of 256
Step 2
1.
A 21 y.o. man complains of having morning pains in his back for the last three months. The pain can be
relieved during the day and after physical exercises. Physical examination revealed reduced mobility in the
lumbar part of his spine, increase of muscle
tonus in the lumbar area and sluch during moving. X
ray pattern of
spine revealed bilateral sclerotic changes in the sacrolumbal part. What test will be the most necessary for
confirming a diagnosis?
A.
Rheumatoid factor
B.
Antinuclear antibodies
Uric acid in blood plasma
D. *
HLA
B27
E.
ESR
2.
A 38 y.o. patient lifted a heavy object that resulted in pain in the lumbar part of spine irradiating to the
posterior surface of his left leg. The pain increases during changing body position and a
lso in the upright
position. Examination revealed positive symptoms of tension. What is the preliminary diagnosis?
A.
Myelopathy
B.
Polyneuritis
C. *
Pathology of intercostal disks
D.
Spinal cord tumor
E.
Arachnomyelitis
3.
A 47
year
-
old obese man complained of periodic attacks of acute arthritis in the 1st left tarsophalangeal
joint. Lab exam revealed increased serum level of uric acid. What is the diagnosis?
A. *
Gout arthritis
B.
Reiter’s disease
C.
Rheumatoid arthritis
D.
Rheumatic arthritis
E.
Osteoarthritis
4.
A 42
year
old woman complains of dyspnea, edema of the legs, and tachycardia during small physical
exertion. Heart borders are displaced to the left and S1 is accentuated, there is
protodiastolic murmur on
xiphoid process. The liver is enlarged by 5 cm. What is the cause of heart failure?
A. *
Mitral stenosis
B.
Mitral regurgitation
C.
Tricuspid stenosis
D.
Tricuspid regurgitation
E.
Aortic stenosis
5.
A 41
year
old woman complains of weakness, fatigue, fever up to 38°C, rash on the face skin, pain in
the wrists and the elbows. On physical exam, erythematous rash on the cheeks with “butterfly” appearance, the
wrists and elbow joints are involved symmetri
cally, swollen, tender on motions, friction rub over the lungs, the
heart sounds are weak, regular, HR of 88/ minute, BP of 160/95 mm Hg. CBC shows anemia, leucopenia,
lymphopenia; on urinalysis: proteinuria, leukocyturia, casts. What is the main mechanism
of disease
development?
A. *
Production of antibodies to double
-
stranded DNA.
B.
Production of antibodies to myocytes.
C.
Production of antibodies to endothelial cells.
D.
Production of antibodies to myosin.
E.
Production of antimitocho
ndrial antibodies.
6.
A 14 year old patient. He complains of chest pain, temperature 38,5, breathlessness. He had acute
tonsillitis2 weeks ago. He is in a bad state. The skin is pale. Heart borders are widened, the tones are weakened.
Above all heart area you can hear pericardi
um friction sound. Electrocardiogramm: the descent of voltage
QRS, the inversion T. The liver is 3 sm enlarged. ESR
4mm/h, ASL
1260, C
reaction protein +++. Your
diagnosis:
A. *
Rheumatic pancarditis
B.
Rheumatic pericarditis
C.
Rheumati
c myocarditis
D.
Rheumatic endocarditis
E.
Septic endocarditis
7.
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 a
rthritis
D.
Rheumatic arthritis
E.
Osteoarthritis
8.
A 25
year
old woman complained of edema on the face and legs, elevation in blood pressure up to
160/100 mm Hg, and weakness. She fell ill 3 weeks after sore throat. On urinalysis, protein of
0.5 g/L,
erythrocytes of 17
20/field, leukocytes of 2
3/field, erythrocyte casts. What treatment should be initiated
after establishing of the
A. *
Penicillin OS
B.
Heparin
C.
Ceftriaxone
D.
Dipyridamole
E.
Ciprofloxacine
9.
A 19
year
old girl admitted to the hospital complained of pain in the knee and fever of 38.6°C. She is ill
for 2 weeks after acute tonsillitis. On exam, hyperemia and swelling of both knees, BT of 37.4°C, HR of
94/min, BP of 120/80 mm Hg, and heart border
is displaced to the left; S1 is weak, systolic murmur is present.
