Year 2005

Posted: May 5, 2012 in Krok II
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1. A full-term new-born suffered ante-and intranatal hypoxia, was born in asphyxia (Apgar score 2-5 points). After birth baby’s excitation is progressing, occurs vomiting, nystagmus, spasms, squint, spontaneous Babinski and Moro’s reflexes. What is the most probable location of the intracranial haemorrhage in this case?

A. Periventricular hemorrhages

B. *Subarachnoid hemorrhages

C. Small hemorrhages in brain tissue

D. Subdural hemorrhages

E. Haemorrhages in ventricles of brain

 

2. 60 y.o. patient experiences acute air insufficiency following of the venoectomy due to subcutaneous vein thrombophlebitis 3 days ago. Skin became cianotic, with grey shade. Marked psychomotor excitement, tachypnea, substernal pain. What postoperative complication has occured?

A. *Thromboembolia of pulmonary artery

B. Myocardial infarction

C. Hemorrhagia

D. Valvular pneumothorax

E. Hypostatic pneumonia

 

3. A 24 y.o. patient complains of nausea, vomiting, headache, shortness of breath. He had an acute nephritis being 10 y.o. Proteinuria was found out in urine. Objectively: a skin is grey-pale, the edema is not present. Accent of II tone above aorta. BP 140/100-180/100 mm Hg. Blood level of residual N2 – 6,6 mmol/L, creatinine — 406 mmol/L. Day’s diuresis-2300 ml, nocturia. Specific density of urine is 1009, albumin – 0,9 g/L, WBC — 0-2 in f/vis. RBC- single in f/vis., hyaline casts single in specimen. Your diagnosis?

A. Hypertensive illness of the II degree

B. *Chronic nephritis with violation of kidney function

C. Nephrotic syndrome

D. Stenosis of kidney artery

E. Feochromocitoma

 

4. A patient, aged 16, complains of headache, mainly in the frontal and temporal areas, superciliary arch, appearing of vomiting at the peak of headache, pain during the eyeballs movement, joint’s pain. On examination: excited, t°- 39°C, Ps — 110/min. Tonic and clonus cramps. Uncertain meningeal signs. What is the most likely diagnosis?

A. *Influenza with cerebral edema manifestations

B. Parainfluenza

C. Influenza, typical disease duration

D. Respiratory syncytial virus

E. Adenovirus infection

 

5. A 40 y.o. child age has hyperesthesia, XNS depression, dyspepsia. Sepsis is suspected. What should the differential diagnosis be made with?

A. Hyperkaliemia

B. *Hypoglycemia

C. Hyperbilirubinemia

D. Hypomagnesemia

E. Hypocalcemia

 

6. Body temperature of a 12 y.o. girl increased up to 39 — 40°C in 4-5 hours after she had taken 2 pills of aspirin. Complains of general discomfort, dizziness, sudden appearance of red spots on the skin with blister formation or exfoliation of the epidermis with erosive surface. Lesions on the skin looked like burns of II degree. Ni-kolsky syndrome is positive. What is the most probable diagnosis?

A. Duhring’s disease

B. Pemphigus vulgaris

C. Bullous dermatitis

D. *Acute epidermical necrolysis

E. Polymorphic exudative erythema

 

7. Male 30 y.o., noted growing fingers and facial scull, changed face. Complains of poor eyesight, weakness, skin darkening, loss of body weight. X-ray shows broadening of sella turcica, thinning of tuberculin sphenoidale, and signs of increased intracranial pressure. What diagnosis can you make?

A. Optico – hiasmatic arachnoiditis

B. Tumor of pondo-cerebellar corner

C. Encephalitis of truncus

D. Adrenal gland tumor

E. *Adenoma of hypophysis

 

8. A 29 y.o. patient was admitted to the hospital with acute girdle pain in epigastric area, vomiting in 1 hour after the meal. On examination: pale, acrocyanosis. Breathing is frequent, shallow. Abdominal muscles are tensed, positive Schotkin-Blumberg’s symptom. What is the maximal term to make a diagnosis?

A. *In 2 hours

B. In 0,5 hours

С. In 3 hours

D. In 6 hours

E. In 1 hour

 

9. A female rheumatic patient experiences diastolic thoracic wall tremor (diastolic thrill), accentuated S at apex, there is diastolic murmur with presystolic intensification, opening snap, S1 accent at pulmonary artery. What rind of heart disorder is observed?

A. Aortic valve insufficiency

B. *Mitral stenosis

C. Mitral valve insufficiency

D. Opened arterial duct

E. Pulmonary artery stenosis

 

10. What methods of the collecting of the information are preferable for study of housing conditions of students of medical HIGH SCHOOL for a training period?

A. Selecting of materials

B. *Questioning

C. Interviewing

D. A method of the directed selection

E. Statistical

 

11. A 20 y.o. pregnant woman with 36 weeks of gestation was admitted to the obstetrical hospital with complains of pain in the lower abdomen and bloody vaginal discharge. The general condition of the patient is good. Her blood pressure is 120/80 mm Hg. The heart rate of the fetus is 140 bpm, rhythmic. Vaginal examination: the cervix of the uterus is formed and closed. The discharge from vagina is bloody up to 200 ml per day. The head of the fetus is located high above the minor pelvis entry. A soft formation was defined through the anterior fornix of the vagina. What is the probable diagnosis?

A. Uterine rupture

B. Incipient abortion

C. Threatened premature labor

D. Premature placental separation

E. *Placental presentation

 

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

A. *Irritable bowel syndrome

B. Atonic colitis

C. Colitis with hypertonic type dyskinesia

D. Spastic colitis

E. Chronic enterocolitis, exacerbation phase

 

13. A 33 y.o. patient was admitted to the hospital with stopped recurrent peptic ulcer bleeding. On examination he is exhausted, pale. Hb — 77 g/L, Ht — 0,25. Due to anemia there were two attempts of blood transfution of identical blood group A(ll)Rh+. Both attempts were stopped because of anaphylactic reaction. What blood transfution environment is desirable in this case?

A. Freshcitrated blood

B. Erythrocyte emulsion

C. Erythrocyte mass (native)

D. *Washed erythrocytes

E. Erythrocyte mass poor for leucocytes and thrombocytes

 

14. A17 y.o. patient complains of acute pain in the knee joint and t°- 38°C. He was ill with angina 3 weeks ago. Objectively: deformation and swelling of the knee joints with skin hyperemia. Small movement causes an acute pain in the joints. Which diagnose is the most correct?

A. Reactive polyarthritis

B. *Rheumatism, polyarthritis

C. Systemic lupus eritematodes

D. Rheumarthritis

E. Infectious-allergic polyarthritis

 

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

A. *Septic shock

B. Bronchial obstruction

C. Emphysema

D. Toxic hepatitis

E. Exudative pleuritis

 

16. An unconscious patient presents with moist skin, shallow breathing. There are signs of previous injection on the shoulders and hips. BP — 110/70 mm Hg. Tonus of skeletal muscles and reflexes are increased. Cramps of muscles of the extremities are seen. What is the most likely disorder?

A. Hyperosmolar coma

B. *Hypoglycemic coma

C. Hyperlactacidotic coma

D. Hyperglycemic coma

E. Stroke

 

17. In a forest summer camp children have variable procedures to harden their organisms. What procedure has the most hardening power?

A. Morning exercises on the fresh air

B. Bath with hydromassage

С. *Contrast shower

D. Walking on the fresh air

E. Hygienic shower

 

18. Deputy of chief medical officer carried out a study of morbidity rate for population which had been served at the polyclinics for the last 5 years. What statistical values can help in calculations of diseases level dissamination?

A. Absolute values

B. Standart values

C. *Relative values

D. Dynamic row

E. Average values

 

19. What developes most often after accidental intake of Hydrochloric acid?

A. Cushing’s syndrome

B. Acute pancreatitis

C. Deylads’s syndrome

D. Kutling’s syndrome

E. *Cardiac insufficiency

 

20. A 1,5 y.o. child fell ill acutely with high temperature 38°C, headache, fatigue. The temperature declined on the fifth day, muscular pain in the right leg occured in the morning, there were no movements and tendon reflexes, sensitivity was reserved. What is the initial diagnosis?

A. Viral encephilitis

B. Hip joint arthritis

C. *Polyomyelitis

D. Polyartropathy

E. Osteomyelitis

 

21. A woman complains of high temperature to 38°C, mild pain in the throat during 3 days. On examination: angle lymphatic nodes of the jaw are 3 cm enlarged, palatinel tonsils are enlarged and coated with grey plaque which spreads to the uvula and frontal palatinel arches. What is the most probable diagnosis?

A. Agranulocytosis

B. Vincent’s angina

C. Oropharyngeal candidosis

D. Infectious mononucleosis

E. *Larynx dyphtheria

 

22. A 37 y.o. woman is suffering from squeezing substernal pain on physical exertion. On examination: AP-130/80 mm Hg, heart rate=pulse rate 72 bpm, heart boarders are dilated to the left side, aortic systolic murmur. ECG-signs of the left venticle hypertrophy. What method of examination is the most informative in this case!

A. Sphygmography

B. Phonocardiography

C. *Echocardiography

D. X-ray

E. Coronarography

 

23. A 18 y.o. woman consulted a gynecologist with complaints of the pain in the lower part of the abdomen, fever up to 37, 5°C, considerable mucopurulent discharges from the genital tract, colic during urinating. After mirror and vagina examination the results are the following: the urethra is infiltrated, cervix of the uterus is hyperemic, erosive. The uterus is painful, ovaries are painful, thickened, free. Bacterioscopy test showed diplococcus. What diagnosis is the most probable?

A. Chlamydiosis

B. Chronic gonorrhea

C. *Recent acute ascending gonorrhea

D. Candydomycosis

E. Trichomoniasis

 

24. A 13 y.o. patient was treated in dermatological hospital for atopic dermatitis exacerbation. He was discharged in the condition of clinical remission. What recommendations should the doctor give to prevent exacerbations?

