Dr.

ASHIQ TUTORAL

ONLINE EXAM
PRE KROK 2 MEDICINE

TIMING; 2 HRS 40 MIN

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

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

1. A 62-year-old woman was brought into the
admission room with complaints of severe
burning retrosternal pain and asphyxia. She has
a 10-year-long history of essential hypertension.
Objectively her condition is moderately severe.
She presents with skin pallor, cyanotic lips, and
vesicular respiration over her lungs. The II heart
sound is accentuated over the aorta. Blood
pressure - 210/120 mm Hg, heart rate (pulse) -
76/min. ECG shows elevation of ST segment in
the leads I, AVL, and V5-V6. What is the most
likely diagnosis?
A. Hypertensive crisis complicated with acute
myocardial infarction
B. Uncomplicated hypertensive crisis
C. Hypertensive crisis complicated with instable
angina pectoris
D. Hypertensive crisis complicated with acute
left ventricular failure
E. Pulmonary embolism
2. A 35-year-old patient developed an epileptic
attack with tonoclonic spasms that lasted for 3
minutes. After the attack the patient fell asleep
but in 5 minutes the second attack occurred.
The first step of emergency aid would be to:
A Prescribe antiepileptic drugs
B. Take blood from the vein for analysis
C. Introduce diazepam intravenously
D. Ensure patency of airways
E. Administer chloral hydrate via an enema
3. A 27-year-old woman, a teacher in the
elementary school, complains of frequent
stools, up to 3 times per day, with lumpy feces
and large amount of mucus, abdominal pain
that gradually abates after a defecation,
irritability. Her skin is pale and icteric. Pulse is
74/min., rhythmic, can be characterized as
satisfactory. Blood pressure is 115/70 mm Hg.
The abdomen is soft, moderately tender along
the colon on palpation. Fiberoptic colonoscopy
detects no changes. What disease can be
suspected?
A. Chronic enteritis
B. Chronic non-ulcerative colitis
C . Irritable bowel syndrome
D. Crohn disease (regional enteritis)
E. Whipple disease
4. A 72-year-old man complains of lower
extremity edema, sensation of heaviness in the
right subcostal area, dyspnea at rest. For over
25 years he has been suffering from COPD.
Objectively: orthopnea, jugular venous
distention, diffuse cyanosis, acrocyanosis.
Barrel chest is observed, on percussion there is
a vesiculotympanitic (bandbox) resonance,
sharply weakened vesicular respiration on both
sides, moist crepitant crackles in the lower
segments of the lungs. Heart sounds are
weakened, the II heart sound is accentuated
over the pulmonary artery. The liver is +3 cm.
What complicated the clinical course of COPD in
this patient?
A. Pulmonary embolism
B Chronic pulmonary heart
C. Acute left ventricular failure
D. Diffuse pneumosclerosis
E. Community-acquired pneumonia
5. A 72-year-old man with pneumonia
complains of marked dyspnea, chest pain,
severe cough with expectoration, t o is 39.5-
40oC, no urination for a whole day. Objectively
the patient is conscious. Respiratory rate is
36/min. Over the right lower pulmonary lobe
percussion sound is dull; on auscultation there
is bronchial respiration and numerous moist
crackles. Blood pressure is 80/60 mm Hg. Heart
rate is 120/min. Heart sounds are muffled,
there is tachycardia. What tactics should the
family doctor choose in the management of this
patient?
A. Hospitalization into the intensive care unit
B. Outpatient treatment
C. Treatment in the day patient facility
D. Hospitalization into the pulmonology unit
E. Hospitalization into the neurology unit
6. 2 hours after eating unknown mushrooms, a
28-year-old man sensed a decrease in his
mobility and deterioration of his ability to focus.
This condition was then followed by a state of
agitation and agression. On examiantion he is
disoriented and his speech is illegible. 4 hours
later he developed fetor hepaticus and lost his
consciousness. What syndrome can be
observed in this patient?
A. . Cytolytic syndrome
B. Hepatolienal syndrome
C. Portal hypertension
D. Cholestatic syndrome
E Acute hepatic failure
7. A 36-year-old man complains of marked
dyspnea and cardiac pain. He ascribes his
disease to the case of influenza that he had 2
weeks ago. Objectively he leans forward when
sitting. The face is swollen, cyanotic, cervical
veins are distended. Heart borders are
extended on the both sides, heart sounds are
muffled, heart rate = Ps = 118/min., BP is 90/60
mm Hg. Blood test: ESR is 46 mm/hour. ECG
shows low voltage. Xray shows trapezoidal
cardiac silhouette and signs of pulmonary
congestion. Choose the treatment tactics:
A. Pericardial puncture (pericardiocenthesis)
B. Diuretics
C. Antibiotics
D. Pericardectomy
E. Glucocorticosteroids
8. A 39-year-old man suffers from chronic
rheumatic heart disease. He complains of
dyspnea during physical exertion, cough with
expectoration, and palpitations. Ausculation
detects intensified I heart sound and diastolic
murmur; the sound of opening mitral valve can
be auscultated at the cardiac apex. The II heart
sound is accentuated over the pulmonary
artery. The patient is cyanotic. X-ray shows
dilated pulmonary root and enlargement of the
right ventricle and left atrium. What is the most
likely diagnosis?
A. Coarctation of the aorta
B. Aortic stenosis
C. Pulmonary artery stenosis
D .Mitral stenosis .
E. Patent ductus arteriosus
9. A 23-year-old man complains of severe pain
in his left knee joint. Objectively the left knee
joint is enlarged, with hyperemic skin, painful
on palpation. Complete blood count:
erythrocytes - 3.8 · 1012/L, Hb- 122 g/L,
leukocytes - 7.4 · 109/L, platelets - 183 · 109/L.
Erythrocyte sedimentation rate - 10 mm/hour.
Bleeding time (Duke method) - 4 min., Lee-
White coagulation time - 24 min. Partial
thromboplastin time (activated) - 89 seconds.
Rheumatoid factor - negative. What is the most
likely diagnosis?
A. . Werlhof disease (immune
thrombocytopenia)
B. Hemophilia, hemarthrosis
C. Rheumatoid arthritis
D. Thrombocytopathy
E. Hemorrhagic vasculitis (Henoch-Schonlein
purpura), articular form
10. A 24-year-old woman, a kindergarten
teacher, has been sick for 2 days already.
Disease onset was acute. She presents with
elevated body temperature up to 38.0oC, pain
attacks in her lower left abdomen, liquid stool
in small amounts with blood and mucus
admixtures 10 times a day. Pulse - 98/min.,
blood pressure - 110/70 mm Hg. Her tongue is
moist and coated with white deposits. The
abdomen is soft, the sigmoid colon is painful
and spastic. Make the provisional diagnosis:
A. . Salmonellosis
B. Escherichiosis
C. Shigellosis
D. Yersiniosis
E. Rotavirus infection
11. A pregnant woman is 28 years old.
Anamnesis: accelerated labor complicated by
the II degree cervical rupture. The following two
pregnancies resulted in spontaneous abortions
at the terms of 12 and 14 weeks. On mirror
examination: the uterine cervix is scarred from
previous ruptures at 9 and 3 hours, the cervical
canal is gaping. On vaginal examination: the
cervix is 2 cm long, the external orifice is open 1
cm wide, the internal orifice is half-open; the
uterus is enlarged to the 12th week of
pregnancy, soft, mobile, painless, the
appendages are without changes. What
diagnosis can be made?
A. Isthmico-cervical insufficiency, habitual
noncarrying of pregnancy
B. Threatened spontaneous abortion
C. Incipient abortion, habitual noncarrying of
pregnancy
D. Cervical hysteromyoma, habitual noncarrying
of pregnancy
E. Cervical pregnancy, 12 weeks
12. On the day 4 after the cesarean section a
woman developed fever with body temperature
up to 39oC and abdominal pain. Pulse -
104/min. She vomited twice. The patient is
sluggish, her tongue is dry and has gray coating.
The abdomen is distended. Signs of peritoneal
irritation are positive in all segments. Peristalsis
cannot be auscultated. No passage of gas
occurs. Uterine fundus is located at the level of
the navel. The uterus is painful on palpation.
The discharge is moderate and contains blood
and pus. What is the most likely diagnosis?
A. . Parametritis
B. Metroendometritis
C. Progressive thrombophlebitis
D. Pelvic peritonitis
E. Diffuse peritonitis
13. A 58-year-old woman came to the
gynecological clinic. She complains of bloody
discharge from her genital tracts. Menopause is
8 years. Gynecological examination: the uterus
is slightly enlarged, dense to touch, with limited
mobility; the uterine appendages cannot be
detected; parametrium is free. Fractional
curettage of the uterine cavity yields a
significant amount of medullary substance in
the scrape. What is the most likely diagnosis?
A. Chorioepithelioma
B. Adenomyosis
C. Uterine corpus cancer
D. Uterine cervix cancer
E. Hormone-producing ovarian tumor
14. A 48-year-old woman complains of
disturbed menstrual cycle: her periods last for
7-9 days and are excessively profuse
throughout the last half-year. She notes
occasional hot flashes in her head, insomnia,
irritability, and headaches. Her skin is of normal
color. Blood pressure - 150/90 mm Hg, pulse -
90/min., rhythmic. The abdomen is soft and
painless. Bimanual examination shows no
uterine enlargement, the appendages cannot
be detected. The vaginal fornices are free. What
is the most likely diagnosis?
A. Climacteric syndrome
B. Premenstrual syndrome
C. Adrenogenital syndrome
D. Stein-Leventhal syndrome (polycystic ovary
syndrome)
E. Uterine myoma
15. A 30-year-old multigravida has been in
labour for 18 hours. 2 hours ago the pushing
stage began. Fetal heart rate is clear, rhythmic,
136/min. Vaginal examination reveals complete
cervical dilatation, the fetal head in the pelvic
outlet plane. Sagittal suture is in line with
obstetric conjugate, the occipital fontanel is
near the pubis. The patient has been diagnosed
with primary uterine inertia. What is the further
tactics of labor management?
A. Vacuum extraction of the fetus
B. Labour stimulation
C. Cesarean section
D. Skin-head Ivanov’s forceps
E. Outlet forceps
16. A woman is 40 weeks pregnant. The fetus is
in the longitudinal lie and cephalic presentation.
Pelvic size: 26-29-31- 20. Expected weight of the
fetus is 4800 gram. The labor contractions has
been lasting for 12 hours, within the last 2
hours they were extremely painful, the
parturient woman is anxious. The waters broke
4 hours ago. On external examination the
contraction ring is located 2 finger widths above
the navel, Henkel-Vasten sign is positive. Fetal
heart rate is 160/min., muffled. On internal
examination the uterine cervix is fully open, the
head is engaged and pressed to the entrance
into the lesser pelvis. What is the most likely
diagnosis?
A. Abruption of the normally positioned
placenta
B. Complete uterine rupture
C. Hyperactive uterine contractions
D .Threatened uterine rupture
E. Anatomically contracted pelvis
17. A 23-year-old woman came to the
gynecological clinic. She complains of pain,
itching, and burning in her vulva, general
weakness, indisposition, elevated body
temperature up to 37.2oC, and headache. On
examination in the vulva there are multiple
vesicles up to 2-3 mm in diameter with clear
contents against the background of hyperemia
and mucosal edema. Make the provisional
diagnosis:
A. Papillomavirus infection
B. Primary syphilis
C. Genital herpes infection
D. Vulvar cancer
E. Cytomegalovirus infection
18. A woman with the pregnancy term of 8
weeks complains of elevated temperature up to
37.6oC, skin rash that can be characterized as
macular exanthema, enlargement of posterior
cervical and occipital lymph nodes, small
amount of bloody discharge from the genital
tracts. She was examined by the infectious
diseases specialist and diagnosed with rubella.
What tactics should the obstetrician-
gynecologist choose?
A. Abortion
B. Prescription of antibacterial therapy
C. Prescription of antiviral therapy
D. Treatment of incipient abortion
E. Prescription of hemostatic therapy
19. A 9-month-old child presents with fever,
cough, dyspnea. The symptoms appeared 5
days ago after a contact with a person with
URTI. Objectively: the child is in grave condition.
Temperature is 38oC, cyanosis of nasolabial
triangle is present. RR- 54/min, nasal flaring
during breathing is observed. There was
percussion dullness on the right below the
scapula angle and tympanic sound over the
other areas of lungs. Auscultation revealed
bilateral fine moist crackles predominating on
the right. What is the most likely diagnosis?
A. Acute bronchiolitis
B. URTI
C. Acute laryngotracheitis
D. Acute bronchitis
E. Pneumonia
20. The mother of a 3-month-old child came to
a family doctor with complaints of her child
being physically underdeveloped and suffering
from cough attacks and dyspnea. Anamnesis:
the child is the result of the second full-term
pregnancy with the risk of miscarriage (the first
child died of pulmonary pathology at the age of
4 months, according to the mother). Body mass
at birth is 2500 g. Cough attacks were observed
from the first days of life, twice the child was
treated for bronchitis. Considering the severity
of the child’s condition the doctor made the
referral for hospitalization. What diagnosis was
most likely stated in the referral?
A. Recurrent obstructive bronchitis
B. Acute obstructive bronchitis
C .Mucoviscidosis (Cystic fibrosis)
D. Pertussis
E. Acute obstructive pneumonia
21. A 46-year-old man notes swollen legs, C. Varicocele
weakness, sensation of fullness and heaviness D. Dystopic kidney
in the right subcostal area; it is the first E. Necrotic papillitis
occurrence of these signs in the patient. The
24. A man complains of constant dull pain in the
patient has 20-year-long history of rheumatoid
perineum and suprapubic area, weak flow of
arthritis. The liver and spleen are enlarged and
urine, frequent difficult painful urination,
dense. Blood creatinine - 0,23 mmol/l,
nocturia. The patient has been suffering from
proteinemia - 68 g/l, cholesterol - 4,2 mmol/l,
this condition for several months, during which
urine specific gravity - 1012, proteinuria - 3,3
urination was becoming increasingly difficult,
g/l, isolated wax-like cylinders, leached
and pain in the perineum has developed. On
erythrocytes in the vision field, leukocytes - 5-6
rectal examination: the prostate is enlarged
in the vision field. What is the most likely
(mainly its right lobe), dense, asymmetrical,
complication?
central fissure is smoothed out, the right lobe is
A. Chronic glomerulonephritis
of stony density, painless, tuberous. What
B. Renal amyloidosis
disease is it?
C. Acute glomerulonephritis
A. Prostate tuberculosis
D. Heart failure
B. Prostate sclerosis
E. Chronic pyelonephritis
C. Urolithiasis, prostatolith of the right lobe
22. A 23-year-old man had taken 1 g of aspirin D. Prostate cancer
to treat acute respiratory infection. After that E. Chronic congestion prostatitis
he developed an asthmatic fit with labored
25. A boy was born at 32 weeks of gestation. 2
expiration that was arrested by introduction of
hours after the birth he developed respiratory
aminophylline. The patient has no medical
distress (RD). The RD severity assessed by
history of allergies. The patient has undergone
Silverman score was 5. The respiratory
two surgeries for nasal polyposis in the past.
disorders progressed, respiratory failure could
What is the most likely diagnosis?
not be eliminated by Martin-Bouyer CPAP
A. . Symptomatic bronchospasm
(continuous positive airway pressure). X-ray of
B. Atopic bronchial asthma
lungs shows reticular and nodular pattern, air
C. Infectious allergic bronchial asthma
bronchogram. What is the most likely cause of
D. Exercise-induced asthma
respiratory distress syndrome?
E. Aspirin-induced asthma
A. Bronchopulmonary dysplasia
23. A 50-year-old patient was delivered to a B. Segmental atelectasis
hospital with complaints of blood traces in C. Hyaline membrane disease
urine. Urination is painless and undisturbed. D. Congenital pulmonary emphysema
Macrohematuria had been observed for 3 days. E. Edematous hemorrhagic syndrome
Objectively: kidneys cannot be palpated,
26. A 9-year-old girl complains of fever up to
suprapubic area is without alterations, external
37,5oC, headache, inertness, weakness, loss of
genitalia are non-pathologic. On rectal
appetite, stomachache, and frequent painful
investigation: prostate is not enlarged, painless,
urination. Provisional diagnosis of acute
has normal structure. Cystoscopy revealed no
pyelonephritis is made. Clinical urine analysis:
alterations. What is the most likely diagnosis?
specific gravity - 1018, no protein, leukocytes -
A. Renal carcinoma
10-15 in the vision field. What investigation
B. Bladder tuberculosis
method can verify the diagnosis of urinary
system infection?
