KROK-2 PAPER 2020 WITH ANSWER KEY
ALL ANSWERS ARE IN THE END OF THIS TEST
Q1. During examination of a patient, the doctor detected in him disorders of the eyes (hemeralopia, Bitot’s spots), skin and skin appendages, mucosa, ang gastrointestinal tract. He was provisionally diagnosed with Prasad’s syndrome. What causes the development of this pathology?
(A) Vanadium deficiency
(B) Copper deficiency
(C) Manganese deficiency
(D) Iron deficiency
(E) Zinc deficiency
Q2. A 17-year old girl has been suffering from hepatic cirrhosis for 3 years. Lately her periods of excitation have been intermittent with depression, she does not sleep enough. Objectively her condition is severe, the girl is sluggish, gives one-word responses, has tremor in her extremities, her skin is icteric, with single hemorrhagic rashes. Name the likely complication of her disease:
(A) Sepsis
(B) Reye syndrome
(C) Bipolar affective disorder
(D) Kidney failure
(E) Hepatic encephalopathy
Q3. An 8-day-old boy was delivered to the hospital on the second day after the onset of the disease. His parents complain of his fussiness, regurgitation, body temperature up to 38.5oC, red skin with infiltration in the lumbar area. His medical history has no peculiarities. The child is in the severe condition, inert, pale, suckles poorly. In the lumbar area, on the sacrum and buttocks there is a tense infiltration with hyperemic and cyanotic areas and with a soft spot 8×7 cm in its center. the stool is 10 times in 24 hours, with green and mucous admixtures. What is the most likely diagnosis?
(A) Adiponecrosis
(B) Erysipelas
(C) Hemangioma
(D) Congenital soft-tissue tumor
(E) Phlegmon of the newborn
Q4. You witnessed a car accident. When examining the place of the accident you noticed a man of about 30 years, who was hit by the car. He is unconscious. On his neck on the left there is a profuse hemorrhage with bright-red blood. How to stop this hemorrhage?
(A) Maximal hyperextension of the neck
(B) Digital occlusion, Mikulich method
(C) Apply a neck brace
(D) Apply a plaster cast
(E) Put him in a stable position
Q5. Forensic autopsy of a body of a 59-year-old man, who died suddenly at home without signs of violent death, shows pink skin and mucosa, liquid bright-red blood, and bright-red plethoric internal organs. Forensic toxicology testing detected 1.44% of ethanol in the blood and carboxyhemoglobin levels of 55%. What is the cause of death?
(A) Alcohol poisoning
(B) Aniline poisoning
(C) Potassium cyanide poisoning
(D) Arsenic poisoning
(E) Carbon monoxide poisoning
Q6. A family doctor performed an external obstetrical examination on a pregnant woman and determined that her uterine fundus is located at the level of the navel. What is the most likely term of pregnancy in this woman?
(A) 16 weeks
(B) 8 weeks
(C) 40 weeks
(D) 24 weeks
(E) 32 weeks
Q7. A 26-year-old man complains of chills, rhinitis, dry cough, and fever up to 38oC. Examination shows him to be in a moderately severe condition; there are small pale pink non-merging spots on the skin of his back, abdomen, and extremities. Palpation reveals enlarged occipital and axillary lymph nodes. No information about vaccination history could be obtained. What is the likely etiology of this disease?
(A) Mumps virus
(B) Rubella virus
(C) Epstein-Barr virus
(D) Streptococcus
(E) Meningococcus
Q8. A 25-year-old woman was brought into the gynecological department with profuse bloody discharge from her genital tracts. She is 12 weeks pregnant, the pregnancy is planned. Within the last 3 days she was experiencing pains in her lower abdomen that eventually started resembling cramps, ahe developed bleeding. Her skin is pale, pulse-88/min, blood pressure-100/60mmHg, body temperature –36.8C. Vaginal examination; the uterus size corresponds to 11 weeks of gestation, the cervical canal allows inserting 1 finger and contains fragments of the fertilized ovum, the discharge is bloody and profuse. What is the most likely diagnosis?
(A) 12-week pregnancy, spontaneous abortion in progress
(B) Disturbed menstrual cycle, amenorrhea
(C) Full-term pregnancy, term labor
(D) Disturbed menstrual cycle, hyperpolymenorrhea
(E) 12-week pregnancy, threatened spontaneous abortion
Q9. A 45-year-old woman complains of increasing body weight throughout the last year. Examination revealed moon face syndrome, brittle hair, hirsutism, stretch marks on the abdomen, and disproportionally thin limbs. The patient’s height is 162 cm, her body weight is 94 kg, her body mass index is 35.8 kg/m2. What type of obesity it?
