Krok!!2023 Jan

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2023 – January – Medicine

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1. Examination of the corpse of a C. External obstetric version of the

man, who died by hanging, reveals that fetus
the spots of livor mortis disappear D. Urgent cesarean section
when pressed and reappear 50 seconds E. Delivery through the natural birth
later. The rigor mortis is moderate and canal
observed only in the masticatory
muscles and muscles of neck and 3. After the pregnant woman’s
fingers. The body temperature is waters broke, it was noted that they are
31.0°C. What is the time of death in significantly contaminated with
this case? meconium. Upon birth, the baby is not
A. 6-7 hours breathing, remains inert, the skin is
B. 8-10 hours cyanotic and covered in meconium,
C. 1-2 hours heart rate is 98/min. What resuscitation
D. 10-18 hours measures should be taken after the
E. 16-24 hours baby is born?
A. Tactile stimulation of the newborn
2. A 34-year-old multipara was B. Give adrenaline intravenously
brought to the labor ward with regular C. Artificial pulmonary ventilation
labor activity. Her pelvic size 26-29- with a mask and Ambu bag
32-22 cm. Vaginal examination shows D. Direct laryngoscopy, intubation,
6 cm cervical dilation, the amniotic sac sanation of the trachea
is unbroken. The fetus is in the breech E. Sanation of the upper respiratory
presentation, with buttocks pressed to tracts with a rubber balloon
the entrance into the lesser pelvis. The
promontory cannot be reached, no 4. A 9-year-old boy fell off a tree
exostoses. Feta heart rate is 140/min, and hit the back of his head. A brief
expected fetal weight is 2800g. What loss of consciousness was observed.
labor tactics should be chosen? The child’s condition is satisfactory,
A. Classic combined external-internal he has a headache and vertigo. Skull
version of the fetus X-ray scans shows depressed fracture
B. Fetal extraction from the pelvic end of the occipital bone in the area of the
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external occipital protuberance. What A. Acute liver failure

treatment tactics is indicated for this B. Acute heart failure
patient? C. Cerebral coma
A. Complex conservative treatment D. Acute adrenal insufficiency
B. Lumbar puncture to relieve the E. Acute hemorrhage
pressure
C. Surgical intervention 7. Examination detected vesicles
D. Anti-inflammatory therapy with seropurulent content on the neck,
E. Hemostatic therapy back of the head, and buttocks of an
infant on the 4th day of life. The
5. A 23-year-old woman without patient’s condition is satisfactory, the
visible cause developed a conflicting child is active, all newborn reflexes
behavior at the workplace. She can be fully induced, the umbilical
accused the management of cord is at the stage of mummification,
underestimating her, claimed that she the umbilical area is without any
can be a deputy director, because she peculiarities. What disease can be
speaks four languages, is very suspected?
attractive, and can make useful A. Phlegmon
connections for the company. She has B. Neonatal pemphigus
been dressing extravagantly, flirting C. Miliaria
with her colleges, and singing loudly D. Vesiculopustulosis
in her office. In fact, she has only the E. Epidermolysis bullosa
training of a computer operator and
speaks no foreign languages. What is 8. A 16-year-old teenager
the likely clinical diagnosis? complains of weakness, dizziness, and
A. Schizophrenia heaviness in the left subcostal region.
B. Mild mental retardation Objectively, the skin and visible
C. Manic episode mucosa are icteric. The tower skull
D. Depressive disorder syndrome is observed. The liver is +2
E. Epilepsy cm. The lower edge of the spleen is at
the level of the navel. In the complete
6. A 21-year-old man was blood count: erythrocytes — 2.7 *
hospitalized on the 2nd day of the 1012/L, Hb — 88 g/L, leukocytes —
disease. His general condition is 5.6-109/L, ESR — 15 mm/hour. What
severe, body temperature is 39°C. On is the most likely change in the
his skin there are numerous irregular bilirubin levels in this patient?
shaped hemorrhagic elements. The A. Decrease in conjugated bilirubin
diagnosis of meningococcemia was levels
made. The next day his body B. Increase in conjugated bilirubin
temperature suddenly decreased, blood levels
pressure was 80/40 mm Hg, pulse was C. Increase in unconjugated bilirubin
120/min. Acrocyanosis was detected. levels
What complication did the patient D. Increase in unconjugated and
develop? conjugated bilirubin levels
E. Decrease in unconjugated bilirubin test: erythrocytes — 3.2 * 1012/L, Hb

Levels — 100 g/L, color index — 0.87,
leukocytes — 100 * 109/L, basophils
9. During regular examination of a — 7%, eosinophils — 5%, monocytes
2-year-old boy, he presents with — 15%, juvenile — 16%, band
enlarged left kidney, painless on neutrophils — 10%, segmented
palpation. The right kidney was neutrophils — 45%, lymphocytes —
undetectable on palpation. Excretory 2%, monocytes — 0%, reticulocytes
urography shows no contrast on the — 0.3%, platelets — 400 * 109/L,
right. Cystoscopy detected ESR — 25 mm/hour. Make the
hemiatrophy of the urinary bladder diagnosis:
trigone, the right ureteral orifice is not A. Chronic myelogenous leukemia
detected. What pathology is it? B. Acute leukemia
A. Agenesis of the right ureter C. Hepatic cirrhosis
B. Ectopic right ureteral orifice D. Chronic lymphocytic leukemia
C. Agenesis of the right kidney E. Erythremia (polycythemia vera)
D. Hypoplasia of the right kidney
E. Dystopia of the right kidney 12. A patient 1 year ago had a Q
wave myocardial infarction of the
10. For a week a 42-year-old patient posterior wall of the left ventricle. For
has been suffering from fever attacks the last 2 weeks he has been suffering
which occur every 48 hours. Body from daily attacks of atrial fibrillation
temperature raises up to 40°C and and bradycardia episodes,
decreases in 3-4 hours with excessive accompanied by bouts of vertigo.
sweating. The patient presents with What tactics is the most advisable in
loss of appetite and general fatigue. this case?
The skin is pale and sallow. The liver A. Pacemaker implantation
and spleen are enlarged and dense on B. Prescription of procainamide
palpation. What method of diagnosis C. Prescription of amiodarone
verification would be most efficient? D. Prescription of bisoprolol
A. Complete blood count E. Prescription of digoxin
B. Microscopy of hanging blood drop
C. Bacteriological analysis 13. During a regular examination,
D. Microscopy of blood smear and an 8-year-old girl with type I diabetes
thick blood film mellitus presents with a swelling on
E. Enzyme-linked immunosorbent the anterior surface of her hip. The
assay swelling is 3 cm in diameter, dense,
painless on palpation. The skin over
11. Throughout the last year a 27- this formation has normal color and
year-old man notes fatigue, excessive temperature. Localization of the
sweating, and heaviness in his left swelling matches the place where the
subcostal region, especially after girl usually receives her insulin
eating. Objectively, his spleen and injections. What is the most likely
liver are enlarged. In clinical blood cause of this clinical presentation?
A. Formation of a post-injection when she climbs the stairs.

abscess Occasionally during movements her
B. Allergic response joint becomes” stuck”. 5 years ago, she
C. Formation of a post-injection suffered a trauma of her left knee.
infiltration Complete blood count and
D. Development of hypertrophic biochemical blood analysis show
lipodystrophy normal results. X-ray shows marked
E. Development of atrophic osteosclerosis and osteophytes. The
lipodystrophy joint space is narrowed. Make the
provisional diagnosis:
A. Rheumatoid arthritis
14. In the demographic structure of
B. Osteoarthritis
a region, the persons aged from 0 to 14
C. Psoriatic arthritis
make up 31% of the population, while
D. Reactive arthritis
the 50+ age group makes up 20% of
E. Gouty arthritis
the population. What population
structure characterizes this
17. A 48-year-old woman was
demographic situation most
delivered into the surgical unit with
accurately?
wounds in her thigh. On examination
A. Stationary population
the wound surface has a dirty-gray
B. Migration of the population
coating with unpleasant sweet smell.
C. Constrictive population
The wound content resembles a
D. Emigration of the population
raspberry jelly. Skin tissues around the
E. Expansive population
wound are glossy and turgid. Palpation
reveals moderate crepitation in the
15. A 27-year-old man complains of
tissues. What bacteria is the most
pain in his leg joints, purulent
likely to cause such inflammation?
discharge from the eyes, and painful
A. Anaerobic non-clostridial
burning sensations during urination.
B. Staphylococci
The disease onset was acute. He has a
C. Anaerobic clostridial
history of influenza. The patient
D. Streptococci
smokes and drinks alcohol in excess.
E. Blue pus bacillus
In his line of work he is often away on
business trips. What is the most likely
18. The body of a 24-year-old
etiological factor of this disease?
woman with probable signs of
A. Adenovirus
poisoning has been found on the street.
B. Candida
Forensic medical examination was
C. Staphylococci
requested by an investigator during
D. Streptococci
examination of the site and the body.
E. Chlamydia
According to the Criminal Procedure
Code currently in force in Ukraine,
16. A 55-year-old woman
forensic medical examination is
complains of pain and popping sounds
in her left knee joint, which occur
required when it is necessary to

