Discoordinated labor activity (new)

Primary uterine inertia (new)

Secondary uterine inertia (new)
Hashimoto thyroiditis (new)
Typhus (new)
Typhoid (new)
Takayasu s disease disease (obliterating aortoarteritis):
• Females < 40 years old
• Pulseless disease (weak upper extremity pulses).
Ankylosing spondyloarthritis ( new ) -bilateral sacroileitis
Beta-hemolytic streptococcus (new)
Lead (new) – red blood cells with basophilic aggregations
Atrial fibrillation- no p wave, f-wave
Ventricular fibrillation - Electrical defibrillation in emergency,
Dressler syndrome (new)
To check effectiveness of l-tyroxine treatment in patient with hypothyroidism – check TSH level
Chronic salpimgoophritis (new )
Myocardial infarction - STEMI
Ulcerative colitis – surgery, colon enlargement
Intestinal obstruction (new) – adhesions
Glomerulonephritis – glucocorticosteroids

11. A 9 y.o. girl has an average height and harmonic growth development. She was ill with acute
respiratory infection for five times. Define the group of her health.
A. 2nd group*
B. 1st group
C. 3rd group
D. 4th group
E. 5th group

A youth, aged 15, from childhood suffers from atopic dermatitis and allergy to the
shellfish. In
the last 3 months after acquiring aquarium fish, rhinitis, conjunctivitis, itching in the
nose
developed. What level of immunologic index should be defined in this case?
A. IgE*
B. IgJ
C. IgM
D. IgA
E. Circulating immunocomplexes

A 38 y.o. woman complains of a purulent discharge from the left nostril. The body
temperature
is 37,50C. The patient is ill during a week and associates her illness with common
cold. Pain
on palpation of her left cheek reveals tenderness. The mucous membrane in the left
nasal
cavity is red and turgescent. The purulent exudates is seen in the middle meatus in
maxillary.
What is the most probable diagnosis?
A. Acute purulent maxillary sinusitis*
B. Acute purulent frontitis
C. Acute purulent ethmoiditis
D. Acute purulent sphenoiditis
E. –

A 37 y.o. primigravida woman has been having labor activity for 10 hours. Labor
pains last for
20-25 seconds every 6-7 minutes. The fetus lies in longitude, presentation is
cephalic, head is
pressed upon the entrance to the small pelvis. Vaginal examination results: cervix of
uterus is
up to 1 cm long, lets 2 transverse fingers in. Fetal bladder is absent. What is the
most probable
diagnosis?
A. Primary uterine inertia*
B. Secondary uterine inertia
C. Normal labor activity
D. Discoordinated labor activity
E. Pathological preliminary period

An 8-year-old child with a 3-year history of diabetes was hospitalized in hyperglycemic

coma. Specify the initial dose of insulin to be administered:
A. 0,1-0,2 U/kg of body weight per hour
B. 0,05 U/kg of body weight per hour
C. 0,2-0,3 U/kg of body weight per hour
D. 0,3-0,4 U/kg of body weight per hour
E. 0,4-0,5 U/kg of body weight per hour

During appointment with the doctor a man complains of painful itching rashes that appeared on his skin under
the beard and moustache one year ago, with frequent exacerbations occurring throughout the year. Objectively
the skin of the facial hair growth areas is bluish-purple, thickened, with pustules, erosions, and scabs covering
its moist surface. The fistulous tracts are surrounded by the area of loose pink-red granulation and discharge
pus. The skin resembles mulberry in appearance. Make the diagnosis:
A. Sycosis
B. Acne rosacea
C. Lupus erythematosus
D. Deep trichophytosis
E. Tuberculous lupus

There is a dynamic growth of number of congenital abnormalities such as central

paralysis,
newborns blindness, idiocy among the population that lives near to pesticides
production
enterprise. Compounds of which pollutant can cause the development of this
pathology?
A. Mercury*
B. Strontium
C. Cadmium
D. Iron
E. Chrome

A 4 month old child fell seriously ill: body temperature rose up to 38,5oC, the child
became
inert and had a single vomiting. 10 hours later there appeared rash over the
buttocks and
lower limbs in form of petechiae, spots and papules. Some haemorrhagic elements
have
necrosis in the centre. What is the most probable disease?
A. Meningococcemia*
B. Rubella
C. Influenza
D. Haemorrhagic vasculitis
E. Scarlet fever

On the 6th day of life a child got multiple vesicles filled with seropurulent fluid in the
region of
occiput, neck and buttocks. General condition of the child is normal. What disease
should be
suspected?
A. Vesiculopustulosis*
B. Impetigo neonatorum
C. Miliaria
D. Impetigo
E. Epidermolysis bullosa

A patient’s X-ray image (anteroposterior projection) shows deformation of lung pattern, pneumofibrosis,
reticular (honeycomb) lung pattern of lower pulmonary segments, cylindric and fusiform lumps. The most
likely diagnosis is:
A. Multiple bronchiectasis
B. Right lung abscess
C. Non-hospital-acquired pneumonia
D. Lungs maldevelopment
E. Diffuse pulmonary fibrosis

A man was undergoing treatment for a myocardial infarction. On day 13, his chest pain
increased and he developed shortness of breath. Objectively, the following is observed:
temperature-38.2° C, pulse respiration rate 112 / min.,26 / min., fine bubbling crackles can be
heard under the right shoulder blade. On day 15, he was diagnosed with rightsided exudative
pleurisy. Complete blood count shows the following: leukocytes – 8.9*109/L, eosinophils-8 %.
ESR-24 mm/hour. What complication of myocardial infarction occurred in this patient?
A. Recurrent myocardial infarction
B. Dressler syndrome
C. Pneumonia
D. Pulmonary embolism
E. Cardiac asthma

38. A 59-year-old woman complains of pain and edema in the small joints of her hands,
shortness of breath, weakness. This condition lasts for 8 years already. Objectively, her body
temperature is 37.8 ° C, she has fine punctate hemorrhages on her torso and limbs, ulnar
deviation of the hands is observed. The borders of the heart are shifted to the left, a systolic
murmur can be detected over the apex. Her pulse is 96 / min. Her blood pressure is 170/100
mm Hg. Complete blood count shows the following: erythrocytes-3.2 10¹2 / L, Hb-108 g / L,
leukocytes-6.8 10 % / L, platelets-220-10 / L, ESR-48 mm / hour, C-reactive protein (+++).
General urinalysis shows the following: specific gravity-1016, protein-2.8 g / L, leukocytes 10-12
in the vision field, erythrocytes-2-4 in the vision field. What is the most likely diagnosis in this
case?
A. Chronic glomerulonephritis
B. Thrombocytopenic purpura
C. Systemic lupus erythematosus
D. Rheumatoid arthritis
E. Rheumatism

