Year 2004

Posted: May 5, 2012 in Krok II
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1. A boy, aged 10, is under treatment in cardiological unit on account of rheumatic fever. The first onset of the decease. Discharged in the satisfactory condition. What medication is the most expedient for secondary rheumatism prevention?

  1. *Bicillin-5
  2. Erythromycin
  3. Bicillin-1
  4. Ampicillin
  5. Oxacillin

 

2. A female patient, aged 45. Two weeks after pneumonia developed shortness of breath during walking, constant ache in precardiac area, shin edema. On examination: t°=37, 2°C, Heart borders without changes, Sound 1 on the apex is weakened. ECG: atrioventricular heart block I degree, lowering of the amplitude of T wave in V2-V6. In blood: Hb – 124 g/L, WBC – 5, 68 * 109/L, ESR -IS mm/h. What is the most likely di­agnosis?

  1. *Acute myocarditis
  2. CHD: unstable angina
  3. Infective endocarditis
  4. Pulmonary embolism
  5. Metabolic cardiopathy

 

3. Biological development indices for the secondary and high school pupils are the following: height, annual height increase, hand ossification, number of permanent teeth. What other index has a special importance for this age group?

  1. *Secondary sexual characters development
  2. Hand muscular force
  3. Chest circumference
  4. Lung vital capacity
  5. Weight

 

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

  1. *Interior genital endometriosis
  2. Hydatidiform mole
  3. Uterus cancer
  4. Uterus fibromyoma
  5. Chorioepithelioma

 

A. To transport the victim to the nearest hospital for reanimation measures

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

Not to waste time on the release” of respiratory tract from water, to undertake cardiopulmonary reanimation

p. To release respiratory tract from water, to create drain position and to undertake measures to restore respiration and blood circulation E. Not to carry out reanimation measures

 

5. A patient, aged 58, was fishing in the winter. On return home after some time felt some pain in the feet. Consulted a doctor. On examination: feet skin was pale, then after rewarming became red, warm to the touch. Edema is not significant, limited to the toes. All types of sensitivity are preserved. No blisters. What degree of frostbite is observed?

B. *I degree

A. Ill degree

C. IV degree

D. II degree

E. V degree

 

6. A woman, aged 30, in labour, is brought to the maternity in term of 35-36 weeks with weakened  labour activity. Fetal movements are not felt. On echography: fetus’s heartbeat not determined. Vaginal inspection: cervix is 6 cm dilated, green amniotic fluid has discharged, and the head of the fetus is engaged to pelvic inlet. What is the further tactic of delivery?

D. *Cephalotomy

A. Forceps delivery

B. Vacuum extraction of the fetus

C. Conservative delivery, wait for natural birth of the fetus

E. Turning of the fetus by Braxton-Hicks

 

7. A woman, aged 64, is hospitalised on account of metrorrhagia and anemia. After 12 years of menstruation absence, 7-8 months ago there appeared at first sero-watery discharge from vagina, then — sero-bloody, with “meat slops ” colour, pain in the lower abdomen. What pathology is the most probable?

B. *Uterus cancer

A. Hydatidiform mole

C. Uterus fibromyoma

D. Inferior genital endometriosis

E. Chorioepithelioma

 

8. A 18-year-old woman consulted a gynecologist with complaints of the pain in the lower part of the abdomen, fever up to 37,50C, considerable; mucopurulent discharges from the genital tract, colic during urinating. After mirror and vagina exam the results are the following: the urethra is infiltrated, cervix of the uterus is hyperemia erosive. The uterus is painful; ovaries are painful, thickened, and free. Bacterioscopy test showed diplococcus. What diagnosis is the most probable?

  1. *Recent acute ascending gonorrhea
  2. Chronic gonorrhea
  3. Trichomoniasis
  4. Chlamydiosis
  5. Candy domycosis

 

9. A 7-year-old girl suddenly fell ill with fever, headache, severe sore throat, vomiting. Minute bright red rash appeared on her reddened skin 3 hours later. It is more intensive in axillas and groin. Mucous membrane of oropharynx is hyperemia on tonsils there are greyish patches. Submaxillary glands are enlarged and painful. What is the most likely diagnosis?

E. *Scarlet fever

A. Enteroviral infection

B. Rubella

C. Pseudotuberculosis

D. Measles

 

10. A worker (battery attendant) the end of the working day complains of intensive pains in the epigastric area, diarrhea, subfebrility, BP — 170/110 mm Hg, skin and scleras are yellow. At the lunch have drunk 250 ml of vodka. What diagnosis is the most likely?

C. *Acute lead intoxication

A. Acute hemolysis

B. Fatty degeneration of liver

D. Acute pancreatitis

E. Acute alcohol intoxication

 

11. A pediatrician examines a healthy mature-breast-fed baby, aged 1 month. Prevention of what condition should be recommended in the first place?

B. *Rachitis

A. Paraophji

C. Anaemia

D. Hypotrophy

E. Spasmophilia

 

12. When examining a patient with supposed pelvis fracture, the doctor exerts pressure with both hands on the wings of ileum in opposite direction. What is the cause of pain syndrome appearing in this case?

E. *Pelvic ring discontinuity

A. Sacral fracture

B. Ischial bones fracture

C. Retroperitoneal haematoma

D. Traumatic injury of intrapelvic organs

 

13. A baby, aged 1,5 months, in the right parietotemporal area has from the birth a tumour-like formation of purple colour, rising over the skin surface, not disappearing on pressure, dimensions 2-3 cm. What is the most likely diagnosis?

E. *Cavernous hemangioma

A. Lymphangioma

B. Congenital vascular macula

C. Angiofibroma

D. Nevus pigmentosis

 

14. In an inhabited locality there is an increase of diphtheria during the last 3 years with separate outbursts in families. What measure can effectively influence the epidemic process of diphtheria and reduce the morbidity rate to single cases?

C. *Immunisation of the population

A. Dismrection in disease focus

B. Hospitalisation of patients

D. Early diagnostics

E. Detection of carriers

 

15. Parents of 5-year-old boy complain of ventral curvature of boy’s penis. Physical examination: external urethral meatus is on the apex of penis, prepuce-is hood-like. What is the most likely diagnosis?

D. *Hypospady without hypospady

A. Induratio penis plastica (Peyronie’s disease)

B. Latent penis

C. Cryptorchidism

E. Epispadia of balanus

 

16. A 2-year-old girl has been ill for 3 days. Today she has low-grade fever, severe catarrhal symptoms, non-abundant maculopapular rash on her buttocks and enlarged occipital glands. What is your diagnosis?

E. *Rubella

A. Pseudotuberculosis

B. Measles

C. Scarlet fever

D. Adenoviral infection

 

17. A 62-year-old patient with DM-2. Diabetes is being compensated by diet and Maninilum. Patient has to undergo an operation for inguinal hernia. What should be the tactics of hypoglycemic therapy?

E. *Prescribe fast-acting insulin

A. Continue with the current therapy

B. Prescribe guanyl guanidines

C. Give Glurenorm in place of Maninilum

D. Prescribe long-acting insulin

 

18. A patient, aged 32, diagnosed with multiple injuries: closed craniocerebral injury, closed chest injury, closed right hip fracture. BP – 100/60 mm Hg, Ps – 124/min, RR – 28/min. 2 hours after skeletal extension under local anesthesia with lidocaine, there appeared abrupt aggravation of the patient’s condition: developed face and neck cyanosis: BP – 60/40 mm Hg, RR – 160/min, RR – 44/min. What complication most probably aggravated the severity of multiple injuries?

D. *Pulmonary fat embolism

A. Acute anaemia

B. Cardiac infarction, cardiogenic shock

C. Pulmonary thromboembolism

E. Pain shock

 

19. A patient was operated on account of perforated stomach ulcer, terminal stage of diffuse peritonitis. After endotoxic shock in the post-operative period the artificial pulmonary ventilation is carried out with inhalation of 60% oxygen. Blood gasses: PaO2 = 70-78 mm Hg, hypoxemia is not diminishing, CVP – 150-180 mm H2O, BP — 90/60 mm Hg (with administeririg of dopamine-in-high doses). Radiologically: diffuse pulmonary infiltration. What is the reason of the resistant arterial hypoxemia?

D. *Respiratory distress-syndrome

A. Bilateral pneumonia

B. Mendelson’s syndrome

C. Pulmonary edema

E. Pneumothorax

 

20. Mother with an infant visited the pediatrician. Her baby was born with body mass of 3,2 kg and 50 cm length. He is 1 year old now. How many teeth the baby should have?

B. *8

A. 20

C. 10

D. 6

E. 12

 

21. A patient was admitted to the hospital on the 7th day of the disease with complaints of high temperature, headache, pain in the muscles, especially in calf muscles. Dermal integuments and scleras are icteric. There is hemorrhagic rash on the skin. Urine is bloody. The patient was fishing two weeks ago. What is the most likely diagnosis?

B. *Leptospirosis

A. Brucellosis

C. Salmonellosis

D. Trichinellosis

E. Yersiniosis

 

22. A 20-year-old woman complains of weakness, wet cough, body temperature raise up to 37,5°C in the evenings during one month. In childhood she was under phthisiatric observation due to conversion of tubercular tests (PPD). The condition is good. No rales in lungs. Chest X-ray: a shadow with dim contours 3×4 cm with a clearing and focuses near the shadow in the upper lobe of the right lung. Blood analysis: ESR – 20 mm/hour, WBC – 7,6 * 109/L-What is the most likely diagnosis?

