Dr.

ASHIQ TUTORAL

ONLINE EXAM
PRE KROK 2 MEDICINE

TIMING; 2 HRS 40 MIN

“EXAMS WILL TEST NOT ONLY YOUR KNOWLEDGE BUT ALSO YOUR STATE OF MIND.
SO CALM DOWN AND BE RELAXED. BECAUSE YOU ARE TRULY THE BEST”

NOTE: This is for your self-evaluation purpose, Don’t cheat yourself

1. A 62-year-old woman was brought into the
admission room with complaints of severe
burning retrosternal pain and asphyxia. She has
a 10-year-long history of essential hypertension.
Objectively her condition is moderately severe.
She presents with skin pallor, cyanotic lips, and
vesicular respiration over her lungs. The II heart
sound is accentuated over the aorta. Blood
pressure - 210/120 mm Hg, heart rate (pulse) -
76/min. ECG shows elevation of ST segment in
the leads I, AVL, and V5-V6. What is the most
likely diagnosis?
A. Hypertensive crisis complicated with acute
myocardial infarction
B. Uncomplicated hypertensive crisis
C. Hypertensive crisis complicated with instable
angina pectoris
D. Hypertensive crisis complicated with acute
left ventricular failure
E. Pulmonary embolism
2. A 35-year-old patient developed an epileptic
attack with tonoclonic spasms that lasted for 3
minutes. After the attack the patient fell asleep
but in 5 minutes the second attack occurred.
The first step of emergency aid would be to:
A Prescribe antiepileptic drugs
B. Take blood from the vein for analysis
C. Introduce diazepam intravenously
D. Ensure patency of airways
E. Administer chloral hydrate via an enema
3. A 27-year-old woman, a teacher in the
elementary school, complains of frequent
stools, up to 3 times per day, with lumpy feces
and large amount of mucus, abdominal pain
that gradually abates after a defecation,
irritability. Her skin is pale and icteric. Pulse is
74/min., rhythmic, can be characterized as
satisfactory. Blood pressure is 115/70 mm Hg.
The abdomen is soft, moderately tender along
the colon on palpation. Fiberoptic colonoscopy
detects no changes. What disease can be
suspected?
A. Chronic enteritis
B. Chronic non-ulcerative colitis
C . Irritable bowel syndrome
D. Crohn disease (regional enteritis)
E. Whipple disease
4. A 72-year-old man complains of lower
extremity edema, sensation of heaviness in the
right subcostal area, dyspnea at rest. For over
25 years he has been suffering from COPD.
Objectively: orthopnea, jugular venous
distention, diffuse cyanosis, acrocyanosis.
Barrel chest is observed, on percussion there is
a vesiculotympanitic (bandbox) resonance,
sharply weakened vesicular respiration on both
sides, moist crepitant crackles in the lower
segments of the lungs. Heart sounds are
weakened, the II heart sound is accentuated
over the pulmonary artery. The liver is +3 cm.
What complicated the clinical course of COPD in
this patient?
A. Pulmonary embolism
B Chronic pulmonary heart
C. Acute left ventricular failure
D. Diffuse pneumosclerosis
E. Community-acquired pneumonia
5. A 72-year-old man with pneumonia
complains of marked dyspnea, chest pain,
severe cough with expectoration, t o is 39.5-
40oC, no urination for a whole day. Objectively
the patient is conscious. Respiratory rate is
36/min. Over the right lower pulmonary lobe
percussion sound is dull; 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 in the management of this
patient?
A. Hospitalization into the intensive care unit
B. Outpatient treatment
C. Treatment in the day patient facility
D. Hospitalization into the pulmonology unit
E. Hospitalization into the neurology unit
6. 2 hours after eating unknown mushrooms, a
28-year-old man sensed a decrease in his
mobility and deterioration of his ability to focus.
This condition was then followed by a state of
agitation and agression. On examiantion he is
disoriented and his speech is illegible. 4 hours
later he developed fetor hepaticus and lost his
consciousness. What syndrome can be
observed in this patient?
A. . Cytolytic syndrome
B. Hepatolienal syndrome
C. Portal hypertension
D. Cholestatic syndrome
E Acute hepatic failure
7. A 36-year-old man complains of marked
dyspnea and cardiac pain. He ascribes his
disease to the case of influenza that he had 2
weeks ago. Objectively he leans forward when
sitting. The face is swollen, cyanotic, cervical
veins are 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. Xray shows trapezoidal
cardiac silhouette and signs of pulmonary
congestion. Choose the treatment tactics:
A. Pericardial puncture (pericardiocenthesis)
B. Diuretics
C. Antibiotics
D. Pericardectomy
E. Glucocorticosteroids
8. A 39-year-old man suffers from chronic
rheumatic heart disease. He complains of
dyspnea during physical exertion, cough with
expectoration, and palpitations. Ausculation
detects intensified I heart sound and diastolic
murmur; the sound of opening 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. Coarctation of the aorta
B. Aortic stenosis
C. Pulmonary artery stenosis
D .Mitral stenosis .
E. Patent ductus arteriosus
9. A 23-year-old man complains of severe pain
in his left knee joint. Objectively the left knee
joint is enlarged, with hyperemic skin, painful
on palpation. Complete blood count:
erythrocytes - 3.8 · 1012/L, Hb- 122 g/L,
leukocytes - 7.4 · 109/L, platelets - 183 · 109/L.
Erythrocyte sedimentation rate - 10 mm/hour.
Bleeding time (Duke method) - 4 min., Lee-
White coagulation time - 24 min. Partial
thromboplastin time (activated) - 89 seconds.
Rheumatoid factor - negative. What is the most
likely diagnosis?
A. . Werlhof disease (immune
thrombocytopenia)
B. Hemophilia, hemarthrosis
C. Rheumatoid arthritis
D. Thrombocytopathy
E. Hemorrhagic vasculitis (Henoch-Schonlein
purpura), articular form
10. A 24-year-old woman, a kindergarten
teacher, has been sick for 2 days already.
Disease onset was acute. She presents with
elevated body temperature up to 38.0oC, pain
attacks in her lower left abdomen, liquid stool
in small amounts with blood and mucus
admixtures 10 times a day. Pulse - 98/min.,
blood pressure - 110/70 mm Hg. Her tongue is
moist and coated with white deposits. The
abdomen is soft, the sigmoid colon is painful
and spastic. Make the provisional diagnosis:
A. . Salmonellosis
B. Escherichiosis
C. Shigellosis
D. Yersiniosis
E. Rotavirus infection
11. A pregnant woman is 28 years old.
Anamnesis: accelerated labor complicated by
the II degree cervical rupture. The following two
pregnancies resulted in spontaneous abortions
at the terms of 12 and 14 weeks. On mirror
examination: the 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. Threatened spontaneous abortion
C. Incipient abortion, habitual noncarrying of
pregnancy
D. Cervical hysteromyoma, habitual noncarrying
of pregnancy
E. Cervical pregnancy, 12 weeks
12. On the day 4 after the cesarean section a
woman developed fever with body temperature
up to 39oC and abdominal pain. Pulse -
104/min. She vomited twice. The patient is
sluggish, her tongue is dry and has gray coating.
The abdomen is distended. Signs of peritoneal
irritation are positive in all segments. Peristalsis
cannot be auscultated. No passage of gas
occurs. Uterine fundus is located at the level of
the navel. The uterus is painful on palpation.
The discharge is moderate and contains blood
and pus. What is the most likely diagnosis?
A. . Parametritis
B. Metroendometritis
C. Progressive thrombophlebitis
D. Pelvic peritonitis
E. Diffuse peritonitis
13. A 58-year-old woman came to the
gynecological clinic. She complains of bloody
discharge from her genital tracts. Menopause is
8 years. Gynecological examination: the uterus
is slightly enlarged, dense to touch, with limited
mobility; the 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. Chorioepithelioma
B. Adenomyosis
C. Uterine corpus cancer
D. Uterine cervix cancer
E. Hormone-producing ovarian tumor
14. A 48-year-old woman complains of
disturbed menstrual cycle: her periods last for
7-9 days and are excessively profuse
throughout the last half-year. She notes
occasional hot flashes in her head, insomnia,
irritability, and headaches. Her skin is of normal
color. Blood pressure - 150/90 mm Hg, pulse -
90/min., rhythmic. The abdomen is soft and
painless. Bimanual examination shows no
uterine enlargement, the appendages cannot
be detected. The vaginal fornices are free. What
is the most likely diagnosis?
