Krok2 - Medicine - 2005

Krok 2 Medicine 2005 1
1. The physician must undertake 6. Define the basic registration document

measures for primary prophylaxis of iron at the profound study of a case rate wi-
deficiency anemia. Which of the following th temporary lost labor ability at the
categories of patient are subject to such industrial enterprise:
primary prophylactic measures?
A. A card of the personal account of a case
A. Pregnant women rate
B. Patients after 60 B. "The Report on reasons of a temporary
C. All children lost labor ability"
D. Patients after operation C. The sick-leave certificate
E. Workers of industrial enterprises D. A ambulatory medical card
E. The inpatient medical record
2. A patient with unstable angi-
na pectoris was given the following 7. A patient, aged 25, complains of pain
complex treatment: anticoagulants, ni- in the I finger on the right hand. On
trates, /alpha-adrenoblockers. However examination: the finger is homogeneously
on the third day of treatment the pain sti- hydropic, in bent position. On attempt to
ll romains. Which in vestigation shoud be unbend the finger the pain gets worse.
carried out to establish diagnosis? Acute pain appears on touching with
the probe in ligament projection. What
A. Coronarography decease is the most likely?
B. Stress-echocardiogram
C. Test with dosed physical exercises A. Thecal whitlow (ligament panaritium)
D. Esophageal electrocardiac stimulator B. Subcutaneous panaritium
E. Myocardial scintigraphy C. Articular (joint) panaritium
D. Bone panaritium
3. The 28 y.o. woman applied to doctor E. Paronychia
because of limited loss of the hair.
In the anamnesis - she had frequent 8. A sample of milk was taken for testi-
headache indisposition, arthromyalgia, ng from a 5 ton milk batch. Lab analysis
fever, irregular casual sexual life, drug showed the following: fat content 2%,
user. RW is negative. What examination specific density- 1,04 g/cm3 , acidity 210 C,
must be done first? reductase probe – weak positive. What
way the product is to be used in? What
A. Examination for HIV would you advise?
B. Examination for neuropathology
C. Examination for gonorrhea A. Sell but inform customers about milk
D. Examination for fungi quality
E. Examination for trichomoniasis B. Write the product off for animal feeding
C. Utilize technically
4. What methods of the collecting of the D. Sell without limitations
information is preferable for study of E. Annihilate the product
housing conditions of students of medical
HIGH SCHOOL for a training period? 9. Patient with thyrotoxicosis is in the
2-beds hospital ward of therapeutic
A. Questioning department. The area of the ward is 18
B. Interviewing
C. Selecting of materials m2 , height 3 m, ventilation rate 2,5/hr.
D. A method of the directed selection Air temperature - 200 , relative humidity
E. Statistical 45%, air movement velocity 0,3 m/s, light
coefficient 1/5, noise level 30 dB. Make
5. Choose a method of a graphic hygienic evaluation of the conditions.
representation of monthly information
about number of the registered cases A. Discomfortable microclimate
of acute intestinal infection and their B. Non-effective ventilation
comparisons to the average monthly C. Poor lighting
values, obtained for 5 previous years: D. High level of noise
E. All conditions are OK
A. The linear diagram
B. The radial diagram 10. 33 y.o. woman works as the secretary.
C. The sector diagram Her diet contains 150 g of protein (includi-
D. The figured diagram ng 100 g of animal protein), 200 g of fat,
E. The curvilinear disgram 600 g of carbohydrates. What pathology
can develop from this diet? dened, deformed, location of segments

ST and of wave T is discordant. The wave
A. Obesity Р is not changed, superimposes QRST,
B. Schizophrenia natural conformity between Р and QRS is
C. Paradontosis not present. What kind of arrhythmia is
D. Common cold present?
E. Uterine fibromyoma
A. Paroxismal ventricular tachycardia
11. A 9 y.o. girl has an average height and B. Sinus tachycardia
harmonic growth development. She was C. Atrial flutter
ill with acute respiratory infection for five D. Ventricular extrasystole
times. Define the group of her health. E. Atrial tachycardia
A. 2nd group 16. Ambulance was called to a 48 y.o.
B. 1st group man. From the words of relatives he has
C. 3rd group had three episodes of lost consciousness
D. 4th group and attacks during the day. On exami-
E. 5th group nation: the following fit is observed: pati-
ent is unconscious, fell on the floor, tonic
12. The child is 11 m.o. He suffers from and then clonic convuesions of trunk and
nervous-arthritic diathesis. The increased extremities happened. The attack lasted
synthesis of what acid is pathogenic at for 4 minute, ended by involuntary uri-
nervous-arthritic diathesis? nation. What type of attack was observed?
A. Uric acid A. Major epileptic seizure
B. Acetic acid B. Vegetatic crisis
C. Phosphoric acid C. Absence
D. Hydrochloric acid D. Episode of hysteria
E. Sulfuric acid E. Fainting
13. A 35 y.o. woman was admitted to 17. A 2 y.o. girl has been ill for 3
thoracic surgery department with fever up days. Today she has low–grade fever,
to 400 C, onset of pain in the side caused by severe catarrhal symptoms, non-abundant
deep breathing, cough with considerable maculopapular rash on her buttocks and
quantity of purulent sputum and blood enlarged occipital glands. What is your di-
with bad smell. What is the most likely diagnosis?
agnosis?
A. Rubella
A. Abscess of the lung B. Scarlet fever
B. Complication of liver echinococcosis C. Measles
C. Bronchiectatic disease D. Adenoviral infection
D. Actinomycosis of lungs E. Pseudotuberculosis
E. Pulmonary tuberculosis
18. Male 30 y.o., noted growing fingers and
14. A 52 y.o. man has recurrent transi- facial scull, changed face. Complains of
ent ischemic attacks. Auscultation of the poor eyesight, weakness, skin darkeni-
carotid arteries detects murmur. What di- ng, loss of body weight. X-ray shows
agnostic method is necessary to apply fi- broadening of sella turcica, thinning of
rst? tuberculin sphenoidale, signs of increased
intracranial pressure. What diagnosis can
A. Ultrasound dopplerography you make?
B. CTof the brain
C. MRI of the brain A. Adenoma of hypophysis
D. Cerebral angiography B. Encephalitis of truncus
E. Electroencephalography C. Optico - hiasmatic arachnoiditis
D. Adrenal gland tumor
15. A 67 y.o. patient complains of palpi-
E. Tumor of pondo-cerebellar corner
tation, dizziness, noise in ears, feeling of
shortage of air. Objectively: pale, damp 19. A patient complains of a tormental
skin. Vesicular respiration, respiratory (agonizing) cough with expectorati-
rate- 22 per min, pulse- 200 bpm, AP- on of up to 600 ml/daily purulent
100/70 mm Hg. On ECG: heart rate- chocolatecolor sputum with a decay smell.
200 bmp, ventricular complexes are wi-
Onset of illness was abrupt, t0 - 390 C, fever
of irregular type. There is the area of A. Subacute bacteria endocarditis

darkening with a cavity in a center on X- B. Recurrence of rheumatic fever
ray film, with irregular contours and level C. Thrombocytopenia purpure
of liquid. What disease is the question? D. Mitral stenosis
E. Aortic stenosis
A. Gangrene of lung
B. Tuberculosis 23. A patient with nosocomial pneumonia
C. Bronchiectatic illness has signs of collapse. Which of the followi-
D. Pneumonia complicated by an abscess ng pneumonia complication is the most li-
E. Lobar pneumonia kely to be accompanied with collapse?
20. A 24 y.o. patient complains of nausea, A. Septic shock
vomiting, headache, shortness of breath. B. Exudative pleuritis
He had an acute nephritis being 10 C. Bronchial obstruction
y.o. Proteinuria was found out in uri- D. Toxic hepatitis
ne. Objectively: a skin is grey-pale, the E. Emphysema
edema is not present. Accent of II tone
above aorta. BP 140/100-180/100 mm Hg. 24. A 27 y.o. man complains of pain in epi-
Blood level of residual N2 - 6,6 mmol/L, gastrium which is relieved by food intake.
creatinine- 406 mmol/L. Day’s diuresis- EGDFS shows antral erosive gastritis,
2300 ml, nocturia. Specific density of uri- biopsy of antral mucous presents Hеli-
ne is 1009, albumin- 0,9 g/L, WBC- 0-2 in cobacter Pylori. What can be diagnosed in
f/vis. RBC.- single in f/vis., hyaline casts this case?
single in specimen. Your diagnosis? A. Gastritis of type B
A. Chronic nephritis with violation of B. Gastritis of A type
kidney function C. Reflux - gastritis
B. Feochromocitoma D. Menetrier’s disease
C. Hypertensive illness of the II degree E. Rigid antral gastritis
D. Nephrotic syndrome 25. A 62 y.o. patient with DM-2. Diabetes
E. Stenosis of kidney artery is being compensated by diet and Manini-
21. A 33 y.o. male patient was admi- lum. Patient has to undergo an operation
tted to a hospital. A patient is pale, at for inguinal hernia. What the tactics of
an attempt to stand up he complains of hypoglycemic therapy should be used?
strong dizziness. There was vomiting like A. Prescribe fast-acting insulin
coffee-grounds approximately hour ago. B. Give Glurenorm in place of Maninilum
BP- 90/60 mm Hg., pulse- 120 b/min. In C. Continue with the current therapy
anamnesis, a patient has suffered from D. Prescribe long-acting insulin
ulcer of the stomach, painless form during E. Prescribe guanyl guanidines
4 years. An ulcer was exposed at gastrofi-
beroscopy. Your diagnosis: 26. A 32 y.o. patient complains of severe
weakness, tremor of extremities. On
A. Ulcer of stomach, complicated with physical examination, there is loss of body
bleeding weight, wet and warm skin. The thyroid
B. Ulcer of duodenum, complicated with gland is enlarged up to the 3rd degree,
bleeding painless, elastic. Ps- 108 bpm. BP- 160/55
C. Erosive gastritis mm Hg. The rest is in norm. What can be
D. Acute pleurisy diagnosed?
E. Acute myocardial infarction, abdominal
form A. Diffuse toxic goitre of the 3rd degree,
thyrotoxicosis of the average degree
22. A 40 y.o. patient of rheumatic heart B. Diffuse euthyroid goitre of the 3rd
disease complains of anorexia, weakness degree
and loss of weigth, breathless and swelling C. Chronic autoimmune thyroiditis,
of feet. On examination: t0 - 390 C, pulse is hypertrophic type
100/min. As ucultation: diastolic murmur D. Chronic fibrous thyroiditis
in the mitral area. Petechical lesion a E. Toxiferous adenoma of the thyroid
round clavicle; spleen was palpable, tooth gland
extraction one month ago.
27. A 30 y.o. female with rheumatoid
arthritis of five years duration complains
of pain in the frist three fingers of her right