A. Frequent skin washing with detergents

B. *Use of neutral creams to protect skin

C. Systematic use of local corticosteroids

D. Systematic skin disinfection

E. Avoidance of skin insolation

 

25. A 43 y.o. patient complains of mass and, pain in the right breast, elevation of temperature to 37,2°C during 3 last months. Condition worsens before the menstruation. On examination: edema of the right breast, hyperemia, retracted nipple. Unclear painful infiltration is palpated in the lower quadrants. What is the most probable diagnosis?

A. Tuberculosis of right mammary gland

B. Right side acute mastitis

C. *Cancer of right mammary gland

D. Right side chronic mastitis

E. Premenstrual syndrome

 

26. A gravida with 7 weeks of gestation is referred for the artificial abortion. On operation while dilating cervical canal with Hegar dilator №8 a doctor suspected uterus perforation. What is immediate doctor’s tactics to confirm the diagnosis?

A. *Probing of uterus cavity

B. Laparoscopy

C. Metrosalpingography

D. Ultrasound examination

E. Bimanual examination

 

27. A male patient complains of heartburn iich gest stronger while bending the body, substernal pain during swallowing. There is a hiatus hernia on X-ray. What disoeder should be expected at gastroscopy?

A. Chronic gastritis

B. Gastric peptic ulcer

C. *Gastroesophageal reflux

D. Acute erosive gastritis

E. Duodenal peptic ulcer

 

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

A. *Measles

B. Rubella

C. Adenovirus infection

D. Enterovirus exanthema

E. Scarlet fever

 

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

A. Endometrium cancer

B. *Menarche

C. Werlhof ‘s disease

D. Juvenile haemorrhage

E. Haemophilia

 

30. A 30 y.o. male patient complains of itching of the skin which intensifies in the evening. He has been ill for 1,5 months. On examination: there is rash with paired papules covered with bloody crusts on the abdomen, hips, buttocks, folds between the fingers, flexor surfaces of the hand. There are traces of line scratches. What additional investigations are necessary to make diagnosis?

A. Blood glucose

B. Determination of dermographism

C. *Examination of rash elements scrape

D. Examination for helmints

E. Serologic blood examination

 

31. A 7 y.o. child had elevation of temperature tol 40°C in anamnesis. For the last 3 months he presents fusiform swelling of fingers, ankle joints and knee joint, pain in the upper part of the sternum and cervical part of the spinal column. What is the most probable diagnosis?

A. Septic arthritis

B. *Juvenile rheumatic arthritis

C. Toxic synovitis

D. Rheumatism

E. Osteoarthrits

 

32. A 31 y.o. woman has suffered from systemic sclerodermia for 14 years. She was treated in hospitals many times. She complains of periodical dull pain in the cardiac area, palpitation, dyspnea, headache, eyelids swelling, weight loss, pain and limbs deformities. Which organ’s disorder worsens the prognosis?

A. Skin and joints

B. Heart

C. Gastro-intestinal tract

D. Lungs

E. *Kidneys

 

33. 30 y.o. woman, had mild trauma of 5th finger of the left hand 15 days ago. She has treated her self at home. She presents to the hospital due to deterioration of the condition and temperature rise. Objectively: hyperemia and swelling on the ventral surface of finger. Restricted movements of the finger. X-ray of the left hand: an early stage of osteomyolitis of the fifth finger could not be excluded. The diagnosis: panaris of 5th finger of the left hand. What form of panaris has occurred in the patient?

A. *Bony

B. Hypodermic

C. Tendon type

D. Paronychia

E. Joints type

 

34. A 14 y.o. girl complains of profuse bloody genital discharges during 10 days after suppresion of menses for 1,5 months. Similiar bleedings recur since 12 years on the background of disordered menstrual cycle. On rectal examination: no pathology on the internal genitalia. In blood: Hb — 70 g/L, RBC — 2,3*1012/L, Ht — 20. What is the most probable diagnosis?

A. Polycyst ovarian syndrome

B. Werlholf’s disease

C. Hormonoproductive ovary tumor

D. *Juvenale bleeding, posthemorrhagic anemia

E. Noncomplete spontaneous abortion

 

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

A. Erysipelatous inflammation

B. Infectional arthritis

C. *Gout

D. Osteoarthritis

E. Rheumatoid arthritis

 

36. A 12 y.o. child with acute glomerulonephritis presented with hypertensive syndrom during first days of the disease. What is the role of angiotesin II in the pathogenesis?

A. Increases heart output

B. Increases erythropoetin production

C. Infibits deppresive action of prostaglandins

D. Increases renine level

E. *Intensifies production and secretion of aldosterone

 

37. A 98 y.o. male patient complains of pain in the left lower limb which intensifies on walking, feeling of cold and numbness in both feet. He has been ill for 6 years. On examination: pale dry skin, hyperkeratosis. Hairy covering is poorly developed on the left shin. “Furrow symptom “is positive on the left. Pulse on foot arteries and popliteal artery isn’t palpated, on the femoral artery it’s weak. On the right limb the artery pulsation is reserved. What is the most probable diagnosis?

A. Obliterating endarteritis

B. Buerger’s disease (thromboangiitis obliterans)

C. *Arteriosclerosis obliterans

D. Raynauld’s disease

E. Hemoral arthery thombosis

 

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

A. Barbiturism

B. *Cocainism

С. Nicotinism

D. Cannabism

E. Morphinism

 

39. A 43 y.o. woman complains of contact hemorrhages during the last 6 months. Bimanual exam: cervix of the uterus is enlarged, restricted in mobility. Mirrors showed the following: cervix of the uterus is in the form of cauliflower. Chrobak and Schiller tests are positive. What is the most probable diagnosis?

A. Polypus of the cervix of the uterus

B. Cervical pregnancy

C. *Cancer of cervix of the uterus

D. Leukoplakia

E. Nascent fibroid

 

40. A 35 y.o. female patient was admitted to the surgical department with symptoms of ulcerative gastric hemorrhage. It’s been the third hemorrhage for the last 2 years. After conservative treatment vomiting with blood stopped, hemoglobin elevated from 60 till 108 g/L. General condition became better. But profuse vomiting with blood reoccured in 2-3 hours. Hemoglobin decreased to 93,1 g/L then to 58,1 g/L. What is the tactics of treatment?

A. Conservative treatment with following surgery

B. Deferred surgery

C. Conservative treatment

D. *Urgent surgery

E. Taylor’s treatment

 

41. A 65 y.o. woman complains of complicated mouth opening following foot trauma 10 days ago. Next day she ate with difficulties, there were muscles tension of back, the back of the head and abdomen. On the third day there was tension of all muscle groups, generalized convulsions every 10-15 min. What is the most probable diagnosis?

A. Epilepsy

B. *Tetanus

C. Tetania

D. Meningoencephalitis

E. Hemorrhagic stroke

 

42. At term of a gestation of 40 weeks height of standing of a uterine fundus is less then assumed for the given term. The woman has given birth to the child in weight of 2500 g, a length of a body 53 cm, with an assessment on a scale of Apgar of 4-6 points. Labor were fast. The cause of such state of the child were:

A. Prematurity

B. Infection of a fetus

C. Delay of an intra-uterine fetation

D. Placental detachment •«

E. *Chronic fetoplacental insufficiency

 

43. At’s planned to construct multifield a new hospital in one of the central city districts. What building type is the most appropriate in this case?

A. Centralized

B. Mixed

C. *Centralized and blocked

D. Decentralized

E. Blocked

 

44. A 30 y.o. patient had deep burn covering 30% of body 30 days ago. Now he presents with continued fever, loss of appetite, night sweats. Burned surface weakly granulates. What is the stage of burn disease?

A. Primary burn shock

B. Secondary burn shock

C. Acute burn toxemia

D. Convalescence

E. *Septicotoxemia

 

45. A 24 y.o. woman presents with prolonged fever, nocturnal sweating. She’s lost weight for 7 kg during the last 3 months. She had irregular intercourses. On examination: enlargement of all lymphaden groups, hepatolienal syndrom. In blood: WBC — 2,2*109/L. What is the most likely diagnosis?

A. Infectious mononucleosis

B. *HIV-infection

C. Lymphogranulomatosis

D. Tuberculosis

E. Chroniosepsis

 

46. A 49 y.o. female patient presents with acute attacks of headache associated with pulsation in temples, increasing AP to 280/140 mm Hg. Pheochromocytoma is suspected. What is the mechanism of hypertensive crisis in this patient?

A. Increasing of plasma renin activity

B. *Increasing of catecholamines concentration

C. Increasing of vasopressin excretion

D. Increasing of aldosterone level in blood

E. Increasing of thyroxine excretion

 

47. A primapara with pelvis size 25-28-31-20 cm has active labor activity. Waters poured out, clear. Fetus weight is 4500 g, the head is engaged to the small pelvis inlet. Vasten’s sign as positive. Cervix of uterus is fully dilated. Amniotic sac is absent. The fetus heartbeat is clear, rhythmic, 136 bpm. What is the labor tactics?

A. Obstetrical forseps

B. Stimulation of the labor activity

C. Conservative tactics of labor

D. Vacuum extraction of the fetus

E. *Caesarean section

 

48. What preparations are used for prevention of fungal infection?

A. *Fluconozol, Orungol, Nisoral

B. Cytosar, Cormyctin, Lomycitin

С. Rubomycin, Bleomycin, Mytomycin С

D. Captopril, Enalapril

E. Isoniazid, Ftibazid, Pyrazinamid

 

49. A 36 y.o. patient is diagnosed with right sided pneumothorax. What method of treatment is indicated to the patient?

A. Symptomatic therapy

B. *Surgical drainage of the pleural cavity

C. Thoracotomy

D. Pleural puncture

E. Antiinflammation therapy

 

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

A. Rain water

B. Water from melted snow

C. Spring water

D. River water

E. *Artesian well water

 

51. A 26 y.o. male patient with postoperative hypothyroidism take thyroxine 100 mg 2 times a day. He has developed tachycardia, sweating, irritability, sleep disorder. Determine further treatment tactics.

