Krok2 - Medicine - 2008

Krok 2 Medicine 2008 1
1. An 8 year old child has low-grade A. Atony of the uterus

fever, arthritis, colicky abdominal pain B. Injury of cervix of the uterus
and a purpuric rash llocalized on the lower C. Hysterorrhexis
extremities. laboratory studies reveal a D. Delay of the part of placenta
guaiac-positive stool, urinalysis with red E. Hypotonia of the uterus
blood cell (RBC) casts and mild protei-
nuria, and a normal platelet count. The 5. On the first day after labour a woman
most likely diagnosis is: had the rise of temperature up to 39o C.
Rupture of fetal membranes took place
A. Henoch-Schonlein’s vasculitis 36 hours before labour. Examination of
B. Systemic lupus erythematosus (SLE) the bacterial flora of cervix of the uterus
C. Rocky Mountain spotted fever revealed hemocatheretic streptococcus of
D. Idiopathic thrombocytopenic purpura A group. The uterus body is soft, tender.
E. Poststreptococcal glomerulonephritis Discharges are bloody, with admixtures of
pus. Specify the most probable postnatal
2. A woman complains of having slight complication:
dark bloody discharges and mild pains in
the lower part of abdomen for several A. Metroendometritis
days. Last menses were 7 weeks ago. B. Thrombophlebitis of veins of the pelvis
The pregnancy test is positive. Bimanual C. Infectious hematoma
investigation: the body of the uterus indi- D. Infective contamination of the urinary
cates for about 5-6 weeks of pregnancy, system
it is soft, painless. In the left appendage E. Apostasis of sutures after the episi-
there is a retort-like formation, 7 х 5 cm otomy
large, mobile, painless. What examination
is necessary for detection of fetus locali- 6. A woman of a high-risk group (chronic
zation? pyelonephritis in anamnesis) had vagi-
nal delivery. The day after labour she
A. Ultrasound complained of fever and loin pains,
B. Hysteroscopy frequent urodynia. Specify the most
C. Hromohydrotubation probable complication:
D. Colposcopy
E. Cystoscopy A. Infectious contamination of the urinary
system
3. A pregnant woman in her 40th week of B. Thrombophlebitis of veins of the pelvis
pregnancy undergoes obstetric examinati- C. Infectious hematoma
on: the cervix of uterus is undeveloped. D. Endometritis
The oxytocin test is negative. Examinati- E. Apostasis of sutures after episiotomy
on at 32 weeks revealed: AP 140/90 mm
Hg, proteinuria 1 g/l, peripheral edemata. 7. A woman in her 39th week of
Reflexes are normal. Choose the most pregnancy, the second labour, has regular
correct tactics: birth activity. Uterine contractions take
place every 3 minutes. What criteria
A. Labour stimulation after preparation describe the beginning of the II labor
B. Absolute bed rest for 1 month stage the most precisely?
C. Complex therapy of gestosis for 2 days
D. Caesarian section immediately A. Cervical dilatation by no less than 4 cm
E. Complex therapy of gestosis for 7 days B. Cervical smoothing over 90%
C. Duration of uterine contractions over
4. A 26 year old woman had the second 30 seconds
labour within the last 2 years with D. Presenting part is in the lower region of
oxytocin application. The child’s wei- small pelvis
ght is 4080 gr. After the placent bi- E. Rupture of fetal bladder
rth there were massive bleeding, si-
gns of hemorrhagic shock. Despite the 8. A 24 years old primipara was hospitali-
introduction of contractive agents, good sed with complaints about discharge of
contraction of the uterus and absence the amniotic waters. The uterus is tonic
of any cervical and vaginal disorders, on palpation. The position of the fetus is
the bleeding proceeds. Choose the most longitudinal, it is pressed with the head
probable cause of bleeding: to pelvic outlet. Palpitation of the fetus
is rhythmical, 140 bpm, auscultated on
the left below the navel. Internal exami-
nation: cervix of the uterus is 2,5 cm
long, dense, the external os is closed, light A. Droperidolum of 0,25% - 2,0 ml

amniotic waters out of it. Point a correct B. Dibazolum of 1% - 6,0 ml
component of the diagnosis: C. Papaverine hydrochloride of 2% - 4,0
ml
A. Antenatal discharge of the amniotic D. Hexenalum of 1% - 2,0 ml
waters E. Pentaminum of 5% - 4,0 ml
B. Early discharge of the amniotic waters
C. The beginning of the 1st stage of labour 12. A 40 year old woman has changes of
D. The end of the 1st stage of labour mammary gland. What are the most often
E. Pathological preterm labour symtomps that precede the malignizati-
on?
9. A 29 year old patient underwent
surgical treatment because of the beni- A. Skin induration with inverted nipple
gn serous epithelial tumour of an ovary. B. Painful movable induration
The postoperative period has elapsed wi- C. Painless movable induration
thout complications. What is it necessary D. Bloody discharges from the nipple
to prescribe for the rehabilitational peri- E. Pure discharges from the nipple
od:
13. A patient who takes diuretics has
A. Hormonotherapy and proteolytic developed arrhythmia as a result of
enzymes cardiac glycoside overdose. What is the
B. Antibacterial therapy and adaptogens treatment tactics in this case?
C. Lasertherapy and enzymotherapy
D. Magnitotherapy and vitamin therapy A. Increased potassium concentration in
E. The patient does not require further blood
care B. Increased sodium consentration in
blood
10. A patient was delivered to a surgical C. Reduced magnesium concentration in
department after a road accident with a blood
closed trauma of chest and right-sided rib D. Increased calcium concentration in
fracture. The patient was diagnosed wi- blood
th right-sided pneumothorax, it is indi- E. -
cated to perform drainage of pleural cavi-
ty. Pleural puncture should be made in: 14. An onset of severe preeclampsia at 16
weeks gestation might be caused by:
A. In the 2nd intercostal space along the
middle clavicular line A. Hydatidiform mole
B. In the 6th intercostal space along the B. Anencephaly
posterior axillary line C. Twin gestation
C. In the 7th intercostal space along the D. Maternal renal disease
scapular line E. Interventricular defect of the fetus
D. In the projection of pleural sinus 15. A 9 year old girl with a history of
E. In the point of the greatest dullness on intermittent wheezing for several years
percussion is brought to the pediatrician. The child
11. A primagravida with pregnancy of 37- has been taking no medications for some
38 weeks complains of headache, nausea, time. Physical examination reveals agitati-
pain in epigastrium. Objective: the skin is on and perioral cyanosis. Intercostal and
acyanotic. Face is hydropic, there is short suprasternal retractions are present. The
fibrillar twitching of blepharons, muscles breath sounds are quiet, and wheezing is
of the face and the inferior extremities. audible bilaterally. The child is admitted
The look is fixed. AP- 200/110 mm Hg; to the hospital. Appropriate interventi-
sphygmus of 92 bpm, intense. Respiration ons might include all of the following
rate is 32/min. Heart activity is rhythmi- EXCEPT:
cal. Appreciable edemata of the inferior A. Prescribe nebulized cromolyn sodium
extremities are present. Urine is cloudy. B. Prescribe intravenous aminophylline
What medication should be administered? C. Administer supplemental oxygen
D. Prescribe intravenous corticosteroids
E. Prescribe nebulized metaproterenol
16. Routine examination of an otherwise
healthy child with a history of bronchial
asthma reveals AP of 140/90 mm Hg. The ldhood. Examination reveals a lift at the
most likely cause of the hypertension is: left sternal border, split S1 , and fixed spli-
tting of S2 . There is a grade 3/6 midsystolic
A. Renal disease pulmonic murmur and a 1/6 middiastolic
B. Theophylline toxicity tricuspid murmur at the lower left sternal
C. Chronic lung disease border. Chest x-ray shows right ventricular
D. Coarctation of the aorta enlargement and prominent pulmonary
E. Obesity arteries. ECG demonstrates atrial fibri-
llation with a right bundle branch block.
17. The average body lenth of newborn The most likely diagnosis is:
boys is 50,9 cm at a sigma 1,66; and
average mass - 3432 at a sigma 5,00. What A. Arterial septal defect
criterion is necessary to compare degree B. Coarctation of the aorta
of variability of these signs? C. Patent ductus arteriosus
D. Tetralogy of Fallot
A. Coefficient of variation E. Ventricular septal defect
B. Sigma
C. Limit 22. Generalized low voltage on an ECG
D. Amplitude (QRS deflection < 5 mm in limb leads and
E. Coefficient of association < 10 mm in precordial leads) may be a
18. What method is applied to establish marker for all of the following disorders
rate of correlation between age of men EXCEPT:
and their mortality due to myocardial A. Hyperthyroidism
infarction? B. Pericardial effusion
A. Method of grade correlation (Spirman) C. Cardiac transplant rejection
B. Correlation ratio D. Amyloidosis
C. The quadrate method (Pirson) E. Coronary artery disease
D. The Indirect method (Student) 23. Five days after a total hip replacement
E. Method of graduated correlation a 72 year old woman becomes acutely
(Armler) short of breath, diaphoretic and
hypotensive. Both lung fields are clear to
19. Adenosine triphosphate may be auscultation and percussion, but exami-
expected to convert which of the followi- nation of the neck reveals mild jugular
ng arrhythmias to sinus rhythm? venous distension with prominent A
A. Paroxysmal supraventricular waves. Heart sounds are normal. ECG
tachycardia shows sinus tachycardia with a new right
B. Paroxysmal ventricular tachycardia bundle branch block and minor nonspeci-
C. Atrial fibrillation fic ST − T wave changes. The most likely
D. Atrial flutter diagnosis is:
E. Ventricular fibrillation A. Pulmonary thromboembolism
20. A 48 year old man complains of fati- B. Acute myocardial infarction
que and shortness of breath. His Ht is C. Aortic dissection
32%, and Hb - 103 g/l. Peripheral blood D. Pericarditis
smear reveals macrocytosis. Serum vi- E. Aspiration
tamin B12 level is 90 pg/ml (normal is 24. A child is 6 years old. Within one year
170 to 940); serum folate level is 6 ng/ml of observation he had URI that lasted 8
(normal is 2 to 14). Possible causes to days. Physical state is satisfactory. Specify
consider include all of the following hi health group:
EXCEPT:
A. I
A. Colonic diverticulitis B. II
B. Vegetarianism C. III (a)
C. Regional enteritis D. III (b)
D. Pancreatitis E. III (c)
E. Fish tapeworm infection
25. Which of the following IS NOT TYPI-
21. A 56 year old man complains of fati- CAL for Addison’s disease?
gue, dyspnea on exertion and palpitati-
ons. He has had a murmur since chi-
A. High serum Na+ A. Nasogastric decompression and