A. Climacteric syndrome
B. Premenstrual syndrome
C. Adrenogenital syndrome
D. Stein-Leventhal syndrome (polycystic ovary
syndrome)
E. Uterine myoma
15. A 30-year-old multigravida has been in
labour for 18 hours. 2 hours ago the pushing
stage began. Fetal heart rate is clear, rhythmic,
136/min. Vaginal examination reveals complete
cervical dilatation, the fetal head in the pelvic
outlet plane. Sagittal suture is in line with
obstetric conjugate, the occipital fontanel is
near the pubis. The patient has been diagnosed
with primary uterine inertia. What is the further
tactics of labor management?
A. Vacuum extraction of the fetus
B. Labour stimulation
C. Cesarean section
D. Skin-head Ivanov’s forceps
E. Outlet forceps
16. A woman is 40 weeks pregnant. The fetus is
in the longitudinal lie and cephalic presentation.
Pelvic size: 26-29-31- 20. Expected weight of the
fetus is 4800 gram. The labor contractions has
been lasting for 12 hours, within the last 2
hours they were extremely painful, the
parturient woman is anxious. The waters broke
4 hours ago. On external examination the
contraction ring is located 2 finger widths above
the navel, Henkel-Vasten sign is positive. Fetal
heart rate is 160/min., muffled. On internal
examination the uterine cervix is fully open, the
head is engaged and pressed to the entrance
into the lesser pelvis. What is the most likely
diagnosis?
A. Abruption of the normally positioned
placenta
B. Complete uterine rupture
C. Hyperactive uterine contractions
D .Threatened uterine rupture
E. Anatomically contracted pelvis
17. A 23-year-old woman came to the
gynecological clinic. She complains of pain,
itching, and burning in her vulva, general
weakness, indisposition, elevated body
temperature up to 37.2oC, and headache. On
examination in the vulva there are multiple
vesicles up to 2-3 mm in diameter with clear
contents against the background of hyperemia
and mucosal edema. Make the provisional
diagnosis:
A. Papillomavirus infection
B. Primary syphilis
C. Genital herpes infection
D. Vulvar cancer
E. Cytomegalovirus infection
18. A woman with the pregnancy term of 8
weeks complains of elevated temperature up to
37.6oC, skin rash that can be characterized as
macular exanthema, enlargement of posterior
cervical and occipital lymph nodes, small
amount of bloody discharge from the genital
tracts. She was examined by the infectious
diseases specialist and diagnosed with rubella.
What tactics should the obstetrician-
gynecologist choose?
A. Abortion
B. Prescription of antibacterial therapy
C. Prescription of antiviral therapy
D. Treatment of incipient abortion
E. Prescription of hemostatic therapy
19. A 9-month-old child presents with fever,
cough, dyspnea. The symptoms appeared 5
days ago after a contact with a person with
URTI. Objectively: the child is in grave condition.
Temperature is 38oC, cyanosis of nasolabial
triangle is present. RR- 54/min, nasal flaring
during breathing is observed. There was
percussion dullness on the right below the
scapula angle and tympanic sound over the
other areas of lungs. Auscultation revealed
bilateral fine moist crackles predominating on
the right. What is the most likely diagnosis?
A. Acute bronchiolitis
B. URTI
C. Acute laryngotracheitis
D. Acute bronchitis
E. Pneumonia
20. The mother of a 3-month-old child came to
a family doctor with complaints of her child
being physically underdeveloped and suffering
from cough attacks and dyspnea. Anamnesis:
the child is the result of the second full-term
pregnancy with the risk of miscarriage (the first
child died of pulmonary pathology at the age of
4 months, according to the mother). Body mass
at birth is 2500 g. Cough attacks were observed
from the first days of life, twice the child was
treated for bronchitis. Considering the severity
of the child’s condition the doctor made the
referral for hospitalization. What diagnosis was
most likely stated in the referral?
A. Recurrent obstructive bronchitis
B. Acute obstructive bronchitis
C .Mucoviscidosis (Cystic fibrosis)
D. Pertussis
E. Acute obstructive pneumonia
21. A 46-year-old man notes swollen legs, C. Varicocele
weakness, sensation of fullness and heaviness D. Dystopic kidney
in the right subcostal area; it is the first E. Necrotic papillitis
occurrence of these signs in the patient. The
24. A man complains of constant dull pain in the
patient has 20-year-long history of rheumatoid
perineum and suprapubic area, weak flow of
arthritis. The liver and spleen are enlarged and
urine, frequent difficult painful urination,
dense. Blood creatinine - 0,23 mmol/l,
nocturia. The patient has been suffering from
proteinemia - 68 g/l, cholesterol - 4,2 mmol/l,
this condition for several months, during which
urine specific gravity - 1012, proteinuria - 3,3
urination was becoming increasingly difficult,
g/l, isolated wax-like cylinders, leached
and pain in the perineum has developed. On
erythrocytes in the vision field, leukocytes - 5-6
rectal examination: the prostate is enlarged
in the vision field. What is the most likely
(mainly its right lobe), dense, asymmetrical,
complication?
central fissure is smoothed out, the right lobe is
A. Chronic glomerulonephritis
of stony density, painless, tuberous. What
B. Renal amyloidosis
disease is it?
C. Acute glomerulonephritis
A. Prostate tuberculosis
D. Heart failure
B. Prostate sclerosis
E. Chronic pyelonephritis
C. Urolithiasis, prostatolith of the right lobe
22. A 23-year-old man had taken 1 g of aspirin D. Prostate cancer
to treat acute respiratory infection. After that E. Chronic congestion prostatitis
he developed an asthmatic fit with labored
25. A boy was born at 32 weeks of gestation. 2
expiration that was arrested by introduction of
hours after the birth he developed respiratory
aminophylline. The patient has no medical
distress (RD). The RD severity assessed by
history of allergies. The patient has undergone
Silverman score was 5. The respiratory
two surgeries for nasal polyposis in the past.
disorders progressed, respiratory failure could
What is the most likely diagnosis?
not be eliminated by Martin-Bouyer CPAP
A. . Symptomatic bronchospasm
(continuous positive airway pressure). X-ray of
B. Atopic bronchial asthma
lungs shows reticular and nodular pattern, air
C. Infectious allergic bronchial asthma
bronchogram. What is the most likely cause of
D. Exercise-induced asthma
respiratory distress syndrome?
E. Aspirin-induced asthma
A. Bronchopulmonary dysplasia
23. A 50-year-old patient was delivered to a B. Segmental atelectasis
hospital with complaints of blood traces in C. Hyaline membrane disease
urine. Urination is painless and undisturbed. D. Congenital pulmonary emphysema
Macrohematuria had been observed for 3 days. E. Edematous hemorrhagic syndrome
Objectively: kidneys cannot be palpated,
26. A 9-year-old girl complains of fever up to
suprapubic area is without alterations, external
37,5oC, headache, inertness, weakness, loss of
genitalia are non-pathologic. On rectal
appetite, stomachache, and frequent painful
investigation: prostate is not enlarged, painless,
urination. Provisional diagnosis of acute
has normal structure. Cystoscopy revealed no
pyelonephritis is made. Clinical urine analysis:
alterations. What is the most likely diagnosis?
specific gravity - 1018, no protein, leukocytes -
A. Renal carcinoma
10-15 in the vision field. What investigation
B. Bladder tuberculosis
method can verify the diagnosis of urinary
system infection?
A. Bacteriological inoculation of urine
B. Rehberg test (creatinine clearance test)
C. Zymnytsky test (measurement of daily
diuresis)
D. Complete blood count
E. Clinical urine analyses, dynamic testing
27. During assessment of work conditions at the
mercury thermometer manufacture, content of
mercury vapors in the air of working area is
revealed to exceed maximum concentration
limit. Specify the main way of mercury
penetration into the body:
A. Intact skin
B. Respiratory organs
C. Damaged skin
D. Gastrointestinal tract
E. Mucous tunics
28. During health assessment of car drivers and
police officers on point duty, the physicians
detected carboxyhemoglobin in the blood of
the patients, weakened reflex responses,
disturbed activity of a number of enzymes.