determine the: 21. A 45-year-old man underwent a
A. Time of death cardiac surgery one week ago. His
B. Manner of death general state has been deteriorating
C. Mode of death since then: dyspnea at rest, retrosternal
D. Cause of death pain that irradiates to the neck, marked
E. Mechanism of death weakness. Objectively his body
temperature is hectic. His cardiac
19. A 17-year-old girl has been borders arc expanded, apical beat is
suffering from hepatic cirrhosis for 3 weakened. Auscultation detects
years. Lately her periods of excitation pericardial friction rub. What is the
have been intermittent with most likely diagnosis?
depression, she does not sleep enough. A. Acute pericarditis
Objectively, her condition is severe, B. Acute myogenic dilatation of the
the girl is sluggish, gives one-word heart
responses, has tremor in her C. Pulmonary embolism
extremities, her skin is icteric, with D. Myocardial infarction
single hemorrhagic rashes. Name the E. Acute cardiac aneurysm
likely complication of her disease:
A. Bipolar affective disorder 22. A 34-year-old man undergoes
B. Sepsis treatment in a psychiatry unit for
C. Hepatic encephalopathy exacerbation of his schizophrenia.
D. Kidney failure Objectively, he stays in bed, his
E. Reye syndrome movements are inhibited, no contact.
The patient does not respond to the
20. A 35-year-old man complains of questions. The position remains
rapidly increasing fatigue, unchanged, the patient is hypomimic,
palpitations, “visual snow”, dizziness. such signs as puckering of the lips,
He has a history of peptic ulcer of the waxy flexibility, “psychological
stomach. Objectively the skin is pale. pillow” are present. The patient has
Vesicular respiration is observed in the been remaining in this condition for a
lungs. Systolic murmur is detected week. He is being fed parenterally.
over the cardiac apex, heart rate is What psychomotor disorder is it?
100/min., BP is 100/70 mm Hg. The A. Anergic stupor
epigastrium is slightly tender on B. Exogenous stupor
palpation. Blood test: erythrocytes — C. Psychogenic stupor
3.2 • 1012/L, Hb — 100 g/L, color D. Depressive stupor
index — 0.94. What type of anemia is E. Catatonic stupor
it?
A. Hypoplastic anemia 23. Forensic autopsy of the body of
B. Chronic iron-deficiency anemia a 59-year-old man, who died suddenly
C. Posthemorrhagic anemia at home without signs of violent death,
D. Hemolytic anemia shows pink skin and mucosa, liquid
E. Sideroblastic anemia bright-red blood, and bright-red
plethoric internal organs. Forensic 26. A 19-year-old girl complains of

toxicology testing detected 1.44% of moderate itching and hair loss on her
ethanol in the blood and head. Objectively, on the skin of her
carboxyhemoglobin levels of 55%. occipital region there is a single round
What is the cause of death? erythematous focus 3 cm in diameter
A. Alcohol poisoning with clear margins. Asbestos-like
B. Aniline poisoning scales can be observed on the surface
C. Potassium cyanide poisoning of the lesion. The hair in the focus of
D. Carbon monoxide poisoning the lesion is broken off at the length of
E. Arsenic poisoning 6-8 mm. What is the most likely
diagnosis?
24. A 65-year-old woman for 5 A. Trichophytosis
weeks has been presenting with a B. Seborrhea
progressing painless jaundice, skin C. Psoriasis
itch, weight loss of 10 kg, and acholia. D. Microsporia
Palpation detects positive Courvoi- E. Scabies
sier’s sign. Make the provisional
diagnosis: 27. A 26-year-old man complains of
A. Liver cancer chills, rhinitis, dry cough, and fever up
B. Gallbladder cancer to 38 0 C. Examination shows him to
C. Malaria be in a moderately severe condition;
D. Pancreatic cancer there are small Pale pink non-merging
E. Viral hepatitis spots on the skin of is back, abdomen,
and extremities. Palpation reveals
25. During the study of pulmonary enlarged occipital and axillary lymph
tuberculosis morbidity, the data on nodes. No information about
socioeconomic living conditions and vaccination history could be obtained.
harmful habits of the patients were What is the likely etiology of this
obtained. What method allows the disease?
assessment of the extent to which these A. Streptococcus
factors influence the tuberculosis B. Rubella virus
morbidity? C. Mumps virus
A. Calculation of standardized D. Meningococcus
indicators E. Epslein-Barr virus
B. Calculation of the agreement
coefficient
C. Calculation of the confidence 28. An employee has been sick for 4
coefficient months, further treatment is necessary,
D. Calculation of the regression the patient is unable to work. Who is
coefficient authorized to provide further disability
E. Calculation of the correlation examination of this patient?
coefficient A. Chief physician of a medical
facility
B. Medical consultative board
C. Sociomedical expert committee B. Feeding no longer that 10 minutes

D. Deputy chief physician responsible through an overlay
for disability examination C. Stop breastfeeding when fissures
E. Physician in charge and the head of appear
the Department D. Feeding on schedule
E. Constant expression of breast milk
29. A 58-year-old woman has type
2 diabetes mellitus that is compensated 31. A 20-year-old woman
with diet and metformin. She prepares complains of headaches, vertigo,
for cholecystectomy. Objectively, her tearfulness, vomiting, pain in the area
height is 164 cm, weight is 90 kg, heart of the heart, and tachycardia. The signs
rate is 72/min., blood pressure is appear 6-7 days before menstruation
130/80 mm Hg. Her abdomen is soft, and disappear in the first days of
painful in the right subcostal region. menstruation. Make the diagnosis:
The liver is not enlarged. Fasting A. Premenstrual syndrome
glucose — 6.2 mmol/L. Glycated B. Metabolic craniopathy
hemoglobin — 6.5%. What further C. Diencephalic syndrome
tactics of sugar-lowering therapy D. Algomenorrhea
should be chosen in this case? E. Stein-Leventhal syndrome
A. Prescription of a long-acting
insulin 32. A 38-year-old patient has been
B. Prescription of an insulin mixture delivered by an ambulance to a
C. Prescription of glurenorm surgical department with complaints of
(gliquidone) general weakness, indisposition, black
D. Continue the present scheme of stool. On examination the patient is
therapy pale, there are dotted hemorrhages on
E. Prescription of a short-acting the skin of his torso and extremities.
insulin On digital investigation there are black
feces on the glove. Complete blood
30. On the 5th day after giving birth count: Hb — 108 g/L,
a postparturient woman complains of a thrombocytopenia. Anamnesis states
pain in her left mammary gland and that similar condition was observed 1
temperature up to 38. PC'. year ago. Make the diagnosis:
Examination shows that her mammary A. Hemophilia
gland is enlarged and painful on B. Rectal tumor
palpation, the nipple is edematous and C. Thrombocytopenic purpura
has fissures, the upper external D. Nonspecific ulcerative colitis
quadrant of the gland is hyperemic. E. Ulcerative bleeding
Name the measures that would have
prevented the development of this 33. A 31-year-old woman has been
complication in the patient: suffering from systemic scleroderma
A. Feeding on demand, expression of for 14 years. She underwent multiple
breast milk, prevention of nipple inpatient treatment courses. She
fissures complains of intermittent dull pain in
the area of her heart, palpitations, the genital tracts. What complication
shortness of breath, headache, swollen occurred in the patient?
eyelids, weight loss, and painful and A. Migraine
deformed joints in her limbs. The B. Dysmenorrhea
prognosis of her condition will be C. Somatoform autonomic
worse if which of the following organs dysfunction of hypotonic type
is affected? D. Posthemorrhagic anemia
A. Skin and joints E. Gastritis
B. Lungs
C. Gastrointestinal tract 36. A 68-year-old woman with
D. Kidneys congestive heart failure and left
E. Heart ventricular ejection fraction of < 40%
receives the following
34. Disease onset was acute. A child pharmacotherapy scheme: ramipril,
developed general weakness, pain in torasemidc, bisoprolol, clopidogrcl,
the joints, and elevated temperature. and digoxin. During one of her regular
Later these signs became accompanied examinations, frequent polymorphic
by itching skin rash manifested as ventricular extrasystoles were detected
erythematous spots 25 mm in size. The in the patient. What medicine should
rash gradually turned hemorrhagic. be removed from her therapy scheme?
Large joints are painful and swollen; A. Digoxin
pain attacks periodically occur in the B. Bisoprolol
paraumbilical area; there are signs of C. Clopidogrel
intestinal hemorrhage. What is the D. Torasemide
most likely diagnosis? E. Ramipril
A. Hemorrhagic vasculitis (Henoch-
37. A 78-year-old man with a
Schonlcin purpura)
prostate adenoma underwent a
B. Scarlet fever
herniotomy for a direct inguinal
C. Rheumatism
hernia. After the surgery he presents
D. Streptococcal impetigo
with absent urination. Enlarged
E. Hemorrhagic meningoencephalitis
urinary bladder is detectable above the
patient’s pubis. What measures should
35. A 14-year-old girl came to a
be taken in this case?
general practitioner with complaints of
A. Apply cold to the urinary bladder
weakness, loss of appetite, headache,
area
rapid fatigability. Her last
B. Prescribe antispasmodics
menstruation was profuse and lasted
subcutaneously
for 14 days after the previous delay of
C. Prescribe proserin (neostigmine)
2 months. Objectively, her skin is pale,
intramuscularly
heart rate is 90/min., BP is 110/70 mm
D. Prescribe processing of the
Hg, Hb is 88 g/L. Rectal examination:
postoperative wound with UHF
the uterus and its appendages are
field
without changes, no discharge from
E. Bladder catheterization
40. A 19-year-old young man

38. A 23-year-old woman with type complains of cough with expectoration
1 diabetes mellitus during the 2nd of purulent sputum in amount of 100
week of community-acquired mL per day, hemoptysis, dyspnea,
pneumonia developed nausea and increased body temperature up to
vomiting. In the evening she has lost 37.8°C, general weakness, weight loss.
her consciousness and was The patient’s condition lasts for 4
hospitalized. Objectively, the patient’s years. Exacerbations occur 2-3 times a
skin is pale and dry. Her respiration is year. The patient presents with
loud, the tongue is dry, with brown malnutrition, pale skin, cyanosis of the
deposit. Her heart rate is 129/min., lips, drumstick (clubbed) fingers.
blood pressure is 85/50 mm Hg. Tympanic percussion sound in the
Palpation of the patient’s abdomen lungs, weakened respiration, and
provokes no response. The liver is +3 various numerous moist crackles in the
cm. Acetone test is markedly positive, lower pulmonary segments on the left
blood glucose is 26 mmol/L. Make the can be observed in this patient.
provisional diagnosis: Complete blood count: erythrocytes —
A. Hepatic coma 3.2 • 1012/L, leukocytes — 8.4 •
B. Hyperosmolar coma 109/L, ESR — 56 mm/hour. On X-ray:
C. Infectious toxic shock lung fields are emphysematous, the left
D. Ketoacidotic coma pulmonary root is deformed and
E. Lactacidemic coma dilated. What is the most likely
diagnosis?
39. A 35-year-old woman came to A. Chronic abscess of the left lung
the family doctor with complaints of B. Chronic left-sided pneumonia
profuse menstruations that last up to 10 C. Left-sided pulmonary cystic
days. Gynecological examination dysplasia
shows that the uterine cervix is without D. Multiple bronchiectasis of the left
changes, the uterus is in anterflexio, lung
has normal size, is mobile and E. Suppuration of the cyst in the left
painless. The uterine appendages on lung
the both sides are without peculiarities.
The family doctor made the 41. A 22-day-old infant developed
provisional diagnosis of abnormal subcutaneous red nodes from 1.0 to 1.5
uterine bleeding. What instrumental cm in size on the scalp; later the nodes
method of examination needs to be suppurated. Temperature increased up
performed first to diagnose this to 37.7°C, intoxication symptoms
pathology? appeared, regional lymph nodes
A. Colposcopy enlarged. Complete blood count:
B. Transabdominal ultrasound anemia, leukocytosis, ncutrocytosis,
C. Trans vaginal ultrasound raised ESR. What diagnosis will you
D. Culdoscopy make?
E. Laparoscopy A. -
B. Pemphigus
C. Scalp phlegmon aVL, and V5-V6. What is the most

