Krok 2 Medicine 1

1. A man with a stab-wound of the right direct - 26µmol/L, indirect - 44µmol/L.

foot applied to doctor. He stepped on the АSТ - 6,2 mmol/L, АLТ - 4,8 mmol/L.
board with nail two hours ago. In the pati- What mechanism underlies the transami-
ent medical chart it is stated that 3 years nase level increase of this patient?
ago he passed the whole course of vacci-
nation against tetanus. What is the tactics A. Intrahepatic cholestasis
of doctor to prevent tetanus in this case? B. Cytolysis of hepatocytes
C. Hypersplenism
A. Administer 3000 U of anti-tetanic D. Failure of the synthetical function of the
serum liver
B. Do not conduct specific prophylaxis E. Failure of bilirubin conjugation
C. Administer 0,5 ml of tetanus toxoid
D. Administer 1,0 ml of tetanus toxoid 6. A 28-year-old man was discharged
E. Administer 1 ml tetanus toxoid and from the hospital after having an out-of
3000 U of anti-tetanic serum -hospital pneumonia. He has no complai-
nts. On physical exam: his temperature is
2. A 9-year-old girl has an average height −36, 60 C, RR-18/min, Ps - 78 bpm, BP-
and harmonic growth development. She 120/80 mm Hg. During ausculation there
was ill with acute respiratory infection for is harsh respiration to the right of the
five times. Define the group of her health. lower part of the lung. Roentgenologi-
cally: infiltrative changes are absent,
A. 5th group intensification of the pulmonary picture
B. 4th group to the right in the lower lobe. How long
C. 2nd group should the doctor keep the patient under
D. 1st group observation?
E. 3rd group
A. 3 months
3. A 65-year-old patient complains of pain B. Permanently
in the right half of face, headache, ri- C. 6 months
se in temperature. He is sick for 3 days, D. 12 months
speaks of the disease due to being in E. 1 month
cold. On physical exam: in the right half
of forehead skin there is inflammatory 7. In 30days, after accidental coitus a
hyperemia, edema. Erosions with necrotic 25-year-old patient developed ulcers on
coating are on places of vesicles. There penis. On physical exam: inside of prepuce
are vesicles with inflammatory hyperemia there is painless round erosion, 1,5 cm
along the border of the nidus. What in diameter, with dense bottom, with
pathology is meant in this case? even edges, without evident inflammatory
changes. What is the most probable di-
A. Eczema agnosis?
B. Lichen planus erythematosus
C. Dermatitis A. Primary syphilis (hard chancre)
D. Herpes zoster B. Herpes simplex
E. Erysipelas C. Chancriform pyoderma
D. Chancroid (soft chancre)
4. A patient undergoes inpatient E. Scabies complicated with pyococcuses
treatment with the diagnosis of acute
pancreatitis. To spare pancreas as much 8. A 58-year-old patient was diagnosed
as possible the doctor prescribed for him basal-cell skin cancer, 1st stage. Tumor is
starvation for 1-3 days. What products is up to 1 cm in size and with up to 0,5 cm
the patient allowed to eat during recovery deep infiltration in tissues. Tumor is locali-
period after cancelling of starvation? zed in the right nasolabial area. Choose
the most optimal method of treatment.
A. Milk
B. Boiled meat A. Surgical treatment
C. Broth B. Short-distance roentgenotherapy
D. Grape juice C. Long-distance roentgenotherapy
E. Potato and carrot mash D. Long-distance gamma therapy
E. Chemotherapy
5. A 10-year-old child is sick with chronic
viral hepatitis B with marked activity of 9. A 25-year-old man has focal shadowings
the process. Total bilirubin - 70µmol/L, of small and medium intensity, unequal
 Krok 2 Medicine 2

contours in 1st and 2nd segments of and faeces. The discharged blood is of
the right lung revealed during routi- dark red color, sometimes with small
ne fluorography. What clinical form of amount of clots. The patient is sick for
tuberculosis can be suspected in this pati- 8 months, has lost some weight. On digital
ent? examination, there is a round constriction
of the rectum with infiltrate at a height of
A. Focal 4-5 cm from the anus. What is the most
B. Tuberculoma probable diagnosis?
C. Miliary
D. Disseminated A. Non-specific ulcer colitis
E. Fibro-cavernous B. Chronic paraproctitis
C. Cancer of the medium-ampullar section
10. A woman is admitted to maternity of the rectum
home with discontinued labor activity and D. Crohn’s disease
slight bloody discharges from vagina. The E. Cicatricial stenosis of the rectum
condition is severe, the skin is pale, consci-
ousness is confused. BP is 80/40 mm Hg. 14. District physician was charged wi-
Heartbeat of the fetus is not heard. There th plan drafting concerning medical and
was a Cesarian section a year ago. Could preventive measures among the populati-
you please determine the diagnosis? on in the area he is assigned to. What
measures must he include in this plan as
A. Hysterorrhesis regards primary prevention of illness?
B. Expulsion of the mucous plug from
cervix uteri A. Measures to improve patients’ life
C. Cord presentation conditions
D. Premature expulsion of amniotic fluid B. Measures to increase patients’ life
E. Placental presentation quality
C. Prevention of disease complications
11. A 72-year-old patient after operati- D. Prevention of disease onset
on due to holecystectomia was prescri- E. Referral of patients to sanatorium
bed gentamicin (80 mg every 8 hours) and
cephalothin (2 g every 6 hours) due to 15. A 4-year-old boy in 2 weeks after the
fever. In 10 days there was an increase of tonsillitis had edema, headache, vomiti-
creatinine up to 310µmol/L. BP - 130/80 ng three times per day. On physical exam:
mm Hg, daily quantity of the urine is 1200 rise of blood pressure, urine is of meat
mL. Urine tests are without pathology. slops color. What is the most probable di-
Ultrasound: the size of kidneys is normal. agnosis?
What is the most probable reason for
renal failure? A. Cystitis
B. Interstitial nephritis
A. Hepatorenal syndrome C. Glomerulonephritis
B. Cortical necrosis of kidneys D. Pyelonephritis
C. Nephrotoxity of gentamicin E. Urethritis
D. Unequal infusion of the liqiud
E. Acute glomerulonephritis 16. A 29-year-old woman has had a
surgical treatment concerning the beni-
12. For persons who work in a zone of fai- gn serous epithelial tumour of the ovary.
lure on nuclear object, the greatest risk The postoperative period passed wi-
of development within the first decade is thout complications.What is necessary to
represented by cancer. By what cancer it prescribe in the rehabilitational period?
is represented?
A. No further observation
A. Breast B. Laser therapy and enzyme therapy
B. Lung C. Antibacterial therapy and adaptogens
C. Thyroid gland D. Magnetic therapy and vitamin therapy
D. Reproduction system organs E. Hormone therapy and proteolytic
E. Skin enzymes
13. A 65-year-old patient complains of 17. A rounded shadow with well-defined
dull pain in the rectum during and after outlines was found at the costo-vertebral
defecation, discharge of mucus and small angle on a chest X-ray of a healthy 9-year-
amount of blood mixed up with mucus old girl. Could you please make the preli-
 Krok 2 Medicine 3

minary diagnosis?
A. The patient in a postoperative period
A. Ganglionevroma B. Blood sugar level
B. Sympatoblastoma C. Blood test
C. Sympatogonioma D. The patient who was discharged to
D. Ganglioneuroblastoma outpatient treatment
E. Sarcoma of the vertebra E. The patient who has a wound surface
18. A 20-year-old adolescent lives in 22. Parents of a 2-year-old boy applied to
the nidus of tuberculous infection. The clinic complaining of right testicle absence
tuberculine Mantoux test with 2 TU in the scrotum of a boy. While examining
was determined as hyperergic. What si- the boy, hypoplasia of the right half of
gns determine the hyperergic test of this the scrotum was revealed, absence of the
adolescent? testicle. Testicle is miniaturized, it palpi-
tates along the inguinal canal but it could
A. 24 mm hyperemia not be moved down to scrotum. What is
B. 4 mm papula the most probable diagnosis?
C. 12 mm hyperemia
D. 20 mm papula A. Right-sided cryptorchism, inguinal
E. 6 mm papula, necrosis form
B. Right-sided cryptorchism, abdominal
19. A 27-year-old patient was brought to form
clinic with a crashed wound of the posteri- C. Retraction of the right testicle
or surface of the right shin in 2 hours (pseudocryptorchism)
after the accident happened. During surgi- D. Left-sided monorchism
cal treatment pieces of dirty clothes and E. Ectopia of the right testicle, pubic form
gravel were removed. What actions from
the given below are the decisive ones to 23. A 24-year-old man on the second
prevent an anaerobic infection? day of the disease with a sudden onset
complains of a strong headache in temples
A. Introduction of the preventive dose of and in the area of orbits, dull pain in the
an anti-gangrene serum body, dry painful cough. His temperature
B. Introduction of the medical dose of the is 390 C. Adynamic. Mucous membrane
anti-gangrene serum of oropharynx is "flaming", rales are not
C. Radical surgical treatment ausculated. What is the most probable di-
D. Hyperbaric oxygenation agnosis?
E. Rational antibiotic therapy
A. Influenza
20. A 30-year-old patient who suffered B. Pneumonia
from headaches, while lifting a heavy C. Parainluenza
subject up, felt an intense headache in D. Respiratory mycoplasmosis
the form of the blow on his head. There E. Meningococcus infection
appeared nausea, vomiting, light dizzi-
ness. In a day there was an objectively 24. A sample of milk was taken for testi-
presented meningial syndrome, t- 37, 60C. ng from a 5 ton milk batch. Lab analysis
The doctor have suspected subarachnoi- showed the following: fat content 2%,
dal hemorrhage. What additional exami- specific density-1,04 g/cm3 , acidity 210 C,
nation is necessary to do to confirm the reductase probe – weak positive. What
diagnosis? way the product is to be used in? What
would you advise?
A. Roentgenography of the cranium
B. Cerebral angiography A. Utilize technically
C. Rheoencephalography B. Annihilate the product
D. Computed tomography C. Sell without limitations
E. Lumbar puncture with liquor exami- D. Write the product off for animal feeding
nation E. Sell but inform customers about milk
quality
21. Point out the unit for statistical
observation for the determination of 25. A 75-year-old patient can not tell the
blood sugar level influence on a wound month, date and season of the year. After
surface healing during postoperative peri- long deliberations she manages to tell
od. her name. She is in irritable and dissati-
 Krok 2 Medicine 4