C. *Infiltrative tuberculosis

A. Decaying cancer

B. Focal tuberculosis

D. Tuberculoma

E. Pneumonia with abscess formation

 

23. A patient, aged 50, during 15 years is ill with essential hypertension, not under treatment. BP – 220/140 mm Hg, Ps – 80 bmp, rhythmic. On percussion: the left heart border is 2 cm to the outside from the left midclavicular line. Sound 1 is moderately weakened. Sound 2 is accentuated over the pulmonary artery. What changes will be characteristic on ultrasound heart examination?

C. *Hypertrophy and dilatation of the left ventricle

A. Blood regurgitation through the mitral valve

B. Blood regurgitation through the aortic valve

D. Hypertrophy and dilatation of the right ventricle

E. Dilatation of the left atrium

 

24. A female patient, aged 25, is hospitalized due to exudative pericarditis. Complains of shortness of breath, weakness, compression in the chest. Believes that she got ill 2 weeks ago, after common cold. What peculiarity found during examination will tell about chronic pericardium affection?

E. *Signs of pericardium calcification

A. Lowering of ECG voltage

B. Significant heart tissue dilation, pulsation weakening

C. Heart sounds deafening

D. Signs of haemostasia in greater circulation

 

25. Woman in childbirth, 25 years old, the second period of labour. 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?

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

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

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

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

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

 

26. A worker of the chemical plant complains of fatigue, insomnia, headache. Works at the amalgam production. On examination: tremor, asymmetry of reflexes, labile pulse, stable red dermographism. Excretory gingivitis. What is the cause of the illness?

D. *Chronic mercury poisoning

A. Chronic cadmium poisoning

B. Chronic aniline poisoning

C. Chronic petrol poisoning

E. Chronic lead poisoning

 

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

A. *Senile cataract

B. Leukoma of the cornea

C. Open-angle glaucoma

D. Disorder of blood circulation in retina vessels

E. Exfoliation of the retina

 

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

A. *Progressive structure of the population

B. Emigration of the population

C. Stationary structure of the population

D. Regressive structure of the population

E. Migration of the population

 

29. A patient complains of fever up to 38,2°C, an edema of the upper lip. On examination: the upper lip is distinctly hydropic, in the centre of the edema there is a cone-shaped swelling. The skin and the mucosa over it are deep-red. A furuncle of the upper lip is diagnosed. Surgeon executed a lancing of furuncle, cleansed the wound with peroxide solution and dressed it with hypertonic solution. What therapeutic regimen should be recommended to the patient?

A. *In-patient treatment with general regimen

B. Out-patient treatment, then – inpatient treatment

C. Out-patient treatment

D.-

E. In-patient treatment with bed rest

 

30. A patient was operated 2 years ago on account of perforated duodenal ulcer, suture plication was performed. In the last 2 months lost 12 kg, which explains by dread of solid food intake because of pain and exhausting nausea appearing after meals. Self-induced vomiting brings relief. What is the most probable preliminary diagnosis?

C. *Cicatricial pyloroduodenal stenosis

A. Duodenal ulcer, exacerbation

B. Pylorospasm

D. Chronic post-operative pancreatitis

E. Perforated duodenal ulcer

 

31. A 29-year-old patient complains of sterility. Sexual life is during 4 years of marriage, 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?

B. *Anovulatory menstrual cycle

A. Anomalies of genitals development

C. Immunologic sterility

D. Chronic adnexitis

E. Genital endometriosis

 

32. A boy, aged 13, suffers from an abrupt aggravation of condition, there appeared shortness of breath, skin paleness with cyanosis. BP – 80/55 mm Hg, Ps — 128/min, heart sounds weakened. On ECG: diffuse muscular changes, polytopic extrasystole. Radi-ologically: acute enlargement of the heart borders in all directions. Two weeks ago there occurred a reaction on analgin administration. What is the most likely diagnosis?

A. *Idiopathic Abramov-Fiedler myocarditis

B. Exudative pericarditis

C. Hypertrophic cardiomyopathy

D. Endocardial fibroelastosis

E. Rheumatic myocarditis

 

33. In order to differentiate diagnosis of anuria and ishuria what supplementary examination should be carried out?

A. *Catheterisation of the urinary bladder

B. Analysis of the blood

C. Analysis of urine

D. –

E. Excretory urography

 

34. A patient, aged 14, suffering from heart failure, undergoes inpatient treatment. On ECG: changes in the form of a trough-shaped displacement of ST segment below isoline and frequent ventricular extrasystoles. What is the most probable cause of these changes?

A. *Cardiac glycosides overdose

B. Potassium overdose

C. Myocardiodystrophy

D. Carditis

E. Myocardiosderosis

 

35. Public health is characterised by a group of indices. Which of the following indices are demographic?

D. *Total mortality

A. Disablement

B. Morbidity

C. Physical development

E. Lethality

 

36. In 2 weeks after pharyngitis a 25- year-old patient started complaining of rise in temperature to 33°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 mediaclavicular line for 1 cm. Sound I on the apex is weakened, soft systolic murmur is auscultated. What etiologic factor caused this pathological process in the most probable way?

A. Virus

B. Staphylococcus

C. Beta hemolytic streptococcus

D. Pneumococcus

E. Fungus

 

37. A patient, aged 38, had acute glomerulonephritis 10 years ago, complains of face and legs swelling, headache, dull pain in loins. BP — 220/130 mm Hg. Urinalysis: protein – 9,9 g/L, WBC — 3-4 in the field of vision, RBC — 10-12 in the field of vision, hyaline cylinders – 3-4 in the field of vision, ceraceous – 2-3 in the field of vision. Creatinine — 102 μmol/L. Which of the mentioned antihypertensive agents are expedient to prescribe in this case?

D. *Captopril

A. Clonidine

B. Propranolol

C. Prazosine

E. Methyldopa

 

38. 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. Niphedipin

B. Kapoten

C. Diba/oi

D. Clophelin

 

39. A 47-year-old man with gastric cancer. complicated by profuse haemorrhage was successfully treated by surgical intervention. After the operation the native blood plasma transfusion was performed. During transfusion developed acrocyanosis, hypersalivation, hyperpnoea, BP – 80/40 mm Hg, Ps -120 bpm. With injection of which substance the initial medication has to begin?

C. *Epinephrine

A. Diphenylhydramin

B. Prednisolon

D. Dopamine

E. Aminophilline

 

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

D. *Henoch-Schoenlein purpura

A. Hemolytic uremic syndrome

B. Thrombotic thrombocytopenic purpura

C. Heavy metal poisoning

E. Subacute bacterial endocarditis

 

41. A patient, aged 25, complains of pain in the 1 finger on the right hand. On examination: the finger is homogeneously hydropic, in bent position. On attempt to unbend the tinge; the pain gets worse. Acute pain appears on touching with the probe in ligament projection. What decease is the most likely?

A. *Thecal whitlow (ligament panaritium)

B. Bone panaritium

C. Articular (joint) panaritium

D. Paronychia

E. Subcutaneous panaritium

 

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

D. *Digital examination of rectum

A. Rectoromanoscopy

B. Laparoscopy

C. Percussion and auscultation of abdomen

E. Roentgenoscopy of abdominal cavity

 

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

B. *Ultrasonic

A. Radionuclide

C. Magnetic-resonance

D. Thermographic

E. Roentgenological

 

44. A patient aged 65 complains of shortness of breath, cough with red foamy sputum, feeling of air deficit, fear of death. On examination: orthopnea, pale skin, acrocyanosis, cold sticky sweat. Rough breathing sounds, in inferior-posterior arias on both sides small and medium moist rales. BR 40/mtn. Heart sounds are distinctly muffled. On the cardiac apex – gallop rhythm. What is the most probable preliminary diagnosis?

D. *Pulmonary edema

A. Asthmatic state

B. Croupous pneumonia

C. Infarction-pneumonia

E. Pulmonary embolism

 

45. A patient, aged 25, is brought to the infection diseases unit with suspected rabies, excitement stage. Four weeks ago on the hunting was bitten in a hand by a fox. What leading symptom will verify the diagnosis?

B. *Hydrophobia

A. Flaccid paralysis of extremities

C. Dryness in the mouth and throat

D. Paresthesia

E. Tonoclonic cramps

 

46. During 3 years a patient with diagnosis of chronic bronchitis has been under regular observation in the clinic. This year he applied 3 times for medical aid on account of exacerbation of this decease. What should be the statistical record of this decease?

B. *To fill in 1 statistical form with (-) for the primary consultation

A. To fill in 1 statistical form with (+) for the primary consultation and with (-) for the follow-up consultations

C. To fill in 3 statistical forms with (-)

D. To fill in 3 statistical forms with (+)

E. To fill in 1 statistical form with (+) for the primary consultation

 

47. A baby, aged 8 months, is examined and a diagnosis of atypical community-acquired pneumonia of chlamidial etiology is made. What is the optimum alternative of antibiotic therapy in this case?

D. *Macrolide antibiotic of the II generation

A. Aminopenicillin

B. Cephalosporin of the II generation

C. Aminoglycoside antibiotic

E. Macrolide antibiotic of the I generation

 

48. A patient complains of ulceration on the inner surface of the lower third of the right shin. On examination: the ulcer is round-shaped, up to 5 cm in diameter, with sloping edges. On the inner surface of this shin there are varicose veins. What complication appeared in this patient?

