STATE ORGANIZATION

«TESTING BOARD FOR PROFESSIONAL COMPETENCE ASSESSMENT OF

HIGHER EDUCATION TRAINEES IN MEDICINE AND PHARMACY AT THE
MINISTRY OF HEALTH OF UKRAINE»

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TEST ITEMS FOR THE LICENSING

INTEGRATED EXAM

KROK 2

MEDICINE
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1. A 27-year-old man received an A. Hemodialysis

electrical injury, when he touched an B. Diuretics
exposed electrical wire with his hand, C. Rheopolyglucin (Dextran)
after which he developed circulatory and D. Xylit, Sorbitol
respiratory arrest. Resuscitation measures E. Antibiotics
restored his cardiac activity after 5
minutes. What complications are possible 5. After lifting a heavy object, a 41-year-
in a few hours or even days after the old man felt a sharp pain in his chest
electrical injury? on the right and developed progressing
shortness of breath. The man’s condition
A. Circulatory arrest is severe. His lips and mucosa are cyanotic,
B. Acute renal failure respiratory rate – 28/min., pulse – 122/min.
C. Respiratory arrest Over the right half of the chest, percussion
D. Pulmonary edema shows tympanitis, while auscultation
E. Acute liver failure detects sharply weakened breathing. The
II heart sound is accentuated over the
2. Survey X-ray of the patient’s abdominal pulmonary artery. His blood pressure is
cavity has shown several hemispherical 80/40 mm Hg. What primary emergency
areas of lucency, located above well- measure must be taken at the prehospital
defined horizontal levels. What might be stage in this case?
the cause of such an X-ray presentation?
A. Aspiration of air from the pleural cavity
A. Intestinal obstruction B. Administration of euphyllin
B. Cancer of the large intestine (aminophylline)
C. Meteorism C. Call for a cardiology team
D. Perforated ulcer D. Administration of adrenaline
E. — E. Oxygen inhalation
3. A patient has visited the doctor at a rural 6. For a month a 60-year-old patient
outpatient clinic twice during the calendar had short-term episodes of decreased
year (in March and in November). In strength in his limbs on the left. Later, after
both cases, he was diagnosed with acute waking up in the morning, he developed
respiratory viral infection. How to fill in a persistent weakness in his extremities.
the statistical forms for registration of final His blood pressure is 140/90 mm Hg. He
(clarified) diagnoses, to account for these is conscious and has central paresis of VII
morbidity cases? and XII pairs of cranial nerves on the left.
On the same side, he presents with central
A. For each case separately with the (+) hemiparesis and hemihyperesthesia. What
sign group of drugs must be chosen for the
B. For each case separately with the (–) sign differentiated treatment of this patient?
C. For the first case with the (+) sign, for
the second case with the (–) sign A. Anticoagulants
D. The forms are not filled for either of B. Hypotensive agents
these cases C. Diuretics
E. For the first case with the (+) sign, for D. Corticosteroids
the second case no form is necessary E. Hemostatics

4. A 55-year-old man is complaining 7. A 45-year-old woman with a normal

of general weakness, decreased fluid body weight was diagnosed with diabetes
excretion, and an aching pain in his mellitus for the first time. Attempts to
heart. For the last 15 years he has been correct his blood glucose levels by means
suffering from chronic pyelonephritis and of a diet were unsuccessful. Her 24-
undergoing an inpatient treatment. His hour glycemia varies between 10 and
skin is dry and has a yellowish tinge. His 15 mmol/L. Which medicine would be
pulse is 80/min., rhythmic, blood pressure optimal in this case?
– 100/70 mm Hg. Cardiac auscultation A. Sulfanilamide hypoglycemic drugs
detects muffled heart sounds and a friction B. Biguanides combined with sulfanilamide
rub in the pericardium. Laboratory results: hypoglycemic drugs
creatinine – 1.1 mmol/L, glomerular C. Insulin
filtration – 5 mL/min. What treatment is D. Insulin combined with sulfanilamide
indicated for this patient? hypoglycemic drugs
E. Biguanides
 922521I1 2

8. Fluorography of a 45-year-old patient victim of an accident, who has fallen from

detects a few foci of low intensity with a height. This patient has clinical signs
blurred margins on the apex of his right of multiple fractures in both legs. The
lung. This sign is observed for the first patient’s condition is severe; the patient
time. Such condition causes him no is conscious, but mentally sluggish; the
discomfort. He has a many-year history of skin is pale gray; the forehead is covered
smoking. Objectively, percussion produces in a cold sweat. The patient’s breathing is
a pulmonary sound above the lungs, shallow, with respiratory rate of 30/min.,
the respiration is vesicular, auscultation blood pressure – 80/60 mm Hg, pulse –
detects no wheezing. Blood test findings 120/min., shallow. What complication has
are normal. Make the right diagnosis: occurred in this person?
A. Focal pulmonary tuberculosis A. Traumatic shock, degree 2
B. Peripheral lung cancer B. Traumatic shock, degree 1
C. Bronchopneumonia C. Traumatic shock, degree 4
D. Disseminated pulmonary tuberculosis D. Syncope
E. Eosinophilic pneumonia E. Traumatic shock, degree 3
9. A 54-year-old patient has been suffering 13. A 30-year-old patient after an
from femoral osteomyelitis for over 20 emotional upset developed tonic seizure
years. In the last month she developed that later gave place to clonic seizures.
gradually progressing leg edemas. In This condition was accompanied by loss of
the urine: proteinuria – 6.6 g/L. In the consciousness, foaming at the mouth, and
blood: dysproteinemia in the form of involuntary urination. No focal signs were
hypoalbuminemia, increased α2 - and γ - detected. Blood pressure is 120/60 mm Hg.
globulin levels, ESR – 50 mm/hour. Make Make the right diagnosis:
the right diagnosis:
A. Epilepsy
A. Secondary renal amyloidosis B. Syncope
B. Acute glomerulonephritis C. Neurasthenia
C. Systemic lupus erythematosus D. Eclampsia
D. Chronic glomerulonephritis E. Stroke
E. Multiple myeloma
14. A full-term delivery has resulted in
10. A 28-year-old man was hospitalized on the birth of a live full-term girl without
the 9th day of illness with complaints of asphyxia. The baby is inert, her skin is pale
fever of 39o C, headache, general weakness, with an icteric tinge, she has no edemas.
constipation, and disturbed sleep. On the The abdomen is soft, the liver and spleen
skin of his abdomen there were isolated are enlarged. The blood tests show that the
roseolas, his pulse is 78/min., the liver is mother’s blood type is A(II) Rh(–), while
enlarged by 2 cm. Make the right diagnosis: the child’s blood type is A(II) Rh(+). Make
the right diagnosis:
A. Typhoid fever
B. Brucellosis A. Hemolytic disease of the newborn
C. Leptospirosis B. Intracranial birth injury
D. Sepsis C. Physiological jaundice
E. Epidemic typhus D. Maldevelopment of parenchymal organs
E. Disturbed cerebral circulation
11. A well was dug on a rural land plot.
It is located at the distance of 20 meters 15. The region in the Carpathian foothills
from the house, 10 meters from the toilet, is characterized with constant high
and 15 meters from the neighbor’s house. atmospheric humidity (over 80%). In the
What is the minimum permissible distance cold season, while the air temperature
between the well and the source of possible is moderately low, the population of this
water pollution, according to the sanitary region feels extreme cold. What type of
norms? heat transfer increases in such conditions?
A. 30 meters A. Convection
B. 25 meters B. –
C. 20 meters C. Evaporation
D. 15 meters D. Radiation
E. 10 meters E. Conduction
12. The ambulance has brought in the 16. A 58-year-old patient complains of
 922521I1 3

an inguinal tumor that increases during

straining and coughing. There is a pulsating A. Congenital toxoplasmosis
tumor-like formation located below and B. Hemolytic disease of the newborn
laterally to the Poupart’s ligament. The C. Sepsis
formation does not diminish during D. Congenital heart defect
palpation. Make the right diagnosis: E. Congenital hepatitis

A. Femoral aneurysm 20. A woman at 12 weeks of her

B. Femoral hernia pregnancy developed a pain in her lower
C. Neurinoma of the femoral nerve abdomen and mild bloody Discharge,
D. Ectopic testicle which occurred with no apparent reason.
E. Inguinal hernia Vaginal examination shows well-formed
cervix with closed external orifice. The
17. A variety of lighting fixtures have body of the uterus is enlarged according
been used to illuminate classrooms. What to her term of pregnancy. Make the right
kind of lighting fixtures creates the most diagnosis:
hygienically acceptable lighting?
A. Threatened miscarriage
A. Lighting fixtures that provide reflected B. Anembryonic pregnancy
lighting C. Ongoing miscarriage
B. Lighting fixtures that provide direct D. Imminent miscarriage
lighting E. Incomplete miscarriage
C. Lighting fixtures that provide scattered
lighting 21. In the demographic structure of a
D. Lighting fixtures that provide semi- region, the people aged from 0 to 14
reflected lighting make up 31% of the population, while
E. Lighting fixtures that provide combined the 50+ age group makes up 20% of the
lighting population. What population structure
characterizes such demographic situation
18. A victim of a car accident received most accurately?
multiple fractures of the limbs and pelvic
bones. He has a history of hemophilia A. Expansive population
A. Objectively, hematomas form at the B. Stationary population
sites of injury. The patient’s condition C. Constrictive population
is deteriorating. The blood pressure is D. Emigration of the population
90/50 mm Hg. What is the optimal E. Migration of the population
combination of infusion agents that should
be given to the patient for treatment after 22. A 13-year-old boy is complaining of
polyglucin (dextran) and saline solutions a dry cough and shortness of breath.
are administered? The onset of the disease was one year
ago. He has brief asphyxia attacks that
A. Cryoprecipitate, packed erythrocytes occur 1–2 times per month. Objectively,
B. Packed erythrocytes, fresh frozen plasma the child is anxious and has expiratory
C. Fresh frozen plasma, albumin dyspnea, his skin is pale, his nasolabial
D. Cryoprecipitate, glucose triangle is cyanotic. His respiratory rate
E. Packed erythrocytes is 48/min. Percussion produces a banbox
resonance over the lungs; auscultation
19. A 40-year-old woman, gravida 6, para detects weakened breathing with bilateral
3, at the 40 weeks of her pathological dry wheezing. Forced expiratory volume is
pregnancy (threatened miscarriage, type 80% of the normal. What medicine should
I gestosis of the second half of her be prescribed to this boy?
pregnancy), gave birth to a girl with
asphyxia. The baby’s condition is severe, A. Salbutamol
the weight is 2 kg, there are signs of B. Euphyllin (Aminophylline)
immaturity and hydrocephalus. The baby’s C. Prednisolone
skin is pale, icteric, and has acrocyanosis. D. Indomethacin
Heart sounds are muffled, there is a E. Suprastin (Chloropyramine)
harsh systolic murmur at all points of 23. A patient with rheumatism presents
auscultation. Abdomen is enlarged, the with diastolic tremor of the chest wall
liver is +3 cm. The urine is saturated, the («cat’s purr»), heart sound I that is
stool is light-colored. An ophthalmologist amplified at the apex, diastolic murmur
has detected chorioretinitis in the baby. with presystolic amplification, a mitral
Make the right diagnosis: opening sound, and an accent of the II
 922521I1 4