sfied mood. She always carries a bundle A. Lipoma of the right inguinal part
with belongings with her, hides a parcel B. Varicose veins of the right thigh
with bread, shoes in her underwear in C. Right-sided femoral hernia
her bosom as well as "invaluable books". D. Right-sided direct inguinal hernia
What is the most probable diagnosis? E. Right-sided indirect inguinal hernia
A. Behavior disorder 29. During the examination of the
B. Dissociated personality (psychopathy) placenta which was just born, the
C. Presenile melancholia defect of 2х3 cm was found.There is no
D. Senile dementia hemorrhage. What is the most appropri-
E. Atherosclerotic(lacunar) dementia ate tactics?
26. A 35-year-old patient complains of A. To prescribe uterotonic medications
BP rise, headache, tinnitus, tachycardia. B. External massage of the uterus
On physical examination, Ps -100 bpm, C. Instrumental revision of the uterine
rhythmical, intensive. BP - 240/100 mm cavity
Hg. Left border of the relative cardiac D. Hand revision of the uterine cavity
dullness is moved to the left for 1 cm, E. Observation of woman after labor
Sound I on the apex is weakened, accent
of the Sound IInd - on aorta. Rough 30. In 2 weeks after pharyngitis a 25-
systolic murmur is ausculated on each si- year-old patient started complaining of
de of the umbilicus. What pathology could rise in temperature to 380 C, fatigue,
cause this clinical picture? shortness of breath during walking, mi-
grating joint intumescence and pain . On
A. Stenosis of renal arteries physical exam: cyanosis of lips, pulse is
B. Chronic glomerulonephritis weak, rhythmical, 100 bpm. The left heart
C. Essential hypertension border is moved outwards from medi-
D. Nephroptosis aclavicular line for 1 cm. Sound I on the
E. Conn’s syndrome apex is weakened, soft systolic murmur
is ausculated. What ethiological factor
27. A 22-year-old man with polyarthralgia caused this pathological process in the
and high-grade fever has right-sided most probable way?
exudative pleuritis. Roentgenologically,
down to the right of the 4th rib there is A. Staphylococcus
a homogeneous dark cloud. To the left, in B. Fungus
the second segment - an isolated dense- C. Virus
focused shadow. Mantoux test with 2 ТU: D. Pneumococcus
16 mm papula. The protein content in the E. Beta hemolytic streptococcus
pleural fluid is increased, Rivalt reaction
is positive, increased amount of leucocytes 31. A 40-year-old patient is sick for 8
with lymphocyte predomination. What is years. He complains of pain in the loin
the most probable etiology of pleuritis? region during physical work, in neck and
thorax parts especially during cough, pain
A. Cancerous in the right hip and joints. On physical
B. Staphylococcal exam: body is fixed in the positon of incli-
C. Tuberculous ne forward with the head pulled down,
D. Autoimmune atrophy of the gluteus. What is the most
E. Viral probable diagnosis?
28. A patient complains of pathological A. Spondyloarthropatia on the background
mass in the right inguinal part during of Reiter’s disease
physical work. The mass is round, about B. Psoriatic spondyloarthropatia
4 cm in diameter, during palpation is of C. Spread osteochondrosis of the vertebral
soft and elastic consistence, located at the column
medial part of the inguinal ligament. This D. Tuberculous spondylitis
mass is situated medial to seminal funi- E. Ancylosing spondyloarthritis
culus. What is the preliminary diagnosis?
32. In 10 min after childbirth by a
22-year-old woman, the placenta was
spontaneousely delivered and 100 ml of
blood came out. Woman weight - 80 kg,
infant weight - 4100 g, length - 53 cm.
 Krok 2 Medicine 5

The uterus contracted. In 10 minutes the A. In the plane of outlet from the minor
hemorrhage renewed and the amount of pelvis
blood constitued 300 ml. What amount of B. In the plane of the narrow part of minor
blood loss is permissible for this woman? pelvis
C. Big segment in the plane of inlet into
A. 500 ml minor pelvis
B. 400 ml D. In the plane of the wide part of minor
C. 1000 ml pelvis
D. 300 ml E. By small segment in the plane of inlet
E. 650 ml into minor pelvis
33. A 32-year-old patient complains of 36. A 27-year-old patient was admitted
severe weakness, tremor of extremities. to the psychiatric hospital for the 4-th
On physical examination, there is loss of time during 2 years. He heard voices
body weight, wet and warm skin. The commenting on his actions, had delusi-
thyroid gland is enlarged up to the 3rd ons of persecution (was sure that mafia
degree, painless, elastic. Ps: 108 bpm. BP- wanted to kill him). He was discharged
160/55 mm Hg. The rest is in norm. What from hospital with the diagnosis of schi-
can be diagnosed? zophrenia, state of remission after a
course of treatment with neurolepti-
A. Toxiferous adenoma of the thyroid cs. What is necessary to do to prevent
gland relapses of schizophrenia?
B. Chronic autoimmune thyroiditis,
hypertrophic type A. Psychoanalytic treatment
C. Chronic fibrous thyroiditis B. Participation in a self-assistance group
D. Diffuse euthyroid goitre of the 3rd C. Supportive treatment with neuroleptics
degree of prolonged action
E. Diffuse toxic goitre of the 3rd degree, D. Psychiatric observation
thyrotoxicosis of the average degree E. Long-term hospitalization
34. A 37-year-old patient has sudden acute 37. A 37-year-old patient was brought to
pain in the right epigastric area after havi- resuscitation unit. General condition of
ng fatty food. What method of radiologi- the patient is very serious. Sopor. The skin
cal investigation is to be used on the first is grey, moist. Turgor is decreased. Pulse
stage of examining the patient? is rapid, intense. BP - 160/110 mm Hg,
muscle tonus is increased. Hyperreflexia.
A. Roentgenological There is an ammonia odor in the air. What
B. Magnetic-resonance is the presumptive diagnosis?
C. Radionuclid
D. Ultrasonic A. Hypoglycemic coma
E. Thermographic B. Uraemic coma
C. Cerebral coma
35. Woman in childbirth, 25 years old, D. Alcoholic coma
the second period of labor. During E. Hyperglycemic coma
internal obstetric examination, openi-
ng of the uterine cervix is full. Fetus 38. The diagnosis of a right-sided
membranes are absent. The head of the pneumothorax is made to a 36- year-old
fetus is represented, the head occupies patient. What method of treatment is indi-
sacral cavity. Sciatic bones are undetermi- cated to the patient?
nable.During contractions perineum is sti-
cking out. Where is the head of the fetus A. Drainage of the pleural cavity
situated? B. Pleural puncture
C. Antiinflammation therapy
D. Symptomatic therapy
E. Thoracotomy
39. A 48-year-old woman complai-
ns of fatigue, weight and appetite
loss, headache. Suffered from acute
glomerulonephritis as adolescent. Suffers
from arterial hypertension since age 25.
Has not systematically undergone medi-
 Krok 2 Medicine 6

cal treatment, applied to doctor very need the inpatient treatment (what peri-
rarely. On laboratory investigation signs ods of pregnancy)?
of chronic renal failure first degree were
found. (creatinine - 0,23 mmol/L). What A. 6-7weeks, 16 weeks, 38 weeks
nutrition recommendations are the most B. 12-16 weeks, 27-28 weeks, 37-38 weeks
suitable for this patient? C. 8-12 weeks, 28–32 weeks, 37 weeks
D. 10-12 weeks, 24 weeks, 37-38 weeks
A. Carbohydrate control E. 16 weeks, 34 weeks, 39-40 weeks
B. Fluid amount increase
C. Ingestion with the increased content of 44. A 33-year-old woman was urgently
the "alkaline" brought to clinic with complaints of the
D. Protein control pain in the lower part of the abdomen,
E. Adipose control mostly on the right, irradiating to rectum,
she also felt dizzy. The above menti-
40. A 35-year-old woman was admitted to oned complaints developed acutely at ni-
thoracic surgery department with rise in ght. Last menses were 2 weeks ago. On
body temperature up to 400 C, onset of physical exam: the skin is pale, Ps - 92
pain with deep breath inside, cough wi- bpm, t- 36, 6O C, BP- 100/60 mm Hg. The
th big quantity of purulent and bloody abdomen is tense, slightly tender in lower
sputum with bad smell. What disease is parts, peritoneal symptoms are slightly
caused by these symptoms? positive. Hb- 98 g/L. What is the most
probable diagnosis?
A. Bronchiectatic disease
B. Actinomycosis of lungs A. Abdominal pregnancy
C. Pulmonary tuberculosis B. Renal colic
D. Abscess of the lung C. Acute appendicitis
E. Complication of liver echinococcosis D. Apoplexy of the ovary
E. Intestinal obstruction
41. A 40-year-old man is ill with autoi-
mmune hepatitis. Blood test: А/G ratio 45. A 65-year-old patient complains of
0,8, bilirubin - 42µmol/L, transaminase: gradual worsening of the left eye vision
ALT- 2,3 mmol g/L, АSТ - 1,8 mmol during 10 months. On physical examinati-
g/L. What is the most effective means in on: acuty of vision of the left eye is 0,01,
treatment from the given below? not correctable. The eye is quiet, pupil
of the eye is grayish, reflex from the eye-
A. Hepatoprotectors ground is absent. Intraocular pressure is
B. Antibacterial medication 18 mm/Hg. What is the most probable
C. Glucocorticoids, cytostatics preliminary diagnosis?
D. Hemosorbtion, vitamin therapy
E. Antiviral medications A. Leukoma of the cornea
B. Exfoliation of the retina
42. A 10-year-old child complains of fever C. Disorder of blood circulation in retina
(temperature is 39O C), frequent painful vessels
urination [pollakiuria]. Urine test: protei- D. Open-angle glaucoma
nuria [0,066 g/L], leukocytouria [entirely E. Senile cataract
within eyeshot], bacteriuria [105 colony
forming units/mL]. What is the most 46. A 29-year-old patient complains of
probable diagnosis? sterility. Sexual life is for 4 years bei-
ng married, does not use contracepti-
A. Urolithiasis on. There was no pregnancy before.
B. Acute glomerulonephritis On physical examination, genitals are
C. Acute cystitis developed normally. Uterine tubes are
D. Dysmetabolic nephropathy passable. Rectal temperature during three
E. Acute pyelonephritis menstrual cycles is monophase. What is
the most probable reason for sterility?
43. A young woman applied to
gynecologist due to her pregnancy of A. Anomalies of genitals development
4-5 weeks. The pregnancy is desirable. B. Genital endometriosis
Anamnesis stated that she had rheumati- C. Chronic adnexitis
sm in the childhood. Now she has combi- D. Immunologic sterility
ned mitral heart disease with the priority E. Anovulatory menstrual cycle
of mitral valve deficiency. When will she
 Krok 2 Medicine 7

47. A 40-year-old patient is being di- amount of "rusty"sputum, pain in the ri-
agnosed: 1. Medullar thyroid gland cancer. ght side of the body during deep respirati-
2. Pheochromocytoma. What operation on and cough. The patient has IDDM. On
should be made first? physical exam, t- 39, 20 C, Ps - 114 bpm,
BP - 110/70 mm Hg, RR - 24/min. The
A. Operation concerning skin is dry, hyperemia of cheeks. Duri-
pheochromocytoma ng ausculation there are moist sonorous
B. Krail’s operation crepitant rales in lower parts of the lung.
C. Subtotal resection of thyroid gland and What are the doctor’s actions?
fascicular resection of limphatic nodes
D. Operation on thyroid gland A. Hospitalization to therapeutic unit
E. Vanach’s operation B. Resuscitation
C. Referral to outpatient department
48. A 62-year-old patient complains of D. Prescription of out-patient treatment
the pain behind the sternum, bad passi- E. Hospitalization to endocrinology unit
ng of solid and liquid food, bad breath,
increased salivation weight, loss of 15 kg 52. The student has got the following devi-
during the period of 2 months. Appetite is ces: Geiger’s counter, Ebert’s counter,
retained. On physical exam: face features Krotov’s apparatus, Mischuk’s device,
are sharpened. The skin is pale, with Ebert’s device. What device can he use
sallow tint, its turgor is decreased. The to assess germ pollution of the air?
liver is not enlarged. Blood Hb - 86g/L.
Gregersen reaction is positive. What kind A. Krotov’s apparatus
of pathology caused the given clinical si- B. Mischuk’s device
tuation? C. Ebert’s counter
D. Geiger’s counter
A. Achalasia of esophagus E. Ebert’s device
B. Cicatricial constriction of esophagus
C. Benign growth of esophagus 53. An unconscious victim in severe condi-
D. Esophagus cancer tion is brought to clinic. It is known that
E. Chronic non-specific esophagitis the patient touched the bare wire with
his hand and during 5 minutes was under
49. A 1,5-year-old child has following the influence of an alternating current
symptoms: chronic cough with purulent with voltage of 220 V. Physical exam:
sputum discharge. Dyspnea, physical skin is pale, cold by touch. Breath is
retardation, large amount of stool. Sweat weakened, BP - 90/50 mm Hg, Ps - 60
chloride is150 mEq/L. The child has been bpm, arrhythmical. There are fields of
ill since 2 month age. Diagnosis: cystic fi- necrosis of the skin on the right hand and
brosis. What is the most suitable therapy? on the right foot. What is the preliminary
diagnosis?
A. Vitamins+antibiotics
B. Vitamins + mucolytics A. Vascular collapse due to electric current
C. Cholepoietic+adaptogenetic medicines lesion
D. Enzymes + antibiotics B. Electroburn of the right foot and right
E. Н2-blockers + hepatoprotectors hand
C. Electroburn of the right foot and right
50. A 26-year-old woman gave birth to hand
a child 6 months ago. She applied to D. Electrotrauma, acute cardiovascular
gynecologist complaining of menstruati- failure
on absence. The child is breast-fed. Vagi- E. High voltaged electroburn of the right
na exam: uterus is of normal form, dense foot and shank
consistence. What is the most probable di-
agnosis? 54. A 5-year-old girl with the transi-
tory immunodeficiency according to T-
A. Gestation system has a clinical picture of a right-
B. Sheehan’s syndrome sided pneumonia during 2 months. How
C. Physiological amenorrhea pneumonia progress can be described?
D. Pseudoamenorrhea
E. Asherman’s syndrome
51. A 48-year-old man called for a district
doctor due to attack of cough with small
 Krok 2 Medicine 8

