ANTHRAX
Anthrax can occur in 4 forms, depending on the route of infection: cutaneous, inhalational, gastrointestinal, and injection. Cutaneous anthrax begins as a pruritic papule or vesicle and progresses over 2 to 6 days to an ulcerated lesion with subsequent formation of a central black eschar. The lesion itself is characteristically painless, with surrounding oedema, hyperaemia, and painful regional lymphadenopathy.
Patients may have associated fever, lymphangitis, and extensive oedema.
Inhalational anthrax is a frequently lethal form of the disease and constitutes a medical emergency. The initial presentation is nonspecific with fever, sweats, non-productive cough, chest pain, headache, myalgia, malaise, nausea, and vomiting, but progresses to the fulminant phase 2 to 5 days later. In some cases, the illness is biphasic with a period of improvement between prodromal symptoms and overwhelming illness. Fulminant manifestations include hypotension, dyspnoea, hypoxia, cyanosis, and shock occurring as a result of haemorrhagic mediastinal lymphadenitis, haemorrhagic pneumonia, haemorrhagic pleural effusions, and toxaemia. A widened mediastinum is the classic finding on imaging of the chest. Chest radiography may also show pleural effusions or infiltrates, both of which may be haemorrhagic in nature.
Gastrointestinal tract disease can present as one of 2 distinct clinical syndromes — intestinal or oropharyngeal. Patients with the intestinal form have nausea, anorexia, vomiting, and fever progressing to severe abdominal pain, massive ascites, hematemesis, and bloody diarrhea, related to development of oedema and ulceration of the bowel, primarily the ileum and cecum. Patients with oropharyngeal anthrax may also have dysphagia with posterior oropharyngeal necrotic ulcers, which can be associated with marked, often unilateral neck swelling, regional adenopathy, fever, and sepsis.
Injection anthrax has not been reported to date in children. Its primary occurrence has been reported among injecting heroin users; however, smoking and snorting of heroin also have been identified as exposure routes. Systemic illness can result from hematogenous and lymphatic dissemination and can occur with any form of anthrax. Most patients with inhalational, gastrointestinal, and injection anthrax have systemic illness. Anthrax meningitis can occur in any patient with systemic illness regardless of origin; it can also occur in patients lacking any other apparent clinical presentation. The case-fatality rate for patients with appropriately treated cutaneous anthrax is usually less than 1%. Even with antimicrobial treatment and supportive care, the mortality rate for inhalational or gastrointestinal tract disease is between 40% and 45% and approaches 100% for meningitis.
2023 - Англійська частина(АМПС)
2023 - Англійська частина(АМПС)
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Текст
Питання 1
Choose the correct statement.
Питання 2
Choose the correct statement.
Питання 3
Injection anthrax can only occur among injecting heroin users.
Питання 4
Which form of anthrax causes the highest rate of mortality?
Питання 5
What is the presentation of the inhalational form of anthrax?
Питання 6
On what does the form of anthrax depend?
Питання 7
The treatment of anthrax does not exist.
Питання 8
Gastrointestinal anthrax can have two syndromes.
Питання 9
The lowest mortality rate happens for the cutaneous form of anthrax.
Питання 10
How does the cutaneous form of anthrax start?
Питання 11
A man has an impairment of a certain part of his central nervous system, which manifests as asthenia, muscle dystonia, and a balance disorder. What part of the central nervous system is affected in this case?
Питання 12
A surgeon suspects inflammation of the Meckel's diverticulum in a 10-year-old child. This condition requires a surgical intervention. What part of the intestine must be inspected to find the diverticulum?
Питання 13
Autopsy shows clinical presentation of diffuse osteoporosis with foci of bone tissue destruction. In the bone marrow, proliferation of atypical plasma cells can be observed. Bence Jones protein is detected in urine. What diagnosis can be made in this case?
Питання 14
Diphtheria toxin is a potent inhibitor of protein synthesis in eukaryotes. What is its molecular mechanism of action?
Питання 15
The cardiology department has received a patient with complaints of tachycardia, shortness of breath, and cyanotic mucosa. Examination detects leg edemas and ascites. What drug must be prescribed to the patient in this case?
Питання 16
Monoamine oxidase inhibitors are widely used as psychotropic drugs. In the synapses, they change the levels of all the neurotransmitters listed below, except:
Питання 17
A 3-year-old child has an acute intestinal infection with profuse diarrhea, followed by the development of anhydremic shock. What is the leading link in the development of this complication?
Питання 18
A 48-year-old woman has been diagnosed with Raynaud syndrome (a spasm of peripheral blood vessels) and prescribed an adrenotropic agent. What group does this drug belong to?
Питання 19
A 56-year-old woman complains of pain in the small joints of her hands and feet. She has been experiencing these symptoms for the last 12 years. Examination of her hands detects a subluxation of the metacarpophalangeal joints with fingers bent outwards («walrus flippers»). There are high molecular weight immune complexes in the patient's blood. What diagnosis can be made in this case?
Питання 20
Oral mucosa sometimes can be traumatized during tooth brushing. However, such bleeding quickly stops by itself due to the presence of the following in the saliva:
Питання 21
Examination shows that the patient's sternocleidomastoid muscle and the upper edge of the trapezius muscle suffer from atrophy. Turning the head into the opposite direction is problematic. What nerve is affected in this case?
Питання 22
During the surgery for a femoral hernia, the doctor operates within the borders of the femoral triangle. What structure forms its upper border?
