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Krok 2
MEDICINE
General Instruction
Every one of these numbered questions or unfinished statements in
this chapter corresponds to answers or statements endings. Choose
the answer (finished statements) that fits best and fill in the circle
with the corresponding Latin letter on the answer sheet.
Authors of items: Abaturov O.Ye., Agarkov V.I., Alexeyenko L.I., Andrusha A.B., Artamonov V.S.,
Badogina L.P., Barannyk S.I., Belyakova V.I., Berezov V.M., Bezborod’ko S.A., Bilous T.M.,
Blikhar V.Ye., Bondarenko V.V., Borovkova S.O., Borysova T.P., Borzova O.Yu., Bukhteyeva E.R.,
Burka O.A., Buryak V.M., Butvyn I.M., Chonka I.I., Demchenko T.V., Derkach V.G., Detsyk O.Z.,
Dobrovols’ka L.M., Dzis’ N.P., Dzyuba G.A., Emiraliyeva Z.R., Franchuk O.A., Galushchenko S.A.,
Gendeleka G.F., Genyk N.I., Gerasymenko O.I., Goryachev V.V., Grebenyuk V.I., Grydasova V.D.,
Gurenko O.G., Gusak O.M., Ivanits’ka O.V., Ivanyuta S.O., Kaporina N.V., Karliychuk O.O.,
Khymenko M.F., Kol’tsova N.I., Kolyadenko N.V., Kondratenko P.G., Konopkina L.I., Koval’ova O.M.,
Kovtun A.I., Kovtunenko R.V., Kravchenko O.V., Krut’ Yu.Ya., Krylova V.Yu., Kryvonosov M.V.,
Kubyschkyn V.F., Kudiyevsky A.V., Kudrevych O.M., Kudrya V.I., Kuz’menko A.Ya., Kuz’menko S.A.,
Kvasnyts’ka O.B., Latypova G.A., Lishchenko N.O., Lysenko D.A., Lysenko V.M., Marichereda V.G.,
Martsynik Ye.M., Martynyuk L.P., Maruschko Yu.V., Mel’nychuk L.V., Mischchenko V.P., Moroz I.M.,
Myerkulova N.F., Mysak A.I., Nikitina N.O., Nitsovych R.M., Nishkumay O.I., Ognyev V.A.,
Okhrimenko G.I., Oliynyk O.Ye., Ostropolets’ M.S., Pavlovych L.V., Perepelyuk M.M., Perminova T.I.,
Pisots’ka L.A., Prokhoda A.F., Prokopchyk G.L., Prokopova L.V., Proniv L.M., Prunchak I.F., Prus L.O.,
Reva V.B., Romanenko V.N., Roshchupkina S.L., Rudenko M.M., Rudenko O.F., Ryapolova T.L.,
Rybalka A.M., Syabadash V.Ye., Sakevych P.P., Sannikova N.M., Selezn’ova S.V., Sels’ka O.V.,
Semenukha K.V., Semenyak A.V., Shcherbatyuk N.Yu., Shevchenko O.A., Shevchenko R.S., Shumko G.I.,
Shusterman T.Y., Sipityi V.I., Sichanova O.V., Slyepichko Yu.M., Slyva V.I., Smirnova V.L., Soldak I.I.,
Spirina I.D., Stepanyuk L.I., Sternyuk Yu.M., Svidro O.V., Svyrydova V.V., Syerkova V.K.,
Synovers’ka O.B., Sychova V.V., Tarallo V.L., Titarenko O.V., Tkachenko M.M., Tkachuk O.L.,
Tomash O.V., Tsyunchyk Yu.G., Tyuyeva N.V., Urbas’ O.V., Uryvayeva M.K., Usychenko O.M.,
Vankhanen N.V., Vankhanen V.D., Varbanets’ D.A., Vasil’yeva N.V., Vasyl’chyshyn Ya.V., Velyka N.V.,
Vereschagina N.Ya., Vinentsov Yu.O., Volyans’ka A.G., Vorkhlyk M.I., Vorokhta Yu.M.,
Yermachenko T.P., Yevdokimova T.B., Yevtushenko V.V., Yakovenko I.K., Yakubyshyna I.G.,
Yamilova T.M., Yudina T.V., Yurchenko I.V., Yurlov V.M., Yutanova A.V., Zakharchenko Yu.B.,
Zakharov V.K., Zavizion V.F., Zazdravnov A.A., Zelyak M.V., Zheliba M.D., Zhuravel V.I., Zhurilo I.P.,
Znakhurenko L.S., Zorya A.V., Zuban’ A.B. and Committees of professional expertise.
Item reviewers. Agafonova O.O., Anisimov Ye.M., Bab’yak T.Ye., Chursina T.Ya., Dyndar O.A.,
Grygorov Yu.B., Grynzovs’ky A.M., Gubka V.O., Gutsalenko O.O., Kalinina S.Yu., Karapetyan K.G.,
Khrapach V.V., Kolesnyk O.M., Kolosovych I.V., Kondratyuk V.Ye., Kopcha V.S., Kravchenko O.V.,
Kutovy O.B., Kuz’mina I.Yu., Malanchuk L.M., Martynyuk L.P., Mishchenko V.P., Muravs’ka O.M.,
Petrushenko V.V., Prokhorova M.P., Pryshlyak O.Ya., Puzanova O.G., Pyptyuk O.V., Shestakova I.V.,
Shevtsova T.I., Stovban I.V., Tsvirenko S.M., Usenko S.G., Vakal’uk I.P., Volyans’ka A.G.
The book includes test items for use at licensing integrated examination “Krok 2. Medicine” and
further use in teaching.
The book has been developed for students of medical, pediatric and medical-and-prophylactic
faculties and academic staff of higher medical educational establishments.
developed on the 14th day of the disease. The 14. A 13-year-old girl complains of periodic
liver diminished in size. What complication of prickly pain in the heart region. Percussi-
viral hepatitis caused deterioration of the pati- on revealed no changes of cardiac borders.
ent’s condition? Auscultation revealed arrhythmic enhanced
heart sounds, extrasystole at the 20-25 cardi-
A. Hepatic encephlopathy ac impulse. ECG showed the sinus rhythm,
B. Meningitis impaired repolarization, single supraventri-
C. Relapse of viral hepatitis cular extrasystoles at rest. What is the most
D. Cholangitis likely diagnosis?
E. Infectious-toxic shock
A. Somatoform autonomic dysfunction
10. An 18-year-old patient was admitted B. Rheumatism
to a hospital with complaints of headache, C. Nonrheumatic carditis
weakness, high fever, sore throat. Objectively: D. Myocardial degeneration
enlargement of all groups of lymph nodes was E. Intoxication syndrome
revealed. The liver is enlarged by 3 cm, spleen
- by 1 cm. In blood: leukocytosis, atypical 15. A 24-year-old patient visited a doctor
lymphocytes - 15%. What is the most probable complaining of enlargement of his submaxi-
diagnosis? llary lymph nodes. Objectively: submaxillary,
axillary and inguinal lymph nodes are enlarged.
