5.

Question
A patient has severe blood loss caused by an injury. What kind of dehydration will be
observed in this particular case?
1.  Hyposmolar
2.  Iso-osmolar
3.  Hyperosmolar
4.  Normosmolar

6. Question
On the 24th day since the onset of disease, a male patient diagnosed with typhoid fever and
undergoing treatment in an infectious diseases hospital has suddenly developed clinical
presentations of acute abdomen leading to the death of the patient. During autopsy peritonitis
has been revealed, with numerous ulcers covering the colon mucosa and reaching as deep
as muscular and, in places, serous tunic. The ulcers have smooth edges and even floor. The
intestinal wall is perforated. What stage of typhoid fever has the lethal complication arisen at?
1.  Dirty ulcer
2.  Medullary swelling
3.  Clean ulcer
4.  Necrosis
5.  Regeneration

8. Question
A comminuted fracture of infraglenoid tubercle caused by shoulder joint injury has been
detected during X-ray examination of a patient. What muscle tendon attached at this site has
been damaged?
1.  Long head of m. biceps brachii
2.  Long head of m. triceps brachii
3.  Medial head of m. triceps brachii
4.  Short head of m. biceps brachii
5.  Lateral head of m. triceps brachii

9. Question
Autopsy of a 50-year-old male who had tuberculosis revealed a dense gray-white nidus in
form of a nodule 2 cm in diameter in the subpleural portion of the upper right lobe. The pleura
in this region was thickened, in the pleural cavity there was a small amount of serous
hemorrhagic fluid. Histological study of the region revealed some glandular structures wi-th
signs of cellular atypia and abnormal mitoses, which were found within the fibrous connective
tissue. What other pathology had developed in the lungs?
1.  Squamous cell carcinoma
2.  Adenocarcinoma
3.  Fibroma
4.  Fibrosarcoma
5.  Adenoma

11. Question
Patients with erythropoietic porphyria (Gunther’s disease) have teeth that fluoresce with bright
red color when subjected to ultraviolet radiation; their skin is light-sensitive, urine is red-
colored. What enzyme can cause this disease, when it is deficient?
1.  Ferrochelatase
2.  Uroporphyrinogen III cosynthase
3.  Uroporphyrinogen decarboxylase
4.  Delta-aminolevulinate synthase
5.  Uroporphyrinogen I synthase

16. Question
A child was born asphyxiated. What drug must be administered to the newborn to stimulate
breathing?
1.  Lobeline
2.  Atropine
3.  Prazosin
4.  Proserine
5.  Aethimizolum

18. Question
A female patient has facial neuritis that has caused mimetic paralysis and hearing
impairment. Hearing impairment results from the paralysis of the following muscle:
1.  Anterior auricular muscle
2.  Stapedius muscle
3.  Nasal muscle
4.  Posterior auricular muscle
5.  Superior auricular muscle

20. Question
Histological examination of biopsy samples taken from the thickened edges of a gastric ulcer
revealed small clusters of small, markedly atypical hyperchromatic epithelial cells that were
localized in the overdeveloped stroma. Specify the tumor:
1.  Undifferentiated sarcoma
2.  Adenoma
3.  Scirrhous undifferentiated carcinoma
4.  Adenocarcinoma
5.  Medullary carcinoma

24. Question
In cancer patients who have been continuously receiving methotrexate, the target cells of
tumor with time become insensitive to this drug. In this case, gene amplification of the
following enzyme is observed:
1.  Deaminase
2.  Thiaminase
3.  Thioredoxin reductase
4.  Dihydrofolate reductase

35. Question
A 49-year-old male patient with acute pancreatitis was likely to develop pancreatic necrosis,
while active pancreatic proteases were absorbed into the blood stream and tissue proteins
broke up. What protective factors of the body can inhibit these processes?
1.  Cryoglobulin, interferon
2.  Immunoglobulin
3.  α2-macroglobulin, α1-antitrypsin
4.  Hemoplexin, haptoglobin
5.  Ceruloplasmin, transferrin

38. Question
A patient with hereditary hyperammonemia due to a disorder of ornithine cycle has developed
secondary orotaciduria. The increased synthesis of orotic acid is caused by an increase in the
following metabolite of ornithine cycle:
1.  Ornithine
2.  Citrulline
3.  Urea
4.  Argininosuccinate
5.  Carbamoyl phosphate
41. Question
Tissue sampling of a 37-year-old male patient with chronic renal disease has revealed the
following: sclerosis, lymphocytic and plasmocytic infiltration of renal pelvis and calices walls,
dystrophy and atrophy of tubules. Remaining tubules are enlarged and stretched with colloid
masses, epithelium is flattened out (“scutiform”or “shield-shaped”kidney). What is the most
likely diagnosis?
1.  Nephrosclerosis
2.  Chronic pyelonephritis
3.  Glomerulonephritis
4.  Acute pyelonephritis
5.  Tubular interstitial nephritis

