Krok 2 - 2021 (General Medicine) 26 May

Krok 2- 2021 (General Medicine) (t.
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Krok 2 – 2021 (General Medicine) 26 May 5. Hypoplastic anemia

1. A 28-year-old woman came to a gynecologist with
complaints of infertility for the last 3 years. Her 4. A 30-year-old man, a cable presser, complains of
menstrual function is normal. She has a history of inertness, memory problems, and pain in his limbs.
one artificial abortion and chronic salpingo- Objectively, he presents with skin pallor, anemia,
oophoritis. She uses no contraception. The reticulocytosis, basophilic stippling of erythrocytes,
spermogram of her husband is normal. What method and high levels of porphyrin in urine. This man has
should be used first to determine the cause of this the signs of the following disease:
woman's infertility? 1. Saturnism
1. Hysteroscopy 2. Mercurialism
2. Hysterosalpingography 3. Asbestosis
3. Laparoscopy 4. Berylliosis
4. Diagnostic uterine curettage 5. Siderosis
5. Hormone testing
5. A 43-year-old man, a coal-face worker with a 15-
2. A 58-year-old man complains of weakness and year-long record of work, complains of cough,
tumor-like formations that appeared on the anterior thoracic pain, and dyspnea. The cough is mild,
surface of his neck and in the inguinal region. usually dry, occurs mostly in the morning. The pain
Palpation detects soft painless mobile cervical and is localized in the interscapular region and
inguinal lymph nodes up to 2 cm in diameter. The aggravates during a deep intake of breath. Dyspnea
liver protrudes by 2 cm from the edge of the costal occurs during physical exertion. Vesicular
margin, the lower splenic pole is at the umbilical respiration in the lungs is weakened. Heart sounds
level. In blood: erythrocytes - 3.5 × 1012/L, H - 88 g/L, are rhythmic, heart rate is 86/min., blood pressure is
leukocytes - 86 × 109/L, band neutrophils - 1%, 135/80 mm Hg. The abdomen is soft and painless. X-
segmented neutrophil - 10%, lymphocytes - 85%, ray shows micronodular pulmonary fibrosis. Make
eosinophils - 2%, basocytes - 0%, monocytes - 2%, the provisional diagnosis:
erythrocyte sedimentation rate - 15 mm/hour, 1. Siderosis
Gumprecht shadows. What is the most likely 2. Berylliosis
diagnosis? 3. Carboconiosis
1. Chronic lymphoid leukemia 4. Metal pneumoconiosis
2. Acute leukemia 5. Byssinosis
3. Lymphocytic leukemoid reaction
4. Chronic myeloid leukemia 6. A woman has undergone a surgery for diffuse
5. Lymphogranulomatosis toxic goiter, degree II. Twelve hours after the
surgery, she developed complaints of hoarseness
3. A 28-year-old woman complains of weakness, and voice loss, problems with breathing, dyspnea,
dizziness, nosebleeds, and hemorrhages on her and anxiety Her post-surgery wound is normal. What
torso. The condition onset was 4 months ago. complication developed in this woman?
Objectively, her condition is of moderate severity. 1. Recurrent laryngeal nerve paresis
There are multicolored painless hemorrhages 1-2 cm 2. Thyrotoxic crisis
in size on her back and abdomen. The peripheral 3. Hypoparathyroidism
lymph nodes are not enlarged. The liver is (-), the 4. Postoperative bleeding
spleen is (+). Blood test shows the following: Hb - 5. Tracheal injury
120 g/L, erythrocytes - 3.4 × 1012/L, color index - 0.9,
reticulocytes - 0.9%, serum iron - 15.01 mcmol/L , 7. A 43-year-old woman complains of persistent
leukocytes - 4.2 × 109/L, eosinophils - 2%, basophils stomachache with recurrent pain attacks, nausea,
- 0%, band neutrophils - 7%, segmented neutrophils repeated vomiting with stagnant bowel content,
- 40%, monocytes - 6%, lymphocytes 45%, platelets abdominal distension, and flatulence. She has been
47.1 × 109/L, ESR – 27 mm/hour. What is the most presenting with these signs for 7 hours. Pulse is
likely diagnosis in this case? 116/min. The tongue is dry and brown. The abdomen
1. Idiopathic thrombocytopenic purpura is symmetrically distended, soft, painful. Percussion
2. Chronic lymphocytic leukemia reveals tympanitis. On auscultation there are bowel
3. Hemolytic anemia sounds with metallic overtones, splashing, and
4. Chronic iron-deficiency anemia dripping. Make the diagnosis?
Krok 2- 2021 (General Medicine) (t.me/krok2GeneralMedicine) - 2
1. Acute intestinal obstruction a burning pain that occurs at the end of urination.
2. Acute nonspecific colitis Urination occurs up to 15 times per 24 hours. The
3. Acute necrotizing pancreatitis urine is turbid and contains blood. Clinical urinalysis
4. Acute erosive gastritis shows leukocytes the whole vision field and isolated
5. Acute destructive cholecystitis erythrocytes. What provisional diagnosis can be
made?
8. On the 5th day after giving birth a postparturient 1. Acute pyelonephritis
woman complains of a pain in her left mammary 2. Acute urethritis
gland and body temperature up to 38.1°C. 3. Acute cystitis
Examination shows that her mammary gland is 4. Acute glomerulonephritis
enlarged and painful on palpation, the nipple is 5. Urolithiasis
edematous and has fissures, the upper external
quadrant of the gland is hyperemic. Name the 12. A 20-year-old man suffers from headache,
measures that would have prevented the general weakness, and face edema that appears in
development of this complication in the patient: the morning. 18 days earlier he had a case of
1. Feeding on schedule tonsillitis. Objectively, his skin is pale, there are
2. Stop breastfeeding when fissures appear edema under his eyes. Heart rate is 60/min., blood
3. Constant expression of breast milk pressure is 185/100 mm Hg. The sign of
4. Feeding on demand, expression of breast milk, costovertebral angle tenderness (punch sign in the
prevention of nipple fissures lumbar region) is negative. Urinalysis: color of
5. Feeding no longer that 10 minutes through an overlay «meat slops», protein - 4.5 g/L, altered erythrocytes -
40-45 in the vision field, leukocytes - 5-6 in the vision
9. A 38-year-old woman came to a dermatologist field. 24-hour diuresis is 400 mL. What is the most
complaining of dry and peeling skin. Examination likely diagnosis?
reveals a papular rash and fine peeling on the 1. Urolithiasis
exterior surfaces of her knee and elbow joints; in the 2. Acute glomerulonephritis
area of hair follicles there are wax-colored nodules 3. Acute pyelonephritis
that rise from the skin. These clinical signs are likely 4. Renal amyloidosis
caused by insufficient dietary intake of the following 5. Systemic lupus erythematosus
substance:
1. Pyridoxine 13. An industrial area has high levels of noise
2. Retinol pollution and the air of the working area is highly
3. Ascorbic acid polluted with sulfur anhydride. What type of harmful
4. Riboflavin effect can these factors have on the body in such
5. Thiamine conditions?
1. Complex
10. A 32-year-old man has a closed cerebrocranial 2. Separate
trauma, a closed chest trauma, and a closed right 3. Specific
femoral fracture. His blood pressure was 100/60 mm 4. Joint
Hg, pulse - 124/min., respiration - 28/min. Two hours 5. Combined
after the skeletal traction was performed under
topical lidocaine anesthesia, the patient's condition 14. A 73-year-old man has a 5-year-long history of
suddenly became worse. His face and neck became benign prostatic hyperplasia. One morning he
cyanotic, blood pressure - 60/40 mm Hg. heart rate - developed an acute urinary retention.
160/min., respiration rate - 44/min. What Catheterization of his bladder is impossible. What
complication has likely developed in this case? urgent aid must be provided for this man?
1. Pain shock 1. Thermal procedures
2. Fat pulmonary embolism 2. Diuretics
3. Myocardial infarction, cardiogenic shock 3. Antispasmodics and analgesics
4. Pulmonary embolism 4. Suprapubic bladder tap
5. Acute posthemorrhagic anemia 5. Adrenergic blockers
11. A 51-year-old man after an overexposure to cold 15. A 7-year-old boy after a fall from a height
has developed acute pain in his lower abdomen and presents with rapid and shallow breathing and
cyanotic face. The right half of his thorax is filled with serous exudate that forms yellowish
distended and takes no part in the respiration. scabs, when dried out. Schorrheic sales are
Percussion detects tympanitis in the affected area, observed on the child's scalp. What is the most
while auscultation detects no breathing there. What likely diagnosis in this case?
pathology is the most likely cause of this clinical 1. Staphyloderma
presentation? What instrumental examination would 2. Allergic (atopic) diathesis
be the most informative in this case? 3. Lymphatic-hypoplastic diathesis
1. Right-sided tension pneumothorax. Chest X-ray 4. Neuro-arthritic diathesis
2. Right-sided hemothorax. Survey X-ray of the chest 5. Exudative-catarrhal diathesis
3. Tension cyst of the right lung. Tracheobronchoscopy
4. Mediastinitis. Survey X-ray of the chest 19. When examining blood coagulation system of a
5. Airway foreign body. Diagnostic and therapeutic man before a surgery, he was found to have a
bronchoscopy deficiency of factor VIII - antihemophilic globulin A.
What disease is it?
16. A 14-year-old boy complains of fatigability, face 1. Hemophilia A
edema, headache, and urination in small portions. 2. Hemophilia B
The urine resembles meat slops in color. The boy is 3. Hemophilia C
registered for regular check-ups since the age of 8 4. Hemorrhagic vasculitis
because of chronic glomerulonephritis. His blood 5. Hemorrhagic angiomatosis
creatinine is 0.350 mmol/L, blood urea - 10.4 mmol/L.
What complication is the most likely cause of this 20. A man, who was diagnosed with scabies and
clinical presentation? underwent a specific treatment, has made a follow-
1. Chronic renal failure up appointment with a doctor. What measures must
2. Acute renal failure he take to prevent a recurrence of scabies?
3. Chronic circulatory failure 1. Correction of the gastrointestinal tract function
4. Renal tuberculosis 2. Laundry disinfection
5. Chronic glomerulonephritis 3. Correction of the immune status
4. Elimination of food allergens
17. A 45-year-old woman complains of general 5. Footwear disinfection
weakness, dyspnea, and dizziness. Within one year
her hair became gray, her nails started peeling, and 21. A 22-year-old woman complains of itching and
she developed gustatory disorders. For the last 5 profuse discharge from her genital tracts. The
years she has been registered for regular check-ups condition developed 10 days ago after a sexual
with a gynecologist for uterine fibromyoma. Her contact. Bacterioscopy of a discharge sample
blood test shows the following: erythrocytes - 3.0 × detected trichomonads. What drug should be
1012/L, Hb - 76 g/L, color index - 0.7, reticulocytes prescribed for treatment in this case?
0.7%, platelets - 160 × 109/L, leukocytes - 5.0 × 109/L, 1. Ampiox (Ampicillin + Oxacillin)
eosinophils - 2%, band neutrophils - 3%, segmented 2. Erythromycin
neutrophils 63%, lymphocytes - 28%, monocytes - 3. Metronidazole
4%, aniso- and microcytosis, ESR - 30 mm/hour. 4. Zovirax (Acyclovir)
What type of anemia can be suspected in this case? 5. Valtrex (Valaciclovir)
1. Hypoplastic anemia
2. Minkowski-Chauffard syndrome 22. A parturient woman has been in labor for 8
3. Autoimmune hemolytic anemia hours. The labor activity is weak, contractions last
4. Iron-deficiency anemia for 25 seconds and occur twice per 10 minutes.
5. B12-deficiency anemia Vaginal examination shows cervical opening of 4
cm, the baby is in the cephalic presentation. During
18. A 3-month-old child has been formula-fed since examination the woman's waters broke. The waters
the age of 2.5 months, because the child's mother contained meconium. Fetal heart rate is 90/min., dull.
has no milk. The mother notes that despite her What tactics of labor management must be chosen
taking a good care of her child, the baby developed in this case?
persistent redness in the skin folds. Three-four days 1. Prescribe labor stimulation with oxytocin solution
later, the child developed itching and hyperemic skin 2. Urgent delivery by means of a cesarean section
patches on the cheeks and chin. The patches are 3. Observation and treatment of fetal distress
4. Continue the conservative management of labor with 1. Osteoarthritis