An 8-day-old boy was delivered to the hospital on the second day after the onset of the disease.
His parents complain of his fussiness, regurgitation, body temperature up to 38.5 C, red skin
with infiltration in the lumbar area. His medical history has no peculiarities. The child is in the
severe condition, inert, pale, suckles poorly. In the lumbar area, on the sacrum and buttocks
there is a tense infiltration with hyperemic and cyanotic areas and with a soft spot 8×7 cm in its
center. the stool is 10 times in 24 hours, with green and mucous admixtures. What is the most
likely diagnosis?
A. Erysipelas
B. Congenital soft-tissue tumor
C. Phlegmon of the newborn
D. Adiponecrosis
E. Hemangioma
A man complains of red and sore skin on his right calf. Objectively, his body temperature is
38.5°C; his inguinal lymph nodes on the right are enlarged and painful; the skin is red, with clear
boundaries between the redness and healthy skin; edema is observed; there are vesicles filled
with a dark liquid; palpation is painful. What is the provisional diagnosis in this case?
A. Herpetic infection
B. Phlegmon of the leg
C. Varicella
D. Erysipelas
E. Cutaneous anthrax

A person has been hospitalized with the diagnosis of trichinellosis. What food product is the
likely cause of this helminthiasis?
A. Rabbit
B. Poultry
C. Beef
D. Mutton
E. Pork

During coke production, the concentration of dust in the air of the working area has been for
many years exceeding the maximum permissible concentration by 4-8 times. What disease is
most likely to develop among the workers in this industry as a result?
A. Anthracosis
B. Byssinosis
C. Asbestosis
D. Silicosis
E. Siderosis

A 36-year-old patient complains of suffocation attacks with predominantly problematic

exhalation. The attacks occur up to 2-3 times a day and can be relieved by inhalation of 2-
adrenomimetics. This condition lasts for 10 years already. Objectively, the chest is expanded,
percussion detects a bandbox resonance over the lungs, auscultation detects harsh respiration
with prolonged exhalation. Laboratory analysis of sputum detects numerous eosinophils,
Charcot-Leyden crystals, and Curschmann spirals. What is the provisional diagnosis in this case?
A. Spontaneous pneumothorax
B. Chronic obstructive bronchitis
C. Bronchial asthma
D. Cardiac asthma
E. Carcinoid syndrome

A 36 y.o. patient is diagnosed with right sided pneumothorax. What method of treatment is
indicated to the patient?
A. Surgical drainage of the pleural cavity*
B. Antiinflammation therapy
C. Symptomatic therapy
D. Pleural puncture
E. Thoracotomy

The patient has developed pain in the axillary area, rise of temperature developed 10 hours
ago. On examination: shaky gait is marked, the tongue is coated by white coating. The pulse is
frequent. The painful lymphatic nodules are determined in the axillary area. The skin is
erythematous and glistering over the lymphatic nodules. What is the most probable diagnosis?
A. Bubonic plague*
B. Acute purulent lymphadenitis
C. Lymphogranulomatosis
D. Anthrax
E. Tularemia

chicken pox incubation

calcium (convulsion)
fluorine
psoriasis
bladder exstrophy
epidemic typhus ( petechia)
battery = lead
secondary syphilis = painless ulcer and then rash

A 3-year-old boy has been hospitalized with severe edemas. Objectively, the boy is pale, his blood
pressure is 90/60 mm Hg, he has oliguria. General urinalysis shows the following: color --- yellow,
specific gravity --- 1020, protein levels --- 3.5 g/L, erythrocytes --- leached, 4--5 in the vision field,
leukocytes --- 2--3 in the vision field, 24-hour proteinuria --- 6.6 g. The cholesterol levels are 9.8 mmol/L.
What next step in the patient's management would be optimal?
Question 77Answer
a. 
Kidney biopsy
b. 
Nechiporenko urine test
c. 
Monitoring throughout the next week
d. 
Computed tomography without contrast
e. 
Zimnitsky test
Feedback
The correct answer is: Kidney biopsy

A 17-year-old girl complains of a pain and swelling of her second finger on the right hand. Three
days ago she made a manicure. The pain developed on the second day after that. Objectively, her
nail fold is swolen, hyperemic, overhangs the nail plate, and is painful on palpation. What is the
most likely diagnosis in this case?
Question 73Answer
a. 
Cutaneous panaritium
b. 
Erysipeloid
c. 
Paronychia
d. 
Subcutaneous panaritium
e. 
Subungual panaritium
Feedback
The correct answer is: Paronychia

Within several days, a person developed a reduction in the peripheral vision, resembling a flap, on the
outer side. The patient does not know the cause of this condition. The eye is calm, the optical media are
transparent. On the nasal side of eye, ophthalmoscopy detects a gray "sail" with vessels that wavers
during eye movements. The optic disc and blood vessels are without changes. What is the most likely
diagnosis in this case?
Question 71Answer
a. 
Vascular pathology of the retina
b. 
Retinal detachment
c. 
Lens subluxation
d. 
Initial signs of glaucoma
e. 
Hemianopsia with a neurological pathology
Feedback
The correct answer is: Retinal detachment

A 27-year-old woman, gravida 1, para 1, was hospitalized into the maternity ward. She had a 3-year-long
history of primary infertility. Contractions started 9 hours ago, occur every 4--5 minutes, and last 20--25
seconds. The waters broke 2.5 hours ago. The fetal heartbeat is 136/min. The small segment of the fetal
head lies in the plane of the inlet into the lesser pelvis. The cervix is smoothed out, its opening is 4 cm.
The amniotic sac is absent. What complication occurred during the childbirth?
Question 143Answer
a. 
Primary weakness of labor activity
b. 
Discoordinated labor activity
c. 
Secondary weakness of labor activity
d. 
Normal labor activity
e. 
Pathological preliminary period
Feedback
The correct answer is: Primary weakness of labor activity

