Krok 2- 2009 (General Medicine) (t.

me/krok2GeneralMedicine) - 1

She got blood and blood substitute transfusions. What is

Krok 2- 2009 (General Medicine)
the most probable diagnosis?
1. A 42 year old woman complains of dyspnea, edema of 1. Stein-Leventhal syndrome
the legs and tachycardia during minor physical exertion.
2. Sheehan’s syndrome
Heart borders are displaced to the left and S1 is 3. Shereshevsky-Turner’s syndrome
accentuated, there is diastolic murmur on apex. The liver 4. Homological blood syndrome
is enlarged by 5 cm. What is the cause of heart failure? 5. Vegetovascular dystonia
1. Mitral stenosis
2. Mitral regurgitation
6. A 38 year old patient complains about inertness,
3. Tricuspid stenosis subfebrile temperature, enlargement of lymph nodes,
4. Aortic stenosis nasal haemorrhages, bone pain. Objectively: the patient’s
5. Tricuspid regurgitation skin and mucous membranes are pale, palpation revealed
enlarged painless lymph nodes; sternalgia; liver was
2. A 37 year old miner has lifted significant loads and
enlarged by 2 cm, spleen – by 5 cm, painless. In blood:
afterwards felt pain in the lumbar area irradiating to his left 12
erythrocytes – 2.7×10 /l, Hb- 84 g/l, leukocytes –
leg. He walks slowly and carefully. Lumbar lordosis is 9
58×10 /l, eosinophils – 1%, stab neutrophils – 2%,
flattened. There is also left-sided scoliosis and tension of segmented neutrophils – 12%, lymphocytes – 83%,
paravertebral muscles. Neri’s and Dejeri-ne’s symptoms lymphoblasts – 2%, smudge cells; ESR-57 mm/h. What is
are positive, there is Lasegue’s sign on the left from the
the most probable di-agnosis?
angle of 350. What method will help to specify the 1. Acute myeloleukemia
diagnosis? 2. Chronic myeloleukemia
1. Lumbal puncture 3. Lymphogranulomatosis
2. Electromyography 4. Chronic lymphatic leukemia
3. Renal sonography
5. Acute lymphatic leukemia
4. CT of lumbosacral part of vertebral column
5. Descending myelography 7. A 43 year old female patient was delivered to the
hospital in grave condition. She suffers from Addison’s
3. A 19 year old boy was admitted to a hospital with disease. The patient had been regularly taking
closed abdominal trauma. In course of operation multiple
prednisolone but a week before she stopped taking this
ruptures of spleen and small intestine were revealed. AP drug. Objectively: sopor, skin and visible mucous
is falling rapidly, it is necessary to perform membranes are pigmented, skin and muscle turgor is
hemotransfusion. Who can specify the patient’s blood lowered. Heart sounds are muffled, rapid. AP- 60/40 mm
group and rhesus compatibility? Hg, heart rate – 96/min. In blood: Na-120 millimole/l, K-
1. A doctor of any speciality
5.8 micromole/l. Development of this complication is
2. A laboratory physician primarily caused by the deficit of the following hormone:
3. An anaesthesilogist 1. Noradrenaline
4. A surgeon 2. Corticotropin (ACTH)
5. A traumatologist 3. Adrostendion
4. Adrenaline
4. On the 6th day of life a child got multiple vesicles filled 5. Cortisol
with seropurulent fluid in the region of occiput, neck and
buttocks. General condition of the child is normal. What 8. Immediately after delivery a woman had haemorrhage,
disease should be suspected? blood loss exceeded postpartum haemorrhage rate and
1. Epidermolysis bullosa
was progressing. There were no symptoms of placenta
2. Impetigo detachment. What tactics should be chosen?
3. Miliaria 1. Manual removal of placenta and afterbirth
4. Vesiculopustulosis 2. Removal of afterbirth by Crede’s method
5. Impetigo neonatorum 3. Intravenous injection of methylergometrine with
glucose
5. A woman consulted a therapeutist about fatigability, 4. Uterus tamponade
significant weight loss, weakness, loss of appetite. She 5. Instrumental revision of uterine cavity walls
has had amenorrhea for 8 months. A year ago she born a
full-term child. Haemorrhage during labour made up 2 l. 9. A child was born with body weight 3250 g and body
length 52 cm. At the age of 1.5 month the actual weight is
Krok 2- 2009 (General Medicine) (t.me/krok2GeneralMedicine) - 2