continuous monitoring of the fetus 2. Gouty arthritis
5. Apply obstetric forceps 3. Rheumatoid arthritis
4. Reactive arthritis
23. In the factory cafeteria there was an outbreak of 5. Psoriatic arthritis
food poisoning. Clinical presentation indicates
staphylococcal etiology of this disease. 15 people 27. A 57-year-old man complains of cough with
are sick. To confirm the diagnosis of food poisoning, profuse mucopurulent sputum (up to 150 mL per 24
samples need to be sent to the laboratory. What hours). Objectively, he has drumstick fingers with
samples should be obtained to find out the watch-glass nails. Percussion produces a shortened
etiological factor of this food poisoning? sound over the lungs. Auscultation detects
1. Vomit masses moderate and large bubbling crackles. Complete
2. Saliva blood count shows leukocytosis and a left shift in
3. Blood (complete blood count) the leukogram. Chest X ray shows intensified
4. Urine pulmonary pattern and ring-like shadows.
5. Blood for hemoculture Bronchography detects multiple cylindrical
thickenings of the bronchi with clear margins. Make
24. On examination a man presents with the the provisional diagnosis: empyema
following signs: progressing weakness, loss of 1. Pulmonary gangrene
working ability, rapid physical and mental 2. Pulmonary echinococcosis
fatigability, sensations of cold and hunger, and 3. Chronic pleural empyema
weight loss. What type of alimentary disorder is it? 4. Bronchiectasis
1. Vitamin deficiency 5. Pulmonary cyst
2. Mineral deficiency
3. Protein-energy undernutrition 28. 40% of the workers who polish the art glass,
4. Dietary fiber deficiency using an abrasive disk, and have a long record of
5. Polyunsaturated fatty acid deficiency employment, are diagnosed with ulnar neuritis, 21%
- with vegetative polyneuritis, and 12% - with
25. A 62-year-old man complains of a moderate pain vegetomyofascitis of the upper limbs. These
in his left foot in the area of his metatarsophalangeal pathologies are associated with the following
joint. The pain intensifies on movement. The disease harmful factor:
onset was 12 years ago, when he first had an (acute 1. Vibration
pain attack). Two years ago, a yellow white nodule 2. Noise
appeared under the skin that covers the joint. 3. Microclimate
Examination shows that the joint is deformed and 4. Electromagnetic field
cyanotic. X ray of the affected joint shows narrowing 5. Dust
of the joint space and well-defined bone tissue
defects in the epiphysis (punched out erosions). 29. A 35-year-old woman, a polisher, complains of
What is the most likely diagnosis in this case? chills, cold bluish fingertips, low mobility of her
1. Reiter's syndrome hand joints, and a contracted sensation in the skin
2. Gouty arthritis of her face and hands. Examination detects anemia.
3. Rheumatoid pouch-like pursing of the mouth, thickened skin of
4. Osteoarthritis checks and hands, pale and cold fingertips. A
5. Reactive arthritis bandbox resonance and isolated fine inspiratory
crackles can be heard over the lungs. Blood test
12
26. A 55-year-old woman complains of pain and shows the following: erythrocytes - 3.8*10 /L,
popping sounds in her left knee joint, which occur leukocytes-4.8-109/L, ESR-45 mm/hour. CRP++. What
when she climbs the stairs. Occasionally, during is the most likely diagnosis in this case?
movements her joint becomes «stuck». 5 years ago 1. Vibration disease
she received a trauma of the left knee. Complete 2. Systemic scleroderma
blood count and biochemical blood analysis show 3. Obliterating endarteritis of the extremities
normal results. X-ray shows marked osteosclerosis 4. Raynaud's disease
and osteophytes. The joint space is narrowed. Make 5. Myxedema
the provisional diagnosis:
30. A 59-year-old man for a month has been 5 Combined

presenting with short-term periodical loss of
strength in his limbs on the left. Later he developed 34. When her car collided with a tree, a 37-year-old
a persistent morning weakness in the affected limbs woman felt a sharp pain in her left hip joint. She was
after wakening. Objectively, he is conscious and has unable to get out of the car. Her position is forced,
central paresis of the VII and XII pairs of his cranial the hip is pressed to the abdomen, fixed, and rotated
nerves on the left. Central hemiparesis and inwards; the limb is flexed in the knee, any attempt
hemihypersthesia are observed on the left side. to change the position results in sharp pain. Make
What are the drugs of choice for treatment of this the diagnosis:
man? 1. Contusion of the left hip joint
1. Anticoagulants 2. Closed dislocation of the left hip
2. Hemostatics 3. Hemarthrosis of the left hip joint
3. Hypotensive agents 4. Arthritis of the left hip joint
4. Diuretics 5. Closed cervical fracture of the left hip
5. Corticosteroids
35. An 18-year-old young man during hospitalization
31. A 30-year-old man complains of itching and a complains of general weakness, body temperature
rash on the skin of his feet. The disease onset was 3 of 37.5°C, loss of appetite, nausea, heaviness in the
years ago. Objectively, on the soles of his feet there right subcostal region, and discolored stool and
are clusters of vesicles that resemble boiled sago urine. The disease onset was 5 days ago.
beans, as well as erosions with flaps of macerated Objectively, his skin and sclerae are slightly icteric.
epidermis on the periphery of the foci. Interdigital The liver protrudes by 3 cm and is tender to
folds on both feet have fissures and erosions. What palpation. Patient's urine is dark brown, while his
is the most likely pathology in this case? stool is light-colored. He usually drinks water from a
1. Dermatitis tap. What is the most likely diagnosis in this case?
2. Rubrophytia of the feet 1. Viral hepatitis B
3. Secondary syphilis 2. Leptospirosis
4. Psoriasis 3. Viral hepatitis A
5. Epidermophytosis of the feet 4. Typhoid fever
5. Malaria
32. A 45-year-old man complains of painless nodules
that appeared on the skin of his limbs and on the 36. A 32-year-old man has been hospitalized with
small of his back. The nodules have a tendency to fever episodes that are accompanied by excessive
grow peripherally and merge together. The disease sweating and occur every 48 hours. Twelve years
onset was 2 years ago. Exacerbations occur mostly ago he was in military service in Tajikistan, where he
in spring. His family history states that his father had a case of malaria. Objectively, his sclerae are
had a similar skin condition. Objectively, the subicteric, his skin is pale, the liver is dense and
pathologic elements manifest as drop-shaped and enlarged by 2 cm, the spleen is enlarged by 5 cm.
coin-shaped nodules and plaques, covered in white What test is necessary to clarify and confirm the
scales. Make the provisional diagnosis: diagnosis in this case?
1. Psoriasis 1. Biochemical blood test
2. Seborrheic eczema 2. Serological blood test
3. Pityriasis rosea 3. Serum bilirubin levels
4. Lichen ruber planus 4. Serum activity of ALT and AST enzymes
5. Atopic dermatitis 5. Microscopy of the thick drop and blood smear
33. In a city, the levels of manganese are elevated in 37. An 8-year-old girl with complaints of painful
the atmospheric air, water, and agricultural foods. urination, frequent low-volume urination, and
What type of effect do these factors have on the leukocyturia was diagnosed with acute cystitis. 10
health of the population? days before the disease onset she was treated by
1. Joint the gynecologist for acute vulvitis. 5 days ago she
2. Separate presented with mild catarrhal symptoms. Her mother
3. Synergistic ascribes the child's disease to her overexposure to
4. Complex cold. Specify the most likely infection route:
1. Lymphogenic 2. Congenital rubella syndrome

