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Krok 2. Medicine – 2011

Posted: March 28, 2013 in Krok II
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Krok 2. Medicine-2011

 1 A children’s health camp received a party of tinned food. External examination of the tins revealed that they had deep dents, could  be easily concaved when pressed and wouldn’t immediately return to the initial state; rust was absent; the tins were greased with  inedible fat. Specify the bloat type:  

A. Physical*

B. Physicochemical

C. Combined  

D. Biological

E. Chemical

 

 2 During a surgery on a 30-year-old patient a dark ileo-ileal conglomerate was discovered, the intussusceptum intestine was  considered to be unviable. The intussuscipiens intestine was dilated to 7-8 cm, swollen, full of intestinal contents and gases. What  pathology led to the surgery?  

A. Strangulation obstruction  

B. Obturation obstruction  

C. Paralytic obstruction  

D. Spastic obstruction  

E. Invagination (combined) obstruction*  

 

 3 A primigravida is 22 years ol d. She has Rh(-), her husband has Rh(+). Antibodies to Rh weren’t found at 32 weeks of pregnancy.  Redetermination of antibodies to Rh didn’t reveal them at 35 weeks of pregnancy as well. How often should the antibodies be  determined hereafter?  

A. Montly  

B. Once in three weeks  

C. Once in two weeks  

D. There is no need in further checks  

E. Once a week*  

 

 4 A 7-year-old boy has been managed for a month. Immediately after hospitalization there were apparent edemata, proteinuria – 7,1  g/l, daily urine protein – 4,2 g. Biochemical blood test shows persistent hypoproteinemia (43,2 g/l), hypercholesterolemia (9,2  millimole/l). The patient is most likely have the following type of glomerulonephritis:  

A. Hematuric  

B. Nephritic  

C. Nephrotic*  

D. Combined  

E. Isolated urinary

preview008  

 

 5 On the 2nd day after a surgery for toxic mixed goiter IV a 35-year-old patient complains of heart pain. ECG shows prolonged QT  intervals. Chvostek’s and Trousseau symptoms cannot be clearly defined. The patient is provisionally diagnosed with latent  tetany. What study will allow to confirm the diagnosis?

A. Determination of thyroid hormones  

B. Determination of sodium  

C. Determination of thyrotropic hormone  

D. Determination of potassim  

E. Determination of blood calcium and phosphor*  

Trousseau Sign

Trousseau Sign

chvostek's sign

chvostek’s sign

 

 6 In autumn a 25-year-old patient developed stomach ache arising 1,5-2 hours after having meals and at night. He complains of  pyrosis and constipation. The pain is getting worse after consuming spicy, salty and sour food, it can be relieved by means of  soda and hot-water bag. The patient has been suffering from this disease for a year. Objectively: furred moist tongue. Abdomen  palpation reveals epigastrial pain on the right, resistance of abdominal muscles in the same region. What is the most likely  diagnosis?

A. Duodenal ulcer*  

B. Diaphragmatic hernia  

C. Stomach ulcer  

D. Chronic cholecystitis  

E. Chronic pancreatitis

    • NB!   Difference Between a Duodenal Ulcer and Gastric Ulcer
  • Both types of ulcer cause pain, particularly gastric pain, climbing up to the esophagus. However, with a gastric ulcer, pain cannot be relieved by eating foods. In a duodenal ulcer, it can be relieved by eating. In a duodenal ulcer, there is bleeding in the stool called melena. In gastric ulcers, there is blood when the patient vomits called hematemesis. In gastric ulcers, pain occurs 1-2 hours after eating. In duodenal ulcers, pain occurs 3-4 hours after eating. 7 A 42-year-old female patient suffers from micronodular cryptogenic cirrhosis. Over the last week her condition has deteriorated:  there appeared convulsions, mental confusion, increased jaundice. What study may explain such aggravation?  

A. Determination of cholesterol ethers  

B. Determination of serum ammonia*

C. Determination of alkaline phosphatase rate  

D. Determination of ALAT and ASAT  

E. Determination of alpha-phetoprotein rate  

NB! Cryptogenic cirrhosis (Idiopathic Cirrhosis) is a type of liver disease for which there is no easily identifiable cause.It’s possible that another type of liver disease known as nonalcoholic steatohepatitis (NASH), which is a buildup of fat in the liver, may lead to cryptogenic cirrhosis.

Most ammonia in the body forms when protein is broken down by bacteria in the intestines. Ammonia levels in the blood rise when the liver is not able to convert ammonia to urea. This may be caused by cirrhosis or severe hepatitis.

 

 8 A parturient woman is 23 years old. Vaginal obstetric examination reveals full cervical dilatation. There is no fetal bladder. Fetal  head is in the plane of pelvic outlet. Sagittal suture is in mesatipellic pelvis, anterior fontanel is closer to pubes. The fetal head  diameter in such presentation will be:  

A. Suboccipito-bregmaticus*  

B. Suboccipitio-frontalis  

C. Biparietal  

D. Fronto-occipitalis recta  

E. Mento-occipitalis  

suboccipitobregmatic1336654161747

 

 9 A 49-year-old patient complains of dyspnea, cough. There are no sputum discharges. He has repeatedly used salbutamol and intal  but with no effect. Objectively: he is only able to sit while leaning on the table. Cyanosis of face, acrocyanosis are present.  Breathing is shallow, laboured, in some parts it cannot be auscultated; there are diffuse rales, expiration is significantly prolonged.  Heart sounds are muffled, tachycardia is present. Ps – 112/min., AP – 110/70 mm Hg. Liver is located near the costal arch. There  are no peripheral edemat a. What is your provisional diagnosis?  

A. Status asthmaticus*  

B. Cardiac asthma  

C. Chronic obstructive bronchitis  

D. Bronchiale asthma, moderate gravity  

E. Foreign object aspiration  

NB!  Acute severe asthma = status asthmaticus = Severe Asthma attacks. Cardiac asthma is a medical diagnosis of wheezing, coughing or shortness of breath due to congestive heart failure. It is known as cardiac asthma because the symptoms mimic ordinary asthma.

 

 10 A patient who had eaten mushrooms in the morning was delivered to the infectious diseases hospital at night. The disease  development was rapi d. The patient presented with stomach pain, frequent diarrhea, intractable vomiting, burning thirst, headache  and dizziness. He died on the third day. What mushrooms are most likely to have caused mycetismus?

A. Russules  

B. Morels  

C. Deadly amanita*  

D. Fly agarics  

E. Sulfur-tufts  

Deadly amanita

Deadly amanita

 

 11 The institutions which take part in carrying out medical examinations can be prevention and treatment facilities, medical board of  Ministry of Defense, medical board of Ministry of Home Affairs, medico-social expert commissions, forensic medical boards etc.  What institutions are responsible for temporary disability examination?

A. Medical boards of Ministry of Defense  

B. Prevention and treatment facilities*  

C. Medical boards of Ministry of Home Affairs  

D. Medico-social expert commissions  

E. Sanitary-and-prophylactic institutions  

 

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

A. X-Ray*  

B. Spirography  

C. Bronchography  

D. Pneumotachometry  

E. Bronchoscopy  

 

 13 A 54-year-old female patient consulted a gynaecologist about bloody discharges from the vagina for 1 month. Last menstruation  was 5 years ago. Gynaecological examination revealed no pathological changes. What is the tactics of choice?  

A. Cytosmear  

B. Colposcopy  

C. Symptomatic therapy  

D. Diagnostic fractional curettage of uterine cavity*  

E. USI  

7071

 

 14 A child was born at a gestational age of 34 weeks in grave condition. The leading symptoms were respiratory distress symptoms,  namely sonorous and prolonged expiration, involving additional muscles into respiratory process. The Silverman score at birth  was 0 points, in 3 hours it was 3 points with clinical findings. Which diagnostic study will allow to diagnose the form of  pneumopathy?  

A. Immunoassay  

B. Proteinogram  

C. X-ray of chest *

D. Determination of blood gas composition  

E. Clinical blood test

Silverman Score (Silverman-Anderson Index)

Silverman Score (Silverman-Anderson Index)

Silverman Scoring for Respiratory Distress

Silverman Scoring for Respiratory Distress

 

 

 15 It is required to analyze the level of daylight illumination in a ward of therapeutics unit. What device should be applied to estimate  the level of daylight illumination?

A. Anemometer  

B. Illuminometer*

C. Actinometer  

D. Psychrometer  

E. Katathermometer

Digital Illuminometer

Digital Illuminometer

 

 

 16 A 38-year-old male patient has been taking alcohol for 3 years. 3 days after a regular drinking period he felt anxiety and fear. It  appeared to him that he was surrounded by spiders and worms, pursued by some “condemnatory voices”. His behaviour became  aggressiv e. The patient demonstrated correct self-awareness but impairment of temporal and spatial orientation. What is the most  likely diagnosis?  

A. Delirium alcoholicum*  

B. Pathologic intoxication  

C. Alcoholic encephalopathy  

D. Alcoholic hallucinosis  

E. Alcoholic paranoia  

 

 17 A pregnant woman was delivered to the gynecological unit with complaints of pain in the lower abdomen and insignificant bloody  discharges from the genital tracts for 3 hours. Last menstruation was 3 months ago. Vaginal examination showed that body of  womb was in the 10th week of gestation, a fingertip could be inserted into the external orifice of uterus, bloody discharges were  insignificant. USI showed small vesicles in the uterine cavity. What is the most likely diagnosis?

A. Threat of spontaneous abortion  

B. Grape mole*  

C. Abortion in progress  

D. Incipient abortion  

E. Incomplete abortion

molar-pregnancy-1 

 

 18 A 58-year-old patient complains about sensation of numbness, sudden paleness of II-IV fingers, muscle rigidness, intermittent  pulse. The patient presents also with polyarthralgia, dysphagia, constipations. The patient’s face is masklike, solid edema of hands  is present. The heart is enlarged; auscultation revealed dry rales in lungs. In blood: ESR – 20 mm/h, crude protein – 85/l,  g-globulines – 25%. What is the most likely diagnosis?  

A. Systemic lupus erythematosus  

B. Dermatomyositis  

C. Raynaud’s disease  

D. Systemic scleroderma*  

E. Rheumatoid arthritis  

Systemic Sclerosis (scleroderma)

Systemic Sclerosis (scleroderma)

systemic scleroderma - Musk Face

systemic scleroderma – Musk Face

 

 19 A 40-year-old patient, the forester, complains of severe headache, body temperature rise up to 39,5oC, trembling limbs. From  the patient’s history we know that he had seriously cut his hand during the dissection of a killed fox. Objectively: depressed mood.  The patient asks not to turn on the light or open the door. Any noise causes apparent motor excitation. When he saw a carafe of  water, he developed convulsive throat spasms. What tactics should an emergency doctor choose?  

A. Deliver the patient to the infectious disease hospital*

B. Deliver the patient to the neurological department  

C. Let him stay at home and consult a psychiatrist  

D. Deliver the patient to the psychiatric hospital  

E. Deliver the patient to the resuscitation department

 

 

 20 While asessing the health status of graduates of a secondary school, the doctor found one of them to have grade 3 tonsillar  hypertrophy, chronic rhinitis and vegetative-vascular dystonia. The organism functionality is reduced. This student belongs to the  following health group:  

A. II  

B. V

C. I

D. IV

E. III*

 

 21 A 32-year-old patient consulted a doctor about being inable to get pregnant for 5-6 years. 5 ago the primipregnancy ended in  artificial abortion. After the vaginal examination and USI the patient was diagnosed with endometrioid cyst of the right ovary. What  is the optimal treatment method?

A. Hormonal therapy with androgenic hormones  

B. Anti-inflammatory therapy  

C. Conservative therapy with estrogen-gestagenic drugs  

D. Sanatorium-and-spa treatment  

E. Surgical laparoscopy*  

 Surgical laparoscopy

Surgical laparoscopy

 

 22 A patient is being prepared for the operation on account of varix dilatation of lower extremities veins. Examination of the patient’s  soles revealed flour-like desquamation along the skin folds. All the toenails are greyish-yellow, thickened and partially decayed.  What dermatosis should be suspected?

A. Microsporia  

B. Candidosis  

C. Pityriasis versicolor  

D. Microbial eczema  

E. Rubromycosis*

Rubromycosis

Rubromycosis

 23 A 3-year-old child has been taken to a pediatrician. He has no recent history of any diseases. Objective examination revealed no  pathology of the internal organs. The child needs the routine immunization against the following disease:

A. Type B hepatitis

B. Measles, rubella, parotitis  

C. Diphtheria and tetanus  

D. Poliomyelitis*  

E. Pertussis  

Picture-10

 

 24 While staying in a stuffy room a 19-year-old emotionally labile girl developed severe weakness, dizziness, blackout, nausea and  loss of consciousness without convulsions. Objectively: the patient is unconscious, the skin is pale, extremities are col d. AP –  90/60 mm Hg, Ps- 96/min, deficient, breathing is shallow. Pupillary and tendon reflexes are present. There are no pathological  signs. What is the most likely diagnosis?  

A. Syncope *

B. Epileptic attack

C. Transient ischemic attack  

D. Hysterical neurosis  

E. Vegetovascular paroxysm

Syncope

Syncope

 

 25 A factory worker has ARD complicated by acute bronchitis. He receives treatment in the outpatient setting. The attending doctor  has issued him a medical certificate for 5 days and then extended its duration by 5 more days. Patient can’t get down to work  because of his health status. Who should extend the duration of medical certificate for this patient?  

A. Deputy medical superintendent in charge of temporary disability examination

B. Medical advisory commission  

C. Medical superintendent  

D. A department chief *

E. Deputy medical superintendent in charge of medical treatment  

 

 26 Head circumference of a 1-month-old boy with signs of excitement is 37 cm, prefontanel is 2×2 cm large. After feeding the child  regurgitates small portions of milk; stool is normal in respect of its volume and composition. Muscle tonus is within norm. What is  the most likely diagnosis?  

A. Meningitis  

B. Pylorospasm *

C. Pylorostenosis  

D. Craniostenosis  

E. Microcephaly  

Congenital pyloric stenosis. The abnormal narrowing of the opening of the pylorus causes episodes of projectile vomiting.

Congenital pyloric stenosis. The abnormal narrowing of the opening of the pylorus causes episodes of projectile vomiting.

 

 27 A 32-year-old male patient has been suffering from pain in the sacrum and coxofemoral joints, painfulness and stiffness in the  lumbar spine for a year. ESR – 56 mm/h. Roentgenography revealed symptoms of bilateral sacroileitis. The patient is the carrier of  HLA B27 antigen. What is the most likely diagnosis?  

A. Ankylosing spondylitis*  

B. Rheumatoid arthritis  

C. Reiter’s disease

D. Coxarthrosis  

E. Spondylosis  

as1

NB! Human Leukocyte Antigen (HLA) B27 (subtypes B*2701-2759) is a class I surface antigen encoded by the B locus in the major histocompatibility complex (MHC) on chromosome 6 and presents antigenic peptides (derived from self and non-self antigens) to T cells. HLA-B27 is strongly associated with ankylosing spondylitis (AS), and other associated inflammatory diseases referred to “spondyloarthropathies”. 

 28 A 14-year-old girl has been presenting with irritability and tearfulness for about a year. A year ago she was also found to have  diffuse enlargement of the thyroid gland (II grade). This condition was regarded as a pubertal manifestation, the girl didn’t undergo  any treatment. The girl’s irritability gradually gave place to a complete apathy. The girl got puffy face, soft tissues pastosity,  bradycardia, constipations. Skin pallor and gland density progressed, the skin became of a  waxen hue. What disease may be  suspected?  

A. Autoimmune thyroiditis*  

B. Thyroid carcinoma  

C. Subacute thyroiditis  

D. Diffuse toxic goiter  

E. Juvenile basophilism

Autoimmune thyroiditis

Autoimmune thyroiditis

 

 

 29 A 38-year-old patient complains of inertness, subfebrile temperature, enlargement of lymph nodes, nasal haemorrhages, bone  pain. Objectively: the patient’s skin and mucous membranes are pale, palpation revealed enlarged painless lymph nodes;  sternalgia; liver was enlarged by 2 cm, spleen – by 5 cm, painless. In blood: erythrocytes – 2,7*1012/l, Hb- 84 g/l,  leukocytes – 58*109/l, eosinophils – 1%, stab neutrophils – 2%, segmented neutrophils – 12%, lymphocytes – 83%,  lymphoblasts – 2%, smudge cells; ESR- 57 mm/h. What is the most likely diagnosis?  

A. Lymphogranulomatosis

B. Chronic myeloleukemia

C. Acute myeloleukemia

D. Acute lymphatic leukemia

E. Chronic lymphatic leukemia*

NB! Chronic lymphocytic leukemia is cancer of a type of white blood cells called lymphocytes. Chronic lymphocytic leukemia (also called CLL) is a blood and bone marrow disease that usually gets worse slowly. CLL is the second most common type of leukemia in adults. It often occurs during or after middle age.

Symptoms_of_Leukemia-pd

 

 30 On the 5th day after a surgery for colon injury a patient complains of bursting pain in the postoperative wound, weakness,  drowsiness, headache, fever up to 40oC. Objectively: the skin around the wound is swollen, there is gas crepitation. The  wound discharges are scarce foul-smelling, of dark-gray colorl. What is the most likely diagnosis?

A. Postoperative wound infection  

B. Abscess  

C. Anaerobic clostridial wound infection*

D. Erysipelas

E. Phlegmon

Alternate Names : Tissue infection - Clostridial, Gangrene - gas, Myonecrosis, Clostridial infection of tissues

Alternate Names : Tissue infection – Clostridial, Gangrene – gas, Myonecrosis, Clostridial infection of tissues

 

 31 A patient is 50 years old, works as a builder with 20 years of service recor d. He was admitted to the hospital for chest pain, dry  cough, minor dyspnea. Objectively: sallow skin, acrocyanosis, asbestos warts on the hands. In lungs – rough respiration, diffuse  dry rales. The x-ray picture shows intensification of pulmonary pattern, signs of pulmonary emphysema. What is the most likely  diagnosis? 

A. Lung cancer  

B. Chronic obstructive bronchitis  

C. Tuberculosis  

D. Asbestosis*  

E. Pneumonia  

chest_xray_asbestosis

 

 32 A 68-year-old patient consulted a doctor about a tumour in her left breast. Objectively: in the upper internal quadrant of the left  breast there is a neoplasm up to 2,5 cm in diameter, dense, uneven, painless on palpation. Regional lymph nodes are not enlarged.  What is the most likely diagnosis? 

A. Cyst  

B. Mastopathy  

C. Lipoma  

D. Fibroadenoma  

E. Cancer*  

SignOfBreastCancer

 

 33 A 50-year-old male suburbanite underwent treatment in rural outpatient clinic for pneumonia. The treatment didn’t have effect and  the disease got complicated by exudative pleuritis. What prevention and treatment facility should the patient be referred to for  further aid?

A. Phthisio-pulmonological dispensary  

B. Tuberculosis dispensary

C. Central district hospital*  

D. Municipal hospital  

E. Regional hospital  

 

 34 A woman consulted a doctor on the 14th day after labour about sudden pain, hyperemy and induration of the left mammary gland,  body temperature rise up to 39oC, headache, indisposition. Objectively: fissure of nipple, enlargement of the left mammary  gland, pain on palpation. What pathology would you think about in this case?

A. Lactational mastitis*

B. Fibrous adenoma of the left mammary gland

C. Phlegmon of mammary gland  

D. Lacteal cyst with suppuration

E. Breast cancer

mastitis-2

 

 35 A 45-year-old man has been exhibiting high activity for the last 2 weeks, he is talkative, euphoric, has little sleep, claims being able  “to save the humanity and solve the problem of cancer and AIDS”, gives money to starangers. What is the most likely diagnosis?  

A. Agitated depression

B. Schizo-affective disorder

C. Panic disorder  

D. Catatonic excitation

E. Maniacal onset*  (insane)

Maniacal onset (insane)

Maniacal onset (insane)

 

 36 A 43-year-old female patient complains of unstable defecation with frequent constipations, abdominal swelling, headache, sleep  disturbance. Body weight is unchanged. What disease are these clinical presentations typical for?  

A. Chronic pancreatitis  

B. Chronic atrophic gastritis  

C. Colorectal cancer  

D. Irritable colon syndrome*

E. Chronic enteritis  

Symptoms and signs of Irritable Bowel Syndrome.

Symptoms and signs of Irritable Bowel Syndrome.

ibs

 

 37 An 8-year-old boy suffering from haemophilia was undergoing transfusion of packed red cells. Suddenly he felt pain behind the  breastbone and in the lumbar area, dyspnea, cold sweat. Objectively: pale skin, heart rate – 100/min, AP – 60/40 mm Hg; oliguria,  brown urine. For the treatment of this complication the following drug should be administered:  

A. Aminophylline  

B. Analgine  

C. Prednisolone*

D. Lasix  

E. Adrenaline  

PrednisolonePackShot 

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

A. Pneumonic plaque*

B. Sepsis  

C. Influenza  

D. Ornithosis  

E. Miliary tuberculosis

1-s2.0-S0169409X01001661-gr1 

 

 39 A 47-year-old patient complains of insomnia, heaviness over his entire body, constantly depressed mood. He considers himself  good-for-nothing, inadequate. Believes that he is a burden to his family, wants to die. The patient is depressed, inactive, has a  hypomimic face with sorrowful expression. He speaks quietly and monotonely,gives short answers. What is the most likely  diagnosis?  

A. Initial stage of Alzheimer’s disease  

B. Atherosclerotic depression  

C. Major depressive disorder*  

D. Late-onset schizophrenia  

E. Neurotic depression  

 

 40 A 30-year-old patient complains of paroxysmal abdominal pain, frequent liquid stools up to 10 times a day. Throughout the first 3  days he had a fever, since the 2nd day of disease there were scant liquid stools mixed with mucus. On palpation: tenderness of  all colon segments. Sigmoid colon was found spastic. What is your provisional diagnosis?  

A. Balantidiasis  

B. Acute dysentery*  

C. Salmonellosis  

D. Intestinal amebiasis  

E. Cholera

Dysentery  

 

 41 A 32-year-old gravida complains of episodes of unconsciousness, spontaneous syncopes that are quickly over after a change of  body position. A syncope can be accompanied by quickly elapsing bradycardia. There are no other complications of gestation.  What is the most likely reason for such condition?  

A. Postcava compresseion by the gravid uterus*  

B. Pressure fall in the veins of extremities  

C. Psychosomatic disorders

D. Vegetative-vascular dystonia (cardiac type)  

E. Pressure rise in the veins of extremities

Gravid uterus

Gravid uterus

 

 

 42 A 58-year-old female patient came to the antenatal clinic with complaints of bloody light-red discharges from the genital tracts.  Menopause is 12 years. Gynaecological examination found externalia and vagina to have age involution; uterine cervix was  unchanged, there were scant bloody discharges from uterine cervix, uterus was of normal size; uterine appendages were not  palpable; parametria were free. What is the most likely diagnosis?  

A. Granulosa cell tumor of ovary

B. Cervical carcinoma

C. Abnormalities of menstrual cycle with climacteric character  

D. Uterine carcinoma*  

E. Atrophic colpitis  

Uterine cancer (endometrial cancer)

Uterine cancer (endometrial cancer)

 

 43 A 43-year-old female patient was delivered to the hospital in grave condition. She has a history of Addison’s disease. The patient  had been regularly taking prednisolone but a week before she stopped taking this drug. Objectively: sopor, skin and visible  mucous membranes are pigmented, skin and muscle turgor is decreased. Heart sounds are muffled, rapi d. AP- 60/40 mm Hg, heart  rate – 96/min. In blood: Na – 120 millimole/l, K – 5,8 millimole/l. Development of this complication is primarily caused by the deficit of  the following hormone:  

A. Adrostendion

B. Corticotropin (ACTH)  

C. Adrenaline  

D. Noradrenaline

E. Cortisol*

Addison's disease

Addison’s disease

 

 44 3 hours ago a 65-year-old female patient felt sharp abdominal pain irradiating to the right scapula, there was a single vomiting. She  has a history of rheumatoid arthritis. Objectively: pale skin, AP- 100/60 mm Hg, Ps- 60/min. Abdomen is significantly painful and  tense in the epigastrium and right subcostal areat, there are positive symptoms of parietal peritoneum irritation over the right costal  arch, that is tympanitis. What is the tactics of an emergency doctor?  

A. To take the patient to the rheumatological department  

B. To inject pain-killers and watch the dynamics  

C. To perform gastric lavage  

D. To inject spasmolytics  

E. To take the patient to the surgical hospital*  

 

 45 While lifting a heavy load a 39-year-old patient suddenly felt a severe headache, pain in the interscapular region,and started  vomiting. Objectively: the pulse is rhythmic, 60/min., AP – 180/100 mm Hg. The patient is agitated. He presents with photophobia,  hyperacusis. There are positive Kernig’s and Brudzinski’s signs on both sides. In blood: WBCs – 10*109/l. CSF is bloody,  cytosis is 240/3. What is the most likely diagnosis?

A. Sympathoadrenal crisis  

B. Subarachnoid haemorrhage *

C. Ischemic stroke  

D. Acute hypertonic encephalopathy  

E. Meningococcal meningitis

 Subarachnoid haemorrhage

Subarachnoid haemorrhage

Rupture of a berry aneurysm at the bifurcation of large arteries at the base of the brain leads to escape of blood under pressure into the subarachnoid space, effectively coating the brain surface with clotted blood. Cerebral blood flow and brain glucose are reduced. Small ischemic lesions produced by microemboli set off recurring waves of CSDs, which, due to dysfunction of neurovascular coupling, are associated with paradoxical vasoconstriction and tissue hypoxia. These ischemic CSDs, which impose additional metabolic stress on the energy-depleted brain, worsen oxygen and glucose deficits, promoting the expansion of the lesions.

Rupture of a berry aneurysm at the bifurcation of large arteries at the base of the brain leads to escape of blood under pressure into the subarachnoid space, effectively coating the brain surface with clotted blood. Cerebral blood flow and brain glucose are reduced. Small ischemic lesions produced by microemboli set off recurring waves of CSDs, which, due to dysfunction of neurovascular coupling, are associated with paradoxical vasoconstriction and tissue hypoxia. These ischemic CSDs, which impose additional metabolic stress on the energy-depleted brain, worsen oxygen and glucose deficits, promoting the expansion of the lesions.

 

 

 46 Examination of a 13-year-old boy reveals that his body length is 147 сm (+2), body weight – 38 kg (+1,5), circumference of chest –  72 cm (+0,2). Estimate the harmonicity of the child’s physical development:

A. Above the average  

B. Sharply disharmonious  

C. Disharmonious*

D. Harmonious  

E. Supernormal  

 

 47 An ambulance delivered a 21-year-old woman to the gynaecological department with complaints of colicky abdominal pain and  bloody discharges from the genital tracts. Bimanual examination revealed that uterus was soft, enlarged to the size of 6 weeks of  gestation, a gestational sac was palpated in the cervical canal. Uterine appendages weren’t palpable. Fornices are free, deep and  painless. Discharges from the genital tracts are bloody and profuse. What is the most likely diagnosis?  

A. Incipient abortion  

B. Cervical pregnancy  

C. Interrupted fallopian pregnancy  

D. Threat of abortion  

E. Abortion in progress*

6WEEKS

 48 HIV displays the highest tropism towards the following blood cells:  

A. Erythrocytes  

B. Thrombocytes  

C. T-helpers*  

D. T-killers  

E. T-suppressors  

 

 49 A 20 year-old patient complains of nosebleeds, numbness of the lower extremities. Objectively: hyperaemia of face, on the upper  extremities AP is160/90 mm Hg, and 80/50 mm Hg on the lower ones. Pulse on the popliteal and pedal arteries is of poor volume,  there is systolic murmur over the carotid arteries. What is the most likely diagnosis?  

A. Atrial septal defect  

B. Ventricular septal defect  

C. Aorta coarctation*  

D. Aortopulmonary window  

E. Dissecting aortic aneurysm  

Coarctation-of-the-Aorta

 

 50 The Carpathian region is characterized by constant high humidity of atmospheric air (over 80%). Inhabitants of this region feel  severe cold in corresponding season at a medium low temperatur e. It’s caused by heat emission by:

A. Vaporization  

B.

C. Convection*  

D. Radiation  

E. Conduction

Convection

Convection

 

 

 51 A 53-year-old woman complained of cardiac pain and rhythm intermissions. She had experienced these presentations since  childhood. The patient’s father had a history of cardiac arrhythmias. Objectively: the patient was in grave condition, Ps – 220 bpm,  AP – 80/60 mm Hg. ECG: heart rate – 215/min, widening and deformation of QRS complex accompanied by atrioventricular  dissociation; positive P wave. Some time later heart rate reduced down to 45/min, there was a complete dissociation of P  wave and QRST complex. Which of the following will be the most effective treatment?  

A. Cardiac glycosides  

B. Calcium antagonists  

C. Cholinolytics  

D. b-adrenoreceptor blocking agents  

E. Implantation of the artificial pacemaker*  

artificial_pacemaker

19566_20826_5

A 77-year-old man with permanent artificial pacemaker. This is his EKG.

A 77-year-old man with permanent artificial pacemaker. This is his EKG.

 52 The correlation between the service record and eosinophil concentration in blood has been studied in female workers of dyeing  shops of textile factories. What index will be the most informative for the analysis of this data?  

A. Correlation factor *

B. Standardized index

C. Fitting criterion  

D. Sign index

E. Student’s criterion

 

 53 The patient complains of a painful swelling in the chin region, malaise, headache. Examination reveals an acutely inflamed  cone-shaped dense node. The skin over it is tense, red. In the center of the node there is an ulcer with overhanging edges and a  necrotic core of a dirty-green colour. Submandibular lymph nodes on the right are enlarged and painful. What is the most likely  diagnosis?

A. Parasitic sycosis  

B. Tertiary syphilis (gummatous form)  

C. Furuncle*  

D. Tuberculosis  

E. Carbuncle  

 Furuncle on the neck

Furuncle on the neck

folliculitis_skin_diagram

 Carbuncle on the neck

Carbuncle on the neck

 

 54 A 58-year-old patient has a 3-year history diabetes mellitus type II. He has been keeping to a diet and regularly taking glyburide. He  has been delivered to a hospital on an emergency basis for acute abdomen. Objectively: the patient is of supernutrition type. The  skin is dry. In the lungs vesicular breathing can be auscultated. Heart sounds are regular, 90/min. AP- 130/70 mm Hg. The symptom  of “wooden belly” is visible. Blood sugar – 9,8 millimole/l. The patients has indication for laparotomy. What is the most appropriate  way of further treatment of diabetes?  

A. To administer Semilong to be taken in the morning and insulin – in the evening  

B. To administer 1 tablet of Glurenorm three times a day  

C. To continue taking glyburide  

D. To administer short insulin*  

E. To administer 1 tablet of Maninil three times a day  

 

 55 A 16-year-old patient who has a history of intense bleedings from minor cuts and sores needs to have the roots of teeth  extracted. Examination reveals an increase in volume of the right knee joint, limitation of its mobility. There are no other changes.  Blood analysis shows an inclination to anaemia (Hb- 120 g/l). Before the dental intervention it is required to prevent the bleeding by  means of:  

A. Dried blood plasma  

B. Fibrinogen  

C. Calcium chloride  

D. Cryoprecipitate* (Frozen Blood)  

E. Epsilon-aminocapronic acid  

Cryoprecipitate-675x332

 

 56 A 30-year-old patient was hospitalized with a diagnosis: intestinal obstruction. During the surgery it was revealed that the  obstruction of the small intestine had been caused by a mass of helminths. What helminths are these?

A. Pinworms  

B. Ascarids*

C. Filarial worms

D. Cysticerci  

E. Guinea worms  

ascarids

 

 57 A 23-year-old patient complains of a dull ache, sensation of heaviness and distention in the epigastrium immediately after meals,  foul-smelling eructation; dry mouth, empty stomach nausea, diarrhea. Objectively: the skin is pale, the patient is of thin build.  Abdomen is soft on palpation, there is epigastric pain. The liver does not extend beyond the costal arch. In  blood: Hb – 110 g/l,  RBCs – 3,4*1012/l, WBC count is normal. ESR – 16 mm/h. What is the most informative study that will allow make a  diagnosis?

A. Duodenal probing  

B. X-ray of digestion organs  

C. Study of gastric juice  

D. pH-metry  

E. Esophageal gastroduodenoscopy*

ei_2578 

 

 58 A 22-year-old vegetarian patient with signs of malnutrition consulted a doctor about smell and taste distortion, angular stomatitis.  Objectively: marked blue sclerae. The patient was diagnosed with iron deficiency anemia. What is the dominating clinical  syndrome?  

A. Haemolytic  

B. Anaemic  

C. Myelodysplastic

D. Sideropenic*  ( iron deficiency in the blood serum)

E. Haemologic  

 

 59 On the 5th day of a respiratory disease accompanied by fever a 24-year-old man developed progressing headaches, systemic  dizziness, double vision, facial muscles paresis on the right, choking from swallowing. He was diagnosed with acute viral  encephalitis. Identify the main tendency of the emergency treatment:  

A. Ceftriaxone  

B. Zovirax*  

C. Haemodezum

D. Lasix  

E. Glucocorticoids

Zovirax-Aciclovir 

 

 60 A 60-year-old patient has been admitted to a hospital with complaints of dyspnea, tightness in the right subcostal area, abdomen  enlargement. These presentations have been progressing for a year. Heart auscultation reveals presystolic gallop rhythm.  Objectively: swelling of the neck veins, ascites, palpable liver and spleen. What disease requires differential diagnostics?  

A. Hepatocirrhosis  

B. Pulmonary embolism  

C. Chronic pulmonary heart  

D. Lung cancer with invasion to the pleura  

E. Constrictive pericarditis*  

ascites-precox-ivc-pericardial-reflection-constrictive-pericarditis

 

Present when a fibrotic, thickened, and adherent pericardium restricts diastolic filling of the heart.This slowly progresses to a chronic stage consisting of fibrous scarring and thickening of the pericardium with obliteration of the pericardial space

Present when a fibrotic, thickened, and adherent pericardium restricts diastolic filling of the heart.This slowly progresses to a chronic stage consisting of fibrous scarring and thickening of the pericardium with obliteration of the pericardial space

Pericardial Calcifications (TB Patient)  VSConstrictive Pericarditis

Pericardial Calcifications (TB Patient) 

 61 A 43-year-old man who often contacts with ethyl gasoline was admitted to a hospital with complaints of general weakness,  dizziness, memory impairment, sleepiness at daytime and insomnia at night, sensation of a hair in the mouth, colicky pains in the  right subcostal region. What is the most likely diagnosis?  

A. Chronic mercury intoxication  

B. Chronic manganese intoxication  

C. Chronic tetraethyl lead intoxication*  

D. Alcoholic delirium  

E. Chronic lead intoxication  

NB! Tetraethyllead (common name tetraethyl lead), abbreviated TEL. It was mixed with gasoline (petrol) beginning in the 1920s as an inexpensive octane booster which allowed engine compression to be raised substantially, which in turn increased vehicle performance and fuel economy.

TEL was phased out starting in the US in the mid-1970s because of its neurotoxicity and its damaging effect on catalytic converters.

ad-1928-ethyl-gasoline

 

 62 2 weeks after recovering from angina a 29-year-old patient noticed face edemata, weakness, decreased work performance.  There was gradual progress of dyspnea, edemata of the lower extremities, lumbar spine. Objectively: pale skin, weakening of the  heart sounds, anasarca. AP- 160/100 mm Hg. In urine: the relative density – 1021, protein – 5 g/l, erythrocytes – 20-30 in the field of  vision, hyaline cylinders – 4-6 in the field of vision. What is the most likely diagnosis?  

A. Essential hypertension  

B. Acute pyelonephritis  

C. Myxedema  

D. Acute glomerulonephritis*

E. Infectious allergic myocarditis  

 

 63 A 22-year-old patient is a clerk. His working day runs in a conditioned room. In summer he was taken by an acute disease with the  following symptoms: fever, dyspnea, dry cough, pleural pain, myalgia, arthralgia. Objectively: moist rales on the right, pleural  friction rub. X-ray picture showed infiltration of the inferior lobe. In blood: WBC – 11*109/l, stab neutrophils – 6%,  segmented neutrophils – 70%, lymphocytes – 8%, ESR – 42 mm/h. What is the ethiological factor of pneumonia?  

A. Staphylococcus  

B. Legionella*

C. Mycoplasm

D. Streptococcus  

E. Pneumococcus

NB! Legionella is a pathogenic Gram negative bacterium, including species that cause legionellosis (Legionnaires’ disease), most notably L. pneumophila. Legionella is water-borne and lives withinamoebae in the natural environment. 

The most common sources of Legionella and Legionnaires’ disease outbreaks are cooling towers (used in industrial cooling water systems), domestic hot water systems,and spas. Additional sources include large central air conditioning systems, fountains, domestic cold water, swimming pools (especially in Scandinavian countries and northern Ireland) and similar disseminators that draw upon a public water supply. Natural sources include freshwater ponds and creeks.

Legionella pneumophila

Legionella pneumophila

 

 64 10 minutes after delivery a woman discharged placenta with a tissue defect 5х6 cm large. Discharges from the genital tracts  were profuse and bloody. Uterus tonus was low, fundus of uterus was located below the navel. Examination of genital tracts  revealed that the uterine cervix, vaginal walls, perineum were intact. There was uterine bleeding with following blood coagulation.  Your actions to stop the bleeding:

A. To put an ice pack on the lower abdomen  

B. To make manual examination of uterine cavity*  

C. To administer uterotonics  

 

D. To apply hemostatic forceps upon the uterine cervix  

E. To introduce an ether-soaked tampon into the posterior fornix  

 

 65 A 38-year-old woman experiences episodic increases in arterial pressure up to 240/120 mm Hg, which is accompanied by  nausea, vomiting, tachycardia, increased sweating, hyperglycemia. The attack is usually followed by the excessive urination.  Renal sonography reveals an additional formation adjacent to the upper pole of the right kidney and possibly belonging to the  adrenal gland. What laboratory test will allow to clarify the diagnosis?  

A. Blood test for thyroxine and thyrotrophic hormone  

B. Blood test for renin level  

C. Estimation of glomerular filtration rate by measuring endogenous creatinine clearance  

D. Blood test for insulin and C-peptide  

E. Determination of urinary excretion of catecholamines and vanillylmandelic acid*  (Vanillyl mandelic acid (VMA) is an end-stage metabolite of the catecholamines epinephrine and norepinephrine. )

 

 66 A 24-year-old patient complains about putting on weight, limosis. Objectively: the patient’s constitution is of hypersthenic type,  body weight index is 33,2 kg/m2, waist circumference is 100 cm. Correlation of waist circumference to the thigh  circumference is 0,95. What is the most likely diagnosis?  

A. Hypothalamic Itsenko-Cushing obesity of the I stage, abdominal type

B. Alimentary constitutional obesity of the II stage, abdominal type

C. Alimentary constitutional obesity of the I stage, abdominal type*

D. Alimentary constitutional obesity of the III stage, gynoid type  

E. Hypothalamic Itsenko-Cushing obesity of the II stage, gynoid type  

abdominal

 

 67 A 65-year-old patient complains of pain in the lumbar spine, moderate disuria. He has been suffering from these presentations for  about half a year. Prostate volume is 45 cm3 (there are hypoechogenic nodes in both lobes, capsule invasion). The rate of  prostate-specific antigen is 60 ng/l. Prostate biopsy revealed an adenocarcinoma. Which of the supplemental examination methods  will allow to determine the stage of neoplastic process in this patient?  

A. Bone scintigraphy

B. Computer tomography of pelvis*  

 

C. Excretory urography  

D. Roentgenography of chest  

E. Roentgenography of lumbar spine  

Computer tomography of pelvis

Computer tomography of pelvis

 

 

 68 A 49-year-old male patient complains of dyspnea of combined nature, cough, shin edemata, abdomen enlargement due to ascites.  He has a 20-year history of chronic bronchitis. For the last 3 years he has been disabled (group II) because of cardiac changes.  Objectively: mixed cyanosis, edemata. Ps – 92/min, rhythmic, AP – 120/70 mm Hg, respiration rate – 24/min. There is accentuation of  the second sound above the pulmonary artery. Auscultation reveals the box resonance above the lungs. There are also dry rales  over the entire surface of lungs. What is the mechanism of heart changes development in this patient?

A. Kitaev’s reflex  

B. Bainbridge reflex  

C. Respiratory reflex  

D. Euler-Liljestrand reflex*

E. Cardiovascular reflex  

NB! The Euler–Liljestrand mechanism describes the connection between ventilation and blood circulation (perfusion) of the lung. If the ventilation in a part of the lung decreases it leads to local hypoxia. The local hypoxia leads to pulmonary vasoconstriction. This adaptive mechanism is beneficial, because it diminishes the amount of blood that passes the lung without being oxygenated.

 

 69 A child is 7 months old. Birth weight was 3450, the child is breastfed. Supplemental feeding was introduced on time. Determine the  daily protein requirements for the child:  

A. 2,5 g/kg  

B. 4,0 g/kg  

C. 3,0 g/kg*

D. 2,0 g/kg  

E. 3,5 g/kg  

 

 70 On the 21 day after appearance of vesiculous chickenpox rash a 7-year-old child developed ataxia, nystagmus, intention tremor,  muscle hypotonia. Liquor analysis shows a low-grade lymphocytic pleocytosis, slightly increased protein rate. What complication  is it?  

A. Acute nephritis  

B. Purulent meningitis  

C. Pneumonitis

D. Encephalitis*  

E. Postherpetic neuralgia

  1.  Pleocytosis = It is often defined specifically as an increased WBC count in CSF.
  2. Increased white blood cell count in the blood is called Leukocytosis. 
Cerebellar Ataxia

Cerebellar Ataxia

Nystagmus

Nystagmus

tremor

Tremor

Hypotonia

Hypotonia In Infants

 

 71 A 60-year-old female patient was admitted to a hospital for acute transmural infarction. An hour later the patient’s contition got  worse. She developed progressing dyspnea, dry cough. Respiratory rate – 30/min, heart rate – 130/min, AP- 90/60 mm Hg. Heart  sounds were muffled, there was also diastolic shock on the pulmonary artery. The patient presented with medium moist rales in  the lower parts of lungs on the right and on the left. Body temperature – 36,4oC. What drug should be given in the first place?  

A. Heparin  

B. Digoxin  

C. Promedol *

D. Aminophylline  

E. Dopamine  

636008_xlarge

Ischemic 04.004

NB! Promedol, a medicinal preparation that belongs to the group of narcotic analgesics. It exerts a pain-relieving and spasmolytic effect on smooth musculature. Promedol is used in the same instances as preparations of the morphine group.

 

 72 A 7-year-old child was brought to a doctor for a check. The child has a 4-year history of bronchial asthma, asthma attacks occur  mainly in spring and summer. Allergy tests revealed hypersensitivity to poplar seed tufts, field herbs. What recommendation should  be given?  

A. Physiotherapy  

B. Phytotherapy  

C. Treatment at a health resort  

D. Needle reflexotherapy  

E. Specific hyposensitization*  

 

 73 4 hours after having meals a patient with signs of malnutrition and steatorrhea experiences stomach pain, especially above navel  and to the left of it. Diarrheas take turns with constipation lasting up to 3-5 days. Palpation reveals moderate painfulness in the  choledochopancreatic region. The amylase rate in blood is stable. X-ray reveals some calcifications located above navel. What is  the most likely diagnosis?

A. Zollinger-Ellison syndrome  

B. Chronic pancreatitis*  

C. Chronic calculous cholecystitis  

D. Chronic gastroduodenitis  

E. Duodenal ulcer

Chronic pancreatitis

Chronic pancreatitis

Chronic pancreatitis

Chronic pancreatitis

 

 

 74 On the 3rd day of life a baby presented with haemorrhagic rash, bloody vomit, black stool. Examination revealed anaemia,  extended coagulation time, hypoprothrombinemia, normal thrombocyte rate. What is the optimal therapeutic tactics?  

A. Fibrinogen  

B. Vitamin K*  

C. Sodium ethamsylate  

D. Calcium gluconate  

E. Epsilon-aminocapronic acid  

 

 75 A 58-year-old female patient complains about periodical headache, dizziness and ear noise. She has been suffering from diabetes  mellitus for 15 years. Objectively: heart sounds are rhythmic, heart rate is 76/min, there is diastolic shock above aorta, AP is  180/110 mm Hg. In urine: OD- 1,014. Daily loss of protein with urine is 1,5 g. What drug should be chosen for treatment of arterial  hypertension?  

A. a-blocker

B. Calcium channel antagonist  

C. Thiazide diuretic

D. Ihibitor of angiotensin converting enzyme*

E. b-blocker

 

 76 After a serious nervous stress a 35-year-old patient has developed on the dorsal surface of hands redness and swelling that  were later replaced by small inflammatory nodules, vesicles and following erosion with a significant serous discharge. The  process is accompanied by severe itching. What is the most likely diagnosis?  

A. Simple contact dermatitis  

B. Toxicoderma

C. True eczema*  

D. Microbal eczema  

E. Allergic dermatitis

Hand_Eczema_Examples

 

 

 77 A 45-year-old patient complains of some painless nodular elements tending to peripheral growth and fusion. He has a 2-year  history of this disease. Aggravation takes place mainly in spring. In anamnesis: the patient’s father had similar skin lesions.  Objectively: pathological elements looke like guttate and nummular nodules, plaques covered with white scales. What is your  provisional diagnosis?  

A. Lichen ruber planus  

B. Pityriasis rosea  

C. Seborrheic eczema  

D. Psoriasis*  

E. Neurodermitis

Guttate Psoriasis

Guttate Psoriasis

Nummular Psoriasis

Nummular Psoriasis

mangosteen-for-eczema-and-psoriasis_1_1

psoriasis

 

 

 78 A 30-year-old gravida consulted a gynecologist about bright red bloody discharges from the vagina in the 32 week of gestation.  She was hospitalized with a suspicion of placental presentation. Under what conditions is it rational to conduct the internal  examination in order to make a diagnosis?  

A. In the delivery room keeping to all the aseptics regulations  

B. In the admission ward of maternity hospital  

C. In the operating room prepared for the operation*

D. In the examination room of antenatal clinic  

E. The examination is not to be conducted because of risk of profuse haemorrhage

criticalperiodshumandevelopment 

 

 79 A schizophrenic patient considers himself to be “an outstanding scientist, a brilliant composer and an unrivalled artist”. He  complains that “family and friends are always jealous of him and want to poison him“. Determine the psychopathological  syndrome:

A. Manic  

B. Paratrophic  

C. Hebephrenic  

D. Paranoid  

E. Paranoiac*

Paranoia FAIL

Paranoia FAIL

 

 80 A child is 9 months old. The patient’s body temperature is 36,7oC, the skin is pale, humid, there is pain in leg muscles. There is  no extremities mobility, sensitivity is present. The child has been diagnosed with poliomyelitis. The causative agent of this disease  relates to the following family:  

A. Adenovirus  

B. Picornavirus*  

C. Rotavirus  

D. Tohovirus  

E. Paramyxovirus  

pol10

effectspico

 

 81 A student analyzes noise level of cold-pressing process. What device should be applied for this hygienic study?  

A. Sound tester  

B. Pyranometer  

C. Actinometer  

D. Noise analyzer  

E. Noise and vibration analyzer*  

Noise and vibration analyzer

Noise and vibration analyzer

 

 82 A 28-year-old patient complains of periodic compressing heart pain. His brother died at the age of 34 from a cardiac disease with  similar symptoms. Objectively: the patients skin is pale. Heart borders display no significant deviations. Heart sounds are loud,  there is a systolic murmur above all the points with a peak above the aorta. Echocardioscopy reveals thickening of the  interventricular septum in the basal parts, reduction of left ventricular cavity. What drug should be administered in order to prevent  the disease progression?  

A. Metoprolol*

B. Furosemide  

C. Captopril  

D. Nitroglycerin  

E. Digoxin

metoprolol-25-mg 

 

 83 A 24-years-old patient has chronic glomerulonephritis.Urine test reveals the following: the relative density is 1010, protein – 1,65  g/l, RBCs – 5-7 in the field of vision, WBCs – 2-3 in the field of vision. Blood creatinine – 0,350 millimole/l. Serum sodium – 148  millimole/l. What is the main reason for hyperazotemia in this patient?

A. Reduction of renal blood flow  

B. Increased proteinuria  

C. Reduction of tubular reabsorption rate  

D. Sodium retention in the organism  

E. Reduction of glomerular filtration rate*  

img009

 

 84 A 47-year-old patient complains about cough with purulent sputum, pain in the lower part of the left chest, periodical body  temperature rise. She has been suffering from these presentations for about 10 years. Objectively: “drumstick” distal phalanges.  What examination would be the most informative for making a diagnosis?

A. Survey radiograph of lungs  

B. Pleural puncture  

C. Bacteriological analysis of sputum  

D. Bronchography*  

E. Bronchoscopy  

Drumstick Distal PhalangesHands of patient with lung cancer, demonstrating clubbing with increased nail base angle to 180 degrees and fusiform enlargement of the distal digit (so-called drumstick fingers).

Drumstick Distal Phalanges
Hands of patient with lung cancer, demonstrating clubbing with increased nail base angle to 180 degrees and fusiform enlargement of the distal digit (so-called drumstick fingers).

Drumstick

Drumstick

Bronchography COPD Chronic obstructive lung diseases

Bronchography
COPD Chronic obstructive lung diseases

 

 85 A 9-year-old boy fell from a tree and hit the occipital region, there was a momentary loss of consciousness. Objectively: the  child’s condition is satisfactory, he complains of the headache and dizziness. The X-ray of skull reveals a comminuted depressed  fracture of occipital bone in the region of inion. What treatment is indicated for the patient?  

A. Surgical intervention*  

B. Anti-inflammatory therapy  

C. Complex conservative treatment  

D. Therapeutic lumbar punctures  

E. Hemostatic therapy  

 Occipital fracture

Occipital fracture

 

 86 A 60-year-old patient had eaten too much fatty food, which resulted in sudden pain in the right subcostal area, nausea, bilious  vomiting, strong sensation of bitterness in the mouth. Two days later the patient presented with jaundice, dark urine. Objectively:  sclera and skin are icteric, abdomen is swollen, liver is increased by 3 cm, soft, painful on palpation, Ortner’s, Kehr’s, Murphy’s,  Zakharyin’s, Mayo-Robson’s symptoms are positive. Which method should be applied for diagnosis in the first place?

A. X-ray of abdominal organs  

B. Fibrogastroduodenoscopy  

C. Radionuclide scanning of liver and gallbladder  

D. USI of gallbladder and biliary duct*  

E. Diagnostic laparotomy  

  1. Kehr’s sign is the occurrence of acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity when a person is lying down and the legs are elevated.
  2. Ortner’s syndrome is a rare cardiovocal syndrome and refers to recurrent laryngeal nerve palsy from cardiovascular disease.
  3. Murphy’s sign refers to a maneuver during a physical examination as part of the abdominal examination and a finding elicited in ultrasonography. It is useful for differentiating pain in the right upper quadrant. Typically, it is positive in cholecystitis.

 

 87 The air of a foundry worker’s working zone contains condensation aerosol with dust particles sized 2 nm (90%), 2-5 nm (2%),  over 5 nm(6%), below 2 nm (about 2%). Characterize the dust dispersivity:  

A. Mist

B. Ultrafine-dispersed  

C. Coarsely dispersed  

D. Fine-dispersed*  

E. Median-dispersed

 

 88 A 17-year-old patient complains of pain in the area of the left knee joint. Soft tissues of thigh in the affected region are infiltrated,  joint function is limited. X-ray picture of the distal metaepiphysis of the left femur shows a destruction focus with periosteum  detachment and Codman’s triangle found at the defect border in the bone cortex. X-ray of chest reveals multiple small focal  metastases. What treatment is indicated?

A. Radioiodine therapy  

B. Disarticulation of the lower extremity  

C. Distance gamma-ray therapy  

D. Palliative chemotherapy*  

E. Amputation of the lower extremity  

18013

 

 89 3 days ago a 29-year-old patient presented with pulsating pain in the region of rectum, fever, general weakness. Objectively: local  tenderness in the anal region in the 6 o’clock position. Digital investigation of rectum revealed a painful infiltration reaching the  pectinate line. What is the most likely diagnosis?

A. Acute haemorrhoids  

B. Acute anal fissure  

C. Acute periproctitis*  

D. Acute prostatitis  

E. Rectum tumour

272182  

 

 90 A 30-year-old female patient has been delivered to the gynaecological department with complaints of acute pain in the lower  abdomen and body temperature 38,8oC. In history: sexual life out of wedlock and two artificial abortions. Gynaecological  examination reveals no changes of uterine. The appendages are enlarged and painful on both sides. Vaginal discharges are  purulent and profuse. What study is required to confirm a diagnosis?

A. Hysteroscopy  

B. Colposcopy  

C. Laparoscopy  

D. Bacteriological and bacterioscopic analysis*  

E. Curettage of uterine cavity  

 

 91 350 workers of a metalurgical plant had to undergo a yearly preventive examination. A territorial polyclinic carried out preventive  examination of 325 workers. As a result of it, 1 worker was recognized as temporarily disabled, 15 workers underwent further  rehabilitation at an after-work sanatorium, 10 workers were provided with diet meal. What index characterizing the preventive  work of the polyclinic should be applied in this case?  

A. Frequency of case detection during examinations  

B. Percentage of people who underwent rehabilitation at an after-work sanatorium 

C. Percentage of people who were provided with diet meal

D. Percentage of temporarily disabled people  

E. Coverage of preventive medical examinations*  

 Metalurgical Industry

Metalurgical Industry

 

 92 A patient suddenly felt an acute chest pain irradiating to the left arm. Objectively: the patient is excited, with pale skin. Breathing  rate – 38/min, AP – 180/110 mm Hg. Later the patient lost consciousness and fell down. Pulse on the great vessels was absent,  the pupils were equally dilated. What is the most likely diagnosis? 

A. Heart attack  

B. Clinical death*  

C. Coma  

D. Agonal state  

E. Disorder of the cerebral circulation  

NB! 

Clinical Death:

1. Stoppage of heart beat, pulse and breathing is called clinical death.

2. Most organs (eye, kidney) remain alive after clinical death.

3. These organs are used for transplantation.

Biological Death:

1. The death caused by degeneration of tissues in brain and other part is called biological death.

2. Most organs become dead after biological death.

3. These organs can not be used for organ transplantation.

 

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

A. Acute myocardial infarction  

B. Pleuritis  

C. Cardiac failure  

D. Pulmonary failure  

E. Spontaneous pneumothorax*  

 NB! Miliary tuberculosis (also known as “disseminated tuberculosis”) is a form of tuberculosis that is characterized by a wide dissemination into the human body and by the tiny size of the lesions (1–5 mm). Its name comes from a distinctive pattern seen on a chest X-ray of many tiny spots distributed throughout the lung fields with the appearance similar to millet seeds—thus the term “miliary” tuberculosis. Miliary TB may infect any number of organs, including the lungs, liver, and spleen. It is a complication of 1–3% of all TB cases.

Miliary tuberculosis

Miliary tuberculosis

Miliary tuberculosis

Miliary tuberculosis

Spontaneous Tension Pneumothorax

Spontaneous Tension Pneumothorax

Spontaneous Tension Pneumothorax

Spontaneous Tension Pneumothorax

 94 Environmental pollution is prevented by mechanical separation of nontoxic solid domestic waste. Specify the method which can be  used for mechanical utilization of these wastes:

A. Burial of wastes  

B. Burning as power-plant fuel  

C. Waste neutralization in biothermal boxes  

D. Compressing of wastes into building blocks*  

E. Hydrolysis  

 

 95 On the fifth day after a casual sexual contact a 25-year-old female patient consulted a doctor about purulent discharges from the  genital tracts and itch. Vaginal examination showed that vaginal part of uterine cervix was hyperemic and edematic. There was an  erosive area around the external orifice of uterus. There were mucopurulent profuse discharges from the cervical canal, uterine  body and appendages exhibited no changes. Bacterioscopic examination revealed bean-shaped diplococci that became red after  Gram’s staining. What is the most likely diagnosis?  

A. Acute gonorrheal endocervicitis*  

B. Candidal vulvovaginitis  

C. Clamydial endocervicitis  

D. Trichomonal colpitis  

E. Bacterial vaginism

gonorrhea

Gonorrhea_In_Women-3

 

 96 A 62-year-old patient has been delivered to the surgical department with complaints of sudden pain in the umbilical region  irradiating to the back and groin, which was accompanied by a syncope. Objectively: the patient is in grave condition, umbilical  region is tender on palpation, bowel sounds are diminished. AP drop is present. USI reveals: free fluid in the abdomen, thickening  of the wall of the abdominal aorta. The most likely diagnosis is:  

A. Rupture of abdominal aortic aneurism*  

B. Stomach ulcer perforation  

C. Peritonitis  

D. Acute appendicitis  

E. Acute pancreatitis  

Abdominal-Aortic-Aneurysm-Picture

 

 97 A 40-year-old patient underwent an operation for a lumbar phlegmon. Body temparature rose again up to 38oC, he got  intoxication symptoms, there was an increase of leukocyte number in blood. The wound that was nearly free from necrotic  tissues and full of granulations started to discharge pus, the granulations turned pale. What complication dveloped in this patient? 

A. Putrid phlegmon  

B. Sepsis*  

C. Erysipelas  

D. Erysipeloid  

E. Allergic reaction  

318009_379889645400468_1349572165_n

sepsis

 IEC Hand Washing A simple and Effective Method for Prevention of Nosocomial Sepsis-971

 98 A farmer hurt his right foot during working in a field and came to the emergency station. He doesn’t remember when he got last  vaccination and he has never served in the army. Examination of his right foot revealed a contaminated wound up to 5-6 cm long  with uneven edges. The further treatment tactics will be:

A. To make an injection of tetanus anatoxin  

B. To administer an antibiotic  

C. To make an injection of tetanus anatoxin and antitetanus serum*  

D. To make an injection of antitetanus serum  

E. Surgical d-bridement only  

Rusty nails Can cause Tetanus

Rusty nails Can cause Tetanus

Tetanus

Tetanus

Tetanus

Tetanus

 

 99 Working conditions of a building company worker are characterized by cooling microclimate effect, silica-containing dust, caustic  alkali (quicklime) and noise. What medical expert should be the chief of the commission that periodically examines the workers of  the mentioned category?  

A. Neurologist  

B. Therapeutist*  

C. Otolaryngologist

D. Dermatologist  

E. Ophthalmologist  

 

 100 A surgeon examined a 42-year-old patient and diagnosed him with right forearm furuncle at the purulo-necrotic stage. The  furuncle was lanced. At the hydration stage the wound dressing should enclose the following medication:  

A. Vishnevsky ointment  

B. Dimexide  

C. Hypertonic solution*  

D. Chloramine  

E. Ichthyol ointment  

hypertonic

 

 101 After lifting a load a patient felt undurable pain in the loin. He was diagnosed with acute lumbosacral radiculitis. Which of the  following is contraindicated for this patient?  

A. Vitamins of B group  

B. Intravenous injection of aminophylline  

C. Dehydrating drugs  

D. Analgetics  

E. Warming procedures* 

NB! Radicular pain, or radiculitis, is pain “radiated” along the dermatome (sensory distribution) of a nerve due to inflammation or other irritation of the nerve root (radiculopathy) at its connection to the spinal column. A common form of radiculitis is sciatica – radicular pain that radiates along the sciatic nerve from the lower spine to the lower back, gluteal muscles, back of the upper thigh, calf, and foot as often secondary to nerve root irritation from a spinal disc herniation or from osteophytes in the lumbar region of the spine.

 lumbarradicular1

Disk Herniation

Disk Herniation

Sciatic-Nerve-Pain-Relief-111 

102 A 49-year-old patient complains of deglutition problems, especially with solid food, hiccups, voice hoarseness, nausea,  regurgitation, significant weight loss (15 kg within 2,5 months). Objectively: body weight is reduced. Skin is pale and dry. In lungs:  vesicular breathing, heart sounds are loud enough, heart activity is rhythmic. The abdomen is soft, painless on palpation. Liver is  not enlarged. What study is required to make a diagnosis?

A. Esophageal duodenoscopy along with biopsy*  

B. Study of gastric secretion  

C. X-ray in Trendelenburg’s position  

D. Clinical blood test  

E. X-ray of digestive tract organs  

swallow

egd

 

 103 A 26-year-old woman complains of having bloody discharges from the genitals for the last 14 days, abdominal pain, general  fatiguability, weakness, weight loss, fever, chest pain, obstructed respiration. 5 weeks ago she underwent an induced abortion in  the 6-7 week of gestation. Objectively: the patient is pale and inert. Bimanual examination revealed that the uterus was enlarged  up to 8-9 weeks of gestation. In blood: Hb – 72 g/l. Urine test for chorionic gonadotropin gave the apparently positive result. What  is the most likely diagnosis?

A. Uterine fibromyoma  

B. Metroendometritis  

C. Uterus perforation  

D. Chorioepithelioma*  

E. Uterine carcinoma  

NB! Chorioepithelioma is a malignant, fast-growing tumor that develops from trophoblastic cells (cells that help an embryo attach to the uterus and help form the placenta). Almost all chorioepitheliomas form in the uterus after fertilization of an egg by a sperm, but a small number form in a testis or an ovary. Chorioepitheliomas spread through the blood to other organs, especially the lungs. They are a type of gestational trophoblastic disease. Also called chorioblastoma, choriocarcinoma, and chorionic carcinoma.

 Complete hydatidiform moles (Molar pregnancy)  have a higher risk of developing into choriocarcinoma — a malignant tumor of trophoblast cells — than do partial moles.

hydatidiformmolelabel

 

 104 After a 10-year-old child had been bitten by a bee, he was delivered to a hospital. There were lip, face and neck edemata. The  patient felt hot and short of breath. Objectively: breathing was laboured and noisy. There were foamy discharges from the mouth,  cough. The skin was pale and cold. There was bradypnoea. Heart sounds were muffled and arrhythmic. Thready pulse was  present. What diagnosis was made by the expert in resuscitation?  

A. Acute cardiovascular collapse  

B. Cerebral coma  

C. Anaphylactic shock*  

D. Quincke’s edema  

E. Bronchial asthma  

anaphylactic-shock-source

 

 105 After birth a child was pale and had arrhythmical breathing. Oxygen therapy didn’t have any effect. Pulse was weak and rapid. It  was difficult to measure arterial pressure accurately. There were no edemata. What is the most likely reason for these  symptoms?

A. Congestive heart failure  

B. Intracranial haematoma  

C. Asphyxia*  

D. Congenital pneumonia  

E. Intrauterine sepsis  

 

 106 A parturient woman is 25 years old, it is her second day of postpartum period. It was her first full-term uncomplicated labour. The  lochia should be:

A. Bloody*  

B. Purulent  

C. Mucous

D. Sanguino-serous

E. Serous

NB !  Lochia is the vaginal discharge for the first fortnight of puerperium (after birth), containing blood, mucus, and placental tissue. Lochia discharge typically continues for 4 to 6 weeks after childbirth.

It is sterile for the first 2-3 days, but not so by the third or fourth day, as the uterus begins to be colonized by vaginal commensals such as non-hemolytic streptococci and E. coli.

lochia1347311163147

 107 A full-term baby (the 1st uncomplicated pregnancy, difficult labour) had a cephalohematoma. On the 2nd day there was jaundice,  on the third the following changes in neurological status appeared: nystagmus, Graefe syndrome. Urine was yellow, feces were  of golden-yellow colour. Mother’s blood group is A (II) Rh-, the baby’s one – A (II) Rh+. On the third day the child’s Hb was  200g/l, RBCs – 6,1*1012/l, blood bilirubin – 58 micromole/l at the expense of unbound fraction. What caused the jaundice in  the child?  

A. Fetal hepatitis  

B. Neonatal anaemia  

C. Biliary atresia  

D. Physiological jaundice  

E. Craniocerebral birth trauma*  

Cephalohematoma

Cephalohematoma

 

 108 A 25-year-old female patient complains about having amenorrhea for 3 years. She associates it with difficult labour complicated  by massive hemorrhage. She also complains of loss of weight, hair fragility and loss, lack of appetite and depression. Objective  examination reveals no pathological changes of uterus and its appendages. What is the desease pathogenesis?

A. Hypoproduction of progesterone

B. Hyperproduction of androgens  

C. Hyperproduction of prolactin

D. Hypoproduction of gonadotropin*  

E. Hyperproduction of estrogens  

 

 109 On the 1st day of life a full-term girl (2nd labour) weighing 3500g, with Apgar score of 8 points, presented with jaundice. Indirect  bilirubin of blood – was 80 micromole/l, 6 hours later – 160 micromole/l. What is the optimal method of treatment?  

A. Enterosorbents  

B. Exchange blood transfusion*  

C. Phenobarbital treatment  

D. Phototherapy  

E. Infusion therapy  

 

 110 A 14-year-old girl complains of pain in vaginal area and lower abdomen that last for 3-4 days and have been observed for 3  months about the same time. Each time pain is getting worse. Objectively: mammary glands are developed, hairiness corresponds  to the age. The virginal membrane is intact, cyanotic and protruded. She has never had menstruation. She has been diagnosed  with primary amenorrhea. What is the reason of amenorrhea?  

A. Turner’s syndrome  

B. Sexual development delay  

C. Babinski-Frohlich syndrome  

D. Pregnancy  

E. Hymen atresia*

v4c08a 

 

 111 A 42-year-old patient complains of back pain, darkened urine, general weakness, dizziness that occurred after treating a cold  with aspirin and ampicillin. Objectively: the patient is pale, with subicteric sclerae. HR – 98 bpm. Liver – +2 cm, spleen – +3 cm. In  blood: RBCs – 2,6*1012/l, Hb – 60 g/l, CI – 0,9, WBCs – 9,4*109/l, basophils – 0,5%, eosinophils – 3%, stab  neutrophils – 6% segmented neutrophils – 58%, lymphocytes – 25%, monocytes – 7%, ESR – 38 mm/hour, reticulocytes – 24%.  Total bilirubin – 38 millimole/l. What complication occurred in the patient?  

A. Cholelithiasis  

B. Agranulocytosis  

C. Paroxysmal nocturnal hemoglobinuria  

D. Acquired hemolytic anemia*  

E. Toxic hepatitis  

Fig2-HereditaryAnemia

 

 

 112 A child is 1 year old. Ater the recent introduction of complementary feeding the child has presented with loss of appetite, diarrhea  with large amounts of feces and occasional vomiting, body temperature is normal. Objectively: body weight is 7 kg, the child is  very pale, there are edemata of both legs, abdomen is significantly enlarged. Coprogram shows many fatty acids and soaps. The  child has been diagnosed with celiac disease and administered the gluten-free diet. What is to be excluded from the ration?  

A. High digestible carbohydrates  

B. Milk and dairy products  

C. Fruit  

D. Cereals – wheat and oats*  

E. Animal protein  

Celiac disease is an increasingly diagnosed chronic inflammatory disorder of the intestine. Damage to the intestine is due to a specific immune response triggered by certain peptides derived from gluten proteins in wheat, rye and barley, and sometimes oats.

Celiac disease is an increasingly diagnosed chronic inflammatory disorder of the intestine. Damage to the intestine is due to a specific immune response triggered by certain peptides derived from gluten proteins in wheat, rye and barley, and sometimes oats.

 

 113 15 minutes after the second vaccination with DTP vaccine a 4-month-old boy exhibited the symptoms of Quincke’s edema. What  medication should be given for emergency aid?  

A. Adrenalin

B. Heparin

C. Seduxen

D. Prednisolone*  

E. Furosemide

 Quincke's edema (Angioedema)

Quincke’s edema (Angioedema)

 

 114 A 10-year-old boy periodically has short states (up to 10-15 seconds) that can be characterized as a “sudden blackout” and are  accompanied by gaze fixation in the upright position, absent-minded and vacant face expression, lack of movements and following  amnesia. Specify this state:  

A. Thought block  

B. Fugue  

C. Absence*  

D. Trance  

E. Obnubilation  

 

 115 Examination of the corpse of a man who died from hanging reveals: death spots disappear when pressed upon and restore after  50 seconds, rigor mortis is moderately expressed only in the masticatory muscles as well as neck and finger muscles, body  temperature is of 31oC. The time of death:  

A. 6-7 hours ago*  

B. 10-18 hours ago  

C. 16-24 hours ago  

D. 1-2 hours ago  

E. 8-10 hours ago  

 

 116 A 42-year-old woman has had hyperpolymenorrhea and progressing algodismenorrhea for the last 10 years. Gynaecological  examination revealed no changes of uterine cervix; discharges are moderate, of chocolate colour, uterus is slightly enlarged and  painful, appendages are not palpable, the fornices are deep and painless. What is the most likely diagnosis?  

A. Uterine carcinoma  

B. Uterine endometriosis*  

C. Endomyometritis  

D. Subserous uterine fibromyoma  

E. Adnexal endmetriosis  

1

 

 117 A municipal hospital reported on the number of operated patients including fatal outcomes following the operations. Which index of  hospital work can be calculated on the ground of this data?  

A.

B. Standardized lethality  

C. Total lethality  

D. Postoperative lethality*  

E. Index of late hospitalization since a disease incursion  

 

 118 A therapeutist needs to analyze adult health in the area of service. Which groups of indicators will be included into this analysis?  

A. Demographic, sickness rates, disability*  

B. Demographic, sickness rates, physical development  

C. Sickness rates, disability, death rates  

D. Birth rates, sickness rates, disability  

E. Sickness rates, death rates, physical development  

 

 119 A 54-year-old male patient complains of aching pain in the lumbar region, that is getting worse after standing in an upright position,  physical exercise, supercooling. The patient also reports of experiencing weakness in the afternoon. Pain in the lumbar region,  said about 10 years old. Objectively: pale skin, to- 37,2oC, AP- 180/100 mm Hg, minor costovertebral angle tenderness  (Pasternatsky symptom). In blood: RBCs – 3,5*1012/l, WBCs – 6,5*109/l, ESR – 22 mm/h. In urine: the relative  density – 1010, leukocytes – 12-15 in the field of vision, erythrocytes – 2-3 in the field of vision. Urine bacterial count – 100000 in 1  ml. What is the most likely diagnosis?  

A. Chronic glomerulonephritis  

B. Polycystic renal disease  

C. Amyloidosis  

D. Nephrolithiasis

E. Chronic pyelonephritis*  

utisrx

 

 120 An 8-year-old girl has been admitted to the cardiology department. Objectively: there is a skin lesion over the extensor surfaces of  joints with atrophic cicatrices, depigmentation, symmetrical affection of skeletal muscles (weakness, edema, hypotrophy). What  disease are these changes most typical for?  

A. Reiter’s disease  

B. Systemic scleroderma  

C. Dermatomyositis*

D. Nodular periarteritis  

E. Systemic lupus erythematosus

Dermatomyositis (in Child)

Dermatomyositis (in Child)

Dermatomyositis at Fingernail

Dermatomyositis at Fingernail

 

 

 121 14 days ago a 49-year-old patient was operated on for perforated appendicitis and disseminated fibrinopurulent peritonitis. The  postoperative period was uneventful. On the 9th day the patient presented with low-grade fever, abdominal pain, frequent liquid  stools. USI of the left mesogastrium reveals a fluid formation 9×10 cm large. In blood: leukocytosis with the left shift. What is your  provisional diagnosis?  

A. Left kidney cyst  

B. Interloop abscess*  

C. Abdominal cavity tumour  

D. Liver abscess  

E. Spleen abscess

Interloop abscess = Surgically removed. if the abscess drains and recurs, there is probably some residual bacteria within the wall and interior of the abscess cavity. in that case, it makes sense to completely remove the abscess after the inflammation has calmed down, including the entire wall, to prevent recurrence. 

 

 122 A 3-year-old child has been delivered to a hospital in soporose state with considerable amyotonia, inhibition of tendon and  periosteal reflexes. Miosis and asthenocoria are also present. Corneal reflexes are preserved. Pulse is rapid and weak. AP- 80/50  mm Hg. The parents suspect the child of accidental taking some tablets. Such clinical presentations are typical for intoxication  with the following tableted drugs:

A. Barbiturates  

B. Antihypertensive drugs  

C. Beta-2-adrenoceptor agonists  

D. Antropine drugs  

E. Tranquilizers*  

Tranquilizers

 

 123 Topographic percussion of lungs in a patient who got a serious job-related barotrauma revealed that the lower lungs borders  were located one rib below normal, there was a significant increase in both lungs height and Kronig’s isthmus. What disease  should be suspected in the first place?  

A. Bronchial asthma  

B. Chronic bronchitis  

C. Pneumothorax  

D. Exudative pleuritis  

E. Pulmonary emphysema*

Kronig’s Isthmus = The narrow straplike portion of the resonant field that extends over the shoulder, connecting the larger areas of resonance over the pulmonary apex in front and behind.

h9991437_001

Signs of hyperinflation can be seen in emphysema, chronic bronchitis and asthma. We can call it emphysema only when hyperinflation is associated with blebs and paucity of vascular markings in the outer third of the film.

Signs of hyperinflation can be seen in emphysema, chronic bronchitis and asthma. We can call it emphysema only when hyperinflation is associated with blebs and paucity of vascular markings in the outer third of the film.

 

 124 A 69-year-old female patient complains of temperature rise up to 38,3oC, haematuria. ESR – 55 mm/h. Antibacterial therapy  turned out to be ineffective. What diagnosis might be suspected?

A. Urolithiasis  

B. Chronic glomerulonephritis  

C. Renal amyloidosis  

D. Renal cancer*

E. Polycystic renal disease  

 

 125 A 62-year-old male has been hospitalized in the intensive care unit with a continuous attack of retrosternal pain that cannot be  relieved by nitroglycerin. Objectively: AP- 80/60 mm Hg, heart rate – 106/min, breathing rate – 22/min. Heart sounds are muffled, a  gallop rhythm is present. How would you explain the AP drop?  

A. Reduction in peripheral resistance  

B. Internal haemorrhage  

C. Reduction in cardiac output*  

D. Blood depositing in the abdominal cavity  

E. Adrenergic receptor block  

 

 126 As a result of lifting a load a 62-year-old female felt acute pain in the lumbar region, in a buttock, posterolateral surface of her right  thigh, external surface of the right shin and dorsal surface of foot. Objectively: weakness of the anterior tibial muscle, long  extensor muscle of the right toes, short extensor muscle of the right toes. Low Achilles reflex on the right. Positive Lasegue’s  sign. What examination method would be the most effective for specification of the diagnosis of discogenic compression of L5  root?  

A. Magnetic resonance scan*  

B. Spinal column X-ray  

C. Angiography  

D. Electromyography  

E. Lumbar puncture  

 

 127 A children’s surgical unit admitted a 1-month-old boy who had been prenatally diagnosed with the left-sided pyelectasis. Such  studies as drip infusion urography, cystography and USI allowed to reveal initial hydronephrosis. There is no information  confirming the secondary pyelonephritis. What tactics of this patient management is most advisable?

A. There is no need in further surveillance and treatment  

B. Antibacterial therapy  

C. Urgent nephrostomy  

D. Anderson-Hynes operation  

E. 6-month surveillance*  

 

 

 128 A 44-year-old patient has been admitted to a hospital with complaints of dull, aching pain in the left lumbar region, the admixture of  pus in the urine. Examination revealed a grade II staghorn calculus on the left. What method of treatment is indicated for this  patient?  

A. Surgery*  

B. Conservative therapy  

C. Ascending litholysis  

D. Contact lithotripsy  

E. Distance lithotripsy  

 

 129 A 72-year-old patient complains of pain and bleeding during defecation. Digital rectal investigation revealed a tumour of the anal  canal. After verification of the diagnosis the patient was diagnosed with squamous cell carcinoma. The secondary (metastatic)  tumour will be most probably found in:  

A. Brain

B. Liver

C. Mediastinum

D. Pelvic bones

E. Lungs*

 

 130 A welder at work got the first-degree burns of the middle third of his right shin. 5 days later the skin around the burn became  edematic and itchy. Objectively: on a background of a well-defined erythema there is polymorphic rash in form of papules,  vesicles, pustules, erosions with serous discharge. What is the most likely diagnosis?  

A. Streptococcal impetigo  

B. True eczema  

C. Toxicoderma  

D. Occupational eczema  

E. Microbal eczema*  

 

 131 An emergency team deliverd a 83-year-old patient complaining of inability of her right leg to support the body after falling on her  right side. Objectively: the patient lies on a gurney, her right leg is rotated outwards, the outside edge of foot touches the bed.  There is positive straight leg raising sign. What is your provisional diagnosis?  

 

A. Hip joint contusion

B. Femoral diaphysis fracture  

C. Hip dislocation  

D. Cotyloid cavity fracture  

E. Femoral neck fracture*  

 

 132 After contusion of the right eye a patient complains of sudden loss of vision with remaining light perception. Objectively: the eye is  not irritated. The cornea is transparent. Pupil reacts to light. The pupil area is black. The fundus reflex is absent. What is the most  likely cause of vision loss?

A. Acute occlusion of retinal vessels  

B. Traumatic cataract  

C. Optic nerve avulsion  

D. Retinal detachment  

E. Hemophthalmia*  

 

 133 A patient has an over a year-old history of fast progressive rheumatoid arthritis. X-raying confirms presence of marginal erosions.  What basic drug would be the most appropriate in this case?  

A. Chloroquine  

B. Prednisolone  

C. Diclofenac sodium  

D. Aspirin  

E. Methotrexate*  

 

 134 At first appointment with an obstetrician-gynaecologist a pregnant woman is referred to other medical specialists. She must be  obligatory examined by the following specialists:  

A. Therapeutist and endocrinologist  

B. ENT and ophthalmologist

C. Therapeutist and dentist*  

D. Dentist and phthisiatrician  

E. Dentist and cardiologist  

 

 135 A 27-year-old patient complains of nasal haemorrhages, multiple bruises on the anterior surface of the trunk and extremities,  sudden weakness. In blood: Hb- 74 g/l, reticulocytes – 16%, RBCs – 2,5*1012/l, platelets – 30*109/l, ESR- 25  mm/h. What is the most effective measure for the treatment of thrombocytopenia?

A. Splenectomy*  

B. Iron preparations  

C. Cytostatics  

D. Hemotransfusion  

E. Vitamin B12

 

 136 A 47-year-old patient came to see a doctor on the 7th day of disease. The disease developed very fast: after the chill body  temperature rose to 40oC and lasted up to 7 hours, then dropped abruptly, which caused profuse sweat. There were three  such attacks occuringonce in two days. Two days ago the patient arrived from Africa. Objectively: pale skin, subicteric sclera,  significantly enlarged liver and spleen. What is the cause of fever attacks in this disease?  

A. Exotoxin of a causative agent  

B. Endotoxin of a causative agent  

C. Tissue schizogony  

D. Erythrocytic schizogony*  

E. Gametocytes  

 

 137 According to the report of water quality control, drinking city water has the following characteristics: turbidity – 1,5 mg/m3,  odour – 3 points, metallic taste – 2 points, pale yellow colour, colour index – 20o, temperature – 12o. Which of these factors  doesn’t comply with hygienic requirements?  

A. Taste  

B. Turbidity  

C. Odour*  

D. Colour index  

E. Temperature  

 

 138 Half an hour after a 30-year-old woman had had some custard cake, she experienced lancinating abdominal pain, nausea,  vomiting. Objectively: body temperature – 36,0oC, pale skin, breathing rate – 20/min, Ps- 100/min. AP- 95/65 mm Hg, loud cardiac  sounds. Dry tongue. Abdomen was painful in its epigastrial part, there were no signs of peritoneum irritation. What is the first  measure to be taken?  

A. Injection of Cerucal  

B. Antibiotic therapy  

C. Intravenous rehydratation  

D. Administration of an enterosorbent  

E. Gastric lavage*  

 

 139 A patient has a stab wound on his right foot. On the fourth day after injury the patient’s body temperature rose up to 38oC,  inguinal lymph nodes became enlarged and painful, skin over them reddened. What complication might be suspected?  

A. Lymphangitis

B. Phlegmon

C. Tetanus

D. Erysipelas

E. Lymphadenitis*  

 

 140 A teacher of a secondary school was diagnosed with pulmonary tuberculosis. What is the maximum duration of his medical  certificate?  

A. Four months  

B. Two months  

C. Ten months*  

D. A month  

E. Five months

 

 141 A 39-year-old patient complains of a tumour on the anterior surface of her neck. The tumour has been observed for 2 years. It is  nonmobile and has enlarged recently. The patient has a changed tone of voice, a sense of pressure. Objectively: in the left lobe of  the thyroid gland a 3 cm node is palpable; it is very dense, tuberous, painless. Cervical lymph nodes are enlarged. Functional  status of the thyroid gland is unchanged. What is the most likely diagnosis?

A. Thyroid gland cancer*  

B. Nodular euthyroid goiter  

C. Nodular hyperthyroid goiter  

D. Chronic fibrous Riedel’s thyroiditis  

E. Chronic lymphomatous Hashimoto’s thyroiditis  

 

 142 A child is 2 years old. The child complains of hoarse voice, dyspnea with obstructed inspiration. The disease started 3 days ago  from dry cough and nose stuffiness. Objectively: general condition is unbalanced, stridor is present. The child’s skin is pale. Body  temperature is 37,7oC. The palatine arches are hyperemic. There is no deposit. Heart sounds are rhythmic. Auscultation of  lungs reveals rough breathing sounds, crepitation is absent. Parainfluenza virus has been detected in nasopharynx lavage. What  is the most likely diagnosis?

A. Epiglottitis  

B. Foreign body  

C. Acute laryngotracheitis*  

D. Laryngospasm  

E. Diphtheria  

 

 143 A 58-year-old patient complains of a headache in the occipital region, nausea, choking, opplotentes. The presentations appeared  after a physical exertion. Objectively: the patient is excited. Face is hyperemic. Skin is pale. Heart sounds are regular, the 2nd  aortic sound is accentuated. AP- 240/120 mm Hg, HR- 92/min. Auscultation reveals some fine moisr rales in the lower parts of the  lungs. Liver is not enlarged. ECG shows signs of hypertrophy and left ventricular overload. What is the most likely diagnosis?

A. Uncomplicated hypertensic crisis  

B. Community-acquired pneumonia  

C. Bronchial asthma exacerbation  

D. Acute myocardial infarction, pulmonary edema  

E. Complicated hypertensic crisis*  

 

 144 A 28-year-old woman has a 12-year history of chronic glomerulonephritis with latent course. Over the past six months she has  developed general weakness, loss of appetite, low work performance, nausea. The patient complains of headache, pain in the  joints. On examination: anemia, blood urea – 34,5 millimole/l, blood creatinine – 0,766 millimole/l, hyperkalemia. What complication has  developed?  

A. Chronic renal insufficiency*

B. Acute renal insufficiency

C. Nephrotic syndrome

D. Renal amyloidosis  

E. Pyelonephritis  

 

 145 A 43-year-old patient had been admitted to a hospital with clinical presentations of ischiorectal periproctitis. On the 12th day of  treatment the patient’s condition deteriorated: there was an increase in the rate of intoxication and hepatic failure, the body  temperature became hectic, AP was 100/60 mm Hg. USI of liver revealed a hydrophilic formation. In blood: WBCs –  19,6*109/l, RBCs.- 3,0*1012/l, Hb- 98 g/l. What complication was developed?

A. Liver abscess*  

B. Pylephlebitis  

C. Hepatic cyst  

D. Budd-Chiari syndrome  

E. Liver necrosis  

 

 146 Examination of a 9-month-old girl revealed skin pallor, cyanosis during excitement. Percussion revealed transverse dilatation of  cardiac borders. Auscultation revealed continuous systolic murmur to the left of the breastbone in the 3-4 intercostal space. This  murmur is conducted above the whole cardiac region to the back. What congenital cardiac pathology can be suspected?  

A. Defect of interatrial septum  

B. Pulmonary artery stenosis  

C. Coarctation of aorta

D. Defect of interventricular septum*

E. Fallot’s tetrad

 

 147 An 8-month-old baby has had problems with nasal breathing and muco-purulent discharge from the nose for a week. Examination  reveals a rhinedema, muco-purulent discharges from the middle nasal meatus as well as on the back of pharynx. What disease  are these symptoms most typical for?

A. Hemisinusitis  

B. Sphenoiditis  

C. Ethmoiditis*  

D. Maxillary sinusitis  

E. Frontitis  

 

 148 A 22-year-old female patient complains of dull pain in her right iliac area that she has been experiencing for a week, morning  sickness and gustatory change. She has a histrory of menstruation delay for 3 weeks. Objectively: AP- 80/50 mm Hg, pulse is 78 bpm, body temperature is 37oC. Bimanual examination reveals that uterus is enlarged, soft, mobile and painless. Uterine  appendages are palpable on the right, there is a dense, elastic and moderately painful formation 3×4 cm large. What is the most  likely diagnosis?

A. Uterogestation  

B. Interrupted fallopian pregnancy  

C. Acute appendicitis  

D. Progressing fallopian pregnancy*  

E. Right ovarian cyst  

 

 149 2 days ago a patient presented with acute pain in the left half of chest, general weakness, fever and headache. Objectively:  between the 4 and 5 rib on the left the skin is erythematous, there are multiple groups of vesicles 2-4 mm in diameter filled with  transparent liquid. What diease are these symptoms typical for?  

A. Herpes zoster* 

B. Herpetiform Duhring’s dermatosis  

C. Pemphigus  

D. Streptococcal impetigo  

E. Herpes simplex  

 

 150 A 62-year-old patient complaining of enlargement of cervical, supraclavicular and axillary lymph nodes, subfebrile temperature for  the last 3 months has been admitted to a hospital. In blood: WBCs – 64109/l, lymphocytes – 72%. What method of study  should be used to specify the diagnosis?  

A. Thermography  

B. Lymphoscintigraphy  

C. Myelogram*  

D. Lymphography  

E. X-rays  

 

 151 A patient is 30 years old, works as a carpenter. Six months ago there appeared some behavioural  changes: he got interested in  philosophy, began writing a treatise on the purpose of his human existence, quitted his job, stopped caring about his children,  went  out carelessly dressed, heard “voices in his head” that guided his behaviour. The patient claimed sure that he was an  Ambassador of God on Earth and was constantly feeling His influence. He is not critical about his disease. What diagnosis can be  assumed?  

