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Mouli Thurusampalayam

КРОК / KROK
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Quiz navigation Started on Wednesday, 7 June 2023, 2:51 PM

1 2 3 4 5 State Finished
Completed on Wednesday, 7 June 2023, 2:52 PM
6 7 8 9 10 Time taken 23 secs
Marks 0.00/150.00
11 12 13 14 15 Grade 0.00 out of 100.00

16 17 18 19 20 Question 1 An 18-year-old young man complains of pain in his

Not answered knee and elbow joints and body temperature up to
21 22 23 24 25 39.5°C. One week and a half earlier he developed
Marked out of
1.00 sore throat. On examination his body temperature
26 27 28 29 30 Flag is 38.5°C. Swelling of the knee and elbow joints is
question observed. Pulse is 106/min., rhythmic. Blood
31 32 33 34 35 pressure is 90/60 mm Hg. Cardiac borders are
unchanged, heart sounds are weakened, at the
36 37 38 39 40 cardiac apex there is a soft systolic murmur. What
factor would be the most indicative of the likely
41 42 43 44 45 disease etiology?

46 47 48 49 50 a. Rheumatoid factor

b. C-reactive protein
51 52 53 54 55
c. Seromucoid
56 57 58 59 60 d. Creatine kinase

61 62 63 64 65 e. Anti-streptolysin O

66 67 68 69 70
The correct answer is: Anti-streptolysin O
71 72 73 74 75

76 77 78 79 80 Question 2 An 18-year-old woman complains of pain in her

Not answered lower abdomen, profuse purulent discharge from
81 82 83 84 85
Marked out of the vagina, temperature rise up to 37,8°C.
1.00 Anamnesis states that she had a random sexual
86 87 88 89 90
Flag contact the day before the signs appeared. She
question was diagnosed with acute bilateral adnexitis. On
91 92 93 94 95 additional examination: leukocytes are present
throughout all vision field, bacteria, diplococci
96 97 98 99 100 with intracellular and extracellular position. What
is the most likely agent in the given case?
101 102 103 104 105
a. Chlamydia trachomatis
106 107 108 109 110
b. Staphylococcus aureus

111 112 113 114 115 c. Escherichia coli

d. Trichomona vaginalis
116 117 118 119 120
e. Neisseria gonorrhoeae
121 122 123 124 125

126 127 128 129 130 The correct answer is: Neisseria gonorrhoeae

131 132 133 134 135

Question 3 A woman complains of a severe pain in her throat

136 137 138 139 140
Not answered on the left, difficult swallowing and mouth
Marked out of opening, elevated body temperature, and general
141 142 143 144 145
1.00 malaise. The onset of the disease was 4 days ago
Flag after a case of tonsillitis. Examination detects a
146 147 148 149 150
question trismus of the masticatory muscles, the left tonsil
is displaced toward the midline, the anterior
Show one page at a time palatal arch is infiltrated and protruding. The
regional lymph nodes on the right are enlarged
Finish review
and painful on palpation. Make the diagnosis:

a. Infectious mononucleosis

b. Tonsillar tumor

c. Peritonsillar abscess

d. Acute pharyngitis

e. Lacunar tonsillitis

The correct answer is: Peritonsillar abscess

Question 4 A 32-year-old woman addressed a dermatologist

Not answered with complaints of slightly itching rashes in the
Marked out of mouth angles. She has been suffering from this
1.00 condition for 3 days. Objectively: there are
Flag isolated small phlyctenas and superficial erosions
question covered in honey-yellow scabs against the
background of slight hyperemia. Make the
diagnosis:

a. Dermatitis

b. Streptoderma

c. Herpes

d. Atopic cheilitis

e. Eczema

The correct answer is: Streptoderma

Question 5 A 44-year-old patient with postinfarction

Not answered cardiosclerosis presents with frequent heart rate
Marked out of disorders and lower extremity edema. Objectively:
1.00 Ps- 95/min., irregular, 10-12 extrasystoles per
Flag minute. BP- 135/90 mm Hg. The 1st heart sound
question at the apex is weakened. Pulmonary respiration is
rough. The liver is enlarged +2 cm. ECG: irregular
sinus rhythm, heart rate - 95/min., frequent
polytopic ventricular extrasystoles. What
antiarrhythmic drug is advisable in this case for
treatment and prevention of extrasystole?

a. Amiodarone

b. Mexiletine

c. Novocainamide (Procainamide)

d. Lidocaine

e. Quinidine

The correct answer is: Amiodarone

Question 6 A 39-year-old man suffers from chronic rheumatic

Not answered heart disease. He complains of dyspnea during
Marked out of physical exertion, cough with expectoration, and
1.00 palpitations. Ausculation detects intensified I heart
Flag sound and diastolic murmur; the sound of opening
question mitral valve can be auscultated at the cardiac
apex. The II heart sound is accentuated over the
pulmonary artery. The patient is cyanotic. X-ray
shows dilated pulmonary root and enlargement of
the right ventricle and left atrium. What is the
most likely diagnosis?

a. Aortic stenosis

b. Patent ductus arteriosus

c. Pulmonary artery stenosis

d. Mitral stenosis

e. Coarctation of the aorta

The correct answer is: Mitral stenosis

Question 7 A planner designs a heating system for a pre-

Not answered school educational establishment. The highest air
Marked out of temperature should be in the following room:
1.00

Flag a. Bedroom of a preschool group

question
b. Gymnasium

c. Bedroom of a nursery group

d. Common room of a preschool group

e. Game room of a nursery group

The correct answer is: Game room of a nursery

group

Question 8 A 73-year-old woman came to the family physician

Not answered for one of her regular follow-up examinations.
Marked out of Three months ago she was found to have type 2
1.00 diabetes mellitus. She was keeping to her diet and
Flag exercise plan and taking phytopreparations. On
question examination her fasting glucose was within the
range of 7.8-8.6 mmol/L, HbА1с - 7.9%. Height -
164 cm, weight - 83 kg. What blood glucose-
controlling medicine should she be prescribed
first in the course of her pharmacological therapy?

a. Gliclazide

b. Glimepiride

c. Glibenclamide

d. Metformin

e. Insulin

The correct answer is: Metformin

Question 9 A burn victim with flame burns of the IIIA-B and IV

Not answered degrees on his face, neck, and anterior surface of
Marked out of the thorax was brought into the admission room.
1.00 The hairs in his nostrils are burnt, his labial and
Flag glossal mucosa are gray-white. The voice is
question hoarse; respirations are frequent and shallow; the
patient has trumpet-like cough that produces
soot-streaked sputum. The signs of respiratory
failure were progressing, while the patient was
being transported into the intensive care unit.
What emergency care must be provided to this
patient?

a. Intubation of the trachea and mechanical

ventilation

b. Administration of respiratory analeptics

c. Inhalation of moisturized oxygen

d. Tracheostomy

e. Administration of bronchial spasmolytics

The correct answer is: Intubation of the trachea

and mechanical ventilation

Question 10 A man came to an urologist with complains of

Not answered painful urination, discharge from urethra. The
Marked out of patient has been suffering from this condition for
1.00 a week. Objectively: hyperemic urinary meatus,
Flag edema, purulent discharge. Microscopy of smears
question detected gram-negative bacteria. Specify the
diagnosis:

a. Chlamydial urethritis

b. Candidal urethritis

c. Trichomonas urethritis

d. Chronic gonorrhea

e. Acute gonorrheal urethritis

The correct answer is: Acute gonorrheal urethritis

Question 11 A 72-year-old man with pneumonia complains of

Not answered marked dyspnea, chest pain, severe cough with
Marked out of expectoration, t° is 39.5-40°C, no urination for the
1.00 last 24 hours. Objectively the patient is conscious.
Flag Respiratory rate is 36/min. Percussion sound is
question dull over the right lower pulmonary lobe; on
auscultation there is bronchial respiration and
numerous moist crackles. Blood pressure is 80/60
mm Hg. Heart rate is 120/min. Heart sounds are
muffled, there is tachycardia. What tactics should
the family doctor choose for the management of
this patient?

a. Hospitalization into the neurology unit

b. Hospitalization into the intensive care unit

c. Hospitalization into the pulmonology unit

d. Outpatient treatment

e. Treatment in the day patient facility

The correct answer is: Hospitalization into the

intensive care unit

Question 12 A 75-year-old man in a severe condition suffers

Not answered from dyspnea at rest, marked weakness, and
Marked out of arrhythmia. Abdominal aortic pulsation is
1.00 observed, further on there is a systolic murmur
Flag detected. Palpation reveals a volumetric formation
question in the mesogastrium. Blood pressure is 70/40 mm
Hg. There is no pulsation over the femoral
arteries. Oliguria is detected. Which diagnosis is
the correct one?

a. Pancreatic cyst

b. Dissecting aortic aneurysm

c. Acute cardiac aneurysm

d. Cardiosclerotic aneurysm

e. Acute pericarditis

The correct answer is: Dissecting aortic aneurysm

Question 13 A 45-year-old man with thrombophlebitis of the

Not answered deep veins in his legs suddenly after physical
Marked out of exertion developed sharp pain in his thorax on the
1.00 right, dyspnea, and hemoptysis. Objectively his
Flag condition is severe; he presents with
question acrocyanosis, shortening of pulmonary percussion
sound on the right, and weakened respiration.
Respiration is 30/min., blood pressure is 110/80
mm Hg. ECG shows sinus tachycardia, his heart
rate is 120/min., the electrical axis of the heart
deviates to the right, S$_I$-Q$_{III$. What is the
most likely diagnosis?

a. Spontaneous pneumothorax

b. Cancer of the right lung

c. Pulmonary embolism

d. Community-acquired right-sided \\
pneumonia

e. Right-sided exudative pleurisy

The correct answer is: Pulmonary embolism

Question 14 A 62-year-old man addresed a urologist with

Not answered complaints of frequent urination at night (5-6
Marked out of times per night), sensation of incomplete voiding
1.00 of the urinary bladder, pain in the lower abdomen,
Flag slow urination. Anamnesis: the II degree essential
question hypertension (peak BP is 160/100 mm Hg).
Current case: the II degree enlargement of the
prostate gland, PSA is 2,2 ng/ml. Select the drug
suitable for long-term therapy of the patient's
combined pathology:

a. Doxazosin

b. Captopril

c. Indapamide

d. Amlodipine

e. Propranolol

The correct answer is: Doxazosin

Question 15 A 48-year-old woman developed insomnia,

Not answered depressive mood, anxiety, fears and suicidal
Marked out of thoughts after the death of her husband that
1.00 occurred one month ago. During her stay in the
Flag hospital she speaks in a low voice, is depressed,
question anxious, avoids sleeping, refuses to eat. What
medications should be prescribed in this case?

a. Antidepressants

b. Antipsychotics

c. Anticonvulsants

d. Group B vitamins

e. Nootropics

The correct answer is: Antidepressants

Question 16 After overexposure to cold a 45-year-old woman

Not answered developed acute pain in her suprapubic and
Marked out of lumbar areas during urination, sharp pains at the
1.00 end of urination, false urges to urinate. Urine is
Flag turbid with blood streaks. The doctor suspects
question urinary tract infection. What results of laboratory
analysis would be the most indicative of such
infection?

a. Daily proteinuria under 3.0

b. Increased blood creatinine and blood urea

c. Daily proteinuria over 3.0

d. Gross hematuria

e. Leukocyturia, gross hematuria

The correct answer is: Leukocyturia, gross

hematuria

Question 17 A 65-year-old man was diagnosed with B₁₂-

Not answered deficient anemia and the treatment was
Marked out of prescribed. A week later control blood test was
1.00 performed. What would be the early indicator of
Flag the therapy effectiveness?
question

a. Megaloblastic hematopoiesis

b. Normoblastic hematopoiesis

c. Increased erythrocyte number

d. Increased hemoglobin level

e. Increased number of reticulocytes

The correct answer is: Increased number of

reticulocytes

Question 18 A 57-year-old patient complains of sensation of

Not answered dryness and pain during swallowing, frequent
Marked out of unbearable cough, the voice is hoarse. Disease
1.00 onset was abrupt. On laryngoscopy: laryngeal
Flag mucosa is hyperemic, vocal folds are swollen,
question laryngeal lumen contains viscous secretion. What
diagnosis is it?

