Krok 2

Major neurological syndromes

The patient 68 years old, servant. About 2 years ago began impaired memory: he became forgetful

at work and at home, could not cope with his responsibilities. Gradually began to forget the names

of relatives, names of objects, became helpless, lost skill of talking. Lost skills of writing, reading,

personal care. Computer tomography found atrophy of the cerebral cortex of the brain. What is the

most likely diagnosis?

A. Alzheimer's Disease

B. Atherosclerotic dementia

C. Progressing paralysis

D. Pick's disease

E. Senile dementia

Woman 47 years old complaining about headaches for the last 5 years. The pain is unilateral ,

intense, localized in the frontal region, accompanied by nausea and abdominal discomfort, begins

suddenly. Before the attack marked " blurred " vision. In history - episodes of high blood pressure,

however, currently no medications now . Between headaches attacks condition is satisfactory.

OBJECTIVE: increased nutrition ( index of body weight- 29 ), BP -170 /95 mmHg Neurological

status was normal. What is the most likely diagnosis?

A. Migraine

B. Benign intracranial hypertension

C. Chronic subdural hematoma

D. Hypertensive encephalopathy

E. Epilepsy

Doctor 64 years old regularly consume alcohol, a year ago suffered a heart attack on a background

hypertension. He do not know the name of drugs has no medical terms, forgot the names of his wife

and children. Complacent. Severe symptoms of oral automatism, sclerosis of retinal vessels.

Determine the type of dementia.

A. Atherosclerotic

B. Senylna

C. Alcohol

D. Presenylna

E. Hypertension

Female 60 years old about 15 years suffering on hypertension. After recurrent stroke she complains

on unwarranted depressed mood, difficulty concentrating, forgetting to close the door, does not

remember the events of the day. There are regions of changes after heart attack in cortical back front

areas in CT. What is the most likely diagnosis do this patient have?

A. Vascular dementia

B. Dissociate amnesia

C. Huntington's disease

D. Pick's disease

E. Alzheimer's Disease

Patient G., 60 years old, retired, worked as a director€s deputy of the Institute. Changes in behavior

were 2 years ago, after her husband's death: stopped care about herself, did not leave the house, then

stopped to clean the apartment, cook. In psychology status: lost orientation in time. She does not

understand a lot of questions. Do not know how to cook soup, fasten a button. Speaking of stutter

and lohokloniyamy. Do not recognize medical personal and patients. Often crying, cause of crying

can not explain. What is the mechanism of pathology:

A Atrophy of the cerebral cortex

B Atherosclerotic changes of cerebral vessels

C deficiency of serotonin

D Breaking the conversion of noradrenalin to adrenalin

E Contravention metabolic of melatonin

Patient 58 years old. About 2 years ago, beginning to weaken memory. Recently, have forgotten

many events of her life, she did not remember whether the grandchildren, the children, can not

remember anything. A few times went out of the apartment and could not find its way back. The

apartment is poorly focused. She can not prepare meals, do not care about her hair, can not dress

herself. Apathetic, inactive. Signs of Parkinson's disease, Huntington's, and severe vascular diseases

have not been identified. Prior to his state of uncritical. What is the diagnosis in this case?

A. Alzheimer's Disease

B. Pick's disease

C. Traumatic dementia

D. Korsakov psychosis

Female 29 years old complains on intermittent headache on the right side of the head , which is

triggered by rescue smells and emotions. The mother of patient sufferering from similar disease.

Internal organs - are without pathology. During the attack there is a general hypersensitivity , nausea

, and in the end - polyuria . During the night temporal artery palpation marked is tension and

soreness. Deneral analysis of blood and urine were normal. What is the most likely diagnosis?

A. Migraine

B. Trigeminal neuralgia

C. epilepsy

D. Meniere's syndrom

E. Neuritis of the facial nerve

Patient A., 42 years old, complained of headache, nausea, and vomiting , which are present

throughout the year , after the patient suffered a head injury . OBJECTIVE: ptosis, strabismus , right

hemiparesis , increasing of muscle tone. On the eye fundus : occurrence of stasis . Kraniohrama : the

signs of intensification digital depresses , expanding movement in the Turkish saddle , deepening of

the fissures. Determine the diagnosis.

A. Postraumatic hydrocephalus.

B. Postraumatic encephalopathy.

C. Postravmautic parkinsonism .

D. Postravmautic hypothalamic syndrome .

E. Postravmautic arachnoiditis .

Patient concerned severe headache, dizziness, nausea. Blood pressure 200/110 mmHg. century. No

focal neurological symptoms. No meningeal signs. What emerged in this case?

A. hypertensive crises

B. acute hypertensive encephalopathy

C. sympathoadrenal management

D. hemorrhagic stroke

E. subarachnoid hemorrhage

Man 54 years old, entered the hospital complaining of sudden severe headache in the occipital

region and vomiting. There are mild hypertension in history, takes hypothiazide. Three days ago,

spoke to a therapist about severe headaches, which decreased after using analgesic. OBJECTIVE:

confused mind , the left pupil enlarged . Severe photophobia and neck muscle tension . Left-sided

hemiparesis with increased muscle tone and reflexes. Temperature is lowered, no scars . BP- 230

/130 mmHg , Ps - 50/hv , number of respiratory movements- 12 min . What is the most likely

diagnosis?

A. Acute subdural hematoma

B. myasthenia

C. Acute bacterial meningitis

D. migraine

E. multiple sclerosis

The patient is 70 years old, waking up in the morning, he felt weakness in the left extremities, which

grew and reached its peak during the day. OBJECTIVE: consciousness is not impaired, no

meningeal signs, left hemiparesis, increased tendon reflexes on the left, hemihipesteziya left. Pulse -

74/min., BP-140/90 mmHg, temperature of 36,5 ° C. What is the preliminary diagnosis?

A.Ischemic stroke

B. Transient cerebral circulation

C. encephalitis

D. Hemorrhagic stroke

E. Brain tumor

In hypertensive patients appeared acutely numbing sensation in the right extremities, weakness in

them. After 2 hours, these events have passed. What disease can be diagnosed?

A. Transient cerebrovascular accident

B. Ischemic stroke

C. Hypertensive crisis

D. Hemorrhagic stroke

E. Circulatory encephalopathy

In patients with aneurysm of cerebral vessels during exercise suddenly appear pain, short loss of

consciousness, vomiting. Objective: the patient is excited, wants somewhere to escape Ps-62/min,

regular, BP-140/90 mmHg, t-37, 50C. Identify stiff neck, Kernig symptom. No focal neurological

symptoms. Determine preliminary diagnosis:

A. Subarachnoid hemorrhage

B. Brain hemorrhage

C. Ischemic stroke

D. Hypertensive crisis

E. meningitis

Patient 60 years old during the month had noted short-term lost of power in left extremities. Later in

the morning after sleep was stable weakness in the limbs. OBJECTIVE: BP-140/90 mmHg, in

conscious, central paresis VII and XII pairs of cranial nerves on the left, on the same side

hemiparesis and central hemihipesteziya. What are the drugs of choice for differentiated treatment

of this patient?

A. anticoagulants

B. hemostatics

C. corticosteroids

D. diuretics

E. antihypertensive

Patient 30 years old sudden knife excruciating headache, vomiting, meningeal signs, diplopia,

psychomotor agitation. BP - 130/80 mm Hg. century. What kind of disease should think in this case?