A. Alcocholic psychosis  

B. Reactive psychosis  

C. Organic psychosis  

D. Schizophrenia*  

E. Somatogenic psychosis  

 

 152 Examination of a 38-year-old patient who had been hit with a blunt object on the left side of chest revealed a fracture of the X rib  with fragments displacement, parietal pneumothorax. The patient complains of pain in the left subcostal area. Objectively: the  patient is pale, AP- 80/40 mm Hg, Ps- 138/min, of poor volume. USI reveals fluid in the left abdomen. Splenic rupture is present.  What treatment tactics should be chosen?  

A. Anti-schock actions and laparotomy following the arterial pressure rise  

B. Drainage of the left pleural cavity and laparotomy*  

C. Left-sided thoracotomy and immediately following laparotomy  

D. Immediate laparotomy and alcohol-novocaine block of the X rib  

E. Immediate upper middle laparotomy and following drainage of the left pleural cavity  

 

 153 A 3-year-old girl presents with pertussis-like cough with thick sputum. There have been persistent changes in lungs since the age  of 6 months when she was first diagnosed with acute pneumonia. Chloride concentration in the perspiration is 112 mEq/l. The  child has been diagnosed with mucoviscidosis. What is the basis for autosomal recessive disease – mucoviscidosis?  

A. Inadequate transport of sodium and chloride ions*  

B. Deposition of calcium triphosphates and carbotates in the alveoles  

C. Pulmonary cysts  

D. a1-antitrypsin deficiency  

E. Pulmonary artery hypoplasia  

 

 154 A 47-year-old woman underwent a thyroid gland resection on ccount of nodular euthyroid goiter. What preparations are most  likely to prevent the disease recurrence?  

A. Thyroid hormones*  

B. Antistruminum (potassium iodide)  

C. Mercazolil  

D. Thyrotropin  

E. Radioactive iodine  

 

 155 After a car accident a 37-year-old patient has an acute pain and bleeding in the middle third of his right thigh. Objectively: there is a  wound on the anterior surface of the right thigh with massive bleeding, abnormal mobility at the level of the middle third of the  thigh. The first aid is to be started with:  

A. Injection of pain-killers  

B. Immobilization of the extremity with a transportation splint  

C. Digital occlusion of the femoral artery*  

D. Venipuncture and intravenous infusion of polyglycine  

E. Tourniquet application  

 

 156 A 28-years-old woman complains of nausea and vomiting about 10 times per day. She has been found to have body weight loss  and xerodermia. The pulse is 100 bpm. Body temperature is 37,2oC. Diuresis is low. USI shows 5-6 weeks of pregnancy.  What is the most likely diagnosis?  

A. Premature abortion  

B. I degree preeclampsia  

C. Food poisoning  

D. Moderate vomiting of pregnancy*  

E. Mild vomiting of pregnancy  

 

 157 Development of chronic venous insufficiency of lower extremities depends on the functional condition of so-called  musculovenous pump. This term refers to the following group of muscles:

A. Foot muscles  

B. Abdominal wall muscles  

C. Thigh muscles  

D. Shin muscles*  

E. Buttock region muscles  

 

 158 On the 2 nd day of illness a 27-year-old patient complains of the unbearable headache, repeated vomiting. Objectively: the patient  is in a grave condition. He is conscious but adynamic. Lies in a forced position with his head thrown back. There is no skin rash.  Occipital muscles are evidently rigid, there are Kernig’s and Brudzinski’s signs. to- 39,5oC, Ps- 120/min., AP- 130/80 mm Hg.  What is the reason for the leading syndrome of this disease?

A. Liquor hypotension  

B. Liquor hypertension*  

C. Hyperthermy  

D. Haemorrhages into the adrenal glands  

E. Affection of the cranial nerve nuclei  

 

 159 A full-term baby was born with body weight of 3200 g, body length of 50 cm, Apgar score – 8-10 points. What is the optimum time  for the first breast-feeding?  

A. First 48 hours  

B. First 6 hours  

C. First 24 hours  

D. After 48 hours 

E. First 30 minutes*  

 

 160 A 40-year-old female patient complain of headache, dizziness, muscle weakness, sometimes – cramps in the extremities. She has  been taking antihypertensive medications for 10 years. AP- 180/100 mm Hg. Blood potassium – 1,8 millimole/l, sodium – 4,8  millimole/l. In urine: alkaline reaction, the relative density – 1012, protein and sugar are not found, WBCs – 3-4 in the field of vision,  RBCs – 1-2 in the field of vision. Conn’s syndrome is suspected. Which drug should be chosen for the treatment of arterial  hypertension?  

A. Propanolol  

B. Hydrochlorothiazide  

C. Clonidine  

D. Enalapril  

E. Spironolactone*  

 

 161 Condition of a patient with purulent otitis has abruptly deteriorated: he presents with headache, vomiting, febrile temperature,  general hyperesthesia. There are meningeal signs, papilledemas. Focal symptoms are absent. Cerebrospinal fluid is turbid,  pressure is high, there is albuminocytologic dissociation with neutrophil predominance. What disease can be suspected?

A. Secondary purulent meningitis*  

B. Meningoencephalitis  

C. Serous meningitis

D. Subarachnoid haemorrhage  

E. Primary purulent meningitis

 

 162 On the 6th day of life a child got multiple vesicles filled with seropurulent fluid in the region of occiput, neck and buttocks. General  condition of the child is normal. What disease should be suspected?

A. Miliaria

B. Vesiculopustulosis*

C. Impetigo neonatorum

D. Epidermolysis bullosa

E. Impetigo

 

 163 A secundipara has regular birth activity. Three years ago she had cesarean section for the reason of acute intrauterine hypoxia.  During parodynia she complains of extended pain in the area of postsurgical scar. Objectively: fetus pulse is rhythmic – 140 bpm.  Vaginal examination shows 5 cm cervical dilatation. Fetal bladder is intact. What is the tactics of choice?  

A. Waiting tactics of labor management  

B. Cesarean section*  

C. Vaginal delivery  

D. Augmentation of labour  

E. Obstetrical forceps  

 

 164 A 43-year-old female patiet complains of eruption on her right leg skin, pain, weakness, body temperature rise up to 38oC. The  disease is acute. Objectively: there is an edema on the right leg skin in the region of foot, a well-defined bright red spot in form of  flame tips which feels hot. There are isolated vesicles in focus. What is your provisional diagnosis?

A. Haemorrhagic vasculitis

B. Erysipelas*  

C. Toxicoderma  

D. Contact dermatitis  

E. Microbial eczema  

 

 165 A 56-year-old patient with diffuse toxic goiter has ciliary arrhythmia with pulse rate of 110 bpm, arterial hypertension, AP- 165/90  mm Hg. What preparation should be administered along with mercazolil?  

A. Verapamil  

B. Procaine hydrochloride  

C. Propranolol*

D. Corinfar  

E. Radioactive iodine  

 

 166 A hospital admitted a patient with coarse breathing (obstructed inspiration), skin cyanosis, tachycardia and arterial hypertension.  He has a histrory of bronchial asthma. An hour ago he was having salbutamol inhalation and forgot to remove a cap that was  aspired while taking a deep breath. What measures should the doctor take?

A. Perform conicotomy immediately  

B. Make a subcutaneous injection of dexamethasone  

C. Perform the Heimlich manoever*  

D. Send for an anesthesiologist and wait for him

E. Use an inhalation of b2-adrenoceptor agonist  

 

 167 Forensic medical expertise of corpse of a newborn revealed: body weight 3500 g, body length 50 cm, the umbilical cord was  smooth, moist, glossy, without any signs of drying. Hydrostatic tests were positive. The test results are the evidence of:

A. Stillbirth  

B. Live birth*  

C. Hyaline membrane disease  

D. Primary atelectasis  

E. Secondary atelectasis  

 

 168 After an accident a patient complains of pain in the hip joint. Objectively: the leg is in the position of flexion, adduction and internal  rotation, significantly contracted. There is elastic resistance to passive adduction or abduction of the extremity. Major trochanter is  located high above the Roser-Nelaton line. A significant lordosis is present. What  is your provisional diagnosis?

A. Femoral neck fracture with a displacement  

B. Iliac dislocation of hip*  

C. Pertrochanteric fracture of hip  

D. Inferoposterior dislocation of hip  

E. Cotyloid cavity fracture with a central dislocation of hip  

 

 169 A 6-year-old girl drank some coloured fizzy drink which gave her a feeling of pressure in the throat. 30 minutes later the child’s  lips got swollen, then edema gradually spread over the whole face, laryngeal breathing became difficult. The child is excited. Ps-  120/min, breathing rate – 28/min, breathing is noisy, indrawing of intercostal spaces is observed. What basic aid is most  appropriate for the restoration of laryngeal breathing?

A. Conicotomy  

B. Sedative drugs  

C. Tracheostomy  

D. Corticosteroids*  

E. Antibacterial drugs  

 

 170 A 30-year-old male patient consulted a family doctor 2 months after he had been operated for an open fracture of brachial bone.  Objectively: the patient’s condition is satisfactory, in the region of the operative wound there is a fistula with some purulent  discharge, redness, fluctuation. X-ray picture shows brachial bone destruction with sequestra. What complication arose in the  postoperative period?  

A. Suture sinus  

B. Hematogenic osteomyelitis  

C. Posttraumatic osteomyelitis*  

D. Wound abscess  

E. Posttraumatic phlegmon  

 

 171 A 35-year-old patient has been in the intensive care unit for acute renal failure due to crush for 4 days. Objectively: the patient is  inadequate. Breathing rate – 32/min. Over the last 3 hours individual moist rales can be auscultated in lungs. ECG shows high T  waves, right ventricular extrasystoles. CVP – 159 mm Hg. In blood: the residual nitrogen – 62 millimole/l, K+- 7,1 millimole/l, Cl-- 78 millimole/l, Na+- 120 millimole/l, Ht – 0,32, Hb – 100 g/l, blood creatinine – 0,9 millimole/l. The most appropriate method of  treatment would be:

A. Plasma sorption  

B. Hemodialysis*  

C. Ultrafiltration  

D. Plasma filtration

E. Hemosorption  

 

 

 172 A 46-year-old patient complains of sudden palpitation, which is accompanied by pulsation in the neck and head, fear, nausea. The  palpitation lasts for 15-20 minutes and is over after straining when holding her breath. What kind of cardiac disorder may be  suspected?  

A. An attack of atrial flutter  

B. An attack of ciliary arrhythmia  

C. An attack of ventricular paroxysmal tachycardia  

D. An attack of supraventricular paroxysmal tachycardia*  

E. An attack of extrasystolic arrhythmia  

 

 173 A 32-year-old patient has a 3-year history of asthma attacks, that can be hardly stopped with berotec. Over a few last months he  has experienced pain in the joints and sensitivity disorder of legs and feet skin. Ps – 80/min, AP – 210/100 mm Hg. In blood:  eosinophilia at the rate of 15%. What disease can be suspected in this case?  

A. Periarteritis nodosa*  

B. Wegener’s disease  

C. Dermatomyositis  

D. Systemic lupus erythematosus  

E. Systemic scleroderma  

 

 174 A 3-year-old child was playing in a playpen when he suddenly developed paroxysmal cough and shortness of breath. Objectively:  dry cough, mixed dyspnea. Lung auscultation revealed some wheezes. Breathing sounds on the right are diminished. The child  doesn’t mix with other children. Immunization is age-appropriate. What pathological condition can be suspected?  

A. Foreign body in the respiratory tracts*  

B. Pneumonia  

C. Bronchial asthma  

D. Pertussis  

E. Acute respiratory viral infection  

 

 175 Bacterial analysis of air in a living space in winter period by means of Krotov’s apparatus revealed that total number of  microorganisms in 1m3 of air was 7200. What is the permissible number of microorganisms for the air to be characterized as  “pure”?  

A. Up to 3500

B. Up to 5500

C. Up to 2500

D. Up to 7500

E. Up to 4500*  

 

 176 A 24-year-old female patient complains of acute pain in the lower abdomen that turned up after a physical stress. She presents  with nausea, vomiting, dry mouth and body temperature 36,6oC. She has a right ovarian cyst in history. Bimanual examination  reveals that uterus is dense, painless, of normal size. The left fornix is deep, uterine appendages aren’t palpable, the right fornix is  contracted. There is a painful formation on the right of uterus. It’s round, elastic and mobile. It is 7х8 cm large. In blood:  leukocytosis with the left shit. What is the most likely diagnosis?  

A. Ovarian cyst with pedicle torsion*  

B. Acute metritis  

C. Extrauterine pregnancy  

D. Subserous fibromyoma of uterus  

E. Right-sided pyosalpinx  

 

 177 A 10-year-old child has been folowed-up for the dilated cardiomyopathy. The child presents with dyspnea, cardialgia. There are  dense, nonmobile edemata on the lower extremities and sacrum. Ps- 120/min. The cardiac borders are extended transversely.  Heart sounds are muffled, there is blowing systolic murmur at the apex and over the xiphoid process. Liver is 3 cm enlarged, urine  output is reduced. The blood total protein – 58.6 g/l. In urine: protein – 0,025 g/l, WBCs – 2-4 in the field of vision, RBCs – 2-3 in the  field of vision. What is the main mechanism of edema syndrome development:

A. Venous congestion of lesser circulation  

B. Venous congestion of greater circulation*  

C. Hypoproteinemia  

D. Peripheral circulation disorder  

E. Secondary nephropathy development  

 

 178 A 25-year-old victim of a road accient complains of chest pain, dyspnea. Objectively: the patient is in a grave condition, Ps-  120/min, AP- 90/70 mm Hg.There is pathological mobility of fragments of III-V ribs on the right. Percussion reveals a box sound  over the right lung, breathing sounds cannot be auscultated on the right. What examination should be administered in the first  place?  

A. Pleural puncture  

B. X-ray of chest organs*  

C. USI of chest organs  

D. Bronchoscopy  

E. Thoracoscopy  

 

 179 A 19-year-old student has been hospitalized on an emergency basis because of severe dyspnea, pain in the left side of chest.  The patient got sick 3 days ago. Objectively: body temperature – 38,8oC. BH – 42/min., hypopnoe. There is dullness of  percussion sound on the right of the scapula middle, breathing sounds cannot be auscultated. The left border of heart is displaced  outwards by 3 cm. Embryocardia is preent, HR – 110/min. The right hypochondrium is painful on palpation. What are the immediate  treatment measures in this situation? 

A. Urgent puncture of pleural cavity*

B. Administartion of antibiotics of penicillin group

C. Injection of cardiac glycosides

D. Injection of lasix

E. Transfer of the patient to the thoracic surgery department

 

 180 A 30-year-old man was injured in a fire and got thermic burns of III-A and III-B degree that affected 20% of the total skin. AP –  110/70 mm Hg, heart rate -120/min. What transfusion means should be used for blind infusion before transportation?  

A. Albumin  

B. 10% glucose solution  

C. Saline solutions*  

D. Fresh frozen plasma  

E. Polyglycine  

 

 181 After treating a field with pesticides a machine operator presents with great weakness, headache, nausea, vomiting, diarrhea,  visual impairment, watery eyes. Objectively: the patient is excited, hypersalivation, hyperhidrosis, muscle fibrillation of tongue and  eyelids are oberved. Pupils are narrowed, there is tachycardia, lung auscultation reveals moist small and medium bubbling rales. In  blood: changed level of cholinesterase activity. What is the most likely diagnosis?  

A. Intoxication with organomercurial pesticides  

B. Intoxication with carbamic acid derivatives  

C. Intoxication with arsenic-containing pesticides  

D. Intoxication with organochlorine pesticides  

E. Intoxication with organophosphorous pesticides*  

 

 

 182 A 3-year-old child has been diagnosed with type I diabetes mellitus, hyperosmolar coma. The laboratory confirmed the diagnosis.  Which laboratory findings are characteristic for such condition?

A. Hyperglycemia and high indicators of acid-base balance  

B. High hyperglycemia without ketonemia*  

C. Hyperglycemia and ketonemia  

D. Hyperglycemia and ketonuria

E. Hyperglycemia and glucosuria  

 

 183 A 44-year-old patient complains about difficult urination, sensation of incomplete urinary bladder emptying. Sonographic  examination of the urinary bladder near the urethra entrance revealed an oval well-defined hyperechogenic formation 2×3 cm  large that was changing its position during the examination. What conclusion can be made?

A. Prostate adenoma  

B. Urinary bladder polyp  

C. Primary ureter tumour  

D. Malignant tumour of the urinary bladder

E. Concrement*  

 

 184 A 54-year-old female patient consulted a doctor about bloody discharges from the genital tracts after 2 years of amenorrhea. USI  and bimanual examination revealed no genital pathology. What is the tactics of choice?  

A. Contracting drugs  

B. Estrogenic haemostasia  

C. Styptic drugs  

D. Fractional biopsy of lining of uterus and uterine mucous membranes*  

E. Hysterectomy  

 

 185 A department chief of an in-patient hospital is going to inspect resident doctors as to observation of medical-technological  standards of patient service. What documentation should be checked for this purpose?

A. Treatment sheets  

B. Registry of operative interventions  

C. Statistic cards of discharged patients

D. Annual report of a patient care institution  

E. Health cards of in-patients*  

 

 186 A 5-year-old child developed an acute disease starting from body temperature rise up to 38,5oC, running nose, cough and  conjunctivitis. On the 4th day the child presented with maculo-papular rash on face. Body temparature rose again up to  39,2oC. Over the next few days the rash spread over the whole body and extremities. Mucous membrane of palate was  hyperemic, there was whitish deposition on cheek mucous membrane next to molars. What is your provisional diagnosis?  

A. Rubella  

B. Acute viral respiratory infection  

C. Measles*  

D. Yersinia  

E. Enterovirus diseases  

 

 187 A 56-year-old scientist experiences constricting retrosternal pain several times a day while walking for 100-150 m. The pain lasts  for up to 10 minutes and can be relieved by nitroglycerine. Objectively: the patient is overweight, heart borders exhibit no  abnormalities, heart sounds are rhythmic, Ps- 78 bpm, AP- 130/80 mm Hg. ECG contains low amplitude of T wave in V4-5.  What disease might be suspected?

A. Stable FC I stenocardia  

B. Instable stenocardia  

C. Stable FC IV stenocardia  

D. Stable FC III stenocardia*  

E. Stable FC II stenocardia  

 

 188 In the current year general practitioners of the municipal polyclinic have referred 11 patients with coronary artery disease to the  in-patient hospital. In 3 cases the diagnosis wasn’t confirmed. What managerial decision shoud be made in such case?

A. Analysis of each case of diagnostic divergence*  

B. Analysis of material and technical basisof the polyclinic  

C. Analysis of medical check-up quality  

D. Analysis of doctors’ skill level  

E. Analysis of diagnostic examination quality  

 

 189 A 35-year-old patient has been admitted to a hospital for pain in the left sternoclavicular and knee joints, lumbar area. The disease  has an acute character and is accompanied by fever up to 38oC. Objectively: the left sternoclavicular and knee joints are  swollen and painful. In blood: WBCs – 9,5*109/l, ESR – 40 mm/h, CRP – 1,5 millimole/l, fibrinogen – 4,8 g/l, uric acid – 0,28  millimole/l. Examination of the urethra scrapings reveals chlamydia. What is the most likely diagnosis?  

A. Rheumatic arthritis  

B. Gout  

C. Reiter’s syndrome*  

D. Rheumatoid arthritis  

E. Bechterew’s disease  

 

 190 A 32-year-old patient lives in an area endemic for echinococcosis. In the last 6 months he reports of pain in the right subcostal  area, fever. He is suspected to have liver echinococcosis. What study would be the most informative in this case?  

A. Angiography  

B. USI*

C. Biochemical laboratory examination  

D. Liver scanning  

E. Survey radiography of abdominal cavity  

 

 191 A 48-year-old patient got a job-related injury of a hypodermic varicose vein on his shin that was accompanied by the intensive  phleborrhagia. Choose the optimal variant of first aid:  

A. Pressure bandage and limb strapping*  

B. Maximal limb flexion in knee joint  

C. Occlusion of femoral artery in a typical place  

D. Application of Esmarch’s tourniquet beneath the injury  

E. Application of Esmarch’s tourniquet above the injury  

 

 192 As a result of prolonged exposure to the sun a 20-year-old patient has developed low-grade fever, pain and swelling in the knee  and ankle joints, erythema on her face and nose bridge, leukopenia and accelerated ESR. She has been provisionally diagnosed  with systemic lupus erythematosus. What pathognomonic laboratory data may confirm this diagnosis?  

A. Lymphocytosis  

B. Antinuclear factor*  

C. Accelerated ESR  

D. C-reactive protein  

E. Anaemia  

 

 193 A full-term infant is 3 days old. On the different parts of skin there are erythemas, erosive spots, cracks, areas of epidermis  peeling. The infant has scalded skin syndrome. Nikolsky’s symptom is positive. General condition of the infant is grave. Anxiety,  hyperesthesia, febrile temperature are evident. What is the most probable diagnosis?  

A. Phlegmon of newborn

B. Impetigo neonatorum

C. Finger’s pseudofurunculosis

D. Mycotic erythema

E. Exfoliative dermatitis*

 

 194 A 40-year-old female patient has a history of rheumatism. She complains about acute pain in her left eye, especially at night, vision  impairment, photophobia, lacrimation. The patient cannot suggest any reasons for the disease. Objectively: weak pericorneal  injection, flattening of iris relief, iris discoloration. What is the most likely diagnosis?  

A. Iridocyclitis*  

B. Iritis  

C. Keratitis  

D. Choroiditis  

E. Acute attack of glaucoma  

 

 195 A patient with bilateral hydrothorax has repeatedly undergone pleural puncture on both sides. After a regular puncture the  patient’s condition has become worse: he presents with fever, chest pain. The next day, the attending physician performing  pleural puncture revealed some pus on the right. What is the mechanism of acute right-sided empyema development?

A. Aerial  

B. Lymphogenous  

C. Hematogenous  

D. Implantation  

E. Contact-and-aspiration*  

 

 196 A patient is on the sick leave for 4 months continuously from the date of injury. The treatment is going to last for 1-2 months. Who  has the right to extend the duration of medical certificate for this patient?

A. Medical advisory commission after medico-social expert commission examination*  

B. Medical advisory commission after inpatient treatment  

C. District doctor by agreement with a department chief  

D. Medical superintendent

E. Medico-social expert commission  

 

 197 A 10-year-old boy underwent treatment in cardiological department for rheumatism, I acute attack of rheumatic fever, active  phase, II degree. The patient was discharged in satisfactory condition. Which drug should be chosen for prevention of rheumatism  recurrence?  

A. Erythromycin  

B. Ampicillin  

C. Oxacillin  

D. Bicillinum-5*

E. Bicillinum-1  

 

 198 Educational rooms are illuminated with various lighting fittings. What type of lighting fittings is the most appropriate in respect of  hygienic norms?  

A. Direct light fittings  

B. Semi-reflected light fittings  

C. Combined light fittings  

D. Ambient light fittings  

E. Indirect light fittings*  

 

 199 A 54-year-old patient has an over 20-year history of femoral osteomyelitis. Over the last month she has developed progressing  edemata of the lower extremities. Urine test reveals: proteinuria at the rate of 6,6 g/l; in blood: dysproteinemia in form of  hypoalbuminemia, increase in a2- and g-globulin rate, ESR – 50 mm/h. What is the most likely diagnosis?

A. Systemic lupus erythematosus  

B. Acute glomerulonephritis  

C. Secondary renal amyloidosis*  

D. Chronic glomerulonephritis  

E. Myelomatosis  

 

 200 A 36-year-old patient complains of skin rash that appeared a week ago and doesn’t cause any subjective problems. Objectively:  palm and sole skin is covered with multiple lenticular disseminated papules not raised above the skin level. The papules are  reddish, dense on palpation and covered with keratinous squamae. What is the provisional diagnosis?

A. Palm and sole callosity  

B. Palmoplanar psoriasis  

C. Secondary syphilis *

D. Palmoplanar rubrophytosis  

E. Verrucosis  

 

 

Krok 2. Medicine – 2009

Posted: January 28, 2013 in Krok II
Tags: , , ,

Krok 2. Medicine – 2009

 1 A 27 year old man complains of pains in epigastrium which are relieved by food intake. EGDFS shows antral erosive gastritis,  biopsy of antral mucous presents Hеlicobacter Pylori. Diagnosis is:   

A. Gastritis of type A   

B. Menetrier’s gastritis    

C. Reflux-gastritis   

D. Gastritis of type B*   

E. Rigid antral gastritis 

 

NB! Type A gastritis primarily affects the body/fundus of the stomach, and is more common with pernicious anemia.It is also sometimes called auto-immune gastritis. In this type of gastritis, the parietal cells which are responsible for the production of acid are attacked, which can in advanced cases lead to complete deterioration of the stomach lining. A particular form of anaemia can also result due to an interruption in the absorption of vitamin B12.

Type B gastritis (most common overall) primarily affects the antrum.This gastritis accounts for 80% of all gastritis cases. It is primarily caused by pathogens like bacteria, viruses or alcohol. In 90% of cases of type B gastritis, there is one primary cause: theHelicobacter pylori bacteria.

 

Helicobacter pylori.

Helicobacter pylori.

 

 2 Examination of placenta revealed a defect. An obstetrician performed manual investigation of uterine cavity, uterine massage.  Prophylaxis of endometritis in the postpartum period should involve following actions:    

A. Instrumental revision of uterine cavity   

B. Antibacterial therapy*   

C. Haemostatic therapy   

D. Contracting agents   

E. Intrauterine instillation of dioxine 

Endometriosis

Endometriosis

Endometriosis

Endometriosis

   

 

 3 A 67 year old female patient complains about edemata of face and legs, pain in the lumbar area that is getting worse at moving;  great weakness, sometimes nasal haemorrhages, rise of body temperature up to 38,4oC. Objectively: painfulness of vertebral  column and ribs on palpation. Laboratorial study revealed daily proteinuria of 4,2 g, ESR- 52 mm/h. What changes of laboratory  indices are to be expected?    

A. Haemoglobin – 165 g/l   

B. g-globulins – 14%   

C. Albumins – 65%   

D. Leukocytes – 15,3 g/l    

E. Whole protein of blood serum – 101 g/l*    

 NB! Serum total protein, also called plasma total protein or total protein, is a Biochemical test for measuring the total amount of protein in blood plasma or serum. Protein in the plasma is made up of albumin and globulin. The globulin in turn is made up of α1, α2, β, and γ globulins. The reference range for total protein is 60-85g/L. (It is also sometimes reported as “6-8.5g/dl”.).

  • Concentrations below the reference range usually reflect low albumin concentration, for instance in liver disease or acute infection.
  • Concentrations above the reference range are found in paraproteinaemia, Hodgkin’s lymphoma or leukaemia.

 

 

4 A 43 year old female patient was delivered to the hospital in grave condition. She suffers from Addison’s disease. The patient had  been regularly taking prednisolone but a week before she stopped taking this drug. Objectively: sopor, skin and visible mucous  membranes are pigmented, skin and muscle turgor is lowered. Heart sounds are muffled, rapid. AP- 60/40 mm Hg, heart rate –  96/min. In blood: Na- 120 millimole/l, K- 5,8 micromole/l. Development of this complication is primarily caused by the deficit of the  following hormone:    

A. Adrostendion   

B. Noradrenaline   

C. Adrenaline    

D. Cortisol*    

E. Corticotropin (ACTH)

 NB! Addison’s disease (also chronic adrenal insufficiency, hypocortisolism, and hypoadrenalism) is a rare, chronic endocrine disorder in which the adrenal glands do not produce sufficient steroid hormones (glucocorticoids and often mineralocorticoids). It is characterised by a number of relatively nonspecific symptoms, such as abdominal pain and weakness, but under certain circumstances, these may progress to Addisonian crisis, a severe illness which may include very low blood pressure and coma.In most cases Addison’s disease is an idiopathic autoimmune disease.


 5 A 52 year old patient was admitted to a hospital because of high hemorrhagic diathesis of mucous membranes, massive skin  haemorrhages in form of ecchymoses and spots, nasal and stomachal haemorrhages. After clinical examinations her illness was  diagnosed as thrombocytopenic purpura. What is the most probable cause of this disease?    

A. Iron deficit in blood serum, bone marrow and depot   

B. Deficit of the VIII factor of blood coagulation   

C. Generation of antithrombocytic antibodies*   

D. Disturbed hemostasis   

E. Inherited insufficiency of plasm factors of blood coagulation   

NB!  Bleeding diathesis (or bleeding tendency or predisposition or ha(e)morrhagic diathesis) is an unusual susceptibility to bleeding (hemorrhage) mostly due to hypocoagulability.

 

 6 A 37 year old patient applied to a local therapeutist. As a result of exacerbation of chronic obstructive bronchitis the patient had  been temporarily disabled for 117 days within 1 year. What tactics will be legally correct?    

A. The patient should be referred to the medicosocial expertise*   

B. The therapeutist should extend a medical certificate   

C. The patient shoul be referred to the sanatorium-and-spa treatment    

D. The therapeutist should issue a new medical certificate    

E. The patient should be referred to the medical consultation comission for extension of medical certificate 

   

 

 

 7 A patient applied to the traumatology cenre and complained about a trauma of the lower third of the volar forearm surface caused  by cut on a piece of galss. Objectively: flexion of the IV and V fingers is impaired, sensitivity of the interior dorsal and palmar  surface of hand as well as of the IV finger is reduced. What nerve is damaged?       

A. Musculoskeletal   

B. Radial   

C. Median   

D. Ulnar*   

E. Axillary    

 

 8 A parturient woman is 27 year old, it was her second labour, delivery was at term, normal course. On the 3rd day of postpartum  period body temperature is 36,8oC, Ps – 72/min, AP – 120/80 mm Hg. Mammary glands are moderately swollen, nipples are  clean. Abdomen is soft and painless. Fundus of uterus is 3 fingers below the umbilicus. Lochia are bloody, moderate. What is the  most probable diagnosis?   

A. Postpartum metroendometritis   

B. Lactostasis   

C. Remnants of placental tissue after labour   

D. Physiological course of postpartum period*   

E. Subinvolution of uterus   

NB! In the field of the obstetrics, lochia is the vaginal discharge for the first fortnight of puerperium (after birth), containing blood, mucus, and placental tissue. Lochia discharge typically continues for 4 to 6 weeks after childbirth.

 

 9 A 43 year old patient was admitted to the infectious diseases hospital with high body temperature and intense headache. The  iIlness has lasted for 2 days. Examination revealed a carbuncle on his forearm. The area around it was apparently edematic and  slightly painful. Regional lymphadenitis and hepatolienal syndrome were also present. It is known from the anamnesis that the  patient works at a cattle-breeding farm. What disease should be suspected in the first place?    

A. Skin cancer   

B. Erysipeloid   

C. Anthrax*   

D. Erysipelas   

E. Eczema   

NB!  Anthrax (Woolsorter’s disease; Ragpicker’s disease; Cutaneous anthrax; Gastrointestinal anthrax)

Anthrax is an infectious disease due to a type of bacteria called Bacillus anthracis. Infection in humans most often involves the skin, gastrointestinal tract, or lungs.

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fig4

19057

 

 

10 A 28 year old woman has bursting pain in the lower abdomen during menstruation; chocolate-like discharges from vagina. It is  known from the anamnesis that the patient suffers from chronic adnexitis. Bimanual examination revealed a tumour-like formation  of heterogenous consistency 7х7 cm large to the left from the uterus. The formation is restrictedly movable, painful when moved.  What is the most probable diagnosis?    

A. Fibromatous node   

B. Follicular cyst of the left ovary    

C. Endometrioid cyst of the left ovary*   

D. Tumour of sigmoid colon   

E. Exacerbation of chronic adnexitis   

sf_05endometriosis

NB! Unfortunately, increasingly more women, especially young women, have this pathology. Adnexitis is a inflammatory diseases that is generally affecting the fallopian tubes and ovaries, but can also affect the uterus. It is called metro-adnexitis (the uterus is affected). Inflammatory lesions occur most commonly in the fallopian tubes and ovaries and uterus are less damaged.

Statistical studies show that one in four women suffers from adnexistis and in 60% of cases the infection becomes chronic.

 

 11 A 68 year old patient complains about acute pain in his right foot, toe edema and darkening of skin of the IV toe. He has been  suffering from diabetes mellitus for 15 years, doesn’t receive regular treatment. What complication of diabetes mellitus is it?    

A. Haematoma   

B. Gangrene of the IV toe on the right foot*  

C. Panaritium   

D. Erysipelas   

E. Fracture of the IV toe on the right foot   

Untitled-4

 

 12 A 52 year old male patient complains about attacks of asphyxia, pain in his left side during respiration. These manifestations turned  up all of a sudden. It is known from his anamnesis that he had been treated for thrombophlebitis of the right leg for the last month.  In the admission ward the patient suddenly lost consciousness, there was a sudden attack of asphyxia and pain in his left side.  Objectively: heart rate – 102/min, respiratory rate – 28/min, AP- 90/70 mm Hg. Auscultation revealed diastolic shock above the  pulmonary artery, gallop rhythm, small bubbling rales above the lungs under the scapula on the right, pleural friction rub. What  examination method will be the most informative for a diagnosis?     

A. Echocardioscopy   

B. Coagulogram   

C. ECG   

D. Study of external respiration function   

E. Angiography of pulmonary vessels*   

 

 13 A 10 year old boy suffers from chronic viral hepatitis type B with maximal activity. What laboratory test can give the most precise  characteristic of cytolysis degree?    

A. Weltman’s coagulation test     

B. Test for whole protein   

C. Takata-Ara test   

D. Transaminase test*   

E. Prothrombin test   

Untitled-5

 

 14 An infant is full-term. Delivery was pathological, with breech presentation. Examination of the infant revealed limited abduction of  the right leg to 50o, positive “clicking” symptom on the right, asymmetric inguinal folds. What is the most probable diagnosis?    

A. Inborn dislocation of the right hip*   

B. Inborn dislocation of both hips   

C. Varus deformity of both femoral necks   

D. Right hip dysplasia   

E. Fracture of both femoral necks   

 

 15 On the 6th day of life a child got multiple vesicles filled with seropurulent fluid in the region of occiput, neck and buttocks. General  condition of the child is normal. What disease should be suspected?    

A. Epidermolysis bullosa   

B. Miliaria   

C. Impetigo neonatorum   

D. Vesiculopustulosis*   

E. Impetigo   

NB! A lesion of the epidermis consisting of a vesicle containing inflammatory cells.

bc6d155bed6e4698ab54449c338a813f1

 

 16 Estimation of physical development of a child involved dynamometry and estimation of body weight and length, annual gain in body  length, chest circumference, number of permanent teeth, secondary sexual characters, lung vital capacity. Which of the  mentioned indices relates to the physiometric ones?    

A. Body length and weight, chest circumference    

B. Lung vital capacity, dynamometry*    

C. Annual gain in body length   

D. Secondary sexual characters    

E. Number of permanent teeth   

 13-1

 17 A 37 year old male patient was admitted to the resuscitation department because of attacks of tonoclonic spasms repeating every  half an hour. Between the attacks the patient remains unconscious. AP is 120/90 mm Hg, Ps- 100 bpm. A day before the patient  was at wedding and consumed alcohol. 5 years ago he had a closed craniocerebral trauma and brain contusion that later caused  single convulsive attacks accompanied by loss of consciousness, but the patient didn’t undergo antiepileptic treatment. What drug  should be injected for emergency aid?    

A. Sodium oxybutyrate    

B. Diazepam*   

C. Aminazine   

D. Sodium thiopental    

E. Magnesium sulfate   

NB! What is diazepam? Diazepam is a benzodiazepine (ben-zoe-dye-AZE-eh-peens). It affects chemicals in the brain that may become unbalanced and cause anxiety.

Diazepam is used to treat anxiety disorders, alcohol withdrawal symptoms, or muscle spasms. Diazepam is sometimes used with other medications to treat seizures.

Generic Name: diazepam
Brand Name: Valium

valium-24190_1

 

 18 A patient has got pain in the axillary area, rise of temperature developed 10 hours ago. On examination: shaky gait is evident, the  tongue is coated with white deposit. The pulse is frequent. The painful lymphatic nodes are revealed in the axillary area. The skin  over the lymph nodes is erythematous and glistering. What is the most probable diagnosis?     

A. Tularemia    

B. Acute purulent lymphadenitis    

C. Bubonic plague*    

D. Lymphogranulomatosis    

E. Anthrax    

Symptoms_of_bubonic_plague

bubound

 

 19 A 14 year old child suffers from vegetovascular dystonia of pubertal period. He has got sympathoadrenal atack. What medicine  should be used for attack reduction?    

A. Corglicone    

B. Amysyl    

C. Aminophylline   

D. Obsidan*    

E. No-shpa

NB! Obsidan 40 mg is a beta-blocker. Obsidan 40 mg is used for high blood pressure (hypertension) diseases of the coronary arteries (coronary heart disease), heart rhythm disorders with increased stroke rate (tachycardia arrhythmia)  functional heart disorders (hyperkinetic heart syndrome) “tremors” unknown cause (essential tremor) preventive treatment of migraine (migraine prophylaxis) treating symptoms of an overactive thyroid (hyperthyroidism), or as an addition to the effect of specific interventions.   

obsidan-40-mg-33797_3 

 

 20 1,5 hour after start of gullet bougienage a 48 year old patient suffering from corrosive stricture felt acute abdominal pain.  Previously he had been suffering from duodenal ulcer. Examination revealed that abdomen was very tense and painful; Ps- 110  bpm, painful sialophagia, skin pallor. What is the most probable diagnosis?     

A. Thrombosis of mesenteric vessels   

B. Perforation of abdominal part of esophagus*   

C. Perforation of duodenal ulcer   

D. Acute myocardium infarction   

E. Strangulation of diaphragmal hernia   

 gerd-and-barrett-s-esophagus_1_1

 21 A 46 year old patient is to be prepared to the operation on account of stomach cancer. Preoperative preparation involves infusion  therapy. It was injected up to 3 l of solutions into his right lunar vein. On the next day he got tensive pain in the region of his right  shoulder. Examination of interior brachial surface revealed an oblong area of hyperemia, skin edema and painful cord. What  complication is it?    

A. Acute thrombophlebitis*    

B. Vein puncture and edema of paravenous cellular tissue   

C. Acute lymphangitis   

D. Phlegmon of paravenous cellular tissue   

E. Necrosis of paravenous cellular tissue   

2008122820481993517

 

 22 A 2 month old full-term child was born with weight 3500 g and was on the mixed feeding. Current weight is 4900 g. Evaluate the  current weight of the child:    

A. Paratrophy of the I grade    

B. 150 g less than necessary    

C. Hypotrophy of the I grade    

D. Corresponding to the age*   

E. Hypotrophy of the II grade    

 

 

 

 23 A child was born with body weight 3250 g and body length 52 cm. At the age of 1,5 month the actual weight is sufficient (4350 g),  psychophysical development corresponds with the age. The child is breast-fed, occasionally there are regurgitations. What is the  cause of regurgitations?     

A. Acute gastroenteritis   

B. Aerophagia*   

C. Pylorospasm   

D. Pylorostenosis   

E. Esophageal atresia   

 

 24 A 58 year old female patient complains about periodical headache, dizziness and ear noise. She has been suffering from diabetes  mellitus for 15 years. Objectively: heart sounds are rhythmic, heart rate is 76/min, there is diastolic shock above aorta, AP is  180/110 mm Hg. In urine: OD- 1,014. Daily loss of protein with urine is 1,5 g. What drug should be chosen for treatment of arterial  hypertension?    

A. Calcium channel antagonist    

B. a-blocker   

C. Thiazide diuretic   

D. b-blocker   

E. Ihibitor of angiotensin converting enzyme*   

 

 25 A 9 year old boy had acute respiratory viral infection. After it there appeared polydipsia, polyuria, weakness, nausea. Examination  revealed the following symptoms: mental confusion, dry skin, soft eyeballs, Kussmaul’s respiration, acetone smell from the mouth,  muffled heart sounds, soft and painless abdomen. Blood sugar was 19 millimole/l. What acute condition is it?    

A. Ketoacidotic coma*   

B. Hepatic coma   

C. Cerebral coma   

D. Acute renal insufficiency   

E. Hyperosmolar coma   

safe_image

11

 

 

 

 26 Which of the following symptoms would occur only if a total-body acute radiation exposure exceeded 5.000 rad (50 Gy)   

A. Diarrhea   

B. Bleeding gums   

C. Nausea and vomiting    

D. Hallucinations and impairment of vision*   

E. Epilation (hair loss)   

 

 27 A 42 year old man works in a boiler room. He complains about girdle headache and recurring vomiting. There was also short-term  consciousness loss. Objectively: increase of tendon reflexes, spontaneous myofibrillations. AP is 150/80 mm Hg, Ps- 104 bpm.  Visible mucous membranes and cutaneous surfaces have crimson colouring. What is the most probable diagnosis?    

A. Poisoning with anilin colouring agents   

B. Poisoning with hydrocyanic acid   

C. Poisoning with methane   

D. Poisoning with carbon monooxide*   

E. Poisoning with benzine   

carbon-monoxide-gas-safety

 

 28 A 32 year old patient complains about cardiac irregularities, dizziness, dyspnea at physical stress. He has never suffered from  this before. Objectively: Ps- 74 bpm, rhythmic. AP- 130/80 mm Hg. Auscultation revealed systolic murmur above aorta, the first  heart sound was normal. ECG showed hypertrophy of the left ventricle, signs of repolarization disturbance in the I, V5 and  V6 leads. Echocardiogram revealed that interventricular septum was 2 cm. What is the most probable diagnosis?    

A. Aortic stenosis   

B. Myocardium infarction   

C. Essential hypertension   

D. Coarctation of aorta   

E. Hypertrophic cardiomyopathy*   

Hypertrophic_Cardiomyopathy_Dia

 

 

 

 

 29 Examination of a 22 year old man suffering from polyarthralgia and high fever revealed right-sided exudative pleuritis. X-ray  picture showed a homogenous shadow below the IV rib on the right. In the II segment there were single dense focal shadows.  Mantoux test with 2 TU resulted in formation of a papula 16 mm largeE. Pleural liquid has increased protein concentration, Rivalta’s  reaction is positive, there was also increased number of leukocytes with prevailing lymphocytes. What is the most probable  etiology of pleuritis?    

A. Viral   

B. Tuberculous*   

C. Staphylococcal   

D. Autoimmune    

E. Cancerous  

NB! Rivalta test is used in order to differentiate a transudate from an exudate .Using a pH 4.0 acetic acid solution, 8 types of proteins were identified in Rivalta reaction-positive turbid precipitates: C-reactive protein (CRP), Alpha 1-antitrypsin (alpha1-AT), Orosomucoid ((Alpha-1-acid glycoprotein or AGP)), haptoglobin (Hp), transferrin (Tf), ceruloplasmin (Cp), fibrinogen (Fg), and hemopexin (Hpx). Since those are Acute-phase proteins, a positive Rivalta’s test may be suggestive of inflammation.

 

 30 A woman consulted a therapeutist about fatigability, significant weight loss, weakness, loss of appetite. She has had amenorrhea  for 8 months. A year ago she born a full-term child. Haemorrhage during labour made up 2 l. She got blood and blood substitute  transfusions. What is the most probable diagnosis?    

A. Homological blood syndrome   

B. Sheehan’s syndrome*   

C. Stein-Leventhal syndrome    

D. Shereshevsky-Turner’s syndrome    

E. Vegetovascular dystonia   

 NB! Sheehan syndrome (Alternate Names : Postpartum hypopituitarism, Postpartum pituitary insufficiency, Hypopituitarism Syndrome)

 

 31 A 36 year old patient was diagnosed with right-sided pneumothorax. What method of treatment is indicated to the patient?    

A. Antiinflammation therapy   

B. Thoracotomy   

C. Symptomatic therapy   

D. Pleural puncture   

E. Surgical treatment: drainage of the pleural cavity*   

 h9991550_001

 

 

 

 32 A patient consulted a venereologist about painful urination, reddening of the external opening of urethra, profuse purulent  discharges from the urethra. He considers himself to be ill for 3 days. He also associates the disease with a casual sexual  contact that took place for about a week ago. If provisional diagnosis “acute gonorrheal urethritis” will be confirmed, then  bacteriological study of urethral discharges will reveal:    

A. Mycoplasma   

B. Gram-positive diplococci   

C. Gram-negative diplococci*    

D. Proteus vulgaris   

E. Spirochaete   

 

 33 A 23 year old female patient complains about periodical chill and body temperature rise up to 40oC, sense of heat taking turns  with profuse sweating. The patient has had already 3 attacks that came once in two days and lasted 12 hours. She has lived in  Africa for the last 2 months. Liver and spleen are enlarged. In blood: erythrocytes – 2,5*1012/l. What is the most probable  diagnosis?     

A. Haemolytic anaemia   

B. Malaria*   

C. Sepsis   

D. Leptospirosis   

E. Spotted fever   

 

 34 A 26 year old woman had the second labour within the last 2 years with oxytocin application. The child’s weight is 4080 g. After  the placent birth there were massive bleeding, signs of hemorrhagic shock. Despite the injection of contractive agents, good  contraction of the uterus and absence of any cervical and vaginal disorders, the bleeding proceeds. Choose the most probable  cause of bleeding:     

A. Hypotonia of the uterus    

B. Injury of cervix of the uterus     

C. Delay of the part of placenta   

D. Hysterorrhexis   

E. Atony of the uterus*   

 

 

 35 A 44 year old man has been working in coke industry for 16 years. Dust concentration at his workplace is 5-10 times more than  maximum permissible concentration. Roentgenography of lungs revealed changes that are typical for pneumoconiosis. What is the  most probable type of pneumoconiosis in this case?     

A. Anthracosilicosis   

B. Asbestosis   

C. Siderosis   

D. Silicatosis    

E. Anthracosis*   

 

 36 It is suspected that a 34 year old patient has an abscess of Douglas pouches. What diagnostic method is to be chosen?    

A. Digital examination of rectum*   

B. Rectoromanoscopy    

C. Laparoscopy    

D. R-scopy of abdominal cavity    

E. Percussion and auscultation of stomach   

 

 37 Female 45 year old patient was admitted to the traumatological ward with the closed fracture of the medial malleolus with its  displacement up to 3 mm. The foot is to be fixed with a plaster cast in the following position:    

A. In position of supination  

B. At right angle with varus positioning of the foot*   

C. In position of dorsal flexion of foot   

D. In position of planter flexion of foot   

E. In position of pronation   

 

 38 In the 43rd week of gestation a long, thin infant was delivered. He is apneic, limp, pale, and covered with “pea soup” amniotic fluid.  The first step in the resuscitation of this infant at delivery should be:   

A. Artificial ventilation with bag and mask    

B. Artificial ventilation with endotracheal tube   

C. Catheterization of the umbilical vein   

D. Suction of the trachea under direct vision*   

E. Administration of 100% oxygen by mask    

 

 39 The average body lenth of newborn boys is 50,9 cm at a sigma 1,66; and average mass – 3432 at a sigma 5,00. What criterion is  necessary in order to compare degree of variability of these signs?    

A. Limit   

B. Sigma    

C. Amplitude   

D. Coefficient of association    

E. Coefficient of variation*   

 

 40 A 27 year old patient suffers from haemophilia. He was admitted to the hospital with melena and skin pallor. Objectively: Ps- 110  bpm, AP- 100/60 mm Hg. In blood: Hb- 80 g/l, erythrocytes – 2,8*1012/l. What medication should be administered in the first  place?    

A. Cryoprecipitate*   

B. Epsilon-aminocapronic acid   

C. Stored blood   

D. Packed red blood cells   

E. Dicinone   

 

 41 A 4 month old child fell seriously ill: body temperature rose up to 38,5oC, the child became inert and had a single vomiting. 10  hours later there appeared rash over the buttocks and lower limbs in form of petechiae, spots and papules. Some haemorrhagic  elements have necrosis in the centr E. What is the most probable disease?    

A. Scarlet fever    

B. Meningococcemia*   

C. Haemorrhagic vasculitis   

D. Influenza   

E. Rubella   

 

 

 42 A 39 year old patient complained about morning headache, appetite loss, nausea, morning vomiting, periodic nasal haemorrhages.  The patient had acute glomerulonephritis at the age of 15. Examination revealed rise of arterial pressure up to 220/130 mm Hg, skin  haemorrhages on his arms and legs, pallor of skin and mucous membranes. What biochemical index  has the greatest diagnostic  importance in this case?   

A. Fibrinogen   

B. Uric acid   

C. Blood bilirubin   

D. Blood creatinine*   

E. Blood sodium   

 

 43 A 12 year old child has the ulcer disease of stomach. What is the etiology of this disease?   

A. Influenza   

B. Salmonella   

C. Helicobacter pylory   

D. Lambliosis   

E. Intestinal bacillus*   

 

 44 A 10 year old boy complains about pain in his left eye and strong photophobia after he had injured his left eye with a pencil at  school. Left eye examination: blepharospasm, ciliary and conjunctival congestion, cornea is transparent, other parts of eyeball  have no changes. Visus 0,9. Right eye is healthy, Visus 1,0. What additional method would you choose first of all?    

A. Cornea sensation-test   

B. Gonioscopia   

C. Tonometria   

D. Staining test with 1% fluorescein*   

E. X-ray examination of orbit   

 

 45 A 63 year old patient was diagnosed with purulent mediastinitis. What of the below listed diseases are NOT the cause of purulent  mediastinitis?       

A. Iatrogenic injury of the trachea   

B. Perforation of the cervical part of the oesophagus   

C. Deep neck phlegmon   

D. Perforation of the thoracic part of the oesophagus    

E. Cervical lymphadenitis*    

 

 46 A 4 year old girl was playing with her toys and suddenly she got an attack of cough, dyspne A. Objectively: respiration rate –  45/min, heart rate – 130/min. Percussion revealed dullness of percutory sound on the right in the lower parts. Auscultation  revealed diminished breath sounds with bronchial resonance on the right. X-ray pictue showed shadowing of the lower part of  lungs on the right. Blood analysis revealed no signs of inflammation. The child was diagnosed with foreign body in the right  bronchus. What complication caused such clinical presentations?     

A. Atelectasis*   

B. Pneumonia   

C. Bronchitis   

D. Emphysema   

E. Pneumothorax   

 

 47 Five days after a total hip joint replacement a 72 year old woman becomes acutely short of breath, diaphoretic and hypotensiv E.  Both lung fields are clear to auscultation and percussion, but examination of the neck reveals mild jugular venous distension with  prominent A waves. Heart sounds are normal. ECG shows sinus tachycardia with a new right bundle branch block and minor  nonspecific ST-T wave changes. The most likely diagnosis is:    

A. Aspiration   

B. Pericarditis   

C. Pulmonary thromboembolism*   

D. Acute myocardial infarction   

E. Aortic dissection   

 

 48 A 3 year old child with weight deficiency suffers from permanent moist cough. In history there are some pneumonias with  obstruction. On examination: distended chest, dullness on percussion over the lower parts of lungs. On auscultation: a great  number of different rales. Level of sweat chloride is 80 millimol/l. What is the most probable diagnosis?    

A. Bronchiectasis    

B. Bronchial asthma    

C. Pulmonary hypoplasia    

D. Recurrent bronchitis    

E. Mucoviscidosis (cystic fibrosis)*   

 

 49 A 34 year old patient complains of profuse sweating at night, skin itching, weight loss (9 kg within the last 3 months). Examination  revealed malnutrition, skin pallor. Palpation of neck and inguinal areas revealed dense elastic lymph nodes for about 1 cm in  diameter, nonmobile, non-adhering to skin. What is the most probable diagnosis?     

A. Lymphosarcoma   

B. Lymphogranulomatosis*     

C. Chronic lymphadenitis    

D. Cancer metastases    

E. Burkitt’s lymphoma    

 

 50 A 47 year old male patient got a flame burn of trunk and upper extremities and was delivered to the hospital. The patient is in grave  condition, confused mental state, with fever. AP- 80/50 mm Hg, Ps- 118 bpm. It was locally stated that the patient got III B degree  burns with total area of 20%. What medical actions should be taken?    

A. Necrotomy of burn surface, haemotransfusion   

B. Primary surgical pocessing    

C. Antibacterial and detoxicating therapy   

D. Administration of detoxicating blood substitutes   

E. Injection of narcotic analgetics and powdered blood substitutes*    

 

 51 On the third day of life an infant’s skin got icteric colouring. The child was born with body weight of 3,200 kg, body length of 52  cm. The child is activ E. There is puerile respiration above the lungs. Respiratory rate is 36/min, heart sounds are rhythmic, heart  rate is 130/min. Abdomen is soft, liver comes out from the edge of costal arch by 2 cm, spleen is not palpabl E. Feces are in form of  meconium. What is the most probable diagnosis?    

A. Physiologic jaundice*   

B. Biliary tracts atresia   

C. Neonatal sepsis   

 

D. Minkowsky-Shauffard disease   

E. Hemolytic disease of newborn   

 52 What is the maximum duration of medical certificate in case of tuberculosis?   

A. 2 months*   

B. 2 weeks   

C. Month   

D. 10 months   

E. Week   

 

 53 A 36 year old man was delivered to the surgical department an hour after a road accident. His condition is getting worse:  respiratory insufficiency is progressing, there are cardiac abnormalities. Clinical and roentgenological investigations revealed  mediastinal displacement. What process has caused this complication?   

A. Closed pneumothorax    

B. Subcutaneous emphysema    

C. Valvular pneumothorax*   

D. Open pneumothorax   

E. Mediastinitis   

 

 54 A female patient consulted a doctor about gain in weight, chill, edemata, dry skin, sleepiness, problems with concentration.  Objectively: the patient’s height is 165 cm, weight is 90 kg, gynoid body proportions, to- 35,8oC, ESR- 58/min, AP- 105/60  mm Hg. Heart sounds are weakened, bradycardia is present. Other internal organs have no changes. Thyroid gland is not  palpable. Mammary glands ooze milk droplets. Hormonal study revealed rise of TSH and prolactin concentration, reduction of  T4. What factor caused obesity?    

A. Secondary hypothyroidism    

B. Primary hypothyroidism*    

C. Prolactinoma   

D. Adiposogenital dystrophy   

E. Hypopituitarism   

 

 55 A 22 year old female patient complains about frequent and painful urination, urge to urinate at night, enuresis, pain in the  suprapubic and lumbar area. Her urine often has beer colouring. She got married a month ago. Objectively: general state is  satisfactory. Lung examination revealed vesicular respiration. Heart sounds are rhythmic, heart rate is 78/min, AP- 128/68 mm Hg.  Abdomen is soft, painful in the suprapubic area. Urine contains 12-18 erythrocytes and 12-15 bacteria within eyeshot. What is the  most probable diagnosis?    

A. Infection of superior urinary tracts – pyelonephritis   

B. Infection of inferior urinary tracts – cystitis*   

C. Gonorrhoea   

D. Urolithiasis   

E. Primary syphilis   

 

 56 On the second day after preventive vaccination a 2 year old boy got abdominal pain without clear localization, body temperature  rose up to 38oC. On the third day the child got red papular haemorrhagic eruption on the extensor surfaces of limbs and  around the joints. Knee joints were edematic and slightly painful. Examination of other organs and systems revealed no  pathological changes. What is the most probable diagnosis?    

A. Haemorrhagic vesiculitis*   

B. Thrombocytopenic purpura   

C. Urticaria   

D. DIC syndrome   

E. Meningococcemia   

 

 57 15 minutes after the second vaccination with diphteria and tetanus toxoids and pertussis vaccine a 4 month old boy manifested  symptoms of Quincke’s edema. What medication should be applied for emergency aid?    

A. Furosemide   

B. Seduxen   

C. Heparin   

D. Adrenalin   

E. Prednisolone*   

 

 

 58 A child is 1 day old. During delivery there had been problems with extraction of shoulders. Body weight is 4300,0. Right arm hangs  down along the body, hand is pronated, movement in the arm is absent. “Scarf” symptom is positive. What is the most probable  diagnosis?    

A. Hemiparesis   

B. Tetraparesis   

C. Total right-sided obstetric paralysis*   

D. Distal right-sided obstetric paralysis   

E. Proximal right-sided obstetric paralysis   

 

 59 A 62 year old patient complains of rest dyspnea, heart pains. 3 years ago he had myocardial infarction. Physical examination:  orthopnea, acrocyanosis, swollen cervical veins. Ps – 92, total heart enlargement, the liver is enlarged by 7 cm, shin edema. What  is the stage of chronic heart failure (CHF)?   

A. CHF- 3   

B. CHF- 2 B*   

C. CHF- 2 А   

D. CHF- 1   

E. CHF- 0   

 

 60 A 3 year old boy has petechial eruption. Examination revealed no other pathological changes. Thrombocyte number is  20*109g/l; haemoglobin and leukocyte concentration is normal. What is the most probable diagnosis?    

A. Disseminated intravascular coagulopathy    

B. Schonlein-Henoch disease   

C. Acute lymphoblastic leukemia    

D. Systemic lupus erythematosus    

E. Immune thrombocytopenic purpura*   

 

 61 Which of the methods of examination is the most informative in the diagnostics of a tube infertility?    

A. Pertubation   

B. Laparoscopy with chromosalpingoscopy*   

C. Bicontrast pelviography    

D. Transvaginal echography   

E. Hysterosalpingography   

 

 62 A 13 year old patient is suffering from an acute disease with the following symptoms: thirst, polyuria, weakness. Objectively: his  general condition is satisfactory, there is no smell of acetone. Glucose concentration in blood on an empty stomach is 32  micromole/l, in urine – 6%, acetone +. What treatment should be administered?    

A. Diet   

B. Sulfonylurea    

C. Biguanides   

D. Long-acting insulin   

E. Short-acting insulin*    

 

 63 A patient has got acute macrofocal myocardial infarction complicated by cardiogenic shock. The latter is progresing under  conditions of weak general peripheric resistance and lowered cardiac output. What antihypotensive drug should be injected to the  patient in the first place?    

A. Noradrenaline   

B. Adrenaline   

C. Prednisolone   

D. Mesatonum   

E. Dopamine*   

 

 64 A 28 year old patient was admitted to the clinic with complaints of the temperature rise up to 39,0oC, headache, weakness,  constipation on the 9th day of the disease. On examination: single roseolas on the skin of the abdomen are present. The pulse rate  is 78 bpm. The liver is enlarged by 2 cm. What is the most probable diagnosis?    

A. Sepsis    

B. Brucellosis    

C. Typhoid fever*   

D. Leptospirosis   

E. Malaria    

 

 65 A 52 year old woman complains about face distortion. It turned up 2 days ago after supercooling. Objectively: body temperature is  38,2oC. Face asymmetry is present. Frontal folds are flattened. Left eye is wider than right one and doesn’t close. Left  nasolabial fold is flattened, mouth corner is lowered. Examination revealed no other pathology. Blood count: leukocytes –  10*109/l, ESR – 20 mm/h. What is the most probable diagnosis?   

A. Hemicrania (migraine)   

B. Ischemic stroke   

C. Facial neuritis*   

D. Trigeminus neuralgia    

E. Brain tumour   

 

 66 At year-end hospital administration has obtained the following data: annual number of treated patients and average annual number  of beds used for patients’ treatment. What index of hospital work can be calculated on the base of this data?     

A. Average bed idle time    

B. Average annual bed occupancy    

C. Average duration of patients’ presence in the hospital     

D. Bed turnover*     

E. Bed resources of the hospital     

 

 67 A male patient, 60 years old, tobacco smoker for 30 years, alcoholic, has dysphagia and weight loss since 4 months. Suggested  diagnosis?   

A. Esophagitis   

B. Hanter’s disease   

C. Esophageal achalasia   

D. Esophageal diverticulum   

E. Cancer of the esophagus*   

 

 68 A 54 year old female patient was admitted to the hospital with evident acrocyanosis, swollen cervical veins, enlarged liver,  ascites. Cardiac borders are dilated. Heart sounds cannot be auscultated, apical beat is undetectable. AP is 100/50 mm Hg. X-ray  picture of chest shows enlarged heart shadow in form of a trapezium. What pathology might have caused these symptoms?   

A. Complex heart defect   

B. Hiatal hernia   

C. Exudative pleuritis   

D. Acute cardiac insufficiency   

E. Cardiac tamponade*   

 

 69 A healthy 75 year old woman who leads a moderately active way of life went through a preventive examination that revealed  serum concentration of common cholesterol at the rate of 5,1 millimole/l and HDL (high-density lipoproteins) cholesterol at the rate  of 70 mg/dl. ECG reveals no pathology. What dietary recommendation is the most adequate?    

A. Decrease of cholesterol consumption   

B. Decrease of carbohydrates consumption    

C. Increase of cellulose consumption    

D. Decrease of saturated fats consumption     

E. Any dietary changes are necessary*    

 

 70 An 18 year old primigravida in her 27-28 week of pregnancy underwent an operation on account of acute phlegmonous  appendicitis. In the postoperative period it is necessary to take measures for prevention of the following pegnancy complication:    

A. Intestinal obstruction   

B. Late gestosis   

C. Fetus hypotrophy   

D. Noncarrying of pregnancy*   

E. Premature placenta detachment   

 

 71 The observed patient’s movements are retarded, she answers no questions. Sometimes she spontaneously stiffens in strange  postures. It is possible to set her body and limbs into different positions artificially. If the psychiatrist lifts her arm or leg, so that she  remains standing on the other leg, the patient can stay in such a position for quite a long time. Name the probable disorder:    

A. Psychogenic stupor, stress disorder    

B. Depressive stupor, bipolar disorder    

C. Apathetic stupor, schizophrenia    

D. Catatonic stupor, schizophrenia*    

E. Dissociative stupor, dissociative psychosis    

 

 72 The man, aged 42, applied to the therapeutist with complaints of pricking pains in scapulas area, dyspnea on physical exertion,  cough with discharge of small amount of sputum. During 10 years he works in coal mining. On percussion-box-note sound in the  lower parts, on auscultation- a harsh breathing. There were no changes in the heart. Possible diagnosis?   

A. Silicosis*   

B. Silicatosis   

C. Tuberculosis of lungs   

D. Bronchiectatic disease   

E. Chronic bronchitis   

 

 73 A woman complains of having slight dark bloody discharges and mild pains in the lower part of abdomen for several days. Last  menses were 7 weeks ago. The pregnancy test is positive. Bimanual investigation: the body of the uterus indicates for about 5-6  weeks of pregnancy, it is soft, painless. In the left appendage there is a retort-like formation, 7х5 cm large, mobile, painless. What  examination is necessary for detection of fetus localization?    

A. Hysteroscopy    

B. Colposcopy   

C. Cystoscopy   

D. Hromohydrotubation   

E. Ultrasound*   

 

 74 A 34 year old patient was delivered to the hospital because of follicular tonsillitis charactirized by high temperature. The patient  has been abusing alcohol for 12 years. In the evening on the day of hospitalization he became anxious, couldn’t stay in bed, left  his ward several times and applied to the staff on duty with different complaints. He reported about seeing alot of spiders and flies  in his ward as well as abou hearing threats from the corridor. He was exasperated by the fact that other patients didn’t hear  them. He lost also spatial orientation. What psychopathological syndrome is it?    

A. Twilight state   

B. Delirious*   

C. Amentive   

D. Asthenic confusion   

E. Oneiric   

 

 75 A patient complains about evaginations in the region of anus that appear during defecation and need to be replaced. Examination  with anoscope revealed 1×1 cm large evaginations of mucosa above the pectineal line. What is the most probable diagnosis?    

A. Acute paraproctitis   

B. -   

C. Anal fissure   

D. External hemorrhoids   

E. Internal hemorrhoids*   

 

 76 A 72 year old patient complains about pain and bleeding during defecation. Digital rectal investigation revealed a tumour of anal  canal. After verification of the diagnosis the patient was diagnosed with squamous cell carcinoma. The secondary (metastatic)  tumour will be most probably found in:   

A. Brain   

B. Liver   

C. Pelvic bones   

D. Lungs*   

E. Mediastinum   

 

 77 A 45 year old woman complains about unbearable pain attacks in the left part of face lasting 1-2 minutes. Such attacks are  provoked by mastication. These symptoms appeared 2 months ago after exposure to cold. Objectively:the pain is localized in the  ending points of trigeminus on the left. A touch near nose wing provokes another pain attack and tonic spasm of face muscles.  What is the most probable diagnosis?    

A. Facial migraine   

B. Maxillary sinusitis   

C. Arthritis of mandibular joint   

D. Neuralgia of trigeminus*   

E. Neuralgia of glossopharyngeal nerve   

 

 78 A 38 year old female patient complains about body stiffness in the morning, especially in the articulations of her upper and lower  limbs, that disappears 30-60 minutes later after active movements. She has also arthritis of metacarpophalangeal and proximal  phalangeal articulations, subfebrile temperature. ESR- 45 mm/h. Roentgenography revealed osteoporosis and erosion of articular  surface of small hand and foot articulations. What is the most probable diagnosis?    

A. Rheumatoid arthritis*   

B. Psoriatic arthropathy   

C. Systemic lupus erythematosus   

D. Osteoarthrosis deformans   

E. Reactive polyarthritis   

 

 79 In the woman of 24 years about earlier normal menstrual function, cycles became irregular, according to tests of function  diagnostics – anovulatory. The contents of prolactin in blood is boosted. Choose the most suitable investigation:   

A. USI of organs of small pelvis   

B. Progesterone assay   

C. Determination of the contents of testosteron-depotum in blood serum   

D. Determination of the level of gonadotropins    

E. Computer tomography of the head*   

 

 80 A 30 year old man complains of intense pain, reddening of skin, edema in the ankle-joint area, fever up to 39oC. There was an  acute onset of the illness. In the past there were similar attacks lasting 5-6 days without residual changes in the joint. The skin  over the joint is hyperemic and ill-defined, without infiltrative bank on the periphery. What is the most likely diagnosis?       

A. Erysipelatous inflammation   

B. Rheumatoid arthritis   

C. Gout*   

D. Infectious arthritis   

E. Osteoarthritis   

 

 

 81 A woman of a high-risk group (chronic pyelonephritis in anamnesis) had vaginal delivery. The day after labour she complained of  fever and loin pains, frequent urodynia. Specify the most probable complication:   

A. Apostasis of sutures after episiotomy    

B. Thrombophlebitis of veins of the pelvis   

C. Endometritis   

D. Infectious contamination of the urinary system*   

E. Infectious hematoma   

 

 82 A 3 month old infant suffering from acute segmental pneumonia has dyspnea (respiration rate – 80 per minute), paradoxical  breathing, tachycardia, total cyanosis. Respiration and pulse – ratio is 1:2. The heart dullness under normal size. Such signs  characterise:   

A. Respiratory failure of II degree   

B. Myocarditis    

C. Respiratory failure of I degree   

D. Congenital heart malformation   

E. Respiratory failure of III degree*   

 

 83 Indices that characterize population health include demographic indices. What environment is used for calculation of these  indices?     

A. Number of patients   

B. Population number*    

C. Number of population being liable to preventive examination    

D. Employment number    

E. Number of hospitalized people    

 

 84 Surgical department admitted a 37 year old patient with a big crushed wound of his left thigh 4 hours after he got this trauma.  What is the main provision for successful prevention of gaseous gangrene?    

A. Wound lavage with 6% solution of hydrogen peroxide    

B. Infiltration of soft tissues around the wound with antibiotic solution   

C. Removal of necrotic tissues and timely surgical processing of the wound*    

D. Injection of specific serum 3 000 U   

E. Injection of specific serum 30 000 U    

 

 85 A 50 year old locksmith was diagnosed with typhoid fever. The patient lives in a separate apartment with all facilities. Apart of him  there are also 2 adults in his family. What actions should be taken about persons communicating with the patient?    

A. Vaccination   

B. Bacteriological study*   

C. Antibiotic prophylaxis    

D. Dispensary observation   

E. Isolation   

 

 86 Three weeks after acute angina the patient is still weak, inert, subfebrile, his retromaxillary lymph nodes are enlarged. Tonsils are  flabby, stick together with arches, there are purulent plugs in lacunae. What is the most probable diagnosis?    

A. Acute lacunar tonsillitis   

B. Chronic tonsillitis*   

C. Chronic pharyngitis   

D. Paratonsillitis   

E. Tonsillar tumour   

 

 87 A 4 month old child was admitted to a surgical department 8 hours after the first attack of anxiety. The attacks happen every 10  minutes and last for 2-3 minutes, there was also one-time vomiting. Objectively: the child’s condition is grave. Abdomen is soft,  palpation reveals a tumour-like formation in the right iliac area. After rectal examination the doctor’s finger was stained with blood.  What is the most probable diagnosis?    

A. Gastrointestinal haemorrhage   

B. Helminthic invasion   

C. Ileocecal invagination*   

D. Pylorostenosis   

E. Wilm’s tumour   

 

 88 After objective clinical examination a 12 year old child was diagnosed with mitral valve prolapse. What complementary instrumental  method of examination should be applied for the diagnosis confirmation?    

A. Phonocardiography   

B. ECG   

C. Roentgenography of chest   

D. Echocardiography*   

E. Veloergometry   

 

 89 A female patient has been suffering from pain in the right subcostal area, bitter taste in the mouth, periodical bile vomiting for a  month. The patient put off 12 kg. Body temperature in the evening is 37,6oC. Sonography revealed that bile bladder was  5,5х2,7 cm large, its wall – 0,4 cm, choledochus – 0,8 cm in diameter. Anterior liver segment contains a roundish hypoechoic  formation up to 5 cm in diameter and another two up to 1,5 cm each, walls of these formations are up to 0,3 cm thick. What is the  most probable diagnosis?    

A. Alveolar echinococcus of liver*   

B. Liver cancer   

C. Cystous liver cancer   

D. Liver abscess   

E. Paravesical liver abscesses   

 

 90 On the 5th day after labor body temperature of a parturient suddenly rose up to 38,7oC. She complains about weakness,  headache, abdominal pain, irritability. Objectively: AP- 120/70 mm Hg, Ps- 92 bpm, to- 38,7oC. Bimanual examination  revealed that the uterus was enlarged up to 12 weeks of pregnancy, it was dense, slightly painful on palpation. Cervical canal lets  in 2 transverse fingers, discharges are moderate, turbid, with foul smell. In blood: skeocytosis, lymphopenia, ESR- 30 mm/h. What  is the most probable diagnosis?   

A. Parametritis   

B. Endometritis*   

C. Lochiometra   

D. Metrophlebitis    

E. Pelviperitonitis    

 

 91 A fitter of a metallurgic factory with occupational exposure to high concentrations of mercury fumes for 16 years presents  instability of pulse and blood pressure, general hyperhydrosis, asymmetric innervations of facial muscles and tongue, positive  subcortical reflexes, hand tremor on physical examination. A dentist revealed paradontosis and chronic stomatitis. What is the  most probable diagnosis?    

A. Acute mercury intoxication   

B. Mercury encephalopathy   

C. Parkinson syndrome   

D. Chronic mercury intoxication*   

E. Neuroinfection   

 

 92 A 40 year old female patient has been observing excessive menstruation accompanied by spasmodic pain in the lower abdomen  for a year. Bimanual examination performed during menstruation revealed a dense formation up to 5 cm in diameter in the cervical  canal. Uterus is enlarged up to 5-6 weeks of pregnancy, movable, painful, of normal consistency. Appendages are not palpabl E.  Bloody discharges are profus E. What is the most probable diagnosis?    

A. Abortion in progress   

B. Cervical myoma   

C. Algodismenorrhea   

D. Cervical carcinoma   

E. Nascent submucous fibromatous node*   

 

 93 Examination of a 26 year old female patient revealed a node in the right lobe of thyroid gland. The node appeared no earlier than 3  months ago. The patient associates this node with stress. She doesn’t complain either about pain or enlargement of the node.  Ultrasonic scanning revealed a 2×2,5 cm large node in the inferior part of the right lobe of thyroid gland. What treatment should be  administered?    

A. Dynamic observation   

B. No need for treatment    

C. –

D. Conservative therapy   

E. Surgical intervention*   

 

 

 94 A 2 year old girl has been ill for 3 days. Today she has low grade fever, severe catarrhal presentations, slight maculopapular rash  on her buttocks and enlarged occipital lymph nodes. What is your diagnosis?    

A. Rubella*    

B. Pseudotuberculosis   

C. Adenoviral infection   

D. Measles   

E. Scarlet fever   

 

 95 Administration of a plant producing red lead paint intends to form a group of medical specialists for periodical medical  examinations. What specialist must be obligatory included into this group?     

A. Otolaryngologyst   

B. Psychiatrist   

C. Neuropathologist*    

D. Gynaecologist    

E. Dermatologist   

 

 96 Study of morbidity rate in a city N revealed that population of different administrative districts differed in age structure. What  statistic method allows to eliminate influence of this factor upon morbidity indices?     

A. Correlative regressive analysis   

B. Analysis of dynamic series   

C. Standardization*    

D. Wilcoxon’s t-criterion    

E. Calculation of average values   

 

 97 A 33 year old patient has acute blood loss (erythrocytes – 2,2*1012/l, Hb- 55 g/l), blood group is A(II)Rh+. Accidentally  the patient got transfusion of donor packed red blood cells of AB(IV)Rh+ group. An hour later the patient became anxious, got  abdominal and lumbar pain. Ps- 134 bpm, AP- 100/65 mm Hg, body temperature – 38,6oC. After catheterization of urinary  bladder 12 ml/h of dark-brown urine were obtained. What complication is it?    

A. Toxic infectious shock   

B. Cardial shock   

C. Allergic reaction to the donor red blood cells   

D. Citrate intoxication     

E. Acute renal insufficiency*   

 

 98 A department chief of an in-patient hospital is going to examine resident doctors as to observation of medical-technological  standards of patient service. What documentation should be checked for this purpose?    

A. Annual report of a patient care institution    

B. Statistic cards of discharged patients   

C. Health cards of in-patients*    

D. Treatment sheets    

E. Registry of operative interventions    

 

 99 A boy is 1 year old. Previously he had purulent otitis. After that he started complaining about pain in the upper third of his left thigh,  body temperature rose up to 39oC. Objectively: the thigh is swollen in its upper third, inguinal fold is smoothed. Extremity is in  half-bent position. Active and passive movements are impossible because of acute pain. What is the most probable diagnosis?    

A. Osteosarcoma   

B. Brodie’s abscess   

C. Acute coxitis   

D. Intermuscular phlegmon   

E. Acute haematogenic osteomyelitis*   

 

 100 A woman consulted a doctor on the 14th day after labour about sudden pain, hyperemy and induration of the left mammary gland,  body temperature rise up to 39oC, headache, indisposition. Objectively: fissure of nipple, enlargement of the left mammary  gland, pain on palpation. What pathology would you think about in this case?    

A. Breast cancer   

B. Lactational mastitis*   

C. Lacteal cyst with suppuration   

D. Phlegmon of mammary gland   

E. Fibrous adenoma of the left mammary gland   

 

 101 The most available and informative diagnostic method for closed trauma of the urinary bladder is:    

A. Pelvic arteriography   

B. Sonography of the urinary bladder   

C. Palpation and percussion of abdomen   

D. Cystography   

E. Retrograde cystography*    

 

 102 The 25 year old patient was admitted on the 1st day of the disease with complaints of double vision in the eyes, difficult  respiration. The day before the patient ate home-made mushrooms. On objective examination: paleness, widened pupils, disorder  of swallowing, bradycardia, constipation are marked.  What is the diagnosis?    

A. Botulism*   

B. Leptospirosis   

C. Yersiniosis   

D. Salmonellosis, gastrointestinal form   

E. Lambliasis    

 

 103 Examination of a 12 year old child revealed diffuse thyroid enlargement of the II degree. Heart auscultation revealed dullness of  heart sounds, heart rate was 64/min. The child has frequent constipations, anemia. Concentration of thyreoglobulin antibodies is  increased. What disease might have caused such symptoms?    

A. Thyroid carcinoma   

B. Autoimmune thyroiditis*   

C. Thyroid hyperplasia   

D. Endemic goiter   

E. Diffuse toxic goiter   

 

 104 A 60 year old man with unstable angina pectoris fails to respond to heparin, nitroglycerin, beta adrenegic blockers and calcium  channel antagonist. The best management includes:   

A. Antihypertensive therapy   

B. Coronary artery bypass grafting*   

C. Intravenous streptokinase   

D. Excercise testing   

E. Oral aspirin   

 

 105 A 29 year old female patient complains about periodical right-sided headache that is usually provoked by strong smells or  excitement. The patient’s mother suffers from the same disease. Objectively: examination of internal organs revealed no  pathology. During the attack there are general hyperesthesia and nausea, at the end of the attack polyuria is observed. Palpation  of the right temporal artery during the attack revealed tension and painfulness of the artery. Complete blood count and urine  analysis reveale dno pecularities. What is the most probable diagnosis?    

A. Neuralgia of trigeminus   

B. Migraine*    

C. Neuritis of the facial nerve   

D. Meniere’s syndrome   

E. Epilepsy   

 

 106 A 59 year old female patient applied to a maternity welfare clinic and complained about bloody discharges from the genital tracts.  Postmenopause is 12 years. Vaginal examination revealed that external genital organs had signs of age involution, uterus cervix  was not erosive, small amount of bloody discharges came from the cervical canal. Uterus was of normal size, uterine  appendages were unpalpable. Fornices were deep and painless. What method should be applied for the diagnosis specification?     

A. Culdoscopy   

B. Puncture of abdominal cavity through posterior vaginal fornix   

C. Extensive colposcopy   

D. Separated diagnosic curretage*   

E. Laparoscopy   

 

 107 A 25 year old patient had pharyngitis 2 weeks ago. Now he complains about body temperature rise up to 38oC, general  weakness, dyspnea during walking, swelling and shifting pain in the articulations. Objectively: cyanosis of lips, rhythmic pulse of  poor volume – 100 bpm. Left cardiac border deviates outwards from the mediaclavicular line by 1 cm. The first heart sound is  weakened on the apex, auscultation revealed systolic souffle. What is the most probable aetiological factor that caused this  pathological process?    

A. Pneumococcus   

B. Virus   

C. Fungi   

D. b-haemolytic streptococcus*   

E. Staphylococcus   

 

 108 Study of morbidity with temporary disability among workers of a machine building plant revealed that average duration of a case  was 20 days. What diseases influenced upon the index value?     

A. Hard to determine    

B. Preexisting diseases    

C. Subacute    

D. Chronic*   

E. Acute    

 

 109 A 68 year old female patient complains about temperature rise up to 38,3oC, haematuria. ESR- 55 mm/h. Antibacterial therapy  turned out to be ineffective. What diagnosis might be suspected?    

A. Renal cancer*   

B. Renal amyloidosis    

C. Chronic glomerulonephritis    

D. Polycystic renal disease   

E. Urolithiasis    

 

 110 A pediatrician talked to a mother of a 7 month old breast-fed boy and found out that the child was fed 7 times a day. How many  times should the child of such age be fed?     

A. 7 times   

B. 3 times   

C. 5 times*   

D. 4 times   

E. 6 times  

 

 111 A 72 year old male patient complains about itch in his left shin, especially around a trophic ulcer. Skin is reddened and edematic,  there are some oozing lesions, single yellowish crusts. The focus of affection is well-defined. What is the most probable  diagnosis?    

A. Streptococcal impetigo   

B. Seborrheic eczema    

C. Microbial eczema*   

D. Allergic dermatitis   

E. Cutaneous tuberculosis    

 

 112 A man, aged 37, working on the collective farm on sowing, was admitted to the infectious hospital with the clinical symptoms:  miosis, labored breathing, sweating.What kind of poisoning is it and what is the first aid?   

A. Poisoning by lead. Treatment: tetacine Calcii   

B. –

C. Poisoning by POC. Treatment: atropine*   

D. Poisoning by the methylic alcohol. Treatment: ethylic alcohol   

E. Poisoning by vapours of mercury. Treatment: unithiol   

 

 113 A 25 year old woman applied to a maternity welfare clinic and complained about being unable to conceive within 3 years of  regular sexual life. Examination revealed weight gain, male pattern of hair distribution on the pubis, excessive pilosis of thighs.  Ovaries were dense and enlarged, basal temperature was monophase. What is the most probable diagnosis?     

A. Tubo-ovaritis   

B. Premenstrual syndrome   

C. Gonadal dysgenesis    

D. Adrenogenital syndrome   

E. Sclerocystosis of ovaries*   

 

 114 A 52 year old patient has hypervolaemic type of essential hypertension. Which of the following medications is to be prescribed  either as monotherapy or in complex with other antihypertensive drugs?    

A. Nifedipin   

B. Clonidine   

C. Dibazol   

D. Kapoten   

E. Hypothiazid*   

 

 115 A woman is 34 years old, it is her tenth labor at full term. It is known from the anamnesis that the labor started 11 hours ago, labor  was active, painful contractions started after discharge of waters and became continuous. Suddenly the parturient got knife-like  pain in the lower abdomen and labor activity stopped. Examination revealed positive symptoms of peritoneum irritation, ill-defined  uterus outlines. Fetus was easily palpable, movable. Fetal heartbeats wasn’t auscultable. What is the most probable diagnosis?    

A. Risk of uterus rupture   

B. Uterine inertia   

C. Discoordinated labor activity   

D. II labor period   

E. Rupture of uterus*   

 

 116 A patient complained about problems with pain and tactile sensitivity, pain in the nail bones at the end of the working day. He  works at a plant with mechanical devices. What pathology can be suspected?   

A. Vibration disease*   

B. Overwork symptoms   

C. Hypovitaminosis of B1   

D. Caisson disease   

E. Noise disease   

 

 

 

 

 117 A 14 year old girl complains of profuse bloody discharges from genital tracts during 10 days after suppresion of menses for 1,5  month. Similiar bleedings recur since 12 years on the background of disordered menstrual cycle. On rectal examination: no  pathology of the internal genitalia. In blood: Нb – 70 g/l, RBC- 2,3*1012/l, Ht – 20. What is the most probable diagnosis?    

A. Werlholf’s disease     

B. Polycyst ovarian syndrome      

C. Incomplete spontaneous abortion    

D. Hormonoproductive ovary tumor    

E. Juvenile bleeding, posthemorrhagic anemia*     

 

 118 A 26 year old manual worker complained of 3 weeks history of fevers and fatigue, weight loss with no other symptoms. Physical  findings: Temperature 37,6oC, Ps- 88 bpm, blood pressure 115/70 mm Hg, superficial lymph nodes (occipital, submental,  cervical, axillary) are enlarged, neither tender nor painful. Rubella-like rash on the trunk and extremities. Herpes simplex lesions on  the lips. Candidosis of oral cavity. What infectious disease would you suspect?    

A. HIV infection*    

B. Rubella   

C. Infectious mononucleosis    

D. Influenza   

E. Tuberculosis   

 

 119 Student В. lives in the canalized house in the flat with complete set of sanitary equipment (WC, bath, shower, local water heater).  How much water consumption has he got?   

A. 10-15 l   

B. 500 l   

C. 160-200 l*

D. 50-100 l   

E. 300-400 l   

 

 

 

 120 Examination of a 3-month-old child revealed scrotum growth on the right. This formation has elastic consistency, its size  decreases during sleep and increases when the child is crying. What examination will be helpful for making a correct diagnosis?    

A. Punction of the scrotum   

B. Palpation of the thickened cord crossing the pubical tubercule (sign of the silk glove)*    

C. Examination of the formation in Trendelenburg’s position   

D. Diaphanoscоpy   

E. Palpation of the external inguinal ring   

 

 121 A 48 year old female patient complains about contact haemorrhage. Speculum examination revealed hypertrophy of uterus cervix.  It resembles of cauliflower, it is dense and can be easily injured. Bimanual examination revealed that fornices were shortened,  uterine body was nonmobile. What is the most probable diagnosis?   

A. Cervical papillomatosis   

B. Endometriosis   

C. Metrofibroma   

D. Cervical carcinoma*   

E. Cervical pregnancy   

 

 122 Prophylactic photoroentgenography 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. Tuberculoma   

B. Fibro-cavernous   

C. Disseminated   

D. Miliary   

E. Focal*   

 

 123 A 39 year old patient suffering from hypertension suddenly gotb intense headache in the region of occiput; there appeared  recurrent vomiting. These presentations has been lasting for 5 hours. Objectively: Ps – 88 bpm, AP – 205/100 mm Hg, painfulness  of occipital points, rigidity of occipital muscles are present. Kernig’s symptom is bilaterally positive. Subarachnoid haemorrhage is  also suspected. What diagnostic method will be of the greatest importance for confirmation of provisional diagnosis?    

A. Ultrasonic dopplerography   

B. Examination of eye fundus   

C. EEG   

D. Computer tomography   

E. Lumbar puncture*   

 

 124 A prematurely born girl is now 8 months old. She has dyspnea, tachycardia, hepatosplenomegaly, physical developmental lag, limb  cyanosis. There is also parasternal cardiac hump, auscultation revealed systolodiastolic murmur in the II intercostal space on the  left. AP is 90/0 mm Hg. What disease should be suspected?    

A. Nonclosure of interventricular septum   

B. Stenosis of aortal valve   

C. Coarctation of aorta   

D. Patent ductus arteriosus*   

E. Stenosis of pulmonary artery   

 

 125 A 32 year old welder complains of weakness and fever. His illness started as tonsillitis a month before. On exam, BT of  38,9oC, RR of 24/min, HR of 100/min, BP of 100/70 mm Hg, hemorrhages on the legs, enlargement of the lymph nodes. CBC  shows Hb of 70 g/l, RBC of 2,2*1012/l, WBC of 3,0*109/l with 32% of blasts, 1% of eosinophiles, 3% of bands,  36% of segments, 20% of lymphocytes, and 8% of monocytes, ESR of 47 mm/h. What is the cause of anemia?   

A. Vitamin B12 deficiency anemia   

B. Chronic lympholeukemia   

C. Acute leukemia*   

D. Chronic hemolytic anemia   

E. Aplastic anema   

 

 126 A 26 year old woman complains about edemata, swelling and painfulness of mammary glands, headache, tearfulness, irritability.  These signs turn up 5 days before menstruation and disappear after its start. What clinical syndrome is it?    

A. Premenstrual syndrome*   

B. Climacteric syndrome    

C. Postcastration syndrome   

D. Adrenogenital syndrome   

E. Stein-Leventhal syndrome    

 

 127 A 38 year old patient complains about inertness, subfebrile temperature, enlargement of lymph nodes, nasal haemorrhages, bone  pain. Objectively: the patient’s skin and mucous membranes are pale, palpation revealed enlarged painless lymph nodes;  sternalgia; liver was enlarged by 2 cm, spleen – by 5 cm, painless. In blood: erythrocytes – 2,7*1012/l, Hb- 84 g/l,  leukocytes – 58*109/l, eosinophils – 1%, stab neutrophils – 2%, segmented neutrophils – 12%, lymphocytes – 83%,  lymphoblasts – 2%, smudge cells; ESR- 57 mm/h. What is the most probable diagnosis?   

