For foreign medical students

State Institution “Dnepropetrovsk Medical Academy

of the Ministry of Health of Ukraine”

The Chair of Phthisiology

The base of anchor tests KROK-2

for foreign medical students

1.On necropsy of 17-years-old girl, dying because of pulmonary insufficiency: the downlow areas of caseous necrosis are exposed in the lower segment of right lung, in bronchopulmonary, bronchial and bifurkational lymphatic knots there are the phenomena of caseous necrosis. What diagnosis is most credible?

*A Hematogenic form of progress of primary tuberculosis..

B Tuberculoma

C Hematogenic tuberculosis with the prevailing defeat of lungs.

D Growth of primary affect at primary tuberculosis.

E Caseous pneumonia at the secondary tuberculosis.

2.On necropsy of a man 44 years, which died after pulmonary-cardiac insufficiency, pneumosclerosis, emphysema of lungs, hypertrophy of right ventricle of heart is exposed. In both lungs, mainly subpleural, there are plural noncommunicative hearths in diameter of 1 cm. Histologically: in a center of a hearth there is an area of necrosis,

on periphery there is a billow of epithelioid cells and lymphocytes with the admixture of macrophages and plasmatic cells. The giant cells of Pirogov - Langkhansa are determined. A bit of capillaries - on periphery of hearth.What is the disease?

* A Hematogenic tuberculosis.

B Actinomycosis of lungs.

C Besnier-Boeck-Schaumann.

D Syphilis.

E Schistosis.

3. On necropsy of a man, 48 years, which died of white plague, the partly emptied symmetric tubercular cavities are exposed in cortic-pleural areas with predominance of productive tissue reaction; in both lungs there are tender reticulated pneumosclerosis and emphysema; pulmonary heart; in bifurcational lymphatic knots there is tubercular caseous lymphadenitis. In the III segment of right lung there is a hearth of Gon. What diagnosis is most credible?

*A Hematogenic generalization of primary tuberculosis.

B Hematogenic-disseminated tuberculosis.

C Chronic primary tuberculosis.

D Chronic miliary tuberculosis.

E Cirrhotic tuberculosis.

4. At microscopic research of lungs of patient, 52 years, there are hearths of necrosis, surrounded the billow of epithelioid cells and lymphocytes. Between lymphocytes and epithelioid cells there are large cells of the rounded form with plenty of kernels, placed on periphery. How such Histologically changes are named?

*A Tubercular granulosum.

B Besnier-Boeck-Schaumann granulosum.

C. Syphilitic granulosum

D Leprous granulosum.

E Sclerotic granulosum.

5. On necropsy of dying, 48 years, in the area of the I segment of right lung there is round formation in a diameter of 5cm with clear contours, surrounded by the thin layer of connective tissue, filled white loose masses. Diagnose the form of the secondary tuberculosis.

* A Tuberculoma.

B Caseous pneumonia.

C Acute cavernous tuberculosis.

D Acute hearth tuberculosis.

E Fibrocavernous tuberculosis.

6. At patient which died after white plague: in the I segment of right lung there is a hearth of pale-grey color, surrounded by a capsule, by a diameter 3 cm. Microscopically: hearth of necrosis with a capsule, absence of perifocal inflammation. Name the form of tuberculosis.

*A Tuberculoma.

B Acute cavernous tuberculosis.

C Fibrocavernous tuberculosis.

D Cirrhotic tuberculosis.

E. Caseous pneumonia

7. At dying with a clinical diagnosis: chronic abscess of lungs - on dissection a cavity is exposed in the II segment of right lung measuring 5 cm, rounded form. The internal surface of cavity is formed by caseous masses, external – by dense tissue of lungs, a pyogenic membrane absents. What process does speech about?

*A Acute cavernous tuberculosis

B Fibrocavernous tuberculosis.

C. Acute abscess.

D Chronic abscess.

E Primary pulmonary cavity.