sufficient (4350 g), psychophysical development ESR-58/min, AP- 105/60 mm Hg. Heart sounds are
corresponds with the age. The child is breast-fed, weakened, bradycardia is present. Other internal organs
occasionally there are regurgitations. What is the cause of have no changes. Thyroid gland is not palpable.
regurgitations? Mammary glands ooze milk droplets. Hormonal study
1. Pylorostenosis revealed rise of TSH and prolactin concentration,
2. Pylorospasm reduction of T4. What factor caused obesity?
3. Esophageal atresia 1. Secondary hypothyroidism
4. Aerophagia 2. Prolactinoma
5. Acute gastroenteritis 3. Primary hypothyroidism
4. Adiposogenital dystrophy
10. A 25 year old woman applied to a maternity welfare 5. Hypopituitarism
clinic and complained about being unable to conceive
within 3 years of regular sexual life. Examination revealed 14. A 30 year old man complains of intense pain,
weight gain, male pattern of hair distribution on the pubis, reddening of skin, edema in the ankle-joint area, fever up
excessive pilosis of thighs. Ovaries were dense and to 39oC. There was an acute onset of the illness. In the
enlarged, basal temperature was monophase. What is the past there were similar attacks lasting 5-6 days without
most probable diagnosis? residual changes in the joint. The skin over the joint is
1. Adrenogenital syndrome hyperemic and ill-defined, without infiltrative bank on the
2. Premenstrual syndrome periphery. What is the most likely diagnosis?
3. Tubo-ovaritis 1. Osteoarthritis
4. Gonadal dysgenesis 2. Infectious arthritis
5. Sclerocystosis of ovaries 3. Rheumatoid arthritis
4. Erysipelatous inflammation
11. A 22 year old female patient complains about frequent 5. Gout
and painful urination, urge to urinate at night, enuresis,
pain in the suprapubic and lumbar area. Her urine often 15. A 38 year old female patient complains about body
has beer colouring. She got married a month ago. stiffness in the morning, especially in the articulations of
Objectively: general state is satisfactory. Lung her upper and lower limbs, that disappears 30-60 minutes
examination revealed vesicular respiration. Heart sounds later after active movements. She has also arthritis of
are rhythmic, heart rate is 78/min, AP- 128/68 mm Hg. metacarpophalangeal and proximal phalangeal
Abdomen is soft, painful in the suprapubic area. Urine articulations, subfebrile temperature. ESR- 45 mm/h.
contains 12-18 erythrocytes and 12-15 bacteria within Roentgenography revealed osteoporosis and erosion of
eyeshot. What is the most probable diagnosis? articular surface of small hand and foot articulations. What
1. Infection of superior urinary tracts - pyelonephritis is the most probable diagnosis?
2. Gonorrhoea 1. Psoriatic arthropathy
3. Urolithiasis 2. Osteoarthrosis deformans
4. Infection of inferior urinary tracts - cystitis 3. Reactive polyarthritis
5. Primary syphilis 4. Systemic lupus erythematosus
5. Rheumatoid arthritis
12. A 26 year old woman complains about edemata,
swelling and painfulness of mammary glands, headache, 16. A fitter of a metallurgic factory with occupational
tearfulness, irritability. These signs turn up 5 days before exposure to high concentrations of mercury fumes for 16
menstruation and disappear after its start. What clinical years presents instability of pulse and blood pressure,
syndrome is it? general hyperhydrosis, asymmetric innervations of facial
1. Stein-Leventhal syndrome muscles and tongue, positive subcortical reflexes, hand
2. Postcastration syndrome tremor on physical examination. A dentist revealed
3. Climacteric syndrome paradontosis and chronic stomatitis. What is the most
4. Adrenogenital syndrome probable diagnosis?
5. Premenstrual syndrome 1. Chronic mercury intoxication
2. Neuroinfection
13. A female patient consulted a doctor about gain in 3. Mercury encephalopathy
weight, chill, edemata, dry skin, sleepiness, problems with 4. Acute mercury intoxication
concentration. Objectively: the patient’s height is 165 cm, 5. Parkinson syndrome
weight is 90 kg, gynoid body proportions, to– 35.8oC,
Krok 2- 2009 (General Medicine) (t.me/krok2GeneralMedicine) - 3

