KROK-2 PAPER 2020 WITH ANSWER KEY
ALL ANSWERS ARE IN THE END OF THIS TEST
Q66. An 18-year old patient always obeys others and adapts his needs to the demands of the people on whom he depends. He excessively defers to their wishes and makes them responsible for his wellbeing, cannot defend his interests and needs support from other people. Such psychic profile has been formed in the childhood, remains unchanged, and hinders adaptation. What psychic disorder is observed in this patient?
(A) Markedly accentuated personality
(B) Psychopathy-like state
(C) Dependent personality disorder
(D) Anxiety (avoidant) personality disorder
(E) Anankastic personality disorder
Q67. During winter epidemics of influenza caused predominantly by virus A/California/04/2009 (H1N1), on the 2nd day after the disease onset a 30-year old hospitalized man presented with high fever, dry cough, myalgia, headache, and general weakness. What should be prescribed as an etiotropic treatment in this case?
(A) Interferon inducers
(B) Acyclovir
(C) Antibiotics
(D) Neuraminidase inhibitors (oseltamivir)
(E) Immunoglobulin
Q68. A 48-year-old man came to a doctor with complaints of vomiting that brings no relief and a burning pain in his left subcostal region that irradiates to the left lumbar region. These signs appeared after a meal. The Ortner’s and Mayo-Robson’s signs are positive. In the blood; leukocytosis and increased ESR. In the urine; elevated diastase levels. Make the diagnosis:
(A) Chronic cholecystitis in the exacerbation stage
(B) Gastric ulcer Performation
(C) Chronic pancreatitis in the exacerbation stage
(D) Chronic gastritis in the exacerbation stage
(E) Renal colic
Q69. A 20-year old woman, gravida 2, para1 has been in labor for 4 hours. Her condition is satisfactory. Moderately painful contractions occur every 3 minutes and last for 35-40 seconds. The waters have not burst yet. The fetus is in longitudinal position. Fetal heartbeats are 136/min., clear and rhythmic. Major segment of the fetal head is engaged to the pelvic inlet. Vaginal examination shows smooth cervix of 6 cm, amniotic sac is intact, sagital suture is in the left oblique diameter, occipital fontanel is on the right near the symphasis pubis. What stage of labor is it?
(A) Precursors of childbirth
(B) Latent phase of the first stage of normal labor
(C) Preliminary stage
(D) The second stage of normal labor
(E) Active phase of the first stage of normal labor
Q70. The director of a medical facility draws up a financial plan for the next year. To improve the economic well-being of his establishment, he decided to increase the amount of medical services provided. How will it change the fixed cost per unit of service?
(A) Decrease
(B) Increase
(C) There is no correlation between these variables
(D) No changes
(E) Fluctuate
Q71. A 9-year-old boy fell off a tree and hit the back of his head. A brief loss of consciousness was observed. The child’s condition is satisfactory, he has a headache and vertigo. Skull X-ray scans shows depressed fracture of the occipital bone in the area of the external occipital protuberance. What treatment tactics is indicated for this patient?
(A) Lumbar puncture to relieve the pressure
(B) Hemostatic therapy
(C) Anti-inflammatory therapy
(D) Complex conservative treatment
(E) Surgical intervention
Q72. For 20 years the role of excessive weight in ischemic heart disease development among the working age male production over 40 was studied. It was determined that overweight men developed ischemic heart disease more often. What type of epidemiological study is it?
(A) Case-control study
(B) Cohort study
(C) Vase series report
(D) Experimental study
(E) Case report
Q73. A 7-year-old boy after a fall from a height presents with rapid and shallow breathing and cyanotic face. The right half of his thorax is distended and takes no part in the respiration. Percussion detects tympanitis in the affected area, while auscultation detects no breathing there. What pathology is the most likely cause of this clinical presentation? What instrumental examination would be most informative in this case?
