Diagnostic radiology methods of musculosceletal system examination

Symptoms and syndroms of bones’ pathology

The 47 y.o. patient has been treated by neurologyst about spine osteochondrosis with
radicular syndrom for 10 years. Last 2 years the treatment has been without clinical effect.
Laboratiry tests are show acute inflamation. On spine X-ray the lumbal lordosis is
disappeared. Bechterew's disease is suspected. Which investigation can help to prove the
diagnosis?
A. *Iliosacral X-ray.
B. HLA-B27 test
C. Blood CRC test.
D. Sternal puncture
E. Raumatoid factor test
The 47 y.o. patient has been treated by neurologyst about spine osteochondrosis with
radicular syndrom for 10 years . Last 2 years the treatment has been without clinical effect.
Laboratiry tests are show acute inflamation. On spine X-ray the lumbal lordosis is
disappeared. Bechterew's disease is suspected. Which investigation can help to prove the
diagnosis?
A. *Iliosacral X-ray
B. Antibody level
C. Blood CRC test
D. Anti-DNA test
E. Raumatoid factor test
The patient С. 24 y.o. has been complaining of permanent pain in the joins of hands, feet,
elbows and knee for 4-th monthes. She was treated in the outpatient setting with weak
positive clinical pperformance. During medical examination the joints’ outlines are
smoothed, local skin temperature is increased. Which X-ray imaging can help to prove the
diagnosis?
A. *Joints of hands and feet
B. Knee joints
C. Metacarpophalangeal joints
D. Skull
E. Cervical spine
The patient В., 35 y.o. complains of lumbal pain with right leg irradiation as result weiht
lifting. The lumbal pain is intensified by leg motion and cough. Objective evidence: long
spine muscle tension; Achilles reflex is sharply weaken. The painful of paravertabral point
is intensified. Lasègue's test is positive. Which additional investigation are you racomended
in the first place?
A. *Spine X-ray
B. CT-scan
C. MRI
D. Electromyography
E. Lumbar puncture
 Diagnostic radiology of inflammation of bones
The patient 8 y.o. complaints of a thoracic spine pain, body weight loss, skin paleness,
anorexia, low grade fever (for last 3 months). Objective evidence: skin paleness, spine
muscular rigidity, limitation of spine movements. Laboratory findings: leukocytosis,
ESR acceleration, anaemia. On X-ray: intervertebral disk is diminished, local
osteoporosis of Th-X boby. What is the most probable diagnosis?
A) *Spine tuberculosis
B) Metastases to the spine
C) Spine osteomyelitis
D) Spine osteopathy
E) Spine osteochondrosis
The patient 18 y.o. complains of right ankle swelling, limitation of spine movements, pain
that the increasing as result of walk is present. PPH: conversion of tubercular tests at 7
y.o. Wasn’t treated as parents renunciation. On X-ray: focal destruction of proximal
tibia epiphysis, joint space is considerably diminished. The tubercular tests with 2 ТО -
18 mm. What is the most probable diagnosis?
A) *Tuberculous osteitis of right ankle
B) Epiphyseal osteomyelitis
C) Sarcoma of right ankle
D) Syphilis of right ankle
E) Traumatic arthritis
The patient 31 y.o complains of acute knee pain, its swelling, rise of body temperature; its
signs occurred suddenly after chill. Objective evidence: knee is swelling, the fluid
within joint space is detected under palpation, limitation of joint movement. On X-ray:
both femur and tibia epiphyseal osteoporosis is present, widening of joint space. The
turbid fluid with fibrin was given after aspiration biopsy of knee. What is the most
probable diagnosis?
A) *Rheumatoid arthritis
B) Arthritis deformans
C) Purulent arthritis
D) Tubercular arthritis
E) Syphilitic osteoarthritis
A 47-year-old obese man complained of periodic attacks of acute arthritis in the 1st left
tarsophalangeal joint. Lab exam revealed increased serum level of uric acid. What is the
diagnosis?
A) *Gout arthritis
B) Reiter’s disease
C) Rheumatoid arthritis
D) Rheumatic arthritis
E) Osteoarthritis
A patient, aged 40, ailing during approximately 8 years, complains of exertion pain in the
lumbar part of the spine, in cervical and thoracal part (especially when coughing), pain
 in the hip and knee joints on the right. On examination: the body is fixed in the forward
inclination with head down, gluteal muscles atrophy. Spine X-ray: ribs osteoporosis,
longitudinal ligament ossification. What is the most likely diagnosis?
A) Psoriatic spondyloarthropathy
B) Spondyloarthropathy caused by Reiter's syndrome
C) *Ankylosing spondylitis
D) Tuberculous spondylitis
E) Disseminated spine osteochondrosis
A patient, aged 25, complains of pain in the I finger on the right hand. On examination: the
finger is homogeneously hydropic, in bent position. On attempt to unbend the finger the
pain gets worse. Acute pain appears on touching with the probe in ligament projection.
What decease is the most likely?
A) *Thecal whitlow (ligament panaritium)
B) Paronychia
C) Articular (joint) panaritium
D) Bone panaritium
E) Subcutaneous panaritium
A 17 y.o. patient complains of acute pain in the knee joint and t 0– 380C. He was ill with
angina 3 weeks ago. Objectively: deformation and swelling of the knee joints with skin
hyperemia. Small movement causes an acute pain in the joints. Which diagnose is the
most correct?
A) Infectious-allergic polyarthritis
B) Reactive polyarthritis
C) Rheumarthritis
D) *Rheumatism, polyarthritis
E) Systemic lupus eritematodes
A 14 y.o. patient suddenly fell ill when high fever, acute pain in the right shin. In two
weeks X-ray showed translucent spaces (destructive focuses) with unevel countours in
the middle third of tibia diaphysis. Along the bone edge there was a narrow line of
shadow (periostitis) 1-2 mm from the surface. What is the most likely diagnosis?
A) Bone cyst of tibia
B) Right shin tuberculosis
C) Right shin syphilis
D) *Right shin osteomielitis
E) Right shin trauma
F) Tendon type
30 y.o. woman, had mild trauma of 5th finger of the left hand 15 days ago. She has treated
her self at home. She presents to the hospital due to deterioration of the condition and
temperature rise. Objectively: hyperemia and swelling on the ventral surface of finger.
Restricted movements of the finger. X-ray of the left hand: an early stage of
оsteomyolitis of the fifth finger could not be excluded. The diagnosis: panaris of 5th
finger of the left hand. What form of panaris has occurred in the patient?
A) Hypodermic
B) *Bony
C) Joints type
D) Paronychia
A 31 y.o. woman has complained for 3 years of pain and swelling of radiocarpal and
metacarpophalangeal articulations, morning stiffness that lasts up to 1,5 hours. Two
weeks ago she felt pain, swelling and reddening of knee joints, body temperature raised
up to 37,50С. Examination of her internal organs revealed no pathologic changes. Her
diagnosis was rheumatoid arthritis. What changes in X-ray pictures of her joints are the
most probable?
A) Cysts in subchondral bone
B) Multiple marginal osteophytes
C) *Constriction of joint space, usura
D) Epiphysis osteolysis
E) Constriction of joint space, subchondral osteosclerosis
A 21 y.o. man complains of having morning pains in his back for the last three months.
The pain can be relieved during the day and after physical exercises. Physical
examination revealed reduced mobility in the lumbar part of his spine, increase of
muscle tonus in the lumbar area and especially during the moving. X-ray pattern of
spine revealed bilateral sclerotic changes in the sacrolumbal part. What test will be the
most necessary for confirming a diagnosis?