A. Subarachnoid hemorrhage

B. Hemorrhagic stroke parenchymal

C. Emorrhage into ventricle of brain

D. Hypertensive cerebral crises

E. Small ischemic stroke

The patient is 30 years old, suffering from headache, when lifting heavy objects felt a severe

headache as a blow to the head, there were nausea, vomiting, dizzy. Next day - objectively -

expressed meningeal syndrome, body temperature - 37,6 C. The doctor suspected subarachnoid

hemorrhage. What additional tests necessary to confirm the diagnosis?

A. Lumbar puncture with CSF study

B. Radiography of the skull

C. Cerebral angiography

D. CT

E. Rheoencephalography

Patient M., 60 years old, at night, after work felt a headache, fell down, unconscious. During 15

years was suffering from hypertension. OBJECTIVE: blood pressure 200/100 mmHg, Ps 80 in 1

min., T 37,70 C. Consciousness absent. The right nasolabial folds smoothed. Tendon and periosteal

reflexes were not called. Muscle tone is low. On examination of the left extremities seen minimal

movements. Rotation of right foot out. Meningeal signs are positive. Set the diagnosis.

A. Hemorrhagic stroke

B. Brain tumor

C. meningitis

D. encephalitis

E. Multiple Sclerosis

The man, 44 years old, there was dysarthria, Horner's syndrome on the right side, hiccups, right-

sided ataxia, loss of pain sensitivity on the face of the right and left of the trunk. Consciousness is

preserved. Brain CT in the normal range. The most rational action would be:

A. The introduction of direct anticoagulants and surveillance

B. Endarterectomy of the left carotid artery

C. Surgical decompression of the brain

D. Endarterectomy of the right carotid artery

E. Outpatient observation

Female 75 years old with coronary heart disease always takes warfarin. Taken to the emergency

therapy room complaining sudden appearance of weakness in the left half of the body and eyeball

deviation to the right. What research should be a priority to the patient?

A. Computed tomography of the brain

B. electroencephalogram

C. Ultrasound examination of the carotid arteries

D. spinal puncture

E. MRI of the brain

Patient B., 42 years old. Suddenly, against the backdrop of a full health felt pain like "blow to the

head," then has developed vomiting, generalized convulsions, lost consciousness. On examination:

coma 1 degree, stiff neck muscles, the left pupil is greater in amount than the right, the right limb

rotated, muscle tone significantly reduced. Diagnosis?

A. Rupture of an aneurysm of the brain.

B. Meningitis.

C. Epilepsy.

D. Ischemic stroke.

E. Intracranial hematoma.

Patient, 39 years old, who suffer from hypertension, sudden intense headache in the back , nausea

and recurrent vomiting ,which continued five hours. OBJECTIVE : Ps- 88/min , AT -205 /100 mm

Hg, soreness occiput points, stiff neck. Symptom Kernig positive on both sides. Suspecting

subarachnoid hemorrhage. Which of the below mentioned research methods is critical to confirm the

preliminary diagnosis ?

A. Lumbar puncture

B. EEG

C. Research fundus

D. CT

E. Ultrasonic Doppler

Patients 50 years old, suddenly having pain in the occipital region, vomiting. OBJECTIVE: sopor,

flushing of the face, the BP-210/120 mmHg, Ps-60/min, stress, body temperature - 37,8 oC.

Horizontal nystagmus. Severe oral automatism reflexes. Tendon reflexes uniform. Stiff neck,

bilateral Kernig symptom. What is the preliminary diagnosis?

A. subarachnoid hemorrhage

B. Hemorrhagic stroke parenchymal

C. meningococcal meningitis

D. Acute hypertensive encephalopathy

E. Subdural hematoma

Patient 49 years old, on the 5 day after the development of subarachnoid hemorrhage , against

moderately severe general cerebral and meningeal symptoms and stable blood pressure ( 130/ 80

mm. Hg. Cent.) in the morning, without lost of consciousness , appear right- hemiparesis , central

paresis VII and XII pairs of cranial nerves on the right , elements of sensory -motor aphasia. What is

the most likely mechanism underlying disease complications ?

A. Angiospasm cerebral vessels with the development of cerebral ischemia.

B. Upture of cerebral vessels with repeated subarachnoid hemorrhage.

C. Perdiapedez permeation .

D. Rupture of cerebral vessels of parenchymal hemorrhage

E. Embolism of cerebral vessels.

Patient 39 years old when lifting load suddenly felt severe headache, pain in the blade area, there

was vomiting. OBJECTIVE: rhythmic pulse, 60/min., BP-180/100 mmHg. Patient excited.

Photophobia, hiperakuziya. Positive symptoms Kernig, Brudzinskogo on both sides. In Blood -

Leuk. - 10h109 / l. CSF bloody, cytosis 240 in 1 ml. Which one is the most likely diagnosis?

A. subarachnoid hemorrhage

B. Sympathoadrenal management

C. Acute hypertensive encephalopathy

D. meningococcal meningitis

E. Ischemic stroke

Man 69 old with prolonged hypertension, complains on dizziness, lost of normal swallowing,

snuffle voice, shaky move. These phenoments appeared about three years ago and gradually

progress. Which of these is most likely diagnosis?

A. Dystcirculating encephalopathy

B. Ischemic stroke

C. Hemorrhagic stroke

D. stem encephalitis

E. Swelling of the brain stem

Female 60 years old, about 15 years suffering from hypertension. After second stroke which

underwent 3 months ago, complaining of absurdity, unjustified depressed mood, difficulty

concentrating, forgetting to close the door, does not remember the events of the day. In CT - Land of

postinfarction left and right changes in cortical backfront areas. What is the most likely diagnosis in

this case?

A.Vascular dementia

B.Alzheimer's Disease

C.Huntington's disease

D.Pick's disease

E. Dissociate amnesia

Occupational diseases NA (topic number 27)

In the early hours of the accident at Chernobyl group of firefighters received significant doses (8-10

Gy) of acute exposure of the whole body and died in 3-5 days after exposure. What was the cause of

death?

A. Changes in the central nervous system

B. hematopoietic violation

C. Gastrointestinal violation

D. Thermal injury

E. Change the function of the thyroid gland

Patient 38 years old over 13 years working in the factory concrete products. The work associated

with the influence of general and local vibration. He complains of general weakness , headaches,

numbness , dizziness, intermittent pain in the heart. OBJECTIVE : Ps- 84/min , regular, BP -150

/100 mmHg, Heart sounds are muffled . The skin of the extremities cold on the touch, cyanotic

hands, when pressing gaps remain . Palpation of the leg muscles marked pain. Pain , tactile and

temperature sensitivity is low. ECG : signs of myocardial hypoxia . On radiographs ankle bone

metatarsal joints observed moderate osteoporosis. What is the most likely diagnosis?

A. Vibration disease

B. polyneuritis

C. Myopathy

D. Neurocirculatory dystonia

E. Funikulyarnyy myeloses

Grinder 50 years old addressed to the guild doctor with complaints of general weakness, torpidity

terminal phalanges of fingers and pain of them. OBJECTIVE: pale skin of the fingers. During the

examination of pain, tactile and temperature sensitivity found minor violations. On the other organs

and systems deviations were not found. What is the most likely diagnosis?

A. Vibration disease

B. polyneuritis

C. Raynaud's disease

D. syringomyelia

E. Deforming arthrosis

In a chemical plant for periodic medical examinations of workers who come into contact with

mercury should be established team of doctors. A doctor whose specialty is the primary person

responsible for direct medical examination in this case?

