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Krok 2. Medicine – 2011

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

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

A. Physical*

B. Physicochemical

C. Combined  

D. Biological

E. Chemical

 

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

A. Strangulation obstruction  

B. Obturation obstruction  

C. Paralytic obstruction  

D. Spastic obstruction  

E. Invagination (combined) obstruction*  

 

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

A. Montly  

B. Once in three weeks  

C. Once in two weeks  

D. There is no need in further checks  

E. Once a week*  

 

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

A. Hematuric  

B. Nephritic  

C. Nephrotic*  

D. Combined  

E. Isolated urinary

preview008  

 

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

A. Determination of thyroid hormones  

B. Determination of sodium  

C. Determination of thyrotropic hormone  

D. Determination of potassim  

E. Determination of blood calcium and phosphor*  

Trousseau Sign

Trousseau Sign

chvostek's sign

chvostek’s sign

 

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

A. Duodenal ulcer*  

B. Diaphragmatic hernia  

C. Stomach ulcer  

D. Chronic cholecystitis  

E. Chronic pancreatitis

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

A. Determination of cholesterol ethers  

B. Determination of serum ammonia*

C. Determination of alkaline phosphatase rate  

D. Determination of ALAT and ASAT  

E. Determination of alpha-phetoprotein rate  

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

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

 

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

A. Suboccipito-bregmaticus*  

B. Suboccipitio-frontalis  

C. Biparietal  

D. Fronto-occipitalis recta  

E. Mento-occipitalis  

suboccipitobregmatic1336654161747

 

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

A. Status asthmaticus*  

B. Cardiac asthma  

C. Chronic obstructive bronchitis  

D. Bronchiale asthma, moderate gravity  

E. Foreign object aspiration  

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

 

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

A. Russules  

B. Morels  

C. Deadly amanita*  

D. Fly agarics  

E. Sulfur-tufts  

Deadly amanita

Deadly amanita

 

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

A. Medical boards of Ministry of Defense  

B. Prevention and treatment facilities*  

C. Medical boards of Ministry of Home Affairs  

D. Medico-social expert commissions  

E. Sanitary-and-prophylactic institutions  

 

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

A. X-Ray*  

B. Spirography  

C. Bronchography  

D. Pneumotachometry  

E. Bronchoscopy  

 

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

A. Cytosmear  

B. Colposcopy  

C. Symptomatic therapy  

D. Diagnostic fractional curettage of uterine cavity*  

E. USI  

7071

 

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

A. Immunoassay  

B. Proteinogram  

C. X-ray of chest *

D. Determination of blood gas composition  

E. Clinical blood test

Silverman Score (Silverman-Anderson Index)

Silverman Score (Silverman-Anderson Index)

Silverman Scoring for Respiratory Distress

Silverman Scoring for Respiratory Distress

 

 

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

A. Anemometer  

B. Illuminometer*

C. Actinometer  

D. Psychrometer  

E. Katathermometer

Digital Illuminometer

Digital Illuminometer

 

 

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

A. Delirium alcoholicum*  

B. Pathologic intoxication  

C. Alcoholic encephalopathy  

D. Alcoholic hallucinosis  

E. Alcoholic paranoia  

 

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

A. Threat of spontaneous abortion  

B. Grape mole*  

C. Abortion in progress  

D. Incipient abortion  

E. Incomplete abortion

molar-pregnancy-1 

 

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

A. Systemic lupus erythematosus  

B. Dermatomyositis  

C. Raynaud’s disease  

D. Systemic scleroderma*  

E. Rheumatoid arthritis  

Systemic Sclerosis (scleroderma)

Systemic Sclerosis (scleroderma)

systemic scleroderma - Musk Face

systemic scleroderma – Musk Face

 

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

A. Deliver the patient to the infectious disease hospital*

B. Deliver the patient to the neurological department  

C. Let him stay at home and consult a psychiatrist  

D. Deliver the patient to the psychiatric hospital  

E. Deliver the patient to the resuscitation department

 

 

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

A. II  

B. V

C. I

D. IV

E. III*

 

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

A. Hormonal therapy with androgenic hormones  

B. Anti-inflammatory therapy  

C. Conservative therapy with estrogen-gestagenic drugs  

D. Sanatorium-and-spa treatment  

E. Surgical laparoscopy*  

 Surgical laparoscopy

Surgical laparoscopy

 

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

A. Microsporia  

B. Candidosis  

C. Pityriasis versicolor  

D. Microbial eczema  

E. Rubromycosis*

Rubromycosis

Rubromycosis

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

A. Type B hepatitis

B. Measles, rubella, parotitis  

C. Diphtheria and tetanus  

D. Poliomyelitis*  

E. Pertussis  

Picture-10

 

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

A. Syncope *

B. Epileptic attack

C. Transient ischemic attack  

D. Hysterical neurosis  

E. Vegetovascular paroxysm

Syncope

Syncope

 

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

A. Deputy medical superintendent in charge of temporary disability examination

B. Medical advisory commission  

C. Medical superintendent  

D. A department chief *

E. Deputy medical superintendent in charge of medical treatment  

 

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

A. Meningitis  

B. Pylorospasm *

C. Pylorostenosis  

D. Craniostenosis  

E. Microcephaly  

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

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

 

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

A. Ankylosing spondylitis*  

B. Rheumatoid arthritis  

C. Reiter’s disease

D. Coxarthrosis  

E. Spondylosis  

as1

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

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

A. Autoimmune thyroiditis*  

B. Thyroid carcinoma  

C. Subacute thyroiditis  

D. Diffuse toxic goiter  

E. Juvenile basophilism

Autoimmune thyroiditis

Autoimmune thyroiditis

 

 

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

A. Lymphogranulomatosis

B. Chronic myeloleukemia

C. Acute myeloleukemia

D. Acute lymphatic leukemia

E. Chronic lymphatic leukemia*

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

Symptoms_of_Leukemia-pd

 

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

A. Postoperative wound infection  

B. Abscess  

C. Anaerobic clostridial wound infection*

D. Erysipelas

E. Phlegmon

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

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

 

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

A. Lung cancer  

B. Chronic obstructive bronchitis  

C. Tuberculosis  

D. Asbestosis*  

E. Pneumonia  

chest_xray_asbestosis

 

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

A. Cyst  

B. Mastopathy  

C. Lipoma  

D. Fibroadenoma  

E. Cancer*  

SignOfBreastCancer

 

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

A. Phthisio-pulmonological dispensary  

B. Tuberculosis dispensary

C. Central district hospital*  

D. Municipal hospital  

E. Regional hospital  

 

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

A. Lactational mastitis*

B. Fibrous adenoma of the left mammary gland

C. Phlegmon of mammary gland  

D. Lacteal cyst with suppuration

E. Breast cancer

mastitis-2

 

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

A. Agitated depression

B. Schizo-affective disorder

C. Panic disorder  

D. Catatonic excitation

E. Maniacal onset*  (insane)

Maniacal onset (insane)

Maniacal onset (insane)

 

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

A. Chronic pancreatitis  

B. Chronic atrophic gastritis  

C. Colorectal cancer  

D. Irritable colon syndrome*

E. Chronic enteritis  

Symptoms and signs of Irritable Bowel Syndrome.

Symptoms and signs of Irritable Bowel Syndrome.

ibs

 

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

A. Aminophylline  

B. Analgine  

C. Prednisolone*

D. Lasix  

E. Adrenaline  

PrednisolonePackShot 

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

A. Pneumonic plaque*

B. Sepsis  

C. Influenza  

D. Ornithosis  

E. Miliary tuberculosis

1-s2.0-S0169409X01001661-gr1 

 

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

A. Initial stage of Alzheimer’s disease  

B. Atherosclerotic depression  

C. Major depressive disorder*  

D. Late-onset schizophrenia  

E. Neurotic depression  

 

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

A. Balantidiasis  

B. Acute dysentery*  

C. Salmonellosis  

D. Intestinal amebiasis  

E. Cholera

Dysentery  

 

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

A. Postcava compresseion by the gravid uterus*  

B. Pressure fall in the veins of extremities  

C. Psychosomatic disorders

D. Vegetative-vascular dystonia (cardiac type)  

E. Pressure rise in the veins of extremities

Gravid uterus

Gravid uterus

 

 

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

A. Granulosa cell tumor of ovary

B. Cervical carcinoma

C. Abnormalities of menstrual cycle with climacteric character  

D. Uterine carcinoma*  

E. Atrophic colpitis  

Uterine cancer (endometrial cancer)

Uterine cancer (endometrial cancer)

 

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

A. Adrostendion

B. Corticotropin (ACTH)  

C. Adrenaline  

D. Noradrenaline

E. Cortisol*

Addison's disease

Addison’s disease

 

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

A. To take the patient to the rheumatological department  

B. To inject pain-killers and watch the dynamics  

C. To perform gastric lavage  

D. To inject spasmolytics  

E. To take the patient to the surgical hospital*  

 

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

A. Sympathoadrenal crisis  

B. Subarachnoid haemorrhage *

C. Ischemic stroke  

D. Acute hypertonic encephalopathy  

E. Meningococcal meningitis

 Subarachnoid haemorrhage

Subarachnoid haemorrhage

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

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

 

 

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

A. Above the average  

B. Sharply disharmonious  

C. Disharmonious*

D. Harmonious  

E. Supernormal  

 

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

A. Incipient abortion  

B. Cervical pregnancy  

C. Interrupted fallopian pregnancy  

D. Threat of abortion  

E. Abortion in progress*

6WEEKS

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

A. Erythrocytes  

B. Thrombocytes  

C. T-helpers*  

D. T-killers  

E. T-suppressors  

 

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

A. Atrial septal defect  

B. Ventricular septal defect  

C. Aorta coarctation*  

D. Aortopulmonary window  

E. Dissecting aortic aneurysm  

Coarctation-of-the-Aorta

 

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

A. Vaporization  

B.

C. Convection*  

D. Radiation  

E. Conduction

Convection

Convection

 

 

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

A. Cardiac glycosides  

B. Calcium antagonists  

C. Cholinolytics  

D. b-adrenoreceptor blocking agents  

E. Implantation of the artificial pacemaker*  

artificial_pacemaker

19566_20826_5

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

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

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

A. Correlation factor *

B. Standardized index

C. Fitting criterion  

D. Sign index

E. Student’s criterion

 

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

A. Parasitic sycosis  

B. Tertiary syphilis (gummatous form)  

C. Furuncle*  

D. Tuberculosis  

E. Carbuncle  

 Furuncle on the neck

Furuncle on the neck

folliculitis_skin_diagram

 Carbuncle on the neck

Carbuncle on the neck

 

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

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

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

C. To continue taking glyburide  

D. To administer short insulin*  

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

 

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

A. Dried blood plasma  

B. Fibrinogen  

C. Calcium chloride  

D. Cryoprecipitate* (Frozen Blood)  

E. Epsilon-aminocapronic acid  

Cryoprecipitate-675x332

 

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

A. Pinworms  

B. Ascarids*

C. Filarial worms

D. Cysticerci  

E. Guinea worms  

ascarids

 

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

A. Duodenal probing  

B. X-ray of digestion organs  

C. Study of gastric juice  

D. pH-metry  

E. Esophageal gastroduodenoscopy*

ei_2578 

 

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

A. Haemolytic  

B. Anaemic  

C. Myelodysplastic

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

E. Haemologic  

 

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

A. Ceftriaxone  

B. Zovirax*  

C. Haemodezum

D. Lasix  

E. Glucocorticoids

Zovirax-Aciclovir 

 

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

A. Hepatocirrhosis  

B. Pulmonary embolism  

C. Chronic pulmonary heart  

D. Lung cancer with invasion to the pleura  

E. Constrictive pericarditis*  

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

 

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

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

Pericardial Calcifications (TB Patient)  VSConstrictive Pericarditis

Pericardial Calcifications (TB Patient) 

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

A. Chronic mercury intoxication  

B. Chronic manganese intoxication  

C. Chronic tetraethyl lead intoxication*  

D. Alcoholic delirium  

E. Chronic lead intoxication  

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

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

ad-1928-ethyl-gasoline

 

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

A. Essential hypertension  

B. Acute pyelonephritis  

C. Myxedema  

D. Acute glomerulonephritis*

E. Infectious allergic myocarditis  

 

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

A. Staphylococcus  

B. Legionella*

C. Mycoplasm

D. Streptococcus  

E. Pneumococcus

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

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

Legionella pneumophila

Legionella pneumophila

 

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

A. To put an ice pack on the lower abdomen  

B. To make manual examination of uterine cavity*  

C. To administer uterotonics  

 

D. To apply hemostatic forceps upon the uterine cervix  

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

 

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

A. Blood test for thyroxine and thyrotrophic hormone  

B. Blood test for renin level  

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

D. Blood test for insulin and C-peptide  

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

 

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

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

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

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

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

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

abdominal

 

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

A. Bone scintigraphy

B. Computer tomography of pelvis*  

 

C. Excretory urography  

D. Roentgenography of chest  

E. Roentgenography of lumbar spine  

Computer tomography of pelvis

Computer tomography of pelvis

 

 

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

A. Kitaev’s reflex  

B. Bainbridge reflex  

C. Respiratory reflex  

D. Euler-Liljestrand reflex*

E. Cardiovascular reflex  

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

 

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

A. 2,5 g/kg  

B. 4,0 g/kg  

C. 3,0 g/kg*

D. 2,0 g/kg  

E. 3,5 g/kg  

 

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

A. Acute nephritis  

B. Purulent meningitis  

C. Pneumonitis

D. Encephalitis*  

E. Postherpetic neuralgia

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

Cerebellar Ataxia

Nystagmus

Nystagmus

tremor

Tremor

Hypotonia

Hypotonia In Infants

 

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

A. Heparin  

B. Digoxin  

C. Promedol *

D. Aminophylline  

E. Dopamine  

636008_xlarge

Ischemic 04.004

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

 

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

A. Physiotherapy  

B. Phytotherapy  

C. Treatment at a health resort  

D. Needle reflexotherapy  

E. Specific hyposensitization*  

 

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

A. Zollinger-Ellison syndrome  

B. Chronic pancreatitis*  

C. Chronic calculous cholecystitis  

D. Chronic gastroduodenitis  

E. Duodenal ulcer

Chronic pancreatitis

Chronic pancreatitis

Chronic pancreatitis

Chronic pancreatitis

 

 

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

A. Fibrinogen  

B. Vitamin K*  

C. Sodium ethamsylate  

D. Calcium gluconate  

E. Epsilon-aminocapronic acid  

 

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

A. a-blocker

B. Calcium channel antagonist  

C. Thiazide diuretic

D. Ihibitor of angiotensin converting enzyme*

E. b-blocker

 

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

A. Simple contact dermatitis  

B. Toxicoderma

C. True eczema*  

D. Microbal eczema  

E. Allergic dermatitis

Hand_Eczema_Examples

 

 

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

A. Lichen ruber planus  

B. Pityriasis rosea  

C. Seborrheic eczema  

D. Psoriasis*  

E. Neurodermitis

Guttate Psoriasis

Guttate Psoriasis

Nummular Psoriasis

Nummular Psoriasis

mangosteen-for-eczema-and-psoriasis_1_1

psoriasis

 

 

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

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

B. In the admission ward of maternity hospital  

C. In the operating room prepared for the operation*

D. In the examination room of antenatal clinic  

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

criticalperiodshumandevelopment 

 

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

A. Manic  

B. Paratrophic  

C. Hebephrenic  

D. Paranoid  

E. Paranoiac*

Paranoia FAIL

Paranoia FAIL

 

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

A. Adenovirus  

B. Picornavirus*  

C. Rotavirus  

D. Tohovirus  

E. Paramyxovirus  

pol10

effectspico

 

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

A. Sound tester  

B. Pyranometer  

C. Actinometer  

D. Noise analyzer  

E. Noise and vibration analyzer*  

Noise and vibration analyzer

Noise and vibration analyzer

 

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

A. Metoprolol*

B. Furosemide  

C. Captopril  

D. Nitroglycerin  

E. Digoxin

metoprolol-25-mg 

 

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

A. Reduction of renal blood flow  

B. Increased proteinuria  

C. Reduction of tubular reabsorption rate  

D. Sodium retention in the organism  

E. Reduction of glomerular filtration rate*  

img009

 

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

A. Survey radiograph of lungs  

B. Pleural puncture  

C. Bacteriological analysis of sputum  

D. Bronchography*  

E. Bronchoscopy  

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

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

Drumstick

Drumstick

Bronchography COPD Chronic obstructive lung diseases

Bronchography
COPD Chronic obstructive lung diseases

 

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

A. Surgical intervention*  

B. Anti-inflammatory therapy  

C. Complex conservative treatment  

D. Therapeutic lumbar punctures  

E. Hemostatic therapy  

 Occipital fracture

Occipital fracture

 

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

A. X-ray of abdominal organs  

B. Fibrogastroduodenoscopy  

C. Radionuclide scanning of liver and gallbladder  

D. USI of gallbladder and biliary duct*  

E. Diagnostic laparotomy  

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

 

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

A. Mist

B. Ultrafine-dispersed  

C. Coarsely dispersed  

D. Fine-dispersed*  

E. Median-dispersed

 

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

A. Radioiodine therapy  

B. Disarticulation of the lower extremity  

C. Distance gamma-ray therapy  

D. Palliative chemotherapy*  

E. Amputation of the lower extremity  

18013

 

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

A. Acute haemorrhoids  

B. Acute anal fissure  

C. Acute periproctitis*  

D. Acute prostatitis  

E. Rectum tumour

272182  

 

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

A. Hysteroscopy  

B. Colposcopy  

C. Laparoscopy  

D. Bacteriological and bacterioscopic analysis*  

E. Curettage of uterine cavity  

 

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

A. Frequency of case detection during examinations  

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

C. Percentage of people who were provided with diet meal

D. Percentage of temporarily disabled people  

E. Coverage of preventive medical examinations*  

 Metalurgical Industry

Metalurgical Industry

 

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

A. Heart attack  

B. Clinical death*  

C. Coma  

D. Agonal state  

E. Disorder of the cerebral circulation  

NB! 

Clinical Death:

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

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

3. These organs are used for transplantation.

Biological Death:

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

2. Most organs become dead after biological death.

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

 

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

A. Acute myocardial infarction  

B. Pleuritis  

C. Cardiac failure  

D. Pulmonary failure  

E. Spontaneous pneumothorax*  

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

Miliary tuberculosis

Miliary tuberculosis

Miliary tuberculosis

Miliary tuberculosis

Spontaneous Tension Pneumothorax

Spontaneous Tension Pneumothorax

Spontaneous Tension Pneumothorax

Spontaneous Tension Pneumothorax

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

A. Burial of wastes  

B. Burning as power-plant fuel  

C. Waste neutralization in biothermal boxes  

D. Compressing of wastes into building blocks*  

E. Hydrolysis  

 

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

A. Acute gonorrheal endocervicitis*  

B. Candidal vulvovaginitis  

C. Clamydial endocervicitis  

D. Trichomonal colpitis  

E. Bacterial vaginism

gonorrhea

Gonorrhea_In_Women-3

 

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

A. Rupture of abdominal aortic aneurism*  

B. Stomach ulcer perforation  

C. Peritonitis  

D. Acute appendicitis  

E. Acute pancreatitis  

Abdominal-Aortic-Aneurysm-Picture

 

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

A. Putrid phlegmon  

B. Sepsis*  

C. Erysipelas  

D. Erysipeloid  

E. Allergic reaction  

318009_379889645400468_1349572165_n

sepsis

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

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

A. To make an injection of tetanus anatoxin  

B. To administer an antibiotic  

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

D. To make an injection of antitetanus serum  

E. Surgical d-bridement only  

Rusty nails Can cause Tetanus

Rusty nails Can cause Tetanus

Tetanus

Tetanus

Tetanus

Tetanus

 

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

A. Neurologist  

B. Therapeutist*  

C. Otolaryngologist

D. Dermatologist  

E. Ophthalmologist  

 

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

A. Vishnevsky ointment  

B. Dimexide  

C. Hypertonic solution*  

D. Chloramine  

E. Ichthyol ointment  

hypertonic

 

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

A. Vitamins of B group  

B. Intravenous injection of aminophylline  

C. Dehydrating drugs  

D. Analgetics  

E. Warming procedures* 

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

 lumbarradicular1

Disk Herniation

Disk Herniation

Sciatic-Nerve-Pain-Relief-111 

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

A. Esophageal duodenoscopy along with biopsy*  

B. Study of gastric secretion  

C. X-ray in Trendelenburg’s position  

D. Clinical blood test  

E. X-ray of digestive tract organs  

swallow

egd

 

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

A. Uterine fibromyoma  

B. Metroendometritis  

C. Uterus perforation  

D. Chorioepithelioma*  

E. Uterine carcinoma  

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

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

hydatidiformmolelabel

 

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

A. Acute cardiovascular collapse  

B. Cerebral coma  

C. Anaphylactic shock*  

D. Quincke’s edema  

E. Bronchial asthma  

anaphylactic-shock-source

 

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

A. Congestive heart failure  

B. Intracranial haematoma  

C. Asphyxia*  

D. Congenital pneumonia  

E. Intrauterine sepsis  

 

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

A. Bloody*  

B. Purulent  

C. Mucous

D. Sanguino-serous

E. Serous

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

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

lochia1347311163147

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

A. Fetal hepatitis  

B. Neonatal anaemia  

C. Biliary atresia  

D. Physiological jaundice  

E. Craniocerebral birth trauma*  

Cephalohematoma

Cephalohematoma

 

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

A. Hypoproduction of progesterone

B. Hyperproduction of androgens  

C. Hyperproduction of prolactin

D. Hypoproduction of gonadotropin*  

E. Hyperproduction of estrogens  

 

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

A. Enterosorbents  

B. Exchange blood transfusion*  

C. Phenobarbital treatment  

D. Phototherapy  

E. Infusion therapy  

 

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

A. Turner’s syndrome  

B. Sexual development delay  

C. Babinski-Frohlich syndrome  

D. Pregnancy  

E. Hymen atresia*

v4c08a 

 

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

A. Cholelithiasis  

B. Agranulocytosis  

C. Paroxysmal nocturnal hemoglobinuria  

D. Acquired hemolytic anemia*  

E. Toxic hepatitis  

Fig2-HereditaryAnemia

 

 

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

A. High digestible carbohydrates  

B. Milk and dairy products  

C. Fruit  

D. Cereals – wheat and oats*  

E. Animal protein  

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

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

 

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

A. Adrenalin

B. Heparin

C. Seduxen

D. Prednisolone*  

E. Furosemide

 Quincke's edema (Angioedema)

Quincke’s edema (Angioedema)

 

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

A. Thought block  

B. Fugue  

C. Absence*  

D. Trance  

E. Obnubilation  

 

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

A. 6-7 hours ago*  

B. 10-18 hours ago  

C. 16-24 hours ago  

D. 1-2 hours ago  

E. 8-10 hours ago  

 

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

A. Uterine carcinoma  

B. Uterine endometriosis*  

C. Endomyometritis  

D. Subserous uterine fibromyoma  

E. Adnexal endmetriosis  

1

 

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

A.

B. Standardized lethality  

C. Total lethality  

D. Postoperative lethality*  

E. Index of late hospitalization since a disease incursion  

 

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

A. Demographic, sickness rates, disability*  

B. Demographic, sickness rates, physical development  

C. Sickness rates, disability, death rates  

D. Birth rates, sickness rates, disability  

E. Sickness rates, death rates, physical development  

 

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

A. Chronic glomerulonephritis  

B. Polycystic renal disease  

C. Amyloidosis  

D. Nephrolithiasis

E. Chronic pyelonephritis*  

utisrx

 

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

A. Reiter’s disease  

B. Systemic scleroderma  

C. Dermatomyositis*

D. Nodular periarteritis  

E. Systemic lupus erythematosus

Dermatomyositis (in Child)

Dermatomyositis (in Child)

Dermatomyositis at Fingernail

Dermatomyositis at Fingernail

 

 

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

A. Left kidney cyst  

B. Interloop abscess*  

C. Abdominal cavity tumour  

D. Liver abscess  

E. Spleen abscess

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

 

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

A. Barbiturates  

B. Antihypertensive drugs  

C. Beta-2-adrenoceptor agonists  

D. Antropine drugs  

E. Tranquilizers*  

Tranquilizers

 

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

A. Bronchial asthma  

B. Chronic bronchitis  

C. Pneumothorax  

D. Exudative pleuritis  

E. Pulmonary emphysema*

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

h9991437_001

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

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

 

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

A. Urolithiasis  

B. Chronic glomerulonephritis  

C. Renal amyloidosis  

D. Renal cancer*

E. Polycystic renal disease  

 

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

A. Reduction in peripheral resistance  

B. Internal haemorrhage  

C. Reduction in cardiac output*  

D. Blood depositing in the abdominal cavity  

E. Adrenergic receptor block  

 

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

A. Magnetic resonance scan*  

B. Spinal column X-ray  

C. Angiography  

D. Electromyography  

E. Lumbar puncture  

 

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

A. There is no need in further surveillance and treatment  

B. Antibacterial therapy  

C. Urgent nephrostomy  

D. Anderson-Hynes operation  

E. 6-month surveillance*  

 

 

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

A. Surgery*  

B. Conservative therapy  

C. Ascending litholysis  

D. Contact lithotripsy  

E. Distance lithotripsy  

 

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

A. Brain

B. Liver

C. Mediastinum

D. Pelvic bones

E. Lungs*

 

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

A. Streptococcal impetigo  

B. True eczema  

C. Toxicoderma  

D. Occupational eczema  

E. Microbal eczema*  

 

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

 

A. Hip joint contusion

B. Femoral diaphysis fracture  

C. Hip dislocation  

D. Cotyloid cavity fracture  

E. Femoral neck fracture*  

 

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

A. Acute occlusion of retinal vessels  

B. Traumatic cataract  

C. Optic nerve avulsion  

D. Retinal detachment  

E. Hemophthalmia*  

 

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

A. Chloroquine  

B. Prednisolone  

C. Diclofenac sodium  

D. Aspirin  

E. Methotrexate*  

 

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

A. Therapeutist and endocrinologist  

B. ENT and ophthalmologist

C. Therapeutist and dentist*  

D. Dentist and phthisiatrician  

E. Dentist and cardiologist  

 

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

A. Splenectomy*  

B. Iron preparations  

C. Cytostatics  

D. Hemotransfusion  

E. Vitamin B12

 

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

A. Exotoxin of a causative agent  

B. Endotoxin of a causative agent  

C. Tissue schizogony  

D. Erythrocytic schizogony*  

E. Gametocytes  

 

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

A. Taste  

B. Turbidity  

C. Odour*  

D. Colour index  

E. Temperature  

 

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

A. Injection of Cerucal  

B. Antibiotic therapy  

C. Intravenous rehydratation  

D. Administration of an enterosorbent  

E. Gastric lavage*  

 

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

A. Lymphangitis

B. Phlegmon

C. Tetanus

D. Erysipelas

E. Lymphadenitis*  

 

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

A. Four months  

B. Two months  

C. Ten months*  

D. A month  

E. Five months

 

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

A. Thyroid gland cancer*  

B. Nodular euthyroid goiter  

C. Nodular hyperthyroid goiter  

D. Chronic fibrous Riedel’s thyroiditis  

E. Chronic lymphomatous Hashimoto’s thyroiditis  

 

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

A. Epiglottitis  

B. Foreign body  

C. Acute laryngotracheitis*  

D. Laryngospasm  

E. Diphtheria  

 

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

A. Uncomplicated hypertensic crisis  

B. Community-acquired pneumonia  

C. Bronchial asthma exacerbation  

D. Acute myocardial infarction, pulmonary edema  

E. Complicated hypertensic crisis*  

 

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

A. Chronic renal insufficiency*

B. Acute renal insufficiency

C. Nephrotic syndrome

D. Renal amyloidosis  

E. Pyelonephritis  

 

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

A. Liver abscess*  

B. Pylephlebitis  

C. Hepatic cyst  

D. Budd-Chiari syndrome  

E. Liver necrosis  

 

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

A. Defect of interatrial septum  

B. Pulmonary artery stenosis  

C. Coarctation of aorta

D. Defect of interventricular septum*

E. Fallot’s tetrad

 

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

A. Hemisinusitis  

B. Sphenoiditis  

C. Ethmoiditis*  

D. Maxillary sinusitis  

E. Frontitis  

 

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

A. Uterogestation  

B. Interrupted fallopian pregnancy  

C. Acute appendicitis  

D. Progressing fallopian pregnancy*  

E. Right ovarian cyst  

 

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

A. Herpes zoster* 

B. Herpetiform Duhring’s dermatosis  

C. Pemphigus  

D. Streptococcal impetigo  

E. Herpes simplex  

 

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

A. Thermography  

B. Lymphoscintigraphy  

C. Myelogram*  

D. Lymphography  

E. X-rays  

 

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

A. Alcocholic psychosis  

B. Reactive psychosis  

C. Organic psychosis  

D. Schizophrenia*  

E. Somatogenic psychosis  

 

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

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

B. Drainage of the left pleural cavity and laparotomy*  

C. Left-sided thoracotomy and immediately following laparotomy  

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

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

 

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

A. Inadequate transport of sodium and chloride ions*  

B. Deposition of calcium triphosphates and carbotates in the alveoles  

C. Pulmonary cysts  

D. a1-antitrypsin deficiency  

E. Pulmonary artery hypoplasia  

 

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

A. Thyroid hormones*  

B. Antistruminum (potassium iodide)  

C. Mercazolil  

D. Thyrotropin  

E. Radioactive iodine  

 

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

A. Injection of pain-killers  

B. Immobilization of the extremity with a transportation splint  

C. Digital occlusion of the femoral artery*  

D. Venipuncture and intravenous infusion of polyglycine  

E. Tourniquet application  

 

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

A. Premature abortion  

B. I degree preeclampsia  

C. Food poisoning  

D. Moderate vomiting of pregnancy*  

E. Mild vomiting of pregnancy  

 

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

A. Foot muscles  

B. Abdominal wall muscles  

C. Thigh muscles  

D. Shin muscles*  

E. Buttock region muscles  

 

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

A. Liquor hypotension  

B. Liquor hypertension*  

C. Hyperthermy  

D. Haemorrhages into the adrenal glands  

E. Affection of the cranial nerve nuclei  

 

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

A. First 48 hours  

B. First 6 hours  

C. First 24 hours  

D. After 48 hours 

E. First 30 minutes*  

 

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

A. Propanolol  

B. Hydrochlorothiazide  

C. Clonidine  

D. Enalapril  

E. Spironolactone*  

 

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

A. Secondary purulent meningitis*  

B. Meningoencephalitis  

C. Serous meningitis

D. Subarachnoid haemorrhage  

E. Primary purulent meningitis

 

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

A. Miliaria

B. Vesiculopustulosis*

C. Impetigo neonatorum

D. Epidermolysis bullosa

E. Impetigo

 

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

A. Waiting tactics of labor management  

B. Cesarean section*  

C. Vaginal delivery  

D. Augmentation of labour  

E. Obstetrical forceps  

 

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

A. Haemorrhagic vasculitis

B. Erysipelas*  

C. Toxicoderma  

D. Contact dermatitis  

E. Microbial eczema  

 

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

A. Verapamil  

B. Procaine hydrochloride  

C. Propranolol*

D. Corinfar  

E. Radioactive iodine  

 

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

A. Perform conicotomy immediately  

B. Make a subcutaneous injection of dexamethasone  

C. Perform the Heimlich manoever*  

D. Send for an anesthesiologist and wait for him

E. Use an inhalation of b2-adrenoceptor agonist  

 

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

A. Stillbirth  

B. Live birth*  

C. Hyaline membrane disease  

D. Primary atelectasis  

E. Secondary atelectasis  

 

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

A. Femoral neck fracture with a displacement  

B. Iliac dislocation of hip*  

C. Pertrochanteric fracture of hip  

D. Inferoposterior dislocation of hip  

E. Cotyloid cavity fracture with a central dislocation of hip  

 

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

A. Conicotomy  

B. Sedative drugs  

C. Tracheostomy  

D. Corticosteroids*  

E. Antibacterial drugs  

 

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

A. Suture sinus  

B. Hematogenic osteomyelitis  

C. Posttraumatic osteomyelitis*  

D. Wound abscess  

E. Posttraumatic phlegmon  

 

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

A. Plasma sorption  

B. Hemodialysis*  

C. Ultrafiltration  

D. Plasma filtration

E. Hemosorption  

 

 

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

A. An attack of atrial flutter  

B. An attack of ciliary arrhythmia  

C. An attack of ventricular paroxysmal tachycardia  

D. An attack of supraventricular paroxysmal tachycardia*  

E. An attack of extrasystolic arrhythmia  

 

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

A. Periarteritis nodosa*  

B. Wegener’s disease  

C. Dermatomyositis  

D. Systemic lupus erythematosus  

E. Systemic scleroderma  

 

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

A. Foreign body in the respiratory tracts*  

B. Pneumonia  

C. Bronchial asthma  

D. Pertussis  

E. Acute respiratory viral infection  

 

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

A. Up to 3500

B. Up to 5500

C. Up to 2500

D. Up to 7500

E. Up to 4500*  

 

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

A. Ovarian cyst with pedicle torsion*  

B. Acute metritis  

C. Extrauterine pregnancy  

D. Subserous fibromyoma of uterus  

E. Right-sided pyosalpinx  

 

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

A. Venous congestion of lesser circulation  

B. Venous congestion of greater circulation*  

C. Hypoproteinemia  

D. Peripheral circulation disorder  

E. Secondary nephropathy development  

 

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

A. Pleural puncture  

B. X-ray of chest organs*  

C. USI of chest organs  

D. Bronchoscopy  

E. Thoracoscopy  

 

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

A. Urgent puncture of pleural cavity*

B. Administartion of antibiotics of penicillin group

C. Injection of cardiac glycosides

D. Injection of lasix

E. Transfer of the patient to the thoracic surgery department

 

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

A. Albumin  

B. 10% glucose solution  

C. Saline solutions*  

D. Fresh frozen plasma  

E. Polyglycine  

 

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

A. Intoxication with organomercurial pesticides  

B. Intoxication with carbamic acid derivatives  

C. Intoxication with arsenic-containing pesticides  

D. Intoxication with organochlorine pesticides  

E. Intoxication with organophosphorous pesticides*  

 

 

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

A. Hyperglycemia and high indicators of acid-base balance  

B. High hyperglycemia without ketonemia*  

C. Hyperglycemia and ketonemia  

D. Hyperglycemia and ketonuria

E. Hyperglycemia and glucosuria  

 

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

A. Prostate adenoma  

B. Urinary bladder polyp  

C. Primary ureter tumour  

D. Malignant tumour of the urinary bladder

E. Concrement*  

 

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

A. Contracting drugs  

B. Estrogenic haemostasia  

C. Styptic drugs  

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

E. Hysterectomy  

 

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

A. Treatment sheets  

B. Registry of operative interventions  

C. Statistic cards of discharged patients

D. Annual report of a patient care institution  

E. Health cards of in-patients*  

 

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

A. Rubella  

B. Acute viral respiratory infection  

C. Measles*  

D. Yersinia  

E. Enterovirus diseases  

 

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

A. Stable FC I stenocardia  

B. Instable stenocardia  

C. Stable FC IV stenocardia  

D. Stable FC III stenocardia*  

E. Stable FC II stenocardia  

 

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

A. Analysis of each case of diagnostic divergence*  

B. Analysis of material and technical basisof the polyclinic  

C. Analysis of medical check-up quality  

D. Analysis of doctors’ skill level  

E. Analysis of diagnostic examination quality  

 

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

A. Rheumatic arthritis  

B. Gout  

C. Reiter’s syndrome*  

D. Rheumatoid arthritis  

E. Bechterew’s disease  

 

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

A. Angiography  

B. USI*

C. Biochemical laboratory examination  

D. Liver scanning  

E. Survey radiography of abdominal cavity  

 

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

A. Pressure bandage and limb strapping*  

B. Maximal limb flexion in knee joint  

C. Occlusion of femoral artery in a typical place  

D. Application of Esmarch’s tourniquet beneath the injury  

E. Application of Esmarch’s tourniquet above the injury  

 

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

A. Lymphocytosis  

B. Antinuclear factor*  

C. Accelerated ESR  

D. C-reactive protein  

E. Anaemia  

 

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

A. Phlegmon of newborn

B. Impetigo neonatorum

C. Finger’s pseudofurunculosis

D. Mycotic erythema

E. Exfoliative dermatitis*

 

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

A. Iridocyclitis*  

B. Iritis  

C. Keratitis  

D. Choroiditis  

E. Acute attack of glaucoma  

 

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

A. Aerial  

B. Lymphogenous  

C. Hematogenous  

D. Implantation  

E. Contact-and-aspiration*  

 

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

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

B. Medical advisory commission after inpatient treatment  

C. District doctor by agreement with a department chief  

D. Medical superintendent

E. Medico-social expert commission  

 

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

A. Erythromycin  

B. Ampicillin  

C. Oxacillin  

D. Bicillinum-5*

E. Bicillinum-1  

 

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

A. Direct light fittings  

B. Semi-reflected light fittings  

C. Combined light fittings  

D. Ambient light fittings  

E. Indirect light fittings*  

 

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

A. Systemic lupus erythematosus  

B. Acute glomerulonephritis  

C. Secondary renal amyloidosis*  

D. Chronic glomerulonephritis  

E. Myelomatosis  

 

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

A. Palm and sole callosity  

B. Palmoplanar psoriasis  

C. Secondary syphilis *

D. Palmoplanar rubrophytosis  

E. Verrucosis  

 

 

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Krok 2. Medicine – 2009

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

Krok 2. Medicine – 2009

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

A. Gastritis of type A   

B. Menetrier’s gastritis    

C. Reflux-gastritis   

D. Gastritis of type B*   

E. Rigid antral gastritis 

 

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

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

 

Helicobacter pylori.