(A) Dysplastic
(B) Alimentary-constitutive
(C) Gynoid
(D) Android
(E) Cerebral
Q10. A 22-year old post parturient woman on the 12th day after the normal childbirth informs of fever up to 39 degree C for the last three days and pain in her right mammary gland. The right mammary gland is enlarged, hot to touch, tense, hyperemic, and painful. Palpation reveals there a dense infiltration 8×8 cm with a fluctuation in its center. What is the most likely diagnosis?
(A) Postpartum period, day 12. Right sided serous mastitis
(B) Postpartum period, day 12. Right sided gangrenous mastitis
(C) Postpartum period, day 12. Right sided lactostasis
(D) Postpartum period, day 12. Right sided infiltrative-purulent mastitis
(E) Postpartum period, day 12. Right sided phlegmonous mastitis
Q11. A 17-year-old girl complains of a pain in her knee and ankle joints and body temperature up to 39oC . 2 weeks ago, she had a case of acute tonsillitis. Objectively, her joints are swollen, sharply painful and their mobility is reduced. On the skin of her truck and limbs there are barely visible circle-shaped pale pink spots. Heart rate is 95/min, blood pressure is 90/60 mmHg, heart sounds are weakened, there is a soft systolic noise over the apex. Make the provisional diagnosis:
(A) Rheumatoid arthritis
(B) Acute rheumatic fever
(C) Erythema nodosum
(D) Systemic scleroderma
(E) Reactive arthritis
Q12. A 55-year-old woman came to a gynecologist with complaints of leukorrhea and bloody discharge from the vagina after 5 years of menopause. Anamnesis states no pregnancies. Bimanual examination: the uterus and uterine appendages are without changes. During diagnostic curettage of the uterine cavity the physician scrapped off a sample of encephaloid matter. What is the most likely diagnosis in this case?
(A) Ovarian carcinoma
(B) Endometrial carcinoma
(C) Cervical carcinoma
(D) Adenomyosis
(E) Subserous uterine myoma
Q13. A 35-year-old woman came to the family doctor with complaints of profuse menstruations that last up to 10 days. Gynecological examinations shows that the uterine cervix is without changes, the uterus is in anterflexio, has normal size , is mobile and painless. The uterine appendages on the both sides are without peculiarities. The family doctor made the provisional diagnosis of the abnormal uterine bleeding. What instrumental method of examination needs to be performed first to diagnose this pathology?
(A) Colposcopy
(B) Laparoscopy
(C) Transvaginal ultrasound
(D) Culdoscopy
(E) Transabdominal ultrasound
Q14. A 45-year-old man with a history of myocardial infarction developed a brief attack of palpitation, accompanied by the sensations of lack of air, fear, and vertigo. His blood pressure is 90/60mmHg. ECG during the attack shows extended QRS complex (0.13 seconds) with heart rate of 160/min, discordant shift of ST segment and T wave, dissociation of atrial and ventricular rhythm. What disturbances of cardiac rhythm it is?
(A) Ventricular fibrillation
(B) Frequent ventricular extrasystole
(C) Paroxysmal ventricular tachycardia
(D) Atrial fibrillation
(E) Paroxysmal supraventricular tachycardia
Q15. What should be prescribed as secondary prevention drugs for a patient with atrial fibrillation after an ischemic stroke caused by cardiac embolism?
(A) Calcium antagonists
(B) Nootropics
(C) Beta blockers
(D) Oral anticoagulants
(E) Aspirin or clopidogrel
Q16. 40% of workers who, who polish the art glass, using an abrasive disk, and have a long record of employment, are diagnosed with ulnar neuritis, 21%- with vegetative polyneuritis, and 12% – with vegetomyofascitis of the upper limbs. These pathologies are associated with the following harmful factor:
(A) Noise
(B) Dust
(C) Vibration
(D) Electromagnetic field
(E) Microclimate
Q17. A 40-year-old victim of a traffic accident sustained the following injuries: closed diaphyseal femur fracture, brain concussion, multiple rib fractures, hemopneumothorax, degloving shin injuries. What injuries require the most urgent attention?