2. Hematogenic 3. Toxoplasmosis
3. Contact 4. Cytomegalovirus infection
4. Ascending 5. Congenital varicella syndrome
5. Descending
42. A 10-year-old girl was hospitalized with signs of
38. A 35-year-old man was hospitalized with signs of carditis. According to her medical history, two
surgical sepsis that has likely been caused by a weeks ago she had an exacerbation of chronic
large carbuncle in his scapular region. Examination tonsillitis. What etiological factor is the most likely in
detected secondary purulent foci in the liver and this case?
right lung. What stage of surgical sepsis is it ? 1. Klebsiella
1. Purulent resorptive fever 2. Staphylococcus
2. Toxemia 3. Pneumococcus
3. Septicemia 4. Proteus
4. Terminal stage 5. Streptococcus
5. Septicopyemia
43. A 39-year-old man suffers from chronic
39. In the computer lab of the research sector at a rheumatic heart disease. He complains of dyspnea
polytechnic institute, the workstations of laboratory during physical exertion, cough with expectoration,
technicians are located close in front of the screens. and palpitations. Auscultation detects intensified I
Throughout their whole working day, the technicians heart sound and diastolic murmur; the sound of
are exposed to the electromagnetic waves of ultra opening mitral valve can be auscultated at the
high frequencies. Exposure to intense cardiac apex. The II heart sound is accentuated over
electromagnetic waves of such frequency is the pulmonary artery. The patient is cyanotic. X-ray
especially dangerous for the: shows dilated pulmonary root and enlargement of
1. Visual analyzer the right ventricle and left atrium. What is the most
2. Pain sensitivity likely diagnosis?
3. Sensory sensitivity 1. Mitral stenosis
4. Tactile sensitivity 2. Coarctation of the aorta
5. Hearing analyzer 3. Aortic stenosis
4. Patent ductus arteriosus
40. A 35-year-old man after an overexposure to cold 5. Pulmonary artery stenosis
developed complaints of frequent painful urination
in small portions, elevated body temperature of 44. A 50-year-old man complains of general
38.6°C that persists for 24 hours already, and chills. weakness, dizziness, periodical episodes of
Digital rectal examination detects enlarged and unconsciousness, and an intense pain in the small
painful prostate. Blood test shows leukocytosis of of his back and right subcostal region. These signs
14.2 × 109/L, while urinalysis detects leukocyturia of appeared after an accident at a paint factory, where
20-25 in the vision field. What is the most likely he works. His skin is earth-gray and his sclera are
diagnosis in this case? icteric. He has acrocyanosis, His blood pressure is
1. Bladder tumor 100/60 mm Hg. His heart sounds are muffled. His
2. Gonorrhea liver is +3 cm and has a dense edge. Blood test
3. Prostatic hyperplasia shows the following: erythrocytes - 2.0 × 1012/L. Hb -
4. Acute prostatitis 90 g/L. Heinz-Ehrlich bodies, leukocytes - 5.6 × 109/L,
5. Acute cystitis ESR 15 mm/hour, methemoglobin - 62%, total
bilirubin - 84.0 mcmol/L, indirect bilirubin - 71.7
41. A newborn boy, born at 38 weeks of gestation mmol/L. What is the most likely diagnosis in this
with weight of 2200 g, presents with a ventricular case?
septal defect, cataracts in both eyes, and 1. Acute aniline poisoning
sensorineural deafness. At the term of 12 weeks, the 2. Acute toluene poisoning
mother of the boy had a case of an influenza-like 3. Acute viral hepatitis
disease accompanied by a rash. In this case, the 4. Chronic cyanide poisoning
newborn will most likely be diagnosed with: 5. Acquired hemolytic anemia
1. Congenital listeriosis
45. A 38-year-old man has been drinking alcohol antidote agent will be the most effective in this
excessively for the last 3 years. Three days after a case?
drinking bout, he developed anxiety and fear. He 1. Desferal (Deferoxamine)
started to see spiders and worms around him, hear 2. Pentacin (Calcium trisodium pentetate)
accusatory voices, and behave aggressively. He is 3. Methylene blue
oriented in himself, but disoriented in time and 4. Succimer
space. What is the most likely diagnosis in this 5. Sodium thiosulfate
case?
1. Alcoholic encephalopathy 49. A 3-year-old boy was hospitalized in a severe
2. Delirium tremens condition. Objectively, he has somnolence,
3. Alcoholic paranoid hyperreflexia, convulsions, hyperesthesia, and
4. Alcoholic hallucinosis intractable vomiting. His body temperature is 39.9°C,
5. Pathological intoxication heart rate - 160/min., blood pressure - 80/40 mm Hg.
What test must be conducted first in this case?
46. During medical examination a cadet in the naval 1. Cranial CT scan
college was detected to have a painless dense ulcer 2. Skull X-ray
1.5x0.5 in size in his perianal area at the 2 o'clock 3. Rheoencephalography
position. The ulcer floor resembles «old fat». What is 4. Echoencephalography
the provisional diagnosis? 5. Lumbar puncture
1. Anal crypt suppuration
2. Anal cancer 50. A 26-year-old man complains of chills, rhinitis,
3. Rectal fissure dry cough, and fever up to 38°C. Examination shows
4. Hard syphilitic chancre of the rectum him to be in a moderately severe condition; there are
5. Rectal fistula small pale pink non-coalescing spots on the skin of
his back, abdomen, and extremities. Palpation
47. The body of a 35-year-old man was found in a reveals enlarged occipital and axillary lymph nodes.
forest, hanging from a no tied to a tree branch. Face No information about vaccination history could be
and neck is of the deceased are cyanotic, while the obtained. What is the likely etiology of this disease?
leg are normally colored. The ligature mark is closed 1. Streptococcus
and dearly defined. What are the cause and manner 2. Epstein-Barr virus
of death in this case? 3. Rubella virus
1. Mechanical asphyxia as the result of strangulation by 4. Mumps virus
noose, the manner of death-homicide 5. Neisseria meningitis
2. Mechanical asphyxia as the result of strangulation by
a noose, the manner of death-not homicide 51. A 12-year-old girl for two weeks presents with
3. Mechanical asphyxia as the result of chest and periodical body temperature elevations to 39°C,
abdomen compression, the manner spindle-shaped swelling of the interphalangeal
4. Mechanical asphyxia as the result of airway joints, pain in the upper chest and neck, and
obstruction, the manner of death - homicide morning stiffness. What is the most likely
5. Mechanical asphyxia as the result of hanging the diagnosis?
manner of death - non- homicide 1. Rheumatism
2. Septic arthritis
48. A 45-year-old man, provisionally diagnosed with 3. Osteoarthritis
a transient ischemic attack, was brought by an 4. Toxic synovitis
ambulance from an aniline-producing factory. 5. Juvenile rheumatoid arthritis
Objectively, his skin and mucosa are cyanotic. His
speech is dysarthric. The man is disoriented in 52. A 13-year-old girl was brought into the
space. His blood test shows the following: gynecological department with complaints of
erythrocytes - 4.6 × 1012/L, Hb - 143 g/L, color index - profuse bloody discharge from her genital tracts for
0.9, leukocytes - 5.6 × 109/L, Heinz bodies - 14%, the last 10 days. Menarche was at the age of 11, the
reticulocytes - 18%, methemoglobin - 36%, ESR - 5 menstrual cycle is irregular. Rectoabdominal
mm/hour. The patient was diagnosed with a examination detects no pathology. Make the
moderately severe acute aniline intoxication. What provisional diagnosis:
1. Juvenile uterine bleeding
2. External genital tract injury ambulance was called. What emergency aid would
3. Endometrial polyp be optimal in this case?
4. Adenomyosis 1. Antibiotic eye drops, broad-spectrum
5. Werlhof's disease (immune thrombocytopenic 2. Pilocarpine, Diacarb (Acetazolamide), Lytic
purpura) mixture
3. Atropine eye drops
53. To fight against the tobacco smoking, Ukraine 4. Dexamethasone eye drops
has ratified the World Health Organization 5. Sulfacetamide sodium eye drop
Framework Convention on Tobacco Control and
prohibited public smoking. What type of prevention 57. A one-month-old child regurgitates every time
is it? after being put to bed after a breastfeeding.
1. Tertiary prevention Pediatrician's examination revealed no pathology in
2. Primary prevention the child's condition. The doctor explained the
3. Secondary prevention regurgitations as a result of digestive system built,
4. Public prevention characteristic for this age, and gave advise, how to
5. Individual prevention take care of the child in this case. What advise is it?
1. Abdominal massage
54. A 16-year-old teenager has been bitten by a dog. 2. Give a pacifier immediately after breastfeeding
The bites are located in the area of face and 3. Prone position of the baby after feeding
fingertips. The dog is a stray and cannot be 4. Thermal compresses to the stomach
observed. Primary surgical treatment of the wound 5. Upright position of the baby immediately after
was performed without removal of the wound edges. feeding
What tactics should be chosen by a doctor for rabies
prevention? 58. Extermal obstetric examination shows the the
1. Prescribe anti-rabies immunoglobulin and ribavirin mother's belly is ovoid; the fetal back can be
2. Prescribe anti-rabies vaccine and human palpated in the left lateral portion of the uterus, in
immunoglobulin the right portion there are fetal small parts, and at
3. Prescribe anti-rabies vaccine and ribavirin the uterine fundus there is a firm balloting part. Fetal
4. Prescribe anti-rabies immunoglobulin and anti- heartbeat can be heard on the left, above the navel.
rabies vaccine What are the lie, position, and presentation of the
5. Prescribe human immunoglobulin and ribavirin fetus?
1. Longitudinal lie, position I, breech presentation
55. A 40-year-old man was brought into a hospital 2. Transversal lie, position I, no presenting part
with a closed chest trauma. Examination shows that 3. Longitudinal lie,position II, breech presentation
the right side of his chest lags behind during 4. Longitudinal lie, position I, cephalic presentation
breathing. Palpation detects a sharp pain in the 5. Longitudinal lie, position II, cephalic presentation
projection of ribs V, VI, and VII on the anterior
axillary line and subcutaneous emphysema on the 59. The condition of a full-term newborn deteriorated
right side of the torso. Percussion reveals on the first day of life. The haty was born from the
tympanitis over the right-sided segments of the third pregnancy during the second half of which
chest. Auscultation detects no breathing on the right gestosis was observed. The mother's blood group is
and vesicular breathing on the left. What surgical 0(I) Rh(-). Examination shows that the baby is inert
procedure is necessary for this patient? and has icteric skin and mucosa; baby's urine and
1. Drainage of subcutaneous emphysema stool are of normal color. Blood serum bilirubin is
2. Drainage of the right pleural cavity 248 mcmol/L, because of indirect bilirubin levels.
3. Splint stabilization of the rib fracture What is the most likely cause of this pathologic
4. Tight bandaging of the chest condition?
5. Immediate thoracotomy 1. Fetal hepatitis
2. Biliary atresia
56. A man diagnosed with closed-angle glaucoma, 3. ABO incompatibility
grade IIa, of the right eye is registered for regular 4. Rh incompatibility
medical check-ups. In the evening an acute 5. Physiological jaundice
glaucoma attack occurred in his right eye; an
60. A woman with blood group B(III) Rh(+) gave birth result of prolonged exposure to such working
to a full-term healthy boy. Examination on the 3rd conditions?
day of the infant's life shows him to have icteric tint 1. Sensory polyneuropathy with angiospastic
to his skin. The child has no problems with suckling, syndrome
sleep is nondisturbed. The abdomen is soft, the liver 2. Somatoform autonomic dysfunction
protrudes by 2 cm from under the costal margin. 3. Hand dermatitis
Complete blood count: hemoglobin - 200 g/L, 4. Sensorineural hearing loss
12
erythrocytes - 5.5 10 /L, total bilirubin - 62 mcmol/L, 5. Psychasthenia
indirect bilirubin - 52 mcmol/L. What condition can
be suspected? 64. A 65-year-old man complains of cough attacks
1. Hemolytic disease of the newborn due to Rh that occur when he eats liquid foods. Three months
incompatibility ago he was diagnosed with a carcinoma in the upper
2. Biliary atresia third of the esophagus. He underwent radiation
3. Congenital hepatitis therapy. What complication developed in this man?
4. Physiological jaundice 1. Tracheoesophageal fistula
5. Hemolytic disease of the newborn due to ABO 2. Spontaneous pneumothorax
incompatibility 3. Tracheal stenosis
4. Perforation of a gastric cardia ulcer
61. After semolina was introduced into the diet, a 1- 5. Lung abscess rupture into the pleural cavity
year-old child for 2 months has been presenting with
loss of appetite, irritability, loss of body mass, and 65. A 32-year-old woman complained of sudden
loss of previously learned skills. The feces are piercing headache and fell down unconscious. In an
copious and foul-smelling. The skin is pale and dry, ambulance, an emergency physician noted her
the hair is brittle. The abdomen is distended, while severe edition, sopor, and meningeal syndrome.
the limbs are thin. Stool test shows high levels of After her hospitalization, the lumbar puncture
fatty acids. What is the most likely diagnosis? yielded bloody cerebrospinal fluid. Her
1. Celiac disease cerebrospinal fluid pressure is 260 mm H₂ O. Make
2. Functional diarrhea the provisional diagnosis:
3. Lactase deficiency 1. Ischemic stroke
4. Irritable bowel syndrome 2. Traumatic brain injury
5. Mucoviscidosis (cystic fibrosis) 3. Aneurysm rupture, subarachnoid hemorrhage
4. Meningoencephalitis
62. A 17-year-old girl complains of a pain and 5. Meningioma
swelling of her second finger on the right hand.
Three days ago she made a manicure. The pain 66. On the 10th day after giving birth a woman came
developed on the second day after that. Objectively, to a doctor complaining of high temperature of 38°C
her nail fold is swollen, hyperemic, overhangs the and sudden pain, hyperemia, and an indigestion in
nail plate, and is painful on palpation. What is the her left breast. Objectively, the skin of her left
most likely diagnosis in this case? mammary gland has local hyperemia in its upper
1. Cutaneous panaritium outer quadrant. During its palpation the pain
2. Erysipeloid intensifies. What is the most likely diagnosis in this
3. Subcutaneous panaritium case?
4. Paronychia 1. Breast hemangioma
5. Subungual panaritium 2. Cyst of the left breast with suppuration
3. Fibroadenoma of the left breast
63. A quarry produces granite, which is then broken 4. Lactational mastitis
into pieces with explosives and manual pneumatic 5. Left breast cancer
hammers. When breaking granite rocks and drilling
blast holes for the explosives, the workers are 67. An 8-year-old girl after a case of acute
exposed to local vibration of medium and high respiratory infection has been complaining for the
frequency. Vibration measurement revealed that it last 2 weeks of a pain in the area of her heart and
exceeds the maximum permissible level. What palpitations. Objectively, her body temperature is
specific changes can develop in the workers as the febrile, her skin is pale, the heart borders are
extended to the left, heart rate is 142/min. The girl
presents with paired atrial extrasystoles, dull heart 56/min. Low levels of free T4 are observed. This
sounds, and a low intensity systolic murmur that patient needs to take the following on a regular
reaches its maximum at point 5. Make the basis:
provisional diagnosis: 1. Lithium carbonate
1. Functional changes in the heart 2. Calcium gluconate
2. Congenital heart disease 3. Furosemide
3. Somatoform vegetative dysfunction 4. Mercazolil (Thiamazole)
4. Endocarditis 5. Thyroxine
5. Myocarditis
72. A 52-year-old man had an acute onset of the
68. A 24-year-old man has fallen on his feet from a disease after an overexposure to cold that occurred
fourth floor balcony. He felt a sharp pain in his back, 3 weeks ago. He complains of cough, high body
because of which he was unable to stand up temperature of 30.5°C, chest pain on the right, and
unassisted. Examination shows smoothed out marked dyspnea. His pulse is 120/min., blood
lumbar lordosis. The spine axial load is positive. pressure - 90/60 mm Hg, respiration rate - 48/min.
Palpation of the spinous processes, especially of Acrocyanosis is observed. Objectively, the right side
Th12, is painful. Sensitivity and mobility of the legs of his chest lags behind during breathing.
are not disturbed. Make the diagnosis: Percussion detects a pulmonary dullness on the
1. Fracture of the lumbar spine spinous processes right. Auscultation detects no breathing over the
2. Th12 fracture with dysfunction of the spinal cord right lung. X-ray shows on the right a shadow with
3. Lumbar spine contusion fuzzy upper margin to the level of rib II. Exudate
4. Th12 compression fracture without dysfunction of contains 90% of neutrophils. What is the most likely
the spinal cord diagnosis in this case?
5. Pelvic fracture with dysfunction of the pelvic organs 1. Lung cancer
2. Exudative tuberculous pleurisy
69. During medical examinations of high and middle 3. Pleural empyema
school students, the doctors were assessing 4. Infiltrative tuberculosis of the right lung
correlation between biological and calendar age of 5. Croupous pneumonia
the school students based on the following criteria:
height growth rate per year, ossification of the 73. A 25-year-old woman has been suffering from
carpal bones, the number of permanent teeth. What diabetes mellitus since she was 9. She was admitted
additional development criterion should be into the nephrology unit with significant edemas of
assessed at this age? the face, arms, and legs. Blood pressure - 200/110
1. Chest circumference mm Hg, Hb - 90 g/L, blood creatinine - 850 mcmol/L,
2. Development of secondary sex characteristics the daily amount of urine is decreased - 200 ml,
3. Vital capacity of lungs urine proteins - 1.0 g/L, leukocytes - 10-15 in the
4. Body mass vision field. Glomerular filtration rate - 10 mL/min.
5. Hand strength What tactics should the doctor choose?
1. Transfer into the hemodialysis unit
70. A man suffers from urolithiasis and periodically 2. Active conservative therapy for diabetic nephropathy
develops hyperoxaluria. What products should be 3. Dietotherapy
reduced in his diet? 4. Kidney transplantation
1. Canned soup 5. Transfer into the endocrinology clinic
2. Dairy products
3. Meat, fish 74. It is the 11th day after a woman has given birth
4. Fatty foods and for the last 5 days she has been ill. She
5. Sorrel, spinach, tomatoes complains of chills. Her body temperature fluctuates
between 35.8°C and 39.9°C. She cannot pump milk
71. A 38-year-old woman complains of weakness, from her left breast. Objectively, her skin and
sleepiness, pain in the joints, weight gain despite mucosa are pale, her left mammary gland is
low appetite, and constipations. She presents with significantly larger than the right one, the skin there
dry and thickened skin, puffy and amimic face, is hyperemic, the upper and lower quadrants are
narrowed palpebral fissures, thick tongue, and deep dense, palpation detects a fluctuation and provokes
hoarse voice. Her heart sounds are weak, pulse is sharp pain. The nipple is edematous and has a
fissure with a purulent crust. The right mammary Objectively, the boy is pale, frightened, and sits,
gland is normal. Make the provisional diagnosis: leaning onto his arms. His body temperature is
1. Postpartum period. Physiological course 36.6°C, heart rate - 120/min., respiration rate 42/min.,
