2011 Flashcards
1
Q
3 days ago a 29-year-old patient presented with pulsating pain in the region of rectum, fever, general weakness. Objectively: local tenderness in the anal region in the 6 o’clock position. Digital investigation of rectum revealed a painful infiltration reaching the pectinate line. What is the most likely diagnosis?
A. Acute periproctitis B. Acute anal fissure C. Acute haemorrhoids D. Rectum tumour E. Acute prostatitis
A
Acute periproctitis
2
Q
A child is 7 months old. Birth weight was 3450, the child is breastfed. Supplemental feeding was introduced on time. Determine the daily protein requirements for the child:
A. 2,0 g/kg B.3.0 g/kg C. 2,5 g/kg D. 3,5 g/kg E. 4,0 g/kg
A
B. 3.0g/kg
3
Q
A 60-year-old female patient was admitted to a hospital for acute transmural infarction. An hour later the patient’s contition got worse. She developed progressing dyspnea, dry cough. Respiratory rate -30/min, heart rate -130/min, AP-90/60 mm Hg. Heart sounds were muffled, there was also diastolic shock on the pulmonary artery. The patient presented with medium moist rales in the lower parts of lungs on the right and on the left. Body temperature 36, 4oC. What drug should be given in the first place? A. Digoxin B. Aminophylline C. Dopamine D. Heparin E. Promedol
A
Answer - Promedol E
4
Q
A 62-year-old male has been hospitalized in the intensive care unit with a continuous attack of retrosternal pain that cannot be relieved by nitroglycerin. Objectively: AP-80/60 mm Hg, heart rate-106/min, breathing rate -22/min. Heart sounds are muffled, a gallop rhythm is present. How would you explain the AP drop?
A. Blood depositing in the abdominal cavity B. Reduction in peripheral resistance C. Reduction in cardiac output D. Adrenergic receptor block E. Internal haemorrhage
A
C. Reduction in cardiac output
5
Q
A patient is on the sick leave for 4 months continuously from the date of injury. The treatment is going to last for 1-2 months. Who has the right to extend the duration of medical certificate for this patient?
A. Medical advisory commission after medico-social expert commission examination
B. Medical superintendent
C. Medical advisory commission after inpatient treatment
D. District doctor by agreement with a department chief
E. Medico-social expert commission
A
Answer - A
6
Q
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 beendiagnosed with poliomyelitis. The causative agent of this disease relates to the following family:
A. Rotavirus B. Paramyxovirus C. Tohovirus D. Adenovirus E. Picornavirus
A
E. Picornavirus
7
Q
Working conditions of a building company worker are characterized by cooling microclimate effect, silicacontaining dust, caustic alkali (quicklime) and noise. What medical expert should be the chief of the commission that periodically examines the workers of the mentioned category?
A. Therapeutist B. Ophthalmologist C. Neurologist D. Dermatologist E. Otolaryngologist
A
A. Therapeutist
8
Q
A full-term baby (the 1st uncomplicated pregnancy, difficult labour) had a cephalogematoma. On the 2nd day there was jaundice, on the third the following changes in neurological status appeared: nystagmus, Graefe syndrome. Urine was yellow, feces were of goldenyellow colour. Mother’s blood group is A (II) Rh−, the baby’s one -A (II) Rh+.On the third day the child’s Hb was 200g/l, RBCs -6,1 · 1012/l, blood bilirubin -58 micromole/l at the expense of unbound fraction. What caused the jaundice in the child?
A. Biliary atresia B. Physiological jaundice C. Neonatal anaemia D. Craniocerebral birth trauma E. Fetal hepatitis
A
D. Craniocerebral birth trauma
9
Q
After birth a child was pale and had arrhythmical breathing. Oxygen therapy didn’t have any effect. Pulse was weak and rapid. It was difficult to measure arterial pressure accurately. There were no edemata. What is the most likely reason for these symptoms?
A. Congestive heart failure B. Asphyxia C. Intracranial haematoma D. Intrauterine sepsis E. Congenital pneumonia
A
B. Asphyxia
10
Q
350 workers of a metalurgical plant had to undergo a yearly preventiveexamination. A territorial polyclinic carried out preventive examination of 325 workers. As a result of it, 1 worker was recognized as temporarily disabled, 15 workers underwent further rehabilitation at an after-work sanatorium, 10 workers were provided with diet meal. What index characterizing the preventive work of the polyclinic should be applied in this case?
A. Percentage of people who underwent rehabilitation at an after-work sanatorium
B. Frequency of case detection during examinations
C. Coverage of preventive medical examinations
D. Percentage of people who were providedwithdietmeal
E. Percentage of temporarily disabled people
A
C. Coverage of preventive medical examinations
11
Q
A 14-year-old girl has been presenting with irritability and tearfulness for about a year. A year ago she was also found to have diffuse enlargement of the thyroid gland (II grade). This condition was regarded as a pubertal manifestation, the girl didn’t undergo any treatment. The girl’s irritability gradually gave place to a complete apathy. The girl got puffy face, soft tissues pastosity, bradycardia, constipations. Skin pallor and gland density progressed, the skin became of a waxen hue. What disease may be suspected?
A. Autoimmune thyroiditis
B. Diffuse toxic goiter
C. Thyroid carcinoma
D. Subacute thyroiditis
E. Juvenile basophilism
A
A. Autoimmune thyroiditis
12
Q
4 hours after having meals a patient with signs of malnutrition and steatorrhea experiences stomach pain, especially above navel and tothe left of it. Diarrheas take turns with constipation lasting up to 3-5 days. Palpation reveals moderate painfulness in the choledochopancreatic region. The amylase rate in blood is stable. X-ray reveals some calcifications located above navel. What is the most likely diagnosis?
A. Chronic calculous cholecystitis
B. Chronic gastroduodenitis
C. Duodenal ulcer
D. Zollinger-Ellison syndrome
E. Chronic pancreatitis
A
E
13
Q
A 56-year-old patient with diffuse toxic goiter has ciliary arrhythmia with pulse rate of 110 bpm, arterial hypertension, AP-165/90 mm Hg. What preparation should be administered along with mercazolil?
A. Propranolol B. Radioactive iodine C. Procaine hydrochloride D. Verapamil E. Corinfar
A
A. Propanolol
14
Q
On the 3rd day of life a baby presented with haemorrhagic rash, bloody vomit, black stool. Examination revealed anaemia, extended coagulation time, hypoprothrombinemia, normal thrombocyte rate. What is the optimal therapeutic tactics? A. Epsilon-aminocapronic acid B. Sodium ethamsylate C. Vitamin K D. Fibrinogen E. Calcium gluconate
A
C. Vitamin K
15
Q
A woman consulted a doctor on the 14th day after labour about sudden pain, hyperemy and induration of the left mammary gland, body temperature rise up to 39oC, headache, indisposition. Objectively: fissure of nipple, enlargement of the left mammary gland, pain on palpation. What pathology would you think about in this case?
A. Breast cancer B. Lacteal cyst with suppuration C. Fibrous adenoma of the left mammary gland D. Lactational mastitis E. Phlegmon of mammary gland
A
D. Lactational mastitis
16
Q
On the 5th day of a respiratory disease accompanied by fever a 24-year-old man developed progressing headaches, systemic dizziness, double vision, facial muscles paresis on the right, choking from swallowing. He was diagnosed with acute viral encephalitis. Identify the main tendency of the emergency treatment:
A. Zovirax B. Glucocorticoids C. Ceftriaxone D. Lasix E. Haemodezum
A
A. Zovirax
17
Q
A 54-year-old male patient complains of aching pain in the lumbar region, that is getting worse after standing in an upright position, physical exercise, supercooling. The patient also reports of experiencing weakness in the afternoon. Pain in the lumbar region, said about 10 years old. Objectively: pale skin, to-37,2oC, AP-180/100 mm Hg, minor costovertebral angle tenderness (Pasternatsky symptom). In blood: RBCs-3,5 · 1012/l, WBCs -6,5 · 109/l, ESR 22 mm/h. In urine: the relative density 1010, leukocytes -12-15 in the field of vision, erythrocytes -2-3 in the field of vision. Urine bacterial count -100000 in 1 ml. What is the most likely diagnosis?
A. Nephrolithiasis B. Chronic pyelonephritis C. Polycystic renal disease D. Chronic glomerulonephritis E. Amyloidosis
A
B. Chronic pyelonephritis
18
Q
A 49-year-old male patient complains of dyspnea of combined nature, cough, shin edemata, abdomen enlargement due to ascites. He has a 20-year history of chronic bronchitis. For the last 3 years he has been disabled (group II) because of cardiac changes. Objectively: mixed cyanosis, edemata. Ps -92/min, rhythmic, AP -120/70 mm Hg, respiration rate-24/min. There is accentuation of the second soundabove the pulmonaryartery. Auscultation reveals the box resonance above the lungs. There are also dry rales over the entire surface of lungs. What is the mechanism of heart changes development in this patient?
A. Respiratory reflex B. Kitaev’s reflex C. Bainbridge reflex D. Cardiovascular reflex E. Euler-Liljestrand reflex
A
E. Euler-Liljestrand reflex
19
Q
A 43-year-old female patient complains of unstable defecation with frequent constipations, abdominal swelling, headache, sleep disturbance. Body weight is unchanged. What disease are these clinical presentations typical for?
A. Irritable colon syndrome  B. Chronic enteritis C. Chronic pancreatitis D. Chronic atrophic gastritis E. Colorectal cancer
A
A. Irritable colon syndrome
20
Q
A 43-year-old man who often contacts with ethyl gasoline was admitted to a hospital with complaints of general weakness, dizziness, memory impairment, sleepiness at daytime and insomnia at night, sensation of a hair in the mouth, colicky pains in the right subcostal region. What is the most likely diagnosis?