A. Bacteriological inoculation of urine
B. Rehberg test (creatinine clearance test)
C. Zymnytsky test (measurement of daily
diuresis)
D. Complete blood count
E. Clinical urine analyses, dynamic testing
27. During assessment of work conditions at the
mercury thermometer manufacture, content of
mercury vapors in the air of working area is
revealed to exceed maximum concentration
limit. Specify the main way of mercury
penetration into the body:
A. Intact skin
B. Respiratory organs
C. Damaged skin
D. Gastrointestinal tract
E. Mucous tunics
28. During health assessment of car drivers and
police officers on point duty, the physicians
detected carboxyhemoglobin in the blood of
the patients, weakened reflex responses,
disturbed activity of a number of enzymes.
Revealed professional health disorders are most
likely to be associated with the effect of:
A. Nitric oxide
B. Sulfurous anhydride
C. Mental stress
D. Aromatic hydrocarbons
E. Carbon monoxide
29. On the 3rd day of life a newborn, who had
suffered birth asphyxia, developed hemorrhage
from the umbilical wound. Laboratory analysis
reveals hypocoagulation, thrombocytopenia,
and hypothrombinemia. What is the cause of
such clinical developments?
A. Congenital angiopathy
B. Hemorrhagic disease of newborn
C. Disseminated intravascular coagulation
D. Thrombocytopenic purpura
E. Umbilical vessel trauma
30. A 32-year-old woman complains of body
weight loss despite her increased appetite,
nervousness, and tremor of the extremities.
Objectively: the skin is moist; the thyroid gland
is diffusely enlarged, painless, soft, and mobile.
Blood test: increased level of T3, T4, and
thyroid-stimulating hormone (THS). What is the
most likely diagnosis?
A. Diffuse toxic goiter
B. Thyroid carcinoma
C. Autoimmune (Hashimoto’s) thyroiditis
D. Thyroid adenoma
E. Diffuse nontoxic goiter
31. A 57-year-old patient complains of
sensation of dryness and pain during
swallowing, frequent unbearable cough, the
voice is hoarse. Disease onset was abrupt. On
laryngoscopy: laryngeal mucosa is hyperemic,
vocal folds are swollen, laryngeal lumen
contains viscous secretion. What diagnosis is it?
A. Acute stenosing laryngotracheitis
B. Acute laryngitis
C. Bronchial asthma
D. Flegmonous laryngitis
E. Laryngeal diphtheria
32. A 24-year-old pregnant woman on her 37th
week of pregnancy has been delivered to a
maternity obstetric service with complaints of
weak fetal movements. Fetal heartbeats are
95/min. On vaginal examination the uterine
cervix is tilted backwards, 2 cm long, external
orifice allows inserting a fingertip. Biophysical
profile of the fetus equals 4 points. What tactics
of pregnancy management should be chosen?
A. . Urgent preparation of the uterine cervix for
delivery
B. Treatment of placental dysfunction and
repeated analysis of the fetal biophysical profile
on the next day
C. Doppler measurement of blood velocity in
the umbilical artery
D Urgent delivery via a cesarean section
E. Treatment of fetal distress, if ineffective, then
elective cesarean section on the next day
33. During regular preventive gynecological
examination a 30-year-old woman was detected
to have dark blue punctulated ”perforations” on
the vaginal portion of the uterine cervix. The
doctor suspects endometriosis of the vaginal
portion of the uterine cervix. What investigation
method would be most informative for
diagnosis confirmation?
A. Colposcopy, target biopsy of the cervix
B. US of small pelvis
C. Hysteroscopy
D. Curettage of the uterine cavity
E. Hormone testing
34. A 26-year-old woman came to a
gynecologist for a regular check-up. She has no
complaints. Per vaginum: the uterus lies in
anteflexion, not enlarged, dense, mobile,
painless. On the left from the uterus in the area
of uterine appendages there is a mobile
painless outgrowth that can be moved
independently from the uterus. On the right the
appendages cannot be detected. What
additional investigation would be informative
for diagnosis clarification?
A. Metrosalpingography
B. US of lesser pelvis
C. Examination for urogenital infection
D. Colposcopy
E. Colonoscopy
35. A 57-year-old patient complains of dyspnea
at rest. The patient presents with orthopnea,
acrocyanosis, bulging cervical veins. On
percussion: dull sound over the lower lung
segments; on auscultation: no respiratory
murmurs. Heart rate is 92/min. Right-sided
cardiac dilatation is observed. The liver is
enlarged by 7 cm. Shins are swollen. Pleural
effusion is suspected. What indicator would
confirm the presence of transudate in this case?
A. Positive Rivalta’s test
B. Presence of atypical cells
C. Total protein content in the pleural fluid
above 30 g/l
D. Specific gravity exceeding 1015
E. Total protein content in the pleural fluid
below 25 g/l
36. A 28-year-old woman complains of girdle
pain in her epigastric and left subcostal areas
with irradiation to the back, nausea, and
vomiting without relief. On examination a
surgeon observes stomach distension and
meteorism. There are positive Mondor’s, Mayo-
Robson’s, and Cullen’s symptoms. What is the
most likely diagnosis?
A Aortic dissecting aneurysm
B. Acute cholecystitis
C. Acute intestinal obstruction
D. Acute pancreatitis
E. Splenic infarction
37. A 36-year-old woman complains of pain in
her lumbar area, which irradiates to her lower
right limb and increases during movements, and
sensation of numbness in her limb. Objectively:
palpation of the shin and thigh muscles is
painful, positive stretch symptom on the right.
MRI scan: herniation of intervertebral disk L5-S1
4 mm in size. What is the most likely diagnosis?
A. Vertebrogenic lumbago
B. Vertebrogenic radicular syndrome of L5-S1
on the right
C. Endarteritis of lower extremities
D. Spinal stroke
E. Acute myelitis
38. During routine medical examination a 35-
year-old woman presents with enlarged cervical
and mediastinal lymph nodes. Her overall
health is satisfactory. ESR is 30 mm/hour.
Cervical node biopsy was performed. In the
specimen there are granulomas composed of
epithelial and giant cells, no caseous necrosis
detected. What is the most likely diagnosis?
A. Infectious mononucleosis
B. Lymphogranulomatosis
C. Sarcoidosis
D. Nonspecific lymphadenitis 42. A 17-year-old girl has made an appointment
E. Lymph node tuberculosis with the doctor. She plans to begin her sex life.
No signs of gynecological pathology were
39. A 39-year-old woman complains of violent
detected. In the family history there was a case
pain in her left lumbar area with irradiation to
of cervical cancer that occurred to the patient’s
the right iliac area. Several years ago she was
grandmother. The patient was consulted about
diagnosed with cholelithiasis and urolithiasis.
the maintenance of her reproductive health.
The patient’s condition is moderately severe,
What recommendation will be the most helpful
the skin is dry. Ortner’s symptom is negative;
for prevention of invasive cervical cancer?
costovertebral angle tenderness is observed on
A. Vaccination against human papillomavirus
the right. The most reasonable treatment
(HPV)
tactics would be
B. Vitamins, calcium, omega-3 C.
A Urgent hemodialysis
Immunomodulators
B. Spasmolytics and analgesics
D. Antiviral and antibacterial drugs
C. Peritoneal dialysis
E. Timely treatment of sexually transmitted
D. Laparoscopic cholecystectomy
diseases
E. Antibiotics
43. A 6-month-old infant is not vaccinated. The
40. An 18-year-old patient complains of skin
physician recommends a DPT (diphtheria,
rash. The patient has been suffering from this
pertussis, tetanus) vaccination but the mother
condition for 5 years. The first instance of this
is absolutely against this procedure. Choose the
disease occurred after a car accident.
most substantial argument in favor of
Objectively: the patient presents with papular
vaccination:
rash covered in silvery scales, ”thimble”
A. Risk of lethal consequences
symptom (small pits on the nails), affected
B. Epidemic risk for the others
joints. What is the most likely diagnosis?
C. Personal professional experience
A. Onychomycosis
D. High quality of vaccines
B.. Panaritium
C. Psoriasis 44. In autumn a 45-year-old man was
D. Lupus erythematosus recommended an elective surgery for coronary
E. Rheumatism artery bypass grafting due to multivessel
coronary artery disease. The patient has never
41. A 20-year-old student was brought to the
received anti-influenza vaccination. Why would
first-aid center. He has a closed fracture of the
the family doctor offer a scheduled yearly
left forearm and a contused lacerated wound
vaccination against influenza to this patient?
on his left shin. After the patient received initial
A. Prevention of seasonal influenza
wound management, he presented the
B. Secondary prevention of exacerbations of
documents confirming that he has received all
chronic ischemic heart disease
the necessary preventive vaccination as
C. Immunoprophylaxis of postoperative
scheduled. What should the doctor do to
pulmonary complications
prevent tetanus in this patient?
D. Primary prevention of influenza during
A. Antibiotic therapy
postoperative care
B. Administration of tetanus immunoglobulin
E. Decrease the risk of mortality due to
C. Administration of anti-tetanus serum
pneumonia and heart failure
D. Dynamic case monitoring
E. Administration of tetanus toxoid
45. A 28-year-old woman has made an
appointment with the family doctor to receive
vaccination against influenza. However, having
collected the patient’s medical history, the
doctor claimed this procedure to be absolutely
contraindicated for this woman. What
anamnestic data is the absolute
contraindication to vaccination?
A Blood hemoglobin - 109 g/L
B. Pregnancy at 30 weeks
C. Egg white intolerance
D. Body temperature - 37.2oC
E. Psoriasis in the remission phase
46. A 26-year-old man complains of chills,
rhinitis, dry cough, and fever up to 38oC.
Examination shows him to be in a moderately
severe condition; there are small pale pink non-
merging spots on the skin of his back, abdomen,
and extremities. Palpation reveals enlarged
occipital and axillary lymph nodes. No
information about vaccination history could be
obtained. What is the likely etiology of this
disease?
A Epstein-Barr virus
B. Rubella virus
C. Streptococcus
D. Mumps virus
E. Neisseria meningitis
47. During administration of planned DPT
vaccination the child suddenly developed acute
anxiety, signs of pain response, dyspnea,
grunting respirations, cutis marmorata, cold
sweat. Objectively the child’s consciousness is
disturbed, heart rate is 150/min., blood
pressure is 60/40 mm Hg, heart sounds are
muffled. The child was diagnosed with
anaphylactic shock. What drug should be
administered first?
A. Epinephrine
B. Lasix (Furosemide)
C. Suprastin (Chloropyramine)
D. Euphylline (Aminophylline)
E. Analgin (Metamizole)
48. Among first-year schoolchildren there was a
case of measles registered. A 7-year-old boy
from the same group was not vaccinated
against measles due to refusal of his parents.
His clinical history has no cases of measles in
the past and is not contraindicatory to
immunobiological agents. Choose the most
rational tactics of measles prevention in this
schoolboy:
A Immunomodulators
B. Isolation for 20 days
C. Antiviral agents
D. Antibiotics
E. Measles-Mumps-Rubella vaccine
49. A 40-year-old man developed fever up to
37.5oC and macular rash 10 days after the first
dose of MMR (Measles-Mumps-Rubella)
vaccine was administered. The vaccination was
considered necessary as there was a measles
outbreak in the city and the patient had not
received MMR vaccination in his childhood. Is
revaccination with MMR vaccine possible?
A Simultaneously with antihistamines
B. Forbidden
C. After a course of glucocorticoids treatment
D. Possible
E. Under supervision in the infectious diseases
inpatient ward
50. A 26-year-old man is undergoing a regular
check-up. One year ago he had a case of
tonsillar diphtheria complicated with
myocarditis. Presently his condition is
satisfactory, no signs of cardiovascular failure;
ECG shows firstdegree atrioventricular block.
What vaccine was administered to this man
according to his age?
A Acellular DPT vaccine
B. Adsorbed diphtheria tetanus vaccine
(modified)
C. Tetanus anatoxin
D. Oral polio vaccine (OPV)
E. BCG vaccine
51. During analysis of morbidity in the city, it
was determined that age structure of
population is different in each district. What
statistical method allows to exclude this factor,
so that it would not skew the morbidity data?
A. Standardization
B. Wilcoxon signed-rank test
C. Correlation-regression analysis
D. Dynamic time series analysis
E. Analysis of average values
52. Clinical statistical investigation was
performed to determine effectiveness of a new
pharmacological preparation for patients with
ischemic heart disease. What parametric test
(coefficient) can be used to estimate the
reliability of the results?
A. Wilcoxon signed-rank test
B. Sign test
C. Matching factor
D. Student’s t-distribution
E. Kolmogorov-Smirnov test
53. In a rural health care area there is an
increasing cervical cancer morbidity observed.
The decision is made to conduct a medical
examination of the women living in this locality.
What type of medical examination is it?
A. Regular
B. Preliminary
C. Target
D. Complex
E. Screening
54. In the process of hiring, a prospective
employee has undergone preventive medical
examination and was declared fit to work in this
manufacturing environment. What type of
preventive medical examination was it?
A. Comprehensive
B. Scheduled
C. Periodical
D. Specific
E. Preliminary
55. On laboratory investigation of a pork sample
there is 1 dead trichinella detected in 24
sections. This meat should be:
A. Sent for technical disposal
B. Allowed for sale with no restrictions
C. Processed and sold through public catering
network
D. Processed for boiled sausage production
E. Frozen until the temperature of -10oC is
reached in the deep layers, with subsequent
exposure to cold for 15 days
56. To assess the effectiveness of medical
technologies and determine the power and
direction of their effect on the public health
indicators, the research was conducted to study
the immunization rate of children and measles
incidence rate by district. What method of
statistical analysis should be applied in this
case?
A. Calculation of correlation coefficient
B. Calculation of morbidity index among the
nonvaccinated
C. Calculation of matching factor
D. Calculation of standardized ratio
E. Calculation of statistical significance of the
difference between two estimates
57. Having studied the relationship between the
distance from villages to the local outpatient
clinics and frequency of visits to the clinics
among the rural population of this area, it was
determined that the rank correlation coefficient
in this case equals -0.9. How can this
relationship be characterized?
A. Strong inverse relationship
B. Strong direct relationship
C. Moderate inverse relationship
D. Moderate direct relationship
58. In the inpatient gynecological unit within a
year 6500 women underwent treatment. They
spent there a total of 102000 bed-days. What
indicator of the gynecological unit work can be
calculated based on these data?
A. Bed turnover rate
B. Average bed occupancy rate per year
C. Number of beds by hospital department
D. Average length of inpatient stay
E. Planned bed occupancy rate per year
59. A middle school teacher with 4-yearlong
record of work was issued a medical certificate
for pregnancy and childbirth leave. What
amount of pay will she receive for the duration
of her leave in this case?
A. 50% of average salary
B.100% of average salary
C. 70% of average salary
D. 60% of average salary
E. 80% of average salary
60. In the air of the feed kitchen at poultry
factory, at the area where formula feed is being
mixed, the dust concentration reaches 200
mg/m3. Air microflora is represented
predominantly by Asperqillus and Mucor fungi.
What effect determines pathogenic properties
of the dust?
A. . Mutagenic
B. Teratogenic
C. Allergenic
D. Fibrogenic
E. Toxic
61. A 16-year-old adolescent has been
hospitalized with complaints of unceasing nasal
hemorrhage and unbearable pain in his right
elbow joint. Objectively: the large joint is
enlarged and defigurated, the skin over the
joint is hyperemic. Arthropathy signs can be
observed in the other joints. Ps- 90/min. Blood
test: erythrocytes - 3, 9 · 1012/l, Нb- 130 g/l,
color index - 1,0, leukocytes - 5, 6 · 109/l,
platelets - 220 · 109/l, ESR- 6 mm/hour. Lee-
White coagulation time: start- 24min , end27
min10 sec. What drug would be most efficient
in the treatment of this patient?
A. Cryoprecipitate
B. Calcium chloride
C. Concentrated red cells
D. Aminocapronic acid
E. Vicasol (Menadione)
62. A 67-year-old man complains of dyspnea on
exertion, attacks of retrosternal pain, dizziness.
He has no history of rheumatism. Objectively:
pale skin, acrocyanosis. There are crackles in
the lower lungs. There is systolic thrill in the II
intercostal space on the right, coarse systolic
murmur conducted to the vessels of neck. BP-
130/90 mm Hg, heart rate - 90/min., regular
rhythm. The liver extends 5 cm from under the
edge of costal arch, shin edemas are present.
