Krok 2 - 2014 (Therapy)
Krok 2 - 2014 (Therapy)
Krok 2 - 2014 (Therapy)
2. A 7 y.o. boy suddenly felt pain in his right knee, it became edematic. The day
before he took part in a cross-country race. Family anamnesis has no data
about hemophilia and bleeding sickness. Objectively: body temperature is
37,5°C. The knee is painful, hot to the touch, edematic with local tissue
tension over it. Blood count: Hb- 123 g/L, leukocytes - 5,6×109/L,
thrombocytes - 354×109/L, prothrombin time - 12 seconds (normally 10-15
seconds), partly activated thromboplastin time - 72 seconds (normally 35-45
seconds). Hemorrhage time is normal, VIII:C factor is 5% of norm. What is
the most probable diagnosis?
A. Hemophilia A
B. Hemophilia B
C. Vitamin K deficiency
D. Thrombocytopenia
E. Schoenlein-Henoch disease
3. On the 3rd day after the acute anterior myocardial infarction a 55 y.o. patient
complains of dull ache behind his breast bone, that can be reduced by bending
forward, and of dyspnea. Objectively: AP- 140/180 mm Hg, heart sounds are
dull. ECG results: atrial fibrillation with frequence of ventricular contractions
at the rate of 110/min, pathological Q wave and S-T segment raising in the
right chest leads. The patient refused from thrombolisis. What is the most
probable diagnosis?
A. Acute pericarditis
B. Pulmonary embolism
C. Dissecting aortic aneurysm
D. Dresslers syndrome
E. Tietzes syndrome
4. A 54 y.o. man was admitted to the hospital with complaints of sudden intense
headache in occipital region and vomiting. In the medical hystory: moderate
arterial hypertension, the patient was taking hydrochlorothiazide. Three days
ago he consulted a therapeutist about intense headache that was suppressed
by an analgetic. Objectively: consciousness is confused, left pupil is mydriatic.
Evident photophobia and tension of neck muscles. Left-side hemiparesis with
increased muscle tonus and reflexes. Body temperature is low, rash is absent.
AP- 230/130 mm Hg, Ps- 50 bpm, BR- 12/min. What is your preliminary
diagnosis?
A. Acute subdural hematoma
B. Disseminated sclerosis
C. Myasthenia
D. Migraine
E. Acute bacterial meningitis
9. A patient with unstable angina pectoris was given the following complex
treatment: anticoagulants, nitrates, a-adrenoblockers. However on the third
day of treatment the pain still romains. Which in vestigation shoud be carried
out to establish diagnosis?
A. Coronarography
B. Test with dosed physical exercises
C. Stress-echocardiogram
D. Esophageal electrocardiac stimulator
E. Myocardial scintigraphy
10. The 28 y.o. woman applied to doctor because of limited loss of the hair. In the
anamnesis - she had frequent headache indisposition, arthromyalgia, fever,
irregular casual sexual life, drug user. RW is negative. What examination must
be done first?
A. Examination for HIV
B. Examination for trichomoniasis
C. Examination for gonorrhea
D. Examination for neuropathology
E. Examination for fungi
11. A 35 y.o. woman was admitted to thoracic surgery department with fever up to
40°C, onset of pain in the side caused by deep breathing, cough with
considerable quantity of purulent sputum and blood with bad smell. What is
the most likely diagnosis?
A. Abscess of the lung
B. Complication of liver echinococcosis
C. Actinomycosis of lungs
D. Pulmonary tuberculosis
E. Bronchiectatic disease
13. Male 30 y.o., noted growing fingers and facial scull, changed face. Complains
of poor eyesight, weakness, skin darkening, loss of body weight. X-ray shows
broadening of sella turcica, thinning of tuberculin sphenoidale, signs of
increased intracranial pressure. What diagnosis can you make?
A. Adenoma of hypophysis
B. Tumor of pondo-cerebellar corner
C. Optico - hiasmatic arachnoiditis
D. Encephalitis of truncus
E. Adrenal gland tumor
18. A 25-year-old man has facial edema, moderate back pains. His temperature is
37,5°C, BP 180/100 mm Hg, hematuria [up to 100 in v/f], proteinuria [2,0
g/L], hyaline casts - 10 in v/f., specific gravity -1020. The onset of the disease
is probably connected with acute tonsillitis that started 2 weeks ago. What is
the most probable diagnosis?
A. Acute glomerulonephritis
B. Urolithiasis
C. Chronic glomerulonephritis
D. Acute pyelonephritis
E. Cancer of the kidney
19. In the development of the inflammation processes glucocorticoids reduce the
level of certain most important active enzyme. It results also in the reducing of
the synthesis of prostaglandins and leucotrienes which have a key role in the
development of inflammation processes. What is the exact name of this
enzyme?
A. Phospholipase A2
B. Arachidonic acid
C. Cyclooxygenase – 1
D. Cyclooxygenase – 2
E. Lipoxygenase
20. A 30 y.o. female with rheumatoid arthritis of five years duration complains of
pain in the first three fingers of her right hand over past 6 weeks. The pain
seems especially severe at night often awakening her from sleep.The most
likelly cause is?
A. Carpal tunnel syndrome
B. Sensory peripheral neuropathy
C. Rheumatoid arthritis without complication
D. Rheumatoid vasculitis
E. Atlanto-axial sublaxation of cervical spine
21. A 19-year-old man has suffered from moderate mental retardation since
childhood. The patient is illiterate, can take care of himself, do simple
household work and other kinds of easy work under supervision. What does
his rehabilitation [tertiary prevention] require?
A. All the options
B. None of the above mentioned
C. Physical work under supervision
D. Supervision of a social worker
E. Supervision of relatives (if any)
22. A 38 y.o. patient was urgently admitted to the hospital with complaints of
sudden weakness, dizziness, loss of consciousness, body weight loss, nausea,
vomiting, severe pain in epigastric area, diarrhea, skin hyperpigmentation.
What is the most probable diagnosis?
A. Addisonic crisis
B. Meningoencephalitis
C. Pellagra
D. Scleroderma
E. Acute gastroenteritis
23. An unconscious patient presents with moist skin, shallow breathing. There are
signs of previous injection on the shoulders and hips. BP- 110/70 mm Hg.
Tonus of skeletal muscles and reflexes are increased. Cramps of muscles of the
extremities are seen. What is the most likely disorder?
A. Hypoglycemic coma
B. Hyperlactacidotic coma
C. Stroke
D. Hyperglycemic coma
E. Hyperosmolar coma
24. A patient was admitted to the hospital on the 7th day of the disease with
complaints of high temperature, headache, pain in the muscles, especially in
calf muscles. Dermal integuments and scleras are icteric. There is
hemorrhagic rash on the skin. Urine is bloody. The patient was fishing two
weeks ago. What is the most likely diagnosis?
A. Leptospirosis
B. Salmonellosis
C. Yersiniosis
D. Brucellosis
E. Trichinellosis
26. A 42-year-old woman suffers from bronchial asthma, has an acute attack of
bronchial asthma. What medication from the listed below is contraindicated
to render a first aid?
