Diagnostic radiology of inflammation of bones



Diagnostic radiology methods of musculosceletal system examination

Symptoms and syndroms of bones’ pathology

The 47 y.o. patient has been treated by neurologyst about spine osteochondrosis with radicular syndrom for 10 years. Last 2 years the treatment has been without clinical effect. Laboratiry tests are show acute inflamation. On spine X-ray the lumbal lordosis is disappeared. Bechterew's disease is suspected. Which investigation can help to prove the diagnosis?

A. *Iliosacral X-ray.

B. HLA-B27 test

C. Blood CRC test.

D. Sternal puncture

E. Raumatoid factor test

The 47 y.o. patient has been treated by neurologyst about spine osteochondrosis with radicular syndrom for 10 years . Last 2 years the treatment has been without clinical effect. Laboratiry tests are show acute inflamation. On spine X-ray the lumbal lordosis is disappeared. Bechterew's disease is suspected. Which investigation can help to prove the diagnosis?

A. *Iliosacral X-ray

B. Antibody level

C. Blood CRC test

D. Anti-DNA test

E. Raumatoid factor test

The patient С. 24 y.o. has been complaining of permanent pain in the joins of hands, feet, elbows and knee for 4-th monthes. She was treated in the outpatient setting with weak positive clinical pperformance. During medical examination the joints’ outlines are smoothed, local skin temperature is increased. Which X-ray imaging can help to prove the diagnosis?

A. *Joints of hands and feet

B. Knee joints

C. Metacarpophalangeal joints

D. Skull

E. Cervical spine

The patient В., 35 y.o. complains of lumbal pain with right leg irradiation as result weiht lifting. The lumbal pain is intensified by leg motion and cough. Objective evidence: long spine muscle tension; Achilles reflex is sharply weaken. The painful of paravertabral point is intensified. Lasègue's test is positive. Which additional investigation are you racomended in the first place?

A. *Spine X-ray

B. CT-scan

C. MRI

D. Electromyography

E. Lumbar puncture

Diagnostic radiology of inflammation of bones

The patient 8 y.o. complaints of a thoracic spine pain, body weight loss, skin paleness, anorexia, low grade fever (for last 3 months). Objective evidence: skin paleness, spine muscular rigidity, limitation of spine movements. Laboratory findings: leukocytosis, ESR acceleration, anaemia. On X-ray: intervertebral disk is diminished, local osteoporosis of Th-X boby. What is the most probable diagnosis?

A) *Spine tuberculosis

B) Metastases to the spine

C) Spine osteomyelitis

D) Spine osteopathy

E) Spine osteochondrosis

The patient 18 y.o. complains of right ankle swelling, limitation of spine movements, pain that the increasing as result of walk is present. PPH: conversion of tubercular tests at 7 y.o. Wasn’t treated as parents renunciation. On X-ray: focal destruction of proximal tibia epiphysis, joint space is considerably diminished. The tubercular tests with 2 ТО - 18 mm. What is the most probable diagnosis?

A) *Tuberculous osteitis of right ankle

B) Epiphyseal osteomyelitis

C) Sarcoma of right ankle

D) Syphilis of right ankle

E) Traumatic arthritis

The patient 31 y.o complains of acute knee pain, its swelling, rise of body temperature; its signs occurred suddenly after chill. Objective evidence: knee is swelling, the fluid within joint space is detected under palpation, limitation of joint movement. On X-ray: both femur and tibia epiphyseal osteoporosis is present, widening of joint space. The turbid fluid with fibrin was given after aspiration biopsy of knee. What is the most probable diagnosis?

A) *Rheumatoid arthritis

B) Arthritis deformans

C) Purulent arthritis

D) Tubercular arthritis

E) Syphilitic osteoarthritis

A 47-year-old obese man complained of periodic attacks of acute arthritis in the 1st left tarsophalangeal joint. Lab exam revealed increased serum level of uric acid. What is the diagnosis?

A) *Gout arthritis

B) Reiter’s disease

C) Rheumatoid arthritis

D) Rheumatic arthritis

E) Osteoarthritis

A patient, aged 40, ailing during approximately 8 years, complains of exertion pain in the lumbar part of the spine, in cervical and thoracal part (especially when coughing), pain in the hip and knee joints on the right. On examination: the body is fixed in the forward inclination with head down, gluteal muscles atrophy. Spine X-ray: ribs osteoporosis, longitudinal ligament ossification. What is the most likely diagnosis?

A) Psoriatic spondyloarthropathy

B) Spondyloarthropathy caused by Reiter's syndrome

C) *Ankylosing spondylitis

D) Tuberculous spondylitis

E) Disseminated spine osteochondrosis

A patient, aged 25, complains of pain in the I finger on the right hand. On examination: the finger is homogeneously hydropic, in bent position. On attempt to unbend the finger the pain gets worse. Acute pain appears on touching with the probe in ligament projection. What decease is the most likely?

A) *Thecal whitlow (ligament panaritium)

B) Paronychia

C) Articular (joint) panaritium

D) Bone panaritium

E) Subcutaneous panaritium

A 17 y.o. patient complains of acute pain in the knee joint and t0– 380C. He was ill with angina 3 weeks ago. Objectively: deformation and swelling of the knee joints with skin hyperemia. Small movement causes an acute pain in the joints. Which diagnose is the most correct?

A) Infectious-allergic polyarthritis

B) Reactive polyarthritis

C) Rheumarthritis

D) *Rheumatism, polyarthritis

E) Systemic lupus eritematodes

A 14 y.o. patient suddenly fell ill when high fever, acute pain in the right shin. In two weeks X-ray showed translucent spaces (destructive focuses) with unevel countours in the middle third of tibia diaphysis. Along the bone edge there was a narrow line of shadow (periostitis) 1-2 mm from the surface. What is the most likely diagnosis?

A) Bone cyst of tibia

B) Right shin tuberculosis

C) Right shin syphilis

D) *Right shin osteomielitis

E) Right shin trauma

F) Tendon type

30 y.o. woman, had mild trauma of 5th finger of the left hand 15 days ago. She has treated her self at home. She presents to the hospital due to deterioration of the condition and temperature rise. Objectively: hyperemia and swelling on the ventral surface of finger. Restricted movements of the finger. X-ray of the left hand: an early stage of оsteomyolitis of the fifth finger could not be excluded. The diagnosis: panaris of 5th finger of the left hand. What form of panaris has occurred in the patient?

A) Hypodermic

B) *Bony

C) Joints type

D) Paronychia

A 31 y.o. woman has complained for 3 years of pain and swelling of radiocarpal and metacarpophalangeal articulations, morning stiffness that lasts up to 1,5 hours. Two weeks ago she felt pain, swelling and reddening of knee joints, body temperature raised up to 37,50С. Examination of her internal organs revealed no pathologic changes. Her diagnosis was rheumatoid arthritis. What changes in X-ray pictures of her joints are the most probable?

A) Cysts in subchondral bone

B) Multiple marginal osteophytes

C) *Constriction of joint space, usura

D) Epiphysis osteolysis

E) Constriction of joint space, subchondral osteosclerosis

A 21 y.o. man complains of having morning pains in his back for the last three months. The pain can be relieved during the day and after physical exercises. Physical examination revealed reduced mobility in the lumbar part of his spine, increase of muscle tonus in the lumbar area and especially during the moving. X-ray pattern of spine revealed bilateral sclerotic changes in the sacrolumbal part. What test will be the most necessary for confirming a diagnosis?

