A. Atony of the uterus B.C.D.E. 5. ﬁrst day after labour a ...mmf.dsmu.edu.ua/attachments/article/22/E92t07_2008E.pdf · fever, arthritis, colicky abdominal pain and a purpuric

Krok 2 Medicine 2008 1

1. An 8 year old child has low-gradefever, arthritis, colicky abdominal painand a purpuric rash llocalized on the lowerextremities. laboratory studies reveal aguaiac-positive stool, urinalysis with redblood cell (RBC) casts and mild protei-nuria, and a normal platelet count. Themost likely diagnosis is:

A. Henoch-Schonlein’s vasculitisB. Systemic lupus erythematosus (SLE)C. Rocky Mountain spotted feverD. Idiopathic thrombocytopenic purpuraE. Poststreptococcal glomerulonephritis

2. A woman complains of having slightdark bloody discharges and mild pains inthe lower part of abdomen for severaldays. Last menses were 7 weeks ago.The pregnancy test is positive. Bimanualinvestigation: the body of the uterus indi-cates for about 5-6 weeks of pregnancy,it is soft, painless. In the left appendagethere is a retort-like formation, 7 х 5 cmlarge, mobile, painless. What examinationis necessary for detection of fetus locali-zation?

A. UltrasoundB. HysteroscopyC. HromohydrotubationD. ColposcopyE. Cystoscopy

3. A pregnant woman in her 40th week ofpregnancy undergoes obstetric examinati-on: the cervix of uterus is undeveloped.The oxytocin test is negative. Examinati-on at 32 weeks revealed: AP 140/90 mmHg, proteinuria 1 g/l, peripheral edemata.Reflexes are normal. Choose the mostcorrect tactics:

A. Labour stimulation after preparationB. Absolute bed rest for 1 monthC. Complex therapy of gestosis for 2 daysD. Caesarian section immediatelyE. Complex therapy of gestosis for 7 days

4. A 26 year old woman had the secondlabour within the last 2 years withoxytocin application. The child’s wei-ght is 4080 gr. After the placent bi-rth there were massive bleeding, si-gns of hemorrhagic shock. Despite theintroduction of contractive agents, goodcontraction of the uterus and absenceof any cervical and vaginal disorders,the bleeding proceeds. Choose the mostprobable cause of bleeding:

A. Atony of the uterusB. Injury of cervix of the uterusC. HysterorrhexisD. Delay of the part of placentaE. Hypotonia of the uterus

5. On the first day after labour a womanhad the rise of temperature up to 39oC.Rupture of fetal membranes took place36 hours before labour. Examination ofthe bacterial flora of cervix of the uterusrevealed hemocatheretic streptococcus ofA group. The uterus body is soft, tender.Discharges are bloody, with admixtures ofpus. Specify the most probable postnatalcomplication:

A. MetroendometritisB. Thrombophlebitis of veins of the pelvisC. Infectious hematomaD. Infective contamination of the urinarysystemE. Apostasis of sutures after the episi-otomy

6. A woman of a high-risk group (chronicpyelonephritis in anamnesis) had vagi-nal delivery. The day after labour shecomplained of fever and loin pains,frequent urodynia. Specify the mostprobable complication:

A. Infectious contamination of the urinarysystemB. Thrombophlebitis of veins of the pelvisC. Infectious hematomaD. EndometritisE. Apostasis of sutures after episiotomy

7. A woman in her 39th week ofpregnancy, the second labour, has regularbirth activity. Uterine contractions takeplace every 3 minutes. What criteriadescribe the beginning of the II laborstage the most precisely?

A. Cervical dilatation by no less than 4 cmB. Cervical smoothing over 90%C. Duration of uterine contractions over30 secondsD. Presenting part is in the lower region ofsmall pelvisE. Rupture of fetal bladder

8. A 24 years old primipara was hospitali-sed with complaints about discharge ofthe amniotic waters. The uterus is tonicon palpation. The position of the fetus islongitudinal, it is pressed with the headto pelvic outlet. Palpitation of the fetusis rhythmical, 140 bpm, auscultated onthe left below the navel. Internal exami-nation: cervix of the uterus is 2,5 cm


long, dense, the external os is closed, lightamniotic waters out of it. Point a correctcomponent of the diagnosis:

A. Antenatal discharge of the amnioticwatersB. Early discharge of the amniotic watersC. The beginning of the 1st stage of labourD. The end of the 1st stage of labourE. Pathological preterm labour

9. A 29 year old patient underwentsurgical treatment because of the beni-gn serous epithelial tumour of an ovary.The postoperative period has elapsed wi-thout complications. What is it necessaryto prescribe for the rehabilitational peri-od:

A. Hormonotherapy and proteolyticenzymesB. Antibacterial therapy and adaptogensC. Lasertherapy and enzymotherapyD. Magnitotherapy and vitamin therapyE. The patient does not require furthercare

10. A patient was delivered to a surgicaldepartment after a road accident with aclosed trauma of chest and right-sided ribfracture. The patient was diagnosed wi-th right-sided pneumothorax, it is indi-cated to perform drainage of pleural cavi-ty. Pleural puncture should be made in:

A. In the 2nd intercostal space along themiddle clavicular lineB. In the 6th intercostal space along theposterior axillary lineC. In the 7th intercostal space along thescapular lineD. In the projection of pleural sinusE. In the point of the greatest dullness onpercussion

11. A primagravida with pregnancy of 37-38 weeks complains of headache, nausea,pain in epigastrium. Objective: the skin isacyanotic. Face is hydropic, there is shortfibrillar twitching of blepharons, musclesof the face and the inferior extremities.The look is fixed. AP- 200/110 mm Hg;sphygmus of 92 bpm, intense. Respirationrate is 32/min. Heart activity is rhythmi-cal. Appreciable edemata of the inferiorextremities are present. Urine is cloudy.What medication should be administered?

A. Droperidolum of 0,25% - 2,0 mlB. Dibazolum of 1% - 6,0 mlC. Papaverine hydrochloride of 2% - 4,0mlD. Hexenalum of 1% - 2,0 mlE. Pentaminum of 5% - 4,0 ml

12. A 40 year old woman has changes ofmammary gland. What are the most oftensymtomps that precede the malignizati-on?

A. Skin induration with inverted nippleB. Painful movable indurationC. Painless movable indurationD. Bloody discharges from the nippleE. Pure discharges from the nipple

13. A patient who takes diuretics hasdeveloped arrhythmia as a result ofcardiac glycoside overdose. What is thetreatment tactics in this case?

A. Increased potassium concentration inbloodB. Increased sodium consentration inbloodC. Reduced magnesium concentration inbloodD. Increased calcium concentration inbloodE. -

14. An onset of severe preeclampsia at 16weeks gestation might be caused by:

A. Hydatidiform moleB. AnencephalyC. Twin gestationD. Maternal renal diseaseE. Interventricular defect of the fetus

15. A 9 year old girl with a history ofintermittent wheezing for several yearsis brought to the pediatrician. The childhas been taking no medications for sometime. Physical examination reveals agitati-on and perioral cyanosis. Intercostal andsuprasternal retractions are present. Thebreath sounds are quiet, and wheezing isaudible bilaterally. The child is admittedto the hospital. Appropriate interventi-ons might include all of the followingEXCEPT:

A. Prescribe nebulized cromolyn sodiumB. Prescribe intravenous aminophyllineC. Administer supplemental oxygenD. Prescribe intravenous corticosteroidsE. Prescribe nebulized metaproterenol

16. Routine examination of an otherwisehealthy child with a history of bronchial


asthma reveals AP of 140/90 mm Hg. Themost likely cause of the hypertension is:

A. Renal diseaseB. Theophylline toxicityC. Chronic lung diseaseD. Coarctation of the aortaE. Obesity

17. The average body lenth of newbornboys is 50,9 cm at a sigma 1,66; andaverage mass - 3432 at a sigma 5,00. Whatcriterion is necessary to compare degreeof variability of these signs?

A. Coefficient of variationB. SigmaC. LimitD. AmplitudeE. Coefficient of association

18. What method is applied to establishrate of correlation between age of menand their mortality due to myocardialinfarction?

A. Method of grade correlation (Spirman)B. Correlation ratioC. The quadrate method (Pirson)D. The Indirect method (Student)E. Method of graduated correlation(Armler)

19. Adenosine triphosphate may beexpected to convert which of the followi-ng arrhythmias to sinus rhythm?

A. Paroxysmal supraventriculartachycardiaB. Paroxysmal ventricular tachycardiaC. Atrial fibrillationD. Atrial flutterE. Ventricular fibrillation

20. A 48 year old man complains of fati-que and shortness of breath. His Ht is32%, and Hb - 103 g/l. Peripheral bloodsmear reveals macrocytosis. Serum vi-tamin B12 level is 90 pg/ml (normal is170 to 940); serum folate level is 6 ng/ml(normal is 2 to 14). Possible causes toconsider include all of the followingEXCEPT:

A. Colonic diverticulitisB. VegetarianismC. Regional enteritisD. PancreatitisE. Fish tapeworm infection

21. A 56 year old man complains of fati-gue, dyspnea on exertion and palpitati-ons. He has had a murmur since chi-

ldhood. Examination reveals a lift at theleft sternal border, split S1, and fixed spli-tting of S2. There is a grade 3/6 midsystolicpulmonic murmur and a 1/6 middiastolictricuspid murmur at the lower left sternalborder. Chest x-ray shows right ventricularenlargement and prominent pulmonaryarteries. ECG demonstrates atrial fibri-llation with a right bundle branch block.The most likely diagnosis is:

A. Arterial septal defectB. Coarctation of the aortaC. Patent ductus arteriosusD. Tetralogy of FallotE. Ventricular septal defect

22. Generalized low voltage on an ECG(QRS deflection < 5 mm in limb leads and< 10 mm in precordial leads) may be amarker for all of the following disordersEXCEPT:

A. HyperthyroidismB. Pericardial effusionC. Cardiac transplant rejectionD. AmyloidosisE. Coronary artery disease

23. Five days after a total hip replacementa 72 year old woman becomes acutelyshort of breath, diaphoretic andhypotensive. Both lung fields are clear toauscultation and percussion, but exami-nation of the neck reveals mild jugularvenous distension with prominent Awaves. Heart sounds are normal. ECGshows sinus tachycardia with a new rightbundle branch block and minor nonspeci-fic ST − T wave changes. The most likelydiagnosis is:

A. Pulmonary thromboembolismB. Acute myocardial infarctionC. Aortic dissectionD. PericarditisE. Aspiration

24. A child is 6 years old. Within one yearof observation he had URI that lasted 8days. Physical state is satisfactory. Specifyhi health group:

A. IB. IIC. III (a)D. III (b)E. III (c)

25. Which of the following IS NOT TYPI-CAL for Addison’s disease?


A. High serum Na+

B. High serum K+

C. Elevated BUND. Dilute urineE. Elevated hematocrit

26. A 38 year old man, previously in goodhealth, suddenly develops severe abdomi-nal pain radiating from the left loin togroin and accompanied by nausea, perspi-ration and the need for frequent urinati-on. He is restless, tossing in bed but hasno abnormal findings. The most likely di-agnosis is:

A. Leftsided renal colicB. Herpes zosterC. Sigmoid diverticulitisD. Torsion of the left testicleE. Retroperitoneal haemorrhage

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

A. Excision biopsyB. MammographyC. ThermographyD. UltrasonographyE. Aspiration biopsy with cytology

28. A 38 year old man was admitted to ahospital from his working place on July19 because of hip fracture. He was invalidtill November 19. Requires prolongationof treatment. Who decides on the issue offurther temporary invalidity?