Helicobacter pylori.

 

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

A. Instrumental revision of uterine cavity   

B. Antibacterial therapy*   

C. Haemostatic therapy   

D. Contracting agents   

E. Intrauterine instillation of dioxine 

Endometriosis

Endometriosis

Endometriosis

Endometriosis

   

 

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

A. Haemoglobin – 165 g/l   

B. g-globulins – 14%   

C. Albumins – 65%   

D. Leukocytes – 15,3 g/l    

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

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

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

 

 

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

A. Adrostendion   

B. Noradrenaline   

C. Adrenaline    

D. Cortisol*    

E. Corticotropin (ACTH)

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


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

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

B. Deficit of the VIII factor of blood coagulation   

C. Generation of antithrombocytic antibodies*   

D. Disturbed hemostasis   

E. Inherited insufficiency of plasm factors of blood coagulation   

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

 

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

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

B. The therapeutist should extend a medical certificate   

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

D. The therapeutist should issue a new medical certificate    

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

   

 

 

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

A. Musculoskeletal   

B. Radial   

C. Median   

D. Ulnar*   

E. Axillary    

 

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

A. Postpartum metroendometritis   

B. Lactostasis   

C. Remnants of placental tissue after labour   

D. Physiological course of postpartum period*   

E. Subinvolution of uterus   

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

 

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

A. Skin cancer   

B. Erysipeloid   

C. Anthrax*   

D. Erysipelas   

E. Eczema   

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

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

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fig4

19057

 

 

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

A. Fibromatous node   

B. Follicular cyst of the left ovary    

C. Endometrioid cyst of the left ovary*   

D. Tumour of sigmoid colon   

E. Exacerbation of chronic adnexitis   

sf_05endometriosis

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

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

 

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

A. Haematoma   

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

C. Panaritium   

D. Erysipelas   

E. Fracture of the IV toe on the right foot   

Untitled-4

 

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

A. Echocardioscopy   

B. Coagulogram   

C. ECG   

D. Study of external respiration function   

E. Angiography of pulmonary vessels*   

 

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

A. Weltman’s coagulation test     

B. Test for whole protein   

C. Takata-Ara test   

D. Transaminase test*   

E. Prothrombin test   

Untitled-5

 

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

A. Inborn dislocation of the right hip*   

B. Inborn dislocation of both hips   

C. Varus deformity of both femoral necks   

D. Right hip dysplasia   

E. Fracture of both femoral necks   

 

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

A. Epidermolysis bullosa   

B. Miliaria   

C. Impetigo neonatorum   

D. Vesiculopustulosis*   

E. Impetigo   

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

bc6d155bed6e4698ab54449c338a813f1

 

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

A. Body length and weight, chest circumference    

B. Lung vital capacity, dynamometry*    

C. Annual gain in body length   

D. Secondary sexual characters    

E. Number of permanent teeth   

 13-1

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

A. Sodium oxybutyrate    

B. Diazepam*   

C. Aminazine   

D. Sodium thiopental    

E. Magnesium sulfate   

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

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

Generic Name: diazepam
Brand Name: Valium

valium-24190_1

 

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

A. Tularemia    

B. Acute purulent lymphadenitis    

C. Bubonic plague*    

D. Lymphogranulomatosis    

E. Anthrax    

Symptoms_of_bubonic_plague

bubound

 

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

A. Corglicone    

B. Amysyl    

C. Aminophylline   

D. Obsidan*    

E. No-shpa

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

obsidan-40-mg-33797_3 

 

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

A. Thrombosis of mesenteric vessels   

B. Perforation of abdominal part of esophagus*   

C. Perforation of duodenal ulcer   

D. Acute myocardium infarction   

E. Strangulation of diaphragmal hernia   

 gerd-and-barrett-s-esophagus_1_1

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

A. Acute thrombophlebitis*    

B. Vein puncture and edema of paravenous cellular tissue   

C. Acute lymphangitis   

D. Phlegmon of paravenous cellular tissue   

E. Necrosis of paravenous cellular tissue   

2008122820481993517

 

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

A. Paratrophy of the I grade    

B. 150 g less than necessary    

C. Hypotrophy of the I grade    

D. Corresponding to the age*   

E. Hypotrophy of the II grade    

 

 

 

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

A. Acute gastroenteritis   

B. Aerophagia*   

C. Pylorospasm   

D. Pylorostenosis   

E. Esophageal atresia   

 

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

A. Calcium channel antagonist    

B. a-blocker   

C. Thiazide diuretic   

D. b-blocker   

E. Ihibitor of angiotensin converting enzyme*   

 

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

A. Ketoacidotic coma*   

B. Hepatic coma   

C. Cerebral coma   

D. Acute renal insufficiency   

E. Hyperosmolar coma   

safe_image

11

 

 

 

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

A. Diarrhea   

B. Bleeding gums   

C. Nausea and vomiting    

D. Hallucinations and impairment of vision*   

E. Epilation (hair loss)   

 

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

A. Poisoning with anilin colouring agents   

B. Poisoning with hydrocyanic acid   

C. Poisoning with methane   

D. Poisoning with carbon monooxide*   

E. Poisoning with benzine   

carbon-monoxide-gas-safety

 

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

A. Aortic stenosis   

B. Myocardium infarction   

C. Essential hypertension   

D. Coarctation of aorta   

E. Hypertrophic cardiomyopathy*   

Hypertrophic_Cardiomyopathy_Dia

 

 

 

 

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

A. Viral   

B. Tuberculous*   

C. Staphylococcal   

D. Autoimmune    

E. Cancerous  

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

 

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

A. Homological blood syndrome   

B. Sheehan’s syndrome*   

C. Stein-Leventhal syndrome    

D. Shereshevsky-Turner’s syndrome    

E. Vegetovascular dystonia   

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

 

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

A. Antiinflammation therapy   

B. Thoracotomy   

C. Symptomatic therapy   

D. Pleural puncture   

E. Surgical treatment: drainage of the pleural cavity*   

 h9991550_001

 

 

 

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

A. Mycoplasma   

B. Gram-positive diplococci   

C. Gram-negative diplococci*    

D. Proteus vulgaris   

E. Spirochaete   

 

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

A. Haemolytic anaemia   

B. Malaria*   

C. Sepsis   

D. Leptospirosis   

E. Spotted fever   

 

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

A. Hypotonia of the uterus    

B. Injury of cervix of the uterus     

C. Delay of the part of placenta   

D. Hysterorrhexis   

E. Atony of the uterus*   

 

 

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

A. Anthracosilicosis   

B. Asbestosis   

C. Siderosis   

D. Silicatosis    

E. Anthracosis*   

 

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

A. Digital examination of rectum*   

B. Rectoromanoscopy    

C. Laparoscopy    

D. R-scopy of abdominal cavity    

E. Percussion and auscultation of stomach   

 

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

A. In position of supination  

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

C. In position of dorsal flexion of foot   

D. In position of planter flexion of foot   

E. In position of pronation   

 

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

A. Artificial ventilation with bag and mask    

B. Artificial ventilation with endotracheal tube   

C. Catheterization of the umbilical vein   

D. Suction of the trachea under direct vision*   

E. Administration of 100% oxygen by mask    

 

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

A. Limit   

B. Sigma    

C. Amplitude   

D. Coefficient of association    

E. Coefficient of variation*   

 

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

A. Cryoprecipitate*   

B. Epsilon-aminocapronic acid   

C. Stored blood   

D. Packed red blood cells   

E. Dicinone   

 

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

A. Scarlet fever    

B. Meningococcemia*   

C. Haemorrhagic vasculitis   

D. Influenza   

E. Rubella   

 

 

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

A. Fibrinogen   

B. Uric acid   

C. Blood bilirubin   

D. Blood creatinine*   

E. Blood sodium   

 

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

A. Influenza   

B. Salmonella   

C. Helicobacter pylory   

D. Lambliosis   

E. Intestinal bacillus*   

 

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

A. Cornea sensation-test   

B. Gonioscopia   

C. Tonometria   

D. Staining test with 1% fluorescein*   

E. X-ray examination of orbit   

 

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

A. Iatrogenic injury of the trachea   

B. Perforation of the cervical part of the oesophagus   

C. Deep neck phlegmon   

D. Perforation of the thoracic part of the oesophagus    

E. Cervical lymphadenitis*    

 

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

A. Atelectasis*   

B. Pneumonia   

C. Bronchitis   

D. Emphysema   

E. Pneumothorax   

 

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

A. Aspiration   

B. Pericarditis   

C. Pulmonary thromboembolism*   

D. Acute myocardial infarction   

E. Aortic dissection   

 

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

A. Bronchiectasis    

B. Bronchial asthma    

C. Pulmonary hypoplasia    

D. Recurrent bronchitis    

E. Mucoviscidosis (cystic fibrosis)*   

 

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

A. Lymphosarcoma   

B. Lymphogranulomatosis*     

C. Chronic lymphadenitis    

D. Cancer metastases    

E. Burkitt’s lymphoma    

 

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

A. Necrotomy of burn surface, haemotransfusion   

B. Primary surgical pocessing    

C. Antibacterial and detoxicating therapy   

D. Administration of detoxicating blood substitutes   

E. Injection of narcotic analgetics and powdered blood substitutes*    

 

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

A. Physiologic jaundice*   

B. Biliary tracts atresia   

C. Neonatal sepsis   

 

D. Minkowsky-Shauffard disease   

E. Hemolytic disease of newborn   

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

A. 2 months*   

B. 2 weeks   

C. Month   

D. 10 months   

E. Week   

 

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

A. Closed pneumothorax    

B. Subcutaneous emphysema    

C. Valvular pneumothorax*   

D. Open pneumothorax   

E. Mediastinitis   

 

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

A. Secondary hypothyroidism    

B. Primary hypothyroidism*    

C. Prolactinoma   

D. Adiposogenital dystrophy   

E. Hypopituitarism   

 

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

A. Infection of superior urinary tracts – pyelonephritis   

B. Infection of inferior urinary tracts – cystitis*   

C. Gonorrhoea   

D. Urolithiasis   

E. Primary syphilis   

 

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

A. Haemorrhagic vesiculitis*   

B. Thrombocytopenic purpura   

C. Urticaria   

D. DIC syndrome   

E. Meningococcemia   

 

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

A. Furosemide   

B. Seduxen   

C. Heparin   

D. Adrenalin   

E. Prednisolone*   

 

 

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

A. Hemiparesis   

B. Tetraparesis   

C. Total right-sided obstetric paralysis*   

D. Distal right-sided obstetric paralysis   

E. Proximal right-sided obstetric paralysis   

 

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

A. CHF- 3   

B. CHF- 2 B*   

C. CHF- 2 А   

D. CHF- 1   

E. CHF- 0   

 

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

A. Disseminated intravascular coagulopathy    

B. Schonlein-Henoch disease   

C. Acute lymphoblastic leukemia    

D. Systemic lupus erythematosus    

E. Immune thrombocytopenic purpura*   

 

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

A. Pertubation   

B. Laparoscopy with chromosalpingoscopy*   

C. Bicontrast pelviography    

D. Transvaginal echography   

E. Hysterosalpingography   

 

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

A. Diet   

B. Sulfonylurea    

C. Biguanides   

D. Long-acting insulin   

E. Short-acting insulin*    

 

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

A. Noradrenaline   

B. Adrenaline   

C. Prednisolone   

D. Mesatonum   

E. Dopamine*   

 

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

A. Sepsis    

B. Brucellosis    

C. Typhoid fever*   

D. Leptospirosis   

E. Malaria    

 

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

A. Hemicrania (migraine)   

B. Ischemic stroke   

C. Facial neuritis*   

D. Trigeminus neuralgia    

E. Brain tumour   

 

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

A. Average bed idle time    

B. Average annual bed occupancy    

C. Average duration of patients’ presence in the hospital     

D. Bed turnover*     

E. Bed resources of the hospital     

 

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

A. Esophagitis   

B. Hanter’s disease   

C. Esophageal achalasia   

D. Esophageal diverticulum   

E. Cancer of the esophagus*   

 

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

A. Complex heart defect   

B. Hiatal hernia   

C. Exudative pleuritis   

D. Acute cardiac insufficiency   

E. Cardiac tamponade*   

 

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

A. Decrease of cholesterol consumption   

B. Decrease of carbohydrates consumption    

C. Increase of cellulose consumption    

D. Decrease of saturated fats consumption     

E. Any dietary changes are necessary*    

 

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

A. Intestinal obstruction   

B. Late gestosis   

C. Fetus hypotrophy   

D. Noncarrying of pregnancy*   

E. Premature placenta detachment   

 

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

A. Psychogenic stupor, stress disorder    

B. Depressive stupor, bipolar disorder    

C. Apathetic stupor, schizophrenia    

D. Catatonic stupor, schizophrenia*    

E. Dissociative stupor, dissociative psychosis    

 

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

A. Silicosis*   

B. Silicatosis   

C. Tuberculosis of lungs   

D. Bronchiectatic disease   

E. Chronic bronchitis   

 

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

A. Hysteroscopy    

B. Colposcopy   

C. Cystoscopy   

D. Hromohydrotubation   

E. Ultrasound*   

 

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

A. Twilight state   

B. Delirious*   

C. Amentive   

D. Asthenic confusion   

E. Oneiric   

 

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

A. Acute paraproctitis   

B. –   

C. Anal fissure   

D. External hemorrhoids   

E. Internal hemorrhoids*   

 

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

A. Brain   

B. Liver   

C. Pelvic bones   

D. Lungs*   

E. Mediastinum   

 

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

A. Facial migraine   

B. Maxillary sinusitis   

C. Arthritis of mandibular joint   

D. Neuralgia of trigeminus*   

E. Neuralgia of glossopharyngeal nerve   

 

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

A. Rheumatoid arthritis*   

B. Psoriatic arthropathy   

C. Systemic lupus erythematosus   

D. Osteoarthrosis deformans   

E. Reactive polyarthritis   

 

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

A. USI of organs of small pelvis   

B. Progesterone assay   

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

D. Determination of the level of gonadotropins    

E. Computer tomography of the head*   

 

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

A. Erysipelatous inflammation   

B. Rheumatoid arthritis   

C. Gout*   

D. Infectious arthritis   

E. Osteoarthritis   

 

 

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

A. Apostasis of sutures after episiotomy    

B. Thrombophlebitis of veins of the pelvis   

C. Endometritis   

D. Infectious contamination of the urinary system*   

E. Infectious hematoma   

 

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

A. Respiratory failure of II degree   

B. Myocarditis    

C. Respiratory failure of I degree   

D. Congenital heart malformation   

E. Respiratory failure of III degree*   

 

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

A. Number of patients   

B. Population number*    

C. Number of population being liable to preventive examination    

D. Employment number    

E. Number of hospitalized people    

 

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

A. Wound lavage with 6% solution of hydrogen peroxide    

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

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

D. Injection of specific serum 3 000 U   

E. Injection of specific serum 30 000 U    

 

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

A. Vaccination   

B. Bacteriological study*   

C. Antibiotic prophylaxis    

D. Dispensary observation   

E. Isolation   

 

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

A. Acute lacunar tonsillitis   

B. Chronic tonsillitis*   

C. Chronic pharyngitis   

D. Paratonsillitis   

E. Tonsillar tumour   

 

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

A. Gastrointestinal haemorrhage   

B. Helminthic invasion   

C. Ileocecal invagination*   

D. Pylorostenosis   

E. Wilm’s tumour   

 

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

A. Phonocardiography   

B. ECG   

C. Roentgenography of chest   

D. Echocardiography*   

E. Veloergometry   

 

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

A. Alveolar echinococcus of liver*   

B. Liver cancer   

C. Cystous liver cancer   

D. Liver abscess   

E. Paravesical liver abscesses   

 

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

A. Parametritis   

B. Endometritis*   

C. Lochiometra   

D. Metrophlebitis    

E. Pelviperitonitis    

 

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

A. Acute mercury intoxication   

B. Mercury encephalopathy   

C. Parkinson syndrome   

D. Chronic mercury intoxication*   

E. Neuroinfection   

 

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

A. Abortion in progress   

B. Cervical myoma   

C. Algodismenorrhea   

D. Cervical carcinoma   

E. Nascent submucous fibromatous node*   

 

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

A. Dynamic observation   

B. No need for treatment    

C. –

D. Conservative therapy   

E. Surgical intervention*   

 

 

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

A. Rubella*    

B. Pseudotuberculosis   

C. Adenoviral infection   

D. Measles   

E. Scarlet fever   

 

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

A. Otolaryngologyst   

B. Psychiatrist   

C. Neuropathologist*    

D. Gynaecologist    

E. Dermatologist   

 

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

A. Correlative regressive analysis   

B. Analysis of dynamic series   

C. Standardization*    

D. Wilcoxon’s t-criterion    

E. Calculation of average values   

 

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

A. Toxic infectious shock   

B. Cardial shock   

C. Allergic reaction to the donor red blood cells   

D. Citrate intoxication     

E. Acute renal insufficiency*   

 

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

A. Annual report of a patient care institution    

B. Statistic cards of discharged patients   

C. Health cards of in-patients*    

D. Treatment sheets    

E. Registry of operative interventions    

 

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

A. Osteosarcoma   

B. Brodie’s abscess   

C. Acute coxitis   

D. Intermuscular phlegmon   

E. Acute haematogenic osteomyelitis*   

 

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

A. Breast cancer   

B. Lactational mastitis*   

C. Lacteal cyst with suppuration   

D. Phlegmon of mammary gland   

E. Fibrous adenoma of the left mammary gland   

 

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

A. Pelvic arteriography   

B. Sonography of the urinary bladder   

C. Palpation and percussion of abdomen   

D. Cystography   

E. Retrograde cystography*    

 

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

A. Botulism*   

B. Leptospirosis   

C. Yersiniosis   

D. Salmonellosis, gastrointestinal form   

E. Lambliasis    

 

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

A. Thyroid carcinoma   

B. Autoimmune thyroiditis*   

C. Thyroid hyperplasia   

D. Endemic goiter   

E. Diffuse toxic goiter   

 

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

A. Antihypertensive therapy   

B. Coronary artery bypass grafting*   

C. Intravenous streptokinase   

D. Excercise testing   

E. Oral aspirin   

 

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

A. Neuralgia of trigeminus   

B. Migraine*    

C. Neuritis of the facial nerve   

D. Meniere’s syndrome   

E. Epilepsy   

 

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

A. Culdoscopy   

B. Puncture of abdominal cavity through posterior vaginal fornix   

C. Extensive colposcopy   

D. Separated diagnosic curretage*   

E. Laparoscopy   

 

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

A. Pneumococcus   

B. Virus   

C. Fungi   

D. b-haemolytic streptococcus*   

E. Staphylococcus   

 

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

A. Hard to determine    

B. Preexisting diseases    

C. Subacute    

D. Chronic*   

E. Acute    

 

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

A. Renal cancer*   

B. Renal amyloidosis    

C. Chronic glomerulonephritis    

D. Polycystic renal disease   

E. Urolithiasis    

 

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

A. 7 times   

B. 3 times   

C. 5 times*   

D. 4 times   

E. 6 times  

 

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

A. Streptococcal impetigo   

B. Seborrheic eczema    

C. Microbial eczema*   

D. Allergic dermatitis   

E. Cutaneous tuberculosis    

 

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

A. Poisoning by lead. Treatment: tetacine Calcii   

B. –

C. Poisoning by POC. Treatment: atropine*   

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

E. Poisoning by vapours of mercury. Treatment: unithiol   

 

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

A. Tubo-ovaritis   

B. Premenstrual syndrome   

C. Gonadal dysgenesis    

D. Adrenogenital syndrome   

E. Sclerocystosis of ovaries*   

 

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

A. Nifedipin   

B. Clonidine   

C. Dibazol   

D. Kapoten   

E. Hypothiazid*   

 

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

A. Risk of uterus rupture   

B. Uterine inertia   

C. Discoordinated labor activity   

D. II labor period   

E. Rupture of uterus*   

 

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

A. Vibration disease*   

B. Overwork symptoms   

C. Hypovitaminosis of B1   

D. Caisson disease   

E. Noise disease   

 

 

 

 

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

A. Werlholf’s disease     

B. Polycyst ovarian syndrome      

C. Incomplete spontaneous abortion    

D. Hormonoproductive ovary tumor    

E. Juvenile bleeding, posthemorrhagic anemia*     

 

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

A. HIV infection*    

B. Rubella   

C. Infectious mononucleosis    

D. Influenza   

E. Tuberculosis   

 

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

A. 10-15 l   

B. 500 l   

C. 160-200 l*

D. 50-100 l   

E. 300-400 l   

 

 

 

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

A. Punction of the scrotum   

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

C. Examination of the formation in Trendelenburg’s position   

D. Diaphanoscоpy   

E. Palpation of the external inguinal ring   

 

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

A. Cervical papillomatosis   

B. Endometriosis   

C. Metrofibroma   

D. Cervical carcinoma*   

E. Cervical pregnancy   

 

 122 Prophylactic photoroentgenography examination of a 25 year old man revealed focal shadowings of small and medium intensity  with irregular contours in the 1st and 2nd segments of the right lung. Which clinical form can be suspected?    

A. Tuberculoma   

B. Fibro-cavernous   

C. Disseminated   

D. Miliary   

E. Focal*   

 

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

A. Ultrasonic dopplerography   

B. Examination of eye fundus   

C. EEG   

D. Computer tomography   

E. Lumbar puncture*   

 

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

A. Nonclosure of interventricular septum   

B. Stenosis of aortal valve   

C. Coarctation of aorta   

D. Patent ductus arteriosus*   

E. Stenosis of pulmonary artery   

 

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

A. Vitamin B12 deficiency anemia   

B. Chronic lympholeukemia   

C. Acute leukemia*   

D. Chronic hemolytic anemia   

E. Aplastic anema   

 

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

A. Premenstrual syndrome*   

B. Climacteric syndrome    

C. Postcastration syndrome   

D. Adrenogenital syndrome   

E. Stein-Leventhal syndrome    

 

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

A. Lymphogranulomatosis   

B. Chronic lymphatic leukemia*   

C. Acute myeloleukemia   

D. Acute lymphatic leukemia   

E. Chronic myeloleukemia   

 

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

A. a-interferon*   

B. Arabinoside monophosphate    

C. Acyclovir    

D. Essentiale-forte    

E. Remantadinum    

 

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

A. Retention of milk   

B. Birth trauma   

C. Acute purulent mastitis*   

D. Pneumonia   

E. Pleuritis   

 

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

A. Measles*   

B. Pseudotuberculosis   

C. Scarlet fever   

D. Rubella   

E. Allergic rash   

 

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

A. Renal colic   

B. Acute pyelonephritis*   

C. Pararenal abscess   

D. Cystitis   

E. Acute glomerulonephritis   

 

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

A. Secondary purulent meningitis*   

B. Subarachnoidal haemorrhage   

C. Parenchymatous subarachnoidal haemorrhage   

D. Tuberculous meningitis   

E. Primary purulent meningitis   

 

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

A. Intravenous infusion of short-acting insulin*   

B. Intravenous infusion of sodium chloride saline   

C. Intravenous infusion of glucose along with insulin   

D. Intravenous infusion of neohaemodesum along with glutamic acid   

E. Introduction of long-acting insulin   

 

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

A. 60 minutes   

B. 15 minutes   

C. 120 minutes*   

D. 180 minutes   

E. 30 minutes   

 

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

A. A traumatologist   

B. An anaesthesilogist   

C. A laboratory physician    

D. A doctor of any speciality*   

E. A surgeon   

 

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

 

A. Infusive cholecystocholangiography   

B. Test for bilirubin    

C. Survey radiography of abdominal organs   

D. Endoscopic retrograde cholangiopancreatography*    

E. Duodenal probing   

 

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

A. Fallot’s tetrad   

B. Coarctation of aorta   

C. Pulmonary artery stenosis    

D. Defect of interatrial septum    

E. Defect of interventricular septum*   

 

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

A. Roentgenography of small pelvis organs   

B. Bimanual vaginal examination   

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

D. Speculum examination   

E. Ultrasonic examination*   

 

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

A. Infectious mononucleosis *  

B. Diphtheria   

 

C. Acute lymphoid leukosis   

D. Adenoviral infection   

E. Angina   

 

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

A. Cancer of transverse colon*    

B. Gastric ulcer   

C. Chronic pancreatitis   

D. Chronic colitis   

E. Stomach cancer   

 

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

A. Increased potassium concentration in blood*   

B. –   

C. Increased calcium concentration in blood    

D. Reduced magnesium concentration in blood   

E. Increased sodium consentration in blood   

 

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

A. Manipulation room   

B. Bathroom unit*   

C. Nursing room   

D. Patient’s examination room   

E. Doctor’s consulting room   

 

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

A. Crude mortality rate    

B. Neonatal mortality    

C. Perinatal mortality*    

D. Natural increase    

E. Natality    

 

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

A. Torsion of the left testicle   

B. Retroperitoneal haemorrhage   

C. Sigmoid diverticulitis   

D. Leftsided renal colic*   

E. Herpes zoster   

 

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

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

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

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

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

E. The necessary registration form is not indicated   

 

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

A. IHd. Functional Class II angina   

B. IHd. Unstable angina*

C. Cardialgia due to spine problem   

D. Myocarditis   

E. Myocardial dystrophy   

 

 

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

A. Medical abortion     

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

C. Decrease of alcohol use    

D. Participation in the A-ANON group     

E. Gyneacological observation    

 

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

A. Calculous cholecystitis   

B. Chronic viral hepatitis*   

C. Acute viral hepatitis   

D. Gilbert’s disease   

E. Chronic cholangitis   

 

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

A. Sepsis   

B. Yersiniosis   

 

C. Typhoid fever   

D. Virus A hepatitis   

E. Leptospirosis*   

 

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

A. Rheumatoid arthritis   

B. Periarteritis nodosa   

C. Systemic lupus erythematosus*   

D. Rheumatism   

E. Dermatomyositis   

 

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

A. Hydradenitis*   

B. Streptococcal impetigo   

C. Furuncle   

D. Mycosis   

E. Herpes zoster   

 

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

A. Labour stimulation after preparation*   

B. Absolute bed rest for 1 month   

C. Complex therapy of gestosis for 7 days    

D. Caesarian section immediately   

E. Complex therapy of gestosis for 2 days   

 

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

A. Herniotomy by Grenov   

B. Herniotomy by Lekser   

C. Herniotomy by Mayo    

D. Herniotomy by Sapezhko   

E. Herniotomy by Mayo-Sapezhko*   

 

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

A. Penicillin OS*   

B. Dipyridamole   

C. Heparin   

D. Ceftriaxone   

E. Ciprofloxacine   

 

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

A. Blind suture   

B. Retension sutures   

C. Wound lavage with soapsuds, retension sutures*   

D. Aseptic bandage   

E. Salve bandage   

 

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

A. 200 beds   

 

B. 100 beds*    

C. Over 1000 beds   

D. 800 beds    

E. 400 beds   

 

 157 A 38 year old man worked at roofing and drain pipes production for 15 years. He seeks medical help for expiratory  breathlessness on exertion, and dry cough. On exam, wheezes above both lungs, grayish warts on fingers are seen. Factory  physician has diagnosed asbestosis. What method is the most important for this diagnosis?   

A. Bronchoscopy   

B. Spirography   

C. Chest X-ray*  

D. Electrocardiography   

E. Blood gas analysis   

 

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

A. Aluminium-bearing antacid*   

B. Н2-blocker   

C. Metoclopramide   

D. Gastrozepin    

E. Inhibitor of proton pump   

 

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

A. Thoracal outlet syndrome   

B. Raynaud’s syndrome   

C. Occlusion of brachiocephalic trunk   

D. Takayasu’s disease   

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

 

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

A. Intravenous introduction of calcium chloride and hospitalization    

B. Intravenous introduction of calcium chloride   

C. Intravenous introduction of prednisolone and hospitalization*    

D. The patient needs no further medical aid   

E. Hospitalization for observation   

 

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

A. Complex partial epilepsy   

B. Simple partial epilepsy   

C. Generalized tonoclonic epilepsy    

D. Jacksonian partial epilepsy   

E. Absentia*    

 

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

A. CT of lumbosacral part of vertebral column*    

B. Lumbal puncture   

C. Renal sonography   

D. Descending myelography   

 

E. Electromyography   

 

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

A. Motilium   

B. Sulfosalasine*    

C. Vikasolum   

D. Linex   

E. Kreon   

 

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

A. Dried plasma   

B. Native plasma   

C. Fresh frozen blood    

D. Fresh frozen plasma*   

E. Cryoprecipitate   

 

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

A. 4   

B. 1   

C. 0   

D. 3    

E. 2*   

 

 

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

A. Calculation of dynamic indices   

B. Calculation of correlation coefficient*   

C. Calculation of coefficient of difference validity   

D. Calculation of regression coefficient   

E. Calculation of conformity coefficient   

 

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

A. Rotaviral infection   

B. Salmonellosis*    

C. Acute shigellosis   

D. Escherichiosis   

E. Staphylococcal enteric infection    

 

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

A. Cardiotonics, respiratory analeptics   

B. Lithium drugs   

C. Antipsychotic neuroleptics   

D. Sedative neuroleptics   

E. Antidepressants*   

 

 

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

A. Mischuk’s device   

B. Krotov’s apparatus*   

C. Geiger’s counter    

D. Ebert’s counter   

E. Ebert’s device   

 

 170 A 42 year old woman complains of dyspnea, edema of the legs and tachycardia during minor physical exertion. Heart borders are  displaced to the left and S1 is accentuated, there is diastolic murmur on apex. The liver is enlarged by 5 cm. What is the cause of  heart failure?     

A. Tricuspid regurgitation   

B. Mitral stenosis*   

C. Mitral regurgitation   

D. Tricuspid stenosis   

E. Aortic stenosis   

 

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

A. Infectious hepatitis   

B. Carcinoma of the head of the pancreas*   

C. Malignant biliary stricture   

D. Metastatic disease of liver   

E. Haemolytic jaundice   

 

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

A. Index of hospitalized morbidity   

B. Common sickness rate*   

C. Index of morbidity with temporary disability   

D. Index of pathological affection   

E. Index of basic non-epidemic morbidity   

 

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

A. Mammography   

B. Thermography   

C. Aspiration biopsy with cytology   

D. Ultrasonography   

E. Excision biopsy*   

 

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

A. Muscle biopsy*   

B. ECG   

C. Echocardiogram   

D. Electromyography   

E. Determination of cortisol concentration in blood and urine   

 

 175 A patient complains about strong dyspnea that is getting worse during physical activity. Presentations appeared suddenly 2 hours  ago at work: acute chest pain on the left, cough. The pain was abating, but dyspnea, dizziness, pallor, cold sweat and cyanosis  were progressing. Vesicular respiration is absent, X-ray picture shows a shadow on the left. What pathology might be  suspected?    