A) Rheumatoid factor

B) Antinuclear antibodies

C) Uric acid in blood plasma

D) *HLA-B27

E) ESR

On the 4-th day of injections a 60 y.o. patient felt pain and tissue induration in the left buttock. Objectively: the skin in the superexternal quadrant of the left buttock is red and hot, palpation reveals a painful infiltrate 6х6 cm large with softening in the centre. Body temperature is 37,90С. What action is necessary to diagnose an abscess?

A) Ultrasonic examination

B) Biopsy

C) X-ray investigation

D) *Punction

E) Clinical blood analysis

A 58 year-old man complained of pain and swelling of the left foot small joints. The skin over these joints was purple, BT was 38°C. For the last 6 years he has had a few episodes of such arthritis with duration of each one up to 7 – 10 days. He also suffered from chronic tonsillitis. On exam, there were abnormal features in the left metatarsophalangeal joints. What is the pathogenetic mechanism of this disease development?

A) *Increased biosynthesis of uric acid

B) Immune response to streptococcal infection

C) Hyperproduction of autoantibodies to collagen

D) Decreased amount of chondroitin sulfate

E) Production of antibodies to native DNA

The woman 38 y.o. complains the morning joint stiffness, especially digital joints of hands and feet, that is disappeared after active motion during 30-60 min. Objective evidence: artritis of metacarpophalangeal and proximal interphalangeal joints. Body tempearture is subfebrile. ESR - 45 mm/hour. X-ray: osteoporosis and erosion the joints surfaces. Which is the most probably diagnosis?

A. *Rheumatoid artritis

B. Psoriatic arthropathy

C. Artritis deformans

D. Systemic lupus erythematosus

E. Reactive polyarthritis

The patient 18 y.o. fall ill acutely 3 week ago. The body temperature is sharply increased, arises severe pain of left shin. On the left shin X-ray multiple destuctive foci with irregular shape and unclear outline. The sequestra are within the destructions. An linear periostitis is around injured bone. Which is the most probably diagnosis?

A.*Acute hematogenous osteomyelitis of left shin bones

B. Tuberculosis of left shin bones

C. Sarcoma of left shin bones

D. Fibrous osteodistrophy of left shin bones

E. Metastases of left shin bones

The patient complains of thoracic spine pain as result of insignificance trauma (fell down the bed). He is admitted in a 40 min after accident. PPH: lung tuberculosis. On spine X-ray is suspected the compresion fractures of VIII and IX thoracic vertebral body. Which spine pathlogy can lead to pathological fracture?

A. *Tuberculous spondilitis

B. Syphilis

C. Metastasis

D. Osteomyelitis

E. Traumatic fracture

The patient G., 14 y.o. falled ill acutely, when high body temperature, febrile chill, sharp right shin pain was arisen. On X-ray of right leg the changes wasn’t found. After 2 week from onset of disease (in time of clinical remision) the repeated right shin X-ray was done: the destructive foci with irregular outline and linear periostitis in the middle third diaphysis of right tibia were diagnosed. Which is the most probably diagnosis?

A. *Right shin osteomyelitis

B. Right shin tuberculosis

C. Right shin syphilis

D. Right shin bone cyst

E. Right shin trauma

The boy 12 y.o. complains of two fistulas in lower third of left femur, high body temperature, general weakness. 6 monthes ago was acute hematogenous osteomielitis of left femur. On left femur X-ray – total left femur sequester (size 12x3 cm) is diagnosed. Which is a previous diagnosis?

A. *Secondary chronic osteomyelitis;

B. Pathological fracture;

C. Tuberculosis;

D. Ewing’s sarcoma;

E. Osteoid-osteoma;

Diagnostic radiology of bones’ tumors

The patient 16 y.o. complains of permanent knee pain, its swelling. Objective evidence: a skin above joint is smooth, superficial viens are widened. Under the palpation is defined sharp knee pain, dense swelling. Blood test: hemoglobin and RBC are decreased. Femur X-ray: the unclear bones destructions on the background of intensive structureless bone tissues in the distal femur, sunburst patern. Which is the most probably diagnosis?

A Osteosarcoma

B Osteochondroma

C Osteochondropathy

D Arthritis deformans

E Fibrous dysplasia

The man 35 y.o. complains of permanent left femur pain (on medial bone surface), the pain doesn’t abate after rest. Weak-intensive pain arose 8 monthes ago. On femur X-ray: femur osteoporosis; osification is not present; low-intensive periostal reaction of left femur distal methaphysis. Which is the most probably diagnosis?

A*Central fibrosarcoma

B Lymphosarcoma.

C Chondrosarcoma.

D Ewing sarcoma.

E Uxtacortical sarcoma.

The patient P, 17 y.o. complains of swelling and pain in lower third femur. The left femur trauma was happied 4 months ago. The patient's condition didn’t responded to treatment. Objective evidence: lower third femur swelling, painful under palpation, limitation in the range of motions the left knee joint. The body temperature is 37,2°С. Blood test: WBC – 5,6 *109/L, RBC – 4,1*1012/L, Hb – 130 g/L, ESR – 15 mm/hour. On left femur X-ray: focal osteoporosis and Codman’s triangle are diagnosed in distal metaphysis of left femur. Which is previous diagnosis?

A Osteogenic sarcoma

B Osteomyelitis

C Ewing sarcoma

D Tuberculosis

E Giant cell tumor

The boy 14 y.o. has been complaining of right third femur pain for a last 2 weeks. The pain is intensified during night-time and abeded as result paracetamol ingestion.

Objective evidence: pathology is not found. On right femur X-ray: destructive focus with sclerotic outline in cortex of proximal third femur. Which is the most probably diagnosis?

A *Osteoid-osteoma

B Enchondroma

C Miltiple myeloma

D Eosinophilic granuloma

E Osteochondroma

The patient 23 y.o. complains of insignificant discomfort in left lateral knee joint after working. Under palpation the swelling of left lateral knee joint is detected. On left knee joint X-ray: the bony prominence on letaral surface of distal femoral metaphysis is diagnosed. Overlying soft tissues are not changed. Pathohystological examination of removed neoplasm: mass with peduncle (about 3 cm) consists of cortical bone that is covered by cartilage. Which is the most probably diagnosis?

A *Osteochondroma

B Giant call tumor

C Bony cyst

D Osteoid-osteoma

E Enchondroma

The patient P. 20 y.o. turns to doctor with complaint of permanent left lower femur pain. The trauma wasn’t occurred. Objective evidence: ordinary skin color, pastose, pain under palpation, limitation in the range of knee joint motion. On knee joint ragion X-ray is detected the destruction and spiculated priostitosi. Blood test – young blood cells; inflamation signs are absent. Which is the most probably diagnosis?

A *Osteogenic sarcoma

B Fibrous dysplasia

C Chronic osteomyelitis

D Myeloma

E Marble-bone disease

The patient, В. 28 y.o. complains of general weakness, osteoalgia, frequent acute viral infection, giddy. Objective evidence: skin and mucous paleness, osteoalgia. Blood test: RBC – 2,7х1012/L, Нв-80 g/L, GV – 0,9, reticulocyte – 0,5, WBC – 5х109/L, eosinophilic leucocyte – 1%, basophilic leukocyte – 3%, stab neutrophil -7%, segmentonuclear leukocyte – 60%, lymphocyte – 23%, monocyte – 2%, plasmocyte – 4%, BP – 280х109/L, ESR – 64 mm/hour. Plasma protein – 120 g/L, Urine analysis: proteinuria. Skull X-ray: punch destructions. Which is the most probably diagnosis?