B. High serum K + parenteral alimentation
C. Elevated BUN B. Retrocolic gastrojejunostomy
D. Dilute urine C. Duodenojejunostomy
E. Elevated hematocrit D. Immediate exploration
E. Tube duodenostomy
26. A 38 year old man, previously in good
health, suddenly develops severe abdomi- 31. A 25 year old man has a sudden onset
nal pain radiating from the left loin to of chest pain on the right and dyspnea. His
groin and accompanied by nausea, perspi- trachea is deviated to the left. All of the
ration and the need for frequent urinati- following would be anticipated EXCEPT:
on. He is restless, tossing in bed but has
no abnormal findings. The most likely di- A. Pleural friction rub on the left
agnosis is: B. Absence of rhonchi
C. Absence of rales
A. Leftsided renal colic D. Hyperresonance over the right chest
B. Herpes zoster E. Distant breath sounds on the right
C. Sigmoid diverticulitis
D. Torsion of the left testicle 32. A 5 tons milk batch was sampled.
E. Retroperitoneal haemorrhage The lab analysis revealed: fat content 2%,
specific density - 1,04 g/cm3 , acidity - 210 Т,
27. A 40 year old woman has a self- reductase probe - weak-positive. What
detected hard breast mass. The procedure way is the product to be used in?
of choice for confirming the diagnosis is:
A. Sell but inform customers about milk
A. Excision biopsy quality
B. Mammography B. Discard for animal feeding
C. Thermography C. Technical utilization
D. Ultrasonography D. Sell without limitations
E. Aspiration biopsy with cytology E. Do the product away
28. A 38 year old man was admitted to a 33. What guarantees against the
hospital from his working place on July preconceived attitude to the physician in
19 because of hip fracture. He was invalid cases of professional law violations do you
till November 19. Requires prolongation know?
of treatment. Who decides on the issue of
further temporary invalidity? A. Sanction of public prosecutor, inquiry
by preliminary investigator of prosecutor’s
A. Specialized (traumatologic) MSEC office, committee of experts
B. DCC B. Draw up a statement about forensic
C. The head physician of a polyclinic medical examination
D. Interregional general MSEC C. Conduct an inquiry by preliminary
E. Regional MSEC investigator of police department
D. Utilisation copy of medical documents
29. During investigation for chronic, E. Conduct forensic medical examination
severe, epigastric pain, a 40 year old by district forensic medicine expert
alcoholic man is found to have multiple
areas of narrowing alternating with di- 34. If a child has adherent fingers on his
latation ("chain of lakes"appearance) of right hand, then what will be your di-
the main pancreatic duct. The operation agnosis?
of choice is:
A. Syndactyly
A. Lateral pancreaticojejunostomy B. Polydactyly
B. Distal pancreaticojejunostomy C. Macrodactyly
C. Sphincterotomy D. Ectrodactyly
D. Distal pancreatectomy E. Ectromelia
E. Total pancreatectomy
35. A 16 year old patient with complai-
30. The treatment of choice for duodenal nts of frequent pain in the abdomen was
obstruction caused by secondary diagnosed with melanoma, examination
duodenal hematoma that developed a few revealed also pigmentation of the mucosa
days after blunt abdominal injury is: and skin, polyp in the stomach and large
intestine. It is know that the patient’s
mother has an analogous pigmentation A. The test for tolerance to glucose

and has been often treated for anemia. B. Determination of the contents of
What disease is suspected? fetoproteinum
C. Bacteriological examination of di-
A. Peytz-Egers’s polyposis scharges from vagina
B. Chron’s disease D. A cardiophonography of fetus
C. Tuberculosis of the intestine E. US of fetus
D. Adolescent polyposis
E. Hirschprung’s disease 40. A patient with acute purulent oti-
tis media complicated by mastoiditis was
36. A 41 year old patient was admitted to admitted to a hospital. Roentgenogram of
the intensive care unit with haemorrhagic mastoid processes showed the shadiowi-
shock due to gastric bleeding. He has a hi- ng of the cellular system on the lesion,
story of hepatitis B during the last 5 years. absence of bone septa was present. What
The source of bleeding are esophageal vei- are the necessary therapeutic +actions at
ns. What is the most effective method for the second stage of mastoiditis?
control of the bleeding?
A. Mastoidotomy
A. Introduction of obturator nasogastric B. Paracentesis of the drum
tube C. Radical operation on the middle ear
B. Intravenous administration of pituitrin D. Tympanoplasty
C. Hemostatic therapy E. Cateterization of the Eustachian tube
D. Operation
E. Administration of plasma 41. A 22 year old patient was admitted to
trauma center with complaints of pain in
37. It is suspected that a 34 year old pati- the left ankle joint that was getting worse
ent has an abscess of Douglas pouches. during moving and weight bearing. On the
What diagnostic method is to be chosen? clinical examination it was found that the
patient had the closed fracture of medial
A. Digital examination of rectum malleolus without displacement. In which
B. Rectoromanoscopy position should the foot be fixed in plaster
C. Laparoscopy cast?
D. Percussion and auscultation of stomach
E. R-scopy of abdominal cavity A. At right angle with varus positioning of
the foot
38. A 52 year old man has recurrent transi- B. In position of planter flexion of foot
ent ischemic attacks. Auscultation of the C. In position of pronation
carotid arteries detected murmur. What D. In position of supination
diagnostic method is to be applied in the E. In position of dorsal flexion of foot
first place?
42. A patient with acute respiratory viral
A. Ultrasound dopplerography infection (3rd day of disease) complains
B. CT of the brain of pain in lumbar region, nausea, dysuria,
C. MRI of the brain oliguria. Urinalysis - hematuria (100-200
D. Cerebral angiography
E. Electroencephalography RBC in eyeshot spot), specific gravity -
1002. The blood creatinin level is 0,18 mi-
39. A 34 year old woman in the 10th llimole/l, potassium level - 6,4 millimole/l.
week of gestation (the second pregnancy) Make the diagnosis:
consulted a doctor of antenatal clinic in A. Acute interstitial nephritis
order to be registered there. In the previ- B. Acute renal failure
ous pregnancy hydramnion was observed, C. Acute glomerylonephritis
the child’s birth weight was 4086 g. What D. Acute cystitis
examination method should be applied in E. Acute renal colic
the first place?
43. A 3 month old infant suffering
from acute segmental pneumonia has
dyspnea (respiration rate - 80 per mi-
nute), paradoxical breathing, tachycardia,
total cyanosis. Respiration / pulse ratio is
1:2. The heart dullness under normal size.
Such signs characterise:
A. Encephalitis
A. Respiratory failure of III degree B. Meningitis
B. Respiratory failure of I degree C. Meningoencephalitis
C. Respiratory failure of II degree D. Myelitis
D. Myocarditis E. Neurotoxic syndrome
E. Congenital heart malformation
48. A 14 year old patient complains of
44. A 3 year old child has been sufferi- chest pain, temperature up to 38, 5o C,
ng from fever, cough, coryza, conjuncti- breathlessness. He had acute tonsillitis
vitis for 4 days. He has been taking 2 weeks ago. He is in grave condition.
sulfadimethoxine. Today it has fever up The skin is pale. Heart borders are di-
to 39o C and maculopapular rash on its lated, heart sounds are quiet. Above total
face. Except of rash the child’s skin has no heart area you can hear pericardium fricti-
changes. What is your diagnosis? on sound. Electrocardiogram: the descent
of QRS voltage, the inversion T. The liver
A. Measles is enlarged by 3 cm. ESR - 4 mm/h, ASL
B. Allergic rash - 0 - 1260, C-reactive protein +++. Your
C. Rubella diagnosis:
D. Scarlet fever
E. Pseudotuberculosis A. Rheumatic pancarditis
B. Rheumatic pericarditis
45. A 2 year old girl has been ill for C. Rheumatic myocarditis
3 days. Today she has low grade fever, D. Rheumatic endocarditis
severe catarrhal presentations, slight E. Septic endocarditis
maculopapular rash on her buttocks and
enlarged occipital lymph nodes. What is 49. A woman born a child. It was her fith
your diagnosis? pregnancy but the first delivery. Mother’s
blood group is A(II)Rh− , newborn’s -
A. Rubella A(II)Rh+ . The level of indirect bilirubin
B. Scarlet fever in umbilical blood was 58 micromole/l,
C. Measles hemoglobin - 140 g/l, RBC- 3, 8·1012/l. In 2
D. Adenoviral infection hours the level of indirect bilirubin turned
E. Pseudotuberculosis 82 micromole/l. The hemolytic disease
46. A 3 year old boy fell ill abruptly: of newborn (icteric-anemic type, Rh-
fever up to 39o C, weakness, vomi- incompatibility) was diagnosed. Choose
tng. Haemorrhagic rash of various size the therapeutic tactics:
appeared on his lower limbs in 5 hours.
Meningococcemia with infective - toxic A. Replacement blood transfusion
shock of the 1 degree was diagnosed. (conservative therapy)
What medications should be admini- B. Conservative therapy
stered? C. Blood transfusion (conservative
therapy)
A. Chloramphenicol succinate and predni- D. Symptomatic therapy
sone E. Antibiotics
B. Penicillin and prednisone
C. Penicillin and immunoglobulin 50. A mother consulted a pediatrician
D. Chloramphenicol succinate and about her son. Her son was born with
interferon body mass of 3 kg and length of 48 cm.
E. Ampicillin and immunoglobulin He’s 1 year old now. What is the required
normal mass?
47. A 7 year old girl has mild form
of varicella. Headache, weakness, verti- A. 10,5 kg
go, tremor of her limbs, ataxia, then B. 9,0 kg
mental confusion appeared on the 5th C. 11,0 kg
day of illness. Meningeal signs are negati- D. 12,0 kg
ve. Cerebrospinal fluid examination is E. 15,0 kg
normal. How can you explain these signs?
51. A 2 month old healthy infant with
good appetite is given artificial feeding
since he turned 1 month old. When is
it recommended to start the corrective
feeding (fruit juice)?
hypervolaemic type of essential