A. Lymphogranulomatosis   

B. Chronic lymphatic leukemia*   

C. Acute myeloleukemia   

D. Acute lymphatic leukemia   

E. Chronic myeloleukemia   

 

 128 A 32 year old patient suffering from chronic viral hepatitis complains about dull pain in the right subcostal area, nausea, dry mouth.  Objectively: liver dimensions are 13-21-11 cm (according to Kurlov), spleen is by 2 cm enlarged, aspartate aminotransferase is  3,2 micromole/l*h, alanine aminotransferase – 4,8 millimole/l*h. Serological study revealed HBeAg, high  concentration of DNA HBV. What drug should be chosen for treatment of this patient?     

A. a-interferon*   

B. Arabinoside monophosphate    

C. Acyclovir    

D. Essentiale-forte    

E. Remantadinum    

 

 129 A parturient complains about pain in the mammary gland. Palpation revealed a 3х4 cm large infiltration, soft in the centre. Body  temperature is 38,5oC. What is the most probable diagnosis?   

A. Retention of milk   

B. Birth trauma   

C. Acute purulent mastitis*   

D. Pneumonia   

E. Pleuritis   

 

 130 A 3 year old child has been suffering from fever, cough, coryza, conjunctivitis for 4 days. He has been taking sulfadimethoxine.  Today it has fever up to 39oC and maculopapular rash on its face. Except of rash the child’s skin has no changes. What is  your diagnosis?    

A. Measles*   

B. Pseudotuberculosis   

C. Scarlet fever   

D. Rubella   

E. Allergic rash   

 

 131 A 15 year old girl suddenly got arthralgia, headache, nausea, vomiting; pain and muscle tension in the lumbar area; body  temperature rose up to 38-39oC. Pasternatsky’s symptom was distinctly positive on the right. In the urine: bacteriuria, pyuria.  What is the most probable diagnosis?    

A. Renal colic   

B. Acute pyelonephritis*   

C. Pararenal abscess   

D. Cystitis   

E. Acute glomerulonephritis   

 

 132 A 38 year old man was delivered to the hospital in unconscious state. The symptoms of illness turned up a day before: headache,  nausea, vomiting, to- 38,5oC, dizziness, delusion. For the last 4 days he had been complaining of pain and hearing loss in  the left ear. Objectively: sopor, rigidity of occipital muscles, bilateral Kernig’s symptom, general hyperesthesia, purulent discharges  from the left ear. What is the most probable diagnosis?     

A. Secondary purulent meningitis*   

B. Subarachnoidal haemorrhage   

C. Parenchymatous subarachnoidal haemorrhage   

D. Tuberculous meningitis   

E. Primary purulent meningitis   

 

 133 During examination a patient is unconscious, his skin is dry and hot, face hyperemia is present. The patient has Kussmaul’s  respiration, there is also smell of acetone in the air. Symptoms of peritoneum irritation are positive. Blood sugar is at the rate of 33  millimole/l. What emergency actions should be taken?    

A. Intravenous infusion of short-acting insulin*   

B. Intravenous infusion of sodium chloride saline   

C. Intravenous infusion of glucose along with insulin   

D. Intravenous infusion of neohaemodesum along with glutamic acid   

E. Introduction of long-acting insulin   

 

 134 A 20 year old patient was delivered to the hospital in summer from the street with haemorrage from the brachial artery. First  medical aid involved aplication of a tourniquet for provisional arrest of bleeding. What is the maximal exposure of the tourniquet?    

A. 60 minutes   

B. 15 minutes   

C. 120 minutes*   

D. 180 minutes   

E. 30 minutes   

 

 135 A 19 year old boy was admitted to a hospital with closed abdominal trauma. In course of operation multiple ruptures of spleen and  small intestine were revealed. AP is falling rapidly, it is necessary to perform hemotransfusion. Who can specify the patient’s  blood group and rhesus compatibility?      

A. A traumatologist   

B. An anaesthesilogist   

C. A laboratory physician    

D. A doctor of any speciality*   

E. A surgeon   

 

 136 A 35 year old female patient suffering from cholelithiasis has broken her diet, and this caused an acute pain attack in the right  subcostal are. The pain eased off on the third day, but the patient got progressing jaundice. What non-invasive diagnostic method  should be applied?    

 

A. Infusive cholecystocholangiography   

B. Test for bilirubin    

C. Survey radiography of abdominal organs   

D. Endoscopic retrograde cholangiopancreatography*    

E. Duodenal probing   

 

 137 Examination of a 9 month old girl revealed skin pallor, cyanosis during excitement. Percussion revealed transverse dilatation of  cardiac borders. Auscultation revealed continuous systolic murmur on the left from the breastbone in the 3-4 intercostal space.  This murmur is conducted above the whole cardiac region to the back. What congenital cardiac pathology can be suspected?    

A. Fallot’s tetrad   

B. Coarctation of aorta   

C. Pulmonary artery stenosis    

D. Defect of interatrial septum    

E. Defect of interventricular septum*   

 

 138 A 26 year old woman who delivered a child 7 months ago has been suffering from nausea, morning vomiting, sleepiness for the  last 2 weeks. She suckles the child, menstruation is absent. She hasn’t applied any contraceptives. What method should be  applied in order to specify her diagnosis?    

A. Roentgenography of small pelvis organs   

B. Bimanual vaginal examination   

C. Palpation of mammary glands and pressing-out of colostrum   

D. Speculum examination   

E. Ultrasonic examination*   

 

 139 An 18 year old patient was admitted to a hospital with complaints of headache, weakness, high temperature, sore throat.  Objectively: enlargement of all groups of lymph nodes was revealed. The liver is enlarged by 3 cm, spleen – by 1 cm. In blood:  leukocytosis, atypical lymphocytes – 15%. What is the most probable diagnosis?    

A. Infectious mononucleosis *  

B. Diphtheria   

 

C. Acute lymphoid leukosis   

D. Adenoviral infection   

E. Angina   

 

 140 A 54 year old male patient complains about permanent dull pain in the mesogastral region, weight loss, dark blood admixtures in the  feces, constipations. He put off 10 kg within a year. In blood: erythrocytes: 3,5*1012/l, Hb- 87 g/l, leukocytes –  12,6*109/l, stab neutrophil shift, ESR- 43 mm/h. What is the most probable diagnosis?    

A. Cancer of transverse colon*    

B. Gastric ulcer   

C. Chronic pancreatitis   

D. Chronic colitis   

E. Stomach cancer   

 

 141 A patient who takes diuretics has developed arrhythmia as a result of cardiac glycoside overdose. What is the treatment tactics in  this case?     

A. Increased potassium concentration in blood*   

B. -   

C. Increased calcium concentration in blood    

D. Reduced magnesium concentration in blood   

E. Increased sodium consentration in blood   

 

 142 It is planned to make complete isolation boxes in the infectious department in order to prevent nosocomial airborne infections. The  boxes consist of a tambour, a ward and a lock chamber. What structure should be also included in a complete isolation box?    

A. Manipulation room   

B. Bathroom unit*   

C. Nursing room   

D. Patient’s examination room   

E. Doctor’s consulting room   

 

 143 A maternity hospital registered 616 live births, 1 stillbirth, 1 death on the 5th day of life over a 1 year period. What index allows the  most precise estimation of this situation?    

A. Crude mortality rate    

B. Neonatal mortality    

C. Perinatal mortality*    

D. Natural increase    

E. Natality    

 

 144 A 38 year old man, previously in good health, suddenly develops severe abdominal pain radiating from the left loin to groin and  accompanied by nausea, perspiration and the need for frequent urination. He is restless, tossing in bed but has no abnormal  findings. The most likely diagnosis is:   

A. Torsion of the left testicle   

B. Retroperitoneal haemorrhage   

C. Sigmoid diverticulitis   

D. Leftsided renal colic*   

E. Herpes zoster   

 

 145 Indicate the registration medical document for the patient, who 21.02. was addressed to the doctor with diagnosis ARVD for the  first time in this year:   

A. The statistical coupon is to be filled in, but a sign (+) is not necessary to be put in   

B. It is necessary to fill in the emergency notice on a case of a contagion    

C. The statistical coupon is to be filled in and it is necessary to deliver on a sign (+) *  

D. The statistical coupon for registration of final diagnosis is not necessary   

E. The necessary registration form is not indicated   

 

 146 A 52 year old patient with history of functional Class II angina complains of having intense and prolonged retrosternal pains,  decreased exercise tolerance for 5 days. Angina is less responsive to nitroglycerine. What is the most probable diagnosis?    

A. IHd. Functional Class II angina   

B. IHd. Unstable angina*

C. Cardialgia due to spine problem   

D. Myocarditis   

E. Myocardial dystrophy   

 

 

147 A woman 26 years old has abused alcohol for 7 years. She has psychological dependence on alcohol, but no withdrawal  syndrome. Drinks almost every day approximately 50-100 g of wine. She is in her 4-th week of pregnancy. Primary prevention of  fetal alcohol syndrome requires:    

A. Medical abortion     

B. Treatment of alcoholism and full abstinance from alcohol during all the period of pregnancy*    

C. Decrease of alcohol use    

D. Participation in the A-ANON group     

E. Gyneacological observation    

 

 148 A 22 year old woman complained of right subcostal aching pain, nausea, and decreased appetite. She fell ill 2 months after  appendectomy when jaundice appeared. She was treated in an infectious hospital. 1 year later above mentioned symptoms  developed. On exam: the subicteric sclerae, enlarged firm liver. Your preliminary diagnosis:   

A. Calculous cholecystitis   

B. Chronic viral hepatitis*   

C. Acute viral hepatitis   

D. Gilbert’s disease   

E. Chronic cholangitis   

 

 149 A 33 year old patient was delivered to the infectious diseases department on the 7-th day of disease. He complained about great  weakness, high temperature, pain in the lumbar area and leg muscles, icteritiousness, dark colour of urine, headache. The acute  disease started with chill, body temperature rise up to 40oC, headache, pain in the lumbar area and sural muscles. Icterus  turned up on the 4th day, nasal and scleral haemorrhages came on the 5th day. Fever has lasted for 6 days. Diuresis – 200 ml.  What is the most probable diagnosis?    

A. Sepsis   

B. Yersiniosis   

 

C. Typhoid fever   

D. Virus A hepatitis   

E. Leptospirosis*   

 

 150 A 13 year old girl was admitted to the cardiological department because of pain in the muscles and joints. Examination of her face  revealed an edematic erythema in form of butterfly in the region of nose bridge and cheeks. What is the most probable diagnosis?     

A. Rheumatoid arthritis   

B. Periarteritis nodosa   

C. Systemic lupus erythematosus*   

D. Rheumatism   

E. Dermatomyositis   

 

 151 A 23 year old patient fell ill 3 weeks ago when she noticed a very painful induration in her axillary crease. 4-5 days later it burst  and discharged a lot of pus. After that some new infiltrations appeared around the affected area. The patient has never suffered  from skin diseases before. What is the most probable diagnosis?    

A. Hydradenitis*   

B. Streptococcal impetigo   

C. Furuncle   

D. Mycosis   

E. Herpes zoster   

 

 152 A pregnant woman in her 40th week of pregnancy undergoes obstetric examination: the cervix of uterus is undeveloped. The  oxytocin test is negative. Examination at 32 weeks revealed: AP 140/90 mm Hg, proteinuria 1 g/l, peripheral edemata. Reflexes are  normal. Choose the most correct tactics:    

A. Labour stimulation after preparation*   

B. Absolute bed rest for 1 month   

C. Complex therapy of gestosis for 7 days    

D. Caesarian section immediately   

E. Complex therapy of gestosis for 2 days   

 

 153 A patient has restrained umbilateral hernia complicated by phlegmon hernia, it is necessary to take following actions:    

A. Herniotomy by Grenov   

B. Herniotomy by Lekser   

C. Herniotomy by Mayo    

D. Herniotomy by Sapezhko   

E. Herniotomy by Mayo-Sapezhko*   

 

 154 A 25 year old woman complained of edema on her face and legs, rise of blood pressure up to 160/100 mm Hg and weakness. She  fell ill 3 weeks after recovering from angina. Urinalysis data: protein of 0,5 g/l, erythrocytes of 17-20/field, leukocytes of 2-3/field,  erythrocyte casts. What treatment should be initiated after specifying the diagnosis?    

A. Penicillin OS*   

B. Dipyridamole   

C. Heparin   

D. Ceftriaxone   

E. Ciprofloxacine   

 

 155 A 40 year old patient was bitten by a stray dog for about an hour ago. The bite can be seen on the patient’s left shin in form of a  wound 4х2х0,5 cm large. What kind of aid would be recommended in this case?    

A. Blind suture   

B. Retension sutures   

C. Wound lavage with soapsuds, retension sutures*   

D. Aseptic bandage   

E. Salve bandage   

 

 156 A plot of land with total area of 2,0 hectare was intended for building of a hospital. The maximal capacity of the hospital will be:    

A. 200 beds   

 

B. 100 beds*    

C. Over 1000 beds   

D. 800 beds    

E. 400 beds   

 

 157 A 38 year old man worked at roofing and drain pipes 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 diagnosis?   

A. Bronchoscopy   

B. Spirography   

C. Chest X-ray*  

D. Electrocardiography   

E. Blood gas analysis   

 

 158 A patient suffering from gastroesophageal reflux has taken from time to time a certain drug that “reduces acidity” for 5 years. This  drug was recommended by a pharmaceutist. The following side effects are observed: osteoporosis, muscle weakness,  indisposition. What drug has such following effects?    

A. Aluminium-bearing antacid*   

B. Н2-blocker   

C. Metoclopramide   

D. Gastrozepin    

E. Inhibitor of proton pump   

 

 159 A 52 year old patient complains about headache, weakness of his upper left extremity. Neurological symptoms become more  intense during physical stress of the left extremity. Pulsation on the arteries of the left extremity is sharply dampened but it remains  unchanged on the carotid arteries. What is the most probable diagnosis?    

A. Thoracal outlet syndrome   

B. Raynaud’s syndrome   

C. Occlusion of brachiocephalic trunk   

D. Takayasu’s disease   

E. Occlusion of the left subclavicular artery, steal syndrome*   

 

 160 A 42 year old man applied to a hospital 10 minutes after he got stung by a bee and complained about face edema and difficult  respiration. Objectively: Ps- 98 bpm, AP- 130/80 mm Hg. A doctor on duty injected him 1 ml of 1% dimedrol solution intramuscularly  and recommended to apply to his local therapeutist on the next day. What tactics of treatment should be chosen for this patient?    

A. Intravenous introduction of calcium chloride and hospitalization    

B. Intravenous introduction of calcium chloride   

C. Intravenous introduction of prednisolone and hospitalization*    

D. The patient needs no further medical aid   

E. Hospitalization for observation   

 

 161 It was noticed that a 7 year old pupil had been innattentive several times during the lessons. The teacher also noticed that the child  had been smacking his lips and had vacant look. There were no falls and convulsions. During such short periods of absence the  child didn’t react to calling his name. His mother notic such phenomena before but didn’t pay much attention to them thinking that the  child was deep in thought. What type of epileptic attack (according to the standard classification) is it?     

A. Complex partial epilepsy   

B. Simple partial epilepsy   

C. Generalized tonoclonic epilepsy    

D. Jacksonian partial epilepsy   

E. Absentia*    

 

 162 A 37 year old miner has lifted significant loads and afterwards felt pain in the lumbar area irradiating to his left leg. He walks  slowly and carefully. Lumbar lordosis is flattened. There is also left-sided scoliosis and tension of paravertebral muscles. Neri’s  and Dejerine’s symptoms are positive, there is Lasegue’s sign on the left from the angle of 350. What method will help to specify  the diagnosis?    

A. CT of lumbosacral part of vertebral column*    

B. Lumbal puncture   

C. Renal sonography   

D. Descending myelography   

 

E. Electromyography   

 

 163 A 41 year old woman has suffered from nonspecific ulcerative colitis for 5 years. On rectoromanoscopy: evident inflammatory  process of lower intestinal parts, pseudopolyposive changes of mucous membrane. In blood: WBC- 9,8*109/l, RBC-  3,0*1012/l, ESR – 52 mm/hour. What medication provides pathogenetic treatment of this patient?      

A. Motilium   

B. Sulfosalasine*    

C. Vikasolum   

D. Linex   

E. Kreon   

 

 164 A 19 year old patient was admitted to a hospital with acute destructive appendicitis. He suffers from hemophilia of B type. What  antihemophilic medications should be included in pre- and post-operative treatment plan?     

A. Dried plasma   

B. Native plasma   

C. Fresh frozen blood    

D. Fresh frozen plasma*   

E. Cryoprecipitate   

 

 165 Infant is 6,5 months now and is given natural feeding since birth. Body mass was 3,5 kg, with length 52 cm at birth. How many  times per day the supplement (up feeding) should be given?   

A. 4   

B. 1   

C. 0   

D. 3    

E. 2*   

 

 

 166 The results of 5 year monitoring allowed to estimate the level of environmental influence upon health indices of popultaion. What  statistic method should be chosen?    

A. Calculation of dynamic indices   

B. Calculation of correlation coefficient*   

C. Calculation of coefficient of difference validity   

D. Calculation of regression coefficient   

E. Calculation of conformity coefficient   

 

 167 A 10 month old boy has been ill for 5 days after consumption of unboiled milk. Body temperature is 38-39oC, there is vomiting,  liquid stool. The child is pale and inert. His tongue is covered with white deposition. Heart sounds are muffled. Abdomen is  swollen, there is borborygmus in the region of ubbilicus, liver is enlarged by 3 cm. Stool is liquid, dark-green, with admixtures of  mucus, 5 times a day. What is the most probable diagnosis?    

A. Rotaviral infection   

B. Salmonellosis*    

C. Acute shigellosis   

D. Escherichiosis   

E. Staphylococcal enteric infection    

 

 168 A 34 year old female patient has been suffering from anxious depression accompanied by panic attacks for 2 years. She has  been a patient of a psychotherapist. Treatment resulted in incomplete remission. The patient had to break off psychotherapy  because of moving to a new place of residence. Soon after this her condition grew significantly worse, she was almost  permanently anxious, panic attacks turned up 5-6 times a day and were accompanied by palpitation, dyspnea, cold sweat,  thanatophobia. What drug group is the most appropriate for medicamental therapy?      

A. Cardiotonics, respiratory analeptics   

B. Lithium drugs   

C. Antipsychotic neuroleptics   

D. Sedative neuroleptics   

E. Antidepressants*   

 

 

 169 The student has the following devices: Geiger counter, Ebert counter, Krotov’s apparatus, Mischuk device, Ebert device. What  device can he use to assess air germ pollution?   

A. Mischuk’s device   

B. Krotov’s apparatus*   

C. Geiger’s counter    

D. Ebert’s counter   

E. Ebert’s device   

 

 170 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. Tricuspid regurgitation   

B. Mitral stenosis*   

C. Mitral regurgitation   

D. Tricuspid stenosis   

E. Aortic stenosis   

 

 171 A 75 year old man who has been suffering from diabetes for the last six months was found to be jaundiced. He was  asymptomatic except for weight loss at the rate of 10 pounds in 6 months. Physical examination revealed a hard, globular, right  upper quadrant mass that moves during respiration. A CT scan shows enlargement of the head of the pancreas, with no filling  defects in the liver. The most likely diagnosis is:    

A. Infectious hepatitis   

B. Carcinoma of the head of the pancreas*   

C. Malignant biliary stricture   

D. Metastatic disease of liver   

E. Haemolytic jaundice   

 

 172 Estimation of community health level involved analysis of a report on diseases registered among the population of district under  charge (reporting form 12). What index is calculated on the grounds of this report?    

A. Index of hospitalized morbidity   

B. Common sickness rate*   

C. Index of morbidity with temporary disability   

D. Index of pathological affection   

E. Index of basic non-epidemic morbidity   

 

 173 A 40 year old woman has a self-detected hard breast mass. The procedure of choice for confirming the diagnosis is:   

A. Mammography   

B. Thermography   

C. Aspiration biopsy with cytology   

D. Ultrasonography   

E. Excision biopsy*   

 

 174 A 36 year old female patient complains about general weakness, edemata of her face and hands, rapid fatigability during walking,  difficult diglutition, cardiac irregularities. These symptoms turned up 11 days after holiday at the seaside. Objectively: face  erythema, edema of shin muscles. Heart sounds are muffled, AP is 100/70 mm Hg. In blood: ASAT activity is 0,95  millimole/h*l, ALAT – 1,3 micromole/h*l, aldolase – 9,2 IU/l, creatine phosphokinase – 2,5 micromole Р/g*l. What  method of study would be the most specific?    

A. Muscle biopsy*   

B. ECG   

C. Echocardiogram   

D. Electromyography   

E. Determination of cortisol concentration in blood and urine   

 

 175 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. Pleuritis   

C. Pulmonary abscess   

D. Left-sided pneumonia   

E. Spontaneous left-sided pneumothorax*   

 

 176 A 28 year old parturient complains about headache, vision impairment, psychic inhibition. Objectively: AP- 200/110 mm Hg, evident  edemata of legs and anterior abdominal wall. Fetus head is in the area of small pelvis. Fetal heartbeats is clear, rhythmic, 190/min.  Internal investigation revealed complete cervical dilatation, fetus head was in the area of small pelvis. What tactics of labor  management should be chosen?     

A. Embryotomy   

B. Forceps operation*   

C. Cesarean    

D. Conservative labor management with episiotomy    

E. Stimulation of labor activity    

 

 177 An outbreak of food poisoning was recorded in an urban settlement. The illness was diagnosed as botulism on the grounds of  clinical presentations. What foodstuffs should be chosen for analysis in the first place in order to confirm the diagnosis?    

A. Boiled meat   

B. Potatoes   

C. Pasteurized milk   

D. Cabbage   

E. Tinned food*   

 

 178 A 3 year old boy fell ill abruptly: fever up to 39oC, weakness, vomitng. Haemorrhagic rash of various size appeared on his  lower limbs within 5 hours. Meningococcemia with infective – toxic shock of the 1 degree was diagnosed. What medications  should be administered?   

A. Ampicillin and immunoglobulin   

B. Chloramphenicol succinate and prednisone*   

C. Penicillin and prednisone   

D. Penicillin and immunoglobulin   

E. Chloramphenicol succinate and interferon   

 

 179 A 5 month old boy was born prematurely, he didn’t suffer from any disease at the infant age and later on. Examination at an  outpatient’s hospital revealed paleness of skin, sleepiness. Blood count: Hb – 95 g/l, erythrocytes – 3,5*1012/l,  reticulocytes – 90/00, colour index – 0,7, osmotic stability of erythrocytes – 0,44-0,33%, serum iron – 4,9 micromole/l. What is  the most probable cause of anemia?    

A. Hemogenesis immaturity   

B. Erythrocyte hemolysis   

C. Iron deficit*   

D. Infectious process   

E. B12 deficit   

 

 180 A patient was delivered to a surgical department after a road accident with a closed trauma of chest and right-sided rib fracture.  The patient was diagnosed with right-sided pneumothorax, it is indicated to perform drainage of pleural cavity. Pleural puncture  should be made in:    

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

B. In the point of the greatest dullness on percussion   

C. In the 6th intercostal space along the posterior axillary line   

D. In the projection of pleural sinus   

E. In the 7th intercostal space along the scapular line   

 

 181 A 25 year old patient complains about weakness, dizziness, haemorrhagic skin rash. She has been suffering from this for a  month. Blood count: erythrocytes: 1,0*1012/l, Hb- 37 g/l, colour index – 0,9, leukocytes – 1,2*109/l, thrombocytes –  42*109/l. What diagnostic method will be the most effective?    

A. Spleen biopsy   

B. Liver biopsy   

C. Coagulogram   

D. Abdominal ultrasound   

E. Sternal puncture*   

 

 182 An 8 year old boy suffering from haemophilia was undergoing transfusion of packed red cells. Suddenly he got pain behind the  breastbone and in the lumbar area, dyspnea, cold sweat. Objectively: pale skin, heart rate – 100/min, AP- 60/40 Hg; oliguria, brown  urine. For treatment of this complication the following drug should be administered:    

A. Prednisolone*   

B. Analgine   

C. Lasix   

D. Adrenaline   

E. Aminophylline   

 

 183 A 72 year old female patient has been treated for urolithiasis in the urological department. After atropine injection she got acute  pain in her left eye and abrupt vision impairment. Objectively: visual acuity of the left eye is 0,01, the eye is dense but painful on  palpation, cornea is opaque, there is cyanotic induration of eyeball vessels. What is the most probable diagnosis?     

A. Acute keratitis of the left eye   

B. Acute attack of primary glaucoma of the left eye*    

C. Secondary glaucoma of the left eye   

D. Degeneration of the left eye cornea    

E. Acute iridocyclitis of the left eye   

 

 184 What guarantees against the preconceived attitude to the physician in cases of professional law violations do you know?   

A. Utilisation copy of medical documents    

B. Conduct an inquiry by preliminary investigator of police department    

C. Sanction of public prosecutor, inquiry by preliminary investigator of prosecutor’s office, committee of experts*     

D. Draw up a statement about forensic medical examination    

E. Conduct forensic medical examination by district forensic medicine expert    

 

 185 Immediately after delivery a woman had haemorrhage, blood loss exceeded postpartum haemorrhage rate and was progressing.  There were no symptoms of placenta detachment. What tactics should be chosen?    

A. Uterus tamponade   

B. Instrumental revision of uterine cavity walls   

C. Manual removal of placenta and afterbirth*   

D. Removal of afterbirth by Crede’s method   

E. Intravenous injection of methylergometrine with glucose   

 

 186 As a result of prophylactic medical examination a 35 year old woman was diagnosed with alimentary and constitutive obesity of  the III degree. It is known from her anamnesis that the patient doesn’t observe rules of rational nutrition: she often overeats, the  last food intake is usually 10-15 minutes before going to bed, prefers fattening and rich in carbohydrates food. What is the main  alimentary risk factor of obesity development?     

A. Excess of carbohydrates   

B. Energetic unprofitableness of nutrition*   

C. Lack of cellulose   

D. Violation of dietary pattern   

E. Excess of fats   

 

 187 25 children at the age of 2-3 years who don’t attend any child welfare institutions should be observed by a district pediatrician  within the current year. How many initial visits of this group of children should be planned?   

A. 20   

B. 100   

C. 50*   

D. 40   

E. 200   

 

 188 A 25 year old patient complains of pain in the I finger on his right hand. On examination: the finger is homogeneously hydropic, in  bent position. On attempt to unbend the finger the pain is getting worse. Acute pain appears during the probe in ligament  projection. What decease is the most likely?     

A. Thecal whitlow (ligament panaritium)*    

B. Articular (joint) panaritium    

C. Paronychia    

D. Subcutaneous panaritium    

E. Bone panaritium    

 

 189 A sergeant was injured by a shell splinter in the left subcostal area. He was bandaged with a first-aid pack on a battlefield. The  patient was delivered to the regiment medical aid station. He complains about dizziness, weakness, thirst, abdominal pain. General  condition is grave, the patient is pale. Ps is 120 bpm. Abdomen is soft, painful on palpation. The bandage is well fixed but a little bit  soaked with blood. The patient should be evacuated to the medical battalion with the following transport and in the following turn:     

A. With a passing car in the third turn   

B. With medical vehicle in the second turn   

C. With a passing car in the second turn   

D. With a passing car in the first turn   

E. With medical vehicle in the first turn*   

 

 190 A nine year old child is at a hospital with acute glomerulonephritis. Clinical and laboratory examinations show acute condition.  What nutrients must not be limited during the acute period of glomerulonephritis?   

A. Salt   

B. Carbohydrates*   

C. Proteins   

D. Liquid   

E. Fats   

 

 191 The amount of ultraviolet radiation dose was measured in minutes. What device was applied for measurement of the biodose?    

A. UV-meter   

B. Gorbachev’s biodosimeter*   

C. Actinometer   

D. Catathermometer   

E. Radiometer   

 

 192 A patient with acute purulent otitis media complicated by mastoiditis was admitted to a hospital. Roentgenogram of mastoid  processes showed the shadiowing of the cellular system on the lesion, absence of bone septa was present. What are the  necessary therapeutic actions at the second stage of mastoiditis?    

A. Tympanoplasty   

B. Mastoidotomy*   

C. Radical operation on the middle ear   

D. Cateterization of the Eustachian tube   

E. Paracentesis of the drum    

 

 193 A 30 year old patient complains about inability to become pregnant over 3 years of married life. The patient is of supernutrition  type, she has hair along the median abdominal line, on the internal thigh surface and in the peripapillary area. Menses started at the  age of 16, they are infrequent and non-profuse. US revealed that the uterus was of normal size, ovaries were 4х5х5 cm large  and had a lot of cystic inclusions. What is the most probable diagnosis?    

A. Menstrual irregularity   

B. Chronic oophoritis   

C. Bilateral ovarian tumours   

D. Polycystic ovaries*   

E. Ovarian cystoma   

 

 194 A 63 year old patient complained about pain in the lumbar area. He underwent a course of physiological treatment on account of  radiculitis but this led to no improvement of his condition. R-graphy of spinal column and pelvic bones revealed osteoporosis and  serious bone defects. Blood analysis revealed moderate normochromic anaemia, urine analysis revealed proteinuria. Whole blood  protein made up 10,7 g/l. What disease should be suspected?    

A. Acute radiculitis   

B. Myelomatosis*   

C. Urolithiasis   

D. Metastases in bones   

E. Systemic osteoporosis   

 

 195 During preventive examination a 16 year old patient presented no problems. Objectively: the patient has signs of malnutrition, he is  asthenic, AP is 110/70 mm Hg, Ps is 80 bpm, cardiac border is normal, auscultation above the cardiac apex reveals three sounds,  cardiac murmur is absent. ECG shows no pathological changes, phonocardiogram shows that the third sound comes 0,15 s after  the second one above the apex. How are these changes called?   

A. Atrial gallop rhythm   

B. Protodiastolic gallop rhythm   

C. Fout-ta-ta-rou (reduplication of the 2nd sound)   

D. IV physiological sound   

E. III physiological sound*  

 

 196 A patient has been in a hospital. The beginning of the disease was gradual: nausea, vomiting, dark urine, аcholic stools,  yellowness of the skin and scleras. The liver is protruded by 3 cm. Jaundice progressed on the 14th day of the disease. The liver  diminished in size. What complication of viral hepatitis caused deterioration of the patient’s condition?    

A. Infectious-toxic shock   

B. Meningitis   

C. Cholangitis   

D. Hepatic encephlopathy*   

E. Relapse of viral hepatitis     

 

 197 A 70 year old man is suffering from coronary heart disease. His mood is evidently depressed, anxious. As a result of continious  sleeplessness he has got fears, suicidal thoughts. He would sit for a long time in the same pose, answer after a pause, in a low,  monotonous voice. His face has a look of suffering, pain, fear. What is the main psychopathologic syndrome?      

A. Asthenic syndrome   

B. Phobic syndrome   

C. Depressive syndrome*   

D. Obsessive syndrome   

E. Paranoid syndrome   

 

 198 A 16 year old female patient underwent an operation on account of diffuse toxic goiter of the III-IV degree 12 years ago. Now she  has recurrence of thyrotoxicosis. The patient was offered operative intervention, but it is necessary first to localize the  functioning gland tissue. What method should be applied for this purpose?     

A. Roentgenography of esophagus    

B. Gland scanning*    

C. USI   

D. Puncture aspiration biopsy    

E. Roentgenography of neck    

 

 199 A woman delivered a child. It was her fifth pregnancy but the first delivery. Mother’s blood group is A(II)Rh-, newborn’s –  A(II)Rh+. The level of indirect bilirubin in umbilical blood was 58 micromole/l, haemoglobin – 140 g/l, RBC- 3,8*1012/l. In  2 hours the level of indirect bilirubin turned 82 micromole/l. The hemolytic disease of newborn (icteric-anemic type,  Rh-incompatibility) was diagnosed. Choose the therapeutic tactics:    

A. Antibiotics   

B. Replacement blood transfusion (conservative therapy)*   

C. Blood transfusion (conservative therapy)   

D. Symptomatic therapy   

E. Conservative therapy   

 

 200 In order to study impact of microclimate upon the human organism it is necessary to make systematic observation of air  temperature over 3 days. Choose a device that will allow to make the most precise temperature records:    

A. Alcohol thermometer   

B. Mercury thermometer   

C. Thermograph*   

D. August’s psychrometer   

E. Assmann psychrometer   

 

 

Krok I Variant I

Posted: May 5, 2012 in Krok I
Tags:

Variant I

 

1.A patient who is being on long-standing treatment becouse of aortic heart defect, isexamined by now. What is the direct auscultatory sign of aortic stenosis?

A)    Accentuation of the II sound at the aorta.

B)    Accentuation of the II sound at the pulmonary artery.

C)    Systolic murmur at the 2nd intercostal space rightwards from the sternum.

D)    Systolic murmur at the xyphoid process.

E)     Systolic murmur at the 2nd intercostal space leftwards from the sternum.

2. A young man is examined by military comission. Paleness of his skin is revealed as well as pulsation of carotic, brachial arteries, rrhythmicalmovments of the head. What heart defect these signs are typical for?

A)    Mitral valve incompetence.

B)    Aortic valve incompetence.

C)    Stenosis of the mitral valve.

D)    Stenosis of the aortic rout.

E)     Trycuspid valve incompetence.

3. At examination of a 30-aged  man the folloving signs are revealed: capillary pulse, positive Musse’s sign, apex beat is diffuse and displaced. Inwhichdirection the heart borders will be displaced in this case?

A)    Upwards and rightwards.

B)    Leftwards.

C)    Leftwards and rightwards.

D)    Upwards, leftwards and rightwards.

E)     Leftwards and downwards.

4. In patient S., 23 years old, pulse rate is about 100 per min. Pulse is high and quick. Blood pressure is 160/30 mm of Hg. Weakening of the I sound at heart apex, diastolic murmur at the aorta and Botkin’s point are heard by auscultation. What heart defect these signs are typical for?

A)    Stenosis of the aortic rout.

B)    Stenosis of the mitral valve.

C)    Trycuspid valve incompetence.

D)    Aortic valve incompetence.

E)     Mitral valve incompetence.

5. Patient M., 25 years old, in physical exertion suddenly has developed dizziness, pain in the heart region, and has lost consciousness. Sharp skin paleness is visible by inspection. Thrill (symptom of “cat’s purr”) is revealed at the 2nd intercostal space rightwards from the sternum. Data of auscultation: the I sound at the heart apex and the 2nd sound at the aorta are wekened. What murmur is likely to be heard in this case?

A)    Systolic murmur at the aorta.

B)    Diastolic murmur at the aorta.

C)    Systolic murmur at the heart apex.

D)    Diastolic murmur at the pulmonary artery.

E)     Systolic murmur at the pulmonary artery.

16. Patient Yu., 30 years old,  has aortic stenosis. Ultrasound examination of the heart was performed for her. Indicate, please,  EhoCG-signs of this disease:

A)    Enlargement of the right ventricular cavity.

B)    Vibration of the mitral valve’s cusps.

C)    Thikening of the aortic valve’s cusps.

D)    Change of movements of the aortic valve’s cusps.

E)     Enlargement of the left atrial cavity.

17. Patient A., 25 years old,  has aortic incompetence. Phonocardiographic examination was performed for her. Indicate, please,  PCG-signs of this disease:

A)    Systolic murmur at the heart apex.

B)    Systolic murmur at the II intercostal space leftwards from the sternum.

C)    Diastolic murmur at the heart apex.

D)    Systolic murmur at the II intercostal space rightwards from the sternum.

E)     Systolic murmur at the xyphoid process.

18. In patient S., 18 years old,  the symptoms of  aortic stenosis were revealed. Phonocardiographic examination was prescribed for him. What  PCG-signs should you expect  to obtain in this case?

A)    Systolic murmur at the heart apex.

B)    Systolic murmur at the II intercostal space leftwards from the sternum.

C)    Diastolic murmur at the heart apex.

D)    Systolic murmur at the II intercostal space rightwards from the sternum.

E)     Systolic murmur at the xyphoid process.

19. Patient C., 18 years old,  has aortic stenosis. Electrocardiographic examination was prescribed for her. What are ECG-signs of this heart defect?

A)    Hyperthrophy of the right ventricle.

B)    Hyperthrophy of the left ventricle.

C)    Hyperthrophy of the left atrium.

D)    Hyperthrophy of the right atrium.

E)     Normogram.

20. Patient A., 28 years old,  has aortic incompetence. Electrocardiographic examination was prescribed for her. What are ECG-signs of this heart defect?

A)    Hyperthrophy of the right ventricle.

B)    Hyperthrophy of the right atrium.

C)    Hyperthrophy of the left ventricle.

D)    Hyperthrophy of the left atrium.

E)     Normogram.

31. Patient R. is on the long-standing treatment in rheumatological department of a hospital becouse of mitral stenosis. Ultrasound examination of his heart was performed. What EchoCG-signs are typical for this heart defect?

A)    Enlargement of the right atrial cavity.

B)    Enlargement of the right ventricular cavity.

C)    Enlargement of the right ventriclular and left atrial cavities.

D)    Enlargement of the left ventriclular and left atrial cavities.

E)     Enlargement of both atrial cavities.

32. Patient M., 30 years old, which has signs of mitral incompetence, was examined by ultrasound method if diagnostics. What EchoCG-signs are typical for this heart defect?

A)    Enlargement of the right atrial cavity.

B)    Enlargement of the right ventricular cavity.

C)    Enlargement of the right ventriclular and right atrial cavities.

D)    Enlargement of the left ventriclular and left atrial cavities.

E)     Enlargement of both atrial cavities.

33. Patient L., 25 years old, is on the long-standing treatment becouse of mitral incompetence. Phonocardiographic examination was prescribed for her. What PCG-signs should you expect tobeobtained in this case?

A)    Weakening of the I sound at the apex.

B)    Intensification of the I sound at the apex.

C)    Prolongation of P-Q-interval.

D)    Abcense of systolic murmur.

E)     Change of Q-to-I sound interval.

34. In patient C.,48 years old, mitral stenosis was verified and phonocardiographic examination was prescribed for him. What PCG-signs should you expect in this case?

A)    Intensification of the I sound.

B)    Weakening of the I sound at the apex.

C)    Prolongation of T-to-II-sound interval.

D)    Abcense of diastolic murmur.

E)     Shortening of Q-to-I-sound interval.

35. Patient H.,36 years old, had atack of  rheumatic fever in childchood and since that time mitral incompetence had developed. X-ray examination of the patient’s heart was performed. What is the main roentgenological sign of this heart defect?

A)    Aortic heart configuration.

B)    Mitral heart configuration.

C)    Enlargement of the aortic rout.

D)    Hyperthrophy of the right ventricle.

E)     Hyperthrophy of the left ventricle.

46. Patient E., 17 years old, is reffered to the hospital by ambulance. She is suffering from sharp rising of blood pressure till 180/110 mm Hg, thirst, discharging of excess volume of urine. Symptoms typical for pheochromocytoma are revealed by physical examination. What additional method of examination is the most important in diagnostics of the disease?

A)    General blood analysis.

B)    Urine analysis.

C)    Roentgenography of bones.

D)    Ultrasound examination.

E)     Computer tomography.

47. Patient of 18 years old suffers from weakness in muscles, decreasing of blood pressure. At inspection a physitian has revealed signs of adrenal insufficiency. What colour of skin is typical for this case?

A)    Usual.

B)    Hyperaemud.

C)    Pale.

D)    Cyanotic.

E)     Bronse.

48. During inspection of patient T., 30 years old, rough voice, dryness of the skin and edematous face were detected. The patient was treated becouse of thyreoiditis in the past. What pathological condition reevealed signs are typical for?

A)    Hypothyreosis.

B)    Thyrotoxycosis.

C)    Acromegaly.

D)    Obesity.

E)     Diabetes mellitus.

49. Asigns of diffuse toxic goitre of the II-III degree were revealed in pregnant woman of 19 years old, by physical examination. Prescribe, please, the main additional method of examination for the patient, which will help to estimate function of the thyroid gland:

A)    Scanogram.

B)    Roentgenogram of the neck.

C)    Ultrasound examination of the thyroid gland.

D)    Determination of TTH, T3, T4 concentration in the blood.

E)     Determination of adrenaline, noradrenaline  concentration in the blood.

50. In the patient with adrenal insufficiency blood pressure has sharply lowered during pleurocentesis and the patient has loosed consciousness. What measures of emergency care should be performed for the patient?

A)    Injection of insulin.

B)    Injection of adrenaline.

C)    Injection of large doses of corticesteroids.

D)    Injection of mesatone.

E)     Injection of cordiaminum.

61. In the patient K., 42 years old,  mild hypertension was determined. Indicate criteria of this disease.

A)    Systolic blood pressure is 120-130 mm of Hg.

B)    Systolic blood pressure is 130-135 mm of Hg.

C)    Systolic blood pressure is 136-140 mm of Hg.

D)    Systolic blood pressure is 140-159 mm of Hg.

E)     Systolic blood pressure is 160-179 mm of Hg.

62. Patient D., 38 years old, suffers from hypertension within recent 6 years. Blood pressure violates within the limit 160/100-180/110 mm of Hg. How to evaluate this type of hypertension according to the lever of blood presure?

A)    Mild hypertension.

B)    Border hypertension.

C)    Moderate hypertension.

D)    Isolated systolic hypertension.

E)     Severe  hypertension.

63. In patient Z., 35 years old, hypertension of the II degree was established. Indicate signs typical for this degree of hypertension.

A)    High stable hypertension.

B)    Hyperthrophy of the left ventricle.

C)    Generalized narrowing of retinal vessels.

D)    Microalbuminuria.

E)     All above mentioned.

64. In patient N., 40 years old, blood pressure violates within the limit 140-149/90/94 mm of Hg. Indicate the most probable origin of hypertension in this case:

A)    Renal.

B)    Cardiovascular.

C)    Renovascular.

D)    Primary.

E)     Renoparenchimatous.

65. Patient M., 48 years old, has applied for medical advise to admissions department with complains on dizziness, headache, dull boring pain in lumbar region, high blood pressure:160/90-190/110 mm Hg, clinical  effect  after administration of hypotensive preparations is abcent. Indicate signs typical for vasorenal hypertension present in this patient:

A)    Hypertension of II-III degree.

B)    Resistance for hypotensive therapy.

C)    Pain in lumbar region.

D)    Patient’s age.

E)     All above mentioned.

76. A patient of 47 years old is on long-standing treatment with complaints on high temperature, pain in the back, swellingof the face, red colouring of urine. 1 month ago he was suffering from thore throat. Data of inspection: paleness of the skin, swelling of the face, edema in paraorbital zones of the face. Blood pressure is 200/130 mmof Hg. What is the type of hypertension in the patient?

A)    Renovascular.

B)    Renoparenchimatous.

C)    Adrenal.

D)    Hypophysary.

E)     Cardiovascular.

77. Patient of 77 years old complains of quick increasing of body weight, headache, elevation of blood pressure, enlargement of brists. Data of inspection: the face is round with deep-red  blush on the cheeks, obesity of the upper part of the body, gynaecomastia. Blood pressure is about 210/130 mm Hg. Whay disease these signs are typical for?

A)    Thyrotoxycosis.

B)    Cushing’s pituitary baasophilism.

C)    Konn’s disease.

D)    Pheochromocytoma.

E)     Hypertonic disease.

78. A patient  of 17 years old is reffered to the hospital by ambulance. Periodical sharp rising of blood pressure, hyperglycaemia and glucosuria are revealed in the patient. At attacks blood pressure rises up to 210/140 mm Hg, patient feels headache, vomits. What is the type of hypertension in the patient?

A)    Renovascular.

B)    Renoparenchimatous.

C)    Adrenal.

D)    Hypophysary.

E)     Cardiovascular.

79. The patient, 32 years old, has visited a policlinic becouse of complaints on headache and derangement of vision. Data of inspection: excessive body weight +30kg, face is moon-like with cyanotic blush, fat depoisition pattern is mostly on the upper part of the body. Blood pressure is 190/120 mm Hg. What substance in patient’s urine should you obtaine for definition of diagnosis?

A)    aldosteron

B)    vinilinmygdal acid

C)    noradrenaline

D)    ketosteroids

E)     creatitine

80. The patient A., 47 years old, suffers during recent 20 years from bronchial asthma with is characterized by  frequent attacks; she takes 3 tables of prednisolon per day permanently. The patient has noticed rising of blood pressure last time. How to characterize this change of blood pressure?

A)    essential hypertension

B)    medicamentous one

C)    adrenal hypertension

D)    thyreoid hypertension

E)     neurogenic one.

91. In patient T., 30 years old, iron-defficiency anemia is proved by laboratiry examination of blood. Indicate the most typical complaint for deffificency of iron.

A)    loosing of tactile sensation

B)     greyness of hear

C)     brittleness of nales

D)    fissures in the angles of the mouth

E)     deranged taste

92. During examination of 17-yeared patient  signs of hematologic disease are revealed. In blood analysis leucocitosis is present up to 36х109/l as well as ESR is 58 mm/hour. In which disease ESR is significantly increased?

A)    Erythremia

B)    Anemia

C)    Acute leucosis

D)    Hemophylia

E)     Myelomatosis

93. Patient A., 63 years old, is suffering from chronic myeloleucosis within recent 5 years. Exacerbations of the disease have became more frequent last year. What symptom is typical for chronic myeloleucosis?

A)    enlargement of liver

B)     hemorragic syndrome

C)     enlargement of lymph nodes

D)    enlargement of spleen

E)     all mentioned above

  1. A physitian  suspects acute leucosis in the patient with heavy necrotic angina. What canges in blood analysis indicate on acute leucosis?

A)    diminishing of amount of erythrocytes

B)    rising of leucocytes amount

C)    diminishing of leucocytes amount

D)    blast cells

E)     thrombocytopenia

  1. The longitudinal diameter of a spleen obtained bypercussion in patient M. is equal to 10,5 cm. What should be this diameter in norm?

A)    4-6 cm

B)    6-8 cm

C)    8-10 cm

D)    10-12 cm

E)     more than 12 cm

106. A man, 52 years old, was applaying for medical help becouse of complaints on frequent urination, thirst, increased appetite, pain in lower limbs, fatique. Data of objective examination: excessive body weight, dryness of skin, excoriations on the skin. Pulse is 78 per min, of satisfactory properties. Blood pressure is 150/90 mm Hg. There aren’s data about pathological changes in another internal organs. What disease is more likey  to be present in the patient?

A)    diabetes mellitus, type I

B)    diabetes mellitus, type II

C)    diabetes incipidus

D)    chronic pyelonephritis

E)     essential hypertesion

107. A man, 52 years old, was applaying for medical help becouse of complaints on frequent urination, thirst, increased appetite, pain in lower limbs, fatique. Data of objective examination: excessive body weight, dryness of skin, excoriations on the skin. Pulse is 78 per min, of satisfactory properties. Blood pressure is 150/90 mm Hg. There aren’s data about pathological changes in another internal organs. What examinations should be performed to define a diagnosis?

A)    glycemic profile and profile of glucose concentration in urine

B)    general blood analysis and biochemical blood analysis

C)    determination of sugar content in the blood and its presence in the urine

D)    determination of sugar content in the blood, coagulogram

E)     determination of insuline content in the blood.

108. Patient K., 42 years old, is suffering from diabetes mellitus, type I,  within recent 16 years. Rising of blood pressure was recorded in him last 2 months as well as pufiness of the face in the morning, dryness in the mouth, pain in the lower limbs. What  complication among following is probably present in the patient?

A)    essential hypertension

B)    diabetic nephropathy

C)    diabetic polyneuropathy

D)    diabetic angiopathy

A)    chronic pyelonephritis

109. In patient N., 20 years old, thirst, frequent urination were observed within recent 2 weeks as well as loosing of body weight while his appetite is increased, general and muscular weakness, abdominal pain, vomiting. Hyperaemia of cheeks, dryness of skin sre obcerved by inspection. Pulse is 90 per min, blood pressure is 125/85 mm Hg. There aren’t data about pathological changes in another internal organs. What disease is more likey  to be present in the patient?

A)    diabetes mellitus, type I

B)    diabetes mellitus, type II

C)    diabetes incipidus

D)    acute appendicitis

E)     difuse toxic goitre

110. In patient N., 20 years old, thirst, frequent urination were observed within recent 2 weeks as well as loosing of body weight while his appetite is increased, general and muscular weakness, abdominal pain, vomiting. Hyperaemia of cheeks, dryness of skin sre obcerved by inspection. Pulse is 90 per min, blood pressure is 125/85 mm Hg. There aren’t data about pathological changes in another internal organs. What examinations should be performed in the first order to define a diagnosis?

A)    general blood analysis, determination of sugar content in the blood

B)    biochemical blood analysis, common urinalysis

C)    determination of sugar content in the blood, determination of sugar and acetone presence in the urine

D)    coagulogram, biochemical blood analysis

E)     Analysis of urine by Nechiporenko, biochemical blood analysis

121. In a patient rising of body temperature up to 38,5-39 °C was established. The morning amount of discharged sputum is insignificant, its character is mucous, smell is unpleasant, sometimes blood streaks are present in the sputum. “Ditrich plagues” are revealed by microscopic examination. What disease of respiratory system this sputum is typical for?

A)    bronchial asthma

B)    chronic bronchitis

C)    bronchiectatic disease

D)    lobar pneumonia

E)     lung emphyzema

122. By objective examination of a patient the following data were revealed: vocal fremitus is intensified downwards from the left scapular angle, percutory sound is dull, bronchial breathing and bronchophony are present here. What syndrome these symptoms are typical for?

A)    The syndrome of pulmonary tissue consolidation

B)    The syndrome of fluid accumulation in the pleural cavity

C)    The syndrome of air overfeeling of lungs

D)    The syndrome of air accumulation in the pleural cavity

E)     The syndrome of bronchial obstruction.

123. By objective examination of a patient the following data are revealed: lagging of the right  part of the chest in respiration, vocal fremitus and bronchophony are abcent  from thisside, dull percutory sound is heard, respiration is not heard. What syndrome these symptoms are typical for?

A)    The syndrome of pulmonary tissue consolidation

B)    The syndrome of presence of cavity in the lungs

C)    The syndrome of fluid accumulation in the pleural cavity

D)    The syndrome of air overfeeling of lungs

E)     The syndrome of bronchial ectasia.

124. By objective examination of a patient the following data are revealed:  accesory muscles take part in respirationthe character of  percutory sound is clear lung sound, respiration is harsh vesicular with prolonged expiration, multiply disseminated dry whistling sounds are heard. What syndrome these symptoms are typical for?

A)    The syndrome of bronchial obstruction

B)    The syndrome of fluid accumulation in the pleural cavity

C)    The syndrome of pulmonary tissue consolidation

D)    The syndrome of air overfeeling of lungs

E)     The syndrome of air accumulation in the pleural cavity

125. By objective examination of a patient the following data are revealed over the entire surface of the chest: equal weakening of vocal fremitus, bundbox percutory sound, weakening of vesicular breathing, absence of bronchophonia. What syndrome these symptoms are typical for?

A)    The syndrome of pulmonary tissue consolidation

B)    The syndrome of air overfeeling of lungs

C)    The syndrome of fluid accumulation in the pleural cavity

D)    The syndrome of air accumulation in the pleural cavity

E)     The syndrome of bronchial obstruction

136. During deep palpation of an abdomen it was established that sigmoid intestine is enlarged and of solid consistence, its surface is tuberous. Which methods of examination will help to define a disagnosis?

A)    Plain  X-ray examination of intestine

B)    colonoscopy

C)    irigoscopy

D)    rectoromanoscopy

E)     coprogram

137. During microscopic examination of feces considerable amount of neutral fats and changed muscular fibers were revealed as well as mass of extracellular starch, soaps and significant amount of cristals of fatty acids. What coprological syndrome these data are typical for?

A)    colic

B)    cholecystitis

C)    pancreatitis

D)    peptic ulcer

E)     enteritis

138. A patient complains of periodical pain in the right hypohondrium, nausea, bitter taste in the mouth, belching, decreasing of appetite. Diseases of which organs should you suspect in this case?

A)    liver and bile  ducts

B)     stomach

C)     intestine

D)    pancreas

E)     esophagus

139. A patient was reffered to a hospital with complaints on sharp pain in the right hypochondrium and vomiting. Pain has developed after intake of fatty and spicy food. Tenderness and pain in the right hypochondrium are revealed by palpation. What pathological condition should you suspect in this case?

A)    billiary colic

B)    exacerbation of peptic ulcer

C)    exacerbation of chronic pancreatitis

D)    exacerbation of chronic colitis

E)     exacerbation of chronic enteritis

140. A patient complains of pain in the right hypochondrium. The upper border  of liver dullness is not changed. The lower liver endge is 5 cm downwards from the costal arch by palpation. The liver margin is solid, arounded, painful, liver surface is smooth. What may be the causes of presented changes of liver margin?

A)    Echinococcosis.

B)     Tumor of the liver

C)    liver cirrhosis

D)    hepatitis.

151. A patient is troubled by dull boring pain in the upper part of the abdomen, instable stool, belching with ameel of rotten eggs.  What disease this belching is  typical for?

A)    stomach ulcer

B)    duodenal ulcer

C)    stomach cancer

D)    liver cyrrosis

E)     pancreatitis

152. A patient with stomach ulcer feels diminishing of abdominal pain intensity and appearance of general weakness. He is trobled by vomiting with masses like “coffee ground”. What pathological condition  such vomiting is  typical for?

A)    pylorostenosis

B)    stomach bleeding on the phone of ahylia

C)    stomach bleeding on the phone of nornochlorhydria or hyperchlorhydria

D)    coffee abuse

E)     perforation of ulser

153. Fractional testing of stomach secreation was performed to a patient with peptic ulcer. Increase acidity was defined. What changes of stool are typical for such patients?

A)    constipation

B)    diarrhoea

C)    constipation and diarrhoea consequently

D)    normal stool

E)     feces with undigested food

154. Data of ECG: rrythm is sinual, regular, heart rate is 70 per min. Voltage is preserved. Electrical axis deviation: angle a 10 0 – deviated leftwards. Disorders of myocardial repolarization. When heart rrhythm is suggested to be regular?

A)    The difference between R-R intervalsis more than 10 %

B)    The difference between R-R intervalsis not more than 0,1 sec

C)    The difference between R-R intervalsis more than 0,1 sec

D)    The difference between R-R intervalsis  more than 0,2 sec

E)     The difference between R-R intervalsis more than 0,3 sec

155. Data of ECG: rrythm is sinual, regular, heart rate is 76 per min. Voltage is preserved. Electrical axis is horizontal. Signs of hypoxia of myacardium.  What is irregular heart rrhythm?

A)    P wave is negative before each complex QRS

B)    P wave is positive before each complex QRS, duration of R-R varies within the rate 0,15-0,45 sec

C)    P wave is positive before each complex QRS, duration of R-R nears 0,10 sec

D)    P wave is of disserent amplitude  and shape  before each complex QRS

E)     P wave is present not before  each complex QRS, duration of P-Q interval varies within the rate 0,25-0,35 sec

161. During analysis of ECG a student has noticed that the wave P is negative in lead aVR, its duration is 0,08 sec. When it may be?

A)    Hyperthrophy of both atriums

B)    In norm

C)    In intraatrial block

D)    In atrial extrasystole

E)     In myocardial infarction of anterriolateral wall of the left ventracle.

162. During analysis of ECG a student has made conclusion that electrical heart axis is deviated rightwards. What signs are necessary tohave to make such a conclusion?

A)     in the I standart lead wave R is the highest while in the III the – wave S is the deepest.

B)      in the III standart lead wave R is the highest while in the I the – wave S is the deepest.

C)      wave R is the highest in the I standart lead.

D)     wave R is the highest in the II standart lead

E)      wave R is the highest in the III standart lead

163. During analysis of ECG a student has made conclusion that electrical heart axis is deviated leftwards. What signs are necessary to have to meake such a conclusion?

A)    in the I standart lead wave R is the highest while in the III tne – wave S is the deepest.

B)    in the III standart lead wave R is the highest while in the I tne – wave S is the deepest.

C)    wave R is the highest in the I standart lead.

D)    wave R is the highest in the II standart lead

E)     wave R is the highest in the III standart lead

164. During analysis of ECG a student has made conclusion that electrical heart axis is not deviated. What signs are necessary to have to meake such a conclusion?

A)    in the I standart lead wave R is the highest while in the III tne – wave S is the deepest.

B)    in the III standart lead wave R is the highest while in the I tne – wave S is the deepest.

C)    wave R is the highest in the I standart lead.

D)    wave R is the highest in the II standart lead

E)     wave R is the highest in the III standart lead

165. Analysing ECG a student has checked that wave T is negative in aVR and V1.  What does ot testify about?

A)    It may be in norm

B)    Subepicardial ischemia

C)    Subendocardial ischemia

D)    Hypoxia of myacardium

E)     About postinfarctional scar.

Krok I Foering 4 year

Posted: May 5, 2012 in Krok I
Tags:

(М/б) 1. A patient with complaints of 3-day-long fever, general weakness, loss of appetite came to visit the infectionist. The doctor suspected enteric fever. Which method of laboratory diagnosis is the best to confirm the diagnosis?

A. Detachment of pure culture

B. Detachment of urine culture

C. Detachment of blood culture

D. Detachment of myeloculture

E. Detachment of feces culture

2. A 63-year-old woman developed symptoms of rheumatoid arthritis. Their increase of which blood values indicators could be the most significant in proving the diagnosis?

A. Acid phosphatase

B. Lipoproteids

C. R-glycosidase

D. General cholesterol

E. Additive glycosaminoglycans

(Н.Ф/П.Ф/Б.Х) 3. There is an inhibited coagulation in the patients with bile ducts obstruction, bleedi ng due to the low level of absorbtion of a vitamin. What vitamin is in deficiency?

A. K

B. D

C. Carotene

D. A

E. E

(Н.Ф/Б.Х) 4. The alveolar ventilation of the patient is 5 L/min, the breath frequency is 10 per/mm] and the tidal volume is 700 ml. What is the patient’s dead space ventilation?

A. 4,3 L/min

B. 1,0 L/min

C. 2,0 L/min

D. 0,7 L/min

E.

(Н.Ф/П.Ф) 5. A 16 year-old patient got numerous traumas in automobile accident. Now the patient is haning a shock. AP – 80/60 mm Hg. daily urine volume 60-80 ml. What pathogenic mechanism leads to kidneys function violation?

A. Decreased hydrostatic pressure in glomerular capillaries

B. Trauma of the urinary bladder

C. Increased vasopressin blood concentrati on

D. Increased pressure in Bowman’s capsule

E. Increased osmotic pressure in glomerular capillaries

6. The alternate usage of dichlotiazide, etacrin acid and lasex did not cause marked diuretic effect in the patient with marked peripheral edema. The aldosterone level in the blood is increased. Indicate which medicine should be prescribed:

A. Mannit

B. Amilorid

C. Clopamid D.Urea

E. Spironolacton

(гіс.) 7. The reason of occurrence of some diseases of an oral cavity is connected with structural peculiarities of its mucous membrane. What morphological attributes characterize these features?

A. No muscularis mucosa, stratified squamous epithelium

B. Transitional epithelium, no submucosa

C. Well developed muscularis, no submucosa

D. Transitional epithelium, no muscularis mucosa

E. Simple columnar ciliated epithelium

(А) 8. A 45-year-old man fell on the right knee and felt the acute pain in the joint. On examination: severe edema on the anterior surface of the knee joint. Crunching sounds are heard while moving the joint. Which bone is destroyed?

A. Left epicondyle of the thigh

B. Knee-cap

C. Right epicondyle of the thigh

D. Head of the thigh bone

E. Neck of the thigh bone

(А) 9. During the fetal period of the development in the vascular system of the fetus a large arterial (Botallo’s) duct is functioning which converts into lig.artemosum after birth. What anatomi cal formations does this duct connect?

A. Aorta and inferior vena cava

B. Right and left auricle

C. Pulmonary trunk and aorta

D. Aorta and superior vena cava

E. Pulmonary trunk and superior vena cava

(А) 10. A patient has a malignisation of thoracic part of esophagus. What lymphatic nodes are regional for this organ?

A. Nodi lymphatici mediastinales posteriores

B. Nodi lymphatici prevertebralis

C. Anulus lymphaticus cardiac

D. Nodi lymphatici paratrachealis

E. Nodi lymphatici pericardiales laterales

(Н.Ф/П.Ф) 11. Glomerular filtration rate (GFR) increased by 20% due to prolonged starvati on of the person. The most evident cause of filtration changes under this conditions is:

A. Increase of penetration of the renal filter

B. Decrease of oncotic pressure of blood plasma

C. Increase of filtration coefficient

D. Increase of renal plasma stream

E. Increase of systemic blood pressure

(Н.Ф) 12. A 60-year-old patient was diagnosed with hypothalamic lateral nuclei stroke. What changes in patient’s behavior may be expected?

A. Thirst

B. Aggressive behaviour

C. The rejection of food

D. Depression

E. Unsatisfied hunger

(Н.Ф) 13. The energy inputs of a healthy man have been measured. In what position was the patient if his energy inputs were less than the main exchange?

A. Sleep

B. Calmness

C. Easy work

D. Nervous exertion

E. Rest

(Н.Ф/П.Ф.) 14. A 2-year-old child has got intestinal dysbacteriosis, which results in hemorrhagic syndrome. What is the most likely cause of hemorrhage of the child?

A. Vitamin K insufficiency

B. PP hypovitaminosis

C. Fibrinogen deficiency

D. Hypocalcemia

E. Activation of tissue thromboplastin

(М/б) 15. A patient who came to the doctor because of his infertility was administered to make tests for toxoplasmosis and chronic gonorrhoea. Which reaction should be performed to reveal latent toxoplasmosis and chronic gonorrhoea of the patient?

A. RDHA – Reverse direct hemagglutinati- on assay

B. (R)CFT- Reiter’s complement fixation test

C. IFA – Immunofluorescence assay

D. RIHA – Reverse indirect hemagglutinati- on assay

E. Immunoblot analysis

(Б/Х) 16. Synthesis of phospholipids is disordered under the liver fat infiltration. Indicate which of the following substances can enhance the process of methylation during phospholipids synthesis?

A. Citrate

B. Glycerin

C. Methionine

D. Glucose

E. Ascorbic acid

(П.Ф./Ф.) 17. A patient had been taking glucocorticoi- ds for a long time. When the preparation was withdrawn he developed the symptoms of disease aggravation, decreased blood pressure and weakness. What is the reason of this condition?

A. Sensibilization

B. Habituation

C. Hyperproduction of ACTH

D. Appearance of adrenal insufficiency

E. Cumulation

(Н.Ф) 18. Blood sampling for bulk analysis is recommended to be performed on an empty stomack and in the morning. What changes in blood composition can occur if to perform blood sampling after food intake?

A. Reduced contents of erythrocytes

B. Increased contents of leukocytes

C. Reduced contents of thrombocytes

D. Increased contents of erythrocytes

E. Increased plasma proteins

(П/А) 19. An autopsy has revealed that kidneys are enlarged, surface is large-granular because of multiple cavities with smooth wall, which are filled with clear fluid. What kidney disease did the patient have?

A. Glomerulonephritis

B. Infarction

C. Necrotic nephrosis

D. Pyelonephritis

E. Polycystic kidney

(Б.Х,) 20. Galactosemia has been revealed in a child. Concentration of glucose in the blood has not considerably changed. What enzyme deficiency caused this illness?

A. Galactokinase

B. Hexokinase

C. Amylo-l,6-glucosidase

D. Phosphoglucomutase

E. Galactose-1-phosphate uridyltransferase

(М/Б. П/Ф) 21. A 27- year-old woman has used penicillin containing eye drops. In a few minutes itching, skin burning, lips and eyelids edema, whistling cough, decreasing BP appeared. What antibodies can lead to this allergic reaction?

A. IgM and IgG

B. IgM and IgD

C. IgA and IgM

D. IgG and IgD

E. IgE and IgG

(П/А) 22. Autopsy of the 58-year-old man hads revealed that mitral valve is deformed, thickened, does not totally close. Microscopically: centers of collagen fibers are eosinophilic, have positive fibrin reaction. The most probable diagnosis is:

A. Amyloidosis

B. Fibrinoid swelling

C. Hyalinosis

D. Mucoid swelling

E. Fibrinoid inflammation

(Ф) 23. A 37-year-old man was admitted to the surgical department with the symptoms of acute pancreatitis: vomiti ng, diarrhea, bradycardia, hypotention, weakness, dehydration of the organism. What medicine should be used first of all?

A. Etaperazine

B. No-spa

C. Platyphylline

D. Ephedrine

E. Contrycal

Б/Х, П/Ф) 24. The gluconeogenesis is activated in the liver after intensive physical trainings .What substance is utilized in gluconeogenesis first of all in this case:

A. Lactate

B. Alanine

C. Glutamate

D. Pyruvate

E. Glucose

(Ф) 25. A doctor administered Allopurinol to a 26-year-old young man with the symptoms of gout. What pharmacological action of Allopurinol ensures therapeutical effect?

A. By increasing uric acid excretion

B. By inhibiting leucocyte migration into the joint

C. By inhibiting uric acid synthesis

D. By general analgetic effect

E. By general anti-inflammatory effect

(Б) 26. A woman who was sick with rubella during the pregnancy gave birth to a deaf child with hare lip and cleft palate. This congenital defect is an example of:

A. Phenocopy

B. Patau’s syndrome

C. Genocopy

D. Edward’s syndrome

E. Down’s syndrome

(Б/Х) 27. Hydroxylation of endogenous substrates and xenobiotics requires a donor of protons. Which of the following vitamins can play this role?

A. Vitamin A

B. Vitamin P

C. Vitamin B

D. Vitamin C

E. Vitamin E

(Б/Х) 28. A denaturation of proteins can be found in some substances. Specify the substance that is used for the incomplete denaturation of hemoglobin:

A. Toluene

B. Faux lupinum

B. Nitric acid

C. Sulfuric acid

D. Urea

E. Sodium hydroxide

(М/Б) 29. A 60-year-old patient was hospitali sed to the surgical department because of infection caused by blue pus bacillus (Pseudomonas aeruginosa) which is sensative to penicillin antibiotics. Indicate which of the given penicillins has marked activity to the Pseudomonas aeruginosa?

A. PhenOxymethylpenicillin

B. Methicillin

C. Oxacillin

D. Carbenicillin disodium

E. Benzylpenicillin

(Б) 30. A woman who was infected with toxoplasmosis during the pregnancy has a child with multiple congenital defects. This is a result of:

A. Recombination

B. Cancerogenesis

C. Teratogenesis

D. Biological mutogenesis

E. Chemical mutogenesis

(Б/Х) 31. A patient, who suffers from congeni tal erythropoietic porphyria, has skin photosensitivity. The accumulation of what compound in the skin can cause it?

A. Coproporphyrinogen 3

B. Uroporphyrinogen 2

C. Protoporphyrin

D. Heme

E. Uroporphyrinogen 1

(Ф) 32. A 42-year-old man who has been injured in a car accident is brought into the emergency room. His blood alcohol level on admission is 250 mg/dL. Hospital records show a prior hospitalization for alcohol related seizures. His wife confirms that he has been drinking heavily for 3 weeks. What treatment should be provided to the patient if he goes into withdrawal?

A. Pentobarbital

B. Diazepam

C. Phenobarbital

D. Phenytoin

E. None

(Б) 33. Nowadays about 50 minor bases have been found in the t-RNA structure besides the main four nitrogenous bases. Choose the minor nitrogenous base:

A. Adenine

B. Uracil

C. Cytosine

D. Cysteine

E. Dihydrouracil

(Н.Ф) 34. In the microspecimen of red bone marrow multiple capillares were revealed through the walls of which mature blood cells penetrated. What type of capillares is it?

A. Lymphatic

B. Fenestrational

C. Sinusoidal

D. Somatical

E. Visceral

(А) 35. A mother of a newborn complains of her baby’s constant belching with undigested milk. Which developmental anomaly is it an evidence of?

A. Esophageal atresia

C. Labium leporium

D. Anal atresia

E. Esophageal fistula

(П.А) 36. A 16-year-old boy was performed an appendectomy. He has been hospitalized for right lower quadrant abdominal pain within 18 hours. The surgical specimen is edematous and erythematous. Infiltration by what of the following cells is the most typical for the process occuring here?

A. Eosinophils

B. Monocytes

C. Basophils

D. Limphocytes

E. Neutrophils

(Б/Х Н.Ф/П.Ф) 37. When the pH level of the stomach lumen decreases to less than 3, the antrum of the stomach releases peptide that acts in paracrine fashion to inhibit gastrin release. This peptide is:

A. Acetylcholine

B. Somatostatin

C. Vasoactive intestinal peptide (VIP)

D. Gastrin-releasing peptide (GRP)

E.GIF

(Б/Х Н.Ф) 38. The formation of a secondary mediator is obligatory in membrane-intracellular mechanism of hormone action. Point out the substance that is unable to be a secondary mediator:

A. Diacylglycerol

B. Ca2+

C. CAMP

D. Inositol-3,4,5-triphosphate

E.Glycerol

(Б/Х Н.Ф) 39. There is only one hormone among the neurohormones which refers to the derivatives of amino acids according to classification. Point it out:

A. Oxytocin

B. Melatonin

C. Vasopressin

D. Thyroliberin

E. Somatotropin

(Н.Ф–Ф–П/Ф) 40. The preventive radioprotector was gi ven to a worker of a nuclear power station. What mechanism from the below menti oned is considered to be the main mechani sm of radioprotection?

A. Increasing of respiration

B. Activation of oxidation reactions

C. Prevention of tissue’s hypoxia

D. Inhibition of free radicals formation

E. Increasing of tissue blood supply

(Н.Ф–П/Ф) 41. A 62-year-old patient was admitted to the neurological department due to cerebral haemorrage. His condition is grave. There is evident progression of deep and frequent breath that turnes into reduction to apnoea and the cycle repeates. What respiration type has developed in the patient?

A. Apneustic respiration

B. Cheyne-Stockes respiration

C. Kussmaul respiration

D. Gasping respiration

E. Biot’s respiration

(Ф) 42. A 58-year-old female has undergone surgery for necrotic bowel. Despite having been treated with antibiotics, on postoperative day 5, she develops symptoms (fever, hypotension, tachycardia, declining urine output, and confusion) consistent with septic shock. What hemodynamic support would be helpful?

A. Fluids and Dobutamine infusion

B. Dobutamine infusion

C. Fluid administration

D. Atropine administration

E. Antibiotic administration

(Б/Х–П/А–П/Ф) 43. Some diseases reveal symptoms of aldosteronism with hypertension and Edema due to sodium retention in the organism. What organ of the internal secretion is affected on aldosteronism?

A. Hypophysis

B. Ovaries

C. Adrenal glands

D. Testicle

E. Pancreas

(Б–П/Ф) 44. A couple came for medical genetic counseling. The man has hemophilia, the woman is healthy and there were no cases of hemophilia in her family. What is the risk of having a sick child in this family?

A. 100 %

B. 50 %

C. 75 %

D. 0

E. 25%

(А) 45. A patient has elbow joint trauma with avulsion of medial epicondyle of humerus. What nerve can be damaged in this trauma?

A. Cardiac cutaneous nerve

B. Medial cutaneous nerve of forearm

C. Musculocutaneous nerve

D. Ulnar

E. Radial

(А) 46. A 18-year-old patient came to the outpatient department with the complaints of bleeding trauma in the vestibule of his nose. On examination: the mechanical injure of the mucous layer of the vestibule without continuation into nasal cavity proper. What is the boundary between the vestibule and nasal cavity proper?

A. Nasal septa

B. Choanes

C. Nasal roller

D. Nostrils

E. Nasal limen

(А) 47. A young man felt sharp pain in the back \ during active tightening on the horizontal bar. Objectively: pain while moving upper extremity, limited pronation and adduction functions. Sprain of what muscle can be observed here?

A. M. romboideus major

B. M. trapezius

C. M. levator scapulae

D. M. subscapularis

E. M. latissimus dorsi

(А) 48. A 55-year-old patien was hospitalized in result of the trauma of the medial group of femoral muscles. What kind of movements is the patient unable to do?

A. Suppination of femur

B. Flexion of femur

C. Extension of femur

D. Adduction of femur

E. Abduction of femur

(Б/х) 49. Patient with diabetes mellitus experi enced loss of consciousness and convulsions after an injection of insulin. What might be the result of biochemical blood analysis for concentration of sugar?

A. 5,5 mmol/L

B. 3,3 mmol/L

C. 10,0 mmol/L

D. 1,5 mmol/L

E. 8,0 mmol/L

(А) 50. A 45-year-old man with domestic apper arm injuiry came to the trauma unit. The objective data are: there are no extension, adduction or pronation functions of the arm. What muscle damage caused this condition?

A. Supraspinous

B. Teres minor

C. Teres major

D. Subscapular

E. Subspinous

(Н.Ф–Б/Х–П/Ф) 51. Chronic glomerulonephritis was diagnosed in a 34-year-old patient 3 years ago. Edema has developed within the last 6 monthes. What caused the edema?

A. Hyperproduction of vasopressin

B. Liver disfunction of protein formation

C. Proteinuria

D. Hyperosmolarity of plasma

E. Hyperaldosteronism

(Г–Н/Ф–П/Ф) 52. A 2-year-old child experienced convulsions because of lowering calcium ions concentration in the blood plasma. Function of what structure is decreased?

A. Adrenal cortex

B. Thymus

C. Parathyroid glands

D. Pineal gland

E. Hypophysis

(П/Ф) 53. A patient visited a dentist with complaints of redness and edema of his mouth mucous membrane in a month after dental prosthesis. The patient was diagnosed with allergic stomatitis. What type of allergic reaction by Gell and Cumbs underlies this disease?

A. Stimulating

B. Immunocomplex

C. Delayed type hypersensitivity

D. Cytotoxic

E. Anaphylactic

(М/Б–П/Ф) 54. Blood analysis of a patient showed signs of HIV infection (human immunodeficiency virus). Which cells does HIV-virus primarily affect?

A. Mast cells

B. Cells that contain receptor T4 (T-helpers)

C. Cells that contain receptor IgM (B- lymphocytes)

D. Specialized nervous cells (neurons)

E. Proliferating cells (stem hematoplastic cells)

(П/Ф) 55. The calcium canals of cardiomyocytes have been blocked on an isolated rabbit’s heart. What changes in the heart’s activity can happen as a result?

A. Heart stops in systole

B. Decreased rate and force of heart beat

C. Decreased heart beat rate

D. Decreased force of the contraction

E. Heart stops in diastole

(Б/Х) 56. Substitution of the glutamic acid on valine was revealed while examining initi al molecular structure. For what inherited pathology is this symptom typical?

A. Favism

B. Hemoglobinosis

C. Sickle-cell anemia

D. Minkowsky-Shauffard disease

E. Thalassemia

(А) 57. A 50 year-old patient had hemorrhage ” of the brain and was taken to the hospital. The place of hemorrhage was revealed on the lateral hemispheres surfaces during the medical examination. What artetywas injured ?

A. The posterior cerebral artery

B. The middle cerebral artery

C. The anterior communicating artery

D. The posterior communicating artery

E. The anterior cerebral artery

(Ф) 58. A 25-year-old woman with red and itchy eczematoid dermatitis visits your office. She had a dental procedure one day earlier with administration of a local anesthetic. There were no other findings, although she indicated that she had a history of allergic reactions. Which of the following drugs is most likely involved?

A. Cocaine

B. Lidocaine

C. Procaine

D. Etidocaine

E. Bupivacaine

(П/А) 59. Decreased blood supply to the organs causes hypoxia that activates fibroblasts function. Volume of what elements is increased in this case?

A. Nerve elements

B. Vessels of microcircular stream

C. Parenchymatous elements of the organ

D. Intercellular substance

E. Lymphatic vessels

(Н.Ф–П/Ф) 60. A patient with hypersecretion of the gastric juices was recomended to exclude concentrated bouillons and vegetable decoctions from the diet because of their stimulation of gastric secretion. What is dominating mechanism of stimulation of secreti on in this case?

A. Stimulation of gastrin production by G-cells

B. Stimulation of excretion of secretin in the duodenum

C. Irritation of taste receptors

D. Irritation of mechanoreceptors of the stomach

E. Irritation of mechanoreceptors of the oral cavity

(Н.Ф–П/Ф) 61. During the experiment on the influence of chemical substances in the muscles the reaction of Ca2+-pump is weakened. Which phenomenum will be observed?

A. Prolonged relaxation

B. Activation of the sodium-potassium pump

C. Decreased velocity of the AP distribution

D. Decreased AP

E. Prolonged duration of the AP

(М/Б) 62. Scraps of the mycelium of a fungus, spores, air bubbles and fat drops were discovered on microscopy of the patient’s hair excluded from the infected areas. What fungus disease is characterised by this mi croscopic picture?

A. Microspory

B. Epidermophytosis

C. Sporotrichosis

D. Trichophytosis

E. Favus

(А) 63. A patient suffering from trombophlebitis of deep veins suddenly died. The autopsy has shown freely lying red friable masses with dim crimped surface in the trunk and bifurcation of the pulmonary artery. What pathologic process was revealed by the morbid anatomist?

A. Fat embolism

B. Tissue embolism

C. Embolism with foreign body

D. Thrombosis

E. Tromboembolism

(П/А) 64. A patient died from acute cardiac insufficiency. The histological examination of his heart revealed the necrotized section in myocardium of the left ventricle, which was separated from undamaged tissue by the zone of hyperimic vessels, small hemorrhages and leukocytic infiltration. What is the most likely diagnosis?

A. Myocardial ischemic dystrophy

B. Myocardial infarction

C. Focal exudate myocarditis

D. Productive myocarditis

E. Diffuse exudate myocarditis

(А) 65. The increased intraocular tension is observed in a patient with glaucoma. Secretion of aqueous humor by the ciliar body is normal. Injury of what structure of the eyeball caused the disorder of flow-out from the anterior chamber?

A. Choroid

B. Venous sinus

C. Back epithelium of cornea

D. Ciliar body

E. Ciliary muscle

(Б) 66. A 10-year-old child complains of weakness, nausea, irritability. Helminthes of white color and 5-10 mm long have been found on the underwear. On microscopy of the scrape from the perianal folds achromicova of the unsymmetrical form have been revealed. Which helminth is in the organism of the child?

A. Trichina

B. Enterobins vermicularis

C. Trichuris

D. Ancylostoma duodenalis

E. Ascaris lumbricoides

(Ф) 67. A 55-year-old patient with continuing ventricular arrhythmias was admitted to the hospital. The patient is taking timolol drops for glaucoma, daily insulin injections for diabetes mellitus, and an ACE inhibitor for hypertension. You have decided to use phenytoin instead of procainamide. What is the reason?

A. The anticholinergic effect of procainami de would aggravate glaucoma

B. The cholinergic effects of procainamide would aggravate the diabetes

C. The hypertensive effects of procainamide would aggravate the hypertension

D. The local anesthetic effect of procainami de would potentiate diabetes

E. The local anesthetic effect of procainami de would aggravate the hypertension

(М/Б) 68.. A patient with abscess of the cut wound applied to the traumatological department.The wound was washed with 3% hydrogen peroxide to be cleaned from the pus. Foam was not observed. What caused inefficiency of the drug?

A. Shallow wound

B. Pus in the wound

C. Inherited insufficiency erythrocyte’s phosphatdehydrogenase

D. Inherited insufficiency of catalase

E. Low concentration

(Б/Х) 69. In case of enterobiasis acrihine – the structural analogue of vitamin – is admi nistered. The synthesis disorder of which enzymes does this medicine cause in mi croorganisms?

A. FAD-dependent dehydrogenases

B. Aminotransferases

C. NAD-dependet dehydrogenases

D. Cytochromeoxidases

E. Peptidases

(П/А) 70. A 40-year-old woman has had a feeling of abdominal discomfort for the past 8 months. On pelvic examination, there is the right adnexal mass. Abdominal CT scan demonstrates a 7 cm cystic mass involving the right ovary with small areas of calcification. The uterus is normal in size. The right fallopian tube and ovary have been removed surgically. Grossly, the mass on sectioning is filled with abundant hair and sebum. Microscopically, the mass has glandular spaces lined by columnar epithelium, squamous epithelium with hair follicles, cartilage, and dense connective tissue. What type of tumour is it?

A. Melanoma

B. Squamous cell carcinoma of ovary

C. Sarcoma of ovary

D. Metastase of cervical carcinoma

E. Teratoma

(Б) 71. On autopsy of a still-born infant abnormalities have been revealed: ventri cles are not separated, a single arterial trunk originates from the right part. For what class of vertebrates is such heart construction characteristic?

A. Birds

B. Mammals

C. Amphibian

D. Fishes

E. Reptiles

(М/Б) 72. At the aboratory experiment the eukocyte culture was mixed with staphylococci. Neutrophile leukocytes engulfed and digested bacterial cells. This processes are termed:

A. Facilitated diffusion

B. Pinocytosis

C. Phagocytosis

D. Diffusion

E. Osmosis

(А) 73. A 19 year-old patient was diagnosed with appendicitis and was hospitalized. The surgical operation on ablating appendix vermiformis is to be performed. What artery must be fixed to stop bleeding during the surgical operation?

A. The iliac

B. The colica sinistra

C. The colica dextra

D. The ileocolic artery

E. The colica media

(Н.Ф) 74. A patient with tissue trauma was taken a blood sample for the determination of blood clotting parameters. Specify the right sequence of extrinsic pathway activation.

A. IV – Vila – Xa

B. Ill – Vila – Xa

C. Ill – IV – Xa

D. Ill-VIII: TF-Xa

E.IV-VIII:TF-Xa

(П/А–П/Ф) 75. A patient in three weeks after acute myocardial infarction has pain in the heart and joints and pneumonia. What is the main mechanism of development of post- infarction Dressler’s syndrome?

A. Thrombosis vessels

B. Autoimmune inflammation

C. Secondary infection

D. Ischemia of myocardium

E. Resorption of enzymes from necrotized area of myocardium

(П/А) 76. A young man has an unpainfull formati on without marked borders in the soft ti ssues of his thigh. On the tissue bioptate the formation lookes like flesh of fish and consists of immature fibroblast-like cells with multiple mitosis growing through the muscles. What is the most likely diagnosis?

A. Myoma

B. Fibroma

C. Myosarcoma

D. Cancer

E. Fibrosarcoma

(А) 77. Usually the intravenous injection is done into median cubital vein because it is slightly movable due to fixation by the soft tissues. What does it fix in the cubital fossa?

A. Brachioradial muscle

B. Tendon of the triceps muscle

C. Anconeus muscle

D. Aponeurosis of biceps muscle

E. Brachial muscle

(Б/Х) 78. Marked increase of activity of MB- forms of CPK (creatinephosphokinase) and LDH-1 was revealed by examination of the patient’s blood. What is the most probable pathology?

A. Cholecystitis

B. Rheumatism

C. Pancreatitis

D. Miocardial infarction

E. Hepatitis

(П/А) 79. A 50-year-old man has felt vague abdominal discomfort within past 4 months. Physical examination revealed no lymphadenopathy , and no abdominal masses or organomegalyat palpation. Bowel sounds are heard. An abdominal CT scan shows a 20 cm retroperitoneal soft tissue mass obscuring the left psoas muscle. A stool specimen tested for occult blood is negative. Which of the following neoplasmsis this man most likely to have?

A. Adenocarcinoma

B. Lipoma

C. Lymphoma

D. Hamartoma

E. Melanoma

(А) 80. During the operation on the hip joint of a 5-year-old child her ligament was damaged which caused bleeding. What ligament was damaged?

A. The head of the thigh

B. Pubofemoral

C. Perpendicular of the acetabule

D. Iliofemoral

E. Ischiofemoral

(М/Б) 81. From the nasopharynx of a 5-year- old child a microorganism was excreted which is identical to Corynebacterium diphtheriae dose according to morphological and biochemical signs. Microorganism does not produce exotoxin. As a result of what process can this microorganism become toxigenic?

A. Chromosome mutation

B. Phage conversion

C. Growing with antitoxic serum

D. Cultivation in the telluric environment

E. Passing through the organism of the sensative animals

(А) 82. An old woman was hospitalized with acute pain, edema in the right hip joint; the movements in the joint are limited. Which bone or part of it was broken?

A. Condyle of the thigh

B. The body of the thigh bone

C. The neck of the thigh

D. Pubic bone

E. Ischial bone

(Н.Ф) 83. When a patient with traumatic impairment of the brain was examined, it was discovered that he had stopped to distinguish displacement of an object on the skin. What part of the brain was damaged?

A. Occipital zone of the cortex

B. Frontal central gurus

C. Parietal zone of the cortex

D. Frontal zone

E. Posterior central gurus

(Ф) 84. A 50-year-old male farm worker has been brought to the emergency room. He was found confused in the orchard and since then has remained unconscious. His heart rate is 45 and his blood pressure is 80/40 mm Hg. He is sweating and salivating profusely. Which of the following should be prescribed?

A. Physostigmine

B. Atropine

C. Proserine

D. Pentamine

E. Norepinephrine

(Б/Х) 85. A worker has decreased buffer capacity of blood due to exhausting muscular work The influx of what acid substance in the blood can cause this symptom?

A. a-ketoglutarate

B. Lactate

C. 3-phosphoglycerate

D. 1,3-bisphosphoglycerate

E. Pyruvate

(Б/Х) 86. The high level of Lactate Dehydrogenase (LDH) isozymes concentration showed the increase of LDH-1 and LDH-2 in a patient’s blood plasma. Point out the most probable diagnosis?

A. Diabetes mellitus

B. Myocardial infarction

C. Viral hepatitis

D. Acute pancreatitis

E. Skeletal muscle dystrophy

(П/А) 87. The pulmonalis embolism has suddenly developed in a 40 year-old patient with opened fracture of the hip. Choose the possible kind of embolism.

A. Tissue

B. Fat

C. Thrombus-embolus

D. Air

E. Foreign body

(П/А) 88. A patient has undergone an amputation of lower extremity. Some time later painful nodules appeared in a stump. Amputatious neuromas were found out at the microscopic examination. To what pathological processes do those formations relate?

A. Hyperemia

B. Inflammation

C. Regeneration

D. Dystrophy

E. Metaplasia

(Н.Ф–Ф) 89. The CNS stimulation produced by methylxanthines, such as caffeine, is most likely due to the antagonism of one of the following receptors:

A. Adenosine receptors

B. Glutamate receptors

C. GABA receptors

D. Glycine receptors

E. Cholinergic muscarinic receptors

(П/А) 90. An intraoperational biopsy of mammal gland has revealed the signs of atypical tissue with disorder of parenchyma’stroma proportion with domination of the last, gland structures of different size and shape, lined with single-layer proliferative epithelium. What is the most probable diagnosis?