hand over past 6 weeks. The pain seems A. Leptospirosis
especially severe at night often awakening B. Yersiniosis
her from sleep.The most likelly cause is? C. Salmonellosis
D. Brucellosis
A. Carpal tunnel syndrome E. Trichinellosis
B. Atlanto-axial sublaxation of cervical
spine 32. A 2,9-kg term male infant is born to
C. Sensory peripheral neuropathy a mother who developed polyhydramnios
D. Rheumatoid vasculitis at 34 weeks’ gestation. At birth, the Apgar
E. Rheumatoid arthritis without compli- scores were 9 and 9. The infant develops
cation choking and cyanosis with the first feed. In
addition, is unable to place a nasogastric
28. A 38 y.o. patient was urgently admi- tube. What is the most likely diagnosis?
tted to the hospital with complaints of
sudden weakness, dizziness, loss of consci- A. Esophageal atresia
ousness, body weight loss, nausea, vomi- B. Choanal atresia
ting, severe pain in epigastric area, di- C. Laryngomalacia
arrhea, skin hyperpigmentation. What is D. Tracheal atresia
the most probable diagnosis? E. Respiratory distress syndrome
A. Addisonic crisis 33. Full term newborn has developed
B. Acute gastroenteritis jaundice at 10 hours of age. Hemolytic
C. Meningoencephalitis disease of newborn due to Rh-
D. Scleroderma incompatibility was diagnosed. 2 hours
E. Pellagra later the infant has indirect serum bili-
rubin level increasing up to 14 mmol/L.
29. An unconscious patient presents wi- What is most appropriate for treatment of
th moist skin, shallow breathing. There hyperbilirubinemia in this infant?
are signs of previous injection on the
shoulders and hips. BP- 110/70 mm Hg. A. Exchange blood transfusion
Tonus of skeletal muscles and reflexes B. Phototherapy
are increased. Cramps of muscles of the C. Phenobarbital
extremities are seen. What is the most li- D. Intestinal sorbents
kely disorder? E. Infusion therapy
A. Hypoglycemic coma 34. At term of a gestation of 40 weeks
B. Hyperglycemic coma height of standing of a uterine fundus is
C. Hyperosmolar coma less then assumed for the given term. The
D. Hyperlactacidotic coma woman has given birth to the child in wei-
E. Stroke ght of 2500 g, a length of a body 53 cm,
with an assessment on a scale of Apgar of
30. 7 y.o. boy with chronic sinusitis and 4-6 points. Labor were fast. The cause of
rercurent pulmonary infections has chest such state of the child were:
X-ray demonstrating a right-sided cardi-
ac silhouette. What is the most likely di- A. Chronic fetoplacental insufficiency
agnosis? B. Delay of an intra-uterine fetation
C. Placental detachment
A. Kartagener syndrome D. Infection of a fetus
B. Cystic fibrosis (mucoviscidosis) E. Prematurity
C. Bronchiolitis obliterans
D. Laryngotracheomalacia 35. A 42 y.o. man died in a road acci-
E. α-antitrypsin deficiency dent after the haemorrhage on the site,
due to acute hemorrhagic anaemia. What
31. A patient was admitted to the hospital minimum percentage volume of the total
on the 7th day of the disease with complai- blood loss would result in death at acute
nts of high temperature, headache, pain haemorrhage?
in the muscles, especially in calf muscles.
Dermal integuments and scleras are A. 25-30%
icteric. There is hemorrhagic rash on the B. 6-9%
skin. Urine is bloody. The patient was fi- C. 10-14%
shing two weeks ago. What is the most D. 15-20%
likely diagnosis? E. 35-50%
36. What preparations are used for treatment is indicated to the patient?
prevention of fungal infection?
A. Surgical drainage of the pleural cavity
A. Fluconozol, Orungol, Nisoral B. Antiinflammation therapy
B. Rubomycin, Bleomycin, Mytomycin C C. Symptomatic therapy
C. Cytosar, Cormyctin, Lomycitin D. Pleural puncture
D. Captopril, Enalapril E. Thoracotomy
E. Isoniazid, Ftibazid, Pyrazinamid
41. A youth, aged 15, from childhood
37. What developes most often after acci- suffers from atopic dermatitis and allergy
dental intake of Hydrochloric acid? to the shellfish. In the last 3 months
after acquiring aquarium fish, rhini-
A. Cardiac insufficiency tis, conjunctivitis, itching in the nose
B. Cushing’s syndrome developed. What level of immunologic
C. Kutling’s syndrome index should be defined in this case?
D. Deylads’s syndrome
E. Acute pancreatitis A. IgE
B. IgJ
38. A woman, aged 40, primigravida, with C. IgM
infertility in the medical history, on the D. IgA
42-43 week of pregnancy. Labour acti- E. Circulating immunocomplexes
vity is weak. Longitudinal presentation
of the fetus, I position, anterior positi- 42. The patient has developed pain in
on. The head of the fetus is engaged to the axillary area, rise of temperature
pelvic inlet. Fetus heart rate is 140 bmp, developed 10 hours ago. On examinati-
rhythmic, muffled. Cervix dilation is 4 cm. on: shaky gait is marked, the tongue is
On amnioscopy: greenish colour of amni- coated by white coating. The pulse is
otic fluid and fetal membranes. Cranial frequent. The painful lymphatic nodules
bones are dense, cranial sutures and small are determined in the axillary area. The
fontanel are skin is erythematous and glistering over
the lymphatic nodules. What is the most
A. Caesarean section probable diagnosis?
B. Amniotomy, labour stimulation, fetal
hypoxia treatment A. Bubonic plague
C. Fetal hypoxia treatment, in the II period B. Acute purulent lymphadenitis
- forceps delivery C. Lymphogranulomatosis
D. Fetal hypoxia treatment, conservative D. Anthrax
delivery E. Tularemia
E. Medication sleep, amniotomy, labour
stimulation 43. A 17 y.o. patient complains of acute
pain in the knee joint and t0 – 380 C. He
39. 30 y.o. woman, had mild trauma of was ill with angina 3 weeks ago. Objecti-
5th finger of the left hand 15 days ago. vely: deformation and swelling of the
She has treated her self at home. She knee joints with skin hyperemia. Small
presents to the hospital due to deteriorati- movement causes an acute pain in the joi-
on of the condition and temperature rise. nts. Which diagnose is the most correct?
Objectively: hyperemia and swelling on
the ventral surface of finger. Restricted A. Rheumatism, polyarthritis
movements of the finger. X-ray of the left B. Systemic lupus eritematodes
hand: an early stage of оsteomyolitis of C. Reactive polyarthritis
the fifth finger could not be excluded. The D. Infectious-allergic polyarthritis
diagnosis: panaris of 5th finger of the left E. Rheumarthritis
hand. What form of panaris has occurred
in the patient? 44. A 38 y.o. woman was hospitalized
to the surgical unit with vomiting and
A. Bony acute abdominal pain irradiating to the
B. Hypodermic spine. On laparocentesis hemmorhagic
C. Paronychia fluid is obtained. What disease should be
D. Tendon type suspected?
E. Joints type
40. A 36 y.o. patient is diagnosed with ri-
ght sided pneumothorax. What method of
A. Acute pancreatitis
B. Renal colic A. Acute purulent maxillary sinusitis
C. Acute enterocolitis B. Acute purulent frontitis
D. Perforated gastric ulcer C. Acute purulent ethmoiditis
E. Acute appendicitis D. Acute purulent sphenoiditis
E. -
45. The girl is 12 y.o. Yesterday she was
overcooled. Now she complains on pain 49. A woman, primagravida, consults
in suprapubic area, frequent painful uri- a gynecologist on 05.03.2002. A week
nation by small portions, temperature is ago she felt the fetus movements for
37, 80 C. Pasternatsky symptom is negati- the first time. Last menstruation was on
ve. Urinalysis: protein- 0,033 g/L, WBC– 10.01.2002. When should she be given
20-25 in f/vis, RBC– 1-2 in f/vis. What di- maternity leave?
agnosis is most probable?
A. 8 August
A. Acute cystitis B. 25 July
B. Dysmetabolic nephropathy C. 22 August
C. Acute glomerulonephritis D. 11 July
D. Acute pyelonephritis E. 5 September
E. Urolithiasis
50. An infant aged 1 year on the third day
46. The girl of 11 y.o. She is ill for 1 of common cold at night developed inspi-
month. She has "butterflytype rash on ratory stridor, hoarse voice and barki-
face (spots and papules), pain and swelling cough. Physical examination revealed
ng of small joints on arms and legs, signs of suprasternal and intercostal chest retracti-
stomatitis (small-sized ulcers in mouth). ons. There is a bluish skin discoloration
CBC: Нb– 80 g/L, RBC– 2, 9 ∗ 1012 /L, moistly seen over the upper lip. The respi-
ratory rate is 52 per min and pulse- 122
WBC– 15 ∗ 109 /L, ESR- 40 mm/hour. Uri-
nalysis: protein– 0,33 g/L. What is the bpm. The body temperature is 37, 50 C.
most probable diagnosis? What disease does the infant have?
A. Systemic lupus erythematosus A. Acute infectious croup due to viral

B. Juvenile rheumatoid arthritis, systemic laryngotracheitis
type B. Acute laryngitis
C. Periarteriitis nodosa C. Bronchopneumonia without complicati-
D. Acute rheumatic fever ons
E. Dermatomyositis D. Acute bronchiolitis with respiratory
distress
47. The 56 y.o. patient has worked at the E. Acute epiglottitis
aluminium plant more than 20 years. Wi-
thin 3 last years he has developed looseni- 51. A newborn aged 3 days with hyperbi-
ng of teeth, bone and joint pains, piercing lirubinemia (428 mkmol/L) developed
pains in heart area, vomiting. The prelimi- following disorders. From beginning
nary diagnosis is: there were severe jaundice with poor
suckling, hypotomia and hypodynamia.
A. Fluorine intoxication Little bit later periodical excitation,
B. Mercury intoxication neonatal convulsions and neonatal primi-
C. Lead intoxication tive reflexes loss are noted. Now physi-
D. Phosphorus intoxication cal examination reveals convergent squi-
E. Manganese intoxication nt, rotatory nystagmus and setting sun eye
sign. How to explain this condition?
48. A 38 y.o. woman complains of a
purulent discharge from the left nostril. A. Encephalopathy due to hyperbilirubi-
The body temperature is 37, 50 C. The pati- nemia
ent is ill during a week and associates her B. Skull injury
illness with common cold. Pain on palpati- C. Brain tumour
on of her left cheek reveals tenderness. D. Hydrocephalus
The mucous membrane in the left nasal E. Spastic cerebral palsy
cavity is red and turgescent. The purulent 52. A 52 y.o. hard smoker patient complai-
exudates is seen in the middle meatus in ns of persistent cough with purulent
maxillary. What is the most probable di- sputum discharge especially in mornings,
agnosis? dyspnea provoked even by slight physi-
cal exertion, wheezing chest, tahypnoe, lower extremities X-Ray shows the thi-
general weakness. He considers himself ckening of flat bones. In the long bones
to be ill during 12 years. The overwri- there is a hyperostosis along the bone
tten conditions appear 3-4 times per year axis.The blood test has not revealed any
usually after common cold and have inflammation activity. Serum calcium is
tendency to progress. What disease do you normal. What disease do you consider in
think about first of all? this case?
A. Chronic obstructive lung disease A. Paget’s disease
B. Bronchial asthma B. Hyperparathyoid dystrophy
C. Mucoviscidosis (cystic fibrosis) C. Chronic osteomyelitis
D. Bronchoectatic disease D. Myeloma
E. Aspergillosis E. Mottled disease (marble disease)
53. 3 weeks ago the patient was ill wi- 57. The woman who has delivered twi-
th tonsillitis. Clinical examination reveals ns has early postnatal hypotonic uterine
edema, arterial hypertension, hematuria, bleeding reached 1,5% of her bodywei-
proteinuria (1,8 g/per day), granular and ght. The bleeding is going on. Conservati-
erythrocital casts. What is the preliminary ve methods to arrest the bleeding have
diagnosis? been found ineffective. The conditions of
patient are pale skin, acrocyanosis, oli-
A. Glomerulonephritis guria. The woman is confused. The pulse
B. Cystitis is 130 bpm, BP– 75/50 mm Hg. What is the
C. Pyelonephritis further treatment?
D. Intestinal nephritis
E. Renal amyloidosis A. Uterine extirpation
B. Supravaginal uterine amputation
54. 47 y.o. patient complains of intensi- C. Uterine vessels ligation
ve skin itching, jaundice, bone pain. The D. Inner glomal artery ligation
skin is hyperpigmentated. There is multi- E. Putting clamps on the uterine cervix
ple xanthelasma palpebrae. The liver is
+6 cm enlarged, hard with acute edge. 58. A 26 y.o. woman complains of a mild
The blood analysis revealed total bili- bloody discharge from the vagina and pain
rubin 160 mkmol/L, direct – 110 mkmol/L, in the lower abdomen. She has had the last
AST (asparate aminotransferase)- 2,1 menstruation 3,5 months ago. The pulse is
mmol/L per hour, ALT– 1,8 mmol/L, 80 bpm. The blood pressure (BP) is 110/60
alkaline phosphotase- 4,6 mmol/L per mm Hg and body temperature is 36, 60 C.
hour, cholesterol– 9,2 mmol/L, antimi- The abdomen is tender in the lower parts.
tochondrial antibodies M2 in a high titer. The uterus is enlarged up to 12 weeks of
What is the probable diagnosis? gestation. What is your diagnosis?
A. Primary biliary liver cirrhosis A. Inevitable abortion
B. Primary liver cancer B. Incipient abortion
C. Chronic viral hepatitis B C. Incomplete abortion
D. Acute viral hepatitis B D. Complete abortion
E. Alcoholic liver cirrhosis E. Disfunctional bleeding
55. The complications of acute cholecysti- 59. 18 y.o. woman complains of pain in
tis which require surgical intervention are the lower abdomen. Some minutes before
as follows EXCEPT: she has suddenly appeared unconscious at
home. The patient had no menses within
A. Jaundice last 3 months. On examination: pale skin,
B. Empyema of the gall-bladder the pulse- 110 bpm, BP- 80/60 mm Hg.
C. Emphysematous gall-bladder The Schyotkin’s sign is positive. Hb- 76
D. Gall-bladder perforation g/L. The vaginal examination: the uterus
E. Cholangitis conditioned by the presence is a little bit enlarged, its displacement is
of stones in the bile tract painful. There is also any lateral swelling
56. The 67 y.o. patient had 5 recurrent of indistinct size. The posterior fornix of
fractures of the lower extremities without the vagina is tendern and overhangs insi-
considerable cause within 5 years. O- de. What is the most probable diagnosis?
shaped deformity of the legs in the knee
joints has appeared. The skull, pelvis and
A. Impaired extrauterine pregnancy through out. What disease should a doctor

