturbed pain of head, joints, in muscles, frequent vomits. Face, neck, overhead part of thorax, is hyperemic. Sclerotic, conjunctivitis. Petechial rush over the trunk. The state got worse. Uterine and intestinal nose-bleeds joined. Hyperemia of face changed by a pallor and puffiness. Patient a dynamic, consciousness is darkened. OliguriA. In spite of haematostatic therapy patient died. About what disease is it possible to think? Lassa fever Yellow fever Q-fever *Crimea hemorrhagic fever Omsk hemorrhagic fever A man, a resident of Nigeria, became ill sharply. Appeared a chill, repeated vomiting, body temperature had risen to 39,5 °C. A patient is excited. Hyperemia and puffiness was marked of face, expressed sclerotic, hyperemia of mycoses mouth cavity. Pulse 130 per 1 min. The icterus of skin and sclera appeared on a 3th day, hemorrhages on a skin. A liver and spleen is enlarged. After the brief improvement in the 5th day of illness the state became worse sharply. A temperature again rose to 39,9 °C. Raves. An icterus grew sharply. Vomit moderate. Vomiting and feces of black color. Nose bleeding. Petechial enanthemA. Tachycardia changed on bradycardiA. Blood pressure 80/50 mm/hg. OlyguriA.About what disease is it possible to think? Lassa fever *Yellow fever Q-fever Crimea hemorrhagic fever Omsk hemorrhagic fever A woman, a resident of Nigeria, became ill sharply. Appeared a chill, repeated vomiting, body temperature had risen to 39,7 °C. A patient is excited. Hyperemia and puffiness was marked of face, expressed sclerotic, hyperemia of mycoses mouth cavity. Pulse 130 per 1 min. The icterus of skin and sclera appeared on a 3th day, hemorrhages on a skin. A liver and spleen is enlarged. After the brief improvement in the 5th day of illness the state became worse sharply. A temperature again rose to 39,9 °C. Raves. An icterus grew sharply. Vomit moderate. Vomiting and feces of black color. Nose bleeding. Petechial enanthemA. Tachycardia changed on bradycardiA. Blood pressure 80/50 mm/hg. OliguriA. Viral hepatitis A Leptospirosis *Yellow fever Crimean fever Malaria At workers laboratories, which looked after marmosets which were brought from Uganda, great pain appeared heads, myalgia’s, dryness in a mouth cavity, nausea, vomits, frequent watery emptying, afterwards pains joined in the area of lower ribs which increased at a cough. On the 4th day of disease a hemorrhagic syndrome appeared are hemorrhages in a conjunctiva, sanguifluousness of gums, blood in vomiting. Maculo-papular pouring out on a trunk. Credible diagnosis? Lassa fever *Marburg fever Leptospirosis Ebola fever Crimean fever A patient, habitant of Nigeria, grumbles about the increase of temperature, general weakness. Gradually a temperature rose to 38,9 °C, pain of head increased, pains appeared in muscles, nausea, and conjunctivitis. On a 3th day necrotizing ulcer pharyngitis developed. Ulcers appeared on soft palatine tonsils. The groups of lymphatic nodes of neck were multiplied. The state got worse. Abdomen-aches joined, vomit, diarrhea, pain in a thorax, cough. Relative bradycardiA. About what disease is it possible to think? Flu Typhoid fever *Hemorrhagic fever Quinsy Spotted fever Patient 45 years old, approached into the hospital on a 5th day of illness, 8 days ago he arrival from Laos, complaining of fever, headache, general weakness. OBJECTIVE: body temperature is 40,2 °C, skin moist, sclera inject, subichteric, acrocyanosis, cardinal tone dull, the increase of liver and spleen. What does the most often complications develop in malignant forms of this disease? Coma Lung edema *IVD syndrome Acute liver failure Acute kidney failure Patient G., complaints on the increased of body temperature to 39-40 °C, a sharp pain in the head, in the back pain, in the muscles of limbs, photophobiA. Objectively: nosolabial triangle was pallor; face, neck, half upper torso was hyperemic, a positive Pasternatskiy‘s symptom on both sides. Gaps narrowed eyes, sclerotic. Mucous membrane of faces bright was red with point hemorrhages. At the neck, thorax side surfaces, in axillary, over collarbone was petechial rash in the form of stars and grouped in the form of red or violet strips. What is the most likely diagnosis? Yellow fever Crimean-Congo hemorrhagic fever *Hemorrhagic fever with renal syndrome hemorrhagic fever Crimean hemorrhagic fever Patient A., 25 years old, is being treated concerning tetanus. Choose the specific treatment. Antibiotics *Immunoglobulin Anticonvulsant medicine Cardiac preparations Respiratory analeptics Patient D., 47 years old, veterinary doctor, admitted to infections department on 2nd day of disease in quite severe condition with expressed intoxication, high temperature (40 °C); general weakness, exhausting cough with runny bloody sputum. Objectively: cyanosis of mouth, pulse 128 per minute, mucous membranes of mouth cavity lightly hyperemic, due to significant edema of nasal and pharyngeal mucous present impediment breathing, during lungs auscultation – dry and moist rales, in permutation – areas of consolidations. Deaf heart tones, AP - 85/50 mmHg. From epidemiologic anamnesis revealed, that patient during a week till the onset of disease work with ill animals. Part of the animals died. What is the most possible diagnosis? Community-acquired pneumonia *Anthrax, lung form Plague, lung form Atypical pneumonia (SARS) Q-fever In a villager, on back surface of right fist appeared itching papule, in the center of which is present swelling with ichoric content. In next 2 days develops edema of fist and forearm. On 4th day increase of body temperature, in axillaries region of right revealed large painful lymphatic nodule. One day before the beginning of disease, patient had contact with dead calf. What is the most possible diagnosis? Plague, skin-bubonic form *Anthrax ulcer, skin form Common carbuncle Tularemia, skin-bubonic form Sepsis To villager an itching papula appeared on the back surface of right hand, in the center of which a bubble with ichor content appeared. During the next two days developed edema of hand and forearm . At 4th day appear body temperature, in right axillary region observe large painful lymph node. Patient examined a dead bull a day ago to beginning of illness. Most credible diagnosis? Plague, skin-bubonic form *Anthrax, skin form Banal carbuncle Tularemia, skin-bubonic form Sepsis Young woman, a milkmaid, was admitted to the infectious department. Became ill 3 days ago. An itching node appeared on the neck. She continued to work, her state became worse on the eve of hospitalization, body temperature – 38,1?C, edema at neck and upper part of thorax, with serous-hemorrhagic excretions, not painful. No animal disease was registered during the last year in diary form, where she works. What diagnosis is it necessary to suspect? Furuncle Tularemia Cu-fever *Anthrax Sap 2 men admitted in the clinic of infectious diseases, attendant of cattle farm. Both complaints on increase of body temperature, headache, and injury of skin of hands like ulcers uncoated by crusty black covering. Became ill 3 days ago. At first at the skin of hands appeared 2-3 red spots, then in the place of spots appear bubbles, bursting with formation of the ulcers covered by a dense black scab. Around the scab appeared inflamed red colored secondary vesicles, all is surrounded by the soft studnevidnim edema but not painful. Patients care for the ill bull 4 days ago to illness. What is the most credible diagnosis? Plague Erysipelas Carbuncle *Anthrax Tularemia Men D., 44 years old, received a suspicious letter. A letter must be read, however a recipient fears that his content can be potentially dangerous in regard to anthrax. In this situation, it is necessary: To through it, not unsealing *Cover a letter by a moist gauze and iron it on heated till 250°C Burn out a letter Deliver it in sanepidemic unit Send back A patient has the suddenly expressed edema in half face and neck. In the center of edema is the black scab surrounded by cmall vesicles. Paracervicle and submandibular lymph nodes are increased in size. The changes on face are not accompanied by pain. During examination, patient has temperature 37,5 °C. What is the most credible diagnosis? *Anthrax Plague Tularemia Erysipelas Furuncle Patient A., 43 years old, was admitted in infectious hospital with complaints on a high body temperature and severe headache. He is ill 2 days. By examination observe carbuncle on forearm with the expressed edema around it and insignificant painful. Regional lymphadenitis. It is known from anamnesis that a patient works on a stock-raising farm. About what disease is it necessary to think about? Erisipelias Cancer of skin Erysipelas *Anthrax Eczema A patient W., 40 years old, veterinary, is ill 3 day: insignificant weakness, body temperature – 38 °C, at right forearm – ulcer of diameter 1,5 cm, covered by dark brown scab, surrounded by hyperemia with cmall vesicles. Expressed edema of soft tissue of forearm. Enlarged and sensible lymph nodes on the right elbow and arm pit. On the hands fresh scratches. What is the most credible diagnosis? *Anthrax Erysipelas Felines Staphylococcal carbuncle Tularemia, ulcerous-bubonic form Patient A., complaints of redness of skin and edema at the right cheek. During examination: body temperature – 38,7 °C, painful and edematous submandibular lymph nodes on the right side, can clearly differentiate between hyperemia and healthy skin, bubbles with a dark liquid inwardly, painful palpation. Your preliminary diagnosis? *Erysipelas, hemorrhagic form Anthrax, skin form Herpetic infection Chicken-pox Phlegmon of cheek Patient V., appealed to the surgeon with expressed edema of left half of neck. During examination a doctor observe a carbuncle on the lateral surface of neck and a few cmall bubbles near it, filled with a rather yellow liquid. Submandibular and anterior cervical lymph nodes are enlarged and painful. What diseases is the most credible? *Anthrax Diphtheria edema Plague Carbuncle of neck Patient P., 40 years old, is a farmer. He is ill during 3 days. He complaints of sub febrile temperature, headache. There is a large edema on the left arm. There is a vesicle (0,3x0,5 cm) in the center of it; which contains the serous and bloody liquid, painless, with considerable peripheral erythemA. What is clinical diagnose? Plague Erysipelas Carbuncle Tularemia *Anthrax Young woman, a milkmaid, was admitted to the infectious department. Became ill 3 days ago. An itching node appeared on the neck. She continued to work, her state became worse on the eve of hospitalization, body temperature – 38,1 °C, edema at neck and upper part of thorax, with serous-hemorrhagic excretions, not painful. No animal disease was registered during the last year in diary form, where she works. What method is possible to confirm a diagnosis? Examination of blood in the dark field RIFA with anthrax antigen *Bacteriologic examination of content of ulcer Bacteriologic examination of blood Patient C. has got significant edema of half of face and neck. In the middle of edema there is a black scab, surrounded by cmall vesicular. There are enlarged submandibular and frontal neck lymph nodes. The changes on face are not accompanied with pain. Temperature of body at examination is 37,5 °C. What is the most credible diagnosis: *Anthrax Plague Rabbit-fever Erysipelas Furuncule A teenager was bitten by a neighbor’s dog. This dog is not instilled; it’s on a leash and bit the boy after provocation in the area of hand. What should be done for the prophylaxis of rabies? Elimination of dog Inoculations on vital testimonies *Conditional course of inoculations Surgical treatment of the wound All answers are correct Woman of 33 years was attacked and bitten by a bat in the area of hand aggressively and bit a woman on her hand. During the laboratory research the diagnosis of rabies was confirmed. What should be done for the urgent prophylactic of the rabies in this case? Human rabies immunoglobulin 18 doses of anti rabies vaccine 12 doses of anti rabies vaccine *Human rabies immunoglobulin and 6 doses of vaccine Human rabies immunoglobulin and 21 dose of vaccine 2 doses of vaccine Wild dog bite man for fingers of the left hand. What kind of specific prophylaxis should be conducted for this patient? *Human rabies immunoglobulin 6 doses of vaccine 12 doses of vaccine Human rabies immunoglobulin and 16 doses of vaccine Human rabies immunoglobulin and 21 dose of vaccine 2 doses of vaccine Patient A., 25 years old, is being treated concerning tetanus. Choose the specific treatment. Antibiotics *Immunoglobulin’s Anticonvulsant medicine Cardiac preparations Respiratory analeptics During a walk in-field a fox attacked on a child, bit his feet and racemes of hands and disappear. An animal disappeared. What is medical tactic. To process a wound surgically *To process a wound soapy solution, to enter an immunoprotein and vaccine