A. Wavelike 59. A 45-year-old man was brought to

B. Delaying clinic with complaints of the pain that
C. Acute started suddenly in the left chest part
D. Recidivating and epigastric area, shortness of breath,
E. Chronic nausea, one-time vomiting. The acute pain
started after weight-lifting. On physical
55. A woman was hospitalised with full- exam: shallow breathing, RR - 38/min, left
term pregnancy. Examination: the uterus chest part is behind during respiration, by
is tender, the abdomen is tense, cardiac percussion - tympanitic sound, respiration
tones of the fetus are not auscultated. is not ausculated. Ps - 110 bpm, of weak
What is the most probable complication filling. BP - 100/60 mm Hg, insignificant
of pregnancy? displacement of heart to the right, sounds
A. Hydramnion are dull. What examination is the most
B. Premature labor expedient to do first?
C. Back occipital presentation A. Bronchoscopy
D. Premature detachment of normally B. Roentgenography
posed placenta C. Electrocardiography
E. Acute hypoxia of a fetus D. Ultrasound of the abdominal cavity
56. A victim of the car crash was brought E. Esophagogastroscopy
to neurosurgery due to craniocerebral 60. A 49-year-old patient complains of
trauma. During examination symptoms of fever of 37, 50Ñ, chest pain, dyspnea.
focused injury of the cerebrum are found, On physical examination, S1 is clappi-
cerebrum contusion is suspected. What ng; S2 is accentuated in the pulmonary
method of examination is to be used? artery, opening snap, presystolic murmurs
A. Computed tomography of the cerebrum are auscultated. What is the most
B. Ultrasound examination of vessels of useful investigation for valvular disorder
the cerebrum assessment?
C. Eye-ground examination A. Ballistocardiogram
D. X- ray of cranium bones B. Echocardi-
E. Antiography of vessels of the cerebrum ography+dopplerechocardiography
57. A 18-year-old patient had subtotal C. Chest X-ray
strumectomy due to malignant capillary D. Electrocardiogram (ECG)
cystadenoma of the thyroid gland. In 2 E. Phonocardiography
months there was a suspicion of metastasis
presence in the lungs. What rontgenologi- 61. A 55-year-old patient complains of
cal method is to be used first? bloating and rumbling in the abdomen,
increased outgoing of gasesfoamy liquid
A. Roentgenoscopy of lungs stool of acid odor. Symptoms appear after
B. Bronchography eating of milk products. What is the name
C. Roentgenography of lungs of such symptom complex?
D. Bronchoscopy
E. Angiopneumonography A. Malabsorbtion syndrome
B. Acid dyspepsia syndrome
58. Melanoma diagnosis was made after C. Decaying dyspepsia syndrome
examination to a 16-year-old patient D. Dyskinesia syndrome
who complained of frequent pain in the E. Adipose dyspepsia syndrome
abdomen. Pigmentation of the mucosa
and skin, polyps in the stomach and large 62. A 37-year-old woman complains of
intestine were found. It is known that generalized fatigue, irritability, dysphagia,
mother of the patient had an analogous chalk hunger. On physical exam: t-
pigmentation and was treated often for 36, 50C, respirations - 20/min, Ps - 96
anemia. What kind of disease is meant? bpm, BP - 110/70 mm Hg. Satisfactory
nourishment. The skin and visible mucous
A. Hirschsprung’s disease membranes are pale. Blood test: Hb -
B. Peutz – Eghers syndrome 70g/L, erythrocytes - 3, 4 ∗ 1012 /L, CI
C. Adolescent polyposis - 0,7, reticulocytes - 2%, leucocytes -
D. Tuberculosis of the intestine 4, 7 ∗ 109 /L, eosinophilis. - 2%, band
E. Crohn’s disease neutrophils - 3%, segmented neutrophi-
ls - 64%, lymphocytes - 26%, monocytes
 Krok 2 Medicine 9

- 5%, ESR - 15 mm/min. Serum ferrum - started after the patient had eaten vinai-
7, 3µmol/L, total protein - 70g/L. Deficit grette. Swelling of lower extremities. BP
of what factor caused the development of - 140/100 mm Hg. Urine became curd
the disease? after boiling. What is the most probable
diagnosis?
A. Folic acid
B. Protein A. Food toxicoinfection
C. Vitamin B12 B. Exacerbation of pyelonephritis
D. Vitamin B6 C. Dropsy of pregnant women
E. Ferrum D. Nephropathy of the 3rd degree
E. Preeclampsia
63. During a period of 1 year 11 600
diseases were registered in the clinic. 67. A 38-year-old man is working for
Among them are: influenza and acute 15 years on the slate producing factory.
respiratory disease - 5800, blood ci- He complains of expiration dyspnoe on
rculatory system diseases - 34 800, digesti- exertion, dry cough. On physical exam:
on organs diseases- 1300 and others- 1020. dullness of the percutory sound in the
What relative index can be calculated interscapular area, harsh respiration, dry
according to this data? diffused rales.There are warts of greyish
color on hands. The doctor of the plant
A. Visual graphic suspects asbestosis. What method is the
B. Extensive most informational to confirm the di-
C. Relative intensity agnosis?
D. Correlation
E. Intensive A. Bronchoalveolar lavage
B. Spirography
64. A 45-year-old woman complains of C. Chest X-ray exam
unbearable crampy pain in the left half D. Bronchoscopy
of face with 1-2 minutes duration. Attacks E. Blood gases analysis
are caused by mastication. The patient fall
ill two months ago after being in cold. On 68. A 26-year-old woman have been
physical exam: pain in exit points of tri- abusing of alcohol for 7 years. She has
geminal nerve on the left. Touch near left psychological dependence on alcohol,
ala nasi causes attack with tonic convulsi- but no withdrawal syndrome. Drinks are
on of facial muscles. What is the most taken almost every day approximately 50
probable diagnosis from the given below? – 100 g of wine. She is at her 4-th week
of pregnancy. What is necessary to do to
A. Sinusitis (maxillaris) prevent alcohol syndrome of fetus?
B. Neuralgia of trigeminal nerve
C. Neuralgia of glossopharyngeal nerve A. Medical abortion
D. Facial migraine B. Treatment of alcoholism and total
E. Arthritis of mandibular joint abstinance from alcohol during the whole
period of pregnancy
65. In the structure of the population of C. Participation in the A-ANON group
N-region, person category of age from D. Decrease of alcohol use
0 till 14 yrs constitued 31%, for people E. Gynecological observation
from 50 yrs and older - 20%. Estimate
the population structure that characteri- 69. A 58-year-old woman complains of
zes the given demographic situation in a osteoarthrosis of knee-joint. For 2 weeks
most efficient way. she had been receiving an in-patient medi-
cal treatment. She was discharged from
A. Migration of the population the hospital in satisfactory condition with
B. Progressive structure of the population complaints of minor pain after prolonged
C. Regressive structure of the population static work. Local hyperemia and exudati-
D. Emigration of the population ve effects in the area of joints are absent.
E. Stationary structure of the population What further tactics is the most expedi-
ent?
66. A woman in the first half of pregnancy
was brought to clinic by an ambulance.
Term of pregnancy is 36 weeks. She
complains of intensive pain in the epi-
gastrium, had vomiting for 2 times. Pain
 Krok 2 Medicine 10

A. Outpatient treatment A. Hypotrophia

B. Repeated in-patient treatment B. Parathropy
C. Conducting arthroscopy C. Spasmophilia
D. Orthopedist consultation D. Anemia
E. Refferral to MSEC E. Rachitis
70. A 14-year-old boy periodically 74. A 27-year-old man complains of pain
complains of pain in the epigastrium on in epigastrium which is relieved by food
an empty stomach, nausea and heartburn intake. EGDFS shows antral erosive
during 3 years. Gastroduodenoscopy: si- gastritis, biopsy of antral mucous presents
gns of gastroduodenitis and ulcer defect of Hеlicobacter Pylori. What can be di-
the mucous membrane of the duodenum. agnosed in this case?
What is the most effective medication to
treat this child? A. Gastritis of type B
B. Menetrier’s disease
A. Atropin C. Rigid antral gastritis
B. No-spa D. Gastritis of A type
C. Papaverin E. Reflux - gastritis
D. De-nol
E. Almagel 75. In mental status of a 22-year-old
patient there is a stable pathological
71. A 75-year-old man who developed depressed mood. The patient is sociable,
diabetes within the last six months replies briefly but to the point. The speech
was found to be jaundiced. He was an is laconic, tempo is slowed, movements
asymptomatic patient except weight loss are constrained and inhibited. Speaks
of 5 kg in 6 months. On physical exami- on the ideas of self-accusation and self-
nation, nontender, globular, right upper humiliation. Medications of what group
quadrant mass that moves with respirati- are to be prescribed to this patient?
on. Abdominal computed tomography
(ACT) scan shows an enlargement of A. Normotimics
the head of the pancreas, with no filli- B. Neuroleptics
ng defects in the liver. What can be di- C. Hypnotics
agnosed? D. Antidepressants
E. Tranquilizers
A. Haemolytic jaundice
B. Malignant biliary stricture 76. During intramuscular DTP vacci-
C. Infectious hepatitis nation in clinic, a 3-month-old chi-
D. Carcinoma of the head of the pancreas ld developed signs of laryngospasm,
E. Metastatic disease of liver paleness of skin, cyanosis of lips, "cock
cry", stop of respiration, tension of the
72. A 26-year-old patient undergoes whole body with overturned backward
a course of treatment due to chronic head. Allergological anamnesis of the chi-
glomerulonephritis. The treatment was ld is not complicated. What is the most
successful, normalization of all the probable diagnosis?
characteristics was recorded. What sani-
torium and health resort treatment could A. Meningism, clonic and tonic spasms
be recommended? B. Meningoencephalitic reaction, clonic
and tonic spasms
A. Not recommended C. Cerebral hemorrhage, tonic spasms
B. Morshyn D. Spasmophilia, tonic spasms
C. Truskavets E. Anaphylactic shock, clonic spasms
D. Myrhorod
E. The south coast of the Crimea 77. A 68-year-old patient with long-
term hypertension complains of dizzi-
73. District pediatrician examines a ness, difficulties by swallowing, nasal voi-
healthy carried 1-month-old child. The ce, wobbly walking. These symptoms
child is breast-fed. Prophylaxis of what appeared about three years ago and are
disease will the doctor recommend to do gradually progressing. What diagnosis of
first? the given below is the most probable?
 Krok 2 Medicine 11