a. Acute stenosing laryngotracheitis

b. Flegmonous laryngitis

c. Acute laryngitis

d. Laryngeal diphtheria

e. Bronchial asthma

The correct answer is: Acute laryngitis

Question 19 On ultrasound of the thyroid gland, a 47-year-old

Not answered woman presents with a hypoechoic node 1.6 cm in
Marked out of diameter with blurred margins and intranodular
1.00 hypervascularization. The doctor suspects thyroid
Flag carcinoma. What method should be used to verify
question the diagnosis?

a. Case monitoring

b. Determine TSH level in the blood

c. Thyroid scintigraphy

d. Positron emission tomography (PET)

e. Fine-needle aspiration biopsy

The correct answer is: Fine-needle aspiration

biopsy

Question 20 A 63-year-old man complains of unmotivated

Not answered weakness and pressing and bursting sensation in
Marked out of the left subcostal area. According to him, these
1.00 signs have been present for a year already.
Flag Previously he was healthy. He took part in
question containment measures during the accident at the
Chornobyl Nuclear Power Plant. Objectively: the
skin is pale, peripheral lymph nodes are not
enlarged, the liver is +3 cm, the spleen is +10 cm.
Complete blood count: erythrocytes -
$3.1\cdot10^{12$/L, Hb- 100 g/L, leukocytes -
$46\cdot10^9$/L, blasts - 2%, promyelocytes -
10%, myelocytes - 18%, band neutrophils - 27%,
segmented neutrophils - 10%, lymphocytes - 12%,
eosinophils - 6%, basocytes - 3%, monocytes -
2%, erythrocyte sedimentation rate - 20 mm/hour.
What is the most likely diagnosis?

a. Chronic lymphatic leukemia

b. Hemolytic anemia

c. Chronic myeloleukemia

d. Acute leukemia

e. Hepatic cirrhosis

The correct answer is: Chronic myeloleukemia

Question 21 A 32-year-old woman complains of general

Not answered weakness, low-grade fever persisting for 4
Marked out of months, lumbar pain, and dysuria. Anamnesis
1.00 includes frequent acute respiratory diseases,
Flag overexposure to cold, low-calorie diet, a case of
question pulmonary tuberculosis in childhood. Clinical urine
analysis: pH- 4.8, leukocyturia, hematuria.
Complete blood count: leukocytosis,
lymphocytosis, raised ESR. Urography concludes:
dilatation of renal pelvis and calyceal system of
both kidneys, foci of calcification in the projection
of right kidney parenchyma. What is the most
likely diagnosis?

a. Right renal cyst

b. Right renal carcinoma

c. Nephrotuberculosis

d. Chronic pyelonephritis

e. Acute glomerulonephritis

The correct answer is: Nephrotuberculosis

Question 22 A 5-year-old child has body temperature risen up

Not answered to febrile numbers, suffers from inertness,
Marked out of weakness. Examination revealed hemorrhage on
1.00 the skin of limbs and torso. Enlargement of
Flag cervical and axillary lymph nodes can be detected.
question The liver is 4 cm below the costal arch; the spleen
is 6 cm below the costal arch. Blood test:
erythrocytes - $2.3\cdot10^{12$/L, Hb- 60 g/L,
platelets - $40\cdot10^9$/L, leukocytes -
$32.8\cdot10^9$/L, eosinophiles - 1%, band
neutrophiles - 1%, segmented neutrophiles - 12%,
lymphocytes - 46%, monocytes - 1%, blasts -
40%, Duke's bleeding time test result is 9 min.
What examination is necessary to make the
diagnosis?

a. Lymph nodes biopsy

b. Abdominal US

c. Analysis of dynamic platelet function

d. Myelogram (bone marrow biopsy)

e. Detection of hepatitis markers

The correct answer is: Myelogram (bone marrow

biopsy)

Question 23 A 30-year-old man was delivered to a

Not answered neurosurgical department with complaints of
Marked out of constant headaches, nausea, vomiting, fever,
1.00 weakness of the right-side limbs. Anamnesis
Flag states that one month ago the patient had a
question surgery for left-sided suppurative otitis and
mastoiditis. He has been undergoing treatment in
an ENT department. Approximately 2 weeks ago
the temperature increased, and the patient
developed headaches. Objectively: heart rate -
98/min., BP- 140/90 mm Hg, temperature -
$38,3^oC$. Neurologically pronounced stiff neck:
bilateral Kernig's symptom, unsteadiness during
the Romberg's maneuver. Computer tomography
of the brain revealed a three-dimensional growth
with a capsule in the left hemisphere. Make the
diagnosis:

a. Hemorrhage

b. Arnold-Chiari malformation

c. Cerebral abscess

d. Hydrocephalus

e. Echinococcus

The correct answer is: Cerebral abscess

Question 24 A newborn has Apgar score of 9. When should

Not answered this infant be put to the breast?
Marked out of
1.00 a. After 2 hours
Flag
b. In the delivery room
question

c. On the 2nd day

d. After 12 hours

e. On the 3rd day

The correct answer is: In the delivery room

Question 25 A 42-year-old man was delivered to a surgical in-

Not answered patient department with complaints of icteric skin,
Marked out of pain in the right subcostal area. Biochemical blood
1.00 analysis: total bilirubin - 140 mcmol/l, direct
Flag bilirubin - 112 mcmol/l. On US: choledoch duct -
question 1,4 cm, a concrement is detected in the distal
area. Gallbladder is 40 cm, no concrements. What
treatment tactics should be chosen?

a. Laparotomy with choledoch duct drain

b. Laparotomy with cholecystectomy

c. Laparoscopic cholecystectomy

d. Threatment in an infectious diseases

hospital

e. Endoscopic papillosphincterotomy

The correct answer is: Endoscopic

papillosphincterotomy

Question 26 A 3-year-old girl is being treated at a resuscitation

Not answered unit with diagnosis ''acute kidney failure,
Marked out of oligoanuric stage''. ECG: high T wave, extended
1.00 QRS complex, displacement of S-T interval
Flag downwards below the isoline. What electrolyte
question imbalance is it?

a. Hyperphosphatemia

b. Hyperkalemia

c. Hypercalcemia

d. Hypokalemia

e. Hypocalcemia

The correct answer is: Hyperkalemia

Question 27 A prematurely born girl is now 8 months old. She

Not answered has dyspnea, tachycardia, hepatosplenomegaly,
Marked out of physical developmental lag, limb cyanosis. There
1.00 is parasternal cardiac hump, auscultation revealed
Flag systolodiastolic murmur in the II intercostal space
question on the left. BP is 90/0 mm Hg. What disease can
be suspected?
 a. Stenosis of aortal valve

b. Stenosis of pulmonary artery

c. Coarctation of aorta

d. Patent ductus arteriosus

e. Nonclosure of interventricular septum

The correct answer is: Patent ductus arteriosus

Question 28 During health assessment of car drivers and

Not answered police officers on point duty, the physicians
Marked out of detected carboxyhemoglobin in the blood of the
1.00 patients, weakened reflex responses, disturbed
Flag activity of a number of enzymes. Revealed
question professional health disorders are most likely to be
associated with the effect of:

a. Mental stress

b. Carbon monoxide

c. Aromatic hydrocarbons

d. Nitric oxide

e. Sulfurous anhydride

The correct answer is: Carbon monoxide

Question 29 Examination of a group of persons living on the

Not answered same territory revealed the following common
Marked out of symptoms: dark-yellow pigmentation of the tooth
1.00 enamel, diffuse osteoporosis of bone apparatus,
Flag ossification of ligaments and joints, functional
question disorders of the central nervous system. This
condition may be caused by the excessive
concentration of the following microelement in
food or drinking water:

a. Iodine

b. Fluorine

c. Cesium

d. Nickel

e. Copper

The correct answer is: Fluorine

Question 30 A 60-year-old man complains of discomfort when

Not answered swallowing solid food, which he has been
Marked out of observing for a month. He changed his diet to
1.00 semiliquid food products. At first the discomfort
Flag had abated but later it renewed despite the
question change in the diet. The patient developed gaseous
eructation and hoarse voice. What examination
should be performed to clarify the diagnosis?

a. Abdominal US

b. Diurnal variations of ECG parameters

c. Esophagoscopy with biopsy

d. Urea breath test for H. pylori

e. Esophageal pH monitoring

The correct answer is: Esophagoscopy with

biopsy

Question 31 A 37-year-old woman complains of acute pain in

Not answered the genital area, swelling of the labia, pain when
Marked out of walking. Objectively: body temperature is 38,7°C,
1.00 Ps- 98/min. In the interior of the right labia there is
Flag a dense, painful tumor-like formation 5,0x4,5 cm
question in size, the skin and mucous membrane of genitals
are hyperemic, there is profuse foul-smelling
discharge. What is the most likely diagnosis?

a. Bartholin gland cyst

b. Labial furuncle

c. Acute bartholinitis

d. Carcinoma of vulva

e. Acute vulvovaginitis

The correct answer is: Acute bartholinitis

Question 32 A 42-year-old man, a dispatcher, suffes from

Not answered peptic ulcer disease of the duodenum. The
Marked out of disease is of moderate severity. He wants to be
1.00 assigned a disability group. Make the conclusion
Flag regarding his working ability:
question

a. Third group of disability

b. First group of disability

c. Second group of disability

d. Capable of working, employable

e. Capable of working, non-employable

The correct answer is: Capable of working,

employable

Question 33 A woman with blood group B(III) Rh(+) gave birth

Not answered to a full-term healthy boy. Examination on the 3rd
Marked out of day of the infant's life shows him to have icteric
1.00 tint to his skin. The child has no problems with
Flag suckling, sleep is nondisturbed. The abdomen is
question soft, the liver protrudes by 2 cm from under the
costal margin. Complete blood count: hemoglobin
- 200 g/L, erythrocytes - $5.5\cdot10^{12$/L, total
bilirubin - 62 mcmol/L, indirect bilirubin - 52
mcmol/L. What condition can be suspected?

a. Biliary atresia

b. Hemolytic disease of the newborn due to

Rh incompatibility

c. Hemolytic disease of the newborn due to

ABO incompatibility

d. Physiologic jaundice

e. Congenital hepatitis

The correct answer is: Physiologic jaundice

Question 34 A 6-year-old child complains of frequent liquid

Not answered stool and vomiting. On the 2nd day of disease the
Marked out of child presented with inertness, temperature rise
1.00 up to $38,2^oC$, Ps- 150/min., scaphoid
Flag abdomen, palpatory painful sigmoid colon,
question defecation 10 times a day with liquid, scarce stool
with mucus and streaks of green. What is the
provisional diagnosis?

a. Escherichiosis

b. Shigellosis

c. Salmonellosis

d. Intestinal amebiasis

e. Yersiniosis

The correct answer is: Shigellosis

Question 35 The following indicators were calculated to

Not answered analyse population health and treatment quality in
Marked out of a cardiological hospital: primary cardiovascular
1.00 morbidity - 62%; total cardiovascular morbidity -
Flag 483,55%; cardiovascular mortality - 10,9%;
question proportion of cardiovascular mortality within total
mortality - 67,0%; primary disablement caused by
cardiovascular diseases - 16,2 per 10.000
population. What indicator is an extensive value?

a. Primary disablement caused by

cardiovascular diseases

b. Total cardiovascular morbidity

c. Primary cardiovascular morbidity

d. Cardiovascular mortality

e. Proportion of cardiovascular mortality

within total mortality

The correct answer is: Proportion of

cardiovascular mortality within total mortality

Question 36 For the last 15 years a 48-year-old patient has

Not answered been working at the factory producing synthetic
Marked out of resins. Lately he has been complaining of
1.00 significant general fatigue, headaches, frequent
Flag urination (predominantly during the day), red color
question of urine. What complication of benzene
nitrocompounds poisoning can be suspected?

