Krok 2 Medicine 2007 1

1. An 8 y.o. child presents with low- cal management should be:

grade fever, arthritis, colicky abdomi-
nal pain, and a purpuric rash limited to A. Ensuring that the airway is open and
the lower extremities. laboratory studies the patient is oxygenating
reveal a guaiac-positive stool, a urinalysis B. Inserting a tongue blade
with red blood cell (RBC) casts and mild C. Administering an instravenous bolus of
proteinuria, and a normal platelet count. 50% dextrose
The most likely diagnosis is: D. Injecting 5 mg of diazepam followed by
a loading dose of phenytoin
A. Henoch-Schonlein’s vasculitis E. Inducing pentobarbital coma
B. Systemic lupus erythematosus (SLE)
C. Rocky Mountain spotted fever 6. Which gestational age gives the
D. Idiopathic thrombocytopenic purpura most accurate estimation of weeks of
E. Poststreptococcal glomerulonephritis pregnancy by uterine size?

2. A 32 y.o. woman consulted a A. Less that 12 weeks

gynecologist about having abundant B. Between 12 and 20 weeks
long menses within 3 months. Bimanual C. Between 21 and 30 weeks
investigation: the body of the uterus is D. Between 31 and 40 weeks
enlarged according to about 12 weeks E. Over 40 weeks
of pregnancy, distorted, tuberous, of
dense consistence. Appendages are not 7. A number of viable fetuses per 1000
women at the age between 15 and 44 is
palpated. Histological test of the uterus
determined by:
body mucosa: adenocystous hyperplasia
of endometrium. Optimal medical tactics: A. Genital index
B. Reproductive level
A. Surgical treatment
C. Birth rate
B. Hormonetherapy
C. Phytotherapy D. Perinatal rate
E. Obstetric rate
D. Radial therapy
E. Phase by phase vitamin therapy 8. A 21 y.o. man complains of having
morning pains in his back for the last three
3. A woman was hospitalised with full- months. The pain can be relieved during
term pregnancy. In survey: the uterus
the day and after physical exercises. Physi-
is morbid, the abdomen is tense, heart
sounds of the fetus are not auscultated. cal examination revealed reduced mobili-
ty in the lumbar part of his spine, increase
What is the most probable complication
of muscle tonus in the lumbar area and
of pregnancy?
sluch during moving. X-ray pattern of spi-
A. Premature detachment of the normally ne revealed bilateral sclerotic changes in
posed placenta the sacrolumbal part. What test will be
B. Preterm labour the most necessary for confirming a di-
C. Back occipital presentation agnosis?
D. Acute hypoxia of a fetus
A. HLA-B27
E. Hydramnion
B. ESR
4. By the end of the 1st period of physi- C. Rheumatoid factor
ological labour the clear amniotic waters D. Uric acid in blood plasma
were given vent. Contractions lasted 35-40 E. Antinuclear antibodies
sec every 4-5 min. Palpitation of the fetus 9. A 44 y.o. man has acute disarthria,
is 100 bpm. The AP is 140/90 mm Hg. Di-
right-sided Horner’s syndrome, hiccup,
agnosis:
right-sided ataxia, loss of pain sensation
A. Acute hypoxia of the fetus of his face to the right and of his body to
B. Labors before term the left. The man is conscious. Computer
C. Premature detachment of normally tomography of brain is normal. The most
posed placenta reasonable measure will be:
D. Back occipital presentation
E. Hydramnion
5. A 51 y.o. women was taken to the
emergency department in convulsive
status epilepticus. The first means of medi-
 Krok 2 Medicine 2007 2

A. Introduction of direct coagulants and A. Echocardiogram

observation B. Catheterization of left pleural cavi-
B. Endarterectomy of the right carotid ty while the outer end of catheter is
artery submerged in water
C. Endarterectomy of the left carotid C. Continued parenteral introduction of
artery fliud in order to raise AP
D. Out-patient observation D. Introduction of peripheral vasodi-
E. Surgical cerebral decompression latators in order to reduce CVP
E. Introduction of loop diuretics in order
10. A 65 y.o. man who has problems with to reduce CVP
urination as a result of benign prostate
gland adenoma dveloped fever and chi- 13. A young man has painful indurati-
ll, hypotension, sinus tachycardia. Skin ons in the peripapillary regions of both
is warm and dry. Clinical blood analysis mammary glands. The most reasonable
revealed absolute granulocytopenia. action will be:
These hemodynamic changes are most li-
kely to be caused by: A. To leave these indurations untouched
B. To remove them
A. Endotoxemia with activation of C. To cut and drain them
complement system D. To take an aspirate for bacterial
B. Secondary reflex vasodilatation as a inoculation and cytology
result of lowered cardiac output E. To administer steroids locally
C. Secondary circulation insufficiency with
retained systolic function as a result of 14. A 34 y.o. woman in her 29-th week
peripheral vasoconstriction of pregnancy, that is her 4-th labor to
D. Reflex vagus stimulation with lowered come, was admitted to the obstetric
cardiac output department with complaints of sudden
E. Secondary endothelial changes as a and painful bloody discharges from vagi-
result of bacterial lesion na that appeared 2 hours ago. The di-
scharges are profuse and contain grumes.
11. A woman in her 39-th week of Cardiac funnction of the fetus is rhytmic,
pregnancy, the second labor, has regular 150 strokes in the minute, uterus tone is
birth activity. Uterine contractions take normal. The most probable provisional
place every 3 minutes. What criteria diagnosis will be:
describe the beginning of the II labor
stage the most precisely? A. Placental presentation
B. Detachment of normally located
A. Cervical dilatation no less than 4 cm placenta
B. Cervical smoothing over 90% C. Vasa previa
C. Duration of uterine contractions more D. Bloody discharges
than 30 seconds E. Disseminated intravascular coagulation
D. Presenting part is in the lower region of syndrome
small pelvis
E. Rupture of membranes 15. A patient is 65 y.o. He has been a
smoker for 40 years. Hew has lost 10
12. A 20 y.o. man has a stab knife wound kg during the last 3 months. Complai-
in the left half of thorax close to ni- ns of pain in the epigastric area after
pple. AP is 90/60 mm Hg, Ps- 130/min, taking meals, diarrhea, jaundice. Physi-
BR- 32/min. During inspiration there is cal examination revealed enlarged, pai-
increase of pulse wave in the region of nless gallbladder. Feces are light-coloured
jugular vein, decrease of peripheral arteri- and clay-like. Blood analysis revealed
al pulse and reduction of AP. Respiratory increased level of whole and direct bili-
murmurs are unchanged. X-ray pattern of rubin, alkaline phosphotase and glutami-
thorax organs has no pecularities. After nepyruvate transferase. Clinical urine
introduction of 2 l of isotonic solution the analysis showed positive bilirubin reacti-
AP stayed low, CVP raised up to 32 cm on and negative urobilinogene reaction.
of water column. The first step in further Where is the initial process that caused
treatment of the patient will be: these changes?
 Krok 2 Medicine 2007 3

A. In pancreas measure will be to introduct:

B. In common bile duct
C. In liver A. Lidocain
D. In duodenum B. Flecainid
E. In gallbladder C. Amyodaron
D. Propafenone
16. A 75 y.o. man has acute pain in E. Veropamil
the paraumbilical region accompanied
by vomiting and feeling of abdominal 20. A 23 y.o. woman who suffers from
swelling in approximately 30 minutes insulin-dependent diabetes was admitted
after meals. He lost 10 kg during the last to the acute care department with mental
months because he doesn’t eat in order confusion, inadequate anxious behavi-
to avoid pain. Abdomen examination our, hyperhidrosis, excessive salivation,
reveals no changes in the periods between tachycardia. What examination will be a
pain attacks. Above the right femoral primary task?
artery a murmur can be auscultated, peri-
pheral pulsation in the lower extrimities is A. Blood test for sugar
weak. X-ray examination of stomach and B. Clinical blood analysis
colonoscopy reealed no changes. What is C. Plasma electrolytes test
the leading factor of this pathogenesis? D. Gaseous composition of arterial blood
E. Blood urea and creatinine test
A. Ischemia
B. Psychogenic changes 21. A 40 y.o. woman has changes of
C. Neoplastic process mammary gland. What are the most often
D. Inflammation symtomps that precede the malignizati-
E. Transient obstruction on?

17. A 75 y.o. woman with coronary heart A. Skin induration with inverted nipple
disease constantly takes warfarin. She B. Painful movable induration
was taken to the acute care department C. Painless movable induration
with complaints of sudden sensation of D. Bloody discharges from the nipple
weakness in the left half of her body and E. Pure discharges from the nipple
eyeball deviation to the left. What exami-
nation of the patient will be a primary 22. A patient who takes diuretics has
task? developed arrhythmia as a result of
cardiac glycoside overdose. What is the
A. Computer tomography of brain treatment tactics in this case?
B. Magnetic resonance tomography of
brain A. Increased potassium concentration in
C. Electroencephalogram blood
D. Ultrasonic examination of carotid B. Increased sodium consentration in
arteries blood
E. Spinal punction C. Reduced magnesium concentration in
blood
18. A 65 y.o. patient has acute pain, D. Increased calcium level in blood
paresthesia, paleness of his left extremi- E. -
ty. Pulse in the a. dorsalis pedis is absent.
There is skin coldness and paleness 23. Name a statistical observation unit
that gradually spreads upwards. These for determination of influence amount
symptoms are most likely to be the evi- of bloodsugar on the healing of wound’s
dence of: surface in a postoperative period:

A. Arterial occlusion A. The patient in a postoperative period

B. Thrombophlebitis of superficial veins B. An amount of bloodsugar
C. Hernia of lumbar disc C. Blood analysis
D. Thrombophelebitis of deep veins D. The patient who has a wound surface
E. - E. The patient who was discharged on an
after-care
19. A 58 y.o. patient developed acute
myocardium infarction 4 hours ago, now 24. The parameter of infantile mortality
he is in the acute care department. for the last year was - 16,3, in present year
ECG registers short paroxysms of ventri- - 15,7. Name a kind of the diagram that can
cular tachycardia. The most appropriate be used for a graphic representation of it:
 Krok 2 Medicine 2007 4