heart sound over the pulmonary artery. A. Subarachnoid hemorrhage

What heart defect was observed in this B. Hypertensive crisis
patient? C. Ischemic stroke
D. Meningitis
A. Stenosis of the left atrioventricular E. Brain hemorrhage
orifice
B. Mitral valve insufficiency 27. A 14-year-old boy developed a
C. Patent ductus arteriosus sympatho-adrenal crisis. What medicine
D. Pulmonary artery stenosis was indicated for crisis relief in this case?
E. Aortic valve insufficiency
A. Propranolol
24. At a factory with harmful working B. Digoxin
conditions, a complex of measures was C. Thiopental sodium
being taken to reduce the morbidity D. Euphyllin (Aminophylline)
among the workers. For better effect, the E. Drotaverine
factory doctor was separately monitoring a
group of people, who fall ill frequently and 28. In the morning, an 8-year-old child
for a long time. What type of morbidity started complaining of general weakness
requires distinguishing such a group of and pain during swallowing. At noon,
people? her parents called for a doctor, because
the girl’s weakness was progressing and
A. Morbidity with temporary disability she developed a bilateral swelling slightly
B. Morbidity associated with acute below and in front of her ears. Make the
infections right diagnosis:
C. General morbidity
D. Morbidity associated with major non- A. Mumps
communicable diseases B. Lymphadenopathy
E. Hospitalized morbidity C. Tumor of the salivary glands
D. Dermoid cysts
25. A 38-year-old patient has episodes E. Tumor of the carotid body
of paroxysmal hypertension that reaches
240/120 mm Hg and is accompanied 29. A 58-year-old patient, a heavy drinker
by nausea, vomiting, tachycardia, and and smoker, came to a hospital with
excessive sweating. Hyperglycemia is complaints of constant coughing and
observed in the blood during such shortness of breath. Lately, he has been
episodes. After the episode, profuse losing weight. His cervical lymph nodes
urination occurs. Renal sonography has are enlarged and dense, the tissues above
shown a new formation adjacent to them exhibit no tension. Chest X-ray has
the upper pole of the right kidney shown fibrosis of an upper pulmonary lobe
that might belong to the adrenal gland. and left-sided pleurisy. The pleural fluid is
What laboratory test will help clarify the straw-colored, with protein levels of 52 g/L
diagnosis? and a high lymphocyte count. Malignant
cells were not detected. Inoculation of the
A. Urinary excretion of catecholamines pleural fluid produced no microbial growth
and vanillylmandelic acid one week later. Make the right diagnosis:
B. Blood levels of thyroxine and thyroid-
stimulating hormone A. Pulmonary tuberculosis
C. Blood renin levels B. Systemic lupus erythematosus
D. Blood levels of insulin and C-peptide C. Sarcoidosis
E. Glomerular filtration rate, measured D. Bronchiectasis
using the endogenous creatinine clearance E. Atypical pneumonia
rate
30. A laboratory has received a milk
26. During physical exertion, a man with sample for analysis. The findings are as
a cerebral artery aneurysm suddenly follows: color is whitish, smell is normal,
developed severe headache and vomiting taste is normal for milk, specific gravity is
and fainted. The patient is agitated and 1,038, acidity is 35o T (degrees Turner), fats
wants to run somewhere. His pulse is is 3.2%. What is the milk quality?
62/min., rhythmic, blood pressure – 140/90
mm Hg, the body temperature is 37.5o C. He
has nuchal rigidity and positive Kernig’s
sign. Focal neurological signs are absent.
Make the provisional diagnosis:
 922521I1 5

A. The milk is of poor quality has: erythrocytes – 3.0 · 1012 /L, Hb – 90

B. The milk is of reduced quality g/L, color index – 1.0, microspherocytosis,
C. The milk is conditionally fit for use reticulocytosis. Total serum bilirubin – 56
D. The milk is a counterfeit product mcmol/L, indirect bilirubin – 38 mcmol/L.
E. The milk is of good quality What treatment method is optimal in this
case?
31. A 7-year-old child fell ill 2 weeks
ago, when he developed a runny nose. A. Splenectomy
An otolaryngologist was consulted about B. Omentohepatopexy
sanguinopurulent discharge from the C. Spleen transplant
child’s nose and maceration of his wings D. Omentosplenopexy
of the nose and upper lip. Rhinoscopy has E. Portocaval anastomosis
detected whitish-gray foci on the nasal
septum. The oropharyngeal mucosa is 35. A 22-year-old woman at 11–12
without changes. Make the right diagnosis: weeks of pregnancy came to a maternity
clinic. Examination has shown a positive
A. Nasal diphtheria Wasserman reaction. A dermatologist
B. Adenovirus infection diagnosed her with secondary latent
C. Maxillary sinusitis syphilis. What are the tactics of pregnancy
D. Rhinovirus infection management in such case?
E. Allergic rhinitis
A. Artificial termination of the pregnancy
32. An 18-year-old young man complains after a course of antisyphilitic therapy
of pain in his knee and ankle joints and B. Prolongation of the pregnancy after a
a fever of 39.5o C. A week and a half course of antisyphilitic therapy
before, he had a case of respiratory disease. C. Artificial termination of the pregnancy
His body temperature is 38.5o C, his knee after the diagnosis is made
and ankle joints are swollen. His pulse D. Artificial termination of the pregnancy
is 106/min., rhythmic. His blood pressure after normalization of the patient’s
is 90/60 mm Hg. The heart borders are Wasserman reaction
normal, the heart sounds are weakened, E. Three antisyphilitic treatment courses
and there is a soft systolic murmur at the throughout the pregnancy
apex. What parameter was most closely
associated with the possible etiology of this 36. A lumbar puncture was made for a
process? newborn with a suspected intracranial
birth injury. Bloody cerebrospinal fluid was
A. Antistreptolysin 0 obtained. What type of hemorrhage was
B. Seromucoid observed in this case?
C. Creatine kinase
D. Rheumatoid factor A. Subarachnoid hemorrhage
E. α1 -antitrypsin B. Cephalohematoma
C. Subtentorial hemorrhage
33. A postparturient woman came to D. Epidural hemorrhage
a doctor on the 14th day after giving E. Supratentorial hemorrhage
birth. She complained of a sudden pain,
hyperemia, and induration in her left 37. The mother of a newborn child is
breast, fever of 39o C, headache, and suffering from chronic pyelonephritis and
indisposition. There is a fissure in the had a case of acute respiratory viral
nipple, the left breast is enlarged, during infection before giving birth. The delivery
its palpation the pain intensifies. What is full-term, the waters did not break for
pathology is suspected in this case? a long time. On the 2nd day of life the
baby developed an erythematous rash.
A. Lactational mastitis Blisters of about 1 cm in size appeared.
B. Breast cancer They are filled with seropurulent contents
C. Suppurated cyst of the left breast and their lancing results in formation of
D. Phlegmon of the breast erosions. The Nikolsky’s sign is positive.
E. Fibroadenoma of the left breast The baby is inert and has a subfebrile body
temperature. Make the diagnosis:
34. A 15-year-old patient presents
with delayed physical development and
periodically develops icteric skin. Spleen
is 16x12x10 cm, cholecystolithiasis is
observed in the patient, there is a skin ulcer
on the left calf in its lower third. The blood
 922521I1 6

A. Neonatal pemphigus Hematuria is observed for the last 3

B. Vesiculopustulosis days. The kidneys are not palpable,
C. Sepsis the suprapubic area is normal, the
D. Ritter’s disease of the newborn external genitalia have no pathology.
E. Pseudofurunculosis Rectal examination detects no prostatic
enlargement. Cystoscopy detects no
38. A 34-year-old patient has been changes. What disease is suspected first?
suffering from pulmonary tuberculosis
for the last 7 years. He complains of A. Kidney cancer
muscle weakness, weight loss, diarrhea, B. Renal dystopia
and frequent urination. His skin, gums, C. Necrotizing papillitis
and buccal mucosa are hyperpigmented. D. Varicocele
His blood pressure is 90/58 mm Hg. In E. Tuberculosis of the urinary bladder
the blood: erythrocytes – 3.1 · 1012 /L, Hb
– 95 g/L, color index – 0.92; leukocytes – 42. A 28-year-old patient complains of
9.4 · 109 /L, eosinophils – 7%, segmented chills in his feet and fingers and pain in
neutrophils – 45%, band neutrophils – 1%, his legs during walking. The disease onset
lymphocytes – 40%, monocytes – 7%, Na+ was one year ago. The skin of his legs is
pale and cold; low turgor and hypotrichosis
– 115 mmol/L, + – 7.3 mmol/L. Make the are observed. Pulsation over the femoral
diagnosis: and popliteal arteries is weakened, on
A. Primary insufficiency of the adrenal the pedal arteries it is palpable after a
cortex nitroglycerin test. Rheographic index is <1.
B. Primary hyperaldosteronism Make the right diagnosis:
C. Congenital hyperplasia of the adrenal A. Obliterating endarteritis
cortex B. Chronic thrombophlebitis
D. Pheochromocytoma C. Wegener vasculitis
E. Diabetes insipidus D. Arteriosclerosis obliterans
39. A 35-year-old woman has red swollen E. Raynaud syndrome
areas on the dorsal surface of her hands 43. A 20-year-old woman complains of
after a severe nervous strain, which was amenorrhea. She has hirsutism and obesity
followed by formation of small inflamed with predominant distribution of adipose
nodules, vesicles, and later erosions with tissue on the face, neck, and upper torso.
significant discharge of a serous fluid. On her face she has acne vulgaris, on
This process was accompanied by severe her skin there are stretch marks. The
itching. Make the right diagnosis: blood pressure is 170/100 mm Hg. Her
A. True eczema mental development and intelligence
B. Microbial eczema are not impaired. Gynecological status
C. Toxicoderma shows moderate hairiness of the external
D. Simple contact dermatitis genitalia and acute hypoplasia of the
E. Allergic dermatitis vagina and uterus. Make the right
diagnosis:
40. A 48-year-old patient, whose blood
test has resulted in positive Wasseman A. Cushing syndrome
and sedimentation reactions thrice, came B. Stein-Leventhal syndrome
to a doctor. His treponema pallidum C. Turner syndrome
immobilization test was positive as D. Sheehan syndrome
well. Examination has shown no clinical E. Babinski-Froehlich syndrome
manifestations of syphilis in the patient’s 44. A 48-year-old patient was hospitalized
skin, internal organs or nervous system. with complaints of headache, nausea, wet
Make the right diagnosis: cough, problematic breathing, impaired
A. Early latent syphilis vision, excessive sweating, and salivation.
B. Latent recurrent syphilis He worked in a team that treated gardens
C. Tertiary syphilis with organophosphorus pesticides. In his
D. Seropositive primary syphilis blood: erythrocytes – 4.1 · 1012 /L, Hb –
E. Recurrent secondary syphilis 136 g/L, color index – 0.9, leukocytes –
13.0 · 109 /L, ESR – 17 mm/hour. He was
41. A 50-year-old man was hospitalized diagnosed with acute intoxication caused
with complaints of blood in the urine. by organophosphorus pesticides. What is
There are no pain or urination disorders. the most important diagnostic criterion of
 922521I1 7

