1. A 38-year-old patient has been treated in a hospital. A fever of 39°C, chest pain which is worsened by breathing, cough, brownish sputum appeared on the 7th day of the treatment. Chest X-ray shows left lower lobe infiltrate. Which of the following is the treatment of choice for this patient?
D. *Cephalosporins of the III generation
2. A 32-year-old woman developed the Laiel’s syndrome after taking the biceptol. What immunotrope remedies are indicated in this situation?
A. *Steroid immune depressants
C. Non-specific immune modulators
D. Non-steroid immune depressants
E. Specific immune modulators
3. An 18-month-old child is taken to hospital on the 4-th day of the disease. The disease began acutely with temperature 39°C, weakness, cough, reathlessness. He is pale has cyanosis, febrile temperature for more than 3 days. There are crepitative fine bubbling rales at the auscultation. Percussion sound is shortened in right under scapula area. X-ray picture: unhomogenius segment infiltration 8-10 in the right, the increase of vascular picture, unstructural rools. What is the most likely diagnosis?
E. *Segmentary pneumonia
C. Interstitial pneumonia
4. A 43-year-old male presents with stomach pain, which relieves with defecation, is accompanied with a feeling of abdominal winds, incomplete evacuation or urgent need for bowel movement, constipation or diarrhea. These symptoms have been lasting for over 3 months. No changes in laboratory tests. What is the most likely diagnosis?
B. *Irritable bowel syndrome
A. Chronic enterocolitis, exacerbation phase
C. Spastic colitis
D. Colitis with hypertonic type dyskinesia
E. Atonic colitis
5. A 62-year-old man presents with the pain in mesogastral area that irradiates to back, general weakness, poor appetite, weight loss. Oh physical examination the patient is of decreased nutrition, skin and eyeballs are light-yellow. Stomach is soft. Enlarged painless gallbladder is palpated in the right hypochondrium. Urine is dark. Stool is colourless. What is the most likely diagnosis?
B. *Cancer in the head of pancreas, mechanic icterus’
A. Hemolytic icterus
C. Liver cirrhosis
D. Parenchimatosus icterus
E. Gallbladder disease, mechanic icterus
6. A 5-year-old child had an attack of palpitation with nausea, dizziness, generalized fatigue. On ECG: tachycardia with HR of 220/min. Ventricle complexes are deformed and widened. P wave is absent. What medication should be given for emergent care?
7. A 43-year-old 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. *Cancer of cervix of the uterus
B. Cervical pregnancy
D. Nascent fibroid
E. Polypus of the cervis of the uterus
8. A 43-year-old woman complains of severe pain in the right side, fever, dryness and bitterness in the mouth. There was multiple vomiting without relief. Patient relates pain to taking of fat and fried meal. Physical examination: Patient lies on the right side. Pale. Dry tongue. Tachycardia. Right side of abdomen is painful upon palpation and somewhat tense in right hypochondrium. What is the most likely diagnosis?
B. *Acute cholecystitits
A. Perforative ulcer
C. Acute appendicitis
D. Acute bowel obstruction
E. Right-sided renal colic
9. A 20-year-old patient is known as using to clash with teachers and classmates in school, to shout, to be able to throw with fists. He was detained several times for fighting and was convicted. He has changed several places of work due to conflicts and aggression. Psychiatric status: he is focused correctly, answers loudly, using obscene words. He demands “to leave him in rest “because “he does not control himself”. In department he shows aggression for the most insignificant reasons. What is your preliminary diagnosis?
A. *Maniacal-depressive psychosis
B. Explosive psychopathy
C. Hysterical psychopathy
D. Hysterical neurosis
10. A 52-year-old male is under gastroenterologist supervision due to chronic autoimmune gastritis for 10 years. He presents with some nausea, feeling of weight in epigastrium after meal. Last exacerbation of disease was 6 month ago. He adheres to a diet, smokes 10 cigarettes per day, and uses alcohol moderately. What measures to prevent stomach cancer are necessary?
B. *Cancellation of smoking and alcohol use
A . Taking antacids periodically
C. Taking H2-blokers periodically
D. Taking antihelycobacter medications periodically
E. Taking gastrocepin periodically
11. 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, denseconsistence. What is the most probable diagnosis?
A. *Physiological amenorrhea
D. Sheehan’s syndrome
E. Asherman’s syndrome
12. A 28-year-old woman comes to the Emergency Room with a slightly reddened, painful “knot, 8 cm above the medial malleolus. Examination in the standing position demonstrates a distended vein above and below the mass. There are no other abnormalities on physical examination. What is the most likely diagnosis?
B. *Superficial venous thrombosis
A. Subcutaneous hematoma
C. Early deep vein thrombosis
E. Insect bite
13. 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?
C. *Ultrasound of the abdominal cavity
14. A 42-year-old man has died in a road accident after the hemorrhage on the site, due to acute hemorrhagic anemia. What minimum percent of all volume of blood could result in death at acute hemorrhage?
15. 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?
B. *Epiphysial osteomyelitis of the humerus
A. Phlegmon of the shoulder
C. Traumatic brachioplexftis
D. Fracture of the humerus
E. Fracture of the clavicle
16. Study of pulmonary tuberculosis provided data about social and everyday conditions of life and bad habits of patients. Which of the following methods allows assessing degree of influence of smoking on tuberculosis incidence?
D. *Calculation of correlation coefficient,
A. Calculation of standardized indices
B. Calculation of regression coefficient
C. Assessment of statistical probability of differences
E. Analysis of dynamic row indices
17. In 2 weeks after receiving of 3 Gy doze of general 7-irradiation, the diminished number of blood cells is marked at injured man. What is the cause of such changes?
A. *Suppression of blood cells production
B. Reduction of peripheral blood cells life time
C. Delay of blood cells in the marrow
D. Prolongation of blood cells growth
E. Increased destruction of peripheral blood cells
18. A 28-year-old man is hospitalized with complaints of expiration dyspnoe after work at summer residence. Physical examination: condition of moderate severity. He sits resting his hands on the seat-back. Ps — 102 bpm, BP 140/90 mmHg. RR — 32/min. Percussion reveals lung sound with box tone. Heterogeneous multiple dry rales are auscultated. Heart work is regular. Which immunoglobulin plays leading role in development of this pathological condition?
19. The 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. The dermal integuments and scleras are icteric. There is hemorrhagic rash on the skin. Urine is bloody. The patient went fishing two weeks ago. What is the diagnosis?
20. A 26-year-old woman complains of spontaneously arising pelvic pain, irradiating to the anus, nausea, giddiness, bloody dark vaginal discharge for one week, the delay of menses for 4 weeks. Signs of peritoneal irritation are positive. Pelvic examination: borders of uterine and adnexa are not determined because of sharp morbidness. The diversion and tenderness of posterior and right lateral fornices vaginae are marked. What is the most probable diagnosis?
E. *Broken tubal pregnancy
A. Acute appendicitis
B. Apoplexy of the ovary
C. Torsion of an ovarian tumour leg
D. Acute right-side adnexitis
21. A 6-year-old asthmatic child is brought to the emergency room because of severe coughing and wheezing during the prior 24 h. The child has been taking theophylline without relief. Physical examination reveals a child who is anxious, has intercostal and suprasternal retractions, expiratory wheezing throughout all lung fields, and RR 60/min. Initial treatment may include the administration of which of the following?
E. *Subcutaneous epinephrine
A. Parenteral gentamicyn
B. Parenteral phenobarbital
C. N-acetyl cysteine and cromolyn by inhaler
D. Intravenous fluids in the first 2 h to correct a water deficiency.
22. A 76-year-old man, with the cardiac pacemaker (demand mode) has periodic episodes of loss of consciousness. Physical examination: Ps 42 bpm, heart beating is irregular. What can cause development of such condition?
A. *Pacemaker malfunction
B. Intraventricular conduction disorder
C. Daroxysmal ventricular tachycardia
D. Paroxysmal supraventricular tachycardia
E. Cerebral atherosclerosis
23. The occipital part of newborn head of dolichocephalic form shows with labor edema with centre in the area of small fontanelle. In which presentation of fetal head did labor occur?
A. *Face presentation
B. Occiput anterior presentation
C. Brow presentation
D. Parietal anterior presentation
E. Occiput posterior presentation
24. A 7-day-old boy is admitted to the hospital for evaluation of vomiting and dehydration. Physical examination is otherwise normal except for minimal hyperpigmentation of the nipples. Serum sodium and potassium concentrations are 120 meq/L and 9 meq/L respectively. What is the most likely diagnosis?
B. *Congenital adrenal hyperplasia
D. Secondary hypothyroidism
E. Pyloric stenosis
25. A growth of the right side of the scrotum was found at the examination of a 3-month-old child. This formation has elastic consistency, its size decreases in sleep and increases when the child is crying. What investigation will be helpful for make a correct diagnosis?