B. Ovarian apoplexy consider first of all?
C. Twist of cystoma of right uterine adnexa
D. Acute salpingoophoritis A. Carbuncle
E. Acute appendicitis B. Furuncle
C. Acute skin cellulitis
60. A 20 y.o. pregnant woman with 36 D. Carbuncle associated with anthrax
weeks of gestation was admitted to the E. Skin abscess
obstetrical hospital with complains of pain
in the lower abdomen and bloody vagi- 63. A 19 y.o. man was admitted to the
nal discharge. The general condition of reception department in 20 minutes after
the patient is good. Her blood pressure being wounded with the knife to the left
is 120/80 mm Hg. The heart rate of the chest. The patient is confused. The heart
fetus is 140 bpm, rhythmic. Vaginal exami- rate is 96 bpm and BP- 80/60 mm Hg.
nation: the cervix of the uterus is formed There are the dilated neck veins, sharply
and closed. The discharge from vagina is diminished apical beat and evident heart
bloody up to 200 ml per day. The head of enlargement What kind of penetrative
the fetus is located high above the minor chest wound complications has developed
pelvis entry. A soft formation was defined in patient?
through the anterior fornix of the vagina.
What is the probable diagnosis? A. Pericardium tamponade
B. Massive hemothorax
A. Placental presentation C. Open pneumothorax
B. Premature placental separation D. Closed pneumothorax
C. Uterine rupture E. Valve-likes pneumothorax
D. Threatened premature labor
E. Incipient abortion 64. A 35 y.o. patient complains of a
difficult swallowing, pain behind the
61. In the gynecologic office a 28 y.o. breastbone. He can eat only liquid food.
woman complains of sterility within three While swallowing sometimes he has
years. The menstrual function is not attacks of cough and dyspnea. Above
impaired. There were one artificial aborti- mentioned complaints are progressing. It
on and chronic salpingo-oophoritis in her is known that the patient has had a chemi-
case history. Oral contraceptives were not cal burn of esophagus one month ago.
used. Her husband’s analysis of semen is What complication does the patient have?
without pathology. From what diagnostic
method will you start the workup in this A. Corrosive esophagitis and stricture
case of sterility? B. Esophagitis
C. Esophageal diverticula
A. Hysterosalpingography D. Cardiac achalasia
B. Hormone investigation E. Cardiac insufficiency
C. Ultra sound investigation
D. Diagnostic scraping out of the uterine 65. An employee of a private company
cavity was ill with acute respiratory viral infecti-
E. Hysteroscopia on. Consulted a district doctor, who
determined the fact of temporary loss of
62. A 33 y.o. patient was admitted to the working ability, but refused to issue a sick-
reception room of the Central District list, arguing that the patient worked in
Hospital. He complains of a severely pai- the private and not state-owned company.
nful swelling localized on posterior neck, Should the sick-list be issued to the
fever up to 38, 40 C and general weakness. employees of private companies?
In anamnesis: diabetes mellitus within 5
years. On physical examination on the A. Issued regardless of company’s
posterior neck surface there is an infiltrate ownership
elevated above surrounding skin. The ti- B. Issued only to empties of state-owned
ssues affected by swelling are tense and companies
blue reddish discoloration in central area. C. Issued only on condition of payment
There are also several purulent necrotic guarantee by the company’s proprietor
pustules which are connected with each D. Issued a medical certificate of a set form
other and form a large skin necrosis. A E. Issued a medical certificate of a free
thinned necrotic skin of this swelling has form
holes looking like sieve, pus discharges 66. A worker was temporarily off work
because of illness during 16 days, was squeering substernal pain which had
under out-patient treatment. The doctor appeared 2 hours ago and irradiated
in charge issued a sick-list first for 5 days, to the left shoulder, marked weakness.
then prolonged it for 10 days. Who can On examination: pale skin, cold sweat.
further prolong the sick-list to this pati- Pulse- 108 bpm, AP- 70/50 mm Hg, heart
ent? sound are deaf, vesicular breathing, soft
abdomen, painless, varicouse vein on the
A. The doctor in charge of the case left shin, ECG: synus rhythm, heart rate is
together with the head of department 100 bmp, ST-segment is sharply elevated
B. Deputy head physician on the working in II, III aVF leads. What is the most li-
ability expertise kely disorder?
C. The doctor in charge of the case with
the permission of the head of department A. Cardiogenic shock
D. Working ability expertise committee B. Cardiac asthma
E. The head of department C. Pulmonary artery thromboembolia
D. Disquamative aortic aneurizm
67. A 13 y.o. patient was treated E. Cardiac tamponade
in dermatological hospital for atopic
dermatitis exacerbation. He was di- 71. In treatment and prevention establi-
scharged in the condition of clinical remi- shments, regardless of their organisati-
ssion. What recommendations should the onal and proprietary form, the rights of
doctor give to prevent exacerbations? the patients should be observed. Which of
these rights is the most significant?
A. Use of neutral creams to protect skin
B. Frequent skin washing with detergents A. The right to the protection of the
C. Systematic use of local corticosteroids patient’s interests
D. Systematic skin disinfection B. The right to the free choice
E. Avoidance of skin insolation C. The right to the information
D. The right to be heard
68. A full-term new-born suffered ante- E. The right to the protection from
and intranatal hypoxia, was born in incompetence
asphyxia (Apgar score 2-5 points). After
birth baby’s excitation is progressing, 72. A military unit stopped for 3-day’s rest
occurs vomiting, nystagmus, spasms, squi- in inhabited locality after a long march.
nt, spontaneous Babinski and Moro’s The sanitary-epidemiological reconnai-
reflexes. What is the most probable locati- ssance found several water sources. It is
on of the intracranial haemorrhage in this necessary to choose the source complyi-
case? ng with the hygienic standards for potable
water in the field
A. Subarachnoid hemorrhages
B. Small hemorrhages in brain tissue A. Artesian well water
C. Subdural hemorrhages B. Spring water
D. Periventricular hemorrhages C. River water
E. Haemorrhages in ventricles of brain D. Rain water
E. Water from melted snow
69. A patient, aged 16, complains of
headache, mainly in the frontal and 73. The district pediatrician is charged wi-
temporal areas, superciliary arch, appeari- th the analysis of infant mortality. What is
ng of vomiting at the peak of headache, taken for the unit of observation in infant
pain during the eyeballs movement, joint’s mortality investigation?
pain. On examination: excited, t0 - 390 ,
Ps- 110/min. Tonic and clonus cramps. A. A baby dead at the age up to 12 months
Uncertain meningeal signs. What is the B. A baby dead at the age up to 1 months
most likely diagnosis? C. A baby dead at the age over 28 days
D. A baby dead at the age up to 6 days
A. Influenza with cerebral edema mani- E. A baby dead at birth
festations
B. Influenza, typical disease duration 74. Chief district pediatrician has to carry
C. Respiratory syncytial virus out analysis of infant mortality rate. What
D. Parainfluenza should he take as a unit of the observati-
E. Adenovirus infection on?
70. A 64 y.o. patient has developed of

A. Child death case at the age up to 1 year out a study of morbidity rate for populati-
B. Child death case at the age up to the on which had been served at the polycli-
first month nics for the last 5 years. What statistical
C. Child death case after 28 days of life values can help in calculations of diseases
D. Child death case during first 7 days of level dissamination?
life
E. Child death case on labor A. Relative values
B. Standart values
75. A 43 y.o. patient complains of mass C. Average values
and, pain in the right breast, elevation D. Absolute values
of temperature to 37, 20 C during 3 last E. Dynamic row
months. Condition worsens before the
menstruation. On examination: edema 79. A 37 y.o. woman is suffering from
of the right breast, hyperemia, retracted squeezing substernal pain on physical
nipple. Unclear painful infiltration is exertion. On examination: AP- 130/80
palpated in the lower quadrants. What is mm Hg, heart rate=pulse rate 72 bpm,
the most probable diagnosis? heart boarders are dilated to the left side,
aortic systolic murmur. ECG- signs of the
A. Cancer of right mammary gland left venticle hypertrophy. What method
B. Right side acute mastitis of examination is the most informative in
C. Right side chronic mastitis this case?
D. Premenstrual syndrome
E. Tuberculosis of right mammary gland A. Echocardiography
B. Phonocardiography
76. A patient, aged 40, has been ill duri- C. Coronarography
ng approximately 8 years, complains of D. Sphygmography
pain in the lumbar part of the spine E. X-ray
on physical excertion, in cervical and
thoracal part (especially when coughi- 80. A child, aged 4, has being ill for 5 days,
ng), pain in the hip and knee joints on suffers from cough, skin rash, t0 - 38, 20,
the right. On examination: the body is fi- facial hydropy, photosensitivity, conjuncti-
xed in the forward inclination with head vitis. On the face, neck, upper part of the
down, gluteal muscles atrophy. Spine chest there is bright maculopapular rash
roentgenography: ribs osteoporosis, longi- with areas of merging. Hyperemic throat.
tudinal ligament ossification. What is the Seropurulent nasal discharge. In lungs
most likely diagnosis? there are dry crackles. What is the most
probable preliminary diagnosis?
A. Ancylosing spondyloarthritis
B. Tuberculous spondylitis A. Measles
C. Psoriatic spondyloarthropatia B. Adenovirus infection
D. Spondyloarthropatia on the background C. Scarlet fever
of Reiter’s disease D. Rubella
E. Spread osteochondrosis of the vertebral E. Enterovirus exanthema
column
81. There were registered 500 cases of
77. A worker, aged 38, working in the urolithiasis per 10000 inhabitants. What
slate production during 15 years, complai- kind of statictical indices is presented?
ns of expiratory exertional dyspnea, dry
cough. On examination: deafening of the A. Prevalence rate
percutory sounds in interscapular regi- B. Correlation coefficient
on, rough breath sounds, dry dissemi- C. Index of visualization
nated rales. On fingers’ skin - greyish D. Incidence rate
warts. Factory’s sectorial doctor suspects E. Index of compliance
asbestosis. Which method is the most 82. At year-end hospital administration
informative for diagnosis verification? has obtained the following data: annual
A. Thorax roentgenography number of treated patients and average
B. Bronchoscopy annual number of patient-used beds.
C. Spirography What index of hospital work can be
D. Bronchoalveolar lavage calculated based upon this data?
E. Blood gases examination
78. Deputy of chief medical officer carried
A. Bed turnover A. Right shin osteomielitis