Revealed professional health disorders are most
likely to be associated with the effect of:
A. Nitric oxide
B. Sulfurous anhydride
C. Mental stress
D. Aromatic hydrocarbons
E. Carbon monoxide
29. On the 3rd day of life a newborn, who had
suffered birth asphyxia, developed hemorrhage
from the umbilical wound. Laboratory analysis
reveals hypocoagulation, thrombocytopenia,
and hypothrombinemia. What is the cause of
such clinical developments?
A. Congenital angiopathy
B. Hemorrhagic disease of newborn
C. Disseminated intravascular coagulation
D. Thrombocytopenic purpura
E. Umbilical vessel trauma
30. A 32-year-old woman complains of body
weight loss despite her increased appetite,
nervousness, and tremor of the extremities.
Objectively: the skin is moist; the thyroid gland
is diffusely enlarged, painless, soft, and mobile.
Blood test: increased level of T3, T4, and
thyroid-stimulating hormone (THS). What is the
most likely diagnosis?
A. Diffuse toxic goiter
B. Thyroid carcinoma
C. Autoimmune (Hashimoto’s) thyroiditis
D. Thyroid adenoma
E. Diffuse nontoxic goiter
31. A 57-year-old patient complains of
sensation of dryness and pain during
swallowing, frequent unbearable cough, the
voice is hoarse. Disease onset was abrupt. On
laryngoscopy: laryngeal mucosa is hyperemic,
vocal folds are swollen, laryngeal lumen
contains viscous secretion. What diagnosis is it?
A. Acute stenosing laryngotracheitis
B. Acute laryngitis
C. Bronchial asthma
D. Flegmonous laryngitis
E. Laryngeal diphtheria
32. A 24-year-old pregnant woman on her 37th
week of pregnancy has been delivered to a
maternity obstetric service with complaints of
weak fetal movements. Fetal heartbeats are
95/min. On vaginal examination the uterine
cervix is tilted backwards, 2 cm long, external
orifice allows inserting a fingertip. Biophysical
profile of the fetus equals 4 points. What tactics
of pregnancy management should be chosen?
A. . Urgent preparation of the uterine cervix for
delivery
B. Treatment of placental dysfunction and
repeated analysis of the fetal biophysical profile
on the next day
C. Doppler measurement of blood velocity in
the umbilical artery
D Urgent delivery via a cesarean section
E. Treatment of fetal distress, if ineffective, then
elective cesarean section on the next day
33. During regular preventive gynecological
examination a 30-year-old woman was detected
to have dark blue punctulated ”perforations” on
the vaginal portion of the uterine cervix. The
doctor suspects endometriosis of the vaginal
portion of the uterine cervix. What investigation
method would be most informative for
diagnosis confirmation?
A. Colposcopy, target biopsy of the cervix
B. US of small pelvis
C. Hysteroscopy
D. Curettage of the uterine cavity
E. Hormone testing
34. A 26-year-old woman came to a
gynecologist for a regular check-up. She has no
complaints. Per vaginum: the uterus lies in
anteflexion, not enlarged, dense, mobile,
painless. On the left from the uterus in the area
of uterine appendages there is a mobile
painless outgrowth that can be moved
independently from the uterus. On the right the
appendages cannot be detected. What
additional investigation would be informative
for diagnosis clarification?
A. Metrosalpingography
B. US of lesser pelvis
C. Examination for urogenital infection
D. Colposcopy
E. Colonoscopy
35. A 57-year-old patient complains of dyspnea
at rest. The patient presents with orthopnea,
acrocyanosis, bulging cervical veins. On
percussion: dull sound over the lower lung
segments; on auscultation: no respiratory
murmurs. Heart rate is 92/min. Right-sided
cardiac dilatation is observed. The liver is
enlarged by 7 cm. Shins are swollen. Pleural
effusion is suspected. What indicator would
confirm the presence of transudate in this case?
A. Positive Rivalta’s test
B. Presence of atypical cells
C. Total protein content in the pleural fluid
above 30 g/l
D. Specific gravity exceeding 1015
E. Total protein content in the pleural fluid
below 25 g/l
36. A 28-year-old woman complains of girdle
pain in her epigastric and left subcostal areas
with irradiation to the back, nausea, and
vomiting without relief. On examination a
surgeon observes stomach distension and
meteorism. There are positive Mondor’s, Mayo-
Robson’s, and Cullen’s symptoms. What is the
most likely diagnosis?
A Aortic dissecting aneurysm
B. Acute cholecystitis
C. Acute intestinal obstruction
D. Acute pancreatitis
E. Splenic infarction
37. A 36-year-old woman complains of pain in
her lumbar area, which irradiates to her lower
right limb and increases during movements, and
sensation of numbness in her limb. Objectively:
palpation of the shin and thigh muscles is
painful, positive stretch symptom on the right.
MRI scan: herniation of intervertebral disk L5-S1
4 mm in size. What is the most likely diagnosis?
A. Vertebrogenic lumbago
B. Vertebrogenic radicular syndrome of L5-S1
on the right
C. Endarteritis of lower extremities
D. Spinal stroke
E. Acute myelitis
38. During routine medical examination a 35-
year-old woman presents with enlarged cervical
and mediastinal lymph nodes. Her overall
health is satisfactory. ESR is 30 mm/hour.
Cervical node biopsy was performed. In the
specimen there are granulomas composed of
epithelial and giant cells, no caseous necrosis
detected. What is the most likely diagnosis?
A. Infectious mononucleosis
B. Lymphogranulomatosis
C. Sarcoidosis
D. Nonspecific lymphadenitis 42. A 17-year-old girl has made an appointment
E. Lymph node tuberculosis with the doctor. She plans to begin her sex life.
No signs of gynecological pathology were
39. A 39-year-old woman complains of violent
detected. In the family history there was a case
pain in her left lumbar area with irradiation to
of cervical cancer that occurred to the patient’s
the right iliac area. Several years ago she was
grandmother. The patient was consulted about
diagnosed with cholelithiasis and urolithiasis.
the maintenance of her reproductive health.
The patient’s condition is moderately severe,
What recommendation will be the most helpful
the skin is dry. Ortner’s symptom is negative;
for prevention of invasive cervical cancer?
costovertebral angle tenderness is observed on
A. Vaccination against human papillomavirus
the right. The most reasonable treatment
(HPV)
tactics would be
B. Vitamins, calcium, omega-3 C.
A Urgent hemodialysis
Immunomodulators
B. Spasmolytics and analgesics
D. Antiviral and antibacterial drugs
C. Peritoneal dialysis
E. Timely treatment of sexually transmitted
D. Laparoscopic cholecystectomy
diseases
E. Antibiotics
43. A 6-month-old infant is not vaccinated. The
40. An 18-year-old patient complains of skin
physician recommends a DPT (diphtheria,
rash. The patient has been suffering from this
pertussis, tetanus) vaccination but the mother
condition for 5 years. The first instance of this
is absolutely against this procedure. Choose the
disease occurred after a car accident.
most substantial argument in favor of
Objectively: the patient presents with papular
vaccination:
rash covered in silvery scales, ”thimble”
A. Risk of lethal consequences
symptom (small pits on the nails), affected
B. Epidemic risk for the others
joints. What is the most likely diagnosis?
C. Personal professional experience
A. Onychomycosis
D. High quality of vaccines
B.. Panaritium
C. Psoriasis 44. In autumn a 45-year-old man was
D. Lupus erythematosus recommended an elective surgery for coronary
E. Rheumatism artery bypass grafting due to multivessel
coronary artery disease. The patient has never
41. A 20-year-old student was brought to the
received anti-influenza vaccination. Why would
first-aid center. He has a closed fracture of the
the family doctor offer a scheduled yearly
left forearm and a contused lacerated wound
vaccination against influenza to this patient?
on his left shin. After the patient received initial
A. Prevention of seasonal influenza
wound management, he presented the
B. Secondary prevention of exacerbations of
documents confirming that he has received all
chronic ischemic heart disease
the necessary preventive vaccination as
C. Immunoprophylaxis of postoperative
scheduled. What should the doctor do to
pulmonary complications
prevent tetanus in this patient?