8. On necropsy of a man of 44 years, which died of pulmonary-cardiac insufficiency, pneumosclerosis, emphysema of lungs, hypertrophy of right ventricle of heart is exposed. In both lungs, mainly subpleural there are plural hearths by a diameter to 1 cm Histologically: in a center of a hearth there is an area of necrosis, on periphery there is a billow of epithelioid cells and lymphocytes with the admixture of macrophages and plasmatic cells. The giant cells of Pirogov-Langkhans are determined. The small number of capillaries is determined on periphery of hearth. What disease takes a place at patient?

* A Hematogenic tuberculosis

B Primary pulmonary consumption

C Carcinomatous tuberculosis

D Primary tuberculosis

E Secondary tuberculosis

9. Sick with 30-years-old experience of work in a mine died of pulmonary-cardiac insufficiency. On dissection lungs are exaggerated, fluffy, on a cut in them there are plenty of knots by sizes of millet corns. Histologically in knots there is the area of necrosis, on periphery there is a billow of epithelioid cells and lymphocytes with the admixture of macrophages and plasmatic cells. The giant cells of Pirogov-Langkhans are determined. Name the most credible disease:

*A Miliary tuberculosis

B Primary pulmonary consumption

C Carcinomatous tuberculosis

D Primary tuberculosis

E Secondary tuberculosis

10.On dissection of patient which died of pneumocardial insufficiency, there are found changes in lungs (cavities) with excrescence of connective tissue. Lungs are deformed, close-settled, the scars of linear form, numerous bronchoektases, expressed pleura unions, "pulmonary" heart, are revealed. What disease did result in death?

* A Cirrhotic tuberculosis

B Bronchoektatic illness

C Chronic nonspecific pneumonia

D Adhesive plevritis with pneumosclerosis

E Acute cavernous tuberculosis

11.On dissection of dying of pulmonary-cardiac insufficiency in lungs a far is exposed dense miliary and large round,oval and wrong form of knots of white color by a diameter 0,1-0,5 cm which placed meet between itself. Except for it net pneumosclerosis, productive granulomatous tissue reaction, emphysema registers in lungs. A heart is megascopic: thickness of wall of right ventricle of 1,0см, counter-clockwise -1,3ñì. It is known from anamnesis, that a patient during 15 years was imprisoned. What disease does take a place at patient?

*A Chronic macrofocal tuberculosis

B Secondary tuberculosis

C Chronic obstructive emphysema of lungs

D Productive pneumosclerosis

E Hypertrophy kardiomiopatiya

12.At necropsy of man 67 years in a lung knots are exposed 0,2-0,3 cm in a diameter, which are felt as grains of sand.Lungs are megascopic in a volume, fluffy, small areas of deposit of coal pigment. About what disease is it necessary to think in this case?

* A Acute milliary tuberculosis

B Asbestosis

C Anthracosis

D Pneumosclerosis

E Emphysema

13.For a child 10 years, which suffers chronic tonsillitis with multiple relapses, a cynanche appeared. During examination there was ulcification on a counter-clockwise amygdale, hyperemia of mucous cheek, increase of neck lymphonoduss. In family of this child a grand-dad is ill on tuberculosis. What diagnosis is most possible?

* A Primary tubercular complex, alimentary way of infection

B Chronic tubercular complex, alimentary way of infection

C Primary tubercular tonsillitis, skyway of infection

D Chronic tuberculosis

E It is a primary tubercular lymphadenitis, aerogenic way of infection

14.At Histologically research of lungs of patient dying of pulmonary-cardiac insufficiency, the cavity of disintegration in the secondary segment of right lung of rounded-oval form is exposed in the diameter of 5,0см, reported with a segmentary bronchial tube. The internal layer of cavity there are caseous masses. What is the character of changes in lungs?