Питання 23
Elevated blood homocysteine is a risk factor for cardiovascular pathology. This amino acid is formed in the body from:
Питання 24
In the removed uterus of a 55-year-old woman, a pathologist has found a dense node in the thick of the myometrium. The node is 5 cm in diameter and has clear boundaries. On section, its tissues are gray-pink and fibrous. Microscopically, the tumor consists of smooth muscle cells that form bundles of varying thickness, which run in different directions, and of layers of connective tissue, hyalinized in some places. What tumor has developed in the patient?
Питання 25
An increase in the circulating blood volume under the influence of aldosterone and antidiuretic hormone leads to the activation of secretion of a certain substance. What substance is it?
Питання 26
A woman, who complains of a constant feeling of fear and anxiety, has been diagnosed with neurosis and prescribed a drug with an anxiolytic effect. What drug is it?
Питання 27
A person with suspected liver abscess has been admitted into the surgical department of a hospital. This person was on a business trip in one of the African countries for a long time and repeatedly had been suffering from acute gastrointestinal disease. What protozoan disease is likely in this patient?
Питання 28
Two weeks ago, an illness was reported in several children at the orphanage. Based on the description of its clinical manifestations and epidemiological data, the epidemiologist suspects an outbreak of measles infection. What type of laboratory analysis can confirm this provisional diagnosis?
Питання 29
A poisoning caused by sulema (mercury dichloride) has occurred at a factory. Two days later, the person, who had suffered from the sulema exposure, developed the 24-hour diuresis of 620 mL, headache, vomiting, convulsions, and dyspnea. What diagnosis can be made in this case?
Питання 30
After an intracerebral hemorrhage, the patient's speech became indistinct. Sound production in the larynx and movements of the lower jaw are retained. The nuclei of what nerves have been affected by the hemorrhage in this case?
Питання 31
A person with a head injury in the temporal region has been diagnosed with an epidural hematoma. What artery is most likely to be damaged in this case?
Питання 32
A 27-year-old parturient woman undergoes a complicated childbirth with impending cervical rupture. What pain relief medicine would be the safest in this case?
Питання 33
A person with dilated subcutaneous veins clearly visible in the area of the navel («caput medusae») has been hospitalized. What large vein has impaired patency in this case?
Питання 34
Participation of a certain part of the central nervous system is mandatory for the formation of voluntary defecation in a child. What part of the central nervous system is it?
Питання 35
Five hours after eating seafood, a 22-year-old woman developed small itchy papules on the skin of her torso and distal parts of her limbs. The papules were partially merging with each other. 24 hours later, the rash spontaneously disappeared. What mechanism of hypersensitivity underlies these changes?
Питання 36
A patient at the oncology department has undergone radiation therapy. After that, morphology detected a significant disruption in the process of regeneration of epithelial layer in the small intestine mucosa. What cells of the epithelial membrane are damaged in this case?
Питання 37
A 50-year-old man suddenly developed intense palpitations, pain in the heart, acute weakness, increased blood pressure, and an irregular pulse with pulse deficit. ECG shows f-waves instead of a P wave; R-R intervals are irregular. What heart rhythm disorder is observed in the patient?
Питання 38
ZolicIons (monoclonal antibodies) were used to determine the person's blood group according to the ABO system. Erythrocyte agglutination did not occur with any of the zolicions. What blood type does this person have?
Питання 39
During a blood transfusion, intravascular hemolysis of erythrocytes started developing in the patient. What type of hypersensitivity has developed in this patient?
Питання 40
A patient with chronic heart failure developed signs of pulmonary edema. What diuretic must be prescribed to the patient for rapid correction of this complication?
Питання 41
One of the rules of surgery is to make incisions along the so-called Langer's lines (lines of skin tension). What tissue forms the strongest layer of the dermis - the reticular dermis?
Питання 42
A 65-year-old man with liver cirrhosis developed a significant decrease in blood pressure. What mechanism can be the cause of arterial hypotension in this case?
Питання 43
Genealogical analysis of a family with a hereditary pathology of optic nerve atrophy has determined that this medical condition is passed on only by the mothers, both girls and boys can be affected, and the sick father does not pass on the disease to his daughters or sons. What type of hereditary disease is it?
Питання 44
Increased levels of angiotensin II have been detected in the blood of a patient with a hypertensive crisis. The pressor effect of angiotensin is associated with the:
Питання 45
A histological specimen of an eyeball shows a biconvex structure, connected to the ciliary body with the fibrous strands of the ciliary zonule and covered on top with a transparent capsule. What structure is it?
Питання 46
When stimulation frequency of an isolated heart of a rabbit increases, incomplete relaxation of the ventricles of the heart can be observed because of:
Питання 47
IgM to the rubella virus have been detected in a pregnant woman. Based on these findings, the obstetrician-gynecologist recommended terminating the pregnancy due to the high probability of teratogenic effects on the fetus. It is important that specifically IgM have been detected, because immunoglobulins of this class:
Питання 48
A patient has been diagnosed with a myocardial infarction. His blood was tested for the activity of cardiospecific enzymes. Which one among the detected enzymes has three isoforms?
Питання 49
As a result of industrial exposure to chromium compounds, a woman has developed allergic dermatitis on both her hands. What skin cells are mainly involved in the manifestation of this disease?
Питання 50
In an experiment, despiralization of the DNA molecule was disrupted in an animal cell. What processes will primarily stop occurring in this cell?