A *Multiple myeloma

B Chronic lymphatic leukemia

C Acute lymphatic leukemia

D Acute myeloleukemia

E Macroglobulinemia

The patient, В. 28 y.o. complains of general weakness, osteoalgia, frequent acute viral infection, giddy. Objective evidence: skin and mucous paleness, osteoalgia. Blood test: RBC – 2,7х1012/L, Нв-80 g/L, GV – 0,9, reticulocyte – 0,5, WBC – 5х109/L, eosinophilic leucocyte – 1%, basophilic leukocyte – 3%, stab neutrophil -7%, segmentonuclear leukocyte – 60%, lymphocyte – 23%, monocyte – 2%, plasmocyte – 4%, BP – 280х109/L, ESR – 64 mm/hour. Plasma protein – 120 g/L, Urine analysis: proteinuria. Skull X-ray: punch destructions. Which method of examination is the most infofmative for diagnosis?

A *Sternal biopsy

B Plasma protein electrophoresis

C Lymph node biopsy

D Rheumatoid factor test

E Schilling's test

The patient 68 y.o. complains of common weakness, osteoalgia, muscle weakness. Urine examination: proteinuria - 5 g/L. Adenectomy was 1 year ago. On skull and pelvis X-ray is diagnosed a lot of small round destructions with diameter 0,8-1,5 cm. Which is the most probably diagnosis?

A. *Multiple myeloma

B. Osteolytic bony metastases

C. Amyloidosis with nephrotic syndrome

D. Parathyroid osteosis

E. Chronic glomerulonephritis with nephrotic syndrome

The patient 57 y.o. complains of lumbal and pelvic pain, body temperature is raised to 380С, general sweating, the body weight is lost. Blood test: anemia, thrombocytopenia, ESR – 70 mm/hour. On skull and pelvis X-ray is diagnosed a lot of small round destructions. Urine analysis: proteinuria. Which is the most probably diagnosis?

A. *Multiple myeloma

B. Stomach cancer

C. Spondylitis deformans

D. Bony metastases

E. Chronic glomerulonephritis

The patient 57 y.o. complains of lumbal and pelvic pain, body temperature is raised to 380С, general sweating, the body weight is lost. Blood test: anemia, thrombocytopenia, ESR – 70 mm/hour. On skull and pelvis X-ray is diagnosed a lot of small round destructions. Urine analysis: proteinuria. Which is the most probably diagnosis?

A *Sternal biopsy

B Plasma protein electrophoresis

C Lymph node biopsy

D Rheumatoid factor test

E Schilling's test

Diagnostic radiology of bones traumas and degenerative diseases

What does it mean “the Monteggia fracture - dislocation ?”

A) *Combination of fracture of the upper half of the ulna with dislocation of the head of the radius

B) Dislocation of the head of the radius

C) Dislocation of both forearm bones

D) Combination of fracture of the radius with dislocation of the head of the ulna

E) Fracture of both forearm bones

What is the external rotation of the lower limb common for?

A) Fracture of the femoral neck

B) Fracture of the pubic bone

C) Fracture of the ischial bone

D) Fracture of the tibia

E) Fracture of the femoral shaft

The 67 y.o. patient had 5 recurrent fractures of the lower extremities without considerable cause within 5 years. O-shaped deformity of the legs in the knee joints has appeared. The skull, pelvis and lower extremities X-Ray shows the thickening of flat bones. In the long bones there is a hyperostosis along the bone axis. The blood test has not revealed any inflammation activity. Serum calcium is normal. What disease do you consider in this case?

A) Chronic osteomyelitis

B) *Paget's disease

C) Mottled disease (marble disease)

D) Hyperparathyoid dystrophy

E) Myeloma

A patient, aged 40, has been ill during approximately 8 years, complains of pain in the lumbar part of the spine on physical excertion, in cervical and thoracal part (especially when coughing), pain in the hip and knee joints on the right. On examination: the body is fixed in the forward inclination with head down, gluteal muscles atrophy. Spine X-ray: ribs osteoporosis, longitudinal ligament ossification. What is the most likely diagnosis?

A) *Ancylosing spondyloarthritis

B) Psoriatic spondyloarthropatia

C) Spondyloarthropatia on the background of Reiter's disease

D) Tuberculous spondylitis

E) Spread osteochondrosis of the vertebral column

A 60 y.o. patient complains of pain in interphalangeal joints of hand that gets worse during working. Objectively: distal and proximal joints of the II-IV fingers are defigured, with Heberden's and Bouchard's nodes, painful, nonelastic. X-ray picture of joints: joint spaces are constricted, there are marginal osteophytes, subchondral sclerosis. What is the most probable diagnosis?

A) Reiter's disease

B) Rheumatic arthritis

C) *Osteoarthritis

D) Psoriatic arthritis

E) Bechterew's disease

The patient 55 y.o. has been complaining of left knee joint pain for 2 months. The skin above left knee joint is hyperemic, swelling; limitation in the range of left knee motions. The uric acid rate is norm. On left knee X-ray: osteosclerosis, osteophytes; joint space is narrowed. What is the most probable diagnosis?

A. *Arthritis defornas

B. Gonorrheal gonitis

C. Gout

D. Rheumatoid arthritis

E. Tuberculous gonotis

The woman 56 y.o. complains of wrist and knee joints pain. She has been being ill for 8 years. The body temperature is 36,6oC. Interphalangeal hand joints is thicked and painful under motion, crunch in knee joints. On knee joints X-ray: osteoporosis, joint spaces narrowing, marginal osteophytes. Blood test: WBC – 6,2х109/L, ESR - 13 mm/hour. What is the most probable diagnosis?

A. *Arthritis deformans

B. Rheumatoid polyarthritis

C. Gout

D. Gonorrheal arthritis

E. Reactive polyarthritis

The woman 49 y.o. complains of shoulder joint pain, that is intensified as result of motion; limitation in rate of joint motions, short-time morning joint stiffness. She has been being ill for several years. She was being sport gimnast in the past. On shoulders X-ray – narrowng joint spaces, subchondral osteosclerosis, lower-medial osteophytes. What is a pathogenesis base of the joint disease?

A. *Abnormality of cartilage metabolism

B. Immune complex sedimentation into synovial membrane

C. Abnormality of uric acid metabolism

D. Calcium pyrophosphate sedimentation into the joint

E. Infectious synovial lession

The woman, 55 y.o., cook, complaints of right knee pain during a month which is intensified to the set of day. Objective evidence: body weight is increased, right knee is swollen and painful under palpation, crunch is under the motion; deformation of I metatarsophalangeal joints of both feed. Blood test is in norm. What radiological features is X-ray of right knee shown?

A. *Narrowing of joint space, marginal osteophytes

B. Osteoporosis, narrowing of joint space, single small erosions

C. Narrowing of joint space, multiple erosions, subluxation

D. Epiphyseal erosions, bony ankylosis

E. Narrowing of joint space, rounded bony defects

The patient 56 y.o. with increased body weight complains of pain in knee joints, which is intensified under walking, particularly under walking up the stairs. He have been being ill to last for 5 years. Objective evidence: knee joints are deformed, swollen; crunch and painful take place during the moution. On X-ray of both knee joints: joint spaces are narrowed, subchondral sclerosis and marginal osteophytes take place. Which diagnosis is the most probable?

A. *Arthritis deformans.

B. Rheumatoid arthritis.

C. Reactive arthritis.

D. Gout.

E. Rheumatoid polyarthritis.

The patient 60 y.o. complains of pain of interphalangeal joints, which is intensified at work. Objective evidence: the intephalangeal joints of II-IV fingers are deformed, painful fixed Heberden's and Bushar’s nodes take place. On X-ray of interphalangeal joints – joint spaces are narrowed, subchondral sclerosis and marginal osteophytes take place. Which diagnosis is the most probable?