B. Bed resources of the hospital B. Right shin tuberculosis
C. Average annual bed occupacy C. Right shin syphilis
D. Average duration of patients presence D. Bone cyst of tibia
in the hospital E. Right shin trauma
E. Average bed idle time
87. A 40 y.o. patient was admitted to
83. A 52 y.o. patient fell from 3 m hight on the gasteroenterology with skin itchi-
the ground with the right lumbar area. ng, jaundice, discomfort in the right
He complains of pain here. There is mi- subcostal area, generalized weakness. On
crohematuria in the urea. On urography examination: skin is jaundice, traces of
kidney’s functioning is satisfactory. What scratches, liver is +5 cm, splin is 6x8
is the most probable diagnosis? cm. In blood: alkaline phosphatase - 2,0
mmol/(hour*L), general bilirubin - 60
A. Kidney’s contusion mkmol/L, cholesterol - 8,0 mmol/L. What
B. Subcapsular kidney’s rupture is the leading syndrome in the patient?
C. Multile kidney’s ruptures
D. Paranephral hematoma A. Сholestatic
E. Kidney’s abruption B. Сytolytic
C. Mesenchymal inflammatory
84. A 3 y.o. child with weight deffici- D. Asthenic
ency suffers from permanent moist cough. E. Liver-cells insufficiency
There was a history of some pneumoni-
as with obstruction. On examination: di- 88. A 43 y.o. patient had cholecystectomy
stended chest, dullness on percussion over 6 years ago due to chronic calculous
the lower parts of lungs. On auscultation: cholecystitis. Lately he has suffered from
a great number of different moist rales. pain in the right subcostal area and
Level of sweat chloride is 80 mol/L. What recurrent jaundice. During last 2 weeks
is the most probable diagnosis? jaundice hasn’t gone. Stenoutic papillitis
0,5 cm in length has been revealed. What
A. Mucoviscidosis (cystic fibrosis) is the best way of treatment?
B. Bronchial asthma
C. Recurrent bronchitis A. To perform endocsopic papillosphi-
D. Bronchiectasis ncterotomy
E. Pulmonary hypoplasia B. To treat conservatively: antibiotics,
spasmolytics, antiinflammatory drugs
85. A 14 y.o. girl complains of profuse C. To perform external choledoch drain
bloody genital discharges during 10 D. To perform choledochoduodenostomy
days after suppresion of menses for 1,5 E. -
months. Similiar bleedings recur since 12
years on the background of disordered 89. A 12 y.o. child with acute
menstrual cycle. On rectal examination: glomerulonephritis presented with
no pathology on the internal genitalia. In hypertensive syndrom during first days of
blood: Нb– 70 g/L, RBC- 2, 3 ∗ 1012/L, Ht– the disease. What is the role of angiotesin
20. What is the most probable diagnosis? II in the pathogenesis?
A. Juvenale bleeding, posthemorrhagic A. Intensifies production and secretion of
anemia aldosterone
B. Werlholf’s disease B. Increases heart output
C. Polycyst ovarian syndrome C. Infibits deppresive action of
D. Hormonoproductive ovary tumor prostaglandins
E. Noncomplete spontaneous abortion D. Increases erythropoetin production
E. Increases renine level
86. A 14 y.o. patient suddenly fell ill when
high fever, acute pain in the right shin. 90. On physiologic-sanitary examinati-
In two weeks X-ray showed translucent on of railway department work it was
spaces (destructive focuses) with unevel revealed that loaders work is of III degree
countours in the middle third of tibia di- of difficulty. They unload vagons with
aphysis. Along the bone edge there was a sand, manually break coagulated mass by
narrow line of shadow (periostitis) 1-2 mm shovel and shift it. What criteria was used
from the surface. What is the most likely to evaluate work of loaders?
diagnosis?
A. Maximun load weigh which is shifted

B. Value of static loading for the shift A. To place suture on the uterus cervix
C. Time of active activities, % to the shift B. To administer tocolytic therapy
duration C. To interrupt pregnancy
D. Time of passive observation, % to the D. To administer hormonal treatment
shift duration E. To perform amniocentesis
E. Intellectual efforts
95. A district pediarician has carried out
91. A 51 y.o. woman complains of dull pain infant mortality rate analysis in his area.
in the right subcostal area and epigastric What data has been used?
area, nausea, appetite decline during 6
months. There is a history of gastric peptic A. Mortality of children under 1 y.o.
ulcer. On examination: weight loss, pulse structured by age, sex, causes
is 70 bpm, AP is 120/70 mm Hg. Diffuse B. Mortality of children under 1 y.o.,
tenderness and resistance of muscles on natimortality
palpation.There is a hard lymphatic node C. Hospital mortality of children,
1x1cm in size over the left clavicle. What structured by age
method of investigation will be the most D. Mortality of district adolescents
useful? E. Mortality of district newborn
A. Esophagogastroduodenoscopy with 96. A 26 y.o. male patient with

biopsy postoperative hypothyroidism take
B. Ultrasound examination of abdomen thyroxine 100 mg 2 times a day. He has
C. pH-metry developed tachycardia, sweating, irritabi-
D. Ureatic test lity, sleep disorder. Determine further
E. Stomach X-ray treatment tactics.
92. A man, aged 68, complains of ti- A. To decrease thyroxine dosage

redness, sweating, enlargement of cervi- B. To increase thyroxine dosage
cal, submaxillary and axillary lymph C. To administer betablockers
nodes. Blood tests: WBC - 35 ∗ D. To add mercasolil to the treatment
109 /L, lymphocytes - 60%, Botkin and E. To administer sedatives
Gumprecht bodies, level of haemoglobin
and quantity of thrombocytes is normal. 97. Body temperature of a 12 y.o. girl
Myelogram showed 40% of lymphocytes. increased up to 39−400 C in 4-5 hours after
What is the most probable diagnosis? she had taken 2 pills of aspirin. Complains
of general discomfort, dizziness, sudden
A. Chronic lympholeucosis appearance of red spots on the skin wi-
B. Chronic myeloleucosis th blister formation or exfoliation of the
C. Lymphogranulomatosis epidermis with erosive surface. Lesions
D. Acute leucosis on the skin looked like burns of II degree.
E. Tuberculous lymphadenitis Nikolsky syndrome is positive. What is the
most probable diagnosis?
93. Examination of placenta, which has
just been born, reveals defect 2x3 cm in A. Acute epidermical necrolysis
size. There is no bleeding. What tactics is B. Pemphigus vulgaris
the most reasonable? C. Polymorphic exudative erythema
D. Bullous dermatitis
A. Manual uretus cavity revision E. Duhring’s disease
B. Administration of uterotonic medicines
C. External uterus massage 98. A patient complains of pathological
D. Parturient supervision lump, appearing in the right inguinal regi-
E. Instrumental uterus cavity revision on on exercise. The lump is round-shaped,
4 cm in diameter, on palpation: soft elastic
94. A 27 y.o. gravida with 17 weeks of consistency, positions near the medial part
gestation was admitted to the hospital. of Poupart’s ligament. The lump is si-
There was a history of 2 spontaneous tuated inwards from the spermatic cord.
miscarriages. On bimanual examination: What is the most probable preliminary di-
uterus is enlarged to 17 weeks of gestati- agnosis?
on, uterus cervix is shortened, isthmus
allows to pass the finger tip. The diagnosis
is isthmico-cervical insufficiency. What is
the doctor’s tactics?
A. Right-sided direct inguinal hernia A. Anovular menstrual cycle

