KROK 2 Medicine 2004

1. A patient complains of intense pressing pain in the pharynx, mainly to the right,
impossibility to swallow even liquid food. The illness started 5 days ago. The patient's
condition is grave. Body temperature - 38,90C, speech is difficult, voice is constrained,
difficulties in opening the mouth. Submaxillary glands to the right are painful, enlarged.
What is the most probable diagnosis?
A. Phlegmonous tonsillitis
B. Peritonsillar abscess
C. Vincent's disease
D. Pharyngeal tumour
E. Diphtheria

2. A pediatrician examines a healthy mature breast-fed baby, aged 1 month. Prevention

of what condition should be recommended in the first place?
A. Hypotrophy
B. Spasmophilia
C. Rachitis
D. Paratrophy
E. Anaemia

3. A patient, aged 70, complains of pain, lacrimation, loss of acuity of vision on the
right eye. Fell ill 3 days ago after eye injury with a tree branch. On examination:
palpebral fissure is narrowed, photophobia, mixed injection. On the cornea there is an
opacity area with irregular borders, progressive edge and epithelial defect. Cornea
sensitivity is normal. Hypopyon. Chronic dacryocystitis. What is the most likely
diagnosis?
A. Serpiginous corneal ulcer
B. Acute iridocyclitis
C. Viral keratitis
D. Acute conjunctivitis
E. Penetrating injury of the right eye cornea

4. A 45-year-old man was brought to clinic with complaints of a sudden pain in the left
chest part and epigastric area, shortness of breath, nausea, one-time vomiting. The acute
pain started after considerable weight lifting. On physical examination: shallow
breathing, RR - 38/min, left chest part is getting behind during respiration, by percussion
- tympanitic sound, respiration is not auscultated. Ps - 110 bpm, of weak filling. BP -
100/60 mm Hg, insignificant displacement of heart to the right, sounds are dull. What
examination is the most expedient?
A. Esophagogastroscopy
B. Roentgenography
C. Bronchoscopy
D. Ultrasound of the abdominal cavity
E. Electrocardiography

5. A 48-year-old man was taken to the emergency department in a grave condition.

Medical history: 3 hrs ago he was treating potato plantations with the pesticides against
Colorado beetles. Physical examination: acrocyanosis, bronchorrhea, tachypnea, BP -
100/60 mm Hg, Ps - 44 bpm. What method of efferent therapy is the most expedient on
this stage?
A. Plasmopheresis
B. Limphosorbtion
C. Haemosorbtion
D. Haemodialisis
E. Plasmodialisis

6. A diagnosis of chronic arsenous intoxication was set to patient who is working as a

nightman. What form of anaemia is characteristic for this disease?
A. B12 - deficiency anaemia
B. Iron deficiency anaemia
C. Hyper sideric anaemia
D. Aplastic anaemia
E. Hemolytic anaemia

7. A 43-year-old male complains of stomach pain, which relieves with defecation, and is
accompanied by abdominal winds, rumbling, the feeling of incomplete evacuation or
urgent need for bowel movement, constipation or diarrhea in alternation. These
symptoms have lasted for over 3 months. No changes in laboratory tests. What is the
most likely diagnosis?
A. Colitis with hypertonic type dyskinesia
B. Atonic colitis
C. Irritable bowel syndrome
D. Chronic enterocolitis, exacerbation phase
E. Spastic colitis

8. A patient, aged 14, suffering from heart failure, undergoes in-patient treatment. On
ECG: changes in the form of a trough-shaped displacement of ST segment below isoline
and frequent ventricular extrasystoles. What is the most probable cause of these changes?
A. Carditis
B. Myocardiosclerosis
C. Potassium overdose
D. Cardiac glycosides overdose
E. Myocardiodystrophy

9. Study of pulmonary tuberculosis provided data about social and everyday conditions
of life and bad habits of patients. Which of the following methods allows to assess degree
of influence of smoking on tuberculosis incidence?
A. Analysis of dynamic row indices
B. Calculation of regression coefficient
C. Assessment of statistical probability of differences
D. Calculation of standardised indices
E. Calculation of correlation coefficient

10. A victim of a road accident suffered multiple fractures of extremities and pelvis
bones. In medical history: haemophilia A. On examination: hematomes are forming on
the injured areas. The patient's condition is aggravating. BP - 90/50 mm Hg. What is the
most expedient combination of infusion medications for patient's treatment after
administering polyglukine and saline?
A. Packed red blood cells, fresh frozen plasma
B. Fresh frozen plasma, albumin
C. Packed red blood cells
D. Cryoprecipitate, glucose
E. Cryoprecipitate, packed red blood cells

11. In 10 min after childbirth by a 22-year-old woman, the placenta was spontaneously
delivered and 100 ml of blood came out. Woman weight - 80 kg, infant weight - 4100 g,
length - 53 cm. The uterus contracted. In 10 minutes the haemorrhage renewed and the
amount of blood constituted 300 ml. What amount of blood loss is permissible for this
woman?
A. 300 ml
B. 1000 ml
C. 400 ml
D. 500 ml
E. 650 ml

12. A 37-year-old patient has sudden acute pain in the right epigastric area after taking
fatty food. What method of radiological investigation is to be used on the first stage of
examining the patient?
A. Magnetic-resonance
B. Radionuclid
C. Ultrasonic
D. Roentgenological
E. Thermographic
 13. A 20-year-old woman complains of weakness, wet cough, body temperature raise
up to 37,50C in the evenings during one month. In childhood she was under phthisiatric
observation due to conversion of tubercular tests (PPD). The condition is good. No rales
in lungs. Chest X-ray: a shadow with dim contours 3х4 cm with a clearing and focuses
near the shadow in the upper lobe of the right lung. Blood analysis: ESR - 20 mm/hour,
WBC - 7,6*109/L. What is the most likely diagnosis?
A. Pneumonia with abscess formation
B. Tuberculoma
C. Decaying cancer
D. Focal tuberculosis
E. Infiltrative tuberculosis

14. A neonate was born from the 1st gestation on term. The jaundice was discovered on
the 2nd day of life, then it became more acute. The adynamia, vomiting and
hepatomegaly were observed. Indirect bilirubin level was 275 mmol/L, direct bilirubin
level - 5 mmol/L, Hb- 150 g/l. Mother’s blood group - 0[I], Rh+, child’s blood group-
A[II], Rh+. What is the most probable diagnosis?
A. Jaundice due to conjugation disorder
B. Hepatitis
C. Hemolytic disease of the neonate [АВО incompatibility], icteric type
D. Physiological jaundice
E. Hemolytic disease of the neonate [Rh -incompatibility]

15. A girl, aged 14, complains of sleep disorders, weight loss, palpitations, heartaches,
fatigue. On examination: thyroid gland hyperplasia ІІ degree, exophthalmus. What
disorders of hormones' level are the most characteristic for this decease?
A. Lowering of the triiodothyronine level
B. Increasing of the protein-bind iodine level
C. Increasing of the thyrotropic hormone level
D. Lowering of the thyroxin level
E. Increasing of the thyroxin and triiodothyronine level

16. A baby, aged 8 months, is examined and a diagnosis of atypical community-

acquired pneumonia of chlamidial etiology is made. What is the optimum alternative of
antibiotic therapy in this case?
A. Aminoglycoside antibiotic
B. Cephalosporin of the II generation
C. Macrolide antibiotic of the I generation
D. Macrolide antibiotic of the II generation
E. Aminopenicillin

17. A district physician has diagnosed domestic accident at worker of chemical factory
who is at home. The worker is temporarily disable. What document should be given to
legalise his disability?
A. Certificate of free form
B. No documents
C. Sick-list from the 1st day
D. Sick-list from the 5th day after presenting to physician
E. Certificate of a definite form

18. A 40-year-old woman complains of yellow colour discharges from the vagina.
Bimanual examination: no pathological changes. Smear test: Trichomonas vaginalis and
mixed flora. Colposcopy: two hazy fields on the front labium, with a negative Iodine
probing. What is your tactics?
A. Specific treatment of Trichomonas colpitis
B. Treatment of specific colpitis with the subsequent biopsy
C. Cryolysis of cervix uteri
D. Cervix ectomy
E. Diathermocoagulation of the cervix uteri

19. A patient aged 65 complains of shortness of breath, cough with red foamy sputum,
feeling of air deficit, fear of death. On examination: orthopnea, pale skin, acrocyanosis,
cold sticky sweat. Rough breathing sounds, in inferior-posterior arias on both sides -
small and medium moist rales. BR - 40/min. Heart sounds are distinctly muffled. On the
cardiac apex - gallop rhythm. What is the most probable preliminary diagnosis?
A. Pulmonary embolism
B. Pulmonary edema
C. Croupous pneumonia
D. Infarction-pneumonia
E. Asthmatic state

20. A 10-year-old child fell ill acutely a week ago after overcooling when there
appeared pain in the stomach and the back, fever up to 380C. Urine analysis: leukocytes
25-30 per v/f, protein 0,33 g/L. Which of the following is the most appropriate test for
prescribing etiotropic treatment?
A. Intravenous urography
B. Nechiporenko test
C. Zimnitsky test
D. Urine culture
E. Cystography

21. A 23-year-old man has a gun-wound on the left arm. The arm bones are undamaged.
What appropriate surgical help must be provided to such a patient?
A. Suturing of the wound
B. Suturing and drying of the wound
C. Primary surgical debridement of the wound with a flowing suction
D. Drying of the wound with towel gauzes
E. Aseptic dressing of the wound

22. A patient complains of an ulceration on the inner surface of the lower third of the
right shin. On xamination: the ulcer is round-shaped, up to 5 cm in diameter, with sloping
edges. On the inner surface of this shin there are varicose veins. What complication
appeared in this patient?
A. Elephantiasis
B. Erysipelatous inflammation
C. Deep venous thrombosis
D. Varicose veins with trophic ulceration
E. Popliteal artery thrombosis

23. A patient, aged 25, suffering from stomach ulcer. Had a course of treatment in the
gastroenterological unit. 2 weeks later developed constant pain, increasing and resistant
to medication. The abdomen is painful in epigastric area, moderate defence in
pyloroduodenal area. Development of which complication aggravated the patient's state?
A. Penetration
B. Malignisation
C. Perforation
D. Stenosis
E. Haemorrhage

24. A victim of a road accident, aged 44, is operated on account of intraperitoneal

haemorrhage. In which case the patient's blood from the abdominal cavity can be used for
autotransfusion?
A. Stomach rupture
B. Bladder rupture
C. Liver rupture
D. Small intestines rupture
E. Splenic rupture

25. A patient, aged 50, during 15 years is ill with essential hypertension, not under
treatment. BP - 220/140 mm Hg, Ps - 80bmp, rhythmic. On percussion: the left heart
border is 2 cm to the outside from the left midclavicular line. Sound 1 is moderately
weakened. Sound 2 is accentuated over the pulmonary artery. What changes will be
characteristic on ultrasound heart examination?
A. Hypertrophy and dilatation of the right ventricle
B. Blood regurgitation through the aortic valve
C. Blood regurgitation through the mitral valve
D. Dilatation of the left atrium
E. Hypertrophy and dilatation of the left ventricle