A. *Arthritis deformans, nodular type.

B. Reiter's disease

C. Bechterew's disease

D. Rheumatoid polyarthritis.

E. Psoriatic arthritis

The woman 57 y.o. complains of pain of right knee joint, which is intensified at motion and in the evening during last year. Objective evidence: t°=36,4°С, height 161 cm, weight 98 kg. The joint is slightly deformed, the local temperature is not increased, crunch and painful take place during the moution. What radiological features is X-ray of right knee shown?

A. *Small marginal osteophytes

B. Epiphysial punch defects

C. Changes are not shown

D. Local osteoporosis

E. Narrowed joint space and singular erosions

The patient С., 56 y.o. with increased body wight complains of pain of hand joints. The joint pathology has been disturbing for 10 years. Objective evidence: expresed deforming and swelling of hand fingers. X-ray of hands: joint spaces are narrowed, osteophytes, erosions, osteoporosis and epiphyseal ankylosis with ulnar deviation of metacarpophalangeal joints take place. Blood test: Нв-95 g/L, ESR-20 mm/hour. Uric acid - 0,38 mmоle/L. Which diagnosis is the most probable?

A. *Both osteoarthrosis and rheumatoid arthritis

B. Rheumatoid arthritis

C. Osteoarthrosis

D. Gout

Е. Reactive arthritis

The patient G., 56 y.o. complains of pain of knee and distal interphalangeal joints. She is ill during 8 years. Body temperatura is in norm. Interphalangeal joints are swolled and painful under palpation, the flexion of knee joints cause crunch. Knee joints X-ray: joint spaces are narrowed, marginal osteophytes take place. Blood test: WBC- 6,2 х 109/L, ESR - 13 mm/hour. Which diagnosis is the most probable?

A. *Osteoarthrosis

B. Rheumatoid arthritis

C. Rheumatoid polyarthritis

D. Gout

E. Reactive arthritis

The woman 56 y.o. complains of knee joints pain. The joints are enlarged, limitation in the range of motions and painful take place, crunch. The previouse diagnosis: osteoartrosis. Which radiological features are you expexted to find on X-ray of knee joints?

A. *Osteosclerosis, osteophytes.

B. Osteoporosis, narrowing of joint spaces.

C. Osteoporosis, punch-defects.

D. Osteoporosis, widening of joint spaces.

E. Osteoporosis, erosions of joint surfaces.

The patient К., 60 y.o. complains of nagging pain, distal interphalangeal joints’ stiffness, their deformation. X-ray of hands: ostephytes, narrowing of the joint space, subchondral sclerosis. Для какого поражения суставов характерна такая рентгенологическая картина?

A. *Osteoarthrosis

B. Rheumatoid arthritis.

C. Gouty arthritis

D. Systemic lupus erythematosus.

E. Sclerodermatitis

The man 40 y.o. turns to doctor with complaint of frequent leg fractures as result of trivial trauma. During last 3 years was ocurred the 5 fractures. Objective evidence: O-shape leg deforming. On skull, pelvis and legs X-rays – flat bones are thicked, tubular bones – hyperostosis. The inflamation sings in blood test is absent. Calcium plasma rate is slightly increased. Which is the most probably diagnisis?

A. *Paget's disease

B. Parathyreoid distrophy

C. Chronic osteomyelitis

D. Multiple myeloma

E. Marble-bone disease

The patient complains of right hip joint pain, that is intensified at motions. He has been being ill for several years. Trauma wasn’t taken place. He was not treated. On right hip joint X-ray can diagnosed: narrowed the joint space, osteophytes, femur’s caput deformation. Which is the most probably diagnisis?

A. *Right coxarthrosis

B. Rheumatoid arthritis

C. Lumbal radiculitis

D. Lumbosacral radiculitis

E. Upper third femur tumor

The boy 12 y.o. complains of acute spine pain and stiffness as result of falled down on spin from a height 5 m. Which first-line investigation is necessary?

A. *Biplane spine X-ray

B. Lateral spine X-ray

C. Anterior-posterior spine X-ray

D. CT-scan of spine

E. MRI of spine

Diagnostic radiology of nonspecific lung’s inflamation

A 56-year-old woman has an acute onset of fever up to 39°C with chills, cough, and pain on respiration in the right side of the chest. On physical examination: HR of 90/minute, BP of 95/60 mm Hg, PR of 26 per minute. There is dullness over the right lung. On X-ray: infiltrate in the right middle lobe of the lung. What is the correct diagnosis?

A) *Community-acquired lobar pneumonia with moderate severity.

B) Community-acquired bronchopneumonia.

C) Acute pleurisy.

D) Acute lung abscess.

E) Hospital-acquired lobar pneumonia.

A 26-year-old man was admitted to the hospital complaining of stabbing back pain on inspiration and dyspnea. On exam, BT of 37°C, PR of 24/min, HR of 92/min, vesicular breath sounds. There is a dry, grating, low-pitched sound heard in both expiration and inspiration in the left lower lateral part of the chest. What is the correct diagnosis?

A) *Acute fibrinous pleuritis

B) Myocarditis

C) Pneumonia

D) Acute bronchitis

E) Pneumothorax

Physical examination of a person with chronic bronchitis reveals expansion of intercostal spaces, hyperresonant percussion note, decreased whispered voice sounds. Chest x-ray shows hyperinflated lungs, low and flattened diaphragm. Which of the signs is helpful to diagnose the lung emphysema?

A) *All of them

B) Low diaphragm

C) Hyperresonant percussion note

D) Hyperinflated lungs

E) Expansion of intercostal spaces

A 38-year-old patient has been treated in a hospital. A fever of 39 C, chest pain which is worsened by breathing, cough, brownish sputum appeared on the 7th day of the treatment. Chest x ray shows left lower lobe infiltrate. Which of the following is the treatment of choice for this patient?

A) *Cephalosporins of the Ш generation

B) Penicillin

C) Erythromycin

D) Tetracycline

E) Streptomycin

The primary bronchopneumonia more often arises as …

A) *Complication of acute bronchitis.

B) Complication of pneumorrhagia.

C) Complication of stagnation of blood in the lungs.

D) Complication of infarct of the lungs.

E) Complication of pneumoconiosis.

When can pulmonary bleeding arise ?

A) *Bronchoectatic disease.

B) Diffuse catarrhal bronchitis.

C) Bronchiolitis.

D) Lobar pneumonia in a stage of red hepatization.

E) Bronchopneumonia.

A 10-year-old boy complains of a headache, weakness, fever (temperature - 400С), vomiting. On physical examination: there is an expressed dyspnea, pale skin with a flush on a right cheek, right hemithorax respiratory movement delays, dullness on percussion of the lower lobe of the right lung, weakness of vesicular respiration in this region. The abdomen is painless and soft by palpation. What disease causes these symptoms and signs?

A) Intestinal infection

B) Acute cholecystitis

C) Influenza

D) Acute appendicitis

E) *Pneumonia crouposa

A 35-year-old woman was admitted to thoracic surgery department with fever up to 400C, onset of pain in the side caused by deep breathing, cough with considerable quantity of purulent sputum and blood with bad smell. What is the most likely diagnosis?

A) Tuberculosis of lungs

B) Actinomycosis of lungs

C) Bronchectatic disease

D) Complication of liver echinococcosis

E) Abscess of the lungs

A patient with nosocomial pneumonia has signs of collapse. Which of the following pneumonia complication is the most likely to be accompanied with collapse?