A. Chronic lead intoxication B. Alcoholic delirium C. Chronic mercury intoxication D. Chronic manganese intoxication E. Chronic tetraethyl lead intoxication
A
E. Chronic tetraethyl lead intoxication
21
Q
A 35-year-old patient has been in the intensive care unit for acute renal failure due to crush for 4 days. Objectively: the patient is inadequate. Breathing rate 32/min. Over the last 3 hours individual moist rales can be auscultated in lungs. ECG shows high T waves, right ventricular extrasystoles. CVP -159 mm Hg. In blood: the residual nitrogen -62 millimole/l, K+-7,1 millimole/l, Cl−-78millimole/l, Na+-120 millimole/l, Ht -0,32, Hb -100 g/l, blood creatinine -0,9 millimole/l. The most appropriate method of treatment would be:
A. Hemodialysis B. Plasma sorption C. Hemosorption D. Plasma filtration E. Ultrafiltration
A
A. Hemodialysis
22
Q
A 47-year-old woman underwent a thyroid gland resection on ccount of nodular euthyroid goiter. What preparations are most likely to prevent the disease recurrence?
A. Thyroid hormones B. Mercazolil C. Thyrotropin D. Antistruminum (potassium iodide) E. Radioactive iodine
A
A. Thyroid hormones
23
Q
A30-year-oldman wasinjured ina fire and got thermic burns of III-A and III-B degree that affected 20% of the total skin. AP -110/70 mm Hg, heart rate -120/min. What transfusion means should be used for blind infusion before transportation? A. 10%glucose solution B. Polyglycine C. Saline solutions D. Fresh frozen plasma E. Albumin
A
C. Saline solutions
24
Q
A patient has an over a year-old history of fast progressive rheumatoid arthritis. X-raying confirms presence of marginal erosions. What basic drug would be the most appropriate in this case?
A. Methotrexate B. Chloroquine C. Prednisolone D. Diclofenac sodium E. Aspirin
A
A. Methotrexate
25
A 3-year-old child has been delivered to a hospital in soporose state with considerable amyotonia, inhibition of tendon and periosteal reflexes. Miosis and asthenocoria are also present. Corneal reflexes are preserved. Pulse is rapid and weak. AP-80/50 mm Hg. The parents suspect the child of accidental taking some tablets. Such clinical presentations are typical for intoxication with the following tableted drugs:
```
A. Beta-2-adrenoceptor agonists
B. Antropine drugs
C. Antihypertensive drugs
D. Barbiturates
E. Tranquilizers
```
E. Tranquilizers
26
A 23-year-old patient complains of a dull ache, sensation of heaviness and distention in the epigastrium immediately after meals, foul-smelling eructation; dry mouth, empty stomach nausea, diarrhea. Objectively: the skin is pale, the patient is of thin build. Abdomen is soft on palpation, there is epigastric pain. The liver does not extend beyond the costal arch. In blood: Hb -110 g/l, RBCs -3,4 · 1012/l, WBC count is normal. ESR -16 mm/h. What is the most informative study that will allow make a diagnosis?
```
A. Esophageal gastroduodenoscopy
B. X-ray of digestion organs
C. Study of gastric juice
D. pH-metry
E. Duodenal probing
```
A. Esophageal gastroduodenoscopy
27
A 49-year-old patient complains of deglutition problems, especially with solid food, hiccups, voice hoarseness, nausea, regurgitation, significant weight loss (15 kg within 2,5 months). Objectively: body weight is reduced. Skin is pale and dry. In lungs: vesicular breathing, heart sounds are loud enough, heart activity is rhythmic. The abdomen is soft, painless on palpation. Liver is not enlarged. What study is required to make a diagnosis?
```
A. X-ray of digestive tract organs
B. Clinical blood test
C. Esophageal duodenoscopy along with biopsy
D. X-ray in Trendelenburg’s position
E. Study of gastric secretion
```
C. Esophageal duodenoscopy along with biopsy
28
A 60-year-old patient has been admitted to a hospital with complaints of dyspnea, tightness in the right subcostal area, abdomen enlargement. These presentations have been progressing for a year. Heart auscultation reveals presystolic gallop rhythm. Objectively: swelling of the neck veins, ascites, palpable liver and spleen. What disease requires differential diagnostics?
```
A. Pulmonary embolism
B. Hepatocirrhosis
C. Lung cancer with invasion to the pleura
D. Chronic pulmonary heart
E. Constrictive pericarditis
```
E. Constrictive pericarditis
29
A 40-year-old patient, the forester, complains of severe headache, body temperature rise up to 39,5oC, trembling limbs. From the patient’s history we know that he had seriously cut his hand during the dissection of a killed fox. Objectively: depressed mood. The patient asks not to turn on the light or open the door. Any noise causes apparent motor excitation. When he saw a carafe of water, he developed convulsive throat spasms. What tactics should an emergency doctor choose?
A. Deliver the patient to the neurological department
B. Deliver the patient to the resuscitation department
C. Deliver the patient to the infectious disease hospital
D. Deliver the patient to the psychiatric hospital
E. Let him stay at home and consult a psychiatrist
C
30
A 28-year-old woman has a 12-year hi story of chronic glomerulonephritis with latent course. Over the past six months she has developed general weakness, loss of appetite, low work performance, nausea. The patient complains of headache, pain in the joints. On examination: anemia, blood urea -34,5 millimole/l, blood creatinine -0,766 millimole/l, hyperkalemia. What complication has developed?
```
A. Renal amyloidosis
B. Acute renal insufficiency
C. Nephrotic syndrome
D. Chronic renal insufficiency
E. Pyelonephritis
```
D. Chronic renal insufficiency
31
A child is 1 year old. Ater the recent introduction of complementary feeding the child has presented with loss of appetite, diarrhea with large amounts of feces and occasional vomiting, body temperature is normal. Objectively: body weight is 7 kg, the child is very pale, there are edemata of both legs, abdomen is significantly enlarged. Coprogram shows many fatty acids and soaps. The child has been diagnosed with celiac disease and administered the gluten-free diet. What is to be excluded from the ration?
```
A. Cereals -wheat and oats
B. Milk and dairy products
C. Fruit
D. Animal protein
E. High digestible carbohydrates
```
A. Cereals -wheat and oats
32
Development of chronic venous insufficiency of lower extremities depends on the functional condition of so-called musculovenous pump. This term refers to the following group of muscles:
```
A. Buttock region muscles
B. Abdominal wall muscles
C. Shin muscles
D. Thigh muscles
E. Foot muscles
```
C. Shin muscles
33
After treating a fieldwithpesticidesamachineoperatorpresentswith great weakness, headache, nausea, vomiting, diarrhea, visual impairment, watery eyes. Objectively: the patient is excited, hypersalivation, hyperhidrosis, muscle fibrillation of tongue and eyelids are oberved. Pupils are narrowed, there is tachycardia, lung auscultation reveals moist small and medium bubbling rales. In blood: changed level of cholinesterase activity. What is the most likely diagnosis?
A.Intoxication with organophosphorous pesticides
B. Intoxication with organochlorine pesticides
C. Intoxication with organomercurial pesticides
D. Intoxication with arsenic-containing pesticides
E. Intoxication with carbamic acid derivatives
A.Intoxication with organophosphorous pesticides
34
```
A 7-year-old child was brought to a doctor for a check. The child has a 4-year history of bronchial asthma, asthma attacks occur mainly in spring and summer. Allergy tests revealed hypersensitivity to poplar seed tufts, field herbs. What recommendation should be given?
A. Needle reflexotherapy
B. Physiotherapy
C. Treatment at a health resort
D. Phytotherapy
E. Specific hyposensitization
```
E. Specific hyposensitization
35
A farmer hurt his right foot during working in a field and came to the emergency station. He doesn’t remember when he got last vaccination and he has never served in the army. Examination of his right foot revealed a contaminated wound up to 5-6 cm long with uneven edges. The further treatment tactics will be:
A. To make an injection of tetanus anatoxin
B. To make an injection of tetanus anatoxin and antitetanus serum
C. To make an injection of antitetanus serum
D. Surgical d-bridement only
E. To administer an antibiotic
B. To make an injection of tetanus anatoxin and antitetanus serum
36
A 35-year-old patient has been admitted to a hospital for pain in the left sternoclavicular and knee joints, lumbar area. The disease has an acute character and is accompanied by fever up to 38oC. Objectively: the left sternoclavicular and knee joints are swollen and painful. In blood: WBCs -9,5·109/l, ESR -40 mm/h, CRP -1,5 millimole/l, fibrinogen -4,8 g/l, uric acid -0,28 millimole/l. Examination of the urethra scrapings reveals chlamydia. What is the most likely diagnosis?
```
A. Reiter’s syndrome
B. Rheumatic arthritis
C. Gout
D. Bechterew’s disease
E. Rheumatoid arthritis
```
A. Reiter’s syndrome
37
Topographic percussion of lungs in a patient who got a serious job-related barotrauma revealed that the lower lungs borders were located one rib below normal, there was a significant increase in both lungs height and Kronig’s isthmus. What disease should be suspected in the f irst place?
```
A. Bronchial asthma
B. Exudative pleuritis
C. Chronic bronchitis
D. Pulmonary emphysema
E. Pneumothorax
```
D. Pulmonary emphysema
38
A 32-year-old patient lives in an area endemic for echinococcosis. In the last 6 months he reports of pain in the right subcostal area, fever. He is suspected to have liver echinococcosis. What study would be the most informative in this case?
A. USI
B. Survey radiography of abdominal cavity
C. Biochemical laboratory examination D. Angiography
E. Liver scanning
A. USI
39
A 30-year-old gravida consulted a gynecologist about bright red bloody discharges from the vagina in the 32 week of gestation. She was hospitalized with a suspicion of placental presentation. Under what conditions is it rational to conduct the internal examination in order to make a diagnosis?