A) Rheumatoid factor
B) Antinuclear antibodies
C) Uric acid in blood plasma
D) *HLA-B27
E) ESR
On the 4-th day of injections a 60 y.o. patient felt pain and tissue induration in the left
buttock. Objectively: the skin in the superexternal quadrant of the left buttock is red and
hot, palpation reveals a painful infiltrate 6х6 cm large with softening in the centre. Body
temperature is 37,90С. What action is necessary to diagnose an abscess?
A) Ultrasonic examination
B) Biopsy
 C) X-ray investigation
D) *Punction
E) Clinical blood analysis
A 58 year-old man complained of pain and swelling of the left foot small joints. The skin
over these joints was purple, BT was 38°C. For the last 6 years he has had a few
episodes of such arthritis with duration of each one up to 7 – 10 days. He also suffered
from chronic tonsillitis. On exam, there were abnormal features in the left
metatarsophalangeal joints. What is the pathogenetic mechanism of this disease
development?
A) *Increased biosynthesis of uric acid
B) Immune response to streptococcal infection
C) Hyperproduction of autoantibodies to collagen
D) Decreased amount of chondroitin sulfate
E) Production of antibodies to native DNA
The woman 38 y.o. complains the morning joint stiffness, especially digital joints of hands
and feet, that is disappeared after active motion during 30-60 min. Objective evidence:
artritis of metacarpophalangeal and proximal interphalangeal joints. Body tempearture is
subfebrile. ESR - 45 mm/hour. X-ray: osteoporosis and erosion the joints surfaces. Which
is the most probably diagnosis?
A. *Rheumatoid artritis
B. Psoriatic arthropathy
C. Artritis deformans
D. Systemic lupus erythematosus
E. Reactive polyarthritis
The patient 18 y.o. fall ill acutely 3 week ago. The body temperature is sharply increased,
arises severe pain of left shin. On the left shin X-ray multiple destuctive foci with irregular
shape and unclear outline. The sequestra are within the destructions. An linear periostitis is
around injured bone. Which is the most probably diagnosis?
A.*Acute hematogenous osteomyelitis of left shin bones
B. Tuberculosis of left shin bones
C. Sarcoma of left shin bones
D. Fibrous osteodistrophy of left shin bones
E. Metastases of left shin bones
The patient complains of thoracic spine pain as result of insignificance trauma (fell down
the bed). He is admitted in a 40 min after accident. PPH: lung tuberculosis. On spine X-ray
is suspected the compresion fractures of VIII and IX thoracic vertebral body. Which spine
pathlogy can lead to pathological fracture?
A. *Tuberculous spondilitis
B. Syphilis
C. Metastasis
D. Osteomyelitis
 E. Traumatic fracture
The patient G., 14 y.o. falled ill acutely, when high body temperature, febrile chill, sharp
right shin pain was arisen. On X-ray of right leg the changes wasn’t found. After 2 week
from onset of disease (in time of clinical remision) the repeated right shin X-ray was done:
the destructive foci with irregular outline and linear periostitis in the middle third diaphysis
of right tibia were diagnosed. Which is the most probably diagnosis?
A. *Right shin osteomyelitis
B. Right shin tuberculosis
C. Right shin syphilis
D. Right shin bone cyst
E. Right shin trauma
The boy 12 y.o. complains of two fistulas in lower third of left femur, high body
temperature, general weakness. 6 monthes ago was acute hematogenous osteomielitis of
left femur. On left femur X-ray – total left femur sequester (size 12x3 cm) is diagnosed.
Which is a previous diagnosis?
A. *Secondary chronic osteomyelitis;
B. Pathological fracture;
C. Tuberculosis;
D. Ewing’s sarcoma;
E. Osteoid-osteoma;

Diagnostic radiology of bones’ tumors

The patient 16 y.o. complains of permanent knee pain, its swelling. Objective evidence: a
skin above joint is smooth, superficial viens are widened. Under the palpation is defined
sharp knee pain, dense swelling. Blood test: hemoglobin and RBC are decreased. Femur X-
ray: the unclear bones destructions on the background of intensive structureless bone
tissues in the distal femur, sunburst patern. Which is the most probably diagnosis?
A Osteosarcoma
B Osteochondroma
C Osteochondropathy
D Arthritis deformans
E Fibrous dysplasia
The man 35 y.o. complains of permanent left femur pain (on medial bone surface), the
pain doesn’t abate after rest. Weak-intensive pain arose 8 monthes ago. On femur X-ray:
femur osteoporosis; osification is not present; low-intensive periostal reaction of left femur
distal methaphysis. Which is the most probably diagnosis?
A*Central fibrosarcoma
B Lymphosarcoma.
C Chondrosarcoma.
D Ewing sarcoma.
E Uxtacortical sarcoma.
The patient P, 17 y.o. complains of swelling and pain in lower third femur. The left femur
trauma was happied 4 months ago. The patient's condition didn’t responded to treatment.
Objective evidence: lower third femur swelling, painful under palpation, limitation in the
range of motions the left knee joint. The body temperature is 37,2°С. Blood test: WBC –
5,6 *109/L, RBC – 4,1*1012/L, Hb – 130 g/L, ESR – 15 mm/hour. On left femur X-ray:
focal osteoporosis and Codman’s triangle are diagnosed in distal metaphysis of left femur.
Which is previous diagnosis?
A Osteogenic sarcoma
B Osteomyelitis
C Ewing sarcoma
D Tuberculosis
E Giant cell tumor
The boy 14 y.o. has been complaining of right third femur pain for a last 2 weeks. The
pain is intensified during night-time and abeded as result paracetamol ingestion.
Objective evidence: pathology is not found. On right femur X-ray: destructive focus with
sclerotic outline in cortex of proximal third femur. Which is the most probably diagnosis?
A *Osteoid-osteoma
B Enchondroma
C Miltiple myeloma
D Eosinophilic granuloma
E Osteochondroma
The patient 23 y.o. complains of insignificant discomfort in left lateral knee joint after
working. Under palpation the swelling of left lateral knee joint is detected. On left knee
joint X-ray: the bony prominence on letaral surface of distal femoral metaphysis is
diagnosed. Overlying soft tissues are not changed. Pathohystological examination of
removed neoplasm: mass with peduncle (about 3 cm) consists of cortical bone that is
covered by cartilage. Which is the most probably diagnosis?
A *Osteochondroma
B Giant call tumor
C Bony cyst
D Osteoid-osteoma
E Enchondroma
The patient P. 20 y.o. turns to doctor with complaint of permanent left lower femur pain.
The trauma wasn’t occurred. Objective evidence: ordinary skin color, pastose, pain under
palpation, limitation in the range of knee joint motion. On knee joint ragion X-ray is
detected the destruction and spiculated priostitosi. Blood test – young blood cells;
inflamation signs are absent. Which is the most probably diagnosis?
A *Osteogenic sarcoma
B Fibrous dysplasia
C Chronic osteomyelitis
D Myeloma
E Marble-bone disease
The patient, В. 28 y.o. complains of general weakness, osteoalgia, frequent acute viral
infection, giddy. Objective evidence: skin and mucous paleness, osteoalgia. Blood test:
RBC – 2,7х1012/L, Нв-80 g/L, GV – 0,9, reticulocyte – 0,5, WBC – 5х109/L, eosinophilic
leucocyte – 1%, basophilic leukocyte – 3%, stab neutrophil -7%, segmentonuclear
leukocyte – 60%, lymphocyte – 23%, monocyte – 2%, plasmocyte – 4%, BP – 280х109/L,
ESR – 64 mm/hour. Plasma protein – 120 g/L, Urine analysis: proteinuria. Skull X-ray:
punch destructions. Which is the most probably diagnosis?