A. Specialized (traumatologic) MSECB. DCCC. The head physician of a polyclinicD. Interregional general MSECE. Regional MSEC

29. During investigation for chronic,severe, epigastric pain, a 40 year oldalcoholic man is found to have multipleareas of narrowing alternating with di-latation ("chain of lakes"appearance) ofthe main pancreatic duct. The operationof choice is:

A. Lateral pancreaticojejunostomyB. Distal pancreaticojejunostomyC. SphincterotomyD. Distal pancreatectomyE. Total pancreatectomy

30. The treatment of choice for duodenalobstruction caused by secondaryduodenal hematoma that developed a fewdays after blunt abdominal injury is:

A. Nasogastric decompression andparenteral alimentationB. Retrocolic gastrojejunostomyC. DuodenojejunostomyD. Immediate explorationE. Tube duodenostomy

31. A 25 year old man has a sudden onsetof chest pain on the right and dyspnea. Histrachea is deviated to the left. All of thefollowing would be anticipated EXCEPT:

A. Pleural friction rub on the leftB. Absence of rhonchiC. Absence of ralesD. Hyperresonance over the right chestE. Distant breath sounds on the right

32. A 5 tons milk batch was sampled.The lab analysis revealed: fat content 2%,specific density - 1,04 g/cm3, acidity - 210Т,reductase probe - weak-positive. Whatway is the product to be used in?

A. Sell but inform customers about milkqualityB. Discard for animal feedingC. Technical utilizationD. Sell without limitationsE. Do the product away

33. What guarantees against thepreconceived attitude to the physician incases of professional law violations do youknow?

A. Sanction of public prosecutor, inquiryby preliminary investigator of prosecutor’soffice, committee of expertsB. Draw up a statement about forensicmedical examinationC. Conduct an inquiry by preliminaryinvestigator of police departmentD. Utilisation copy of medical documentsE. Conduct forensic medical examinationby district forensic medicine expert

34. If a child has adherent fingers on hisright hand, then what will be your di-agnosis?

A. SyndactylyB. PolydactylyC. MacrodactylyD. EctrodactylyE. Ectromelia

35. A 16 year old patient with complai-nts of frequent pain in the abdomen wasdiagnosed with melanoma, examinationrevealed also pigmentation of the mucosaand skin, polyp in the stomach and largeintestine. It is know that the patient’s


mother has an analogous pigmentationand has been often treated for anemia.What disease is suspected?

A. Peytz-Egers’s polyposisB. Chron’s diseaseC. Tuberculosis of the intestineD. Adolescent polyposisE. Hirschprung’s disease

36. A 41 year old patient was admitted tothe intensive care unit with haemorrhagicshock due to gastric bleeding. He has a hi-story of hepatitis B during the last 5 years.The source of bleeding are esophageal vei-ns. What is the most effective method forcontrol of the bleeding?

A. Introduction of obturator nasogastrictubeB. Intravenous administration of pituitrinC. Hemostatic therapyD. OperationE. Administration of plasma

37. It is suspected that a 34 year old pati-ent has an abscess of Douglas pouches.What diagnostic method is to be chosen?

A. Digital examination of rectumB. RectoromanoscopyC. LaparoscopyD. Percussion and auscultation of stomachE. R-scopy of abdominal cavity

38. A 52 year old man has recurrent transi-ent ischemic attacks. Auscultation of thecarotid arteries detected murmur. Whatdiagnostic method is to be applied in thefirst place?

A. Ultrasound dopplerographyB. CT of the brainC. MRI of the brainD. Cerebral angiographyE. Electroencephalography

39. A 34 year old woman in the 10thweek of gestation (the second pregnancy)consulted a doctor of antenatal clinic inorder to be registered there. In the previ-ous pregnancy hydramnion was observed,the child’s birth weight was 4086 g. Whatexamination method should be applied inthe first place?

A. The test for tolerance to glucoseB. Determination of the contents offetoproteinumC. Bacteriological examination of di-scharges from vaginaD. A cardiophonography of fetusE. US of fetus

40. A patient with acute purulent oti-tis media complicated by mastoiditis wasadmitted to a hospital. Roentgenogram ofmastoid processes showed the shadiowi-ng of the cellular system on the lesion,absence of bone septa was present. Whatare the necessary therapeutic +actions atthe second stage of mastoiditis?

A. MastoidotomyB. Paracentesis of the drumC. Radical operation on the middle earD. TympanoplastyE. Cateterization of the Eustachian tube

41. A 22 year old patient was admitted totrauma center with complaints of pain inthe left ankle joint that was getting worseduring moving and weight bearing. On theclinical examination it was found that thepatient had the closed fracture of medialmalleolus without displacement. In whichposition should the foot be fixed in plastercast?

A. At right angle with varus positioning ofthe footB. In position of planter flexion of footC. In position of pronationD. In position of supinationE. In position of dorsal flexion of foot

42. A patient with acute respiratory viralinfection (3rd day of disease) complainsof pain in lumbar region, nausea, dysuria,oliguria. Urinalysis - hematuria (100-200RBC in eyeshot spot), specific gravity -1002. The blood creatinin level is 0,18 mi-llimole/l, potassium level - 6,4 millimole/l.Make the diagnosis:

A. Acute interstitial nephritisB. Acute renal failureC. Acute glomerylonephritisD. Acute cystitisE. Acute renal colic

43. A 3 month old infant sufferingfrom acute segmental pneumonia hasdyspnea (respiration rate - 80 per mi-nute), paradoxical breathing, tachycardia,total cyanosis. Respiration / pulse ratio is1:2. The heart dullness under normal size.Such signs characterise:


A. Respiratory failure of III degreeB. Respiratory failure of I degreeC. Respiratory failure of II degreeD. MyocarditisE. Congenital heart malformation

44. A 3 year old child has been sufferi-ng from fever, cough, coryza, conjuncti-vitis for 4 days. He has been takingsulfadimethoxine. Today it has fever upto 39oC and maculopapular rash on itsface. Except of rash the child’s skin has nochanges. What is your diagnosis?

A. MeaslesB. Allergic rashC. RubellaD. Scarlet feverE. Pseudotuberculosis

45. A 2 year old girl has been ill for3 days. Today she has low grade fever,severe catarrhal presentations, slightmaculopapular rash on her buttocks andenlarged occipital lymph nodes. What isyour diagnosis?

A. RubellaB. Scarlet feverC. MeaslesD. Adenoviral infectionE. Pseudotuberculosis

46. A 3 year old boy fell ill abruptly:fever up to 39oC, weakness, vomi-tng. Haemorrhagic rash of various sizeappeared on his lower limbs in 5 hours.Meningococcemia with infective - toxicshock of the 1 degree was diagnosed.What medications should be admini-stered?

A. Chloramphenicol succinate and predni-soneB. Penicillin and prednisoneC. Penicillin and immunoglobulinD. Chloramphenicol succinate andinterferonE. Ampicillin and immunoglobulin

47. A 7 year old girl has mild formof varicella. Headache, weakness, verti-go, tremor of her limbs, ataxia, thenmental confusion appeared on the 5thday of illness. Meningeal signs are negati-ve. Cerebrospinal fluid examination isnormal. How can you explain these signs?

A. EncephalitisB. MeningitisC. MeningoencephalitisD. MyelitisE. Neurotoxic syndrome

48. A 14 year old patient complains ofchest pain, temperature up to 38, 5oC,breathlessness. He had acute tonsillitis2 weeks ago. He is in grave condition.The skin is pale. Heart borders are di-lated, heart sounds are quiet. Above totalheart area you can hear pericardium fricti-on sound. Electrocardiogram: the descentof QRS voltage, the inversion T. The liveris enlarged by 3 cm. ESR - 4 mm/h, ASL- 0 - 1260, C-reactive protein +++. Yourdiagnosis:

A. Rheumatic pancarditisB. Rheumatic pericarditisC. Rheumatic myocarditisD. Rheumatic endocarditisE. Septic endocarditis

49. A woman born a child. It was her fithpregnancy but the first delivery. Mother’sblood group is A(II)Rh−, newborn’s -A(II)Rh+. The level of indirect bilirubinin umbilical blood was 58 micromole/l,hemoglobin - 140 g/l, RBC- 3, 8·1012/l. In 2hours the level of indirect bilirubin turned82 micromole/l. The hemolytic diseaseof newborn (icteric-anemic type, Rh-incompatibility) was diagnosed. Choosethe therapeutic tactics:

A. Replacement blood transfusion(conservative therapy)B. Conservative therapyC. Blood transfusion (conservativetherapy)D. Symptomatic therapyE. Antibiotics

50. A mother consulted a pediatricianabout her son. Her son was born withbody mass of 3 kg and length of 48 cm.He’s 1 year old now. What is the requirednormal mass?

A. 10,5 kgB. 9,0 kgC. 11,0 kgD. 12,0 kgE. 15,0 kg

51. A 2 month old healthy infant withgood appetite is given artificial feedingsince he turned 1 month old. When isit recommended to start the correctivefeeding (fruit juice)?


A. 4,0 monthsB. 1,5 monthsC. 2,0 monthsD. 3,0 monthsE. 1,0 months

52. A nine year old child is at a hospi-tal with acute glomerulonephritis. Cli-nical and laboratory examinations showacute condition. What nutrients must notbe limited during the acute period ofglomerulonephritis?

A. CarbohydratesB. SaltC. LiquidD. ProteinsE. Fats

53. Examination of a 3-month-old childrevealed scrotum growth on the right. Thisformation has elastic consistency, its sizedecreases during sleep and increases whenthe child is crying. What examination willbe helpful for making a correct diagnosis?

A. Palpation of the thickened cord crossingthe pubical tubercule (sign of the silkglove)B. DiaphanoscоpyC. Palpation of the external inguinal ringD. Puncture of the scrotumE. Examination of the formation inTrendelenburg’s position

54. A rounded well-defined shadow wasfound in the costo-vertebral angle onthe chest roentgenogram of an otherwisehealthy 9 year old girl. Make a prelimi-nary diagnosis:

A. GanglioneuromaB. SympatoblastomaC. GanglioneuroblastomaD. SympatogoniomaE. Sarcoma of the vertebra

55. A 52 year old patient with history offunctional Class II angina complains ofhaving intense and prolonged retrosternalpains, decreased exercise tolerance for5 days. Angina is less responsive to ni-troglycerine. What is the most probablediagnosis?