A. *Palpation of the thickened cord, crossing the pubical tubercule
B. Punction of the scrotum
C. Examination of the formation in Trendelenburg’s position
D. Palpation of the external inguinal ring
26. A 36-year-old male, at 4:00 a.m. had intensive attack of chest pain, which was accompanied by weakness, cold perspiration, fear of death. ECG: ST segment elevation in leads II, III, aVF, V5, V6. After stop of heart attack the ECG has normalised. What is Your preliminary diagnosis?
B. *Variant (Prinzmetal’s) angina
A. Myocardial infarction of the back side of left ventricular wall
C. Acute pericarditis
D. Dilated cardiomyopathy
E. Prolonged angina attack
27. In the young patient at the reference to policlinic there was diagnosed the 1 stage of hypertension. How many times during the year it is necessary to examine him?
E. *2 times
A. 3 times
B. 5 times
C. 4 times
D. 1 time
28. A 30-year-old woman, who lives at Carpathians, presents with enlargement of thyroid gland. Examination: diffuse increase of thyroid gland up to 1A degree, the function is normal. What kind of preventive maintenance of endemic goitre will you advise?
D. *Antistrumin 1 tablet per week
A. Antistrumin 1 tablet twice per week
B. L-thyroxin 25 microgram daily
C. L-thyroxin 50 microgram daily
E. Merkasolil 20 mg daily
29. A 47-year-old man with gastric cancer, complicated by profuse hemorrhage was successfully treated by surgical intervention. After the operation the native blood plasma transfusion was performed. During transfusion developed there acrocyanosis, hypersalivation, hyperpnoea, BP 80/40 mmHg, Ps -120 bpm. The initial drug therapy had to begin with injection of:
30. A 26-year-old man was admitted to the hospital complaining of stabbing back pain on inspiration and dyspnea. On exam, t – 37°C, Ps 92/min, RR of 24/min, vesicular breath sounds. There is a dry, grating, low-pitched sound heard in both expiration and inspiration in the left lower lateral part of the chest. What is the most likely diagnosis?
C. *Acute fibrinous pleuritis
A. Acute bronchitis
31. At the radiological unit of the hospital, gamma-devices of radiotherapy of “Agat” 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. *Screening of the source and the use of means of individual protection of respiration organs
B. Shortening of working time and screening of the source
C. Systematical cleansing of surfaces from the radioactive contamination and shortening of working time
D. Capsulation of devices and organization of room ventilation
E. The increase of distance to the source and individual hygiene compliance
32. Woman in childbirth, 25 years old, the second stage of labor. During internal obstetric examination, opening of the uterine cervix is full. Fetus membranes are absent. The head of the fetus is presented, the head occupies sacral cavity. Sciatic bones are undeterminable. During contractions perineum is sticking out. Where is the head of the fetus situated?
A. *In the plane of outlet from the minor pelvis
B. By small segment in the plane of inlet into minor pelvis
C. In the plane of the narrow part of minor pelvis
D. Big segment in the plane of inlet into minor pelvis
E. In the plane of the wide part of minor pelvis
33. A primiparous woman whose blood type is 0(Rh+) birth at term to an infant who has A(Rh+) blood and a hematocrit of 55%. A serum bilirubin level obtained at 36 h of age is 12 umol/L. Which of the following laboratory findings would be LEAST characteristic of ABO hemolytic disease?
E. *Negative direct Coombs’ test
A. An elevated reticulocyte count
B. Spherocytes on blood smear
C. Fragmented red blood cells in the blood smear
D. Nucleated red blood cells in the blood ear
34. A 37-year-old man presents to the clinic in 1 hour after being wounded complaining of pain around umbilicus. Physical examination: there is prick and cut wound of about 0.5 x 1 cm on abdominal wall with slight bleeding. What help would you provide to the patient?
C. *Laparotomy, survey of organs of abdominal cavity, primary surgical processing of the wound
A. Suturing of the wound
B. Survey of he wound with canal probe
D. Aseptic bandage
E. Drainage of the wound with rubber strip
35. A patient, while making repairs at home, suddenly stood quite still with the painting brush in his hand. This state lasted for a few seconds. After that the patent was rather confused, for some moments he couldn’t understand what was happening. He totally forgot the state he was in and the events around him, occurring while he was in that state. Name the disorder:
E. *Petit mal, epilepsy
A. Disphoria, epilepsy
B. Jacksonian fit, epilepsy
C. Grand mal, epilepsy
D. Twilight state, epilepsy
36. A 38-year-old woman is hospitalized with complaints of shortness of breath at physical load, weakness, fatigue. Medical history: rheumatism since 18 years old. Physical examinations: condition of moderate severity, “facies mitrale”. Ps 80 bpm, BP130/80 mmHg. Cardiac rhythm is irregular, Sound 1 increased in intensity, an opening snap and diastolic murmur are heard at the apex. Lungs are clear upon auscultation. What medications would you prescribe the patient?
A. *Cardiac glycosides + calcium antagonists
B. Calcium antagonists + beta-adrenergic blockers
C. Beta-adrenergic blockers + cardiac glycosides
D. Diuretics + ACE inhibitors
E. Cardiac glycosides + calcium antagonists
37. 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.
38. A patient with ischemic heart disease and chronic heart failure develops sudden loss of consciousness. On exam: cyanosis, the widened pupils, peripheral pulse and blood pressure are not denned. On ECG: ventricular complexes are absent; instead of them there are waves of different shape and amplitude with irregular rhythm. What is the mechanism of this rhythm disorder development?
D. *Multiple microreentry in the ventricles
A. Disorder of neurohumoral regulatory systems
B. Accelerated diastolic depolarization, a disorder in electrolyte balance
C. Sick sinus syndrome
E. Enhanced automatic activity of the ventricles
39. A 1-year-old child with fibroelastosis fell ill with acute respiratory viral infection. Suddenly he develops anxiety, acrocyanosis, Ps- 132 bpm, RR – 50/min, small bubbling rales in lower lungs, pO2 60 mmHg, pCO2 55 mmHg. On X-ray: cardiomegaly, amplification of lung pattern, radix pulmonis resembles butterfly wings. What is the most likely reason of child condition worsening?
E. *Pulmonary edema
A. Pulmonary abscess
B. Angioneurotic (Quincke’s) edema
D. Double-sided pneumonia
40. The family doctor diagnosed acute intestinal bleeding in a patient. What is medical tactics in this situation?
E. *Urgent hospitalisation to surgical unit
A. Urgent hospitalization to therapeutic unit
B. Hospitalization at home
C. Intravenous injection of aminocapronic acid
D. Hospitalization to day-time hospital
41. 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. Report addressed to Chief
B. Infectious disease report
D. Statistical coupon of final (precise) diagnosis
E. Abstract of outpatient medical card
42. A man presents to physician with
cramping pain in left side of the chest, general weakness, fever and headache that have appeared 2 days ago. In the morning skin rash on chest is noted. Physical examination: multiple aggregated vesicles with edematous roofs filled with transparent liquid, 2-4 mm in diameter. Vesicles are situated on the erythematous and edematous background along 4-5 intercostals. What is the most likely diagnosis?
E. *Herpes zoster varicellosus
A. Pityriasis rosea
B. Streptococcal (Fox’s) impetigo
C. Allergic dermatitis
D. Herpes simplex
43. A 49-year-old patient complains of fever of 37,5°C, chest pain, dyspnea. On physical examination: Sound 1 is clapping; Sound 2 is accentuated in the pulmonary artery, opening snap, presystolic murmurs are auscultated. What is the most useful investigation for valvular disorder assessment?
A. Electrocardiogram (ECG)
E. Chest X-ray
44. A 54-year-old woman complains of increasing fatigue and easy bruising for 3 weeks. Physical examination: pallor, scattered ecchymoses, petechiae, mild hepatosplenomegaly. Blood analysis: Hb 73 g/L, Hct 20%, RBC 2,55*1012/L, WBC 162*109/L with 82% blasts, that contain Auric rods, positive peroxidase stain, thromb. 23*109/L. What is the most probable diagnosis?
E. *Acute leukemia
A. Chronic leukemia
C. Megaloblastic anemia
D. Hemolytic anemia
45. A 25-year-old pregnant woman (35 weeks) is admitted to the hospital because of bleeding discharge. In her past history there were two artificial abortions. In a period of 28-32 weeks there was noted the onset of hemorrhage and USI showed a placental presentation. The uterus is in normotonus, the fetus position was transversal (1st position). The heartbeats were clear, rhythmical, 140 bpm. What is further tactics of managing the pregnant woman?