* A Acute cavernous tuberculosis

B Acute abscess of lung

C Chronic cavity

D Chronic abscess

E Phlegmon

15.For a dying of intoxication man during dissection the increase of thurl is exposed in a volume, on-the-spot skin - whistle with a selection from them of turbid liquid; a thigh-bone is incrassate and deformed, formation of sequestra takes a place; at microscopic research sequestral cavities are surrounded granulation and connective tissue with the presence of lymphocytes, not numerous plasmocytes and single neutrophiles, epithelioid cells, cells of Pirogov - Lankhgans. What diagnosis is most reliable?

* A Hematogenic tuberculosis with extra pulmonary defeats

B Acute hematogenic osteomielitisis

C Gonarthrocace

D Tracheokyphosis

E Primary tubercular coxartrosis

16.On dissection of man, megascopic in a volume close-settled lungs are found with the far of miliary hearths which are felt as grains of sand. These changes are anymore shown in overhead segments. What from the transferred diagnoses most reliable?

* A Acute miliary tuberculosis

B A diffusely-sclerotic form is tuberculosis

C Primary tuberculosis with hematogenic distribution

D Secondary tuberculosis with the primary defeat of lungs

E Chronic miliary tuberculosis

17.In lungs of patient of 34 years, which in a flow 9 years worked as polish, found out lobular curd bronchopneumonia, phenomena of endobronchitis, mesobronkhitis and pan of bronchitis, inflammatory infiltration with formation of billow from lymphocytes, epithelioid and giant cells. The displays of what disease there are in lungs?

* A Acute hearth tuberculosis

B Chronic primary tuberculosis

C Fibrofocal tuberculosis

D Chronic bronchitis and caseous pneumonia

E Polisegmental bronchopneumonia

18. At 40 years at progress of periodontitis it is found out a patient inflammation of alveolar sprout and amygdale. On an amygdale it is exposed oval form ulcification. The lymphatic knots of neck are megascopic. Microscopically round lymphatic vessels found out the inflammatory reaction of granulomatous character with the presence of epithelioid and giant cells. Name a disease.

* A Primary tuberculosis

B Secondary tuberculosis

C Hematogenic tuberculosis

D Ulcero-necrotic quinsy

E Festering periostitis and tonsilitis

19.For a sick girl 12 years changes take a place in an intestine. In limfoidnoy tissue of blind gut it is found out necrosis of mucous with formation ulcer. In the mesenterial knots of granulomatous inflammatory infiltration is with caseous necrosis. What from the transferred diagnoses most reliable?

* A Primary tuberculosis

B Secondary tuberculosis

C Progress of the secondary tuberculosis of mesenterial lymphonoduss

D Hematogenic tuberculosis of intestine

E Heterospecific ulcerous colitis

20. At research of tissue of coxal joint there is chronic inflammation of compact matter and marrow, formations of sequester, expressed inflammatory reaction of granulomatous character with the presence of epithelioid and giant cells, is exposed. What disease do such changes develop at?

*A Hematogenic tuberculosis

B. Acute tracheokyphosis

C. Chronic osteomielitis

D. Gonarthrocace

E, Productive osteomielitis

21. On dissection of patient which a lot of years worked on a mine and died of chronic pulmonary-cardiac insufficiency, it is exposed, that lungs are little air, close-settled, sclerotic, the apexes are emphysematous changed, hearth productive tissue reaction, net pneumosclerosis, shallow knots in a parenchima both the lungs. Presence at patient of tubercular gonitis. What illness did death come from?

*A Hematogenic-disseminated tuberculosis

B. Tubercular poliartritis

C. Pneumosclerosis

D. Emphysema of lungs

E. Chronic pneumonia and gonarthrocace

22. At necropsy woman 50 years, dying of uremia, the hemilesion of kidneys is found. In the crust ball of right kidney in a papillary ball the hearths of destruction are revealed with formation of cavities of filled by caseous masses. Round them inflammatory infiltration takes a place lymphocytes, histiocytes, epithelioid cells. What illness is most reliable?