A. *Varicose veins with trophic ulceration

B. Elephantiasis

C. Deep venous thrombosis

D. Popliteal artery thrombosis

E. Erysipelatous inflammation

 

49. A 40-year-old man complains of headache in occipital area. On physical examination: the skin is pale; face and hand edema, BP – 170/130 mm Hg. On EchoCG: concentric hypertrophy of the left ventricle. Ultrasound examination of the kidneys reveals thinned cortical layer. Urine analysis shows proteinuria of 3,5 g/day. What is the probable diagnosis?

D. *Chronic glomerulonephritis

A. Chronic pyelonephritis

B. Cushing’s disease

C. Polycystic disease of the kidneys

E. Essential arterial hypertension

 

50. A woman was hospitalized 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?

C. *Premature detachment of normally posed placenta

A. Back occipital presentation

B. Premature labour

D. Hydramnion

E. Acute hypoxia of a fetus

 

51. In medical history of a 2-years-old girl: recurring pneumonias with obstructive course. Auscultation: heterogeneous moist and dry rales in lungs, weakened breathing. Difficult excretion of thick, viscous sputum. Observed “drumstick” fingers, mental deficiency. What is the preliminary diagnosis?

D. *Cystic fibrosis, pulmonary form

A. Recurrent bronchitis

B. Congenital polycystic lung disease

C. Pulmonary tuberculosis

E. Bronchial asthma

 

52. A child, aged 5, is ill with fever, vesicular rash mainly on the trunk and head skin. On the 8th day there appeared severe headache, ataxia, lethargy, movement discoordination, tremor of the extremities. On the second wave of the fever encephalitis is diagnosed. Complication of what decease can be encephalitis in this case?

A. *Chicken pox

B. Herpetic infection

C. Enterovirus infection

D. Measles

E. Rubella

 

53. A man, aged 56, complains of shortness of breath with difficult expiration, sputum excretion in the mornings during 22 years. Smokes 1 packet of cigarettes per day starting from the age of I8. On external respiration tests with bronchial spasmolytic: respiratory obstruction reversibility is 10%. What medication should be prescribed in the beginning of the treatment?

C. *Inhalation cholinergic antagonists (Atrovent)

A. Antibiotics

B. Inhalation glucocorticoids

D. Membrane stabiliser (Intal, Tyled)

E. Inhalation sympathomimetic agents (Berotec)

 

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

D. *Drainage of the pleural cavity

A. Anti-inflammatory therapy

B. Pleural puncture

C. Thoracotomy

E. Symptomatic therapy

 

55. 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. Urine analysis: leukocytes 25-30 per v/f, protein 0,33 g/L. Which of the following is the most appropriate test for prescribing etiotropic treatment?

A. *Urine culture

B. Intravenous urography

C. Nechiporenko test

D. Cystography

E. Zimnilsky test

 

56. A neonate was born from the 1st gestation on term. The jaundice was discovered on the 2nd day of life, and then it became more acute. The adynamia, vomiting and hepatomegaly were observed. Indirect bilirubin level was 275 µmol/L, direct bilirubin level — 5 μmol/L. Hb – 150 g/I. Mother’s blood group – 0[I]. Rh-K child’s blood group-[II], Rh+. What is the most probable diagnosis?

C. *β: Hemolytic disease of the neonate [ABO-incompatibility], icteric type

A. Jaundice due to conjugation disorder

B. Hemolytic disease of the neonate [Rh – incompatibility]

D. Hepatitis

E. Physiological jaundice

 

57. 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?

E. *Calculation of correlation coefficient

A. Calculation of regression coefficient

B. Analysis of dynamic row indices

C. Calculation of standardized indices

D. Assessment of statistical probability of differences

 

58. 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. *3000 IU daily

A.1000 IU every other day

B. 500 IU daily

D. 500 IU every other day

E. 1000 IU daily

 

59. A male patient, aged 38, accountant. During acute allergic infectious myocarditis developed the full left bundle-branch block. After treatment and 2 months of observation patient’s condition is satisfactory, absence of complains or objective and clinical manifestations of decease, but there are still changes on the ECG. What should be the doctor’s tactics in this case?

E. *Follow-up by general practitioner

A. Rehospitalisation

B. Implanting a pacemaker

C. Electrophysiological examination

D. Referral to the MSEC

 

60. A 3-year-old boy fell suddenly ill: 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?

B. *Chloramphenicol succinate and prednisone

A. Penicillin and immunoglobulin

C. Chloramphenicol succinate and interferon

D. Ampicillin and immunoglobulin

E. Penicillin and prednisone

 

61. A woman, aged 40, primigravida, with infertility in the medical history, on the 42-43 week of pregnancy. Labour activity is weak. Longitudinal presentation of the fetus, 1 position, anterior position. The head of the fetus is engaged to pelvic inlet. Fetus heart rate is 140 bmp, rhythmic, muffled. Cervix dilation is 4 cm. On amnioscopy: greenish colour of amniotic fluid and fetal membranes. Cranial bones are dense, cranial sutures and small fontanel are diminished. What should be tactics of delivery?

C. *Caesarean section

A. Fetal hypoxia treatment, in the II period – forceps delivery

B. Amniotomy, labour stimulation, fetal hypoxia treatment

D. Medication sleep, amniotomy, labour stimulation

E. Fetal hypoxia treatment, conservative delivery

 

62. A woman complains of fever up to 39°C the next day after the child-birth. Fetal membranes rupture took place 36 hours before delivery. 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?

D. *Metroendometritis

A. Infected hematoma

B. Infective contamination of the urinary system

C. Thrombophlebitis of veins of the pelvis

E. Apostatis of stitches after the episiotomy

 

63. A woman, aged 30, in the second childbirth there is a baby born with anaemicicteric form of the hemolytic disease. Blood group of the mother is A(II) Rh-, blood group of the new born is B(III) Rh+, blood group of the father is B(I1I) Rh+. What is the most probable cause of immune conflict?

C. *Rhesus incompatibility

A. Antigen A conflict

B. Antigen AB conflict

D. Antigen ABO conflict

E. Antigen B conflict

 

64. The district doctor is charged with the analysis of the morbidity rate in the area he is assigned to. Which type of morbidity characterizes the group of protractedly and frequently ill?

B. *With temporary loss of ability

A. Acute respiratory working

C. With main non-epidemic deceases

D. Hospitalised

E. General

 

65. 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 among the inhabitants of this city?

A. *Fluorosis

B. Thyrotoxicosis

C. Caries

D. Endemic goitre

E. Methemoglobinemia

 

66. A military unit after long march stopped for 3-day’s rest in the vicinity of an inhabited locality. The sanitary-epidemiological reconnaissance found several water sources. It is necessary to choose the source complying with the hygienic standards for potable water in the field conditions.

B. *Artesian well water

A. Water from melted snow

C. Spring water

D. Rain water

E. River water

 

67. In treatment and prevention establishments, regardless of their organizational and proprietary form, the rights of the patients should be observed. Which of these rights is the most significant?

B. *The right to the protection of the patient’s interests

A. The right to the protection from incompetence

C. The right to be heard

D. The right to the free choice

E. The right to the information

 

68. A patient, aged 16, complains of headache, mainly in the frontal and temporal areas, superciliary arch, appearing of vomiting at the peak of headache, pain during the eyeballs movement, joints pain. On examination: excited, t° — 39°C, Ps – 110/min. Tonic and clones cramps. Uncertain meningeal signs. What is the most likely diagnosis?

B. *Influenza with cerebral edema manifestations

A. Parainfluenza

C. Adenovirus infection

D. Respiratory syncytial virus

E. Influenza, typical disease duration

 

69. 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?

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

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

B. Systematic cleansing of surfaces from the radioactive contamination and shortening of working time

D. Capsulation of devices and organization of room ventilation

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

 

70. A primipara is in labour 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 fontanel is on the left. Lower uterine segment is tender on pressing. What medical tactics should be chosen?

A. *Urgent caesarean section

B. Application of obstetrical forceps

C. Craniotomy

D. Stimulation of labour activity with intravenous oxytocin

E. Vacuum-extractor operation

 

71. A 29-year-old woman is enticaly ill. The illness was manifested by high fever, chills, sweating, aching pain in lumbar area, a discomfort during urination, and frequent bowel voiding. Pasternatsky’s sign is positive in both sides. On lab exam, WBC – 20*109/L; Urinalysis: protein – 0,6 g/L, leukocyturia, bacteriuria. What is the preliminary diagnosis?

E. *Acute pyelonephritis

A. Acute cystitis

B. Nephrolithiasis

C. Acute glomerulonephritis

D. Exacerbation of chronic pyelonephritis

 

72. 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, consulted doctor very rarely. On laboratory investigation signs of chronic renal failure first degree were found, (creatinine — 0,23 µmol/L). What nutrition recommendations are the most suitable for this patient?

A. *Protein control

B. Ingestion with the increased content of the” “alkaline” food

C. Carbohydrate control

D. Fluid volume increase

E. Adipose control

 

73. A girl, aged 14, complains of sleep disorders, weight loss, palpitations, heartaches, fatigue. On examination: thyroid gland hyperplasia II degree, exophthalmus. What disorders of hormones’ level are the most characteristic for this decease?

D. *Increasing of the thyroxin and triiodothyronine level

A. Lowering of the thyroxin level

B. Increasing of the thyrotropic hormone level

C. Increasing of the protein-bind iodine level

E. Lowering of the triiodothyronine level

 

74. 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 aspi-rin. 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?