A. Pulmonary infarction   

B. Pleuritis   

C. Pulmonary abscess   

D. Left-sided pneumonia   

E. Spontaneous left-sided pneumothorax*   

 

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

A. Embryotomy   

B. Forceps operation*   

C. Cesarean    

D. Conservative labor management with episiotomy    

E. Stimulation of labor activity    

 

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

A. Boiled meat   

B. Potatoes   

C. Pasteurized milk   

D. Cabbage   

E. Tinned food*   

 

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

A. Ampicillin and immunoglobulin   

B. Chloramphenicol succinate and prednisone*   

C. Penicillin and prednisone   

D. Penicillin and immunoglobulin   

E. Chloramphenicol succinate and interferon   

 

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

A. Hemogenesis immaturity   

B. Erythrocyte hemolysis   

C. Iron deficit*   

D. Infectious process   

E. B12 deficit   

 

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

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

B. In the point of the greatest dullness on percussion   

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

D. In the projection of pleural sinus   

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

 

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

A. Spleen biopsy   

B. Liver biopsy   

C. Coagulogram   

D. Abdominal ultrasound   

E. Sternal puncture*   

 

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

A. Prednisolone*   

B. Analgine   

C. Lasix   

D. Adrenaline   

E. Aminophylline   

 

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

A. Acute keratitis of the left eye   

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

C. Secondary glaucoma of the left eye   

D. Degeneration of the left eye cornea    

E. Acute iridocyclitis of the left eye   

 

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

A. Utilisation copy of medical documents    

B. Conduct an inquiry by preliminary investigator of police department    

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

D. Draw up a statement about forensic medical examination    

E. Conduct forensic medical examination by district forensic medicine expert    

 

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

A. Uterus tamponade   

B. Instrumental revision of uterine cavity walls   

C. Manual removal of placenta and afterbirth*   

D. Removal of afterbirth by Crede’s method   

E. Intravenous injection of methylergometrine with glucose   

 

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

A. Excess of carbohydrates   

B. Energetic unprofitableness of nutrition*   

C. Lack of cellulose   

D. Violation of dietary pattern   

E. Excess of fats   

 

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

A. 20   

B. 100   

C. 50*   

D. 40   

E. 200   

 

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

A. Thecal whitlow (ligament panaritium)*    

B. Articular (joint) panaritium    

C. Paronychia    

D. Subcutaneous panaritium    

E. Bone panaritium    

 

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

A. With a passing car in the third turn   

B. With medical vehicle in the second turn   

C. With a passing car in the second turn   

D. With a passing car in the first turn   

E. With medical vehicle in the first turn*   

 

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

A. Salt   

B. Carbohydrates*   

C. Proteins   

D. Liquid   

E. Fats   

 

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

A. UV-meter   

B. Gorbachev’s biodosimeter*   

C. Actinometer   

D. Catathermometer   

E. Radiometer   

 

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

A. Tympanoplasty   

B. Mastoidotomy*   

C. Radical operation on the middle ear   

D. Cateterization of the Eustachian tube   

E. Paracentesis of the drum    

 

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

A. Menstrual irregularity   

B. Chronic oophoritis   

C. Bilateral ovarian tumours   

D. Polycystic ovaries*   

E. Ovarian cystoma   

 

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

A. Acute radiculitis   

B. Myelomatosis*   

C. Urolithiasis   

D. Metastases in bones   

E. Systemic osteoporosis   

 

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

A. Atrial gallop rhythm   

B. Protodiastolic gallop rhythm   

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

D. IV physiological sound   

E. III physiological sound*  

 

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

A. Infectious-toxic shock   

B. Meningitis   

C. Cholangitis   

D. Hepatic encephlopathy*   

E. Relapse of viral hepatitis     

 

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

A. Asthenic syndrome   

B. Phobic syndrome   

C. Depressive syndrome*   

D. Obsessive syndrome   

E. Paranoid syndrome   

 

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

A. Roentgenography of esophagus    

B. Gland scanning*    

C. USI   

D. Puncture aspiration biopsy    

E. Roentgenography of neck    

 

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

A. Antibiotics   

B. Replacement blood transfusion (conservative therapy)*   

C. Blood transfusion (conservative therapy)   

D. Symptomatic therapy   

E. Conservative therapy   

 

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

A. Alcohol thermometer   

B. Mercury thermometer   

C. Thermograph*   

D. August’s psychrometer   

E. Assmann psychrometer   

 

 

Year 2006

Posted: May 5, 2012 in Krok II
Tags:

 

1. A 41 y.o. patient complains of acute pain in the right side of the thorax and sudden progress of dyspnea following the lifting of a heavy object. The patient’s condition is grave: lips and mucous membranes are cyanotic, BR – 28/min, Ps — 122 bpm, AP – 80/40 mm Hg. There is tympanitis on percussion and weakened breathing on auscultaion on the right. S^ sound is accentuated above pulmonary artery. What is the main urgent measure on the prehospital stage?

A. Call for cardiologic team

B. Euphilline introduction

C. Epinephrine introduction

D. Air aspiration from the pleural cavity

E. Oxygen inhalation

 

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

A. Abscess of the lung

B. Pulmonary tuberculosis

C. Bronchiectatic disease

D. Actinomycosis of lungs

E. Complication of liver echinococcosis

 

3. A 58 y.o. man complained of severe inspiratory dyspnea and expectoration of frothy and blood-tinged sputum. He has been suffering from essential hypertension and ischemic heart disease. On examination: acrocyanosis, “bubbling” breathing, Ps – 30/min, BP — 230/130 mm Hg, bilateral rales. Choose medicines for treatment.

A. Strophanthine, potassium chloride, plathyphylline

B. Morphine, furosemide, nitroprusside sodium

C. Theophylline, prednisolon

D. Cordiamine, isoproterenol

E. Albuterol, atropine, papaverine

 

4. A 17 y.o. patient complains of acute pain in the knee joint and t° — 38°C. He was ill with angina 3 weeks ago. Objectively: deformation and swelling of the knee joints with skin hyperemia. Small movement causes an acute pain in the joints. Which diagnose is the most correct?

A. Rheumatism, polyarthritis

B. Rheumatoid arthritis

C. Infectious-allergic polyarthritis

D. Reactive polyarthritis

E. Systemic lupus erythematodes

 

5. A 40 y.o. woman is ill with rheumatic disease with prevalence of the stenosis of left venous foramen. Complains of palpitation, fatigability, progressing dyspnea, attacks of dyspnea and hemoptysis. Now she cannot be engaged even in the easy activities. What tactics is the most expedient?

A.-

B. Prescription of venous vasodilatators

C. Conduction of current bicilino-prophilaxis

D. Prescription of anticoagulants

E. Mitral comissurotomia

 

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

A. Dried plasma

B. Fresh frozen plasma

C. Fresh frozen blood

D. Cryoprecipitate

E. Native plasma

 

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

A. Out-patient treatment

B. Strict supervision at home

C. Psychotherapeutic conversation

D. Admission to the mental hospital

E. Admission to the neurological department

 

8. A 47 y.o. woman complains of having paroxysmal headaches for the last 5 years. The pain is one-sided, intense, localized in frontal region of head, accompanied by nausea and stomach iscomfort, begins one of a sudden. Onset is usually preceded by vision reduction. Anamnesis gives evidence of periodical AP rise, but at the moment the woman doesn’t take any medicines. In between the onsets of headache her state is satisfactory. Objectively: high-calorie diet (body weight index – 29), AP – 170/95 mm Hg. Neurologic state has no pecularities. What is the most probable diagnosis?

A. Chronic subdural hematoma

B. Migraine

C. Benign intracranial hypertension

D. Hypertensive encephalopathy

E. Epilepsy

 

9. A 16 y.o. teenager complains of weakness, dizziness, sense of heaviness in the left hypochondrium. Objectively: skin and visible mucous membranes are icteric. Steeple skull. Liver +2 cm, the lower pole of spleen is at the level of navel. Blood test: RBC – 2.7* 1012/L, Hb- 88 g/L, WBC- 5,6* 109/L, ESR – 15 mm/h. What is the most probable reason of bilirubin level change?

composite mitral disease with

A. Decrease of conjugated bilirubin

B. Increase of unconjugated and conjugated bilirubin

C. Increase of unconjugated bilirubin

D. Decrease of unconjugated bilirubin

E. Increase of conjugated bilirubin

 

10. A 6 y.o. asthmatic child was taken to the emergency hospital because of severe coughing and wheezing for the last 24 hours. Physical examination reveals that the child is excitable, has intercostal and suprasternal retractions, expiratory wheezing throughout all lung fields, RR — 60/min. Initial treatment may include the prescription of:

A. N-acetyl cysteine and cromolyn by inhalation

B. Parenteral gentamicyn

C. Subcutaneous epinephrine

D. Parenteral phenobarbital

E. Intravenous fluids in the first 2 h to compensate water deficiency

 

11. A 41 y.o. woman complains of weakness, fatigue, fever up to 38°C, rash on the face skin, pain in the wrists and the elbows. On physical examination: erythematous rash on the cheeks with “butterfly” look, the wrists and elbow joints are involved symmetrically, swollen, sensitive, friction rub over the lungs, the heart sounds are weak, regular, HR – 88/min, BP — 160/95 mm Hg. CBC shows anemia, leucopenia, lymphopenia; on urine analysis: proteinuria, leukocyturia, casts. What is the main mechanism of disease development?

A. Production of antibodies to double-stranded DNA

B. Production of antimitochondrial antibodies

C. Production of myosin antibodies

D. Production of antibodies to endothelial cells

E. Production of myocytes antibodies

 

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

A. Artesian well water

B. River water

C. Spring water

D. Rain water

E. Water from melted snow

 

13. A 31 y.o. woman has complained for 3 years of pain and swelling of radiocarpal and metacarpophalangeal articulations, morning stiffness that lasts up to 1.5 hours. Two weeks ago she felt pain, swelling and reddening of knee joints, body temperature raised up to 37.5°C. Examination of her internal organs revealed no pathologic changes. Her diagnosis was rheumatoid arthritis. What changes in X-ray pictures of her joints are the most probable?

A. Multiple marginal osteophytes

B. Constriction of joint space, subchondral osteosclerosis

C. Cysts in subchondral bone

D. Constriction of joint space, usura

E. Epiphysis osteolysis

 

14. A pregnant woman was registered in a maternity welfare clinic in her 11th week of pregnancy. She was being under observation during the whole term, the pregnancy course was normal. What document must the doctor give the pregnant woman to authorize her hospitalization in maternity hospital?

A. Medical certificate

B. Exchange card

C. Individual prenatal record

D. Sanitary certificate

E. Appointment card for hospitalization

 

15. Name a statistical observation unit for determination of blood sugar impact on the healing of wound’s surface in a postoperative period:

A. An amount of blood sugar

B. The patient who was discharged on an after-care

C. The patient in a postoperative period

D. Blood analysis

E. The patient who has a wound surface

 

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

A. High level of noise

B. Discomfortable microclimate

C. Non-effective ventilation

D. Poor lighting

E. All conditions meet the requirements

 

17. A 33 y.o. woman has been suffering from DM (diabetes mellitus) for 5 years. For the last 3 years she has been taking more than 100 units of insulin per day. Body weight has increased up to 10 kg. Fasting blood glucose is 13 mmol/L, glucoseuria — 3%. Generalized microangiopathy. By increasing the dose of insulin the parameters of glycemia do not change. The diagnosis is:

A. DM 1st type, severe form, decompensation, allergic reaction to insulin

B. DM 2nd type, moderate form, Zabrodiphenomenon

C. DM 1st type, severe form, decompensation, insulin resistant

D. DM st type, severe form, subcompensation, Somoji phenomenon

E. DM 2nd type, severe form, decompensation

 

18. A patient is 16 y.o. In the last year his behaviour has gradually changed: he secluded himself, was not interested in communication with friends, in learning. He became indifferent towards relatives, motivelessly rude, was speaking or laughing to himself. He answers the questions formally correctly, laconically. Considers he to be absolutely healthy but a little tired, says, he’s thinking about writing a book “Projection of humanity on the plane of Universe”. He always has a copy-book with which is full of a great many of the same daggers. What is the most probable diagnosis?

A. Schizophrenia

B. Schizoid personality disorder

C. Pick’s disease

D. Depressive disorder

E. Autistic personality disorder

 

19. A 1.5 y.o. child fell seriously ill: chill, body temperature rise up to 40.1°C, then rapid dropping to 36, 2°C, skin is covered with voluminous hemorrhagic rash and purple cyanotic spots. Extremities are cold, face features are sharpened. Diagnosis: meningococcosis, fulminant form, infection-toxic shock. What antibiotic must be used at the pre-admission stage?

A. Sulfamonometoxin

B. Lincomycin

C. Penicillin

D. Gentamycin

E. Soluble Levomycetine succinate

 

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

A. Motilium

B. Kreon

C. Sulfasalasine

D. Vikasolum

E. Linex

 

21. A 27 y.o. woman complains of having the disoders of menstrual function for 3 months, irregular pains in abdomen. On bimanual examination: in the dextral appendage range of uterus there is an elastic spherical formation, painless, 7 cm in diameter. USI: in the right ovary – a fluid formation, 4 cm in diameter, unicameral, smooth. What method of treatment is the most preferable?

A. Dispensary observation of the patient

B. Prescription of an estrogen-gestogen complex for 3 months with repeated examination

C. Anti-inflammatory therapy

D. Operative treatment

E. Chemotherapeutic treatment

 

22. A mineshaft is situated on the territory of homestead land; it is 20 m away from the house, 10 m – from the toilet and 15 m – from the neighbor’s house. What is the smallest distance that, according to the sanitary code, should be established between the well and the source of probable water pollution?

A. 20 m

B. 25 m

C. *30 m

D. 15 m

E. 10 m

 

23. A 25 y.o. woman complained of fatigue, hair loss and brittle nails. The examination revealed pallor of skin, Ps- 94/min, BP- 110/70 mm Hg. On blood count: Hb- 90 g/L, RBC – 3,5* 1012/L, C.I. – 0,7; ESR – 20 mm/h. Serum iron level was 8.7 mcmol/L. What treatment would you initiate?

A. Iron dextrin injections

B. Vitamin B12– intramuscularly

C. Packed RBCs transfusion

D. Blood transfusion

E. Ferrous sulfate orally

 

24. Condition of a parturient woman has been good for 2 hours after live birth: uterus is thick, globe-shaped; its bottom is at the level of umbilicus, bleeding is absent. The clamp put on the umbilical cord remains at the same level, when the woman takes a deep breath or she is being pressed over the symphysis with the verge of hand, the umbilical cord drows into the vagina. Bloody discharges from the sexual tracts are absent. What is the doctor’s further tactics?

A. To apply Abdul adze method

B. To introduct oxitocine intravenously

C. To do manual removal of afterbirth

D. To do curettage of uterine cavity

E. To apply Crede’s method

 

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

A. IgM

B. IgJ

C. IgA

D. Circulating immunocomplexes

E. IgE

 

26. A mother with an infant visited the pediatrician for expertise advice. Her baby was born with body weight 3.2 kg and body length 50 cm. He is 1 year old now. How many teeth the baby should have?

A. 20

B. 6

C. 8

D. 10

E. 12

 

27. A woman is admitted to the maternity hospital with stopped birth activity and mild bloody discharges from the vagina. The condition is serious, the skin is pale, and consciousness is confused. AP – 80/40 mm Hg. The palpitation of the fetus is not determined. In medical history there was a Cesarean section a year ago. Make a diagnosis:

A. Hysterorrhesis

B. Premature expultion of the amniotic waters

C. Abjointing of the mucous fuse from cervix of the uterus

D. Presentation of the cord

E. Placental presentation

 

28. In a city with population 400000 people 5.600 fatal cases were recorded, including 3300 cases because of blood circulation diseases, 730 – because of tumors. What index will allow characterizing mortality from blood circulation diseases in this city?

A. Relative intensity index

B. Extensive index

C. Correlation index

D. Visuality index

E. Intensive index

 

29. On the 3rd day after the acute anterior myocardial infarction a 55 y.o. patient complains of dull ache behind his breast bone, that can be reduced by bending forward, and of dyspnea. Objectively: AP- 140/180 mm Hg, heart sounds are dull. ECG results: atrial fibrillation with frequence of ventricular contractions at the rate of 110/min, pathological Q wave and S-T segment raising in the right chest leads. The patient refused from thrombolisis. What is the most probable diagnosis?

A. Tietze’s syndrome

B. -Acute pericarditis

C. Dressler’s syndrome

D. Pulmonary embolism

E. Dissecting aortic aneurysm

 

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

A. Periventricular hemorrhages

B. Subdural hemorrhages

C. Hemorrhages in ventricles of brain

D. Small hemorrhages in brain tissue

E. Subarachnoid hemorrhages

 

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

A. The right to the free choice

B. The right to be heard

C. The right to the information

D. The right to the protection from incompetence

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

 

32. A 56 y.o. woman has an acute onset of fever up to 39°C with chills, cough, and pain on respiration in the right side of her chest. On physical examination: HR – 90/min, BP – 95/60 mm Hg, Ps – 26/min. There is dullness over the right lung. On X-ray: infiltrate in the right middle lobe of the lung en palpation. What is the diagnosis?

A. -Community-acquired lobar pneumonia with moderate severity

B. Acute pleurisy

C. Acute lung abscess

D. Hospital-acquired lobar pneumonia

E. Community-acquired bronchopneumonia

 

33. Fluorography of a 45 y.o. man revealed some foci of small intensity with no distinct outlines on the top of his right lung. The patient doesn’t feel worse. He has been smoking for many years. Objectively: vesicular resonance over lungs, respiration is vesicular, rales are absent. Blood count is not changed. What is the most probable diagnosis?

A. Eosinophilic pneumonia

B. Disseminated pulmonary tuberculosis

C. Focal pulmonary tuberculosis

D. Bronchiolitis

E. Peripheral cancer of lung

 

34. A 48 y.o. farmer was admitted to the hospital with complaints of headache, nausea, vomiting, cough with sputum, breath shortage, weak sight, sweating, and salivation. He was cultivated the garden with phosphoorganic pesticides. Blood count RBC – 4.1 * 1012/L, Hb- 136 g/L, C.I.- 0.9, leukocytes – 13.0 * 109/L, ESR – 17 mm/h. His diagnosis is acute intoxication with phosphoorganic pesticides. What is the most important diagnostic criterion for this pathology?

A. Anemia

B. Low level of choline esterase

C. Thrombocytopenia

D. Reticulocytosis

E. Leukocytosis

 

35. A 28 y.o. man fell seriously ill, he feels chill, has got a fever, body temperature raised up to 38, 5°C, paroxysmal pain in the left iliac region, frequent defecation in form of fluid bloody and mucous mass. Abdomen palpation reveals painfulness in its left half, sigmoid colon is spasmed. What is the most probable diagnosis?

A. Amebiasis

B. Colibacillosis

C. Nonspecific ulcerative colitis

D. Malignant tumors of large intestine

E. -Acute dysentery

 

36. A surgical department admitted a newborn boy with foamy discharges from nose and mouth, cyanosis attacks. X-ray examination: blind end of esophagus is at the level of the II thoracic vertebra; gastric air bubble is under the left cupula of diaphragm. What is the most probable diagnosis?

A. Esophagus atresia without a fistula

B. Total esophagus atresia

C. Paraesophageal hernia

D. Esophagus atresia, tracheo-esophageal fistula

E. Bronchoesophageal fistula

 

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

A. Lactational mastitis

B. Phlegmon of mammary gland

C. Fibrous adenoma of the left mammary gland

D. Lacteal cyst with suppuration

E. Breast cancer

 

38. A patient complains of skin painfullness and reddness of the right gastrocnemius muscle. Objectively: body temperature is 38.5°C, enlarged and painful inguinal lymph nodes on the right. Skin of extremity is edematic, hyperemic, covered with eruption in form of vesicles containing dark fluid; its palpation is painful. There is distinct border between normal and hyperemic skin. What is the most probable diagnosis?

A. Anthrax, dermal form

B. Chickenpox

C. Crus phlegmon

D. Herpetic infection

E. -Erysipelas, hemorrhagic form

 

39. A 40 y.o. patient was diagnosed: 1. Medular thyroid gland cancer. 2. Feochromocytoma. What operation should be performed at first?

A. Operation on account of feochromocytoma

B. Operation on thyroid gland

C. Vanach’s operation

D. Krail’s operation

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

 

40. A man, 42 years old, died in a road accident after the hemorrhage on the spot, because of acute hemorrhagic anemia. What minimum percent of the whole blood volume could result in death by acute hemorrhage?

A. 35-50%

B. 10-14%

C. 15-20%

D. 25-30%

E. 6-9%

 

41. 200 patients suffering from essential hypertension were examined in order to obtain data about patients’ arterial pressure and age. What statistic value should be applied in order to measure relation between these characteristics?

A. Student’s coefficient

B. Sygmal deviation

C. Representation error

D. Correlation coefficient

E. Coefficient of variation

 

42. A child with chronic cardialtis, cardial insufficiency IIA that is being treated with digoxin has got progressing bradycardia, nausea, vomiting, dizziness, and sleep disorders. ECG results: extrasystole, PQ – 0.18. What is the most probable cause of this condition?

A. Hypokaliemia

B. Atrioventricular heart block of the I degree

C. Pulmonary edema

D. Acute enteric infection

E. Cardiac glucosides overdose or intolerance

 

43. A 60 y.o. man complains of sense of heaviness in the region of scrotum. Objectively: scrotum edema in the left part. Testicle is of normal size, but there is a soft, scrotum limited edema over it that can be pressed and disappears when the patient lies down. What is the preliminary diagnosis?

A. Ectopic testicle

B. Varicosity of subcutaneous veins

C. Varicocele

D. Inguinal lymphadenopathy

E. Inguinal hernia

 

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

A. Depth of study room

B. Natural light coefficient

C. Light coefficient

D. Presence of mixed (upper-lateral) light

E. Time of the room insolation

 

45. A 15 y.o. boy was twice attacked by bees; as a result he had severe anaphylactic shock. What is the most effective prophylaxis method?

A. Protective clothing

B. Prescription of corticosteroids for summer

C. Limitation of outside staying during summer months

D. Long-term prophylactic treatment with antihistamines

E. Desensibilisation by means of bee venom extract

 

46. During the medical examination a port crane operator complained of dizziness, nausea, sense of pressure against tympanic membranes, tremor, dyspnoea, and cough. He works aloft; the work is connected with emotional stress. Workers are affected by vibration (general and local), noise, ultrasound, microclimate that warms in summer and cools in winter. What factor are the worker’s complaints connected with?

A. Infrasound

B. Noise

C. Altitude work

D. Vibration

E. Intensity of work

47. A laboratory obtained a milk sample sent for analysis. Analysis gave the following data: color – whitish, smell – has no pecularities, taste – typical for milk, density – 1.038, acidity – Turner’s 35°, fat – 3.2%. What is the quality level of this milk?

A. The milk is of high quality

B. The milk is falsificated

C. The milk is of reduced quality

D. The milk is of poor quality

E. The milk is nominally qualified

 

48. An 18 y.o. patient was admitted to the hematologic department with complaints of headache, general weakness, poor appetite, body temperature rise up to 39° C, neck swelling. Objectively: skin and mucous membranes are extremely pale, lymph nodes on the both sides of neck are up to 1 cm large, painless. Liver is enlarged +1 cm, painless, spleen +0.5 cm, t°- 38°C. Blood count: Hb – 98 g/L, RBC- 2,9*1012/L, leukocytes – 32*109/L, stab neutrophils – 0%, segmental leukocytes – 28%, monocytes – 2%, lymphocytes – 39%, blasts – 31%, reticulocytes – 31%, thrombocytes -120*109/L, ESR- 36 mm/h. What form of leukosis does the patient have?

A. Acute lymphoblastic leukosis

B. Chronic lympholeukosis

C. Acute myeloblasts leukosis

D. Chronic myeloleukosis

E. Undifferentiated leukosis

 

49. 8 hours after a road accident an unconscious victim with closed craniocerebral trauma was admitted to the hospital. Objectively: anisocoria, wound in the parietal region – 3.0 x 1,0 cm, neck muscles rigidity, Ps-58/min, tense. Convulsive syndrome. What is the most important indication for the immediate surgical procedure?

A. Wounds

B. Unconsciousness

C. Anisocoria

D. Intracranial hemorrhage

E. Intensification of convulsions

 

50. A 7 y.o. boy has been treated in a hospital for a month. At the time of admission he had evident edemata, proteinuria – 7.1 g/L, protein content in the daily urine – 4.2 g. Biochemical blood analysis reveals permanent hypoproteinemia (43,2 g/L), hypercholesterolemia (9.2 mmol/L). What variant of glomerulonephritis is the most probable?

A. Nephritic

B. Hematuric

C. Nephrotic

D. Mixed

E. Isolated urinary

 

51. People who live in the radiation polluted regions are recommended to include pectins into their dietary intake for the radioactive nuclides washout. What products is the main source of pectin’s?

A. Meat

B. Bread

C. Macaroni

D. Fruit and vegetables

E. Milk

 

52. A 31 y.o. patient has been suffering from systemic scleroderma for 14 years. She has been treated in hospital many times. She complains of occasional dull pain in the heart region, palpitation, dyspnea, headache, eye-lid edemata, weight loss and deformation of extremities joints. What organ affection worsens the disease prognosis?

A. Skin and joints

B. Heart

C. Gastrointestinal tract

D. Kidneys

E. Lungs

 

53. A 42 y.o. patient was admitted 3 hours after a trauma with evident subcutaneous emphysema of the upper part of his body, dyspnea, tachycardia 120/min. X-ray examination revealed no pneumothorax, significant dilatation of mediastinum to the both

sides. What emergency care is needed?

A. Toracoscopy

B. Drainage of anterior mediastinum

C. Toracotomy

D. Pleural cavity drainage

E. Pleural cavity punction

 

54. Studying of pulmonary tuberculosis incidence provided data about patients’ socioeconomic living conditions and bad habits. What method allows estimating the impact of these factors on tuberculosis incidence?

A. Calculation of reliability coefficient

B. Calculation of correlation coefficient

C. Calculation of regression coefficient

D. Standardized index calculation

E. Calculation of correspondence index

 

55. A pregnant woman (35 weeks), aged 25, was admitted to the hospital because of bloody discharges. In her medical history there were two artificial abortions. In a period of 28-32 weeks there was noted the onset of hemorrhage and USD showed a placental presentation. The uterus is in normotonus, the fetus position is transversal (1st position). The heartbeats is clear, rhythmical, 140 bpm. What is the further tactics of the pregnant woman care?

A. Stimulate the delivery by intravenous introduction of oxytocin

B. To keep the intensity of hemorrhage under observation and after the bleeding is controlled to prolong the pregnancy

C. To perform the hemotransfusion and to prolong the pregnancy

D. To perform a delivery by means of Cesarean section

E. To introduct the drugs to increase the blood coagulation and continue observation

 

56. A 28 y.o. woman consulted a doctor about edematic face, moderate legs edemata; occasionally her urine has colour of “meat slops”. When she was a teenager she often fell ill with angina. Objectively: skin is pallor, body temperature is 36.8°C, Ps – 68/min, rhythmic. AP — 170/110 mm Hg. What urine changes are the most probable?

A. Increase of relative density, hematuria, bacteriuria

B. Decrease of relative density, proteinuria

C. Erythrocyturia and urinozuria

D. Proteinuria, hematuria, cylindrouria

E. Decrease of relative density, proteinuria, and some urinary sediment

 

 

57. A 3 y.o. girl has had a temperature rise up to 38°C, rhinitis, dry superficial cough, flabbiness, appetite loss. Palpation didn’t reveal any changes over her lungs. Percussion sound has a wooden resonance, auscultation revealed puerile breathing, no rales. In blood: leukopenia, lymphocytosis, increased ESR. What is the most probable diagnosis?

A. Acute simple bronchitis

B. Recurrent bronchitis, acute condition

C. Acute obstructive bronchitis

D. -Acute simple tracheitis

E. Bilateral microfocal pneumonia

 

58. A 60 y.o. patient complains of having passing reduction of strength in his left extremities for a month. Some time later he has got persistent weakness of extremities in the mornings. Objectively: AP-140/90 mm Hg, conscious, central paresis of the VII and XII pair of left-side cranial nerves, central hemiparesis and hemihyperesthesia also on the left side. What medicines should be chosen for the differentiated treatment of the patient?

A. Corticosteroids

B. Hypotensive

C. Diuretics

D. -Anticoagulants

E. Hemostatics

 

59. A 28 y.o. patient without permanent residence was admitted to the hospital with the preliminary diagnosis influenza. On the fifth day of illness he got a maculopapular petechial rash on his body and internal surfaces of extremities. Body temperature is 41°C, euphoria, face hyperemia, sclera reddening, tongue tremor, tachycardia, splenomegaly, excitement. What is the most probable diagnosis?

A. Measles

B. Leptospirosis

C. Typhoid fever

D.- Epidemic typhus

E. Delirium alcoholicum

 

60. The doctors in maternity hospital made a newborn boy the following diagnosis: congenital heart disease (interventricular septal defect). At the age of 2 months the boy has got a dyspnea. Objectively: BR- up to 60/min, tachycardia up to 170/min, liver is 3 cm below the costal margin. What medicines must be immediately prescribed?

A. β-adrenoceptor blockers

B. Cardiac glycosides

C. Potassium preparations

D. Glucocorticoids

E. Nonsteroidal antiinflammatory drugs

 

61. A 38 y.o. woman suffers from paroxysmal AP rises up to 240/120 mm Hg accompanied by nausea, vomiting, tachycardia, excessive sweating. During the onset blood is hyperglycemic. After the onset there is voluminous urination. Kidneys sonography revealed accessory mass bordering upon the upper pole of the right kidney; presumably it belongs to the adrenal gland. What laboratory test will allow making a more precise diagnosis?

A. Estimation of thyroxin and thyrotropic hormon in blood

B. -Estimation of catecholamine and vanillylmandelic acid excretion with urine

C. Estimation of insulin and C-peptide content in blood

D. Estimation of renin content in blood

E. Estimation of glomerular nitration rate

 

62. 3 weeks ago a patient was ill with tonsillitis. Clinical examination reveals edema, arterial hypertension, hematuria, proteinuria (1.8 g/per day), granular and erythrocital casts. What is the preliminary diagnosis?

A. Renal amyloidosis

B. Intestinal nephritis

C. Pyelonephritis

D. Glomerulonephritis

E. Cystitis

 

63. A 28 y.o. woman consulted a doctor with the complaints of enlargening in size of an inborn pigment nevus; it was also wetting and itching. What test should not be used for diagnostics in this case?

A. Radioisotope diagnostics

B. Incision biopsy

C. Termography

D. Yaks’s reaction

E. Glass-print

 

64. A pregnant woman in her 8th week was admitted to the hospital for artificial abortion. In course of operation during dilatation of cervical canal of uterus by means of Hegar’s dilator, N° 8 the doctor suspected uterus perforation. What is the immediate tactics for confirmation of this diagnosis?

A. US examination

B. Laparoscopy

C. Metrosalpingography

D. Uterine probing

E. Bimanual examination

 

65. A child was born with body weight 3.250 g and body length 52 cm. At the age of 1.5 month the actual weight is sufficient (4.350 g), psychophysical development corresponds with the age. The child is breast-fed, occasionally there are regurgitations. What is the cause of regurgitations?

A. Pylorospasm

B. Esophageal atresia

C. Acute gastroenteritis

D. Aerophagia

E. Pylorostenosis

 

66. A 37 y.o. primigravida woman has been having labor activity for 10 hours. Labor pains last for 20-25 seconds every 6-7 minutes. The fetus lies in longitude, presentation is cephalic, and head is pressed upon the entrance to the small pelvis. Vaginal examination results: cervix of uterus is up to 1 cm long, lets 2 transverse fingers in. Fetal bladder is absent. What is the most probable diagnosis?

A. Primary uterine inertia

B. Discoordinated labor activity

C. Secondary uterine inertia

D. Pathological preliminary period

E. Normal labor activity

 

67. A 25 y.o. patient complains of body temperature rise up to 37°C, pain at the bottom of her abdomen and vaginal discharges. Three days ago, when she was in her 11th week of pregnancy, she had an artificial abortion. Objectively: cervix of uterus is clean; uterus is a little bit enlarged in size, painful. Appendages cannot be determined. Fornixes are deep, painless. Vaginal discharges are sanguinopurulent. What is the most probable diagnosis?

A. Postabortion uterus perforation

B. Pelvic peritonitis

C. Hematometra

D. Parametritis

E. Postabortion endometritis

 

68. A 70 y.o. patient complains of weakness, dizziness, short periods of loss of consciousness, pain in the region of heart. Objectively: HR- 40/min, sounds are rhytmic, the 1st sound is dull, occasionally very intensive. AP — 180/90 mm Hg. What is the most probable reason of hemodynamic disorders?

A. Sinus bradycardia

B. Complete block of the left branch of His bundle

C. I degree atrioventricular heart block

D.- III degree atrioventricular heart block

E. Bradysystolic form of the atrial fibrillation

 

69. A 37 y.o. patient complains of pain in the right arm which increases during motion, raised body temperature up to 39°C. In the right cubital fossa there is a trace of injection, hyperemia and thickening along the vein. Your diagnosis?

A. Abscess

B. Phlebit

C. Erysipelas

D. Inflammation of lymph

E. Phlegmon

 

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

A. Hemorrhagic diathesis

B. Marchiafava-Micheli’s disease

C. Hemophilia

D. Idiopathic thrombocytopenic purpura

E. Iron deficiency anemia

 

71. An 18 y.o. woman consulted a gynecologist about the pain in the lower part of abdomen, fever up to 37, 5°C, considerable mucopurulent discharges from the genital tracts, painful urination. Vaginal examination with mirrors: the urethra is infiltrated, cervix of the uterus is hyperemic, erosive. The uterus is painful, ovaries are painful, thickened; fornixes are free. Bacterioscopy test revealed diplococcus. What diagnosis is the most probable?

A. Trichomoniasis

B. Candydomycosis

C. Recent acute ascending gonorrhea

D. Chronic gonorrhea

E. Chlamydiosis

 

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

A. Haemophilia

B. Juvenile hemorrhage

C. Menarche

D. Werlhof’s disease

E. Endometrium cancer

 

73. A 32 y.o. patient lives in an endemic echinococcous region. For the last 6 months he has been having pain in the right hypochondrium, temperature rise. Echinococcus liver affection is suspected. What type of examination will be the most informative in this case?

A. USI examination

B. Biochemical laboratory analysis

C. Angiography

D. Plan radiography of abdominal cavity

E. Liver scanning

 

74. A 7 y.o. girl has mild form of varicella. Headache, weakness, vertigo, tremor of her limbs, ataxia, and then mental confusion appeared on the 5th day of illness. Meningeal signs are negative. Cerebrospinal fluid examination is normal. How can you explain these signs?

A. Meningitis

B. -Encephalitis

C. Neurotoxic syndrome

D. Meningoencephalitis

E. Myelitis

 

75. The results of a separate diagnostic curettage of the mucous of the uterus’ cervix and body made up in connection with bleeding in a postmenopausal period: the scrape of the mucous of the cervical canal revealed no pathology, in endometrium — the highly differentiated adenocarcinoma was found. Metastases are not found. What method of treatment is the most correct?