46. Question
In an experiment a dog had been conditioned to salivate at the sight of food and a flash of
light. After conditioning the reflex, the light was then paired with the bell. The dog didn’t start
to salivate. What type of inhibition was observed?
1.  Differential
2.  Extinctive
3.  Persistent
4.  External
5.  Protective
49. Question
A 35-year-old female patient has been hospitalised with acute intoxication caused by salts of
high-density metals (lead, most probably). As a part of complex therapy the antidote that
contains two active sulfhydric groups has been prescribed. Specify this antidote:
1.  Metamizole
2.  Dimercaprol
3.  Nalorphine hydrochloride
4.  Calcium chloride
5.  Mannitol
53. Question
A child has a history of hepatomegaly, hypoglycemia, seizures, especially on an empty
stomach and in stressful situations. The child is diagnosed with Gierke disease. This disease
is caused by the genetic defect of the following enzyme:
1.  Glycogen phosphorylase
2.  Glucose-6-phosphatase
3.  Amyloid-1,6-glycosidase
4.  Glucokinase
5.  Phosphoglucomutase
58. Question
Decarboxylation of glutamate induces production of gamma-aminobutyric acid (GABA )
neurotransmitter. After breakdown, GABA is converted into a metabolite of the citric acid
cycle, that is:
1.  Fumarate
2.  Succinate
3.  Citric acid
4.  Oxaloacetate
5.  Malate
61. Question
A 19-year-old victim has been delivered to the casualty department with a cut wound of the
trapezius muscle. Which of the cervical fasciae forms a sheath for this muscle?
1.  Carotid sheath of cervical fascia
2.  Visceral part of the pretracheal layer of cervical fascia
3.  Investing layer of cervical fascia
4.  Muscular part of the pretacheal layer of cervical fascia
5.  Prevertebral layer of cervical fascia

9. Question
A young woman suddenly developed fever up to 39oC accompanied by a strong headache.
Examination revealed marked nuchal rigidity. Spinal puncture was performed. Gram-stained
smear of cerebrospinal fluid contained many neutrophils and Gram-positive diplococci. What
bacteria could be the cause of this disease?
1.  Streptococcus pneumonia
2.  Haemophilus influenzae
3.  Staphylococcus aureus
4.  Neisseria meningitides
5.  Pseudomonas aeruginosa

20. Question
A male patient is 28 years old. Histological study of a cervical lymph node revealed a change
of its pattern due to the proliferation of epithelioid, lymphoid cells and macrophages having
nuclei in form of a horseshoe. In the center of some cell clusters there were non-structured
light-pink areas with fragments of nuclei. What disease are these changes typical for?
1.  Hodgkin’s disease
2.  Syphilis
3.  Actinomycosis
4.  Tuberculosis
5.  Tumor metastasis

27. Question
A child with a normal karyotype is diagnosed with cleft lip and hard palate, defects of the
cardiovascular system, microcephaly. The child’s mother suffered rubella during pregnancy.
This pathology in the child may be an example of:
1.  Phenocopy
2.  Monosomy
3.  Trisomy
4.  Genocopy

40. Question
A 3-year-old child has continuous fever, lymph nodes are enlarged, the amount of
lymphocytes in blood is significantly increased. Enzyme-linked immunosorbent assay (ELISA)
revealed antigen of Epstein-Barr virus. What diagnosis can be made based on the information
given above?
1.  Generalized infection caused by herpes-zoster
2.  Herpetic lymphadenopathy
3.  Infectious mononucleosis
4.  Burkitt’s lymphoma
5.  Cytomegalovirus infection

44. Question
A pneumonia patient has been administered acetylcysteine as a part of complex therapy.
What principle of therapy has been taken into consideration when applying this drug?
1.  Pathogenetic
2.  Antimicrobial
3.  Etiotropic
4.  Symptomatic
5.  Immunomodulatory

53. Question
An electron micrograph shows a cell-to-cell adhesion consisting, in each cell, of an
attachment plaque. The intercellular space is filled with electron-dense substance including
transmembrane fibrillar structures. Specify this adhesion:
1.  Desmosome
2.  Synapse
3.  Tight junction
4.  Nexus
5.  Adherens junction