B. Right-sided oblique inguinal hernia B. Chronic adnexitis
C. Right-sided femoral hernia C. Abnormalities in genital development
D. Varicose veins of the right hip D. Immunologic infertility
E. Lipoma of the right inguinal area E. Genital endometriosis
99. A 52 y.o. woman complains of 103. A 43 y.o. woman complains of contact
weakness, painful itching after washing hemorrhages during the last 6 months.
and bathing, sensation of heaviness in the Bimanual exam: cervix of the uterus is
head. On examination: hyperemia of skin enlarged, restricted in mobility. Mirrors
of face, neck, extremities. АP- 180/100 showed the following: cervix of the uterus
mm Hg. Speeln is 4 cm below the rib is in the form of cauliflower. Chrobak and
arch edge. What is thechronic
most form of polycythemia ofSchiller tests are positive. What is the most
probable di-
agnosis? unknown cause, characterized probable diagnosis?
by an increase in blood volume
A. Erythremia and red blood cells, bone
A. Cancer of cervix of the uterus
B. Essential hypertension
marrow hyperplasia, redness B. Polypus of the cervis of the uterus
C. Dermatomyositis or cyanosis of the skin, and C. Cervical pregnancy
D. Allergic dermatitis enlargement of the spleen. D. Nascent fibroid
E. Systemic sclerodermia E. Leukoplakia
100. A 55 y.o. patient complains of 104. A local doctor has to prepare a
distended abdomen and rumbling, report about the health condition of the
increased winds evacuation, liguid foamy population of his region. What medical
feces with sour smell following the diary indexes of population health condition
products consumption. What is the correct should he use?
name of this syndrome?
A. Morbidity, disabilities, demographic,
A. Syndrome of fermentative dyspepsia physical development
B. Syndrome of decayed dyspepsia B. Social welfare, satisfaction of life quality
C. Syndrome of fatty dyspepsia C. Way of life, genetic, pollution
D. Dyskinesia syndrome D. Average treatment duration, compli-
E. Malabsorption syndrome cations
E. Average longevity
101. In an inhabited locality there is an
increase of diphtheria during the last 3 105. A boy, aged 9, is examined: height-
years with separate outbursts in families. 127 cm (-0,36), weight - 28,2 kg (+0,96),
What measure can effectively influence chest circumference- 64,9 cm (+0,66), lung
the epidemic process of diphtheria and vital capacity - 1520 ml (-0,16). What is the
reduce the morbidity rate to single cases? integrated assessment of the child’s physi-
cal development?
A. Immunization of the population
B. Hospitalization of patients A. Harmonious
C. Detection of carriers B. Disharmonious
D. Early diagnostics C. Markedly disharmonious
E. Disinfection in disease focus D. Excessive
E. Below the average
102. A 27 y.o. woman turns to the materni-
ty welfare centre because of infertility. 106. A 14 y.o. child suffers from of
She has had sexual life in marriage for 4 vegetovascular dystonia of pubertal peri-
years, doesn’t use contraceptives. She di- od. He has developed sympathoadrenal
dn’t get pregnant. On examination: geni- crisis. What medicine should be used for
tal development is without pathology, crisis reduction?
uterus tubes are passable, basal (rectal)
temperature is one-phase during last 3 A. Obsidan
menstrual cycles. What is the infertility B. No-shpa
cause? C. Amisyl
D. Euphyline
E. Corglicone
107. A woman complains of high
temperature to 380 C, mild pain in the
throat during 3 days. On examinati-
on: angle lymphatic nodes of the jaw 111. A 18 y.o. male patient complains of
are 3 cm enlarged, palatinel tonsils are pain in knee and ankle joints, temperature
enlarged and coated with grey plaque whi- elevation to 39, 50 C. He had a respiratory
ch spreads to the uvula and frontal palati- disease 1,5 week ago. On examination:
nel arches. What is the most probable di- temperature- 38, 50C, swollen knee and
agnosis? ankle joints, pulse- 106 bpm, rhythmic,
AP- 90/60 mm Hg, heart borders wi-
A. Larynx dyphtheria thout changes, sounds are weakened, soft
B. Infectious mononucleosis systolic apical murmur. What indicator is
C. Vincent’s angina connected with possible etiology of the
D. Agranulocytosis process?
E. Oropharyngeal candidosis
A. Antistreptolysine-0
108. A 36 y.o. patient was admitted to B. 1-antitrypsine
the hospital with sharp pain in substernal C. Creatinkinase
area following occasional swallowing D. Rheumatic factor
of a fish bone. On esophagoscopy the E. Seromucoid
foreign body wasn’t revealed. The pain
increased and localized between scapulas. 112. A 19 y.o. patient was admitted to the
In a day temperature elevated, conditi- hospital with acute destructive appendici-
on became worse, dysphagia intensified. tis. He sufferes from hemophilia B-type.
What complication has developed? What antihemophilic medicine should
be inclended in pre-and post-operative
A. Perforation of esophagus with mediasti- treatment plan?
nitis
B. Esophageal hemorrhage A. Fresh frosen plasma
C. Obstruction of esophagus B. Cryoprecipitate
D. Pulmonary atelectasis C. Fresh frosen blood
E. Aspirative pneumonia D. Native plasma
E. Dried plasma
109. A child from the first non-
complicated pregnancy but complicated 113. A 24 y.o. male patient was transferred
labor had cephalhematoma. On the to the chest surgery department from
second day there developed jaundice. general surgical department with acute
On the 3th day appeared changes of post-traumatic empyema of pleura. On
neurologic status: nystagmus, Graefe’s si- the X-ray: wide level horizontal of fluid
gn. Urea is yellow, feces- golden-yellow. on the right. What method of treatment
Mother’s blood group is (II)Rh−, child- should be prescribed?
(II)Rh+. On the third day child’s Hb is
200 g/L, RBC- 6, 1 ∗ 1012 /L, bilirubin in A. Punction and drainage of pleural cavity
blood - 58 mk mol/L due to unconjugated B. Decortication of pleura
bilirubin, Ht- 0,57. What is the child’s C. Pneumoectomy
jaundice explanation? D. Thoracoplasty
E. Lobectomy
A. Brain delivery trauma
B. Physiologic jaundice 114. A 28 y.o. homeless male was admi-
C. Hemolytic disease of newborn tted to the hospital because of initial di-
D. Bile ducts atresia agnosis "influenza". Roseolo-petechiae
E. Fetal hepatitis rash has appeared on the trunk and
internal surfaces of the limbs on the fifth
110. A gravida with 7 weeks of gestation day. Temperature is 410 C, euphoria, face
is referred for the artificial abortion. On and sclera’s hyperemia, tongue tremor,
operation while dilating cervical canal wi- tachycardia, splenomegaly, excitement.
th Hegar dilator №8 a doctor suspected What is the most probable diagnosis?
uterus perforation. What is immediate
doctors tactics to confirm the diagnosis? A. Typhus
B. Alcogolic delirium
A. Probing of uterus cavity C. Leptospirosis
B. Bimanual examination D. Measles
C. Ultrasound examination E. Abdominal typhoid
D. Laparoscopy
E. Metrosalpingography 115. A patient complains of intense pressi-
ng pain in the pharynx, mainly to the
right, impossibility to swallow even li- 119. A 30 y.o. male patient complains of
quid food. The illness started 5 days ago. itching of the skin which intensifies in the
The patient’s condition is grave. Body evening. He has been ill for 1,5 months.
temperature - 38, 90 C, speech is difficult, On examination: there is rash with paired
voice is constrained, difficulties in opening papules covered with bloody crusts on the
the mouth. Submaxillary glands to the ri- abdomen, hips, buttocks, folds between
ght are painful, enlarged. What is the most the fingers, flexor surfaces of the hand.
probable diagnosis? There are traces of line scratches. What
additional investigations are necessary to
A. Peritonsillar abscess make diagnosis?
B. Diphtheria
C. Pharyngeal tumour A. Examination of rash elements scrape
D. Vincent’s disease B. Determination of dermographism
E. Phlegmonous tonsillitis C. Serologic blood examination
D. Blood glucose
116. In a 65 y.o. female patient a tumor E. Examination for helmints
13х8 сm in size in the umbilical area
and above is palpated, mild tenderness 120. A child was delivered severely
on palpation, unmovable, pulsates. On premature. After the birth the child has
ausculation: systolic murmur. What is the RI symptoms, anasarca, fine bubbling
most probable diagnosis? moist rales over the lower lobe of the right
lung. Multiple skin extravasations, bloody
A. Abdominal aortic aneurism foam from the mouth have occured after
B. Stomach tumor the 2 day. On chest X-ray: atelectasis of
C. Arterio-venous aneurism the lower lobe of the right lung. In blood:
D. Tricuspid valve insufficiency Hb-100 g/L, Ht- 0,45. What is the most
E. Mitral insufficiency probable diagnosis?
117. A 25 y.o. woman complains of profuse A. Edematous-hemorrhagic syndrome
foamy vaginal discharges, foul, burning B. Disseminated intravascular clotting
and itching in genitalia region. She has syndrome
been ill for a week. Extramarital sexual C. Pulmonary edema
life. On examination: hyperemia of vagi- D. Hyaline membrane disease
nal mucous, bleeding on touching, foamy E. Congenital pneumonia
leucorrhea in the urethral area. What is
the most probable diagnosis? 121. A 58 y.o. male patient is examined
by a physician and suffers from general
A. Trichomonas colpitic weakness, fatigue, mild pain in the left
B. Gonorrhea subcostal area, sometimes frequent pai-
C. Chlamydiosis nful urination. Moderate splenomegaly
D. Vagina candidomicosis has been revealed. Blood test: neutrophi-
E. Bacterial vaginosis lic leukocytosis with the progress to
myelocyte; basophil- 2%; eosinophil-
118. A 18 y.o. woman consulted a 5%. There is a urate crystales in urine,
gynecologist with complaints of the pain erythrocyte- 2-3 in the field of vision.
in the lower part of the abdomen, fever What is the preliminary diagnosis?
up to 37, 50C, considerable mucopurulent
discharges from the genital tract, colic A. Chronic myeloleucosis
during urinating. After mirror and vagina B. Leukemoid reaction
examination the results are the followi- C. Lymphogranulomatosis
ng: the urethra is infiltrated, cervix of D. Hepar cirrhosis
the uterus is hyperemic, erosive. The E. Urolithiasis
uterus is painful, ovaries are painful, thi-
ckened, free. Bacterioscopy test showed 122. A 2 m.o. child was delivered at term
diplococcus. What diagnosis is the most with weight 3500 g and was on the mi-
probable? xed feeding. Current weight is 4900 g.
Evaluate the current weight of child.
A. Recent acute ascending gonorrhea
B. Trichomoniasis
C. Candydomycosis
D. Chronic gonorrhea
E. Chlamydiosis
A. Corresponding to the age all muscle groups, generalized convulsi-

B. 150 g less than necessary ons every 10-15 min. What is the most
C. Hypotrophy of I grade probable diagnosis?
D. Hypotrophy of II grade
E. Paratrophy of I grade A. Tetanus
B. Tetania
123. A 2 m.o. breast-fed child suffers from C. Meningoencephalitis
cheek skin hyperemia, sporadic papulous D. Hemorrhagic stroke
elements on the skin of the chest and E. Epilepsy
back following the apple juice introducti-
on. The child is restless. What is the initial 127. A 18 y.o. female student complains
pediatritian’s tactics? of dyspnea during the intensive exertion.
The condition became worse half a year
A. Clarify mother’s diet and exlude obli- ago. On examination: pulse rate is 88 bpm,
gate allergens accelerated, AP- 180/20 mm Hg, pale skin,
B. Refer to prescribe dermathologist heart borders are dilated to the left and
C. Administer general ultraviolet irradiati- up. There is systolic-diastolic murmur in
on the 2hd intercostal space, S2 at pulmonary
D. Treat with claritine artery is accentuated. ECG has revealed
E. Apply ointment with corticosteroids to both ventricles hypertrophy. Thoracic X-
affected skin areas ray has revealed pulsation and protrusi-
on of the left ventricle, lung trunk. What
124. A 43 y.o. woman complains of severe doctor’s tactics should be?
pain in the right abdominal side irradi-
ating in the right supraclavicular area, A. Cardiosurgeon consultation
fever, dryness and bitterness in the mouth. B. Dispensary observation
There were multiple vomitings without C. Administration of therapeutic treatment
relief. Patient relates the onset of pain to D. Continuation of investigation
the taking of fat and fried food. Physi- E. Exemption from physical exercises
cal examination: the patient lies on the
right side, pale, dry tongue, tachycardia. 128. A 35 y.o. woman is suspected of
Right side of abdomen is painful during aplastic anemia. The bone marrow puncti-
palpation and somewhat tense in right on has been administered with the di-
hypochondrium. What is the most likely agnostic purpose. What changes in the
diagnosis? marrow punctatum are suggested?
A. Perforative ulcer A. Replacement of marrow elements with
B. Acute cholecystitis adipose tissue
C. Acute bowel obstruction B. Replacement of marrow elements with
D. Acute appendicitis fibrous tissue
E. Right-sided renal colic C. Prevalence of megaloblasts
D. Presence of blast cells
125. On the 5-th day of the respiratory E. Absolute lymphocytosis
disease a 24 y.o. man has developed
progressive headaches systemic dizziness, 129. A girl, aged 13, consults the school
feeling of seeing double, paresis of mi- doctor on account of moderate bloody
mic muscles on the right, choking while discharge from the genital tracts, which
swallowing. Acute viral encephalitis has appeared 2 days ago. Secondary sexual
been diagnosed. What is the main directi- characters are developed. What is the
on of urgent therapy? most probable cause of bloody discharge?
A. Zovirax A. Menarche
B. Glucocorticoids B. Juvenile haemorrhage
C. Ceftriaxon C. Haemophilia
D. Lasix D. Endometrium cancer
E. Hemodesis E. Werlhof’s disease
126. A 65 y.o. woman complains of compli- 130. A 55 y.o. male patient complains of
cated mouth opening following foot weakness during 2 months, pain in the
trauma 10 days ago. Next day she ate with right side of the thorax, cough, blood-
difficulties, there were muscles tension of streaked sputum. On X-ray: intensive tri-
back, the back of the head and abdomen. angle shadow in the area of lower lobe
On the third day there was tension of that is connected to mediastinum. What is
the most likely disorder in the lungs? A. Aortic stenosis