a. Chronic pyelonephritis

b. Acute glomerulonephritis

c. Malignant tumor of the urinary bladder

d. Chronic prostatitis

e. Chronic cystitis

The correct answer is: Malignant tumor of the

urinary bladder

Question 37 A 35-year-old patient developed an epileptic

Not answered attack with tonoclonic spasms that lasted for 3
Marked out of minutes. After the attack the patient fell asleep
1.00 but in 5 minutes the second attack occurred. The
Flag first step of emergency aid would be to:
question

a. Ensure patency of airways

b. Take blood from the vein for analysis

c. Administer chloral hydrate via an enema

d. Prescribe antiepileptic drugs

e. Introduce diazepam intravenously

The correct answer is: Ensure patency of airways

Question 38 For 4 days a 35-year-old man has been treated in

Not answered the resuscitation unit for acute renal failure
Marked out of caused by compartment syndrome. The patient is
1.00 disoriented. ECG shows high T waves and right
Flag ventricular extrasystoles. His central venous
question pressure is 159 mmH₂O; for the last 3 hours
auscultation has been detecting isolated moist
crackles in the lungs. Respirations are 32/min.
Blood test: residual nitrogen - 62 mmol/L, K⁺ - 7.1
mmol/L, $Cl^-$ - 78 mmol/L, $Na^+$ - 120
mmol/L, Ht- 0.32 L/L, Hb- 100 g/L, blood
creatinine - 0.9 mmol/L. In this case the most
advisable would be to perform:

a. Hemosorption

b. Plasmafiltration

c. Hemodialysis

d. Plasmasorption

e. Ultrafiltration

The correct answer is: Hemodialysis

Question 39 hours after a trauma, a young man developed

Not answered bradycardia of 46/min., anisocoria D>S, hemi-
Marked out of hyperreflexia S>D, hemihypesthesia on the left,
1.00 and a convulsive disorder. The character of this
Flag process needs to be clarified. What method of
question examination will be the most accurate for this
purpose?

a. Echoencephalography

b. Skull X-ray

c. Head CT

d. Lumbar puncture

e. Electroencephalography

The correct answer is: Head CT

Question 40 A multigravida, labor II, 36-37 weeks of gestation,

Not answered has gone into labor. Her waters broke 8 hours ago,
Marked out of the labor activity continues for the last 4 hours, it
1.00 is regular, with contractions that last 35 seconds
Flag and occur every 3-4 minutes. The child is in the
question cephalic presentation, with the head pressed to
the entrance into the lesser pelvis. The parturient
woman complains of a sudden sharp abdominal
pain. Her pulse is 100/min., blood pressure is
110/70 - 100/70 mm Hg. The uterus is tense and
does not relax between the contractions. Fetal
heartbeat is muffled - 100/min. The amniotic fluid
is blood-colored and continues to leak. What is
the most likely diagnosis?

a. Cervical rupture

b. Uterine rupture

c. Rupture of the umbilical vessels

d. Partial placenta previa

e. Premature detachment of the normally

positioned placenta

The correct answer is: Premature detachment of

the normally positioned placenta

Question 41 A 58-year-old woman came to the gynecological

Not answered clinic. She complains of bloody discharge from her
Marked out of genital tracts. Menopause is 8 years.
1.00 Gynecological examination: the uterus is slightly
Flag enlarged, dense to touch, with limited mobility; the
question uterine appendages cannot be detected;
parametrium is free. Fractional curettage of the
uterine cavity yields a significant amount of
medullary substance in the scrape. What is the
most likely diagnosis?

a. Adenomyosis

b. Uterine cervix cancer

c. Hormone-producing ovarian tumor

d. Uterine corpus cancer

e. Chorioepithelioma

The correct answer is: Uterine corpus cancer

Question 42 A 39-year-old man suffers from chronic adrenal

Not answered insufficiency and receives replacement
Marked out of glucocorticoid therapy (hydrocortisone - 15
1.00 mg/day). He is to undergo elective surgery for
Flag calculous cholecystitis. What medication
question adjustment should be made on the day of the
surgery to prevent the development of acute
adrenal insufficiency?

a. Add antibiotic

b. Increase the dosage by 2-3 times

c. Add mineralocorticoid

d. Cancel the drug for the day of the surgery

e. Prescribe large volume intravenous fluid

infusion

The correct answer is: Increase the dosage by 2-3

times

Question 43 A 78-year-old man with a prostate adenoma

Not answered underwent a herniotomy for a direct inguinal
Marked out of hernia. After the surgery he presents with absent
1.00 urination. Enlarged urinary bladder is detectable
Flag above the patient's pubis. What measures should
question be taken in this case?

a. Bladder catheterization

b. Prescribe antispasmodics subcutaneously

c. Prescribe proserin (neostigmine)

intramuscularly

d. Apply cold to the urinary bladder area

e. Prescribe processing of the postoperative

wound with UHF field

The correct answer is: Bladder catheterization

Question 44 A 28-year-old woman has made an appointment

Not answered with the family doctor to receive vaccination
Marked out of against influenza. However, having collected the
1.00 patient's medical history, the doctor claimed this
Flag procedure to be absolutely contraindicated for
question this woman. What anamnestic data is the absolute
contraindication to vaccination?

a. Pregnancy at 30 weeks

b. Egg white intolerance

c. Psoriasis in the remission phase

d. Body temperature - 37.2°C

e. Blood hemoglobin - 109 g/L

The correct answer is: Egg white intolerance

Question 45 A 38-year-old woman developed a medical

Not answered condition 7 days after her return from Bangladesh.
Marked out of Periodical elevation of temperature was
1.00 accompanied by chills and excessive sweating.
Flag She was diagnosed with tropical malaria. Next day
question her condition further deteriorated: body
temperature - 38°C, inertness, periodical loss of
consciousness, generalized seizures, tachycardia,
hypotension, and icteric skin. What complication
can be suspected in this case?

a. Acute hepatic failure

b. Serous meningitis

c. Purulent meningitis

d. Cerebral coma

e. Acute heart failure

The correct answer is: Cerebral coma

Question 46 A 43-year-old man, who has been abusing alcohol

Not answered and suffering from pulmonary tuberculosis, in the
Marked out of course of two weeks gradually developed general
1.00 weakness, headache, diplopia, vomiting.
Flag Objectively: ptosis on the left, anisocoria S>D,
question exotropia of the left eye, neck stiffness; Kernig's
and Brudzinski's signs are positive. In
cerebrospinal fluid: lymphocytic pleocytosis, low
glucose, precipitation of cerebrospinal fluid
resulted in production of fibrin film. What is the
most likely diagnosis?

a. Acute myelitis

b. Basal arachnoiditis

c. Brainstem encephalitis

d. Tuberculous meningitis

e. Subarachnoid hemorrhage

The correct answer is: Tuberculous meningitis

Question 47 A 37-year-old man suffers from attacks of

Not answered unconsciousness, dyspnea during physical
Marked out of exertion, periodical sensations of heart rate
1.00 disorder. Father of the patient died suddenly at
Flag the age of 45. Objectively: heart rate is 90/min.,
question BP is 140/90 mm Hg. On heart US: ejection
fraction - 55%, significant myocardium thickening
of the left ventricle and interventricular septum.
What drug should be prescribed for the
treatment?

a. Bisoprolol

b. Phenyhydinum (Nifedipine)

c. Furosemide

d. Hydrochlorothiazide

e. Enalapril

The correct answer is: Bisoprolol

Question 48 The dermatologist has an appointment with a 30-

Not answered year-old man that complains of severely itching
Marked out of rashes that especially disturb him at night. The
1.00 rashes developed 2 weeks ago, after he had
Flag returned from a travel. Objectively on the lateral
question surfaces of his fingers, hands, wrists, elbows,
lower abdomen, genitals, and thighs there are
paired papulovesicles, single pustules, and
scratch marks. What disease can be suspected?

a. Eczema

b. Dermatitis

c. Pyoderma

d. Scabies

e. Shingles

The correct answer is: Scabies

Question 49 A 54-year-old patient complains of weakness,

Not answered jaundice, itching skin. Disease onset was 1.5
Marked out of months ago: fever up to $39^oC$ appeared at
1.00 first, with progressive jaundice developed 2 weeks
Flag later. On hospitalisation jaundice was severely
question progressed. Liver cannot be palpated. Gallbladder
is enlarged and painless. Blood bilirubin is 190
mcmol/L (accounting mainly for direct bilirubin).
Stool is acholic. What is the most likely reason for
jaundice in this patient?

a. Caroli syndrome

b. Gilbert's syndrome

c. Mechanical jaundice

d. Hepatocellular jaundice

e. Hemolytic jaundice

The correct answer is: Mechanical jaundice

Question 50 A 40-year-old female patient complains of having

Not answered a bulge on the anterior surface of neck for 5 years.
Marked out of Objectively: Ps- 72/min., arterial pressure - 110/70
1.00 mm Hg, in the right lobe of thyroid gland palpation
Flag reveals a mobile node 4x2 cm in size, the left lobe
question is not palpable, the basal metabolic rate is 6%.
What is the most likely diagnosis?

a. Median cervical cyst

b. Mixed euthyroid goiter

c. Riedel's thyroiditis

d. Nodular hyperthyroid goiter

e. Nodular euthyroid goiter

The correct answer is: Nodular euthyroid goiter

Question 51 On laboratory investigation of a pork sample there

Not answered is 1 dead trichinella detected in 24 sections. This
Marked out of meat should be:
1.00

Flag a. Frozen until the temperature of -10°C is

question reached in the deep layers, with
subsequent exposure to cold for 15 days

b. Allowed for sale with no restrictions

c. Processed and sold through public catering

network

d. Handed over for technical disposal

e. Processed for boiled sausage production

The correct answer is: Handed over for technical

disposal

Question 52 A 57-year-old patient complains of dyspnea at

Not answered rest. The patient presents with orthopnea,
Marked out of acrocyanosis, bulging cervical veins. On
1.00 percussion: dull sound over the lower lung
Flag segments. On auscultation: no respiratory sounds.
question Heart rate is 92/min. Right-sided cardiac dilatation
is observed. The liver is +7 cm. Shins are swollen.
Pleural effusion is suspected. What indicator
would confirm the presence of transudate in this
case?

a. Total protein content in the pleural fluid

exceeding 30 g/L

b. Positive Rivalta's test

c. Total protein content in the pleural fluid

below 25 g/L

d. Presence of atypical cells

e. Specific gravity exceeding 1015

The correct answer is: Total protein content in the

pleural fluid below 25 g/L

Question 53 A 7-year-old girl has been twice treated with

Not answered antibacterial agents for urinary tract infection. US
Marked out of shows no severe renal defects. The child presents
1.00 with recurrence of leukocyturia and bacteriuria,
Flag elevated body temperature up to 38.5°C, and pain
question in her left lumbar area. What examination should
be conducted first to clarify the cause of urinary
infection recurrence?

a. Excretory urography

b. Radioisotope renography

c. Micturating cystourethrography

d. Immunogram

e. Retrograde pyelography

The correct answer is: Micturating

cystourethrography

Question 54 What should be prescribed as secondary

Not answered prevention drugs for a patient with atrial fibrillation
Marked out of after an ischemic stroke caused by cardiac
1.00 embolism?
Flag
question a. Aspirin or clopidogrel

b. β-blockers

c. Oral anticoagulants

d. Nootropics

e. Calcium antagonists

The correct answer is: Oral anticoagulants

Question 55 A 45-year-old patient complains of pain in the

Not answered epigastric region, left subcostal area, abdominal
Marked out of distension, diarrhea, loss of weight. He has been
1.00 suffering from this condition for 5 years.
Flag Objectively: the tongue is moist with white coating
question near the root; deep palpation of abdomen reveals
slight pain in the epigastric region and Мауо-
Robson's point. Liver is painless and protrudes by
1 cm from the costal arch. Spleen cannot be
palpated. What disease can be primarily
suspected?