A. 4,0 months hypertension. Which of the following
B. 1,5 months medications is to be prescribed either as
C. 2,0 months monotherapy or in complex with other
D. 3,0 months antihypertensive drugs?
E. 1,0 months
A. Hypothiazid
52. A nine year old child is at a hospi- B. Dibazol
tal with acute glomerulonephritis. Cli- C. Clonidine
nical and laboratory examinations show D. Kapoten
acute condition. What nutrients must not E. Nifedipin
be limited during the acute period of
glomerulonephritis? 57. A 62 year old patient complains of
rest dyspnea, heart pains. 3 years ago
A. Carbohydrates he had myocardial infarction. Physical
B. Salt examination: orthopnea, acrocyanosis,
C. Liquid swollen cervical veins. Ps - 92, total heart
D. Proteins enlargement, the liver is enlarged by 7 cm,
E. Fats shin edema. What is the stage of chronic
heart failure (CHF)?
53. Examination of a 3-month-old child
revealed scrotum growth on the right. This A. CHF- 2 B
formation has elastic consistency, its size B. CHF- 1
decreases during sleep and increases when C. CHF- 2 А
the child is crying. What examination will D. CHF- 0
be helpful for making a correct diagnosis? E. CHF- 3
A. Palpation of the thickened cord crossing 58. A patient, aged 49, complains of fever
the pubical tubercule (sign of the silk of 37, 5o C, heart pain, dyspnea. S1 is
glove) clapping; S2 is accentuated in the aortic
B. Diaphanoscоpy area; opening snap, presystolic murmur
C. Palpation of the external inguinal ring can be auscultated. What is the most effi-
D. Puncture of the scrotum cient examination for valvular disorder
E. Examination of the formation in assessment?
Trendelenburg’s position
A. Echocardiography+Doppler-
54. A rounded well-defined shadow was Echocardiography
found in the costo-vertebral angle on B. Phonocardiography
the chest roentgenogram of an otherwise C. Ballistocardiogram
healthy 9 year old girl. Make a prelimi- D. Chest X-ray
nary diagnosis: E. ECG
A. Ganglioneuroma 59. A patient with nosocomial pneumonia
B. Sympatoblastoma presents signs of collapse. Which of
C. Ganglioneuroblastoma the following pneumonia complications
D. Sympatogonioma is most likely to be accompanied by
E. Sarcoma of the vertebra collapse?
55. A 52 year old patient with history of A. Septic shock
functional Class II angina complains of B. Exudative pleuritis
having intense and prolonged retrosternal C. Bronchial obstruction
pains, decreased exercise tolerance for D. Toxic hepatitis
5 days. Angina is less responsive to ni- E. Emphysema
troglycerine. What is the most probable
diagnosis? 60. A patient, aged 48, complains of heavi-
ness in the right hypochondrium, itchi-
A. IHD. Unstable angina ng of the skin. Repeatedly he had been
B. Cardialgia due to spine problem treated in infectious diseases hospital
C. IHD. Functional Class II angina because of icterus and itch. Objectively:
D. Myocarditis meteorism, ascitis, dilation of abdomi-
E. Myocardial dystrophy nal wall veins, protruding navel, spleen
enlargement. Diagnosis is:
56. A 52 year old patient has
A. Liver cirrhosis
B. Cancer of the liver A. Hypothalamus
C. Cancer of the head of pancreas B. Frontal lobes
D. Gallstones C. Pituitary
E. Viral hepatitis B D. Hippocampus
E. Corpus callosum
61. A 27 year old man complains of pai-
ns in epigastrium which are relieved by 66. The observed patient’s movements
food intake. EGDFS shows antral erosive are retarded, she answers no questions.
gastritis, biopsy of antral mucous presents Sometimes she spontaneously stays in
Hеlicobacter Pylori. Diagnosis is: strange postures. It is possible to set her
body and limbs into different positions
A. Gastritis of type B artificially. If the psychiatrist lifts her arm
B. Gastritis of type A or leg, so that she remains standing on the
C. Reflux-gastritis other leg, the patient can stay in such a
D. Menetrier’s gastritis position for quite a long time. Name the
E. Rigid antral gastritis probable disorder:
62. A 62 year old patient suffers from A. Catatonic stupor, schizophrenia
DM-2. Diabetes is being compensated by B. Depressive stupor, bipolar disorder
diet and Maninilum. The patient has to C. Apathetic stupor, schizophrenia
undergo an operation on inguinal hernia. D. Psychogenic stupor, stress disorder
What tactics of hypoglycemic therapy E. Dissociative stupor, dissociative
should be chosen? psychosis
A. Prescribe fast-acting insulin 67. A 50 year old patient has been
B. Give Glurenorm instead of Maninilum admitted to the clinics with atrophic
C. Continue with the current therapy gastritis. Blood count: erythrocytes -
D. Prescribe long-acting insulin 3, 8 · 1012 /l, Hb - 68 g/l, c.i. - 1,
E. Prescribe guanyl guanidines macroanisocytosis, poikilocytosis. There
is megaloblastic type of haemopoesis.
63. Prophylactic photoroentgenography A number of leukocytes, reticulocytes
examination of a 25 year old man revealed and thrombocytes is lreduced. Which
focal shadowings of small and medium pathology is suspected?
intensity with irregular contours in the 1st
and 2nd segments of the right lung. Which A. B12 -deficiency anemia
clinical form can be suspected? B. Irondeficiency anemia
C. Hemolytic anemia
A. Focal D. Post-hemorrhagic anemia
B. Disseminated E. Thalassaemia
C. Miliary
D. Fibro-cavernous 68. A 28 year old patient was admi-
E. Tuberculoma tted to the clinic with complaints of the
temperature rise up to 39, 0oC, headache,
64. A triad of symptoms ("stearing spot", weakness, constipation on the 9th day
"terminal film", "blood dew") has been of the disease. On examination: single
revealed on examination of a patient. roseolas on the skin of the abdomen are
What disease should you think about? present. The pulse rate is 78 bpm. The li-
A. Psoriasis ver is enlarged by 2 cm. What is the most
probable diagnosis?
B. Lichen ruber planus
C. Vasculitis A. Typhoid fever
D. Seborrhea B. Leptospirosis
E. Ritter’s disease C. Brucellosis
D. Sepsis
65. A female 28 years old patient became
depressed, her mood is melancholic; E. Malaria
this state is accompanied by hypobulia, 69. A patient has been in a hospital. The
hypokinesia, slow speed of thinking. Her beginning of the disease was gradual:
attitude towards her past, present and nausea, vomiting, dark urine, аcholic
future is pessimistic. The pathogenetic stools, yellowness of the skin and scleras.
mechanism of this state is supposed to The liver is protruded by 3 cm. Jaundice
involve dysfunction in the: progressed on the 14th day of the disease.
The liver diminished in size. What compli- necessary in this clinical situation:
cation of viral hepatitis caused deteriorati-
on of the patient’s condition? A. Controlled respiration
B. Gastric lavage
A. Hepatic encephlopathy C. Oxygen inhalation
B. Meningitis D. Caffeine injection
C. Relapse of viral hepatitis E. Cordiamine injection
D. Cholangitis
E. Infectious-toxic shock 74. A pregnant woman may be diagnosed
with hepatitis if it is confirmed by the
70. An 18 year old patient was admitted presence of elevated:
to a hospital with complaints of headache,
weakness, high temperature, sore throat. A. SGOT (ALT)
Objectively: enlargement of all groups of B. Sedimentation rates
lymph nodes was revealed. The liver is C. WBCs
enlarged by 3 cm, spleen - by 1 cm. In D. Alkaline phosphatase
blood: leukocytosis, atypical lymphocytes E. BUN
- 15%. What is the most probable di-
agnosis? 75. An endometrial adenocarcinoma that
has extended to the uterine serosa would
A. Infectious mononucleosis be classified as stage:
B. Acute lymphoid leukosis
C. Diphtheria A. IIIA
D. Angina B. IC
E. Adenoviral infection C. IIA
D. IIB
71. A 75 year old man who has been E. IV AB
suffering from diabetes for the last six
months was found to be jaundiced. He 76. A 56 year old woman has an acute
was asymptomatic except for weight loss onset of fever up to 39o C with chills,
at the rate of 10 pounds in 6 months. cough, and pain on respiration in the right
Physical examination revealed a hard, side of her chest. On physical examinati-
globular, right upper quadrant mass that on: HR - 90/min, BP- 95/60 mm Hg, RR-
moves during respiration. A CT scan 26/min. There is dullness over the right
shows enlargement of the head of the lung on percussion. On X-ray: infiltrate in
pancreas, with no filling defects in the li- the right middle lobe of the lung. What is
ver. The most likely diagnosis is: the diagnosis?
A. Carcinoma of the head of the pancreas A. Community-acquired lobar pneumonia

B. Infectious hepatitis of moderate severity
C. Haemolytic jaundice B. Community-acquired
D. Malignant biliary stricture bronchopneumonia
E. Metastatic disease of liver C. Acute pleuritis
D. Acute lung abscess
72. A 33 year old male patient was E. Nosocomial lobar pneumonia
brought to Emergency Department wi-
th the signs of cardiovascular collapse: BP 77. A 26 year old man was admitted to
- 60/30 mm Hg, Ps - 140 bpm, the skin is the hospital because of stabbing back pain
pale and moist, diuresis 20 ml/h, Hb - 80 on inspiration and dyspnea. Examination
g/l, red blood cell count - 2, 5 · 1012 /l. The results: BT of 37o C, Ps of 24/min, HR of
reduction of blood volume averages: 92/min, vesicular breath sounds. There is
a dry, grating, low-pitched sound heard on
A. 30-40% both expiration and inspiration in the left
B. 10-15% inferior lateral part of the chest. What is
C. 15-20% the most likely diagnosis?
D. 20-25%
E. 25-30% A. Acute fibrinous pleuritis
B. Myocarditis
73. A 19 year old girl was admitted to C. Pneumonia
emergency department: unconsciousness, D. Acute bronchitis
cyanosis, myotic pupils are present, E. Pneumothorax
superficial breathing is 12/min. BP is 90/60
mm Hg, Ps- 78/min. Choose the action 78. A 34 year old woman fell ill 3 months
ago after cold exposure. She complai- A. Chronic mercury intoxication