A. To administer betablockers

B. To add mercasolil to the treatment

C. *То decrease thyroxine dosage

D. To increase thyroxine dosage

E. To administer sedatives

 

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

A. *Essential arterial hypertension

B. Polycystic disease of the kidneys

C. Chronic pyelonephritis

D. Cushing’s disease

E. Chronic glomerulonephritis

 

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

A. Trichinellosis

B. *Leptospirosis

C. Yersiniosis

D. Salmonellosis

E. Brucellosis

 

54. A 14 y.o. child suffers from of vegetovascular dystonia of pubertal period. He has developed sympathoadrenal crisis. What medicine should be used for crisis reduction?

A. Euphyline

B. Amisyl

C. No-shpa

D. Corglicone

E. *Obsidan

 

55. A 28 y.o. homeless male was admitted to the hospital because of initial diagnosis “influenza”. Roseolo-petechiae rash has appeared on the trunk and internal surfaces of the limbs on the fifth day. Temperature is 41°C, euphoria, face and sclera’s hyperemia, tongue tremor, tachycardia, splenomegaly, excitement. What is the most probable diagnosis?

A. Abdominal typhoid

B. Alcogolic delirium

C. Leptospirosis

D. *Typhus

E. Measles

 

56. To replace the blood loss replacement 1000 ml of the same group of Rhesus-compatible donated blood was transfused to the patient. The blood was conserved by sodium citrate. At the end of hemotransfusion there appeared excitement, pale skin, tachycardia, muscles cramps in the patient. What complication should be suspected?

A. Allergic reaction

B. Pyrogenous reaction

C. Anaphylactic shock

D. *Citrate intoxication

E. Citrate shock

 

57. A 2 y.о. breast-fed child suffers from cheek skin hyperemia, sporadic papulous elements on the skin of the chest and back following the apple juice introduction. The child is restless. What is the initial pediatritian’s tactics?

A. Treat with claritine

B. *Clarify mother’s diet and exlude obligate allergens

C. Apply ointment with corticosteroids to affected skin areas

D. Administer general ultraviolet irradiation

E. Refer to prescribe dermathologist

 

58. A 38 y.o. patient was urgently admitted to the hospital with complaints of sudden weakness, dizziness, loss of consciousness, body weight loss, nausea, vomiting, severe pain in epigastric area, diarrhea, skin hyperpigmentation. What is the most probable diagnosis?

A. Scleroderma

B. Meningoencephalitis

C. *Addisonic crisis

D. Acute gastroenteritis.

E. Pellagra

 

59. 7 y.o. boy with chronic sinusitis and rercurent pulmonary infections has chest X-ray demonstrating a right-sided cardiac silhouette. What is the most likely diagnosis?

A. Cystic fibrosis (mucoviscidosis)

B. «-antitrypsin deficiency

C. *Kartagener syndrome

D. Bronchiolitis obliterans

E. Laryngotracheomalacia

 

60. A 26 y.o. woman complains of a mild bloody discharge from the vagina and pain in the lower abdomen. She has had the last menstruation 3,5 months ago. The pulse is 80 bpm. The blood pressure (BP) is 110/60 mm Hg and body temperature is 36,6°C. The abdomen is tender in the lower parts. The uterus is enlarged up to 12 weeks of gestation. What is your diagnosis?

A. *Inevitable abortion

B. Complete abortion

C. Disfunctional bleeding

D. Incipient abortion

E. Incomplete abortion

 

61. A child was born at 34 weeks of gestation in bad condition. The cardinal symptoms show respiratoty disorders: sound prolonged expiration, additional muscles taking part in breathing, crepitation rales on the background of the rough breath sounds. Assesment according to Silverman’s scale was 0, in 3 hours- 6 with presence of clinical data. What diagnostic method can determine pneumopathy’s type in the child?

A. Immunologic investigation

B. *Chest X-ray

C. Blood gases

D. Proteinogram

E. Blood test

 

62. A 56 y.o. man, who has taken alcoholic drinks regularly for 20 years, complains of intensive girdle pain in the abdomen. Profuse nonformed stool 2-3- times a day has appeared for the last 2 years, loss of weight for 8 kg for 2 years. On examination: abdomen is soft, painless. Blood amylase — 12g/L. Feces examination-neutral fat 15 g per day, starch grains. What is the most reasonable treatment at this stage?

A. Levomicytine

B. Aminocapron acid

C. Imodium

D. Contrykal

E. *Pancreatine

 

63. A 27 y.o. woman turns to the maternity welfare centre because of infertility. She has had sexual life in marriage for 4 years, doesn’t use contraceptives. She didn’t get pregnant. On examination: genital development is without pathology, uterus tubes are passable, basal (rectal) temperature is one-phase during last 3 menstrual cycles. What is the infertility cause?

A. Abnormalities in genital development

B. Genital endometriosis

C. Immunologic infertility

D. Chronic adnexitis

E. *Anovular menstrual cycle

 

64. A 2 y.o. boy was admitted to the hospital with weight loss, unstable discharges, anorexia, following the semoli­na’s introduction (since 5 months). The child is adymanic, flabby, pale dry skin, subcutaneous layer is emaciated. Distended and tensed abdomen, tympanitis on percussion of the upper part of the abdomen, splashing sounds, feces are foamy, of light color, foul. On coprocytogram: a lot of neutral fat. What is the cause of the disease?

A. Intestinal dysbacteriosis

B. Mucoviscidosis (cystic fibrosis)

C. *Celiakia (celiac disease)

D. Disaccharidase insufficiency

E. Chronic enteritis

 

65. In the gynecologic office a 28 y.o. woman complains of sterility within three years. The menstrual function is not impaired. There were one artificial abortion and chronic salpingo-oophoritis in her case history. Oral contraceptives were not used. Her husband’s analysis of semen is without pathology. From what diagnostic method will you start the workup in this case of sterility?

A. Diagnostic scraping out of the uterine cavity

B. Ultra sound investigation

C. *Hysterosalpingography

D. Hormone investigation

E. Hysteroscopia

 

66. Define the basic registration document at the profound study of a case rate with temporary lost labor ability at the industrial enterprise:

A. A ambulatory medical card

B. “The Report on reasons of temporary lost labor ability”

C. The inpatient medical record

D. *A card of the personal account of a case rate

E. The sick-leave certificate

 

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

A. Tuberculous lymphadenitis

B. Chronic myeloleucosis

C. Lymphogranulomatosis

D. Acute leucosis

E. *Chronic lympholeucosis

 

68. Chief district pediatrician has to carry out analysis of infant mortality rate. What should he take as a unit of the observation?

A. Child death case at the age up to the first month

B. Child death case during first 7 days of life

С. *Child death case at the age up to 1 year

D. Child death case on labor

E. Child death case after 28 days of life

 

69. There is a dynamic growth of number of congenital abnormalities such as central paralysis, newborns blindness, idiocy among the population that lives near to pesticides production enterprise. Compounds of which pollutant can cause the development of this pathology?

A. *Mercury

B. Chrome

C. Iron

D. Cadmium

E. Strontium

 

70. A 64 y.o. patient has developed of squeering substernal pain which had appeared 2 hours ago and irradiated to the left shoulder, marked weakness. On examination: pale skin, cold sweat. Pulse — 108 bpm, AP — 70/50 mm Hg, heart sound are deaf, vesicular breathing, soft abdomen, painless, varicouse vein on the left shin, ECG: synus rhythm, heart rate is 100 bmp, ST-segment is sharply elevated in II, III aVF leads. What is the most likely disorder?

A. Cardiac asthma

B. Pulmonary artery thromboembolia

C. Cardiac tamponade

D. *Cardiogenic shock

E. Disquamative aortic aneurizm

 

71. The 67 y.o. patient had 5 recurrent fractures of the lower extremities without considerable cause within 5 years. O-shaped deformity of the legs in the knee joints has appeared. The skull, pelvis and lower extremities X-Ray shows the thickening of flat bones. In the long bones there is a hyperostosis along the bone axis. The blood test has not revealed any inflammation activity. Serum calcium is normal. What disease do you consider in this case?

A. *Paget’s disease

B. Myeloma

C. Hyperparathyoid dystrophy

D. Chronic osteomyelitis

E. Mottled disease (marble disease)

 

72. A 43 y.o. woman complains of shooting heart pain, dyspnea, and irregularities in the heart activity, progressive fatigue during 3 weeks. She had acute respiratory disease a month ago. On examination: AP-120/80 mm Hg, heart rate 98 bpm, heart boarders +1,5 cm left side, sounds are muffled, soft systolic murmur at apex and Botkin’s area; sporadic extrasystoles. Liver isn’t palpated, there is no edema. Blood test: WBC — 6,7*109/L, sedimentation rate-21 mm/hour. What is the most probable diagnosis?

A. *Acute myocarditis

B. Rheumatism, mitral insufficiency

C. Climacteric myocardiodystrophia

D. Ichemic heart disease, angina pectoris

E. Hypertrophic cardiomyopathy

 

73. A 18 y.o. female student complains of dyspnea during the intensive exertion. The condition became worse half a year ago. On examination: pulse rate is 88 bpm, accelerated, AP-180/20 mm Hg, and pale skin, heart borders are dilated to the left and up. There is systolic-diastolic murmur in the 2hd intercostal space, 52 at pulmonary artery is accentuated. ECG has revealed both ventricles hypertrophy. Thoracic X-ray has revealed pulsation and protrusion of the left ventricle, lung trunk. What doctor’s tactics should be?

A. Continuation of investigation

B. *Cardiosurgeon consultation

C. Dispensary observation

D. Administration of therapeutic treatment

E. Exemption from physical exercises

 

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

A. Deputy head physician on the working ability expertise

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

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

D. The head of department

E. Working ability expertise committee

 

75. The girl of 11 y.o. She is ill for 1 month. She has “butterflytype rash on face (spots and papules), pain and swelling of small joints on arms and legs, signs of stomatitis (small-sized ulcers in mouth). CBC: Hb — 80 g/L, RBC — 2,9*1012/L, WBC — 15*109/L, ESR — 40 mm/hour. Urinalysis: protein — 0,33 g/L. What is the most probable diagnosis?