(A) Closed diaphyseal femur fracture
(B) Multiple rib fractures, hemopneumothorax
(C) All injuries are equivalent
(D) Degloving shin injuries
(E) Brain concussion
Q18. Employees work in conditions of high dust concentration. Certain chemical (silicon dioxide content) and physical properties of dust aerosols contribute to the development of occupational dust-induced diseases. What is the main physical property of dust aerosols?
(A) Magnetization
(B) Electric charge
(C) Dispersion
(D) Ionization
(E) Solubility
Q19. After semolina was introduced into the diet, a1-year old child for 2 months has been presenting with loss of appetite, irritability, loss of body mass, and loss of previously learned skills. The feces are copious and foul smelling. The skin is pale and dry, the hair is brittle. The abdomen is distended, while the limbs are thin. Stool test shows high levels of fatty acids. What is the most likely diagnosis?.
(A) Functional diahhrea
(B) Mucoviscidosis
(C) Lactase deficiency
(D) Irritable bowel syndrome
(E) Celiac disease
Q20. A 65-year old man with acute anterior myocardial infarction developed an asphyxia attack. Examination detected diffuse cyanosis. In the lungs there are numerous heterogenous wet crackles. Heart rate is 100/min. Blood pressure is 120/100 mm Hg. What complication occurred in this patient?
(A) Pulmonary embolism
(B) Pulmonary edema
(C) Cardiogenic shock
(D) Hypertensive crisis
(E) Ventricular septal rupture
Q21. A 45-year old woman was hospitalized with complaints of periodical severe headaches against the background of elevated blood pressure up to 180/90 mmHg, muscle weakness, and frequent urination (at night as well). Her anamnesis states that despite combining various antihypertensive drugs and adjusting the dosage her arterial hypertension cannot be corrected with drugs. The patient’s blood serum potassium levels are 2.0 mmmol/L, blood serum sodium level are 160mmmol/L. Ultrasound imaging detects three dimensional formations approximately 1.0 cm in diameter in the both adrenal glands. Selective endovascular blood sampling from the suprarenal vein was performed which revealed significant increase of cortisol and aldosterone levels. Make the diagnosis:
(A) Cushing’s syndrome
(B) Androsteroma
(C) Pheochromocytoma
(D) Aldosteroma
(E) Cushing’s disease
Q22. A 16-year-old boy developed dizziness. His heart rate is 35/min, blood pressure is 85/45mmHg, heart borders are not enlarged. Heart sounds are loud and clear. ECG shows P waves disconnected from QRS complex, dissociation and different rhythm of atria and ventricles is accompanied by varying location of P wave in relation to QRST complex. This presentation is the most characteristic of the following disease:
(A) Extrasystole
(B) Complete atrioventricular block (III block)
(C) Atrioventricular block (II degree)
(D) Atrioventricular dissociation
(E) Sinus bradycardia
Q23. A 25-year old man was hospitalized with complaints of pain in his lower abdomen and right lumbar area that appeared one hour ago. The patients general state is moderately severe. Body temperature- 38.2oC, heart rate-102/min. The tongue is dry. The abdomen is painful on deep palpation j the right iliac area and in the petit triangle. Aure-Rozanov and Gabay signs are positive. Make the provisional diagnosis:
(A) Acute appendicitis
(B) Intestinal obstruction
(C) Cecal tumor
(D) Right-sided renal colic
(E) Acute cholecystitis
Q24. A 38-year-old patient has been delivered by an ambulance toa surgical department with complaints of general weakness, indisposition, black stool. On examination the patient is pale, there are dotted hemorrhages on the skin of his torso and extremities. On digital investigation there are black feces on the glove. Blood test: Hb-108g/L, thrombocytopenia. Anamnesis states that similar condition was observed I year ago. Make the diagnosis:
(A) Ulcerative bleeding
(B) Nonspecific ulcerative colitis
(C) Thrombocytopenic purpura
(D) Hemophilia
(E) Rectal tumor
Q25. A 19-year-old young man was diving and hit his head on the bottom of the pool. He complains of pain in the neck, head movements are limited and painful. During examination his head is bowed forward and to the right and the patient supports it with his hands. Palpation detects tense neck muscles and protruding spinous process of the IV cervical vertebra(C4). When pressure is applied to this process and to the head (axial load), the pain intensifies. Make the provisional diagnosis:
(A) Neck muscle injury
(B) Cervical contusion
(C) Spinal root injury
(D) Complicated cervical fracture
(E) Uncomplicated cervical fracture
Q26. A 45-year old man came to the hematologist with complaints of general weakness, elevated body temperature, excessive sweating, enlarged cervical lymph nodes. Objectively, his body temperature is 37.5oC, the skin is pale and dry, the posterior cervical lymph nodes are dense and elastic, upto 2 cm in diameter, mobile. There are no peculiarities in the patient’s heart and lungs. Hepatosplenomegaly was detected. What examination is necessary to determine the scope of pathologic process?