(A) Mediastinitis. Survey X-ray of the chest
(B) Airway foreign body. Diagnostic therapeutic bronchoscopy
(C) Tension cyst of the right lung. Tracheobronchoscopy
(D) Right-sided hemothorax. Survey X-ray of the chest
(E) Right-sided tension pneumothorax. Chest X-ray
Q74. A 6-year-old girl complains of body temperature up to 39oC, rhinitis, dry cough, dyspnea. She has been presenting with these signs for 5 days already. On examination her condition is of moderate severity. Her dyspnea is of mixed genesis. Respirations are 28/min. Percussion produces a dull sound in the right lower segments; in the same area auscultation detects weakened respiration and fine vesicular wet crackles; coarse respiration can be detected on the left. Make the provisional diagnosis:
(A) Right-sided community acquired pneumonia
(B) Acute simple bronchitis
(C) Stenosing laryngotracheitis
(D) Acute obstructive bronchitis
(E) Acute bronchiolitis
Q75. A 65-year old man underwent a left hemicolectomy due to a malignant tumor in the descending colon. On the 4th day after the surgery he developed pain and edema in his left shin. The Homans sign is positive on the left. What postoperative complication developed in this patient?
(A) Acute disturbance of the cerebral blood flow
(B) Acute postoperative lymphangitis of the left shin
(C) Postoperative allergic reaction
(D) Acute postoperative thrombosis of the popliteal artery on the left
(E) Acute postoperative thrombosis of the deep veins in the left shin
Q76. On laboratory investigation of a pork sample there is 1 dead trichinella detected in 24 sections. This meat should be:
(A) Allowed for sale with no restrictions
(B) Processed and sold through public catering network
(C) Handed over for technical disposal
(D) Frozen until the temperature of -10 degree C is reached in the deep layers, with subsequent exposure to cold for 15 days
(E) Processed for boiled sausage production
Q77. On the 5th day after giving birth a post parturient woman complains of a pain in her left mammary gland and body temperature up to 38.1oC. Examination shows that her mammary gland is enlarged and painful on palpation, the nipple is edematous and has fissures, the upper external quadrant of the gland is hyperemic. Name the measures that would have prevented the development of this complication in the patient
(A) Stop breastfeeding when fissures appear
(B) Feeding on schedule
(C) Feeding on demand, expression of breast milk, prevention of nipple fissures
(D) Feeding no longer that 10 minutes through an overlay
(E) Constant expression of breast milk
Q78. A man works in casting of nonferrous metals and alloys for 12 years. In the air of working area there was registered high content of heavy metals, carbon monoxide, and nitrogen. During periodic health examination the patient presents with asthenovegetative syndrome, sharp abdominal pains, constipations, pain in the hepatic area. In urine: aminolaevulinic acid and coproporphyrin are detected. In blood: reticulocytosis, low hemoglobin level. Such intoxication is caused by:
(A) Nitric oxide
(B) Tin
(C) Zinc
(D) Lead and lead salts
(E) Carbon monoxide
Q79. A 30-year-old woman made an appointment with the family doctor for scheduled vaccination of her 2-year-old child. What type of healthcare provides such medical services?
(A) Primary healthcare
(B) Emergency aid
(C) Palliative care
(D) Secondary healthcare
(E) Tertiary healthcare
Q80. A 21-year-old man was hospitalized on the 2nd day of the disease. His general condition is severe, body temperature is 39oC. On his skin there are numerous irregular-shaped hemorrhghic elements. The diagnosis of meningococcemia was made. The next day his body temperature suddenly decreased, blood pressure was 80/40mmHg, pulse was 120/min. Acrocyanosis was detected. What complication did the patient develop?
(A) Acute hemorrhage
(B) Cerebral coma
(C) Acute liver failure
(D) Acute heart failure
(E) Acute adrenal insufficiency
Q81. A multigravida, labor II, 36-37 weeks of gestation, has gone into labor. Her waters broke 8 hours ago, the labor activity continues for the last 4 hours, it is regular, with contractions that last 35 seconds and occur every 3 –4 minutes. The child is in the cephalic presentation, with the head pressed to the entrance into the lesser pelvis. The parturient woman complains of a sudden sharp abdominal pain. Her pulse is100/min, blood pressure is 110/70- 100/70 mmHg. The uterus is tense and does not relax between the contractions. Fetal heartbeat is muffled- 100/min. The amniotic fluid is blood-colored and continues to leak. What is the most likely diagnosis?