this pathology? scleritis and subicteric sclerae. The liver is

+3 cm. 24-hour urine output is 700 mL.
A. Decreased cholinesterase levels Make the right diagnosis:
B. Reticulocytosis
C. Leukocytosis A. Leptospirosis
D. Thrombocytopenia B. Yersiniosis
E. Anemia C. Influenza
D. Viral hepatitis
45. A 55-year-old man on the 3rd day after E. Hemorrhagic fever with renal syndrome
an acute anterior myocardial infarction
complains of shortness of breath and a dull 49. A 38-year-old man lives in an area
pain behind the sternum that decreases that is endemic for echinococcosis. For the
when he leans forward. His blood pressure last 6 months he has been suffering from
is 140/80 mm Hg and his heart sounds are pain in his right subcostal region and fever.
muffled. ECG has shown atrial fibrillation Echinococcal liver damage was suspected.
with the ventricular rate of 110/min., What study will be the most informative in
pathological Q wave, and ST segment this case?
elevation in the right-sided chest leads.
Make the right diagnosis: A. Ultrasound examination
B. Liver scan
A. Acute pericarditis C. Angiography
B. Dressler syndrome D. Biochemical testing
C. Tietze syndrome E. Survey X-ray-of the abdominal cavity
D. Pulmonary embolism
E. Dissecting aortic aneurysm 50. A 29-year-old woman was brought
to the admission room with complaints
46. The blood pressure and age were of a sudden pain in her lower abdomen,
studied among 200 patients with essential weakness, and loss of consciousness. Her
hypertension. What statistical value can last menstruation was 6 weeks ago. Her
be used to measure the strength of the pulse is 120/min., blood pressure – 80/50
relationship between these characteristics? mm Hg. There are pain and signs of
peritoneal irritation low on the right side.
A. Correlation coefficient In the blood: Hb – 106 g/L. Make the right
B. Representation error diagnosis:
C. Variation coefficient
D. Sigma deviation A. Interrupted tubal pregnancy
E. Student’s t-test B. Ovarian torsion
C. Ovarian apoplexy
47. A 38-year-old woman, para 3, has D. Acute appendicitis
a history of 5 artificial abortions. Five E. Acute right-sided adnexitis
minutes after giving birth, she started
bleeding from her genital tracts (350 mL). 51. A woman was hospitalized with
The patient’s condition is satisfactory, her complaints of periodical pain in the
pulse is 92/min., blood pressure is 100/60 lower abdomen that intensifies during
mm Hg. There are no signs of placental menstruation, as well as weakness,
expulsion, its manual removal has to be indisposition, nervousness, and smearing
performed. In some spots the placenta is discharge of dark blood from the vagina
somewhat difficult to detach. Make the before and after menstruation. Bimanual
right diagnosis: research has shown enlarged uterine
body, the uterine appendages cannot be
A. Partial placenta adherens detected, the surface of the posteror fornix
B. Trapped placenta is tuberous. Laparoscopy detects cyanotic
C. Total placenta adherens inclusions on the ovaries, in the recto-
D. Placenta accreta uterine pouch of the peritoneal cavity,
E. Hypotonic bleeding and on the paraproctium. Make the right
diagnosis:
48. A woman, who works at a pig farm,
against the background of complete health A. Disseminated endometriosis
developed sudden chills, fever of 39.9o C, B. Polycystic ovaries
intense headache, and nausea. The next C. Chronic salpingitis
day, she noticed a pain in her leg muscles D. Genital tuberculosis
and nosebleeds. On the 3rd day after the E. Ovarian cystoma
onset of the disease the woman’s condition
is severe, her face is hyperemic, she has 52. A 31-year-old patient has been
 922521I1 8

suffering from systemic scleroderma for A. Systemic lupus erythematosus

14 years. She underwent multiple inpatient B. Rheumatism
treatment courses. She is complaining of C. Acute lymphoblastic leukemia
intermittent dull pain in the area of her D. Systemic scleroderma
heart, palpitations, shortness of breath, E. Juvenile rheumatoid arthritis
headache, swollen eyelids, weight loss, and
painful and deformed joints in her limbs. 56. After manual repositioning of bone
The prognosis of her condition will be fragments and application of a plaster
worse if the following organ is affected: splint, a patient with forearm fractures
developed edema, pain, and disturbed
A. Kidneys sensitivity in his hand and fingers. What
B. Skin and joints tactics must the doctor choose?
C. Gastrointestinal tract
D. Lungs A. Cut the bandage that secures the splint
E. Heart B. Expectant management, because this is
a natural phenomenon – the edema will
53. An ambulance team has brought a decrease on its own in 24 hours
man diagnosed with acute respiratory viral C. Remove the splint
infection into the inpatient department. D. Prescribe analgesics and diuretics
The onset of the disease was acute, with E. Repeat the repositioning
fever of 39.9o C. The patient is complaining
of a headache in his fronto-temporal 57. A 58-year-old woman developed
regions, pain in the eyeballs, aches all over profuse bleeding from a ruptured varicose
his body, stuffed nose, sore throat, and dry node on her left calf. What first aid will you
cough. At home, he had two episodes of provide in this case?
nosebleeds. What type of acute respiratory A. Elevated position of the limb, a sterile
viral infection does this patient have? compression bandage
A. Influenza B. Tourniquet proximal to the source of
B. Enterovirus infection bleeding
C. Respiratory syncytial infection C. Tourniquet distal to the source of
D. Adenovirus infection bleeding
E. Parainfluenza D. Troyanov-Trendelenburg operation
E. Z-shaped suture, applied to the ruptured
54. An 28-year-old man was hospitalized varicose node
on the 7th day of illness with complaints
of headache, general weakness, fever, 58. Two days ago a 28-year-old man has
and sore throat. All the groups of lymph injured the distal phalanx of his right
nodes are enlarged to 1–3 cm in diameter. index finger with a needle. He complains
Palpation shows dense, elastic, and slightly of a sharp throbbing pain and edema in
painless lymph nodes that are not matted the area of this phalanx and markedly
together. Enlarged tonsils are covered impaired finger mobility. His index finger
with purulent plaque. The liver is +3 is slightly bent, its distal phalanx is
cm. In the blood: leukocytosis, relative hyperemic and significantly enlarged. The
lymphomonocytosis, virocytes – 15%. probe clearly determines the point of
Make the right diagnosis: maximum pain. The body temperature is
36.9o C. What treatment will be necessary
A. Infectious mononucleosis in this case?
B. Adenovirus infection
C. Acute lymphocytic leukemia A. Lancing and drainage of the purulent
D. Diphtheria process in the finger after applying Oberst-
E. Tonsillitis Lukashevich anesthesia
B. Application of semi-alcoholic
55. A 13-year-old girl is complaining of a compresses
febrile body temperature that is observed C. Lancing and drainage of the abscess
within the last month, pain in the joints, after applying general anesthesia
and periodical skin rash. Examination D. Injections with antibiotics and novocaine
detects LE-cells and a persitent increase (procaine) around the affected area
in ESR in the child’s blood. Make the right E. Resection of the distal phalanx of the
diagnosis: finger
59. A 28-year-old woman came to a doctor
with complaints of facial edema, moderate
leg edemas, and urine that periodically
 922521I1 9

assumes the color of «meat slops». As a redness in his right calf. He has a fever of
teenager, she had frequent tonsillitis. Her 38.5o C and enlarged and painful inguinal
skin is pale, to – 36.8o C, pulse – 68/min., lymph nodes on the right. The skin of the
rhythmic, blood pressure – 170/110 mm Hg. affected limb is edematous, hyperemic, and
What changes in the patient’s urine are the has rash elements in the form of vesicles
most likely in this case? filled with a dark liquid. Its palpation is
painful. There is a clear margin between
A. Proteinuria, hematuria, cylindruria the red area and healthy skin. Make the
B. Erythrocyturia and uricosuria right diagnosis:
C. Increased specific gravity, hematuria,
bacteriuria A. Erysipelas, hemorrhagic form
D. Decreased specific gravity, proteinuria, B. Herpes infection
myoglobinuria C. Chickenpox
E. Decreased specific gravity, proteinuria, a D. Phlegmon of the calf
small amount of urine sediment E. Anthrax, cutaneous form
60. A 51-year-old woman has a 2.5- 63. A 54-year-old patient was brought to
month-long menstruation delay. She is a hospital with complaints of a sudden
complaining of profuse bloody discharge sharp pain in his chest that appeared when
from her vagina for the last 15 days, he was lifting a heavy object. The pain is
irritability, and disturbed sleep. She has a localized in the center of his chest. It does
history of menstrual dysfunction observed not irradiate to other areas, nor does it
within the last year. Ultrasound shows intensify with changes in the position of
that her uterus is normal for her age, the body. The pain was accompanied by
the uterine appendages are normal, nausea without vomiting. No respiratory
endometrial thickness is 14 mm. What symptoms are observed. The man has a
tactics will the doctor choose in this case? history of essential hypertension and takes
angiotensin-converting-enzyme inhibitors.
A. Diagnostic curettage of the walls of the Objectively, his skin is pale and moist. His
uterine cavity pulse is 115/min., respiratory rate – 20/min.
B. Supravaginal amputation of the uterus ECG shows sinus tachycardia. Chest X-
without the appendages ray shows a darkening in the upper left
C. Hysterectomy and lower right segments. His cardiac
D. Conservative treatment of the bleeding enzyme levels are normal. Make the right
E. TORCH panel test diagnosis:
61. After an overexposure to cold, a A. Dissecting aortic aneurysm
32-year-old patient developed general B. Myocarditis
weakness, excessive sweating, fever, and C. Strangulated hiatal hernia
cough. His overall condition is moderately D. Acute pericarditis
severe, his skin is moist, his lips are E. Acute myocardial infarction
cyanotic. His chest is symmetrically
involved in the act of breathing. Under the 64. When playing football, a 20-year-old
shoulder blade on the right, the percussion man squatted sharply on his right leg
sound is slightly dull; vesicular respiration with a simultaneous turn to the left. This
there is weakend, with sonorous moist movement resulted in a sharp pain in his
finely-vesicular crackles. Above the rest of right knee, after which he was brought to a
the lung surface there is harsh breathing first-aid station. The range of movements
with scattered dry crackles. The heart in the right knee joint is 100–150o , there is
sounds are intensified, the second heart no lateral mobility in the knee. Make the
sound is accentuated over the pulmonary right diagnosis:
artery. In the blood: leukocytes – 13.2 ·
109 /L, ESR – 21 mm/hour. Make the right A. Damage to the internal meniscus
diagnosis: B. Subluxation of the patella, possibly
habitual
A. Right-sided focal pneumonia C. Damage to the medial collateral
B. Acute bronchitis ligament
C. Exacerbation of chronic non-obstructive D. Tense hemarthrosis of the knee joint
bronchitis E. Damage to the anterior cruciate
D. Lung cancer ligament
E. Tuberculosis
65. An 18-year-old young man was brought
62. A man complains of pain and skin into to the hematology department
with complaints of a headache, general
 922521I1 10