Specify the suspected valvular defect:
A. Ventricular septal defect
B. Pulmonary artery stenosis
C. Mitral insufficiency
D .Aortic stenosis
E. Tricuspid regurgitation
63. A 24-year-old female teacher complains of
dizziness and heart pain irradiating to the left
nipple. Pain is not associated with physical
activity and cannot be relieved by nitroglycerin,
it abates after taking Valocordin and lasts an
hour or more. The patient has a nearly 2-year
history of this disease. Objectively: Ps- 76/min.,
BP110/70 mm Hg. Heart borders are normal,
heart sounds are clear. The ECG shows
respiratory arrhythmia. Radiograph of the
cervicothoracic spine reveals no pathology.
Lungs, abdomen are unremarkable. What
changes in blood formula can be expected?
A. Increased ESR
B. Leukocytosis
C. Thrombocytopenia
D. Leukemic hiatus
E. No changes
64. A 51-year-old female patient complains of
frequent defecation and liquid blood-streaked
stools with mucus admixtures, diffuse pain in
the inferolateral abdomen, 6 kg weight loss
within the previous month. Objectively: body
temperature - 37, 4oC, malnutrition, skin is pale
and dry. Abdomen is soft, sigmoid is painful and
spasmodic, makes a rumbling sound. Liver is
dense, painful, extends 3 cm below the costal
margin. What is the most likely diagnosis?
A. Helminthic invasion
B. Bacillary dysentery
C. Sprue
D. Intestinal enzymopathy
E. Non-specific ulcerative colitis
65. Chief physician of a polyclinic charged a
district doctor with a task to determine the
pathological prevalence of disease N in his
district. What document allows to estimate the
disease prevalence in the population of a
medical district?
A. .Statistic coupons (-)
B. Statistic coupons (+)
C Prophylactic examinations register
D. Statistic coupons (+) and (-)
E. Vouchers for medical appointments
66. A 32-year-old woman complains of
dizziness, headache, palpitation, tremor. For the
last several months she has been under
outpatient observation for increased arterial
pressure. Since recently such attacks have
become more frequent and severe. Objectively:
the skin is covered with clammy sweat, tremor
of the extremities is present. HR110/min., BP-
220/140 mm Hg. Heart sounds are muffled.
Blood test results: WBCs- 9, 8 · 109/l, ESR- 22
mm/hour. Blood glucose - 9,8 millimole/l. What
disease is the most likely cause of this crisis?
A. Preeclampsia
B. Essential hypertension
C. Pheochromocytoma
D. Primary hyperaldosteronism
E. Diabetic glomerulosclerosis
67. A 14-year-old boy presents with moderate
bronchial asthma in its exacerbation period.
What drug should be prescribed to stop an
acute attack of expiratory dyspnea?
A. Strophanthine (cardiac glycosides)
B. Cromolyn sodium (Cromoglicic acid)
C. Dexamethasone
D. Lasolvan (Ambroxol)
E. Salbutamol
68. A newborn with gestational age of 31 weeks
presents with hypotonia and depressed
consciousness. Hematocrit is 35%,
cerebrospinal fluid analysis shows increased
content of erythrocytes and protein, and low
glucose. These data correspond with the clinical
presentation of:
A. Meningitis
B. Intracranial hemorrhage
C. Sepsis
D. Anemia
E. Prenatal infection
69. A 16-year-old girl has primary amenorrhea,
no pubic hair growth, normally developed
mammary glands; her genotype is 46 ХY; uterus
and vagina are absent. What is your diagnosis?
A. Sheehan syndrome
B. Mayer-Rokitansky-Kuster-Hauser syndrome
C. Cushing syndrome
D. Testicular feminization syndrome
E. Cushing disease
70. 6 hours ago the waters of a 30-year-old
gravida 1, para 0, burst; her preliminary period
was pathologic and lasted for over 2 days; the
term of pregnancy is 39 weeks. No labor activity
is observed. Fetal head presents above the
pelvic inlet. Fetal heartbeats are 142/min., clear
and rhytmic. On vaginal examination the
uterine cervix is not dilated. What further
tactics should the doctor choose?
A. Stimulate the labor with oxytocin
B. Induce cervical dilation with prostaglandins
C .Perform cesarean section
D. Wait for the onset of spontaneous labor
E. Prolong the pregnancy, while providing
antibacterial treatment
71. Mother of an 8-year-old girl complains that
the child is too short and has excessive body
weight. Objectively: obesity with fat deposits on
the torso and face (round moon-like face), acne, E . Veloergometry
striae on the thighs and lower abdomen,
75 A 59-year-old male patient with essential
hirsutism. What hormone can cause such
hypertension of stage II is registered with the
symptoms, when in excess?
dispensary department of a polyclinic. The
A. Glucagon
patient regularly takes ACE inhibitors and
B. Thyroxin
calcium antagonists. How often should a
C. Testosterone therapeutist examine this patient (except for
D. Insulin exacerbation periods)?
E. Cortisol
A. Every 6 months
72. An emergency team deliverd a 83year-old B. Every 3 months
patient complaining of inability of her right leg C. Every 4 months
to support the body after falling on her right D. Once a year
side. Objectively: the patient lies on a gurney,
E. Every 9 months
her right leg is rotated outwards, the outside
edge of foot touches the bed. There is positive
straight leg raising sign. What is your provisional
diagnosis? 76. A 47-year-old woman came to the
admission room with complaints of general
A. Femoral neck fracture weakness, dizziness, vomiting with blood clots.
B. Femoral diaphysis fracture Condition onset was 3 hours ago. The patient
C. Hip dislocation has no preceding illnesses. Blood pressure is
D. Hip joint contusion 90/60 mm Hg, pulse is 106/min., of poor
E. Cotyloid cavity fracture volume. The abdomen is soft, with mild
tenderness in the epigastrium. Blood test:
73. A newborn has Apgar score of 9. When
erythrocytes - 2.1·1012/L, Нb- 70 g/L,
should the infant be put to the breast?
hematocrit - 28%. What tactics should the
A. After 2 hours
doctor on duty choose?
B. After 12 hours
A. Refer the patient to the family doctor
C. In the delivery room
B. Consult the surgeon
D. On the 2nd day
C. Give spasmolytics
E. On the 3rd day
D. Perform gastric lavage
74. A hospital admitted an 11-yearold boy E. Make an appointment for colonoscopy
diagnosed with medium-severe asthma,
77. A 45-year-old woman complains of
exacerbation period. In order to arrest the
paroxysmal intolerable facial pain on the left
attacks the boy was administered
with attacks that last for 1-2 minutes. Attacks
broncholytic nebulizer therapy. During the
day the child’s condition stabilized. What is are provoked by chewing. The disease onset
the most appropriate method for further was two month ago after overexposure to cold.
monitoring of respiratory function in this Objectively: pain at the exit points of the
patient? trigeminal nerve on the left. Touching near the
wing of nose on the left induces new pain
A. Peak flowmetry attack with tonic spasm of the facial muscles.
B. Spirometry What is the most likely diagnosis among those
C. Pneumotachometry listed?
D. Bronchodilatation tests A. Maxillary sinusitis
B.Glossopharyngeal neuralgia
C. Temporomandibular joint arthritis
D. Facial migraine
E. Trigeminal neuralgia
78. A 10-year-old boy with symptoms of
arthritis and myocarditis was delivered into a
hospital. Based on clinical examination the
preliminary diagnosis of juvenile rheumatoid
arthritis was made. What symptom is the most
contributive for the diagnostics of this disease?
A. Reduced mobility of the joints in the morning
B. Regional hyperemia of the joints
C. Affection of the large joints
D. Enlarged heart
E. Increased heart rate
79. A 25-year-old patient was delivered to an
infectious diseases unit on the 3rd day of illness
with complaints of headache, pain in lumbar
spine and gastrocnemius muscles, high fever,
chill. Objectively: condition of moderate
severity. Scleras are icteric. Pharynx is
hyperemic. Tongue is dry with dry brown
coating. Abdomen is distended. Liver is
enlarged by 2 cm. Spleen is not enlarged.
Palpation of muscles, especially gastrocnemius
muscles, is painful. Urine is dark in colour. Stool
is normal in colour. The most likely diagnosis is:
A. Malaria
B. Viral hepatitis type A
C. Leptospirosis
D. Infectious mononucleosis
E. Yersiniosis
80. A 28-year-old woman complains of skin
hemorrhages after minor traumas and
spontaneous appearance of hemorrhages on
the front of her torso and extremities. On
examination: the skin is variegated (old and
new hemorrhages), bleeding gums. Blood
platelets - 20 · 109/L; in the bone marrow there
is increased number of megakaryocytes and no
platelet production. Treatment with steroid
hormones was effective. What is the likely
diagnosis?
A. . Rendu-Osler-Weber disease (Hereditary
hemorrhagic telangiectasia)
B. Hemophilia
C. Idiopathic thrombocytopenic purpura
D. Disseminated intravascular coagulation
E. Acute vascular purpura
81. A 7-year-old boy has been an inpatient for
1.5 months. He had been delivered to the
hospital with complaints of edemas all over his
body, low urine output, and headache. Clinical
urinalysis: proteins - 7.1 g/L, leukocytes - 1-2 in
the vision field, erythrocytes - 3-4 in the vision
field. During the course of treatment the
edemas gradually dissipated, headache abated,
diuresis normalized. Daily urine proteins - 3 g/L.
Biochemical blood test: total protein - 43.2 g/L,
urea - 5.2 mmol/L, cholesterol - 9.2 mmol/L.
What glomerulonephritis syndrome is the most
likely to be present in the patient?
A. Nephritic
B. Nephrotic
C. Isolated urinary
D. Hematuric
E. Mixed
82. 2 weeks after labour a parturient woman
developed breast pain being observed for 3 days.
Examination revealed body temperature at the
rate of 39oC, chills, weakness, hyperaemia,
enlargement, pain and deformity of the
mammary gland. On palpation the infiltrate was
found to have an area of softening and
fluctuation. What is the most likely diagnosis?
A. Infiltrative-purulent mastitis
B. Phlegmonous mastitis
C. Lactostasis
D. Serous mastitis
E. Mastopathy
83. A 10-year-old girl complains of stomachache
that appears and intensifies after she eats
rough or spicy food, sour eructation, heartburn,
frequent constipations, headaches, irritability.
She has been presenting with these signs for 12
months. Her meals are irregular and consist of
dry food. Objectively her diet is suffi- cient in
calories. The tongue is moist with white coating
near the root. The abdomen is soft and painful
in the epigastrium. What method would be
optimal for diagnosis-making in this case?
A. Biochemical blood test
B. Intragastric pH-metry
C. Fractional gastric analysis (Fractional test
meals)
D. Phase-contrast X-ray imaging
E. Esophagogastroduodenoscopy
84. A 64-year-old patient complains of severe
pain in the right side of chest, dyspnea, dry
cough which appeared suddenly on exertion.
Objectively: the right side of the chest lags
behind in the act of breathing. Percussion
reveals tympanic sound. Auscultation reveals
pronouncedly diminished breath sounds on the
right. Ps100/min, weak, arrhythmic. AP- 100/50
mm Hg. Cardiac sounds are decreased. What
disease can be suspected in this patient?
A. Right-sided pneumothorax
B. Right-sided hydrothorax
C. Right-sided dry pleurisy
D. Right-sided pleuropneumonia
E. PATE
85. A 23-year-old primigravida at 39 weeks
gestation has been admitted to the maternity
ward with irregular contractions. The intensity
of uterine contractions is not changing, the
intervals between them stay long. Bimanual
examination reveals that the cervix is centered,
soft, up to 1,5 cm long. There is no cervical
dilatation. What diagnosis should be made?
A. Pregnancy I, 39 weeks, labor I, 1 period, the
latent phase
B. Pregnancy I, 39 weeks, preliminary period
C.Pregnancy I, 39 weeks, labor I, period 1, the
active phase
D.Pregnancy I, 39 weeks, birth I, 1 period, the
acceleration phase
E. Pregnancy I, 39 weeks, pathological
preliminary period
86. The institutions that take part in medical
examinations include prevention and treatment
facilities, medical board of Ministry of Defense,
medical board of Ministry of Home Affairs,
medico-social expert commissions, forensic
medical boards etc. What institutions are
responsible for temporary disability
examination?
A. Medico-social expert commissions
B. Sanitary-and-prophylactic institutions
C. Prevention and treatment facilities
D. Medical boards of Ministry of Defense
E. Medical boards of Ministry of Home Affairs
87. After a lengthy march an army regiment has
set camp for 3 days near a settlement. Sanitary-
hygienic investigation detected several water
sources. Choose the source that would satisfy
the demands for potable water the most under
the given field conditions:
A. Melt water B. Brook
C. River
D. Rain water
E. Artesian well
88. Examination of an electric welder with 15
years of service record revealed dry rales in the
lower lung fields. Radiograph shows diffuse
nodules sized 3-4 mm in the middle and lower
lung fields. What disease can be suspected?
A. Heavy-metal coniosis
B. Silicosis
C. Silicatosis
D. Carbon pneumo coniosis
E. Bronchitis
89. A 30-year-old parturient woman was
delivered to a maternity hospital with full-term
pregnancy. She complains of severe lancinating
pain in the uterus that started 1 hour ago,
nausea, vomiting, cold sweat. Anamnesis states
cesarean section 2 years ago. Uterine
contractions stopped. Skin and mucous
membranes are pale. Heart rate is 100/min., BP
is 90/60 mm Hg. Uterus has no clear margins, is
sharply painful. No heartbeat can be
auscultated in the fetus. Moderate bloody
discharge from the uterus can be observed.
Uterus cervix is 4 cm open. Presenting part is
not visible. The most likely diagnosis is
A. Uterine rupture
B. Initial uterine rupture
C. Threatened uterine rupture
D. Premature detachment of normally
positioned placenta
E. Compression of inferior pudendal vein
90. A parturient woman is 23 years old. Internal
obstetric examination shows the uterine cervix
to be completely open. Fetal bladder is absent.
Cephalic presentation is observed in the plane
of the small pelvic outlet. Sagittal suture is at
the longitudinal section of the small pelvic
outlet, small fontanel is situated closer to the
uterus. What cephalic position will the newborn
have during birth in this case?
A. Longitudinal lie
B. Minor oblique lie
C. Transverse lie
D. Medium oblique lie
E. Major oblique lie
91. Against the background of angina a patient
has developed pain in tubular bones.
Examination revealed generalized enlargement
of lymph nodes, hepatolienal syndrome,
sternalgia. In blood: RBCs - 3, 6 · 1012/l, Hb87
g/l, thrombocytes - 45 · 109/l, WBCs - 13 · 109/l,
blasts - 87%, stab neutrophiles - 1%, segmented
neutrophiles - 7%, lymphocytes - 5%, ESR - 55
mm/h. What is the most likely diagnosis?
A. Chronic myeloid leukemia
B. Erythremia
C. Chronic lymphocytic leukemia
D. Acute leukemia
E. Multiple myeloma
92. For a long time to eradicate weeds on
agricultural lands herbicides retaining in
environment have been used. Point out the
most probable way of herbicides reaching
human organism from soil:
A. Soil-animals-human
B. Soil-microorganisms-human
C. Soil-plants-human
D. Soil-protozoa-human
E. Soil-insects-human
93. A 52-year-old patient complains of pain in
the right part of her chest, dyspnea, cough with
a lot of albuminoid sputum emitting foul smell
of "meat slops". Objectively: the patient’s
condition is grave, cyanosis is observed,
breathing rate is 31/min, percussion sound
above the right lung is shortened, auscultation
revealed various moist rales (crackles). What is
the most probable diagnosis?
A. Chronic pneumonia
B. Lung abscess
C. Pleura empyema
D. Multiple bronchiectasis
E. Lung gangrene
94. A 15-year-old patient suffers from
headache, nasal haemorrhages, sense of lower
extremity coldness. Objectively: muscles of
shoulder girdle are developed, lower
extremities are hypotrophied. Pulsation on the
pedal and femoral arteries is sharply
dampened. BP is 150/90 mm Hg, 90/60 in the
legs. Systolic murmur can be auscultated above
carotid arteries. What is the most probable
diagnosis?
A. Aorta coarctation
B. Aorta aneurism
C. Aortal stenosis
D. Aortal insufficiency
E. Coarctation of pulmonary artery
95. A patient with frostbite of both feet was
delivered to an admission ward. What actions
should be taken
A. To apply a bandage, to introduce vasodilating
medications
B. To administer cardiac medications
C. To put feet into hot water
D. To rub feet with snow
E. To apply an alcohol compress
96. A 26 y.o. male patient with postoperative
hypothyroidism take thyroxine 100 mg 2 times
a day. He has developed tachycardia, sweating,
irritability, sleep disorder. Determine further
treatment tactics.