50%, level of noise 30 dB. What occupati-

A. Stylar onal hazard is the principal one under
B. Linear these conditions?
C. Intrastylar
D. Sector A. Air pollution with anesthetic
E. Radial B. Improper occupational microclimate
C. High level of noise
25. A 25 y.o. patient complains of pain D. Mental overfatigue
in the I finger on the right hand. On E. Compelled working pose
examination: the finger is homogeneously
hydropic, in bent position. On attempt 30. What guarantees against the
to unbend the finger the pain is getti- preconceived attitude to the physician in
ng worse. Acute pain appears during cases of professional law violations do you
the probe in ligament projection. What know?
decease is the most likely?
A. Sanction of public prosecutor, inquiry
A. Thecal whitlow (ligament panaritium) by preliminary investigator of prosecutor’s
B. Subcutaneous panaritium office, committee of experts
C. Articular (joint) panaritium B. Draw up a statement about forensic
D. Bone panaritium medical examination
E. Paronychia C. Conduct an inquiry by preliminary
investigator of police department
26. A 9 y.o. child with diagnosis "chronic D. Utilisation copy of medical documents
tonsillitis"stands dispanserization control. E. Conduct forensic medical examination
Within 1 year of observation there was by district forensic medicine expert
one exacerbation of disease. Physical
condition is satisfactory. The general state 31. A 34 y.o. patient 3 hours ago was bi-
is not infringed. Define group of health: tten by a dog. He has got a non-bleeding
wound in his left arm caused by the dog’s
A. III (a) bite. What surgical care would you provi-
B. II-d de to the patient?
C. I-st
D. III (b) A. Wound bathing with detergent water
E. III (c) and antiseptic application
B. Aseptic bandage
27. An engineer-chemist at the age of 47 C. Cream bandage
often fells ill with an occupational skin di- D. Complete suturing of the wound
sease. Who makes a decision to transfer E. Incomplete suturing of the wound
him to other job accepts?
32. A 37 y.o. patient complains of pain in
A. DCC the right arm which increases during moti-
B. A head physician on, raised body temperature up to 390 C.
C. The attending physician In the right cubital fossa there is a trace of
D. The chief of shop injection, hyperemia and thickening along
E. MSEC the vein. Your diagnosis?
28. A 5 tons milk batch was sampled. A. Phlebit
The lab analysis revealed: fat content 2%, B. Phlegmon
specific density - 1,04 g/cm3 , acidity - 210 Т, C. Abscess
reductase probe - weak-positive. What D. Inflammation of lymph
way is the product to be used in? E. Erysipelas
A. Sell but inform customers about milk 33. A 38 y.o. woman was hospitalized to
quality the surgical unit with acute abdominal
B. Discard for animal feeding pain irradiating to the spine and vomiti-
C. Technical utilization ng. On laparocentesis hemmorhagic fluid
D. Sell without limitations is obtained. What disease is suspected?
E. Do the product away
29. An anestesiologist gives narcosis to the
patient, he uses a non-reversive contour.
Anesthetic is halothane. Air temperature
in the operation room is 210
, humidity
 Krok 2 Medicine 2007 5

A. Acute pancreatitis
B. Renal colic A. Determination of the level of
C. Acute enterocolitis Gonadotropins
D. Perforative gastric ulcer B. USI of organs of a small pelvis
E. Acute appendicitis C. Progesteron assay
D. Computer tomography of the head
34. A 40 weeks pregnant woman in intri- E. Determination of the contents of
nsic obstetric investigation: the cervix of a Testosteron-Depotum in Serum of blood
uterus is undeveloped. The oxytocin test
is negative. Upon inspection at 32 weeks 38. For the persons who live in a hot area
it is revealed: AP- 140/90 mm Hg, protei- after an accident at a nuclear object, the
nuria 1 g/l, peripheric edemata. Reflexes greatest risk within the first decade is
are normal. Choose the most correct tacti- represented by cancer of:
cs of guiding the pregnant:
A. Thyroid gland
A. Laborstimulation after preparation B. Skin
B. Strict bed regimen for 1 month C. Reproduction system organs
C. Complex therapy of gestosis for 2 days D. Breast
D. Cesarean section immediately E. Lungs
E. Complex therapy of gestosis for 7 days
39. A 34 y.o. woman in the 10-th week
35. A 41 y.o. patient was admitted to of gestation (the second pregnancy)
the intensive care unit with hemorrhagic consulted a doctor of antenatal clinic with
shock due to gastric bleeding. He has a hi- purpose of statement on the dyspensary
story of hepatitis B during the last 5 years. record. In the previous pregnancy there
The source of bleeding are esophageal vei- took place hydramnion, the child’s birth
ns. What is the most effective method for weight was 4086. What method of exami-
control of the bleeding? nation is necessary for carrying out, first
of all?
A. Introduction of obturator nasogastric
tube A. The test for tolerance to glucose
B. Intravenous administration of pituitrin B. Determination of the contents of
C. Hemostatic therapy fetoproteinum
D. Operation C. Bacteriological investigation of di-
E. Administration of plasma scharge from the vagina
D. A cardiophonography of fetus
36. A woman had the rise of temperature E. USI of the fetus
up to 390
on the first day after labour.
The rupture of fetal membranes took 40. Patient 22 y.o., was admitted to trauma
place 36 hours before labour. The investi- center with complains of pain in the
gation of the bacterial flora of cervix left ankle joint, which increased while
of the uterus revealed hemocatheretic movements and weight bearing. On the
streptococcus of group A. The uterus clinical examination it was found, that the
body is soft, tender. Discharges are bloody, patient had the closed fracture of medial
mixed with pus. Specify the most probable malleolus without displacement. In which
postnatal complication: position the foot has to be fixed in plaster
cast?
A. Metroendometritis
B. Thrombophlebitis of pelvic veins A. At right angle with varus positioning of
C. Infected hematoma the foot
D. Infection of the urinary system B. In position of planter flexion of foot
E. Apostatis of junctures after the episi- C. In position of pronation
otomy D. In position of supination
E. In position of dorsal flexion of foot
37. A 24 y.o. patient 13 months after
the first labour consulted a doctor about 41. The 10 y.o. boy has complains on
amenorrhea. Pregnancy has concluded headache, weakness, fever 400
, vomiting,
by a Cesarean section concerning to a expressed dyspnea, pale skin with flush on
premature detachment of normally posed right cheek, lag of right hemithorax respi-
placenta hemorrhage has made low fi- ratory movement, dullness on percussi-
delity 2000 ml owing to breakdown of on over low lobe of right lung, weakness
coagulability of blood. Choose the most of vesicular respiration in this zone. The
suitable investigation: abdomen is painless and soft at palpati-
 Krok 2 Medicine 2007 6

on. Which disease lead to these symptoms A. Encephalitis

and signs? B. Meningitis
C. Meningoencephalitis
A. Pneumonia croupousa D. Myelitis
B. Intestinal infection E. Neurotoxic syndrome
C. Acute appendicitis
D. Acute cholecystitis 46. A 7 y.o. girl fell ill abruptly: fever,
E. Flu headache, severe sore throat, vomiti-
ng. Minute bright red rash appear in
42. The patient with acute respiratory vi- her reddened skin in 3 hours. It is
ral infection (3-rd day of disease) has more intensive in axillae and groin.
complaints on pain in lumbar region, Mucous membrane of oropharynx is
nausea, dysuria, oliguria. Urinalysis - hyperemic. Greyish patches is on the
hematuria (100-200 RBC in eyeshot tonsills. Submaxillary lymph nodes are
spot), specific gravity - 1002. The blood enlarged and painful. What is your di-
creatinin level is 0,18 mmol/L, potassium agnosis?
level - 6,4 mmol/L. Make the diagnosis:
A. Scarlet fever
A. Acute interstitial nephritis B. Measles
B. Acute renal failure C. Rubella
C. Acute glomerylonephritis D. Pseudotuberculosis
D. Acute cystitis E. Enteroviral infection
E. Acute renal colic
47. The child has complains of the "ni-
43. The 7 m.o. infant is suffering from ght"and "hungry"abdominal pains. At fi-
acute pneumonia which was compli- broscopy in area a bulbus ofa duodenum
cated by cardiovascular insufficiency and the ulcerrative defect of 4 mms diameter
respiratory failure of II degree. The is found, the floor is obtected with a fi-
accompanied diagnosis is malnutrition brin, (H.p +). Administer the optimum
of II degree. Choose the best variant of schemes of treatment:
therapy:
A. Omeprasole - Trichopolum - Clari-
A. Ampiox and Amicacin tromicin
B. Macropen and Penicillin B. De-nol
C. Penicillin and Ampiox C. Maalox - Ranitidin
D. Gentamycin and Macropen D. Vicalinum - Ranitidin
E. Ampiox and Polymixin E. Trichopolum
44. A 2 y.o. girl has been ill for 3 48. 6 m.o. infant was born with body’s
days. Today she has low grade fever, mass 3 kg and length 50 cm. He is given
severe catarrhal presentations, slight natural feeding. How many times per day
maculopapular rash on her buttocks and the infant should be fed?
enlarged occipital lymph nodes. What is
your diagnosis? A. 5
B. 7
A. Rubella C. 6
B. Scarlet fever D. 8
C. Measles E. 4
D. Adenoviral infection
E. Pseudotuberculosis 49. A 40 y.o. patient with rheumatic heart
disease complains of anorexia, weakness
45. A 7 y.o. girl has mild form of varicella. and loss of weight, breathlessness and
Headache, weakness, vertigo, tremor of swelling of feet. The patient had tooth
her limbs, ataxia, then mental confusion extraction one month ago. On examinati-
appeared on the 5th day of illness. Meni- on: t0 - 390 C, Ps- 100/min. Auscultation: di-
ngeal signs are negative. Cerebrospinal astolic murmur in the mitral area. Petechi-
fluid examination is normal. How can you al lesion around the clavicle; spleen was
explain these signs? palpable.
 Krok 2 Medicine 2007 7

A. Subacute bacteria endocarditis "terminal film", "blood dew") have been

B. Recurrence of rheumatic fever revealed on examination of a patient.
C. Thrombocytopenia purpura What disease should you think about?
D. Mitral stenosis
E. Aortic stenosis A. Psoriasis
B. Lichen ruber planus
50. A patient with nosocomial pneumonia C. Vasculitis
presents signs of collapse. Which of D. Seborrhea
the following pneumonia complications E. Ritter’s disease
is most likely to be accompanied with
collapse? 55. Patient 27 y.o. was hospitalized to the
psychiatric hospital for the 4-th time duri-
A. Septic shock ng 2 years. Heard voices commenting on
B. Exudative pleuritis his actions, had delusions of persecution
C. Bronchial obstruction (was sure that the Mafia wanted to ki-
D. Toxic hepatitis ll him). After a course of treatment with
E. Emphysema neuroleptics was discharged from hospital
with the diagnosis of schizophrenia, state
51. A 38 y.o. patient has been treated in a
of remission. The secondary prevention of
hospital. A fever of 390 C, chest pain which the relapses of schizophrenia requires:
is worsened by breathing, cough, browni-
sh sputum appeared on the 7-th day of the A. Supportive treatment with neuroleptics
treatment. Chest X- ray shows left lower of prolonged action
lobe infiltrate. Which of the following is B. Long-term hospitalization
the treatment of choice for this patient? C. Psychiatric observation
D. Participation in a self-help group
A. Cephalosporins of the III generation E. Psychoanalytic treatment
B. Penicillin
C. Erythromycin 56. A 42 y.o. woman works at
D. Tetracycline the factory on the fabrication of
E. Streptomycin mercury thermometers, complains of the
headache, swoons, reduction of memory,
52. A 62 y.o. patient suffers from DM-2. small and frequent flutter of fingers of
Diabetes is being compensated by diet drawn hands, the eyelids and the tongue,
and Maninilum. Patient has to undergo an bleeding gums, gingivitis. What preparati-
operation on inguinal hernia. What tactics on is it nessesary to use for the elimination
of hypoglycemic therapy should be used? of mercury from the organism?
A. Prescribe fast-acting insulin A. Unithiol
B. Give Glurenorm in place of Maninilum B. Pentoxil
C. Continue with the current therapy C. Magnesium sulphate
D. Prescribe long-acting insulin D. Sodium hydrate of carbon
E. Prescribe guanyl guanidines E. Seduxen
53. A patient of 32 y.o. complains of severe 57. The disease began acutely. The
weakness, tremor of extremities. Objecti- frequent watery stool developed 6 hours
ve examination: body weight loss, wet and ago. The body’s temperature is normal.
warm skin. The thyroid gland is enlarged Then the vomiting was joined. On exami-
up to the 3-rd degree, painless, elastic. Ps- nation: his voice is hoarse, eyes are deeply
108/min. BP- 160/55 mm Hg. There are no sunken in the orbits. The pulse is frequent.
other abnormalties. The diagnosis is: Blood pressure is low. There is no urine.
A. Diffuse toxic goiter of the 3-rd degree, What is the preliminary diagnosis?
thyrotoxicosis of the average degree A. Cholera
B. Diffuse euthyroid goiter of the 3-rd B. Toxic food-borne infection
degree C. Salmonellosis
C. Chronic autoimmune thyroiditis, D. Dysentery
hypertrophic type E. Typhoid fever
D. Chronic fibrous thyroiditis
E. Toxiferous adenoma of the thyroid 58. A 28 y.o. man fell seriously ill, he feels
gland chill, has got a fever, body temperature
raised up to 38, 50
, paroxysmal pain in
54. A triad of symptoms ("stearing spot", the left iliac region, frequent defecation
 Krok 2 Medicine 2007 8

in form of fluid bloody and mucous mass.