26. A patient, while making repairs at home, suddenly stood quite still with the
painting brush in his hand. This state lasted for a few seconds. After that the patient was
rather confused, for some moments he couldn’t understand what was happening. He
totally forgot the state he was in and the events around him, occurring while he was in
that state. What disorder is the most probable?
A. Jacksonian fit, epilepsy
B. Petit mal, epilepsy
C. Grand mal, epilepsy
D. Twilight state, epilepy
E. Disphoria, epilepsy

27. District physician was charged with plan preparation concerning the conducting of
medical and preventive measures among the population in the area he is assigned to.
What measures must he include in this plan as regards secondary prevention of illness?
A. Elimination of causes of diseases onset
B. Improvement of patients' life conditions
C. Prevention of disease complications
D. Prevention of disease onset
E. Conducting of rehabilitation measures

28. A 65-year-old patient complains of gradual worsening of the left eye vision during
10 months. On physical examination: acuity of vision of the left eye is 0,01, not
correctable. The eye is not irritated, the pupil of the eye is greyish, reflex from the fundus
is absent. Intraocular pressure is 18 mm Hg. What is the most probable preliminary
diagnosis?
A. Open-angle glaucoma
B. Disorder of blood circulation in retina vessels
C. Senile cataract
D. Exfoliation of the retina
E. Leukoma of the cornea

29. A patient, aged 34, has been suffering for 7 years from pulmonary tuberculosis. He
complains of muscle weakness, weight loss, diarrhea, frequent urination. On
examination:
hyperpigmentation of skin, gums, and inner sides of the cheeks. BP - 90/58 mm Hg. In
blood: RBC - 3,1*1012/L, Hb - 95 g/L, colour index of blood – 0,92; WBC - 9,4*109/L,
eosinophils - 7, segmented neutrophils - 45, band neutrophils - 1, lymphocytes - 40,
monocytes - 7, Na+ - 115 mmol/L, К+ - 7,3 mmol/L. What is the preliminary diagnosis?
A. Congenital adrenal hyperplasia
B. Primary aldosteronism
C. Diabetes insipidus
D. Pheochromocytoma
E. Primary adrenocortical insufficiency

30. A 30-year-old man has a history of recurrent pneumonias and chronic cough with
foul smell, purulent sputum, occasionally blood tinged, which becomes worse in the
morning and in reclining position. On physical examination, it is a chronic patient with
clubbing of fingers, wet inspiratory rales at the root of lungs from behind. What is the
most probable diagnosis?
A. Chronic obstructive emphysema
B. Chronic bronchitis
C. Bronchoectasis
D. Disseminated pulmonary tuberculosis
E. Pulmonary neoplasm

31. A patient, aged 64, complains of pain in the knee-joints, appearing 2–3 hours after
walking. On examination: knee-joint deformation, restriction of joints movements due to
painfulness, crackling on movement, on both hands there are Heberden's nodes. In
medical history: stomach ulcer. Which of the mentioned medications is expedient to
prescribe to this patient?
A. Aspirin
B. Pyroxicam
C. Nimesulid
D. Indometacin
E. Ortophen

32. A man, aged 30, complains of intense pain, reddening of skin, edema in the ankle-
joint area, fever up to 390С. Sudden onset of the illness. In the past there were similar
attacks lasting 5-6 days without residual changes in the joint. The skin over the joint is
hyperemic without definite borders and without infiltrative bank on the periphery. What
is the most likely diagnosis?
A. Osteoarthritis
B. Gout
C. Infectional arthritis
D. Rheumatoid arthritis
E. Erysipelatous inflammation

33. A female, aged 20, after smoking notices a peculiar inebriation with the feeling of
burst of energy, elation, irreality and changing of surroundings: the world gets full of
bright colours, the objects change their dimensions, people's faces get cartoon features,
loss of time and space judgement. What is the most likely diagnosis?
A. Nicotinism
B. Barbiturism
C. Cocainism
D. Morphinism
E. Cannabism

34. A child, aged 6, suffers from "bold" patches on the head. On examination: single
large focuses, in which the hairs are broken on the same level - 6-8 mm from the skin
surface. What is the most probable preliminary diagnosis?
A. Surface trichophytosis
B. Seborrhea
C. Microsporia
D. Circular alopecia
E. Infiltrative suppurative trichophytosis

35. A woman aged 35 has been suffering with pulmonary tuberculosis for 10 years.
When in phthisiatric clinic, she started to act strangely: put on a gaudy make-up, gathered
the other patients around herself, was singing and dancing with them. Highly excited,
passed all the time among males, flirted, started sexually-biased conversations. The
whole night absented from the clinic ("was on a date"). What leading syndrome of mental
disorders is observed?
A. Hebephrenic
B. Psychopathy-like
C. Morion-like
D. Xenophobic
E. Maniacal

36. A 62-year-old patient with DM-2. Diabetes is being compensated by diet and
Maninilum. Patient has to undergo an operation for inguinal hernia. What should be the
tactics of hypoglycemic therapy?
A. Give Glurenorm in place of Maninilum
B. Prescribe fast-acting insulin
C. Prescribe guanyl guanidines
D. Continue with the current therapy
E. Prescribe long-acting insulin

37. A 48-year-old woman complains of fatigue, weight and appetite loss, headache.
Suffered from acute glomerulonephritis as adolescent. Suffers from arterial hypertension
since age 25. Has not systematically undergone medical treatment, consulted doctor very
rarely. On laboratory investigation signs of chronic renal failure first degree were found.
(creatinine - 0,23 mmol/L). What nutrition recommendations are the most suitable for this
patient?
A. Adipose control
B. Protein control
C. Carbohydrate control
D. Ingestion with the increased content of the "alkaline" food
E. Fluid volume increase

38. A youth aged 17 complains of a sudden onset of palpitation 10 minutes ago. On

examination: skin of the normal colour. Heart borders without changes, HR=Ps=200bmp,
regular rhythm, BP - 135/75 mm Hg. Heart sounds are intensified. On ECG: QRS = 0,09
sec. What measure is to be undertaken on the first stage of aid?
A. Vagal tests
B. No treatment
C. Cardioversion
D. Propranolol per os
E. Novocainamid I.V.

39. A woman aged 30 complains of dizziness, weakness, nails fragility, falling-out of

hair, taste disorder. On examination: pale skin, Ps - 98bmp, BP - 100/60 mm Hg. In
blood: Hb - 80 g/L, RBC - 3,4*1012/L, colour index of blood - 0,7, ESR - 20 mm/h.
Serum iron - 7,2 mmol/L. What medicine is expedient to prescribe?
A. Iron parenterally
B. Packed red blood cells I.V.
C. Whole blood I.V.
D. Vitamins intramuscularly
E. Iron рег os

40. A 41-year-old woman complains of weakness, fatigue, fever up to 380C, rash on the
face skin, pain in the wrists and elbows. Physical exam: erythematous rash on the cheeks
with "butterfly" appearance. The wrist and elbow joints are affected symmetrically,
swollen, tender on motions. Pleural friction rub over the lungs, the heart sounds are weak,
regular, HR - 88/min, BP - 160/95 mm Hg. CBA: anaemia, leucopenia, lymphopenia.
Urinalysis: proteinuria, leukocyturia, cylinders. What is the main mechanism of disease
development?
A. Production of antibodies to myocytes
B. Production of antibodies to myosin
C. Production of antibodies to double-stranded DNA
D. Production of antimitochondrial antibodies
E. Production of antibodies to endothelial cells

41. A 35-year-old woman was admitted to thoracic surgery department with fever up to
400C, onset of pain in the side caused by deep breathing, cough with considerable
quantity of purulent sputum and blood with bad smell. What is the most likely diagnosis?
A. Tuberculosis of lungs
B. Actinomycosis of lungs
C. Bronchectatic disease
D. Complication of liver echinococcosis
E. Abscess of the lungs

42. A pupil of the 8th form after trauma has acute atrophy of the left leg muscles, tonus
of which is distinctly decreased, active movements are only in the knee joint, his foot is
deformed. Support function of the left leg is absent, support function of the right leg is
preserved. The boy wears an orthopedic footwear. What group of physical training does
the boy belong to?
A. Additional
B. Other
C. Special
D. Preparatory
E. Basic

43. A patient, aged 40, ailing during approximately 8 years, complains of exertion pain
in the lumbar part of the spine, in cervical and thoracal part (especially when coughing),
pain in the hip and knee joints on the right. On examination: the body is fixed in the
forward inclination with head down, gluteal muscles atrophy. Spine roentgenography:
ribs osteoporosis, longitudinal ligament ossification. What is the most likely diagnosis?
A. Psoriatic spondyloarthropathy
B. Spondyloarthropathy caused by Reiter's syndrome
C. Ankylosing spondylitis
D. Tuberculous spondylitis
E. Disseminated spine osteochondrosis

44. A man, aged 56, complains of shortness of breath with difficult expiration, sputum
excretion in the mornings during 22 years. Smokes 1 packet of cigarettes per day starting
from the age of 18. On external respiration tests with bronchial spasmolytic: respiratory
obstruction reversibility is 10%. What medication should be prescribed in the beginning
of the treatment?
A. Inhalation cholinergic antagonists (Atrovent)
B. Antibiotics
C. Inhalation glucocorticoids
D. Membrane stabiliser (Intal, Tyled)
E. Inhalation sympathomimetic agents (Berotec)

45. A female patient, aged 25, is hospitalised due to exudative pericarditis. Complains of
shortness of breath, weakness, compression in the chest. Believes that she got ill 2 weeks
ago, after common cold. What peculiarity found during examination will tell about
chronic pericardium affection?
A. Signs of pericardium calcification
B. Lowering of ECG voltage
C. Heart sounds deafening
D. Significant heart tissue dilation, pulsation weakening
E. Signs of haemostasia in greater circulation

46. A patient, aged 28, complains of pain in the legs during walking, chilliness of feet,
toes. Has being ill for a year. On examination: pale and cool legs skin, turgor diminished,
hypotrichosis. Weakened pulsation on the hip and popliteal arteries, pulsation on the feet
arteries is felt after nitroglycerine test. Rheographic index <1. What is the most likely
diagnosis?
A. Obliterating endarteritis
B. Obliterating atherosclerosis
C. Raynaud's disease
D. Chronic trombophlebitis
E. Buerger's disease

47. A baby, aged 2 years, has a syndrome of malabsorbtion. On ECG: S-T segment
depression, wave T inversion and high wave U. What is the cause of these changes?
A. Hypokalihistia
B. Hypomagnesemia
C. Hypercalcihistia
D. Hyperkalihistia
E. Hypocalcihistia