D. Pseudofurunculosis likely diagnosis?
E. Vesiculopustulosis A. Uncomplicated hypertensive
urgency
42. A 7-year-old boy suddenly B. Pulmonary embolism
developed pain and edema in his right C. Hypertensive emergency
knee. The day before, at school, he complicated with acute myocardial
took part in cross-country skiing. infarction
There is no family history of D. Hypertensive emergency
hemophilia or susceptibility to complicated with acute left
bleeding. Objectively, his body ventricular failure
temperature is 37.5°C. The knee is E. Hypertensive emergency
painful on palpation, hot to the touch, complicated with unstable angina
and has edema with local tissue tension pectoris
above it. Incomplete blood count: Hb
— 123 g/L, leukocytes — 5.6 • 109/L, 44. A multigravida, labor II, 36-37
platelets — 354 •109/L, prothrombin weeks of gestation, has gone into
time — 12 seconds (normal range is labor. Her waters broke 8 hours ago,
10-15 seconds), activated partial the labor activity continues for the last
thromboplastin time — 72 seconds 4 hours, it is regular, with contractions
(normal range is 35^15 seconds). that last 35 seconds and occur every 3-
Bleeding time is normal, the factor 4 minutes. The child is in the cephalic
VIII levels constitute 5% of normal presentation, with the head pressed to
value. Make the diagnosis: the entrance into the lesser pelvis. The
A. Hemophilia B parturient woman complains of a
B. Hemophilia A sudden sharp abdominal pain. Her
C. Thrombocytopenia pulse is 100/min., blood pressure is
D. Vitamin K deficiency 110/70 — 100/70 mm Hg. The uterus
E. Henoch-Schoenlein purpura is tense and does not relax between the
contractions. Fetal heartbeat is muffled
43. A 62-year-old woman was — 100/min. The amniotic fluid is
brought into the admission room with blood-colored and continues to leak.
complaints of severe burning What is the most likely diagnosis?
retrosternal pain and asphyxia. She has A. Premature detachment of the
a 10-year-long history of essential normally positioned placenta
hypertension. Objectively her B. Cervical rupture
condition is moderately severe. She C. Partial placenta previa
presents with skin pallor, cyanotic lips, D. Rupture of the umbilical vessels
and vesicular respiration over her E. Uterine rupture
lungs. The II heart sound is
accentuated over the aorta. Blood 45. A 45-year-old woman was
pressure — 210/120 mm Hg, heart rate hospitalized with complaints of
(pulse) — 76/min. ECG shows periodical severe headaches against
elevation of ST segment in the leads I, the background of elevated blood
pressure up to 180/90 mm Hg, muscle disease occurred after a car accident.

weakness, and frequent urination (at Objectively: the patient presents with a
night as well). Her anamnesis states papular rash covered in silvery scales,
that despite combining various “thimble” sign (small pits on the nails),
antihypertensive drugs and adjusting affected joints. What is the most likely
their dosage her arterial hypertension diagnosis?
cannot be corrected with drugs. The A. Onychomycosis
patient’s blood serum potassium levels B. Panaritium
are 2.0 mmol/L, blood serum sodium C. Rheumatism
levels are 160.0 mmol/L. Ultrasound D. Lupus erythematosus
imaging detects three-dimensional E. Psoriasis
formations approximately 1.0 cm in
diameter in the both adrenal glands. 48. A 19-year-old young man was
Selective endovascular blood diving and hit his head on the bottom
sampling from the suprarenal veins of the pool. He complains of pain in the
was performed, which revealed neck, his head movements are limited
significant increase of cortisol and and painful. During examination his
aldosterone levels. Make the head is bowed forward and to the right
diagnosis: and the patient supports it with his
A. Pheochromocytoma hands. Palpation detects tense neck
B. Aldosteroma muscles and protruding spinous
C. Cushing’s syndrome process of the IV cervical vertebra
D. Androsteroma (C4). When pressure is applied to this
E. Cushing’s disease process and to the head (axial load),
the pain intensifies. Make the
46. A 28-year-old man was provisional diagnosis:
hospitalized on the 9th day of illness A. Neck muscle injury
with complaints of fever of 39°C, B. Cervical spine contusion
headache, general weakness, C. Complicated spine cervical fracture
constipation, and disturbed sleep. D. Spinal root injury
Objectively, on the skin of his E. Uncomplicated cervical spine
abdomen there are isolated roseolas, fracture
his pulse is 78/min., the liver is
enlarged by 2 cm. Make the diagnosis: 49. A 48-year-old woman
A. Epidemic typhus complains of disturbed menstrual
B. Sepsis cycle: her periods last for 7-9 days and
C. Leptospirosis arc excessively profuse throughout the
D. Brucellosis last half-year. She notes occasional hot
E. Typhoid fever flashes in her head, insomnia,
irritability, and headaches. Her skin is
47. An 18-year-old patient of normal color. Blood pressure —
complains of skin rash. The patient has 150/90 mm Hg, pulse — 90/min.,
been suffering from this condition for rhythmic. The abdomen is soft and
5 years. The first instance of this painless. Bimanual examination shows
no uterine enlargement, the condition. He has a history of purulent

appendages cannot be detected. The otitis. His temperature is now 38.5°C'.
vaginal fornices are free. What is the The left leg is pressed to the torso,
most likely diagnosis? active movements are absent, the
A. Adrenogenital syndrome lower third of the thigh and knee joint
B. Climacteric syndrome are thickened, hyperemic, with
C. Stein-Leventhal syndrome localized fever. Axial load leads to
(polycystic ovary syndrome) acute discomfort of the patient. What
D. Uterine myoma is the most likely diagnosis?
E. Premenstrual syndrome A. Rheumatoid arthritis
B. Osteogenic sarcoma
50. A 12-year-old girl after a case of C. Left hip fracture
respiratory infection developed D. Hygroma of the knee
dyspnea at rest, paleness of skin. Heart E. Epiphyseal osteomyelitis on the left
rate is 110/min., BP is 90/55 mm Hg.
Heart sounds are muffled. Borders of 53. A 7-year-old boy has been
relative heart dullness: right — the receiving treatment for a month. At the
parasternal line, upper — the III rib, time of hospitalization, he had marked
left — 1,0 cm outwards from the edemas, and daily urine protein of 4.2
midclavicular line. Make the g. Biochemical blood test shows
provisional diagnosis: persistent hypoproteinemia (43.2 g/L)
A. Infectious myocarditis and hypercholesterolemia (9.2
B. Hypertrophic cardiomyopathy mmol/L). What leading
C. Exudative pericarditis glomerulonephritis syndrome is most
D. Somatoform autonomic likely in this patient?
dysfunction A. Mixed
E. Functional cardiopathy B. Nephritic
C. Hematuric
51. An unconscious patient was D. Nephrotic
delivered to a hospital by an E. Isolated urinary
ambulance. Objectively, his body
temperature is 39°C, he presents with 54. Survey X-ray of the patient’s
convulsions and red dry skin. It is abdominal cavity shows severed
known that the patient works as a hemispherical areas of lucency,
stoker in the boiler room. What is the located above well-defined horizontal
likely diagnosis? levels. What is the cause of such an X-
A. CO poisoning ray presentation?
B. Heat stroke A. Metcorism
C. Acute food poisoning B. Cancer of the large intestine
D. Hypertensive urgency C. Intestinal obstruction
E. Acute viral respiratory infection D. Perforated ulcer
E. –
52. A 3-year-old child presents with
sharp deterioration of his general
55. After playing with “mosaics” a A. Eczema

2-year-old child suddenly developed B. Scabies
cough, stridorous respirations, urges to C. Neurodermatitis
vomit, and cyanosis against the D. Epidermophytosis
background of relative somatic health. E. Herpes
What should the doctor suspect first
when examining this child? 58. A 45-year-old man came to the
A. Acute obstructive bronchitis hematologist with complaints of
B. Pertussis general weakness, elevated body
C. Acute laryngotracheitis temperature, excessive sweating,
D. Foreign body aspiration enlarged cervical lymph nodes.
E. Pneumonia Objectively, his body temperature is
375°C, the skin is pale and dry, the
56. A 23-year-old woman came to posterior cervical lymph nodes are
the gynecological clinic. She dense and elastic, up to 2 cm in
complains of pain, itching, and diameter, mobile.
burning in her vulva, general Hepatosplenomegaly was detected.
weakness, indisposition, elevated body What examination is necessary to
temperature up to 372°C, and determine the scope of the pathologic
headache. On examination in the vulva process?
there are multiple vesicles up to 2-3 A. Bone scintigraphy
mm in diameter with clear contents B. Abdominal X-ray
against the background of hyperemia C. Ultrasound of the cervical lymph
and mucosal edema. Make the nodes
provisional diagnosis: D. Complete blood count
A. Cytomegalovirus infection E. Computed tomography
B. Vulvar cancer
C. Papillomavirus infection 59. 2 hours after eating unknown
D. Genital herpes infection mushrooms, a 28-year-old man sensed
E. Primary syphilis a decrease in his mobility and
deterioration of his ability to focus.
57. A 30-ycar-old woman This condition was then followed by a
complains of itching skin, state of agitation and aggression. On
predominantly in the evening and at examination he is disoriented and his
night. The condition lasts for 2 weeks speech is illegible. 4 hours later he
already. On the skin of the interdigital developed fetor hepaticus and lost his
folds, mammary glands, abdomen, consciousness. What syndrome can be
buttocks, and thighs there are observed in this patient?
numerous fine papular and A. Cytolytic syndrome
papulovesicular rashes located in B. Cholestatic syndrome
pairs, excoriations. There is no rash on C. Hepatolienal syndrome
the face and neck. Similar rash is D. Acute hepatic failure
observed in the husband of the patient. E. Portal hypertension
What is the most likely diagnosis?
60. A 45-year-old man developed arrhythmia is detected, heart rate is