weakness, loss of appetite, fever of 39o C, are icteric, the liver protrudes from under
and a swelling on his neck. His, to – 38o С, the edge of the costal arch by 3 cm and
the skin and mucosa are markedly pale, is tender on palpation; the spleen cannot
the cervical lymph nodes on both sides are be palpated. Patient’s urine is dark, his
up to 1 cm in size and painless. The liver is feces are partially acholic. Make the right
+1 cm and painless, the spleen is +0.5 cm. diagnosis:
In the blood: Hb – 98 g/L, erythrocytes –
2.9 · 1012 /L, leukocytes – 32 · 109 /L, blast A. Viral hepatitis A
neutrophils – 0%, segmented neutrophils B. Intestinal yersiniosis
– 28%, monocytes – 2%, lymphocytes – C. Hemolytic anemia
39%, blasts – 31%, reticulocytes – 31%, D. Infectious mononucleosis
platelets – 120 · 109 /L , ESR – 36 mm/hour. E. Leptospirosis
Specify the form of the patient’s leukemia: 69. A 30-year-old man is complaining of
A. Acute lymphoblastic leukemia intense pain, skin redness, swollen ankle,
B. Chronic lymphocytic leukemia and fever of 39o C. The onset of the disease
C. Undifferentiated leukemia was sudden. In the past, he had similar
D. Chronic myelogenous leukemia episodes that lasted 5–6 days without
E. Acute myeloblastic leukemia changes in the joint. The skin over the
ankle joint is hyperemic, without clear
66. A 16-year-old teenager complains margins or an infiltrative bank on the
of weakness, dizziness, and heaviness in periphery. Make the right diagnosis:
the left subcostal region. The skin and
visible mucosa are icteric. The tower skull A. Gout
syndrome is observed. The liver is +2 cm. B. Osteoarthrosis
The lower edge of the spleen is at the level C. Rheumatoid arthritis
of the navel. The blood has: erythrocytes D. Erysipelas
E. Infectious arthritis
– 2.7 · 1012 /L, Hb – 88 g/L, leukocytes –
5.6 · 109 /L, ESR – 15 mm/hour. What is the 70. A 7-year-old boy has been
most likely change in the bilirubin levels in receiving treatment for a month. At
this patient? the time of hospitalization, he had
marked edemas, proteinuria of 7.1
A. Increase in unconjugated bilirubin levels g/L, and daily urine protein of 4.2
B. Decrease in unconjugated bilirubin g. Biochemical blood test has shown
levels persistent hypoproteinemia (43.2 g/L) and
C. Increase in conjugated bilirubin levels hypercholesterolemia (9.2 mmol/L ). What
D. Increase in unconjugated and conjugated leading glomerulonephritis syndrome is
bilirubin levels most likely in this patient?
E. Decrease in conjugated bilirubin levels
A. Nephrotic
67. A 58-year-old patient has undergone an B. Mixed
urgent cholecystectomy and drainage of C. Isolated urinary
the abdominal cavity. In the postoperative D. Nephritic
period, she was prescribed heparin and E. Hematuric
developed hemorrhagic syndrome. What
medicine must be used to eliminate the 71. A 65-year-old man complains of
side effects of heparin in this case? asphyxia, cough with pink foaming
sputum, sensation of lack of air, and fear
A. 1% solution of protamine sulfate of death. He has orthopnea, pale skin,
B. 10% solution of calcium chloride and acrocyanosis and is covered in cold
C. 1% solution of vicasol (menadione) sticky sweat. His respiration is harsh, in
D. 1% solution of calcium chloride the lower posterior segments there are wet
E. 5% solution of aminocaproic acid finely vesicular and moderately vesicular
68. A 20-year-old young man was brought crackles on both sides. His respiratory
to a clinic on the 7th day of his illness rate is 40/min. The heart sounds are
with complaints of icteric skin and sclerae, markedly muffled. At the cardiac apex, the
dark urine, one episode of vomiting, low gallop rhythm is observed. Make the right
appetite, and fever of 38o C throughout diagnosis:
the last 2 days. Three weeks ago he
went fishing with friends, during which
they all shared the same tableware. He
is inert, to – 36.8o C, his skin and sclerae
 922521I1 11

A. Pulmonary edema who died by hanging, reveals that the spots

B. Pulmonary embolism of livor mortis disappear when pressed and
C. Infarction pneumonia then reappear 50 seconds later. The rigor
D. Status asthmaticus mortis is moderate and observed only in
E. Croupous pneumonia the masticatory muscles and muscles of
neck and fingers. The body temperature is
72. In April, during medical examination 31.0o C. What is the time of death is likely
of the population, 27% of the examined in this case?
people were complaining of their
decreased working ability and high A. 6–7 hours
fatigability. Examination revealed swollen B. 8–10 hours
loose gums that markedly bleed C. 16–24 hours
when pressed. On the skin, follicular D. 1–2 hours
hyperkeratosis is observed against the E. 10–18 hours
background of normal skin moisture. What
pathology is most likely cause of this 76. A child has suddenly developed a
condition? respiratory arrest, cyanotic skin, and
pinpoint pupils. There is no pulse on the
A. Hypovitaminosis C great blood vessels. What measures must
B. Hypovitaminosis A be taken first in this case?
C. Periodontosis
D. Hypovitaminosis B1 A. Artificial pulmonary ventilation, closed-
E. Polyhypovitaminosis chest cardiac massage
B. Intracardiac injection of adrenaline
73. A 37-year-old woman complains C. Intravenous injection of euphyllin
of shortness of breath and constricting (aminophylline)
retrosternal pain. One week ago she had D. Gastric lavage
a flu. She has acrocyanosis, her heart E. Oxygen therapy
rate is 98/min., blood pressure – 90/75
mm Hg, respiratory rate – 26/min. The 77. For the last 2 years, a 51-year-old
cardiac borders are expanded to the left woman has been experiencing a dull pain
and right by 3 cm. The heart sounds are with periodical exacerbations in her right
muffled, above the cardiac apex there are a subcostal region. The pain was associated
protodiastolic gallop rhythm and a systolic with eating fatty foods. The woman is
murmur. Hb – 100 g/L, ESR – 25 mm/hour. complaining of bitterness in her mouth in
Make the right diagnosis: the morning, constipations, and flatulence.
She is overeating, to – 36.9o C, the tongue
A. Infectious-allergic myocarditis is coated near its root, the abdomen is
B. Ischemic heart disease, angina pectoris moderately distended and painful at the
C. Exudative pericarditis point of gallbladder projection. What
D. Myocardial dystrophy study would be the most useful for making
E. Dilated cardiomyopathy a diagnosis?
74. A 25-year-old multipara was A. Abdominal ultrasound
hospitalized at the first period of labor with B. Cholecystography
moderately strong contractions. This is her C. Duodenoscopy
third pregnancy. She has a history of one D. Liver scan
cesarean section due to clinically narrow E. Duodenal sounding
pelvis and one artificial abortion. Suddenly
she developed severe abdominal pain and 78. A 17-year-old girl was hospitalized
weakness. The blood pressure dropped to into the gynecological department with
90/50 mm Hg. Moderate bloody discharge complaints of profuse bloody discharge
appeared from the vagina. The fetal from her genital tracts and a cramping
heartbeat cannot be auscultated. The pain in her lower abdomen. The last
labor activity has ceased. Make the right menstruation was 10 weeks ago. Her blood
diagnosis: pressure is 100/60 mm Hg, pulse is 90/min..
Vaginal examination has shown that the
A. Uterine rupture external orifice of the uterine cervix allows
B. Inferior vena cava syndrome inserting one finger. The uterus is painless
C. Placental abruption and enlarged to 6 weeks of pregnancy. The
D. Placenta previa uterine appendages cannot be detected,
E. Amniotic fluid embolism the fornices are free. Make the right
diagnosis:
75. Examination of the corpse of a man,
 922521I1 12

