Krok 2 Medicine Past Paper 2019 PDF

1. It is the 3rd day after the first normal term D. Skin-head Ivanov’s forceps labor; the infant is rooming-in with the mother E. Vacuum extraction of the fetus and is on breastfeeding. Objectively: the mother’s general condition is satisfactory. Temperature is 5. Human body...

1. It is the 3rd day after the first normal term D. Skin-head Ivanov’s forceps labor; the infant is rooming-in with the mother E. Vacuum extraction of the fetus and is on breastfeeding. Objectively: the mother’s general condition is satisfactory. Temperature is 5. Human body receives from the atmosphere a 36.4°C, heart rate is 80/min., BP is 120/80 mm number of chemicals. What type of action results Hg. Mammary glands are soft and painless; in the combined effect that is less than the sum of lactation is moderate, unrestricted milk flow. The isolated effects of these chemicals on the body? uterus is dense, the uterine fundus is located 3 A.* Antagonism finger widths below the navel. Lochia are B. Complex action sanguino-serous, moderate in volume. Assess the C. Isolated action dynamics of uterine involution: D. Potentiation A.* Physiological involution E. Synergistic action B. Hematometra C. Subinvolution 6. A woman has been working as a polisher for a D. Pathologic involution year and a half. Her workstation is equipped with E. Lochiometra a grinding machine (grinding wheels). She complains of white discoloration of her fingers 2. A 30-year-old woman came to the and toes that appears when she is nervous. gynecological department. She complains of sharp Objectively there are no changes in the coloration pain in her lower abdomen and temperature of of the distal segments of her limbs. Grip strength 38.8°C. She has a history of extramarital sexual measured with a dynamometer is 25 kg, activity and 2 artificial abortions. On algesimetry findings are 0.1; 0.3; 0.5. Cold gynecological examination the uterus is stimulus is extremely positive on the upper and unchanged. The appendages are bilaterally lower limbs. Internal organs are without enlarged and painful. Profuse purulent discharge pathologies. Make the diagnosis: is being produced from the vagina. What A.* Vibration disease examination needs to be conducted to clarify the B. Syringomyelia diagnosis? C. Polyneuritis A.* Bacteriological and bacterioscopic analysis D. Raynaud syndrome B. Colposcopy E. Raynaud disease C. Laparoscopy D. Curettage of the uterine cavity 7. A 10-year-old boy was brought into the hospital E. Hysteroscopy with complaints of expiratory dyspnea, respirations are 30/min. He explains his state by a 3. A 34-year-old man on the 3rd day of change in the weather conditions. For the last 4 ceftriaxone treatment for acute otitis (daily dosage years the boy has been registered for regular - 2 grams) developed diarrhea occurring 5-6 times check-ups due to his diagnosis of third degree per day. Feces are without mucus or blood persistent bronchial asthma. To provide admixtures. Temperature is 36.6°C. Gregersen emergency aid for this child, first he needs to be reaction (occult blood in feces) is negative. Stool given: culture detected no pathogenic germs. What is the A.* Salbutamol or short-acting /32-agonists most likely cause of diarrhea in this case? B. Euphylline (Aminophylline) A.* Antibiotic-associated diarrhea C. Claritin (Loratadine) B. Bacterial overgrowth syndrome D. Dexamethasone C. Ulcerative colitis E. Adrenaline D. Crohn’s disease (regional enteritis) E. Intestinal dysbiosis 8. A 27-year-old woman complains of foulsmelling discharge from her genital tracts, 4. A 30-year-old multigravida has been in labour pain in her lower abdomen, and elevated for 18 hours. 2 hours ago the pushing stage began. temperature. The complaints arose 2 days ago. Fetal heart rate is clear, rhythmic, 136/min. She has a history of surgical abortion at the term Vaginal examination reveals complete cervical of 8 weeks one week ago. Mirror examination: the dilatation, the fetal head in the pelvic outlet plane. uterine cervix is clear, external orifice produces Sagittal suture is in line with obstetric conjugate, foul-smelling discharge. Vaginal examination: the the occipital fontanel is near the pubis. The patient uterus lies in anteflexion, is mobile, painful, and has been diagnosed with primary uterine inertia. slightly enlarged. The appendages are without What is the further tactics of labor management? changes. Make the provisional diagnosis: A.* Outlet forceps A.* Postabortal endometritis B. Cesarean section B. Enterocolitis C. Labour stimulation C. Appendicitis D. Acute respiratory disease friable gingiva that bleeds when pressed, E. Salpingoophoritis hyperkeratosis follicularis not accompanied by skin dryness. These symptoms most likely result 9. A middle school teacher with 4-year-long from the following pathology: record of work was issued a medical certificate for A.* C-hypovitaminosis pregnancy and childbirth leave. What amount of B. Polyhypovitaminosis pay will she receive for the duration of her leave C. A-hypovitaminosis in this case? D. B1-hypovitaminosis A.* 100% of average salary E. Parodontosis B. 70% of average salary C. 80% of average salary 13. A 63-year-old man complains of unmotivated D. 50% of average salary weakness and pressing and bursting sensation in E. 60% of average salary the left subcostal area. According to him, these signs have been present for a year already. 10. A pregnant woman is 28 years old. Previously he was healthy. He took part in Anamnesis: accelerated labor complicated by the containment measures during the accident at the II degree cervical rupture. The following two Chornobyl Nuclear Power Plant. Objectively: the pregnancies resulted in spontaneous abortions at skin is pale, peripheral lymph nodes are not the terms of 12 and 14 weeks. On mirror enlarged, the liver is +3 cm, the spleen is +10 cm. examination: the uterine cervix is scarred from Complete blood count: erythrocytes - 3.1 previous ruptures at 9 and 3 hours, the cervical 1012/L, Hb- 100 g/L, leukocytes - 46 109/L, canal is gaping. On vaginal examination: the blasts - 2%, promyelocytes - 10%, myelocytes - cervix is 2 cm long, the external orifice is open 1 18%, band neutrophils - 27%, segmented cm wide, the internal orifice is half-open; the neutrophils - 10%, lymphocytes - 12%, uterus is enlarged to the 12th week of pregnancy, eosinophils - 6%, basocytes - 3%, monocytes - soft, mobile, painless, the appendages are without 2%, erythrocyte sedimentation rate - 20 mm/hour. changes. What diagnosis can be made? What is the most likely diagnosis? A.* Isthmico-cervical insufficiency, habitual A.* Chronic myeloleukemia noncarrying of pregnancy B. Acute leukemia B. Incipient abortion, habitual noncarrying of C. Hemolytic anemia pregnancy D. Hepatic cirrhosis C. Cervical hysteromyoma, habitual noncarrying E. Chronic lymphatic leukemia of pregnancy D. Threatened spontaneous abortion 14. An 18-year-old young man complains of pain E. Cervical pregnancy, 12 weeks in his knee and elbow joints and body temperature up to 39.5°C. One week and a half earlier he 11. A 51-year-old man complains of vomiting developed sore throat. On examination his body with blood. He has been drinking alcohol temperature is 38.5°C. Swelling of the knee and excessively. Health disorder has been observed elbow joints is observed. Pulse is 106/min., since he was 40, when he first developed jaundice. rhythmic. Blood pressure is 90/60 mm Hg. On examination the skin and visible mucosa are Cardiac borders are unchanged, heart sounds are icteric, with a stellate vascular pattern. The patient weakened, at the cardiac apex there is a soft is malnourished and presents with abdominal systolic murmur. What factor would be the most distension, umbilical hernia, and ascites. The edge indicative of the likely disease etiology? of the liver is tapered and painless, +3 cm, the A.* Anti-streptolysin O spleen is +2 cm. Blood test: Hb- 80 g/L, B. Creatine kinase leukocytes - 3 109/L, platelets - 85 109/L. C. Rheumatoid factor What is the cause of portal hypertension in this D. Seromucoid patient? E. C-reactive protein A.* Hepatic cirrhosis B. Constrictive pericarditis 15. A 65-year-old man complains of dyspnea, C. Budd-Chiari syndrome severe cough with expectoration of small amounts D. Thrombosis of the splenic vein of blood-streaked sputum, weight loss, body E. Hemochromatosis temperature 37,2°C, loss of appetite, and weakness. He has been suffering from this 12. In April during the medical examination of condition for years. The patient’s condition various population groups, 27% of individuals deteriorated one year ago, dyspnea developed 3 presented with low working ability and rapid weeks ago. The patient is a lifelong smoker. He is fatigability. The following symptoms were a carpenter by occupation. Objectively he is of observed in the affected individuals: swollen normal body type but emaciated. Right side of the chest is retracted, excurcions are limited, A.* Acantholytic pemphigus accessory muscles take part in the respiration, B. Herpes respiratory rate is 22/min. Percussion detects dull C. Duhring’s disease (dermatitis herpetiformis) sound over the right upper segment. Chest X-ray D. Nonacantholytic pemphigus shows shrunken right upper lobe with E. Toxicodermia homogeneous shadow connected to the root of the lung; the root is deformed; mediastinal organs are 20. In the air of the feed kitchen at the poultry displaced to the right. What is the most likely factory, at the area where formula feed is being diagnosis? mixed, the dust concentration reaches 200 mg/m3. A.* Obstructive atelectasis Air microflora is represented predominantly by B. Pulmonary sarcoidosis Asperqillus and Mucor fungi. What effect C. Complete right-sided pneumothorax determines pathogenic properties of the dust? D. Pulmonary tuberculosis A.