constricting retrosternal pain that 128/min., pulse — 82/min., blood
occurs during walks at the distance of pressure is 100/70 mm Hg. What is the
200 m. Objectively heart rate is most likely diagnosis?
80/min., BP is 160/90 mm Hg. During A. Pulmonary embolism
cardiopulmonary exercise test at 50 W B. Community-acquired pneumonia
there is a depression of S-T segment by C. Coarctation of the aorta
3 mm below the isoline in V3-V4. D. Lutembacher syndrome
What is the provisional diagnosis? E. Infective endocarditis
A. Exertional angina pectoris,
functional class II 63. A patient with chronic
B. Alcoholic myocardiodystrophy pancreatitis complains of diarrhea
C. Exertional angina pectoris, occurring up to 5 times per day (no
functional class III blood traces), loss of body weight,
D. Somatoform autonomic abdominal distention, dryness of skin,
dysfunction, hypertension type loss of hair, thirst, bleeding gums,
E. Exertional angina pectoris, convulsions. Complete blood count:
functional class IV leukocytes — 5.8 * 109/L; Hb — 86
g/L; ESR — 15 mm/g; Blood protein
61. A 43-year-old man complains of test: protein — 48 g/L; albumins — 28
facial edema, dyspnea, and difficult g/L. What indicators of coprological
swallowing that appeared 3 hours after analysis would accompany this
he was stung by an insect. Objectively, syndrome?
the skin of his eyelids, cheeks, and lips A. Steatorrhea, creatorrhea
is acutely hyperemic and edematous. B. Gas bubbles, acid reaction
What medicines should he be C. Large amount of starch grains and
prescribed for emergency aid? cellulose
A. Glucocorticosteroids D. Large numbers of iodinophilous
B. Nonsteroidal anti-inflammatory microbes
drugs E. Large amount of mucus,
C. Antihistamines amylorrhea
D. Diuretics
E. Muscle relaxants 64. A woman came to the
gynecologist to plan her pregnancy.
62. A 31-year-old drug-addicted She was advised to increase her intake
person complains of a cough with of the products rich in folic acid,
bloody expectorations, dyspnea, particularly soy beans, bread made of
persistent fever, and leg edemas. The coarsely ground flour, fruits, leafy
jugular veins are distended. There is a green vegetables. Such changes in her
coarse pansystolic murmur detected diet will work toward the prevention
above the base of the xiphoid process of:
and in the second intercostal space on A. Non-closure of the fontanel
the left, close to the edge of the B. Iron-deficiency anemia in the
sternum. Heart sounds are clear, pregnant woman
C. Non-closure of the neural tube in mg/dL) and high-density lipoprotein

the fetus levels of 70mg/dL. Her ECG is
D. Polyhydramnios normal. What advise about her diet
E. Rickets should be given to this woman?
A. Reduce the cholesterol intake
65. A 48-year-old woman B. Increase the fiber intake
developed insomnia, depressive mood, C. Reduce the intake of simple
anxiety, fears and suicidal thoughts carbohydrates
after the death of her husband that D. Reduce the intake of saturated fats
occurred one month ago. During her E. No changes in the diet
stay in the hospital she speaks in a low
voice, is depressed, anxious, avoids 68. A multigravida on the 38th
sleeping, refuses to eat. What week of her pregnancy complains of
medications should be prescribed in increased BP up to 140/90 mm Hg,
this case? edema of the shins for 2 weeks. In the
A. Group B vitamins last month she gained 3.5 kg of weight.
B. Antidepressants Urine analysis: protein — 0.33 g/L.
C. Nootropics What is the most likely diagnosis:
D. Antipsychotics A. Moderate preeclampsia
E. Anticonvulsants B. Severe preeclampsia
C. Pregnancy hypertension
66. A 74-year-old woman D. Mild preeclampsia
complains of painful and distended E. Pregnancy edema
abdomen and nausea. She suffers from
postinfarction and atherosclerotic 69. It is the 3rd day after the normal
cardiosclerosis and ischemic heart term labor; the infant is rooming-in
disease. Objectively, she is in a severe with the mother and is on
condition, her abdomen is distended, breastfeeding. Objectively: the
the abdominal wall is barely involved mother’s general condition is
in the act of breathing. Laparoscopy satisfactory. Temperature is 36.4°C,
detects a small amount of turbid heart rate is 80/min., BP is 120/80 mm
exudate in the abdominal cavity, one Hg. Mammary glands are soft and
of the small intestine loops is dark painless; lactation is moderate,
blue. Make the diagnosis: unrestricted milk flow. The uterus is
A. Erysipelas dense, the uterine fundus is located by
B. Volvulus 3 fingers width below the navel.
C. Ischemic abdominal syndrome Lochia are sanguino-serous, moderate
D. Acute intestinal obstruction in volume. Assess the dynamics of
E. Mesenteric thrombosis uterine involution:
A. Lochiometra
67. Preventive examination of a 75- B. Hcmatometra
year-old woman with a moderately C. Subinvolution
active lifestyle shows total serum D. Physiological involution
cholesterol of 5.1 mmol/L (208 E. Pathologic involution
removal of radionuclides from the

70. A 38-year-old man complains of body. What products are the main
periodical problematic swallowing of source of pectin?
both solid and liquid foods that is A. Vegetables and fruits
observed for many months. Sometimes B. Milk
he develops an intense retrosternal C. Meat
pain, especially after hot beverages. D. Pasta
Asphyxia attacks are observed at night. E. Bread
He has no weight loss. Objectively, his
general condition is satisfactory, the 73. A 32-year-old woman
skin is of normal color. Examination complains of general weakness, low-
detects no changes in the grade fever persisting for 4 months,
gastrointestinal tract. Chest X-ray lumbar pain, and dysuria. Anamnesis
shows dilation of the esophagus with includes frequent acute respiratory
air-fluid levels in it. Make the diseases, overexposure to cold, low-
diagnosis: calorie diet, a case of pulmonary
A. Esophageal cancer tuberculosis in childhood. Clinical
B. Esophageal candidiasis urine analysis: pH — 4.8,
C. Myasthenia leukocyturia, hematuria. Complete
D. Gastroesophageal reflux disease blood count: leukocytosis,
E. Esophageal achalasia lymphocytosis, raised ESR.
Urography concludes: dilatation of
71. A 17-year-old girl complains of renal pelvis and calyceal system of
a pain in her knee and ankle joints and both kidneys, foci of calcification in
body temperature up to 39°C'. 2 weeks the projection of right kidney
ago, she had a case of acute tonsillitis. parenchyma. What is the most likely
Objectively, her joints are swollen, diagnosis?
sharply painful, and their mobility is A. Chronic pyelonephritis
reduced. On the skin of her trunk and B. Right renal cyst
limbs there are barely visible circle- C. Acute glomerulonephritis
shaped pale pink spots. Heart rate is D. Right renal carcinoma
95/min., blood pressure is 90/60 mm E. Nephrotuberculosis
Hg, heart sounds are weakened, there
is a soft systolic noise over the apex. 74. During examination a 4-month-
Make the provisional diagnosis: old child with meningococcemia
A. Rheumatoid arthritis presents with acrocyanosis, cold
B. Systemic scleroderma extremities, tachypnea, and thready
C. Reactive arthritis pulse, blood pressure of 30/0 mm Hg,
D. Acute rheumatic fever anuria, and sopor. What clinical
E. Erythema nodosum syndrome is it?
A. Acute renal failure
72. The people living in a radiation- B. Encephalic syndrome
contaminated area are recommended C. Neurotoxicosis
to include pectin in their diet for D. Exicosis
E. Toxic shock syndrome 77. A 38-year-old woman