frontal area. It is accompanied by nausea

A. Incomplete miscarriage and abdominal discomfort and begins
B. Imminent miscarriage suddenly. The headaches are preceded by
C. Threatened miscarriage blurred vision. The woman has a history of
D. Complete miscarriage hypertension episodes, but currently takes
E. Anembryonic pregnancy no medicines. Between the headaches, her
condition is satisfactory. She is overeating
79. A 53-year-old woman complains of (body mass index is 29), her blood pressure
an aching pain in the lower abdomen, a is 170/95 mm Hg. Her neurological status
significant abdominal distention within the is normal. Make the right diagnosis:
last 5 months, weight loss, and weakness.
The cervix is clean, the uterus is not A. Migraine
enlarged, painless, and immobile. On the B. Hypertensive encephalopathy
both sides, there are dense mildlymobile C. Benign intracranial hypertension
tumors 10x13 cm in size with an uneven D. Chronic subdural hematoma
surface. Abdominal percussion detects a E. Epilepsy
fluctuation. Make the right diagnosis:
83. A 38-year-old man is complaining of
A. Ovarian cancer periodical problematic swallowing of both
B. Floating kidney solid and liquid foods that is observed
C. Uterine fibromyoma for many months. Sometimes he develops
D. Endometriosis an intense retrosternal pain, especially
E. Tubo-ovarian tumor after hot beverages. Asphyxia attacks
are observed at night. He has no weight
80. In a 37-year-old primigravida the labor loss. His general condition is satisfactory,
lasts for 10 hours already. Contractions the skin is of normal color. Examination
last 20–25 seconds and occur every 6– detects no changes in the gastrointestinal
7 minutes. The fetus is in a longitudinal tract. Chest X-ray shows dilation of the
lie with cephalic presentation, the head is esophagus with air-fluid levels in it. Make
pressed against the entrance to the lesser the right diagnosis:
pelvis. Vaginal examination has shown that
the uterine cervix is up to 1 cm long and A. Esophageal achalasia
allows 2 finger-widths. The amniotic sac is B. Esophageal cancer
absent. Make the right diagnosis: C. Gastroesophageal reflux disease
D. Myasthenia
A. Primary weakness of labor activity E. Esophageal candidiasis
B. Normal labor activity
C. Discoordinated labor activity 84. A 60-year-old man has complains of a
D. Pathological preliminary period heavy sensation in his scrotum. There is
E. Secondary weakness of labor activity a scrotal edema on the left. The testicle
is of normal size, but above it a soft
81. A 36-year-old woman is complaining edema is palpable. The edema is limited
of epigastric pain that occurs after eating, to the scrotum, can be compressed, and
nausea, belching, and loose stools. The disappears when the patient lies down.
disease gradually progresses over the Make the right diagnosis:
course of the last 2 years. Her skin is pale
and dry, her tongue is coated, moist, and A. Varicocele
has teeth imprints on its edges. Abdominal B. Subcutaneous varicose veins
palpation detects diffuse epigastric pain. C. Inguinal hernia
What study will be the most informative in D. Ectopic testicle
this case? E. Inguinal lymphadenopathy
A. Fibrogastroscopy with biopsy of the 85. A 42-year-old man, who has been
gastric mucosa suffering from a duodenal ulcer for 20
B. X-ray of the stomach and intestine years, has developed a constant feeling
C. Comprehensive clinical blood test of heaviness in the stomach after eating.
D. Fractional study of gastric secretion His eructation carries the smell of decay
E. Computed tomography of the abdominal and vomiting occurs with the food eaten
cavity the day before. He has lost weight.
His condition is relatively satisfactory,
82. A 47-year-old woman is complaining tissue turgor is reduced. The abdomen
of paroxysmal headaches that have been is soft on palpation, there are no signs
occurring for the past 5 years. The pain of peritoneal irritation, and a «sloshing
is unilateral, intense, and localized in the
 922521I1 13

sound» can be heard in the epigastrium. All the questions he answers laconically.
Defecation occurs once in 3 days. What He considers himself to be healthy, but
complication most likely corresponds with tired, says that he thinks about writing a
the patient’s condition and the described book titled «Projection of mankind onto
clinical presentation? the plane of the universe», and carries
around a notebook with pages that are
A. Ulcerative stenosis of the pylorus filled with numerous identical crosses.
B. Ulcer penetration Make the right diagnosis:
C. Stomach cancer
D. Chronic pancreatitis A. Schizophrenia
E. Covered perforation of an ulcer B. Pick’s disease
C. Major depressive disorder
86. A district doctor was tasked with D. Autism spectrum disorder
preparation of a plan for a complex E. Schizoid personality disorder
of treatment and prevention measures
among the population in his district. What 90. A 35-year-old woman has complains
measures for secondary disease prevention of pain in her left arm that progresses
must be included in this plan? over the last 4 months and intensifies
after physical exertion of the affected
A. Prevention of disease complications limb. Also, she notes a cold and «tingling»
B. Improving the living conditions of the sensation in her arm. The pain decreases
population slightly at night, when the arm hangs
C. Rehabilitation measures down from the bed. The woman notes
D. Disease prevention deteriorating vision and the weight loss
E. Elimination of the causes of diseases of 4 kg. She does not smoke. She is
undereating, the pulse on the left arm
87. Preventive examination of a 75-year- cannot be found. There is no pulsation
old woman with a moderately active over the left carotid artery, a murmur is
lifestyle has shown total serum cholesterol heard above the right carotid artery. Make
of 5.1 mmol/L (208 mg/dL) and high- the right diagnosis:
density lipoprotein levels of 70 mg/dL. Her
ECG is normal. What advise about her diet A. Obliterating aortoarteritis
can be given to this woman? B. Systemic lupus erythematosus
C. Arterial thrombosis of the left arm
A. No changes in the diet D. Neurological amyotrophy
B. Reduce the intake of saturated fats E. Dermatomyositis
C. Increase the fiber intake
D. Reduce the intake of simple 91. A person was hospitalized with a closed
carbohydrates craniocerebral trauma 8 hours after a
E. Reduce the cholesterol intake car accident. The patient is unconscious.
There are anisocoria, a wound in the
88. A 46-year-old woman was awakened parietal area 3.0x1.0 cm in size, and neck
at 3 a.m. by a sharp pain in her right muscles rigidity. The pulse is 58/min., hard.
subcostal region, which irradiated into her Convulsive syndrome was observed. What
right shoulder. The woman is anxious, had is the most important indication for an
two episodes of vomiting, notes fever and immediate surgery in this case?
excessive sweating. Her temperature is
39.0o C. Her abdominal muscles are tense A. Intracranial hemorrhage
in the right subcostal region. Make the B. Anisocoria
right diagnosis: C. Unconsciousness
D. Wounds
A. Acute cholecystitis E. Intensifying seizures
B. Benign stricture of the common bile duct
C. Unstable angina pectoris 92. The inpatient care provided to the
D. Peptic ulcer disease population of a certain district is being
E. Cholelithiasis analyzed. What indicator could be used
when deciding, whether to reduce the
89. A 16-year-old patient throughout the number of available hospital beds?
last year presents with gradual changes
in his behavior. He started preferring
solitude and has lost interest in his friends
and studies. He became indifferent to
his family and rude without provocation,
started speaking and laughing with himself.
 922521I1 14

A. Average annual bed occupancy 97. During medical examination, a port

B. Mortality rate crane operator has complains of dizziness,
C. Average duration of inpatient stay nausea, a feeling of pressure in his
D. Average duration of treatment eardrums, tremor, asphyxia, and cough.
E. Bed turnover He is working at a high altitude associated
with nervous and emotional strain. Also,
93. A 32-year-old woman was treated in the workers are exposed to vibration
an inpatient department for an abscess (general and local), noise, infrasound, and
of the right lung. After coughing, she a microclimate that heats them in summer
suddenly developed labored breathing, and cools them in winter. What factor
cyanosis, and chest pain on the right. What is the most likely cause of the worker’s
complication is most likely in this case? complaints?
A. Pyopneumothorax A. Infrasound
B. Exudative pleurisy B. Strenuous work
C. Esophageal perforation C. Noise
D. Myocardial infarction D. Work at a high altitude
E. Infarction pneumonia E. Vibration
94. A 42-year-old man was hospitalized 98. A pregnant woman was registered with
3 hours after an injury with marked a maternity consultancy at the term of
subcutaneous emphysema of the upper 11 weeks and was monitored throughout
torso, dyspnea, and tachycardia of 120/min. the whole normal course of her pregnancy.
X-ray has detected no pneumothorax, What document will be given by the doctor
but has shown a significant expansion of to this woman for hospitalization to a
the mediastinum in both directions. What maternity clinic?
emergency aid must be provided in this
case? A. Exchange medical record
B. Medical sertificate issued by a sanitary
A. Drainage of the anterior mediastinum and
B. Thoracoscopy epidemiological station
C. Puncture of the pleural cavity C. Temporary disability certificate
D. Drainage of the pleural cavity D. Personal medical record of the pregnant
E. Thoracotomy woman
95. In a city with the population of 400.000, E. Hospitalization referral
per year 5,600 deaths are registered, 99. A 63-year-old man complains of
including 3,300 deaths caused by diseases weakness without an obvious cause,
of the circulatory system and 730 cases fatigability, loss of appetite, and a feeling of
of neoplasm-related mortality. What disgust towards meat products. Two weeks
parameter will allow to characterize the ago he had a gastric bleeding. Objectively,
circulatory-related mortality in this city? to – 37.5o C, respiratory rate – 20/min., pulse
A. Intensity parameter – 96/min., blood pressure – 110/75 mm
B. Relative intensity parameter Hg. Epigastric palpation detects pain and
C. Percentage correlation coefficient muscle tension. In the blood: Hb – 82 g/L,
D. Correlation coefficient ESR – 35 mm/hour. What study will be the
E. Extensivity parameter most useful for making a diagnosis?

96. Palpation of the thyroid gland of a 40- A. Cytology

year-old woman has detected a dense and B. X-ray
moderately painful nodule in the left lobe. C. Endoscopy
Ultrasound has shown the nodule to have D. Stool test
high density, while scintigraphy with 131 I E. Gastric contents analysis
shows it to be a «cold» nodule. What study 100. A medical committee consists of a
would be the most useful for clarification therapist, dermatologist, traumatologist,
of the diagnosis in this case? ophthalmologist, neurologist, immunologist,
A. Fine needle aspiration biopsy surgeon, otolaryngologist, and hematologist
B. Reflexometry was called in for the regular medical
C. Urinary iodine excretion examination of the workers at a chemical
D. Thyroid-stimulating hormone levels in factory that produces chromium- and
the blood nickel-containing mineral compounds.
E. Thermography Name the minimum composition of
 922521I1 15