A. Fibroadenoma

B. Infiltrative cancer

C. Mastitis

D. Papilloma

E. Noninfiltrative cancer

(Ф) 91. A 35-year-old man under the treatment for pulmonary tuberculosis has acute-onset of right big toe pain, swelling, and low-grade fever. The gouty arthritis was diagnosed and high serum uric acid level was found. Which of the following antituberculosis drugs are known for causing high uric acid levels?

A. Cycloserine

B. Rifampicin

C. Pyrazinamide

D. Thiacetazone

E. Aminosalicylic acid

(П/Ф) 92. A 68-year-old woman can not move ^ her upper and lower right extremities after stroke. Muscle tone of these extremities and reflexes are increased. There are pathological reflexes. What form of the paralysis is it?

A. Hemiplegia

B. Dissociation

C. Tetraplegia

D. Paraplegia

E. Monoplegia

(М/Б) 93. The sterile Petri dishes and pipettes are necessary to prepare for microbiological tests in bacteriological laboratory. What way of sterilization should be applied in this case?

A. Steam sterilization in autoclave

B. Boiling

C. Tyndaflization

D. Dry-heat sterilization

E. Pasteurization

(Ф) 94. A 13-year-old girl with history of asthma complained of cough, dyspnea and wheezing. Her symptoms became so severe that her parents brought her to the emergency room. Physical examination revealed diaphoresis, dyspnea, tachycardia and tachypnea. Her respiratory rate was 42/min, pulse rate was 110 beats per mi nute, and blood pressure was 130/70 mm Hg. Choose from the following list the most appropriate drug to reverse the bronchoconstriction rapidly:

A. Ipratropium

B. Beclomethasone

C. Cromolyn

D. Methylprednidsolone

E. Salbutamol

(Н.Ф–П/Ф) 95. X-ray examination discovered lungs emphysema in the patient. What is the reason of short breath development in this case?

A. Decreasing of alveoli receptors sensitivity

B. Excitation of respiratory center

C. Inhibition of respiratory center

D. Decreased lungs elasticity

E. Increased lungs elasticity

(Ф) 96. To anaesthetize the manipulation related to burn surface treatment, a patient was intravenously injected a medication for short-acting narcosis. 1 minute later the patient being under anaesthesia had increased blood pressure, tachycardia, increased tone of sceletal muscles; reflexes remained. After awakening the patient had desorientation and visual hallucinations. What medication was the patient injected?

A. Thiopental sodium

B. Nitrous oxide

C. Ketamine

D. Diethyl ether

E. Sombrevin

(П/Ф) 97. A patient after hypertension stroke does not have voluntary movements in his right arm and leg with the increased muscle tone in these extremites. What type of disfunction of nervous system is it?

A. Peripheral paralysis

B. Central paralysis

C. Peripheral paresis

D. Central paresis

E. Reflex paresis

(Н.Ф–П/Ф) 98. A damage of the atomic power plant reactor resulted in the run-out of radioelements. People in the superstandard radiation zone were radiated with approxi mately 250-300 r. and were immediately hospitalized. What changes in the blood count would be typical?

A. Anemia

B. Lymphopenia

C. Leukopenia

D. Neutropenia

E. Thrombopenia

(Н.Ф) 99. The penetration of the irritable cell membrane for potassium ions has been increased during an experiment. What changes of membrane electric status can occur?

A. Local response

B. Action potential

C. Depolarization

D. Hyperpolarization

E. No changes

(А) 100. A 30-year-old patient was hospitalized due to bleeding of the facial artery . What place on the face has to be pressed to stop bleeding?

A. The mandible’s branch

B. The nose’s back

C. The molar bone

D. The mandible’s edge

E. The mental process

101. Succinate dehydrogenase catalyses the dehydrogenation of succmate. Malonic acid HOOC – CH? -COO His used to interrupt the action of this enzyme. Choose the inhibition type:

A. Limited proteolysis

B. Competitive

C. Non-competitive

D. Dephosphorylation

E. Allosteric

102. Only one factor can influence the charge of amino acid radicals in the active centre of enzyme. Name this factor:

A. The presence of a competitive inhibitor

B. The surplus of a product

C. pH medium

D. Pressure

E. Temperature

103. A tissue sample of benign tumor was studied under the electron microscope. A lot of small (15-20 nm) spherical bodies, consisting of 2 unequal subunits were detected. These are:

A. Ribosomes

B. Microtubules

C. Smooth endoplasmic reticulum

D. Mitochondria

E. Golgi complex

104. (Н.Ф) The low specific gravity of the secondary urine (1002) was found out in the sick person. What is the most distant part of nephron where concentration of secondary urine takes place?

A. In the nephron’s glomerulus

B. In proximal tubule of nephron

C. In ascending part of loop of Henle

D. In the collecting duck

E. In distal tubule of nephron

105. A patient with bronchial asthma had been taking tablets which caused insomnia, headache, increased blood pressure. What medecine can cause such complications?

A. Izadrine

B. Ephedrine

C. Chromohn sodium

D. Euphylme

E. Adrenaline

106. A 22-year-old patient was admitted to the hospital with complaints of heavy nasal breathing. During the examination of her nasal cavity the doctors found thickened mucous membrane, a lot of mucus and nodular infiltrates without erosions in the nose.The nasal rhinoscleroma was diagnosed. The biopsy was taken. What typi cal morphological changes may be found?

A. Granulomas with Mikulicz’s cells

B. Granulomas with Langhan’s cells

C. Interstitial inflammation

D. Granulomas with Virchow’s cells ,

E. Granulomas with foreign body cells

107. Part of the DNA chain turned about 180 degrees due to gamma radiation. What type of mutation took place in the DNA chain?

A. Inversion

B. Replication

C. Translocation

D. Doubling

E. Deletion

108. Ovarian tumour was diagnozed in a woman. Surgery should be perfomed. What ligament should be extracted by the surgeon to disconnect the ovary and the uterus?

A. Lateral umbilical ligament

B. The ovarial ligament

C. Suspensory ligament of ovary

D. Round ligament of uterus

E. Broad ligament of uterus

109. A highly injured person has gradually died. Please choose the indicator of biologi cal death:

A. Absence of movements

B. Loss of consciousness

C. Autolysis and decay in the cells

D. Absence of palpitation and breathing

E. Disarray of chemical processes

110. Inhibition of alpha-motoneuron of the extensor muscles was noticed after stimulation of a-motoneuron of the flexor muscles during the experiment on the spinal column. What type of inhibition can be caused by this process?

A. Recurrent

B. Presynaptic

C. Reciprocal

D. Lateral

E. Depolarizational

111. Punctata hemorrhage was found out in the patient after application of a tourniquet. With disfunction of what blood cells is it connected?

A. Neutrophiles

B. Eosinophiles

C. Lymphocytes

D. Monocytes

E. Platelets

112. A patient after pathological process has a thickened alveolar membrane. The direct consequence of the process will be the reduction of:

A. Oxygen capacity of blood

B. Alveolar lung ventilation

C. Reserve expiratiory capacity

D. Diffuse lung capacity

E. Minute respiratory capacity

113. A lung of a premature infant is presented on electronic photomicrography of biopsy material. Collapse of the alveolar wall caused by the deficiency of surfactant was revealed. Disfunction of what cells of the alveolar wall caused it?

A. Fibroblasts

B. Alveocytes type II

C. Alveocytes type I

D. Secretory cells

E. Alveolar macrophages

114. A microscopic examination of the enlarged neck gland of a 14-year-old girl revealed destruction of the tissue structure of the node, absence of the lymph follicles, sclerotic and necrosis parts. Cell constitution of the node is polymorphous, lymphocites, eosinophiles, atypical cells of the large size with multiple-lobule nuclei (Beresovsky-Shternberg cells) and onenudeus large size cells are observed. What is the most likely diagnosis?

A. Fungous mycosis

B. Acute lympholeucosis

C. Lymphogranulomatous

D. Berkitt’s lymphoma

E. Chronic lympholeucosis

115. The concentration of albumins in human blood sample is lower than normal. This leads to edema of tissues. What blood function is damaged?

A. All answers are correct

B. Maintaining the oncoticblood pressure

C. Maintaining the blood sedimentation system

D. Maintaining the body temperature

E. Maintaining the Ph level

116. A patient complains of frequent and difficult urination. Imperfection of what formation can cause it?

A. Prostate

B. Testicle adnexa

C. Sperm bubbles

D. Testicles

E. Bulb-uretic glands

117. Necrosis focus was observed in the area of hyperemia and skin edema in a few hours after burn. What mechanism strengthens destructive effects in the inflammation area?

A. Emigration of lymphocytes

B. Primary alteration

C. Secondary alteration

D. Diapedesis of erythrocytes

E. Proliferation of fibroblasts

118. A patient with hypochromic anemia has splitting and loss of hair, increased nail brittling and taste alteration. What is the mechanism of the symptoms development?

A. Deficiency of vitamin A

B. Decreased production of parathyrin

C. Deficiency of vitamin 612

D. Decreased production of thyroid hormones

E. Deficiency of iron-containing enzymes

119. After breathing with poisonous steams there is an increased quantity of slime in respiratory passages of a chemical production worker. What of respiratory tract epithelial cells participate in mucousa moi stening?

A. Intercalated cells

B. Goblet cells

C. Endocrine cells

D. Fibroblasts

E. Langergans cells

120. Purulent endometritis developed in a woman after delivery. Treating with anti biotics inhibitors of murein synthesis was ineffective. Wide spectrum bactericidal antibiotic was administered to her. In 6 hours temperature rapidly increased up to 40°C with shiver. Muscle pains have appeared. BP dropped down to 70/40 mmHg. Oligurahas developed. What is the main reason for the development of this condition?

A. Endotoxic shock

B. Bacteremia

C. Anaphylactic shock

D. Toxic effect of preparation

E. Internal bleeding

121. Obturative jaundice developed in a 60-year-old patient because of malignant tumour of the big papillary of the duodenal. Lumen of what anatomical structure is squeezed with tumour?

A. Cystic duct

B. Right hepatic duct

C. Common hepatic duct

D. Left hepatic duct

E. Hepatopancreatic ampulla

122. (М/Б)) A 50-year-old patient with typhoid fever was treated with Levomycetin, the next day his condition became worse, temperature rose to 39,6°C. What caused the complication?

A. Allergic reaction

B. Irresponsiveness of an agent to the levomycetin

C. Reinfection

D. The effect of endotoxin agent

E. Secondary infection addition

123. (Н.Ф) A 50 year-old patien was injured on the occipital region of the head. The closed skull’s trauma was diagnosed. She was taken to the hospital. The medical examination: deregulation of walking and balance, trembling of arms. What part of brain was injured?

A. The medulla oblongata

B. The inter-brain

C. The cerebellum

D. The mind-brain

E. The spinal cord

124. (Н.Ф) After the trauma, the patient’s right ‘ n.vagus was damaged. Which violation of the cardiac activity is possible in this case?

A. Violation of the automatism of a atrio- ventricular node

B. Violation of the automatism of a Kiss- Fleck node

C. Violation of a conductivity in the right auricle

D. Block of a conductivity in the atrio- ventricular node

E. Arrhythmia

125. (Н.Ф) The action of electric current on the exitable cell caused depolarization of its membrane. Movement of what ions through the membrane caused depolarisation?

A. Ca2+

B. HCO3

C. K+

D. Na+

E. Cl-

126. An autopsy revealed large (1-2 cm) , brownish-red, easy crumbling formations covering ulcerative defects on the external surface of the aortic valve. What is the most likely diagnosis?

A. Diffusive endocarditis

B. Polypus-ulcerative endocarditis

C. Fibroplasticendocarditis

D. Acute warty endocarditis

E. Recurrent warty endocarditis

127. (М/Б)) While enrolling a child to school J Mantu’s test was made to define whether revaccination was needed. The test result is negative. What does this test result mean?

A. Presence of cell immunity to the tuberculosis

B. Absence of cell immunity to the tuberculosis

C. Absence of antitoxic immunity to the tuberculosis

D. Presence of antibodies for tubercle bacillus

E. Absence of antibodies for tubercle bacillus

128. The electronic microphoto of kidney fragment has exposed afferent glomerular arteriole, which has giant cells under its endothelium, containing secretory granules. Name the type of these cells:

A. Smoothmuscular

B. Interstitial

C. Mesangial

D. Juxtavascular

E. Juxtaglomerular

129. (М/Б)) The donor who had not donated the blood for a long time was examined with IFA method. Anti-HBs antibodies were revealed. What does positive result of IFA in this case mean?

A. Chronic hepatitis B

B. Acute hepatitis C

C. Chronic hepatitis C

D. Acute hepatitis B

E. Previous hepatitis B

130. (Н.Ф) A 56-year-old patient complaining of thirst and frequent urination was diagnosed with diabete mellitus. Butamin was prescri bed. How does the medicine act?

A. It helps to absorb the glucose by the cells of the organism tissues

B. It stimulates /?-cells of Langergans’ islets

C. It inhibits absorption of glucose in the intestines

D. It relieves transport of glucose through the cells’ membranes

E. It inhibits a-cells of Langergans’ islets

131. (Н.Ф) Examination of a person revealed that minute volume of heart is 3500 mL, systolic volume is 50 mL. What is the frequency of cardiac contraction?

A. 70bpm

B. 90bpm

C. 80 bpm

D. 50 bpm

E. 60 bpm

132. (Н.Ф) During the endoscopy the inflammation of a major papilla of the duodenum and the disturbances of bile secretion were found. In which part of duodenum were the problems found?

A. Bulb

B. Ascendant part

C. Descendent part

D. Upper horizontal part

E. Lower horizontal part

133. (М/Б)) A patient has been brought to the hospital with the complaints of headache, pain in left hypochondrium. He has been ill for 1,5 weeks. The sudden illness began with the increase of body temperature up to 39,9°C. In 3 hours the temperature decreased and hydropoiesis began. Theattacks repeat rhythmically in 48 hours. The patient had visited one an African country. The doctors have suspected malaria. What method of laboratory diagnostics is necessary to use?

A. Examination of vaginal and urethral discharge

B. Immunological tests

C. Urine examination

D. Stool examination

E. Blood examination

134. Methotrexate (structural analogue of the folic acid which is competitive inhibitor of the dihydrofolatreductase) is prescribed for treatment of the malignant tumour. On which level does methotrexate hinder synthesis of the nucleic acids?

A. Processing

B. Transcription

C. Replication

D. Mononucleotide synthesis

E. Reparation

135. Where should the cathetor for evacuation of the lymph from the thoracic lymph duct beinserted?

A. To the inferior vena cava

B. To the right venous corner

C. To the superior vena cava

D. To the left venous corner

E. To the left inguinal vein

136. The patient with pneumonia was treated with antibiotics for a long period. After treatment patient complains of frequent and watery stool, abdomenal pain. What is the reason of intestine function disorder?

A. Hereditary enzyme defect

B. Autoimmune reaction development

C. Antibiotics toxic influence on the GIT

D. Bacteria toxins influence

E. Intestinal disbacteriosis development

137. An isolated muscle of a frog is rhythmi cally irritated with electric impulses. Every next impulse is in a period of relaxation from the previus contraction. What contraction of the muscle occurs?

A. Continuous (smooth) tetanus

B. Asynchronous

C. Tonic

D. Waved tetanus

E. Single

138. The study of the genealogy of a family with hypertrichosis (helix excessive pi- losis) has demonstrated that this symptom is manifested in all generations only in men and is inherited by son from his father. What

is the type of hypertrichosis inheritance?

A. Y-linked chromosome

B. X-linked dominant chromosome

C. X-linked recessive chromosome

D. Autosome-dominant

E. Autosome-recessive

139. (М/Б))Live vaccine is injected into the human body. Increasing activity of what cells of connective tissue can be expected?

A. Pigmentocytes and pericytes

B. Plasmocytes and lymphocytes

C. Adipocytes and adventitious cells

D. Macrophages and fibroblasts

E. Fibroblasts and labrocytes

140. Analeptical remedy of reflective type from the H-cholinomimetics group was gi ven to the patient for restoration of breathing after poisoning with carbon monoxide. What medicine was prescribed to the pati ent?

A. Lobeline hydrochloride

B. Adrenalin hydrochloride

C. Atropine sulphate

D. Pentamin

E. Mesaton

141. Moving of the daughter chromatids to the poles of the cell is observed in the mi totically dividing cell. On what stage of the mitotic cycle is this cell?

A. Anaphase

B. Prophase

C. Interfase

D. Metaphase

E. Telophase

142. Periodic renal colics attacks are observed in a woman with primery hyperparathyroidizm. Ultrasonic examination revealed small stones in the kidneys. What is the most plausible reason of the stones’s formation?

A. Hypercalcemia

B. Hypercholesterinemia

C. Hyperkalemia

D. Hyperphosphatemia

E. Hyperuricemia

143. A 45-year-old woman suffers from allergic seasonal coryza caused by the ambrosia blossoming. What adipose cells group stabilizer medicine can be used for prevention of this disease?

A. Phencarol

B. Ketotifen

C. Tavegyl

D. Dimedrol

E. Diazoline

144. (Н.Ф) A student is thoroughly summarising a lecture. When his groupmates begin talking the quality of the summarising worsens greatly. What type of inhibition in the cerebral cortex is the cause of it?

A. Protective

B. External

C. Dying

D. Differential

E. Delayed

145. A 57-year-old patient was admitted to the gastroenterological department with suspicion of Zollinger-Ellison syndrom because of rapid increase of gastrin level in the blood serum. What the most probable disorder of the secretory function of the stomach here?

A. Hyperacidity hypersecretion

B. Hyperacidity hyposecretion

C. Hypoacidity hypersecretion

D. Achylia

E. Hypoacidity hyposecretion

146. The conjugated protein necessarily contains special component as a non- protein part. Choose the substance that can’t carry out this function:

A. Thiamine pyrophosphate

B. HNO3

C. ATP

D. AMP

E. Glucose

147. A 52 year-old patient with bronchial asthma was treated with glucocorticoids. Fever reaction appeared as a result of postinjective abscess. The patient had sub febrile temperature, which didn’t correspond to latitude and severity of inflammatory process. Why did patient have low fever reaction?

A. Violation of heat-producing mechanisms

B. Inhibited endogen pyrogens production

C. Violation of heat loss through lungs

D. Inflammatory barrier formation in injection place

E. Thermoregulation center inhibition

148. (Н.Ф) A person has steady HR not exceeding 40 bpm. What is the pacemaker of the heart rhythm in this person?

A. Branches of His’ bundle

B. His’bundle

C. Purkinye’fibers

D. Sinoatrial node

E. Atrioventricular node

149. (Н.Ф) A 19-year-old female suffers from tachycardia in rest condition, weight loss, excessive sweating, exophtalmos and irritability. What hormone would you expect to find elevated in her serum?

A. Thyroxine

B. Cortisol

C. ACTH

D. Mineralocorticoids

E. Insulin

150. (Н.Ф) A histological spacemen presents parenchymal organ, which has cortex and medulla. Cortex consists of epitheliocytes bars with blood capillaries between them; the bars form three zones. Medulla consists of chromaffinocytes and venous sinusoids. Which organ has these morphological features?

A. Kidney

B. Adrenal gland

C. Thymus

D. Thyroid

E. Lymph node

151. Patient 54 year-old, 5th day after surgical operation. Blood count: Erythrocytes 3, 6* 1012/1, Hemoglobin 95 g/1, Erythrocyte’s hemoglobin content (color index) 0,78; Leukocytes 16 * 109/1, Platelets 450* 109/1 Blood picture: anizocytosis, poiki- locytosis, reticulocytes- 3,8%. What anemia does this patient have?

A. Acquired hemolytic anemia

B. Chronic posthemorragic anemia

C. Hypoplastic anemia

D. Acute posthemorragic anemia

E. Anemia from iron deficiency

152. Inflamation is characterised by increasing penetration of vessels of mi- crocirculation stream, increasing of their fluid dynamic blood pressure. Increasing of the osmotic concentration and dispersity of protein structures can be found in the intercellular fluid. What kind of edema are to be observed in this case?

A. Lymphogenic

B. Hydrodynamic

C. Membranogenic

D. Colloid-osmotic

E. Mixed

153. A woman suffering from dysfunctional metrorrhagia was made a diagnostic abortion. Histologically in the scrape there were a lot of small stamped glandulars covered with multirowed epithelium. The lumens of some glandulars were cystically extended. Choose the variant of general pathologic process in the endometrium.

A. Metaplasia of endometrium

B. Atrophy of endometrium

C. Neoplasm of endometrium

D. Glandular-cystic hyperplasia of endometrium

E. Hypertrophic growth

154. In the ovary specimen colored with hematoxylin-eosin, follicle is determined where cubic-shaped follicle epithelium cells are placed in 1-2 layers, and scarlet covering is seen around ovocyte. Name this follicle:

A. Primordial

B. Mature

C. Atretic

D. Secondary

E. Primary

155. A journalist’s body temperature has sharply increased in the morning three weeks after his mission in India, it was accompanied with shivering and bad headache. A few hours later the temperature decreased. The attacks began to repeat in a day. He was diagnosed with tropical malaria. What stage of development of Plasmodium is infective for anopheles-female?

A. Microgamete

B. Merozoites

C. Sporozoites

D. Gametocytes

E. Shizontes

156. (М/Б)) Red colonies spread in the large quantity in the Endo culture medium were revealed on bacteriological stool examination of a 4-month-old baby with the symptoms of acute bowel infection. What microorganism can it be?

A. Staphylococcus

B. Salmonella

C. Escherichia

D. Shigell

E. Streptococcus

157. A 6-year-old child fell on the cutting object and traumatized soft tissues between tibia and fibula. What kind of bone connection was injured?

A. Ligament

B. Suture

C. Gomphosis

D. Fontanel

E. Membrane

158. A 46 year-old patient has complained of headache, fatigue, thirst, pains in the spine and joints for the last 2 years. Clinically observed disproportional enlargement of hands, feet, nose, superciliary arches. He notes that he needed to buy bigger shoes three times. What is the main reason of such disproportional enlargement of different parts of the body?

A. Increased sensitivity of the tissues to insulin

B. Cartilaginous tissue proliferation under growth hormone influence

C. Joints chronic inflammation development

D. Increased sensitivity of the tissues to growth hormone

E. Joints dystrophy development

159. A patient’s blood was analyzed and the decreased erythrocyte’s sedimentation rate (ESR) was discovered. What disease from the listed below is accompanied with decreased ESR?

A. Hepatitis

B. Polycytemia

C. Myocardial infarction

D. Vitamin B deficiency

E. Splenomegaly

160. (Н.Ф) Electrocardiogram of a 45-year-old man showed absence of P-wave in all the leads. What part of the conducting system is blocked?

A. Sinu-atrial node

B. Purkinje’s fibres

C. Common branch of the bundle of His

D. Atrioventricular node

E. Branches of the bundle of His

161. (Н.Ф) The process of heart transplantation determined the viability of myocardial cells. The determination of what myocardium parameter is the most important?

A. Concentration of calcium-ions in myofi- brils

B. Rest potential of cardiomyocytes

C. Concentration of Ca-ions in heart vessels

D. Concentration of oxygen in heart vessels

E. Heart temperature

162. (М/Б)) A 46 year-old man complains of difficult nose breathing. Mikulich cells, storage of epithelioid cells, plasmocytes, lymphocytes, hyaline balls are discovered in the biopsy material of the nose thickeni ng. What is the most likely diagnosis?

A. Rhinovirus infection

B. Scleroma

C. Meningococcal nasopharyngitis

D. Allergic rhinitis

E. Virus rhinitis

163. (М/Б)) During the breakout of acute respi ratory infection in order to diagnose influenza the express-diagnosis, based on revealing of specific viral antigen in the examined material (nasopharyngial lavage), is carried out. Which reaction is used for this?

A. Complement binding

B. Precipitation

C. Agglutination

D. Immunofluorescence

E. Opsonization

164. A patient with the symptoms of acute alcoholic poisoning was brought to the hospital. What carbohydrates metabolism changes are typical for this condition?

A. The gluconeogenesis velocity in liver is decreased

B. The anaerobic glucose metabolism predominates in muscles

C. The anaerobic breakage of glucose is increased in muscles

D. The breakage of glycogen is increased in liver

E. The gluconeogenesis is increased in liver

165. A patient with injured muscles of the lower extremities was admitted to the traumatological department. Due to what cells is reparative regeneration of the muscle fibers and restoration of the muscle function possible?

A. Myofibroblasts

B. Myoblasts

C. Satellite-cells

D. Fibroblasts

E. Myoepithelial cells

166. For a long time a 49-year-old woman had suffered from glomerulonephritis which caused death. The autopsy revealed that the size of her kidneys was 7x3x2,5 sm, weight 65,0 g, they were dense and small-grained. Microscopically: fibrinogenous inflammation of serous and mucous capsules, dystrophic changes of parenchymatous organs, brain edema. What complication can cause such changes of serous capsules and inner organs?

A. Thrombopenia

B. Sepsis

C. Anemia

D. DIC-syndrome

E. Uraemia

167. A man died 8 days after the beginning of the disease. He was diagnosed with dysentery. At the autopsy it was found out a thickened wall of the sigma and rectum, fibrinous membrane on the surface of mucous membrane. Histologically: there is a deep necrosis of mucous membrane with infiltration of necrotic masses with fibrin. What kind of colitis does correspond to the changes?

A. Catarrhal

B. Chronic

C. Gangrenous

D. Ulcerative

E. Diphtheritic

168. The patient with diabetes mellitus has been delivered in hospital in the state of unconsciousness. Arterial pressure is low. The patient has acidosis. Point substances, which accumulation in the blood results in these manifestations:

A. Amino acids

B. Ketone bodies

C. Monosaccharides

D. Cholesterol esters

E. High fatty acids

169. An individual is characterized by rounded face, broad forehead, a mongolian type of eyelid fold, flattened nasal bridge, permanently open mouth, projecting lower lip, protruding tongue, short neck, flat hands, and stubby fingers. What diagnosis can be put to the patient?

A. Alkaptonuria

B. Turner’s syndrome

C. Klinefelter’s syndrome

D. Down’s syndrome

E. Supermales

170. An autopsy revealed: soft arachnoid membrane of the upper parts of cerebral hemisphere is plethoric, of yellowish-green color, soaked with purulent and fibrose exudate, it lookes like a cap. What disease is characterised by these symtoms?

A. Influenza meningitis

B. Meningococcal meningitis

C. Tuberculous meningitis

D. Meningitis at typhus

E. Meningitis at anthrax

171. On autopsy a 35-year-old man the focus of carnification 5 cm in diametre enclosed in a thin capsule was revealed in the second segment of the right lung . The focus consists of a tough dry friable tissue with a dim surface. For what disease are these morphological changes typical?

A. Postinflammatory pneumosclerosis

B. Tuberculoma

C. Tumorous form of silicosis

D. Chondroma

E. Lung cancer

172. A patient with encephalopathy was admitted to neurological department. Correlation of increasing encephalopathy and substances absorbed by the bloodstream from the intestines was revealed. What substances created in the intestines can cause endotoxemia?

A. Butyrate

B. Indole

C. Ornithine

D. Biotin

E. Acetacetate

173. (Н.Ф) If strong oxidizers get into the bloodstream, a methemoglobin is formed. It is a compound, where iron (II) becomes iron (III). What has to be done to save the patient?

A. Interchangeable hemotransfusion has to be done

B. He has to be calmed down and put to bed

C. Patient has to be exposed to the fresh air

D. Respiratory centers have to be stimulated

E. He has to be given pure oxygen

174. There is the change of teeth at the 6-8- year-old children: deciduous are replaced by permanent. What embrionic tissues are the sources of formation of permanent teeth tissues?

A. Entodermal epithelium of a tooth plate and mesenhime

B. Entodermal epithelium and mesoderm

C. Ectodermal epithelium of a tooth plate and mesenhime

D. Mesodermal epithelium and mesenhime

E. I, II brachial arches

175. During histological examination of the stomach it was found out that glands contained very small amount of pariental cells or they were totally absent. Mucose membrane of what part of the stomach was studied?

A. Body of stomach

B. –

C. Pyloric part

D. Cardia

E. Fundus of stomach

176. A patient suffering from thyrotoxicosis symptoms of vegetoasthenic syndrome was revealed. What of the following would show the histological appearance of a thyroid gland being stimulated by thyroid- stimulating hormone (TSH)?

A. An abundance of colloid in the lumen of the follicle

B. Decreased numbers of parafollicular capillaries

C. Increased numbers of parafollicular cells

D. Decreased numbers of follicular cells

E. Columnar-shaped follicular cells

177. (М/Б)) A consumptive patient has an open pulmonary form of disease. Choose what sputum staining should be selected for fi nding out the tubercle (Koch’s) bacillus?

A. Method of Burry-Gins

B. Method of Neisser

C. Method of Romanowsky-Giemsa

D. Method of Ziel-Neelsen

E. Method of Gram

178. (Н.Ф) The patient has come to the hospital from the smelting workshop in the conditi on of hyperthermia. What is the direct cause of loss of consciousness at the heat stroke?

A. Arterial pressure drop

B. Dilatation of peripheral vessels

C. Increased water loss through sweating

D. Decreased brain blood supply

E. Decrease of heart output

179. A 10-year-old child complains of weakness, nausea, irritability. Helminthes of while color and 5-10 mm long were found on the underwear. On microscopy of the scrape from the perianal folds achromic ovums of imsymmetrical form were revealed. Indi cate what helminth is parasiting on the child?

A. Enterobins vermicularis

B. Ascaris lumbricoides

C. Ancylostoma duodenalis

D. Trichina

E. Trichuris

180. A businessman came to India from South America. On examination the physi cian found that the patient was suffering from sleeping-sickness. What was the way of invasion?

A. After contact with a sick dogs

B. As a result of bug’s bites

C. As a result of mosquito’s bites

D. With contaminated fruits and vegetables

E. Through dirty hands

181. A patient has been taking a mixture prescribed by neuropathologist for neurasthenia for two weeks. The patient feels better but has developed coryza, conjunctivitis, rash, inertia, decrease of memory. She is diagnosed with bromizm. What should be prescribed to decrease the symptoms?

A. Natrium chloride

B. –

C. Polyglucin

D. Asparcam

E. Glucose solution 5%

182. A 32-year-old patient has been diagnosed with bartholinitis (inflammation of Bartholin’s glands ). In what part of the female urogenital system are the Bartholin’s glands located?

A. The labia minor

B. The uterus

C. The clitoris

D. The vagina

E. The labia major

183. The B cells of endocrine portion of pancreas are selectively damaged by alloxan poisoning. How will it be reflected in blood plasma?

A. The content of fibrinogen decrease

B. The content of albumins decreases

C. The content of sugar increases

D. The content of globulins decreases

E. The level of sugar decreases

184. Pyruvate concentration in the patient’s urine has increased 10 times from normal amount. What vitamin deficiency can be the reason of this change:

A. Vitamin Be

B. Vitamin B1

C. Vitamin C

D. Vitamin E

E. Vitamin A

185. Oval and round organelles with double wall are seen at the electron micrograph. The outer membrane is smooth, the inner membrane folded into cristae contain enzyme ATPase synthetase. These are:

A. Lysosomes

B. Mitochondria

C. Golgi complex

D. Ribosomes

E. Centrioles

186. Slime, blood and protozoa 30-200 mi crons of length have been revealed in a man’s feces. The body is covered with cilias and has correct oval form with a little bit narrowed forward and wide round shaped back end. On the forward end a mouth is visible. In cytoplasm there are two nucleuses and two short vacuoles. For whom are the described attributes typical?

A. Dysenteric amoeba

B. Intestinal amoeba

C. Balantidium

D. Lamblia

E. Trichomonas

187. A 59-year-old man has symptoms of parenchymatous jaundice and portal hypertension. Histological examination of the puncture of the liver bioptate has revealed an affected beam-lobule structure, part of hepatocytes has signs of fat dystrophy, port-portal connective tissue septa with formation of pseudo-lobules, with periportal lympho-macrophage infiltrations. What is the most probable diagnosis?

A. Liver cirrhosis

B. Viral hepatitis

C. Alcohol hepatitis

D. Toxic dystrophy

E. Chronic hepatosis

188. (Н.Ф) In the blood of a 26-year-old man 18% of erythrocytes of the spherical, ball- shaped, flat and thorn-like shape have been revealed. Other eritrocytes were in the form of the concavo-concave disks. How is this phenomenon called?

A. Physiological anisocytosis

B. Erytrocytosis

C. Physiological poikilocytosis

D. Pathological poikilocytosis

E. Pathological anisocytosis

189. (М/Б)) A sick man with high temperature and a lot of tiny wounds on the body has been admitted to the hospital. Lice have been found in the folds of his clothing. What disease can be suspected in the patient?

A. Plague

B. Tularemia

C. Scabies

D. Epidemic typhus

E. Malaria

190. (М/Б)) During surgical operation a blood transfusion was made. The blood must be checked to find antigens of some disease. What disease is expected to be found?

A. Enterovirus

B. Virus of hepatitis B

C. Virus of hepatitis E

D. Adenovirus

E. Virus of hepatitis A

191. M-r S presents all signs of the hepatic coma: loss of consciousness, absence of reflexes, cramps, convulsion, disorder of heart activity, recurrent (periodical) respiration. What are cerebrotoxical substances which accumulate in blood under hepar insufficiency?

A. Ammonia

B. IL-1

C. Autoantibody

D. Necrosogenic substances

E. Ketonic body

192. A patient with clinical signs of immunodeficiency has unchanged number and functional activity of T and B lymphocytes. Dysfunction’s defect of antigen-presentation to the immunocompetent cells was found during investigation on the molecule level. Defect of what cells is the most probable here?

A. Macrophages, monocytes

B. 0-lymphocytes

C. Fibroblasts, T-lymphocytes, B- lymphocytes

D. NK-cells

E. T-lymphocytes, B-lymphocytes

193. (Н.Ф) A man after 1,5 litre blood loss has suddenly reduced diuresis. The increased secretion of what hormone caused such diuresis alteration?

A. Corticotropin

B. Natriuretic

C. Parathormone

D. Cortisol

E. Vasopressin

194. A patient died 3 days after the operation because of perforated colon with manifestations of diffuse purulent peritonitis. The autopsy revealed: colon mucos membrane was thickened and covered with a fibrin film, isolated ulcers penetrated at different depth. The histology result: mucous membrane necrosis, leukocytes infiltration with hemorrhages focuses. What disease complication caused the patient’s death?

A. Nonspecific ulcerative colitis

B. Typhoid

C. Crohn’s disease

D. Dysentery

E. Amebiasis

195. During complicated labour the symphysis pubis ruptured. What organ “tan be damaged mostly?

A. Rectum

B. Urinary blader

C. Uterus

D. Ovaria

E. Uterine tubes

196. A healthy woman has three sons affected by color blindness who were born after her two marriages. Children both of her husbands are healthy. What is the most possible pattern of inheritance of this disease?

A. X-linked dominant

B. Autosomal dominant

C. Autosomal recessive

D. X-linked recessive

E. Y-linked

197. Different functional groups can be presented in the structure of L-amino aci d’s radicals. Identify the group that is able to form ester bond:

A. -CONH2

B. -OH

C. -SH

D. -NH2

E. -CHS

198. (М/Б)) A person was selling “homemade pork “sausages on the market. State sani tary inspector suspected falcification of the sausages. What serological immune reaction can identifiy food substance?

A. Complement- fixation test

B. Indirect hemagglutination test

C. Precipitation test

D. Immunofluorescence test

E. Agglutination test

199. (Н.Ф) Intrapleural pressure is being measured in a person. In what phase does a person hold his breath if the pressure is – 25 cm?

A. -

B. Forced expiration

C. Quiet expiration

D. Quiet inspiration

E. Forced inspiration

200. (М/Б)) A patient with suspicion on epidemic typhus was admitted to the hospital. Some arachnids and insects have been found in his flat. Which of them may be a carrier of the pathogen of epidemic typhus?

A. Spiders

B. Lice

C. Houseflies

D. Bed-bugs

E. Cockroaches

 

Krok I 2004

Posted: May 5, 2012 in Krok I
Tags:

MINISTRY OF PUBLIC HEALTH OF UKRAINE

Board of education and science of MPH of Ukrai

 

Test items for licensing examination

Krokl

MEDICINE

2004

 

List of abbreviations

 

A/G          Albumin/globulin ratio

A-ANON   Alcoholics anonymous

ACT         Abdominal computed tomography

ADP         Adenosine diphosphate

ALT          Alanin aminotranspherase

AMP         Adenosine monophosphate

AP            Action potential

ARF          Acute renal failure

AST          Aspartat aminotranspherase

ATP          Adenosine triphosphate

BP            Blood pressure

bpm         Beats per minute

C.I.             Color Index

CBC         Complete blood count

CHF           Chronic heart failure

CT             Computer tomography

DIC            Disseminated intravascular coagualtion

DCC          Doctoral controlling committee

DM-2         Non-Insulin dependent diabetes mellitus

DTP           Anti diphtheria-tetanus vaccine

ECG          Electrocardiogram

ESR           Erythrocyte sedimentation rate

FC             Function class

FAD           Flavin adenine dinucleotide

FADH2      Flavin adenine dinucleotide restored

FEGDS      Fibro-esphago-gastro-duodenoscopy

FMNH2      Flavin mononucleotide restored

GIT            Gastrointestinal tract

GMP          Guanosine monophosphate

Hb             Hemoglobin

HbA1c      Glycosylated hemoglobin

Hct            Hematocrit

HIV            Human immunodeficiency virus

 

HR Heart rate
IDDM Insulin dependent diabetes mellitus
IFA Immunofluorescence assay
IHD Ischemic heart disease
IU International unit
LDH Lactate dehydrogenase
MSEC Medical and sanitary expert committee
NAD Nicotine amide adenine dinucleotide
NADPH Nicotine amide adenine dinucleotide
  phosphate restored
NIDDM Non-Insulin dependent diabetes mellitus
PAC Polyunsaturated aromatic carbohydrates
PAS Periodic acid & sniff reaction
pC02 C02 partial pressure
p02 CO2 partial pressure
pm Per minute
Ps Pulse rate
r roentgen
RBC Red blood count
RDHA Reverse direct hemagglutination assay
Rh Rhesus
(R)CFT Reiter’s complement fixation test
RIHA Reverse indirect hemagglutination assay
RNA Ribonucleic acid
RR Respiratory rate
S1 Heart sound 1
S2 Heart sound 2
TU Tuberculin unit
U Unit
USI Ultrasound investigation
V/f Vision field
WBC White blood count
X-ray Roentgenogram

 

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1. Collagen, elaslin and reliculin belong to the fibrillar elements of connective tissue. Indicate the arninoacid which constitutes only collagen, and identification of which in biological fluids is used for the diagnosing of the connective tissue diseases.

W. Hydroxyproline

B. Proline
C Lysine

D. Phenylalanine

E. Glycine

2.    A histological spacemen presents
parenchymal organ, which has cortex and
medulla. Cortex consists of epitheliocytes
bars, between them there are blood capi­
llaries; the bars form three zones. Medulla
consists of chromaffinocytes and venous si­
nusoids. What organ has these morphologi­
cal features?

A. Kidney <tJ? Adrenal gland

C. Lymph node

D.      Thyroid

E. Thymus

3. Genetic structure of eukaryote is “exon-
intron-exon”. This structure-functional
organization of gene caused transcripti­
on peculiarities. What will be pro-i-RNA
according to the scheme?

A.      Intron-exon

B. Exon-in tron

C Exon-exon-intron (Pi Exon-intron-exon E. Exon-exon

4. A patient underwent the surgical removal
of pathologically disordered distal quarter
of small intestine. How will it influense the
absorption of nutritional substances in case
of patient’s ordinary diet?

A. Proteins absorption will be reduced w) Absorption will not be altereded

C. Carbohydrates absorption will be reduced

D.      Water absorption will be reduced

E. Lipids absorption will be reduced

5. The auscultation of a patient with dry
pleuritis has revealed plueral friction rub.
What epithelium type can cause such signs?

A- Laminated epithelium (MBp Simple flat epithelium

C. Simple prismatic epithelium

D.       Simple cubical epithelium

E. Transitional epithelium

6.  A patient with liver disease revealed
the decreasing of prothrombin level in the
blood. It can, first of all, result in the impai­
rment of:

vv The second phase of the coagulatory

hemostasis

B. Vascular-thrombocytic hemostasis

C Anticoagulative properties of the blood

D.   The   first  phase  of  the  coagulatory
hemostasis

E. Fibrinolysis

7.  A 58-year-old woman complaints of
increased tiredness, decreased capasity for
work, somnolence and dyspnea during fast
walking. Blood test revealed: erythrocytes
- 4.6 * 1012/1, hemoglobin – 92 g/1, colour
index – 0,6. Blood smear demonstrated hi­
gh contents of microcytes and anulocytes.
What anemia is it typical for?

A. Sickle cell

B.  Hemolytic
(O Iron deficiency

D. Acute posthemorrhagic

E. Penicious

8. A 39-year-old patient after radiotherapy
because of hepatoma developed ulcer of
small intestine. It was caused by the inhibi­
tion of mytotic activity of the cells, which
are responsible for regeneration of small
intestine surface epithelium. Inhibition of
what cells mitotic activity does this patient-
have?

A.       Exocryocytes with acidophilic granules

B. Columnar cells
C Endocrine cells

M>2 Crypt columnar cells without margins E. Caliciform exocrynocytes

9. A 42-year-old man was admitted to the
cardiological department because of angi­
na pectoris. Among the medicines admi­
nistered to the patient there was inhibitor
of phosphodiesterase. The concentration of
what substance in the heart muscle will be
increased?

A. ATP
B.ADP
C.GMP
D.AMP

(ft Cyclo-AMP

10. A patient with prolonged bronchopneumonia
was     admitted     to     the     therapeutic
department.    Antibiotic    therapy    was
ineffective. What medicine should be added

to the complex therapy of the patient to increase the immune status?

C^/Timalin

B. Analgin

C. Dimedrol

D. Paracetamol

E. Sulfocamphocain

 

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11.  Buffer capacity of blood was decreased
in the worker due to exhausting muscular
work. Entry of what acid substance to the
blood can this state be explained by?

A. a-ketoglutarate

B. 1,3-bisphosphoglycerate

C. Lactate

D. Pyruvate

E. 3-phosphogIycerate

12.  Galactosemia is revealed in a child.
Concentration of glucose in the blood is not
considerably changed. Deficiency of what
enzyme caused this illness?

A.       Amylo-l,6-glucosidase

B. Hexokinase

C Galactose-1-phosphate uridyltransferase

D. Galactokinase

E. Phosphoglucomutase

13.  A 35-year-old woman with chronic renal
disease has developed osteoporosis. Defi­
ciency of which from the belowmentioned
substances causes such complication?

A. A?

B. Cholesterol
CD3

D. 1.25(OH)2D3

E. 250HDS                                              m

14.  A patient with ascariasis was admi­
nistered a medicine which influenses
the immune system and is used as
immunomodulator. What medicine was
administered?

A. Piperazine adipinate

B. Naphthamon
C Pyrantel

D. Phenasol

E. Levamisole

15.  A patient with bronchial asthma duri­
ng 2 months was taking pills of predni-
solon. After she began feeling much better
she suddenly stopped taking the medicine.
What complication can develop in this case?

A. Hypotension

B. Obesity of upper part of the body
C Itsenko-Cushing syndrome

D. Abstinence syndrome

E. Gastric hemorrhage

16.i )A 16-year-old patient died because [Ofiliffuse fibrinopurulent peritonitis. The autopsy in the inferior region of small intestine revealed an ulcer with a form of Peyer's plaque, with the perforation of intestine wall. The microscopic examinati­on revealed lymph tissue pattern vagueness, the displacement of this tissue with-proli-ferating monocytes, which were forming

granulomas. Complication of what disease caused the death?

A.       Nonspecific ulcerative colitis

B. DVsentry

C. Cholera

D. Brucellosis

E. Typhoid

17. A patient with bronchial asthma is admi­
nistered inhalation of 0,5% isadrine soluti­
on. Bronchospasm was releaved, but the
patient began complaining of pain in the
heart region and palpitation. It is connected
with the stimulation of:

A.        M-cholinergic receptors

B. Acetylcholine synthesis

C. /?j2-adrenoreceptors

D. /?i -adrenoceptors

E. ai-adrenoceptors

18. A 65-year-old man with signs of profuse
obesity and risk of fatty liver dystrophy
was recommended high-lipotropic diet. The
contents of what substance in his diet is the
most effective in this case?

A.        Glucose

B. Methionine

C. Glycin

D.        Cholesterol

E. Vitamin C

19. A malarial Plasmodium (haemamoeba)
- the pathogene of vivax malaria - has two
strains: southern and northern. They differ
by the duration of their incubation period:
the southern has short and the northern -
long one. What selection works in this case?

A. Artificial

B. Sexual
C Cutting

D. Moving

E. Stabilizing

20. After brain injuiry a patient has lost
his vision. What zone of the brain cortex
is damaged in this case?

A.        Occipital

B. Frontal

C. Temporal and parietal
O. Parietal

E. Temporal

21. The microscopic examination of wound
lavage of a patient with acute woundy
process of his shin revealed big contents of
irregular extended-formed cells, with tough
nucleus, the basophilic cytoplasm of which
includes many lysosomes, phagosomes and
pinocytotic bubbles. What cells are found
out in the wound?

 

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A. Fibroblasts

B. Connective tissue macrophages

C. Plasmocytes

D. Tissue basophils

E. Fibrocytes

22.  The electronic microphoto of kidney
fragment has demonstrated the afferent
glomerular arteriole, which under its
endothelium has giant cells, containing
secretory granules. Name the type of these
cells:

A.       Interstitial

B. Mcsangial

C. Juxtavascular

D. Juxtaglomerular

E. Smoothmuscular

23.  A patient has myocardial infarction in
the region ofanterior wall of the left ventri­
cle. What artery basin has the circulatory
impairment occured in?

A.  Atrioventricular branch of left coronal
artery

B. Circumflex branch of left coronal artery

C. Left marginal branch of left coronal artery

D.  Anterior interventricular branch of left
coronal artery

E.  Anterior ventricular branches of right
coronal artery

24.  A 50-year-old man had been blocked up
for 2 days because of earthquake. After he
was rescued, the diagnosis of compression
syndrome was made. What further compli­
cation is the most likely to develop in this
case?

A. Acute hepatic failure

B. Acute respiratory failure

C. Acute cardiac failure

D. Acute renal failure

E. Acute vascular failure

25.  A child, suffering from pylorostenosis
accompanied by frequent vomiting,
developed signs of dehydration. What form
of acid-base disbalance can develop in this
case?

A. Metabolic acidosis

B. Gaseous acidosis

C. Nongaseous alkalosis

D. Nongaseous acidosis

E. Gaseous alkalosis

2(5. A woman came to the surgeon because of the solid mass in her mamma. What di­rection should the surgeon make an incision in during the operation to injure the lobe less?

A. Transverse

B. Radial
G-

D. Arcuate

E. Vertical

(27J A 59-year-old man has signs of the parenchymatous jaundice and portal hypertension. On histological examinati­on of the puncture of the liver bi op talc, it was revealed: beam-lobule structure is affected, part of hepatocytes has signs of fat dystrophy, port-portal connective tissue septa with formation of pseudo-lobulcs.with periportal lympho-macrophage infiltrations. What Is the most probable diagnosis?

A. Toxic dystrophy

B. Alcohol hepatitis

C. Viral hepatitis

D. Liver cirrhosis

E. Chronic hepatosis

28.  During the bacteriological tests of the
purulent secreta from urethra there were
found bacteria, which according to Gramm
were negatively staining, looked like coffee
beans. These bacteria were splitting glucose
and maltose to acid, they were located insi­
de the leucocytes. The aetiological agent of
what disease are these microorganisms?

A. Syphilis

B. Chancroid

C. Melioidosis

D. Venereal lymphogranulomatosis

E. Gonorrhoea

29.  Shock and signs of acute renal failure
(ARF) developed in the patient due to
severe injury. What is the leading cause of
development of ARF in the case?

A.       Decreased arterial pressure

B. Decreased oncotic BP

C. Increased pressure in the nephron capsule

D. Urine excretion violation

E. Increased pressure in the renal arteries

30.  During the examination of blood gases
a patient with chronic respiratory diseases
accompanied by dyspnea, tachycardia and
cyanosis demonstrated the development of
hypoxemia and hypercapnia. What disorder
of the external respiration does the patient
have?

A. Hypoperfusion

B. Hyperdiffusion

C. Hypoventilation

D. Hyperventilation

E. Hyperperfusion

31.  A 25-year-old patient complained of vi­
sion reduction. Accommodation disorder,
dilated pupil, not reacting on the light were

 

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revealed on examination. Function of what muscles is disturbed?

A. Pupil narrowing muscle, ciliary

B.  Pupil narrowing and dilating muscle

C.  Pupil dilating muscle, ciliary

D. Inferior oblique muscle, ciliary

E. Lateral rectus muscle, pupil narrowing

32. A woman, who was keeping a diet for a long time and eating refined rice, has developed polyneuritis (beriberi disease). The absence of what vitamin in the diet causes the development of such disease?

A.     Pyridoxal

B. Folic acid

C. Thiamine

D. Riboflavin

E. Ascorbic acid

 

,330 A patient with diabetes mellitus Suddenly began having sharp pajn in his ri­ght foot. The examination revealed black hallux, swallen foot tissues, focuses of epi­dermis detachment, sccreia with unpleasant smell. What clinico-morphological form of necrosis developed in a patient?

A.                                                           Moist gangrene

B. Bedsore

C. Dry gangrene

D.     Sequester

E. Infarction

34. A young man increased his energy inputs from 500 to 2000 kJ per hour. What from the suggested can cause it?

A. Food taking

B. Physical activity
C Rising of external temperature

D. Mental activity

E. Change of sleeping for waking

A patient died from acute cardiac *—msufficiency.The histological examination of his heart revealed in myocardium of the left ventricle the necrotized section, whi­ch was separated from-undamaged tissue by the zone of hyperimic vessels, small hemorrhages and leukocytic infiltration. What is the most likely diagnosis?

A.     Focal exudate myocarditis

B. Diffuse exudate myocarditis

C. Productive myocarditis

D.     Myocardial ischemic dystrophy

E. Myocardial infarction

36, Substitution of the glutamic acid on valine was revealed while examining initi­al molecular structure. For what inherited pathology is this typical?

A. Favism

B. Sickle-cell anemia

C. Hemoglobinosis

D. Minkowsky-Shauffard disease

E. Thalassemia

37. The heart rate and the systemic arteri­
al blood pressure of a man have increased
due to voluntary respiratory delay for 40 c.
Realisation of what regulation mechanism
caused these changes?

A.        Unconditioned parasympathetic reflexes

B. Unconditioned sympathetic reflexes

C. Conditioned sympathetic reflexes
D.-

E. Conditioned parasympathetic reflexes

38.   To anaesthetize the manipulation
connected with burn surface treatment, a
patient was intravenously injected a medi­
cation for short-acting narcosis. 1 minute
later the patient being under anaesthesia
had elevated blood pressure, tachycardia,
increased tone of sceletal muscles: the
reflexes were reserved. After awakeni­
ng the patient had desorientation and vi­
sual hallucinations. What medication was
injected to the patient?

A. Sombrevin

B. Thiopental sodium

C. Nitrous oxide

D. Ketamine

E. Diethyl ether

39. A woman with myasthenia developed
respiratory disorders, which required arti­
ficial ventilation. What typey^f respiratory
insufficiency did the woman have?

A. Obstructive

B. Thoracophrenic

C. Neuromuscular

D.        Restrictive

E. Centrogenic

40.  Dystrophic changes of the heart
muscle are accompanied with cardiac cavi­
ty enlargement, decrease of the strength
of heart contraction, increased amount of
blood, which remains in the heart during
systolic phase, overfilled veins. For what
state of heart is it characteristic?

A.  Emergency stage of hyperfunction and
hypertrophy

B. Myogenic dilatation

C. Cardiosclerosis

D. Tonogenic dilatation

E. Tamponage of the heart

41.   Because of suspected inlrahospital
infection in the neonatal department of the
maternity home the inspection was carried
out. In some children and on some general

 

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things Staphylococcus aureus was revealed. What properties of these cultures allow to establish their origin from one source?

A. Phagotype

B. Biochemical activity

C. Antibioticogramma

D. Antigenic structure

E. Chromogenesis

42.  A patient with paroxysmal attacks of
asphyxia, which appear after inhalation
of different aromatic substances has been
made a diagnosis of bronchial asthma. Ig E
rate is elevated. What type of reaction is it
the most typical for?

A. Delayed type of hypersensitivity

B. Immunocomplcx
C Cytotoxic

D. Anaphylactic

E. Autoimmune

43.  A 33- year-old woman who has been
treated for a long time from chronic
polyarthritis complains of increased blood
pressure, changes in the distribution of
the adipose tissue and dysmenorrhea. The
usage of what medicine could cause such
complaints?

A.        Butadion

B. Indometacin
C Sinafian

D. Beclometasone

E. Prednisolone

44.    The electrocardiogramme analysis
demonstrated that the duration of man's
heart cycle is Isec. What is the heart rate
per minute?

A. 80

B.50 C.60 D. 100 E.70

45. A 2-year-old boy has some enlargement
of his liver and spleen and cataract. Sugar
concentration in blood is elevated but
glucose tolerance test is normal. The
congenital metabolic disorder of what
substance is the cause of this condition?

A. Sucrose

B. Fructose

C. Galactose

D. Maltose

E. Glucose

46.   On the 8th day since the patient
was inoculated with antitclanic serum
because of dirty wound of his foot he
has developed rising temperature up to
38°C, pains in the joints, rash and itch.

The blood tests revealed leukopenia and thrombocytopenia. Allergic reaction of what type has developed in this case?

A. Anaphylactic

B. Cytotoxic

C. Immunocomplex

D. Delayed type of hypersensitivity

E. Stimulating

47.  A 42-year-old woman with trigeminal
nerve neuralgia complaints of redness of ri­
ght part of her face and neck, feeling of heat
rush and increased dermal sensitiveness.
What is the arterial hyperemia in this case
according to pathophysiological mechani­
sm?

A. Metabolic

B. Neuroparalytic

C. Neurotonic

D. Working

E. Reactive

48. A 6-months-old baby has got frequent
and extensive subdermal hemorrhages. The
administration of the synthetic analogue of
vitamin K (vicasol) was effective. Gamma-
carboxylation of glutamic acid of what
protein of blood coagulation system does
this vitamin take part in?

A. Rosental's factor

B. Fibrinogen

C. Prothrombin

D. Antihemophilic globulin A

E. Hagcman's factor

49. Analeptical remedy of reflective type
from the H-cholinomimctics group was gi­
ven to the patient for restoration of breathi­
ng after poisoning with carbon monoxide.
What medicine was prescribed to the pati­
ent?

A.        Adrenalin hydrochloride

B. Pentamin

C. Atropine sulphate

D. Lobeline hydrochloride

E. Mesaton

50. A 39-year-old man has got an increased
risk of infectious processes development,
hyperkeratinizattion, disorder of mesopic
vision. What vitamin should be admini­
stered?

A. Pyridoxine hydrochloride

B. Ergocalciferol

C. Tocopherol acetate

D. Riboflavine

E. Retinoi acetate

51. During the examination of a patient wi­
th bleeding wounds the doctor found out
that the tissue was damaged by maggots,

 

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there were local maturations. The diagnosis was obligate myiasis. The maggots of what insect caused the disease?

A. Filth (house) fly

B. Tsetse fly (Glossina)

C. Stable fly

D. Blow fly (Musca Volfarti)

E. Triatomic bug

/52>tA padent died 3 days after the operati-S-tinf because of perforated colon with the manifestations of diffuse purulent peritoni­tis. The autopsy demonstrated: colon mucos membrane was thickened and covered wi­th a fibrin film, isolated ulcers penetrated into different depth. Results of histology: mucous membrane necrosis, leukocytes infi­ltration with hemorrhages focuses. The complication of what disease caused the patient's death?

A. Typhoid

B. Amebiasis

C Nonspecific ulcerative colitis

D. Crohn's disease

E. Dysentery

53.  Patient with pneumonia has intolerance
to antibiotics. Which of the combined
sulfanilamide medicines should be prescri­
bed to the patient?

A. Aethazol

B. Natrium sulfacyi
C Sulfadimethoxine

D. Biseptol

E. Streptocid

54.  The examination of blood serum of
a patient with immunodeficiency signs
revealed antybodies to gP120 i gP41 protei­
ns. The presence of what infection of this
patient does it confirm?

A. HLTV-1-infection

B. HBV-infcction
CHIV-infection
D.TORCH-infection
E. ECHO-infection

55.  During the expirement performed on
a rabbit the superior cervical node of
sympathaticstem was removed. On the side
of the extraction there is redness and rising
temperature of the head skin. What form of
peripheral circulation disorder developed in
this case?

A. Neuroparalytic arterial hyperemia

B. Neurotonic arterial hyperemia
C Metabolic arterial hyperemia

D. Stasis

E. Venous hyperemia

pfi.^During the examination of a patient,

who had been to the mountain pasture and had been hospitalized in a bad condi­tion with fever, the doctor found out the enlargement of inguinal lymph nodes to 8 cm, which were attached to the surroundi­ng tissues, immovable, the skin above them was red and tender. The microscopic examination of the node revealed acute serohemorrhagic inflammation. What di­sease is it typical for? 6

A. Tularemia

B. Plague

C. Brucellosis

D. Syphilis

E. Anthrax

57.  A patient has tissue ischemia lower the
knee joint, accompanied with "intermittent
claudication". Which artery is occluded in
this case?

A.       Anterior tibial

B. Proximal part of the femoral

C. Tibial

D. Popliteal

E. Posterior tibial

58.  An old man had infarction of the ri­
ght cerebrum hemisphere. One year later,
taking into consideration the absence of
movements of his left extremities, the pati­
ent underwent computer tomography of
the cerebrum, which revealed a smooth-
walled cavity, full of liquor. What pathologi­
cal process is found out in the cerebrum?

A.        Gray maceration of the brain

B. Hydrocephaly

C. Hematoma

D. Postinfarction cyst

E. Brain infarction

59.  A patient with fibrillation, who has had
bronchial asthma in his anamnethis, should
be administered antiarrhythmic drug. Whi­
ch preparation from the suggested group is
contramdicated for this patient?

A. Nifedipine

B. Novocainamid

C. Ajmaline

D. Anapriline (Propranolol)

E. Verapamil

60.   Chronic glomerulonephritis was di­
agnosed in a 34-year-old patient 3 years ago.
Edema has developed for the last 6 months.
What caused it?

 

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A. Hyperosmolar! ly of plasma

B. Hyperaldosleronism

C. Proteinuria

D. Hyperproduction of vasopressin

E.   Disorder the livers protein formation
function

61. Patients with collagenousis have the
destruction of the connective tissue. It is
confirmed by increasing in the blood of:

A. Contents of oxyprolin and oxylysin

B. Activity of transaminases

G. Contents of creatine and creatinine

D. Acyivity of isoenzymes of LDH

E. Contents of urates

62. During metabolic process active forms
of the oxygen including superoxide anion
radical are formed in the human body. With
help of what enzyme is this anion activated?

A.     Peroxidase

B. Glutathionereductase

C. Catalase

D. Superoxide dismutase

E. Glutathioneperoxidase

63. Processes of repolarisation are disturbed
in ventricular myocardium in examined
person. It will cause amplitude abnormali­
ties of configuration and duration of the
wave:

A.S B.Q C.R D.P

E.T

[ 6-Ojnpainfull formation without marked Mwfaers_appeared in the soft tissues of the * thigh"(lep^of the young man. On the tissue bioptate the formation lookes like a meat of a fish, consisting of the immature fibroblast-like cells with multiple mitosis, which grow through the muscles. What is the most likely diagnosis?

A.     Fibroma

B. Myosarcoma

C. Myoma

D. Fibrosarcoma

E. Cancer

(©5.X 30-year-old patient with bacteriologi-cally proved dysentery developed the signs of paraproctitis. What is the stage of local changes of this patient?

A. Fibrinous colitis

B. Healing of the ulcers stage
C Catarrhal colitis

D. Ulceration stage

E. Follicular colitis

66.  During ultrasound examination of the
heart the doctor observes the leaves of the
mitral valve. What happends to them during
the systole?

A.      They clasp with wall of the vessel

B. They close up covering the lumen of the
orifice

C. They turn inside the cavity of the atrium

D. They clasp with the walls of the atrium

E. They turn inside the cavity of the ventricle

67.  An experimental dog by means of
stomach tube was given 150 ml of meat
broth. The concentration of which of
the belowmentioned substances will be
increased in animal's blood?

A. Neurotensin

B. Somatostatin

C Vasoactive intestinal polypeptide

D. Insulin

E. Gastrin

68.  A female patient complaining of indi­
gestion and diffuse abdominal pain came
to the doctor. During the examination the
doctor found out considerably decreased
hemoglobulin level in the blood. During the
inquiry it turned out that the woman, living
in the Far East, was frequently eating lightly
salted caviar. Some relatives, who were livi­
ng with her, had the same complaints. What
was the diagnosis?

A.     Ascariasis

B. Trichinosis

C. Echinococcosis

D. Thenyosis

E. Diphyllobothriasis

69.   4 months ago a 43-year-old man
underwent traumatic amputation of his left
lower extremity. At the time of his exami­
nation the patient complaints of feeling of
present amputated extremity and constant
sometimes unbearable pain in it. What pain
type does the patient have?

A. Phantom limb

B. Thalamic
C Reflex

D. Neuralgia

E. Causalgia

/vOJExtensive thromboembolic infarction of She left cerebral hemispheres, large septic spleen, immunocomplex glomerulonephri­tis, ulcers on the edges of the aortic valves, covered with polypous thrombus with colonies of staphylococcus were revealed on autopsy of the young man who di­ed in coma. What disease caused cerebral thromboemboly?

 

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A. Septic bacterial endocarditis

B. Acute rheumatic valvulitis
C Septicopyemia

D. Septicemia

E. Rheumatic thromboendocarditis

(TlJTbe autopsy of the dead body revealed Naflarged, solid with rounded margins liver, on section the tissue was yellow-brown in colour with dark red spots and stripes, whi­ch resembled nutmeg. What pathological process led to such liver changes?

A. Chronic venous polyemia

B. Chronic hemorrhage
C Arterial anemia

D. Arterial polyemia

E. Acute venous polyemia

72.    A patient with clinical signs of
encephalitis was admitted to the infectious
hospital. In his anamnesis there is informati­
on about tick bite. During the hemaggluti­
nation ihibition reaction there were found
antybodies against the pathogen of tick-
borne encephalitis in diluton 1:20, which is
not diagnostic What should the doctor do
next, after he has got such results?

A. Reexamine the same serum

B. Remake the examination of the serum
taken 10 days later

C  Canceal  the  diagnosis  of tick-borne encephalitis

D. Use more sensitive reaction

E. Remake the examination with another
diagnosticum

73.   A patient with urolithiasis after the
examination was administered allopurinol
- competitive inhibitor of xanthine oxidase.
It was influenced by chemical analysis of the
calculuses, which consisted mainly of:

A.      Calcium phosphate

B. Sodium urate

C. Calcium oxolate dihydrate

D. Calcium sulphate

E. Calcium oxolate monohydrate

74.   A patient suffers from nocturnal
paroxysms of bronchial asthma accompani­
ed by bradycardia, spastic intestinal pains
and diarrhea. Medicine of what group can
releavc these symptoms?

A.      /?-adrenoblockers

B. M-cholinergic receptors

C. Saluretics

D. Sympatholytics

E. H-cholinergicreceptors

75. In the microspacemen of spinal medulla
it is necessary to analyse the condition of the
nucleus, neurons of which form the motor
endings in the skeletal musculature. What

nucleus of the spinal medulla is it about?

A. Nucleus thoracicus (Clarke'snucleus)

B. Nucleus intermediolaterallis

C. Posterior horn proper nucleus

D. Disseminate nucleus

E. Gray substance proper nucleus

76. A 50-year-old patient complains of thi­
rst, drinking of a lot of water, marked
polyuria. Blood glucose is 4,8mmol/L. uri­
ne glucose and acetone bodies are absent,
urine is colorless, specific gravity is 1,002-
1,004. What is the cause of polyuria?

A.       Insulin insufficiency

B. Vasopressin insufficiency

C. Aldosteronism

D. Hypothyroidism

E. Thyrotoxicosis

77.    The examination of an youth
with mental retardation revealed
eunuchoid body construction and geni­
tals underdevelopment. The cells of the
oral cavity cantained chromatine. What
method of genetic investigation should
be performed to make more specified di­
agnosis?

A.       Population-statistic

B. Dermatoglyphics

C. Biochemical

D. Cytological

E. Clinico-genealogical

78.   A patient, who suffers from congeni­
tal erythropoietic porphyria, has skin
photosensitivity. The accumulation of which
compound in the skin can cause it?

A. Uroporphyrinogen 1

B. Coproporphyrinogen 3

C. Uroporphyrinogen 2

D. Protoporphyrin

E. Heme

79.   A patient who came to the doctor
because of his infertility was administered
to make tests for toxoplasmosis and chronic
gonorrhoea. Which reaction should be
performed to reveal latent toxoplasmosis
and chronic gonorrhoea in this patient?

A. Immunoblot analysis

B. RIHA - Reverse indirect hemagglutinati­
on assay

C. RDHA - Reverse direct hemagglutination
assay

D. I FA - Immunofluorescence assay

E.  (R)CFT- Reiter's complement fixation
test

80.   For serological diagnostics of the
whooping cough there was made a large-
scale   reaction   with   parapertussis   and

 

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pertussis diagnostics. At the bottom of the test-tubes with diagnosticum of Bordetella parapertussis grain-like sediment was formed. What antibodies have this reacti­on revealed?

A.       Bacteriolysins

B. Precipitins

C. Opsonins

D. Agglutinins

E. Antitoxins

81. A patient, undergoing a course of curati­
ve starvation, has a normal glucose level of
the blood mainly due to glucogenesis. What
aminoacid in human liver the most actively
synthesizes glucose?

A.       Valine

B. Leucine

C. Alanine

D. Glutamic acid

E. Lysine

82. Where should the cathetor for evacuati­
on of the lymph from the thoracic lymph
duct be inserted?

A.       To the right venous corner

B. To the inferior vena cava
C To the superior vena cava

D. To the left inguinal vein

E. To the left venous corner

83. During total (with water) alimentary
starvation the generalized edemata have
developed. Which of the pathogenic factors
is dominant in this case?

A. Increased osmotic pressure of interstitial
fluid

B.  Reduced hydrostatic pressure of intersti­
tial fluid

C.   Reduced  oncolitic pressure of blood
plasma

D. Increased oncolitic pressure of interstitial

ifiuid                                                           sy

E.   Reduced  osmotic pressure  of blood
plasma

84. The alternate usage of dichlotiazide,
etacrin acid and lasex didn't cause substanti­
al diuretic effect in patient with evi­
dent peripheral edema. There is increased
amount of aldosterone in the blood. Indi­
cate the medicine to be prescribed.

A.        Mannit

B. Urea                                           ■

C. Spironolacton

D. Clopamid

E. Amilorid

85. Prozerin, given systematically to the rat,
increases skeletal muscles tone. Halothane
(phthoroihan) causes the relaxation of the

skeletal muscles and weakens the effect of prozerin. Determine the nature of interacti­vity of prozerin and halothane.

A. Incompetitive antagonism

B. Independent antagonism

C. Direct functional antagonism

D. Competitive antagonism

E. Indirect functional antagonism

86.  A 50- year-old man suddenly began
having severe palpitation, pain in the
heart, sharp weakness, high blood pressure;
arrhythmic pulse, with deficiency. The ECG
revealed no P waves and there was different
duration of R-R intervals. What disorder of
heart rhythm did the patient have?

A. Paroxysmal tachicardia

B. Respiratory arrhythmia

C. Sinus extrasystolia

D. Atrial fibrillation

E. Transversal heart block

87.   A patient during a visit to his denti­
st developed severe hypotension. Which
of the medicines, stimulating adrenergic
structures, should be used to normalise
blood pressure?

A. Doxazozin

B. Ergotamine
C Sanorin

D. Mesaton

E. Xylomethazolin hydrochloride

88rfThe intraoperative biopsy of mammal feland has revealed the signs of atypical ti­ssue with disorder of parenchyma-stroma proportion with domination of the last, gland structures of different size and shape, fined with single-layer proliferative epi­thelium. What is the most appropriate di­agnosis?

A. Infiltrative cancer

B. Papilloma

C. Noninfiltrative cancer

D. Mastitis

E. Fibroadenoma

89.   Blood sampling for bulk analysis is
recommended to be performed on an empty
stomack and in the morning. What changes
in blood count can occur if to perform blood
sampling after food intake?

A. Increased contents of leukocytes

B. Reduced contents of erythrocytes

C. Increased contents of erythrocytes

D. Reduced contents of thrombocytes

E. Increased plasma proteins

90. After the genealogy analysis a geneticist
came to the conclusion: a feature is mani­
fested in each generation, men and women

 

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inherit the feature with equal frequency, parents in the equal way give this feature to their offspring. What type of inheritance does the investigated feature have?

A. Autosomal-dominant

B.  X-linked dominant inheritance
C X-linked recessive inheritance

D. Autosomal-recessive

E. Y-linked inheritance

91.  A patient suffers from hemeralopia.
Which of the suggested substances will have
curable effect?

A. Carotene

B. Keratin

C. Creatine

D. Carnosine

E. Carnitine

92.   Patients with diabetes mellitus and
people during starvation have the increased
contents of acetone bodies in their blood,
which are used as energy material. What
substance are they synthesized from?

A.        Malate

B. Ketoglutarate

C. Succinyl-CoA carboxylase

D.        Citrate

E. Acetyl-CoA carboxylase

93.   The person was selling "homemade
pork"sausages on the market. State sani­
tary inspector suspected falcification of
the sausages.With help of what serologi­
cal immune reaction can food substance be
identified?

A. Precipitation test

B. Immunofluorescence test

C Indirect hemagglutination test

D. Complement-fixation test

E. Agglutination test

94.   A 44-year-old woman was admitted
to the therapeutic department because of
right-side pleuritis. The examination confi­
rmed the presence of liquid in the pleural
cavity. What sinus of the pleura will have
the biggest accumulation or the serosity?

A. Right mediasiinodiaphragmatic

B. Lett costomediastinal

C. Right costomediastinal

D. Right costodiaphragmatic

E. Left mediastinodiaphragmatic i

95. A 45-year-oldInfan with domes-tic apper
arm injuiry applied, to the trauma unit. The
objective data are: no extension, adduction
and pronation functions of the arm. What
muscle damage caused this condition?

A. Teres minor

B. Subscapular

C. Supraspinous

D. Subspinous

E. Teres major

96. A 30-year-old man with culling wound
of his forearm has got an impairment of his
fingers extension. What nerve is damaged?

A.       Radial

B. Middle

C. Ulnar

D. Muscularcutaneous

E. Medial antebrachial cutaneous nerve

97.  Systemic amebiasis with involvment of
intestines, liver, lungs was diagnosed in a
52-year-old patient. What drug should be
prescribed?

A.       Metronidasol

B. Tetracycline

C. Quiniofone

D.       Quingamine

E. Enteroseptol

98.  Some time later after the intensi­
ve physical training a sportman activates
his gluconeogenesis. What is its main
substance?

A. Serine

B. a-ketoglutaratc

C. Lactate

D. Glutamic acid

E. Aspartic acid

99.  A woman complaining of coryza,
phonastenia, eyelids redness and lacrymati-
on during spring period came to the doctor.
What type of allergic reaction by Gell ano
Coombs classification develops in this case?

A. Cytotoxic

B. Immunocomplex

C. Delayed type of hypersensitivity

D. Stimulating

E. Anaphylactic

AOOThe autopsy of the man's body, that was wofking for a long time as a miner and di­ed beacuse of chronic pulmonary-cardiac insufficiency, revealed that lungs were not in their ful volume, significantly thickened, sclerotic, the apaxis were emphysematous^ changed, the^Sorface was gray-black in colour, on section the lung tissue was aspid-black in colour. What disease caused the death?

A.       Aluminosis

B. Talcosis

C. Asbcstosis

D.       Anthracosis

E. Silicosis

 

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101.   A 38-year-old patient after taking
aspirin and sulphanilamides has profound
hemolysis of erythrocytes, which is caused
by glucose 6-phosphate dehydrogenase
insufficiency. The disorder of formation of
what coenzyme causes this pathology?

A. Pyridoxalphosphate

B.NADPH

OFMNHn

D. Ubiquinone

E. FADH-i

102.   The examination of a foreigner
revealed intestinal schistosomiasis. How
could the patient be infected?

A.        Through dirty hands

B. While eating meat

C. While eating fish

D.        During river swimming

E. Through insects bites

103. The study of the genealogy of a family
with hypertrichosis (helix excessive pilosis)
demonstrated, that this feature is mani­
fested in all generations only in men and
is inherited by son from his father. What is
the type of hypertrichosis inheritance?

A. X-linked recessive chromosome

B. X-linked dominant chromosome
G. Y-linked chromosome

D. Autosome-recessive

E. Autosome-dominant

104.   Synthesis of phospholipids is di­
sordered due to fat infiltration of liver. Indi­
cate which of the presented substances can
enhance the process of methylation during
phospholipids synthesis?

A. Methionine

B. Citrate

C. Ascorbic acid

D. Glycerin

E. Glucose

105.   Patient with vomiting, dizziness,
sensation of dubble vision, difficult
swallowing was admitted to the hospi­
tal. Doctor suspects botulism. What di­
agnostic methods should be used for di­
agnosis approving?

A.        Bacteriological, mycological

B. Biological test, bacteriological

C. Allergic test, serological

D.        Protozoological, microscopical
E.-

106.  A patient complaining of weight loss
(10 kg during 2 months), pallpilalion and
exophthalmos came to the endocrinologi­
st. For the hyperfunction of what endocri­
ne gland (glands) are these complaints the

most typical?

A. Thyroid

B. Pancreas

|C Adrenal glands

D. Parathyroid glands

E. Ovaria

107.  A man because of 1,5 litre blood
loss has suddenly reduced diuresis. The
increased secretion of what hormone
caused such diuresis alteration?

A. Natriuretic

B. Corticotropin

C. Cortisol

D. Parathormone

E. Vasopressin

108.     A patient has increased contents of uric
acid in his blood, what is clinically mani­
fested by pain syndrome due to accumulati­
on of urates in his joints. What process does
the formation of this acid result from?

A.        Purine bases re-using

B. Purine nucleotide decay

C. Heme catabolism

D.        Pyrimidine nucleotide decay

E. Proteolysis

109.     In case of enterobiasis acrihine - the
structural analogue of vitamin B-2 - is admi­
nistered. The synthesis disorder of which
enzymes does this medicine cause in mi­
croorganisms?

A. FAD - dependent dehydrogenases

B. Peptidases

C Cytochromeoxidases

D. NAD - dependent dehydrogenases

E. Aminotransferases

110. Patient in the unconscious state was
admitted to the emergency room. Skin
is cold, pupils are delayed, breathing is
heavy, with cycles of the Cheyne-Stokes
type, blood pressure is decreased, urinary
bladder is overloaded. Poisoning with what
substance is the most likely?

A. Non-narcotic analgesics

B. Narcotic analgesics

C. Sedatives
D.-

E. M-choIinergic antagonists

111. A 42-year-old man was administered
prymajan in order to prevent the distant
results pf quartan malaria. 3 days since the
beginning of the treatment with therapeutic
dosage of this medicine the patient has
developed pain in the cardiac and abdomi­
nal regions, dyspepsia and general cyanosis.
What could cause such side effects?

 

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A. Potential activity with other preparations

B. Delay preparation excretion with urine

C.   Reduced activity of microsomal liver
enzymes                               - ;>.

D. Accumulation of the medication

E.    Genetic   insufficiency   of   glucose   6-
phosphate dehydrogenase

112. During the postsynthetic period of mi­
totic cycle the synthesis of proteins - tubuli-
nes, which take part in the mitosis formati­
on, was destroyed. It can cause the impai­
rment of:

A. Duration of mitosis

B. Chromosome spiralization
C Chromosome despiralization

D. Chromosome separation

E. Cytokinesis

113. After the usage of acetylsalicylic acid
a patient developed epigastric pain because
oi exacerbation of his ulcer, what are the
principles of this medication ulcerogenity?

A. Stimulation of pepsin secretion

B. Spasm of vessels

C. Immunodepressive effect

D. Cholagogic effect

E. Antiprostaglandinic effect

[lJ4pThe microscopic examination of liver Biopsy revealed granulomata, consisting of plasmatic, lymphoid, giant polynuclear cells of Pirogov-Laehgans type, small vessels wi­th the signs of endo- and perivasculitis, and there were focuses of caseation necrosis. What disease are these granulomata typical for?

A.        Rhinoscleroma

B. Leprosy

C. Syphilis

D.        Tuberculosis

E. Glanders

115. A patient after trauma has developed paralyses, algesthia impairment on the ri-ghf; there are no paralyses on the left but temperature and pain sensivity are also impaired. What is the cause of this?

A. Brainstem injuiry

B. Unilateral right-side spinal cord injuiry

C. Midbrain injuiry

D. Cerebellum injuiry

E. Motor zone brain cortex injuiry

11<5. During the breakout of acute respi­ratory infection in order to diagnose influenza the express-diagnosis, based on revealing of specific viral antigen in the examined material (nasopharyngial lavage), is carried out. Which reaction is used for this?

A. Agglutination

B. Immunofluorescence

C. Complement binding

D. Opsonization

E. Precipitation

117.  A patient with thrombophlebitis is
administered the complex therapy, which
influences different stages of clotforming.
Which of the given substances contributes
to the restoration of the vascular permeabi­
lity?

A. Acetylsalicylic acid

B. Dipiridamol

C. Heparin

D. Ncodykumarin

E. Fibrinolysin                                       H

118. In the micropreparation made from
patient's regional lymph node punctate
and stained according to Romanovsky-
Giemsa method, the doctor found out thin
microorganisms with 12-14 equal ringlets
and pale-pink sharp pointes 10-13 mkm in
length. The pathogen of what disease is it
about?

A. Surra

B. Syphilis

C. Relapsing fever

D. Leptospirosis

E. Leishmaniasis

119.  A 27-year-old man has purulent
inflammation of gallblader. What region of
the peritoneal cavity will the pus fall into if
gallblader ruptures in his typical position?

A. Into the left lateral duct

B. Into the superior duodenal sinus
C Into hepatic bursa

D. Into pancreatic bursa

E. Into epiploic bursa

120.  In the microspecimen of red bone
marrow there were revealed multiple capi­
llars through the walls of which mature
blood cells penetrated. What type of capi­
llars is it?                                                &$,

A.        Somatical

B. Sinusoidal

C. Fenestrational

D. Lymphatic

E. Visceral

121.  A patient who had been suffering
for many years from bronchial asthma di­
ed from asphyxia. The histological exami­
nation of his lungs revealed the following:
much mucus with eosinophiles contents in
the lumen of bronchioles and small bronci,
sclerosis of interalveolar septa, dilation of
alveolar lumen. Which of the mechanisms
of allergy development is it?

 

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A.       Granulomatosis

B. Reagin

C. Cytotoxic

D. Cytolysis, caused by lymphocytes

E. Immunocomplex

n22!) During the intraoperative biopsy of rthyroid gland the histological examination *? revealed lymphoid structures with growth centers, which were among the folliculi full of colloid. What disease was it?

A. Endemic goiter

B.  Ridel's goiter

C Hashimoto's thyroiditis (lymphadenoid goiter)        f

D. Sporadic goiter

E. Thyrotoxicosis (Basedow's goiter)

123. A patient has got frequent internal
organs' and mucosal hemorrhages.
The analysis indicated insufficiency of
hydroxyproline and hydroxylysine in the
collagenous fibres. The insufficiencuy of
what vitamin caused the impairment of
bydroxylysation of abovementioncd ami-
noacids in a patient?

A. Vitamin PP

B. Vitamin C
C Vitamin K

D. Vitamin A

E. Vitamin H

124. The increased intraocular tension is
observed in the patient with glaucoma.
Secretion of aqueous humor by the ciliar
body is normal. Injury of what structure of
the eyeball wall caused the disorder of fluid
flow-out from the anterior chamber?

A. Back epithelium of cornea

B. Choroid

C. Ciliar body

D. Ciliary muscle

E.  Venous sinus

125.  A patient because of pathological
process has thickened alveolar membrane.
What will be reduced directly as a result
this?

A.       Oxygen capacity of blood

B. Diffuse lung capacity

C. Minute respiratory capacity

D. Reserve expiratiory capacity

E. Alveolar lung ventilation

126. On blood grouping on the system
ABO, standard serum of the I and II groups
caused erythrocytes agglutination of the
examined blood and serum group of the
III didn't. What agglutinogens are in this
erythrocytes?

A. A

B.B

C. D and C

D.C

E.A and B

127. An 18-year-old man with asthenic body
constitution: tall, narrow shoulders, broad
pelvis and with poor hair on his face came
to the geneticist. There was marked mental
retardatoin. The preliminary diagnosis was
Klinefelter's syndrome. What method of
medical genetics can confirm the diagnosis?

A.        Dermaioglypbics

B. Population-statistic

C. Genealogic                                         9

D. Cytogenic

E. Gemellary

128. A 48-year-old patient after severe
psychoemotional exertion suddenly began
feeling sharp pain in the heart region,
irradiating into left arm. Nitroglycerin
releaved pain 10 minutes later. What
pathogenetic mechanism is responsible for
the development of pain in this case?

A.        Dilation of peripheral vessels

B. Compression of coronary vessels

C. Spasm of coronary vessels

D. Increase of myocardial needs in oxygen

E. Occlusion of coronary vessels

129. Local lymphonodulcs enlarged near
the infected wound. Increased amount
of macrophages, lymphocytes, lymphatic
follicles in the cortical layer and large
amount of plasma cells were revealed on
histological examination. What process in
the lymphatic nodules represent these hi­
stological changes?

A.   Innate insufficiency of the lymphoid
tissue

B. Hypersensibility reaction

C. Antigen stimulation

D.  Acquired insufficiency of the lymphoid
tissue

E. Tumour transformation

130.  The penetration of the irritable cell
membrane for potassium ions has been
increased experimentally. What changes of
membrane electric status can occur?

A. Hyperpolarization

B. Depolarization

C. Local response

D. No changes

E. Action potential

131.   A 56-year-old patient with complains of
thirst and frequent urination was diagnosed
to have diabetes mellitus and butamin was
prescribed. What is the mechanism of acti-

 

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on of this medicine?

A.  It stimulates beta-cells of Langergans'
islets

B. It inhibits alpha cells of Langergans] islets

C. It inhibits absorption of glucose in the
intestines

D. It helps to absorb the glucose by the cells
of the organism tissues

E. It relieves transport of glucose through
the cells’ membranes

132.    A 26-year-old woman is complaining of
thirst and dryness in her mouth. The exami­
nation has revealed glucosuria and blood
glucose content of 6,5 mmol/l. What condi­
tion are these symptoms the most typical
for?

A.       Diabetes mcllitus

B. Diabetes insipidus

C. Alimentary glucosuria

D. Renal diabetes

E. Steroid diabetes

133.   Karyotyping of healthy man cells
is carried out. In the karyotype there
was found out a fine acrocentric odd
chromosome. What chromosome is it?

A.        Group A chromosome

B. Group B chromosome
C X-chromosome

D. Y-chromosome

E. Group C chromosome

134. Highly injured person gradually died.
Please choose the indicator of biological
death:

A. Loss of consciousness

B. Absence of movements

C. Disarray of chemical processes

D. Autolysis and decay in the cells

E. Absence of palpitation

13fO A patient died with uremia.The autopsy demonstrated kidneys to be enlarged, of flabby consistence, cortex was broad, edematous, with red spots; medulla was dark red in colour. Microscopic exami­nation in the glomeruli capsule cavity revealed “semilunar formations”,squeezing capillaries, nephrocytes dystrophy, edema and infiltration of stroma. What disease caused the death of the patient?

A.        Glomeruloncph rosis

B. Nephrotic syndrome

C. Renal amyloidosis

D. Pyclonepn rosis

E. Nephrolithiasis

136. A student is thoroughly summarising a lecture. When his groupmates began talki­ng the quality of the summarising worsened

greatly. What type of the inhibition in the cerebral cortex is the cause of this?

A. Protective

B. External

C. Dying

D. Delayed

E.  Differential

137. Complaints and objective data allow to
suggest that a patient has inflammation in
his gallblader. bile colloidoclasia, probabili­
ty of gallstones formation. What can be the
main cause of gallstones formation?

A.        Oxolates

B. Urates

C. Chlorides

D. Cholesterol

E. Phosphates

138. The energy inputs of a healthy man
have been identified. What position was the
patient if his energy inputs were less than
the main exchange?

A.        Easy work

B. Sleep

C. Calmness

D. Rest

E. Nervous exertion

139.  The speed of excitement conducti­
on through the atrioventricular node in a
healthy adult is 0,02-0,05 mps. What does
artrioventricular delay supply?

A.        Sequence of atria and ventricles contracti­
on

B. Sufficient force of ventricles contraction

C. Simultaneous contraction of both atria

D.        Sufficient force of atria contraction

E. Simultaneous contraction of both ventri­
cles

140. After trauma a 44-year-old patient had
a rupture of left palm muscle tendons and of
the surface of blood vessels. A fter operation
and removal of the most part of the necroti-
cally changed muscle tissue the bloodstream
was normalized. What vessels helped to
restore the bloodstream?

A.        Aa. digitales palmares communes

B. Aa. metacarpeae palmares
C Arcus palmaris profundus

D. Arcus palmaris supcrficialis

E. Aa. perforantcs

141.   The patient has taken the mi­
xture prescribed by neuropathologist for
neurasthenia for 2 weeks. Patient fell better
but developed coryza, conjunctivitis, rash,
inertia, decrease ol memory. Bromizm was
diagnosed. What should be prescribed to
decrease symptoms?

 

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A.-

B. Asparcam

C Glucose solution 5%

D. Polyglucin   >

E. Natrium chloride

142.   The patient with complaints of
permanent thirst applied to the doctor.
Hyperglycemia, polyuria and increased
concentration of 17-ketosteroids in the uri­
ne were revealed. What disease is the most
likely?

