Year 2002 (With Answers)

Posted: May 5, 2012 in Krok II
Tags:

1. A 24-year-old man on the 5th day of acute respiratory disease with high grade temperature started having strong headaches, systemic dizziness, sensation of double vision, paresis of mimic muscles to the right, tickling by swallowing. Diagnosis: Acute viral encephalitis. Determine the basic direction of the emergent therapy.

C. *Zovirax

A. Glucocorticoids

B. Hemodesis

D. Cephtriaxon

E. Lasix

Used For Viral Infections

2. A 29-year-old woman has had a surgical treatment concerning the benign serous epithelial tumour of the ovary. The postoperative period passed without complications.What is necessary to prescribe in the rehabilitational period?

E. *Hormone therapy and proteolytic enzymes

A. No further observation

B. Antibacterial therapy and adaptogens

C. Magnetic therapy and vitamin therapy

D. Laser therapy and enzyme therapy

 Tumour of the ovary

Tumour of the ovary

3. A 54-year-old patient applied with complaints of acute pain in the shoulder-joint. 10 minutes earlier he fell in the street with his arms stretched. Doctor of the traumatological unit noticed an acute deformation of the right shoulder-joint, the impossibilty of active movement in the right extremity. Roentgenologically: uncoincidence of articulating surfaces. What is the most probable diagnosis?

D. *Dislocation of the clavicle

A. Dislocation of the scapula

B. Contusion of the humerus

C. Dislocation of the humerus

E. Fracture of the humerus

his injury most commonly occurs in sports when an athlete falls and hits the ground with the tip of the shoulder.

This injury most commonly occurs in sports when an athlete falls and hits the ground with the tip of the shoulder.

4. A 19-year-old woman complains of pain in the abdomen and joints, asks for more analgetics and somnifacient injections. The patient was examined. Gynecological and urological pathologies are absent. There are signs of previous punctures along superficial veins of the extremities. The patient does not explain the origin of punctures. Tendon reflexes of upper and lower extremities are the same, quick. Photoreaction of the pupil of the eye is weak. The tongue is grey coated. During communication the patient in affectively not even-tempered. There is diarrhea wi­thout pathologic inclusions. What tactics is necessary to improve the condition of this patient?

A. *Consultation of an expert in narcology

B. Additional consultation of surgeon

C. Prescription of medications the patient asks for.

D. Treatment with antibiotics

E. Consultation of infectious diseases doctor

Drug Abused

Drug Abused

5. A 52-year-old woman suffering from obesity complains of bloody discharges from sexual paths during 4 days. Last normal menses were 2 years ago. Histological investigation of biopsy of the endometrium has revealed adenomatous hyperplasia. What reason from the mentioned below caused the development of disease?

C. *Excessive transformation of preandrogens from adipose tissues

A. The increased contents of follicle-stimulating hormone

B. Poor aromatization of preandrogens due to hypothyroidism

D. Hypersecretion of estrogens by tissues of the organism

E. Supersecretion of androgens by the cortex of paranephroses

Endometrial Hyperplasia

Endometrial Hyperplasia

endo2

6. A patient with nosocomial pneumonia has signs of collapse. Which of the following pneumonia complication is the most likely to be accompanied with collapse?

C. *Septic shock

A. Toxic hepatitis

B. Bronchial obstruction

D. Emphysema

E. Exudative pleuritis

2005_s2_pp16_t01_LG2005_s2_pp14_t02_LG1305_1313_3

7. A 20-year-old woman is having timed labor continued for 4 hours. Light amniotic fluid came off. The fetus head is pressed to the orifice in the small pelvis. The anticipated fetus mass is 4000,0g ± 200,0g. Heartbeat of the fetus is normal. Intrinsic examination: cervix is absent, disclosure – 2 cm, the fetal membranes are not present. The head is in 1-st plane of the pelvis, a sagittal suture is in the left slanting dimension. What is the purpose of glucose-calcium-hormone – vitaminized background conduction?

D. *Prophylaxes of weakness of labor activity

A. Fetus hypoxia prophylaxes

B. Antenatal preparation

C. Treatment of weakness of labor activity.

E. Labor stimulation

normal-delivery

8. A 7-year-old girl suddenly fell ill with fever, headache, severe sore throat, vomiting. Minute bright red rash appeared on her ablushed skin in 3 hours. It is more intensive in axillas and groin. Mucous membrane of oropharynx is hyperemic. Greyish patches are on tonsills. Submaxillary glands are enlarged and painful. What is your diagnosis?

B. *Scarlet fever

A. Enteroviral infection

C. Pseudotuberculosis

D. Rubella

E. Measles

f082fda1d633b6be13ffff3b54593471

9. A 58-year-old patient was diagnosed basal-cell skin cancer, 1st stage. Tumor is up to 1 cm in size and with up to 0,5 cm deep infiltration in tissues. Tumor is localized in the right nasolabial area. Choose the most optimal method of treatment.

E. *Short-distance roentgenotherapy ( X-radiation is called Röntgen radiation, after Wilhelm Röntge)

A. Long-distance roentgenotherapy

B. Chemotherapy

C. Surgical treatment

D. Long-distance gamma therapy

Wilhelm Röntge

Wilhelm Röntge

10. Thrombosis of the coronary artery caused myocardial infarction. What mechanisms of injury will be the dominating ones in this disease?

B. *Calcium mechanisms

A. Lipid mechanisms

C. Protein mechanisms

D. Acidotic mechanisms

E. Electrolytoosmotic mechanisms

heart_attack

11. A 28-year-old man was discharged from the hospital after having an out-of-hospital pneumonia. He has no complaints. On physical exam: his temperature is — 36,6°C, RR-18/min, Ps — 78 bpm, BP — 120/80 mm Hg. During ausculation there is harsh respiration to the right of the lower part of the lung. Roentgenologically: infiltrative changes are absent, intensification of the pulmonary picture to the right in the lower lobe. How long should the doctor keep the patient under observation?

C. *12 months

A. 1 month

B. 3 months

D. Permanently

E. 6 months

12. A 55-year-old patient complains of bloating and rumbling in the abdomen, increased outgoing of gasesfoamy liquid stool of acid odor. Symptoms appear after eating of milk products. What is the name of such symptom complex?

A. *Acid dyspepsia syndrome

B. Adipose dyspepsia syndrome

C. Dyskinesia syndrome

D. Decaying dyspepsia syndrome

E. Malabsorbtion syndrome

13. A 27-year-old patient was admitted to the psychiatric hospital for the 4-th time during 2 years. He heard voices commenting on his actions, had delusions of persecution (was sure that mafia wanted to kill him). He was discharged from hospital with the diagnosis of schizophrenia, state of remission after a course of treatment with neuroleptics. What is necessary to do to prevent relapses of schizophrenia?

E. *Supportive treatment with neuroleptics of prolonged action

A. Psychiatric observation

B. Participation in a self-assistance group

C. Long-term hospitalization

D. Psychoanalytic treatment

14. A woman in the first half of pregnancy was brought to clinic by an ambulance. Term of pregnancy is 36 weeks. She complains of intensive pain in the epigastrium, had vomiting for 2 times. Pain started after the patient had eaten vinaigrette. Swelling of lower extremities. BP — 140/100 mm Hg. Urine became curd after boiling. What is the most probable diagnosis?

D. *Preeclampsia

A. Dropsy of pregnant women

B. Exacerbation of pyelonephritis

C. Nephropathy of the 3rd degree

E. Food toxicoinfection

15. A 2-months-old child after preventive vaccination had a prolonged hemorrhage from the vaccination place and due to those an intramuscular hematoma. Duri ng examination of the child a considerable rise of prothrombin consumption and a significant prolongation of the activated partial thromboplastic time were found. What is the most probable diagnosis?

A. *Hemophilia

B. Werlhof’s disease

C. Henoch-Schoenlein disease

D. Hemorrhagic disease of the neonate

E. Inborn afibrinogenemia

16. District physician was charged with plan drafting concerning medical and preventive measures among the population in the area he is assigned to. What measures must he include in this plan as regards primary prevention of illness?

C. *Prevention of disease onset

A. Referral of patients to sanatorium

B. Measures to improve patients’ life conditions

D. Prevention of disease complications

E. Measures to increase patients’ life quality

17. A 27-year-old patient was brought to clinic with a crashed wound of the posterior surface of the right shin in 2 hours after the accident happened. During surgical treatment pieces of dirty clothes and gravel were removed. What actions from the given below are the decisive ones to prevent an anaerobic infection?

A. *Radical surgical treatment

B. Introduction of the medical dose of the anti-gangrene serum

C. Rational antibiotic therapy

D. Hyperbaric oxygenation

E.  Introduction of the preventive dose of an anti-gangrene serum

18. A pupil of the 8th form after trauma has acute atrophy of the left arm muscles, tonus of which is distinctly decreased, active movements are only in the left joint, pupil’s foot is deformed. Function of support of the left leg is absent; support function of the right leg is preserved. The boy wears orthopedic footwear. What group of physical training does the boy belong to?

D. *Special

A. Preparatory

B. Additional

C. Other

E. Basic

19. The woman from a group of risk (chronic pyelonephritis in anamnesis) had labor through natural birth canal. In one day after labor she started complaining of fever and loin pains, often urodynia. Establish the most probable complication.

E. *Infection contamination of the urinary system

A. Apostatis of stitches after episiotomy

B. Endometritis

C. Infected hematoma

D. Thrombophlebitis of veins of the pelvis

20. A 18-year-old patient had subtotal strumectomy due to malignant capillary cystadenoma of the thyroid gland. In 2 months there was a suspicion of metastasis presence in the lungs. What rontgenological method is to be used first?

E. *Roentgenography of lungs

A. Bronchoscopy

B. Angiopneumonography

C. Roentgenoscopy of lungs

D. Bronchography

21. During a period of 1 year 11 600 diseases were registered in the clinic. Among them are: influenza and acute respiratory disease – 5800, blood circulatory system diseases — 34 800, digestion organs diseases — 1300 and others-1020. What relative index can be calculated according to this data?

A. *Extensive

B. Intensive

C. Relative intensity

D. Visual graphic

E. Correlation

22. A 12-year-old girl applied to doctor with complaints of swelling on the front part of the neck. The doctor diagnosed hyperplasia of the thyroid gland of the second degree, euthyroidism. Ultrasound suspected autoimmune thyroiditis. Blood was taken for titre of antibodies to thyroglobulin. What titre of antibodies will be diagnostically important?