A. In the admission ward of maternity hospital
B. In the examination room of antenatal clinic
C. In the operating room prepared for the operation
D. In the delivery room keeping to all the aseptics regulations
E. The examination is not to be conducted because of risk of profuse haemorrhage
C. In the operating room prepared for the operation
40
After a serious nervous stress a 35year-old patient has developed on the dorsal surface of hands redness and swelling that were later replaced by small inflammatory nodules, vesicles and following erosion with a significant serous discharge. The process is accompanied by severe itching. What is the most likely diagnosis ?
A. True eczema B. Allergic dermatitis C. Microbal eczema D. Simple contact dermatitis E. Toxicoderma
A. True eczema
41
```
A 36-year-old patient complains of skin rash that appeared a week ago and doesn’t cause any subjective problems. Objectively: palm and sole skin is covered with multiple lenticular disseminated papules not raised above the skin level. The papules arereddish, dense on palpation and covered with keratinous squamae. What is the provisional diagnosis?
A. Palmoplanar rubrophytosis
B. Verrucosis
C. Palmoplanar psoriasis
D. Secondary syphilis
E. Palm and sole callosity
```
D. Secondary syphilis
42
A 30-year-old patient complains of paroxysmal abdominal pain, frequent liquid stools up to 10 times a day. Throughout the first3dayshehad a fever, since the 2nd day of disease there were scant liquid stools mixed with mucus. On palpation: tenderness of all colon segments. Sigmoid colon was found spastic. What is your provisional diagnosis?
```
A. Intestinal amebiasis
B. Acute dysentery
C. Salmonellosis
D. Cholera
E. Balantidiasis
```
B. Acute dysentery
43
A38-year-old woman experiences episodic increases in arterial pressure up to 240/120 mm Hg, which is accompanied by nausea, vomiting, tachycardia, increased sweating, hyperglycemia. The attack is usually followed by the excessive urination. Renal sonography reveals an additional formation adjacent to the upper pole of the right kidney and possibly belonging to the adrenal gland. What laboratory test will allow to clarify the diagnosis?
A. Determination of urinary excretion of catecholamines and vanillylmandelic acid
B. Blood test for insulin and C-peptide
C. Estimation of glomerular filtration rate by measuring endogenous creatinine clearance
D. Blood test for thyroxine and thyrotrophic hormone
E. Blood test for renin level
A. Determination of urinary excretion of catecholamines and vanillylmandelic acid
44
```
A 32-year-old patient has a 3-year history of asthma attacks, that can be hardly stopped with berotec. Over a few last months he has experienced pain in the joints and sensitivity disorder of legs and feet skin. Ps -80/min, AP -210/100 mm Hg. In blood: eosinophilia at the rate of 15%. What disease can be suspected in this case?
A. Wegener’s disease
B. Systemic lupus erythematosus
C. Systemic scleroderma
D. Dermatomyositis
E. Periarteritis nodosa
```
E. Periarteritis nodosa
45
A 46-year-old patient complains of sudden palpitation, which is accompanied bypulsation in the neck and head, fear, nausea. The palpitation lasts for 15-20 minutes and is over after straining when holding her breath. What kind of cardiac disorder may be suspected? 
A. An attack of supraventricular paroxysmal tachycardia
B. An attack of ventricular paroxysmal tachycardia
C. An attack of atrial flutter
D. An attack of ciliary arrhythmia
E. An attack of extrasystolic arrhythmia
A. An attack of supraventricular paroxysmal tachycardia
*** holding your breath while straining is an example of vagal manuevre
Vagal manuevres is the first line of treatment of hemodynamically stable SVT by increasing vagal parasympathetic tone
Other examples of vagal manuevres include :
Carotid sinus massage or Czermak-Hering test
Valsava manuevre
Cold water immersion (diving reflex)
Less common ones -
- Eyeball pressure (also known as the oculocardiac reflex or Aschner-Dagnini reflex)
- coughing
- gagging
46
The patient complains of a painful swelling in the chin region, malaise, headache. Examination reveals an acutely inflamed cone-shaped dense node. The skin over it is tense, red. In the center of the node there is an ulcer with overhanging edges and a necrotic core of a dirtygreencolour. Submandibular lymphnodes on the right are enlarged and painful. What is the most likely diagnosis?
```
A. Furuncle
B. Tuberculosis
C. Carbuncle
D. Tertiary syphilis (gummatous form)
E. Parasitic sycosis
```
A
47
A welder at work got the first-degree burns of the middle third of his right shin. 5 days later the skin around the burn became edematic and itchy. Objectively: on a background of a well-defined erythema there is polymorphic rash in form of papules, vesicles, pustules, erosions with serous discharge. What is the most likely diagnosis?
```
A. Streptococcal impetigo
B. True eczema
C. Toxicoderma
D. Occupational eczema
E. Microbal eczema
```
E. Microbal eczema
48
A 58-year-old patient has a 3-year history diabetes mellitus type II. He has been keeping to a diet and regularly taking glyburide. He has been delivered to a hospital on an emergency basis for acute abdomen. Objectively: the patient is of supernutrition type. The skin is dry. In the lungs vesicular breathing can be auscultated. Heart sounds are regular, 90/min. AP-130/70 mm Hg. The symptom of "wooden belly"is visible. Blood sugar-9,8 millimole/l. The patients has indication for laparotomy. What is the most appropriate way of further treatment of diabetes?
A. To continue taking glyburide
B. To administer short insulin
C. To administer Semilong to be taken in the morning and insulin -in the evening D. To administer 1 tablet of Glurenorm threetimesaday
E. To administer 1 tablet of Maninil three times a day
B. To administer short insulin
49
An 8-year-old girl has been admitted to the cardiology department. Objectively: there is a skin lesion over the extensor surfaces of joints with atrophic cicatrices, depigmentation, symmetrical affection of skeletal muscles (weakness, edema, hypotrophy). What disease are these changes most typical for?
```
A. Systemic lupus erythematosus
B. Systemic scleroderma
C. Nodular periarteritis
D. Dermatomyositis
E. Reiter’s disease
```
D. Dermatomyositis
50
```
A 43-year-old female patiet complains of eruption on her right leg skin, pain, weakness, body temperature rise up to 38oC. The disease is acute. Objectively: there is an edema on the right leg skin in the region of foot, a well-defined bright red spot in form of flame tips which feels hot. There are isolated vesicles in focus. What is your provisional diagnosis?
A. Erysipelas
B. Microbial eczema
C. Contact dermatitis
D. Toxicoderma
E. Haemorrhagic vasculitis
```
A. Erysipelas
51
```
A 45-year-old patient complains of some painless nodular elements tending to peripheral growth and fusion. He has a 2-year history of this disease. Aggravation takes place mainly in spring.In anamnesis: the patient’s father had similar skin lesions. Objectively: pathological elements looke like guttate and nummular nodules, plaques covered with white scales. What is your provisional diagnosis?
A. Neurodermitis
B. Lichen ruber planus
C. Psoriasis
D. Pityriasis rosea
E. Seborrheic eczema
```
C. Psoriasis
52
```
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
```
A. Erythrocytic schizogony
53
On the 2 nd day of illness a 27-yearold patient complains of the unbearable headache, repeated vomiting. Objectively: the patient is in a grave condition. He is conscious but adynamic. Lies in a forced position with his headthrownback. There is no skin rash. Occipital muscles are evidently rigid, there are Kernig’s and Brudzinski’s signs. to-39,5oC,Ps120/min., AP-130/80 mm Hg. What is the reason for the leading syndrome of this disease?
```
A. Hyperthermy
B. Liquor hypotension
C. Affection of the cranial nerve nuclei
D. Haemorrhages into the adrenal glands
E. Liquor hypertension
```
E. Liquor hypertension
54
On the 1st day of life a full-term girl (2nd labour) weighing 3500g, with Apgar score of 8 points, presented with jaundice. Indirect bilirubin of blood -was 80 micromole/l, 6 hours later -160 micromole/l. Wha tis the optimal method of treatment?
```
A. Exchange blood transfusion
B. Phototherapy
C. Infusion therapy
D. Phenobarbital treatment
E. Enterosorbents
```
A. Exchange blood transfusion
55
A 42-year-old female patient suffers from micronodular cryptogenic cirrhosis. Over the last week her condition has deteriorated: there appeared convulsions, mental confusion, increased jaundice. What study may explain such aggravation?
A. Determination of alpha-phetoprotein rate
B. Determination of cholesterol ethers
C. Determination of serum ammonia
D. Determination of ALAT and ASAT
E. Determination of alkaline phosphatase rate
C. Determination of serum ammonia
56
A 30-year-old patient was hospitalized with a diagnosis: intestinal obstruction. During the surgery it was revealed that the obstruction of the small intestine had been caused by a massof helminths. What helminths are these?
```
A. Cysticerci
B. Guinea worms
C. Filarial worms
D. Ascarids
E. Pinworms
```
D. Ascarids
57
On the 5th day after a surgery for colon injury a patient complains of bursting pain in the postoperative wound, weakness, drowsiness, headache, fever up to 40oC. Objectively: the skin around the wound is swollen, there is gas crepitation. The wound discharges are scarce foulsmelling, of dark-gray colorl. What is the most likely diagnosis?
A. Anaerobic clostridial wound infection B. Abscess
C. Postoperative wound infection
D. Erysipelas
E. Phlegmon
A. Anaerobic clostridial wound infection
58
A child was born at a gestational age of 34 weeks in grave condition. The leading symptoms were respiratory distress symptoms, namely sonorous and prolonged expiration, involving additional muscles into respiratory process. The Silverman score at birth was 0 points, in 3 hours it was 3 points with clinical findings. Which diagnostic study will allow to diagnose the form of pneumopathy?