(A) Partial placenta previa
(B) Premature detachment of the normally positioned placenta
(C) Rupture of the umbilical vessels
(D) Cervical rupture
(E) Uterine rupture
Q82. A newborn has a round red formation in the suprapubic region. Examination shows that urine is being discharged in pulses from the two orifices located in the lower part of this formation. Name this developmental anomaly:
(A) Bladder agenesis
(B) Bladder exstrophy
(C) Urachal cyst
(D) Bladder diverticulum
(E) Vesico-umbilical fistula
Q83. After the pregnant woman’s water broke, it was noted that they are significantly contaminated with meconium. Upon birth, the baby is not breathing, remains inert, the skin is cyanotic and covered in meconium, heart rate is 98/min. What resuscitation measures should be taken after the baby is born?
(A) Tactile stimulation of the newborn
(B) Sanation of the upper respiratory tracts with a rubber balloon
(C) Direct laryngoscopy, intubation, sanation of the trachea
(D) Artificial pulmonary ventilation with a mask and Ambu bag
(E) Give adrenaline intravenously
Q84. A 37-year old woman received an occupational trauma that resulted in a severe vision impairment. Now she needs to be trained for another occupation. What type of rehabilitation should be doctor choose for the patient in this case?
(A) Occupational rehabilitation
(B) Target rehabilitation
(C) Psychological rehabilitation
(D) Social rehabilitation
(E) Medical rehabilitation
Q85. A 52-year-old woman has been suffering for 2 years from dull, occassionally exacerbating pain in her right subcostal area, occuring after eating high-fat foods, bitter taste in her mouthin the morning, constipations, and flatulence. Objectively, she is obese, her body temperature is 36.9oC; there is a coating on the root of her tongue; abdomen is moderately distended and painful in the area of the gallbladder projection. What examination would be most helpful for diagnosis making?
(A) Cholecystography
(B) Ultrasound
(C) Liver scanning
(D) Duodenal probe
(E) Duodenoscopy
Q86. A 35-year old woman had acute onset of the disease that started with fever up to 39.0oC and cough. 3 days later a dyspnea at rest increased to 35/minute. Downward from her right shoulder blade angle, percussion detects a dull sound. No vocal fremitus, respiratory sounds cannot be auscultated. What is the treatment tactics?
(A) Artificial lung ventilation
(B) Physiotherapy
(C) Antibiotic therapy
(D) Oxygen therapy
(E) Pleural tap
Q87. The 5-year old child has been ill for 2 weeks. Cough attacks developed first and were then followed by reprises. During coughing the child’s face turns red and cervical veins bulge. The cough attacks induce vomiting. X-ray shows intensified bronchial pattern. Blood test: leukocytes-16 x 109/L, lymphocytes-72%, erythrocyte sedimentation rate-4mm/hour. What is the most likely diagnosis?
(A) Foreign body
(B) Obstructive bronchitis
(C) Adenovirus infection
(D) Pneumonia
(E) Pertussis
Q88. A patient 1 year had a Q wave myocardial infarction of the posterior wall of the left ventricle. For the last 2 weeks he has been suffering from daily attacks of atrial fibrillation and bradycardia episodes, accompanied by bouts of vertigo. What tactics is the most advisable in this case?
(A) Prescription of bisoprolol
(B) Pacemaker implantation
(C) Prescription of digoxin
(D) Prescription of amiodarone
(E) Prescription of procainamide
Q89. A 68-year old woman with congestive heart failure and left ventricular ejection fraction of less than 40% receives the following pharmacotherapy scheme: ramipril, torasemide, bisoprolol, clopidogrel and digoxin. During one of her regular examination, frequent polymorphic ventricular extrasystole were detected in the patient. What medicine should be removed from her therapy scheme?
(A) Digoxin
(B) Ramipril
(C) Bisoprolol
(D) Torasemide
(E) Clopidogrel
Q90. A 39-year-old man, a battery attendant suddenly developed weakness, loss of appetite, nonlocalized colicky abdominal pains, and nausea. Objectively, his skin, its grey, there is pink-gray stripe on his gums; the abdomen is soft and sharply painful. Blood test detected erythrocytes with basophilic stippling and anemia. The patient has a history of peptic ulcer disease of the stomach. Constipations occur each 3-4 days. What is the most likely provisional diagnosis?