Abdomen palpation reveals painfulness A. Doxazosin
in its left half, sigmoid colon is spasmed. B. Labetalol
What is the most probable diagnosis? C. Phetolamine
D. Propranolol
A. Acute dysentery E. Isoproterenol
B. Amebiasis
C. Colibacillosis 63. A 30 y.o. man presents with a history
D. Nonspecific ulcerative colitis of recurrent pneumonias and a chronic
E. Malignant tumors of large intestine cough production of foul smelling, pi-
rulent sputum, ocassionally glood tinged,
59. The patient was admitted to the which is worse in the morning and on lying
hospital on the 7-th day of the disease down. On physical examination, the pati-
with complaints of high temperature, ent appears chronically ill with clubbing
headache, pain in the muscles, especi- of fingers, inspiratory rales at the base of
ally in calf muscles. The dermal lungs posteriorly. Most likely diagnosis:
integuments and scleras are icteric. There
is hemorrhagic rash on the skin. Urine A. Bronchoectasis
is bloody. The patient went fishing two B. Chronic bronchitis
weeks ago. What is the diagnosis? C. Disseminated pulmonary tuberculosis
D. Pulmonary neoplasm
A. Leptospirosis E. Chronic obstructive emphysema
B. Yersiniosis
C. Salmonellosis 64. The family doctor examined a patient
D. Brucellosis and diagnosed an acute bleeding of an
E. Trichinellosis intestine. What is the doctor’s professi-
onal tactics in this situation?
60. A 43 y.o. patient was admitted to
the hospital with complaints of high A. The urgent hospitalization in to the
temperature of the body and severe surgical department
headache. On examination: carbuncle B. Aminocapronic acid intravenously
is revealed on the forearm. There are C. The urgent hospitalization in to tthe
intense edema around it, insignificant herapeutic department
pain, regional lymphadenitis. The patient D. Treatment at a day time hospital
is a worker of cattle-ranch. What disease E. Treatment at home
is it necessary to think about first?
65. A 19 y.o. girl was admitted to
A. Anthrax Emergency Department: unconsionsness
B. Carcinoma of skin state, cyanosis, myotic pupil, superficial
C. Erysipelas breathing - 12/min. BP- 90/60 mm Hg, Ps-
D. Erysipeloid 78/min. Choose the action corresponding
E. Eczema to this clinical situation:
61. A 16 y.o. female presents with abdomi- A. Controlled respiration
nal pain and purpuric spots on the B. Gastric lavage
skin. Laboratory investigations reveals a C. Oxygen inhalation
normal platelet count, with haematuria D. Caffeine injection
and proteinuria.The most likely diagnosis: E. Cordiamine injection
A. Schonlein-Henoch purpura 66. A 58 y.o. man complaines of severe
B. Haemolytic uraemic syndrome inspiratory dyspnea and expectorati-
C. Thrombotic thrombocytopenic purpura on of frothy and blood-tinged sputum.
D. Heavy metal poisoning He has been suffering from essential
E. Sub acute bacterial endocarditis hypertension and ischemic heart disease.
On examination: acrocyanosis, "bubbli-
62. A 60 y.o. asthmatic man comes for a ng"breathing, Ps- 30/min, BP- 230/130 mm
check up and complains that he is havi- Hg, bilateral rales. Choose medicines for
ng some difficulty in "starting to urinate". treatment.
Physical examination indicates that the
man has blood pressure of 160/100 mm
Hg, and a slight enlarged prostate. Whi-
ch of the following medications would be
useful in treating both of these conditions:
 Krok 2 Medicine 2007 9

A. Morphine, furosemide, nitroprusside A. Ultrasound examination of the

sodium gallbladder
B. Theophylline, prednisolon B. Liver function tests
C. Albuterol, atropine, papaverine C. X-ray examination of the gastrointesti-
D. Strophanthine, potassium chloride, nal tract
plathyphylline D. Ultrasound study of the pancreas
E. Cordiamine, isoproterenol E. Blood cell count
67. A 41 y.o. woman complains of 70. A 25 y.o. woman complained of fati-
weakness, fatigue, fever up to 380 C, rash gue, hair loss and brittle nails. The exami-
on the face skin, pain in the wrists and nation revealed pallor of skin, Ps- 94/min,
the elbows. On physical examination: BP- 110/70 mm Hg. On blood count: Hb-
erythematous rash on the cheeks with 90 g/L, RBC- 3, 5·1012/L, C.I.- 0,7; ESR- 20
"butterfly"look, the wrists and elbow joi- mm/h. Serum iron level was 8,7 mcmol/l.
nts are involved symmetrically, swollen, What treatment would you initiate?
sensitive, friction rub over the lungs,
the heart sounds are weak, regular, HR- A. Ferrous sulfate orally
88/min, BP- 160/95 mm Hg. Hematology B. Iron dextrin injections
shows anemia, leucopenia, lymphopenia; C. Vitamin B12 intramuscularly
on urinalysis: proteinuria, leukocyturia, D. Blood transfusion
casts. What is the main mechanism of di- E. Packed RBCs transfusion
sease development?
71. A 38 y.o. woman is seriously ill. She
A. Production of antibodies to double- complains of frequent paroxysms of expi-
stranded DNA ratory dyspnea. The last paroxysm lasted
B. Production of myocytes antibodies over 12 hours and failed to respond to
C. Production of antibodies to endothelial theophylline. The skin is palish gray, moi-
cells st, RR of 26/min. On auscultation, breath
D. Production of myosin antibodies sounds are absent over some areas. Your
E. Production of antimitochondrial anti- preliminary diagnosis?
bodies
A. Bronchial asthma, status asthmaticus
68. A 56 y.o. woman has an acute onset of B. Chronic obstructive bronchitis
fever up to 390 C with chills, cough, and C. Atopic bronchial asthma, respiratory
pain on respiration in the right side of failure of the III degree
her chest. On physical examination: HR- D. Bronchiectasis, respiratory failure of
90/min, BP- 95/60 mm Hg, RR- 26/min. the II-III degree
There is dullness over the right lung on E. Ischemic heart disease, pulmonary
percussion. On X-ray: infiltrate in the ri- edema
ght middle lobe of the lung. What is the 72. A 19 y.o. girl admitted to the hospi-
diagnosis? tal complained of pain in the knee and
A. Community-acquired lobar pneumonia fever of 38, 60 C. She is ill for 2 weeks after
with moderate severity acute tonsillitis. On exam, hyperemia and
B. Community-acquired swelling of both knees, temperature is
bronchopneumonia 37, 40C, HR- 94/min, BP- 120/80 mm Hg,
C. Acute pleurisy and heart border is displaced to the left;
D. Acute lung abscess S1 is weak, systolic murmur is present.
E. Hospital-acquired lobar pneumonia Total blood count shows the following:
Hb- 120 g/L, WBC- 9, 8 · 109 /L, ESR of
69. A 50 y.o. woman for 1 year complai- 30 mm/L. ECG findings: the rhythm is
ned of attacks of right subcostal pain after regular, PQ = 0,24 sec. What is a causative
fatty meal. Last week the attacks have agent of the disease?
repeated every day and become more pai-
nful. What diagnostic study would you A. Beta-hemolytic streptococci
recommend? B. Viral-bacterial association
C. Autoimmune disorder
D. Staphylococci
E. Ricchetsia
73. A 42 y.o. woman complains of dyspnea,
edema of the legs, and tachycardia during
 Krok 2 Medicine 2007 10

small physical exertion. Heart borders are

displaced to the left and S1 is accentuated, A. 18-45 days after conception
there is diastolic murmur on apex. The li- B. The first 7 days
ver is enlarged by 5 cm. What is the cause C. 10-14 days after conception
of heart failure? D. 90-120 days after conception
E. The third trimester
A. Mitral stenosis
B. Mitral regurgitation 78. A 7 d.o. boy is admitted to the hospital
C. Tricuspid stenosis for evaluation of vomiting and dehydrati-
D. Tricuspid regurgitation on. Physical examination is otherwi-
E. Aortic stenosis se normal except for minimal hyperpi-
gmentation of the nipples. Serum sodi-
74. A 54 y.o. woman complains of increasi- um and potassium concentrations are 120
ng fatigue and easy bruising of 3 weeks’ meq/L and 9 meq/L respectively. The most
duration. Physical findings included pale, likely diagnosis is:
scattered ecchymoses and petechiae and
mild hepatosplenomegaly. In blood: RBC- A. Congenital adrenal hyperplasia
2, 5 · 1012 /L; Hb- 73 g/L; HCT- 20%; PLT- B. Pyloric stenosis
23 · 109/L; and WBC- 162 · 109/L with 82% C. Secondary hypothyroidism
blasts, that contained Auric rods; peroxi- D. Panhypopituitarism
dase stain was positive. What is the most E. Hyperaldosteronism
probable diagnosis? 79. A 7 y.o. boy has crampy abdomi-
A. Acute leukemia nal pain and a rash on the back of
B. Chronic leukemia his legs and buttocks as well as on
C. Thrombocytopenia the extensor surfaces of his forearms.
D. Hemolytic anemia Laboratory analysis reveals proteinuria
E. Megaloblastic anemia and microhematuria. He is most likely to
be affected by:
75. A 39 y.o. woman complaines of
squeezed epigastric pain 1 hour after A. Anaphylactoid purpura
meal and heartburn. She had been ill B. Systemic lupus erythematosus
for 2 years. On palpation, there was C. Poststreptococcal glomerulonephritis
moderate tenderness in pyloroduodenal D. Polyarteritis nodosa
area. Antral gastritis was revealed on E. Dermatomyositis
gastroscopy. What study can establish 80. A 27 y.o. patient has been havi-
genesis of the disease? ng for almost a year fatigue, hyperhi-
A. Revealing of Helicobacter infection in drosis, heaviness in the left hypochondri-
gastric mucosa um, especially after meals. Objectively:
B. Detection of autoantibodies in the spleen and liver enlargement. In blood:
serum erythrocytes - 3, 2 · 1012 /l, Hb- 100
C. Gastrin level in blood g/l, colour index - 0,87, leukocutes -
D. Examination of stomach secretion 100 · 109 /l, basophils - 7%, eosinophils -
E. Examination of stomach motor function 5%, myelocytes - 15%, juveniles - 16%,
stab neutrophils - 10%, segmentonuclear
76. A male, 50 y.o., has a black flat mole leukocytes - 45%, lymphocytes - 2%,
on the skin of the leg for 10 years. Si- monocytes - 0%, reticulocytes - 0,3%,
nce 4 months ago the shapes of the thrombocytes - 400 · 109 /l, ESR- 25 mm/h.
mole become irregular. What diagnostic What is the most probable diagnosis?
methods should be used?
A. Chronic myeloleukosis
A. Excision biopsy B. Chronic lympholeukosis
B. Fine needle biopsy C. Acute leukosis
C. Smear for microscopic examination D. Erythremia
D. Incision biopsy E. Hepatocirrhosis
E. Thermography
81. A 28 y.o. woman comes to the
77. The highest risk of congenital anomali- Emergency Room with a slightly
es probably occurs when human embryos reddened, painful "knot", 8 cm above
or fetuses are exposed to ionizing radi- the medial malleolus. Examination in
ation. During which part of gestational the standing position demonstrates a di-
period does it occur? stended vein above and below the mass.
 Krok 2 Medicine 2007 11