* Allergenic E. Fibrosing alveolitis B. Teratogenic C. Toxic 16. A 10-year-old boy with symptoms of arthritis D. Mutagenic and myocarditis was brought to a hospital. Based E. Fibrogenic on clinical examination the provisional diagnosis of juvenile rheumatoid arthritis was made. What 21. A 17-year-old girl has made an appointment symptom is the most contributive for the with the doctor. She plans to begin her sex life. diagnostics of this disease? No signs of gynecological pathology were A.* Reduced mobility of the joints in the morning detected. In the family history the patient’s B. Increased heart rate grandmother had cervical cancer. The patient was C. Regional hyperemia of the joints consulted about the maintenance of her D. Affection of the large joints reproductive health. What recommendation will E. Enlarged heart be the most helpful for prevention of invasive cervical cancer? 17. A 78-year-old man with a prostate adenoma A.* Vaccination against human papillomavirus underwent a herniotomy for a direct inguinal (HPV) hernia. After the surgery he presents with absent B. Vitamins, calcium, omega-3 urination. Enlarged urinary bladder is detectable C. Antiviral and antibacterial drugs above the patient’s pubis. What measures should D. Immunomodulators be taken in this case? E. Timely treatment of sexually transmitted A.* Bladder catheterization diseases B. Prescribe antispasmodics subcutaneously C. Prescribe proserin (neostigmine) 22. A 30-year-old man came to the family intramuscularly physician. 2 months ago he underwent a surgery D. Apply cold to the urinary bladder area for open fracture of the humerus. On examination E. Prescribe processing of the postoperative the patient’s condition is satisfactory; in the area wound with UHF field of the postoperative wound there is a fistula that discharges a small amount of pus; the area itself is 18. A district doctor has diagnosed one of his red; fluctuation is detected. X-ray shows patients with dysentery. What accounting destruction of the humerus with sequestra. What document reflects this type of morbidity? complication did the patient develop during the A.* Urgent report postoperative period? B. Report on a major non-epidemic disease A.* Posttraumatic osteomyelitis C. Control card of a patient registered for regular B. Suture sinus check-ups C. Posttraumatic phlegmon D. Certificate of temporary disability D. Wound suppuration E. Statistical report E. Hematogenous osteomyelitis 19. A 53-year-old man complains of general 23. A newborn with gestational age of 31 weeks weakness, loss of appetite, and painful vesicles presents with hypotonia and depressed appearing on his skin. The disease onset occurred consciousness. Hematocrit is 35%, general suddenly, after hyperinsolation one week ago. cerebrospinal fluid analysis shows increased Examination detects isolated vesicles with content of erythrocytes and protein, and low wrinkled opercula and occasional painful erosions glucose. These data correspond with the clinical on the skin of the patient’s torso and limbs. presentation of: Nikolsky sign is positive. What is the most likely A.* Intracranial hemorrhage diagnosis? B. Anemia C. Sepsis of the left eye. The cornea is thick and swollen. D. Meningitis The anterior chamber is shallow, moist, and clear. E. Intrauterine infection The pupil is dilated and unresponsive to the light, the fundus of the eye is not visible. What is the 24. A 27-year-old man complains of pain in his most likely diagnosis? leg joints, purulent discharge from the eyes, and A.* Acute attack of glaucoma of the left eye painful burning sensations during urination. B. Endophthalmitis of the left eye Disease onset was acute. He has a history of C. Acute iridocyclitis of the left eye influenza. The patient smokes and drinks alcohol D. Panophthalmitis of the left eye in excess. In his line of work he is often away on E. Stage II intraocular tumor of the left eye business trips. What is the most likely etiological factor of this disease? 29. A 62-year-old patient has been hospitalized A.* Chlamydia with complaints of pain in the thorax on the right B. Staphylococci during breathing, dyspnea, and dry cough. Ten C. Streptococci days ago he slipped and fell hitting his right side. D. Candida On examintaion: the patient lies on the left side. E. Adenovirus The right side of the thorax lags during breathing. On the right there are crepitation and pain in the 25. During regular medical examination a lyceum III-IV ribs. Dullness of percussion sound and student presents with signs of cheilitis that sharply diminished breath sounds can be manifests as epithelial maceration in the area of observed. On X-ray: signs of exudate, fracture of lip seal. The lips are bright-red, with single the III- IV ribs. On pleurocentesis: blood is vertical cracks covered with brown- red scabs. detected. Choose the further tactics: These clinical signs are most likely caused by A.* Transfer to a thoracic surgery department insufficient content of the following in the diet: B. Refer to a traumatologist A.* Riboflavin C. Perform repeated pleural taps B. Retinol D. Apply a fixation bandage to the rib cage C. Thiamine E. Prescribe conservative therapy D. Ascorbic acid E. Calciferol 30. A woman came to the doctor with complaints of increased body temperature up to 37.8°C and 26. In a rural health care area there is an moderately sore throat for the last 3 days. increasing cervical cancer morbidity observed. Objectively: mandibular lymph nodes are enlarged The decision is made to conduct a medical up to 3 cm. Palatine tonsils are hypertrophied and examination of the women living in this locality. covered with gray coating that spreads to the What type of medical examination is it? uvula and anterior pillars of the fauces. What is A.* Target the most likely diagnosis? B. Regular A.* Oropharyngeal diphtheria C. Screening B. Oropharyngeal candidiasis D. Preliminary C. Infectious mononucleosis E. Complex D. Agranulocytosis E. Pseudomembranous (Vincent’s) tonsillitis 27. A 3-week-old infant developed large, flaccid vesicles with purulent contents on the skin of 31. A 62-year-old woman was brought into the chest and abdomen. The vesicles rupture quickly. admission room with complaints of severe Make the provisional diagnosis: burning retrosternal pain and asphyxia. She has a A.* Pemphigus neonatorum 10-year-long history of essential hypertension. B. Pseudofurunculosis Objectively her condition is moderately severe. C. Vesiculopustulosis She presents with skin pallor, cyanotic lips, and D. Toxic erythema vesicular respiration over her lungs. The II heart E. Pemphigus syphiliticus sound is accentuated over the aorta. Blood pressure - 210/120 mm Hg, heart rate (pulse) - 28. A 59-year-old man complains of pain in his 76/min. ECG shows elevation of ST segment in left eye and left side of his head, significant vision the leads I, AVL, and V5-V6. What is the most impairment of the left eye, nausea, and vomiting. likely diagnosis? Visual acuity of the right eye is 1.0. Visual acuity A.* Hypertensive crisis complicated with acute of the left eye is 0.03, attempts at correction bring myocardial infarction no improvement. Right eye intraocular pressure - B. Hypertensive crisis complicated with instable 21 mm Hg, left eye intraocular pressure - 65 mm angina pectoris Hg. Congestive injection is observed on the sclera C. Pulmonary embolism D. Uncomplicated hypertensive crisis A.* Postpartum period, day 12. Right-sided E. Hypertensive crisis complicated with acute left infiltrative-purulent mastitis ventricular failure B. Postpartum period, day 12. Right-sided lactostasis 32. A 15-year-old girl complains of dizziness and C. Postpartum period, day 12. Right-sided sensation of lack of air that she develops in gangrenous mastitis emotionally straining situations. Relief occurs D. Postpartum period, day 12. Right-sided after she takes corvalol. Objectively: phlegmonous mastitis hyperhidrosis and marble-like pattern of the skin E. Postpartum period, day 12. Right-sided serous of her palms and feet. Clinical and instrumental mastitis examination revealed no organic changes in the central nervous, cardiovascular, and respiratory 36. A 10-year-old boy, who was outdoors in systems. What provisional diagnosis can be made? windy and cold weather, developed moderate pain A.* Somatoform autonomic dysfunction and tingling in his fingers and toes. When he B. Obstructive bronchitis returned home, his parents noticed that the tips of C. Stenosing laryngotracheitis his fingers and toes were white and their D. Bronchial asthma sensitivity was lost. As the affected areas were E. Acute epiglottitis warming up, the fingers and toes developed tingling and painful sensations. Skin pallor 33. A 43-year-old man, a coal-face worker with changed into redness, tingling stopped, mild 15-year-long record of work, complains of cough, itching and swelling of the fingers appeared. thoracic pain, and dyspnea. The cough is mild, Determine the frostbite degree in this child: usually dry, occurs mostly in the morning. The A.* Frostbite of the I degree pain is localized in the interscapular region and B. Perniosis aggravates during a deep intake of breath. C. Frostbite of the III degree Dyspnea occurs during physical exertion. D. Frostbite of the IV degree Vesicular respiration in the lungs is weakened. E. Frostbite of the II degree Heart sounds are rhythmic, heart rate is 86/min., blood pressure is 135/80 mm Hg. The abdomen is 37. In the factory cafeteria there was an outbreak soft and painless. X- ray shows micronodular of food poisoning. Clinical presentation indicates pulmonary fibrosis. Make the provisional staphylococcal etiology of this disease. 15 people diagnosis: are sick. To confirm the diagnosis of food A.* Carboconiosis poisoning, samples need to be sent to the B. Byssinosis laboratory. What samples should be obtained for C. Metal pneumoconiosis analysis? D. Siderosis A.