A. Infectious mononucleosis Chest X-ray shows: enlarged lymph nodes
B. Acute lymphoid leukosis of mediastinum. Blood test: erythrocytes -
C. Diphtheria 3, 4 · 1012 /l, Hb- 100 g/l, blood colour index
D. Angina
E. Adenoviral infection - 0,88, platelets - 190 · 109 /l, leucocytes -
7, 5 · 109 /l, eosinophiles - 8%, band neutrophi-
11. A 60-year-old woman, mother of 6 children, les - 2%, segmented neutrophiles - 67%,
developed a sudden onset of upper abdomi- lymphocytes - 23%, ESR - 22 mm/h. What
nal pain radiating to the back, accompani- test must be prescribed to verify the cause of
ed by nausea, vomiting, fever and chills. lymphadenopathy?
Subsequently, she noticed yellow discolorati-
on of her sclera and skin. On physical exami- A. Open biopsy of lymph nodes
nation the patient was found to be febrile with B. Ultrasonography of abdominal cavity
temperature of 38, 9o C , along with right upper C. Mediastinum tomography
quadrant tenderness. The most likely diagnosis D. Puncture biopsy of lymph nodes
is: E. Sternal puncture
A. Territorial sanitation center mes joined by hemoptysis and pain in the ri-
B. Plant ght side of chest. Breathing is vesicular. X-ray
C. Social Insurance Fund shows darkening and sharp decrease in size of
D. Trade union the lower lobe distinctly visible on the X-ray
E. Medical unit image as a streak 2-3 cm wide situated at the
angle from lung root to the frontal costodi-
18. 4 days after a patient received a gunshot aphragmatic recess. The most likely diagnosis
wound of the middle third of the thigh soft ti- is:
ssues his condition suddenly began deteriorati-
ng. There are complaints of bursting pain in the A. Peripheral lung cancer
wound; pain increases during the last 12 hours. B. Bronchiectasis
Edema of skin and hypodermic tissue quickly C. Pneumonia
grows. Body temperature is 38, 2o C , heart rate D. Middle lobe syndrome
is 102/min. The wound edges gape, are dull in E. Interlobular pleurisy
color; the muscles, viable as of day before, now
protrude into the wound, look boiled, are dull 23. A 52-year-old patient, who has been sufferi-
in colour, have dirty-grey coating and fall apart ng from angina pectoris for 2 weeks, has
when being held with forceps. What infection more and more frequent pain attacks in the
has developed in the wound? area behind his sternum and his need for ni-
troglycerine increased. Objectively: the condi-
A. Anaerobic tion is of moderate severity. Skin is pale. Heart
B. Aerobic gram-negative sounds are weakened, rhythmic. Heart rate is
C. Putrid 84 per minute. ECG shows no signs of focal
D. Aerobic gram-positive myocardial damage. What is the most likely di-
E. Diphtheria of wound agnosis?
19. Bacterial analysis of air in a living space in A. Progressive angina pectoris
winter period by means of Krotov’s apparatus B. First-time angina pectoris
revealed that total number of microorganisms C. Stable FC II angina pectoris
in 1m3 of air was 7200. What is the allowed D. Variant angina pectoris
number of microorganisms for the air to be E. Acute cardiac infarction
characterized as "pure"?
24. An 8-year-old boy during preventive exami-
A. Up to 4500 nation was determined to have changes in
B. Up to 2500 his spine curvature in frontal plane: the ri-
C. Up to 3500 ght shoulder is lowered and flat, scapulae
D. Up to 5500 angles are of different height due to the ri-
E. Up to 7500 ght scapula being shifted down. Waist triangles
are pronounced on the both sides; longitudinal
20. Maximum permissible concentration of muscles of the back form muscle cushion on
carbon dioxide in the air is considered to be the left. What type of posture is detected in the
a sanitary index of air purity in a classroom. child?
What concentration of carbon dioxide in the
air is accepted as a permissible maximum? A. Scoliotic
B. Kyphotic
A. 0,1% C. Lordotic
B. 0,05% D. Stooping
C. 0,15% E. Corrected
D. 0,2%
E. 0,3% 25. A patient with cardiac infarction is on sick
leave with his medical certificate being conti-
21. When examining the parameters of desk nuously extended for 4 months according to a
natural lighting in a school class it was determi- standard procedure. The disease is progressi-
ned that: light angle is 25o , window angle is ng. The issue is put forward to refer the pati-
3o , window-to-floor area ratio is 1:4, dayli- ent to the industrial injury assessment board.
ght factor is 0,5%, and window-head-to-room- Who among the medical staff of medical and
depth ratio is 2. What parameter does not preventive treatment facility is authorized to
correspond to hygienic norms? do this?
A. Daylight factor A. Medical expert committee
B. Window angle B. Attending medical doctor
C. Window-to-floor area ratio C. Head doctor of hospital department
D. Window-head-to-room-depth ratio D. Deputy head doctor for assessment of
E. Light angle temporary disability
E. Head doctor
22. A 29-year-old patient works as a motor
mechanic. Anamnesis shows frequent exposure 26. A 9-year-old boy has been suffering from
to cold, exacerbation of chronic bronchitis bronchoectasis since he was 3. Exacerbations
attended by cough with relativly small amount occur quite often, 3-4 times a year. Conservati-
of mucopurulent sputum, subfebrility, someti- ve therapy results in short periods of remi-
Крок 2 Medicine (англомовний варiант, iноземнi студенти) 2015 рiк 4
ssion. The disease is progressing, the child 31. A 46-year-old patient once took part in eli-
has physical retardation. The child’s skin is mination of breakdown at an atomic power
pale, acrocyanotic, he has "watch glass"nail plant. Currently he is being treated at an in-
deformation. Bronchography revealed saccular patient hospital unit. He was diagnosed with
bronchiectases of the lower lobe of his right progressing somatoform autonomic dysfuncti-
lung. What is the further treatment tactics? on. This disease relates to the following group
of ionizing radiation effects:
A. Surgical treatment
B. Further conservative therapy A. Somato-stochastic
C. Physiotherapeutic treatment B. Somatic
D. Sanatorium-and-spa treatment C. Genetic
E. Tempering of the child’s organism D. Hormesis
E. Heterosis
27. A 29-year-old female patient complains of
dyspnea, heaviness and chest pain on the ri- 32. A patient complains of fatigue, lack of
ght, body temperature rise up to 37, 2o C . The appetite, pain and burning sensation in the
disease is associated with a chest trauma recei- tongue, numbness of the distal limbs, diarrhea.
ved 4 days ago. Objectively: skin is pale and Objectively: pale skin with lemon-yellow tint,
moist. Heart rate is 90 bpm, regular. Palpation face puffiness, brown pigmentation in the form
reveals a dull sound on the right, auscultati- of a "butterfly", bright red areas on the tongue.