A) Exudative pleuritis

B) Emphysema

C) Bronchial obstruction

D) Toxic hepatitis

E) *Septic shock

The diagnosis of a right-sided pneumothorax is set to a 36-year-old patient. What method of treatment is indicated to the patient?

A) Anti-inflammatory therapy

B) Drainage of the pleural cavity

C) Symptomatic therapy

D) Thoracotomy

E) Pleural puncture

A child was born at 34 weeks of gestation in bad condition. The cardinal symptoms show respiratoty disorders: sound prolonged expiration, additional muscles taking part in breathing, crepitation rales on the background of the rough breath sounds. Assesment according to Silverman's scale was 0, in 3 hours- 6 with presence of clinical data. What diagnostic method can determine pneumopathy's type in the child?

A) Blood test

B) *Chest X-ray

C) Proteinogram

D) Immunologic investigation

E) Blood gases

A patient complains of a hacking cough with expectoration of up to 600 ml/daily purulent chocolatecolor sputum with a decay smell. Onset of illness was abrupt, t0- 390C, fever of irregular type. There is the area of darkening with a cavity in a center on X-ray film, with irregular contours and level of liquid. What disease is the question?

A) Pneumonia complicated by an abscess

B) Bronchiectatic illness

C) Tuberculosis

D) *Gangrene of lung

E) Lobar pneumonia

A 32 y.o. patient who has been staying in a hospital on account of acute abscess of his right lung suddenly felt pain after coughing in the right half of thorax, he got heavy breathing, cyanosis. What complication is the most probable?

A) *Pyopneumothorax

B) Exudative pleurisy

C) Myocardial infarction

D) Esophagus perforation

E) Infarction-pneumonia

A 15 y.o. girl was examined. Her medical history registers gradual onset of fever, malaise, loss of weight. There was nothing typical about the kind of fever which has been present for more than 7-10 days and changed quickly. Physical examination didn't give evident results. What is the only most important examination for excluding miliary tuberculosis?

A) Liver or bone marrow biopsy

B) Tuberculin skin testing

C) *Chest X-ray

D) Bronchoscopy

E) Sputum smear and culture of m. tuberculosis

A 56 y.o. woman has an acute onset of fever up to 390C with chills, cough, and pain on respiration in the right side of her chest. On physical examination: HR- 90/min, BP- 95/60 mm Hg, Ps- 26/min. There is dullness over the right lung. On X-ray: infiltrate in the right middle lobe of the lung en palpation. What is the diagnosis?

A) *Community-acquired lobar pneumonia with moderate severity

B) Acute pleurisy

C) Hospital-acquired lobar pneumonia

D) Community-acquired bronchopneumonia

E) Acute lung abscess

X-ray pattern of thorax organs revealed a large intensive inhomogeneous opacity with indistinct outlines on the right side at the level of the 4-th rib. In the centre of this opacity there is a horizontal level and clearing of lung tissue above it. What disease does this X-ray pattern correspond with?

A) -

B) *Abscess of the right lung

C) Peripheral cancer

D) Right-sided pneumothorax

E) Tuberculoma of the right lung

An 8 y.o. boy complains of constant cough along with discharge of greenish sputum, dyspnea during physical activities. At the age of 1 year and 8 months he fell ill for the first time with bilateral pneumonia that had protracted course. Later on there were recurrences of the disease 5-6 times a year, during the remission periods there was constant productive cough. What examination results will be the most important for making a final diagnosis?

A) *Bronchography

B) X-ray of thorax organs

C) Spirography

D) Bronchoscopy

E) Bacterial inoculation of sputum

A 38 y.o. woman is seriously ill. She complains of frequent paroxysms of expiratory dyspnea. The last paroxysm lasted over 12 hours and failed to respond to theophylline. The skin is palish gray, moist, RR of 26/min. On auscultation, breath sounds are absent over some areas. What is your preliminary diagnosis?

A) Chronic obstructive bronchitis

B) *Bronchial asthma, status asthmaticus

C) Ischemic heart disease, pulmonary edema

D) Atopic bronchial asthma, respiratory failure of the III degree

E) Bronchiectasis, respiratory failure of the II-III degree

Prophylactic photoX-ray examination of a 25 year old man revealed focal shadowings of small and medium intensity with irregular contours in the 1st and 2nd segments of the right lung. Which clinical form can be suspected?

A) Fibro-cavernous

B) Disseminated

C) Miliary

D) *Focal

E) Tuberculoma

A patient with nosocomial pneumonia presents signs of collapse. Which of the following pneumonia complications is most likely to be accompanied by collapse?

A) Exudative pleuritis

B) Bronchial obstruction

C) Toxic hepatitis

D) *Septic shock

E) Emphysema

F) Nosocomial lobar pneumonia

A 6 week old child is admitted because of tachypnea. Birth had been uneventful, although conjunctivitis developed on the third day of life and lasted for about 2 weeks. Physical examination reveals tachypnea, bilateral inspiratory crackles and single expiratory wheezing. Bilateral pneumonia is evident on chest X-ray. The child is afebrile and has no history of fever. White blood cell count is 15*109/l, with 28% of eosinophils. The most likely cause of this child's symptoms is:

A) Visceral larva migrans

B) Varicella

C) Pneumocystis carinii

D) *Clamydia trachomanis

E) Mycoplasma pneumoniae

An 18 month child, taken to hospital on the 4-th day of the disease. The disease began acutely with temperature 39, weakness, cough, breathlessness. He is pale has cyanosis, febrile temperature for more than 3 days. There are crepitative fine bubbling rales at the auscultation. Percussion sound is shortened in right under scapula area. X-ray picture: unhomogenius segment infiltration 8-10 in the right, the increase of vascular picture, unstructural rools. Your diagnosis:

A) *Segmentary pneumonia

B) Grippe

C) Bronchitis

D) Bronchiolitis

E) Interstitial pneumonia

Diagnostic radiology of Lung Tuberculosis and

Occupational diseases of lung

In case of tuberculosis of genital organs a primary focus is located most often in:

A) Lungs

B) Bones

C) Urinary excretory system

D) Lymph nodes

E) At the peritoneum

A 15-year-old girl was examined with a history of gradual onset of fever, malaise, loss of weight. There was nothing typical about the kind of fever, which has been present for more than 7-10 days and changed quickly. Physical examination was unremarkable. What is the single most important examination for excluding miliary tuberculosis?

A) *Chest x-ray

B) Liver or bone marrow biopsy

C) Tuberculin skin testing

D) Sputum smear and culture of M.tuberculosis

E) Bronchoscopy

In a male aged 25 focal shadowings of small and medium intensity with unequal contours in the 1st and 2nd segments of the right lung were revealed during prophylactic photoX-ray investigation. Which clinical form can be suspected in this patient?

A) Focal

B) Disseminated

C) Miliary

D) Fibro-cavernous

E) Tuberculoma

A 5-year-old boy was progressively getting more unwell than during the previous 2 months. A chest x-ray had shown right middle lobe collapse. A tuberculin skin test had been strongly positive. What is the most characteristic finding in primary tuberculosis?

A) Hilar or paratracheal lymph node enlargement

B) Atelectasis with obstructive pneumonia

C) Cavity formation

D) Miliary tuberculosis

E) Hematogenous dissemination leading to extrapulmonary tuberculosis

A 38-year-old man worked at roofing and drain piper production for 15 years. He seeks medical help for expiratory breathlessness on exertion, and dry cough. On exam, wheezes above both lungs, grayish warts on fingers are seen. Factory physician has diagnosed asbestosis. What method is the most important for this patient?