Total blood count shows the following: Hb
120 g/L, WBC
–
9.8•109/L, ESR of 30 mm/L. ECG findings: the
rhythm is regular, PQ = 0.24 sec. What is a causative agent of the disease?
A. *
Be
ta
hemolytic streptococci.
B.
Viral
bacterial association.
C.
Autoimmune disorder.
D.
Staphylococci.
E.
Ricchetsia.
10.
A 42
year
old woman complains of dyspnea, edema of the legs, and tachycardia during small physical
exertion. Heart b
orders are displaced to the left and S1 is accentuated, there is protodiastolic murmur on
xiphoid process. The liver is enlarged by 5 cm. What is the cause of heart failure?
A. *
Mitral stenosis
B.
Mitral regurgitation
C.
Tricuspid stenosis
Tricuspid regurgitation
E.
Aortic stenosis
11.
A 33
year
old man with a history of rheumatic fever complains of fever up to 38
39°, abdominal
pain, dyspnea, tachycardia. Heart borders are displaced to the left by 2 cm, systolic and diastolic murmurs
above aorta, BP of 160/30 mm Hg. Petechial rash oc
curs after measurement of blood pressure. Liver is
enlarged by 3 cm, spleen is palpable. Urine is brown
yellow. What is the most probable diagnosis?
A. *
Infectious endocarditis
B.
Rheumatic fever
C.
Acute hepatitis
D.
Acute nephritis
E.
Aortic regurgitation
12.
Woman age 40,ill on rheumatic disease with composite mitral disease with prevalence of the stenosis
of left
venous foramen.Complainse on the palpitation,fatigability progressing dyspnea,attacks of a dyspnea
and hemoptysis.N
ow she can not execute even the mild activities.What tactics is the most expedient?
A. *
Mitral comissurotomia.
B.
Conduction of current bicilino
prophilaxis.
C.
Assiging of anticoagulants.
D.
Assiging of venous vasodilatators .
13.
A patient 55 years complains about pain, slight swelling in the joints of brushes, long constraint at
mornings, limitation of mobility. 1 year is ill. Treated oneself with ibuprofen with a small effect. Objectively:
swelling of metacarpal
phalange, proxima
l interphalange joints of the II
III fingers of both brushes with pain
limitation of mobility. ESR 37 mm/hour. What researches are most informing for clarification of diagnosis of
rheumatoid
A. *
Rheumatoid factor, X
ray of brushes joints
B.
Determi
nation of uric acid in blood
C.
Titers of antichlamidias antibodies
D.
Presence of LE
cells
E.
Determination of blood lipids level
14.
The atrial flutter with heart rate up to 130 per min firstly appeared in a woman aged 28 yr considere
before healthy. Physical examination reveals pale bluish cheeks. The respiratory rate is 24 per min.
Cardiac auscultation is difficult because of high rate but S1 tone is loud. The chest is free and abdomen is
soft and painless. ECG revealed right
ventricle hypertrophy and atrial flutter. This woman was not consulted
by any doctor because she lives in a small village. What is the most probable diagnosis?
A. *
Mitral stenosis
B.
Myocarditis
C.
Thyrotoxicosis
D.
Artherosclerotic cardiosclerosis
E.
Myocardiodistrophy
15.
The patient, 32 years old, came to the doctor with complaints for the increase of body temperature up to
38 degrees Celsius, pain in his joints, conjunctivitis. He felt ill acute after the a
ccidental sexual contact. During
the examination the skin over the right ankle joint, the left knee joint and the right hip joint was hyperemic, hot
to
A. *
Reyter’s disease
B.
Psoriatic arthritis
C.
Behterev’s disease
D.
Lupus aerytematosis
E.
Arthritis rheumatoidis
16.
A 4 year old female has been limping with swelling of her right knee for several months. Physical
examination demonstrates swelling of her right knee, flexion contracture of 10 degrees and flexion t
o 120
degrees. Lab. data: WBC 8 g/l, with 45
% neutr., 47 lymphs
%, 8
% mon. Hgb 120 g/l. ESR 20mm/h.
Rheum. factor neg., ANA 1:640 speckled. What is the most probable diagnosis?
A. *
Juvenile Rheumatoid Arthritis
B.
Rheumatism
C.
Lupus
D.
Osteomyelitis