a. Chronic cholecystitis
 b. Chronic enteritis

c. Chronic pancreatitis

d. Peptic stomach ulcer

e. Atrophic gastritis

The correct answer is: Chronic pancreatitis

Question 56 A 55-year-old woman came to a gynecologist with

Not answered complaints of leukorrhea and bloody discharge
Marked out of from the vagina after 5 years of menopause.
1.00 Anamnesis states no pregnancies. Bimanual
Flag examination: the uterus and uterine appendages
question are without changes. During diagnostic curettage
of the uterine cavity the physician scraped off
enchephaloid matter. What is the most likely
diagnosis in this case?

a. Adenomyosis

b. Subserous uterine myoma

c. Cervical carcinoma

d. Ovarian carcinoma

e. Endometrial carcinoma

The correct answer is: Endometrial carcinoma

Question 57 An 18-year-old patient complains of skin rash. The

Not answered patient has been suffering from this condition for
Marked out of 5 years. The first instance of this disease occurred
1.00 after a car accident. Objectively: the patient
Flag presents with papular rash covered in silvery
question scales, ''thimble'' symptom (small pits on the
nails), affected joints. What is the most likely
diagnosis?

a. Psoriasis

b. Panaritium

c. Lupus erythematosus

d. Onychomycosis

e. Rheumatism

The correct answer is: Psoriasis

Question 58 Examination of a 43-year-old man objectively

Not answered revealed pallor of skin and mucous membranes,
Marked out of loss of tongue papillae, transverse striation of
1.00 fingernails, cracks in the mouth corners,
Flag tachycardia. Blood test results: Hb- 90 g/l,
question anisocytosis, poikilocytosis. The most likely
causative factor of this condition is the inadequate
intake of:

a. Copper

b. Selene

c. Zinc

d. Iron

e. Magnesium

The correct answer is: Iron

Question 59 After semolina was introduced into the diet, a 1-

Not answered year-old child for 2 months has been presenting
Marked out of with loss of appetite, irritability, loss of body mass,
1.00 and loss of previously learned skills. The feces are
Flag copious and foul-smelling. The skin is pale and
question dry, the hair is brittle. The abdomen is distended,
while the limbs are thin. Stool test shows high
levels of fatty acids. What is the most likely
diagnosis?

a. Mucoviscidosis

b. Lactase deficiency

c. Celiac disease

d. Irritable bowel syndrome

e. Functional diarrhea

The correct answer is: Celiac disease

Question 60 A woman with atopic bronchial asthma was found

Not answered to have one allergen to dog hair +++. Carpets
Marked out of were removed from the apartment, the apartment
1.00 was renovated, and air conditioner was installed.
Flag However, recurrent asphyxia attacks still occur
question every night, despite the patient undergoing
pathogenetic therapy. What long-term treatment
tactics can help this patient to decrease her
sensitivity to the allergen?

a. Specific hyposensitization

b. Referral for speleotherapy

c. Buteyko breathing technique

d. Antihistamine therapy

e. Continuation of prior treatment

The correct answer is: Specific hyposensitization

Question 61 A young man has made an appointment with the

Not answered dermatologist. He complains of a painful facial
Marked out of rash in the beard and mustache area. This
1.00 condition has been persisting for several weaks
Flag already. After shaving, the patient's condition
question aggravates. The diagnosis of sycosis is made.
What primary morphological elements can be
observed in the rash in this case?

a. Pustules, papulae

b. Phlyctenae, maculae

c. Nodes, nodules

d. Pustules, bumps

e. Maculae, nodes

The correct answer is: Pustules, papulae

Question 62 On the 9th day after childbirth the obstetric

Not answered patient developed high fever up to 38°C. She
Marked out of complains of pain in the right mammary gland. On
1.00 examination a sharply painful infiltrate can be
Flag palpated in the right mammary gland, the skin
question over the infiltrate is red, subareolar area and
nipple are swollen and painful. What is your
diagnosis?

a. Abscess of the right mammary gland

b. Fibrous cystic degeneration of the right

mammary gland

c. Mastopathy

d. Serous mastitis

e. Cancer of the right mammary gland

The correct answer is: Abscess of the right

mammary gland

Question 63 A 35-year-old patient undergoing treatment for

Not answered heart disorder in cardiological department has
Marked out of developed complaints of acute sudden pain in the
1.00 epigastrium, temperature rise up to $38,3^oC$.
Flag Blumberg's and Razdolsky's (abduction of femur)
question signs are positive. What necessitates surgical aid
in the given case?

a. Progress as a surgical disease

b. Severity of the concomitant pathology

c. Extent of congenital and acquired

development disorders

d. Activity of the heart disorder

e. Urgent aid is required to save the patient's

life

The correct answer is: Progress as a surgical

disease

Question 64 An unconscious patient was delivered to a hospital

Not answered by an ambulance. Objectively, his body
Marked out of temperature is 39°C, he presents with convulsions
1.00 and red dry skin. It is known that the patient works
Flag as a stoker in the boiler room. What is the likely
question diagnosis?

a. Hypertensive urgency

b. Acute viral respiratory infection

c. Acute food poisoning

d. $CO$ poisoning

e. Heat stroke

The correct answer is: Heat stroke

Question 65 A worker at a workshop that produces car

Not answered batteries came to a doctor with complaints of
Marked out of nausea, loss of appetite, sharp pain in the
1.00 abdominal cavity, and constipations. Examination
Flag reveals elevated blood pressure, bradycardia, an
question enlarged liver, pain in the right subcostal region, a
grayish-blue stripe on the gums, and gray skin.
Complete blood count indicates the presence of
erythrocytes with basophilic stippling and reduced
hemoglobin levels. Aminolevulinic acid and
coproporphyrin can be detected in the patient's
urine. What is the most likely provisional diagnosis
in this case?

a. Cadmium poisoning

b. Lead poisoning

c. Aluminum poisoning

d. Mercury poisoning

e. Food poisoning

The correct answer is: Lead poisoning

Question 66 A patient with signs of general overexposure to

Not answered cold presenting with local frostbites of fingers has
Marked out of been delivered into an admission room.
1.00 Objectively: conscious, inert, speech is slow, the
Flag skin of the face is cold, body temperature is 34°C,
question heart rate is 68/min. What would be the actions of
a doctor on call?

a. Refer to a family doctor on the next day

b. Let the patient go home

c. Hospitalize the patient to the surgical

department

d. Hospitalize the patient to the therapeutics

department

e. Hospitalize the patient to the traumatology

department

The correct answer is: Hospitalize the patient to

the surgical department

Question 67 A woman undergoing in-patient treatment for viral

Not answered hepatitis type B developed headache, nausea,
Marked out of recurrent vomiting, memory lapses, flapping
1.00 tremor of her hands, and rapid pulse. Sweet smell
Flag from her mouth is detected. Body temperature is
question 37.6°C, heart rate is 89/min. What complication
developed in the patient?

a. Gastrointestinal hemorrhage

b. Ischemic stroke

c. Acute liver failure

d. Hypoglycemic shock

e. Meningoencephalitis

The correct answer is: Acute liver failure

Question 68 A 35-year-old female patient has gained 20 kg

Not answered weight within a year with the normal diet. She
Marked out of complains of chill, sleepiness, dyspnea. The
1.00 patient's mother and sister are corpulent.
Flag Objectively: height - 160 cm, weight - 92 kg, BMI-
question 35,9. Obesity is uniform, there are no striae. The
face is amimic. The skin is dry. The tongue is
thickened. Heart sounds are muffled. Heart rate -
56/min., BP- 140/100 mm Hg. The patient has
constipations, amenorrhea for 5 months. TSH- 28
mkME/l (normal rate - 0,32-5). Craniogram shows
no pathology. What is the etiology of obesity in
this case?

a. Hypo-ovarian

b. Hypercorticoid

c. Hypothalamic-pituitary

d. Hypothyroid

e. Alimentary and constitutive

The correct answer is: Hypothyroid

Question 69 A 38-year-old patient complains of pain in the

Not answered area of the metatarsophalangeal joints of toes 1-
Marked out of -2 on the right foot. Examination detects bluish-
1.00 purple skin over the affected joints that is hot to
Flag the touch. There are nodular formations covered
question with thin shiny skin in the area of the auricles.
What drug must be prescribed for this patient as a
part of the urate-lowering therapy?

a. Allopurinol

b. Colchicine

c. Methotrexate

d. Febuxostat

e. Nimesulide

The correct answer is: Allopurinol

Question 70 A 30-year-old woman came to the gynecological

Not answered department. She complains of sharp pain in her
Marked out of lower abdomen and temperature of 38.8°C. She
1.00 has a history of extramarital sexual activity and 2
Flag artificial abortions. On gynecological examination
question the uterus is unchanged. The appendages are
bilaterally enlarged and painful. Profuse purulent
discharge is being produced from the vagina.
What examination needs to be conducted to
clarify the diagnosis?

a. Colposcopy

b. Laparoscopy

c. Hysteroscopy

d. Curettage of the uterine cavity

e. Bacteriological and bacterioscopic analysis

The correct answer is: Bacteriological and

bacterioscopic analysis

Question 71 In a traffic accident two persons died. An

Not answered appointed forensic medical expert was called on
Marked out of duty to another accident location; therefore,
1.00 according to the crininal law in force in Ukraine, an
Flag investigator called in the following specialist for
question examination of the location and bodies:

a. Nearest available dispensing chemist

b. Nearest available dental mechanic

c. Nearest available medical doctor

d. Medical assistant

e. Surgical nurse

The correct answer is: Nearest available medical

doctor

Question 72 A 36-year-old man has been complaining of

Not answered marked weakness, low appetite, and nausea for
Marked out of the last year, year and a half. Within the last year
1.00 he has lost 10 kg of body mass. The skin is
Flag darkened, especially on his face, neck, and arms.
question Skin folds and nipples are hyperpigmented, there
are pigment spots on the patient's inner thighs.
Pulse is 60/min., blood pressure is 80/50 mm Hg.
What is the provisional diagnosis?

a. Adrenal insufficiency

b. Chronic gastritis

c. Cholestatic hepatitis

d. Diabetes mellitus

e. Hemochromatosis

The correct answer is: Adrenal insufficiency

Question 73 A 56-year-old woman complains of itching skin of

Not answered her torso, constant nausea, constipation,
Marked out of sensation of heaviness and pain in the right
1.00 subcostal area, extreme general fatigue. The
Flag patient suffers from biliary cirrhosis. The skin is
question pale icteric. The abdomen is soft, the liver
protrudes 2,0 cm from under the margin of the
right costal arch, sensitive on palpation.
Biochemical investigation: total bilirubin - 142,0
mcmol/l, conjugated bilirubin - 139,0 mcmol/l,
alanine aminotransferase - 0,98
mmol/hour$\cdot$l, aspartate aminotransferase -
0,82 mmol/hour$\cdot$l, alkaline phosphatase -
8,7 mmol/hour$\cdot$l. What drug should be
prescribed in the first place?

a. Allochol

b. Livolin forte

c. Ursodeoxycholic acid

d. Sirepar

e. Essentiale forte (Phospholipides)

The correct answer is: Ursodeoxycholic acid

Question 74 A woman addressed a gynecologist on the 20th

Not answered day of puerperal period with complaints of pain in
Marked out of the left mammary gland, puruent discharge from
1.00 the nipple. Objectively: Ps- 120/min., body
Flag temperature is $39^oC$. The left mammary gland
question is painful, larger than the right one, the skin there
is hyperemic; in the upper quadrant there is an
infiltrate 10x15 cm in size with soft center. Blood
test: ESR- 50 mm/hour, leukocytes - $15,0\cdot
10^9$/l. What would be the treatment tactics?