There are no other abnormalities on nd of complications should we think about

physical examination. The most likely di- first of all?
agnosis is:
A. Intestinal haemorrhage
A. Superficial venous thrombosis B. Thrombophlebitis
B. Early deep vein thrombosis C. Meningitis
C. Insect bite D. Nephroso-nephritis
D. Cellulitis E. Hepatite
E. Subcutaneous hematoma
86. The patients has sustained blunt
82. A patient with a history of coronary trauma to the chest. Which of the followi-
artery disease and atrial fibrillation has ng would most likely be the cause of acute
the onset of sudden pain and weakness of cardiopulmonary collapse?
the left leg. Examination reveals a cool,
pale extremity with absent pulses below A. Pneumothorax
the groin and normal contralateral leg. B. Hemothorax
The most likely diagnosis is: C. Pulmonary contusion
D. Rib fractures
A. Arterial embolism E. Acute adult respiratory distress
B. Arterial thrombosis syndrome (ARDS)
C. Acute thrombophlebitis
D. Cerebrovascular accident 87. A patient has got pain in the axillary
E. Dissecting aortic aneurysm area, rise of temperature developed 10
hours ago. On examination: shaky gait is
83. A 30 y.o. man complains of sharp evident, the tongue is coated with white
pain in the right ear, hearing loss, hi- coating. The pulse is frequent. The painful
gh temperature for three days. Objecti- lymphatic nodes are revealed in the axi-
vely: right ear whispering language - 0,5 llary area. The skin is erythematous and
m, external ear is intact, otoscopically glistering over the lymphatic nodes. What
- eardrum protrusion, hyperemia and is the most probable diagnosis?
swelling, loss of landmarks. What disease
is it? A. Bubonic plague
B. Acute purulent lymphadenitis
A. Acute purulent otitis media C. Lymphogranulomatosis
B. Acute mastoiditis D. Anthrax
C. Chronic secretory otitis media E. Tularemia
D. Chronic purulent otitis media
E. Eustachian tube disfunction 88. A 56 y.o. patient has worked at the
aluminium plant over 20 years. Within 3
84. A 22 y.o. man complains of acute last years he has got loosening of teeth,
throat pain, increasing upon swallowing bone and joint pains, piercing pains in
during 3 days. Body temperature 38, 30
, heart region, vomiting. The provisional
neck lymph nodules are slightly enlarged diagnosis is:
and painful. Pharyngoscopically - tonsi-
lar hyperemia, enlargement and edema, A. Fluorine intoxication
tonsils are covered by round yellow fi- B. Mercury intoxication
brinous patches around crypts openings. C. Lead intoxication
Beta-haemolytic streptococcus in swab D. Phosphorus intoxication
analysis. What is the diagnosis? E. Manganese intoxication

A. Acute membranous tonsilitis 89. A 34 y.o. patient has been suffering

B. Acute follicular tonsilitis from pulmonary tuberculosis for 7 years;
C. Pharyngeal diphtheria he complains of muscle feebleness, weight
D. Infectious mononucleosis loss, diarrheas, increased frequency of uri-
E. Pharyngeal candidosis nation. Objectively: hyperpigmentation of
skin, gums, internal cheek surfaces. AP is
85. A patient is staying in the hospital with 90/58 mm Hg. Blood count: erythrocutes
the diagnosis of abdominal typhus. Duri- - 3, 1 · 1012 /L, Hb- 95 g/L, C.I.- 0,92;
ng the 3-d week from the beginning of the leukocytes - 9, 4 · 109 /L, eosinophils
disease the patient stopped keeping di- - 7, segmentonuclear leukocytes - 45,
et and confinement to bed. As a result stab neutrophils - 1, lymphocytes - 40,
the body temperature and rapid pulse monocytes - 7, Na+ - 115 mmole/L, + -
decreased and melena appeared. What ki- 7,3 mmole/L. What is the preliminary di-
 Krok 2 Medicine 2007 12

agnosis? A. IHD. Unstable angina

B. Cardialgia due to spine problem
A. Primary insufficiency of adrenal cortex C. IHD. Functional Class II angina
B. Pheochromocytoma D. Myocarditis
C. Primary hyperaldosteronism E. Myocardial dystrophy
D. Congenital adrenal hyperplasia
E. Diabetes insipidus 94. A full-term child survived antenatal
and intranatal hypoxia, it was born in
90. 3 weeks ago a patient was ill with asphyxia (2-5 points on Apgar score).
tonsillitis. Clinical examination reveals After birth the child has progressi-
edema, arterial hypertension, hematuria, ng excitability, there are also vomi-
proteinuria (1,8 g/per day), granular and ting, nystagmus, spasms, strabismus,
erythrocital casts. What is the preliminary spontaneous Moro’s and Babinsky’s
diagnosis? reflexes. What localization of intracrani-
al hemorrhage is the most probable?
A. Glomerulonephritis
B. Cystitis A. Subarachnoid hemorrhage
C. Pyelonephritis B. Small cerebral tissue hemorrhages
D. Intestinal nephritis C. Subdural hemorrhage
E. Renal amyloidosis D. Periventricular hemorrhages
E. Hemorrhages into the brain ventricles
91. A patient complains of feeling heavi-
ness behind his breast bone, periodical 95. The patient 25 y.o. was admitted on the
sensation of food stoppage, dysphagy. 1st day of the disease with complaints of
During the X-ray examination bari- double vision in the eyes, heavy breathi-
um contrast revealed a single saccular ng. The day before the patient ate home-
outpouching of anterodextral esophagus made mushrooms. On objective exami-
wall with regular contours and rigidly nation: paleness, widened pupils, disorder
outlined neck. What is the most probable of swallowing, bradycardia, constipation
diagnosis? are marked. What is the diagnosis?
A. Esophageal diverticulum A. Botulism
B. Cancer of esophagus B. Yersiniosis
C. Hiatal hernia C. Leptospirosis
D. Varix dilatation of esophageal veins D. Salmonellosis, gastrointestinal form
E. Esophageal polyp E. Lambliasis
92. A 40 y.o. patient complains of yellowi- 96. A healthy 75 y.o. woman who leads
sh discharges from the vagina. Bimanual a moderately active way of life went
examination: no pathological changes. through a preventive examination that
The smear contains Trichomonas vaginalis revealed serum concentration of common
and blended flora. Colposcopy: two hazy cholesterol at the rate of 5,1 mmol/l
fields on the front labium, with a negative and HDL (high-density lipoproteins)
Iodum test. Your tactics: cholesterol at the rate of 70 mg/dl.
ECG reveals no pathology. What dietary
A. Treatment of specific colpitis and with recommendation is the most adequate?
the subsequent biopsy
B. Diathermocoagulation of the cervix of A. Any dietary changes are necessary
the uterus B. Decrease of cholesterol consumption
C. Specific treatment of Trichomonas C. Decrease of saturated fats consumption
colpitis D. Decrease of carbohydrates consumpti-
D. Cervix ectomy on
E. Cryolysis of cervix of the uterus E. Increase of cellulose consumption
93. A 52 y.o. patient with previously functi- 97. Laparotomy was performed to a 54
onal Class II angina complains of 5 days y.o. woman on account of big formation
of intensified and prolonged retrosternal in pelvis that turned out to be one-sided
pains, decreased exercise tolerance. Angi- ovarian tumor along with considerable
na is less responsive to Nitroglycerinum. omental metastases. The most appropri-
Which of the following diagnosis is most ate intraoperative tactics involves:
likely?
 Krok 2 Medicine 2007 13

A. Ablation of omentum, uterus and both A. Artesian well water

ovaries with tubes B. Spring water
B. Biopsy of omentum C. River water
C. Biopsy of an ovary D. Rain water
D. Ablation of an ovary and omental E. Water from melted snow
metastases
E. Ablation of omentum and both ovaries 102. A 10 y.o. boy with hemophilia has
with tubes signs of acute respiratory viral infection
with fever. What of the mentioned anti-
98. Heart auscultation of a 16 y.o. boy wi- febrile medications are contraindicated to
thout clinical symptoms revealed accent this patient?
of the S II and systolic murmur above
the pulmonary artery. Heart sounds are A. Acetylsalicylic acid
resonant, rhythmic. What is the most B. Analgin
probable diagnosis? C. Pipolphen
D. Paracetamol
A. Functional murmur E. Panadol extra
B. Stenosis of pulmonary artery valve
C. Insufficiency of pulmonary artery valve 103. A full-term newborn child has a di-
D. Nonclosure of Botallo’s duct agnosis newborn’s Rh-factor hemolytic di-
E. Defection of interatrial septum sease. Bilirubin rate is critical. The child’s
blood group is B(III), his mother’s blood
99. A 74 y.o. patient has been sufferi- group - A(II). The child has indication for
ng from hypertension for 20 years. He hemotransfusion. What donor blood must
complains of frequent headache, dizzi- be chosen?
ness, he takes enalapril. Objectively:
accent of the SII above aorta, Ps- 84 bpm, A. Blood group B(III)Rh−
rhythmic, AP- 180/120 mm Hg. What B. Blood group A(II)Rh−
group of hypotensive medications could C. Blood group B(III)Rh+
be additionally prescribed under consi- D. Blood group A(II)Rh+
deration of the patient’s age? E. Blood group O(I)Rh−
A. Thiazide diuretics 104. At year-end hospital administration
B. Loop diuretics has obtained the following data: annual
C. β-adrenoceptor blockers number of treated patients and average
D. α-adrenoceptor blockers annual number of beds used for patient’s
E. Central sympatholytics treatment. What index of hospital work
can be calculated based upon this data?
100. In treatment and prevention establi-
shments, regardless of their organisational A. Bed turnover
and proprietary form, the rights of pati- B. Bed resources of the hospital
ents should be observed. Which of these C. Average annual bed occupancy
rights are the most significant? D. Average duration of patients presence
in the hospital
A. The right to the protection of the E. Average bed idle time
patient’s interests
B. The right to the free choice 105. A 52 y.o. patient fell from 3 m hei-
C. The right to the information ght on the flat ground with the right
D. The right to be heard lumbar area. He complains of pain in
E. The right to the protection from this area. There is microhematuria in the
incompetence urea. Excretory urography revealed that
kidney’s functioning is satisfactory. What
101. A military unit stopped for 3- is the most probable diagnosis?
day’s rest in inhabited locality after a
long march. The sanitary-epidemiological A. Kidney’s contusion
reconnaissance found several water B. Subcapsular kidney’s rupture
sources. It is necessary to choose the C. Multiple kidney’s ruptures
source complying with the hygienic D. Paranephral hematoma
standards for drinking water in the field E. Kidney’s abruption
conditions.
106. A 3 y.o. child with weight defficiency
suffers from permanent moist cough. In
history there are some pneumonias with
 Krok 2 Medicine 2007 14