A) *Chest X-ray

B) Bronchoscopy

C) Blood gas analysis

D) Spirography

E) Electrocardiography

A 45-year-old coal miner complains of cough with black sputum, breathlessness on exertion, which occurred 4 years before. On physical examination, wheezes above both lungs, heart sounds are without changes, heart rate of 72 beats per minute. Chest radiography shows multiple, small irregular opacifications throughout both lungs. What is the most probable diagnosis?

A) *Anthracosis, nodular, slowly progressing form, first stage.

B) Silicosis, nodular, slowly progressing form, first stage.

C) Siderosis, interstitial, slowly progressing form, first stage.

D) Bissinosis, interstitial, slowly progressing form, first stage.

E) Asbestosis, interstitial, slowly progressing form, first stage.

A 20-year-old woman complains of weakness, wet cough, body temperature raise up to 37,50C in the evenings during one month. In childhood she was under phthisiatric observation due to conversion of tubercular tests (PPD). The condition is good. No rales in lungs. Chest X-ray: a shadow with dim contours 3х4 cm with a clearing and focuses near the shadow in the upper lobe of the right lung. Blood analysis: ESR - 20 mm/hour, WBC - 7,6*109/L. What is the most likely diagnosis?

A) Pneumonia with abscess formation

B) Tuberculoma

C) Decaying cancer

D) Focal tuberculosis

E) Infiltrative tuberculosis

A worker, aged 38, working in the slate production during 15 years, complains of expiratory exertional dyspnea, dry cough. On examination: deafening of the percutory sounds in interscapular region, rough breath sounds, dry disseminated rales. On fingers' skin – greyish warts. Factory's sectorial doctor suspects asbestosis. Which method is the most informative for diagnosis verification?

A) Bronchoalveolar lavage

B) Spirography

C) Blood gases examination

D) Bronchoscopy

E) *Thorax X-ray

On chest X-ray in upper field of left lung the ring-shaped shadow is detected – it is the ellipsoid cavity with thin smooth walls. The pleural thickening is located upward and lateraly from cavity. Bronchial and perybronchial fibrosis connects Bronchial path conects the cavity with cavity and lung root. The fluid level within cavity is absent. Other lung field is without visible alteration. Which pathology is the most probably coresponded with the radiological description?

A. *Fibrous cavernous TBC.

B. Lung’s abscess.

C. Cancer with destruction.

D. Lung emphysema.

E. Gas-filled cyst.

35 y.o. woman was admitted to thoracic surgery department with fever up to 400C, onset of pain in the side caused by deep breathing, cough with considerable quantity of purulent sputum and blood with bad smell. What is the most likely diagnosis?

A) Actinomycosis of lungs

B) Abscess of the lung

C) Bronchiectatic disease

D) *Pulmonary tuberculosis

E) Complication of liver echinococcosis

Diagnostic radiology of Lung Tumor

Emergency diagnostic radiology of chest pathology

The diagnosis of Right sided pnuemothorax is made to a 36 year old patient. What method of treatment is indicated to the patient?

A) *Surgical treatment: Drainage of the pleural cavity.

B) Antiinflammation therapy.

C) Symptomatic therapy.

D) Pleural puncture.

E) Thoracotomy.

A 45-year-old man was brought to clinic with complaints of a sudden pain in the left chest part and epigastric area, shortness of breath, nausea, one-time vomiting. The acute pain started after considerable weight lifting. On physical examination: shallow breathing, RR - 38/min, left chest part is getting behind during respiration, by percussion - tympanitic sound, respiration is not auscultated. Ps - 110 bpm, of weak filling. BP - 100/60 mm Hg, insignificant displacement of heart to the right, sounds are dull. What examination is the most expedient?

A) Esophagogastroscopy

B) *X-ray

C) Bronchoscopy

D) Ultrasound of the abdominal cavity

E) Electrocardiography

A patient aged 65 complains of shortness of breath, cough with red foamy sputum, feeling of air deficit, fear of death. On examination: orthopnea, pale skin, acrocyanosis, cold sticky sweat. Rough breathing sounds, in inferior-posterior arias on both sides - small and medium moist rales. BR - 40/min. Heart sounds are distinctly muffled. On the cardiac apex - gallop rhythm. What is the most probable preliminary diagnosis?

A) Pulmonary embolism

B) Pulmonary edema

C) Lobar pneumonia

D) Infarction-pneumonia

E) Asthmatic state

A patient was operated on account of perforated stomach ulcer, terminal stage of diffuse peritonitis. After endotoxic shock in the post-operative period the artificial pulmonary ventilation is carried out with inhalation of 60% oxygen. Blood gasses: РаО2 = 70-78 mm Hg, hypoxemia is not diminishing, CVP - 150-180 mm H2O, BP - 90/60 mm Hg (with administering of dopamine in high doses). Radiologically: diffuse pulmonary infiltration. What is the reason of the resistant arterial hypoxemia?

A) Respiratory distress-syndrome

B) Pneumothorax

C) Pulmonary edema

D) Bilateral pneumonia

E) Mendelson's syndrome

A man, aged 64, complains of cough with sputum discharge, sometimes with blood spitting. Smokes during 30 years. In the last 3 months has lost 8 kg. On roentgenologic examination in the middle lobe of the right lung there is a cavernous formation, the inner outline is irregular, contains a small quantity of fluid, on the right the central lymph nodes are enlarged. What examination is the most informative to define the diagnosis?

A) Spirography

B) Sputum analysis

C) *Bronchoscopy with biopsy

D) Pulmonary tomography

E) Bronchography

A patient, aged 32, diagnosed with multiple injuries: closed craniocerebral injury, closed chest injury, closed right hip fracture. BP - 100/60 mm Hg, Рs - 124/min, RR - 28/min. 2 hours after skeletal extension under local anaesthesia with lidocaine, there appeared abrupt aggravation of the patient's condition: developed face and neck cyanosis, BP - 60/40 mm Hg, HR - 160/min, RR - 44/min. What complication most probably aggravated the severity of multiple injuries?

A) Acute anaemia

B) Pain shock

C) Cardiac infarction, cardiogenic shock

D) Pulmonary thromboembolism

E) *Pulmonary fat embolism

On examination of a patient, aged 49, cancer of the right lung, ІІА stage, is diagnosed. What TNM combination corresponds to this stage?

A) T2N0M0

B) T2NXM0

C) T2N2M0

D) *Т1N1M0

E) T1N2M0

In medical history of a 2-years-old girl: recurring pneumonias with obstructive course. Auscultation: heterogeneous moist and dry rales in lungs, weakened breathing. Difficult excretion of thick, viscous sputum. Observed "drumstick" fingers, mental deficiency. What is the preliminary diagnosis?

A) Congenital polycystic lung disease

B) *Cystic fibrosis, pulmonary form

C) Pulmonary tuberculosis

D) Bronchial asthma

E) Recurrent bronchitis

A 60 y.o. patient experiences acute air insufficiency following of the venoectomy due to subcutaneous vein thrombophlebitis 3 days ago. Skin became cianotic, with grey shade. Marked psychomotor excitement, tachypnea, substernal pain. What postoperative complication has occured?

A) Myocardial infarction

B) *Thromboembolia of pulmonary artery

C) Hemorrhagia

D) Valvular pneumothorax

E) Hypostatic pneumonia

A 24 y.o. male patient was transferred to the chest surgery department from general surgical department with acute post-traumatic empyema of pleura. On the X-ray: wide level horizontal of fluid on the right. What method of treatment should be prescribed?