D. *To fulfil a delivery by means of Cesarean section.
A. To fulfil the observation for the intensity of hemorrhage and at the moment of stopping the bleeding to prolong the pregnancy
B. To introduct the drugs increasing blood coagulation and continue observation
C. To fulfil the hemotransfusion and to g the pregnancy
E. To fulfil the stimulation of delivery by intravenous introduction of oxytocin
46. 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.
D. *The linear diagram
A. The sector diagram
B. The curvilinear diagram
C. The radial diagram
E. The figured diagram
47. A 24-year-old primapara was hospitalized with complains on expulsion of the amniotic fluid. The uterus on palpation is tonic. The fetus is posed longitudinally, with the head pressed to pelvic inlet. The fetus heartbeat is rhythmical, 140 bpm, auscultated to the left below umbilicus. Pelvic examination: uterine cervix is 2,5 cm long, dense, the external os is closed, leakage of light amniotic fluid. Indicate the correct component of the diagnosis.
D. *Antenatal expulsion of the amniotic fluid
A. Pathological preliminary stage
B. End of the 1st stage of labor
C. Early expulsion of the amniotic fluid
E. Beginning of the 1st stage of labor
48. Indicate the unit of statistical observation for determination of influence of blood sugar level on the healing of wound’s surface in the postoperative period.
E. *Patient in the postoperative period
A. Blood sugar level
B. Patient with wound surface
C. Patient who is discharged to aftercare
D. Blood analysis
49. A 40-year-old man complains of headache in occipital area. On physical examination, the skin is pale; there is face and hand edema, BP 170/130 mmHg. On EchoCG, there was concentric hypertrophy of the left ventricle. Ultrasound examination of the kidneys reveals thinned cortical layer. Urinalysis shows proteinuria of 3,5 g/day. What is the diagnosis?
B. *Chronic glomerulonephritis
A. Chronic pyelonephritis
C. Cushing’s disease
D. Polycystic disease of the kidneys
E. Essential arterial hypertension
50. A 48-year-old man 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?
B. *Liver cirrhosis.
A. Cancer of the head of pancreas
D. Cancer of the liver
E. Viral hepatitis B
51. A primipara is in labor for 19 hours, amniotic fluid has discharged 7 hours ago. Pelvic sizes are: 24-25-29-18 cm. Fetal position is longitudinal, head presents and is engaged to pelvic inlet. Fetus heart rate is 160 bpm. No autonomous urination. Vaginal inspection: cervix is smoothed and 8 cm dilated. Head is presented, sagittal suture occupies the transverse diameter of pelvic inlet; small fontanelle is on the left. Lower uterine segment is tender on pressing. What medical tactics should be chosen?
A. *Urgent cesarian section
B. Vacuum-extractor operation
C. Application of obstetrical forceps
D. Stimulation of labor activity with intravenous oxytocin
52. 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 preliminary diagnosis?
B. *Pulmonary edema
A. Embolic pneumonia
C. Thromboembolism of pulmonary artery
D. Croupous pneumonia
E. Asthmatic status
53. A 39-year-old woman complains of heartburn and squeezing epigastric pain 1 hour after meal. She has been ill for 2 years. On palpation, there is moderate tenderness in pyloroduodenal area. Gastroscopy: antral gastritis. What study can establish genesis of the disease?
D. *Revealing of Helicobacter infection in gastric mucosa
A. Detection of autoantibodies in the serum
B. Gastrin level in blood
C. Examination of stomach motor function
E. Examination of stomach secretion
54. A woman 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?
B. *Stone of the right kidney, renal colic
A. Tumour of the right kidney pelvis
C. Acute appendicitis
D. Intestine invagination
E. Twist of the right ovary cyst
55. A 30-year-old man who suffered from headaches, felt an intense headache in the form of the blow on his head while lifting a heavy subject up. There appeared nausea, vomiting, and light dizziness. In a day there was an objectively presented meningial syndrome, t – 37,6°C The doctor have suspected subarachnoidal hemorrhage. What additional examination is necessary to do to confirm the diagnosis?
B. *Lumbar puncture with liquor examination
A. Cerebral angiography
C. Roentgenography of the cranium
D. Computed tomography
56. A 24-year-old woman with previously normal menstrual function, complains that her cycles became irregular. Tests of function diagnostics: anovulatory cycles. Blood level of prolactin is elevated. Choose the most suitable investigation.
E. *Computer tomography of the head
A. Measurement of serum levels of testosteron-depotum
B. Progesteron assay
C. USI of the small pelvis
D. Measurement of gonadotropins levels
57. A worker is taken on the staff and undergoes medical preventive inspection, results of which have allowed him to work in this industry. What is the type of medical preventive inspection that is use in this case?
58. A 31-year-old man with past history of rheumatic fever is severely ill and complains of fever up to 38-39°C, abdominal pain, dyspnea, palpitation; he felt ill 6 days ago. On exam, the left heart border is shifted to the left, heart sounds are faint, systolic and dyastolic murmurs at the aortic area, BP of 160/30 mmHg, positive Rumpel-Leede sign, enlargement of the liver and the spleen, diarrhea, and dark urea. What is the most likely diagnosis?
C. *Infective endocarditis
A. Rheumatic aortic valve disease
B. Acute viral hepatitis
D. Typhoid fever
E. Acute nephritis
59. A 32-year-old woman complains of the pain in the left epigastric area that has appeared in 2 hours after meal. She also complains of nausea, bloating of the abdomen, tendency to diarrhea. On physical exam: icteric sclera’s. 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 – 20μmol/L. What is the most probable disease?
B. *Chronic pancreatitis
A. Chronic enterocolitis
C. Chronic hepatitis
D. Chronic gastritis
E. Chronic cholecystitis
60. A 16-year-old female presents with abdominal pain and purpuric spots on the skin. Laboratory investigations reveals normal platelet count, with haematuria and proteinuria. What is the most likely diagnosis?
D. *Henoch Schonlein purpura
A. Thrombotic thrombocytopenic purpura
B. Haemolytic uraemic syndrome
C. Sub acute bacterial endocarditis
E. Heavy metal poisoning
61. 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?
62. A 50-year-old woman for 1 year complains of attacks of right subcostal pain after fatty meal. Last week the attacks have repeated every day and become more painful. What diagnostic study would you recommend?
B. *Ultrasound investigation of gallbladder
A. Liver function tests
C. Blood cell count
D. Ultrasound study of the pancreas
E. X-ray examination of the gastrointestinal tract
63. A 29-year-old woman underwent surgical treatment concerning the benign serous epithelial tumour of the ovary. The postoperative period has passed without complications. What is it necessary to prescribe in the rehabilitational period?
A. *Hormone therapy and proteolytic enzymes
B. Laser therapy and enzyme therapy
C. Antibacterial therapy and adaptogens
D. Does not demand the further observation
E. Magnetic therapy and vitamin therapy
64. After delivery and revision of placenta there was found the defect of placental lobe. General condition of woman is normal, uterine is firm, there is moderate bloody discharge. Inspection of birth canal with mirrors shows absence of lacerations. What is the following necessary action?
C. *Manual exploration of the uterine cavity
A. External massage of uterus
B. Use of uterine contracting agents
D. Use of haemostatic medications
E. Urine drainage, cold at lower abdomen
65. A diagnosis of chronic arsenous intoxi cation was defined at the patient who is working as a nightman. What form of anemia is characteristic for this disease?
B. *Hemolytic anemia
A. Iron deficiency anemia
C. Hyper sideric anemia
D. B12 – deficiency anemia
E. Aplastic anemia
66. A 34-year-old woman fell ill 3 months ago after cold exposure. She complains of pain in the hand and knee joints, morning stiffness, and fever up to 38°C. Interphalangeal, metacarpophalangeal and knee joints are swollen, hot, with decreased ranges of motions. ESR of 45 mm/h, CRP (+++), Vaaler-Rouse test of 1:128. What group of medicines would you recommend to the patient?
B. *Nonsteroidal anti-inflammatory drugs
67. A 33-year-old woman works as secretary. Her diet contains 150 g of protein (including 100 g of animal), 200 g of fat, and 600 g of carbohydrates. What pathology can effect this diet?
C. Common cold
D. Uterine fibromyoma
68. A 25-year-old man is hospitalized with complaints of double vision, worsening of eyesight, difficulty of breath, dryness in the mouth. He fell ill acutely 12 hours ago. Before falling ill he ate mushrooms. Physical examination: skin is pale, pupils are wide with weak reaction to light, swallowing is disturbed. Ps 55 bpm. Severe muscle weakness. The stomach is bloated . What is your preliminary diagnosis?
A. Salmonella infection, gastrointestinal form
69. A 65-year-old patient complains of gradual worsening of the left eye vision during 10 months. On physical examination: acute 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?