A. Radial therapy

B. Surgical treatment + chemotherapy

C. Surgical treatment and hormonotherapy

D. –

E. Surgical treatment and radial therapy

 

76. A 32 y.o. man is divorced, has an irregular sexual life. He complains of falling out of hair in the region of eyelashes, eyebrows, and scalp. Objectively: diffuse alopecia is observed, eyebrow margin is absent, eyelashes are stair-like (Pinkus’ sign). What examination should be carried out first of all?

A.CBC

B. Consultation of neuropathist

C. Detection of the nasal mucous membrane for Micobacterium Leprae Hansen

D. T.pallidum Immobilization Test (TPI)

E. Wasserman test, IFT

 

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

A. Continue with the current therapy

B. Prescribe long-acting insulin

C. Prescribe guanyl guanidines

D. Prescribe fast-acting insulin

E. Give Glurenorm in place of Maninilum

 

78. A 34 y.o. patient 3 hours ago was bitten by a dog. He has got a non-bleeding wound in his left arm caused by the dog’s bite. What surgical care would you provide to the patient?

A. Wound bathing with detergent water and antiseptic application

B. Cream bandage

C. Incomplete suturing of the wound

D. Complete suturing of the wound

E. Aseptic bandage

 

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

A. Gout

B. Osteoarthritis

C. Rheumatoid arthritis

D. Erysipelatous inflammation

E. Infectional arthritis

 

80. After manual reposition and application of plaster splint a patient with fractures of forearm bones had an edema of hand and fingers, he felt pain and lack of sensitivity. What tactics should the doctor choose?

A. To cut the bandage that fastens the splint

B. To prescribe analgetics and diuretics

C. It’s a natural phenomena, the edema will dissipate in a day

D. To repeat reposition

E. To remove the plaster

 

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

A. Recurrent bronchitis

B. Pulmonary hypoplasia

C. -Mucoviscidosis (cystic fibrosis)

D. Bronchial asthma

E. Bronchiectasis

 

82. A 38 y.o. man complains of having occasional problems with swallowing of both hard and fluid food for many months. Sometimes he feels intense pain behind his breast bone, especially after hot drinks. There are asphyxia onsets at night. He has not put off weight. Objectively: his general condition is satisfactory, skin is of usual colour. Examination revealed no changes of gastrointestinal tract. X-ray picture of thorax organs presents esophagus dilatation with level of fluid in it. What is the preliminary diagnosis?

A. Esophagus candidosis

B. Cancer of esophagus

C. Myastenia

D. Esophagus achalasia

E. Gastroesophageal reflux

 

83. The family doctor examined a patient and diagnosed an acute bleeding of an intestine. What is professional tactics of the doctor in this situation?

A. The urgent hospitalization in therapeutic department

B. Treatment at a day time hospital

C. Treatment at home

D. To inject intravenously the aminocapronic acid

E. The urgent hospitalization in surgical department

 

84. A 2 month old child who was born with body weight 5100 g has jaundice, hoarse cry, umbilical hernia, developmental lag. His liver is +2 cm, spleen isn’t enlarged. Stool and urine are of normal color. In anamnesis: delayed falling-away of umbilical rest. Blood count: Hb — 120 g/L, RBC – 4, 5 * 1012/L, ESR – 3 mm/h. General level of serum bilirubin – 28 mcmol/L, unconjugated bilirubin – 20 mcmol/L, conjugated bilirubin — 8 mcmol/L. What disease would you think about first of all?

A. Cytomegalovirus infection

B. Congenital thyreoid deficiency

C. Congenital hepatitis

D. Conjugated jaundice

E. Hemolitic anemia

 

85. An employee has been invalid for 6 months as a result of a hip fracture. Who has the right to authorize the issue of the medical sick-list for the last 2 months?

A. Head physician of the polyclinic

B. DCC

C. MSEC

D. DCC together with the head physician of a polyclinic

E. Deputy head physician on working capacity

 

86. A 56 y.o. patient has worked at the aluminum plant over 20 years. Within 3 last years he has got loosening of teeth, bone and joint pains, piercing pains in heart area, vomiting. The preliminary diagnosis is:

A. Mercury intoxication

B. Fluorine intoxication

C. Manganese intoxication

D. Lead intoxication

E. Phosphorus intoxication

 

87. A 42 y.o. woman suffers from micronodular cryptogenic cirrhosis. During the last week her condition has been worsening: she had spasms, consciousness aberration, and jaundice. What examination may account for the worsening of the patient’s condition?

A. Estimation of alanine aminotransferase and aspartate aminotransferase

B. Estimation of serum ammonia

C. Estimation of cholesterol esters

D. Estimation of α-fetoprotein content

E. Estimation of alkaline phosphatase level

 

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

A. Acute purulent sphenoiditis

B. Acute purulent frontitis

C.

D.- Acute purulent maxillary sinusitis

E. Acute purulent ethmoiditis

 

89. A 45 y.o. man has complained of having epigastric and right subcostal aching pain, pruritus, indigestion, dark color of the urine and acholic stool, fever and significant weight loss for 1 month. On examination: jaundice, presence of Curvuasier’s sign. US scan did not reveal stones in the gallbladder and choledochus. What is the most likely diagnosis?

A. Gallbladder stones

B. Cancer of the pancreas head

C. Chronic pancreatitis

D. Chronic cholangitis

E. Chronic hepatitis

 

90. A 35 y.o. woman consulted a doctor about occasional pains in paraumbilical and iliac region that reduce after defecation or passage of gases. Defecation takes place up to 6 times a day; stool is not solid, with some mucus in it. Appetite is normal; she has not put off weight. First such symptoms appeared 1.5 year ago, but colonoscopy data reveals no organic changes. Objectively: abdomen is soft, a little bit painful in the left iliac region. Blood and urine are normal. What is the preliminary diagnosis?

A. Irritable bowels syndrome

B. Dispancreatism

C. Celiac disease

D. Crohn’s disease

E. Pseudomembranous colitis

 

91. The Transcarpathian region is characterized by constant high (over 80%) air moisture. Population of this region feels an intense cold in winter when the temperature is temperately low. What way of heat emission becomes more active?

A. Irradiation

B. Radiation

C. Convection

D. Evaporation

E. Conduction

 

92. Vaginal inspection of a parturient woman revealed: cervix dilation is up to 2 cm, fetal bladder is intact. Sacral cavity is free, sacral promontory is reachable only with a bent finger, the inner surface of the sacrococcygeal joint is accessible for examination. The fetus has cephalic presentation. Sagittal suture occupies the transverse diameter of pelvic inlet, the small fontanel to the left, on the side. What labor stage is this?

A. Prodromal stage

B. Stage of fetus expulsion

C. Placental stage

D. Cervix dilatation stage

E. Preliminary stage

 

93. A 46 y.o. patient complains of skin itch, sweating, especially at night, body temperature rise up to 38,6°C. Objectively: chest skin has marks of scratching, supraclavicular lymph nodes are as big as a pigeon egg, and they are not matted together with skin. What test is the most reasonable?

A. Common blood count

B. Punction of an enlarged lymph node

C. Whole protein and protein fractions

D. Plan radiography of thorax

E. Immunogram

 

94. A 14 y.o. girl complains of profuse bloody discharges from genital tracts during 10 days after suppresion of menses for 1.5 month. Similiar bleedings recur since 12 years on the background of disordered menstrual cycle. On rectal examination: no pathology of the internal genitalia. In blood: Hb – 70 g/L, RBC – 2.3* 1012/L, Ht – 20. What is the most probable diagnosis?

A. Werlholf’s disease

B. Polycyst ovarian syndrome

C. Juvenile bleeding, posthemorrhagic anemia

D. Noncomplete spontaneous abortion

E. Hormonoproductive ovary tumor

 

95. Ambulance was called to a 48 y.o. man. According to the relatives he has had three episodes of lost consciousness and attacks during the day. Patient is unconscious, fell on the floor, tonic and then clonic convulsions of trunk and extremities happened. The attack lasted for 4 minutes, ended by involuntary urination. What type of attack was observed?

A. Vegetatic crisis

B. Major epileptic seizure

C. Episode of hysteria

D. Fainting

E. Absence

 

96. A patient has undergone an operation on account of perforated ulcer of stomach, terminal phase of diffuse peritonitis and endotoxic shock. In the post-operative period he is prescribed artificial pulmonary ventilation with 60% oxygen inhalation. Blood gases: PaO2– 70-78 mm Hg, hypoxemy doesn’t ecrease, CVP (central venous pressure) – 150-180 mm of water column, AP — 90/60 mm Hg (against the backgound of taking big doses of dopamine). Radiogram shows diffuse pulmonary infiltration. What cause the refractory arterial hypoxemia?

A. -Respiratory distress syndrome

B. Pneumothorax

C. Pulmonary edema

D. Mendelson’s syndrome

E. Bilateral pneumonia

 

97. A 32 y.o. woman has got the Laiel’s syndrome after taking the biceptol. What immunotrope medicines are to be prescribed in this situation?

A. Specific immune modulators

B. Interferons

C. Non-specific immune modulators

D. Steroid immunosupressants

E. Non-steroid immunosupressants

 

98. A patient has got a sudden attack of severe substernal pain at night. On examination: confusion, pallor of the skin, acrocyanosis, cold sweat, BP – 80/50 mm Hg, Ps – 120/min, irregular and weak pulse. What condition are these symptoms typical for?

A. Acute right-side heart failure

B.- Cardiogenic shock

C. Acute left-side heart failure

D. Acute vascular insufficiency

E. Radicular syndrome

 

99. A 49 y.o. female patient was admitted to the hospital with acute attacks of headache accompanied by pulsation in temples; increasing AP up to 280/140 mm Hg. Pheochromocytoma is suspected. What mechanism of hypertensive atack does this patient have?

A. Increasing of plasma renin activity

B. Increasing of thyroxine excretion

C. Increasing of aldosterone level in blood

D. Increasing of vasopressin excretion

E. Increasing of catecholamines concentration

 

100. A 60 y.o. patient complains of pain in interphalangeal joints of hand that gets worse during working. Objectively: distal and proximal joints of the II-IV fingers are defigured, with Heberden’s and Bouchard’s nodes, painful, stiff. X-ray picture of joints: joint spaces are constricted; there are marginal osteophytes, subchondral sclerosis. What is the most probable diagnosis?

A. Psoriatic arthritis

B. Rheumatic arthritis

C. Osteoarthritis

D. Bechterew’s disease

E. Reiter’s disease

 

101. A baby boy was born in time, it was his mother’s 1st pregnancy. The jaundice was revealed on the 2nd day of life, then it progressed. The adynamia, vomiting and hepatomegaly were presented. The indirect bilirubin level was 275 mcmol/L, the direct bilirubin level – 5 mcmol/L, Hb- 150 g/L. Mother’s blood group – 0(7), Rh+, child’s blood group – A(II), Rh+. Make a diagnosis.

A. Hemolytic disease of newborn (Rh -incompatibility)

B. Physiological jaundice

C. Hemolytic disease of newborn (ABO incompatibility), icteric type

D. Hepatitis

E. Jaundice due to conjugation disorder

 

102. A triad of symptoms (“stearing spot”, “terminal film”, “and blood dew”) have been revealed on examination of a patient. What disease should you think about?

A. Ritter’s disease

B. Vasculitis

C. -Psoriasis

D. Lichen ruber planus

E. Seborrhea

 

103. An 8 y.o. boy was ill with B hepatitis one year ago. In the last 2 months he has complaints of undue fatiguability, sleep disorder, appetite loss, nausea, especially in the mornings. Skin isn’t icterious, liver and spleen are 1 cm below the costal margins, painless. Alanine aminotransferase activity is 2.2 mcmol/L. How can this condition be estimated?

A. Residual effects of old viral hepatitis type B

B. Recurrance of viral hepatitis type B

C. Development of liver cirrhosis

D. -Development of chronic hepatitis

E. Biliary dyskinesia

 

104. A 4 y.o. child attends the kindergarten. Complains of poor appetite, fatigue. Objective examination: skin and mucous membrane are pale, child is asthenic. In the hemogram: hypochromatic anemia 1st, leucomoide reaction of the eosinophile type. What pathology must be excluded first of all?

A. Hypoplastic anemia

B. Atrophic gastritis

C. Duodenal ulcer

D. Lymphoprolipherative process

E. -Helminthic invasion

 

105. A patient of a somatic hospital has got psychomotor agitation as a result of high fever: he tried to run about the department; thought that some water was running down the walls, he pretended to see rats and cockroaches on the floor. Claimed he were in a hostel, recognized his “aquaintances”. After introduction of sedative drugs he fell asleep. In the morning he remembered this condition. What psychopathologic syndrome is it?

A. Maniacal syndrome

B. Twilight disorder of consciousness

C. Hallucinatory paranoid syndrome

D. Delirium

E. Oneiric syndrome

 

106. A 5 y.o. girl was by accident closed in a dark room for several minutes. When the door was opened, the child was standing motionless in the middle of the room staring at one point, her face had a look of terror, she didn’t respond to any stimuli. 40 minutes after her state changed into crying. On the next day she could remember nothing of this incident. What is the most probable mechanism of this reaction?

A. Psychogenic

B. Conditioned reflex

C. Endogenically organic

D. Exogenously organic

E. Endogenic

 

107. An employee had an abortion by medical indications on the 6.03.2001 and she stayed in a hospital till 17.03.2001. What term is the medical sick-list issued for?

A. For 4 days

B. For 12 days

C. For 3 days

D. For 11 days

E. For 10 days

 

108.     A 48 y.o. patient has been staying in the emergency department for 2 days on account of acute anteroseptal myocardial infarction. In the course of examination he suddenly “snored”. There was a tonic contraction of skeletal muscles; eye pupils dilatated. Pulse on a.carotis is absent. What is the immediate tactics?

A. Intracardiac introduction of adrenalin with atropine

B. -Electric defibrillation

C. Precardiac stroke

D. ECG record

E. Saphar’s triple airway maneuver

 

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

A. Cervical pregnancy

B. Leukoplakia

C. Polypus of the cervis of the uterus

D. Nascent fibroid

E. Cancer of cervix of the uterus

 

110. A 60 y.o. woman complains of unbearable pains in the right hypochondrium. In the medical history: acute pancreatitis. Body temperature is 38,2°C. Objectively: sclera icteritiousness. No symptoms of peritonium irritation are present. There are positive Ortner’s and Hubergrits-Skulski’s symptoms. Urine diastase is 320 g/h. What diagnosis is the most probable?

A. Chronic cholecystitis

B. Cancer of pancreas

C. Acute cholecystitis

D. Acute cholangitis

E. Chronic pancreatitis

 

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

A. No-shpa

B. Obsidan

C. Amisyl

D. Corglicone

E. Euphyline

 

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

A. Thecal whitlow (ligament panaritium)

B. Subcutaneous panaritium

C. Bone panaritium

D. Paronychia

E. Articular (joint) panaritium

 

113. A 51 y.o. patient complains of having intensive bloody discharges from vagina for 15 days after delay of menstruation for 2.5 months. In anamnesis: disorders of menstrual function during a year, at the same time she felt extreme irritability and had sleep disorders. US examination results: uterus corresponds with age norms, appendages have no pecularities, endometrium is 14 mm thick. What is the doctor’s tactics?

A. Supravaginal amputation of uterus without appendages

B.- Diagnostic curettage of uterine cavity

C. Conservative treatment of bleeding

D. Hysterectomy

E. TORCH-infection test

 

114. A girl is 12 y.o. Yesterday she was overcooled. Now she is complaining on pain in suprapubic area, frequent painful urination by small portions, temperature is 37, 8°C. Pasternatsky symptom is negative. Urine analysis: protein – 0.033 g/L, WBC- 20-25 in f/vis, RBC- 1-2 in f/vis. What diagnosis is the most probable?

A. Urolithiasis

B. Dysmetabolic nephropathy

C. Acute cystitis

D. Acute pyelonephritis

E. Acute glomerulonephritis

 

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

A. Right-sided oblique inguinal hernia

B. Varicose veins of the right hip

C. Lipoma of the right inguinal area

D. Right-sided femoral hernia

E. Right-sided direct inguinal hernia

 

116. The disease of a 21 y.o. patient began with raise of temperature up to 39.0°C, headache, chill, repeated vomiting. Rigidity of occipital muscles is determined. The analysis of liquor revealed: cytosis – 1.237 in 1 ml, including: 84% of neutrophils, 16% of lymphocytes. On bacterioscopy: gram-negative cocci are found in liquor. What is the most probable disease?

A. Secondary purulent meningitis

B. Meningococcal infection: serous meningitis

C. -Meningococcal infection: purulent meningitis

D. Infectious mononucleosis

E. Serous meningitis

 

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

A. Vesiculopustulosis

B. Ritter’s dermatitis

C. Pseudofurunculosis

D. -Newborn pemphigus

E. Sepsis

 

118. A 60 y.o. woman has had increased BP up to 210/110 mm Hg for the last 7 years. On examination: heart apex is displaced to the left. There are signs of left ventricular hypertrophy on ECG. What is the most probable diagnosis?

A. Cardiomyopathy

B. Essential hypertension, 1st stage

C. Symptomatic hypertension

D. Ischemic heart disease

E. -Essential hypertension, 2nd stage

 

119. A 58 y.o. woman had voluminous bleeding from the ruptured varicous node on the left crus. What first aid should be provided?

A. Z-shaped stitch on the raptured varicose node

B. Distal tourniquet

C. Heightened position of extremity, compressive sterile bandage

D. Proximal turniquet

E. Troyanov-Trendelenburg operation

 

120. A 10 y.o. boy was ill with angina 2 weeks ago, has complaints of joint pain and stiffness of his left knee and right elbow. There was fever (38.5°) and ankle disfunction, enlargement of cardiac dullness by 2 cm, tachycardia, weakness of the 1st sound, gallop rhythm, weak systolic murmur near apex. What diagnosis corresponds with such symptoms?

A. Reiter’s disease

B. Juvenile rheumatoid arthritis

C. -Acute rheumatic fever

D. Reactive arthritis

E. Systemic lupus erythematosis

 

121. A 32 y.o. patient who has been staying in a hospital on account of acute abscess of his right lung suddenly felt pain after coughing in the right half of thorax; he got heavy breathing, cyanosis. What complication is the most probable?

A. Infarction-pneumonia

B. Exudative pleurisy

C. Pyopneumothorax

D. Myocardial infarction

E. Esophagus perforation

 

122. A 15 y.o. patient has a developmental lag, occasionally he has skin yellowing. Objectively: spleen is 16x12x10 cm, cholecystolithiasis, skin ulcer of the lower third of left crus. Blood count: RBC – 3,0 * 1012/L, Hb – 90 g/L, C.I.-1,0; microspherocytosis, reticulocytosis. Total serum bilirubin is 56 mcmol/L, unconjugated – 38 mcmol/L. What therapy will be the most appropriate?

A. Spleen transplantation

B. Omentosplenopexy

C. Portacaval shunt

D.- Splenectomy

E. Omentohepatopexy

 

123. A 50 y.o. woman who suffers from chronic pyelonephritis was prescribed a combination of antibiotics for the period of exacerbation – gentamicin (80 mg 3 times a day) and biseptol (960 mg twice a day). What consequences may be caused by such a combination of antibiotics?

A. Acute suprarenal insufficiency

B. Chronic renal insufficiency

C. Glomerulosclerosis

D. Acute renal insufficiency

E. Antibiotic combination is optimal and absolutely safe

 

124. A 15 y.o. girl was examined. Her medical history registers gradual onset of fever, malaise, loss of weight. There was nothing typical about the kind of fever which has been present for more than 7-10 days and changed quickly. Physical examination didn’t give evident results. What is the only most important examination for excluding miliary tuberculosis?

A. Chest X-ray

B. Liver or bone marrow biopsy

C. Sputum smear and culture of m. tuberculosis

D. Bronchoscopy

E. Tuberculin skin testing

 

125. A 30 y.o. man complains of intense pain, skin reddening in the region of ankle joint, temperature rise up to 39°C. He fell ill suddenly. In the past there were such onsets that lasted for 5-6 days and didn’t cause any residual changes of the joint. The skin over the joint is hyperemic, without distinct outlines and infiltrative bank at the periphery. What is the most probable diagnosis?

A. Infectional arthritis

B. Erysipelatous inflammation

C. Osteoarthrosis

D. Gout

E. Rheumatoid arthritis

 

126. A 25 y.o. pregnant woman in her 34th week was taken to the maternity house in grave condition. She cpmplains of headache, visual impairment, nausea. Objectively: solid edemata, AP- 170/130 mm Hg. Suddenly there appeared fibrillary tremor of face muscles, tonic and clonic convulsions, breathing came to a stop. After 1.5 minute the breathing recovered, there appeared some bloody spume from her mouth. In urine: protein – 3.5 g/L. What is the most probable diagnosis?

A. Epilepsy

B. Cerebral edema

C. Cerebral hemorrhage

D. Eclampsia

E. Stomach ulcer

 

127. A 54 y.o. patient has been suffering from osteomyelitis of femoral bone for over 20 years. In the last month there appeared and gradually progressed edemata of lower extremities. Urine analysis: proteinuria – 6,6 g/L. Blood analysis: disproteinemia in form of hypoalbuminemia, increase of a2- and 7-globulins, ESR – 50 mm/h. What is the most probable diagnosis?

A. Myelomatosis

B. Acute glomerulonephritis

C. Systemic lupus erythematosus

D. Chronic glomerulonephritis

E. -Secondary renal amyloidosis

 

128. A 74 y.o. patient has been ill with benign prostate hyperplasy for the last 5 years. 4 days ago, after alcochol consumption, there was an acute retention of urination. At the pre-admission stage his urinary bladder was catheterized with metallic catheter. Examination revealed: right epididymis is enlarged, thick and painful; there are purulent discharges from urethra. What way of emergency care must be chosen?

A. Placing of intraprostatic stent

B. Transuretral resection or prostatectomy

C. Microwave thermotherapy of prostate

D. Trocar or open epicystostomy

E. Introduction of permanent urethral catheter

 

129. A 20 y.o. patient complains of amenorrhea. Objectively: hirsutism, obesity with fat tissue prevailing on the face, neck, upper part of body. On the face there are acne vulgaris, on the skin – striae cutis distense. Psychological and intellectual development is normal. Gynecological condition: external genitals are moderately hairy, acute vaginal and uterine hypoplasia. What diagnosis is the most probable?

A. Stein-Levental’s syndrome

B. Itsenko-Cushing syndrome

C. Shichan’s syndrome

D. Babinski-Froehlich syndrome

E. Turner’s syndrome

 

130. A 30 y.o. man complains of sharp pain in the right ear, hearing loss, high temperature for three days. Objectively: right ear whispering language — 0.5 m, external ear is intact, otoscopically – eardrum protrusion, hyperemia and swelling, loss of landmarks. What disease is it?

A. Acute purulent otitis media

B. Chronic purulent otitis media

C. Chronic secretory otitis media

D. Acute mastoiditis

E. Eustachian tube disfunction

 

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

A. Echocardiography

B. General blood count

C. Veloergometry

D. Transaminases of blood

E. Lipoprotein test

 

132. A 54 y.o. man was admitted to the hospital with complaints of sudden intense headache in occipital region and vomiting. In the medical history: moderate arterial hypertension, the patient was taking hydrochlorothiazide. Three days ago he consulted a therapeutist about intense headache that was suppressed by an analgetic. Objectively: consciousness is confused, left pupil is mydriatic. Evident photophobia and tension of neck muscles. Left-side hemiparesis with increased muscle tonus and reflexes. Body temperature is low, rash is absent. AP – 230/130 mm Hg, Ps — 50 bpm, BR – 12/min. What is your preliminary diagnosis?

A. -Acute subdural hematoma

B. Migraine

C. Myasthenia

D. Acute bacterial meningitis

E. Disseminated sclerosis

 

133. A 30 y.o. primigravida woman has got intensive labor pains every 1-2 minutes that last 50 seconds. The disengagement has started. The perineum with the height of 4 cm has grown pale. What actions are necessary in this situation?

A. Episiotomy

B. Perineum protection

C. Perineotomy

D. Expectant management

E. Vacuum extraction of fetus

 

134. A healthy 75 y.o. woman who leads a moderately active way of life went through a preventive examination that revealed serum concentration of common cholesterol at the rate of 5.1 mmol/L and HDL (high-density lipoproteins) cholesterol at the rate of 70 mg/dl. ECG reveals no pathology. What dietary recommendation is the most adequate?

A. Increase of cellulose consumption

B. Decrease of cholesterol consumption

C. Any dietary changes are necessary

D. Decrease of carbohydrates consumption

E. Decrease of saturated fats consumption

 

135. A 42 y.o. man who has been ill with duodenal ulcer for 20 years complains of getting a sense of heaviness in stomach after meal, foul-smelling eructation, vomiting, and weight loss. Objectively: his state is relatively satisfactory, tissue turgor is diminished. On palpation the belly is soft; there are no symptoms of peritenium irritation, “splashing sounds” in epigastrium. Defecation – once in 3 days. What complication corresponds with the patient’s state and described clinical presentations?

A. Ulcer penetration

B.- Ulcerative pyloric stenosis

C. Stomach cancer

D. Chronic pancreatitis

E. Concealed ulcer perforation

 

136. 47 y.o. patient complains of intensive skin itching, jaundice, bone pain. The skin is hyperpigmentated. There are multiple xanthelasma palpebrae. The liver is +6 cm enlarged, solid with acute edge. The blood analysis revealed total bilirubin – 160 mkmol/L, direct – 110 mkmol/L, AST – 2.1 mmol/L, ALT — 1.8 mmol/L, alkaline phosphotase — 4.6 mmol/L, cholesterol – 9.2 mmol/L, antimitochondrial antibodies M2 in a high titer. What is the probable diagnosis?

A.- Primary biliary liver cirrhosis

B. Primary liver cancer

C. Alcoholic liver cirrhosis

D. Chronic viral hepatitis B

E. Acute viral hepatitis B

 

137. A 32 y.o. woman has been suffering for 5 months from pain in lumbar region, low grade fever, frequent urination. Urine analysis: moderate proteinuria, leukocytes occupy the whole field of sight, bacteri-uria. Blood analysis: leukocytosis, increased ESR. What is the most probable diagnosis?

A. Chronic pyelonephritis

B. Urolithiasis

C. Acute glomerulonephritis

D. Chronic glomerulonephritis

E. Acute pyelonephritis

 

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

A. -Rubella

B. Pseudotuberculosis

C. Scarlet fever

D. Measles

E. Adenoviral infection

 

139. A 20 y.o. patient was admitted to the hospital with complaints of having skin and sclera icteritiousness, dark urine, single vomiting, appetite loss, body temperature rise up to 38°C for 2 days. Three weeks ago he went in for fishing and shared his dishes with friends. Objectively: the patient is flabby, t°- 36.8°C, skin and scleras are icteritious, liver sticks from under the costal margin by 3 cm, it is sensitive; spleen isn’t palpable. Urine is dark, stool is partly acholic. What is the most probable diagnosis?

A. Infectious mononucleosis

B. Virus A hepatitis

C. Leptospirosis

D. Intestinal yersiniosis

E. Hemolytic anemia

 

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

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

B. Conduct an inquiry by preliminary investigator of police department

C. Conduct forensic medical examination by district forensic medicine expert

D. Draw up a statement about forensic medical examination

E. Utilisation copy of medical documents

 

141. A 24 y.o. woman consulted a doctor about continued fever, night sweating. She lost 7 kg within the last 3 months. She had casual sexual contacts. Objectively: enlargement of all lymph nodes, hepatoli-enal syndrome. Blood count: leukocytes – 2.2* 109/L. What disease can be suspected?

A. Infectionous mononucleosis

B. HIV-infection

C. Tuberculosis

D. Chroniosepsis

E. Lymphogranulomatosis

 

142. A 26 y.o. woman complains of sudden pains in the bottom of abdomen irradiating to the anus, nausea, giddiness, bloody dark discharges from sexual tracts for one week, and the delay of menses for 4 weeks. Signs of the peritoneum irritation are positive. Bimanual examination: borders of the uterus body and its appendages are not determined because of sharp painfullness. The diverticulum and painfullness of the back and dextral fornixes of the vagina are evident. What is the most probable diagnosis?

A. Acute right-side adnexitis

B. Torsion of the crus of the ovary tumor

C. Acute appendicitis

D. Apoplexy of the ovary

E. Broken tubal pregnancy

 

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

A. Hormone investigation

B. Diagnostic scraping out of the uterine cavity

C. Ultra sound investigation

D. Hysterosalpingography

E. Hysteroscopia

 

144. A 70 y.o. man is ill with ischemic heart disease. His mood is evidently depressed, anxious. As a result of continuous sleeplessness he has got fears, suicidal thoughts. He would sit for a long time in the same pose, answer after a pause, in a low, monotonous voice. His face has a look of suffering, pain, fear. What is the main psychopathologic syndrome?

A. Asthenic syndrome

B. Depressive syndrome

C. Obsessive syndrome

D. Phobic syndrome

E. Paranoid syndrome

 

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

A. Mesenterial vessels thrombosis

B. Acute intestinal obstruction

C. Volvulus

D. Ichemic abdominal syndrome

E. Erysipelas

 

146. A 35 y.o. male patient suffers from chronic glomerulonephritis and has been treated with hemodialysis for the last 3 years. He has got irregularities in the heart activity, hypotension, progressive weakness, dyspnea. On ECG: bradycardia, 1st degree atrioventricular block, high sharpened T-waves. Some time before he had seriously broken the water consumption and dietary pattern. What is the most likely cause of these changes?

A. -Hyperkaliemia

B. Hypocalcemia

C. Hypernatremia

D. Hyperhydratation

E. Hypokaliemia

 

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

A. Anthrax

B. Tularemia

C. Acute purulent lymphadenitis

D. Lymphogranulomatosis

E.- Bubonic plague

 

148. For the persons who live in a hot area after an accident at a nuclear object, the greatest risk within the first decade is represented by cancer of:

A. Thyroid gland

B. Lungs

C. Skin

D. Reproduction system organs

E. Breast

 

149. Plan radiography of the patient’s abdominal cavity reveals some hemispherical lucent areas situated above distinct horizontal levels. What is the cause of such X-ray picture?

A. Meteorism

B. Intestinal obstruction

C. Price’s disease

D. Cancer of large intestine

E. Perforative ulcer

 

150. A 34 y.o. patient has been suffering from pulmonary tuberculosis for 7 years; he complains of muscle weakness, weight loss, diarrhea, frequent urination. Objectively: hyperpigmentation of skin, gums, internal surface of cheeks. AP – 90/58 mm Hg. Blood count: RBC- 3.1 * 1012/L, Hb – 95 g/L, C.I. – 0.92; leukocytes – 9.4 * 109/L, eosinophils — 7, segmentonuclear leukocytes – 45, stab neutrophils -1, lymphocytes — 40, monocytes – 7, Na+ – 115 mmol/L, K+ – 7,3 mmol/L. What is the preliminary diagnosis?

A. Pheochromocytoma

B. Congenital adrenocortical hyperplasia

C. Diabetes insipidus

D. -Primary adrenocortical insufficiency

E. Primary hyperaldosteronism

 

151. A 50 y.o. patient was admitted to the

hospital with complaints of blood in urine. There was no pain or urination disorders, hematuria has lasted for 3 days. Objectively: kidneys are not palpable, suprapubic region has no pecularities, external genitals have no pathology. Rectal examination revealed: prevesical gland is not enlarged. Cytoscopy revealed no changes. What disease would you think about first of all?

A. Varicocele

B. Kidney dystopy

C. Tuberculosis of urinary bladder

D. Necrotic papillitis

E. Cancer of kidney

 

152. A 52 y.o. patient complains of dyspnea caused even by moderate physical activity, cough with hardly secreted sputum. He has been ill for 12 years. Objectively: BR — 26/min. Lung examination: tympanitis, diminished vesicular breathing with prolonged expiration, disseminated dry rales. In the past he was taking only theopecym or aminophylline inravenously. Prescribe him the basic treatment after the exacerbation is suppressed:

A. Inhacort

B. Tilade

C. Aminophylline

D. Alupent

E. -Atrovent

 

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

A. Bronchial asthma

B. Aspergillosis

C. Bronchoectatic disease

D. Chronic obstructive lung disease

E. Mucoviscidosis (cystic fibrosis)

 

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

A. A traumatologist

B. An anaesthesilogist

C. A surgeon

D. A doctor of any speciality

E. A laboratory physician

 

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

A. Chronic lympholeucosis

B. Lymphogranulomatosis

C. Tuberculous lymphadenitis

D. Chronic myeloleucosis

E. Acute leucosis

 

156. A 2 m.o. child was delivered in time with weight 3.500 g and was on the mixed feeding. Current weight is 4.900 g. Evaluate the current weight of the child:

A. Hypotrophy of the I grade

B. Hypotrophy of the II grade

C. Corresponding to the age

D. 150 g less than necessary

E. Paratrophy of the I grade

 

157. Examination of a hanged man’s corpse revealed the following: livores mortis disappear when pressed, restore in 50 seconds, rigor mortis is moderately evident only in masseteric muscles, neck muscles and fingers. Body temperature is 31.0°C. What is the prescription of death coming?

A. 10-18 hours

B. 16-24 hours

C. 8-10 hours

D. 1-2 hours

E. 6-7 hours

 

158. A 27 y.o. man complained of aching epigastric pain right after meal, heartburn and nausea. Stomach endoscopy revealed a large amount of mucus, hyperemia and edema of mucous membrane in gastric fundus with areas of atrophy. Make a diagnosis.

A. Chronic gastritis of type A

B. Chronic gastritis of type B

C. Peptic ulcer of stomach

D. Menetrier’s disease

E. Chronic gastritis of type C

 

159. Examination of a 32 y.o. patient who had apendectomy because of gangrenous appendicitis revealed clinical picture of pelvic abscess. What is the best way to expose pelvic abscess of this patient?

A. Through the obturator foramen

B. Through the postoperative wound

C. Through the anterior abdominal wall

D. By means of the sacral approach

E. Through the rectum

 

160. A 43 y.o. patient had cholecystectomy 6 years ago because of chronic calculous cholecystitis. Lately he has been suffering from pain in the right subcostal area and recurrent jaundice. Jaundice hasn’t gone for the last 2 weeks. Stenoutic papillitis 0.5 cm long has been revealed. What is the best way of treatment?

A. To perform choledochoduodenostomy

B. To perform transduodenal papillosphincterotomy

C. To perform endocsopic papillosphincterotomy

D. To perform external choledoch drainage

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

 

161. A 43 y.o. patient complains of formation and pain in the right mammary gland, rise of temperature up to 37.2°C during the last 3 months. Condition worsens before the menstruation. On examination: edema of the right breast, hyperemia, retracted nipple. Unclear painful infiltration is palpated in the lower quadrants. What is the most probable diagnosis?