A 64-year-old man is undergoing outpatient treatment for ischemic heart disease, diffuse cardiosclerosis,
persistent atrial fibrillation, and functional class III heart failure. The pharmacotherapy consists of
cordarone (amiodarone) twice a day, torasemide every other day, and trimetazidine twice a day. The
family physician recommended taking warfarin (3 mg per day) to prevent thrombus formation. What
parameter should be measured in this case for optimal control of the effectiveness and safety of the
anticoagulant therapy?
Question 105Answer
a. 
Platelet count
b. 
Fibrinogen levels
c. 
Erythrocyte sedimentation rate
d. 
Lee-White clotting time
e. 
International normalized ratio
Feedback
The correct answer is: International normalized ratio

A 72-year-old patient suffering from acute myocardial infarction, ECG monitoring revealed paroxysmal
ventricular tachycardia. At the same time he developed an acute ventricular failure. BP - 80/40 mm Hg.
What is the most effective and safe ay to treat the patiet?
Question 64Answer
a. 
Amiodarone
b. 
Mexitil
c. 
Lidocaine
d. 
Novocainamid
e. 
Electrical stimulation
Feedback
The correct answer is: Electrical stimulation

In recent months, a 29-year-old woman developed complaints of pain in her right iliac region, diarrhea
with mucus and pus, pain in the hip joints, and periodic increases in body temperature. The abdomen
during palpation is soft, with tenderness in the right iliac region. Irrigography shows that the mucosa
resembles a "cobblestone pavement", the ileocecal junction is narrowed. What disease can be suspected in
this case?
Question 107Answer
a.
Gluten enteropathy (celiac disease)
b.
Tuberculous ileotyphlitis
c.
Crohn's disease
d.
Whipple's disease
e.
Pseudomembranous enterocolitis
Feedback
The correct answer is: Crohn's disease

A 30-year-old man has received second-degree burns that cover 40% of his body. On the fourth day
after the injury, his general condition acutely deteriorated. He developed inspiratory dyspnea,
frequent cough with frothy sputum, and cyanotic skin. Auscultation detects numerous wet crackles
in the lungs. His blood pressure is 110/60 mm Hg, heart rate -- 100/min., respiration rate -- 32/min.,
central venous pressure -- 100 mm H₂O, total protein -- 50 g/L, Ht -- 30%, Hb -- 90 g/L. ECG
shows sinus tachycardia. What mechanism of pulmonary edema pathogenesis is the main one in
this case?
Question 123Answer
a. 
Decreased plasma osmotic pressure
b. 
Decreased contractility of the myocardium
c. 
Pulmonary hypoventilation
d. 
Surfactant dysfunction
e. 
Hypervolemia of the pulmonary circulation
Feedback
The correct answer is: Decreased plasma osmotic pressure

In the computer lab of the research sector at a polytechnic institute, the workstations of laboratory
technicians are located close in front of the screens. Throughout their whole working day, the technicians
are exposed to the electromagnetic waves of ultra high frequencies. Exposure to intense electromagnetic
waves of such frequency is especially dangerous for the:
Question 132Answer
a. 
Hearing analyzer
b. 
Visual analyzer
c. 
Sensory sensitivity
d. 
Pain sensitivity
e. 
Tactile sensitivity
Feedback
The correct answer is: Visual analyzer

A 26-year-old pregnant woman was hospitalized into the intensive care unit at 36 weeks of her pregnancy
with complaints of an intense headache in the frontal region. Physical examination detected the following:
blood pressure --- 170/90 mm Hg, pulse --- 85/min., respiratory rate --- 15/min., body temperature ---
36.9°C, edema of the limbs, fetal heart rate --- 159/min. During the examination, the woman developed an
attack of generalized tonic-clonic seizures. What drug must be administered first in this case?
Question 110Answer
a. 
Diazepam
b. 
Sodium valproate
c. 
Magnesium sulfate
d. 
Lamotrigine
e. 
Phenytoin
Feedback
The correct answer is: Magnesium sulfate

A 55-year-old woman complains of deformed finger joints and pain in them during movements.
Objectively, there are small bony formations on the lateral surfaces of the distal interphalangeal joints.
The formations are slightly painful to palpation. What are they called?
Question 115Answer
a. 
Bouchard's nodes
b. 
Rheumatoid nodules
c. 
Erythema nodosum
d. 
Heberden's nodes
e. 
Tophi
Feedback
The correct answer is: Heberden's nodes

A 37-year-old man complains of chills, headache in the frontal region and temples, pain in the
muscles, pain during eye movement, photophobia, and extreme weakness. His oropharyngeal
mucosa is hyperemic. Scleritis is observed in the patient. Auscultation detects isolated dry crackles
and weakened heart sounds. Heart rate --- 98/min., blood pressure --- 130/70 mm Hg, body
temperature --- 39.8°C) What is the optimal way of preventing this disease in the contact persons?
Question 104Answer
a.
Administration of intranasal interferons
b.
Antibiotic prophylaxis
c.
Vaccination
d.
Wearing a face mask
e.
Administration of oxolin ointment
Feedback
The correct answer is: Vaccination

A full-term girl with chronic fetoplacental insufficiency was born from the second pregnancy that risked
termination at 25--27 weeks. During the childbirth, the umbilical cord was revealed to be wrapped once
around the neck of the baby, the extraction of the shoulders was difficult. After the birth, the Apgar scale
was used to evaluate the baby's condition at the first minute of life: no breathing, the heart rate of 50/min.,
total cyanosis, atony, areflexia. What would be the Apgar score in this case?
Question 54Answer
a. 
2 points
b. 
0 points
c. 
3 points
d. 
4 points
e. 
1 point
Feedback
The correct answer is: 1 point

A 32-year-old man complains of pain in his legs that intensifies during walking, intermittent claudication,
numbness of his toes, extremity
coldness, and inability to walk more that 100 meters. When he sleeps, his leg usually hangs down. The
patient has been smoking since he
was 16. He drinks alcohol in excess. The left leg is colder than the right one; the skin of the extremities is
dry. No pulse can be detected on
the pedal arteries, while pulsation of the femoral arteries is retained. What is the most likely diagnosis?
a. Raynaud disease
b. Leriche syndrome (aortoiliac occlusive disease)
c. Deep thrombophlebitis
d. Obliterating endarteritis ✓
e. Diabetic angiopathy
The correct answer is: Obliterating endarteritis (nafs el idea)