D. *Senile cataract
A. Exfoliation of the retina
B. Leukoma of the cornea
C. Open-angle glaucoma
E. Disorder of blood circulation in retina vessels
70. 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?
D. *Prescribe fast-acting insulin
A. Give Glurenorm in place of Maninilum
B. Prescribe guanyl guanidines
C. Prescribe long-acting insulin
E. Continue with the current therapy
71. A 9-year-old woman has fitlike abdominal pains after fried food. No fever. She has the pain in point Cera. The liver is not enlarged. Portion B (duodenal probe) – 5 ml. What is the most likely diagnosis:
B. *Biliary tracts dyskinesia, hypotonic type.
A. Ulcer disease
C. Acute colitis
D. Chronic duodenum
72. Parents of 5-year-old boy complain of ventral curvature of penis. Physical examination: external urethral meatus is on the apex of penis, prepuce is hood-like. What is the most likely diagnosis?
C. *Hypospady without hypospady
A. Epispadia of balanus
D. Induratio penis plastica (Peyronie’s disease)
E. Latent penis
73. A 38-year-old man worked at roofing and drain piper production for 15 years. He seeks medical help for expiratory breathlessness on exertion, and dry cough. On exam, wheezes above both lungs, grayish warts on fingers are seen. Factory physician has suspected asbestosis. What method is the most important for this diagnosis?
D. *Chest X-ray
C. Blood gas analysis
74. The sample from 5 tons milk batch was taken. In the lab analysis it was defined: fat content 2%, specific density 1,04 g/cm3, acidity 21°T, reductase probe – weak positive. How should the product be used?
B. *Sell but inform customers about milk quality
A. Technical utilization
C. Sell without limitations
D. Destroy product
E. Write off for animal feeding
75. A 30-year-old man has a history of recurrent pneumonias and chronic cough production of foul smell, purulent sputum, occasionally gloom tinged, which becomes worses in the morning and in reclining position. On physical examination, it is a chronic patient with clubbing of fingers, wet inspiratory rales at the root of lungs from behind. What is the most probable diagnosis?
A. Chronic bronchitis
B. Disseminated pulmonary tuberculosis
C. Pulmonary neoplasm
E. Chronic obstructive emphysema
76. A 15-year-old teenager complains of poor night vision. Physical examination: 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 the cause of the disease?
B. *Retinole deficit
A. Napthtoquinone deficit
C. Thiamine deficit
D. Folic acid deficit
E. Biotin deficit
77. 25 unorganized children of pediatric district in the age 2 -3 years will be observed in the current year. What scheduled number of initial visitations will make to this group of children?
78. A 20-year-old woman complains of weakness, wet cough, body temperature raise up to 37, 5°C by evenings for one month. In childhood was under supervision at phthisiatrician due to bend of tuberculin test (PPD). The condition is good. No rales in lungs. Chest X-ray: a shadow with dim contours 3 x 4 cm with areas of enlightenment and centers near shadow in the upper lobe of right lung. Blood analysis: ESR 20 mm/hour. What is the most likely diagnosis?
A. Infiltrative tuberculosis
B. Pneumonia with abscess formation
D. Decaying cancer
E. Focal tuberculosis
79. An ECG of postinfartional (a year ago) patient shows pathological QS waves in leads VI-V3, I, aVL. Determine the location of old myocardial infarction.
A. *Septal and anterior
80. A 20-year-old woman with a 3-4 month history of bloody diarrhoea. Sigmoidoscopic examination: oedema, hyperemia and ulceration of the rectum and sigmoid colon. Stool examination: negative for ova and parasites. Normal small bowel series. Stool cultures: negative for Clostridium, Campylobacter and Yesinia. What is the most likely diagnosis?
B. *Ulcerative colitis
A. Zollinger-Ellison syndrome
D. Carcinoid syndrome
E. Granulomatous colitis
81. At the patient of 34 years of age you suspect an abscess of Douglas spaces. What method of investigation is preferable to diagnostics?
C. *Finger examination of rectum
A. X-ray of abdominal cavity
E. Percussion and auscultation of stomach
82. What methods of the collecting of the information is preferable for study of housing conditions of students of medical HIGH SCHOOL for a training period?
A. Selecting of materials
D. A method of the directed selection
83. A man with meningococcus meningitis has been taking penicillin for 7 days. Last 4 days a body’s temperature is normal. Meningitic signs are absent. When is it possible to cancel antibiotic?
D. *If liquor cytosis is 100 or less, mainly due to lymphocytes
A. If liquor cytosis is 150, mainly due to lymphocytes
B. Right away
C. If leucocytosis and left neutrophil shift are absent
E. If liquor cytosis is 100 or less, mainly due to neutrophils
84. A 52-year-old woman suffering from obesity complains of bloody discharges from sexual paths during 4 days. Last normal menses was 2 years ago. Histological investigation of biopsy of the endometrium has revealed adenomatous hyperplasia. Which reasons from listed below promoted the development of disease?
E. *Excessive transformation of preandrogens from fatty tissues
A. Elevated level of FSH
B. Hypersecretion of estrogens by body tissues
C. Poor aromatization of preandrogens due to hypothyroidism
D. Hypersecretion of androgens by adrenal cortex
85. A sick person is staying in the hospital with the diagnosis of abdominal typhus. During the 3rd week from the beginning of the disease the patient stopped keeping diet and confinement to bed. As a result the body temperature and rapid pulse developed and melena appeared. What kind of complications should we think first of?
A. *Intestinal haemorrhage
86. A 68-year-old man 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 hemoglobin and quantity of thrombocytes is normal. Myelogram showed 40% of lymphocytes. What is the most probable diagnosis?
B. *Chronic lympholeucosis
A. Acute leucosis
C. Chronic myeloleucosis
D. Tuberculous lymphadenitis
87. The woman complains of slight dark bloody discharges and lower abdominal discomfort for several days. Her last menstrual period was 7 weeks ago. The test for pregnancy is positive. Pelvic examination: the uterine is about 5-6-week of gestation size, of softish consistence, painless. In the left ovary a retort like formation, 7×5 cm, mobile, painless is palpated. What it is necessary to do to determinate the fetal eggs localization?
A. *Ultrasound investigation
88. A child has attached fingers of his right hand. What is your diagnosis?
89. To study physical development of children and adolescents, anthropometric investigations are widely used. Choose a physiometric method of investigation from the below given.
D. *Determination of vital capacity of lungs
A. Determination of thorax form
B. Determination of vertebra form
C. Determination of body weight
E. Measurement of growth
90. A 40-year-old woman complains of yellow vaginal discharge. Bimanual investigation: no pathological changes. In smear: Trichomonas vagynalis and blended flora. Colposcopy: two hazy fields on the front labium, with a negative Iodum probing. What is your tactics?
E. *Treatment of specific colpitis and subsequent biopsy
A. Diathermocoagulation of the uterine cervix
D. Cryolysis of cervix of the uterus
91. An employee was disabled during 6 months as a result of the hip fracture. Who is entitled to sign the sick-leave for the last 2 months?
A. DCC together with the head physician of the polyclinic
B. Head physician of the polyclinic
C. Doctoral controlling committee (DCC)
D. Deputy head physician of the enterprise
92. 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. Uterotonic medications
B. Observation of woman after labor
C. Instrumental revision of the uterine cavity
D. External massage of the uterus
93. 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?
B. *Immunization of the population
A. Disinfection in disease focus
C. Revelation of carriers
D. Early diagnostics
E. Hospitalization of patients
94. A 50-year-old male patient was brought to Emergency Department with diffuse abdominal pain and signs of cardiovascular collapse. Upon arrival he had BP 95/60 mmHg, Ps — 120 bpm, diuresis 20 mL/H, Hg 100 g/L, RBC 2,1*1012/L. The patient needs infusion of:
E. *Crystalloid and colloid
A. 5 % dextrose and colloid
B. Crystalloid and 5% dextrose
C. Crystalloid and red blood cells
D. 5% dextrose and red blood cells
95. A man fell ill acutely 6 hours ago with frequent watery stool. 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?
A. Typhoid fever
D. Toxic food-borne infection
96. The woman was hospitalised with full-term pregnancy. Pelvic 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. *Acute hypoxia of the fetus.
A. Premature detachment of the normally posed placenta
C. Occiput posterior presentation
E. Premature labor
97. 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?
98. Workers of fishery are subjected to low temperatures of the air (from —5°C till — 15°C). Diseases of what organs and systems are the most frequent among workers of such enterprises?
D. *Respiratory system
B. Gastrointestinal tract
C. Cardiovascular system
99. A 57-year-old patient with megaloblastic anemia is getting worse. He complains of weakness, headache, dizziness, paresthesia, palpitation, and fever. Physical examination: The consciousnes is confused, the skin is subicteric pale, sternalgia. Blood count: Hb 65 g/L; RBC 1,0* 1012/L, colour index 1,2; WBC 3,4*109/L, Tromb. 120*109/L. What condition is observed?