A. Cancer of the right mammary gland

B. Right-side acute mastitis

C. Premenstrual syndrome

D. Right-side chronic mastitis

E. Tuberculosis of the right mammary gland

 

162. A 67 y.o. patient complains of dyspnea, breast pain, and common weakness. He has been ill for 5 months. Objectively: t°- 37.3°C, Ps – 96/min. Vocal tremor over the right lung cannot be determined, percussion sound is dull, breathing cannot be auscultated. In sputum: blood diffusively mixed with mucus. What is the most probable diagnosis?

A. Focal pulmonary tuberculosis

B. -Cancer of lung

C. Bronchoectatic disease

D. Macrofocal pneumonia

E. Exudative pleuritis

 

163. A patient has complained of great weakness for 6 years. He fell seriously ill, the illness is accompanied by body temperature rise, indisposition, pain in joints and along the legs muscles. Objectively: violet-bluish erythema around eyes and over knee joints. HR — 120/min, heart sounds are weak. Blood count: leukocytes – 12 * 109/L, ESR – 40 mm/h. What is the most probable diagnosis?

A. Rheumathoid arthritis

B. -Dermatomyositis

C. Systemic lupus erythematosus

D. Atopic dermatitis

E. Reactive polyarthritis

 

164. A 61 y.o. man complained of sneezing and substernal pain on exertion. In the last 2 weeks such pain appeared at rest, with increased frequency, and couldn’t be suppressed by 1 tablet of nitroglycerin. What is the most likely diagnosis?

A. Unstable angina pectoris

B. Myocarditis

C. Radiculitis

D. Angina pectoris of a new onset

E. Stable angina pectoris of the III functional class

 

165. A 30 y.o. woman is in her second labor that has been lasting for 14 hours. Fetal heartbeats are muffled, arrhythmic, 100/min. Vaginal examination results: cervical dilatation is complete, fetal head is close to the exit of small pelvis. Sagittal suture has the direct diameter; small crown is close to the pubis. What is the further tactics of labor management?

A. Use of obstetrical forceps

B. Labor stimulation by means of oxitocine

C. Craniodermal forceps

D. Use of cavity forceps

E. Cesarean section

 

166. According to results of medical and pedagogical observation during the gymnastics lesson in the 9th grade there was plotted a phisiological curve characterized by gradual increasing of pulse rate during the opening part of lesson, 80% increase during the main part; the curve has 4 waves. How can the lesson’s structure be assessed?

A. Long interval between exercises

B. Exercise stress is adequate

C. The lesson’s structure is correct

D. Exercise stress is insufficient

E. Exercise stress is excesive

 

167. A 2,5 m.o. child has got muscle hypotony, sweating, occipital alopecia. Along with massage and therapeutic exercises the child was prescribed vitamin D. What dosage and frequency are correct?

A. 3000IU every day

B. 500IU every day

C. 500 IU every other day

D. 1000 IU every day

E. 1000 IU every other day

 

168. In course of herniotomy of a 12 y.o. patient doctors revealed a testicle in the hernial sac. What type of hernia is it?

A. Obturator hernia

B. Direct inguinal hernia

C. Femoral hernia

D. Congenital oblique inguinal hernia

E. Acquired oblique inguinal hernia

 

169. A 29 y.o. woman is critically ill. The illness is presented by high fever, chills, sweating, aching pain in lumbar area, and discomfort during urination and frequent voiding. Pasternatsky’s sign is positive in both sides. On lab examination: WBC – 20*109/L; on urine analysis: protein – 0.6 g/L, leukocyturia, bacteriuria. Yaear preliminary diagnosis.

A. Nephrolithiasis

B. Acute glomerulonephritis

C. Exacerbation of chronic pyelonephritis

D. Acute cystitis

E. Acute pyelonephritis

 

170. A mother of a 5 y.o. girl consulted a doctor about doughter’s involuntary urination at night, nightmares, sleep disorders, slow gaining of body weight. Objectively: malnutrition, intellectual development is good; the girl can read and explains common situations quite adultly. Her skin is very pale, liver is enlarged in size. Her mother suffers from holetithiasis. What type of diathesis is the most probable in the child’s case?

A. Allergic diathesis

B. Gouty diathesis

C. Exudative diathesis

D. Urine acid diathesis

E. Lymphohypoplastic diathesis

 

171. A 23 y.o. patient has a gunshot wound of his left arm. The bones of the arm are not damaged. What appropriate surgical care must be provided to the patient?

A. Aseptic dressing of the wound

B. Primary surgical processing with a flowing suction

C. Wound saturing

D. Wound saturing and drying

E. Wound drying with towel gauzes

 

172. A 15 year old adolescent was taken to the hospital with complaints of poor night vision. Objectively: increased darkness adaptation time, Bitot’s spots on conjuctiva. The patient’s skin is dry, scales off; folliculitis signs of the face skin are present. What is the cause of this disease?

A. Biotin deficit

B. Thiamine deficit

C. Retinole deficit

D. Napthtochynones deficit

E. Folic acid deficit

 

173. It is determined that 30 of a 100 women with risk factor had preterm labor, and of a 100 women without risk factor 5 women had preterm labor. What method of statistic data processing should the doctor use in order to estimate reliability of differences between the compared groups?

A. Correlation analysis

B. Standardization method

C. Student’s criterion calculation

D. Average computing

E. Relative numbers calculation

 

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

A. Bed resources of the hospital

B. Average bed idle time

C. Bed turnover

D. Average annual bed occupancy

E. Average duration of patients’ presence in the hospital

 

175. A district doctor was commisioned with a task to work out a plan of treatment-and-prophylaxis actions for the population of his district. What actions of secondary prophylaxis must he include into this plan?

A. Prevention of disease complications

B. Elimination of disease causes

C. Improvement of population’s living conditions

D. Disease prevention

E. Rehabilitation actions

 

176. A 33 y.o. patient with first time detected diabetes mellitus keeps the diet and maintains glycemia at the level of 10,0 mmol/L after meal. He keeps himself from insuli-notherapy. What examination is the most important for differentiation of the 1st (insulin-dependent) and the 2nd (insulin-independent) types of diabetes?

A. Glucose-tolerant test

B. Determination of insular cells antibodies

C. Glycemia examination on an empty stomach

D. Estimation of glucolized blood hemoglobin

E. Fructosamine estimation

 

177. A 28 y.o. patient complains of pain in legs during walking, chill of feet and toes. He has been ill for a year. Objectively: leg skin is pale, cool; turgor is decreased, hypotrichosis. Femoral and popliteal artery pulsation is weak; it is palpable on the foot arteries only after nitroglycerine test. Rheographic index is <1. What is the most probable diagnosis?

A. Raynaud’s disease

B. Buerger’s disease

C.- Obliterating endarteritis

D. Chronic thrombophlebitis

E. Obliterating aterosclerosis

 

178. A patient was admitted to the hospital with complaints of occasional pains at the bottom of abdomen that get worse during menses, weakness, indisposition, nervousness, some dark bloody discharges from vagina on the day before and the day after menses. Bimanual examination results: body of womb is enlarged, appendages cannot be determined, posterior fornix has tuberous surface. Laparoscopy results: ovaries, peritoneum of rectouterine pouches and pararectal fat are covered with “cyanotic spots”. What is the most probable diagnosis?

A. Ovarian cystoma

B. Genital organs tuberculosis

C. Polycystic ovaries

D. Chronic salpingitis

E. -Widespread form of endometriosis

 

179. A 5 tons milk batch was sampled. The lab analysis revealed: fat content 2%, specific density – 1.04 g/cm3, acidity – 21°T, reductase probe – weak-positive. What way is the product to be used in?

A. Discard for animal feeding

B. Do the product away

C. Sell but inform customers about milk quality

D. Technical utilization

E. Sell without limitations

 

180. A 12 y.o. girl took 2 pills of aspirine and 4 hours later her body temperature raised up to 39 — 40°C. She complains of general indisposition, dizziness, sudden rash in form of red spots and blisters. Objectively: skin lesions resemble of second-degree burns, here and there with erosive surface or epidermis peeling. Nikolsky’s symptom is positive. What is the most probable diagnosis?

A. Bullous dermatitis

B. Polymorphous exudative erythema

C. Duhring’s disease

D. Acute epidermal necrolisis

E. Pemphigus vulgaris

 

181. A 63 y.o. woman complains of moti veless weakness, rapid fatigability, loss of appetite, aversion to meat. Two days ago she had stomach bleeding. Objectively: temperature – 37.5°C, BR – 20/min, Ps-96/min, AP – 110/75 mm Hg. On palpation in epigastrium – pain and muscle tension. Blood count: Hb – 82 g/L, ESR- 35 mm/h. What examination will allow making a diagnosis?

A. Stomach content examination

B. Coprology

C. Radiography

D. Endoscopy

E. -Cytologic

 

182. A boy of 7 y.o. had an attack of asthma and distant whistling rales after playing with a dog. In the medical hystory: atopic dermatitis caused by eating eggs, chicken, beef. What group of allergens is the reason of the development of bronchial asthma attacks?

A. Chemical

B. Epidermal

C. Dust

D. Itch mite

E. Pollen

 

183. A patient at a doctor complains of temperature rise up to 38,2°C, edema in the region of his upper lip. Objectively: upper lip is evidently edematic, in the middle of edema there is a cone-shaped swelling. Skin and mucous membrane over it are dark-red. Diagnosis: labial furuncle. A surgeon cut the furuncle, treated the wound with hydrogen peroxide solution and applied a bandage with hypertensive solution. What therapeutic regimen should be recommended?

A. First out-patient treatment, then outpatient treatment

B. Out-patient treatment

C.

D. In-patient treatment with bed rest

E. In-patient treatment with common regimen

 

184. A 7 y.o. boy suddenly felt pain in his right knee, it became edematic. The day before he took part in a cross-country race. Family anamnesis has no data about hemophilia and bleeding sickness. Objectively: body temperature is 37.5°C. The knee is painful, hot to the touch, edematic with local tissue tension over it. Blood count: Hb — 123 g/L, leukocytes — 5.6*109/L,thrombocytes — 354 * 109/L, prothrombin time — 12 seconds (normally 10-15 seconds), partly activated thromboplastin time – 72 seconds (normally 35-45 seconds). Hemorrhage time is normal, VIII: C factor is 5% of norm. What is the most probable diagnosis?

A. Hemophilia B

B. Thrombocytopenia

C. Schoenlein-Henoch disease

D. Vitamin K deficiency

E. -Hemophilia A

 

185. A boy, aged 9, was examined: height – 127 cm (- 0.36), weight – 28.2 kg (+0,96), chest circumference – 64.9 cm (+0,66), lung vital capacity – 1.520 ml (-0,16). What is the complex assessment of the child’s physical development?

A. Apparently disharmonious

B. Below the average

C. Harmonious

D. Excessive

E. Disharmonious

 

186. A 36 y.o. woman is in the 12-th week of her first pregnancy. She was treated for infertility in the past. She contacted a child who fell ill with rubella 2 days after their meeting. Woman doesn’t know if she has ever been infected with rubella. What is the adequate tactics?

A. Fetus wastage

B. Immunoglobulin injection

C. Interferon prescription

D. Monitoring of the specific IgG IgM with the ELISA

E. Cyclovin prescription

 

187. A 33 y.o. patient, works as a secretary. Her diet contains 150 g of protein (including 100 g of animal protein), 200 g of fat, and 600 g of carbohydrates. What pathology can result from this diet?

A. Common cold

B. Uterine fibromyoma

C. Obesity

D. Schizophrenia

E. Paradontosis

 

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

A. Manual exploration of the uterine cavity

B. Use of hemostatic medications

C. Urine drainage, cold on the lower abdomen

D. Use of uterine contracting agents

E. External massage of uterus

 

189. A 40 y.o. patient complains of yellowish discharges from the vagina. Bimanual examination: no pathological changes. The smear contains Trichomonas vaginalis and blended flora. Colposcopy: two hazy fields on the front labium, with a negative Iodum test. Your tactics:

A. Specific treatment of Trichomonas colpitis

B. Diathermocoagulation of the cervix of the uterus

C. Cryolysis of cervix of the uterus

D. Treatment of specific colpitis and with the subsequent biopsy

E. Cervix ectomy

 

190. A full-term newborn child has a diagnosis Rh-factor hemolytic disease of newborn. Bilirubin rate is critical. The child’s blood group is B(III), his mother’s blood group – A(II). The child has indication for hemotransfusion. What donor blood must be chosen?

A. Blood group A(II), Rh (-)

B. Blood group A(II), Rh (+)

C. Blood group B(III), Rh (-)

D. Blood group O(I), Rh (-)

E. Blood group B(III), Rh (+)

 

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

A. The head of department

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

C. Deputy head physician on the working ability expertise

D. Working ability expertise committee

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

 

192.     A 50 y.o. male patient was taken to the emergency department with diffuse abdominal pain and signs of cardiovascular collapse. On arrival he had BP – 95/60 mm Hg, Ps- 120/min, diuresis – 20 ml/h, HgB -100 g/L, RBC- 2.1 * 1012/L. The patient needs introduction of:

A. Crystalloid and 5% dextrose

B. 5% dextrose and colloid

C. 5% dextrose and red blood cells

D. Crystalloid and red blood cells

E. -Crystalloid and colloid

 

193. Ambulace brought to the hospital a patient with acute respiratory viral infection. The illness began suddenly with temperature rise up to 39.9°C. He complains of headache in frontotemporal lobes, pain in eyeballs, aching of the whole body, nose stuffiness, sore throat, dry cough. At home he had a nasal hemorrhage twice. What type of acute respiratory viral infection is it?

A. RS-infection

B. Parainfluenza

C. -Influenza

D. Enterovirus infection

E. Adenoviral infection

 

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

A. Mucoviscidosis (cystic fibrosis)

B. Disaccharidase insufficiency

C. Intestinal dysbacteriosis

D. -Celiakia (celiac disease)

E. Chronic enteritis

 

195. A 40 y.o. patient with rheumatic heart disease complains of anorexia, weakness and loss of weigth, breathlessness and swelling of feet. The patient had tooth extraction one month ago. On examination: t°- 39°C, Ps – 100/min. Auscultation: diastolic murmur in the mitral area. Petechial lesion are round of clavicle; spleen was palpable.

A. Recurrence of rheumatic fever

B. Thrombocytopenia purpura

C. Mitral stenosis

D. Aortic stenosis

E.- Subacute bacteria endocarditis

 

196. Examination of a just born placenta reveals defect 2 x 3 cm large. Hemorrhage is absent. What tactic is the most reasonable?

A. Prescription of uterotonic medicines

B. Instrumental uterus cavity revision

C. Parturient supervision

D. Manual uretus cavity revision

E. External uterus massage

 

197. A 76 y.o. woman complains of progressing swallowing disorder, mostly she has had problems with solid food for the last 6 weeks. Sometimes she has regurgitation of solid masses. Swallowing is not painful. She lost 6 kg. 10 years ago she had myocardiac infarction, she takes constantly aspirine and prolonged nitrates. She consumes alcohol in moderate proportions, smokes. Objectively: icteric skin, neck has no pecularities, lymph nodes are not enlarged. Thorax has no changes, cardiovascular system has no evident changes. Liver is +3 cm. What is the preliminary diagnosis?

A. Diaphragmatic hernia

B. Esophageal achalasia

C. Myasthenia

D. Diffuse constriction of esophagus

E. Cancer of esophagus

 

198. A 52 y.o. patient fell from 3 m height on the flat ground with the right lumbar area. He complains of pain in this area. There is microhematuria in the urea. Excretory urography revealed that kidney’s functioning is satisfactory. What is the most probable diagnosis?

A. Subcapsular kidney’s rupture

B. Kidney’s contusion

C. Kidney’s abruption

D. Paranephral hematoma

E. Multiple kidney’s ruptures

 

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

A. The radial diagram

B. The linear diagram

C. The figured diagram

D. The sector diagram

E. Curvilinear diagram

 

200. An 18 y.o. patient complains of painfulness and swelling of mammary glands, headaches, irritability, edemata of lower extremities. These symptoms have been present since the begin of menarche, appear 3-4 days before regular menstruation. Gynecological examination revealed no pathology. What is the most probable diagnosis?

A. Neurasthenia

B. Premenstrual syndrome

C. -Mastopathy

D. Renal disease

E. Disease of cardiovascular system

Year 2005

Posted: May 5, 2012 in Krok II
Tags:

 

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

A. Periventricular hemorrhages

B. *Subarachnoid hemorrhages

C. Small hemorrhages in brain tissue

D. Subdural hemorrhages

E. Haemorrhages in ventricles of brain

 

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

A. *Thromboembolia of pulmonary artery

B. Myocardial infarction

C. Hemorrhagia

D. Valvular pneumothorax

E. Hypostatic pneumonia

 

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

A. Hypertensive illness of the II degree

B. *Chronic nephritis with violation of kidney function

C. Nephrotic syndrome

D. Stenosis of kidney artery

E. Feochromocitoma

 

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

A. *Influenza with cerebral edema manifestations

B. Parainfluenza

C. Influenza, typical disease duration

D. Respiratory syncytial virus

E. Adenovirus infection

 

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

A. Hyperkaliemia

B. *Hypoglycemia

C. Hyperbilirubinemia

D. Hypomagnesemia

E. Hypocalcemia

 

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

A. Duhring’s disease

B. Pemphigus vulgaris

C. Bullous dermatitis

D. *Acute epidermical necrolysis

E. Polymorphic exudative erythema

 

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

A. Optico – hiasmatic arachnoiditis

B. Tumor of pondo-cerebellar corner

C. Encephalitis of truncus

D. Adrenal gland tumor

E. *Adenoma of hypophysis

 

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

A. *In 2 hours

B. In 0,5 hours

С. In 3 hours

D. In 6 hours

E. In 1 hour

 

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

A. Aortic valve insufficiency

B. *Mitral stenosis

C. Mitral valve insufficiency

D. Opened arterial duct

E. Pulmonary artery stenosis

 

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

A. Selecting of materials

B. *Questioning

C. Interviewing

D. A method of the directed selection

E. Statistical

 

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

A. Uterine rupture

B. Incipient abortion

C. Threatened premature labor

D. Premature placental separation

E. *Placental presentation

 

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

A. *Irritable bowel syndrome

B. Atonic colitis

C. Colitis with hypertonic type dyskinesia

D. Spastic colitis

E. Chronic enterocolitis, exacerbation phase

 

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

A. Freshcitrated blood

B. Erythrocyte emulsion

C. Erythrocyte mass (native)

D. *Washed erythrocytes

E. Erythrocyte mass poor for leucocytes and thrombocytes

 

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

A. Reactive polyarthritis

B. *Rheumatism, polyarthritis

C. Systemic lupus eritematodes

D. Rheumarthritis

E. Infectious-allergic polyarthritis

 

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

A. *Septic shock

B. Bronchial obstruction

C. Emphysema

D. Toxic hepatitis

E. Exudative pleuritis

 

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

A. Hyperosmolar coma

B. *Hypoglycemic coma

C. Hyperlactacidotic coma

D. Hyperglycemic coma

E. Stroke

 

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

A. Morning exercises on the fresh air

B. Bath with hydromassage

С. *Contrast shower

D. Walking on the fresh air

E. Hygienic shower

 

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

A. Absolute values

B. Standart values

C. *Relative values

D. Dynamic row

E. Average values

 

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

A. Cushing’s syndrome

B. Acute pancreatitis

C. Deylads’s syndrome

D. Kutling’s syndrome

E. *Cardiac insufficiency

 

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

A. Viral encephilitis

B. Hip joint arthritis

C. *Polyomyelitis

D. Polyartropathy

E. Osteomyelitis

 

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

A. Agranulocytosis

B. Vincent’s angina

C. Oropharyngeal candidosis

D. Infectious mononucleosis

E. *Larynx dyphtheria

 

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

A. Sphygmography

B. Phonocardiography

C. *Echocardiography

D. X-ray

E. Coronarography

 

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

A. Chlamydiosis

B. Chronic gonorrhea

C. *Recent acute ascending gonorrhea

D. Candydomycosis

E. Trichomoniasis

 

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

A. Frequent skin washing with detergents

B. *Use of neutral creams to protect skin

C. Systematic use of local corticosteroids

D. Systematic skin disinfection

E. Avoidance of skin insolation

 

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

A. Tuberculosis of right mammary gland

B. Right side acute mastitis

C. *Cancer of right mammary gland

D. Right side chronic mastitis

E. Premenstrual syndrome

 

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

A. *Probing of uterus cavity

B. Laparoscopy

C. Metrosalpingography

D. Ultrasound examination

E. Bimanual examination

 

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

A. Chronic gastritis

B. Gastric peptic ulcer

C. *Gastroesophageal reflux

D. Acute erosive gastritis

E. Duodenal peptic ulcer

 

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

A. *Measles

B. Rubella

C. Adenovirus infection

D. Enterovirus exanthema

E. Scarlet fever

 

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

A. Endometrium cancer

B. *Menarche

C. Werlhof ‘s disease

D. Juvenile haemorrhage

E. Haemophilia

 

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

A. Blood glucose

B. Determination of dermographism

C. *Examination of rash elements scrape

D. Examination for helmints

E. Serologic blood examination

 

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

A. Septic arthritis

B. *Juvenile rheumatic arthritis

C. Toxic synovitis

D. Rheumatism

E. Osteoarthrits

 

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

A. Skin and joints

B. Heart

C. Gastro-intestinal tract

D. Lungs

E. *Kidneys

 

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

A. *Bony

B. Hypodermic

C. Tendon type

D. Paronychia

E. Joints type

 

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

A. Polycyst ovarian syndrome

B. Werlholf’s disease

C. Hormonoproductive ovary tumor

D. *Juvenale bleeding, posthemorrhagic anemia

E. Noncomplete spontaneous abortion

 

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

A. Erysipelatous inflammation

B. Infectional arthritis

C. *Gout

D. Osteoarthritis

E. Rheumatoid arthritis

 

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

A. Increases heart output

B. Increases erythropoetin production

C. Infibits deppresive action of prostaglandins

D. Increases renine level

E. *Intensifies production and secretion of aldosterone

 

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

A. Obliterating endarteritis

B. Buerger’s disease (thromboangiitis obliterans)

C. *Arteriosclerosis obliterans

D. Raynauld’s disease

E. Hemoral arthery thombosis

 

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

A. Barbiturism

B. *Cocainism

С. Nicotinism

D. Cannabism

E. Morphinism

 

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

A. Polypus of the cervix of the uterus

B. Cervical pregnancy

C. *Cancer of cervix of the uterus

D. Leukoplakia

E. Nascent fibroid

 

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

A. Conservative treatment with following surgery

B. Deferred surgery

C. Conservative treatment

D. *Urgent surgery

E. Taylor’s treatment

 

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

A. Epilepsy

B. *Tetanus

C. Tetania

D. Meningoencephalitis

E. Hemorrhagic stroke

 

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

A. Prematurity

B. Infection of a fetus

C. Delay of an intra-uterine fetation

D. Placental detachment •«

E. *Chronic fetoplacental insufficiency

 

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

A. Centralized

B. Mixed

C. *Centralized and blocked

D. Decentralized

E. Blocked

 

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

A. Primary burn shock

B. Secondary burn shock

C. Acute burn toxemia

D. Convalescence

E. *Septicotoxemia

 

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

A. Infectious mononucleosis

B. *HIV-infection

C. Lymphogranulomatosis

D. Tuberculosis

E. Chroniosepsis

 

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

A. Increasing of plasma renin activity

B. *Increasing of catecholamines concentration

C. Increasing of vasopressin excretion

D. Increasing of aldosterone level in blood

E. Increasing of thyroxine excretion

 

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

A. Obstetrical forseps

B. Stimulation of the labor activity

C. Conservative tactics of labor

D. Vacuum extraction of the fetus

E. *Caesarean section

 

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

A. *Fluconozol, Orungol, Nisoral

B. Cytosar, Cormyctin, Lomycitin

С. Rubomycin, Bleomycin, Mytomycin С

D. Captopril, Enalapril

E. Isoniazid, Ftibazid, Pyrazinamid

 

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

A. Symptomatic therapy

B. *Surgical drainage of the pleural cavity

C. Thoracotomy

D. Pleural puncture

E. Antiinflammation therapy

 

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

A. Rain water

B. Water from melted snow

C. Spring water

D. River water

E. *Artesian well water

 

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

A. To administer betablockers

B. To add mercasolil to the treatment

C. *То decrease thyroxine dosage

D. To increase thyroxine dosage

E. To administer sedatives

 

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

A. *Essential arterial hypertension

B. Polycystic disease of the kidneys

C. Chronic pyelonephritis

D. Cushing’s disease

E. Chronic glomerulonephritis

 

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

A. Trichinellosis

B. *Leptospirosis

C. Yersiniosis

D. Salmonellosis

E. Brucellosis

 

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

A. Euphyline

B. Amisyl

C. No-shpa

D. Corglicone

E. *Obsidan

 

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

A. Abdominal typhoid

B. Alcogolic delirium

C. Leptospirosis

D. *Typhus

E. Measles

 

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

A. Allergic reaction

B. Pyrogenous reaction

C. Anaphylactic shock

D. *Citrate intoxication

E. Citrate shock

 

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

A. Treat with claritine

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

C. Apply ointment with corticosteroids to affected skin areas

D. Administer general ultraviolet irradiation

E. Refer to prescribe dermathologist

 

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

A. Scleroderma

B. Meningoencephalitis

C. *Addisonic crisis

D. Acute gastroenteritis.

E. Pellagra

 

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

A. Cystic fibrosis (mucoviscidosis)

B. «-antitrypsin deficiency

C. *Kartagener syndrome

D. Bronchiolitis obliterans

E. Laryngotracheomalacia

 

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

A. *Inevitable abortion

B. Complete abortion

C. Disfunctional bleeding

D. Incipient abortion

E. Incomplete abortion

 

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

A. Immunologic investigation

B. *Chest X-ray

C. Blood gases

D. Proteinogram

E. Blood test

 

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

A. Levomicytine

B. Aminocapron acid

C. Imodium

D. Contrykal

E. *Pancreatine

 

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

A. Abnormalities in genital development

B. Genital endometriosis

C. Immunologic infertility

D. Chronic adnexitis

E. *Anovular menstrual cycle

 

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

A. Intestinal dysbacteriosis

B. Mucoviscidosis (cystic fibrosis)

C. *Celiakia (celiac disease)

D. Disaccharidase insufficiency

E. Chronic enteritis

 

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

A. Diagnostic scraping out of the uterine cavity

B. Ultra sound investigation

C. *Hysterosalpingography

D. Hormone investigation

E. Hysteroscopia

 

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

A. A ambulatory medical card

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

C. The inpatient medical record

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

E. The sick-leave certificate

 

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

A. Tuberculous lymphadenitis

B. Chronic myeloleucosis

C. Lymphogranulomatosis

D. Acute leucosis

E. *Chronic lympholeucosis

 

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

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

B. Child death case during first 7 days of life

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

D. Child death case on labor

E. Child death case after 28 days of life

 

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

A. *Mercury

B. Chrome

C. Iron

D. Cadmium

E. Strontium

 

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

A. Cardiac asthma

B. Pulmonary artery thromboembolia

C. Cardiac tamponade

D. *Cardiogenic shock

E. Disquamative aortic aneurizm

 

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

A. *Paget’s disease

B. Myeloma

C. Hyperparathyoid dystrophy

D. Chronic osteomyelitis

E. Mottled disease (marble disease)

 

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

A. *Acute myocarditis

B. Rheumatism, mitral insufficiency

C. Climacteric myocardiodystrophia

D. Ichemic heart disease, angina pectoris

E. Hypertrophic cardiomyopathy

 

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

A. Continuation of investigation

B. *Cardiosurgeon consultation

C. Dispensary observation

D. Administration of therapeutic treatment

E. Exemption from physical exercises

 

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

A. Deputy head physician on the working ability expertise

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

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

D. The head of department

E. Working ability expertise committee

 

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

A.  Juvenile rheumatoid arthritis, systemic type

B. *Systemic lupus erythematosus

C. Dermatomyositis

D. Acute rheumatic fever

E. Periarteriitis nodosa

 

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

A. Stomach tumor

B. Tricuspid valve insufficiency

C. Mitral insufficiency

D. Arterio-venous aneurism

E. *Abdominal aortic aneurism

 

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

A. Cytolytic

B. Asthenic

C. Mesenchymal inflammatory

D. Liver-cells insufficiency

E. *Cholestatic

 

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

A. Shunting

B. Developing of cardiac insufficiency

C. Depositing of blood in venous channel

D. *Increase of bleeding speed

E. Presence of hypervolemia

 

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

A. Gastro-intestinal disease prevention

B. *Strict following of feeding regimen

C. Feces observation

D. Common cold prophilaxis

E. Hardening of the child

 

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

A. Essential hypertension

B. Allergic dermatitis

C. *Erythremia

D. Systemic sclerodermia

E. Dermatomyositis

 

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

A. Pseudofurunculosis

B. Vesiculopustulosis

C. *Newborn pemphigus

D. Ritter’s dermatitis

E. Sepsis

 

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

A. Kreon

B. *Sulfasalasine

C. Linex

D. Vikasolum

E. Motilium

 

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

A. Hypotrophy of I grade

B. *Corresponding to the age

C. 150 g less than necessary

D. Paratrophy of I grade

E. Hypotrophy of II grade

 

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

A. Acute cholecystitis

B. Right-sided renal colic

C. Acute bowel obstruction

D. *Perforative ulcer

E. Acute appendicitis

 

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

A. *Spasmophilia, tonic spasms

B. Meningoencephalitic reaction, clonic and tonic spasms

C. Meningism, clonic and tonic spasms

D. Cerebral haemorrhage, tonic spasms

E. Anaphylactic shock, clonic spasms

 

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

A. *IgE

B. IgM

C. lgA

D. IgJ

E. Circulating immunocomplexes

 

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

A. Medication sleep, amniotomy, labour stimulation

B. Fetal hypoxia treatment, conservative delivery

C. *Caesarean section

D. Amniotomy,  labour stimulation, fetal hypoxia treatment

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

 

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

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

B. Intellectual efforts

C. *Maximun load weigh which is shifted

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

E. Value of static loading for the shift

 

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

A. Brain tumour

B. Spastic cerebral palsy

C. Skull injury

D. Hydrocephalus

E. *Encephalopathy due to hyperbilirubi­nemia

 

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

A. Markedly disharmonious

B. Excessive

C. *Harmonious

D. Disharmonious

E. Below the average

 

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

A. Pseudotuberculosis

B. Measles

C. *Rubella

D. Scarlet fever

E. Adenoviral infection

 

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

A. *Out-patient treatment

B. *Admission to the mental hospital

C. Strict home supervision

D. Admission to’ the nu erological department

E. Psychotherapeutic conversation

 

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

A. *Dried plasma

B. Fresh frosen blood

C. *Fresh frosen plasma

D. Native plasma

E. Cryoprecipitate

 

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

A. Ulcer of duodenum, complicated with bleeding

B. Acute myocardial infarction, abdominal form

C. Erosive gastritis

D. Acute pleurisy

E. *Ulcer of stomach, complicated with bleeding

 

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

A. Use of hemostatic medications

B. Urine drainage, cold at lower abdomen

C. *Manual exploration of the uterine cavity

D. Use of uterine contracting agents

E. External massage of uterus

 

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

A. Parturient supervision

B. Instrumental uterus cavity revision

C. *Manual uterus cavity revision

D. External uterus massage

E. Administration of uterotonic medicines

 

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

A. Mortality of district newborn

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

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

D. Mortality of district adolescents

E. Hospital mortality of children, structured by age

 

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

A. Utilize technically

B. *Sell but inform customers about milk

C. Write the product off for animal feeding

D. Annihilate the product

E. Sell without limitations

 

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

A. Mild condition

B. *Moderate severity condition

C. Asthmatic status

D. Serious condition

E. Intermittent flow

 

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

A. Complication of liver echinococcosis

B. Pulmonary tuberculosis

C. *Abscess of the lung

D. Actinomycosis of lungs

E. Bronchiectatic disease

 

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

A. *Air aspiration from the pleural cavity

B. Oxygen inhalation

C. Call for cardiologic team

D. Epinephrine introduction

E. Euphilline introduction

 

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

A. Recurrence of rheumatic fever

B. Mitral stenosis

C. Thrombocytopenia purpure

D. *Subacute bacteria endocarditis

E. Aortic stenosis

 

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

A. *Right-sided direct inguinal hernia

B. Right-sided oblique inguinal hernia

C. Varicose veins of the right hip

D. Lipoma of the right inguinal area

E. Right-sided femoral hernia

 

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

A. *Exudative pleuritis

B. Infarction-pneumonia

C. Cirrhotic tuberculosis

D. Spotaneous pneumothorax

E. Atelectasis of lung

 

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

A. Valve-likes pneumothorax

B. Open pneumothorax

C. Closed pneumothorax

D. *Pericardium tamponade

E. Massive hemothorax

 

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

A. There is no RI

B. RI of obstructive type

C. RI of mixed type with prevailing restriction

D. *RI of mixed type with prevailing obstruction

E. RI of restrictive type

 

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

A. Examination for fungi

B. Examination for trichomoniasis

C. Examination for gonorrhea

D. Examination for neuropathology

E. *Examination for HIV

 

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

A. *Acute cystitis

B. Dysmetabolic nephropathy

C. Acute pyelonephritis

D. Urolithiasis

E. Acute glomerulonephritis

 

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

A. Twist of cystoma of right uterine adiiexa

B. *Impaired extrauterine pregnancy

C. Acute appendicitis

D. Ovarian apoplexy

E. Acute salpingoophoritis

 

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

A. Spondyloarthropatia on the background of Reiter’s disease

B. Tuberculous spondylitis

C. Psoriatic spondyloarthropatia

D. *Ancylosing spondyloarthritis

E. Spread osteochondrosis of the vertebral column

 

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

A. Inner glomal artery ligation

B. Uterine vessels ligation

C. *Uterine extirpation

D. Supravaginal uterine amputation

E. Putting clamps on the uterine cervix

 

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

A. *Discomfortable microclimate

B. Non-effective ventilation

С. Poor lighting

D. All conditions are OK

E. High level of noise

 

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

A. Stimulators

B. Neuroleptics

C. Tranquillisers

D. Antidepressants

E. *Nootropics

 

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

A. The radial diagram

B. The figured diagram

С. *The linear diagram

D. The sector diagram

E. The curvilinear disgram

 

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

A. Ichemic abdominal syndrome

B. Volvulus

C. Erysipelas

D. Acute intestinal obstruction

E. *Mesenterial vessels thrombosis

 

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

A. Lobar pneumonia

B. Bronchiectatic illness

C. Pneumonia complicated by an abscess

D. *Gangrene of lung

E. Tuberculosis

 

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

A. Maintenance of pregnancy till delivery term

B. Pregnancy interruption at 24-25 weeks

C. Pregnancy interruption after urine normalization

D. Maintenance of pregnancy till 36 weeks

E. *Immediate pregancy interruption

 

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

A. Hemophilia

B. Iron deficiency anemia

C. Marchiafava-Micheli’s disease

D. *Idiopathic thrombocytopenic purpura

E. Hemorrhagic diathesis

 

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

A. B2-hypovitaminosis

B. В6-hypovitaminosis

C. *A-hypovitaminosis

D. C-hypovitaminosis

E. В1 -hypovitaminosis

 

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

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

A. Esophageal hemorrhage

B. *Perforation of esophagus with mediastinitis

C. Obstruction of esophagus

D. Aspirative pneumonia

E. Pulmonary atelectasis

 

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

A. *Aortic stenosis

B. Defect of interventricular septum

C. Defect of interatrial septum

D. Open aortic duct

E. Coarctation of the aorta

 

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

A. Preliminary stage

B. Placental stage у

C. Expulsion of fetus stage V

D. *Cervix dilation stage

E. Prodromal stage

 

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

A. *Exchange blood transfusion

B. Phenobarbital

С Intestinal sorbents

D. Infusion therapy

E. Phototherapy

 

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

A. Seromucoid

B. *Antistreptolysine-0

C. Creatinkinase

D. 1-antitrypsine

E. Rheumatic factor

 

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

A. Early diagnostics

B. *Immunization of the population

C. Detection of carriers

D. Hospitalization of patients

E. Disinfection in disease focus

 

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

A. *Acute purulent maxillary sinusitis

B. –

C. Acute purulent ethmoiditis

D. Acute purulent frontitis

E. Acute purulent sphenoiditis

 

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

A. Light coefficient

B. Depth of study room

C. Time of the room insolation

D. Presence of mixed (upper-lateral) light

E. *Natural light coefficient

 

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

When should she be given maternity leave?