complains of weakness, sleepiness,
75. A 73-year-old woman came to pain in the joints, weight gain despite
the family physician for one of her low appetite, and constipations. She
regular follow up examinations. Three presents with dry and thickened skin,
months ago she was found to have type puffy and amimic face, narrowed
2 diabetes mellitus. She was keeping to palpebral fissures, thick tongue, and
her diet and exercise plan and taking deep hoarse voice. Her heart sounds
phytopreparations. On examination are weak, pulse is 56/min. Low levels
her fasting glucose was within the of free T4 are observed. This patient
range of 78-8.6 mmol/L, HbAlc — needs to take the following on a
79%. Height — 164 cm, weight — 83 regular basis:
kg. What blood glucose-controlling A. Furosemide
medicine should she be prescribed first B. Lithium carbonate
in the course of her pharmacological C. Thyroxine
therapy? D. Mercazolil (Thiamazole)
A. Glibenclamide E. Calcium gluconate
B. Insulin
C. Glimepiride 78. A pregnant woman at 34 weeks
D. Metformin of gestation underwent dopplerometry
E. Gliclazide of umbilical circulation, which
revealed a reverse diastolic
76. A 25-year-old woman has been component. Objectively, the height of
suffering from diabetes mellitus since the uterus is 27 cm above the pubic
she was 9 years of old. She was bone, the head of the fetus is mobile
admitted into the nephrology unit with and located above the entrance to the
significant edemas of the face, upper lesser pelvis. Fetal heartbeat is
and lower extremities. Blood pressure 136/min. Vaginal examination shows
— 200/110 mm Hg. In the laboratory that the uterine cervix is closed, its
analysis of the blood: Hb — 90 g/L, length is 3 cm. What tactics should the
blood creatinine — 850 mcmol/L, obstetrician choose?
urine proteins — 1.0 g/L, leukocytes A. Ultrasound photometry of the fetus
— 10-15 in the vision field. B. Repeated dopplerometry next day
Glomerular filtration rate — 10 C. Fetal biophysical profile
mL/min. What tactics should the D. Urgent cesarean section
doctor choose? E. Labor induction with oxytocin
A. Dietotherapy
B. Active conservative therapy for 79. A 45-ycar-old woman
diabetic nephropathy complains of increasing body weight
C. Transfer into the hemodialysis unit throughout the last year. Examination
D. Transfer into the endocrinology revealed moon face syndrome, brittle
clinic hair, hirsutism, stretch marks on the
E. Liver transplantation abdomen, and disproportionally thin
limbs. The patient’s height is 162 cm,
her body weight is 94 kg, her body fetal respiratory distress syndrome.
mass index is 35.8 kg/m2. What type What medicine was she prescribed?
of obesity is it? A. Gynipral (hexoprenaline)
A. Alimentary-constitutive B. Dexamethasone
B. Gynoid C. Misoprostol
C. Android D. Oxytocin
D. Cerebral E. Progesterone
E. Dysplastic
83. A 22-year-old postparturient
80. A 55-year-old woman woman on the 12th day after the
complains of thyroid gland normal childbirth informs of fever up
enlargement that can be observed to 39°C for the last 3 days and pain in
throughout the last 2 years and a her right mammary gland. The right
discomfort during swallowing. mammary gland is enlarged, hot to
Objectively, she has signs of touch, tense, hyperemic, and painful.
hypothyroidism. The thyroid gland on Palpation reveals there a dense
palpation is dense, non-fused with the infiltration 8x8 cm with a fluctuation
surrounding tissues and mobile on in its center. What is the most likely
swallowing. The regional lymph nodes diagnosis?
are not enlarged. In the serum there are A. Postpartum period, day 12.
antithyroid antibodies detected. What infiltrative-purulent mastitis
is the most likely diagnosis? B. Postpartum period, day 12.
A. Thyroid cancer gangrenous mastitis
B. Acute thyroiditis C. Postpartum period, day 12.
C. Midlinc cervical cyst phlegmonous mastitis
D. Hashimoto’s thyroiditis D. Postpartum period, day 12. serous
E. Endemic goiter mastitis
E. Postpartum period, day 12.
81. . Children from a certain Lactostasis
township present with brittle teeth,
malocclusion, dental enamel erosions, 84. A 34-year-old woman after
and dental pigmentation that looks like rapidly changing her position from
yellow-brown spots. What is the likely horizontal to vertical suddenly paled,
cause of this presentation? fell down, her skin became moist, her
A. Low levels of sulfates in water limbs are cold, her pupils are dilated.
B. High levels of nitrates The pulse is rapid and blood pressure
C. Low levels of fluorine in water is 50/25 mm Hg. What condition has
D. High levels of sulfates in water likely developed in the patient?
E. High levels of fluorine in water A. Shock
B. Coma
82. A pregnant woman at 32 weeks C. Collapse
of gestation with the risk of preterm D. Morgagni-Adams-Stokes
labor undergoes a treatment to prevent syndrome
E. Ventricular fibrillation
right thigh. Bright-red blood flows

85. A 66-year-old man complains of from deep within the wound in a
marked weakness. The onset of the pulsing stream. Characterize this type
disease was acute: he developed fever of bleeding:
and pain in the joints and along the A. Venous
muscles of his legs. Objectively, he has B. Arterial
a violet-cyanotic erythema around his C. Mixed
eyes and over the knee joints. His heart D. Parenchimatous
rate is 120/min., heart sounds are E. Capillary
weakened. Blood test: leukocytes —
12 • 109/L, ESR — 40 mm/hour. Make 88. The left hand of a newborn is
the diagnosis. extended in all its joints, stretched
A. Rheumatoid arthritis along the torso, and pronated in the
B. Dermatomyositis forearm. Active movements of the
C. Atopic dermatitis shoulder joint are retained. The hand is
D. Systemic lupus erythematosus flattened, atrophied, cold to touch,
E. Reactive polyarthritis hangs passively. Grasping and
palmomental reflexes are absent at the
86. A 60-year-old woman affected side. Hemogram indicators
complains of pain in the are normal. Make the most likely
interphalangeal joints of her hands that diagnosis:
exacerbates during work. Objectively, A. Inferior distal obstetrical paralysis
the distal and proximal joints of her B. Hypoxic-ischemic encephalopathy
fingers II-IV are defigured, painful, C. Osteomyelitis
have Heberden and Bouchard nodes, D. Complete obstetrical paralysis
and their mobility is limited. X-ray of E. Proximal obstetrical paralysis
the joints shows narrowed joint spaces,
marginal osteophytes, and 89. A man works in casting of
subchondral sclerosis. A Make the nonferrous metals and alloys for 12
diagnosis: years. In the air of working area there
A. Reiter disease (reactive arthritis) was registered high content of heavy
B. Rheumatic arthritis metals, carbon monoxide, and
C. Bekhterev disease (ankylosing nitrogen. During periodic health
spondylitis) examination the patient presents with
D. Osteoarthrosis deformans, nodular asthenovegetative syndrome, sharp
form abdominal pains, constipations, pain in
E. Psoriatic arthritis the hepatic area. In the laboratory
analysis of urine: aminolevulinic acid
87. A surgery unit received a person and coproporphyrin are detected. In
with an incised stab wound on the the laboratory analysis of blood:
upper third of the right thigh. reticulocytosis, low hemoglobin level.
Examination detects an incised stab Such intoxication is caused by:
wound 3.0x0.5x2.0 cm in size on the A. Carbon monoxide
inner surface of the upper third of the B. Nitric oxide
C. Lead and lead salts A. Hyperosmolar coma

D. Tin B. Hyperglycemic coma
E. Zinc C. Acute renal failure
D. Uremic coma
90. On ultrasound of the thyroid E. Acute disturbance of cerebral
gland, a 47-year-old woman presents circulation
with a hypoechoic node 1.6 cm in
diameter with blurred margins and 93. During the analysis of morbidity
intranodular hypervascularization. The in the city, it was determined that the
doctor suspects thyroid carcinoma. age structure of population is different
What method should be used to verify in each district. What statistical
the diagnosis? method allows to exclude this factor,
A. Case monitoring so that it would not skew the morbidity
B. Thyroid scintigraphy data?
C. Fine-needle aspiration biopsy A. Correlation-regression analysis
D. Positron emission tomography B. Wilcoxon signed-rank test
(PET) C. Dynamic time series analysis
E. Determine TSH level in the blood D. Analysis of average values
E. Standardization
91. What should be prescribed as
secondary prevention drugs for a 94. A 28-year-old man, a teacher,
patient with atrial fibrillation after an after an emotional stress developed
ischemic stroke caused by cardiac painful muscle spasms in his right
embolism? hand that occur during writing; now he
A. Calcium antagonists has to hold the pen between the second
B. Nootropics and third fingers. He has no problems
C. Aspirin or clopidogrel with typing or writing on the
D. Oral anticoagulants blackboard; no other motor
E. beta blockers disturbances or neurological
pathologies are detected. What is the
92. A patient has gradually lost his most likely diagnosis?
consciousness. The skin is pale and A. Writer’s cramp
dry. There is smell of ammonia from B. Parkinsonism
the mouth. Respirations are deep and C. Cortical agraphia
noisy. Heart sounds are muffled, D. Neuropathy of the right ulnar nerve
pericardial friction rub is present. E. Neuropathy of the right radial nerve
Blood pressure is 180/130 mm Hg.
Blood test: Hb — 80 g/L, leukocytes 95. A 35-year-old woman had acute
— 12 • 109/L, blood glucose — 6.4 onset of the disease that started with
mmol/L, urea — 50 mmol/L, fever up to 39.0°C and cough. 3 days
creatinine — 1200 mcmol/L, blood later her dyspnea at rest increased up
osmolarity — 350 mOsmol/kg H20. to 35/min. Downward from her right
No urinary excretion. Make the shoulder-blade angle, percussion
diagnosis: detects a dull sound. No vocal
fremitus, respiratory sounds cannot be 98. A 31-year-old woman