A. To decrease thyroxine dosage
B. To increase thyroxine dosage
C. To administer betablockers
D. To add mercasolil to the treatment
E. To administer sedatives
97. A 20 y.o. patient was admitted to the
hospital with complaints of having skin and
sclera icteritiousness, dark urine, single
vomiting, appetite loss, body temperature rise
up to 380 for 2 days. Three weeks ago he went
in for fishing and shared his dishes with friends.
Objectively: the patient is flabby, t 0- 36, 80,
skin and scleras are icteritious, liver sticks from
under the costal margin by 3 cm, it is sensitive;
spleen isn’t palpable. Urine is dark, stool is
partly acholic. What is the most probable
diagnosis?
A. Infectious mononucleosis
B. Leptospirosis
C. Virus A hepatitis
D. Hemolytic anemia
E. Intestinal yersiniosis
98. A 36-year-old female pesented to a
gynecological hospital with a significant bleeding
from the genital tract and a 1-month delay of
menstruation. Bimanual examination revealed
soft barrel-shaped cervix. Uterus was of normal
size, somewhat softened. Appendages were
unremarkable on both sides. Speculum
examination revealed that the cervix was
cyanotic, enlarged, with the the external orifice
disclosed up to 0,5 cm. Urine hCG test was
positive. What is the most likely diagnosis?
A. Uterogestation
B. Cervical pregnancy
C. Abortion in progress
D. Threatened miscarriage
E. Ectopic pregnancy
99. A 68 year old patient has been suffering
from chronic pancreatitis for 35 years. During
the last 5 years he has been observing
abatement of pain syndrome, abdominal
swelling, frequent defecations up to 3-4 times a
day (feces are greyish, glossy, with admixtures
of undigested food), progressing weight loss.
Change of symptom set is caused by joining of:
A. Chronic enterocolitis
B. Endocrine pancreatic insufficiency
C. Syndrome of lactase deficiency
D. Irritable bowels syndrome
E. Exocrine pancreatic insufficiency
100. A patient suffering from acute
posttraumatic pain received an injection of
morphine that brought him a significant relief.
Which of the following mechanisms of action
provided antishock effect of morphine in this
patient?
A. Block of central cholinergic receptors
B. Stimulation of opiate receptors
C. Stimulation of benzodiazepine receptors
D. Inhibition of dopamine mediation
E. Intensification of GABA-ergic reactions
101. During the induction of labor of a 41.5-
week multigravida woman, with misoprostol,
the mother begins to feel increasing pelvic
pressure and low back pain. FHTs are reassuring
and maternal vital signs are p-92, BP 110/68, R-
18; T-37 contractions are every 2 to 3 minutes
and moderate. Her cervix is 2 cm50%, —2
station with blood tinged mucus. What does
this situation represent?
(A) impending rupture of the uterus
(B) normal early labor
(C) tachysystole
(D) misoprostol syndrome
(E) primary arrest of labor
102. A 23-year-old woman with right-sided
lower abdominal pain and chills is seen in the
emergency department. The pain began 3 days
ago and is associated with a vaginal discharge.
Her LMP was 5 days ago. She uses an
intrauterine device for contraception and had
coitus 1 week ago with her new boyfriend.
There is no history of nausea, vomiting, or
diarrhea. Her vital signs are blood pressure,
120/80 mmHg; pulse, 100 bpm; and
temperature, 101.4°F. Abdominal examination
shows bilateral lower quadrant guarding with
rebound tenderness on the right side. Pelvic
examination shows pus at the cervical os and a
tender 6-cmright adnexal mass. Laboratory data
are hematocrit, 38% (normal, 35% to 45%);
WBC count, 25,000/mL (normal, 3–10,000/mL);
and serumpregnancy test, negative.
Transvaginal sonography shows a 6-cmcomplex
right adnexal mass. The uterus and left adnexa
are normal. Which of the following is the most
likely diagnosis?
(A) appendicitis
(B) adnexal torsion
(C) pyosalpinx
(D) hydrosalpinx
(E) endometritis
103. A 36-year-old man has had stable
ulcerative colitis for 5 years. He is being treated
with sulfasalazine 1000 mg three times daily.
On routine follow-up, he is found to have an
ALT of 250 IU/L, an AST of 225 IU/L, an alkaline
phosphatase of 450 IU/L, and a bilirubin of 2
μmol/L. Ultrasound of the abdomen reveals no
bile duct dilatation or gallstones. Endoscopic
retrograde cholangiopancreatography (ERCP)
reveals multifocal strictures and dilatations of
both the intrahepatic and extrahepatic bile
ducts. What is the MOST likely diagnosis?
A. sclerosing cholangitis
B. common bile duct stone
C. primary biliary cirrhosis
D . drug-induced hepatitis
104. A 41-year-old patient, a hunter, complains
of heaviness in the right subcostal area. No
other complaints recorded. Anamnesis states
causeless urticaria and skin itching that
occurred 1 year ago. Objectively: liver margin is
rounded, painless, and can be palpated 3 cm
below the costal arch. No other pathology was
detected during physical examination of the
patient. Body temperature is normal. X-ray
reveals a hemispherical protrusion in the right
cupula of the diaphragm. What disease can be
suspected in the given case?
A. Liver abscess
B. Hydatid disease of liver
C. Hepatocellular carcinoma
D. Metastatic tumor
E. Subdiaphragmatic abscess
105. A 33-year-old woman presents with a
cellulitis of the dorsum of the right hand 24
hours following a cat bite. A Gram stain of
serosanguinous discharge from a puncture site
shows neutrophils and small gram negative
rods. What is the treatment of choice for this
patient?
A. cefazolin
B . norfloxacin C. amoxicillin/clavulanic acid
D. gentamicin
106. In utero heart failure, often with fetal
pleural and pericardial effusions and
generalized ascites (non-immune hydrops
fetalis) may occur in ?
A. ventricular septal defect
B. coarctation of aorta
C. d-Transposition of great arteries
D. Ebstein anomaly
E. single ventricle
107. You are discussing the risk of radiotherapy
with the parents of a child with
medulloblastoma; the mother has a concern
about the late neurological complications post
radiotherapy. The statement that should be
included in the discussion that late neurological
sequelae post radiotherapy is more severe
with?
A. focal radiotherapy rather than craniospinal
irradiation
B. children with an age of less than 3 year
C. concomitant chemo-radiotherapy
D. low grade tumors rather than high grade
tumors
E. infratentorial tumors rather than
supratentorial tumors
108. Which of the following statements are
true?
A. Identification of the causative organism
should be done before starting antibiotics.
B Wounds are best managed by delayed
primary or secondary closure.
C Subcuticular continuous skin closure
decreases the incidence of wound infection.
D Polymeric films can be useful in infected
wounds.
E Administration of antibiotic preparations
locally is more effective than the oral route.
109. Which of the following statements
regarding burn depth are true?
A) The depth of a burn together with
percentage of TBSA and smoke inhalation are
key parameters in the assessment and
management of a burn.
B)Alkalis, including cement, usually result in
superficial burns.
C) Fat burns are deeper than electrical contact
burns.
D )Capillary filling is not present in superficial
burns.
E) Deep dermal burns take a maximum of 2
weeks to heal without surgery.
110. A 47-year-old patient came to see a doctor
on the 7th day of disease. The disease
developed very fast: after the chill body
temperature rose to 40oC and lasted up to 7
hours, then dropped abruptly, which caused
profuse sweat. There were three such attacks
occuringonce in two days. Two days ago the
patient arrived from Africa. Objectively: pale
skin, subicteric sclera, significantly enlarged
liver and spleen. What is the cause of fever
attacks in this disease?
A. Erythrocytic schizogony
B. Tissue schizogony
C. Exotoxin of a causative agent
D. Endotoxin of a causative agent
E. Gametocytes
111. A patient is 30 years old, works as a
carpenter. Six months ago there appeared some
behavioural changes: he got interested in
philosophy, began writing a treatise on the
purpose of his human existence, quitted his job,
stopped caring about his children, went out
carelessly dressed, heard "voices in his
head"that guided his behaviour. The patient
claimed sure that he was an Ambassador of God
on Earth and was constantly feeling His
influence. He is not critical about his disease.
What diagnosis can be assumed?
A. Reactive psychosis
B. Alcocholic psychosis
C. Schizophrenia
D. Somatogenic psychosis
E. Organic psychosis
112. A 27-year-old patient complains of nasal
haemorrhages, multiple bruises on the anterior
surface of the trunk and extremities, sudden
weakness. In blood: Hb- 74 g/l, reticulocytes -
16%, RBCs - 2, 5 · 1012/l, platelets - 30 · 109/l,
ESR- 25 mm/h. What is the most effective
measure for the treatment of
thrombocytopenia?
A. Iron preparations
B. Splenectomy
C. Hemotransfusion
D. Cytostatics
E. Vitamin B12
113. 2 days ago a patient presented with acute
pain in the left half of chest, general weakness,
fever and headache. Objectively: between the 4
and 5 rib on the left the skin is erythematous,
there are multiple groups of vesicles 2-4 mm in
diameter filled with transparent liquid. What
diease are these symptoms typical for?
A. . Streptococcal impetigo
B. Pemphigus
C. Herpes simplex
D. Herpes zoster
E. Herpetiform Duhring’s dermatosis
114. After lifting a load a patient felt undurable
pain in the loin. He was diagnosed with acute
lumbosacral radiculitis. Which of the following
is contraindicated for this patient?
A. Warming procedures
B. Dehydrating drugs
C. Analgetics
D. Vitamins of B group
E. Intravenous injection of aminophylline
115. A 30-year-old woman complains of
irregular copious painful menstruations, pain
irradiates to the rectum. Anamnesis states
10year-long infertility. On bimanual
examination: uterus is of normal size; uterine
appendages on the both sides are corded, with
rectricted mobility, painful; there are dense
nodular painful growths detected in the
posterior fornix. A doctor suspects
endometriosis. What method allows to verify
this diagnosis?
A. Laparoscopy
B. Diagnostic curettage of uterine cavity
C. Paracentesis of posterior fornix
D. Uterine probing
E. Hysteroscopy
116.A 60-year-old man presents with
subcompensated viral liver cirrhosis (HCV Child-
Pugh class B. What tactics should I chosen
regarding the vaccination again influenza in this
case?
A. . Contraindicated due to disease progress
stage, as shown by Child- Pugh class
B. Scheduled yearly vaccination
C. In case of influenza outbreak
D. Combined with antiviral drugs
E. Contraindicated due to elderly age of patient
117.A healthy child 1 year and 5 month of age is
being vaccinated agains the hapatitis B. The child
did not receive the first dose the vaccine
previously, while in the maternity hospital. The
doctor makes an individual vaccination schedule
for this child and planning the administration of
the next dose the vaccine. What is the minimum
interval between doses of vaccine in this case?
A. 2 months B. 3 months C. 6 months D. 12
months E. 1 month
118. A 19-year-old has been bleeding
intermittently for 26 weeks. She presents with a
change to dark bleeding and minimal cramping
for 4 days. Your clinic ultrasound notes an
intrauterine fetal demise. She is distraught. She
would prefer to let “nature take its course.” She
asks if there is any risk to her. What do you
explain as the only significant risk?
(A) a positive human chorionic gonadotropin
(hCG) titer (B) systemic allergies (C) bone
marrow depression (D) coagulopathy (E)
toxemia
119. A 15-year-old patient complains of
excessive body weight, headache, irritability,
rapid fatigability. Significant increase of body
weight occurred at the age of 14. Objectively:
weight is 90 kg; height is 160 sm, proportional
body built. Fatty tissue is distributed evenly.
There are thin pink striae (stretch marks) on the
thighs, abdomen and mammary glands. BP -
145/90 mm Hg. Provisional diagnosis is:
A. Pubertate dyspituitarism
B. Alimentary constitutive obesity
C. Somatoform autonomic dysfunction
D. Itsenko-Cushing’s disease
E. Cushing’s syndrome
120.A 12-year-old girl after a case of respiratory
infection developed dyspnea at rest, paleness of
skin. Heart rate is 110/min., BP is 90/55 mm Hg.
Heart sounds are muffled. Borders of relative
heart dullness: right - the parasternal line, upper
- the III rib, left - 1,0 cm outwards from the
midclavicular line. Make the provisional
diagnosis:
A. Somatoform autonomic dysfunction
B. Functional cardio C. Infectious myocarditis
D.Hypertrophic cardiomyopathy E. Exudative
pericarditis
121.A child is 9 months old. The patient’s body
temperature is 36,7oC, the skin is pale, humid,
there is pain in leg muscles. There is no
extremities mobility, sensitivity is present. The
child has been diagnosed with poliomyelitis.
The causative agent of this disease relates to
the following family:
A. Paramyxovirus
B. Picornavirus
C. Tohovirus
D. Adenovirus
E . Rotavirus
122. A parturient woman is 27 year old, it was
her second labour, delivery was at term, normal
course. On the 3rd day of postpartum period
body temperature is 36,8oC, Ps - 72/min, AP -
120/80 mm Hg. Mammary glands are
moderately swollen, nipples are clean.
Abdomen is soft and painless. Fundus of uterus
is 3 fingers below the umbilicus. Lochia are
bloody, moderate. What is the most probable
diagnosis?
A. Physiological course of postpartum period
B. Subinvolution of uterus
C. Postpartum metroendometritis
D. Remnants of placental tissue after labour
E . Lactostasis
123 Which of the following is an unusual
feature of the replication cycle in
coronaviruses?
A. They take advantage of recombination with
the long RNA genome
B. The RNAs all terminate in a common 3´ and
produce nested set transcripts.
C.They are not highly mutable.
D.They use capped cellular mRNA's.
124. Describe the coronavirus structure.
A .Club shaped glycoprotein spikes protrude
through a lipid bilayer
B. An icosahedral structure with an envelope
C. An icosahedral large pleomorphic virus
D. Large regimented barrel shaped virus
125. A 21-year-old male, working in a grocery
store in California where the virus has spread,
had high fever, fatigue, and body ache similar to
the symptoms of regular flu/common cold. He
was suspected of COVID-19 by his doctor. He
had mild symptoms and was recommended to
isolate and take care of himself at home. If the
symptoms worsen with difficulty in breathing, a
confirmation test for COVID-19 must be
performed. All of the following statements are
true for the COVID-19 test, EXCEPT?
A. Nasal swab, throat swab, and saliva are taken
as a sample for the detection of the virus
B. The samples taken immediately after the
exposure to the virus may give false-negative
test results
C. A blood test is the primary diagnostic test for
the identification of the virus
D. RT-PCR technique is used as a diagnostic test
for the identification of the virus
126 A 38-year-old African American woman
presents with heavy menses and an enlarged
uterus. After an examination the clinical
diagnosis is leiomyoma of the uterus. Which of
the following best describes this finding?
(A) a soft, interdigitating mass of the uterine
wall
(B) a premalignant papule of the uterine wall
(C) a rapidly dividing necrotic malignancy
(D) a rounded, smooth, firm, well-circumscribed
mass
(E) erythematous, tender, and hereditary
127. A 16-year-old girl is brought to clinic by her
mother with concerns regarding the lack of any
signs of puberty. The appearance of external
genitalia is of a normal prepubertal female.
Laboratory studies show markedly elevated FSH following, the MOST appropriate
and LH levels. Which of the following causes of explanation for the child behavior is
delayed puberty accompanies elevated
circulating gonadotropin levels? A) acute phobic hallucination B) early sign
(A) chronic illness of schizophrenia C)delusional infestation
(B) gonadal dysgenesis D) night terror E)bipolar disorder
(C) hypothalamic tumors
(D) Kallmann syndrome
(E) malnutrition

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

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

129. A 35-year-old multiparous woman presents

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

130 A parents came to your clinic complaining

that their 5-year-old boy had attacks of
frightening with imagination of a snake
crawling over him and he is acting as trying
to remove it. You assessed the child and
find no acute physical illness and he is
cooperative and quite intelligent. Of the
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1. Clinical trials have
proved the ”Lipoflavon”
drug to be effective for
treatment of unstable
angina pectoris in the
control group and
experimental group of
patients. Neither patients
nor researchers knew who
belonged to which group.
Name this type of study:
A. Total-blind study
B. Simple blind study
C. Triple-blind study
D. Double blind study
E. Multicenter study
2. In a rural health care
area there is an increasing
cervical cancer morbidity
observed. The decision is
made to conduct a
medical examination of the
women living in this locality.