A. *8 August

B. 5 September

C. 22 August

D. 25 July

E. 11 July

 

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

A. Stress-echocardiogram

B. *Coronarography

С. Esophageal electrocardiac stimulator

D. Test with dosed physical exercises

E. Myocardial scintigraphy

 

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

A. *Punction and drainage of pleural cavity

B. Decortication of pleura

С. Lobectomy

D. Pneumoectomy

E. Thoracoplasty

 

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

A. *Syndrome of fermentative dyspepsia

B. Dyskinesia syndrome

С Syndrome of fatty dyspepsia

D. Malabsorption syndrome

E. Syndrome of decayed dyspepsia

 

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

A. Stimulation of the labor activity with oxitocyne

B. Ceasarian section

C. Application of obstetrical cavity forceps

D. *Application of obstetrical forceps

E. Application of craniodermal forceps by Ivanov’s

 

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

A. Hemolytic disease of newborn

B. Bile ducts atresia

C. Physiologic jaundice

D. *Brain delivery trauma

E. Fetal hepatitis

 

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

A. Right shin syphilis

B. Right shin tuberculosis

C. Bone cyst of tibia

D. Right shin trauma

E. *Right shin osteomielitis

 

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

A. Articular (joint) panaritium

B. Subcutaneous panaritium

C. Bone panaritium

D. Paronychia

E. *Thecal whitlow (ligament panaritium)

 

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

A. Reflux -‘gastritis

B. Gastritis of A type

C. Rigid antral gastritis

D. *Gastritis of type В

E. Menetrier’s disease

 

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

A. *Obesity

B. Hyperglycemia

C. Arterial hypertension

D. Hypercholesterolemia

E. Hyperuricemia

 

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

A. Typhus

B. Sepsis

C. Leptospirosis

D. *Abdominal typhoid

E. Brucellosis

 

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

A. *Esophagogastroduodenoscopy with biopsy

B. Ultrasound examination of abdomen

С. pH-metry

D. Ureatic test

E. Stomach X-ray

 

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

A. *Bubonic plague

B. Acute purulent lymphadenitis

C. Anthrax

D. Tularemia

E. Lymphogranulomatosis

 

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

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

B. A baby dead at birth

C. A baby dead at the age over 28 days

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

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

 

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

A. 3rd group

B. 1st group

C. 4th group

D. 5th group

E. *2nd group

 

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

A. Vegetatic crisis

B. Fainting

C. Episode of hysteria

D. *Major epileptic seizure

E. Absence

 

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

A. *Acute pancreatitis

B. Acute appendicitis

C. Acute enterocolitis

D. Renal colic

E. Perforated gastric ulcer

 

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

A. Transaminases of blood

B. General blood count

C. *Bicycle ergometry

D. Blood lipoproteins

E. Echocardiography

 

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

A. Congenital pneumonia

B. *Edematous-hemorrhagic syndrome

С. Hyaline membrane disease

D. Pulmonary edema

E. Disseminated intravascular clotting syndrome

 

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

A. II degree

B. IV degree

C. Ill degree

D. *I degree

E. V degree

 

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

A. Viral

B. Virus-bacterial

C. Neurogenic

D. *Autoimmune

E. Bacterial

 

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

A. Ceftriaxon

B. Lasix

C. *Zovirax

D. Hemodesis

E. Glucocorticoids

 

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

A. *Intervertebral ligaments disorder

B. Myelopathy

C. Polyneuritis

D. Spinal cord tumor

E. Arachnomielitis

 

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

A. Compulsive neurosis

B. Depressive neurosis

C. Schizophrenia

D. Ipochondric neurosis

E. *Neurasthenia

 

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

A. Phosphoric acid

B. Sulfuric acid

C. Acetic acid

D. Hydrochloric acid

E. *Uric acid

 

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

A. Antibiotics

B. NSAID

C. Calcium antagonists

D. Diuretics

E. *Corticosteroids

 

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

A. *Paroxismal ventricular tachycardia

B. Atrial flutter

C. Atrial tachycardia

D. Sinus tachycardia

E. Ventricular extrasystole

 

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

A. Atlanto-axial sublaxation of cervical spine

B. Sensory peripheral neuropathy

C. Rheumatoid vasculitis

D. Rheumatoid arthritis without complication

E. *Carpal tunnel syndrome

 

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

A. Average longevity

B. *Morbidity, disabilities, demographic, physical development

С Way of life, genetic, pollution

D. Social welfare, satisfaction of life quality

E. Average treatment duration, complications

 

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

A. Chronic fibrous thyroiditis

B. Chronic autoimmune thyroiditis, hypertrophic type

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

D. Diffuse euthyroid goitre of the 3rd degree

E. Toxiferous adenoma of the thyroid gland

 

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

A. Acute bronchiolitis with respiratory distress

B. Bronchopneumonia without complications

C. Acute epiglottitis

D. *Acute  infectious croup due to viral laryngotracheitis

E. Acute laryngitis

 

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

A. Average annual bed occupacy

B. Average bed idle time

C. Average duration of patients presence in the hospital

D. *Bed turnover

E. Bed resources of the hospital

 

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

A. Tuberculosis of lungs

B. *Central cancer of lungs

C. Pleuropneumonia

D. Pulmonary infarction

E. Bronchiectasia

 

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

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

A. Carbuncle associated with anthrax

B. *Carbuncle

С. Skin abscess

D. Acute skin cellulitis

E. Furuncle

 

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

A. Rightside kidney colic

B. Acute cholecystitis

C. *Acute appendicitis

D. Perforated ulcer

E. Acute pancreatitis

 

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

A. Pyelonephritis

B. Cystitis

С. Intestinal nephritis

D. Renal amyloidosis

E. *Glomerulonephritis

 

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

A. *Pregnant women

B. Patients after 60

C. Workers of industrial enterprises

D. Patients after operation

E. All children

 

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

A. Emphysematous gall-bladder

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

C. *Jaundice

D. Empyema of the gall-bladder

E. Gall-bladder perforation

 

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

A. Cerebral tumor

B. Hemorrhagic stroke

C. Transitory ischemic attack

D. Epidural hematoma

E. *Ischemic stroke

 

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

A. *Kidney’s contusion

B. Subcapsular kidney’s rupture

C. Paranephral hematoma

D. Kidney’s abruption

E. Multile kidney’s ruptures

 

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

A. Chlamydiosis

B. Gonorrhea

С. Bacterial vaginosis

D. *Trichomonas colpitic

E. Vagina candidomicosis

 

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

A. Spontaneous abortion which has begun

B. Stopped pregnancy

С. Hydatid molar pregnancy

D. *Threatened spontaneous abortion

E. Placenta presentation

 

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

A. Urinary incontinence

B. Pollakiuria

С. *Paradoxal ischuria

D. Dysuria

E. Enuresis

 

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

A. Aspergillosis

B. Mucoviscidosis (cystic fibrosis)

C. Bronchoectatic disease

D. *Chronic obstructive lung disease

E. Bronchial asthma

 

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

A. MRI of the brain

B. *Ultrasound dopplerography

С. Electroencephalography

D. Cerebral angiography

E. CT of the brain

 

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

A. Bronchoalveolar lavage

B. *Thorax roentgenography

C. Spirography

D. Blood gases examination

E. Bronchoscopy

 

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

A. Right eye’s keratitis

B. Right eye’s uveitis

C. *Acute glaucoma attack

D. Eye nerve’s neuritis

E. Maculodystrophy

 

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

A. *Primary biliary liver cirrhosis

B. Primary liver cancer

C. Acute viral hepatitis В

D. Chronic viral hepatitis В

E. Alcoholic liver cirrhosis

 

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

A. *Hyperkaliemia

B. Hyperhydratation

C. Hypokaliemia

D. Hypocalcemia

E. Hypernatremia

 

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

A. Diphtheria

B. *Peritonsillar abscess

C. Vincent’s disease

D. Pharyngeal tumor

E. Phlegmonous tonsillitis

 

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

A. *Fluorine intoxication

B. Mercury intoxication

C. Manganese intoxication

D. Phosphorus intoxication

E. Lead intoxication

 

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

A. Bronchial asthma

B. Recurrent bronchitis

C. Bronchiectasis

D. Pulmonary hypoplasia

E. *Mucoviscidosis (cystic fibrosis)

 

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

A. Atherosclerotic (lacunar) dementia

B. *Senile dementia

С Presenile melancholia

D. Dissociated personality (psychopathy)

E. Behavior disorder

 

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

A. Splenic rupture

B. Bladder rupture

C. Small intestines rupture

D. *Stomach rupture

E. Liver rupture

 

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

A. 15-20%

B. 6-9%

С. 35-50%

D. *25-30%

E. 10-14%

 

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

A. Choanal atresia

B. Tracheal atresia

C. Laryngomalacia

D. *Esophageal atresia

E. Respiratory distress syndrome

 

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

A. The right to be heard

B. The right to the protection from incompetence

C. The right to the information

D. The right to the free choice

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

 

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

A. Observation

B. Perineum protection

C. Vacuum extraction of the fetus

D. Perineotomy

E. *Episiotomy

 

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

A. Prescribe guanyl guanidines

B. *Prescribe fast-acting insulin

C. Continue with the current therapy

D. Prescribe long-acting insulin

E. Give Glurenorm in place of Maninilum

 

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

A. Cervical pregnancy

B. Fibromatous node which is being born

C. Cancer of body of uterus

D. *Cancer of cervix of uterus

E. Polypose of cervix of uterus

 

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

A. Common cold

B. Uterine fibromyoma

C. Schizophrenia

D. *Obesity

E. Paradontosis

 

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

A. *Prevalence rate

B. Index of compliance

C. Correlation coefficient

D. Incidence rate

E. Index of visualization

 

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

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

B. Issued a medical certificate of a free form

C. *Issued regardless of company’s ownership

D. Issued only to empties of state-owned companies

E. Issued a medical certificate of a set form

 

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

A. Replacement of marrow elements with fibrous tissue

B. Presence of blast cells

C. Prevalence of megaloblasts

D. *Replacement of marrow elements with adipose tissue

E. Absolute lymphocytosis

 

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

A. *Chronic myeloleucosis

B. Urolithiasis

C. Hepar cirrhosis

D. Leukemoid reaction

E. Lymphogranulomatosis

 

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

A. Gangrene of lungs

B. Chronic bronchitis

C. Pneumonia

D. Tuberculosis

E. *Bronchiectasia

 

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

A. *To perform endocsopic papillosphincterotomy

B.-

C. To perform choledochoduodenostomy

D. To perform external choledoch drain

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

 

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

A. 1000IU every other day

B. 500 IU daily

С. 1000 IU daily

D. *3000 IU daily

E. 500 IU every other day

 

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

A. To administer tocolytic therapy

B. To interrupt pregnancy

C. To administer hormonal treatment

D. To perform amniocentesis

E. *To place suture on the uterus cervix

 

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

A. *Corrosive esophagitis and stricture

B. Cardiac achalasia

C. Esophageal diverticula

D. Cardiac insufficiency

E. Esophagitis

 

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

A. A surgeon

B. An anaesthesilogist

C. A laboratory physician

D. A traumotologist

E. *A doctor of any speciality

 

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

A. Intubation

B. Analgetics

C. Intravenous infusions

D. Oxigenotherapy

E. *Pleural cavity drainage

 

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

A. Perforation

B. Haemorrhage

С. Stenosis

D. Penetration

E. *Malignisation

 

Year 2004

Posted: May 5, 2012 in Krok II
Tags:

 

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

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

 

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

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

 

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

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

 

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

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

 

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

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

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

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

 

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

B. *I degree

A. Ill degree

C. IV degree

D. II degree

E. V degree

 

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

D. *Cephalotomy

A. Forceps delivery

B. Vacuum extraction of the fetus

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

E. Turning of the fetus by Braxton-Hicks

 

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

B. *Uterus cancer

A. Hydatidiform mole

C. Uterus fibromyoma

D. Inferior genital endometriosis

E. Chorioepithelioma

 

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

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

 

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

E. *Scarlet fever

A. Enteroviral infection

B. Rubella

C. Pseudotuberculosis

D. Measles

 

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

C. *Acute lead intoxication

A. Acute hemolysis

B. Fatty degeneration of liver

D. Acute pancreatitis

E. Acute alcohol intoxication

 

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

B. *Rachitis

A. Paraophji

C. Anaemia

D. Hypotrophy

E. Spasmophilia

 

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

E. *Pelvic ring discontinuity

A. Sacral fracture

B. Ischial bones fracture

C. Retroperitoneal haematoma

D. Traumatic injury of intrapelvic organs

 

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

E. *Cavernous hemangioma

A. Lymphangioma

B. Congenital vascular macula

C. Angiofibroma

D. Nevus pigmentosis

 

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

C. *Immunisation of the population

A. Dismrection in disease focus

B. Hospitalisation of patients

D. Early diagnostics

E. Detection of carriers

 

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

D. *Hypospady without hypospady

A. Induratio penis plastica (Peyronie’s disease)

B. Latent penis

C. Cryptorchidism

E. Epispadia of balanus

 

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

E. *Rubella

A. Pseudotuberculosis

B. Measles

C. Scarlet fever

D. Adenoviral infection

 

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

E. *Prescribe fast-acting insulin

A. Continue with the current therapy

B. Prescribe guanyl guanidines

C. Give Glurenorm in place of Maninilum

D. Prescribe long-acting insulin

 

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

D. *Pulmonary fat embolism

A. Acute anaemia

B. Cardiac infarction, cardiogenic shock

C. Pulmonary thromboembolism

E. Pain shock

 

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

D. *Respiratory distress-syndrome

A. Bilateral pneumonia

B. Mendelson’s syndrome

C. Pulmonary edema

E. Pneumothorax

 

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

B. *8

A. 20

C. 10

D. 6

E. 12

 

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

B. *Leptospirosis

A. Brucellosis

C. Salmonellosis

D. Trichinellosis

E. Yersiniosis

 

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

C. *Infiltrative tuberculosis

A. Decaying cancer

B. Focal tuberculosis

D. Tuberculoma

E. Pneumonia with abscess formation

 

23. A patient, aged 50, during 15 years is ill with essential hypertension, not under treatment. BP – 220/140 mm Hg, Ps – 80 bmp, rhythmic. On percussion: the left heart border is 2 cm to the outside from the left midclavicular line. Sound 1 is moderately weakened. Sound 2 is accentuated over the pulmonary artery. What changes will be characteristic on ultrasound heart examination?

C. *Hypertrophy and dilatation of the left ventricle

A. Blood regurgitation through the mitral valve

B. Blood regurgitation through the aortic valve

D. Hypertrophy and dilatation of the right ventricle

E. Dilatation of the left atrium

 

24. A female patient, aged 25, is hospitalized due to exudative pericarditis. Complains of shortness of breath, weakness, compression in the chest. Believes that she got ill 2 weeks ago, after common cold. What peculiarity found during examination will tell about chronic pericardium affection?

E. *Signs of pericardium calcification

A. Lowering of ECG voltage

B. Significant heart tissue dilation, pulsation weakening

C. Heart sounds deafening

D. Signs of haemostasia in greater circulation

 

25. Woman in childbirth, 25 years old, the second period of labour. 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

 

Year 2003

Posted: May 5, 2012 in Krok II
Tags:

 

1. A 38-year-old patient has been treated in a hospital. A fever of 39°C, chest pain which is worsened by breathing, cough, brownish sputum appeared on the 7th day of the treatment. Chest X-ray shows left lower lobe infiltrate. Which of the following is the treatment of choice for this patient?

D. *Cephalosporins of the III generation

A. Erythromycin

B. Streptomycin

C. Penicillin

E. Tetracycline

 

2. A 32-year-old woman developed the Laiel’s syndrome after taking the biceptol. What immunotrope remedies are indicated in this situation?

A. *Steroid immune depressants

B. Interferons

C. Non-specific immune modulators

D. Non-steroid immune depressants

E. Specific immune modulators

 

3. An 18-month-old child is taken to hospital on the 4-th day of the disease. The disease began acutely with temperature 39°C, weakness, cough, reathlessness. He is pale has cyanosis, febrile temperature for more than 3 days. There are crepitative fine bubbling rales at the auscultation. Percussion sound is shortened in right under scapula area. X-ray picture: unhomogenius segment infiltration 8-10 in the right, the increase of vascular picture, unstructural rools. What is the most likely diagnosis?

E. *Segmentary pneumonia

A. Bronchitis

B. Bronchiolitis

C. Interstitial pneumonia

D. Grippe

 

4. A 43-year-old male presents with stomach pain, which relieves with defecation, is accompanied with a feeling of abdominal winds, incomplete evacuation or urgent need for bowel movement, constipation or diarrhea. These symptoms have been lasting for over 3 months. No changes in laboratory tests. What is the most likely diagnosis?

B. *Irritable bowel syndrome

A. Chronic enterocolitis, exacerbation phase

C. Spastic colitis

D. Colitis with hypertonic type dyskinesia

E. Atonic colitis

 

5. A 62-year-old man presents with the pain in mesogastral area that irradiates to back, general weakness, poor appetite, weight loss. Oh physical examination the patient is of decreased nutrition, skin and eyeballs are light-yellow. Stomach is soft. Enlarged painless gallbladder is palpated in the right hypochondrium. Urine is dark. Stool is colourless. What is the most likely diagnosis?

B. *Cancer in the head of pancreas, mechanic icterus’

A. Hemolytic icterus

C. Liver cirrhosis

D. Parenchimatosus icterus

E. Gallbladder disease, mechanic icterus

 

6. A 5-year-old child had an attack of palpitation with nausea, dizziness, generalized fatigue. On ECG: tachycardia with HR of 220/min. Ventricle complexes are deformed and widened. P wave is absent. What medication should be given for emergent care?

A. *Lydocain

B. Seduxen

C. Strophantin

D. Isoptin

E. Novocainamides

 

7. A 43-year-old woman complains of contact hemorrhages during the last 6 months. Bimanual exam: cervix of the uterus is enlarged, restricted in mobility. Mirrors showed the following: cervix of the uterus is in the form of cauliflower. Chrobak and Schiller tests are positive. What is the most probable diagnosis?

A. *Cancer of cervix of the uterus

B. Cervical pregnancy

C. Leukoplakia

D. Nascent fibroid

E. Polypus of the cervis of the uterus

 

8. A 43-year-old woman complains of severe pain in the right side, fever, dryness and bitterness in the mouth. There was multiple vomiting without relief. Patient relates pain to taking of fat and fried meal. Physical examination: Patient lies on the right side. Pale. Dry tongue. Tachycardia. Right side of abdomen is painful upon palpation and somewhat tense in right hypochondrium. What is the most likely diagnosis?

B. *Acute cholecystitits

A. Perforative ulcer

C. Acute appendicitis

D. Acute bowel obstruction

E. Right-sided renal colic

 

9. A 20-year-old patient is known as using to clash with teachers and classmates in school, to shout, to be able to throw with fists. He was detained several times for fighting and was convicted. He has changed several places of work due to conflicts and aggression. Psychiatric status: he is focused correctly, answers loudly, using obscene words. He demands “to leave him in rest “because “he does not control himself”. In department he shows aggression for the most insignificant reasons. What is your preliminary diagnosis?

A. *Maniacal-depressive psychosis

B. Explosive psychopathy

C. Hysterical psychopathy

D. Hysterical neurosis

E. Schizophrenia

 

10. A 52-year-old male is under gastroenterologist supervision due to chronic autoimmune gastritis for 10 years. He presents with some nausea, feeling of weight in epigastrium after meal. Last exacerbation of disease was 6 month ago. He adheres to a diet, smokes 10 cigarettes per day, and uses alcohol moderately. What measures to prevent stomach cancer are necessary?

B. *Cancellation of smoking and alcohol use

A . Taking antacids periodically

C. Taking H2-blokers periodically

D. Taking antihelycobacter medications periodically

E. Taking gastrocepin periodically

 

11. A 26-year-old woman gave birth to a child 6 months ago. She applied to gynecologist complaining of menstruation absence. The child is breast-fed. Vagina exam: uterus is of normal form, denseconsistence. What is the most probable diagnosis?

A. *Physiological amenorrhea

B. Pseudoamenorrhea

C. Gestation

D. Sheehan’s syndrome

E. Asherman’s syndrome

 

12. A 28-year-old woman comes to the Emergency Room with a slightly reddened, painful “knot, 8 cm above the medial malleolus. Examination in the standing position demonstrates a distended vein above and below the mass. There are no other abnormalities on physical examination. What is the most likely diagnosis?

B. *Superficial venous thrombosis

A. Subcutaneous hematoma

C. Early deep vein thrombosis

D. Cellulitis

E. Insect bite

 

13. A 45-year-old man was brought to clinic with complaints of the pain that started suddenly in the left chest part and epigastric area, shortness of breath, nausea, one-time vomiting. The acute pain started after weight-lifting. On physical exam: shallow breathing, RR – 38/min, left chest part is behind during respiration, by percussion – tympanitic sound, respiration is not ausculated. Ps – 110 bpm, of weak filling. BP – 100/60 mm Hg, insignificant displacement of heart to the right, sounds are dull. What examination is the most expedient to do first?

C. *Ultrasound of the abdominal cavity

A. Esophagogastroscopy

B. Bronchoscopy

D. Electrocardiography

E. Roentgenography

 

14. A 42-year-old man has died in a road accident after the hemorrhage on the site, due to acute hemorrhagic anemia. What minimum percent of all volume of blood could result in death at acute hemorrhage?

A. *25-30%

B. 15-20%

C. 10-14%

D. 35-50%

E. 6-9%

 

15. While making a round, a doctor had noticed the edema of the right shoulder of a 26-day-old child with diagnosis of “umbilical sepsis”. Active movements in the shoulder joint were absent, right hand was hanging down. Mother stated that her child’s condition had worsened for the last 24 hours what resulted in child’s refusal to be breast-fed, restlessness, weeping while swaddling, rise in body temperature up to 38,8°C. What is the most probable preliminary diagnosis?

B. *Epiphysial osteomyelitis of the humerus

A. Phlegmon of the shoulder

C. Traumatic brachioplexftis

D. Fracture of the humerus

E. Fracture of the clavicle

 

16. Study of pulmonary tuberculosis provided data about social and everyday conditions of life and bad habits of patients. Which of the following methods allows assessing degree of influence of smoking on tuberculosis incidence?

D. *Calculation of correlation coefficient,

A. Calculation of standardized indices

B. Calculation of regression coefficient

C. Assessment of statistical probability of differences

E. Analysis of dynamic row indices

 

17. In 2 weeks after receiving of 3 Gy doze of general 7-irradiation, the diminished number of blood cells is marked at injured man. What is the cause of such changes?

A. *Suppression of blood cells production

B. Reduction of peripheral blood cells life time

C. Delay of blood cells in the marrow

D. Prolongation of blood cells growth

E. Increased destruction of peripheral blood cells

 

18. A 28-year-old man is hospitalized with complaints of expiration dyspnoe after work at summer residence. Physical examination: condition of moderate severity. He sits resting his hands on the seat-back. Ps — 102 bpm, BP 140/90 mmHg. RR — 32/min. Percussion reveals lung sound with box tone. Heterogeneous multiple dry rales are auscultated. Heart work is regular. Which immunoglobulin plays leading role in development of this pathological condition?

A. *IgE

B. IgG

C. lgD

D. IgM

E. IgA

 

19. The patient was admitted to the hospital on the 7th day of the disease with complaints of high temperature, headache, pain in the muscles, especially in calf muscles. The dermal integuments and scleras are icteric. There is hemorrhagic rash on the skin. Urine is bloody. The patient went fishing two weeks ago. What is the diagnosis?

E. *Leptospirosis

A. Brucellosis

B. Yersiniosis

C. Trichinellosis

D. Salmonellosis

 

20. A 26-year-old woman complains of spontaneously arising pelvic pain, irradiating to the anus, nausea, giddiness, bloody dark vaginal discharge for one week, the delay of menses for 4 weeks. Signs of peritoneal irritation are positive. Pelvic examination: borders of uterine and adnexa are not determined because of sharp morbidness. The diversion and tenderness of posterior and right lateral fornices vaginae are marked. What is the most probable diagnosis?

E. *Broken tubal pregnancy

A. Acute appendicitis

B. Apoplexy of the ovary

C. Torsion of an ovarian tumour leg

D. Acute right-side adnexitis

 

21. A 6-year-old asthmatic child is brought to the emergency room because of severe coughing and wheezing during the prior 24 h. The child has been taking theophylline without relief. Physical examination reveals a child who is anxious, has intercostal and suprasternal retractions, expiratory wheezing throughout all lung fields, and RR 60/min. Initial treatment may include the administration of which of the following?

E. *Subcutaneous epinephrine

A. Parenteral gentamicyn

B. Parenteral phenobarbital

C. N-acetyl cysteine and cromolyn by inhaler

D. Intravenous fluids in the first 2 h to correct a water deficiency.

 

22. A 76-year-old man, with the cardiac pacemaker (demand mode) has periodic episodes of loss of consciousness. Physical examination: Ps 42 bpm, heart beating is irregular. What can cause development of such condition?

A. *Pacemaker malfunction

B. Intraventricular conduction disorder

C. Daroxysmal ventricular tachycardia

D. Paroxysmal supraventricular tachycardia

E. Cerebral atherosclerosis

 

23. The occipital part of newborn head of dolichocephalic form shows with labor edema with centre in the area of small fontanelle. In which presentation of fetal head did labor occur?

A. *Face presentation

B. Occiput anterior presentation

C. Brow presentation

D. Parietal anterior presentation

E. Occiput posterior presentation

 

24. A 7-day-old boy is admitted to the hospital for evaluation of vomiting and dehydration. Physical examination is otherwise normal except for minimal hyperpigmentation of the nipples. Serum sodium and potassium concentrations are 120 meq/L and 9 meq/L respectively. What is the most likely diagnosis?

B. *Congenital adrenal hyperplasia

A. Panhypopituitarism

C. Hyperaldosteronism

D. Secondary hypothyroidism

E. Pyloric stenosis

 

25. A growth of the right side of the scrotum was found at the examination of a 3-month-old child. This formation has elastic consistency, its size decreases in sleep and increases when the child is crying. What investigation will be helpful for make a correct diagnosis?

A. *Palpation of the thickened cord, crossing the pubical tubercule

B. Punction of the scrotum

C. Examination of the formation in Trendelenburg’s position

D. Palpation of the external inguinal ring

E. Diaphanoscopy

 

26. A 36-year-old male, at 4:00 a.m. had intensive attack of chest pain, which was accompanied by weakness, cold perspiration, fear of death. ECG: ST segment elevation in leads II, III, aVF, V5, V6. After stop of heart attack the ECG has normalised. What is Your preliminary diagnosis?

B. *Variant (Prinzmetal’s) angina

A. Myocardial infarction of the back side of left ventricular wall

C. Acute pericarditis

D. Dilated cardiomyopathy

E. Prolonged angina attack

 

27. In the young patient at the reference to policlinic there was diagnosed the 1 stage of hypertension. How many times during the year it is necessary to examine him?

E. *2 times

A. 3 times

B. 5 times

C. 4 times

D. 1 time

 

28. A 30-year-old woman, who lives at Carpathians, presents with enlargement of thyroid gland. Examination: diffuse increase of thyroid gland up to 1A degree, the function is normal. What kind of preventive maintenance of endemic goitre will you advise?

D. *Antistrumin 1 tablet per week

A. Antistrumin 1 tablet twice per week

B. L-thyroxin 25 microgram daily

C. L-thyroxin 50 microgram daily

E. Merkasolil 20 mg daily

 

29. A 47-year-old man with gastric cancer, complicated by profuse hemorrhage was successfully treated by surgical intervention. After the operation the native blood plasma transfusion was performed. During transfusion developed there acrocyanosis, hypersalivation, hyperpnoea, BP 80/40 mmHg, Ps -120 bpm. The initial drug therapy had to begin with injection of:

A. *Epinephrine

B. Diphenylhydramin

C. Prednisolon

D. Aminophilline

E. Dopamine

 

30. A 26-year-old man was admitted to the hospital complaining of stabbing back pain on inspiration and dyspnea. On exam, t – 37°C, Ps 92/min, RR of 24/min, vesicular breath sounds. There is a dry, grating, low-pitched sound heard in both expiration and inspiration in the left lower lateral part of the chest. What is the most likely diagnosis?

C. *Acute fibrinous pleuritis

A. Acute bronchitis

B. Pneumonia

D. Pneumothorax

E. Myocarditis

 

31. At the radiological unit of the hospital, gamma-devices of radiotherapy of “Agat” type and other closed sources of ionizing radiation are used for treatment of malignant neoplasms. What are the measures to be taken to protect personnel at the time of work with radioactive sources of such type?

A. *Screening of the source and the use of means of individual protection of respiration organs

B. Shortening of working time and screening of the source

C. Systematical cleansing of surfaces from the radioactive contamination and shortening of working time

D. Capsulation of devices and organization of room ventilation

E. The increase of distance to the source and individual hygiene compliance

 

32. Woman in childbirth, 25 years old, the second stage of labor. During internal obstetric examination, opening of the uterine cervix is full. Fetus membranes are absent. The head of the fetus is presented, the head occupies sacral cavity. Sciatic bones are undeterminable. During contractions perineum is sticking out. Where is the head of the fetus situated?

A. *In the plane of outlet from the minor pelvis

B. By small segment in the plane of inlet into minor pelvis

C. In the plane of the narrow part of minor pelvis

D. Big segment in the plane of inlet into minor pelvis

E. In the plane of the wide part of minor pelvis

 

33. A primiparous woman whose blood type is 0(Rh+) birth at term to an infant who has A(Rh+) blood and a hematocrit of 55%. A serum bilirubin level obtained at 36 h of age is 12 umol/L. Which of the following laboratory findings would be LEAST characteristic of ABO hemolytic disease?

E. *Negative direct Coombs’ test

A. An elevated reticulocyte count

B. Spherocytes on blood smear

C. Fragmented red blood cells in the blood smear

D. Nucleated red blood cells in the blood ear

 

34. A 37-year-old man presents to the clinic in 1 hour after being wounded complaining of pain around umbilicus. Physical examination: there is prick and cut wound of about 0.5 x 1 cm on abdominal wall with slight bleeding. What help would you provide to the patient?

C. *Laparotomy, survey of organs of abdominal cavity, primary surgical processing of the wound

A. Suturing of the wound

B. Survey of he wound with canal probe

D. Aseptic bandage

E. Drainage of the wound with rubber strip

 

35. A patient, while making repairs at home, suddenly stood quite still with the painting brush in his hand. This state lasted for a few seconds. After that the patent was rather confused, for some moments he couldn’t understand what was happening. He totally forgot the state he was in and the events around him, occurring while he was in that state. Name the disorder:

E. *Petit mal, epilepsy

A. Disphoria, epilepsy

B. Jacksonian fit, epilepsy

C. Grand mal, epilepsy

D. Twilight state, epilepsy

 

36. A 38-year-old woman is hospitalized with complaints of shortness of breath at physical load, weakness, fatigue. Medical history: rheumatism since 18 years old. Physical examinations: condition of moderate severity, “facies mitrale”. Ps 80 bpm, BP130/80 mmHg. Cardiac rhythm is irregular, Sound 1 increased in intensity, an opening snap and diastolic murmur are heard at the apex. Lungs are clear upon auscultation. What medications would you prescribe the patient?

A. *Cardiac glycosides + calcium antagonists

B. Calcium antagonists + beta-adrenergic blockers

C. Beta-adrenergic  blockers + cardiac glycosides

D. Diuretics + ACE inhibitors

E. Cardiac glycosides + calcium antagonists

 

37. A 24-year-old man on the 5th day of acute respiratory disease with high grade temperature started having strong headaches, systemic dizziness, sensation of double vision, paresis of mimic muscles to the right, tickling by swallowing. Diagnosis: Acute viral encephalitis. Determine the basic direction of the emergent therapy.

E. *Zovirax

A. Lasix

B. Glucocorticoids

C. Cephtriaxon

D. Hemodesis

 

38. A patient with ischemic heart disease and chronic heart failure develops sudden loss of consciousness. On exam: cyanosis, the widened pupils, peripheral pulse and blood pressure are not denned. On ECG: ventricular complexes are absent; instead of them there are waves of different shape and amplitude with irregular rhythm. What is the mechanism of this rhythm disorder development?

D. *Multiple microreentry in the ventricles

A. Disorder of neurohumoral regulatory systems

B. Accelerated diastolic depolarization, a disorder in electrolyte balance

C. Sick sinus syndrome

E. Enhanced automatic activity of the ventricles

 

39. A 1-year-old child with fibroelastosis fell ill with acute respiratory viral infection. Suddenly he develops anxiety, acrocyanosis, Ps- 132 bpm, RR – 50/min, small bubbling rales in lower lungs, pO2 60 mmHg, pCO2 55 mmHg. On X-ray: cardiomegaly, amplification of lung pattern, radix pulmonis resembles butterfly wings. What is the most likely reason of child condition worsening?