2. Postpartum period. Sepsis speaks in syllables. The exhale is long and
3. Postpartum period. Right breast cancer accompanied by wheezing. Percussion detects a
4. Postpartum period. Serous mastitis of the right breast bandbox resonance over the lungs. An inhalation of
5. Postpartum period. Right breast abscess ventolin (salbutamol) solution was started via a
nebulizer. What can help assess the child's need for
75. A 20-year-old student after failing an exam oxygen therapy in this case?
developed complaints of a sensation of a round 1. Chest X-ray
foreign body in her throat, difficult swallowing. She 2. Assessment of accessory muscles involvement
fixates on her condition, limits her diet, often cries, 3. Spirometry
seeks attention, exhibits demonstrative attitude. She 4. Pneumotachometry
is highly susceptible to psychotherapeutic 5. Pulse oximetry
suggestions. What psychiatric diagnosis can be
made in this case? 79. A 7-day-old girl is markedly inert and suffers
1. Hysterical neurosis from recurrent (sometimes projectile) vomiting,
2. Paranoid personality disorder liquid stools, exicosis, and marked progressing
3. Obsessive neurosis hypotension. She gains no weight. Her skin is earthy
4. Hypochondriacal neurosis gray and her nipples are pigmented. She presents
5. Depressive neurosis with enlarged clitoris, incomplete union of the vulvar
lips, and incomplete separation of the urethra and
76. A 29-year-old woman complains of a general vagina. She has marked hyperkalemia and
weakness, increased fatigability. weight loss, and hyponatremia, metabolic acidosis, and
infrequent scanty periods. One year ago she had a hypoglycemia. Her blood aldosterone levels are low,
childbirth. complicated with a massive bleeding. while her plasma renin activity is high. Make the
Objectively, the woman is asthenic, her skin is pale provisional diagnosis:
and dry, the hair cover is thin on her scalp and 1. Turner syndrome
absent in her armpits. Her mammary glands and 2. Adrenogenital syndrome, simple-virilizing form
genitals are hypertrophic. Make the provisional 3. Adrenogenital syndrome, hypertensive form
diagnosis: 4. Hermaphroditism
1. Pituitary tumor 5. Adrenogenital syndrome, salt-wasting form
2. Anorexia nervosa
3. Asthenoneurotic syndrome 80. A pregnant woman at 32 weeks of gestation with
4. Sheehan's syndrome the risk of preterm labor undergoes a treatment to
5. Hypoplastic anemia prevent fetal respiratory distress syndrome. What
medicine was she prescribed?
77. A 17-year-old girl has made an appointment with 1. Gynipral (hexoprenaline)
the doctor. She plans to begin her sex life. No signs 2. Misoprostol
of gynecological pathology were detected. In the 3. Oxytocin
family history there was a case of cervical cancer 4. Dexamethasone
that occurred to the patient's grandmother. The 5. Progesterone
patient was consulted about the maintenance of her
reproductive health. What recommendation will be 81. A 25-year-old parturient woman is hospitalized
the most helpful for prevention of invasive cervical with contractions that have been occurring for 12
cancer? hours already. The contractions last 25 seconds,
1. Antiviral and antibacterial drug while the intervals between them last 3-4-7 minutes.
2. Vaccination against human papillomavirus (HPV) The contractions are irregular and sharply painful,
3. Vitamins, calcium, omega-3 with pain spreading upwards from the lower uterine
4. Timely treatment of sexually transmitted diseases segment. The baby is in the cephalic presentation,
5. Immunomodulators the head is pressed to the entrance into the lesser
pelvis. Uterine hypertonus is observed. Internal
78. A 7-year-old boy after playing with a cat obstetric examination shows that the cervix is
suddenly developed problems with breathing. smoothed and the opening of the external orifice
uterus is 3 cm. The amniotic sac is intact. Make the 85. A 62-year-old woman was brought into the
provisional diagnosis: admission room with complaints of severe burning
1. Discoordinated labor activity retrosternal pain and asphyxia. She has a 10-year-
2. Physiological course of the labor long history of essential hypertension. Objectively
3. Cervical dystocia her condition is moderately severe. She presents
4. Primary weakness of the labor activity with skin pallor, cyanotic lips, and vesicular
5. Secondary weakness of the labor activity respiration over her lungs. The II heart sound is
accentuated over the aorta. Blood pressure - 210/120
82. A 65-year-old man has an over 17-year-long mm Hg. heart rate (pulse) - 76/min. ECG shows
history of chronic obstructive bronchitis. He elevation of ST segment in the leads 1, AVL, and VS-
complains of dyspnea with difficult inspiration, V6. What is the most likely diagnosis?
heaviness in his right subcostal region, and edema 1. Pulmonary embolism
of feet and shins. Auscultation detects rough 2. Hypertensive crisis complicated with acute left
respiration and dry crackles over the lungs and an ventricular failure
accentuated split second heart sound in the second 3. Uncomplicated hypertensive crisis
intercostal region. What changes can be expected 4. Hypertensive crisis complicated with acute
on the ECG? myocardial infarction
1. Extrasystole 5. Hypertensive crisis complicated with instable angina
2. Left atrial hypertrophy pectoris
3. Deviation of the electrical axis of the heart to the left
4. Right ventricular myocardial hypertrophy 86. A 40-year-old woman after an unsuccessful
5. Ciliary arrhythmia treatment by a neurologist was referred to a
gynecologist. She complains of swollen breasts,
83. For the last 2 years, a 32-year-old woman has depression intermittent with aggression, weakness,
been observing periodical pain attacks in her right tearfulness, numb arms, and meteorism that appear
subcostal area that could be removed with no-spa 2-3 days before a menstruation and disappear after
(drotaverine). The pain is not always associated with the menstruation is over. She considers herself ill
meals, sometimes it is caused by anxiety and for the last 2 years. Gynecological examination
accompanied by cardiac pain and palpitations. detects no pathologic changes in her genitals. She
Objectively, the woman is emotionally labile. was diagnosed with premenstrual syndrome. What
Abdominal palpation detects a slight pain in the area clinical form of premenstrual syndrome is the most
of the gallbladder. What pathology is the most likely likely in this case?
to cause such clinical presentation? 1. Crisis
1. Chronic cholangitis 2. Mixed
2. Duodenitis 3. Cephalgic
3. Chronic cholecystitis 4. Edematous
4. Chronic pancreatitis 5. Neuropsychic
5. Biliary dyskinesia
87. During examination a 4-month-old child with
84. A 36-year-old woman complains of nausea, meningococcemia presents with acrocyanosis, cold
belching, liquid stool, and a pain in the epigastrium extremities, tachypnea, and thready pulse, blood
after meals. For the last 2 years the disease has pressure of 30/0 mm Hg, anuria, and sopor. What
been slowly progressing. Objectively, her skin is clinical syndrome is it?
pale and dry, her tongue is coated, moist, and has 1. Exicosis
imprints of the teeth on its edges. Abdominal 2. Encephalic syndrome
palpation detects a diffuse pain in the epigastrium. 3. Acute renal failure
What test will be the most informative in this case 4. Neurotoxicosis
and should be conducted next? 5. Toxic shock syndrome
1. Comprehensive complete blood count
2. Gastrointestinal X-ray 88. A 39-year-old woman complains of high body
3. Fractional analysis of gastric secretion temperature of 37.8°C that persists for two days
4. Fibrogastroscopy with biopsy of the gastric already, frequent urination, and a dull lumbar pain.
mucosa These sighs appeared for the first time, after an
5. Abdominal CT scan overexposure to cold. During physical examination,
palpation of the renal region is painful. Urinalysis 1. Acute ascending thrombophlebitis of the saphenous
shows the following: pH alkaline, protein - 0.099 g/L, veins in the left leg
leukocytes cover the whole vision field, erythrocytes 2. Acute deep vein thrombosis in the left leg
- 0 in the vision field, cylinders - 0 in the vision field. 3. Thrombosis of the tibial arteries on the left
Complete blood count shows the following: 4. Varicose saphenous veins in the left leg
hemoglobin - 140 g/L, leukocytes - 9.2-109/L, ESR - 5. Postthrombotic syndrome of the left leg
30 mm/hour. What medicine should be chosen for
empiric antibiotic therapy in this case? 92. A 48-year-old woman complains of disturbed
1. Amikacin menstrual cycle: her periods last for 7-9 days and
2. Fosfomycin are excessively profuse throughout the last half-
3. Trimethoprim/sulfamethoxazole year. She notes occasional hot flashes in her head,
4. Amoxicillin insomnia, irritability, and headaches. Her skin is of
5. Ciprofloxacin normal color. Blood pressure - 150/90 mm Hg. pulse
- 90/min., rhythmic. The abdomen is soft and
89. A 60-year-old man came to a hospital painless. Bimanual examination shows no uterine
complaining of a bursting sensation behind his enlargement, the appendages cannot be detected.
sternum that develops during fast walking and The vaginal fornices are free. What is the most likely
physical exertion. The pain lasts for approximately 5 diagnosis?
minutes and passes on its own in a resting state. 1. Uterine myoma
Objectively, his pulse is 75/min., blood pressure - 2. Stein-Leventhal syndrome (polycystic ovary
140/80 mm Hg. The heart borders are normal. Heart syndrome)
sounds are slightly weakened, rhythmic, and clear. 3. Adrenogenital syndrome
ECG shows no changes. Make the provisional 4. Climacteric syndrome
diagnosis: 5. Premenstrual syndrome
1. Exertional angina pectoris
2. Somatoform autonomic dysfunction 93. A 12-year-old boy with hypertrophic
3. Variant angina pectoris cardiomyopathy complains of dyspnea caused by
4. Myositis the slightest physical exertion. Echocardiography
5. Intercostal neuralgia detected asymmetrical left ventricular hypertrophy,
signs of pulmonary hypertension, and left
90. A baby is 4 days old. The baby's condition after ventricular dilatation, its ejection fraction is 59%.
birth is severe (tonic-clonic seizures, no newborn These developments are indicative of:
reflexes). The muscle tone is asymmetrical. The 1. Heart failure with preserved ejection fraction
large fontanelle exhibits increased pulsation and is 2. Primary pulmonary hypertension
3x3 cm in size. The baby's respiration rate is 32/min., 3. Primary arterial hypertension
with apnea episodes. The heart sounds are clear and 4. Symptomatic arterial hypertension
rhytmical, the heart rate is 122/min. Neurosonogram 5. Heart failure with reduced ejection fraction
shows enlarged lateral ventricles with echo- positive
inclusions in the ependyma. What is the most likely 94. During a regular examination, an 8-year-old girl
cause of the child's condition in this case? with type 1 diabetes mellitus presents with a
1. Spinal cord birth injury swelling on the anterior surface of her hip. The
2. Respiratory distress syndrome swelling is 3 cm in diameter, dense, painless on
3. Meningitis palpation. The skin over this formation has normal
4. Intraventricular hemorrhage color and temperature. Localization of the swelling
5. Hydrocephalus matches the place where the girl usually receives
her insulin injections. What is the most likely cause
91. A 39-year-old man came to a doctor complaining of this clinical presentation?
of a pain in his left leg. The disease onset was 2 1. Allergic response
days ago. Objectively. His body temperature is 2. Development of atrophic lipodystrophy
37.8°C and he has subcutaneous varicose veins on 3. Development of hypertrophic lipodystrophy
the inner surface of his left thigh and shin. The skin 4. Formation of a post-injection abscess
over the varicose veins is hot and red. The Moses 5. Formation of a post-injection infiltration
and Homans signs are negative. What is the most
likely diagnosis in this case?
95. Anthropometric measurements are widely used 99. A 55-year-old woman complains. of a recurrent
to study the physical development of children and diarrhea, peeling and pigmentation of the exposed
teenagers. What measurement is the functional one? areas of her skin (neck, hands, and feet), irritability,
1. Determining the shape of the backbone and anxiety. What vitamin deficiency is it?
2. Measuring the vital capacity of the lungs 1. Pantothenic acid
3. Weight measurement 2. Riboflavin
4. Determining the shape of the chest 3. Nicotinic acid
5. Height measurement 4. Thiamine
5. Retinol
96. A 27-year-old man complains of dry cough,
dyspnea during the slightest exertion, chest pain, 100. A 35-year-old pregnant woman with
and high temperature of 37.3°C that persists for the hypertension, developed edemas and headache at
last 3 weeks. He has a past history of drug abuse. the 33 week of her pregnancy. Objectively her
His respiration is rough, without crackles. He has general condition is satisfactory, blood pressure -
tachycardia of 120/min. X-ray shows interstitial 160/100 mm Hg, normal uterine tone. Fetal heart rate
changes on the both sides of his lungs. is 140/min., rhythmic. She was diagnosed with daily
Bronchoscopy detects Pneumocista carinii in the proteinuria - 4 g/L, daily diuresis - 1100 mL.
lavage fluid. What medicine will be the most Creatinine - 80 mcmol/L, urca - 7 mmol/L, platelets -
9
effective for the treatment of this patient? 100 * 10 /L. What complication of pregnancy
1. Erythromycin, rifampicin occurred?
2. Cefamezin (cefazolin), nitroxoline 1. Hypertensive crisis
3. Ampicillin, nizoral (ketoconazole) 2. Severe preeclampsia
4. Biseptol (co-trimoxazole), clindamycin 3. Renal failure
5. Interferon, rimantadine 4. Mild preeclampsia
5. Moderate preeclampsia
97. During regular examination of a 2 year-old boy,
he presents with enlarged left kidney, painless on 101. A 30-year-old man has received second-degree
palpation. The right kidney was undetectable on burns that cover 40% of his body. On the fourth day
palpation. Excretory urography shows no contrast after the injury, his general condition acutely
on the right. Cystoscopy detected hemiatrophy of deteriorated. E developed inspiratory dyspnea,
the urinary bladder trigone, the right ureteral orifice frequent cough with frothy sputum, and cyane skin.
is not detected. What pathology is it? Auscultation detects numerous crackles in the
1. Hypoplasia of the right kidney lungs. His blood press is 110/60 mm Hg, heart rate -
2. Dystopia of the right kidney 100/m respiration rate 32/ min, Central ves pressure
3. Agenesis of the right ureter 100 mm H₂ O, total protein 50 g/L, Ht 30%, Hb - 90
4. Ectopic right ureteral orifice g/L. shows sinus tachycardia. What mechanism of
5. Agenesis of the right kidney pulmonary edema pathogenesis is the
1. Decreased contractility of the myocardium
98. A 20-year-old man was hospitalized on the 9th 2. Hypervolemia of the pulmonary
day of the disease. He attributes his disease to 3. Surfactant dysfunction
eating of insufficiently thermally processed pork. At 4. Pulmonary hypoventilation
its onset this condition manifested in periorbital 5. Decreased plasma osmotic pressure
edemas and fever. Objectively, his body temperature
is 38.5°C. The face is puffy and the eyelids are 102. A 28-Year-Old man after lifting weight felt an
markedly swollen. Palpation of gastrocnemius intense lumbar pain that irradiated to the right leg.
muscles is sharply painful. Blood test shows He made an appointment with a doctor. After
hypereosinophilia. What is the etiology of this examination, the doctor diagnosed him with acute
disease? discogenic lumbosacral radiculitis. What additional
1. Echinococci examination is necessary to confirm this diagnosis?
2. Trichuris 1. Lumbar puncture
3. Ascarididae 2. Lumbar MRI
4. Trichinella 3. Urinalysis
5. Leptospira 4. Kidney X-ray
5. Electromyography of the leg muscles
103. A man complains of a heaviness behind his was diagnosed with central ankylosing spondylitis.
sternum, periodical sensation of food retention, and This man is likley to be a carrier of the following HLA
dysphagia. During X-ray the barium contrast reveals antigen:
a single pouch-like protrusion in the right anterior 1. HLA-B27
wall of the esophagus. The protrusion has clear 2. HLA-B5
margins and a clearly defined neck. What is the most 3. HLA-DR20
likely diagnosis in this case? 4. HLA-DR8
1. Esophageal carcinoma 5. HLA-DR4
2. Esophageal diverticulum
3. Hiatal hernia 108. A 7-year-old child complains of stomachache
4. Varicose veins of the esophagus episodes that occur after mental stress, cold drinks,
5. Esophageal polyp or ice cream. After clinical and instrumental
examination the boy was diagnosed with
104. Analysis of the population morbidity in a hypertensive biliary dyskinesia. What medicines
village, located near a chemical factory, shows that should be prescribed first for the treatment in this
within the last several years the number of gout and case?
esophageal cancer cases has significantly 1. Antibiotics
increased. What pollutant of the environment is the 2. Antioxidants
likely cause of such dynamics? 3. Sedatives and cholekinetics
1. Nickel 4. Antispasmodics and choleretics
2. Molybdenum 5. Choleretics and cholekinetics
3. Mercury
4. Strontium 109. A 32-year-old woman presents with obesity
5. Manganese (mostly her shoulders and torso are affected),
hirsutism, and menstrual irregularities. She has
105. A 56-year-old woman was diagnosed with stage purple-cyanotic striae and stretch marks on her
2 hypertension of the 2nd degree. She belongs to shoulders, chest, abdomen, and thighs. What is the
the group of moderate risk and has bronchial cause of striae development in this case?
asthma. What group of drugs is contraindicated to 1. Hypoestrogenemia
this patient? 2. Catabolic effect of corticosteroid excess
1. Angiotensin-converting enzyme inhibitors 3. Insulin resistance
2. Imidazoline receptor antagonists 4. Overproduction of androgens
3. β-blockers 5. Hypergonadotropinemia
4. Diuretics
5. Calcium antagonists 110. A 3-year-old child, while playing. suddenly
developed cough attacks and problems with
106. A 47-year-old man has been ill for 3 days breathing. Objectively, the child has a dry cough and
already. Palpation detects a painful inflamed mixed type dyspnea. Auscultation detects a small
infiltration in his right subcostal region. His body amount of dry crackles in the lungs. Respiration is
temperature is 38.9°C. Sonography allowed weakened on the right. The child does not attend
diagnosing him with calculous destructive kindergarden and has all necessary immunizations
cholecystitis. Clinical and laboratory data are not for that age. What pathology can be suspected?
indicative of choledocholithiasis. What tactics 1. Airway foreign body
should be chosen for the treatment of this man? 2. Pertussis
1. Monitoring, cholecystectomy if peritonitis starts 3. Acute respiratory viral infection
developing 4. Bronchial asthma
2. Choleretics, hepatoprotectors, Corticosteroids 5. Pneumonia
3. Complex anti-inflammatory therapy
4. Surgical treatment - cholecystectomy 111. A man, who one day ago returned from a trip to
5. Laparocentesis, abdominal drainage Africa, presents with a sharply painful cluster of
lymph nodes in his armpit. The skin over the lymph
107. A 37-year-old man complains of a pain in his node cluster is hyperemic. Bubonic plague is
lumbar and thoracic spine and limited spinal suspected. What must the contact persons use for
mobility for the last 5 years. After examination he urgent prevention of this disease?
1. Homologous immunoglobulin wound surface has dirty-gray coating with