48. A patient was operated on account of perforated stomach ulcer, terminal stage of
diffuse peritonitis. After endotoxic shock in the post-operative period the artificial
pulmonary ventilation is carried out with inhalation of 60% oxygen. Blood gasses: РаО2
= 70-78 mm Hg, hypoxemia is not diminishing, CVP - 150-180 mm H 2O, BP - 90/60 mm
Hg (with administering of dopamine in high doses). Radiologically: diffuse pulmonary
infiltration. What is the reason of the resistant arterial hypoxemia?
A. Respiratory distress-syndrome
B.Pneumothorax
C. Pulmonary edema
D. Bilateral pneumonia
E. Mendelson's syndrome

49. A 49-year-old patient complains of fever of 37,50С, chest pain, dyspnea. On

physical examination: Sound 1 is clapping; Sound 2 is accentuated in the pulmonary
artery, opening snap, presystolic murmurs are auscultated. What is the most useful
investigation for valvular disorder assessment?
A. Phonocardiography
B. Electrocardiogram (ECG)
C. Chest X-ray
D. Echocardiography + dopplerechocardiography
E. Ballistocardiogramme

50. A woman, aged 28, consulted a doctor with the complaints of increasing size of
pigment nevus which was present from birth, its maceration, itching. What method of
investigation should be used for diagnostic in this case?
A. Thermography
B. Radioisotope diagnostics
C. Yaks’s reaction
D. Glass-print
E. Incision biopsy

51. A 40-year-old man complains of headache in occipital area. On physical

examination: the skin is pale; face and hand edema, BP - 170/130 mm Hg. On EchoCG:
concentric hypertrophy of the left ventricle. Ultrasound examination of the kidneys
reveals thinned cortical layer. Urine analysis shows proteinuria of 3,5 g/day. What is the
probable diagnosis?
A. Polycystic disease of the kidneys
B. Cushing’s disease
C. Chronic pyelonephritis
D. Chronic glomerulonephritis
E. Essential arterial hypertension

52. To study physical development of children and adolescents, anthropometric

investigations are widely used. Choose a physiometric method of investigation from the
below given.
A. Determination of body weight
B. Determination of vertebra form
C. Determination of thorax form
D. Determination of vital capacity of lungs
E. Measurement of growth
 53. A 2,5-month-old child presents with muscle hypotonia, sweating, alopecia of the
back of the head. The child is prescribed massage, curative gymnastics and vitamin D.
What is the dosage and frequency of vitamin D administration?
A. 500 IU daily
B. 1000 IU every other day
C. 1000 IU daily
D. 3000 IU daily
E. 500 IU every other day

54. Biological development indices for the secondary and high school pupils are the
following: height, annual height increase, hand ossification, number of permanent teeth.
What other index has a special importance for this age group?
A. Secondary sexual characters development
B. Chest circumference
C. Weight
D. Hand muscular force
E. Lung vital capacity

55. In a college with the majority of 14-year-old students preventive anti-tuberculosis

planned examination is taking place. Which method from the following should be used?
A. Sputum analysis for tuberculosis mycobacteria
B. Fluorographic
C. Physical examination
D. Mantoux [ tuberculin ] test with 2 ТU
E. General blood analysis

56. A 2–year-old girl has been ill for 3 days. Today she has low–grade fever, severe
catarrhal symptoms, non-abundant maculopapular rash on her buttocks and enlarged
occipital glands. What is your diagnosis?
A. Scarlet fever
B. Measles
C. Pseudotuberculosis
D. Rubella
E. Adenoviral infection

57. Woman in childbirth, 25 years old, the second period of labour. During internal
obstetric examination, opening of the uterine cervix is full. Fetus membranes are absent.
The head of the fetus is represented, the head occupies sacral cavity. Sciatic bones are
undeterminable. During contractions perineum is sticking out. Where is the head of the
fetus situated?
A. Big segment in the plane of inlet into minor pelvis
B. By small segment in the plane of inlet into minor pelvis
C. In the plane of the narrow part of minor pelvis
D. In the plane of outlet from the minor pelvis
E. In the plane of the wide part of minor pelvis

58. Left eye vision disorders were registered in a male patient aged 22. A year later
there developed a weakness of the right foot. On examination: lateral nystagmus, paling
of temporal half of the left disk of optic nerve, absence of abdominal reflexes,
hyperreflexia on the extremities, clonus of the left foot, Babinski's signs on both sides.
What is the most likely diagnosis?
A. Neuropathy of the right fibular nerve
B. Retrobulbar optic neuritis
C. Myelitis
D. Disseminated sclerosis
E. Poliomyelitis

59. A 68-year-old patient with long-term hypertension complains of dizziness,

difficulties by swallowing, nasal voice, wobbly walking. These symptoms appeared about
three years ago and are gradually progressing. What diagnosis is the most probable?
A. Stem encephalitis
B. Hemorrhagic attack
C. Cerebral stem tumour
D. Ischemic attack
E. Discirculating encephalopathy

60. A patient is unconscious, with head injuries in the form of calvarium fracture, BP -
60/40 mm Hg, with pathological neurologic signs. On what basis these injuries can be
considered as severe?
A. Pathological neurologic signs
B. Permanent disability
C. Nature of injury
D. Terms of health impairment
E. Life-threatening symptoms

61. A woman, aged 60, complains of unendurable pain in the right hypochondrium. In
medical history: acute pancreatitis. The body temperature - 38,20С. On examination:
scleral icteritiousness. No signs of peritoneum irritation. Positive Ortner's symptom,
Gubergrits-Skulsky symptom. Urine diastasis - 320 g/h. What diagnosis is the most
likely?
A. Chronic pancreatitis
B. Chronic cholecystitis
C. Pancreas cancer
D. Acute cholecystitis
E. Acute cholangitis

62. A man aged 68 complains of tiredness, sweating, enlargement of cervical,

submaxillary and axillary lymph nodes. Blood tests: WBC - 35*109/L, lymphocytes -
60%, Botkin and Gumprecht bodies, level of haemoglobin and quantity of thrombocytes
is normal. Myelogram showed 40% of lymphocytes. What is the most probable
diagnosis?
A. Lymphogranulomatosis
B. Acute leucosis
C. Chronic lympholeucosis
D. Tuberculous lymphadenitis
E. Chronic myeloleucosis

63. A patient, aged 35, complains of frequent heart-burns, air and acid eructation,
burning, constringent pains behind the breast-bone, along esophagus, that appear after
meals, during forward inclination of body. The patient was not examined, takes Almagel
by self-medication, after the intake of which feels better. What is the most probable
diagnosis?
A. Cardiospasm
B. Duodenal ulcer
C. Functional dyspepsia
D. Gastroesophageal reflux
E. Stomach ulcer

64. A man with meningococcus meningitis has been taking penicillin for 7 days. During
last 4 days a body temperature is normal. Meningitic signs are absent. When is it possible
to cancel antibiotic?
A. If liquor cytosis is 100 or less, prevalence of neutrophils
B. If leucocytosis and left neutrophil shift are absent
C. If liquor cytosis is 100 or less, prevalence of lymphocytes
D. If liquor cytosis is 150, prevalence of lymphocytes
E. Immediately

65. A 5-year-old child with stigmas of dysembryogenesis (small chin, thick lips, opened
mouth, hyperthelorismus) has systolic murmur in the second intercostal to the right of the
sternum. The murmur passes to the neck and along the sternum left edge. The pulse on
the left brachial artery is weakened. BP on the right arm is 110/60 mm Hg, on the left -
100/60 mm Hg. ECG results: hypertrophy of the right ventricle. What defect is the most
probable?
A. Defect of interatrial septum
B. Defect of interventricular septum
C. Open aortic duct
D. Coarctation of the aorta
E. Aortic stenosis

66. A 32-year-old patient complains of severe weakness, tremor of extremities. On

physical examination, there is loss of body weight, wet and warm skin. The thyroid gland
is enlarged up to the 3rd degree, painless, elastic. Ps: 108 bpm. BP- 160/55 mm Hg. The
rest is in norm. What can be diagnosed?
A. Chronic autoimmune thyroiditis, hypertrophic type
B. Diffuse euthyroid goitre of the 3rd degree
C. Diffuse toxic goitre of the 3rd degree, thyrotoxicosis of the average degree
D. Toxiferous adenoma of the thyroid gland
E. Chronic fibrous thyroiditis

67. A 27-year-old woman was admitted to clinic with complaints of pain in right ankle
joint, impossibility to stand on those extremity. Clinical examination: the patient had a
fracture of anterior part of distal metaepiphisis of tibia [Pott-Desto's fracture]. What is the
mechanism of such injury?
A. Pronation of the foot
B. Load along the axis with dorsal flexion of foot
C. Direct blow
D. Load along the axis with planter flexion of foot
E. Supination of the foot

68. In the structure of the population of N-region, person category of age from 0 till 14
years constituted 31%, for people from 50 years and older - 20%. Estimate the population
structure that characterises the given demographic situation in a most efficient way.
A. Progressive structure of the population
B. Emigration of the population
C. Migration of the population
D. Stationary structure of the population
E. Regressive structure of the population

69. A baby boy with body weight 3700 g is born in a maternity hospital. The general
condition of the baby is satisfactory. In the centre of the abdomen there is a formation
circa 12 cm in diameter. The formation is covered with smooth membranes through
which the intestinal loops and liver are seen. What is the most likely diagnosis?
A. Gastroschisis
B. Ventral hernia
C. Omphalocele
D. Complicated embryonic hernia
E. Noncomplicated embryonic hernia

70. A 28-years-old man, without permanent residence, was hospitalised with the
preliminary diagnosis of "influenza". On the 5th day of the disease there appeared
typhoid maculopapular and petechial skin rash on trunk and inner sides of extremities. t0-
410C, euphoria, facial hyperaemia, sclera reddening, tongue tremor. Ps - 104 bpm.
Splenomegalia. What is the most likely diagnosis?
A. Alcoholic delirium
B. Leptospirosis
C. Typhoid fever
D. Measles
E. Exanthematic typhus (Spotted fever)

71. A 26-year-old woman gave birth to a child 6 months ago. She consulted a
gynaecologist complaining of menstruation absence. The child is breast-fed. Vagina
exam: uterus is of normal form, dense consistence. What is the most probable diagnosis?
A. Physiological amenorrhea
B. Gestation
C. Asherman's syndrome
D. Sheehan's syndrome
E. Pseudoamenorrhea

72. You suspect that a 34-year-old patient has got an abscess of Douglas spaces. What
method of investigation is preferable to diagnostics?
A. Rectoromanoscopy
B. Roentgenoscopy of abdominal cavity
C. Percussion and auscultation of abdomen
D. Laparoscopy
E. Digital examination of rectum

73. A woman, aged 30, in the second childbirth there is a baby born with anaemic-
icteric form of the hemolytic disease. Blood group of the mother is А(ІІ) Rh-, blood
group of the new-born is В(ІІІ) Rh+, blood group of the father is В(ІІІ) Rh+. What is the
most probable cause of immune conflict?
A. Antigen ABO conflict
B. Antigen A conflict
C. Antigen B conflict
D. Rhesus incompatibility
E. Antigen AB conflict
 74. A man, aged 28, suddenly fell ill. There appeared chills, sensation of heat, fever up
to 38,50С, intermitting pain in the left iliac area, frequent liquid stool in the form of
sanguinomucoid mass. On palpation: the left part of the abdomen is painful, spastic
sigmoid colon. What is the most likely diagnosis?
A.Non-specific ulcerative colitis
B. Amebiasis
C. Escherichiosis
D. Malignant growth of the large intestine
E. Acute dysentery