A. Stem encephalitis st small and medium-vesicular rales are

B. Ischemic attack in lower and hind parts on both sides.
C. Hemorrhagic attack What is the most probable presumptive
D. Discirculating encephalopathy diagnosis?
E. Cerebral stem tumour
A. Croupous pneumonia
78. A diagnosis of chronic arsenous intoxi- B. Asthmatic status
cation was defined at Y patient who is C. Edema of lung
working as a nightman. What form of D. Embolic pneumonia
anemia is characteristic for this disease? E. Thromboembolism of pulmonary artery
A. B12 - deficiency anemia 83. A 60-year-old man with unstable angi-
B. Hyper sideric anemia na pectoris fails to respond to heparin,
C. Aplastic anemia nitroglycerin, beta adrenegic blockers and
D. Iron deficiency anemia calcium channel antagonisst. What is the
E. Hemolytic anemia best treatment for this patient?
79. A 52-year-old patient has hypervolemic A. Aspirin, orally
type of essential hypertension. What B. Coronary artery bypass grafting
medication is necessary to prescribe ei- C. Antihypertensive therapy
ther as monotherapy or in complex with D. Intravenous strpetokinase
other antihypertensive remedies? E. Excercise testing
A. Hypothiazid 84. A 42-year-old woman who works at
B. Clophelin mercury thermometers factory, complains
C. Niphedipin of the headache, syncopes, reduction of
D. Kapoten memory, small and frequent flutter of fi-
E. Dibazol ngers of stretched hands, eyelids and the
tongue, bleeding gums, gingivitis. What
80. A 5-year-old child had an attack medication is necessary to use for mercury
of palpitation with nausea, dizziness, elimination?
generalized fatigue. On ECG: tachycardia
with heartbeat rate of 220/min. Ventricle A. Magnesium sulphate
complexes are deformed and widened. P B. Unithiol
wave is absent. What medication is to be C. Sodium hydrate of carbon
prescribed to provide first aid? D. Seduxen
E. Pentoxil
A. Lydocain
B. Seduxen 85. A 33-year-old woman works as the
C. Novocainamides secretary. Her diet contains 150 g of
D. Strophantin protein (including 100 g of animal), 200
E. Isoptin g of fat, 600 g of carbohydrates. What
pathology this diet can cause?
81. A 4-day-old girl was born from a
second desired gestation, second delivery A. Obesity
on the 39 week term. On physical exam: B. Schizophrenia
characters of the pre-natal retardation, C. Paradontosis
aliform folds on the neck, lymphatic D. Uterine fibromyoma
edema of hands and feet that disappeared E. Common cold
without treatment during first 24 hours.
What is your assessment of the child? 86. You suspect that a 34-year-old pati-
ent has got an abscess of Douglas
A. Healthy child spaces. What method of investigation is
B. Immature lymphatic system preferable to diagnostics?
C. Congenital hypothyreosis
D. Shereshevsky-Turner syndrome A. Roentgenoscopy of abdominal cavity
E. Sclerema B. Laparoscopy
C. Digital examination of rectum
82. A 65-year-old patient complains of D. Rectoromanoscopy
asphyxia, cough with foamy red sputum, E. Percusion and auscultation of abdomen
air deficiency, death fear. On physical
exam: the skin is pale, acrocyanosis, cold 87. A patient complains of intense pressi-
sticky perspiration. Harsh breathing, moi- ng pain in the pharynx, mainly to the right
 Krok 2 Medicine 12

impossibility to swallow even liquid food. started having headache, muscles pain,
The patient is sick for 5 days. His conditi- her temperature has risen up to 38, 8O C.
on is severe. Body temperature is 38, 90C, What is the reason for such condition of
it is difficult to talk, voice is constrai- the patient?
ned, it is difficult to open the mouth.
Submaxillary glands to the right are pai- A. Bacterial and toxic shock development
nful, enlarged. What is the most probable B. Hemotransfusional shock development
diagnosis? C. Air embolism
D. Allergic reaction
A. Diphtheria E. Pyrogenic reaction of medium severity
B. Pharyngeal tumor
C. Phlegmonous tonsillitis 92. A 52-year-old patient with previously
D. Peritonsillar abscess functional Class II angina complains of
E. Vincent’s disease intensive and prolonged retrosternal pai-
ns, decreased exercise tolerance for 5
88. A mother who is on partially paid days. Angina is less responsive to Ni-
maternity leave got sick and was hospi- troglycerinum. Which of the following di-
talized. What document is to be issued to agnosis is the most probable?
a working father who will be taking care
of a child during his mother’s illness? A. IHD. Unstable angina
B. Myocardial dystrophy
A. Extract from the medical card of out- C. Cardialgia due to spine problem
or in-patient D. Myocarditis
B. Sick-leave E. IHD. Functional Class II angina
C. Certificate of child’s care necessity
D. Free-form certificate 93. Twenty-five unorganized toddlers (2-
E. Certificate of mother’s illness 3 years old) will be observed by district
pediatrician current year. What scheduled
89. A 62-year-old patient complains of number of preventive observations is to
dyspnea on rest,chest pain. 3 years ago be made for this group of children?
he had myocardial infarction. On physi-
cal examination, there is an orthopnea, A. 20
acrocyanosis, swollen cervical veins. Ps – B. 200
92 bpm, total heart enlargement, the liver C. 100
is enlarged by 7 cm, shin edema. What is D. 40
the stage of chronic heart failure [CHF]? E. 50
A. CHF-0 94. On the 20th of June a townsman
B. CHF-3 was brought to clinic. The disease broke
C. CHF- 2 А out acutely, starting with fever, rise in
D. CHF- 1 temperature to 38 − 390 C. There also was
E. CHF-2 B weakness, acute headache, nausea, vomi-
ting, pain all over the body, sleep disorder.
90. During examination of a patient, On physical examination: hyperemia of
masses in the form of condyloma on skin of face, neck, thorax. Meningeal si-
a broad basis are found in the area of gns are positive. 12 days ago the patient
the perineum. What is the tactics of the returned from the Siberia, from the forest.
doctor? What is the most probable diagnosis?
A. Antiviral treatment A. Omsk hemorrhagic fever
B. Cryodestruction of condyloms B. Tick-borne encephalitis
C. Chemical coagulator treatment C. Pseudotuberculosis
D. To send a woman into dermatological D. Influenza
and venerological centre E. Epidemic typhus
E. Surgical ablation of condyloms
95. A 6-month-old infant was born with
91. A 40-year-old woman with body mass of 3 kg and 50 cm length. He
acute gastrointestinal hemorrhage was is breast-fed. How many times per day
transfused 400 ml of the preserved blood should the infant be fed?
after having conducted all compatibility
tests. After hemotransfusion the condi-
tion of the patient became worse. She
 Krok 2 Medicine 13

A. 8 A. Erysipelatouslike cancer of the

B. 6 mammary gland
C. 4 B. Hydropic and infiltrative cancer of the
D. 7 mammary gland
E. 5 C. Paget’s cancer
D. Acute mastitis
96. A woman while working in vegetable E. Diffusive mastopathy
garden developed severe pain in the loin.
Lasague’s and Nery tension signs are 100. After a wasp-bite there was an itchi-
obviously marked on the right. Lumbar ng of skin, hoarse voice, barking cough,
lordosis is smoothed, movements are anxiety. On physical exam: there is edema
harshly restrained in lumbar part of the of lips, eyelids, cyanosis. What medicine is
spine. Right ankle (Achilles) reflex is to be taken first?
absent. What kind of disease can it be?
A. Adrenalin
A. Hepatic colic B. Lasix
B. Neuritis of femoral nerve C. Euphylin
C. Lumbar-sacral radiculitis D. Prednisolone
D. Renal colic E. Seduxen
E. Lumbalgia
101. A 3-month-old infant who is suffering
97. A 32-year-old in-patient with the di- from acute segmental pneumonia reveals
agnosis of "acute abscess of the right dyspnea [respiration rate – 80 per minute],
lung"after cough had developed sudden paradoxical breathing, tachicardia, total
difficult breathing, cyanosis. There is cyanosis. Respiration-pulse ratio is 1:2.
pain in the right half of thorax. What is The heart size is normal. What are these
the most probable complication that is signs indicative of?
observed in the patient?
A. Respiratory failure of III degree
A. Myocardial infarction B. Myocarditis
B. Exudative pleurisy C. Respiratory failure of II degree
C. Embolic pneumonia D. Respiratory failure of I degree
D. Perforation of the esophagus E. Congenital heart disease
E. Pyopneumothorax
102. A 7-year-old child is sick for 2 weeks
98. A 16-year-old woman complains of the with running nose, was taking nasal drops.
abdominal pain and purpuric spots on the The boy suffers with alimentary allergy.
skin. Laboratory investigations revealed He applied to doctor due to suppurati-
normal platelet count with hematuria and ve and bloody discharges from nose,
proteinuria. What is the most probable di- maceration of ala nasi and upper lip. Rhi-
agnosis? noscopy results: there are whitish-greyish
areas at nasal septum. Mucous membrane
A. Hemolytic uremic syndrome of oropharynx is not changed. What is the
B. Henoch-Schoenlein purpura most probable disease?
C. Subacute bacterial endocarditis
D. Thrombotic thrombocytopenic purpura A. Allergic rhinitis
E. Heavy metal poisoning B. Sinusitis (maxillar sinus))
C. Rhinovirus
99. A 36-year-old woman applied D. Adenovirus
to doctor with complaints of the E. Diphtheria of the nose
enlargement of the right mammary gland.
On physical exam: the right mammary 103. A 38-year-old patient is under
gland is enlarged, hardened; nipple wi- observation having polyneuritic syndrome
th areola is pasty and hydropic, looks li- with considerable loss of weight, fever,
ke "lemon peel". There palpates a lymph rise in BP. Blood test:: considerable
node in the right axilla, 1,5 cm in diameter, inflammatory changes. What examinati-
dense consistence, not mobile. What is the on is the most expedient to make the di-
most probable diagnosis? agnosis?
 Krok 2 Medicine 14

A. Determination of antinuclear antibodi- abuse and abnormal diet complai-

es ns of pain in epigastrium that occurs
B. Muscular biopsy with histological in 1-1,5 hours after having meal.
investigation of the material Fibrogastroduodenoscopy: marked
C. Determination of HLA antigens hyperemia, small defects, easy appearance
D. Blood culture of sores on the mucous membrane in the
E. Electromyography antral section of the stomach. What is the
most probable reason for this pathology?
104. A 20-year-old woman is having ti-
med labor continued for 4 hours. Light A. Helicobacter pуlori infection
amniotic fluid came off. The fetus head is B. Presence of antibodies to parietal cells
pressed to the orifice in the small pelvis. C. Alimentary factor
The anticipated fetus mass is 4000, 0g ± D. Nervous overstrain
200, 0g. Heartbeat of the fetus is normal. E. Toxic action of alcohol
Intrinsic examination: cervix is absent, di-
sclosure – 2 cm, the fetal membranes are 108. A 36-year-old alcoholic patient has
not present. The head is in 1-st plane of cirrhosis and pancreatic failure due to
the pelvis, a sagittal suture is in the left recurrent pancreatitis. He complaints of
slanting dimension. What is the purpose nightblindness, decreased ability to taste
of glucose-calcium-hormone - vitamini- food, dry skin with hyperpigmentation.
zed background conduction? What deficiency does these symptoms
show?
A. Fetus hypoxia prophylaxes
B. Antenatal preparation A. Copper
C. Labor stimulation B. Zinc
D. Treatment of weakness of labor activity. C. Selenium
E. Prophylaxes of weakness of labor acti- D. Manganese
vity E. Chromium
105. A 8-year-old boy has suffered from 109. A 62-year-old patient is having NI-
tonsilitis. In 2 weeks he started complaini- DDM. Diabetes is being compensated by
ng of migratory joint pain, edema of joi- diet and Maninilum. The pаtient has to be
nts, restriction of movements, fever. On operated for inguinal hernia. What is the
examination, an acute rheumatic heart di- tactics of hypoglycemic therapy?
sease, activity of the III-rd degree, pri-
mary rheumocarditis, polyarthritis; acute A. To continue current therapy
course of disease, cardiovascular failure B. To prescribe short-acting insulin
IIA. What medication is to be prescribed? C. To prescribe guanyl guanidines
D. To prescribe long-acting insulin
A. Delagil E. To prescribe Glurenorm instead of
B. Prednisone Maninilum.
C. Cefazolin
D. Erythromycin 110. In 13 months after the first
E. Diprazinum labor a 24-year-old woman complains
of amenorrhea. Cesarian section was
106. A patient complains of an extremely conducted as a result of premature
intense pain in epigastrium. He has peptic detachment of normally posed placenta.
ulcer disease of duodenum for 10 years. Hemorrhage has made low fidelity of 2000
The patient is in the forced position bei- ml due to breakdown of coagulation of
ng on the right side with legs abducted to blood. Choose the most suitable investi-
stomach. Abdomen has acute tenderness gation.
in the epigastrium. Guarding contraction
of the abdominal wall muscles is observed. A. Determination of the contents of
What is the preliminary diagnosis? testosteron-depotum in blood serum
B. Computer tomography of the head
A. Thrombosis of mesenteric vessels C. Progesteron test
B. Acute condition of peptic ulcer disease D. Ultrasound of organs of a small pelvis
C. Perforation of ulcer E. Determination of the level of
D. Penetration of ulcer into pancreas gonadotropin
E. Acute pancreatitis
111. A 2-months-old child after
107. A 35-year-old patient with alcohol preventive vaccination had a prolonged
 Krok 2 Medicine 15