A. neurologist

B. gynecologist

C. Dermatologist

D. ENT

E. therapist

Chemical plant worker complains of decreased performance, insomnia, headache. Powered by

producing amalgams. OBJECTIVE: tremor, asymmetry of reflexes, labile pulse steady red

dermographism. Phenomena excretory gingivitis. What causes the disease?

A. Chronic mercury poisoning

B. Chronic poisoning gasoline

C. Chronic cadmium poisoning

D. Chronic lead poisoning

E. Chronic poisoning with aniline

Patient A. the worker, 46 years old, 19 years old in contact with mercury vapor in concentrations

0,09-0,18 mg/m3. Examinations by a neurologist. Found: asthenic syndrome mikroorganic

symptoms of intentional tremor, subcortical positive symptoms, the presence of mercury depot

(respectively 0.01 and 0.04 before and after provocation unitiol), hypotonic type REG. Development

of what disease we can assumed?

A. Chronic mercury poisoning.

B. Residual neuroinfections

C. Parkinson syndrome

D. cerebral atherosclerosis

E. neurasthenia

Locksmith mercury smelting plant , 16 years in terms of the impact of mercury vapor in

concentrations exceeding the norm by 5-10 times. The examination revealed lability vazomotors

skin, heart rate, blood pressure, general hyperhidrosis, innervation asymmetry of facial muscles and

tongue positive subcortical reflexes, intentsionnyy tremor. Consultation dentist : gum , stomatitis.

Development of what disease we can assumed ?

A. Chronic mercury poisoning

B. Residual neuroinfektion

C. Parkinson syndrome

D. Acute mercury intoxication

E. mercurial encephalopathy

Diseases of the SPA (topic number 28)

Young woman 14 years old periodically disturbed headaches in temple and eye area. They were

preceded by visual disturbances - loss of sight. Sometimes vomiting during the attack. The attack

lasts from 12 hours to 2 days. Often, passes after sleep. About what disease should we think?

A. migraine

B. vegetative-vascular dystonia

C. tumor of the occipital lobe of the brain

D. epilepsy

E. optic nerve neuralgia

The girl, 14 years old, on the lesson of math had received a bad mark and reprimanded from teacher

and then she was crying long time. After the lesson suddenly fainted and fell. OBJECTIVE: skin is

white-pink, Ps-100/min, satisfactory properties, BP 110/70 mmHg eyelids are lowered. No visible

damage. What is the most likely diagnosis?

A. Isteric swoon

B. Sympatykotonic collapse

C. Vahotonic consciousness

D. The syndrome of prolonged Q-T interval

E. Epilepsiya

Women, 35 years old, after the 30 minute staying in line at the store observed dizziness stuffy. On

examination: pale skin, blood pressure 80/50 mmHg. century., pulse 52 beats / min. On the

electroencephalogram no pathology. What is the most likely diagnosis

A. Vegetative-vascular dystonia

B. Seizures

C. Ischemic stroke

D. Hypertensive crisis

E. Hysterical attack

Teenage girl after school complaining of a headache, general weakness, rapid fatigue. On

examination: pale face, blood pressure 90/60 mmHg, pulse 56/min, distal hyperhidrosis. Pathology

of the internal organs were not found. What is the diagnosis?

A. Vegetative-vascular dystonia

B. Epilepsy

C. Meningitis

D. Hypertensive crisis

E. Hysteria

The patient 32 years old complains on dissatisfaction breath, pain in the heart lasting 20 minutes or

more, which decrease after taking Validol 30 minutes, periodic interruptions in the heart, more

alone, at night. The ECG - high T in V2 - V4. What is the most likely role of this condition in

pathogenesis:

A. Disorders of the autonomic nervous system.

B. Bronchospasm.

C. Cervical-thoracic osteochondrosis.

D. Autoimmune inflammation of the myocardium.

E. Ischemic myocardial injury.

Patient N., 23 years old, during two years marks the colding of fingers. Thus they become bluish-

white and insensitive. After 5-10 minutes skin become redness and fingers are warmer, which

accompanied by a sharp pain. What is your diagnosis?

A. Rayno disease

B. Polinevritis

C. Obliterans endarteryyit

D. Atherosclerosis

E. Buerger's disease

Patient , 31 years old, entered the hospital complaining of pain in the heart aching character , low

intensity , which is caused by psyhycal overloading and relieved by tranquilizers. The pain is

accompanied by pain , palpitations, dizziness , feeling of inner tremor . OBJECTIVE: condition is

satisfactory . Symptoms of poor circulation are absencent. PS - 80/min . BP - 130/ 80 mmHg The

heart is not enlarged , sonorous tones , accents available. When VEM - test features of myocardial

ischemia have been identified. Laboratory parameters unchanged. What is the most likely diagnosis?

A. Neurocirculatory dystonia.

B. Myocarditis .

C. intercostal neuralgia

D. Myocardial infarction.

E. Cardiomyopathy .

A child 14 years old, suffering from vegetative-vascular dystonia puberty, developed

sympathoadrenal crisis. Which of drugs indicated for the relief of the crisis?

A. obzidan

B. Eufilin

C. Nospanum

D. Amizyl

E. Corglycon

The boy 4 months old, after 15 minutes after second vaccine DTP were reported signs of

angioedema. Which drugs should be used to provide emergency child care?

A. Prednisone

B. Heparin

C. adrenalin

D. Seduxen

E. Furosemide

The patient has a body trembling after stress attack, fear of death, heart rate, pale skin, feeling short

of breath on a background of dry mouth, dizziness, increased blood pressure. Neuro-organic

symptoms were missed. What disease could be suspected?

A. Sympathoadrenal autonomic management

B. Vagoinsulyarnyh vegetative management

C. Cerebral hypertensive crisis

D. Paroxysm of asthma

E. Transient ischemic attack

The young man suddenly felt a pain in the epigastric region, general weakness, dizziness, nausea,

breathing difficulties. OBJECTIVE: bradycardia, hypotension, miosis. Your preliminary diagnosis?

A. vagoinsulyar management

B. sympathoadrenal management

C. Mixed sympatoparasympatic management

D. Transient ischemic attack

E. Small ischemic stroke

Female 42 years old after a family stressful situations bother stabbing pains in the area of apex of

heart and long aching pain over the area of heart palpitations, a feeling of " sinking " of the heart,

short of breath , irritability. After receiving Validol condition improves. OBJECTIVE: emotionally

labile, red spots on face , wet and cold brushes. Thyroid gland is not enlarged. Pulse for 92 min. ,

Rhythmic . The boundaries of the heart is normal. Cardiac sounding , short systolic murmur over the

apex . Blood pressure was 130 /85 mmHg The ECG - early repolarization syndrome ventricles.

Which of the following diagnosis is the most likely ?

A. Vegetative- vascular dystonia

B. Angina , which first appeared

C. neurasthenia

D. Hypertension

E. rheumatism

Shortly after neuroinfection with hight temperature, 22-year-old patient began to complain on

attacks of palpitation, shortness of breath, sleep disorders, weight gain, recurrent spontaneous fever.

OBJECTIVE: Obesity face and trunk, tachycardia, blood pressure 160/90 mercury, t - 37,60 C

anizorefleksion, reinforced growing of hair on face. Identify the location of damage.

A. Hypothalamus

B. The limbic system

C. Brain stem

D. Tsiliospynalnyy center Bunge

E. Vagus nerve

Woman, 27-year-old suffering from vegetative-vascular dystonia. Six months ago, at first after

sudden emotional stress blood pressure rose to 180/95, there were tachycardia, sweating, pale skin,

mydriasis, panic fear of death. After half an hour - light urine polyuria. The patient fell asleep.