A. Insulin-dependent diabetes mellitus

B. Type 1 glycogenosis

C. Steroid diabetes

D. Addison’s disease

E. Myxoedema

143.     Decreased blood supply to the organs
causes hypoxia that activates fibroblasts
function. Volume of what elements is
increased in this case?

A. Nerve elements

B. Intercellular substance

C. Parenchymatous elements of the organ

D. Lymphatic vessels

E. “Vessels of microcircular stream

144.     A patient in winter fall down into ice-
hole, froze and fall ill. The temperature
increased up to 39,7°C and ranged from
39,0°C to 39.8°C. Name the type of
temperature curve of this patient.

A. Febris remittens

B. Febris continua

C. Febris intermittens

D. Febris recurrens

E. Febris hectica

145.     A child was diagnosed to have fracture
of humerus. The broken arm began retardi­
ng in growth. What part of the bone was
damaged?

A. Diaphysis B.Metaphysis

C. Marrow canal

D.        Apophysis

E. Epiphysis

146.  A 6-month-old child is suffocating
while lying on his back.The palpation on
the anterior wall of trachea up to jugular
notch of the sternum revealed tumor-like
mass, stretching into the anterior mediasti­
num. What from the belowmentioned can
squeeze trachea?

A. Parathyroid glands

B. Parathyroid lymph nodes

C. Peritracheal lymph nodes

D. Thymus gland

E. Thyroid gland

147.  A palient’l liver can not normally
detoxify its natural metabolites and
xenobiotics.The reduced activity of what
cytochrome can cause this?

A. Cytochrome C — 1

B.  Cytochrome R – 450

C.  Cytochromoxidase

D. Cytochrome B

E. Hemoglobulin

148.  During investigation of patient, it was
found formation in the white substance of
cerebral hemispheres with location in the
knee and frontal part of posterior crus of
internal capsule. Fibres of what conductive
tract of the brain will be disrupted?

A.       Tr. frontopontinus

B. Tr. thalamocorticalis

C. Tr. parietooccipitopontinus

D.       Tr. frontothalamicus

E. Tr. pyramidalis

149.   A patient with iron deficiency
anemia has been treated at the in-patient
hematological department of the regional
children’s hospital during 13 years. What
hypoxia type does this patient have?

A.       Respiratory

B. Tissue

C. Circulatory

D.       Combined

E. Hemic

150.    After the radiactive exposure a patient
has stem cells disorder. The regeneration of
what cells of friable connective tissue will
be damaged?

A. Adipocytes

B.  Fibroblasts

C.  Macrophages

D. Pericytes

E. Pigment cells

151. A 2-year-old child has got intestinal
dysbacteriosis, which results in hemorrhagic
syndrome. What is the most likely cause of
hemorrhage of this child?

A. PP hypovitaminosis

B. Hypocalcemia

C. Activation of tissue thromboplastin

D. Fibrinogen deficiency

E. Vitamin K insufficiency

fl5X)The autopsy a 35-year-old man body “”revealed in the second segment of the right

 

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lung the focus of carnification, which was 5 cm in diametre and was enclosed in a thin capsule. The focus was a tough dry friable tissue with a dim surface. What disease are such morphological changes typical for?

A.       Chondroma

B. Postinflammatory pneumosclerosis

C. Tumorous form of silicosis

D. Lung cancer

E. Tuberculoma

153.  Child asked you to puff up the balloon
as much as possible for a one exhalati-
on.What air volume will you use?

A. Total volume of the lungs

B. Vital volume of the lungs

C. Inspiration volume

D. Functional residual volume

E.  Backup volume of the inspiration

154.    A 43-year-old man suffers from
chronic atrophic gastritis and megaloblastic
hyperchromic anemia. He also has
methylmalonic aciduria. Insufficiency of
what vitamin led to the development of such
complex of symptoms?

A.       Vitamin 65

B. Vitamin B12
C Vitamin B3

D. Vitamin Bi

E. Vitamin Bo

155. A patient with brain bloodstream di­
sorder has got difficulties with swallowing,
he can choke over while eating liquid food.
What part of the brain is damaged?

A.        Thalamencephalon

B. Midbrain

C. Medulla

D. Cerebellum

E. Cervical part of the spinal medulla

156. A 40-year-old man was admitted to the
surgical department with spleen rupture.
What anatomic formation will accumulate
the blood?

A. Right lateral canal

B. Hepatic bursa

C Rectovesical excavation

D. Bursa pregastrica

E. Omental bursa

157. On examination of the person it was
revealed that minute volume of heart is
3500 mL, systolic volume is 50 mL. What
is the frequency of cardiac contraction?

A. 80 bpm

B. 70 bpm

C. 90 bpm

D. 50 bpm

E. 60 bpm

158.   During the complicated labour the
symphysis pubis ruptured. What organ can
be damaged the most?

A. Urinary blader

B. Uterine tubes

C. Rectum

D. Uterus

E.  Ovaria

159.  During the merry-go-round riding a 25-
year-old woman began having nausia, vomi­
ting and intensive sweat. Activation of whi­
ch receptors caused the reflex development
of these symptoms?

A. Vestibular receptors of semicircular duct

B.  Optic receptors

C.  Receptors of Corti’s organ

D. Otolith vestibular receptors

E. Proprioreceptors of skeletal muscles

160.  Woman applied to the medico-genetic
consulting centre for information about the
risk of haemophilia in her son. Her husband
has been suffering from this disease since
birth. Woman and her parents are healthy
(don’t have haemophilia). Is the’boy likely
to have the disease in this family?

A. 25% of the boys will be ill

B. AH boys will be ill

C. All boys will be healthy

D. 50% of the boys will be ill

E. 75% of the boys will be ill

161.     A doctor made the diagnosis
of gonorrhoea. It was known from
the anamnesis that a patient had had
gonorrhoea before and he had been treated
completely. What type of infection can this
new disease be attributed to?

A. Secondary infection

B. Superinfection

C. Relapse

D. Autoinfection

E. Reinfection

162. Ion cells have been blocked in the exci­
tative cell. It doesn’t change significantly
the quiet potential, hut (he cell has lost its
capacity to the generation of AP (action
potential). What canals have been blocked?

 

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A.      Calcium

B. Chlorine

C. Sodium

D. Sodium and potassium

E. Potassium

163.   A 63-year-old man, suffering from
cancer of esophagus, has metastases to
mediastenum, lymph nodes and cancer
cachexy. What is the pathogenetic stage of
the given tumorous process?

A. Progression

B. Promotion
C-

D. Initiation

E. Transformation

164.   Because of present gallstone in the
common bile duct, a patient has no bile
excretion into duodenum. What disorder
can it cause?

A. Lipids digestion

B. Carbohydrates absorption

C. Proteins absorption

D. Proteins digestion

E. Carbohydrates digestion

165.   A patient with acute myeloblast
leucosis has developed liver and spleen
enlargement, anemia, myeloblasts in peri­
pheral blood. What principal sign allows
to differ, myeloblast leukosis from chronic
one?

A.      Blast cells in peripheral blood

B. Leukemic collapse

C. Pancytopenia

D. Anemia

E. Thrombocytopenia

(l66yfTht examination of skin biopsy of a patient with hemorrhage vasculitis revealed the next: the vessel wall was thickened, hjgmggenous, stained in yellow colour by means of picrofuchsin, PAS-positive. What pathologic process has developed in the vessels walls?

A.      Mucoid swelling

B. Lipidosis

C. Amyloidosis

D. Fibrinoid swelling

E. Hyalinosis

167. A 60-year-old man after cerebral hemorrhage felt asleep for a long time. Damage of what structure caused this state?

A.      Black substances

B. Reticular formation

C Cortex of the large hemispheres

D. Nuclears of the cerebral nerves

E. Hippocampus

168.  Careless student occasionaly met his
dean. The concentration of what hormone
will most likely increase in the blood of the
student?

A. Corticotropin

B. Adrenalin

C. Thyrotropin-releasing hormone

D. Cortisol

E. Somatotropin

169.   A man in a quiet condition has
increased activity of the muscles, responsi­
ble for the inspiration. What from the
belowmentioncd can cause this?

A.        Reduction of minute respiratory capacity

B. Superficial breathing

C. Infrequent breathing

D. Negative intrapleural pressure

E. Airways narrowing

170. A patient was admitted to the hospital
with a wound in the region of his neck. The
examination revealed the damaged nerve,
situated in front of the anterior ladder
muscle. What nerve is damaged?

A. Cervical part of sympathetic trunk

B. Glossopharyngeal

C. Sublingual

D. Phrenic

E. Vagus

171. A patient with chronic heart failure bei­
ng treated by digitalis drugs developed the
symptoms, which confirmed the beginning
of cardiac glycosides toxic activity. What
drug should be administered to reduce the
negative effect of cardiac glycosides?

A. Potassium chloride

B. Sodium caffeine-benzoate

C. Dipiroxim

D. Ethymizol

E. Atropine sulfate

172. A patient after hypertension stroke has
no voluntary movements in his right arm
and leg, muscle tone in these extrcmites
is increased. What type of dysfunction of
nervous system is it?

A. Peripheral paralysis

B. Reflex paresis

C. Central paresis

D. Central paralysis

E. Peripheral paresis

173.    A patient after tooth extraction
developed persistent substernal pain. Subli­
ngual antianginal substance releavcd the
substernal pain, but the patient complained
of headache and dizziness. What medicine
did the patient use?

 

E91I02

18

 

 

 

A. Metoprolol

B. Valklol

C. Anapriline

D. Verapamil

E. Nytroglycerin

174. The study of mitotic cycle phases of
onion root revealed the cell, in which the
chromosomes are situated in the equatorial
plane, forming a star. What stage of the cell
mitosis is it?

A. Interphase

B. Metaphase-

C. Prophase

D. Anaphase

E. Telophase

175. A patient becomes quickly tired duri­
ng his work. In vertical position with closed
eyes he is dizzying and loosing equilibri­
um. Skeletal muscle tone is reduced. Which
of the belowmentioned brain structures is
damaged?

A. Basal ganglia

B. Thalamus

C. Hypothalamus

D. Precentral gyrus of cerebral hemispheres
cortex

E. Cerebellum

176. Patients with similar complaints appli­
ed to the doctor: weakness, pain in the
intestines, disorder of GIT. Examination of
the faeces revealed that one patient with
four nucleus cysts should be hospitalized
immidiatcly. For what protozoa arc such
cysts typical?

A. Trichomonas

B. Dysenteric amoeba

C. Lamblia

D. Intestinal amoeba

K. Balaniidium

177. During the staining of sputum smear
of a patient with suspected croupous
pneumonia the following reactives and
stainers were used: gential violet soluti­
on, Lugol’s solution, 06° spiritus and water
fuchsin. What method of staining is used in
this case?

A.        Gram’s

B. Romanovsky’s

C. Lefflcr’s

D. Zichl-Neclsen’s

E. Neisscr’s

178. A 56-year-old patient with cardiac fai­
lure notices edematous feel and shins, the
skin in the place of edema is pale and cold.
What is the leading pathogenesis of this
patient’s edema?

A.     Increased    hydrostatic    pressure    in
vcnulaes

B. Increased capillary penetration

C. Reduced oncotic pressure in capillaries
I>. Lymph outflow impairment

E. Positive water balance

179. Patient was admitted to the infection
unit with diagnosis of bacterial dysentery.
On laboratory studies it was revealed
that causative element is sensitive to
many antimicrobial medicines, but patient
had anemia. What medicine was contra-
indicated to the patient?

A. Furazolidone

B. Enteroseptol

C. Levomycctin

D. Ampicillih

E. Phthalazol

180. Testosterone and it’s analogs increase
the mass of skeletal muscles that allows to
use them for treatment of dystrophy. Due
to interaction of the hormon with what cell
substance is this action caused?

A. Membrane receptors

B. Proteins-activators of transcription

C. Ribosomes

D. Nuclear receptors

E. Chromatin

181. During the football match a player
injuried his knee joint. The X-ray exami­
nation showed fracture of the bone, which is
situated in the tendon thickness of musculus
quadriceps femoris. What of the mentioned
groups does this bone belong to?

A. Flat

B. Tubular

C. Hollow

D. Combined

E. Sesamoid

182.    A patient suffers from arterial
hypertension strokes, accompanied by
tachycardia, excessive sweat, sharp pain in
the epigastric region. Which of the menti­
oned tumorous diseases are these symptoms
the most typical for?

I A. Pituitary basophil adenoma

B. Ovarian tumor

C.  Glomerular adrenal adenoma

D. Thyroid adenoma

E. Phcochromocytoma

183.  On bacteriological examination of the
defecation of a 4-months-old baby with the
symptoms of acute bowel iufection there
were revealed red colonies spread in the
large quantity in the Endo medium. What
microorganism can it be?

 

E9JI02

19

 

 

 

A.       Shigcll

B. Streptococcus
C Escherichia

D. Salmonella

E. Staphylococcus

184.   A patient, who had been blowing
a cloud (smoking tobacco) for a long
time developed lung cancer. Which of
the suggested cancerogenic substances is
contained in the tobacco smoke and is
attributed to the polyunsaturated aromatic
carbohydrates (PAC)?

A.        P- naphthylamine

B. Diethylnitrosamine

C. Benzpyrene

D.        Dimethylaminoazobenzene

E. Orthoaminoazotoluene

185.     A patient with symmetric dermatitis of
open dermal areas came to the doctor. Talki­
ng to the patient the doctor found out that
the patient mostly eats cereals and eats little
meat, milk and eggs. The deficiency of whi­
ch of the mentioned vitamins is dominant in
this patient?

A.        Nicotinamide

B. Folic acid

C. Biotin

D. Calciferol

E. Tocopherol

186. A child with diphtheria 10 days after
injection of antitoxic antidiphtherial serum
has developed skin rash, accompanied by
severe itch, rising temperature up to 38°C
and joints pain. What is the cause of these
symptoms?

A. Contact allergy

B. Delayed type of hypersensitivity

C. Atopia

D. Serum sickness

E. Anaphylactic reaction

187.   A group of men applied to the
doctor complaining of rising temperature,
headache, swelling of face and eyelids,
myalgia. From the history it became known
that they all were hunters and they often
ate meat of wild animals. What is the most
likely diagnosis?

A.        Trichinosis

B. Teniasis

C. Filariasis

p. Teniarrhinchosis E. Cysticercosis

188.     A patient has a suspected pneumonia.
In his sputum there were revealed
gramposilive diplococci, prolonged with the
slightly pointed opposite ands. What mi­
croorganisms are revealed in the sputum?

A.        Staphylococcus aureus

B. Streptococcus pneumoniae

C. Neisseria gonorrhoeae

D. Neisseria meningitidis

E. Klebsiella pneumoniae

J89^\ 46-year-old man on his head skin has got a little bulged out nevus pigmentosis of a dark colour which didn’t trouble him. For the last time the nevus began growing in size, a pain developed, the colour became black-brown; the palpati­on of it demonstrated a node at its base. The histological examination of the removed tissue revealed spindle-shaped and polymorphic cells, the cytoplasm of which contained the pigment of fulvous colour. What tumor is it about?

A. Hemangioma

B. Carcinoid

C. Basalioma

D. Hematoma

E. Melanoma

190yA patient with burn disease died due Toprogressive septicaemia. The autopsy in the anterior abdominal wall by means of microscopic examination revealed di­ffuse infiltration of intermuscular spaces by segmentonuclear leukocytes, tissues edema and lysis of muscular fibres. Determine the nature of the pathological process.

A. Necrosis

B. Catarrhal inflammation

C. Abscess

D. Phlegmon

E. Diphtheritic inflammation

191.     A 58-year-old man has a clinical picture
of acute pancreatitis. The increase of what
substance in the urine from belowmenti-
oned will confirm the diagnosis?

A. Urea

B. Amylase

C. Albumin

D. Nonprotein (rest) nitrogen

E. Uric acid

192.     In the blood smear, stained according
to Romanovsky-Giemsa method, there are
20% big (20 mem in diametre), rounded
cells with pale-basophilic cytoplasm and
bean-shaped nucleus. How is this conditi­
on characterised clinically?

A.        Leukopenia

B. Neutrophilosis

C. Monocytosis

D.        Lymphocytosis

E. Reticulocytosis

193.   A   40-year-old   pregnant   woman

 

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20

 

 

 

underwent amniocentesis. The examinati­on of fetus karyotype revealed 47Xy+21. What pathology of the fetus was found out?

A. Phenylketonuria

B. Patau’s disease

C. Klinefelter’s syndrome

D. Down’s syndrome

E. Schereschevsky-Terner’s disease

194.  Person has stable HR, not more than
40 bpm. What is the pacemaker of the heart
rhythm in this person?

A.       Sinoatrial node

B. Atrioventricular node

C. His’ bundle

D. Branches of His’ bundle

E. Purkinye’ fibers

195.  2 weeks since the blood transfusi­
on a recepient has developed fever. What
protozoal disease can it be?

A.       Trypanosomiasis

B. Malaria

C. Leishmaniasis

D. Toxoplasmosis

E. Amebiasis

196.  A 42-year-old man suffering from
gout has increased level of urinary acid in
the blood. Allopurinol was prescribed to
decrease the level of urinary acid. Competi­
tive inhibitor of what enzyme is allopurinol?

A.        Hypoxantinphosphoribosiltransferase

B. Xanthinoxidase

C Guaninedeaminase

D. Adenosinedeaminase

E. Adeninephosphbribosiltransferase

19Z)On autopsy of the 58-year-old man it !s~fevealed: mitral valve is deformed, thi-

ckened, not totally closed. Microscopically: centers of collagen fibers are eosinophilic, have positive fibrin reaction. The most li­kely it isf

A.. Hyalinosis

B. Mucoid swelling

C. Amyloidosis

D. Fibrinoid swelling

E. Fibrinoid inflammation

198.  While examining the child the doctor
revealed sym.netric cheeks roughness, di­
arrhea, disfunction of the nervous system.
Lack of what food components caused it?

A.        Nicotinic acid, tryptophane

B. Lysine, ascorbic acid

G. Threonine, pantothenic acid

D. Methionine, lipoic acid

E. Phenylalanine, pangamic acid

199.  A 40-year-old man ran 10 km per 60
minutes. What changes of energy exchange
will take place in his muscular tissue?

A. Glyconeogenesis intensification

B. Proteolysis intensification

C. Increase of fatty acids oxidation rate

D. Glycolysis intensification

E. Glycogenosis intensification

200.  Isolated muscle of a frog is rhythmi­
cally irritated with electric impulses. Every
next impulse is in a period of relaxati­
on from the previus contraction. What
contraction of the muscle appears?

A. Continuous (smooth) tetanus

B. Single

C. Tonic

D. Waved tetanus

E. Asynchronous

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MINISTRY OF

Boa3rd of education and science of MPH of Ukraine Testing Boa

 

Test items for licensing examination

Krokl

MEDICINE

2005

 

General Instruction Every one of these numbered questions or unfinished statements in this chapter corresponds to answers or statements endings. Choose the answer (finished statements) that fits best and fill in the circle with the corresponding Latin letter on the answer sheet.

 

EEK

54.1*73 61

 

Authors of Items: Andronov D.YU., Amautova L.V., Barinov B.P., Byclousova I.R, Boiko O.V., Boriscnko B.O., Vaschuk A.A., Visockiy I.YU., Vilhova I.V., Volohova G.O., Vorobcts Z.D., Gavrilyuk O.M., Gargin V.V., Glamazdina N.M., Goldobina O.V., Guzik N.M., Gurcalova LP., Davidcnko I.S., Dcm’yancnko I.A., Demchcnko O.M., Dycitsova O.I., Dogadina I.V., Zhadinskiy M.V., Zhilyuk V.I., Zhulinskiy V.O., Zagorulko O.K., Zaharov V.I., Zclenina N.M., Zlcnko O.T., Ivascnko A.V., Kaptyuh R.F., Kirjakulov G.S., Klincova S.P., Klopockiy G.A., Koroicnko G.S., Korol A.P., Krushinska T.YU., Kryuk YU.YA., Kubishkin A.V.. Kuzik I.JA., Kukovska I.L., Kulaccnko B.V., Kulitka E.F., Kuccvol O.V., Lazarev K.L., Loiytra A.O., Lucyuk M.B., Makovctskiy O.V., Matyushcnko P.M., Michaiylyuk I.O., Mrug V.M., Navniko T.S., Ncchiporcnko G.V., Nikifrchin R.M., Nikonova A.A., Nikolcnko O.I., Nikolenko YU.I., Nikoncnko T.M., Ovchinnikov S.O., Pandikidis N.I., Piddubnyak YU.G., Poguda A.A., Pushkar M.S., Romancnko M.I., Savchcnko N.V., Semcnyuk T.M., Sidorchuk I.Y., Skorobagata T.G., Skrcbkova O.YU., Skripka O.V., Skryabina O.M., Sluchcnko O.M., Smolyakova G.M., Starlichanova L.D., Stcblyuk M.V., Slcts V.R., Tananakina T.P., Tatarko S.V., Tertishniy S.I., Tomashova S.A., Tumas’yants N.YU., Ulyanccva E.A., Fartushok N.V., Fcdorchenko O.V., Halaturnik G.M., Holodkova O.L., Hramova R.A., Chcrkasov V.G., Cherkashina L.P., Chcsnokova M.M., Shalanin V.V., Shcvtsova A.I., Shcmonacva K.F., Scherbakov S.M., Schcrbakov M.S., Scherbakov C.N., Yasinskiy V.I. and Committees of professional expertise.

Item reviewers. Andrycyeva V.F., Basiy R.V., Borzenko B.G., Visotskiy I.YU., Vinnikov YU.M., Golovatyuk O.L., Gorgol N.I., Deyneka S.YE., Dycitsova O.I., Zhadinskiy M.V, Zclenina N.M., Zinkovska L.YA., Yoltuhivskiy M.V, Kalikik K.G., Kalugina S.M., Kirichck L.T., Kiryuhin I.R, Kovalchuk L.YE., Korolenko G.S., Krushinska T.YU., Linchevska L.R, Lyubinets L.A., Mrug V.M., Nikolcnko O.I., Ovchinnikov S.O., Ostrovska S.S., Pcntyuk O.O., Pototska I.I., Pushkar M.S., Sikora V.Z., Tcleshova O.V, Trzhetsinskiy S.D., Fcdechko IY.M., Fomina L.V, Chemenko N.A.

Composers. Artemchuk L., Bulakh I., Homchenkova N.

The book Includes test items for use at licensing integrated examination “Krok 1. Medicine” and further use In teaching.

The book has been developed for students of medical, pediatric and mcdical-and-prophylactic faculties and academic staff of higher medical educational establishments.

 

Approved by Ministry or Public Health of Ukraine as examination and teaching publication based on expert conclusions (Orders of MPH of Ukraine of 14.08.1998 Jfl-251, of 27.12.1999 JVM03, of 18.06.2002 JVb22l, of 16.10.2002 JYW74, of 16.04.2003 M239, of 29.05.2003 JV4233).

© Copyright

Testing Board, 2005.

 

Krok 1 Medicine 2005

1

 

 

 

1. The conjugated protein necessarily contains special component as a non-protein part. Choose the substance that can’t carry out this function:

A. AMP

B.  Thiamine pyrophosphate
IC HN03

D.ATP E. Glucose

2.  Marked increase of activity of MB-forms
of CPK (creatinephosphokinase) and LDH-
1 was revealed by examination of the pati­
ent’s blood. What is the most probable
pathology?

A. Cholecystitis

B. Miocardial infarction

C. Pancreatitis

D. Hepatitis

E. Rheumatism

3.  A 46 year-old man complains of difficult
hose breathing. Mikulich cells, storage of
epithelioid cells, plasmocytes, lymphocytes,
hyaline balls are discovered in the biopsy
material of the nose thickening. What is the
most likely diagnosis?

A. Meningococcal nasopharyngitis

B. Scleroma

C. Rhinovirus infection

D. Virus rhinitis

E. Allergic rhinitis

4.  A man after 1,5 litre blood loss has
suddenly reduced diuresis. The increased
secretion of what hormone caused such di­
uresis alteration?

A. Corticotropin

B. Natriuretic

C. Parathormone

D. Cortisol

E. Vasopressin

5.  A 45-year-old woman suffers from allergic
seasonal coryza caused by the ambrosia
blossoming. What adipose cells group stabi­
lizer medicine can be used for prevention of
this disease?

A. Tavegyl

B.  Ketotifen

C.  Diazoline

D. Phencarol

E. Dimedrol

6.  A 32-year-old patient has been diagnosed
with bartholinitis (inflammation of Bartholi­
n’s glands ). In what part of the female
urogenital system are the Bartholin’s glands
located?

A.        The labia minor

B. The clitoris

C. The uterus

D. The vagina

E. The labia major

7.  The action of electric current on the
exitable cell caused depolarization of its
membrane. Movement of what ions through
the membrane caused depolarisation?

A.C/” B.K+

C. Ca2+

D. HCOJ
E.Na+

8.    A 10-year-old child complains of
weakness, nausea, irritability. Helminthes
of white color and 5-10 mm long have been
found on the underwear. On microscopy of
the scrape from the perianal folds achromic
ova of the unsymmetrical form have been
revealed. Which helminth is in the organism
of the child?

A. Trichuris

B. Trichina

C. Ascaris lumbricoides

D. Ancylostoma duodenalis

E. Enterobins vermicularis

9.  A 2-year-old child experienced convulsi­
ons because of lowering calcium ions
concentration in the blood plasma. Function
of what structure is decreased?

A. Adrenal cortex

B. Thymus

C. Parathyroid glands

D. Pineal gland

E. Hypophysis

10.  A patient with injured muscles of the
lower extremities was admitted to the
traumatological department. Due to what
cells is reparative regeneration of the muscle
fibers and restoration of the muscle function
possible?

A.        Myoepithelial cells

B. Myoblasts

C. Fibroblasts

D. Myofibroblasts

E. Satellite-cells

11.  A 27- year-old woman has used penicillin
containing eye drops. In a few minutes itchi­
ng, skin burning, lips and eyelids edema,
whistling cough, decreasing BP appeared.
What antibodies can lead to this allergic
reaction?

 

Krok 1 Medicine 2005

2

 

 

 

A. IgM and IgG

B. IgM and IgD
C IgG and IgD

D. IgE and IgG

E. IgA and IgM

12.   A 50 year-old patien was injured on
the occipital region of the head. The closed
skull’s trauma was diagnosed. She was taken
to the hospital. The medical examinati­
on: deregulation of walking and balance,
trembling of arms. What part of brain was
injured?

A.       The cerebellum

B. The inter-brain

C. The spinal cord

D. The medulla oblongata

E. The mind-brain

13.   An autopsy revealed large (1-2 cm)
brownish-red, easy crumbling formations
covering ulcerative defects on the external
surface of the aortic valve. What is the most
likely diagnosis?

A. Acute warty endocarditis

B. Recurrent warty endocarditis

C. Fibroplastic endocarditis

D. Polypus-ulcerative endocarditis

E. Diffusive endocarditis

14. A denaturation of proteins can be found
in some substances, specify the substance
that is used for the incomplete denaturation
of hemoglobin:

A. Nitric acid B.Urea

C. Toluene

D. Sulfuric acid

E. Sodium hydroxide

15.  A 6-year-old child fell on the cutti­
ng object and traumatized soft tissues
between tibia and fibula. What kind of bone
connection was injured?

A. Fontanel

B. Gomphosis

C. Suture

D. Membrane

E. Ligament

16.  A patient with hypersecretion of the
gastric juices was recomended to exclude
concentrated bouillons and vegetable
decoctions from the diet because of their sti­
mulation of gastric secretion. What is domi­
nating mechanism of stimulation of secreti­
on in this case?

A.   Stimulation  of gastrin  production  by
G-cells

B. Irritation of taste receptors

C.   Irritation of mcchanoreccptors of the
stomach

D. Stimulation of excretion of secretin in the
duodenum

E. Irritation of mechanoreceptors of the oral
cavity

17.  In the ovary specimen colored with
hematoxylin-eosin, follicle is determined
where cubic-shaped follicle epithelium cells
are placed in 1-2 layers, and scarlet covering
is seen around ovocyte. Name this follicle:

A. Primary B.Secondary

C. Mature

D. Atretic

E. Primordial

18. A 57-year-old patient was admitted to the
gastroenterological department with suspi­
cion of Zollinger-Ellison syndrom because
of rapid increase of gastrin level in the blood
serum. What the most probable disorder of
the secretory function of the stomach here?

A. Achylia

B. Hypoacidity hyposecretion
C Hyperacidity hyposecretion

D. Hypoacidity hypersecretion

E. Hyperacidity hypersecretion

19. The patient with diabetes mellitus has
been delivered in hospital in the state of
unconsciousness. Arterial pressure is low.
The patient has acidosis. Point substances,
which accumulation in the blood results in
these manifestations:

A.        Ketone bodies

B. Amino acids

C. High fatty acids

D. Monosaccharides

E. Cholesterol esters

20. The low specific gravity of the secondary
urine (1002) was found out in the sick
person. Wat is the most distant part of
nephron where concentration of secondary
urine takes place?

A. In the collecting duck

B. In the nephron’s glomerulus

C. In ascending part of loop of Henle

D. In proximal tubule of nephron

E. In distal tubule of nephron

21.     Glomerular filtration rate (GFR)
increased by 20% due to prolonged starvati­
on of the person. The most evident cause of
filtration changes under this conditions is:

 

Krok 1 Medicine 2005

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A.   Decrease of oncotic pressure of blood
plasma

B. Increase of penetration of the renal filter

C. Increase of filtration coefficient

D. Increase of systemic blood pressure

E. Increase of renal plasma stream

22.  Scraps of.the mycelium of a fungus,
spores, air bubbles and fat drops were di­
scovered on microscopy of the patient’s
hair excluded from the infected areas. What
fungus disease is characterised by this mi­
croscopic picture?

A. Trichophytosis

B. Epidermophytosis
G. Favus

D. Sporotrichosis

E. Microspory

23.  Moving of the daughter chromatids to
the poles of the cell is observed in the mi-
totically dividing cell. On what stage of the
mitotic cycle is this cell?

A. Interfase

B. Telophase

C. Metaphase

D. Prophase

E. Anaphase

24.  A couple came for medical genetic
counseling. The man has hemophilia, the
woman is healthy and there were no cases of
hemophilia in her family. What is the risk of
having a sick child in this family?

A. 100% B.50% C. 75%

D.25% E.0

25.  After the trauma, the patient’s right
n.vagus was damaged. Which violation of
the cardiac activity is possible in this case?

A. Block of a conductivity in the atrio­
ventricular node

B. Violation of a conductivity in the right
auricle

C. Arrhythmia

D.  Violation of the automatism of a atrio­
ventricular node

E.  Violation of the automatism of a Kiss-
Fleck node

26.  Purulent endometritis developed in a
woman after delivery. Treating with anti­
biotics inhibitors of murein synthesis was
ineffective. Wide spectrum bactericidal anti­
biotic was administered lo her. In 6 hours
temperature rapidly increased up to 40°C
with shiver. Muscle pains have appeared.
BP dropped down to 70/40 mmHg. Oligura
has developed. What is the main reason for

the development of this condition?

A.        Bacteremia

B. Endotoxic shock

C. Internal bleeding

D. Anaphylactic shock

E. Toxic effect of preparation

27. When the pH level of the stomach lumen
decreases to less than 3, the antrum of
the stomach releases peptide that acts in
paracrine fashion to inhibit gastrin release.
This peptide is:

A.        Acetylcholine

B. Gastrin-releasing peptide (GRP)

C. Somatostatin

D. Vasoactive intestinal peptide (VIP)
E.GIF

28.   A 22-year-old’ patient was admitted
to the hospital with complaints of heavy
nasal breathing. During the examination
of her nasal cavity the doctors found thi­
ckened mucous membrane, a lot of mucus
and nodular infiltrates without erosions in
the nose.The nasal rhinoscleroma was di­
agnosed. The biopsy was taken. What typi­
cal morphological changes may be found?

A. Granulomas with foreign body cells

B. Granulomas with Mikulicz’s cells

C. Interstitial inflammation

D. Granulomas with Langhan’s cells

E. Granulomas with Virchow’s cells

29.  Synthesis of phospholipids is disordered
under the liver fat infiltration. Indicate
which of the following substances can
enhance the process of methylation during
phospholipids synthesis?

A. Glycerin

B. Citrate

C. Glucose

D. Methionine

E. Ascorbic acid

30.   Obturative jaundice developed in a
60-year-old patient because of malignant
tumour of the big papillary of the duodenal.
Lumen of what anatomical structure is
squeezed with tumour?

A. Hepatopancreatic ampulla

B. Left hepatic duct

C. Cystic duct

D. Right hepatic duct

E. Common hepatic duct

31.  Live vaccine is injected into the human
body. Increasing activity of what cells of
connective tissue can be expected?

 

Krok 1 Medicine 2005

4

 

 

 

A.       Fibroblasts and labrocytes

B. Macrophages and fibroblasts

C. Adipocytes and adventitious cells

D. Plasmocytes and lymphocytes

E. Pigmentocytes and pericytes

32. The patient with pneumonia was treated
with antibiotics for a long period. After
treatment patient complains of frequent and
watery stool, abdomenal pain. What is the
reason of intestine function disorder?

A. Intestinal disbacteriosis development

B. Bacteria toxins influence

C. Autoimmune reaction development

D. Hereditary enzyme defect

E. Antibiotics toxic influence on the GIT

33.   In the microspecimen of red bone
marrow multiple capillares were revealed
through the walls of which mature blood
cells penetrated. What type of capillares is
it?

A. Somatical

B. Fenestrational
C Visceral

D. Lymphatic

E. Sinusoidal

34.  There is only one hormone among the
neurohormones which refers to the derivati­
ves of amino acids according to classificati­
on. Point it out:

A. Somatotropin

B. Oxytocin
C Melatonin
P. Vasopressin
E. Thyroliberin

35.  A young man has an unpainfull formati­
on without marked borders in the soft ti­
ssues of his thigh. On the tissue bioptate
the formation lookes like flesh of fish and
consists of immature fibroblast-like cells
with multiple mitosis growing through the
muscles. What is the most likely diagnosis?

A.        Myoma

B. Fibroma

C. Fibrosarcoma

D. Myosarcoma

E. Cancer

36.  A worker has decreased buffer capacity
of blood due to exhausting muscular work
The influx of what acid substance in the
blood can cause this symptom?

A. 3-phosphoglycerate

B. Lactate

C. Pyruvate

D. 1,3-bisphosphoglycerate

E. a-ketoglutarate

37. Ovarian tumour was diagnozed in a

woman. Surgery should be perfomed. What ligament should be extracted by the surgeon to disconnect the ovary and the uterus?

A.        Broad ligament of uterus

B. The ovanal ligament

C. Lateral umbilical ligament

D. Round ligament of uterus

E. Suspensory ligament of ovary

38.  The electronic microphoto of kidney
fragment has exposed afferent glomerular
arteriole, which has giant cells under its
endothelium, containing secretory granules.
Name the type of these cells:

A. Juxtaglomerular

B. Interstitial

C Smoothmuscular

D. Mesangial

E. Juxtavascular

39.  The reason of occurrence of some di­
seases of an oral cavity is connected wi­
th structural peculiarities of its mucous
membrane. Wnat morphological attributes
characterize these features?

A. Well developed muscularis, no submucosa

B. Transitional epithelium, no submucosa

C.  Transitional epithelium, no muscularis
mucosa

D.     No    muscularis    mucosa,    stratified
squamous epithelium

E. Simple columnar ciliated epithelium

40. The energy inputs of a healthy man have
been measured. In what position was the
patient if his energy inputs were less than
the main exchange?

A. Calmness

B. Easy work
GRest

D. Sleep

E. Nervous exertion

41. A patient after hypertension stroke does
not have voluntary movements in his right
arm and leg with the increased muscle tone
in these extremites. What type of disfuncti­
on of nervous system is it?

A.        Peripheral paresis

B. Central paralysis

C. Peripheral paralysis

D. Reflex paresis

E. Central paresis

42. There is the change of teeth at the 6-8-
year-old children: deciduous are replaced by
permanent. What embrionic tissues are the
sources of formation of permanent teeth ti­
ssues?

 

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A.        Mesodermal epithelium and mesenhime

B. Enlodermal epithelium of a tooth plate
and mesenhime

C. Entodermal epithelium and mesoderm

D. Ectodermal epithelium of a tooth plate
and mesenhime

E. I, II brachial arches

43. A tissue sample of benign tumor was
studied under the electron microscope. A lot
of small (15-20 nm) spherical bodies, consi­
sting of 2 unequal subunits were detected.
These are:

A. Smooth endoplasmic reticulum

B. Mitochondria

C. Golgi complex

D. Microtubules

E.  Ribosomes

44. Part of the DNA chain turned about 180
degrees due to gamma radiation. What type
of mutation took place in the DNA chain?

A. Replication

B. Deletion

C. Inversion

D. Doubling

E. Translocation

45. Red colonies spread in the large quantity
in the Endo culture medium were revealed
on bacteriological stool examination of a 4-
month-old baby with the symptoms of acute
bowel infection. What microorganism can it
be?

A. Salmonella

B. Staphylococcus
C Escherichia

D. Shigell

E. Streptococcus

46.  A patient’s blood was analyzed and
the decreased erythrocyte’s sedimentation
rate (ESR) was discovered. What disease
from the listed below is accompanied with
decreased ESR?

A. Polycytemia

B. Myocardial infarction

C. Hepatitis

D. Splenomegaly

E.  Vitamin B deficiency

47.  A 13-year-old girl with history of asthma
complained of cough, dyspnea and wheezi­
ng. Her symptoms became so severe that her
parents brought her to the emergency room.
Physical examination revealed diaphoresis,
dyspnea, tachycardia and tachypnea. Her
respiratory rate was 42/min, pulse rate was
110 beats per minute, and blood pressure
was 130/70 mm Hg. Choose from the
following list the most appropriate drug to
reverse the bronchoconstnetion rapidly:

A. Ipratropium

B. Salbutamol

C. Methylprednidsolone

D. Cromolyn

E. Beclomethasone

48. Slime, blood and protozoa 30-200 mi­
crons of length have been revealed in a
man’s feces. The body is covered with cili-
as and has correct oval form with a little bit
narrowed forward and wide round shaped
back end. On the forward end a mouth is vi­
sible. In cytoplasm there are two nucleuses
and two short vacuoles. For whom are the
described attributes typical?

A.        Dysenteric amoeba

B. Intestinal amoeba

C. Balantidium

D. Trichomonas

E. Lamblia

49. An autopsy has revealed that kidneys are
enlarged, surface is large-granular because
of multiple cavities with smooth wall, which
are filled with clear fluid. What kidney di­
sease did the patient have?

A. Necrotic nephrosis

B. Polycystic kidney

C. Pyelonephritis

D. Infarction

E. Glomerulonephritis

50. An isolated muscle of a frog is rhythmi­
cally irritated with electric impulses. Every
next impulse is in a period of relaxation from
the previus contraction. What contraction of
the muscle occurs?

A. Single

B. Tonic

C. Continuous (smooth) tetanus

D. Asynchronous

E. Waved tetanus

51.   During surgical operation a blood
transfusion was made. The blood must be
checked to find antigens of some disease.
What disease is expected to be found?

A. Virus of hepatitis E

B. Virus of hepatitis B

C. Enterovirus

D. Virus of hepatitis A

E. Adenovirus

52.  A patient with the symptoms of acute
alcoholic poisoning was brought to the
hospital, what carbohydrates metabolism
changes are typical for this condition?

 

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A. The breakage of glycogen is increased in
liver

B.  The gluconeogenesis velocity in liver is
decreased

C.    The   anaerobic   glucose   metabolism
predominates in muscles

D. The gluconeogenesis is increased in liver

E.  The anaerobic breakage of glucose is
increased in muscles

53. A patient after pathological process has
a thickened alveolar membrane. The di­
rect consequence of the process will be the
reduction of:

A.        Oxygen capacity of blood

B. Minute respiratory capacity

C. Diffuse lung capacity

D. Alveolar lung ventilation

E. Reserve expiratiory capacity

54. During the breakout of acute respiratory
infection in order to diagnose influenza
the express-diagnosis, based on revealing
of specific viral antigen in the examined
material (nasopharyngial lavage), is carri­
ed out. Which reaction is used for this?

A. Agglutination

B. Complement binding

C. Precipitation

D. Opsonization

E. Immunofluorescence

55. Pyruvate concentration in the patient’s
urine has increased 10 times from normal
amount. What vitamin deficiency can be the
reason of this change:

A.        Vitamin A

B. Vitamin B{
G Vitamin C

D. Vitamin B6

E. Vitamin E

56.  A patient complains of frequent and
difficult urination. Imperfection of what
formation can cause it?

A. Sperm bubbles

B. Bulb-uretic glands

C. Testicle adnexa

D. Prostate

E. Testicles

57.   A patient in three weeks after acute
myocardial infarction has pain in the heart
and joints and pneumonia. What is the
main mechanism of development of post­
infarction Dressler’s syndrome?

A. Thrombosis vessels

B. Ischemia of myocardium

C. Autoimmune inflammation

D.  Resorption of enzymes from necrotized
area of myocardium

E. Secondary infection

58. Different functional groups can be presented in the structure of L-amino aci­d’s radicals. Identify the group that is able to form ester bond:

A.-OH

B. -NH2

C. -CONH2

D. -CH3
E.-SH

5Ps A patient has undergone an amputation of lower extremity. Some time later painful nodules appeared in a stump. Amputatious neuromas were found out at the microscopic examination. To what pathological processes do those formations relate?

A.        Metaplasia

B. Dystrophy

C. Regeneration

D. Inflammation

E. Hyperemia

60.  A patient, who suffers from congeni­
tal erythropoietic porphyria, has skin
photosensitivity. The accumulation of what
compound in the skin can cause it?

A. Coproporphyrinogen 3

B. Uroporphyrinogen 2
C Uroporphyrinogen 1

D. Protoporphyrin

E.  Heme

61.  A patient who came to the doctor
because of his infertility was administered
to make tests for toxoplasmosis and chronic
gonorrhoea. Which reaction should be
performed to reveal latent toxoplasmosis
and chronic gonorrhoea of the patient?

A. RDHA – Reverse direct hemagglutination
assay

B. Immunoblot analysis

C. RIHA – Reverse indirect hemagglutinati­
on assay

D.   (R)CFT- Reiter’s complement fixation
test

E. IFA – Immunofluorescence assay

62.    A 63-year-old woman developed
symptoms of rheumatoid arthritis. Their
increase of which blood values indicators
could be the most significant in proving the
diagnosis?

 

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A. Lipoproteids

B. R-glycosidase

C Acid phosphatase

D. General cholesterol

E. Additive glycosaminoglycans

63.  The process of heart transplantation
determined the viability of myocardial cells.
The determination of what myocardium
parameter is the most important?

A. Concentration of calcium-ions in myofi­
brils

B. Heart temperature

C. Rest potential of cardiomyocytes

D. Concentration of oxygen in heart vessels

E. Concentration of Ca-ions in heart vessels

64.  During the fetal period of the
development in the vascular system of
the fetus a large arterial (Botallo’s)
duct is functioning which converts into
lig.arteriosum after birth. What anatomi­
cal formations does this duct connect?

A. Right and left auricle                            I

B. Pulmonary trunk and aorta

C. Aorta and superior vena cava

D. Aorta and inferior vena cava

IE. Pulmonary trunk and superior vena cava

65.  The formation of a secondary medi­
ator is obligatory in membrane-intracellular
mechanism of hormone action. Point out the
substance that is unable to be a secondary
mediator:

A. Glycerol

B. Ca?+

C. Inositol-3,4,5-triphosphate

D. CAMP

E. Diacylglycerol

66fA patient with bronchial asthma had been taking tablets which caused insomnia, headache, increased blood pressure. What medecine can cause such complications?

A. Euphyline

B. Adrenaline

C. Izadrine

D. Chromolin sodium

E. Ephedrine

67. A patient with abscess of the cut wound applied to the traumatological department .The wound was washed with 3% hydrogen peroxide to be cleaned from the pus. Foam was not observed. What caused inefficiency of the drug?

A. Shallow wound

B. Low concentration H2O2

C. Inherited insufficiency of catalase

D. Pus in the wound

E.    Inherited   insufficiency   erythrocyte’s
phosphatdehydrogenase

68.    On autopsy of a still-born infant
abnormalities have been revealed: ventri­
cles are not separated, a single arterial trunk
originates from the right part. For what class
of vertebrates is such heart construction
characteristic?

A.        Mammals

B. Reptiles

C. Amphibian

D.        Fishes

E. Birds

69.   A 37-year-old man was admitted
to the surgical department with the
symptoms of acute pancreatitis: vomiti­
ng, diarrhea, bradycardia, hypotention,
weakness, dehydration of the organism.
What medicine should be used first of all?

A.        Contrycal

B. Platyphylline

C. Etaperazine

D.        No-spa

E. Ephedrine

70.’ A businessman came to India from South America. On examination the physi­cian found that the patient was suffering from sleeping-sickness. What was the way of invasion?

A.        As a result of mosquito’s bites

B. With contaminated fruits and vegetables
C As a result of bug’s bites

D.        After contact with a’ sick dogs

E. Through dirty hands

71. The CNS stimulation produced by
methylxanthines, such as caffeine, is most
likely due to the antagonism of one of the
following receptors:

A. Adenosine receptors

B. Glutamate receptors

C. GABA receptors

D. Glycine receptors

E. Cholinergic muscarinic receptors

72. Nowadays about 50 minor bases have
been found in the t-RNA structure besides
the main four nitrogenous bases. Choose the
minor nitrogenous case:

A. Uracil

B. Cysteine

C. Dihydrouracil

D. Cytosine

E. Adenine

 

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73. The donor who had not donated the
blood for a long time was examined wi­
th IFA method. Anti-HBs antibodies were
revealed. What does positive result of IFA
in this case mean?

A. Acute hepatitis C

B. Previous hepatitis B
C Chronic hepatitis C

D. Acute hepatitis B

E. Chronic hepatitis B

74. A 45-year-old man with domestic apper
arm injuiry came to the trauma unit. The
objective data are: there are no extension,
adduction or pronation functions of the arm.
What muscle damage caused this condition?

A.        Teres major

B. Subspinous

C. Supraspinous

D. Subscapular

E. Teres minor

75. Inflamation is characterised by increasi­
ng penetration of vessels of microcirculati­
on stream, increasing of their fluid dynamic
blood pressure. Increasing of the osmotic
concentration and dispersity of protein
structures can be found in the intercellular
fluid. What kind of edema are to be
observed in this case?

A. Membranogenic

B. Colloid-osmotic

C. Mixed

D. Hydrodynamic

E. Lymphogenic

76. A patient died from acute cardiac insuffi­
ciency. The histological examination of
his heart revealed the necrotized section
in myocardium/of the left ventricle, whi­
ch was separated from undamaged tissue
by the zone of hyperimic vessels, small
hemorrhages and leukocytic infiltration.
What is the most likely diagnosis?

A.        Diffuse exudate myocarditis

B. Focal exudate myocarditis

C. Myocardial infarction

D. Productive myocarditis

E. Myocardial ischemic dystrophy

77. An autopsy revealed: soft arachnoid
membrane of the upper parts of cerebral
hemisphere is plethoric, of yellowish-green
color, soaked with purulent and fibrose
exudate, it lookes like a cap. What disease
is characterised by these symtoms?

A. Meningitis at typhus

B. Influenza meningitis

C. Meningitis at anthrax

D. Tuberculous meningitis

E. Meningococcal meningitis

78.  The preventive radioprotector was gi­
ven to a worker of a nuclear power station.
What mechanism from the below mentioned
is considered to be the main mechanism of
radioprotection?

A.        Increasing of respiration

B. Inhibition of free radicals formation

C. Prevention of tissue’s hypoxia

D. Activation of oxidation reactions

E. Increasing of tissue blood supply

79.  A consumptive patient has an open
pulmonary form of disease. Choose what
sputum staining should be selected for findi­
ng out the tubercle (Koch’s) bacillus?

A. Method of Romanowsky-Giemsa

B. Method of Burry-Gins

C. Method of Neisser

D. Method of Gram

E. Method of Ziel-Neelsen

80.   Chronic glomerulonephritis was di­
agnosed in a 34-year-old patient 3 years
ago. Edema has developed within the last
6 monthes. What caused the edema?

A. Hyperproduction of vasopressin

B. Proteinuria

C. Hyperosmolarity of plasma

D. Liver disfunction of protein formation

E. Hyperaldosteronism

8J”. Inhibition of alpha-motoneuron of the extensor muscles was noticed after sti­mulation of a-motoneuron of the flexor muscles during the experiment on the spi­nal column. What type of inhibition can be caused by this process?

A.        Presynaptic

B. Reciprocal
C Lateral

D. Recurrent

E.  Depolarizational

82.  Necrosis focus was observed in the area
of hyperemia and skin edema in a few hours
after burn. What mechanism strengthens
destructive effects in the inflammation area?

A. Proliferation of fibroblasts

B. Diapedesis of erythrocytes

C. Secondary alteration

D. Primary alteration

E. Emigration of lymphocytes

83.  For a long time a 49-year-old woman
had suffered from glomerulonephritis win­
ch caused death. The autopsy revealed
that the size of her kidneys was 7x3x2,5
sm, weight 65,0 g, they were dense
and small-grained. Microscopically: libri-
nogenous inflammation of serous and
mucous capsules, dystrophic changes of

 

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parenchymatous organs, brain edema. What complication can cause such changes of serous capsules and inner organs?

A.       DIC-syndrome

B. Anemia

C. Thrombopenia

D. Sepsis

E. Uraemia

84. Autopsy of the 58-year-old man had*
revealed that mitral valve is deformed, thi­
ckened, does not totally close. Microscopi­
cally: centers of collagen fibers are eosi­
nophilic, have positive fibrin reaction. The
most probable diagnosis is:

A. Hyalinosis

B. Amyloidosis

C. Mucoid swelling

D. Fibrinoid swelling

E. Fibrinoid inflammation

85. A patient with encephalopathy was
admitted to neurological department.
Correlation of increasing encephalopathy
and substances absorbed by the
bloodstream from the intestines was
revealed. What substances created in the
intestines can cause endotoxemia?

A. Butyrate

B. Acetacetate
G. Indole

D. Ornithine

E. Biotin

86. Punctata hemorrhage was found out in
the patient after application of a tourniquet.
With disfunction of what blood cells is it
connected?

A. Lymphocytes

B. Neutrophiles
C Platelets

D. Monocytes

E. Eosinophiles

87. A woman who was sick with rubella duri-
ngthe_pregnancy. gave birth to a deaf child”
wltHhare lip and cleft palate. This congeni­
tal defect is an example of:

A. Edward’s syndrome

B. Patau’s syndrome

C. Phenocopy

D. Genocopy

E. Down’s syndrome

88.    A person was selling “homemade
pork”sausages on the market. State sani­
tary inspector suspected falcification of the
sausages. What serological immune reaction
can identifiy food substance?

A. Indirect hemagglutination test

B. Complement- fixation test

C. Agglutination test

D. Immunofluorescence test

E. Precipitation test

89. While enrolling a child to school Mantu’s
test was made to define whether revaccinati-
on was needed. The test result is negative.
What does this test result mean?

A.  Absence of antitoxic immunity to the
tuberculosis

B.    Presence   of   cell   immunity   to   the
tuberculosis

C.    Absence   of   cell   immunity   to   the
tuberculosis

D. Absence of antibodies for tubercle baci­
llus

E. Presence of antibodies for tubercle baci­
llus

90. A patient had been taking glucocorticoi­
ds for a long time. When the preparation
was withdrawn he developed the symptoms
of disease aggravation, decreased blood
pressure and weakness. What is the reason
of this condition?

A.        Hyperproduction of ACTH

B. Sensibilization

C. Habituation

D. Appearance of adrenal insufficiency

E. Cumulation

91. A mother of a newborn complains of her
baby’s constant belching with undigested
milk. Which developmental anomaly is it
an evidence of?

A. Anal atresia

B. Esophageal fistula

C. Esophageal atresia

D. Labium leporium

E. Faux lupinum

92. A 30-year-old patient was hospitalized
due to bleeding of the facial artery . What
place on the face has to be pressed to stop
bleeding?^

A.        The mandible’s branch

B. The nose’s back

C. The molar bone

D. The mental process

E. The mandible’s edge

93. The concentration of albumins in human
blood sample is lower than normal. This
leads to edema of tissues. What blood functi­
on is damaged?

 

Krok 1 Medicine 2005

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A. Maintaining the Ph level

B.   Maintaining  the  blood sedimentation
system

C. Maintaining the body temperature

D. All answers are correct

E. Maintaining the oncotic blood pressure

94. A young man felt sharp pain in the back
during active tightening on the horizontal
bar. Objectively: pain while moving upper
extremity, limited pronation and adducti­
on functions. Sprain of what muscle can be
observed here?

A.       M.latissimus dorsi

B. M.subscapularis

C. M.levator scapulae

D. M.romboideus major

E. M.trapezius

95.   From the nasopharynx of a 5-year-
old child a microorganism was excreted
which is identical to Corynebacterium di-
phtheriae dose according to morphological
and biochemical signs. Microorganism does
not produce exotoxin. As a result of what
process can this microorganism become
toxigenic?

A. Growing with antitoxic serum

B. Phage conversion

C. Chromosome mutation

D.   Passing through the organism of the
sensative animals

E. Cultivation in the telluric environment

96.   A patient with hypochromic anemia
has splitting and loss of hair, increased nail
britthng and taste alteration. What is the
mechanism of the symptoms development?

A. Decreased production of parathyrin      l\

B.    Decreased    production    of    thyroid
hormones

C. Deficiency of vitamin B12

D. Deficiency of vitamin A

E. Deficiency of iron-containing enzymes

97. A healthy woman has three sons affected
by color blindness who were born after
her two marriages. Children both of her
husbands are healthy. What is the most
possible pattern of inheritance of this di­
sease?

A. Y-linked

B. X-linked recessive

C. Autosomal dominant

D. X-linked dominant

E. Autosomal recessive

98.   The alternate usage of dichlotiazide,
etacrin acid and lasex did not cause marked
diuretic effect in the patient with marked
peripheral edema. The aldosterone level in
the blood is increased. Indicate which medi-

cine should be prescribed:

A. Spironolacton

B. Amilorid

C. Urea

D. Clopamid

E.  Mannit

99.   Blood sampling for bulk analysis is
recommended to be performed on an empty
stomack and in the morning. What changes
in blood composition can occur if to perform
blood sampling after food intake?

A. Increased contents of leukocytes

B. Increased contents of erythrocytes

C. Increased plasma proteins

D. Reduced contents of erythrocytes

E. Reduced contents of thrombocytes

100.   A patient has a malignisation of
thoracic part of esophagus. What lymphatic
nodes are regional for this organ?

A. Nodi lymphatici paratrachealis

B. Nodi lymphatici mediastinales posteriores

C. Anulus lymphaticus cardiae

D. Nodi lymphatici pericardiales laterales

E. Nodi lymphatici prevertebralis

     101. On autopsy a 35-year-old man the focus pLcamification 5 cm in diametre enclosed ‘ in a tbin capsule was revealed in the second segment of the right lung. The focus consi­sts of a tough dry friable -Hssue^with a dim surface. For what disease are these morphological changes typical?

A. Tumorous form of silicosis

B. Chondroma

C. Tuberculoma

D. Lung cancer

E. Postinflammatory pneumosclerosis

102. A 25-year-old woman with red and itchy
eczematoid dermatitis visits your office. She
had a dental procedure one day earlier with
administration of a local anesthetic. There
were no other findings, although she indi­
cated that she had a history of allergic reacti­
ons. Which of the following drugs is most
likely involved?

A. Procaine

B. Cocaine

C. Bupivacaine

D. Etidocaine

E. Lidocaine

103. A 55-year-old patien was hospitalized in
result of the trauma of the medial group of
femoral muscles. What kind of movements
is the patient unable to do?

 

 

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A. Adduction of femur

B. Suppination of femur
C Flexion of femur

D. Abduction of femur

E. Extension of femur

104.  An old woman was hospitalized with
acute pain, edema in the right hip joint; the
movements in the joint are limited. Which
bone or part of it was broken?                   fcj

A.        Pubic bone

B. The body of the thigh bone

C. The neck of the thigh

D.        Condyle of the thigh

E. Ischial bone

105. The penetration of the irritable cell
membrane for potassium ions has been
increased during an experiment. What
changes of membrane electric status can
occur?

A. Hyperpolarization

B. No changes

C Depolarization

D. Action potential

E. Local response

106.     The alveolar ventilation of the patient is
5 L/rnin, the breath frequency is 10 per/min,
and the tidal volume is 700 ml. What is the
patient’s dead space ventilation?

A. 4,3 L/min

B. 1,0 L/min

C. 2,0 L/min

D. 0,7 L/min
E.-

107. A 50-year-old patient with typhoid fever
was treated with Levomycetin, the next day
his condition became worse, temperature
rose to 39,6°C. What caused the complicati­
on?

A. The effect of endotoxin agent

B. Secondary infection addition

C.   Irresponsiveness  of  an  agent  to  the
levomycetin

D. Allergic reaction

E. Reinfection

108. A patient with complaints of 3-day-
long fever, general weakness, loss of appeti­
te came to visit the infectionist. The doctor
suspected enteric fever. Which method of
laboratory diagnosis is the best to confirm
the diagnosis?

A.        Detachment of myeloculture

B. Detachment of blood culture
C Detachment of pure culture

D. Detachment of feces culture

E. Detachment of urine culture

109. A 60-year-old patient was hospitali-

sed to the surgical department because of infection caused by blue pus bacillus (Pseudomonas aeruginosa) which is sensati-ve to penicillin antibiotics. Indicate which of the given penicillins has marked activity to the Pseudomonas aeruginosa?

A.        Oxacillin

B. Phenoxymethylpenicillin

C. Carbenicillin disodium

D.        Methicillin

E. Benzylpenicillin

110.  Only one factor can influence the
charge of amino acid radicals in the active
centre of enzyme. Name this factor:

A.        The presence of a competitive inhibitor

B. Pressure

C. The surplus of a product

D.        Temperature

E. pH medium

111.     A doctor administered Allopurinol to a
26-year-old young man with the symptoms
of gout. What pharmacological action of
Allopurinol ensures therapeutical effect?

A. By inhibiting uric acid synthesis

B. By general analgetic effect

C. By inhibiting leucocyte migration into the
joint

D. By general anti-inflammatory effect

E.  By increasing uric acid excretion

112.     A patient with tissue trauma was taken
a blood sample for the determination of
blood clotting parameters. Specify the right
sequence of extrinsic pathway activation.

A. IV-Vila-Xa

B. Ill-VIII: TF-Xa

C. Ill-Vila-Xa
D.III-IV-Xa
E.IV-VIII:TF-Xa

113.     A 56-year-old patient complaining of
thirst and frequent urination was diagnosed
with diabete mellitus. Butamin was prescri­
bed. How does the medicine act?

A. It helps to absorb the glucose by the cells
of the organism tissues

B. It relieves transport of glucose through
the cells’ membranes

C. It stimulates /3-cells of Langergans’ islets

D. It inhibits a-cells of Langergans’ islets

E. It inhibits absorption of glucose in the
intestines

114.   Periodic renal colics attacks are
observed in a woman with primery
hyperparathyroidizm. Ultrasonic examinati­
on revealed small stones in the kidneys.
What is the most plausible reason of the
stones’s formation?

 

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A. Hyperphosphatemia

B. Hyperkalemia

C. Hyperuricemia

D. Hypercalcemia

E. Hypercholesterinemia

115. A person has steady HR not exceeding
40 bpm. What is the pacemaker of the heart
rhythm in this person?

A. Sinoatrial node

B. Atrioventricular node

C. His’ bundle

D. Purkinye’ fibers

E. Branches of His’ bundle

116. An intraoperational biopsy of mammal
gland has revealed the signs of atypical ti­
ssue with disorder of parenchyma stroma
proportion with domination of the last,
gland structures of different size and shape,
lined with single-layer proliferative epitheli­
um. What is the most probable diagnosis?

A. Mastitis

B. Infiltrative cancer

C. Noninfiltrative cancer

D. Fibroadenoma

E. Papilloma

117.  A highly injured person has gradually
died. Please choose the indicator of biologi­
cal death:

A. Absence of movements

B. Loss of consciousness

C Disarray of chemical processes

D. Autolysis and decay in the cells

E. Absence of palpitation and breathing

118.    A histological spacemen presents
parenchymal organ, which has cortex and
medulla. Cortex consists of epitheliocytes
bars with blood capillaries between them;
the bars form three zones. Medulla consi­
sts of chromaffinocytes and venous sinusoi­
ds. Which organ has these morphological
features?

A. Kidney

B. Lymph node

C. Thyroid

D. Adrenal gland

E. Thymus

119. A 35-year-old man under the treatment
for pulmonary tuberculosis has acute-onset
of right big toe pain, swelling, and low-grade
fever. The gouty arthritis was diagnosed and
high serum uric acid level was found. Which
of the following antituberculosis drugs are
known for causing high uric acid levels?

A. Rifampicin

B. Cycloserine

C. Pyrazinamide

D. Aminosalicylic acid

E. Thiacetazone

120. After breathing with poisonous steams
there is an increased quantity of slime in
respiratory passages of a chemical producti­
on worker. What of respiratory tract epi­
thelial cells participate in mucousa moisteni­
ng?

A. Intercalated cells

B. Goblet cells

C. Fibroblasts

D. Langergans cells

E. Endocrine cells

121. The sterile Petri dishes and pipettes
are necessary to prepare for microbiologi­
cal tests in bacteriological laboratory. What
way of sterilization should be applied in this
case?

A. Dry-heat sterilization

B. Steam sterilization in autoclave

C. Tyndallization

D. Boiling

E. Pasteurization

122.  Methotrexate (structural analogue of
the folic acid which is competitive inhibi­
tor of the dihydrofolatreductase) is prescri­
bed for treatment of the malignant tumour.
On which level does methotrexate hinder
synthesis of the nucleic acids?

A.        Mononucleotide synthesis

B. Reparation

C. Processing

D. Replication

E. Transcription

123. A patient died 3 days after the operati­
on because of perforated colon with mani­
festations of diffuse purulent peritoni­
tis. The autopsy revealed: colon mucos
membrane was thickened and covered with
a fibrin film, isolated ulcers penetrated at di­
fferent depth. The histology result: mucous
membrane necrosis, leukocytes infiltration
with hemorrhages focuses. What disease
complication caused the patient’s death?

A. Typhoid

B. Amebiasis

C. Dysentery

D. Crohn’s disease

E. Nonspecific ulcerative colitis

124.    If strong oxidizers get into the
bloodstream, a methemoglobin is formed.
It is a compound, where iron (II) becomes
iron (III). What has to be done to save the
patient?

 

Krok J Medicine 2005                                                       13

 

A.  Interchangeable hemotransfusion has to
be done

B. He has to be calmed down and put to bed
C Respiratory centers have to be stimulated

D. Patient has to be exposed to the fresh air

E. He has to be given pure oxygen

125. During the operation on the hip joint of
a 5-year-old child tier ligament was damaged
which caused bleeding.What ligament was
damaged?

A. The head of the thigh

B. Iliofemoral
C Pubofemoral

D. Perpendicular of the acetabule

E. Ischiofemoral

126. The pulmonalis embolism has suddenly
developed in a 40 year-old patient with
opened fracture of the hip. Choose the possi­
ble kind of embolism.

A. Air

B. Thrombus-embolus
CFat

D. Foreign body

E. Tissue

127.   X-ray examination discovered lungs
emphysema in the patient. What is the
reason of short breath development in this
case?

A. Inhibition of respiratory center

B.  Increased lungs elasticity

C Decreasing of alveoli receptors sensitivity

D. Excitation of respiratory center

E. Decreased lungs elasticity

128. A19 year-old patient was diagnosed wi­
th appendicitis and was hospitalized. The
surgical operation on ablating appendix
vermiformis is to be performed. What artery
must be fixed to stop bleeding during the
surgical operation?

A. The colica media

B. The ileocolic artery

C. The colica sinistra

D. The colica dextra

E. The iliac

129. Succinate dehydrogenase catalyses the
dehydrogenation of succinate. Malonic acid
\HOOC - CH-i – COOH is used to interrupt
the action of this enzyme. Choose the inhi­
bition type:

A.        Competitive

B. Dephosphorylation

C. Allosteric

p. Limited proteolysis E. Non-competitive

J30. Substitution of the glutamic acid on

valine was revealed while examining initi­al molecular structure. For what inherited pathology is this symptom typical?

A.        Thalassemia

B. Hemoglobinosis
C Sickle-cell anemia

D. Minkowsky-Shauffard disease

E. Favism

131.  A 16 year-old patient got numerous
traumas in automobile accident. Now the
patient is haning a shock. AP – 80/60 mm
Hg. daily urine volume 60-80 ml. What
pathogenic mechanism leads to kidneys
function violation?

A. Trauma of the urinary bladder

B. Increased osmotic pressure in glomerular
capillaries

C.    Decreased   hydrostatic   pressure    in
glomerular capillaries

D. Increased vasopressin blood concentrati­
on

E. Increased pressure in Bowman’s capsule

132.   A 42-year-old man who has been
injured in a car accident is brought into the
emergency room. His blood alcohol level on
admission is 250 mg/dL. Hospital records
show a prior hospitalization for alcohol
related seizures. His wife confirms that he
has been drinking heavily for 3 weeks. What
treatment should be provided to the patient
if he goes into withdrawal?

A. None

B. Phenobarbital

C. Phenytoin

D. Diazepam

E. Pentobarbital

133.  The patient has come to the hospital
from the smelting workshop in the conditi­
on of hyperthermia. What is the direct cause
of loss of consciousness at the heat stroke?

A.        Decrease of heart output

B. Increased water loss through sweating

C. Dilatation of peripheral vessels

D. Arterial pressure drop

E. Decreased brain blood supply

134.  Patient with diabetes mellitus experi­
enced loss of consciousness and convulsions
after an injection of insulin. What might be
the result of biochemical blood analysis for
concentration of sugar?

A.        1,5 mmol/L

B. 5,5 mmol/L

C. 10,0 mmol/L

D. 8,0 mmol/L

E. 3,3 mmol/L

135.   A patient has been taking a mi­
xture prescribed by neuropathologist for

 

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neurasthenia for two weeks. The pati­ent feels better but has developed coryza. conjunctivitis, rash, inertia, decrease of memory. She is diagnosed with bromizm. What should be prescribed to decrease the symptoms?

A. Glucose solution 5%

B. Asparcam

C. Natrium chloride

D. Polyglucin
E.-

136. A patient suffering from thyrotoxi­
cosis symptoms of vegetoasthenic syndrome
was revealed. What of the following would
show the histological appearance of a
thyroid gland being stimulated by thyroid-
stimulating hormone (TSH)?

A.   Decreased  numbers  of parafollicular
capillaries

B. Decreased numbers of follicular cells

C. Increased numbers of parafollicular cells

D. An abundance of colloid in the lumen of
the follicle

E. Columnar-shaped follicular cells

137.  A 10-year-old child complains of
weakness, nausea, irritability. Helminthes of
while color and 5-10 mm long were found on
the underwear. On microscopy of the scrape
from the perianal folds achromic ovums of
unsymmetrical form were revealed. Indicate
what helminth is parasiting on the child?

A.        Trichuris

B. Trichina

C. Ascaris lumbricoides

D. Enterobins vermicularis

E. Ancylostoma duodenalis

138. A patient has been brought to the
hospital with the complaints of headache,
pain in left hypochondrium. He has been
ill for 1,5 weeks. The sudden illness began
with the increase of body temperature up
to 39,9°C. In 3 hours the temperature
decreased and hydropoiesis began. The
attacks repeat rhythmically in 48 hours.
The patient had visited one an Afri­
can country. The doctors have suspected
malaria. What method of laboratory di­
agnostics is necessary to use?

A.        Stool examination

B. Blood examination

C. Urine examination

D.   Examination  of vaginal  and  urethral
discharge

E. Immunological tests

139. When a patient with traumatic impai­
rment of the brain was examined, it was di­
scovered that he had stopped to distinguish
displacement of an object on the skin. What

part of the brain was damaged?

A. Occipital zone of the cortex

B. Frontal central gurus
C Posterior central gurus

D. Parietal zone of the cortex

E. Frontal zone

140.   A 19-year-old female suffers from
tachycardia in rest condition, weight loss,
excessive sweating, exophtalmos and irri­
tability. What hormone would you expect to
find elevated in her serum?

A. Mineralocorticoids

B. Cortisol
CACTH

D.        Insulin

E. Thyroxine

141. A 62-year-old patient was admitted to
the neurological department due to cerebral
haemorrage. His condition is grave. There
is evident progression of deep and frequent
breath that turnes into reduction to apnoea
and the cycle repeates. What respiration
type has developed in the patient?

A. Cheyne-Stockes respiration

B. Apneustic respiration
G. Kussmaul respiration

D. Gasping respiration

E. Biot’s respiration

142. The gluconeogenesis is activated in the
liver after intensive physical trainings .What
substance is utilized in gluconeogenesis first
of all in this case:

A. Pyruvate

B. Glucose

C. Alanine

D. Lactate

E. Glutamate

143.   A 50-year-old man has felt vague
abdominal discomfort within past 4
months. Physical examination revealed
no lymphadenopathy, and no abdominal
masses or organomegaly at palpation. Bowel
sounds are heard. An abdominal CT scan
shows a 20 cm retroperitoneal soft tissue
mass obscuring the left psoas muscle. A
stool specimen tested for occult blood is
negative. Which of the following neoplasms
is this man most likely to have?

A. Hamartoma

B. Melanoma

C. Adenocarcinoma

D. Lipoma

E. Lymphoma

144.   Some diseases reveal symptoms of
aldosteronism with hypertension and edema
due to sodium retention in the organism.
What organ of the internal secretion is

 

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affected on aldosteronism?

A. Adrenal glands

B. Testicle

C. Hypophysis

D. Ovaries

E. Pancreas

145.  The study of the genealogy of a family
with hypertrichosis (helix excessive pilosis)
has demonstrated that this symptom is mani­
fested in all generations only in men and is
inherited by son from his father. What is the
type of hypertrichosis inheritance?

A. X-linked recessive chromosome

B. Autosome-recessive
C Autosome-dominant

D.        X-linked dominant chromosome

E. Y-linked chromosome

146. A 2-year-old child has got intestinal
dysbacteriosis, which results in hemorrhagic
syndrome. What is the most likely cause of
hemorrhage of the child?

A. Vitamin K insufficiency

B. Fibrinogen deficiency
C PP hypovitaminosis

D. Hypocalcemia

E. Activation of tissue thromboplastin

147. A 50 year-old patient had hemorrhage
of the brain and was taken to the hospi­
tal. The place of hemorrhage was revealed
on the lateral hemispheres surfaces during
the medical examination. What artety was
injured ?

A.        The posterior communicating artery

B. The posterior cerebral artery
C The middle cerebral artery

D. The anterior communicating artery

E. The anterior cerebral artery

148.   A microscopic examination of the
enlarged neck gland of a 14-year-old girl
revealed destruction of the tissue structure
of the node, absence of the lymph follicles,
sclerotic and necrosis parts. Cell constitution
of the node is polymorphous, lymphocites,
eosinophilcs. atypical cells of the large si­
ze with multiple-lobule nuclei (Beresovsky-
Shternberg cells) and onenucleus large size
cells are observed. What is the most likely
diagnosis?

A. Fungous mycosis

B. Berkitt’s lymphoma
C Acute lympholeucosis
O. Chronic lympholeucosis
E. Lymphogranulomatous

149. A 40-year-old woman has had a feeli­
ng of abdominal discomfort for the past
8 months. On pelvic examination, there is

the right adnexal mass. Abdominal CT scan demonstrates a 7 cm cystic mass involving the right ovary with small areas of calcifi­cation. The uterus is normal in size. The right fallopian tube and ovary have been removed surgically. Grossly, the mass on sectioning is filled with abundant hair and sebum. Mi­croscopically, the mass has glandular spaces lined by columnar epithelium, squamous epithelium with hair follicles, cartilage, and dense connective tissue. What type of tumour is it?

A.        Teratoma

B. Sarcoma of ovary

C. Squamous cell carcinoma of ovary

D.        Melanoma

E. Metastase of cervical carcinoma

150. A 52 year-old patient with bronchi­
al asthma was treated with glucocorticoids.
Fever reaction appeared as a result of posti-
njective abscess. The patient had subfebri-
le temperature, which didn’t correspond
to latitude and severity of inflammatory
process. Why did patient have low fever
reaction?

A.        Inhibited endogen pyrogens production

B. Thermoregulation center inhibition

C. Inflammatory barrier formation in injecti­
on place

D.        Violation of heat-producing mechanisms

E. Violation of heat loss through lungs

151. A 58-year-old female has undergone
surgery for necrotic bowel. Despite havi­
ng been treated with antibiotics, on
postoperative day 5, she develops symptoms
(fever, hypotension, tachycardia, declining
urine output, and confusion) consistent with
septic shock. What hemodynamic support
would be helpful?

A.        Antibiotic administration

B. Fluid administration

C. Fluids and Dobutamine infusion

D.        Dobutamine infusion

E. Atropine administration

152.   A journalist’s body temperature
has sharply increased in the morning
three weeks after his mission in India,
it was accompanied with shivering and
bad headache. A few hours later the
temperature decreased. The attacks began
to repeat in a day. He was diagnosed with
tropical malaria. What stage of development
of Plasmodium is infective for anopheles-
female?

 

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A. Microgamete

B. Merozoites
C Sporozoites

D. Shizontes

E. Gametocytes

153.     Examination of a person revealed that
minute volume of heart is 3500 mL, systolic
volume is 50 mL. What is the frequency of
cardiac contraction?

A. 80 bpm

B. 50 bpm
C 90 bpm

D. 70 bpm

E. 60 bpm

154.     A patient has elbow joint trauma with
avulsion of medial epicondyle of humerus1.
What nerve can be damaged in this trauma?

A. Musculocutaneous nerve

B. Cardiac cutaneous nerve

C Medial cutaneous nerve of forearm

D. Radial

E. Ulnar

155.     A 16-year-old boy was performed an
appendectomy. He has been hospitalized
for right lower quadrant abdominal pain
within 18 hours. The surgical specimen is
edematous and erythematous. Infiltration
by what of the following cells is the most
typical for the process occuring here?

A. Monocytes

B. Eosinophils

C. Neutrophils

D. Limphocytes

E. Basophils

156.     A 60-year-old patient was diagnosed
with hypothalamic lateral nuclei stroke.
What changes in patient’s behavior may be
expected?

A.        Thirst

B. Unsatisfied hunger

C. The rejection of food

D.        Depression

E. Aggressive behaviour

157. Blood analysis of a patient showed signs
of HIV infection (human immunodeficiency
virus). Which cells does HIV-virus primarily
affect?

A.  Proliferating cells (stem hematoplastic
cells)

B. Cells that contain receptor T4 (T-hclpers)
C Cells that contain receptor IgM (B-
lymphocytes)

D. Specialized nervous cells (neurons)

E. Mast cells

is observed in a patient with glaucoma. Secretion of aqueous humor by the ciliar body is normal. Injury of what structure of the eyeball caused the disorder of flow-out from the anterior chamber?

A. Venous sinus

B. Ciliar body

C. Choroid

D. Back epithelium of cornea

E. Ciliary muscle

159. A 68-year-old woman can not move
her upper and lower right extremities after
stroke. Muscle tone of these extremities and
reflexes are increased. There are pathologi­
cal reflexes. What form of the paralysis is it?

A. Monoplegia

B. Dissociation

C. Hemiplegia

D. Tetraplegia

E. Paraplegia

160.    Where should the catheter for evacuati­
on of the lymph from the thoracic lymph
duct be inserted?

A.       To the left venous corner

B. To the right venous corner

C. To the left inguinal vein

D.       To the inferior vena cava

E. To the superior vena cava

161.    M-r S presents all signs of the hepatic
coma: loss of consciousness, absence of
reflexes, cramps, convulsion, disorder of
heart activity, recurrent (periodical) respi­
ration. What are cerebrotoxical substances
which accumulate in blood under hepar
insufficiency?

A. IL-1

B. Necrosogenic substances

C. Ketonic body

D. Ammonia

E. Autoantibody

162.    During the endoscopy the inflammation
of a major papilla of the duodenum and the
disturbances of bile secretion were found. In
which’ part of duodenum were the problems
found?

A. Bulb

B. Descendent part

C.  Ascendant part

D. Upper horizontal part

E. Lower horizontal part

.•163. The calcium canals of cardiomyocytes have been blocked on an isolated rabbit’s heart. What changes in the heart’s activity can happen as a result?

 

158.   The   increased   intraocular   tension

 

Krok 1 Medicine 2005

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A. Decreased heart beat rate

B. Heart stops in diastole

C. Heart stops in systole

D. Decreased rate and force of heart beat

E. Decreased force of the contraction

164.  Analeptical remedy of reflective type
from the H-cholinomimetics group was gi­
ven to the patient for restoration of breathi­
ng after poisoning with carbon monoxide.
What medicine was prescribed to the pati­
ent?

A. Lobeline hydrochloride

B. Mesaton

C Adrenalin hydrochloride

D. Pentamin

E. Atropine sulphate

165.  A 45-year-old man fell on the right
knee and felt the acute pain in the joint. On
examination: severe edema on the anterior
surface of the knee joint. Crunching sounds
are heard while moving the joint. Which
bone is destroyed?

A. Neck of the thigh bone

B. Knee-cap

C. Head of the thigh bone

D. Left epicondyle of the thigh

E. Right epicondyle of the thigh

166.  During histological examination of the
stomach it was found out that glands contai­
ned very small amount of pariental cells or
they were totally absent. Mucose membrane
of what part of the stomach was studied?

A. Fundus of stomach

B. Cardia

C Pyloric part

D. Body of stomach

E.-

167.   Decreased blood supply to the organs
causes hypoxia that activates fibroblasts
function. Volume of what elements is
increased in this case?

A. Lymphatic vessels

B. Intercellular substance

C. Nerve elements

D. Vessels of microcircular stream

E. Parenchymatous elements of the organ

168.  A damage of the atomic power plant
reactor resulted in the run-out of radi-
oelcments. People in the ‘ superstandard
radiation zone were radiated with approxi­
mately 250-300 r. and were immediately
hospitalized. What changes in the blood
count would be typical?

A. Lymphopenia

B. Anemia

C. Neutropenia

D. Leukopenia

E. Thrombopenia

169.  A patient with suspicion on epidemic
typhus was admitted to the hospital. Some
arachnids and insects have been found in his
flat. Which of them may be a carrier of the
pathogen of epidemic typhus?

A. Cockroaches

B. Bed-bugs

C. Lice

D. Spiders

E. Houseflies

170.  A man died 8 days after the beginni­
ng of the disease. He was diagnosed with
dysentery. At the autopsy it was found out a
thickened wall of the sigma and rectum, fi­
brinous membrane on the surface of mucous
membrane. Histologically: there is a deep
necrosis of mucous membrane with infiltrati­
on of necrotic masses with fibrin. What kind
of colitis does correspond to the changes?

A.        Catarrhal

B. Chronic

C. Diphtheritic

D. Gangrenous

E. Ulcerative

171.  A 55-year-old patient with continui­
ng ventricular arrhythmias was admitted to
the hospital. The patient is taking timolol
drops for glaucoma, daily insulin injections
for diabetes mellitus, and an ACE inhibitor
for hypertension. You have decided to use
phenytoin instead of procainamide. What is
the reason?

A.        The local anesthetic effect of procainami­
de would aggravate the hypertension

B. The hypertensive effects of procainamide
would aggravate the hypertension

C. The cholinergic effects of procainamide
would aggravate the diabetes

D. The local anesthetic effect of procainami­
de would potentiate diabetes

E. The anticholinergic effect of procainamide
would aggravate glaucoma

172.  In the blood of a 26-year-old man
18% of erythrocytes of the spherical, ball-
shaped, flat and thorn-like shape have been
revealed. Other eritrocytes were in the form
of the concavo-concave disks. How is this
phenomenon called?

A.        Pathological poikilocytosis

B. Physiological anisocytosis

C. Erytrocytosis

D. Pathological anisocytosis

E. Physiological poikilocytosis

 

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173.    An individual is characterized by
rounded face, broad forehead, a mongoli­
an type of eyelid fold, flattened nasal bri­
dge, permanently open mouth, projecting
lower lip, protruding tongue, short neck, flat
hands, and stubby fingers. What diagnosis
can be put to the patient?

A. Klinefelter’s syndrome

B. Down’s syndrome

C. Turner’s syndrome

D. Supermales

E.  Alkaptonuria

174.      A patient with clinical signs
of immunodeficiency has unchanged
number and functional activity of
T and B lymphocytes. Dysfunction’s
defect of antigen-presentation to the
immunocompetent cells was found during
investigation on the molecule level. Defect
of what cells is the most probable here?

A. Macrophages, monocytes

B. NK-cells

C. O-lymphocytes

D. T-lymphocytes, B-lymphocytes

E.         Fibroblasts,      T-lymphocytes,      B-
lymphocytes

175. Oval and round organelles with double
wall are seen at the electron micrograph.
The outer membrane is smooth, the inner
membrane folded into cristae contain
enzyme ATPase synthetase. These are:

A.  Centrioles

B.  Golgi complex

C Ribosomes

D.  Lysosomes

E.  Mitochondria

176.      During complicated labour the
symphysis pubis ruptured. What organ can
be damaged mostly?

A.  Ovaria

B.  Rectum

C Uterine tubes

D.  Urinary blader

E.  Uterus

177.   A 59-year-old man has symptoms
of parenchymatous jaundice and portal
hypertension. Histological examination
of the puncture of the liver bioptate
has revealed an affected beam-lobule
structure, part of hepatocytes has signs of
fat dystrophy, port-portal connective tissue
septa with formation of pseudo-lobules, with
periportal lympho-macrophage infiltrations.
What is the most probable diagnosis?

A.  Alcohol hepatitis

B.  Viral hepatitis

C.  Chronic hepatosis

D.  Liver cirrhosis

E.  Toxic dystrophy

178.  A 18-year-old patient came to the out­
patient department with the complaints of
bleeding trauma in the vestibule of his nose.
On examination: the mechanical injure of
the mucous layer of the vestibule without
continuation into nasal cavity proper. What
is the boundary between the vestibule and
nasal cavity proper?

A.  Nasal septa

B.  Nasal roller
C Nasal limen

D.  Choanes

E.  Nostrils

179.       The     high     level     of     Lactate
Dehydrogenase (LDH) isozymes concentrati­
on showed the increase of LDH-1 and LDH-
2 in a patient’s blood plasma. Point out the
most probable diagnosis:

A.  Viral hepatitis

B.  Diabetes mellitus

C.  Skeletal muscle dystrophy

D.  Myocardial infarction

E.  Acute pancreatitis

180. A patient visited a dentist with complai­
nts of redness and edema of his mouth
mucous membrane in a month after dental
prosthesis. The patient was diagnosed wi­
th allergic stomatitis. What type of allergic
reaction by Gell and Cumbs underlies this
disease?

A.  Anaphylactic

B.  Stimulating

G Immunocomplex

D.  Delayed type hypersensitivity

E.  Cytotoxic

181.    To anaesthetize the manipulation
related to burn surface treatment, a patient
was intravenously injected a medication for
short-acting narcosis. 1 minute later the pati­
ent being under anaesthesia had increased
blood pressure, tachycardia, increased tone
of sceletal muscles; reflexes remained. After
awakening the patient had desorientation
and visual hallucinations. What medication
was the patient injected?

A.  Sombrevin

B.  Diethyl ether
C Nitrous oxide

D.  Thiopental sodium

E.  Ketamine

182. During the experiment on the influence
of chemical substances in the muscles the

 

 

Krokl Medicine 2005

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reaction of Ca2+ -pump is weakened. Which phcnomcnum will be observed?

A. Activation of the sodium-potassium pump

B. Prolonged duration of the AP

C. Decreased velocity of the AP distribution

D. Decreased AP

E. Prolonged relaxation

183. Intrapleural pressure is being measured
in a person. In what phase does a person
hold his breath if the pressure is – 25 cm

HoO?

A. Forced-inspiration

B.-

C Forced expiration

D. Quiet expiration

E. Quiet inspiration

184.      Hydroxylation of endogenous
substrates and xenobiotics requires a donor
of protons. Which of the following vitamins
can play this role?

A.        Vitamin A

B. Vitamin Be

C. Vitamin P

D.        Vitamin C

E. Vitamin E

185.   Electrocardiogram of a 45-year-old
man showed absence of P-wave in all the
leads. What part of the conducting system is
blocked?

A. Branches of the bundle of His

B. Atrioventricular node

C. Sinu-atrial node

D. Purkinje’s fibres

E. Common branch of the bundle of His

186.  A woman who was infected with
toxoplasmosis during the pregnancy has a
child with multiple congenital defects/This is
a result of:

I A. Biological mutagenesis

B. Cancerogenesis

C. Recombination

D. Teratogenesis

E. Chemical mutagenesis

187.     At the aboratory experiment
the eukocyte culture was mixed wi­
th staphylococci. Neutrophile leukocytes
engulfed and digested bacterial cells. This
processes are termed:

A. Diffusion

B. Pinocytosis
C Osmosis

D. Phagocytosis

E. Facilitated diffusion

188. There is an inhibited coagulation in the
patients with bile ducts obstruction, bleedi-

ng due to the low level of absorbtion of a vitamin. What vitamin is in deficiency?

A.K                                                        8

B. Carotene

CD

D.A

E.E

189. A student is thoroughly summarising a
lecture. When his groupmates begin talki­
ng the quality of the summarising worsens
greatly. What type of inhibition in the
cerebral cortex is the cause of it?

A.        External

B. Differential

C. Dying

D.        Delayed

E. Protective

190.  A lung of a premature infant is
presented on electronic photomicrography
of biopsy material. Collapse of the alveolar
wall caused by the deficiency of surfactant
was revealed. Disfunction of what cells of
the alveolar wall caused it?

A.        Fibroblasts

B. Alveocytes type I

C. Alveocytes type II

D.        Alveolar macrophages

E. Secretory cells

191. Galactosemia has been revealed in a
child. Concentration of glucose in the blood
has not considerably changed. What enzyme
deficiency caused this illness?