B. Acute infection
E. Acute haemorrhage
100. A 35-year-old woman was admitted to thoracic surgery department with fever up to 40°C, onset of pain related to deep breath in the side, cough with big quantity of purulent sputum and blood with bad smell. What is the most likely diagnosis?
C. *Abscess of the lungs
A. Bronchectatic disease
B. Actinomycosis of lungs
D. Tuberculosis of lungs
E. Complication of liver echinococcosis
101. A 3-day-old newborn who has suffered asphyxia in labor presents with bleeding from umbiligal sore. Labo tests: hypocoagulation, thrombocytopenia, hypothrombinemia. What is the most likely cause of clinical and laboratory changes?
E. *Disseminated intravascular coagulation (DIC)
A. Trauma of umbilical vessel
B. Thrombocytopenic purpura
C. Inborn angiopathy
D. Hemolytic disease of newborn
102. A 4-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 control of the bleeding?
D. *Introduction of obturator nasogastric tube.
A. Intravenous administration of pituitrin
B. Administration of plasma
E. Hemostatic therapy
103. A 32-year-old patient complains of severe weakness, tremor of extremities. Physical examination: body weight loss, wet and warm skin. The thyroid gland is enlarged up to the 3rd degree, painless, elastic. Ps: 108 bpm, BP – 160/55 mmHg. Everything else is normal. What is the most likely diagnosis:
D. *Diffuse toxic goiter of the 3rd degree, thyrotoxicosis of the average degree
A. Toxiferous adenoma of the thyroid gland
B. Chronic autoimmune thyroiditis, hypertrophic type
C. Diffuse euthyroid goiter of the 3rd degree
E. Chronic fibrous thyroiditis
104. A 34-year-old woman on the 10th week of gestation (2nd pregnancy) has come to obstetrician with the purpose of statement on the dyspensary record. In the previous pregnancy there took place hydramnion, the child was born with body weight of 4086 g. What investigation is necessary to administer first of all?
B. *Glucose tolerance test
A. USI of the fetus
B. Cardiophonography of epy fetus
D. Measurement of α-fetoproteinum level
E. Bacteriological investigation of vaginal discharge
105. A 9-year-old girl has an average height and harmonic growth development. She was ill with acute respiratory infection five times. Define the group of her health.
B. *2nd group
A. 1st group
C. 3rd group
D. 5th group
E. 4th group
106. A 35-year-old man 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 1 on the apex is weakened, Sound 2 is accentuated – in aorta. Rough systolic murmur is ausculated on each side of the umbilicus. What pathology could cause this clinical picture?
E. *Stenosis of renal arteries
A. Essential hypertension
B. Conn’s syndrome
C. Chronic glomerulonephritis
107. A 32-year-old woman complains of fever, headache, acute weakness, sleeplessness for 8 days. On physical examinations: t – 39,8°C, Ps 86 bpm, BP 90/60 mmHg. Skin is pale with solitary roseola rash at the abdomen. Tongue is dry, covered by spot and prints of teeth on lateral surface. Abdomen is soft with dullness of percussion sound in ileocecal area. Hepatosplenomegalia .What is the most likely diagnosis?
A. *Exanthematic typhus (Spotted fever)
B. Typhoid fever
E. Miliary tuberculosis
108. A 23-year-old man presents with gun-wound on the left arm. The arm bones are undamaged. What appropriate surgical help must be provided to such a patient?
B. *Primary surgical processing with a flowing suction
A. Suturing of wound
C. Drying of wound with towel gauzes
D. Suturing and drying of wound
E. Aseptic dressing of the wound
109. A 60-year-old boiler-man presents to factory’s sectorial doctor with headache and tiredness. Lab tests: carboxyhemoglobin in blood. Poisoning with which substance is the most likely to cause formation of carboxyhemoglobin in blood?
A. *Carbon oxide
110. A 28-year-old woman presents to doctor complaining of enlargement, getting wet and itching of pigment nevus which was present from birth. What method of investigation should not be applied to diagnostics in this case?
D. *Incision biopsy
A. Yaks’s reaction
C. Radioisotope diagnostics
111. A 4-month-old girl with blond hair and blue eyes has “mousy” odor of sweat and urine, delayed psychomotoric development. What is the mostly typical laboratory data for this disorder?
A. *Positive urine ferric chloride test
B. High level of oxyproline in urine
C. High concentration of chlorides in sweat
D. High level of glycosaminoglycanes in urine
E. Low level of thyroid gland hormones in blood
Do 112. 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?
113. A student 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. 50-100 L
C. 500 L
E. 1.300-400 L
114. A 41-year-old woman complains of weakness, fatigue, fever up to 38°C, rash on the face skin, pain in the wrists and the elbows. Physical exam: erythematous rash on the cheeks with “butterfly”appearance. The wrist and elbow joints are involved symmetrically, swollen, and tender on motions. Frictions rub over the lungs, the heart sounds are weak, regular, HR 88/min, BP 160/95 mmHg. CBC: anemia, leucopenia, ymphopenia. Urinalysis: 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 antibodies to myocytes
D. Production of antibodies to myosin
E. Production of antibodies to endothelial cells
115. 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?
E. *400 ml
A. 1000 ml
B. 650 ml
C. 300 ml
D. 500 ml
116. A 3-month-old infant who is suffering from acute segmental pneumonia reveals dyspnea [RR – 80 per minute], paradoxical breathing, tachycardia, generalized cyanosis. Respiration-pulse ratio is 1:2. The heart size is normal. What are these signs indicative of?
C. *Respiratory failure of III degree
B. Congenital heart disease
D. Respiratory failure of I degree
E. Respiratory failure of II degree
117. A 8-year-old boy fell ill acutely: fever, weakness, headache, abdominal pain, recurrent vomiting, then diarrhea and tenesmus. Stools occur 12 times daily, are scanty, contain a lot of mucus, pus, streaks of blood. His sigmoid gut is tender and hardened. What is your diagnosis?
E. Staphylococcal gastroenteritis
118. A 54-year-old man complains 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. X-ray: uncoinsidence of articulating surfaces. What is the most probable diagnosis?
D. *Dislocation of the clavicle
A. Dislocation of the scapula
B. Dislocation of the humerus y
C. Contusion of the humerus
E. Fracture of the humerus
119. A newborn girl has congenital lymphedema of the hands and feet, short neck with loose skin, antimongoloid slant of palpebral fissures, epicanthal folds. In epithelial cells of buccal scrape X-chromatin (Barr body) is absent. What is the most likely diagnosis?
D. *Shereshevsky-Turner syndrome
A. Klinefelter syndrome
B. Edwards syndrome
C. Down syndrome
E. Patau syndrome
120. What is the treatment of choice for the patient with 1,5 cm uncomplicated, asymptomatic, calcium oxalate renal stone?
B. *Extra-corporeal shock wave lithotripsy
A. Watchful waiting
C. Descending litholisis
D. Open pyelolithotomy
E. Percutaneous nephrostonelithotomy
121. A 3-year-old child is admitted to hospital due to decrease of urine volume (200 mL per day), peripheral and cavity edema. Urinanalysis: protein 3,3 g/L. What is the most likely diagnosis?
A. *Acute glomerulonephritis with nephrosis
B. Interstitial nephritis
C. Infection of urinary tract
D. Chronic glomerulonephritis
E. Acute glomerulonephritis with nephritic syndrome
122. 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.
E. *Discomfortable microclimate
A. Poor lighting
B. All conditions are OK
C. High level of noise
D. Non-effective ventilation
123. A man complains of pain in lower abdomen with frequent urges for urination for 3 hours. Pain has appeared after load lifting and constantly increases. Physical examination: dense painful hernial protrusion (diameter 4cm) in right inguinal region above inguinal (Poupart’s) ligament. Both testicles are in scrotum. Right testicle is painful on palpation. What is Your preliminary diagnosis?
E. *Irreducible right-sided inguinal hernia
A. Irreducible inguinoscrotal hernia
B. Sliding hernia of urinary bladder
C. Strangulated right-sided inguinal hernia
D. Traumatic orchitis, inguinal lynphadenitis on the right side
124. A 49-year-old woman is being treated for renal colic. Examination reveals a small cyst (diameter 2,5 cm) of the right kidney. What prophylactic investigation is indicated for patient in 6 months in order to define treatment plan?