A *Multiple myeloma
B Chronic lymphatic leukemia
C Acute lymphatic leukemia
D Acute myeloleukemia
E Macroglobulinemia
The patient, В. 28 y.o. complains of general weakness, osteoalgia, frequent acute viral
infection, giddy. Objective evidence: skin and mucous paleness, osteoalgia. Blood test:
RBC – 2,7х1012/L, Нв-80 g/L, GV – 0,9, reticulocyte – 0,5, WBC – 5х109/L, eosinophilic
leucocyte – 1%, basophilic leukocyte – 3%, stab neutrophil -7%, segmentonuclear
leukocyte – 60%, lymphocyte – 23%, monocyte – 2%, plasmocyte – 4%, BP – 280х109/L,
ESR – 64 mm/hour. Plasma protein – 120 g/L, Urine analysis: proteinuria. Skull X-ray:
punch destructions. Which method of examination is the most infofmative for diagnosis?
A *Sternal biopsy
B Plasma protein electrophoresis
C Lymph node biopsy
D Rheumatoid factor test
E Schilling's test
The patient 68 y.o. complains of common weakness, osteoalgia, muscle weakness. Urine
examination: proteinuria - 5 g/L. Adenectomy was 1 year ago. On skull and pelvis X-ray is
diagnosed a lot of small round destructions with diameter 0,8-1,5 cm. Which is the most
probably diagnosis?
A. *Multiple myeloma
B. Osteolytic bony metastases
C. Amyloidosis with nephrotic syndrome
D. Parathyroid osteosis
E. Chronic glomerulonephritis with nephrotic syndrome
The patient 57 y.o. complains of lumbal and pelvic pain, body temperature is raised to
380С, general sweating, the body weight is lost. Blood test: anemia, thrombocytopenia,
ESR – 70 mm/hour. On skull and pelvis X-ray is diagnosed a lot of small round
destructions. Urine analysis: proteinuria. Which is the most probably diagnosis?
A. *Multiple myeloma
B. Stomach cancer
C. Spondylitis deformans
D. Bony metastases
E. Chronic glomerulonephritis
The patient 57 y.o. complains of lumbal and pelvic pain, body temperature is raised to
380С, general sweating, the body weight is lost. Blood test: anemia, thrombocytopenia,
ESR – 70 mm/hour. On skull and pelvis X-ray is diagnosed a lot of small round
destructions. Urine analysis: proteinuria. Which is the most probably diagnosis?
A *Sternal biopsy
B Plasma protein electrophoresis
C Lymph node biopsy
 D Rheumatoid factor test
E Schilling's test

Diagnostic radiology of bones traumas and degenerative diseases

What does it mean “the Monteggia fracture - dislocation ?”
A) *Combination of fracture of the upper half of the ulna with dislocation of the head
of the radius
B) Dislocation of the head of the radius
C) Dislocation of both forearm bones
D) Combination of fracture of the radius with dislocation of the head of the ulna
E) Fracture of both forearm bones
What is the external rotation of the lower limb common for?
A) Fracture of the femoral neck
B) Fracture of the pubic bone
C) Fracture of the ischial bone
D) Fracture of the tibia
E) Fracture of the femoral shaft
The 67 y.o. patient had 5 recurrent fractures of the lower extremities without considerable
cause within 5 years. O-shaped deformity of the legs in the knee joints has appeared.
The skull, pelvis and lower extremities X-Ray shows the thickening of flat bones. In
the long bones there is a hyperostosis along the bone axis. The blood test has not
revealed any inflammation activity. Serum calcium is normal. What disease do you
consider in this case?
A) Chronic osteomyelitis
B) *Paget's disease
C) Mottled disease (marble disease)
D) Hyperparathyoid dystrophy
E) Myeloma
A patient, aged 40, has been ill during approximately 8 years, complains of pain in the
lumbar part of the spine on physical excertion, in cervical and thoracal part (especially
when coughing), pain in the hip and knee joints on the right. On examination: the body
is fixed in the forward inclination with head down, gluteal muscles atrophy. Spine X-
ray: ribs osteoporosis, longitudinal ligament ossification. What is the most likely
diagnosis?
A) *Ancylosing spondyloarthritis
B) Psoriatic spondyloarthropatia
C) Spondyloarthropatia on the background of Reiter's disease
 D) Tuberculous spondylitis
E) Spread osteochondrosis of the vertebral column
A 60 y.o. patient complains of pain in interphalangeal joints of hand that gets worse during
working. Objectively: distal and proximal joints of the II-IV fingers are defigured, with
Heberden's and Bouchard's nodes, painful, nonelastic. X-ray picture of joints: joint
spaces are constricted, there are marginal osteophytes, subchondral sclerosis. What is
the most probable diagnosis?
A) Reiter's disease
B) Rheumatic arthritis
C) *Osteoarthritis
D) Psoriatic arthritis
E) Bechterew's disease
The patient 55 y.o. has been complaining of left knee joint pain for 2 months. The skin
above left knee joint is hyperemic, swelling; limitation in the range of left knee motions.
The uric acid rate is norm. On left knee X-ray: osteosclerosis, osteophytes; joint space is
narrowed. What is the most probable diagnosis?
A. *Arthritis defornas
B. Gonorrheal gonitis
C. Gout
D. Rheumatoid arthritis
E. Tuberculous gonotis
The woman 56 y.o. complains of wrist and knee joints pain. She has been being ill for 8
years. The body temperature is 36,6oC. Interphalangeal hand joints is thicked and painful
under motion, crunch in knee joints. On knee joints X-ray: osteoporosis, joint spaces
narrowing, marginal osteophytes. Blood test: WBC – 6,2х109/L, ESR - 13 mm/hour. What
is the most probable diagnosis?
A. *Arthritis deformans
B. Rheumatoid polyarthritis
C. Gout
D. Gonorrheal arthritis
E. Reactive polyarthritis
The woman 49 y.o. complains of shoulder joint pain, that is intensified as result of
motion; limitation in rate of joint motions, short-time morning joint stiffness. She has been
being ill for several years. She was being sport gimnast in the past. On shoulders X-ray –
narrowng joint spaces, subchondral osteosclerosis, lower-medial osteophytes. What is a
pathogenesis base of the joint disease?
A. *Abnormality of cartilage metabolism
B. Immune complex sedimentation into synovial membrane
C. Abnormality of uric acid metabolism
D. Calcium pyrophosphate sedimentation into the joint
E. Infectious synovial lession
The woman, 55 y.o., cook, complaints of right knee pain during a month which is
intensified to the set of day. Objective evidence: body weight is increased, right knee is
swollen and painful under palpation, crunch is under the motion; deformation of I
metatarsophalangeal joints of both feed. Blood test is in norm. What radiological features is
X-ray of right knee shown?
A. *Narrowing of joint space, marginal osteophytes
B. Osteoporosis, narrowing of joint space, single small erosions
C. Narrowing of joint space, multiple erosions, subluxation
D. Epiphyseal erosions, bony ankylosis
E. Narrowing of joint space, rounded bony defects
The patient 56 y.o. with increased body weight complains of pain in knee joints, which is
intensified under walking, particularly under walking up the stairs. He have been being ill
to last for 5 years. Objective evidence: knee joints are deformed, swollen; crunch and
painful take place during the moution. On X-ray of both knee joints: joint spaces are
narrowed, subchondral sclerosis and marginal osteophytes take place. Which diagnosis is
the most probable?
A. *Arthritis deformans.
B. Rheumatoid arthritis.
C. Reactive arthritis.
D. Gout.
E. Rheumatoid polyarthritis.
The patient 60 y.o. complains of pain of interphalangeal joints, which is intensified at
work. Objective evidence: the intephalangeal joints of II-IV fingers are deformed, painful
fixed Heberden's and Bushar’s nodes take place. On X-ray of interphalangeal joints – joint
spaces are narrowed, subchondral sclerosis and marginal osteophytes take place. Which
diagnosis is the most probable?