such a committee, taking into account A. Lung abscess

the characteristics of the products B. Chronic pneumonia
manufactured by this factory: C. Purulent pleurisy
D. Lung cancer
A. Otolaryngologist, therapist, E. Pleural empyema
dermatologist
B. Therapist, dermatologist, traumatologist 104. A 28-year-old man is undergoing a
C. Therapist, immunologist, surgeon treatment for pulmonary tuberculosis. He
D. Therapist, hematologist, has complains of shortness of breath and a
ophthalmologist sharp chest pain on the right that appeared
E. Therapist, ophthalmologist, neurologist suddenly. Percussion detects a bandbox
resonance over the right lung, auscultation
101. A 70-year-old patient complains of detects no breathing there. X-ray has
weakness, dizziness, brief episodes of shown that the right lung is collapsed to
nuconsciousneus, and pain in the cardiac its root by 1/2 of its volume, the heart and
region. His heart rate is 40/min., heart mediastinal organs are shifted to the left.
sounds are rhythmic, the first heart sound What complication has developed in this
is muffled and significantly intensifies from patient?
time to time. Blood pressure is 180/90 mm
Hg. What is most likely the cause of these A. Spontaneous pneumothorax
hemodynamic disorders? B. Pulmonary infarction
C. Exudative pleurisy
A. Third-degree AV block D. Dry pleurisy
B. First-degree AV block E. Pleural empyema
C. Sinus bradycardia
D. Bradysystolic form of ciliary arrhythmia 105. A 76-year-old woman is complaining
E. Complete block of the His left bundle of a progressive swallowing disorder,
branch predominantly when she eats solid foods.
This sign is observed over the past 6 weeks.
102. A 76-year-old man has complains of Sometimes she notes episodes of vomiting
epigastric pain and periodical vomiting with solid vomitus. Swallowing is painless.
throughout the past 2 months. He has no She has lost 6 kg. Ten years ago she had
dysphagia or «coffee grounds» vomiting. a myocardial infarction. She permanently
During this period, he has lost 5 kg, his takes aspirin and long-acting nitrates,
appetite is low. He does not smoke and drinks alcohol in moderation, and smokes.
is not a heavy drinker. Previously, due to Her skin is icteric, her neck is normal, the
gastric dyspepsia he was taking antacids lymph nodes are not enlarged. The chest is
and proton pump inhibitors, but recently normal. The cardiovascular system shows
these drugs have stopped bringing him no marked changes. The liver is +3 cm.
relief. He is undereating, a lymph node Make the right diagnosis:
can be palpated in his left supraclavicular
fossa. The liver is not enlarged. Make the A. Esophageal cancer
right diagnosis: B. Diaphragmatic hernia
C. Myasthenia
A. Gastric carcinoma D. Esophageal achalasia
B. Esophageal tumor E. Diffuse esophageal narrowing
C. Diaphragmatic hernia
D. Gastric ulcer 106. A girl was born with the weight of
E. Pylorostenosis 3250 g and the body length of 52 cm. At
the age of 1.5 months, the child’s actual
103. For the last 2 months, a 29-year-old body weight is sufficient (4350 g) and the
woman has been complaining of chest pain psychophysical development corresponds
on the left, cough, shortness of breath, with the child’s age. The child is on
and fever of 39.6o C. The left half of her breastfeeding. Periodical regurgitation is
chest lags behind in the act of breathing, observed. What may cause regurgitation in
her vesicular respiration is weakened, and this child?
there is a shortening of the percussion
sound on the left. X-ray has shown a round A. Aerophagia
shadow in the lower lobe of the left lung. B. Pylorostenosis
Make the right diagnosis: C. Esophageal atresia
D. Acute gastroenteritis
E. Pylorospasm
107. A 12-year-old girl took two aspirin
 922521I1 16

tablets. 4 hours later her body temperature are 220 units. How this condition can be
increased to 39–40o C. She is complaining interpreted?
of general indisposition, dizziness, and
spontaneous development of red spots A. Development of chronic hepatitis
and blisters on her skin. The skin lesions B. Biliary dyskinesia
resemble burns of the second degree, C. Development of hepatic cirrhosis
in some places there are erosions or D. Residual effects of hepatitis B
exfoliation of the epidermis. The Nikolsky E. Recurrence of viral hepatitis B
sign is positive. Make the right diagnosis:
111. A 78-year-old woman complains of
A. Acute epidermal necrolysis lumbar pain. The pain increases during
B. Pemphigus vulgaris movements, decreases at rest, and does not
C. Bullous dermatitis irradiate to other areas. Her temperature
D. Erythema multiforme exudativum is normal, the body weight remains
E. Duhring dermatitis herpetiformis unchanged. Her peripheral joints are
normal, she has moderate obesity, the
108. On the fifth day after a full-term mobility of the lumbar spine is limited. A
birth, a postparturient woman developed local tension is observed in the soft tissues
a fever of 38.8o C, abdominal pain, and over the L2 vertebra. In the blood: Hb –
general weakness. Her blood pressure 147 g/L, leukocytes – 8.8 · 109 /L, platelets –
is 120/80 mm Hg, pulse is 100/min. The 222 · 109 /L, ESR – 5 mm/hour, Na+ – 140
breasts are moderately distended. The mmol/L, K + – 4.2 mmol/L, Ca2+ – 2.35
abdomen is soft and participates in the mmol/L. Make the right diagnosis:
act of breathing. The uterine fundus is
located three finger-widths below the A. Osteoporosis with a pathological
navel. Vaginal examination shows that fracture
the cervix allows inserting one finger; B. Amyloidosis
the uterus is soft, painful, and enlarged C. Secondary hyperparathyroidism
to 13 weeks of pregnancy. There is a D. Sciatica
seropurulent foul-smelling discharge from E. Multiple myeloma
the genital tracts. Make the right diagnosis:
112. A 39-year-old patient undergoes
A. Postpartum purulent metroendometritis treatment in the surgical department for
B. Lactostasis acute cholecystitis. He was transferred to
C. Uterine subinvolution the therapy department due to an increase
D. Septic shock in blood pressure to 180/120 mm Hg,
E. Postpartum endometritis protein excretion with urine, and persistent
fever. This persistent subfebrile body
109. A surgical department has received a temperature was resistant to antibiotic
boy on the first day of his life. He produces therapy. 10 days after the treatment,
a foaming discharge from his nose and the patient had an asphyxia attack with
mouth and has cyanosis attacks. X-ray difficult expiration. Later, he developed
has shown the esophagus that ends in arthralgias and erythematous skin lesions.
a blind-ended pouch at the level of the Eosinophil levels in the blood are 18%.
Th2 vertebra and the gastric air bubble What disease might be suspected in this
that is located under the left dome of the patient?
diaphragm. Make the right diagnosis:
A. Polyarteritis nodosa
A. Esophageal atresia, tracheoesophageal B. Nonspecific aortoarteritis
fistula C. Hemorrhagic vasculitis
B. Bronchoesophageal fistula (Henoch-Schoenlein purpura)
C. Paraesophageal hernia of the esophageal D. Systemic lupus erythematosus
hiatus of the diaphragm E. Acute glomerulonephritis
D. Total esophageal atresia
E. Esophageal atresia without fistula 113. A 74-year-old man has been suffering
from benign prostate hyperplasia for the
110. One year ago an 8-year-old boy had a last 5 years. 4 days ago, after drinking
case of hepatitis B. For the last two months alcohol, an acute urinary retention
he has been complaining of fatigability, occurred. At the prehospital stage, his
disturbed sleep, loss of appetite, and bladder was catheterized with a metallic
nausea, especially in the morning. His catheter twice a day. The examination
skin is not icteric, the liver and spleen has shown enlarged, dense, and painful
are painless and can be palpated 1 cm epididymis of the right testicle. There is
below the costal margin. His ALT levels
 922521I1 17

purulent discharge from the urethra. What 117. Medical examination of the
kind of emergency aid must be provided in population has revealed and registered
this case? chronic diseases, various pathological
conditions, and abmormalities. What type
A. Trocar or open epicystostomy of morbidity is being studied in this case?
B. Transurethral resection or prostatectomy
C. Transurethral microwave thermotherapy A. Pathological morbidity
of the prostate B. Primary morbidity
D. Installation of a permanent urethral C. Morbidity with temporary disability
catheter D. Prevalence of the disease
E. Installation of an intraprostatic stent E. General morbidity
114. The people living in a radiation- 118. A man has developed acute chills,
contaminated area were recommended to headache, vomiting, and fever of 38.5o C.
include pectin in their diet for removal In the evening, nuchal rigidity and positive
of radionuclides from the body. What Kernig’s sign has appeared. Herpetic
products can be the main source of pectin? blisters are visible on the mucosa of his
lips and nose. No focal neurological signs
A. Vegetables and fruits were detected. Make the right diagnosis:
B. Milk
C. Meat A. Meningococcal meningitis
D. Pasta B. Herpesviral encephalitis
E. Bread C. Brain abscess
D. Brain hemorrhage
115. A 25-year-old woman is complaining E. Subarachnoid hemorrhage
of fever of 37o C, pain in her lower
abdomen, and vaginal discharge. Three 119. A 60-year-old woman is complaining
days ago, at 10 weeks of pregnancy, of pain in the interphalangeal joints of
an artificial abortion was performed. her hands that exacerbates during work.
The cervix is clean, the uterus is The distal and proximal joints of her
slightly enlarged and painful. The fingers II-IV are defigured, painful, have
uterine appendages cannot be detected. Heberden and Bouchard nodes, and their
The fornices are deep and painless. mobility is limited. X-ray of the joints has
Sanguinopurulent discharge is being shown narrowed joint spaces, marginal
produced from the vagina. Make the right osteophytes, and subchondral sclerosis.
diagnosis: Make the right diagnosis:
A. Postabortion metroendometritis A. Osteoarthrosis deformans, nodular form
B. Uterine perforation after an abortion B. Psoriatic arthritis
C. Pelvioperitonitis C. Bekhterev disease (ankylosing
D. Parametritis spondylitis)
E. Hematometra D. Reiter disease (reactive arthritis)
E. Rheumatic arthritis
116. A 72-year-old woman has been
hospitalized with a nosebleed. Within the 120. A 19-year-old young man was
last 6 years, her blood pressure had spikes admitted to the surgical inpatient
up to 180/100 mm Hg. Her skin is pale, department with a closed abdominal
the heart sounds are quite sonorous, the injury. During the surgery, multiple
second heart sound is accentuated over ruptures of the spleen and small intestine
the aorta, there is an audible systolic were detected. The patient’s blood
murmur. Blood pressure – 150/80 mm Hg. pressure is progressively decreasing.
In the blood: Hb – 92 g/L, erythrocytes – Blood transfusion is required. Who can
2.7 · 1012 /L. In the urine: specific gravity – determine the patient’s blood type and
1022, leukocytes – 3–7 in the vision field, rhesus factor?
erythrocytes – 0–2 in the vision field. What
is most likely the cause of hypertension in A. Doctor of any specialty
this case? B. Traumatologist
C. Anesthesiologist
A. Aortic atherosclerosis D. Surgeon
B. Chronic pyelonephritis E. Medical laboratory scientist
C. Coarctation of the aorta
D. Chronic glomerulonephritis 121. A 2-month-old boy was born with
E. Essential hypertension body weight of 5100 g. The baby has
jaundice, hoarse cry, umbilical hernia, and
 922521I1 18