ned of pain in her hand and knee joints, B. Neuroinfection
morning stiffness and fever up to 38oC. C. Parkinson syndrome
Interphalangeal, metacarpophalangeal D. Acute mercury intoxication
and knee joints are swollen, hot, with E. Mercury encephalopathy
reduced ranges of motions; ESR of 45
mm/h, CRP (+++), Vaaler-Rouse test of 82. A 6 week old child is admitted because
1:128. What group of medicines would you of tachypnea. Birth had been uneventful,
recommend the patient? although conjunctivitis developed on the
third day of life and lasted for about
A. Nonsteroidal anti-inflammatory drugs 2 weeks. Physical examination reveals
B. Cephalosporines tachypnea, bilateral inspiratory crackles
C. Tetracyclines and single expiratory wheezing. Bilateral
D. Sulfonamides pneumonia is evident on chest X-ray. The
E. Fluorchinolones child is afebrile and has no history of fever.
White blood cell count is 15 · 109 /l, with
79. A 50 year old woman complained of 28% of eosinophils. The most likely cause
attacks of right subcostal pain after fatty of this child’s symptoms is:
meal she has been suffering from for a
year. Last week the attacks repeated every A. Clamydia trachomanis
day and became more painful. What di- B. Pneumocystis carinii
agnostic study would you recommend? C. Mycoplasma pneumoniae
D. Visceral larva migrans
A. Ultrasound examination of the E. Varicella
gallbladder
B. Liver function tests 83. A 42 year old woman complai-
C. X-ray examination of the gastrointesti- ns of dyspnea, edema of the legs and
nal tract tachycardia during minor physical exerti-
D. Ultrasound study of the pancreas on. Heart borders are displaced to the left
E. Blood cell count and S1 is accentuated, there is diastolic
murmur on apex. The liver is enlarged by
80. A 25 year old woman complained 5 cm. What is the cause of heart failure?
of edema on her face and legs, rise
of blood pressure up to 160/100 mm A. Mitral stenosis
Hg and weakness. She fell ill 3 weeks B. Mitral regurgitation
after recovering from angina. Urinalysis C. Tricuspid stenosis
data: protein of 0,5 g/l, erythrocytes D. Tricuspid regurgitation
of 17-20/field, leukocytes of 2-3/field, E. Aortic stenosis
erythrocyte casts. What treatment should
be initiated after specifying the diagnosis? 84. A 60 year old man complains of
fever, significant weight loss, bone and
A. Penicillin OS joint pain, bleeding gums. Examinati-
B. Heparin on revealed paleness, lymphadenopathy,
C. Ceftriaxone hepato- and splenomegaly. CBC: WBC
D. Dipyridamole - 270 · 109 /l with 13% lymphocytes,
E. Ciprofloxacine 1% monocytes, 21% basophiles,
29% neutrophils, 9% blasts, 12%
81. A fitter of a metallurgic factory promyelocytes, 12% myelocytes, 2%
with occupational exposure to high metamyelocytes, 1% eosinophils. ESR -
concentrations of mercury fumes for 16 22 mm/h. Name the drug for treatment:
years presents instability of pulse and
blood pressure, general hyperhydrosis, A. Myelosan
asymmetric innervations of facial muscles B. Prednisolone
and tongue, positive subcortical reflexes, C. Cytosar
hand tremor on physical examination. A D. Vinblastine
dentist revealed paradontosis and chronic E. Blood transfusion
stomatitis. What is the most probable di-
agnosis? 85. A 54 year old woman complains
of increasing fatigue and easy bruising
of 3 weeks’ duration. Physical findings
included pale, scattered ecchymoses and
petechiae and mild hepatosplenomegaly.
Blood count: RBC- 2, 5 · 1012 /l; Hb - 73
g/l; Ht - 20%; PLT- 23 · 109 /l; and WBC- A. Acute purulent otitis media
162 · 109 /l with 82% blasts, that contained B. Acute mastoiditis
Auric rods; peroxidase stain was positive. C. Chronic secretory otitis media
What is the most probable diagnosis? D. Chronic purulent otitis media
E. Eustachian tube disfunction
A. Acute leukemia
B. Chronic leukemia 90. Among the following causes of acute
C. Thrombocytopenia renal failure, the one that would be classi-
D. Hemolytic anemia fied as "postrenal"is:
E. Megaloblastic anemia
A. Calculi
86. The highest risk of congenital anomali- B. Cardiac failure
es probably occurs when human embryos C. Septicemia
or fetuses are exposed to ionizing radiati- D. Rhabdomyolysis
on. At what stage of gestational period E. Acute glomerulonephritis
does it occur?
91. A patient complains about strong
A. 18-45 days after conception dyspnea that is getting worse during
B. The first 7 days physical activity. Presentations appeared
C. 10-14 days after conception suddenly 2 hours ago at work: acute chest
D. 90-120 days after conception pain on the left, cough. The pain was
E. The third trimester abating, but dyspnea, dizziness, pallor,
cold sweat and cyanosis were progressi-
87. A 28 year old woman was admi- ng. Vesicular respiration is absent, X-ray
tted to the emergency room with a sli- picture shows a shadow on the left. What
ghtly reddened, painful "knot"8 cm above pathology might be suspected?
the medial malleolus. Examination in
the standing position demonstrates a di- A. Spontaneous left-sided pneumothorax
stended vein above and below the mass. B. Pulmonary infarction
There are no other abnormalities on C. Pleuritis
physical examination. The most likely di- D. Left-sided pneumonia
agnosis is: E. Pulmonary abscess
A. Superficial venous thrombosis 92. During an operation for presumed

B. Early deep vein thrombosis appendicitis the appendix was found to
C. Insect bite be normal; however, the terminal ileum
D. Cellulitis is evidently thickened and feels rubbery,
E. Subcutaneous hematoma its serosa is covered with grayish-white
exudate, and several loops of apparently
88. A 25 year old patient complains of normal small intestine are adherent to it.
pain in the I finger on his right hand. On The most likely diagnosis is:
examination: the finger is homogeneously
hydropic, in bent position. On attempt A. Crohn’s disease of the terminal ileum
to unbend the finger the pain is getti- B. Perforated Meckel’s diverticulum
ng worse. Acute pain appears during C. Ulcerative colitis
the probe in ligament projection. What D. Ileocecal tuberculosis
decease is the most likely? E. Acute ileitis
A. Thecal whitlow (ligament panaritium) 93. A 50 year old woman with a 2-year
B. Subcutaneous panaritium history of mild, diffuse, tender thyroid
C. Articular (joint) panaritium enlargement complains of 10 pound wei-
D. Bone panaritium ght gain and fatigue. What is the most
E. Paronychia probable diagnosis?
89. A 30 year old man complains of acute A. Hashimoto’s thyroiditis

pain in his right ear, hearing loss, hi- B. Riedel’s thyroiditis
gh temperature for three days. Objecti- C. Subacute thyroiditis
vely: right ear whispering language - 0,5 D. Suppurative thyroiditis
mm, external ear is intact, otoscopically E. Papillary thyroid carcinoma
- eardrum protrusion, hyperemia and 94. A severely traumatized patient who
swelling, loss of landmarks. What disease has been receiving prolonged parenteral
is it? alimentation develops diarrhea, mental
depression, alopecia and perioral and ation of heart and mediastinum shadows
periorbital dermatitis. Administration of towards the lesion. What is the most
which of the following trace elements is probable diagnosis?
most likely to reverse these complicati-
ons? A. Cenral cancer of lung
B. Lung abscess
A. Zinc C. Lung cyst
B. Iodine D. Peripheral cancer of lung
C. Selenium E. Atelectasis
D. Silicon
E. Copper 99. A 68 year old patient has been sufferi-
ng from chronic pancreatitis for 35 years.
95. A patient has got pain in the axillary During the last 5 years he has been
area, rise of temperature developed 10 observing abatement of pain syndrome,
hours ago. On examination: shaky gait is abdominal swelling, frequent defecations
evident, the tongue is coated with white up to 3-4 times a day (feces are greyi-
deposit. The pulse is frequent. The painful sh, glossy, with admixtures of undigested
lymphatic nodes are revealed in the axi- food), progressing weight loss. Change of
llary area. The skin over the lymph nodes symptom set is caused by joining of:
is erythematous and glistering. What is the
most probable diagnosis? A. Exocrine pancreatic insufficiency
B. Endocrine pancreatic insufficiency
A. Bubonic plague C. Syndrome of lactase deficiency
B. Acute purulent lymphadenitis D. Irritable bowels syndrome
C. Lymphogranulomatosis E. Chronic enterocolitis
D. Anthrax
E. Tularemia 100. A 60 year old patient has been
suffering from arterial hypertension for
96. A 56 year old patient has worked at 15 years. After recurrent stroke she
the aluminium plant over 20 years. Wi- started complaining about amotivati-
thin 3 last years he has been experiencing onal bad mood, problems with attenti-
loosening of teeth, bone and joint pains, on concentration; she forgets to close
piercing pains in heart region, vomiting. the entrance door, cannot recall events
The provisional diagnosis is: of the last day. Computer tomography
shows areas of postinfarction changes in
A. Fluorine intoxication the cortical postfrontal regions. What is
B. Mercury intoxication the most probable diagnosis?
C. Lead intoxication
D. Phosphorus intoxication A. Vascular dementia
E. Manganese intoxication B. Alzheimer’s disease
C. Huntington’s chorea
97. An excited patient constantly tries D. Pick’s disease
to look into the next room because he E. Dissociative amnesia
is sure of his friends’ presence. He clai-
ms to hear his friends and other people 101. A 40 year old patient complains
talking although no-one is there. He tri- of yellowish discharges from the vagi-
es to persuade his doctor that people in na. Bimanual examination revealed no
the next room are disputing about "his pathological changes. The smear contains
punishment", repeats aloud phrases he Trichomonas vaginalis and blended flora.
has allegedly heard from the next room. Colposcopy revealed two hazy fields on
What state is it? the frontal labium, with a negative Iodine
test. Your tactics:
A. Acute hallucinosis
B. Verbal illusions A. Treatment of specific colpitis and
C. Delusion subsequent biopsy
D. Confabulations B. Diathermocoagulation of the cervix of
E. Obsessional ideas the uterus
C. Specific treatment of Trichomonas
98. Survey radiograph of chest of a 62 colpitis
year old smoker who often suffers from D. Cervix ectomy
"pneumonias"showed a triangle shadow E. Cryolysis of cervix of the uterus
in the right lung, its vertex is pointing
towards the lung root. It also showed devi- 102. A patient complained about
problems with pain and tactile sensitivi- permissible?