(A) Acute appendicitis
(B) Saturnism (lead poisoning)
(C) Performation of gastric ulcer
(D) Chronic alcoholism
(E) Acute cholecystitis
Q91. A 72-year-old man with pneumonia complains of marked dyspnea, chest pain, severe cough with expectoration, temperature is 39.5-40oC, no urination for the last 24 hours. Objectively, the patient is conscious. Respiratory rate is 36/min. Percussion sound is dull over the right lower pulmonary lobe; on auscultation there is bronchial respiration and numerous moist crackles. Blood pressure is 80/60 mmHg. Heart rate is 120/min. Heart sounds are muffled, there is tachycardia. What tactics should the family doctor choose for the management for this patient?
(A) Treatment in the day patient facility
(B) Hospitalization into the intensive care unit
(C) Hospitalization into the neurology unit
(D) Hospitalization into the pulmonary unit
(E) Outpatient treatment
Q92. A 38-year-old woman has been suffering from glomerulonephritis for 20 years. For approximately 16 years she has been presenting with progressing renal parenchymal arterial hypertension that became refractory and accompanied by leg edemas. She receives a combination of 100mg losartan and 20mg lercanidipine with insufficient antihypertensive effect. What medicine can she be recommended for intensification of the antihypertensive effect of her therapy?
(A) Torasemide
(B) Doxazosin
(C) Bisoprolol
(D) Urapidil
(E) Lisinopril
Q93. Children from a certain township presents with brittle teeth, malocclusion, dental enamel erosions, and dental pigmentation that looks like yellow- brown spots. What is the likely cause of this presentation?
(A) Low levels of sulfates in water
(B) Low levels of fluorine in water
(C) High levels of nitrates
(D) High levels of fluorine in water
(E) High levels of sulfates in water
Q94. When planning treatment of a patient, it was decided to use a medicine with evidence level A. what trials produce the evidence that allows to classify the medicine level as A?
(A) Case-control studies
(B) Data obtained from several randomized clinical trials
(C) Data obtained from one randomized clinical trial
(D) Expert consensus
(E) Data obtained from many non-randomized trials
Q95. A 34-year-old woman after rapidly changing her position from horizontal to vertical suddenly paled, fell down, her skin became moist, her limbs are cold, her pupils are dilated. The pulse is rapid and thready, blood pressure is 50/25 mmHg. What condition has likely developed in the patient?
(A) Ventricular fibrillation
(B) Morgagni-Adams-stokes syndrome
(C) Shock
(D) Coma
(E) Collapse
Q96. The body of a citizen was found at the place of his dwelling. On his face, neck, and hands there were detected irregular-shaped wounds, varying from 2×3 cm to 4×5 cm in size. The skin and underlying tissues are absent in the wounds. The margins of the wounds are uneven, with major and minor scalloping along the edges and no signs of bleeding. What is the initiating mechanism of these wounds?
(A) Blast injury
(B) Pellet gunshot wound
(C) Multiple stab and incised wounds
(D) Local effect of cold
(E) Animal bite wounds
Q97. A 75-year-old man in a severe condition suffers from dyspnea at rest, marked weakness, and arrhythmia. Abdominal aortic pulsation is observed, further on is a systolic murmur detected. Palpation reveals a volumetric formation in the mesogastrium. Blood pressure is 70/40mmHg. There is no pulsation over the femoral arteries. Oliguria is detected. Which diagnosis is the correct one?
(A) Cardio sclerotic aneurysm
(B) Dissecting aortic aneurysm
(C) Acute cardiac aneurysm
(D) Pancreatic cyst
(E) Acute pericarditis
Q98. A 54-year-old woman complains of fogged vision in her right eye, rainbow circles in her vision, headache, and nausea. Within the last month she twice experienced a similar condition, but back the all the signs eventually disappeared and her sight was restored. Currently, all the signs have beed persisting for over 2 days. Objectively, the patient has eyelid edema, congestive injection of the eyeball, corneal opacity, shallow anterior chamber of the eye, and dilated pupil that is unresponsive to the light. Her intraocular pressure is 48mmHg. Make the diagnosis:
(A) Cyclitis
(B) Iridocyclitis
(C) Keratitis
(D) Glaucoma
(E) Iritis
Q99. A child was born at 40 weeks of gestation with the weight of 3700g. The child’s Apgar score is 7/9. The baby was put to breast immediately after birth and suckled actively. On the 3rd day of life, the child’s weight decreased to 3600g. What transitory condition is observed in this child?