auscultated. What is the treatment complains of pain and swelling in her
tactics? radiocarpal and metacarpophalangeal
A. Pleural tap joints and morning stiffness for up to
B. Physiotherapy 1.5 hours. Two weeks ago she
C. Antibiotic therapy developed pain, swelling, and redness
D. Oxygen therapy in her knee joints and fever of 37.5°C.
E. Artificial lung ventilation Examination of her internal organs
shows no pathological changes. She
96. A 10-year-old boy came to the was diagnosed with rheumatoid
polyclinic with complaints of stuffy arthritis. What changes will most
nose. It is known that these signs occur likely be visible on the X-ray scan of
in the child periodically (in spring and her joints?
autumn). He has a history of atopic A. Multiple marginal osteophytes
dermatitis. The father of the child has B. Cysts in the subchondral bone
bronchial asthma. Objectively, the C. Narrowing of the joint space,
boy’s face is pale and slightly swollen. subchondral osteosclerosis
Respirations are 22/min. Auscultation D. Osteolysis of the epiphyses
detects vesicular respiration over the E. Narrowing of the joint space,
lungs. Rhinoscopy shows swollen and usuras (bone lesions)
pale nasal mucosa. What disease can
be suspected? 99. A 35-year-old man, who for the
A. Acute adenoiditis last 3 years has been on hemodialysis
B. Allergic rhinitis due to chronic glomerulonephritis,
C. Recurrent respiratory disease developed disturbances of the cardiac
D. Acute rhinitis performance, hypotension,
E. Acute maxillary sinusitis progressing weakness, and dyspnea.
ECG shows bradycardia, 1st degree
97. A district doctor has been tasked atrioventricular block, tall and sharp T-
with preparation of a plan for a waves. The day before he had a serious
complex of treatment and prevention break from his solid and liquid diet.
measures among the population in his What biochemical changes are the
district. What measures for secondary most likely cause of the described
disease prevention should be included clinical presentation?
in this plan? A. Hypernatremia
A. Improving the living conditions of B. Hypocalcemia
the population C. Hyperhydration
B. Disease prevention D. Hypokalemia
C. Prevention of disease E. Hyperkalemia
complications
D. Rehabilitation measures 100. family doctor performed an
E. Elimination of the causes of external obsterical examination of a
diseases pregnant woman and determined that
her uterine fundus is located at the
level of the navel. What is the most auscultation there are bowel sounds
likely term of pregnancy in this with a metallic overtone, sounds of
woman? splashing and dripping. Make the
A. 16 weeks diagnosis:
B. 24 weeks A. Acute nonspecific colitis
C. 32 weeks B. Acute erosive gastritis
D. 8 weeks C. Acute destructive cholecystitis
E. 40 weeks D. Acute intestinal obstruction
E. Acute necrotizing pancreatitis
101. A 19-year-old student was
urgently hospitalized due to a marked 103. A 2.5-year-old child is ill for the
dyspnea and chest pain on the left. Her second day. The onset of the disease
body temperature is 38.8°C. She has was associated with the temperature up
been presenting with these signs for 3 to 37.8°C, a single bout of vomiting,
days. Respiratory rate is 42/min., and watery diarrhea up to 5 times per
shallow. Percussion sound is dull to day. During the second day, vomiting
the left from the center of the scapula, occurred twice, body temperature is
no respiration can be auscultated. The 38.0°C, the child has low appetite,
left heart border is displaced outwards watery diarrhea continues. The
by 3 cm. Embryocardia and heart rate treatment of the child should start with
of 110/min are observed. Palpation of the following:
the right subcostal area is painful. A. Prescribe polymyxin
What urgent measures should be taken B. Prescribe oral rehydration
in this case? C. Prescribe nifuroxazide
A. Administration of cardiac D. Prescribe ceftriaxone
glycosides E. Prescribe loperamide
B. Urgent thoracocentesis
C. Referral into the thoracic surgery 104. On the 3rd day after the artificial
unit abortion the woman was hospitalized
D. Prescription of penicillin into the gynecological department in a
antibiotics severe condition with signs of
E. Administration of furosemide intoxication, abdominal pain, and
purulent discharge from the vagina.
102. A 43-year-old woman Objectively, the patient’s condition is
complains of persistent abdominal severe, her body temperature is
pain with recurrent pain attacks, 38.8°C', pulse is 100/min., blood
nausea, repeated vomiting with pressure is 110/70 mm Hg, the uterus
stagnant bowel content, abdominal is soft, the uterine fundus is located at
distension, and flatulence. She has the level of the navel, there are positive
been presenting with these signs for 7 signs of peritoneal irritation. What is
hours. Pulse is 116/min. The tongue is the most likely diagnosis?
dry and brown. The abdomen is A. Pelviperitonitis
symmetrically distended, soft, painful. B. Acute metroendometritis
Percussion reveals tympanitis. On C. Uterine perforation
D. Ectopic pregnancy E. Acute rheumatic fever

E. Acute suppurative salpingo-
oophoritis 107. A 16-year-old patient has made
an appointment with an
105. A 15-year-old patient presents otolaryngologist. He complains of
with delayed physical development fever and sore throat. The disease
and periodically develops icteric skin. onset was 2 days ago, after the patient
Objectively, the spleen is 16x12x10 ate two portions of ice-cream.
cm, cholecystolithiasis is observed in Pharyngoscopy shows hyperemic
the patient, there is a skin ulcer on the mucosa of the palatine tonsils, with
left calf in its lower third. In the blood: purulent exudate in the lacunae. Make
erythrocytes — 3.0 • 1012 /L, Hb — 90 the provisional diagnosis:
g/L, color index — 1.0, A. Pseudomembranous (Vincent’s)
microspherocytosis, reticulocytosis. tonsillitis
Total serum bilirubin — 56 mcmol/L, B. Diphtheria
indirect bilirubin — 38 mcmol/L. C. Follicular tonsillitis
What treatment method would be D. Acute pharyngitis
optimal in this case? E. Lacunar tonsillitis
A. Portocaval anastomosis
B. Spleen transplant 108. During examination of a patient,
C. Splenectomy the doctor detected in him disorders of
D. Omentohepatopexy the eyes (hemeralopia, Bitot’s spots),
E. Omentosplenopexy skin and skin appendages, mucosa, and
gastrointestinal tract. He was
106. A 3-year-old child has been provisionally diagnosed with Prasad’s
brought to a hospital with complaints syndrome. What causes the
of pain in the legs, fever, and loss of development of this pathology?
appetite. Objectively: pale skin and A. Copper deficiency
mucosa, hemorrhagic rash. Lymph B. Zinc deficiency
nodes are enlarged, painless, dense and C. Manganese deficiency
elastic, not matted together. Bones, D. Vanadium deficiency
joints, and abdomen are painful. The E. Iron deficiency
liver and spleen are enlarged.
Hemogram: Hb — 88 g/L, color index 109. The region at the Carpathian
— 1.3, platelets — 80 • 109/L, foothills is characterized by constant
leukocytes — 25.8 •109/L, high atmospheric humidity (over
lymphoblasts — 70%, ESR — 52 80%). In the cold season, while the air
mm/hour. Make the provisional temperature is moderately low, the
diagnosis: population of this region feels extreme
A. Thrombocytopenic purpura cold. What type of heat transfer
B. Hemorrhagic vasculitis (Henoch- increases in such conditions?
Schonlein purpura) A. Conduction
C. Infectious mononucleosis B. Evaporation
D. Acute leukemia C. -
D. Convection Lingual papillae are smoothed out. The

E. Radiation liver and pancreas are not enlarged.
Complete blood count shows the
110. The overall condition of a 24- following: Hb — 77 g/L, erythrocytes
year-old man, who was being treated — 1,65 *109/L, color index — 1.4,
for meningococcemia, took a turn for reticulocytes — 0.2%, leucocytes —
the worse. Objectively, he has 2.8 * 109/L; ESR — 22 mm/hour,
acrocyanosis, anuria, his limbs arc macrocyte. What additional test can
cold, his respiration is 30/min., heart reveal the cause of anemia?
rate is140/min., blood pressure is 40/0 A. Vitamin B 12 levels
mm Hg. What emergency medical B. Copper levels
condition did the patient develop? C. Calcium levels
A. Hemolytic-uremic syndrome D. Iron levels
B. Pulmonary artery thrombosis E. Vitamin D levels
C. Anaphylactic shock
D. Septic shock 113. An ambulance was called to a
E. Hypovolemic shock 45-year-old man. According to his
family, the onset of the disease was
111. A child is 8 months old. One sudden, after he returned from a ski
week ago, the child had a case of acute resort. His body temperature increased
viral respiratory infection. The child’s up to 38.7°C, he developed headache
physical and mental development and vomiting. Objectively, his skin is
corresponds with the age. There are pale with a cyanotic tint, there is a
complaints of inertness, loss of thick hemorrhagic rash all over the
appetite, unmotivated recurrent body, sometimes with necrosis in the
vomiting, temperature up to 38°C center. Blood pressure is 45/0 mm Hg,
within the last 24 hours, pallor, pulse is 126/min., low volume. The
frequent urination with low urine patient has marked nuchal rigidity and
output, tachycardia. Urinalysis: positive Kernig’s sign. Make the
protein — 0.099g/L, leukocytes — 15- provisional diagnosis:
20 in the vision field, bacteriuria — A. Influenza
+++, mucus — +++. What disease can B. Poliomyelitis
be suspected? C. Vesicular rickettsiosis
A. Phosphate diabetes D. Meningococcal infection
B. Deficient care E. Typhus
C. Acute pyelonephritis
D. Acute glomerulonephritis 114. A 37-year-old woman
E. Dysmetabolic nephropathy complains of marked general
weakness, edema of the face and
112. A 60-year-old man complains of hands, rapid fatigability when walking,
dyspnea, paresthesia, vertigo, and difficult swallowing, disturbances of
fatigability. He has a history of the cardiac performance. These signs
atrophic gastritis. Objectively, his skin appeared 11 days after a vacation at the
and mucosa are pale and icteric. seaside. Objectively, the patient has
face erythema, “glasses” sign, edema 116. A 10-year-old child, living in a