A. *Arthritis deformans, nodular type.
B. Reiter's disease
C. Bechterew's disease
D. Rheumatoid polyarthritis.
E. Psoriatic arthritis
The woman 57 y.o. complains of pain of right knee joint, which is intensified at motion
and in the evening during last year. Objective evidence: t°=36,4°С, height 161 cm, weight
98 kg. The joint is slightly deformed, the local temperature is not increased, crunch and
painful take place during the moution. What radiological features is X-ray of right knee
shown?
A. *Small marginal osteophytes
B. Epiphysial punch defects
C. Changes are not shown
D. Local osteoporosis
E. Narrowed joint space and singular erosions
The patient С., 56 y.o. with increased body wight complains of pain of hand joints. The
joint pathology has been disturbing for 10 years. Objective evidence: expresed deforming
and swelling of hand fingers. X-ray of hands: joint spaces are narrowed, osteophytes,
erosions, osteoporosis and epiphyseal ankylosis with ulnar deviation of
metacarpophalangeal joints take place. Blood test: Нв-95 g/L, ESR-20 mm/hour. Uric acid
- 0,38 mmоle/L. Which diagnosis is the most probable?
A. *Both osteoarthrosis and rheumatoid arthritis
B. Rheumatoid arthritis
C. Osteoarthrosis
D. Gout
Е. Reactive arthritis
The patient G., 56 y.o. complains of pain of knee and distal interphalangeal joints. She is
ill during 8 years. Body temperatura is in norm. Interphalangeal joints are swolled and
painful under palpation, the flexion of knee joints cause crunch. Knee joints X-ray: joint
spaces are narrowed, marginal osteophytes take place. Blood test: WBC- 6,2 х 109/L, ESR
- 13 mm/hour. Which diagnosis is the most probable?
A. *Osteoarthrosis
B. Rheumatoid arthritis
C. Rheumatoid polyarthritis
D. Gout
E. Reactive arthritis
The woman 56 y.o. complains of knee joints pain. The joints are enlarged, limitation in
the range of motions and painful take place, crunch. The previouse diagnosis: osteoartrosis.
Which radiological features are you expexted to find on X-ray of knee joints?
A. *Osteosclerosis, osteophytes.
B. Osteoporosis, narrowing of joint spaces.
C. Osteoporosis, punch-defects.
D. Osteoporosis, widening of joint spaces.
E. Osteoporosis, erosions of joint surfaces.
The patient К., 60 y.o. complains of nagging pain, distal interphalangeal joints’ stiffness,
their deformation. X-ray of hands: ostephytes, narrowing of the joint space, subchondral
sclerosis. Для какого поражения суставов характерна такая рентгенологическая
картина?
A. *Osteoarthrosis
B. Rheumatoid arthritis.
C. Gouty arthritis
D. Systemic lupus erythematosus.
E. Sclerodermatitis
The man 40 y.o. turns to doctor with complaint of frequent leg fractures as result of
trivial trauma. During last 3 years was ocurred the 5 fractures. Objective evidence: O-shape
leg deforming. On skull, pelvis and legs X-rays – flat bones are thicked, tubular bones –
hyperostosis. The inflamation sings in blood test is absent. Calcium plasma rate is slightly
increased. Which is the most probably diagnisis?
A. *Paget's disease
B. Parathyreoid distrophy
C. Chronic osteomyelitis
D. Multiple myeloma
 E. Marble-bone disease
The patient complains of right hip joint pain, that is intensified at motions. He has been
being ill for several years. Trauma wasn’t taken place. He was not treated. On right hip
joint X-ray can diagnosed: narrowed the joint space, osteophytes, femur’s caput
deformation. Which is the most probably diagnisis?
A. *Right coxarthrosis
B. Rheumatoid arthritis
C. Lumbal radiculitis
D. Lumbosacral radiculitis
E. Upper third femur tumor
The boy 12 y.o. complains of acute spine pain and stiffness as result of falled down on spin
from a height 5 m. Which first-line investigation is necessary?
A. *Biplane spine X-ray
B. Lateral spine X-ray
C. Anterior-posterior spine X-ray
D. CT-scan of spine
E. MRI of spine
Diagnostic radiology of nonspecific lung’s inflamation
A 56-year-old woman has an acute onset of fever up to 39°C with chills, cough, and pain
on respiration in the right side of the chest. On physical examination: HR of 90/minute,
BP of 95/60 mm Hg, PR of 26 per minute. There is dullness over the right lung. On X-
ray: infiltrate in the right middle lobe of the lung. What is the correct diagnosis?
A) *Community-acquired lobar pneumonia with moderate severity.
B) Community-acquired bronchopneumonia.
C) Acute pleurisy.
D) Acute lung abscess.
E) Hospital-acquired lobar pneumonia.
A 26-year-old man was admitted to the hospital complaining of stabbing back pain on
inspiration and dyspnea. On exam, BT of 37°C, PR of 24/min, HR of 92/min, vesicular
breath sounds. There is a dry, grating, low-pitched sound heard in both expiration and
inspiration in the left lower lateral part of the chest. What is the correct diagnosis?
A) *Acute fibrinous pleuritis
B) Myocarditis
C) Pneumonia
D) Acute bronchitis
E) Pneumothorax
Physical examination of a person with chronic bronchitis reveals expansion of intercostal
spaces, hyperresonant percussion note, decreased whispered voice sounds. Chest x-ray
shows hyperinflated lungs, low and flattened diaphragm. Which of the signs is helpful to
diagnose the lung emphysema?
 A) *All of them
B) Low diaphragm
C) Hyperresonant percussion note
D) Hyperinflated lungs
E) Expansion of intercostal spaces
A 38-year-old patient has been treated in a hospital. A fever of 39 C, chest pain which is
worsened by breathing, cough, brownish sputum appeared on the 7th day of the
treatment. Chest x ray shows left lower lobe infiltrate. Which of the following is the
treatment of choice for this patient?
A) *Cephalosporins of the Ш generation
B) Penicillin
C) Erythromycin
D) Tetracycline
E) Streptomycin
The primary bronchopneumonia more often arises as …
A) *Complication of acute bronchitis.
B) Complication of pneumorrhagia.
C) Complication of stagnation of blood in the lungs.
D) Complication of infarct of the lungs.
E) Complication of pneumoconiosis.
When can pulmonary bleeding arise ?
A) *Bronchoectatic disease.
B) Diffuse catarrhal bronchitis.
C) Bronchiolitis.
D) Lobar pneumonia in a stage of red hepatization.
E) Bronchopneumonia.
A 10-year-old boy complains of a headache, weakness, fever (temperature - 40 0С),
vomiting. On physical examination: there is an expressed dyspnea, pale skin with a flush
on a right cheek, right hemithorax respiratory movement delays, dullness on percussion
of the lower lobe of the right lung, weakness of vesicular respiration in this region. The
abdomen is painless and soft by palpation. What disease causes these symptoms and
signs?
A) Intestinal infection
B) Acute cholecystitis
C) Influenza
D) Acute appendicitis
 E) *Pneumonia crouposa
A 35-year-old woman was admitted to thoracic surgery department with fever up to 40 0C,
onset of pain in the side caused by deep breathing, cough with considerable quantity of
purulent sputum and blood with bad smell. What is the most likely diagnosis?
A) Tuberculosis of lungs
B) Actinomycosis of lungs
C) Bronchectatic disease
D) Complication of liver echinococcosis
E) Abscess of the lungs
A patient with nosocomial pneumonia has signs of collapse. Which of the following
pneumonia complication is the most likely to be accompanied with collapse?