*A. Hematogenic tuberculosis

B. Generalized hematogenic tuberculosis

C. Primary tuberculosis of kidneys

D. Tuberculoma of kidney

E. Secondary tuberculosis

23. At necropsy man 56 years and Histologically research in lungs it was found the hearths of sclerosis round bronchial tubes and vessels of lungs; excrescence of connective tissue is in alveolar partitions, hearth of caseous necrosis in

the third segment of right lung. In bifurcational lymphonoduss caseous masses of hearth character, inflammatory perivascular infiltration of granulomatous character, are revealed with the presence of cells of Pirogov-Lankhgans . Infiltration is revealed and on motion lymphatic vessels in by a right lung. What form of disease does take a place?

*A. Primary tuberculosis

B. Tuberculosis hematogenic

C. Secondary tuberculosis

D. Tuberculoma

E. Croupous pneumonia with granulomatous lymphadenitis

24. Microscopically in the remote secondary segment of right easy miner the rounded knots are found in a diameter from 2,0до 5,0см, built from the concentric layers of caseous masses, surrounded a connecting capsule. Most reliable diagnosis:

*A. Secondary tuberculosis

B. Metastases of shrine

C. Primary tubercular complex

D. Hematogenic tuberculosis

E. Cancer of lungs

25. Spongy and cortical layers of tibia on separate areas in a state of disintegration, cavities which appeared are filled the masses of grey color, granulomatous character of inflammation with the presence of lymphocytes, single leucocytes, plasmocytes, giant cells is revealed. Most reliable diagnosis:

*A. Hematogenic tuberculosis

B. Chronic osteomielitis

C. Acute osteomielitis

D. Secondary tuberculosis

E. Generalized tuberculosis

26. In the house of child at examination for a child in age 1,5 years exposed hearth formations in a spine, presented destruction, presence of sequestra. At Histologically research the giant cells of Pirogov-Langkhans are determined. What is the disease?

*A. Hematogenic tuberculosis

B. Secondary tuberculosis

C. Primary tuberculosis

D. Festering osteomielitis

E. Osteomalation

27. For a woman in 20 complaints are about a weakness, pathological fatigue ability, increase of temperature, disorders of menstrual cycle. At research of scrape of endometrium there were found out such changes: necrosis, round him focal infiltration lymphocytes, epithelioid cells, giant cells of Pirogov-Lankhgans, single, neutrophiles. Your diagnosis?

*A. Hematogenic tuberculosis

B. Primary tubercular endometritis

C. Secondary tubercular endometritis

D. Extra pulmonary primary tubercular complex

E. Infiltrative tuberculosis

28. A hospital has admitted a 52-year-old patient with disseminated pulmonary tuberculosis, complaints of acute pain in the right half of chest, that developed after going upstairs to the 3rd floor; cough, dyspnea at rest, marked cyanosis. What kind of complication should suspected first of all?

*A.Spontaneous pneumothorax

B. Cardiac failure

C . Pulmonary failure

D . Pleuritis

E. Acute myocardial infarction

29. A 7-year-old boy had complained of headache, nausea, fatigue for 3 weeks. His condition gradually deteriorated, headache and general weakness progressed. The boy had bronchitis at the age of 3. His father has a history of pulmonary tuberculosis. Objectively: body temperature $37,5^oC$, conscious, lies supine, with the hip and knee flexed to 90 degrees, nuchal rigidity +6 cm, partial ptosis of the right eyelid, the dilated right pupil. General hyperalgesia is present. Liquor: transparent, pressure - 400 mm of water column, protein - 1,5\%, cytosis - 610/3 with predominant lymphocytes, sugar - 1,22 mmol/l, chlorides - 500 mmol/l. What is the most likely diagnosis?

*A.Tuberculous meningitis

B.Secondary purulent meningitis

C.Epidemic cerebrospinal meningitis

D.Serous meningitis

E.Pneumococcal meningitis

30. For a man, 50 years, which was ill on tuberculosis and died on a background of the phenomena of pulmonarycardiac insufficiency, on dissection there is lobar character of defeat of lungs: the overhead segment of right lung is megascopic, dense, yellow, loose, on a pleura there are fibrinous stratifications. From what form of the secondary

tuberculosis does the indicated pathology belong to?