a delay in physical development. The liver doctor. Two days ago she first developed
is +2 cm, the spleen is not enlarged. The moderate bloody discharge from her
umbilical cord separation was delayed genital tracts. Her secondary sexual
in the baby. In the blood: Hb – 120 characteristics are developed. What is most
g/L, erythrocytes – 4.5 · 1012 /L, ESR – likely the cause of the bloody discharge in
3 mm/hour. Total serum bilirubin – 28 this case?
mcmol/L, indirect bilirubin – 20 mcmol/L,
direct bilirubin – 8 mcmol/L. What disease A. Menarche
is suspected first? B. Hemophilia
C. Endometrial cancer
A. Congenital hypothyroidism D. Werlhof’s disease
B. Cytomegalovirus infection E. Juvenile bleeding
C. Hemolytic anemia
D. Congenital hepatitis 125. For 2 hours after giving birth, the
E. Conjugated jaundice condition of the mother remains stable.
Her uterus is dense and spherical, its
122. A 31-year-old woman has complains floor is at the level of the navel, there
of pain and swelling in her radiocarpal is no bleeding. The clamp applied to
and metacarpophalangeal joints and the umbilical cord remains at the same
morning stiffness for up to 1.5 hours. level. When the woman is taking a deep
These signs have been observed for breath and the edge of the palm is pressed
the last 3 years. Two weeks ago she over her symphysis, the umbilical cord
developed pain, swelling, and redness retracts into the vagina. There is no bloody
in her knee joints and fever of 37.5o C. discharge from the genital tracts. What are
The examination of her internal organs the doctor’s next tactics?
shows no pathological changes. She was
diagnosed with rheumatoid arthritis. What A. Remove the placenta manually
changes will most likely be visible on the B. Administer oxytocin intravenously
X-ray scan of her joints? C. Apply the Abuladze technique
D. Perform the Crede-Lazarevich maneuver
A. Narrowing of the joint space, usuras E. Perform the uterine curettage
(bone lesions)
B. Multiple marginal osteophytes 126. A 28-year-old man had an acute
C. Cysts in the subchondral bone onset of the disease. He began feeling too
D. Osteolysis of the epiphyses hot and developed chills, fever of 38.5o C,
E. Narrowing of the joint space, tenesmus, paroxysmal pain in his left iliac
subchondral osteosclerosis region, and frequent liquid stools with
blood and mucus. Abdominal palpation
123. A 7-year-old boy suddenly developed is painful on the left, the sigmoid colon is
pain and edema in the right knee. The spastic. Make the right diagnosis:
day before, at school, he took part in
cross-country skiing. There is no family A. Dysentery
history of hemophilia or susceptibility to B. Amoebiasis
bleeding. His body temperature is 37.5o C. C. Nonspecific ulcerative colitis
The knee is painful on palpation, hot to D. Malignant tumors of the large intestine
the touch, and has edema with local tissue E. Escherichia coli infection
tension above it. In the blood: Hb – 123 127. A 54-year-old man was hospitalized
g/L, leukocytes – 5.6 · 109 /L, platelets – with complaints of a sudden severe
354 · 109 /L, prothrombin time – 12 seconds headache in the back of the head and
(normal range is 10–15 seconds), activated vomiting. He has a history of moderate
partial thromboplastin time – 72 seconds hypertension and takes hypothiazide.
(normal range is 35–45 seconds). Bleeding Three days ago he came to a therapist,
time is normal, the factor VIII levels complaining of an intense headache,
constitute 5% of normal value. Make the which was relieved with an analgesic.
right diagnosis: His consciousness is clouded and his left
pupil is dilated. He presents with marked
A. Hemophilia A photophobia, tense neck muscles, and left-
B. Hemophilia B sided hemiparesis with increased muscle
C. Thrombocytopenia tone and reflexes. His temperature is low.
D. Vitamin K deficiency No rash is observed in the patient. His
E. Henoch-Schoenlein purpura blood pressure is 230/130 mm Hg, pulse
– 50/min., respiratory rate – 12/min. Make
124. A 13-year-old girl came to a school the right diagnosis:
 922521I1 19

indicated in this case?

A. Acute subdural hematoma
B. Myasthenia A. Washed erythrocytes
C. Acute bacterial meningitis B. Fresh citrated blood
D. Multiple sclerosis C. Erythrocyte mixture
E. Migraine D. Leukoreduced and platelet-depleted
packed erythrocytes
128. A 25-year-old woman at 34 weeks of E. Packed erythrocytes (native)
pregnancy was hospitalized in a critical
condition into the maternity clinic. She has 132. A 74-year-old woman complains
complains of headache, vision impairment, of painful and distended abdomen and
and nausea. She has edemas, her blood nausea. She suffers from postinfarction
pressure is 170/130 mm Hg. Suddenly, and atherosclerotic cardiosclerosis and
the woman developed fibrillar twitching ischemic heart disease. She is in a severe
of her facial muscles, tonic and clonic condition, her abdomen is distended, the
seizures, and respiratory arrest. One and abdominal wall is barely involved in the act
a half minutes later her breathing resumed of breathing. Laparoscopy detected a small
and blood-tinged foam appeared from her amount of turbid exudate in the abdominal
mouth. Her urinary protein levels are 3.5 cavity, one of the small intestine loops is
g/L. Make the right diagnosis: dark blue. Make the right diagnosis:
A. Eclampsia A. Mesenteric thrombosis
B. Brain hemorrhage B. Ischemic abdominal syndrome
C. Gastric ulcer C. Acute intestinal obstruction
D. Epilepsy D. Volvulus
E. Brain edema E. Erysipelas
129. During the study of pulmonary 133. It was determined that in a group
tuberculosis morbidity, the data on socio- of 100 births, given women with risk
economic living conditions and harmful factors, there were 30 premature births,
habits of the patients were obtained. while among the 100 births, given by
What methods allow the assessment of the women without risk factors, there were
extent to which these factors influence the 5 premature births. What method of
tuberculosis morbidity? statistical data processing is optimal, if a
physician needs to assess the validity of
A. Calculation of the correlation coefficient such differences in compared groups?
B. Calculation of the confidence coefficient
C. Calculation of the agreement coefficient A. Student’s t-test
D. Calculation of the regression coefficient B. Correlation analysis
E. Calculation of standardized indicators C. Calculation of average values
D. Calculation of relative values
130. A 2-month-old girl was being E. Standardization
transferred to formula feeding. She was
born with the body weight of 3500 g. Now, 134. For the last 3 days a 2-year-old
her body weight is 3900 g. What is the girl has been presenting with fever of
normal daily volume of feeding for this 38.0o C, runny nose, dry cough, inertness,
baby? and appetite loss. Percussion sound has a
bandbox resonance. Auscultation detects
A. 650 mL puerile breathing without wheezing. In the
B. 750 mL blood there are leukopenia, lymphocytosis,
C. 690 mL and accelerated ESR. Make the right
D. 600 mL diagnosis:
E. 730 mL
A. Acute tracheitis
131. A 33-year-old man was hospitalized B. Acute obstructive bronchitis
with a recurrent ulcer bleeding that was C. Recurrent bronchitis, exacerbation
stopped. During the examination he is phase
exhausted and pale. Blood test shows Hb D. Acute bronchitis
of 77 g/L and Ht that equals 0.25. Due E. Bilateral microfocal pneumonia
to anemia, there were two attempts to
transfuse him with the blood of his group 135. A 25-year-old man has complains of
– A(II) Rh(+). Both transfusions must be weakness, progressive shortness of breath,
stopped because of anaphylactic reaction and leg edemas. Previously, he was healthy,
development. What transfusion medium is but recently he has been taking ibuprofen
 922521I1 20

for his sprained ankle ligaments. His pulse A. Pulmonary infarction

is 90/min., blood pressure is 180/100 mm B. Pneumonia
Hg. The heart sounds are sonorous. In the C. Pulmonary abscess
lungs, the percussion sound is dull in the D. Pneumothorax
lower right segment. The liver is +3 cm. E. Exudative pleurisy
In the blood: Hb – 103 g/L, leukocytes –
6.7·109/L, platelets – 236·109/L, urea – 24.6 139. Throughout the last year a 27-year-
old man notes fatigue, excessive sweating,
mmol/L, creatinine – 0.254 mcmol/L, Na+ and heaviness in his left subcostal region,
– 135 mmol/L, K + – 5.6 mmol/L, albumin especially after eating. His spleen and liver
– 27 g/L. Chest X-ray has shown right- are enlarged. Blood test: erythrocytes –
sided pleurisy, the heart is normal. What
pathological condition is observed in the 3.2 · 1012 /L, Hb – 100 g/L, color index –
patient? 0.87, leukocytes – 100 · 109 /L, basophils
– 7%, eosinophils – 5%, monocytes –
A. Nephrotic syndrome 15%, juvenile – 16%, band neutrophils
B. Nephritic syndrome – 10%, segmented neutrophils – 45%,
C. Renal tuberculosis lymphocytes – 2%, monocytes – 0%,
D. Acute pyelonephritis reticulocytes – 0.3%, platelets – 400 ·
E. Acute renal failure 109 /L, ESR – 25 mm/hour. Make the right
diagnosis:
136. A mother of a 5-year-old girl has
complains of nocturnal incontinence in her A. Chronic myelogenous leukemia
child, night terrors, disturbed sleep, and B. Acute leukemia
low weight gain. The girl is undereating, C. Chronic lymphocytic leukemia
intellectually well developed, can read, D. Erythremia (polycythemia vera)
explains life situations as an adult. Her skin E. Hepatic cirrhosis
is pale, the liver is enlarged. The mother
suffers from cholelithiasis. What type of 140. A 66-year-old man has complains of
diathesis is most likely the child has? marked weakness. The onset of the disease
was acute: he developed fever and pain
A. Neuroarthritic diathesis in the joints and along the muscles of his
B. Exudative-catarrhal diathesis legs. He has a violet-cyanotic erythema
C. Uric acid diathesis around his eyes and over the knee joints.
D. Lymphatic-hypoplastic diathesis His heart rate is 120/min., heart sounds
E. Allergic diathesis are weakened. Blood test: leukocytes –
12 · 109 /L, ESR – 40 mm/hour. Make the
137. A 42-year-old woman is suffering from right diagnosis:
micronodular cryptogenic cirrhosis of the
liver. During the last week, her condition A. Dermatomyositis
has been deteriorating she developed B. Reactive polyarthritis
seizures and clouded consciousness, her C. Rheumatoid arthritis
jaundice intensified. What test can help D. Systemic lupus erythematosus
find the cause of deterioration in this E. Atopic dermatitis
patient’s condition?
141. A 22-year-old young woman has
A. Serum ammonia levels complains of an aching pain in her right
B. Cholesterol ethers iliac region throughout the last week,
C. Alkaline phosphatase levels morning sickness, and taste distortions.
D. α-fetoprotein levels Her menstruation is delayed for 3 weeks
E. ALT and AST levels already. Her blood pressure is 110/70
mm Hg, pulse – 78/min., to – 37.0o C.
138. On the 4th day after a surgery for Bimanual examination shows that her
a cystoma in the right ovary, a woman uterus is slightly enlarged, soft, mobile,
suddenly developed a fever of 37.7o C and a and painless. Palpation of the uterine
chest pain on the right with expectoration appendages detects on the right a painful
of pink sputum. Examination of the lungs and moderately mobile dense-elastic
has revealed a dull pulmonary sound and formation 3x4 cm in size. Make the right
isolated wet crackles in the lower right diagnosis:
segments. What complication is most likely
developed in this patient?
 922521I1 21