D. Primary prevention of influenza during
A. Antibiotic therapy
postoperative care
B. Administration of tetanus immunoglobulin
E. Decrease the risk of mortality due to
C. Administration of anti-tetanus serum
pneumonia and heart failure
D. Dynamic case monitoring
E. Administration of tetanus toxoid
45. A 28-year-old woman has made an
appointment with the family doctor to receive
vaccination against influenza. However, having
collected the patient’s medical history, the
doctor claimed this procedure to be absolutely
contraindicated for this woman. What
anamnestic data is the absolute
contraindication to vaccination?
A Blood hemoglobin - 109 g/L
B. Pregnancy at 30 weeks
C. Egg white intolerance
D. Body temperature - 37.2oC
E. Psoriasis in the remission phase
46. A 26-year-old man complains of chills,
rhinitis, dry cough, and fever up to 38oC.
Examination shows him to be in a moderately
severe condition; there are small pale pink non-
merging spots on the skin of his back, abdomen,
and extremities. Palpation reveals enlarged
occipital and axillary lymph nodes. No
information about vaccination history could be
obtained. What is the likely etiology of this
disease?
A Epstein-Barr virus
B. Rubella virus
C. Streptococcus
D. Mumps virus
E. Neisseria meningitis
47. During administration of planned DPT
vaccination the child suddenly developed acute
anxiety, signs of pain response, dyspnea,
grunting respirations, cutis marmorata, cold
sweat. Objectively the child’s consciousness is
disturbed, heart rate is 150/min., blood
pressure is 60/40 mm Hg, heart sounds are
muffled. The child was diagnosed with
anaphylactic shock. What drug should be
administered first?
A. Epinephrine
B. Lasix (Furosemide)
C. Suprastin (Chloropyramine)
D. Euphylline (Aminophylline)
E. Analgin (Metamizole)
48. Among first-year schoolchildren there was a
case of measles registered. A 7-year-old boy
from the same group was not vaccinated
against measles due to refusal of his parents.
His clinical history has no cases of measles in
the past and is not contraindicatory to
immunobiological agents. Choose the most
rational tactics of measles prevention in this
schoolboy:
A Immunomodulators
B. Isolation for 20 days
C. Antiviral agents
D. Antibiotics
E. Measles-Mumps-Rubella vaccine
49. A 40-year-old man developed fever up to
37.5oC and macular rash 10 days after the first
dose of MMR (Measles-Mumps-Rubella)
vaccine was administered. The vaccination was
considered necessary as there was a measles
outbreak in the city and the patient had not
received MMR vaccination in his childhood. Is
revaccination with MMR vaccine possible?
A Simultaneously with antihistamines
B. Forbidden
C. After a course of glucocorticoids treatment
D. Possible
E. Under supervision in the infectious diseases
inpatient ward
50. A 26-year-old man is undergoing a regular
check-up. One year ago he had a case of
tonsillar diphtheria complicated with
myocarditis. Presently his condition is
satisfactory, no signs of cardiovascular failure;
ECG shows firstdegree atrioventricular block.
What vaccine was administered to this man
according to his age?
A Acellular DPT vaccine
B. Adsorbed diphtheria tetanus vaccine
(modified)
C. Tetanus anatoxin
D. Oral polio vaccine (OPV)
E. BCG vaccine
51. During analysis of morbidity in the city, it
was determined that age structure of
population is different in each district. What
statistical method allows to exclude this factor,
so that it would not skew the morbidity data?
A. Standardization
B. Wilcoxon signed-rank test
C. Correlation-regression analysis
D. Dynamic time series analysis
E. Analysis of average values
52. Clinical statistical investigation was
performed to determine effectiveness of a new
pharmacological preparation for patients with
ischemic heart disease. What parametric test
(coefficient) can be used to estimate the
reliability of the results?
A. Wilcoxon signed-rank test
B. Sign test
C. Matching factor
D. Student’s t-distribution
E. Kolmogorov-Smirnov test
53. In a rural health care area there is an
increasing cervical cancer morbidity observed.
The decision is made to conduct a medical
examination of the women living in this locality.
What type of medical examination is it?
A. Regular
B. Preliminary
C. Target
D. Complex
E. Screening
54. In the process of hiring, a prospective
employee has undergone preventive medical
examination and was declared fit to work in this
manufacturing environment. What type of
preventive medical examination was it?
A. Comprehensive
B. Scheduled
C. Periodical
D. Specific
E. Preliminary
55. On laboratory investigation of a pork sample
there is 1 dead trichinella detected in 24
sections. This meat should be:
A. Sent for technical disposal
B. Allowed for sale with no restrictions
C. Processed and sold through public catering
network
D. Processed for boiled sausage production
E. Frozen until the temperature of -10oC is
reached in the deep layers, with subsequent
exposure to cold for 15 days
56. To assess the effectiveness of medical
technologies and determine the power and
direction of their effect on the public health
indicators, the research was conducted to study
the immunization rate of children and measles
incidence rate by district. What method of
statistical analysis should be applied in this
case?
A. Calculation of correlation coefficient
B. Calculation of morbidity index among the
nonvaccinated
C. Calculation of matching factor
D. Calculation of standardized ratio
E. Calculation of statistical significance of the
difference between two estimates
57. Having studied the relationship between the
distance from villages to the local outpatient
clinics and frequency of visits to the clinics
among the rural population of this area, it was
determined that the rank correlation coefficient
in this case equals -0.9. How can this
relationship be characterized?
A. Strong inverse relationship
B. Strong direct relationship
C. Moderate inverse relationship
D. Moderate direct relationship
58. In the inpatient gynecological unit within a
year 6500 women underwent treatment. They
spent there a total of 102000 bed-days. What
indicator of the gynecological unit work can be
calculated based on these data?
A. Bed turnover rate
B. Average bed occupancy rate per year
C. Number of beds by hospital department
D. Average length of inpatient stay
E. Planned bed occupancy rate per year
59. A middle school teacher with 4-yearlong
record of work was issued a medical certificate
for pregnancy and childbirth leave. What
amount of pay will she receive for the duration
of her leave in this case?
A. 50% of average salary
B.100% of average salary
C. 70% of average salary
D. 60% of average salary
E. 80% of average salary
60. In the air of the feed kitchen at poultry
factory, at the area where formula feed is being
mixed, the dust concentration reaches 200
mg/m3. Air microflora is represented
predominantly by Asperqillus and Mucor fungi.
What effect determines pathogenic properties
of the dust?
A. . Mutagenic
B. Teratogenic
C. Allergenic
D. Fibrogenic
E. Toxic
61. A 16-year-old adolescent has been
hospitalized with complaints of unceasing nasal
hemorrhage and unbearable pain in his right
elbow joint. Objectively: the large joint is
enlarged and defigurated, the skin over the
joint is hyperemic. Arthropathy signs can be
observed in the other joints. Ps- 90/min. Blood
test: erythrocytes - 3, 9 · 1012/l, Нb- 130 g/l,
color index - 1,0, leukocytes - 5, 6 · 109/l,
platelets - 220 · 109/l, ESR- 6 mm/hour. Lee-
White coagulation time: start- 24min , end27
min10 sec. What drug would be most efficient
in the treatment of this patient?
A. Cryoprecipitate
B. Calcium chloride
C. Concentrated red cells
D. Aminocapronic acid
E. Vicasol (Menadione)
62. A 67-year-old man complains of dyspnea on
exertion, attacks of retrosternal pain, dizziness.
He has no history of rheumatism. Objectively:
pale skin, acrocyanosis. There are crackles in
the lower lungs. There is systolic thrill in the II
intercostal space on the right, coarse systolic
murmur conducted to the vessels of neck. BP-
130/90 mm Hg, heart rate - 90/min., regular
rhythm. The liver extends 5 cm from under the
edge of costal arch, shin edemas are present.
Specify the suspected valvular defect:
A. Ventricular septal defect
B. Pulmonary artery stenosis
C. Mitral insufficiency
D .Aortic stenosis
E. Tricuspid regurgitation
63. A 24-year-old female teacher complains of
dizziness and heart pain irradiating to the left
nipple. Pain is not associated with physical
activity and cannot be relieved by nitroglycerin,
it abates after taking Valocordin and lasts an
hour or more. The patient has a nearly 2-year
history of this disease. Objectively: Ps- 76/min.,
BP110/70 mm Hg. Heart borders are normal,
heart sounds are clear. The ECG shows
respiratory arrhythmia. Radiograph of the
cervicothoracic spine reveals no pathology.