D. *Ultrasound investigation of kidney
A. Excretory urography
B. Kidney scintigraphy
C. X-ray of kidney
E. CT of kidney
125. A 28-years-old man, without a constant place of residence, was hospitalised with the preliminary diagnosis of “influenza”. At the 5th day of the disease there appeared typhoid maculopapular and petechial skin rash on trunk and extremities, t – 41°C, euphoria, facial hyperaemia, sclera reddening, tongue tremor. Ps 104 bpm. Splenomegalia. What is the most likely diagnosis?
E. *Exanthematic typhus (Spotted fever)
A. Typhoid fever
B. Alcoholic delirium
126. A 1-year-old infant is admitted for failure to thrive. During the neonatal period he had an exploratory laparotomy for intestinal obstruction. At 3,8 and 11 month of age, he had respiratory infections diagnosed as bronchitis. Physical examination: weight of 6,8 kg, thin extremities with very little subcutaneous tissue, and a protuberant abdomen. The essentials diagnostic study in this child is:
D. *Sweat electrolytes
A. Skin test for milk allergy
C. Serum immunoglobulin level
E. Tuberculin skin test
127. A 32-year-old woman comes to the gynecologist complaining of heavy long menses during 3 months. Pelvic examination: the he uterus is enlarged according to about 12 week’s gestation, distorted, tuberous, of dense consistence. Adnexa are not palpated. Histological investigation of uterine mucosa: adenocystous hyperplasia of endometrium. What is the optimum medical tactics?
D. *Surgical treatment
A. Phase by phase vitamin therapy
C. Hormone therapy
E. Radial therapy
128. A 37-year-old man complains of pain in left hand primarily during movements, fever up to 39°C. Physical examination reveals trace of injections, hyperemia, thickening along veins in right cubital area. What is the most likely diagnosis?
129. A 60-year-old asthmatic man comes for a check up and complains that he is having some difficulty in “starting to urinate”. Physical examination: BP 160/100 mmHg, and a slightly enlarged prostate. Which of the following medications would be useful in treating both of these conditions?
130. During an operation for presumed appendicitis, the appendix is found to be normal; however, the terminal ileum is markedly thickened and felt rubbery to firm, its serosa is covered with gray-white exudate, and several loops of apparently normal small intestine are adherent to it. The most likely diagnosis is:
B. *Crohn’s disease of the terminal ileum
A. Ulcerative colitis
C. Acute ileitis
D. Perforated Meckel’s diverticulum
E. Ileocecal tuberculosis
131. 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. Phlegmonous tonsillitis
C. Pharyngeal tumor
E. Vincent’s disease
132. A 38-year-old woman was hospitalized to the surgical unit with acute abdominal pain irradiating to the spine and vomiting. On laparocentesis hemmorhagic fluid is obtained. What disease is suspected?
A. *Acute pancreatitis
B. Acute enterocolitis
C. Renal colic
D. Acute appendicitis
E. Perforative gastric ulcer
133. An anestesiologist 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%, level of noise 30 dB. What occupational hazards is the principal one in these conditions?
A. *Air pollution with anesthetic
B. Improper occupational microclimate
C. Mental overfatigue
D. Compelled working pose
E. High level of noise
134. A 30-year-old man has suffered from traffic accident. Consciousness is absent. Ps on the carotid artery is undeterminable, no respiration. There is a wide leather belt on man’s waist. What measures are to be taken?
B. *Conduct an artificial ventilation of lungs and closed-chest cardiac massage after having released from the belt
A. Start immediate artificial ventilation of lungs and closed-chest cardiac massage
C. Put the victim with his back on the shield
D. Turn the victim to the right side
E. Do not touch the victim until the arrival of the police
135. In 30 days after accidental coitus, a 25-year-old patient develops 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. Chancriform pyoderma
D. Chancroid (soft chancre)
E. Scabies complicated with pyococcuses
136. A patient with a history of coronary artery disease and atrial fibrillation develops sudden pain and weakness of the left leg. Examination reveals a cool, pale extremity with absent pulses below the groin and normal contralateral leg. What is the most likely diagnosis?
A. *Arterial embolism
B. Acute thrombophlebitis
C. Cerebrovascular accident
D. Arterial thrombosis
E. Dissecting aortic aneurysm
137. A 29-year-old woman is critically ill. The illness was manifested by high fever, chills, sweating, aching pain in lumbar area, a discomfort in urination, and frequent voiding. Pasternatsky’s sign is positive in both sides. On lab exam, WBC of 20 * 109/L; Urinalysis: protein of 0,6 g/L, leukocyturia, bacteriuria. What is preliminary diagnosis?
A. *Acute pyelonephritis
B. Exacerbation pf chronic pyelonephritis
C. Acute glomerulonephritis
E. Acute cystitis
138. A 40-year-old man, veterinary by profession, complains of moderate weakness,fever 38° C for 3 days. On physical examination an ulcer on right forearm is revealed, diameter 1,5 cm, covered with dark brown scab, surrounded by zone of hyperaemia with fine vesicles. There is a severe edema of forearm soft tissues. The right-side cubital and axillary lymphatic nodes are enlarged and tender. He has fresh scratches on his hands. What is the most probable diagnosis?
B. Staphylococcus carbuncle
D. Tularaemia, ulcerobubonic form
139. A 25-year-old woman complains of absense of menses during 3 months, nausea. On vaginal examination: vulval and vaginal mucosa is bluish, uterine corpus is enlarged, uterine fundus is 3 cm above symphysis pubis. Uterus is soft, and becomes dense upon palpation. Adnexa are not identified. Discharge is mucosus.
What is the most likely diagnosis?
C. *l2-week pregnancy
A. Disorder of menstruation cycle
D. Fibromioma of uterus
140. 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?
B. *Gastritis of type
A. Reflux – gastritis
C. Menetrier’s disease
D. Gastritis of A type
E. Rigid antral gastritis
141. A 1-year-old child suffers of attack-like cough. The child presents with the history of dyspepsia since birth. On physical examination there are signs of delay in physical development, bronchial obstruction, respiratory insufficiency, 1 grade. Blood count: signs of inflammatory process. Sweat chlorides 120 mEq/L. What is the most likely diagnosis?
D. *Cystic fibrosis
A. Bronchopulmonary dysplasia
B. Kartagener’s syndrome
C. Acute respiratory infection, bronchitis
E. Severe bronchial asthma
142. A 60-year-old man has been diagnosed osteoarthritis of knee joints. Which of the following medications is the most appropriate for treatment?
143. A patient with nosocomial pneumonia presents signs of collapse. Which of the following pneumonia complications is most likely to be accompanied with collapse?
D. *Septic shock
A. Toxic hepatitis
B. Bronchial obstruction
E. Exudative pleuritis
144. A 22-year-old woman complains of dull right subcostal pain, nausea, decreased appetite. History: disease started with jaundice in 2 months after appendectomy. She was treated in an infectious hospital. 1 year later present complaints have developed. Physical examination: subicteric sclerae, enlarged firm liver. What is your preliminary diagnosis?
A. *Chronic viral hepatitis
B. Chronic cholangitis
C. Acute viral hepatitis
D. Calculous cholecystitis
E. Gilbert’s disease
145. 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 insufficiency. When will she need the inpatient treatment (what periods of pregnancy)?
B. *8-12 weeks, 28-32 weeks, 37 weeks
A. 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
146. A non-alcoholic 45-year-old woman presents with an asymptomatic, septated 10-cm cystic mass in the body of the pancreas. She should be advised for the following:
D. *Complete excision of the lesion.
A. Lesion is cancerous and woman will likely die in 12 months
B. Observation only due to probably benign lesion
C. Total pancreatectomy
E. Drainage by Roux-en-Y jejunostomy
147. 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?
D. *Acute glomerulonephritis
A. Chronic glomerulonephritis
C. Cancer of the kidney
E. Acute pyelonephritis
148. A 27- year-old woman was admitted to the clinic with complaints of pain in right ankle joint, non-bearable extremity. Physical examination: the patient had a fracture of anterior part of distal metaepiphisis of tibia [Pott-Desto’s fracture]. What is the mechanism of such an injury?
D. *Supination of the foot
A. Load along the axis with dorsal flexion of foot
B. Load along the axis with planter flexion of foot
C. Pronation of the foot
E. Direct blow
149. Water that is used for supply of the city, contains fluoride 2,0 mg/L, nitrates 43 mg/L, chlorides 250 mg/L, ferrum 0,2 mg/L, residual nitrogen 0,5 mg/L. What medical condition is the most likely to occur in inhabitants of this city?
D. Endemic goitre
150. A 7-year-old boy has an attack of asphyxia and distant whistling rale after playing with a dog. History: atopic dermatitis caused by eating eggs, chicken, beef. What group of allergens is the reason of the development of bronchial asthma attacks?