A patient was hospitalized into the neurosurgery department with a closed craniocerebral injury, a
fracture of the right temporal bone. Five hours later, the patient's condition sharply deteriorated, he
developed respiratory disorders, periodical tonic seizures, and anisocoria (dilation of the right pupil).
What complication can be suspected in this case?
Question 39Answer
a. 
Brain abscess
b. 
Characteristics associated with the course of concussion
c. 
Ischemic stroke in the area of the right cerebral peduncle
d. 
Subarachnoid hemorrhage
e. 
Epidural hematoma
Feedback
The correct answer is: Epidural hematoma

A premature newborn boy (pregnancy 5, birth 1, gestation term --- 27 weeks) has irregular respiration of
<30/min. after birth and $SpO_2$ of 70 %. Retractions of the pliable areas of the chest and expiratory
groaning are observed. Without oxygen support, generalized cyanosis occurs. Auscultation reveals
crepitus in the basal segments. There are no data on the prevention of respiratory distress syndrome in the
baby. What treatment tactics must be chosen in this case?
Question 6Answer
a. 
Provide artificial pulmonary ventilation with an Ambu bag and a mask
b. 
Administer the surfactant preparation intratracheally within the first 15 minutes after birth
c. 
Provide oxygen therapy using an oxygen tent
d. 
Prescribe an antibacterial therapy
e. 
Administer the surfactant preparation intratracheally 2 hours after birth
Feedback
The correct answer is: Administer the surfactant preparation intratracheally within the first 15 minutes
after birth

The condition of a full-term newborn deteriorated on the first day of life. The baby was born from the
third pregnancy, during the second half of which gestosis was observed. The mother's blood group is 0(I)
Rh(-). Examination shows that the baby is inert and has icteric skin and mucosa; baby's urine and stool
are of normal color. Blood serum bilirubin is 248 mcmol/L, because of indirect bilirubin levels. What is
the most likely cause of this pathologic condition?
Question 9Answer
a. 
Rh incompatibility
b. 
ABO incompatibility
c. 
Biliary atresia
d. 
Fetal hepatitis
e. 
Physiological jaundice
Feedback
The correct answer is: Rh incompatibility

A 65-year-old man has an over 17-year-long history of chronic obstructive bronchitis. He complains
of dyspnea with difficult inspiration, heaviness in his right subcostal region, and edema of feet and
shins. Auscultation detects rough respiration and dry crackles over the lungs and an accentuated
split second heart sound in the second intercostal region. What changes can be expected on the
ECG?
Question 14Answer
a. 
Right ventricular myocardial hypertrophy
b. 
Ciliary arrhythmia
c. 
Deviation of the electrical axis of the heart to the left
d. 
Left atrial hypertrophy
e. 
Extrasystole
Feedback
The correct answer is: Right ventricular myocardial hypertrophy

A 35-year-old man was found dead in his own garage. Forensic examination detects the following:
horizontal closed strangulation mark, petechial hemorrhages on the skin of the head and neck, facial
cyanosis, marked livor mortis, and multiple Tardieu spots. What indicates that the man did not die by
hanging?
Question 55Answer
a. 
Petechial hemorrhages on the skin
b. 
Facial cyanosis
c. 
Multiple Tardieu spots
d. 
Marked livor mortis
e. 
Horizontal strangulation mark
Feedback
The correct answer is: Horizontal strangulation mark

A 49-year-old man complains of angina pectoris attacks that occur when he walks up to 500 m. He has a
many-year-long history of chronic bronchitis. Examination detects a small number of dry diffuse crackles
in the lungs, the respiratory rate is 18/min. The borders of the heart are expanded to the left, the heart
sounds are muffled, the heart rate=PS=86/min., the blood pressure is 160/100 mm Hg. Complete blood
count shows the following: Hb --- 160 g/L, leukocytes --- $6.4 · 10^9$/L, ESR --- 7 mm/hour. ECG
shows hypertrophy of the left ventricle. What group of drugs is contraindicated in this case, taking into
account the concomitant pathology?
Question 62Answer
a. 
Long-acting nitrates
b. 
Antiplatelet drugs
c. 
Calcium antagonists
d. 
Beta blockers
e. 
Angioprotectors
Feedback
The correct answer is: Beta blockers
A 73-year-old man has a 5-year-long history of benign prostatic hyperplasia. One morning he developed
an acute urinary retention. Catheterization of his bladder is impossible. What urgent aid must be provided
for this man?
Question 64Answer
a. 
Antispasmodics and analgesics
b. 
Thermal procedures
c. 
Diuretics
d. 
Suprapubic bladder tap
e. 
Adrenergic blockers
Feedback
The correct answer is: Suprapubic bladder tap

One week ago, a 68-year-old woman suddenly developed pain in the left half of her chest and shortness of
breath. Objectively, the following is observed: cyanosis, distended neck veins, pulse --- 100/min., blood
pressure --- 110/70 mm Hg, respiratory rate --- 28/min., liver +4 cm, the left lower leg is edematous and
sharply painful to palpation. Auscultation detects a dull lung sound on the left, below the scapula;
sonorous moist fine vesicular crackles are present; the borders of the heart are expanded on the right; the
II heart sound is accentuated over the pulmonary artery. ECG shows deep S waves in leads I and aVL, as
well as deep Q waves in leads III and aVF, and a negative T wave in leads III and aVF. What is the most
likely diagnosis in this case?
Question 80Answer
a. 
Pleurisy
b. 
Myocardial infarction
c. 
Croupous pneumonia
d. 
Thromboembolism of pulmonary artery branches
e. 
Pericarditis
Feedback
The correct answer is: Thromboembolism of pulmonary artery branches

A man, who one day ago returned from a trip to Africa, presents with a sharply painful cluster of lymph
nodes in his armpit. The skin over the lymph node cluster is hyperemic. Bubonic plague is suspected.
What must the contact persons use for urgent prevention of this disease?
Question 95Answer
a. 
Praziquantel
b. 
Homologous immunoglobulin
c. 
Heterologous serum
d. 
Doxycycline
e. 
Fluconazole
Feedback
The correct answer is: Doxycycline