A. X-ray of chest
B. Clinical blood test
C. Determination of blood gas composition
D. Proteinogram
E. Immunoassay
A. X-ray of chest
59
A children’s surgical unit admitted a 1-month-old boy who had been prenatally diagnosed with the left-sided pyelectasis. Such studies as drip infusion urography, cystography and USI allowed to reveal initial hydronephrosis. There is no information confirming the secondary pyelonephritis. What tactics of this patient management is most advisable? A. 6-month surveillance
B. Urgent nephrostomy
C. Anderson-Hynes operation
D. There is no need in further surveillance and treatment
E. Antibacterial therapy
A. 6-month surveillance
60
A 24-years-old patient has chronic glomerulonephritis.Urine test reveals the following: the relative density is 1010, protein -1,65 g/l, RBCs -5-7 in the field of vision, WBCs -2-3 in the field of vision. Blood creatinine -0,350 millimole/l. Serum sodium -148 millimole/l. What is the main reason for hyperazotemia in this patient?
A. Reduction of tubular reabsorption rate
B. Reduction of glomerular filtration rate
C. Increased proteinuria
D. Reduction of renal blood flow
E. Sodium retention in the organism
B
61
102. After an accident a patient complains of pain in the hip joint. Objectively: the leg is in the position of flexion, adduction and internal rotation, significantly contracted. There is elastic resistance to passive adduction or abduction of the extremity. Major trochanter is located high above the Roser-Nelaton line. A significant lordosis is present. What is your provisional diagnosis?
A.Pertrochanteric fracture of hip
B. Femoral neck fracture with a displacement
C. Cotyloid cavity fracture with a central dislocation of hip
D. Inferoposterior dislocation of hip
E. Iliac dislocation of hip
E
62
As a result of prolonged exposure to the sun a 20-year-old patient has developed low-grade fever, pain and swelling in the knee and ankle joints, erythema on her face and nose bridge, leukopenia and accelerated ESR. She has been provisionally diagnosed with systemic lupus erythematosus. What pathognomonic laboratory data may confirm this diagnosis?
```
A. Antinuclear factor
B. Accelerated ESR
C. C-reactive protein
D. Anaemia
E. Lymphocytosis
```
A. Antinuclear factor
63
```
Examination of the corpse of a man who died from hanging reveals: death spots disappear when pressed upon and restore after 50 seconds, rigor mortis is moderately expressed only in the masticatory muscles as well as neck and finger muscles, body temperature is of 31oC.The time of death:
A. 6-7 hours ago
B. 1-2 hours ago
C. 16-24 hours ago
D. 8-10 hours ago
E. 10-18 hours ago
```
A. 6-7 hours ago
64
```
After contusion of the right eye a patient complains of sudden loss of vision with remaining light perception. Objectively: the eye is not irritated. The cornea is transparent. Pupil reacts to light. The pupil area is black. The fundus reflex is absent. What is the most likely cause of vision loss?
A. Hemophthalmia
B. Retinal detachment
C. Traumatic cataract
D. Acute occlusion of retinal vessels
E. Optic nerve avulsion
```
A. Hemophthalmia
65
```
A 68-year-old patient consulted a doctor about a tumour in her left breast. Objectively: in the upper internal quadrant of the left breast there is a neoplasm up to 2,5 cm in diameter, dense, uneven, painless on palpation. Regional lymph nodes arenot enlarged. Whatis the most likely diagnosis?
A. Cancer
B. Cyst
C. Fibroadenoma
D. Mastopathy
E. Lipoma
```
A. Cancer
66
A 65-year-old patient complains of pain in the lumbar spine, moderate disuria. He has been suffering from these presentations for about half a year. Prostate volume is 45 cm3 (there are hypoechogenic nodes in both lobes, capsule invasion). The rate of prostatespecific antigen is 60 ng/l. Prostate biopsy revealed an adenocarcinoma. Which of the supplemental examination methods will allow to determine the stage of neoplastic process in this patient?
```
A. Bone scintigraphy
B. Roentgenography of lumbar spine
C. Excretory urography
D. Computer tomography of pelvis
E. Roentgenography of chest
```
D. Computer tomography of pelvis
67
```
A 65-year-old patient complains of pain in the lumbar spine, moderate disuria. He has been suffering from these presentations for about half a year. Prostate volume is 45 cm3 (there are hypoechogenic nodes in both lobes, capsule invasion). The rate of prostatespecific antigen is 60 ng/l. Prostate biopsy revealed an adenocarcinoma. Which of the supplemental examination methods will allow to determine the stage of neoplastic process in this patient?
A. Computer tomography of pelvis
B. Roentgenography of lumbar spine
C. Excretory urography
D. Bone scintigraphy
E. Roentgenography of chest
```
A. Computer tomography of pelvis
68
```
While staying in a stuffy room a 19year-old emotionally labile girl developed severe weakness, dizziness, blackout, nausea and loss of consciousness without convulsions. Objectively: the patient is unconscious, the skin is pale, extremities are cold. AP -90/60 mm Hg, Ps-96/min, deficient, breathing is shallow. Pupillary and tendon reflexes arepresent. There are no pathological signs. What is the most likely diagnosis? A. Syncope
B. Vegetovascular paroxysm
C. Epileptic attack
D. Hysterical neurosis
E. Transient ischemic attack
```
A. Syncope
69
```
The air of a foundry worker’s working zone contains condensation aerosol with dust particles sized 2 nm (90%), 2-5 nm (2%), over 5 nm(6%), below 2 nm (about 2%). Characterize the dust dispersivity:
A. Ultrafine-dispersed
B. Median-dispersed
C. Coarsely dispersed
D. Fine-dispersed
E. Mist
```
D. Fine-dispersed
70
A 40-year-old female patient complain of headache, dizziness, muscle weakness, sometimes -cramps in the extremities. She has been taking antihypertensive medications for 10 years. AP-180/100 mm Hg. Blood potassium 1,8 millimole/l, sodium -4,8 millimole/l. In urine: alkaline reaction, the relative density -1012, protein and sugar are not found, WBCs-3-4inthefieldofvision,RBCs-12inthefield of vision. Conn’s syndrome is suspected. Which drug should be chosen for the treatment of arterial hypertension?
```
A. Clonidine
B. Propanolol
C. Enalapril
D. Hydrochlorothiazide
E. Spironolactone
```
E. Spironolactone
71
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. Schizophrenia
B. Alcocholic psychosis
C. Reactive psychosis
D. Somatogenic psychosis
E. Organic psychosis
```
A. Schizophrenia
72
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. Whatis the most effective measure for the treatment of thrombocytopenia?
```
A. Iron preparations
B. Splenectomy
C. Hemotransfusion
D. Cytostatics
E. Vitamin B12
```
B. Splenectomy
73
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 f illed with transparent liquid. What diease are these symptoms typical for?
```
A. Herpes simplex
B. Pemphigus
C. Herpes zoster
D. Streptococcal impetigo
E. Herpetiform Duhring’s dermatosis
```
C. Herpes zoster
74
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
```
A. Warming procedures
75
The institutions which take part in carrying out medical examinations can be 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. Prevention and treatment facilities
B. Sanitary-and-prophylactic institutions
C. Medico-social expert commissions
D. Medical boards of Ministry of Defense
E. Medical boards of Ministry of Home Affairs
A. Prevention and treatment facilities
76
10 minutes after delivery a woman discharged placenta with a tissue defect 5х6 cm large. Discharges from the genital tracts were profuse and bloody. Uterus tonus was low, fundus of uterus was located below the navel. Examination of genital tracts revealed that the uterine cervix, vaginal walls, perineum were intact. There was uterine bleeding with following blood coagulation. Your actions to stop the bleeding:
A. To put an ice pack on the lower abdomen
B. To apply hemostatic forceps upon the uterine cervix
C. To introduce an ether-soaked tampon into the posterior fornix
D. To make manual examination of uterine cavity
E. To administer uterotonics
D. To make manual examination of uterine cavity
77
While lifting a heavy load a 39year-old patient suddenly felt a severe headache, pain in the interscapular region,and started vomiting. Objectively: the pulse is rhythmic, 60/min., AP -180/100 mm Hg. The patient is agitated. He presents with photophobia, hyperacusis. There are positive Kernig’s and Brudzinski’s signs on both sides. In blood: WBCs-10 · 109/l. CSF is bloody, cytosis is 240/3. What is the most likely diagnosis?
```
A. Ischemic stroke
B. Sympathoadrenal crisis
C. Acute hypertonic encephalopathy
D. Meningococcal meningitis
E. Subarachnoid haemorrhage
```
E. Subarachnoid haemorrhage
78
A surgeon examined a 42-yearold patient and diagnosed him with right forearm furuncle at the purulonecrotic stage. The furuncle was lanced. Atthehydration stagethe wounddressing should enclose the following medication:
```
A. Hypertonic solution
B. Vishnevsky ointment
C. Ichthyol ointment
D. Chloramine
E. Dimexide
```
A. Hypertonic solution
79
After a 10-year-old child had been bitten by a bee, he was delivered to a hospital. There were lip, face and neck edemata. The patient felt hot and short of breath. Objectively: breathing was laboured and noisy. There were foamy discharges from the mouth, cough. The skin was pale and cold. There was bradypnoea. Heart sounds were muffled and arrhythmic. Thready pulse was present. What diagnosis was made by the expert in resuscitation?
```
A. Acute cardiovascular collapse
B. Quincke’s edema
C. Bronchial asthma
D. Anaphylactic shock
E. Cerebral coma
```
D. Anaphylactic shock
80
```
Half an hour after a 30-year-old woman had had some custard cake, she experienced lancinating abdominal pain, nausea, vomiting. Objectively: body temperature -36,0oC, pale skin, breathing rate -20/min, Ps-100/min. AP-95/65 mmHg,loud cardiac sounds. Dry tongue. Abdomen was painful in its epigastrial part, there were no signs of peritoneum irritation. What is the first measure to be taken?
A. Intravenous rehydratation
B. Administration of an enterosorbent
C. Injection of Cerucal
D. Gastric lavage
E. Antibiotic therapy
```
D. Gastric lavage
81
A 45-year-old patient, a sailor, was hospitalized on the 2nd day of the disease. A week ago he returned from India. Complains of body temperature of 41oC, severe headache, dyspnea, cough with frothy rusty sputum. Objectively: the patient is pale, mucous membranes are cyanotic, breathing rate -24/min, tachycardia is present. In lungs: diminished breath sounds, moist rales over both lungs, crepitation. What is the most likely diagnosis?