obstruction. On examination: distended stool becomes fatty. Reduced production

chest, dullness on percussion over the of what factor is the most probable cause
lower parts of lungs. On auscultation: a of steatorrhea?
great number of different rales. Level of
sweat chloride is 80 mmol/L. What is the A. Lipase
most probable diagnosis? B. Tripsin
C. Acidity of gastric juice
A. Mucoviscidosis (cystic fibrosis) D. Amylase
B. Bronchial asthma E. Alkaline phosphatase
C. Recurrent bronchitis
D. Bronchiectasis 111. A 54 y.o. woman has been ill with
E. Pulmonary hypoplasia osteomyelitis of femoral bone for over
20 years. During the last month there
107. A 14 y.o. girl complains of profuse appeared and have been steadily increasi-
bloody discharges from genital tracts duri- ng edemata of lower extremities. Urine
ng 10 days after suppresion of menses for analysis revealed: proteinuria - 6,6 g/l.
1,5 month. Similiar bleedings recur since Blood analysis: disproteinemia in form
12 years on the background of disordered of hypoalbuminemia, raise of α2 - and γ-
menstrual cycle. On rectal examination: globulines, ESR- 50 mm/h. What is the
no pathology of the internal genitalia. In most probable diagnosis?
blood: Нb- 70 g/L, RBC- 2, 3 · 1012 /L, Ht-
20. What is the most probable diagnosis? A. Secondary renal amyloidosis
B. Acute glomerulonephritis
A. Juvenile bleeding, posthemorrhagic C. Myelomatosis
anemia D. Chronic glomerulonephritis
B. Werlholf’s disease E. Systematic lupus erythematosus
C. Polycyst ovarian syndrome
D. Hormonoproductive ovary tumor 112. A 43 y.o. woman complains of contact
E. Noncomplete spontaneous abortion hemorrhages during the last 6 months. Bi-
manual examination: cervix of the uterus
108. A 43 y.o. patient had cholecystectomy is enlarged, its mobility is reduced. Mi-
6 years ago because of chronic calculous rrors showed the following: cervix of
cholecystitis. Lately he has been suffering the uterus is in the form of cauliflower.
from pain in the right subcostal area and Chrobak and Schiller tests are positive.
recurrent jaundice. Jaundice hasn’t gone What is the most probable diagnosis?
for the last 2 weeks. Stenoutic papillitis
0,5 cm long has been revealed. What is A. Cancer of cervix of the uterus
the best way of treatment? B. Polypus of the cervis of the uterus
C. Cervical pregnancy
A. To perform endocsopic papillosphi- D. Nascent fibroid
ncterotomy E. Leukoplakia
B. To treat conservatively: antibiotics,
spasmolytics, antiinflammatory drugs 113. After a long periode of subfebrility
C. To perform external choledoch drainage a patient registered increase of dyspnea,
D. To perform transduodenal papillosphi- pain in the right hypochondrium, leg
ncterotomy edemata. Objectively: neck veins are
E. To perform choledochoduodenostomy edematic. Ps is 120 bpm, sometimes it di-
sappears during inspiration. Heart sounds
109. Prevalence of a disease in region N are very weakened. ECG showed low-
amounted 1156 occurences per 1000 of voltage waves of ventricular complex. A
inhabitants. What of the mentioned indi- month ago there was raise of ST V1 − V4
ces characterizes the disease prevalence? segment. Cardiac silhouette is enlarged,
roundish. What is the most probable di-
A. Intensive agnosis?
B. Extensive
C. Ratio A. Exudative pericarditis
D. Visual index B. Small-focal myocardial infarction
E. Standardized C. Postinfarction cardiosclerosis
D. Metabolic postinfection myocardi-
110. A patient suffers from chronic opathy
recurrent pancreatitis with evident di- E. Primary rheumatic carditis
sturbance of exocrinous function. After
intake of rich spicy food and spirits his 114. A 14 y.o. child suffers from
 Krok 2 Medicine 2007 15

vegetovascular dystonia of pubertal peri- nts including back. AP is 100/20 mm Hg.

od. He has got sympathoadrenal atack. What is the most probable diagnosis?
What medicine should be used for atack
reduction? A. Opened arterial duct
B. Interventricular septal defect
A. Obsidan C. Isolated stenosis of pulmonary arterial
B. No-shpa orifice
C. Amisyl D. Interatrial septal defect
D. Euphyline E. Valvar aortic stenosis
E. Corglicone
118. A patient was admitted to the hospi-
115. A patient consulted a doctor about tal with complaints of periodical pain
acure respiratory viral infection. The pati- in the lower part of abdomen that gets
ent was acknowledged to be off work. The worse during menses, weakness, malai-
doctor issued him a medical certificate for se, nervousness, dark bloody smears
5 days. The patient is not recovering. What from vagina directly before and after
measures should the doctor take in order menses. Bimanual examination revealed
to legalize the further disability of pati- that uterus body is enlarged, appendages
ent? cannot be palpated, posterior fornix has
tuberous surface. Laparoscopy revealed:
A. To prolong the medical certificate at his ovaries, peritoneum of rectouterine pouch
own discretion but no more than for 10 and pararectal fat have "cyanotic eyes".
days in total What is the most probable diagnosis?
B. To prolong the medical certificate at his
own discretion but no more than for 6 days A. Disseminated form of endometriosis
in total B. Polycystic ovaries
C. To prolong the medical certificate C. Chronic salpingitis
together with department superintendent D. Tuberculosis of genital organs
D. To send the patient to the medical E. Ovarian cystoma
consultative commission
E. To send the patient to the medical social 119. A 19 y.o. patient was admitted to the
expert comission hospital with acute destructive appendici-
tis. He suffers from hemophilia B-type.
116. A 58 y.o. patient complains What antihemophilic medicine should
of weakness, leg edemata, dyspnea, be included in pre- and post-operative
anorexia. He has been suffering from treatment plan?
chronic bronchitis for many years. During
the last 5 years he has been noting intensi- A. Fresh frozen plasma
fied discharge of sputum that is often B. Cryoprecipitate
purulent. Objectively: RR- 80/min, AP- C. Fresh frozen blood
120/80 mm Hg. Disseminated edemata, D. Native plasma
skin is dry and pale, low turgor. In urine: E. Dried plasma
intense proteinuria, cylindruria. Specify
the most probable pathological process in 120. A 28 y.o. patient who has no
kidneys: permanent residence was admitted to
the hospital with preliminary diagnosis
A. Renal amyloidosis "influenza", on the 5-th day of di-
B. Chronic glomerulonephritis sease there are appeared maculopapular
C. Chronic pyelonephritis and petechial rash on his body and
D. Interstitial nephritis internal surfaces of his extremities. Body
E. Acute glomerulonephritis temperature is 410
, euphoria, hyperemic
face, scleras reddening, tongue tremor,
117. A 4 y.o. boy was admitted to the tachycardia, splenomegaly, excitement.
hospital with complaints of dyspnea, What is the most probable diagnosis?
rapid fatigability. His anamnesis regi-
sters frequent respiratory diseases. On A. Spotted fever
percussion: heart borders are dilatated B. Delirium alcoholicum
to the left and upwards. On auscultation: C. Leptospirosis
amplification of the SII above pulmonary D. Measles
artery, a harsh systolodyastolic "machi- E. Typhoid fever
ne"murmur is auscultated between the II
and the III rib to the left of breast bone, 121. An 18 y.o. woman consulted a
this murmur is conducted to all other poi- gynecologist about the pain in the lower
 Krok 2 Medicine 2007 16

part of abdomen, fever up to 37, 50C, A. Corresponding to the age

considerable mucopurulent discharges B. 150 g less than necessary
from the genital tracts, painful urinati- C. Hypotrophy of the I grade
on. Vaginal examination with mirrors: the D. Hypotrophy of the II grade
urethra is infiltrated, cervix of the uterus E. Paratrophy of the I grade
is hyperemic, erosive. The uterus is pai-
nful, ovaries are painful, thickened; forni- 125. A 46 y.o. patient complains of coli-
xes are free. Bacterioscopy test revealed cky pain in the right lumbar region that is
diplococcus. What diagnosis is the most irradiating to the lower part of abdomen,
probable? nausea. She didn’t have such pains before.
Survey radiograph of abdominal cavity
A. Recent acute ascending gonorrhea organs didn’t reveal any pathological stai-
B. Trichomoniasis ns. Ultrasonic sonogram revealed in the
C. Candydomycosis enlarged right renal pelvis a hyperechoic
D. Chronic gonorrhea mass approximately 1,5 cm large that gi-
E. Chlamydiosis ves rise to an "ultrasonic track". What is
the most probable diagnosis?
122. An infant is 2 d.o. It was full-term
born with signs of intrauterine infection, A. Renal calculus
that’s why it was prescribed antibiotics. B. Benign tumor of kidney
Specify, why the gap between antibiotic C. Renal cyst
introductions to the new-born children is D. Renal tuberculosis
longer and dosage is smaller compared to E. Malignant tumor of kidney
the older children and adults?
126. A woman consulted a doctor on
A. The newborns have a lower level of the 14-th day after labor about sudden
glomerular filtration pain, hyperemy and induration of the left
B. The newborns have lower concentration mammary gland, body temperature ri-
of protein and albumins in blood se up to 390
, headache, indisposition.
C. The newborns have reduced activity of Objectively: fissure of nipple, enlargement
glucuronil transferase of the left mammary gland, pain on
D. The newborns have diminished blood palpation. What pathology would you thi-
pH nk about in this case?
E. The newborns have bigger hematocrit
A. Lactational mastitis
123. A district doctor keeps the record of B. Lacteal cyst with suppuration
reconvalescents after infectious diseases, C. Fibrous adenoma of the left mammary
people who are disposed to frequent gland
and long-lasting diseases, patients with D. Breast cancer
chronic pathologies. What category of E. Phlegmon of mammary gland
patients should belong to the III health
group? 127. A 42 y.o. patient complains of
weakness, heartbeat, nasal hemorrhages,
A. People with chronic diseases cutaneous hemorrhages. His condition
B. People disposed to frequent and long- has been worsening progressively for a
lasting diseases month. Objectively: grave condition, the
C. People with chronic pathologies and extremities and body skin has spotted and
disposed to frequent and long-lasting petechial hemorrhages, lymph nodes are
diseases not palpable, Ps- 116/min, liver is +2 cm
D. Reconvalescents after infectious di- enlarged, spleen is not palpable. Blood
seases and patients with chronic pathologi- has evident pancytopenia. What disease
es should you think about first of all?
E. All above mentioned categories
A. Hypoplastic anemia
124. A 2 m.o. child was delivered in ti- B. Acute leukosis
me with weight 3500 g and was on the C. Werlhof’s disease
mixed feeding. Current weight is 4900 g. D. Hemorrhagic vasculitis
Evaluate the current weight of the child: E. Acute agranulocytosis
128. A 63 y.o. patient was operated on
account of big multinodular euthyroid
goiter. Despite of techical difficulties a
forced subtotal resection of both parts
 Krok 2 Medicine 2007 17