E. *Acute epidermal necrolysis

A. Bullous dermatitis

B. Duhring’s disease

C. Polymorphic exudative erythema

D. Pemphigus vulgaris

 

75. A child, aged 4, .has being ill for 5 days, suffers from cough, skin rash, t° — 38,2°C, facial hydropy, photosensitivity, conjunctivitis. On the face, neck, upper part of the chest there is bright maculopapular rash with areas of merging. Hyperemic throat. Seropurulent nasal discharge. In lungs there are dry crackles. What is the most probable preliminary diagnosis?

E. *Measles

A. Adenovirus infection

B. Rubella

C. Scarlet fever

D. Enterovirus exanthema

 

76. 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?

E. *Cancer of cervix of the uterus

A. Nascent fibroid

B. Cervical pregnancy

C. Leukoplakia

D. Polypus of the cervix of the uterus

 

77. A patient aged IS with a crania injury was in comatose state during several hours. In post-comatose period gets tired quickly non-productive in dialog – in the beginning answers 2-3 questions, then gets tired and can not understand the point of the question. Which psychotropic should be given to the patient to prevent psychoorganic syndrome?

E. *Nootropics

A. Neuroleptics

B. Antidepressants

C. Stimulators

D. Tranquillisers

 

78. A 5-year-old child with stigmas of dysembryogenesis (small chin, thick lips, opened mouth, hyperthelorismus) has systolic murmur in the second intercostals 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?

C. *Aortic stenosis

A. Open aortic duct

B. Defect of interatrial septum

D. Coarctation of the aorta

E. Defect of interventricular septum

 

79. A woman aged 30 complains of dizziness, weakness, nails fragility, falling-out of hair, taste disorder. On examination: pale skin, Ps – 98 bmp, BP -100/60 mm Hg. In blood: Hb – 80 g/L, RBC – 3.4 * l012/L, colour index of blood — 0,7. ESR – 20 mm/h. Serum iron – 7.2 /µmol/L. What medicine is expedient lo prescribed?

A. *lron per os

B. Whole blood I.V

C. Packed red blood cells I.V

D. Iron parenterally

E. Vitamins intramuscularly

 

80. A woman, primipara, consults a gynecologist on 05.03.2002. A week ago felt the fetus movements for the first time. Last menstruation was on 10.01.2002. When she should be given maternity leave?

B. *8 August

A. 25 July

C. 22 August

D. 11 July

E. 5 September

 

81. 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?

D. *Gastritis of type B

A. Gastritis of A type

B. Rigid antral gastritis

C. Reflux-gastritis

E. Menetrier’s disease

 

82. A baby, aged 2 months, is hospitalized to the surgery unit with fever up to 38,5°C, edema, hyperemia and absence of movements in the left shoulder joint. In medical history — omphalitis, pseudofurunculosis. What is the most likely diagnosis?

B. *Metaepiphyscal osteomyelitis

A. Plexitis

C. Erbe’s paralysis

D. Shoulder injury

E. Phlegmon of the new-born

 

83. On examination of a patient, aged 49, cancer of the right lung, IIA stage, is diagnosed. What TNM combination corresponds to this stage?

D. *TINIM0

A. T2N2M0

B. T1N2M0

C. T2NXM0

E. T2N0M0

 

84. A woman, aged 26, is brought to emergency department with complaints of sudden pain in the lower abdomen, weakness, loss of consciousness at home. The previous menstruation absented. Hb – 106 g/L, Ps – 120/min, BP — 80/50 mm Hg. Painfulness and peritoneum irritation symptoms in the lower right flank. What is the most likely diagnosis?

E. *Disturbed tube pregnancy

A. Acute appendicitis

B. Torsion of ovarian cyst pedicle

C. Ovarian apoplexy

D. Acute adnexitis on the right

 

85. A 10-year-old boy complains of a headache, weakness, fever [temperature — 400C], 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?

D. *Pneumonia crouposa

A. Influenza

B. Acute appendicitis

C. Acute cholecystitis

E. Intestinal infection

 

86. A 36-year-old male, at 4:00 a.m. had an intensive attack of lacerating chest pain, which was accompanied by weakness, cold perspiration, fear of death. ECG: dome-shaped ST segment elevation in leads II, III, aVF, V5, V6. After pain relieving the ECG has normalized. What is the preliminary diagnosis?

B. *Variant (Prinzmetal’s) angina

A. Acute pericarditis

C. Prolonged angina attack

D. Dilated cardiomyopathy

E. Myocardial infarction of the back side of left ventricular wall

 

87. A 23-year-old man has a gun-wound on the left arm. The arm bones are undamaged. What appropriate surgical help must be provided to such a patient?

E. *Primary surgical debridement of the wound with a flowing suction

A. Suturing of the wound

B. Drying of the wound with towel gauzes

C. Aseptic dressing of the wound

D. Suturing and drying of the wound

 

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

E. *Cytolysis of hepatocytes

A. Intrahepatic cholestasis

B. Hypersplenism

C. Failure of the synthetic function of the liver

D. Failure of bilirubin conjugation

 

89. A woman, aged 64, suffering from unstable angina, suddenly collapsed during walking. On examination: unconscious, absence of pulsation on a.carotis and heart sounds, miotic pupils and infrequent shallow respiration. What is the first measure to start resuscitation?

C. *Precardiac punch

A. Adrenaline I.V.

B. Intubation and ALV

D. Atropine I.V

E. Transesophagial pacing

 

90. 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. Shunting

C. Depositing of blood in venous channel

D. Presence of hypervolemia

E. Increase of bleeding speed

 

91. A 72-year-old patient after operation of holecystectomia was prescribed gentamicyn (80 mg every 8 hours) and cephalothin (2 g every 6 hours) because of fever. In 10 days there was an increase of creatinine up to 310/miol/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?

C. *Nephrotoxity of gentamicyn

A. Unequal infusion of the liquid

B. Acute glomerulonephritis

D. Cortical necrosis of kidneys

E. Hepatorenal syndrome

 

92. 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?

B. *Sick-list from the 1st day

A. Certificate of a definite form

C. Sick-list from the 5th day after presenting to physician

D. Certificate of free form

E. No documents

 

93. A patient, aged 64, complains of pain in the knee-joints, appearing 2-3 hours after walking. On examination: knee-joint deformation, restriction of joints movements due to painfulness, crackling on movement, on both hands there are Heberden’s nodes. In medical history: stomach ulcer. Which of the mentioned medications is expedient to prescribe to this patient?

D. *Nimesulid

A. Ortophen

B. Pyroxicam

C. Indometacin

E. Aspirin

 

94. A breakdown on a nuclear power-plant caused the radioactive fuel material release in the atmosphere, which resulted in the radionuclide pollution of a large territory and increasing of the background ionizing radiation. The incidence of what deceases will be increased among the population of this territory in the future?

A. *Malignant neoplasms

B. Cardiovascular deceases

C. ENT deceases

D. Ophthalmic deceases

E. Gastrointestinal deceases

 

95. 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 is the most probable?

B. *Discirculaling encephalopathy

A. Stem encephalitis

C. Hemorrhagic attack

D. Ischemic attack

E. Cerebral stem tumour

 

96. A 48-year-old man was taken to the emergency department in a grave condition. Medical history: 3 hrs ago he was treating potato plantations with the pesticides against Colorado beetles. Physical examination: acrocyanosis, bronchorrhea, tachypnea, BP – 100/60 mm Hg. Ps – 44 bpm. What method of efferent therapy is the most expedient on this stage?

A. *Haemosorbtion

B. Haemodialisis

C. Plasmodialisis

D. Limphosorbtion

E. Plasmopheresis

 

97. A victim of a road accident suffered multiple fractures of extremities and pelvis bones. In medical history; haemophilia A. On examination: hematomes are forming on the injured areas. The patient’s condition is aggravating. BP — 90/50 mm Hg. What is the most expedient combination of infusion medications for patient’s treatment after administering polyglukine and saline?

E. *Cryoprecipitate, packed red blood cells

A. Packed red blood cells, fresh frozen plasma

B. Packed red blood cells

C. Cryoprecipitate, glucose

D. Fresh frozen plasma, albumin

 

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

B. *Roentgenography

A. Bronchoscopy

C. Electrocardiography

D. Ultrasound of the abdominal cavity

E. Esophagogastroscopy

 

99. A 40-year-old woman complains of yellow colour 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 Iodine probing. What is your tactics?

E. *Treatment of specific colpitis with the subsequent biopsy

A. Specific treatment of Trichomonas colpitis

B. Cryolysis of cervix uteri

C. Cervix ectomy

D. Diathermocoagulation of the cervix uteri

 

100. A 6-year-old asthmatic child is brought to the emergency room with severe coughing and wheezing during the prior 24 h. The child has been taking theophylline without relief. Physical examination reveals a chi-Id who is anxious, has intercostals and suprasternal retractions, expiratory wheezing throughout all lung fields, and RR – 60/min. Initial treatment may include the administration of which of the following?

B. *Subcutaneous epinephrine and axillary lymph nodes enlargement,

A. Intravenous fluids in the first 2 h to correct a water deficiency

C. N-acetyl cysteine and cromolyn by inhaler

D. Parenteral gentamicyn

E. Parenteral Phenobarbital

 

101. In a new-born baby-girl on the 4 day of life there determined the swelling of the mammary glands with secretions, swelling of the vulva, bloody discharge from the genital tracts. What is the most probable cause of this condition?