E. *Pulmonary edema

A. Pulmonary abscess

B. Angioneurotic (Quincke’s) edema

C. Bronchiolitis

D. Double-sided pneumonia

 

40. The family doctor diagnosed acute intestinal bleeding in a patient. What is medical tactics in this situation?

E. *Urgent hospitalisation to surgical unit

A. Urgent hospitalization to therapeutic unit

B. Hospitalization at home

C. Intravenous injection of aminocapronic acid

D. Hospitalization to day-time hospital

 

41. District doctor of rural medical department was called to a 42-year-old patient. While examining the patient, the doctor suspected the dysentery. What document must the doctor issue?

C. *Urgent notification of infectious disease

A. Report addressed to Chief

B. Infectious disease report

D. Statistical coupon of final (precise) diagnosis

E. Abstract of outpatient medical card

 

42. A man presents to physician with

cramping pain in left side of the chest, general weakness, fever and headache that have appeared 2 days ago. In the morning skin rash on chest is noted. Physical examination: multiple aggregated vesicles with edematous roofs filled with transparent liquid, 2-4 mm in diameter. Vesicles are situated on the erythematous and edematous background along 4-5 intercostals. What is the most likely diagnosis?

E. *Herpes zoster varicellosus

A. Pityriasis rosea

B. Streptococcal (Fox’s) impetigo

C. Allergic dermatitis

D. Herpes simplex

 

43. A 49-year-old patient complains of fever of 37,5°C, chest pain, dyspnea. On physical examination: Sound 1 is clapping; Sound 2 is accentuated in the pulmonary artery, opening snap, presystolic murmurs are auscultated. What is the most useful investigation for valvular disorder assessment?

B. *Echocardiography+dopplerechocardiography

A. Electrocardiogram (ECG)

C. Phonocardiography

D. Ballistocardiogram

E. Chest X-ray

 

44. A 54-year-old woman complains of increasing fatigue and easy bruising for 3 weeks. Physical examination: pallor, scattered ecchymoses, petechiae, mild hepatosplenomegaly. Blood analysis: Hb 73 g/L, Hct 20%, RBC 2,55*1012/L, WBC 162*109/L with 82% blasts, that contain Auric rods, positive peroxidase stain, thromb. 23*109/L. What is the most probable diagnosis?

E. *Acute leukemia

A. Chronic leukemia

B. Thrombocytopenia

C. Megaloblastic anemia

D. Hemolytic anemia

 

45. A 25-year-old pregnant woman (35 weeks) is admitted to the hospital because of bleeding discharge. In her past history there were two artificial abortions. In a period of 28-32 weeks there was noted the onset of hemorrhage and USI showed a placental presentation. The uterus is in normotonus, the fetus position was transversal (1st position). The heartbeats were clear, rhythmical, 140 bpm. What is further tactics of managing the pregnant woman?

D. *To fulfil a delivery by means of Cesarean section.

A. To fulfil the observation for the intensity of hemorrhage and at the moment of stopping the bleeding to prolong the pregnancy

B. To introduct the drugs increasing blood coagulation and continue observation

C. To fulfil the hemotransfusion and to g the pregnancy

E. To fulfil the stimulation of delivery by intravenous introduction of oxytocin

 

46. Choose the method of graphic representation of monthly information about the number of registered cases of acute intestinal infection in comparison to the average monthly values, obtained for 5 previous years.

D. *The linear diagram

A. The sector diagram

B. The curvilinear diagram

C. The radial diagram

E. The figured diagram

 

47. A 24-year-old primapara was hospitalized with complains on expulsion of the amniotic fluid. The uterus on palpation is tonic. The fetus is posed longitudinally, with the head pressed to pelvic inlet. The fetus heartbeat is rhythmical, 140 bpm, auscultated to the left below umbilicus. Pelvic examination: uterine cervix is 2,5 cm long, dense, the external os is closed, leakage of light amniotic fluid. Indicate the correct component of the diagnosis.

D. *Antenatal expulsion of the amniotic fluid

A. Pathological preliminary stage

B. End of the 1st stage of labor

C. Early expulsion of the amniotic fluid

E. Beginning of the 1st stage of labor

 

48. Indicate the unit of statistical observation for determination of influence of blood sugar level on the healing of wound’s surface in the postoperative period.

E. *Patient in the postoperative period

A. Blood sugar level

B. Patient with wound surface

C. Patient who is discharged to aftercare

D. Blood analysis

 

49. A 40-year-old  man complains of headache in occipital area. On physical examination, the skin is pale; there is face and hand edema, BP 170/130 mmHg. On EchoCG, there was concentric hypertrophy of the left ventricle. Ultrasound examination of the kidneys reveals thinned cortical layer. Urinalysis shows proteinuria of 3,5 g/day. What is the diagnosis?

B. *Chronic glomerulonephritis

A. Chronic pyelonephritis

C. Cushing’s disease

D. Polycystic disease of the kidneys

E. Essential arterial hypertension

 

50. A 48-year-old man complains of heaviness in the right hypochondrium, itching of the skin. He had been treated in infectious diseases hospital  repeatedly due to icterus and itch. On physical exam: meteorism, ascitis, dilation of abdominal wall veins, protruded umbilicus, spleen enlargement. What can be diagnosed in this case?

B. *Liver cirrhosis.

A. Cancer of the head of pancreas

C. Gallstones

D. Cancer of the liver

E. Viral hepatitis B

 

51. A primipara is in labor for 19 hours, amniotic fluid has discharged 7 hours ago. Pelvic sizes are: 24-25-29-18 cm. Fetal position is longitudinal, head presents and is engaged to pelvic inlet. Fetus heart rate is 160 bpm. No autonomous urination. Vaginal inspection: cervix is smoothed and 8 cm dilated. Head is presented, sagittal suture occupies the transverse diameter of pelvic inlet; small fontanelle is on the left. Lower uterine segment is tender on pressing. What medical tactics should be chosen?

A. *Urgent cesarian section

B. Vacuum-extractor operation

C. Application of obstetrical forceps

D. Stimulation of labor activity with intravenous oxytocin

E. Craniotomy

 

52. A 65-year-old patient complains of asphyxia, cough with foamy red sputum, air deficiency, death fear. On physical exam: the skin is pale, acrocyanosis, cold sticky perspiration. Harsh breathing, moist small and medium-vesicular rales are in lower and hind parts on both sides. What is the most probable preliminary diagnosis?

B. *Pulmonary edema

A. Embolic pneumonia

C. Thromboembolism of pulmonary artery

D. Croupous pneumonia

E. Asthmatic status

 

53. A 39-year-old woman complains of heartburn and squeezing epigastric pain 1 hour after meal. She has been ill for 2 years. On palpation, there is moderate tenderness in pyloroduodenal area. Gastroscopy: antral gastritis. What study can establish genesis of the disease?

D. *Revealing of Helicobacter infection in gastric mucosa

A. Detection  of autoantibodies in the serum

B. Gastrin level in blood

C. Examination of stomach motor function

E. Examination of stomach secretion

 

54. A woman suffers from suddenly arising crampy pain in the right loin area. 2 hours after the pain had started, hematuria took place. Loin X-ray: no pathological shadows. Ultrasound: pyelocaliectasis on the right, the left part is normal. What is the most probable diagnosis?

B. *Stone of the right kidney, renal colic

A. Tumour of the right kidney pelvis

C. Acute appendicitis

D. Intestine invagination

E. Twist of the right ovary cyst

 

55. A 30-year-old man who suffered from headaches, felt an intense headache in the form of the blow on his head while lifting a heavy subject up. There appeared nausea, vomiting, and light dizziness. In a day there was an objectively presented meningial syndrome, t – 37,6°C The doctor have suspected subarachnoidal hemorrhage. What additional examination is necessary to do to confirm the diagnosis?

B. *Lumbar puncture with liquor examination

A. Cerebral angiography

C. Roentgenography of the cranium

D. Computed tomography

E. Rheoencephalography

 

56. A 24-year-old woman with previously normal menstrual function, complains that her cycles became irregular. Tests of function diagnostics: anovulatory cycles. Blood level of prolactin is elevated. Choose the most suitable investigation.

E. *Computer tomography of the head

A. Measurement of serum levels of testosteron-depotum

B. Progesteron assay

C. USI of the small pelvis

D. Measurement of gonadotropins levels

 

57. A worker is taken on the staff and undergoes medical preventive inspection, results of which have allowed him to work in this industry. What is the type of medical preventive inspection that is use in this case?

C. *Routine

A. Special

B. Preliminary

D. Periodic

E. Systematic

 

58. A 31-year-old man with past history of rheumatic fever is severely ill and complains of fever up to 38-39°C, abdominal pain, dyspnea, palpitation; he felt ill 6 days ago. On exam, the left heart border is shifted to the left, heart sounds are faint, systolic and dyastolic murmurs at the aortic area, BP of 160/30 mmHg, positive Rumpel-Leede sign, enlargement of the liver and the spleen, diarrhea, and dark urea. What is the most likely diagnosis?

C. *Infective endocarditis

A. Rheumatic aortic valve disease

B. Acute viral hepatitis

D. Typhoid fever

E. Acute nephritis

 

59. A 32-year-old woman complains of the pain in the left epigastric area that has appeared in 2 hours after meal. She also complains of nausea, bloating of the abdomen, tendency to diarrhea. On physical exam: icteric sclera’s. The abdomen is painful by palpation in the Gubergrits and Skulsky point. The liver is at the ribs edge. Blood tests: amylase — 288 mmol/L, total bilirubin – 20μmol/L. What is the most probable disease?

B. *Chronic pancreatitis

A. Chronic enterocolitis

C. Chronic hepatitis

D. Chronic gastritis

E. Chronic cholecystitis

 

60. A 16-year-old female presents with abdominal pain and purpuric spots on the skin. Laboratory investigations reveals normal platelet count, with haematuria and proteinuria. What is the most likely diagnosis?

D. *Henoch Schonlein purpura

A. Thrombotic thrombocytopenic purpura

B. Haemolytic uraemic syndrome

C. Sub acute bacterial endocarditis

E. Heavy metal poisoning

 

61. A 14-year-old boy periodically complains of pain in the epigastrium on an empty stomach, nausea and heartburn during 3 years. Gastroduodenoscopy: signs of gastroduodenitis and ulcer defect of the mucous membrane of the duodenum. What is the most effective medication to treat this child?

C. *De-nol

A. Atropin

B. No-spa

D. Papaverin

E. Almagel

 

62. A 50-year-old woman for 1 year complains of attacks of right subcostal pain after fatty meal. Last week the attacks have repeated every day and become more painful. What diagnostic study would you recommend?

B. *Ultrasound investigation of gallbladder

A. Liver function tests

C. Blood cell count

D. Ultrasound study of the pancreas

E. X-ray examination of the gastrointestinal tract

 

63. A 29-year-old woman underwent surgical treatment concerning the benign serous epithelial tumour of the ovary. The postoperative period has passed without complications. What is it necessary to prescribe in the rehabilitational period?

A. *Hormone therapy and proteolytic enzymes

B. Laser therapy and enzyme therapy

C. Antibacterial therapy and adaptogens

D. Does not demand the further observation

E. Magnetic therapy and vitamin therapy

 

64. After delivery and revision of placenta there was found the defect of placental lobe. General condition of woman is normal, uterine is firm, there is moderate bloody discharge. Inspection of birth canal with mirrors shows absence of lacerations. What is the following necessary action?

C. *Manual exploration of the uterine cavity

A. External massage of uterus

B. Use of uterine contracting agents

D. Use of haemostatic medications

E. Urine drainage, cold at lower abdomen

 

65. A diagnosis of chronic arsenous intoxi cation was defined at the patient who is working as a nightman. What form of anemia is characteristic for this disease?

B. *Hemolytic anemia

A. Iron deficiency anemia

C. Hyper sideric anemia

D. B12 – deficiency anemia

E. Aplastic anemia

 

66. A 34-year-old woman fell ill 3 months ago after cold exposure. She complains of pain in the hand and knee joints, morning stiffness, and fever up to 38°C. Interphalangeal, metacarpophalangeal and knee joints are swollen, hot, with decreased ranges of motions. ESR of 45 mm/h, CRP (+++), Vaaler-Rouse test of 1:128. What group of medicines would you recommend to the patient?

B. *Nonsteroidal anti-inflammatory drugs

A. Fluorchinolones

C. Tetracyclines

D. Cephalosporines

E. Sulfonamides

 

67. A 33-year-old woman works as secretary. Her diet contains 150 g of protein (including 100 g of animal), 200 g of fat, and 600 g of carbohydrates. What pathology can effect this diet?

B. *Obesity

A. Paradontosis

C. Common cold

D. Uterine fibromyoma

E. Schizophrenia

 

68. A 25-year-old man is hospitalized with complaints of double vision, worsening of eyesight, difficulty of breath, dryness in the mouth. He fell ill acutely 12 hours ago. Before falling ill he ate mushrooms. Physical examination: skin is pale, pupils are wide with weak reaction to light, swallowing is disturbed. Ps 55 bpm. Severe muscle weakness. The stomach is bloated . What is your preliminary diagnosis?

C. *Botulism

A. Salmonella infection, gastrointestinal form

B. Yersiniosis

D. Leptospirosis

E. Lambliasis

 

69. A 65-year-old patient complains of gradual worsening of the left eye vision during 10 months. On physical examination: acute of vision of the left eye is 0,01, not correctable. The eye is quiet, pupil of the eye is grayish, reflex from the eye-ground is absent. Intraocular pressure is 18 mm/Hg. What is the most probable preliminary diagnosis?

D. *Senile cataract

A. Exfoliation of the retina

B. Leukoma of the cornea

C. Open-angle glaucoma

E. Disorder of blood circulation in retina vessels

 

70. A 62-year-old patient with DM-2. Diabetes is being compensated by diet and Maninilum. Patient has to undergo an operation for inguinal hernia. What should be the tactics of hypoglycemic therapy?

D. *Prescribe fast-acting insulin

A. Give Glurenorm in place of Maninilum

B. Prescribe guanyl guanidines

C. Prescribe long-acting insulin

E. Continue with the current therapy

 

71. A 9-year-old woman has fitlike abdominal pains after fried food. No fever. She has the pain in point Cera. The liver is not enlarged. Portion B (duodenal probe) – 5 ml. What is the most likely diagnosis:

B. *Biliary tracts dyskinesia, hypotonic type.

A. Ulcer disease

C. Acute colitis

D. Chronic duodenum

E. Hepatocirrhosis

 

72. Parents of 5-year-old boy complain of ventral curvature of penis. Physical examination: external urethral meatus is on the apex of penis, prepuce is hood-like. What is the most likely diagnosis?

C. *Hypospady without hypospady

A. Epispadia of balanus

B. Cryptorchidism

D. Induratio penis plastica (Peyronie’s disease)

E. Latent penis

 

73. A 38-year-old man worked at roofing and drain piper production for 15 years. He seeks medical help for expiratory breathlessness on exertion, and dry cough. On exam, wheezes above both lungs, grayish warts on fingers are seen. Factory physician has suspected asbestosis. What method is the most important for this diagnosis?

D. *Chest X-ray

A. Bronchoscopy

B. Spirography

C. Blood gas analysis

E. Electrocardiography

 

74. The sample from 5 tons milk batch was taken. In the lab analysis it was defined: fat content 2%, specific density 1,04 g/cm3, acidity 21°T, reductase probe – weak positive. How should the product be used?

B. *Sell but inform customers about milk quality

A. Technical utilization

C. Sell without limitations

D. Destroy product

E. Write off for animal feeding

 

75. A 30-year-old man has a history of recurrent pneumonias and chronic cough production of foul smell, purulent sputum, occasionally gloom tinged, which becomes worses in the morning and in reclining position. On physical examination, it is a chronic patient with clubbing of fingers, wet inspiratory rales at the root of lungs from behind. What is the most probable diagnosis?

D. *Bronchoectasis

A. Chronic bronchitis

B. Disseminated pulmonary tuberculosis

C. Pulmonary neoplasm

E. Chronic obstructive emphysema

 

76. A 15-year-old teenager complains of poor night vision. Physical examination: increased darkness adaptation time, Bitot’s spots on conjunctiva. The patient skin is dry, scales off; folliculitis signs of the face skin are present. What is the cause of the disease?

B. *Retinole deficit

A. Napthtoquinone deficit

C. Thiamine deficit

D. Folic acid deficit

E. Biotin deficit

 

77. 25 unorganized children of pediatric district in the age 2 -3 years will be observed in the current year. What scheduled number of initial visitations will make to this group of children?

C. *50

A. 200

B. 20

D. 100

E. 40

 

78. A 20-year-old woman complains of weakness, wet cough, body temperature raise up to 37, 5°C by evenings for one month. In childhood was under supervision at phthisiatrician due to bend of tuberculin test (PPD). The condition is good. No rales in lungs. Chest X-ray: a shadow with dim contours 3 x 4 cm with areas of enlightenment and centers near shadow in the upper lobe of right lung. Blood analysis: ESR 20 mm/hour. What is the most likely diagnosis?

C. *Tuberculoma

A. Infiltrative tuberculosis

B. Pneumonia with abscess formation

D. Decaying cancer

E. Focal tuberculosis

 

79. An ECG of postinfartional (a year ago) patient shows pathological QS waves in leads VI-V3, I, aVL. Determine the location of old myocardial infarction.

A. *Septal and anterior

B. Postrolateral

C. Anterolateral

D. Anterior

E. Inferior

 

80. A 20-year-old woman with a 3-4 month history of bloody diarrhoea. Sigmoidoscopic examination: oedema, hyperemia and ulceration of the rectum and sigmoid colon. Stool examination: negative for ova and parasites. Normal small bowel series. Stool cultures: negative for Clostridium, Campylobacter and Yesinia. What is the most likely diagnosis?

B. *Ulcerative colitis

A. Zollinger-Ellison syndrome

C. Gastroenteritis

D. Carcinoid syndrome

E. Granulomatous colitis

 

81. At the patient of 34 years of age you suspect an abscess of Douglas spaces. What method of investigation is preferable to diagnostics?

C. *Finger examination of rectum

A. X-ray of abdominal cavity

B. Rectoromanoscopy

D. Laparoscopy

E. Percussion and auscultation of stomach

 

82. What methods of the collecting of the information is preferable for study of housing conditions of students of medical HIGH SCHOOL for a training period?

C. *Questioning

A. Selecting of materials

B.  Interviewing

D. A method of the directed selection

E. Statistical

 

83. A man with meningococcus meningitis has been taking penicillin for 7 days. Last 4 days a body’s temperature is normal. Meningitic signs are absent. When is it possible to cancel antibiotic?

D. *If liquor cytosis is 100 or less, mainly due to lymphocytes

A. If liquor cytosis is 150, mainly due to lymphocytes

B. Right away

C. If leucocytosis and left neutrophil shift are absent

E. If liquor cytosis is 100 or less, mainly due to neutrophils

 

84. A 52-year-old woman suffering from obesity complains of bloody discharges from sexual paths during 4 days. Last normal menses was 2 years ago. Histological investigation of biopsy of the endometrium has revealed adenomatous hyperplasia. Which reasons from listed below promoted the development of disease?

E. *Excessive transformation of preandrogens from fatty tissues

A. Elevated level of FSH

B. Hypersecretion of estrogens by body tissues

C. Poor aromatization of preandrogens due to hypothyroidism

D. Hypersecretion of androgens by adrenal cortex

 

85. A sick person is staying in the hospital with the diagnosis of abdominal typhus. During the 3rd week from the beginning of the disease the patient stopped keeping diet and confinement to bed. As a result the body temperature and rapid pulse developed and melena appeared. What kind of complications should we think first of?

A. *Intestinal haemorrhage

B. Thrombophlebitis

C. Nephroso-nephritis

D. Hepatite

E. Meningitis

 

86. A 68-year-old man complains of tiredness, sweating, enlargement of cervical, submaxillary and axillary lymph nodes. Blood tests: WBC – 35 * 109/L, lymphocytes — 60%, Botkin and Gumprecht bodies, level of hemoglobin and quantity of thrombocytes is normal. Myelogram showed 40% of lymphocytes. What is the most probable diagnosis?

B. *Chronic lympholeucosis

A. Acute leucosis

C. Chronic myeloleucosis

D. Tuberculous lymphadenitis

E. Lymphogranulomatosis

 

87. The woman complains of slight dark bloody discharges and lower abdominal discomfort for several days. Her last menstrual period was 7 weeks ago. The test for pregnancy is positive. Pelvic examination: the uterine is about 5-6-week of gestation size, of softish consistence, painless. In the left ovary a retort like formation, 7×5 cm, mobile, painless is palpated. What it is necessary to do to determinate the fetal eggs localization?

A. *Ultrasound investigation

B. Colposcopy

C. Cystoscopy

D. Hysteroscopy

E. Chromohydrotubation

 

88. A child has attached fingers of his right hand. What is your diagnosis?

D. *Syndactyly

A. Macrodactily

B. Ectromelia

C. Ectrodactyly

E. Polydactily

 

89. To study physical development of children and adolescents, anthropometric investigations are widely used. Choose a physiometric method of investigation from the below given.

D. *Determination of vital capacity of lungs

A. Determination of thorax form

B. Determination of vertebra form

C. Determination of body weight

E. Measurement of growth

 

90. A 40-year-old woman complains of yellow vaginal discharge. Bimanual investigation: no pathological changes. In smear: Trichomonas vagynalis and blended flora. Colposcopy: two hazy fields on the front labium, with a negative Iodum probing. What is your tactics?

E. *Treatment of specific colpitis and subsequent biopsy

A. Diathermocoagulation of the uterine cervix

B.—

C. Cervixectomy

D. Cryolysis of cervix of the uterus

 

91. An employee was disabled during 6 months as a result of the hip fracture. Who is entitled to sign the sick-leave for the last 2 months?

E. *MSEC

A. DCC together with the head physician of the polyclinic

B. Head physician of the polyclinic

C. Doctoral controlling committee (DCC)

D. Deputy head physician of the enterprise

 

92. During the examination of the placenta which was just born, the defect of 2 x 3 cm was found. There is no hemorrhage. What is the most appropriate tactics?

E. *Hand revision of the uterine cavity

A. Uterotonic medications

B. Observation of woman after labor

C. Instrumental revision of the uterine cavity

D. External massage of the uterus

 

93. In the inhabited locality there is an increase of diphtheria during the last 3 years with separate outbursts in families. What measure can effectively influence the epidemic process of diphtheria and decrease the morbidity with diphtheria to single cases?

B. *Immunization of the population

A. Disinfection in disease focus

C. Revelation of carriers

D. Early diagnostics

E. Hospitalization of patients

 

94. A 50-year-old male patient was brought to Emergency Department with diffuse abdominal pain and signs of cardiovascular collapse. Upon arrival he had BP 95/60 mmHg, Ps — 120 bpm, diuresis 20 mL/H, Hg 100 g/L, RBC 2,1*1012/L. The patient needs infusion of:

E. *Crystalloid and colloid

A. 5 % dextrose and colloid

B. Crystalloid and 5% dextrose

C. Crystalloid and red blood cells

D. 5% dextrose and red blood cells

 

95. A man fell ill acutely 6 hours ago with frequent watery stool. The body’s temperature is normal. Then vomiting took place. On physical examination: man’s voice is hoarse; eyes are deeply set in the orbits. The pulse is frequent. Blood pressure is low. There is no urine. What is the preliminary diagnosis?

C. *Cholera

A. Typhoid fever

B. Salmonellosis

D. Toxic food-borne infection

E. Dysentery

 

96. The woman was hospitalised with full-term pregnancy. Pelvic examination: the uterus is tender, the abdomen is tense, cardiac tones of the fetus are not auscultated. What is the most probable complication of pregnancy?

B. *Acute hypoxia of the fetus.

A. Premature detachment of the normally posed placenta

C. Occiput posterior presentation

D. Hydramnion

E. Premature labor

 

97. A 52-year-old patient has hypervolemic type of essential hypertension. What medication is necessary to prescribe either as monotherapy or in complex with other antihypertensive remedies?

C. *Hypothiazid

A. Clophelin

B. Nipnedipin

D. Kapoten

E. Dibazol

 

98. Workers of fishery are subjected to low temperatures of the air (from —5°C till — 15°C). Diseases of what organs and systems are the most frequent among workers of such enterprises?

D. *Respiratory system

A. Liver

B. Gastrointestinal tract

C. Cardiovascular system

E. Blood

 

99. A 57-year-old patient with megaloblastic anemia is getting worse. He complains of weakness, headache, dizziness, paresthesia, palpitation, and fever. Physical examination: The consciousnes is confused, the skin is subicteric pale, sternalgia. Blood count: Hb 65 g/L; RBC 1,0* 1012/L, colour index 1,2; WBC 3,4*109/L, Tromb. 120*109/L. What condition is observed?

A. *Stroke

B. Acute infection

C. Precoma

D. Erythroleukemia

E. Acute haemorrhage

 

100. A 35-year-old woman was admitted to thoracic surgery department with fever up to 40°C, onset of pain related to deep breath in the side, cough with big quantity of purulent sputum and blood with bad smell. What is the most likely diagnosis?

C. *Abscess of the lungs

A. Bronchectatic disease

B. Actinomycosis of lungs

D. Tuberculosis of lungs

E. Complication of liver echinococcosis

 

101. A 3-day-old newborn who has suffered asphyxia in labor presents with bleeding from umbiligal sore. Labo tests: hypocoagulation, thrombocytopenia, hypothrombinemia. What is the most likely cause of clinical and laboratory changes?

E. *Disseminated intravascular coagulation (DIC)

A. Trauma of umbilical vessel

B. Thrombocytopenic purpura

C. Inborn angiopathy

D. Hemolytic disease of newborn

 

102. A 4-year-old patient was admitted to the intensive care unit with hemorrhagic shock due to gastric bleeding. He has a history of hepatitis B during the last 5 years. The source of bleeding is esophageal veins. What is the most effective method for control of the bleeding?

D. *Introduction of obturator nasogastric tube.

A. Intravenous administration of pituitrin

B. Administration of plasma

C. Operation

E. Hemostatic therapy

 

103. A 32-year-old patient complains of severe weakness, tremor of extremities. Physical examination: body weight loss, wet and warm skin. The thyroid gland is enlarged up to the 3rd degree, painless, elastic. Ps: 108 bpm, BP – 160/55 mmHg. Everything else is normal. What is the most likely diagnosis:

D. *Diffuse toxic goiter of the 3rd degree, thyrotoxicosis of the average degree

A. Toxiferous adenoma of the thyroid gland

B. Chronic autoimmune thyroiditis, hypertrophic type

C. Diffuse euthyroid goiter of the 3rd degree

E. Chronic fibrous thyroiditis

 

104. A 34-year-old woman on the 10th week of gestation (2nd pregnancy) has come to obstetrician with the purpose of statement on the dyspensary record. In the previous pregnancy there took place hydramnion, the child was born with body weight of 4086 g. What investigation is necessary to administer first of all?

B. *Glucose tolerance test

A. USI of the fetus

B. Cardiophonography of epy fetus

D. Measurement of α-fetoproteinum level

E. Bacteriological investigation of vaginal discharge

 

105. A 9-year-old girl has an average height and harmonic growth development. She was ill with acute respiratory infection five times. Define the group of her health.

B. *2nd group

A. 1st group

C. 3rd group

D. 5th group

E. 4th group

 

106. A 35-year-old man complains of BP rise, headache, tinnitus, tachycardia. On physical examination, Ps -100 bpm, rhythmical, intensive. BP – 240/100 mm Hg. Left border of the relative cardiac dullness is moved to the left for 1 cm, Sound 1 on the apex is weakened, Sound 2 is accentuated – in aorta. Rough systolic murmur is ausculated on each side of the umbilicus. What pathology could cause this clinical picture?

E. *Stenosis of renal arteries

A. Essential hypertension

B. Conn’s syndrome

C. Chronic glomerulonephritis

D. Nephroptosis

 

107. A 32-year-old woman complains of fever, headache, acute weakness, sleeplessness for 8 days. On physical examinations: t – 39,8°C, Ps 86 bpm, BP 90/60 mmHg. Skin is pale with solitary roseola rash at the abdomen. Tongue is dry, covered by spot and prints of teeth on lateral surface. Abdomen is soft with dullness of percussion sound in ileocecal area. Hepatosplenomegalia .What is the most likely diagnosis?

A. *Exanthematic typhus (Spotted fever)

B. Typhoid fever

C. Influenza

D. Sepsis

E. Miliary tuberculosis

 

108. A 23-year-old man presents with gun-wound on the left arm. The arm bones are undamaged. What appropriate surgical help must be provided to such a patient?

B. *Primary surgical processing with a flowing suction

A. Suturing of wound

C. Drying of wound with towel gauzes

D. Suturing and drying of wound

E. Aseptic dressing of the wound

 

109. A 60-year-old boiler-man presents to factory’s sectorial doctor with headache and tiredness. Lab tests: carboxyhemoglobin in blood. Poisoning with which substance is the most likely to cause formation of carboxyhemoglobin in blood?

A. *Carbon oxide

B. Lead

C. Manganese

D. Chlorine

E. Mercury

 

110. A 28-year-old woman presents to doctor complaining of enlargement, getting wet and itching of pigment nevus which was present from birth. What method of investigation should not be applied to diagnostics in this case?

D. *Incision biopsy

A. Yaks’s reaction

B. Glass-print

C. Radioisotope diagnostics

E. Thermography

 

111. A 4-month-old girl with blond hair and blue eyes has “mousy” odor of sweat and urine, delayed psychomotoric development. What is the mostly typical laboratory data for this disorder?

A. *Positive urine ferric chloride test

B. High level of oxyproline in urine

C. High concentration of chlorides in sweat

D. High level of glycosaminoglycanes in urine

E. Low level of thyroid gland hormones in blood

 

Do 112. A pupil of the 8th form after trauma has acute atrophy of the left arm muscles, tonus of which is distinctly decreased, active movements are only in the left joint, pupil’s foot is deformed. Function of support of the left leg is absent, support function of the right leg is preserved. The boy wears orthopedic footwear. What group of physical training does the boy belong to?

E. *Special

A. Preparatory

B. Other

C. Basic

D. Additional

 

113. A student lives in the canalized house in the flat with complete set of sanitary equipment (WC, bath, shower, local water heater). How much water consumption has he got?

D. *160-200

A. 10-15 L

B. 50-100 L

C. 500 L

E. 1.300-400 L

 

114. A 41-year-old woman complains of weakness, fatigue, fever up to 38°C, rash on the face skin, pain in the wrists and the elbows. Physical exam: erythematous rash on the cheeks with “butterfly”appearance. The wrist and elbow joints are involved symmetrically, swollen, and tender on motions. Frictions rub over the lungs, the heart sounds are weak, regular, HR 88/min, BP 160/95 mmHg. CBC: anemia, leucopenia, ymphopenia. Urinalysis: proteinuria, leukocyturia, casts. What is the main mechanism of disease development?

A. *Production of antibodies to double-stranded DNA

B. Production of antimitochondrial antibodies

C. Production of antibodies to myocytes

D. Production of antibodies to myosin

E. Production of antibodies to endothelial cells

 

115. In 10 min after childbirth by a 22-year-old woman, the placenta was spontaneousely delivered and 100 ml of blood came out. Woman weight – 80 kg, infant weight – 4100 g, length – 53 cm. The uterus contracted. In 10 minutes the hemorrhage renewed and the amount of blood constitued 300 ml. What amount of blood loss is permissible for this woman?

E. *400 ml

A. 1000 ml

B. 650 ml

C. 300 ml

D. 500 ml

 

116. A 3-month-old infant who is suffering from acute segmental pneumonia reveals dyspnea [RR – 80 per minute], paradoxical breathing, tachycardia, generalized cyanosis. Respiration-pulse ratio is 1:2. The heart size is normal. What are these signs indicative of?

C. *Respiratory failure of III degree

A. Myocarditis

B. Congenital heart disease

D. Respiratory failure of I degree

E. Respiratory failure of II degree

 

117. A 8-year-old boy fell ill acutely: fever, weakness, headache, abdominal pain, recurrent vomiting, then diarrhea and tenesmus. Stools occur 12 times daily, are scanty, contain a lot of mucus, pus, streaks of blood. His sigmoid gut is tender and hardened. What is your diagnosis?

A. *Dysentery

B. Escherichiosis

C. Salmonellosis

D. Cholera

E. Staphylococcal gastroenteritis

 

118. A 54-year-old man complains of acute pain in the shoulder-joint. 10 minutes earlier he fell in the street with his arms stretched. Doctor of the traumatological unit noticed an acute deformation of the right shoulder-joint, the impossibilty of active movement in the right extremity. X-ray: uncoinsidence of articulating surfaces. What is the most probable diagnosis?

D. *Dislocation of the clavicle

A. Dislocation of the scapula

B. Dislocation of the humerus y

C. Contusion of the humerus

E. Fracture of the humerus

 

119. A newborn girl has congenital lymphedema of the hands and feet, short neck with loose skin, antimongoloid slant of palpebral fissures, epicanthal folds. In epithelial cells of buccal scrape X-chromatin (Barr body) is absent. What is the most likely diagnosis?

D. *Shereshevsky-Turner syndrome

A. Klinefelter syndrome

B. Edwards syndrome

C. Down syndrome

E. Patau syndrome

 

120. What is the treatment of choice for the patient with 1,5 cm uncomplicated, asymptomatic, calcium oxalate renal stone?

B. *Extra-corporeal shock wave lithotripsy

A. Watchful waiting

C. Descending litholisis

D. Open pyelolithotomy

E. Percutaneous nephrostonelithotomy

 

121. A 3-year-old child is admitted to hospital due to decrease of urine volume (200 mL per day), peripheral and cavity edema. Urinanalysis: protein 3,3 g/L. What is the most likely diagnosis?

A. *Acute glomerulonephritis with nephrosis

B. Interstitial nephritis

C. Infection of urinary tract

D. Chronic glomerulonephritis

E. Acute glomerulonephritis with nephritic syndrome

 

122. Thyreotoxicosis patient is in the two-place hospital ward of therapeutic department. The area of the ward is 18m2, height is 3 m, ventilation rate is 2,5/h. Air temperature is 20°C, relative humidity is 45%, air movement velocity is 0,3 m/sec, light coefficient is 1/5, noise level constitutes 30 dB. Make a hygienic assessment of these conditions.