What type of medical
examination is it?
A. Target
B. Preliminary
C. Regular
D. Complex
E. Screening
3. A district doctor has
diagnosed one of his
patients with dysentery.
What accounting
document reflects this
type of morbidity?
A. Statistical report
B. Urgent report
C. Report on a major non-
epidemic disease
D. Certificate of temporary
disability
E. Control card of a patient
registered for regular
check-ups
4. During regular
preventive gynecological
examination a 30-year-old
woman was detected to
have dark blue punctulated
”perforations” on the
vaginal portion of the
uterine cervix. The doctor
suspects endometriosis of
the vaginal portion of the
uterine cervix. What
investigation method
would be most informative
for diagnosis confirmation?
A. Colposcopy, target biopsy
of the cervix
B. US of the lesser pelvis
C. Hysteroscopy
D. Curettage of the uterine
cavity
E. Hormone testing
5. A 22-year-old post
parturient woman on the
12th day after the
normal childbirth informs
of elevated body
temperature up to 39oC
for the last 3 days and
pain in her right
mammary gland. The
right mammary gland is
enlarged, hot to touch,
tense, hyperemic, and
painful. Palpation reveals
there a dense infiltration
8x8 cm with a fluctuation
in its center. What is the
most likely diagnosis?
A. Postpartum period, day
12. Right-sided gangrenous
mastitis
B. Postpartum period, day
12. Right-sided serous
mastitis
C. Postpartum period, day
12. Right-sided infiltrative-
purulent mastitis
D. Postpartum period, day
12. Right-sided
phlegmonous mastitis
E. Postpartum period, day
12. Right-sided lactostasis
6. A healthy child 1 year and 5
months of age is being
vaccinated against hepatitis B.
The child did not receive the
first dose of the vaccine
previously, while in the
maternity hospital. The doctor
makes an individual vaccination
schedule for this child and
plans the administration of the
next dose of the vaccine. What
is the minimum interval
between doses of vaccine in
this case?
A. 3 months B. 6 months
C. 2 months D. 1 month
E. 12 months
7. The mother of an epileptic
son complains of her son
periodically presenting with
irritable depression, when he
becomes excited and prone to
physical aggression and
violence. These moods last for
5-10minutes, after which the
patient exhausts himself and
falls asleep. Upon waking he is
depressed, sad, cannot recall
his actions or recalls the monly
partially. What
psychopathologic condition is it
?
A. Ambulatory automatism
B. Dysthymia
C. Epileptic delirium
D. Pathologic affect
E. Dysphoria
8. During examination a 4-
month-old child with
meningococcemia presents
with acrocyanosis, cold
extremities, tachypnea,
and thready pulse, blood
pressure of 30/0 mm Hg,
anuria, and sopor. What
clinical syndrome is it?
A. Neurotoxicosis
B. Toxic shock syndrome
C. Exicosis
D. Encephalic syndrome
E. Acute renal failure
9. At the railroad crossing a
passenger train collided
with a bus. In this collision
26 bus passenges died,
another 18 passengers
received mechanical
injuries of varying severity.
Where will be professional
medical aid provided for
the victims of this
accident? Who will provide
this aid?
A. At the site of the
accident; specialized
second-response
emergency teams
B. At the site of the
accident; first-response
emergency teams
C. In medico-prophylactic
institutions; general
physicians and surgeons
D. In medico-
prophylactic
institutions; specialized
second-response
emergency teams
E. In medical institutions;
all listed types of
healthcare workers
10. A boy had a foreign body
removed from under his nail
plate. 3 days later he
developed a sharp
throbbing pain at the end of
his distal phalanx, which
intensifies when the phalanx
is pressed, hyperemia of the
nail fold, elevated body
temperature up to 38.5o C,
and nail plate discoloration.
Make the diagnosis:
A. Erysipeloid
B. Erysipelas
C. Paronychia
D. Subungual panaritium
E. Abscess
11. A 45-year-old man
diagnosed with acute
pulmonary abscess
suddenly developed sharp
pain in his chest on the
right and dyspnea up to
30/min. Examination
detects facial cyanosis and
shallow rapid respirations.
Auscultation reveals
acutely weakened
respiration throughout the
whole right lung;
percussion reveals a
vesiculotympanitic
(bandbox) resonance at the
lung apex and dullness in
the lower lobe. What
complication developed in
this patient?
A. Pyopneumothorax
B. Pleuropneumonia
C. Pneumothorax
D. Acute mediastinitis
E. Esophageal perforation
12. The body of a 24-year-
old woman with suspected
poisoning has been found
on the street. Forensic
medical examination was
requested by an
investigator during
examination of the site and
the body. According to the
Criminal Procedure Code
currently in force in
Ukraine, forensic medical
examination is required
when it is necessary to
determine the:
A. Mode of death
B. Manner of death
C. Time of death
D. Cause of death
E. Mechanism of death
13. On the 15th day after a
small trauma of the right
foot, the patient developed
indisposition, fatigability,
irritability, headache,
elevated body temperature,
and sensation of
constriction, tension, and
twitching in the muscles of
the right shin. What disease
can be suspected?
A. Tetanus
B. Anaerobic gas gangrene
C. Erysipelas
D. Acute thrombophlebitis
E. Thrombophlebitis of the
popliteal artery
14. A 48-year-old woman
has arrived to the surgical
unit with wounds in her
thigh. On examination the
wound surface has dirty-
gray coating with
unpleasant sweet smell.
Wound content resembles
raspberry jelly. Skin tissues
around the wound are
glossy and turgid. Palpation
reveals moderate
crepitation in the tissues.
What microflora is the
most likely to cause such
inflammation?
A. Streptococci
B. Anaerobic non-clostridial
C. Anaerobic clostridial
D. Staphylococci
E. Blue pus bacillus
15. A 65-year-old woman
on abdominal palpation
presents with a tumor in
the umbilical region and
above it; the tumor is 13x8
cm in size, moderately
painful, non- mobile,
pulsing. On auscultation
systolic murmur can be
observed. What is the most
likely diagnosis?
A. Arteriovenous aneurysm
B. Gastric tumor
C. Abdominal aortic
aneurysm
D. Tricuspid insufficiency
E. Bicuspid insufficiency
16. A 26-year-old man
complains of chills,
rhinitis, dry cough, and
fever up to 38oC.
Examination shows him to
be in a moderately severe
condition; there are small
pale pink non-merging
spots on the skin of his
back, abdomen, and
extremities. Palpation
reveals enlarged occipital
and
axillary lymph nodes. No
information about
vaccination history could
be obtained. What is the
likely etiology of this
disease?
A. Mumps virus
B. Epstein-Barr virus
C. Streptococcus
D. Rubella virus
E. Neisseria meningitis
17. The dermatologist has
an appointment with a
30-year-old man that
complains of severely
itching rashes that
especially disturb him at
night. The rashes
developed 2 weeks ago,
after he had returned from
a travel. Objectively on the
lateral surfaces of his
fingers, hands, wrists,
elbows, lower abdomen,
genitals, and thighs there
are paired papulovesicles,
single pustules, and
scratch marks. What
disease can be suspected?
A. Shingles
B. Pyoderma
C. Dermatitis
D. Eczema
E. Scabies
18. A 48-year-old woman
has been hospitalized due
to development of
tachysystolic atrial
fibrillation. She has lost 5
kg of body weight within 2
months. On palpation
there is a node in the left
lobe of the thyroid gland.
What pathology resulted
in the development of this
condition?
A. Toxic nodular goiter
B. Aterosclerotic
cardiosclerosis
C. Chronic thyroiditis
D. Nontoxic nodular goiter
E. Autoimmune thyroiditis
19. A 72-year-old man
diagnosed with ischemic
heart disease presents with
diffuse cardiosclerosis,
permanent tachysystolic
atrial fibrillation, heart
failure IIа, FC III. Objective
examination of vital signs:
blood pressure is 135/80
mm Hg, heart rate is
160/min., pulse is 125/min.
Left ventricular ejection
fraction is 32%. What drug
is indicated in this case and
should be presribed to the
patient?
A. Procainamide
(Novocainamide)
B. Digoxin
C. Isadrine (Isoprenaline)
D. Verapamil
E. Ivabradine
20. A 39-year-old man
suffers from chronic
rheumatic heart disease.
He complains of dyspnea
during physical exertion,
cough with expectoration,
and palpitations.
Ausculation detects
intensified I heart sound
and diastolic murmur; the
sound of opening mitral
valve can be auscultated
at the cardiac apex. The
II heart sound is
accentuated over the
pulmonary artery. The
patient is cyanotic. X-ray
shows dilated pulmonary
root and enlargement of
the right ventricle and left
atrium. What is the most
likely diagnosis?
A. Pulmonary artery stenosis
B. Aortic stenosis
C. Mitral stenosis
D. Coarctation of the aorta
E. Patent ductus arteriosus
21. A 35-year-old patient
developed an epileptic
attack with tonoclonic
spasms that lasted for 3
minutes. After the attack
the patient fell asleep but
in 5 minutes the second
attack occurred. The first
step of emergency aid
would be to:
A. Prescribe antiepileptic
drugs
B. Take blood from the vein
for analysis
C. Introduce diazepam
intravenously
D. Ensure patency of airways
E. Administer chloral
hydrate via an enema
22. A 45-year-old man, a
farmer, presents with acute
onset of a disease. He
complains of headache,
high temperature, pain in
the gastrocnemius muscles,
icteric face, and dark urine.
Objectively: body
temperature - 38oC, blood
pressure - 100/70 mm Hg,
conjunctival hemorrhages,
hepatosplenomegaly, and
oliguria. What is the most
likely provisional
diagnosis?
A. Viral hepatitis
B. Brucellosis
C. Leptospirosis
D. Pseudotuberculosis
Trichinosis
23. A 20-year-old student
after failing an exam
developed complaints of a
sensation of a round
foreign body in her throat,
difficult swallowing. She
fixates on her condition,
limits her diet, often cries,
seeks attention, exhibits
demonstrative attitude.
She is highly susceptible to
psychotherapeutic
suggestion. What
psychiatric diagnosis can
be made in this case?
A. Hysterical neurosis
B. Hypochondriacal neurosis
C. Depressive neurosis
D. Obsessive neurosis
E. Paranoid personality
disorder
24. A 42-year-old man, a
dispatcher, suffers from
peptic ulcer disease of the
duodenum. The disease is
of moderate severity. He
wants to be assigned a
disability group. Make the
conclusion regarding his
working ability:
A. First group of disability
B. Capable of working, non-
employable
C. Capable of working,
employable
D. Second group of disability
E. Third group of disability
25. A 34-year-old man on the
3rd day of ceftriaxone
treatment for acute otitis (daily
dosage - 2grams) developed
diarrhea occurring 5-6times per
day. Feces are with out mucus
or blood ad mixtures.
Temperature is 36.6oC.
Gregersen reaction(occult
blood in feces)is negative. Stool
culture detected no pathogenic
germs. What is the most likely
cause of diarrhea in this case?
A. Ulcerative colitis
B. Intestinal dysbiosis
C. Bacterial over growth
syndrome
D. Antibiotic-associated
diarrhea
E. Crohn’s disease (regional
enteritis)
26. Caries morbidity rate is 89%
among residents of a
community. It is determined
that fluorine content in water is
0.1mg/L.What preventive
measures should be taken?
A. Introduce more vegetables
to the diet
B. Tooth brushing
C. Fluorine inhalations
D. Seal ant application
E. Water fluorination
27. A patient has gradually lost
consciousness. The skin is pale
and dry. Theres a smell of
ammonia from the mouth.
Respirations are deep and
noisy. Heart sounds are
muffled, pericardial friction rub
is present. Blood pressure is
180/130mm Hg. Blood test:Нb-
80g/L, leukocytes- 12 · 109/L,
bloodglucose-6.4mmol/L, urea-
50mmol/L,creatinine-
1200mcmol/L, blood osmolarity
350mOsmol/L. No urinary
excretion. Make the diagnosis:
A. Acute renal failure
B. Hyper glycemic coma
C. Uremic coma
D. Acute disturbance of
cerebral circulation
E. Hyperosmolarcoma
28. A 20-year-old patient
complains of severe headache,
double vision, weakness, fever,
irritability. Objectively: body
temperature is 38.1oC, the
patient is reluctant to contact,
sensitive to stimuli. There are
ptosis of the left eyelid,
exotropia, anisocoria S>D,
pronounced meningeal
syndrome. On lumbar puncture
the cerebrospinal fluid flowed
out under a pressure of 300mm
Hg, the fluid is clear, slightly
opalescent. 24 hours later the
reappeared fibrin film.Protein-
1.4g/L,lymphocytes-600/3 per
mm3, sugar-0.3mmol/L. What
is the provisional diagnosis?
A. Meningococcal meningitis
B. Tuberculous meningitis
C.Lymphocytic(Armstrong’s)
meningitis
D. Syphilitic meningitis
E. Mumps meningitis
29. A 16-year-old girl has
primary amenorrhea, no
pubic hair growth, normally
developed mammary
glands; her genotype is 46
ХY; uterus and vagina are
absent. What is your
diagnosis?
A. Sheehan syndrome
B. Mayer-Rokitansky-
Kuster-Hauser syndrome
C. Cushing syndrome
D. Testicular feminization
syndrome
E. Cushing disease
30. A 13-year-old girl has
30% of excessive body
mass, she started to gain
weight at the age of 3. She
has a family history of
obesity. Her height and
sexual development are
normal for her age. The
appetite is excessive. She
complains of periodical
headaches. Blood pressure
- 120/80 mm Hg.
Subcutaneous fat is evenly
distributed, she has no
stretch marks. There is
juvenile acne on her face.
What type of obesity is it?
A. Hypothalamic obesity
B. Alimentary constitutive
obesity
C. Adrenal obesity
D. Hypothalamic syndrome
of puberty
E. Hypothyroid obesity
31. A 1-month-old boy is
brought to the physician for a
routine visit. His prenatal and
birth histories are
unremarkable. His vital signs
and pulse oximetry are normal.
Examination shows a harsh,
III/VI holo systolic murmur over
the left lower sternal border.
Palpation Indicates no thrill
over the precordial region.
Brachial and femoral pulses are
2+ and equal. The skin is pink
and well perfused.
Electrocardiogram is normal.
Which of the following is the
most appropriate course of
action?
A. Digoxin and diuretic therapy
B. Echocardiography
C. Oxygen administration
D. Prostaglandin E1 therapy
E. Reassurance, no further
workup
F. Surgical repair
32. A 7-year-old girl is brought
to the physician for a routine
physical examination. She and
her parents have no
complaints. The girl is in the
second grade and has several
friends at school. She can tie
her shoes independently and
ride a 2-wheel bicycle. Weight
is at the 50th percentile and
height is at the 5th percentile.
Examination shows a short,
webbed neck; a broad chest;
and widely spaced nipples.
Karyotype results are
abnormal. Which
cardiovascular anomaly is most
likely to be present in this
patient?
A. Atrial septal defect
B. Bicuspid aortic valve
C. Mitral valve prolapse
D. Patent ductus arteriosus
E. Tetralogy of Fallot
F. Ventricular septal defect
33. A 15-year-old boy collapses
suddenly while playing
basketball with his friends. The
boy played basketball every
weekend without any
symptoms and was in his usual
state of health prior to this
event. He has no known past
medical history and takes no
medications. Family history is
significant for a maternal uncle
who died at age 25 for
unknown reasons.
Cardiopulmonary resuscitation
is unsuccessful and the patient
is pronounced dead. Post-
mortem examination would
most likely show which of the
following?
A. Abnormal brain mass
B. Coronary atherosclerosis
C. Hypertrophic
cardiomyopathy
D. Mutation in the LQT1 gene
E. No underlying disease
F. Pulmonary embolus
G. Ruptured aortic aneurysm
34. A 3-year-old boy is brought
to the office by his parents for
the evaluation of dry eyes and
photophobia. He has some
difficulty in adapting to
darkness. He is a very poor
eater, and his diet consists
mainly of canned foods, and
very rarely, fresh vegetables or
milk. Examination reveals dry,
scaly skin, follicular
hyperkeratosis in the extensor
surfaces of the extremities, and
dry, silver-gray plaques on the
bulbar conjunctiva. What is the
most likely diagnosis of this
patient?
