KROK ‘14
34
A brick kiln worker 32 years complains cough with little sputum, loss of appetite, sweating, shortness of
breath, body temperature is 37,5oC. Over the top of our lungs are heard and breathing hard.
Radiographically: in the upper and middle lungs symmetrically hearth medium intensity, with no clear
contours, in places, storm. At the root of swapneri lymph node. Analysis of blood leukocytes is 9,h/l, ESR 28 mm/hour. The ILO by the method of smear microscopy is not detected. Mantoux test with 2 te PPD-L papule 15 mm is the Most likely diagnosis?
A * Disseminated pulmonary tuberculosis.
B Sarcoidosis II century
C Metastatic carcinomatosis.
D Bilateral focal pneumonia.
E Pneumoconiosis.
35
The man 29 years old, whose father is sick cirrhotic tuberculosis, during x-ray examination revealed changes
in the lungs. Five years ago, was treated at a ulcer of a stomach, a lot of smoke. Sometimes pain in epigastric
area. Objectively lesions were found. A blood test without changes. The office in the sputum by the method
of smear microscopy is not detected. Mantoux test with TO PPD-L - papule 12 mm Radiographically - on
both the top of the unit, of different size and intensity of the shadows with a diameter of 1 cm, some of them
with indistinct contours. The most likely diagnosis.
A * Focal tuberculosis of the lungs.
B Disseminated pulmonary tuberculosis.
C Pneumoconiosis.
D Focal pneumonia.
E Metastatic tumors in the lung.
97
In the intensive care unit delivered the man 45, which is 2.5 - 3 hours ago
working in the garage accidentally took 100 ml of liquid, which resembles the taste of vodka products.
Complains vomiting, diarrhea, epigastric pain and lower back. Objectively: the symptoms of alcohol
intoxication. Soon the patient's condition worsened: there is a collapse, pulmonary edema, convulsions.
Transferred to artificial lung ventilation. Which of the substances caused the poisoning?
A *etilenglikol
B alcohol;
C acid;
D meadows
E FOZ.
203
Work With., 40 years old, came to the clinic with complaints of fatigue, occasional abdominal pain, sleep
disorders. A year and a half working on private enterprise “Car” in the shop charging the batteries and
vulcanization of tire. Objective: muffled heart sounds, JSC - 140/70 mm Hg, the pulse 84 beats./minute,
respiration vesicular. Blood test: NV - 120 g/L., erythrocytes - 4,h/l, 35 0/00 of erythrocytes with Basilea
grain, total number of reticulocytes 2 0/00. Analysis of urine: specific weight of 1,018 g/cm3., leucocytes - 5
field of view, creatinine urine - 300 g/g, Define professional pathology and specify which laboratory studies
confirm its presence.
A * Chronic lead intoxication (Saturn); Basilia grain of erythrocytes and urine creatinine.
B Chronic mercury intoxication (mercurialism); creatinine urine.
C Carboxydocella; the level of hemoglobin in the blood.
D Zinc intoxication; total number of reticulocytes.
E Chronic lead intoxication (Saturn), complaints of the patient.
215
Porter paints 56, 2 days worked in a room that was painted. Suddenly he felt a headache, weakness,
dizziness, vomiting. About me: staggering when walking, sclera substation, moist skin and mucous
membranes gray-blue. Pulse 100 beats/ min, rhythmic, HELL 130/80 mm RT. senior Respiration vesicular,
16/min Edge liver + 1 cm, tendon reflexes increased. In blood: EP. 5,h/l, Hb 146 g/l, L 6,h/l, SIZE - 5
mm/min, single calf Ganza. Urine: traces of protein, Ayr. up to 8 m/s , weakly positive qualitative samples
for urobilin, methemoglobin. ECG: the phenomenon of cardiomyopathy. Which method is most appropriate
for establishing reliable diagnosis?
A *in the blood metgemoglobin
B blood on the carboxyhemoglobin
C the Level of acetylcholinesterase and acetylcholine in the blood
D the blood sugar Level
E blood caramoran
216
In dye automobile diagnosed with acute poisoning adorally benzene moderate severity. After hospital
treatment is a significant improvement. What the expert decision should be taken in this case?