B. Defect of interventricular septum
A. Central cancer of lungs C. Defect of interatrial septum
B. Tuberculosis of lungs D. Coarctation of the aorta
C. Bronchiectasia E. Open aortic duct
D. Pulmonary infarction
E. Pleuropneumonia 135. At’s planned to construct multifield
a new hospital in one of the cental city
131. In a forest summer camp children districts. What building type is the most
have variable procedures to harden their appropriate in this case?
organisms. What procedure has the most
hardening power? A. Centralized and blocked
B. Centralized
A. Contrast shower C. Decentralized
B. Morning exercises on the fresh air D. Mixed
C. Hygienic shower E. Blocked
D. Walking on the fresh air
E. Bath with hydromassage 136. A 60 y.o. patient experiences acute air
insufficiency following of the venoectomy
132. There is a dynamic growth of due to subcutaneous vein thrombophlebi-
number of congenital abnormalities such tis 3 days ago. Skin became cianotic, wi-
as central paralysis, newborns blindness, th grey shade. Marked psychomotor exci-
idiocy among the population that lives tement, tachypnea, substernal pain. What
near to pesticides production enterprise. postoperative complication has occured?
Compounds of which pollutant can cause
the development of this pathology? A. Thromboembolia of pulmonary artery
B. Hemorrhagia
A. Mercury C. Hypostatic pneumonia
B. Strontium D. Myocardial infarction
C. Cadmium E. Valvular pneumothorax
D. Iron
E. Chrome 137. A 1,5 y.o. child fell ill acutely with
high temperature 380 C, headache, fati-
133. A 7 y.o. child had elevation of gue. The temperature declined on the
temperature tol 400 C in anamnesis. For fifth day, muscular pain in the right leg
the last 3 months he presents fusiform occured in the morning, there were no
swelling of fingers, ankle joints and knee movements and tendon reflexes, sensiti-
joint, pain in the upper part of the sternum vity was reserved. What is the initial di-
and cervical part of the spinal column. agnosis?
What is the most probable diagnosis?
A. Polyomyelitis
A. Juvenile rheumatic arthritis B. Viral encephilitis
B. Rheumatism C. Polyartropathy
C. Toxic synovitis D. Osteomyelitis
D. Septic arthritis E. Hip joint arthritis
E. Osteoarthrits
138. On observation of sanitary conditions
134. A 5 y.o. child with stigmas of of studying at the technical university it
dysembryogenesis (small chin, thick li- was necessary to evaluate the visual regi-
ps, opened mouth, hyperthelorismus) has men of students, who study from 9 a.m to
systolic murmur in the second intercostal 3 p.m. What index of natural light will be
to the right of the sternum. The murmur the most informative?
passes to the neck and along the sternum
left edge. The pulse on the left brachi- A. Natural light coefficient
al artery is weakened. BP on the right B. Light coefficient
arm is 110/60 mm Hg, on the left - 100/60 C. Depth of study room
mm Hg. ECG results: hypertrophy of the D. Time of the room insolation
right ventricle. What defect is the most E. Presence of mixed (upper-lateral) light
probable? 139. A 24 y.o. woman presents with
prolonged fever, nocturnal sweating. She’s
lost weight for 7 kg during the last 3
months. She had irregular intercourses.
On examination: enlargement of all nation: heart boarders are dilated to the

lymphaden groups, hepatolienal syndrom. left side, sounds are muffled, pulse- 76
In blood: WBC- 2, 2 ∗ 109 /L. What is the bmp, rhythmic, AP- 155/80 mm Hg, ECG:
most likely diagnosis? the left type, the rest of signs are normal.
What additional examination is necessary
A. HIV-infection to confirm the diagnosis?
B. Lymphogranulomatosis
C. Tuberculosis A. Bicycle ergometry
D. Infectious mononucleosis B. Echocardiography
E. Chroniosepsis C. Blood lipoproteins
D. General blood count
140. A female rheumatic patient experi- E. Transaminases of blood
ences diastolic thoracic wall tremor (di-
astolic thrill), accentuated S1 at apex, 144. A 35 y.o. male patient suffers
there is diastolic murmur with presystolic from chronic glomerulohephritis and
intensification, opening snap, S2 accent at has been on hemodialysis for the last
pulmonary artery. What rind of heart di- 3 years. He has developed irregulari-
sorder is observed? ties in the heart activity, hypotension,
progressive weakness, dyspnea. On ECG:
A. Mitral stenosis bradycardia, 1st degree atrioventicular
B. Aortic valve insufficiency block, high sharpened T-waves. Before
C. Pulmonary artery stenosis he had severely disturbed the drinking
D. Mitral valve insufficiency and diet regimen. What is the most likely
E. Opened arterial duct cause of these changes?
141. A 31 y.o. woman has suffered from A. Hyperkaliemia
systemic sclerodermia for 14 years. She B. Hyperhydratation
was treated in hospitals many times. C. Hypokaliemia
She complains of periodical dull pain in D. Hypernatremia
the cardiac area, palpitation, dyspnea, E. Hypocalcemia
headache, eyelids swelling, weight loss,
pain and limbs deformities. Which organ’s 145. A 20 daily y.o. female patient
disorder worsens the prognosis? is suffering from chronic bronchitis.
Recently there has been production about
A. Kidneys 0,5 L of purulent sputum with maximum
B. Heart discharge in the morning. Fingers are li-
C. Lungs ke "drum sticks", there are "watching
D. Gastro-intestinal tract glass"nails. What is the most probable di-
E. Skin and joints agnosis?
142. A 70 y.o. male patient with mi- A. Bronchiectasia
ld headaches complains of speech di- B. Pneumonia
sorder, weakness in right limbs. There C. Chronic bronchitis
was a history of miocardial infarction and D. Gangrene of lungs
arrhythmia. On nu eroligical examinati- E. Tuberculosis
on there are elements of motor aphasia,
central paresis of VII and XII cranial 146. A 18 y.o. woman complains of
nerves pairs on the right side, cental type weakness, dizziness, loss of appetite,
of hemiparesis and hemihyperesthisia on menorrhagia. There are petechiae on the
the same side. What is the most probable skin of the upper extremities. Blood test:
diagnosis? Hb– 105 g/L; RBC- 3, 2 ∗ 1012 /L; coloured
index– 0,95; thromb.– 20 ∗ 109/L. The sedi-
A. Ischemic stroke mantation time according to Lee White
B. Hemorrhagic stroke is 5 ; hemorrhagia duration according to
C. Transitory ischemic attack Duke is 8 , "pinch and tourniquet"test is
D. Epidural hematoma positive. What is the most probable di-
E. Cerebral tumor agnosis?
143. A 52 y.o. male patient suffers from
squeezing pain attacks in substernal area
which irradiates to the left hand and
occurs occasionally and on physical exerti-
on. He has had it for 1 year. On exami-
A. Idiopathic thrombocytopenic purpura concentric hypertrophy of the left ventri-

B. Hemophilia cle. Ultrasound examination of the ki-
C. Hemorrhagic diathesis dneys reveals thinned cortical layer. Urine
D. Iron deficiency anemia analysis shows proteinuria of 3,5 g/day.
E. Marchiafava-Micheli’s disease What is the probable diagnosis?
147. A 30 y.o. primipara has intensive labor A. Essential arterial hypertension
pushings with an interval of 1-2 min and of B. Chronic pyelonephritis
50 sec duration. There is a appearing of C. Chronic glomerulonephritis
the fetus head. Perineum is of 4 cm hei- D. Polycystic disease of the kidneys
ght, has turned pale. What should be done E. Cushing’s disease
in this case?
152. A 28 y.o. primagravida, pregnancy
A. Episiotomy is 15-16 weaks of gestation, presents to
B. Perineum protection the maternity clinics with dull pain in
C. Perineotomy the lower part of the abdomen and in
D. Vacuum extraction of the fetus lumbar area. On vaginal examination:
E. Observation uterus cervix is 2,5 cm, external isthmus
allows to pass the finger tip. Uterus body
148. A 28 y.o. male patient was admi- is enlarged according to the pregnancy
tted to the hospital because of high term. Genital discharges are mucous, mi-
temperature 390 C, headache, generalized ld. What is the diagnosis?
fatigue, constipation, sleep disorder for 9
days. There are sporadic roseolas on the A. Threatened spontaneous abortion
abdomen, pulse- 78 bpm, liver is enlarged B. Spontaneous abortion which has begun
for 2 cm. What is the most probable di- C. Stopped pregnancy
agnosis? D. Hydatid molar pregnancy
E. Placenta presentation
A. Abdominal typhoid
B. Typhus 153. A primapara with pelvis size 25-28-
C. Sepsis 31-20 cm has active labor activity. Waters
D. Brucellosis poured out, clear. Fetus weight is 4500 g,
E. Leptospirosis the head is engaged to the small pelvis
inlet. Vasten’s sign as positive. Cervix
149. A 40 h.o. child age has hyperosthesia, of uterus is fully dilated. Amniotic sac
CNS depression, dyspepsia. Sepsis is is absent. The fetus heartbeat is clear,
suspected. What should the differential rhythmic, 136 bpm. What Positive
is the labor tacti-
Vasten' sign (if
diagnosis be made with? cs? disproportion between fetal
A. Hypoglycemia head and symphisis pubis is
A. Caesarean section prominent -
B. Hypocalcemia B. Vacuum extraction of the fetus
C. Hyperbilirubinemia C. Obstetrical forseps
D. Hyperkaliemia D. Conservative tactics of labor
E. Hypomagnesemia E. Stimulation of the labor activity
150. A 20 y.o. patient with bronchial 154. A 41 y.o. man complains of acute
asthma experiences dyspnea attacks 3-4 pain in the right side of the thorax and
times a week. Nocturnal attacks are 1 time sudden increase of dyspnea following
a week. FEV1- 50% of necessary figures, the lifting of heavy object. The patient’s
during the day it’s variations is 25%. What condition is serious: lips and mucous are
is the severity of bronchial asthma condi- cyanotic, breathing rate is 28 per min,
tion? pulse- 122 bpm., AP- 80/40 mm Hg. There
is tympanitis on percussion and weakened
A. Moderate severity condition breathing on auscultaion on the right. S2 is
B. Mild condition accentuated over pulmonary artery. What
C. Serious condition is the urgent measure on the prehospital
D. Asthmatic status stage?
E. Intermittent flow
151. A 40 y.o. man complains of headache FEV1 greater 80% of predicted= normal
in occipital area. On physical exami- FEV1 60% to 79% of predicted = Mild obstruction
nation: the skin is pale; face and hand FEV1 40% to 59% of predicted = Moderate obstruction
edema, BP- 170/130 mm Hg. On EchoCG: FEV1 less than 40% of predicted = Severe obstruction
A. Air aspiration from the pleural cavity labor?