A 55-year-old woman complains of deformed finger joints and pain in them during movements.
Objectively, there are small bony formations on the lateral surfaces of the distal interphalangeal joints.
The formations are slightly painful to palpation. What are they called?
Question 115Answer
a. 
Bouchard's nodes
b. 
Rheumatoid nodules
c. 
Erythema nodosum
d. 
Heberden's nodes
e. 
Tophi
Feedback
The correct answer is: Heberden's nodes

A 35-year-old man was hospitalized with signs of surgical sepsis that has likely been caused by a large
carbuncle in his scapular region. Examination detected secondary purulent foci in the liver and right lung.
What stage of surgical sepsis is it?
Question 118Answer
a. 
Terminal stage
b. 
Septicemia
c. 
Purulent resorptive fever
d. 
Septicopyemia
e. 
Toxemia
Feedback
The correct answer is: Septicopyemia

A 72-year-old patient came to a doctor with complaints of hand tremors, stiffness, slowness of walking
and speech, and difficulties in performing routine household chores. Physical examination detects general
bradykinesia, hypomimia, emprosthotonus, "shuffling" gait, hand tremors at rest, D>S, plastic type of
increased muscle tone, the "cogwheel rigidity" phenomenon, and marked postural instability. What
medicines must be a primary part of the treatment regimen for this patient?
Question 147Answer
a. 
Anticholinergic agents
b. 
Medicines containing levodopa
c. 
Antidepressants
d. 
Anticholinesterase drugs
e. 
Medicines that improve microcirculation
Feedback
The correct answer is: Medicines containing levodopa

A 74-year-old woman came to a doctor complaining of a pain in her right inguinal region. The signs
appeared suddenly, approximately 2 hours ago. The woman notes that she already had these signs 3
weeks ago, but back then they disappeared on their own after she lay down. Objectively, palpation detects
below the Poupart's ligament a sharply painful, dense, and tense formation 3.5 cm in diameter. The
Dejerine sign (aggravation on coughing) is negative. What is the most likely diagnosis in this case?
Question 101Answer
a. 
Acquired strangulated inguinal hernia
b. 
Inguinal lymphadenitis
c. 
Acquired strangulated femoral hernia
d. 
Acquired incarcerated femoral hernia
e. 
Acquired incarcerated inguinal hernia
Feedback
The correct answer is: Acquired strangulated femoral hernia

In a 70-year-old woman, chest fluorography shows a shadow of a heterogeneous structure over the left
dome of the diaphragm. X-ray with contrast detects the abdominal segment of the esophagus in the chest
cavity. What is the most likely diagnosis in this case?
Question 150Answer
a. 
Esophagitis
b. 
Achalasia cardia
c. 
Esophageal diverticulum
d. 
Benign esophageal tumor
e. 
Hiatal hernia
Feedback
The correct answer is: Hiatal hernia

A boy suffering from bronchial asthma started to experience suffocation attacks several times a day.
During the last attack, inhalation of astmopent (orciprenaline) had no effect. Intensive therapy was unable
to stop the attack. The child was transferred into the intensive care unit with the diagnosis of II degree
status asthmaticus. What was the leading mechanism of the development of this condition in the child?
a. Complete refractoriness (blockade) of beta-2-adrenoceptors
b. Edema of the bronchial mucosa
c. Increased secretion of bioactive substances by mast cells
d. Inflammation of the bronchial mucosa
e. Spasm of the bronchial smooth muscles
The correct answer is: Complete refractoriness (blockade) of beta-2-adrenoceptors

A newborn with hemolytic disease according to Rh - factor have a О (I) Rh (+) blood group, in mother А
(II) Rh(-). What blood shoul be transfused during replacement blood transfusion&
Question 123Answer
a. 
A (II) Rh(+)
b. 
О (I) Rh (-)
c. 
A (II) Rh (-)
d. 
O (I) Rh (+)
e. 
В (III) Rh(-)
Feedback
The correct answer is: О (I) Rh (-)

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:
Question 74Answer
a. 
Pulmonary artery stenosis
b. 
Tricuspid regurgitation
c. 
Ventricular septal defect
d. 
Mitral insufficiency
e. 
Aortic stenosis
Feedback
The correct answer is: Aortic stenosis

A 35-year-old forestry officer was delivered to the hospital on the 7th day after the onset of the disease.
He complains of chills, elevated body temperature up to 40.0°C, sharp headache, and myalgias. On
examination his face is puffy and hyperemic, the tongue is dry, ''chalk-dusted''. In the left inguinal area, a
sharply painful conglomeration of enlarged lymph nodes can be palpated. The skin over the
conglomeration is hyperemic and tense. What etiotropic therapy should be prescribed to this patient?
Question 132Answer
a. 
Ketoconazole
b. 
Administration of heterologous serum
c. 
Ribavirin
d. 
Human immunoglobulin intravenously
e. 
Streptomycin
Feedback
The correct answer is: Streptomycin

A 58-year-old man had a moderate ischemic stroke in the right hemisphere of the brain 10 days ago. At
the time of hospitalization, the deficit score on the NIHSS scale was 9 points. He suffers from moderate
arterial hypertension, atrial fibrillation, urolithiasis, and gout (remission). What must be prescribed to the
patient for secondary prevention of stroke?
Question 58Answer
a. 
Oral anticoagulants (warfarin or NOACs --- dabigatran, rivaroxaban, apixaban)
b. 
Drugs that improve cerebral blood flow
c. 
High doses of lipid-lowering agents (e.g., atorvastatin --- 80 mg per day)
d. 
Clopidogrel, 75 mg per day
e. 
Aspirin, 100 mg per day
Feedback
The correct answer is: Oral anticoagulants (warfarin or NOACs --- dabigatran, rivaroxaban, apixaban)

A woman complains of frequent and copious foamy stools without pathological admixtures, cramp-like
pain in her periumbilical region, rumbling in the stomach, and fever. From her history, it is known that
she was eating soft-boiled duck eggs. What is the most likely causative agent of her condition?
Question 93Answer
a. 
Salmonella typhi
b. 
Escherichia coli
c. 
Shigella sonnei
d. 
V. cholerae
e. 
Salmonella enteritidis
Feedback
The correct answer is: Salmonella enteritidis