2. Heterologous serum unpleasant sweet smell. Wound content resembles
3. Praziquantel raspberry jelly. Skin tissues around the wound are
4. Fluconazole glossy and turgid. Palpation reveals moderate
5. Doxycycline crepitation in the tissues. What microflora is the
most likely to cause such inflammation?
112. You witnessed a car accident. When examining 1. Blue pus bacillus
the place of the accident you noticed a man of about 2. Anaerobic clostridial
30 years, who was hit by the car. He is unconscious. 3. Staphylococci
On his neck on the left there is a profuse 4. Streptococci
hemorrhage with bright-red blood. How to stop this 5. Anaerobic non-clostridial
hemorrhage?
1. Put him in a stable position 116. When helping a man with a bleeding, the
2. Apply a neck brace emergency physician has pricked his own finger.
3. Maximal hyperextension of the neck The patient is an injecting drug user, who underwent
4. Apply a plaster cast a test for HIV, but the results of the test are
5. Digital occlusion, Mikulich method unknown. What measures must the doctor take in
this case?
113. A 21-year-old woman came to a surgeon 5 1. Nothing needs to be done
hours after she had scalded her left forearm with 2. Process the contaminated skin area, test the
boiling water. Objectively, a skin patch 17x10 cm in patient for HIV, start chemoprophylaxis
size had flaccid vesicles; epidermis there was torn 3. Process the contaminated skin area, start antiviral and
and displaced in some areas. The wound bottom antibiotic treatment
was whitish-gray, dry, and its pain sensitivity was 4. Process the contaminated skin area, administer donor
reduced. After a treatment with bandages soaked immunoglobulin
with a solution of furacilin (nitrofural), levosin, and 5. Process the contaminated skin area. examine the
hiposol, on the 29th day after the burn, the necrotic patient for TORCH infections, start antibiotic treatment
scab came off, leaving a pink superficial scar in its
place. What was the degree of the burn in this case? 117. A 2-year-old boy against the background of
1. IIIA degree burns lacunar tonsillitis developed problematic breathing
2. IIIB degree burns through the nose and mouth. Mesopharyngoscopy
3. IV degree burns shows hyperemic palatine tonsils and posterior
4. Il degree burns pharyngeal wall, yellow films in the openings of the
5. I degree burns tonsillar crypts, and a protrusion on the posterior
wall of the oropharynx that fluctuates during
114. A man suddenly developed a sharp pain in the palpation. What complication must be avoided
right side of his chest. Dyspnea has rapidly during the surgical treatment of this condition?
progressed. Objectively, the patient has marked 1. Mediastinitis
acrocyanosis and is in a severe condition. 2. Esophagitis
Subcutaneous emphysema is observed in the area 3. Major vessel injury
of the patient's neck and upper chest. Over the right 4. Disturbed lymphatic efflux
lung a bandbox resonance can be heard, respiration 5. Pus aspiration
is absent there. The heart borders are displaced to
the left. The patient's heart rate is 110/min., blood 118. Employees work in conditions of high dust
pressure -100/60 mm Hg. What is the most likely concentration. Certain chemical (silicon dioxide
disease in this case? content) and physical properties of dust aerosols
1. Community-acquired pneumonia contribute to the development of occupational dust-
2. Exudative pleurisy induced diseases. What is the main physical
3. Lung infarction property of dust aerosols?
4. Spontaneous pneumothorax 1. Magnetization
5. Myocardial infarction 2. Dispersion
3. Ionization
115. A 48-year-old woman was arrived to the surgical 4. Electric charge
unit with wounds in her thigh. On examination the 5. Solubility
119. A 46-year-old woman has diarrhea with and dry cough at the highest point of inhalation. On
abdominal distension, loss of body mass, and large examination the following is observed: pale skin,
amounts of porridge-like foul-smelling stool without cyanotic lips, «Hippocratic fingers». Auscultation
blood streaks or tenesmus. Objective examination detects Velcro-type crackles (like opening a Velcro
detects moderate tenderness in the mesogastrium fastener). X-ray shows a «ground glass opacity»
and left abdominal flank. Stool analysis detects pattern. What is the most likely diagnosis
steatorrhea with neutral fat and creatorrhea. What 1. Exogenous allergic alveolitis
prescription would be the most advisable in this 2. Pulmonary histiocytosis X
case? 3. Idiopathic pulmonary hemosiderosis
1. Antacids and antispasmodics 4. Hand-Schuller-Christian disease
2. Anticholinergic drugs and antibacterial agents 5. Idiopathic pulmonary fibrosis
3. Metronidazole and loperamide
4. Anticholinergic drugs 124. A 62-year-old woman has an acute onset of the
5. Multi-enzyme preparations disease: high temperature of 39.8°C, chills, intense
headache, and aching body. She complains of
120. An 18-year-old girl complains of sneezing nausea and one episode of vomiting. 18 hours later,
attacks that occur mostly in the morning 15-20 times her right inguinal lymph nodes became enlarged and
in a row, an itch in her nose and throat, profuse sharply painful. After another 6 hours, she
watery discharge from her nose, rhinitis, and pain in developed edema of the right shin and skin
her eyes. What test will be the most informative for hyperemia with irregular-shaped clear margins.
diagnosis-making in this case? What is the most likely diagnosis in this case?
1. Droplet test 1. Phlegmon of the right shin
2. Skin prick test 2. Anthrax, edematous form
3. Intradermal test 3. Bubonic tularemia
4. Provocation test 4. Bubonic plague
5. Total IgE levels 5. Erysipelas, erythematous form
121. A 56-year-old woman has been working as a 125. A 17-year-old young man demands a plastic
disinfector for 19 years. She complains of general surgery. He thinks that it's impossible to live with
weakness, nausea, bitter taste in her mouth, heavy such an ugly nose as his. He claims that wherever
sensation in her right subcostal area, and rapid he is, everyone is laughing at him and mocking him
fatigability. Objectively, her body temperature is behind his back. He walks with a cap pulled low over
37.1°C, the sclerae are icteric, and the liver is his face, turns his face downwards, and pulls up his
enlarged. Total bilirubin is 40 mcmol/L. What is the scarf up to his eyes. Objectively, there are no
likely diagnosis? indications for rhinoplasty - the young man has a
1. Acute cholecystitis nearly classical shape of the nose. What
2. Biliary dyskinesia psychopathological condition is it?
3. Chronic pancreatitis 1. Intrusive thoughts
4. Chronic cholecystitis 2. Dysmorphomania
5. Occupational toxic hepatitis 3. Capgras syndrome
4. Body schema disorder
122. A 1-year-old child with a case of URTI suddenly 5. Hypochondriacal neurosis
developed noisy respirations with difficult
inspiration, intercostal retractions, and barking 126. A 36-year-old woman complains of a headache,
cough on the 2nd night after the disease onset. What paresthesia, muscle weakness, spasms, thirst, and
is the most likely diagnosis? polyuria. Objectively, her temperature is 36.6°C,
1. Acute bronchiolitis respiration rate - 18/min., pulse - 92/min., blood
2. Acute pulmonary inflammation pressure - 180/110 mm Hg. Her ECG shows ST
3. Stenosing laryngotracheobronchitis depression. Her potassium levels in blood plasma
4. Acute bronchitis are low, sodium levels are high, plasma renin
5. Bronchial asthma activity is significantly decreased, aldosterone
concentration is high. 24-hour urine specific gravity
123. A patient was brought into the pulmonology does not exceed 1.008-1.011, alkaline reaction is
department with complaints of inspiratory dyspnea observed. Spironolactone test is positive. CT scan
shows enlarged right adrenal gland. What is the 130. A man complains of a headache, problematic
most likely diagnosis in this case? breathing through the nose, and purulent discharge
1. Cushing's syndrome from the nose that are observed for the last 3
2. Androsteroma months. Four months ago he underwent a treatment
3. Diabetes insipidus of his upper right premolar. X-ray shows a shadow
4. Conn's syndrome over the right maxillary sinus. Its diagnostic
5. Pheochromocytoma puncture yielded a large amount of thick foul-
smelling granulated pus. What is the most likely
127. A 23-year-old woman, para 2, full term, is in diagnosis in this case?
labor. Her waters were clear and broke three hours 1. Maxillary sinus tumor
ago. The labor activity is regular. The contractions 2. Chronic purulent odontogenic maxillary sinusitis
last 25-30 seconds, with intervals of 4-5 minutes. 3. Chronic purulent maxillary sinusitis
The baby is in the longitudinal lie, cephalic 4. Chronic atrophic maxillary sinusitis
presentation. The head is pressed to the entrance 5. Acute purulent maxillary sinusitis
into the lesser pelvis, Fetal heart rate is 136/min.
Internal examination shows that the cervix is 131. A 9-year-old boy is in a severe condition. His
smoothed out, the opening of the external orifice of body temperature is - 38-39°C, he has nosebleeds
uterus is 3 cm, no amniotic sac, the lower pole of the and complains of pain in his bones. Objectively, the
fetal head is at the level of l. terminalis. What stage boy presents with acute pallor, hemorrhagic rash,
of labor is it? and ulcerative necrotizing stomatitis. All the groups
1. Stage II of labor of lymph nodes are enlarged. The liver is +5 cm. The
2. Labor precursors spleen is +4 cm. What test will be decisive for
3. Stage III of labor diagnosis-making in this case?
4. Preliminary stage 1. Immune complex testing
5. Stage I of labor 2. Abdominal ultrasound
3. Complete blood count
128. One year ago a 46-year-old woman underwent a 4. X-ray of the mediastinum
partial thyroidectomy duc so multinodular goiter. 5. Myelogram
Now she complains of general weakness,
drowsiness, constant fatigue, low working ability, 132. A 38-year-old man has been for many years
constipations edema of her face and limbs. suffering from epilepsy. Three days ago he had an
Objectively her body temperature is 36°C. Her skin is episode of clouded consciousness that started
dry and wrinkled. She started losing her hair and suddenly and was accompanied by anger. In this
developed amenorrhea. What condition is it? state he was speaking nonsense, breaking furniture,
1. Primary hypothyroidism and hit his wife. He remained in this state for about
2. Thyrotoxicosis an hour, after which he fell asleep. Later he was
3. Chronic thyroiditis claiming that he didn't remember any of the events
4. Hypoparathyroidism that had happened during the episode. What is the
5. Subclinical hypothyroidism most likely definition of this condition?
1. Ambulatory automatism
129. A 19-year-old young man after a treatment for 2. Twilight state
bilateral pneumonia developed thirst, high appetite, 3. Trance
weight loss, and dry mouth. The signs continue to 4. Fugue state
intensify. Examination shows fasting glycemia of 5. Amentive state
19.7 mmol/L, glucosuria of 2.8 g/L, and signs of
acetonuria. What treatment should he be 133. Two weeks after an antibacterial therapy for a
prescribed? febrile illness, a 25-year-old woman developed
1. Glucose solution severe watery diarrhea, colicky abdominal pain, and
2. Physiological saline elevated body temperature. Proctosigmoidoscopy
3. Biguanides detects focal mucosal lesions with a pale yellow
4. Insulin coating. What is the most likely diagnosis in this
5. Metformin case?
1. Pseudomembranous colitis
2. Ulcerative colitis
3. Crohn's disease 138. A 73-year-old man against the background of