A. Euphylinum
B. Corazolum
C. Izardin
D. Morphinum hydrochloride
E. Strophanthin hydrochloride
27. 4 days ago a 32-year-old patient caught a cold: he presented with sore throat,
fatigue. The next morning he felt worse, developed dry cough, body
temperature rose up to 38,2°C, there appeared muco-purulent expectoration.
Percussion revealed vesicular resonance over lungs, vesicular breathing
weakened below the angle of the right scapula, fine sonorous and sibilant
wheezes. What is the most likely diagnosis?
A. Focal right-sided pneumonia
B. Pulmonary carcinoma
C. Pulmonary gangrene
D. Bronchial asthma
E. Acute bronchitis
29. A 38 y.o. woman complains of a purulent discharge from the left nostril. The
body temperature is 37,5°C. The patient has been ill for a week and associates
her illness with common cold. There are a pain and tenderness on palpation of
her left cheek. The mucous membrane in the left nasal cavity is red and
turgescent. The purulent exudate is seen in the middle meatus in maxillary.
What is the most probable diagnosis?
A. Acute purulent maxillary sinusitis
B. Acute purulent sphenoiditis
C. Acute purulent frontitis
D. Acute purulent ethmoiditis
30. A 40-year-old female patient has been hospitalized for attacks of asphyxia,
cough with phlegm. She has a 4-year history of the disease. The first attack of
asphyxia occurred during her stay in the countryside. Further attacks occurred
while cleaning the room. After 3 days of inpatient treatment the patients
condition has significantly improved. What is the most likely etiological
factor?
A. Household allergens
B. Pollen
C. Chemicals
D. Psychogenic
E. Infectious
31. The complications of acute cholecystitis which require surgical intervention
are as follows EXCEPT:
A. Jaundice
B. Gall-bladder perforation
C. Cholangitis conditioned by the presence of stones in the bile tract
D. Empyema of the gall-bladder
E. Emphysematous gall-bladder
32. A 22-year-old girl has been complaining of having itching rash on her face for
2 days. She associates this disease with application of cosmetic face cream.
Objectively: apparent reddening and edema of skin in the region of cheeks,
chin and forehead; fine papulovesicular rash. What is the most likely
diagnosis?
A. Allergic dermatitis
B. Erysipelas
C. Neurodermatitis
D. Dermatitis simplex
E. Eczema
34. A 43-year-old alcohol abuser had not consumed alcohol for the last two days.
In the evening he claimed to see rats and feel like they bite his feet. The
patient is disoriented, agitated, all the time attempts to run somewhere.
Specify the psychopathological syndrome:
A. Delirious
B. Gansers syndrome
C. Oneiroid
D. Amential
E. Choreatic
37. A 38-year-old male patient has been taking alcohol for 3 years. 3 days after a
regular drinking period he felt anxiety and fear. It appeared to him that he was
surrounded by spiders and worms, pursued by some "condemnatory voices".
His behaviour became aggressive. The patient demonstrated correct self-
awareness but impairment of temporal and spatial orientation. What is the
most likely diagnosis?
A. Delirium alcoholicum
B. Alcoholic hallucinosis
C. Pathologic intoxication
D. Alcoholic encephalopathy
E. Alcoholic paranoia
38. A painter working at a motorcar plant has been diagnosed with moderately
severe intoxication with amide compounds of benzene. The in-patient
treatment resulted in a considerable health improvement. What expert
decision should be made in this case?
A. The patient should be issued a sick list for out-patient treatment
B. The patient should be referred to the medio-social expert commission for
evaluation of percentage of work capicty loss
C. The patient may get back to work providing he will keep to hygiene and
sanitary regulations
D. The patient should be referred to the medio-social expert commission for
attributing the disability group because of an occupational disease
39. A 16-year-old patient who has a history of intense bleedings from minor cuts
and sores needs to have the roots of teeth extracted. Examination reveals an
increase in volume of the right knee joint, limitation of its mobility. There are
no other changes. Blood analysis shows an inclination to anaemia (Hb- 120
g/l). Before the dental intervention it is required to prevent the bleeding by
means of:
A. Cryoprecipitate
B. Fibrinogen
C. Calcium chloride
D. Dried blood plasma
E. Epsilon-aminocapronic acid
41. A 7-year-old boy had complained of headache, nausea, fatigue for 3 weeks. His
condition gradually deteriorated, headache and general weakness progressed.
The boy had bronchitis at the age of 3. His father has a history of pulmonary
tuberculosis. Objectively: body temperature 37,5°C, conscious, lies supine,
with the hip and knee flexed to 90 degrees, nuchal rigidity +6 cm, partial
ptosis of the right eyelid, the dilated right pupil. General hyperalgesia is
present. Liquor: transparent, pressure - 400 mm of water column, protein -
1,5%, cytosis - 610/3 with predominant lymphocytes, sugar - 1,22 mmol/l,
chlorides - 500 mmol/l. What is the most likely diagnosis?
A. Tuberculous meningitis
B. Epidemic cerebrospinal meningitis
C. Pneumococcal meningitis
D. Serous meningitis
E. Secondary purulent meningitis
42. A 35-year-old patient complains about pain and morning stiffness of hand
joints and temporomandibular joints that lasts over 30 minutes. She has had
these symptoms for 2 years. Objectively: edema of proximal interphalangeal
digital joints and limited motions of joints. What examination should be
administered?
A. Roentgenography of hands
B. Rose-Waaler reaction
C. Complete blood count
D. Immunogram
E. Proteinogram
44. Examination of a 35-year-old patient with rheumatism revealed that the right
heart border was 1 cm displaced outwards from the right parasternal line, the
upper border was on the level with inferior margin of the 1st rib, the left
border was 1 cm in from the left midclavicular line. Auscultation revealed
atrial fibrillation, loud apical first sound, diastolic shock above the pulmonary
artery. Echocardiocopy revealed abnormal pattern of the mitral valve motion.
What heart disease is characterized by these symptoms?
A. Mitral stenosis
B. Mitral valve insufficiency
C. Mitral valve prolapse
D. Aortic stenosis
E. Tricuspid valve insufficiency
45. A 54-year-old male patient works as an engineer. At the age of 35, he got
infected with syphilis and treated it with "traditional remedies". About 5 years
ago, he became forgetful, unable to cope with work, told cynical jokes, bought
useless things, collected cigarette butts in the street. Objectively: the patient is
indifferent, has slow speech, dysarthria, can make only primitive judgments, is
unabe to perform simple arithmetic operations or explain simple metaphors.
The patient is untidy, takes no interest in anything, passive. Considers himself
to be completely healthy. Qualify mental condition of the patient:
A. Total dementia
B. Somnolentia
C. Hysterical pseudodementia
D. Korsakoffs (amnesic) syndrome
E. Lacunar (dysmnestic) dementia
46. A 47-year-old patient complains of insomnia, heaviness over his entire body,
constantly depressed mood. He considers himself good-for-nothing,
inadequate. Believes that he is a burden to his family, wants to die. The patient
is depressed, inactive, has a hypomimic face with sorrowful expression. He
speaks quietly and monotonely,gives short answers. What is the most likely
diagnosis?