* Vomit masses E. Berylliosis B. Blood (complete blood count) C. Saliva 34. Having examined a 52-year-old patient, the D. Blood for hemoculture doctor diagnosed him with obesity (body mass E. Urine index - 34 kg/m2, waist circumference - 112 cm) and arterial hypertension (170/105 mm Hg). 2- 38. On the 15th day after a small trauma of the hour postprandial blood sugar is 10.8 mmol/L. right foot, the patient developed indisposition, What biochemical blood analysis needs to be fatigability, irritability, headache, elevated body conducted to diagnose the patient with metabolic temperature, and sensation of constriction, syndrome X? tension, and twitching in the muscles of the right A.* Lipid profile shin. What disease can be suspected? B. Bilirubin A.* Tetanus C. Creatinine and urea B. Acute thrombophlebitis D. Electrolytes C. Thrombophlebitis of the popliteal artery E. Calcium and phosphorus D. Anaerobic gas gangrene E. Erysipelas 35. A 22-year-old postparturient woman on the 12th day after the normal childbirth informs of 39. A 14-year-old girl came to the general elevated body temperature up to 39°C for the last practitioner with complaints of weakness, loss of 3 days and pain in her right mammary gland. The appetite, headache, rapid fatigability. Her last right mammary gland is enlarged, hot to touch, menstruation was profuse and lasted for 14 days tense, hyperemic, and painful. Palpation reveals after the previous delay of 2 months. Objectively: there a dense infiltration 8x8 cm with a fluctuation the skin is pale, heart rate is 90/min., BP is 110/70 in its center. What is the most likely diagnosis? mm Hg, Hb is 88 g/L. Rectal examination: the uterus and its appendages are without changes, no slightly painful carbuncle 3 cm in diameter, discharge from the genital tracts. What surrounded by a painless swelling that reaches the complication occurred in the patient? clavicle. Temperature is subfebrile, under 37.8°C. A.* Posthemorrhagic anemia The doctor suspects anthrax. What drug should B. Dysmenorrhea this man be prescribed for treatment? C. Gastritis A.* Penicillin D. Somatoform autonomic dysfunction of B. Azidothymidin (Zidovudine) hypotonic type C. Levomycetin (Chloramphenicol) E. Migraine D. Interferon alpha E. Biseptol (Co-trimoxazole) 40. A woman is 40 weeks pregnant. The fetus is in the longitudinal lie and cephalic presentation. 44. A 38-year-old patient has been brought by an Pelvic size: 26-29-31-20. Expected weight of the ambulance to the surgical department with fetus is 4800 gram. The labor contractions has complaints of general weakness, indisposition, been lasting for 12 hours, within the last 2 hours black stool. On examination the patient is pale, they were extremely painful, the parturient woman there are dotted hemorrhages on the skin of his is anxious. The waters broke 4 hours ago. On torso and extremities. On digital investigation external examination the contraction ring is there are black feces on the glove. Blood test: Hb- located 2 finger widths above the navel, Henkel- 108 g/L, thrombocytopenia. Anamnesis states that Vasten sign is positive. Fetal heart rate is a similar condition was observed 1 year ago. 160/min., muffled. On internal examination the Make the diagnosis: uterine cervix is fully open, the head is engaged A.* Thrombocytopenic purpura and pressed to the entrance into the lesser pelvis. B. Hemophilia What is the most likely diagnosis? C. Rectal tumor A.* Threatened uterine rupture D. Ulcerative bleeding B. Anatomically contracted pelvis E. Nonspecific ulcerative colitis C. Complete uterine rupture D. Abruption of the normally positioned placenta 45. During medical examination a cadet in the E. Hyperactive uterine contractions naval college was detected to have a painless dense ulcer 1.5x0.5 in size in his perianal area at 41. A 45-year-old man with thrombophlebitis of the 2 o’clock position. The ulcer floor resembles the deep veins in his legs suddenly after physical ’’old fat’'. What is the provisional diagnosis? exertion developed sharp pain in his thorax on the A.* Hard syphilitic chancre of the rectum right, dyspnea, and hemoptysis. Objectively his B. Anal cancer condition is severe; he presents with acrocyanosis, C. Anal crypt suppuration shortening of pulmonary percussion sound on the D. Rectal fistula right, and weakened respiration. Respiration is E. Rectal fissure 30/min., blood pressure is 110/80 mm Hg. ECG shows sinus tachycardia, heart rate is 120/min., 46. A woman with atopic bronchial asthma was electrical axis of the heart deviates to the right, found to have one allergen to dog hair +++. S1-QIII. What is the most likely diagnosis? Carpets were removed from the apartment, the A.* Pulmonary embolism apartment was renovated, and air conditioner was B. Cancer of the right lung installed. However, recurrent asphyxia attacks still C. Right-sided exudative pleurisy occur every night, despite the patient undergoing D. Community-acquired right-sided pneumonia pathogenetic therapy. What long-term treatment E. Spontaneous pneumothorax tactics can help this patient to decrease her sensitivity to the allergen? 42. A 30-year-old woman made an appointment A.* Specific hyposensitization with the family doctor for scheduled vaccination B. Antihistamine therapy of her 2-year-old child. What type of healthcare C. Continuation of prior treatment provides such medical services? D. Referral for speleotherapy A.* Primary healthcare E. Buteyko breathing technique B. Secondary healthcare C. Emergency aid 47. An 11-year-old boy for a month has been D. Tertiary healthcare presenting with increasing pain in the right femur. E. Palliative care In the painful area there is a non- mobile painful tumor with unclear margins. The child complains 43. A 42-year-old man, a worker at the meat of general indisposition, weakness, increased body processing factory, developed an itching spot on temperature up to 39°C. X-ray shows widened his lower jaw, which gradually transformed into a medullary cavity, small foci of cancellous bone destruction, and onion-like lamellar exfoliation of B. Mercazolil (Thiamazole) the cortical layer. What is the most likely C. Furosemide pathology resulting in such clinical presentation? D. Calcium gluconate A.* Ewing sarcoma E. Lithium carbonate B. Osteogenic sarcoma C. Juxtacortical sarcoma 52. The body of a 24-year-old woman with D. Chondrosarcoma suspected poisoning has been found on the street. E. Fibrosarcoma Forensic medical examination was requested by an investigator during examination of the site and 48. Having studied the relationship between the the body. According to the Criminal Procedure distance from villages to the local outpatient Code currently in force in Ukraine, forensic clinics and frequency of visits to the clinics medical examination is required when it is among the rural population of this area, it was necessary to determine the: determined that the rank correlation coefficient in A.* Cause of death this case equals -0.9. How can this relationship be B. Mode of death characterized? C. Time of death A.* Strong inverse relationship D. Mechanism of death B. - E. Manner of death C. Moderate inverse relationship D. Strong direct relationship 53. A boy had a foreign body removed from under E. Moderate direct relationship his nail plate. 3 days later he developed a sharp throbbing pain at the end of his distal phalanx, 49. A 1.5-month-old child on breasfeeding which intensifies when the phalanx is pressed, presents from birth with daily vomiting, irregular hyperemia of the nail fold, elevated body liquid foamy feces, and meteorism, which are temperature up to 38.5°C, and nail plate resistant to antibacterial and probiotic therapy; no discoloration. Make the diagnosis: increase of body mass is observed. The child’s A.* Subungual panaritium condition improved, when breastmilk was B. Erysipelas substituted with "NAN low lactose” formula. C. Abscess What pathology is it? D. Paronychia A.* Lactase deficiency E. Erysipeloid B. Infectious enteritis C. Drug-induced enteritis 54. A 73-year-old woman came to the family D. Intestinal lambliasis (Giardiasis) physician for one of her regular follow-up E. Functional dyspepsia examinations. Three months ago she was found to have type 2 diabetes mellitus. She was keeping to 50. After overexposure to cold a 45-year- old her diet and exercise plan and taking woman developed acute pain in her suprapubic phytopreparations. On examination her fasting and lumbar areas during urination, sharp pains at glucose was within the range of 7.8- 8.6 mmol/L, the end of urination, false urges to urinate. Urine HbAlc - 7.9%. Height - 164 cm, weight - 83 kg. is turbid with blood streaks. The doctor suspects What blood sugar-controlling medicine should she urinary tract infection. What results of laboratory be prescribed first in the course of her analysis would be the most indicative of such pharmacological therapy? infection? A.* Metformin A.* Leukocyturia, gross hematuria B. Glibenclamide B. Increased blood creatinine and blood urea C. Gliclazide C. Gross hematuria D. Insulin D. Daily proteinuria over 3.0 E. Glimepiride E. Daily proteinuria under 3.0 55. A 35-year-old patient developed an epileptic 51. A 38-year-old woman complains of weakness, attack with tonoclonic spasms that lasted for 3 sleepiness, pain in the joints, weight gain despite minutes. After the attack the patient fell asleep but low appetite, and constipations. She presents with in 5 minutes the second attack occurred. The first dry and thickened skin, puffy and amimic face, step of emergency aid would be to: narrowed palpebral fissures, thick tongue, and A.* Ensure patency of airways deep hoarse voice. Her heart sounds are weak, B. Introduce diazepam intravenously pulse is 56/min. Low levels of free T4 are C. Prescribe antiepileptic drugs observed. This patient needs to take the following D. Administer chloral hydrate via an enema on a regular basis: E. Take blood from the vein for analysis A.