4. Gastroenteritis acute transmural anterior myocardial infarction has
5. Ischemic colitis developed a decrease in systolic pressure (70 mm
Hg) and diuresis (100 mL per 24 hours) and an
134. Daily diet of a 10-year-old girl contains the increase in blood creatinine (480 mcmol/L).
following: vitamin B₁ - 1.2 mg, vitamin B2 - 0.6 mg, Proteinuria is observed in the urine (0.066 g per 24
vitamin B6- 1.4 mg, vitamin PP - 15 mg, vitamin C - 65 hours). What is the cause of decreased diuresis?
mg. Assessment of the girl's nutrition status reveals 1. Congested kidney
that she has cheilosis, glossitis, angular cheilitis, 2. Acute tubulointerstitial nephritis
and conjunctivitis. The girl is likely to have: 3. Acute renal failure
1. Vitamin C hypovitaminosis 4. Prerenal acute kidney injury
2. Vitamin B2 hypovitaminosis 5. Rapidly progressive glomerulonephritis
3. Vitamin PP hypovitaminosis
4. Vitamin B6 hypovitaminosis 139. A 74-year-old woman came to a doctor
5. Vitamin B₁ hypovitaminosis complaining of a pain in her right inguinal region.
The signs appeared suddenly, approximately 2
135. A 38-year-old woman complains of a tensive hours ago. The woman notes that she already had
pain in her lower abdomen and the small of her back these signs 3 weeks ago, but back then they
that is observed within the last month and disappeared on their own after she lay down.
intensifies on the day before menstruation. Objectively, palpatio detects below the Poupart's
Premenstrual dark bloody discharge was observed. ligament a sharply painful, dense, and tense
She has a history of four medical abortions and one formation 3.5 cm in diameter. The Dejerine sign
birth. Ultrasound shows isolated foci of increased (aggravation on coughing) is negative. What is the
echogenicity in the myometrium, increased most likely diagnosis in this case?
anteroposterior size of the uterus, and round 1. Acquired strangulated femoral hernia
hypoechogenic inclusions 2 mm in diameter. What is 2. Acquired incarcerated inguinal hernia
the most likely diagnosis in this case? 3. Inguinal lymphadenitis
1. Hormone-producing ovarian tumor 4. Acquired incarcerated femoral hernia
2. Chorionepithelioma 5. Acquired strangulated inguinal hernia
3. Ovarian endometriosis
4. Retrocervical endometriosis 140. When investigating a case of mass poisoning, it
5. Adenomyosis was determined that the car mechanics, who tested
diesel engines in a repair bay with a broken exhaust
136. During analysis of morbidity in the city, it was ventilation, at the end of their working day
determined that age structure of population is developed the following signs: headache, nausea,
different in each district. What statistical method vomiting, tinnitus, labile pulse. Objectively, their
allows to exclude this factor, so that it would not skin and mucosa are cherry-red. What toxic factor
skew the morbidity data? has caused mass poisoning of the car mechanics?
1. Correlation-regression analysis 1. Carbon dioxide
2. Analysis of average values 2. Sulfur dioxide
3. Standardization 3. Carbon disulfide
4. Dynamic time series analysis 4. Nitrogen oxide
5. Wilcoxon signed-rank test 5. Carbon monoxide
137. A regional cardiologist is given a task to 141. A 68-year-old man diagnosed with acute
develop a plan for preventive measures aimed at myocardial infarction is in an intensive care unit.
decreasing cardiovascular mortality rates. What Suddenly he fell unconscious. Objectively, his pulse
measures should be planned for secondary and blood pressure cannot be detected. ECG shows
prevention? frequent irregular waves of varying shape and
1. Prevention of recurrences and complications amplitude. What complication occurred in this
2. Referring patients for inpatient treatment patient?
3. Optimization of lifestyle and living conditions 1. Acute heart failure
4. Prevention of diseases 2. Pulmonary embolism
5. Referring patients for sanatorium-and spa treatment 3. Asystole
4. Paroxysmal ventricular tachycardia 4. Ovarian apoplexy