A.  Juvenile rheumatoid arthritis, systemic type

B. *Systemic lupus erythematosus

C. Dermatomyositis

D. Acute rheumatic fever

E. Periarteriitis nodosa

 

76. In a 65 y.o. female patient a tumor 13 x 8 cm in size in the umbilical area and above is palpated, mild tenderness on palpation, unmovable, pulsates. On auscultation: systolic murmur. What is the most probable diagnosis?

A. Stomach tumor

B. Tricuspid valve insufficiency

C. Mitral insufficiency

D. Arterio-venous aneurism

E. *Abdominal aortic aneurism

 

77. A 40 y.o. patient was admitted to the gasteroenterology with skin itching, jaundice, discomfort in the right subcostal area, generalized weakness. On examination: skin is jaundice, traces of scratches, liver is +5 cm, splin is 6×8 cm. In blood: alkaline phosphatase — 2, 0 mmol/(hour*L), general bilirubin — 60 mkmol/L, cholesterol — 8,0 mmol/L. What is the leading syndrome in the patient?

A. Cytolytic

B. Asthenic

C. Mesenchymal inflammatory

D. Liver-cells insufficiency

E. *Cholestatic

 

78. During dynamic investigation of a patient the increase of central venous pressure is combined with the decrease of arterial pressure. What process is proved by such combination?

A. Shunting

B. Developing of cardiac insufficiency

C. Depositing of blood in venous channel

D. *Increase of bleeding speed

E. Presence of hypervolemia

 

79. A child is being discharged from the surgical department after conservative treatment of invagination. What recommendations should doctor give to mother to prevent this disease recurrence?

A. Gastro-intestinal disease prevention

B. *Strict following of feeding regimen

C. Feces observation

D. Common cold prophilaxis

E. Hardening of the child

 

80. A 52 y.o. woman complains of weakness, painful itching after washing and bathing, sensation of heaviness in the head. On examination: hyperemia of skin of face, neck, extremities. AP — 180/100 mm Hg. Speeln is 4 cm below the rib arch edge. What is the most probable diagnosis?

A. Essential hypertension

B. Allergic dermatitis

C. *Erythremia

D. Systemic sclerodermia

E. Dermatomyositis

 

81. A mother of a newborn child suffers from chronic pyelonephritis. She had acute respiratory viral disease before the labor. Labor in time, with prolonged period without waters. A child had erythematous eruption on the 2 day, and then there were seropurulent vesicles about l cm. Nikolsky’s symptom is positive. Erosions have occured after vesicle rupture. The child is flabby. The temperature is subfebrile. What is the most probable diagnosis?

A. Pseudofurunculosis

B. Vesiculopustulosis

C. *Newborn pemphigus

D. Ritter’s dermatitis

E. Sepsis

 

82. A 41 y.o. woman has suffered from nonspecific ulcerative colitis during 5 years. On rectoromanoscopy: marked inflammatory process of lower intestinal parts, pseudopolyposive changes of mucous. In blood: WBC- 9,8 * 109/L, RBC — 3,0*1012/L, sedimentation rate — 52 mm/hour. What medication provides pathogenetic treatment of this patient?

A. Kreon

B. *Sulfasalasine

C. Linex

D. Vikasolum

E. Motilium

 

83. A 2 m.о. child was delivered at term with weight 3.500 g and was on the mixed feeding. Current weight is 4900 g. Evaluate the current weight of child.

A. Hypotrophy of I grade

B. *Corresponding to the age

C. 150 g less than necessary

D. Paratrophy of I grade

E. Hypotrophy of II grade

 

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

A. Acute cholecystitis

B. Right-sided renal colic

C. Acute bowel obstruction

D. *Perforative ulcer

E. Acute appendicitis

 

85. During intramuscular DTP vaccination in clinic, a 3 y.о. child developed signs of laryngospasm, paleness of skin, cyanosis of lips, “cock cry”, stop of respiration, tension of the whole body with overturned backward head. Allergological history of the child is not complicated. What is the most probable diagnosis?

A. *Spasmophilia, tonic spasms

B. Meningoencephalitic reaction, clonic and tonic spasms

C. Meningism, clonic and tonic spasms

D. Cerebral haemorrhage, tonic spasms

E. Anaphylactic shock, clonic spasms

 

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

A. *IgE

B. IgM

C. lgA

D. IgJ

E. Circulating immunocomplexes

 

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

A. Medication sleep, amniotomy, labour stimulation

B. Fetal hypoxia treatment, conservative delivery

C. *Caesarean section

D. Amniotomy,  labour stimulation, fetal hypoxia treatment

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

 

88. On physiologic-sanitary examination of railway department work it was revealed that loaders work is of III degree of difficulty. They unload, vagons with sand, manually break coagulated mass by shovel and shift it. What criteria was used to evaluate work of loaders?

A. Time of active activities, % to the shift duration

B. Intellectual efforts

C. *Maximun load weigh which is shifted

D. Time of passive observation, % to the shift duration

E. Value of static loading for the shift

 

89. A newborn aged 3 days with hyperbilirubinemia (428 mkmol/L) developed following disorders. From beginning there were severe jaundice with poor suckling, hypotomia and hypodynamia. Little bit later periodical excitation, neonatal convulsions and neonatal primitive reflexes loss are noted. Now physical examination  reveals convergent squint, rotatory nystagmus and setting sun eye sign. How to explain this condition?

A. Brain tumour

B. Spastic cerebral palsy

C. Skull injury

D. Hydrocephalus

E. *Encephalopathy due to hyperbilirubi­nemia

 

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

A. Markedly disharmonious

B. Excessive

C. *Harmonious

D. Disharmonious

E. Below the average

 

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

A. Pseudotuberculosis

B. Measles

C. *Rubella

D. Scarlet fever

E. Adenoviral infection

 

92. A 31y.o. patient has had mental disorder for a long time. He suffers from insomnia for a long time. He has developed fears, suicidal thoughts, tried to hang himself. His mood is depressed, he refuses from treatment. What measures are the most expedient for the prevention of suicide?

A. *Out-patient treatment

B. *Admission to the mental hospital

C. Strict home supervision

D. Admission to’ the nu erological department

E. Psychotherapeutic conversation

 

93. A 19 y.o. patient was admitted to the hospital with acute destructive appendicitis. He sufferes from hemophilia B-type. What antihemophilic medicine should be inclended in pre-and post-operative treatment plan?

A. *Dried plasma

B. Fresh frosen blood

C. *Fresh frosen plasma

D. Native plasma

E. Cryoprecipitate

 

94. A 33 y.o. male patient was admitted to a hospital. A patient is pale, at an attempt to stand up he complains of strong dizziness. There was vomiting like coffee-grounds approximately hour ago. BP- 90/60 mm Hg., pulse-120 b/min. In anamnesis, a patient has suffered from ulcer of the stomach, painless form during 4 years. An ulcer was exposed at gastrofiberoscopy. Your diagnosis:

A. Ulcer of duodenum, complicated with bleeding

B. Acute myocardial infarction, abdominal form

C. Erosive gastritis

D. Acute pleurisy

E. *Ulcer of stomach, complicated with bleeding

 

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

A. Use of hemostatic medications

B. Urine drainage, cold at lower abdomen

C. *Manual exploration of the uterine cavity

D. Use of uterine contracting agents

E. External massage of uterus

 

96. Examination of placenta, which has just been born, reveals defect 2×3 cm in size. There is no bleeding. What tactics is the most reasonable?

A. Parturient supervision

B. Instrumental uterus cavity revision

C. *Manual uterus cavity revision

D. External uterus massage

E. Administration of uterotonic medicines

 

97. A district pediarician has carried out infant mortality rate analysis in his area. What data has been used?

A. Mortality of district newborn

B. *Mortality of children under 1 y.o. structured by age, sex, causes

C. Mortality of children under 1 y.o., natimortality

D. Mortality of district adolescents

E. Hospital mortality of children, structured by age

 

98. A sample of milk was taken for testing from a 5 ton milk batch. Lab analysis showed the following: fat content 2%, specific density — 1,04 д/стг, acidity 21°C, reductase probe — weak positive. What way the product is to be used in? What would you advise?

A. Utilize technically

B. *Sell but inform customers about milk

C. Write the product off for animal feeding

D. Annihilate the product

E. Sell without limitations

 

99. A 20 y.o. patient with bronchial asthma experiences dyspnea attacks 3-4 times a week. Nocturnal attacks are 1 time a week. FEV1 — 50% of necessary figures, during the day it’s variations is 25%. What is the severity of bronchial asthma condition?

A. Mild condition

B. *Moderate severity condition

C. Asthmatic status

D. Serious condition

E. Intermittent flow

 

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

A. Complication of liver echinococcosis

B. Pulmonary tuberculosis

C. *Abscess of the lung

D. Actinomycosis of lungs

E. Bronchiectatic disease

 

101. A 41 y.o. man complains of acute pain in the right side of the thorax and sudden increase of dyspnea following the lifting of heavy object. The patient’s condition is serious: lips and mucous are cyanotic, breathing rate is 28 per min, pulse — 122 bpm., AP — 80/40 mm Hg. There is tympanitis on percussion and weakened breathing on auscultaion on the right. S is accentuated over pulmonary artery. What is the urgent measure on the prehospital stage?

A. *Air aspiration from the pleural cavity

B. Oxygen inhalation

C. Call for cardiologic team

D. Epinephrine introduction

E. Euphilline introduction

 

102. A 40 y.o. patient of rheumatic heart disease complains of anorexia, weakness and loss of weight, breathless and swelling of feet. On examination: t° — 39° С, pulse is 100/min. As ucultation: diastolic murmur in the mitral area. Petechical lesion a round clavicle; spleen was palpable, tooth extraction one month ago.