B. *1:100

A. 1:50

C. 1:150

D. 1:200

E. 1:250

23. A 10-year-old child complains of fever (temperature is 39°C), frequent painful urination [pollakiuria]. Urine test: proteinuria [0,066 g/L], leukocytouria [entirely within eyeshot], bacteriuria [105 colony forming units/mL]. What is the most probable diagnosis?

D. *Acute pyelonephritis

A. Acute glomerulonephritis

B. Acute cystitis

C. Dysmetabolic nephropathy

E. Urolithiasis

24. Define the basic registration document on the profound study of rate of cases with temporary loss of ability to work on the industrial enterprise.

A. *A card of the personal account of rate of cases

B. An ambulatory medical card

C. Sick-leave

D. Report of temporary loss of ability to work

E. An inpatient medical card

25. By the end of the 1st period of physiological labor clear amniotic fluid came off. Contractions lasted 35-40 sec every 4-5min. Heartbeat of the fetus was 100 bpm. The BP was 140/90 mm Hg. What is the most probable diagnosis?

C. *Acute hypoxia of the fetus

A. Hydramnion

B. Premature detachment of normally posed placenta

D. Back occipital presentation

E. Premature labor

26. A 22-year-old man with polyarthralgia and high-grade fever has right-sided exudative pleuritis. Roentgenological, down to the right of the 4th rib there is a homogeneous dark cloud. To the left, in the second segment — an isolated dense-focused shadow. Mantoux test with 2 TU: 16 mm papula. The protein content in the pleural fluid is increased, Rivalt reaction is positive, increased amount of leucocytes with lymphocyte predomination. What is the most probable etiology of pleuritis?

B. *Tuberculous

A. Cancerous

C. Viral

D. Autoimmune

E. Staphylococcal

27. A 38-year-old woman was hospitalized to the surgical unit with acute abdominal pain irradiating to the spine and vomiting. On laparocentesis hemorrhagic fluid is obtained. What disease is meant?

D. *Acute pancreatitis

A. Renal colic

B. Acute appendicitis

C. Perforative gastric ulcer

E. Acute enterocolitis

28. A 7-year-old child is sick for 2 weeks with running nose, was taking nasal drops. The boy suffers with alimentary allergy. He applied to doctor due to suppurative and bloody discharges from nose, maceration of ala nasi and upper lip. Rhinoscopy results: there are whitish-greyish areas at nasal septum. Mucous membrane of oropharynx is not changed. What is the most probable disease?

D. *Diphtheria of the nose

A. Allergic rhinitis

B. Sinusitis (maxillar sinus))

C. Rhinovirus

E. Adenovirus

29. In 13 months after the first labor a 24-year-old woman complains of amenorrhea. Cesarian section was conducted as a result of premature detachment of normally posed placenta. Hemorrhage has made low fidelity of 2000 ml due to breakdown of coagulation of blood. Choose the most suitable investigation.

E. *Determination of the level oi gonadotropin

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

B. Computer tomography of the head

C. Ultrasound of organs of a small pelvis

D. Progesteron test

30. What information gathering method is preferable to study housing conditions of medical students during training period?

E. *Questionnaire

A. Materials selection

B. Statistical

C. Directed selection method

D. Interviewing

31. A 36-year-old woman applied to doctor with complaints of the enlargement of the right mammary gland. On physical exam: the right mammarj gland is enlarged, hardened; nipple with areola is pasty and hydropic, looks like “lemon peel”. There palpates a lymph node in the right axilla, 1,5 cm in diameter, dense consistence, not mobile. What is the most probable diagnosis?

E. *Hydropic and infiltrative cancer of the mammary gland

A. Erysipelatouslike cancer of the mammary gland

B. Paget’s cancer

C. Diffusive mastopathy

D. Acute mastitis

32. At the radiological unit of the hospital, gamma-devices of radiotherapy of “Agaf’type and other closed sources of ionizing radiation are used for treatment of malignant neoplasms. What are the measures to be taken to protect personnel at the time of work with radioactive sources of such type?

A. *Shortening of working time and screening of the source

B. Capsulation of devices and organization of room ventilation

C. Systematical cleansing of surfaces from the radioactive contamination and shortening of working time

D. The increase of distance to the source and individual hygiene compliance

E. Screening of the source and the use of means of individual protection of respiration organs

33. A 16-year-old adolescent was vaccinated with DTP. In eight days there was stiffness and pain in the joints, subfebrile temperature, urticarial skin eruption, enlargement of inguinal, cervical lymph nodes and spleen. What kind of allergic reaction is observed?

D. *Immunocomplex

A. Hypersensitivity of delayed type

B. Cytoxic

C-

E. Hypersensitivity of immediate type

34. The adolescent of 15 years old was brought to the hospital with complaints of poor night eyesight. On physical exam: increased darkness adaptation time, Bitot’s spots on conjunctiva. The patient skin is dry, scales off; folliculitis signs of the face skin are present. What is a cause of this disease?

C. *Retinole deficit

A. Thiamine deficit

B. Biotin deficit

D. Folic acid deficit

E. Napthtochynones deficit

35. A 75-year-old patient can not tell the month, date and season of the year. After long deliberations she manages to tell her 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?

D. *Senile dementia

A. Behavior disorder

B. Presenile melancholia

C. Atherosclerotic(lacunar) dementia

E. Dissociated personality (psychopathy)

36. A 27-year-old woman was admitted to clinic with complaints of pain in right ankle joint, impossibility to stand on those extremity. Clinical examination: the patient had a fracture of anterior part of distal metaepiphisis of tibia [Pott-Desto’s fracture]. What is the mechanism of such injury?

D. *Supination of the foot

A. Load along the axis with planter flexion of foot

B. Direct blow

C. Load along the axis with dorsal flexion of foot

E. Pronation of the foot

37. A 32-year-old in-patient with the diagnosis of “acute abscess of the right lung “after cough had developed sudden difficult breathing, cyanosis. There is pain in the right half of thorax. What is the most probable complication that is observed in the patient?

B. *Pyopneumothorax

A. Embolic pneumonia

C. Perforation of the esophagus

D. Myocardial infarction

E. Exudative pleurisy

38. A 62-year-old patient is having NI-DDM. Diabetes is being compensated by diet and Maninilum. The patient has to be operated for inguinal hernia. What is the tactics of hypoglycemic therapy?

D. *To prescribe short-acting insulin

A. To prescribe Glurenorm instead of Maninilum.

B. To continue current therapy

C. To prescribe guanyl guanidines

E. To prescribe long-acting insulin

39. A 58-year-old woman complains of osteoarthrosis of knee-joint. For 2 weeks she had been receiving an in-patient medical treatment. She was discharged from the hospital in satisfactory condition with complaints of minor pain after prolonged static work. Local hyperemia and exudative effects in the area of joints are absent. What further tactics is the most expedi­ent?

C. *Outpatient treatment

A. Orthopedist consultation

B. Refferral to MSEC

D. Repeated in-patient treatment

E. Conducting arthroscopy

40. A woman is admitted to maternity home with discontinued labor activity and slight bloody discharges from vagina. The condition is severe, the skin is pale, consciousness is confused. BP is 80/40 mm Hg. Heartbeat of the fetus is not heard. There was a Cesarian section a year ago. Could you please determine the diagnosis?

C. *Hysterorrhesis

A. Premature expulsion of amniotic fluid

B. Placental presentation

D. Expulsion of the mucous plug from cervix uteri

E. Cord presentation

41. A 36-year-old woman is on the 12-th week of her first pregnancy. In the past history she had undergone treatment for infertility. Recently she visited guests and contacted a child who developed rubella in 2 days after meeting. The woman doesn’t remember whether she was infected with rubella or not. What is the adequate tactics?

E. *Monitoring of the specific Ig G Ig M with the enzyme-linked immunosorbent assay (ELISA)

A. Cyclovin administration

B. Immune globulin injection

C. Interruption of the pregnancy

D. Interferon administration

42. A 37-year-old patient was brought to resuscitation unit. General condition of the patient is very serious. Sopor. The skin is grey, moist. Turgor is decreased. Pulse is rapid, intense. BP — 160/110 mm Hg, muscle tonus is increased. Hyperreflexia. There is an ammonia odor in the air. What is the presumptive diagnosis?

B. *Uraemic coma

A. Hyperglycemic coma

C. Alcoholic coma

D. Hypoglycemic coma

E. Cerebral coma

43. A patient complains of pathological mass in the right inguinal part during physical work. The mass is round; about 4 cm in diameter, during palpation is of soft and elastic consistence, located at the medial part of the inguinal ligament. This mass is situated medial to seminal funi­culus. What is the preliminary diagnosis?

A. *Right-sided direct inguinal hernia

B. Right-sided femoral hernia

C. Lipoma of the right inguinal part

D. Varicose veins of the right thigh

E. Right-sided indirect inguinal hernia

44. After a wasp-bite there was an itching of skin, hoarse voice, barking cough, anxiety. On physical exam: there is edema of lips, eyelids, cyanosis. What medicine is to be taken first?

A. *Prednisolone

B. Adrenalin

C. Euphylin

D. Lasix

E. Seduxen

45. A 75-year-old man who developed diabetes within the last six months was found to be jaundiced. He was an asymptomatic patient except weight loss of 5 kg in 6 months. On physical examination, nontender, globular, right upper quadrant mass that moves with respiration. Abdominal computed tomography (ACT) scan shows an enlargement of the head of the pancreas, with no filling defects in the liver. What can be diagnosed?

A. *Carcinoma of the head of the pancreas

B. Metastatic disease of liver

C. Haemolytic jaundice

D. Malignant biliary stricture

E. Infectious hepatitis

46. A 42-year-old man died in a road accident after the hemorrhage on the place due to acute hemorrhagic shock. What minimum percent of all blood volume could cause the death?

B. *25-30%

A. 35-50%

C. 6-9%

D. 15-20%

E. 10-14%

47. A 26-year-old woman gave birth to a child 6 months ago. She applied to gynecologist complaining of menstruation absence. The child is breast-fed. Vagina exam: uterus is of normal form, dense consistence. What is the most probable diagnosis?

A. *Physiological amenorrhea

B. Sheehan’s syndrome

C. Pseudoamenorrhea

D. Gestation

E. Asherman’s syndrome

48. District physician was charged with plan preparation concerning the conducting of medical and preventive measures among the population in the area he is assigned to. What measures must he include in this plan as regards secondary prevention of illness?