Preventive vaccination To process wounds surgically, to enter an human rabies immunoglobulin and vaccine Preventive human rabies immunoglobulin A 23 years old person, became ill sharply: fever 38.2 °C, moderate diffuse pharyngalgia at swallowing, pain and itching in the right eye. Objectively: tonsillitis, pharyngitis, conjunctivitis. What is previous diagnosis? Adenoviral infection Enteroviral infection Para influenza Flu Acute respiratory infection A 25 years old patient, fell ill rapidly, with chills and temperature rose to 39,9, headache appeared in front temporal regions, pain in eyeballs, dull pain in all trunk, closed nose. Dry cough after 2 days of illness, there was nose bleeding. Objectively: hyperemia with sputum, isolated petechial rash and shallow grittiness of soft palate. Difficult breathing in lungs. What is the most possible diagnosis? Leptospirosis Adenoviral infection Typhoid fever Flu Epidemic typhus A child 10 years old with temperature 38,0 °C, conjunctivitis, moist cough, hyperemia of the mucous membranes of cheeks and lips. Gums are pallor. What is your diagnosis? Measles *Adenoviral infection Acute respiratory viral infection Enteroviral infection Infectious mononucleosis A child 3 years old is found in the grave condition – naughty, forced breathing, dry «barking» coughing, voice is hoarse, perioral cyanosis. The third day, temperature of body is sub febrile, mild common cold. In lungs single dry wheezes can be heard. Moderate tachycardiA. For which disease these symptoms are characteristic? Localized diphtheria of oropharynx Whooping-cough *Para influenza, false croup Bronchopneumonia Adenoviral infection A child of age 2 years has temperature of body 37.3 °C, cold, hoarse voice “barking cough” appeared suddenly the anxiety, shortness of breath, appeared with participation of auxiliary muscles. Supposed diagnosis? *Para influenza, false croup Diphtheria croup Allergic laryngitis, croup Flu, laryngitis Acute exudative pleurisies A patient 14 years old, hospitalized in the infectious department in severe condition with considerable headache mainly in frontal and temporal area, pain in eyeballs, in muscles and joints. Objectively: patient is excited, temperature of the body is 39 °C. Bradycardia changed by tachycardiA. Muscles tonic and colonic cramps. Positive meningeal signs. It is found in epidemic anamnesis, his brother is also sick. What is your diagnosis? *Flu with pneumonia and edema of brain Flu, typical course Para influenza, false croup Respiratory-syncytial infection Adenoviral infection, pneumonia A patient 17 years old, became suddenly ill: temperature rose to 40,3 °C. Severe headache, motive excitation, frequent vomiting, tremor of fingers of extremities. Hemorrhagic spots of round form and different sizes, more frequently as stars, mainly on buttocks and trunk. Meningeal signs are positive. What is the most possible diagnosis? Encephalitis Flu with a hemorrhagic syndrome *Meningococcal infection Measles Leptospirosis A patient 17 years, 11th class student, were a lot of cases of ARI (acute respiratory infection) have happened, appealed to a doctor in clinic at 3rd day of disease with complaints of chills, general weakness, a moderate sore throat, running nose, swelling of face, watering from eyes. Objective examination: minor palatal hyperemia brackets and tonsillitis, on a background of moderate edema of tissues. Conjunctivitis. During palpation not painful enlarged inframaxillary lymph nodes, and enlarged neck lymph nodes were found. Crepitation can’t be found. Liver and spleen moderately increased. What is the most likely diagnosis? Diphtheria *Adenoviral infection Meningococcal nasopharyngitis Influenza Infectious mononucleosis A patient 18 years old, with complaints of headache, pharyngalgia, weakness, high temperature. Objectively: all groups of lymph nodes, 1-3 cm in a diameter, dense, elastic, enlarged, hepatospleenomegaly. Blood analysis: leukocytosis, mononuclear – 15 %. What is possible diagnosis? *Infectious mononucleosis Adenoviral infection Angina Diphtheria Acute lymphocytosis A patient 20 years old fell ill rapidly with increasing of temperature to 39.9 °C. Complaints of headache in front temporal region, pain in eyeballs, dull ache in whole trunk, closed nose, scrapes in the throat, dry cough. There was nose-bleeding. What diagnosis is most possible? *Influenza Adenoviral infection Para influenza RS-infection Enteroviral infection A patient 20 years old, complaints of increasing of temperature up to 39 act, headache in frontal area, pain in eyeballs, photophobia, pain in muscles, dry cough. Became ill sharply. Objectively: severe state. Face is hyperemic, eyes brilliant, injections of sclera’s. Pulse 96/min, rhythmic, tones of heart arehypostheniac. Meningeal symptoms are not present. Blood analysis: leuk 9*109, е 1 %, bands 6 %, seg 51 %, lymp 35 %, mono 7 %. What is the most possible diagnosis? *Influenza Adenovirus infection Leptospirosis Pneumonia Epidemic typhus A patient 26 years old, became sick rapidly: temperature 39.5 оC, severe headache, mainly in frontal and temporal areas, pain in muscles and joints. Examined on the 2nd day of illness: state of middle weight, skin is clean. Moderate hyperemia with cyanosis, pulse 120 per min, rhythmic. Heart activity is rhythmic, tones are muffled, in lungs there is vesicular breathing. What is the treatment of this patient? Aspirin *Remantadin Ampicillin Ascorbic acid Ribonuclease A patient 27 years old, entered clinic on the 4th day of illness with a diagnosis ARVI, allergodermiA. Fell ill with the rise of temperature to 38,0 °C, headache, hyperemia of the throat, then barking cough appeared. On the 3rd day rash appeared on the skin and neck. Was treated by aspirin. Objectively: temperature 38.8 °C. Face is puffy, conjunctivitis. On the skin of neck and upper part of chest is an abundant red-papular rash as rings which do not itch. Mucosa of epiglottis is brightly hyperemic. Submandibular and neck lymphadenitis. Liver and spleen were not enlarged. What is your diagnosis? Measles *Allergic dermatitis Infectious mononucleosis German measles Scarlet fever A patient 56 years old, the day before felt easy indisposition, insignificant headache, and weakness. Afterwards the increasing of temperature appeared to 38,5 оC with chills, headache increased considerably, mainly in forehead and temples. Skin and conjunctiva is hyperemic, dry, barking cough. Pharynx is hyperemic. On soft palate present grainy granules, placed point hemorrhages. Difficult breathing. What is the most possible diagnosis? Typhoid fever Leptospirosis Epidemic typhus *Flu Enteroviral infection A patient becomes sick very fast: chills, increasing of temperature to 40,1 оC, headache in frontal and temporal regions, pain in eyeballs, close nose, dry cough and pain in the chest. The nose bleeding, nausea, double vomits. Objectively: conjunctivitis, hyperemia, edema, hemorrhages in mucous of otopharhynx, tachycardiA. Blood pressure is low. Difficult breathing . What is the most possible diagnosis? Meningococcemia Epidemic typhus Leptospirosis *Flu Typhoid fever A patient 56 years old, workwomen of pig farm, on a background chills appeared, the temperature rose to 39,9 °C, headache, and nauseA. The next day marked pains in the muscles of lower extremities appeared, the nose bleeding began. At the receipt, on the 3rd day common state deteriorated. Hyperemic spots, subecteric appeared. Liver +3 cm. daily – diuresis 700 ml. What is the previous diagnosis? Hemorrhagic fever with a kidney syndrome Hepatitis A Escerichiosis Flu *Leptospirosis A patient A., 30 years old, on the 4th day of illness a district doctor marked such subjective and objective data: insignificant indisposition, mild headache, hoarseness of voice, itching in throat, breaking dry cough, temperature of the body 37,4 °C. Pulse 86/min., difficult nasal breathing, insignificant serous excretions from nose. Which acute respiratory infection does the patient carry? Influenza *RS-viral infection Para influenza Adenoviral infection Enteroviral infection A patient admitted in the infectious department with diagnosis of acute respiratory viral infection. Became ill suddenly, the disease is accompanied by the increase of temperature of body till 39 °C, by severe headache, mainly in area of frontal, temporal, above eyes, dryness in nose, itching in throat, dry cough, and dull pain in all body. He had bleeding from nose twice at home. Which acute respiratory disease has the patient? Adenoviral infection RS-infection *Flu Para influenza Enteroviral infection A patient C., was hospitalized on the 2nd day of illness with complaints of hoarseness of voice, rough barking cough, labored breathing. Objectively: the state is severe, uneasy, pallor, temperature 37.1 °C, BR 30/min., breathing is noisy, can hear from the distance, with participation of auxiliary musculature. Which viruses could cause development of similar state? Rhino virus Influenza virus Adenovirus *Para influenza virus Cytomegalovirus A patient caused a doctor home. Age – 75 years. Complaints of a sub febrile temperature, general weakness, pharyngalgia, conjunctivitis. In family a child is ill the acute adenoviral disease. A patient considers itself a patient the second day. At a review are found out the signs of acute blepharoconjunctivitis, pharyngitis. There are megascopic lymphatic knots: neck front and back, arm-pits and inguinal, to 1 cm in a diameter, soft, not is soldered between itself and with surrounding cellulose. A pharynx is hyperemic, tonsils are hypertrophied and hyperemic. In lights of wheezes it is not. Breathing clean. Tones of heart are muffled. BP is 140/80 mm Hg. Ps – 80 per 1 minute. Abdomen soft. A megascopic liver which comes forward on 3 cm below costal arc and spleen are palpated – soft, painless. Choose the most credible diagnosis: *Adenoviral infection Flu Megablastoma Infectious mononucleosis Hepatitis A A patient fell ill very rapidly: chills, increase of temperature to 40.1 °C, headache in front temporal regions, pain in eyeballs, close nose, dry cough, and chest pain. Nose bleeding, nausea, vomiting appeared after 4 hours. Objectively: conjunctivitis, hyperemia, edema, point hemorrhages in mucus of epiglottis, tachycardiA. Blood pressure is low. Weaken breathing in the lungs. What is the most possible diagnosis? Leptospirosis Epidemic typhus *Flu Meningococcemia Enteroviral infection A patient H., 22 years old, with flu was hospitalized into infectious department with the acute worsening of the common state. Consciousness is stored. The patient strangles. Pallor of skin with cyanosis. Respiratory rate 50 per min, AP 80/55 mmHg, pulse 110 per a min, temperature 39.8 оC. During percussion of lungs tympanic sound with dullness in lower quadrant was found. Crackles in the lower-back parts of lungs. What complication of influenza has developed in that patient? Pneumonia Edema of lungs Edema of brain *Infectious-toxic shock Meningoencephalitis A patient on the background of ARVI the fever developed to 40,1 °C, frequency of breathing is 40 for a minute. What measures are necessary? *Decreasing of patients temperature Artificial ventilation Oxygen. inhalation Infusion therapy Antibiotic therapy A patient P., 14 years old, is hospitalized in the infectious dept. in grave condition. Complaints on headache, mainly in frontal and temporal regions, superciliary arcs, vomiting on severe pain, pain on movement of eyeballs, in muscles, joints. Objectively – a patient is excited, temperature of the body 39 °C. BP 100/60 mmHg. Bradycardia was replaced by tachycardiA. Tonic cramps appeared. Doubtful meningeal signs. From anamnesis it is found that at home his brother has flu. What preparations must be injected? Verospiron, euphyllin, dimedrol *Mannitol, paracetamol, prednisolone, euphyllin Analgin, dimedrol, aspirin, ampicillin Mannitol, aspirin Lasix, analgin, ampicillin A patient with flu complicated by pneumonia, during some days there are the displays of infectious-toxic shock of ІІ degree. In BA the level of urea and keratinize increases. What from these preparations is not recommended to enter in such a situation? *Adrenalin Prednisolone Polyconic solutions Dofaminum Heparin A patient Т., 45 years old, was hospitalized at the 2nd day of disease. One week ago got back from India (sailor of the distant swimming). Complaints of temperature 41.3 °C, great headache, shortness of breathing; cough with foamy pink color sputum. Objectively: pale of face, cyanosis of mucous, breath rate 24/min, tachycardiA. Lungs: breathing is hyposthenia, moist wheezes in both lungs, crepitation. What is possible diagnosis? Flu Miliary tuberculosis *Plaque, pulmonary form Leptospirosis Sepsis A patient, 20 years old, during few days complaints of pharyngalgias. After supercoiling the state became worse: sudden chills, increase of temperature to 40.6 °C, headache. On the skin