A. Vitamin A deficiency
B. Thiamine deficiency
C. ribo flavinosis
D. Scurvy
E. Hyper vitaminosis A
35. An 8-year-old African
American child is brought to
the office for the evaluation of
a 1-day history of fever and
back pain. He has sickle cell
disease, and has had 5
hospitalizations for similar
painful crises. His laboratory
report shows normocytic
anemia, reticulocytosis and
leukocytosis. What finding is
most likely to be present on
this patient's peripheral smear?
A. Bite cells
B. Helmet cells
C. Howell Joly bodies
D. Heinz bodies
E. Basophilic stippling
36. A 58-year-old woman
comes to the office due to
recent-onset tremor,
palpitations, weight loss, and
fatigue. She has no other
medical conditions and takes
no medications or over-the-
counter supplements. The
patient's mother had
hypothyroidism and
osteoporosis. Blood pressure is
144/80 mm Hg. pulse is
110/min, and respirations are
18/min. On examination, there
is diffuse, nontender
enlargement of the thyroid
gland. Ocular examination
shows bilateral proptosis, lid
lag, and periorbital puffiness.
The patient has diplopia and
ocular discomfort on extremes
of lateral gaze. Laboratory tests
show a suppressed TSH and
elevated thyroid homone
levels. Which of the following
treatment options is most likely
to worsen this patient's eye
disease?
A. Prednisone
B. Propranolol
C. Propylthiouracil
D. Radioactive iodine
E. Thyroidectomy
37. A 25-year-old woman
comes to the physician with a
3-month history of weight loss.
Irritability, Insomnia, and
palpitations. Her past medical
history is Insignificant. She is
not currently taking any
medications. The patient does
not use tobacco, alcohol, or
illicit drugs. Blood pressure is
155/70 mm Hg and pulse is
110/min. Physical examination
shows lid retraction, dry skin,
and fine tremor of the hands.
Which of the following is the
most Iikely cause of this
patient's hypertension?
A. Elevated serum calcium level
B. Increased myocardial
contractility
C. Increased peripheral vascular
resistance
D. Increased synthesis of
catecholamines
E. Nocturnal hypoventilation
38. A 39-year-old woman who
recently underwent
thyroldectomy for Grave's
disease complains of anxiety,
muscle cramps, and poor sleep.
Her medications include daily
multivitamin supplements and
lansoprazole for acid reflux
disease. Her temperature is
36.6 C (98 F). blood pressure is
142/85 mm Hg, and pulse is
82/min. Electrocardiogram
shows normal sinus rhythm
with prolongation of the
corrected QT interval to 510 m
sec (normal <460 m sec). Which
of the following is the most
likely diagnosis?
A. Hyperkalemia
B. Hypocalcemia
C. Hyponatremia
D. Persistent hyperthyroidism
E. Vitamin D toxicity
39. A 30-year-old man comes to
the emergency department
screaming, "Something blew
into my right eye while I was
drilling!" He complains of a
foreign body sensation in the
right eye photophobia, and
excessive lacrimation Gross
examination of the right eye
with a penlight after the
application of a topical
anesthetic is insignificant. What
is the best next step in the
management of this patient?
A. Tonometry
B Fluorescein examination
C. Topical antibiotic
D. Ultrasoragraphy
E. MRI of the orbits
40. A 65-year-old man comes to
the emergency department due
to a sudden loss of vision in his
right eye. He has had diabetes,
and has been treated with
metformin and glyburide for
the past 10 years. visual acuity
is reduced to light perception in
his right eye, and normal in his
left. His vital signs are normal.
Ophthalmoscopy reveals loss of
fundus details, floating debris
and a dark red glow. What is
the most likely diagnosis?
A. Retinal detachment
B. Diabetic retinopathy
C. Vitreous hemorrhage
D. Central retinal vein occlusion
E. Age related macular
degeneration
41. During assessment of work
conditions at the factory
manufacturing mercury
thermometers, the content of
mercury vapors in the air of the
working area is revealed to
exceed the maximum
concentration limit. Specify the
main pathway of human body
exposure to mercury:
A. Damaged skin
B. Intact skin
C. Respiratory organs
D. Gastrointestinal tract
E. Mucous tunics
42. The doctor has an
appointment with a patient,
who 2 days ago developed
severe chest pain on the left,
general weakness, high
temperature, and headache.
Objectively along the 4th and
5th intercostal nerves on the
left the skin is hyperemic and
there are tight clusters of small
vesicles filled with clear serous
content. What is the most likely
diagnosis?
A. Pemphigus
B. Herpes simplex
C. Streptococcal impetigo
D. Herpes zoster
E. Dermatitis herpetiformis
(Duhring’sdisease)
43. A prematurely born girl is
now 8
months old. She has dyspnea,
tachycardia,
hepatosplenomegaly, physical
developmental lag, limb
cyanosis. There is parasternal
cardiac hump, auscultation
revealed systolodiastolic
murmur in the II intercostal
space on the left. BP is 90/0
mm Hg. What disease can be
suspected?
A. Stenosis of pulmonary artery
B. Coarctation of aorta
C. Stenosis of aortal valve
D. Patent ductus arteriosus
E. Nonclosure of
interventricular septum
44. A worker of a glass-blowing
workshop complains of
headache, irritability, visual
impairment - he sees
everything as if through a
”net”. Objectively: hyperemic
sclera, thickened cornea,
decreased opacity of pupils,
visual acuity is 0,8 in the left
eye, 0,7 in the right eye. The
worker uses no means of
personal protection. What is
the most likely diagnosis?
A. Cataract
B. Conjunctivitis
C. Keratitis
D. Blepharospasm
E. Progressive myopia
45. An 9-year-old child was
hospitalized for fever up to
39,8oC, inertness, moderate
headache, vomiting.
Examination revealed
meningeal symptoms. Lumbar
puncture was performed. The
obtained fluid was
characterised by increased
opening pressure, was
transparent, with the cell count
of 450 cells per 1 mcL (mainly
lymphocytes - 90%), glucose
level of 3,6 mmol/l. What agent
could have caused the disease
in the child?
A. Enterovirus
B. Neisseria meningitidis
C. Mycobacterium tuberculosis
D. Staphylococcus aureus
E. Streptococcus pneumoniae
46. A full-term new born (born
with the body weight of 3900 g
at gestational age of 39 weeks)
on the first day of his life
developed respiratory
disturbances: dyspnea,
arrhythmic respiration,
cyanosis attacks. On
examination there is
paradoxical respiration
observed and left side of the
chest lags behind in the act of
breathing. On auscultation the
respiration is weakened in the
lungs on the left. Neurologist
diagnosed the patient with left-
sided ErbDuchenne palsy.
Complete blood count shows
no changes.What is the most
likely diagnosis?
A. Respiratory distress
syndrome
B. Congenital pneumonia
C. Left-sided pneumothorax
D. Left-sided diaphragm paresis
E. Transient tachypnea of the
newborn
47. During last several weeks
an 11-yearold girl has been
complaining of dyspnea and
edema of shins and feet after
physical exercise. After a long
rest or sleep through the night
her edemas diminish
significantly. On clinical
examination there are enlarged
liver and rasping systolic
murmur over the cardiac area.
Blood and urine analyses
arewithout changes. What is
the most likely cause of the
child’s edema?
A. Angioneurotic edema
B. Heart failure
C. Acute pyelonephritis
D. Hepatocirrhosis
E. Nephrotic syndrome
48. A 65-year-old man was
diagnosed with B12-deficient
anemia and the treatment was
prescribed. A week later
control blood test was
performed.What would be the
early indicator of the therapy
effectiveness?
A. Normoblastic hematopoiesis
B. Increased hemoglobin level
C. Megaloblastic hematopoiesis
D. Increased number of
reticulocytes
E. Increased erythrocyte
number
49. A 42-year-old woman
complains of severe pulsing
headache in the frontoparietal
area, vertigo, palpitations. She
has been suffering from
hypertension for 3 years.
Significant increase of BP
occurs 2-3 times per month and
lasts for 3-8 hours. The left
ventricle is enlarged, heart
sounds are clear, heart rate -
105/min., BP- 225/115 mm Hg.
ECG: signs of left ventricular
hypertrophy. What drug would
be the most effective for
termination of cerebral crisis
attack?
A. Hydrochlorothiazide
(Hypothiazide)
B. Labetalol
C. Captopril
D. Losartan
E. Clonidine (Clophelin)
50. A 10-year-old boy with
symptoms of arthritis and
myocarditis was delivered into
a hospital. Based on clinical
examination the preliminary
diagnosis of juvenile
rheumatoid arthritis was made.
What symptom is the most
contributive for the diagnostics
of this disease?
A. Affection of the large joints
B. Regional hyperemia of the
joints
C. Reduced mobility of the
joints in the morning
D. Enlarged heart
E. Increased heart rate
51. A 23-year-old man had
taken 1 g of aspirin to treat
acute respiratory infection.
After that he developed an
asthmatic fit with labored
expiration that was arrested by
introduction of aminophylline.
The patient has no medical
history of allergies. The patient
has undergone two surgeries
for nasal polyposis in the past.
What is the most likely
diagnosis?
A. Exercise-induced asthma
B. Atopic bronchial asthma
C. Infectious allergic bronchial
asthma
D. Aspirin-induced asthma
E. Symptomatic bronchospasm
52. Vaginal examination reveals
the head of the fetus, which
fills the posterior surface of
symphysis pubis and hollow of
the sacrum. The lower edge of
symphysis pubis, ischiadic
spines, and sacrococcygeal joint
can be palpated.Where in the
lesser pelvis is the fetal head
situated?
A. Above pelvic inlet
B. In the wide plane of lesser
pelvis
C. In the narrow plane of lesser
pelvis
D. In the area of brim
E. In the area of pelvic outlet
53. A 3-year-old girl is being
treated at a resuscitation unit
with diagnosis ”acute kidney
failure, oligoanuric stage”. ECG:
high T wave, extended QRS
complex, displacement of S-T
interval downwards below the
isoline. What electrolyte
imbalance is it?
A. Hyperkalemia
B. Hypokalemia
C. Hypocalcemia
D. Hypercalcemia
E. Hyperphosphatemia
54. Examination of a 43-year-
old man objectively revealed
pallor of skin and mucous
membranes, loss of tongue
papillae, transverse striation of
fingernails, cracks in the mouth
corners, tachycardia. Blood test
results:Hb- 90 g/l, anisocytosis,
poikilocytosis. The most likely
causative factor of this
condition is the inadequate
intake of:
A. Magnesium
B. Copper
C. Zinc
D. Iron
E. Selene
55. A multigravida on the 38th
week of her pregnancy
complains of increased BP up to
140/90mmHg, edema of the
shins for 2 weeks. In the last
month she gained 3,5 kg of
weight. Urine analysis: protein -
0,033 g/l. Make the diagnosis:
A. Moderate preeclampsia
B. Mild preeclampsia
C. Pregnancy hypertension
D. Severe preeclampsia
E. Pregnancy edema
56. A 43-year-old man has
undergone a surgery for
osteomyelitis of the left thigh.
On the 6th day the patient’s
condition was complicated with
sepsis. Despite complex
therapy of sepsis on the 9th
day the patient persistently
presents with temperature up
to 40oC, heart rate is 110/min.,
respiration rate is 23/min., BP is
100/60 mm Hg. Blood test:
leukocytes - 16 · 109/l, band
neutrophils - 16%. What phase
of clinical course is it?
A. Rehabilitation
B. Anabolic
C. Catabolic
D. Functional
E. Tension
57. A 35-year-old patient
complains of heartburn,
gasseous and sour eructation,
burning constricting pain
behind the sternum and along
the esophagus, developing
when bowing the torso to the
front. No previous examination;
the patient takes almagel at his
own discretion, after which he
notes improvement of his
general state. Make the
provisional diagnosis:
A. Gastroesophageal reflux
disease
B. Functional dyspepsia
C. Cardiospasm
D. Ulcer disease of the stomach
E. Ulcer disease of the
duodenum
 tongue is thickened. Heart
sounds are muffled. HR-
58. A 15-year-old girl complains
56/min, BP- 140/100 mm Hg.
of dizziness and sensation of
The patient has been suffering
lack of air that she develops in
from amenorrhea for 5 months,
emotionally straining
has constipations. TSH- 28
situations. Relief occurs after
mcIU/l (norm is 0,32-5).
she takes corvalol. Objectively:
Craniogram shows no
hyperhidrosis and marble-like
pathology. What is the etiology
pattern of the skin of her palms
of obesity?
and feet. Clinical and
A. Hypothalamic-pituitary
instrumental examination
B. Hypo-ovarian
revealed no organic alterations
C. Hypothyroid
of the central nervous,
D. Alimentary and constitutive
cardiovascular, and respiratory
E. Hypercorticoid
systems. What provisional
diagnosis can be made?
A. Stenosing laryngotracheitis
60. A multigravida at 39 weeks
B. Obstructive bronchitis
of gestation presenting with
C. Bronchial asthma
regular labour activity for 8
D. Somatoform autonomic
hours has been delivered to a
dysfunction
hospital; the waters broke an
E. Acute epiglottitis
hour ago. She complains of
headache, seeing spots. BP is
180/100 mm Hg. Urine test
59. A 35-year-old woman has
results: protein - 3,3 g/l, hyaline
gained 20 kg weight within a
cylinders. Fetal heart rate is
year with the normal diet. She
140/min, rhythmical. Vaginal
complains of chills, sleepiness,
examination reveals complete
shortness of breath. The
cervical dilatation, the fetal
patient’s mother and sister are
head is on the pelvic floor,
corpulent. Objectively: height -
sagittal suture is in line with
160 cm, weight - 92 kg, BMI-
obstetric conjugate, the
35,9. Obesity is uniform, there
occipital fontanel is under the
are no striae. The face is
amimic. The skin is dry. The
pubis.What is the optimal area, Which of the following
tactics of labour management? additional skin examination
A. Cavity forceps findings would be most
B. Outlet forceps conceming for malignancy?
C. Cesarean section
D. Vacuum extraction of the A. Central keratin plug
fetus B. Golf ball-size subcutanecus
E. Conservative labour mass
management C. Multicolored lesion
D. Perphersi scaling
E. "Stuck-on" appearance
61. A 32-year-old woman
comes to the office due to a
62. A 56-year-old woman
'mole." The lesion is located on
comes to the office with skin
her back, and she believes it
lesions on her right arm that
has been present for years but
she noticed 3 weeks ago. She
does not recall when it first
underwent a right mastectomy
appeared. The patient thinks it
for advanced breast cancer 7
might be enlarging and is
years ago and was treated with
concerned due to a family
radiation and chemotherapy.
history of skin cancer. The
Since her treatment, the
lesion is not painful and does
patient has had swelling of the
not itch or bleed. She has fair
right arm. Her mother was
skin and a history of severe
recently diagnosed with
sunburns in childhood. Medical
shingles. Family history is
history is unremarkable, and
significant for breast cancer in
she does not use tobacco,
her aunt. BRCA1 and BRCA2
alcohol, or ilicit drugs. Vital
testing was negative. Physical
signs are nomal. Skin
examination shows nonpitting
examination shows a few
edems of the right upper
scattered benign-appearing
extremity. There are 3 firm
nevi and a single prominent
purple papules on the inner
lesion at her right scapular
surface of the right arm. Which
of the following is the best next
step in management of this
patient?
A. Antifungal therapy
B. Lesion biopsy
C Low-potency topical steroid
cream
D. Oral valacyclovir
E. Reassurance and observation
63. A 65-year-old man comes to
the office 4 years after a burn
injury to his left leg that
required extensive local care
and skin grafting, resulting in
significant residual scar tissue.
During treatment of the burn,
the patient also developed a
chronic draining wound that
never completely closed. For
the last 6 weeks, he has had an
enlarging nodule at the lesion
site associated with persistent
pain and increased drainage.
Treatment with topical therapy
has not helped. On biopsy of
the nodule, which of the
following is most likely to be
Identified?
A. Basal cell carcinoma
B. Cutaneous T-cell lymphoma
C. Kaposi sarcoma
D. Melanoma
E. Squamous cell carcinoma
64. A 6-month-old boy is
brought to the office for
evaluation of a progressive
facial rash that started 3 weeks
ago near his eyebrows and
spread to areas of the face and
scalp. The rash does not appear
to be painful or pruritic. The
mother recently started using a
mild. unscented shampoo that
slightly Improved the scalp
rash. In addition,
erythematous. Scaly plaques
are on the eyebrows, nasolebial
folds, and behind the ears.
Which of the following is the
most likely diagnosis?