A. *Prevention of disease complications

B. Improvement of patients’ life conditions

C. Prevention of disease onset

D. Elimination of causes of diseases onset

E. Conducting of rehabilitation measures

49. A 30-year-old man has a history of recurrent pneumonias and chronic cough production of foul smell, purulent sputum, ocassionally gloom tinged, which becomes worse in the morning and in reclining position. On physical examination, it is a chronic patient with clubbing of fingers, wet inspiratory tract at the root of lungs from behind. What is the most probable diagnosis?

A. *Bronchoectasis

B. Disseminated pulmonary tuberculosis

C. Pulmonary neoplasm

D. Chronic bronchitis

E. Chronic obstructive emphysema

50. A 34-year-old patient is hospitalized with complaints of cervical and axillary lymph nodes enlargement, subfebrile temperature during the last 2 months, increased sweating. There are Reed-Sternberg (Berezovsky) cells in the punctation of lymph nodes. What method of investigation is expedient to use to study the extent of tumor process?

C. *Lymphoscintigraphy

A. Antiography

B. Thermography

D. Roentgenological investigation

E. Lymphography

51. A 43-year-old patient complains of contact hemorrhages during the last 6 months. Bimanual examxervix 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?

C. *Cancer of cervix of the uterus

A. Leukoplakia

B. Cervical pregnancy

D. Nascent fibroid

E. Polypus of the cervix of the uterus

52. A 5-year-old child had strong headache, vomiting, ataxy, dormancy, di-scoordination of movements, tremor of the extremities on the 8th day of the disease. It was followed by rise in body temperature, vesiculosis rash mainly on the skin of the body and the hairy part of the head. At the second wave of the fever a diagnosis of encephalitis was given. What disease complicated encephalitis in this case?

A. *Chicken pox

B. Measles

C. Herpetic infection

D. Enterovirus ifection

E. German measles

53. A 26-year-old patient undergoes a course of treatment due to chronic glomerulonephritis. The treatment was successful, normalization of all the characteristics was recorded. What sanitorium and health resort treatment could be recommended?

C. *The south coast of the Crimea

A. Morshyn

B. Truskavets

D. Myrhorod

E. Not recommended

54. A 1,5-year-old child has following symptoms: chronic cough with purulent sputum discharge. Dyspnea, physical retardation, large amount of stool. Sweat chloride isl50 mEq/L. The child has been ill since 2 month age. Diagnosis: cystic fibrosis. What is the most suitable therapy?

E. *Enzymes + antibiotics

A. Vitamins + mucolytics

B. H2-blockers + hepatoprotectors

C. Cholepoietic+adaptogenetic medicines

D. Vitamins+antibiotics

55. A 65-year-old patient complains of gradual worsening of the left eye vision during 10 months. On physical examination: acuty of vision of the left eye is 0,01, not correctable. The eye is quiet, pupil of the eye is grayish, reflex from the eye-ground is absent. Intraocular pressure is 18 mm/Hg. What is the most probable preliminary diagnosis?

A. *Senile cataract

B. Open-angle glaucoma

C. Leukoma of the cornea

D. Disorder of blood circulation in retina vessels

E. Exfoliation of the retina

56. A 42-year-old patient applied to hospital with complaints of pain behind the sternum with irradiation to the left scapula. The pain appears during significant physical work; this lasts for 5-10 minutes and is over on rest. The patient is sick for 3 weeks. What is the preliminary diagnosis?

A. *IHD: First established angina pectoris

B. IHD: Variant angina pectoris (Pri­nzmetal’s)

C. IHD: Stable angina pectoris of effort IV FC

D. IHD: Progressive angina pectoris

E. IHD: Stable angina pectoris of effort I FC

57. A 8-year-old boy has suffered from tonsillitis. In 2 weeks he started complaining of migratory joint pain, edema of joints, restriction of movements, fever. On examination, an acute rheumatic heart disease, activity of the III-rd degree, primary rheumocarditis, polyarthritis; acute course of disease, cardiovascular failure IIA. What medication is to be prescribed?

A. *Prednisone

B. Erythromycin

C. Cefazolin

D. Diprazinum

E. Delagil

58. An anesthesiologist gives narcosis to the patient; he uses a non-reversive contour. Anesthetic is halothane. Air temperature in the operation room is 21°C, humidity 50%, and level of noise 30 dB. What occupational hazard is the principal one in these conditions?

A. Improper occupational microclimate

B. (Air pollution with anesthetic

C. Compelled working pose

D. High level of noise

E. Mental overfatigue

59. A 40-year-old woman complains of colic pains in the lower part of abdomen and abundant bloody discharges from genital tract. Last 2 years she had menses for 15-16 days, abundant, with clots, painful. Had 2 medical abortions. In bimanual investigation: from the canal of the cervix uteri — a fibromatous node, 3 cm in diameter, on the thin stem. Discharges are bloody, moderate. Choose the correct tactics.

C. *Operation: untwisting of born node

A. Hormonal hemostasis

B. Hysterectomy without ovaries

D. Phase by phase vitamin therapy

E. Supravaginal ablation  of the  uterus without ovaries

60. Purulent mediastinitis is diagnosed at a 63-year-old patient. What diseases from the stated below CANNOT cause the purulent mediastinitis?

E. *Cervical lymphadenitis

A. Deep neck phlegmon

B. Iatrogenic injury of the trachea

C. Perforation of the cervical part of the easophagus

D. Perforation of the thoracic part of the easophagus

61. At the gynaecological department there is a patient of 32 years with the diagnosis: “acute bartholinitis “.Body temperature is 38,2°C, leucocytes count 10,4*109/£, the ESR is 24 mm/hour. In the area of big gland of the vestibulum -the dermahemia, the sign of the fluctuation, sharp tenderness (pain). What is the most correct tactics of the doctor?

A. *Surgical dissecting, a drainage of an abscess of the gland, antibiotics

B. Antibiotics, Sulfanilamidums

C. Antibiotic therapy

D. Surgical dissection, drainage of the abscess of the gland

E. Antibiotics, detoxication and biostimulants.

62. District doctor of rural medical department was called to a 42-year-old patient. While examining the patient, the doctor suspected the dysentery. What document must the doctor issue?

C. *Urgent notification of infectious disease

A. Statistical coupon of final (precise) diagnosis

B. Abstract of outpatient medical card

D. Infectious disease report

E. Report addressed to Head of the village

63. A 5-year-old child had an attack of palpitation with nausea, dizziness, generalized fatigue. On ECG: tachycardia with heartbeat rate of 220/min. Ventricle complexes are deformed and widened. P wave is absent. What medication is to be prescribed to provide first aid?

C. *Lydocain

A. Isoptin

B. Seduxen

D. Novocainamides

E. Strophantin

64. A 18-year-old patient applied to gynecologist with complaints of the pain in the lower part of the abdomen, rise in body temperature to 37,5°C, considerable mucopurulent  discharges from the genital tract, colic by urinating. After mirror and vagina exam the results are the following: the urethra is infiltrated, cervix of the uterus is hyperemic, erosive. The uterus is painful; ovaries are painful, thickened, and free. Bacterioscopy test showed diplococcus. What diagnosis is the most probable?

D. *Recent acute ascending gonorrhea

A. Chronic gonorrhea

B. Chlamydiosis

C. Trichomoniasis

E. Candydomycosis

65. A 32-year-old woman complains of the pain in the left epigastric area that appeared in 2 hours after meal. She also complains of nausea, bloating of the abdomen, tendency to diarrhea. On physical exam: icteric scleras. The abdomen is painful by palpation in the Gubergrits and Skulsky point. The liver is at the ribs edge. Blood tests: amylase — 288 mmol/L, total bilirubin – 20//mol/L. What are the most probable diseases?

B. *Chronic pancreatitis

A. Chronic gastritis

C. Chronic cholecystitis

D. Chronic hepatitis

E. Chronic enterocolitis

66. A man with a stab-wound of the right foot applied to doctor. He stepped on the board with nail two hours ago. In the patient medical chart it is stated those 3 years ago he passed the whole course of vaccination against tetanus. What is the tactics of doctor to prevent tetanus in this case?

E. *Do not conduct specific prophylaxis

A. Administer 0,5 ml of tetanus toxoid

B. Administer 1 ml tetanus toxoid and 3000 U of anti-tetanic serum

C. Administer 1,0 ml of tetanus toxoid

D. Administer 3000 U of anti-tetanic serum

67. During the examination of the placenta which was just born, the defect of 2 x 3 cm was found. There is no hemorrhage. What is the most appropriate tactics?

E. *Hand revision of the uterine cavity

A. To prescribe uterotonic medications

B. External massage of the uterus

C. Observation of woman after labor

D. Instrumental revision of the uterine cavity

68. A 65-year-old patient complains of asphyxia, cough with foamy red sputum, air deficiency, death fear. On physical exam: the skin is pale, acrocyanosis, cold sticky perspiration. Harsh breathing, moist small and medium-vesicular rales are in lower and hind parts on both sides. What is the most probable presumptive diagnosis?

A. *Edema of lung

B. Croupous pneumonia

C. Asthmatic status

D. Embolic pneumonia

E. Thromboembolism of pulmonary artery

69. A 9-year-old 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.

C. *2nd group

A. 4th group

B. 3rd group

D. 1st group

E. 5th group

70. A 65-year-old patient complains of dull pain in the rectum during and after defecation, discharge of mucus and small amount of blood mixed up with mucus and faeces. The discharged blood is of dark red color, sometimes with small amount of clots. The patient is sick for 8 months, has lost some weight. On digital examination, there is a round constriction of the rectum with infiltrate at a height of 4-5 cm from the anus. What is the most probable diagnosis?

E. *Cancer of the medium-ampullar section of the rectum

A. Cicatricial stenosis of the rectum

B. Crohn’s disease

C. Non-specific ulcer colitis

D. Chronic paraproctitis

71. A 4-year-old child on the 5th day of illness complains of cough, rash on the skin. Temperature is 38,2°C, face is puffy, photophobia, conjunctivitis. There is a bright papulomacular rash on the face, neck, upper half of the thorax. Pharynx is hyperemiated. There are serous and purulent discharge from nose, dry rales in the lungs. What is your preliminary diagnosis?

C. *Measles

A. German measles

B. Enterovirus infection

D. Adenovirus infection

E. Scarlet fever

72. A 52-year-old patient has hypervolemic type of essential hypertension. What medication is necessary to prescribe either as monotherapy or in complex with other antihypertensive remedies?

E. *Hypothiazid

A. Dibazol

B. Niphedipin

C. Kapoten

D. Clophelin

73. A mother who is on partially paid maternity leave got sick and was hospitalized. What document is to be issued to a working father who will be taking care of a child during his mother’s illness?