54. Question
A newborn baby has numerous hemorrhages. Blood coagulation tests reveal increased
prothrombin time. The child is most likely to have a disorder of the following biochemical
process:
1.  Hydroxylation of proline
2.  Production of gamma-carboxyglutamate
3.  Conversion of homocysteine to methionine
4.  Conversion of methylmalonyl CoA to succinyl CoA
5.  Degradation of glutathione

59. Question
Malaria is treated with structural analogs of vitamin B2 (riboflavin). These drugs disrupt the
synthesis of the following enzymes in plasmodium:
1.  Cytochrome oxidase
2.  Peptidase
3.  FAD-dependent dehydrogenase
4.  NAD-dependent dehydrogenase
5.  Aminotransferase

60. Question
For biochemical diagnostics of myocardial infarction it is necessary to measure activity of a
number of enzymes and their isoenzymes. What enzymatic test is considered to be the best
to prove or disprove the diagnosis of infarction in the early period after the chest pain is
detected?
1.  LDH2 lactate dehydrogenase isoenzyme
2.  Creatine kinase isoenzyme CK-MB
3.  Aspartate aminotransferase cytoplasmic isoenzyme
4.  Creatine kinase isoenzyme CK-MM
5.  LDH1 lactate dehydrogenase isoenzyme

71. Question
A 55-year-old male had been delivered to the resuscitation unit unconscious. Relatives
reported him to have mistakenly drunk an alcoholic solution of unknown origin. On
examination the patient was diagnosed with methanol intoxication. What antidote should be
used in this case?
1.  Ethanol
2.  Teturamum
3.  Acetylcysteine
4.  Protamine sulfate
5.  Naloxone

75. Question
A 39-year-old female patient with a history of diabetes was hospitalized in a precomatose
state for diabetic ketoacidosis. This condition had been caused by an increase in the following
metabolite level:
1.  Aspartate
2.  Malonate
3.  Alpha-ketoglutarate
4.  Acetoacetate
5.  Citrate

79. Question
Symptoms of pellagra (vitamin PP deficiency) is particularly pronounced in patients with low
protein diet, because nicotinamide precursor in humans is one of the essential amino acids,
namely:
1.  Histidine
2.  Threonine
3.  Arginine
4.  Lysine
5.  Tryptophan

87. Question
A patient complains of pain in the heart area during acute attack of gastric ulcer. What
vegetative reflex can cause this painful feeling?
1.  Viscerodermal reflex
2.  Dermatovisceral reflex
3.  Visceromotor reflex
4.  Motor-visceral reflex
5.  Viscerovisceral reflex

93. Question
During the hystological study of cortical shaft, basophilic cells with developed synthesis
organelles can be seen on the bone surface under the layer of fibers. These cells take part in
bone tissue regeneration. What shaft layer are they located in?
1.  Bone
2.  Osteon layer
3.  Periosteum
4.  Outer lamellae of compact bone tissue
5.  Inner lamellae of compact bone tissue

97. Question
As a result of an injury, the integrity of the anterior spinal cord root was broken. Specify the
neurons and their processes that had been damaged:
1.  Motor neuron dendrites
2.  Dendrites of association neurons
3.  Axons of motor neurons
4.  Dendrites of sensory neurons
5.  Axons of sensory neurons

115. Question
A male patient complains of skin insensitivity of inferior eyelid, external lateral surface of nose
and upper lip. A doctor in the course of examination has revealed inflammation of the second
branch of trigeminal nerve. What cranial foramen does this branch go through?
1.  Lacerum
2.  Superior orbital fissure
3.  Spinosum
4.  Oval
5.  Supraorbital

118. Question
A patient takes cholagogues. What other process besides biliary excretion will be stimulated?
1.  Pancreatic juice secretion
2.  Intestinal motility
3.  Gastric juice secretion
4.  Water absorption
5.  Gastric motor activity

127. Question
A 42-year-old male with a lesion of the ulnar nerve is unable to flex the II and V fingers to the
midline. Which muscle function is impaired in this case?
1.  Palmar interosseous muscles
2.  Short palmar muscle
3.  Dorsal interosseous muscle
4.  Fidicinales
5.  Abductor muscle of little finger

130. Question
Steatosis is caused by the accumulation of triacylglycerols in hepatocytes. One of the
mechanisms of this disease development is a decrease in the utilization of VLDL neutral fat.
What lipotropics prevent the development of steatosis?
1.  Arginine, B2, B3
2.  Alanine, B1, P P
3.  Methionine, B6, B12
4.  Isoleucine, B1, B2
5.  Valine, B3, B2

132. Question
As a result of a road accident a 37-year-old female victim developed urinary incontinence.
What segments of the spinal cord had been damaged?
1.  Th1 − L1
2.  L1 − L2
3.  Th2 − Th5
4.  Th1 − Th5
5.  S2 − S4