(A) Uric acid infarction
(B) Physiological jaundice
(C) Transient dysbiosis
(D) Physiological weight loss
(E) Toxic erythema
Q100. A 28-year old man, a teacher, after an emotional stress developed painful muscle spasms in his right hand that occur during writing; now he has to hold the pen between the second and the third fingers. He has no problems with typing or writing on the black board, no other motor disturbances or neurological pathologies are detected. What is the most likely diagnosis?
(A) Neuropathy of the right radial nerve
(B) Cortical agraphia
(C) Writer’s cramp
(D) neuropathy of the right ulnar nerve
(E) Parkinsonism
Q101. A 58-year old woman has type2 diabetes mellitus that is compensated with diet and metformin. She prepares for cholecystectomy. Objectively, her height is 164 cm, weight is 90 kg, heart rate is 72/min, blood pressure is 130/80 mmHg. Her abdomen is soft, painful in the right subcostal region. The liver is not enlarged. Fasting glucose-6.2 mmol/L. Glycated hemoglobin- 6.5%. what further tactics of sugar lowering therapy should be chosen in this case?
(A) Prescription of a short-acting insulin
(B) Prescription of an insulin mixture
(C) Continue the present scheme of therapy
(D) Prescription of a long-acting insulin
(E) Prescription of glurenorm (gliquidone)
Q102. During regular examination of a 2-year old boy, he presents with enlarged left kidney, painless on palpation. The right kidney was undetectable on palpation. Excretory urography shows no contrast on the right. Cytoscopy detected hemi atrophy of the urinary bladder trigone, the right ureteral orifice is not detected. What pathology is it?
(A) Dystopia of the right kidney
(B) Ectopic right ureteral orifice
(C) Hypoplasia of the right kidney
(D) Agenesis of the right ureter
(E) Agenesis of the right kidney
Q103. A surgery unit received a person with an incised stab wound on the upper third of the right thigh. Examination detects an incised stab wound 3.0×0.5×2.0 cm in size on the inner surface of the upper third of the right thigh. Bright red blood flow from deep within the wound in a pulsing stream. Characterize this type of bleeding:
(A) Mixed
(B) Capillary
(C) Parenchymatous
(D) Venous
(E) Arterial
Q104. A 26-year-old woman was hospitalized into the gynecological department with the complains of body temperature up to 38.2oC, fever, general weakness, and dirty-red blood discharge from her genital tracts. She is hemodynamically stable. Two days ago, she underwent a medical abortion on the 8th week of pregnancy. Ultrasound detects the remains of the fertilized egg in her uterine cavity. What are the tactics of the patient management in this case?
(A) Revision of the uterine cavity with vacuum aspirator. Antibiotic therapy
(B) Laparotomy, extirpation of the uterus and tubes. Abdominal drainage
(C) Laparotomy, supravaginal uterine amputation. Abdominal drainage
(D) Uterine cavity treatment with antibiotic solutions
(E) Pipelle biopsy
Q105. On the 3rd day after the artificial abortion the woman was hospitalized into the gynecological department in a severe condition with signs of intoxication, abdominal pain, and purulent discharge from the vagina. Objectively, the patient’s condition is severe, her body temperature is 38.8oC, pulse is 100/min, blood pressure is 110/70 mmHg, the uterus is soft, the uterine fundus is located at the level of navel, there are positive signs of peritoneal irritation. What is the most likely diagnosis?
(A) Acute metro endometritis
(B) Ectopic pregnancy
(C) Acute suppurative salpingo-oophoritis
(D) Uterine perforation
(E) Pelviperitonitis
Q106. A pregnant woman at 32 weeks of gestation with the risk of preterm labor undergoes a treatment to prevent fetal respiratory distress syndrome. What medicine was she prescribed?
(A) Progesterone
(B) Misoprostol
(C) Dexamethasone
(D) Oxytocin
(E) Gynipral ( hexoprenaline)
Q107. A patient was brought into the pulmonology department with complaints of inspiratory dyspnea and dry cough at the highest point of inhalation. On the examination the following is observed: pale skin, cyanotic lips, “Hippocratic fingers”. Auscultation detects Velcro-type crackles (like opening a Velcro fastener). X- ray shows a “ground glass opacity” pattern. What is the most likely diagnosis?