75. A 60-year-old boiler-house worker presents to factory's sectorial doctor with

headache and tiredness. Lab tests: carboxyhemoglobin in blood. Poisoning with which
substance is the most likely to cause formation of carboxyhemoglobin in blood?
A. Mercury
B. Manganese
C. Carbon oxide
D. Lead
E. Chlorine

76. A patient, aged 25, complains of pain in the I finger on the right hand. On
examination: the finger is homogeneously hydropic, in bent position. On attempt to
unbend the finger the pain gets worse. Acute pain appears on touching with the probe in
ligament projection. What decease is the most likely?
A. Thecal whitlow (ligament panaritium)
B. Paronychia
C. Articular (joint) panaritium
D. Bone panaritium
E. Subcutaneous panaritium

77. A 52-year-old man has recurrent transient ischemic attacks. Auscultation of the
carotid arteries detects murmur. What diagnostic method is necessary to apply first?
A. MRI of the brain.
B. Electroencephalography
C. Ultrasound dopplerography
D. Cerebral angiography
E. CT of the brain

78. A 20-year-old man complains of pain and edema in the right buttock. Physical
examination: limited tenderness, painful swelling with skin hyperaemia and local
hyperthermia. Positive fluctuation symptom. Abscess is diagnosed. What are the tactics
for the therapy?
A. Lancing and draining of abscess, prescription of broad spectrum antibiotic
B. Local application of dimexide
C. Prescription of broad spectrum antibiotic and sulphonamide
D. Administration of tetanus antitoxin and medication for immunity stimulation
E. Physiotherapy

79. In laboratory a sample of milk is analysed. There determined the following: colour –
whitish, smell – without peculiarities, taste – specific for milk, density – 1,038, acidity –
350 Turner, fats – 3,2%. What is the degree of milk quality?
A. Milk of good quality
B. Milk of poor quality
C. Adulterated milk
D. Milk of reduced quality
E. Milk conditionally usable

80. A 47-year-old man with gastric cancer, complicated by profuse haemorrhage was
successfully treated by surgical intervention. After the operation the native blood plasma
transfusion was performed. During transfusion developed acrocyanosis, hypersalivation,
hyperpnea, BP - 80/40 mm Hg, Ps- 120 bpm. With injection of which substance the
initial medication has to begin?
A. Epinephrine
B. Aminophilline
C. Dopamine
D. Diphenylhydramin
E. Prednisolon

81. Mother with an infant visited the pediatrician. Her baby was born with body mass of
3,2 kg and 50 cm length. He is 1 year old now. How many teeth the baby should have?
A. 20
B. 6
C. 8
D. 12
E. 10

82. A 42-year-old man has died in a road accident after the haemorrhage on the site, due
to acute hemorrhagic anaemia. Loss of what minimum percentage of the total blood
volume would result in death at acute haemorrhage?
A. 6-9%
B. 15-20%
C. 35-50%
D. 25-30%
E. 10-14%

83. A man, aged 30, intravenous drug addict complains of weakness, moderate jaundice,
sensation of heaviness in the right hypochondrium. The patient's condition aggravated
gradually. Biochemical tests: Total bilirubin - 48,2 mmol/L; ALT - 3,0 mmol/h*L. What
examination will verify the diagnosis?
A. Polymerase chain reaction (HCY – RNA)
B. Determination of НВ antigen
C. Ultrasound examination of liver
D. Determination of AlATin dynamics
E. Computer-aided tomography

84. A 8-year-old boy has suffered from tonsillitis. In 2 weeks he started complaining of
migratory joint pain, edema of joints, restriction of movements, fever. On examination,
an acute rheumatic heart disease, activity of the III-rd degree, primary rheumocarditis,
polyarthritis; acute course of disease, cardiovascular failure IIA. What medication is to be
prescribed?
A. Cefazolin
B. Erythromycin
C. Prednisone
D. Diprazinum
E. Delagil

85. A 52-year-old woman suffering from obesity, complains of bloody discharges from
genital tracts during 4 days. Last normal menses were 2 years ago. Histological
investigation of biopsy of the endometrium has revealed adenomatous hyperplasia. What
reason from the mentioned below caused the development of disease?
A. Excessive transformation of preandrogens from adipose tissues
B. Hypersecretion of estrogens by tissues of the organism.
C. Poor aromatization of preandrogens due to hypothyroidism
D. Supersecretion of androgens by the cortex of paranephroses.
E. The increased contents of follicle-stimulating hormone

86. A woman was hospitalised with full-term pregnancy. Examination: the uterus is
tender, the abdomen is tense, cardiac tones of the fetus are not auscultated. What is the
most probable complication of pregnancy?
A. Acute hypoxia of a fetus
B. Premature detachment of normally posed placenta
C. Premature labour
D. Hydramnion
E. Back occipital presentation
 87. A baby, aged 1,5 months, in the right parietotemporal area has from the birth a
tumour-like formation of purple colour, rising over the skin surface, not disappearing on
pressure, dimensions 2–3 cm. What is the most likely diagnosis?
A. Nevus pigmentosis
B. Congenital vascular macula
C. Cavernous hemangioma
D. Angiofibroma
E. Lymphangioma

88. A 72-year-old patient after operation of holecystectomia was prescribed gentamicyn

(80 mg every 8 hours) and cephalothin (2 g every 6 hours) because of fever. In 10 days
there was an increase of creatinine up to 310 mu mol/L. BP - 130/80 mm Hg, daily
quantity of the urine is 1200 ml. Urine tests are without pathology. Ultrasound: the size of
kidneys is normal. What is the most probable reason for renal failure?
A. Unequal infusion of the liquid
B. Nephrotoxity of gentamicyn
C. Hepatorenal syndrome
D. Cortical necrosis of kidneys
E. Acute glomerulonephritis

89. A 29-year-old woman is critically ill. The illness was manifested by high fever,
chills, sweating, aching pain in lumbar area, a discomfort during urination, and frequent
bowel voiding. Pasternatsky’s sign is positive in both sides. On lab exam, WBC -
20*109/L; Urinalysis: protein - 0,6 g/L, leukocyturia, bacteriuria. What is the preliminary
diagnosis?
A. Acute pyelonephritis
B. Exacerbation of chronic pyelonephritis
C. Acute glomerulonephritis
D. Nephrolithiasis
E. Acute cystitis

90. A patient, aged 49, was operated on account of acute catarrhal appendicitis. 8 days
later there appeared vomiting, no passage of gasses or defecation. On examination: the
abdomen is inflated, positive Sklyarov's and Wahl's symptoms. Leucocytosis. Acute
intestinal obstruction is suspected. What supplementary examination methods are the
most informative to diagnose the complication?
A. Laparoscopy
B. Colonoscopy
C. Survey radiography of abdomen
D. Echography of abdomen
E. Gastroduodenoscopy
 91. A patient was operated 2 years ago on account of perforated duodenal ulcer, suture
plication was performed. In the last 2 months lost 12 kg, which explains by dread of solid
food intake because of pain and exhausting nausea appearing after meals. Self-induced
vomiting brings relief. What is the most probable preliminary diagnosis?
A. Perforated duodenal ulcer
B. Cicatricial pyloroduodenal stenosis
C. Chronic post-operative pancreatitis
D. Duodenal ulcer, exacerbation
E. Pylorospasm

92. A man fell abruptly ill. Frequent watery stool developed 6 hours ago. The body
temperature is normal. Then vomiting took place. On physical examination: man's voice
is hoarse, eyes are deeply set in the orbits. The pulse is frequent. Blood pressure is low.
There is no urine. What is the preliminary diagnosis?
A. Salmonellosis
B. Dysentery
C. Cholera
D. Toxic food-borne infection
E. Typhoid fever

93. A patient with nosocomial pneumonia has signs of collapse. Which of the following
pneumonia complication is the most likely to be accompanied with collapse?
A. Exudative pleuritis
B. Emphysema
C. Bronchial obstruction
D. Toxic hepatitis
E. Septic shock

94. A patient is suffering from a severe attack of bronchial asthma lasting for over 1
hour in spite of administration of beta -adrenoceptor agonists by inhalation and I.V.,
aminophilline and anticholinergics. What medication should be added to the urgent
treatment?
A. β-adrenoceptor antagonists I.V.
B. Corticosteroids I.V.
C. Nonsteroidal anti-inflammatory drugs
D. Antihistamines
E. Corticosteroids by inhalation

95. A 10-year-old child is sick with chronic viral hepatitis B with marked activity of the
process. Total bilirubin - 70 mmol/L, direct - 26 mmol/L, indirect - 44 mmol/L. АSТ - 6,2
 mmol/L, АLТ - 4,8 mmol/L. What mechanism underlies the transaminase level increase
of this patient?
A. Failure of bilirubin conjugation
B. Cytolysis of hepatocytes
C. Hypersplenism
D. Failure of the synthetic function of the liver
E. Intrahepatic cholestasis

96. District physician was charged with plan drafting concerning medical and
preventive measures among the population in the area he is assigned to. What measures
must he include in this plan as regarding primary prevention of illness?
A. Prevention of disease complications
B. Prevention of disease onset
C. Measures to improve patients' life conditions
D. Measures to increase patients' life quality
E. Referral of patients to sanatorium

97. During intramuscular DTP vaccination in clinic, a 3-month-old child developed

signs of laryngospasm, paleness of skin, cyanosis of lips, "cock cry", stop of respiration,
tension of the whole body with overturned backward head. Allergological history of the
child is not complicated. What is the most probable diagnosis?
A. Meningoencephalitic reaction, clonic and tonic spasms
B. Meningism, clonic and tonic spasms
C. Cerebral haemorrhage, tonic spasms
D. Spasmophilia, tonic spasms
E. Anaphylactic shock, clonic spasms

98. A patient, aged 25, is brought to the infection diseases unit with suspected rabies,
excitement stage. Four weeks ago on the hunting was bitten in a hand by a fox. What
leading symptom will verify the diagnosis.
A. Tonoclonic cramps
B. Dryness in the mouth and throat
C. Paresthesia
D. Hydrophobia
E. Flaccid paralysis of extremities

99. A 43-year-old woman complains of contact hemorrhages during the last 6 months.
Bimanual exam: cervix of the uterus is enlarged, restricted in mobility. Mirrors showed
the following: cervix of the uterus is in the form of cauliflower. Chrobak and Schiller
tests are positive. What is the most probable diagnosis?
A. Cancer of cervix of the uterus
B. Polypus of the cervix of the uterus
C. Leukoplakia
D. Cervical pregnancy
E. Nascent fibroid