137. Question
A 10-year-old child was found to have a congenital hypoplasia of the left kidney. Ultrasound
examination revealed that the right kidney was markedly enlarged and had regular shape. No
functional disorders were revealed. Specify the process that developed in the right kidney:
1.  Vicarious hypertrophy
2.  Pseudohypertrophy
3.  Working hypertrophy
4.  Hypertrophic growth
5.  Metaplasia

144. Question
A smear from the tonsillar coating of a patient with suspected diphtheria was found to contain
blue bacilli with a thickening at the poles. What method of smear staining was used?
1.  Burri
2.  Hins
3.  Leffler
4.  Gram
5.  Neisser

51. Question
A patient intending to undergo a gender reassignment surgery has been admitted to a
specialised clinic. In the course of examination both male and female gonades have been
revealed, with male structure of external genitals. What kind of genital maldevelopment has
the patient?
1.  Ectopia of testis
2.  Female pseudohermaphroditism
3.  Male pseudohermaphroditism
4.  True hermaphroditism
5.  Accessory ovary

154. Question
Nucleolar organizers of the 13-15, 21, 22 human chromosomes contain about 200 cluster
genes that synthesize RNA. These regions of chromosomes bear the information on the
following type of RNA:
1.  rRNA
2.  tRNA + rRNA
3.  snRNA
4.  mRNA
5.  tRNA

168. Question
A smear of streptobacillus preparation stained by Ozheshko method has been studied
microscopically with oil immersion. What structural feature of the bacteria has been studied?
1.  Capsule
2.  Structure of cell wall
3.  Flagella
4.  Spores
5.  Inclusions

177. Question
An outbreak of an intestinal infection occurred in a kindergarten on the eve of New Year
holidays. Bacteriological examination of patients’ faeces didn’t reveal any pathogenic
bacteria. Electron microscopy revealed roundish structures with clear outer edges and a thick
core resembling a wheel. Specify the most likely causative agent of this infection:
1.  E.coli
2.  Coxsacki-virus
3.  Adenovirus
4.  Rotavirus
5.  P.vulgaris

178. Question
Degenerative changes in posterior and lateral columns of spinal cord (funicular myelosis)
caused by methylmalonic acid accumulation occur in patients with B12-deficiency anemia.
This results in synthesis disruption of the following substance:
1.  Serotonin
2.  Acetylcholine
3.  Myelin
4.  Norepinephrine
5.  Dopamine

186. Question
Autopsy has revealed shrunken kidneys weighing 50 mg, with fine-grained surface and
uniformly thinned substance. Microscopic investi-gation has shown the thickening of arteriole
walls due to accumulation of homogeneous anhistic pink-coloured masses in them.
Glomerules were undersized, sclerotic, with atrophied tubules. What disease are these
changes characteristic of?
1.  Essential hypertension
2.  Renal amyloidosis
3.  Membranous nephropathy
4.  Pyelonephritis with kidney shrinkage
5.  Acute glomerulonephritis

189. Question
An underage patient has signs of achondroplasia (dwarfism). It is known that this is a
monogenic disease and the gene that is responsible for the development of such
abnormalities is a dominant one. The development of that child’s brother is normal. Specify
the genotype of the healthy child:
1.  AABB
2.  aa
3.  AaBb
4.  Aa
5.  AA

193. Question
A public utility specialist went down into a sewer well without protection and after a while lost
consciousness. Ambulance doctors diagnosed him with hydrogen sulfide intoxication. What
type of hypoxia developed?
1.  Tissue
2.  Overload
3.  Respiratory
4.  Hemic
5.  Circulatory

196. Question
A 36-year-old female patient has a history of B2-hypovitaminosis. The most likely cause of
specific symptoms (epithelial, mucosal, cutaneous, corneal lesions) is the deficiency of:
1.  Cytochrome A1
2.  Cytochrome B
3.  Cytochrome oxidase
4.  Flavin coenzymes
5.  Cytochrome C

197. Question
At a bacteriological laboratory animal skins are analyzed by means of Ascoli precipitaion test.
What is detected if the reaction is positive?
1.  Anaerobic infection toxin
2.  Anthrax agent antigens
3.  Plague agent
4.  Brucellosis agent
5.  Yersinia surface antigen

200. Question
A 55-year-old patient with a characteristic rash, fever, dizziness has been admitted to a
hospital. He has been provisionally diagnosed with typhus. No similar cases have been
reported. In his youth (15 years old) the patient suffered typhus in a boardi-ng school. What
disease is it?
1.  Rubella
2.  Cholera
3.  Typhoid fever
4.  Measles
5.  Brill’s disease