A. Major depressive disorder
B. Initial stage of Alzheimers disease
C. Neurotic depression
D. Late-onset schizophrenia
E. Atherosclerotic depression
47. A patient, aged 16, complains of headache, mainly in the frontal and temporal
areas, superciliary arch, appearing of vomiting at the peak of headache, pain
during the eyeballs movement, joints pain. On examination: excited, to- 39°C,
Ps- 110/min. Tonic and clonus cramps. Uncertain meningeal signs. What is
the most likely diagnosis?
A. Influenza with cerebral edema manifestations
B. Parainfluenza
C. Adenovirus infection
D. Influenza, typical disease duration
E. Respiratory syncytial virus
48. A 64 y.o. patient has developed of squeering substernal pain which had
appeared 2 hours ago and irradiated to the left shoulder, marked weakness.
On examination: pale skin, cold sweat. Pulse- 108 bpm, AP- 70/50 mm Hg,
heart sound are deaf, vesicular breathing, soft abdomen, painless, varicouse
vein on the left shin, ECG: synus rhythm, heart rate is 100 bmp, ST-segment is
sharply elevated in II, III aVF leads. What is the most likely disorder?
A. Cardiogenic shock
B. Disquamative aortic aneurizm
C. Cardiac tamponade
D. Cardiac asthma
E. Pulmonary artery thromboembolia
49. A 64-year-old patient complains of severe pain in the right side of chest,
dyspnea, dry cough which appeared suddenly on exertion. Objectively: the
right side of the chest lags behind in the act of breathing. Percussion reveals
tympanic sound. Auscultation reveals pronouncedly diminished breath
sounds on the right. Ps- 100/min, weak, arrhythmic. AP- 100/50 mm Hg.
Cardiac sounds are decreased. What disease can be suspected in this patient?
A. Right-sided pneumothorax
B. Right-sided dry pleurisy
C. Right-sided hydrothorax
D. Right-sided pleuropneumonia
E. PATE
50. A 29-year-old female patient complains of dyspnea, heaviness and chest pain
on the right, body temperature rise up to 37,2°C. The disease is associated
with a chest trauma received 4 days ago. Objectively: skin is pale and moist.
Ps- 90 bpm, regular. Palpation reveals a dull sound on the right, auscultation
reveals significantly weakened vesicular breathing. In blood: RBCs -
2,8×1012/l, colour index - 0,9, Hb- 100 g/l, WBCs - 8,0×109/l, ESR - 17
mm/h. What results of diagnostic puncture of the pleural cavity can be
expected?
A. Haemorrhagic punctate
B. Transudate
C. Purulent punctate
D. Chylous liquid
E. Exudate
51. A 54-year-old drowned man was rescued from the water and delivered to the
shore. Objectively: the man is unconscious, pale, breathing cannot be
auscultated, pulse is thready. Resuscitation measures allowed to save the
patient. What complications may develop in the near future?
A. Pulmonary edema
B. Encephalopathy
C. Respiratory arrest
D. Cardiac arrest
E. Bronchospasm
52. An 18-year-old patient since childhood suffers from bleeding disorder after
minor injuries. His younger brother also has bleeding disorders with
occasional haemarthrosis. Which laboratory test will be informative for
diagnosis verification?
A. Clotting time
B. Thrombocyte count
C. Determination of prothrombin time
D. Fibrinogen rate
E. Blood clot retraction
54. A patient, aged 40, has been ill during approximately 8 years, complains of
pain in the lumbar part of the spine on physical excertion, in cervical and
thoracal part (especially when coughing), pain in the hip and knee joints on
the right. On examination: the body is fixed in the forward inclination with
head down, gluteal muscles atrophy. Spine roentgenography: ribs
osteoporosis, longitudinal ligament ossification. What is the most likely
diagnosis?
A. Ancylosing spondyloarthritis
B. Tuberculous spondylitis
C. Spondyloarthropatia on the background of Reiters disease
D. Spread osteochondrosis of the vertebral column
E. Psoriatic spondyloarthropatia
55. A worker, aged 38, working in the slate production during 15 years, complains
of expiratory exertional dyspnea, dry cough. On examination: deafening of the
percutory sounds in interscapular region, rough breath sounds, dry
disseminated rales. On fingers skin - greyish warts. Factorys sectorial doctor
suspects asbestosis. Which method is the most informative for diagnosis
verification?
A. Thorax roentgenography
B. Bronchoscopy
C. Bronchoalveolar lavage
D. Blood gases examination
E. Spirography
58. A 36-year-old female has a 7-year history of pollen allergy. Over the last 2
years in August and September (during ragweed flowering), the patient has
had 2-3 asthma attacks that could be treated with one dose of salbutamol.
Objectively: body temperature - 36,5°C, respiratory rate - 18/min, Ps -
78/min, AP - 115/70 mm Hg. There is vesicular breathing above the lungs.
Cardiac sounds are sonorous, of regular rhythm. What drug would be most
effective to prevent asthma attacks during the critical season for the patient?
A. Intalum inhalation
B. Atrovent inhalation
C. Berotec inhalation
D. Suprastin administration
E. Theopecum administration
59. A 42-year-old patient applied to hospital with complaints of pain behind the
sternum with irradiation to the left scapula. The pain appears during
significant physical work, this lasts for 5-10 minutes and is over on rest. The
patient is sick for 3 weeks. What is the preliminary diagnosis?
A. IHD:First established angina pectoris
B. IHD:Stable angina pectoris of effort IV FC
C. IHD:Progressive angina pectoris
D. IHD:Variant angina pectoris (Prinzmetals)
E. IHD:Stable angina pectoris of effort I FC
62. A 24-year-old patient felt sick in 16 hours after dried fish intake. There was
nausea, vomiting, weakness, flabbiness, double vision. On physical exam,
there was decrease of a muscle tone, anisocoria, flaccid swallowing and tendon
reflex. What is the most probable diagnosis?
A. Botulism
B. Acute gastritis
C. Salmonellosis
D. Acute encephalitis
E. Food toxicoinfection
64. A 40 y.o. patient was admitted to the gasteroenterology with skin itching,
jaundice, discomfort in the right subcostal area, generalized weakness. On
examination: skin is jaundice, traces of scratches, liver is +5 cm, splin is 6x8
cm. In blood: alkaline phosphatase - 2,0 mmol/(hourL), general bilirubin - 60
mkmol/L, cholesterol - 8,0 mmol/L. What is the leading syndrome in the
patient?
A. Cholestatic
B. Cytolytic
C. Asthenic
D. Liver-cells insufficiency
E. Mesenchymal inflammatory
65. A 55-year-old male had been treated at the surgical department for acute
lower-extremity thrombophlebitis. On the 7th day of treatment he suddenly
developed pain in the left part of chest, dyspnea and cough. Body temperature
was 36,1°C, respiratory rate - 36/min. The patient was also found to have
diminished breath sounds without wheezing. Ps- 140/min, thready. AP- 70/50
mm Hg. The ECG shows QIII-S1 syndrome. What is the most likely diagnosis?
A. Pulmonary embolism
B. Bronchial asthma
C. Pneumothorax
D. Myocardial infarction
E. Cardiac asthma
69. A 16-year-old adolescent was vaccinated with DTP. In eight days there was
stiffness and pain in the joints, subfebrile temperature, urticarial skin
eruption, enlargement of inguinal, cervical lymph nodes and spleen. What
kind of allergic reaction is observed?