A 19-year-old patient complains of a dry cough, muscle pain, and a fever of 39°C) A sore throat and
subfebrile body temperature were observed for the last week. Objectively, the respiration is harsh.
Complete blood count shows the following: leukocytes --- $10.0 · 10^9$/L, leukocyte left shift, ESR ---
26 mm/hour. Chest X-ray shows an intensified pulmonary pattern, low-intensity focal shadows in the
lower segments of the right lung. What medicines should be prescribed in this case?
Question 129Answer
a. 
Sulfanilamides
b. 
Aminoglycosides
c. 
Second or third generation cephalosporins
d. 
Penicillin antibiotics
e. 
Macrolides
Feedback
The correct answer is: Penicillin antibiotics

On examination a man presents with the following signs: progressing weakness, loss of working ability,
rapid physical and mental fatigability, sensations of cold and hunger, and weight loss. What type of
alimentary disorder is it?
Question 63Answer
a. 
Vitamin deficiency
b. 
Dietary fiber deficiency
c. 
Mineral deficiency
d. 
Protein-energy undernutrition
e. 
Polyunsaturated fatty acid deficiency
Feedback
The correct answer is: Protein-energy undernutrition

A 20-year-old woman is being treated for anemia (hemoglobin --- 72 g/L). A year and a half ago, she had
an involuntary miscarriage with a significant blood loss at 16 weeks of pregnancy, after which the woman
developed memory deterioration, fatigability, loss of appetite, dry skin, brittle nails, and irregular
menstrual cycles. Objectively, the following is observed: blood pressure --- 80/55 mm Hg, pulse ---
54/min., height --- 168 cm, weight --- 48 kg, genital hypoplasia. What medicine would be the optimal
choice for this patient?
Question 10Answer
a. 
Hydrocortisone
b. 
Methotrexate
c. 
Hydroxychloroquine
d. 
Infliximab
e. 
Human normal immunoglobulin
Feedback
The correct answer is: Hydrocortisone
In an eight-month-old child, tonic tension of facial muscles, carpopedal spasm, and laryngospasm are
noted, followed by generalized clonic convulsions with loss of consciousness for several minutes.
Positive symptoms of Khvostek, Trousseau, Lust. What emergency condition is observed in the child?
Question 28Answer
a. Epileptic attack
b. Choking and cyanotic attack
c. Hypocalcemic (tetanic) convulsions
d. Affective respiratory convulsions
e. Febrile convulsions
Feedback The correct answer is: Hypocalcemic (tetanic) convulsions

A 38-year-old patient turned to the doctor with complaints of pain and discomfort behind the sternum,
which have lasted for the past 4 hours, the symptoms appeared after dinner. The pain sometimes
intensifies, then subsides, irradiation in the left scapula and hand is not noted. It is known from the
anamnesis that the patient's father died at the age of 55 due to an acute myocardial infarction.
Objectively observed: body temperature 37.3°C, blood pressure --- 138/85 mm Hg. st., pulse --- 115/min,
BH --- 16/min. During auscultation, vesicular breathing is determined. ECG revealed: sinus tachycardia.
Previously, the patient took 3 tablets of nitroglycerin with an interval of 5 minutes and aspirin, which
improved his condition. What are the further tactics in the management of this patient? Question
135Answer
a. Conduct a physical exercise test
b. Determination of cardiac biomarkers (CFC-MV, troponin I, N-terminal peptide of natriuretic hormone)
c. Chest CT and FGDS
d. X-ray with barium mixture
e. Give the patient a pain reliever
Feedback The correct answer is: Determination of cardiac biomarkers (CFC-MV, troponin I, N-terminal
peptide of natriuretic hormone)

A 36-year-old woman consulted a doctor with complaints of general weakness, abdominal pain, and
yellowness of the skin. These complaints gradually increased during the last 3 months. The patient
denies drug use and unprotected sex. During the physical examination: icteric sclera and yellowness
of the skin, pain upon palpation of the right subcostal region is observed. During the laboratory
examination of blood serum, the following were found: total bilirubin -- 6_4_._5_ _μm_o_l_/_l_,_
_d_i_r_e_c_t_ _--- 2_2_._7_ _μm_o_l_/_l_,_ _A_S_T_ _--- 822 U/l, ALT --- 1237 U/l, HBsAg - --
positive, HBeAg --- positive. What is the most appropriate treatment strategy for this patient?
Question 97Answer
a. Human immunoglobulin is normal
b. Prednisone and ribavirin
c. Specific immunoglobulin against hepatitis B virus
d. Hepatitis B vaccine and lamivudine
e. PEG-interferon alpha-2a
Feedback The correct answer is: PEG-interferon alfa-2a

The child is 1 year old, hospitalized on the 4th day of illness with complaints of an increase in body
temperature to 39°C, shortness of breath. Objectively: cyanosis of the nasolabial triangle, during
auscultation of the lungs on the right, breathing is sharply weakened, wet crepitus. Standard
antibacterial therapy during the first three days of treatment is ineffective. A staphylococcal
etiology of pneumonia is assumed. What antibacterial therapy is most appropriate in this case?
Question 146Select one:
A. Ampicillin
B. Penicillin
C. Azithromycin
D. Vancomycin
E. Erythromycin
Feedback The correct answer is: Vancomycin

The mother of a 12-year-old girl turned to the gynecologist to vaccinate the child against highly
oncogenic types of the human papilloma virus. From what age is it advisable to vaccinate? Question
4Answer
a. 20--21 years
b. 16--17 years old
c. 14--15 years old
d. 12--13 years old
e. 18--19 years old
Feedback The correct answer is: 12--13 years

1. A 28-year-old woman came to a gynecologist with complaints of infertility for

the last 3 years. Her menstrual function is normal. She has a history of one
artificial abortion and chronic salpingo-oophoritis. She uses no contraception. The
spermogram of her husband is normal. What method should be used first to
determine the cause of this woman's infertility?
A. Hysteroscopy
B. Hysterosalpingography
C. Laparoscopy
D. Diagnostic uterine curettage
E. Hormone testing

3. A 28-year-old woman complains of weakness, dizziness, nosebleeds, and

hemorrhages on her torso. The condition onset was 4 months ago. Objectively, her
condition is of moderate severity. There are multicolored painless hemorrhages 1-2
cm in size on her back and abdomen. The peripheral lymph nodes are not enlarged.
The liver is (-), the spleen is (+). Blood test shows the following: Hb - 120 g/L,
erythrocytes - 3.4 × 1012/L, color index - 0.9, reticulocytes - 0.9%, serum iron -
15.01 mcmol/L, leukocytes - 4.2 × 109/L, eosinophils - 2%, basophils - 0%, band
neutrophils - 7%, segmented neutrophils - 40%, monocytes - 6%, lymphocytes
45%, platelets 47.1 × 109/L, ESR – 27 mm/hour. What is the most likely diagnosis
in this case?
A. Idiopathic thrombocytopenic purpura
B. Chronic lymphocytic leukemia
C. Hemolytic anemia
D. Chronic iron-deficiency anemia