A. Recurrence of rheumatic fever

B. Mitral stenosis

C. Thrombocytopenia purpure

D. *Subacute bacteria endocarditis

E. Aortic stenosis

 

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

A. *Right-sided direct inguinal hernia

B. Right-sided oblique inguinal hernia

C. Varicose veins of the right hip

D. Lipoma of the right inguinal area

E. Right-sided femoral hernia

 

104. A 52 y.o. male patient has become ill gradually. There is pain in the left side of the thorax during 2 weeks, elevation of temperature till 38 — 39°C. On examination: left chest side falls behind in breathing movement no voice tremor over the left lung. Dullness that is more intensive in lower parts of this lung. Right heart border is deviated outside. Sharply weakened breathing over the left lung, no rales. Heart sounds are mufflet, tachycardia. What is the most probable diagnosis?

A. *Exudative pleuritis

B. Infarction-pneumonia

C. Cirrhotic tuberculosis

D. Spotaneous pneumothorax

E. Atelectasis of lung

 

105. A 19 y.o. man was admitted to the reception department in 20 minutes after being wounded with the knife to the left chest. The patient is confused. The heart rate is 96 bpm and BP- 80/60 mm Hg. There are the dilated neck veins, sharply diminished apical beat and evident heart enlargement. What kind of penetrative chest wound complications has developed in patient?

A. Valve-likes pneumothorax

B. Open pneumothorax

C. Closed pneumothorax

D. *Pericardium tamponade

E. Massive hemothorax

 

106. A 54 y.o. male patient suffers from dyspnea during mild physical exertion, cough with sputum which is excreted with difficulty. On examination: diffuse cyanosis. Is Barrel-chest. Weakened vesicular breathing with prolonged expiration and dry whistling rales. AP is 140/80 mm Hg, pulse is 92 bpm, rhythmic. Spirography: vital capacity (VC) predicted vital capacity — 65%, FEV1/FVC — 50%. Determine the type of respiratory insufficiency (RI).

A. There is no RI

B. RI of obstructive type

C. RI of mixed type with prevailing restriction

D. *RI of mixed type with prevailing obstruction

E. RI of restrictive type

 

107. The 28 y.o. woman applied to doctor because of limited loss of the hair. In the anamnesis — she had frequent headache indisposition, arthromyalgia, fever, irregular casual sexual life, drug user. RW is negative. What examination must be done first?

A. Examination for fungi

B. Examination for trichomoniasis

C. Examination for gonorrhea

D. Examination for neuropathology

E. *Examination for HIV

 

108. The girl is 12 y.o. Yesterday she was overcooled. Now she complains on pain in suprapubic area, frequent painful urination by small portions, temperature is 37,8°C. Pasternatsky symptom is negative. Urinalysis: protein- 0,033 g/L, WBC — 20-25 in f/vis, RBC —1-2 in f/vis. What diagnosis is most probable?

A. *Acute cystitis

B. Dysmetabolic nephropathy

C. Acute pyelonephritis

D. Urolithiasis

E. Acute glomerulonephritis

 

109. 18 y.o. woman complains of pain in the lower abdomen. Some minutes before she has suddenly appeared unconscious at home. The patient had no menses within last 3 months. On examination: pale skin, the pulse —110 bpm, BP — 80/60 mm Hg. The Schyotkin’s sign is positive. Hb — 76 g/L. The vaginal examination: the uterus is a little bit enlarged, its displacement is painful. There is also any lateral swelling of indistinct size. The posterior fornix of the vagina is tendern and overhangs inside. What is the most probable diagnosis?

A. Twist of cystoma of right uterine adiiexa

B. *Impaired extrauterine pregnancy

C. Acute appendicitis

D. Ovarian apoplexy

E. Acute salpingoophoritis

 

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

A. Spondyloarthropatia on the background of Reiter’s disease

B. Tuberculous spondylitis

C. Psoriatic spondyloarthropatia

D. *Ancylosing spondyloarthritis

E. Spread osteochondrosis of the vertebral column

 

111. The woman who has delivered twins has early postnatal hypotonic uterine bleeding reached 1,5% of her body weight. The bleeding is going on. Conservative methods to arrest the bleeding have been found ineffective. The conditions of patient are pale skin, acrocyanosis, oliguria. The woman is confused. The pulse is 130 bpm, BP- 75/50 mm Hg. What is the further treatment?

A. Inner glomal artery ligation

B. Uterine vessels ligation

C. *Uterine extirpation

D. Supravaginal uterine amputation

E. Putting clamps on the uterine cervix

 

112. Patient with thyrotoxicosis is in the 2-beds hospital ward of therapeutic department. The area of the ward is 18 m2, height 3 m, ventilation rate 2,5/hr. Air temperature — 20°C, relative humidity 45%, air movement velocity 0,3 m/s, light coefficient 1/5, noise level 30 dB. Make hygienic evaluation of the conditions.

A. *Discomfortable microclimate

B. Non-effective ventilation

С. Poor lighting

D. All conditions are OK

E. High level of noise

 

113. A patient aged 18 with a cranial injury was in comatose state during several hours. In post-comatose period gets tired quickly, non-productive in dialog – in the beginning answers 2-3 questions, then gets tired and can not understand the point of the question. Which psychotropic should be given to the patient to prevent psychoorganic syndrome?

A. Stimulators

B. Neuroleptics

C. Tranquillisers

D. Antidepressants

E. *Nootropics

 

114. Choose a method of a graphic representation of monthly information about number of the registered cases of acute intestinal infection and their comparisons to the average monthly values, obtained for 5 previous years:

A. The radial diagram

B. The figured diagram

С. *The linear diagram

D. The sector diagram

E. The curvilinear disgram

 

115. A 74 y.o. female patient complains of pain, distended abdomen, nausea. She suffers from heart ischemia, postinfarction and diffusive cardiosclerosis. On examination: grave condition, distended abdomen, abdominal wall fails to take active part in breathing. On laparoscopy: some cloudy effusion, one of the bowel loops is dark-blue. What is the most probable diagnosis?

A. Ichemic abdominal syndrome

B. Volvulus

C. Erysipelas

D. Acute intestinal obstruction

E. *Mesenterial vessels thrombosis

 

116. A patient complains of a tormental (agonizing) cough with expectoration of up to 600 ml/daily purulent chocolatecolor sputum with a decay smell. Onset of illness was abrupt, t°— 39°C, fever of irregular type. There is the area of darkening with a cavity in a center on X-ray film, with irregular contours and level of liquid. What disease is the question?

A. Lobar pneumonia

B. Bronchiectatic illness

C. Pneumonia complicated by an abscess

D. *Gangrene of lung

E. Tuberculosis

 

117. A 27 y.o. woman suffers from pyelonephritits of the only kidney. She presents to the maternity welfare centre because of suppresion of menses for 2,5 months. On examination pregnancy 11 weeks of gestation was revealed. In urine: albumine 3,3 g/L, leucocytes cover the field of vision. What is doctor’s tactics in this case?

A. Maintenance of pregnancy till delivery term

B. Pregnancy interruption at 24-25 weeks

C. Pregnancy interruption after urine normalization

D. Maintenance of pregnancy till 36 weeks

E. *Immediate pregancy interruption

 

118. A 18 y.o. woman complains of weakness, dizziness, loss of appetite, menorrhagia. There are petechiae on the skin of the upper extremities. Blood test: Hb — 105 g/L; RBC- 3,2*1012/L; coloured index- 0,95; thromb.- 20*109/L. The sedimentation time according to Lee White is 5′; hemorrhagia duration according to Duke is 8′, “pinch and tourniquet “test is positive. What is the most probable diagnosis?

A. Hemophilia

B. Iron deficiency anemia

C. Marchiafava-Micheli’s disease

D. *Idiopathic thrombocytopenic purpura

E. Hemorrhagic diathesis

 

119. On medical observation a doctor identified girl (162 cm tall and 59 kg weight) who complained loss of ability to see surrounding objects clearly in the evening. On examination: dry skin, hyperkeratosis. Her daily ration includes the following vitamines: vitamine A — 0,5 mg, vit.B6 — 2,0 mg, vit.B2 — 2,5 mg, vit.B6 — 2 mg, vit.C — 70 mg. What is the hypovitaminosis type?

A. B2-hypovitaminosis

B. В6-hypovitaminosis

C. *A-hypovitaminosis

D. C-hypovitaminosis

E. В1 -hypovitaminosis

 

120. A 36 y.o. patient was admitted to the hospital with sharp pain in substernal area following occasional swallowing of a fish bone. On esophagoscopy the foreign body wasn’t revealed. The pain increased and localized between scapulas. In a day

temperature elevated, condition became worse, dysphagia intensified. What complication has developed?

A. Esophageal hemorrhage

B. *Perforation of esophagus with mediastinitis

C. Obstruction of esophagus

D. Aspirative pneumonia

E. Pulmonary atelectasis

 

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

A. *Aortic stenosis

B. Defect of interventricular septum

C. Defect of interatrial septum

D. Open aortic duct

E. Coarctation of the aorta

 

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

A. Preliminary stage

B. Placental stage у

C. Expulsion of fetus stage V

D. *Cervix dilation stage

E. Prodromal stage

 

123. Full term newborn has developed jaundice at 10 hours of age. Hemolytic disease of newborn due to Rh-incompatibility was diagnosed. 2 hours later the infant has indirect serum bilirubin level increasing up to 14 mmol/L. What is most appropriate for treatment of hyperbilirubinemia in this infant?

A. *Exchange blood transfusion

B. Phenobarbital

С Intestinal sorbents

D. Infusion therapy

E. Phototherapy

 

124. A 18 y.o. male patient complains of pain in knee and ankle joints, temperature elevation to 39, 5°C. He had a respiratory disease 1,5 week ago. On examination: temperature — 38,5°C, swollen knee and ankle joints, pulse — 106 bpm, rhythmic, AP — 90/60 mm Hg, heart borders without changes, sounds are weakened, soft systolic apical murmur. What indicator is connected with possible etiology of the process?