A. IHD. Unstable anginaB. Cardialgia due to spine problemC. IHD. Functional Class II anginaD. MyocarditisE. Myocardial dystrophy

56. A 52 year old patient has

hypervolaemic type of essentialhypertension. Which of the followingmedications is to be prescribed either asmonotherapy or in complex with otherantihypertensive drugs?

A. HypothiazidB. DibazolC. ClonidineD. KapotenE. Nifedipin

57. A 62 year old patient complains ofrest dyspnea, heart pains. 3 years agohe had myocardial infarction. Physicalexamination: orthopnea, acrocyanosis,swollen cervical veins. Ps - 92, total heartenlargement, the liver is enlarged by 7 cm,shin edema. What is the stage of chronicheart failure (CHF)?

A. CHF- 2 BB. CHF- 1C. CHF- 2 АD. CHF- 0E. CHF- 3

58. A patient, aged 49, complains of feverof 37, 5oC, heart pain, dyspnea. S1 isclapping; S2 is accentuated in the aorticarea; opening snap, presystolic murmurcan be auscultated. What is the most effi-cient examination for valvular disorderassessment?

A. Echocardiography+Doppler-EchocardiographyB. PhonocardiographyC. BallistocardiogramD. Chest X-rayE. ECG

59. A patient with nosocomial pneumoniapresents signs of collapse. Which ofthe following pneumonia complicationsis most likely to be accompanied bycollapse?

A. Septic shockB. Exudative pleuritisC. Bronchial obstructionD. Toxic hepatitisE. Emphysema

60. A patient, aged 48, complains of heavi-ness in the right hypochondrium, itchi-ng of the skin. Repeatedly he had beentreated in infectious diseases hospitalbecause of icterus and itch. Objectively:meteorism, ascitis, dilation of abdomi-nal wall veins, protruding navel, spleenenlargement. Diagnosis is:


A. Liver cirrhosisB. Cancer of the liverC. Cancer of the head of pancreasD. GallstonesE. Viral hepatitis B

61. A 27 year old man complains of pai-ns in epigastrium which are relieved byfood intake. EGDFS shows antral erosivegastritis, biopsy of antral mucous presentsHеlicobacter Pylori. Diagnosis is:

A. Gastritis of type BB. Gastritis of type AC. Reflux-gastritisD. Menetrier’s gastritisE. Rigid antral gastritis

62. A 62 year old patient suffers fromDM-2. Diabetes is being compensated bydiet and Maninilum. The patient has toundergo an operation on inguinal hernia.What tactics of hypoglycemic therapyshould be chosen?

A. Prescribe fast-acting insulinB. Give Glurenorm instead of ManinilumC. Continue with the current therapyD. Prescribe long-acting insulinE. Prescribe guanyl guanidines

63. Prophylactic photoroentgenographyexamination of a 25 year old man revealedfocal shadowings of small and mediumintensity with irregular contours in the 1stand 2nd segments of the right lung. Whichclinical form can be suspected?

A. FocalB. DisseminatedC. MiliaryD. Fibro-cavernousE. Tuberculoma

64. A triad of symptoms ("stearing spot","terminal film", "blood dew") has beenrevealed on examination of a patient.What disease should you think about?

A. PsoriasisB. Lichen ruber planusC. VasculitisD. SeborrheaE. Ritter’s disease

65. A female 28 years old patient becamedepressed, her mood is melancholic;this state is accompanied by hypobulia,hypokinesia, slow speed of thinking. Herattitude towards her past, present andfuture is pessimistic. The pathogeneticmechanism of this state is supposed toinvolve dysfunction in the:

A. HypothalamusB. Frontal lobesC. PituitaryD. HippocampusE. Corpus callosum

66. The observed patient’s movementsare retarded, she answers no questions.Sometimes she spontaneously stays instrange postures. It is possible to set herbody and limbs into different positionsartificially. If the psychiatrist lifts her armor leg, so that she remains standing on theother leg, the patient can stay in such aposition for quite a long time. Name theprobable disorder:

A. Catatonic stupor, schizophreniaB. Depressive stupor, bipolar disorderC. Apathetic stupor, schizophreniaD. Psychogenic stupor, stress disorderE. Dissociative stupor, dissociativepsychosis

67. A 50 year old patient has beenadmitted to the clinics with atrophicgastritis. Blood count: erythrocytes -3, 8 · 1012/l, Hb - 68 g/l, c.i. - 1,macroanisocytosis, poikilocytosis. Thereis megaloblastic type of haemopoesis.A number of leukocytes, reticulocytesand thrombocytes is lreduced. Whichpathology is suspected?

A. B12-deficiency anemiaB. Irondeficiency anemiaC. Hemolytic anemiaD. Post-hemorrhagic anemiaE. Thalassaemia

68. A 28 year old patient was admi-tted to the clinic with complaints of thetemperature rise up to 39, 0oC, headache,weakness, constipation on the 9th dayof the disease. On examination: singleroseolas on the skin of the abdomen arepresent. The pulse rate is 78 bpm. The li-ver is enlarged by 2 cm. What is the mostprobable diagnosis?

A. Typhoid feverB. LeptospirosisC. BrucellosisD. SepsisE. Malaria

69. A patient has been in a hospital. Thebeginning of the disease was gradual:nausea, vomiting, dark urine, аcholicstools, yellowness of the skin and scleras.The liver is protruded by 3 cm. Jaundiceprogressed on the 14th day of the disease.


The liver diminished in size. What compli-cation of viral hepatitis caused deteriorati-on of the patient’s condition?

A. Hepatic encephlopathyB. MeningitisC. Relapse of viral hepatitisD. CholangitisE. Infectious-toxic shock

70. An 18 year old patient was admittedto a hospital with complaints of headache,weakness, high temperature, sore throat.Objectively: enlargement of all groups oflymph nodes was revealed. The liver isenlarged by 3 cm, spleen - by 1 cm. Inblood: leukocytosis, atypical lymphocytes- 15%. What is the most probable di-agnosis?

A. Infectious mononucleosisB. Acute lymphoid leukosisC. DiphtheriaD. AnginaE. Adenoviral infection

71. A 75 year old man who has beensuffering from diabetes for the last sixmonths was found to be jaundiced. Hewas asymptomatic except for weight lossat the rate of 10 pounds in 6 months.Physical examination revealed a hard,globular, right upper quadrant mass thatmoves during respiration. A CT scanshows enlargement of the head of thepancreas, with no filling defects in the li-ver. The most likely diagnosis is:

A. Carcinoma of the head of the pancreasB. Infectious hepatitisC. Haemolytic jaundiceD. Malignant biliary strictureE. Metastatic disease of liver

72. A 33 year old male patient wasbrought to Emergency Department wi-th the signs of cardiovascular collapse: BP- 60/30 mm Hg, Ps - 140 bpm, the skin ispale and moist, diuresis 20 ml/h, Hb - 80g/l, red blood cell count - 2, 5 · 1012/l. Thereduction of blood volume averages:

A. 30-40%B. 10-15%C. 15-20%D. 20-25%E. 25-30%

73. A 19 year old girl was admitted toemergency department: unconsciousness,cyanosis, myotic pupils are present,superficial breathing is 12/min. BP is 90/60mm Hg, Ps- 78/min. Choose the action

necessary in this clinical situation:

A. Controlled respirationB. Gastric lavageC. Oxygen inhalationD. Caffeine injectionE. Cordiamine injection

74. A pregnant woman may be diagnosedwith hepatitis if it is confirmed by thepresence of elevated:

A. SGOT (ALT)B. Sedimentation ratesC. WBCsD. Alkaline phosphataseE. BUN

75. An endometrial adenocarcinoma thathas extended to the uterine serosa wouldbe classified as stage:

A. IIIAB. ICC. IIAD. IIBE. IV AB

76. A 56 year old woman has an acuteonset of fever up to 39oC with chills,cough, and pain on respiration in the rightside of her chest. On physical examinati-on: HR - 90/min, BP- 95/60 mm Hg, RR-26/min. There is dullness over the rightlung on percussion. On X-ray: infiltrate inthe right middle lobe of the lung. What isthe diagnosis?

A. Community-acquired lobar pneumoniaof moderate severityB. Community-acquiredbronchopneumoniaC. Acute pleuritisD. Acute lung abscessE. Nosocomial lobar pneumonia

77. A 26 year old man was admitted tothe hospital because of stabbing back painon inspiration and dyspnea. Examinationresults: BT of 37oC, Ps of 24/min, HR of92/min, vesicular breath sounds. There isa dry, grating, low-pitched sound heard onboth expiration and inspiration in the leftinferior lateral part of the chest. What isthe most likely diagnosis?

A. Acute fibrinous pleuritisB. MyocarditisC. PneumoniaD. Acute bronchitisE. Pneumothorax

78. A 34 year old woman fell ill 3 months


ago after cold exposure. She complai-ned of pain in her hand and knee joints,morning stiffness and fever up to 38oC.Interphalangeal, metacarpophalangealand knee joints are swollen, hot, withreduced ranges of motions; ESR of 45mm/h, CRP (+++), Vaaler-Rouse test of1:128. What group of medicines would yourecommend the patient?

A. Nonsteroidal anti-inflammatory drugsB. CephalosporinesC. TetracyclinesD. SulfonamidesE. Fluorchinolones

79. A 50 year old woman complained ofattacks of right subcostal pain after fattymeal she has been suffering from for ayear. Last week the attacks repeated everyday and became more painful. What di-agnostic study would you recommend?

A. Ultrasound examination of thegallbladderB. Liver function testsC. X-ray examination of the gastrointesti-nal tractD. Ultrasound study of the pancreasE. Blood cell count

80. A 25 year old woman complainedof edema on her face and legs, riseof blood pressure up to 160/100 mmHg and weakness. She fell ill 3 weeksafter recovering from angina. Urinalysisdata: protein of 0,5 g/l, erythrocytesof 17-20/field, leukocytes of 2-3/field,erythrocyte casts. What treatment shouldbe initiated after specifying the diagnosis?

A. Penicillin OSB. HeparinC. CeftriaxoneD. DipyridamoleE. Ciprofloxacine

81. A fitter of a metallurgic factorywith occupational exposure to highconcentrations of mercury fumes for 16years presents instability of pulse andblood pressure, general hyperhydrosis,asymmetric innervations of facial musclesand tongue, positive subcortical reflexes,hand tremor on physical examination. Adentist revealed paradontosis and chronicstomatitis. What is the most probable di-agnosis?