ty, pain in the nail bones at the end of
the working day. He works at a plant with A. 0,1%
mechanical devices. What pathology can B. 0,05%
be suspected? C. 0,15%
D. 0,2%
A. Vibration disease E. 0,3%
B. Caisson disease
C. Noise disease 107. Study of actual diet of an adult
D. Overwork symptoms revealed the following: proteins make
E. Hypovitaminosis of B1 up 16% of energy value of daily rati-
on, fats - 25%, carbohydrates - 59%.
103. A 25 year old patient complains Evaluate compliance of protein, fat and
about weakness, dizziness, appearance of carbohydrate share in the energy value of
haemorrhagic skin rash. She has been daily ration with the recommended shares
suffering from this for a month. Blood of these nutrients?
count: erythrocytes: 1, 0 · 1012 /l, Hb- 37 g/l,
colour index - 0,9, leukocytes - 1, 2 · 109 /l, A. Carbohydrate share is insufficient, there
is excess of proteins
thrombocytes - 42 · 109 /l. What diagnostic B. Fat share is insufficient
method will be the most effective? C. Carbohydrate share is insufficicent
A. Sternal puncture D. Carbohydrate share is excessive
B. Spleen biopsy E. Nutrient content complies with the
C. Liver biopsy recommended shares of energy value
D. Coagulogram 108. A healthy 75 year old woman who
E. Abdominal ultrasound leads a moderately active way of life
104. A 28 year old woman had the second went through a preventive examinati-
labour and born a girl with manifestati- on that revealed serum concentration
ons of anemia and progressing jaundice. of common cholesterol at the rate of
The child’s weight was 3 400 g, the length 5,1 millimol/l and HDL (high-density li-
was 52 cm. The woman’s blood group is poproteins) cholesterol at the rate of
B (III) Rh− , the father’s blood group is 70 mg/dl. ECG reveals no pathology.
A (III) Rh+ , the child’s blood group is B What dietary recommendation is the most
adequate?
(III) Rh+ . What is the cause of anemia?
A. Any dietary changes are necessary
A. Rhesus incompatibility B. Decrease of cholesterol consumption
B. Antigen A incompatibility C. Decrease of saturated fats consumption
C. Antigen B incompatibility D. Decrease of carbohydrates consumpti-
D. Antigen AB incompatibility on
E. Intrauterine infection E. Increase of cellulose consumption
105. A 25 year old patient was admitted on 109. Periodical survey of a worker
the 1st day of the disease with complai- of a chemicals plant revealed a mali-
nts of double vision in the eyes, heavy gnant neoplasm on the urinary bladder.
breathing. The day before the patient This occupational disease was the most
ate home-made mushrooms. On objective probably caused by contact with the
examination: paleness, mydriatic pupils, following industrial poison:
difficult diglutition, bradycardia, consti-
pation. What is the diagnosis? A. Benzidine
B. Vinyl chloride
A. Botulism C. Nickel carbonyl
B. Yersiniosis D. Asbestos
C. Leptospirosis E. Arsenic
D. Salmonellosis, gastrointestinal form
E. Lambliasis 110. A 52 year old patient was admi-
tted to a hospital because of hi-
106. Maximum permissible concentration gh hemorrhagic diathesis of mucous
of carbon dioxide in the air is considered membranes, massive skin haemorrhages
to be a sanitary index of air purity in a in form of ecchymoses and spots, nasal
classroom. What concentration of carbon and stomachal haemorrhages. After clini-
dioxide in the air is accepted as maximum cal examinations her illness was diagnosed
as thrombocytopenic purpura. What is the Stool is liquid in form of rice water. What
most probable cause of this disease? is the most probable diagnosis?
A. Generation of antithrombocytic anti- A. Cholera
bodies B. Acute dysentery
B. Disturbed hemostasis C. Salmonellosis
C. Deficit of the VIII factor of blood D. Escherichiosis
coagulation E. Intestinal amebiasis
D. Inherited insufficiency of plasm factors
of blood coagulation 115. At year-end hospital administration
E. Iron deficit in blood serum, bone has obtained the following data: annual
marrow and depot number of treated patients and average
annual number of beds used for patients’
111. A child with tetralogy of Fallot is treatment. What index of hospital work
most likely to exhibit: can be calculated on the base of this data?
A. Increased pressure in the right ventricle A. Bed turnover
B. Increased pulmonary blood flow B. Bed resources of the hospital
C. Increased pulse pressure C. Average annual bed occupancy
D. Normal pressure gradient across the D. Average duration of patients’ presence
pulmonary valve in the hospital
E. Normal oxygen tension (P aO2) in the E. Average bed idle time
left ventricle
116. A 3 year old child with weight deffici-
112. In treatment and prevention establi- ency suffers from permanent moist cough.
shments, regardless of their organisational In history there are some pneumonias
and proprietary form, the rights of pati- with obstruction. On examination: di-
ents should be observed. Which of these stended chest, dullness on percussion over
rights is the most significant? the lower parts of lungs. On auscultation:
a great number of different rales. Level of
A. The right to the protection of the sweat chloride is 80 millimol/l. What is the
patient’s interests most probable diagnosis?
B. The right to the free choice
C. The right to the information A. Mucoviscidosis (cystic fibrosis)
D. The right to be heard B. Bronchial asthma
E. The right to the protection from C. Recurrent bronchitis
incompetence D. Bronchiectasis
E. Pulmonary hypoplasia
113. A military unit stopped for 3-day’s
rest in an inhabited locality after a 117. A 14 year old girl complains of
long march. The sanitary-epidemiological profuse bloody discharges from genital
reconnaissance found several water tracts during 10 days after suppresion of
sources. It is necessary to choose the menses for 1,5 month. Similiar bleedings
source complying with the hygienic recur since 12 years on the background
standards for drinking water in the field of disordered menstrual cycle. On rectal
conditions: examination: no pathology of the internal
genitalia. In blood: Нb - 70 g/l, RBC-
A. Artesian well water 2, 3 · 1012 /l, Ht - 20. What is the most
B. Spring water probable diagnosis?
C. River water
D. Rain water A. Juvenile bleeding, posthemorrhagic
E. Melt snow water anemia
B. Werlholf’s disease
114. A man in grave condition was deli- C. Polycyst ovarian syndrome
vered to the admission ward of a hospi- D. Hormonoproductive ovary tumor
tal on the 2nd day of illness. Examinati- E. Incomplete spontaneous abortion
on revealed body temperature of 36, 1oC,
sharpened features of face, dry skin that 118. A 43 year old patient had
makes a fold, aphonia, convulsive twitchi- cholecystectomy 6 years ago because of
ng of some muscle groups. Acrocyanosis chronic calculous cholecystitis. Lately he
is present. Heart sounds are muffled, Ps is has been suffering from pain in the ri-
102 bpm, AP is 50/20 mm Hg. Abdomen is ght subcostal area and recurrent jaundi-
soft, drawn-in, painless. Anuria is presnt. ce. Jaundice hasn’t gone for the last 2
weeks. Stenosing papillitis 0,5 cm long has meal. Exacerbations happen in spring
been revealed. What is the best way of and in autumn. The patient has food
treatment? intolerance of eggs and fish. Objecti-
vely: stomach palpation reveals pai-
A. To perform endocsopic papillosphi- nfulness in the gastroduodenal area.
ncterotomy Electrophasoduodenoscopy revealed a
B. To treat conservatively: antibiotics, 5 mm ulcer on the anterior wall of
spasmolytics, antiinflammatory drugs duodenum. Urease test is positive. What
C. To perform external choledoch drainage is the most probable leading mechanism
D. To perform transduodenal papillosphi- of disease development?
ncterotomy
E. To perform choledochoduodenostomy A. Chelicobacterial infection
B. Dietary allergy
119. A full-term infant is 3 days old. C. Autoantibody production
On the different parts of skin there are D. Reduced prostaglandin synthesis
erythemas, erosive spots, cracks, areas of E. Disorder of gastric motor activity
epidermis peeling. The infant has scalded
skin syndrome. Nikolsky’s symptom is 123. A 48 year old woman complains
positive. General condition of the infant about weakness, weight loss, appetite
is grave. Anxiety, hyperesthesia, febrile loss, headache. The patient had acute
temperature are evident. What is the most glomerulonephritis when she was young.
probable diagnosis? She has been suffering from arterial
hypertension since she was 25. She didn’t
A. Exfoliative dermatitis undergo systematic treatment, consulted
B. Phlegmon of newborn a doctor rarely. Examination revealed si-
C. Finger’s pseudofurunculosis gns of chronic renal insufficiency of the I
D. Impetigo neonatorum stage (creatinine - 0,43 millimole/l). What
E. Mycotic erythema dietary recommendations are the most
reasonable?
120. An outpatient hospital made record
of 11600 diseases within one year. Among A. Restriction of protein consumption
them influenza and ARD make up 5800, B. Restriction of fat consumption
circulatory system diseases - 3480, digesti- C. Restriction of carbohydrate consumpti-
on diseases - 1300, other diseases - 1020. on
What relative index can be calculated D. Diet with high content of "alkali-
according this data? ne"dishes
E. Consumption of higher amounts of
A. Extensive
liquid
B. Intensive
C. Visualization 124. A 50 year old woman complains
D. Correlation about dull cardiac pain, asphyxia, body
E. - temperature rise up to 38oC. She had
influenza a week ago. Objectively: Ps -
121. A 35 year old woman consulted 100 bpm, dropped-beat pulse during inspi-
a doctor about affection of arm skin ration. AP - 100/70 mm Hg, heart sounds
and lower third of forearm in form of a
are muffled. ECG: reduced voltage, ST
large edema, hyperemia, vesiculation and segment is above the isoline in all leads.
maceration. The disease developed after
X-ray picture shows extensively enlarged
using a laundry detergent "Lotos". The
cardiac silhouette. Palmus is of small
patient has been using it for a month. She amplitude. What is the most probable di-
hasn’t suffered from dermatological di-
agnosis?
seases before. What is the most probable
diagnosis? A. Exudative pericarditis
B. Myocardium infarction
A. Allergic dermatitis
C. Dilatation cardiomyopathy
B. Dermatitis simplex
D. Myocarditis
C. Toxicoallergic dermatitis E. Stenocardia
D. Microbial eczema
E. Localized neurodermatitis 125. Examination of a 4 month old child
revealed some lemon-yellow squamae wi-
122. A 32 year old patient complains th fatty crusts on the scalp. What is the
about heartburn and dull pain in the most probable diagnosis?
epigastrium that appear 2-3 hours after
would be the most adequate in this case?

A. Gneiss
B. Milk crust A. Parenteral introduction of polyvalent
C. Strophulus antibotulinic serum
D. Pseudofurunculosis B. Parenteral disintoxication
E. Infantile eczema C. Parenteral introduction of antibiotics
D. Gastric lavage
126. A 39 year old patient complai- E. Parenteral introduction of antitetanus
ned about morning headache, appeti- serum
te loss, nausea, morning vomiting, peri-
odic nasal haemorrhages. The patient had 130. A 19 year old patient was admi-
acute glomerulonephritis at the age of tted to a hospital with acute destructive
15. Examination revealed rise of arteri- appendicitis. He suffers from hemophilia
al pressure up to 220/130 mm Hg, skin of B type. What antihemophilic medicati-
haemorrhages on his arms and legs, pallor ons should be included in pre- and post-
of skin and mucous membranes. What operative treatment plan?
chemestry test has the greatest diagnostic
importance in this case? A. Fresh frozen plasma
B. Cryoprecipitate
A. Blood creatinine C. Fresh frozen blood
B. Blood bilirubin D. Native plasma
C. Blood sodium E. Dried plasma
D. Uric acid
E. Fibrinogen 131. An 18 year old woman consulted a
gynecologist about the pain in the lower
127. A 14 year old child suffers from part of abdomen, fever up to 37, 5o C,
vegetovascular dystonia of pubertal peri- considerable mucopurulent discharges
od. He has got sympathoadrenal atack. from the genital tracts, painful urinati-
What medicine should be used for attack on. Vaginal and speculum examination
reduction? results: the urethra is infiltrated, cervix
of the uterus is hyperemic, erosive. The
A. Obsidan uterus is painful, ovaries are painful, thi-
B. No-shpa ckened; fornixes are free. Bacterioscopy
C. Amysyl test revealed diplococcus. What diagnosis
D. Aminophylline is the most probable?
E. Corglicone
A. Recent acute ascending gonorrhea
128. A 23 year old man complains B. Trichomoniasis
about face edemata, headache, dizzi- C. Candydomycosis
ness, reduced urination, change of urine D. Chronic gonorrhea
colour (dark-red). These presentations E. Chlamydiosis
appeared after pharyngitis. Objectively:
face edemata, pale skin, temperature - 132. A 26 year old woman who delivered
37, 4oC; heart rate - 86/min, AP - 170/110 a child 7 months ago has been suffering
mm Hg. Heart sounds are muffled, the II from nausea, morning vomiting, sleepi-
sound is accentuated above aorta. What ness for the last 2 weeks. She suckles the
etiological factor is probable in this case? child, menstruation is absent. She hasn’t
applied any contraceptives. What method
A. β-hemolytic streptococcus should be applied in order to specify her
B. Staphylococcus aureus diagnosis?
C. Alpha-hemolytic streptococcus
D. Pyogenic streptococcus A. Ultrasonic examination
E. Saprophytic staphylococcus B. Roentgenography of small pelvis organs
C. Palpation of mammary glands and
129. A 12 year old girl complains about pressing-out of colostrum
abrupt weakness, nausea, dizziness, visi- D. Bimanual vaginal examination
on impairment. The day before she ate E. Speculum examination
home-made stockfish, beef. Examination
revealed skin pallor, a scratch on the left 133. A 2 month old full-term child was
knee, dryness of mucous membranes of born with weight 3500 g and was on the
oral pharynx, bilateral ptosis, mydriatic mixed feeding. Current weight is 4900 g.
pupils. The girl is unable to read a simple Evaluate the current weight of the child:
text (mist over the eyes). What therapy
A. Corresponding to the age Examination at an outpatient’s hospi-