A *Issue the “Propylamine” for outpatient treatment
B Can continue to work at observance sanitary-hygienic norms
C to Issue a certificate of incapacity for outpatient treatment
D be Directed at VTEK to determine the percentage of incapacity
E to Send VTEC for establishing the degree of disability due to occupational disease
233
In the drifter mine (24 years), the concentration of quartz dust in the workplace 160-200 mg/m3 (MPC 4
mg/m3). On the x-ray of light detected changes, characteristic of pneumoconiosis. What kind of
pneumoconiosis most likely in this case?
A * Silicosis
B Antracot
C Silmacos
D Antracosilicosis
E Carboranes
376
In the hospital reception delivered to the patient Century, 43 years. In the process of work on manufacture of
dyes had contact with benzene, aniline, vapors of nitric acid. Objective: weakness, headache, dizziness. The
mucous membranes, fingers, ears are bluish, wobbly gait, speech slurred speech. Muffled heart sounds,
HELL 130/90 mm RT. senior HR - 84 in 1 min. Heredity is not burdened. In blood: Hb - 143 g/l, Ayr. 4,6*1012/l, p - 0,9, ESR - 5 mm/h, l - 5,3*109/l, the calf of Heinze - 14%, and the MtHb - 36%. Urine positive aminophenols. Which of the following diagnosis most likely?
A *Acute exposure to aniline
B Acute exposure to benzene
C Congenital methemoglobinemia
D Acute poisoning with alcohol Elokim
E Acute poisoning of nitric acid
377
The doctor-radiologist with 20-year work experience in the last 2 years have started to complain of headache,
dizziness, memory loss. Objective: dry skin brush, the fragility of nails, hair loss, rash, skin rash,
tachycardia, JSC - 110/60 mm RT. senior blood test: Hb - 142 g/l, Ayr. - 4,h/l, l - 2,1 × 109/l, that is, - 0,5%,
L. a - 10%, platelet - h/l, ESR - 8 mm/H. From the most likely diagnoses?
A *Chronic radiation disease caused by environmental exposure
B Chronic radiation sickness caused by the supply of isotopes in the body
C Acute radiation sickness
D Acute leukemia
E Chronic leukemia
405
The centre for family planning appealed for help to the spouses, which after three years of marriage
remained childless. After the medical examination the woman has not revealed infringements generative
health, and men working in chemical production, in the ejaculate found numerous pathological forms of
sperm. Which of the listed industrial poisons most likely caused infertility husband?
A *Lead
B carbon Oxide
C Styrene
D Benzene
E-Dinitrophenol
406
In the from a chemical plant delivered a patient in grave poor condition. Objectively: gray-blue skin. Pulse
90/min. The sizes of liver is increased by 3 cm, painful on palpation. In blood anemia, methemoglobin
concentration of 40%, founded Heinz bodies. In urinalysis gross hematuria. The diagnosis is:
A *Acute intoxication by amino compounds of benzene
B Acute intoxication be carbon monoxide
C Acute intoxication by benzene
D Acute intoxication by vinegar
E Acute toxic hepatitis
431
When working with aminoz associations of benzene derivatives (dinitrobenzene, aminotoluol) woman '28
occurred acute poisoning by pairs of aminopohidnyh benzene. Complaints of general weakness, palpitations
and nausea. Objectively: cyanosis of the skin and mucous membranes with a greenish tinge; subicteric sclera.
Blood brown hue due to methemoglobin, which is 30%. Which type of hypoxia has evolved to patient?
A *Hemic
B Hypoxic
C Histotoxic
D Hypoxaemic
E Tissue
437
In the infirmary asked smelter plant which worked for changing at a blast furnace with complaints of
dizziness, dimness before the eyes, nausea, one time vomiting, dry mouth, tinnitus. The skin is pale with
cyanotic. Pulse 110 bpm., RR - 34/min., the body temperature - 40.5 oC, tachycardia. In the lungs vesicular
breathing. What form of overheating was developed ?
A *Heat Stroke
B Convulsive form
C Hyperthermia form
D Precomatose condition
E Coma
569
In sinker, who worked at the mine for 12 years, on flurogram of lungs revealed on a background of diffuse
increased lung marking founded nodule shadow figure 2 mm in diameter on both sides bronchoadenitis, left
in the middle of fate - focal shade up to 3 cm in diameter with a path to the root. What is the most likely
diagnosis?