A.        Amylo-l,6-glucosidase

B. Hexokinase

C. Galactose-1-phosphate uridyltransferase

D. Galactokinase

E. Phosphoglucomutase

192. A 50-year-old male farm worker has
been brought to the emergency room. He
was found confused in the orchard and since
then has remained unconscious. His heart
rate is 45 and his blood pressure is 80/40 mm
Hg. He is sweating and salivating profusely.
Which of the following should be prescri­
bed?

A.        Proserine

B. Atropine

C. Physostigminc

D.        Norepinephrine

E. Pentamine

193.  In case of enterobiasis acrihine – the
structural analogue of vitamin Bi - is admi­
nistered. The synthesis disorder of which
enzymes does this medicine cause in mi­
croorganisms?

 

Krok 1 Medicine 2005

20

 

 

 

A. FAD-dependent dehydrogenases

B. Aminotransferases

C. Cytochromeoxidases

D. Peptidases

E. NAD-dependet dehydrogenases

194.  Usually the intravenous injection is
done into median cubital vein because it is
slightly movable due to fixation by the soft
tissues. What does it fix in the cubital fossa?

A. Brachioradial muscle

B. Aponeurosis of biceps muscle

C. Brachial muscle

D. Tendon of the triceps muscle

E. Anconeus muscle

195. The B cells of endocrine portion of
pancreas are selectively damaged oy alloxan
poisoning. How will it be reflected in blood
plasma?

A. The content of globulins decreases

B. The content of fibrinogen decrease

C. The content of sugar increases

D. The level of sugar decreases

E. The content of albumins decreases

196.     Patient 54 year-old, 5th day after surgi­
cal operation. Blood count: Erythrocytes
3,6*1012/1, Hemoglobin 95 g/1, Erythrocyte’s
hemoglobin content (color index) 0,78;
Leukocytes 16 * 109/1, Platelets 450 * 109/1
Blood picture: anizocytosis, poikilocytosis,
reticulocytes- 3,8%. What anemia does this
patient have?

A.        Hypoplastic anemia

B. Acquired hemolytic anemia

C. Anemia from iron deficiency

D.        Chronic posthemorragic anemia

E. Acute posthemorragic anemia

197. A 46 year-old patient has complained
of headache, fatigue, thirst, pains in the spi­
ne and joints for the last 2 years. Clinically
observed disproportional enlargement of
hands, feet, nose, superciliary arches. He
notes that he needed to buy bigger shoes
three times. What is the main reason of such
disproportional enlargement of different
parts of the body?

A. Joints chronic inflammation development

B.  Increased sensitivity of the tissues to
growth hormone

C. Joints dystrophy development

D.  Increased sensitivity of the tissues to
insulin

E.  Cartilaginous tissue proliferation under
growth hormone influence

198. A woman suffering from dysfunctional
metrorrhagia was made a diagnostic aborti­
on. Histologically in the scrape there were a
lot of small stamped glandulars covered with
multirowed epithelium. The lumens of some
glandulars were cystically extended. Choose
the variant of general pathologic process in
the endometrium.

A. Neoplasm of endometrium

B.      Glandular-cystic      hyperplasia      of
endometrium

C. Atrophy of endometrium

D. Hypertrophic growth

E. Metaplasia of endometrium

199.     A sick man with high temperature and
a lot of tiny wounds on the body has been
admitted to the hospital. Lice have been
found in the folds of his clothing. What di­
sease can be suspected in the patient?

A. Plague

B. Malaria
C Tularemia

D. Scabies

E. Epidemic typhus

200.     A patient suffering from trombophlebi-
tis of deep veins suddenly died. The autopsy
has shown freely lying red friable masses
with dim crimped surface in the trunk and
bifurcation of the pulmonary artery. What
pathologic process was revealed by the
morbid anatomist?

A.        Tissue embolism

B. Thrombosis

C. Embolism with foreign body

D.        Tromboembolism

E. Fat embolism

 

t o

INSTRUCTIONAL BOOK

 

 

Ministry of public health of Ukraine (MPH of Ukraine) loard of education and science of MPH of Ukraine esting Board

 

TEST ITEMS FOR LICENSING EXAMINATION: KROK I. MEDICINE. 2005.

Composers:              Artemchuk’ Ludmila

Bulakh Iryna Homchenkova Natalya

 

Kyiv. Testing Board. (English language).

Editor A.Potapova

Technical editor: P.Ostapenko, V.Zhdanov

Approved to print 06.10.2005. <DopiuaT 60×84 1/8 Offset paper. Typeface. Times New Roman Cyr. Offset print. Conditional print pages 12. Accounting publishing pages 12. Issue. 470 copies

 

MINISTRY OF PUBLIC HEALTH OF UKRAINE

Department of manpower policy, education and science of MPH of Ukraine

 

Krok 1

•medicine

2006

 

General Instruction Every one of these numbered questions or unfinished statements in this chapter corresponds to answers or statements endings. Choose the answer (finished statements) that fits best and fill in the circle with the corresponding Latin letter on the answer sheet.

Authors of items: Abramets 1.1., Andreeva V.F., Andronov D.YU., Arnautova L.V., Basiy R.V., Byelousova LP., Bilets M.V., Borisenko B.O., Brazhnikov A.M., Bruk B.B., Vasilenko I.V., Vaschuk A.A., Verchova O.O., Visockiy I.YU., Vlasenko M.S., Vlasenko O.V., VovkV.V., Volohova CO.. Vorobec Z.D.,   Gaydash I.S., Gargin V.V., Garets B.I., Goldobina O.V., Gorgol N.I., Grebenik L.I., Gudivok YA.S., Gurcalova I.P., Davidenko I.S., Dem’yanenko I.A., Demchenko O.M., Dyelcova O.I., Yelskiy V.M., Zhadinskiy M.V., Zhilyuk V.I., Zhulinskiy V.O., Zagorulko O.K., Zelenina N.M., Zlenko O.T., Ivascnko A.V., Izmaylova L.V., Kaplyuh R.F., Kir”yakulov G.S., Klincova S.P., Klish I.M., Klopockiy G.A., Koldunov V.V., Komissarov I.V., Korolenko G.S., Korol A.P., Kosik O.G. Krushinska T.YU., Kryuk YU.YA., Kubishkin A.V., Kuzik I.YA., Kukovska I.L., Kulachenko B.V., Kulikova N.A., Kulitka E.F., Kulish A.S., Lazarev K.L.,   Linchevska L.P., Loiytra A.O., Lukovich I.M., Lucyuk M.B., Luchko I.M., Makats Ye.F., Makovetskiy O.V., Matyushenko P.M., Michaiylyuk I.O., Mishalov V.D., Mischenko K.M., Mozhayeva O.B.,   MotaO.M.,   NavnikoT.S., Nechiporenko G.V., Nikonova A.A., Nikolenko O.G., Nikolenko YU.I. Nikonova A.O., Okulov V.I., Pentyuk O.O., Piddubnyak YU.G., Poguda A.A., Popova L.D., Primova L.O., Pushkar M.S., Romanenko M.I., Savchenko N.V., Samura I.B., Svislun YU.D., Serdyuchenko I.YA., Sidorchuk I.Y., Skorobagata T.G., Skorobogatova Z.M., Skrebkova O.YU., Skripka O.V., Smirnova T.V., Smolyakova G.M., Sokolovska L.V., Starlichanova L.D., Steblyuk M.V., Stepanyuk G.I., Stec V.R., Tananakina T.P., Tatarko S.V., Tertishniy S.I., Titarenko V.M., Tomashova S.A., Tumas’yants N.YU., Ugrin O.M., Fartushok N.V., Fedonyuk YA.I., Fedorchenko O.YE., Fedorchenko O.V., Feketa V.P., Filipec N.D., Halaturnik G.M., Holodkova O.L., CherVyak M.M., Cherkasov V.G.,   Cherkashina L.P.,   Chemenko G.P., Chesnokova M.M., Shalanin V.V., Shanko V.M., Shevtsova A.I., Shemonaeva K.F., Shpak S.I., Scherbakov S.M., Scherbakov C.N., Yakubishina L.V., Yasinskiy V.I. and Committees of professional expertise.

Item reviewers. Andrycyeva V.F., Basiy R.V., Borzenko B.G., Visotskiy I.YU., Vinnikov YU.M., Golovatyuk O.L., Gorgol N.I., Deyneka S.YE., Dyeltsova O.I., Zhadinskiy M.V., Zelenina N.M., Zinkovska L.YA., Yoltuhivskiy M.V., Kalikik K.G., Kalugina S.M., Kirichek L.T., Kiryuhin I.F., Kovalchuk L.YE., Korolcnko G.S., Krushinska T.YU., Linchevska L.P., Lyubinets L.A., Mrug V.M., Nikolenko O.I., Ovchinnikov S.O., Ostrovska S.S., Pentyuk O.O., Pototska I.I., Pushkar M.S., Sikora V.Z., Teleshova O.V., Trzhetsinskiy S.D., Fedechko IY.M., Fomina L.V., Chernenko N.A.

Composers. Artemchuk L., Bulakh I., Homchenkova N.

The book includes test items for use at licensing integrated examination “Krok 1. Medicine” and further use in teaching.

The book has been developed for students of medical, pediatric and mcdical-and-prophy lactic faculties and academic staff of higher medical educational establishments.

Approved by Ministry of Public Health of Ukraine as examination and teaching publication based on expert conclusions (Orders of MPH of Ukraine of 14.08.1998 ISSSb °i27A2A9W ^303, of 18.06.2002 JV«221, of 16.10.2002 JVb374, of 16.04.2003 Jfe239, of 29.05.2003 JV«233).

© Copyright

Testing Board, 2006.

 

910406

I

 

 

 

1. A 46-year-old patient has complained of headache, fatigue, thirst, pains in the spi­ne and joints for the last 2 years. Clinically observed disproportional enlargement of hands, feet, nose, superciliary arches. He notes that he needed to buy bigger shoes three times. What is the main reason of such disproportional enlargement of different parts of the body?

A.   Increased sensitivity of the tissues to
insulin

B. Joints chronic inflammation development

C.  Cartilaginous tissue proliferation under
growth hormone influence

D.  Increased sensitivity of the tissues to
growth hormone

E. Joints dystrophy development

2. Low level of albumins and fibrinogen was
detected in the patient’s blood. Decreased
activity of what organelle of the liver
hepatocytes can most probably cause it?

**   j.

A. Lysosomes

B. Granular endoplasmatic reticulum

C. Agranular endoplasmatic reticulum

D. Golgi complex

E. Mitochondrions

3. A 55-year-old patient with continuing
ventricular arrhythmias was admitted to
the hospital. The patient is taking timolol
drops for glaucoma, daily insulin injections
for diabetes mellitus, and an ACE inhibitor
for hypertension. You have decided to use
phenytoin instead of procainamide. What is
the reason?

A.  The cholinergic effects of procainamide
would aggravate the diabetes

B. The anticholinergic effect of procainamide
would aggravate glaucoma

C. The local anesthetic effect of procainami­
de would potentiate diabetes

D. The hypertensive effects of procainamide
would aggravate the hypertension

E. The local anesthetic effect of procainami­
de would aggravate the hypertension

4. Diagnostic scraping was performed to the
woman with dysfunctional uterine bleedi­
ng. Multiple convoluted glands, gangli-
ally dilated lumens of some glands were
revealed histologically in the scrape. Name
the type of general pathological process in
endometry:

A. Atrophy

B. Hyperplasia glandulocystica
C Hypertrophic excrescence

D. Displasia

E. Metaplasia

5. Synthesis of phospholipids is disturbed
as a result fatty infiltration of liver. Indi-

cate which of the following substances can enhance the process of methylation during phospholipids synthesis?

A. Ascorbic acid

B. Citrate

C. Methionine

D. Glucose

E. Glycerin

6.   The alternate usage of dichlotiazide,
etacrin acid and lasex did not influence
diuretically upon the patient with marked
peripheral edemata. The aldosterone rate in
the blood is increased. Indicate which medi­
cine should be prescribed:

A. Clopamid

B. Urea

C. Amilorid

D. Mannit

E. Spironolacton

7.  A patient with diabetes mellitus experi­
enced loss of consciousness and convulsi­
ons after injection of insulin. What is the
result of biochemical blood analysis for
concentration of the sugar?

A.                                                             5,5 mmol/L

B. 10,0 mmol/L

C. 3,3 mmol/L

D. 8,0 mmol/L

E. 1,5 mmol/L

8.   A 40-year-old patient complains of
intensive heartbeats, sweating, nausea, vi­
sual impairment, arm tremor, hypertensi­
on. From his anamnesis: 2 years ago he
was diagnosed with pheochromocytoma.
Hyperproduction of what hormones causes
the given pathology?

A.        Thyroidal hormones

B. Catecholamines

C. Glucocorticoids
D.ACTH

E. Aldosterone

9.  A 34-year-old patient was diagnosed wi­
th chronic glomerulonephritis 3 years ago.
Edemata have developed within the last 6
monthes. What caused the edemata?

A. Liver dysfunction of protein formation

B. Hyperaldosteronism

C. Hyperproduction of vasopressin

D. Proteinuria

E. Hyperosmolarity of plasma

10.   A 60-year-old patient fell ill with
obturative jaundice as a result of malignant
tumour of the big papillary of the duodenal.
Lumen of what anatomical structure is
compressed by tumour?

 

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A. Cystic duct

B. Left hepatic duct
C Right hepatic duct

D. Common hepatic duct

E. Hepatopancreatic ampulla

11.   In course of metabolic process active
forms of oxygen including superoxide anion
radical are formed in the human body. By
means of what enzyme is this anion inacti­
vated?

A. Glutathioneperoxidase

B. Glutathionereductase
C Catalase

D. Peroxidase

E. Superoxide dismutase

12.  A 68-year-old woman can’t move her
upper and lower right extremities due to
the stroke. Muscle tone of these extremiti­
es and their reflexes are increased. There are
pathological reflexes. What form of paralysis
is it?

A.       Monoplegia

B. Tetraplegia

C. Dissociation

D. Paraplegia

E. Hemiplegia

13.   A physician examined a patient and
found inguinal hernia. Through what
anatomic formation does it penetrate into
the skin?

>    *:<;.’.”}.;

A.        Canalis adductorius

B. Anulus femoralis

C. Hiatus saphenus

D. Anulus inguinalis superficialis

E. Lacuna musculorum

14.   An 18-year-old patient has enlarged
inguinal lymphnodes, they are painless, thi­
ckened on palpation. In the area of geni­
tal mucous membrane there is a small-
sized ulcer with thickened edges and
“laquer” bottom of greyish colour. What is
the most probable diagnosis?

A.        Tuberculosis

B. Lepra

C. Trophic ulcer

D.        Syphilis

E. Gonorrhea

15.   A person was selling “homemade
pork”sausages at the market. State sani­
tary inspector suspected falcification of the
sausages. What serological immune reaction
can identifiy food substance?

A. Complement-fixation test

B. Agglutination test

C. Indirect hemagglutination test

D. Immunofluorescence test

E. Precipitation test

16. During the operation on the hip joint of a
5-year-old child her ligament was damaged
which caused bleeding.What ligament was
damaged?

A.       Ischiofemoral

B. The head of the thigh

C Perpendicular of the acetabule

D. Pubofemoral

E.  Iliofemoral

17. While preparing a patient to the operati­
on the neart chambers’ pressure was
measured. In one of them the pressure
changed during one heart cycle from 0 to
120 mm Hg. What chamber of heart was it?

A. Right ventricle

B. Left atrium
C Left ventricle
D.-

E. Right atrium

18.   A genetics specialist analyzed the
genealogy of a family and found that both
males and females may have the illness, not
across all the generations, and that healthy
parents may have ill children. What is the
type of illness inheritance?

A.       Autosomal recessive

B. Y-linked

C. Autosomal dominant

D. X-linked dominant

E. X-linked recessive

19. Tuberculine was introduced intracutaneously
to the child for tuberculin test. Marked
hyperemia, tissue infiltration developed on
the place of injection in 24 hours. What
mechanism caused these modifications?

A.        Cell cytotoxity

B. Antibody cytotoxity

C. Immunocomplex cytotoxity

D. Reagin type cytotoxity

E. Granuloma formation

20.  A patient has got a spasm of smooth
muscles of bronchi. Activators of what
membrane cytoreceptors are phisiologically
reasoned to stop an attack?

A.        /3-adrenoreceptors

B. M-cholinoreceptors

C. o-adrenoreceptors

D. n- and /3-adrenoreceptors

E. H-cholinoreceptors

21.  A 17-year-old boy fell seriously ill,
body temperature rose up to 38,5°C, there

 

910406

3

 

 

 

is cough, rhinitis. lacrimation. nasal di­scharges. What kind of inflammation is it?

A. Serous inflammation

B. Hemorrhagic inflammation
G. Catarrhal inflammation

D. Suppurative inflammation

E. Fibrinous inflammation

22.    A 50-year-old man has felt vague
abdominal discomfort within past 4
months. Physical examination revealed
no lymphadenopathy, and no abdominal
masses or organomegaly at palpation. Bowel
sounds are heard. An abdominal CT scan
shows a 20 cm retroperitoneal soft tissue
mass obscuring the left psoas muscle. A
stool specimen tested for occult blood is
negative. Which of the following neoplasms
is this man most likely to have?

A. Lipoma

B. Lymphoma
C Hamartoma

D. Adenocarcinoma

E. Melanoma

23.    Inflammatory process of modified
subserous layer around cervix of the uterus
caused an intensive pain syndrome. In what
region of genitals does the pathological
process take place?

A. Mesometrium

B. Perimetrium

C. Myometrium

D. Endometrium

E. Parametrium

24.   Under some diseases it is observed
aldosteronism accompanied by hypertensi­
on and edema due to sodium retention in
the organism. What organ of the internal
secretion is affected under aldosteronism?

A. Ovaries

B. Pancreas

C. Testicle

D. Hypophysis

E. Adrenal glands

25.  Concentration of pyruvate is increased
in the patient’s blood, the most of which is
excreted with urine. What avitaminosis has
the patient?

A. Avitaminosis E

B. Avitaminosis B|

C. Avitaminosis Bo

D. Avitaminosis B2

E. Avitaminosis B3

26.  A considerable increase of activity of
MB-forms of CPK (creatinephosphokinase)
and LDH-1 was revealed on the examinati­
on of patient’s blood. What is the most likely

pathology?

A. Cholecystitis

B. Pancreatitis

C. Rheumatism

D. Miocardial infarction

E. Hepatitis

27.   Different functional groups can be
presented in the structure of L-amino aci­
d’s radicals. Identify the group that is able to
form ester bond:

A.-OH B.-SH

C.  -NH2                                           t

D. -CONH2

E. -C.H3

28. Blood analysis of a patient showed signs
of HIV infection (human immunodeficiency
virus). Which cells does HIV-virus primarily
affect?

A.  Proliferating cells (stem hematoplastic
cells)

B. Specialized nervous cells (neurons)

C. Mast cells

D. Cells that contain receptor T4 (T-helpers)

E.   Cells  that  contain  receptor IgM  (B-
lymphocytes)

29.   Patient with injured muscles of the
lower extremities was admitted to the
traumatological department. Due to what
cells is reparative regeneration of the muscle
fibers and restoration of the muscle function
possible?

A.        Myoepithelial cells

B. Myoblasts

C. Satellite-cells

D. Myofibroblasts

E. Fibroblasts

30.   Objective examination of a patient
revealed: slender figure, big skull, highly
developed frontal region of face, short
extremities. What constitutional type is it
characteristic for?

A. Cerebral

B. Digestive

C. Mixed

D. Muscular

E. Respiratory

31. A sick man with high temperature and a
lot of tiny wounds on the body has been
admitted to the hospital. Lice have been
found in the folds of his clothing. What di­
sease can be suspected?

 

910406

4

 

 

 

A. Epidemic typhus

B. Plague

C Tularemia

D. Scabies

E. Malaria

32.  Slime, blood and protozoa 30-200 mi­
crons long have been revealed in a man’s
feces. The body is covered with cilias and has
correct oval form with a little bit narrowed
anterior and wide round shaped posterior
end. At the anterior end a mouth is visi­
ble. In cytoplasm there are two nucleui and
two short vacuoles. What are the described
features typical for?

A. Trichomonas

B.  Lamblia

C.  Balantidium

D. Dysenteric amoeba

E. Intestinal amoeba

33.  An old woman was hospitalized with
acute pain, edema in the right hip joint; the
movements in the joint are limited. Which
bone or part of it was broken?

A.       Pubic bone

B. Condyle of the thigh
C The neck of the thigh

D. The body of the thigh bone

E. Ischial bone

34. A student is writing a thorough summary
of a lecture. Quality of summarizing has
considerably worsened when his neighbours
started talking. What kind of inhibition in
the cerebral cortex caused this effect?

A. Fading

B. Differentiated
C Delayed

D. External

E. Protective

35. A 39-year-old woman has madescence in
the region of mammilla, a small ulcer wi­
th inflammatory hyperemia and cutaneous
edema. Histologic examination of tissue
sampling from this area revealed in the
malpighian layer of thickened epidermis
atypical cells with light and optically empty
cytoplasm, with no intracellular bridges.
Such cells were also found in the orifice of
big mammal gland ducts. What is the most
probable diagnosis?

A. Paget’s disease

B. Mclanocarcinoma

C. Epidermoid cancer

D. Intraductal cancer

E. Basal cell carcinoma

36. Analeptical remedy of reflective type
from the H-cholinomimetics group was gi­
ven to the patient for restoration of breathi-

ng after poisoning with carbon monoxide. What medicine was prescribed to the pati­ent?

A* Pentamin

B. Atropine sulphate

C. Adrenalin hydrochloride

D.       Lobeline hydrochloride

E. Mesaton

37.  A 46-year-old man complains of di­
fficulties with nasal breathing. Mikulicz’s
cells, accumulation of epithelioid cells,
plasmocytes, lymphocytes, hyaline balls
were discovered in the biopsy material of the
thickened nasal mucosa. What is the most li­
kely diagnosis?

A. Allergic rhinitis

B. Scleroma

C. Virus rhinitis

D. Meningococcal nasopharyngitis

E. Rhinovirus infection

38.  The ovary specimen colored with
hematoxylin-eosin contains a follicle, in whi­
ch cubic-shaped follicle epithelium cells are
placed in 1-2 layers, and scarlet membrane is
seen around the ovocyte. Name this follicle:

A. Atretic

B. Primary

C. Secondary

D. Mature

E. Primordial

39.  Autopsy revealed that right lung is   J
enlarged, solid, there are fibrin layers on
the pleura. Lung tissue is light grey color on
incision with muddy liqued exudates. What
lung disease are these symptoms typical for?

A. Fibrosing alveolitis

B. Bronchopneumonia
C Croupous pneumonia

D. Interstitial pneumonia

E. Pulmonary gangrene

40. The pulmonalis embolism has suddenly
developed in a 40-year-old patient with
opened fracture of the hip. Choose the possi­
ble kind of embolism:

A. Foreign body

B. Thrombus-embolus
G Tissue

D.Fat E.Air

41. A 27-year-old woman has dropped peni­
cillin containing eye drops. In a few minutes
there appeared feeling of itching, burning
of the skin, lips and eyelids edema, whistling
cough, decrease of BR What imunoglobulins
take part in the development of this allergic
reaction?

 

910406                                                                   5

 

A. IgE and IgG

B. IgG and IgD

C. IgA and IgM

D. IgM and IgD

E. IgM and IgG

42. A pregnant woman had been haying
toxicosis with severe repeated vomiting
for 24 hours. In the end of the day there
appeared tetanic convulsions and fluid loss,
what shift of acid-base state caused these
changes?

A. Excretory acidosis

B. Gaseous alkalosis

C. Metabolic acidosis

D. Excretory alkalosis

E. Gaseous acidosis

43. The calcium canals of cardiomyocytes
have been blocked on an isolated rabbit’s
heart. What changes in the heart’s activity
can result from it?

A. Decreased rate and force of heart beat

B. Heart stops in diastole

C. Decreased heart beat rate

D. Decreased force of the contraction

E. Heart stops in systole

44. Microscopic examination of the enlarged
neck gland of a 14-year-old girl revealed
destruction of the tissue structure of
the node, absence of the lymph folli­
cles, sclerotic areas and necrosis foci, cell
constitution of the node is polymorphous,
lymphocites, eosinophiles, big atypical
cells with multilobular nuclei (Beresovsky-
Sternberg cells) and mononuclear cells of
the large size are present. What is the most
likely diagnosis?

A.        Berkitt’s lymphoma

B. Lymphogranulomatosis

C. Fungoid mycosis

D.        Acute lympholeucosis

E. Chronic lympholeucosis

45. A young man has a painlessl formation
without marked borders in the soft tissues of
his thigh. On the tissue bioptate the formati­
on looks like flesh of fish and consists of
immature fibroblast-like cells with multiple
mitosis growing through the muscles. What
is the most likely diagnosis?

A. Fibroma

B. Myosarcoma
C Cancer

D.                                                             Myoma

E. Fibrosarcoma

46.  Diabetes mellitus causes ketosis as a
result of activated oxidation of fatty aci­
ds. What disorders of acid-base equilibrium
may be caused by excessive accumulation of

ketone bodies in blood?

A. Metabolic alcalosis

B. Metabolic acidosis

C. Respiratory alcalosis

D. Any changes woun’t happen

E. Respiratory acidosis

47. A 56-year-old patient complaining of thi­
rst and frequent urination was diagnosed
with diabete mellitus. Butamin was prescri-
bed. How does the medicine act?

A.  It inhibits absorption of glucose in the
intestines

B. It helps to absorb the glucose by the cells
of the organism tissues

C It inhibits a-cells of Langergans’ islets D. It relieves transport of glucose through the cells’ membranes E.’ It stimulates /3-cells of Langergans’ islets

48.       Children often have heavy nasal breathi­
ng resulting from excessive development
of lymphoid tissue of pharyngeal mucous
membrane. What tonsils growth may cause
this effect?

A. Tonsilla palatina

B. All above mentioned tonsils
C Tonsilla tubaria

D. Tonsilla pharyngea

E. Tonsilla lingualis

49.       A patient with continious bronchopneumonia
was admitted to the therapeutic department.      \
Antibiotic therapy didn’t give much effect.
What   medication   for   improvement   of
immune  state should  be  added  to  the
complex treatment of this patient?

A. Analgin

B. Paracetamol

C. Benadryl

D. Timaline

E. Sulfocamphocaine

50.       A patient with hypochromic anemia has
splitting hair and loss of hair, increased nail
brittling and taste alteration. What is the
mechanism of the development of these
symptoms?

A. Decreased production of parathyrin

B. Deficiency of vitamin A

C.     Decreased    production    of    thyroid
hormones

D. Deficiency of iron-containing enzymes

E. Deficiency of vitamin B12

51.  A patient’s blood was analyzed and
the decreased erythrocyte’s sedimentation
rate (ESR) was discovered. What disease
from the listed below is accompanied with
decreased ESR?

 

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A.       Myocardial infarction

B. Polycytemia

C. Hepatitis

D. Vitamin B deficiency

E. Splenomegaly

152. A 38-year-old woman was admitted to the admission-diagnostic department with uterine bleeding. What are the most likely changes of blood?

A. Leukopenia

B. Polycythemia

C. Increase of haematocrite rate

D. Reduction of haematocrite rate

E. Leucocytosis

53. Desulfiram is widely used in medical
practice to prevent alcocholism. It inhi­
bits aldehyde dehydrogenase. Increased
level of what metabolite causes aversion to
alcochol?

A. Ethanol

B. Propionic aldehyde
C Methanol

D. Malonyl aldehyde

E. Acetaldehyde

54.  A patient with rheumatoid arthritis who
had been treated with indometacin has got
signs of gastropathy. What activity of the
drug can this complication be connected wi­
th?

A. Antiserotonin

B. Antihistamine

C. Antikinine

D. Anticyclooxygenase

E. Locally irritating

55. A 16-year-old boy was performed an
appendectomy. He has been hospitalized
for right lower quadrant abdominal pain
within 18 hours. The surgical specimen is
edematous and erythematous. Infiltration
by what of the following cells is the most
typical for the process occuring here?

A. Neutrophils

B. Basophils

C. Monocytes

D. Limphocytes

E. Eosinophils

56. A patient visited a dentist with complai­
nts of redness and edema of his mouth
mucous membrane in a month after dental
prosthesis. The patient was diagnosed wi­
th allergic stomatitis. What type of allergic
reaction by Gell and Cumbs underlies this
disease?

A.        Anaphylactic

B. Immunocomplex

C. Stimulating

D.        Delayed type hypersensitivity

E. Cytotoxic

57. A 40-year-old woman was admitted to
the infectious diseases department with hi­
gh body temperature. Objectively: marked
meningeal symptoms. A spinal cord puncti-
on was made. What anatomic formation was
puncturated?

A. Spatium epidurale

B. Spatium subarachnoideum

C. Cavum trigeminale

D. Cisterna cerebellomedullaris posterior

E. Spatium subdurale

58. Decreased blood supply to the organs
causes hypoxia that activates fibroblasts
function. Volume of what elements is
increased in this case?

A. Nerve elements

B. Vessels of microcircular stream

C. Parenchymatous elements of an organ

D. Intercellular substance

E. Lymphatic vessels

59. A doctor administered Allopurinol to a
26-year-old young man with the symptoms
of gout. What pharmacological action of
Allopurinol ensures therapeutical effect?

A. By general analgetic effect

B. By increasing uric acid excretion

C. By general anti-inflammatory effect

D. By inhibiting uric acid synthesis

E. By inhibiting leucocyte migration into the
joint

60. A businessman came to India from
South America. On examination the physi­
cian found that the patient was suffering
from sleeping-sickness. What was the way of
invasion?

A. As a result of bug’s bites.

B. As a result of mosquito’s bites
C After contact with sick dogs

D. Through dirty hands

E. With contaminated fruits and vegetables

61. A mother of a newborn complains of her
baby’s constant belching with undigested
milk. Which developmental anomaly is it
an evidence of?

A. Faux in pin um

B. Labium leporium

C. Esophageal fistula

D. Anal atresia

E. Esophageal atresia

62. Part of alveoles of a preterm infant didn’t
spread because of enhanced elastic recoil of

 

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lungs. How can this recoil be reduced?

A.       By surfactant introduction

B. By fluid suction from the respiratory tracts

C. By artificial pulmonary ventilation

D. By glycose introduction

E. By pure oxygene inhalation

63.  A patient, who suffers from congeni­
tal erythropoietic porphyria, has skin
photosensitivity. The accumulation of what
compound in the skin cells can cause it?

A.        Heme

B. Uroporphyrinogen 1

C. Protoporphyrin

D.        Uroporphyrinogen 2

E. Coproporphyrinogen 3

64.   A 38-year-old patient died during
intractable attack or bronchial asthma.
Histologic examination revealed mucus
accumulation in bronchial lumen, a lot of
fat cells (labrocytes) in the wall of bronches,
many of them are in the state of degranulati-
on, there are also a lot of eosinophils. What
pathogenesis of bronchial changes is it?

A. Immunocomplex mechanism

B.  Granulomatosis

C.  Atopy

D. Cytotoxic, cytolytic action of antibodies

E. Cellular cytolysis

65.       A woman with 0 (I) bllod group has born
a child with AB blood group. This woman’s
husband has A blood group. What genetic
interaction explains this phenomenon?

A. Incomplete dominance

B. Codominance
C Polymery

D. Recessive epistasis

E. Complementation

66. A child has inhaled a button. Where is it
likely to be?

A. In the left main bronchus

B. In the right main bronchus

C. In the larynx

D. In the trachea

E. In the esophagus

67. A patient had been taking glucocorticoi­
ds for a long ti me. When the preparation
was withdrawn he developed the symptoms
of disease aggravation, decreased blood
pressure and weakness. What is the reason
of this condition?

A. Cumulation

B. Hyperproduction of ACTH

C. Habituation

D. Sensibilization

E. Appearance of adrenal insufficiency

68. A young man felt acute pain in the back
during active drawing up on the horizontal
bar. Objectively: pain while moving upper
extremity, reduced pronation and adducti­
on functions. Sprain of what muscle can be
observed here?

A. lA.trapezius

B. M.romboideus major

C. M.levator scapulae

D. M.latissimus dorsi

E.  M.subscapularis

69.  A 45-year-old man applied to the
trauma station because of domestic shoulder
trauma. Objectively: extension, reduction
and pronation functions of the shoulder are
absent. What muscle was injured?

A. Supraspinous muscle

B. Infraspinous muscle

C. Subscapular muscle

D. Teres major muscle

E. Teres minor muscle

70.  A 10-year-old girl often experiences
acute respiratory infections with multi­
ple punctate haemorrages in the places of
clothes friction. Hypovitaminosis of what vi­
tamin has the girl?

A.C B.B2

CBi D.A

E.B6

71.       While enrolling a child to school Mantu’s
test was made to define whether revaccinati-
on was needed. The test result is negative.
What does this test result mean?

A.  Absence of antibodies for tubercle baci­
llus

B.  Absence of antitoxic immunity to the
tuberculosis

C   Presence   of   cell   immunity   to   the tuberculosis

D. Presence of antibodies for tubercle baci­
llus

E.    Absence   of   cell   immunity   to   the
tuberculosis

72.   Thyrotoxicosis leads to increased
production of thyroidal hormones I3 and
T.\, weight loss, tachycardia, psychic exci­
tement and so on. How do thyroidal
hormones effect energy metabolism in the
mitochondrion of cells?

A. Activate substrate phosphorylation

B. Activate oxidative phosphorylation

C. Stop respiratory chain

D.    Disconnect   oxidation   and   oxidative
phosphorylation

E. Slop substrate phosphorylation

 

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73.      A 58-year-old patient with acute cardiac
insufficiency has decreased volume of daily
urine – oliguria. What is the mechanism of
this phenomenon?

A. Decreased glomerular filtration

B.    Decreased   number   of   functioning
glomerules

C. Reduced permeamility of renal filter

D.  Rise of hydrostatic blood pressure in
capillars

E. Drop of oncotic blood pressure

74.  Blood sampling for the haematology
is recommended to carry out on an empty
stomach and in the morning. What changes
in blood formula are possible if blood
sampling was carried out after food intake?

A. Increase of plasm proteins

B. Increase of leukocyte number
C Increase of erythrocyte number

D. Decrease of thrombocyte number

E. Decrease of erythrocyte number

75. An intraoperational biopsy of mammal
gland has revealed the signs of atypical ti­
ssue presented by disorder of parenchyma
stroma proportion with domination of the
last, gland structures of different size and
shape, lined with single-layered proliferati­
ve epithelium. What is the most probable
diagnosis?

A. Noninfiltrative cancer

B.  Mastitis

C.  Infiltrative cancer

D. Fibroadenoma

E. Papilloma

76. A 25-year-old woman with red and itchy
eczematoid dermatitis visits your office. She
had a dental procedure one day earlier with
administration of a local anesthetic. There
were no other findings, although she indi­
cated that she had a history of allergic reacti­
ons. Which of the following drugs is most
likely involved?

A. Cocaine

B.  Bupivacaine
C Etidocaine
D. Procaine
IE. Lidocaine

77. A 7-year-old girl has signs of anemia.
Laboratory examination revealed pyruvate
kinase deficiency in erythrocytes. What
process disturbance plays the main role in
anemia development?

A. Tissue respiration

B. Oxidative phosphorylation

C. Anaerobic glycolysis

D. Aminoacids desamination

E. Peroxide decomposition

78.   A woman who was infected with
toxoplasmosis during the pregnancy has
born a child with multiple congenital
defects.This is a result of:

A. Cancerogenesis

B. Recombination

C. Biological mutogenesis

D. Chemical mutogenesis

E. Teratogenesis

79. On autopsy of the 58-year-old man it
was revealed: mitral valve is deformed, thi­
ckened, not totally closed. Microscopically:
foci of collagen fibers are eosinophilic, have
positive fibrin reaction. The most likely it is:

A. Fibrinoid swelling

B. Fibrinoid inflammation

C. Hyalinosis

D. Amyloidosis

E. Mucoid swelling

80. An 18-year-old patient came to the out­
patient department with the complaints of
bleeding trauma in the vestibule of his nose.
On examination: the mechanical injury of
the mucous layer of the vestibule without
continuation into nasal cavity proper. What
is the boundary between the vestibule and
nasal cavity proper?

A. Nasal septa

B. Choanes

C Nasal limen

D. Nostrils

E. Nasal roller

81.  After a serious viral infection a 3-
year-old child has repeated vomiting, loss
of consciousness, convulsions. Examinati­
on revealed hyperammoniemia. What may
have caused changes of biochemical blood
indices of this child?

A.  Disorder of biogenic amines neutralizati­
on

B.  Disorder of ammonia neutralization in
ornithinic cycle

G   Inhibited   activity   of   transamination enzymes

D.   Increased purtefaction of proteins in
intestines

E.   Activated   processes   of   aminoacids
decarboxylation

82.  In the blood of a 26-year-old man
18% of erythrocytes of the spherical, ball-
shaped, flat and spinous shape have been
revealed. Other eritrocytes were in form
of the concavo-concave disks. How is this
phenomenon called?

 

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A.       Pathological poikilocytosis

B. Pathological anisocytosis

C. Erytrocytosis

D. Physiological anisocytosis

E. Physiological poikilocytosis

83.  RNA-polymerase B(II) is blocked due to
amanitine poisoning (poison of death-cup).
It disturbs:

A. Synthesis of t-RNA

B.  Reverse transcription

C.  Primers synthesis

D. Synthesis of m-RNA

E. Maturation of m-RNA

84.  A 52-year-old patient has the followi­
ng diagnosis: systemic amebiasis with
involvment of intestines, liver, lungs. What
drug should be prescribed?

A. Quiniofone

B. Quingamine

C. Enteroseptol

D. Tetracycline

E. Metronidasol

85.  Necrosis focus appeared in the area of
hyperemia and skin edema in few hours
after burn. What mechanism strengthens
destructive effect in the inflammation area?

A. Primary alteration

B. Secondary alteration

C. Proliferation of fibroblasts

D. Emigration of lymphocytes

E. Diapedesis of erythrocytes

86. The energy inputs of a healthy man have
been measured. In what state was the pati­
ent if his energy inputs were less than the
main exchange?

A.        Calmness

B. Rest

C. Sleep

D. Nervous exertion

E. Easy work

87. The process of heart transplantation
determined the viability of myocardial cells.
The determination of what myocardium
parameter is the most important?

A. Concentration of oxygen in heart vessels

B. Concentration of Ca-ions in heart vessels

C. Heart temperature

D. Concentration of calcium-ions in myofi­
brils

E. Rest potential of cardiomyocytes

88. Hypertrychosis of auricles is caused by
a gene that is localized in Y-chromosome.
Father has this feature. What is the probabi­
lity to give birth to a boy with such anomaly?

A. 35%

B. 100%

C. 0%

D. 25%

E. 75%

89.       Autopsy of a 46-year-old man revealed
multiple brown-and-green layers and
hemmorhages on the mucous membrane
of rectum and sigmoid colon; slime and
some blood in colon lumen; histologically
- fibrinous colitis. In course of bacteriologi­
cal analysis of colon contents S.Sonne were
found. What is the most probable diagnosis?

A. Salmonellosis

B. Dysentery
C Cholera

D. Crohn’s disease

E. Yersiniosis

90.       A 50-year-old patient with typhoid fever
was treated with Levomycetin, next day his
condition became worse, temperature rose
to 39,6°C. What caused the complication?

A.   Irresponsiveness of an  agent  to  the
levomycetin

B. The effect of endotoxin agent
C Allergic reaction

D. Secondary infection addition

E. Reinfection

91.  A patient with suspected diphtheria
went through bacterioscopic examination.
Examination of throat swab revealed rod-
shaped bacteria with volutin granules. What
etiotropic preparation should be chosen in
this case?

A.        Diphtheria antitoxin

B. Bacteriophage

C. Interferon

D. Antidiphtheric antitoxic serum

E. Eubiotic

92.  A 37-year-old man was admitted
to the surgical department with the
symptoms of acute pancreatitis: vomiti­
ng, diarrhea, bradycardia, hypotention,
weakness, dehydration of the organism.
What medicine should be used first of all?

A. Ephedrine

B. ContrycaL

C. No-spa

D. Platyphylline

E. Etaperazine

93.    A person has reduced diuresis,
hypernatremia, hypokalemia. Hypersecreti­
on of what hormone can cause such
changes?

 

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A. Vasopressin

B. Parathormone

C. Aldosterone

D. Adrenalin

E. Auricular sodiumuretic factor

94.   A 60-year-old man  felt asleep after
cerebral   hemorrhage   for   a   long   time.

Damage of what structure caused this state?

A. Nuclears of the cerebral nerves

B. Hippocampus

C. Black substance

D. Cortex of the large hemispheres

E. Reticular formation

95.  During examination of a patient, there
was found a neoplasm in the white substance
of cerebral hemispheres with localization in
the knee and frontal part of posterior crus of
internal capsule. Fibres of what conductive
tract of the brain will be disrupted?

A. TV. frontothalamicus

B. Tr. parietooccipitopontinus

C. Tr. frontopontinus

D. Tr. thalamocorticalis

E. Tr. pyramidalis

96.  Intake of oral contraceptives containi­
ng sex hormones inhibits secretion of the
hypophysiae hormones. Secretion of whi­
ch of the indicated hormones is inhibited
while taking oral contraceptives with sex
hormones?

A. Follicle-stimulating

B. Oxytocin
C Thyrotropic

D. Vasopressin

E. Somatotropic

97. A patient died from acute cardiac insuffi­
ciency. The histological examination of
his heart revealed the necrotized section
in myocardium of the left ventricle, whi­
ch was separated from undamaged tissue
by the zone of hyperimic vessels, small i
hemorrhages and leukocytic infiltration.
What is the most likely diagnosis?’

A. Focal exudate myocarditis

B.  Myocardial infarction

C.  Productive myocarditis

D. Myocardial ischemic dystrophy

E. Diffuse exudate myocarditis

98. A patient with tissue trauma was taken
a blood sample for the determination of
blood clotting parameters. Specify the right
sequence of extrinsic pathway activation:

A.       Ill-Vila-Xa

B. Ill-VIII: TF-Xa

C. IV – Vila – Xa

D. IV -VIII:TF-Xa

E. Ill – IV – Xa

99.  Intrapleural pressure of an individual is
being measured. In what phase did he hold
his breath if the pressure is – 25 cm H-iOl

A. Forced expiration B.-

C. Forced inspiration

D. Quiet inspiration

E. Quiet expiration

100.     Donor skin transplantation was
performed to a patient with extensive burns.
On the 8-th day the graft became swollen
and changed colour; on the 11-th day graft
rejection started. What cells take part in this
process?

A.       T-lymphocytes

B. B-lymphocytes

C. Erythrocytes

D. Basophils

E. Eosinophils

101.  A 38-year-old man who poisoned hi­
mself with mercury dichloride was taken
to the admission room in grave conditi­
on. What antidote should be immediately
introduced?

A.       Unithiol

B. Isonitrosine

C. Dipiroxim

D.       Atropine

E. Nalorphine

102.  A man who was bitten by the unknown
dog applied to the surgeon. Wide ragged
woundes were localized on the face. What
curative-prophylactic aid should be given to
prevent rabies?

A.    Immediately   inject   normal   gamma
globulin

B. Start immunisation with rabies vaccine

C. Immediate injection of DPT(Diphtheria,
Pertusis, Tetanus) vaccine

D. Prescribe combined antibiotic therapy

E. Hospitalize the patient and keep under
the doctor’s supervision

103.  Scraps of the mycelium of a fungus,
spores, air bubbles and fat drops were di­
scovered on microscopy of the patient’s
hair excluded from the infected areas. What
fungus disease is characterised by this mi­
croscopic picture?

 

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A.        Epidermophytosis

B. Trichophytosis

C. Sporotrichosis

D. Microspory

E. Favus

104.  Live vaccine was injected into the
human body. Increasing activity of what
connective tissue cells can be expected?

A. Macrophages and fibroblasts

B. Plasmocytes and lymphocytes

C Adipocytes and adventitious cells

D. Pigmentocytes and pericytes

E. Fibroblasts and labrocytes

105.    Buffer capacity of a worker’s blood was
decreased due to exhausting muscular work.
By coming of what acid substance in the
blood can this state be explained?

A. 1,3-bisphosphoglycerate

B. a-ketoglutarate
C Pyruvate

D. Lactate

E. 3-phosphoglycerate

106.   During the fetal period of the
development in the vascular system of
the fetus a large arterial (Botallo’s)
duct is functioning which converts into
lig.arteriosum after birth. What anatomi­
cal formations does this duct connect?

A. Pulmonary trunk and superior vena cava

B. Pulmonary trunk and aorta
C Aorta and superior vena cava

D. Right and left auricles

E. Aorta and inferior vena cava

107. On autopsy it was revealed: pia mater
of the upper parts of cerebral hemisphere
is plethoric, of yellowish-green color, soaked
with purulent and fibrose exudate, looks like
a cap. What disease is it typical for?

A. Meningitis connected with typhus

B. Meningitis connected with anthrax
C Grippal meningitis

D. Tuberculous meningitis

E. Meningococcal meningitis

108.  A patient with thrombophlebitis of
lower extremities had got chest pains, blood
spitting, growing respiratory failure that
caused his death. Autopsy revealed multi­
ple pulmonary infarctions. What is the most
probable reason of their development?

A.        Pulmonary venous thrombosis

B. Bronchial artery embolism
C Pulmonary artery embolism

D.        Bronchial artery thrombosis

E. Pulmonary artery thrombosis

109.  Patient with abscess of the cut wound
applied to the traumatological department.

In order to clean the wound from the pus doctor washed it with 3% hydrogen peroxi­de. Foam was absent. What caused the absence of the drug activity?

A. Inherited insufficiency of catalase

B.    Inherited insufficiency of erythrocyte
phosphatdehydrogenase

C. Shallow wound

D. Pus in the wound

E. Low concentration H-iPi

110. Autopsy of a man who died from
chronic cardiacvascular collapse revealed
“tiger heart”. Sidewards of endocardium
a yellowish-white banding can be seen;
myocardium is dull, dark-yellow. What
process caused this pathology?

A. Fatty parenchymatous degeneration

B. Carbohydrate degeneration

C Fatty vascular-stromal degeneration

D. Amyloidosis

E. Hyaline degeneration

111. Cerebral trauma caused increase of
ammonia formation. What aminoacid takes
part in removal of ammonia from cerebral
tissue?

A. Tryptophan

B. Tyrosine

C. Valine

D. Lisine

E. Glutamic

112. A 5-year-old child who often fells ill
with respiratory diseases has eczematous
appearances after consumption of some
food products, tendency to prolonged
course of inflammatory processes. What ki­
nd of diathesis can be suspected in this case?

A. Lymphohypoplastic

B. Asthenic

C. Exudative-catharral

D. Hemmorhagic

E. Arthritism

113. ATP synthesis is totaly blocked in a
cell. How will the value of membrane rest
potential change?

A. First it will decrease, then increase

B. It will disappear

C. It will be considerably increased
I). First it will increase, then decrease
E. It will be slightly increased

114.  A 44-year-old woman complains of
common weakness, heart pain, considerable
increase of body weigt. Objectively: moon­
like face, hirsutism, AP- 16S/100 mm He,
height -164 cm. weight -103 kg; fat is mostly
accumulated in the region of neck, upper
shoulder girdle, stomach. What is the main
pathogenetic mechanism of obesity?

 

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A. Decreased production of glucagon

It.   Decreased   production   of   thyroidal

hormones

C.  Increased production of mineralocorticol-
cls

D. Increased production of insulin

E. Increased production of glucocorticoids

115.   Glomerular filtration rate (GFR)
increased by 20% as a result of prolonged
starvation of an individual. The most evi­
dent cause of filtration changes under this
conditions is:

A.  Decrease of oncotic pressure of blood
plasma

B. Increase of systemic blood pressure >

C. Increase of penetration of the renal Alter
1). Increase of nitration coefficient

E. Increase of renal plasma stream

116.   Inhibition of o-motoneuron of the
extensor muscles was noticed after sti­
mulation of n-motoneuron of the flexor
muscles during the experiment on the spinal
cord. What typo of inhibition is this process
based upon?

A. Recurrent

B. Reciprocal

C. Lateral

D. Depolarizational

E. Presynaptic

117.    A 45-year-old woman suffers from
seasonal allergic rhinitis caused by the
ambrosia blossoming. What medicine from
the stabilizer of the adipose cells group can
be used for prevention of this disease?

A. Tavegyl

B. Dimearol

C. Ketotifen

D. Phencarol

E. Diazoline

118.   A 57-year-old patient was admitted
to the gastroenterological department wi­
th suspicion of /.ollinger-Kllison syndrom
because of rapid increase of gastrin level
in the blood serum. What is the most
probable disorder of the secretory functi­
on of stomach?

A. Hypcracidic hypersecretion

B. Achylla

C I lypei acidic hyposecrelion

D. Hypoacidic hyposccretion

E.  Hypoacidic hypersecretion

119. Inflamatlon is characterised by Increased permeability of vessels of mi­crocirculation stream, increase of their hydrodynamic blood pressure. Increasing or the osmotic concentration and dlspersi-

ty of protein structures is present In the intercellular fluid. What kind of edema will appear in this case?

A. Mcmbi allogenic

B. Mixed

C. Hydrodynnmic

D. Lymphogenic

E. Colloid-osmotic

120. Tuberculosis can be treated by means
of combined chemotherapy that includes
substances with different mechanisms of
action.What nntituberculous medication
inhibits transcription of RNA into DNA in
mycobacteria?

A. Ethionamide

B. Isoniazid

C. Streptomycin

D. Para-aminosalicylic acid

E. Rifampicin

121. A patient who was previously ill with
mastectomy as a result of breast cancer was
prescribed radiation therapy. What vitamin
preparation has marked radioprotective
action caused by antioxidant activity?

A. Folic acid

B. Riboflavin

C. Thiamine chloride

D. Tocopherol acetate

E. Ergocalciferoi

122. A person has steady MR not exceedi­
ng 40 hpni. What is the pacemaker of this
person’s heart rhythm?

A. Sinoatrial node

B. Purkinje’s fibers

C. Atrioventricular node

D. His’ bundle

E. Branches of His’ bundle

123. A patient has undergone an amputation
of lower extremity. Some time later painful
nodules appeared in a stump. Amputations
neuromas were found out at the microscopic
examination. To what pathological processes
do those formations relate?

A. Regeneration

B. Hyperemia
G. Inflammation
I). Metaplasia
E. Dystrophy

124. Upper neck node of sympathetic trunk
was removed from the rabbit on experiment.
Reddening and increased temperature of
the skin of head is observed. What disorder
of peripheral circulation of the blood has
developed?

 

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A.        Neurotonic arterial hyperemia

B. Metabolic arterial hyperemia
C Venous hyperemia

D. Neuroparalytic arterial hyperemia

E. Stasis

125. A 30-year-old woman was diagnosed with insufficiency of exocrinous function of

ancreas. Hydrolisis of what nutrients will

e disturbed?

A. Proteins

B. Proteins, fats

C. Proteins, fats, carbohydrates

D. Fats, carbohydrates

E. Proteins, carbohydrates

126. A patient has elbow joint trauma with
avulsion of medial epicondyle of humerus.
What nerve can be damaged in this trauma?

A.        Ulnar

B. Medial cutaneous nerve of forearm
C Radial

D. Musculocutaneous nerve

E. Cardiac cutaneous nerve

127.  A patient operated on complicated
appendicitis has the following changes of
blood count: erythrocytes – 4,0 • 1012/f,
Hb – 120 g/1, color index – 0,9, leukocytes
- 18 • 109//, basophils – 0, eosinophils – 0,
myelocytes – 0, juvenile – 0, stab neutrophi­
ls – 20, segmentonuclear neutrophils – 53,
lymphocytes – 21, monocytes – 5. How is such
nuclear shift of leukocytic formula called?

A. Degenerative left shift

B. Regeneratively-degenerative

C. Hyperregenerative

D. Regenerative left shift

E. Right shift                                               |

128.  A 60-year-old patient has reduced
perception of high-frequency sounds. What
structures’ disorder of auditory analizer
caused these changes?

A.  Main membrane of cochlea near heli-
cotrema

B. Eustachian tube

C Tympanic membrane

D. Muscles of middle ear

E. Main membrane of cochlea near the oval
window

129.  A patient with clinical signs of
immunodeficiency has no changes of
the number and functional activity of
T- and B- lymphocytes. Defect with di­
sfunction of antigen-presentation to the
immunocompetent cells was found during
examinatio on the molecule level. Defect of
what cells is the most probable?

A. Macrophages, monocytes

B. 0-lympnocytes

C T-lymphocytes, B-lymphocytes

B-

D.       Fibroblasts,       T-lymphocytes,
lymphocytes

E. NK-cells

130. A 50-year-old patient was injured on
the occipital region of the head. The closed
skull trauma was diagnosed. She was taken
to the hospital. The medical examinati­
on: deregulation of walking and balance,
trembling of arms. What part of brain was
injured?

A.        The mind-brain

B. The spinal cord

C. The cerebellum

D.        The medulla oblongata

E. The inter-brain

131. A patient with diabetes mellitus has
been delivered in hospital in the state of
unconsciousness. Arterial pressure is low.
The patient has acidosis. Point substances,
which accumulation in the blood results in
these manifestations:

A. Ketone bodies

B. High fatty acids

C. Cholesterol esters

D. Monosaccharides

E. Amino acids

132. Autopsy of a 12-year-old girl revealed:
multiple cutaneous hemmorhages (mostly
into the skin of buttocks, lower extremi­
ties), serous and mucous memrane
hemmorhages, cerebral hemmorhages.
Adrenal glands show focal necrosis and
massive hemmorhages; kidneys show
necrotic nephrosis, suppurative arthritis,
iridocyclitis, vasculitis. What is the most
probable diagnosis?

A. Meningococcemia

B. Epidemic typhus

C. Systemic lupus erythematosus

D. Periarteritis nodosa

E. Radiation sickness

133.  A 2-year-old child has got intesti­
nal dysbacteriosis, which resultsed in
hemorrhagic syndrome. What is the most
likely cause of hemorrhage of the child?

A. Activation of tissue thromboplastin

B. PP hypovitaminosis

C. Fibrinogen deficiency

D. Vitamin K deficiency

E. Hypocalcemia

134. An isolated muscle of a frog is rhythmi­
cally irritated with electric impulses. Every
next impulse is in a period of relaxation from
the previus contraction. What contraction of

 

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the muscle occurs?

A.        Asynchronous

B. Single

C Waved tetanus

D. Tonic

E. Continuous (smooth) tetanus

135.  It is planned to use the territory of an
old cattle burial ground (which is not used
for more than 50 years) for building houses.
But ground analysis revealed presence of
the pathogen of a very dangerous illness.
Which of the indicated microorgonisms is li­
kely to remain in the ground for such a long
time?

A. Francisella tularensis

B. Mycobacterium bovis

C. Brucella abortus

D. Yersinia pestis

E. Bacillus anthracis

136.   An experiment proved that UV-
radiated cells of patients with xeroderma
pigmentosum restore the native DNA
structure slower than cells of healthy indi­
viduals as a result of reparation enzyme
defection. What enzyme helps this process?

| A. Primase

B. DNA polymerase III

C. Endonuclease

D. DNA gyirase

E. RNA ligase

137. Albinos can’t stand sun impact – they
don’t aquire sun-tan but get sunburns. Di­
sturbed metabolism of what aminoacid
underlies this phenomenon?

A.        Histidine

B. Methionine

C. Tryptophan

D. Glutamic acid

E. Phenilalanine

138. Examination of a newborn boy’s geni­
tals revealed a cleft of urethra that opens
on the inferior surface of his penis. What
developmental anomaly is meant?

A. Cryptorchism

B. Hermaphroditism

C. Epispadia

D. Monorchism

E. Hypospadia

139. A 54-year-old man was admitted to the
hospital with complaints of pain in the ri­
ght subcostal region, vomiting with blood.
Objectively: enlarged liver, varicose veins in
the stomach and esophagus. Disfunction of
what vessel is likely to have taken place?

A. Vena porta

B. Vena hepatica

C. Vena cava superior

D. Vena cava inferior

E. Aorta abdominalis

140. A patient who has been strictly keeping
to a certain diet for 10 days went through
examination of respiratory coefficient. It
was determined that it was equal 1. What
have the patient been keeping to?

A. With domination of proteins and fat

B.    With   domination   of   proteins   and
carbohydrates

C. Mixed

D. With domination of fat and carbohydrates

E. With domination of carbohydrates

141.  In course of prophylactic medical
examination a 7-year-old boy was diagnosed
to have daltonism. Parents are healthy, color
vision is normal. But grandfather from the
mother’s side has the same disorder. What is
the type of inheriting of this anomaly?

A. Autosomal-dominant

B. Autosomal-recessive
C Dominant, sex-linked

D. Incomplete domination

E. Recessive, sex-linked

142.  A 25-year-old patient complained of
the decreased vision. Accommodation di­
sorders, dilated pupil, lack of reaction for
the light were revealed on examination.
What muscles function is disturbed?

A. Inferior oblique muscle, ciliary

B. Lateral rectus muscle, pupil narrowing

C. Pupil narrowing and dilating muscles

D. Pupil narrowing muscle, ciliary

E. Pupil dilating muscle, ciliary

143.  A 63-year-old woman shows symptoms
of rheumatoid arthritis. The increase of what
blood indices could be the most significant
for proving the diagnosis?

A. Additive glycosaminoglycans

B. Lipoproteids

C.  Acid phosphatase

D. R-glycosidase

E. General cholesterol

144.  A 60-year-old patient was admitted to
the surgical department because of infection
caused by blue pus bacillus (Pseudomonas
aeruginosa) which is sensative to penici­
llin antibiotics. Indicate which of the gi­
ven penicillins has marked activity to the
Pseudomonas aeruginosa?

 

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A.       Carbenicillin disodium

B. Phenoxymethylpenicillin
C Benzylpenicillin

D. Methicillin

E.  Oxacillin

145.  A duodenal content smear of a pati­
ent with indigestion contains protosoa 10-18
mem large. They have piriform bodies, 4 pai­
rs of filaments, two symmetrically located
nuclei in the broadened part of body. What
kind of the lowest organisms is it?

A. Lamblia

B. Balantidium

G. Intestinal ameba

D. Dysentery ameba

E. Trichomonas

146.  A 22-year-old patient was admitted
to the hospital with complaints of heavy
nasal breathing. During the examination
of her nasal cavity the doctors found thi­
ckened mucous membrane, a lot of mucus
and nodular infiltrates without erosions in
the nose.The nasal rhinoscleroma was di­
agnosed. The biopsy was taken. What typi­
cal morphological changes may be found?

A. Granulomas with Virchow’s cells

B. Granulomas with Langhan’s cells
C Granulomas with foreign body cells

D. Granulomas with Mikulicz’s cells

E. Interstitial inflammation

147.    A patient with encephalopathy
was admitted to the neurological in­
patient department. There was revealed
a correlation between increasing of
encephalopathy and substances absorbed by
the bloodstream from the intestines. What
substances that are formed in the intestines
can cause endotoxemia?

A. Acetacetate

B. Butyrate

C. Ornithine

D. Biotin

E. Indole

148. Nowadays about 50 minor bases have
been found in the t-RNA structure besides
the main four nitrogenous bases. Choose the
minor nitrogenous base:

A.        Dihydrouracil

B. Adenine

C. Cysteine

D. Uracil

E. Cytosine

149. A patient with suspicion on epidemic
typhus was admitted to the hospital. Some
arachnids and insects have been found in his
flat. Which of them may be a carrier of the
pathogen of epidemic typhus?

A. Bed-bugs

B. Spiders

C. Cockroaches

D. Lice

E. Houseflies

150.    Secretion of what gastrointestinal
hormones will be primarily decreased as a
result of iduodenum removal?

A. Gastrin

B. Gastrin and histamine

C. Histamine

D. Cholecystokinin and secretin

E. Neurotensin

151.     Microspecimen of spinal cord contai-’
ns a nucleus that should be analyzed. Its
neurons form motor endings in the skeletal
muscles. What nucleus of spinal cord is
meant?

A. Proper nucleus of the anterior horn

B. Proper nucleus of the posterior horn
C Intermediate lateral nucleus

D. Thoracic nucleus

E. Proper nucleus of gray substance

152.     The donor who didn’t donate the
blood for a long time was investigated wi­
th IFA method. Anti-HBs antibodies were
revealed. What does positive result of IFA
in this case mean?

A. Chronic hepatitis C

B. Previous hepatitis B

C. Acute hepatitis B

D. Acute hepatitis C

E. Chronic hepatitis B

153.     A patient has tissue ischemia below the
knee joint accompanied with intermittent
claudication. What artery occlusion should
be suspected?

A. Popliteal artery

B. Posterior tibial artery

C. Peroneal artery

D. Anterior tibial artery
E.JProximal part of femoral artery

154.     The preventive radioprotector was gi­
ven to a worker of a nuclear power station.
What mechanism from the below mentioned
is considered to be the main mechanism of
radioprotection?

A. Activation of oxidation reactions

B. Increasing of tissue blood supply

C. Prevention of tissue’s hypoxia

D. Increasing of respiration

E. Inhibition of free radicals formation

155. A patient who came to the doctor
because of his infertility was administered
to make tests for toxoplasmosis and chronic

 

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gonorrhoea. Which reaction should be performed to reveal latent toxoplasmosis and chronic gonorrhoea of the patient?

A. IFA – Immunofluorescence assay

B. (R)CFT- Reiter’s complement fixation
test

C Immunoblot analysis

D. RIHA – Reverse indirect hemagglutinati­
on assay

E. RDHA – Reverse direct hemagglutination
assay

156.    While shifting the gaze to the closely si­
tuated object the refracting power of eye’s
optical mediums will increase by 10 di­
opters. It results from changing of such eye
structure:

A. Cornea

B. Muscle that dilatates pupil
CLens

D. Vitreous body

E. Liquid of the anterior chamber of eye

157.      A large-scale reaction with
parapertussis and pertussis diagnosticums
was made in order to make serological di­
agnostics of the whooping cough. At the
bottom of the test-tubes with diagnosti­
cum of Bordetella parapertussis a granular
sediment formed. What antibodies did this
reaction reveal?

A. Opsonins

B. Antitoxins
C Precipitins

D. Agglutinins

E. Bacteriolysins

158.  While having the dinner the child
choked and aspirated the food. Meavy
cough has started, skin and mucose are
cyanotic, pulse is rapid, respiration is
infrequent, expiration is prolonged. What
disorder of the external respiration has the
child?

A. Alternating respiration

B. Biot’s respiration

C Stage of expiratory dyspnea on asphyxia

D. Stenotic respiration

E. Stage of inspiratory dyspnea on asphyxia

159.  An isolated cell of human heart
automatically generates excitation impulses
with frequency 60 times pro minute. What
structure does this cell belong to?

A. Sinoatrial node

B. Atrium

C. Atrioventricular node

D. Ventricle

jE. His’ bundle

160.   A  patient  working at  a  chemical

plant was admitted to the toxicological department with mercury poisoning, what medicine should be used?

A. Unithiol

B. Naloxone
G. Isonitrozin

D. Activated carbon

E. Enterosorbent

161.     Healthy parents have got a fair-haired,
blue-eyed girl. Irritability, anxiety, sleep and
feeding disturbance developed in the fi­
rst months of the infant’s life. Neurologi­
cal examination revealed developmental
lag. What method of genetic investigation
should be used for the exact diagnosis?

A. Population-statistical

B.  Cytological

C. Genealogical

D. Gemellary

E. Biochemical

162.  An individual is characterized by
rounded face, broad forehead, a mongoli­
an type of eyelid fold, flattened nasal bri­
dge, permanently open mouth, projecting
lower lip, protruding tongue, short neck, flat
hands, and stubby fingers. What diagnosis
can be put to the patient?

A. Klinefelter’s syndrome

B. Down’s syndrome
C Alkaptonuria

D.        Supermales

E. Turner’s syndrome

163.     As a result of craniocerebral trauma
a patient reveals the following symptoms:
intention tremor, dysmetry, adiadochoki-
nesis, dysarthria. What structure of the brain
is injured?

A. Black substance

B. Pale sphere

C. Cerebellum

D. Striatum

E. Motor cortex

164.     A patient suffering from trombophlebi-
tis of the deep crural veins suddenly di­
ed. Autopsy has shown freely lying red
friable masses with dim crimped surface
in the trunk and bifurcation of the
pulmonary artery. What pathologic process
was revealed by morbid anatomist?

A. Tromboembolism

B. Tissue embolism

C. Embolism with foreign body

D. Thrombosis

E. Fat embolism

165.     A 35-year-old man under the treatment
for pulmonary tuberculosis has acute pain
onset of right big toe, swelling, and low-

 

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grade fever. The gouty arthritis was di­agnosed and high serum uric acid level was found. Which of the following anti-tuberculous drugs are known for causing hi­gh uric acid levels?

A.        Pyrazinamide

B. Cycloserine

C. Thiacetazone

D.        Rifampicin

E. Aminosalicylic acid

166. A patient had been ill with bronchi­
al asthma for many years and died from
asthmatic fit. Histologic lung examination
revealed: lumen of bronchioles and small]
bronches contain a lot of mucus with some
eosinophils, there is sclerosis of alveolar
septums. dilatation of alveole lumen. What
mechanism of development of hypersensibi-
lity reaction took place?

A. Reagin reaction

B. Immunocomplex reaction

C. Cytotoxic reaction

D. Cytolysis determined by lymphocytes

E. Granulomatosis

167. During the endoscopy the inflammation
of a major papilla of the duodenum and thel
disturbances of bile secretion were found. In
which part of duodenum were the problems
found?

A. Lower horizontal part

B. Descendent part
C Ascendant part

D. Bulb

E. Upper horizontal part

168. Moving of the daughter chromatids to
the poles of the cell is observed in the mi-
toticaliy dividing cell. At what stage of the
mitotic cycle is this cell?                                    \

A. Prophase

B. Telophase
C Anaphase

D. Interphase

E. Metaphase

169.   A patient with serious damage of
muscular tissue was admitted to the
t Hematological department. What bi­
ochemical urine index will be increased in
this case?

A. Common lipids

B. Creatinine

C. Glucose

D. Uric acid

E. Mineral salts

170. Microscopic examination of the sputum
of a patient with pneumonia occasionally
revealed some larvae. Eosinophiles were
detected  on   blood  examination.   What

helminthiasis can be diagnosed?

A. Trichocephaliasis

B. Ascariasis

C. Opisthorchosis

D. Enterobiosis

E. Paragonimiasis

171.  As a result of the damage of one of
the Atomic Power Plant reactors the run-|
out of radioelements took place. People
in the high-radiation area were radiated
with approximately 250-300 r. They were
immediately hospitalized. What changes in
the blood count would be typical for the vi­
ctims?

A. Neutropenia

B. Lymphopenia

C. Anemia

D. Leukopenia

E. Thrombopenia

172.  A patient with complaints of dryness in
the mouth, photophobia and vision impai­
rment was admitted to the reception-room.
Skin is hypercmic, dry, pupils are dilated,!
tachycardia. Poisoning with belladonna
alkaloids was diagnosed on further exami­
nation. What medicine should be prescri­
bed?

A. Prozerin

B. Dipiroxim

C. Diazepam

D. Armine

E. Pilocarpine

173.  Microspecimen of red bone marrow
contains multiple capillares through the
walls of which mature blood cells penetrate
into the bloodstream. What type of capi­
llares are these?

A. Somatical

B. Visceral

C. Sinusoidal

D. Lymphatic

E.  Fenestrational

174.  In the specimen of one of the parts
of respiratory system a tubular organ wasj
found. It has low epithelium, well developed
muscular tunic, glands and cartilage are
absent. Name this organ:

A. Trachea

B. Larynx

C. Major bronchs

D. Median bronchs

E. Minor bronchs

175.  Increased fragility of vessels, enamel
and   dentine   destruction   resulting   from!
scurvy are caused by disorder of collagen
maturation.   What   stage   of  procollagen
modification is disturbed under this avitami-

 

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nosis?

A. Hydroxylation of proline

B. Detaching of N-ended peptide

C   Removal   of   C-ended   peptide   from procollagen

D. Glycosylation of hydroxylysine residues

E. Formation of polypeptide chains

176.   Dystrophic alterations of heart are
accompanied with dilation of heart caviti­
es, decreased force of heart contractions,
increased blood volume that remains duri­
ng systole in the heart cavity, vein overfill.
What heart condition is it typiccal for?

A. Myogenic dilatation

B. Tonogenic dilatation

C. Emergency stage of hyperfunction and
hypertrophy

D. Cardiosclerosis

E. Cardiac tamponade

177. A patient with infectious mononucleosis
had been taking glucocorticoids for two
weeks. He was brought into remission, but
he fell ill with acute attack of chronic tonsi­
llitis. What action of glucocorticoids caused
this complication?

A. Anti-inflammatory

B.  Antishock.

C.  Antiallergic

D. Immunosuppressive

E. Antitoxic

178. From the nasopharynx of a 5-year-old
child it was excreted a microorganism which
is identical to Corynebacterium diphtherias
dose according to morphological and bi­
ochemical signs. But this microorganism
does not produce exotoxin. As a result
of what process can this microorganism
become toxigenic?

A. Growing with antitoxic serum

B. Phage conversion

C.   Passing through  the organism of the
sensative animals

D. Chromosome mutation

E. Cultivation in the telluric environment

179.  A 1-year-old child with symptoms of
muscle involvement was admitted to the
hospital. Examination revealed carnitine
deficiency in his muscles. What process di­
sturbance is the biochemical basis of this
pathology?

A. Transporting of fatty acids to mitochodri-
ons

B. Substrate phosphorylation
C Actin and myosin synthesis

D. Lactic acid utilization

E.  Regulation of 6′«n level in mitochondri-
ons

180.  A patient who has been treated
with diazepam on account of neurosis
complains of toothache. Doctor admini­
stered him an analgetic, but its dose was
lower than average therapeutic dose. What
phenomenon did the doctor take into
account while prescribing the patient an
underdose?

A. Potentiation

B. Tolerance

C. Drug dependence

D. Summation

E. Cumulation

181. A 42-year-old man suffering from gout
has increased level of urinary acid in blood.
Allopurinol was prescribed to decrease the
level of urinary acid. Competitive inhibitor
of what enzyme is allopurinol?

A. Guanine deaminase

B. Xanthine oxidase

C Adenine phosphoribosiltransferase

D. Adenosine deaminase

E. Hypoxanthine phosphoribosiltransferase

182.  Part of the DNA chain turned 180
degree as a result of gamma radiation. What
type of mutation took place in the DNA
chain?

A. Translocation

B. Deletion

C. Doubling

D. Inversion

E. Replication

183.  An autopsy revealed large (1-2 cm)
brownish-red, easy crumbling formations
covering ulcerative defects on the external
surface of the aortic valve. What is the most
likely diagnosis?

A. Fibroplastic endocarditis

B. Recurrent warty endocarditis

C. Diffusive endocarditis

D. Acute verrucous endocarditis

E. Polypous-ulcerative endocarditis

184.  Analysis of amniotic fluid that was
obtained as a result of amniocentesis
(puncture of amniotic sac) revealed cells
the nuclei of which contain sex chromatin
(Barr’s body). What can it be evidence of?

A.        Genetic disorders of fetus development

B. Polyploidy

C. Trisomy

D.        Development of female fetus

E. Development of male fetus

185. To anaesthetize the surgical treatment
of burn surface, a patient was intravenously
injected a medication for short-acting
narcosis. 1 minute later the patient being

 

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under anaesthesia showed increased blood pressure, tachycardia, increased tone of skeletal muscles; reflexes remained. After recovering from anaesthesia the patient had disorientation and visual hallucinations. What medication was the patient injected?

A.       Sombrevin

B. Ketamine

C. Diethyl ether

D.       Nitrous oxide

E. Thiopental sodium

186. Patients with bile ducts obstruction
suffer from inhibition of blood coagulation,
bleedings as a result of low level of vitamin
assimilation. What vitamin is in deficiency?

A.K B.A CE D.D E. Carotene

187.  A person felt thirsty after staying under
the conditions of hot weather for a long ti­
me. Signals of what receptors caused it first
of all?

A. Osmoreceptors of liver

B. Glucoreceptors of hypothalamus
C Sodium receptors of hypothalamus

D. Baroreceptors of aortic arch

E. Osmoreceptors of hypothalamus

188. To prevent long-term effects of 4-day
malaria a 42-year-old patient was prescri­
bed primaquine. On the 3-rd day from the
begin of treatment there appeared stomach
and heart pains, dyspepsia, general cyanosis,
hemoglobinuria. What caused side effects of
the preparation?

A. Cumulation of the preparation

B. Drug potentiation by other preparations

C.    Delayed   urinary   excretion   of   the
preparation

D.    Genetic   insufficiency   of   glucose   6-
phosphate dehydrogenase

E.  Decreased activity of microsomal liver
enzymes

189.    A child has got galactosemia.
Concentration of glucose in blood has not
considerably changed. Deficiency of what
enzyme caused this illness?

A.        Phosphoglucomutase

B. Amylo-l,6-glucosidase

C. Galactose-1-phosphate uridyltransferase

D.        Hexokinase

E. Galactokinase

190. When a patient with traumatic impai­
rment of the Brain was examined, it was di­
scovered that he had stopped to distinguish
displacement of an object on the skin. What

part of the brain was damaged?

A.        Posterior central gurus

B. Frontal zone

C. Occipital zone of the cortex

D. Parietal zone of the cortex

E. Frontal central gurus

191.    A tissue sample of benign tumor was
studied under the electron microscope. A lot
of small (15-20 nm) spherical bodies, consi­
sting of 2 unequal subunits were detected.
These are:

A. Microtubules

B. Smooth endoplasmic reticulum

C. Mitochondria

D. Ribosomes

E. Golgi complex

192.    Most participants of Magellan expediti­
on to America died from avitominosis. This
disease declared itself by general weakness,
subcutaneous hemmorhages, falling of
teeth, gingival hemmorhages. What is the
name of this avitiminosis?

A. Rachitis

B. Polyneuritis (beriberi)

C. Biermer’s anemia

D. Pellagra

E. Scurvy

193.  Parents with an ill child consulted
an infectionist. They had been working in
one of Asian countries for a long time.
The child has sallow skin, loss of appeti­
te, laxity, enlarged liver, spleen, peripheral
lymph nodes. What protozoal illness can be
suspected?

A. Balantidiasis

B. Amebiasis

C. Lambliasis

D. Visceral leishmaniasis

E. Toxoplasmosis

194. Kidneys of a man under examination
show increased resorbtion of calcium ions
and decreased resorbtion of phosphate ions.
What hormone causes this phenomenon?

A.        Parathormone

B. Vasopressin

C. Aldosterone

D.                                                             Hormonal form D3

E. Thyrocalcitonin

195.   Examination of initial molecular
structure revealed substitution of the
glutamic acid by valine. What inherited
pathology is it typical for?

 

A.        Hemoglobinosis

B. Minkowsky-Shauffard disease

C. Thalassemia

D. Favism

E. Sickle-cell anemia

196. After a trauma a 44-year-old patient
had a rupture of left palm muscle tendons
and of the superficial blood vessels. After
operation and removal of the most part of
the necrotically changed muscle tissue the
bloodstream was normalized. What vessels
have helped to restore the bloodstream?

A.        Arcus palmaris profundus

B. Arcus palmaris super ficialis

C. Aa. perforantes

D. Aa. metacarpeae palmares

E. Aa. digitales palmares communes

197. The effect of electric current on the
exit able cell caused depolarization of its
membrane. Movement of what ions through
the membrane caused depolarisation?

A. HCOJ

B.cr

D.jVa+ E. Ca2+

198. Testosterone and it’s analogs increase
the mass of skeletal muscles that allows to
use them for treatment of dystrophy. Due to
interaction of the hormone with what cell
substrate is this action caused?

20

A. Proteins-activators of transcription

B. Membrane receptors

C. Chromatin

D. Nuclear receptors

E. Ribosomes

199.  For a long time a 49-year-old woman
had suffered from glomerulonephritis which
caused death. The autopsy revealed that the
size of her kidneys was 7 x 3 x 2,5 cm, weight
65,0 g, they were dense and small-grained.
Microscopically: iibrinogenous inflammati­
on of serous and mucous membranes,
dystrophic changes of parenchymatous
organs, brain edema. What complication can
cause such changes of serous membranes
and inner organs?

A.        Uraemia

B. Anemia

C. Thrombopenia

D. Sepsis

E. DIC-syndrome

200.    A patient experienced a sudden
temperature rise up to 39°C. After 6 hours
the temperature normalized. On the 2-nd
day the attack recurred: in the period of
paroxysm the temperature reached 4l°C,
apyrexial period began after 8 hours. What
type of temperature profile is it?

A.        Continued

B. Intermitting

C. Recurrent

D. Hectic

E. Septic

 

INSTRUCTIONAL       BOOK

Ministry of public health of Ukraine (MPH of Ukraine)

Department of manpower policy, education and science of MPH of Ukraine

Testing Board

TEST ITEMS FOR LICENSING EXAMINATION: KROK 1. MEDICINE. 2006.

Composers:            Artcmchuk Ludmila

Bulakh Irynn Homchcnkova Natalya

03

Kyiv.Tcsting Board. (English language).

Editor. A.Potapova

Technical editor: P.Ostapcnko, V.Zhdanov, V.Sobko

Approved to print 09.10.2006. Format 84 xlOSO 1/8 Offset paper. Typeface. Times New Roman Cyr. Offset print. Conditional print pagcs.-3,0;i„ Accounting publishing pages..- 6 ji., Issue. 750 copies

 

List of abbreviations

 

 

A/G Albumin/globulin ratio HR Heart rate
A-ANON Alcoholics anonymous IDDM Insulin dependent diabetes mellitus
ACT Abdominal computed tomography

I FA       1

Immunofluorescence assay                1
ADP Adenosine diphosphate D3D Ischemic heart disease
ALT Alanin aminotranspherase IU International unit
AMP Adenosine monophosphate LDH Lactate dehydrogenase
AP Action potential MSEC Medical and sanitary expert committee
ARF Acute renal failure NAD Nicotine amide adenine dinucleotide A
AST Aspartat aminotranspherase NADPH Nicotine amide adenine dinucleotide
ATP Adenosine triphosphate   phosphate restored
BP Blood pressure NIDDM Non-Insulin dependent diabetes mellitus
bpm Beats per minute PAC Polyunsaturated aromatic carbohydrates
CI. Color Index PAS Periodic acid & shifF reaction
CBC Complete blood count pC02 C02 partial pressure
CHF Chronic heart failure p02 C02 partial pressure
CT Computer tomography pm Per minute
DIC Disseminated intravascular coagualtion Ps Pulse rate
DCC Doctoral controlling committee r roentgen
DM-2 Non-Insulin dependent diabetes mellitus RBC Red blood count
DTP      1 Anti diphtheria-tetanus vaccine RDHA Reverse direct hemagglutination assay
ECG Electrocardiogram Rh Rhesus
ESR Erythrocyte sedimentation rate (R)CFT Reiter’s complement fixation test
FC Function class RIHA Reverse indirect hemagglutination assay
FAD Flavin adenine dinucleotide RNA Ribonucleic acid                            4fc Respiratory rate
FADH2 Flavin adenine dinucleotide restored RR
FEGDS Fibro-esphago-gastro-duodenoscopy SI Heart sound 1
FMNH2 Flavin mononucleotide restored S2 Heart sound 2
GIT Gastrointestinal tract TU Tuberculin unit
GMP Guanosine monophosphate U Unit
Hb Hemoglobin USI Ultrasound investigation
HbAlc Glycosylated hemoglobin V/f Vision field
Hct Hematocrit WBC White blood count
HIV Human immunodeficiency virus X-ray Roentgenogram

 

Year 2006

Posted: May 5, 2012 in Krok II
Tags:

 

1. A 41 y.o. patient complains of acute pain in the right side of the thorax and sudden progress of dyspnea following the lifting of a heavy object. The patient’s condition is grave: lips and mucous membranes are cyanotic, BR – 28/min, Ps — 122 bpm, AP – 80/40 mm Hg. There is tympanitis on percussion and weakened breathing on auscultaion on the right. S^ sound is accentuated above pulmonary artery. What is the main urgent measure on the prehospital stage?

A. Call for cardiologic team

B. Euphilline introduction

C. Epinephrine introduction

D. Air aspiration from the pleural cavity

E. Oxygen inhalation

 

2. A 35 y.o. woman was admitted to thoracic surgery department with fever up to 40°C, 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. Abscess of the lung

B. Pulmonary tuberculosis

C. Bronchiectatic disease

D. Actinomycosis of lungs

E. Complication of liver echinococcosis

 

3. A 58 y.o. man complained of severe inspiratory dyspnea and expectoration of frothy and blood-tinged sputum. He has been suffering from essential hypertension and ischemic heart disease. On examination: acrocyanosis, “bubbling” breathing, Ps – 30/min, BP — 230/130 mm Hg, bilateral rales. Choose medicines for treatment.

A. Strophanthine, potassium chloride, plathyphylline

B. Morphine, furosemide, nitroprusside sodium

C. Theophylline, prednisolon

D. Cordiamine, isoproterenol

E. Albuterol, atropine, papaverine

 

4. A 17 y.o. patient complains of acute pain in the knee joint and t° — 38°C. 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. Rheumatism, polyarthritis

B. Rheumatoid arthritis

C. Infectious-allergic polyarthritis

D. Reactive polyarthritis

E. Systemic lupus erythematodes

 

5. A 40 y.o. woman is ill with rheumatic disease with prevalence of the stenosis of left venous foramen. Complains of palpitation, fatigability, progressing dyspnea, attacks of dyspnea and hemoptysis. Now she cannot be engaged even in the easy activities. What tactics is the most expedient?

A.-

B. Prescription of venous vasodilatators

C. Conduction of current bicilino-prophilaxis

D. Prescription of anticoagulants

E. Mitral comissurotomia

 

6. A 19 y.o. patient was admitted to the hospital with acute destructive appendicitis. He suffers from hemophilia B-type. What antihemophilic medicine should be included in pre- and post-operative treatment plan?

A. Dried plasma

B. Fresh frozen plasma

C. Fresh frozen blood

D. Cryoprecipitate

E. Native plasma

 

7. A 31 y.o. patient has had mental disorder for a long time. He suffers from insomnia for a long time. He has got fears, suicidal thoughts, tried to hang himself. His mood is depressed, he refuses from treatment. What measures are the most expedient for the prevention of suicide?

A. Out-patient treatment

B. Strict supervision at home

C. Psychotherapeutic conversation

D. Admission to the mental hospital

E. Admission to the neurological department

 

8. A 47 y.o. woman complains of having paroxysmal headaches for the last 5 years. The pain is one-sided, intense, localized in frontal region of head, accompanied by nausea and stomach iscomfort, begins one of a sudden. Onset is usually preceded by vision reduction. Anamnesis gives evidence of periodical AP rise, but at the moment the woman doesn’t take any medicines. In between the onsets of headache her state is satisfactory. Objectively: high-calorie diet (body weight index – 29), AP – 170/95 mm Hg. Neurologic state has no pecularities. What is the most probable diagnosis?

A. Chronic subdural hematoma

B. Migraine

C. Benign intracranial hypertension

D. Hypertensive encephalopathy

E. Epilepsy

 

9. A 16 y.o. teenager complains of weakness, dizziness, sense of heaviness in the left hypochondrium. Objectively: skin and visible mucous membranes are icteric. Steeple skull. Liver +2 cm, the lower pole of spleen is at the level of navel. Blood test: RBC – 2.7* 1012/L, Hb- 88 g/L, WBC- 5,6* 109/L, ESR – 15 mm/h. What is the most probable reason of bilirubin level change?

composite mitral disease with

A. Decrease of conjugated bilirubin

B. Increase of unconjugated and conjugated bilirubin

C. Increase of unconjugated bilirubin

D. Decrease of unconjugated bilirubin

E. Increase of conjugated bilirubin

 

10. A 6 y.o. asthmatic child was taken to the emergency hospital because of severe coughing and wheezing for the last 24 hours. Physical examination reveals that the child is excitable, has intercostal and suprasternal retractions, expiratory wheezing throughout all lung fields, RR — 60/min. Initial treatment may include the prescription of:

A. N-acetyl cysteine and cromolyn by inhalation

B. Parenteral gentamicyn

C. Subcutaneous epinephrine

D. Parenteral phenobarbital

E. Intravenous fluids in the first 2 h to compensate water deficiency

 

11. A 41 y.o. woman complains of weakness, fatigue, fever up to 38°C, rash on the face skin, pain in the wrists and the elbows. On physical examination: erythematous rash on the cheeks with “butterfly” look, the wrists and elbow joints are involved symmetrically, swollen, sensitive, friction rub over the lungs, the heart sounds are weak, regular, HR – 88/min, BP — 160/95 mm Hg. CBC shows anemia, leucopenia, lymphopenia; on urine analysis: proteinuria, leukocyturia, casts. What is the main mechanism of disease development?

A. Production of antibodies to double-stranded DNA

B. Production of antimitochondrial antibodies

C. Production of myosin antibodies

D. Production of antibodies to endothelial cells

E. Production of myocytes antibodies

 

12. A military unit stopped for 3-day’s rest in inhabited locality after a long march. The sanitary-epidemiological reconnaissance found several water sources. It is necessary to choose the source complying with the hygienic standards for drinking water in the field

A. Artesian well water

B. River water

C. Spring water

D. Rain water

E. Water from melted snow

 

13. 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 37.5°C. 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. Multiple marginal osteophytes

B. Constriction of joint space, subchondral osteosclerosis

C. Cysts in subchondral bone

D. Constriction of joint space, usura

E. Epiphysis osteolysis

 

14. A pregnant woman was registered in a maternity welfare clinic in her 11th week of pregnancy. She was being under observation during the whole term, the pregnancy course was normal. What document must the doctor give the pregnant woman to authorize her hospitalization in maternity hospital?

A. Medical certificate

B. Exchange card

C. Individual prenatal record

D. Sanitary certificate

E. Appointment card for hospitalization

 

15. Name a statistical observation unit for determination of blood sugar impact on the healing of wound’s surface in a postoperative period:

A. An amount of blood sugar

B. The patient who was discharged on an after-care

C. The patient in a postoperative period

D. Blood analysis

E. The patient who has a wound surface

 

16. Patient with thyreotoxicosis is in the 2 beds hospital ward of therapeutic department. The area of the ward is 18 m2, height 3 m, ventilation rate 2,5/hr. Air temperature — 20°C, relative humidity — 45%, air movement velocity — 0,3 m/s, light coefficient -1/5, noise level — 30 dB. Do hygienic evaluations of the conditions meet the standards?