of low extremities, trunk and buttocks there are a lot of different sizes hemorrhagic spots, acrocyanosis. Consciousness is preserved. Meningeal signs are absent. What is the previous diagnosis? *Meningococcal infection Flu Epidemic typhus Hemorrhagic fever Leptospirosis A student, 18 years old, for 7 days complaints of weakness, hyperthermia to 37.8 °C, mucous excretions from a nose, pharyngalgia at swallowing, pain in eyeballs. Objectively: increased lymph nodes of neck and mandible, lymphadenitis, edema and injection of conjunctiva, hyperemia of mucous of epiglottis, hypertrophy of tonsils. What is the most reliable diagnosis: *Adenoviral infection Influenza Infectious mononuleosis Rhinoviral infection Parainfluenza A woman 27 years old, complaints of the general weakness, absence of appetite, coughing, fever up to 37.5 °C for three weeks. Ulcerous illness of abdomen, myocarditis is in anamnesis. What inspection is primarily need to do? Electrocardiography Fibrobronchoscopy Fibrogastroscopy *Fluorography Common blood analysis In a patient of 16 years old, the disease began gradually, from the catarrhal syndrome. For 2-3 days the temperature of body increase till 38,5 °C, cold, severe cough with the negligible quantity of mucous sputum, «souring» eyes. Peripheral lymph nodes are soft, painless and some enlarged. Mucous of pharynx is hyperemic, granules on posterior part of pharynx. General state is satisfactory. What is the drug of choice? Ascorbic acid Aspirin *Deoxyribonucleas Remantadin Aminocapronic acid In girl V., 1 year old, appeared the thump of nose, dry cough, body temperature rose till 37,5 °C. Next day cough become attack like with the excretion of cmall amount of viscid sputum. Noisy breathing. Sharply expressed expiratory dyspnea, breating rate 40 times/minute. During examination: acrocyanosis and emphysematous thorax, at lungs dissipated dry and single moist rales. Tear of frenulum of tongue. What will be the preliminary diagnosis? *Parainfluenza Pneumonia Influenza Respiratory-syncytial infection Whooping-cough A sick person, 45 years old, was hospitalized after 2 days of disease. On Sunday he came back from India (sailor). Complaints of increasing of temperature to 41 оC, severe headache, shortness of breath, cough, with sputum. Objectively: pallor, cyanosis of mucous, tachycardiA. Breathing is weaken, crackles in the lower-back parts of the lungs, crepitation. What is the possible diagnosis? *Flu complicated by pneumonia Miliary tuberculosis Plague, pulmonary form Leptospirosis Sepsis A sick woman, 42 years old, complaints of temperature 39.3 °C, headache in the frontal area, pain in the eyeballs, photophobia, pain in muscles, dry cough. Became ill suddenly one day before. Objectively: state is severe. Hyperemia of the face, eyes shinny, injection of scleras. Pulse 96/min., rhythmic. Tones of heart are hypotonic. Both lungs are dissipated. Dry wheezes. Mucosa of epiglottis is hyperemic, grainy, vessels are extended. Meningeal symptoms are not present. Analysis of blood: leuk – 3?109/l, еos – 1 %, band – 6 %, seg – 51 %, lymp – 35 %, mono – 7 %. What is the most possible diagnosis? *Flu Measles Meningococcal infection Pneumonia Epidemic typhus In a patient of 16 years old, the disease began gradually, from the catarrhal syndrome. For 2-3 days the temperature of body increase till 38,5 °C, cold, severe cough with the negligible quantity of mucous sputum, «souring» eyes. Peripheral lymph nodes are soft, painless and some enlarged. Mucous of pharynx is hyperemic, granules on posterior part of pharynx. General state is satisfactory. What is the drug of choice? Ascorbic acid Aspirin *Desoxyribonucleas Remantadin Aminocapronic acid Patient 22 years old, has increase temperature of body till 37,8 °C. Treated under the supervision of district doctor with a diagnosis of influenzA. On the 5th day of illness temperature remained the same; it began difficultly in opening eyes. On examination – edema on face, expressed conjunctivitis with film stratifications. Mucous pharynx is heperemia, on the back wall of gullet considerable graininess. Lymph nodes are enlarged in neck. The general state of patient is satisfactory. This disease is related to cold. What disease you suspect? Leptospirosis Infectious mononucleosis *Adenoviral infection Allergic dermatitis Meningococcal infection Patient A., 28 years old, hospitalized with a previous diagnosis of flu. On the 5th day of illness, rash appeared on the trunk and internal surfaces of extremities. Temperature 41.5 °C, hyperemia of sclera, tremor of tongue, tachycardia, spleenomegaly, excitation. What is the most possible diagnosis? Measles Meningococcal infection Leptospirosis *Epidemic typhus Typhoid fever Patient B., 20 years old, complaints of severe headache in temples and orbits, dull ache in the trunk, dry cough. Temperature of the body 39.6 °C. Inflammatory changes of mucous membrane of oropharynx. Normal breathing in the lungs. What is the most credible diagnosis? Pneumonia Parainfluenza Respiratory micoplacma *Flu Meningococcal infection Patient L., 18 years old is sick with fever till 38 °C which proceeds 5 days. he has moderate dry cough, common cold, badly opens eyes. On examination –edema on face, expressed conjunctivitis with film raids. Mucous of pharynx is hyperemic, posterior wall of pharynx is grainy. Internal organs are without pathology. What form of disease does the described picture correspond to? Viral conjunctivitis Allergic dermatitis *Adenoviral infection Influenza Rhinoviral infection Patient M., 11 years old, complaints on general weakness, cough, at night suddenly temperature rose till 39,5 °C, appeared restlessness, barking cough, noisy whistling breathing with drowing in supra- and subclavicular cavities, intercostal spaces. He was in contact with the patient acute respiratory viral infection. What should recommend him the first line? *Prednisolon, hot foot-baths Seduxsen, euphylin Euphylin, vitamin C Antibiotics, dimedrol Astmopen, diazolin Patient P., 14 years old, is hospitalized in the infectious department in the severe condition. Complaints on expressed headache, mainly in frontal and temporal regions, supercilliary arcs, origin of vomiting appear in condition of severe pain, pains by moving the eyeballs, in muscles and joints. Objectively: patient is excited, body temperature-39 ?C. BP-100/60 mmHg. Bradycardia was replaced by tachycardiA. Appeared tonic cramps. Doubtful meningeal signs. From anamnesis it is clear that his brother has flu at home. What will be your diagnosis? Influenza, typical flow *Influenza with the phenomena of edema of brain Respiratory-syncytial infection Parainfluenza Adenoviral infection Patient R., 16 years old, hospitalized for 5-day illness with complaints of moderate headache in fronto-temporal region, laid nose, sore throat, pain in the left eye, rise in temperature to 38.1-38.5 °C. General condition is satisfactory. Shortness of nasal breath, mucous discharging from the nose, hyperemia of face, enlargment of the neck and submaxillary lymph glands, left foamy conjunctivitis. What is preliminary diagnosis? Influenza Infectious mononucleosis Enteroviral infection *Adenoviral infection parainfluenza Sick M., 22 years old, complaints of increasing of body temperature to 39 оC, headache in frontal area, pain in eyeballs, photophobia, pain in a muscles, dry cough. Became ill suddenly. The state is heavy. Objectively face is hyperemic, injection of scleras. Pulse 96 per min, rhythmic. Tones of heart are hypotonic. In the lungs – dissipated dry wheezes. Mucous membrane of oropharynx is hyperemic, grainy, vessels are extended. menengial symptoms are not present. Analysis of blood: leukocytes 3*109/L, е 1 %, band neut. 6 %, seg. neut 51 %, lymphocytes 35 %, мonocytes 7 %. What is most probable diagnosis? Measles *Flu Meningococcal disease Epidemic typhus Pneumonia The patient P., 14 years old, is suffering from flu. He is hospitalized in infectious dept. due to worsening of his condition. He is conscious. A patient is suffocated. Pallor of skin covers with cyanosis, breathing rate 50 times/minute. BP-80/55 mmHg, pulse 110 times /minute. Body temperature-39,5 °C. Excretion of rose foamy sputum. On percussion of lungs there is tympanic sound with dullness in lower part of lung .On auscultation there is moist rales in lower posterior part of lungs. What complication of flu appeared in patient? Bronchitis Edema of brain *Pneumonia Edema of lungs infectious-toxic shock To the district doctor a patient, complaints of abundant excretions from a nose, moderate headache, hearing loss, perversion of taste. On examination – dry of skin, nose excoriation, in a pharynx – mild hyperemiA. Temperature of body is subfebrile. Pathological changes of internal organs are absent. Which acute respiratory viral infection carries the patient? Adenoviral infection Parainfluenza *Rhinoviral infection RC-infection Influenza At a child with the clinical displays of ARVI a generilized lymphadenopathy, one-sided conjunctivitis increase of liver and spleen, is marked. Most reliable diagnosis? Infectious mononucleosis Leptospirosis *Adenoviral infection Flu Pseudotuberculosis A patient caused a doctor home. Age – 75 years. Complaints of a subfebrile temperature, general weakness, pharyngalgia, conjunctivitis. In family a child is ill the acute adenoviral disease. A patient considers itself a patient on second day. At a review are found out the signs of acute blepharoconjunctivitis, pharyngitis. There are megascopic lymphatic knots: neck front and back, arm-pits and inguinal, to 1 cm in a diameter, soft, not is soldered between itself and with a surrounding cellulose. A pharynx is hyperemic, tonsills are hypertrophied and hyperemic. In lights of wheezes it is not. Breathing clean. Tones of heart are muffled. BP is 140/80 mm Hg. Ps – 80 per 1 minute. Abdomen soft. A megascopic liver which comes forward on 3 cm below costal arc and spleen are palpated – soft, painless. Choose the most credible diagnosis: *Acute adenoviral infection Flu Megacaryoblastoma Infectious mononucleosis Hepatitis A Sick M., 22 years old, complaints of increasing of body temperature to 39 оC, headache in frontal area, pain in eyeballs, photophobia, pain in a muscles, dry cough. Became ill suddenly. The state is heavy. Objectively face is hyperemic, injection of scleras. Pulse 96 per min, rhythmic. Tones of heart are hypotonic. In the lungs – dissipated dry wheezes. Mucous membrane of oropharynx is hyperemic, grainy, vessels are extended. menengial symptoms are not present. Analysis of blood: leukocytes 3*109/L, е 1 %, band neut. 6 %, seg. neut 51 %, lymphocytes 35 %, мonocytes 7 %. What is most probable diagnosis? Measles *Flu Meningococcal disease Epidemic typhus Pneumonia A patient 14 years old, hospitalized in the infectious department in severe condition with considerable headache mainly in frontal and temporal area, pain in eyeballs, in muscles and joints. Objectively: patient is excited, temperature of the body is 39 оC. Bradycardia changed by tachycardiA. Muscles tonic and clonic cramps. Positive meningeal signs. It is found in epidemic anamnesis, his brother is also sick. What is your diagnosis? *Flu with pneumonia and edema of brain Flu, typical course Parainfluenza, false croupe Respiratory-sencytial infection Adenoviral infection, pneumonia A patient H., 22 years old, with flu was hospitalized to infectious department with the acute worsening of the common state. Consiousness is clear. The patient strangles. Pallor of skin with cynosis. Respiratory rate 50 per min, AP 80/55 mmHg, pulse 110 per a min, temperature 39.8 оC. During percussion of lungs tympanic sound with dullness in lower quadrant was found. Crackles in the lower-back parts of lungs. What complication of influenza has developed in that patient? Pneumonia *Edema of lungs Edema of brain Infectious-toxic shock Meningoencephalitis A sick, 54 years old, hospitalized in infectious department in the grave condition. Complaints are headache, mainly in frontal and temporal areas superciliary arcs, origin of vomiting on peak of pain. Objectively: patient is excited, temperature of body 39 оC, AP 100/60 mm Hg. Bradycardia changed to tachycardiA. Tonic cramps, meningeal signs appeared. From anamnesis it is known that father is also sick. What treatment should be prescribed? *Mannitol, lasix, prednisolone, еuphyllin, suprastain Mannitol, acetophene Lasix, analgin, ampicillin Verospiron, euphyllin, demidrol Aspirin, analgin, demidrol A patient becomes sick very fast: chills, increasing of temperature to 40,1 оC, headache in frontal and temporal regions, pain in eyeballs, close nose, dry cough and pain in the chest. The nose bleeding, nausea, double vomits. Objectively: conjunctivitis, hyperemia, edema, hemorrhages in mucous of otopharhynx, tachycardiA. Blood pressure is low. Difficult breathing . What is the most possible diagnosis? Meningococcemia