```
A. Ornithosis
B. Miliary tuberculosis
C. Influenza
D. Pneumonic plaque
E. Sepsis
```
D. Pneumonic plaque
82
HIV displays the highest tropism towards the following blood cells:
```
A. T-helpers
B. T-suppressors
C. T-killers
D. Thrombocytes
E. Erythrocytes
```
A. T-helpers
83
Educational rooms are illuminated with various lighting fittings. What type of lighting fittings is the most appropriate in respect of hygienic norms?
```
A. Ambient light fittings
B. Direct light fittings
C. Semi-reflected light fittings
D. Indirect light fittings
E. Combined light fittings
```
D. Indirect light fittings
84
A 24-year-old female patient complains of acute pain in the lower abdomen that turned up after a physical stress. She presents with nausea, vomiting, dry mouth and body temperature 36,6oC. She has a right ovarian cyst in history. Bimanual examination reveals that uterus is dense, painless, of normal size. The left fornix is deep, uterine appendages aren’t palpable, the right fornix is contracted. There is a painful formation on the right of uterus. It’s round, elastic and mobile. It is 7х8 cm large. In blood: leukocytosis with the left shit. What is the most likely diagnosis?
```
A. Extrauterine pregnancy
B. Right-sided pyosalpinx
C. Subserous fibromyoma of uterus
D. Acute metritis
E. Ovarian cyst with pedicle torsion
```
E. Ovarian cyst with pedicle torsion
85
A 39-year-old patient complains of a tumour on the anterior surface of her neck. The tumour has been observed for 2 years. It is nonmobile and has enlarged recently. The patient has a changed tone of voice, a sense of pressure. Objectively: in the left lobe of the thyroid gland a 3 cm node is palpable; it is very dense, tuberous, painless. Cervical lymph nodes are enlarged. Functional status of the thyroid gland is unchanged. What is the most likely diagnosis?
```
A. Thyroid gland cancer
B. Nodular euthyroid goiter
C. Nodular hyperthyroid goiter
D. Chronic lymphomatous Hashimoto’s thyroiditis
E. Chronic fibrous Riedel’s thyroiditis
```
A. Thyroid gland cancer
86
A 22-year-old patient is a clerk. His working day runs in a conditioned room. In summer he was taken by an acute disease with the following symptoms: fever, dyspnea, dry cough, pleural pain, myalgia, arthralgia. Objectively: moist rales on the right, pleural friction rub. X-ray picture showed infiltration of the inferior lobe. In blood: WBC -11 · 109/l, stab neutrophils -6%, segmented neutrophils -70%, lymphocytes -8%, ESR -42 mm/h. What is the ethiological factor of pneumonia?
```
A. Staphylococcus
B. Mycoplasm
C. Streptococcus
D. Legionella
E. Pneumococcus
```
D. Legionella
87
A 53-year-old woman complained of cardiac pain and rhythm intermissions. She had experienced these presentations since childhood. The patient’s father had a history of cardiac arrhythmias. Objectively: the patient was in grave condition, Ps-220 bpm,AP-80/60mmHg.ECG:heart rate -215/min, widening and deformation of QRS complex accompanied by atrioventricular dissociation; positive P wave. Some time later heart rate reduced down to 45/min, there was a complete dissociation of P wave and QRST complex. Which of the following will be the most effective treatment?
```
A. Implantation of the artificial pacemaker
B. β-adrenoreceptor blocking agents
C. Cholinolytics
D. Calcium antagonists
E. Cardiac glycosides
```
A. Implantation of the artificial pacemaker
88
A 47-year-old patient complains about cough with purulent sputum, pain in the lower part of the left chest, periodical body temperature rise. She has been suffering from these presentations for about 10 years. Objectively: "drumstick"distal phalanges. What examination would bethe most informative for making a diagnosis?
```
A. Pleural puncture
B. Bronchoscopy
C. Survey radiograph of lungs
D. Bronchography
E. Bacteriological analysis of sputum
```
D. Bronchography
89
A 49-year-old patient complains of dyspnea, cough. There are no sputum discharges. He has repeatedly used salbutamol and intal but with no effect. Objectively: he is only able to sit while leaning on the table. Cyanosis of face, acrocyanosis are present. Breathing is shallow, laboured, in some parts it cannot be auscultated; there are diffuse rales, expiration is significantly prolonged. Heart sounds are muffled, tachycardia is present. Ps -112/min., AP -110/70 mm Hg. Liver is located near the costal arch. There are no peripheral edemata. What is your provisional diagnosis?
A. Chronic obstructive bronchitis
B. Status asthmaticus
C. Bronchiale asthma, moderate gravity D. Foreign object aspiration
E. Cardiac asthma
B. Status asthmaticus
90
A 3-year-old girl presents with pertussis-like cough with thick sputum. There have been persistent changes in lungs since the age of 6 months when she wasfirst diagnosed with acute pneumonia. Chloride concentration in the perspiration is 112 mEq/l. The child has been diagnosed with mucoviscidosis. What is the basis for autosomal recessive disease mucoviscidosis?
A. Deposition of calcium triphosphates and carbotates in the alveoles
B. α1-antitrypsin deficiency
C. Inadequate transport of sodium and chloride ions
D. Pulmonary cysts
E. Pulmonary artery hypoplasia
Inadequate transport of sodium and chloride ions
91
```
A parturient woman is 23 years old. Vaginal obstetric examination reveals full cervical dilatation. There is no fetal bladder. Fetal head is in the plane of pelvic outlet. Sagittal suture is in mesatipellic pelvis, anterior fontanel is closer to pubes. The fetal head diameter in such presentation will be:
A. Suboccipito-bregmaticus
B. Fronto-occipitalis recta
C. Biparietal
D. Suboccipitio-frontalis
E. Mento-occipitalis
```
A. Suboccipito-bregmaticus
92
A 42-year-old woman has had hyperpolymenorrhea and progressing algodismenorrhea for the last 10 years. Gynaecological examination revealed no changes of uterine cervix; discharges are moderate, of chocolate colour, uterus is slightly enlarged and painful, appendages are not palpable, the fornices are deep and painless. What is the most likely diagnosis?
```
A. Endomyometritis
B. Uterine carcinoma
C. Subserous uterine fibromyoma
D. Uterine endometriosis
E. Adnexal endmetriosis
```
Uterine endometriosis
93
Examination of a 38-year-old patient who had been hit with a blunt object on the left side of chest revealed a fracture of the X rib with fragments displacement, parietal pneumothorax. The patient complains of pain in the left subcostal area. Objectively: the patient is pale, AP-80/40 mm Hg, Ps-138/min, of poor volume. USI reveals fluidinthe left abdomen. Splenic rupture is present. What treatment tactics should be chosen?
A. Immediate upper middle laparotomy and following drainage of the left pleural cavity
B. Drainage of the left pleural cavity and laparotomy
C. Immediate laparotomy and alcoholnovocaine block of the X rib
D. Anti-schock actions and laparotomy following the arterial pressure rise
E. Left-sided thoracotomy and immediately following laparotomy
B. Drainage of the left pleural cavity and laparotomy
94
15 minutes after the second vaccination with DTP vaccine a 4-month-old boy exhibited the symptoms of Quincke’s edema. What medication should be given for emergency aid?
```
A. Prednisolone
B. Heparin
C. Adrenalin
D. Furosemide
E. Seduxen
```
A. Prednisolone
95
On the 2nd day after a surgery for toxic mixed goiter IV a 35-year-old patient complains of heart pain. ECG shows prolonged QT intervals. Chvostek’s and Trousseau symptoms cannot be clearly defined. The patient is provisionally diagnosed with latent tetany. What study will allow to confirm the diagnosis?
A. Determination of thyroid hormones
B. Determination of thyrotropic hormone
C. Determination of potassim
D. Determination of sodium
E. Determination of blood calcium and phosphor
96
A patient with bilateral hydrothorax has repeatedly undergone pleural puncture on both sides. After a regular puncture the patient’s condition has become worse: he presents with fever, chest pain. The next day, the attending physician performing pleural puncture revealed some pus on the right. What is the mechanism of acute right-sided empyema development?
A patient with bilateral hydrothorax has repeatedly undergone pleural puncture on both sides. After a regular puncture the patient’s condition has become worse: he presents with fever, chest pain. The next day, the attending physician performing pleural puncture revealed some pus on the right. What is the mechanism of acute right-sided empyema development?
```
A. Contact-and-aspiration
B. Lymphogenous
C. Hematogenous
D. Implantation
E. Aerial
```
Contact-and-aspiration
97
A student analyzes noise level of cold-pressing process. What device should be applied for this hygienic study?
```
A. Noise analyzer
B. Noise and vibration analyzer
C. Sound tester
D. Actinometer
E. Pyranometer
```
B. Noise and vibration analyzer
98
Environmental pollution is prevented by mechanical separation of nontoxic solid domestic waste. Specify the method which can be used for mechanical utilization of these wastes:
A. Compressing of wastes into building blocks
B. Hydrolysis
C. Burning as power-plant fuel
D. Burial of wastes
E. Waste neutralization in biothermal boxes
A. Compressing of wastes into building blocks
99
A 26-year-old woman complains of having bloody discharges from the genitals for the last 14 days, abdominal pain, general fatiguability, weakness, weight loss, fever, chest pain, obstructed respiration. 5 weeks ago she underwent an induced abortion in the 6-7 week of gestation. Objectively: the patient is pale and inert. Bimanual examination revealed that the uterus was enlarged up to 8-9 weeks of gestation. In blood: Hb -72 g/l. Urine test for chorionic gonadotropin gave the apparently positive result. What is the most likely diagnosis?