B. 150 g less than necessary tal revealed paleness of skin, sleepiness.
C. Hypotrophy of the I grade Blood count: Hb - 95 g/l, erythrocytes
D. Hypotrophy of the II grade - 3, 5 · 1012 /l, reticulocytes - 90 /00 ,
E. Paratrophy of the I grade colour index - 0,7, osmotic stability of
erythrocytes - 0,44-0,33%, serum iron - 4,9
134. A woman consulted a doctor on micromole/l. What is the most probable
the 14th day after labour about sudden cause of anemia?
pain, hyperemy and induration of the left
mammary gland, body temperature ri- A. Iron deficit
se up to 39o C, headache, indisposition. B. Hemogenesis immaturity
Objectively: fissure of nipple, enlargement C. Infectious process
of the left mammary gland, pain on D. Erythrocyte hemolysis
palpation. What pathology would you thi- E. B12 deficit
nk about in this case?
138. A 13 year old girl consulted the
A. Lactational mastitis school doctor on account of moderate
B. Lacteal cyst with suppuration bloody discharge from the genital tracts,
C. Fibrous adenoma of the left mammary which appeared 2 days ago. Secondary
gland sexual characters are developed. What
D. Breast cancer is the most probable cause of bloody di-
E. Phlegmon of mammary gland scharge?
135. A 32 year old patient complai- A. Menarche
ns about pain in small joints of her B. Juvenile hemorrhage
hands, paresthesia at the tips of fi- C. Haemophilia
ngers, weakness, difficult diglutition. D. Endometrium cancer
She has been suffering from this for E. Werlhof’s disease
13 years. Objectively: face amimia,
shortening of nail bones, skin indurati- 139. An 8 year old girl complains about
ons in the area of shoulder girdle are joint pain, temperature rise up to 38o C,
present. Roentgenological examination dyspnea. Objectively: the left cardiac
of lungs revealed basal pneumosclerosis. border is deviated by 2,5 cm to the left,
Fibrogastroscopy revealed esophagus tachycardia, systolic murmur on the apex
constriction in its cardial part. Blood and in the V point are present. Blood
count: leukocytes - 9, 8 · 109 /l, ESR - 22 count: leukocytes - 20, 0 · 109 /l, ESR - 18
mm/h, γ-globulin - 22%. What is the most mm/h. What sign gives the most substanti-
probable diagnosis? al proof for rheumatism diagnosis?
A. Systemic scleroderma A. Carditis
B. Systemic lupus erythematosus B. Arthralgia
C. Rheumatoid arthritis C. Leukocytosis
D. Dermatomyositis D. Fever
E. Myxedema E. Accelerated ESR
136. A 30 year old woman ill with 140. During inspection of sanitary conditi-
influenza felt palpitation and dull cardi- ons of studying at a technical university it
ac pain during moderate physical exerci- was necessary to evaluate the visual regi-
se. Objectively: Ps - 96 bpm, AP - 100/60 men of students, who study from 9 a.m to
mm Hg. The first sound is quiet above 3 p.m. What index of natural light will be
the apex, soft systolic murmur is present. the most informative?
What complication is indicated by these
clinical presentations? A. Natural light coefficient
B. Light coefficient
A. Acute viral myocarditis C. Depth of study room
B. Acute allergic infectious myocarditis D. Time of the room insolation
C. Idiopathic myocarditis E. Presence of mixed (superolateral) light
D. Myocardiopathy
E. Neurocirculatory dystonia 141. A 70 year old man is suffering from
coronary heart disease. His mood is evi-
137. A 5 month old boy was born dently depressed, anxious. As a result
prematurely, he didn’t suffer from any of continious sleeplessness he has got
disease at the infant age and later on. fears, suicidal thoughts. He would sit for
a long time in the same pose, answer be of the greatest importance for confi-
after a pause, in a low, monotonous voi- rmation of provisional diagnosis?
ce. His face has a look of suffering, pain,
fear. What is the main psychopathologic A. Lumbar puncture
syndrome? B. Examination of eye fundus
C. Ultrasonic dopplerography
A. Depressive syndrome D. EEG
B. Paranoid syndrome E. Computer tomography
C. Asthenic syndrome
D. Phobic syndrome 145. A 10 year old girl complains about
E. Obsessive syndrome abdominal pain that is arising and getti-
ng worse after eating rough or spicy food.
142. A 37 year old farmer complains She complains also about sour eructati-
about general weakness, spastic pain in on, heartburn, frequent constipations,
the lower parts of his abdomen, mainly headache, irritability. She has been sufferi-
in the left iliac area, frequent defecati- ng from this for 12 months. Objectively:
ons up to 18 times a day, feces contain the girl’s diet is adequate. Tongue is moist
admixtures of mucus and blood. The with white deposit at the root. Abdomen
illness began abruptly 3 days ago with is soft, painful in its epigastric part. What
chill, fever, headache. General condition study method will help to make a di-
is moderately severe, body temperature is agnosis?
37, 8oC. Sigmoid colon is spasmed and pai-
nful. What is the most probable diagnosis? A. Esophagogastroduodenoscopy
B. Intragastral pH-metry
A. Dysentery C. Fractional examination of gastric juice
B. Amebiasis D. Contrast roentgenoscopy
C. Nonspecific ulcerative colitis E. Biochemical blood analysis
D. Yersiniosis
E. Salmonellosis 146. A 35 year old patient who suffers
from chronic glomerulonephritis and has
143. A 3 year old child fell acutely ill, been hemodialysis-dependent for the last
body temperature rose up to 39, 5oC, three years developed intermissions of
the child became inert, there appeared heart activity, hypotension, progressi-
recurrent vomiting, headache. Exami- ng weakness, dyspnea. ECG showed
nation revealed positive meningeal bradycardia, atrioventricular block type
symptoms, after this lumbal puncture was I, high pointed waves T . The day before
performed. Spinal fluid is turbid, runs the flagrant violation of diet took place.
out under pressure, protein concentrati- What is the most probable cause of these
on is 1,8 g/l; Pandy reaction is +++, sugar changes?
concentration is 2,2 millimole/l, chloride
concentration - 123 millimole/l, cytosis is A. Hyperkaliemia
2, 35 · 109 (80% of neutrophils, 20% of B. Hyperhydratation
lymphocytes). What is the most probable C. Hypokaliemia
diagnosis? D. Hypernatriemia
E. Hypocalciemia
A. Purulent meningitis
B. Serous viral meningitis 147. A 34 year old coal miner who has
C. Serous tuberculous meningitis been in service for 10 years was di-
D. Subarachnoid haemorrhage scharged from an occupational disease
E. Brain tumour clinic after examination and treatment.
He was diagnosed with the I stage of
144. A 39 year old patient suffering anthracosilicosis, peribronchitis, 0 stage
from hypertension felt suddenly intense of respiratory failure. What expert deci-
headache in the region of occiput; there sion should be taken about his working
appeared recurrent vomiting. These capacity?
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 positi-
ve. Subarachnoid haemorrhage is also
suspected. What diagnostic method will
A. He should be referred to the local medi- 151. A 24 year old patient complai-
cal expert comission for determination ns about general weakness, dizziness,
of his disability group for the period of body temperature rise up to 37, 5o C,
re-training sore throat, neck edema, enlargement
B. He can continue working as coal miner of submaxillary lymph nodes. Objecti-
provided that sanitary and hygienic condi- vely: mucous membrane of oropharynx
tions are observed is edematic and cyanotic, tonsils are
C. He should be given medical certificate enlarged and covered with films that
for the further out-patient treatment spread beyond the tonsils and cannot
D. He should stay on the sick-list to be easily removed. What is the leading
consolidate treatment results mechanism of this illness’ development?
E. He should be referred to the local medi-
cal expert comission for determination of A. Action of bacterial exotoxin
percentage of working capacity loss B. Action of bacterial endotoxin
C. Allergic
148. A 52 year old woman complains D. Accumulation of suboxidated products
about face distortion. It appeared 2 days E. Bacteriemia
ago after supercooling. Objectively: body
temperature is 38, 2oC. Face asymmetry is 152. A 38 year old man complains
present. Frontal folds are flattened. Left about mild pain and muscle weakness
eye is wider than right one and doesn’t of shoulder and pelvic girdles and back
close. Left nasolabial fold is flattened, that has been progressing for the last 3
mouth corner is lowered. Examination weeks. He has also significant problems
revealed no other pathology. Blood count: with getting up, going up and down the
leukocytes - 10 · 109 /l, ESR - 20 mm/h. stairs and shaving. It is suspected that the
What is the most probable diagnosis? patient is suffering from dermatomyosi-
tis. Blood count: Hb - 114 g/l, leukocytes
A. Facial neuritis - 10, 8 · 109 /l, eosin - 9%, ESR - 22 mm/h,
B. Trigeminus neuralgia C-reactive protein (++). Change of the
C. Hemicrania (migraine) following laboratory factor will be of the
D. Ischemic stroke greatest diagnostic importance:
E. Brain tumour
A. Creatine phosphokinase
149. A patient complained about general B. Ceruloplasmin
weakness, fever, painful rash on his trunk C. Sialic acids
skin . He has been suffering from this for 3 D. Antibodies to the native DNA
days. Objectively: lateral surface of trunk E. γ-globulins
on the left is hyperemic and edematic,
there are some groups of vesicles with 153. A 9 year old boy has been sufferi-
serous and haemorrhagic contents. What ng from diabetes mellitus for a year. He
is the most probable diagnosis? gets insulin injections (humulin R, NPH),
the dose makes up 0,4 units per 1 kg of
A. Herpes zoster body weight a day. Insulin is untroduced
B. Contact dermatitis simplex subcutaneously (into the shoulder) by
C. Contact allergic dermatitis means of a syringe. What measures
D. Microbial eczema should be taken in order to prevent li-
E. Herpetiform Duhring’s dermatosis podystrophy?
150. Internal obstetric examination of A. To change point of introduction
a parturient woman revealed that the B. To limit fats in the boy’s diet
sacrum hollow was totally occupied wi- C. To reduce insulin dose
th fetus head, ischiadic spines couldn’t be D. To apply periodically other types of
detected. Sagittal suture is in the strai- insulin
ght diameter, occipital fontanel is directed E. To administer antioxidants
towards symphysis. In what plane of small
pelvis is the presenting part of the fetus? 154. A 25 year old pediatrician fell
ill a week ago: body temperature rose
A. Plane of pelvic outlet up to 37, 6o C, there appeared a slight
B. Wide pelvic plane swelling on his neck. His illness was di-
C. Narrow pelvic plane agnosed as ARD, cervical lymphadenitis.
D. Plane of pelvic inlet Treatment course included erythromycin,
E. Over the pelvic inlet hot compress on the neck. In course of
treatment body tempearture rose up to lacunae. What is the most probable di-
39o C, there appeared headache, repeated agnosis?
vomiting, meningeal syndrome. What
studies are necessary for the final di- A. Chronic tonsillitis
agnosis? B. Chronic pharyngitis
C. Acute lacunar tonsillitis
A. Cerebrospinal puncture D. Paratonsillitis
B. Puncture of cervical lymph node E. Tonsillar tumour
C. Complete blood count
D. Sputum test for secondary flora 159. A 43 year old patient had right-
E. Roentgenological examination of lungs sided deep vein thrombosis of iliofemoral
segment 3 years ago. Now he is sufferi-
155. A 41 year old woman has suffered ng from the sense of heaviness, edema
from nonspecific ulcerative colitis for of the lower right extremity. Objectively:
5 years. On rectoromanoscopy: evident moderate edema of shin, brown indurati-
inflammatory process of lower intesti- on of skin in the lower third of shin, varix
nal parts, pseudopolyposive changes of dilatation of superficial shin veins are
mucous membrane. In blood: WBC- 9, 8 · present. What is the most probable di-
109 /l, RBC- 3, 0 · 1012/l, ESR - 52 mm/hour. agnosis?
What medication provides pathogenetic
treatment of this patient? A. Postthrombophlebitic syndrome, vari-
cose form
A. Sulfosalasine B. Acute thrombosis of right veins
B. Motilium C. Lymphedema of lower right extremity
C. Vikasolum D. Parkes-Weber syndrome
D. Linex E. Acute thrombophlebitis of superficial
E. Kreon veins
156. A 49 year old female patient was 160. A 23 year old patient fell ill 3
admitted to a hospital with acute attacks weeks ago when she noticed a very pai-
of headache accompanied by pulsation in nful induration in her axillary crease. 4-5
temples, AP rose up to 280/140 mm Hg. days later it burst and discharged a lot
Pheochromocytoma is suspected. What of pus. After that some new infiltrations
mechanism of hypertensive atack does appeared around the affected area. The
this patient have? patient has never suffered from skin di-
seases before. What is the most probable
A. Increase of catecholamine concentrati- diagnosis?
on
B. Increase of aldosterone level in blood A. Hydradenitis
C. Increase of plasma renin activity B. Furuncle
D. Increase of vasopressin secretion C. Mycosis
E. Increase of thyroxine secretion D. Herpes zoster
E. Streptococcal impetigo
157. A child was born with body weight
3250 g and body length 52 cm. At the age 161. A child is 1 day old. During delivery
of 1,5 month the actual weight is suffici- there had been problems with extraction
ent (4350 g), psychophysical development of shoulders. Body weight is 4300,0. Right
corresponds with the age. The child is arm hangs down along the body, hand is
breast-fed, occasionally there are regurgi- pronated, movement in the arm is absent.
tations. What is the cause of regurgitati- "Scarf"symptom is positive. What is the
ons? most probable diagnosis?
A. Aerophagia A. Total right-sided obstetric paralysis
B. Pylorostenosis B. Proximal right-sided obstetric paralysis
C. Pylorospasm C. Distal right-sided obstetric paralysis
D. Acute gastroenteritis D. Hemiparesis
E. Esophageal atresia E. Tetraparesis
158. Three weeks after acute angina 162. An outbreak of food poisoning was
the patient is still weak, inert, subfebri- recorded in an urban settlement. The
le, his retromaxillary lymph nodes are illness was diagnosed as botulism on the
enlarged. Tonsils are flabby, stick together grounds of clinical presentations. What
with arches, there are purulent plugs in foodstuffs should be chosen for analysis
in the first place in order to confirm the patients with coronary heart disease.
diagnosis? What parametric criterion (coefficient)
can be used for estimation of results vali-
A. Tinned food dity?
B. Potatoes
C. Pasteurized milk A. Student’s coefficient (t)
D. Boiled meat B. Sign criterion
E. Cabbage C. Conformity coefficient
D. Wilcoxon’s t-criterion
163. A 42 year old metalworker has E. Kolmogorov-Smirnov’s criterion
been working at the turning machine
for production of heavy large-size parts 167. It is planned to make complete
for 5 years. His work requires using isolation boxes in the infectious
of hand and pedal levers that involves department in order to prevent nosocomi-
considerable physical force. What means al airborne infections. The boxes consist
for osteoarthrosis prevention should be of a tambour, a ward and a lock chamber.
recommended? What structure should be also included in
a complete isolation box?
A. To limit physical work
B. To administer protein-and-carbohydrate A. Bathroom unit
diet B. Manipulation room
C. To administer protein-and-vitamin diet C. Doctor’s consulting room
D. To improve health at the Black sea coast D. Patient’s examination room
E. To go in for weightlifting E. Nursing room
164. A 30 year old patient undergoes 168. A 30 year old man complains of
treatment because of Werlhof’s disease. intense pain, reddening of skin, edema
Objectively: the patient is pale, there are in the ankle-joint area, fever up to 39o C.
petechial haemorrhages on the extension There was an acute onset of the illness. In
surfaces of forearms. Ps is 92 bpm, AP is the past there were similar attacks lasting
100/60 mm Hg. The lower edge of spleen 5-6 days without residual changes in the
is at a level with umbilicus. Blood count: joint. The skin over the joint is hyperemic
erythrocytes: 2, 8 · 1012 /l, Hb - 90 g/l, Ht - and ill-defined, without infiltrative bank
0,38, thrombocytes - 30 · 109 /l. The patient on the periphery. What is the most likely
is being prepared for splenectomy. What diagnosis?
transfusion medium should be chosen
in the first place for the preoperational A. Gout
preparation? B. Infectious arthritis
C. Rheumatoid arthritis
A. Thrombocytic mass D. Erysipelatous inflammation
B. Stored blood E. Osteoarthritis
C. Native erythrocytic mass
D. Erythrocytic suspension 169. Preventive examination of a 55 year
E. Washed erythrocytes old patient revealed diabetes mellitus.
The patient hasn’t received treatment for
165. A 19 year old boy was admitted to a it. Objectively: height is 170 cm, weight
hospital with closed abdominal trauma. In is 106 kg, skin humidity is normal. Ps is
course of operation multiple ruptures of 76 bpm, rhythmic, left border of relati-
spleen and small intestine were revealed. ve heart dullness is deviated by 1 cm to
AP is falling rapidly, it is necessary to the left from the middle clavicular line,
perform hemotransfusion. Who can speci- heart sounds are quiet, AP is 140/80 mm
fy the patient’s blood group and rhesus Hg. Glycemia on an empty stomach is 6,9
compatibility? millimole/l. Glucose rate in the daily uri-
ne is 0,5%, diuresis makes up 2,5 l. What
A. A doctor of any speciality treatment tactics should be chosen?
B. A laboratory physician
C. A surgeon A. To administer dietotherapy
D. A traumatologist B. To administer metformin
E. An anaesthesilogist C. To administer glibenclamid
D. To administer repaglinide
166. Clinical and statistical study E. To administer insulin
was devoted to the effect of a new
pharmacological medication upon the 170. The results of 5 year monitoring
allowed to estimate the level of envi- has Kussmaul’s respiration, there is also
ronmental influence upon health indi- smell of acetone in the air. Symptoms of
ces of popultaion. What statistic method peritoneum irritation are positive. Blood
should be chosen? sugar is at the rate of 33 millimole/l. What
emergency actions should be taken?
A. Calculation of correlation coefficient
B. Calculation of conformity coefficient A. Intravenous infusion of short-acting
C. Calculation of coefficient of difference insulin
validity B. Intravenous infusion of glucose along
D. Calculation of regression coefficient with insulin
E. Calculation of dynamic indices C. Introduction of long-acting insulin
D. Intravenous infusion of
171. In order to improve organism neohaemodesum along with glutamic
tolerance of boarding-school pupils acid
a doctor developed a program. The E. Intravenous infusion of sodium chloride
program is based upon the following pri- saline
nciples: graduality, consistency, indivi-
duality, coomplexity. What of the main 175. In order to study impact of microcli-
principles of organism tempering wasn’t mate upon the human organism it is
taken into account? necessary to make systematic observati-
on of air temperature over 3 days. Choose
A. Systematicness a device that will allow to make the most
B. Autodefense increase precise temperature records:
C. Increase of influence force
D. Increase of influence intensity A. Thermograph
E. Increase of resistance B. Alcohol thermometer
C. Mercury thermometer
172. A patient complains about D. August’s psychrometer
pyrosis and permanent pain behind his E. Assmann psychrometer
breastbone. When he bends forward
after eating there appears regurgi- 176. A 3 month old child has occiput
tation. Roentgenological examination alopecia, anxious sleep, excessive sweati-
revealed extrasaccular cardiofunctional ng. What disease might be suspected?
hernia of esophageal opening of di-
aphragm. Esophagoscopy revealed si- A. Rachitis
gns of reflux-esophagitis. What is the B. Spasmophilia
necessary tretment tactics? C. Anemia
D. Phosphate diabetes
A. Operation in a surgical department E. Chondrodystrophy
B. Conservative treatment in an outpati-
ents’ clinic 177. After delivery and revision of
C. Conservative treatment in the placenta there was found the defect of
therapeutic hospital placental lobule. General condition of
D. Conservative treatment in a surgical woman is normal, uterus is firm, there
department is moderate bloody discharge. Speculum
E. Treatment at a health resort inspection of birth canal shows absence of
lacerations and raptures. What action is
173. 15 minutes after the second vacci- nesessary?
nation with diphteria and tetanus toxoi-
ds and pertussis vaccine a 4 month old A. Manual exploration of the uterine
boy manifested symptoms of Quincke’s cavity
edema. What medication should be appli- B. External massage of uterus
ed for emergency aid? C. Introduction of uterine contracting
agents
A. Prednisolone D. Urine drainage, cold on the lower
B. Heparin abdomen
C. Adrenalin E. Introduction of hemostatic medications
D. Furosemide
E. Seduxen 178. A 7 year old boy has periods of loss of
attention that last 10-15 seconds and occur
174. During examination a patient is several times a day. During these peri-
unconscious, his skin is dry and hot, ods he stands still in one position, doesn’t
face hyperemia is present. The patient answer the questions or react when he is
called by his name. Neurological exami-