A. Chronic mercury intoxicationB. NeuroinfectionC. Parkinson syndromeD. Acute mercury intoxicationE. Mercury encephalopathy

82. A 6 week old child is admitted becauseof tachypnea. Birth had been uneventful,although conjunctivitis developed on thethird day of life and lasted for about2 weeks. Physical examination revealstachypnea, bilateral inspiratory cracklesand single expiratory wheezing. Bilateralpneumonia is evident on chest X-ray. Thechild is afebrile and has no history of fever.White blood cell count is 15 · 109/l, with28% of eosinophils. The most likely causeof this child’s symptoms is:

A. Clamydia trachomanisB. Pneumocystis cariniiC. Mycoplasma pneumoniaeD. Visceral larva migransE. Varicella

83. A 42 year old woman complai-ns of dyspnea, edema of the legs andtachycardia during minor physical exerti-on. Heart borders are displaced to the leftand S1 is accentuated, there is diastolicmurmur on apex. The liver is enlarged by5 cm. What is the cause of heart failure?

A. Mitral stenosisB. Mitral regurgitationC. Tricuspid stenosisD. Tricuspid regurgitationE. Aortic stenosis

84. A 60 year old man complains offever, significant weight loss, bone andjoint pain, bleeding gums. Examinati-on revealed paleness, lymphadenopathy,hepato- and splenomegaly. CBC: WBC- 270 · 109/l with 13% lymphocytes,1% monocytes, 21% basophiles,29% neutrophils, 9% blasts, 12%promyelocytes, 12% myelocytes, 2%metamyelocytes, 1% eosinophils. ESR -22 mm/h. Name the drug for treatment:

A. MyelosanB. PrednisoloneC. CytosarD. VinblastineE. Blood transfusion

85. A 54 year old woman complainsof increasing fatigue and easy bruisingof 3 weeks’ duration. Physical findingsincluded pale, scattered ecchymoses andpetechiae and mild hepatosplenomegaly.Blood count: RBC- 2, 5 · 1012/l; Hb - 73


g/l; Ht - 20%; PLT- 23 · 109/l; and WBC-162 · 109/l with 82% blasts, that containedAuric rods; peroxidase stain was positive.What is the most probable diagnosis?

A. Acute leukemiaB. Chronic leukemiaC. ThrombocytopeniaD. Hemolytic anemiaE. Megaloblastic anemia

86. The highest risk of congenital anomali-es probably occurs when human embryosor fetuses are exposed to ionizing radiati-on. At what stage of gestational perioddoes it occur?

A. 18-45 days after conceptionB. The first 7 daysC. 10-14 days after conceptionD. 90-120 days after conceptionE. The third trimester

87. A 28 year old woman was admi-tted to the emergency room with a sli-ghtly reddened, painful "knot"8 cm abovethe medial malleolus. Examination inthe standing position demonstrates a di-stended vein above and below the mass.There are no other abnormalities onphysical examination. The most likely di-agnosis is:

A. Superficial venous thrombosisB. Early deep vein thrombosisC. Insect biteD. CellulitisE. Subcutaneous hematoma

88. A 25 year old patient complains ofpain in the I finger on his right hand. Onexamination: the finger is homogeneouslyhydropic, in bent position. On attemptto unbend the finger the pain is getti-ng worse. Acute pain appears duringthe probe in ligament projection. Whatdecease is the most likely?

A. Thecal whitlow (ligament panaritium)B. Subcutaneous panaritiumC. Articular (joint) panaritiumD. Bone panaritiumE. Paronychia

89. A 30 year old man complains of acutepain in his right ear, hearing loss, hi-gh temperature for three days. Objecti-vely: right ear whispering language - 0,5mm, external ear is intact, otoscopically- eardrum protrusion, hyperemia andswelling, loss of landmarks. What diseaseis it?

A. Acute purulent otitis mediaB. Acute mastoiditisC. Chronic secretory otitis mediaD. Chronic purulent otitis mediaE. Eustachian tube disfunction

90. Among the following causes of acuterenal failure, the one that would be classi-fied as "postrenal"is:

A. CalculiB. Cardiac failureC. SepticemiaD. RhabdomyolysisE. Acute glomerulonephritis

91. A patient complains about strongdyspnea that is getting worse duringphysical activity. Presentations appearedsuddenly 2 hours ago at work: acute chestpain on the left, cough. The pain wasabating, but dyspnea, dizziness, pallor,cold sweat and cyanosis were progressi-ng. Vesicular respiration is absent, X-raypicture shows a shadow on the left. Whatpathology might be suspected?

A. Spontaneous left-sided pneumothoraxB. Pulmonary infarctionC. PleuritisD. Left-sided pneumoniaE. Pulmonary abscess

92. During an operation for presumedappendicitis the appendix was found tobe normal; however, the terminal ileumis evidently thickened and feels rubbery,its serosa is covered with grayish-whiteexudate, and several loops of apparentlynormal small intestine are adherent to it.The most likely diagnosis is:

A. Crohn’s disease of the terminal ileumB. Perforated Meckel’s diverticulumC. Ulcerative colitisD. Ileocecal tuberculosisE. Acute ileitis

93. A 50 year old woman with a 2-yearhistory of mild, diffuse, tender thyroidenlargement complains of 10 pound wei-ght gain and fatigue. What is the mostprobable diagnosis?

A. Hashimoto’s thyroiditisB. Riedel’s thyroiditisC. Subacute thyroiditisD. Suppurative thyroiditisE. Papillary thyroid carcinoma

94. A severely traumatized patient whohas been receiving prolonged parenteralalimentation develops diarrhea, mental


depression, alopecia and perioral andperiorbital dermatitis. Administration ofwhich of the following trace elements ismost likely to reverse these complicati-ons?

A. ZincB. IodineC. SeleniumD. SiliconE. Copper

95. A patient has got pain in the axillaryarea, rise of temperature developed 10hours ago. On examination: shaky gait isevident, the tongue is coated with whitedeposit. The pulse is frequent. The painfullymphatic nodes are revealed in the axi-llary area. The skin over the lymph nodesis erythematous and glistering. What is themost probable diagnosis?

A. Bubonic plagueB. Acute purulent lymphadenitisC. LymphogranulomatosisD. AnthraxE. Tularemia

96. A 56 year old patient has worked atthe aluminium plant over 20 years. Wi-thin 3 last years he has been experiencingloosening of teeth, bone and joint pains,piercing pains in heart region, vomiting.The provisional diagnosis is:

A. Fluorine intoxicationB. Mercury intoxicationC. Lead intoxicationD. Phosphorus intoxicationE. Manganese intoxication

97. An excited patient constantly triesto look into the next room because heis sure of his friends’ presence. He clai-ms to hear his friends and other peopletalking although no-one is there. He tri-es to persuade his doctor that people inthe next room are disputing about "hispunishment", repeats aloud phrases hehas allegedly heard from the next room.What state is it?

A. Acute hallucinosisB. Verbal illusionsC. DelusionD. ConfabulationsE. Obsessional ideas

98. Survey radiograph of chest of a 62year old smoker who often suffers from"pneumonias"showed a triangle shadowin the right lung, its vertex is pointingtowards the lung root. It also showed devi-

ation of heart and mediastinum shadowstowards the lesion. What is the mostprobable diagnosis?

A. Cenral cancer of lungB. Lung abscessC. Lung cystD. Peripheral cancer of lungE. Atelectasis

99. A 68 year old patient has been sufferi-ng from chronic pancreatitis for 35 years.During the last 5 years he has beenobserving abatement of pain syndrome,abdominal swelling, frequent defecationsup to 3-4 times a day (feces are greyi-sh, glossy, with admixtures of undigestedfood), progressing weight loss. Change ofsymptom set is caused by joining of:

A. Exocrine pancreatic insufficiencyB. Endocrine pancreatic insufficiencyC. Syndrome of lactase deficiencyD. Irritable bowels syndromeE. Chronic enterocolitis

100. A 60 year old patient has beensuffering from arterial hypertension for15 years. After recurrent stroke shestarted complaining about amotivati-onal bad mood, problems with attenti-on concentration; she forgets to closethe entrance door, cannot recall eventsof the last day. Computer tomographyshows areas of postinfarction changes inthe cortical postfrontal regions. What isthe most probable diagnosis?

A. Vascular dementiaB. Alzheimer’s diseaseC. Huntington’s choreaD. Pick’s diseaseE. Dissociative amnesia

101. A 40 year old patient complainsof yellowish discharges from the vagi-na. Bimanual examination revealed nopathological changes. The smear containsTrichomonas vaginalis and blended flora.Colposcopy revealed two hazy fields onthe frontal labium, with a negative Iodinetest. Your tactics:

A. Treatment of specific colpitis andsubsequent biopsyB. Diathermocoagulation of the cervix ofthe uterusC. Specific treatment of TrichomonascolpitisD. Cervix ectomyE. Cryolysis of cervix of the uterus

102. A patient complained about


problems with pain and tactile sensitivi-ty, pain in the nail bones at the end ofthe working day. He works at a plant withmechanical devices. What pathology canbe suspected?

A. Vibration diseaseB. Caisson diseaseC. Noise diseaseD. Overwork symptomsE. Hypovitaminosis of B1

103. A 25 year old patient complainsabout weakness, dizziness, appearance ofhaemorrhagic skin rash. She has beensuffering from this for a month. Bloodcount: erythrocytes: 1, 0 · 1012/l, Hb- 37 g/l,colour index - 0,9, leukocytes - 1, 2 · 109/l,thrombocytes - 42 · 109/l. What diagnosticmethod will be the most effective?

A. Sternal punctureB. Spleen biopsyC. Liver biopsyD. CoagulogramE. Abdominal ultrasound

104. A 28 year old woman had the secondlabour and born a girl with manifestati-ons of anemia and progressing jaundice.The child’s weight was 3 400 g, the lengthwas 52 cm. The woman’s blood group isB (III) Rh−, the father’s blood group isA (III) Rh+, the child’s blood group is B(III) Rh+. What is the cause of anemia?

A. Rhesus incompatibilityB. Antigen A incompatibilityC. Antigen B incompatibilityD. Antigen AB incompatibilityE. Intrauterine infection

105. A 25 year old patient was admitted onthe 1st day of the disease with complai-nts of double vision in the eyes, heavybreathing. The day before the patientate home-made mushrooms. On objectiveexamination: paleness, mydriatic pupils,difficult diglutition, bradycardia, consti-pation. What is the diagnosis?

A. BotulismB. YersiniosisC. LeptospirosisD. Salmonellosis, gastrointestinal formE. Lambliasis

106. Maximum permissible concentrationof carbon dioxide in the air is consideredto be a sanitary index of air purity in aclassroom. What concentration of carbondioxide in the air is accepted as maximum

permissible?

A. 0,1%B. 0,05%C. 0,15%D. 0,2%E. 0,3%

107. Study of actual diet of an adultrevealed the following: proteins makeup 16% of energy value of daily rati-on, fats - 25%, carbohydrates - 59%.Evaluate compliance of protein, fat andcarbohydrate share in the energy value ofdaily ration with the recommended sharesof these nutrients?