Epidemic typhus Leptospirosis *Flu Typhoid fever A patient 56 years old, the day before he felt easy indisposition, insignificant headache, and weakness. Afterwards the increasing of temperature appeared to 38,5 оC with chills, headache increased considerably, mainly in forehead and temples. Skin and conjunctiva is hyperemic, dry, barking cough. Pharynx is hyperemic. On soft palate present grainy granules, placed point hemorrhages. Difficult breathing. What is the most possible diagnosis? Typhoid fever Leptospirosis Epidemic typhus *Flu Enteroviral infection A sick person, 45 years old, was hospitalized after 2 days of disease. On Sunday he came back from India (sailor). Complaints of increasing of temperature to 41 оC, severe headache, shortness of breath, cough, with sputum. Objectively: pallor, cyanosis of mucous, tachycardiA. Breathing is weaken, crackles in the lower-back parts of the lungs, crepitation. What is the possible diagnosis? *Flu complicated by pneumonia Miliary tuberculosis Plague, pulmonary form Leptospirosis Sepsis A 25 years old patient, fell ill rapidly, with chills and temperature rose to 39,9 оC, headache appeared in frontotemporal regions, pain in eyeballs, dull pain in all trunk, closed nose. Dry cough after 2 days of illness, there was nose bleeding. Objectively: hyperemia with sputum, isolated petechial rash and shallow grittiness of soft palate. Difficult breathing in lungs. What is the most possible diagnosis? Leptospirosis Adenoviral infection Typhoid fever *Flu Epidemic typhus A patient 26 years old, became sick rapidly: temperature 39.5 оC, severe headache, mainly in frontal and temporal areas, pain in muscles and joints. By examining on the 2nd day of illness: state of middle weight, skin is clean. Moderate hyperemia with cyanosis, pulse 120 per min, rhythmic. Heart activity is rhythmic, tones are muffled, in lungs there is vesicular breathing. What is the treatment of this patient? Aspirin *Remantadin Ampicillin Ascorbic acid Ribonuclease A patient fell ill very rapidly: chills, increase of temperature to 40.1 °C, headache in frontotemporal regions, pain in eyeballs, close nose, dry cough, and chest pain. Nose bleeding, nausea, vomiting appeared after 4 hours. Objectively: conjunctivitis, hyperemia, edema, point hemorrhages in mucus of epiglottis, tachycardiA. Blood pressure is low. Weaken breathing in the lungs. What is the most possible diagnosis? Leptospirosis Epidemic typhus *Flu Мeningococcemia Enteroviral infection A student, 18 years old, for 7 days complaints of weakness, hyperthermia to 37.8 °C, mucous excretions from a nose, pharyngalgia at swallowing, pain in eyeballs. Objectively: increased lymph nodes of neck and mandible, lymphadenitis, edema and injection of conjunctiva, hyperemia of mucous of epiglottis, hypertrophy of tonsils. What is the most reliable diagnosis? *Adenoviral infection Influenza Infectious mononuleosis Rhinoviral infection Parainfluenza A patient Т., 45 years old, was hospitalized on the 2nd day of disease. One week ago he came back from India (sailor of the distant swimming). Complaints of temperature 41.3 °C, great headache, shortness of breathing; cough with foamy pink colour sputum. Objectively: pale of face, cyanosis of mucous, breath rate 24/min, tachycardiA. Lungs: breathing is hyposthenic, moist wheezes in both lungs, crepitation. What is possible diagnosis? Flu Miliary tuberculosis *Plaque, pulmonary form Leptospirosis Sepsis A patient 20 years old sick rapidly with increasing of temperature to 39.9 °C. complaints of headache in frontotemporal region, pain in eyeballs, dull ache in whole trunk, closed nose, scrapes in the throat, dry cough. There was nose-bleeding. What diagnosis is most possible? *Influenza Adenoviral infection Parainfluenza RS-infection Enteroviral infection 4 years old child complaints of: cough, temperature of body 38.1 °C. Conjunctiva is hyperemic. On mucous of cheeks there are points of hyperemia gum blushs. Weaken breathing in the lungs. What is the most possible diagnosis? Scarlet fever Rubella *Measles Herpetic infection Flu A patient, 20 years old, during few days complaints of pharyngalgias. After supercooling the state became worse: sudden chills, increase of temperature to 40.6 °C, headache. On the skin of low extremities, trunk and buttocks there are a lot of different sizes hemorrhagic spots, acrocyanosis. Consiouness is preserved. Meningeal signs are absent. What is the previous diagnosis? *Meningococcal infection Flu Epidemic typhus Hemorrhagic fever Leptospirosis A patient 56 years old, workwomen of pig farm, on a background chills appeared, the temperature rose to 39,9 °C, headache, nauseA. The next day marked pains in the muscles of lower extremities appeared, the nose bleeding began. At the receipt, on the 3rd day common state deteriorated. Hyperemic spots, subicteric appeared. Liver +3 cm. Daily – diuresis 700 ml. What is the previous diagnosis? Hemorrhagic fever with a kidney syndrome Hepatitis A Escerichiosis Flu *Leptospirosis A sick 19 years old, sick rapidly, when a temperature rose to 39,2 °C, coughing appeared, closed nose. Pains in muscles and joints. On the 3rd day of disease, shallow spots on the trunk appeared, extremities with hyperemia and edematous feet. Generalized lymphadenopathy, hyperemia of cheeks, enlargement of the liver were found out. What is previous diagnosis? *Pseudotuberculosis Flu Infectious mononucleosis Herpetic infection Epidemic typhus A woman who came back from a tour trip, the next day called emergency help. It is known from the anamnesis, that within a week the temperature of body was moderately high. Complaints of bad sleep and bad appetite, pain in the abdomen. During the assescment of the sick it is found out roseolas on the pale skin of breasts and abdomen. Pulse is normal, temperature of body 38,2 °C, hepatospleenomegaly. What is your previous diagnosis? *Typhoid fever Epidemic typhus Flu Enteroviral infection Leptospirosis A patient C., 25 years old, fell suddenly ill. Every morning severe headache, frequent vomiting, temperature of the body is 39.9 °C. Adopted fatigue, then state got much worse. In the evening lost of consciousness. Expressed muscles pains of back and head. Positive Кеrning’s symptom. Leukocytes – 18,0?109. What is the most reliable diagnosis? Flu Epidemic typhus, typhus state Viral menigoencephalitis Sepsis, infectious-toxic shock *Bacterial menigoencephalitis A patient 17 years old, became suddenly ill: temperature rose to 40,3 °C. Severe headache, motive excitation, frequent vomiting, tremor of fingers of extremities. Hemorrhagic spots of round form and different sizes, more frequently as stars, mainly on buttocks and trunk. Meningeal signs are positive. What is the most possible diagnosis? Encephalitis Flu with a hemorrhagic syndrome *Meningococcal infection Measles Leptospirosis Patient B., 20 years old, complaints of severe headache in temples and orbits, dull ache in the trunk, dry cough. Temperature of the body 39.6 °C. Inflammatory changes of mucous membrane of oropharynx. Normal breathing in the lungs. What is the most credible diagnosis? Pneumonia Parainfluenza Respiratory micoplacma *Flu Meningococcal infection A sick woman, 42 years old, complaints of temperature 39.3 °C, headache in the frontal area, pain in the eyeballs, photophobia, pain in muscles, dry cough. Became ill suddenly one day before. Objectively: state is severe. Hyperemia of the face, eyes shinny, injection of scleras. Pulse 96/min., rhythmic. Tones of heart are hypotonic. Both lungs are dissipated. Dry wheezes. Mucosa of epiglottis is hyperemic, grainy, vessels are extended. Meningeal symptoms are not present. Analysis of blood: leuk – 3?109/l, еos – 1 %, band – 6 %, seg – 51 %, lymp – 35 %, mono – 7 %. What is the most possible diagnosis? *Flu Measles Meningococcal infection Pneumonia Epidemic typhus Patient A., 28 years old, hospitalized with a previous diagnosis of flu. On the 5th day of illness, rash appeared on the trunk and internal surfaces of extremities. Temperature 41.5 °C, hyperemia of sclera, tremor of tongue, tachycardia, spleenomegaly, excitation. What is the most possible diagnosis? Measles Meningococcal infection Leptospirosis *Epidemic typhus Typhoid A sick explorer of train, 39 years old is hospitalized on the 4th day of illness with complaints of headache, weakness, dizziness, chills, insomnia, fever. The person is hyperemic, conjunctivitis. On the transitional fold of conjunctiva there is a single rash. On the skin of trunk, thorax, abdomen, extremities there are abundant red coloured rashes. TachycardiA. AP 100/60 mm of Hg. Tremor of tongue. Liver and spleen were enlarged. Stool fistula is detained. What is the most reliable diagnosis? *Epidemic typhus Typhoid Flu Меnigococcemia Leptospirosis Sick, 52 years old, with complaints of pain in lumbar region, headache edema of chin. It is known from anamnesis that the sick suffers from obesity of ІІ degree. Recently carried heavy neurological stress and had flu. He has chronic bronchitis for 5 years, chronic gastritis for 8 years. Objectively: Temperature of the body 38.2 °C, AP – 140/90 mm Hg. It is proposed the diagnosis of acute glomerulonephritis. What transferred factors could be the reason of disease? Neuro psycologic stress Chronic bronchitis Chronic gastritis Obesity *Flu A patient C., was hospitalized on the 2nd day of illness with complaints of hoarseness of voice, rough barking cough, labored breathing. Objectively: the state is severe, uneasy, pallor, temperature 37.1 °C, BR 30/min., breathing is noisy, can hear from the distance, with participation of auxiliary musculature. Which viruses could cause development of similar state? Rhino virus Influenza virus Adenovirus *Parainfluenza virus Cytomegalovirus A sick 70 years old, became ill sharply, the temperature of body rose to 39.2 °C, excited, euphoric, hyperemia of face, Rozenberg’s exanthema appears. Ricketsia titer is 1:160, IgG – 87 %. What is diagnosis? *Epidemic typhus Meningococcal infection Epidemic spotted fever Flu Parainfluenza At patient with pediculosis rapidly rise temperature of body up to 41.2 °C, headache, euphoria appeared in 4 days from the beginning of illness. Red colour rash on the lateral thorax and back. Titer of Rickettsia antibodies 1:640, Ig M – 89 %. What is diagnosis? Flu Enteroviral infection Brill-Zinsser disease *Epidemic typhus Parainfluenza A patient 27 years old, entered clinic on the 4th day of illness with a diagnosis ARVI, allergodermiA. Fell ill with the rise of temperature to 38,0 °C, headache, hyperemia of the throat, then barking cough appeared. On the 3rd day rash appeared on the skin and neck. Was treated by aspirin. Objectively: temperature 38.8 °C. Face is puffy, conjunctivitis. On the skin of neck and upper part of chest is abundant red-papular rashes as rings which does not itch. Mucosa of epiglottis is brightly hyperemic. Submandibular and neck lymphadenitis. Liver and spleen were not enlarged. What is your diagnosis? *Measles Allergic dermatitis Infectious mononucleosis German measles Scarlet fever A patient K., 23 years old, with 3 days of moderate illness, with high temperature of body to 40.0 °C, headache and petechial rash on skin, is hospitalized. After introduction of penicillin at 2 o’clock, the BP fell down to 40/10 mm of hg. Peripheral pulse and мeningeal signs does not concerne. What is the diagnosis of the patient? *Меningococcemia, infectious-toxic shock ARVI, anaphylactic shock Measles, severe course Epidemic typhus, severe course Scarlet fever, severe course A patient, 75 years old, called a doctor at home. Rashes and subfebrile temperature, general weakness, pharyngalgia, conjunctivitis. In family a child is ill with acute adenoviral disease. A patient considers himself ill on the second day. At a review there are signs of pharyngitis. There are enlarged lymphatic nodes: of neck, front and back, armpits and inguinal up to 1 cm in diameter, soft. Pharynx is hyperemic, tonsils are hypertrophy and hyperemic. Both lungs have wheezing sounds. Not clean breathing. Tones of heart are muffled. AP 140/80 mm Hg. Heart rate 80 for 1 minute. Abdomen is soft. Enlarged liver 3 cm below costal arch and spleen is palpable. Palpation is soft, painless. Choose the most possible diagnosis? *Adenoviral infection Flu Hepatitis B Infectious mononucleosis Hepatitis A A patient 18 years old, with complaints of headache, pharyngalgia, weakness, high temperature. Objectively: all groups of lymphonodes, 1-3 cm in a diameter, dense, elastic, enlarged, hepatospleenomegaly. Blood analysis: leukocytosis, mononuclear – 15 %. What is possible diagnosis? *Infectious mononucleosis Adenoviral infection Angina Diphtheria Acute lympoleycosis A child of age 2 years has temperature of body 37.3 °C, cold, hoarse voice “barking cough” appeared suddenly the anxiety, shortness of breath, appeared with participation of auxiliary