of the thyroid gland was performed. A. Glucocorticoids

On the 4-th day after the operation the B. Antibiotics
woman had cramps of face muscles and C. Nootropics
upper extremities, stomach ache. Positive D. Desensitizing medications
Chvostek’s and Trousseau’s signs. What is E. Vitamins
the most probable cause of such conditi-
on? 133. A 70 y.o. man is ill with ischemic
heart disease. His mood is evidently
A. Insufficiency of parathyroid glands depressed, anxious. As a result of conti-
B. Postoperative hypothyroidism nious sleeplessness he has got fears, suici-
C. Thyrotoxic crisis dal thoughts. He would sit for a long time
D. Injury of recurrent nerve in the same pose, answer after a pause, in
E. Tracheomalacia a low, monotonous voice. His face has a
look of suffering, pain, fear. What is the
129. A girl 13 y.o. consulted the school main psychopathologic syndrome?
doctor on account of moderate bloody
discharge from the genital tracts, which A. Depressive syndrome
appeared 2 days ago. Secondary sexual B. Paranoid syndrome
characters are developed. What is the C. Asthenic syndrome
most probable cause of bloody discharge? D. Phobic syndrome
E. Obsessive syndrome
A. Menarche
B. Juvenile hemorrhage 134. A 32 y.o. patient has been suffering
C. Haemophilia from systematic scleroderma for 14 years.
D. Endometrium cancer She was repeatedly exposed to treatment
E. Werlhof’s disease in the in-patient department. Complains
of periodical dull cardiac pain, dyspnea,
130. A 30 y.o. victim of fire has thermal headache, eyelid edemata, weight loss,
burns of III-A and III-B degree that pain and deformation of extremities joi-
amount 20% of total skin coverlet. AP nts. What organ’s lesion deteriorates the
is 110/70 mm Hg, HR- 120/min. What prognosis for the disease?
transfusion means shoul be used for blind
infusion correction during transportation? A. Kidneys
B. Heart
A. Salines C. Lungs
B. Polyglucine D. Gastrointestinal tract
C. 10% glucose solution E. Skin and joints
D. Fresh frozen plasma
E. Albumin 135. A 2 m.o. child with birth weight
5100 g has jaundice, hoarse cry, umbi-
131. In course of observation of sanitary lical hernia, physical development lag.
conditions of studying at the technical uni- Liver is +2 cm enlarged, spleen is not
versity it was necessary to evaluate the vi- enlarged. In anamnesis: delayed falling-
sual regimen of students, who study from away of umbilical cord rest. In blood:
9 a.m to 3 p.m. What index of natural light Hb- 120 g/L, erythrocytes - 4, 5 · 1012 /L,
will be the most informative? ESR- 3 mm/h. Whole serum bilirubin is 28
mcmole/L, indirect - 20 mcmole/L, direct
A. Natural light coefficient - 8 mcmole/L. What is the most probable
B. Light coefficient diagnosis?
C. Depth of study room
D. Time of the room insolation A. Congenital hypothyreosis
E. Presence of mixed (upper-lateral) light B. Congenital hepatitis
C. Hemolitic anemia
132. A 25 y.o. man who has been suffering D. Conjugated jaundice
from disseminated sclerosis for 4 years E. Cytomegalovirus infection
complains of increasing unsteadyness,
weakness of his lower extremities, uri- 136. A 13 y.o. girl complains of having
nary retention. Objectively: central temperature rises up to febrile figures for
tetraparesis. Cerebellar ataxia. Disturbed a month, joint ache, periodical skin rash.
function of pelvic organs. What is the most Examination revealed steady enhanci-
appropriate therapy in this case? ng of ESR, LE-cells. What is the most
probable diagnosis?
 Krok 2 Medicine 2007 18

A. Systematic lupus erythematosus A. Cereals - wheat, oats

B. Juvenile rheumatoid arthritis B. Milk and dairy produce
C. Systematic scleroderma C. Fruit
D. Acute lymphoblast leukosis D. Animal protein
E. Rheumatics E. Digestible carbohydrates
137. A 50 y.o. woman who suffers from 141. Fluorography of a 45 y.o. man
chronic pyelonephritis was prescribed a revealed some little intensive foci with
combination of antibiotics for the period indistinct outlines on the top of his ri-
of exacerbation - gentamicin (80 mg 3 ti- ght lung for the first time. The patient
mes a day) and biseptol (960 mg twice a doesn’t feel worse. He has been smoking
day). What consequences may be caused for many years. Objectively: pulmonary
by such a combination of antibiotics? sound above lungs on percussion, respi-
ration is vesicular, no rales. Blood count
A. Acute renal insufficiency is unchanged. What is the most probable
B. Glomerulosclerosis diagnosis?
C. Chronic renal insufficiency
D. Antibiotic combination is optimal and A. Focal pulmonary tuberculosis
absolutely safe B. Peripheral cancer of lung
E. Acute suprarenal insufficiency C. Eosinophilic pneumonia
D. Bronchopneumonia
138. A patient has been suffering from E. Disseminated pulmonary tuberculosis
morning cough accompanied by discharge
of small amount of sputum, dyspnea for 8 142. An 8 y.o. boy complains of constant
years. He has been smoking for 10 years. cough along with discharge of greenish
Objectively: cyanosis, prolonged expirati- sputum, dyspnea during physical activi-
on, dry rales. What is the most probable ties. At the age of 1 year and 8 months
diagnosis? he fell ill for the first time with bilateral
pneumonia that had protracted course.
A. Chronic obstructive bronchitis Later on there were recurrences of the
B. Chronic non-obstructive bronchitis disease 5-6 times a year, during the remi-
C. Idiopatic fibrosing alveolitis ssion periods there was constant producti-
D. Multiple bronchiectasis ve cough. What examination results will
E. Bronchial asthma be the most important for making a final
diagnosis?
139. A 70 y.o. patient complains of
weakness, dizziness, short periods of A. Bronchography
unconsciousness, pain in the cardiac area. B. Roentgenography of thorax organs
Objectively: HR- 40 bpm, heart sounds C. Bacterial inoculation of sputum
are rhythmic, the S1 is dull, periodically D. Bronchoscopy
amplified. AP is 180/90 mm Hg. What is E. Spirography
the most probable cause of hemodynamic
disturbances? 143. A 35 y.o. patient who suffers
from chronic glomerulonephritis and has
A. Atrioventricular block type III been hemodialysis-dependent for the
B. Atrioventricular block type I last three years developed intermissions
C. Bradysystolic form of ciliary arrhythmia of heart activity, hypotension, increasi-
D. Sinus bradycardia ng weakness, dyspnea. ECG showed
E. Complete left bandle-branch block bradycardia, atrioventricular block type
I, high pointed waves T. The day before
140. A child is 1 y.o. Within the last months the flagrant violation of diet took place.
after the begining of supplemental feeding What is the most probable cause of these
the child has appetite loss, diarrhea with changes?
massive defecation, sometimes vomiting.
Objectively: body temperature is normal. A. Hyperkaliemia
Body weight is 7 kg. Evident pallor of B. Hyperhydratation
skin, leg edemata, enlarged abdomen. C. Hypokaliemia
Coprogram shows a lot of fatty acids and D. Hypernatriemia
soaps. The child was diagnosed with celi- E. Hypocalciemia
ac disease and prescribed gluten-free diet.
What shoul be excluded from the dietary 144. A 60 y.o. patient cpmplains of
intake in this case? weakness, dizziness, heaviness in the
upper part of abdomen, paresthesia of
 Krok 2 Medicine 2007 19

toes and fingers. Objectively: skin icteri- 148. A 43 y.o. patient complains of peri-
tiousness, tongue is crimson, smooth. odical pain attacks in the right half of her
Hepatomegaly. In blood: Hb- 90 g/l, face. The attack is characterized by spasm
erythrocytes - 2, 3 · 1012 /l, reticulocytes of mimetic muscles of the right face’s half,
- 0,2%; color index - 1,2, macrocytosis; reddening of skin on this side. Blood has
Jolly’s bodies, Cabot’s ring bodies. What no pathologies. She was diagnosed with
medication is the most appropriate for right-sided trifacial neuralgia. What medi-
treatment? cation should be prescribed?
A. Vitamin 12 A. Finlepsin
B. Feroplex B. Prednisolone
C. Packed red blood cells C. Actovegine
D. Prednisolone D. Analgine
E. Dyspherol E. Indometacin
145. A 30 y.o. primigravida woman has got 149. A 35 y.o. patient experienced a strong
intensive labor pain every 1-2 minutes that nervous stress that resulted in formati-
lasts 50 seconds. The disengagement has on of reddened and edematic areas on
started. The perineum with the height of the back surface of her hands with further
4 cm has grown pale. What actions are formation of small inflammated nodules,
necessary in this situation? vesicles and then erosions accompanied
by profuse discharge of serous liquid. The
A. Episiotomy process is also accompanied by intense
B. Perineum protection itching. What is the most probable di-
C. Perineotomy agnosis?
D. Vacuum extraction of fetus
E. Expectant management A. Common eczema
B. Allergic dermatitis
146. A doctor of the general practice has C. Microbial eczema
registered the following death causes for D. Common contact dermatitis
the previous year: the first place was taken E. Toxicodermia
by cardiovascular diseases (60%), the
second - by tumors (18%), then - traumas 150. A 42 y.o. patient lifted a heavy object
(8,3%) etc. What diagrams will provide that resulted in acute pain in the right half
the most substantial information about of his chest, increased dyspnea. The pati-
the registered ocurrences? ent’s condition is grave: cyanosis of lips
and mucous membranes, RR is 28 pm, Ps-
A. Pie diagram 122 bpm. On percussion there is tympani-
B. Cartogram tis above the right half of chest, on
C. Line diagram auscultation - stongly diminished breath
D. Circle diagram sounds; accent of the II heart sound above
E. Column diagram the pulmonary artery. AP is 80/40 mm Hg.
What is the main emergency action at the
147. A patient complains of nycturia, pre-admission stage?
constant boring pain in perineum and
suprapubic region, weak urine jet, A. Air aspiration from the pleural cavity
frequent, obstructed and painful urinati- B. Adrenaline introduction
on. He has been ill for several months, C. Aminophylline introduction
pain in perineum appeared after getting D. Calling a cardiological brigade
problems with urination. Rectal exami- E. Oxygen inhalation
nation revealed that prostate is enlarged
(mostly owing to the right lobe), dense, 151. A 74 y.o. patient complains of
asymmetric, its central sulcus is flattened, abdomen pain and sweling, nausea. She
the right lobe is dense, painless, tuberous. suffers from ischemic heart disease,
What disease can it be? postinfarction and atherosclerotic cardi-
osclerosis. Objectively: the patient is in
A. Cancer of prostate grave condition, abdomen is swollen,
B. Prostate sclerosis abdominal wall doesn’t take active part in
C. Urolithiasis, stone of the right lobe of respiration. Laparoscopy revealed a small
prostate amount of muddy effusion in abdominal
D. Prostate tuberculosis cavity, one of the loops of small intestine
E. Chronic congestive prostatitis is dark-cyan. What is the most probable
diagnosis?
 Krok 2 Medicine 2007 20