A. Carbohydrate share is insufficient, thereis excess of proteinsB. Fat share is insufficientC. Carbohydrate share is insufficicentD. Carbohydrate share is excessiveE. Nutrient content complies with therecommended shares of energy value

108. A healthy 75 year old woman wholeads a moderately active way of lifewent through a preventive examinati-on that revealed serum concentrationof common cholesterol at the rate of5,1 millimol/l and HDL (high-density li-poproteins) cholesterol at the rate of70 mg/dl. ECG reveals no pathology.What dietary recommendation is the mostadequate?

A. Any dietary changes are necessaryB. Decrease of cholesterol consumptionC. Decrease of saturated fats consumptionD. Decrease of carbohydrates consumpti-onE. Increase of cellulose consumption

109. Periodical survey of a workerof a chemicals plant revealed a mali-gnant neoplasm on the urinary bladder.This occupational disease was the mostprobably caused by contact with thefollowing industrial poison:

A. BenzidineB. Vinyl chlorideC. Nickel carbonylD. AsbestosE. Arsenic

110. A 52 year old patient was admi-tted to a hospital because of hi-gh hemorrhagic diathesis of mucousmembranes, massive skin haemorrhagesin form of ecchymoses and spots, nasaland stomachal haemorrhages. After clini-cal examinations her illness was diagnosed


as thrombocytopenic purpura. What is themost probable cause of this disease?

A. Generation of antithrombocytic anti-bodiesB. Disturbed hemostasisC. Deficit of the VIII factor of bloodcoagulationD. Inherited insufficiency of plasm factorsof blood coagulationE. Iron deficit in blood serum, bonemarrow and depot

111. A child with tetralogy of Fallot ismost likely to exhibit:

A. Increased pressure in the right ventricleB. Increased pulmonary blood flowC. Increased pulse pressureD. Normal pressure gradient across thepulmonary valveE. Normal oxygen tension (PaO2) in theleft ventricle

112. In treatment and prevention establi-shments, regardless of their organisationaland proprietary form, the rights of pati-ents should be observed. Which of theserights is the most significant?

A. The right to the protection of thepatient’s interestsB. The right to the free choiceC. The right to the informationD. The right to be heardE. The right to the protection fromincompetence

113. A military unit stopped for 3-day’srest in an inhabited locality after along march. The sanitary-epidemiologicalreconnaissance found several watersources. It is necessary to choose thesource complying with the hygienicstandards for drinking water in the fieldconditions:

A. Artesian well waterB. Spring waterC. River waterD. Rain waterE. Melt snow water

114. A man in grave condition was deli-vered to the admission ward of a hospi-tal on the 2nd day of illness. Examinati-on revealed body temperature of 36, 1oC,sharpened features of face, dry skin thatmakes a fold, aphonia, convulsive twitchi-ng of some muscle groups. Acrocyanosisis present. Heart sounds are muffled, Ps is102 bpm, AP is 50/20 mm Hg. Abdomen issoft, drawn-in, painless. Anuria is presnt.

Stool is liquid in form of rice water. Whatis the most probable diagnosis?

A. CholeraB. Acute dysenteryC. SalmonellosisD. EscherichiosisE. Intestinal amebiasis

115. At year-end hospital administrationhas obtained the following data: annualnumber of treated patients and averageannual number of beds used for patients’treatment. What index of hospital workcan be calculated on the base of this data?

A. Bed turnoverB. Bed resources of the hospitalC. Average annual bed occupancyD. Average duration of patients’ presencein the hospitalE. Average bed idle time

116. A 3 year old child with weight deffici-ency suffers from permanent moist cough.In history there are some pneumoniaswith obstruction. On examination: di-stended chest, dullness on percussion overthe lower parts of lungs. On auscultation:a great number of different rales. Level ofsweat chloride is 80 millimol/l. What is themost probable diagnosis?

A. Mucoviscidosis (cystic fibrosis)B. Bronchial asthmaC. Recurrent bronchitisD. BronchiectasisE. Pulmonary hypoplasia

117. A 14 year old girl complains ofprofuse bloody discharges from genitaltracts during 10 days after suppresion ofmenses for 1,5 month. Similiar bleedingsrecur since 12 years on the backgroundof disordered menstrual cycle. On rectalexamination: no pathology of the internalgenitalia. In blood: Нb - 70 g/l, RBC-2, 3 · 1012/l, Ht - 20. What is the mostprobable diagnosis?

A. Juvenile bleeding, posthemorrhagicanemiaB. Werlholf’s diseaseC. Polycyst ovarian syndromeD. Hormonoproductive ovary tumorE. Incomplete spontaneous abortion

118. A 43 year old patient hadcholecystectomy 6 years ago because ofchronic calculous cholecystitis. Lately hehas been suffering from pain in the ri-ght subcostal area and recurrent jaundi-ce. Jaundice hasn’t gone for the last 2


weeks. Stenosing papillitis 0,5 cm long hasbeen revealed. What is the best way oftreatment?

A. To perform endocsopic papillosphi-ncterotomyB. To treat conservatively: antibiotics,spasmolytics, antiinflammatory drugsC. To perform external choledoch drainageD. To perform transduodenal papillosphi-ncterotomyE. To perform choledochoduodenostomy

119. A full-term infant is 3 days old.On the different parts of skin there areerythemas, erosive spots, cracks, areas ofepidermis peeling. The infant has scaldedskin syndrome. Nikolsky’s symptom ispositive. General condition of the infantis grave. Anxiety, hyperesthesia, febriletemperature are evident. What is the mostprobable diagnosis?

A. Exfoliative dermatitisB. Phlegmon of newbornC. Finger’s pseudofurunculosisD. Impetigo neonatorumE. Mycotic erythema

120. An outpatient hospital made recordof 11600 diseases within one year. Amongthem influenza and ARD make up 5800,circulatory system diseases - 3480, digesti-on diseases - 1300, other diseases - 1020.What relative index can be calculatedaccording this data?

A. ExtensiveB. IntensiveC. VisualizationD. CorrelationE. -

121. A 35 year old woman consulteda doctor about affection of arm skinand lower third of forearm in form of alarge edema, hyperemia, vesiculation andmaceration. The disease developed afterusing a laundry detergent "Lotos". Thepatient has been using it for a month. Shehasn’t suffered from dermatological di-seases before. What is the most probablediagnosis?

A. Allergic dermatitisB. Dermatitis simplexC. Toxicoallergic dermatitisD. Microbial eczemaE. Localized neurodermatitis

122. A 32 year old patient complainsabout heartburn and dull pain in theepigastrium that appear 2-3 hours after

meal. Exacerbations happen in springand in autumn. The patient has foodintolerance of eggs and fish. Objecti-vely: stomach palpation reveals pai-nfulness in the gastroduodenal area.Electrophasoduodenoscopy revealed a5 mm ulcer on the anterior wall ofduodenum. Urease test is positive. Whatis the most probable leading mechanismof disease development?

A. Chelicobacterial infectionB. Dietary allergyC. Autoantibody productionD. Reduced prostaglandin synthesisE. Disorder of gastric motor activity

123. A 48 year old woman complainsabout weakness, weight loss, appetiteloss, headache. The patient had acuteglomerulonephritis when she was young.She has been suffering from arterialhypertension since she was 25. She didn’tundergo systematic treatment, consulteda doctor rarely. Examination revealed si-gns of chronic renal insufficiency of the Istage (creatinine - 0,43 millimole/l). Whatdietary recommendations are the mostreasonable?

A. Restriction of protein consumptionB. Restriction of fat consumptionC. Restriction of carbohydrate consumpti-onD. Diet with high content of "alkali-ne"dishesE. Consumption of higher amounts ofliquid

124. A 50 year old woman complainsabout dull cardiac pain, asphyxia, bodytemperature rise up to 38oC. She hadinfluenza a week ago. Objectively: Ps -100 bpm, dropped-beat pulse during inspi-ration. AP - 100/70 mm Hg, heart soundsare muffled. ECG: reduced voltage, STsegment is above the isoline in all leads.X-ray picture shows extensively enlargedcardiac silhouette. Palmus is of smallamplitude. What is the most probable di-agnosis?

A. Exudative pericarditisB. Myocardium infarctionC. Dilatation cardiomyopathyD. MyocarditisE. Stenocardia

125. Examination of a 4 month old childrevealed some lemon-yellow squamae wi-th fatty crusts on the scalp. What is themost probable diagnosis?


A. GneissB. Milk crustC. StrophulusD. PseudofurunculosisE. Infantile eczema

126. A 39 year old patient complai-ned about morning headache, appeti-te loss, nausea, morning vomiting, peri-odic nasal haemorrhages. The patient hadacute glomerulonephritis at the age of15. Examination revealed rise of arteri-al pressure up to 220/130 mm Hg, skinhaemorrhages on his arms and legs, pallorof skin and mucous membranes. Whatchemestry test has the greatest diagnosticimportance in this case?

A. Blood creatinineB. Blood bilirubinC. Blood sodiumD. Uric acidE. Fibrinogen

127. A 14 year old child suffers fromvegetovascular dystonia of pubertal peri-od. He has got sympathoadrenal atack.What medicine should be used for attackreduction?

A. ObsidanB. No-shpaC. AmysylD. AminophyllineE. Corglicone

128. A 23 year old man complainsabout face edemata, headache, dizzi-ness, reduced urination, change of urinecolour (dark-red). These presentationsappeared after pharyngitis. Objectively:face edemata, pale skin, temperature -37, 4oC; heart rate - 86/min, AP - 170/110mm Hg. Heart sounds are muffled, the IIsound is accentuated above aorta. Whatetiological factor is probable in this case?

A. β-hemolytic streptococcusB. Staphylococcus aureusC. Alpha-hemolytic streptococcusD. Pyogenic streptococcusE. Saprophytic staphylococcus

129. A 12 year old girl complains aboutabrupt weakness, nausea, dizziness, visi-on impairment. The day before she atehome-made stockfish, beef. Examinationrevealed skin pallor, a scratch on the leftknee, dryness of mucous membranes oforal pharynx, bilateral ptosis, mydriaticpupils. The girl is unable to read a simpletext (mist over the eyes). What therapy

would be the most adequate in this case?

A. Parenteral introduction of polyvalentantibotulinic serumB. Parenteral disintoxicationC. Parenteral introduction of antibioticsD. Gastric lavageE. Parenteral introduction of antitetanusserum

130. A 19 year old patient was admi-tted to a hospital with acute destructiveappendicitis. He suffers from hemophiliaof B type. What antihemophilic medicati-ons should be included in pre- and post-operative treatment plan?

A. Fresh frozen plasmaB. CryoprecipitateC. Fresh frozen bloodD. Native plasmaE. Dried plasma

131. An 18 year old woman consulted agynecologist about the pain in the lowerpart of abdomen, fever up to 37, 5oC,considerable mucopurulent dischargesfrom the genital tracts, painful urinati-on. Vaginal and speculum examinationresults: the urethra is infiltrated, cervixof the uterus is hyperemic, erosive. Theuterus is painful, ovaries are painful, thi-ckened; fornixes are free. Bacterioscopytest revealed diplococcus. What diagnosisis the most probable?