100. A 6-year-old asthmatic child is brought to the emergency room with severe
coughing and wheezing during the prior 24 h. The child has been taking theophylline
without relief. Physical examination reveals a child who is anxious, has intercostal and
suprasternal retractions, expiratory wheezing throughout all lung fields, and RR - 60/min.
Initial treatment may include the administration of which of the following?
A. Parenteral gentamicyn
B. Subcutaneous epinephrine
C. N-acetyl cysteine and cromolyn by inhaler
D. Parenteral phenobarbital
E. Intravenous fluids in the first 2 h to correct a water deficiency

101. A 52-year-old patient has hypervolemic type of essential hypertension. What

medication is necessary to prescribe either as monotherapy or in complex with other
antihypertensive remedies?
A. Clophelin
B. Kapoten
C. Hypothiazid
D. Niphedipin
E. Dibazol

102. Water that is used for supply of the city, contains fluoride - 2,0 mg/L, nitrates - 43
mg/L, chlorides - 250 mg/L, ferrum - 0,2 mg/L, residual nitrogen - 0,5 mg/L. What
medical condition is the most likely to occur among the inhabitants of this city?
A. Thyrotoxicosis
B. Methemoglobinemia
C. Caries
D. Endemic goitre
E. Fluorosis

103. Public health is characterised by a group of indices. Which of the following indices
are demographic?
A. Total mortality
B. Morbidity
C. Lethality
D. Disablement
E. Physical development
 104. A woman complains of fever up to 390С the next day after the child-birth. Fetal
membranes rupture took place 36 hours before delivery. Pelvic examination: the uterus is
soft, tender. Discharges are bloody, mixed with pus. Uterine culture: haemolytic
streptococcus, group A. What is the most probable postnatal complication?
A. Apostatis of stitches after the episiotomy
B. Infective contamination of the urinary system
C. Metroendometritis
D. Infected hematoma
E. Thrombophlebitis of veins of the pelvis

105. A boy, aged 10, is under treatment in cardiological unit on account of rheumatic
fever. The first onset of the decease. Discharged in the satisfactory condition. What
medication is the most expedient for secondary rheumatism prevention?
A. Ampicillin
B. Bicillin–1
C. Bicillin–5
D. Erythromycin
E. Oxacillin

106. During dynamic investigation of a patient the increase of central venous pressure is
combined with the decrease of arterial pressure. What process is proved by such
combination?
A. Depositing of blood in venous channel
B. Presence of hypervolemia
C. Shunting
D. Developing of cardiac insufficiency
E. Increase of bleeding speed

107. A primipara is in labour for 19 hours, amniotic fluid has discharged 7 hours ago.
Pelvic sizes are: 24-25-29-18 cm. Fetal position is longitudinal, head presents and is
engaged to pelvic inlet. Fetus heart rate is 160 bpm. No autonomous urination. Vaginal
inspection: cervix is smoothed and 8 cm dilated. Head is presented, sagittal suture
occupies the transverse diameter of pelvic inlet; small fontanel is on the left. Lower
uterine segment is tender on pressing. What medical tactics should be chosen?
A. Application of obstetrical forceps
B. Urgent caesarean section
C. Vacuum-extractor operation
D. Stimulation of labour activity with intravenous oxytocin
E. Craniotomy
 108. After delivery and revision of placenta there was found the defect of placental lobe.
General condition of woman is normal, uterine is firm, there is moderate bloody
discharge. Inspection of birth canal with mirrors shows absence of lacerations. What is
the following necessary action?
A. Use of uterine contracting agents
B. External massage of uterus
C. Manual exploration of the iterine cavity
D. Use of hemostatic medications
E. Urine drainage, cold at lower abdomen

109. A 37-year-old patient has come to clinic being wounded in the area of umbilicus an
hour ago. On physical exam, there is a prick and cut painful wound of about 0,5x1 cm
around umbilicus on the abdominal skin with slight bleeding. How would you help this
patient?
A. Suture on the wound
B. Laparotomy, abdominal cavity organs inspection. Primary surgical processing of the
wound
C. Aseptic bandage
D. Drainage of the wound with rubber strip
E. Inspection of the wound with canal probe

110. A patient was admitted to the hospital on the 7th day of the disease with complaints
of high temperature, headache, pain in the muscles, especially in calf muscles. Dermal
integuments and scleras are icteric. There is hemorrhagic rash on the skin. Urine is
bloody. The patient was fishing two weeks ago. What is the most likely diagnosis?
A. Leptospirosis
B. Brucellosis
C. Yersiniosis
D. Salmonellosis
E. Trichinellosis

111. A woman, aged 64, is hospitalised on account of metrorrhagia and anaemia. After
12 years of menstruation absence, 7-8 months ago there appeared at first sero-watery
discharge from vagina, then - sero-bloody, with "meat slops" colour, pain in the lower
abdomen. What pathology is the most probable?
A. Uterus fibromyoma
B. Interior genital endometriosis
C. Hydatidiform mole
D. Uterus cancer
E. Chorioepithelioma
 112. A patient complains of pathological lump, appearing in the right inguinal
region on exercise. The lump is round-shaped, circa 4 cm in diameter, on palpation: soft
elastic consistency, positions near the medial part of Poupart's ligament. The lump is
situated inwards from the spermatic cord. What is the most probable preliminary
diagnosis?
A. Varicose veins of the right hip
B. Right-sided direct inguinal hernia
C. Right-sided femoral hernia
D. Lipoma of the right inguinal area
E. Right-sided oblique inguinal hernia

113. A 30-year-old man who suffered from headaches, felt an intense headache in the
form of the blow on his head while lifting up a heavy object with the following onset of
nausea, vomiting, light dizziness. In a day there was an objectively presented meningeal
syndrome, t0- 37,60C. The doctor have suspected subarachnoidal haemorrhage. What
additional examination is necessary to confirm the diagnosis?
A. Rheoencephalography
B. Lumbar puncture with liquor examination
C. Cerebral angiography
D. Computer-aided tomography
E. Roentgenography of the cranium

114. A 14-year-old boy periodically complains of pain in the epigastrium on an empty

stomach, nausea and heartburn during 3 years. Gastroduodenoscopy: signs of
gastroduodenitis and ulcer defect of the mucous membrane of the duodenum. What is the
most effective medication to treat this child?
A. No-spa
B. Almagel
C. De-nol
D. Atropine
E. Papaverin

115. In morgue there are dead bodies with the following causes of death: electrotrauma;
rupture of the spleen with acute anaemia. There is one unknown person; one ethyl alcohol
poisoned person and one drowned man. What dead body should the blood group be
determined for?
A. Body of person with internal haemorrhage
B. Body of person with a sudden death
C. All dead bodies of the unknown persons
D. Body of poisoned person
E. Body of drowned man
 116. In order to differentiate diagnosis of anuria and ishuria what supplementary
examination should be carried out?
A. Catheterisation of the urinary bladder
B. Excretory urography
C. Analysis of urine
D. Analysis of the blood
E. -

117. A patient complains of fever up to 38,20С, an edema of the upper lip. On

examination: the upper lip is distinctly hydropic, in the centre of the edema there is a
cone-shaped swelling. The skin and the mucosa over it are deep-red. A furuncle of the
upper lip is diagnosed. Surgeon executed a lancing of furuncle, cleansed the wound with
peroxide solution and dressed it with hypertonic solution. What therapeutic regimen
should be recommended to the patient?
A. In-patient treatment with general regimen
B. Out-patient treatment, then - in-patient treatment
C. -
D. In-patient treatment with bed rest
E. Out-patient treatment

118. A 3-day-old new-born who has suffered from asphyxia in birth, presents
with bleeding from umbilical sore. Lab tests: hypocoagulation, thrombocytopenia,
hypothrombinemia. What is the most likely cause of clinical and laboratory changes?
A. Disseminated intravascular coagulation (DIC)
B. Haemolytic disease of new-born
C. Trauma of umbilical vessel
D. Thrombocytopenic purpura
E. Inborn angiopathy

119. Parents of 5-year-old boy complain of ventral curvature of boy's penis. Physical
examination: external urethral meatus is on the apex of penis, prepuce is hood-like. What
is the most likely diagnosis?
A. Cryptorchidism
B. Epispadia of balanus
C. Induratio penis plastica (Peyronie's disease)
D. Hypospady without hypospady
E. Latent penis

120. A 75-year-old patient can not tell the month, date and season of the year.
After long deliberations she manages to tell her name. She is in irritable and dissatisfied
mood. She always carries a bundle with belongings with her, hides a parcel with bread,
shoes in her underwear in her bosom as well as "invaluable books". What is the most
probable diagnosis?
A. Dissociated personality (psychopathy)
B. Presenile melancholia
C. Behaviour disorder
D. Atherosclerotic (lacunar) dementia
E. Senile dementia

121. A woman, aged 40, primigravida, with infertility in the medical history, on the 42–
43 week of pregnancy. Labour activity is weak. Longitudinal presentation of the fetus, I
position, anterior position. The head of the fetus is engaged to pelvic inlet. Fetus heart
rate is 140 bmp, rhythmic, muffled. Cervix dilation is 4 cm. On amnioscopy: greenish
colour of amniotic fluid and fetal membranes. Cranial bones are dense, cranial sutures
and small fontanel are diminished. What should be tactics of delivery?
A. Caesarean section
B. Fetal hypoxia treatment, in the ІІ period – forceps delivery
C. Fetal hypoxia treatment, conservative delivery
D. Amniotomy, labour stimulation, fetal hypoxia treatment
E. Medication sleep, amniotomy, labour stimulation

122. When examining a patient with supposed pelvis fracture, the doctor exerts pressure
with both hands on the wings of ileum in opposite direction. What is the cause of pain
syndrome appearing in this case?
A. Sacral fracture
B. Retroperitoneal haematoma
C. Traumatic injury of intrapelvic organs
D. Ischial bones fracture
E. Pelvic ring discontinuity

123. A 7-year-old girl suddenly fell ill with fever, headache, severe sore throat,
vomiting. Minute bright red rash appeared on her reddened skin 3 hours later. It is more
intensive in axillas and groin. Mucous membrane of oropharynx is hyperemic. On tonsils
there are greyish patches. Submaxillary glands are enlarged and painful. What is the most
likely diagnosis?
A. Measles
B. Rubella
C. Enteroviral infection
D. Pseudotuberculosis
E. Scarlet fever
 124. A man, aged 64, complains of cough with sputum discharge, sometimes with blood
spitting. Smokes during 30 years. In the last 3 months has lost 8 kg. On roentgenologic
examination in the middle lobe of the right lung there is a cavernous formation, the inner
outline is irregular, contains a small quantity of fluid, on the right the central lymph nodes
are enlarged. What examination is the most informative to define the diagnosis?
A. Spirography
B. Sputum analysis
C. Bronchoscopy with biopsy
D. Pulmonary tomography
E. Bronchography

125. A 16-year-old woman complains of the abdominal pain and purpuric spots
on the skin. Laboratory investigations discovered normal platelet count with hematuria
and proteinuria. What is the most probable diagnosis?
A. Henoch-Schoenlein purpura
B. Heavy metal poisoning
C. Thrombotic thrombocytopenic purpura
D. Hemolytic uremic syndrome
E. Subacute bacterial endocarditis