5. Ventricular fibrillation 5. Pelvioperitonitis
142. A pregnant woman at the term of 11-12 weeks 145. A 72-year-old man has been brought into a
was hospitalized into the gynecological department vascular surgery department with complaints of pain
with uterine bleeding and cramping pain in her lower and chills in his legs. Ultrasound of his leg arteries
abdomen. Vaginal examination shows that her shows atherosclerotic lesions of the vascular wall.
vagina is filled with blood clots and her cervical What diagnostic method is necessary to determine
opening is 2 cm. A tense amniotic sac can be the localization and the extent of the pathologic
detected in the birth canal. The uterus is tense and process in this case?
enlarged to the size that corresponds to the period 1. Angiography
of 11-12 weeks of pregnancy. The discharge is 2. Thermometry
profuse and bloody. What must the doctor do in this 3. X-ray of the extremities
case? 4. Chest X-ray
1. Prescribe progesterone 5. ECG
2. Perform uterine curettage
3. Perform conservative monitoring 146. Having examined a 52-year-old patient, the
4. Conduct blood transfusion doctor diagnosed him with obesity (body mass
5. Conduct tocolytic therapy index - 34 kg/m², waist circumference - 112 cm) and
arterial hypertension (170/105 mm Hg). 2-hour
143. A 72-year-old man on the 7th day after a postprandial blood sugar is 10.8 mmol/L. What
surgical reposition of an intertrochanteric hip biochemical blood analysis needs to be conducted
fracture has suddenly developed dyspnea and an to diagnose the patient with metabolic syndrome X?
intense pain in the left side of his chest. Examination 1. Bilirubin
reveals distended cervical veins and cyanosis. His 2. Calcium and phosphorus
respiration rate is 26/min. Auscultation detects 3. Creatinine and urea
weakened breathing over the left lung Heart rate - 4. Lipid profile
98/min. Blood pressure - 120/70 mm Hg. CT scan 5. Electrolytes
shows significant disappearance of the lung pattern
on the left. Echocardiography shows no signs of 147. A 75-year-old man in a severe condition suffers
right ventricle overload. What next step will be the from dyspnea at rest, marked weakness, and
most advisable in this case? arrhythmia. Abdominal aortic pulsation is observed,
1. Installing a vena cava filter further on there is a systolic murmur detected.
2. Prescribing aspirin (acetylsalicylic acid) Palpation reveals a volumetric formation in the
3. Surgical embolectomy mesogastrium. Blood pressure is 70/40 mm Hg.
4. Thrombolytic injection into the left pulmonary artery There is no pulsation over the femoral arteries.
5. Prescribing low molecular weight heparin Oliguria is detected. Which diagnosis is the correct
one?
144. A 25-year-old woman was hospitalized into the 1. Dissecting aortic aneurysm
gynecological department with complaints of pain in 2. Pancreatic cyst
her lower abdomen and high temperature of 39.7°C. 3. Cardiosclerotic aneurysm
Objectively, her blood pressure is 120/80 mm Hg, 4. Acute cardiac aneurysm
pulse- 108/min., of satisfactory strength and volume. 5. Acute pericarditis
The abdomen is moderately distended and sharply
painful in its lower segments. The Bloomberg's sign 148. A child is 4 months old. The disease onset was
is positive in the hypogastrium. During vaginal acute and manifested as a temperature of 37.8°C and
examination, the uterus and its appendages cannot a slight cough. On the third day after the onset, the
be palpated because of anterior abdominal wall cough intensified and became accompanied by
rigidity. The posterior vaginal fornix is overhanging dyspnea. Percussion detects a tympanic sound over
and sharply painful. What is the most likely the lungs, while auscultation reveals numerous wet
diagnosis in this case? fine bubbling and sibilant wheezes during the
1. Acute adnexitis exhalation. Make the provisional diagnosis:
2. Acute endometritis 1. Focal pneumonia
3. Ectopic pregnancy 2. Bronchopneumonia
3. Acute bronchiolitis
4. Acute bronchitis
5. Obstructive bronchitis
149. A 35-year-old man complains of rapidly