Lungs, abdomen are unremarkable. What
changes in blood formula can be expected?
A. Increased ESR
B. Leukocytosis
C. Thrombocytopenia
D. Leukemic hiatus
E. No changes
64. A 51-year-old female patient complains of
frequent defecation and liquid blood-streaked
stools with mucus admixtures, diffuse pain in
the inferolateral abdomen, 6 kg weight loss
within the previous month. Objectively: body
temperature - 37, 4oC, malnutrition, skin is pale
and dry. Abdomen is soft, sigmoid is painful and
spasmodic, makes a rumbling sound. Liver is
dense, painful, extends 3 cm below the costal
margin. What is the most likely diagnosis?
A. Helminthic invasion
B. Bacillary dysentery
C. Sprue
D. Intestinal enzymopathy
E. Non-specific ulcerative colitis
65. Chief physician of a polyclinic charged a
district doctor with a task to determine the
pathological prevalence of disease N in his
district. What document allows to estimate the
disease prevalence in the population of a
medical district?
A. .Statistic coupons (-)
B. Statistic coupons (+)
C Prophylactic examinations register
D. Statistic coupons (+) and (-)
E. Vouchers for medical appointments
66. A 32-year-old woman complains of
dizziness, headache, palpitation, tremor. For the
last several months she has been under
outpatient observation for increased arterial
pressure. Since recently such attacks have
become more frequent and severe. Objectively:
the skin is covered with clammy sweat, tremor
of the extremities is present. HR110/min., BP-
220/140 mm Hg. Heart sounds are muffled.
Blood test results: WBCs- 9, 8 · 109/l, ESR- 22
mm/hour. Blood glucose - 9,8 millimole/l. What
disease is the most likely cause of this crisis?
A. Preeclampsia
B. Essential hypertension
C. Pheochromocytoma
D. Primary hyperaldosteronism
E. Diabetic glomerulosclerosis
67. A 14-year-old boy presents with moderate
bronchial asthma in its exacerbation period.
What drug should be prescribed to stop an
acute attack of expiratory dyspnea?
A. Strophanthine (cardiac glycosides)
B. Cromolyn sodium (Cromoglicic acid)
C. Dexamethasone
D. Lasolvan (Ambroxol)
E. Salbutamol
68. A newborn with gestational age of 31 weeks
presents with hypotonia and depressed
consciousness. Hematocrit is 35%,
cerebrospinal fluid analysis shows increased
content of erythrocytes and protein, and low
glucose. These data correspond with the clinical
presentation of:
A. Meningitis
B. Intracranial hemorrhage
C. Sepsis
D. Anemia
E. Prenatal infection
69. A 16-year-old girl has primary amenorrhea,
no pubic hair growth, normally developed
mammary glands; her genotype is 46 ХY; uterus
and vagina are absent. What is your diagnosis?
A. Sheehan syndrome
B. Mayer-Rokitansky-Kuster-Hauser syndrome
C. Cushing syndrome
D. Testicular feminization syndrome
E. Cushing disease
70. 6 hours ago the waters of a 30-year-old
gravida 1, para 0, burst; her preliminary period
was pathologic and lasted for over 2 days; the
term of pregnancy is 39 weeks. No labor activity
is observed. Fetal head presents above the
pelvic inlet. Fetal heartbeats are 142/min., clear
and rhytmic. On vaginal examination the
uterine cervix is not dilated. What further
tactics should the doctor choose?
A. Stimulate the labor with oxytocin
B. Induce cervical dilation with prostaglandins
C .Perform cesarean section
D. Wait for the onset of spontaneous labor
E. Prolong the pregnancy, while providing
antibacterial treatment
71. Mother of an 8-year-old girl complains that
the child is too short and has excessive body
weight. Objectively: obesity with fat deposits on
the torso and face (round moon-like face), acne, E . Veloergometry
striae on the thighs and lower abdomen,
75 A 59-year-old male patient with essential
hirsutism. What hormone can cause such
hypertension of stage II is registered with the
symptoms, when in excess?
dispensary department of a polyclinic. The
A. Glucagon
patient regularly takes ACE inhibitors and
B. Thyroxin
calcium antagonists. How often should a
C. Testosterone therapeutist examine this patient (except for
D. Insulin exacerbation periods)?
E. Cortisol
A. Every 6 months
72. An emergency team deliverd a 83year-old B. Every 3 months
patient complaining of inability of her right leg C. Every 4 months
to support the body after falling on her right D. Once a year
side. Objectively: the patient lies on a gurney,
E. Every 9 months
her right leg is rotated outwards, the outside
edge of foot touches the bed. There is positive
straight leg raising sign. What is your provisional
diagnosis? 76. A 47-year-old woman came to the
admission room with complaints of general
A. Femoral neck fracture weakness, dizziness, vomiting with blood clots.
B. Femoral diaphysis fracture Condition onset was 3 hours ago. The patient
C. Hip dislocation has no preceding illnesses. Blood pressure is
D. Hip joint contusion 90/60 mm Hg, pulse is 106/min., of poor
E. Cotyloid cavity fracture volume. The abdomen is soft, with mild
tenderness in the epigastrium. Blood test:
73. A newborn has Apgar score of 9. When
erythrocytes - 2.1·1012/L, Нb- 70 g/L,
should the infant be put to the breast?
hematocrit - 28%. What tactics should the
A. After 2 hours
doctor on duty choose?
B. After 12 hours
A. Refer the patient to the family doctor
C. In the delivery room
B. Consult the surgeon
D. On the 2nd day
C. Give spasmolytics
E. On the 3rd day
D. Perform gastric lavage
74. A hospital admitted an 11-yearold boy E. Make an appointment for colonoscopy
diagnosed with medium-severe asthma,
77. A 45-year-old woman complains of
exacerbation period. In order to arrest the
paroxysmal intolerable facial pain on the left
attacks the boy was administered
with attacks that last for 1-2 minutes. Attacks
broncholytic nebulizer therapy. During the
day the child’s condition stabilized. What is are provoked by chewing. The disease onset
the most appropriate method for further was two month ago after overexposure to cold.
monitoring of respiratory function in this Objectively: pain at the exit points of the
patient? trigeminal nerve on the left. Touching near the
wing of nose on the left induces new pain
A. Peak flowmetry attack with tonic spasm of the facial muscles.
B. Spirometry What is the most likely diagnosis among those
C. Pneumotachometry listed?
D. Bronchodilatation tests A. Maxillary sinusitis
B.Glossopharyngeal neuralgia
C. Temporomandibular joint arthritis
D. Facial migraine
E. Trigeminal neuralgia
78. A 10-year-old boy with symptoms of
arthritis and myocarditis was delivered into a
hospital. Based on clinical examination the
preliminary diagnosis of juvenile rheumatoid
arthritis was made. What symptom is the most
contributive for the diagnostics of this disease?
A. Reduced mobility of the joints in the morning
B. Regional hyperemia of the joints
C. Affection of the large joints
D. Enlarged heart
E. Increased heart rate
79. A 25-year-old patient was delivered to an
infectious diseases unit on the 3rd day of illness
with complaints of headache, pain in lumbar
spine and gastrocnemius muscles, high fever,
chill. Objectively: condition of moderate
severity. Scleras are icteric. Pharynx is
hyperemic. Tongue is dry with dry brown
coating. Abdomen is distended. Liver is
enlarged by 2 cm. Spleen is not enlarged.
Palpation of muscles, especially gastrocnemius
muscles, is painful. Urine is dark in colour. Stool
is normal in colour. The most likely diagnosis is:
A. Malaria
B. Viral hepatitis type A
C. Leptospirosis
D. Infectious mononucleosis
E. Yersiniosis
80. A 28-year-old woman complains of skin
hemorrhages after minor traumas and
spontaneous appearance of hemorrhages on
the front of her torso and extremities. On
examination: the skin is variegated (old and
new hemorrhages), bleeding gums. Blood
platelets - 20 · 109/L; in the bone marrow there
is increased number of megakaryocytes and no
platelet production. Treatment with steroid
hormones was effective. What is the likely
diagnosis?