nation revealed no changes. What di- A. Lymphadenitis
agnostic method should be applied to B. Lymphangitis
specify his diagnosis? C. Phlegmon
D. Tetanus
A. Electroencephalography E. Erysipelas
B. Skull roentgenogram
C. Computer tomogram 183. A 52 year old patient complains
D. Echoencephalography about headache, weakness of his upper
E. Examination of evoked potentials left extremity. Neurological symptoms
become more intense during physical
179. A 52 year old patient complains stress of the left extremity. Pulsation on
about pain in the right part of her chest, the arteries of the left extremity is sharply
dyspnea, cough with a lot of foul-smelling dampened but it remains unchanged on
albuminoid sputum in form of "meat the carotid arteries. What is the most
slops". Objectively: the patient’s condi- probable diagnosis?
tion is grave, cyanosis is present, breathi-
ng rate is 31/min, percussion sound above A. Occlusion of the left subclavicular
the right lung is shortened, auscultation artery, steal syndrome
revealed different rales. What is the most B. Thoracal outlet syndrome
probable diagnosis? C. Raynaud’s syndrome
D. Takayasu’s disease
A. Lung gangrene E. Occlusion of brachiocephalic trunk
B. Lung abscess
C. Pleura empyema 184. A 57 year old patient abruptly lost the
D. Multiple bronchiectasis sight of one eye. Examination revealed
E. Chronic pneumonia that his sight made up 0,02 excentri-
cally, eye fundus has haemorrhages of
180. A 15 year old patient suffers from different forms and sizes ("squashed
headache, nasal haemorrhages, sense of tomato"symptom). Disc of optic nerve is
lower extremity coldness. Objectively: hyperemic. In anamnesis general vascular
muscles of shoulder girdle are developed, pathology is recorded. Direct-acting anti-
lower extremities are hypotrophied. coagulants were administered. What is the
Pulsation on the pedal and femoral arteri- most probable diagnosis?
es is sharply dampened. AP is 150/90 mm
Hg, 90/60 on the legs. Systolic murmur A. Thrombosis of central vein of retina
can be auscultated above carotid arteries. B. Hypertensive angiopathy
What is the most probable diagnosis? C. Hypertensive angioneuropathy
D. Embolism of central artery of retina
A. Aorta coarctation E. Diabetic retinopathy
B. Aorta aneurism
C. Aortal stenosis 185. A 28 year old patient complained
D. Aortal insufficiency about prolongation of intermenstrual
E. Coarctation of pulmonary artery periods up to 2 months, hirsutism.
Gynaecological examination revealed
181. A patient with frostbite of both feet that the ovaries were enlarged, pai-
was delivered to the admission ward. nless, compact, uterus had no peculari-
What actions should be taken? ties. Pelvic ultrasound revealed that the
ovaries were 4-5 cm in diameter and had
A. To apply a bandage, to introduce multiple enlarged follicles on periphery.
vasodilating medications Roentgenography of skull base showed
B. To administer cardiac medications that sellar region was dilated. What is the
C. To put feet into hot water most probable diagnosis?
D. To rub feet with snow
E. To apply an alcohol compress A. Stein-Leventhal syndrome
B. Algodismenorrhea
182. A patient has a stab wound on his ri- C. Sheehan’s syndrome
ght foot. On the fourth day after injury D. Premenstrual syndrome
the patient’s body temperature rose up E. Morgagni-Stewart syndrome
to 38o C, inguinal lymph nodes became
enlarged and painful, skin over them 186. A woman consulted a therapeuti-
reddened. What complication might be st about fatigability, significant weight
suspected? loss, weakness, loss of appetite. She has
been having amenorrhea for 8 months. thrice a year - in February, in April and in
A year ago she born a full-term child. December. How should these occurences
Haemorrhage during labour made up 2 be recorded?
l. She got blood and blood substitute
transfusions. What is the most probable A. It is necessary to fill in 3 statistic talons
diagnosis? signed (+)
B. It is necessary to fill in 3 statistic talons
A. Sheehan’s syndrome signed (−)
B. Stein-Leventhal syndrome C. It is necessary to fill in 1 statistic talon
C. Shereshevsky-Turner’s syndrome signed (+)
D. Homological blood syndrome D. It is necessary to fill in 1 statistic talon
E. Vegetovascular dystonia signed (+) and 2 statistic talons signed (−)
E. It is necessary to fill in 1 statistic talon
187. A 68 year old patient complains about signed (−)
acute pain in his right foot, toe edema
and darkening of skin of the IV toe. He 191. Researchers studied disease inci-
has been suffering from diabetes melli- dence of influenza and acute respiratory
tus for 15 years, doesn’t receive regular viral infection within the last 5 years.
treatment. What complication of diabetes What kind of graphic presentation should
mellitus is it? be used for the best visualization of this
data?
A. Gangrene of the IV toe on the right
foot A. Linear diagram
B. Panaritium B. Pie diagram
C. Haematoma C. Bar diagram
D. Erysipelas D. Histogram
E. Fracture of the IV toe on the right foot E. Radial diagram
188. Preventive examination of an 11 year 192. A 55 year old patient felt suddenly
old boy helped to determine his habi- sick in a hospital corridor, he was immedi-
tus type. It was established that the chi- ately examined by a doctor. Examination
ld’s shoulders were deviated and brought revealed that the patient’s skin was pale,
forward, with forward flexion of head, autonomous respiration was absent, pulse
the thorax was flattened, abdomen was on carotid arteries couldn’t be felt, pupi-
convex. The child’s backbone had signs of ls were mydriatic. What action should be
deepened cervical and lumbar curvatures. taken at the beginning of cardiac resusci-
What habitus is it? tation?
A. Kyphosis A. Precordial thump
B. Lordosis B. Mouth-to-mouth ventilation
C. Round-shouldered C. Closed-chest cardiac massage
D. Corrected D. Restoration of airway patency
E. Normal E. Defibrillation
189. During hygienic examination of a 193. A 24 year old patient complai-
hospital it was established that the area ned about putting on weight, limosis.
for each bed in a double ward was: in the Objectively: the patient’s constitution is
infectious department for children - 7 2 , of hypersthenic type, body weight index
in the infectious department for adults - is 33,2 kg/m2 , waist circumference is 100
8 2 , in the burns department - 9 2 , in cm. Correlation of waist circumference to
the radiological department - 10 2 , in the the thigh circumference is 0,95. What is
critical care department - 13 2 . In whi- the most probable diagnosis?
ch wards the area for each bed doesn’t
correspond with hygienic requirements?
A. In burns wards
B. In infectious wards for children
C. In infectious wards for adults
D. In radiological wards
E. In critical care wards
190. A 2 year old child has been ill with
acute respiratory viral infection of upper
A. Alimentary constitutional obesity of A. β-adrenoceptor blocker