(A) Bone scintigraphy
(B) Ultrasound of the cervical lymph nodes
(C) Abdominal X-ray
(D) Complete blood count
(E) Computed tomography
Q27. An 18-year-old patient complains of skin rash. The patient has been suffering from this condition for 5 years. The first instance of this disease occurred after a car accident. Objectively, the patient presents with a papular rash covered in silvery scales, “thimble” sign (small pits on the nails) affected joints. What is the most likely diagnosis?
(A) Psoriasis
(B) Rheumatism
(C) Lupus erythematosus
(D) Onychomycosis
(E) Panaritium
Q28. In a pediatric clinic, located in a rural area, there are 9 children, who simultaneously fell ill. The following signs were detected: low physical activity, acrocyanosis of the nasolabial triangle and fingertips, mucosal cyanosis, tachycardia, dyspnea. It was determined that all the sick children were fed with a formula that was dissolved in the water taken from a dug well. Laboratory analysis revealed high levels of methemoglobin in the blood of the children. These signs can be caused by increased content of a certain element in the water. Name this element:
(A) Sulfates
(B) Methyl mercury
(C) Lead
(D) Selenium
(E) Nitrates
Q29. A patient has gradually lost his consciousness. The skin is pale and dry. There is smell of ammonia from the mouth. Respiration is deep and noisy. Heart sound muffled, pericardial friction rub are present, blood pressure is 180/130mmHg. Blood test : Hb – 80g/l, leukocytes- 12 x 109/L , blood glucose-6.4mmol/l ,urea – 50mmol/l, creatine- 1200mmol/l, blood osmolarity – 350 mOsmol/kg H2O.No urinary excretion. Make the diagnosis:
(A) Hyperosmolar coma
(B) Uremic coma
(C) Acute disturbance of cerebral circulation
(D) Acute renal failure
(E) Hyperglycemic coma
Q30. 3 hours after a trauma, a young man developed bradycardia of 46/min, anisocoria D >S, hemi-hyperreflexia S >D, hemi hypesthesia on the left, and a convulsive disorder. The character of this process needs to be clarified. What method of examination will be the most accurate for this purpose?
(A) Lumbar puncture
(B) Skull X-ray
(C) Electroencephalography
(D) Echoencephalography
(E) Head CT
Q31. 2 hours after eating unknown mushrooms, a 28-year-old man sensed a decrease in his mobility and deterioration of his ability to focus. This condition was then followed by a state of agitation and aggression. On examination, he is disoriented and his speech is illegible. 4 hours later he developed fetor hepaticus and lost his consciousness. What syndrome can be observed in this patient?
(A) Cholestatic syndrome
(B) Hepatolienal syndrome
(C) Cytolytic syndrome
(D) Acute hepatic failure
(E) Portal hypertension
Q32. A 55-year old woman complaints of thyroid gland enlargement that can be observed throughout the last two years and a discomfort during swallowing. Objectively, she has signs of hypothyroidism. The thyroid gland on palpation is dense, non-fused with the surrounding tissues and mobile on swallowing. The regional lymph nodes are not enlarged. In the serum there are antithyroid antibodies detected. What is the most likely diagnosis?
(A) Endemic goiter
(B) Midline cervical cyst
(C) Thyroid cancer
(D) Acute thyroiditis
(E) Hashimoto’s thyroiditis
Q33. A 12-year-old girl after a case of respiratory infection developed dyspnea at rest, paleness of skin. Heart rate is 110/min, BP is 90/55 mmHg. Heart sounds are muffled. Borders of relative heart dullness: right- the left parasternal line, upper- the III rib, left- 1,0 cm outwards from the midclavicular line. Make the provisional diagnosis:
(A) Infectious myocarditis
(B) Functional cardiomyopathy
(C) Somatoform autonomic dysfunction
(D) Exudative pericarditis
(E) Hypertrophic cardiopathy
Q34. A woman with the pregnancy term of 8 weeks complains of elevated temperature up to 37.6oC, skin rash that can be characterized as macular exanthema, enlargement of posterior cervical and occipital lymph nodes, small amount of bloody discharge from the genital tracts. She was examined by the infectious diseases specialist and diagnosed with rubella. What tactics should be obstetrician- gynecologist choose?