A. . Rendu-Osler-Weber disease (Hereditary
hemorrhagic telangiectasia)
B. Hemophilia
C. Idiopathic thrombocytopenic purpura
D. Disseminated intravascular coagulation
E. Acute vascular purpura
81. A 7-year-old boy has been an inpatient for
1.5 months. He had been delivered to the
hospital with complaints of edemas all over his
body, low urine output, and headache. Clinical
urinalysis: proteins - 7.1 g/L, leukocytes - 1-2 in
the vision field, 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. Nephritic
B. Nephrotic
C. Isolated urinary
D. Hematuric
E. Mixed
82. 2 weeks after labour a parturient woman
developed breast pain being observed for 3 days.
Examination revealed body temperature at the
rate of 39oC, chills, weakness, hyperaemia,
enlargement, pain and deformity of the
mammary gland. On palpation the infiltrate was
found to have an area of softening and
fluctuation. What is the most likely diagnosis?
A. Infiltrative-purulent mastitis
B. Phlegmonous mastitis
C. Lactostasis
D. Serous mastitis
E. Mastopathy
83. A 10-year-old girl complains of stomachache
that appears and intensifies after she eats
rough or spicy food, sour eructation, heartburn,
frequent constipations, headaches, irritability.
She has been presenting with these signs for 12
months. Her meals are irregular and consist of
dry food. Objectively her diet is suffi- cient in
calories. The tongue is moist with white coating
near the root. The abdomen is soft and painful
in the epigastrium. What method would be
optimal for diagnosis-making in this case?
A. Biochemical blood test
B. Intragastric pH-metry
C. Fractional gastric analysis (Fractional test
meals)
D. Phase-contrast X-ray imaging
E. Esophagogastroduodenoscopy
84. A 64-year-old patient complains of severe
pain in the right side of chest, dyspnea, dry
cough which appeared suddenly on exertion.
Objectively: the right side of the chest lags
behind in the act of breathing. Percussion
reveals tympanic sound. Auscultation reveals
pronouncedly diminished breath sounds on the
right. Ps100/min, weak, arrhythmic. AP- 100/50
mm Hg. Cardiac sounds are decreased. What
disease can be suspected in this patient?
A. Right-sided pneumothorax
B. Right-sided hydrothorax
C. Right-sided dry pleurisy
D. Right-sided pleuropneumonia
E. PATE
85. A 23-year-old primigravida at 39 weeks
gestation has been admitted to the maternity
ward with irregular contractions. The intensity
of uterine contractions is not changing, the
intervals between them stay long. Bimanual
examination reveals that the cervix is centered,
soft, up to 1,5 cm long. There is no cervical
dilatation. What diagnosis should be made?
A. Pregnancy I, 39 weeks, labor I, 1 period, the
latent phase
B. Pregnancy I, 39 weeks, preliminary period
C.Pregnancy I, 39 weeks, labor I, period 1, the
active phase
D.Pregnancy I, 39 weeks, birth I, 1 period, the
acceleration phase
E. Pregnancy I, 39 weeks, pathological
preliminary period
86. The institutions that take part in medical
examinations include prevention and treatment
facilities, medical board of Ministry of Defense,
medical board of Ministry of Home Affairs,
medico-social expert commissions, forensic
medical boards etc. What institutions are
responsible for temporary disability
examination?
A. Medico-social expert commissions
B. Sanitary-and-prophylactic institutions
C. Prevention and treatment facilities
D. Medical boards of Ministry of Defense
E. Medical boards of Ministry of Home Affairs
87. After a lengthy march an army regiment has
set camp for 3 days near a settlement. Sanitary-
hygienic investigation detected several water
sources. Choose the source that would satisfy
the demands for potable water the most under
the given field conditions:
A. Melt water B. Brook
C. River
D. Rain water
E. Artesian well
88. Examination of an electric welder with 15
years of service record revealed dry rales in the
lower lung fields. Radiograph shows diffuse
nodules sized 3-4 mm in the middle and lower
lung fields. What disease can be suspected?
A. Heavy-metal coniosis
B. Silicosis
C. Silicatosis
D. Carbon pneumo coniosis
E. Bronchitis
89. A 30-year-old parturient woman was
delivered to a maternity hospital with full-term
pregnancy. She complains of severe lancinating
pain in the uterus that started 1 hour ago,
nausea, vomiting, cold sweat. Anamnesis states
cesarean section 2 years ago. Uterine
contractions stopped. Skin and mucous
membranes are pale. Heart rate is 100/min., BP
is 90/60 mm Hg. Uterus has no clear margins, is
sharply painful. No heartbeat can be
auscultated in the fetus. Moderate bloody
discharge from the uterus can be observed.
Uterus cervix is 4 cm open. Presenting part is
not visible. The most likely diagnosis is
A. Uterine rupture
B. Initial uterine rupture
C. Threatened uterine rupture
D. Premature detachment of normally
positioned placenta
E. Compression of inferior pudendal vein
90. A parturient woman is 23 years old. Internal
obstetric examination shows the uterine cervix
to be completely open. Fetal bladder is absent.
Cephalic presentation is observed in the plane
of the small pelvic outlet. Sagittal suture is at
the 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. Transverse lie
D. Medium oblique lie
E. Major oblique lie
91. Against the background of angina a patient
has developed pain in tubular bones.
Examination revealed generalized enlargement
of lymph nodes, hepatolienal syndrome,
sternalgia. In blood: RBCs - 3, 6 · 1012/l, Hb87
g/l, thrombocytes - 45 · 109/l, WBCs - 13 · 109/l,
blasts - 87%, stab neutrophiles - 1%, segmented
neutrophiles - 7%, lymphocytes - 5%, ESR - 55
mm/h. What is the most likely diagnosis?
A. Chronic myeloid leukemia
B. Erythremia
C. Chronic lymphocytic leukemia
D. Acute leukemia
E. Multiple myeloma
92. For a long time to eradicate weeds on
agricultural lands herbicides retaining in
environment have been used. Point out the
most probable way of herbicides reaching
human organism from soil:
A. Soil-animals-human
B. Soil-microorganisms-human
C. Soil-plants-human
D. Soil-protozoa-human
E. Soil-insects-human
93. A 52-year-old patient complains of pain in
the right part of her chest, dyspnea, cough with
a lot of albuminoid sputum emitting foul smell
of "meat slops". Objectively: the patient’s
condition is grave, cyanosis is observed,
breathing rate is 31/min, percussion sound
above the right lung is shortened, auscultation
revealed various moist rales (crackles). What is
the most probable diagnosis?
A. Chronic pneumonia
B. Lung abscess
C. Pleura empyema
D. Multiple bronchiectasis
E. Lung gangrene
94. A 15-year-old patient suffers from
headache, nasal haemorrhages, sense of lower
extremity coldness. Objectively: muscles of
shoulder girdle are developed, lower
extremities are hypotrophied. Pulsation on the
pedal and femoral arteries is sharply
dampened. BP is 150/90 mm Hg, 90/60 in the
legs. Systolic murmur can be auscultated above
carotid arteries. What is the most probable
diagnosis?
A. Aorta coarctation
B. Aorta aneurism
C. Aortal stenosis
D. Aortal insufficiency
E. Coarctation of pulmonary artery
95. A patient with frostbite of both feet was
delivered to an admission ward. What actions
should be taken
A. To apply a bandage, to introduce vasodilating
medications
B. To administer cardiac medications
C. To put feet into hot water
D. To rub feet with snow
E. To apply an alcohol compress
96. A 26 y.o. male patient with postoperative
hypothyroidism take thyroxine 100 mg 2 times
a day. He has developed tachycardia, sweating,
irritability, sleep disorder. Determine further
treatment tactics.
A. To decrease thyroxine dosage
B. To increase thyroxine dosage
C. To administer betablockers
D. To add mercasolil to the treatment
E. To administer sedatives
97. A 20 y.o. patient was admitted to the
hospital with complaints of having skin and
sclera icteritiousness, dark urine, single
vomiting, appetite loss, body temperature rise
up to 380 for 2 days. Three weeks ago he went
in for fishing and shared his dishes with friends.
Objectively: the patient is flabby, t 0- 36, 80,
skin and scleras are icteritious, liver sticks from
under the costal margin by 3 cm, it is sensitive;
spleen isn’t palpable. Urine is dark, stool is
partly acholic. What is the most probable
diagnosis?