muscles. Supposed diagnosis? *Parainfluenza, false croup Diphtheria croup Allergic laryngitis, croup Flu, laryngitis Acute exudative pleuritis A patient of 5 years old, which treated at home on an occasion of flu by aspirin, calcium gluconatis, on the second day from the beginning of disease “coffee grounds” vomiting appeared, melenA. What complication arises? Neurotoxicosis Pneumonia *Hemorrhagic syndrome Infectious-toxic Bowel obstruction A patient with flu complicated by pneumonia, during some days there are the displays of infectious-toxic shock of ІІ degree. In BA the level of urea and creatinine increases. What from these preparations is not recommended to enter in such a situation? *Adrenalin Prednisolone Polioniic solutions Dofaminum Heparin A sick 15 years old, 3rd day of illness. On the background the catarrhal pneumonia, weakness in hands appeared, double vision, cross-eye. Voice is weak. Palatoplegia and extended extremities. Pulse 90/min. AP 130/90 mm Hg .What is your previous diagnosis? Diphtheria *Poliomyelitis Botulicm Epidemic encephalitis Enteroviral infection A 23 years old person, became ill sharply: fever 38.2 °C, moderate diffuse pharyngalgia at swallowing, pain and itching in the right eye. Objectively: tonsillitis, pharyngitis, conjunctivitis. What is previous diagnosis? *Adenoviral infection Enteroviral infection Parainfluenza Flu Acute respiratory infection A patient 52 years old, hospitalized with the severe form of viral hepatitis B. The signs of flu appeared in the department. The indexes of bilirubin rose up and transaminase falls down. What complication can arise in that patient? *Acute hepatic insufficiency Infectious-toxic shock Gastric bleeding Neurotoxicosis Cerebral comma A child 10 years old with temperature 38,0 °C, conjunctivitis, moist cough, hyperemia of the mucous membranes of cheeks and lips. Gums are pallor. What is your diagnosis? *Measles Adenoviral infection Acute respiratory viral infection Enteroviral infection Infectious mononucleosis A patient with temperature of body 40.0 °C, nonproductive cough, photophobia, puffiness of face, dots on gums, blushes on the mucus of cheeks your diagnosis? Tuberculosis Меningococcemia *Measles Enteroviral infection Staphylococcal sepsis A patient on the background of ARVI the fever developed to 40,1 °C, frequency of breathing is 40 for a minute. What measures are necessary? *Decreasing of patients temperature Artificial ventillation Oxygen. inhalation Infusion therapy Antibioticotherapy A woman 27 years old, complaints of the general weakness, absence of appetite, coughing, fever up to 37.5 °C for three weeks. Ulcerous illness of abdomen, myocarditis is in anamnesis. What inspection is primarily need to do? Electrocardiography Fibrobronchoscopy Fibrogastroscopy *Fluorography Common blood analysis A patient 17 years, 11th class student, were a lot of cases of ARI (acute respiratory infection) have happened, appealed to a doctor in clinic at 3rd day of disease with complaints of chills, general weakness, a moderate sore throat, running nose, swelling of face, watering from eyes Objective examination: minor palatal hyperemia brackets and tonsillitis, on a background of moderate edema of tissues. Conjunctivitis. During palpation not painful enlarged inframaxillary lymph nodes, and enlarged neck lymph nodes were found. Crepitation can’t be find. Liver and spleen moderately increased. What is the most likely diagnosis? Diphtheria *Adenoviral infection Meningococcal nasopharyngitis Influenza Infectious mononucleosis Patient R., 16 years old, hospitalized for 5-day illness with complaints of moderate headache in fronto-temporal region, laid nose, sore throat, pain in the left eye, rise in temperature to 38.1-38.5 °C. General condition is satisfactory. Shortness of nasal breath, mucous discharging from the nose, hyperemia of face, enlargment of the neck and submaxillary lymph glands, left foamy conjunctivitis. What is preliminary diagnosis? Influenza Infectious mononucleosis Enteroviral infection *Adenoviral infection Influenza Sick M., 22 years old, complaints of increasing of body temperature to 39 оC, headache in frontal area, pain in eyeballs, photophobia, pain in a muscles, dry cough. Became ill suddenly. The state is heavy. Objectively face is hyperemic, injection of scleras. Pulse 96 per min, rhythmic. Tones of heart are hypotonic. In the lungs – dissipated dry wheezes. Mucous membrane of oropharynx is hyperemic, grainy, vessels are extended. menengial symptoms are not present. Analysis of blood: leukocytes 3*109/L, е 1 %, band neut. 6 %, seg. neut 51 %, lymphocytes 35 %, мonocytes 7 %. What is most probable diagnosis? Measles *Flu Meningococcal disease Epidemic typhus Pneumonia A patient 14 years old, hospitalized in the infectious department in severe condition with considerable headache mainly in frontal and temporal area, pain in eyeballs, in muscles and joints. Objectively: patient is excited, temperature of the body is 39 оC. Bradycardia changed by tachycardiA. Muscles tonic and clonic cramps. Positive meningeal signs. It is found in epidemic anamnesis, his brother is also sick. What is your diagnosis? *Flu with pneumonia and edema of brain Flu, typical course Parainfluenza, false croupe Respiratory-sencytial infection Adenoviral infection, pneumonia A patient H., 22 years old, with flu was hospitalized into infectious department with the acute worsening of the common state. Consiousness is stored. The patient strangles. Pallor of skin with cynosis. Respiratory rate 50 per min, AP 80/55 mmHg, pulse 110 per a min, temperature 39.8 оC. During percussion of lungs tympanic sound with dullness in lower quadrant was found. Crackles in the lower-back parts of lungs. What complication of influenza has developed in that patient? Pneumonia *Edema of lungs Edema of brain Infectious-toxic shock Meningoencephalitis A sick, 54 years old, hospitalized in infectious department in the grave condition. Complaints of expressed headache, mainly in frontal and temporal areas superciliary arcs, origin of vomiting on peak of pain. Objectively: patient is excited, temperature of body 39 оC, AP 100/60 mm Hg. Bradycardia changed to tachycardiA. Tonic cramps, meningeal signs appeared. From anamnesis it is known that father is also sick. What treatment should be prescribed? *Mannitol, lasix, prednisolone, еuphyllin, suprastain Mannitol, acetophene Lasix, analgin, ampicillin Verospiron, euphyllin, demidrol Aspirin, analgin, demidrol A patient becomes sick very fast: chills, increasing of temperature to 40,1 оC, headache in frontal and temporal regions, pain in eyeballs, close nose, dry cough and pain in the chest. The nose bleeding, nausea, double vomits. Objectively: conjunctivitis, hyperemia, edema, hemorrhages in mucous of otopharhynx, tachycardiA. Blood pressure is low. Difficult breathing . What is the most possible diagnosis? Meningococcemia Epidemic typhus Leptospirosis *Flu Typhoid fever A patient 56 years old, the day before felt easy indisposition, insignificant headache, weakness. Afterwards the increasing of temperature appeared to 38,5 оC with chills, headache increased considerably, mainly in forehead and temples. Skin and conjunctiva is hyperemic, dry, barking cough. Pharynx is hyperemic. On soft palate present grainy granules, placed point hemorrhages. Difficult breathing. What is the most possible diagnosis? Typhoid fever Leptospirosis Epidemic typhus *Flu Enteroviral infection A sick person, 45 years old, was hospitalized after 2 days of disease. On Sunday he came back from India (sailor). Complaints of increasing of temperature to 41 оC, severe headache, shortness of breath, cough, with sputum. Objectively: pallor, cyanosis of mucous, tachycardiA. Breathing is weaken, crackles in the lower-back parts of the lungs, crepitation. What is the possible diagnosis? *Flu complicated by pneumonia Miliary tuberculosis Plague, pulmonary form Leptospirosis Sepsis A 25 years old patient, fell ill rapidly, with chills and temperature rose to 39,9 оC, headache appeared in frontotemporal regions, pain in eyeballs, dull pain in all trunk, closed nose. Dry cough after 2 days of illness, there was nose bleeding. Objectively: hyperemia with sputum, isolated petechial rash and shallow grittiness of soft palate. Difficult breathing in lungs. What is the most possible diagnosis? Leptospirosis Adenoviral infection Typhoid fever *Flu Epidemic typhus A patient 20 years old, complaints of increasing of temperature up to 39 оC, headache in frontal area, pain in eyeballs, photophobia, pain in muscles, dry cough. Became ill sharply. Objectively: severe state. Face is hyperemic, injections of scleras. Pulse 96/min, rhythmic, tones of heart are hyposthenic. Menengial symptoms are not present. Blood analysis: leuk 9?109, е 1 %, bands 6 %, seg 51 %, lymp 35 %, mono 7 %. What is the most possible diagnosis? *Influenza Adenovirus infection Leptospirosis Pneumonia Epidemic typhus A patient 26 years old, became sick rapidly: temperature 39.5 оC, severe headache, mainly in frontal and temporal areas, pain in muscles and joints. Examined on the 2nd day of illness: state of middle weight, skin is clean. Moderate hyperemia with cyanosis, pulse 120 per min, rhythmic. Heart activity is rhythmic, tones are muffled, in lungs there is vesicular breathing. What is the treatment of this patient? Aspirin *Remantadin Ampicillin Ascorbic acid Ribonuclease A patient fell ill very rapidly: chills, increase of temperature to 40.1 °C, headache in frontotemporal regions, pain in eyeballs, close nose, dry cough, and chest pain. Nose bleeding, nausea, vomiting appeared after 4 hours. Objectively: conjunctivitis, hyperemia, edema, point hemorrhages in mucus of epiglottis, tachycardiA. Blood pressure is low. Weaken breathing in the lungs. What is the most possible diagnosis? Leptospirosis Epidemic typhus *Flu Мeningococcemia Enteroviral infection A student, 18 years old, for 7 days complaints of weakness, hyperthermia to 37.8 °C, mucous excretions from a nose, pharyngalgia at swallowing, pain in eyeballs. Objectively: increased lymph nodes of neck and mandible, lymphadenitis, edema and injection of conjunctiva, hyperemia of mucous of epiglottis, hypertrophy of tonsils. What is the most reliable diagnosis: *Adenoviral infection Influenza Infectious mononuleosis Rhinoviral infection Parainfluenza A patient Т., 45 years old, was hospitalized at the 2nd day of disease. One week ago got back from India (sailor of the distant swimming). Complaints of temperature 41.3 °C, great headache, shortness of breathing; cough with foamy pink colour sputum. Objectively: pale of face, cyanosis of mucous, breath rate 24/min, tachycardiA. Lungs: breathing is hyposthenic, moist wheezes in both lungs, crepitation. What is possible diagnosis? Flu Miliary tuberculosis *Plaque, pulmonary form Leptospirosis Sepsis A patient 20 years old become sick rapidly with increasing of temperature to 39.9 °C. complaints of headache in frontotemporal region, pain in eyeballs, dull ache in whole trunk, closed nose, scrapes in the throat, dry cough. There was nose-bleeding. What diagnosis is most possible? *Influenza Adenoviral infection Parainfluenza RS-infection Enteroviral infection A 4 years old child complaints of: cough, temperature of body 38.1 °C. Conjunctiva is hyperemic. On mucous of cheeks there are points of hyperemia gum blushs. Weaken breathing in the lungs. What is the most possible diagnosis? Scarlet fever Rubella *Measles Herpetic infection Flu A patient, 20 years old, during few days complaints of pharyngalgias. After supercooling the state became worse: sudden chills, increase of temperature to 40.6 °C, headache. On the skin of low extremities, trunk and buttocks there are a lot of different sizes hemorrhagic spots, acrocyanosis. Consiouness is preserved. Meningeal signs are absent. What is the previous diagnosis? *Meningococcal infection Flu Epidemic typhus Hemorrhagic fever Leptospirosis A patient 56 years old, workwomen of pig farm, on a background chills appeared, the temperature rose to 39,9 °C, headache, nauseA. The next day marked pains in the muscles of lower extremities appeared, the nose bleeding began. At the receipt, on the 3rd day common state deteriorated. Hyperemic spots, subecteric appeared. Liver +3 cm. Daily – diuresis 700 ml. What is the previous diagnosis? Hemorrhagic fever with a kidney syndrome Hepatitis A Escerichiosis Flu *Leptospirosis A sick 19 years old, fell ill rapidly, when a temperature rose to 39,2 °C, coughing appeared, closed nose. Pains in muscles and joints. On the 3rd day of disease, shallow spots on the trunk appeared, extremities with hyperemia and edematous feet. Generalized lymphadenopathy, hyperemia of cheeks, enlargement of the liver were found out. What is previous diagnosis? *Pseudotuberculosis Flu Infectious mononucleosis Herpetic infection Epidemic typhus A woman which came back from a tour trip, the next