* Thyroxine 56. For three years a 31-year-old woman has been stimulating hormone (THS). What is the most complaining of pain and swelling of her likely diagnosis? radiocarpal and metacarpophalangeal articulations A.* Diffuse toxic goiter and their reduced mobility in the morning, which B. Thyroid adenoma persisted up to 1.5 hours. Two weeks ago she C. Autoimmune (Hashimoto’s) thyroiditis developed pain, swelling, and reddening of her D. Diffuse nontoxic goiter knee joints, her body temperature increased up to E. Thyroid carcinoma 37,5°C. The treatment was untimely. Examination of the internal organs revealed no pathologic 60. A parturient woman is 30 years old, stage I of alterations. Diagnosis of rheumatoid arthritis was the labor is ongoing. The fetus is in the cephalic made. What changes are most likely to be visible presentation. Auscultation of the fetal heart on the arthrogram? sounds detects bradycardia. Evaluation of A.* Joint space narrowing, usuration cardiotocogram yielded the following data: B. Numerous marginal osteophytes decrease of basal heart rate down to 90/min., C. Cysts in the subchondral bone variability - monotonous (2 and less); late D. Epiphyseal osteolysis decelerations with amplitude of 50/min. Make the E. Joint space narrowing, subchondral diagnosis and choose the obstetrical tactics osteosclerosis necessary in this case: A.* Fetal distress. Urgent cesarean section 57. A 32-year-old woman complains of tumorlike delivery formation on the anterior surface of her neck that B. Fetal distress. Vacuum extraction delivery appeared 2 years ago. Within the last 3 months the C. Normal condition of the fetus. Vaginal birth tumor has been rapidly growing. It hinders D. Fetal distress. Stimulation of uterine swallowing and impairs speech; the tumor causes contractions a sensation of pressure. Objectively the skin E. Fetal distress. Forceps delivery moisture is normal, pulse is 80/min., rhythmic, blood pressure is 130/80 mm Hg. In the right lobe 61. A chronic alcoholic was hospitalized into the of the thyroid gland there is a dense lumpy node therapeutic inpatient unit due to pneumonia. On 3.0x3.5 cm that moves during swallowing. the day 5 of his hospitalization he became Scanning image shows a "cold nodule” in the disoriented in time and space, developed fear- thyroid gland. Make the provisional diagnosis: inducing visual hallucinations and motor A.* Thyroid cancer agitation. Full body tremor and tremor of the B. Thyroid cyst limbs are observed. X-ray and physical C. Autoimmune thyroiditis examinations detect the signs of his convalescence D. Thyroid adenoma from pneumonia. What tactics should be chosen E. Nodular goiter regarding this patient? A.* Transfer into the inpatient narcology 58. A 26-year-old man complains of chills, department rhinitis, dry cough, and fever up to 38°C. B. Discharge from the hospital Examination shows him to be in a moderately C. Compulsory medical treatment for alcoholism severe condition; there are small pale pink non- D. Transfer into the neuroresuscitation department merging spots on the skin of his back, abdomen, E. Continue the treatment in the therapeutic and extremities. Palpation reveals enlarged department occipital and axillary lymph nodes. No information about vaccination history could be 62. A 25-year-old woman complains of fatigue, obtained. What is the likely etiology of this dizziness, hemorrhagic rashes on the skin. She has disease? been presenting with these signs for a month. A.* Rubella virus Blood test: erythrocytes - 1.0 · 1012/L, Hb- 37 B. Mumps virus g/L, color index - 1.1, leukocytes - 1.2 109/L, C. Streptococcus platelets - 42 · 109/L. What analysis would be the D. Epstein-Barr virus most advisable for diagnosis- making in this case? E. Neisseria meningitis A.* Sternal puncture (bone marrow biopsy) B. US of the gastrointestinal tract 59. A 32-year-old woman complains of body C. Coagulation studies weight loss despite her increased appetite, D. Splenic biopsy nervousness, and tremor of the extremities. E. Liver biopsy Objectively: the skin is moist; the thyroid gland is diffusely enlarged, painless, soft, and mobile. 63. A 19-year-old young man complains of cough Blood test: increased level of T3, T4, and thyroid- with expectoration of purulent sputum in the amount of 100 mL per day, hemoptysis, dyspnea, increased body temperature up to 37,8°C, general Objectively his skin is gray; there is a pink-gray weakness, weight loss. The patient’s condition stripe on his gums; the stomach is soft and sharply lasts for 4 years. Exacerbations occur 2-3 times a painful. Blood test detected erythrocytes with year. The patient presents with malnutrition, pale basophilic stippling and anemia. The patient has a skin, cyanosis of the lips, drumstick (clubbed) history of peptic ulcer disease of the stomach. fingers. Tympanic percussion sound in the lungs, Constipation tends to occur every 3-4 days. What weakened respiration, numerous various moist is the most likely provisional diagnosis? crackles in the lower pulmonary segments on the A.* Saturnism (lead poisosning) left can be observed. In blood: erythrocytes - 3.2 B. Acute appendicitis 1012/L, leukocytes - 8.4 109/L, ESR- 56 C. Chronic alcoholism mm/hour. On X-ray: lung fields are D. Perforation of gastric ulcer emphysematous, the left pulmonary root is E. Acute cholecystitis deformed and dilated. What is the most likely diagnosis? 68. A 3-month-old child with signs of rickets A.* Multiple bronchiectasis of the left lung presents with positive Chvostek, Trousseau, and B. Left-sided pulmonary cystic dysplasia Maslov signs. One day ago the parents witnessed C. Chronic left-sided pneumonia a cyanotic attack in their child - the child broke D. Chronic abscess of the left lung into a cold sweat, the eyes bulged, and respiratory E. Suppuration of the cyst in the left lung arrest occurred. One minute later the child drew in a loud breath and the child’s condition normalized 64. In the process of hiring, a prospective again. What is the cause of the described signs of employee has undergone preventive medical the disease? examination and was declared fit to work in this A.* Decrease of blood calcium levels manufacturing environment. What type of B. Increase of blood phosphorus levels preventive medical examination was it? C. Increase of blood calcium levels A.* Preliminary D. Metabolic acidosis B. Scheduled E. Decrease of blood phosphorus levels C. Specific D. Periodical 69. A 39-year-old man suffers from chronic E. Comprehensive rheumatic heart disease. He complains of dyspnea during physical exertion, cough with 65. A 45-year-old man was brought by an expectoration, and palpitations. Ausculation ambulance into the emergency hospital. He detects intensified I heart sound and diastolic complains of sudden pain in the lumbar area, murmur; the sound of opening mitral valve can be frequent painful urination, and vomiting. auscultated at the cardiac apex. The II heart sound Examination detects pain in the lumbar area, is accentuated over the pulmonary artery. The costovertebral angle tenderness, pain on palpation patient is cyanotic. X-ray shows dilated of kidneys and along the ureter on the right. Urine pulmonary root and enlargement of the right test: proteins, fresh erythrocytes, leukocytes. ventricle and left atrium. What is the most likely Make the provisional diagnosis: diagnosis? A.* Urolithiasis, renal colic A.* Mitral stenosis B. Polycystic kidney disease B. Aortic stenosis C. Acute pyelonephritis C. Patent ductus arteriosus D. Acute glomerulonephritis D. Coarctation of the aorta E. Acute renal failure E. Pulmonary artery stenosis 66. After eating shrimps, a 25-year-old man 70. A 48-year-old woman developed insomnia, suddenly developed skin itching, some areas of depressive mood, anxiety, fears and suicidal his skin became hyperemic or erupted into thoughts after the death of her husband that vesicles. Make the diagnosis: occurred one month ago. During her stay in the A.* Acute urticaria hospital she speaks in a low voice, is depressed, B. Psoriasis anxious, avoids sleeping, refuses to eat. What C. Scabies medications should be prescribed in this case? D. Hemorrhagic vasculitis (Henoch-Schonlein A.* Antidepressants purpura) B. Group B vitamins E. Urticaria pigmentosa C. Anticonvulsants D. Nootropics 67. A 39-year-old man, a battery attendant, E. Antipsychotics suddenly developed weakness, loss of appetite, nonlocalized colicky abdominal pains, and nausea. 71. A 30-year-old man was brought to the B. Hypoglycemic shock neurosurgical department with complaints of C. Gastrointestinal hemorrhage constant headaches, nausea, vomiting, fever, and D. Ischemic stroke weakness of the right-side limbs. Anamnesis E. Meningoencephalitis states that one month ago the patient had a surgery for left-sided suppurative otitis and mastoiditis. 75. A 56-year-old woman was diagnosed with He has been undergoing treatment in an ENT stage 2 hypertension of the 2nd degree. She department. Approximately 2 weeks ago the belongs to the group of moderate risk and has temperature increased, and the patient developed bronchial asthma. What group of drugs is headaches. Objectively: heart rate - 98/min., BP- CONTRAINDICATED to this patient? 140/90 mm Hg, temperature - 38.3°C. A.* β-blockers Neurologically manifested stiff neck: bilateral B. Imidazoline receptor antagonists Kernig’s symptom, unsteadiness during the C. Diuretics Romberg’s maneuver. Computer tomography of D. Angiotensin-converting enzyme inhibitors the brain revealed a three- dimensional growth E. Calcium antagonists with a capsule in the left hemisphere. Make the diagnosis: 76. To assess the effectiveness of medical A.