the I stage, abdominal type B. Adenosine pyrophosphate inhibitor
B. Hypothalamic Itsenko-Cushing obesity C. Diuretic
of the II stage, gynoid type D. α-adrenoceptor blocker
C. Alimentary constitutional obesity of the E. Dihydropyridine calcium antagonist
III stage, gynoid type
D. Alimentary constitutional obesity of the 197. A 30 year old patient complains
II stage, abdominal type about inability to become pregnant over
E. Hypothalamic Itsenko-Cushing obesity 3 years of married life. The patient is of
of the I stage, abdominal type supernutrition type, she has hair along the
median abdominal line, on the internal
194. A parturient woman is 27 year old, thigh surface and in the peripapillary area.
it was her second labour, delivery was at Menses started at the age of 16, they are
term, normal course. On the 3rd day of infrequent and non-profuse. US revealed
postpartum period body temperature is that the uterus was of normal size, ovaries
36, 8oC, Ps - 72/min, AP - 120/80 mm Hg. were 4х5х5 cm large and had a lot of cystic
Mammary glands are moderately swollen, inclusions. What is the most probable di-
nipples are clean. Abdomen is soft and agnosis?
painless. Fundus of uterus is 3 fingers
below the umbilicus. Lochia are bloody, A. Polycystic ovaries
moderate. What is the most probable di- B. Ovarian cystoma
agnosis? C. Chronic oophoritis
D. Menstrual irregularity
A. Physiological course of postpartum E. Bilateral ovarian tumours
period
B. Subinvolution of uterus 198. A 4 month old child was admitted
C. Postpartum metroendometritis to a surgical department 8 hours after
D. Remnants of placental tissue after the first attack of anxiety. The attacks
labour happen every 10 minutes and last for 2-
E. Lactostasis 3 minutes, there was also one-time vomi-
ting. Objectively: the child’s condition is
195. Esophagus wall of a 72 year grave. Abdomen is soft, palpation reveals
old patient with severe concomitant a tumour-like formation in the right ili-
pathology was injured during urgent fi- ac area. After rectal examination the
broesophagogastroscopy. This resulted in doctor’s finger was stained with blood.
progressing of acute respiratory failure What is the most probable diagnosis?
and collapse of the left lung. What aid
should be rendered? A. Ileocecal invagination
B. Gastrointestinal haemorrhage
A. Drainage of pleural cavity by Bullaux C. Wilm’s tumour
method, mediastinum drainage, anti- D. Helminthic invasion
bacterial therapy E. Pylorostenosis
B. Buelau’s drainage of pleural cavity,
antibacterial therapy 199. During preventive examination a 16
C. Left-sided thoracotomy, closure of year old patient presented no problems.
esophagus and mediastinum wound Objectively: the patient has signs of
D. Left-sided thoracotomy, closure of malnutrition, he is asthenic, AP is 110/70
esophagus wound mm Hg, Ps is 80 bpm, cardiac border
E. Endoscopic closure of esophagus is normal, auscultation above the cardi-
wound, drainage ac apex reveals three sounds, cardi-
ac murmur is absent. ECG shows no
196. A 46 year old woman who has been pathological changes, phonocardiogram
suffering from hypertension for 5 years shows that the third sound comes 0,15 s
was diagnosed with hypertensive crisis. after the second one above the apex. How
She complains about palpitation, sense are these changes called?
of head pulsation; heart rate is 100/min,
AP is 190/100 mm Hg (haemodynamics A. III physiological sound
is of hyperkinetic type). What medication B. Fout-ta-ta-rou (reduplication of the 2nd
should be the medication of choice? sound)
C. Protodiastolic gallop rhythm
D. Atrial gallop rhythm
E. IV physiological sound
200. A 52 year old patient with dissemi- pathogenetic point of view?

nated vertebral osteochondrosis lifted a
significant load that resulted in lumbar A. Diclofenac
pain and pain along the sciatic nerve. B. Aspirin
Objectively: positive Lasegue’s sign on C. Analgin
the left, reduced Achilles reflex. What D. Novocaine
drug would be the most effective from the E. Spasmalgon

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Krok 2 Medicine 2008 1

1. An 8 year old child has low-grade A. Atony of the uterus

long, dense, the external os is closed, light A. Droperidolum of 0,25% - 2,0 ml

A. High serum Na+ A. Nasogastric decompression and

mother has an analogous pigmentation A. The test for tolerance to glucose

hypervolaemic type of essential

A. Carcinoma of the head of the pancreas A. Community-acquired lobar pneumonia

ago after cold exposure. She complai- A. Chronic mercury intoxication

A. Superficial venous thrombosis 92. During an operation for presumed

89. A 30 year old man complains of acute A. Hashimoto’s thyroiditis

problems with pain and tactile sensitivi- permissible?

would be the most adequate in this case?

A. Corresponding to the age Examination at an outpatient’s hospi-

called by his name. Neurological exami-

A. Alimentary constitutional obesity of A. β-adrenoceptor blocker

200. A 52 year old patient with dissemi- pathogenetic point of view?

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