(A) Pulmonary histiocytosis X
(B) Idiopathic pulmonary fibrosis
(C) Idiopathic pulmonary hemosiderosis
(D) Exogenous allergic alveolitis
(E) Hand-Schuller-Christian disease
Q108. A patient is 45 year old. He was referred for a consultation with a psychiatrist due to complains of abdominal pain and discomfort that occur in emotional staining situation. Objectively, no changes of the gastrointestinal tract was detected. The complaints emerged over 10 years ago against the background of severe alcohol poisoning. The patient has been repeatedly visiting gastroenterologists, who were unable to find any significant changes in the patient. The prescribed therapy was ineffective. What is the likely conclusion?
(A) No disorder
(B) Organic brain disorder
(C) Chronic alcoholism
(D) Somatoform autonomic dysfunction
(E) Functional dyspepsia
Q109. A woman came to the gynecologist to plan her pregnancy. She was advised to increase her intake of the products rich in folic acid, particularly soy beans, bread made of coarsely ground flour, fruits, leafy green vegetables. Such changes in her diet will work toward the prevention of:
(A) Rickets
(B) Iron- deficiency anemia in the pregnant woman
(C) Non-closure of the fontanel
(D) Polyhydramnios
(E) Non- closure of the neural tube in the fetus
Q110. A woman complains of a severe pain in her throat on the left, difficult swallowing and mouth opening, elevated body temperature, and general malaise. The onset of the disease was 4 days ago after a case of tonsillitis. Examination detects a trismus of the masticatory muscles; the left tonsil is displaced toward the midline; the anterior palatal arch is infiltrated and protruding. The regional lymph nodes on the right are enlarged and painful on palpation. Make the diagnosis:
(A) Lacunar tonsillitis
(B) Infectious mononucleosis
(C) Peritonsillar abscess
(D) Acute pharyngitis
(E) Tonsillar tumor
Q111. A 10-year-old boy came to the polyclinic with complaints of stuffy nose. It is known that these signs occur in the child periodically (in spring and autumn). He has a history of atopic dermatitis. The father of the child had bronchial asthma. Objectively, the boy’s face is pale and slightly swollen. Respirations are 22/min. Auscultation detects vesicular respiration over the lungs. Rhinoscopy shows swollen and pale nasal mucosa. What disease can be suspected?
(A) Acute rhinitis
(B) Allergic rhinitis
(C) Acute maxillary sinusitis
(D) Acute adenoiditis
(E) Recurrent respiratory disease
Q112. A 34-year-old multipara was brought to the labor ward with regular labor activity. Her pelvic size 26-29-32-22 cm. Vaginal examination shows 6 cm cervical dilation, the amniotic sac is unbroken. The fetus is in the breech presentation, with buttocks pressed to the entrance into the lesser pelvis. The promontory cannot be reached, no exostoses. Feta heart rate is 140/min, expected fetal weight is 2800g. What labor tactics should be chosen?
(A) Classic combined external-internal version of the fetus
(B) Fetal extraction from the pelvic end
(C) Delivery through the natural birth canal
(D) External obstetric version of fetus
(E) Urgent cesarean section
Q113. A 19-year-old girl complains of moderate, itching and hair loss on her head. Objectively, on the skin of her occipital region there is a single round erythematous focus 3 cm in diameter with clear margins. Asbestos- like scales can be observed on the surface of the lesion. The hair in the focus of the lesion is broken off at the length of 6-8 cm. What is the most likely diagnosis?
(A) Psoriasis
(B) Seborrhea
(C) Microsporia
(D) Scabies
(E) Trichophytosis
Q114. A full-term newborn (born with the body weight of 3900 g at gestational age of 39 weeks) on the first day of his life developed respiratory disturbances: dyspnea, arrhythmic respiration, cyanosis attacks. On examination there is paradoxical respiration observed and left side of the chest lags behind in the act of breathing. On auscultation the respiration is weakened in the lungs on the left. Neurologist diagnosed the patient with left- sided Erb-Duchenne palsy. Complete blood count shows no changes. What is the most likely diagnosis?