10. A 32-year-old man has a closed cerebrocranial trauma, a closed chest trauma,
and a closed right femoral fracture. His blood pressure was 100/60 mm Hg, pulse -
124/min., respiration - 28/min. Two hours after the skeletal traction was performed
under topical lidocaine anesthesia, the patient's condition suddenly became worse.
His face and neck became cyanotic, blood pressure - 60/40 mm Hg. heart rate -
160/min., respiration rate - 44/min. What complication has likely developed in this
case?
A. Pain shock
B. Fat pulmonary embolism
C. Myocardial infarction, cardiogenic shock
D. Pulmonary embolism
E. Acute posthemorrhagic anemia

11. A 51-year-old man after an overexposure to cold has developed acute pain in
his lower abdomen and a burning pain that occurs at the end of urination. Urination
occurs up to 15 times per 24 hours. The urine is turbid and contains blood. Clinical
urinalysis shows leukocytes the whole vision field and isolated erythrocytes. What
provisional diagnosis can be made?
A. Acute pyelonephritis
B. Acute urethritis
C. Acute cystitis
D. Acute glomerulonephritis
E. Urolithiasis

16. A 45-year-old woman complains of general weakness, dyspnea, and dizziness.

Within one year her hair became gray, her nails started peeling, and she developed
gustatory disorders. For the last 5 years she has been registered for regular check-
ups with a gynecologist for uterine fibromyoma. Her blood test shows the
following: erythrocytes - 3.0 × 1012/L, Hb - 76 g/L, color index - 0.7, reticulocytes
0.7%, platelets - 160 × 109/L, leukocytes - 5.0 × 109/L, eosinophils - 2%, band
neutrophils - 3%, segmented neutrophils 63%, lymphocytes - 28%, monocytes -
4%, aniso- and microcytosis, ESR - 30 mm/hour. What type of anemia can be
suspected in this case?
A. Hypoplastic anemia
B. Minkowski-Chauffard syndrome
C. Autoimmune hemolytic anemia
D. Iron-deficiency anemia
E. B12-deficiency anemia

22. On examination a man presents with the following signs: progressing

weakness, loss of working ability, rapid physical and mental fatigability, sensations
of cold and hunger, and weight loss. What type of alimentary disorder is it?
A. Vitamin deficiency
B. Mineral deficiency
C. Protein-energy undernutrition
D. Dietary fiber deficiency
E. Polyunsaturated fatty acid deficiency

25. A 57-year-old man complains of cough with profuse mucopurulent sputum (up
to 150 mL per 24 hours). Objectively, he has drumstick fingers with watch-glass
nails. Percussion produces a shortened sound over the lungs. Auscultation detects
moderate and large bubbling crackles. Complete blood count shows leukocytosis
and a left shift in the leukogram. Chest X ray shows intensified pulmonary pattern
and ring-like shadows. Bronchography detects multiple cylindrical thickenings of
the bronchi with clear margins. Make the provisional diagnosis: empyema
A. Pulmonary gangrene
B. Pulmonary echinococcosis
C. Chronic pleural empyema
D. Bronchiectasis
27. A 35-year-old woman, a polisher, complains of chills, cold bluish fingertips,
low mobility of her hand joints, and a contracted sensation in the skin of her face
and hands. Examination detects anemia. pouch-like pursing of the mouth,
thickened skin of checks and hands, pale and cold fingertips. A bandbox resonance
and isolated fine inspiratory crackles can be heard over the lungs. Blood test shows
the following: erythrocytes - 3.8*1012/L, leukocytes-4.8-109/L, ESR-45 mm/hour.
CRP++. What is the most likely diagnosis in this case?
A. Vibration disease
B. Systemic scleroderma
C. Obliterating endarteritis of the extremities
D. Raynaud's disease
E. Myxedema

28. A 59-year-old man for a month has been presenting with short-term periodical
loss of strength in his limbs on the left. Later he developed a persistent morning
weakness in the affected limbs after wakening. Objectively, he is conscious and
has central paresis of the VII and XII pairs of his cranial nerves on the left. Central
hemiparesis and hemihypersthesia are observed on the left side. What are the drugs
of choice for treatment of this man?
A. Anticoagulants
B. Hemostatics
C. Hypotensive agents
D. Diuretics
E. Corticosteroids

32. An 18-year-old young man during hospitalization complains of general

weakness, body temperature of 37.5°C, loss of appetite, nausea, heaviness in the
right subcostal region, and discolored stool and urine. The disease onset was 5 days
ago. Objectively, his skin and sclerae are slightly icteric. The liver protrudes by 3
cm and is tender to palpation. Patient's urine is dark brown, while his stool is light-
colored. He usually drinks water from a tap. What is the most likely diagnosis in
this case?
A. Viral hepatitis B
B. Leptospirosis
C. Viral hepatitis A
D. Typhoid fever
E. Malaria

4. A 30-year-old man, a cable presser, complains of inertness, memory problems,

and pain in his limbs. Objectively, he presents with skin pallor, anemia,
reticulocytosis, basophilic stippling of erythrocytes, and high levels of porphyrin in
urine. This man has the signs of the following disease:
A. Saturnism
B. Mercurialism
C. Asbestosis
D. Berylliosis
E. Siderosis

45. A 45-year-old man, provisionally diagnosed with a transient ischemic attack,

was brought by an ambulance from an aniline-producing factory. Objectively, his
skin and mucosa are cyanotic. His speech is dysarthric. The man is disoriented in
space. His blood test shows the following: erythrocytes - 4.6 × 1012/L, Hb - 143
g/L, color index - 0.9, leukocytes - 5.6 × 109/L, Heinz bodies - 14%, reticulocytes -
18%, methemoglobin - 36%, ESR – 5 mm/hour. The patient was diagnosed with a
moderately severe acute aniline intoxication. What antidote agent will be the most
effective in this case?
A. Desferal (Deferoxamine)
B. Pentacin (Calcium trisodium pentetate)
C. Methylene blue
D. Succimer
E. Sodium thiosulfate