*A Caseous pneumonia.

B Fibronodular tuberculosis.

C Infiltrative tuberculosis.

D. Tuberculoma

E Acute hearth tuberculosis.

31. A 20-year-old adolescent lives in the nidus of tuberculous infection. The tuberculine Mantoux test with 2 TU was determined as hyperergic. What signs determine the hyperergic test of this adolescent?

*A. 6 mm papula, necrosis

B. 20 mm papula

C . 24 mm hyperemia

D . 4 mm papula

E. 12 mm hyperemia

32.A 25-year-old patient complains of general weakness, dry cough, sweating, subfebrile temperature. Objectively: lung auscultation reveals vesicular resiration with no wheezing Fluorogram shows focal shadows of high intensity in the 1-2 segments of the right lung. Mantoux test gave a reaction of 16 mm of induration. What clinical form of tuberculosis is most likely?

*A. Focal

B. Infiltrative

C Disseminated

D. Tuberculoma

E. Miliary

1.Spongy and cortical layers of tibial bone here and there are in a state of disintegration, cavities which arose up arefilled by creamy masses of sulphur color. Most credible form of inflammation:

* A festering

B tubercular

C granulomatous

D proliferative

E mixed

2.For a 1,5 year-old boy which died of viral pneumonia, it is exposed on autopsy: salient cervical and frontal humps("square head "), saddle-like nose, flat back of head, uncopsy large top, bulge in the areas of osteoarticular connections of ribs and epiphysis of long tubular bones, X-deformation of lower extremities. There is an area of growth of bones at macroscopic research - uneven, extended, glassy; Histologically is expansion of cartilaginous area with wrong alternation and location of cartilaginous cells, absent clear and even boundary line between cartilaginous and ossiform tissues. Diagnose the disease of skeleton.

* A Rachitis

B Trachelokyphosis

C Chondrodisplasy

D Imperfect osteogenesis

E Hematogenic tuberculosis with mainly extra pulmonary localization

3.On dissection of man 59 years, dying of chronic pulmonary-cardiac insufficiency found out the followings changes: lungs are megascopic, dense, little air, on a cut in them the great number of the diffusely located knots of whitish color, 2-3 mm, is determined in a diameter. Microscopically knots are presented the hearths of caseous, perifocal lympho-plasmacytic infiltration, epithelioid and giant cells. What disease does speech go about?

* A Miliary white plague

B Infiltrative tuberculosis

C Fibrous alveolitis

D Microfocal giant cell pneumonia

E Metastases of tumour in lungs, carcinomatosis

4. A patient complains of a tormental (agonizing) cough with expectoration of up to 600 ml/daily purulent chocolatecolor sputum with a decay smell. Onset of illness was abrupt, t^0$- 39^0C, 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. Gangrene of lung

B . Tuberculosis

C. Bronchiectatic illness

D. Pneumonia complicated by an abscess

E.Lobar pneumonia

5. 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 roentgenography: ribs osteoporosis, longitudinal ligament ossification. What is the most likely diagnosis?

*A. Ancylosing spondyloarthritis

B. Tuberculous spondylitis

C. Psoriatic spondyloarthropatia

D . Spondyloarthropatia on the background of Reiter's disease

E. Spread osteochondrosis of the vertebral column

6. A man, aged 68, complains of tiredness, sweating, enlargement of cervical, submaxillary and axillary lymph nodes. Blood test: WBC- $35*10^9$/L, lymphocytes - 60\%, Botkin and Gumprecht bodies, level of haemoglobin and quantity of thrombocytes is normal. Myelogram showed 40\% of lymphocytes. What is the most probable diagnosis?