```
A. Uterus perforation
B. Metroendometritis
C. Chorioepithelioma
D. Uterine fibromyoma
E. Uterine carcinoma
```
C. Chorioepithelioma
100
A 28-years-old woman complains of nausea and vomiting about 10 times per day. She has been found to have body weight loss and xerodermia. The pulse is 100 bpm. Body temperature is 37,2oC. Diuresis is low. USI shows 5-6 weeks of pregnancy. What is the most likely diagnosis?
```
A. Mild vomiting of pregnancy
B. Moderate vomiting of pregnancy
C. I degree preeclampsia
D. Premature abortion
E. Food poisoning
```
B. Moderate vomiting of pregnancy
101
```
A full-term baby was born with body weight of 3200 g, body length of 50 cm, Apgar score -8-10 points. What is the optimum time for the first breast-feeding?
A. First 30 minutes
B. First 6 hours
C. First 24 hours
D. First 48 hours
E. After 48 hours
```
A. First 30 minutes
102
A 26-year-old patient with left lower lobe pneumonia experiences an acute chest pain on the left during coughing. Objectively: diffuse cyanosis, widening of the left half of chest. Percussion reveals high tympanitis. Auscultation reveals no respiratory murmurs above the left half of chest. There is a deviation of the right cardiac border towards the midclavicular line. What examination will be the most informative?
```
A. Spirography
B. Bronchoscopy
C. Bronchography
D. Pneumotachometry
E. X-Ray
```
E. X-Ray
103
A 3-year-old child has been taken to a pediatrician. He has no recent history of any diseases. Objective examination revealed no pathology of the internal organs. The child needs the routine immunization against the following disease:
```
A. Poliomyelitis
B. Diphtheria and tetanus
C. Measles, rubella, parotitis
D. Pertussis
E. Type B hepatitis
```
A. Poliomyelitis
104
```
A 40-year-old patient underwent an operation for a lumbar phlegmon. Body temparature rose again up to 38oC,he got intoxication symptoms, there was an increase of leukocyte number in blood. The wound that was nearly free from necrotic tissues and full of granulations started to discharge pus, the granulations turned pale. What complication dveloped in this patient?
A. Erysipeloid
B. Putrid phlegmon
C. Erysipelas
D. Allergic reaction
E. Sepsis
```
E. Sepsis
105
After a car accident a 37-year-old patient has an acute pain and bleeding in the middle thirdof his rightthigh. Objectively: there is a wound on the anterior surface of the right thigh with massive bleeding, abnormal mobility at the level of the middle third of the thigh. The first aid is to be started with:
A. Tourniquet application
B. Injection of pain-killers
C. Digital occlusion of the femoral artery
D. Immobilization of the extremity with a transportation splint
E. Venipuncture and intravenous infusion of polyglycine
C. Digital occlusion of the femoral artery
106
A 9-year-old boy fell from a tree and hit the occipital region, there was a momentarylossofconsciousness. Objectively: the child’s condition is satisfactory, he complains of the headache and dizziness. The X-ray of skull reveals a comminuted depressed fracture of occipital bone in the region of inion. What treatment is indicated for the patient?
```
A. Complex conservative treatment
B. Anti-inflammatory therapy
C. Hemostatic therapy
D. Therapeutic lumbar punctures
E. Surgical intervention
```
E. Surgical intervention
107
A 40-year-old female patient has a history of rheumatism. She complains about acute pain in her left eye, especially at night, vision impairment, photophobia, lacrimation. The patient cannot suggest any reasons for the disease. Objectively: weak pericorneal injection, flattening of iris relief, iris discoloration. What is the most likely diagnosis?
```
A. Choroiditis
B. Iritis
C. Keratitis
D. Iridocyclitis
E. Acute attack of glaucoma
```
D. Iridocyclitis
108
```
14 days ago a 49-year-old patient was operated on for perforated appendicitis and disseminated fibrinopurulent peritonitis. The postoperative period was uneventful. On the 9th day the patient presented with low-grade fever, abdominal pain, frequent liquid stools. USI of the left mesogastrium reveals a fluid formation 9x10 cm large. In blood: leukocytosis with the left shift. What is your provisional diagnosis?
A. Interloop abscess
B. Abdominal cavity tumour
C. Liver abscess
D. Left kidney cyst
E. Spleen abscess
```
A. Interloop abscess
109
The Carpathian region is characterized by constant high humidity of atmospheric air (over 80%). Inhabitants of this region feel severe cold in corresponding season at a medium low temperature. It’s caused by heat emission by:
A. Vaporization
B. Radiation
C. Convection
D. Conduction
C. Convection
110
```
A 22-year-old female patient complains of dull pain in her right iliac area that she has been experiencing for a week, morning sickness and gustatory change. She has a histrory of menstruation delay for 3 weeks. Objectively: AP80/50 mm Hg, pulse is 78 bpm, body temperature is 37oC. Bimanual examination reveals that uterus is enlarged, soft, mobile and painless. Uterine appendages are palpable on the right, there is a dense, elastic and moderately painful formation 3x4 cm large. What is the most likely diagnosis?
A. Uterogestation
B. Interrupted fallopian pregnancy
C. Right ovarian cyst
D. Progressing fallopian pregnancy
E. Acute appendicitis
```
D. Progressing fallopian pregnancy
111
3 hours ago a 65-year-old female patient felt sharp abdominal pain irradiating to the right scapula, there was a single vomiting. She has a history of rheumatoid arthritis. Objectively: pale skin, AP100/60 mm Hg, Ps-60/min. Abdomen is significantly painful and tense in the epigastrium and right subcostal areat, there are positive symptoms of parietal peritoneum irritation over the right costal arch, that is tympanitis. What is the tactics of an emergency doctor?
A. To take the patient to the surgical hospital
B. To inject pain-killers and watch the dynamics
C. To perform gastric lavage
D. To inject spasmolytics
E. To take the patient to the rheumatological department
A. To take the patient to the surgical hospital
112
A 72-year-old patient complains of pain andbleedingduringdefecation. Digital rectal investigation revealed a tumour of the anal canal. After verification of the diagnosis the patient was diagnosed with squamous cell carcinoma. The secondary (metastatic) tumour will be most probably found in:
```
A. Pelvic bones
B. Liver
C. Lungs
D. Mediastinum
E. Brain
```
C. Lungs
113
A patient has a stab wound on his right foot. On the fourth day after injury the patient’s body temperature rose up to 38oC, inguinal lymph nodes became enlarged and painful, skin over them reddened. What complication might be suspected?
```
A. Lymphangitis
B. Lymphadenitis
C. Phlegmon
D. Tetanus
E. Erysipelas
```
B. Lymphadenitis
114
A 25-year-old female patient complains about having amenorrhea for 3 years. She associates it with difficult labour complicated by massive hemorrhage. She also complains of loss of weight, hair fragility and loss, lack of appetite and depression. Objective examination reveals no pathological changes of uterus and its appendages. What is the desease pathogenesis?
```
A. Hypoproduction of progesterone
B. Hyperproduction of estrogens
C. Hyperproduction of androgens
D. Hypoproduction of gonadotropin
E. Hyperproduction of prolactin
```
D. Hypoproduction of gonadotropin
115
During a surgery on a 30-year-old patient a dark ileo-ileal conglomerate was discovered, the intussusceptum intestine was considered to be unviable. The intussuscipiens intestine was dilated to 7-8 cm, swollen, full of intestinal contents and gases. What pathology led to the surgery?
A. Invagination (combined) obstruction B. Strangulation obstruction
C. Obturation obstruction
D. Paralytic obstruction
E. Spastic obstruction
A. Invagination (combined) obstruction
116
In the current year general practitioners of the municipal polyclinic have referred 11 patients with coronary artery disease to the in-patient hospital. In 3 cases the diagnosis wasn’t confirmed. What managerial decision shoud be made in such case?
A. Analysis of each case of diagnostic divergence
B. Analysis of medical check-up quality
C. Analysis of diagnostic examination quality
D. Analysis of doctors’ skill level
E. Analysis of material and technical basisof the polyclinic
A. Analysis of each case of diagnostic divergence
117
It is required to analyze the level of daylight illumination in a ward of therapeutics unit. What device should be applied to estimate the level of daylight illumination?
```
A. Psychrometer
B. Anemometer
C. Katathermometer
D. Actinometer
E. Illuminometer
```
E. Illuminometer
118
A 43-year-old patient had been admitted to a hospital with clinical presentations of ischiorectal periproctitis. On the 12th day of treatment the patient’s condition deteriorated: there was an increase in the rate of intoxication and hepatic failure, the body temperature became hectic, AP was 100/60 mm Hg. USI of liver revealed a hydrophilic formation. In blood: WBCs -19,6 · 109/l, RBCs.3, 0 · 1012/l, Hb-98 g/l. What complication was developed?
```
A. Budd-Chiari syndrome
B. Pylephlebitis
C. Hepatic cyst
D. Liver necrosis
E. Liver abscess
```
E. Liver abscess
119
A 32-year-old gravida complains of episodes of unconsciousness, spontaneous syncopes that are quickly over after a change of body position. A syncope can be accompanied by quickly elapsing bradycardia. There are no other complications of gestation. What is the most likely reason for such condition?
A. Pressure rise in the veins of extremities
B. Postcava compresseion by the gravid uterus
C. Pressure fall in the veins of extremities
D. Vegetative-vascular dystonia (cardiac type)
E. Psychosomatic disorders
B. Postcava compresseion by the gravid uterus
120
A 54-year-old female patient consulted a gynaecologist about bloody discharges from the vagina for 1 month. Last menstruation was 5 years ago. Gynaecological examination revealed no pathological changes. What is the tactics of choice?
```
A. Diagnostic fractional curettage of uterine cavity
B. Colposcopy
C. USI
D. Cytosmear
E. Symptomatic therapy
```
Diagnostic fractional curettage of uterine cavity
121
A factory worker has ARD complicated by acute bronchitis. He receives treatment in the outpatient setting. The attending doctor has issued him a medical certificate for 5 days and then extended its duration by 5 more days. Patient can’t get downtoworkbecauseof his health status. Who should extend the duration of medical certificate for this patient?