C. *Sick-leave

A. Certificate of child’s care necessity

B. Free-form certificate

D. Extract from the medical card of out- or in-patient

E. Certificate of mother’s illness

74. A 62-year-old patient complains of the pain behind the sternum, bad passing of solid and liquid food, bad breath, increased salivation weight, loss of 15 kg during the period of 2 months. Appetite is retained. On physical exam: face features are sharpened. The skin is pale, with sallow tint, its turgor is decreased. The liver is not enlarged. Blood Hb — 86g/L. Gregersen reaction is positive. What kind of pathology caused the given clinical situation?

B. *Esophagus cancer

A. Benign growth of esophagus

C. Cicatricial constriction of esophagus

D. Chronic non-specific esophagitis

E. Achalasia of esophagus

75. In the anamnesis of a 2-year-old girl there are recurrent pneumonias with signs of obstruction. There are heterogeneous moist and dry rales, respiration is weakened. Dense, viscous secretion is difficult to hawk. There are “drumsticks”, physical retardation. What is the most probable diagnosis?

D. *Mucoviscidosis, pulmonary form

A. Pulmonary tuberculosis

B. Bronchial asthma

C. Recidivating bronchitis

E. Congenital pulmonary polycystosis

76. A 33-year-old woman works as the secretary. Her diet contains 150 g of protein (including 100 g of animal), 200 g of fat, 600 g of carbohydrates. What pathology this diet can cause?

C. *Obesity

A. Paradontosis

B. Uterine fibromyoma

D. Schizophrenia

E. Common cold

77. A 35-year-old man was operated on peptic ulcer of the stomach. Mass deficit of the body is 10 kg. The level of glucose after operation in the undiluted cellular blood on an empty stomach is 6,7 mmol. During repeated examination — 11,1 mmol (after meal), level of HbAlc -10%. Could you please make an interpretation of the given data?

D. *Diabetes mellitus

A. Disordered tolerance to glucose

B. Diabetes mellitus risk group

C. Norm

E. Postoperative hyperinsulinemia

78. A 35-year-old woman was admitted to resuscitation department in asthmatic status. What is the most trustworthy criterion of breath effectiveness?

E. *PaCO2 and PaO2

A. Determination of “dead” space

B. Minute respiratory volume

C. Respiration rate

D. Respiratory volume

79. A 42-year-old woman who works at mercury thermometers factory, complains of the headache, syncopes, reduction of memory, small and frequent flutter of fingers of stretched hands, eyelids and the tongue, bleeding gums, gingivitis. What medication is necessary to use for mercury elimination?

A. *Unithiol

B. Sodium hydrate of carbon

C. Seduxen

D. Pentoxil

E. Magnesium sulphate

80. In 30days, after accidental coitus a 25-year-old patient developed ulcers on penis. On physical exam: inside of prepuce there is painless round erosion, 1,5 cm in diameter, with dense bottom, with even edges, without evident inflammatory changes. What is the most probable diagnosis?

A. *Primary syphilis (hard chancre)

B. Herpes simplex

C. Scabies complicated with pyococcuses

D. Chancriform pyoderma

E. Chancroid (soft chancre)

81. A 23-year-old patient wounded his left arm as a result of gunfire. The bones of the arm are undamaged. What appropriate surgical help must be provided to this patient?

D. *Primary surgical processing with a flowing suction

A. Suture wound and dries it

B. Aseptic dressing of the wound

C. Suture wound

E. Dry wound with towel gauzes

82. A 10-year-old boy complains of a headache, weakness, fever [temperature — 40° C], vomiting. On physical examination: there is an expressed dyspnea, pale skin with a flush on a right cheek, right hemithorax respiratory movement delays, dullness on percussion of the lower lobe of the right lung, weakness of vesicular respiration in this region. The abdomen is painless and soft by palpation. What disease causes these symptoms and signs?

A. *Pneumonia croupousa

B. Intestinal infection

C. Acute appendicitis

D. Acute cholecystitis

E. Influenza

83. While making a round, a doctor had noticed the edema of the right shoulder of a 26-day-old child with diagnosis of “umbilical sepsis”. Active movements in the shoulder joint were absent, right hand was hanging down. Mother stated that her child’s condition had worsened for the last 24 hours what resulted in child’s refusal to be breast-fed, restlessness, weeping while swaddling, rise in body temperature up to 38,8°C. What is the most probable preliminary diagnosis?

D. *Epiphysial osteomyelitis of the humerus

A. Fracture of the humerus

B. Traumatic brachioplexitis

C. Phlegmon of the shoulder

E. Fracture of the clavicle

84. A 40-year-old woman with acute gastrointestinal hemorrhage was transfused 400 ml of the preserved blood after having conducted all compatibility tests. After hemotransfusion the condition of the patient became worse. She started having headache, muscles pain, her temperature has risen up to 38,8° C. What is the reason for such condition of the patient?

B. *Pyrogenic reaction of medium severity

A. Allergic reaction

C. Air embolism

D. Hemotransfusional shock development

E. Bacterial and toxic shock development

85. A 5-year-old child with stigmas of dysembryogenesis (small chin, thick lips, opened mouth, hyperthelorismus) has systolic murmur in the second intercostal to the right of the sternum. The murmur passes to the neck and along the sternum left edge. The pulse on the left brachi­al artery is weakened. BP on the right arm is 110/60 mm Hg, on the left -100/60 mm Hg. ECG results: hypertrophy of the right ventricle. What defect is the most probable?

B. *Aortic stenosis

A. Open aortic duct

C. Defect of interventricular septum

D. Defect of interatrial septum

E. Coarctation of the aorta

86. A 16-year-old woman complains of the abdominal pain and purpuric spots on the skin. Laboratory investigations revealed normal platelet count with hematuria and proteinuria. What is the most probable diagnosis?

C. *Henoch-Schoenlein purpura

A. Thrombotic thrombocytopenic purpura

B. Heavy metal poisoning

D. Hemolytic uremic syndrome

E. Subacute bacterial endocarditis

87. A 38-year-old patient is under observation having polyneuritic syndrome with considerable loss of weight, fever, and rise in BP Blood test: considerable inflammatory changes. What examination is the most expedient to make the diagnosis?

A. *Muscular biopsy with histological investigation of the material

B. Blood culture

C. Determination of antinuclear antibodies

D. Electromyography

E. Determination of HLA antigens

88. A patient complains of an extremely intense pain in epigastrium. He has peptic ulcer disease of duodenum for 10 years. The patient is in the forced position being on the right side with legs abducted to stomach. Abdomen has acute tenderness in the epigastrium. Guarding contraction of the abdominal wall muscles is observed. What is the preliminary diagnosis?

D. *Perforation of ulcer

A. Penetration of ulcer into pancreas

B. Acute pancreatitis

C. Acute condition of peptic ulcer disease

E. Thrombosis of mesenteric vessels

89. A 24-year-old man on the second day of the disease with a sudden onset complains of a strong headache in temples and in the area of orbits, dull pain in the body, dry painful cough. His temperature is 39°C. Adynamic. Mucous membrane of oropharynx is “flaming”, rales are not ausculated. What is the most probable diagnosis?

D. *Influenza

A. Parainluenza

B. Meningococcus infection

C. Pneumonia

E. Respiratory mycoplasmosis

90. Chest X-ray of the miner (with 24-year-length of service; dust concentration on working place is 260—280 mg/m3,15% of which is free silicon dioxide) showed the signs that are typical of pneumoconiosis. What kind of pneumoconiosis is this?

C. *Anthraco-silicosis

A. Silicosis

B. Carboconiosis

D. Silicatosis

E. Anthraco-silicatosis

91. A 45-year-old woman complains of unbearable crampy pain in the left half of face with 1-2 minutes duration. Attacks are caused by mastication. The patients fall ill two months ago after being in cold. On physical exam: pain in exit points of trigeminal nerve on the left. Touch near left ala nasi causes attack with tonic convulsi­on of facial muscles. What is the most probable diagnosis from the given below?

C. *Neuralgia of trigeminal nerve

A. Arthritis of mandibular joint

B. Sinusitis (maxillaris)

D. Neuralgia of glossopharyngeal nerve

E. Facial migraine

92. A neonate was born from the 1st gestation on term. The jaundice was revealed on the 2nd day of life, and then it became more acute. The adynamia, vomiting and hepatomegaly were observed. Indirect bilirubin level was 275/imol/L, direct bilirubin level – Sμ mol/L, Hb — 150 g/1. Mother’s blood group – 0[I], Rh+, child’s blood group- A[II], Rh+. What is the most probable diagnosis?

A. *Hemolytic disease of the neonate [ABO incompatibility], icteric type

B. Physiological jaundice

C. Hepatitis

D. Hemolytic disease of the neonate [Rh -incompatibility]

E. Jaundice due to conjugation disorder

93. A 28-year-old patient was admitted on the 9th day of the disease to the clinic with complaints of temperature up to 39,0°C, headache, weakness, constipation. On physical examination, single roseolas are on skin of the abdomen. Ps — 78 bpm. The liver is enlarged by 2 cm. What is the probable diagnosis?

B. *Typhoid fever

A. Brucellosis

C. Malaria

D. Leptospirosis

E. Sepsis

94. A 38-year-old man is working for 15 years on the slate producing factory. He complains of expiration dyspnoe on exertion, dry cough. On physical exam: dullness of the percutory sound in the interscapular area, harsh respiration, dry diffused rales. There are warts of grayish color on hands. The doctor of the plant suspects asbestosis. What method is the most informational to confirm the diagnosis?

B. *Chest X-ray exam

A. Blood gases analysis

C. Bronchoscopy

D. Spirography

E. Bronchoalveolar lavage

95. A patient had disorder of nasal respiration, mucopurulent discharges from nose, headache for 3 weeks. At anterior rhinoscopy in middle nasal meathus the stria of pus, edema, hyperemia of the mucosa of the nose have been determined. What diagnostic method is necessary to administer first of all?

B. *An X-ray of paranasal sinuses

A. General blood test

C. CT of a skull

D. Bacteriology analysis of the mucous

E. Punction of the maxillar sinus nasal

96. A 35-year-old patient complains of BP rise, headache, tinnitus, tachycardia. On physical examination, Ps —100 bpm, rhythmical, intensive. BP — 240/100 mm Hg. Left border of the relative cardiac dullness is moved to the left for 1 cm, Sound I on the apex is weakened, accent of the Sound Ilnd – on aorta. Rough systolic murmur is ausculated on each side of the umbilicus. What pathology could cause this clinical picture?