A) *Punction and drainage of pleural cavity

B) Decortication of pleura

C) Pneumoectomy

D) Thoracoplasty

E) Lobectomy

A 55 y.o. male patient complains of weakness during 2 months, pain in the right side of the thorax, cough, blood-streaked sputum. On X-ray: intensive triangle shadow in the area of lower lobe that is connected to mediastinum. What is the most likely disorder in the lungs?

A) *Central cancer of lungs

B) Tuberculosis of lungs

C) Bronchiectasia

D) Pulmonary infarction

E) Pleuropneumonia

A patient has undergone an operation on account of perforated ulcer of stomach, terminal phase of diffuse peritonitis and endotoxic shock. In the post-operative period he is prescribed artificial pulmonary ventilation with 60% oxygen inhalation. Blood gases: РаО2- 70-78 mm Hg, hypoxemy doesn't ecrease, CVP (central venous pressure) - 150-180 mm of water column, AP- 90/60 mm Hg (against the backgound of taking big doses of dopamine). Radiogram shows diffuse pulmonary infiltration. What cause the refractory arterial hypoxemia?

A) Bilateral pneumonia

B) Mendelson's syndrome

C) *Respiratory distress syndrome

D) Pneumothorax

E) Pulmonary edema

The patients has sustained blunt trauma to the chest. Which of the following would most likely be the cause of acute cardiopulmonary collapse?

A) Acute adult respiratory distress syndrome (ARDS)

B) *Pneumothorax

C) Pulmonary contusion

D) Hemothorax

E) Rib fractures

A patient complains about strong dyspnea that is getting worse during physical activity. Presentations appeared suddenly 2 hours ago at work: acute chest pain on the left, cough. The pain was abating, but dyspnea, dizziness, pallor, cold sweat and cyanosis were progressing. Vesicular respiration is absent, X-ray picture shows a shadow on the left. What pathology might be suspected?

A) Pulmonary infarction

B) Left-sided pneumonia

C) *Spontaneous left-sided pneumothorax

D) Pleuritis

E) Pulmonary abscess

Survey radiograph of chest of a 62 year old smoker who often suffers from "pneumonias" showed a triangle shadow in the right lung, its vertex is pointing towards the lung root. It also showed deviation of heart and mediastinum shadows towards the lesion. What is the most probable diagnosis?

A) Atelectasis

B) Peripheral cancer of lung

C) *Cenral cancer of lung

D) Lung cyst

E) Lung abscess

Diagnostic radiology of Heart pathology

Purulent medisatinitis is diagnosed on a 63 year old patient. What of the below listed diseases are not the cause of purulent mediasdtinitis?

A) *Cervical lymfadinitis.

B) Deep nech phlegmon.

C) Perforation of the cervical part of the easophagus.

D) Perforation of the thoracic the easophagus.

E) Iatrogenic injury of the trachea.

A 44-year-old woman complained of weakness, subfebrile fever, and pallor of the skin. Physical examination revealed the enlarged lymph nodes in the right supraclavicular area. On X-ray film, there was enlargement of bronchopulmonary and paratracheal lymph nodes. The liver was enlarged, with increased firmness. What is the most probable diagnosis?

A) *Hodgkin’s disease.

B) Tuberculosis.

C) Sarkoidosis.

D) Tumor metastases.

E) Chronic myelocytic leukemia.

A patient, aged 49, complains of fever of 37,5 0С, heart pain, dyspnea. S1 is clapping; S2 is accentuated in the aortic area; opening snap, presystolic murmur are auscultated. What is the most useful investigation for valvular disorder assessment?

A) *Echocardiography+Doppler-Echocardiography

B) Phonocardiography

C) Ballistocardiogram

D) Chest X-ray

E) ECG

A 30- year-old patient complains of breathlessness, pain in the right rib arc place, dry cough and the leg edema. He is ill for 2 months. He was treated for rheumatic fever without effect. On exam, cyanosis, edema of the legs, BT of 36.6°C, RR of 28/min, HR of 90/min, BP of 110/80 mm Hg, crackles above low parts of both lungs, heart borders are displaced to the left and to the right, weak sounds, systolic murmur above the apex. What is your previous diagnosis?

A) *Dilated cardiomyopathy

B) Infectious endocarditis

C) Acute myocarditis

D) Rheumatic fever, mitral stenosis

E) Acute pericarditis

A patient, aged 50, during 15 years is ill with essential hypertension, not under treatment. BP - 220/140 mm Hg, Ps - 80bmp, rhythmic. On percussion: the left heart border is 2 cm to the outside from the left midclavicular line. Sound 1 is moderately weakened. Sound 2 is accentuated over the pulmonary artery. What changes will be characteristic on ultrasound heart examination?

A) Hypertrophy and dilatation of the right ventricle

B) Blood regurgitation through the aortic valve

C) Blood regurgitation through the mitral valve

D) Dilatation of the left atrium

E) Hypertrophy and dilatation of the left ventricle

A 49-year-old patient complains of fever of 37,50С, chest pain, dyspnea. On physical examination: Sound 1 is clapping; Sound 2 is accentuated in the pulmonary artery, opening snap, presystolic murmurs are auscultated. What is the most useful investigation for valvular disorder assessment?

A) Phonocardiography

B) Electrocardiogram (ECG)

C) Chest X-ray

D) Echocardiography + dopplerechocardiography

E) Ballistocardiogramme

A 5-year-old child with stigmas of dysembryogenesis (small chin, thick lips, opened mouth, hyperthelorismus) has systolic murmur in the second intercostal to the right of the sternum. The murmur passes to the neck and along the sternum left edge. The pulse on the left brachial artery is weakened. BP on the right arm is 110/60 mm Hg, on the left - 100/60 mm Hg. ECG results: hypertrophy of the right ventricle. What defect is the most probable?

A) Defect of interatrial septum

B) Defect of interventricular septum

C) Open aortic duct

D) Coarctation of the aorta

E) *Aortic stenosis

A 52-year-old man has recurrent transient ischemic attacks. Auscultation of the carotid arteries detects murmur. What diagnostic method is necessary to apply first?

A) MRI of the brain.

B) Electroencephalography

C) *Ultrasound dopplerography

D) Cerebral angiography

E) CT of the brain

A female patient, aged 45. Two weeks after pneumonia developed shortness of breath during walking, constant ache in precardiac area, shin edema. On examination: t0 = 37,20С, Heart borders without changes, Sound 1 on the apex is weakened. ECG: atrioventricular heart block I degree, lowering of the amplitude of Т wave in V2-V6. In blood: Hb - 124 g/L, WBC - 5,68*109/L, ESR - 18 mm/h. What is the most likely diagnosis?

A) Pulmonary embolism

B) Metabolic cardiopathy

C) CHD: unstable angina

D) Infective endocarditis

E) Acute myocarditis

A patient, aged 36, is diagnosed with ascites, splenomegaly, liver dimensions by Kurlov 11х9х8 cm, varicose esophagus veins. In medical history: abdominal injury, stomach bleeding. AST – 0,46 mmol/g*L; ALT – 0,68 mmol/g*L; total bilirubin – 21 mu mol/L, unconjugated bilirubin – 17,1 mu mol/L. What is the preliminary diagnosis?

A) Constrictive pericarditis

B) Hepatic vein thrombosis

C) Portal vein thrombosis

D) Inferior vena cava thrombosis

E) Peritoneum tumour (mesothelioma)

A boy, aged 13, suffers from an abrupt aggravation of condition, there appeared shortness of breath, skin paleness with cyanosis. BP - 80/55 mm Hg, Ps- 128/min, heart sounds weakened. On ECG: diffuse muscular changes, polytopic extrasystole. Radiologically: acute enlargement of the heart borders in all directions. Two weeks ago there occurred a reaction on analgin administration. What is the most likely diagnosis?