73. A 7-year-old boy after playing with a cat suddenly developed problems with
breathing. Objectively, the boy is pale, frightened, and sits, leaning onto his arms.
His body temperature is 36.6°C, heart rate - 120/min., respiration rate 42/min.,
speaks in syllables. The exhale is long and accompanied by wheezing. Percussion
detects a bandbox resonance over the lungs. An inhalation of ventolin (salbutamol)
solution was started via a nebulizer. What can help assess the child's need for
oxygen therapy in this case?
A. Chest X-ray
B. Assessment of accessory muscles involvement
C. Spirometry
D. Pneumotachometry
E. Pulse oximetry

75. A pregnant woman at 32 weeks of gestation with the risk of preterm labor
undergoes a treatment to prevent fetal respiratory distress syndrome. What
medicine was she prescribed?
A. Gynipral (hexoprenaline)
B. Misoprostol
C. Oxytocin
D. Dexamethasone
E. Progesterone

76. A 25-year-old parturient woman is hospitalized with contractions that have

been occurring for 12 hours already. The contractions last 25 seconds, while the
intervals between them last 3-4-7 minutes. The contractions are irregular and
sharply painful, with pain spreading upwards from the lower uterine segment. The
baby is in the cephalic presentation, the head is pressed to the entrance into the
lesser pelvis. Uterine hypertonus is observed. Internal obstetric examination shows
that the cervix is smoothed and the opening of the external orifice uterus is 3 cm.
The amniotic sac is intact. Make the provisional diagnosis:
A. Discoordinated labor activity
B. Physiological course of the labor
C. Cervical dystocia
D. Primary weakness of the labor activity
E. Secondary weakness of the labor activity
79. A 36-year-old woman complains of nausea, belching, liquid stool, and a pain in
the epigastrium after meals. For the last 2 years the disease has been slowly
progressing. Objectively, her skin is pale and dry, her tongue is coated, moist, and
has imprints of the teeth on its edges. Abdominal palpation detects a diffuse pain in
the epigastrium. What test will be the most informative in this case and should be
conducted next?
A. Comprehensive complete blood count
B. Gastrointestinal X-ray
C. Fractional analysis of gastric secretion
D. Fibrogastroscopy with biopsy of the gastric mucosa
E. Abdominal CT scan

114. A 56-year-old woman has been working as a disinfector for 19 years. She
complains of general weakness, nausea, bitter taste in her mouth, heavy sensation
in her right subcostal area, and rapid fatigability. Objectively, her body
temperature is 37.1°C, the sclerae are icteric, and the liver is enlarged. Total
bilirubin is 40 mcmol/L. What is the likely diagnosis?
A. Acute cholecystitis
B. Biliary dyskinesia
C. Chronic pancreatitis
D. Chronic cholecystitis
E. Occupational toxic hepatitis

92. A 20-year-old man was hospitalized on the 9th day of the disease. He attributes
his disease to eating of insufficiently thermally processed pork. At its onset this
condition manifested in periorbital edemas and fever. Objectively, his body
temperature is 38.5°C. The face is puffy and the eyelids are markedly swollen.
Palpation of gastrocnemius muscles is sharply painful. Blood test shows hyper -
eosinophilia. What is the etiology of this disease?
A. Echinococci
B. Trichuris
C. Ascarididae
D. Trichinella
E. Leptospira
97. A man complains of a heaviness behind his sternum, periodical sensation of
food retention, and dysphagia. During X-ray the barium contrast reveals a single
pouch-like protrusion in the right anterior wall of the esophagus. The protrusion
has clear margins and a clearly defined neck. What is the most likely diagnosis in
this case?
A. Esophageal carcinoma
B. Esophageal diverticulum
C. Hiatal hernia
D. Varicose veins of the esophagus
E. Esophageal polyp

137. A 25-year-old woman was hospitalized into the gynecological department

with complaints of pain in her lower abdomen and high temperature of 39.7°C.
Objectively, her blood pressure is 120/80 mm Hg, pulse- 108/min., of satisfactory
strength and volume. The abdomen is moderately distended and sharply painful in
its lower segments. The Bloomberg's sign is positive in the hypogastrium. During
vaginal examination, the uterus and its appendages cannot be palpated because of
anterior abdominal wall rigidity. The posterior vaginal fornix is overhanging and
sharply painful. What is the most likely diagnosis in this case?
A. Acute adnexitis
B. Acute endometritis
C. Ectopic pregnancy
D. Ovarian apoplexy
E. Pelvioperitonitis

1. Human body receives from atmosphere a number of chemicals. What type the
of
action results in the combined effect that is less than the sum of isolated effects
of these
chemicals on the body?
A. Synergistic action
B. Complex action
C. Isolated action
D. *Antagonism
E. Potentiation

A three-year-old boy has been suffering from stool retention since birth. Every 3--4 days, the mother
gives her child enemas. The boy lags behind his peers in physical development. Objectively, he has pale
skin and distended abdomen. What disease can be suspected in this child?
a. Intestinal tumor
b. Peritonitis
c. Helminthiasis
d. Hirschsprung's disease
e. Coprostasis
The correct answer is: Hirschsprung's disease

A 64-year-old man came to the emergency department with complaints of swelling of the lower
extremities, lower back, and anterior abdominal wall. There is a history of chronic bronchitis with
bronchiectasis. During physical examination, body temperature is 37.2°C, blood pressure is 110/75
mm Hg, pulse is 82/min., respiratory rate is 19/min. During the laboratory examination in the general
analysis of urine (ZAS): specific gravity - 1025, protein - 9.9 g/l, leukocytes - 2-3 in the field of
vision, erythrocytes - 1-2 in the field of vision, cylinders - no. Daily proteinuria - 11.4 g/day. In the
biochemical blood analysis, total protein is 52 g/l, albumin is 30 g/l, and cholesterol is 9.6 mmol/l.
What type of kidney damage is most likely in this patient?
Question 9Select one:
A. Diabetic nephropathy, nephritic syndrome
B. AA amyloidosis, nephrotic syndrome
C. Pyelonephritis, urinary syndrome
D. Glomerulonephritis, nephritic syndrome
E. Tubulo-interstitial nephritis, nephrotic syndrome
Feedback The correct answer is: AA amyloidosis, nephrotic syndrome