ness, asthenovegetative syndrome. What

A. Thrombosis of mesenteric vessels a severity degree of chronic intoxication
B. Twisted bowels with benzol corresponds with described
C. Acute intestinal obstruction symptoms?
D. Ischemic abdominal syndrome
E. Erysipelas A. Minor
B. Moderate
152. A 10 y.o. child who is at oligoanuretic C. Severe
stage of acute renal insufficiency has got D. Disease is not connected with work
sensations of pricking in the mucous conditions
membrane of oral cavity and tongue, E. -
extremities numbness, reduced reflexes,
respiratory disturbance, arrhythmia. What 156. A 30 y.o. man was always reserved
are these symptoms caused by? by nature. He never consulted psychiatri-
sts. He complains of headache, sensation
A. Hyperkaliemia "as if something bursts, moves, bubbles
B. Hyponatremia under his skin". Objectively: no pathology
C. Hyperazotemia was revealed. What is the most probable
D. Acidosis psychopathologic symptom in this case?
E. Alkalosis
A. Cenestopathy
153. A 30 y.o. woman has the 2-nd B. Paresthesia
labour that has been lasting for 14 hours. C. Hallucination
Hearbeat of fetus is muffled, arrhythmic, D. Hypersthesia
100/min. Vaginal examination: cervix of E. Dysmorphopsia
uterus is completely opened, fetus head
is level with outlet from small pelvis. 157. A 45 y.o. man complains of having
Saggital suture is in the straight diameter, intensive pain in the epigastric region 1,5-
small crown is near symphysis. What is the 2 hours later after food intake. He has
further tactics of handling the delivery? been suffering from ulcer for 11 years.
Objectively: t0 - 36, 50
, RR- 16/min, Ps-
A. Use of obstetrical forceps 70 bpm, AP- 120/80 mm Hg. On palpati-
B. Stimulation of labour activity by on: local painfulness in the right epigastric
oxytocin region. What parameters of intragastric
C. Cesarean section Ph-meter in the region of stomach body
D. Cranio-cutaneous (Ivanov’s) forceps are the most typical for this patient’s di-
E. Use of cavity forceps sease?
154. A 75 y.o. man with IHD A. рН = 1,0-2,0
(atherosclerotic cardiosclerosis, atrial fi- B. рН = 3,0-4,0
brillation, cardiac insufficiensy stage 2 B; C. рН = 4,0-5,0
chronic pyelonephritis) was prescribed di- D. рН = 5,0-6,0
goxin. During the first 6 days the digoxin E. рН = 6,0-7,0
dose amounted 0,25 mg twice per day that
let to abatement of dyspnea, edemata and 158. A 13 y.o. teenager who suffers from
cyanosis. But on the 7-th day the pati- hemophilia A was taken to the hospi-
ent developed nausea and bradycardia. tal after a fight at school. His diagnosis
What is the most probable cause of di- is right-sided hemarthros of knee joint,
goxin intoxication? retroperitoneal hematoma. What should
be primarily prescribed?
A. Disturbed elimination of the medicati-
on by kidneys A. Fresh frozen plasma
B. Too long intake of saturating dose B. Aminocapronic acid
C. Exceeding daily saturating dose C. Washed thrombocytes
D. Disturbed metabolism of digoxin in D. Placental albumin
liver E. Dry plasma
E. Treatment complex doesn’t include
unitiole 159. A 3 m.o. child fell seriously ill,
body temperature rised up to 37, 80 C,
155. A patient who has been contacti- there is semicough. On the 3-rd day the
ng with benzol for 6 years has a cough grew worse, dyspnea appeared. On
nonevident leukopenia, moderate reti- percussion: tympanic sound above lungs,
culocytosis, gingival hemorrhage, dizzi- on auscultation: a lot of fine moist and
 Krok 2 Medicine 2007 21

wheezing rales during expiration. What is 9, 8 · 109/L, RBC- 3, 0 · 1012/L, sedimentati-

the most probable diagnosis? on rate - 52 mm/hour. What medication
provides pathogenetic treatment of this
A. Acute respiratory viral infection, patient?
bronchiolitis
B. Acute respiratory viral infection, A. Sulfosalasine
bronchopneumonia B. Motilium
C. Acute respiratory viral infection, C. Vikasolum
bronchitis D. Linex
D. Acute respiratory viral infection, E. Kreon
bronchitis with asthmatic component
E. Acute respiratory viral infection, focal 164. A 49 y.o. female patient was admi-
pneumonia tted to the hospital with acute attacks of
headache accompanied by pulsation in
160. A worker at a porcelain factory who temples, AP rised up to 280/140 mm Hg.
has been in service for 10 years complains Pheochromocytoma is suspected. What
of cough, dyspnea, ache in his chest. What mechanism of hypertensive atack does
occupational disease are these complaints this patient have?
most typical for?
A. Increasing of catecholamines
A. Silicosis concentration
B. Multiple bronchiectasis B. Increasing of aldosterone level in blood
C. Chronic dust bronchitis C. Increasing of plasma renin activity
D. Occupational bronchial asthma D. Increasing of vasopressin excretion
E. Chronic cor pulmonale E. Increasing of thyroxine excretion
161. Mother of a newborn child suffers 165. A child was born with body weight
from chronoc pyelonephritis. She survi- 3250 g and body length 52 cm. At the age
ved acute respiratory viral infection di- of 1,5 month the actual weight is suffici-
rectly before labour. Delivery was at term, ent (4350 g), psychophysical development
the period before discharge of waters was corresponds with the age. The child is
prolonged. On the 2-nd day the child breast-fed, occasionally there are regurgi-
got erythematous rash, later on - vesi- tations. What is the cause of regurgitati-
cles about 1 cm large with seropurulent ons?
content. Nikolsky’s symptom is positive.
Dissection of vesicles results in erosions. A. Aerophagia
The child is inert, body temperature is B. Pylorostenosis
subfebrile. What is the most probable di- C. Pylorospasm
agnosis? D. Acute gastroenteritis
E. Esophageal atresia
A. Impetigo neonatorum
B. Vesicular pustulosis 166. A patient with hepatic cirrhosis drank
C. Pseudofurunculosis some spirits that resulted in headache,
D. Sepsis vomiting, aversion to food, insomnia,
E. Ritter’s dermatitis jaundice, fetor hepaticus, abdominal
swelling. What complication of hepatic ci-
162. Medical examination of a man rrhosis is meant?
revealed "geographic tongue". This mi-
crosymptom is the evidence of the followi- A. Hepatocellular insufficiency
ng vitamin deficiency: B. Hemorrhage from varicosely dilatated
veins of esophagus
A. Vitamins of B group C. Portal hypertension
B. Vitamin A D. Acute stomach ulcer
C. Vitamin C E. Thrombosis of mesenteric vessels
D. Vitamin D
E. Vitamin P P 167. On the 4-th day of injections a 60
y.o. patient felt pain and tissue induration
163. A 41 y.o. woman has suffered in the left buttock. Objectively: the skin
from nonspecific ulcerative colitis for in the superexternal quadrant of the left
5 years. On rectoromanoscopy: evident buttock is red and hot, palpation reveals a
inflammatory process of lower intesti- painful infiltrate 6х6 cm large with softeni-
nal parts, pseudopolyposive changes of ng in the centre. Body temperature is
mucous membrane. In blood: WBC- 37, 90
. What action is necessary to di-
 Krok 2 Medicine 2007 22

agnose an abscess? A. Combined

B. Complex
A. Punction C. Associated
B. Biopsy D. Adjacent
C. Ultrasonic examination E. Mixed
D. X-ray investigation
E. Clinical blood analysis 172. X-ray pattern of thorax organs
revealed a large intensive inhomogeneous
168. A 39 y.o. patient complains of havi- opacity with indistinct outlines on the ri-
ng dyspnea during physical activity, crus ght side at the level of the 4-th rib. In the
edemata, palpitation, heart intermissions. centre of this opacity there is a horizontal
Objectively: HR is 150 bpm, atrial fibri- level and clearing of lung tissue above
llation. Heart is both ways enlarged. Heart it. What disease does this X-ray pattern
sounds are muted. Liver is 6 cm below the correspond with?
costal margin. Echocardiogram reveals di-
latation of heart chambers (end diastolic A. Abscess of the right lung
volume of left ventricle is 6,8 cm) is 29% B. Peripheral cancer
EF, valve apparatus is unchanged. What is C. Tuberculoma of the right lung
the most probable diagnosis? D. Right-sided pneumothorax
E. -
A. Dilated cardiomyopathy
B. Exudative pericarditis 173. A 30 y.o. patient has got multiple
C. Restrictive cardiomyopathy body skin rash consisting of small pai-
D. Hypertrophic cardiomyopathy red elements that are scattered on the
E. Thyreotoxic cardiomyopathy skin diorderly and mostly focally, they are
accompanied by itch. The rash appeared
169. The major repair of a hospital a few days after attending sport centre
included renewal of colour design of and sauna. What is the most probable di-
hospital premises because it is of great agnosis?
psychological and aesthetical importance;
and so the walls of patient wards will be A. Scab
painted under consideration of: B. Eczema
C. Contact dermatitis
A. Windows orientation D. Allergic dermatitis
B. Hospital profile E. Neurodermitis
C. Diseases of patients who will be staying
in these wards 174. A 56 y.o. patient ill with
D. Wall reflection coefficient cholecystectomy suddenly had an intense
E. Creation of cozy atmosphere hemorrhage. She needs blood transfusi-
on. Her blood group is (V )Rh− .
170. A 10 y.o. child has average indi- Hemotransfusion station doesn’t dispose
ces of body length and her chest ci- of this group. What group of donors can
rcumference exceeds average indices, be involved?
body weight index is heightened due to
lipopexia. Functional characteristics of A. Donors of rare blood groups
physical development are below average. B. Donors of active group
Physical development of this child can be C. Relatives
estimated as: D. Emergency donors
E. Reserve donors
A. Disharmonic
B. Average 175. A 33 y.o. patient was admitted to the
C. Below average hospital with stopped repeated ulcerati-
D. Harmonic ve bleeding. He was pale and exhausted.
E. Deeply disharmonic Blood count: Нb- 77 g/l, Нt- 0,25. In
view of anemia there were made two
171. Atmospheric air of an industri- attempts of blood transfusion of the same
al centre is polluted with the following group - ()Rh+ . In both cases the
wastes of metallurgical plants: sulphuric, transfusion had to be stopped because
nitric, metal, carbon oxides that have of development of anaphylactic reaction.
negative influence upon the inhabitants’ What transfusion medium would be advi-
health. The effct of these hazards can be sable in this case?
characterized as:
 Krok 2 Medicine 2007 23