A) Exudative pleuritis
B) Emphysema
C) Bronchial obstruction
D) Toxic hepatitis
E) *Septic shock
The diagnosis of a right-sided pneumothorax is set to a 36-year-old patient. What method
of treatment is indicated to the patient?
A) Anti-inflammatory therapy
B) Drainage of the pleural cavity
C) Symptomatic therapy
D) Thoracotomy
E) Pleural puncture
A child was born at 34 weeks of gestation in bad condition. The cardinal symptoms show
respiratoty disorders: sound prolonged expiration, additional muscles taking part in
breathing, crepitation rales on the background of the rough breath sounds. Assesment
according to Silverman's scale was 0, in 3 hours- 6 with presence of clinical data. What
diagnostic method can determine pneumopathy's type in the child?
A) Blood test
B) *Chest X-ray
C) Proteinogram
D) Immunologic investigation
E) Blood gases
A patient complains of a hacking cough with expectoration of up to 600 ml/daily purulent
chocolatecolor sputum with a decay smell. Onset of illness was abrupt, t 0- 390C, fever
of irregular type. There is the area of darkening with a cavity in a center on X-ray film,
 with irregular contours and level of liquid. What disease is the question?
A) Pneumonia complicated by an abscess
B) Bronchiectatic illness
C) Tuberculosis
D) *Gangrene of lung
E) Lobar pneumonia
A 32 y.o. patient who has been staying in a hospital on account of acute abscess of his right
lung suddenly felt pain after coughing in the right half of thorax, he got heavy breathing,
cyanosis. What complication is the most probable?
A) *Pyopneumothorax
B) Exudative pleurisy
C) Myocardial infarction
D) Esophagus perforation
E) Infarction-pneumonia
A 15 y.o. girl was examined. Her medical history registers gradual onset of fever, malaise,
loss of weight. There was nothing typical about the kind of fever which has been present
for more than 7-10 days and changed quickly. Physical examination didn't give evident
results. What is the only most important examination for excluding miliary tuberculosis?
A) Liver or bone marrow biopsy
B) Tuberculin skin testing
C) *Chest X-ray
D) Bronchoscopy
E) Sputum smear and culture of m. tuberculosis
A 56 y.o. woman has an acute onset of fever up to 39 0C with chills, cough, and pain on
respiration in the right side of her chest. On physical examination: HR- 90/min, BP-
95/60 mm Hg, Ps- 26/min. There is dullness over the right lung. On X-ray: infiltrate in
the right middle lobe of the lung en palpation. What is the diagnosis?
A) *Community-acquired lobar pneumonia with moderate severity
B) Acute pleurisy
C) Hospital-acquired lobar pneumonia
D) Community-acquired bronchopneumonia
E) Acute lung abscess
X-ray pattern of thorax organs revealed a large intensive inhomogeneous opacity with
indistinct outlines on the right side at the level of the 4-th rib. In the centre of this
opacity there is a horizontal level and clearing of lung tissue above it. What disease does
this X-ray pattern correspond with?
 A) -
B) *Abscess of the right lung
C) Peripheral cancer
D) Right-sided pneumothorax
E) Tuberculoma of the right lung
An 8 y.o. boy complains of constant cough along with discharge of greenish sputum,
dyspnea during physical activities. At the age of 1 year and 8 months he fell ill for the
first time with bilateral pneumonia that had protracted course. Later on there were
recurrences of the disease 5-6 times a year, during the remission periods there was
constant productive cough. What examination results will be the most important for
making a final diagnosis?
A) *Bronchography
B) X-ray of thorax organs
C) Spirography
D) Bronchoscopy
E) Bacterial inoculation of sputum
A 38 y.o. woman is seriously ill. She complains of frequent paroxysms of expiratory
dyspnea. The last paroxysm lasted over 12 hours and failed to respond to theophylline.
The skin is palish gray, moist, RR of 26/min. On auscultation, breath sounds are absent
over some areas. What is your preliminary diagnosis?
A) Chronic obstructive bronchitis
B) *Bronchial asthma, status asthmaticus
C) Ischemic heart disease, pulmonary edema
D) Atopic bronchial asthma, respiratory failure of the III degree
E) Bronchiectasis, respiratory failure of the II-III degree
Prophylactic photoX-ray examination of a 25 year old man revealed focal shadowings of
small and medium intensity with irregular contours in the 1st and 2nd segments of the
right lung. Which clinical form can be suspected?
A) Fibro-cavernous
B) Disseminated
C) Miliary
D) *Focal
E) Tuberculoma
A patient with nosocomial pneumonia presents signs of collapse. Which of the following
pneumonia complications is most likely to be accompanied by collapse?
A) Exudative pleuritis
 B) Bronchial obstruction
C) Toxic hepatitis
D) *Septic shock
E) Emphysema
F) Nosocomial lobar pneumonia
A 6 week old child is admitted because of tachypnea. Birth had been uneventful, although
conjunctivitis developed on the third day of life and lasted for about 2 weeks. Physical
examination reveals tachypnea, bilateral inspiratory crackles and single expiratory
wheezing. Bilateral pneumonia is evident on chest X-ray. The child is afebrile and has
no history of fever. White blood cell count is 15*109/l, with 28% of eosinophils. The
most likely cause of this child's symptoms is:
A) Visceral larva migrans
B) Varicella
C) Pneumocystis carinii
D) *Clamydia trachomanis
E) Mycoplasma pneumoniae
An 18 month child, taken to hospital on the 4-th day of the disease. The disease began
acutely with temperature 39, weakness, cough, breathlessness. He is pale has cyanosis,
febrile temperature for more than 3 days. There are crepitative fine bubbling rales at the
auscultation. Percussion sound is shortened in right under scapula area. X-ray picture:
unhomogenius segment infiltration 8-10 in the right, the increase of vascular picture,
unstructural rools. Your diagnosis:
A) *Segmentary pneumonia
B) Grippe
C) Bronchitis
D) Bronchiolitis
E) Interstitial pneumonia
Diagnostic radiology of Lung Tuberculosis and
Occupational diseases of lung
In case of tuberculosis of genital organs a primary focus is located most often in:
A) Lungs
B) Bones
C) Urinary excretory system
D) Lymph nodes
E) At the peritoneum
A 15-year-old girl was examined with a history of gradual onset of fever, malaise, loss of
 weight. There was nothing typical about the kind of fever, which has been present for
more than 7-10 days and changed quickly. Physical examination was unremarkable.
What is the single most important examination for excluding miliary tuberculosis?
A) *Chest x-ray
B) Liver or bone marrow biopsy
C) Tuberculin skin testing
D) Sputum smear and culture of M.tuberculosis
E) Bronchoscopy
In a male aged 25 focal shadowings of small and medium intensity with unequal contours
in the 1st and 2nd segments of the right lung were revealed during prophylactic photoX-
ray investigation. Which clinical form can be suspected in this patient?
A) Focal
B) Disseminated
C) Miliary
D) Fibro-cavernous
E) Tuberculoma
A 5-year-old boy was progressively getting more unwell than during the previous 2
months. A chest x-ray had shown right middle lobe collapse. A tuberculin skin test had
been strongly positive. What is the most characteristic finding in primary tuberculosis?
A) Hilar or paratracheal lymph node enlargement
B) Atelectasis with obstructive pneumonia
C) Cavity formation
D) Miliary tuberculosis
E) Hematogenous dissemination leading to extrapulmonary tuberculosis
A 38-year-old man worked at roofing and drain piper production for 15 years. He seeks
medical help for expiratory breathlessness on exertion, and dry cough. On exam,
wheezes above both lungs, grayish warts on fingers are seen. Factory physician has
diagnosed asbestosis. What method is the most important for this patient?