A. Atopic dermatitis
B. Contact dermatitis
C. Psoriasis
D. Seborrheic dermatitis
E Tinea capitis
65. A 6-day-old infant is
brought to the emergency
department by his mother for
lethargy and poor feeding. The
mother's medical history is
unremarkable. The pregnancy
and delivery were uneventful,
but she did not have adequate
prenatal checkups and care.
Physical examination of the
infant shows hypotonia, poor
reflexes. and bulging
fontanelles. Temperature is
39.4° C (103° F). Initial
laboratory studies show a white
blood cell count of 16.000/ul
with 20% bands. What is the
most likely cause of this infant's
condition?
A. Group B Streptococcus
B. Haemophilus influenzae
C. Herpes simplex virus
D. Listeria monocytogenes
E. Neisseria meningitidis
F. Toxoplasma gondi
66. A 25 year old women,
gravida 1 para 0, at 10 weeks
gestation comes to the office
due to a malodorous vaginal
discharge. He is sexually active,
has no chronic medical
conditions, and has no
medication allergies. Vital signs
are normal. BMI is 26 kg/m2.
Fetal heart tones are 160/min
speculum examinations reveals
a thin, grey discharge that cotes
the vaginal walls, but no
erethima or edema is present
on the vaginal walls or the
vulva. There is no cervical or
adnexal tenderness. A saline
wet mount examination reveals
numerous epithelial cells
coated with bacteria. No white
blood cells or motile organisms
are seen. Which of the
following is the best
management option for this
patient?
A. Boric acid vaginal
suppository
B. Delay treatment until 2nd
trimester
C. Oral azithromycin
D. Oral Metronidazole
E. Povidone-iodine vaginal
douche
F. Tropical fluconazole
67. A 25-year-cld woman
presents to your office
complaining of a seven-week
history of amenorrhea. She also
states that she has had nausea
and vomiting for five weeks,
She is sexually active. Her
medical and obstetrical
histories are unremarkable
Serum hCG level is elevated.
Which of the following is the
most important direct role of
hCG in pregnancy?
A. Inhbition of uterine
contractions
B. Induction of prolactin
production by the pituitary
C. Promotion and maintenance
of implantation
D. Maintenance of the corpus
luteum
E. Induction of early embryonic
division and differentiation
68. A 53 year old woman comes
to the office with strange, itchy
rash on her left breast, which
has been present for last
month. The patient applied
over the counter corticosteroid
ointment on to this rash with
no relief of symptoms. She
takes no medication. The
patients last menstrual periods
was 2years ago. She has a
history of hypertension that
improved with weight loss and
exercise. Physical examination
shows an eczematous plaque
on the left nipple and areola
which of the following
condition is most likely
associated with the patients
finding?
A. Adenocarcinoma
B. Fibroadenoma
C. lymphoma
D. papilloma
E. squamous cell carcinoma
69. An 18 year old women
comes to the office due to
lower abdominal pain that
radiates to her lower back and
thighs during menses. The
patient had no pain while on
oral contraceptives but stopped
taking them 5 months ago due
to unscheduled breakthrough
bleeding. Menstrual periods
now occur every 30 days with 5
days of bleeding the pain and
bleeding are worse on the 2nd
day, requiring the patient to
change her pad every 4 hours.
She also has nausea and fatigue
during the first 2 days of
menses. The patient is sexually
active with a male partner and
uses condoms in constantly.
She has no intermenstrual
bleeding or pain with
intercourse. Vital signs are
normal. BMI is 19.5 kg/m2.
Pelvic examination reveals a
small, mobile uterus and no
palpable adnexal masses.
Which of the following is the
most likely diagnosis in this
patient?
A. Adenomyosis
B. Endometriosis
C. Intermittent ovarien torsion
D. Pelvic congestion syndrome
E. Primary dysmenorrhea
F. Uterine leiomyoma
70. A 38 year old women,
gravida 3 para 3, Comes to the
office for evaluation of
abnormal uterine bleeding. The
patient had regular monthly
menses until 6 months ago,
when she began to have inter
mensural spotting and has now
been amenorrheic for 3
months. She has had increased
abdominal bloating and
cramping during the last few
months but no heart flushes or
weight changes. The patient
has no chronic medical
conditions and underwent a
bilateral tubal ligation after her
last delivery 2 years ago. She
takes no daily medications and
does not use tobacco, alcohol
or illicit drugs. Blood pressure is
124/70 mm hg and pulse is
88/min. BMI is 29 kg/m2. There
is coarse hair on the upper lip
and bitemporal hair thinning.
Examination reveals a large
pelvic mass extending
throughout the left lower
quadrant, but no tenderness or
ascites. The cervix appears
multiparous with no active
bleeding. Urine pregnancy test
is negative. Which of the
following the most likely
diagnosis in this patient?
A. Choriocarcinoma
B. Ovarian thecoma
C. Polycystic ovary syndrome
D. Sertoli leidig cell tumor
E. Struma ovarii teratoma
F, Uterine Leiomyoma
71. A 26-year-old woman came
to a gynaecologist for are gular
check-up. She has no
complaints. Pervaginum: the
uterus lies in ante flexion, not
enlarged, dense, mobile,
painless. On the left from the
uterus in the area of uterine
appendages there is a mobile
painless out growth that can be
moved independently from the
uterus. On the right the
appendages cannot be
detected. What additional
investigation would be
informative for diagnosis
clarification?
A. Ultrasound of the lesser
pelvis B. Metro
salpingography C.
Examination for urogenital
infection
D. Colposcopy
E. Colonoscopy
72. When her car collided with
a tree, a 37- year-old woman
felts harp pain in her left hip
joint. She was unable to get out
of the car. Her position is
forced, the hip is pressed to the
abdomen, fixed, and rotated
inwards; the limb is flexed in
the knee, any attempt to
change the position results in
sharp pain. Make the diagnosis:
A. Arthritis of the left hip joint
B. Contusion of the left hip joint
C. Hemarthrosis of the left hip
joint D. Closed dislocation of
the left hip E. Closed cervical
fracture of the left hip
73. A 7-year-old child complains
of cramping pain occuring after
mental exertion, cold drinks
and eating ice-cream.
Instrumental examination
allowed to diagnose biliary
dyskinesia of hypertensive
type. What group of drugs
should be prescribed for
treatment?
A. Sedatives and cholekinetics
B. Choleretics and cholekinetics
C. Antispasmodics and
choleretics
D. Antioxydants
E. Antibiotics
74. 40-50 minutes after the
completion of repair works
conducted in a closed garage,
with car engine running, the
repair workers developed
severe head ache in the
temporal area, nausea, tinnitus,
vertigo, etc. These symptoms
are characteristic of acute
poisoning with:
A. Aldehydes
B. Carbon monoxide
C. Organochlorides
D. Hydrogen sulfide
E. Fluoride
75. A 37-year-old woman
complains of headaches,
nausea, vomiting, spasms. The
onset of the disease occurred
the day before due to her
overexposure to cold.
Objectively: fever up to 40oC;
somnolence; rigid neck;
Kernig’s symptom is positive on
the both sides; general
hyperesthesia. Blood test:
leucocytosis, increased ESR.
Cerebrospinal fluid is turbid,
yellow-tinted. What changes of
the cerebrospinal fluid are
most likely?
A. Neutrophilic pleocytosis
B. Lymphocytic pleocytosis
C. Blood in the cerebrospinal
fluid
D. Xanthochromia in the
cerebrospinal fluid
E. Albuminocytological
dissociation
76. A 28-year-old woman
complains of girdle pain in her
epigastric and left subcostal
areas with irradiation to the
back, nausea, and vomiting
without relief. On examination
a surgeon observes stomach
distension and meteorism.
There are positive Mondor’s
Mayo-Robson’s, and Cullen’s
symptoms. What is the most
likely diagnosis?
A. Aortic dissecting aneurysm
B. Acute cholecystitis
C. Acute intestinal obstruction
D. Acute pancreatitis
E. Splenic infarction
77. A resuscitation unit
received a 46-year old woman,
who has been suffering from
diabetes mellitus type 1 for
approximately 30 years.
Objectively: the skin is pale,
heart sounds are weakened, BP
is 170/100 mm Hg, lower limbs
are markedly swollen. Blood
creatinine - 1125 mcmol/l, urea
- 49,6 mmol/l, potassium - 6.3
mmol/l, glucose - 7,6 mmol/l,
glomerular filtration rate - 5
ml/min. What treatment is
indicated for the patient in the
first place?
A. Kidney transplantation
B. Hemodialysis
C. Hemofiltration
D. Enterosorption
E. Conservative detoxification
therapy
78. A 43-year-old man, who has
been abusing alcohol and
suffering from pulmonary
tuberculosis, in the course of
two weeks gradually developed
general weakness, headache,
diplopia, vomiting. Objectively:
ptosis on the left, anisocoria
S>D, exotropia of the left eye,
neck stiffness; Kernig’s and
Brudzinski’s signs are positive.
In cerebrospinal fluid:
lymphocytic pleocytosis, low
glucose, precipitation of
cerebrospinal fluid resulted in
production of fibrin film. What
is the most likely diagnosis?
A. Acute myelitis
B. Subarachnoid hemorrhage
C. Brainstem encephalitis
D. Tuberculous meningitis
E. Basal arachnoiditis
79. Establishments
participating in medical
examinations include:
medical and preventive
treatment facilities, hygiene
and preventive treatment
facilities, social medical
expert committees, Ministry
of Defencemedical
committees, Ministry of
Domestic Affairs medical
committees, forensic
medicine agency, etc. Specify
what service deals with
sociomedical assessment of
temporary disability:
A.Medicalandpreventive
treatmentfacilities
B.Hygiene and preventive
treatment facilities
C.Sociomedical expert
committees
D. Ministry of Defence medical
committees
E.Ministry of Domestic Affairs
medical committees
80. A woman with blood group
B (III)Rh(+) gave birth to a full-
term healthy boy. Examination
on the 3rd day of the infant’s
life shows him to have
icterictint to his skin. The child
has no problems with suckling,
sleep is non disturbed. The
abdomen is soft, the liver
protrudes by 2cm from under
the costal margin. Complete
blood count: hemoglobin-
200g/L, erythrocytes- 5.5 ·
1012/L, total bilirubin-
62mcmol/L, indirect bilirubin-
52 mcmol/L. What condition
can be suspected?
A. Hemolytic disease of the
new born due to Rh
incompatibility B.
Congenital hepatitis
C. Physiologic jaundice
D. Biliary atresia
E. Hemolytic disease of the new
born due to ABO
incompatibility
81. A 43 y.o. woman complains
of severe pain in the right
abdominal side irradiating in
the right supraclavicular area,
fever, dryness and bitterness in
the mouth. There were
multiple vomitings without
relief. Patient relates the onset
of pain to the taking of fat and
fried food. Physical
examination: the patient lies on
the right side, pale, dry tongue,
tachycardia. Right side of
abdomen is painful during the
palpation and somewhat tense
in right hypochondrium. What
is the most likely diagnosis?
A. Acute cholecystitis
B. Acute bowel obstruction
C. Right-sided renal colic
D. Perforative ulcer
E. Acute appendicitis
82. Infant is 6.5 months now
and is given natural feeding
since birth. Body mass was 3.5
kg, with length 52 cm at birth.
How many times per day the
supplement (up feeding) should
be given?
A. 4
B. 0
C. 2
D. 3
E. 1
83. During a surgery on a 30-
year-old patient a dark ileoileal
conglomerate was discovered,
the intussusceptum intestine
was considered to be
unavaiable. The
intussuscipiems intestine was
dilated to 7-8 cm, swollen, full
of intestinal contents and
gases. What pathology led to
the surgery?
A. Spastic obstruction
B. Paralytic obstruction
C. Invagination (combined)
obstruction
D. Strangulation obstruction
E. Obturation obstruction
84. 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, super cooling. 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,
2°C, AP- 180/100 mm Hg, minor
costovertebral angle
tenderness (Pasternatsky
symptom). In blood: RBCS – 3,
5· 1012/1, 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. Amyloidosis
B. Polycystic renal disease
C. Chronic glomerulonephritis
D. Nephrolithiasis
E. Chronic pyelonephritis
85. A 12-year-old boy has a 6-
year history of insulin-
dependent diabetes. The
disease is labile. Since recently
there have been periodical rises
in blood pressure.
Microalbuminuria test gave
positive results. The patient's
condition corresponds with the
following stage of diabetic
nephropathy:
A. Stage II-histological changes
in the kidneys
B. V stage- chronic renal failure
C. Stage I-renal hypertrophy
and hyperfunction
D. Stage III-early-stage
nephropathy
E. Stage IV-advanced clinical
nephropathy
86. A 38-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. Blood test for renin level
B. Estimation of glomerular
filtration rate by measuring
endogenous creatinine
clearance
C. Blood test for thyroxine and
thyrotrophic hormone
D. Determination of urinary
excretion of catecholamines
and vanillylmandelic acid
E. Blood test for insulin and C-
peptide
87. At night a 63-year-old
woman suddenly developed an
asphyxia attack. She has a 15
year long history of essential
hypertension and has a
myocardial infarction 2 year
ago. Objectively her position in
bed is orthopneic, the skin is
pale, the patient is covered
with cold sweat, acrocyanosis is
observed. Pulse - 10/min. blood
pressure 210/130 mmHg,
respiration rate - 38/min.
Pulmonary percussion sound is
clear, with slight dullness in the
lower segments; throughout
the lungs single dry crackles can
be heard that become bubbling
and non-resonant in the lower
segments. What is the most
likely complication in this
patient?
A. Paroxysmal tachycardia
B. Bronchial asthma attack
C. Acute right ventricular failure
D. Acute left ventricular Failure
E. Pulmonary embolism
88. A 45 year old man was
brought by an ambulance into
the emergency hospital. He
complains of sudden pain in the
humbar area, frequent painful
urination and vomiting.
Examination detects pain in the
lumbar area, costovertebral
angle tenderness, pain on
palpution of kidneys and along
the ureter on the right. Urine
test: proteins, fresh
erythrocytes, leukocytes. Make
the provisional diagnosis:
A. Urolithiasis, renal colic
B. Acute glomerulonephritis
C. Polycystic kidney disease
D. Acute renal failure
E. Acute pyelonephritis
89. After excessive
consumption of fatty food a 60-
year-old woman suddenly
developed pain in herright
subcostal area, nausea,
bilevomiting, sharp bitter taste
in her mouth. In 2 days she
developed jaundice,her urine
darkened. Objectively: sclera
and skin are icteric, the
abdomen is distended, the liver
is enlarged by 3 cm,soft and
painful on palpation, Ortner’s,
Murphy’s, Kehr’s, Zakharyin’s,
Mayo-Robson’s signs are
positive. What diagnostic
technique should be used in
the first place to confirm the
diagnosis?
A. Laparoscopy
B. Esophago duodenoscopy
C. Abdominal X-ray
D. Radionuclide scanning of the
liver and gallbladder
E. Ultra sound
90. A patient complains of
suppuration from the ear and
impaired hearing of the left ear,
which have been observed for
the past 6 years. The patient
had periodical headaches,
general indisposition, fever.
Objectively: otoscopy of the
external auditory meatus
revealed ucopurulent odorless
substance. The eardrum is of
normal color, with central
perforation. What is the most
likely diagnosis?
A. Chronic mesotympanitis
B. Otosclerosis
C. Acute otitis media
D. Chronic sensorineural
hearing loss
E. Chronic epitympanitis
91. A primigravida at the term
of 20 weeks complains of pain
in her lower abdomen,
smearing blood-streaked
discharge from the genital
tracts. Uterine tone is
increased, fetus is mobile. On
vaginal examination: the uterus
is enlarged according to the
term, uterine cervix is
shortened to 0,5 cm, external
cervical orifice is open by 2 cm.
What is the most likely
diagnosis?
A. Risk of late abortion without
hemorrhage
B.The process of late abortion
C. Risk of late abortion with
hemorrhage
D. Incomplete late abortion
E. Attempted late abortion
92. A parturient woman is 23
years old. Internal obstetric
examination shows the uterine
cervix to be completely open.
Fetal bladder is absent.
Cephalic presentation is
observed in the plane of the
small pelvic outlet. Sagittal
suture is at the longitudinal
section of the small pelvic
outlet, small fontanel is
situated closer to the uterus.
What cephalic position will the
newborn have during birth in
this case?
A. Minor oblique lie
B. Longitudinal lie
C. Transverse lie
D. Medium oblique lie
E. Major oblique lie
93. A 54-year-old patient has
been suffering from diabetes
mellitus for 5 years, with diet
being his only treatment.
