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
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.
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
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:
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?
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
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
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.
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
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?
B. Gangrene of the IV toe on the right foot*
E. Fracture of the IV toe on the right foot
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?
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
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
C. Impetigo neonatorum
NB! A lesion of the epidermis consisting of a vesicle containing inflammatory cells.
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
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
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
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?
B. Acute purulent lymphadenitis
C. Bubonic plague*
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?
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.
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
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
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
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
C. Thiazide diuretic
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
26 Which of the following symptoms would occur only if a total-body acute radiation exposure exceeded 5.000 rad (50 Gy)
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
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*
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?
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
C. Symptomatic therapy
D. Pleural puncture
E. Surgical treatment: drainage of the pleural cavity*
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:
B. Gram-positive diplococci
C. Gram-negative diplococci*
D. Proteus vulgaris
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
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
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?
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*
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?
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?
B. Epsilon-aminocapronic acid
C. Stored blood
D. Packed red blood cells
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
C. Haemorrhagic vasculitis
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?
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?
C. Helicobacter pylory
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
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?
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:
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?
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?
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
D. 10 months
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
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*
D. Adiposogenital dystrophy
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*
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
D. DIC syndrome
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?
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?
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?
B. Laparoscopy with chromosalpingoscopy*
C. Bicontrast pelviography
D. Transvaginal echography
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?
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?
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?
C. Typhoid fever*
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?
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?
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?
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
D. Asthenic confusion
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
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:
C. Pelvic bones
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
D. Infectious arthritis
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
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
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?
B. Bacteriological study*
C. Antibiotic prophylaxis
D. Dispensary observation
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
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*
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?
C. Roentgenography of chest
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?
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*
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
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
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?
C. Adenoviral infection
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?
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
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?
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
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?
D. Salmonellosis, gastrointestinal form
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
C. Neuritis of the facial nerve
D. Meniere’s syndrome
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?
B. Puncture of abdominal cavity through posterior vaginal fornix
C. Extensive colposcopy
D. Separated diagnosic curretage*
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?
D. b-haemolytic streptococcus*
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
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
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
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?
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?
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*
C. Infectious mononucleosis
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
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
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?
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
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?
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?
B. Arabinoside monophosphate
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*
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?
C. Scarlet fever
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
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 *
C. Acute lymphoid leukosis
D. Adenoviral infection
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*
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
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
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?
C. Typhoid fever
D. Virus A hepatitis
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*
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?
B. Streptococcal impetigo
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*
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?
C. Chest X-ray*
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*
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
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
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?
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*
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?
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
C. Acute shigellosis
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
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:
C. Aspiration biopsy with cytology
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*
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
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?
B. Forceps operation*
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
C. Pasteurized milk
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
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:
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?
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
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?
191 The amount of ultraviolet radiation dose was measured in minutes. What device was applied for measurement of the biodose?
B. Gorbachev’s biodosimeter*
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?
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
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
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*
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:
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
D. August’s psychrometer
E. Assmann psychrometer