A. Immunocomplex
B. Hypersensitivity of delayed type
C. Hypersensitivity of immediate type
D. Cytoxic
70. 2 weeks after recovering from angina a 29-year-old patient noticed face
edemata, weakness, decreased work performance. There was gradual progress
of dyspnea, edemata of the lower extremities, lumbar spine. Objectively: pale
skin, weakening of the heart sounds, anasarca. AP- 160/100 mm Hg. In urine:
the relative density - 1021, protein - 5 g/l, erythrocytes - 20-30 in the field of
vision, hyaline cylinders - 4-6 in the field of vision. What is the most likely
diagnosis?
A. Acute glomerulonephritis
B. Infectious allergic myocarditis
C. Myxedema
D. Essential hypertension
E. Acute pyelonephritis
73. A 51 y.o. woman complains of dull pain in the right subcostal area and
epigastric area, nausea, appetite decline during 6 months. There is a history of
gastric peptic ulcer. On examination: weight loss, pulse is 70 bpm, AP is
120/70 mm Hg. Diffuse tenderness and resistance of muscles on
palpation.There is a hard lymphatic node 1x1cm in size over the left clavicle.
What method of investigation will be the most useful?
A. Esophagogastroduodenoscopy with biopsy
B. Stomach X-ray
C. pH-metry
D. Ultrasound examination of abdomen
E. Ureatic test
74. On the 20th of June a townsman was brought to clinic. The disease broke out
acutely, starting with fever, rise in temperature to 38-39°C. There also was
weakness, acute headache, nausea, vomiting, pain all over the body, sleep
disorder. On physical examination: hyperemia of skin of face, neck, thorax.
Meningeal signs are positive. 12 days ago the patient returned from the
Siberia, from the forest. What is the most probable diagnosis?
A. Tick-borne encephalitis
B. Pseudotuberculosis
C. Epidemic typhus
D. Influenza
E. Omsk hemorrhagic fever
75. A 37-year-old patient has sudden acute pain in the right epigastric area after
having fatty food. What method of radiological investigation is to be used on
the first stage of examining the patient?
A. Ultrasonic
B. Thermographic
C. Radionuclid
D. Roentgenological
E. Magnetic-resonance
78. A 32-year-old male patient has been suffering from pain in the sacrum and
coxofemoral joints, painfulness and stiffness in the lumbar spine for a year.
ESR- 56 mm/h. Roentgenography revealed symptoms of bilateral sacroileitis.
The patient is the carrier of HLA B27 antigen. What is the most likely
diagnosis?
A. Ankylosing spondylitis
B. Rheumatoid arthritis
C. Spondylosis
D. Reiters disease
E. Coxarthrosis
80.A 26 y.o. male patient with postoperative hypothyroidism take thyroxine 100
mg 2 times a day. He has developed tachycardia, sweating, irritability, sleep
disorder. Determine further treatment tactics.
A. To decrease thyroxine dosage
B. To administer betablockers
C. To administer sedatives
D. To add mercasolil to the treatment
E. To increase thyroxine dosage
81. A 28-year-old man was discharged from the hospital after having an out-of -
hospital pneumonia. He has no complaints. On physical exam: his
temperature is 36,6°C, RR-18/min, Ps - 78 bpm, BP- 120/80 mm Hg. During
ausculation there is harsh respiration to the right of the lower part of the lung.
Roentgenologically: infiltrative changes are absent, intensification of the
pulmonary picture to the right in the lower lobe. How long should the doctor
keep the patient under observation?
A. 12 months
B. 3 months
C. Permanently
D. 6 months
E. 1 month
83. A survey radiograph of a miner (24 years of service record, the dust
concentration in the workplace is at the rate of 260-280 mg/m3 with 15% of
free silica) shows lung changes that are typical for pneumoconiosis. What type
of pneumoconiosis is it?
A. Anthracosilicosis
B. Anthracosilicatosis
C. Silicosis
D. Carboconiosis
E. Silicatosis
84. A patient complains of pathological lump, appearing in the right inguinal
region on exercise. The lump is round-shaped, 4 cm in diameter, on palpation:
soft elastic consistency, is positioned near the medial part of Pouparts
ligament. The lump is situated inwards from the spermatic cord. What is the
most probable preliminary diagnosis?
A. Right-sided direct inguinal hernia
B. Lipoma of the right inguinal area
C. Right-sided femoral hernia
D. Right-sided oblique inguinal hernia
E. Varicose veins of the right hip
85. A 35-year-old man was operated on peptic ulcer of the stomach. Mass deficit
of the body is 10 kg. The level of glucose after operation in the undiluted
cellular blood on an empty stomach is 6,7 mmol. During repeated examination
- 11,1 mmol (after meal), level of HbA1c - 10%. Could you please make an
interpretation of the given data?
A. Diabetes mellitus
B. Diabetes mellitus risk group
C. Postoperative hyperinsulinemia
D. Norm
E. Disordered tolerance to glucose
86. A 52 y.o. woman complains of weakness, painful itching after washing and
bathing, sensation of heaviness in the head. On examination: hyperemia of
skin of face, neck, extremities.BP- 180/100 mm Hg. Spleen is 4 cm below the
rib arch edge. What is the most probable diagnosis?
A. Erythremia
B. Dermatomyositis
C. Essential hypertension
D. Allergic dermatitis
E. Systemic sclerodermia
92. A 14-year-old victim was drawn out of the water in winter after 15 minutes of
being in the water. The victim shows no vital signs. What measures are to be
taken?
A. To release respiratory tract from water, to create drain position
and to take on measures to restore respiration and blood
circulation
B. To transport the victim to the nearest warm room to carry out reanimation
measures
C. Not to carry out reanimation measures
D. Not to waste time on the release of respiratory tract from water, to take on
cardiopulmonary reanimation
E. To transport the victim to the nearest hospital to carry out reanimation
measures
94. A woman complains of high temperature to 38°C, mild pain in the throat
during 3 days. On examination: angle lymphatic nodes of the jaw are 3 cm
enlarged, palatinel tonsils are enlarged and coated with grey plaque which
spreads to the uvula and frontal palatinel arches. What is the most probable
diagnosis?
A. Larynx dyphtheria
B. Agranulocytosis
C. Oropharyngeal candidosis
D. Infectious mononucleosis
E. Vincents angina
95. A 48-year-old male patient complains of constant pain in the upper abdomen,
mostly on the left, that is getting worse after taking meals; diarrhea, weight
loss. The patient is an alcohol abuser. 2 years ago he had acute pancreatitis.
Blood amylase is 4 g/hl. Coprogram shows steatorrhea, creatorrhea. Blood
glucose is 6,0 mmol/l. What treatment is indicated for this patient?
A. Panzinorm forte
B. Contrycal
C. No-spa
D. Insulin
E. Gastrozepin
96. A 60-year-old female patient had been admitted to a hospital for acute
transmural infarction. An hour later the patients contition got worse. She
developed progressing dyspnea, dry cough. Respiratory rate - 30/min, heart
rate - 130/min, AP- 90/60 mm Hg. Heart sounds were muffled, there was also
diastolic shock on the pulmonary artery. The patient presented with medium
moist rales in the lower parts of lungs on the right and on the left. Body
temperature - 36,4°C. What drug should be given in the first place?