A. Adepartment chief
B. Medical superintendent
C. Deputy medical superintendent in charge of temporary disability examination
D. Deputy medical superintendent in charge of medical treatment
E. Medical advisory commission
A. Adepartment chief
122
An ambulance delivered a 21year-old woman to the gynaecological department with complaints of colicky abdominal pain and bloody discharges from the genital tracts. Bimanual examination revealed that uterus was soft, enlarged to the size of 6 weeks of gestation, a gestational sac was palpated in the cervical canal. Uterine appendages weren’t palpable. Fornices are free, deep and painless. Discharges from the genital tracts are bloody and profuse. What is the most likely diagnosis?
```
A. Cervical pregnancy
B. Abortion in progress
C. Threat of abortion
D. Incipient abortion
E. Interrupted fallopian pregnancy
```
B. Abortion in progress
123
According to the report of water quality control, drinking city water has the following characteristics: turbidity-1,5mg/m3, odour -3 points, metallic taste -2 points, pale yellow colour, colour index -20o, temperature -12o. Which of these factors doesn’t comply with hygienic requirements?
```
A. Odour
B. Turbidity
C. Colour index
D. Temperature
E. Taste
```
A. Odour
124
```
On the fifth day after a casual sexual contact a 25-year-old female patient consulted a doctor about purulent discharges from the genital tracts and itch. Vaginal examination showed that vaginal part of uterine cervix was hyperemic and edematic. There was an erosive area around the external orifice of uterus. There were mucopurulent profuse discharges from the cervical canal, uterine body and appendages exhibited no changes. Bacterioscopic examination revealed bean-shaped diplococci that became red after Gram’s staining. What is the most likely diagnosis?
A. Acute gonorrheal endocervicitis
B. Trichomonal colpitis
C. Candidal vulvovaginitis
D. Clamydial endocervicitis
E. Bacterial vaginism
```
A. Acute gonorrheal endocervicitis
125
The correlation between the service record and eosinophil concentration in blood has been studied in female workers of dyeing shops of textile factories. What index will be the most informative for the analysis of this data?
```
A. Sign index
B. Student’s criterion
C. Standardized index
D. Fitting criterion
E. Correlation factor
```
E. Correlation factor
126
A 30-year-old female patient has been delivered to the gynaecological department with complaints of acute pain in the lower abdomen and body temperature 38,8oC. In history: sexual life out of wedlock and two artificial abortions. Gynaecological examination reveals no changes of uterine. The appendages are enlarged and painful on both sides. Vaginal discharges are purulent and profuse. What study is required to confirm a diagnosis?
```
A. Laparoscopy
B. Hysteroscopy
C. Curettage of uterine cavity
D. Colposcopy
E. Bacteriological and bacterioscopic analysis
```
E. Bacteriological and bacterioscopic analysis
127
A 38-year-old patient complains of inertness, subfebrile temperature, enlargement of lymph nodes, nasal haemorrhages, bone pain. Objectively: the patient’s skin and mucous membranes are pale, palpation revealed enlarged painless lymph nodes; sternalgia; liver was enlarged by 2 cm, spleen -by 5 cm, painless. In blood: erythrocytes 2, 7 · 1012/l, Hb-84 g/l, leukocytes -58 · 109/l, eosinophils -1%, stab neutrophils -2%, segmented neutrophils -12%, lymphocytes -83%, lymphoblasts -2%, smudge cells; ESR-57 mm/h. What is the most likely diagnosis?
```
A. Chronic lymphatic leukemia
B. Chronic myeloleukemia
C. Acute lymphatic leukemia
D. Acute myeloleukemia
E. Lymphogranulomatosis
```
A. Chronic lymphatic leukemia
128
A25-year-old victim of a road accient complains of chest pain, dyspnea. Objectively: the patient is in a grave condition, Ps-120/min, AP-90/70 mm Hg.There is pathological mobility of fragments of IIIV ribs on the right. Percussion reveals a box sound over the right lung, breathing sounds cannot be auscultated on the right. What examination should be administered in the first place?
```
A. Thoracoscopy
B. Bronchoscopy
C. Pleural puncture
D. USI of chest organs
E. X-ray of chest organs
```
E. X-ray of chest organs
129
A 24-year-old patient complains about putting on weight, limosis. Objectively: the patient’s constitution is of hypersthenic type, body weight index is 33,2 kg/m2, waistcircumference is 100 cm. Correlation of waist circumference to the thigh circumference is 0,95. What is the most likely diagnosis?
A. Alimentary constitutional obesity of the III stage, gynoid type
B. Hypothalamic Itsenko-Cushing obesity of the II stage, gynoid type
C. Alimentary constitutional obesity of the I stage, abdominal type
D. Alimentary constitutional obesity of the II stage, abdominal type
E. Hypothalamic Itsenko-Cushing obesity of the I stage, abdominal type
C. Alimentary constitutional obesity of the I stage, abdominal type
130
```
A 58-year-old patient complains about sensation of numbness, sudden paleness of II-IV fingers, muscle rigidness, intermittent pulse. The patient presents also with polyarthralgia, dysphagia, constipations. The patient’s face is masklike, solid edema of hands is present. The heart is enlarged; auscultation revealed dry rales in lungs. In blood: ESR -20 mm/h, crude protein -85/l, γglobulines -25%. What is the most likely diagnosis?
A. Systemic scleroderma
B. Dermatomyositis
C. Rheumatoid arthritis
D. Systemic lupus erythematosus
E. Raynaud’s disease
```
A. Systemic scleroderma
131
```
A 45-year-old man has been exhibiting high activity for the last 2 weeks, he is talkative, euphoric, has little sleep, claims being able "to save the humanity and solve the problem of cancer and AIDS", gives money to starangers. What is the most likely diagnosis?
A. Schizo-affective disorder
B. Panic disorder
C. Agitated depression
D. Maniacal onset
E. Catatonic excitation
```
D. Maniacal onset
132
A parturient woman is 25 years old, it is her second day of postpartum period. It was her first full-term uncomplicated labour. The lochia should be:
A. Serous B. Sanguino-serous C. Mucous D. Purulent E. Bloody
E. Bloody
133
A 32-year-old patient consulted a doctor about being inable to get pregnant for 5-6 years. 5 ago the primipregnancy endedinartificial abortion. After the vaginal examination and USI the patient was diagnosed with endometrioid cyst of the right ovary. What is the optimal treatment method?
A. Surgical laparoscopy
B. Anti-inflammatory therapy
C. Conservative therapy with estrogengestagenic drugs
D. Hormonal therapy with androgenic hormones
E. Sanatorium-and-spa treatment
A. Surgical laparoscopy
134
```
A 6-year-old girl drank some coloured fizzy drink which gave her a feeling of pressure in the throat. 30 minutes later the child’s lips got swollen, then edema gradually spread over the whole face, laryngeal breathing became difficult. The child is excited. Ps-120/min, breathing rate -28/min, breathing is noisy, indrawing of intercostal spaces is observed. What basic aid is most appropriate for the restoration of laryngeal breathing?
A. Corticosteroids
B. Sedative drugs
C. Tracheostomy
D. Antibacterial drugs
E. Conicotomy
```
A. Corticosteroids
135
A 60-year-old patient had eaten too much fatty food, which resulted in sudden pain in the right subcostal area, nausea, bilious vomiting, strong sensation of bitterness in the mouth. Two days later the patient presented with jaundice, dark urine. Objectively: sclera and skin are icteric, abdomenis swollen, liver is increased by 3 cm, soft, painful on palpation, Ortner’s, Kehr’s, Murphy’s, Zakharyin’s, MayoRobson’s symptoms are positive. Which method should be applied for diagnosis in the first place?
```
A. USI of gallbladder and biliary duct
B. Fibrogastroduodenoscopy
C. X-ray of abdominal organs
D. Radionuclide scanning of liver and gallbladder
E. Diagnostic laparotomy
```
A. USI of gallbladder and biliary duct
136
```
A 20 year-old patient complains of nosebleeds, numbness of the lower extremities. Objectively: hyperaemia of face, on the upper extremities AP is160/90 mm Hg, and 80/50 mm Hg on the lower ones. Pulse on the popliteal and pedal arteries is of poor volume, there is systolic murmur over the carotid arteries. What is the most likely diagnosis?
A. Ventricular septal defect
B. Dissecting aortic aneurysm
C. Aortopulmonary window
D. Aorta coarctation
E. Atrial septal defect
```
D. Aorta coarctation
137
An 8-month-old baby has had problems with nasal breathing and mucopurulent discharge from the nose for a week. Examination reveals a rhinedema, muco-purulent discharges from the middle nasal meatus as well as on the back of pharynx. What disease are these symptoms most typical for?
```
A. Sphenoiditis
B. Ethmoiditis
C. Maxillary sinusitis
D. Frontitis
E. Hemisinusitis
```
B. Ethmoiditis
138
A department chief of an in-patient hospital is going to inspect resident doctors as to observation of medicaltechnological standards of patient service. What documentation should be checked for this purpose?
A. Health cards of in-patients
B. Statistic cards of discharged patients C. Treatment sheets
D. Registry of operative interventions
E. Annual report of a patient care institution
A. Health cards of in-patients
139
While asessing the health status of graduates of a secondary school, the doctor found one of them to have grade 3 tonsillar hypertrophy, chronic rhinitis and vegetative-vascular dystonia. The organism functionality is reduced. This student belongs to the following health group:
A. III B. II C. I D. IV E. V
A. III
140
A 17-year-old patient complains of pain in the area of the left knee joint. Soft tissues of thigh in the affected region are infiltrated, joint function is limited. X-ray picture of the distal metaepiphysis of the left femur shows a destruction focus with periosteum detachment and Codman’s triangle found at the defect border in the bone cortex. X-ray of chest reveals multiple small focal metastases. What treatment is indicated?