A. Seromucoid

B. *Antistreptolysine-0

C. Creatinkinase

D. 1-antitrypsine

E. Rheumatic factor

 

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

A. Early diagnostics

B. *Immunization of the population

C. Detection of carriers

D. Hospitalization of patients

E. Disinfection in disease focus

 

126. A 38 y.o. woman complains of a purulent discharge from the left nostril. The body temperature is 37,5°C. The patient is ill during a week and associates her illness with common cold. Pain on palpation of her left cheek reveals tenderness. The mucous membrane in the left nasal cavity is red and turgescent. The purulent exudates is seen in the middle meatus in maxillary. What is the most probable diagnosis?

A. *Acute purulent maxillary sinusitis

B. –

C. Acute purulent ethmoiditis

D. Acute purulent frontitis

E. Acute purulent sphenoiditis

 

127. On observation of sanitary conditions of studying at the technical university it was necessary to evaluate the visual regimen of students, who study from 9 a.m to 3 p.m. What index of natural light will be the most informative?

A. Light coefficient

B. Depth of study room

C. Time of the room insolation

D. Presence of mixed (upper-lateral) light

E. *Natural light coefficient

 

128. A woman, primagravida, consults a gynecologist on 05.03.2002. A week ago she felt the fetus movements for the first time. Last menstruation was on 10.01.2002.

When should she be given maternity leave?

A. *8 August

B. 5 September

C. 22 August

D. 25 July

E. 11 July

 

129. A patient with unstable angina pectoris was given the following complex treatment: anticoagulants, nitrates, a-adrenoblockers. However on the third day of treatment the pain still romains. Which in vestigation shoud is carried out to establish diagnosis?

A. Stress-echocardiogram

B. *Coronarography

С. Esophageal electrocardiac stimulator

D. Test with dosed physical exercises

E. Myocardial scintigraphy

 

130. A 24 y.o. male patient was transferred to the chest surgery department from general surgical department with acute post-traumatic empyema of pleura. On the X-ray: wide level horizontal of fluid on the right. What method of treatment should be prescribed?

A. *Punction and drainage of pleural cavity

B. Decortication of pleura

С. Lobectomy

D. Pneumoectomy

E. Thoracoplasty

 

131. A 55 y.o. patient complains of di­stended abdomen and rumbling, increased winds evacuation, liquid foamy feces with sour smell following the diary products consumption. What is the correct name of this syndrome?

A. *Syndrome of fermentative dyspepsia

B. Dyskinesia syndrome

С Syndrome of fatty dyspepsia

D. Malabsorption syndrome

E. Syndrome of decayed dyspepsia

 

132. A 30 y.o. woman has second labor which lasts for 14 hours. The fetus heartbeat is mufflet, arrhythmic, 100 bpm. On vaginal examination: complete cervix dilatation, fetus head is in the area of small pelvis outlet. Sagital suture is in the direct size. The small fontanelle is at the symphis. What is the further tactics of the labor?

A. Stimulation of the labor activity with oxitocyne

B. Ceasarian section

C. Application of obstetrical cavity forceps

D. *Application of obstetrical forceps

E. Application of craniodermal forceps by Ivanov’s

 

133. A child from the first non-complicated pregnancy but complicated labor had cephalhematoma. On the second day there developed jaundice. On the 3rd day appeared changes  of neurologic status: nystagmus, Graefe’s sign. Urea is yellow, feces- golden-yellow. Mother’s blood group is A(II)Rh-, child — A{II)Rh+. On the third day child’s Hb is 200 g/L, RBC — 6,1*1012/L, bilirubin in blood — 58 mk mol/L due to unconjugated bilirubin, Ht — 0,57. What is the child’s jaundice explanation?

A. Hemolytic disease of newborn

B. Bile ducts atresia

C. Physiologic jaundice

D. *Brain delivery trauma

E. Fetal hepatitis

 

134. A 14 y.o. patient suddenly fell ill when high fever, acute pain in the right shin. In two weeks X-ray showed translucent spaces (destructive focuses) with unevel countours in the middle third of tibia diaphysis. Along the bone edge there was a narrow line of shadow (periostitis) 1-2 mm from the surface. What is the most likely diagnosis?

A. Right shin syphilis

B. Right shin tuberculosis

C. Bone cyst of tibia

D. Right shin trauma

E. *Right shin osteomielitis

 

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

A. Articular (joint) panaritium

B. Subcutaneous panaritium

C. Bone panaritium

D. Paronychia

E. *Thecal whitlow (ligament panaritium)

 

136. A 27 y.o. man complains of pain in epigastrium which is relieved by food intake. EGDFS shows antral erosive gastritis, biopsy of antral mucous presents Helicobacter Pylori. What can be diagnosed in this case?

A. Reflux -‘gastritis

B. Gastritis of A type

C. Rigid antral gastritis

D. *Gastritis of type В

E. Menetrier’s disease

 

137. A patient had macrofocal myocardial infarction. He is overweight for 36%, AP is 150/90 mm Hg, blood sugar — 5,9 mmol/L, general cholesterol — 4,9 mmol/L, uric acid — 0,211 mmol/L. Which risk factor should be urgently eradicated during the secondary prevention?

A. *Obesity

B. Hyperglycemia

C. Arterial hypertension

D. Hypercholesterolemia

E. Hyperuricemia

 

138. A 28 y.o. male patient was admitted to the hospital because of high temperature 39°C, headache, generalized fatigue, constipation, sleep disorder for 9 days. There are sporadic roseolas on the abdomen, pulse — 78 bpm, liver is enlarged for 2 cm. What is the most probable diagnosis?

A. Typhus

B. Sepsis

C. Leptospirosis

D. *Abdominal typhoid

E. Brucellosis

 

139. A 51 y.o. woman complains of dull pain in the right subcostal area and epigastric area, nausea, appetite decline during 6 months. There is a history of gastric peptic ulcer. On examination: weight loss, pulse is 70 bpm, AP is 120/70 mm Hg. Diffuse tenderness and resistance of muscles on palpation. There is a hard lymphatic node l x l cm in size over the left clavicle. What method of investigation will be the most useful?

A. *Esophagogastroduodenoscopy with biopsy

B. Ultrasound examination of abdomen

С. pH-metry

D. Ureatic test

E. Stomach X-ray

 

140. The patient has developed pain in the axillary area, rise of temperature developed 10 hours ago. On examination: shaky gait is marked; the tongue is coated by white coating. The pulse is frequent. The painful lymphatic nodules are determined in the axillary area. The skin is erythematous and glistering over the lymphatic nodules. What is the most probable diagnosis?

A. *Bubonic plague

B. Acute purulent lymphadenitis

C. Anthrax

D. Tularemia

E. Lymphogranulomatosis

 

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

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

B. A baby dead at birth

C. A baby dead at the age over 28 days

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

E. A baby dead at the age up to 1 months

 

142. A 9 y.o. girl has an average height and harmonic growth development. She was ill with acute respiratory infection for five ti­mes. Define the group of her health.

A. 3rd group

B. 1st group

C. 4th group

D. 5th group

E. *2nd group

 

143. Ambulance was called to a 48 y.o. man. From the words of relatives he has had three episodes of lost consciousness and attacks during the day. On examination: the following fit is observed: patient is unconscious, fell on the floor, tonic and then clonic convuesions of trunk and extremities happened. The attack lasted for 4 minute, ended by involuntary urination. What type of attack was observed?

A. Vegetatic crisis

B. Fainting

C. Episode of hysteria

D. *Major epileptic seizure

E. Absence

 

144. A 38 y.o. woman was hospitalized to the surgical unit with vomiting and acute abdominal pain irradiating to the spine. On laparocentesis hemmorhagic fluid is obtained. What disease should be suspected?

A. *Acute pancreatitis

B. Acute appendicitis

C. Acute enterocolitis

D. Renal colic

E. Perforated gastric ulcer

 

145. A 52 y.o. male patient suffers from squeezing pain attacks in substernal area which irradiates to the left hand and occurs occasionally and on physical exertion. He has had it for 1 year. On examination: heart boarders are dilated to the left side, sounds are muffled, pulse — 76 bmp, rhythmic, AP-155/80 mm Hg, ECG: the left type, the rest of signs is normal. What additional examination is necessary to confirm the diagnosis?

A. Transaminases of blood

B. General blood count

C. *Bicycle ergometry

D. Blood lipoproteins

E. Echocardiography

 

146. A child was delivered severely premature. After the birth the child has RI symptoms, anasarca, fine bubbling moist rales over the lower lobe of the right lung. Multiple skin extravasations, bloody foam from the mouth have occured after the 2 day. On chest X-ray: atelectasis of the lower lobe of the right lung. In blood: Hb — 100 g/L, Ht — 0,45. What is the most probable diagnosis?

A. Congenital pneumonia

B. *Edematous-hemorrhagic syndrome

С. Hyaline membrane disease

D. Pulmonary edema

E. Disseminated intravascular clotting syndrome

 

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

A. II degree

B. IV degree

C. Ill degree

D. *I degree

E. V degree

 

148. A 6 y.o child complains of thirst, polyuria, and increased appetite for 2 months with weight loss for 3 kg. There has been nocturnal enuresis during last week. On examination: hyperglycemia 14 mol/L. The diagnosis is diabetis mellitus I type. What is the genesis of this disease?

A. Viral

B. Virus-bacterial

C. Neurogenic

D. *Autoimmune

E. Bacterial

 

149. On the 5-th day of the respiratory disease a 24 y.o. man has developed progressive headaches systemic dizziness, feeling of seeing double, paresis of mimic muscles on the right, choking while swallowing. Acute viral encephalitis has been diagnosed. What is the main direction of urgent therapy?