A. Promedol
B. Dopamine
C. Aminophylline
D. Heparin
E. Digoxin
97. A 62-year-old male has been hospitalized in the intensive care unit with a
continuous attack of retrosternal pain that cannot be relieved by nitroglycerin.
Objectively: AP- 80/60 mm Hg, heart rate - 106/min, breathing rate - 22/min.
Heart sounds are muffled, a gallop rhythm is present. How would you explain
the AP drop?
A. Reduction in cardiac output
B. Reduction in peripheral resistance
C. Adrenergic receptor block
D. Internal haemorrhage
E. Blood depositing in the abdominal cavity
98. A 35-year-old female reports heart pain (aching and drilling) occurring mainly
in the morning in autumn and spring and irradiating to the neck, back and
abdomen; rapid heartbeat; low vitality. Occurrence of this condition is not
associated with physical activity. In the evening, the patients condition
improves. Study of somatic and neurological status, and ECG reveal no
pathology. What pathology is most likely to have caused these clinical
presentations?
A. Somatization depression
B. Pseudoneurotic schizophrenia
C. Resting stenocardia
D. Neurocirculatory asthenia
E. Hypochondriacal depression
99. A 18 y.o. male patient complains of pain in knee and ankle joints, temperature
elevation to 39,5°C. He had a respiratory disease 1,5 week ago. On
examination: temperature- 38,5°C, swollen knee and ankle joints, pulse- 106
bpm, rhythmic, AP- 90/60 mm Hg, heart borders without changes, sounds are
weakened, soft systolic apical murmur. What indicator is connected with
possible etiology of the process?
A. Antistreptolysine-0
B. Rheumatic factor
C. Seromucoid
D. 1-antitrypsine
E. Creatinkinase
100. A 30 y.o. male patient complains of itching of the skin which intensifies
in the evening. He has been ill for 1,5 months. On examination: there is rash
with paired papules covered with bloody crusts on the abdomen, hips,
buttocks, folds between the fingers, flexor surfaces of the hand. There are
traces of line scratches. What additional investigations are necessary to make
diagnosis?
A. Examination of rash elements scrape
B. Blood glucose
C. Examination for helmints
D. Determination of dermographism
E. Serologic blood examination
102. 4 hours after having meals a patient with signs of malnutrition and
steatorrhea experiences stomach pain, especially above navel and to the left of
it. Diarrheas take turns with constipation lasting up to 3-5 days. Palpation
reveals moderate painfulness in the choledochopancreatic region. The
amylase rate in blood is stable. X-ray reveals some calcifications located above
navel. What is the most likely diagnosis?
A. Chronic pancreatitis
B. Duodenal ulcer
C. Chronic gastroduodenitis
D. Zollinger-Ellison syndrome
E. Chronic calculous cholecystitis
104. A 56-year-old patient with diffuse toxic goiter has ciliary arrhythmia
with pulse rate of 110 bpm, arterial hypertension, AP- 165/90 mm Hg. What
preparation should be administered along with mercazolil?
A. Propranolol
B. Radioactive iodine
C. Verapamil
D. Corinfar
E. Procaine hydrochloride
106. A 43 y.o. woman complains of severe pain in the right abdominal side
irradiating in the right supraclavicular area, fever, dryness and bitterness in
the mouth. There were multiple vomitings without relief. Patient relates the
onset of pain to the taking of fat and fried food. Physical examination: the
patient lies on the right side, pale, dry tongue, tachycardia. Right side of
abdomen is painful during palpation and somewhat tense in right
hypochondrium. What is the most likely diagnosis?
A. Perforative ulcer
B. Acute bowel obstruction
C. Acute cholecystitis
D. Acute appendicitis
E. Right-sided renal colic
109. A 24-year-old man on the 5th day of acute respiratory disease with high
grade temperature started having strong headaches, systemic dizziness,
sensation of double vision, paresis of mimic muscles to the right, tickling by
swallowing. Diagnosis: Acute viral encephalitis. Determine the basic direction
of the emergent therapy.
A. Zovirax
B. Lasix
C. Hemodesis
D. Glucocorticoids
E. Cephtriaxon
110. A 30-year-old patient was delivered to the admission ward of the
infectious disease department. The disease had started acutely on the
background of normal temperature with the appearance of frequent, liquid,
profuse stool without pathological impurities. Diarrhea was not accompanied
by abdominal pain. 12 hours later there appeared recurrent profuse vomiting.
The patient rapidly developed dehydration. What is the most likely diagnosis?
A. Cholera
B. Shigellosis
C. Salmonellosis
D. Campylobacteriosis
E. Staphylococcal food toxicoinfection
120. A 24-year-old man on the second day of the disease with a sudden
onset complains of a strong headache in temples and in the area of orbits, dull
pain in the body, dry painful cough. His temperature is 39°C. Adynamic.
Mucous membrane of oropharynx is "flaming", rales are not ausculated. What
is the most probable diagnosis?
A. Influenza
B. Respiratory mycoplasmosis
C. Meningococcus infection
D. Pneumonia
E. Parainluenza
125. A 35-year-old patient has been in the intensive care unit for acute renal
failure due to crush for 4 days. Objectively: the patient is inadequate.
Breathing rate - 32/min. Over the last 3 hours individual moist rales can be
auscultated in lungs. ECG shows high T waves, right ventricular extrasystoles.
CVP - 159 mm Hg. In blood: the residual nitrogen - 62 millimole/l, K+- 7,1
millimole/l, Cl- - 78 millimole/l, Na+- 120 millimole/l, Ht - 0,32, Hb - 100 g/l,
blood creatinine - 0,9 millimole/l. The most appropriate method of treatment
would be:
A. Hemodialysis
B. Hemosorption
C. Ultrafiltration
D. Plasma filtration
E. Plasma sorption
126. A 45-year-old man was brought to clinic with complaints of the pain
that started suddenly in the left chest part and epigastric area, shortness of
breath, nausea, one-time vomiting. The acute pain started after weight-lifting.
On physical exam: shallow breathing, RR - 38/min, left chest part is behind
during respiration, by percussion - tympanitic sound, respiration is not
ausculated. Ps - 110 bpm, of weak filling. BP- 100/60 mm Hg, insignificant
displacement of heart to the right, sounds are dull. What examination is the
most expedient to do first?
A. Roentgenography
B. Esophagogastroscopy
C. Ultrasound of the abdominal cavity
D. Electrocardiography
E. Bronchoscopy
140. A 72-year-old male had had a moderate headache. Two days later, he
developed the progressing speech disorders and weakness in the right
extremities. The patient has a history of myocardial infarction, arrhythmia.
Study of the neurologic status revealed elements of motor aphasia, central
paresis of the VII I XII cranial nerves on the right, central hemiparesis on the
same side and hyperaesthesia. What is the most likely diagnosis?
A. Ischemic stroke
B. Transient ischemic attack
C. Hemorrhagic stroke
D. Epidural hematoma
E. Brain tumor
142. After treating a field with pesticides a machine operator presents with
great weakness, headache, nausea, vomiting, diarrhea, visual impairment,
watery eyes. Objectively: the patient is excited, hypersalivation, hyperhidrosis,
muscle fibrillation of tongue and eyelids are oberved. Pupils are narrowed,
there is tachycardia, lung auscultation reveals moist small and medium
bubbling rales. In blood: changed level of cholinesterase activity. What is the
most likely diagnosis?