B. Epinephrine introduction
C. Euphilline introduction A. Application of obstetrical forceps
D. Call for cardiologic team B. Stimulation of the labor activity with
E. Oxygen inhalation oxitocyne
C. Ceasarian section
155. A 6 y.o child complains of thirst, D. Application of craniodermal forceps by
polyuria, increased appetite for 2 months Ivanov’s
with weight loss for 3 kg. There has been E. Application of obstetrical cavity forceps
nocturnal enuresis during last week. On
examination: hyperglycemia 14 mol/L. 159. A 31y.o. patient has had mental
The diagnosis is diabetis mellitus I type. disorder for a long time. He suffers
What is the genesis of this disease? from insomnia for a long time. He has
developed fears, suicidal thoughts, tried
A. Autoimmune to hang himself. His mood is depressed,
B. Viral he refuses from treatment. What measures
C. Bacterial are the most expedient for the prevention
D. Neurogenic of suicide?
E. Virus-bacterial
A. Admission to the mental hospital
156. A 74 y.o. female patient complai- B. Admission to the nu erological
ns of pain, distended abdomen, nausea. department
She suffers from heart ichemia, post- C. Out-patient treatment
infarction and diffusive cardiosclerosis. D. Psychotherapeutic conversation
On examination: grave condition, di- E. Strict home supervision
stended abdomen, abdominal wall fai-
ls to take active part in breathing. On 160. A 43 y.o. woman complains of shooti-
laparoscopy: some cloudy effusion, one ng heart pain, dyspnea, irregularities in
of the bowel loops is dark-blue. What is the heart activity, progressive fatigue duri-
the most probable diagnosis? ng 3 weeks. She had acute respiratory
disease a month ago. On examination:
A. Mesenterial vessels thrombosis AP- 120/80 mm Hg, heart rate 98 bpm,
B. Volvulus heart boarders +1,5 cm left side, sounds
C. Acute intestinal obstruction are muffled, soft systolic murmur at apex
D. Ichemic abdominal syndrome and Botkin’s area; sporadic extrasystoles.
E. Erysipelas Liver isn’t palpated, there are no edema.
Blood test: WBC- 6, 7∗109/L, sedimentati-
157. A 56 y.o. man, who has taken on rate- 21 mm/hour. What is the most
alcoholic drinks regularly for 20 years, probable diagnosis?
complains of intensive girdle pain in the
abdomen. Profuse nonformed stool 2- A. Acute myocarditis
3- times a day has appeared for the last B. Climacteric myocardiodystrophia
2 years, loss of weight for 8 kg for 2 C. Ichemic heart disease, angina pectoris
years. On examination: abdomen is soft, D. Rheumatism, mitral insufficiency
painless. Blood amylase - 12g/L. Feces E. Hypertrophic cardiomyopathy
examination-neutral fat 15 g per day,
starch grains. What is the most reasonable 161. A 52 y.o. male patient has become
treatment at this stage? ill gradually. There is pain in the left si-
de of the thorax during 2 weeks, elevati-
A. Pancreatine on of temperature till 38 − 390 C. On
B. Contrykal examination: left chest side falls behind
C. Aminocapron acid in breathing movement no voice tremor
D. Levomicytine over the left lung. Dullness that is more
E. Imodium intensive in lower parts of this lung.
158. A 30 y.o. woman has second labor Right heart border is deviated outside.
which lasts for 14 hours. The fetus Sharply weakened breathing over the left
heartbeat is mufflet, arrhythmic, 100 bpm. lung, no rales. Heart sounds are mufflet,
On vaginal examination: complete cervix tachycardia. What is the most probable
dilatation, fetus head is in the area of diagnosis?
small pelvis outlet. Sagital suture is in the
direct size. The small fontanelle is at the
symphis. What is the further tactics of the
A. Exudative pleuritis Pain occured 2 days ago. On exami-

B. Spotaneous pneumothorax nation: Vis OD- 0,03, congested injecti-
C. Atelectasis of lung on of the eye ball, significant cornea
D. Cirrhotic tuberculosis edema, front chamber is deep, pupil
E. Infarction-pneumonia is narrow, athrophic iris, there is optic
nerve excavation on the eye fundus,
162. A mother of a newborn child suffers intraocular pressure- 38 mm Hg. Vis OS-
from chronic pyelonephritis. She had 0,8 unadjustable. The eye is calm, healthy.
acute respiratory viral disease before Intraoccular pressure- 22 mm Hg. What is
the labor. Labor in time, with prolonged the most probable diagnosis?
period without waters. A child had
erythematous eruption on the 2 day, A. Acute glaucoma attack
then there were seropurulent vesicles B. Right eye’s uveitis
about 1cm. Nikolsky’s symptom is posi- C. Right eye’s keratitis
tive. Erosions have occured after vesi- D. Eye nerve’s neuritis
cle rupture. The child is flabby. The E. Maculodystrophy
temperature is subfebrile. What is the
most probable diagnosis? 166. A 41 y.o. woman has suffered from
nonspecific ulcerative colitis during 5
A. Newborn pemphigus years. On rectoromanoscopy: marked
B. Vesiculopustulosis inflammatory process of lower intesti-
C. Pseudofurunculosis nal parts, pseudopolyposive changes of
D. Sepsis mucous. In blood: WBC- 9, 8 ∗ 109 /L,
E. Ritter’s dermatitis RBC- 3, 0 ∗ 1012 /L, sedimentation rate-
52 mm/hour. What medication provides
163. A child was born at 34 weeks of pathogenetic treatment of this patient?
gestation in bad condition. The cardi-
nal symptoms show respiratoty disorders: A. Sulfasalasine
sound prolonged expiration, additional B. Motilium
muscles taking part in breathing, crepitati- C. Vikasolum
on rales on the background of the rough D. Linex
breath sounds. Assesment according to E. Kreon
Silverman’s scale was 0, in 3 hours- 6 with
presence of clinical data. What diagnostic 167. A 49 y.o. female patient presents wi-
method can determine pneumopathy’s th acute attacks of headache associated
type in the child? with pulsation in temples, increasing AP
to 280/140 mm Hg. Pheochromocytoma
A. Chest X-ray is suspected. What is the mechanism of
B. Blood test hypertensive crisis in this patient?
C. Blood gases
D. Proteinogram A. Increasing of catecholamines
E. Immunologic investigation concentration
B. Increasing of aldosterone level in blood
164. During intramuscular DTP vaccinati- C. Increasing of plasma renin activity
on in clinic, a 3 m.o. child developed si- D. Increasing of vasopressin excretion
gns of laryngospasm, paleness of skin, E. Increasing of thyroxine excretion
cyanosis of lips, "cock cry", stop of respi-
ration, tension of the whole body with 168. To replace the blood loss replacement
overturned backward head. Allergologi- 1000 ml of the same group of Rhesus-
cal history of the child is not complicated. compatible donated blood was transfused
What is the most probable diagnosis? to the patient. The blood was conserved
by sodium citrate. At the end of
A. Spasmophilia, tonic spasms hemotransfusion there appeared exci-
B. Anaphylactic shock, clonic spasms tement, pale skin, tachycardia, muscles
C. Meningoencephalitic reaction, clonic cramps in the patient. What complicati-
and tonic spasms on should be suspected?
D. Cerebral haemorrhage, tonic spasms
E. Meningism, clonic and tonic spasms A. Citrate intoxication
B. Citrate shock
165. A 60 y.o. man complains of signifi- C. Allergic reaction
cant pain in the right eye, photophobia, D. Anaphylactic shock
lacrimation, reduced vision of this eye, E. Pyrogenous reaction
headache of the right part of the head.
169. A 20 y.o. patient suddely felt ill 12 A. Arteriosclerosis obliterans

hours ago. There was pain in epigactric B. Obliterating endarteritis
area, nausea, sporadic vomiting. He had C. Hemoral arthery thombosis
taken alcohol before. In few hours the D. Raynauld’s disease
pain localized in the right iliac area. On E. Buerger’s disease (thromboangiitis
examination: positive rebound tenderness obliterans)
symptoms. WBC- 12, 2 ∗ 109/L. What is the
most probable diagnosis? 173. A patient had macrofocal myocardial
infarction. He is overweight for 36%, AP
A. Acute appendicitis is 150/90 mm Hg, blood sugar- 5,9 mmol/L,
B. Acute pancreatitis general cholesterol- 4,9 mmol/L, uric acid-
C. Perforated ulcer 0,211 mmol/L. Which risk factor should be
D. Rightside kidney colic urgently eradicated during the secondary
E. Acute cholecystitis prevention?
170. A patient, aged 58, was fishing in A. Obesity
the winter. On return home after some B. Arterial hypertension
time felt some pain in the feet. Consulted C. Hyperglycemia
a doctor. On examination: feet skin was D. Hypercholesterolemia
pale, then after rewarming became red, E. Hyperuricemia
warm to the touch. Edema is not signifi-
cant, limited to the toes. All types of sensi- 174. A 2 y.o. boy was admitted to the
tivity are preserved. No blisters. What hospital with weight loss, unstable di-
degree of frostbite is observed? scharges, anorexia, following the semoli-
na’s introduction (since 5 months). The
A. I degree child is adymanic, flabby, pale dry skin,
B. II degree subcutaneous layer is emaciated. Di-
C. III degree stended and tensed abdomen, tympani-
D. IV degree tis on percussion of the upper part of
E. V degree the abdomen, splashing sounds, feces
are foamy, of light color, foul. On
171. A 24 y.o. emotionally-labile woman coprocytogram: a lot of neutral fat. What
presents with irritation, depressed mood, is the cause of the disease?
palpitation, shooting pain in the heart
area, generalized fatigue following A. Celiakia (celiac disease)
the divorce. On examination: palm B. Mucoviscidosis (cystic fibrosis)
hyperhydrosis, pulse rate- 72-78 bpm, labi- C. Intestinal dysbacteriosis
le, heart without changes. ECG is normal. D. Chronic enteritis
What is the most probable pathology in E. Disaccharidase insufficiency
this case?
175. On medical observation a doctor
A. Neurasthenia identified girl (162 cm tall and 59 kg wei-
B. Ipochondric neurosis ght) who complained loss of ability to see
C. Compulsive neurosis surrounding objects clearly in the evening.
D. Schizophrenia On examination: dry skin, hyperkeratosis.
E. Depressive neurosis Her daily ration includes the following vi-
tamines: vitamine А– 0,5 mg, vit.1 – 2,0
172. A 98 y.o. male patient complai- mg, vit.2 – 2,5 mg, vit.6 – 2 mg, vit.С– 70
ns of pain in the left lower limb whi- mg. What is the hypovitaminosis type?
ch intensifies on walking, feeling of cold
and numbness in both feet. He has been A. A-hypovitaminosis
ill for 6 years. On examination: pale B. B1 -hypovitaminosis
dry skin, hyperkeratosis. Hairy coveri- C. B2 -hypovitaminosis
ng is poorly developed on the left shin. D. B6 -hypovitaminosis
"Furrow symptom "is positive on the left. E. C-hypovitaminosis
Pulse on foot arteries and popliteal artery
isn’t palpated, on the femoral artery it’s 176. A woman in labor, on vaginal
weak. On the right limb the artery pulsati- inspection: cervix dilation is up to 2 cm,
on is reserved. What is the most probable fetal bladder is intact. Sacral cavity is
diagnosis? free, sacral promontory is reachable only
with a bent finger, the inner surface of
the sacrococcygeal joint is accessible for
inspection. The head of the fetus presents. with bread, shoes in her underwear in
Sagittal suture occupies the transverse di- her bosom as well as "invaluable books".
ameter of pelvic inlet, the small fontanel What is the most probable diagnosis?
to the left, on the side. What labor stage is
this? A. Senile dementia
B. Atherosclerotic (lacunar) dementia
A. Cervix dilation stage C. Presenile melancholia
B. Preliminary stage D. Behaviour disorder
C. Prodromal stage E. Dissociated personality (psychopathy)
D. Expulsion of fetus stage
E. Placental stage 181. A 29 y.o. patient was admitted to
the hospital with acute girdle pain in epi-
177. A 30 y.o. patient had deep burn gastric area, vomiting in 1 hour after the
covering 30% of body 30 days ago. Now meal. On examination: pale, acrocyanosis.
he presents with continued fever, loss of Breathing is frequent, shallow. Abdomi-
appetite, night sweats. Burned surface nal muscles are tensed, positive Schotkin-
weakly granulates. What is the stage of Blumberg’s symptom. What is the maxi-
burn disease? mal term to make a diagnosis?
A. Septicotoxemia A. In 2 hours
B. Primary burn shock B. In 0,5 hours
C. Secondary burn shock C. In 1 hour
D. Acute burn toxemia D. In 3 hours
E. Convalescence E. In 6 hours
178. A 45 y.o. woman complains of contact 182. A 33 y.o. patient was admitted to
bleedings during 5 months. On speculum the hospital with stopped recurrent peptic
examination: hyperemia of uterus cervix, ulcer bleeding. On examination he is
looks like cauliflower, bleeds on probi- exhausted, pale. Нb– 77 g/L, Нt– 0,25.
ng. On bimanual examination: cervix is Due to anemia there were two attempts of
of densed consistensy, uterus body isn’t blood transfution of identical blood group
enlarged, mobile, nonpalpable adnexa, ()Rh+. Both attempts were stopped
parametrium is free, deep fornixes. What because of anaphylactic reaction. What
is the most likely diagnosis? blood transfution environment is desi-
rable in this case?
A. Cancer of cervix of uterus
B. Cancer of body of uterus A. Washed erythrocytes
C. Fibromatous node which is being born B. Freshcitrated blood
D. Cervical pregnancy C. Erythrocyte mass (native)
E. Polypose of cervix of uterus D. Erythrocyte emulsion
E. Erythrocyte mass poor for leucocytes
179. A female, aged 20, after smoking and thrombocytes
notices a peculiar inebriation with the
feeling of burst of energy, elation, irreality 183. A 19 y.o. boy was admitted to the
and changing of surroundings: the world hospital with closed abdominal trauma.
gets full of bright colours, the objects On operation multiple ruptures of spleen
change their dimensions, people’s faces and small intestine were revealed. AP
get cartoon features, loss of time and is falling, it is necessary to perform
space judgement. What is the most likely hemotransfusion. Who can determine
diagnosis? patient’s blood group and rhesus compati-
bility?
A. Cocainism
B. Morphinism A. A doctor of any speciality
C. Barbiturism B. A laboratory physician
D. Nicotinism C. A surgeon
E. Cannabism D. A traumotologist
E. An anaesthesilogist
180. A 75 y.o patient can not tell the
month, date and season of the year. After 184. A 27 y.o. woman suffers from
long deliberations she manages to tellher pyelonephritits of the only kidney. She
name. She is in irritable and dissatisfi- presents to the maternity welfare centre
ed mood. She always carries a bundle because of suppresion of menses for 2,5
with belongings with her, hides a parcel months. On examination pregnancy 11
weeks of gestation was revealed. In uri- in the gastroenterological unit. 2 weeks