A. Recent acute ascending gonorrheaB. TrichomoniasisC. CandydomycosisD. Chronic gonorrheaE. Chlamydiosis

132. A 26 year old woman who delivereda child 7 months ago has been sufferingfrom nausea, morning vomiting, sleepi-ness for the last 2 weeks. She suckles thechild, menstruation is absent. She hasn’tapplied any contraceptives. What methodshould be applied in order to specify herdiagnosis?

A. Ultrasonic examinationB. Roentgenography of small pelvis organsC. Palpation of mammary glands andpressing-out of colostrumD. Bimanual vaginal examinationE. Speculum examination

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


A. Corresponding to the ageB. 150 g less than necessaryC. Hypotrophy of the I gradeD. Hypotrophy of the II gradeE. Paratrophy of the I grade

134. A woman consulted a doctor onthe 14th day after labour about suddenpain, hyperemy and induration of the leftmammary gland, body temperature ri-se up to 39oC, headache, indisposition.Objectively: fissure of nipple, enlargementof the left mammary gland, pain onpalpation. What pathology would you thi-nk about in this case?

A. Lactational mastitisB. Lacteal cyst with suppurationC. Fibrous adenoma of the left mammaryglandD. Breast cancerE. Phlegmon of mammary gland

135. A 32 year old patient complai-ns about pain in small joints of herhands, paresthesia at the tips of fi-ngers, weakness, difficult diglutition.She has been suffering from this for13 years. Objectively: face amimia,shortening of nail bones, skin indurati-ons in the area of shoulder girdle arepresent. Roentgenological examinationof lungs revealed basal pneumosclerosis.Fibrogastroscopy revealed esophagusconstriction in its cardial part. Bloodcount: leukocytes - 9, 8 · 109/l, ESR - 22mm/h, γ-globulin - 22%. What is the mostprobable diagnosis?

A. Systemic sclerodermaB. Systemic lupus erythematosusC. Rheumatoid arthritisD. DermatomyositisE. Myxedema

136. A 30 year old woman ill withinfluenza felt palpitation and dull cardi-ac pain during moderate physical exerci-se. Objectively: Ps - 96 bpm, AP - 100/60mm Hg. The first sound is quiet abovethe apex, soft systolic murmur is present.What complication is indicated by theseclinical presentations?

A. Acute viral myocarditisB. Acute allergic infectious myocarditisC. Idiopathic myocarditisD. MyocardiopathyE. Neurocirculatory dystonia

137. A 5 month old boy was bornprematurely, he didn’t suffer from anydisease at the infant age and later on.

Examination at an outpatient’s hospi-tal revealed paleness of skin, sleepiness.Blood count: Hb - 95 g/l, erythrocytes- 3, 5 · 1012/l, reticulocytes - 90/00,colour index - 0,7, osmotic stability oferythrocytes - 0,44-0,33%, serum iron - 4,9micromole/l. What is the most probablecause of anemia?

A. Iron deficitB. Hemogenesis immaturityC. Infectious processD. Erythrocyte hemolysisE. B12 deficit

138. A 13 year old girl consulted theschool doctor on account of moderatebloody discharge from the genital tracts,which appeared 2 days ago. Secondarysexual characters are developed. Whatis the most probable cause of bloody di-scharge?

A. MenarcheB. Juvenile hemorrhageC. HaemophiliaD. Endometrium cancerE. Werlhof’s disease

139. An 8 year old girl complains aboutjoint pain, temperature rise up to 38oC,dyspnea. Objectively: the left cardiacborder is deviated by 2,5 cm to the left,tachycardia, systolic murmur on the apexand in the V point are present. Bloodcount: leukocytes - 20, 0 · 109/l, ESR - 18mm/h. What sign gives the most substanti-al proof for rheumatism diagnosis?

A. CarditisB. ArthralgiaC. LeukocytosisD. FeverE. Accelerated ESR

140. During inspection of sanitary conditi-ons of studying at a technical university itwas necessary to evaluate the visual regi-men of students, who study from 9 a.m to3 p.m. What index of natural light will bethe most informative?

A. Natural light coefficientB. Light coefficientC. Depth of study roomD. Time of the room insolationE. Presence of mixed (superolateral) light

141. A 70 year old man is suffering fromcoronary heart disease. His mood is evi-dently depressed, anxious. As a resultof continious sleeplessness he has gotfears, suicidal thoughts. He would sit for


a long time in the same pose, answerafter a pause, in a low, monotonous voi-ce. His face has a look of suffering, pain,fear. What is the main psychopathologicsyndrome?

A. Depressive syndromeB. Paranoid syndromeC. Asthenic syndromeD. Phobic syndromeE. Obsessive syndrome

142. A 37 year old farmer complainsabout general weakness, spastic pain inthe lower parts of his abdomen, mainlyin the left iliac area, frequent defecati-ons up to 18 times a day, feces containadmixtures of mucus and blood. Theillness began abruptly 3 days ago withchill, fever, headache. General conditionis moderately severe, body temperature is37, 8oC. Sigmoid colon is spasmed and pai-nful. What is the most probable diagnosis?

A. DysenteryB. AmebiasisC. Nonspecific ulcerative colitisD. YersiniosisE. Salmonellosis

143. A 3 year old child fell acutely ill,body temperature rose up to 39, 5oC,the child became inert, there appearedrecurrent vomiting, headache. Exami-nation revealed positive meningealsymptoms, after this lumbal puncture wasperformed. Spinal fluid is turbid, runsout under pressure, protein concentrati-on is 1,8 g/l; Pandy reaction is +++, sugarconcentration is 2,2 millimole/l, chlorideconcentration - 123 millimole/l, cytosis is2, 35 · 109 (80% of neutrophils, 20% oflymphocytes). What is the most probablediagnosis?

A. Purulent meningitisB. Serous viral meningitisC. Serous tuberculous meningitisD. Subarachnoid haemorrhageE. Brain tumour

144. A 39 year old patient sufferingfrom hypertension felt suddenly intenseheadache in the region of occiput; thereappeared recurrent vomiting. Thesepresentations has been lasting for 5 hours.Objectively: Ps - 88 bpm, AP - 205/100mm Hg, painfulness of occipital points,rigidity of occipital muscles are present.Kernig’s symptom is bilaterally positi-ve. Subarachnoid haemorrhage is alsosuspected. What diagnostic method will

be of the greatest importance for confi-rmation of provisional diagnosis?

A. Lumbar punctureB. Examination of eye fundusC. Ultrasonic dopplerographyD. EEGE. Computer tomography

145. A 10 year old girl complains aboutabdominal pain that is arising and getti-ng worse after eating rough or spicy food.She complains also about sour eructati-on, heartburn, frequent constipations,headache, irritability. She has been sufferi-ng from this for 12 months. Objectively:the girl’s diet is adequate. Tongue is moistwith white deposit at the root. Abdomenis soft, painful in its epigastric part. Whatstudy method will help to make a di-agnosis?

A. EsophagogastroduodenoscopyB. Intragastral pH-metryC. Fractional examination of gastric juiceD. Contrast roentgenoscopyE. Biochemical blood analysis

146. A 35 year old patient who suffersfrom chronic glomerulonephritis and hasbeen hemodialysis-dependent for the lastthree years developed intermissions ofheart activity, hypotension, progressi-ng weakness, dyspnea. ECG showedbradycardia, atrioventricular block typeI, high pointed waves T . The day beforethe flagrant violation of diet took place.What is the most probable cause of thesechanges?

A. HyperkaliemiaB. HyperhydratationC. HypokaliemiaD. HypernatriemiaE. Hypocalciemia

147. A 34 year old coal miner who hasbeen in service for 10 years was di-scharged from an occupational diseaseclinic after examination and treatment.He was diagnosed with the I stage ofanthracosilicosis, peribronchitis, 0 stageof respiratory failure. What expert deci-sion should be taken about his workingcapacity?


A. He should be referred to the local medi-cal expert comission for determinationof his disability group for the period ofre-trainingB. He can continue working as coal minerprovided that sanitary and hygienic condi-tions are observedC. He should be given medical certificatefor the further out-patient treatmentD. He should stay on the sick-list toconsolidate treatment resultsE. He should be referred to the local medi-cal expert comission for determination ofpercentage of working capacity loss

148. A 52 year old woman complainsabout face distortion. It appeared 2 daysago after supercooling. Objectively: bodytemperature is 38, 2oC. Face asymmetry ispresent. Frontal folds are flattened. Lefteye is wider than right one and doesn’tclose. Left nasolabial fold is flattened,mouth corner is lowered. Examinationrevealed no other pathology. Blood count:leukocytes - 10 · 109/l, ESR - 20 mm/h.What is the most probable diagnosis?

A. Facial neuritisB. Trigeminus neuralgiaC. Hemicrania (migraine)D. Ischemic strokeE. Brain tumour

149. A patient complained about generalweakness, fever, painful rash on his trunkskin . He has been suffering from this for 3days. Objectively: lateral surface of trunkon the left is hyperemic and edematic,there are some groups of vesicles withserous and haemorrhagic contents. Whatis the most probable diagnosis?

A. Herpes zosterB. Contact dermatitis simplexC. Contact allergic dermatitisD. Microbial eczemaE. Herpetiform Duhring’s dermatosis

150. Internal obstetric examination ofa parturient woman revealed that thesacrum hollow was totally occupied wi-th fetus head, ischiadic spines couldn’t bedetected. Sagittal suture is in the strai-ght diameter, occipital fontanel is directedtowards symphysis. In what plane of smallpelvis is the presenting part of the fetus?

A. Plane of pelvic outletB. Wide pelvic planeC. Narrow pelvic planeD. Plane of pelvic inletE. Over the pelvic inlet

151. A 24 year old patient complai-ns about general weakness, dizziness,body temperature rise up to 37, 5oC,sore throat, neck edema, enlargementof submaxillary lymph nodes. Objecti-vely: mucous membrane of oropharynxis edematic and cyanotic, tonsils areenlarged and covered with films thatspread beyond the tonsils and cannotbe easily removed. What is the leadingmechanism of this illness’ development?

A. Action of bacterial exotoxinB. Action of bacterial endotoxinC. AllergicD. Accumulation of suboxidated productsE. Bacteriemia

152. A 38 year old man complainsabout mild pain and muscle weaknessof shoulder and pelvic girdles and backthat has been progressing for the last 3weeks. He has also significant problemswith getting up, going up and down thestairs and shaving. It is suspected that thepatient is suffering from dermatomyosi-tis. Blood count: Hb - 114 g/l, leukocytes- 10, 8 · 109/l, eosin - 9%, ESR - 22 mm/h,C-reactive protein (++). Change of thefollowing laboratory factor will be of thegreatest diagnostic importance:

A. Creatine phosphokinaseB. CeruloplasminC. Sialic acidsD. Antibodies to the native DNAE. γ-globulins

153. A 9 year old boy has been sufferi-ng from diabetes mellitus for a year. Hegets insulin injections (humulin R, NPH),the dose makes up 0,4 units per 1 kg ofbody weight a day. Insulin is untroducedsubcutaneously (into the shoulder) bymeans of a syringe. What measuresshould be taken in order to prevent li-podystrophy?