A *Silicotuberculosis
B Lung Cancer
C Silicosis
D Anthracosis
E Sarcoidosis
570
Worker of the foundry shop with experience of working in conditions of high dust concentration 15 years,
complaining of dyspnoe with heavy physical work, frequent colds, cough with little sputum, which does not
disappear after normalization of body temperature. Sore for 2 years. Objective: diffuse dry rhonchi in the
lungs. On the x-ray of lungs - signs of emphysema, deformation pulmonary pattern. Were found a decrease
in the maximum speed of exhalation, maximum ventilation. What is the most likely diagnosis?
A *Dust bronchitis
B Chronic bronchitis
C Bronchiectasis
D Tuberculosis
E Bronchial asthma
571
Infectionist began to notice the emergence of a runny nose, watery eyes after cleaning the cabinet with
chlorine disinfectants. Soon her at work had an attack of breathlessness. During vacation such attacks were
not. After returning to work after 2 days again there was a similar attack. The patient has addressed to the
doctor. What actions of doctor will be right?
A *Send to the occupational physician
B Assign outpatient treatment
C Be sent to the research Institute of labour medicine
D Be hospitalized in pulmonology department
E Recommend to change specialty
577
Worker workshop 53 years, 15 years of experience, at carrying out of periodic medical examination was
complaining of frequent headaches, poor sleep, tingling in the heart, irritability, fatigue,loss of hearing. For
many years the noise level exceeds MPC by 10-15 dB. A year ago passed the course of treatment about
hypertension. What is the most likely diagnosis?
A *Noise disease
B Hypertension.
C Neurasthenia
D Astheno-vegetative syndrome
E Atherosclerotic encephalopathy
581
Miner have been working in the mine for 18 years, and complaining of shortness of breath, a dry cough,
weakness, sweating, chest pain, breathing hard in the lungs R-graphy of lungs: nodular shadow in the lower
and middle sections, calcification of lymph nodes on the type of “egg-shell”. What is the most likely
diagnosis?
A *Silicosis.
B Tuberculosis.
C Carcinomatosis.
D Collagenosis.
E Mycosis.
583
26 year old miner, work experience in the dusty conditions 4 years. Complains of suffocation for several
weeks, and general weakness. Chest x-ray of lungs was found total small foci dissemination with a diameter
of foci to 4 mm in the case in the first segment the top of fate plot infiltration diameter up to 3 cm, without
sharp edges. What is the most likely diagnosis?
A *Tuberculosis.
B Sarcoidosis.
C Pneumoconiosis
D Coniotuberculosis
E Canceromatosis
605
In electrician, which caters to the shop, where work is connected with great pollination, radiographically
detected small linear net shadows in the middle and lower lung fields. Concentration of free silicon dioxide
in the air is 18%. There are no complaints. Auscultatory there is no deviation. External breathing function is
normal. Which x-ray form of pneumoconiosis is it?
A *Interstitial
B Nodulated.
C Nodular.
D Interstitial-nodular.
E Moderate pneumofibrosis
645
A man of 35 years worked 13 years as a bulldozer driver. Complains of dizziness, headache at the end of the
day, numbness of the fingers and the pain in the muscles of the legs at night. The examination detected a
violation of pain and sensitivity in peripheral type, pain calf muscles ripple on arteria dorsalis pedis saved.
What the disease is most likely?
A *Vibration disease
B Raynaud's Disease
C Sringara
D Vegetative polyneuritis
E Obliterating atherosclerosis
712
A man of 42 years, which operates at a poultry farm, complains chills, shortness of breath, body temperature
39,60C, pain in left side of his chest. Two years ago suffered a myocardial infarction. During examination:
cyanosis, CDR - 26/min, HR - 102/min Percussion above the light is not modified, respiration vesicular.
Pastos legs. The x-ray picture from both sides throughout the lungs many small 2-3 mm focal shadows of
low intensity, which are located in chain along vessels. SIZE - 30 mm/H. Mantoux Test with 2 T O infiltrate 15 mm Which diagnosis is most likely?
A *Miliary tuberculosis
B Congestive pneumonia
C Focal tuberculosis
D Idiopathic alveolitis
E-Acute disseminated tuberculosis
715
The patient received radiation exposure. Staritsa on weakness, frequent nosebleeds, “bruises” on the body,
palpitations, shortness of breath. Often suffers from respiratory diseases. In blood: er.- 1,2*1012/l, Hb - 54
g/l, leuk - 1,7*109/l, E. - 0%, p. - 0%, S. - 32%, l - 62%, m - 6%; EPS - 52 mm/h; a blood clot.- 30*109/L.