a. Refer to a postnatal department

b. Transfer to a surgical department for

surgical treatment

c. Refer to a surgeon for conservative

treatment

d. Refer to a gynecology department

e. Lance the mammary gland abscess in a

maternity department

The correct answer is: Transfer to a surgical

department for surgical treatment

Question 75 A 32-year-old woman complains of body weight

Not answered loss despite her increased appetite, nervousness,
Marked out of and tremor of the extremities. Objectively: the skin
1.00 is moist; the thyroid gland is diffusely enlarged,
Flag painless, soft, and mobile. Blood test: increased
question level of T3, T4, and decreased thyroid-stimulating
hormone (TSH). What is the most likely diagnosis?

a. Diffuse nontoxic goiter

b. Thyroid carcinoma

c. Autoimmune (Hashimoto's) thyroiditis

d. Thyroid adenoma

e. Diffuse toxic goiter

The correct answer is: Diffuse toxic goiter

Question 76 Survey radiograph of a 52-year-old worker of an

Not answered agglomeration plant (28 years of experience, the
Marked out of concentration of metal dust is 22-37 mg/m³)
1.00 shows mildly pronounced interstitial fibrosis with
Flag diffused contrast well-defined small nodular
question shadows. The patient has no complaints.
Pulmonary function is not compromised. What is
the provisional diagnosis?

a. Silicatosis

b. Siderosis

c. Anthracosis

d. Anthraco-silicatosis

e. Silicosis

The correct answer is: Siderosis

Question 77 A 3-year-old child presents with sharp

Not answered deterioration of his general condition. He has a
Marked out of history of purulent otitis. His temperature is now
1.00 38.5°C. The left leg is pressed to the torso, active
Flag movements are absent, the lower third of the thigh
question and knee joint are thickened, hyperemic, with
localized fever. Axial load leads to acute
discomfort of the patient. What is the most likely
diagnosis?

a. Osteogenic sarcoma

b. Epiphyseal osteomyelitis on the left

c. Hygroma of the knee

d. Left hip fracture

e. Rheumatoid arthritis

The correct answer is: Epiphyseal osteomyelitis on

the left

Question 78 A 45-year-old patient (14-year-long work record

Not answered as a house painter) upon the contact with
Marked out of synthetic paint develops skin reddening, edema,
1.00 severe itching and oozing lesions on her face.
Flag Symptoms disappear after the contact with this
question chemical substance stops but even the smell of
paint alone is enough to make them reappear each
time. Each recurrence is characterised by
increased severity of symptoms. What provisional
diagnosis can be made?

a. Toxicodermia

b. Professional eczema

c. Allergic contact dermatitis

d. Simple contact dermatitis

e. Urticaria

The correct answer is: Professional eczema

Question 79 During regular medical examination a lyceum

Not answered student presents with signs of cheilitis that
Marked out of manifests as epithelial maceration in the area of lip
1.00 seal. The lips are bright-red, with single vertical
Flag cracks covered with brown-red scabs. These
question clinical signs are most likely caused by insufficient
content of the following in the diet:

a. Riboflavin

b. Thiamine

c. Calciferol

d. Ascorbic acid

e. Retinol

The correct answer is: Riboflavin

Question 80 A pregnant woman is 28 years old. Anamnesis:

Not answered accelerated labor complicated by the II degree
Marked out of cervical rupture. The following two pregnancies
1.00 resulted in spontaneous abortions at the terms of
Flag 12 and 14 weeks. On mirror examination: the
question uterine cervix is scarred from previous ruptures at
9 and 3 hours, the cervical canal is gaping. On
vaginal examination: the cervix is 2 cm long, the
external orifice is open 1 cm wide, the internal
orifice is half-open; the uterus is enlarged to the
12th week of pregnancy, soft, mobile, painless, the
appendages are without changes. What diagnosis
can be made?

a. Isthmico-cervical insufficiency, habitual

noncarrying of pregnancy

b. Cervical pregnancy, 12 weeks

c. Threatened spontaneous abortion

d. Cervical hysteromyoma, habitual

noncarrying of pregnancy

e. Incipient abortion, habitual noncarrying of

pregnancy

The correct answer is: Isthmico-cervical

insufficiency, habitual noncarrying of pregnancy

Question 81 A woman in her early- to mid-thirties has lost her

Not answered consciousness 3-5 minutes ago. On examination:
Marked out of the skin is pale, no pulse over the carotid arteries,
1.00 no spontaneous respiration, pupils are dilated; the
Flag patient is nonresponsive, presents with atony. The
question patient's condition can be determined as:

a. Natural death

b. Brain death

c. Clinical death

d. Syncope

e. Comatose state

The correct answer is: Clinical death

Question 82 A 14-year-old girl is being examined by a

Not answered pediatrician. Objectively, she has a tall stature,
Marked out of asthenic body type, striae on the skin of the
1.00 abdomen, blue sclera. She was diagnosed with a
Flag scoliotic posture and chest deformity. She has
question hypermobile joints, her fingers and arms are long.
Cardiac ultrasound visualizes a mitral valve
prolapse. What is the most likely cause of her tall
stature?

a. Williams syndrome

b. Noonan syndrome

c. Marfan syndrome

d. Klinefelter syndrome

e. Ehlers-Danlos syndrome

The correct answer is: Marfan syndrome

Question 83 Posture of an 11-year-old boy was determined
Not answered during preventive examination. The child presents
Marked out of with curled forward rounded shoulders, the head
1.00 is bowed forward, the thorax is flattened, the
Flag stomach is bulging. In the vertebral column there
question are deepened cervical and lumbar flexures. What
posture does the child have?

a. Stooping

b. Lordosis

c. Normal

d. Corrected

e. Kyphosis

The correct answer is: Kyphosis

Question 84 A 45-year-old woman has been suffering from

Not answered rheumatoid arthritis for 10 years and takes
Marked out of methotrexate twice a week. What statement
1.00 regarding vaccination against pneumococci (23-
Flag valent vaccine) would conform to the
question recommendations for the management of
rheumatoid arthritis issued by the European
League Against Rheumatism in 2010?

a. Vaccination necessitates increase in the

dosage of the long-term medicines

b. Vaccination is contraindicated in cases

when inflammatory process is active

c. Vaccination is recommended

d. Vaccination is not recommended

e. Vaccination is contraindicated to the

patients who take methotrexate

The correct answer is: Vaccination is

recommended

Question 85 A newborn with gestational age of 31 weeks

Not answered presents with hypotonia and depressed
Marked out of consciousness. Hematocrit is 35%, general
1.00 cerebrospinal fluid analysis shows increased
Flag content of erythrocytes and protein, and low
question glucose. These data correspond with the clinical
presentation of:

a. Anemia

b. Sepsis

c. Meningitis

d. Intrauterine infection

e. Intracranial hemorrhage

The correct answer is: Intracranial hemorrhage

Question 86 After the pregnant woman's waters broke, it was

Not answered noted that they are significantly contaminated
Marked out of with meconium. Upon birth, the baby is not
1.00 breathing, remains inert, the skin is cyanotic and
Flag covered in meconium, heart rate is 98/min. What
question resuscitation measures should be taken after the
baby is born?

a. Direct laryngoscopy, intubation, sanation of

the trachea

b. Sanation of the upper respiratory tracts

with a rubber balloon

c. Give adrenaline intravenously

d. Artificial pulmonary ventilation with a mask

and Ambu bag

e. Tactile stimulation of the newborn

The correct answer is: Direct laryngoscopy,

intubation, sanation of the trachea

Question 87 A patient with fibromyoma of uterus sized up to 8-

Not answered 9 weeks of pregnancy consulted a gynaecologist
Marked out of about acute pain in the lower abdomen.
1.00 Examination revealed pronounced positive
Flag symptoms of peritoneal irritation, high
question leukocytosis. Vaginal examination revealed that
the uterus was enlarged corresponding to 9 weeks
of pregnancy due to the fibromatous nodes, one
of which was mobile and extremely painful.
Appendages were not palpable. There were
moderate mucous discharges. What is the optimal
treatment tactics?

a. Fractional diagnostic curettage of the

uterine cavity

b. Surveillance and spasmolytic therapy

c. Surveillance and antibacterial therapy

d. Surgical laparoscopy

e. Urgent surgery (laparotomy)

The correct answer is: Urgent surgery

(laparotomy)

Question 88 A 44-year-old woman has undergone subtotal

Not answered thyroid resection due to diffuse toxic goiter. On
Marked out of the second day after the surgery the patient's
1.00 condition deteriorated; she developed
Flag palpitations, dyspnea, sweating, and diarrhea, and
question became fearful The patient is anxious, her skin is
moist and hot to the touch. Her temperature is
39.2°C. Heart sounds are muffled, tachycardia is
observed, pulse is 160/min., blood pressure is
85/40 mm Hg. The stomach is soft and painless.
What should be measured to clarify the patient's
condition?

a. Serum transaminases

b. Thyroid hormones

c. Blood sugar

d. Blood epinephrine and norepineprine

e. 17-KS and 17-OCS in urine

The correct answer is: Thyroid hormones

Question 89 A 44-year-old patient complains of difficult

Not answered urination, sensation of incomplete urinary bladder
Marked out of emptying. Sonographic examination of the urinary
1.00 bladder near the urethra entrance revealed an oval
Flag well-defined hyperechogenic formation 2x3 cm
question large that was changing its position during the
examination. What conclusion can be made?

a. Malignant tumour of the urinary bladder

b. Urinary bladder polyp

c. Prostate adenoma

d. Primary ureter tumour

e. Stone

The correct answer is: Stone

Question 90 A 60-year-old man has a diet consisting of

Not answered unvaried food staples: mostly cereals, potato,
Marked out of pasta; few vegetables and little fats (especially
1.00 animal fats). During medical examination he
Flag complains of deterioration of his twilight vision.
question This condition can be caused by lack of:

a. Amino acids

b. Carbohydrates

c. Fats

d. Retinol

e. Calcium

The correct answer is: Retinol

Question 91 A 60-year-old woman has been suffering from

Not answered arterial hypertension for 15 years. After recurrent
Marked out of stroke she started complaining of unmotivated
1.00 bad mood, problems with attention concentration;
Flag she forgets to close the entrance door, cannot
question recall events of the past day. Computer
tomography shows areas of postinfarction
changes in the cortical postfrontal areas. What is
the most probable diagnosis?

a. Dissociative amnesia

b. Huntington's disease

c. Vascular dementia

d. Alzheimer's disease

e. Pick's disease

The correct answer is: Vascular dementia

Question 92 A 32-year-old woman complains of increasing

Not answered spastic pains in her lower abdomen that occur
Marked out of after emotional stress. Bowel movements are
1.00 intermittent: 2-3 defecations after waking in the
Flag morning alternate with constipations that last for
question 1-2 days. Objectively body mass is retained,
palpation of the sigmoid colon is moderately
painful. Hb- 130 g/L, leukocytes - 5.2 g/L, ESR- 9
mm/hour. Rectoromanoscopy is painful due to
spastic condition of the intestine, intestinal
mucosa is without changes. Intestinal lumen
contains large amounts of mucus. What is the
most likely diagnosis in this case?

a. Malabsorption syndrome

b. Nonspecific ulcerative colitis

c. Acute mesenteric ischemia

d. Irritable bowel syndrome

e. Crohn's disease (regional enteritis)

The correct answer is: Irritable bowel syndrome

Question 93 A 50-year-old man, who works as a polisher at a

Not answered combine-building factory, addressed the factory's
Marked out of sectorial doctor with complaints of general
1.00 fatigue, sensations of numbness and pain in his
Flag fingers. Objectively: the skin of his fingers is pale.
question Reaction to pain, tactile and thermal stimuli was
revealed to be slightly disrupted. No disruptions
can be observed within the other organs and
systems. What disorder is most likely?