Similar seizures recurring monthly, preferably on the background of menstrual cycle. Your

diagnosis?

A. Sympathoadrenal management

B. Parasympathetic management

C. Mixed vegetative management

D. Hypertensive crises-CSF

E. Hipotenziyno-CSF management

Meningitis (topic number 30)

The patient 10 years old taken to the hospital in serious condition. Two months ago, ended treatment

of miliary tuberculosis. During this time the child's condition was satisfactory. Two days ago there

was a severe headache, vomiting, cramps, fever up to 40C. Identify stiff neck, positive Kernig

symptoms, Brudzinskogo. MRT - brain without changes. What disease should be suspected in this

patient?

A. Tuberculous meningitis

B. brain abscess

C. encephalitis

D. brain Tumor

E. meningiomas

A child suffering of bilateral chronic otitis during several years. 2 days ago headache was intensify,

especially during coughing, and tensioning . OBJECTIVE: subfebrility, meningeal symptoms,

hearing loss, pharyngeal reflex was reduced, deviation of the tongue to the right. Central left-side

hemiparesis. Preliminary diagnosis?

A Basal meningoencephalitis

B. Secondary encephalitis

C. Cerebellar abscess

D. Secondary meningitis

E. Swelling of the brain stem

The patient is 43 years old, fell ill acutely. Added the flushing of the skin of the left half of the face

and pain, temperature 38 C, weakness. At 2-3 days of disease appeared vesicular rash on the left part

of face. Then joined headache and vomiting. OBJECTIVE: paresis of the left facial muscles, local

palpation is painful, neck stiffness determined, deviation of the tongue, the skin of the cheek -

vesicular rash hyperemic background. What is the complication of this disease?

A. Meningoencephalitis

B. Myelitis

C. Poliradikulonevrytis

D. Ventrikulitis

E. Erysipelas

Woman 37 years old complains of headache, nausea, vomiting, seizures. She became ill yesterday

after hypothermia. Objectively: the temperature of 40C. Somnolentsivli state. Determined the stiff of

the neck muscles, Kernig symptom on the both sides, general hyperesthesia. In Blood: leukocytosis,

accelerated erythrocyte sedimentation rate. CSF turbid, yellowish. What are the characteristic

changes in spinal fluid are most likely?

A. Neutrophilic pleocytosis

B. Lymphocytic pleocytosis

C. Bloody CSF

D. Ksantohronic CSF

E. Protein-cell dissociation

The boy, 7 years old during 3 weeks complains on headache , nausea, fatigue, his condition

deteriorated gradually: increased headache , weakness . He had bronchitis in 3 years old. His father

is suffering on pulmonary tuberculosis. OBJECTIVE : temperature 37.5C, he is in consciousness, in

the pointer dog position, stiff of the neck muscles + 6 cm, partial ptosis of the right eyelid, right

pupil is enlarged . Total hyperalgesia . CSF : transparent , pressure 400 mm water column . protein

1.5 g / l, 610 cytosis in 1 ml, mainly lymphocytes , sugar 1.22 mmol / L, chloride 500 mmol / l.

A. Tuberculous meningitis.

B. The secondary purulent meningitis.

C. Epidemic cerebrospinal meningitis.

D. Serous meningitis.

E. Pneumococcal meningitis.

Patient 27 years old, on 5 day of respiratory disease had acute headache, accompanied by nausea,

recurrent vomiting, hyperesthesia, photophobia. OBJECTIVE: lying with upturned head, legs are

shown to trunk, marked neck rigidity, positive Kernig symptom, symptoms Brudzinskogo. Paresis

were not found. Tell the main neurological syndrome:

A.Meningeal syndrome

B. Vegetation management

C. Liquor hypotension syndrome

D. Liquor hypertension syndrome

E. Radicular syndrome

Patient 27 years old, on the 2nd day of the disease complains of excruciating headache, repeated

vomiting. OBJECTIVE: serious condition. Conscious adynamical. In bed takes forced position with

put back head. Skin is without rash. Severe muscle stiffness in the neck, Kernig symptoms,

Brudzinskogo. Temperature 39,5 C, Ps-120/min, BP-130/80 mmHg. What cause of the main disease

syndrome?

A. CSF hypertension

B. CSF hypotension

C. Lesions of the nuclei of cranial nerves

D. Hemorrhage of the adrenal gland

E. Hyperthermia

Patient K., 23 years old, on the 3 days of illness, which was accompanied by mild runny nose, high

body temperature to 40C, headache and petechial rash on the skin were taken to the hospital. After

using penitsillin after 2 hours blood pressure dropped to 40/10mm mmHg. Peripheral pulse and

meningeal signs are not defined. What is the diagnosis in this patient?

A. Meningococcemia, toksykoinfektsion shock

B. Spotted fever, severe course

C. Cyrus severe course

D. Scarlet fever, severe course

C. SARS, anaphylaxis

Child, 8 years old, complains on headache and vomiting. Sick 1 day. OBJECTIVE: t - 39,3 C, skin

is clear, mouth is flushed, tongue is coated, conjunctivitis, scleritis. Mild stiffness of the neck

muscles. Positive Kernig symptom to the right. CSF: cytosis - 340 lymphomas. - 87% neutrofil. -

13% protein - 140 mg / l. What is the most likely diagnosis?

A. Serous meningitis

B. Purulent meningitis

C. Arachnoiditis

D. Neurotoksykosis

E. Brain tumor

The child, 3 years old, become ill acutely, increased body temperature to 39,50 C, became lethargic ,

recurrent vomiting , headache. On examination found positive meningeal signs , performed lumbar

puncture . Cerebrospinal fluid is turbid, flowing under pressure, protein - 1.8 g / l Pandey reaction +

+ + sugar - 2.2 mmol / l, chloride - 123 mg / dL, cytosis - 2350 in 1 microliter (80% neutrophils ,

20% lymphocytes). What is the most likely diagnosis?

A. Purulent meningitis

B. Serous meningitis tuberculous

C. Serous meningitis viral

D. Brain tumor

E. Subarachnoid hemorrhage

A man, 38 years old, came to the hospital unconscious . Become ill yesterday : there was a headache

, nausea and vomiting , t-38,5 C, there was dizziness , delirium . During 4 days complained on pain

and loss of hearing in his left ear. OBJECTIVE: sopor, stiff neck , Kernig symptom on both sides,

general hyperesthesia , pus is flowing from left ear. Which of these is most likely diagnosis ?

A. The secondary purulent meningitis

B. Tuberculous meningitis

C. Primary purulent meningitis

D. Parenchymal , subarachnoid hemorrhage

E. Subarachnoid hemorrhage

Patient,35 years old, has acute nasopharyngitis, fever dramatically 39,5 ° C, headache, vomiting,

myalgia, hemorrhagic rash on the sclera, hands, feet, buttocks. On examination: stiff neck, Kernig

symptoms, Brudzinskoho. What is the most likely diagnosis?

A. Meningococcal disease

B. Trombocytopenic purpura

C. Typhus

D. Leptospirosis

E. Acute leukemia

Child, 1.5 years old, became ill acutely: fever up to 39 C, there was vomiting 5 times. Nervous

system examination found positive Kernig symptoms, and Brudzinskogo. These symptoms are

related to:

A. meningeal signs

B. Entsefalic syndrome

C. Signs of infection toxicity

D. incoordination syndrome

E. Syndrome movement disorders

In patients with purulent otitis abruptly appeared headache, vomiting, febrile temperature, general

hyperesthesia. It has been revealed meningeal signs, congested optic nerve discs. There are no

neurological focal symptoms. Cerebrospinal fluid is turbid, pressure is increased, and there is cell-

protein dissociation due to neutrophils. What disease should suspect?