(A) Treatment of insipient abortion
(B) Abortion
(C) Prescription of hemostatic therapy
(D) Prescription of antibacterial therapy
(E) Prescription of antiviral therapy
Q35. A 35-year old forestry officer was delivered to the hospital on the 7th day after the onset of the disease. He complains of chills, elevated body temperature up to 40.0oC, sharp headache, and myalgias. On examination his face is puffy and hyperemic, the tongue is dry, “chalk-dusted”. In the left inguinal area, a sharply painful conglomeration of enlarged lymph nodes can be palpated. The skin over the conglomeration is hyperemic and tense. What etiotropic therapy should be prescribed to this patient?
(A) Streptomycin
(B) Administration of heterologous serum
(C) Ketoconazole
(D) Human immunoglobulin intravenously
(E) Ribavirin
Q36. A 45-year old man has been suffering from ankylosing spondylitis for 15 years. For the last 3 years he has been noticing facial swelling and edemas of the limbs. Objectively he assumes a “beggar’s” position. X-ray shows “bamboo spine” changes in the thoracic and lumbar segments. Heart ultrasound shows aortic regurgitation. Complete blood count: Hb-106g/L; leukocytes- 8.9 x 109/L; ESR-40mm/hour. Daily proteinuria-9.6 grams per 24 hours. Blood creatinine-230 mcmol/L. What is the cause of kidney failure in this case?
(A) Medicine side effects
(B) Urolithiasis
(C) Renal amyloidosis
(D) Concomitant heart disease
(E) Pyelonephritis
Q37. What modern organizational method can provide the patients in the remote settlements with timely access to quality medical aid and such medical services as consulting, diagnostics, and treatment, especially in the situations when time and distance are crucial?
(A) Air medical services
(B) Ambulance services
(C) Field medical services
(D) Telemedicine
(E) Mobile communication
Q38. A 48-year old woman has been hospitalized due to development of tachysystolic atrial fibrillation. She has lost 5 kg of body weight within 2 months. On palpation there is a node in the left lobe of the thyroid gland. What pathology resulted in the development of this condition?
(A) Toxic nodular goiter
(B) Atherosclerotic cardiosclerosis
(C) Chronic thyroiditis
(D) Nontoxic nodular goiter
(E) Autoimmune thyroiditis
Q39. A 19-year-old young man complains of cough with expectoration of purulent sputum in amount of 100 ml per day, hemoptysis, dyspnea, increased body temperature up to 37.8oC, general weakness, weight loss. The patients condition lasts for 4 years. Exacerbations occur 2-3 times a year. The patient presents with malnutrition, pale skin, cyanosis of the lips, drumstick (clubbed fingers). Tympanic percussion sound in the lungs, weakened respiration, and various numerous moist crackles in the lower pulmonary segments on the left can be observed in this patient. in blood: erythrocytes-3.2 x 1012/L, leukocytes- 8.4 x 109/L, ESR-56 mm/hour. On X-ray: lung fields are emphysematous, the left pulmonary root is deformed and dilated. What is the most likely diagnosis?
(A) Multiple bronchiectasis of the left lung
(B) Left-sided pulmonary cystic dysplasia
(C) Chronic left-sided pneumonia
(D) Suppuration of the cyst in the left lung
(E) Chronic abscess of the left lung
Q40. A 45-year old woman undergoes an inpatient treatment. She complains of elevated body temperature up to 39.0oC, pain in her right lumbar area, turbid urine with blood. CT scan shows an area of low density within the parenchyma, no difference between the cortical and medullary layers, an increased density of the perinephric fat due to edema. What is the diagnosis?
(A) Renal carcinoma
(B) Para nephritis
(C) Renal abscess
(D) Pyelonephritis
(E) Glomerulonephritis
Q41. A 2.5-year –old child is ill for the second day. The onset of the disease was associated with the temperature up to 37.8oC, a single bout of vomiting, a watery diarrhea up to 5 times per day. During the second day, vomiting occurred twice, body temperature is 38.0oC, the child has low appetite, watery diarrhea continues. The treatment of the child should start with the following:
(A) Prescribe oral rehydration
(B) Prescribe loperamide
(C) Prescribe nifuroxazide
(D) Prescribe ceftriaxone
(E) Prescribe polymyxin
Q42. A 23-year old woman without visible cause developed a conflicting behavior at the work place. She accused the management of underestimating her, claimed that she can be a deputy director, because she speaks four languages, is very attractive, and can make useful connections for the company. She has been dressing extravagantly, flirting with her colleges, and singing loudly in her office. Infact, she has only the training of a computer operator and speaks no foreign languages. What is the likely clinical diagnosis?