a. Raynaud's disease

b. Pneumatic hammer disease

c. Multiple neuritis

d. Syringomyelia

e. Deforming arthrosis

The correct answer is: Pneumatic hammer disease

Question 94 A woman complains of weight gain, chills, edema,

Not answered xeroderma, somnolence, difficulties with focusing.
Marked out of Objectively: height is 165 cm; weight is 90 kg;
1.00 body proportions are of female type, t°- 35,8°C,
Flag heart rate - 58/min, BP- 105/60 mm Hg. Heart
question sounds are weakened, bradycardia is observed.
Other internal organs have no alterations. Thyroid
gland cannot be palpated. Milk secretion from
mammary glands is observed. Hormone test
revealed increased levels of thyroid-stimulating
hormone (TSH) and prolactin, and decreased level
of thyroxine ($Т_4$). What is the cause of
obesity?

a. Primary hypothyroidism

b. Adiposogenital dystrophy

c. Secondary hypothyroidism

d. Hypopituitarism

e. Prolactinoma

The correct answer is: Primary hypothyroidism

Question 95 A 35-year-old patient complains of heartburn,

Not answered gasseous and sour eructation, burning
Marked out of constricting pain behind the sternum and along
1.00 the esophagus, developing when bowing the torso
Flag to the front. No previous examination; the patient
question takes almagel at his own discretion, after which he
notes improvement of his general state. Make the
provisional diagnosis:

a. Functional dyspepsia

b. Cardiospasm

c. Gastroesophageal reflux disease

d. Ulcer disease of the stomach

e. Ulcer disease of the duodenum

The correct answer is: Gastroesophageal reflux

disease

Question 96 A 42-year-old woman has been hospitalized with

Not answered complaints of intense pain attacks in the lumbar
Marked out of and right iliac areas, which irradiate to the vulvar
1.00 lips, frequent urination, nausea. The pain onset
Flag was acute. Objectively: the abdomen is soft,
question moderately painful in the right subcostal area,
costovertebral angle tenderness on the right.
Common urine analysis: specific gravity - 1016,
traces of protein, leukocytes - 6-8 in the vision
field, erythrocytes - 12-16 in the vision field, fresh.
What diagnosis can be made?

a. Acute right-sided pyelonephritis

b. Right-sided renal colic

c. Acute appendicitis

d. Acute cholecystitis

e. Acute right-sided adnexitis

The correct answer is: Right-sided renal colic

Question 97 After significant physical exertion a 66-year-old

Not answered man with deep vein thrombosis of the extremities
Marked out of developed shortness of breath, intense pain in the
1.00 chest on the left, marked palpitations. The
Flag patient's condition is grave, his face is cyanotic,
question the cervical veins are swollen, BP is 60/40 mm Hg.
What investigation method would be the most
advisable in this case?

a. Magnetic resonance imaging of the chest

b. Selective angiopneumography

c. Chest X-ray

d. Echocardiography

e. Fiber-optic bronchoscopy

The correct answer is: Selective

angiopneumography

Question 98 Estimation of community health level involved

Not answered analysis of a report on diseases registered among
Marked out of the population of district under charge (reporting
1.00 form 12). What index is calculated based on this
Flag report?
question

a. Index of pathological affection

b. Index of basic non-epidemic morbidity

c. Prevalence

d. Index of hospitalized morbidity

e. Index of morbidity with temporary disability

The correct answer is: Prevalence

Question 99 A healthy child 1 year and 5 months of age is

Not answered being vaccinated against hepatitis B. The child did
Marked out of not receive the first dose of the vaccine
1.00 previously, while in the maternity hospital. The
Flag doctor makes an individual vaccination schedule
question for this child and plans the administration of the
next dose of the vaccine. What is the minimum
interval between doses of vaccine in this case?

a. 3 months

b. 6 months

c. 1 month

d. 12 months

e. 2 months

The correct answer is: 1 month

Question 100 A 32-year-old woman addressed a maternity clinic

Not answered with complaints of infertility that has been lasting
Marked out of for 7 years. Her menstrual cycle occurs in two
1.00 phases. Hysterosalpingography reveals
Flag obstruction of the uterine tubes in the ampullar
question areas, an adhesive process in the small pelvis can
be observed. What treatment is most advisable in
this case?

a. Hydrotubation

b. Laparoscopy

c. Tubectomy

d. Adnexectomy

e. Laparotomy

The correct answer is: Laparoscopy

Question 101 A 65-year-old woman was diagnosed with the

Not answered following: chronic rheumatic heart disease, I
Marked out of degree of rheumatic activity; combined mitral
1.00 heart disease with prevalence of III degree
Flag stenosis; heart failure IIA with retained left
question ventricular ejection fraction, functional class III
(NYHA). What tactics of vaccination against
respiratory infections should be chosen to provide
secondary prevention of exacerbations and to
avoid heart failure decompensation in this patient?

a. Scheduled yearly vaccination against

influenza and pneumococci

b. Vaccination is contraindicated due to

severe heart failure

c. Any vaccination is contraindicated due to

elderly age of the patient

d. Any vaccination is contraindicated due to

mitral valve disease

e. Vaccination should be combined with

antibiotic administration

The correct answer is: Scheduled yearly

vaccination against influenza and pneumococci

Question 102 Vaginal examination reveals the head of the fetus,

Not answered which fills the posterior surface of symphysis
Marked out of pubis and hollow of the sacrum. The lower edge of
1.00 symphysis pubis, ischiadic spines, and
Flag sacrococcygeal joint can be palpated. Where in
question the lesser pelvis is the fetal head situated?

a. In the narrow plane of lesser pelvis

b. Above pelvic inlet

c. In the area of pelvic outlet

d. In the area of brim

e. In the wide plane of lesser pelvis

The correct answer is: In the narrow plane of

lesser pelvis

Question 103 A 35-year-old man complains of rapidly incresing

Not answered fatigue, palpitations, ''visual snow'', and dizziness.
Marked out of He has a history of peptic ulcer of the stomach.
1.00 Objectively the skin is pale. Vesicular respiration is
Flag observed in the lungs. Systolic murmur is
question detected over the cardiac apex, heart rate is
100/min., BP is 100/70 mm Hg. The epigastrium is
slightly tender on palpation. Blood test:
erythrocytes - $3.2\cdot10^{12$/L, Нb- 100 g/L,
color index - 0.95. What type of anemia is the
most likely present in this case?

a. Hypoplastic anemia

b. Hemolytic anemia

c. Chronic iron-deficiency anemia

d. Sideroblastic anemia

e. Posthemorrhagic anemia

The correct answer is: Posthemorrhagic anemia

Question 104 At night a 63-year-old woman suddenly

Not answered developed an asphyxia attack. She has a 15-year-
Marked out of long history of essential hypertension and had a
1.00 myocardial infarction 2 years ago. Objectively her
Flag position in bed is orthopneic, the skin is pale, the
question patient is covered with cold sweat, acrocyanosis is
observed. Pulse - 104/min. Blood pressure -
210/130 mm Hg, respiration rate - 38/min.
Pulmonary percussion sound is clear, with slight
dullness in the lower segments; throughout the
lungs single dry crackles can be heard that
become bubbling and non-resonant in the lower
segments. What is the most likely complication in
this patient?

a. Pulmonary embolism

b. Bronchial asthma attack

c. Paroxysmal tachycardia

d. Acute left ventricular failure

e. Acute right ventricular failure

The correct answer is: Acute left ventricular failure

Question 105 During medical examination a cadet in the naval

Not answered college was detected to have a painless dense
Marked out of ulcer 1.5x0.5 in size in his perianal area at the 2
1.00 o'clock position. The ulcer floor resembles ''old
Flag fat''. What is the provisional diagnosis?
question

a. Anal cancer

b. Hard syphilitic chancre of the rectum

c. Rectal fissure

d. Anal crypt suppuration

e. Rectal fistula

The correct answer is: Hard syphilitic chancre of

the rectum

Question 106 An 8-year-old boy developed a temperature of

Not answered $37,5^oC$ two days after his recovery from the
Marked out of case of URTI. He complains of suffocation, heart
1.00 pain. Objectively: the skin is pale, tachycardia, the
Flag I heart sound is weakened, short systolyc murmur
question in the 4th intercostal area near the left edge of the
breastbone. What heart disorder such clincal
presentation is characteristic of?

a. Nonrheumatic myocarditis

b. Myocardiodystrophy

c. Cardiomyopathy

d. Primary rheumatic carditis

e. Fallot's tetrad

The correct answer is: Nonrheumatic myocarditis

Question 107 A 39-year-old woman complains of violent pain in

Not answered her left lumbar area with irradiation to the right
Marked out of iliac area. Several years ago she was diagnosed
1.00 with cholelithiasis and urolithiasis. The patient's
Flag condition is moderately severe, the skin is dry.
question Ortner's symptom is negative; costovertebral
angle tenderness is observed on the right. The
most reasonable treatment tactics would be:

a. Antibiotics

b. Peritoneal dialysis

c. Laparoscopic cholecystectomy

d. Urgent hemodialysis

e. Spasmolytics and analgesics

The correct answer is: Spasmolytics and

analgesics

Question 108 It is the 3rd day after the first normal term labor;
Not answered the infant is rooming-in with the mother and is on
Marked out of breastfeeding. Objectively: the mother's general
1.00 condition is satisfactory. Temperature is 36.4°C,
Flag heart rate is 80/min., BP is 120/80 mm Hg.
question Mammary glands are soft and painless; lactation is
moderate, unrestricted milk flow. The uterus is
dense, the uterine fundus is located 3 finger
widths below the navel. Lochia are sanguino-
serous, moderate in volume. Assess the dynamics
of uterine involution:

a. Pathologic involution

b. Hematometra

c. Physiological involution

d. Lochiometra

e. Subinvolution

The correct answer is: Physiological involution

Question 109 A 72-year-old patient came to a doctor with

Not answered complaints of hand tremors, stiffness, slowness of
Marked out of walking and speech, and difficulties in performing
1.00 routine household chores. Physical examination
Flag detects general bradykinesia, hypomimia,
question emprosthotonus, "shuffling" gait, hand tremors at
rest, D>S, plastic type of increased muscle tone,
the "cogwheel rigidity" phenomenon, and marked
postural instability. What medicines must be a
primary part of the treatment regimen for this
patient?

a. Medicines containing levodopa

b. Antidepressants

c. Anticholinesterase drugs

d. Medicines that improve microcirculation

e. Anticholinergic agents

The correct answer is: Medicines containing

levodopa

Question 110 A 36-year-old man complains of marked dyspnea

Not answered and cardiac pain. He ascribes his disease to the
Marked out of case of influenza that he had 2 weeks ago.
1.00 Objectively he leans forward when sitting. The
Flag face is swollen, cyanotic, cervical veins are
question distended. Heart borders are extended on the
 both sides, heart sounds are muffled, heart rate =
Ps = 118/min., BP is 90/60 mm Hg. Blood test: ESR
is 46 mm/hour. ECG shows low voltage. X-ray
shows trapezoidal cardiac silhouette and signs of
pulmonary congestion. Choose the treatment
tactics:

a. Diuretics

b. Antibiotics

c. Pericardial puncture (pericardiocenthesis)

d. Pericardectomy

e. Glucocorticosteroids

The correct answer is: Pericardial puncture

(pericardiocenthesis)

Question 111 A patient complains of suppuration from the ear

Not answered and impaired hearing of the left ear, which have
Marked out of been observed for the past 6 years. The patient
1.00 had periodical headaches, general indisposition,
Flag fever. Objectively: otoscopy of the external
question auditory meatus revealed mucopurulent odorless
substance. The eardrum is of normal color, with
central perforation. What is the most likely
diagnosis?