A. Secondary purulent meningitis

B. Subarachnoid hemorrhage

C. Serous meningitis

D. Primary purulent meningitis

E. Meningoencephalitis

It had been suddenly deteriorated condition of three years child which was treated for a week due to

suppurative otitis. There were vomiting, headache, fever up to 390С. It had been identified neck

muscles stiffness, Kernig’s symptom both-sided, general hyperesthesia. What complications may be

suspected?

A. Secondary meningitis

B. Exacerbation of chronic otitis

C. Secondary encephalitis

D. Acute respiratory viral infection

E. Brain tumor

The patient’s body temperature suddenly increased up to 400C, it has been appeared severe headache

and vomiting. Patient is lying with closed eyes, head is thrown backwards, legs and torso are flexed.

There are blisters rash on the lips, petechial rash on the abdomen and inner thighs. Which

investigation is necessary to perform for the diagnosis?

A. exam of cerebrospinal fluid

B. CT brain

C. electroencephalography

D. rheoencephalography

E. blood chemistry exam

The patient is being treated in a tuberculosis hospital, during the last 3 weeks complaints of

gradually increased headache. It has been revealed neck muscles rigidity, there are no focal

neurological symptoms. What is the preliminary diagnosis?

A. tuberculous meningitis

B. chorea

C. brain tumor

D. myelitis

E. convexital arachnoiditis

A patient is suffering acute fever, headache, vomiting, fever up to 38,50 C. In the evening it has been

appeared neck muscles rigidity, Kernig’s symptom. There are herpetic vesicles on the lips and nose.

There are no focal neurological symptoms. What is the most likely diagnosis?

A. meningococcal meningitis

B. brain abscess

C. herpetic encephalitis

D. brain hemorrhage

E. subarachnoid hemorrhage

It had been appeared a severe headache, vomiting, increased body temperature in patients with

chronic suppurative otitis. There are presented meningeal symptoms. There are no focal

neurological symptoms. What should be doctor's tactics?

A. emergent hospitalization and diagnostic lumbar puncture

B. skull x-ray exam

C. patient observation

D. anti-inflammatory therapy

E. otolaryngologist consultation

In patient with severe meningeal syndrome, petechial rash, fever 390C, inflammatory changes in

peripheral blood and neutrophil pleocytosis in CSF it has been diagnosed a purulent meningitis.

Which syndrome is crucial for meningitis diagnosing?

A. neutrophilic pleocytosis

B. petechial rash

C. meningeal syndrome

D. fever

E. inflammatory changes in the peripheral blood

Encephalities (topic № 31)

In man with influenza it had been appeared mild meningeal syndrome, and a day later - focal

neurological symptoms. What complications may be suspected?

A. influenza encephalitis

B. secondary meningitis

C. meninhizm due to influenza

D. acute respiratory viral infection

E. influenza myelitis

Patient 35 years old, woodcutter, in late May suffered fever, high body temperature, and headache.

On the 6th day it had been appeared hiccups, weakness of hands and neck. In the neurological status

there are paresis of the hand muscle with atonia and areflexia. Head is hanging on breast. What is

the preliminary diagnosis?

A. tick-borne encephalitis

B. acute poliomyelitis

C. ischemic stroke

D. swelling of the spinal cord

E. shoulder plexopathy

On 20th

of June a resident of the city was hospitalized. The disease began acutely with, fever up to

38 - 39°C. Patient complaints of weakness, sudden headache, nausea, vomiting, pain in the whole

body, and sleep disorders. OBJECTIVE: flushing of the face, neck and chest. Meningeal signs are

positive. It was known that 12 days ago patient had returned from Siberia forests. What is the most

likely diagnosis?

A. tick-borne encephalitis

B. typhus

C. flu

D. Omsk hemorrhagic fever

E. pseudotuberculosis

The 24-year-old who is suffering acute respiratory viral infection for 5 days suddenly noted abruptly

intensive headache, systemic dizziness, double vision, paresis of the right facial muscles, swallowing

disorder. It had been diagnosed acute viral encephalitis. What is the emergent drug?

A. zovirax

B. hemodez

C. lazix

D. glucocorticoids

E. ceftriaxone

The patient 16 years old complains of headaches (mainly in the frontal and temporal areas and brow

arches), vomiting at the height of headache, eyeballs pain during their movements, paint in the

joints. OBJECTIVE: patient is excited, body temperature 39° C, pulse – 110 per minute. There are

tonic and clonic convulsions. Meningeal signs are doubtful. What is the most likely diagnosis?

A. Flu with symptoms of cerebral edema

B. Adenovirus infection

C. Influenza with typical course

D. Respiratory infection

E. parainfluenza

In 7 years child on 21th day after vesicular rash due to chickenpox it has been appeared ataxia,

nystagmus, intentional tremor, muscular hypotonia. In CSF - lymphocytic pleocytosis, slightly

increased proteins level. What complication has developed in this child?

A. encephalitis

B. pneumonitis

C. postherpetic neuralgia

D. Acute neuritis

E. Purulent meningitis

Patient S. complains of nausea, one-time vomiting, dry mouth, double vision, presence of "fog"

before her eyes, disordering of liquids swallowing. OBJECTIVE: body temperature 36,4 °C, ptosis,

mydriasis, anisocoria, absence of vomiting and pharyngeal reflexes, dryness of mucous. There are

abnormalities of internal organs. What is most likely diagnosis?

A Botulism

B acute cerebrovascular accident

C viral meningoencephalitis

D Tuberculous meningoencephalitis

E brainstem encephalitis

Neurosyphilis. Neurorheumatism. Neurological manifestations of polymyositis-

dermatomyositis (topic № 33)

8-year-old girl, who had recovered a sore throat, became restless, grimaced. It had been appeared

limbs twitching, which impeded writing and eating. She complains of pain in the heart, joints.

OBJECTIVE: muscle tone and tendon reflexes are reduced. There sre systolic murmur at the heart

apex. What is preliminary diagnosis?

A. Small (rheumatic) chorea

B. Jacksonian epilepsy

C. Kozhevnikovska epilepsy

D. myoclonic absences

E. Hysterical attack

Patient 38 years old has combination of polyneuropathic syndrome, significant weight loss,

fever, high blood pressure. In general clinical analysis – there are significant inflammatory

changes. What investigation is the most appropriate for the diagnosis?

A. Muscle biopsy with histological examination of the material

B. Determination of antinuclear antibodies

C. Determination of blood culture

D. Determination of HLA antigens

E. Electromyography

The patient 22 years old, 5 weeks after hypothermia complains of fever, fatigue, muscle pain,

inability to move. Objective: pain and hardness of shoulder muscles, legs, active movements are

minimal, erythema in front of chest, periorbital swelling with erythema. Symptom of Hottron is

positive. What investigation needs to be undertaken for verification of the diagnosis?

A. muscle biopsy

B. aminotransferase activity

C. Radiography of the joints

D. ASLO titer

E. Rheumatoid factor

The woman 29 years old felt ill suddenly with fever up to 39оC, appearance of dark purple rash on

the skin of the face, on the forehead around the eyes, on the neck and on the front anterior surface of

the chest. Skeletal muscles are flaccid, painful during palpation, the muscles’ power is reduced.