A. Infectious mononucleosis
B. Leptospirosis
C. Virus A hepatitis
D. Hemolytic anemia
E. Intestinal yersiniosis
98. A 36-year-old female pesented to a
gynecological hospital with a significant bleeding
from the genital tract and a 1-month delay of
menstruation. Bimanual examination revealed
soft barrel-shaped cervix. Uterus was of normal
size, somewhat softened. Appendages were
unremarkable on both sides. Speculum
examination revealed that the cervix was
cyanotic, enlarged, with the the external orifice
disclosed up to 0,5 cm. Urine hCG test was
positive. What is the most likely diagnosis?
A. Uterogestation
B. Cervical pregnancy
C. Abortion in progress
D. Threatened miscarriage
E. Ectopic pregnancy
99. A 68 year old patient has been suffering
from chronic pancreatitis for 35 years. During
the last 5 years he has been observing
abatement of pain syndrome, abdominal
swelling, frequent defecations up to 3-4 times a
day (feces are greyish, glossy, with admixtures
of undigested food), progressing weight loss.
Change of symptom set is caused by joining of:
A. Chronic enterocolitis
B. Endocrine pancreatic insufficiency
C. Syndrome of lactase deficiency
D. Irritable bowels syndrome
E. Exocrine pancreatic insufficiency
100. A patient suffering from acute
posttraumatic pain received an injection of
morphine that brought him a significant relief.
Which of the following mechanisms of action
provided antishock effect of morphine in this
patient?
A. Block of central cholinergic receptors
B. Stimulation of opiate receptors
C. Stimulation of benzodiazepine receptors
D. Inhibition of dopamine mediation
E. Intensification of GABA-ergic reactions
101. During the induction of labor of a 41.5-
week multigravida woman, with misoprostol,
the mother begins to feel increasing pelvic
pressure and low back pain. FHTs are reassuring
and maternal vital signs are p-92, BP 110/68, R-
18; T-37 contractions are every 2 to 3 minutes
and moderate. Her cervix is 2 cm50%, —2
station with blood tinged mucus. What does
this situation represent?
(A) impending rupture of the uterus
(B) normal early labor
(C) tachysystole
(D) misoprostol syndrome
(E) primary arrest of labor
102. A 23-year-old woman with right-sided
lower abdominal pain and chills is seen in the
emergency department. The pain began 3 days
ago and is associated with a vaginal discharge.
Her LMP was 5 days ago. She uses an
intrauterine device for contraception and had
coitus 1 week ago with her new boyfriend.
There is no history of nausea, vomiting, or
diarrhea. Her vital signs are blood pressure,
120/80 mmHg; pulse, 100 bpm; and
temperature, 101.4°F. Abdominal examination
shows bilateral lower quadrant guarding with
rebound tenderness on the right side. Pelvic
examination shows pus at the cervical os and a
tender 6-cmright adnexal mass. Laboratory data
are hematocrit, 38% (normal, 35% to 45%);
WBC count, 25,000/mL (normal, 3–10,000/mL);
and serumpregnancy test, negative.
Transvaginal sonography shows a 6-cmcomplex
right adnexal mass. The uterus and left adnexa
are normal. Which of the following is the most
likely diagnosis?
(A) appendicitis
(B) adnexal torsion
(C) pyosalpinx
(D) hydrosalpinx
(E) endometritis
103. A 36-year-old man has had stable
ulcerative colitis for 5 years. He is being treated
with sulfasalazine 1000 mg three times daily.
On routine follow-up, he is found to have an
ALT of 250 IU/L, an AST of 225 IU/L, an alkaline
phosphatase of 450 IU/L, and a bilirubin of 2
μmol/L. Ultrasound of the abdomen reveals no
bile duct dilatation or gallstones. Endoscopic
retrograde cholangiopancreatography (ERCP)
reveals multifocal strictures and dilatations of
both the intrahepatic and extrahepatic bile
ducts. What is the MOST likely diagnosis?
A. sclerosing cholangitis
B. common bile duct stone
C. primary biliary cirrhosis
D . drug-induced hepatitis
104. A 41-year-old patient, a hunter, complains
of heaviness in the right subcostal area. No
other complaints recorded. Anamnesis states
causeless urticaria and skin itching that
occurred 1 year ago. Objectively: liver margin is
rounded, painless, and can be palpated 3 cm
below the costal arch. No other pathology was
detected during physical examination of the
patient. Body temperature is normal. X-ray
reveals a hemispherical protrusion in the right
cupula of the diaphragm. What disease can be
suspected in the given case?
A. Liver abscess
B. Hydatid disease of liver
C. Hepatocellular carcinoma
D. Metastatic tumor
E. Subdiaphragmatic abscess
105. A 33-year-old woman presents with a
cellulitis of the dorsum of the right hand 24
hours following a cat bite. A Gram stain of
serosanguinous discharge from a puncture site
shows neutrophils and small gram negative
rods. What is the treatment of choice for this
patient?
A. cefazolin
B . norfloxacin C. amoxicillin/clavulanic acid
D. gentamicin
106. In utero heart failure, often with fetal
pleural and pericardial effusions and
generalized ascites (non-immune hydrops
fetalis) may occur in ?
A. ventricular septal defect
B. coarctation of aorta
C. d-Transposition of great arteries
D. Ebstein anomaly
E. single ventricle
107. You are discussing the risk of radiotherapy
with the parents of a child with
medulloblastoma; the mother has a concern
about the late neurological complications post
radiotherapy. The statement that should be
included in the discussion that late neurological
sequelae post radiotherapy is more severe
with?
A. focal radiotherapy rather than craniospinal
irradiation
B. children with an age of less than 3 year
C. concomitant chemo-radiotherapy
D. low grade tumors rather than high grade
tumors
E. infratentorial tumors rather than
supratentorial tumors
108. Which of the following statements are
true?
A. Identification of the causative organism
should be done before starting antibiotics.
B Wounds are best managed by delayed
primary or secondary closure.
C Subcuticular continuous skin closure
decreases the incidence of wound infection.
D Polymeric films can be useful in infected
wounds.
E Administration of antibiotic preparations
locally is more effective than the oral route.
109. Which of the following statements
regarding burn depth are true?
A) The depth of a burn together with
percentage of TBSA and smoke inhalation are
key parameters in the assessment and
management of a burn.
B)Alkalis, including cement, usually result in
superficial burns.
C) Fat burns are deeper than electrical contact
burns.
D )Capillary filling is not present in superficial
burns.
E) Deep dermal burns take a maximum of 2
weeks to heal without surgery.
110. A 47-year-old patient came to see a doctor
on the 7th day of disease. The disease
developed very fast: after the chill body
temperature rose to 40oC and lasted up to 7
hours, then dropped abruptly, which caused
profuse sweat. There were three such attacks
occuringonce in two days. Two days ago the
patient arrived from Africa. Objectively: pale
skin, subicteric sclera, significantly enlarged
liver and spleen. What is the cause of fever
attacks in this disease?
A. Erythrocytic schizogony
B. Tissue schizogony
C. Exotoxin of a causative agent
D. Endotoxin of a causative agent
E. Gametocytes
111. A patient is 30 years old, works as a
carpenter. Six months ago there appeared some
behavioural changes: he got interested in
philosophy, began writing a treatise on the
purpose of his human existence, quitted his job,
stopped caring about his children, went out
carelessly dressed, heard "voices in his
head"that guided his behaviour. The patient
claimed sure that he was an Ambassador of God
on Earth and was constantly feeling His
influence. He is not critical about his disease.
What diagnosis can be assumed?
A. Reactive psychosis
B. Alcocholic psychosis
C. Schizophrenia
D. Somatogenic psychosis
E. Organic psychosis
112. A 27-year-old patient complains of nasal
haemorrhages, multiple bruises on the anterior
surface of the trunk and extremities, sudden
weakness. In blood: Hb- 74 g/l, reticulocytes -
16%, RBCs - 2, 5 · 1012/l, platelets - 30 · 109/l,
ESR- 25 mm/h. What is the most effective
measure for the treatment of
thrombocytopenia?