a. Chronic mesotympanitis

b. Acute otitis media

c. Chronic epitympanitis

d. Otosclerosis

e. Chronic sensorineural hearing loss

The correct answer is: Chronic mesotympanitis

Question 112 A 58-year-old man complains of weakness and

Not answered tumor-like formations that appeared on the
Marked out of anterior surface of his neck and in the inguinal
1.00 region. Palpation detects soft painless mobile
Flag cervical and inguinal lymph nodes up to 2 cm in
question diameter. The liver protrudes by 2 cm from the
edge of the costal margin, the lower splenic pole
is at the umbilical level. In blood: erythrocytes -
$3.5\cdot10^{12$/L, Hb- 88 g/L, leukocytes -
$86\cdot10^9$/L, band neutrophils - 1%,
segmented neutrophils - 10%, lymphocytes -
85%, eosinophils - 2%, basophils - 0%,
monocytes - 2%, erythrocyte sedimentation rate -
15 mm/hour, Gumprecht shadows. What is the
most likely diagnosis?

a. Chronic lymphocytic leukemia

b. Lymphogranulomatosis

c. Lymphocytic leukemoid reaction

d. Acute leukemia

e. Chronic myeloid leukemia

The correct answer is: Chronic lymphocytic

leukemia

Question 113 A 55-year-old woman complains of pain and

Not answered popping sounds in her left knee joint, which occur
Marked out of when she climbs the stairs. Occasionally during
1.00 movements her joint becomes ''stuck''. 5 years
Flag ago she suffered a trauma of her left knee.
question Complete blood count and biochemical blood
analysis show normal results. X-ray shows marked
osteosclerosis and osteophytes. The joint space is
narrowed. Make the provisional diagnosis:

a. Osteoarthritis

b. Gouty arthritis

c. Psoriatic arthritis

d. Reactive arthritis

e. Rheumatoid arthritis

The correct answer is: Osteoarthritis

Question 114 A three-year-old boy has been suffering from

Not answered stool retention since birth. Every 3--4 days, the
Marked out of mother gives her child enemas. The boy lags
1.00 behind his peers in physical development.
Flag Objectively, he has pale skin and distended
question abdomen. What disease can be suspected in this
child?

a. Intestinal tumor

b. Helminthiasis

c. Coprostasis

d. Peritonitis

e. Hirschsprung's disease

The correct answer is: Hirschsprung's disease

Question 115 A 54-year-old patient complains of weakness,

Not answered jaundice, itching skin. Disease onset was 1,5
Marked out of months ago: fever up to $39^oC$ appeared at
1.00 first, with progressive jaundice developed 2 weeks
Flag later. On hospitalisation jaundice was severely
question progressed. Liver cannot be palpated. Gallbladder
is enlarged and painless. Blood bilirubin is 190
micromole/l (accounting for direct bilirubin). Stool
is acholic. What is the most likely jaundice genesis
in this patient?

a. Gilbert's syndrome

b. Hepatocellular jaundice

c. Caroli syndrome

d. Hemolytic jaundice

e. Mechanical jaundice

The correct answer is: Mechanical jaundice

Question 116 An 8-year-old child presents with blood pressure

Not answered up to 180/100 mm Hg in the upper limbs
Marked out of accompanied by headaches, tinnitus, occasional
1.00 nosebleeds, and high fatigability. On examination
Flag there is no pulse over the leg arteries. ECG shows
question left ventricular hypertrophy. MRI-scan shows
aortic narrowing to 5 mm in the typical place.
Coarctation of aorta is diagnosed. What kind of
treatment should be prescribed in this case?

a. Case monitoring

b. Conservative

c. Physical therapy

d. Surgical

e. Abstain from surgery in favor of complex

conservative therapy

The correct answer is: Surgical

Question 117 A 58-year-old patient complains of a headache in

Not answered the occipital region, nausea, choking, opplotentes.
Marked out of The presentations appeared after a physical
1.00 exertion. Objectively: the patient is excited. Face is
Flag hyperemic. Skin is pale. Heart sounds are regular,
question the 2nd aortic sound is accentuated. BP- 240/120
mm Hg, HR- 92/min. Auscultation reveals some
fine moist crackles in the lower lungs. Liver is not
enlarged. ECG shows signs of hypertrophy and
left ventricular overload. What is the most likely
diagnosis?

a. Complicated hypertensic crisis

b. Acute myocardial infarction, pulmonary

edema

c. Community-acquired pneumonia

d. Bronchial asthma exacerbation

e. Uncomplicated hypertensic crisis

The correct answer is: Complicated hypertensic

crisis

Question 118 A 58-year-old patient was delivered to an

Not answered admission room with complaints of pain in the
Marked out of thorax on the left. On clinical examination: aside
1.00 from tachycardia (102/min.) no other changes. On
Flag ECG: pathologic wave Q in І, аVL, QS in V1, V2, V3
question leads and 'domed' ST elevation with negative T.
What diagnosis is most likely?

a. Aortic dissection

b. Acute left ventricular posterior myocardial

infarction

c. Acute left ventricular anterior myocardial

infarction

d. Variant angina pectoris

e. Exudative pericarditis

The correct answer is: Acute left ventricular

anterior myocardial infarction

Question 119 Due to introduction of a new treatment method,

Not answered average duration of therapy in the experimental
Marked out of group was 12.3±0.2 days compared to 15.4±0.4
1.00 days in the control group that was treated by the
Flag old method. What calculations should be made to
question estimate the statistical significance of the
difference in the results?

a. Kolmogorov-Smirnov test

b. T-test (Student's t-distribution)

c. Matching factor (chi-squared test)

d. Wilcoxon T-test

e. Sign test (Z-test)

The correct answer is: T-test (Student's t-

distribution)

Question 120 A patient is being treated in the tuberculosis clinic.

Not answered Throughout the last 3 weeks he has been
Marked out of suffering from headaches of increasing intensity.
1.00 Neurological examination detects nuchal rigidity
Flag without focal signs. Make the provisional
question diagnosis:

a. Tuberculous meningitis

b. Convexital arachnoiditis

c. Myelitis

d. Brain tumor

e. Chorea minor

The correct answer is: Tuberculous meningitis

Question 121 A 38-year-old patient has been delivered by an

Not answered ambulance to a surgical department with
Marked out of complaints of general weakness, indisposition,
1.00 black stool. On examination the patient is pale,
Flag there are dotted hemorrhages on the skin of his
question torso and extremities. On digital investigation
there are black feces on the glove. Blood test: Hb-
108 g/L, thrombocytopenia. Anamnesis states that
similar condition was observed 1 year ago. Make
the diagnosis:

a. Thrombocytopenic purpura

b. Rectal tumor

c. Nonspecific ulcerative colitis

d. Hemophilia

e. Ulcerative bleeding

The correct answer is: Thrombocytopenic purpura

Question 122 After excessive consumption of fatty food a 60-

Not answered year-old woman suddenly developed pain in her
Marked out of right subcostal area, nausea, bile vomiting, sharp
1.00 bitter taste in her mouth. In 2 days she developed
Flag jaundice, her urine darkened. Objectively: sclera
question and skin are icteric, the abdomen is distended, the
liver is enlarged by 3 cm, soft and painful on
palpation, Ortner's, Murphy's, Kehr's, Zakharyin's,
Mayo-Robson's signs are positive. What
diagnostic technique should be used in the first
place?

a. Radionuclide scanning of the liver and

gallbladder

b. Fibrogastroduodenoscopy

c. X-ray of the abdomen

d. US of the gallbladder and bile duct

e. Laparoscopy

The correct answer is: US of the gallbladder and

bile duct

Question 123 A woman has been working as a polisher for a year

Not answered and a half. Her workstation is equipped with a
Marked out of grinding machine (grinding wheels). She
1.00 complains of white discoloration of her fingers and
Flag toes that appears when she is nervous.
question Objectively there are no changes in the coloration
of the distal segments of her limbs. Grip strength
measured with a dynamometer is 25 kg,
algesimetry findings are 0.1; 0.3; 0.5. Cold
stimulus is extremely positive on the upper and
lower limbs. Internal organs are without
pathologies. Make the diagnosis:

a. Syringomyelia

b. Polyneuritis

c. Raynaud syndrome

d. Raynaud disease

e. Vibration disease

The correct answer is: Vibration disease

Question 124 A 45-year-old woman undergoes an inpatient

Not answered treatment. She complains of elevated body
Marked out of temperature up to 39.0°C, pain in her right lumbar
1.00 area, turbid urine with blood. CT scan shows an
Flag area of low density within the parenchyma, no
question difference between the cortical and medullary
layers, and increased density of the perinephric
fat due to edema. What is the diagnosis?

a. Glomerulonephritis

b. Paranephritis

c. Renal carcinoma

d. Pyelonephritis

e. Renal abscess

The correct answer is: Pyelonephritis

Question 125 A 48-year-old patient was found to have diffuse

Not answered enlargement of the thyroid gland, exophthalmia,
Marked out of weight loss of 4 kg in 2 months, sweating.
1.00 Objectively: HR- 105/min, BP- 140/70 mm Hg.
Flag Defecation act is normal. What kind of therapy is
question recommended in this case?

a. Thyroxine

b. Lugol's solution

c. Radioactive iodine

d. Mercazolil

e. Propranolol

The correct answer is: Mercazolil

Question 126 A 3-year-old child has been brought to a hospital

Not answered with complaints of pain in the legs, fever, and loss
Marked out of of appetite. Objectively: pale skin and mucosa,
1.00 hemorrhagic rash. Lymph nodes are enlarged,
Flag painless, dense and elastic, not matted together.
question Bones, joints, and abdomen are painful. The liver
and spleen are enlarged. Hemogram: Hb- 88 g/L,
color index - 1.3, platelets - $80\cdot10^9$/L,
leukocytes - $25.8\cdot10^9$/L, lymphoblasts -
70%, ESR- 52 mm/hour. Make the provisional
diagnosis:

a. Infectious mononucleosis

b. Hemorrhagic vasculitis \\ (Henoch-

Schonlein purpura)

c. Thrombocytopenic purpura

d. Acute rheumatic fever

e. Acute leukemia

The correct answer is: Acute leukemia

Question 127 A 34-year-old woman came to a doctor with

Not answered complaints of muscle weakness, thirst, increased
Marked out of urination at night, paresthesias, and seizure
1.00 attacks. Objectively, her general condition is
Flag satisfactory, her face and legs are doughy, her
question pulse is 80/min., her blood pressure is 200/110
mm Hg, the II heart sound is accentuated over the
aorta. Complete blood count shows K⁺ levels of 3.1
mmol/L and Na⁺ levels of 165 mmol/L. ECG shows
inversion of T waves and depression of S--T
segments. Ultrasound detects hyperplasia of the
right adrenal gland. What is the provisional
diagnosis in this case?

a. Essential hypertension

b. Pheochromocytoma

c. Hypoparathyroidism

d. Glucosteroma

e. Primary hyperaldosteronism

The correct answer is: Primary

hyperaldosteronism

Question 128 A 40-year-old man, a welder, uses manganese

Not answered electrodes in his line of work (18 years of
Marked out of experience). He complains of difficulties with
1.00 writing, bad mood, inertness, gait abnormalities,
Flag problems with speech, and hand tremors.
question Objectively the following is observed in the
patient: hypomimia, increased muscle tone of
plastic type, and quiet monotonous speech,
tremor of the tongue, pill-rolling tremor of the
fingers, and retropulsion. What syndrome
developed in this patient due to manganese
poisoning?

a. Vestibular syndrome

b. Parkinsonism

c. Hypothalamic syndrome

d. Polyneuritic syndrome

e. Meningism

The correct answer is: Parkinsonism

Question 129 Having examined a 52-year-old patient, the doctor

Not answered diagnosed him with obesity (body mass index - 34
Marked out of kg/m², waist circumference - 112 cm) and arterial
1.00 hypertension (170/105 mm Hg). 2-hour
Flag postprandial blood sugar is 10.8 mmol/L. What
question biochemical blood analysis needs to be conducted
to diagnose the patient with metabolic syndrome
X?