(A) Manic episode
(B) Schizophrenia
(C) Epilepsy
(D) Depressive disorder
(E) Mild mental retardation
Q43. A 45-year old man underwent a cardiac surgery one week ago. His general state has been deteriorating since then: dyspnea at rest, retrosternal pain that irradiates to the neck, marked weakness. Objectively, his body temperature is hectic. His cardiac borders are expanded, apical beat is weakened. Auscultation detects pericardial friction rub. What is the most likely diagnosis?
(A) Myocardial infarction
(B) Pulmonary embolism
(C) Acute myogenic dilation of the heart
(D) Acute cardiac aneurism
(E) Acute pericarditis
Q44. A 23-year-old woman with type 1 diabetes mellitus during the 2nd week of community-acquired pneumonia developed nausea and vomiting. In the evening she has lost her consciousness and was hospitalized. Objectively, the patient’s skin is pale and dry. Her respiration is long, the tongue is dry, with brown deposit. Her heart rate is 129/min, blood pressure is 85/50mmHg. Palpation of the patient’s abdomen provokes no response. the liver is +3 cm. Acetone test is markedly positive, blood glucose is 26 mmol/l. Make the provisional diagnosis:
(A) Ketoacidotic coma
(B) Lacticaemic coma
(C) Hepatic coma
(D) Infectious toxic shock
(E) Hyperosmolar coma
Q45. A 56-year old woman was diagnosed with stage 2 hypertension of the 2nd degree. She belongs to the group of moderate risk and has bronchial asthma. What group of drugs is CONTRAINDICATED to this patient?
(A) Imidazoline receptor antagonist
(B) Calcium antagonists
(C) Beta blockers
(D) Angiotensin converting enzyme inhibitors
(E) Diuretics
Q46. A 3-month-old child with sighs of rickets presents with positive Chvostek, Trousseau, and Maslov signs. One days ago, the parents witnessed a cyanotic attack in their child- the child broke into a cold sweat, the eyes bulged, and respiratory arrest occurred. One minute later the child drew in a loud breath and child’s condition normalized again. What is the cause the described signs of the disease?
(A) Metabolic acidosis
(B) Increase of blood phosphorus levels
(C) Decrease of blood phosphorus levels
(D) Decrease of blood calcium levels
(E) Increase of blood calcium levels
Q47. A 20-year-old woman complains of headaches, vertigo, tearfulness, vomiting, pain in the area of the heart, and tachycardia. The signs appear 6-7 days before menstruation and disappear in the first days of menstruation. Make the diagnosis
(A) Algomenorrhea
(B) Premenstrual syndrome
(C) Diencephalic syndrome
(D) Stein-leventhal syndrome
(E) Metabolic craniopathy
Q48. A 56-year-old woman has been working as a disinfector for 19 years. She complains of general weakness, nausea, bitter taste in her mouth, heavy sensation in her right subcostal area, and rapid fatigability. Objectively, her body temperature is 37.1oC, the sclerae are icteric, and the liver is enlarged. Total bilirubin is 40 mcmol/L. What is the likely diagnosis?
(A) Biliary dyskinesia
(B) Chronic cholecystitis
(C) Chronic pancreatitis
(D) Occupational toxic hepatitis
(E) Acute cholecystitis
Q49. A woman complains of frequent watery stool (up to 9-10 times per day) with mucus and blood admixtures, dull pain in the hypogastrium, weight loss of 4kg within the last year. Objectively, malnutrition, dry skin, low turgor, aphthous stomatitis. The abdomen is soft, the sigmoid colon is spastic and painful on palpation. Occult blood test is positive. Fibro colonoscopy; edema, hyperemia, mucosal granulation, pseudopolyps, small ulcers with irregular edged. Make the diagnosis:
(A) Colon cancer
(B) Chronic enterocolitis
(C) Crohn’s disease (regional enteritis)
(D) Nonspecific ulcerative colitis
(E) Irritable bowel syndrome
Q50. A 22-year-old infant developed subcutaneous red nodes from 1.0 to 1.5 cm in size on the scalp; later the nodes enlarged. Complete blood count: anemia, leukocytosis, neutrocytosis, raised ESR. What diagnosis will you make?