day she called emergency help. It is known from the anamnesis, that within a week the temperature of body was moderately high. Complaints of bad sleep and bad appetite, pain in the abdomen. During the assescment of the sick it is found out roseolas on the pale skin of breasts and abdomen. Pulse is normal, temperature of body 38,2 °C, hepatospleenomegaly. What is your previous diagnosis? *Typhoid fever Epidemic typhus Flu Enteroviral infection Leptospirosis A patient C., 25 years old, fell suddenly ill. Every morning severe headache, frequent vomiting, temperature of the body is 39.9 °C. Adopted fatigue, then state got much worse. In the evening lost of consciousness. Expressed muscles pains of back and head. Positive Кеrning’s symptom. Leukocytes – 18,0*109. What is the most reliable diagnosis? Flu Epidemic typhus, typhus state Viral menigoencephalitis Sepsis, infectious-toxic shock *Bacterial menigoencephalitis A patient 17 years old, became suddenly ill: temperature rose to 40,3 °C. Severe headache, motive excitation, frequent vomiting, tremor of fingers of extremities. Hemorrhagic spots of round form and different sizes, more frequently as stars, mainly on buttocks and trunk. Meningeal signs are positive. What is the most possible diagnosis? Encephalitis Flu with a hemorrhagic syndrome *Meningococcal infection Measles Leptospirosis Patient B., 20 years old, complaints of severe headache in temples and orbits, dull ache in the trunk, dry cough. Temperature of the body 39.6 °C. Inflammatory changes of mucous membrane of oropharynx. Normal breathing in the lungs. What is the most credible diagnosis? Pneumonia Parainfluenza Respiratory micoplacma *Flu Meningococcal infection A patient B., 17 years old, student of 11th class, where cases of acute respiratory infection were noted came to the policlinic. On the 3rd day of illness, start with complaints of chills, general weakness, moderate pharyngalgia, cold, edema of face. Objectively: insignificant hyperemia of palatal tonsils. Moderate edema of the face, conjunctivitis. Enlargement of lymphatic nodes. Liver and spleen were moderately enlarged. What is the most possible diagnosis? *Adenoviral infection Diphtheria Meningococcal pharyngitis Flu Infectious mononucleosis A sick woman, 42 years old, complaints of temperature 39.3 °C, headache in the frontal area, pain in the eyeballs, photophobia, pain in muscles, dry cough. Became ill suddenly one day before. Objectively: state is severe. Hyperemia of the face, eyes shinny, injection of scleras. Pulse 96/min., rhythmic. Tones of heart are hypotonic. Both lungs are dissipated. Dry wheezes. Mucosa of epiglottis is hyperemic, grainy, vessels are extended. Meningeal symptoms are not present. Analysis of blood: leuk – 3?109/l, еos – 1 %, band – 6 %, seg – 51 %, lymp – 35 %, mono – 7 %. What is the most possible diagnosis? *Flu Measles Meningococcal infection Pneumonia Epidemic typhus Patient A., 28 years old, hospitalized with a previous diagnosis of flu. On the 5th day of illness, rash appeared on the trunk and internal surfaces of extremities. Temperature 41.5 °C, hyperemia of sclera, tremor of tongue, tachycardia, spleenomegaly, excitation. What is the most possible diagnosis? Measles Meningococcal infection Leptospirosis *Epidemic typhus Typhoid A sick explorer of train, 39 years old is hospitalized on the 4th day of illness with complaints of headache, weakness, dizziness, chills, insomnia, fever. The person is hyperemic, conjunctivitis. On the transitional fold of conjunctiva there is a single rash. On the skin of trunk, thorax, abdomen, extremities there are abundant red coloured rashes. TachycardiA. AP 100/60 mm of Hg. Tremor of tongue. Liver and spleen were enlarged. Stool fistula is detained. What is the most reliable diagnosis? *Epidemic typhus Typhoid Flu Меnigococcemia Leptospirosis Sick, 52 years old, with complaints of pain in lumbar region, headache edema of chin. It is known from anamnesis that the sick suffers from obesity of ІІ degree. Recently carried heavy neurological stress and had flu. He has chronic bronchitis for 5 years, chronic gastritis for 8 years. Objectively: Temperature of the body 38.2 °C, AP – 140/90 mm Hg. It is proposed the diagnosis of acute glomerulonephritis. What transferred factors could be the reason of disease? Neuro psycologic stress Chronic bronchitis Chronic gastritis Obesity *Flu A patient C., was hospitalized on the 2nd day of illness with complaints of hoarseness of voice, rough barking cough, labored breathing. Objectively: the state is severe, uneasy, pallor, temperature 37.1 °C, BR 30/min., breathing is noisy, can hear from the distance, with participation of auxiliary musculature. Which viruses could cause development of similar state? Rhino virus Influenza virus Adenovirus *Parainfluenza virus Cytomegalovirus A sick 70 years old, became ill sharply, the temperature of body rose to 39.2 °C, excited, euphoric, hyperemia of face, Rozenberg’s exanthema appears. Ricketsia titer is 1:160, IgG – 87 %. What is diagnosis? *Epidemic typhus Meningococcal infection Epidemic spotted fever Flu Parainfluenza At patient with pediculosis rapidly rise temperature of body up to 41.2 °C, headache, euphoria appeared in 4 days from the beginning of illness. Red colour rash on the lateral thorax and back. Titer of Rickettsia antibodies 1:640, Ig M – 89 %. What is diagnosis? Flu Enteroviral infection Brill-Zinsser disease *Epidemic typhus Parainfluenza A patient 27 years old, entered clinic on the 4th day of illness with a diagnosis ARVI, allergodermiA. Fell ill with the rise of temperature to 38,0 °C, headache, hyperemia of the throat, then barking cough appeared. On the 3rd day rash appeared on the skin and neck. Was treated by aspirin. Objectively: temperature 38.8 °C. Face is puffy, conjunctivitis. On the skin of neck and upper part of chest is abundant red-papular rashes as rings which does not itch. Mucosa of epiglottis is brightly hyperemic. Submandibular and neck lymphadenitis. Liver and spleen were not enlarged. What is your diagnosis? *Measles Allergic dermatitis Infectious mononucleosis German measles Scarlet fever A patient K., 23 years old, with 3 days of moderate illness, with high temperature of body to 40.0 °C, headache and petechial rash on skin, is hospitalized. After introduction of penicillin at 2 o’clock, the BP fell down to 40/10 mm Hg. Peripheral pulse and мeningeal signs does not concerne. What is the diagnosis of the patient? *Меningococcemia, infectious-toxic shock ARVI, anaphylactic shock Measles, severe course Epidemic typhus, severe course Scarlet fever, severe course A patient, 75 years old, called a doctor at home. Rashes and subfebrile temperature, general weakness, pharyngalgia, conjunctivitis. In family a child is ill with acute adenoviral disease. A patient considers himself ill on the second day. At a review there are signs of pharyngitis. There are enlarged lymphatic nodes: of neck, front and back, armpits and inguinal up to 1 cm in diameter, soft. Pharynx is hyperemic, tonsils are hypertrophy and hyperemic. Both lungs have wheezing sounds. Not clean breathing. Tones of heart are muffled. AP 140/80 mm Hg. Heart rate 80 for 1 minute. Abdomen is soft. Enlarged liver 3 cm below costal arch and spleen is palpable. Palpation is soft, painless. Choose the most possible diagnosis: *Adenoviral infection Flu Hepatitis B Infectious mononucleosis Hepatitis A A patient 18 years old, with complaints of headache, pharyngalgia, weakness, high temperature. Objectively: all groups of lymphonodes, 1-3 cm in a diameter, dense, elastic, enlarged, hepatospleenomegaly. Blood analysis: leukocytosis, mononuclear – 15 %. What is possible diagnosis? *Infectious mononucleosis Adenoviral infection Angina Diphtheria Acute lympoleycosis A child of age 2 years has temperature of body 37.3 °C, cold, hoarse voice “barking cough” appeared suddenly the anxiety, shortness of breath, appeared with participation of auxiliary muscles. Supposed diagnosis? *Parainfluenza, false croup Diphtheria croup Allergic laryngitis, croup Flu, laryngitis Acute exudative pleuritis A patient of 5 years old, which treated at home on an occasion of flu by aspirin, calcium gluconatis, on the second day from the beginning of disease “coffee grounds” vomiting appeared, melenA. What complication arises? Neurotoxicosis Pneumonia *Hemorrhagic syndrome Infectious-toxic Bowel obstruction A patient with flu complicated by pneumonia, during some days there are the displays of infectious-toxic shock of ІІ degree. In BA the level of urea and creatinine increases. What from these preparations is not recommended to enter in such a situation? *Adrenalin Prednisolone Polioniic solutions Dofaminum Heparin A sick 15 years old, 3rd day of illness. On the background the catarrhal pneumonia, weakness in hands appeared, double vision, cross-eye. Voice is weak. Palatoplegia and extended extremities. Pulse 90/min. AP 130/90 mm Hg .What is your previous diagnosis? Diphtheria *Poliomyelitis Botulicm Epidemic encephalitis Enteroviral infection A 23 years old person, became ill sharply: fever 38.2 °C, moderate diffuse pharyngalgia at swallowing, pain and itching in the right eye. Objectively: tonsillitis, pharyngitis, conjunctivitis. What is previous diagnosis? *Adenoviral infection Enteroviral infection Parainfluenza Flu Acute respiratory infection A patient 52 years old, hospitalized with the severe form of viral hepatitis B. The signs of flu appeared in the department. The indexes of bilirubin rose up and transaminase falls down. What complication can arise in that patient? *Acute hepatic insufficiency Infectious-toxic shock Gastric bleeding Neurotoxicosis Cerebral comma A child 10 years old with temperature 38,0 °C, conjunctivitis, moist cough, hyperemia of the mucous membranes of cheeks and lips. Gums are pallor. What is your diagnosis? *Measles Adenoviral infection Acute respiratory viral infection Enteroviral infection Infectious mononucleosis A patient with temperature of body 40.0 °C, nonproductive cough, photophobia, puffiness of face, dots on gums, blushes on the mucus of cheeks your diagnosis? Tuberculosis Меningococcemia *Measles Enteroviral infection Staphylococcal sepsis A patient on the background of ARVI the fever developed to 40,1 °C, frequency of breathing is 40 for a minute. What measures are necessary? *Decreasing of patients temperature Artificial ventillation Oxygen. inhalation Infusion therapy Antibioticotherapy A woman 27 years old, complaints of the general weakness, absence of appetite, coughing, fever up to 37.5 °C for three weeks. Ulcerous illness of abdomen, myocarditis is in anamnesis. What inspection is primarily need to do? Electrocardiography Fibrobronchoscopy Fibrogastroscopy *Fluorography Common blood analysis A man, 47 years old, became ill suddenly, appeared chills, fever 39,0 °C, head and muscular pain, nausea, vomiting and diarrheA. Cough, shortness of breath, appeared on the 3rd day of illness. Pulse is 68 per min, rhythmic. Breath rate 44/min. Physical examination revealed. Right sided pneumonia in roentgenologic diagnosed. Liver +2,5 cm. It is known that the patient, week prior to illness lived in a hotel with conditioners. What disease does it follow to think about? Bacterial pneumonia Psittacosis Tuberculosis Myocard infarction *Legionellosis A 55 years old businescman died from the edema of lungs on the background of severe bilateral pneumonia which is confirmed roentgenologically. A patient 5 days prior to beginning of illness got back from Sweden, where he was in the business trip for 2 weeks. In the hotel, where he lived, he used a swimming pool and conditioner. What etiology of pneumonia most possible in his death? Tubercular Micoplacma Chlamydia *Legionellosis Pneumococcal Among the tourists who lived in a fashionable hotel, where was the outbreake of respiratory disease in daylight saving time of the year. The illness of three patients have pneumonic form. In the blood after inspection found out with antibodies to L. pneumophila in a titer 1:256 (reaction of indirect immunofluorescence). Antibiotics of what group is the most expedient to appoint in this case? Penicillin Aminoglycosides *Macrolides Теtracyclines Cephalosporines A sick , 45 years old, is on treatment with a diagnosis of pneumoniA. Gets the antibiotics of penicillin group. Condition does not get better. In blood analysis found growth of titre of protomycoplacma antibodies in 4 times. What from the resulted preparations does follow to appoint for etiotropic treatment of patient? *Теtracyclines, еrythromycin Ampicillin, levomycetin Acyclovir, zovirax Gentamycin, penicillin Furazolidon, nifuroksazid A patient 23 years old with pregnancy of 12 weeks. Scars do not appear. She has passed the inspection in a woman consultation. Protomycoplacma antibodies in a titre of 1:10 was found in her analysis. What tactics of gynecologist should be? *To repeat analysis