B. *Oestrogen transition from mother to fetus

A. Testicular feminization

C. Hormone intake in the course of pregnancy

D. Granulosa cell tumour

E. Increase of thyrotropic hormone level in the new-born

 

102. A 28-years-old man, without permanent residence, was hospitalised with the preliminary diagnosis of “influenza”. On the 5th day of lire disease there appeared typhoid maculopapular and petechial skin rash on trunk and inner sides of extremities. T — 41°C. euphoria, facial hyperaemia, sclera reddening, tongue tremor. Ps — 104 bpm. Splenomegalia. What is the most likely diagnosis?

A. Alcoholic delirium

B. Typhoid fever

C. Measles

D. Leptospirosis

E. Exanthematic typhus (Spotted fever)

 

103. A female, aged 20, after smoking notices a peculiar inebriation with the feeling of burst of energy, elation, unreality and changing of surroundings: the world gets full of bright colours, the objects change their dimensions, people’s faces get cartoon features, loss of time and space judgment. What is the most likely diagnosis?

D. *Cannabism

A. Barbiturism

B. Nicotinism

C. Morphinism

E. Cocainism

 

104. A 34-year-old patient is hospitalised with complaints of cervical and axillary lymph nodes enlargement, subfebrile temperature during the last are Reed-stemberg (Berezovsky) cells in the puncture of lymph nodes. What method of investigation is expedient to study the extent of tumour process?

C. *Lymphoscintigraphy

A. Roentgenological investigation

B. Angiography

D. Thermography

E. Lymphography

 

105. A man, aged 52, fell down from the height of 3 m on the level surface of the earth hurting his right lumbar region. Complains of the pain in the right lumbar region. Urinalysis: microhematuria. Excretory urography: kidneys function is satisfactory. What is the most likely diagnosis?

D. *Kidney contusion

A. Kidney abruption

B. Subcapsular kidnev rupture

C. Multiple kidney ruptures

E. Paranephral haematoma

 

106. A 2.5-year-old child fell ill 10 hours ago, became anxious, held on the stomach, and had 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’s anxiety. Digital rectal investigation reveals overhang of front rectum wall. What is the most likely diagnosis?

D. *Acute appendicitis, peritonitis

A. Primary peritonitis

B. Acute mesadenitis

C. Acute adenoviral infection

E. Acute enteric infection

 

107. A patient, aged 36, is diagnosed with ascites, splenomegaly, liver dimensions by Kurlov 11x9x8 cm, varicose esophagus veins. In medical history: abdominal injury, stomach bleeding. AST – 0.46 mmol/g*L ALT – 0.68 mmol/g*L; total bilirubin – 21 µmol/L, unconjugated bilirubin – 17.1 µmol/L. What is the preliminary diagnosis?

D.*Portal vein thrombosis

A. Peritoneum tumour (mesothelioma)

B. Inferior vena cava thrombosis

C Hepatic vein thrombosis

E. Constrictive pericarditis

 

108. A woman, aged 23, complains of periodical febrile chills with fever up to 40°C, sensation of heat alternating with profuse sweat. During last three months has lived in a tropical African country. The patient has already suffered 3 such attacks, which appeared every other day, lasted 12 hours, and were accompanied by the headache, lumbar and muscular pain. The face is pale with yellowish tinge. Cyanotic lips. Liver, spleen are enlarged. In blood: RBC 2.5 * lO12/L. What is the most likely diagnosis?

E. *Malaria

A. Leptospirosis

B. Epidemic typhus

C. Sepsis

D. Hemoiytic anaemia

 

109. A patient is suffering from a severe attack of bronchial asthma lasting for over 1 hour in spite of administration of β-adrenoceptor agonists by inhalation and I.V. aminophilline and anticholinergics. What medication should be added to the urgent treatment?

D. *Corticosteroids LV

A. Nonsteroidal anti-inflammatory drugs

B. Corticosteroids by inhalation

C Antihistamines

E. β-adrenoceptor antagonists T.V

 

110. A 41-year-old woman complains of weakness, fatigue, fever up to 380C, rash on the face skin, pain in the wrists and elbows. Physical exam: erythematous rash on the cheeks with “butterfly” appearance. The wrist and elbow joints are affected symmetrically, swollen, tender on motions. Pleural friction rub over the lungs, the heart sounds are weak, regular, HR – 88/mm, BP — 160/95 mm Hg. CBA: anemia, leucopema, lymphopenia. Urinalysis: proteinuria, leiikocyturia, cylinders. What is the main mechanism of disease development?

C. *Production of antibodies to double- stranded DMA

A. Production of antibodies to myocytes

B. Production of antibodies to myosin

D. Production of antimitochondrial antibodies

E. Production of antibodies to endothelial cells

 

111. A boy, aged 9, is examined: height – 127 cm (-0,36), weight – 28,2 kg (+ 0,96), chest circumference – 64,9 cm (+0,66), lung vital capacity – 1520 ml (-0,16). What is the integrated assessment of the child’s physical development?

B. *Harmonious

A. Below the average

C. Markedly disharmonious

D. Disharmonious

E. Excessive

 

112. A. diagnosis of chronic arsenous intoxication was set to patient who is working as a nightman. What form of anemia is characteristic for this disease?

C. *Hemolytic anemia

A. Iron deficiency anemia

B. B12 – deficiency anemia

D. Hyper sideric anemia

E. Aplastic anemia

 

113. A man aged 64, complains of cough with sputum discharge, sometimes with blood spitting. Smokes during 30 years. In the last 3 months has lost 8 kg. On roentgenologic examination, in the middle lobe of the right lung there is a cavernous formation, the inner outline is irregular, contains a small quantity of fluid, on the right the central lymph nodes are enlarged. What examination is the most informative to define the diagnosis?

A. *Bronchoscopy with biopsy

B. Spirography

C. Pulmonary tomography

D. Bronchography

E. Sputum analysis

 

114. A patient, aged 28, complains of pain in the legs during walking, chilliness of feet, toes. Has being ill for a year. On examination: pale and cool legs skin, turgor diminished, hypotrichosis. Weakened pulsation on the hip and popliteal arteries, pulsation on the feet arteries is felt after nitroglycerine test. Rheographic index <1. What is the most likely diagnosis?

B. *Obliterating endarteritis

A. Obliterating atherosclerosis

C. Buerger’s disease

D. Raynaud’s disease

E. Chronic trombophlebitis

 

115. The district pediatrician is charged with the analysis of infant mortality. What is taken for the unit of observation in infant mortality investigation?

D. *A baby dead at the age up to 12 months

A. A baby dead at the age up to 1 month

B. A baby dead at birth

C. A baby dead at the age up to 6 days

E. A baby dead at the age over 28 days

 

116. A 42-year-old man has died in a road accident after the haemorrhage on the site, due to acute hemorrhagic anaemia. Loss of what minimum percentage of the total blood volume would result in death at acute haemorrhage?

D. *25-30%

A. 15-20%

B. 35-50%

C. 6-9%

E. 10-14%

 

117. A man, aged 30T complains of intense pain, reddening of skin, edema in the ankle-joint area, fever up to 39°C. Sudden onset of the illness. In the past there were similar attacks lasting 5-6 days without residual changes in the joint. The skin over the joint is hyperemic without definite borders and without infiltrative bank on the periphery. What is the most likely diagnosis?

A. *Gout

B. Osteoarthritis

C. Inflectional arthritis

D. Erysipelatous inflammation

E. Rheumatoid arthritis

 

118. A youth, aged 15, from childhood suffers from atopic dermatitis and allergy to the shellfish. In the last 3 months, after acquiring aquarium fish, developed rhinitis, conjunctivitis, itching in the nose. The level of what immunologic index should be defined in this case?

A. *IgE

B. IgM

C. IgA

D. IgJ

E. Circulating immunocomplexes

 

119. In 10 min after childbirth by a 22-year-old woman, the placenta was spontaneously 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 haemorrhage renewed and the amount of blood constituted 300 ml. What amount of blood loss is permissible for this woman?

E. *400 ml

A. 1000 ml

B. 650 ml

C. 500 ml

D. 300 ml

 

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

E. *Septic shock

A. Toxic hepatitis

B. Exudative pleuritis

C. Emphysema

D. Bronchial obstruction

 

121. A man, aged 54, complains of constant dull ache in nasogastric area, weight loss, dark blood admixtures in feces, constipations. In the course of the year the weight loss is up to 10 kg. In blood: RBC – 3.5·1012/L, Hb – 87 g/L, WBC-12.6*l09/L, stab shift, ESR – 43 mm/h. What is the most probable preliminary diagnosis?

E. *Transverse colon cancer

A. Stomach ulcer

B. Stomach cancer

C. Chronic colitis

D. Chronic pancreatitis

 

122. 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?

C. *Ultra sound dopplerography

A. Cerebral angiography

B. Electroencephalography

D. MRI of the brain.

E. CT of the brain

 

123. A man with meningococcus meningitis has been taking penicillin for 7 days. During last 4 days a body temperature is normal. Meningitic signs are absent. When is it possible to cancel antibiotic?

C. *If liquor cytosis is 100 or less, prevalence of lymphocytes

A. If leucocytosis and left neutrophil shift are absent

B. Immediately

D. If liquor cytosis is 150, prevalence of lymphocytes

E. If liquor cytosis is 100 or less, prevalence of neutrophils

 

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

E. *Sick-leave

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

B. Certificate of mother’s illness

C. Certificate of child’s care necessity

D. Free-form certificate

 

125. A patient, aged 35, complains of frequent heart-burns, air and acid eructation, burning, constringent pains behind the breast-bone, along esophagus, that appear after meals, during  forward inclination of body. The patient was not examined, takes Almagel by self-medication, after the intake of which feels better. What is the most probable diagnosis?