A) *Chest X-ray
B) Bronchoscopy
C) Blood gas analysis
D) Spirography
E) Electrocardiography
A 45-year-old coal miner complains of cough with black sputum, breathlessness on
exertion, which occurred 4 years before. On physical examination, wheezes above both
lungs, heart sounds are without changes, heart rate of 72 beats per minute. Chest
radiography shows multiple, small irregular opacifications throughout both lungs. What
 is the most probable diagnosis?
A) *Anthracosis, nodular, slowly progressing form, first stage.
B) Silicosis, nodular, slowly progressing form, first stage.
C) Siderosis, interstitial, slowly progressing form, first stage.
D) Bissinosis, interstitial, slowly progressing form, first stage.
E)Asbestosis, interstitial, slowly progressing form, first stage.
A 20-year-old woman complains of weakness, wet cough, body temperature raise up to
37,50C in the evenings during one month. In childhood she was under phthisiatric
observation due to conversion of tubercular tests (PPD). The condition is good. No rales
in lungs. Chest X-ray: a shadow with dim contours 3х4 cm with a clearing and focuses
near the shadow in the upper lobe of the right lung. Blood analysis: ESR - 20 mm/hour,
WBC - 7,6*109/L. What is the most likely diagnosis?
A) Pneumonia with abscess formation
B) Tuberculoma
C) Decaying cancer
D) Focal tuberculosis
E) Infiltrative tuberculosis
A worker, aged 38, working in the slate production during 15 years, complains of
expiratory exertional dyspnea, dry cough. On examination: deafening of the percutory
sounds in interscapular region, rough breath sounds, dry disseminated rales. On fingers'
skin – greyish warts. Factory's sectorial doctor suspects asbestosis. Which method is the
most informative for diagnosis verification?
A) Bronchoalveolar lavage
B) Spirography
C) Blood gases examination
D) Bronchoscopy
E) *Thorax X-ray
On chest X-ray in upper field of left lung the ring-shaped shadow is detected – it is the
ellipsoid cavity with thin smooth walls. The pleural thickening is located upward and
lateraly from cavity. Bronchial and perybronchial fibrosis connects Bronchial path conects
the cavity with cavity and lung root. The fluid level within cavity is absent. Other lung field
is without visible alteration. Which pathology is the most probably coresponded with the
radiological description?
A. *Fibrous cavernous TBC.
B. Lung’s abscess.
C. Cancer with destruction.
D. Lung emphysema.
E. Gas-filled cyst.
35 y.o. woman was admitted to thoracic surgery department with fever up to 400C, onset of
pain in the side caused by deep breathing, cough with considerable quantity of purulent
sputum and blood with bad smell. What is the most likely diagnosis?
A) Actinomycosis of lungs
B) Abscess of the lung
C) Bronchiectatic disease
D) *Pulmonary tuberculosis
E) Complication of liver echinococcosis
Diagnostic radiology of Lung Tumor
Emergency diagnostic radiology of chest pathology
The diagnosis of Right sided pnuemothorax is made to a 36 year old patient. What method
of treatment is indicated to the patient?
A) *Surgical treatment: Drainage of the pleural cavity.
B) Antiinflammation therapy.
C) Symptomatic therapy.
D) Pleural puncture.
E) Thoracotomy.
A 45-year-old man was brought to clinic with complaints of a sudden pain in the left chest
part and epigastric area, shortness of breath, nausea, one-time vomiting. The acute pain
started after considerable weight lifting. On physical examination: shallow breathing,
RR - 38/min, left chest part is getting behind during respiration, by percussion -
tympanitic sound, respiration is not auscultated. Ps - 110 bpm, of weak filling. BP -
100/60 mm Hg, insignificant displacement of heart to the right, sounds are dull. What
examination is the most expedient?
A) Esophagogastroscopy
B) *X-ray
C) Bronchoscopy
D) Ultrasound of the abdominal cavity
E) Electrocardiography
A patient aged 65 complains of shortness of breath, cough with red foamy sputum, feeling
of air deficit, fear of death. On examination: orthopnea, pale skin, acrocyanosis, cold
sticky sweat. Rough breathing sounds, in inferior-posterior arias on both sides - small
and medium moist rales. BR - 40/min. Heart sounds are distinctly muffled. On the
cardiac apex - gallop rhythm. What is the most probable preliminary diagnosis?
A) Pulmonary embolism
B) Pulmonary edema
C) Lobar pneumonia
 D) Infarction-pneumonia
E) Asthmatic state
A patient was operated on account of perforated stomach ulcer, terminal stage of diffuse
peritonitis. After endotoxic shock in the post-operative period the artificial pulmonary
ventilation is carried out with inhalation of 60% oxygen. Blood gasses: РаО 2 = 70-78
mm Hg, hypoxemia is not diminishing, CVP - 150-180 mm H 2O, BP - 90/60 mm Hg
(with administering of dopamine in high doses). Radiologically: diffuse pulmonary
infiltration. What is the reason of the resistant arterial hypoxemia?
A) Respiratory distress-syndrome
B) Pneumothorax
C) Pulmonary edema
D) Bilateral pneumonia
E) Mendelson's syndrome
A man, aged 64, complains of cough with sputum discharge, sometimes with blood
spitting. Smokes during 30 years. In the last 3 months has lost 8 kg. On roentgenologic
examination in the middle lobe of the right lung there is a cavernous formation, the
inner outline is irregular, contains a small quantity of fluid, on the right the central
lymph nodes are enlarged. What examination is the most informative to define the
diagnosis?
A) Spirography
B) Sputum analysis
C) *Bronchoscopy with biopsy
D) Pulmonary tomography
E) Bronchography
A patient, aged 32, diagnosed with multiple injuries: closed craniocerebral injury, closed
chest injury, closed right hip fracture. BP - 100/60 mm Hg, Рs - 124/min, RR - 28/min. 2
hours after skeletal extension under local anaesthesia with lidocaine, there appeared
abrupt aggravation of the patient's condition: developed face and neck cyanosis, BP -
60/40 mm Hg, HR - 160/min, RR - 44/min. What complication most probably
aggravated the severity of multiple injuries?
A) Acute anaemia
B) Pain shock
C) Cardiac infarction, cardiogenic shock
D) Pulmonary thromboembolism
E) *Pulmonary fat embolism
On examination of a patient, aged 49, cancer of the right lung, ІІА stage, is diagnosed.
What TNM combination corresponds to this stage?
A) T2N0M0
 B) T2NXM0
C) T2N2M0
D) *Т1N1M0
E) T1N2M0
In medical history of a 2-years-old girl: recurring pneumonias with obstructive course.
Auscultation: heterogeneous moist and dry rales in lungs, weakened breathing. Difficult
excretion of thick, viscous sputum. Observed "drumstick" fingers, mental deficiency.
What is the preliminary diagnosis?
A) Congenital polycystic lung disease
B) *Cystic fibrosis, pulmonary form
C) Pulmonary tuberculosis
D) Bronchial asthma
E) Recurrent bronchitis
A 60 y.o. patient experiences acute air insufficiency following of the venoectomy due to
subcutaneous vein thrombophlebitis 3 days ago. Skin became cianotic, with grey shade.
Marked psychomotor excitement, tachypnea, substernal pain. What postoperative
complication has occured?
A) Myocardial infarction
B) *Thromboembolia of pulmonary artery
C) Hemorrhagia
D) Valvular pneumothorax
E) Hypostatic pneumonia
A 24 y.o. male patient was transferred to the chest surgery department from general
surgical department with acute post-traumatic empyema of pleura. On the X-ray: wide
level horizontal of fluid on the right. What method of treatment should be prescribed?