* Cerebral abscess technologies and determine the power and B. Hydrocephalus direction of their effect on the public health C. Echinococcus indicators, the research was conducted to study D. Arnold-Chiari malformation the immunization rate of children and measles E. Hemorrhage incidence rate by district. What method of statistical analysis should be applied in this case? 72. A 22-day-old infant developed subcutaneous A.* Calculation of correlation coefficient red nodes from 1.0 to 1.5 cm in size on the scalp; B. Calculation of morbidity index among the later the nodes suppurated. Temperature increased nonvaccinated up to 37.7 °C, intoxication symptoms appeared, C. Calculation of statistical significance of the regional lymph nodes enlarged. Complete blood difference between two estimates count: anemia, leukocytosis, neutrocytosis, D. Calculation of standardized ratio increased ESR. What diagnosis can be made? E. Calculation of matching factor A.* Pseudofurunculosis B. Vesiculopustulosis 77. The bums unit received a patient, who 6 hours C. Scalp phlegmon ago during a fire received flame burns. On the D. - patient's body there is gray- brown area of E. Pemphigus necrosis that covers 3/4 of the body perimeter. Occasionally there are small blisters with 73. A 58-year-old woman came to the hemorrhagic contents and patches of shredded gynecological clinic. She complains of bloody epidermis. What local therapy is necessary in this discharge from her genital tracts. Menopause is 8 case? years. Gynecological examination: the uterus is A.* Decompression necrectomy slightly enlarged, dense to touch, with limited B. Necrectomy with dermal autograft mobility; the uterine appendages cannot be C. Blister puncture detected; parametrium is free. Fractional curettage D. Necrectomy with xenotransplantation of the uterine cavity yields a significant amount of E. Chemical necrolysis medullary substance in the scrape. What is the most likely diagnosis? 78. A 43-year-old man complains of a protrusion A.* Uterine corpus cancer in the right inguinal region, that enlarges due to B. Uterine cervix cancer strain. He has been presenting with this condition C. Chorioepithelioma for 6 months. Within this period the protrusion has D. Adenomyosis grown. Objectively in the right inguinal region an E. Hormone-producing ovarian tumor elastic protrusion 8x5 cm is visible. On palpation it disappears, leaving an empty space 4x4 cm 74. A woman undergoing in-patient treatment for between the pedicles of the Poupart ligament. viral hepatitis type B developed headache, nausea, ’’Cough push” sign is positive over this opening. recurrent vomiting, memory lapses, flapping Make the diagnosis: tremor of her hands, and rapid putee. Sweet smell A.* Right-sided reducible inguinal hernia from her mouth is detected. Body temperature is B. Cyst of the right spermatic cord 37.6°C, heart rate is 89/min. What complication C. Right-sided inguinal lymphadenitis developed in the patient? D. Right-sided reducible femoral hernia A.* Acute liver failure E. Right-sided reducible arcuate line hernia  D. At the site of the accident; first-response 79. A 25-year-old woman has been suffering from emergency teams" diabetes mellitus since she was 9. She was E. In medico-prophylactic institutions; specialized admitted into the nephrology unit with significant second-response emergency teams" edemas of the face, arms, and legs. Btood pressure - 200/110 mm Hg, Hb- 90 g/L, blood creatinine - 83. A 20-year-old man was hospitalized on the 9th 850 mcmol/L, urine proteins - 1.0 g/L, leukocytes day of the disease. He attributes his disease to - 10-15 in the vision field. Glomerular filtration eating of insufficiently thermally processed pork. rate - 10 mL/min. What tactics should the doctor At its onset this condition manifested as choose? periorbital edemas and fever. Objectively his body A.* Transfer into the hemodialysis unit temperature is 38.5°C. The face is puffy and the B. Active conservative therapy for diabetic eyelids are markedly swollen. Palpation of nephropathy gastrocnemius muscles is sharply painful. Blood C. Dietotherapy test shows hypereosinophilia. What is the etiology D. Transfer into the endocrinology clinic of this disease? E. Renal transplantation A.* Trichinella B. Ascarididae 80. A 72-year-old man with pneumonia complains C. Trichuris of marked dyspnea, chest pain, severe cough with D. Echinococci expectoration, t° is 39.5-40°C, no urination for a E. Leptospira whole day. Objectively the patient is conscious. Respiratory rate is 36/min. Over the right lower 84. A newborn girl has Apgar score of 7-8 points pulmonary lobe percussion sound is dull; on at the 1-5 minutes after birth. During the labor auscultation there is bronchial respiration and there was a brief difficulty with extraction of the numerous moist crackles. Blood pressure is 80/60 shoulder girdle. After birth the baby presents with mm Hg. Heart rate is 120/min. Heart sounds are disturbed function of the proximal segment and muffled, there is tachycardia. What tactics should forced position of the right arm. The shoulder is the family doctor choose in the management of rotated inwards, the elbow is extended, the this patient? forearm is pronated, and the whole upper limb A.* Hospitalization into the intensive care unit resembles an arm of a doll. What is the most B. Outpatient treatment likely clinical diagnosis in this case? C. Hospitalization into the neurology unit A.* Erb-Duchenne palsy D. Treatment in the day patient facility B. Osteomyelitis of the right arm E. Hospitalization into the pulmonology unit C. Intracranial hemorrhage D. Soft tissue injury of the right arm 81. A 42-year-old man, a dispatcher, suffes from E. Thoracic spine trauma peptic ulcer disease of the duodenum. The disease is of moderate severity. He wants to be assigned a 85. A 33-year-old man developed multiple rashes disability group. Make the conclusion regarding on the skin of his torso and extensor surfaces of his working ability: his upper and lower limbs. The rashes itch and A.* Capable of working, employable occasionally fuse together and form plaques. The B. Second group of disability elements of rash are covered with silver-white fine C. Third group of disability scales that easily flake off when scratched. D. First group of disability Grattage test results in three sequential E. Capable of working, non-employable phenomena: stearin spot, terminal film, and punctate hemorrhage. What diagnosis can be 82. At the railroad crossing a passenger train suspected? collided with a bus. In this collision 26 bus A.* Psoriasis passenges died, another 18 passengers received B. Pyoderma mechanical injuries of varying severity. Where C. Parapsoriasis will be professional medical aid provided for the D. Lichen ruber planus victims of this accident? Who will provide this E. Secondary papular syphilid aid? A.* In medico-prophylactic institutions; general 86. A man was brought into the admission room physicians and surgeons" after an overexposure to cold. He complains of B. In medical institutions; all listed types of sharp pain in the small of his back and elevated healthcare workers" body temperature up to 38°C. He took some C. At the site of the accident; specialized second- aspirin. Blood test: leukocytes - 10.5 1012/L, response emergency teams" eosinophils - 5%, band neutrophils - 8%, segmented neutrophils - 51%, lymphocytes - 32%, monocytes - 4%, erythrocyte sedimentation rate - D. A foreign body in the right bronchus, partial 28 mm/hour. Urinalysis: protein - 0.6 g/L, bronchostenosis leukocytes - cover the whole vision field, large E. A foreign body in the left bronchus, complete amount of mucus. What is the most likely bronchostenosis diagnosis? A.* Acute pyelonephritis 90. A 35-year-old pregnant woman with degree 1 B. Tubulointerstitial nephritis essential hypertension, developed edemas and C. Chronic pyelonephritis headache at the 33 week of her pregnancy. D. Acute glomerulonephritis Objectively her general condition is satisfactory, E. Subacute malignant glomerulonephritis blood pressure - 160/100 mm Hg, normal uterine tone. Fetal heart rate is 140/min., rhythmic. She 87. At night a 2-year-old child with upper was diagnosed with daily proteinuria - 4 g/L, daily respiratory tract infection suddenly developed diuresis - 1100 mL. Creatinine - 80 mcmol/L, urea dyspnea with labored inspiration. Objectively the - 7 mmol/L, platelets - 100 · 109/L. What skin is pale, perioral cyanosis and slight complication of pregnancy occurred? acrocyanosis are observed. Breathing is loud, A.* Moderate preeclampsia respiration rate is 32/min. Jugular, supra- and B. Hypertensive crisis infraclavicular fossae retract during breathing. C. Mild preeclampsia Respiration is coarse on auscultation. Heart D. Renal failure sounds are clear and sonorous, heart rate is E. Severe preeclampsia 120/min. What condition was complicated by the development of the upper respiratory tract 91. A 35-year-old woman complains of high body infection? temperature and pain in the upper outer quadrant A.* Stenosing laryngotracheitis of her right buttock, which developed after an B. Obstructive bronchitis injection. She has been presenting with this C. Airway foreign body condition for 3 days. At the site of injection the D. Bronchial asthma skin is hyperemic; there is a painful infiltrate with E. Bronchiolitis an area of softening in its center. The woman is diagnosed with a postinjection abscess of the right 88. Clinical trials have proved the ’’Lipoflavon” buttock. What tactics should the surgeon choose drug to be effective for treatment of unstable in this case? angina pectoris in the control group and A.* Abscess incision, sanation and drainage of the experimental group of patients. Neither patients cavity nor researchers knew who belonged to which B. Antipyretic agents, massage, and application of group. Name this type of study: dry heat to the right buttock A.