*A. Chronic lympholeucosis

B. Chronic myeloleucosis

C. Lymphogranulomatosis

D. Acute leucosis

E. Tuberculous lymphadenitis

7. 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

8. A 20 daily y.o. female patient is suffering from chronic bronchitis. Recently there has been production about 0,5 L of purulent sputum with maximum discharge in the morning. Fingers are like "drum sticks", there are "watching glass" nails. What is the most probable diagnosis?

*A. Bronchiectasia

B. Pneumonia

C. Chronic bronchitis

D . Gangrene of lungs

E. Tuberculosis

9. A 56-year-old patient complains of having persistent chest pain on the right for the last 2 months. The pain is not associated with respiration. He also complains of cough with blood-streaked sputum, weakness, decreased performance, fatigue. Chest radiograph shows a globular shade of 4x6 cm connected to the root of the lung in the lower part of the right lung. What is the most likely diagnosis?

*A. Peripheral lung cancer

B. Metastasis

C. Lung abscess

D . Pneumonia

E. Tuberculoma

10. A 45-year-old patient, a sailor, was hospitalized on the 2nd day of the disease. A week ago he returned from India. Complains of body temperature of $41^oC$, severe headache, dyspnea, cough with frothy rusty sputum. Objectively: the patient is pale, mucous membranes are cyanotic, breathing rate is 24/min, tachycardia is present. In lungs: diminished breath sounds, moist rales over both lungs, crepitation. What is the most likely diagnosis?

*A. Pneumonic plaque

B. Miliary tuberculosis

C. Influenza

D. Ornithosis

E. Sepsis

11. A 16 year old patient with complaints of frequent pain in the abdomen was diagnosed with melanoma, examination revealed also pigmentation of the mucosa and skin, polyp in the stomach and large intestine. It is know that the patient's mother has an analogous pigmentation and has been often treated for anemia. What disease is suspected?

*A. Peytz-Egers's polyposis

B. Chron's disease

C. Tuberculosis of the intestine

D. Adolescent polyposis

E. Hirschprung's disease

12. A 24 y.o. woman consulted a doctor about continued fever, night sweating. She lost 7 kg within

the last 3 months. She had casual sexual contacts. Objectively: enlargement of all lymph nodes,

hepatolienal syndrome. Blood count: leukocytes - $2,2*10^9$/L. What disease can be

suspected?

A HIV-infection

B Lymphogranulomatosis

C Tuberculosis

D Infectionous mononucleosis

E Chroniosepsis

1.For a worker the signs of sharp violation of cerebral circulation of blood, fainting fit, appeared 37 years. In a few days he died. On a section in the soft shells of cerebrum found out the shallow knots of grey color, shell pale with an edema, especially expressed change in barrel part of cerebrum. At histological research found out infiltration mainly of lymphocytic character with the single cells of Pirogov-Lankhgans. What process did take a place in a cerebrum?

* A Viral encephalitis

B Tubercular meningitis

C Hydromeningitis

D Second meningitis

E Staphylococcus meningo-encephalitis

2.Man 40 years, death came from uremia. On a section: kidneys are megascopic with the phenomena of pyonefrosis, in a cork layer cells of destruction with formation of cavities, in an ureter there are found out caseous masses.Specify pathology of kidneys, which developed.

* A Tuberculosis of kidneys, as a form of tuberculosis

B Hydronephrosisis with pyonephrosis

C Bilateral cortical nephrosis

D Sepsis, septicopyemia, abscesses of cork layer of kidneys

E Tuberculosis of kidneys, as a form of the second tuberculosis

3.A man is 40 years hospitalized concerning pneumonia. On the third days he died. At microscopic research found out the plural shallow knots of grey color in all organs. Microscopically it is necrotizing cells without a proliferative reaction, a weak exsudate reaction appeared in lungs. For what disease the characteristic described changes?