hemorrhage from the vaccination place A. Premature detachment of normally

and due to those an intramuscular posed placenta
hematoma. During examination of the B. Premature labor
child a considerable rise of prothrombin C. Acute hypoxia of the fetus
consumption and a significant prolongati- D. Back occipital presentation
on of the activated partial thromboplastic E. Hydramnion
time were found. What is the most
probable diagnosis? 115. A 30-year-old patient complains
of pain, hyperemia along subcutaneous
A. Hemorrhagic disease of the neonate veins, rise in body temperature. While
B. Inborn afibrinogenemia examining the large shin subcutaneous
C. Henoch-Schoenlein disease vein, there is hyperemia, pain by pressi-
D. Hemophilia ng. Homanss and Luses’s symptoms are
E. Werlhof’s disease negative. What is the preliminary di-
agnosis?
112. A 50-year-old patient was hospitali-
zed in severe condition with complaints of A. Acute ileophemoral phlebothrombosis
chills, high grade temperature, dryness in B. Lymphostasis
the mouth, multiple vomiting, pain in the C. Embolism of aorta
epigastrium, frequent watery, foamy, dirty D. Acute thrombophlebitis of
green color stool of unpleasant odor. The subcutaneous veins
tongue and the skin are dry. BP - 80/40 E. Thrombosis of aorta
mm Hg. What first aid is necessary for the
patient? 116. The child was born from the 5th
pregnancy and 1st delivery. Mother’s
A. Sympathomimetics blood group - A[II] Rh-, neonate’s -
B. Fresh-frozen plasma transfusion A[II] Rh+. The level of indirect bili-
C. To prescribe polyglucin rubin in umbilical blood was 58µmol/L,
D. Intravenous injection of sodium soluti- hemoglobin - 140 g/L, RBC- 3, 8 ∗ 1012 /L.
ons The level of indirect bilirubin in 2 hours
E. Hemosorbtion was 82µmol/l. The hemolytic disease of
the neonate [icteric-anemic type, Rh-
113. A 14-year-old victim was drawn out incompatibility] was diagnosed. Choose
of the water in winter after 15 minutes of the therapeutic tactics.
being in the water. The victim shows no vi-
tal signs. What measures are to be taken? A. Replacement blood transfusion
B. Symptomatic therapy
A. To release respiratory tract from water, C. Antibiotics
to create drain position and to take on D. Gormonal therapy
measures to restore respiration and blood E. Plasma transfusion
circulation
B. Тo transport the victim to the nearest 117. An anesthesiologist gives narcosis
warm room to carry out reanimation to the patient, he uses a non-reversive
measures contour. Anesthetic is halothane. Air
C. Not to carry out reanimation measures temperature in the operation room is
D. To transport the victim to the nearest 210 Ñ, humidity 50%, level of noise 30 dB.
hospital to carry out reanimation measures What occupational hazard is the principal
E. Not to waste time on the release of one in these conditions?
respiratory tract from water, to take on
cardiopulmonary reanimation A. High level of noise
B. Air pollution with anesthetic
114. By the end of the 1st period of physi- C. Improper occupational microclimate
ological labor clear amniotic fluid came D. Mental overfatigue
off. Contractions lasted 35-40 sec every E. Compelled working pose
4-5min. Heartbeat of the fetus was 100
bpm. The BP was 140/90 mm Hg. What is 118. A 30-year-old man has suffered
the most probable diagnosis? from traffic accident. Consciousness is
absent. Pulse on the carotid artery is
undeterminable, no respiration. There is
a wide leather belt on man’s waist. What
measures are to be taken?
 Krok 2 Medicine 16

A. Turn the victim to the right side temperature is normal. Then vomiting
B. Do not touch the victim until the arrival took place. On physical examination:
of the police man’s voice is hoarse, eyes are deeply set
C. Conduct an artificial ventilation of lungs in the orbits. The pulse is frequent. Blood
and closed-chest cardiac massage after pressure is low. There is no urine. What is
having released from the belt the preliminary diagnosis?
D. Put the victim with his back on the
shield A. Dysentery
E. Start immediate artificial ventilation of B. Salmonellosis
lungs and closed-chest cardiac massage C. Toxic food-borne infection
D. Cholera
119. A 5-year-old child with stigmas of E. Typhoid fever
dysembryogenesis (small chin, thick li-
ps, opened mouth, hyperthelorismus) has 123. A 4-year-old child on the 5th day of
systolic murmur in the second intercostal illness complains of cough, rash on the
to the right of the sternum. The murmur skin. Temperature is 38, 2O C , face is puffy,
passes to the neck and along the sternum photophobia, conjunctivitis. There is a
left edge. The pulse on the left brachi- bright papulomacular rash on the face,
al artery is weakened. BP on the right neck, upper half of the thorax. Pharynx
arm is 110/60 mm Hg, on the left - 100/60 is hyperemiated. There are serous and
mm Hg. ECG results: hypertrophy of the purulent discharge from nose, dry rales
right ventricle. What defect is the most in the lungs. What is your preliminary di-
probable? agnosis?
A. Defect of interatrial septum A. Enterovirus infection
B. Coarctation of the aorta B. Scarlet fever
C. Defect of interventricular septum C. Measles
D. Aortic stenosis D. Adenovirus infection
E. Open aortic duct E. German measles
120. A pupil of the 8th form after trauma 124. A 7-year-old girl suddenly fell ill with
has acute atrophy of the left arm muscles, fever, headache, severe sore throat, vomi-
tonus of which is distinctly decreased, acti- ting. Minute bright red rash appeared on
ve movements are only in the left joi- her ablushed skin in 3 hours. It is more
nt, pupil’s foot is deformed. Function of intensive in axillas and groin. Mucous
support of the left leg is absent, support membrane of oropharynx is hyperemic.
function of the right leg is preserved. The Greyish patches are on tonsills. Submaxi-
boy wears an orthopedic footwear. What llary glands are enlarged and painful.
group of physical training does the boy What is your diagnosis?
belong to?
A. Pseudotuberculosis
A. Preparatory B. Rubella
B. Additional C. Scarlet fever
C. Special D. Measles
D. Basic E. Enteroviral infection
E. Other
125. A 40-year-old woman complains of
121. A patient with nosocomial colic pains in the lower part of abdomen
pneumonia has signs of collapse. Which and abundant bloody discharges from
of the following pneumonia complication genital tract. Last 2 years she had menses
is the most likely to be accompanied with for 15-16 days, abundant, with clots, pai-
collapse? nful. Had 2 medical abortions. In bi-
manual investigation: from the canal of
A. Toxic hepatitis the cervix uteri - a fibromatous node, 3 cm
B. Septic shock in diameter, on the thin stem. Discharges
C. Bronchial obstruction are bloody, moderate.Choose the correct
D. Exudative pleuritis tactics.
E. Emphysema
122. In a man the disease started wi-
th acute onset. Frequent watery stool
developed 6 hours ago. The body’s
 Krok 2 Medicine 17

A. Supravaginal ablation of the uterus of malignant neoplasms. What are the

without ovaries measures to be taken to protect personnel
B. Hysterectomy without ovaries at the time of work with radioactive
C. Hormonal hemostasis sources of such type?
D. Operation: untwisting of born node
E. Phase by phase vitamin therapy A. The increase of distance to the source
and individual hygiene compliance
126. A 20-year-old patient complains of B. Systematical cleansing of surfaces
amenorrhea. On physical exam: hirsutism, from the radioactive contamination and
obesity with primarily localization of adi- shortening of working time
pose tissue on face, neck, upper part of the C. Capsulation of devices and organization
body. There is an acne vulgaris on the face, of room ventilation
on the skin - striae cutis distensae. BP - D. Shortening of working time and screeni-
170/100 mm Hg. Mental development and ng of the source
intellect are normal. Gynecological status: E. Screening of the source and the use of
excessive hairiness on external genitals, means of individual protection of respirati-
drastic hypoplasia of vagina and uterus. on organs
What is the most probable diagnosis?
130. A 38-year-old woman was hospitali-
A. Shereshevsky-Turner syndrome zed to the surgical unit with acute abdomi-
B. Stein-Leventhal syndrome nal pain irradiating to the spine and vomi-
C. Sheehan’s syndrom ting. On laparocentesis hemorrhagic fluid
D. Itsenko-Cushing’s syndrome is obtained. What disease is meant?
E. Pechranz-Babinsky and Frelich
syndrome A. Acute pancreatitis
B. Renal colic
127. A 41-year-old patient was admitted to C. Acute appendicitis
the intensive care unit with hemorrhagic D. Acute enterocolitis
shock due to gastric bleeding. He has a hi- E. Perforative gastric ulcer
story of hepatitis B during the last 5 years.
The source of bleeding is esophageal vei- 131. Thyreotoxicosis patient is in the
ns. What is the most effective method for two-place hospital ward of therapeutic
bleeding control? department. The area of the ward is 18m2 ,
height is 3 m, ventilation rate is 2,5/h. Air
A. Operation temperature is 200 Ñ, relative humidity is
B. Intravenous administration of pituitrin 45%, air movement velocity is 0,3 m/sec,
C. Introduction of obturator nasogastric light coefficient is 1/5, noise level consti-
tube tutes 30 dB. Make a hygienic assessment
D. Hemostatic therapy of these conditions.
E. Administration of plasma
A. Non-effective ventilation
128. A 54-year-old patient applied with B. Discomfortable microclimate
complaints of acute pain in the shoulder- C. High level of noise
joint. 10 minutes earlier he fell in the D. All conditions are OK
street with his arms stretched. Doctor of E. Poor lighting
the traumatological unit noticed an acute
deformation of the right shoulder-joint, 132. A 40-year-old woman complains of
the impossibilty of active movement in yellow color discharges from the vagina.
the right extremity. Roentgenologically: Bimanual examination: no pathological
uncoincidence of articulating surfaces. changes. Smear test: Trichomonas vagi-
What is the most probable diagnosis? nalis and mixed flora. Colposcopy: two
hazy fields on the front labium, with a
A. Fracture of the humerus negative Iodum probing. What is your
B. Dislocation of the humerus tactics?
C. Dislocation of the clavicle
D. Contusion of the humerus
E. Dislocation of the scapula
129. At the radiological unit of the hospi-
tal , gamma-devices of radiotherapy of
"Agat"type and other closed sources of
ionizing radiation are used for treatment
 Krok 2 Medicine 18