E. *Gastroesophageal reflux

A. Cardiospasm

B. Duodenal ulcer

C. Functional dyspepsia

D. Stomach ulcer

 

126. 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?

C. *All dead bodies of the unknown persons

A. Body of poisoned person

B. Body of person with internal haemorrhage

D. Body of drowned man

E. Body of person with a sudden death

 

127. A patient, aged 40, ailing during approximately 8 years, complains of exertion pain in the lumbar part of the spine, in cervical and thoracal part (especially when coughing), pain in the hip and knee joints on the right. On examination: the body is fixed in the forward inclination with head down, gluteal muscles atrophy. Spine roentgenography: ribs osteoporosis, longitudinal ligament ossification. What is the most likely diagnosis?

A. *Ankylosing spondylitis

B. Tuberculous spondylitis

C. Spondyloarthopathy caused by Reiter’s syndrome

D. Disseminated spine osteochondrosis

E. Psoriatic spondyloarthropathy

 

128. 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?

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

A. Toxiferous adenoma of the thyroid gland

C. Chronic fibrous thyroiditis

D. Diffuse euthyroid goitre of the 3rd degree

E. Chronic autoimmune thyroiditis, hypertrophic type

 

129. 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?

A. *Prevention of disease onset

B. Prevention of disease complications

C. Referral of patients to sanatorium

D. Measures to improve patients’ life conditions

E. Measures to increase patients’ life quality

 

130. A 76-year-old man, with the cardiac pacemaker (demand mode) has periodic episodes of loss of consciousness. Physical examination: Ps — 42 bpm, cardiac rhythm is regular. What can cause the development of such condition?

E. *Pacemaker malfunction

A. Paroxysmal ventricular tachycardia

B. Intraventricular conduction disorder

C. Cerebral atherosclerosis

D. Paroxysmal supraventricular tachycardia

 

131. A 49-year-old patient complains of fever of 37,50C, 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. *Echocardiography dopplerechocardiography

B. Electrocardiogram (ECG)

C. Ballistocardiogramme

D. Phonocardiography

E. Chest X-ray

 

132. A 30-year-old man who suffered from headaches, felt an intense headache in the form of the blow on his head while lifting up a heavy object with the following onset of nausea, vomiting, light dizziness. In a day there was an objectively presented meningeal syndrome, t0 — 37,6°C. The doctor has suspected subarachnoidal haemorrhage. What additional examination is necessary to confirm the diagnosis?

D. *Lumbar puncture with liquor examination

A. Rheoencephalography

B. Roentgenography of the cranium

C. Cerebral angiography

E. Computer-aided tomography

 

133. A.75-year-oId 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. Dissociated personality (psychopathy)

B. Behavior disorder

C. Atherosclerotic (lacunar) dementia

E. Presenile melancholia

 

134. A patient is unconscious, with head injuries in the form of calvarium fracture, BP — 60/40 mm Hg, with pathological neurologic signs. On what basis these injuries can be considered as severe?

E. *Life-threatening symptoms

A. Terms of health impairment

B. Pathological neurologic signs

C. Permanent disability

D. Nature of injury

 

135. The mental status of a 22-year-old man is characterized by a stable pathological depressed mood. The patient is sociable, replies briefly but to the point. The speech is laconic, in slowed tempo, 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?

D. *Antidepressants

A. Tranquillisers

B. Neuroleptics

C. Hypnotics

E. Normotimics

 

136. A woman aged 35 has been suffering with pulmonary tuberculosis for 10 years. When in phthisiatric clinic, she started to act strangely: put on a gaudy make-up, gathered the other patients around her, was singing and dancing with them. Highly excited, passed all the time among males, flirted, started sexually-biased conversations. The whole night absented from the clinic (“was on a date”). What leading syndrome of mental disorders is observed?

D. *Maniacal

A. Morion-like

B. Psychopathy-like

C. Xenophobic

E. Hebephrenic

 

137. A baby boy with body weight 3700 g is born in a maternity hospital. The general condition of the baby is satisfactory. In the centre of the abdomen there is a formation circa 12 cm in diameter. The formation is covered with smooth membranes through which the intestinal loops and liver are seen. What is the most likely diagnosis?

E. *Noncomplicated embryonic hernia

A. Gastroschisis

B. Omphalocele

C Ventral hernia

D. Complicated embryonic hernia

 

138. A 60-year-old boiler-house worker presents to factory’s sectarian 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?

E. *Carbon oxide

A. Mercury

B. Chlorine

C Manganese

D. Lead

 

139. A child, aged 6, suffers from “bold” patches on the head. On examination: single large focuses, in which the hairs are broken on the same level – 6-8 mm from the skin surface. What is the most probable preliminary diagnosis?

C. *Microsporia

A. Circular alopecia

B. Seborrhea

D. Surface trichophytosis

E. Infiltrative suppurative trichophytosis

 

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

E. *Determination of vital capacity of lungs

A. Measurement of growth

B. Determination of vertebra form

C. Determination of thorax form

D. Determination of body weight

 

141. A 43-year-old male complains of stomach pain, which relieves with defecation, and is accompanied by abdominal winds, rumbling, the feeling of incomplete evacuation or urgent need for bowel movement, constipation or diarrhea in alternation. These symptoms have lasted for over 3 months. No changes in laboratory tests. What is the most likely diagnosis?

A. Irritable bowel syndrome

B. Chronic enterocolitis, exacerbation phase

C. Atonic colitis

D. Colitis with hypertonic type dyskinesia

E. Spastic colitis

 

142. A woman complains of unpleasant feelings in different body parts and organs and sometimes “very burdensome feelings of compression, torsion, turning-over”. Repeated consultations with specialists, clinical examinations, after that — referral for psychiatric advice. What psychopathological disorder is most likely?

C. *Cenestopathy

A. Depersonalisation

B. Paresthesia

D. Hypochondria

E. Synesthesia

 

143. A 35-year-old woman was admitted to thoracic surgery department with fever up to 40°C, onset of pain in the side caused by deep breathing, cough with considerable quantity of purulent sputum and blood with bad smell. What is the most likely diagnosis?

B. *Abscess of the lungs

A. Tuberculosis of lungs

C. Actinomycosis of lungs

D. Bronchectatic disease

E. Complication of liver echinococcosis

 

144. A man, aged 28, suddenly fell ill. “There appeared chills, sensation of heat, fever up to 38,5°C, intermitting pain in the left iliac area, frequent liquid stool in the form of sangui-nomucoid mass. On palpation: the left part of the abdomen is painful, spastic sigmoid colon. What is the most likely diagnosis?

E. *Acute dysentery

A. Amebiasis

B. Escherichiosis

C. Non-specific ulcerative colitis

D. Malignant growth of the large intestines

 

145. A 3-day-old new-born who has suffered from asphyxia in birth presents with bleeding from umbilical sore. Lab tests: hypocoagulation, thrombocytopenia, hypothrombinemia. What is the most likely cause of clinical and laboratory changes?

B. *Disseminated intravascular coagulation (DIC)

A. Thrombocytopenic purpura

C. Inborn angiopathy

D. Trauma of umbilical vessel

E. Haemolytic disease of new-born

 

146. In a college with the majority of 14-year-old students preventive antituberculosis planned examination is taking place. Which method from the following should be used?

A. *Mantoux [ tuberculin ] test with 2 TU

B. Fluorographic

C. Sputum analysis for tuberculosis mycobacteria

D. General blood analysis

E. Physical examination

 

147. A woman, aged 28, consulted a doctor with the complaints of increasing size of pigment nevus which was present from birth, its maceration, itching. What method of investigation should be used for diagnostic in this case?

A. *Incision biopsy

B. Glass-print

C. Radioisotope diagnostics

D. Thermography

E. Yaks:s reaction

 

148. A man aged 68 complains of tiredness, sweating, enlargement of cervical, submaxillary and axillary’s lymph nodes. Blood tests; WBC – 35 * 109/L, lymphocytes – 60%, Botkin and Gumprecht bodies, level of haemoglobin and quantity of thrombocytes is normal. Myelogram showed 40% of lymphocytes. What is the most probable diagnosis?

B. *Chronic lympholeucosis

A. Acute leucosis

C. Tuberculous lymphadenitis

D. Lymphogranulomatosis

E. Chronic myeloleucosis

 

149. In the development of the inflammation processes glucocorticoids reduce the level of a 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?

A. *Phospholipase

B. Lipoxygenase

C. Arachidonic acid

D. Cyclooxygenase-2

E. Cyclooxygenase- 1

 

150. 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?

C. *Lydocain

A. Strophantin

B. Seduxen

D. Novocainamides

E. Isoptin

 

151. A 26-year-oid woman gave birth to a child 6 months ago. She consulted a 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?

E. *Physiological amenorrhea

A. Sheehan’s syndrome

B. Gestation

C. Pseudoamenorrhea

D. Asherman’s syndrome

 

152. A patient, aged 25, suffering from stomach ulcer. Had a course of treatment in the gastroenterological unit. 2 weeks later developed constant pain, increasing and resistant to medication. The abdomen is painful in epigastric area, moderate defence in pyloroduodenal area. Development of which complication aggravated the patient’s state?

A. *Penetration

B. Haemorrhage

C. Perforation

D. Stenosis

E. Malignisation

 

153. A man, aged 30, intravenous drug addict complains of weakness, moderate jaundice, sensation of heaviness in the right hypochondrium. The patient’s condition aggravated gradually. Biochemical tests: Total bilirubin – 48,2 µmol/L; ALT – 3,0 mmoI/h*L. What examination will verify the diagnosis?