of the lower leg muscles. Heart sounds large industrial city, presents with
are muffled, blood pressure is 100/70 encephalopathy, polyneuritis,
mm Hg. In the blood: ASAT -95U, disturbed mental development, and
ALAT -130U, increased activity of reduced learning ability. In the blood:
aldolase and creatine phosphokinase. reticulocytosis, basophilic stippling of
What examination will be the most the erythrocytes. What poisoning can
informative in this case? be suspected?
A. Electrocardiography A. Iron
B. Muscle biopsy B. Mercury
C. Test for circulating immune C. Zinc
complexes D. Lead
D. Gastroduodenofibroscopy E. Copper
Electromyography
117. A 30-year-old woman
115. The patient’s respirations are complains of general weakness,
28/min., tachycardia is up to 100/min., difficult swallowing when eating, dry
there are signs of intoxication. In the skin and brittle hair. Objectively, her
area of the right scapula the percussion body temperature is 36.6°C,
sound is dull, the respiration is respirations — 16/min., Ps — 92/min.,
bronchial, with single fine vesicular blood pressure — 110/70 mm Hg. The
crackles and crepitation sounds. X-ray skin and visible mucosae are pale. In
shows a massive inflammatory the blood: Hb — 65 g/L, erythrocytes
infiltration in the middle pulmonary — 3.2 1012/L, color index — 0.6,
field. Three days later, against the reticulocytes — 3%, leucocytes — 6.7
background of treatment, the patient * 109/L, eosinophils — 2%, stab
developed a cough attack, during neutrophils — 3%, segmented
which he expectorated 200 mL of neutrophils — 64%, lymphocytes —
purulent sputum. After that his body 26%, monocytes — 5%, ESR — 17
temperature dropped to subfebrile mm/hour. Serum iron — 74 mcmol/L,
values and his overall condition total protein — 78 g/L. What factor is
improved. At the level of the scapular deficient, causing this condition?
angle, against the background of the A. Vitamin Be
pulmonary infiltration, there is a round B. Protein
area of radiolucency with the C. Folic acid
horizontal level of liquid. Make the D. Glucose 6-phosphate
diagnosis: dehydrogenase
A. Pleural empyema E. Iron
B. Pulmonary abscess
C. Multiple bronchiectasis 118. A 38-year-old man complains of
D. Right-sided bronchitis a spasmodic abdominal pain, frequent
E. Gangrene of the right lung liquid stool with mucus and fresh
blood admixtures. He has been
suffering from this condition for 2
years, during which he has lost 12 kg. soft, the liver is +1 cm, the spleen is
Objectively: Ps — 92/min., blood The feces are yellow. The blood group
pressure — 100/70 mm Hg, body of the mother is A (II) Rh+. The blood
temperature — 374°C'. The abdomen group of the child is 0 (I) Rh+.
is soft and painful along the large Bilirubin levels on the 4th day are as
intestine. The sigmoid colon is spastic. follows: indirect — 140 mc mol/L,
In the blood: erythrocytes — 3.2 direct — 0, ALT — 25 mmol/L, AST
×1012/L, Hb — 92 g/L, leukocytes — — 18 mmol/L. Make the diagnosis:
10.6 •109/L, ESR — 32 mm/hour. A. Physiological jaundice
Irrigoscopy shows narrowing of the B. Hemolytic disease of the newborn
large intestine, no haustra, blurred C. Hemolytic anemia
margins, “lead-pipe” sign. What is the D. Congenital hepatitis
most likely diagnosis? E. Biliary atresia
A. Gastric carcinoma
B. Crohn’s disease New questions
C. Diverticular disease of the intestine
D. Ulcerative colitis 121. A 40-year-old patient presents
E. Amoebic dysentery with cough in the morning with
production of mucopurulent sputum
119. A 47-year-old woman, who 2 and elevated body temperature up to
days ago returned from Peru, 37°C. He has been smoking since he
complains of a pain and enlargement was 17 years old. Objectively,
of the lymph nodes in her right auscultation detects coarse respirations
inguinal region. She was diagnosed and diffuse dry crackles in the lungs.
with bubonic plague. What medicine Complete blood count: leukocytes —
should be prescribed to the contact 12 • 109 /L, ESR — 19 mm/hour.
persons for urgent prevention of this Bronchoscopy shows purulent
disease? catarrhal endobronchitis. Make the
A. Heterologous serum diagnosis:
B. Doxycycline A. Bronchial asthma
C. Fluconazole B. Pulmonary tuberculosis
D. Chloroquine C. Community-acquired pneumonia
E. Human immunoglobulin D. Chronic bronchitis
E. Lung cancer
120. A 5-day-old girl from the first
pregnancy was born with the weight of 122. A 30-year-old woman
3100 g and the length of 51 cm. Her complains of subfebrile body
Apgar score was 8/9. On the 3rd day temperature that persists for the last 3
she developed icteric skin. On the 4th weeks, loss of appetite and working
day of life her condition is satisfactory, ability, excessive sweating (especially
she suckles well, her voice is loud. The at night), malaise. Objectively, her
umbilical wound is clean. In the lungs pulmonary percussion indicates no
there is a puerile respiration, heart changes in the lungs, auscultation
sounds are sonorous. The abdomen is detects crackles in the projection of the
upper lobe of the right lung. X-ray E. 1.0 mL of tetanus anatoxin, 50000
shows a dense focus of moderate IU of anti-tetanus serum
intensity, 6 mm in diameter, in
segment S2. Make the provisional 125. A 15-year-old boy complains of
diagnosis: periodical headaches and fatigability.
A. Pulmonary tuberculoma On examination, the boy is active, his
B. Focal pulmonary tuberculosis psychoemotional development
C. Metastatic lung cancer corresponds with his age, his skin is
D. Peripheral lung cancer pale and clammy. No abnormalities of
E. Community-acquired pneumonia the internal organs were detected.
Blood pressure is 120/80 mm Hg.
123. A 26-year-old man has an Noticeable is the excessive
external bleeding from a lacerated subcutaneous fat that is evenly
wound of the shin. Dark-red blood distributed throughout the body. The
flows from the wound in a steady doctor suspects obesity in the child.
stream. The total blood loss is What parameter should be measured
approximately 400 mL. What method first to confirm this diagnosis?
should be used to stop the blood loss A. Body mass to height ratio
during the preadmission stage? B. Body mass
A. Apply a clamp to the bleeding C. Obesity of family members
vessel D. Body mass index
B. Apply a tight bandage to the wound E. Thickness of subcutaneous fat
C. Apply a tourniquet below the site of
the bleeding 126. A premature newborn from the
D. Apply an arterial tourniquet to the first pregnancy was born at 37 weeks
thigh of gestation, with the weight of 2400 g
E. Press the femoral artery with your and the length of 51 cm. The infant is
finger anxious, has limb tremor, does not
suckle, exhibits respiratory
124. During agricultural work in the disturbances and hepatosplenomegaly.
field, a tractor driver received an open At the end of the first day of life the
trauma of the hand. The tractor driver child developed icteric skin and
has never completed the full course of mucosa. On the second day, skin
planned antitetanus immunization. rashes appeared: both separate vesicles
What should he be given for urgent and clusters of vesicles located over
specific prevention of tetanus in this the ribcage. Make the provisional
case? diagnosis:
A. 1.0 mL of tetanus anatoxin, 3000 A. Toxoplasmosis
IU of anti-tetanus serum B. Rubella
B. 0.5 mL of tetanus anatoxin, 3000 C. Congenital herpes infection
IU of anti-tetanus serum D. Vesiculopustulosis
C. No prevention is necessary E. Neonatal pemphigus
D. 3000 IU of anti-tetanus serum
127. A 29-year-old woman C. Reduced protein synthesis function

complains of no menstruations within of the liver
a year. She has a history of two D. Disturbed renal hemodynamics
abortions. Objectively, her secondary E. Reduced cardiac ejection fraction
sexual characters are developed and venous congestion
normally, she has adult woman pattern
of hair distribution, galactorrhea from 129. A 22-year-old woman with
the mammary glands is observed. Her primary infertility complains of
prolactin levels are high. What irregular menstruations and of
additional examination is necessary for colostrum being produced from her
diagnosis verification? mammary glands. Ultrasound of the
A. Genetic testing lesser pelvis shows hypoplastic uterus
B. Magnetic resonance imaging of the and ovaries without pecularities. MRI
brain of the sella turcica detects no
C. Breast ultrasound abnormalities. The patient’s prolactin
D. Dynamic testing of prolactin levels is 3 times higher the normal level. The
E. Mammography follicle-stimulating and luteinizing
hormones are below the normal levels.
128. A 3-ycar-old child was brought The levels of cortisol and testosterone
to the hospital by the mother with are within the normal range. What
complaints of leg edema, dyspnea, medicines should be chosen for the
cough, and abdominal pain. Heart treatment of this pathology?
murmurs were detected in the child at A. Glucocorticoids
the early age, but back then the parents B. Dopamine agonists
declined further examination. After a C. Combined oral contraceptives
case of acute viral respiratory infection D. Progestagens
one month ago, the mother noticed that E. Estrogens
the child had become inert and
periodically fussy and started 130. The patient complains of an
developing edema of the shins. The inflammatory infiltration in the middle
child’s condition is severe. third of the left forearm. It is the first
Respirations are 40/min. Foot and shin occurrence of this condition in the
edema is observed. There are wet patient. In the middle third of the left
crackles in the lower posterior forearm there is an inflammatory
segments of the lungs. The left border infiltration up to 3 cm in diameter that
of the relative cardiac dullness is protrudes in a cone-like shape above
located along the left anterior axillary the surface of the skin. The skin over
line. Heart sounds are muffled and the infiltration is hyperemic,
arrhythmic. The child’s heart rate is edematous, its palpation is sharply
120/min. The liver is +5 cm. Diuresis painful. On the infiltration apex there
is decreased. Name the pathogenesis of is a small accumulation of pus with a
the edema in this child: black dot in the center. Body
A. Increased vascular permeability temperature is 376°C. What disease is
B. Protein loss in stool described?
A. Phlegmon of the forearm defecation, diarrhea up to 6 times in 24

B. Furuncle on the forearm hours with pus and dark blood in the
C. Carbuncle on the forearm feces. Objectively, his physical and
D. Erysipelas of the forearm sexual development is delayed. The
E. Inflammatory infiltration of the skin is pale and dry. The abdomen is
forearm distended and painful in the umbilical
region and in the right iliac region.
131. A 17-year-old girl has height of Crohn’s disease is suspected. What
172 cm and weight of 40 kg. examination is necessary to confirm
Nevertheless, she considers herself to the diagnosis?
be extremely overweight. For the last 2 A. Abdominal ultrasound
years she has been keeping to a strict B. Rectoromanoscopy
low-caloric diet, while simultaneously C. Colonoscopy
working out to exhaustion and tightly D. Fecal cytology
binding her waist with a cord. She E. Fibroesophagogastroduodenoscop
often self-induces vomiting. The girl y
complains of unpleasant sensations in
her esophagus and amenorrhea. What 134. A 58-year-old man complains of
is the most likely diagnosis? weakness, edema of the face, legs, and
A. Response to stress lumbar region, dyspnea, and wet
B. Personality disorder cough. For many years he has been
C. Anorexia suffering from chronic obstructive
D. Bulimia pulmonary disease. Within the last 5
E. Depression years he has been noting increased
production of sputum that often is
132. A 25-year-old man suffers from purulent. Objectively, his heart rate is
a disease that manifests with fever and 80/min., blood pressure is 120/80 mm
vesicular rash that appears mostly on Hg. He has pale and dry skin with poor
the trunk and scalp. On the 10th day turgor and diffuse edema. Daily
after the onset of the disease, he proteinuria is 6.6 g/L. In the blood:
developed an intense headache, hypoalbuminemia, increased levels of
vomiting, ataxia, sluggishness, «2-and 7-globulins, ESR is 50
discoordination of movements, limb mm/hour. Blood creatinine is 188
tremor. He was diagnosed with mcmol/L. Which is the correct
encephalitis. This condition is the diagnosis?
complication of the following disease: A. Secondary renal amyloidosis,
A. Chickenpox nephrotic syndrome
B. Scarlet fever B. Secondary renal amyloidosis,
C. Vesicular rickettsiosis azotemic stage
D. Rubella C. Senile amyloidosis
E. Measles D. Secondary renal amyloidosis,
proteinuric stage
133. A 15-year-old boy complains of E. Primary amyloidosis
pain attacks in his abdomen during
135. A 48-year-old man complains of subcutaneous varicose veins that are