A) *Punction and drainage of pleural cavity
B) Decortication of pleura
C) Pneumoectomy
D) Thoracoplasty
E) Lobectomy
A 55 y.o. male patient complains of weakness during 2 months, pain in the right side of
the thorax, cough, blood-streaked sputum. On X-ray: intensive triangle shadow in the
area of lower lobe that is connected to mediastinum. What is the most likely disorder in
the lungs?
A) *Central cancer of lungs
B) Tuberculosis of lungs
 C) Bronchiectasia
D) Pulmonary infarction
E) Pleuropneumonia
A patient has undergone an operation on account of perforated ulcer of stomach, terminal
phase of diffuse peritonitis and endotoxic shock. In the post-operative period he is
prescribed artificial pulmonary ventilation with 60% oxygen inhalation. Blood gases: РаО 2-
70-78 mm Hg, hypoxemy doesn't ecrease, CVP (central venous pressure) - 150-180 mm of
water column, AP- 90/60 mm Hg (against the backgound of taking big doses of dopamine).
Radiogram shows diffuse pulmonary infiltration. What cause the refractory arterial
hypoxemia?
A) Bilateral pneumonia
B) Mendelson's syndrome
C) *Respiratory distress syndrome
D) Pneumothorax
E) Pulmonary edema
The patients has sustained blunt trauma to the chest. Which of the following would most
likely be the cause of acute cardiopulmonary collapse?
A) Acute adult respiratory distress syndrome (ARDS)
B) *Pneumothorax
C) Pulmonary contusion
D) Hemothorax
E) Rib fractures
A patient complains about strong dyspnea that is getting worse during physical activity.
Presentations appeared suddenly 2 hours ago at work: acute chest pain on the left,
cough. The pain was abating, but dyspnea, dizziness, pallor, cold sweat and cyanosis
were progressing. Vesicular respiration is absent, X-ray picture shows a shadow on the
left. What pathology might be suspected?
A) Pulmonary infarction
B) Left-sided pneumonia
C) *Spontaneous left-sided pneumothorax
D) Pleuritis
E) Pulmonary abscess
Survey radiograph of chest of a 62 year old smoker who often suffers from "pneumonias"
showed a triangle shadow in the right lung, its vertex is pointing towards the lung root.
It also showed deviation of heart and mediastinum shadows towards the lesion. What is
the most probable diagnosis?
A) Atelectasis
 B) Peripheral cancer of lung
C) *Cenral cancer of lung
D) Lung cyst
E) Lung abscess
Diagnostic radiology of Heart pathology
Purulent medisatinitis is diagnosed on a 63 year old patient. What of the below listed
diseases are not the cause of purulent mediasdtinitis?
A) *Cervical lymfadinitis.
B) Deep nech phlegmon.
C) Perforation of the cervical part of the easophagus.
D) Perforation of the thoracic the easophagus.
E) Iatrogenic injury of the trachea.
A 44-year-old woman complained of weakness, subfebrile fever, and pallor of the skin.
Physical examination revealed the enlarged lymph nodes in the right supraclavicular
area. On X-ray film, there was enlargement of bronchopulmonary and paratracheal
lymph nodes. The liver was enlarged, with increased firmness. What is the most
probable diagnosis?
A) *Hodgkin’s disease.
B) Tuberculosis.
C) Sarkoidosis.
D) Tumor metastases.
E) Chronic myelocytic leukemia.
A patient, aged 49, complains of fever of 37,5 0С, heart pain, dyspnea. S1 is clapping; S2 is
accentuated in the aortic area; opening snap, presystolic murmur are auscultated. What
is the most useful investigation for valvular disorder assessment?
A) *Echocardiography+Doppler-Echocardiography
B) Phonocardiography
C) Ballistocardiogram
D) Chest X-ray
E) ECG
A 30- year-old patient complains of breathlessness, pain in the right rib arc place, dry
cough and the leg edema. He is ill for 2 months. He was treated for rheumatic fever
without effect. On exam, cyanosis, edema of the legs, BT of 36.6°C, RR of 28/min, HR
of 90/min, BP of 110/80 mm Hg, crackles above low parts of both lungs, heart borders
are displaced to the left and to the right, weak sounds, systolic murmur above the apex.
What is your previous diagnosis?
A) *Dilated cardiomyopathy
 B) Infectious endocarditis
C) Acute myocarditis
D) Rheumatic fever, mitral stenosis
E) Acute pericarditis
A patient, aged 50, during 15 years is ill with essential hypertension, not under treatment.
BP - 220/140 mm Hg, Ps - 80bmp, rhythmic. On percussion: the left heart border is 2
cm to the outside from the left midclavicular line. Sound 1 is moderately weakened.
Sound 2 is accentuated over the pulmonary artery. What changes will be characteristic
on ultrasound heart examination?
A) Hypertrophy and dilatation of the right ventricle
B) Blood regurgitation through the aortic valve
C) Blood regurgitation through the mitral valve
D) Dilatation of the left atrium
E) Hypertrophy and dilatation of the left ventricle
A 49-year-old patient complains of fever of 37,50С, chest pain, dyspnea. On physical
examination: Sound 1 is clapping; Sound 2 is accentuated in the pulmonary artery,
opening snap, presystolic murmurs are auscultated. What is the most useful
investigation for valvular disorder assessment?
A) Phonocardiography
B) Electrocardiogram (ECG)
C) Chest X-ray
D) Echocardiography + dopplerechocardiography
E) Ballistocardiogramme
A 5-year-old child with stigmas of dysembryogenesis (small chin, thick lips, opened
mouth, hyperthelorismus) has systolic murmur in the second intercostal to the right of
the sternum. The murmur passes to the neck and along the sternum left edge. The pulse
on the left brachial artery is weakened. BP on the right arm is 110/60 mm Hg, on the left
- 100/60 mm Hg. ECG results: hypertrophy of the right ventricle. What defect is the
most probable?
A) Defect of interatrial septum
B) Defect of interventricular septum
C) Open aortic duct
D) Coarctation of the aorta
E) *Aortic stenosis
A 52-year-old man has recurrent transient ischemic attacks. Auscultation of the carotid
arteries detects murmur. What diagnostic method is necessary to apply first?
A) MRI of the brain.
 B) Electroencephalography
C) *Ultrasound dopplerography
D) Cerebral angiography
E) CT of the brain
A female patient, aged 45. Two weeks after pneumonia developed shortness of breath
during walking, constant ache in precardiac area, shin edema. On examination: t 0 =
37,20С, Heart borders without changes, Sound 1 on the apex is weakened. ECG:
atrioventricular heart block I degree, lowering of the amplitude of Т wave in V2-V6. In
blood: Hb - 124 g/L, WBC - 5,68*109/L, ESR - 18 mm/h. What is the most likely
diagnosis?
A) Pulmonary embolism
B) Metabolic cardiopathy
C) CHD: unstable angina
D) Infective endocarditis
E) Acute myocarditis
A patient, aged 36, is diagnosed with ascites, splenomegaly, liver dimensions by Kurlov
11х9х8 cm, varicose esophagus veins. In medical history: abdominal injury, stomach
bleeding. AST – 0,46 mmol/g*L; ALT – 0,68 mmol/g*L; total bilirubin – 21 mu mol/L,
unconjugated bilirubin – 17,1 mu mol/L. What is the preliminary diagnosis?
A) Constrictive pericarditis
B) Hepatic vein thrombosis
C) Portal vein thrombosis
D) Inferior vena cava thrombosis
E) Peritoneum tumour (mesothelioma)
A boy, aged 13, suffers from an abrupt aggravation of condition, there appeared shortness
of breath, skin paleness with cyanosis. BP - 80/55 mm Hg, Ps- 128/min, heart sounds
weakened. On ECG: diffuse muscular changes, polytopic extrasystole. Radiologically:
acute enlargement of the heart borders in all directions. Two weeks ago there occurred a
reaction on analgin administration. What is the most likely diagnosis?