A. Cryolysis of cervix uteri - 78 bpm. The liver is enlarged by 2 cm.

B. Cervix ectomy What is the probable diagnosis?
C. Treatment of specific colpitis with the
subsequent biopsy A. Leptospirosis
D. Diathermocoagulation of the cervix B. Typhoid fever
uteri C. Brucellosis
E. Specific treatment of Trichomonas D. Sepsis
colpitis E. Malaria
133. Purulent mediastinitis is diagnosed 137. A 34-year-old patient was bitten by
at a 63-year-old patient. What diseases a dog 3 hours ago.There is a wound by
from the stated below CANNOT cause dog teeth without bleeding in the left arm.
the purulent mediastinitis? What surgical help would you provide to
this patient?
A. Iatrogenic injury of the trachea
B. Cervical lymphadenitis A. Clean wound with detergent water and
C. Perforation of the cervical part of the apply anti-septic
easophagus B. Aseptic bandage
D. Perforation of the thoracic part of the C. Complete suture of the wound
easophagus D. Incomplete suture of the wound
E. Deep neck phlegmon E. Cream bandage
134. Rise in temperature up to 390 Ñ was 138. A neonate was born from the 1st
registered the next day after a woman gestation on term. The jaundice was
had labor. Fetal membranes rupture took revealed on the 2nd day of life, then it
place 36 hours prior to labors. The exami- became more acute. The adynamia, vomi-
nation of the bacterial flora of cervix ting and hepatomegaly were observed.
uteri revealed the following: haemolytic Indirect bilirubin level was 275µmol/L, di-
streptococcus of group A. The uterus ti- rect bilirubin level - 5µ mol/L, Hb - 150
ssue is soft, tender. Discharges are bloody, g/l. Mother’s blood group - 0[I], Rh+, chi-
with mixing of pus. Establish the most ld’s blood group- A[II], Rh+. What is the
probable postnatal complication. most probable diagnosis?
A. Apostatis of stitches after the episi- A. Jaundice due to conjugation disorder
otomy B. Hemolytic disease of the neonate [Rh -
B. Metroendometritis incompatibility]
C. Thrombophlebitis of veins of the pelvis C. Hemolytic disease of the neonate [АВО
D. Infective contamination of the urinary incompatibility], icteric type
system D. Hepatitis
E. Infected hematoma E. Physiological jaundice
135. A 43-year-old patient complains of 139. A patient had disorder of nasal respi-
contact hemorrhages during the last 6 ration, mucopurulent discharges from
months. Bimanual exam:cervix of the nose, headache for 3 weeks. At anteri-
uterus is enlarged, restricted in mobility. or rhinoscopy in middle nasal meathus
Mirrors showed the following: cervix of the stria of pus, edema, hyperemia of the
the uterus is in the form of cauliflower. mucosa of the nose have been determi-
Chrobak and Schiller tests are positive. ned. What diagnostic method is necessary
What is the most probable diagnosis? to administer first of all?
A. Nascent fibroid A. CT of a skull
B. Cervical pregnancy B. General blood test
C. Polypus of the cervis of the uterus C. An X-ray of paranasal sinuses
D. Leukoplakia D. Punction of the maxillar sinus
E. Cancer of cervix of the uterus E. Bacteriology analysis of the nasal
mucous
136. A 28-year-old patient was admitted
on the 9th day of the disease to the cli- 140. Workers of fishery are subjected to
nic with complaints of temperature up low temperatures of the air (from 5 ti-
to 39, 00Ñ, headache, weakness, consti- ll 150 C). Diseases of what organs and
pation. On physical examination, single systems are the most frequent among
roseolas are on skin of the abdomen. Ps workers of such enterprises?
 Krok 2 Medicine 19

A. Supersecretion of androgens by the

A. Cardiovascular system cortex of paranephroses.
B. Respiratory system B. Excessive transformation of
C. Gastrointestinal tract preandrogens from adipose tissues
D. Liver C. Poor aromatization of preandrogens
E. Blood due to hypothyroidism
D. The increased contents of follicle-
141. A 24-year-old man on the 5th day stimulating hormone
of acute respiratory disease with high E. Hypersecretion of estrogens by tissues
grade temperature started having strong of the organism.
headaches, systemic dizziness, sensati-
on of double vision, paresis of mimic 145. Define the basic registration
muscles to the right, tickling by swallowi- document on the profound study of rate
ng. Diagnosis: Acute viral encephalitis. of cases with temporary loss of ability to
Determine the basic direction of the work on the industrial enterprise.
emergent therapy.
A. An ambulatory medical card
A. Glucocorticoids B. Report of temporary loss of ability to
B. Zovirax work
C. Lasix C. An inpatient medical card
D. Hemodesis D. Sick-leave
E. Cephtriaxon E. A card of the personal account of rate
of cases
142. A student lives in the modern house
in the flat with a complete set of sanitary 146. A 19-year-old woman complains of
equipment (WC, bath, shower, local water pain in the abdomen and joints, asks
heater). How much water consumption for more analgetics and somnifacient
has he got? injections. The patient was examined.
Gynecological and urological pathologi-
A. 10-15 L/day es are absent. There are signs of previous
B. 500 -600 L/day punctures along superficial veins of the
C. 300-400 L/day extremities. The patient does not explain
D. 160-200 L/day the origin of punctures. Tendon reflexes of
E. 50-100 L/day upper and lower extremities are the same,
quick. Photoreaction of the pupil of the
143. District physician was charged with eye is weak. The tongue is grey coated.
plan preparation concerning the conducti- During communication the patient in
ng of medical and preventive measures affectively not even-tempered. There is
among the population in the area he diarrhea without pathologic inclusions.
is assigned to. What measures must he What tactics is necessary to improve the
include in this plan as regards secondary condition of this patient?
prevention of illness?
A. Prescription of medications the patient
A. Prevention of disease onset asks for.
B. Elimination of causes of diseases onset B. Additional consultation of surgeon
C. Improvement of patients’ life conditions C. Consultation of an expert in narcology
D. Conducting of rehabilitation measures D. Treatment with antibiotics
E. Prevention of disease complications E. Consultation of infectious diseases
144. A 52-year-old woman suffering from doctor
obesity, complains of bloody discharges 147. A 32-year-old woman complains of
from sexual paths during 4 days. Last the pain in the left epigastric area that
normal menses were 2 years ago. Hi- appeared in 2 hours after meal. She
stological investigation of biopsy of the also complains of nausea, bloating of the
endometrium has revealed adenomatous abdomen, tendency to diarrhea. On physi-
hyperplasia. What reason from the menti- cal exam: icteric scleras. The abdomen is
oned below caused the development of painful by palpation in the Gubergrits and
disease? Skulsky point. The liver is at the ribs edge.
Blood tests: amylase - 288 mmol/L, total
bilirubin - 20µmol/L. What is the most
probable disesase?
 Krok 2 Medicine 20

A. Chronic hepatitis A. Antibiotic therapy

B. Chronic enterocolitis B. Surgical dissection, drainage of the
C. Chronic pancreatitis abscess of the gland
D. Chronic cholecystitis C. Surgical dissecting, a drainage of an
E. Chronic gastritis abscess of the gland, antibiotics
D. Antibiotics, Sulfanilamidums
148. A 37-year-old patient has come to cli- E. Antibiotics, detoxication and biosti-
nic being wounded in the area of umbili- mulants.
cus an hour ago.On physical exam, there
is a prick and cut painful wound of about 152. While making sanitary examination
0,5x1 cm around umbilicus on the abdomi- of burn unit for adults it was stated that
nal skin with slight bleeding.How would wards for 4 persons are of 28m2 square.
you help this patient? What should be the minimum ward area
in this unit?
A. Aseptic bandage
B. Drainage of the wound with rubber A. 52ì2
strip B. 28ì2
C. Suture on the wound C. 30ì2
D. Inspection of the wound with canal D. 40ì2
probe E. 24ì2
E. Laparotomy, abdominal cavity organs
inspection. Primary surgical processing of 153. A 5-year-old child had strong
the wound headache, vomiting, ataxy, dormancy, di-
scoordination of movements, tremor of
149. Chest X-ray of the miner ( with 24- the extremities on the 8th day of the di-
year-length of service; dust concentration sease. It was followed by rise in body
on working place is 260 − 280mg/m3, 15% temperature, vesiculosis rash mainly on
of which is free silicon dioxide) showed the skin of the body and the hairy part
the signs that are typical of pneumoconi- of the head. At the second wave of the
osis. What kind of pneumoconiosis is this? fever a diagnosis of encephalitis was gi-
ven. What disease complicated encephali-
A. Silicosis tis in this case?
B. Anthraco-silicatosis
C. Silicatosis A. Measles
D. Carboconiosis B. Herpetic infection
E. Anthraco-silicosis C. German measles
D. Enterovirus ifection
150. Neonate is 5 days old. What vacci- E. Chicken pox
nation dose of bacillius Calmette-Guerin
(bCG) vaccine is necessary for this child? 154. A 23-year-old patient wounded his
left arm as a result of gunfire. The bones of
A. 0.05 мg the arm are undamaged. What appropri-
B. 0.2 мg ate surgical help must be provided to this
C. 0.075 мg patient?
D. 0.1 мg
E. 0.025 мg A. Suture wound
B. Primary surgical processing with a
151. At the gynaecological department flowing suction
there is a patient of 32 years with C. Dry wound with towel gauzes
the diagnosis: "acute bartholinitis".Body D. Suture wound and dry it
temperature is 38, 20C, leucocytes count E. Aseptic dressing of the wound
10, 4 ∗ 109 /L, the ESR is 24 mm/hour. In
the area of big gland of the vestibulum - 155. A 18-year-old patient applied to
the dermahemia, the sign of the fluctuati- gynecologist with complaints of the pain
in the lower part of the abdomen, rise
on, sharp tenderness (pain). What is the
most correct tactics of the doctor? in body temperature to 37, 5O C, consi-
derable mucopurulent discharges from
the genital tract, colic by urinating. After
mirror and vagina exam the results are the
following:the urethra is infiltrated, cervix
of the uterus is hyperemic, erosive. The
uterus is painful, ovaries are painful, thi-
 Krok 2 Medicine 21

ckened, free. Bacterioscopy test showed A. None of the above mentioned

diplococcus. What diagnosis is the most B. Supervision of relatives (if any)
probable? C. Physical work under supervision
D. Supervision of a social worker
A. Trichomoniasis E. All the above mentioned
B. Candydomycosis
C. Chlamydiosis 160. A patient was admitted to the
D. Recent acute ascending gonorrhea hospital on the 7th day of the disease
E. Chronic gonorrhea with complaints of high temperature,
headache, pain in the muscles, especially
156. Mother with an infant visited the in calf muscles. Dermal integuments and
pediatrician. Her baby was born with scleras are icteric. There is hemorrhagic
body mass of 3,2 kg and 50 cm length. rash on the skin. Urine is bloody. The pati-
He is 1 year old now. How many teeth the ent was fishing two weeks ago. What is the
baby should have? most likely diagnosis?
A. 6 A. Trichinellosis
B. 10 B. Salmonellosis
C. 20 C. Leptospirosis
D. 12 D. Brucellosis
E. 8 E. Yersiniosis
157. A 20-year-old woman with a 3- 161. A 10-year-old boy complains of a
4 month history of bloody diarrhea; headache, weakness, fever [temperature
stool examinationn is negative for ova - 400 Ñ], vomiting. On physical examinati-
and parasites; stool cultures negative for on: there is an expressed dyspnea, pale
clostridium, campylobacter and yersi- skin with a flush on a right cheek, right
nia; normal small bowel series; edema, hemithorax respiratory movement delays,
hyperemia and ulceration of the rectum dullness on percussion of the lower lobe
and sigmoid colon are seen on sigmoi- of the right lung, weakness of vesicular
doscopic examination. Choose the most respiration in this region. The abdomen is
likely diagnosis. painless and soft by palpation. What di-
sease causes these symptoms and signs?
A. Ulcerative colitis
B. Granulomatous colitis A. Acute cholecystitis
C. Carcinoid syndrome B. Influenza
D. Zollinger-Ellison syndrome C. Intestinal infection
E. Gastroenteritis D. Pneumonia croupousa
E. Acute appendicitis
158. In the development of the
inflammation processes glucocorticoids 162. A patient with suspicion of pelvic
reduce the level of certain most important bones fraction is under examination
active enzyme. It results also in the reduci- conducted by the doctor who presses alae
ng of the synthesis of prostaglandins and ilii in medial direction with his both hands.
leucotrienes which have a key role in the What causes painful syndrome of the pati-
development of inflammation processes. ent?
What is the exact name of this enzyme?
A. Traumatic injury of the intrapelvic
A. Lipoxygenasе organs
B. Arachidonic acid B. Disorder of continuity of the pelvic ring
C. Phospholipase A2 C. Fracture of sciatic bones
D. Cyclooxygenase – 1 D. Retroperitoneal hematoma
E. Cyclooxygenase – 2 E. Fracture of the sacrum
159. A 19-year-old man has suffered from 163. Body temperature of a 12-year-old
moderate mental retardation since chi- girl increased up to 39 − 400 C in 4-5
ldhood. The patient is illiterate, can take hours after she had taken 2 pills of aspi-
care of himself, do simple household rin. Complains of general discomfort, di-
work and other kinds of easy work under zziness, sudden appearance of red spots
supervision. What does his rehabilitation on the skin with blister formation or
[tertiary prevention] require? exfoliation of the epidermis with erosi-
ve surface. Lesions on the skin looked like
 Krok 2 Medicine 22