(A) Pseudo furunculosis
(B) Vesiculopustulosis
(C) Scalp phlegmon
(D) Pemphigus
(E)
Q51. After a long drive with the window open a man developed a facial asymmetry; he cannot close his right eye, his right nasolabial fold is smoothed out, movements of expression are absent on the right, there is a disturbance of taste sensation in the tongue on the right. No other neurological abnormalities were detected. What disease can be provisionally diagnosed in this case?
(A) Neuropathy of the oculomotor nerve
(B) Neuropathy of the trigeminal nerve
(C) Neuropathy of the facial nerve
(D) Trigeminal ganglionitis
(E) Ischemic stroke
Q52. A 5-year-old child had acute onset of the disease that manifested in body temperature up to 39.5oC, marked chills, weakness, inertness, skin pallor, and headache. 8 hours later a hemorrhagic rash developed on the skin of the buttocks and les. The child is sluggish, the body temperature has dropped, blood pressure is 80/40, respirations are 28-30/min, diuresis is decreased. Make the provisional diagnosis:
(A) Reye syndrome
(B) thrombocytopenic purpura
(C) Hemorrhagic vasculitis (Henoch-Schonlein purpura)
(D) Measles
(E) Meningococcemia
Q53. A 32-year-old woman complains of general weakness, low-grade, fever persisting for 4 months, lumbar pain, and dysuria. Anamnesis includes frequent acute respiratory diseases, overexposure to cold, low-calorie diet, a case of pulmonary tuberculosis in childhood. Clinical urine analysis; pH 4.8 leukocytosis, hematuria. Complete blood count: leukocytosis, lymphocytosis, raised ESR, urography concludes; dilation of renal pelvis and calyceal system of both kidneys, foci of the calcification in the projection of right kidney parenchyma. What is the most likely diagnosis?
(A) Right renal cyst
(B) Chronic pyelonephritis
(C) Acute glomerulonephritis
(D) Nephrotuberculosis
(E) Right renal carcinoma
Q54. A 13-year- old girl for a month has been complaining of fatigability, dull pain in her right subcostal area, abdominal distension, and constipations. Abdominal palpation reveals positive Kehr, Murphy, and Ortner signs, while Desjardins and Mayo-Robson points are painless. Total bilirubin is 14.7 mcmol/L, predominantly indirect, ALT-20 U/L, AST- 40 U/L, amylase – 6.3 mmol/L. Echo cholecystography shows practically no contraction of the gallbladder. Make the provisional diagnosis:
(A) Chronic pancreatitis
(B) Chronic hepatitis
(C) Hyperkinetic biliary dyskinesia
(D) Hypokinetic biliary dyskinesia
(E) Acute pancreatitis
Q55. A 58-year old man complains of weakness and tumor-like formations that appeared on the anterior surface of his neck and in the inguinal region. Palpation detects soft painless mobile cervical and inguinal lymph nodes up to 2cm in diameter. The liver protrudes by 2cm from the edge of the costal margin, the lower splenic pole is at the umbilical level. In blood: erythrocytes- 3.5 x 1012/L, Hb- 88 g/L, leukocytes- 86 x 109/L, band neutrophils- 1%, segmented neutrophils-10%, lymphocytes- 85%, eosinophils-2%, basophils-0%, monocytes-2%, erythrocyte sedimentation rate- 15 mm/hour, Gumprecht shadows. What is the most likely diagnosis?
(A) Chronic lymphocytic leukemia
(B) Lymphogranulomatosis
(C) Acute leukemia
(D) Chronic myeloid leukemia
(E) Lymphocytic leukemoid reaction
Q56. During regular medical examination a lyceum student present with signs of cheilitis that manifests as epithelial maceration in the area of lip seal. The lips are bright-red with single vertical cracks covered with brown-red scabs. These clinical signs are mostly likely caused by insufficient content of the following in the diet:
(A) Calciferol
(B) Retinol
(C) Ascorbic acid
(D) Thiamine
(E) Riboflavin
Q57. A 45-year old man with thrombophlebitis of the deep veins in his legs suddenly after physical exertion developed sharp pain in his thorax on the right, dyspnea, and hemoptysis. Objectively his condition is severe; he presents with acrocyanosis, shortening of pulmonary percussion sound on the right, and weakened respiration. Respiration is 30/min, blood pressure is 110/80mm Hg. ECG shows sinus tachycardia, his heart rate is 120/min, the electrical axis of the heart deviates to the right. S1-Q3. What is the most likely diagnosis?