126. A child, aged 4, has being ill for 5 days, suffers from cough, skin rash, t0- 38,20С,
facial hydropy, photosensitivity, conjunctivitis. On the face, neck, upper part of the chest
there is bright maculopapular rash with areas of merging. Hyperemic throat. Seropurulent
nasal discharge. In lungs there are dry crackles. What is the most probable preliminary
diagnosis?
A. Rubella
B. Adenovirus infection
C. Measles
D. Enterovirus exanthema
E. Scarlet fever

127. A patient, aged 16, complains of headache, mainly in the frontal and
temporal areas, superciliary arch, appearing of vomiting at the peak of headache, pain
during the eyeballs movement, joints pain. On examination: excited, t0- 390С, Ps -
110/min. Tonic and clonus cramps. Uncertain meningeal signs. What is the most likely
diagnosis?
A. Parainfluenza
B. Respiratory syncytial virus
C. Influenza with cerebral edema manifestations
D. Adenovirus infection
E. Influenza, typical disease duration
 128. A patient, aged 32, diagnosed with multiple injuries: closed craniocerebral injury,
closed chest injury, closed right hip fracture. BP - 100/60 mm Hg, Рs - 124/min, RR -
28/min. 2 hours after skeletal extension under local anaesthesia with lidocaine, there
appeared abrupt aggravation of the patient's condition: developed face and neck cyanosis,
BP - 60/40 mm Hg, HR - 160/min, RR - 44/min. What complication most probably
aggravated the severity of multiple injuries?
A. Acute anaemia
B. Pain shock
C. Cardiac infarction, cardiogenic shock
D. Pulmonary thromboembolism
E. Pulmonary fat embolism

129. A 5-year-old child had an attack of palpitation with nausea, dizziness, generalised
fatigue. On ECG: tachycardia with HR of 220/min. Ventricle complexes are deformed
and widened. P wave is absent. What medication should be given for emergent care?
A. Isoptin
B. Strophantin
C. Novocainamides
D. Lydocain
E. Seduxen

130. A man, aged 52, fell down from the height of 3 m on the level surface of the earth
hurting his right lumbar region. Complains of the pain in the right lumbar region.
Urinalysis: microhematuria. Excretory urography: kidneys function is satisfactory. What
is the most likely diagnosis?
A. Subcapsular kidney rupture
B. Kidney contusion
C. Paranephral haematoma
D. Kidney abruption
E. Multiple kidney ruptures

131. A man, aged 54, complains of constant dull ache in mesogastric area, weight
loss, dark blood admixtures in feces, constipations. In the course of the year the weight
loss is up to 10 kg. In blood: RBC - 3,5*1012/L, Hb - 87 g/L, WBC – 12,6*109/L, stab
shift, ESR – 43 mm/h. What is the most probable preliminary diagnosis?
A. Stomach cancer
B. Transverse colon cancer
C. Stomach ulcer
D. Chronic colitis
E. Chronic pancreatitis
 132. A sample of milk was taken for testing from a 5 ton milk batch. Lab analysis
showed the following: fat content 2%, specific density- 1,04 g/cm3, acidity 210C,
reductase probe – weak positive. What way the product is to be used in? What would you
advise?
A. Write the product off for animal feeding
B. Sell but inform customers about milk quality
C. Utilise technically
D. Annihilate the product
E. Sell without limitations

133. A 30-year-old man complains of a sharp pain in the right ear, hearing loss, high
temperature during three days. Objectively – right ear whispering language – 0,5 m,
external ear is intact, otoscopically - eardrum protrusion, hyperaemia and swelling, loss
of landmarks. What is the most likely diagnosis?
A. Acute mastoiditis
B. Eustachian tube dysfunction
C. Acute purulent otitis media
D. Chronic purulent otitis media
E. Chronic secretory otitis media

134. A woman, aged 30, in labour, is brought to the maternity in term of 35–36
weeks with weakened labour activity. Fetal movements are not felt. On echography:
fetus's heartbeat not determined. Vaginal inspection: cervix is 6 cm dilated, green
amniotic fluid has discharged, the head of the fetus is engaged to pelvic inlet. What is the
further tactic of delivery?
A. Forceps delivery
B. Turning of the fetus by Braxton-Hicks
C. Cephalotomy
D. Vacuum extraction of the fetus
E. Conservative delivery, wait for natural birth of the fetus

135. A 27-year-old man complains of pain in epigastrium which is relieved by food

intake. EGDFS shows antral erosive gastritis, biopsy of antral mucous presents
Hеlicobacter Pylori. What can be diagnosed in this case?
A. Gastritis of type B
B. Rigid antral gastritis
C. Gastritis of A type
D. Menetrier's disease
E. Reflux-gastritis

136. A patient complains of periodic rash eruptions in the course of the year on the
elbow and knee joints. The first eruption occurred after stress. Now it consists of multiple
plates, the central part of which is covered with silvery scales. What is the most likely
diagnosis?
A. Psoriasis
B. Lichen ruber planus
C. Dermatitis
D. Eczema
E. Erythematosis

137. A girl, aged 13, consults the school doctor on account of moderate bloody
discharge from the genital tracts, which appeared 2 days ago. Secondary sexual characters
are developed. What is the most probable cause of bloody discharge?
A. Menarche
B. Haemophilia
C. Juvenile haemorrhage
D. Endometrium cancer
E. Werlhof's disease

138. A 3-year-old boy fell suddenly ill: fever up to 390C, weakness, vomiting.
Haemorrhagic rash of various size appears on his lower limbs in 5 hours.
Meningococcemia with infective - toxic shock of 1 degree was diagnosed. What
medications should be administered?
A. Penicillin and prednisone
B. Chloramphenicol succinate and prednisone
C. Penicillin and immunoglobulin
D. Chloramphenicol succinate and interferon
E. Ampicillin and immunoglobulin

139. A patient, aged 58, was fishing in the winter. On return home after some
time felt some pain in the feet. Consulted a doctor. On examination: feet skin was pale,
then after rewarming became red, warm to the touch. Edema is not significant, limited to
the toes. All types of sensitivity are preserved. No blisters. What degree of frostbite is
observed?
A. II degree
B. V degree
C. III degree
D. I degree
E. IV degree

140. A baby, aged 2 months, is hospitalised to the surgery unit with fever up to
38,5 С, edema, hyperaemia and absence of movements in the left shoulder joint. In
0
medical history – omphalitis, pseudofurunculosis. What is the most likely diagnosis?
A. Metaepiphyseal osteomyelitis
B. Erbe's paralysis
C. Phlegmon of the new-born
D. Shoulder injury
E. Plexitis

141. A male patient, aged 38, accountant. During acute allergic infectious myocarditis
developed the full left bundle-branch block. After treatment and 2 months of observation
patient's condition is satisfactory, absence of complains or objective and clinical
manifestations of decease, but there are still changes on the ECG. What should be the
doctor's tactics in this case?
A. Rehospitalisation
B. Implanting a pacemaker
C. Referral to the MSEC
D. Electrophysiological examination
E. Follow-up by general practitioner

142. A worker (battery attendant) in the end of the working day complains of intensive
pains in the epigastric area, diarrhea, subfebrility, BP - 170/110 mm Hg, skin and scleras
are yellow. At the lunch have drunk 250 ml of vodka. What diagnosis is the most likely?
A. Acute lead intoxication
B. Fatty degeneration of liver
C. Acute hemolysis
D. Acute pancreatitis
E. Acute alcohol intoxication

143. A worker was temporarily off work because of illness during 16 days, was
under out-patient treatment. The doctor in charge of the case issued a sick-list first for 5
days, then prolonged it for 10 days. Who can further prolong the sick-list to this patient?
A. Working ability expertise committee
B. The doctor in charge of the case with the permission of the head of department
C. The doctor in charge of the case together with the head of department
D. The head of department
E. Deputy head physician on the working ability expertise

144. In treatment and prevention establishments, regardless of their organisational and

proprietary form, the rights of the patients should be observed. Which of these rights is
the most significant?
A. The right to the free choice
B. The right to be heard
C. The right to the information
D. The right to the protection of the patient's interests
E. The right to the protection from incompetence

145. A woman, aged 23, complains of periodical febrile chills with fever up to 400С,
sensation of heat alternating with profuse sweat. During last three months has lived in a
tropical African country. The patient has already suffered 3 such attacks, which appeared
every other day, lasted 12 hours, were accompanied by the headache, lumbar and
muscular pain. The face is pale with yellowish tinge. Cyanotic lips. Liver, spleen are
enlarged. In blood: RBC - 2,5*1012/L. What is the most likely diagnosis?
A. Leptospirosis
B. Epidemic typhus
C. Malaria
D. Sepsis
E. Hemolytic anaemia

146. Body temperature of a 12-year-old girl increased up to 39-400C in 4-5 hours after
she had taken 2 pills of aspirin. Complains of general discomfort, dizziness, sudden
appearance of red spots on the skin with blister formation or exfoliation of the epidermis
with erosive surface. Lesions on the skin looked like burns of II degree. Nikolsky
syndrome is positive. What is the most probable diagnosis?
A. Duhring's disease
B. Acute epidermal necrolysis
C. Pemphigus vulgaris
D. Bullous dermatitis
E. Polymorphic exudative erythema

147. A 10-year-old boy complains of a headache, weakness, fever (temperature -

40 С), vomiting. On physical examination: there is an expressed dyspnea, pale skin with
0

a flush on a right cheek, right hemithorax respiratory movement delays, dullness on

percussion of the lower lobe of the right lung, weakness of vesicular respiration in this
region. The abdomen is painless and soft by palpation. What disease causes these
symptoms and signs?
A. Intestinal infection
B. Acute cholecystitis
C. Influenza
D. Acute appendicitis
E. Pneumonia crouposa

148. On examination of a patient, aged 49, cancer of the right lung, ІІА stage, is
diagnosed. What TNM combination corresponds to this stage?
A. T2N0M0
B. T2NXM0
C. T2N2M0
D. Т1N1M0
E. T1N2M0

149. The occipital part of new-born head of dolichocephalic form shows with labour
edema with centre in the area of small fontanel. In which presentation of fetal head did
child-birth occur?
A. Face presentation
B. Brow presentation
C. Occiput posterior presentation
D. Parietal anterior presentation
E. Occiput anterior presentation

150. A patient, aged 81, complains of constant urinary excretion in drops, feeling
of fullness in the lower abdomen. On examination: above pubis there is a spherical
protrusion, over which there is a dullness of percussion sound, positive suprapubic punch.
What symptom is observed in this patient?
A. Dysuria
B. Enuresis
C. Pollakiuria
D. Urinary incontinence
E. Paradoxal ischuria

151. A female patient, aged 45. Two weeks after pneumonia developed shortness of
breath during walking, constant ache in precardiac area, shin edema. On examination: t0 =
37,20С, Heart borders without changes, Sound 1 on the apex is weakened. ECG:
atrioventricular heart block I degree, lowering of the amplitude of Т wave in V2-V6. In
blood: Hb - 124 g/L, WBC - 5,68*109/L, ESR - 18 mm/h. What is the most likely
diagnosis?
A. Pulmonary embolism
B. Metabolic cardiopathy
C. CHD: unstable angina
D. Infective endocarditis
E. Acute myocarditis