A. High level of noise

B. Discomfortable microclimate

C. Non-effective ventilation

D. Poor lighting

E. All conditions meet the requirements

 

17. A 33 y.o. woman has been suffering from DM (diabetes mellitus) for 5 years. For the last 3 years she has been taking more than 100 units of insulin per day. Body weight has increased up to 10 kg. Fasting blood glucose is 13 mmol/L, glucoseuria — 3%. Generalized microangiopathy. By increasing the dose of insulin the parameters of glycemia do not change. The diagnosis is:

A. DM 1st type, severe form, decompensation, allergic reaction to insulin

B. DM 2nd type, moderate form, Zabrodiphenomenon

C. DM 1st type, severe form, decompensation, insulin resistant

D. DM st type, severe form, subcompensation, Somoji phenomenon

E. DM 2nd type, severe form, decompensation

 

18. A patient is 16 y.o. In the last year his behaviour has gradually changed: he secluded himself, was not interested in communication with friends, in learning. He became indifferent towards relatives, motivelessly rude, was speaking or laughing to himself. He answers the questions formally correctly, laconically. Considers he to be absolutely healthy but a little tired, says, he’s thinking about writing a book “Projection of humanity on the plane of Universe”. He always has a copy-book with which is full of a great many of the same daggers. What is the most probable diagnosis?

A. Schizophrenia

B. Schizoid personality disorder

C. Pick’s disease

D. Depressive disorder

E. Autistic personality disorder

 

19. A 1.5 y.o. child fell seriously ill: chill, body temperature rise up to 40.1°C, then rapid dropping to 36, 2°C, skin is covered with voluminous hemorrhagic rash and purple cyanotic spots. Extremities are cold, face features are sharpened. Diagnosis: meningococcosis, fulminant form, infection-toxic shock. What antibiotic must be used at the pre-admission stage?

A. Sulfamonometoxin

B. Lincomycin

C. Penicillin

D. Gentamycin

E. Soluble Levomycetine succinate

 

20. A 41 y.o. woman has suffered from nonspecific ulcerative colitis for 5 years. On rectoromanoscopy: evident inflammatory process of lower intestinal parts, pseudopolyposive changes of mucous membrane. In blood: WBC – 9,8 * 109/L, RBC – 3,0 * 1012/L, sedimentation rate – 52 mm/hour. What medication provides pathogenetic treatment of this patient?

A. Motilium

B. Kreon

C. Sulfasalasine

D. Vikasolum

E. Linex

 

21. A 27 y.o. woman complains of having the disoders of menstrual function for 3 months, irregular pains in abdomen. On bimanual examination: in the dextral appendage range of uterus there is an elastic spherical formation, painless, 7 cm in diameter. USI: in the right ovary – a fluid formation, 4 cm in diameter, unicameral, smooth. What method of treatment is the most preferable?

A. Dispensary observation of the patient

B. Prescription of an estrogen-gestogen complex for 3 months with repeated examination

C. Anti-inflammatory therapy

D. Operative treatment

E. Chemotherapeutic treatment

 

22. A mineshaft is situated on the territory of homestead land; it is 20 m away from the house, 10 m – from the toilet and 15 m – from the neighbor’s house. What is the smallest distance that, according to the sanitary code, should be established between the well and the source of probable water pollution?

A. 20 m

B. 25 m

C. *30 m

D. 15 m

E. 10 m

 

23. A 25 y.o. woman complained of fatigue, hair loss and brittle nails. The examination revealed pallor of skin, Ps- 94/min, BP- 110/70 mm Hg. On blood count: Hb- 90 g/L, RBC – 3,5* 1012/L, C.I. – 0,7; ESR – 20 mm/h. Serum iron level was 8.7 mcmol/L. What treatment would you initiate?

A. Iron dextrin injections

B. Vitamin B12- intramuscularly

C. Packed RBCs transfusion

D. Blood transfusion

E. Ferrous sulfate orally

 

24. Condition of a parturient woman has been good for 2 hours after live birth: uterus is thick, globe-shaped; its bottom is at the level of umbilicus, bleeding is absent. The clamp put on the umbilical cord remains at the same level, when the woman takes a deep breath or she is being pressed over the symphysis with the verge of hand, the umbilical cord drows into the vagina. Bloody discharges from the sexual tracts are absent. What is the doctor’s further tactics?

A. To apply Abdul adze method

B. To introduct oxitocine intravenously

C. To do manual removal of afterbirth

D. To do curettage of uterine cavity

E. To apply Crede’s method

 

25. A youth, aged 15, from childhood suffers from atopic dermatitis and allergy to the shellfish. In the last 3 months after acquiring aquarium fish rhinitis, conjunctivitis, itching in the nose developed. Level of what immunologic index should be defined in this case?

A. IgM

B. IgJ

C. IgA

D. Circulating immunocomplexes

E. IgE

 

26. A mother with an infant visited the pediatrician for expertise advice. Her baby was born with body weight 3.2 kg and body length 50 cm. He is 1 year old now. How many teeth the baby should have?

A. 20

B. 6

C. 8

D. 10

E. 12

 

27. A woman is admitted to the maternity hospital with stopped birth activity and mild bloody discharges from the vagina. The condition is serious, the skin is pale, and consciousness is confused. AP – 80/40 mm Hg. The palpitation of the fetus is not determined. In medical history there was a Cesarean section a year ago. Make a diagnosis:

A. Hysterorrhesis

B. Premature expultion of the amniotic waters

C. Abjointing of the mucous fuse from cervix of the uterus

D. Presentation of the cord

E. Placental presentation

 

28. In a city with population 400000 people 5.600 fatal cases were recorded, including 3300 cases because of blood circulation diseases, 730 – because of tumors. What index will allow characterizing mortality from blood circulation diseases in this city?

A. Relative intensity index

B. Extensive index

C. Correlation index

D. Visuality index

E. Intensive index

 

29. On the 3rd day after the acute anterior myocardial infarction a 55 y.o. patient complains of dull ache behind his breast bone, that can be reduced by bending forward, and of dyspnea. Objectively: AP- 140/180 mm Hg, heart sounds are dull. ECG results: atrial fibrillation with frequence of ventricular contractions at the rate of 110/min, pathological Q wave and S-T segment raising in the right chest leads. The patient refused from thrombolisis. What is the most probable diagnosis?

A. Tietze’s syndrome

B. -Acute pericarditis

C. Dressler’s syndrome

D. Pulmonary embolism

E. Dissecting aortic aneurysm

 

30. A full-term new-born suffered from ante- and intranatal hypoxia, was born in asphyxia (Apgar score 2-5 points). After birth baby’s excitation is progressing, occurs vomiting, nystagmus, spasms, squint, spontaneous Babinski and Moro’s reflexes. What is the most probable location of the intracranial hemorrhage in this case?

A. Periventricular hemorrhages

B. Subdural hemorrhages

C. Hemorrhages in ventricles of brain

D. Small hemorrhages in brain tissue

E. Subarachnoid hemorrhages

 

31. In treatment and prevention establishments, regardless of their organizational and proprietary form, the rights of patients should be observed. Which of these rights are the most significant?

A. The right to the free choice

B. The right to be heard

C. The right to the information

D. The right to the protection from incompetence

E. The right to the protection of the patient’s interests

 

32. A 56 y.o. woman has an acute onset of fever up to 39°C 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. Acute lung abscess

D. Hospital-acquired lobar pneumonia

E. Community-acquired bronchopneumonia

 

33. Fluorography of a 45 y.o. man revealed some foci of small intensity with no distinct outlines on the top of his right lung. The patient doesn’t feel worse. He has been smoking for many years. Objectively: vesicular resonance over lungs, respiration is vesicular, rales are absent. Blood count is not changed. What is the most probable diagnosis?

A. Eosinophilic pneumonia

B. Disseminated pulmonary tuberculosis

C. Focal pulmonary tuberculosis

D. Bronchiolitis

E. Peripheral cancer of lung

 

34. A 48 y.o. farmer was admitted to the hospital with complaints of headache, nausea, vomiting, cough with sputum, breath shortage, weak sight, sweating, and salivation. He was cultivated the garden with phosphoorganic pesticides. Blood count RBC – 4.1 * 1012/L, Hb- 136 g/L, C.I.- 0.9, leukocytes – 13.0 * 109/L, ESR – 17 mm/h. His diagnosis is acute intoxication with phosphoorganic pesticides. What is the most important diagnostic criterion for this pathology?

A. Anemia

B. Low level of choline esterase

C. Thrombocytopenia

D. Reticulocytosis

E. Leukocytosis

 

35. A 28 y.o. man fell seriously ill, he feels chill, has got a fever, body temperature raised up to 38, 5°C, paroxysmal pain in the left iliac region, frequent defecation in form of fluid bloody and mucous mass. Abdomen palpation reveals painfulness in its left half, sigmoid colon is spasmed. What is the most probable diagnosis?

A. Amebiasis

B. Colibacillosis

C. Nonspecific ulcerative colitis

D. Malignant tumors of large intestine

E. -Acute dysentery

 

36. A surgical department admitted a newborn boy with foamy discharges from nose and mouth, cyanosis attacks. X-ray examination: blind end of esophagus is at the level of the II thoracic vertebra; gastric air bubble is under the left cupula of diaphragm. What is the most probable diagnosis?

A. Esophagus atresia without a fistula

B. Total esophagus atresia

C. Paraesophageal hernia

D. Esophagus atresia, tracheo-esophageal fistula

E. Bronchoesophageal fistula

 

37. A woman consulted a doctor on the 14th day after labor about sudden pain, hyperemy and induration of the left mammary gland, body temperature rise up to 39°C, headache, and indisposition. Objectively: fissure of nipple, enlargement of the left mammary gland, pain on palpation.What pathology would you think about in this case?

A. Lactational mastitis

B. Phlegmon of mammary gland

C. Fibrous adenoma of the left mammary gland

D. Lacteal cyst with suppuration

E. Breast cancer

 

38. A patient complains of skin painfullness and reddness of the right gastrocnemius muscle. Objectively: body temperature is 38.5°C, enlarged and painful inguinal lymph nodes on the right. Skin of extremity is edematic, hyperemic, covered with eruption in form of vesicles containing dark fluid; its palpation is painful. There is distinct border between normal and hyperemic skin. What is the most probable diagnosis?

A. Anthrax, dermal form

B. Chickenpox

C. Crus phlegmon

D. Herpetic infection

E. -Erysipelas, hemorrhagic form

 

39. A 40 y.o. patient was diagnosed: 1. Medular thyroid gland cancer. 2. Feochromocytoma. What operation should be performed at first?

A. Operation on account of feochromocytoma

B. Operation on thyroid gland

C. Vanach’s operation

D. Krail’s operation

E. Subtotal resection of thyroid gland and fascicular resection of limphatic nodes

 

40. A man, 42 years old, died in a road accident after the hemorrhage on the spot, because of acute hemorrhagic anemia. What minimum percent of the whole blood volume could result in death by acute hemorrhage?

A. 35-50%

B. 10-14%

C. 15-20%

D. 25-30%

E. 6-9%

 

41. 200 patients suffering from essential hypertension were examined in order to obtain data about patients’ arterial pressure and age. What statistic value should be applied in order to measure relation between these characteristics?

A. Student’s coefficient

B. Sygmal deviation

C. Representation error

D. Correlation coefficient

E. Coefficient of variation

 

42. A child with chronic cardialtis, cardial insufficiency IIA that is being treated with digoxin has got progressing bradycardia, nausea, vomiting, dizziness, and sleep disorders. ECG results: extrasystole, PQ – 0.18. What is the most probable cause of this condition?

A. Hypokaliemia

B. Atrioventricular heart block of the I degree

C. Pulmonary edema

D. Acute enteric infection

E. Cardiac glucosides overdose or intolerance

 

43. A 60 y.o. man complains of sense of heaviness in the region of scrotum. Objectively: scrotum edema in the left part. Testicle is of normal size, but there is a soft, scrotum limited edema over it that can be pressed and disappears when the patient lies down. What is the preliminary diagnosis?

A. Ectopic testicle

B. Varicosity of subcutaneous veins

C. Varicocele

D. Inguinal lymphadenopathy

E. Inguinal hernia

 

44. In course of observation of sanitary conditions of studying at the technical university it was necessary to evaluate the visual regimen of students, who study from 9 a.m. to 3 p.m. What index of natural light will be the most informative?

A. Depth of study room

B. Natural light coefficient

C. Light coefficient

D. Presence of mixed (upper-lateral) light

E. Time of the room insolation

 

45. A 15 y.o. boy was twice attacked by bees; as a result he had severe anaphylactic shock. What is the most effective prophylaxis method?

A. Protective clothing

B. Prescription of corticosteroids for summer

C. Limitation of outside staying during summer months

D. Long-term prophylactic treatment with antihistamines

E. Desensibilisation by means of bee venom extract

 

46. During the medical examination a port crane operator complained of dizziness, nausea, sense of pressure against tympanic membranes, tremor, dyspnoea, and cough. He works aloft; the work is connected with emotional stress. Workers are affected by vibration (general and local), noise, ultrasound, microclimate that warms in summer and cools in winter. What factor are the worker’s complaints connected with?

A. Infrasound

B. Noise

C. Altitude work

D. Vibration

E. Intensity of work

47. A laboratory obtained a milk sample sent for analysis. Analysis gave the following data: color – whitish, smell – has no pecularities, taste – typical for milk, density – 1.038, acidity – Turner’s 35°, fat – 3.2%. What is the quality level of this milk?

A. The milk is of high quality

B. The milk is falsificated

C. The milk is of reduced quality

D. The milk is of poor quality

E. The milk is nominally qualified

 

48. An 18 y.o. patient was admitted to the hematologic department with complaints of headache, general weakness, poor appetite, body temperature rise up to 39° C, neck swelling. Objectively: skin and mucous membranes are extremely pale, lymph nodes on the both sides of neck are up to 1 cm large, painless. Liver is enlarged +1 cm, painless, spleen +0.5 cm, t°- 38°C. Blood count: Hb – 98 g/L, RBC- 2,9*1012/L, leukocytes – 32*109/L, stab neutrophils – 0%, segmental leukocytes – 28%, monocytes – 2%, lymphocytes – 39%, blasts – 31%, reticulocytes – 31%, thrombocytes -120*109/L, ESR- 36 mm/h. What form of leukosis does the patient have?

A. Acute lymphoblastic leukosis

B. Chronic lympholeukosis

C. Acute myeloblasts leukosis

D. Chronic myeloleukosis

E. Undifferentiated leukosis

 

49. 8 hours after a road accident an unconscious victim with closed craniocerebral trauma was admitted to the hospital. Objectively: anisocoria, wound in the parietal region – 3.0 x 1,0 cm, neck muscles rigidity, Ps-58/min, tense. Convulsive syndrome. What is the most important indication for the immediate surgical procedure?

A. Wounds

B. Unconsciousness

C. Anisocoria

D. Intracranial hemorrhage

E. Intensification of convulsions

 

50. A 7 y.o. boy has been treated in a hospital for a month. At the time of admission he had evident edemata, proteinuria – 7.1 g/L, protein content in the daily urine – 4.2 g. Biochemical blood analysis reveals permanent hypoproteinemia (43,2 g/L), hypercholesterolemia (9.2 mmol/L). What variant of glomerulonephritis is the most probable?

A. Nephritic

B. Hematuric

C. Nephrotic

D. Mixed

E. Isolated urinary

 

51. People who live in the radiation polluted regions are recommended to include pectins into their dietary intake for the radioactive nuclides washout. What products is the main source of pectin’s?

A. Meat

B. Bread

C. Macaroni

D. Fruit and vegetables

E. Milk

 

52. A 31 y.o. patient has been suffering from systemic scleroderma for 14 years. She has been treated in hospital many times. She complains of occasional dull pain in the heart region, palpitation, dyspnea, headache, eye-lid edemata, weight loss and deformation of extremities joints. What organ affection worsens the disease prognosis?

A. Skin and joints

B. Heart

C. Gastrointestinal tract

D. Kidneys

E. Lungs

 

53. 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. Toracoscopy

B. Drainage of anterior mediastinum

C. Toracotomy

D. Pleural cavity drainage

E. Pleural cavity punction

 

54. Studying of pulmonary tuberculosis incidence provided data about patients’ socioeconomic living conditions and bad habits. What method allows estimating the impact of these factors on tuberculosis incidence?

A. Calculation of reliability coefficient

B. Calculation of correlation coefficient

C. Calculation of regression coefficient

D. Standardized index calculation

E. Calculation of correspondence index

 

55. A pregnant woman (35 weeks), aged 25, was admitted to the hospital because of bloody discharges. In her medical history there were two artificial abortions. In a period of 28-32 weeks there was noted the onset of hemorrhage and USD showed a placental presentation. The uterus is in normotonus, the fetus position is transversal (1st position). The heartbeats is clear, rhythmical, 140 bpm. What is the further tactics of the pregnant woman care?

A. Stimulate the delivery by intravenous introduction of oxytocin

B. To keep the intensity of hemorrhage under observation and after the bleeding is controlled to prolong the pregnancy

C. To perform the hemotransfusion and to prolong the pregnancy

D. To perform a delivery by means of Cesarean section

E. To introduct the drugs to increase the blood coagulation and continue observation

 

56. A 28 y.o. woman consulted a doctor about edematic face, moderate legs edemata; occasionally her urine has colour of “meat slops”. When she was a teenager she often fell ill with angina. Objectively: skin is pallor, body temperature is 36.8°C, Ps – 68/min, rhythmic. AP — 170/110 mm Hg. What urine changes are the most probable?

A. Increase of relative density, hematuria, bacteriuria

B. Decrease of relative density, proteinuria

C. Erythrocyturia and urinozuria

D. Proteinuria, hematuria, cylindrouria

E. Decrease of relative density, proteinuria, and some urinary sediment

 

 

57. A 3 y.o. girl has had a temperature rise up to 38°C, rhinitis, dry superficial cough, flabbiness, appetite loss. Palpation didn’t reveal any changes over her lungs. Percussion sound has a wooden resonance, auscultation revealed puerile breathing, no rales. In blood: leukopenia, lymphocytosis, increased ESR. What is the most probable diagnosis?

A. Acute simple bronchitis

B. Recurrent bronchitis, acute condition

C. Acute obstructive bronchitis

D. -Acute simple tracheitis

E. Bilateral microfocal pneumonia

 

58. A 60 y.o. patient complains of having passing reduction of strength in his left extremities for a month. Some time later he has got persistent weakness of extremities in the mornings. Objectively: AP-140/90 mm Hg, conscious, central paresis of the VII and XII pair of left-side cranial nerves, central hemiparesis and hemihyperesthesia also on the left side. What medicines should be chosen for the differentiated treatment of the patient?

A. Corticosteroids

B. Hypotensive

C. Diuretics

D. -Anticoagulants

E. Hemostatics

 

59. A 28 y.o. patient without permanent residence was admitted to the hospital with the preliminary diagnosis influenza. On the fifth day of illness he got a maculopapular petechial rash on his body and internal surfaces of extremities. Body temperature is 41°C, euphoria, face hyperemia, sclera reddening, tongue tremor, tachycardia, splenomegaly, excitement. What is the most probable diagnosis?

A. Measles

B. Leptospirosis

C. Typhoid fever

D.- Epidemic typhus

E. Delirium alcoholicum

 

60. The doctors in maternity hospital made a newborn boy the following diagnosis: congenital heart disease (interventricular septal defect). At the age of 2 months the boy has got a dyspnea. Objectively: BR- up to 60/min, tachycardia up to 170/min, liver is 3 cm below the costal margin. What medicines must be immediately prescribed?

A. β-adrenoceptor blockers

B. Cardiac glycosides

C. Potassium preparations

D. Glucocorticoids

E. Nonsteroidal antiinflammatory drugs

 

61. A 38 y.o. woman suffers from paroxysmal AP rises up to 240/120 mm Hg accompanied by nausea, vomiting, tachycardia, excessive sweating. During the onset blood is hyperglycemic. After the onset there is voluminous urination. Kidneys sonography revealed accessory mass bordering upon the upper pole of the right kidney; presumably it belongs to the adrenal gland. What laboratory test will allow making a more precise diagnosis?

A. Estimation of thyroxin and thyrotropic hormon in blood

B. -Estimation of catecholamine and vanillylmandelic acid excretion with urine

C. Estimation of insulin and C-peptide content in blood

D. Estimation of renin content in blood

E. Estimation of glomerular nitration rate

 

62. 3 weeks ago a patient was ill with tonsillitis. Clinical examination reveals edema, arterial hypertension, hematuria, proteinuria (1.8 g/per day), granular and erythrocital casts. What is the preliminary diagnosis?

A. Renal amyloidosis

B. Intestinal nephritis

C. Pyelonephritis

D. Glomerulonephritis

E. Cystitis

 

63. A 28 y.o. woman consulted a doctor with the complaints of enlargening in size of an inborn pigment nevus; it was also wetting and itching. What test should not be used for diagnostics in this case?

A. Radioisotope diagnostics

B. Incision biopsy

C. Termography

D. Yaks’s reaction

E. Glass-print

 

64. A pregnant woman in her 8th week was admitted to the hospital for artificial abortion. In course of operation during dilatation of cervical canal of uterus by means of Hegar’s dilator, N° 8 the doctor suspected uterus perforation. What is the immediate tactics for confirmation of this diagnosis?

A. US examination

B. Laparoscopy

C. Metrosalpingography

D. Uterine probing

E. Bimanual examination

 

65. A child was born with body weight 3.250 g and body length 52 cm. At the age of 1.5 month the actual weight is sufficient (4.350 g), psychophysical development corresponds with the age. The child is breast-fed, occasionally there are regurgitations. What is the cause of regurgitations?

A. Pylorospasm

B. Esophageal atresia

C. Acute gastroenteritis

D. Aerophagia

E. Pylorostenosis

 

66. A 37 y.o. primigravida woman has been having labor activity for 10 hours. Labor pains last for 20-25 seconds every 6-7 minutes. The fetus lies in longitude, presentation is cephalic, and head is pressed upon the entrance to the small pelvis. Vaginal examination results: cervix of uterus is up to 1 cm long, lets 2 transverse fingers in. Fetal bladder is absent. What is the most probable diagnosis?

A. Primary uterine inertia

B. Discoordinated labor activity

C. Secondary uterine inertia

D. Pathological preliminary period

E. Normal labor activity

 

67. A 25 y.o. patient complains of body temperature rise up to 37°C, pain at the bottom of her abdomen and vaginal discharges. Three days ago, when she was in her 11th week of pregnancy, she had an artificial abortion. Objectively: cervix of uterus is clean; uterus is a little bit enlarged in size, painful. Appendages cannot be determined. Fornixes are deep, painless. Vaginal discharges are sanguinopurulent. What is the most probable diagnosis?

A. Postabortion uterus perforation

B. Pelvic peritonitis

C. Hematometra

D. Parametritis

E. Postabortion endometritis

 

68. A 70 y.o. patient complains of weakness, dizziness, short periods of loss of consciousness, pain in the region of heart. Objectively: HR- 40/min, sounds are rhytmic, the 1st sound is dull, occasionally very intensive. AP — 180/90 mm Hg. What is the most probable reason of hemodynamic disorders?

A. Sinus bradycardia

B. Complete block of the left branch of His bundle

C. I degree atrioventricular heart block

D.- III degree atrioventricular heart block

E. Bradysystolic form of the atrial fibrillation

 

69. A 37 y.o. patient complains of pain in the right arm which increases during motion, raised body temperature up to 39°C. In the right cubital fossa there is a trace of injection, hyperemia and thickening along the vein. Your diagnosis?

A. Abscess

B. Phlebit

C. Erysipelas

D. Inflammation of lymph

E. Phlegmon

 

70. An 18 y.o. girl complains of weakness, dizziness, loss of appetite, menorrhagia. There are many-coloured petechiae on the skin of the upper extremities. Blood test: Hb 105 g/l; RBC – 3,2 *1012/L; CI.- 0,95; thromb. – 20*109/L. The sedimentation time according to Lee White is 5′; hemorrhagia duration according to Duke is 8′, “pinch and tourniquet “test is positive. What is the most probable diagnosis?

A. Hemorrhagic diathesis

B. Marchiafava-Micheli’s disease

C. Hemophilia

D. Idiopathic thrombocytopenic purpura

E. Iron deficiency anemia

 

71. An 18 y.o. woman consulted a gynecologist about the pain in the lower part of abdomen, fever up to 37, 5°C, considerable mucopurulent discharges from the genital tracts, painful urination. Vaginal examination with mirrors: the urethra is infiltrated, cervix of the uterus is hyperemic, erosive. The uterus is painful, ovaries are painful, thickened; fornixes are free. Bacterioscopy test revealed diplococcus. What diagnosis is the most probable?

A. Trichomoniasis

B. Candydomycosis

C. Recent acute ascending gonorrhea

D. Chronic gonorrhea

E. Chlamydiosis

 

72. A girl, aged 13, consulted the school doctor on account of moderate bloody discharge from the genital tracts, which appeared 2 days ago. Secondary sexual characters are developed. What is the most probable cause of bloody discharge?

A. Haemophilia

B. Juvenile hemorrhage

C. Menarche

D. Werlhof’s disease

E. Endometrium cancer

 

73. A 32 y.o. patient lives in an endemic echinococcous region. For the last 6 months he has been having pain in the right hypochondrium, temperature rise. Echinococcus liver affection is suspected. What type of examination will be the most informative in this case?

A. USI examination

B. Biochemical laboratory analysis

C. Angiography

D. Plan radiography of abdominal cavity

E. Liver scanning

 

74. A 7 y.o. girl has mild form of varicella. Headache, weakness, vertigo, tremor of her limbs, ataxia, and then mental confusion appeared on the 5th day of illness. Meningeal signs are negative. Cerebrospinal fluid examination is normal. How can you explain these signs?

A. Meningitis

B. -Encephalitis

C. Neurotoxic syndrome

D. Meningoencephalitis

E. Myelitis

 

75. The results of a separate diagnostic curettage of the mucous of the uterus’ cervix and body made up in connection with bleeding in a postmenopausal period: the scrape of the mucous of the cervical canal revealed no pathology, in endometrium — the highly differentiated adenocarcinoma was found. Metastases are not found. What method of treatment is the most correct?

A. Radial therapy

B. Surgical treatment + chemotherapy

C. Surgical treatment and hormonotherapy

D. -

E. Surgical treatment and radial therapy

 

76. A 32 y.o. man is divorced, has an irregular sexual life. He complains of falling out of hair in the region of eyelashes, eyebrows, and scalp. Objectively: diffuse alopecia is observed, eyebrow margin is absent, eyelashes are stair-like (Pinkus’ sign). What examination should be carried out first of all?

A.CBC

B. Consultation of neuropathist

C. Detection of the nasal mucous membrane for Micobacterium Leprae Hansen

D. T.pallidum Immobilization Test (TPI)

E. Wasserman test, IFT

 

77. A 62 y.o. patient suffers from DM-2. Diabetes is being compensated by diet and Maninilum. Patient has to undergo an operation on inguinal hernia. What tactics of hypoglycemic therapy should be used?

A. Continue with the current therapy

B. Prescribe long-acting insulin

C. Prescribe guanyl guanidines

D. Prescribe fast-acting insulin

E. Give Glurenorm in place of Maninilum

 

78. A 34 y.o. patient 3 hours ago was bitten by a dog. He has got a non-bleeding wound in his left arm caused by the dog’s bite. What surgical care would you provide to the patient?

A. Wound bathing with detergent water and antiseptic application

B. Cream bandage

C. Incomplete suturing of the wound

D. Complete suturing of the wound

E. Aseptic bandage

 

79. A man, aged 30, complains of intense pain, reddening of skin, edema in the ankle- joint area, fever up to 39°C. There was acute onset of the illness. In the past there were similar attacks lasting 5-6 days without residual changes in the joint. The skin over the joint is hyperemic without definite borders and without infiltrative bank on the periphery. What is the most likely diagnosis?

A. Gout

B. Osteoarthritis

C. Rheumatoid arthritis

D. Erysipelatous inflammation

E. Infectional arthritis

 

80. After manual reposition and application of plaster splint a patient with fractures of forearm bones had an edema of hand and fingers, he felt pain and lack of sensitivity. What tactics should the doctor choose?

A. To cut the bandage that fastens the splint

B. To prescribe analgetics and diuretics

C. It’s a natural phenomena, the edema will dissipate in a day

D. To repeat reposition

E. To remove the plaster

 

81. A 3 y.o. child with weight deficiency suffers from permanent moist cough. In history there are some pneumonias with obstruction. On examination: distended chest, dullness on percussion over the lower parts of lungs. On auscultation: a great number of different rales. Level of sweat chloride is 80 mmol/L. What is the most probable diagnosis?

A. Recurrent bronchitis

B. Pulmonary hypoplasia

C. -Mucoviscidosis (cystic fibrosis)

D. Bronchial asthma

E. Bronchiectasis

 

82. A 38 y.o. man complains of having occasional problems with swallowing of both hard and fluid food for many months. Sometimes he feels intense pain behind his breast bone, especially after hot drinks. There are asphyxia onsets at night. He has not put off weight. Objectively: his general condition is satisfactory, skin is of usual colour. Examination revealed no changes of gastrointestinal tract. X-ray picture of thorax organs presents esophagus dilatation with level of fluid in it. What is the preliminary diagnosis?

A. Esophagus candidosis

B. Cancer of esophagus

C. Myastenia

D. Esophagus achalasia

E. Gastroesophageal reflux

 

83. The family doctor examined a patient and diagnosed an acute bleeding of an intestine. What is professional tactics of the doctor in this situation?

A. The urgent hospitalization in therapeutic department

B. Treatment at a day time hospital

C. Treatment at home

D. To inject intravenously the aminocapronic acid

E. The urgent hospitalization in surgical department

 

84. A 2 month old child who was born with body weight 5100 g has jaundice, hoarse cry, umbilical hernia, developmental lag. His liver is +2 cm, spleen isn’t enlarged. Stool and urine are of normal color. In anamnesis: delayed falling-away of umbilical rest. Blood count: Hb — 120 g/L, RBC – 4, 5 * 1012/L, ESR – 3 mm/h. General level of serum bilirubin – 28 mcmol/L, unconjugated bilirubin – 20 mcmol/L, conjugated bilirubin — 8 mcmol/L. What disease would you think about first of all?

A. Cytomegalovirus infection

B. Congenital thyreoid deficiency

C. Congenital hepatitis

D. Conjugated jaundice

E. Hemolitic anemia

 

85. An employee has been invalid for 6 months as a result of a hip fracture. Who has the right to authorize the issue of the medical sick-list for the last 2 months?

A. Head physician of the polyclinic

B. DCC

C. MSEC

D. DCC together with the head physician of a polyclinic

E. Deputy head physician on working capacity

 

86. A 56 y.o. patient has worked at the aluminum plant over 20 years. Within 3 last years he has got loosening of teeth, bone and joint pains, piercing pains in heart area, vomiting. The preliminary diagnosis is:

A. Mercury intoxication

B. Fluorine intoxication

C. Manganese intoxication

D. Lead intoxication

E. Phosphorus intoxication

 

87. A 42 y.o. woman suffers from micronodular cryptogenic cirrhosis. During the last week her condition has been worsening: she had spasms, consciousness aberration, and jaundice. What examination may account for the worsening of the patient’s condition?

A. Estimation of alanine aminotransferase and aspartate aminotransferase

B. Estimation of serum ammonia

C. Estimation of cholesterol esters

D. Estimation of α-fetoprotein content

E. Estimation of alkaline phosphatase level

 

88. A 38 y.o. woman complains of a purulent discharge from the left nostril. The body temperature is 37,5°C. The patient has been ill for a week and associates her illness with common cold. There are a pain and tenderness on palpation of her left cheek. The mucous membrane in the left nasal cavity is red and turgescent. The purulent exudate is seen in the middle meatus in maxillary. What is the most probable diagnosis?

A. Acute purulent sphenoiditis

B. Acute purulent frontitis

C.

D.- Acute purulent maxillary sinusitis

E. Acute purulent ethmoiditis

 

89. A 45 y.o. man has complained of having epigastric and right subcostal aching pain, pruritus, indigestion, dark color of the urine and acholic stool, fever and significant weight loss for 1 month. On examination: jaundice, presence of Curvuasier’s sign. US scan did not reveal stones in the gallbladder and choledochus. What is the most likely diagnosis?

A. Gallbladder stones

B. Cancer of the pancreas head

C. Chronic pancreatitis

D. Chronic cholangitis

E. Chronic hepatitis

 

90. A 35 y.o. woman consulted a doctor about occasional pains in paraumbilical and iliac region that reduce after defecation or passage of gases. Defecation takes place up to 6 times a day; stool is not solid, with some mucus in it. Appetite is normal; she has not put off weight. First such symptoms appeared 1.5 year ago, but colonoscopy data reveals no organic changes. Objectively: abdomen is soft, a little bit painful in the left iliac region. Blood and urine are normal. What is the preliminary diagnosis?

A. Irritable bowels syndrome

B. Dispancreatism

C. Celiac disease

D. Crohn’s disease

E. Pseudomembranous colitis

 

91. The Transcarpathian region is characterized by constant high (over 80%) air moisture. Population of this region feels an intense cold in winter when the temperature is temperately low. What way of heat emission becomes more active?

A. Irradiation

B. Radiation

C. Convection

D. Evaporation

E. Conduction

 

92. Vaginal inspection of a parturient woman revealed: cervix dilation is up to 2 cm, fetal bladder is intact. Sacral cavity is free, sacral promontory is reachable only with a bent finger, the inner surface of the sacrococcygeal joint is accessible for examination. The fetus has cephalic presentation. Sagittal suture occupies the transverse diameter of pelvic inlet, the small fontanel to the left, on the side. What labor stage is this?

A. Prodromal stage

B. Stage of fetus expulsion

C. Placental stage

D. Cervix dilatation stage

E. Preliminary stage

 

93. A 46 y.o. patient complains of skin itch, sweating, especially at night, body temperature rise up to 38,6°C. Objectively: chest skin has marks of scratching, supraclavicular lymph nodes are as big as a pigeon egg, and they are not matted together with skin. What test is the most reasonable?

A. Common blood count

B. Punction of an enlarged lymph node

C. Whole protein and protein fractions

D. Plan radiography of thorax

E. Immunogram

 

94. A 14 y.o. girl complains of profuse bloody discharges from genital tracts during 10 days after suppresion of menses for 1.5 month. Similiar bleedings recur since 12 years on the background of disordered menstrual cycle. On rectal examination: no pathology of the internal genitalia. In blood: Hb – 70 g/L, RBC – 2.3* 1012/L, Ht – 20. What is the most probable diagnosis?

A. Werlholf’s disease

B. Polycyst ovarian syndrome

C. Juvenile bleeding, posthemorrhagic anemia

D. Noncomplete spontaneous abortion

E. Hormonoproductive ovary tumor

 

95. Ambulance was called to a 48 y.o. man. According to the relatives he has had three episodes of lost consciousness and attacks during the day. Patient is unconscious, fell on the floor, tonic and then clonic convulsions of trunk and extremities happened. The attack lasted for 4 minutes, ended by involuntary urination. What type of attack was observed?

A. Vegetatic crisis

B. Major epileptic seizure

C. Episode of hysteria

D. Fainting

E. Absence

 

96. 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: PaO2- 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. -Respiratory distress syndrome

B. Pneumothorax

C. Pulmonary edema

D. Mendelson’s syndrome

E. Bilateral pneumonia

 

97. A 32 y.o. woman has got the Laiel’s syndrome after taking the biceptol. What immunotrope medicines are to be prescribed in this situation?

A. Specific immune modulators

B. Interferons

C. Non-specific immune modulators

D. Steroid immunosupressants

E. Non-steroid immunosupressants

 

98. A patient has got a sudden attack of severe substernal pain at night. On examination: confusion, pallor of the skin, acrocyanosis, cold sweat, BP – 80/50 mm Hg, Ps – 120/min, irregular and weak pulse. What condition are these symptoms typical for?

A. Acute right-side heart failure

B.- Cardiogenic shock

C. Acute left-side heart failure

D. Acute vascular insufficiency

E. Radicular syndrome

 

99. A 49 y.o. female patient was admitted to the hospital with acute attacks of headache accompanied by pulsation in temples; increasing AP up to 280/140 mm Hg. Pheochromocytoma is suspected. What mechanism of hypertensive atack does this patient have?

A. Increasing of plasma renin activity

B. Increasing of thyroxine excretion

C. Increasing of aldosterone level in blood

D. Increasing of vasopressin excretion

E. Increasing of catecholamines concentration

 

100. 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, stiff. X-ray picture of joints: joint spaces are constricted; there are marginal osteophytes, subchondral sclerosis. What is the most probable diagnosis?

A. Psoriatic arthritis

B. Rheumatic arthritis

C. Osteoarthritis

D. Bechterew’s disease

E. Reiter’s disease

 

101. A baby boy was born in time, it was his mother’s 1st pregnancy. The jaundice was revealed on the 2nd day of life, then it progressed. The adynamia, vomiting and hepatomegaly were presented. The indirect bilirubin level was 275 mcmol/L, the direct bilirubin level – 5 mcmol/L, Hb- 150 g/L. Mother’s blood group – 0(7), Rh+, child’s blood group – A(II), Rh+. Make a diagnosis.

A. Hemolytic disease of newborn (Rh -incompatibility)

B. Physiological jaundice

C. Hemolytic disease of newborn (ABO incompatibility), icteric type

D. Hepatitis

E. Jaundice due to conjugation disorder

 

102. A triad of symptoms (“stearing spot”, “terminal film”, “and blood dew”) have been revealed on examination of a patient. What disease should you think about?

A. Ritter’s disease

B. Vasculitis

C. -Psoriasis

D. Lichen ruber planus

E. Seborrhea

 

103. An 8 y.o. boy was ill with B hepatitis one year ago. In the last 2 months he has complaints of undue fatiguability, sleep disorder, appetite loss, nausea, especially in the mornings. Skin isn’t icterious, liver and spleen are 1 cm below the costal margins, painless. Alanine aminotransferase activity is 2.2 mcmol/L. How can this condition be estimated?

A. Residual effects of old viral hepatitis type B

B. Recurrance of viral hepatitis type B

C. Development of liver cirrhosis

D. -Development of chronic hepatitis

E. Biliary dyskinesia

 

104. A 4 y.o. child attends the kindergarten. Complains of poor appetite, fatigue. Objective examination: skin and mucous membrane are pale, child is asthenic. In the hemogram: hypochromatic anemia 1st, leucomoide reaction of the eosinophile type. What pathology must be excluded first of all?

A. Hypoplastic anemia

B. Atrophic gastritis

C. Duodenal ulcer

D. Lymphoprolipherative process

E. -Helminthic invasion

 

105. A patient of a somatic hospital has got psychomotor agitation as a result of high fever: he tried to run about the department; thought that some water was running down the walls, he pretended to see rats and cockroaches on the floor. Claimed he were in a hostel, recognized his “aquaintances”. After introduction of sedative drugs he fell asleep. In the morning he remembered this condition. What psychopathologic syndrome is it?

A. Maniacal syndrome

B. Twilight disorder of consciousness

C. Hallucinatory paranoid syndrome

D. Delirium

E. Oneiric syndrome

 

106. A 5 y.o. girl was by accident closed in a dark room for several minutes. When the door was opened, the child was standing motionless in the middle of the room staring at one point, her face had a look of terror, she didn’t respond to any stimuli. 40 minutes after her state changed into crying. On the next day she could remember nothing of this incident. What is the most probable mechanism of this reaction?

A. Psychogenic

B. Conditioned reflex

C. Endogenically organic

D. Exogenously organic

E. Endogenic

 

107. An employee had an abortion by medical indications on the 6.03.2001 and she stayed in a hospital till 17.03.2001. What term is the medical sick-list issued for?

A. For 4 days

B. For 12 days

C. For 3 days

D. For 11 days

E. For 10 days

 

108.     A 48 y.o. patient has been staying in the emergency department for 2 days on account of acute anteroseptal myocardial infarction. In the course of examination he suddenly “snored”. There was a tonic contraction of skeletal muscles; eye pupils dilatated. Pulse on a.carotis is absent. What is the immediate tactics?

A. Intracardiac introduction of adrenalin with atropine

B. -Electric defibrillation

C. Precardiac stroke

D. ECG record

E. Saphar’s triple airway maneuver

 

109. A 43 y.o. woman complains of contact hemorrhages during the last 6 months. Bimanual examination: cervix of the uterus is enlarged, its mobility is reduced. Mirrors showed the following: cervix of the uterus is in the form of cauliflower. Chrobak and Schiller tests are positive. What is the most probable diagnosis?

A. Cervical pregnancy

B. Leukoplakia

C. Polypus of the cervis of the uterus

D. Nascent fibroid

E. Cancer of cervix of the uterus

 

110. A 60 y.o. woman complains of unbearable pains in the right hypochondrium. In the medical history: acute pancreatitis. Body temperature is 38,2°C. Objectively: sclera icteritiousness. No symptoms of peritonium irritation are present. There are positive Ortner’s and Hubergrits-Skulski’s symptoms. Urine diastase is 320 g/h. What diagnosis is the most probable?

A. Chronic cholecystitis

B. Cancer of pancreas

C. Acute cholecystitis

D. Acute cholangitis

E. Chronic pancreatitis

 

111. A 14 y.o. child suffers from vegetovascular dystonia of pubertal period. He has got sympathoadrenal atack. What medicine should be used for attack reduction?

A. No-shpa

B. Obsidan

C. Amisyl

D. Corglicone

E. Euphyline

 

112. 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 is getting worse. Acute pain appears during the probe in ligament projection. What decease is the most likely?

A. Thecal whitlow (ligament panaritium)

B. Subcutaneous panaritium

C. Bone panaritium

D. Paronychia

E. Articular (joint) panaritium

 

113. A 51 y.o. patient complains of having intensive bloody discharges from vagina for 15 days after delay of menstruation for 2.5 months. In anamnesis: disorders of menstrual function during a year, at the same time she felt extreme irritability and had sleep disorders. US examination results: uterus corresponds with age norms, appendages have no pecularities, endometrium is 14 mm thick. What is the doctor’s tactics?

A. Supravaginal amputation of uterus without appendages

B.- Diagnostic curettage of uterine cavity

C. Conservative treatment of bleeding

D. Hysterectomy

E. TORCH-infection test

 

114. A girl is 12 y.o. Yesterday she was overcooled. Now she is complaining on pain in suprapubic area, frequent painful urination by small portions, temperature is 37, 8°C. Pasternatsky symptom is negative. Urine analysis: protein – 0.033 g/L, WBC- 20-25 in f/vis, RBC- 1-2 in f/vis. What diagnosis is the most probable?

A. Urolithiasis

B. Dysmetabolic nephropathy

C. Acute cystitis

D. Acute pyelonephritis

E. Acute glomerulonephritis

 

115. A patient complains of pathological lump, appearing in the right inguinal region on exercise. The lump is round-shaped, 4 cm in diameter, on palpation: soft elastic consistency is positioned near the medial part of Poupart’s ligament. The lump is situated inwards from the spermatic cord. What is the most probable preliminary diagnosis?

A. Right-sided oblique inguinal hernia

B. Varicose veins of the right hip

C. Lipoma of the right inguinal area

D. Right-sided femoral hernia

E. Right-sided direct inguinal hernia

 

116. The disease of a 21 y.o. patient began with raise of temperature up to 39.0°C, headache, chill, repeated vomiting. Rigidity of occipital muscles is determined. The analysis of liquor revealed: cytosis – 1.237 in 1 ml, including: 84% of neutrophils, 16% of lymphocytes. On bacterioscopy: gram-negative cocci are found in liquor. What is the most probable disease?

A. Secondary purulent meningitis

B. Meningococcal infection: serous meningitis

C. -Meningococcal infection: purulent meningitis

D. Infectious mononucleosis

E. Serous meningitis

 

117. A mother of a newborn child suffers from chronic pyelonephritis. She had acute respiratory viral disease before the labor. Labor in time, with prolonged period without waters. A child had erythematous eruption on the 2 day, and then there were seropurulent vesicles for about l cm large. Nikolsky’s symptom is positive. Erosions have occured after vesicle rupture. The child is flabby. The temperature is subfebrile. What is the most probable diagnosis?

A. Vesiculopustulosis

B. Ritter’s dermatitis

C. Pseudofurunculosis

D. -Newborn pemphigus

E. Sepsis

 

118. A 60 y.o. woman has had increased BP up to 210/110 mm Hg for the last 7 years. On examination: heart apex is displaced to the left. There are signs of left ventricular hypertrophy on ECG. What is the most probable diagnosis?

A. Cardiomyopathy

B. Essential hypertension, 1st stage

C. Symptomatic hypertension

D. Ischemic heart disease

E. -Essential hypertension, 2nd stage

 

119. A 58 y.o. woman had voluminous bleeding from the ruptured varicous node on the left crus. What first aid should be provided?

A. Z-shaped stitch on the raptured varicose node

B. Distal tourniquet

C. Heightened position of extremity, compressive sterile bandage

D. Proximal turniquet

E. Troyanov-Trendelenburg operation

 

120. A 10 y.o. boy was ill with angina 2 weeks ago, has complaints of joint pain and stiffness of his left knee and right elbow. There was fever (38.5°) and ankle disfunction, enlargement of cardiac dullness by 2 cm, tachycardia, weakness of the 1st sound, gallop rhythm, weak systolic murmur near apex. What diagnosis corresponds with such symptoms?

A. Reiter’s disease

B. Juvenile rheumatoid arthritis

C. -Acute rheumatic fever

D. Reactive arthritis

E. Systemic lupus erythematosis

 

121. 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. Infarction-pneumonia

B. Exudative pleurisy

C. Pyopneumothorax

D. Myocardial infarction

E. Esophagus perforation

 

122. A 15 y.o. patient has a developmental lag, occasionally he has skin yellowing. Objectively: spleen is 16x12x10 cm, cholecystolithiasis, skin ulcer of the lower third of left crus. Blood count: RBC – 3,0 * 1012/L, Hb – 90 g/L, C.I.-1,0; microspherocytosis, reticulocytosis. Total serum bilirubin is 56 mcmol/L, unconjugated – 38 mcmol/L. What therapy will be the most appropriate?

A. Spleen transplantation

B. Omentosplenopexy

C. Portacaval shunt

D.- Splenectomy

E. Omentohepatopexy

 

123. A 50 y.o. woman who suffers from chronic pyelonephritis was prescribed a combination of antibiotics for the period of exacerbation – gentamicin (80 mg 3 times a day) and biseptol (960 mg twice a day). What consequences may be caused by such a combination of antibiotics?

A. Acute suprarenal insufficiency

B. Chronic renal insufficiency

C. Glomerulosclerosis

D. Acute renal insufficiency

E. Antibiotic combination is optimal and absolutely safe

 

124. 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. Chest X-ray

B. Liver or bone marrow biopsy

C. Sputum smear and culture of m. tuberculosis

D. Bronchoscopy

E. Tuberculin skin testing

 

125. A 30 y.o. man complains of intense pain, skin reddening in the region of ankle joint, temperature rise up to 39°C. He fell ill suddenly. In the past there were such onsets that lasted for 5-6 days and didn’t cause any residual changes of the joint. The skin over the joint is hyperemic, without distinct outlines and infiltrative bank at the periphery. What is the most probable diagnosis?

A. Infectional arthritis

B. Erysipelatous inflammation

C. Osteoarthrosis

D. Gout

E. Rheumatoid arthritis

 

126. A 25 y.o. pregnant woman in her 34th week was taken to the maternity house in grave condition. She cpmplains of headache, visual impairment, nausea. Objectively: solid edemata, AP- 170/130 mm Hg. Suddenly there appeared fibrillary tremor of face muscles, tonic and clonic convulsions, breathing came to a stop. After 1.5 minute the breathing recovered, there appeared some bloody spume from her mouth. In urine: protein – 3.5 g/L. What is the most probable diagnosis?

A. Epilepsy

B. Cerebral edema

C. Cerebral hemorrhage

D. Eclampsia

E. Stomach ulcer

 

127. A 54 y.o. patient has been suffering from osteomyelitis of femoral bone for over 20 years. In the last month there appeared and gradually progressed edemata of lower extremities. Urine analysis: proteinuria – 6,6 g/L. Blood analysis: disproteinemia in form of hypoalbuminemia, increase of a2- and 7-globulins, ESR – 50 mm/h. What is the most probable diagnosis?

A. Myelomatosis

B. Acute glomerulonephritis

C. Systemic lupus erythematosus

D. Chronic glomerulonephritis

E. -Secondary renal amyloidosis

 

128. A 74 y.o. patient has been ill with benign prostate hyperplasy for the last 5 years. 4 days ago, after alcochol consumption, there was an acute retention of urination. At the pre-admission stage his urinary bladder was catheterized with metallic catheter. Examination revealed: right epididymis is enlarged, thick and painful; there are purulent discharges from urethra. What way of emergency care must be chosen?

A. Placing of intraprostatic stent

B. Transuretral resection or prostatectomy

C. Microwave thermotherapy of prostate

D. Trocar or open epicystostomy

E. Introduction of permanent urethral catheter

 

129. A 20 y.o. patient complains of amenorrhea. Objectively: hirsutism, obesity with fat tissue prevailing on the face, neck, upper part of body. On the face there are acne vulgaris, on the skin – striae cutis distense. Psychological and intellectual development is normal. Gynecological condition: external genitals are moderately hairy, acute vaginal and uterine hypoplasia. What diagnosis is the most probable?

A. Stein-Levental’s syndrome

B. Itsenko-Cushing syndrome

C. Shichan’s syndrome

D. Babinski-Froehlich syndrome

E. Turner’s syndrome

 

130. A 30 y.o. man complains of sharp pain in the right ear, hearing loss, high temperature for three days. Objectively: right ear whispering language — 0.5 m, external ear is intact, otoscopically – eardrum protrusion, hyperemia and swelling, loss of landmarks. What disease is it?

A. Acute purulent otitis media

B. Chronic purulent otitis media

C. Chronic secretory otitis media

D. Acute mastoiditis

E. Eustachian tube disfunction

 

131. A 52 y.o. male patient suffers from squeezing pain attacks in substernal area which irradiates to the left hand and occurs occasionally and on physical exercises. He has had it for 1 year. On examination: heart borders are enlargement to the left side, sounds are muffled, Ps – 76 bpm, rhythmic, AP- 155/80 mm Hg, ECG: the left type, the rest signs are normal. What additional examination is necessary to confirm the diagnosis?

A. Echocardiography

B. General blood count

C. Veloergometry

D. Transaminases of blood

E. Lipoprotein test

 

132. A 54 y.o. man was admitted to the hospital with complaints of sudden intense headache in occipital region and vomiting. In the medical history: moderate arterial hypertension, the patient was taking hydrochlorothiazide. Three days ago he consulted a therapeutist about intense headache that was suppressed by an analgetic. Objectively: consciousness is confused, left pupil is mydriatic. Evident photophobia and tension of neck muscles. Left-side hemiparesis with increased muscle tonus and reflexes. Body temperature is low, rash is absent. AP – 230/130 mm Hg, Ps — 50 bpm, BR – 12/min. What is your preliminary diagnosis?

A. -Acute subdural hematoma

B. Migraine

C. Myasthenia

D. Acute bacterial meningitis

E. Disseminated sclerosis

 

133. A 30 y.o. primigravida woman has got intensive labor pains every 1-2 minutes that last 50 seconds. The disengagement has started. The perineum with the height of 4 cm has grown pale. What actions are necessary in this situation?

A. Episiotomy

B. Perineum protection

C. Perineotomy

D. Expectant management

E. Vacuum extraction of fetus

 

134. A healthy 75 y.o. woman who leads a moderately active way of life went through a preventive examination that revealed serum concentration of common cholesterol at the rate of 5.1 mmol/L and HDL (high-density lipoproteins) cholesterol at the rate of 70 mg/dl. ECG reveals no pathology. What dietary recommendation is the most adequate?

A. Increase of cellulose consumption

B. Decrease of cholesterol consumption

C. Any dietary changes are necessary

D. Decrease of carbohydrates consumption

E. Decrease of saturated fats consumption

 

135. A 42 y.o. man who has been ill with duodenal ulcer for 20 years complains of getting a sense of heaviness in stomach after meal, foul-smelling eructation, vomiting, and weight loss. Objectively: his state is relatively satisfactory, tissue turgor is diminished. On palpation the belly is soft; there are no symptoms of peritenium irritation, “splashing sounds” in epigastrium. Defecation – once in 3 days. What complication corresponds with the patient’s state and described clinical presentations?

A. Ulcer penetration

B.- Ulcerative pyloric stenosis

C. Stomach cancer

D. Chronic pancreatitis

E. Concealed ulcer perforation

 

136. 47 y.o. patient complains of intensive skin itching, jaundice, bone pain. The skin is hyperpigmentated. There are multiple xanthelasma palpebrae. The liver is +6 cm enlarged, solid with acute edge. The blood analysis revealed total bilirubin – 160 mkmol/L, direct – 110 mkmol/L, AST – 2.1 mmol/L, ALT — 1.8 mmol/L, alkaline phosphotase — 4.6 mmol/L, cholesterol – 9.2 mmol/L, antimitochondrial antibodies M2 in a high titer. What is the probable diagnosis?

A.- Primary biliary liver cirrhosis

B. Primary liver cancer

C. Alcoholic liver cirrhosis

D. Chronic viral hepatitis B

E. Acute viral hepatitis B

 

137. A 32 y.o. woman has been suffering for 5 months from pain in lumbar region, low grade fever, frequent urination. Urine analysis: moderate proteinuria, leukocytes occupy the whole field of sight, bacteri-uria. Blood analysis: leukocytosis, increased ESR. What is the most probable diagnosis?

A. Chronic pyelonephritis

B. Urolithiasis

C. Acute glomerulonephritis

D. Chronic glomerulonephritis

E. Acute pyelonephritis

 

138. A 2 y.o. girl has been ill for 3 days. Today she has low grade fever, severe catarrhal presentations, slight maculopapular rash on her buttocks and enlarged occipital lymph nodes. What is your diagnosis?

A. -Rubella

B. Pseudotuberculosis

C. Scarlet fever

D. Measles

E. Adenoviral infection

 

139. A 20 y.o. patient was admitted to the hospital with complaints of having skin and sclera icteritiousness, dark urine, single vomiting, appetite loss, body temperature rise up to 38°C for 2 days. Three weeks ago he went in for fishing and shared his dishes with friends. Objectively: the patient is flabby, t°- 36.8°C, skin and scleras are icteritious, liver sticks from under the costal margin by 3 cm, it is sensitive; spleen isn’t palpable. Urine is dark, stool is partly acholic. What is the most probable diagnosis?

A. Infectious mononucleosis

B. Virus A hepatitis

C. Leptospirosis

D. Intestinal yersiniosis

E. Hemolytic anemia

 

140. What guarantees against the preconceived attitude to the physician in cases of professional law violations do you know?

A. Sanction of public prosecutor, inquiry by preliminary investigator of prosecutor’s office, committee of experts

B. Conduct an inquiry by preliminary investigator of police department

C. Conduct forensic medical examination by district forensic medicine expert

D. Draw up a statement about forensic medical examination

E. Utilisation copy of medical documents

 

141. A 24 y.o. woman consulted a doctor about continued fever, night sweating. She lost 7 kg within the last 3 months. She had casual sexual contacts. Objectively: enlargement of all lymph nodes, hepatoli-enal syndrome. Blood count: leukocytes – 2.2* 109/L. What disease can be suspected?

A. Infectionous mononucleosis

B. HIV-infection

C. Tuberculosis

D. Chroniosepsis

E. Lymphogranulomatosis

 

142. A 26 y.o. woman complains of sudden pains in the bottom of abdomen irradiating to the anus, nausea, giddiness, bloody dark discharges from sexual tracts for one week, and the delay of menses for 4 weeks. Signs of the peritoneum irritation are positive. Bimanual examination: borders of the uterus body and its appendages are not determined because of sharp painfullness. The diverticulum and painfullness of the back and dextral fornixes of the vagina are evident. What is the most probable diagnosis?

A. Acute right-side adnexitis

B. Torsion of the crus of the ovary tumor

C. Acute appendicitis

D. Apoplexy of the ovary

E. Broken tubal pregnancy

 

143. In the gynecologic office a 28 y.o. woman complains of sterility within three years. The menstrual function is not impaired. There were one artificial abortion and chronic salpingo-oophoritis in her case history. Oral contraceptives were not used. Her husband’s analysis of semen is without pathology. What diagnostic method will you start from the workup in this case of sterility?

A. Hormone investigation

B. Diagnostic scraping out of the uterine cavity

C. Ultra sound investigation

D. Hysterosalpingography

E. Hysteroscopia

 

144. A 70 y.o. man is ill with ischemic heart disease. His mood is evidently depressed, anxious. As a result of continuous sleeplessness he has got fears, suicidal thoughts. He would sit for a long time in the same pose, answer after a pause, in a low, monotonous voice. His face has a look of suffering, pain, fear. What is the main psychopathologic syndrome?

A. Asthenic syndrome

B. Depressive syndrome

C. Obsessive syndrome

D. Phobic syndrome

E. Paranoid syndrome

 

145. A 74 y.o. female patient complains of pain, abdominal distension, nausea. She suffers from heart ichemia, post-infarction and atherosclerotic cardiosclerosis. On examination: grave condition, distended abdomen, abdominal wall fails to take active part in breathing. On laparoscopy: some cloudy effusion in abdominal cavity, one of the bowel loops is dark-blue. What is the most probable diagnosis?

A. Mesenterial vessels thrombosis

B. Acute intestinal obstruction

C. Volvulus

D. Ichemic abdominal syndrome

E. Erysipelas

 

146. A 35 y.o. male patient suffers from chronic glomerulonephritis and has been treated with hemodialysis for the last 3 years. He has got irregularities in the heart activity, hypotension, progressive weakness, dyspnea. On ECG: bradycardia, 1st degree atrioventricular block, high sharpened T-waves. Some time before he had seriously broken the water consumption and dietary pattern. What is the most likely cause of these changes?

A. -Hyperkaliemia

B. Hypocalcemia

C. Hypernatremia

D. Hyperhydratation

E. Hypokaliemia

 

147. A patient has got pain in the axillary area, rise of temperature developed 10 hours ago. On examination: shaky gait is evident; the tongue is coated with white coating. The pulse is frequent. The painful lymphatic nodes are revealed in the axillary area. The skin is erythematous and glistering over the lymphatic nodes. What is the most probable diagnosis?

A. Anthrax

B. Tularemia

C. Acute purulent lymphadenitis

D. Lymphogranulomatosis

E.- Bubonic plague

 

148. For the persons who live in a hot area after an accident at a nuclear object, the greatest risk within the first decade is represented by cancer of:

A. Thyroid gland

B. Lungs

C. Skin

D. Reproduction system organs

E. Breast

 

149. Plan radiography of the patient’s abdominal cavity reveals some hemispherical lucent areas situated above distinct horizontal levels. What is the cause of such X-ray picture?

A. Meteorism

B. Intestinal obstruction

C. Price’s disease

D. Cancer of large intestine

E. Perforative ulcer

 

150. A 34 y.o. patient has been suffering from pulmonary tuberculosis for 7 years; he complains of muscle weakness, weight loss, diarrhea, frequent urination. Objectively: hyperpigmentation of skin, gums, internal surface of cheeks. AP – 90/58 mm Hg. Blood count: RBC- 3.1 * 1012/L, Hb – 95 g/L, C.I. – 0.92; leukocytes – 9.4 * 109/L, eosinophils — 7, segmentonuclear leukocytes – 45, stab neutrophils -1, lymphocytes — 40, monocytes – 7, Na+ – 115 mmol/L, K+ – 7,3 mmol/L. What is the preliminary diagnosis?

A. Pheochromocytoma

B. Congenital adrenocortical hyperplasia

C. Diabetes insipidus

D. -Primary adrenocortical insufficiency

E. Primary hyperaldosteronism

 

151. A 50 y.o. patient was admitted to the

hospital with complaints of blood in urine. There was no pain or urination disorders, hematuria has lasted for 3 days. Objectively: kidneys are not palpable, suprapubic region has no pecularities, external genitals have no pathology. Rectal examination revealed: prevesical gland is not enlarged. Cytoscopy revealed no changes. What disease would you think about first of all?

A. Varicocele

B. Kidney dystopy

C. Tuberculosis of urinary bladder

D. Necrotic papillitis

E. Cancer of kidney

 

152. A 52 y.o. patient complains of dyspnea caused even by moderate physical activity, cough with hardly secreted sputum. He has been ill for 12 years. Objectively: BR — 26/min. Lung examination: tympanitis, diminished vesicular breathing with prolonged expiration, disseminated dry rales. In the past he was taking only theopecym or aminophylline inravenously. Prescribe him the basic treatment after the exacerbation is suppressed:

A. Inhacort

B. Tilade

C. Aminophylline

D. Alupent

E. -Atrovent

 

153. A 52 y.o. hard smoker complains of persistent cough with purulent sputum discharge especially in the mornings, dyspnea provoked even by slight physical exercises, wheezing chest, tachypnoe, general weakness. He considers himself to be ill for 12 years. The foresaid presentations appear 3-4 times per year usually after a common cold and have tendency to progress. What disease do you think about first of all?

A. Bronchial asthma

B. Aspergillosis

C. Bronchoectatic disease

D. Chronic obstructive lung disease

E. Mucoviscidosis (cystic fibrosis)

 

154. A 19 y.o. boy was admitted to the hospital with closed abdominal trauma. In course of operation multiple ruptures of spleen and small intestine were revealed. AP is falling rapidly, it is necessary to perform hemotransfusion. Who can determine the patient’s blood group and rhesus compatibility?

A. A traumatologist

B. An anaesthesilogist

C. A surgeon

D. A doctor of any speciality

E. A laboratory physician

 

155. A man, aged 68, complains of tiredness, weating, enlargement of cervical, submaxillary and axillary lymph nodes. Blood test: WBC — 35 * 109/L, lymphocytes – 60%, Botkin and Gumprecht bodies, level of haemoglobin and quantity of thrombocytes is normal. Myelogram showed 40% of lymphocytes. What is the most probable diagnosis?

A. Chronic lympholeucosis

B. Lymphogranulomatosis

C. Tuberculous lymphadenitis

D. Chronic myeloleucosis

E. Acute leucosis

 

156. A 2 m.o. child was delivered in time with weight 3.500 g and was on the mixed feeding. Current weight is 4.900 g. Evaluate the current weight of the child:

A. Hypotrophy of the I grade

B. Hypotrophy of the II grade

C. Corresponding to the age

D. 150 g less than necessary

E. Paratrophy of the I grade

 

157. Examination of a hanged man’s corpse revealed the following: livores mortis disappear when pressed, restore in 50 seconds, rigor mortis is moderately evident only in masseteric muscles, neck muscles and fingers. Body temperature is 31.0°C. What is the prescription of death coming?

A. 10-18 hours

B. 16-24 hours

C. 8-10 hours

D. 1-2 hours

E. 6-7 hours

 

158. A 27 y.o. man complained of aching epigastric pain right after meal, heartburn and nausea. Stomach endoscopy revealed a large amount of mucus, hyperemia and edema of mucous membrane in gastric fundus with areas of atrophy. Make a diagnosis.

A. Chronic gastritis of type A

B. Chronic gastritis of type B

C. Peptic ulcer of stomach

D. Menetrier’s disease

E. Chronic gastritis of type C

 

159. Examination of a 32 y.o. patient who had apendectomy because of gangrenous appendicitis revealed clinical picture of pelvic abscess. What is the best way to expose pelvic abscess of this patient?

A. Through the obturator foramen

B. Through the postoperative wound

C. Through the anterior abdominal wall

D. By means of the sacral approach

E. Through the rectum

 

160. A 43 y.o. patient had cholecystectomy 6 years ago because of chronic calculous cholecystitis. Lately he has been suffering from pain in the right subcostal area and recurrent jaundice. Jaundice hasn’t gone for the last 2 weeks. Stenoutic papillitis 0.5 cm long has been revealed. What is the best way of treatment?

A. To perform choledochoduodenostomy

B. To perform transduodenal papillosphincterotomy

C. To perform endocsopic papillosphincterotomy

D. To perform external choledoch drainage

E. To treat conservatively: antibiotics, spasmolytics, antiinflammatory drugs

 

161. A 43 y.o. patient complains of formation and pain in the right mammary gland, rise of temperature up to 37.2°C during the last 3 months. Condition worsens before the menstruation. On examination: edema of the right breast, hyperemia, retracted nipple. Unclear painful infiltration is palpated in the lower quadrants. What is the most probable diagnosis?

A. Cancer of the right mammary gland

B. Right-side acute mastitis

C. Premenstrual syndrome

D. Right-side chronic mastitis

E. Tuberculosis of the right mammary gland

 

162. A 67 y.o. patient complains of dyspnea, breast pain, and common weakness. He has been ill for 5 months. Objectively: t°- 37.3°C, Ps – 96/min. Vocal tremor over the right lung cannot be determined, percussion sound is dull, breathing cannot be auscultated. In sputum: blood diffusively mixed with mucus. What is the most probable diagnosis?

A. Focal pulmonary tuberculosis

B. -Cancer of lung

C. Bronchoectatic disease

D. Macrofocal pneumonia

E. Exudative pleuritis

 

163. A patient has complained of great weakness for 6 years. He fell seriously ill, the illness is accompanied by body temperature rise, indisposition, pain in joints and along the legs muscles. Objectively: violet-bluish erythema around eyes and over knee joints. HR — 120/min, heart sounds are weak. Blood count: leukocytes – 12 * 109/L, ESR – 40 mm/h. What is the most probable diagnosis?

A. Rheumathoid arthritis

B. -Dermatomyositis

C. Systemic lupus erythematosus

D. Atopic dermatitis

E. Reactive polyarthritis

 

164. A 61 y.o. man complained of sneezing and substernal pain on exertion. In the last 2 weeks such pain appeared at rest, with increased frequency, and couldn’t be suppressed by 1 tablet of nitroglycerin. What is the most likely diagnosis?

A. Unstable angina pectoris

B. Myocarditis

C. Radiculitis

D. Angina pectoris of a new onset

E. Stable angina pectoris of the III functional class

 

165. A 30 y.o. woman is in her second labor that has been lasting for 14 hours. Fetal heartbeats are muffled, arrhythmic, 100/min. Vaginal examination results: cervical dilatation is complete, fetal head is close to the exit of small pelvis. Sagittal suture has the direct diameter; small crown is close to the pubis. What is the further tactics of labor management?

A. Use of obstetrical forceps

B. Labor stimulation by means of oxitocine

C. Craniodermal forceps

D. Use of cavity forceps

E. Cesarean section

 

166. According to results of medical and pedagogical observation during the gymnastics lesson in the 9th grade there was plotted a phisiological curve characterized by gradual increasing of pulse rate during the opening part of lesson, 80% increase during the main part; the curve has 4 waves. How can the lesson’s structure be assessed?

A. Long interval between exercises

B. Exercise stress is adequate

C. The lesson’s structure is correct

D. Exercise stress is insufficient

E. Exercise stress is excesive

 

167. A 2,5 m.o. child has got muscle hypotony, sweating, occipital alopecia. Along with massage and therapeutic exercises the child was prescribed vitamin D. What dosage and frequency are correct?

A. 3000IU every day

B. 500IU every day

C. 500 IU every other day

D. 1000 IU every day

E. 1000 IU every other day

 

168. In course of herniotomy of a 12 y.o. patient doctors revealed a testicle in the hernial sac. What type of hernia is it?

A. Obturator hernia

B. Direct inguinal hernia

C. Femoral hernia

D. Congenital oblique inguinal hernia

E. Acquired oblique inguinal hernia

 

169. A 29 y.o. woman is critically ill. The illness is presented by high fever, chills, sweating, aching pain in lumbar area, and discomfort during urination and frequent voiding. Pasternatsky’s sign is positive in both sides. On lab examination: WBC – 20*109/L; on urine analysis: protein – 0.6 g/L, leukocyturia, bacteriuria. Yaear preliminary diagnosis.

A. Nephrolithiasis

B. Acute glomerulonephritis

C. Exacerbation of chronic pyelonephritis

D. Acute cystitis

E. Acute pyelonephritis

 

170. A mother of a 5 y.o. girl consulted a doctor about doughter’s involuntary urination at night, nightmares, sleep disorders, slow gaining of body weight. Objectively: malnutrition, intellectual development is good; the girl can read and explains common situations quite adultly. Her skin is very pale, liver is enlarged in size. Her mother suffers from holetithiasis. What type of diathesis is the most probable in the child’s case?

A. Allergic diathesis

B. Gouty diathesis

C. Exudative diathesis

D. Urine acid diathesis

E. Lymphohypoplastic diathesis

 

171. A 23 y.o. patient has a gunshot wound of his left arm. The bones of the arm are not damaged. What appropriate surgical care must be provided to the patient?

A. Aseptic dressing of the wound

B. Primary surgical processing with a flowing suction

C. Wound saturing

D. Wound saturing and drying

E. Wound drying with towel gauzes

 

172. A 15 year old adolescent was taken to the hospital with complaints of poor night vision. Objectively: increased darkness adaptation time, Bitot’s spots on conjuctiva. The patient’s skin is dry, scales off; folliculitis signs of the face skin are present. What is the cause of this disease?

A. Biotin deficit

B. Thiamine deficit

C. Retinole deficit

D. Napthtochynones deficit

E. Folic acid deficit

 

173. It is determined that 30 of a 100 women with risk factor had preterm labor, and of a 100 women without risk factor 5 women had preterm labor. What method of statistic data processing should the doctor use in order to estimate reliability of differences between the compared groups?

A. Correlation analysis

B. Standardization method

C. Student’s criterion calculation

D. Average computing

E. Relative numbers calculation

 

174. At year-end hospital administration has obtained the following data: annual number of treated patients and average annual number of beds used for patient’s treatment. What index of hospital work can be calculated based upon this data?

A. Bed resources of the hospital

B. Average bed idle time

C. Bed turnover

D. Average annual bed occupancy

E. Average duration of patients’ presence in the hospital

 

175. A district doctor was commisioned with a task to work out a plan of treatment-and-prophylaxis actions for the population of his district. What actions of secondary prophylaxis must he include into this plan?

A. Prevention of disease complications

B. Elimination of disease causes

C. Improvement of population’s living conditions

D. Disease prevention

E. Rehabilitation actions

 

176. A 33 y.o. patient with first time detected diabetes mellitus keeps the diet and maintains glycemia at the level of 10,0 mmol/L after meal. He keeps himself from insuli-notherapy. What examination is the most important for differentiation of the 1st (insulin-dependent) and the 2nd (insulin-independent) types of diabetes?

A. Glucose-tolerant test

B. Determination of insular cells antibodies

C. Glycemia examination on an empty stomach

D. Estimation of glucolized blood hemoglobin

E. Fructosamine estimation

 

177. A 28 y.o. patient complains of pain in legs during walking, chill of feet and toes. He has been ill for a year. Objectively: leg skin is pale, cool; turgor is decreased, hypotrichosis. Femoral and popliteal artery pulsation is weak; it is palpable on the foot arteries only after nitroglycerine test. Rheographic index is <1. What is the most probable diagnosis?

A. Raynaud’s disease

B. Buerger’s disease

C.- Obliterating endarteritis

D. Chronic thrombophlebitis

E. Obliterating aterosclerosis

 

178. A patient was admitted to the hospital with complaints of occasional pains at the bottom of abdomen that get worse during menses, weakness, indisposition, nervousness, some dark bloody discharges from vagina on the day before and the day after menses. Bimanual examination results: body of womb is enlarged, appendages cannot be determined, posterior fornix has tuberous surface. Laparoscopy results: ovaries, peritoneum of rectouterine pouches and pararectal fat are covered with “cyanotic spots”. What is the most probable diagnosis?

A. Ovarian cystoma

B. Genital organs tuberculosis

C. Polycystic ovaries

D. Chronic salpingitis

E. -Widespread form of endometriosis

 

179. A 5 tons milk batch was sampled. The lab analysis revealed: fat content 2%, specific density – 1.04 g/cm3, acidity – 21°T, reductase probe – weak-positive. What way is the product to be used in?

A. Discard for animal feeding

B. Do the product away

C. Sell but inform customers about milk quality

D. Technical utilization

E. Sell without limitations

 

180. A 12 y.o. girl took 2 pills of aspirine and 4 hours later her body temperature raised up to 39 — 40°C. She complains of general indisposition, dizziness, sudden rash in form of red spots and blisters. Objectively: skin lesions resemble of second-degree burns, here and there with erosive surface or epidermis peeling. Nikolsky’s symptom is positive. What is the most probable diagnosis?

A. Bullous dermatitis

B. Polymorphous exudative erythema

C. Duhring’s disease

D. Acute epidermal necrolisis

E. Pemphigus vulgaris

 

181. A 63 y.o. woman complains of moti veless weakness, rapid fatigability, loss of appetite, aversion to meat. Two days ago she had stomach bleeding. Objectively: temperature – 37.5°C, BR – 20/min, Ps-96/min, AP – 110/75 mm Hg. On palpation in epigastrium – pain and muscle tension. Blood count: Hb – 82 g/L, ESR- 35 mm/h. What examination will allow making a diagnosis?

A. Stomach content examination

B. Coprology

C. Radiography

D. Endoscopy

E. -Cytologic

 

182. A boy of 7 y.o. had an attack of asthma and distant whistling rales after playing with a dog. In the medical hystory: atopic dermatitis caused by eating eggs, chicken, beef. What group of allergens is the reason of the development of bronchial asthma attacks?

A. Chemical

B. Epidermal

C. Dust

D. Itch mite

E. Pollen

 

183. A patient at a doctor complains of temperature rise up to 38,2°C, edema in the region of his upper lip. Objectively: upper lip is evidently edematic, in the middle of edema there is a cone-shaped swelling. Skin and mucous membrane over it are dark-red. Diagnosis: labial furuncle. A surgeon cut the furuncle, treated the wound with hydrogen peroxide solution and applied a bandage with hypertensive solution. What therapeutic regimen should be recommended?

A. First out-patient treatment, then outpatient treatment

B. Out-patient treatment

C.

D. In-patient treatment with bed rest

E. In-patient treatment with common regimen

 

184. A 7 y.o. boy suddenly felt pain in his right knee, it became edematic. The day before he took part in a cross-country race. Family anamnesis has no data about hemophilia and bleeding sickness. Objectively: body temperature is 37.5°C. The knee is painful, hot to the touch, edematic with local tissue tension over it. Blood count: Hb — 123 g/L, leukocytes — 5.6*109/L,thrombocytes — 354 * 109/L, prothrombin time — 12 seconds (normally 10-15 seconds), partly activated thromboplastin time – 72 seconds (normally 35-45 seconds). Hemorrhage time is normal, VIII: C factor is 5% of norm. What is the most probable diagnosis?

A. Hemophilia B

B. Thrombocytopenia

C. Schoenlein-Henoch disease

D. Vitamin K deficiency

E. -Hemophilia A

 

185. A boy, aged 9, was examined: height – 127 cm (- 0.36), weight – 28.2 kg (+0,96), chest circumference – 64.9 cm (+0,66), lung vital capacity – 1.520 ml (-0,16). What is the complex assessment of the child’s physical development?

A. Apparently disharmonious

B. Below the average

C. Harmonious

D. Excessive

E. Disharmonious

 

186. A 36 y.o. woman is in the 12-th week of her first pregnancy. She was treated for infertility in the past. She contacted a child who fell ill with rubella 2 days after their meeting. Woman doesn’t know if she has ever been infected with rubella. What is the adequate tactics?

A. Fetus wastage

B. Immunoglobulin injection

C. Interferon prescription

D. Monitoring of the specific IgG IgM with the ELISA

E. Cyclovin prescription

 

187. A 33 y.o. patient, works as a secretary. Her diet contains 150 g of protein (including 100 g of animal protein), 200 g of fat, and 600 g of carbohydrates. What pathology can result from this diet?

A. Common cold

B. Uterine fibromyoma

C. Obesity

D. Schizophrenia

E. Paradontosis

 

188. After delivery and revision of placenta there was found the defect of placental lobe. General condition of woman is normal, uterus is firm, and there is moderate bloody discharge. Inspection of birth canal with mirrors shows absence of lacerations and raptures. What action is necessary?

A. Manual exploration of the uterine cavity

B. Use of hemostatic medications

C. Urine drainage, cold on the lower abdomen

D. Use of uterine contracting agents

E. External massage of uterus

 

189. A 40 y.o. patient complains of yellowish discharges from the vagina. Bimanual examination: no pathological changes. The smear contains Trichomonas vaginalis and blended flora. Colposcopy: two hazy fields on the front labium, with a negative Iodum test. Your tactics:

A. Specific treatment of Trichomonas colpitis

B. Diathermocoagulation of the cervix of the uterus

C. Cryolysis of cervix of the uterus

D. Treatment of specific colpitis and with the subsequent biopsy

E. Cervix ectomy

 

190. A full-term newborn child has a diagnosis Rh-factor hemolytic disease of newborn. Bilirubin rate is critical. The child’s blood group is B(III), his mother’s blood group – A(II). The child has indication for hemotransfusion. What donor blood must be chosen?

A. Blood group A(II), Rh (-)

B. Blood group A(II), Rh (+)

C. Blood group B(III), Rh (-)

D. Blood group O(I), Rh (-)

E. Blood group B(III), Rh (+)

 

191. A worker was temporarily off work because of illness for 16 days, was under out-patient treatment. The doctor in charge issued a sick-list first for 5 days, and then prolonged it for 10 days. Who can further prolong the sick-list of this patient?

A. The head of department

B. The doctor in charge of the case together with the head of department

C. Deputy head physician on the working ability expertise

D. Working ability expertise committee

E. The doctor in charge of the case with the permission of the head of department

 

192.     A 50 y.o. male patient was taken to the emergency department with diffuse abdominal pain and signs of cardiovascular collapse. On arrival he had BP – 95/60 mm Hg, Ps- 120/min, diuresis – 20 ml/h, HgB -100 g/L, RBC- 2.1 * 1012/L. The patient needs introduction of:

A. Crystalloid and 5% dextrose

B. 5% dextrose and colloid

C. 5% dextrose and red blood cells

D. Crystalloid and red blood cells

E. -Crystalloid and colloid

 

193. Ambulace brought to the hospital a patient with acute respiratory viral infection. The illness began suddenly with temperature rise up to 39.9°C. He complains of headache in frontotemporal lobes, pain in eyeballs, aching of the whole body, nose stuffiness, sore throat, dry cough. At home he had a nasal hemorrhage twice. What type of acute respiratory viral infection is it?

A. RS-infection

B. Parainfluenza

C. -Influenza

D. Enterovirus infection

E. Adenoviral infection

 

194. A 2 y.o. boy was admitted to the hospital with weight loss, unstable feces, anorexia, following the semolina’s introduction (since 5 months). The child is adynamic, flabby, his skin is pale and dry, subcutaneous fat layer is emaciated. Distended and tensed abdomen, tympanitis on percussion of the upper part of abdomen, splashing sounds; feces are foamy, of light color, foul. On coprocytogram: a lot of neutral fat. What is the most probable cause of the disease?

A. Mucoviscidosis (cystic fibrosis)

B. Disaccharidase insufficiency

C. Intestinal dysbacteriosis

D. -Celiakia (celiac disease)

E. Chronic enteritis

 

195. A 40 y.o. patient with rheumatic heart disease complains of anorexia, weakness and loss of weigth, breathlessness and swelling of feet. The patient had tooth extraction one month ago. On examination: t°- 39°C, Ps – 100/min. Auscultation: diastolic murmur in the mitral area. Petechial lesion are round of clavicle; spleen was palpable.

A. Recurrence of rheumatic fever

B. Thrombocytopenia purpura

C. Mitral stenosis

D. Aortic stenosis

E.- Subacute bacteria endocarditis

 

196. Examination of a just born placenta reveals defect 2 x 3 cm large. Hemorrhage is absent. What tactic is the most reasonable?

A. Prescription of uterotonic medicines

B. Instrumental uterus cavity revision

C. Parturient supervision

D. Manual uretus cavity revision

E. External uterus massage

 

197. A 76 y.o. woman complains of progressing swallowing disorder, mostly she has had problems with solid food for the last 6 weeks. Sometimes she has regurgitation of solid masses. Swallowing is not painful. She lost 6 kg. 10 years ago she had myocardiac infarction, she takes constantly aspirine and prolonged nitrates. She consumes alcohol in moderate proportions, smokes. Objectively: icteric skin, neck has no pecularities, lymph nodes are not enlarged. Thorax has no changes, cardiovascular system has no evident changes. Liver is +3 cm. What is the preliminary diagnosis?

A. Diaphragmatic hernia

B. Esophageal achalasia

C. Myasthenia

D. Diffuse constriction of esophagus

E. Cancer of esophagus

 

198. A 52 y.o. patient fell from 3 m height on the flat ground with the right lumbar area. He complains of pain in this area. There is microhematuria in the urea. Excretory urography revealed that kidney’s functioning is satisfactory. What is the most probable diagnosis?

A. Subcapsular kidney’s rupture

B. Kidney’s contusion

C. Kidney’s abruption

D. Paranephral hematoma

E. Multiple kidney’s ruptures

 

199. Choose a method of graphic representation of monthly information about the number of registered cases of acute intestinal infection and their comparison to the average monthly values, obtained for 5 last years:

A. The radial diagram

B. The linear diagram

C. The figured diagram

D. The sector diagram

E. Curvilinear diagram

 

200. An 18 y.o. patient complains of painfulness and swelling of mammary glands, headaches, irritability, edemata of lower extremities. These symptoms have been present since the begin of menarche, appear 3-4 days before regular menstruation. Gynecological examination revealed no pathology. What is the most probable diagnosis?

A. Neurasthenia

B. Premenstrual syndrome

C. -Mastopathy

D. Renal disease

E. Disease of cardiovascular system

Year 2005

Posted: May 5, 2012 in Krok II
Tags:

 

1. A full-term new-born suffered ante-and intranatal hypoxia, was born in asphyxia (Apgar score 2-5 points). After birth baby’s excitation is progressing, occurs vomiting, nystagmus, spasms, squint, spontaneous Babinski and Moro’s reflexes. What is the most probable location of the intracranial haemorrhage in this case?

A. Periventricular hemorrhages

B. *Subarachnoid hemorrhages

C. Small hemorrhages in brain tissue

D. Subdural hemorrhages

E. Haemorrhages in ventricles of brain

 

2. 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. *Thromboembolia of pulmonary artery

B. Myocardial infarction

C. Hemorrhagia

D. Valvular pneumothorax

E. Hypostatic pneumonia

 

3. A 24 y.o. patient complains of nausea, vomiting, headache, shortness of breath. He had an acute nephritis being 10 y.o. Proteinuria was found out in urine. Objectively: a skin is grey-pale, the edema is not present. Accent of II tone above aorta. BP 140/100-180/100 mm Hg. Blood level of residual N2 – 6,6 mmol/L, creatinine — 406 mmol/L. Day’s diuresis-2300 ml, nocturia. Specific density of urine is 1009, albumin – 0,9 g/L, WBC — 0-2 in f/vis. RBC- single in f/vis., hyaline casts single in specimen. Your diagnosis?

A. Hypertensive illness of the II degree

B. *Chronic nephritis with violation of kidney function

C. Nephrotic syndrome

D. Stenosis of kidney artery

E. Feochromocitoma

 

4. A patient, aged 16, complains of headache, mainly in the frontal and temporal areas, superciliary arch, appearing of vomiting at the peak of headache, pain during the eyeballs movement, joint’s pain. On examination: excited, t°- 39°C, Ps — 110/min. Tonic and clonus cramps. Uncertain meningeal signs. What is the most likely diagnosis?

A. *Influenza with cerebral edema manifestations

B. Parainfluenza

C. Influenza, typical disease duration

D. Respiratory syncytial virus

E. Adenovirus infection

 

5. A 40 y.o. child age has hyperesthesia, XNS depression, dyspepsia. Sepsis is suspected. What should the differential diagnosis be made with?

A. Hyperkaliemia

B. *Hypoglycemia

C. Hyperbilirubinemia

D. Hypomagnesemia

E. Hypocalcemia

 

6. Body temperature of a 12 y.o. girl increased up to 39 — 40°C in 4-5 hours after she had taken 2 pills of aspirin. Complains of general discomfort, dizziness, sudden appearance of red spots on the skin with blister formation or exfoliation of the epidermis with erosive surface. Lesions on the skin looked like burns of II degree. Ni-kolsky syndrome is positive. What is the most probable diagnosis?

A. Duhring’s disease

B. Pemphigus vulgaris

C. Bullous dermatitis

D. *Acute epidermical necrolysis

E. Polymorphic exudative erythema

 

7. Male 30 y.o., noted growing fingers and facial scull, changed face. Complains of poor eyesight, weakness, skin darkening, loss of body weight. X-ray shows broadening of sella turcica, thinning of tuberculin sphenoidale, and signs of increased intracranial pressure. What diagnosis can you make?

A. Optico – hiasmatic arachnoiditis

B. Tumor of pondo-cerebellar corner

C. Encephalitis of truncus

D. Adrenal gland tumor

E. *Adenoma of hypophysis

 

8. A 29 y.o. patient was admitted to the hospital with acute girdle pain in epigastric area, vomiting in 1 hour after the meal. On examination: pale, acrocyanosis. Breathing is frequent, shallow. Abdominal muscles are tensed, positive Schotkin-Blumberg’s symptom. What is the maximal term to make a diagnosis?

A. *In 2 hours

B. In 0,5 hours

С. In 3 hours

D. In 6 hours

E. In 1 hour

 

9. A female rheumatic patient experiences diastolic thoracic wall tremor (diastolic thrill), accentuated S at apex, there is diastolic murmur with presystolic intensification, opening snap, S1 accent at pulmonary artery. What rind of heart disorder is observed?

A. Aortic valve insufficiency

B. *Mitral stenosis

C. Mitral valve insufficiency

D. Opened arterial duct

E. Pulmonary artery stenosis

 

10. What methods of the collecting of the information are preferable for study of housing conditions of students of medical HIGH SCHOOL for a training period?