on reveals significantly weakened vesicular The liver is 3 cm below the costal margin, soft.
breathing. In blood: RBCs - 2, 8 · 1012 /l, colour Blood count: RBCs - 1, 5 · 1012 /l, colour index -
index - 0,9, Hb- 100 g/l, WBCs - 8, 0 · 109 /l, ESR 1,2, WBCs - 3, 8·109 /l, thrombocytes - 180·109 /l,
- 17 mm/h. What results of diagnostic puncture eosinophiles - 0%, stab neutrophiles - 1%,
of the pleural cavity can be expected? segmented neutrophiles - 58%, lymphocytes -
38% monocytes - 3%, RBC macrocytosis. ESR
A. Haemorrhagic punctate - 28 mm/h. What diagnosis are these presentati-
B. Chylous liquid ons typical for?
C. Exudate
D. Transudate A. B12 -deficiency anemia
E. Purulent punctate B. Iron deficiency anemia
C. Aplastic anemia
28. A 54-year-old man had been drowning at D. Acute erythromyelosis
sea, when he was found and evacuated to the E. Chronic adrenal failure
shore. Objectively: unconscious, pale face, no
breathing can be auscultated, thready pulse. 33. A 25-year-old female patient complains of
Resuscitation measures allowed to save the marked weakness, sleepiness, blackouts, di-
man. What complication can develop in him zziness, taste disorder. The patient has a hi-
in the nearest future? story of menorrhagia. Objectively: the pati-
ent has marked weakness, pale skin, cracks
A. Pulmonary edema in the corners of her mouth, peeling nails,
B. Respiratory arrest systolic apical murmur. Blood test results: RBC
C. Encephalopathy - 3, 4 · 1012 /l, Hb- 70 g/l, colour index - 0,75,
D. Cardiac arrest
E. Bronchial spasm platelets - 140 · 109 /l, WBC- 6, 2 · 109 /l. What is
the most likely diagnosis?
29. A 7-year-old child complains of cramping
pain occuring after mental exertion, cold dri- A. Chronic posthemorrhagic anemia
nks and eating ice-cream. Instrumental exami- B. Acute leukemia
nation allowed to diagnose biliary dyskinesia of C. Acute posthemorrhagic anemia
hypertensive type. What group of drugs should D. B12 -deficiency anemia
be prescribed for treatment? E. Werlhof’s disease
35. A child was taken to a hospital with focal treatment is going to last for another 1-2
changes in the skin folds. The child was anxi- months. Who is authorised to extend the
ous during examination, examination revealed duration of medical certificate for this patient?
dry skin with solitary papulous elements and
ill-defined lichenification zones. Skin erupti- A. Medical advisory commission after medico-
on was accompanied by strong itch. The child social expert commission examination
usually feels better in summer, his condition B. Medical superintendent
is getting worse in winter. The child has been C. Medical advisory commission after inpatient
on bottle feeding since he was 2 months old. treatment
He has a history of exudative diathesis. His D. District doctor by agreement with a
grandmother on his mother’s side has bronchi- department chief
al asthma. What is the most likely diagnosis? E. Medico-social expert commission
43. A 14-year-old girl has been presenting wi- Objectively: focal neurological symptoms
th irritability and tearfulness for about a year. were not found. Pronounced meningeal
A year ago she was also found to have diffuse symptoms were revealed. BP - 120/80 mm
enlargement of the thyroid gland (II grade). Hg. According to clinical and liquorologi-
This condition was regarded as a pubertal cal findings the patient was diagnosed wi-
manifestation, the girl did not undergo any th subarachnoid haemorrhage. After admi-
treatment. The girl’s irritability gradually gave nistration of dehydrants the patient’s condi-
place to a complete apathy. The girl got tion somewhat improved. What is the main
puffy face, soft tissues pastosity, bradycardia, component of further emergency care?
constipations. Skin pallor and gland density
progressed, the skin got a waxen hue. What di- A. Coagulants
sease may be assumed? B. Anticoagulants
C. Antiaggregants
A. Autoimmune thyroiditis D. Fibrinolytics
B. Diffuse toxic goiter E. Corticosteroids
C. Thyroid carcinoma
D. Subacute thyroiditis 48. A 42-year-old man has undergone gastric
E. Juvenile basophilism analysis. Free hydrochloric acid is absent
at all phases. On endoscopy: pallor, gastric
44. A 26-year-old woman, who delivered a child mucosa loss, gastric folds are smoothed out.
7 months ago, has been suffering from nausea, On microscopy: glands atrophy with intestinal
morning vomiting, sleepiness for the last 2 metaplasia. What disease can be characterized
weeks. She breastfeeds the child, menstruation by such presentation?
is absent. She has not applied any contracepti-
ves. What method should be applied in order A. Chronic gastritis type A
to specify her diagnosis? B. Chronic gastritis type B
C. Chronic gastritis type C
A. Ultrasonic examination D. Menetrier’s disease
B. X-ray of small pelvis E. Stomach cancer
C. Palpation of mammary glands and pressing-
out of colostrum 49. A 24-year-old woman, teacher by professi-
D. Bimanual vaginal examination on, complains of dizziness and heart pain
E. Speculum examination irradiating to the left nipple. Pain is not associ-
ated with physical activity and cannot be reli-
45. Over a current year among workers of an eved by nitroglycerin, it abates after taking
institution 10% have not been ill a single time, Valocordin and lasts for an hour or more. The
30% have been ill once, 15% - twice, 5% - 4 patient has a nearly 2-year history of this di-
times, the rest - 5 and more times. What is the sease. Objectively: Heart rate - 76 bpm. BP
percentage of workers belonging to the I health - 110/70 mm Hg. Heart borders are normal,
group? heart sounds are clear. The ECG shows respi-
ratory arrhythmia. X-ray of the cervicothoracic
A. 55% spine shows no pathology. Lungs, abdomen are
B. 10% unremarkable. What changes in blood formula
C. 40% can be expected?
D. 60%
E. 22% A. No changes
B. Leukocytosis
46. A 34-year-old patient after vacation in C. Thrombocytopenia
Crimea has developed severe pain in her D. Leukemic hiatus
elbow joints, dyspnea and weakness. Body E. Increased ESR
temperature is 37, 6o C , skin pallor and
erythema on the cheeks and bridge of nose 50. Chief physician of a polyclinic tasked a di-
are observed, lip mucosa is ulcerated. The joi- strict doctor with determining the pathologi-
nts are not visibly deformed, movement of the cal prevalence of disease N in his district.
right elbow joint is restricted. Pleura friction What document allows to estimate the disease
sound is detected in the lungs on the right side prevalence in the population of a medical di-
below the angle of scapula. Heart sounds are strict?