152. A patient is hospitalised with the complaints of acute fatigue, fever up to 39,20С,
pain in the throat during swallowing, hemorrhagic rash on the skin of the trunk. On
examination the blood analysis shows anaemia, thrombocytopenia, blastocytes – 14%,
ESR - 40 mm/h. What examination is necessary to define the diagnosis?
A. Sternal puncture
B. Coagulogramme
C. Detailed blood test
D. Rontgenography of the scull bones
E. Bacterial inoculation from tonsills

153. The diagnosis of a right-sided pneumothorax is set to a 36-year-old patient.

What method of treatment is indicated to the patient?
A. Anti-inflammatory therapy
B. Drainage of the pleural cavity
C. Symptomatic therapy
D. Thoracotomy
E. Pleural puncture

154. A woman in labour, on vaginal inspection: cervix dilation is up to 2 cm, fetal

bladder is intact. Sacral cavity is free, sacral promontory is reachable only with a bent
finger, the inner surface of the sacrococcygeal joint is accessible for inspection. The head
of the fetus presents. Sagittal suture occupies the transverse diameter of pelvic inlet, the
small fontanel to the left, on the side. What labour stage is this?
A. Prodromal stage
B. Preliminary stage
C. Placental stage
D. Expulsion of fetus stage
E. Cervix dilation stage

155. A boy, aged 7, is under treatment during 1 month. On hospitalisation: significant

edema, proteinuria - 7,1 g/L, protein in daily urine - 4,2 g. Blood biochemical profile:
stable hypoproteinaemia (43,2 g/L), hypercholesterinaemia (9,2 mmol/L). Which variant
of glomerulonephritis is the most probable in this case?
A. Mixed
B. Nephrotic
C. Isolated urinary
D. Nephritic
E. Hematuric

156. In medical history of a 2-years-old girl: recurring pneumonias with obstructive

course. Auscultation: heterogeneous moist and dry rales in lungs, weakened breathing.
Difficult excretion of thick, viscous sputum. Observed "drumstick" fingers, mental
deficiency. What is the preliminary diagnosis?
A. Congenital polycystic lung disease
B. Cystic fibrosis, pulmonary form
C. Pulmonary tuberculosis
D. Bronchial asthma
E. Recurrent bronchitis

157. A woman, primipara, consults a gynecologist on 05.03.2002. A week ago felt the
fetus movements for the first time. Last menstruation was on 10.01.2002. When she
should be given maternity leave?
A. 25 July
B. 22 August
C. 8 August
D. 11 July
E. 5 September

158. An employee of a private company was ill with acute respiratory viral infection.
Consulted a district doctor, who determined the fact of temporary loss of working ability,
but refused to issue a sick-list, arguing that the patient worked in the private and not state-
owned company. Should the sick-list be issued to the employees of private companies?
A. Issued only to empties of state-owned companies
B. Issued a medical certificate of a set form
C. Issued only on condition of payment guarantee by the company's proprietor
D. Issued regardless of company's ownership
E. Issued a medical certificate of a free form

159. A 76-year-old man, with the cardiac pacemaker (demand mode) has periodic
episodes of loss of consciousness. Physical examination: Ps - 42 bpm, cardiac rhythm is
regular. What can cause the development of such condition?
A. Intraventricular conduction disorder
B. Cerebral atherosclerosis
C. Pacemaker malfunction
D. Paroxysmal ventricular tachycardia
E. Paroxysmal supraventricular tachycardia

160. A military unit after long march stopped for 3-day's rest in the vicinity of a
inhabited locality. The sanitary-epidemiological reconnaissance found several water
sources. It is necessary to choose the source complying with the hygienic standards for
potable water in the field conditions.
A. Artesian well water
B. River water
C. Water from melted snow
D. Spring water
E. Rain water
 161. A 18-year-old woman consulted a gynaecologist with complaints of the pain
in the lower part of the abdomen, fever up to 37,50C, considerable mucopurulent
discharges from the genital tract, colic during urinating. After mirror and vagina exam the
results are the following: the urethra is infiltrated, cervix of the uterus is hyperemic,
erosive. The uterus is painful, ovaries are painful, thickened, free. Bacterioscopy test
showed diplococcus. What diagnosis is the most probable?
A. Chlamydiosis
B. Candydomycosis
C. Recent acute ascending gonorrhea
D. Chronic gonorrhea
E. Trichomoniasis

162. A full-term new-born suffered ante- and intranatal hypoxia, was born in asphyxia
(Apgar score 2-5 points). After birth baby's excitation is progressing, occurs vomiting,
nystagmus, spasms, squint, spontaneous Babinski and Moro's reflexes. What is the most
probable location of the intracranial haemorrhage in this case?
A. Haemorrhages in ventricles of brain
B. Subdural hemorrhages
C. Subarachnoid hemorrhages
D. Periventricular hemorrhages
E. Small hemorrhages in brain tissue

163. In the development of the inflammation processes glucocorticoids reduce the level
of a certain most important active enzyme. It results also in the reducing of the synthesis
of prostaglandins and leucotrienes which have a key role in the development of
inflammation processes. What is the exact name of this enzyme?
A. Cyclooxygenase – 2
B. Arachidonic acid
C. Lipoxygenasе
D. Phospholipase A2
E. Cyclooxygenase – 1

164. A patient aged 18 with a cranial injury was in comatose state during several hours.
In post-comatose period gets tired quickly, non-productive in dialog - in the beginning
answers 2-3 questions, then gets tired and can not understand the point of the question.
Which psychotropic should be given to the patient to prevent psychoorganic syndrome?
A. Neuroleptics
B. Nootropics
C. Antidepressants
D. Tranquillisers
E. Stimulators
 165. In an inhabited locality there is an increase of diphtheria during the last 3 years
with separate outbursts in families. What measure can effectively influence the epidemic
process of diphtheria and reduce the morbidity rate to single cases?
A. Disinfection in disease focus
B. Immunisation of the population
C. Detection of carriers
D. Early diagnostics
E. Hospitalisation of patients

166. A patient, aged 36, is diagnosed with ascites, splenomegaly, liver dimensions by
Kurlov 11х9х8 cm, varicose esophagus veins. In medical history: abdominal injury,
stomach bleeding. AST – 0,46 mmol/g*L; ALT – 0,68 mmol/g*L; total bilirubin – 21 mu
mol/L, unconjugated bilirubin – 17,1 mu mol/L. What is the preliminary diagnosis?
A. Constrictive pericarditis
B. Hepatic vein thrombosis
C. Portal vein thrombosis
D. Inferior vena cava thrombosis
E. Peritoneum tumour (mesothelioma)

167. A woman, aged 26, is brought to emergency department with complaints of sudden
pain in the lower abdomen, weakness, loss of consciousness at home. The previous
menstruation absented. Hb - 106 g/L, Ps - 120/min, BP - 80/50 mm Hg. Painfulness and
peritoneum irritation symptoms in the lower right flank. What is the most likely
diagnosis?
A. Acute appendicitis
B. Torsion of ovarian cyst pedicle
C. Ovarian apoplexy
D. Acute adnexitis on the right
E. Disturbed tube pregnancy

168. The district doctor is charged with the analysis of the morbidity rate in the
area he is assigned to. Which type of morbidity characterises the group of protractedly
and frequently ill?
A. Hospitalised
B. With main non-epidemic deceases
C. Acute respiratory
D. With temporary loss of working ability
E. General

169. A woman, aged 37, primigravida, is in labour during 10 hours. The contractions
last 20-25 sec every 6-7 min. Fetal position is longitudinal, head presents and is engaged
to pelvic inlet. Vaginal inspection: cervix is 1 cm long, lets in 2 horizontal fingers. Fetal
bladder is absent. What is the most likely diagnosis?
A. Normal labour activity
B. Pathological preliminary period
C. Primary uterine inertia
D. Secondary uterine inertia
E. Discoordinated labour activity

170. A 43-year-old woman complains of severe pain in the right abdominal side
irradiating in the right supraclavicular area, fever, dryness and bitterness in the mouth.
There was multiple vomiting without relief. Patient relates the onset of pain to the taking
of fat and fried food. Physical examination: the patient lies on the right side, pale, dry
tongue, tachycardia. Right side of abdomen is painful during palpation and somewhat
tense in right hypochondrium. What is the most likely diagnosis?
A. Acute appendicitis
B. Acute cholecystitis
C. Acute bowel obstruction
D. Right-sided renal colic
E. Perforative ulcer

171. A 2-months baby, after preventive vaccination, suffered from protracted

haemorrhage from the point of injection, later there developed an intramuscular
hematoma. On examination: a significant growth of prothrombine consumption and
distinct prolongation of activated partial thromboplastin time. What is the most likely
diagnosis?
A. Schoenlein-Henoch's disease
B. Haemophilia
C. Hemorrhagic new-borns' disease
D. Werlhof's disease
E. Congenital afibrinogenemia

172. A 2,5-year-old child fell ill 10 hours ago, became anxious, held on the
stomach, had fever up to 380C. In 7 hours condition has worsened with vomiting and
diarrhea. Physical examination: tongue is dry, coated. Abdomen barely participates in
breathing. Palpation is impossible due to child's anxiety. Digital rectal investigation
reveals overhang of front rectum wall. What is the most likely diagnosis?
A. Primary peritonitis
B. Acute mesadenitis
C. Acute appendicitis, peritonitis
D. Acute adenoviral infection
E. Acute enteric infection
 173. A man, aged 28, power-supply system operator, was at his working place during
the breakdown on the nuclear power plant. In the result of the steam-air explosion there
was an emission of circa 30 kg radioactive iodine (І131). Which radioprotector is expedient
in this case?
A. Thiourea
B. Potassium iodide
C. Valine
D. Cystamine
E. Leucine

174. A worker of the chemical plant complains of fatigue, insomnia, headache. Works at
the amalgam production. On examination: tremor, asymmetry of reflexes, labile pulse,
stable red dermographism. Excretory gingivitis. What is the cause of the illness?
A. Chronic lead poisoning
B. Chronic mercury poisoning
C. Chronic petrol poisoning
D. Chronic cadmium poisoning
E. Chronic aniline poisoning

175. A patient, aged 24, is suffering from an asthmatic fit with non-productive cough
and skin itch after diclofenac intake. In medical history: urticaria. On examination:
edematous face, swelling of the cervical veins, the patient is supporting himself in a
seated position, audible stridor breathing. What is the most likely diagnosis?
A. Nervous asthma
B. Quincke's edema
C. Diclofenac tablet aspiration
D. Cardiac asthma
E. Bronchial asthma