ne: albumine 3,3 g/L, leucocytes cover the later developed constant pain, increasing
field of vision. What is doctor’s tactics in and resistant to medication. The abdomen
this case? is painful in epigastric area, moderate
defence in pyloroduodenal area. Which
A. Immediate pregancy interruption complication development aggravated the
B. Pregnancy interruption after urine patient’s state?
normalization
C. Maintenance of pregnancy till 36 weeks A. Malignisation
D. Pregnancy interruption at 24-25 weeks B. Penetration
E. Maintenance of pregnancy till delivery C. Perforation
term D. Haemorrhage
E. Stenosis
185. A 35 y.o. female patient was admitted
to the surgical department with symptoms 189. A 54 y.o. male patient suffers from
of ulcerative gastric hemorrhage. It’s been dyspnea during mild physical exertion,
the third hemorrhage for the last 2 years. cough with sputum which is excreted
After conservative treatment vomiting wi- with diffculty. On examination: diffuse
th blood stopped, hemoglobin elevated cyanosis. Is Barrel-chest. Weakened vesi-
from 60 till 108 g/L. General conditi- cular breathing with prolonged expirati-
on became better. But profuse vomiti- on and dry whistling rales. AP is 140/80
ng with blood reoccured in 2-3- hours. mm Hg, pulse is 92 bpm, rhythmic. Spi-
Hemoglobin decreased to 93,1 g/L then to rography: vital capacity (VC)/predicted
58,1 g/L. What is the tactics of treatment? vital capacity- 65%, FEV1/FVC– 50%.
Determine the type of respiratory insuffi-
A. Urgent surgery ciency (RI).
B. Deferred surgery
C. Conservative treatment A. RI of mixed type with prevailing
D. Conservative treatment with following obstruction
surgery B. RI of restrictive type
E. Taylor’s treatment C. RI of obstructive type
D. RI of mixed type with prevailing resri-
186. A victim of a road accident, aged 44, ction
is operated on account of intraperitoneal E. There is no RI
haemorrhage. In which case can the pati-
ent’s blood from the abdominal cavity be 190. A patient aged 18 with a cranial injury
used for autotransfusion? was in comatose state during several
hours. In post-comatose period gets ti-
A. Stomach rupture red quickly, non-productive in dialog - in
B. Bladder rupture the beginning answers 2-3 questions, then
C. Liver rupture gets tired and can not understand the poi-
D. Splenic rupture nt of the question. Which psychotropic
E. Small intestines rupture should be given to the patient to prevent
187. A man, aged 30, complains of intense psychoorganic syndrome?
pain, reddening of skin, edema in the A. Nootropics
ankle-joint area, fever up to 390 . Sudden B. Neuroleptics
onset of the illness. In the past there were C. Stimulators
similar attacks lasting 5-6 days without D. Tranquillisers
residual changes in the joint. The skin E. Antidepressants
over the joint is hyperemic without defi-
nite borders and without infiltrative bank 191. A 25 y.o. patient was admitted with
on the periphery. What is the most likely chest trauma. Clinical and X-ray exami-
diagnosis? nation have revealed tense pneumothorax
on the left. What emergency treatment
A. Gout should be undertaken?
B. Infectional arthritis
C. Rheumatoid arthritis A. Pleural cavity drainage
D. Erysipelatous inflammation B. Intravenous infusions
E. Osteoarthritis C. Oxigenotherapy
D. Intubation
188. A patient, aged 25, suffering from E. Analgetics
stomach ulcer. Had a course of treatment
192. A 38 y.o. patient complains of pain in 197. A 2,5 m.o. child presents with muscle
lumbar part of spinal column with irradi- hypotonia, sweating, alopecia of the back
ation to the back surface of the left leg of the head. The child is prescribed
following the lifting of a heavy object. massage, curative gymnastics and vitamin
Pain is increasing on change of the body D. What is the dosage and frequency of
position and in vertical position. positi- vitamin D administration?
ve stretching symptoms were revealed on
examination. What is an initial diagnosis? A. 3000 IU daily
B. 500 IU daily
A. Intervertebral ligaments disorder C. 1000 IU daily
B. Spinal cord tumor D. 500 IU every other day
C. Arachnomielitis E. 1000 IU every other day
D. Polyneuritis
E. Myelopathy 198. A 43 y.o. male complains of stomach
pain, which relieves with defecation,
193. A child is being discharged from and is accompanied by abdominal wi-
the surgical department after conservati- nds, rumbling, the feeling of incomplete
ve treatment of invagination. What evacuation or urgent need for bowel
recommendations should doctor gi- movement, constipation or diarrhea
ve to mother to prevent this disease in alternation. These symptoms have
recurrence? lasted for over 3 months. No changes in
laboratory tests. What is the most likely
A. Strict following of feeding regimen diagnosis?
B. Common cold prophilaxis
C. Feces observation A. Irritable bowel syndrome
D. Gastro-intestinal disease prevention B. Spastic colitis
E. Hardening of the child C. Colitis with hypertonic type dyskinesia
D. Chronic enterocolitis, exacerbation
194. A male patient presents with swollen phase
ankles, face, eyelids, elevated AP- 160/100 E. Atonic colitis
mm Hg, pulse- 54 bpm, daily loss of
albumine with urine- 4g. What therapy 199. After delivery and revision of
is pathogenetic in this case? placenta there was found the defect
of placental lobe. General condition of
A. Corticosteroids woman is normal, uterine is firm, there is
B. Diuretics moderate bloody discharge. Inspection of
C. NSAID birth canal with mirrors shows absence
D. Calcium antagonists of lacerations. What is the following
E. Antibiotics necessary action?
195. During dynamic investigation of a A. Manual exploration of the uterine
patient the increase of central venous cavity
pressure is combined with the decrease of B. External massage of uterus
arterial pressure. What process is proved C. Use of uterine contracting agents
by such combination? D. Urine drainage, cold at lower abdomen
E. Use of hemostatic medications
A. Increase of bleeding speed
B. Developing of cardiac insufficiency 200. A patient, aged 81, complains of
C. Shunting constant urinary excretion in drops, feeli-
D. Depositing of blood in venous channel ng of fullness in the lower abdomen.
E. Presence of hypervolemia On examination: above pubis there is a
spherical protrusion, over which there is
196. A male patient complains of a dullness of percussion sound, positi-
heartburn which gest stronger while ve suprapubic punch. What symptom is
bending the body, substernal pain duri- observed in this patient?
ng swallowing. There is a hiatus hernia on
X-ray. What disoeder should be expected A. Paradoxal ischuria
at gastroscopy? B. Urinary incontinence
C. Dysuria
A. Gastroesophageal reflux D. Enuresis
B. Chronic gastritis E. Pollakiuria
C. Gastric peptic ulcer
D. Acute erosive gastritis
E. Duodenal peptic ulcer

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Krok 2 Medicine 2005 1

1. The physician must undertake 6. Define the basic registration document

can develop from this diet? dened, deformed, location of segments

of irregular type. There is the area of A. Subacute bacteria endocarditis

of pain in the frist three fingers of her right

A. Systemic lupus erythematosus A. Acute infectious croup due to viral

A. Impaired extrauterine pregnancy through out. What disease should a doctor

70. A 64 y.o. patient has developed of

A. Bed turnover A. Right shin osteomielitis

A. Maximun load weigh which is shifted

A. Esophagogastroduodenoscopy with 96. A 26 y.o. male patient with

92. A man, aged 68, complains of ti- A. To decrease thyroxine dosage

A. Right-sided direct inguinal hernia A. Anovular menstrual cycle

A. Corresponding to the age all muscle groups, generalized convulsi-

the most likely disorder in the lungs? A. Aortic stenosis

On examination: enlargement of all nation: heart boarders are dilated to the

A. Idiopathic thrombocytopenic purpura concentric hypertrophy of the left ventri-

A. Air aspiration from the pleural cavity labor?

A. Exudative pleuritis Pain occured 2 days ago. On exami-

169. A 20 y.o. patient suddely felt ill 12 A. Arteriosclerosis obliterans

weeks of gestation was revealed. In uri- in the gastroenterological unit. 2 weeks

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