A. Iron preparations
B. Splenectomy
C. Hemotransfusion
D. Cytostatics
E. Vitamin B12
113. 2 days ago a patient presented with acute
pain in the left half of chest, general weakness,
fever and headache. Objectively: between the 4
and 5 rib on the left the skin is erythematous,
there are multiple groups of vesicles 2-4 mm in
diameter filled with transparent liquid. What
diease are these symptoms typical for?
A. . Streptococcal impetigo
B. Pemphigus
C. Herpes simplex
D. Herpes zoster
E. Herpetiform Duhring’s dermatosis
114. After lifting a load a patient felt undurable
pain in the loin. He was diagnosed with acute
lumbosacral radiculitis. Which of the following
is contraindicated for this patient?
A. Warming procedures
B. Dehydrating drugs
C. Analgetics
D. Vitamins of B group
E. Intravenous injection of aminophylline
115. A 30-year-old woman complains of
irregular copious painful menstruations, pain
irradiates to the rectum. Anamnesis states
10year-long infertility. On bimanual
examination: uterus is of normal size; uterine
appendages on the both sides are corded, with
rectricted mobility, painful; there are dense
nodular painful growths detected in the
posterior fornix. A doctor suspects
endometriosis. What method allows to verify
this diagnosis?
A. Laparoscopy
B. Diagnostic curettage of uterine cavity
C. Paracentesis of posterior fornix
D. Uterine probing
E. Hysteroscopy
116.A 60-year-old man presents with
subcompensated viral liver cirrhosis (HCV Child-
Pugh class B. What tactics should I chosen
regarding the vaccination again influenza in this
case?
A. . Contraindicated due to disease progress
stage, as shown by Child- Pugh class
B. Scheduled yearly vaccination
C. In case of influenza outbreak
D. Combined with antiviral drugs
E. Contraindicated due to elderly age of patient
117.A healthy child 1 year and 5 month of age is
being vaccinated agains the hapatitis B. The child
did not receive the first dose the vaccine
previously, while in the maternity hospital. The
doctor makes an individual vaccination schedule
for this child and planning the administration of
the next dose the vaccine. What is the minimum
interval between doses of vaccine in this case?
A. 2 months B. 3 months C. 6 months D. 12
months E. 1 month
118. A 19-year-old has been bleeding
intermittently for 26 weeks. She presents with a
change to dark bleeding and minimal cramping
for 4 days. Your clinic ultrasound notes an
intrauterine fetal demise. She is distraught. She
would prefer to let “nature take its course.” She
asks if there is any risk to her. What do you
explain as the only significant risk?
(A) a positive human chorionic gonadotropin
(hCG) titer (B) systemic allergies (C) bone
marrow depression (D) coagulopathy (E)
toxemia
119. A 15-year-old patient complains of
excessive body weight, headache, irritability,
rapid fatigability. Significant increase of body
weight occurred at the age of 14. Objectively:
weight is 90 kg; height is 160 sm, proportional
body built. Fatty tissue is distributed evenly.
There are thin pink striae (stretch marks) on the
thighs, abdomen and mammary glands. BP -
145/90 mm Hg. Provisional diagnosis is:
A. Pubertate dyspituitarism
B. Alimentary constitutive obesity
C. Somatoform autonomic dysfunction
D. Itsenko-Cushing’s disease
E. Cushing’s syndrome
120.A 12-year-old girl after a case of respiratory
infection developed dyspnea at rest, paleness of
skin. Heart rate is 110/min., BP is 90/55 mm Hg.
Heart sounds are muffled. Borders of relative
heart dullness: right - the parasternal line, upper
- the III rib, left - 1,0 cm outwards from the
midclavicular line. Make the provisional
diagnosis:
A. Somatoform autonomic dysfunction
B. Functional cardio C. Infectious myocarditis
D.Hypertrophic cardiomyopathy E. Exudative
pericarditis
121.A child is 9 months old. The patient’s body
temperature is 36,7oC, the skin is pale, humid,
there is pain in leg muscles. There is no
extremities mobility, sensitivity is present. The
child has been diagnosed with poliomyelitis.
The causative agent of this disease relates to
the following family:
A. Paramyxovirus
B. Picornavirus
C. Tohovirus
D. Adenovirus
E . Rotavirus
122. A parturient woman is 27 year old, it was
her second labour, delivery was at term, normal
course. On the 3rd day of postpartum period
body temperature is 36,8oC, Ps - 72/min, AP -
120/80 mm Hg. Mammary glands are
moderately swollen, nipples are clean.
Abdomen is soft and painless. Fundus of uterus
is 3 fingers below the umbilicus. Lochia are
bloody, moderate. What is the most probable
diagnosis?
A. Physiological course of postpartum period
B. Subinvolution of uterus
C. Postpartum metroendometritis
D. Remnants of placental tissue after labour
E . Lactostasis
123 Which of the following is an unusual
feature of the replication cycle in
coronaviruses?
A. They take advantage of recombination with
the long RNA genome
B. The RNAs all terminate in a common 3´ and
produce nested set transcripts.
C.They are not highly mutable.
D.They use capped cellular mRNA's.
124. Describe the coronavirus structure.
A .Club shaped glycoprotein spikes protrude
through a lipid bilayer
B. An icosahedral structure with an envelope
C. An icosahedral large pleomorphic virus
D. Large regimented barrel shaped virus
125. A 21-year-old male, working in a grocery
store in California where the virus has spread,
had high fever, fatigue, and body ache similar to
the symptoms of regular flu/common cold. He
was suspected of COVID-19 by his doctor. He
had mild symptoms and was recommended to
isolate and take care of himself at home. If the
symptoms worsen with difficulty in breathing, a
confirmation test for COVID-19 must be
performed. All of the following statements are
true for the COVID-19 test, EXCEPT?
A. Nasal swab, throat swab, and saliva are taken
as a sample for the detection of the virus
B. The samples taken immediately after the
exposure to the virus may give false-negative
test results
C. A blood test is the primary diagnostic test for
the identification of the virus
D. RT-PCR technique is used as a diagnostic test
for the identification of the virus
126 A 38-year-old African American woman
presents with heavy menses and an enlarged
uterus. After an examination the clinical
diagnosis is leiomyoma of the uterus. Which of
the following best describes this finding?
(A) a soft, interdigitating mass of the uterine
wall
(B) a premalignant papule of the uterine wall
(C) a rapidly dividing necrotic malignancy
(D) a rounded, smooth, firm, well-circumscribed
mass
(E) erythematous, tender, and hereditary
127. A 16-year-old girl is brought to clinic by her
mother with concerns regarding the lack of any
signs of puberty. The appearance of external
genitalia is of a normal prepubertal female.
Laboratory studies show markedly elevated FSH following, the MOST appropriate
and LH levels. Which of the following causes of explanation for the child behavior is
delayed puberty accompanies elevated
circulating gonadotropin levels? A) acute phobic hallucination B) early sign
(A) chronic illness of schizophrenia C)delusional infestation
(B) gonadal dysgenesis D) night terror E)bipolar disorder
(C) hypothalamic tumors
(D) Kallmann syndrome
(E) malnutrition

128. A 65-year-old man who has lived all his life

in Britain presents with severe and constant
back pain at L3, which does not radiate down
the legs. It wakes him at night and he has night
sweats. X-rays show destruction of the disc
space at L2/L3 with invasion of the destruction
into the adjacent vertebral bodies. What would
you expect to find on needle biopsy?
A Tumour cells (metastases)
B Primary chondrosarcoma cells
C Mycobacterium tuberculosis
D Escherichia coli
E Sterile avascular necrosis.

129. A 35-year-old multiparous woman presents

with marked dyspnea and orthopnea in the
ninth month of what is known to be a twin
pregnancy. She is in atrial fibrillation, and
her blood pressure is 130/95 mm Hg. She
has elevated jugular venous pressure,
cardiomegaly, and a third heart sound.
There is a grade 2/6 pansystolic murmur at
the apex. Chest examination reveals
bibasilar inspiratory crackles. In addition to
digoxin and furosemide, which of the
following medications would be MOST
appropriate?
A. hydralazine B. captopril C. prednisone
D. warfarin

130 A parents came to your clinic complaining

that their 5-year-old boy had attacks of
frightening with imagination of a snake
crawling over him and he is acting as trying
to remove it. You assessed the child and
find no acute physical illness and he is
cooperative and quite intelligent. Of the