(A) Left-sided pneumonia
(B) Left-sided diaphragm paresis
(C) Congenital pneumonia
(D) Respiratory distress syndrome
(E) Transient tachypnea of the newborn
Q115. Disease onset was acute. A child developed general weakness, pain in the joints, and fever. Later these signs became accompanied by itching skin rash manifested as erythematous spots 2-5 mm in size. The rash gradually turned hemorrhagic. Large joints are painful and swollen ;pain attacks periodically occur in paraumbilical area; there are signs of intestinal hemorrhage. What is the most likely diagnosis?
(A) Hemorrhagic meningoencephalitis
(B) Hemorrhagic vasculitis (Henoch-Schonlein purpura)
(C) Rheumatism
(D) Scarlet fever
(E) Streptococcal impetigo
Q116. A 48-year old woman was delivered into the surgical unit with wounds in her thigh. On examination the wound surface has a dirty-gray coating with unpleasant sweet smell. The wound content resembles a raspberry jelly. Skin tissues around the wound are glossy and turgid. Palpation reveals moderate crepitation in the tissues. What bacteria is the most likely to cause such inflammation?
(A) Staphylococci
(B) Anaerobic clostridial
(C) Blue pus bacillus
(D) Streptococci
(E) Anaerobic non-clostridial
Q117. A 20-year old patient complains of a severe headache, double vision, weakness, fever, irritability. Objectively: body temperature is 38.1oC, the patient is reluctant to contact, sensitive to stimuli. There is ptosis of the left eyelid, exotropia, anisocoria S >D, and pronounced meningeal syndrome. On the lumbar puncture the cerebrospinal fluid flowed out under a pressure of 300 mmHg, the fluid is clear, slightly opalescent. 24 hours later there appeared a fibrin film. Protein- 1.4 g/L, lymphocytes- 600 per mm3, glucose- 0.3 mmol/L. What is the provisional diagnosis?
(A) Meningococcal meningitis
(B) Syphilitic meningitis
(C) Tuberculous meningitis
(D) Lymphocytic (Armstrong’s) meningitis
(E) Mumps meningitis
Q118. A 35-year old woman complaints of a pain in her right axillary region. She has been suffering from this condition for a week. Her body temperature is 38oC. in the right axillary region there are 2 formations, 2 cm in size each. The skin over the formations is dark red and thin, palpation produces a yellow-white discharge from the fistular openings. What is the most likely diagnosis?
(A) Furuncle
(B) Folliculitis
(C) Carbuncle
(D) Lymphadenitis
(E) Hydradenitis
Q119. A dweller of the northern Dnieper area, a fisherman, for the last several days has been complaining of a discomfort in his right subcostal region, periodical episodes of diahhrea, intermittent with constipation, frequent skin rashes. Abdominal ultrasound shows enlarged liver and pancreatic head. Make the provisional diagnosis:
(A) Ornithosis
(B) Taeniasis
(C) Onchocerciasis
(D) Trichinellosis
(E) Opisthrochiasis
Q120. A 73-year-old woman came to the family physician for one of her regular follow-up examinations. Three months ago she was found to have type 2 diabetes mellitus. She was keeping to her diet and exercise plan and taking Phyto preparations. On examination her fasting glucose was within the range of 7.8-8.6mmol/L,HbA1c- 7.9%. height –164cm, weight –83kg. What blood glucose controlling medicine should be prescribed first in the course of her pharmacological therapy?
(A) Metformin
(B) Insulin
(C) Glibenclamide
(D) Glimepiride
(E) Gliclazide
Q121. A pregnant woman of 32 weeks of gestation underwent dopperometry of umbilical circulation, which revealed a reverse diastolic component. Objectively, the height of the uterus is 27 cm above the pubic bone, head of the fetus is mobile and located above the entrance to the lesser pelvis. Fetal heartbeat is 136/min. Vaginal examination shows that the uterine cervix is closed, its length is 3 cm. What tactics should the obstetrician choose?
(A) Ultrasound photometry of the fetus
(B) Labor induction with oxytocin
(C) Repeated dopplerometry next day
(D) Fetal biophysical profile
(E) Urgent cesarean section
Q122. A patient underwent suture plication of the perforated duodenal ulcer. On the 3rd day after the operation he started producing a large amount of discharge from the abdominal drain tube. The discharge contains bile and has high amylase levels. What complication occurred in the patient?