The most appropriate treatment in this case:
A *bone marrow Transplantation
B a platelet Transfusion
C Transfusion eritrocitarnae mass
D Transfusion of whole blood
E Antilimfocitarnyi immunoglobulin
717
Work concentrator 37 years during the fire was in the area of high concentrations of CO2. The clinic
delivered unconscious. In the analysis of blood: er - 4,5*1012/l, HB - 136 g/l, CPU. - 0,89, leuk. 17,2*109/l, e - 0%, p - 15%., C - 55%, l - 22%, m - 3%, EPS - 3 mm/time, carboxyhemoglobin in the blood 5%. What is the most important criterion for determining the severity of the victim?
A *Duration of loss of consciousness
B of breathing problems
C the Results of ECG and spirography
D the Prevalence of trophic disorders
E Development of vascular disorders
718
The working of the mine (experience 24 years; the concentration of dust in the workplace 260-280 mg/m3,
15% of which is free silica) review x-ray of the lungs revealed changes characteristic of pneumoconiosis.
What kind of pneumoconiosis?
A *Anthraco-silicosis
B Carboranes
C Silicatos
D Anthraco-silicates
E Silicosis
749
He complains of cough with sputum, which worried sick for several years, hoarseness, weakness. Living
near the plant on processing of asbestos. Objective:in the lungs cause - decreased breath with a longer
expiration, dry rales. On the radiograph in the field of root and root zone matter heterogeneous, with
indistinct contours Eclipse, increased light airiness. ENT paresis of the right voice. What is the most likely
diagnosis?
A *Central right lung cancer
B Right-wing radical pneumonia
C Chronic dust bronchitis
D Asbestosis
E Tuberculosis
750
A man 44 years old complains periodic headache, increased blood pressure, pain in the heart area whining
character, pain and whitening of hands when diving in cold water, which disappear in 15 minutes after the
usual work, paresthesia, and numbness of the upper extremities. Objective: AT/100 mm Hg, accent of II tone
of the aorta, systolic murmur at the apex of the heart. Positive symptom of “white spots”, Pile, cold test
positive. Of diagnoses is most likely ?
A *Vibration disease
B Hypertension
C Raynaud's Syndrome
D Osteochondrosis with radicular syndrome
E Coronary heart disease
753
Patient 42, tractor, delivered to the clinic by passing cars. It is known that 3 hours ago I worked at the
warehouse with pesticides. General condition of the patient serious. There has been a sharp narrowing pupils,
tremors, spasms of the muscles of the whole body disorder of the function of the sphincter. In blood there is
a decrease in the activity of cholinesterase 40%. What is the most likely diagnosis in a patient.
A *Acute poisoning compounds fosfoorganicescimi
B Acute poisoning by chlorine-organic compounds
C Acute poisoning compounds rotorgene
D Acute poisoning compounds arsenovski
E Acute poisoning compounds ntraveling
773
In the intensive care unit in a serious condition delivered male 48 years. With
the anamnesis it is known that the person working in agriculture and a few hours ago (3 hours) spent
processing of potato plantings poison against the Colorado potato beetle. Admission: acrocyanosis,
bronhorea, tachypnea, BP - 100/60 mm Hg, the pulse 44 1 min. What method of efferent therapy is the most
appropriate at this stage?
A *Hemosorbtion
B Hemodialysis
C Plasmapheresis
D Limfozita
E Plasmadas.
782
In electric welder with 15 years of experience during the medical examination revealed dry rales in the lower
lung x-ray observed diffuse nodules a 3-4 mm in the middle and lower lung. What disease can be suspected?
A *Metallocenes.
B Silicosis.
C Silkies.
D Carboranes.
E Bronchitis.
786
The explosion of the tank with benzene at a chemical plant there are killed and wounded in a large number
(over 50 people) with burns, mechanical injuries and poisoning. Specify the main elements that provides
medical-evacuation provision in this situation?
A *Sorting, medical aid, evacuation
B Sorting, evacuation, treatment
C medical care, evacuation, insulation
D Isolation, rescue, recovery
E Sorting, recovery, salvation