A. Itch mite
151. A 25-year-old woman complains of edema on the face and legs, elevation in blood pressure up to 160/100 mm Hg, and weakness. She fell ill 3 weeks after sore throat. On urinalysis, protein of 0,5 g/L, erythrocytes of 17 – 20/field, leukocytes of 2 – 3/field, erythrocyte casts. What treatment should be initiated after establishing of the exact diagnosis?
152. An attack of severe substernal pain developed in a patient at night. On exam: confusion, pallor of the skin, acrocyanosis, cold sweating, BP of 80/50 mmHg, heart rate 120/min, irregular and weak pulse. What kind of condition has developed?
B. *Cardiogenic shock
A. Acute left-sided heart failure
C. Acute vascular insufficiency
D. Acute right-sided heart failure
E. Radicular syndrome
153. A district physician has diagnosed domestic accident at worker of chemical factory who is at home. The worker is temporarily disable. What document should be given to legalize his disability?
E. *Sick-list from the 1st day
A. Sick-list from the 5 th day after presenting to physician
B. No documents
C. Certificate of free form
D. Certificate of definite form
154. A 37-yea-old man suddenly felt a strong pain in metatars-phalanx joint of 1st finger on left foot. Pain has appeared at night after celebrating a birthday. Physical examination: skin above the joint is red, the joint is swollen . Blood count: WBC 9,6* 109/L, Neutrophils 74%, ESR 30 mm/h. Uric acid 0,49 mmol/L. What medication do you prescribe to the patient?
155. A 52-year-old man has recurrent transient ischemic attacks. Auscultation of the carotid arteries detects murmur. What diagnostic method is necessary to apply at first?
A. *Ultrasound dopplerography
C. CT of the brain
D. Cerebral angiography
E. MRI of the brain.
156. A 46-year-old male was hospitalized with complaints of shortness of breath at rest, palpitation, irregular work of heart, weakness. Physical examinations: severe condition, orthopnea, acrocyanosis.RR 28/min. Ps 94 bpm, BP 150/70 mmHg. Cardiac enlargement, the dullness of heart sounds and ventricular gallop. Rales is auscultated in lower lungs. A liver is slightly enlarged. The moderate edema of lower extremities. What revealed symptom is an authentic sigh of congestive heart failure?
A. Cardiac enlargement
B. Pulmonary rales
E. Ventricular gallop
157. A 27-year-old man came to consult a psychiatrist with the following complaints: after a bad car accident, the victim of which he was and in which his wife was killed, he suffered depression, anxiety, flashbacks of the event, sleep disorders and nightmares about the accident. He also had emotional numbness and fatigue. The cause of the disorder was:
A. *Severe stress
B. Environmental factors
C. Patient’s personality features
D. Adjustment disorder
E. Endogenic factors
158. A 48-year-old man was taken to the emergency department in severe condition. Medical history: 3 hrs ago he was processing potato plants with the poison against Colorado beetles. Physical examination: acrocyanosis, bronchorrhea, tachypnea, BP 100/60 mmHg, Ps 44 bpm. What method of efferent therapy is the most expedient on this stage?
159. The diagnosis of right-sided pneumothorax is made to a 36-year-old patient. What method of treatment is indicated to this patient?
C. *Surgical drainage of the pleural cavity
A. Antiinflammation therapy
D. Pleural puncture
E. Symptomatic therapy
160. A 3-year-old boy fell ill abruptly: fever up to 39°C, weakness, vomiting. Haemorrhagic rash of various sizes appears on his lower limbs in 5 hours. Meningococcemia with infective – toxic shock of 1 degree was diagnosed. What medications should be administered?
A. *Chloramphenicol succinate and prednisone
B. Penicillin and immunoglobulin
C. Chloramphenicol succinate and interferon
D. Penicillin and prednisone
E. Ampicillin and immunoglobulin
161. In mental status of a 22-year-old man 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?
162. A 10-year-old boy complains of joint pain and impossibility of movement in left knee and right elbow. 2 weeks ago he had tonsillitis Physical examination: t – 38,5°C and ankle dysfunction, enlargement of cardiac dullness on 2 cm, tachycardia, weakness of Sound 1, gallop rhythm, weak systolic murmur near apex. Which diagnosis corresponds to such symptoms?
B. *Acute rheumatic heart disease
A. Reactive arthritis
C. Juvenile rheumatoid arthritis
D. Reiter’s disease
E. Systemic lupus erythematosus
163. A 32-year-old female complains of feeling too lazy, reduction of work capacity, and hopelessness of life. The suicide idea takes place. During 2 weeks before, the raised activity, uncontrollable fun and levity was observed. What is your diagnosis?
C. *Bipolar affective disorder
A. Recurrent depressive disorder
B. Schizoaffective disorder
D. Depressive episode
E. Maniacal episode
164. A 27-year-old man was hospitalized to the psychiatric hospital for the 4-th time during 2 years. He hears voices commenting on his actions, has delusions of persecution (is sure that the Mafia wants to kill him). After a course of treatment with neuroleptics is discharged from hospital with the diagnosis of schizophrenia, state of remission. The
secondary prevention of the relapses of schizophrenia requires:
C. *Supportive treatment with neuroleptics of prolonged action
A. Participation in a self-help group
B. Long-term hospitalization
D. Psychiatric observation
E. Psychoanalytic treatment
165. A 18-year-old woman applied to 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 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, free. Bacterioscopy test showed diplococcus. What diagnosis is the most probable?
C. *Recent acute ascending gonorrhea
D. Chronic gonorrhea
166. A 40-year-old woman who has worked in weaving branch for 10 years complains of frequent headache, sleeplessness, irritability, fatigue, tiredness. Physical examination reveals instability of blood pressure, internal organs are without changes. What is the most probable diagnosis?
C. *Noise-induced disease
D. Asteno-vegetative syndrome
E. Atopic bronchial asthma
167. A 9-year-old child with diagnosis «chronic tonsillitis” stands dispanserization control. For 1 year of observation there was one exacerbation of disease. Physical condition is satisfactory. The general state is not infringed. Define group of health:
E. *III (a)
C. III (c)
D. III (b)
168. A 32-year-old woman is admitted to gynecology department with the diagnosis of acute bartholinitis. Physical examination: t — 38,2°C. Skin hyperemia in the area of vestibule big gland, positive fluctuation sign, and sharp tenderness. Blood count: WBC 10,4 * 109/L, ESR 24 mm/h. What is the most correct tactics of the doctor?
E. *Surgical dissecting; drainage of an of the gland; antibiotics
A. Antibiotics, sulfonamides
B. Antibiotics, detoxication and biosti-mulators
C. Surgical dissection; drainage of the abscess of the gland
D. Antibiotic therapy
169. A 20-year-old man complains of pain and edema in right buttock. Physical examination: limited tenderness, painful swelling with hyperemia of skin above and local hyperthermia. Positive fluctuation symptom. Abscess is diagnosed. What is your tactics?
A. *Lancing and draining of abscess, broad spectrum antibiotic
C. Broad spectrum antibiotic and sulfonamide
D. Administration of tetanus antitoxin and medications for stimulation of immunity
E. Local application of dimexide
170. 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?
171. A 44-year-old woman complains of weakness, subfebrile fever, and pallor of the skin. Physical examination reveales the enlarged lymph nodes in the right supraclavicular area. On X-ray: enlargement of bronchopulmonary and paratracheal lymph nodes. The liver is enlarged, with increased firmness. What is the diagnosis?
C. *Hodgkin’s disease
A. Chronic myelocytic leukemia
B. Tumor metastases
172. 6-month-old infant was born with body’s mass 3 kg and length 50 cm. He is given natural feeding. How many times per day the infant should be fed?
173. 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 /itmol/L, direct bilirubin level – 5 mol/L, Hb -150 g/L. Mother’s blood group – 0[I], Rh+, child’s blood group- A[II], Rh+. What is the most probable diagnosis?
C. *Hemolytic disease of the neonate [ABO incompatibility]
A. Jaundice due to conjugation disorder
B. Physiological jaundice
D. Hemolytic disease of the neonate [Rh -incompatibility]
174. A 8-month-old child is diagnosed atypical community-acquired Chlamidia trachomatis pneumonia. Select the best antibiotic.
A. *Macrolide of 2nd generation
B. Macrolide of 1st generation
D. Cephalosporine of 2nd generation
175. A 2,5-month-old 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?
C. *3000IU daily
A. 1000IU daily
B. 1000 IU every other day
D. 500 IU every other day
E. 500 IU daily
176. A 30-year-old patient complains of shortness of breath, pain in the right rib arc place, dry cough and leg edema. He has been ill for 2 months. He was treated for rheumatic fever without effect. On exam: cyanosis, edema of the legs, t – 36,6°C, RR 28/min, HR 90/min, BP 110/80 mm Hg. Bilateral pulmonary rales on lower lungs. Heart borders are displaced to the left and to the right. Cardiac sounds are weakened, systolic murmur above the apex. What is the most likely preliminary diagnosis?