(A) Acute cholecystitis
(B) Hemorrhage from the ulcer
(C) Suture incompetence of the ulcerative defect
(D) Early postoperative adhesive obstruction
(E) Acute postoperative pancreatitis
Q123. After eating shrimps, a 25-year old man suddenly developed skin itching, some areas of his skin became hyperemic or erupted into vesicles. Make the diagnosis:
(A) Urticaria pigmentosa
(B) Acute urticaria
(C) Hemorrhagic vasculitis (Henoch-Schonlein purpura)
(D) Psoriasis
(E) Scabies
Q124. An unconscious patient was delivered to a hospital by an ambulance. Objectively, his body temperature is 39 C, he presents with convulsion and red dry skin. It is known that the patient works as a stoker in the boiler room. What is the likely diagnosis?
(A) CO poisoning
(B) Hypertensive urgency
(C) Acute viral respiratory infection
(D) Heat stroke
(E) food poisoning
Q125. A 48-year-old woman complains of disturbed menstrual cycle; her periods last for 7-9 days and are excessively profuse throughout the last half-year. She notes occasional hot flashes in her head, insomnia, irritability, and headaches. Her skin is of normal color. Blood pressure – 150/90mmHg, pulse –90/min, rhythmic. The abdomen is soft and painless. Bimanual examination shows no uterine enlargement, the appendages cannot be detected. The vaginal fornixes are free. What is the most likely diagnosis?
(A) Uterine myoma
(B) Premenstrual syndrome
(C) Stein- leventhal syndrome (polycystic ovary syndrome)
(D) Adrenogenital syndrome
(E) Climacteric syndrome
Q126. A 27-year-old man complains of pain in his leg joints, purulent discharge from the eyes, and painful burning sensations during urination. The disease onset was acute. He has a history of influenza. The patient smokes and drinks alcohol in excess. In his line of work, he is often away on business trips. What is the most likely etiological factor of this disease?
(A) Streptococci
(B) Adenovirus
(C) Candida
(D) Chlamydia
(E) Staphylococci
Q127. A 20-year old man suffers from headache, general weakness, and face edema that appears in the morning. 18 days earlier he had a case of tonsillitis. Objectively, his skin is pale, there are edema under his eyes. Hear rate is 60/min, blood pressure is 185/100 mmHg. The sign of costovertebral angle tenderness (punch sign in the lumbar region) is negative. Urinalysis: color of “meat slops”, protein-4.5 g/, altered erythrocytes- 40-45 in the vision field, leukocytes- 5-6 in the vision field. 24-hour diuresis is 400 mL. What is the most likely diagnosis?
(A) Systemic lupus erythematosus
(B) Urolithiasis
(C) Acute glomerulonephritis
(D) Acute pyelonephritis
(E) Renal amyloidosis
Q128. On ultrasound of the thyroid gland. A 47-year-old woman presents with a hypoechoic node 1.6 cm in diameter with blurred margins and intranodular hypervascularization. The doctor suspects thyroid carcinoma. What method should be used to verify the diagnosis?
(A) Determine TSH levels in the blood
(B) Thyroid scintigraphy
(C) Position emission tomography (PET)
(D) Fine-needle aspiration biopsy
(E) Case monitoring
Q129. After playing with” mosaics”, a two-year-old child suddenly developed cough, stridorous respiration, urges to vomit, and cyanosis against the background of relative stomatic health. What should the doctor suspect first when examining the child?
(A) Acute laryngotracheitis
(B) Foreign body aspiration
(C) Pertussis
(D) Acute obstructive bronchitis
(E) Pneumonia
Q130. A 57-year-old man, a miner, complaints of a pain in his chest, dyspnea on physical exertion, excessive sweating, constant sub febrile temperature, and cough that produces blood-steaked sputum. He has been smoking for approximately 40 years (2 packs a day) and frequently has ”pneumonias”. Survey chest X-ray shows a triangular shadow in the middle lobe of the right lung. One of the apices of the shadow points to the lung root. Cardiac and mediastinal shadows are displaced toward the affected area. Make the provisional diagnosis:
(A) Pneumoconiosis
(B) Chronic bronchitis
(C) Cancer of the right lung
(D) Tuberculosis of the right lung
(E) Right-sided pleuropneumonia