a. Bilirubin

b. Lipid profile

c. Electrolytes

d. Calcium and phosphorus

e. Creatinine and urea

The correct answer is: Lipid profile

Question 130 A 9-year-old girl complains of fever up to 38.5°C,

Not answered headache, inertness, weakness, loss of appetite,
Marked out of stomachache, and frequent painful urination.
1.00 Provisional diagnosis of acute pyelonephritis is
Flag made. Clinical urine analysis: specific gravity -
question 1016, no protein, leukocytes - 10-15 in the vision
field. What investigation method can verify the
diagnosis of urinary tract infection?

a. Complete blood count

b. Zymnytsky test (density measurement of

daily diuresis)

c. Clinical urine analyses, dynamic testing

d. Rehberg test (creatinine clearance test)

e. Bacteriological inoculation of urine

The correct answer is: Bacteriological inoculation

of urine

Question 131 A patient with chronic pancreatitis complains of

Not answered diarrhea occurring up to 5 times per day (no blood
Marked out of traces), loss of body weight, abdominal distention,
1.00 dryness of skin, loss of hair, thirst, bleeding gums,
Flag convulsions. Complete blood count: leukocytes -
question $5,8\cdot10^9$/l; Hb- 86 g/l; ESR- 15 mm/g;
Blood protein test: protein - 48 g/l; albumins - 28
g/l. What indicators of coprological analysis would
accompany this syndrom?

a. Large amount of starch grains and cellulose

b. Large amount of mucus, amylorrhea

c. Steatorrhea, creatorrhea

d. Large numbers of iodinophilous microbes

e. Gas bubbles, acid reaction

The correct answer is: Steatorrhea, creatorrhea

Question 132 After a contact with chemicals a plant worker has

Not answered suddenly developed stridor, voice hoarseness,
Marked out of barking cough, progressing dyspnea. Objective
1.00 examination reveals acrocyanosis. What is your
Flag provisional diagnosis?
question

a. PATE

b. Laryngeal edema

c. Pulmonary atelectasis

d. Laryngeal carcinoma

e. Pneumothorax

The correct answer is: Laryngeal edema

Question 133 You witnessed a car accident. When examining

Not answered the place of the accident you noticed a man of
Marked out of about 30 years, who was hit by the car. He is
1.00 unconscious. On his neck on the left there is a
Flag profuse hemorrhage with bright-red blood. How to
question stop this hemorrhage?

a. Maximal hyperextension of the neck

b. Put him in a stable position

c. Digital occlusion, Mikulich method

d. Apply a neck brace

e. Apply a plaster cast

The correct answer is: Digital occlusion, Mikulich

method

Question 134 A 38-year-old woman has been suffering from

Not answered glomerulonephritis for 20 years. For approximately
Marked out of 16 years she has been presenting with
1.00 progressing renal parenchymal arterial
Flag hypertension that became refractory and
question accompanied by leg edemas. She receives a
combination of 100 mg losartan and 20 mg
lercanidipine with insufficient antihypertensive
effect. What medicine can she be recommended
for intensification of the antihypertensive effect of
her therapy?

a. Doxazosin

b. Urapidil

c. Torasemide

d. Bisoprolol

e. Lisinopril

The correct answer is: Torasemide

Question 135 A 7-year-old boy has been an inpatient for 1.5

Not answered months. He had been brought to the hospital with
Marked out of complaints of edemas all over his body, low urine
1.00 output, and headache. Clinical urinalysis: proteins
Flag - 7.1 g/L, leukocytes - 1-2 in the vision field,
question erythrocytes - 3-4 in the vision field. During the
course of treatment the edemas gradually
dissipated, headache abated, diuresis normalized.
Daily urine proteins - 3 g/L. Biochemical blood
test: total protein - 43.2 g/L, urea - 5.2 mmol/L,
cholesterol - 9.2 mmol/L. What glomerulonephritis
syndrome is the most likely to be present in the
patient?

a. Hematuric

b. Isolated urinary

c. Nephritic

d. Nephrotic

e. Mixed

The correct answer is: Nephrotic

Question 136 A 38-year-old patient has been delivered by an

Not answered ambulance to a surgical department with
Marked out of complaints of general weakness, indisposition,
1.00 black stool. On examination the patient is pale,
Flag there are dotted hemorrhages on the skin of his
question torso and extremities. On digital investigation
there are black feces on the glove. Blood test: Hb-
108 g/L, thrombocytopenia. Anamnesis states that
similar condition was observed 1 year ago. Make
the diagnosis:

a. Nonspecific ulcerative colitis

b. Rectal tumor

c. Bleeding from an ulcer

d. Hemophilia

e. Thrombocytopenic purpura

The correct answer is: Thrombocytopenic purpura

Question 137 A 40-year-old victim of a traffic accident

Not answered sustained the following injuries: closed diaphyseal
Marked out of femur fracture, brain concussion, multiple rib
1.00 fractures, hemopneumothorax, degloving shin
Flag injuries. What injuries require the most urgent
 question attention?

a. Degloving shin injuries

b. Brain concussion

c. Multiple rib fractures, \\

hemopneumothorax

d. All injuries are equivalent

e. Closed diaphyseal femur fracture

The correct answer is: Multiple rib fractures, \\

hemopneumothorax

Question 138 An 18-year-old patient complains of skin rash. The

Not answered patient has been suffering from this condition for
Marked out of 5 years. The first instance of this disease occurred
1.00 after a car accident. Objectively: the patient
Flag presents with a papular rash covered in silvery
question scales, ''thimble'' sign (small pits on the nails),
affected joints. What is the most likely diagnosis?

a. Rheumatism

b. Psoriasis

c. Onychomycosis

d. Lupus erythematosus

e. Panaritium

The correct answer is: Psoriasis

Question 139 A 37-year-old man working as a typesetter in a

Not answered print shop complains of rapid fatigability,
Marked out of paroxysmal attacks of stomachache, weak
1.00 drooping hands. Examination of neurological
Flag status revealed hypotrophy of the forearm
question muscles. Carporadial reflexes are sharply
weakened. Sensitivity is not disturbed. Gums
present with dark blue border. What neurological
pathology is it?

a. Lead polyneuropathy

b. Brachial plexitis

c. Ulnar neuropathy

d. Shingles

e. Guillain-Barre syndrome (postinfectious

polyneuritis)

The correct answer is: Lead polyneuropathy

Question 140 A 48-year-old woman has been hospitalized due

Not answered to development of tachysystolic atrial fibrillation.
Marked out of She has lost 5 kg of body weight within 2 months.
1.00 On palpation there is a node in the left lobe of the
Flag thyroid gland. What pathology resulted in the
question development of this condition?

a. Nontoxic nodular goiter

b. Chronic thyroiditis

c. Autoimmune thyroiditis

d. Aterosclerotic cardiosclerosis

e. Toxic nodular goiter

The correct answer is: Toxic nodular goiter

Question 141 Examination of a newborn girl detects a

Not answered hemorrhage on the child's head. The hemorrhage
Marked out of is limited to one cranial bone, does not pulsate,
1.00 and is painless. What condition did the child
Flag develop?
question

a. Cephalohematoma

b. Physiological birth-related edema

c. Neonatal pemphigus

d. Hydrocephalus

e. Intracranial birth injury

The correct answer is: Cephalohematoma

Question 142 The mother of an epileptic son complains of her

Not answered son periodically presenting with irritable
Marked out of depression, when he becomes excited and prone
1.00 to physical agression and violence. These moods
Flag last for 5-10 minutes, after which the patient
question exhausts himself and falls asleep. Upon waking he
is depressed, sad, cannot recall his actions or
recalls them only partially. What psychopathologic
condition is it?

a. Dysphoria

b. Dysthymia

c. Ambulatory automatism

d. Epileptic delirium

e. Pathologic affect

The correct answer is: Dysphoria

Question 143 In the inpatient gynecological unit within a year

Not answered 6500 women underwent treatment. They spent
Marked out of there a total of 102000 bed-days. What indicator
1.00 of the gynecological unit work can be calculated
Flag based on these data?
question

a. Average length of inpatient stay

b. Planned bed occupancy rate per year

c. Average bed occupancy rate per year

d. Number of beds by hospital department

e. Bed turnover rate

The correct answer is: Average length of inpatient

stay

Question 144 A parturient woman is 23 years old. Internal

Not answered obstetric examination shows the uterine cervix to
Marked out of be completely open. Fetal bladder is absent.
1.00 Cephalic presentation is observed in the plane of
Flag the small pelvic outlet. Sagittal suture is at the
question longitudinal section of the small pelvic outlet,
small fontanel is situated closer to the uterus.
What cephalic position will the newborn have
during birth in this case?

a. Longitudinal lie

b. Minor oblique lie

c. Medium oblique lie

d. Transverse lie

e. Major oblique lie

The correct answer is: Minor oblique lie

Question 145 The process of open-cut mining requires drilling

Not answered and blasting operations, rock and ore excavation,
Marked out of transportation of ore to fragmentation and sorting
1.00 factories and transportation of barren rock to
Flag slag-heaps, road building and maintenance, repair
question works. What factor of production is most
important for miner's health?

a. Adverse microclimate

b. Vibration

c. High content of dust in the air

d. High content of explosion gas

e. Noise

The correct answer is: High content of dust in the

air

Question 146 A 32-year-old woman complains of episodes of

Not answered intense fear that occur without visible cause and
Marked out of last for 10-20 minutes; the episodes are
1.00 characterized by rapid pulse, sweating, labored
Flag breathing, and vertigo. Specify the likely
question diagnosis:

a. Simple schizophrenia

b. Paranoid syndrome

c. Panic disorder

d. Manic syndrome

e. Claustrophobia

The correct answer is: Panic disorder

Question 147 After tonsillectomy a woman with systemic lupus

Not answered erythematosus, who has been taking prednisolone
Marked out of for a year, developed acute weakness, nausea,
1.00 vomiting, pain in the right iliac area, watery stool
Flag up to 5 times per day. Ps- 96/min., BP- 80/50 mm
question Hg. What preventive therapy should have been
administered prior to the surgery?

a. Administration of 10% NaCl solution

b. Administration of Ringer's solution

c. Prescription of antibiotics

d. Prescription of desoxycorticosterone
acetate

e. Increase of prednisolone dosage

The correct answer is: Increase of prednisolone

dosage

Question 148 weeks after labour a parturient woman developed

Not answered breast pain being observed for 3 days.
Marked out of Examination revealed body temperature at the
1.00 rate of $39^oC$, chills, weakness, hyperaemia,
Flag enlargement, pain and deformity of the mammary
question gland. On palpation the infiltrate was found to
have an area of softening and fluctuation. What is
the most likely diagnosis?

a. Phlegmonous mastitis

b. Lactostasis

c. Infiltrative-purulent mastitis

d. Serous mastitis

e. Mastopathy

The correct answer is: Infiltrative-purulent mastitis

Question 149 A 32-year-old man complains of pain in his legs

Not answered that intensifies during walking, intermittent
Marked out of claudication, numbness of his toes, extremity
1.00 coldness, and inability to walk more that 100
Flag meters. When he sleeps, his leg usually hangs
question down. The patient has been smoking since he was
16. He drinks alcohol in excess. The left leg is
colder than the right one; the skin of the
extremities is dry. No pulse can be detected on
the pedal arteries, while pulsation of the femoral
arteries is retained. What is the most likely
diagnosis?

a. Diabetic angiopathy

b. Obliterating endarteritis

c. Leriche syndrome (aortoiliac occlusive

disease)

d. Deep thrombophlebitis

e. Raynaud disease

The correct answer is: Obliterating endarteritis

Question 150 An infant is 3 weeks old. Since birth there has

Not answered been observed periodical vomiting within a few
Marked out of minutes after feeding. The amount of vomitive
1.00 masses does not exceed the volume of previous
Flag feeding. The infant has age-appropriate body
question weight. What is the most likely cause of this
symptom?

a. Pylorospasm

b. Esophageal achalasia

c. Pyloristenosis

d. Adrenogenital syndrome

e. Esophageal chalasia

The correct answer is: Pylorospasm

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