* Double blind study C. Hospitalization, prescription of antibiotics, B. Simple blind study UHF C. Total-blind study D. 10-15 minutes of low-intensity laser radiation D. Triple-blind study directed at the right buttock E. Multicenter study E. Abscess puncture, pus removal followed by application of antiseptics 89. A 5-year-old child was brought to the ENT department by an ambulance. The child presents 92. Heart X-ray of a 31-year-old man has revealed with cough and difficult respiration. From the the following: with tightly filled opacified patient’s history it is known that the child was esophagus there is a marginal filling defect in its playing with a toy construction set, when middle third on the posterior wall; the defect is suddenly started coughing and developed labored 1.8x1.3 cm in size with clear oval border. Mucosal breathing. Examination detects periodical cough, folds are retained and envelop the defect; wall labored expiration, and respiratory lag in the left peristalsis and elasticity are not affected. There side of the child’s thorax. Auscultation: are no complaints regarding the condition of the diminished respiration on the left. Percussion: patient’s alimentary canal. Make the provisional tympanitis. X-ray shows a displacement of the diagnosis: mediastinal organs to the right. Make the A.* Esophageal tumor diagnosis: B. Esophageal burns A.* A foreign body in the left bronchus, valvular C. Diverticulum bronchostenosis D. Barrett esophagus B. A foreign body in the right bronchus, valvular E. Achalasia cardiae bronchostenosis C. A foreign body in the trachea 93. A 57-year-old woman complains of weakness, dyspnea, loss of appetite, and liquid feces. She has been suffering from this condition for 2 years. Objectively she presents with pale skin, subicteric 97. A 48-year-old woman complains of disturbed sclerae, and bright- red fissured tongue. Lymph menstrual cycle: her periods last for 7-9 days and nodes are not enlarged. Pulse - 100/min. BP- are excessively profuse throughout the last half- 105/70 mm Hg. Liver +3 cm, the spleen cannot be year. She notes occasional hot flashes in her head, palpated. Blood test: erythrocytes - 1.2 1012/L, insomnia, irritability, and headaches. Her skin is Hb- 56 g/L, color index - 1.4, macrocytes, of normal color. Blood pressure -150/90 mm Hg, leukocytes - 2,5 · 109/L, eosinophils - 1%, pulse - 90/min., rhythmic. The abdomen is soft juvenile - 1%, metamyelocytes - 1%, band and painless. Bimanual examination shows no neutrophils - 8%, segmented neutrophils - 47%, uterine enlargement, the appendages cannot be lymphocytes - 38%, monocytes - 4%, detected. The vaginal fornices are free. What is reticulocytes - 0.1%, platelets - 100 109/L, ESR- the most likely diagnosis? 30 mm/hour, indirect bilirubin - 26 mmol/L. What A.* Climacteric syndrome changes can be expected in the bone marrow B. Stein-Leventhal syndrome (polycystic ovary puncture material? syndrome) A.* Prevalence of megaloblasts C. Uterine myoma B. Presence of blast cells D. Adrenogenital syndrome C. Increased number of sideroblasts E. Premenstrual syndrome D. Erythroid hyperplasia E. Prevalence of lymphoid tissue 98. A 57-year-oid woman during a regular ultrasound examination presented with a space- 94. A woman in her early- to mid-thirties has lost occupying heterogeneous lesion in the right her consciousness 3-5 minutes ago. On kidney. What is the most informative method of examination: the skin is pale, no pulse over the renal tumor diagnostics? carotid arteries, no spontaneous respiration, pupils A.* Spiral computed tomography are dilated; the patient is nonresponsive, presents B. Retrograde pyelography with atony. The patient’s condition can be C. Three glass urine test determined as: D. Excretory urography A.* Clinical death E. Radioisotope renography B. Comatose state C. Natural death 99. A 72-year-old man complains of lower D. Syncope extremity edema, sensation of heaviness in the E. Brain death right subcostal area, dyspnea at rest. For over 25 years he has been suffering from COPD. 95. 3 hours after a trauma, a young man developed Objectively: orthopnea, jugular venous distention, bradycardia of 46/min., anisocoria D>S, hemi- diffuse cyanosis, acrocyanosis. Barrel chest is hyperreflexia S>D, hemihypesthesia on the left, observed, on percussion there is a and a convulsive disorder. The character of this vesiculotympanitic (bandbox) resonance, sharply process needs to be clarified. What method of weakened vesicular respiration on both sides, examination will be the most accurate for this moist crepitant crackles in the lower segments of purpose? the lungs. Heart sounds are weakened, the II heart A.* Brain CT sound is accentuated over the pulmonary artery. B. Skull X-ray The liver is +3 cm. What complicated the clinical C. Echoencephalography course of COPD in this patient? D. Lumbar puncture A.* Chronic pulmonary heart E. Electroencephalography B. Community-acquired pneumonia C. Pulmonary embolism 96. During regular preventive gynecological D. Acute left ventricular failure examination a 30-year-old woman was detected to E. Diffuse pneumosclerosis have dark blue punctulated ’’perforations” on the vaginal portion of the uterine cervix. The doctor 100. A 55-year-old woman complains of pain and suspects endometriosis of the vaginal portion of popping sounds in her left knee joint, which occur the uterine cervix. What investigation method when she climbs the stairs. Occasionally during would be most informative for diagnosis movements her joint becomes ’’stuck’.’ 5 years confirmation? ago she suffered a trauma of her left knee. A.* Colposcopy, target biopsy of the cervix Complete blood count and biochemical blood B. Hysteroscopy analysis show normal results. X-ray shows C. US of the lesser pelvis marked osteosclerosis and osteophytes. The joint D. Curettage of the uterine cavity space is narrowed. Make the provisional E. Hormone testing diagnosis: A.* Osteoarthritis practically no contraction of the gallbladder. Make B. Rheumatoid arthritis the provisional diagnosis: C. Gouty arthritis A.* Hypokinetic biliary dyskinesia D. Reactive arthritis B. Chronic pancreatitis E. Psoriatic arthritis C. Chronic hepatitis D. Hyperkinetic biliary dyskinesia 101. A 47-year-old man developed the signs of E. Acute pancreatitis decompensated laryngeal stenosis against the background of acute flegmonous laryngitis. He 105. A 45-year-old man diagnosed with acute presents with inspiratory dyspnea at rest, forced pulmonary abscess suddenly developed sharp pain position, cyanotic skin covered in cold sweat, in his chest on the right and dyspnea up to 30/min. tachycardia, deficient pulse, and low blood Examination detects facial cyanosis and shallow pressure. What urgent treatment tactics should be rapid respirations. Auscultation reveals acutely chosen? weakened respiration throughout the whole right A.* Tracheostomy lung; percussion reveals a vesiculotympanitic B. Administration of glucocorticoid hormones (bandbox) resonance at the lung apex and dullness C. Oral administration of hyposensitization in the lower lobe. What complication developed in substances and broncholytics this patient? D. Oxygen therapy A.* Pyopneumothorax E. Intravenous administration of dehydrating B. Acute mediastinitis agents C. Pneumothorax D. Esophageal perforation 102. A patient has the second and third degree E. Pleuropneumonia burns of the 15% of the body surface. On the 20th day after the trauma the patient presents with 106. A 40-year-old victim of a traffic accident sharp increase of body temperature, general sustained the following injuries: closed diaphyseal weakness, rapid vesicular respiration; facial femur fracture, brain concussion, multiple rib features are sharpened, BP is 90/50 mm Hg, heart fractures, hemopneumothorax, degloving shin rate is 112/min. What complication is it? injuries. What injuries require the most urgent A.* Sepsis attention? B. Purulent bronchitis A.* Multiple rib fractures, hemopneumothorax C. Acute intoxication B. All injuries are equivalent D. Anaerobic infection C. Closed diaphyseal femur fracture E. Pneumonia D. Degloving shin injuries E. Brain concussion 103. A 38-year-old woman developed a medical condition 7 days after her return from Bangladesh. 107. In the inpatient gynecological unit within a Periodical elevation of temperature was year 6500 women underwent treatment. They accompanied by chills and excessive sweating. spent there a total of 102000 bed-days. What She was diagnosed with tropical malaria. Next indicator of the gynecological unit work can be day her condition further deteriorated: body calculated based on these data? temperature - 38°C, inertness, periodical loss of A.* Average length of inpatient stay consciousness, generalized seizures, tachycardia, B. Average bed occupancy rate per year hypotension, and icteric skin. What complication C. Planned bed occupancy rate per year can be suspected in this case? D. Bed turnover rate A.* Cerebral coma E. Number of beds by hospital department B. Serous meningitis C. Acute hepatic failure 108. After a surgery for a left thigh phlegmon the D. Acute heart failure disease progression was complicated by sepsis. E. Purulent meningitis On the 7th day after the surgery there are marked signs of a generalized inflammatory reaction, in 104. A 13-year-old girl for a month has been blood there are signs of toxic anemia and complaining of fatigability, dull pain in her right progressing hypoproteinemia, bilirubin levels are subcostal area, abdominal distension, and 40 mcmol/L, AST and ALT exceed the norm by constipations. Abdominal palpation reveals 2.5 times. Oliguria persists (700 mL of urine per positive Kehr, Murphy, and Ortner signs, while day). Name the phase of sepsis progression: Desjardins and Mayo-Robson points are painless. A.