A. Washed erythrocytes rash. Body temperature is of hectic nature.

B. Fresh citrate blood What is the most probable diagnosis?
C. Erythrocytic mass (native)
D. Erythrocytic suspension A. Sepsis
E. Erythrocytic mass poor in leukocytes B. Hemorrhagic disease of newborn
and thrombocytes C. Hemolytic disease of newborn
D. Thrombocytopathy
176. A 19 y.o. boy was admitted to the E. Omphalitis
hospital with closed abdominal trauma. In
course of operation multiple ruptures of 180. Elderly people develop tumors more
spleen and small intestine were revealed. frequently. One of the main causes is:
AP is falling rapidly, it is necessary
to perform hemotransfusion. Who can A. Decreased activity of cellular immunity
determine the patient’s blood group and B. Decreased intensity of antibodies
rhesus compatibility? formation
C. Increased disfunctioning of mitoses
A. A doctor of any speciality D. Increased activity of cellular immunity
B. A laboratory physician E. Increased intensity of antibodies
C. A surgeon formation
D. A traumatologist
E. An anaesthesilogist 181. A 30 y.o. man complains of intense
pain, reddening of skin, edema in the
177. A 20 y.o. patient complains of ankle-joint area, fever up to 390
. There
amenorrhea. Objectively: hirsutism, was acute onset of the illness. In the past
obesity with fat tissue prevailing on the there were similar attacks lasting 5-6 days
face, neck, upper part of body. On the without residual changes in the joint. The
face there are acne vulgaris, on the skin over the joint is hyperemic without
skin - striae cutis distense. Psychological definite borders and without infiltrative
and intellectual development is normal. bank on the periphery. What is the most
Gynecological condition: external geni- likely diagnosis?
tals are moderately hairy, acute vaginal
and uterine hypoplasia. What diagnosis is A. Gout
the most probable? B. Infectional arthritis
C. Rheumatoid arthritis
A. Itsenko-Cushing syndrome D. Erysipelatous inflammation
B. Turner’s syndrome E. Osteoarthritis
C. Stein-Levental’s syndrome
D. Shichan’s syndrome 182. A 7 y.o. boy was admitted to the
E. Babinski-Froehlich syndrome hospital. He complains of unpleasant
sensations in the heart region, pain in the
178. A 14 y.o. girl got a bad mark at the epigastrium, dizziness, vomiting. Objecti-
lesson of math as well as teacher’s repri- vely: evident paleness of skin, dyspnea,
mand that made her cry for a long time. jugular pulse. Heart borders are within
At the end of the lesson she suddenly lost the normal range. Heart sounds are clear,
consciousness and fell down. Objectively: HR- 170/min, small pulse. AP- 90/50 mm
skin is of pale pink colour, Ps- 100 bpm, Hg. EKG showed: paroxysm of ventri-
satisfactory, AP- 110/70 mm Hg. Eyeli- cular tachycardia. The paroxysm can be
ds are closed and don’t give away to the suppressed by:
tries of their opening. There are no evi-
dent injuries. What is the provisional di- A. Lidocain
agnosis? B. Morphine
C. Enalapril
A. Hysteric syncope D. Nifedipine
B. Epilepsy E. Strophanthine
C. Vagotonic syncope
D. Long QT syndrome 183. A child is 2 m.o. Inguinofemoral folds
E. Sympathicotonic collapse contain acutely inflamed foci with distinct
borders in form of spots that are slightly
179. A newborn child has purulent di- above the surrounding areas due to skin
scharges from the umbilical wound, skin edema. The rash has appeared during the
around the umbilicus is swollen. Objecti- week. Vesiculation and wetting are absent.
vely: the child’s skin is pale, of yellow- What is the most probable diagnosis?
greyish colour, generalized hemorrhagic
 Krok 2 Medicine 2007 24

A. Napkin-area dermatitis 188. After delivery and revision of

B. Infantile eczema placenta there was found the defect
C. Dermatomycosis of placental lobe. General condition of
D. Psoriasis woman is normal, uterus is firm, there is
E. Complicated course of scabies moderate bloody discharge. Inspection of
birth canal with mirrors shows absence of
184. A 38 y.o. patient lifted a heavy object lacerations and raptures. What action is
that resulted in pain in the lumbar part of nesessary?
spine irradiating to the posterior surface
of his left leg. The pain increases during A. Manual exploration of the uterine
changing body position and also in the cavity
upright position. Examination revealed B. External massage of uterus
positive symptoms of tension. What is the C. Use of uterine contracting agents
preliminary diagnosis? D. Urine drainage, cold on the lower
abdomen
A. Pathology of intercostal disks E. Use of hemostatic medications
B. Spinal cord tumor
C. Arachnomyelitis 189. A 67 y.o. patient complains of
D. Polyneuritis dyspnea, breast pain, common weakness.
E. Myelopathy He has been ill for 5 months. Objecti-
vely: t0 - 37, 30
, Ps- 96/min. Vocal tremor
185. A 35 y.o. patient was admitted to over the right lung cannot be determined,
the local hospital a week after a road percussion sound is dull, breathing cannot
accident with clinical picture of clotted be auscultated. In sputum: blood diffusi-
hemothorax. What is the most appropri- vely mixed with mucus. What is the most
ate treatment tactic for prevention of probable diagnosis?
acute pleural empyema?
A. Lung cancer
A. Surgical removal of clotted hemothorax B. Macrofocal pneumonia
B. Treatment by pleural punctions C. Bronchoectatic disease
C. Complex conservative therapy D. Focal pulmonary tuberculosis
D. Passive drainage of pleural cavity E. Exudative pleuritis
E. Active drainage of pleural cavity
190. Poorly refined wastes of an industrial
186. An aircraft factory processes materi- plant are usually thrown into the river that
als with use of lasers. It is determined that supplies drinking water. It causes peri-
the device radiates in the light spectrum shing of some microorganisms, disturbs
and that levels of laser radiation at the processes of water self-purification and
workplaces exceed the alarm level. Speci- worsens its quality that can have negati-
fy, what organs will be affected in the first ve influence upon people’s health. How
place? is this effect of environmental factors
A. Eyes called?
B. Skin A. Indirect
C. Liver B. Direct
D. Spleen C. Associated
E. Kidneys D. Complex
187. At a machine-building plant the casts E. Combined
are cleaned by means of abrasion machi- 191. A 22 y.o. patient complains of having
nes that are a source of local vibration. boring pain in the right iliac region for
What are the most efficient preventive one week, morning sickness, taste change.
measures for preventing harmful effect of Delay of menstruation is 3 weeks. Objecti-
vibration on workers’ organisms?
vely: AP- 110/70 mm Hg, Ps- 78/min, t0 -
A. Use of gloves that reduce vibration 37, 00
. Bimanual examination revealed
B. Preliminary and periodical medical that uterus is a little enlarged, soft,
examinations movable, painless. Appendages palpation:
C. Hand massaging a painful formation 3х4 cm large on the
D. Warm hand baths right, it is dense and elastic, moderately
E. Giving sanitary instructions to the movable. What is the most probable di-
workers agnosis?
 Krok 2 Medicine 2007 25

A. Progressing tubal pregnancy 195. On the 15-th day after a minor trauma
B. Interrupted tubal pregnancy of the right foot a patient felt malai-
C. Cyst of the right ovary se, fatigability, irritability, headache, high
D. Uterine pregnancy body temperature, feeling of compressi-
E. Acute appendicitis on, tension and muscular twitching of his
right crus. What disease can it be?
192. A 15 y.o. patient has developmental
lag, periodical skin yellowing. Objectively: A. Tetanus
spleen is 16х12х10 cm large, holecistoli- B. Anaerobic gas gangrene
thiasis, skin ulcer on the lower third of C. Erysipelas
his left crus. Blood count: erythrocytes D. Acute thrombophlebitis
- 3, 0 · 1012 /L, Hb- 90 g/L, C.I.- 1,0, mi- E. Thromboembolism of popliteal artery
crospherocytosis, reticulocytosis. Blood
bilirubin - 56 mmole/L, indirect bili- 196. 10 years ago a patient had a fracture
rubin - 38 mmole/L. Choose the way of in the middle one-third of his left femoral
treatment: bone, and during the last 7 years he
has been having acute inflammation in
A. Splenectomy the area of old fracture accompanied by
B. Spleen transplantation formation of a fistula through which some
C. Portocaval anastomosis pus with small fragments of bone tissue is
D. Omentosplenopexy discharged. After a time the fistula closes.
E. Omentohepatopexy What complication of the fracture is it?
193. A 30 y.o. parturient woman was taken A. Chronic osteomyelitis
to the maternity house with complaints of B. Bone tuberculosis
having acute, regular labour pains that last C. Soft tissue phlegmon
25-30 seconds every 1,5-2 minutes. Labour D. False joint
activity began 6 hours ago. Uterus is in E. Trophic ulcer
higher tonus, head of the fetus is above
the opening into the small pelvis. Fetal 197. Medical examination of a 43 y.o. man
heartbeat is 136/min. P.V: cervical dilatati- revealed objectively pailness of skin and
on is 4 cm, uterine fauces is spasming at mucous membranes, smoothness of li-
a height of parodynia. Head is level with ngual papillas, transverse striation of nails,
opening into the small pelvis, it is being fissures in the mouth corners, tachycardia.
pushed off. What is the most probable di- Hemoglobin content amounts 90 g/l; there
agnosis? are anisocytosis, poikilocytosis. The most
probable causative agent of this condi-
A. Discoordinated labour activity tion is deficiency of the following mi-
B. Secondary powerless labour activity croelement:
C. Pathological preliminary period
D. Primary powerless labour activity A. Iron
E. Normal labour activity B. Copper
C. Zinc
194. A primigravida woman appealed to D. Magnesium
the antenatal clinic on the 22.03.03 wi- E. Selenium
th complaints of boring pain in the lower
part of abdomen. Anamnesis registered 198. The total area of ground intended
that her last menstruation was on the for building of a regional hospital is 2,0
4.01.03. Bimanual examination revealed hectare. What is the highest possible
that uterine servix is intact, external capacity of the in-patient hospital that can
fauces is closed, uterus is enlarged up be built upon this ground?
to the 9-th week of pregnancy, movable,
painless. What complication can be A. 100 beds
suspected? B. 200 beds
C. 400 beds
A. Risk of abortion in the 9-th week of D. 800 beds
pregnancy E. Over 1000 beds
B. Abortion that started in the 9-th week
of pregnancy 199. A 33 y.o. woman survived two
C. Hysteromyoma operations on account of extrauteri-
D. Vesicular mole ne pregnancy, both uterine tubes were
E. - removed. She consulted a doctor with a
question about possibility of having a chi-
 Krok 2 Medicine 2007 26

ld. What can be advised in this case? document should be used for registration
of this disease?
A. Extracorporal fertilization
B. Insemination with her husband’s semen A. Urgent report on infectious disease
C. Substitutional maternity B. Statistic coupon for registration of final
D. Artifical fertilization with donor’s diagnoses
semen C. Outpatient’s card
E. Induction of ovulation D. Inpatient’s card
E. Statistic card of the patient who left
200. A worker diagnosed with "acute in-patient hospital
dysentery"was sent to the infectious
department by a doctor of aid post. What