E. *Discomfortable microclimate

A. Poor lighting

B. All conditions are OK

C. High level of noise

D. Non-effective ventilation

 

123. A man complains of pain in lower abdomen with frequent urges for urination for 3 hours. Pain has appeared after load lifting and constantly increases. Physical examination: dense painful hernial protrusion (diameter 4cm) in right inguinal region above inguinal (Poupart’s) ligament. Both testicles are in scrotum. Right testicle is painful on palpation. What is Your preliminary diagnosis?

E. *Irreducible right-sided inguinal hernia

A. Irreducible inguinoscrotal hernia

B. Sliding hernia of urinary bladder

C. Strangulated right-sided inguinal hernia

D. Traumatic orchitis, inguinal lynphadenitis on the right side

 

124. A 49-year-old woman is being treated for renal colic.  Examination reveals a small cyst (diameter 2,5 cm) of the right kidney. What prophylactic investigation is indicated for patient in 6 months in order to define treatment plan?

D. *Ultrasound investigation of kidney

A. Excretory urography

B. Kidney scintigraphy

C. X-ray of kidney

E. CT of kidney

 

125. A 28-years-old man, without a constant place of residence, was hospitalised with the preliminary diagnosis of “influenza”. At the 5th day of the disease there appeared typhoid maculopapular and petechial skin rash on trunk and extremities, t – 41°C,  euphoria, facial hyperaemia, sclera reddening, tongue tremor. Ps 104 bpm. Splenomegalia. What is the most likely diagnosis?

E. *Exanthematic typhus (Spotted fever)

A. Typhoid fever

B. Alcoholic delirium

C. Leptospirosis

D. Measles

 

126. A 1-year-old infant is admitted for failure to thrive. During the neonatal period he had an exploratory laparotomy for intestinal obstruction. At 3,8 and 11 month of age, he had respiratory infections diagnosed as bronchitis. Physical examination: weight of 6,8 kg, thin extremities with very little subcutaneous tissue, and a protuberant abdomen. The essentials diagnostic study in this child is:

D. *Sweat electrolytes

A. Skin test for milk allergy

B. Bronchoscopy

C. Serum immunoglobulin level

E. Tuberculin skin test

 

127. A 32-year-old woman comes to the gynecologist complaining of heavy long menses during 3 months. Pelvic examination: the he uterus is enlarged according to about 12 week’s gestation, distorted, tuberous, of dense consistence. Adnexa are not palpated. Histological investigation of uterine mucosa: adenocystous hyperplasia of endometrium. What is the optimum medical tactics?

D. *Surgical treatment

A. Phase by phase vitamin therapy

B. Phytotherapy

C. Hormone therapy

E. Radial therapy

 

128. A 37-year-old man complains of pain in left hand primarily during movements, fever up to 39°C. Physical examination reveals trace of injections, hyperemia, thickening along veins in right cubital area. What is the most likely diagnosis?

A. *Phlebitis

B. Phlegmon

C. Erysipelas

D. Abscess

E. Lymphangitis

 

129. A 60-year-old asthmatic man comes for a check up and complains that he is having some difficulty in “starting to urinate”. Physical examination: BP 160/100 mmHg, and a slightly enlarged prostate. Which of the following medications would be useful in treating both of these conditions?

D. *Doxazosin

A. Phentolamine

B. Isoproterenol

C. Propranolol

E. Labetalol

 

130. During an operation for presumed appendicitis, the appendix is found to be normal; however, the terminal ileum is markedly thickened and felt rubbery to firm, its serosa is covered with gray-white exudate, and several loops of apparently normal small intestine are adherent to it. The most likely diagnosis is:

B. *Crohn’s disease of the terminal ileum

A. Ulcerative colitis

C. Acute ileitis

D. Perforated Meckel’s diverticulum

E. Ileocecal tuberculosis

 

131. A patient complains of intense pressing pain in the pharynx, mainly to the right impossibility to swallow even liquid food. The patient is sick for 5 days. His condition is severe. Body temperature is 38,9°C, it is difficult to talk, voice is constrained, it is difficult to open the mouth. Submaxillary glands to the right are painful, enlarged. What is the most probable diagnosis?

A. *Peritonsillar abscess

B. Phlegmonous tonsillitis

C. Pharyngeal tumor

D. Diphtheria

E. Vincent’s disease

 

132. A 38-year-old woman was hospitalized to the surgical unit with acute abdominal pain irradiating to the spine and vomiting. On laparocentesis hemmorhagic fluid is obtained. What disease is suspected?

A. *Acute pancreatitis

B. Acute enterocolitis

C. Renal colic

D. Acute appendicitis

E. Perforative gastric ulcer

 

133. An anestesiologist gives narcosis to the patient; he uses a non-reversive contour. Anesthetic is halothane. Air temperature in the operation room is 21°C, humidity 50%, level of noise 30 dB. What occupational hazards is the principal one in these conditions?

A. *Air pollution with anesthetic

B. Improper occupational microclimate

C. Mental overfatigue

D. Compelled working pose

E. High level of noise

 

134. A 30-year-old man has suffered from traffic accident. Consciousness is absent. Ps on the carotid artery is undeterminable, no respiration. There is a wide leather belt on man’s waist. What measures are to be taken?

B. *Conduct an artificial ventilation of lungs and closed-chest cardiac massage after having released from the belt

A. Start immediate artificial ventilation of lungs and closed-chest cardiac massage

C. Put the victim with his back on the shield

D. Turn the victim to the right side

E. Do not touch the victim until the arrival of the police

 

135. In 30 days after accidental coitus, a 25-year-old patient develops ulcers on penis. On physical exam: inside of prepuce there is painless round erosion, 1,5 cm in diameter, with dense bottom, with even edges, without evident inflammatory changes. What is the most probable diagnosis?

A. *Primary syphilis (hard chancre)

B. Herpes simplex

C. Chancriform pyoderma

D. Chancroid (soft chancre)

E. Scabies complicated with pyococcuses

 

136. A patient with a history of coronary artery disease and atrial fibrillation develops sudden pain and weakness of the left leg. Examination reveals a cool, pale extremity with absent pulses below the groin and normal contralateral leg. What is the most likely diagnosis?

A. *Arterial embolism

B. Acute thrombophlebitis

C. Cerebrovascular accident

D. Arterial thrombosis

E. Dissecting aortic aneurysm

 

137. A 29-year-old woman is critically ill. The illness was manifested by high fever, chills, sweating, aching pain in lumbar area, a discomfort in urination, and frequent voiding. Pasternatsky’s sign is positive in both sides. On lab exam, WBC of 20 * 109/L; Urinalysis: protein of 0,6 g/L, leukocyturia, bacteriuria. What is preliminary diagnosis?

A. *Acute pyelonephritis

B. Exacerbation pf chronic pyelonephritis

C. Acute glomerulonephritis

D. Nephrolithiasis

E. Acute cystitis

 

138. A 40-year-old man, veterinary by profession, complains of moderate weakness,fever 38° C for 3 days. On physical examination an ulcer on right forearm is revealed, diameter 1,5 cm, covered with dark brown scab, surrounded by zone of hyperaemia with fine vesicles. There is a severe edema of forearm soft tissues. The right-side cubital and axillary lymphatic nodes are enlarged and tender. He has fresh scratches on his hands. What is the most probable diagnosis?

C. *Anthrax

A. Felinosis

B. Staphylococcus carbuncle

D. Tularaemia, ulcerobubonic form

E. Erysipelas

 

139. A 25-year-old woman complains of absense of menses during 3 months, nausea. On vaginal examination: vulval and vaginal mucosa is bluish, uterine corpus is enlarged, uterine fundus is 3 cm above symphysis pubis. Uterus is soft, and becomes dense upon palpation. Adnexa are not identified. Discharge is mucosus.

What is the most likely diagnosis?

C. *l2-week pregnancy

A. Disorder of menstruation cycle

B. Amenorrhea

D. Fibromioma of uterus

E. Chorionepithelioma

 

140. A 27-year-old man complains of pain in epigastrium which is relieved by food intake. EGDFS shows antral erosive gastritis, biopsy of antral mucous presents Helicobacter Pylori. What can be diagnosed in this case?

B. *Gastritis of type

A. Reflux – gastritis

C. Menetrier’s disease

D. Gastritis of A type

E. Rigid antral gastritis

 

141. A 1-year-old child suffers of attack-like cough. The child presents with the history of dyspepsia since birth. On physical examination there are signs of delay in physical development, bronchial obstruction, respiratory insufficiency, 1 grade. Blood count: signs of inflammatory process. Sweat chlorides 120 mEq/L. What is the most likely diagnosis?

D. *Cystic fibrosis

A. Bronchopulmonary dysplasia

B. Kartagener’s syndrome

C. Acute respiratory infection, bronchitis

E. Severe bronchial asthma

 

142. A 60-year-old man has been diagnosed osteoarthritis of knee joints. Which of the following medications is the most appropriate for treatment?

C. *Delagil

A. Crizonol

B. Rumalon

D. Prednisolon

E. Colchicine

 

143. A patient with nosocomial pneumonia presents signs of collapse. Which of the following pneumonia complications is most likely to be accompanied with collapse?

D. *Septic shock

A. Toxic hepatitis

B. Bronchial obstruction

C. Emphysema

E. Exudative pleuritis

 

144. A 22-year-old woman complains of dull right subcostal pain, nausea, decreased appetite. History: disease started with jaundice in 2 months after appendectomy. She was treated in an infectious hospital. 1 year later present complaints have developed. Physical examination: subicteric sclerae, enlarged firm liver. What is your preliminary diagnosis?

A. *Chronic viral hepatitis

B. Chronic cholangitis

C. Acute viral hepatitis

D. Calculous cholecystitis

E. Gilbert’s disease

 

145. A young woman applied to gynecologist due to her pregnancy of 4-5 weeks. The pregnancy is desirable. Anamnesis stated that she had rheumatism in the childhood. Now she has combined mitral heart disease with the priority of mitral valve insufficiency. When will she need the inpatient treatment (what periods of pregnancy)?

B. *8-12 weeks, 28-32 weeks, 37 weeks

A. 12-16 weeks, 27-28 weeks, 37-38 weeks

C. 10-12 weeks, 24 weeks, 37-38 weeks

D. 6-7weeks, 16 weeks, 38 weeks

E. 16 weeks, 34 weeks, 39-40 weeks

 

146. A non-alcoholic 45-year-old woman presents with an asymptomatic, septated 10-cm cystic mass in the body of the pancreas. She should be advised for the following:

D. *Complete excision of the lesion.

A. Lesion is cancerous and woman will likely die in 12 months

B. Observation only due to probably benign lesion

C. Total pancreatectomy

E. Drainage by Roux-en-Y jejunostomy

 

147. A 25-year-old man has facial edema, moderate back pains. His temperature is 37,5°C, BP 180/100 mm Hg, hematuria (up to 100 in v/f), proteinuria (2,0 g/L), hyaline-casts – 10 in v/f, specific gravity —1020. The onset of the disease is probably connected with acute tonsillitis that started 2 weeks ago. What is the most probable diagnosis?

D. *Acute glomerulonephritis

A. Chronic glomerulonephritis

B. Urolithiasis

C. Cancer of the kidney

E. Acute pyelonephritis

 

148. A 27- year-old woman was admitted to the clinic with complaints of pain in right ankle joint, non-bearable extremity. Physical examination: the patient had a fracture of anterior part of distal metaepiphisis of tibia [Pott-Desto’s fracture]. What is the mechanism of such an injury?

D. *Supination of the foot

A. Load along the axis with dorsal flexion of foot

B. Load along the axis with planter flexion of foot

C. Pronation of the foot

E. Direct blow

 

149. Water that is used for supply of the city, contains fluoride 2,0 mg/L, nitrates 43 mg/L, chlorides 250 mg/L, ferrum 0,2 mg/L, residual nitrogen 0,5 mg/L. What medical condition is the most likely to occur in inhabitants of this city?

E. *Fluorosis

A. Thyrotoxicosis

B. Methemoglobinemia

C. Caries

D. Endemic goitre

 

150. A 7-year-old boy has an attack of asphyxia and distant whistling rale after playing with a dog. History: atopic dermatitis caused by eating eggs, chicken, beef. What group of allergens is the reason of the development of bronchial asthma attacks?

E. *Epidermal

A. Itch mite

B. Chemical

C. Pollen

D. Dust

 

151. A 25-year-old woman complains of edema on the face and legs, elevation in blood pressure up to 160/100 mm Hg, and weakness. She fell ill 3 weeks after sore throat. On urinalysis, protein of 0,5 g/L, erythrocytes of 17 – 20/field, leukocytes of 2 – 3/field, erythrocyte casts. What treatment should be initiated after establishing of the exact diagnosis?

D. *Penicillin

A. Ceftriaxone

B. Ciprofloxacine

C. Heparin

E. Dipyridamole

 

152. An attack of severe substernal pain developed in a patient at night. On exam: confusion, pallor of the skin, acrocyanosis, cold sweating, BP of 80/50 mmHg, heart rate 120/min, irregular and weak pulse. What kind of condition has developed?

B. *Cardiogenic shock

A. Acute left-sided heart failure

C. Acute vascular insufficiency

D. Acute right-sided heart failure

E. Radicular syndrome

 

153. A district physician has diagnosed domestic accident at worker of chemical factory who is at home. The worker is temporarily disable. What document should be given to legalize his disability?

E. *Sick-list from the 1st day

A. Sick-list from the 5 th day after presenting to physician

B. No documents

C. Certificate of free form

D. Certificate of definite form

 

154. A 37-yea-old man suddenly felt a strong pain in metatars-phalanx joint of 1st finger on left foot. Pain has appeared at night after celebrating a birthday. Physical examination: skin above the joint is red, the joint is swollen . Blood count: WBC 9,6* 109/L, Neutrophils 74%, ESR 30 mm/h. Uric acid 0,49 mmol/L. What medication do you prescribe to the patient?

A. *Diclofenac

B. Allopurinol

C. Prednisolon

D. Anturan

E. Aethamid

 

155. A 52-year-old man has recurrent transient ischemic attacks. Auscultation of the carotid arteries detects murmur. What diagnostic method is necessary to apply at first?

A. *Ultrasound dopplerography

B. Electroencephalography

C. CT of the brain

D. Cerebral angiography

E. MRI of the brain.

 

156. A 46-year-old male was hospitalized with complaints of shortness of breath at rest, palpitation, irregular work of heart, weakness. Physical examinations: severe condition, orthopnea, acrocyanosis.RR 28/min. Ps 94 bpm, BP 150/70 mmHg. Cardiac enlargement, the dullness of heart sounds and ventricular gallop. Rales is auscultated in lower lungs. A liver is slightly enlarged. The moderate edema of lower extremities. What revealed symptom is an authentic sigh of congestive heart failure?

D. *Orthopnea

A. Cardiac enlargement

B. Pulmonary rales

C. Tachycardia

E. Ventricular gallop

 

157. A 27-year-old man came to consult a psychiatrist with the following complaints: after a bad car accident, the victim of which he was and in which his wife was killed, he suffered depression, anxiety, flashbacks of the event, sleep disorders and nightmares about the accident. He also had emotional numbness and fatigue. The cause of the disorder was:

A. *Severe stress

B. Environmental factors

C. Patient’s personality features

D. Adjustment disorder

E. Endogenic factors

 

158. A 48-year-old man was taken to the emergency department in severe condition. Medical history: 3 hrs ago he was processing potato plants with the poison against Colorado beetles. Physical examination: acrocyanosis, bronchorrhea, tachypnea, BP 100/60 mmHg, Ps 44 bpm. What method of efferent therapy is the most expedient on this stage?

C. *Haemosorbtion

A. Plasmopheresis

B. Haemodialisis

D. Limphosorbtion

E. Plasmodialisis

 

159. The diagnosis of right-sided pneumothorax is made to a 36-year-old patient. What method of treatment is indicated to this patient?

C. *Surgical drainage of the pleural cavity

A. Antiinflammation therapy

B. Thoracotomy

D. Pleural puncture

E. Symptomatic therapy

 

160. A 3-year-old boy fell ill abruptly: fever up to 39°C, weakness, vomiting. Haemorrhagic rash of various sizes appears on his lower limbs in 5 hours. Meningococcemia with infective – toxic shock of 1 degree was diagnosed. What medications should be administered?

A. *Chloramphenicol succinate and prednisone

B. Penicillin and immunoglobulin

C. Chloramphenicol succinate and interferon

D. Penicillin and prednisone

E. Ampicillin and immunoglobulin

 

161. In mental status of a 22-year-old man there is a stable pathological depressed mood. The patient is sociable, replies briefly but to the point. The speech is laconic, tempo is slowed, and movements are constrained and inhibited. Speaks on the ideas of self-accusation and self-humiliation. Medications of what group are to be prescribed to this patient?

C. *Antidepressants

A. Tranquilizers

B. Hypnotics

D. Neuroleptics

E. Normotimics

 

162. A 10-year-old boy complains of joint pain and impossibility of movement in left knee and right elbow. 2 weeks ago he had tonsillitis Physical examination: t – 38,5°C and ankle dysfunction, enlargement of cardiac dullness on 2 cm, tachycardia, weakness of Sound 1, gallop rhythm, weak systolic murmur near apex. Which diagnosis corresponds to such symptoms?

B. *Acute rheumatic heart disease

A. Reactive arthritis

C. Juvenile rheumatoid arthritis

D. Reiter’s disease

E. Systemic lupus erythematosus

 

163. A 32-year-old female complains of feeling too lazy, reduction of work capacity, and hopelessness of life. The suicide idea takes place. During 2 weeks before, the raised activity, uncontrollable fun and levity was observed. What is your diagnosis?

C. *Bipolar affective disorder

A. Recurrent depressive disorder

B. Schizoaffective disorder

D. Depressive episode

E. Maniacal episode

 

164. A 27-year-old man was hospitalized to the psychiatric hospital for the 4-th time during 2 years. He hears voices commenting on his actions, has delusions of persecution (is sure that the Mafia wants to kill him). After a course of treatment with neuroleptics is discharged from hospital with the diagnosis of schizophrenia, state of remission. The

secondary prevention of the relapses of schizophrenia requires:

C. *Supportive treatment with neuroleptics of prolonged action

A. Participation in a self-help group

B. Long-term hospitalization

D. Psychiatric observation

E. Psychoanalytic treatment

 

165. A 18-year-old woman applied to gynecologist with complaints of the pain in the lower part of the abdomen, fever up to 37,5°C, considerable mucopurulent discharges from the genital tract, colic by urinating. After mirror and vagina exam the results are the following: the urethra is infiltrated, cervix of the uterus is hyperemic, erosive. The uterus is painful, ovaries are painful, thickened, free. Bacterioscopy test showed diplococcus. What diagnosis is the most probable?

C. *Recent acute ascending gonorrhea

A. Chlamydiosis

B. Trichomoniasis

D. Chronic gonorrhea

E. Candydomycosis

 

166. A 40-year-old woman who has worked in weaving branch for 10 years complains of frequent headache, sleeplessness, irritability, fatigue, tiredness. Physical examination reveals instability of blood pressure, internal organs are without changes. What is the most probable diagnosis?

C. *Noise-induced disease

A. Encephalopathy

B. Hypertension

D. Asteno-vegetative syndrome

E. Atopic bronchial asthma

 

167. A 9-year-old child with diagnosis «chronic tonsillitis” stands dispanserization control. For 1 year of observation there was one exacerbation of disease. Physical condition is satisfactory. The general state is not infringed. Define group of health:

E. *III (a)

A. I

B. II

C. III (c)

D. III (b)

168. A 32-year-old woman is admitted to gynecology department with the diagnosis of acute bartholinitis. Physical examination: t — 38,2°C. Skin hyperemia in the area of vestibule big gland, positive fluctuation sign, and sharp tenderness. Blood count: WBC 10,4 * 109/L, ESR 24 mm/h. What is the most correct tactics of the doctor?

E. *Surgical dissecting; drainage of an of the gland; antibiotics

A. Antibiotics, sulfonamides

B. Antibiotics, detoxication and biosti-mulators

C. Surgical dissection; drainage of the abscess of the gland

D. Antibiotic therapy

 

169. A 20-year-old man complains of pain and edema in right buttock. Physical examination: limited tenderness, painful swelling with hyperemia of skin above and local hyperthermia. Positive fluctuation symptom. Abscess is diagnosed. What is your tactics?

A. *Lancing and draining of abscess, broad spectrum antibiotic

B. Physiotherapy

C. Broad spectrum antibiotic and sulfonamide

D. Administration of tetanus antitoxin and medications for stimulation of immunity

E. Local application of dimexide

 

170. A 25-year-old man has focal shadowing of small and medium intensity, unequal contours in 1st and 2nd segments of the right lung revealed during routine fluorography. What clinical form of tuberculosis can be suspected in this patient?

C. *Focal

A. Fibro-cavernous

B. Tuberculoma

D. Disseminated

E. Miliary

 

171. A 44-year-old woman complains of weakness, subfebrile fever, and pallor of the skin. Physical examination reveales the enlarged lymph nodes in the right supraclavicular area. On X-ray: enlargement of bronchopulmonary and paratracheal lymph nodes. The liver is enlarged, with increased firmness. What is the diagnosis?

C. *Hodgkin’s disease

A. Chronic myelocytic leukemia

B. Tumor metastases

D. Tuberculosis

E. Sarkoidosis

 

172. 6-month-old infant was born with body’s mass 3 kg and length 50 cm. He is given natural feeding. How many times per day the infant should be fed?

E. *5

A. 7

B. 6

C. 8

D. 4

 

173. A neonate was born from the 1st gestation on term. The jaundice was revealed on the 2nd day of life, and then it became more acute. The adynamia, vomiting and hepatomegaly were observed. Indirect bilirubin level was 275 /itmol/L, direct bilirubin level – 5 mol/L, Hb -150 g/L. Mother’s blood group – 0[I], Rh+, child’s blood group- A[II], Rh+. What is the most probable diagnosis?

C. *Hemolytic disease of the neonate [ABO incompatibility]

A. Jaundice due to conjugation disorder

B. Physiological jaundice

D. Hemolytic disease of the neonate [Rh -incompatibility]

E. Hepatitis

 

174. A 8-month-old child is diagnosed atypical community-acquired Chlamidia trachomatis pneumonia. Select the best antibiotic.

A. *Macrolide of 2nd generation

B. Macrolide of 1st generation

C. Aminopenicilline

D. Cephalosporine of 2nd generation

E. Aminoglycoside

 

175. A 2,5-month-old child presents with muscle hypotonia, sweating, alopecia of the back of the head. The child is prescribed massage, curative gymnastics and vitamin D. What is the dosage and frequency of vitamin D administration?

C. *3000IU daily

A. 1000IU daily

B. 1000 IU every other day

D. 500 IU every other day

E. 500 IU daily

 

176. A 30-year-old patient complains of shortness of breath, pain in the right rib arc place, dry cough and leg edema. He has been ill for 2 months. He was treated for rheumatic fever without effect. On exam: cyanosis, edema of the legs, t – 36,6°C, RR 28/min, HR 90/min, BP 110/80 mm Hg. Bilateral pulmonary rales on lower lungs. Heart borders are displaced to the left and to the right. Cardiac sounds are weakened, systolic murmur above the apex. What is the most likely preliminary diagnosis?

B. *Dilated (congestive) cardiomyopathy

A. Infectious endocarditis

C. Rheumatic fever, mitral stenosis

D. Acute myocarditis

E. Acute pericarditis

 

177. What is the treatment choice for 60-year-old male with renal cell carcinoma T2N0M0 and normal contralateral kidney?

D. *Radical nephrectomy

A. Resection of the kidney

B. Radiation therapy

C. Nephroureterectomy

E. Simple nephrectomy

 

178. A 2-month-old healthy infant with good appetite, is given artificial feeding since 1-st month. When is it advised to start the corrective feeding (fruit juice)?

D. *4,0 months

A. 2,0 months

B. 1,0 months

C. 1,5 months

E. 3,0 months

 

179. An 18-year-old  pregnant woman comes to see an obstetrician  at 11-12 weeks gestation. Medical history states that 1 month ago woman has suffered with rubella. What influence on fetus is the most likely in this woman?

E. *Congenital developmental abnormaliti fetus

A. Chromosomial abnormalities of fetus

B. Labour trauma of newborn

C. Hemolytis disease of newborn

D. Hyaline membrane disease

 

180. A 4-year-old child attends the kindergarten. Complaints of the bad appetite, fatigue. Objective examination: skin and mucous membrane are pale, child is asthenic. In the hemogram: hypochromatic anemia 1st., leucomoide reaction, of the eosinophile type. What pathology must be excluded at first?

B. *Worm invasion

A. Lymphoprolipherative process

C. Duodenal ulcer

D. Hypoplastic anemia

E. Atrophic gastritis

 

181. A man is diagnosed disorder of purine metabolism that manifestates itself with acute arthritis of 1st metatarsophalangeal joint. Provide the patient with the most reasonable recommendation regarding his diet.

E. *Restriction of meat and legumes

A. Restriction of milk products

B. Restriction of free liquid

C. Restriction of cereal and macaroni

D. Restriction of vegetables and fruits’

 

182. The patient has worked 13 years as a bulldozer driver. He complains of dizziness, headache, finger dumbness and pain at night. On exam, tactile sensivity of peripheral type disturbes him, ankle muscles are painful, and pulsation on a.dorsalis pedis is weak. What is the most probable diagnosis?

A. *Vibration disease

B. Syringomyelia

C. Periarteritis nodosa

D. Raynaud’s disease

E. Atherosclerosis obliterans

 

183. The patient with aquired heart failure has diastolic pressure 0 mm Hg. What heart failure does the child have?

E. *Aortal insufficiency

A. Rheumatism

B. Aortal i stenosis

C. Mitral insufficiency

D. Mitral stenosis

 

184. A 5-year-old boy fell ill abruptly: fever up to 39,8°C, recurrent vomiting, severe headache. Convulsions occur in 3 hours. Physician found out positive meningeal sign. Pleocytosis of 2500 cells chiefly polymorphonuclear cells, elevated protein concentration and normal glucose concentration was found in cerebrospinal fluid examination. What is your diagnosis?

B. *Purulent meningitis

A. Tuberculous meningitis

C. Serous meningitis

D. Subarachnoidal hemorrhage

E. Encephalitis

 

185. A 62-year-old man complains of the pain behind the sternum, bad pasage of solid and liquid food, badsmell breath, increased salivation, weight loss of 15 kg during 2 months. Appetite is retained. On physical exam: face features are sharpened. The skin is pale, with sallow tint, its turgor is decreased. The liver is not enlarged. Blood Hb – 86g/L. Gregersen reaction is positive. What kind of pathology has caused the given clinical situation?

E. *Esophagus cancer

A. Benign growth of esophagus

B. Cicatricial constriction of esophagus

C. Chronic non-specific esophagitis

D. Achalasia of esophagus

 

186. District physician was charged With plan drafting concerning medical and preventive measures among the population in the area he is assigned to. What measures must he include in this plan as regarding primary prevention of illness?

E. *Prevention of disease onset

A. Prevention of disease complications

B. Measures to increase patients life quality

C. Measures to improve patients life conditions

D. Referral of patients to sanatorium

 

187. A 25-year-old woman complained of fatigue, hair loss, and brittle nails. On exam, pallor of skin, Ps 94/min, BP 110/70 mmHg. On blood cell count, Hb 90 g/L, RBC 3,5* 1012/L, color index of 0,7; ESR of 20 mm/H. Serum iron level was 8,7 μmol/L. What treatment would you initiate?

E. *Ferrous sulfate orally

A. Packed RBCs transfusion

B. Vitamin B12 intramuscularly

C. Blood transfusion

C. Iron dextrin injections

 

188. A 34-year-old was bit by the dog 3 hours ago. In the left arm there is a wound by the tooth of dog’s bite without bleeding . What surgical help would you provide to such a patient?

D. *Washing of the wound with detergent water and applying anti-septic

A. Aseptic bandage

B. Cream bandage

C. Complete suturing of the wound

E. Incomplete suturing of the wound

 

189. A man suffering with virus hepatitis B presents with increase of jaundice and bloody vomiting after break of diet and nervous stress. Physical examination: Ps 110 bmp, BP 80/50 mmHg. The liver is painful at palpation and is reduced in size. What complication is the most likely being observed?

B. *Acute hepatic failure

A. Toxico-infection shock

C. Haemolytic crisis

D. Acute adrenal failure

E. Acute renal failure

 

190. A 37-year-old woman is sick with bronchial asthma for 15 years. Recenlty asthmatic attacks occur 4-5 times per week, night attacks -2-3 times per month. To stop attacks, the patient takes salbutamol. On physical exam: condition is relatively satisfactory. RR – 20/min, Ps is 76 bpm, BP -120/80 mm Hg. Respiration in lungs is vesicular. Cardiac sounds are muted, rhythm is normal. What medication should be prescribed to prevent attacks of bronchial asthma on the first stage?

B. *Cromoglycat sodium

A. Injection of corticosteroids

C. Regular dose of salbutamol

D. Inhalation corticosteroids

E. Tabletted corticosteroids

 

191. Fever up to 39°C is registered the next day after a woman had labor. Fetal membranes rupture took place 36 hours before labor. Pelvic examination: the uterus is soft, tender. Discharges are bloody, mixed with pus. Uterine culture: haemolytic streptococcus, group A. What is the most probable postnatal complication?

E. *Metroendometritis

A. Apostatis of stitches after the episiotomy

B. Infected hematoma

C. Thrombophlebitis of veins of the pelvis

D. Infective contamination of the urinary system

 

192. A 10-year-old child fell ill acutely a week ago after overcooling when there appeared pain in the stomach and the back, fever up to 38°C. Urinanalysis: leucocytes 25-30 per v/f, protein 0,33 g/L. Which of the following is the most appropriate test for prescribing of etiotropic treatment?

B. *Urine culture

A. Nechiporenko test

C. Zimnitsky test

D. Cystography

E. Intravenous urography

 

193. A 78-year-old woman is urgently admitted to surgical department due to chronic intestinal obstruction. On physical examination significant narrowing of anal orifice is observed due to dense bumpy tumor that occupies more than half of anal circle. Finger investigation reveals stone-dense fecal masses in ampulla of rectum. What is the most likely diagnosis?

A. *Cancer of anal part of rectum

B. Polypus of anal part of rectum

C. Chronic paraproctitis

D. Atresia of anal channel

E. Hemorrhoids

 

194. A 9-year-old child is ill for 5 days. Physical examination:  Conscious, inert. Puffy face. Cataral conjunctivitis, scleritis. Bright-red papulous middle-spotted skin rash on face and behind ears. Somewhere elements merge. Diffuse hyperemia in pharynx. Soft palate shows enanthema. The child is not vaccinated. What is the most likely diagnosis?

B. *Measles

A. Allergic dermatitis

C. Pseudotuberculosis

D. Scarlet fever

E. Rubella

 

195. A patient has disturbance of nasal respiration, mucopurulent discharge from the nose, headache for three weeks. At anterior rhinoscopy the stria of pus, edema, hyperemia of the mucosa of the nose have been determined in middle nasal meathus. What further investigation is necessary?

D. *X-ray of paranasal sinuses

A. Computer tomography of the skull

B. Bacteriology analysis of the nasal mucous

C. Punction of the maxillar sinus

E. General blood analysis

 

196. A 7-year-old girl suddenly fell ill with fever, headache, severe sore throat, vomiting. Minute bright red rash appeared on her ablushed skin in 3 hours. It is more intensive in axillas and groin. Mucous membrane of oropharynx is hyperemic. Greyish patches are on tonsills. Submaxillary glands are enlarged and painful. What is your diagnosis?

D. *Scarlet fever

A. Rubella

B. Enteroviral infection

C. Measles

E. Pseudotuberculosis

 

197. The student has following devices: Geiger counter, Ebert counter, Krotov’s apparatus, Mischuk device, Ebert device. What device can he use to assess air germ pollution?

B. *Krotov’s apparatus

A. Ebert’s device

C. Geiger’s counter

D. Mischuk’s device

E. Ebert’s counter

 

198. A man with liver cirrhosis complains of nasal bleedings, right subcostal pain, weakness, nausea. On physical examination: jaundice, hemorrhagic rash, enlarged liver span (of 14 cm), liver edge irregular. What is the cause of hemorrhagic syndrome in this patient?

E. *Decreased liver production of focoagulants

A. Disseminated intravascular coagulation

B. Thrombocytopenia

C. K and C hypovitaminosis

D. Portal hypertension

 

199. A 2,5-year-old child fell ill 10 hours ago with anxiety, touching of stomach, fever up to 38°C. In 7 hours condition has worsened with vomiting and diarrhea. Physical examination: tongue is dry, coated. Abdomen barely participates in breathing. Palpation is impossible due to child anxiety. Finger rectal investigation reveals overhang of front rectum wall. What is the most likely diagnosis?

B. *Acute appendicitis, peritonitis

A. Acute mesadenitis

C. Primary peritonitis

D. Acute enteric infection

E. Acute adenoviral infection

 

200. A 36-year-old woman is on the 12-th week of the first pregnancy. Earlier she was treated for infertility. She had contacted with the child who developed rubella in 2 days after meeting. Woman doesn’t know if she has ever been infected with rubella. What is the adequate tactics?

D. *Monitory of the specific IgG IgM with the ELISA

A. Immune globulin injection

B. Interferon administration

C. Interruption of pregnancy

E. Cyclovir administration

 

Year 2002 (With Answers)

Posted: May 5, 2012 in Krok II
Tags:

1. A 24-year-old man on the 5th day of acute respiratory disease with high grade temperature started having strong headaches, systemic dizziness, sensation of double vision, paresis of mimic muscles to the right, tickling by swallowing. Diagnosis: Acute viral encephalitis. Determine the basic direction of the emergent therapy.

C. *Zovirax

A. Glucocorticoids

B. Hemodesis

D. Cephtriaxon

E. Lasix

Used For Viral Infections

2. A 29-year-old woman has had a surgical treatment concerning the benign serous epithelial tumour of the ovary. The postoperative period passed without complications.What is necessary to prescribe in the rehabilitational period?

E. *Hormone therapy and proteolytic enzymes

A. No further observation

B. Antibacterial therapy and adaptogens

C. Magnetic therapy and vitamin therapy

D. Laser therapy and enzyme therapy

 Tumour of the ovary

Tumour of the ovary

3. A 54-year-old patient applied with complaints of acute pain in the shoulder-joint. 10 minutes earlier he fell in the street with his arms stretched. Doctor of the traumatological unit noticed an acute deformation of the right shoulder-joint, the impossibilty of active movement in the right extremity. Roentgenologically: uncoincidence of articulating surfaces. What is the most probable diagnosis?

D. *Dislocation of the clavicle

A. Dislocation of the scapula

B. Contusion of the humerus

C. Dislocation of the humerus

E. Fracture of the humerus