* A Peracute tubercular sepsis without primary localization

B Chronic miliary tuberculosis

C Hematogenic-disseminated tuberculosis

D Second tuberculosis, diffuse infiltrative form

4. A 37-year-old patient complains of pain in the lumbar spine that is getting stronger during walking; restricted mobility, edema of the right side of abdomen. He has a history of focal tuberculosis. X-ray picture shows the destruction of the adjacent surfaces of the 1-2 vertebral bodies of the lumbar spine, vertebral body height is decreased, intervertebral foramen is undetectable. Abdominal ultrasound reveals a 15x20 cm formation in the retroperitoneal space, there are echo signals of fluid presence. What is the most likely diagnosis?

*A. Tuberculous spondylitis of the lumbar spine

B. Fracture of the 1-2 vertebral bodies of the lumbar spine

C. Spinal metastases

D. Spondylolisthesis of the lumbar spine

E. Osteochondrosis

5. A patient who undergoes treatment at a tuberculosis clinic has complained of having progressing headache for the last 3 weeks. Neurological examination reveals rigidity of occipital muscles, no focal symptoms. What is your provisional diagnosis?

*A. Tuberculous meningitis

B. Chorea minor

C. Brain tumour

D. Myelitis

E. Convexital arachnoiditis

1.For a man, 50 years, which was ill on tuberculosis and died on a background of the phenomena of pulmonarycardiac insufficiency, on dissection there is lobar character of defeat of lungs: the overhead segment of right lung is megascopic, dense, yellow, loose, on a pleura there are fibrinous stratifications. From what form of the secondary

tuberculosis does the indicated pathology belong to?

A Tuberculoma.

B Fibronodular tuberculosis.

C Infiltrative tuberculosis.

* D Caseous pneumonia.

E Acute hearth tuberculosis.

2.At patient is with high temperature, shortness of breath, pain in right part of thorax. Pleural punction gave 700 ml of viscid liquid of sulphur color. What pathological process did develop in a pleural cavity?

* A Empyema of pleura

B Serosal plevritis

C Hematogenic tuberculosis with the primary defeat of lungs

D Carcinomatous pleuritis

E Tubercular pleuritis

3.For a dying patient with fibrofocal tuberculosis at dissection it is found, that a right lung is megascopic, dense, yellow, on a pleura the expressed fibrinous impositions. How to describe these changes?

* A Caseous pneumonia

B Croupous pneumonia in the stage of grey hepatization

C Necropneumonia

D Empyema of pleura and croupous pneumonia

E Phlegmon of lung

4. Medical examination of a 19-year-old worker revealed generalized lymphadenopathy mainly affecting the posterior cervical, axillary and ulnar lymph nodes. There are multiple injection marks on the elbow bend skin. The man denies taking drugs, the presence of injection marks ascribes to influenza treatment. Blood count: RBCs- $3,2\cdot10^{12}$/l, Hb- 100 g/l, WBCs- $3,1\cdot10^9$/l, moderate lymphopenia. What study is required in the first place?

*A. ELISA for HIV

B . Immunogram

C. Sternal puncture

D. X-ray of lungs

E. Lymph node biopsy

5. A 28-year-old man was discharged from the hospital after having an out-of -hospital pneumonia. He has no complaints. On physical exam: his temperature is $-36,6^0C$, RR-18/min, Ps – 78 bpm, BP- 120/80 mm Hg. During ausculation there is harsh respiration to the right of the lower part of the lung. Roentgenologically: infiltrative changes are absent, intensification of the pulmonary picture to the right in the lower lobe. How long should the doctor keep the patient under observation?

*A. 12 months

B. 1 month

C . 3 months

D. 6 months

E. Permanently

6. A 45-year-old man was brought to clinic with complaints of the pain that started suddenly in the left chest part and epigastric area, shortness of breath, nausea, one-time vomiting. The acute pain started after weight-lifting. On physical exam: shallow breathing, RR - 38/min, left chest part is behind during respiration, by percussion - tympanitic sound, respiration is not ausculated. 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 to do first?