A. Ceftriaxon

B. Lasix

C. *Zovirax

D. Hemodesis

E. Glucocorticoids

 

150. A 38 y.o. patient complains of pain in lumbar part of spinal column with irradiation to the back surface of the left leg following the lifting of a heavy object. Pain is increasing on change of the body position and in vertical position, positive stretching symptoms were revealed on examination. What is an initial diagnosis?

A. *Intervertebral ligaments disorder

B. Myelopathy

C. Polyneuritis

D. Spinal cord tumor

E. Arachnomielitis

 

151. A 24 y.o. emotionally-labile woman presents with irritation, depressed mood, palpitation, shooting pain in the heart area, generalized fatigue following the divorce. On examination: palm hyperhydrosis, pulse rate — 72-78 bpm, labile, heart without changes. ECG is normal. What is the most probable pathology in this case?

A. Compulsive neurosis

B. Depressive neurosis

C. Schizophrenia

D. Ipochondric neurosis

E. *Neurasthenia

 

152. The child is 11y.о. He suffers from nervous-arthritic diathesis. The increased synthesis of what acid is pathogenic at nervous-arthritic diathesis?

A. Phosphoric acid

B. Sulfuric acid

C. Acetic acid

D. Hydrochloric acid

E. *Uric acid

 

153. A male patient presents with swollen ankles, face, eyelids, elevated AP — 160/100 mm Hg, pulse – 54 bpm, daily loss of albumine with urine — 4g. What therapy is pathogenetic in this case?

A. Antibiotics

B. NSAID

C. Calcium antagonists

D. Diuretics

E. *Corticosteroids

 

154. A 67 y.o. patient complains of palpitation, dizziness, noise in ears, feeling of shortage of air. Objectively: pale, damp skin. Vesicular respiration, respiratory rate — 22 per min, pulse — 200 bpm, AP—100/70 mm Hg. On ECG: heart rate — 200 bmp, ventricular complexes are widened, deformed, location of segments ST and of wave T is discordant. The wave P is not changed, superimposes QRST, natural conformity between P and QRS is not present. What kind of arrhythmia is present?

A. *Paroxismal ventricular tachycardia

B. Atrial flutter

C. Atrial tachycardia

D. Sinus tachycardia

E. Ventricular extrasystole

 

155. A 30 y.o. female with rheumatoid arthritis of five years duration complains of pain in the first three fingers of her right hand over past 6 weeks. The pain seems especially severe at night often awakening her from sleep. The most likely cause is?

A. Atlanto-axial sublaxation of cervical spine

B. Sensory peripheral neuropathy

C. Rheumatoid vasculitis

D. Rheumatoid arthritis without complication

E. *Carpal tunnel syndrome

 

156. A local doctor has to prepare a report about the health condition of the population of his region. What medical indexes of population health condition should he use?

A. Average longevity

B. *Morbidity, disabilities, demographic, physical development

С Way of life, genetic, pollution

D. Social welfare, satisfaction of life quality

E. Average treatment duration, complications

 

157. A 32 y.o. patient complains of severe weakness, tremor of extremities. On physical examination, there is loss of body weight, wet and warm skin. The thyroid gland is enlarged up to the 3rd degree, painless, elastic. Ps — 108 bpm. BP — 160/55 mm Hg. The rest is in norm. What can be diagnosed?

A. Chronic fibrous thyroiditis

B. Chronic autoimmune thyroiditis, hypertrophic type

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

D. Diffuse euthyroid goitre of the 3rd degree

E. Toxiferous adenoma of the thyroid gland

 

158. An infant aged 1 year on the third day of common cold at night developed inspiratory stridor, hoarse voice and barking cough. Physical examination revealed suprasternal and intercostals chest retractions. There is a bluish skin discoloration . Moistly seen over the upper lip. The respiratory rate is 52 per min and pulse — 122 bpm. The body temperature is 37,5°C. What disease does the infant have?

A. Acute bronchiolitis with respiratory distress

B. Bronchopneumonia without complications

C. Acute epiglottitis

D. *Acute  infectious croup due to viral laryngotracheitis

E. Acute laryngitis

 

159. At year-end hospital administration has obtained the following data: annual number of treated patients and average annual number of patient-used beds. What index of hospital work can be calculated based upon this data?

A. Average annual bed occupacy

B. Average bed idle time

C. Average duration of patients presence in the hospital

D. *Bed turnover

E. Bed resources of the hospital

 

160. A 55 y.o. male patient complains of weakness during 2 months, pain in the right side of the thorax, cough, blood-streaked sputum. On X-ray: intensive triangle shadow in the area of lower lobe that is connected to mediastinum. What is the most likely disorder in the lungs?

A. Tuberculosis of lungs

B. *Central cancer of lungs

C. Pleuropneumonia

D. Pulmonary infarction

E. Bronchiectasia

 

161. A 33 y.o. patient was admitted to the reception room of the Central District Hospital. He complains of a severely painful swelling localized on posterior neck, fever up to 38,4°C and general weakness. In anamnesis: diabetes mellitus within 5 years. On physical examination on the posterior neck surface there is an infiltrate elevated above surrounding skin. The tissues affected by swelling are tense and blue reddish discoloration in central area. There are also several purulent necrotic pustules which are connected with each other and form a large skin necrosis. A thinned necrotic skin of this swelling has holes looking like sieve, pus discharges through

out. What disease should a doctor consider first of all?

A. Carbuncle associated with anthrax

B. *Carbuncle

С. Skin abscess

D. Acute skin cellulitis

E. Furuncle

 

162. A 20 y.o. patient suddenly felt ill 12 hours ago. There was pain in epigactric area, nausea, sporadic vomiting. He had taken alcohol before. In few hours the pain localized in the right iliac area. On examination: positive rebound tenderness symptoms. WBC — 12,2*109/L. What is the most probable diagnosis?

A. Rightside kidney colic

B. Acute cholecystitis

C. *Acute appendicitis

D. Perforated ulcer

E. Acute pancreatitis

 

163. 3 weeks ago the patient was ill with tonsillitis. Clinical examination reveals edema, arterial hypertension, hematuria, proteinuria (1,8 g/per day), granular and erythrocital casts. What is the preliminary diagnosis?

A. Pyelonephritis

B. Cystitis

С. Intestinal nephritis

D. Renal amyloidosis

E. *Glomerulonephritis

 

164. The physician must undertake measures for primary prophylaxis of iron deficiency anemia. Which of the following categories of patient are subject to such primary prophylactic measures?

A. *Pregnant women

B. Patients after 60

C. Workers of industrial enterprises

D. Patients after operation

E. All children

 

165. The complications of acute cholecystitis which require surgical intervention are as follows EXCEPT:

A. Emphysematous gall-bladder

B. Cholangitis conditioned by the presence of stones in the bile tract

C. *Jaundice

D. Empyema of the gall-bladder

E. Gall-bladder perforation

 

166. A 70 y.o. male patient with mild headaches complains of speech disorder, weakness in right limbs. There was a history of miocardial infarction and arrhythmia. On neurological examination there are elements of motor aphasia, central paresis of VII and XII cranial nerves pairs on the right side, central type of hemiparesis and hemihyperesthisia on the same side. What is the most probable diagnosis?

A. Cerebral tumor

B. Hemorrhagic stroke

C. Transitory ischemic attack

D. Epidural hematoma

E. *Ischemic stroke

 

167.  A 52 y.o. patient fell from 3 m hight on the ground with the right lumbar area. He complains of pain here. There is mi­crohematuria in the urea. On urography kidney’s functioning is satisfactory. What is the most probable diagnosis?

A. *Kidney’s contusion

B. Subcapsular kidney’s rupture

C. Paranephral hematoma

D. Kidney’s abruption

E. Multile kidney’s ruptures

 

168. A 25 y.o. woman complains of profuse foamy vaginal discharges, foul, burning and itching in genitalia region. She has been ill for a week. Extramarital sexual life. On examination: hyperemia of vagi­nal mucous, bleeding on touching, foamy leucorrhea in the urethral area. What is the most probable diagnosis?

A. Chlamydiosis

B. Gonorrhea

С. Bacterial vaginosis

D. *Trichomonas colpitic

E. Vagina candidomicosis

 

169.  A 28 y.o. primagravida, pregnancy is 15-16 weeks of gestation, presents to the maternity clinics with dull pain in the lower part of the abdomen and in lumbar area. On vaginal examination: uterus cervix is 2,5 cm, external isthmus allows to pass the fi­nger tip. Uterus body is enlarged according to the pregnancy term. Genital discharges are mucous, mild. What is the diagnosis?

A. Spontaneous abortion which has begun

B. Stopped pregnancy

С. Hydatid molar pregnancy

D. *Threatened spontaneous abortion

E. Placenta presentation

 

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

A. Urinary incontinence

B. Pollakiuria

С. *Paradoxal ischuria

D. Dysuria

E. Enuresis

 

171. A 52 y.o. hard smoker patient complai­ns   of   persistent   cough   with   purulent sputum discharge especially in mornings, dyspnea provoked even by slight physi­cal exertion, wheezing chest, tahypnoe, general weakness. He considers himself to be ill during 12 years. The overwri­tten conditions appear 3-4 times per year usually   after   common   cold   and   have tendency to progress. What disease do you think about first of all?

A. Aspergillosis

B. Mucoviscidosis (cystic fibrosis)

C. Bronchoectatic disease

D. *Chronic obstructive lung disease

E. Bronchial asthma

 

172. A 52 y.o. man has recurrent transi­ent ischemic attacks. Auscultation of the carotid arteries detects murmur. What di­agnostic method is necessary to apply first?

A. MRI of the brain

B. *Ultrasound dopplerography

С. Electroencephalography

D. Cerebral angiography

E. CT of the brain

 

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

A. Bronchoalveolar lavage

B. *Thorax roentgenography

C. Spirography

D. Blood gases examination

E. Bronchoscopy

 

174.  A 60 y.o. man complains of significant pain in the right eye, photophobia, lacrimation, reduced vision of this eye, headache of the right part of the head. Pain occurred 2 days ago. On examination: Vis OD — 0,03, congested injection of the eye ball, significant cornea edema, front chamber is deep, pupil is narrow, atrophic iris, there is optic nerve excavation on the eye fundus, intraocular pressure — 38 mm Hg. Vis OS — 0,8 unadjustable. The eye is calm, healthy. Intraoccular pressure — 22 mm Hg. What is the most probable diagnosis?