A. Intoxication with organophosphorous pesticides
B. Intoxication with carbamic acid derivatives
C. Intoxication with organomercurial pesticides
D. Intoxication with organochlorine pesticides
E. Intoxication with arsenic-containing pesticides
143. A 40-year-old man is ill with autoimmune hepatitis. Blood test: A/G
ratio 0,8, bilirubin – 42 mumol/L, transaminase: ALT- 2,3 mmol g/L, AST -
1,8 mmol g/L. What is the most effective means in treatment from the given
below?
A. Glucocorticoids, cytostatics
B. Antibacterial medication
C. Antiviral medications
D. Hemosorbtion, vitamin therapy
E. Hepatoprotectors
144. A farmer hurt his right foot during working in a field and came to the
emergency station. He doesnt remember when he got last vaccination and he
has never served in the army. Examination of his right foot revealed a
contaminated wound up to 5-6 cm long with uneven edges. The further
treatment tactics will be:
A. To make an injection of tetanus anatoxin and antitetanus serum
B. To make an injection of antitetanus serum
C. To administer an antibiotic
D. Surgical d-bridement only
E. To make an injection of tetanus anatoxin
145. A 35-year-old patient has been admitted to a hospital for pain in the left
sternoclavicular and knee joints, lumbar area. The disease has an acute
character and is accompanied by fever up to 38°C. Objectively: the left
sternoclavicular and knee joints are swollen and painful. In blood: WBCs -
9,5×109/l, ESR - 40 mm/h, CRP - 1,5 millimole/l, fibrinogen - 4,8 g/l, uric
acid - 0,28 millimole/l. Examination of the urethra scrapings reveals
chlamydia. What is the most likely diagnosis?
A. Reiters syndrome
B. Rheumatoid arthritis
C. Gout
D. Rheumatic arthritis
E. Bechterews disease
146. A 20 daily y.o. female patient is suffering from chronic bronchitis.
Recently there has been production about 0,5 L of purulent sputum with
maximum discharge in the morning. Fingers are like "drum sticks", there are
"watching glass" nails. What is the most probable diagnosis?
A. Bronchiectasia
B. Pneumonia
C. Gangrene of lungs
D. Tuberculosis
E. Chronic bronchitis
149. A 28 y.o. male patient was admitted to the hospital because of high
temperature 39°C, headache, generalized fatigue, constipation, sleep disorder
for 9 days. There are sporadic roseolas on the abdomen, pulse- 78 bpm, liver is
enlarged for 2 cm. What is the most probable diagnosis?
A. Abdominal typhoid
B. Leptospirosis
C. Sepsis
D. Typhus
E. Brucellosis
150. A 50-year-old patient complains about having pain attacks in the right
subcostal area for about a year. He pain arises mainly after taking fattening
food. Over the last week the attacks occurred daily and became more painful.
On the 3rd day of hospitalization the patient presented with icteritiousness of
skin and scleras, light-colored feces and dark urine. In blood: neutrophilic
leukocytosis - 13,1×109/l, ESR- 28 mm/h. What is the most likely diagnosis?
A. Chronic calculous cholecystitis
B. Fatty degeneration of liver
C. Hypertensive dyskinesia of gallbladder
D. Chronic cholangitis, exacerbation stage
E. Chronic recurrent pancreatitis
155. A 36-year-old patient complains of skin rash that appeared a week ago
and doesnt cause any subjective problems. Objectively: palm and sole skin is
covered with multiple lenticular disseminated papules not raised above the
skin level. The papules are reddish, dense on palpation and covered with
keratinous squamae. What is the provisional diagnosis?
A. Secondary syphilis
B. Palmoplanar psoriasis
C. Palm and sole callosity
D. Palmoplanar rubrophytosis
E. Verrucosis
159. A 32-year-old patient has a 3-year history of asthma attacks, that can
be hardly stopped with berotec. Over a few last months he has experienced
pain in the joints and sensitivity disorder of legs and feet skin. Ps - 80/min,
AP - 210/100 mm Hg. In blood: eosinophilia at the rate of 15%. What disease
can be suspected in this case?
A. Periarteritis nodosa
B. Systemic scleroderma
C. Systemic lupus erythematosus
D. Dermatomyositis
E. Wegeners disease
160. 3 hours before, a 68-year-old male patient got a searing chest pain
radiating to the neck and left forearm, escalating dyspnea. Nitroglycerin failed
to relieve pain but somewhat reduced dyspnea. Objectively: there is crimson
cyanosis of face. Respiratory rate is 28/min. The patient has vesicular
breathing with isolated sibilant rales. Heart sounds are muffled, with a gallop
rhythm. Ps - 100/min, AP - 100/65 mmHg. ECG shows negative T-wave in
V2-V6 leads. What drug can reduce the hearts need for oxygen without
aggravating the disease?
A. Isosorbide dinitrate
B. Atenolol
C. Corinfar
D. Streptokinase
E. Aminophylline
161. A 46-year-old patient complains of sudden palpitation, which is
accompanied by pulsation in the neck and head, fear, nausea. The palpitation
lasts for 15-20 minutes and is over after straining when holding her breath.
What kind of cardiac disorder may be suspected?
A. An attack of supraventricular paroxysmal tachycardia
B. An attack of atrial flutter
C. An attack of extrasystolic arrhythmia
D. An attack of ciliary arrhythmia
E. An attack of ventricular paroxysmal tachycardia
163. A welder at work got the first-degree burns of the middle third of his
right shin. 5 days later the skin around the burn became edematic and itchy.
Objectively: on a background of a well-defined erythema there is polymorphic
rash in form of papules, vesicles, pustules, erosions with serous discharge.
What is the most likely diagnosis?
A. Microbal eczema
B. True eczema
C. Occupational eczema
D. Streptococcal impetigo
E. Toxicoderma
164. A 58-year-old patient has a 3-year history diabetes mellitus type II. He
has been keeping to a diet and regularly taking glyburide. He has been
delivered to a hospital on an emergency basis for acute abdomen. Objectively:
the patient is of supernutrition type. The skin is dry. In the lungs vesicular
breathing can be auscultated. Heart sounds are regular, 90/min. AP- 130/70
mm Hg. The symptom of "wooden belly" is visible. Blood sugar - 9,8
millimole/l. The patients has indication for laparotomy. What is the most
appropriate way of further treatment of diabetes?
A. To administer short insulin
B. To administer 1 tablet of Maninil three times a day
C. To administer Semilong to be taken in the morning and insulin - in the
evening
D. To continue taking glyburide
E. To administer 1 tablet of Glurenorm three times a day
165. A 56 y.o. man, who has taken alcoholic drinks regularly for 20 years,
complains of intensive girdle pain in the abdomen. Profuse nonformed stool
2-3- times a day has appeared for the last 2 years, loss of weight for 8 kg for 2
years. On examination: abdomen is soft, painless. Blood amylase - 12g/L.
Feces examination-neutral fat 15 g per day, starch grains. What is the most
reasonable treatment at this stage?