A) Endocardial fibroelastosis
B) *Idiopathic Abramov-Fiedler myocarditis
C) Rheumatic myocarditis
D) Exudative pericarditis
E) Hypertrophic cardiomyopathy
A female rheumatic patient experiences diastolic thoracic wall tremor (diastolic thrill),
accentuated S1 at apex, there is diastolic murmur with presystolic intensification,
opening snap, S2 accent at pulmonary artery. What does the heart pathology this patient
 have?
A) Aortic valve insufficiency
B) *Mitral stenosis
C) Opened arterial duct
D) Pulmonary artery stenosis
E) Mitral valve insufficiency
A 64 y.o. patient has developed of squeering substernal pain which had appeared 2 hours
ago and irradiated to the left shoulder, marked weakness. On examination: pale skin,
cold sweat. Pulse- 108 bpm, AP- 70/50 mm Hg, heart sound are deaf, vesicular
breathing, soft abdomen, painless, varicouse vein on the left shin, ECG: synus rhythm,
heart rate is 100 bmp, ST-segment is sharply elevated in II, III aVF leads. What is the
most likely disorder?
A) Pulmonary artery thromboembolia
B) Cardiac tamponade
C) *Cardiogenic shock
D) Cardiac asthma
E) Disquamative aortic aneurizm
A 19 y.o. man was admitted to the reception department in 20 minutes after being
wounded with the knife to the left chest. The patient is confused. The heart rate is 96
bpm and BP- 80/60 mm Hg. There are the dilated neck veins, sharply diminished
apical beat and evident heart enlargement What kind of penetrative chest wound
complications has developed in in patient?
A) Valve-likes pneumothorax
B) Open pneumothorax
C) Massive hemothorax
D) *Pericardium tamponade
E) Closed pneumothorax
A 37 y.o. woman is suffering from squeezing substernal pain on physical exertion. On
examination: AP- 130/80 mm Hg, heart rate=pulse rate 72 bpm, heart boarders are
dilated to the left side, aortic systolic murmur. ECG- signs of the left venticle
hypertrophy. What method of examination is the most informative in this case?
A) *Echocardiography
B) X-ray
C) Coronarography
D) Sphygmography
E) Phonocardiography
A 40 y.o. man complains of headache in occipital area. On physical examination: the skin
 is pale; face and hand edema, BP- 170/130 mm Hg. On EchoCG: concentric
hypertrophy of the left ventricle. Ultrasound examination of the kidneys reveals
thinned cortical layer. Urine analysis shows proteinuria of 3,5 g/day. What is the
probable diagnosis?
A) Chronic glomerulonephritis
B) Chronic pyelonephritis
C) Cushing's disease
D) *Essential arterial hypertension
E) Polycystic disease of the kidneys
A 42 y.o. patient was admitted 3 hours after a trauma with evident subcutaneous
emphysema of the upper part of his body, dyspnea, tachycardia 120/min. X-ray
examination revealed no pneumothorax, significant dilatation of mediastinum to the
both sides. What emergency care is needed?
A) Pleural cavity drainage
B) Toracotomy
C) Toracoscopy
D) *Drainage of anterior mediastinum
E) Pleural cavity punction
A 39 y.o. patient complains of having dyspnea during physical activity, crus edemata,
palpitation, heart intermissions. Objectively: HR is 150 bpm, atrial fibrillation. Heart is
both ways enlarged. Heart sounds are muted. Liver is 6 cm below the costal margin.
Echocardiogram reveals dilatation of heart chambers (end diastolic volume of left
ventricle is 6,8 cm) is 29% EF, valve apparatus is unchanged. What is the most probable
diagnosis?
A) Thyreotoxic cardiomyopathy
B) Restrictive cardiomyopathy
C) *Dilated cardiomyopathy
D) Exudative pericarditis
E) Hypertrophic cardiomyopathy
A 42 y.o. woman complains of dyspnea, edema of the legs, and tachycardia during small
physical exertion. Heart borders are displaced to the left and S1 is accentuated, there is
diastolic murmur on apex. The liver is enlarged by 5 cm. What is the cause of heart
failure?
A) Tricuspid regurgitation
B) Mitral regurgitation
C) Aortic stenosis
D) *Mitral stenosis
 E) Tricuspid stenosis
After a long period of subfebrility a patient registered increase of dyspnea, pain in the right
hypochondrium, leg edema. Objectively: neck veins are edematic. Ps is 120 bpm,
sometimes it disappears during inspiration. Heart sounds are very weakened. ECG
showed low-voltage waves of ventricular complex. A month ago there was raise of ST
V1-V4 segment. Cardiac silhouette is enlarged, roundish. What is the most probable
diagnosis?
A) Small-focal myocardial infarction
B) Metabolic postinfection myocardiopathy
C) *Exudative pericarditis
D) Postinfarction cardiosclerosis
E) Primary rheumatic carditis
A rounded well-defined shadow was found in the costo-vertebral angle on the chest
roentgenogram of an otherwise healthy 9 year old girl. Make a preliminary diagnosis:
A) Sympatoblastoma
B) Ganglioneuroblastoma
C) *Ganglioneuroma
D) Sympatogonioma
E) Sarcoma of the vertebra
A 56 year old man complains of fatigue, dyspnea on exertion and palpitations. He has had
a murmur since childhoo D. Examination reveals a lift at the left sternal border, split S 1,
and fixed splitting of S2. There is a grade 3/6 midsystolic pulmonic murmur and a 1/6
middiastolic tricuspid murmur at the lower left sternal border. Chest x-ray shows right
ventricular enlargement and prominent pulmonary arteries. ECG demonstrates atrial
fibrillation with a right bundle branch block. The most likely diagnosis is:
A) Tetralogy of Fallot
B) Coarctation of the aorta
C) Patent ductus arteriosus
D) Ventricular septal defect
E) *Atrial septal defect
A 52 year old man has recurrent transient ischemic attacks. Auscultation of the carotid
arteries detected murmur. What diagnostic method is to be applied in the first place?
A) CT of the brain
B) Electroencephalography
C) MRI of the brain
D) *Doppler Ultrasound
E) Cerebral angiography
A 42 year old woman complains of dyspnea, edema of the legs and tachycardia during
minor physical exertion. Heart borders are displaced to the left and S1 is accentuated,
there is diastolic murmur on apex. The liver is enlarged by 5 cm. What is the cause of
heart failure?
A) Aortic stenosis
B) Mitral regurgitation
C) Tricuspid regurgitation
D) Tricuspid stenosis
E) *Mitral stenosis
A patient, aged 49, complains of fever of 37,5 oC, heart pain, dyspnea. S1 is clapping; S2 is
accentuated in the aortic area; opening snap, presystolic murmur can be auscultate D.
What is the most efficient examination for valvular disorder assessment?
A) *Echocardiography+Doppler-Echocardiography
B) Ballistocardiogram
C) Chest X-ray
D) Phonocardiography
E) ECG
A 50 year old woman complains about dull cardiac pain, asphyxia, body temperature rise
up to 38oC. She had influenza a week ago. Objectively: Ps - 100 bpm, dropped-beat
pulse during inspiration. AP - 100/70 mm Hg, heart sounds are muffled. ECG: reduced
voltage, ST segment is above the isoline in all leads. X-ray picture shows extensively
enlarged cardiac silhouette. Palmus is of small amplitude. What is the most probable
diagnosis?
A) *Exudative pericarditis
B) Myocarditis
C) Myocardium infarction
D) Stenocardia
E) Dilatation cardiomyopathy