Patient has swallowing disorders. There are high positive acute phase parameters in blood analysis.

ESR - 39 mm/h, Er - 2,9 х1012

, Hb - 72 g/l. Definition of which enzyme is most essential for

diagnosis verification?

A. creatine phosphokinase

B. transaminase

C. transferring

D. alkaline phosphatase

E. copper oxidase

Male 32 years old notes the growing weakness in the limbs during last 4 days. Patient suffered a

respiratory infection 10 days ago. Temperature 37,80

C, BP -130 /80 mm, Ps- 94 per minute,

respiratory rate – 42 per minute . Breathing is superficial. There symmetrical muscle weakness of

both halves of the face and the proximal and distal muscle groups of the extremities. Sensitivity is

saved. Deep tendon reflexes are absent, plantar flexor reflexes are presented. What is the most likely

diagnosis?

A. polymyositis

B. acute disseminated encephalomyelitis

C. poliomyelitis

D. Guillain Barre syndrome

E. myasthenia gravis

HIV infection. Poliomyelitis. Tuberculosis (topic № 34)

The child 2.5 years old contacted 15 day ago with patient who was suffering poliomyelitis.

Yesterday child had mild catarrhal manifestations in the form of a runny nose and dry cough. Today

it has been appeared loss of appetite, weakness, disturbed sleep. The child is capricious, languid,

neck muscles are rigid, hyperesthesia along right sciatic nerve, temperature-38,2o C. What is the

period of the paralytic form of polio in this child?

A. preparalityc

B. paralytic

C. incubatory

D. residual

E. recovery

Patient 15 years old, after 3 days of fever and mild intoxication symptoms, suddenly notes signs of

flaccid paralysis of the left leg without changing the sensitivity. What disease could cause such

condition?

A. poliomyelitis

B. brucellosis

C. pseudotuberculosis

D. tetanus.

E. rabies

Patient, 16 years old, was hospitalized in the infectious clinic with complaints of a lack of

movement in the lower extremities. The disease started 2 days ago, in form of fever 38o C, diarrhea

3-5 times per day. There were pains in the lower extremities, headache. OBJECTIVE : temperature

36,8o C, active movements of lower extremities are absent, there are areflexia, muscles hypotonis.

Sensitivity is preserved. Meningeal symptoms are slightly positive. What disease we should suspect

?

A. Polio.

B. Meningococcal infection.

C. Leptospirosis.

D. Parainfective encephalitis.

E. Tuberculous meningoencephalitis

Man, 22 years old, noted gradual headaches, slight cough, fatigue, nausea. Two days later it had

been appeared skin hypersensitivity, stiffness of neck muscles, Kernig and Brudzinsky symptoms,

excessive sweating, fibrillar twitching of definitive muscle groups, decreasing and asymmetry of

reflexes, pain in the spine. On the 6th day of illness it had been appeared flaccid paresis, paralysis of

legs and shoulders muscles, and pain along the nerve trunk in extremities. What is the preliminary

diagnosis?

A. Polio, paralytic form

B. meningococcal meningoencephalitis

C. tick-borne encephalitis

D. Polyradiculoneuritis

E. enteroviral infection

A patient, 20 years old, complains of severe headache, double vision, fatigue, fever, irritability.

OBJECTIVE: temperature 38,1oC, contacts with doctors are reluctant, all irritations are painful.

Ptosis of the left eye, divergent strabismus, anisocoria S>D. There is pronounced meningeal

syndrome. Cerebrospinal fluid pressure is 300 mm of water. CSF is transparent, with a slight

opalescence. One day later in CSF fibrinous film has been appeared. Protein - 1.4 g/l, lymphocytes -

600 in 1 ml, sugar - 0.3 mmol/l. What is the preliminary diagnosis?

A. Tuberculous meningitis

B. meningococcal meningitis

C. Syphilitic meningitis

D. Lymphocytic meningitis Armstrong

E. mumps meningitis

The patient 10 years old was hospitalized in serious condition. Two months ago, he finished

treatment of miliary tuberculosis. After treatment the child's condition was satisfactory. Two days

ago there was a severe headache, vomiting, cramps, fever up to 400C. There are neck muscles

stiffness, positive Kernig and Brudzinsky symptoms. Brain MRI without any changes. What disease

should be suspected in the patient?

A. tuberculous meningitis

B. brain abscess

C. encephalitis

D. brain tumor

E. meningiomas

Child 1.5 years old, sharply felt in form of body temperature - 38,5 0

C, headache, and weakness. On

the fifth day of illness the temperature dropped. On the morning there were muscle pain, lack of

active movement and tendon reflexes in right leg. Sensitivity of right leg is preserved. What is the

most likely diagnosis?

A. poliomyelitis

B. viral encephalitis

C. osteomyelitis

D. poliarhtropathy

E. arthritis of hip joint

The patient was being treated in a tuberculosis hospital, during the last 3 weeks suffered gradually

increasing headache. Neurological examination revealed neck muscles rigidity, there are no focal

neurological symptoms. What is the preliminary diagnosis?

A. tuberculous meningitis

B. chorea

C. brain tumor

D. myelitis

E. convexital arachnoiditis

The boy 7 years old complains of headache, nausea, fatigue during last 3 weeks. Patient’s condition

deteriorated gradually in form of increasing headache, weakness. In the age of 3 years patient had

suffered bronchitis. Patient’s father is suffering pulmonary tuberculosis. OBJECTIVE : temperature

37.5 C0, consciousness is preserved, pronounced neck muscles stiffness, partial ptosis of the right

eye, right pupil is enlarged. There is total hyperalgesia. CSF is transparent, CSF pressure is 400 mm

of water. CSF content: protein 1.5 g/l, 610 cytosis in 1 ml (mainly lymphocytes), sugar 1.22

mmol/L, chlorides 500 mg/dL.

A. Tuberculous meningitis.

B. The secondary purulent meningitis.

C. Epidemic cerebrospinal meningitis.

D. Serous meningitis.

E. Pneumococcal meningitis.

Progressive diseases of nervous system (topic № 35)

Patient 25 years visited doctor complaining of fast fatigue during physical exercises, double vision,

which appears during the second half-day, weakness of masticatory muscles during prolonged

chewing. OBJECTIVE: repeated eyes closings follows with ptosis, multiple exams of tendon

reflexes lead to their decreasing. What diagnostic drug test should be performed to confirm

suspected of myasthenia gravis?

A. Prozerin

B. Corticosteroid

C. Dimedrol

D. Pilokarpin

E. Aspirin

Patient 26 years old complains of ptosis, double vision, impaired swallowing and chewing a solid

food, increased fatigue, especially in the evening. All complaints emerged gradually for months

without any apparent reason. OBJECTIVE: bilateral ptosis, diplopia, "nasal” tone of voice, during

the conversation patient’s voice is fading. After prolonged chewing patient cannot close mouth and

swallow a food. There is limbs weakness, which increases sharply during repetitive stereotyped

movements. Prozerin test is positive. What drugs are required to treat the disease?

A. Anticholinesterase agents

B. Ganglioblockers

C. Calcium channels blockers

D. Muscle relaxants

E. Antiplatelet

Dimyelinating diseases (topic № 36)

Male 25 years old, suffers multiple sclerosis for last 4 years. Patient is complaining of increased

ataxia, weakness of the lower limbs, urinary retention. OBJECTIVE: central tetraparesis. Cerebellar

ataxia. Impaired function of the pelvic organs. What is the most appropriate treatment in this case?