176. A patient, aged 38, had acute glomerulonephritis 10 years ago, complains of
face and legs swelling, headache, dull pain in loins. BP - 220/130 mm Hg. Urinalysis:
protein - 9,9 g/L, WBC - 3-4 in the field of vision, RBC - 10-12 in the field of vision,
hyaline cylinders - 3-4 in the field of vision, ceraceous - 2-3 in the field of vision.
Creatinine - 102 mu mol/L. Which of the mentioned antihypertensive agents are
expedient to prescribe in this case?
A. Clonidine
B. Prazosine
C. Methyldopa
D. Captopril
E. Propranolol
177. A boy, aged 9, is examined: height – 127 cm (-0,36), weight – 28,2 kg (+0,96),
chest circumference - 64,9 cm (+0,66), lung vital capacity – 1520 ml (-0,16). What is the
integrated assessment of the child's physical development?
A. Markedly disharmonious
B. Below the average
C. Disharmonious
D. Excessive
E. Harmonious

178. A boy, aged 13, suffers from an abrupt aggravation of condition, there appeared
shortness of breath, skin paleness with cyanosis. BP - 80/55 mm Hg, Ps- 128/min, heart
sounds weakened. On ECG: diffuse muscular changes, polytopic extrasystole.
Radiologically: acute enlargement of the heart borders in all directions. Two weeks ago
there occurred a reaction on analgin administration. What is the most likely diagnosis?
A. Endocardial fibroelastosis
B. Idiopathic Abramov-Fiedler myocarditis
C. Rheumatic myocarditis
D. Exudative pericarditis
E. Hypertrophic cardiomyopathy

179. In 2 weeks after pharyngitis a 25-year-old patient started complaining of rise in

temperature to 380C, fatigue, shortness of breath during walking, migrating joint
intumescence and pain. On physical exam: cyanosis of lips, pulse is weak, rhythmical,
100 bpm. The left heart border is moved outwards from mediaclavicular line for 1 cm.
Sound I on the apex is weakened, soft systolic murmur is auscultated. What etiologic
factor caused this pathological process in the most probable way?
A. Fungus
B. Beta hemolytic streptococcus
C. Pneumococcus
D. Staphylococcus
E. Virus

180. A man consults a physician with complaints of cramping pain in left side of the
chest, general weakness, fever and headache that have appeared 2 days ago. This morning
the patient noticed a skin rash on the chest. Physical examination: multiple aggregated
vesicles with edematous covers filled with transparent liquid, 2-4 mm in diameter.
Vesicles are situated on the erythematous and edematous background along 4-5
intercostals. What is the most likely diagnosis?
A. Allergic dermatitis
B. Herpes Zoster varicellosus
C. Pityriasis rosea
D. Streptococcal (Fox's) impetigo
E. Herpes simplex
 181. A breakdown on a nuclear power-plant caused the radioactive fuel material release
in the atmosphere, which resulted in the radionuclid pollution of a large territory and
increasing of the background ionising radiation. The incidence of what deceases will be
increased among the population of this territory in the future?
A. Gastrointestinal deceases
B. Cardiovascular deceases
C. Ophthalmic deceases
D. Malignant neoplasms
E. ENT deceases

182. A 27-year-old patient was admitted to the psychiatric hospital for the 4-th time
during 2 years. He heard voices commenting on his actions, had delusions of persecution
(was sure that mafia wanted to kill him). He was discharged from the hospital with the
diagnosis of schizophrenia, state of remission after a course of treatment with
neuroleptics. What is necessary to do to prevent relapses of schizophrenia?
A. Long-term hospitalisation
B. Psychiatric observation
C. Participation in a self-assistance group
D. Psychoanalytic treatment
E. Supportive treatment with neuroleptics of prolonged action

183. A 14-year-old victim was drawn out of the water in winter after 15 minutes after
drowning. The victim shows no vital signs. What measures are to be taken?
A. Not to waste time on the release of respiratory tract from water, to undertake
cardiopulmonary reanimation
B. Not to carry out reanimation measures
C. To transport the victim to the nearest hospital for reanimation measures
D. Тo transport the victim to the nearest warm premises to carry out reanimation
measures
E. To release respiratory tract from water, to create drain position and to undertake
measures to restore respiration and blood circulation

184. A 36-year-old male, at 4:00 a.m. had an intensive attack of lacerating chest pain,
which was accompanied by weakness, cold perspiration, fear of death. ECG: dome-
shaped ST segment elevation in leads ІІ, ІІІ, aVF, V5, V6. After pain relieving the ECG
has normalised. What is the preliminary diagnosis?
A. Dilated cardiomyopathy
B. Variant (Prinzmetal's) angina
C. Prolonged angina attack
D. Myocardial infarction of the back side of left ventricular wall
E. Acute pericarditis

185. A woman, aged 64, suffering from unstable angina, suddenly collapsed during
walking. On examination: unconscious, absence of pulsation on a. carotis and heart
sounds, miotic pupils and infrequent shallow respiration. What is the first measure to start
resuscitation?
A. Transesophagial pacing
B. Intubation and ALV
C. Precardiac punch
D. Atropine I.V.
E. Adrenaline I.V.

186. A child, aged 5, is ill with fever, vesicular rash mainly on the trunk and head skin.
On the 8th day there appeared severe headache, ataxia, lethargy, movement
discoordination, tremor of the extremities. On the second wave of the fever encephalitis is
diagnosed. Complication of what decease can be encephalitis in this case?
A. Measles
B. Herpetic infection
C. Rubella
D. Chicken pox
E. Enterovirus infection

187. A pregnant woman, aged 35, is in grave condition, complains of headache, vision
disorders, "midges" before the eyes. On examination: anasarca, BP - 180/120 mm Hg.
Suddenly there appeared fibrillar twitching of the facial muscles, tonic spasms. Breathing
stopped. 1 minute later breathing restarted. A profuse foam discharge from the mouth.
Amnesia. In clinical urine analysis: protein - 7 g/L. What is the most likely diagnosis?
A. Epilepsy
B. Preeclampsia, severe degree
C. Eclampsia
D. Hypertension attack
E. Craniocerebral injury

188. A 48-year-old patient complains of heaviness in the right hypochondrium, itching

of the skin. He had been treated in infectious diseases hospital repeatedly due to icterus
and itch. On physical exam: meteorism, ascitis, dilation of abdominal wall veins,
protruded umbilicus, spleen enlargement. What can be diagnosed in this case?
A. Cancer of the head of pancreas
B. Gallstones
C. Liver cirrhosis
D. Cancer of the liver
E. Viral hepatitis B

189. A worker, aged 38, working in the slate production during 15 years, complains of
expiratory exertional dyspnea, dry cough. On examination: deafening of the percutory
sounds in interscapular region, rough breath sounds, dry disseminated rales. On fingers'
skin – greyish warts. Factory's sectorial doctor suspects asbestosis. Which method is the
most informative for diagnosis verification?
A. Bronchoalveolar lavage
B. Spirography
C. Blood gases examination
D. Bronchoscopy
E. Thorax roentgenography

190. At the radiological unit of the hospital, gamma-devices of radiotherapy of "Agat"

type and other closed sources of ionising radiation are used for treatment of malignant
neoplasms. What are the measures to be taken to protect personnel at the time of work
with radioactive sources of such type?
A. Systematic cleansing of surfaces from the radioactive contamination and shortening of
working time
B. The increase of distance to the source and individual hygiene compliance
C. Shortening of working time and screening of the source
D. Screening of the source and the use of means of individual protection of respiration
organs
E. Capsulation of devices and organisation of room ventilation

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

192. A 29-year-old patient complains of sterility. Sexual life is during 4 years of

marriage, does not use contraception. There was no pregnancy before. On physical
examination, genitals are developed normally. Uterine tubes are passable. Rectal
temperature during three menstrual cycles is monophase. What is the most probable
reason for sterility?
A. Chronic adnexitis
B. Genital endometriosis
C. Anomalies of genitals development
D. Anovulatory menstrual cycle
E. Immunologic sterility

193. During 3 years a patient with diagnosis of chronic bronchitis has been under
regular observation in the clinic. This year he applied 3 times for medical aid on account
of exacerbation of this decease. What should be the statistical record of this decease?
A. To fill in 1 statistical form with (+) for the primary consultation
B. To fill in 1 statistical form with (+) for the primary consultation and with (-) for the
follow-up consultations
C. To fill in 1 statistical form with (-) for the primary consultation
D. To fill in 3 statistical forms with (+)
E. To fill in 3 statistical forms with (-)

194. The mental status of a 22-year-old man is characterised by a stable

pathological depressed mood. The patient is sociable, replies briefly but to the point. The
speech is laconic, in slowed tempo, movements are constrained and inhibited. Speaks on
the ideas of self-accusation and self-humiliation. Medications of what group are to be
prescribed to this patient?
A. Hypnotics
B. Antidepressants
C. Tranquillisers
D. Neuroleptics
E. Normotimics

195. During 2 hours after delivery the condition of the woman is good: the uterus is
firm, spherical, the fundus of uterus is on level of the navel, no haemorrhage. The clamp,
placed on the umbilical cord segment, remains on the same level. On deep inhalation and
on pressing with edge of the hand above symphysis the umbilical cord retraction into the
vagina. There is no bloody discharge from the genital tracts. What should be the further
tactics of the doctor?
A. Application of Krede-Lasarevich's method
B. Application of Abuladze's method
C. I.V. injection of oxytocin
D. Curettage of uterine cavity
E. Manual removal of afterbirth

196. In a new-born baby-girl on the 4 day of life there determined the swelling of the
mammary glands with secretions, swelling of the vulva, bloody discharge from the
genital tracts. What is the most probable cause of this condition?
A. Hormone intake in the course of pregnancy
B. Increase of thyrotropic hormone level in the new-born
C. Granulosa cell tumour
D. Testicular feminisation
E. Oestrogen transition from mother to fetus

197. A woman complains of unpleasant feelings in different body parts and organs, and
sometimes "very burdensome feelings of compression, torsion, turning-over". Repeated
consultations with specialists, clinical examinations, after that - referral for psychiatric
advice. What psychopathological disorder is most likely?
A. Paresthesia
B. Cenestopathy
C. Depersonalisation
D. Synesthesia
E. Hypochondria

198. A mother who is on partially paid maternity leave got sick and was hospitalised.
What document is to be issued to a working father who will be taking care of a child
during his mother's illness?
A. Extract from the medical card of out- or in-patient
B. Certificate of child's care necessity
C. Certificate of mother's illness
D. Free-form certificate
E. Sick-leave

199. The district pediatrician is charged with the analysis of infant mortality. What is
taken for the unit of observation in infant mortality investigation?
A. A baby dead at birth
B. A baby dead at the age up to 12 months
C. A baby dead at the age up to 1 months
D. A baby dead at the age up to 6 days
E. A baby dead at the age over 28 days

200. A 34-year-old patient is hospitalised with complaints of cervical and axillary

lymph nodes enlargement, subfebrile temperature during the last 2 months, increased
sweating. There are Reed- Sternberg (Berezovsky) cells in the puncture of lymph nodes.
What method of investigation is expedient to study the extent of tumour process?
A. Lymphoscintigraphy
B. Thermography
C. Lymphography
D. Angiography
E. Roentgenological investigation