burns of II degree. Nikolsky syndrome is reflex. What is the most probable di-
positive. What is the most probable di- agnosis?
agnosis?
A. Botulism
A. Bullous dermatitis B. Acute encephalitis
B. Acute epidermical necrolysis C. Acute gastritis
C. Polymorphic exudative erythema D. Salmonellosis
D. Pemphigus vulgaris E. Food toxicoinfection
E. Duhring’s disease
168. An employee was disabled during 6
164. A 34-year-old woman with 10-week months as a result of a hip fracture. Who is
pregnancy (the second pregnancy) has entitled to sign the sick-leave for the last
consulted gynaecologist to make a record 2 months?
in patient chart. There was a hydramnion
previous pregnancy, the birth weight of a A. Deputy head physician of a working
child was 4086 g. What tests are necessary capacity
first of all? B. Head physician of the polyclinic
C. MSEC
A. Fetus cardiophonography D. Doctoral controlling committee
B. Ultrasound of the fetus E. DCC together with the head physician
C. The test for tolerance to glucose of a polyclinic
D. Bacteriological test of discharge from
the vagina 169. A 52-year-old man has recurrent
E. Determination of the contents of α transient ischemic attacks. Auscultation of
fetoprotein the carotid arteries detects murmur. What
diagnostic method is necessary to apply
165. In the inhabited locality there is an first?
increase of diphtheria during the last 3
years with separate outbursts in families. A. Ultrasound dopplerography
What measure can effectively influence B. Electroencephalography
the epidemic process of diphtheria and C. Cerebral angiography
decrease the morbidity with diphtheria to D. MRI of the brain.
single cases? E. CT of the brain

A. Disinfection in disease focus 170. While making a round, a doctor had

B. Hospitalization of patients noticed the edema of the right shoulder
C. Early diagnostics of a 26-day-old child with diagnosis of
D. Revelation of carriers "umbilical sepsis". Active movements in
E. Immunization of the population the shoulder joint were absent, right hand
was hanging down. Mother stated that her
166. A 68-year-old patient complai- child’s condition had worsened for the last
ns of tiredness, sweating, enlargement 24 hours what resulted in child’s refusal to
of cervical, submaxillary and axillary be breast-fed, restlessness, weeping while
lymph nodes. Blood tests: leucocytes- swaddling, rise in body temperature up to
35∗109 /L, lymphocytes - 60%, Botkin and 38, 80C. What is the most probable preli-
Gumprecht bodies, level of hemoglobin minary diagnosis?
and quantity of thrombocytes is normal.
Myelogram showed 40% of lymphocytes. A. Epiphysial osteomyelitis of the humerus
What is the most probable diagnosis? B. Fracture of the clavicle
C. Traumatic brachioplexitis
A. Acute leucosis D. Phlegmon of the shoulder
B. Lymphogranulomatosis E. Fracture of the humerus
C. Chronic myeloleucosis
D. Tuberculous lymphadenitis 171. During dynamic investigation of a
E. Chronic lympholeucosis patient the increase of central venous
pressure is combined with the decrease of
167. A 24-year-old patient felt sick in arterial pressure. What process is proved
16 hours after dried fish intake. There by such combination?
was nausea, vomiting, weakness, flabbi-
ness, double vision. On physical exam,
there was decrease of a muscle tone, ani-
socoria, flaccid swallowing and tendon
 Krok 2 Medicine 23

A. Increase of bleeding speed es with the following causes of death:

B. Presence of hypervolemia electrotrauma; rupture of the spleen wi-
C. Shunting th acute anemia. There is one unknown
D. Developing of cardiac insufficiency person; one ethyl alcohol poisoned person
E. Depositing of blood in venous channel and one drowned man. What dead body
should the blood group be determined
172. A 16-year-old adolescent was vacci- for?
nated with DTP. In eight days there was
stiffness and pain in the joints, subfebri- A. Body of drowned man
le temperature, urticarial skin eruption, B. Body of person with internal
enlargement of inguinal, cervical lymph hemorrhage
nodes and spleen. What kind of allergic C. Body of poisoned person
reaction is observed? D. Body of person with a sudden death
E. All dead bodies of the unknown persons
A. Hypersensitivity of delayed type
B. Hypersensitivity of immediate type 177. A 35-year-old woman was admitted
C. – to resuscitation department in asthmatic
D. Immunocomplex status. What is the most trustworthy cri-
E. Cytoxic terion of breath effectiveness?
173. A 42-year-old man died in a road acci- A. Minute respiratory volume
dent after the hemorrhage on the place B. Respiratory volume
due to acute hemorrhagic shock. What mi- C. ÐàÑÎ2 and ÐàÎ2
nimum percent of all blood volume could D. Respiration rate
cause the death? E. Determination of “dead” space
A. 6-9% 178. A 34-year-old patient is hospitali-
B. 15-20% zed with complaints of cervical and axi-
C. 25-30% llary lymph nodes enlargement, subfebri-
D. 10-14% le temperature during the last 2 months,
E. 35-50% increased sweating. There are Reed-
Sternberg (Berezovsky) cells in the
174. A 42-year-old patient applied to punctation of lymph nodes. What method
hospital with complaints of pain behind of investigation is expedient to use to
the sternum with irradiation to the left study the extent of tumor process?
scapula. The pain appears during signifi-
cant physical work, this lasts for 5-10 mi- A. Lymphography
nutes and is over on rest. The patient is B. Roentgenological investigation
sick for 3 weeks. What is the preliminary C. Lymphoscintigraphy
diagnosis? D. Thermography
E. Antiography
A. IHD:Stable angina pectoris of effort IV
FC 179. A 27-year-old woman was admitted
B. IHD:Stable angina pectoris of effort I to clinic with complaints of pain in right
FC ankle joint, impossibility to stand on those
C. IHD:Progressive angina pectoris extremity. Clinical examination: the pati-
D. IHD:First established angina pectoris ent had a fracture of anterior part of di-
E. IHD:Variant angina pectoris (Pri- stal metaepiphisis of tibia [Pott-Desto‘s
nzmetal’s) fracture]. What is the mechanism of such
injury?
175. To study physical development of
children and adolescents, anthropometric A. Load along the axis with planter flexion
investigations are widely used. Choose of foot
a physiometric method of investigation B. Load along the axis with dorsal flexion
from the below given. of foot
C. Pronation of the foot
A. Determination of vital capacity of lungs D. Direct blow
B. Determination of vertebra form E. Supination of the foot
C. Measurement of growth
D. Determination of body weight 180. A neonate from gestation with severe
E. Determination of thorax form gestosis of the second half was born on
the 41st week with 2400 g birth weight
176. In morgue there are dead bodi-
 Krok 2 Medicine 24

and 50cm long. On physical examination:

skin is flaccid, subcutaneous fatty cellular A. Napthtochynones deficit
tissue is thin, muscle hypotonia, new-born B. Thiamine deficit
period reflexes are decreased. Internal C. Folic acid deficit
organs are without pathological changes. D. Biotin deficit
How would you estimate this child? E. Retinole deficit
A. Term infant with normal body weight 185. A 37-year-old woman is sick with
B. Postmature infant bronchial asthma for 15 years. Recenlty
C. Immature infant asthmatic attacks occur 4-5 times per
D. Term infant with pre-natal growth week, night attacks -2-3 times per
retardation month. To stop attacks, the patient takes
E. Premature infant salbutamol. On physical exam: condition
is relatively satisfactory. RR - 20/min, Ps is
181. Thrombosis of the coronary artery 76 bpm, BP - 120/80 mm Hg. Respiration
caused myocardial infarction. What in lungs is vesicular. Cardiac sounds are
mechanisms of injury will be the domi- muted, rhythm is normal. What medicati-
nating ones in this disease? on should be prescribed to prevent attacks
of bronchial asthma on the first stage?
A. Protein mechanisms
B. Electrolytoosmotic mechanisms A. Regular dose of salbutamol
C. Calcium mechanisms B. Injection of corticosteroids
D. Lipid mechanisms C. Inhalation corticosteroids
E. Acidotic mechanisms D. Cromoglycat sodium
E. Tabletted corticosteroids
182. A 2–year-old girl has been ill for
3 days. Today she has low–grade fever, 186. A 30-year-old man has a history of
severe catarrhal symptoms, non-abundant recurrent pneumonias and chronic cough
maculopapular rash on her buttocks and production of foul smell, purulent sputum,
enlarged occipital glands. What is your di- ocassionally gloom tinged,which becomes
agnosis? worse in the morning and in reclining
position. On physical examination, it is
A. Scarlet fever a chronic patient with clubbing of fingers,
B. Measles wet inspiratory tract at the root of lungs
C. Rubella from behind. What is the most probable
D. Pseudotuberculosis diagnosis?
E. Adenoviral infection
A. Bronchoectasis
183. A 12-year-old girl applied to doctor B. Chronic obstructive emphysema
with complaints of swelling on the front C. Disseminated pulmonary tuberculosis
part of the neck. The doctor diagnosed D. Pulmonary neoplasm
hyperplasia of the thyroid gland of the E. Chronic bronchitis
second degree, euthyroidism. Ultrasound
suspected autoimmune thyroiditis. Blood 187. A 57-year-old man complains of
was taken for titre of antibodies to shortness of breath, swelling on shanks,
thyroglobulin. What titre of antibodies wi- irregularity in cardiac work, pain in the
ll be diagnostically important? left chest half with irradiation to the
left scapula.Treatment is uineffective. On
A. 1:50 physical exam: heart’s sounds are dimini-
B. 1:250 shed, soft systolic murmur on the apex.
C. 1:150 Ps - 100/min, arrhythmical, BP - 115/75
D. 1:200 mm Hg. The liver is +2 cm, painful.
E. 1:100 Roentgenoscopy: enlargement of heart
shadow to all sides, pulsation is weak.
184. The adolescent of 15 years old was
Electrocardiogram (ECG): leftventricled
brought to the hospital with complaints extrasystolia, decreased voltage. What
of poor night eyesight. On physical exam:
method of investigation is necessary to
increased darkness adaptation time, Bi-
do to determine the diagnosis?
tot’s spots on conjuctiva. The patient skin
is dry, scales off, folliculitis signs of the
face skin are present. What is a cause of
this disease?
 Krok 2 Medicine 25