A. *Stenosis of renal arteries

B. Essential hypertension

C. Chronic glomerulonephritis

D. Nephroptosis

E. Conn’s syndrome

97. A 27-year-old 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?

E. *Gastritis of type B

A. Reflux-gastritis

B. Gastritis of A type

C. Rigid antral gastritis

D. Menetrier’s disease

98. Thyreotoxicosis patient is in the two-place hospital ward of therapeutic department. The area of the ward is 18m2, height is 3 m, ventilation rate is 2,5/h. Air temperature is 20° C, relative humidity is 45%, air movement velocity is 0,3 m/sec, light coefficient is 1/5, noise level constitutes 30 dB. Make a hygienic assessment of these conditions.

D. *Discomfortable microclimate

A. All conditions are OK

B. Non-effective ventilation

C. High level of noise

E. Poor lighting

99. The diagnosis of a right-sided pneumothorax is made to a 36-year-old patient. What method of treatment is indicated to the patient?

E. *Drainage of the pleural cavity

A. Pleural puncture

B. Thoracotomy

C. Symptomatic therapy

D. Antiinflammation therapy

100. A 35-year-old patient with alcohol abuse and abnormal diet complains of pain in epigastrium that occurs in 1-1,5 hours after having meal. Fibrogastroduodenoscopy: marked hyperemia, small defects, and easy appearance of sores on the mucous membrane in the antral section of the stomach. What is the most probable reason for this pathology?

C. *Helicobacter pylori infection

A. Presence of antibodies to parietal cells

B. Nervous overstrain

D. Alimentary factor

E. Toxic action of alcohol

101. Melanoma diagnosis was made after examination to a 16-year-old patient who complained of frequent pain in the abdomen. Pigmentation of the mucosa and skin, polyps in the stomach and large intestine were found. It is known that mother of the patient had an analogous pigmentation and was treated often for anemia. What kind of disease is meant?

A. *Peutz – Eghers syndrome

B. Crohn’s disease

C. Tuberculosis of the intestine

D. Hirschsprung’s disease

E. Adolescent polyposis

102. A 40-year-old patient is sick for 8 years. He complains of pain in the loin region during physical work, in neck and thorax parts especially during cough, pain in the right hip and joints. On physical exam: body is fixed in the positon of incline forward with the head pulled down, atrophy of the gluteus. What is the most probable diagnosis?

A. *Ancylosing spondyloarthritis

B. Spread osteochondrosis of the vertebral column

C. Tuberculous spondylitis

D. Spondyloarthropatia on the background of Reiter’s disease

E. Psoriatic spondyloarthropatia

103. A 57-year-old man complains of shortness of breath, swelling on shanks, irregularity in cardiac work, and pain in the left chest half with irradiation to the left scapula. Treatment is ineffective. On physical exam: heart’s sounds are diminished, soft systolic murmur on the apex. Ps — 100/min, arrhythmical, BP – 115/75 mm Hg. The liver is +2 cm, painful. Roentgenoscopy: enlargement of heart shadow to all sides, pulsation is weak. Electrocardiogram (ECG): leftventricled extrasystolia, decreased voltage. What method of investigation is necessary to do to determine the diagnosis?

E. *Echocardiography

A. Coronarography

B. X-ray kymography

C. Veloergometria

D. ECG in the dynamics

104. During examination of a patient, masses in the form of condyloma on a broad basis are found in the area of the perineum. What is the tactics of the doctor?

A. *To send a woman into dermatological and venerological centre

B. Antiviral treatment

C. Cryodestruction of condyloms

D. Chemical coagulator treatment

E. Surgical ablation of condyloms

105. To study physical development of children and adolescents, anthropometric investigations are widely used. Choose a physiometric method of investigation from the below given.

A. *Determination of vital capacity of lungs

B. Determination of vertebra form

C. Measurement of growth

D. Determination of thorax form

E. Determination of body weight

106. Neonate is 5 days old. What vaccination dose of bacillius Calmette-Guerin (bCG) vaccine is necessary for this child?

E. *0.05 Mg

A. 0.1 Mg

B. 0.025 Mg

C. 0.075 Mg

D. 0.2 Mg

107. In the structure of the population of N-region, person category of age from 0 till 14 yrs constituted 31%, for people from 50 yrs and older — 20%. Estimate the population structure that characterizes the given demographic situation in a most efficient way.

B. *Progressive structure of the population

A. Migration of the population

C. Stationary structure of the population

D. Regressive structure of the population

E. Emigration of the population

108. A patient complains of intense pressing pain in the pharynx, mainly to the right impossibility to swallow even liquid food. The patient is sick for 5 days. His condition is severe. Body temperature is 38,9°C, it is difficult to talk, voice is constrained, it is difficult to open the mouth. Submaxillary glands to the right are painful, enlarged. What is the most probable diagnosis?

A. *Peritonsillar abscess

B. Diphtheria

C. Vincent’s disease

D. Pharyngeal tumor

E. Phlegmonous tonsillitis

109. A woman while working in vegetable garden developed severe pain in the loin. Lasague’s and Nery tension signs are obviously marked on the right. Lumbar lordosis is smoothed, movements are harshly restrained in lumbar part of the spine. Right ankle (Achilles) reflex is absent. What kind of disease can it be?

E. *Lumbar-sacral radiculitis

A. Hepatic colic

B. Neuritis of femoral nerve

C. Renal colic

D. Lumbalgia

110. A 6-month-old infant was born with body mass of 3 kg and 50 cm length. He is breast-fed. How many times per day should the infant is fed?

E. *5

A. 8

B. 4

C. 6

D. 7

111. An employee was disabled during 6 months as a result of a hip fracture. Who is entitled to sign the sick-leave for the last 2 months?

A. *MSEC

B. DCC together with the head physician of a polyclinic

C. Deputy head physician of a working capacity

D. Doctoral controlling committee

E. Head physician of the polyclinic

112. For persons who work in a zone of failure on nuclear object, the greatest risk of development within the first decade is represented by cancer. By what cancer it is represented?

D. *Thyroid gland

A. Lung

B. Skin

C. Breast

E. Reproduction system organs

113. A 20-year-old patient complains of amenorrhea. On physical exam: hirsutism, obesity with primarily localization of adipose tissue on face, neck, upper part of the body. There is an acne vulgaris on the face, on the skin — striae cutis distensae. BP -170/100 mm Hg. Mental development and intellect are normal. Gynecological status: excessive hairiness on external genitals, drastic hypoplasia of vagina and uterus. What is the most probable diagnosis?

A. *Itsenko-Cushing’s syndrome

B. Stein-Leventhal syndrome

C. Pechranz-Babinsky and Frelich syndrome

D. Sheehan’s syndrom

E. Shereshevsky-Turner syndrome

114. A 52-year-old man has recurrent transient ischemic attacks. Auscultation of the carotid arteries detects murmur. What diagnostic method is necessary to apply first?

E. *Ultrasound dopplerography

A. Cerebral angiography

B. Electroencephalography

C. CT of the brain

D. MRI of the brain.

115. A 42-year-old woman suffers from bronchial asthma, has an acute attack of bronchial asthma. What medication from the listed below is contraindicated to render a first aid?

E. *Euphylinum

A. Corazolum

B. Strophanthin hydrochloride

C. Morphinum hydrochloride

D. Izardin

116. A 29-year-old patient complains of sterility. Sexual life is for 4 years being married, does not use contraception. There was no pregnancy before. On physical examination, genitals are developed normally. Uterine tubes are passable. Rectal temperature during three menstrual cycles is monophase. What is the most probable reason for sterility?

E. *Chronic adnexitis

A. Immunologic sterility

B. Genital endometriosis

C. Anomalies of genitals development

D. Anovulatory menstrual cycle

117. A 45-year-old man was brought to clinic with complaints of the pain that started suddenly in the left chest part and epigastric area, shortness of breath, nausea, one-time vomiting. The acute pain started after weight-lifting. On physical exam: shallow breathing, RR – 38/min, left chest part is behind during respiration, by percussion — tympanitic sound, respiration is not ausculated. Ps — 110 bpm, of weak filling. BP – 100/60 mm Hg, insignificant displacement of heart to the right, sounds are dull. What examination is the most expedient to do first?

B. *Roentgenography

A. Electrocardiography

C. Esophagogastroscopy

D. Bronchoscopy

E. Ultrasound of the abdominal cavity

118. A 14-year-old victim was drawn out of the water in winter after 15 minutes of being in the water. The victim shows no vital signs. What measures are to be taken?

E. *To release respiratory tract from water, to create drain position and to take on measures to restore respiration and blood circulation

A. To transport the victim to the nearest hospital to carry out reanimation measures

B. To transport the victim to the nearest warm room to carry out reanimation measures

C. Not to carry out reanimation measures

D. Not to waste time on the release of respiratory tract from water, to take on cardiopulmonary reanimation

119. 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?

E. *Leptospirosis

A. Brucellosis

B. Salmonellosis

C. Yersiniosis

D. Trichinellosis

120. A 65-year-old patient complains of pain in the right half of face, headache, and rise in temperature. He is sick for 3 days, speaks of the disease due to being in cold. On physical exam: in the right half of forehead skin there is inflammatory hyperemia, edema. Erosions with necrotic coating are on places of vesicles. There are vesicles with inflammatory hyperemia along the border of the nodes. What pathology is meant in this case?

C. *Herpes zoster

A. Eczema

B. Lichen planus erythematosus

D. Dermatitis

E. Erysipelas

121. A 37-year-old patient has sudden acute pain in the right epigastric area after having fatty food. What method of radiological investigation is to be used on the first stage of examining the patient?

E. *Ultrasonic

A. Radionuclide

B. Magnetic-resonance

C. Roentgenological

D. Thermographic

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

E. *Krotov’s apparatus

A. Geiger’s counter

B. Mischuk’s device

C. Ebert’s counter

D. Ebert’s device

123. A victim of the car crash was brought to neurosurgery due to craniocerebral trauma. During examination symptoms of focused injury of the cerebrum are found, cerebrum contusion is suspected. What method of examination is to be used?