B. *Polymerase chain reaction (HCY -RNA)

A. Determination of HB antigen

C. Determination of AlATin dynamics

D. Ultrasound examination of liver

E. Computer-aided tomography

 

154. A worker, aged 38, working in the slate production during 15 years, complains of expiratory exertional dyspnea, dry cough. On examination: deafening of the percutory sounds in interscapular region, rough breath sounds, and dry disseminated rales. On fingers’ skin — greyish warts. Factory’s sectorial doctor suspects asbestosis. Which method is the most informative for diagnosis verification?

A. *Thorax roentgenography

B. Blood gases examination

C. Bronchoscopy

D. Spirography

E. Bronchoalveolar lavage

 

155. 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 warned to kill him). He was discharged from the 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?

B. *Supportive treatment with neuroleptics of prolonged action

A. Psychiatric observation

C. Psychoanalytic treatment

D. Participation in a self-assistance group

E. Long-term hospitalization

 

156. A patient, aged 24, is suffering from an asthmatic fit with nonproductive cough and skin itch after diclofenac intake. In medical history: urticaria. On examination: edematous face, swelling of the cervical veins, the patient is supporting himself in a seated position, audible stridor breathing. What is the most likely diagnosis?

D. *Quincke’s edema

A. Cardiac asthma

B. Nervous asthma

C. Diclofenac tablet aspiration

E. Bronchial asthma

 

157. A 30-year-old man has a history of recurrent pneumonias and chronic cough with foul smell, purulent sputum, occasionally blood 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 rales at the root of lungs from behind. What is the most probable diagnosis?

A. *Bronchoectasis

B. Pulmonary neoplasm

C. Chronic obstructive emphysema

D. Chronic bronchitis

E. Disseminated pulmonary tuberculosis

 

158. A patient complains of periodic rash eruptions in the course of the year on the elbow and knee joints. The first eruption occurred after stress. Now it consists of multiple plates, the central part of which is covered with silvery scales. What is the most likely diagnosis?

A. *Psoriasis

B. Dermatitis

C. Eczema

D. Erythematosis

E. Lichen ruber planus

 

159. A patient, aged 81, complains of constant urinary excretion in drops, feeling of fullness in the lower abdomen. On examination: above pubis there is a spherical protrusion: over which there is a dullness of percussion sound, positive suprapubic punch. What symptom is observed in this patient?

E. *Paradoxal ischuria

A. Urinary incontinence

B. Enuresis

C. Dysuria

D. Pollakiuria

 

160. A patient, aged 49, was operated on account of acute catarrhal appendicitis. 8 days later there appeared vomiting, no passage of gasses or defecation. On examination: the abdomen is inflated, positive Sklyarov’s and Wahl’s symptoms. Leucocytosis. Acute intestinal obstruction is suspected. What supplementary examination methods arc the most informative to diagnose the complication?

B. *Survey radiography of abdomen

A. Laparoscope,

C. Colonoscopy

D. Gastroduodenoscopy

E. Echography of abdomen

 

161. A woman in labour, on vaginal inspection: cervix dilation is up to 2 cm, fetal bladder is intact. Sacral cavity is free, sacral promontory is reachable only with a bent finger, the inner surface of the sacrococcygeal joint is accessible for inspection. The head of the fetus presents. Sagittal suture occupies the transverse diameter of pelvic inlet, the small fontanel to the left, on the side. What labour stage is this?

E. *Cervix dilation stage

A. Preliminary stage

B. Prodromal stage

C. Expulsion of fetus stage

D. Placental stage

 

162. A girl, aged 13, consults the school doctor on account of moderate bloody discharge from the genital tracts, which appeared 2 days ago. Secondary sexual characters are developed. What is the most probable cause of bloody discharge?

D. *Menarche

A. Juvenile haemorrhage

B. Werlhof’s disease

C. Endometrium cancer

E. Haemophilia

 

163. A patient complains of intense pressing pain in the pharynx, mainly to the right, impossibility to swallow even liquid food. The illness started 5 days ago. The patient’s condition is grave. Body temperature — 38,9°C speech is difficult, voice is constrained, difficulties in opening the mouth. Submaxillary lands to the right are painful, enlarged; hat is the most probable diagnosis?

A. *Peritonsillar abscess

B. Pharyngeal tumour

C. Diphtheria

D. Vincent’s disease

E. Phlegmonous tonsillitis

 

164. A boy aged 7, is under treatment during 1 month. On hospitalization: significant edema, proteinuria — 7.1 g/L, protein in daily urine — 4.2 g. Blood biochemical profile: stable hypoproteinaemia (43.2 g/L). hypercholesterinaemia (9.2 mmol/L). Which variant of glomerulonephritis is the most probable in this case?

B. *Nephrotic

A. Isolated urinary

C. Hematuric

D. Mixed

E. Nephritic

 

165. A 43-year-old woman complains of severe pain in the right abdominal side irradiating in the right supraclavicular area, fever, dryness and bitterness in the mouth. There was multiple vomiting without relief. Patient relates the onset of pain to the taking of fat and fried food. Physical examination: the patient lies on the right side, pale, dry tongue, and tachycardia. Right side of abdomen is painful during palpation and somewhat tense in right hypochondrium. What is the most likely diagnosis?

B. *Acute cholecystitis

A. Acute bowel obstruction

C. Perforative ulcer

D. Right-sided renal colic

E. Acute appendicitis

 

166. A full-term new-born suffered ante- and intranatal hypoxia, was born in asphyxia (Apgar score 2-5 points). After birth baby’s excitation is progressing, occurs vomiting, nystagmus, spasms, squint, spontaneous Babinski and Moro’s reflexes. What is the most probable location of the intracranial haemorrhage in this case?

C. *Subarachnoid hemorrhages

A. Haemorrhages in ventricles of brain

B. Periventricular hemorrhages

D. Subdural hemorrhages

E. Small hemorrhages in brain tissue

 

167. A pupil of the 8th form after trauma has acute atrophy of the left leg muscles, tonus of which is distinctly decreased, active movements are only in the knee joint, his foot is deformed. Support function 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?

B. *Special

A. Other

C. Preparatory

D. Basic

E Additional

 

168. A patient is hospitalized with the complaints of acute fatigue, fever up to 39,2°C, pain in the throat during swallowing, hemorrhagic rash on the skin of the trunk. On examination the blood analysis shows anaemia, thrombocytopenia, blastocytes — 14%, ESR — 40 mm/h. What examination is necessary to define the diagnosis?

A. *Sternal puncture

B. Detailed blood test

C. Bacterial inoculation from tonsills

D. Rontgenography of the scull bones

E. Coagulogramme

 

169. During 2 hours after delivery the condition of the woman is good: the uterus is firm, spherical, the fundus of uterus is on level of the navel, no haemorrhage. The clamp, placed on the umbilical cord segment, remains on the same level. On deep inhalation and on pressing with edge of the hand above symphysis the umbilical cord retraction into the vagina. There is no bloody discharge from the genital tracts. What should be the further tactics of the doctor?

B. *Manual removal of afterbirth

A. Application of Abuladze’s method

C. Curettage of uterine cavity

D. Application of Krede-Lasarcvich’s method

E. I.V injection of oxytocin

 

170. 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?

D. *Liver cirrhosis

A. Cancer of the head of pancreas

B. Viral hepatitis B

C. Cancer of the liver

E. Gallstones

 

171. A patient, aged 34, has been suffering for 7 years from pulmonary tuberculosis. He complains of muscle weakness, weight loss, diarrhea, frequent urination. On examination: hyperpigmentation of skin, gums, and inner sides of the cheeks. BP – 90/58 mm Hg. In blood: RBC – 3, l*1012/L. Hb – 95 g/L, colour index of blood – 0,92; WBC – 9,4 * 109/L, eosinophils – 7, segmented neutrophils – 45, band neutrophils – 1, lymphocytes – 40, monocytes – 7, Na+ – 115 mmol/L, K+ – 7,3 mmol/L. What is the preliminary diagnosis?

C. *Primary adrenocortical insufficiency

A. Pheochromocytoma

B. Primary aldosteronism

D. Congenital adrenal hyperplasia

E. Diabetes insipidus

 

172. A woman, aged 60, complains of unendurable pain in the right hypochondrium. In medical history: acute pancreatitis. The body temperature – 38.2°C. On examination: scleral icteiitiousness. No signs of peritoneum irritation. Positive Ortner’s symptom, Gubergrits-Skulsky symptom. Urine diastasis – 320 g/h. What diagnosis is the most likely?

A. *Chronic pancreatitis

B. Pancreas cancer

C. Acute cholangitis

D. Acute cholecystitis

E. Chronic cholecystitis

 

173. A 27-ycar-old woman was admitted to clinic with complaints of pain in right ankle joint, impossibility to stand on those extremities. 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?

C. *Supination of the foot

A. Load along the axis with planter flexion of foot

B. Load along the axis with dorsal flexion of foot

D. Pronation of the foot

E. Direct blow

 

174. A patient, aged 70, complains of pain, lacrimation, loss of acuity of vision on the right eye. Fell ill 3 days ago after eye injury with a tree branch. On examination: palpebral fissure is narrowed, photophobia, mixed injection. On the cornea there is an opacity area with irregular borders, progressive edge and epithelial defect. Cornea sensitivity is normal. Hypopyon. Chronic dacryocystitis. What is the most likely diagnosis?