with mycoplacma diagnostics in 14 days To appoint tetracyclin To appoint еrythromycin To cut pregnancy short To repeat analysis with a mycoplacma diagnostic after childbirth In a newborn, the septic state was accompanied with the increase of temperature to 40 oC which developed on 5th day, with pneumonia expressed intoxication: pallor, vomiting, shortness of breath, disturbance, cramps. Appeared rash (blisters with hemorrhages) on skin, mucous membrane of mouth cavity, throat and conjuctivA. The child suffers with congenital herpes. Lungs: difficult breathing and vesicular wheezing. Mild enlargement of liver. What is the most reliable diagnosis? *Herpetic infection Cytomegaloviral infection Chicken pox Rubella AIDS A new born child on 10th day of life became worse: Temperature 39.2 °C, no frequent vomiting, generalized cramps, violations of consciousness, spastic paresis of left extremities. Month prior to his birth herpes virus was present in the mother, which she did not treated. What disease is most possible? *Herpetic encephalitis Meningococcal meningitis Subarechnoid hemorrhage Cerebral abscess Violation of blood cerebral circulation A patient has herpetic meningitis. What preparation of specific therapy for viral neuro infection should be given? *Acyclovir Cefataxime Ceftriaxone Gentamycin Furazolidon A patient, 22 years old, became ill sharply. History showed fever up to 38.2 °C with headache, repeated vomiting, olfactory and tastes hallucinations. Quickly got complex of meningeal symptoms, pyramidal paresis. The general epileptic attack and comatose state also developed. Neurolymph is with mixed lymphocytosis, cytochrome, single red corpuscles. What is previous diagnosis? Brain abscess Subdural empyema *Herpetic encephalitis Tumor of brain Encephalopathy A boy 11 years old, complaints of sickness at mastication, increasing of temperature to 37.1 °C, enlargment of parotid salivary glands . At the age of 8 years carried a paraflu infection. Objectively: in the region of right parotid salivary gland tubular sickly at palpation, a skin above it is not changed. A pharynx is moderate hyperemic, tonsils are not coated. What is your previous diagnosis? *Cytomegaloviral syaloadenitis Lymphadenitis Parotitis Infectious mononucleosis Cholylithiasis At junior nurse, who works in child’s infectious department, herpes simplex was found. What manager of department must do? *Create a quarantine in the department To appoint an immunoprotein to the children Discharge all children from the department To appoint immunomodulators with a prophylactic purpose To inspect a junior nurse on a staphylococcus A woman 65 years old had the disease beginning sharply from increase of temperature to 39.0 °C, weakness, and pain in the left part of thorax that increased with breathing motions. On 3rd day of disease vesicular breathing appeared after motion of rib on the left on a hyperemic background. Together with sick a grandchild lives 4 years. What measures of prophylaxis of disease need to be adopted? Vaccination Final disinfection Reception of specific immunoprotein *Isolation of patient Acyclovir administration A patient 60 years old for 2 days has disturbed severe pain in a right arm. On 3rd day appeared blisters, pouring out as a chain on the skin of shoulder, forearm and brush. Sensitiveness in the area of pouring out is mionectic. What disease can be diagnosed? Dermatitis *Herpetic ganglionitis Neck-pectoral redicals Psoriasis Allergy The patient, 58 years old, was hospitalised in the infectious department with complaints of pain in the left half of thorax, fever. At a review: temperature of body 37.5 °C, in XI-XII intercostal area the grouped shallow blisters on a hyperemic-filling background are filled by transparent maintenance. Preparation of choice for treatment of this patient is: Suprastin Prednisolone Biseptolum-480 Semavin *Laferon A pregnant woman, 27 years (pregnancy ІІ, 8-10 weeks.), temperature of body increased. At the inspection on a TORCH-infection antibodies are found to the herpes virus, ІІ types of class IGM. What we must recommend to pregnant women? *To cut pregnancy To prolong the supervision Treatment with acyclovir Symptomatic treatment Appoint of alpha-fetoprotein A patient appealed to the doctor with complaints of difficulties in opening of the mouth. Two weeks ago fell down and head was hurt, did not have medication. At a review mouth opens on 1.5 cm, moderate expressed pain of muscles at the back of head. The paralysis of muscles of person, eyeballs, are more prominent. In a temporal area dry bloody crusts in the place of traumA. What are your diagnosis? Neuritis of facial nerve Throat abscess *Facial paralytic stupor of Rоsе Bulbar encephalitis Herpetic ganglionitis of knot of trifacial A patient came with complaints of sickly erosions on his penis. From anamnesis frequent appearance of similar rashes is found out during a year. Objectively: on a balanus are the grouped blisters and erosions, soft on palpation. What is your diagnose? *Recurrent herpes of ІІ type Vulvar pemphigus Primary syphyllis Shankoform pyoderma Recurrent herpes of ІІІ type Sick patient, 25 years old, was consulted by a doctor on the third day of illness with complaints of pouring out on lips, wings of nose and ears, pain and swelling in the places of these pouring out. Objectively: temperature of body – 37.7 °C, unchanged skin of overhead lip, wings of nose, auricles, there is vesicular scars 1-2 mm with the group location. What disease you may think about? Erysipelas, bullous form Anthrax *Herpetic infection Anthrax, skin form Chicken pox Sick A., complaints of turning red rash and edema on a right cheek. During a review: temperature of body – 38.7 °C, submandibular lymph nodes enlarged and painful, border between turning red and healthy skin is clear, there are blisters with a dark liquid inwardly, palpation is painful. What is your previous diagnosis? *Erysipelas, hemorrhagic form Anthrax, skin form Herpetic infection Chicken pox Phlegmon of cheek A 32 years old patient appealed to a doctor on a background of fever and increase of temperature to 38.0 °C, pain in the right ear area, left side “deviation” appear during the next day . On examination: right side cmoothed out frontal and occipital skinning folds, right eyelids fissure is wider than left, a mouth is overtighten to the left, a right eyebrow does not rise upwards, and a cheek “hyperemia”, xerostomia and violation of taste receptors on front 2/3 right halves of tongue. Herpetic blisters in right external auditory canal and auricle. What is the most possible diagnosis? *Hunt’s syndrome Post herpetic neuralgia of the I- and II- branches of right trifacial nerve Post herpetic neuralgia of all branches of right trifacial nerve Sludder’s syndrome Rosolimo-Меlkerson-Rozantalia syndrome A s 40 years old scientist, became ill sharply with chill, temperature of body – 39.8 °C, severe headache, vomiting, pain in muscles. Did not went to the doctor, the state had become worse, hyperemia of sclera, appeared, on lips herpes with hemorrhagic maintenance, the nose-bleeding, skin and sclera, became icteric, urine color is of strong tea, diuresis 200 ml, an anacholia was not present. What is the most reliable source of infection? *Rats Cats Infected people Bacillocarrier Mosquito A patient came with complaints of erosions of his penis. From anamnesis frequent appearance of similar rashes during a year is found out. Objectively: on a balanus are the grouped blisters and erosions of polycyclic outlines, with clear margin, soft during palpation. What is your diagnosis? *Recurrent congenital herpes Pemphigus vulgaris Primary syphillis Pyodermia Scabies At a 36 years old sick person, 4 days ago a rash appeared on a skin that is accompanied by itching. Swelling of abdomen. Disturbed dull pain in right subcostal area had constipation. Day prior to it he ate the smoked meat. Atypical reactions appeared after the use of tomatoes, strawberry, chocolate. Objectively: on the skin of body, trunk, extremities a lot of rashes. Level of general IgE in normal. What is most possible diagnosis? *Pseudoallergy Idiosyncrasy Food allergy Herpetic infection Erysipelas Sick 65 years old patient, complaints of pain in a subscapular region. Objectively: on a skin surface of subscapular region the placed arcwise rose-red filling out hearths some infiltrative, with clear scopes was present. On-the-spot hearths grouped vesicles with transparent maintenance. What is the diagnosis? Impetigo Herpes simplex Erysipelas Allergodermia *Herpes zoster A sick person, 65 years old, complaints of rash, pain in a subscapular region. Objectively: on a skin surface of the subscapular region present the arcwise rose-red filling out hearths some infiltrative, with clear scopes. On-the-spot hearths grouped vesicles with transparent maintenance. What preparation he should take? Suprastyn Prednisolone Biseptolum-480 Loratidin *Laferon A patient N., 45 years old, complaints of headache, general weakness increasing of temperature, to 37.4 °C. In 2 days pain appeared in the pectoral region of spine with an irradiation in a right between scapular regions. After some time skin in this region turned red as a strip from a spine to the subarmpit line, and in 2 days red knots which through the set time grew into blisters with transparent maintenance appeared in this place. What is your diagnosis? *Herpes zoster Thoracal rediculopathy Neurology of intercostal nerves Neurology of superscapular nerve Herpetiform dermatitis A 37 years old patient, 2 days ago a spot on a hand appeared, which for days grew into pustule with a black bottom, painless at touch, with the crown of daughters vesicles on periphery. There are painless edema on a hand and shoulder. Temperature rise to 39.0 °C, dizziness appeared. Pulse – 100 beats per min, AP – 95/60 mm Hg. BR – 30 per a minute. What is the most possible diagnosis? *Anthrax Plague Tularemia Brucellosis Herpes A 70 years old sick person, after supercooling severy pain in the left half of head in the area of forehead and left eye appeared. 3 days ago the temperature of body increased to 37.6 °C, the blister of pouring out at the head and left overhead eyelid appeared. What disease can be diagnosed? *Herpetic ganglionitis Encephalitis Allergy Dermatitis Trifacial neuritis A sick 3 years old child came to the doctor with symptoms of the fever, languor, waiver of meal. A boy is capricious, temperature of body 37.9 °C. On the mucus shell of soft palate, cheeks are single vesicle hypersalivation. What is the diagnosis? *Herpetic stomatitis Candidosis of oral cavity Leucoplacia Follicular tonsillitis Lacunar tonsillitis Sick, 49 years old, came to the doctor with complaints of pain. On the 3rd day he became ill, first marked heartburn and pain in thorax, yesterday is pouring out. At examination: temperature of body 37.8 °C, after motion of the V-VI intercostals intervals on a hyperemic skin group of the blisters filled by transparent maintenance. What is the diagnosis? *Herpes zoster Chicken pox Erysipelas, erythematous-bulous form Allergic dermatitis Myositis Test to figures A mechanism of transmission at this illness is (Fig. 49): Air-drop Fecal-oral * Contact Transmissiv Vertical A mechanism of transmission at this illness is (Fig. 40): Air-drop Fecal-oral * Contact Transmissiv Vertical A mechanism of transmission at this illness is (Fig. 46): Air-drop Fecal-oral * Contact Transmissiv Vertical Appoint adequate therapy to this patient (Fig. 61) in blood of which is RNA HCV. * Intron A 3 millions 3 times for a week Intron A 3 millions 5 times for a week Intron A 5 millions 3 times for a week Intron A 5 millions 5 times for a week Intron A 10 millions 3 times for a week At what infectious disease does conduct this symptom (Fig. 58)? Poisoning mushrooms Meningo-encefalit Poliomyelitis Rabies * Tetanus Curent treatment for HIV infection (Fig. 3) consists of highly active artiretroviral therapy. Choose the correct combination of preparations: 1 NRTIs + 2 IP 1 NRTIs + 1 IP + 2 NNRTI * 3 NRTIs 2 NRTIs + 2 IP 2 NNRTIs + 1 IP Curent treatment for HIV infection (Fig. 3) consists of highly active artiretroviral therapy. Choose the correct combination of preparations: 1 NRTIs + 2 IP 1 NRTIs + 1 IP + 2 NNRTI 2 NRTIs 2 NRTIs + 2 IP * 2 NRTIs + 1 IP Curent treatment for HIV infection (Fig. 3) consists of highly active artiretroviral therapy. Choose the correct combination of preparations: 1 NRTIs + 2 IP 1 NRTIs + 1 IP+ 2 NNRTI * 2 NRTIs + 1 NNRTI 2 NRTIs + 2 IP 2 NNRTIs + 1 IP Curent treatment for HIV infection (Fig. 3) consists of highly active artiretroviral therapy. Choose the correct combination of preparations: 1 NRTIs + 2 IP 1 NRTIs + 1 IP + 2 NNRTI * 3 NRTIs 2 NRTIs + 2 IP 1 NNRTIs + 1 IP + 1 NNRTI ?For what family of viruses does this exciter (Fig. 1) belong to? Paramyxovirus Reovirus Rabdovirus * Retrovirus Herpesvirus For what group does this infectious