A. Progressing tubal pregnancy A. Ruptured varicose veins in the

B. Cyst of the right ovary esophagus
C. Acute appendicitis B. Esophageal achalasia
D. Interrupted tubal pregnancy C. Mallory-Weiss syndrome
E. Uterine pregnancy D. Budd-Chiari syndrome
E. Peptic ulcer disease of the duodenum
142. For the past 6 years a 37-year-old
woman has been experiencing frequent 145. A 63-year-old woman has undergone a
nosebleeds, severe metrorrhagias, and surgery for a large multinodular euthyroid
periodic bruising on her skin. 12 days ago, goiter. Subtotal resection of the both lobes
after a severe nosebleed, her weakness of the thyroid gland had to be performed,
intensified, she developed dizziness and which was done with technical difficulties.
palpitations. Her skin is pale, there On the 4th day after the surgery, the
are multiple petechiae and isolated woman developed abdominal pain and
ecchymoses on the anterior surface of her muscle spasms in her face and arms.
torso, legs, and arms. In the blood: Hb – The Chvostek and Trousseau signs were
80 g/L, erythrocytes – 4.0 · 1012 /L, color positive. What is the most likely the cause
index – 0.7; leukocytes – 5.3 · 109 /L; band of the patient’s condition?
neutrophils – 2%, segmented neutrophils
– 65%, eosinophils – 2%, lymphocytes – A. Hypoparathyroidism
24%, monocytes – 5%, platelets – 10 · B. Thyrotoxic crisis
C. Tracheomalacia
109 /L, ESR – 15 mm/hour. Make the right D. Damage to the recurrent nerve
diagnosis: E. Postoperative hypothyroidism
A. Idiopathic thrombocytopenic purpura 146. A 3-year-old child has a cough and
B. Hemophilia runny nose. Two other family members
C. Hemorrhagic vasculitis have the same signs. On the third
D. Aplastic anemia day after the onset of the disease, the
E. Iron deficiency anemia cough intensified and became dry and
143. A patient in a state of clinical death persistent. The temperature increased to
receives closed-chest cardiac massage 37.8o C. The act of breathing involves the
and mouth-to-mouth artificial pulmonary auxiliary muscles. Percussion produces a
ventilation. The doctor noticed that the air banbox resonance bilaterally in the lungs.
does not enter the patient’s airways, and Breathing is harsh, expiration is prolonged,
his head and torso are at the same level. there are moderate and large bubbling
Why is the artificial pulmonary ventilation wheezes. The wheezes are diffuse and
ineffective in this case? mostly wet, though in some places they
are dry. Make the right diagnosis:
A. Swallowed tongue
B. Closed-chest cardiac massage A. Acute obstructive bronchitis
C. The volume of inhaled air is too low B. Acute bronchiolitis
D. The patient’s mouth is too small C. Bilateral bronchopneumonia
E. No gastric tube D. Stenosing laryngotracheitis
E. Bronchial asthma
144. A 54-year-old patient, a heavy drinker,
who 4 years ago had a case of viral hepatitis 147. A 35-year-old man has complains
B, has been experiencing heartburn and a of a chest pain that persists for several
burning pain retrosternal for the past two months already and an occasionally
months. In the morning, after eating and observed bitter taste in his mouth. The
lifting a heavy object, he had an episode of pain is localized behind the sternum,
vomiting with fresh dark blood. His skin occurs at rest, and sometimes irradiates
is pale and moist, pulse – 92/min., blood into the neck. It doesn’t intensify during
pressure – 90/60 mm Hg. His sclerae are physical exertion, but may intensify after
icteric. His abdomen is enlarged due to drinking alcohol or eating a large meal.
ascites and hepatosplenomegaly. What is At night, this condition becomes worse.
the most likely cause of bleeding in this Swallowing is not disturbed. The body
case? weight is increased. Examination detected
no changes. Make the right diagnosis:
 922521I1 22

A. Gastroesophageal reflux disease a tingling sensation in the tongue and

B. Esophageal achalasia oral mucosa, numbness of the limbs,
C. Globus hystericus decreased reflexes, respiratory disorders,
D. Esophageal tumor and arrhythmia. What are the causes of
E. Diaphragmatic hernia these signs?
148. A 35-year-old patient for the last 3 A. Hyperkalemia
years is on hemodialysis due to chronic B. Hyponatremia
glomerulonephritis. He developed cardiac C. Alkalosis
irregularities, hypotension, progressing D. Hyperazotemia
weakness, and dyspnea. ECG has shown E. Acidosis
bradycardia, first-degree atrioventricular
block, and tall and sharp T waves. The day 150. A child with chronic carditis,
before, he had a gross violation of drinking heart failure class IIA, who was being
and dietary regimes. What biochemical treated with digoxin, developed increasing
changes are most likely the cause of the bradycardia, nausea, vomiting, dizziness,
described clinical presentation? and disturbed sleep. ECG has shown an
extrasystole, PQ is 0.18. What is most likely
A. Hyperkalemia the cause of this condition?
B. Hypokalemia
C. Hypernatremia A. Overdose or intolerance of cardiac
D. Hypocalcemia glycosides
E. Hyperhydration B. Acute intestinal infection
C. Hypokalemia
149. At the oligoanuric stage of acute renal D. First-degree atrioventricular block
failure, a 10-year-old child has developed E. Pulmonary edema
 922521I1 23

Laboratory values
Complete blood count
Laboratory value Normal reference range
Male: 4.3 − 5.9 · 1012 /L
Erythrocyte count
Female: 3.5 − 5.5 · 1012 /L
Male: 135–175 g/L
Hemoglobin, blood
Female: 120–160 g/L
Color index 0.85–1.05
Reticulocyte count 0.5–1.5%
Platelet count 150 − 400 · 109 /L
Leukocyte 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%)
Band neutrophils 0.04 − 0.30 · 109 /L (1–6%)
Segmented neutrophils 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 sedimentation rate Male: 0–15 mm/h
(ESR) Female: 0–20 mm/h
Male: 41–53%
Hematocrit
Female: 36–46%
Biochemical blood analysis (Metabolic panel)
Total proteins 60–78 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%)
Immunoglobulins:
IgD 0–0.15 g/L
IgG 6.5–15 g/L
IgM 0.4–3.45 g/L
IgA 0.76–3.90 g/L
IgE 0–380 kU/L
Bilirubin:
Total 2–17 mcmol/L
Indirect (unconjugated) 2–17 mcmol/L
Direct (conjugated) 0–5 mcmol/L
Triglycerides 0.59–1.77 mmol/L
Total cholesterol 3.9–6.2 mmol/L
Lipoproteins:
high-density lipoproteins (β - <4.2 mmol/L
Lipoproteins)
low-density lipoproteins (α- 0.8–1.8 mmol/L
Lipoproteins)
Glucose, blood 3.3–6.1 mmol/L (fasting)
Glycated hemoglobin 6%
Iron, blood 9–30 mcmol/L
Potassium, plasma 3.5–5.0 mmol/L
 922521I1 24

Sodium, plasma 136–145 mmol/L

Calcium, plasma 0.75–2.5 mmol/L
Magnesium, plasma 0.75–1 mmol/L
Phosphorus (inorganic), serum 0.646–1.292 mmol/L
Chloride, blood 95–105 mmol/L
Urea, serum 3.33–8.32 mmol/L
Creatinine 53–106 mcmol/L
Male: 0.12–0.38 mcmol/L
Uric acid
Female: 0.12–0.46 mcmol/L
Lactate dehydrogenase (LDH) 45–90 U/L
α-Amylase (diastase), blood 25–125 U/L
Aspartate aminotransferase (AST) 15–40 U/L
Alanine aminotransferase (ALT) 10–40 U/L
Phosphatase (alkaline) 30–115 U/L
Coagulogram
Prothrombin time 80–100% (< 12 seconds)
Fibrinogen 2–4 g/L
Partial thromboplastin time (activated) < 28 seconds
Lee-White coagulation time 5–10 minutes
Bleeding time (Duke method) < 4 minutes
Acid-base balance
pH arterial blood 7.35–7.45
Pco2 arterial blood 33–45 mm Hg
Po2 arterial blood 75–105 mm Hg
Bicarbonate, blood (HCO3 ) 22–28 mmol/L
Other blood values
Cortisol, serum 230–750 nmol/L
Osmolality, serum 275–295 mOsmol/kg H2 O
Thyroid-stimulating hormone, serum or 0.5–5 mIU/L
plasma
Thyroxine (T4), serum 65–155 nmol/L
Triiodothyronine (T3), serum 1.77–2.43 nmol/L
Male: 15–200 mcg/L
Ferritin, serum
Female: 12–150 mcg/L
Thymol turbidity test <5U
C-reactive protein (CRP) <6 mg/dL
Antistreptolysin 0 (ASL0) 250 U
Antistreptohyaluronidase (ASH) 250 U
Urine
Urine specific gravity 1.016–1.022
Nechiporenko’s test:
leukocytes < 2 · 106 /л
erythrocytes < 1 · 106 /л
Proteins, total <45.0–75.0 mg/24 h (<0.033 g/L)
Calcium 2.5–7.5 mmol/24 h
Male: 97–137 mL/min
Creatinine clearance
Female: 88–128 mL/min
Oxalate 90–445 mcmol/L
17-Ketosteroids Male: 27.7–79.7 mcmol/24 h
(17-KS) Female: 17.4–55.4 mcmol/24 h
17-Hydroxycorticosteroids (17-OCS) 5.5–27.6 mcmol/24 h
α-Amylase (diastase), urine 28–160 U/L