A. Glucocorticoids

B. Nootropics

C. Desensitizing drugs

D. Antibiotics

E. Vitamins

Patient 25 years old complains of sudden and significant reduction of right eye vision.

Ophthalmologist diagnosed retrobulbar neuritis. OBJECTIVE: abdominal reflexes are absent,

vibrating sensitivity is reduced. Define the diagnosis.

A. Multiple sclerosis.

B. Lateral amyotrophic sclerosis

C. Funicular myelosis.

D. Brain tumor.

E. Optic nerve atrophy.

Patient, 22 years old, noted reduction of left eye vision. A year later, there was weakness of the right

foot. OBJECTIVE: horizontal nystagmus, temporal half of the left optic disc is pale, absence of

abdominal reflexes, hyperreflexia in the extremities, right foot clonus, symptoms Babinsky both-

sided. What is the most likely diagnosis?

A. Multiple sclerosis

B. Myelitis

C. Right peroneal nerve neuropathy

D. Retrobulbar optic neuritis

E. Poliomyelitis

Diseases of peripheral nervous system (topics № 37 – 38)

Patient, 43 years old, complains of recurrent attacks of pain in the right half of the face. During the

pain attacks there is a spasm of facial muscles and skin redness of the right half of the face. There

are no abnormalities in blood analysis. It has been diagnosed right sided trigeminal neuralgia. Which

is most appropriately drug for the patient?

A. Finlepsin

B. Prednisone

C. Actovegin

D. Analgin

E. Indomethacin

In the newborn, who was born as a result of rapid delivery, there is paresis of hand muscles.

Grasping and hand-mouth reflexes are absent. Hand sensitivity is absent. What is the most likely

diagnosis?

A. Déjerine-Klumpke paresis

B. Total brachial plexus lesions

C. Horner syndrome

D. Diaphragm paresis

E. Duchenne-Erb paresis

A patient suffering diabetes, noted suddenly dropping of right upper eyelid. Doctor found right

pupils enlargement and right divergent strabismus. There are no other neurological abnormalities.

What is disease?

A. Right oculomotor nerve neuropathy

B. Diabetic polyneuropathy

C. Brain tumor

D. Acute cerebrovascular event

E. Secondary meningitis

The patient was operated on stomach. During surgery, the patient's left upper limb was abducted and

fixed to the operating table for anesthesia. In the postoperative period patient noted dysfunction of

the upper extremity in the form of "hanging" brush. Which anatomical structure was impaired?

A. radial nerve

B. inguinal nerve

C. ulnar nerve

D. median nerve

E. muscle-cutaneous nerve

Patient was hospitalized due to fever, headache, pain in the left side of chest. Objective: there are

swelling, skin redness, and small vesicular rash in the left intercostal spaces. Palpation of the left

intercostal spaces is painful. What drug needs to be prescribed?

A Acyclovir

B Remantadin

C RNA

D Retrovir

E Lamivudin

Newborn after pathological delivery has not active movement of right hand. There is no Moro reflex

on right arm. Tendon-periosteal reflexes in the right arm are dramatically reduced. What is the most

likely diagnosis?

A. Traumatic plexitis, total type

B. Intracranial birth trauma

C. Traumatic fracture of the right humerus

D. Right humerus osteomyelitis

E. Traumatic plexitis, distal type

The baby was born a day before. There was impaired releasing of shoulders during the birth. Body

weight is 4300 grams. OBJECTIVE: right arm is hanging along the trunk, right hand movements are

absent. Scarf symptom is positive. What is the most likely diagnosis?

A. Total right-obstetric paralysis

B. Hemiparesis

C. Tetraparesis

D. Proximal type of right-sided obstetric paralysis

E. Distal type of right-sided obstetric paralysis

Female, 52 years old, complains of face asymmetry. Patient felt ill 2 days ago after hypothermia.

OBJECTIVE: temperature 38,2 0C. There is marked face asymmetry. Skin wrinkles on the left

forehead are smoothed. Left eye slit is wider in comparison with right one. Left nasolabial wrinkle is

smoothed, left mouth angle is lowered. There are no other abnormalities. In blood: leucocytes -

10х109/L, erythrocyte sedimentation rate 20 mm/h. What is the most likely diagnosis?

A. Neuritis of the facial nerve

B. Trigeminal neuralgia

C. Ischemic stroke

D. Brain tumor

E. Hemicrania (migraine)

Patient visited emergency room due to the cut with glass the inner surface of the lower third of

forearm. OBJECTIVE: impaired flexion of IV and V fingers, reduced sensitivity of inner and

palmar surface of the hand and IV finger. What nerve is injured?

A. cubital

B. median

C. radial

D. muscular-cutaneous

E. axillary

Female, 45 years old, complains of excruciating pain attacks in the left half of the face which last 1-

2 minutes. The pain attacks is provoked by chewing. Patient felt ill two months ago after

hypothermia. OBJECTIVE: left trigeminal nerve points are painful. Touching of nose’s left wing

follows with attack of facial muscles tonic spasm. What is most likely diagnosis?

A. Trigeminal neuralgia

B. Sinusitis

C. Facial migraine

D. Neuralgia of glossopharyngeal nerve

E. Arthritis of temporal-mandibular joint

A girl was born with Apgar scores 7-8 points . During labor there was a short-term difficulty in the

release of the shoulder girdle. After the birth child had dysfunction of the right shoulder and forced

position of the right arm. The shoulder is rotated inward, right elbow is extended. There is pronation

of right forearm. Right hand is flexed like "doll hand". What is clinical diagnosis?

A. Duchenne-Erb paresis

B. Injury of right arm’s soft tissue

C. Osteomyelitis of the right arm

D. Injury of thoracic spine

E. Intracranial hemorrhage

Patient, 60 years old, suffers severe pain in the right hand during last 2 days. At the 3rd day it has

been appeared the blister rash like a chain on the skin of shoulder, arm and hand. Sensitivity of rash

areas is reduced. What disease may be diagnosed?

A. herpetic ganglionitis

B. dermatitis

C. cervical-thoracic radiculitis

D. psoriasis

E. allergy

Patient, 65 years old, complains of rash, severe pain in the right subscapular area. Objective: there

are linear-like pink and red swollen, slightly infiltrated, with clear boundaries rash on the skin of

right subscapular area. On the rash surface there are grouped vesicles with clear content. What is

diagnosis?

A. Shingles.

B. Dermatitis.

C. Erysipelas.

D. Allergic dermatitis.

E. Impetigo.

Neurological syndromes of spine ostheochondrosis (topic №39)

Male, 45 years old, truck driver, complains of pain in back and right leg. He suffered during last 2

months, there were no any alleviation after conservative treatment. OBJECTIVE: there are limited

movements in the lumbar spine. Right symptom Lasegue is positive. Knee reflexes are brisk, D = S.

Achilles reflexes S>D. What investigation should be performed for further diagnosis?

A. MRI

B. spine X-ray exam

C. electromyography

D. rheovasography

E. all answers are correct

Miner, 37 years old, complains of pain in lumbar area irradiating to the left leg. Pain had appeared

just after weights lifting. Patient’s gait is sparing. Lumbar lordosis is flattened. There is left-sided

scoliosis. Paravertebral muscles are tensed. There are positive symptoms of Neri, Dezherin, left-

sided symptom of Lasegue. What investigation should be performed for further diagnosis?