E. *Computed tomography of the cerebrum

A. Ultrasound examination of vessels of the cerebrum

B. Antiography of vessels of the cerebrum

C. X- ray of cranium bones

D. Eye-ground examination

124. In morgue there are dead bodies with the following causes of death: electrotrauma; rupture of the spleen with acute anemia. There is one unknown person; one ethyl alcohol poisoned person and one drowned man. What dead body should the blood group is determined for?

with internal

D. *All dead bodies of the unknown persons

A. Body of drowned man

B. Body of person hemorrhage

C. Body of person with a sudden death

E. Body of poisoned person

125. A 41-year-old patient was admitted to the intensive care unit with hemorrhagic shock due to gastric bleeding. He has a history of hepatitis B during the last 5 years. The source of bleeding is esophageal veins. What is the most effective method for bleeding control?

D. *Introduction of obturator nasogastric tube

A. Hemostatic therapy

B. Intravenous administration of pituitrin

C. Administration of plasma

E. Operation

126. A diagnosis of chronic arsenous intoxication was defined at Y patient who is working as a night man. What form of anemia is characteristic for this disease?

B. *Hemolytic anemia

A. Aplastic anemia

C. B12 – deficiency anemia

D. Hyper sideric anemia

E. Iron deficiency anemia

127. A 30-year-old patient who suffered from headaches, while lifting a heavy subject up, felt an intense headache in the form of the blow on his head. There appeared nausea, vomiting, light dizziness. In a day there was an objectively presented meningial syndrome, t — 37,6°C. The doctor has suspected subarachnoidal hemorrhage. What additional examination is necessary to do to confirm the diagnosis?

B. *Lumbar puncture with liquor examination

A. Rheoencephalography

C. Computed tomography

D. Cerebral angiography

E. Roentgenography of the cranium

128. In the development of the inflammation processes glucocorticoids reduce the level of certain most important active enzyme. It results also in the reduci­ng of the synthesis of prostaglandins and leucotrienes which have a key role in the development of inflammation processes. What is the exact name of this enzyme?

C. *Phospholipase A2

A. Arachidonic acid

B. Cyclooxygenase -1

D. Lipoxygenase

E. Cyclooxygenase – 2

129. A 3-year-old boy suddenly fell ill with fever up to 39°C, weakness, vomiting. Hemorrhagic rash of various size appeared on his lower extremities in 5 hours. Meningococcemia with infective-toxic shock of the 1st degree was diagnosed. What medications should be prescribed?

B. *Chloramphenicol succinate and prednisone

A. Chloramphenicol succinate and interferon

C. Penicillin and immunoglobulin

D. Penicillin and prednisone

E. Ampicillin and immunoglobulin

130. A patient with suspicion of pelvic bones fraction is under examination conducted by the doctor who presses alae ilii in medial direction with his both hands. What causes painful syndrome of the patient?

D. *Disorder of continuity of the pelvic ring

A. Traumatic injury of the intrapelvic organs

B. Fracture of sciatic bones

C. Retroperitoneal hematoma

E. Fracture of the sacrum

131. In the 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 decrease the morbidity with diphtheria to single cases?

C. *Immunization of the population

A. Revelation of carriers

B. Early diagnostics

D. Hospitalization of patients

E. Disinfection in disease focus

132. In 2 weeks after pharyngitis a 25-year-old patient started complaining of rise in temperature to 38° C, fatigue, shortness of breath during walking, migrating joint intumescence and pain . On physical exam: cyanosis of lips, pulse is weak, rhythmical, 100 bpm. The left heart border is moved outwards from medi-aclavicular line for 1 cm. Sound I on the apex is weakened, soft systolic murmur is ausculated. What ethiological factor caused this pathological process in the most probable way?

A. *Beta hemolytic streptococcus

B. Staphylococcus

C. Pneumococcus

D. Virus

E. Fungus

133. You suspect that a 34-year-old patient has got an abscess of Douglas spaces. What method of investigation is preferable to diagnostics?

C. *Digital examination of rectum

A. Roentgenoscopy of abdominal cavity

B. Laparoscopy

D. Rectoromanoscopy

E. Percusion and auscultation of abdomen

134. Woman in childbirth, 25 years old, the second period of labor. During internal obstetric examination, opening of the uterine cervix is full. Fetus membranes are absent. The head of the fetus is represented, the head occupies sacral cavity. Sciatic bones are undeterminable. During contractions perineum is sticking out. Where is the head of the fetus situated?

D. *In the plane of outlet from the minor pelvis

A. In the plane of the narrow part of minor pelvis

B. In the plane of the wide part of minor pelvis

C. By small segment in the plane of inlet into minor pelvis

E. Big segment in the plane of inlet into minor pelvis

135. A 19-year-old man has suffered from moderate mental retardation since childhood. The patient is illiterate, can take care of him, do simple household work and other kinds of easy work under supervision. What does his rehabilitation [tertiary prevention] require?

A. Supervision of a social worker

B. Physical work under supervision

C. Supervision of relatives (if any)

D. 8All the above mentioned

E. None of the above mentioned

136. The child was born from the 5th pregnancy and 1st delivery. Mother’s blood group — A[II]  Rh-, neonate’s -A[II] Rh+. The level of indirect bilirubin in umbilical blood was 58/µmol/L, hemoglobin – 40 g/L, RBC — 3,8* 1012/L. The level of indirect bilirubin in 2 hours was 82µmol/l. The hemolytic disease of the neonate [icteric-anemic type, Rh-incompatibility] was diagnosed. Choose the therapeutic tactics.

A. Symptomatic therapy

B. Hormonal therapy

C. 8Replacement blood transfusion

D. Plasma transfusion

E. Antibiotics

137. A 25-year-old man has focal shadowing of small and medium intensity, unequal contours in 1st and 2nd segments of the right lung revealed during routine fluorography. What clinical form of tuberculosis can be suspected in this patient?

B. *Focal

A. Tuberculoma

C. Miliary

D. Disseminated

E. Fibro-cavernous

138. A 48-year-old patient complains of heaviness in the right hypochondrium, itching of the skin. He had been treated in infectious diseases hospital repeatedly due to icterus and itch. On physical exam: meteorism, ascitis, dilation of abdominal wall veins, protruded umbilicus, spleen enlargement. What can be diagnosed in this case?

A. *Liver cirrhosis

B. Gallstones

C. Cancer of the liver

D. Cancer of the head of pancreas

E. Viral hepatitis B

139. A 4-year-old boy in 2 weeks after the tonsillitis had edema, headache, vomiting three times per day. On physical exam: rise of blood pressure, urine is of meat slops color. What is the most probable diagnosis?

E. *Glomerulonephritis

A. Interstitial nephritis

B. Cystitis

C. Pyelonephritis

D. Urethritis

140. A 35-year-old woman was admitted to thoracic surgery department with rise in body temperature up to 40°C, onset of pain with deep breath inside, cough with big quantity of purulent and bloody sputum with bad smell. What disease is caused by these symptoms?

A. *Abscess of the lung

B. Bronchiectatic disease

C. Pulmonary tuberculosis

D. Actinomycosis of lungs

E. Complication of liver echinococcosis

141. Point out the unit for statistical observation for the determination of blood sugar level influence on a wound surface healing during postoperative period.

C. *The patient in a postoperative period

A. Blood sugar level

B. The patient who has a wound surface

D. Blood test

E. The patient who was discharged to outpatient treatment

142. Parents of a 2-year-old boy applied to clinic complaining of right testicle absence in the scrotum of a boy. While examining the boy, hypoplasia of the right half of the scrotum was revealed, absence of the testicle. Testicle is miniaturized, it palpitates along the inguinal canal but it could not be moved down to scrotum. What is the most probable diagnosis?

D. *Right-sided cryptorchism, inguinal form

A. Right-sided cryptorchism, abdominal form

B. Ectopia of the right testicle, pubic form

C. Left-sided monorchism

E. Retraction of the right testicle (pseudocryptorchism)

143. A 26-year-old woman have been abusing of alcohol for 7 years. She has psychological dependence on alcohol, but no withdrawal syndrome. Drinks are taken almost every day approximately 50-100 g of wine. She is at her 4-th week of pregnancy. What is necessary to do to prevent alcohol syndrome of fetus?

E. *Treatment of alcoholism and total abstinance from alcohol during the whole period of pregnancy

A. Decrease of alcohol use

B. Gynecological observation

C. Medical abortion

D. Participation in the A-ANON group

144.  Workers of fishery are subjected to low temperatures of the air (from 5 till 15°C). Diseases of what organs and systems are the most frequent among workers of such enterprises?

D. *Respiratory system

A. Blood

B. Cardiovascular system

C. Gastrointestinal tract

E. Liver

145. 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. Adenoviral infection

B. Measles

C. Pseudotuberculosis

D. Scarlet fever

146. A 36-year-old alcoholic patient has cirrhosis and pancreatic failure due to recurrent pancreatitis. His complaints of nightblindness, decreased ability to taste food, dry skin with hyperpigmentation. What  deficiency  does these symptoms show?

B. *Zinc

A. Copper

C. Chromium

D. Manganese

E. Selenium

147. A 10-year-old child is sick with chronic viral hepatitis B with marked activity of the process. Total bilirubin —70/^mol/L, direct – 26/xmol/L, indirect — 44 µmol/L. AST — 6,2 mmoUL, ALT — 4,8 mmol/L. What mechanism underlies the transaminase level increase of this pati­ent?

D. *Cytolysis of hepatocytes

A. Failure of bilirubin conjugation

B. Intrahepatic cholestasis

C. Hypersplenism

E. Failure of the synthetical function of the liver

148. Twenty-five unorganized toddlers (2-3 years old) will be observed by district pediatrician current year. What scheduled number of preventive observations is to be made for this group of children?

D. *50

A. 20

B. 100

C. 200

E. 40

149. District pediatrician examines a healthy carried 1-month-old child. The child is breast-fed. Prophylaxes of what disease will the doctor recommend to do first?

A. *Rachitis

B. Spasmophilia

C. Hypotrophia

D. Parathropy

E. Anemia

150. Choose the method of graphic representation of monthly information about the number of registered cases of acute intestinal infection in comparison to the average monthly values, obtained for 5 previous years.

E. *The linear diagram

A. The radial diagram

B. The figured diagram

C. Curvilinear

D. The sector diagram

151. A 33-year-old woman was urgently brought to clinic with complaints of the pain in the lower part of the abdomen, mostly on the right, irradiating to rectum, she also felt dizzy. The above mentioned complaints developed acutely at night. Last menses were 2 weeks ago. On physical exam: the skin is pale, Ps — 92 bpm, t- 36,6°C, BP—100/60 mm Hg. The abdomen is tense, slightly tender in lower parts, peritoneal symptoms are slightly positive. Hb — 98 g/L. What is the most probable diagnosis?