A. Right eye’s keratitis

B. Right eye’s uveitis

C. *Acute glaucoma attack

D. Eye nerve’s neuritis

E. Maculodystrophy

 

175. 47 y.o. patient complains of intensive skin itching, jaundice, bone pain. The skin is hyperpigmentated. There is multiple xanthelasma palpebrae. The liver is +6 cm enlarged, hard with acute edge. The blood analysis revealed total bilirubin 160 mkmol/L, direct — 110 mkmol/L, AST (asparate aminotransferase) — 2,1 mmol/L per hour, ALT-1,8 mmol/L, alkaline phosphotase — 4,6 mmol/L per hour, cholesterol- 9,2 mmol/L, antimitochondri-al antibodies M2 in a high titer. What is the probable diagnosis?

A. *Primary biliary liver cirrhosis

B. Primary liver cancer

C. Acute viral hepatitis В

D. Chronic viral hepatitis В

E. Alcoholic liver cirrhosis

 

176. A 35 y.o. male patient suffers from chronic glomerulohephritis and has been on hemodialysis for the last 3 years. He has developed irregularities in the heart activity, hypotension, progressive weakness, dyspnea. On ECG: bradycardia, 1st degree atrioventicular block, high sharpened T-waves. Before he had severely disturbed the drinking and diet regimen. What is the most likely cause of these changes?

A. *Hyperkaliemia

B. Hyperhydratation

C. Hypokaliemia

D. Hypocalcemia

E. Hypernatremia

 

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

A. Diphtheria

B. *Peritonsillar abscess

C. Vincent’s disease

D. Pharyngeal tumor

E. Phlegmonous tonsillitis

 

178. The 56 y.o. patient has worked at the aluminium plant more than 20 years. Within 3 last years he has developed loosening of teeth, bone and joint pains, piercing pains in heart area, vomiting. The preliminary diagnosis is:

A. *Fluorine intoxication

B. Mercury intoxication

C. Manganese intoxication

D. Phosphorus intoxication

E. Lead intoxication

 

179. A 3 y.o. child with weight deficiency suffers from permanent moist cough. There was a history of some pneumonias with obstruction. On examination: distended chest, dullness on percussion over the lower parts of lungs. On auscultation: a great number of different moist rales. Level of sweat chloride is 80 mol/L. What is the most probable diagnosis?

A. Bronchial asthma

B. Recurrent bronchitis

C. Bronchiectasis

D. Pulmonary hypoplasia

E. *Mucoviscidosis (cystic fibrosis)

 

180. A 75 y.o patient can not tell the month, date and season of the year. After long deliberations she manages to tellher name. She is in irritable and dissatisfied mood. She always carries a bundle with belongings with her, hides a parcel with bread, shoes in her underwear in her bosom as well as “invaluable books”. What is the most probable diagnosis?

A. Atherosclerotic (lacunar) dementia

B. *Senile dementia

С Presenile melancholia

D. Dissociated personality (psychopathy)

E. Behavior disorder

 

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

A. Splenic rupture

B. Bladder rupture

C. Small intestines rupture

D. *Stomach rupture

E. Liver rupture

 

182. A 42 y.o. man died in a road accident after the hemorrhage on the site, due to acute hemorrhagic anaemia. What minimum percentage volume of the total blood loss would result in death at acute haemorrhage?

A. 15-20%

B. 6-9%

С. 35-50%

D. *25-30%

E. 10-14%

 

183. A 2,9-kg term male infant is born to a mother who developed polyhydramnios at 34 weeks’ gestation. At birth, the Apgar scores were 9 and 9. The infant develops choking and cyanosis with the first feed. In addition, is unable to place a nasogastric tube. What is the most likely diagnosis?

A. Choanal atresia

B. Tracheal atresia

C. Laryngomalacia

D. *Esophageal atresia

E. Respiratory distress syndrome

 

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

A. The right to be heard

B. The right to the protection from incompetence

C. The right to the information

D. The right to the free choice

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

 

185. A 30 y.o. primipara has intensive labor pushings with an interval of 1-2 min and of 50 sec duration. There is a appearing of the fetus head. Perineum is of 4 cm height, has turned pale. What should be done in this case?

A. Observation

B. Perineum protection

C. Vacuum extraction of the fetus

D. Perineotomy

E. *Episiotomy

 

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

A. Prescribe guanyl guanidines

B. *Prescribe fast-acting insulin

C. Continue with the current therapy

D. Prescribe long-acting insulin

E. Give Glurenorm in place of Maninilum

 

187. A 45 y.o. woman complains of contact bleedings during 5 months. On speculum examination: hyperemia of uterus cervix looks like cauliflower bleeds on probi­ng. On bimanual examination: cervix is of densed consistensy, uterus body isn’t enlarged, mobile, nonpalpable adnexa, parametrium is free, deep fornixes. What is the most likely diagnosis?

A. Cervical pregnancy

B. Fibromatous node which is being born

C. Cancer of body of uterus

D. *Cancer of cervix of uterus

E. Polypose of cervix of uterus

 

188. 33 y.o. woman works as the secretary. Her diet contains 150 g of protein (including 100 g of animal protein), 200 g of fat, and 600 g of carbohydrates. What pathology can develop from this diet?

A. Common cold

B. Uterine fibromyoma

C. Schizophrenia

D. *Obesity

E. Paradontosis

 

189.  There were registered 500 cases of urolithiasis per 10000 inhabitants. What kind of statictical indices is presented?

A. *Prevalence rate

B. Index of compliance

C. Correlation coefficient

D. Incidence rate

E. Index of visualization

 

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

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

B. Issued a medical certificate of a free form

C. *Issued regardless of company’s ownership

D. Issued only to empties of state-owned companies

E. Issued a medical certificate of a set form

 

191. A 35 y.o. woman is suspected of aplastic anemia. The bone marrow punction has been administered with the diagnostic purpose. What changes in the marrow punctatum are suggested?

A. Replacement of marrow elements with fibrous tissue

B. Presence of blast cells

C. Prevalence of megaloblasts

D. *Replacement of marrow elements with adipose tissue

E. Absolute lymphocytosis

 

192. A 58 y.o. male patient is examined by a physician and suffers from general weakness, fatigue, mild pain in the left subcostal area, sometimes frequent painful urination. Moderate splenomegaly has been revealed. Blood test: neutrophilic leukocytosis with the progress to myelocyte; basophil — 2%; eosinophil — 5%. There is a urate crystals in urine, erythrocyte — 2-3 in the field of vision. What is the preliminary diagnosis?

A. *Chronic myeloleucosis

B. Urolithiasis

C. Hepar cirrhosis

D. Leukemoid reaction

E. Lymphogranulomatosis

 

193. A 20 daily y.o. female patient is suffering from chronic bronchitis. Recently there has been production about 0,5 L of purulent sputum with maximum discharge in the morning. Fingers are like “drum sticks”, there are “watching glass “nails. What is the most probable diagnosis?

A. Gangrene of lungs

B. Chronic bronchitis

C. Pneumonia

D. Tuberculosis

E. *Bronchiectasia

 

194. A 43 y.o. patient had cholecystectomy 6 years ago due to chronic calculous cholecystitis. Lately he has suffered from pain in the right subcostal area and recurrent jaundice. During last 2 weeks jaundice hasn’t gone. Stenoutic papillitis 0,5 cm in length has been revealed. What is the best way of treatment?

A. *To perform endocsopic papillosphincterotomy

B.-

C. To perform choledochoduodenostomy

D. To perform external choledoch drain

E. To treat conservatively: antibiotics, spasmolytics, antiinflammatory drugs

 

195. A 2,5 y.о. child presents with muscle hypotonia, sweating, alopecia of the back of the head. The child is prescribed massage, curative gymnastics and vitamin D. What is the dosage and frequency of vitamin D administration?

A. 1000IU every other day

B. 500 IU daily

С. 1000 IU daily

D. *3000 IU daily

E. 500 IU every other day

 

196. A 27 y.o. gravida with 17 weeks of gestation was admitted to the hospital. There was a history of 2 spontaneous miscarriages. On bimanual examination: uterus is enlarged to 17 weeks of gestation, uterus cervix is shortened, and isthmus allows passing the finger tip. The diagnosis is isthmico-cervical insufficiency. What is the doctor’s tactics?

A. To administer tocolytic therapy

B. To interrupt pregnancy

C. To administer hormonal treatment

D. To perform amniocentesis

E. *To place suture on the uterus cervix

 

197. A 35 y.o. patient complains of a difficult swallowing, pain behind the breastbone. He can eat only liquid food. While swallowing sometimes he has attacks of cough and dyspnea. Above mentioned complaints are progressing. It is known that the patient has had a chemical burn of esophagus one month ago. What complication does the patient have?

A. *Corrosive esophagitis and stricture

B. Cardiac achalasia

C. Esophageal diverticula

D. Cardiac insufficiency

E. Esophagitis

 

198. A 19 y.o. boy was admitted to the hospital with closed abdominal trauma. On operation multiple ruptures of spleen and small intestine were revealed. AP is falling, it is necessary to perform hemotransfusion. Who can determine patient’s blood group and rhesus compatibility?

A. A surgeon

B. An anaesthesilogist

C. A laboratory physician

D. A traumotologist

E. *A doctor of any speciality

 

199. A 25 y.o. patient was admitted with chest trauma. Clinical and X-ray examination have revealed tense pneumothorax on the left. What emergency treatment should be undertaken?

A. Intubation

B. Analgetics

C. Intravenous infusions

D. Oxigenotherapy

E. *Pleural cavity drainage

 

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

A. Perforation

B. Haemorrhage

С. Stenosis

D. Penetration

E. *Malignisation

 

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