*A. Roentgenography

B . Electrocardiography

C. Bronchoscopy

D . Esophagogastroscopy

E . Ultrasound of the abdominal cavity

7. A 52 y.o. male patient has become ill gradually. There is pain in the left side of the thorax during 2 weeks, elevation of temperature till $38-39^0C$. On examination: left chest side falls behind in breathing movement no voice tremor over the left lung. Dullness that is more intensive in lower parts of this lung. Right heart border is deviated outside. Sharply weakened breathing over the left lung, no rales. Heart sounds are mufflet, tachycardia. What is the most probable diagnosis?

*A. Exudative pleuritis

B. Spotaneous pneumothorax

C. Atelectasis of lung

D . Cirrhotic tuberculosis

E . Infarction-pneumonia

8. A 26-year-old male patient complains of piercing pain during breathing, cough, dyspnea. Objectively: $t^o$- $37,3^oC$, respiration rate - 19/min, heart rate = Ps- 92/min; AP- 120/80 mm Hg. Vesicular respiration. In the inferolateral parts of chest auscultation in both inspiration and expiration phase revealed noise that was getting stronger at phonendoscope pressing and can be still heard after cough. ECG showed no pathological changes. What is the most likely giagnosis?

*A. Acute pleuritis

B. Intercostal neuralgia

C. Subcutaneous emphysema

D. Spontaneous pneumothorax

E. Pericarditis sicca

9. A 22-year-old patient is a clerk. His working day runs in a conditioned room. In summer he was taken by an acute disease with the following symptoms: fever, dyspnea, dry cough, pleural pain, myalgia, arthralgia. Objectively: moist rales on the right, pleural friction rub. X-ray picture showed infiltration of the inferior lobe. In blood: WBC - $11\cdot10^9$/l$, stab neutrophils - 6\%, segmented neutrophils - 70\%, lymphocytes - 8\%, ESR - 42 mm/h. What is the ethiological factor of pneumonia?

*A.Legionella

B. Mycoplasm

C. Streptococcus

D . Staphylococcus

E. Pneumococcus

10. A 26-year-old patient with left lower lobe pneumonia experiences an acute chest pain on the left during coughing. Objectively: diffuse cyanosis, extension of the left side of chest. Percussion reveals high tympanitis. Auscultation reveals no respiratory murmurs above the left side of chest. There is a deviation of the right cardiac border towards the midclavicular line. What examination will be the most informative?

*A. X-Ray

B. Bronchoscopy

C. Bronchography

D. Pneumotachometry

E. Spirography

11. A patient was delivered to a surgical department after a road accident with a closed trauma of

chest and right-sided rib fracture. The patient was diagnosed with right-sided pneumothorax, it is

indicated to perform drainage of pleural cavity. Pleural puncture should be made in:

A In the 2nd intercostal space along the middle clavicular line

B In the 6th intercostal space along the posterior axillary line

C In the 7th intercostal space along the scapular line

D In the projection of pleural sinus

E In the point of the greatest dullness on percussion

12. The diagnosis of a right-sided pneumothorax is made to a 36- year-old patient. What method of

treatment is indicated to the patient?

A Drainage of the pleural cavity

B Antiinflammation therapy

C Symptomatic therapy

D Pleural puncture

E Thoracotomy

13. A 36 year old patient was diagnosed with right-sided pneumothorax. 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

14. On the 4th day after recovering from a cold a patient was hospitalized with complaints of solitary

spittings of mucoid sputum. On the 2nd day there was a single discharge of about 250 ml of

purulent blood-streaked sputum. Objectively: the patient's condition is moderately severe.

Respiratory rate - 28-30/min, Ps- 96 bpm, AP- 110/70 mm Hg. Respiration above the left lung is

vesicular, weak above the right lung. There are moist rales of different types above the lower

lobe and amphoric breath near the angle of scapula. What is the most likely diagnosis?

A Acute pulmonary abscess

B Exudative pleuritis

C Acute focal pneumonia

D Pleural empyema

E Pyopneumothorax