A. *Apoplexy of the ovary

B. Renal colic

C. Intestinal obstruction

D. Abdominal pregnancy

E. Acute appendicitis

152. 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 g/cm3, acidity 21° C, reductase probe — weak positive. What way the product is to be used in? What would you advise?

E. *Sell but inform customers about milk quality

A. Sell without limitations

B. Annihilate the product

C. Utilize technically

D. Write the product off for animal feeding

153. A 49-year-old patient complains of fever of 37,5°C, chest pain, dyspnea. On physical examination, SI is clapping; S2 is accentuated in the pulmonary artery, opening snap, presystolic murmurs are auscultated. What is the most useful investigation for valvular disorder assessment?

C. *Echocardiography+dopplerechocardiography

A. Phonocardiography

B. Electrocardiogram (ECG)

D. Ballistocardiogram

E. Chest X-ray

154. A 37-year-old patient has come to clinic being wounded in the area of umbilicus an hour ago. On physical exam, there is a prick and cut painful wound of about 0,5 x 1 cm around umbilicus on the abdominal skin with slight bleeding.How would you help this patient?

A. *Laparotomy, abdominal cavity organs inspection. Primary surgical processing of the wound

B. Suture on the wound

C. Aseptic bandage

D.  Inspection of the wound with canal probe

E. Drainage of the wound with rubber strip

155. A 48-year-old man called for a district doctor due to attack of cough with small amount of “rusty” sputum, pain in the right side of the body during deep respiration and cough. The patient has IDDM. On physical exam, t — 39,2°C, Ps — 114 bpm, BP – 110/70 mm Hg, RR – 24/min. The skin is dry, hyperemia of cheeks. During ausculation there are moist sonorous crepitant rales in lower parts of the lung. What are the doctor’s actions?

A. *Hospitalization to therapeutic unit

B. Hospitalization to endocrinology unit

C. Resuscitation

D. Referral to outpatient department

E. Prescription of out-patient treatment

156. A 40-year-old patient is being diagnosed: 1. Medullar thyroid gland cancer. 2. Pheochromocytoma. What operation should be made first?

A. *Operation concerning pheochromocytoma

B. Krail’s operation

C. Subtotal resection of thyroid gland and fascicular resection of limphatic nodes

D. Operation on thyroid gland

E. Vanach’s operation

157.  Rise in temperature up to 39°C was registered the next day after a woman had labor. Fetal membranes rupture took place 36 hours prior to labors. The examination of the bacterial flora of cervix uteri revealed the following: haemolytic streptococcus of group A. The uterus tissue is soft, tender. Discharges are bloody, with mixing of pus. Establish the most probable postnatal complication.

D. *Metroendometritis

A. Apostatis of stitches after the episiotomy

B. Infective contamination of the urinary system

C. Thrombophlebitis of veins of the pelvis

E. Infected hematoma

158. A 30-year-old man has suffered from traffic accident. Consciousness is absent. Pulse on the carotid artery is undeterminable, no respiration. There is a wide leather belt on man’s waist. What measures are to be taken?

E. *Conduct an artificial ventilation of lungs and closed-chest  cardiac massage after having released from the belt

A. Put the victim with his back on the shield

B. Start immediate artificial ventilation of lungs and closed-chest cardiac massage

C. Turn the victim to the right side

D. Do not touch the victim until the arrival of the police

159. A 25-year-old man has facial edema, moderate back pains. His temperature is 37,5°C, BP 180/100 mm Hg, hematuria up to 100 in v/f], proteinuria [2,0 g/L], hyaline casts — 10 in v/f., specific gravity —1020. The onset of the disease is probably connected with acute tonsillitis that started 2 weeks ago. What is the most probable diagnosis?

E. *Acute glomerulonephritis

A. Urolithiasis

B. Cancer of the kidney

C. Acute pyelonephritis

D. Chronic glomerulonephritis

160. A patient undergoes inpatient treatment with the diagnosis of acute pancreatitis. To spare pancreas as much as possible the doctor prescribed for him starvation for 1-3 days. What products is the patient allowed to eat during recovery period after cancelling of starvation?

C. *Potato and carrot mash

A. Boiled meat

B. Broth

D. Milk

E. Grape juice

161. A 34-year-old patient was bitten by a dog 3 hours ago. There is a wound by dog teeth without bleeding in the left arm. What surgical help would you provide to this patient?

A. *Clean wound with detergent water and apply anti-septic

B. Complete suture of the wound

C. Aseptic bandage

D. Cream bandage

E. Incomplete suture of the wound

162.  A 5-year-old girl with the transitory immunodeficiency according to T-system has a clinical picture of a right-sided pneumonia during 2 months. How pneumonia progress can be described?

B. *Delaying

A. Acute

C. Reactivating

D. Chronic

E. Wavelike

163. A 37-year-old woman is sick with bronchial asthma for 15 years. Recenlty asthmatic attacks occur 4-5 times per week, night attacks -2-3 times per month. To stop attacks, the patient takes salbutamol. On physical exam: condition is relatively satisfactory. RR – 20/min, Ps is 76 bpm, BP -120/80 mm Hg. Respiration in lungs is vesicular. Cardiac sounds are muted, rhythm is normal. What medication should be prescribed to prevent attacks of bronchial asthma on the first stage?

E. *Cromoglycat sodium

A. Tabletted corticosteroids

B. Regular dose of salbutamol

C. Injection of corticosteroids

D. Inhalation corticosteroids

164. A patient suffers from suddenly arising crampy pain in the right loin area. 2 hours after the pain had started, hematuria took place. Loin X-ray: no pathological shadows. Ultrasound: pyelocaliectasis on the right, the left part is normal. What is the most probable di­agnosis?

C. *Stone of the right kidney, renal colic

A. Twist of the right ovary cyst

B. Intestine invagination

D. Acute appendicitis

E. Tumour of the right kidney pelvis

165. A 20-year-old adolescent lives in the nidus of tuberculous infection. The tuberculine Mantoux test with 2 TU was determined as hyperergic. What signs determine the hyperergic test of this adolescent?

E. *6 mm papula, necrosis

A. 20 mm papula

B. 12 mm hyperemia

C. 4 mm papula

D. 24 mm hyperemia

166. A 68-year-old patient complains of tiredness, sweating, enlargement of cervical, submaxillary and axillary lymph nodes. Blood tests: leucocytes — 35* Itf/L, lymphocytes — 60%, Botkin and Gumprecht bodies, level of hemoglobin and quantity of thrombocytes is normal. Myelogram showed 40% of lymphocytes. What is the most probable diagnosis?

E. *Chronic lympholeucosis

A. Tuberculous lymphadenitis

B. Chronic myeloleucosis

C. Acute leucosis

D. Lymphogranulomatosis

167. In mental status of a 22-year-old patient there is a stable pathological depressed mood. The patient is sociable, replies briefly but to the point. The speech is laconic, tempo is slowed, and movements are constrained and inhibited. Speaks on the ideas of self-accusation and self-humiliation. Medications of what group are to be prescribed to this patient?

E. *Antidepressants

A. Hypnotics

B. Normotimics

C. Neuroleptics

D. Tranquilizers

168. A 40-year-old man is ill with autoimmune hepatitis. Blood test: A/G ratio 0,8, bilirubin — 42/imol/L, transaminase : ALT — 2,3 mmol g/L, AST — 1,8 mmol g/L. What is the most effective means in treatment from the given below?

C. *Glucocorticoids, cytostatics

A. Hepatoprotectors

B. Antibacterial medication

D. Hemosorbtion, vitamin therapy

E. Antiviral medications

169. An unconscious victim in severe condition is brought to clinic. It is known that the patient touched the bare wire with his hand and during 5 minutes was under the influence of an alternating current with voltage of 220 V Physical exam: skin is pale, cold by touch. Breath is weakened, BP – 90/50 mm Hg, Ps — 60 bpm, arrhythmical. There are fields of necrosis of the skin on the right hand and on the right foot. What is the preliminary diagnosis?

D. *Electroburn of the right foot and right hand

A. Electrotrauma, acute cardiovascular failure

B. Electroburn of the right foot and right hand

C. High voltaged electroburn of the right foot and shank

E. Vascular collapse due to electric current lesion

170. A 3-month-old infant who is suffering from acute segmental pneumonia reveals dyspnea [respiration rate — 80 per minute], paradoxical breathing, tachicardia, total cyanosis. Respiration-pulse ratio is 1:2. The heart size is normal. What are these signs indicative of?

B. *Respiratory failure of III degree

A. Congenital heart disease

C. Respiratory failure of I degree

D. Respiratory failure of II degree

E. Myocarditis

171. A 4-day-old girl was born from a second desired gestation, second delivery on the 39 week term. On physical exam: characters of the pre-natal retardation, aliform folds on the neck, lymphatic edema of hands and feet that disappeared without treatment during first 24 hours. What is your assessment of the child?

A. *Shereshevsky-Turner syndrome

B. Healthy child

C. Sclerema

D. Immature lymphatic system

E. Congenital hypothyreosis

172. Body temperature of a 12-year-old 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. Nikolsky syndrome is positive. What is the most probable diagnosis?

A. *Acute epidermical necrolysis

B. Duhring’s disease

C. Pemphigus vulgaris

D. Polymorphic exudative erythema

E. Bullous dermatitis

173. A 9-year-old girl has attacks of abdominal pain after fried food. No fever. She has pain in Cera point. The liver is not enlarged. Portion B [duodenal probe] — 50 ml. What is your diagnosis?

C. *Biliary tracts dyskinesia, hypotonic type

A. Acute colitis

B. Hepatocirrhosis

D. Peptic ulcer

E. Chronic duodenum

174. A 30-year-old patient complains of pain, hyperemia along subcutaneous veins, rise in body temperature. While examining the large shin subcutaneous vein, there is hyperemia, pain by pressing. Homanss and Luses’s symptoms are negative. What is the preliminary diagnosis?

A. *Acute thrombophlebitis of subcutaneous veins

B. Embolism of aorta

C. Acute ileophemoral phlebothrombosis

D. Thrombosis of aorta

E. Lymphostasis

175. A woman was hospitalised with full-term pregnancy. Examination: the uterus is tender, the abdomen is tense, cardiac tones of the fetus are not auscultated. What is the most probable complication of pregnancy?

B. *Premature detachment of normally posed placenta

A. Back occipital presentation

C. Hydramnion

D. Premature labor

E. Acute hypoxia of a fetus

176. During intramuscular DTP vacci nation in clinic, a 3-month-old child developed signs of laryngospasm, paleness of skin, cyanosis of lips, “cock cry”, stop of respiration, and tension of the whole body with overturned backward head. Allergological anamnesis of the child is not complicated. What is the most probable diagnosis?