dull, tachycardia, gallop rhythm, heart rate -
114/min, BP - 100/60 mm Hg. The most likely A. Prophylactic examinations register
diagnosis is: B. Statistic coupons (+)
C. Statistic coupons (-)
A. Systemic lupus erythematosus D. Statistic coupons (+) and (-)
B. Rheumatic carditis E. Vouchers for medical appointments
C. Rheumatoid arthritis
D. Infectious allergic myocarditis 51. A 32-year-old woman complains of di-
E. Dry pleurisy zziness, headache, palpitation, tremor. For
the last several months she has been under
47. Several hours before, a 28-year-old pati- outpatient monitoring for increased arterial
ent suddenly developed acute headache and pressure. Recently such attacks have become
repeated vomiting, then lost consciousness. more frequent and severe. Objectively: skin
Крок 2 Medicine (англомовний варiант, iноземнi студенти) 2015 рiк 7
A. Chronic calculous cholecystitis other day. Two days ago the patient arrived
B. Chronic recurrent pancreatitis from Africa. Objectively: pale skin, subicteric
C. Fatty degeneration of liver sclera, significantly enlarged liver and spleen.
D. Chronic cholangitis, exacerbation stage What is the cause of fever attacks in this di-
E. Hypertensive dyskinesia of gallbladder sease?
60. A 52-year-old woman complains of face di- A. Erythrocytic schizogony
stortion. It appeared 2 days ago after exposure B. Tissue schizogony
to cold. Objectively: body temperature is C. Exotoxin of a causative agent
38, 2o C . Face asymmetry is present. Frontal D. Endotoxin of a causative agent
folds are flattened. Left eye is wider than the ri- E. Gametocytes
ght one and cannot close. Left nasolabial fold is
flattened, mouth corner is lowered. Examinati- 65. A 49-year-old patient 2 years ago was di-
on revealed no other pathology. Blood count: agnosed with stage 1 silicosis. He complains of
leukocytes - 10 · 109 /l, ESR - 20 mm/h. What is increased dyspnea and pain in the infrascapular
the most probable diagnosis? regions. X-ray shows diffuse intensification
and distortion of lung pattern with numerous
A. Facial neuritis nodular shadows 2-4 mm in diameter. Hardeni-
B. Trigeminus neuralgia ng of right interlobar pleura is detected. Lung
C. Hemicrania (migraine) roots are hardened and expanded. What X-ray
D. Ischemic stroke type of pneumosclerosis does the patient have?
E. Brain tumour
A. Nodular
61. A 28-year-old female patient with a six-year B. Interstitial
history of Raynaud’s syndrome has recently C. Interstitial-nodular
developed pain in the small joints of hands, di- D. Nodal
fficult movement of food down the esophagus. E. Tumor-like
What disease can be suspected in this case?
66. A 24-year-old patient complains of general
A. Systemic scleroderma weakness, dizziness, body temperature ri-
B. Periarteritis nodosa se up to 37, 5o C , sore throat, neck edema,
C. Rheumatoid arthritis enlargement of submaxillary lymph nodes.
D. Systemic lupus erythematosus Objectively: mucous membrane of oropharynx
E. Pseudotrichiniasis is edematic and cyanotic, tonsils are enlarged
and covered with films that spread beyond
62. An 8-year-old boy, who has been sufferi- the tonsils and cannot be easily removed.
ng from diabetes mellitus for 3 years, was What is the leading mechanism of this illness
delivered to a hospital in a condition of development?
hyperglycemic coma. Primary dose of insulin
should be prescribed basing on the following A. Action of bacterial exotoxin
calculation: B. Action of bacterial endotoxin
C. Allergic
A. 0,1-0,2 units/kg of body mass per hour D. Accumulation of suboxidated products
B. 0,05 units/kg of body mass per hour E. Bacteriemia
C. 0,2-0,3 units/kg of body mass per hour
D. 0,3-0,4 units/kg of body mass per hour 67. A 40-year-old woman with a history of
E. 0,4-0,5 units/kg of body mass per hour combined mitral valve disease with predomi-
nant stenosis complains of dyspnea, asthma
63. A 43-year-old female patient complains of attacks at night, heart problems. At present,
rash on the skin of her right leg, pain, weakness, she is unable to do even easy housework. What
body temperature rise up to 38o C . The disease is the optimal tactics of the patient treatment?
is acute. Objectively: there is an edema on the
skin of her right leg in the foot area, a well- A. Mitral commissurotomy
defined bright red spot in the irregular shape B. Implantation of an artificial valve
of flame tips, which is hot to touch. There are C. Antiarrhythmia therapy
isolated vesicles in the focus. What is your D. Treatment of heart failure
provisional diagnosis? E. Antirheumatic therapy
A. Erysipelas 68. A 30-year-old woman with a long history
B. Microbial eczema of chronic pyelonephritis complains of consi-
C. Contact dermatitis derable weakness, sleepiness, decrease in di-
D. Toxicoderma uresis down to 100 ml per day. BP is 200/120
E. Haemorrhagic vasculitis mm Hg. In blood: creatinine - 0,62 millimole/l,
hypoproteinemia, albumines - 32 g/l, potassi-
64. A 47-year-old patient came to see a doctor um - 6,8 millimole/l, hypochromic anemia,
on the 7th day of disease. The disease is increased ESR. What is the first step in the
acute: after the chill body temperature rose patient treatment tactics?
to 40o C and lasted up to 7 hours, then dropped
abruptly, which caused profuse sweat. There
were three such attacks occurring once every
Крок 2 Medicine (англомовний варiант, iноземнi студенти) 2015 рiк 9
is: A. Thermograph
B. Alcohol thermometer
A. Paroxysmal atrial tachycardia C. Mercury thermometer
B. Sinus tachycardia D. August’s psychrometer
C. Paroxysmal ventricular tachycardia E. Assmann psychrometer
D. Complete AV-block
E. Atrial fibrillation 91. Against the background of angina a patient
has developed pain in tubular bones. Exami-
86. During examination a patient is unconsci- nation revealed generalized enlargement
ous, his skin is dry and hot, face hyperemia of lymph nodes, hepatolienal syndrome,
is present. The patient has Kussmaul’s respi- sternalgia. In blood: RBCs - 3, 6 · 1012 /l, Hb-
ration, there is also smell of acetone in the 87 g/l, thrombocytes - 45 · 109 /l, WBCs -
air. Symptoms of peritoneum irritation are
positive. Blood sugar is 33 millimole/l. What 13 · 109 /l, blasts - 87%, stab neutrophiles - 1%,