A. Pancreatine
B. Aminocapron acid
C. Imodium
D. Levomicytine
E. Contrykal
166. A 43-year-old female patiet complains of eruption on her right leg skin,
pain, weakness, body temperature rise up to 38°C. The disease is acute.
Objectively: there is an edema on the right leg skin in the region of foot, a
well-defined bright red spot in form of flame tips which feels hot. There are
isolated vesicles in focus. What is your provisional diagnosis?
A. Erysipelas
B. Haemorrhagic vasculitis
C. Contact dermatitis
D. Microbial eczema
E. Toxicoderma
168. A 47-year-old patient came to see a doctor on the 7th day of disease.
The disease developed very fast: after the chill body temperature rose up to
40°C and lasted up to 7 hours, then it dropped abruptly, which caused profuse
sweat. There were three such attacks occuring once in two days. Two days ago
the patient arrived from Africa. Objectively: pale skin, subicteric sclera,
significantly enlarged liver and spleen. What is the cause of fever attacks in
this disease?
A. Erythrocytic schizogony
B. Exotoxin of a causative agent
C. Gametocytes
D. Endotoxin of a causative agent
E. Tissue schizogony
174. A 52 y.o. male patient has become ill gradually. There is pain in the left
side of the thorax during 2 weeks, elevation of temperature till 38-39°C. On
examination: left chest side falls behind in breathing movement no voice
tremor over the left lung. Dullness that is more intensive in lower parts of this
lung. Right heart border is deviated outside. Sharply weakened breathing over
the left lung, no rales. Heart sounds are mufflet, tachycardia. What is the most
probable diagnosis?
A. Exudative pleuritis
B. Spotaneous pneumothorax
C. Cirrhotic tuberculosis
D. Infarction-pneumonia
E. Atelectasis of lung
175. A 50-year-old patient was hospitalized in severe condition with
complaints of chills, high grade temperature, dryness in the mouth, multiple
vomiting, pain in the epigastrium, frequent watery, foamy, dirty green color
stool of unpleasant odor. The tongue and the skin are dry. BP - 80/40 mm Hg.
What first aid is necessary for the patient?
A. Intravenous injection of sodium solutions
B. Hemosorbtion
C. To prescribe polyglucin
D. Fresh-frozen plasma transfusion
E. Sympathomimetics
177. A patient has chronic heart failure of the II stage. He takes furosemide
regularly three times a week. He had developed bronchopneumonia and had
been administered combined pharmacotherapy. On the fifth day of therapy
the patient complained of hearing impairment. What drug coadministered
with furosemide might have caused the hearing loss?
A. Gentamicin
B. Mucaltin
C. Nystatin
D. Linex
E. Tavegil
180. A 28-year-old patient has been hospitalized for the pain in the
epigastric region. He has a 10-year history of duodenal ulcer (DU). Recently,
the pain character has changed: it became permanent, persistent, irradiating
to the back. There are general weakness, dizziness, fatigue. The patient has
put off weight. Objectively: HR- 68/min, AP- 120/80 mm Hg. What is most
likely cause of deterioration?
A. Penetration
B. Haemorrhage
C. Exacerbation of duodenal ulcer
D. Stenosis development
E. Perforation of duodenal wall
193. A 58-year-old patient was diagnosed basal-cell skin cancer, 1st stage.
Tumor is up to 1 cm in size and with up to 0,5 cm deep infiltration in tissues.
Tumor is localized in the right nasolabial area. Choose the most optimal
method of treatment.
A. Short-distance roentgenotherapy
B. Surgical treatment
C. Long-distance gamma therapy
D. Long-distance roentgenotherapy
E. Chemotherapy
195. 2 days ago a patient presented with acute pain in the left half of chest,
general weakness, fever and headache. Objectively: between the 4 and 5 rib on
the left the skin is erythematous, there are multiple groups of vesicles 2-4 mm
in diameter filled with transparent liquid. What diease are these symptoms
typical for?
A. Herpes zoster
B. Herpes simplex
C. Pemphigus
D. Streptococcal impetigo
E. Herpetiform Duhrings dermatosis
197. After lifting a load a patient felt undurable pain in the loin. He was
diagnosed with acute lumbosacral radiculitis. Which of the following is
contraindicated for this patient?
A. Warming procedures
B. Vitamins of B group
C. Intravenous injection of aminophylline
D. Dehydrating drugs
E. Analgetics
199. After lifting a load, a 36-year-old male patient has experienced a severe
pain in the lumbar region, which spread to the right leg and was getting worse
when he moved his foot or coughed. Objectively: the long back muscles on the
right are strained. Achilles jerk is reduced on the right. There is a pronounced
tenderness of paravertebral points in the lumbar region. The straight leg raise
(Lasegues sign ) is positive on the right. What additional tests should be
performed in the first place?
A. Radiography of the spinal column
B. Lumbar puncture
C. Magnetic resonance tomography
D. Computed tomography
E. Electromyography
200. A female, aged 20, after smoking notices a peculiar inebriation with the
feeling of burst of energy, elation, irreality and changing of surroundings: the
world gets full of bright colours, the objects change their dimensions, peoples
faces get cartoon features, loss of time and space judgement. What is the most
likely diagnosis?
A. Cocainism
B. Morphinism
C. Nicotinism
D. Cannabism
E. Barbiturism
201. A 75 y.o patient can not tell the month, date and season of the year.
After long deliberations she manages to tellher name. She is in irritable and
dissatisfied mood. She always carries a bundle with belongings with her, hides
a parcel with bread, shoes in her underwear in her bosom as well as
"invaluable books". What is the most probable diagnosis?
A. Senile dementia
B. Behaviour disorder
C. Dissociated personality (psychopathy)
D. Atherosclerotic (lacunar) dementia
E. Presenile melancholia
203. While lifting a heavy load a 39-year-old patient suddenly felt a severe
headache, pain in the interscapular region, and started vomiting. Objectively:
the pulse is rhythmic, 60/min, AP- 180/100 mm Hg. The patient is agitated.
He presents with photophobia, hyperacusis. There are positive Kernigs and
Brudzinskis signs on both sides. In blood: WBCs – 10×109/l. CSF is bloody,
cytosis is 240/3. What is the most likely diagnosis?
A. Subarachnoid haemorrhage
B. Meningococcal meningitis
C. Ischemic stroke
D. Sympathoadrenal crisis
E. Acute hypertonic encephalopathy
206. HIV displays the highest tropism towards the following blood cells:
A. T-helpers
B. Thrombocytes
C. Erythrocytes
D. T-suppressors
E. T-killers
214. On the second day of the disease a 22-year-old male patient complains
of high-grade fever, headache in the region of forehead and superciliary
arches, and during eye movement; aching muscles and joints. Objectively:
body temperature is 39°C. Face is hyperemic, sclerae are injected. The mucous
membrane of the soft palate and posterior pharyngeal wall is bright hyperemic
and has petechial hemorrhages. What changes in the hemogram are typical for
this disease?
A. Leukopenia
B. Neutrocytosis
C. Accelerated ESR
D. Anemia
E. Leukocytosis
215. A female patient consulted a dermatologist about the rash on the trunk
and extremities. Objectively: interdigital folds, flexor surfaces of wrists and
navel region are affected with pairs of nodulo-cystic eruptions and crusts. The
rash is accompanied by skin itch that is getting stronger at night. What
external treatment should be administered?