A. Selecting of materials

B. *Questioning

C. Interviewing

D. A method of the directed selection

E. Statistical

 

11. A 20 y.o. pregnant woman with 36 weeks of gestation was admitted to the obstetrical hospital with complains of pain in the lower abdomen and bloody vaginal discharge. The general condition of the patient is good. Her blood pressure is 120/80 mm Hg. The heart rate of the fetus is 140 bpm, rhythmic. Vaginal examination: the cervix of the uterus is formed and closed. The discharge from vagina is bloody up to 200 ml per day. The head of the fetus is located high above the minor pelvis entry. A soft formation was defined through the anterior fornix of the vagina. What is the probable diagnosis?

A. Uterine rupture

B. Incipient abortion

C. Threatened premature labor

D. Premature placental separation

E. *Placental presentation

 

12. A 43 y.o. male complains of stomach pain, which relieves with defecation, and is accompanied by abdominal winds, rumbling, the feeling of incomplete evacuation or urgent need for bowel movement, constipation or diarrhea in alternation. These symptoms have lasted for over 3 months. No changes in laboratory tests. What is the most likely diagnosis?

A. *Irritable bowel syndrome

B. Atonic colitis

C. Colitis with hypertonic type dyskinesia

D. Spastic colitis

E. Chronic enterocolitis, exacerbation phase

 

13. A 33 y.o. patient was admitted to the hospital with stopped recurrent peptic ulcer bleeding. On examination he is exhausted, pale. Hb — 77 g/L, Ht — 0,25. Due to anemia there were two attempts of blood transfution of identical blood group A(ll)Rh+. Both attempts were stopped because of anaphylactic reaction. What blood transfution environment is desirable in this case?

A. Freshcitrated blood

B. Erythrocyte emulsion

C. Erythrocyte mass (native)

D. *Washed erythrocytes

E. Erythrocyte mass poor for leucocytes and thrombocytes

 

14. A17 y.o. patient complains of acute pain in the knee joint and t°- 38°C. 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. Reactive polyarthritis

B. *Rheumatism, polyarthritis

C. Systemic lupus eritematodes

D. Rheumarthritis

E. Infectious-allergic polyarthritis

 

15. 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. *Septic shock

B. Bronchial obstruction

C. Emphysema

D. Toxic hepatitis

E. Exudative pleuritis

 

16. An unconscious patient presents with moist skin, shallow breathing. There are signs of previous injection on the shoulders and hips. BP — 110/70 mm Hg. Tonus of skeletal muscles and reflexes are increased. Cramps of muscles of the extremities are seen. What is the most likely disorder?

A. Hyperosmolar coma

B. *Hypoglycemic coma

C. Hyperlactacidotic coma

D. Hyperglycemic coma

E. Stroke

 

17. In a forest summer camp children have variable procedures to harden their organisms. What procedure has the most hardening power?

A. Morning exercises on the fresh air

B. Bath with hydromassage

С. *Contrast shower

D. Walking on the fresh air

E. Hygienic shower

 

18. Deputy of chief medical officer carried out a study of morbidity rate for population which had been served at the polyclinics for the last 5 years. What statistical values can help in calculations of diseases level dissamination?

A. Absolute values

B. Standart values

C. *Relative values

D. Dynamic row

E. Average values

 

19. What developes most often after accidental intake of Hydrochloric acid?

A. Cushing’s syndrome

B. Acute pancreatitis

C. Deylads’s syndrome

D. Kutling’s syndrome

E. *Cardiac insufficiency

 

20. A 1,5 y.o. child fell ill acutely with high temperature 38°C, headache, fatigue. The temperature declined on the fifth day, muscular pain in the right leg occured in the morning, there were no movements and tendon reflexes, sensitivity was reserved. What is the initial diagnosis?

A. Viral encephilitis

B. Hip joint arthritis

C. *Polyomyelitis

D. Polyartropathy

E. Osteomyelitis

 

21. A woman complains of high temperature to 38°C, mild pain in the throat during 3 days. On examination: angle lymphatic nodes of the jaw are 3 cm enlarged, palatinel tonsils are enlarged and coated with grey plaque which spreads to the uvula and frontal palatinel arches. What is the most probable diagnosis?

A. Agranulocytosis

B. Vincent’s angina

C. Oropharyngeal candidosis

D. Infectious mononucleosis

E. *Larynx dyphtheria

 

22. 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. Sphygmography

B. Phonocardiography

C. *Echocardiography

D. X-ray

E. Coronarography

 

23. A 18 y.o. woman consulted a gynecologist with complaints of the pain in the lower part of the abdomen, fever up to 37, 5°C, considerable mucopurulent discharges from the genital tract, colic during urinating. After mirror and vagina examination the results are the following: the urethra is infiltrated, cervix of the uterus is hyperemic, erosive. The uterus is painful, ovaries are painful, thickened, free. Bacterioscopy test showed diplococcus. What diagnosis is the most probable?

A. Chlamydiosis

B. Chronic gonorrhea

C. *Recent acute ascending gonorrhea

D. Candydomycosis

E. Trichomoniasis

 

24. A 13 y.o. patient was treated in dermatological hospital for atopic dermatitis exacerbation. He was discharged in the condition of clinical remission. What recommendations should the doctor give to prevent exacerbations?

A. Frequent skin washing with detergents

B. *Use of neutral creams to protect skin

C. Systematic use of local corticosteroids

D. Systematic skin disinfection

E. Avoidance of skin insolation

 

25. A 43 y.o. patient complains of mass and, pain in the right breast, elevation of temperature to 37,2°C during 3 last months. Condition worsens before the menstruation. On examination: edema of the right breast, hyperemia, retracted nipple. Unclear painful infiltration is palpated in the lower quadrants. What is the most probable diagnosis?

A. Tuberculosis of right mammary gland

B. Right side acute mastitis

C. *Cancer of right mammary gland

D. Right side chronic mastitis

E. Premenstrual syndrome

 

26. A gravida with 7 weeks of gestation is referred for the artificial abortion. On operation while dilating cervical canal with Hegar dilator №8 a doctor suspected uterus perforation. What is immediate doctor’s tactics to confirm the diagnosis?

A. *Probing of uterus cavity

B. Laparoscopy

C. Metrosalpingography

D. Ultrasound examination

E. Bimanual examination

 

27. A male patient complains of heartburn iich gest stronger while bending the body, substernal pain during swallowing. There is a hiatus hernia on X-ray. What disoeder should be expected at gastroscopy?

A. Chronic gastritis

B. Gastric peptic ulcer

C. *Gastroesophageal reflux

D. Acute erosive gastritis

E. Duodenal peptic ulcer

 

28. A child, aged 4, has being ill for 5 days, suffers from cough, skin rash, t°- 38, 2°C, facial hydropy, photosensitivity, conjunctivitis. On the face, neck, upper part of the chest there is bright maculopapular rash with areas of merging. Hyperemic throat. Seropurulent nasal discharge. In lungs there are dry crackles. What is the most probable preliminary diagnosis?

A. *Measles

B. Rubella

C. Adenovirus infection

D. Enterovirus exanthema

E. Scarlet fever

 

29. A girl, aged 13, consults the school doctor on account of moderate bloody discharge from the genital tracts, which appeared 2 days ago. Secondary sexual characters are developed. What is the most probable cause of bloody discharge?

A. Endometrium cancer

B. *Menarche

C. Werlhof ‘s disease

D. Juvenile haemorrhage

E. Haemophilia

 

30. A 30 y.o. male patient complains of itching of the skin which intensifies in the evening. He has been ill for 1,5 months. On examination: there is rash with paired papules covered with bloody crusts on the abdomen, hips, buttocks, folds between the fingers, flexor surfaces of the hand. There are traces of line scratches. What additional investigations are necessary to make diagnosis?

A. Blood glucose

B. Determination of dermographism

C. *Examination of rash elements scrape

D. Examination for helmints

E. Serologic blood examination

 

31. A 7 y.o. child had elevation of temperature tol 40°C in anamnesis. For the last 3 months he presents fusiform swelling of fingers, ankle joints and knee joint, pain in the upper part of the sternum and cervical part of the spinal column. What is the most probable diagnosis?

A. Septic arthritis

B. *Juvenile rheumatic arthritis

C. Toxic synovitis

D. Rheumatism

E. Osteoarthrits

 

32. A 31 y.o. woman has suffered from systemic sclerodermia for 14 years. She was treated in hospitals many times. She complains of periodical dull pain in the cardiac area, palpitation, dyspnea, headache, eyelids swelling, weight loss, pain and limbs deformities. Which organ’s disorder worsens the prognosis?

A. Skin and joints

B. Heart

C. Gastro-intestinal tract

D. Lungs

E. *Kidneys

 

33. 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 osteomyolitis 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. *Bony

B. Hypodermic

C. Tendon type

D. Paronychia

E. Joints type

 

34. A 14 y.o. girl complains of profuse bloody genital discharges during 10 days after suppresion of menses for 1,5 months. Similiar bleedings recur since 12 years on the background of disordered menstrual cycle. On rectal examination: no pathology on the internal genitalia. In blood: Hb — 70 g/L, RBC — 2,3*1012/L, Ht — 20. What is the most probable diagnosis?

A. Polycyst ovarian syndrome

B. Werlholf’s disease

C. Hormonoproductive ovary tumor

D. *Juvenale bleeding, posthemorrhagic anemia

E. Noncomplete spontaneous abortion

 

35. A man, aged 30, complains of intense pain, reddening of skin, edema in the ankle-joint area, fever up to 39°C. Sudden onset of the illness. In the past there were similar attacks lasting 5-6 days without residual changes in the joint. The skin over the joint is hyperemic without definite borders and without infiltrative bank on the peri­phery. What is the most likely diagnosis?

A. Erysipelatous inflammation

B. Infectional arthritis

C. *Gout

D. Osteoarthritis

E. Rheumatoid arthritis

 

36. A 12 y.o. child with acute glomerulonephritis presented with hypertensive syndrom during first days of the disease. What is the role of angiotesin II in the pathogenesis?

A. Increases heart output

B. Increases erythropoetin production

C. Infibits deppresive action of prostaglandins

D. Increases renine level

E. *Intensifies production and secretion of aldosterone

 

37. A 98 y.o. male patient complains of pain in the left lower limb which intensifies on walking, feeling of cold and numbness in both feet. He has been ill for 6 years. On examination: pale dry skin, hyperkeratosis. Hairy covering is poorly developed on the left shin. “Furrow symptom “is positive on the left. Pulse on foot arteries and popliteal artery isn’t palpated, on the femoral artery it’s weak. On the right limb the artery pulsation is reserved. What is the most probable diagnosis?

A. Obliterating endarteritis

B. Buerger’s disease (thromboangiitis obliterans)

C. *Arteriosclerosis obliterans

D. Raynauld’s disease

E. Hemoral arthery thombosis

 

38. A female, aged 20, after smoking notices a peculiar inebriation with the feeling of burst of energy, elation, irreality and changing of surroundings: the world gets full of bright colours, the objects change their dimensions, people’s faces get cartoon features, loss of time and space judgement. What is the most likely diagnosis?

A. Barbiturism

B. *Cocainism

С. Nicotinism

D. Cannabism

E. Morphinism

 

39. A 43 y.o. woman complains of contact hemorrhages during the last 6 months. Bimanual exam: cervix of the uterus is enlarged, restricted in mobility. Mirrors showed the following: cervix of the uterus is in the form of cauliflower. Chrobak and Schiller tests are positive. What is the most probable diagnosis?

A. Polypus of the cervix of the uterus

B. Cervical pregnancy

C. *Cancer of cervix of the uterus

D. Leukoplakia

E. Nascent fibroid

 

40. A 35 y.o. female patient was admitted to the surgical department with symptoms of ulcerative gastric hemorrhage. It’s been the third hemorrhage for the last 2 years. After conservative treatment vomiting with blood stopped, hemoglobin elevated from 60 till 108 g/L. General condition became better. But profuse vomiting with blood reoccured in 2-3 hours. Hemoglobin decreased to 93,1 g/L then to 58,1 g/L. What is the tactics of treatment?

A. Conservative treatment with following surgery

B. Deferred surgery

C. Conservative treatment

D. *Urgent surgery

E. Taylor’s treatment

 

41. A 65 y.o. woman complains of complicated mouth opening following foot trauma 10 days ago. Next day she ate with difficulties, there were muscles tension of back, the back of the head and abdomen. On the third day there was tension of all muscle groups, generalized convulsions every 10-15 min. What is the most probable diagnosis?

A. Epilepsy

B. *Tetanus

C. Tetania

D. Meningoencephalitis

E. Hemorrhagic stroke

 

42. At term of a gestation of 40 weeks height of standing of a uterine fundus is less then assumed for the given term. The woman has given birth to the child in weight of 2500 g, a length of a body 53 cm, with an assessment on a scale of Apgar of 4-6 points. Labor were fast. The cause of such state of the child were:

A. Prematurity

B. Infection of a fetus

C. Delay of an intra-uterine fetation

D. Placental detachment •«

E. *Chronic fetoplacental insufficiency

 

43. At’s planned to construct multifield a new hospital in one of the central city districts. What building type is the most appropriate in this case?

A. Centralized

B. Mixed

C. *Centralized and blocked

D. Decentralized

E. Blocked

 

44. A 30 y.o. patient had deep burn covering 30% of body 30 days ago. Now he presents with continued fever, loss of appetite, night sweats. Burned surface weakly granulates. What is the stage of burn disease?

A. Primary burn shock

B. Secondary burn shock

C. Acute burn toxemia

D. Convalescence

E. *Septicotoxemia

 

45. A 24 y.o. woman presents with prolonged fever, nocturnal sweating. She’s lost weight for 7 kg during the last 3 months. She had irregular intercourses. On examination: enlargement of all lymphaden groups, hepatolienal syndrom. In blood: WBC — 2,2*109/L. What is the most likely diagnosis?

A. Infectious mononucleosis

B. *HIV-infection

C. Lymphogranulomatosis

D. Tuberculosis

E. Chroniosepsis

 

46. A 49 y.o. female patient presents with acute attacks of headache associated with pulsation in temples, increasing AP to 280/140 mm Hg. Pheochromocytoma is suspected. What is the mechanism of hypertensive crisis in this patient?

A. Increasing of plasma renin activity

B. *Increasing of catecholamines concentration

C. Increasing of vasopressin excretion

D. Increasing of aldosterone level in blood

E. Increasing of thyroxine excretion

 

47. A primapara with pelvis size 25-28-31-20 cm has active labor activity. Waters poured out, clear. Fetus weight is 4500 g, the head is engaged to the small pelvis inlet. Vasten’s sign as positive. Cervix of uterus is fully dilated. Amniotic sac is absent. The fetus heartbeat is clear, rhythmic, 136 bpm. What is the labor tactics?

A. Obstetrical forseps

B. Stimulation of the labor activity

C. Conservative tactics of labor

D. Vacuum extraction of the fetus

E. *Caesarean section

 

48. What preparations are used for prevention of fungal infection?

A. *Fluconozol, Orungol, Nisoral

B. Cytosar, Cormyctin, Lomycitin

С. Rubomycin, Bleomycin, Mytomycin С

D. Captopril, Enalapril

E. Isoniazid, Ftibazid, Pyrazinamid

 

49. A 36 y.o. patient is diagnosed with right sided pneumothorax. What method of treatment is indicated to the patient?

A. Symptomatic therapy

B. *Surgical drainage of the pleural cavity

C. Thoracotomy

D. Pleural puncture

E. Antiinflammation therapy

 

50. A military unit stopped for 3-day’s rest in inhabited locality after a long march. The sanitary-epidemiological reconnaissance found several water sources. It is necessary to choose the source complying with the hygienic standards for potable water in the field conditions.

A. Rain water

B. Water from melted snow

C. Spring water

D. River water

E. *Artesian well water

 

51. A 26 y.o. male patient with postoperative hypothyroidism take thyroxine 100 mg 2 times a day. He has developed tachycardia, sweating, irritability, sleep disorder. Determine further treatment tactics.

A. To administer betablockers

B. To add mercasolil to the treatment

C. *То decrease thyroxine dosage

D. To increase thyroxine dosage

E. To administer sedatives

 

52. 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. *Essential arterial hypertension

B. Polycystic disease of the kidneys

C. Chronic pyelonephritis

D. Cushing’s disease

E. Chronic glomerulonephritis

 

53. A patient was admitted to the hospital on the 7th day of the disease with complaints of high temperature, headache, pain in the muscles, especially in calf muscles. Dermal integuments and scleras are icteric. There is hemorrhagic rash on the skin. Urine is bloody. The patient was fishing two weeks ago. What is the most likely diagnosis?

A. Trichinellosis

B. *Leptospirosis

C. Yersiniosis

D. Salmonellosis

E. Brucellosis

 

54. A 14 y.o. child suffers from of vegetovascular dystonia of pubertal period. He has developed sympathoadrenal crisis. What medicine should be used for crisis reduction?

A. Euphyline

B. Amisyl

C. No-shpa

D. Corglicone

E. *Obsidan

 

55. A 28 y.o. homeless male was admitted to the hospital because of initial diagnosis “influenza”. Roseolo-petechiae rash has appeared on the trunk and internal surfaces of the limbs on the fifth day. Temperature is 41°C, euphoria, face and sclera’s hyperemia, tongue tremor, tachycardia, splenomegaly, excitement. What is the most probable diagnosis?

A. Abdominal typhoid

B. Alcogolic delirium

C. Leptospirosis

D. *Typhus

E. Measles

 

56. To replace the blood loss replacement 1000 ml of the same group of Rhesus-compatible donated blood was transfused to the patient. The blood was conserved by sodium citrate. At the end of hemotransfusion there appeared excitement, pale skin, tachycardia, muscles cramps in the patient. What complication should be suspected?

A. Allergic reaction

B. Pyrogenous reaction

C. Anaphylactic shock

D. *Citrate intoxication

E. Citrate shock

 

57. A 2 y.о. breast-fed child suffers from cheek skin hyperemia, sporadic papulous elements on the skin of the chest and back following the apple juice introduction. The child is restless. What is the initial pediatritian’s tactics?

A. Treat with claritine

B. *Clarify mother’s diet and exlude obligate allergens

C. Apply ointment with corticosteroids to affected skin areas

D. Administer general ultraviolet irradiation

E. Refer to prescribe dermathologist

 

58. A 38 y.o. patient was urgently admitted to the hospital with complaints of sudden weakness, dizziness, loss of consciousness, body weight loss, nausea, vomiting, severe pain in epigastric area, diarrhea, skin hyperpigmentation. What is the most probable diagnosis?

A. Scleroderma

B. Meningoencephalitis

C. *Addisonic crisis

D. Acute gastroenteritis.

E. Pellagra

 

59. 7 y.o. boy with chronic sinusitis and rercurent pulmonary infections has chest X-ray demonstrating a right-sided cardiac silhouette. What is the most likely diagnosis?

A. Cystic fibrosis (mucoviscidosis)

B. «-antitrypsin deficiency

C. *Kartagener syndrome

D. Bronchiolitis obliterans

E. Laryngotracheomalacia

 

60. A 26 y.o. woman complains of a mild bloody discharge from the vagina and pain in the lower abdomen. She has had the last menstruation 3,5 months ago. The pulse is 80 bpm. The blood pressure (BP) is 110/60 mm Hg and body temperature is 36,6°C. The abdomen is tender in the lower parts. The uterus is enlarged up to 12 weeks of gestation. What is your diagnosis?

A. *Inevitable abortion

B. Complete abortion

C. Disfunctional bleeding

D. Incipient abortion

E. Incomplete abortion

 

61. 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. Immunologic investigation

B. *Chest X-ray

C. Blood gases

D. Proteinogram

E. Blood test

 

62. A 56 y.o. man, who has taken alcoholic drinks regularly for 20 years, complains of intensive girdle pain in the abdomen. Profuse nonformed stool 2-3- times a day has appeared for the last 2 years, loss of weight for 8 kg for 2 years. On examination: abdomen is soft, painless. Blood amylase — 12g/L. Feces examination-neutral fat 15 g per day, starch grains. What is the most reasonable treatment at this stage?

A. Levomicytine

B. Aminocapron acid

C. Imodium

D. Contrykal

E. *Pancreatine

 

63. A 27 y.o. woman turns to the maternity welfare centre because of infertility. She has had sexual life in marriage for 4 years, doesn’t use contraceptives. She didn’t get pregnant. On examination: genital development is without pathology, uterus tubes are passable, basal (rectal) temperature is one-phase during last 3 menstrual cycles. What is the infertility cause?

A. Abnormalities in genital development

B. Genital endometriosis

C. Immunologic infertility

D. Chronic adnexitis

E. *Anovular menstrual cycle

 

64. A 2 y.o. boy was admitted to the hospital with weight loss, unstable discharges, anorexia, following the semoli­na’s introduction (since 5 months). The child is adymanic, flabby, pale dry skin, subcutaneous layer is emaciated. Distended and tensed abdomen, tympanitis on percussion of the upper part of the abdomen, splashing sounds, feces are foamy, of light color, foul. On coprocytogram: a lot of neutral fat. What is the cause of the disease?

A. Intestinal dysbacteriosis

B. Mucoviscidosis (cystic fibrosis)

C. *Celiakia (celiac disease)

D. Disaccharidase insufficiency

E. Chronic enteritis

 

65. In the gynecologic office a 28 y.o. woman complains of sterility within three years. The menstrual function is not impaired. There were one artificial abortion and chronic salpingo-oophoritis in her case history. Oral contraceptives were not used. Her husband’s analysis of semen is without pathology. From what diagnostic method will you start the workup in this case of sterility?

A. Diagnostic scraping out of the uterine cavity

B. Ultra sound investigation

C. *Hysterosalpingography

D. Hormone investigation

E. Hysteroscopia

 

66. Define the basic registration document at the profound study of a case rate with temporary lost labor ability at the industrial enterprise:

A. A ambulatory medical card

B. “The Report on reasons of temporary lost labor ability”

C. The inpatient medical record

D. *A card of the personal account of a case rate

E. The sick-leave certificate

 

67. A man, aged 68, complains of tiredness, sweating, enlargement of cervical, submaxillary and axillary lymph nodes. Blood tests: WBC — 35*109/L, lymphocytes — 60%, Botkin and Gumprecht bodies, level of haemoglobin and quantity of thrombocytes is normal. Myelogram showed 40% of lymphocytes. What is the most probable diagnosis?

A. Tuberculous lymphadenitis

B. Chronic myeloleucosis

C. Lymphogranulomatosis

D. Acute leucosis

E. *Chronic lympholeucosis

 

68. Chief district pediatrician has to carry out analysis of infant mortality rate. What should he take as a unit of the observation?

A. Child death case at the age up to the first month

B. Child death case during first 7 days of life

С. *Child death case at the age up to 1 year

D. Child death case on labor

E. Child death case after 28 days of life

 

69. There is a dynamic growth of number of congenital abnormalities such as central paralysis, newborns blindness, idiocy among the population that lives near to pesticides production enterprise. Compounds of which pollutant can cause the development of this pathology?

A. *Mercury

B. Chrome

C. Iron

D. Cadmium

E. Strontium

 

70. 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. Cardiac asthma

B. Pulmonary artery thromboembolia

C. Cardiac tamponade

D. *Cardiogenic shock

E. Disquamative aortic aneurizm

 

71. 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. *Paget’s disease

B. Myeloma

C. Hyperparathyoid dystrophy

D. Chronic osteomyelitis

E. Mottled disease (marble disease)

 

72. A 43 y.o. woman complains of shooting heart pain, dyspnea, and irregularities in the heart activity, progressive fatigue during 3 weeks. She had acute respiratory disease a month ago. On examination: AP-120/80 mm Hg, heart rate 98 bpm, heart boarders +1,5 cm left side, sounds are muffled, soft systolic murmur at apex and Botkin’s area; sporadic extrasystoles. Liver isn’t palpated, there is no edema. Blood test: WBC — 6,7*109/L, sedimentation rate-21 mm/hour. What is the most probable diagnosis?

A. *Acute myocarditis

B. Rheumatism, mitral insufficiency

C. Climacteric myocardiodystrophia

D. Ichemic heart disease, angina pectoris

E. Hypertrophic cardiomyopathy

 

73. A 18 y.o. female student complains of dyspnea during the intensive exertion. The condition became worse half a year ago. On examination: pulse rate is 88 bpm, accelerated, AP-180/20 mm Hg, and pale skin, heart borders are dilated to the left and up. There is systolic-diastolic murmur in the 2hd intercostal space, 52 at pulmonary artery is accentuated. ECG has revealed both ventricles hypertrophy. Thoracic X-ray has revealed pulsation and protrusion of the left ventricle, lung trunk. What doctor’s tactics should be?

A. Continuation of investigation

B. *Cardiosurgeon consultation

C. Dispensary observation

D. Administration of therapeutic treatment

E. Exemption from physical exercises

 

74. A worker was temporarily off work because of illness during 16 days, was under out-patient treatment. The doctor in charge issued a sick-list first for 5 days, and then prolonged it for 10 days. Who can further prolong the sick-list to this patient?

A. Deputy head physician on the working ability expertise

B. The doctor in charge of the case with the permission of the head of department

C. *The doctor in charge of the case together with the head of department

D. The head of department

E. Working ability expertise committee

 

75. The girl of 11 y.o. She is ill for 1 month. She has “butterflytype rash on face (spots and papules), pain and swelling of small joints on arms and legs, signs of stomatitis (small-sized ulcers in mouth). CBC: Hb — 80 g/L, RBC — 2,9*1012/L, WBC — 15*109/L, ESR — 40 mm/hour. Urinalysis: protein — 0,33 g/L. What is the most probable diagnosis?

A.  Juvenile rheumatoid arthritis, systemic type

B. *Systemic lupus erythematosus

C. Dermatomyositis

D. Acute rheumatic fever

E. Periarteriitis nodosa

 

76. In a 65 y.o. female patient a tumor 13 x 8 cm in size in the umbilical area and above is palpated, mild tenderness on palpation, unmovable, pulsates. On auscultation: systolic murmur. What is the most probable diagnosis?

A. Stomach tumor

B. Tricuspid valve insufficiency

C. Mitral insufficiency

D. Arterio-venous aneurism

E. *Abdominal aortic aneurism

 

77. A 40 y.o. patient was admitted to the gasteroenterology with skin itching, jaundice, discomfort in the right subcostal area, generalized weakness. On examination: skin is jaundice, traces of scratches, liver is +5 cm, splin is 6×8 cm. In blood: alkaline phosphatase — 2, 0 mmol/(hour*L), general bilirubin — 60 mkmol/L, cholesterol — 8,0 mmol/L. What is the leading syndrome in the patient?

A. Cytolytic

B. Asthenic

C. Mesenchymal inflammatory

D. Liver-cells insufficiency

E. *Cholestatic

 

78. During dynamic investigation of a patient the increase of central venous pressure is combined with the decrease of arterial pressure. What process is proved by such combination?

A. Shunting

B. Developing of cardiac insufficiency

C. Depositing of blood in venous channel

D. *Increase of bleeding speed

E. Presence of hypervolemia

 

79. A child is being discharged from the surgical department after conservative treatment of invagination. What recommendations should doctor give to mother to prevent this disease recurrence?

A. Gastro-intestinal disease prevention

B. *Strict following of feeding regimen

C. Feces observation

D. Common cold prophilaxis

E. Hardening of the child

 

80. A 52 y.o. woman complains of weakness, painful itching after washing and bathing, sensation of heaviness in the head. On examination: hyperemia of skin of face, neck, extremities. AP — 180/100 mm Hg. Speeln is 4 cm below the rib arch edge. What is the most probable diagnosis?

A. Essential hypertension

B. Allergic dermatitis

C. *Erythremia

D. Systemic sclerodermia

E. Dermatomyositis

 

81. A mother of a newborn child suffers from chronic pyelonephritis. She had acute respiratory viral disease before the labor. Labor in time, with prolonged period without waters. A child had erythematous eruption on the 2 day, and then there were seropurulent vesicles about l cm. Nikolsky’s symptom is positive. Erosions have occured after vesicle rupture. The child is flabby. The temperature is subfebrile. What is the most probable diagnosis?

A. Pseudofurunculosis

B. Vesiculopustulosis

C. *Newborn pemphigus

D. Ritter’s dermatitis

E. Sepsis

 

82. A 41 y.o. woman has suffered from nonspecific ulcerative colitis during 5 years. On rectoromanoscopy: marked inflammatory process of lower intestinal parts, pseudopolyposive changes of mucous. In blood: WBC- 9,8 * 109/L, RBC — 3,0*1012/L, sedimentation rate — 52 mm/hour. What medication provides pathogenetic treatment of this patient?

A. Kreon

B. *Sulfasalasine

C. Linex

D. Vikasolum

E. Motilium

 

83. A 2 m.о. child was delivered at term with weight 3.500 g and was on the mixed feeding. Current weight is 4900 g. Evaluate the current weight of child.

A. Hypotrophy of I grade

B. *Corresponding to the age

C. 150 g less than necessary

D. Paratrophy of I grade

E. Hypotrophy of II grade

 

84. A 43 y.o. woman complains of severe pain in the right abdominal side irradiating in the right supraclavicular area, fever, dryness and bitterness in the mouth. There were multiple vomitings without relief. Patient relates the onset of pain to the taking of fat and fried food. Physical examination: the patient lies on the right side, pale, dry tongue, and tachycardia. Right side of abdomen is painful during palpation and somewhat tense in right hypochondrium. What is the most likely diagnosis?

A. Acute cholecystitis

B. Right-sided renal colic

C. Acute bowel obstruction

D. *Perforative ulcer

E. Acute appendicitis

 

85. During intramuscular DTP vaccination in clinic, a 3 y.о. child developed signs of laryngospasm, paleness of skin, cyanosis of lips, “cock cry”, stop of respiration, tension of the whole body with overturned backward head. Allergological history of the child is not complicated. What is the most probable diagnosis?

A. *Spasmophilia, tonic spasms

B. Meningoencephalitic reaction, clonic and tonic spasms

C. Meningism, clonic and tonic spasms

D. Cerebral haemorrhage, tonic spasms

E. Anaphylactic shock, clonic spasms

 

86. A youth, aged 15, from childhood suffers from atopic dermatitis and allergy to the shellfish. In the last 3 months after acquiring aquarium fish, rhinitis, conjunctivitis, itching in the nose developed. What level of immunologic index should be defined in this case?

A. *IgE

B. IgM

C. lgA

D. IgJ

E. Circulating immunocomplexes

 

87. A woman, aged 40, primigravida, with infertility in the medical history, on the 42-43 week of pregnancy. Labour activity is weak. Longitudinal presentation of the fetus, I position, anterior position. The head of the fetus is engaged to pelvic inlet. Fetus heart rate is 140 bmp, rhythmic, muffled. Cervix dilation is 4 cm. On amni-oscopy: greenish colour of amniotic fluid and fetal membranes. Cranial bones are dense, cranial sutures and small fontanel are diminished. What should be tactics of delivery?

A. Medication sleep, amniotomy, labour stimulation

B. Fetal hypoxia treatment, conservative delivery

C. *Caesarean section

D. Amniotomy,  labour stimulation, fetal hypoxia treatment

E. Fetal hypoxia treatment, in the II period – forceps delivery

 

88. On physiologic-sanitary examination of railway department work it was revealed that loaders work is of III degree of difficulty. They unload, vagons with sand, manually break coagulated mass by shovel and shift it. What criteria was used to evaluate work of loaders?

A. Time of active activities, % to the shift duration

B. Intellectual efforts

C. *Maximun load weigh which is shifted

D. Time of passive observation, % to the shift duration

E. Value of static loading for the shift

 

89. A newborn aged 3 days with hyperbilirubinemia (428 mkmol/L) developed following disorders. From beginning there were severe jaundice with poor suckling, hypotomia and hypodynamia. Little bit later periodical excitation, neonatal convulsions and neonatal primitive reflexes loss are noted. Now physical examination  reveals convergent squint, rotatory nystagmus and setting sun eye sign. How to explain this condition?

A. Brain tumour

B. Spastic cerebral palsy

C. Skull injury

D. Hydrocephalus

E. *Encephalopathy due to hyperbilirubi­nemia

 

90. A boy, aged 9, is examined: height-127 cm (-0,36), weight – 28,2 kg (+0,96), chest circumference- 64,9 cm (+0,66), lung vital capacity – 1520 ml (-0,16). What is the integrated assessment of the child’s physical development?

A. Markedly disharmonious

B. Excessive

C. *Harmonious

D. Disharmonious

E. Below the average

 

91. A 2 y.o. girl has been ill for 3 days. Today she has low-grade fever, severe catarrhal symptoms, non-abundant maculopapular rash on her buttocks and enlarged occipital glands. What is your diagnosis?

A. Pseudotuberculosis

B. Measles

C. *Rubella

D. Scarlet fever

E. Adenoviral infection

 

92. A 31y.o. patient has had mental disorder for a long time. He suffers from insomnia for a long time. He has developed fears, suicidal thoughts, tried to hang himself. His mood is depressed, he refuses from treatment. What measures are the most expedient for the prevention of suicide?

A. *Out-patient treatment

B. *Admission to the mental hospital

C. Strict home supervision

D. Admission to’ the nu erological department

E. Psychotherapeutic conversation

 

93. A 19 y.o. patient was admitted to the hospital with acute destructive appendicitis. He sufferes from hemophilia B-type. What antihemophilic medicine should be inclended in pre-and post-operative treatment plan?

A. *Dried plasma

B. Fresh frosen blood

C. *Fresh frosen plasma

D. Native plasma

E. Cryoprecipitate

 

94. A 33 y.o. male patient was admitted to a hospital. A patient is pale, at an attempt to stand up he complains of strong dizziness. There was vomiting like coffee-grounds approximately hour ago. BP- 90/60 mm Hg., pulse-120 b/min. In anamnesis, a patient has suffered from ulcer of the stomach, painless form during 4 years. An ulcer was exposed at gastrofiberoscopy. Your diagnosis:

A. Ulcer of duodenum, complicated with bleeding

B. Acute myocardial infarction, abdominal form

C. Erosive gastritis

D. Acute pleurisy

E. *Ulcer of stomach, complicated with bleeding

 

95. After delivery and revision of placenta there was found the defect of placental lobe. General condition of woman is normal, uterine is firm, and there is moderate bloody discharge. Inspection of birth canal with mirrors shows absence of lacerations. What is the following necessary action?

A. Use of hemostatic medications

B. Urine drainage, cold at lower abdomen

C. *Manual exploration of the uterine cavity

D. Use of uterine contracting agents

E. External massage of uterus

 

96. Examination of placenta, which has just been born, reveals defect 2×3 cm in size. There is no bleeding. What tactics is the most reasonable?

A. Parturient supervision

B. Instrumental uterus cavity revision

C. *Manual uterus cavity revision

D. External uterus massage

E. Administration of uterotonic medicines

 

97. A district pediarician has carried out infant mortality rate analysis in his area. What data has been used?

A. Mortality of district newborn

B. *Mortality of children under 1 y.o. structured by age, sex, causes

C. Mortality of children under 1 y.o., natimortality

D. Mortality of district adolescents

E. Hospital mortality of children, structured by age

 

98. A sample of milk was taken for testing from a 5 ton milk batch. Lab analysis showed the following: fat content 2%, specific density — 1,04 д/стг, acidity 21°C, reductase probe — weak positive. What way the product is to be used in? What would you advise?

A. Utilize technically

B. *Sell but inform customers about milk

C. Write the product off for animal feeding

D. Annihilate the product

E. Sell without limitations

 

99. A 20 y.o. patient with bronchial asthma experiences dyspnea attacks 3-4 times a week. Nocturnal attacks are 1 time a week. FEV1 — 50% of necessary figures, during the day it’s variations is 25%. What is the severity of bronchial asthma condition?

A. Mild condition

B. *Moderate severity condition

C. Asthmatic status

D. Serious condition

E. Intermittent flow

 

100. A 35 y.o. woman was admitted to thoracic surgery department with fever up to 40°C, 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. Complication of liver echinococcosis

B. Pulmonary tuberculosis

C. *Abscess of the lung

D. Actinomycosis of lungs

E. Bronchiectatic disease

 

101. A 41 y.o. man complains of acute pain in the right side of the thorax and sudden increase of dyspnea following the lifting of heavy object. The patient’s condition is serious: lips and mucous are cyanotic, breathing rate is 28 per min, pulse — 122 bpm., AP — 80/40 mm Hg. There is tympanitis on percussion and weakened breathing on auscultaion on the right. S is accentuated over pulmonary artery. What is the urgent measure on the prehospital stage?

A. *Air aspiration from the pleural cavity

B. Oxygen inhalation

C. Call for cardiologic team

D. Epinephrine introduction

E. Euphilline introduction

 

102. A 40 y.o. patient of rheumatic heart disease complains of anorexia, weakness and loss of weight, breathless and swelling of feet. On examination: t° — 39° С, pulse is 100/min. As ucultation: diastolic murmur in the mitral area. Petechical lesion a round clavicle; spleen was palpable, tooth extraction one month ago.

A. Recurrence of rheumatic fever

B. Mitral stenosis

C. Thrombocytopenia purpure

D. *Subacute bacteria endocarditis

E. Aortic stenosis

 

103. A patient complains of pathological lump, appearing in the right inguinal region on exercise. The lump is round-shaped, 4 cm in diameter, on palpation: soft elastic consistency, positions near the medial part of Poupart’s ligament. The lump is situated inwards from the spermatic cord. What is the most probable preliminary diagnosis?

A. *Right-sided direct inguinal hernia

B. Right-sided oblique inguinal hernia

C. Varicose veins of the right hip

D. Lipoma of the right inguinal area

E. Right-sided femoral hernia

 

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

A. *Exudative pleuritis

B. Infarction-pneumonia

C. Cirrhotic tuberculosis

D. Spotaneous pneumothorax

E. Atelectasis of lung

 

105. 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 patient?

A. Valve-likes pneumothorax

B. Open pneumothorax

C. Closed pneumothorax

D. *Pericardium tamponade

E. Massive hemothorax

 

106. A 54 y.o. male patient suffers from dyspnea during mild physical exertion, cough with sputum which is excreted with difficulty. On examination: diffuse cyanosis. Is Barrel-chest. Weakened vesicular breathing with prolonged expiration and dry whistling rales. AP is 140/80 mm Hg, pulse is 92 bpm, rhythmic. Spirography: vital capacity (VC) predicted vital capacity — 65%, FEV1/FVC — 50%. Determine the type of respiratory insufficiency (RI).

A. There is no RI

B. RI of obstructive type

C. RI of mixed type with prevailing restriction

D. *RI of mixed type with prevailing obstruction

E. RI of restrictive type

 

107. The 28 y.o. woman applied to doctor because of limited loss of the hair. In the anamnesis — she had frequent headache indisposition, arthromyalgia, fever, irregular casual sexual life, drug user. RW is negative. What examination must be done first?

A. Examination for fungi

B. Examination for trichomoniasis

C. Examination for gonorrhea

D. Examination for neuropathology

E. *Examination for HIV

 

108. The girl is 12 y.o. Yesterday she was overcooled. Now she complains on pain in suprapubic area, frequent painful urination by small portions, temperature is 37,8°C. Pasternatsky symptom is negative. Urinalysis: protein- 0,033 g/L, WBC — 20-25 in f/vis, RBC —1-2 in f/vis. What diagnosis is most probable?

A. *Acute cystitis

B. Dysmetabolic nephropathy

C. Acute pyelonephritis

D. Urolithiasis

E. Acute glomerulonephritis

 

109. 18 y.o. woman complains of pain in the lower abdomen. Some minutes before she has suddenly appeared unconscious at home. The patient had no menses within last 3 months. On examination: pale skin, the pulse —110 bpm, BP — 80/60 mm Hg. The Schyotkin’s sign is positive. Hb — 76 g/L. The vaginal examination: the uterus is a little bit enlarged, its displacement is painful. There is also any lateral swelling of indistinct size. The posterior fornix of the vagina is tendern and overhangs inside. What is the most probable diagnosis?

A. Twist of cystoma of right uterine adiiexa

B. *Impaired extrauterine pregnancy

C. Acute appendicitis

D. Ovarian apoplexy

E. Acute salpingoophoritis

 

110. A patient, aged 40, has  been ill during approximately 8 years, complains of pain in the lumbar part of the spine on physical excertion, in cervical and thoracal part (especially when coughing), pain in the hip and knee joints on the right. On examination: the body is fixed in the forward inclination with head down, gluteal muscles atrophy. Spine roentgenography: ribs osteoporosis, longitudinal ligament ossification. What is the most likely diagnosis?

A. Spondyloarthropatia on the background of Reiter’s disease

B. Tuberculous spondylitis

C. Psoriatic spondyloarthropatia

D. *Ancylosing spondyloarthritis

E. Spread osteochondrosis of the vertebral column

 

111. The woman who has delivered twins has early postnatal hypotonic uterine bleeding reached 1,5% of her body weight. The bleeding is going on. Conservative methods to arrest the bleeding have been found ineffective. The conditions of patient are pale skin, acrocyanosis, oliguria. The woman is confused. The pulse is 130 bpm, BP- 75/50 mm Hg. What is the further treatment?

A. Inner glomal artery ligation

B. Uterine vessels ligation

C. *Uterine extirpation

D. Supravaginal uterine amputation

E. Putting clamps on the uterine cervix

 

112. Patient with thyrotoxicosis is in the 2-beds hospital ward of therapeutic department. The area of the ward is 18 m2, height 3 m, ventilation rate 2,5/hr. Air temperature — 20°C, relative humidity 45%, air movement velocity 0,3 m/s, light coefficient 1/5, noise level 30 dB. Make hygienic evaluation of the conditions.

A. *Discomfortable microclimate

B. Non-effective ventilation

С. Poor lighting

D. All conditions are OK

E. High level of noise

 

113. A patient aged 18 with a cranial injury was in comatose state during several hours. In post-comatose period gets tired quickly, non-productive in dialog – in the beginning answers 2-3 questions, then gets tired and can not understand the point of the question. Which psychotropic should be given to the patient to prevent psychoorganic syndrome?

A. Stimulators

B. Neuroleptics

C. Tranquillisers

D. Antidepressants

E. *Nootropics

 

114. Choose a method of a graphic representation of monthly information about number of the registered cases of acute intestinal infection and their comparisons to the average monthly values, obtained for 5 previous years:

A. The radial diagram

B. The figured diagram

С. *The linear diagram

D. The sector diagram

E. The curvilinear disgram

 

115. A 74 y.o. female patient complains of pain, distended abdomen, nausea. She suffers from heart ischemia, postinfarction and diffusive cardiosclerosis. On examination: grave condition, distended abdomen, abdominal wall fails to take active part in breathing. On laparoscopy: some cloudy effusion, one of the bowel loops is dark-blue. What is the most probable diagnosis?

A. Ichemic abdominal syndrome

B. Volvulus

C. Erysipelas

D. Acute intestinal obstruction

E. *Mesenterial vessels thrombosis

 

116. A patient complains of a tormental (agonizing) cough with expectoration of up to 600 ml/daily purulent chocolatecolor sputum with a decay smell. Onset of illness was abrupt, t°— 39°C, 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. Lobar pneumonia

B. Bronchiectatic illness

C. Pneumonia complicated by an abscess

D. *Gangrene of lung

E. Tuberculosis

 

117. A 27 y.o. woman suffers from pyelonephritits of the only kidney. She presents to the maternity welfare centre because of suppresion of menses for 2,5 months. On examination pregnancy 11 weeks of gestation was revealed. In urine: albumine 3,3 g/L, leucocytes cover the field of vision. What is doctor’s tactics in this case?

A. Maintenance of pregnancy till delivery term

B. Pregnancy interruption at 24-25 weeks

C. Pregnancy interruption after urine normalization

D. Maintenance of pregnancy till 36 weeks

E. *Immediate pregancy interruption

 

118. A 18 y.o. woman complains of weakness, dizziness, loss of appetite, menorrhagia. There are petechiae on the skin of the upper extremities. Blood test: Hb — 105 g/L; RBC- 3,2*1012/L; coloured index- 0,95; thromb.- 20*109/L. The sedimentation time according to Lee White is 5′; hemorrhagia duration according to Duke is 8′, “pinch and tourniquet “test is positive. What is the most probable diagnosis?

A. Hemophilia

B. Iron deficiency anemia

C. Marchiafava-Micheli’s disease

D. *Idiopathic thrombocytopenic purpura

E. Hemorrhagic diathesis

 

119. On medical observation a doctor identified girl (162 cm tall and 59 kg weight) who complained loss of ability to see surrounding objects clearly in the evening. On examination: dry skin, hyperkeratosis. Her daily ration includes the following vitamines: vitamine A — 0,5 mg, vit.B6 — 2,0 mg, vit.B2 — 2,5 mg, vit.B6 — 2 mg, vit.C — 70 mg. What is the hypovitaminosis type?

A. B2-hypovitaminosis

B. В6-hypovitaminosis

C. *A-hypovitaminosis

D. C-hypovitaminosis

E. В1 -hypovitaminosis

 

120. A 36 y.o. patient was admitted to the hospital with sharp pain in substernal area following occasional swallowing of a fish bone. On esophagoscopy the foreign body wasn’t revealed. The pain increased and localized between scapulas. In a day

temperature elevated, condition became worse, dysphagia intensified. What complication has developed?

A. Esophageal hemorrhage

B. *Perforation of esophagus with mediastinitis

C. Obstruction of esophagus

D. Aspirative pneumonia

E. Pulmonary atelectasis

 

121. A 5 y.o. 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. *Aortic stenosis

B. Defect of interventricular septum

C. Defect of interatrial septum

D. Open aortic duct

E. Coarctation of the aorta

 

122. A woman in labor, on vaginal inspection: cervix dilation is up to 2 cm, fetal bladder is intact. Sacral cavity is free, sacral promontory is reachable only with a bent finger, the inner surface of the sacrococcygeal joint is accessible for inspection. The head of the fetus presents. Sagittal suture occupies the transverse diameter of pelvic inlet, the small fontanel to the left, on the side. What labor stage is this?

A. Preliminary stage

B. Placental stage у

C. Expulsion of fetus stage V

D. *Cervix dilation stage

E. Prodromal stage

 

123. Full term newborn has developed jaundice at 10 hours of age. Hemolytic disease of newborn due to Rh-incompatibility was diagnosed. 2 hours later the infant has indirect serum bilirubin level increasing up to 14 mmol/L. What is most appropriate for treatment of hyperbilirubinemia in this infant?

A. *Exchange blood transfusion

B. Phenobarbital

С Intestinal sorbents

D. Infusion therapy

E. Phototherapy

 

124. A 18 y.o. male patient complains of pain in knee and ankle joints, temperature elevation to 39, 5°C. He had a respiratory disease 1,5 week ago. On examination: temperature — 38,5°C, swollen knee and ankle joints, pulse — 106 bpm, rhythmic, AP — 90/60 mm Hg, heart borders without changes, sounds are weakened, soft systolic apical murmur. What indicator is connected with possible etiology of the process?

A. Seromucoid

B. *Antistreptolysine-0

C. Creatinkinase

D. 1-antitrypsine

E. Rheumatic factor

 

125. In an inhabited locality there is an increase of diphtheria during the last 3 years with separate outbursts in families. What measure can effectively influence the epidemic process of diphtheria and reduce the morbidity rate to single cases?

A. Early diagnostics

B. *Immunization of the population

C. Detection of carriers

D. Hospitalization of patients

E. Disinfection in disease focus

 

126. A 38 y.o. woman complains of a purulent discharge from the left nostril. The body temperature is 37,5°C. The patient is ill during a week and associates her illness with common cold. Pain on palpation of her left cheek reveals tenderness. The mucous membrane in the left nasal cavity is red and turgescent. The purulent exudates is seen in the middle meatus in maxillary. What is the most probable diagnosis?

A. *Acute purulent maxillary sinusitis

B. -

C. Acute purulent ethmoiditis

D. Acute purulent frontitis

E. Acute purulent sphenoiditis

 

127. On observation of sanitary conditions of studying at the technical university it was necessary to evaluate the visual regimen of students, who study from 9 a.m to 3 p.m. What index of natural light will be the most informative?

A. Light coefficient

B. Depth of study room

C. Time of the room insolation

D. Presence of mixed (upper-lateral) light

E. *Natural light coefficient

 

128. A woman, primagravida, consults a gynecologist on 05.03.2002. A week ago she felt the fetus movements for the first time. Last menstruation was on 10.01.2002.

When should she be given maternity leave?

A. *8 August

B. 5 September

C. 22 August

D. 25 July

E. 11 July

 

129. A patient with unstable angina pectoris was given the following complex treatment: anticoagulants, nitrates, a-adrenoblockers. However on the third day of treatment the pain still romains. Which in vestigation shoud is carried out to establish diagnosis?

A. Stress-echocardiogram

B. *Coronarography

С. Esophageal electrocardiac stimulator

D. Test with dosed physical exercises

E. Myocardial scintigraphy

 

130. 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

С. Lobectomy

D. Pneumoectomy

E. Thoracoplasty

 

131. A 55 y.o. patient complains of di­stended abdomen and rumbling, increased winds evacuation, liquid foamy feces with sour smell following the diary products consumption. What is the correct name of this syndrome?

A. *Syndrome of fermentative dyspepsia

B. Dyskinesia syndrome

С Syndrome of fatty dyspepsia

D. Malabsorption syndrome

E. Syndrome of decayed dyspepsia

 

132. A 30 y.o. woman has second labor which lasts for 14 hours. The fetus heartbeat is mufflet, arrhythmic, 100 bpm. On vaginal examination: complete cervix dilatation, fetus head is in the area of small pelvis outlet. Sagital suture is in the direct size. The small fontanelle is at the symphis. What is the further tactics of the labor?

A. Stimulation of the labor activity with oxitocyne

B. Ceasarian section

C. Application of obstetrical cavity forceps

D. *Application of obstetrical forceps

E. Application of craniodermal forceps by Ivanov’s

 

133. A child from the first non-complicated pregnancy but complicated labor had cephalhematoma. On the second day there developed jaundice. On the 3rd day appeared changes  of neurologic status: nystagmus, Graefe’s sign. Urea is yellow, feces- golden-yellow. Mother’s blood group is A(II)Rh-, child — A{II)Rh+. On the third day child’s Hb is 200 g/L, RBC — 6,1*1012/L, bilirubin in blood — 58 mk mol/L due to unconjugated bilirubin, Ht — 0,57. What is the child’s jaundice explanation?

A. Hemolytic disease of newborn

B. Bile ducts atresia

C. Physiologic jaundice

D. *Brain delivery trauma

E. Fetal hepatitis

 

134. 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. Right shin syphilis

B. Right shin tuberculosis

C. Bone cyst of tibia

D. Right shin trauma

E. *Right shin osteomielitis

 

135. 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. Articular (joint) panaritium

B. Subcutaneous panaritium

C. Bone panaritium

D. Paronychia

E. *Thecal whitlow (ligament panaritium)

 

136. A 27 y.o. man complains of pain in epigastrium which is relieved by food intake. EGDFS shows antral erosive gastritis, biopsy of antral mucous presents Helicobacter Pylori. What can be diagnosed in this case?

A. Reflux -’gastritis

B. Gastritis of A type

C. Rigid antral gastritis

D. *Gastritis of type В

E. Menetrier’s disease

 

137. A patient had macrofocal myocardial infarction. He is overweight for 36%, AP is 150/90 mm Hg, blood sugar — 5,9 mmol/L, general cholesterol — 4,9 mmol/L, uric acid — 0,211 mmol/L. Which risk factor should be urgently eradicated during the secondary prevention?

A. *Obesity

B. Hyperglycemia

C. Arterial hypertension

D. Hypercholesterolemia

E. Hyperuricemia

 

138. A 28 y.o. male patient was admitted to the hospital because of high temperature 39°C, headache, generalized fatigue, constipation, sleep disorder for 9 days. There are sporadic roseolas on the abdomen, pulse — 78 bpm, liver is enlarged for 2 cm. What is the most probable diagnosis?

A. Typhus

B. Sepsis

C. Leptospirosis

D. *Abdominal typhoid

E. Brucellosis

 

139. A 51 y.o. woman complains of dull pain in the right subcostal area and epigastric area, nausea, appetite decline during 6 months. There is a history of gastric peptic ulcer. On examination: weight loss, pulse is 70 bpm, AP is 120/70 mm Hg. Diffuse tenderness and resistance of muscles on palpation. There is a hard lymphatic node l x l cm in size over the left clavicle. What method of investigation will be the most useful?

A. *Esophagogastroduodenoscopy with biopsy

B. Ultrasound examination of abdomen

С. pH-metry

D. Ureatic test

E. Stomach X-ray

 

140. The patient has developed pain in the axillary area, rise of temperature developed 10 hours ago. On examination: shaky gait is marked; the tongue is coated by white coating. The pulse is frequent. The painful lymphatic nodules are determined in the axillary area. The skin is erythematous and glistering over the lymphatic nodules. What is the most probable diagnosis?

A. *Bubonic plague

B. Acute purulent lymphadenitis

C. Anthrax

D. Tularemia

E. Lymphogranulomatosis

 

141. The district pediatrician is charged with the analysis of infant mortality. What is taken for the unit of observation in infant mortality investigation?

A. *A baby dead at the age up to 12 months

B. A baby dead at birth

C. A baby dead at the age over 28 days

D. A baby dead at the age up to 6 days

E. A baby dead at the age up to 1 months

 

142. A 9 y.o. girl has an average height and harmonic growth development. She was ill with acute respiratory infection for five ti­mes. Define the group of her health.

A. 3rd group

B. 1st group

C. 4th group

D. 5th group

E. *2nd group

 

143. Ambulance was called to a 48 y.o. man. From the words of relatives he has had three episodes of lost consciousness and attacks during the day. On examination: the following fit is observed: patient is unconscious, fell on the floor, tonic and then clonic convuesions of trunk and extremities happened. The attack lasted for 4 minute, ended by involuntary urination. What type of attack was observed?

A. Vegetatic crisis

B. Fainting

C. Episode of hysteria

D. *Major epileptic seizure

E. Absence

 

144. A 38 y.o. woman was hospitalized to the surgical unit with vomiting and acute abdominal pain irradiating to the spine. On laparocentesis hemmorhagic fluid is obtained. What disease should be suspected?

A. *Acute pancreatitis

B. Acute appendicitis

C. Acute enterocolitis

D. Renal colic

E. Perforated gastric ulcer

 

145. A 52 y.o. male patient suffers from squeezing pain attacks in substernal area which irradiates to the left hand and occurs occasionally and on physical exertion. He has had it for 1 year. On examination: heart boarders are dilated to the left side, sounds are muffled, pulse — 76 bmp, rhythmic, AP-155/80 mm Hg, ECG: the left type, the rest of signs is normal. What additional examination is necessary to confirm the diagnosis?

A. Transaminases of blood

B. General blood count

C. *Bicycle ergometry

D. Blood lipoproteins

E. Echocardiography

 

146. A child was delivered severely premature. After the birth the child has RI symptoms, anasarca, fine bubbling moist rales over the lower lobe of the right lung. Multiple skin extravasations, bloody foam from the mouth have occured after the 2 day. On chest X-ray: atelectasis of the lower lobe of the right lung. In blood: Hb — 100 g/L, Ht — 0,45. What is the most probable diagnosis?

A. Congenital pneumonia

B. *Edematous-hemorrhagic syndrome

С. Hyaline membrane disease

D. Pulmonary edema

E. Disseminated intravascular clotting syndrome

 

147. A patient, aged 58, was fishing in the winter. On return home after some time felt some pain in the feet. Consulted a doctor. On examination: feet skin was pale, then after re warming became red, warm to the touch. Edema is not significant, limited to the toes. All types of sensitivity are preserved. No blisters. What degree of frostbite is observed?

A. II degree

B. IV degree

C. Ill degree

D. *I degree

E. V degree

 

148. A 6 y.o child complains of thirst, polyuria, and increased appetite for 2 months with weight loss for 3 kg. There has been nocturnal enuresis during last week. On examination: hyperglycemia 14 mol/L. The diagnosis is diabetis mellitus I type. What is the genesis of this disease?

A. Viral

B. Virus-bacterial

C. Neurogenic

D. *Autoimmune

E. Bacterial

 

149. On the 5-th day of the respiratory disease a 24 y.o. man has developed progressive headaches systemic dizziness, feeling of seeing double, paresis of mimic muscles on the right, choking while swallowing. Acute viral encephalitis has been diagnosed. What is the main direction of urgent therapy?

A. Ceftriaxon

B. Lasix

C. *Zovirax

D. Hemodesis

E. Glucocorticoids

 

150. A 38 y.o. patient complains of pain in lumbar part of spinal column with irradiation to the back surface of the left leg following the lifting of a heavy object. Pain is increasing on change of the body position and in vertical position, positive stretching symptoms were revealed on examination. What is an initial diagnosis?

A. *Intervertebral ligaments disorder

B. Myelopathy

C. Polyneuritis

D. Spinal cord tumor

E. Arachnomielitis

 

151. A 24 y.o. emotionally-labile woman presents with irritation, depressed mood, palpitation, shooting pain in the heart area, generalized fatigue following the divorce. On examination: palm hyperhydrosis, pulse rate — 72-78 bpm, labile, heart without changes. ECG is normal. What is the most probable pathology in this case?

A. Compulsive neurosis

B. Depressive neurosis

C. Schizophrenia

D. Ipochondric neurosis

E. *Neurasthenia

 

152. The child is 11y.о. He suffers from nervous-arthritic diathesis. The increased synthesis of what acid is pathogenic at nervous-arthritic diathesis?

A. Phosphoric acid

B. Sulfuric acid

C. Acetic acid

D. Hydrochloric acid

E. *Uric acid

 

153. A male patient presents with swollen ankles, face, eyelids, elevated AP — 160/100 mm Hg, pulse – 54 bpm, daily loss of albumine with urine — 4g. What therapy is pathogenetic in this case?

A. Antibiotics

B. NSAID

C. Calcium antagonists

D. Diuretics

E. *Corticosteroids

 

154. A 67 y.o. patient complains of palpitation, dizziness, noise in ears, feeling of shortage of air. Objectively: pale, damp skin. Vesicular respiration, respiratory rate — 22 per min, pulse — 200 bpm, AP—100/70 mm Hg. On ECG: heart rate — 200 bmp, ventricular complexes are widened, deformed, location of segments ST and of wave T is discordant. The wave P is not changed, superimposes QRST, natural conformity between P and QRS is not present. What kind of arrhythmia is present?

A. *Paroxismal ventricular tachycardia

B. Atrial flutter

C. Atrial tachycardia

D. Sinus tachycardia

E. Ventricular extrasystole

 

155. A 30 y.o. female with rheumatoid arthritis of five years duration complains of pain in the first three fingers of her right hand over past 6 weeks. The pain seems especially severe at night often awakening her from sleep. The most likely cause is?

A. Atlanto-axial sublaxation of cervical spine

B. Sensory peripheral neuropathy

C. Rheumatoid vasculitis

D. Rheumatoid arthritis without complication

E. *Carpal tunnel syndrome

 

156. A local doctor has to prepare a report about the health condition of the population of his region. What medical indexes of population health condition should he use?

A. Average longevity

B. *Morbidity, disabilities, demographic, physical development

С Way of life, genetic, pollution

D. Social welfare, satisfaction of life quality

E. Average treatment duration, complications

 

157. A 32 y.o. patient complains of severe weakness, tremor of extremities. On physical examination, there is loss of body weight, wet and warm skin. The thyroid gland is enlarged up to the 3rd degree, painless, elastic. Ps — 108 bpm. BP — 160/55 mm Hg. The rest is in norm. What can be diagnosed?

A. Chronic fibrous thyroiditis

B. Chronic autoimmune thyroiditis, hypertrophic type

C. *Diffuse toxic goitre of the 3rd degree, thyrotoxicosis of the average degree

D. Diffuse euthyroid goitre of the 3rd degree

E. Toxiferous adenoma of the thyroid gland

 

158. An infant aged 1 year on the third day of common cold at night developed inspiratory stridor, hoarse voice and barking cough. Physical examination revealed suprasternal and intercostals chest retractions. There is a bluish skin discoloration . Moistly seen over the upper lip. The respiratory rate is 52 per min and pulse — 122 bpm. The body temperature is 37,5°C. What disease does the infant have?

A. Acute bronchiolitis with respiratory distress

B. Bronchopneumonia without complications

C. Acute epiglottitis

D. *Acute  infectious croup due to viral laryngotracheitis

E. Acute laryngitis

 

159. At year-end hospital administration has obtained the following data: annual number of treated patients and average annual number of patient-used beds. What index of hospital work can be calculated based upon this data?

A. Average annual bed occupacy

B. Average bed idle time

C. Average duration of patients presence in the hospital

D. *Bed turnover

E. Bed resources of the hospital

 

160. 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. Tuberculosis of lungs

B. *Central cancer of lungs

C. Pleuropneumonia

D. Pulmonary infarction

E. Bronchiectasia

 

161. A 33 y.o. patient was admitted to the reception room of the Central District Hospital. He complains of a severely painful swelling localized on posterior neck, fever up to 38,4°C and general weakness. In anamnesis: diabetes mellitus within 5 years. On physical examination on the posterior neck surface there is an infiltrate elevated above surrounding skin. The tissues affected by swelling are tense and blue reddish discoloration in central area. There are also several purulent necrotic pustules which are connected with each other and form a large skin necrosis. A thinned necrotic skin of this swelling has holes looking like sieve, pus discharges through

out. What disease should a doctor consider first of all?

A. Carbuncle associated with anthrax

B. *Carbuncle

С. Skin abscess

D. Acute skin cellulitis

E. Furuncle

 

162. A 20 y.o. patient suddenly felt ill 12 hours ago. There was pain in epigactric area, nausea, sporadic vomiting. He had taken alcohol before. In few hours the pain localized in the right iliac area. On examination: positive rebound tenderness symptoms. WBC — 12,2*109/L. What is the most probable diagnosis?

A. Rightside kidney colic

B. Acute cholecystitis

C. *Acute appendicitis

D. Perforated ulcer

E. Acute pancreatitis

 

163. 3 weeks ago the patient was ill with tonsillitis. Clinical examination reveals edema, arterial hypertension, hematuria, proteinuria (1,8 g/per day), granular and erythrocital casts. What is the preliminary diagnosis?

A. Pyelonephritis

B. Cystitis

С. Intestinal nephritis

D. Renal amyloidosis

E. *Glomerulonephritis

 

164. The physician must undertake measures for primary prophylaxis of iron deficiency anemia. Which of the following categories of patient are subject to such primary prophylactic measures?

A. *Pregnant women

B. Patients after 60

C. Workers of industrial enterprises

D. Patients after operation

E. All children

 

165. The complications of acute cholecystitis which require surgical intervention are as follows EXCEPT:

A. Emphysematous gall-bladder

B. Cholangitis conditioned by the presence of stones in the bile tract

C. *Jaundice

D. Empyema of the gall-bladder

E. Gall-bladder perforation

 

166. A 70 y.o. male patient with mild headaches complains of speech disorder, weakness in right limbs. There was a history of miocardial infarction and arrhythmia. On neurological examination there are elements of motor aphasia, central paresis of VII and XII cranial nerves pairs on the right side, central type of hemiparesis and hemihyperesthisia on the same side. What is the most probable diagnosis?

A. Cerebral tumor

B. Hemorrhagic stroke

C. Transitory ischemic attack

D. Epidural hematoma

E. *Ischemic stroke

 

167.  A 52 y.o. patient fell from 3 m hight on the ground with the right lumbar area. He complains of pain here. There is mi­crohematuria in the urea. On urography kidney’s functioning is satisfactory. What is the most probable diagnosis?

A. *Kidney’s contusion

B. Subcapsular kidney’s rupture

C. Paranephral hematoma

D. Kidney’s abruption

E. Multile kidney’s ruptures

 

168. A 25 y.o. woman complains of profuse foamy vaginal discharges, foul, burning and itching in genitalia region. She has been ill for a week. Extramarital sexual life. On examination: hyperemia of vagi­nal mucous, bleeding on touching, foamy leucorrhea in the urethral area. What is the most probable diagnosis?

A. Chlamydiosis

B. Gonorrhea

С. Bacterial vaginosis

D. *Trichomonas colpitic

E. Vagina candidomicosis

 

169.  A 28 y.o. primagravida, pregnancy is 15-16 weeks of gestation, presents to the maternity clinics with dull pain in the lower part of the abdomen and in lumbar area. On vaginal examination: uterus cervix is 2,5 cm, external isthmus allows to pass the fi­nger tip. Uterus body is enlarged according to the pregnancy term. Genital discharges are mucous, mild. What is the diagnosis?

A. Spontaneous abortion which has begun

B. Stopped pregnancy

С. Hydatid molar pregnancy

D. *Threatened spontaneous abortion

E. Placenta presentation

 

170.   A patient, aged 81, complains of constant urinary excretion in drops, feeli­ng of fullness in the lower abdomen. On examination: above pubis there is a spherical protrusion, over which there is a dullness of percussion sound, positi­ve suprapubic punch. What symptom is observed in this patient?

A. Urinary incontinence

B. Pollakiuria

С. *Paradoxal ischuria

D. Dysuria

E. Enuresis

 

171. A 52 y.o. hard smoker patient complai­ns   of   persistent   cough   with   purulent sputum discharge especially in mornings, dyspnea provoked even by slight physi­cal exertion, wheezing chest, tahypnoe, general weakness. He considers himself to be ill during 12 years. The overwri­tten conditions appear 3-4 times per year usually   after   common   cold   and   have tendency to progress. What disease do you think about first of all?

A. Aspergillosis

B. Mucoviscidosis (cystic fibrosis)

C. Bronchoectatic disease

D. *Chronic obstructive lung disease

E. Bronchial asthma

 

172. A 52 y.o. 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. *Ultrasound dopplerography

С. Electroencephalography

D. Cerebral angiography

E. CT of the brain

 

173. 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. *Thorax roentgenography

C. Spirography

D. Blood gases examination

E. Bronchoscopy

 

174.  A 60 y.o. man complains of significant pain in the right eye, photophobia, lacrimation, reduced vision of this eye, headache of the right part of the head. Pain occurred 2 days ago. On examination: Vis OD — 0,03, congested injection of the eye ball, significant cornea edema, front chamber is deep, pupil is narrow, atrophic iris, there is optic nerve excavation on the eye fundus, intraocular pressure — 38 mm Hg. Vis OS — 0,8 unadjustable. The eye is calm, healthy. Intraoccular pressure — 22 mm Hg. What is the most probable diagnosis?

A. Right eye’s keratitis

B. Right eye’s uveitis

C. *Acute glaucoma attack

D. Eye nerve’s neuritis

E. Maculodystrophy

 

175. 47 y.o. patient complains of intensive skin itching, jaundice, bone pain. The skin is hyperpigmentated. There is multiple xanthelasma palpebrae. The liver is +6 cm enlarged, hard with acute edge. The blood analysis revealed total bilirubin 160 mkmol/L, direct — 110 mkmol/L, AST (asparate aminotransferase) — 2,1 mmol/L per hour, ALT-1,8 mmol/L, alkaline phosphotase — 4,6 mmol/L per hour, cholesterol- 9,2 mmol/L, antimitochondri-al antibodies M2 in a high titer. What is the probable diagnosis?

A. *Primary biliary liver cirrhosis

B. Primary liver cancer

C. Acute viral hepatitis В

D. Chronic viral hepatitis В

E. Alcoholic liver cirrhosis

 

176. A 35 y.o. male patient suffers from chronic glomerulohephritis and has been on hemodialysis for the last 3 years. He has developed irregularities in the heart activity, hypotension, progressive weakness, dyspnea. On ECG: bradycardia, 1st degree atrioventicular block, high sharpened T-waves. Before he had severely disturbed the drinking and diet regimen. What is the most likely cause of these changes?

A. *Hyperkaliemia

B. Hyperhydratation

C. Hypokaliemia

D. Hypocalcemia

E. Hypernatremia

 

177. A patient complains of intense pressing pain in the pharynx, mainly to the right, impossibility to swallow even liquid food. The illness started 5 days ago. The patient’s condition is grave. Body temperature — 38,9°C, speech is difficult, voice is constrained, difficulties in opening the mouth. Submaxillary glands to the right are painful, enlarged. What is the most probable diagnosis?

A. Diphtheria

B. *Peritonsillar abscess

C. Vincent’s disease

D. Pharyngeal tumor

E. Phlegmonous tonsillitis

 

178. The 56 y.o. patient has worked at the aluminium plant more than 20 years. Within 3 last years he has developed loosening of teeth, bone and joint pains, piercing pains in heart area, vomiting. The preliminary diagnosis is:

A. *Fluorine intoxication

B. Mercury intoxication

C. Manganese intoxication

D. Phosphorus intoxication

E. Lead intoxication

 

179. A 3 y.o. child with weight deficiency suffers from permanent moist cough. There was a history of some pneumonias with obstruction. On examination: distended chest, dullness on percussion over the lower parts of lungs. On auscultation: a great number of different moist rales. Level of sweat chloride is 80 mol/L. What is the most probable diagnosis?

A. Bronchial asthma

B. Recurrent bronchitis

C. Bronchiectasis

D. Pulmonary hypoplasia

E. *Mucoviscidosis (cystic fibrosis)

 

180. A 75 y.o patient can not tell the month, date and season of the year. After long deliberations she manages to tellher name. She is in irritable and dissatisfied mood. She always carries a bundle with belongings with her, hides a parcel with bread, shoes in her underwear in her bosom as well as “invaluable books”. What is the most probable diagnosis?

A. Atherosclerotic (lacunar) dementia

B. *Senile dementia

С Presenile melancholia

D. Dissociated personality (psychopathy)

E. Behavior disorder

 

181. A victim of a road accident, aged 44, is operated on account of intraperitoneal haemorrhage. In which case can the patient’s blood from the abdominal cavity be used for autotransfusion?

A. Splenic rupture

B. Bladder rupture

C. Small intestines rupture

D. *Stomach rupture

E. Liver rupture

 

182. A 42 y.o. man died in a road accident after the hemorrhage on the site, due to acute hemorrhagic anaemia. What minimum percentage volume of the total blood loss would result in death at acute haemorrhage?

A. 15-20%

B. 6-9%

С. 35-50%

D. *25-30%

E. 10-14%

 

183. A 2,9-kg term male infant is born to a mother who developed polyhydramnios at 34 weeks’ gestation. At birth, the Apgar scores were 9 and 9. The infant develops choking and cyanosis with the first feed. In addition, is unable to place a nasogastric tube. What is the most likely diagnosis?

A. Choanal atresia

B. Tracheal atresia

C. Laryngomalacia

D. *Esophageal atresia

E. Respiratory distress syndrome

 

184. In treatment and prevention establishments, regardless of their organizational and proprietary form, the rights of the patients should be observed. Which of these rights is the most significant?

A. The right to be heard

B. The right to the protection from incompetence

C. The right to the information

D. The right to the free choice

E. *The right to the protection of the pati­ent’s interests

 

185. A 30 y.o. primipara has intensive labor pushings with an interval of 1-2 min and of 50 sec duration. There is a appearing of the fetus head. Perineum is of 4 cm height, has turned pale. What should be done in this case?

A. Observation

B. Perineum protection

C. Vacuum extraction of the fetus

D. Perineotomy

E. *Episiotomy

 

186. A 62 y.o. patient with DM-2. Diabetes is being compensated by diet and Maninilum. Patient has to undergo an operation for inguinal hernia. What the tactics of hypoglycemic therapy should be used?

A. Prescribe guanyl guanidines

B. *Prescribe fast-acting insulin

C. Continue with the current therapy

D. Prescribe long-acting insulin

E. Give Glurenorm in place of Maninilum

 

187. A 45 y.o. woman complains of contact bleedings during 5 months. On speculum examination: hyperemia of uterus cervix looks like cauliflower bleeds on probi­ng. On bimanual examination: cervix is of densed consistensy, uterus body isn’t enlarged, mobile, nonpalpable adnexa, parametrium is free, deep fornixes. What is the most likely diagnosis?

A. Cervical pregnancy

B. Fibromatous node which is being born

C. Cancer of body of uterus

D. *Cancer of cervix of uterus

E. Polypose of cervix of uterus

 

188. 33 y.o. woman works as the secretary. Her diet contains 150 g of protein (including 100 g of animal protein), 200 g of fat, and 600 g of carbohydrates. What pathology can develop from this diet?

A. Common cold

B. Uterine fibromyoma

C. Schizophrenia

D. *Obesity

E. Paradontosis

 

189.  There were registered 500 cases of urolithiasis per 10000 inhabitants. What kind of statictical indices is presented?

A. *Prevalence rate

B. Index of compliance

C. Correlation coefficient

D. Incidence rate

E. Index of visualization

 

190. An employee of a private company was ill with acute respiratory viral infection. Consulted a district doctor, who determined the fact of temporary loss of working ability, but refused to issue a sick-list, arguing that the patient worked in the private and not state-owned company. Should the sick-list be issued to the employees of private companies?

A. Issued only on condition of payment guarantee by the company’s proprietor

B. Issued a medical certificate of a free form

C. *Issued regardless of company’s ownership

D. Issued only to empties of state-owned companies

E. Issued a medical certificate of a set form

 

191. A 35 y.o. woman is suspected of aplastic anemia. The bone marrow punction has been administered with the diagnostic purpose. What changes in the marrow punctatum are suggested?

A. Replacement of marrow elements with fibrous tissue

B. Presence of blast cells

C. Prevalence of megaloblasts

D. *Replacement of marrow elements with adipose tissue

E. Absolute lymphocytosis

 

192. A 58 y.o. male patient is examined by a physician and suffers from general weakness, fatigue, mild pain in the left subcostal area, sometimes frequent painful urination. Moderate splenomegaly has been revealed. Blood test: neutrophilic leukocytosis with the progress to myelocyte; basophil — 2%; eosinophil — 5%. There is a urate crystals in urine, erythrocyte — 2-3 in the field of vision. What is the preliminary diagnosis?

A. *Chronic myeloleucosis

B. Urolithiasis

C. Hepar cirrhosis

D. Leukemoid reaction

E. Lymphogranulomatosis

 

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

A. Gangrene of lungs

B. Chronic bronchitis

C. Pneumonia

D. Tuberculosis

E. *Bronchiectasia

 

194. A 43 y.o. patient had cholecystectomy 6 years ago due to chronic calculous cholecystitis. Lately he has suffered from pain in the right subcostal area and recurrent jaundice. During last 2 weeks jaundice hasn’t gone. Stenoutic papillitis 0,5 cm in length has been revealed. What is the best way of treatment?

A. *To perform endocsopic papillosphincterotomy

B.-

C. To perform choledochoduodenostomy

D. To perform external choledoch drain

E. To treat conservatively: antibiotics, spasmolytics, antiinflammatory drugs

 

195. A 2,5 y.о. child presents with muscle hypotonia, sweating, alopecia of the back of the head. The child is prescribed massage, curative gymnastics and vitamin D. What is the dosage and frequency of vitamin D administration?

A. 1000IU every other day

B. 500 IU daily

С. 1000 IU daily

D. *3000 IU daily

E. 500 IU every other day

 

196. A 27 y.o. gravida with 17 weeks of gestation was admitted to the hospital. There was a history of 2 spontaneous miscarriages. On bimanual examination: uterus is enlarged to 17 weeks of gestation, uterus cervix is shortened, and isthmus allows passing the finger tip. The diagnosis is isthmico-cervical insufficiency. What is the doctor’s tactics?

A. To administer tocolytic therapy

B. To interrupt pregnancy

C. To administer hormonal treatment

D. To perform amniocentesis

E. *To place suture on the uterus cervix

 

197. A 35 y.o. patient complains of a difficult swallowing, pain behind the breastbone. He can eat only liquid food. While swallowing sometimes he has attacks of cough and dyspnea. Above mentioned complaints are progressing. It is known that the patient has had a chemical burn of esophagus one month ago. What complication does the patient have?

A. *Corrosive esophagitis and stricture

B. Cardiac achalasia

C. Esophageal diverticula

D. Cardiac insufficiency

E. Esophagitis

 

198. A 19 y.o. boy was admitted to the hospital with closed abdominal trauma. On operation multiple ruptures of spleen and small intestine were revealed. AP is falling, it is necessary to perform hemotransfusion. Who can determine patient’s blood group and rhesus compatibility?

A. A surgeon

B. An anaesthesilogist

C. A laboratory physician

D. A traumotologist

E. *A doctor of any speciality

 

199. A 25 y.o. patient was admitted with chest trauma. Clinical and X-ray examination have revealed tense pneumothorax on the left. What emergency treatment should be undertaken?

A. Intubation

B. Analgetics

C. Intravenous infusions

D. Oxigenotherapy

E. *Pleural cavity drainage

 

200. A patient, aged 25, suffering from stomach ulcer. Had a course of treatment in the gastroenterological unit. 2 weeks later developed constant pain, increasing and resistant to medication. The abdomen is painful in epigastric area, moderate defence in pyloroduodenal area. Which complication development aggravated the patient’s state?

A. Perforation

B. Haemorrhage

С. Stenosis

D. Penetration

E. *Malignisation

 

Year 2004

Posted: May 5, 2012 in Krok II
Tags:

 

1. A boy, aged 10, is under treatment in cardiological unit on account of rheumatic fever. The first onset of the decease. Discharged in the satisfactory condition. What medication is the most expedient for secondary rheumatism prevention?

  1. *Bicillin-5
  2. Erythromycin
  3. Bicillin-1
  4. Ampicillin
  5. Oxacillin

 

2. 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°=37, 2°C, Heart borders without changes, Sound 1 on the apex is weakened. ECG: atrioventricular heart block I degree, lowering of the amplitude of T wave in V2-V6. In blood: Hb – 124 g/L, WBC – 5, 68 * 109/L, ESR -IS mm/h. What is the most likely di­agnosis?

  1. *Acute myocarditis
  2. CHD: unstable angina
  3. Infective endocarditis
  4. Pulmonary embolism
  5. Metabolic cardiopathy

 

3. Biological development indices for the secondary and high school pupils are the following: height, annual height increase, hand ossification, number of permanent teeth. What other index has a special importance for this age group?

  1. *Secondary sexual characters development
  2. Hand muscular force
  3. Chest circumference
  4. Lung vital capacity
  5. Weight

 

4. A 14-year-old victim was drawn out of the water in winter after 15 minutes after drowning. The victim shows no vital signs. What measures are to be taken?

  1. *Interior genital endometriosis
  2. Hydatidiform mole
  3. Uterus cancer
  4. Uterus fibromyoma
  5. Chorioepithelioma

 

A. To transport the victim to the nearest hospital for reanimation measures

B. To transport the victim to the nearest warm premises to carry out reanimation measures

Not to waste time on the release” of respiratory tract from water, to undertake cardiopulmonary reanimation

p. To release respiratory tract from water, to create drain position and to undertake measures to restore respiration and blood circulation E. Not to carry out reanimation measures

 

5. A patient, aged 58, was fishing in the winter. On return home after some time felt some pain in the feet. Consulted a doctor. On examination: feet skin was pale, then after rewarming became red, warm to the touch. Edema is not significant, limited to the toes. All types of sensitivity are preserved. No blisters. What degree of frostbite is observed?

B. *I degree

A. Ill degree

C. IV degree

D. II degree

E. V degree

 

6. A woman, aged 30, in labour, is brought to the maternity in term of 35-36 weeks with weakened  labour activity. Fetal movements are not felt. On echography: fetus’s heartbeat not determined. Vaginal inspection: cervix is 6 cm dilated, green amniotic fluid has discharged, and the head of the fetus is engaged to pelvic inlet. What is the further tactic of delivery?

D. *Cephalotomy

A. Forceps delivery

B. Vacuum extraction of the fetus

C. Conservative delivery, wait for natural birth of the fetus

E. Turning of the fetus by Braxton-Hicks

 

7. A woman, aged 64, is hospitalised on account of metrorrhagia and anemia. After 12 years of menstruation absence, 7-8 months ago there appeared at first sero-watery discharge from vagina, then — sero-bloody, with “meat slops ” colour, pain in the lower abdomen. What pathology is the most probable?

B. *Uterus cancer

A. Hydatidiform mole

C. Uterus fibromyoma

D. Inferior genital endometriosis

E. Chorioepithelioma

 

8. A 18-year-old woman consulted a gynecologist with complaints of the pain in the lower part of the abdomen, fever up to 37,50C, considerable; mucopurulent discharges from the genital tract, colic during urinating. After mirror and vagina exam the results are the following: the urethra is infiltrated, cervix of the uterus is hyperemia erosive. The uterus is painful; ovaries are painful, thickened, and free. Bacterioscopy test showed diplococcus. What diagnosis is the most probable?

  1. *Recent acute ascending gonorrhea
  2. Chronic gonorrhea
  3. Trichomoniasis
  4. Chlamydiosis
  5. Candy domycosis

 

9. A 7-year-old girl suddenly fell ill with fever, headache, severe sore throat, vomiting. Minute bright red rash appeared on her reddened skin 3 hours later. It is more intensive in axillas and groin. Mucous membrane of oropharynx is hyperemia on tonsils there are greyish patches. Submaxillary glands are enlarged and painful. What is the most likely diagnosis?

E. *Scarlet fever

A. Enteroviral infection

B. Rubella

C. Pseudotuberculosis

D. Measles

 

10. A worker (battery attendant) the end of the working day complains of intensive pains in the epigastric area, diarrhea, subfebrility, BP — 170/110 mm Hg, skin and scleras are yellow. At the lunch have drunk 250 ml of vodka. What diagnosis is the most likely?

C. *Acute lead intoxication

A. Acute hemolysis

B. Fatty degeneration of liver

D. Acute pancreatitis

E. Acute alcohol intoxication

 

11. A pediatrician examines a healthy mature-breast-fed baby, aged 1 month. Prevention of what condition should be recommended in the first place?

B. *Rachitis

A. Paraophji

C. Anaemia

D. Hypotrophy

E. Spasmophilia

 

12. When examining a patient with supposed pelvis fracture, the doctor exerts pressure with both hands on the wings of ileum in opposite direction. What is the cause of pain syndrome appearing in this case?

E. *Pelvic ring discontinuity

A. Sacral fracture

B. Ischial bones fracture

C. Retroperitoneal haematoma

D. Traumatic injury of intrapelvic organs

 

13. A baby, aged 1,5 months, in the right parietotemporal area has from the birth a tumour-like formation of purple colour, rising over the skin surface, not disappearing on pressure, dimensions 2-3 cm. What is the most likely diagnosis?

E. *Cavernous hemangioma

A. Lymphangioma

B. Congenital vascular macula

C. Angiofibroma

D. Nevus pigmentosis

 

14. In an inhabited locality there is an increase of diphtheria during the last 3 years with separate outbursts in families. What measure can effectively influence the epidemic process of diphtheria and reduce the morbidity rate to single cases?

C. *Immunisation of the population

A. Dismrection in disease focus

B. Hospitalisation of patients

D. Early diagnostics

E. Detection of carriers

 

15. Parents of 5-year-old boy complain of ventral curvature of boy’s penis. Physical examination: external urethral meatus is on the apex of penis, prepuce-is hood-like. What is the most likely diagnosis?

D. *Hypospady without hypospady

A. Induratio penis plastica (Peyronie’s disease)

B. Latent penis

C. Cryptorchidism

E. Epispadia of balanus

 

16. A 2-year-old girl has been ill for 3 days. Today she has low-grade fever, severe catarrhal symptoms, non-abundant maculopapular rash on her buttocks and enlarged occipital glands. What is your diagnosis?

E. *Rubella

A. Pseudotuberculosis

B. Measles

C. Scarlet fever

D. Adenoviral infection

 

17. A 62-year-old patient with DM-2. Diabetes is being compensated by diet and Maninilum. Patient has to undergo an operation for inguinal hernia. What should be the tactics of hypoglycemic therapy?

E. *Prescribe fast-acting insulin

A. Continue with the current therapy

B. Prescribe guanyl guanidines

C. Give Glurenorm in place of Maninilum

D. Prescribe long-acting insulin

 

18. A patient, aged 32, diagnosed with multiple injuries: closed craniocerebral injury, closed chest injury, closed right hip fracture. BP – 100/60 mm Hg, Ps – 124/min, RR – 28/min. 2 hours after skeletal extension under local anesthesia with lidocaine, there appeared abrupt aggravation of the patient’s condition: developed face and neck cyanosis: BP – 60/40 mm Hg, RR – 160/min, RR – 44/min. What complication most probably aggravated the severity of multiple injuries?

D. *Pulmonary fat embolism

A. Acute anaemia

B. Cardiac infarction, cardiogenic shock

C. Pulmonary thromboembolism

E. Pain shock

 

19. 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: PaO2 = 70-78 mm Hg, hypoxemia is not diminishing, CVP – 150-180 mm H2O, BP — 90/60 mm Hg (with administeririg of dopamine-in-high doses). Radiologically: diffuse pulmonary infiltration. What is the reason of the resistant arterial hypoxemia?

D. *Respiratory distress-syndrome

A. Bilateral pneumonia

B. Mendelson’s syndrome

C. Pulmonary edema

E. Pneumothorax

 

20. Mother with an infant visited the pediatrician. Her baby was born with body mass of 3,2 kg and 50 cm length. He is 1 year old now. How many teeth the baby should have?

B. *8

A. 20

C. 10

D. 6

E. 12

 

21. A patient was admitted to the hospital on the 7th day of the disease with complaints of high temperature, headache, pain in the muscles, especially in calf muscles. Dermal integuments and scleras are icteric. There is hemorrhagic rash on the skin. Urine is bloody. The patient was fishing two weeks ago. What is the most likely diagnosis?

B. *Leptospirosis

A. Brucellosis

C. Salmonellosis

D. Trichinellosis

E. Yersiniosis

 

22. A 20-year-old woman complains of weakness, wet cough, body temperature raise up to 37,5°C 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 3×4 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?

C. *Infiltrative tuberculosis

A. Decaying cancer

B. Focal tuberculosis

D. Tuberculoma

E. Pneumonia with abscess formation

 

23. A patient, aged 50, during 15 years is ill with essential hypertension, not under treatment. BP – 220/140 mm Hg, Ps – 80 bmp, 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?

C. *Hypertrophy and dilatation of the left ventricle

A. Blood regurgitation through the mitral valve

B. Blood regurgitation through the aortic valve

D. Hypertrophy and dilatation of the right ventricle

E. Dilatation of the left atrium

 

24. A female patient, aged 25, is hospitalized due to exudative pericarditis. Complains of shortness of breath, weakness, compression in the chest. Believes that she got ill 2 weeks ago, after common cold. What peculiarity found during examination will tell about chronic pericardium affection?

E. *Signs of pericardium calcification

A. Lowering of ECG voltage

B. Significant heart tissue dilation, pulsation weakening

C. Heart sounds deafening

D. Signs of haemostasia in greater circulation

 

25. Woman in childbirth, 25 years old, the second period of labour. Dur