* Catabolic phase Total bilirubin is 14.7 mcmol/L, predominantly B. Anabolic phase indirect, ALT- 20 U/L, AST- 40 U/L, amylase - C. Stress phase 6.3 mmol/L. Echocholecystography shows D. Recovery phase E. Mixed phase Echocardioscopy detects aortic dextraposition, ventricular septal defect, pulmonary artery 109. A 48-year-old woman has arrived to the stenosis, and right ventricular hypertrophy. What surgical unit with wounds in her thigh. On is the most likely diagnosis? examination the wound surface has dirty-gray A.* Tetrad of Fallot coating with unpleasant sweet smell. Wound B. Transposition of the great vessels content resembles raspberry jelly. Skin tissues C. Acquired valvular disease around the wound are glossy and turgid. Palpation D. Coarctation of the aorta reveals moderate crepitation in the tissues. What E. Ventricular septal defect microflora is the most likely to cause such inflammation? 114. Indicators of work of inpatient departments A.* Anaerobic clostridial in the city hospitals for the past year were B. Blue pus bacillus analyzed. After that the meeting was held at the C. Streptococci central city hospital and, based on the results of D. Anaerobic non-clostridial the analysis, a decision was made to decrease the E. Staphylococci number of beds in the inpatient departments, and instead open daycare units with partial 110. A 9-month-old infant presents with delayed hospitalization in the city polyclinics. What is the tooth eruption and fontanel closure, weakness, and main goal of this decision? excessive sweating. What type of hypovitaminosis A.* Rational use of the bed fund is the most likely in this child? B. Decreased mortality during inpatient treatment A.* Hypovitaminosis D C. Decrease of the length of inpatient stay B. Hypovitaminosis B6 D. Optimization of the average bed occupancy C. Hypovitaminosis C rate per year D. Hypovitaminosis B1 E. Intensification of the bed fund usage E. Hypovitaminosis A 115. Clinical statistical investigation was 111. A 20-year-old student after failing an exam performed to determine effectiveness of a new developed complaints of a sensation of a round pharmacological preparation for patients with foreign body in her throat, difficult swallowing. ischemic heart disease. What parametric test She fixates on her condition, limits her diet, often (coefficient) can be used to estimate the reliability cries, seeks attention, exhibits demonstrative of the results? attitude. She is highly susceptible to A.* Student’s t-distribution psychotherapeutic suggestion. What psychiatric B. Wilcoxon signed-rank test diagnosis can be made in this case? C. Matching factor A.* Hysterical neurosis D. Kolmogorov-Smirnov test B. Paranoid personality disorder E. Sign test C. Depressive neurosis D. Hypochondriacal neurosis 116. Disease onset was acute. A child developed E. Obsessive neurosis general weakness, pain in the joints, and elevated temperature. Later these signs became 112. A 45-year-old man developed constricting accompanied by itching skin rash manifested as retrosternal pain that occurs during walks at the erythematous spots 2- 5 mm in size. The rash distance of 200 m. Objectively: heart rate is gradually turned hemorrhagic. Large joints are 80/min., BP is 160/90 mm Hg. During painful and swollen; pain attacks periodically cardiopulmonary exercise test at 50 W there is a occur in the paraumbilical area; there are signs of depression of S-T segment by 3 mm below the intestinal hemorrhage. What is the most likely isoline in V3-V4. What is the provisional diagnosis? diagnosis? A.* Hemorrhagic vasculitis (Henoch-Schonlein A.* Exertional angina pectoris, functional class III purpura) B. Alcoholic myocardiodystrophy B. Scarlet fever C. Somatoform autonomic dysfunction, C. Rheumatism hypertension type D. Hemorrhagic meningoencephalitis D. Exertional angina pectoris, functional class II E. Streptococcal impetigo E. Exertional angina pectoris, functional class IV 117. Employees work in conditions of high dust 113. A 3-year-old child presents with dyspnea that concentration. Certain chemical (silicon dioxide abates in the sitting position, occasional loss of content) and physical properties of dust aerosols consciousness and seizures, delayed physical contribute to the development of occupational development, cyanosis, drumstick fingers. dust-induced diseases. What is the main physical extremities is dry. No pulse can be detected on the property of dust aerosols? pedal arteries, while pulsation of the femoral A.* Dispersion arteries is retained. What is the most likely B. Solubility diagnosis? C. Magnetization A.* Obliterating endarteritis D. Electric charge B. Deep thrombophlebitis E. Ionization C. Leriche syndrome (aortoiliac occlusive disease) D. Raynaud disease 118. A 2-year-old child with persisting cough and E. Diabetic angiopathy subfebrile body temperature after a case of URTI developed dyspnea, cyanosis of the nasolabial 122. A young man has made an appointment with triangle, percussion dullness and weakened the dermatologist. He complains of a painful respiration in the lower lobe of the right lung, and facial rash in the beard and mustache area. This a slight mediastinal displacement to the left. What condition has been persisting for several weaks pulmonary pathology is likely to cause this already. After shaving, the patient’s condition clinical presentation? aggravates. Tire diagnosis of sycosis is made. A.* Pleurisy What primary morphological elements can be B. Pneumonia observed in the rash in this case? C. Bronchitis A.* Pustules, papulae D. Emphysema B. Maculae, nodes E. Atelectasis C. Nodes, nodules D. Phlyctenae, maculae 119. A 38-year-old woman works in flax E. Pustules, bumps processing, she dries flax. She came to the hospital complaining of difficult breathing, 123. A woman with the pregnancy term of 8 constricting sensation in her chest, and cough weeks complains of elevated temperature up to attacks. These signs appear on the first day of her 37.6°C, skin rash that can be characterized as working week and gradually diminish on the macular exanthema, enlargement of posterior following days. What respiratory disease is likely cervical and occipital lymph nodes, small amount in this case? of bloody discharge from the genital tracts. She A.* Byssinosis was examined by the infectious diseases specialist B. Allergic rhinopharyngitis and diagnosed with rubella. What tactics should C. Bronchial asthma the obstetrician-gynecologist choose ? D. Asthmatic bronchitis A.* Abortion E. Silicosis B. Treatment of incipient abortion C. Prescription of hemostatic therapy 120. A 23-year-old man complains of facial D. Prescription of antibacterial therapy edemas, headache, dizziness, low urinary output, E. Prescription of antiviral therapy and urine discoloration (dark red). These complaints arose after a case of acute tonsillitis. 124. A 46-year-old woman came to the maternity On examination there are facial edemas, the skin clinic with complaints of moderate blood is pale, temperature is 37.4°C; heart rate is discharge from the vagina, which developed after 86/min., blood pressure is 170/110 mm Hg. Heart the menstruation delay of 1.5 months. On vaginal sounds are muffled, the II heart sound is examination: the cervix is clean; the uterus is not accentuated over the aorta. What etiological factor enlarged, mobile, painless; appendages without is the most likely in this case? changes. Make the diagnosis: A.* Beta-hemolytic streptococcus A.* Dysfunctional uterine bleeding B. Streptococcus pyogenes B. Submucous uterine myoma C. Staphylococcus saprophyticus C. Cancer of the uterine body D. Staphylococcus aureus D. Adenomyosis E. Streptococcus viridans E. Ectopic pregnancy 121. A 32-year-old man complains of pain in his 125. A 28-year-old man complains of skin rash legs that intensifies during walking, intermittent and itching on the both of his hands. The claudication, numbness of his toes, extremity condition persists for 1.5 years. The exacerbation coldness, and inability to walk more that 100 of his condition he ascribes to the occupational meters. When he sleeps, his leg usually hangs contact with formaldehyde resins. Objectively the down. The patient has been smoking since he was lesion foci are symmetrically localized on both 16. He drinks alcohol in excess. The left leg is hands. Against the background of erythema with colder than the right one; the skin of the blurred margins there are papulae, vesicles, erosions, crusts, and scales. What is the most 130. A 37-year-old man suddenly developed acute likely pathology? headache accompanied by nausea, vomiting, and A.* Occupational eczema impaired consciousness. Objectively blood B. Erythema multiforme pressure is 190/120 mm Hg, the face is C. Simple contact dermatitis hyperemic. Patient’s consciousness is clouded, his D. Idiopathic eczema answers to the questions are short, monosyllabic. E. Allergic dermatitis Movement and sensory disturbances are absent. Meningeal signs are positive. Cerebrospinal fluid 126. On the day 4 after the cesarean section a contains blood. What provisional diagnosis can be woman developed fever with body temperature up made? to 39°C and abdominal pain. Pulse - 104/min. She A.* Subarachnoid hemorrhage vomited twice. The patient is sluggish, her tongue B. Ischemic stroke is dry and has gray coating. The abdomen is C. Encephalitis distended. Signs of peritoneal irritation are D. Cerebral vascular embolism positive in all segments. Peristalsis cannot be E. Meningitis auscultated. No passage of gas occurs. Uterine fundus is located at the level of the navel. The 131. A patient is being treated in the tuberculosis uterus is painful on palpation. The discharge is clinic. Throughout the last 3 weeks he has been moderate and contains blood and pus. What is the suffering from headaches of increasing intensity. most likely diagnosis? Neurological examination detects nuchal rigidity A.