A. 20% benzyl benzoate emulsion
B. 5% tetracycline ointment
C. 2% sulfuric paste
D. 5% sulfuric ointment
E. 5% naphthalan ointment
216. A 54 y.o. male patient suffers from dyspnea during mild physical
exertion, cough with sputum which is excreted with diffculty. On examination:
diffuse cyanosis. Is Barrel-chest. Weakened vesicular breathing with
prolonged expiration and dry whistling rales. AP is 140/80 mm Hg, pulse is
92 bpm, rhythmic. Spirography: vital capacity (VC)/predicted vital capacity-
65%, FEV1/FVC– 50%. Determine the type of respiratory insufficiency (RI).
A. RI of mixed type with prevailing obstruction
B. RI of mixed type with prevailing resriction
C. There is no RI
D. RI of restrictive type
E. RI of obstructive type
219. A 26-year-old patient has abused alcohol since the age of 16, needs a
morning-after drink to cure hangover. He takes alcohol nearly every day, "a
little at a time". Twice a week he gets severely drunk. The patient works as a
motor mechanic, over the last 2 years work conflicts have become more
frequent. What medical and tactical actions should be taken in this case?
A. Voluntary consultation and treatment at an addiction clinic
B. Compulsory treatment
C. Referral to medical-social expert commission for assessment of his working
ability
D. Consultation with a psychologist
E. Referral to treatment at an activity therapy centre
222. A male patient presents with swollen ankles, face, eyelids, elevated AP-
160/100 mm Hg, pulse- 54 bpm, daily loss of albumine with urine- 4g. What
therapy is pathogenetic in this case?
A. Corticosteroids
B. Diuretics
C. Calcium antagonists
D. Antibiotics
E. NSAID
223. After myocardial infarction, a 50-year-old patient had an attack of
asthma. Objectively: bubbling breathing with frequency of 32/min, cough with
a lot of pink frothy sputum, acrocyanosis, swelling of the neck veins. Ps-
108/min, AP- 150/100 mm Hg. Heart sounds are muffled. Mixed moist rales
can be auscultated above the entire lung surface. What drug would be most
effective in this situation?
A. Nitroglycerin intravenously
B. Dopamine intravenously
C. Aminophylline intravenously
D. Pentamin intravenously
E. Strophanthin intravenously
228. A 49-year-old female patient with schizophrenia is all the time listening
to something, insists that "there is a phone in her head" as she hears the voice
of her brother who tells her to go home. The patient is anxious, suspicious,
looks around all the time. Specify the psychopathological syndrome:
A. Hallucinatory
B. Depressive
C. Paranoiac
D. Generalized anxiety disorder
E. Paraphrenic
235. A 45-year-old man has been exhibiting high activity for the last 2
weeks, he became talkative, euphoric, had little sleep, claimed being able "to
save the humanity" and solve the problem of cancer and AIDS, gave money
the starangers. What is the most likely diagnosis?
A. Maniacal onset
B. Schizo-affective disorder
C. Catatonic excitation
D. Panic disorder
E. Agitated depression
238. As a result of lifting a load a 62-year-old female felt acute pain in the
lumbar region, in a buttock, posterolateral surface of her right thigh, external
surface of the right shin and dorsal surface of foot. Objectively: weakness of
the anterior tibial muscle, long extensor muscle of the right toes, short
extensor muscle of the right toes. Low Achilles reflex on the right. Positive
Lasegues sign. What examination method would be the most effective for
specification of the diagnosis of discogenic compression of L5 root?
A. Magnetic resonance scan
B. Lumbar puncture
C. Electromyography
D. Spinal column X-ray
E. Angiography
240. A 23-year-old female patient has a mental disease since the age of 18,
the course of disease has no remission periods. At a hospital the patient
mostly presents with non-purposeful foolish excitation: she makes stereotypic
grimaces, exposed, masturbating in front of a loud laugh, repeating the
stereotypical abusive shouts. The patient should be assigned:
A. Neuroleptics
B. Nootropics
C. Mood stabilizers
D. Antidepressants
E. Tranquilizers
248. In a cold weather, the emergency room admitted a patient pulled out of
the open water. There was no respiratory contact with the water. The patient
is excited, pale, complains of pain, numbness of hands and feet, cold shiver.
Respiratory rate is 22/min, AP - 120/90 mm Hg, Ps - 110/min, rectal
temperature is 34,5°C. What kind of warming is indicated for this patient?
A. Passive warming
B. Hot compresses
C. Hemodialysis with blood warming
D. Warm bath
E. Infusion of 37°C solutions
256. A 19-year-old male patient complains of intense pain in the left knee
joint. Objectively: the left knee joint is enlarged, the overlying skin is
hyperemic, the joint is painful on palpation. Blood test results: RBC -
3,8×1012/l, Hb - 122 g/l, lymphocytes - 7,4×109/l, platelets – 183×109/l. ESR
- 10 mm/h. Duke bleeding time is 4 minutes, Lee-White clotting time - 24
minutes. A-PTT is 89 s. Rheumatoid factor is negative. What is the most likely
diagnosis?
A. Hemophilia, hemarthrosis
B. Hemorrhagic vasculitis, articular form
C. Rheumatoid arthritis
D. Werlhofs disease
E. Thrombocytopathy
257. Explosion of a tank with benzene at a chemical plant has killed and
wounded a large number of people. There are over 50 victims with burns,
mechanical injuries and intoxication. Specify the main elements of medical
care and evacuation of population in this situation:
A. Sorting, medical assistance, evacuation
B. Isolation, rescue activity, recovery
C. Sorting, recovery, rescue activity
D. Sorting, evacuation, treatment
E. Medical assistance, evacuation, isolation
260. A 57-year-old male patient had an attack of retrosternal pain that lasted
more than 1,5 hours. Objectively: the patient is inert, adynamic, has pale skin,
cold extremities, poor volume pulse, heart rate - 120/min, AP - 70/40 mm Hg.
ECG shows ST elevation in II, III, aVF leads. What condition are these
changes typical for?
A. Cardiogenic shock
B. Acute pericarditis
C. Acute pancreatitis
D. Arrhythmogenic shock
E. Perforated gastric ulcer
263. A 45-year-old male patient complains of acute pain in his right side
irradiating to the right thigh and crotch. The patient claims also to have
frequent urination with urine which resembles a meat slops. The patient has
no previous history of this condition. There is costovertebral angle tenderness
on the right (positive Pasternatskys symptom). What is the most likely
diagnosis?
A. Urolithiasis
B. Acute appendicitis
C. Acute cholecystitis.
D. Acute pancreatitis
E. Acute pyelonephritis
264. A 38-year-old male works within the range of ionizing radiation. At a
routine medical examination he presents no problems. In blood: RBCs -
4,5×1012/l, Hb- 80 g/l, WBCs - 2,8×109/l, thrombocytes – 30×109/l. Decide
if this person can work with sources of ionizing radiation:
A. Working with radioactive substances and other sources of ionizing
radiation is contraindicated
B. The patient can only work with radioactive substances of low activity
C. The patient is allowed to work with radioactive substances for the limited
period of time
D. The patient can be allowed to work after an extended medical examination
E. The patient is allowed to work with radioactive substances