(A) Community acquires right sided pneumonia
(B) Cancer of the right lung
(C) Right-sided exudative pleurisy
(D) Pulmonary embolism
(E) Spontaneous pneumothorax
Q58. A 23-year-old woman came to the gynecological clinic. she complains of pain, itching, and burning in her vulva, general weakness, indisposition, elevated body temperature up to 37.2oC, and headache. On examination in the vulva there are multiple vesicles up to 2-3 mm in diameter with clear contents against the background of hyperemia and mucosal edema. Make the provisional diagnosis:
(A) Primary syphilis
(B) Cytomegalovirus infection
(C) Vulvar cancer
(D) Papillomavirus infection
(E) Genital herpes infection
Q59. A 3-year-old child has been brought to a hospital with pain in the legs, fever, and loss of appetite. Objectively: pale skin and mucosa, hemorrhagic rash. Lymph nodes are enlarged, painless, dense and elastic, not matted together. Bones, joints and abdomen are painful. The liver and spleen are enlarged. Hemogram: Hb-88g/L, color index- 1.3, platelets- 80 x 109/L, leukocytes- 25.8 x 109/L, lymphoblasts- 70%, ESR-52 mm/hour. Make the provisional diagnosis:
(A) Acute leukemia
(B) Infectious mononucleosis
(C) Thrombocytopenic purpura
(D) Acute rheumatic fever
(E) Hemorrhagic vasculitis (Henoch-Schonlein purpura)
Q60. A 31-year-old drug-addicted person complains of a cough with bloody expectorations, dyspnea, persistent fever, and leg edemas. The jugular veins are distended. There is a coarse pansystolic murmur detected above the base of the xiphoid process and in the second intercostal space on the left, close to the edge of the sternum. Heart sounds are clear, arrythmia is detected, heart rate is 128/min, pulse-82/min, blood pressure is 100/70 mmHg. What is the most likely diagnosis?
(A) Infective endocarditis
(B) Coarctation of the aorta
(C) Community acquired pneumonia
(D) Lutembacher syndrome
(E) Pulmonary embolism
Q61. A 43-year old man complains of facial edema, dyspnea, and difficult swallowing that appeared 3 hours after he was stung by an insect. Objectively, the skin of his eyelids, cheeks and lips is acutely hyperemic and edematous. What medicines should he be prescribed for emergency aid?
(A) Diuretics
(B) Muscle relaxants
(C) Glucocorticoids
(D) Antihistamines
(E) Nonsteroidal anti-inflammatory drugs
Q62. Examination detected vesicles with seropurulent content on the neck, back of the head, and buttocks of an infant on the 4th day of life. The patient’s condition is satisfactory, the child is active, all newborn reflexes can be fully induced, the umbilical cord is at the stage of mummification, the umbilical area is without any peculiarities. What disease can be suspected?
(A) Phlegmon
(B) Miliaria
(C) Epidermolysis bullosa
(D) Vesiculopustulosis
(E) Neonatal pemphigus
Q63. A district doctor has diagnosed one of his patients with dysentery. What accounting document reflects this type of morbidity?
(A) Control card of a patient registered for regular check-ups
(B) Report on a major non-epidemic disease
(C) Statistical report
(D) Urgent report
(E) Certificate of temporary disability
Q64. During a regular examination, an 8-year old girl with type 1 diabetes mellitus presents with a swelling on the anterior surface of her hip. The swelling is 3 cm in diameter, dense, painless on palpation. The skin over this formation has normal color and temperature. Localization of the swelling matches the place where the girl usually receives her insulin injections. What is the most likely cause of this clinical presentation?
(A) Development of hypertrophic lipodystrophy
(B) Development of atrophic lipodystrophy
(C) Formation of post-injection abscess
(D) Allergic response
(E) Formation of post-injection infiltration
Q65. A 30-year old woman complains of itching skin, predominantly in the evening and at night. The condition lasts for 2 weeks already. On the skin of interdigital folds, mammary glands, abdomen, buttocks, and thighs there are numerous fine papular and papulovesicular rashes located in pairs, excoriations. There is no rash on the face and neck. Similar rash is observed in the husband of the patient. What is the most likely diagnosis?
(A) Neurodermatitis
(B) Epidermophytosis
(C) Eczema
(D) Herpes
(E) Scabies