A. To change point of introductionB. To limit fats in the boy’s dietC. To reduce insulin doseD. To apply periodically other types ofinsulinE. To administer antioxidants

154. A 25 year old pediatrician fellill a week ago: body temperature roseup to 37, 6oC, there appeared a slightswelling on his neck. His illness was di-agnosed as ARD, cervical lymphadenitis.Treatment course included erythromycin,hot compress on the neck. In course of


treatment body tempearture rose up to39oC, there appeared headache, repeatedvomiting, meningeal syndrome. Whatstudies are necessary for the final di-agnosis?

A. Cerebrospinal punctureB. Puncture of cervical lymph nodeC. Complete blood countD. Sputum test for secondary floraE. Roentgenological examination of lungs

155. A 41 year old woman has sufferedfrom nonspecific ulcerative colitis for5 years. On rectoromanoscopy: evidentinflammatory process of lower intesti-nal parts, pseudopolyposive changes ofmucous membrane. In blood: WBC- 9, 8 ·109/l, RBC- 3, 0 ·1012/l, ESR - 52 mm/hour.What medication provides pathogenetictreatment of this patient?

A. SulfosalasineB. MotiliumC. VikasolumD. LinexE. Kreon

156. A 49 year old female patient wasadmitted to a hospital with acute attacksof headache accompanied by pulsation intemples, AP rose up to 280/140 mm Hg.Pheochromocytoma is suspected. Whatmechanism of hypertensive atack doesthis patient have?

A. Increase of catecholamine concentrati-onB. Increase of aldosterone level in bloodC. Increase of plasma renin activityD. Increase of vasopressin secretionE. Increase of thyroxine secretion

157. A child was born with body weight3250 g and body length 52 cm. At the ageof 1,5 month the actual weight is suffici-ent (4350 g), psychophysical developmentcorresponds with the age. The child isbreast-fed, occasionally there are regurgi-tations. What is the cause of regurgitati-ons?

A. AerophagiaB. PylorostenosisC. PylorospasmD. Acute gastroenteritisE. Esophageal atresia

158. Three weeks after acute anginathe patient is still weak, inert, subfebri-le, his retromaxillary lymph nodes areenlarged. Tonsils are flabby, stick togetherwith arches, there are purulent plugs in

lacunae. What is the most probable di-agnosis?

A. Chronic tonsillitisB. Chronic pharyngitisC. Acute lacunar tonsillitisD. ParatonsillitisE. Tonsillar tumour

159. A 43 year old patient had right-sided deep vein thrombosis of iliofemoralsegment 3 years ago. Now he is sufferi-ng from the sense of heaviness, edemaof the lower right extremity. Objectively:moderate edema of shin, brown indurati-on of skin in the lower third of shin, varixdilatation of superficial shin veins arepresent. What is the most probable di-agnosis?

A. Postthrombophlebitic syndrome, vari-cose formB. Acute thrombosis of right veinsC. Lymphedema of lower right extremityD. Parkes-Weber syndromeE. Acute thrombophlebitis of superficialveins

160. A 23 year old patient fell ill 3weeks ago when she noticed a very pai-nful induration in her axillary crease. 4-5days later it burst and discharged a lotof pus. After that some new infiltrationsappeared around the affected area. Thepatient has never suffered from skin di-seases before. What is the most probablediagnosis?

A. HydradenitisB. FuruncleC. MycosisD. Herpes zosterE. Streptococcal impetigo

161. A child is 1 day old. During deliverythere had been problems with extractionof shoulders. Body weight is 4300,0. Rightarm hangs down along the body, hand ispronated, movement in the arm is absent."Scarf"symptom is positive. What is themost probable diagnosis?

A. Total right-sided obstetric paralysisB. Proximal right-sided obstetric paralysisC. Distal right-sided obstetric paralysisD. HemiparesisE. Tetraparesis

162. An outbreak of food poisoning wasrecorded in an urban settlement. Theillness was diagnosed as botulism on thegrounds of clinical presentations. Whatfoodstuffs should be chosen for analysis


in the first place in order to confirm thediagnosis?

A. Tinned foodB. PotatoesC. Pasteurized milkD. Boiled meatE. Cabbage

163. A 42 year old metalworker hasbeen working at the turning machinefor production of heavy large-size partsfor 5 years. His work requires usingof hand and pedal levers that involvesconsiderable physical force. What meansfor osteoarthrosis prevention should berecommended?

A. To limit physical workB. To administer protein-and-carbohydratedietC. To administer protein-and-vitamin dietD. To improve health at the Black sea coastE. To go in for weightlifting

164. A 30 year old patient undergoestreatment because of Werlhof’s disease.Objectively: the patient is pale, there arepetechial haemorrhages on the extensionsurfaces of forearms. Ps is 92 bpm, AP is100/60 mm Hg. The lower edge of spleenis at a level with umbilicus. Blood count:erythrocytes: 2, 8 · 1012/l, Hb - 90 g/l, Ht -0,38, thrombocytes - 30 · 109/l. The patientis being prepared for splenectomy. Whattransfusion medium should be chosenin the first place for the preoperationalpreparation?

A. Thrombocytic massB. Stored bloodC. Native erythrocytic massD. Erythrocytic suspensionE. Washed erythrocytes

165. A 19 year old boy was admitted to ahospital with closed abdominal trauma. Incourse of operation multiple ruptures ofspleen and small intestine were revealed.AP is falling rapidly, it is necessary toperform hemotransfusion. Who can speci-fy the patient’s blood group and rhesuscompatibility?

A. A doctor of any specialityB. A laboratory physicianC. A surgeonD. A traumatologistE. An anaesthesilogist

166. Clinical and statistical studywas devoted to the effect of a newpharmacological medication upon the

patients with coronary heart disease.What parametric criterion (coefficient)can be used for estimation of results vali-dity?

A. Student’s coefficient (t)B. Sign criterionC. Conformity coefficientD. Wilcoxon’s t-criterionE. Kolmogorov-Smirnov’s criterion

167. It is planned to make completeisolation boxes in the infectiousdepartment in order to prevent nosocomi-al airborne infections. The boxes consistof a tambour, a ward and a lock chamber.What structure should be also included ina complete isolation box?

A. Bathroom unitB. Manipulation roomC. Doctor’s consulting roomD. Patient’s examination roomE. Nursing room

168. A 30 year old man complains ofintense pain, reddening of skin, edemain the ankle-joint area, fever up to 39oC.There was an acute onset of the illness. Inthe past there were similar attacks lasting5-6 days without residual changes in thejoint. The skin over the joint is hyperemicand ill-defined, without infiltrative bankon the periphery. What is the most likelydiagnosis?

A. GoutB. Infectious arthritisC. Rheumatoid arthritisD. Erysipelatous inflammationE. Osteoarthritis

169. Preventive examination of a 55 yearold patient revealed diabetes mellitus.The patient hasn’t received treatment forit. Objectively: height is 170 cm, weightis 106 kg, skin humidity is normal. Ps is76 bpm, rhythmic, left border of relati-ve heart dullness is deviated by 1 cm tothe left from the middle clavicular line,heart sounds are quiet, AP is 140/80 mmHg. Glycemia on an empty stomach is 6,9millimole/l. Glucose rate in the daily uri-ne is 0,5%, diuresis makes up 2,5 l. Whattreatment tactics should be chosen?

A. To administer dietotherapyB. To administer metforminC. To administer glibenclamidD. To administer repaglinideE. To administer insulin

170. The results of 5 year monitoring


allowed to estimate the level of envi-ronmental influence upon health indi-ces of popultaion. What statistic methodshould be chosen?

A. Calculation of correlation coefficientB. Calculation of conformity coefficientC. Calculation of coefficient of differencevalidityD. Calculation of regression coefficientE. Calculation of dynamic indices

171. In order to improve organismtolerance of boarding-school pupilsa doctor developed a program. Theprogram is based upon the following pri-nciples: graduality, consistency, indivi-duality, coomplexity. What of the mainprinciples of organism tempering wasn’ttaken into account?

A. SystematicnessB. Autodefense increaseC. Increase of influence forceD. Increase of influence intensityE. Increase of resistance

172. A patient complains aboutpyrosis and permanent pain behind hisbreastbone. When he bends forwardafter eating there appears regurgi-tation. Roentgenological examinationrevealed extrasaccular cardiofunctionalhernia of esophageal opening of di-aphragm. Esophagoscopy revealed si-gns of reflux-esophagitis. What is thenecessary tretment tactics?

A. Operation in a surgical departmentB. Conservative treatment in an outpati-ents’ clinicC. Conservative treatment in thetherapeutic hospitalD. Conservative treatment in a surgicaldepartmentE. Treatment at a health resort

173. 15 minutes after the second vacci-nation with diphteria and tetanus toxoi-ds and pertussis vaccine a 4 month oldboy manifested symptoms of Quincke’sedema. What medication should be appli-ed for emergency aid?

A. PrednisoloneB. HeparinC. AdrenalinD. FurosemideE. Seduxen

174. During examination a patient isunconscious, his skin is dry and hot,face hyperemia is present. The patient

has Kussmaul’s respiration, there is alsosmell of acetone in the air. Symptoms ofperitoneum irritation are positive. Bloodsugar is at the rate of 33 millimole/l. Whatemergency actions should be taken?

A. Intravenous infusion of short-actinginsulinB. Intravenous infusion of glucose alongwith insulinC. Introduction of long-acting insulinD. Intravenous infusion ofneohaemodesum along with glutamicacidE. Intravenous infusion of sodium chloridesaline

175. In order to study impact of microcli-mate upon the human organism it isnecessary to make systematic observati-on of air temperature over 3 days. Choosea device that will allow to make the mostprecise temperature records:

A. ThermographB. Alcohol thermometerC. Mercury thermometerD. August’s psychrometerE. Assmann psychrometer

176. A 3 month old child has occiputalopecia, anxious sleep, excessive sweati-ng. What disease might be suspected?

A. RachitisB. SpasmophiliaC. AnemiaD. Phosphate diabetesE. Chondrodystrophy

177. After delivery and revision ofplacenta there was found the defect ofplacental lobule. General condition ofwoman is normal, uterus is firm, thereis moderate bloody discharge. Speculuminspection of birth canal shows absence oflacerations and raptures. What action isnesessary?

A. Manual exploration of the uterinecavityB. External massage of uterusC. Introduction of uterine contractingagentsD. Urine drainage, cold on the lowerabdomenE. Introduction of hemostatic medications

178. A 7 year old boy has periods of loss ofattention that last 10-15 seconds and occurseveral times a day. During these peri-ods he stands still in one position, doesn’tanswer the questions or react when he is


called by his name. Neurological exami-nation revealed no changes. What di-agnostic method should be applied tospecify his diagnosis?