emergency actions should be taken? segmented neutrophiles - 7%, lymphocytes -
5%, ESR - 55 mm/h. What is the most likely
A. Intravenous infusion of short-acting insulin diagnosis?
B. Intravenous infusion of glucose along with
insulin A. Acute leukemia
C. Introduction of long-acting insulin B. Erythremia
D. Intravenous infusion of neohaemodesum C. Chronic lymphocytic leukemia
along with glutamic acid D. Chronic myeloid leukemia
E. Intravenous infusion of sodium chloride E. Multiple myeloma
saline 92. For a long time to eradicate weeds on
87. A patient complains of evaginations in the agricultural lands herbicides retaining in envi-
region of anus that appear during defecation ronment have been used. Point out the most
and need resetting. Examination with anoscope probable way of herbicides reaching human
revealed 1x1 cm large evaginations of mucosa organism from soil:
above the pectineal line. What is the most A. Soil-plants-human
probable diagnosis? B. Soil-microorganisms-human
A. Internal hemorrhoids C. Soil-animals-human
B. Acute paraproctitis D. Soil-protozoa-human
C. External hemorrhoids E. Soil-insects-human
D. Anal fissure 93. A 52-year-old patient complains of pain in
E. - the right part of her chest, dyspnea, cough wi-
88. During the newborn infant’s examinati- th a lot of albuminoid sputum emitting foul
on redness of the skin was detected, which smell of "meat slops". Objectively: the pati-
occurred immediately after birth and became ent’s condition is grave, cyanosis is observed,
the most pronounced on the second day of the breathing rate is 31/min, percussion sound
infant’s life. What provisional diagnosis can be above the right lung is shortened, auscultation
made? revealed various moist rales (crackles). What is
the most probable diagnosis?
A. Simple erythema
B. Toxic erythema A. Lung gangrene
C. Transient erythema B. Lung abscess
D. Erythema nodosum C. Pleura empyema
E. Erythema anulare centrifugum D. Multiple bronchiectasis
E. Chronic pneumonia
89. A baby was born by a young smoker. The
labour was complicated by uterine inertia, diffi- 94. A 15-year-old patient suffers from
cult delivery of the baby’s head and shoulders. headache, nasal haemorrhages, sense of lower
The baby’s Apgar score was 4. Which of the extremity coldness. Objectively: muscles of
following is a risk factor for a spinal cord shoulder girdle are developed, lower extremi-
injury? ties are hypotrophied. Pulsation on the pedal
and femoral arteries is sharply dampened. BP
A. Difficult delivery of the head and shoulders is 150/90 mm Hg, 90/60 in the legs. Systolic
B. Young age of the mother murmur can be auscultated above carotid
C. Pernicious habits arteries. What is the most probable diagnosis?
D. Uterine inertia
E. Chronic hypoxia A. Aorta coarctation
B. Aorta aneurism
90. In order to study impact of microclimate on C. Aortal stenosis
the human organism it is necessary to make D. Aortal insufficiency
systematic observation of air temperature E. Coarctation of pulmonary artery
during the period of 3 days. Choose a devi-
ce that will allow to make the most precise 95. A patient with frostbite of both feet was
temperature records: delivered to an admission ward. What actions
should be taken?
Крок 2 Medicine (англомовний варiант, iноземнi студенти) 2015 рiк 12
A. Chronic suppurative odontogenic sinusitis 129. In a traffic accident two persons died. An
B. Acute purulent sinusitis appointed forensic medical expert was called
C. Chronic purulent sinusitis on duty to another accident location; therefore,
D. Chronic atrophic sinusitis according to the crininal law in force in Ukrai-
E. Tumor of the maxillary sinus ne, an investigator called in the following speci-
alist for examination of the location and bodi-
125. During a surgical operation necessitated es:
by the patient’s suffering from autoimmune
thyroiditis with concomitant multinodular goi- A. Nearest available medical doctor
ter the right lobe was removed and subtotal B. Medical assistant
resection of the left lobe was performed. C. Surgical nurse
What should be prescribed to the patient for D. Nearest available dispensing chemist
postoperative hypothyroidism prevention? E. Nearest available dental mechanic
ce of 24 years has undergone palestesiometry vely: tuberous slightly movable lump can be
test (Vibration Sensitivity Measurement). palpated in the right subcostal area; veins
Test revealed increased vibration sensitivity of spermatic cord and scrotum are dilated.
threshold at the frequencies of 63-125-259 Hz Blood test: Hb - 86 g/l, ESR - 44 mm/h. Uri-
to 25 dB. Dynamometry is 20 kg on the right ne test: specific gravity - 1020, proteine - 0,99
and 16 kg on the left. Cold stimulus test is posi- g/l, erythrocytes - all field of vision, leukocytes
tive, time of hand temeperature restoration is - 4-6 in the field of vision. The provisional di-
52 minutes. Blanching at pressure symptom is agnosis is:
positive and equals 21. Hypesthesia of upper
and lower limbs is observed and can be classifi- A. Kidney tumor
ed as "gloves"and "socks"polyneuritic pattern. B. Urolithiasis
Make the provisional diagnosis. C. Acute pyelonephritis
D. Acute glomerulonephritis
A. Vibration disease, I stage, caused by combi- E. Nephroptosis
ned vibration
B. Vibration disease, I stage, caused by local 144. A 58-year-old patient complains of
vibration headache in the occipital region, nausea, choki-
C. Vibration disease, II stage, caused by combi- ng, opplotentes. The presentations appeared
ned vibration after a physical exertion. Objectively: the pati-
D. Vibration disease, II stage, caused by local ent is excited. Face is hyperemic. Skin is pale.
vibration Heart sounds are regular, the 2nd aortic sound
E. Vibration disease, I stage, caused by general is accentuated. BP - 240/120 mm Hg, heart
vibration rate - 92/min. Auscultation reveals some fine
moist rales (crackles) in the lower parts of the
140. A patient’s X-ray image (anteroposterior lungs. Liver is not enlarged. ECG shows signs
projection) shows deformation of lung pattern, of hypertrophy and left ventricular overload.
pneumofibrosis, reticular (honeycomb) lung What is the most likely diagnosis?
pattern of lower pulmonary segments, cylindric A. Complicated hypertensic crisis
and fusiform lumps. The most likely diagnosis B. Acute myocardial infarction, pulmonary
is: edema
A. Multiple bronchiectasis C. Bronchial asthma exacerbation
B. Right lung abscess D. Uncomplicated hypertensic crisis
C. Non-hospital-acquired pneumonia E. Community-acquired pneumonia
D. Lungs maldevelopment 145. A 37-year-old patient complains of pain
E. Diffuse pulmonary fibrosis in the lumbar spine, which increases during
141. A 41-year-old patient with Addi- walking, limited mobility, edema of the right si-
son’s disease had influenza. After that he de of abdomen. Focal tuberculosis is recorded
developed adynamia, depression, nausea, in the anamnesis. X-ray shows destruction
vomiting, diarrhea and hypoglycemia. BP of adjacent surfaces of the bodies of the 1-
is 75/50 mm Hg. Blood test: decreased 2 lumbar vertebrae, vertebral bodies height
content of corticosterone, hydrocortisone, is decreased, intervertebral fissure cannot be
13-oxycorticosteroids, 17-oxycorticosteroids. detected. Abdominal US reveals a growth
What condition has developed in the patient? 15x20 cm in size in the retroperitoneal space