stool 2-3 times a day, with a large painless on palpation. Make the
amount of foul-smelling feces, which diagnosis:
is accompanied by a pain in the A. Arteriosclerosis obliterans of the
umbilical region, hair loss, and vessels in the left leg
paresthesia. Examination shows pale B. Post-thrombotic syndrome in the
skin, ow body mass, and leg edema. left leg
Palpation of the umbilical region and C. Acute thrombosis of the deep veins
intestine is painful. Blood test shows in the left leg
anemia; stool test shows steatorrhea, D. Subcutaneous varicose veins in the
creatorrhea, amylorrhea. What left leg
syndrome can be observed in the E. Acute ascending thrombophlebitis
patient? of the subcutaneous veins in the left
A. Malabsorption syndrome leg
B. Afferent loop syndrome
C. Zollinger-Ellison syndrome 138. For 2 weeks a 37-year-old HIV-
D. Dumping syndrome positive man has been presenting with
E. Hypercatabolic exudative progressing dyspnea and body
enteropathy syndrome temperature up to 37. 7°C. He was
diagnosed with pneumocystic
136. A 55-year-old man complains of pneumonia. What etiotropic drug is
a pain in the sternum, lumbar spine, indicated in this case?
and ribs. He has a history of bone A. Metronidazole
fracture in his right shin. In the blood: B. Ceftriaxone
total protein — 100 g/L, M-gradient is C. Acyclovir
positive. In the urine there is Bence D. Co-trimoxazole
Jones protein. Make the diagnosis: E. Fluconazole
A. Osteochondrosis
B. Neuralgia 139. A 55-year-old woman
C. Exertional angina pectoris, 2 FC complains of a tumor-like formation
D. Multiple myeloma that can be palpated in the kidney area
E. Glomerulonephritis on the left, moderate dull in in her left
side, periodical discharge of bright-red
137. A 55-year-old woman came to a blood during urination. Objectively,
doctor with complaints of a heavy the patient has lost weight, her skin is
sensation in her left shin and periodical pale and dry. Palpation of the abdomen
cramps of the gastrocnemius muscles detects an clastic formation in the left
that occur at night. She has been renal region. The formation is mobile
suffering from this condition for 5 and painless. Urinalysis detects
years since the moment when these macrohematuria and atypical cells.
signs first appeared. Her condition has Blood Hb is 82 g/L, ESR is 70
been remaining untreated all this time. mm/hour. What is the most likely
Objectively, on the medial surface of pathology, causing this clinical
the left shin and thigh there are dense presentation?
A. Chronic pancreatitis been working at the various industrial

B. Tumor of the left ureter objects, where, in violation of the
C. Tumor of the large intestine hygienic norms, the high levels of
D. Tumor of the left kidney exposure to the chemicals were
E. Acute pyelonephritis registered. What harmful factor is the
likely cause of this pathology?
140. Before her discharge from a A. Benzene
hospital, a full-term newborn girl on B. Cadmium
the 3rd day of her life developed a C. Mercury
recurrent vomiting with blood and D. Lead
stool resembling a “raspberry jelly”.’ It E. Manganese
is known that her mother refused to let
her child receive any intramuscular 143. A 46-year-old man, suffering
injections. What laboratory test will be from a constricting pain in the cardiac
the most informative for confirmation area, developed circulatory and
of the diagnosis? respiratory arrest. ECG monitor shows
A. Platelet count a large-wave ventricular fibrillation.
B. Partial thromboplastin time What would be done first in this case?
C. Thrombin time A. Give lidocaine intravenously
D. Bleeding time B. Implant an electronic pacemaker
E. Prothrombin time C. Give atropine intravenously
D. Give dopamine intravenously
141. A 60-year-old man complains of E. Perform defibrillation
mild disturbances of memory,
coordination, gait. Cerebral 144. The dispatching department of
atherosclerosis was confirmed. Blood the Center for Emergency Medical
pressure is within the norm. Magnetic Care and Disaster Medicine received a
resonance imaging shows call from a local citizen, who
leukoaraiosis in the periventricular complained of retrosternal constricting
area. What is the most likely pains irradiating to the left hand. The
diagnosis? taking of nitroglycerine brings no
A. Lacunar cerebral stroke relief. Specify the terms within which
B. Hypoxic-ischemic encephalopathy an emergency medical team should
C. Transient ischemic attacks arrive in this case:
D. Binswanger’s disease (subcortical A. 30 minutes after the call was made
arteriosclerotic encephalopathy) B. 60 minutes after the call was made
E. Alzheimer’s disease C. 20 minutes after the call was made
D. 10 minutes after the call was made
142. A patient with complaints of E. 15 minutes after the call was made
disturbed gait and forced laughter was
hospitalized into the neurological Parkinsonism question 2019
department. Objectively, he has a 145. A 32-year-old woman during an
mask-like face and muscle occupational medical examination
hypersthenia. For a long time, he has underwent a colposcopy that revealed
a punctuation area in zone 1 of the D. Fractures of the base of the cotyloid

uterine cervix. Cytologically there was cavity
dysplasia of the 3rd degree detected. E. Superior iliac spine fracture
After additional examination, the
patient was diagnosed with carcinoma 148. In a certain region an increase in
in situ of the uterine cervix. What cardiovascular morbidity is observed
treatment method should be chosen in in the population. A family
this case? doctor/general practitioner plans to
A. Radiation therapy take preventive measures against
B. Cervical conization cardiovascular diseases. What
C. Wertheim operation measures can be classified as primary
D. Uterine extirpation without ones:
appendages A. Referral to a specialized clinic
E. Uterine extirpation with B. Referral for sanatorium-and-spa
appendages treatment
C. Referral for inpatient treatment
Tricky new question D. Complex examination
E. Modification of risk factors
146. Amortization costs for CT scan
are included into its’ price and
149. A 28-year-old pregnant woman
annually amount to 10% of its original
was hospitalized into the inpatient
cost. When can the CT scan be
department. Her diagnosis is as
replaced?
follows: pregnancy III, 7-8 weeks of
A. In 5 years
gestation; rheumatism, inactive phase,
B. In 10 years
III-degree mitral stenosis. What is the
C. In 7 years
management plan for this patient?
D. In 20 years
A. Termination of the pregnancy after
E. In 15 years
surgical treatment of the valvular
defect (mitral commissurotomy)
147. A 51-year-old man was hit by a
B. Maintenance of the pregnancy,
car. He complains of a pain in his
planned hospitalization during the
pelvis on the left. Examination shows
critical periods, conservative
no disturbances of pelvic
therapy
configuration, there is a swelling in the
C. Prescription of corticosteroids and
left inguinal region. Palpation of this
immunosuppressants
region is sharply painful. The Larrey’s
D. Medically-indicated termination of
sign and Gabai’s sign are positive, the
the pregnancy
patient is unable to lift the extended
E. Maintenance of the pregnancy,
leg, as if the heel was glued down.
surgical treatment of the valvular
Make the provisional diagnosis:
defect (mitral commissurotomy)
A. Fracture of the ischium
B. Fracture of the superior pubic
150. A 26-year-old woman,
ramus
pregnancy I, 10 weeks of gestation, has
C. Pubic symphysis fracture
been suffering from rheumatism since

her childhood. With pregnancy her
condition has deteriorated: her
dyspnea increased and she developed
edema in her lower extremities. Her
pulse is 86/min., the lips are cyanotic,
there are systolic and diastolic
murmurs over the cardiac apex. The
liver protrudes 4 cm from under the
costal margin. The woman was
diagnosed with III degree heart failure,
her left ventricular ejection fraction is
less than 40%. What are the tactics of
the patient management in this case?
A. Termination of the pregnancy via
minor cesarean section
B. Prolongation of the pregnancy with
periodical treatment in the
cardiology department
C. Termination of the pregnancy with
vacuum aspirator
D. Prolongation of the pregnancy with
periodical hospitalization into the
obstetrical inpatient department
during the critical periods
E. Medication-induced termination of
the pregnancy

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2023-Jan-k2 medicine https://krokology.

2023 – January – Medicine

1. Examination of the corpse of a C. External obstetric version of the

external occipital protuberance. What A. Acute liver failure

E. Decrease in unconjugated bilirubin test: erythrocytes — 3.2 * 1012/L, Hb

A. Formation of a post-injection when she climbs the stairs.

required when it is necessary to

plethoric internal organs. Forensic 26. A 19-year-old girl complains of

C. Sociomedical expert committee B. Feeding no longer that 10 minutes

40. A 19-year-old young man

C. Scalp phlegmon aVL, and V5-V6. What is the most

pressure up to 180/90 mm Hg, muscle disease occurred after a car accident.

no uterine enlargement, the condition. He has a history of purulent

55. After playing with “mosaics” a A. Eczema

60. A 45-year-old man developed arrhythmia is detected, heart rate is

C. Non-closure of the neural tube in mg/dL) and high-density lipoprotein

removal of radionuclides from the

E. Toxic shock syndrome 77. A 38-year-old woman

right thigh. Bright-red blood flows

C. Lead and lead salts A. Hyperosmolar coma

fremitus, respiratory sounds cannot be 98. A 31-year-old woman

D. Ectopic pregnancy E. Acute rheumatic fever

D. Convection Lingual papillae are smoothed out. The

face erythema, “glasses” sign, edema 116. A 10-year-old child, living in a

127. A 29-year-old woman C. Reduced protein synthesis function

A. Phlegmon of the forearm defecation, diarrhea up to 6 times in 24

135. A 48-year-old man complains of subcutaneous varicose veins that are

A. Chronic pancreatitis been working at the various industrial

a punctuation area in zone 1 of the D. Fractures of the base of the cotyloid

been suffering from rheumatism since

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