* Diffuse peritonitis without focal signs. Make the provisional B. Pelvic peritonitis diagnosis: C. Metroendometritis A.* Tuberculous meningitis D. Progressive thrombophlebitis B. Convexital arachnoiditis E. Parametritis C. Myelitis D. Chorea minor 127. Increased general morbidity of the local E. Brain tumor population is observed in the area near a factory, where atmosphere is being intensively polluted 132. A 24-year-old woman, a kindergarten with sullurous gas. What effect does polluted air teacher, has been sick for 2 days already. Disease have on human body in this case? onset was acute. She presents with elevated body A.* Chronic nonspecific temperature up to 38.0°C, pain attacks in her B. Acute nonspecific lower left abdomen, liquid stool in small amounts C. Acute specific with blood and mucus admixtures 10 times a day. D. Selective Pulse - 98/min., blood pressure - 110/70 mm Hg. E. Chronic specific Her tongue is moist and coated with white deposits. The abdomen is soft, the sigmoid colon 128. A 37-year-old patient complains of pain in is painful and spastic. Make the provisional the spinal column, reduced mobility. The diagnosis: condition persists for 7 years. ’’Sway back” is A.* Shigellosis observed, there is no movement in all spinal B. Escherichiosis regions. X-ray shows ’’bamboo spine” vertebral C. Rotavirus infection column. What is the most likely diagnosis? D. Yersiniosis A.* Ankylosing spondyloarthritis E. Salmonellosis should this infant be put to the B. Osteochondrosis breast? C. Spondylitis deformans D. Tuberculous spondylitis 133. A newborn has Apgar score of 9. When E. Spondylolisthesis should this infant be put to the breast? A.* In the delivery room 129. A 1-year-old child with a case of URTI B. After 2 hours suddenly developed noisy respirations with C. On the 2nd day difficult inspiration, intercostal retractions, and D. On the 3rd day barking cough on the 2nd night after the disease E. After 12 hours onset. What is the most likely diagnosis? A.* Stenosing laryngotracheobronchitis 134. A surgery unit received a person with an B. Acute pulmonary inflammation incised stab wound on the upper third of the right C. Acute bronchitis thigh. Examination detects an incised stab wound D. Bronchial asthma 3.0x0.5x2.0 cm in size on the inner surface of the E. Acute bronchiolitis upper third of the right thigh. Bright-red blood flows from deep within the wound in a pulsing temperature is 36.9°C; there is a coating on the stream. Characterize this type of bleeding: root of her tongue; the abdomen is moderately A.* Arterial distended and painful in the area of gallbladder B. Mixed projection. What examination would be the most C. Venous helpful for diagnosis-making? D. Capillary A.* Ultrasound E. Parenchimatous B. Duodenoscopy C. Duodenal intubation 135. A 25-year-old woman was brought into the D. Liver scanning gynecological department with profuse bloody E. Cholecystography discharge from her genital tracts. She is 12 weeks pregnant, the pregnancy is planned. Within the 138. A 23-year-old man complains of severe pain last 3 days she was experiencing pains in her in his left knee joint. Objectively the left knee lower abdomen that eventually started resembling joint is enlarged, with hyperemic skin, painful on cramps, she developed bleeding. Her skin is pale, palpation. Complete blood count: erythrocytes - pulse - 88/min.. blood pressure - 100/60 mm Hg, 3.8 1012/L, Hb-122 g/L, leukocytes - 7.4 body temperature - 36.8°C. Vaginal examination: 109/L, platelets - 183 109/L. Erythrocyte the uterus size corresponds with 11 weeks of sedimentation rate -10 mm/hour. Bleeding time pregnancy, the cervical canal allows inserting 1 (Duke method) - 4 min., Lee- White coagulation finger and contains fragments of the fertilized time - 24 min. Partial thromboplastin time ovum, the discharge is bloody and profuse. What (activated) - 89 seconds. Rheumatoid factor - is the most likely diagnosis? negative. What is the most likely diagnosis? A.* 12-week pregnancy, spontaneous abortion in A.* Hemophilia, hemarthrosis progress B. Hemorrhagic vasculitis (Henoch-Schonlein B. 12-week pregnancy, threatened spontaneous purpura), articular form abortion C. Thrombocytopathy C. Full-term pregnancy, term labor D. Werlhof disease (immune thrombocytopenia) D. Disturbed menstrual cycle, E. Rheumatoid arthritis hyperpolymenorrhea E. Disturbed menstrual cycle, amenorrhea 139. An 18-year-old patient always obeys others and adapts his needs to the demands of the people 136. A 34-year-old man complains of pale edema on whom he depends. He excessively defers to of the face, feet, shins, and lumbar area, elevated their wishes and makes them responsible for his blood pressure up to 160/100 mm Hg, and general wellbeing, cannot defend his interests and needs weakness. He has a clinical history of nonspecific support from other people. Such psychic profile ulcerative colitis. Objectively: pulse - 84/min., has been formed in the childhood, remains rhythmic, blood pressure - 165/100 mm Hg; unchanged, and hinders adaptation. What psychic edemas all over the body; the skin is pale and dry, disorder is observed in this patient? with low turgor. The kidneys cannot be palpated, A.* Dependent personality disorder on an attempt to palpate them they are painless. B. Psychopathy-like state Blood test: erythrocytes - 3.0 1012/L, Hb- 100 C. Markedly accentuated personality g/L, erythrocyte sedimentation rate - 50 mm/hour. D. Anankastic personality disorder Urinalysis: proteins - 3.5 g/L, erythrocytes - 7-10 E. Anxiety (avoidant) personality disorder in the vision field, leukocytes - 5-6 in the vision field. Daily proteinuria - 6 grams. What analysis 140. A 23-year-old man has accidentally should be conducted additionally to verify the swallowed brake fluid. After that he has been diagnosis? presenting with anuria for 5 days already; his A.* Gingival biopsy for the diagnosis of amyloid creatinine levels elevated up to 0.569 mmol/L. disease What treatment tactics should be chosen in this B. Survey and excretory urography case? C. Renal ultrasound A.* Hemodialysis D. Urinalysis for Bence-Jones protein B. Plasmapheresis E. Radioisotopic examination of kidneys C. Diuretics D. Antidotal therapy 137. A 52-year-old woman has been suffering for E. Detoxication therapy 2 years from dull, occasionally exacerbating pain in her right subcostal area, occurring after eating 141. A patient has gradually lost consciousness. high-fat foods, bitter taste in her mouth in the The skin is pale and dry. There is a smell of morning, constipations, and flatulence. ammonia from the mouth. Respirations are deep Objectively she has excess weight, her body and noisy. Heart sounds are muffled, pericardial friction rub is present. Blood pressure is 180/130 mm Hg. Blood test: Hb- 80 g/L, leukocytes - 12 · 145. A 13-year-old girl for the last two weeks has 109/L, blood glucose - 6.4 mmol/L, urea - 50 been complaining of dyspnea and shin and foot mmol/L, creatinine - 1200 mcmol/L, blood edemas that appear after a physical exertion. In osmolarity - 350 mOsmol/L. No urinary excretion. the morning the edemas significantly decrease. Make the diagnosis: Clinical examination revealed enlarged liver and A.* Uremic coma coarse systolic murmur over the heart area. Blood B. Acute renal failure test and urinalysis are without changes. What is C. Acute disturbance of cerebral circulation the most likely cause of edemas in this child? D. Hyperglycemic coma A.* Heart failure E. Hyperosmolar coma B. Angioneurotic edema C. Acute pyelonephritis 142. A 23-year-old woman came to the D. Hepatic cirrhosis gynecological clinic. She complains of pain, E. Nephrotic syndrome itching, and burning in her vulva, general weakness, indisposition, elevated body 146. A 28-year-old woman complaining of temperature up to 37.2°C, and headache. On irregular menstruations and infertility came to the examination in the vulva there are multiple gynecological clinic. Menstruations occur since vesicles up to 2-3 mm in diameter with clear the age of 15, irregular, with delays up to 2 contents against the background of hyperemia and months. On examination she presents with marked mucosal edema. Make the provisional diagnosis: hirsutism and excessive body weight. On vaginal A.* Genital herpes infection examination the uterus is reduced in size and B. Vulvar cancer painless. The ovaries on the both sides are dense C. Primary syphilis and enlarged. Ultasound shows microcystic D. Cytomegalovirus infection changes in the ovaries, the ovaries are 5x4 cm and E. Papillomavirus infection 4.5x4 cm in size with dense ovarian capsule. Basal body temperature is monophasic. What is 143. A 58-year-old man complains of weakness the most likely diagnosis? and tumor-like formations that appeared on the A.* Polycystic ovary syndrome anterior surface of his neck and in the inguinal B. Ovarian carcinoma region. Palpation detects soft painless mobile C. Bilateral adnexitis cervical and inguinal lymph nodes up to 2 cm in D. Krukenberg tumor diameter. The liver protrudes by 2 cm from the E. Endometrioid cysts edge of the costal margin, the lower splenic pole is at the umbilical level. In blood: erythrocytes - 147. A 57-year-old patient complains of dyspnea 3.5 1012/L, Hb- 88 g/L, leukocytes - 86 109/L, at rest. The patient presents with orthopnea, band neutrophils -1%, segmented neutrophils - acrocyanosis, bulging cervical veins. On 10%, lymphocytes - 85%, eosinophils - 2%, percussion: dull sound over the lower lung basocytes - 0%, monocytes - 2%, erythrocyte segments. On auscultation: no respiratory sounds. sedimentation rate - 15 mm/hour, Gumprecht Heart rate is 92/min. Right-sided cardiac dilatation shadows. What is the most likely diagnosis? is observed. The liver is +7 cm. Shins are swollen. A.* Chronic lymphatic leukemia Pleural effusion is suspected. What indicator B. Lymphocytic leuke