and echo signs of liquid. What diagnosis can be
A. Acute adrenal gland insufficiency suspected?
B. Acute gastritis
C. Acute enterocolitis A. Lumbar tuberculous spondylitis
D. Collapse B. Fracture of the 1-2 lumbar vertebrae body
E. Diabetes mellitus C. Metastatic damage of vertebral column
D. Lumbar spondylolisthesis
142. After a contact with chemicals a plant E. Osteochondrosis
worker has suddenly developed stridor, voi-
ce hoarseness, barking cough, progressi- 146. A 45-year-old patient (14-year-long work
ng dyspnea. Objective examination reveals record as a house painter) upon the contact
acrocyanosis. What is your provisional di- with synthetic paint develops skin reddeni-
agnosis? ng, edema, severe itching and oozing lesions
on her face. Symptoms disappear after the
A. Laryngeal edema contact with this chemical substance stops
B. Laryngeal carcinoma but even the smell of paint alone is enough
C. PATE to make them reappear each time. Each
D. Pulmonary atelectasis recurrence is characterised by increased severi-
E. Pneumothorax ty of symptoms. What provisional diagnosis can
be made?
143. A 58-year-old patient complains of general
weakness, weight loss up to 10 kg within the
last 1,5 months, progressive pain in the small
of the back, raise of blood pressure to 220/160
mm Hg, subfebrile body temperature. Objecti-
Крок 2 Medicine (англомовний варiант, iноземнi студенти) 2015 рiк 18
A. Latent A. Echocardiography
B. Active B. Electrocardiography
C. Slowing-down C. X-ray
D. Physiological preliminary period D. Phonocardiography
E. Primary uterine inertia E. Rheography
155. A 23-year-old woman after stress has 159. A 64-year-old patient has been hospitali-
developed thirst, polydipsia, polyuria, weight sed with complaints of progressive jaundice
loss, increasing fatigue. Later she developed that developed over 3 weeks ago without pain
nausea and somnolence, lost consciousness syndrome, general weakness, loss of appetite.
and was hospitalised. Glycemia is 27 mmol/l, Objectively: temperature is 36, 8o C , heart rate
acetone in urine is sharply positive. Treatment is 78/min, abdomen is soft and painless, peri-
for ketoacidotic coma was initiated. When toneum irritation symptoms are not detected,
would it be advisable to start preventive palpation reveals sharply enlarged tense
treatment of hypoglycemia by introduction of gallbladder. What disease can be characteri-
5% glucose solution? sed with these symptoms?
A. After glycemia rate drops to 13-14 mmol/l A. Cancer of pancreas head
B. 2 hours after beginning of insulinotherapy B. Duodenal ulcer
C. When patient becomes conscious C. Acute cholecystitis
D. After glycemia rate becomes normal D. Chronic cholecystitis
E. If glycemia decreases with the rate over 5 E. Cholecystitis caused by lambliasis
mmol/l per hour
160. A 22-year-old woman on a reduced diet,
156. A 53-year-old woman complains of weight vegetarian, attended a hospital with complai-
loss up to 10 kg within the last 2 years, liquid nts of distorted smell and taste perception and
foul-smelling stool two times a day that poorly lesions in the angles of her mouth. Objecti-
washes off the toilet, periodic bouts of nausea, vely: sclera is distinctly blue. Diagnosis: iron-
girdle pain in the upper abdomen. Objecti- deficiency anemia. What clinical syndrome is
vely: pain in Gubergrits zone (on the right from expressed primarily?
navel) and Mayo-Robson’s point. Biochemical
blood analysis: glucose - 3,2 mmol/l, bilirubin - A. Sideropenic
16,5 micromole/l, crude protein - 56,4 g/l. Urine B. Anemic
diastase - 426 g/h/l. D-xylose test (oral admi- C. Hemorrhagic
D. Hemolytic
nistration of 25 g of d-xylose) after 5 hours E. Myelodysplasic
reveals 3 g of xylose in urine. The most likely
diagnosis is: 161. A 15-year-old patient complains of
excessive body weight, headache, irritability,
A. Pancreatitis. Malabsorption syndrome rapid fatigability. Significant increase of body
B. Pseudomembranous colitis weight occurred at the age of 14. Objectively:
C. Nonspecific ulcerative colitis weight is 90 kg; height is 160 sm, proportional
D. Irritable bowel syndrome body built. Fatty tissue is distributed evenly.
E. Chronic gastritis
There are thin pink striae (stretch marks) on
157. A 23-year-old patient after intake of brake the thighs, abdomen and mammary glands. BP
fluid has developed anuria that has been lasting - 145/90 mm Hg. Provisional diagnosis is:
for 5 days already. Creatinine level increased up
to 0,769 mmol/l. What treatment tactics should A. Pubertate dyspituitarism
be chosen in the given case? B. Alimentary constitutive obesity
C. Somatoform autonomic dysfunction
A. Hemodialysis D. Itsenko-Cushing’s disease
B. Detoxification therapy E. Cushing’s syndrome
C. Antidotal therapy
D. Diuretics 162. A 6-year-old girl attended a general practi-
E. Plasmapheresis tioner with her mother. The child complains
of burning pain and itching in her external
158. A 15-year-old teenager has undergone genitalia. The girl was taking antibiotics the
medical examination in military recruitment day before due to her suffering from acute
center. The following was revealed: interval bronchitis. On examination: external genitalia
systolic murmur at the cardiac apex, accent are swollen, hyperemic, there is white deposit
of the II heart sound over the pulmonary accumulated in the folds. The most likely di-
artery, tachycardia. What additional examinati- agnosis is:
on method will be the most informative for
determining diagnosis? A. Candidal vulvovaginitis
B. Trichomoniasis
C. Nonspecific vulvitis
D. Helminthic invasion
E. Herpes vulvitis
163. A 44-year-old man complains of dyspnea
Крок 2 Medicine (англомовний варiант, iноземнi студенти) 2015 рiк 20
with sensation of lack of air on inhale, palpi- are detected, the skin covering them is bluish-
tations occurring during slight physical exerti- red in colour. Some nodules have fistulous
on, and shin edemas that appear in eveni- openings producing thick purulent mass. Body
ng and resolve in morning. His condition has temperature is 38, 5O c, general malaise. The
been lasting for 5 months already, deteriorati- most likely diagnosis is:
on is gradual. What method of instrumental
diagnostics allows to verify decrease of systolic A. Hydradenitis
function in this patient? B. Carbuncle
C. Cutaneous tuberculosis
A. Echocardiography D. Necrotizing ulcerative trichophytosis
B. Electrocardiography E. Pyoderma chancriformis
C. Computed tomogram
D. Phonocardiography 168. A patient complains of weight gain, chill,
E. Holter blood pressure monitoring edemas, xeroderma, somnolence, difficulties
with focusing. Objectively: height is 165 cm;
164. When playing in a kindergarten a 3- weight is 90 kg; body proportions are of female
year-old child sudenly developed dyspnea, type, to - 35, 8o C , heart rate - 58/min, BP -
paroxysmal compulsive dry cough. The face 105/60 mm Hg. Heart sounds are weakened,
is cyanotic, the eyes are tearful. Vomiting bradycardia is observed. Other internal organs
occurred several times. Breathing is weakened have no changes. Thyroid gland cannot be
over the whole right side of the chest. The palpated. Milk secretion from mammary