A. ElectroencephalographyB. Skull roentgenogramC. Computer tomogramD. EchoencephalographyE. Examination of evoked potentials

179. A 52 year old patient complainsabout pain in the right part of her chest,dyspnea, cough with a lot of foul-smellingalbuminoid sputum in form of "meatslops". Objectively: the patient’s condi-tion is grave, cyanosis is present, breathi-ng rate is 31/min, percussion sound abovethe right lung is shortened, auscultationrevealed different rales. What is the mostprobable diagnosis?

A. Lung gangreneB. Lung abscessC. Pleura empyemaD. Multiple bronchiectasisE. Chronic pneumonia

180. A 15 year old patient suffers fromheadache, nasal haemorrhages, sense oflower extremity coldness. Objectively:muscles of shoulder girdle are developed,lower extremities are hypotrophied.Pulsation on the pedal and femoral arteri-es is sharply dampened. AP is 150/90 mmHg, 90/60 on the legs. Systolic murmurcan be auscultated above carotid arteries.What is the most probable diagnosis?

A. Aorta coarctationB. Aorta aneurismC. Aortal stenosisD. Aortal insufficiencyE. Coarctation of pulmonary artery

181. A patient with frostbite of both feetwas delivered to the admission ward.What actions should be taken?

A. To apply a bandage, to introducevasodilating medicationsB. To administer cardiac medicationsC. To put feet into hot waterD. To rub feet with snowE. To apply an alcohol compress

182. A patient has a stab wound on his ri-ght foot. On the fourth day after injurythe patient’s body temperature rose upto 38oC, inguinal lymph nodes becameenlarged and painful, skin over themreddened. What complication might besuspected?

A. LymphadenitisB. LymphangitisC. PhlegmonD. TetanusE. Erysipelas

183. A 52 year old patient complainsabout headache, weakness of his upperleft extremity. Neurological symptomsbecome more intense during physicalstress of the left extremity. Pulsation onthe arteries of the left extremity is sharplydampened but it remains unchanged onthe carotid arteries. What is the mostprobable diagnosis?

A. Occlusion of the left subclavicularartery, steal syndromeB. Thoracal outlet syndromeC. Raynaud’s syndromeD. Takayasu’s diseaseE. Occlusion of brachiocephalic trunk

184. A 57 year old patient abruptly lost thesight of one eye. Examination revealedthat his sight made up 0,02 excentri-cally, eye fundus has haemorrhages ofdifferent forms and sizes ("squashedtomato"symptom). Disc of optic nerve ishyperemic. In anamnesis general vascularpathology is recorded. Direct-acting anti-coagulants were administered. What is themost probable diagnosis?

A. Thrombosis of central vein of retinaB. Hypertensive angiopathyC. Hypertensive angioneuropathyD. Embolism of central artery of retinaE. Diabetic retinopathy

185. A 28 year old patient complainedabout prolongation of intermenstrualperiods up to 2 months, hirsutism.Gynaecological examination revealedthat the ovaries were enlarged, pai-nless, compact, uterus had no peculari-ties. Pelvic ultrasound revealed that theovaries were 4-5 cm in diameter and hadmultiple enlarged follicles on periphery.Roentgenography of skull base showedthat sellar region was dilated. What is themost probable diagnosis?

A. Stein-Leventhal syndromeB. AlgodismenorrheaC. Sheehan’s syndromeD. Premenstrual syndromeE. Morgagni-Stewart syndrome

186. A woman consulted a therapeuti-st about fatigability, significant weightloss, weakness, loss of appetite. She has


been having amenorrhea for 8 months.A year ago she born a full-term child.Haemorrhage during labour made up 2l. She got blood and blood substitutetransfusions. What is the most probablediagnosis?

A. Sheehan’s syndromeB. Stein-Leventhal syndromeC. Shereshevsky-Turner’s syndromeD. Homological blood syndromeE. Vegetovascular dystonia

187. A 68 year old patient complains aboutacute pain in his right foot, toe edemaand darkening of skin of the IV toe. Hehas been suffering from diabetes melli-tus for 15 years, doesn’t receive regulartreatment. What complication of diabetesmellitus is it?

A. Gangrene of the IV toe on the rightfootB. PanaritiumC. HaematomaD. ErysipelasE. Fracture of the IV toe on the right foot

188. Preventive examination of an 11 yearold boy helped to determine his habi-tus type. It was established that the chi-ld’s shoulders were deviated and broughtforward, with forward flexion of head,the thorax was flattened, abdomen wasconvex. The child’s backbone had signs ofdeepened cervical and lumbar curvatures.What habitus is it?

A. KyphosisB. LordosisC. Round-shoulderedD. CorrectedE. Normal

189. During hygienic examination of ahospital it was established that the areafor each bed in a double ward was: in theinfectious department for children - 7 �2,in the infectious department for adults -8 �

2, in the burns department - 9 �2, in

the radiological department - 10 �2, in thecritical care department - 13 �

2. In whi-ch wards the area for each bed doesn’tcorrespond with hygienic requirements?

A. In burns wardsB. In infectious wards for childrenC. In infectious wards for adultsD. In radiological wardsE. In critical care wards

190. A 2 year old child has been ill withacute respiratory viral infection of upper

thrice a year - in February, in April and inDecember. How should these occurencesbe recorded?

A. It is necessary to fill in 3 statistic talonssigned (+)B. It is necessary to fill in 3 statistic talonssigned (−)C. It is necessary to fill in 1 statistic talonsigned (+)D. It is necessary to fill in 1 statistic talonsigned (+) and 2 statistic talons signed (−)E. It is necessary to fill in 1 statistic talonsigned (−)

191. Researchers studied disease inci-dence of influenza and acute respiratoryviral infection within the last 5 years.What kind of graphic presentation shouldbe used for the best visualization of thisdata?

A. Linear diagramB. Pie diagramC. Bar diagramD. HistogramE. Radial diagram

192. A 55 year old patient felt suddenlysick in a hospital corridor, he was immedi-ately examined by a doctor. Examinationrevealed that the patient’s skin was pale,autonomous respiration was absent, pulseon carotid arteries couldn’t be felt, pupi-ls were mydriatic. What action should betaken at the beginning of cardiac resusci-tation?

A. Precordial thumpB. Mouth-to-mouth ventilationC. Closed-chest cardiac massageD. Restoration of airway patencyE. Defibrillation

193. A 24 year old patient complai-ned about putting on weight, limosis.Objectively: the patient’s constitution isof hypersthenic type, body weight indexis 33,2 kg/m2, waist circumference is 100cm. Correlation of waist circumference tothe thigh circumference is 0,95. What isthe most probable diagnosis?


A. Alimentary constitutional obesity ofthe I stage, abdominal typeB. Hypothalamic Itsenko-Cushing obesityof the II stage, gynoid typeC. Alimentary constitutional obesity of theIII stage, gynoid typeD. Alimentary constitutional obesity of theII stage, abdominal typeE. Hypothalamic Itsenko-Cushing obesityof the I stage, abdominal type

194. A parturient woman is 27 year old,it was her second labour, delivery was atterm, normal course. On the 3rd day ofpostpartum period body temperature is36, 8oC, Ps - 72/min, AP - 120/80 mm Hg.Mammary glands are moderately swollen,nipples are clean. Abdomen is soft andpainless. Fundus of uterus is 3 fingersbelow the umbilicus. Lochia are bloody,moderate. What is the most probable di-agnosis?

A. Physiological course of postpartumperiodB. Subinvolution of uterusC. Postpartum metroendometritisD. Remnants of placental tissue afterlabourE. Lactostasis

195. Esophagus wall of a 72 yearold patient with severe concomitantpathology was injured during urgent fi-broesophagogastroscopy. This resulted inprogressing of acute respiratory failureand collapse of the left lung. What aidshould be rendered?

A. Drainage of pleural cavity by Bullauxmethod, mediastinum drainage, anti-bacterial therapyB. Buelau’s drainage of pleural cavity,antibacterial therapyC. Left-sided thoracotomy, closure ofesophagus and mediastinum woundD. Left-sided thoracotomy, closure ofesophagus woundE. Endoscopic closure of esophaguswound, drainage

196. A 46 year old woman who has beensuffering from hypertension for 5 yearswas diagnosed with hypertensive crisis.She complains about palpitation, senseof head pulsation; heart rate is 100/min,AP is 190/100 mm Hg (haemodynamicsis of hyperkinetic type). What medicationshould be the medication of choice?

A. β-adrenoceptor blockerB. Adenosine pyrophosphate inhibitorC. DiureticD. α-adrenoceptor blockerE. Dihydropyridine calcium antagonist

197. A 30 year old patient complainsabout inability to become pregnant over3 years of married life. The patient is ofsupernutrition type, she has hair along themedian abdominal line, on the internalthigh surface and in the peripapillary area.Menses started at the age of 16, they areinfrequent and non-profuse. US revealedthat the uterus was of normal size, ovarieswere 4х5х5 cm large and had a lot of cysticinclusions. What is the most probable di-agnosis?

A. Polycystic ovariesB. Ovarian cystomaC. Chronic oophoritisD. Menstrual irregularityE. Bilateral ovarian tumours

198. A 4 month old child was admittedto a surgical department 8 hours afterthe first attack of anxiety. The attackshappen every 10 minutes and last for 2-3 minutes, there was also one-time vomi-ting. Objectively: the child’s condition isgrave. Abdomen is soft, palpation revealsa tumour-like formation in the right ili-ac area. After rectal examination thedoctor’s finger was stained with blood.What is the most probable diagnosis?

A. Ileocecal invaginationB. Gastrointestinal haemorrhageC. Wilm’s tumourD. Helminthic invasionE. Pylorostenosis

199. During preventive examination a 16year old patient presented no problems.Objectively: the patient has signs ofmalnutrition, he is asthenic, AP is 110/70mm Hg, Ps is 80 bpm, cardiac borderis normal, auscultation above the cardi-ac apex reveals three sounds, cardi-ac murmur is absent. ECG shows nopathological changes, phonocardiogramshows that the third sound comes 0,15 safter the second one above the apex. Howare these changes called?

A. III physiological soundB. Fout-ta-ta-rou (reduplication of the 2ndsound)C. Protodiastolic gallop rhythmD. Atrial gallop rhythmE. IV physiological sound


200. A 52 year old patient with dissemi-nated vertebral osteochondrosis lifted asignificant load that resulted in lumbarpain and pain along the sciatic nerve.Objectively: positive Lasegue’s sign onthe left, reduced Achilles reflex. Whatdrug would be the most effective from the

pathogenetic point of view?

A. DiclofenacB. AspirinC. AnalginD. NovocaineE. Spasmalgon

Documents

A. Atony of the uterus B.C.D.E. 5. ﬁrst day after labour a ...mmf.dsmu.edu.ua/attachments/article/22/E92t07_2008E.pdf · fever, arthritis, colicky abdominal pain and a purpuric