Within the last half a year he
lost 7 kg of body weight,
complains of thirst, vertigo
when raising from bed,
decrease of erectile function,
frequent stool, specially at
night. Objectively: malnutrition,
dry skin. BP in lying position is
160/90 mm Hg; BP in standing
position is 170/85 mm Hg. No
edemas. Fasting plasma glucose
level is 12 mmol/l. Glycated
haemoglobin accounts for 11%.
Albumin excreted with urine is
20 mg per day. The most likely
diagnosis is:
A. Diabetes mellitus type 1
with encephalomyelopathy
B. Diabetes mellitus type 1
with ketoacidosis
C. Diabetes mellitus type 2
with visceral neuropathy
D. Diabetes mellitus type 2
with nephropathy
E. Diabetes mellitus type 2
with polyneuropathy
94. A 5 y.o. child with stigmas
of dysembryogenesis (small
chin, thick lips, opened mouth,
hyperthelorismus) has systolic
murmur in the second
intercostal to the right of the
sternum. The murmur passes to
the neck and along the sternum
left edge. The pulse on the left
brachial artery is weakened. BP
on the right arm is 110/60 mm
Hg, on the left - 100/60 mm Hg.
ECG results: hypertrophy of the
right ventricle. What defect is
the most probable?
A Aortic stenosis
B Defect of interventricular
septum
C Defect of interatrial septum
D Coarctation of the aorta
E Open aortic duct
95. A 14 year old child suffers
from vegeto vascular dystonia
of pubertal period. He has got
sympatho adrenal attack .
What medicine should be used
for attack reduction?
A Obsidan
B No-shpa
C Amysyl
D Aminophylline
E Corglicone
96. A 34 year old man
complains of pale edema of the
face, feet, shins and lumbar
area, elevated BP upto 160/100
mmHg, und general weakness.
He has a clinical history of
nonspecific ulcerative colitis.
Objectively: pulse - 84/min,
rhythmic, blood pressure –
165/100 mmHg; edemas all
over the body; the skin is pale
and dry, with low turgor. The
kidneys cannot be palpated, on
an attempt to palpate them
they are painless. Blood test:
erythrocytes - 3.0 x 1012/L, Hb -
100 g/L, erythrocyte
sedimentation rate - 50
mm/hour. Urinalysis: proteins -
3.5 g/L, erythrocytes - 7-10 in
the vision field, leukocytes - 5-6
in the vision field. Daily
proteinuria – 6 grams. What
analysis should be conducted
additionally to verify the
diagnosis?
A. Radio isotopic examination
of kidneys
B. Gingival biopsy for the
diagnosis of amyloid disease
C. Renal ultrasound
D. Survey and excretory
urography
E. Urinalysis for Bence-Jones
protein
97. A 20 year old man, a
calibrator of dosimetry
equipment, committed a gross
violation of safety regulations,
when he put two ampoules
with cobal-60, each with the
radioactivity of 7 MCI, in the
pockets of his trousers and
jacket. He has been keeping the
ampoules in his pocket for 8
hours. The tissue at the
distance of 0.5 cm from the
source received the dose of 30
Gy (3000 R), while the tissues at
the distance of 20 Cm – 2 R. Did
this man develop radiation
sickness?
A. Yes, he developed a severe
form of acute radiation
syndrome
B Yes, he developed chronic
radiation syndrome
C.Yes, he developed a mild
form of acute radiation
syndrome
D. Yes, he developed a
moderate form of acute
radiation syndrome
E. No, he did not
98. Indicators of work of
impatient departments in the
city hospitals for the past year
were analysed. After that the
meeting was held at the central
city hospital and based on the
results of the analysis, a
decision was made to decrease
the number of beds in the
impatient departments and
instead open day care units
with partial hospitalization in
the city poly clinics. What is the
main goal of this decision?
A. Decreased mortality during
impatient treatment
B. Optimization of the average
bed occupancy rate per year
C. Decrease of the length of
impatient stay
D. Rational use of the bed fund
E. Intensification of the bed
fund usage
99. A boy is 8 year old. His
physical development is
compliant with his age. The
child has had cardiac murmur
since birth. Objectively: skin
and visible mucous membranes
are of normal colour. AP-
100/70 mm Hg. Auscultation
revealed systolo-diastolic
murmur and diastolic shock
above the pulmonary artery.
ECG shows overload of the left
heart. Roentgenoscopy shows
coarsening of the lung pattern,
heart shadow of normal form.
What is the most likely
diagnosis?
A. Patent ductus arteriosus
B. Pulmonary artery stenosis
C. Atrioseptal defect
D. Fallot's tetrad
E. Aorta contraction
100. A primagravida in her 20th
week of gestation complains
about pain in her lower
abdomen, blood smears from
the genital tracts. The uterus
has an increased tonus, the
patient feels the fetus
movements. Bimanual
examination revealed that the
uterus size corresponded the
term of gestation, the uterine
cervix was contracted down to
0.5 cm, the externmal orifice
was open by 2 cm. The
discharges were bloody and
smeary. What is the most likely
diagnosis?
A. Missed miscarriage
B. Incomplete abortion
C. Abortion in progress
D. Risk of abortion
E. Incipient abortion
101. A 32 weeks premature,
healthy infant weighing less
than 1 kg is having jaundice
with serum bilirubin level of 5
mg%. Ideal management in
such a case would be:
a. Observation
b. Phototherapy
c. Medical management
d. Exchange transfusion
102. A 30-year-old lady
delivered a small for age child
at 38 weeks of pregnancy On
examination, the new born was
having rhinitis, abdominal
distension, wrinkled skin and
maculopapular rash. There is
past history of abortions and
stillbirths. Presentation is
suggestive of:
A. Congenital rubella
B. Congenital toxoplasmosis
C. Congenital syphilis
D. Neonatal pemphigus
103. Hereditary fructose
intolerance is due to the
deficiency of:
A. Phosphofructokinase
B. Xylitol dehydrogenase
C. Aldolase B
D. Fructokinase
104. A 5-year-boy presented
with massive hematemesis. He
is NOT febrile. Per abdomen
examination revealed massive
splenomegaly without
hepatomegaly. Most probable
diagnosis would be:
a. Non-cirrhotic portal fibrosis
b. Extrahepatic portal venous
obstruction
c. Budd-Chiari syndrome
d. Hepatic carcinoma
105. Ideal management of a 37
weeks pregnant elderly
primigravida with placenta
praevia and active bleeding:
a. Labor induction
b. Cesarean section
c. Vaginal delivery
d. Expectant treatment
106. Which of the following is
known as pacemaker of uterine
contractions?
a. Fundus
b. Anterior uterine wall
С. Posterior uterine wall
d. Tubal ostia
107. Which of the following
types of placenta complicates
third stage of labor and is
associated with a past history
of cesarean section:
a. Placenta succenturita
b. Placenta extracholis
c. Placenta membranecae
d. Placenta accrete
108. Golf club appearance of
fallopian tube on
hysterosalpingography suggest
the diagnosis of:
a. ТВ
b. Gonorrhea
c. Chlamydial infection
d. None of the above
109. A 46-year-old lady has
abnormal uterine bleeding with
simple hyperplasia of
endometrium. The treatment
of choice would be:
a. Total hysterectomy
b. Progesterone
c. Estrogen+ progestogen
d. Estrogen
110. 18-year-old girl presented
with primary amenorrhea,
normal breast development,
absent pubic and axillary hair.
Condition is:
a. Turner syndrome
b. Mullerian agenesis
c. Premature ovarian failure
d. Testicular feminizing
syndrome
111. A 10-year-old boy was
brought into the hospital
with complaints of
expiratory dyspnea,
respirations are 30/min. He
explains his state by a
change in the weather
conditions. For the last 4
years the boy has been
registered for regular
check-ups due to his
diagnosis of third degree
persistent bronchial
asthma. To provide
emergency aid for this
child, first he needs to be
given:
A. Adrenaline
B. Dexamethasone
C. Salbutamol or short-
acting β2-agonists
D. Euphylline
(Aminophylline)
E. Claritin (Loratadine)
112. A 6-month-old child on
breastfeeding is
hospitalized in the inpatient
department. After the child
recovers, the doctor
recommends the mother to
start introducing solid food
to the child’s diet. What
products should be
introduced to the child’s
diet first?
A. Semolina porridge
B. Fermented dairy products
C. Grated apple
D. Vegetable puree
E. Buckwheat porridge
113. A newborn has Apgar
score of 9. When should
this infant be put to the
breast?
A. In the delivery room
B. After 12 hours
C. After 2 hours
D. On the 2nd day
E. On the 3rd day
114. A 28-year-old man, a
teacher, after emotional stress
developed painful muscle
spasms in his right hand that
occur during writing; now he
has to hold the pen between
the second and third fingers.
He has no problems with typing
or writing on the black board;
no other motor disturbance
sorne urological pathologies
are detected. What is the most
likely diagnosis?
A. Neuropathy of the right
ulnar nerve
B. Cortical agraphia
C. Parkinsonism
D. Writer’s cramp
E. Neuropathy of the right
radial nerve
115. A 69-year-old woman was
diagnosed with the following:
ischemic heart disease; stable
exertional angina pectoris, FC
III; heart failure II A with
retained left ventricular
rejection fraction, functional
class III (NYHA). What vaccine
should be chosen for influenza
prevention and to avoid
destabilization of the patient’s
condition?
A. Recombinant influenza
vaccine(RIV)
B. Inactivated influenza
vaccine(IIV)
C. Type of influenza vaccine is
not important
D. Vaccination is
contraindicated due to severe
heart failure E.
Vaccination is contra indicated
due to elderly age of the
patient
116. During administration of
planned DPT vaccination the
child suddenly developed acute
anxiety, signs of pain response,
dyspnea, grunting respirations,
cut is marmorata, cold sweat.
Objectively the child’s
consciousness is disturbed,
heart rate is 150/min., blood
pressure is 60/40mmHg, hearts
pounds are muffled. The child
was diagnosed with
anaphylactic shock. What drug
should bead ministered first?
A. Euphylline (Aminophylline)
B. Lasix(Furosemide)
C. Suprastin (Chloropyramine)
D. Epinephrine
E. Analgin (Metamizole)
117. A 60-year-old woman
complains of unbearable pain
in her right subcostal area. She
has a history of acute
pancreatitis. Temperature is
38.2oC. Objectively her sclera
are icteric. There are no signs of
peritoneal irritation. Ortner’s
and Gubergrits’ symptoms are
positive. Urine diastase is
320U/L.What is the most likely
diagnosis?
A. Acute cholangitis
B. Exacerbation of chronic
pancreatitis
C. Chronic cholecystitis
D. Acute cholecystitis
E. Pancreatic cancer
118. A 10-year-old boy with
symptoms of arthritis and
myocarditis was delivered into
a hospital. Based on clinical
examination the preliminary
diagnosis of juvenile
rheumatoid arthritis was made.
What symptom is the most
contributive for the diagnostics
of this disease?
A. Reduced mobility of the
joints in the morning
B. Regional hyperemia of the
joints C. Affection of the large
joints D. Enlarged
heart E.
Increased heartrate
119. A 36-year-old man has
been complaining of marked
weakness, low appetite, and
nausea for the last year, year
and a half. With in the last year
he has lost 10kg of body mass.
The skin is darkened, especially
on his face, neck, and arms.
Skin fold sand nipples are hyper
pigmented, the re are pigment
spots on the patient’s inner
thighs. Pulse is 60/min., blood
pressure is 80/50mmHg.What
is the provisional diagnosis?
A. Chronic gastritis
B. Diabetes mellitus
C. Adrenal insufficiency
D. Hemochromatosis
E. Cholestatichepatitis
120. Due to introduction of a
new treatment method,
average duration of the rapying
the experimental group was
12.3±0.2 days compared
to15.4±0.4 days in the control
group that was treated by the
old method. What calculations
should be made to estimate the
statistical significance of the T wave and deforms it,
difference in the results? moderate lengthening of PQ
interval, QRS complex is
A. Sign test(Z-test)
without alterations. What
B. T-test (Student’st- pathology does this child have?
distribution) C. Matching A. WPW syndrome
factor(chi-squaredtest) D. B. Atrial hypertrophy
WilcoxonT-test C. Ventricular hypertrophy
E. Kolmogorov-Smirnovtest D. Paroxysmal atrial
tachycardia
E. Extra systole
121. Survey radiograph of a 52-
123. A 3-month-old child
year-old worker of an
presents with saffron-yellow
agglomeration plant (28-year
coloring of the skin, sclera, and
long record of service, the
mucous membranes. The
concentration of metal dust is
abdomen is enlarged,
22-37 mg/m3) shows mildly
hepatomegaly and
pronounced interstitial fibrosis
splenomegaly are observed. In
with diffused contrasting well-
blood there is conjugated
defined small nodular shadows.
bilirubin-induced
The patient has no complaints.
hyperbilirubinemia. On
Pulmonary function is not
intravenous
compromised. What is the
cholangiocholecystography:
provisional diagnosis?
opacified bile is discharged into
A. Anthraco-silicatosis
the intestine. Transaminase
B. Silicosis
activity is normal. What is the
C. Siderosis
most likely diagnosis?
D. Silicatosis
A. Physiologic jaundice
E. Anthracosis
B. Biliary atresia
C. Hemolytic disease of
newborn
122. ECG revealed the following
D. Crigler-Najjar syndrome
in a 10-year-old child: sharp
E. Congenital hepatitis
acceleration of the heart rate -
240/min., P wave overlaps with
124. A woman in her early- to
mid-thirties has lost her
consciousness 3-5 minutes ago.
On examination: the skin is
pale, no pulse over the carotid
arteries, no spontaneous
respiration, pupils are dilated;
the patient is nonresponsive,
presents with atony. The
patient’s condition can be
determined as:
A. Syncope
B. Natural death
C. Apparent death
D. Brain death
E. Coma
125. A 43-year-old woman
complains of pain in the lumbar
area, which irradiates to her
left leg and aggravates on
movement, and sensation of
numbness in this leg.
Objectively palpation of her
shin and thig his painful, there
are painful stretch symptoms of
on the left and gastrocnemius
cramps. There is no sensory
loss or weakening of reflex
responses. Make the diagnosis:
A. End arteritis of the lower
extremities
B. Vertebrogenous radicular
syndrome of L5-S1 on the left
C. Left-sided coxitis
D. Left sided Vertebrogenous
lumbar ischialgia
E. Spinal stroke
126. A 35-year-old patient
developed an epileptic attack
with tonoclonic spasms that
lasted for 3 minutes. After the
attack the patient fell asleep
but in 5 minutes the second
attack occurred. The first step
of emergency aid would be to:
A. Take blood from the vein for
analysis
B. Ensure patency of airways
C. Introduce diazepam
intravenously
D. Prescribe antiepileptic drugs
E. Administer chloral hydrate
via enema
127. Estimation of community
health level involved analysis of
are port on diseases registered
among the population of
district under charge (reporting
form12).What index is
calculated based on this
report?
A. Prevalence
B. Index of pathological
affection C. Index of
morbidity with temporary
disability D.
Index of hospitalized morbidity
E. Index of basic non-epidemic
morbidity
128. During regular
examination of a 2-year old
boy, he presents with enlarged
left kidney, painless on
palpation. The right kidney was
undetectable on palpation.
Excretory urography shows no
contrast on the right.
Cytoscopy detected
hemiatrophy of the urinary
bladder trigone, the right
ureteral orifice is not detected.
What pathology is it?
A. Hypoplasia of the right
kidney B. Dystopia of the
right kidney C. Agenes is
of the right kidney D.
Agenes is of the right ureter
E. Ectopic right ureteral orifice
129. A 30-year-old woman
complains of milk discharge
from her breasts and no
menstruation for the last 5
months. One physiologic child
birth was 4 years ago. There are
no mal developments of
mammary glands. Bi- manual
examination revealed
diminished uterus and normal
sized ovaries. MRI- scan shows
no brain pathologies. Thyroid
stimulating hormone is with in
normal limits. Serum prolactin
is high. What is the most likely
diagnosis?
A. Hypothyroidism
B. Hyperprolactinemia
C. Poly cystic ovaries
D. Pituitary adenoma
E. Sheehan’s syndrome
(postpartum hypo pituitarism)
130. A 45-year-old woman
came to the maternity clinic
with complaints of periodical
pain sin her mammary glands
that start 1 day before
menstruation and stop after
the menstruation begins.
Palpation of the mammary
glands detects diffuse nodes
predominantly in the upper
outer quadrants. What is the C. Mastitis
most likely diagnosis? D. Fibro cystic mastopathy
E. Breast cyst
A. Hyperprolactinemia
B. Breast cancer

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