provisional diagnosis is: glands is observed. Hormone investigation
revealed increased levels of thyroid-stimulating
A. Foreign body
B. Obstructive bronchitis hormone (TSH) and prolactin, and decreased
C. Bronchial asthma level of thyroxine (T4). Which one is the cause
D. Hysteria fit for obesity?
E. Stenosing laryngotracheitis A. Primary hypothyroidism
165. A patient with otopyosis is in sharply B. Secondary hypothyroidism
deteriorating condition: he developed C. Prolactinoma
headache, vomiting, febrile temperature, D. Hypopituitarism
general hyperesthesia. Meningeal symptoms E. Adiposogenital dystrophy
and stagnant optic disks are observed. There 169. A 54-year-old patient complains of
is no focal symptoms. Liquor is turbid, blood weakness, jaundice, itching skin. Disease onset
pressure is high, albuminocytological dissoci- was 1,5 months ago: fever up to 39o C appeared
ation occurs with neutrophils. What disease at first, with progressive jaundice developed 2
can be suspected? weeks later. On hospitalisation jaundice was
A. Secondary purulent meningitis severely progressed. Liver cannot be palpated.
B. Meningoencephalitis Gallbladder is enlarged and painless. Blood
C. Serous meningitis bilirubin is 190 micromole/l (accounting for
D. Primary purulent meningitis direct bilirubin). Stool is acholic. What is the
E. Subarachnoid hemorrhage most likely jaundice genesis in this patient?
the left mammary gland. Body temperature is 183. A 70-year-old patient consulted a doctor
38, 8o C , Ps- 94 bpm. The left mammary gland is about arrhythmic cardiac activity, dyspnea.
edematic, the supero-external quadrant of skin Objectively: BP - 150/90 mm Hg, extrasystole
is hyperemic. Fluctuation symptom is absent. arrhythmia (10-12 beats per minute), left
The nipples discharge drops of milk when ventricular systolic dysfunction (ejection fracti-
pressed. What is a doctor’s further tactics? on at the rate of 42%). Which of anti-
arrhythmic drugs should be administered as
A. Antibiotic therapy, immobilization and initial therapy in this case?
expression of breast milk
B. Compress to both mammary glands A. Amiodarone
C. Inhibition of lactation B. Flecainide
D. Physiotherapy C. Encainide
E. Opening of the abscess and drainage of the D. Moracizine
mammary gland E. Digoxin
180. An 8-year-old child was hospitalized 184. A 45-year-old male patient complains of
for fever up to 39, 8o C , inertness, moderate acute pain in his right side irradiating to the
headache, vomiting. Examination revealed right thigh and crotch. The patient claims also
meningeal symptoms. Lumbar puncture was to have frequent urination with urine which
performed. The obtained fluid had raised resembles a "meat slops"in color. The patient
opening pressure, it was transparent, with has no previous history of this condition. There
the cell count of 450 cells per 1 mcL (mai- is costovertebral angle tenderness on the right
nly lymphocytes - 90%), glucose level of 2,6 (positive Pasternatsky’s symptom). What is the
mmol/l. What causative agent might have most likely diagnosis?
caused the disease in the child?
A. Urolithiasis
A. Enterovirus B. Acute appendicitis
B. Meningococcus C. Acute pyelonephritis
C. Koch’s bacillus D. Acute cholecystitis. Renal colic
D. Staphylococcus E. Acute pancreatitis
E. Pneumococcus
185. A 38-year-old man works within the
181. A 25-year-old patient during self- range of ionizing radiation. At a routine medi-
examination detected a tumor in the upper cal examination he presents no problems. In
external quadrant of the right mammary gland. blood: RBCs - 4, 5 · 1012 /l, Hb- 80 g/l, WBCs -
On palpation: painless, dense, mobile growth 2
cm in diameter is detected in the mammary 2, 8 · 109 /l, thrombocytes - 30 · 109 /l. Decide if
gland; no changes in the peripheral lymph this person can work with sources of ionizing
nodes are observed. On mammary glands US: radiation:
in the upper external quadrant of the right A. Working with radioactive substances and
mammary gland there is a space-occupying other sources of ionizing radiation is contraindi-
lesion of increased echogenicity 21х18 mm in cated
size. The most likely diagnosis is: B. The patient is allowed to work with radioacti-
A. Fibrous adenoma ve substances
B. Lacteal cyst C. The patient can only work with radioactive
C. Diffuse mastopathy substances of low activity
D. Breast cancer D. The patient can be allowed to work after an
E. Mastitis extended medical examination
E. The patient is allowed to work with radioacti-
182. A 20-year-old woman complains of feeling ve substances for the limited period of time
of air shortage, lingering dull pain in the heart
area, irritability. Objectively: general condition 186. A maternity patient breastfeeding for 1,5
is satisfactory, heart rate lability, BP is 130/60 weeks has attended a doctor. She considers
mm Hg. ECG reveals disruption of repolari- the onset of her disease to be when proporti-
zation proceses. The patient is diagnosed with onal breast engorgement occurred. Mammary
somatoform autonomic dysfunction of cardi- glands are painful. Body temperature is
al type. Specify the conditions of the patient 36, 6o C . Expression of breast milk is hindered.
treatment: The most likely diagnosis is:
ld had tonsillitis 3 weeks ago. The knee joi- ultrastructural change of ciliated epithelium.
nts are swollen, local raise of temperature is What is the basis of the given syndrome?