B. *Dilated (congestive) cardiomyopathy
A. Infectious endocarditis
C. Rheumatic fever, mitral stenosis
D. Acute myocarditis
E. Acute pericarditis
177. What is the treatment choice for 60-year-old male with renal cell carcinoma T2N0M0 and normal contralateral kidney?
D. *Radical nephrectomy
A. Resection of the kidney
B. Radiation therapy
E. Simple nephrectomy
178. A 2-month-old healthy infant with good appetite, is given artificial feeding since 1-st month. When is it advised to start the corrective feeding (fruit juice)?
D. *4,0 months
A. 2,0 months
B. 1,0 months
C. 1,5 months
E. 3,0 months
179. An 18-year-old pregnant woman comes to see an obstetrician at 11-12 weeks gestation. Medical history states that 1 month ago woman has suffered with rubella. What influence on fetus is the most likely in this woman?
E. *Congenital developmental abnormaliti fetus
A. Chromosomial abnormalities of fetus
B. Labour trauma of newborn
C. Hemolytis disease of newborn
D. Hyaline membrane disease
180. A 4-year-old child attends the kindergarten. Complaints of the bad 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 at first?
B. *Worm invasion
A. Lymphoprolipherative process
C. Duodenal ulcer
D. Hypoplastic anemia
E. Atrophic gastritis
181. A man is diagnosed disorder of purine metabolism that manifestates itself with acute arthritis of 1st metatarsophalangeal joint. Provide the patient with the most reasonable recommendation regarding his diet.
E. *Restriction of meat and legumes
A. Restriction of milk products
B. Restriction of free liquid
C. Restriction of cereal and macaroni
D. Restriction of vegetables and fruits’
182. The patient has worked 13 years as a bulldozer driver. He complains of dizziness, headache, finger dumbness and pain at night. On exam, tactile sensivity of peripheral type disturbes him, ankle muscles are painful, and pulsation on a.dorsalis pedis is weak. What is the most probable diagnosis?
A. *Vibration disease
C. Periarteritis nodosa
D. Raynaud’s disease
E. Atherosclerosis obliterans
183. The patient with aquired heart failure has diastolic pressure 0 mm Hg. What heart failure does the child have?
E. *Aortal insufficiency
B. Aortal i stenosis
C. Mitral insufficiency
D. Mitral stenosis
184. A 5-year-old boy fell ill abruptly: fever up to 39,8°C, recurrent vomiting, severe headache. Convulsions occur in 3 hours. Physician found out positive meningeal sign. Pleocytosis of 2500 cells chiefly polymorphonuclear cells, elevated protein concentration and normal glucose concentration was found in cerebrospinal fluid examination. What is your diagnosis?
B. *Purulent meningitis
A. Tuberculous meningitis
C. Serous meningitis
D. Subarachnoidal hemorrhage
185. A 62-year-old man complains of the pain behind the sternum, bad pasage of solid and liquid food, badsmell breath, increased salivation, weight loss of 15 kg during 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 has caused the given clinical situation?
E. *Esophagus cancer
A. Benign growth of esophagus
B. Cicatricial constriction of esophagus
C. Chronic non-specific esophagitis
D. Achalasia of esophagus
186. 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 regarding primary prevention of illness?
E. *Prevention of disease onset
A. Prevention of disease complications
B. Measures to increase patients life quality
C. Measures to improve patients life conditions
D. Referral of patients to sanatorium
187. A 25-year-old woman complained of fatigue, hair loss, and brittle nails. On exam, pallor of skin, Ps 94/min, BP 110/70 mmHg. On blood cell count, Hb 90 g/L, RBC 3,5* 1012/L, color index of 0,7; ESR of 20 mm/H. Serum iron level was 8,7 μmol/L. What treatment would you initiate?
E. *Ferrous sulfate orally
A. Packed RBCs transfusion
B. Vitamin B12 intramuscularly
C. Blood transfusion
C. Iron dextrin injections
188. A 34-year-old was bit by the dog 3 hours ago. In the left arm there is a wound by the tooth of dog’s bite without bleeding . What surgical help would you provide to such a patient?
D. *Washing of the wound with detergent water and applying anti-septic
A. Aseptic bandage
B. Cream bandage
C. Complete suturing of the wound
E. Incomplete suturing of the wound
189. A man suffering with virus hepatitis B presents with increase of jaundice and bloody vomiting after break of diet and nervous stress. Physical examination: Ps 110 bmp, BP 80/50 mmHg. The liver is painful at palpation and is reduced in size. What complication is the most likely being observed?
B. *Acute hepatic failure
A. Toxico-infection shock
C. Haemolytic crisis
D. Acute adrenal failure
E. Acute renal failure
190. 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?
B. *Cromoglycat sodium
A. Injection of corticosteroids
C. Regular dose of salbutamol
D. Inhalation corticosteroids
E. Tabletted corticosteroids
191. Fever up to 39°C is registered the next day after a woman had labor. Fetal membranes rupture took place 36 hours before labor. Pelvic examination: the uterus is soft, tender. Discharges are bloody, mixed with pus. Uterine culture: haemolytic streptococcus, group A. What is the most probable postnatal complication?
A. Apostatis of stitches after the episiotomy
B. Infected hematoma
C. Thrombophlebitis of veins of the pelvis
D. Infective contamination of the urinary system
192. A 10-year-old child fell ill acutely a week ago after overcooling when there appeared pain in the stomach and the back, fever up to 38°C. Urinanalysis: leucocytes 25-30 per v/f, protein 0,33 g/L. Which of the following is the most appropriate test for prescribing of etiotropic treatment?
B. *Urine culture
A. Nechiporenko test
C. Zimnitsky test
E. Intravenous urography
193. A 78-year-old woman is urgently admitted to surgical department due to chronic intestinal obstruction. On physical examination significant narrowing of anal orifice is observed due to dense bumpy tumor that occupies more than half of anal circle. Finger investigation reveals stone-dense fecal masses in ampulla of rectum. What is the most likely diagnosis?
A. *Cancer of anal part of rectum
B. Polypus of anal part of rectum
C. Chronic paraproctitis
D. Atresia of anal channel
194. A 9-year-old child is ill for 5 days. Physical examination: Conscious, inert. Puffy face. Cataral conjunctivitis, scleritis. Bright-red papulous middle-spotted skin rash on face and behind ears. Somewhere elements merge. Diffuse hyperemia in pharynx. Soft palate shows enanthema. The child is not vaccinated. What is the most likely diagnosis?
A. Allergic dermatitis
D. Scarlet fever
195. A patient has disturbance of nasal respiration, mucopurulent discharge from the nose, headache for three weeks. At anterior rhinoscopy the stria of pus, edema, hyperemia of the mucosa of the nose have been determined in middle nasal meathus. What further investigation is necessary?
D. *X-ray of paranasal sinuses
A. Computer tomography of the skull
B. Bacteriology analysis of the nasal mucous
C. Punction of the maxillar sinus
E. General blood analysis
196. 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?
D. *Scarlet fever
B. Enteroviral infection
197. The student has following devices: Geiger counter, Ebert counter, Krotov’s apparatus, Mischuk device, Ebert device. What device can he use to assess air germ pollution?
B. *Krotov’s apparatus
A. Ebert’s device
C. Geiger’s counter
D. Mischuk’s device
E. Ebert’s counter
198. A man with liver cirrhosis complains of nasal bleedings, right subcostal pain, weakness, nausea. On physical examination: jaundice, hemorrhagic rash, enlarged liver span (of 14 cm), liver edge irregular. What is the cause of hemorrhagic syndrome in this patient?
E. *Decreased liver production of focoagulants
A. Disseminated intravascular coagulation
C. K and C hypovitaminosis
D. Portal hypertension
199. A 2,5-year-old child fell ill 10 hours ago with anxiety, touching of stomach, fever up to 38°C. In 7 hours condition has worsened with vomiting and diarrhea. Physical examination: tongue is dry, coated. Abdomen barely participates in breathing. Palpation is impossible due to child anxiety. Finger rectal investigation reveals overhang of front rectum wall. What is the most likely diagnosis?
B. *Acute appendicitis, peritonitis
A. Acute mesadenitis
C. Primary peritonitis
D. Acute enteric infection
E. Acute adenoviral infection
200. A 36-year-old woman is on the 12-th week of the first pregnancy. Earlier she was treated for infertility. She had contacted with the child who developed rubella in 2 days after meeting. Woman doesn’t know if she has ever been infected with rubella. What is the adequate tactics?
D. *Monitory of the specific IgG IgM with the ELISA
A. Immune globulin injection
B. Interferon administration
C. Interruption of pregnancy
E. Cyclovir administration