A. Distance gamma-ray therapy
B. Radioiodine therapy
C. Palliative chemotherapy
D. Disarticulation of the lower extremity E. Amputation of the lower extremity
C. Palliative chemotherapy
141
Head circumference of a 1-monthold boy with signs of excitement is 37 cm, prefontanel is 2x2 cm large. After feeding the child regurgitates small portions of milk; stool is normal in respect of its volume and composition. Muscle tonus is within norm. What is the most likely diagnosis?
```
A. Pylorostenosis
B. Meningitis
C. Pylorospasm
D. Microcephaly
E. Craniostenosis
```
C. Pylorospasm
142
As a result of lifting a load a 62-yearold female felt acute pain in the lumbar region, in a buttock, posterolateral surface of her right thigh, external surface of the right shin and dorsal surface of foot. Objectively: weakness of the anterior tibial muscle, long extensor muscle of the right toes, short extensor muscle of the right toes. Low Achilles reflex on the right. Positive Lasegue’s sign. What examination method would be the most effective for specification of the diagnosis of discogenic compression of L5 root?
```
A. Magnetic resonance scan
B. Spinal column X-ray 
C. Electromyography
D. Angiography
E. Lumbar puncture
```
A. Magnetic resonance scan
143
At first appointment with an obstetrician-gynaecologist a pregnant woman is referred to other medical specialists. She must be obligatory examined by the following specialists:
```
A. Therapeutist and dentist
B. Therapeutist and endocrinologist
C. Dentist and phthisiatrician
D. ENTandophthalmologist
E. Dentist and cardiologist
```
A. Therapeutist and dentist
144
A hospital admitted a patient with coarse breathing (obstructed inspiration), skin cyanosis, tachycardia and arterial hypertension. He has a histrory of bronchial asthma. An hour ago he was having salbutamol inhalation and forgot to remove a cap that was aspired while taking a deep breath. What measures should the doctor take?
A. Send for an anesthesiologist and wait for him
B. Perform conicotomy immediately
C. Perform the Heimlich manoever
D. Use an inhalation of β2-adrenoceptor agonist
E. Make a subcutaneous injection of dexamethasone
C. Perform the Heimlich manoever
145
A19-year-old student has been hospitalized on an emergency basis because of severe dyspnea, pain in the left side of chest. The patient got sick 3 days ago. Objectively: body temperature 38, 8oC. BH -42/min., hypopnoe. There is dullness of percussion sound on the right of the scapula middle, breathing sounds cannot be auscultated. The left border of heart is displaced outwards by 3 cm. Embryocardia is preent, HR 110/min. The right hypochondrium is painful on palpation. What are the immediate treatment measures in this situation?
A. Urgent puncture of pleural cavity
B. Administartion of antibiotics of penicillin group
C. Injection of lasix
D. Injection of cardiac glycosides
E. Transfer of the patient to the thoracic surgery department
A. Urgent puncture of pleural cavity
146
On the 6th day of life a child got multiple vesicles filled with seropurulent f luid in the region of occiput, neck and buttocks. General condition of the child is normal. What disease should be suspected?
```
A. Impetigo
B. Impetigo neonatorum
C. Miliaria
D. Vesiculopustulosis
E. Epidermolysis bullosa
```
D. Vesiculopustulosis
147
```
A pregnant woman was delivered to the gynecological unit with complaints of pain in the lower abdomen and insignif icant bloody discharges from the genital tracts for 3 hours. Last menstruation was 3 months ago. Vaginal examination showed that body of womb was in the 10th week of gestation, a fingertip could be inserted into the external orifice of uterus, bloody discharges were insignificant. USI showed small vesicles in the uterine cavity. What is the most likely diagnosis?
A. Incipient abortion
B. Abortion in progress
C. Grape mole
D. Threat of spontaneous abortion
E. Incomplete abortion
```
C. Grape mole
148
```
A 30-year-old male patient consulted a family doctor 2 months after he had been operated for an open fracture of brachial bone. Objectively: the patient’s condition is satisfactory, in the region of the operative wound there is a fistula with some purulent discharge, redness, f luctuation. X-ray picture shows brachial bone destruction with sequestra. What complication arose in the postoperative period?
A. Wound abscess
B. Hematogenic osteomyelitis
C. Posttraumatic osteomyelitis
D. Posttraumatic phlegmon
E. Suture sinus
```
C. Posttraumatic osteomyelitis
149
```
A 50-year-old male suburbanite underwent treatment in rural outpatient clinic for pneumonia. The treatment didn’t have effect and the disease got complicated by exudative pleuritis. What prevention and treatment facility should the patient be referred to for further aid?
A. Central district hospital
B. Regional hospital
C. Phthisio-pulmonological dispensary
D. Municipal hospital
E. Tuberculosis dispensary
```
A. Central district hospital
150
A patient is being prepared for the operation on account of varix dilatation of lower extremities veins. Examination of the patient’s soles revealed flour-like desquamation along the skin folds. All the toenails are greyish-yellow, thickened and partially decayed. What dermatosis should be suspected?
```
A. Microsporia
B. Pityriasis versicolor
C. Candidosis
D. Rubromycosis
E. Microbial eczema
```
D. Rubromycosis
151
A 58-year-old patient complains of a headache in the occipital region, nausea, choking, opplotentes. The presentations appeared after a physical exertion. Objectively: the patient is excited. Face is hyperemic. Skin is pale. Heart sounds are regular, the 2nd aortic sound is accentuated. AP-240/120 mm Hg, HR92/min. Auscultation reveals some fine moisr rales in the lower parts of the lungs. Liver is not enlarged. ECG shows signs of hypertrophy and left ventricular overload. What is the most likely diagnosis?
```
A. Bronchial asthma exacerbation
B. Acute myocardial infarction, pulmonary edema
C. Complicated hypertensic crisis
D. Uncomplicated hypertensic crisis
E. Community-acquired pneumonia
```
Complicated hypertensic crisis
152
```
A 43-year-old female patient was delivered to the hospital in grave condition. She has a history of Addison’s disease. The patient had been regularly taking prednisolone but a week before she stopped taking this drug. Objectively: sopor, skin and visible mucous membranes are pigmented, skin and muscle turgor is decreased. Heart sounds are muffled, rapid. AP-60/40 mm Hg, heart rate -96/min. In blood: Na -120 millimole/l, K -5,8 millimole/l. Development of this complication is primarily caused by the deficit of the following hormone:
A. Cortisol
B. Corticotropin (ACTH)
C. Adrenaline
D. Noradrenaline
E. Adrostendion
```
A. Cortisol
153
```
Forensic medical expertise of corpse of a newborn revealed: body weight 3500 g, body length 50 cm, the umbilical cord was smooth, moist, glossy, without any signs of drying. Hydrostatic tests were positive. The test results are the evidence of:
A. Hyaline membrane disease
B. Stillbirth
C. Primary atelectasis
D. Secondary atelectasis
E. Live birth
```
E. Live birth
154
A primigravida is 22 years old. She has Rh(-), her husband has Rh(+). Anti bodies to Rh weren’t found at 32 weeks of pregnancy. Redetermination of antibodies to Rh didn’t reveal them at 35 weeks of pregnancy as well. How often should the antibodies be determined hereafter?
```
A. Monthly
B. Once in two weeks
C. Once in three weeks
D. Once a week
E. There is no need in further checks
```
D. Once a week
155
```
A patient is 50 years old, works as a builder with 20 years of service record. Hewasadmittedtothehospitalforchest pain, dry cough, minor dyspnea. Objectively: sallow skin, acrocyanosis, asbestos warts on the hands. In lungs -rough respiration, diffuse dry rales. The x-ray picture shows intensification of pulmonary pattern, signs of pulmonary emphysema. What is the most likely diagnosis?
A. Asbestosis
B. Lung cancer
C. Pneumonia
D. Chronic obstructive bronchitis
E. Tuberculosis
```
A. Asbestosis
156
```
A 14-year-old girl complains of pain in vaginal area and lower abdomen that last for 3-4 days and have been observed for 3 months about the same time. Each time pain is getting worse. Objectively: mammary glands are developed, hairiness corresponds to the age. The virginal membrane is intact, cyanotic and protruded. She has never had menstruation. She has been diagnosed with primary amenorrhea. What is the reason of amenorrhea?
A. Pregnancy
B. Turner’s syndrome
C. Babinski-Frohlich syndrome
D. Hymen atresia
E. Sexual development delay
```
D. Hymen atresia
157
```
A 22-year-old vegetarian patient with signs of malnutrition consulted a doctor about smell and taste distortion, angular stomatitis. Objectively: marked blue sclerae. The patient was diagnosed with iron deficiency anemia. What is the dominating clinical syndrome?
A. Myelodysplastic
B. Anaemic
C. Haemologic
D. Haemolytic
E. Sideropenic
```
E. Sideropenic
158
```
Condition of a patient with purulent otitis has abruptly deteriorated: he presents with headache, vomiting, febrile temperature, general hyperesthesia. There are meningeal signs, papilledemas. Focal symptoms are absent. Cerebrospinal fluid is turbid, pressure is high, there is albuminocytologic dissociation with neutrophil predominance. What disease can be suspected?
A. Secondary purulent meningitis
B. Meningoencephalitis
C. Serous meningitis
D. Primary purulent meningitis
E. Subarachnoid haemorrhage
```
A. Secondary purulent meningitis
159
A municipal hospital reported on the number of operated patients including fatal outcomes following the operations. Which index of hospital work can be calculated on the ground of this data?
A. Postoperative lethality
B. Total lethality
C. Index of late hospitalization since a disease incursion
D. Standardized lethality
A. Postoperative lethality
160
```
A 10-year-old boy periodically has short states (up to 10-15 seconds) that can be characterized as a "sudden blackout"and are accompanied by gaze f ixation in the upright position, absentminded and vacant face expression, lack of movements and following amnesia. Specify this state:
A. Absence
B. Obnubilation
C. Trance
D. Fugue
E. Thought block
```
A. Absence