observed, mobility is reduced. Heart sounds
are weakened, extrasystole is present; at the A. Primary ciliary diskinesia
cardiac apex systolic noise can be auscultated, B. Proteoglycans insufficiency
which is not conducted to the left axillary regi- C. Surfactant deficit
on. ESR is 38 mm/h. CRP 2+. Antistreptolysin- D. Muscle cells atony
O titers are 400. The most likely disease is: E. Alpha-1-antitrypsin deficiency
A. Acute rheumatic fever 192. A newborn infant (the first labor, lasted
B. Somatoform autonomic dysfunction for 26 hours) is 1-day-old, postmature; body
C. Non-rheumatic carditis weight is 3850 g; body length is 52 cm. Deli-
D. Juvenile rheumatoid arthritis very was performed by applying obstetrical
E. Reactive arthritis forceps in sincipital presentation, Apgar score
is 1/3. The face is bluish-pale. The head is
188. A 60-year-old man has a diet consisting of thrown back; severe birth trauma is present; the
unvaried food staples: mostly cereals, potato, infant is excitable, shrill "cerebral scream"is
pasta; few vegetables and little fats (especially present; the eyes are half-open; facial expressi-
animal fats). During medical examination he on is attentive; hyperesthesia, hypersthenia and
complains of deterioration of his twilight visi- readiness for convulsions are present. Liquor
on. This condition can be caused by lack of: has high content of erythrocytes, lymphocytic
cytosis occurs. The most likely diagnosis is:
A. Retinol
B. Amino acids A. Subarachnoid hemorrhage
C. Fats B. Epidural hemorrhage
D. Calcium C. Subdural hemorrhage
E. Carbohydrates D. Intraventricular hemorrhage
E. Intracerebral hemorrhage
189. A 45-year-old patient was hospitalised
in surgical in-patient unit with intermuscular 193. A 74-year-old patient visited a urologist
phlegmon of the right thigh on the 6th day from with complaints of pain above the pubis and
the onset of disease. Abscess formed under the inability to urinate for 8 hours. At home he
fascia lata was diagnosed, lanced and widely had taken antispasmodics and had a warm bath
drained, necrotic tissues were removed. Anti- but no improvement occurred. Objectively:
biotic therapy with cephalosporines and the abdomen is soft and painful above the pubis;
III generation fluoroquinolones was prescri- dullness of percussion sound is observed above
bed, as well as immune corrective and detoxifi- the pubis. Murphy’s (Pasternatski’s) punch sign
cation infusion therapy (2,5 liters per day), di- is negative on the both sides. What condition
uresis stimulation, UV irradiation of blood and does the patient have?
plasmapheresis. What is the main component
of sepsis prevention? A. Acute urinary retention
B. Paradoxal ischuria
A. Surgical invasion C. Shronic urinary retention
B. General antibiotic therapy D. Anuria
C. Topical antibiotic therapy E. Oliguria
D. Immune correction therapy
E. Detoxification therapy 194. A 37-year-old patient has been undergoing
treatment of diskogenic lumbosacral radiculitis
190. An Rh-negative woman with 32-week- for a month. There is skin numbness observed
long term of pregnancy has been exami- at the lateral surface of the right lower extremi-
ned. It was observed that Rh-antibodies ti- ty, Achilles jerk is absent. MRI of lumbar spine
ter had increased four times within the last revealed intervertebral disk L5 -S1 prolapse up
2 weeks and was 1:64. First two pregnancies to 8 mm. Choose the further tactics for patient
ended in antenatal death of fetus caused by treatment:
hemolytic disease. What tactics of pregnancy
management should be chosen? A. Surgical extraction of intervertebral disk
B. Conservative treatment
A. Preterm delivery C. Stabilizing spinal surgery
B. Delivery at 37 weeks term D. Corset
C. Rh-antibody test in 2 weeks; if Rh-antibodies E. Manual therapy
increase in number conduct delivery
D. Introduction of anti-Rh immunoglobulin 195. A 40-year-old patient complains of
E. US examination to determine signs of fetal constant moderate pain in the lumbar spine
erythroblastosis and significantly reduced mobility. The pati-
ent has been suffering from this condition for
191. A 2-year-old child has been suffering the last 7 years since pain appeared first in the
since birth from recurring inflammatory di- sacrum area. X-ray: ankylosis of sacroiliac arti-
seases of lungs, purulent pansinusites, heari- culation, significant narrowing of intervertebral
ng deterioration, multiple cylindrical bronchi- joint fissures of lumbar vertebrae and calcifi-
ectases. Dextrocardia is observed. On biopsy: cation of spinal ligaments. What pathology is
Крок 2 Medicine (англомовний варiант, iноземнi студенти) 2015 рiк 24
most likely to cause such X-ray image? 198. A 30-year-old woman complains of
irregular copious painful menstruations, pain
A. Ankylosing spondylitis irradiates to the rectum. Anamnesis states 10-
B. Spinal tuberculosis year-long infertility. On bimanual examination:
C. Spinal osteochondrosis uterus is of normal size; uterine appendages
D. Vertebral osteochondropathy on the both sides are corded, with rectricted
E. Rheumatoid arthritis mobility, painful; there are dense nodular pai-
nful growths detected in the posterior fornix. A
196. A 7-year-old child became ill again 2 doctor suspects endometriosis. What method
weeks after he had tonsillitis. There are the allows to verify this diagnosis?
following complaints: temperature rise up to
38o C , hemorrhagic rash on the extremities, A. Laparoscopy
enlargement of the ankle joints. Blood test: B. Diagnostic curettage of uterine cavity
hemoglobin is 120 g/l, platelets are 170 · 109 /l, C. Paracentesis of posterior fornix
ESR is 30 mm/h. Urine test: proteinuria up D. Uterine probing
to 0,7 g/l, cylinders - 5-6 in the field of visi- E. Hysteroscopy
on, erythrocytes - 8-10 in the field of vision.
What mechanism of hemorrhagic syndrome is 199. A 14-year-old girl complains of tooth
present in the given case? caries; the tooth should be filled. Anamnesis
states that artificial mitral valve was installed 2
A. Vessel wall damage caused by immune years ago due to mitral insifficiency. What anti-
complexes bacterial drug should be prescribed to prevent
B. Platelet dysfunction infective endocarditis?
C. Suppression of hematopoietic stem cells
D. Decrease of adhesive-aggregative function A. Amoxicillin
of platelets B. Lincomycin
E. Vessel wall damage caused by bacteria C. Ceftriaxone
D. Erythromycin
197. A 48-year-old patient was delivered to a E. Midecamycin
hospital in-patient unit with uterine bleeding
that occurred after the 2-week-long delay of 200. A 30-year-old woman complains of inferti-
menstruation. Anamnesis states single birth. lity during her 10-year-long married life.
Examination of the uterine cervix with mirrors Menstruations occur since she was 14 and are
revealed no pathologies. On bimanual exami- irregular, with delays up to a month and longer.
nation: uterus is of normal size, painless, mobi- Body mass is excessive. Hirsutism is observed.
le; uterine appendages have no changes. Di- On bimanual examination: uterine body is
scharge is bloody and copious. What primary decreased in size; ovaries are increased in si-
hemostatic measure should be taken in the gi- ze, dense, painless, and mobile. The most likely
ven case? diagnosis is:
A. Fractional curettage of uterine cavity A. Stein–Leventhal syndrome (Polycystic ovary
B. Hormonal hemostasis syndrome)
C. Hemostatics B. Follicular cyst of ovaries
D. Uterine tamponade C. Genital endometriosis
E. Uterotonics D. Genital tuberculosis
E. Inflammatory tumor of ovaries
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