diseases caused by this exciter (Fig. 1) belong to by L. Gromashevskij classification? Intestinal infection Infections of respiratory tract Behave to all indicated groups Blood infection * Infection of external covers For what infectious pathology is it characteristically (Fig. 51)? Poisoning mushrooms Meningo-encefalit Poliomyelitis Rabies * Tetanus For what infectious pathology is it characteristically (Fig. 52)? Poisoning mushrooms Encefalomeningit Poliomyelitis Rabies * Tetanus For what infectious pathology is it characteristically (Fig. 53)? Poisoning mushrooms Meningo-encefalit Poliomyelitis Rabies * Tetanus For what infectious pathology is it characteristically (Fig. 54)? Poisoning mushrooms Meningo-encefalit Poliomyelitis Rabies * Tetanus For what infectious pathology is it characteristically (Fig. 55)? Poisoning mushrooms Meningo-encefalit Poliomyelitis Rabies * Tetanus For what infectious pathology is it characteristically (Fig. 56)? Poisoning mushrooms Meningo-encefalit Poliomyelitis Rabies * Tetanus For what infectious pathology is it characteristically (Fig. 57)? Poisoning mushrooms Meningo-encefalit Poliomyelitis Rabies * Tetanus How is this symptom named (Fig. 51)? * Opisthotonos Emprostotonus Plevrostotonus Risus sardonicus Lockjaw How is this symptom named (Fig. 53)? Opisthotonos Emprostotonus Plevrostotonus Risus sardonicus Lockjaw How is this symptom named (Fig. 54)? Opisthotonos Emprostotonus Plevrostotonus Risus sardonicus * Lockjaw How is this symptom named (Fig. 55)? Opisthotonos Emprostotonus Plevrostotonus * Risus sardonicus All right How is this symptom named (Fig. 56)? Opisthotonos Emprostotonus Plevrostotonus All right * Lockjaw How is this symptom named (Fig. 57)? Opisthotonos Emprostotonus Plevrostotonus * Risus sardonicus Lockjaw How is this symptom named (Fig. 58)? * Lorin-Epshteyn Blyumberg Murson Rozenberg Koplik Man V., 26 years, has HIV infection 5 years. What is your diagnosis (Fig. 5)? HIV infection. Pneumococal pneumonia HIV infection. Megakaryoblastoma * HIV infection. Pneumocystis pneumonia HIV infection. Visceral leshmaniasis HIV infection. Pneumococal pneumonia. Megakaryoblastoma Man V., 26 years, has HIV infection 5 years. What is your diagnosis (Fig. 6)? Dementsia of AIDS Patient has еncephalopathy (AIDS-related complex) Rabies Anxiously depressed syndrome for HIV infection * Toxoplasmosis Put a preliminary diagnosis (Fig. 40)? * Erysipelas Phlegmon Sepsis Herpetic infection Erysipelotrix Put a preliminary diagnosis (Fig. 41)? * Erysipelas, erytematous form Erysipelas, erytematous-bulous form Erysipelas, erytematous-hemorrhagic form Erysipelas, bulous-hemorrhagic form Erysipelas, bulous form Put a preliminary diagnosis (Fig. 42)? * Erysipelas, erytematous form Erysipelas, erytematous-bulous form Erysipelas, erytematous-hemorrhagic form Erysipelas, bulous-hemorrhagic form Erysipelas, bulous form Put a preliminary diagnosis (Fig. 44)? Erysipelas, erytematous form * Erysipelas, erytematous-bulous form Erysipelas, erytematous-hemorrhagic form Erysipelas, bulous-hemorrhagic form Erysipelas, bulous form Put a preliminary diagnosis (Fig. 45)? * Erysipelas, erytematous form Erysipelas, erytematous-bulous form Erysipelas, erytematous-hemorrhagic form Erysipelas, bulous-hemorrhagic form Erysipelas, bulous form Put a preliminary diagnosis (Fig. 46)? Erysipelas, erytematous form Erysipelas, erytematous-bulous form Erysipelas, erytematous-hemorrhagic form * Erysipelas, bulous-hemorrhagic form Erysipelas, bulous form Put a preliminary diagnosis (Fig. 47)? Erysipelas, erytematous form Erysipelas, erytematous-bulous form Erysipelas, erytematous-hemorrhagic form * Erysipelas, bulous-hemorrhagic form Erysipelas, bulous form Put a preliminary diagnosis (Fig. 49)? * Erysipelas Phlegmon Sepsis Herpetic infection Erysipelotrix Put a preliminary diagnosis (Fig. 50)? * Erysipelas Phlegmon Sepsis Herpetic infection Erysipelotrix Put a previous diagnosis (Fig. 61)? Viral hepatitis Leptospirosis Malaria Amebiaz, visceral form All is right Specify the measures of urgent prophylaxis of this desease (Fig. 15). Anti-anthrax bacteriofag * Penicillinum or tetracyclinum during 5 days Vaccination Medical supervision Biseptolum 5 days Specify the measures of urgent prophylaxis of this desease (Fig. 16). Anti-anthrax bacteriofag * Penicillinum or tetracyclinum during 5 days Vaccination Medical supervision Biseptolum 5 days Specify the measures of urgent prophylaxis of this desease (Fig. 18). Anti-anthrax bacteriofag * Penicillinum or tetracyclinum during 5 days Vaccination Medical supervision Biseptolum 5 days The duration of incubation period of the most possible disease (Fig. 20) is: 3 to 8 days; 2 to 12 days; 2 to 10 days; 1 to 8 days. * 2 to 6 days; The duration of incubation period of the most possible disease (Fig. 21) is: 3 to 8 days; 2 to 12 days; 2 to 10 days; 1 to 8 days. * 2 to 6 days; The duration of incubation period of the most possible disease (Fig. 22) is: 3 to 8 days; 2 to 12 days; 2 to 10 days; 1 to 8 days. * 2 to 6 days; The experts of WHO consider suspicious in relation to AIDS (Fig. 12): Increase 2 and more lymph nodes in two anatomical groups (except for inguinal), by sizes more than 2 cm in diameter, which lasts more than 2 months Increase 3 and rmore lymph nodes in two anatomical topographic groups (except for inguinal) by sizes more than 2 cm in diameter, which lasts more than 3 months Increase 2 and more lymph nodes in two аnatomical groups (except for inguinal), by sizes more than 1 cm in diameter, which lasts more than 2 months * Increase 2 and more lymph nodes in two аnatomical groups (except for inguinal), by sizes more than 1 cm in diameter, which lasts more than 3 months Increase 3 and more lymph nodes in two anatomical groups (except for inguinal), by sizes more than 2 cm in diameter, which lasts more than 1 months The experts of WHO consider suspicious in relation to AIDS (Fig. 7): Loss of weight (9 % and more) Loss of weight (5 % and more) Loss of weight (6 % and more) * Loss of weight (10 % and more) Loss of weight (3 % and more) The experts of WHO consider suspicious in relation to AIDS (Fig. 8): Diarhea which lasts more than 6 months Diarhea which lasts more than 4 months Diarhea which lasts more than 2 months Diarhea which lasts more than 3 months * Diarhea which lasts more than 1 months What cells are infected by this virus (Fig. 1)? CD 1 CD 2 CD 3 * CD 4 CD 5 What clinical features of sarcoma Kaposhi in such (Fig. 2) patients? A sarcoma metastasis in internal and marked high lethality Pouring out with necrosis and ulceration Primary elements appear on a head and trunk Will strike the persons of young and middle age All adopted features What clinical features of sarcoma Kaposhi in such (Fig. 2) patients? * A sarcoma metastasis in internal and marked high lethality Pouring out without necrosis and ulceration Primary elements appear on a leg Will strike the persons of old age All adopted features What clinical features of sarcoma Kaposhi in such (Fig. 2) patients? A sarcoma do not metastasis in internal and marked high lethality * Pouring out with necrosis and ulceration Primary elements appear on a leg Will strike the persons of old age All adopted features What clinical features of sarcoma Kaposhi in such (Fig. 2) patients? A sarcoma do not metastasis in internal and marked high lethality Pouring out without necrosis and ulceration * Primary elements appear on a head and trunk Will strike the persons of old age All adopted features What clinical features of sarcoma Kaposhi in such (pic. 2) patients? A sarcoma do not metastasis in internal and marked high lethality Pouring out without necrosis and ulceration Primary elements appear on a leg * Will strike the persons of yung and middle age All adopted features What complication may appear only in patient with HIV infection (Fig. 5)? Pneumococal pneumonia Megakaryoblastoma * Pneumocystis pneumonia Visceral leshmaniasis Tularemia What drug did use for the treatment of the most possible disease (Fig. 20)? Amoxicillin * Streptomycin Penicillin Biseptol 5-NOK What drug did use for the treatment of the most possible disease (Fig. 21)? Amoxicillin * Streptomycin Penicillin Biseptol 5-NOK What drug did use for the treatment of the most possible disease (Fig. 22)? Amoxicillin * Streptomycin Penicillin Biseptol 5-NOK What drug did use for the treatment of the most possible disease (Fig. 9)? Merapenem Flukonazol * Interferon Vitamin K Levomicetyn What drug did use for the treatment of the most possible disease (Fig. 10)? Merapenem Flukonazol * Interferon Vitamin K Levomicetyn What is optimum preparation for the prophylaxis of relapse of this disease (Fig. 42)? Bicillinum 1 Glyukokortikoides Bicillinum 3 and glyukokortikoides * Bicillinum 5 Bicillinum 5 and glyukokortikoides What is optimum preparation for the prophylaxis of relapse of this disease (Fig. 50)? Bicillinum 1 Glyukokortikoides Bicillinum 3 and glyukokortikoides * Bicillinum 5 Bicillinum 5 and glyukokortikoides What is optimum preparation for treatment of this disease (Fig. 40)? * Bicillinum Glyukokortikoides Levomicetin Furagin Tetracyclinum What is optimum preparation for treatment of this disease (Fig. 41)? * Bicillinum Glyukokortikoides Levomicetin Furagin Tetracyclinum What is optimum preparation for treatment of this disease (Fig. 42)? * Bicillinum Glyukokortikoides Levomicetin Furagin Tetracyclinum What is optimum preparation for treatment of this disease (Fig. 44)? * Bicillinum Glyukokortikoides Levomicetin Furagin Tetracyclinum What is optimum preparation for treatment of this disease (Fig. 45)? * Bicillinum Glyukokortikoides Levomicetin Furagin Tetracyclinum What is optimum preparation for treatment of this disease (Fig. 46)? * Bicillinum Glyukokortikoides Levomicetin Furagin Tetracyclinum What is optimum preparation for treatment of this disease (Fig. 47)? * Bicillinum Glyukokortikoides Levomicetin Furagin Tetracyclinum What is the most possible diagnosis (Fig. 10)? Plague, septic form Anthrax, septic form * Hemorrhagic fever Tularemia, septic form Sepsis What is the most possible diagnosis (Fig. 15)? Plague, skin-bubonic form * Anthrax, skin form Common carbuncle Tularemia, skin-bubonic form Sepsis What is the most possible diagnosis (Fig. 16)? Plague, skin-bubonic form * Anthrax, skin form Common carbuncle Tularemia, skin-bubonic form Sepsis What is the most possible diagnosis (Fig. 18)? Plague, skin-bubonic form * Anthrax, skin form Common carbuncle Tularemia, skin-bubonic form Sepsis What is the most possible diagnosis (Fig. 20)? * Plague, skin-bubonic form Anthrax, skin form Common carbuncle Tularemia, skin-bubonic form Sepsis What is the most possible diagnosis (Fig. 21)? * Plague, skin-bubonic form Anthrax, skin form Common carbuncle Tularemia, skin-bubonic form Sepsis What is the most possible diagnosis (Fig. 22)? * Plague, skin-bubonic form Anthrax, skin form Common carbuncle Tularemia, skin-bubonic form Sepsis What is the most possible diagnosis (Fig. 9)? Plague, septic form Anthrax, septic form * Hemorrhagic fever Tularemia, septic form Sepsis What is your diagnosis (Fig. 13)? * Sarcoma Kaposhi Candidos CMV-infection Toxoplasmosis Diphtheria What is your diagnosis (Fig. 2)? * Sarcoma Kaposhi Candidos CMV-infection Toxoplasmosis Diphtheria What is your diagnosis (Fig. 4)? * Sarcoma Kaposhi Toxoplasmosis Chicken pox CMV-infection Small pox What is your diagnosis (Fig. 4)? Leycoplakia * Sarcoma Kaposhi Furunculosis Rubella CMV-infection What kind of specific prophylaxis should be conducted for this patient which was bitten (Fig. 60)? Gamma-globulin and 18 doses of Kab 12 doses of Kab * 6 doses of Kab Gamma-globulin and 21 dose of Kab 2 doses of Kab What kind of specific prophylaxis should be conducted for this patient which was bitten (Fig. 60)? Gamma-globulin * Vaccine Vaccine and gamma-globulin Gamma-globulin and serum Serum What kind of specific prophylaxis should be conducted for this patient which was bitten (Fig. 60)? Gamma-globulin + tetanus antitoxin * Antyrabies vaccine + tetanus antitoxin Antyrabies vaccine and gamma-globulin Gamma-globulin and serum Serum + tetanus antitoxin What mechanism of transmission of this virus (Fig. 1)? Droplet Fecal-oral Transmissiv * Contact Vertical What specific test is used for diagnostic of this disease (Fig. 15)? Compliment fixation test Indirect hemaglutination test * Coetaneous test with antraxin Hemaglutination test RIFA with anthrax antigen What specific test is used for diagnostic of this disease (Fig. 16)? Compliment fixation test Indirect hemaglutination test * Coetaneous test with antraxin Hemaglutination test RIFA with anthrax antigen What specific test is used for diagnostic of this disease (Fig. 18)? Compliment fixation test Indirect hemaglutination test * Coetaneous test with antraxin Hemaglutination test RIFA with anthrax antigen Yüklə 3,17 Mb. Dostları ilə paylaş:
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