C. *Spasmophilia, tonic spasms

A. Anaphylactic shock, clonic spasms

B. Meningism, clonic and tonic spasms

D. Meningoencephalitic reaction, clonic and tonic spasms

E. Cerebral hemorrhage, tonic spasms

177. A 52-year-old patient with previously functional Class II angina complains of intensive and prolonged retrosternal pains, decreased exercise tolerance for 5 days. Angina is less responsive to Nitroglycerinum. Which of the following diagnosis is the most probable?

C. *IHD. Unstable angina

A. Myocarditis

B. Cardialgia due to spine problem

D. Myocardial dystrophy

E. IHD. Functional Class II angina

178. 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?

A. *8

B. 10

C. 20

D. 6

E. 12

179. A 20-year-old woman with a 3-4 month history of  bloody diarrhea; stool examinationn is negative for ova and parasites; stool cultures negative for Clostridium, Campylobacter and yersinia; normal small bowel series; edema, hyperemia and ulceration of the rectum and sigmoid colon are seen on sigmoidoscopic examination. Choose the most likely diagnosis.

D. *Ulcerative colitis

A. Granulomatous colitis

B. Zollinger-EUison syndrome

C. Carcinoid syndrome

E. Gastroenteritis

180. In 10 min after childbirth by a 22-year-old woman, the placenta was spontaneousely delivered and 100 ml of blood came out. Woman weight — 80 kg, infant weight — 4100 g, length — 53 cm. The uterus contracted. In 10 minutes the hemorrhage renewed and the amount of blood constitued 300 ml. What amount of blood loss is permissible for this woman?

B. *400 ml

A. 300 ml

C. 500 ml

D. 650 ml

E. 1000 ml

181. A 48-year-old woman complains of fatigue, weight and appetite loss, headache. Suffered from acute glomerulonephritis as adolescent. Suffers from arterial hypertension since age 25. Has not systematically undergone medical treatment, applied to doctor very rarely. On laboratory investigation signs of chronic renal failure first degree were found, (creatinine — 0,23 mmol/L). What nutrition recommendations are the most suitable for this patient?

E. *Protein control

A. Ingestion with the increased content of the “alkaline”

B. Fluid amount increase

C. Adipose control

D. Carbohydrate control

182. A 68-year-old patient with long-term hypertension complains of dizziness, difficulties by swallowing, nasal voice, wobbly walking. These symptoms appeared about three years ago and are gradually progressing. What diagnosis of the given below is the most probable?

C. *Discirculating encephalopathy

A. Cerebral stem tumour

B. Ischemic attack

D. Stem encephalitis

E. Hemorrhagic attack

183. A 60-year-old man with unstable angina pectoris fails to respond to heparin, nitroglycerin, beta adrenegic blockers and calcium channel antagonisst. What is the best treatment for this patient?

A. *Coronary artery bypasses grafting

B. Aspirin, orally

C. Intravenous strpetokinase

D. Excercise testing

E. Antihypertensive therapy

184. A young woman applied to gynecologist due to her pregnancy of 4-5 weeks. The pregnancy is desirable. Anamnesis stated that she had rheumatism in the childhood. Now she has combined mitral heart disease with the priority of mitral valve deficiency When will she need the inpatient treatment (what periods of pregnancy)?

A. *8-12 weeks, 28-32 weeks, 37 weeks

B. 12-16 weeks, 27-28 weeks, 37-38 weeks

C. 10-12 weeks, 24 weeks, 37-38 weeks

D. 6-7weeks, 16 weeks, 38 weeks

E. 16 weeks, 34 weeks, 39-40 weeks

185. A 24-year-old patient felt sick in 16 hours after dried fish intake. There was nausea, vomiting, weakness, flabbiness, double vision. On physical exam, there was decrease of a muscle tone, anisocoria, flaccid swallowing and tendon reflex. What is the most probable diagnosis?

B. *Botulism

A. Food toxicoinfection

C. Acute gastritis

D. Salmonellosis

E. Acute encephalitis

186. While making sanitary examination of burn unit for adults it was stated that wards for 4 persons are of 28 m2 square. What should be the minimum ward area in this unit?

C. *40 m2

A. 24 m2

B. 28 m2

D. 52 m2

E. 30 m2

187. A 50-year-old patient was hospitalized in severe condition with complaints of chills, high grade temperature, dryness in the mouth, multiple vomiting, pain in the epigastrium, frequent watery, foamy, dirty green color stool of unpleasant odor. The tongue and the skin are dry. BP — 80/40 mm Hg. What first aid is necessary for the patient?

D. *Intravenous injection of sodium soluti­ons

A. Hemosorbtion

B. Sympathomimetics

C. To prescribe polyglucin

E. Fresh-frozen plasma transfusion

188. A 62-year-old patient complains of dyspnea on rest, chest pain. 3 years ago he had myocardial infarction. On physical examination, there is an orthopnea, acrocyanosis, swollen cervical veins. Ps — 92 bpm, total heart enlargement, the liver is enlarged by 7 cm, shin edema. What is the stage of chronic heart failure [CHF]?

E. *CHF-2 B

A. CHF-1

B. CHF- 2 A

C. CHF-0

D. CHF-3

189. A 34-year-old woman with 10-week pregnancy (the second pregnancy) has consulted gynaecologist to make a record in patient chart. There was a hydramnion previous pregnancy; the birth weight of a child was 4086 g. What tests are necessary first of all?

E. *The test for tolerance to glucose

A. Ultrasound of the fetus

B. Determination of the contents of a fetoprotein

C. Bacteriological test of discharge from the vagina

D. Fetus cardiophonography

190. On the 20th of June a townsman was brought to clinic. The disease broke out acutely, starting with fever, rise in temperature to 38 — 39°C. There also was weakness, acute headache, nausea, vomiting, pain all over the body, sleep disorder. On physical examination: hyperemia of skin of face, neck, thorax. Meningeal signs are positive. 12 days ago the patient returned from the Siberia, from the forest. What is the most probable diagnosis?

B. *Tick-borne encephalitis

A. Omsk hemorrhagic fever

C. Pseudotuberculosis

D. Epidemic typhus

E. Influenza

191. A 40-year-old woman complains of yellow color discharges from the vagina. Bimanual examination: no pathological changes. Smear test: Trichomonas vaginalis and mixed flora. Colposcopy: two hazy fields on the front labium, with a negative Iodum probing. What is your tactics?

D. *Treatment of specific colpitis with the subsequent biopsy

A. Cervix ectomy

B. Specific treatment of Trichomonas colpitis

C. Cryolysis of cervix uteri

E. Diathermocoagulation of the cervix uteri

192.  A 37-year-old woman complains of generalized fatigue, irritability, dysphagia, chalk hunger. On physical exam: t-36,5° C, respirations — 20/min, Ps — 96 bpm, BP — 110/70 mm Hg. Satisfactory nourishment. The skin and visible mucous membranes are pale. Blood test: Hb —70g/L, erythrocytes 3,4*1012/L, CI — 0,7, reticulocytes — 2%, leucocytes — 4,7*109/ L, eosinophilis. — 2%, band neutrophils — 3%, segmented neutrophils — 64%, lymphocytes — 26%, monocytes – 5%, ESR — 15 mrn/min. Serum ferrum —7,3/µmol/L, total protein — 70g/L. Deficit of what factor caused the development of the disease?

B. *Ferrum

A. Vitamin B12

C. Protein

D. Folic acid

E. Vitamin B6

193. In a man the disease started with acute onset. Frequent watery stool developed 6 hours ago. The body’s temperature is normal. Then vomiting took place. On physical examination: man’s voice is hoarse, eyes are deeply set in the orbits. The pulse is frequent. Blood pressure is low. There is no urine. What is the preliminary diagnosis?

B. *Cholera

A. Typhoid fever

C. Toxic food-borne infection

D. Salmonellosis

E. Dysentery

194. A 32-year-old 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?

D. *Diffuse toxic goitre of the 3rd degree, thyrotoxicosis of the average degree

A. Toxiferous adenoma of the thyroid gland

B. Chronic autoimmune thyroiditis, hypertrophic type

C. Chronic fibrous thyroiditis

E. Diffuse euthyroid goitre of the 3rd degree

195. A rounded shadow with well-defined outlines was found at the costo-vertebral angle on a chest X-ray of a healthy 9-year-old girl. Could you please make the preliminary diagnosis?

A. *Ganglionevroma

B. Sarcoma of the vertebra

C. Sympatoblastoma

D. Ganglioneuroblastoma

E. Sympatogonioma

196. A 14-year-old boy periodically complains of pain in the epigastrium on an empty stomach, nausea and heartburn during 3 years. Gastroduodenoscopy: signs of gastroduodenitis and ulcer defect of the mucous membrane of the duodenum. What is the most effective medication to treat this child?

C. *De-nol

A. Almagel

B. Papaverin

D. No-spa

E. Atropin

197. A 72-year-old patient after operation due to holecystectomia was prescribed gentamicin (80 mg every 8 hours) and cephalothin (2 g every 6 hours) due to fever. In 10 days there was an increase of creatinine up to 31(µmol/L. BP — 130/80 mm Hg, daily quantity of the urine is 1200 mL. Urine tests are without pathology. Ultrasound: the size of kidneys is normal. What is the most probable reason for renal failure?

B. *Nephrotoxity of gentamicin

A. Hepatorenal syndrome

C. Cortical necrosis of kidneys

D. Acute glomerulonephritis

E. Unequal infusion of the liqiud

198. A neonate from gestation with severe gestosis of the second half was born on the 41st week with 2400 g birth weight and 50cm long. On physical examination: skin is flaccid, subcutaneous fatty cellular tissue is thin, muscle hypotonia, new-born period reflexes are decreased. Internal organs are without pathological changes. How would you estimate this child?

C. *Term infant with pre-natal growth retardation

A. Term infant with normal body weight

B. Premature infant

D. Postmature infant

E. Immature infant

199. 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. *Developing of cardiac insufficiency

B. Depositing of blood in venous channel

C. Presence of hypervolemia

D. Shunting

E. Increase of bleeding speed

200. A student lives in the modern house in the flat with a complete set of sanitary equipment (WC, bath, shower, local water heater). How much water consumption has he got?

B. *160-200 L/day

A. 500 -600 L/day

C. 300-400 L/day

D. 50-100 L/day

E. 10-15 L/day

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s