increasing fatigue, palpitations, «visual snow»,
dizziness. He has a history of peptic ulcer of the
stomach. Objectively the skin is pale. Vesicular
respiration is observed in the lungs. Systolic
murmur is detected over the cardiac apex, heart rate
is 100/min., blood pressure is 100/70 mm Hg. The
epigastrium is slightly tender on palpation. Blood
12
test: erythrocytes - 3.2 * 10 /L, Hb - 100 g/L, color
index - 0.95. What type of anemia is the most likely
present in this case?
1. Posthemorrhagic anemia
2. Hemolytic anemia
3. Sideroblastic anemia
4. Hypoplastic anemia
5. Chronic iron-deficiency anemia
150. A 42-year-old man has received a polytrauma in

a car accident: closed displaced fractures of his
right humerus and the bones of his left forearm and
a closed blunt abdominal trauma. He was brought
into the admission room 30 minutes after the
trauma. His skin is pale. His blood pressure is 90/20
mm Hg. The fracture sites are deformed and painful.
The abdomen is rigid and its palpation causes sharp
pain. The Bloomberg's sign is positive. What
medical procedures must be performed first in this
case?
1. Additional examination to determine the exact
diagnosis
2. Urgent laparotomy
3. Infusion therapy to stabilize the blood pressure
4. Immobilization of the fractures, pain relief
5. Fracture blockade with a topical anesthetic
Krok 2- 2021 (General Medicine) Answer Key

01.(2) 21.(3) 41.(2) 61.(1) 81.(1) 101.(1) 121.(5)
02.(1) 22.(2) 42.(5) 62.(5) 82.(4) 102.(2) 122.(1)
03.(1) 23.(1) 43.(1) 63.(1) 83.(5) 103.(2) 123.(5)
04.(1) 24.(3) 44.(2) 64.(1) 84.(4) 104.(1) 124.(1)
05.(3) 25.(2) 45.(2) 65.(3) 85.(4) 105.(3) 125.(2)
06.(1) 26.(1) 46.(4) 66.(4) 86.(5) 106.(4) 126.(4)
07.(1) 27.(4) 47.(5) 67.(5) 87.(5) 107.(1) 127.(1)
08.(4) 28.(1) 48.(3) 68.(4) 88.(5) 108.(4) 128.(4)
09.(3) 29.(2) 49.(1) 69.(2) 89.(1) 109.(2) 129.(4)
10.(2) 30.(1) 50.(3) 70.(5) 90.(5) 110.(1) 130.(2)
11.(1) 31.(5) 51.(5) 71.(5) 91.(4) 111.(5) 131.(5)
12.(2) 32.(3) 52.(5) 72.(3) 92.(4) 112.(5) 132.(4)
13.(5) 33.(3) 53.(4) 73.(1) 93.(1) 113.(1) 133.(1)
14.(4) 34.(2) 54.(4) 74.(2) 94.(3) 114.(4) 134.(2)
15.(1) 35.(3) 55.(2) 75.(1) 95.(2) 115.(2) 135.(5)
16.(1) 36.(5) 56.(2) 76.(4) 96.(4) 116.(2) 136.(3)
17.(4) 37.(4) 57.(5) 77.(2) 97.(5) 117.(5) 137.(1)
18.(1) 38.(5) 58.(3) 78.(5) 98.(4) 118.(2) 138.(4)
19.(1) 39.(1) 59.(4) 79.(5) 99.(3) 119.(5) 139.(1)
20.(2) 40.(4) 60.(1) 80.(4) 100.(5) 120.(5) 140.(5)
141.(5) 142.(2) 143.(3) 144.(5) 145.(1)

146.(4) 147.(1) 148.(3) 149.(1) 150.(2)

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Krok 2- 2021 (General Medicine) (t.

Krok 2 – 2021 (General Medicine) 26 May 5. Hypoplastic anemia

4. Continue the conservative management of labor with 1. Osteoarthritis

30. A 59-year-old man for a month has been 5 Combined

1. Lymphogenic 2. Congenital rubella syndrome

1. Homologous immunoglobulin wound surface has dirty-gray coating with

3. Crohn's disease 138. A 73-year-old man against the background of

4. Paroxysmal ventricular tachycardia 4. Ovarian apoplexy

149. A 35-year-old man complains of rapidly

150. A 42-year-old man has received a polytrauma in

Krok 2- 2021 (General Medicine) Answer Key

141.(5) 142.(2) 143.(3) 144.(5) 145.(1)

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