A) Endocardial fibroelastosis

B) *Idiopathic Abramov-Fiedler myocarditis

C) Rheumatic myocarditis

D) Exudative pericarditis

E) Hypertrophic cardiomyopathy

A female rheumatic patient experiences diastolic thoracic wall tremor (diastolic thrill), accentuated S1 at apex, there is diastolic murmur with presystolic intensification, opening snap, S2 accent at pulmonary artery. What does the heart pathology this patient have?

A) Aortic valve insufficiency

B) *Mitral stenosis

C) Opened arterial duct

D) Pulmonary artery stenosis

E) Mitral valve insufficiency

A 64 y.o. patient has developed of squeering substernal pain which had appeared 2 hours ago and irradiated to the left shoulder, marked weakness. On examination: pale skin, cold sweat. Pulse- 108 bpm, AP- 70/50 mm Hg, heart sound are deaf, vesicular breathing, soft abdomen, painless, varicouse vein on the left shin, ECG: synus rhythm, heart rate is 100 bmp, ST-segment is sharply elevated in II, III aVF leads. What is the most likely disorder?

A) Pulmonary artery thromboembolia

B) Cardiac tamponade

C) *Cardiogenic shock

D) Cardiac asthma

E) Disquamative aortic aneurizm

A 19 y.o. man was admitted to the reception department in 20 minutes after being wounded with the knife to the left chest. The patient is confused. The heart rate is 96 bpm and BP- 80/60 mm Hg. There are the dilated neck veins, sharply diminished apical beat and evident heart enlargement What kind of penetrative chest wound complications has developed in in patient?

A) Valve-likes pneumothorax

B) Open pneumothorax

C) Massive hemothorax

D) *Pericardium tamponade

E) Closed pneumothorax

A 37 y.o. woman is suffering from squeezing substernal pain on physical exertion. On examination: AP- 130/80 mm Hg, heart rate=pulse rate 72 bpm, heart boarders are dilated to the left side, aortic systolic murmur. ECG- signs of the left venticle hypertrophy. What method of examination is the most informative in this case?

A) *Echocardiography

B) X-ray

C) Coronarography

D) Sphygmography

E) Phonocardiography

A 40 y.o. man complains of headache in occipital area. On physical examination: the skin is pale; face and hand edema, BP- 170/130 mm Hg. On EchoCG: concentric hypertrophy of the left ventricle. Ultrasound examination of the kidneys reveals thinned cortical layer. Urine analysis shows proteinuria of 3,5 g/day. What is the probable diagnosis?

A) Chronic glomerulonephritis

B) Chronic pyelonephritis

C) Cushing's disease

D) *Essential arterial hypertension

E) Polycystic disease of the kidneys

A 42 y.o. patient was admitted 3 hours after a trauma with evident subcutaneous emphysema of the upper part of his body, dyspnea, tachycardia 120/min. X-ray examination revealed no pneumothorax, significant dilatation of mediastinum to the both sides. What emergency care is needed?

A) Pleural cavity drainage

B) Toracotomy

C) Toracoscopy

D) *Drainage of anterior mediastinum

E) Pleural cavity punction

A 39 y.o. patient complains of having dyspnea during physical activity, crus edemata, palpitation, heart intermissions. Objectively: HR is 150 bpm, atrial fibrillation. Heart is both ways enlarged. Heart sounds are muted. Liver is 6 cm below the costal margin. Echocardiogram reveals dilatation of heart chambers (end diastolic volume of left ventricle is 6,8 cm) is 29% EF, valve apparatus is unchanged. What is the most probable diagnosis?

A) Thyreotoxic cardiomyopathy

B) Restrictive cardiomyopathy

C) *Dilated cardiomyopathy

D) Exudative pericarditis

E) Hypertrophic cardiomyopathy

A 42 y.o. woman complains of dyspnea, edema of the legs, and tachycardia during small physical exertion. Heart borders are displaced to the left and S1 is accentuated, there is diastolic murmur on apex. The liver is enlarged by 5 cm. What is the cause of heart failure?

A) Tricuspid regurgitation

B) Mitral regurgitation

C) Aortic stenosis

D) *Mitral stenosis

E) Tricuspid stenosis

After a long period of subfebrility a patient registered increase of dyspnea, pain in the right hypochondrium, leg edema. Objectively: neck veins are edematic. Ps is 120 bpm, sometimes it disappears during inspiration. Heart sounds are very weakened. ECG showed low-voltage waves of ventricular complex. A month ago there was raise of ST V1-V4 segment. Cardiac silhouette is enlarged, roundish. What is the most probable diagnosis?

A) Small-focal myocardial infarction

B) Metabolic postinfection myocardiopathy

C) *Exudative pericarditis

D) Postinfarction cardiosclerosis

E) Primary rheumatic carditis

A rounded well-defined shadow was found in the costo-vertebral angle on the chest roentgenogram of an otherwise healthy 9 year old girl. Make a preliminary diagnosis:

A) Sympatoblastoma

B) Ganglioneuroblastoma

C) *Ganglioneuroma

D) Sympatogonioma

E) Sarcoma of the vertebra

A 56 year old man complains of fatigue, dyspnea on exertion and palpitations. He has had a murmur since childhoo D. Examination reveals a lift at the left sternal border, split S1, and fixed splitting of S2. There is a grade 3/6 midsystolic pulmonic murmur and a 1/6 middiastolic tricuspid murmur at the lower left sternal border. Chest x-ray shows right ventricular enlargement and prominent pulmonary arteries. ECG demonstrates atrial fibrillation with a right bundle branch block. The most likely diagnosis is:

A) Tetralogy of Fallot

B) Coarctation of the aorta

C) Patent ductus arteriosus

D) Ventricular septal defect

E) *Atrial septal defect

A 52 year old man has recurrent transient ischemic attacks. Auscultation of the carotid arteries detected murmur. What diagnostic method is to be applied in the first place?

A) CT of the brain

B) Electroencephalography

C) MRI of the brain

D) *Doppler Ultrasound

E) Cerebral angiography

A 42 year old woman complains of dyspnea, edema of the legs and tachycardia during minor physical exertion. Heart borders are displaced to the left and S1 is accentuated, there is diastolic murmur on apex. The liver is enlarged by 5 cm. What is the cause of heart failure?

A) Aortic stenosis

B) Mitral regurgitation

C) Tricuspid regurgitation

D) Tricuspid stenosis

E) *Mitral stenosis

A patient, aged 49, complains of fever of 37,5oC, heart pain, dyspnea. S1 is clapping; S2 is accentuated in the aortic area; opening snap, presystolic murmur can be auscultate D. What is the most efficient examination for valvular disorder assessment?

A) *Echocardiography+Doppler-Echocardiography

B) Ballistocardiogram

C) Chest X-ray

D) Phonocardiography

E) ECG

A 50 year old woman complains about dull cardiac pain, asphyxia, body temperature rise up to 38oC. She had influenza a week ago. Objectively: Ps - 100 bpm, dropped-beat pulse during inspiration. AP - 100/70 mm Hg, heart sounds are muffled. ECG: reduced voltage, ST segment is above the isoline in all leads. X-ray picture shows extensively enlarged cardiac silhouette. Palmus is of small amplitude. What is the most probable diagnosis?

A) *Exudative pericarditis

B) Myocarditis

C) Myocardium infarction

D) Stenocardia

E) Dilatation cardiomyopathy

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