A. Veloergometria for infertility. Recently she visited guests

B. Echocardiography and contacted a child who developed
C. ECG in the dynamics rubella in 2 days after meeting. The
D. X-ray kymography woman doesn’t remember whether she
E. Coronarography was infected with rubella or not. What
is the adequate tactics?
188. District doctor of rural medical
department was called to a 42-year-old A. Interferon administration
patient. While examining the patient, the B. Interruption of the pregnancy
doctor suspected the dysentery. What C. Monitoring of the specific Ig G Ig M
document must the doctor issue? with the enzyme-linked immunosorbent
assay (ELISA)
A. Urgent notification of infectious disease D. Immune globulin injection
B. Statistical coupon of final (precise) E. Cyclovin administration
diagnosis
C. Report addressed to Head of the village 193. A 42-year-old woman suffers from
D. Abstract of outpatient medical card bronchial asthma, has an acute attack
E. Infectious disease report of bronchial asthma. What medication
from the listed below is contraindicated
189. What information gathering method to render a first aid?
is preferable to study housing conditions
of medical students during training peri- A. Strophanthin hydrochloride
od? B. Izardin
C. Corazolum
A. Questionaire D. Morphinum hydrochloride
B. Statistical E. Euphylinum
C. Materials selection
D. Interviewing 194. Choose the method of graphic
E. Directed selection method representation of monthly information
about the number of registered cases of
190. A 9-year-old girl has attacks of acute intestinal infection in comparison to
abdominal pain after fried food. No fever. the average monthly values, obtained for
She has pain in Cera point. The liver is not 5 previous years.
enlarged. Portion B [duodenal probe] - 50
ml. What is your diagnosis? A. Curvilinear
B. The radial diagram
A. Acute colitis C. The sector diagram
B. Chronic duodenum D. The figured diagram
C. Hepatocirrhosis E. The linear diagram
D. Peptic ulcer
E. Biliary tracts dyskinesia, hypotonic type 195. The woman from a group of risk
(chronic pyelonephritis in anamnesis) had
191. A 3-year–old boy suddenly fell ill labor through natural birth canal. In one
with fever up to 39O C, weakness, vomi- day after labor she started complaining
ting.Hemorrhagic rash of various size of fever and loin pains, often urodynia.
appeared on his lower extremities in 5 Establish the most probable complication.
hours.Meningococcemia with infective –
toxic shock of the 1st degree was di- A. Thrombophlebitis of veins of the pelvis
agnosed. What medications should be B. Endometritis
prescribed? C. Apostatis of stitches after episiotomy
D. Infection contamination of the urinary
A. Chloramphenicol succinate and predni- system
sone E. Infected hematoma
B. Ampicillin and immunoglobulin
C. Penicillin and prednisone 196. A patient suffers from suddenly
D. Penicillin and immunoglobulin arising crampy pain in the right loin
E. Chloramphenicol succinate and area. 2 hours after the pain had started,
interferon hematuria took place. Loin X-ray:
no pathological shadows. Ultrasound:
192. A 36-year-old woman is on the 12- pyelocaliectasis on the right, the left part
th week of her first pregnancy. In the is normal. What is the most probable di-
past history she had undergone treatment agnosis?
 Krok 2 Medicine 26

A. Diabetes mellitus risk group

A. Intestine invagination B. Diabetes mellitus
B. Tumour of the right kidney pelvis C. Disordered tolerance to glucose
C. Twist of the right ovary cyst D. Postoperative hyperinsulinemia
D. Acute appendicitis E. Norm
E. Stone of the right kidney, renal colic
199. A 25-year-old man has facial edema,
197. A 48-year-old patient complains of moderate back pains. His temperature is
heaviness in the right hypochondrium, 37, 5O Ñ, BP 180/100 mm Hg, hematuria
itching of the skin.He had been treated [up to 100 in v/f], proteinuria [2,0 g/L],
in infectious diseases hospital repeatedly hyaline casts - 10 in v/f., specific gravi-
due to icterus and itch. On physical exam: ty -1020. The onset of the disease is
meteorism, ascitis, dilation of abdominal probably connected with acute tonsillitis
wall veins, protruded umbilicus, spleen that started 2 weeks ago. What is the most
enlargement. What can be diagnosed in probable diagnosis?
this case?
A. Cancer of the kidney
A. Liver cirrhosis B. Urolithiasis
B. Gallstones C. Chronic glomerulonephritis
C. Cancer of the liver D. Acute glomerulonephritis
D. Cancer of the head of pancreas E. Acute pyelonephritis
E. Viral hepatitis B
200. In the anamnesis of a 2-year-
198. A 35-year-old man was operated on old girl there are recurrent pneumoni-
peptic ulcer of the stomach. Mass deficit as with signs of obstruction. There
of the body is 10 kg. The level of glucose are heterogeneous moist and dry rales,
after operation in the undiluted cellular respiration is weakened. Dense, viscous
blood on an empty stomach is 6,7 mmol. secretion is difficult to hawk. There are
During repeated examination - 11,1 mmol "drumsticks", physical retardation. What
(after meal), level of HbA1c - 10%. Could is the most probable diagnosis?
you please make an interpretation of the
given data? A. Recidivating bronchitis
B. Bronchial asthma
C. Mucoviscidosis, pulmonary form
D. Congenital pulmonary polycystosis
E. Pulmonary tuberculosis
 Krok 2 Medicine 27

Laboratory values
Total blood count
Value Norm
Erythrocyte male: 4, 0 − 5, 0 ∗ 1012 /L
count Female: 3, 9 − 4, 7 ∗ 1012 /L
Hemoglobin, Male: 135-180 g/L
blood Female: 120-140 g/L
Color index 0,85- 1,15
Reticulocyte count 0,2 - 1%
Platelet count (Thrombocytes) 180, 0 − 320, 0 ∗ 109 /L
Leucocyte count 4, 0 − 9, 0 ∗ 109 /L
Basophils 0 − 0, 065 ∗ 109 /L (0-1%)
Eosinophils 0, 02 − 0, 30 ∗ 109 /L (0,5 - 5,0%)
Neutrophils, band 0, 04 − 0, 30 ∗ 109 /L (1 - 6 %)
Neutrophils, segmented 2, 0 − 5, 50 ∗ 109 /L (47 - 72%)
Monocytes 0, 09 − 0, 60 ∗ 109 /L (3 - 11%)
Lymphocytes 1, 2 − 3, 0 ∗ 109 /L (19 - 37%)
Erythrocyte Male: 2 - 10 mm/h
sedimentation rate Female: 2 - 15 mm/h
Male: 40 - 48%
Hematocrit Female: 36 - 42%
Blood Biochemical Profile
Proteins total, serum 65-85 g/L
Albumin 35-50 g/L (52-65%)
Globulin: 23-35 g/L (35-48%)
α1 -globulin 2-4 g/L (4,2-7,2%)
α2 -globulin 5-9 g/L (6,8-12%)
β-globulin 6-11 g/L (9,3-15%)
γ-globulin 11-15 g/L (15-19%)
Albumin - Globulin ratio 1,2-2,0
Immunoglobulin, serum: (Immune serum
globulin)
IgD 0 - 0,15 g/L
IgG 50-112,5 µmol/L
IgM 0,6-2,5 µmol/L
IgA 5,6-28,1 µmol/L
IgE 0,3-30 nmol/L
Bilirubin, serum:
total 8,5-20,5 µmol/L
undirect (nonconjugated) 1,7-17,11 µmol/L
direct (conjugated) ) 0,86-5,1 µmol/L
Lipids, serum (total) 5-7 g/L
Triglycerides 0,59-1,77 mmol/L
Total cholesterol, serum 2,97-8,79 mmol/L
Lipoproteins:
very low density (pre-beta-lipoproteins) 1,5-2,0 g/L (0,63-0,69 mmol/L)
low density (beta-lipoproteins) 3-4,5 g/L (3,06-3,14 mmol/L)
high density (alpha-lipoproteins) 1,25-6,5 g/L (1,13-1,15 mmol/L)
Chylomicrones 0-0,5 g/L (0-0,1 mmol/L)
Glucose, serum 3,3-5,5 mmol/L
Glycosylated hemoglobin 4 - 7%
 Krok 2 Medicine 28

Ferrum, serum 8,53-28,06 µmol/L

Potassium (K + ),plasma 3,8-5,2 mmol/L
Sodium (Na+ ), plasma 138-217 mmol/L
Calcium (Ca++ ), plasma 0,75-2,5 mmol/L
Magnesium (Mg 2+ ), plasma 0,78 - 0,91 mmol/L
Phosphorus inorganic, serum 0,646-1,292 mmol/L
Chloride (Cl− ), serum 97-108 mmol/L
Nitrogen residual (non-protein) 14,28 - 25 mmol/L
Urea, serum 3,33 - 8,32 mmol/L
Creatinine, serum 53 - 106,1 µmol/L
Male: 15,25-45,75 µmol/L
Creatine, serum Female:45,75-76,25 µmol/L
Male: 0,12-0,38 µmol/L
Urine acid Female: 0,12-0,46 µmol/L
Lactate dehydrogenase(LDG) < 7 mmol/(h*L)
Aldolase 0,2-1,2 mmol/h*L
α-amylase (diastase) 12-32 г/ h*L
Aspartate aminotransferase (AST, AsAT, 0,1-0,45 mmol/h*L
GOT)
Alanine aminotransferase (ALT, AlAT, 0,1-0,68 mmol/h*L
GPT)
Cholinesterase 160-340 mmol/h*L
Alkaline phosphatase 0,5-1,3 mmol/h*L
Creatine kinase 0,152-0,305 mmol/h*L
Creatine phosphokinase (KPhK), serum < 1,2 mmol Р/h.L
Lipase 0,4-30 mmol/(h.L)
Coagulogram
Prothrombin index 80-100%
Plasma recalcification time 60-120 sec
Thrombotest IV-V grade
Fibrinogen, factor I 5,9-11,7 µmol/L
Fibrinogen Negative
Fibrinolytic activity 183-263 minutes
Plasma tolerance to heparin 3-6 (7-11) minutes
Citrate clotting time(Lee-White) 5-10 minutes
Bleeding time(Duke) < 4 minutes
Clot retraction time 44-65% (retraction index 0,3-0,5)
Acid-base status value
рН, arterial blood 7,4
рН, venous blood 7,35
Carbone dioxide partial pressure, Ða CO2 :
аrterial blood 40 mm Hg
venous blood 46 mm Hg
Oxygen partial pressure, Ða O2 , arterial 75 - 105 mm Hg
blood
Base excess (deficite)(ВЕ) ± 2,3 mmol/L
Total blood buffer base (ВВ) 45-50 mmol/L
Standard bicarbonate (В):
arterial blood 24 mmol/L
venous blood 26 mmol/L
Active bicarbonate (АВ) 27 mmol/L
 Krok 2 Medicine 29

Other blood values

Cortisol, serum 230 -750 nmol/L
Osmolality, serum 275 - 295 mosmol/kg
Parathyroid hormone, serum 42, 6 ± 9, 31 pmol/L
Somatotropic hormone 0 - 118 pmol/L
Thyroid hormone, serum or plasma 128 ± 28 pmol/L
Tyroxine (Т4), serum 65-155 nmol/L
Triiodothyronine (Т3), serum 1,77 - 2,43 nmol/L
Male: 96 ± 7, 63 mkg/L
Ferritin, serum Female: 45, 5 ± 4, 58 mkg/L
α1 -seromucoid 12,47-31,75 µmol/L
Thymol test up to 5 units
Sialic acid 550-790 мg/L
С-reactive protein Negative
Antistreptolysin-О (АSL-О) 250 U
Antistreptohyaloronidase (АSG) 250 U
Urine values
value Norm
Deferent urine density 1,016-1,022
Urine elements count: (by Kakovski-
Addise method) :
leukocyte up to 2 ∗ 106 /24h
erythrocyte up to 1 ∗ 106 /24h
cylinders up to 2 ∗ 104 /24h
( by Nechiporenko):
leukocyte up to 4 ∗ 106 /L
erythrocyte up to 1 ∗ 106 /L
Protein, total 45,0 - 75,0 mg/24h
Potassium 38 - 77 mmol/24h
Calcium 2,5 - 7,5 mmol/24h
Male: 97 - 137 ml/min
Creatinine clearance Male: 88 - 128 ml/min
Uric acid 1,48 - 4,43 mmol/24h
Sodium varies on diet
Oxalate 90 - 445 µmol/L
Chloride 4,1 - 13,7 µmol/24g
Male: 27,7 -79,7 µmol/24h
17-ketosteroids Female 17,4 - 55,4 µmol/24h
17-oxycorticosteroids 0,11 - 0,77 µmol/24h
α-amilase (diastase) urine 28-160 g/h*L (28-160 U)
Male: 6,8-17,6 mmol/24h
Urine creatinine female: 7,1-15,9 mmol/24h