C. *Serpiginous corneal ulcer

A. Penetrating injury of the right eye cornea

B. Acute conjunctivitis

D. Acute iridocyclitis

E. Viral keratitis

 

175. After delivery and revision of placenta there was found the defect of placental lobe. General condition of woman is normal, uterine is firm, and there is moderate bloody discharge. Inspection of birth canal with mirrors shows absence of lacerations. What is the following necessary action?

C. *Manual exploration of the iterine cavity

A. Use of hemostatic medications

B. Use of uterine contracting agents

D. Urine drainage, cold at lower abdomen

E. External massage of uterus

 

176. A victim of a road accident, aged 44, is operated on account of intraperitoneal haemorrhage. In which case the patient’s blood from the abdominal cavity can be used for autotransfusion?

D. *Splenic rupture

A. Small intestines rupture

B. Liver rupture

C. Bladder rupture

E. Stomach rupture

 

177. A pregnant woman, aged 35, is in grave condition, complains of headache, vision disorders, “midges” before the eyes. On examination: anasarca, BP – I80/120 mm Hg. Suddenly there appeared fibrillar twitching of the facial muscles, tonic spasms. Breathing stopped. 1 minute later breathing restarted. A profuse foam discharge from the mouth. Amnesia. In clinical urine analysis: protein – 7 g/L. What is the most likely diagnosis?

E. *Eclampsia

A. Preeclampsia, severe degree

B. Craniocerebral injury

C. Epilepsy

D. Hypertension attack

 

178. 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?

D. *Prevention of disease complications

A. Prevention of disease onset

B. Elimination of causes of diseases onset

C. Improvement of patients’ life conditions

E. Conducting of rehabilitation measures

 

179. A 20-year-old man complains of pain and edema in the right buttock. Physical examination: limited tenderness, painful swelling with skin hyperemia and local hyperthermia. Positive fluctuation symptom. Abscess is diagnosed. What are the tactics for the therapy?

A. *Lancing and draining of abscess, prescription of broad spectrum antibiotic

B. Administration of tetanus antitoxin and medication for immunity stimulation

C. Local application of dimexide

D. Prescription of broad spectrum antibiotic and sulphonamide

E. Physiotherapy

 

180. A baby, aged 2 years, has a syndrome of malabsorbtion. On ECG: S-T segment depression, wave T inversion and high wave U. What is the cause of these changes?

B. *Hypokalihistia

A. Hypomagnesaemia

C. Hyperkalihistia

D. Hypercalcihistia

E. Hypocalcihistia

 

181. The occipital part of new-born head of dolichocephalic form shows with labour edema with centre in the area of small fontanel. In which presentation of fetal head did child-birth occur?

E. *Occiput anterior presentation

A. Occiput posterior presentation

B. Brow presentation

C. Face presentation

D. Parietal anterior presentation

 

182. 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?

A. Annihilate the product.

B. Write the product off for animal feeding

C. Sell but inform customers about milk quality

D. Utilize technically

E. Sell without limitations

 

183. A woman, aged 37, primigravida, is in labour during 10 hours. The contractions last 20-25 sec every 6-7 min. Fetal position is longitudinal, head presents and is engaged to pelvic inlet. Vaginal inspection: cervix is 1 cm long, lets in 2 horizontal fingers. Fetal bladder is absent. What is the most likely diagnosis?

E. *Primary uterine inertia

A. Normal labour activity

B. Secondary uterine inertia

C. Pathological preliminary period

D. Discoordinated labour activity

 

184. 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 patient was rather confused, for some moments he couldn’t understand what was happening. He totally forgot the slate he was in and the events around him, occurring while he was in that state. What disorder is the most probable?

D. *Petit mal, epilepsy

A. Jacsonia fit. epilepsy

B. Grand mal, epilepsy

C. Disphoria, epilepsy

E. Twilight state, epilepsy

 

185. A 52-year-old woman suffering from obesity complains of bloody discharges from genital tracts 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?

D. *Excessive transformation of preandrogens from adipose tissues

A. Poor aromatization of preandrogens due to hypothyroidism

B. Supersecretion of androgens by the cortex of paranephroses.

C. Hypersecretion of estrogens by tissues of the organism.

E. The increased contents of follicle-stimulating hormone

 

186. A man fell abruptly ill. Frequent watery stool developed 6 hours ago. The body 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?

E. *Cholera

A. Toxic food-borne infection

B. Typhoid fever

C. Dysentery

D. Salmonellosis

 

187. A 30-year-old man complains of a sharp pain in the right ear, hearing loss, high temperature during three days. Objectively – right ear whispering language – 0,5 m, external ear is intact, otoscopically – eardrum protrusion, hyperemia and swelling, loss of landmarks. What is the most likely diagnosis?

E. *Acute purulent otitis media

A. Eustachian tube dysfunction

B. Acute mastoiditis

C. Chronic purulent otitis media

D. Chronic secretory otitis media

 

188. A man, aged 28, power-supply system operator, was at his working place during the breakdown on the nuclear power plant. In the result of the steam-air explosion there was an emission of circa 30 kg radioactive iodine (I131). Which radioprotector is expedient in this case?

B. *Potassium iodide

A. Cystamine

C. Thiourea

D. Leucine

E. Valine

 

189. A worker was temporarily off work because of illness during 16 days, was under out-patient treatment. The doctor in charge of the case issued a sick-list first for 5 days, and then prolonged it for 10 days. Who can further prolong the sick-list to this patient?

A. *The doctor in charge of the case together with the head of department

B. The doctor in charge of the case with the permission of the head of department

C. Deputy head physician on the working ability expertise

D. The head of department

E. Working ability expertise committee

 

190. A 2-months baby, after preventive vaccination, suffered from protracted haemorrhage from the point of injection, later there developed an intramuscular hematoma. On examination: a significant growth of prothrombine consumption and distinct prolongation of activated partial thromboplastin time. What is the most likely diagnosis?

C. *Hemophilia

A. Schoenlein-Henoch’s disease

B. Werlhof’s disease

D. Congenital afibrinogenemia

E. Hemorrhagic new-borns’, disease

 

191. 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?

B. *De-nol

A. Papaverin

C. No-spa

D. Almagel

E. Atropine

 

192. A S-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?

B. *Prednisone

A. Delagil

C. Diprazinum

D. Erythromycin

E. Cefazolin

 

193. A youth aged 17 complains of a sudden onset of palpitation 10 minutes ago. On examination, skin of the normal colour. Heart borders without changes, HR=Ps=200 bmp, regular rhythm. BP – 135/75 mm Hg. Heart sounds are intensified. On ECG: QRS = 0.09 sec. What measure is to be undertaken on the first stage of aid?

C. *Vagal tests

A. Cardioversion

B. Novocainamid I.V.

D. Propranolol per os

E. No treatment

 

194. In laboratory a sample of milk is analysed. There determined the following: colour – whitish, smell – without peculiarities, taste – specific for milk, density – 1.038, acidity – 35° Turner, fats – 3.2%. What is the degree of milk quality?

A. *Milk of poor quality

B. Adulterated milk.

C. Milk of good quality

D. Milk conditionally usable

E. Milk of reduced quality

 

195. A patient complains of pathological lump, appearing in the right inguinal region on exercise. The lump is round-shaped, circa 4 cm in diameter, on palpation: soft elastic consistency, positions near the medial part of Poupart’s ligament. The lump is situated inwards from the spermatic cord. What is the most probable preliminary diagnosis?

A. *Right-sided direct inguinal hernia

B. Lipoma of the right inguinal area

C. Right-sided oblique inguinal hernia

D. Varicose veins of the right hip

E. Right-sided femoral hernia

 

196. Left eye vision disorders were registered in a male patient aged 22. A year later there developed a weakness of the right foot. On examination: lateral nystagmus, paling of temporal half of the left disk of optic nerve, absence of abdominal reflexes, hyperreflexia on the extremities, clonus of the left foot, Babinski’s signs on both sides. What is the most likely diagnosis?

E. *Disscminaled sclerosis

A. Retrobulbar optic neuritis

B. Neuropathy of the right fibular nerve

C. Myelitis

D. Poliomyelitis

 

197. During intramuscular DTP vaccination 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 history of the child is not complicated. What is the most probable diagnosis?

D. *Spasmophilia, tonic spasms

A. Cerebral haemorrhage, tonic spasms

B. Meningoencephalitic reaction, clonic and tonic spasms

C. Anaphylactic shock, clonic spasms

E. Meningism, clonic and tonic spasms

 

198. An employee of a private company was ill with acute respiratory viral infection. Consulted a district doctor, who determined the fact of temporary loss of working ability, but refused to issue a sick-list, arguing that the patient worked in the private and not state-owned company. Should the sick-list be issued to the employees of private companies?

A. *Issued regardless of company’s ownership

B. Issued only to empties of state-owners companies

C. Issued a medical certificate of a free form

D. Issued only on condition of payment guarantee by the company’s proprietor

E. Issued a medical certificate of a set form

 

199. 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?

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

A. Suture on the wound

B. Inspection of the wound with canal probe

C. Drainage of the wound with rubber strip

D. Aseptic bandage

 

200. A man consults a physician with complaints of cramping pain in left side of the chest, general weakness, fever and headache that have appeared 2 days ago. This morning the patient noticed a skin rash on the chest. Physical examination: multiple aggregated vesicles with edematous covers 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?

A. *Herpes Zoster varicellosus

B. Pityriasis rosea

C. Streptococcal (Fox’s) impetigo

D. Allergic dermatitis

E. Herpes simplex

 

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