A. CT of the lumbosacral spine

B. Lumbar puncture

C. Kidneys sonography

D. Descending myelography

E. Electromyography

Female, 62 years old, felt a sharp pain in the lumbar area, buttocks, postero-lateral surface of the

right thigh, outer surface of the right leg and dorsum of right foot just after the weight lifting.

OBJECTIVE: weakness of the anterior tibial muscle, long extensor of the thumb, short extensor of

the toes of the right foot. Right Achilles reflex is decreased. Lasegue symptom is positive. What is

the most informative method of investigation for the diagnosis discogenic compression of the L5

radix?

A. MRI

B. X-ray exam of spine

C. Electromyography

D. Angiography

E. Lumbar puncture

Patient, 38 years old, complains of pain in the lumbar area and irradiating to the back surface of the

left leg. Pain appeared after the weight lifting. The pain is increased because of posture changing

and vertical position. There are positive tension symptoms. What is the most likely diagnosis?

A. Pathology of intervertebral discs

B. Myelopathy

C. Arachnomyelitis

D. Polyneuritis

E. Spinal tumors

In patients after weight lifting appeared unbearable pain in lumbar area. Family physician diagnosed

acute lumbar-sacral radiculitis. Which procedure is contraindicated for this patient?

A. heat procedure

B. vitamin B

C. intravenous aminophylline

D. dehydrating agents

E. analgesics

Hereditary degenerative disease of pyramidal, extrapyramidal, cerebellar systems (topic №

41)

In male, 46 years old, with progressive loss of memory and intellect, it had been gradually evolved

and increased forced movements of facial muscles, limbs and trunk. OBJECTIVE: general irregular

muscle twitching, which increase during excitement and disappear during sleep. There are excessive

gesticulation, "dancing gait", diffuse muscle hypotonia and mild tendon hyperreflexia. Similar

symptoms were presented in patient’s older brother and mother. What is the most likely diagnosis?

A. Huntington’s chorea

B. Hepato-cerebral dystrophy (Wilson’s disease).

C. Infectious (rheumatic) chorea.

D. Fridreich familial ataxia.

E. Olive-pons-cerebellar degeneration

Somato-neurologic syndromes (topic № 42)

Patient, 40 years old, has acute hepatitis type B. At 10th

day of hospitalization patient’s condition

abruptly deteriorated - nausea, repeated vomiting, increased pain in the right subcostal area,

increased jaundice of sclera and skin. Leukocytosis was increased up to 12х109/l, total bilirubin

levels - 250 mcmol/l (mostly indirect fraction), ALT - 10 mg/dL. What is the complication of

hepatic disease?

A. Hepatic encephalopathy

B. Aggravation of cholecystitis

C. Renal insufficiency

D. Increased lysis of erythrocytes

E. Intrahepatic cholestasis

Epilepsy. Neurosis.

Boy, 13 years old, suddenly lost consciousness, there were generalized tonic and clonic convulsions.

OBJECTIVE: pupils are dilated, photoreactions are absent, cyanosis of the face, tongue is bitten,

release of white foam from the mouth, involuntary urination and defecation. Such attacks are

presented from the age of three, several times per a year. The child regularly takes sedatives and

anticonvulsants. Ambulance diagnosed by status epilepticus. What drug is most useful for attack’s

termination?

A.diazepam

B. corglycon

C. atropine

D. aminazin

E. adrenalin

Women, 30 years old, after the emotional stress had loss of consciousness, tonic seizures that have

changed into clonic ones, followed by the appearance of foam from the mouth, involuntary

urination. There were no focal neurological symptoms were. AP 120/60 mm Hg. What is the most

likely diagnosis?

A. epilepsy

B. eclampsia

C. stroke

D. syncope

E. neurasthenia

7-year-old boy during a day has "off" episodes for 10-15 seconds, during which he freezes in one

position, does not respond to the question, do not respond to his name. After these attacks he doesn’t

remember what had happened with him. Neurological investigation revealed no changes. What

investigation should be performed for further diagnosis?

A. Electroencephalography

B. Investigation of evoked potentials

C. Echo-encephloscopy

D. Scull X-ray exam

E. Brain computer tomography

Patient, 50 years old, had for 1 h three attacks of tonic-clonic seizures during 1 hour, consciousness

between seizures was impaired. AP - 160/100 mm Hg, heart rate – 100 per minute. Breathing is

noisy, involves auxiliary muscles. What is the most likely state of the patient?

A. Status epilepticus

B. Series of epileptic seizures

C. Transient ischemic attacks

D. Cerebro-vascular crises

E. Prolonged epileptic seizure

18-year-old boy complained of a headache for a last month. A few days ago suddenly appeared tonic

spasms in the toes of the right foot, which spread to the right leg and arm, and were changed into

clonic seizures. During the attack consciousness was clear. The attack lasted for 3 minutes.

OBJECTIVE: paresis of the right foot after the attack right-sided Babinsky symptom. What is the

attack’s name?

A. Jackson epilepsy

B. Kozhevnikov epilepsy

C. Myoclonic absences

D. Tonic-clonic seizures

E. Hysterical attack

Patient 31 years old, an economist, suffers tonic clonic epileptic seizures from adult age, he

regularly uses anticonvulsant drugs. Patient was hospitalized due to significant acceleration of

epileptic attacks. In the department there are serial repetitive seizures between which the patient was

unconscious state. What measure is most useful for the patient?

A. 0.5% sibazon solution intravenously

B. Parenteral administration of 2.5% chlorpromazine solution

C. To increases the doses of used medications

D. administration of camphor-containing drugs

E. Electro-shock therapy.

Patient, 15 years old, during a lesson at school suddenly fainted and fell on floor, his face turned

blue, patient made a muffled cry, muscles were tensed, and then it had been appeared the twitching

of whole body, released a bloody saliva from his mouth. The seizures lasted 2-3 minutes, after that

patient regained consciousness, but did not know what had happened to him. Five minutes later, the

patient felt sleep for an hour of sleep. After waked up patient complained of general weakness. What

is the attack’s name?

A. Generalized epileptic seizures

B. Partial epileptic seizure

C. Jackson epilepsy

D. Vasomotor syncope

E. Coma

Patient 24 years old, is very companionable, emotionally labile. After divorce she complained of

increased irritability, depressed mood, palpitations, stabbing pain in the heart, fatigue. OBJECTIVE:

there is palms hyperhidrosis, Ps - 72-78 per minute. There is no cardiac pathology. ECG is normal.

What pathology is diagnosis?

A.neurasthenia

B. hypochondriacal neurosis

C. depressive neurosis

D. maloprohrediyentna schizophrenia

E. obsessive-compulsive disorder

Patient, 30 years old, is in the psychiatric ward. She is demonstrative, capricious, talkative, always

try to attract the attention of others. She complains of pain in the whole body. In presence of doctor,

patient moans, grabs her head, cry, demonstrates the inability to walk, and holds surrounding

objects. When patient is alone her walking is normal, she sings, puts makeup. Determine the

patient's condition.

A. Hysterical neurosis

B. Hypochondriacal development of personality

C. Schizophrenia

D. Manic-depressive psychosis

E. Obsessive-compulsive disorder

Patient, 30 years old, has the expansive, active character. He complains of depressed mood, fatigue,

morning weakness. Night sleep is superficial at night and there is drowsiness during daytime.

Patient is disquieted because it seems to him he has incurable disease. Due to this condition patient

has a sense of own inferiority. Patient performs the job only through the will efforts. What drug

needs to be administered?

A. Antidepressants

B. Nootropic drugs

C. Antipsychotics

D. Psychostimulant

E. Tranquilizers