17. A 13 year old girl was admitted to the cardiological at 32 weeks revealed: AP 140/90 mm Hg, proteinuria 1 g/l,
department because of pain in the muscles and joints. peripheral edemata. Reflexes are normal. Choose the
Examination of her face revealed an edematic erythema in most correct tactics:
form of butterfly in the region of nose bridge and cheeks. 1. Complex therapy of gestosis for 7 days
What is the most probable diagnosis? 2. Complex therapy of gestosis for 2 days
1. Systemic lupus erythematosus 3. Labour stimulation after preparation
2. Rheumatoid arthritis 4. Absolute bed rest for 1 month
3. Dermatomyositis 5. Caesarian section immediately
4. Rheumatism
5. Periarteritis nodosa 22. A 19 year old patient was admitted to a hospital with
acute destructive appendicitis. He suffers from hemophilia
18. A 25 year old patient had pharyngitis 2 weeks ago. of B type. What antihemophilic medications should be
Now he complains about body temperature rise up to included in pre- and post-operative treatment plan?
38oC, general weakness, dyspnea during walking, 1. Fresh frozen blood
swelling and shifting pain in the articulations. Objectively: 2. Native plasma
cyanosis of lips, rhythmic pulse of poor volume – 100 3. Cryoprecipitate
bpm. Left cardiac border deviates outwards from the 4. Dried plasma
mediaclavicular line by 1 cm. The first heart sound is 5. Fresh frozen plasma
weakened on the apex, auscultation revealed systolic
souffle. What is the most probable aetiological factor that 23. Student В. lives in the canalized house in the flat with
caused this pathological process? complete set of sanitary equipment (WC, bath, shower,
1. Virus local water heater). How much water consumption has he
2. Fungi got?
3. Pneumococcus 1. 10-15 l
4. β-haemolytic streptococcus 2. 160-200 l
5. Staphylococcus 3. 300-400 l
4. 50-100 l
19. A 72 year old male patient complains about itch in his 5. 500 l
left shin, especially around a trophic ulcer. Skin is
reddened and edematic, there are some oozing lesions, 24. A 68 year old female patient complains about
single yellowish crusts. The focus of affection is well- temperature rise up to 38.3oC, haematuria. ESR- 55
defined. What is the most probable diagnosis? mm/h. Antibacterial therapy turned out to be ineffective.
1. Allergic dermatitis What diagnosis might be suspected?
2. Streptococcal impetigo 1. Urolithiasis
3. Seborrheic eczema 2. Renal cancer
4. Microbial eczema 3. Renal amyloidosis
5. Cutaneous tuberculosis 4. Chronic glomerulonephritis
5. Polycystic renal disease
20. A 54 year old female patient was admitted to the
hospital with evident acrocyanosis, swollen cervical veins, 25. An 18 year old primigravida in her 27-28 week of
enlarged liver, ascites. Cardiac borders are dilated. Heart pregnancy underwent an operation on account of acute
sounds cannot be auscultated, apical beat is phlegmonous appendicitis. In the postoperative period it is
undetectable. AP is 100/50 mm Hg. X-ray picture of chest necessary to take measures for prevention of the following
shows enlarged heart shadow in form of a trapezium. pegnancy complication:
What pathology might have caused these symptoms? 1. Intestinal obstruction
1. Acute cardiac insufficiency 2. Premature placenta detachment
2. Cardiac tamponade 3. Late gestosis
3. Complex heart defect 4. Noncarrying of pregnancy
4. Exudative pleuritis 5. Fetus hypotrophy
5. Hiatal hernia
26. A 63 year old patient complained about pain in the
21. A pregnant woman in her 40th week of pregnancy lumbar area. He underwent a course of physiological
undergoes obstetric examination: the cervix of uterus is treatment on account of radiculitis but this led to no
undeveloped. The oxytocin test is negative. Examination improvement of his condition. R-graphy of spinal column
Krok 2- 2009 (General Medicine) (t.me/krok2GeneralMedicine) - 4

and pelvic bones revealed osteoporosis and serious bone 1. Thrombophlebitis of veins of the pelvis
defects. Blood analysis revealed moderate normochromic 2. Infectious hematoma
anaemia, urine analysis revealed proteinuria. Whole blood 3. Endometritis
protein made up 10.7 g/l. What disease should be 4. Infectious contamination of the urinary system
suspected? 5. Apostasis of sutures after episiotomy
1. Systemic osteoporosis
2. Urolithiasis 31. A 59 year old female patient applied to a maternity
3. Acute radiculitis welfare clinic and complained about bloody discharges
4. Myelomatosis from the genital tracts. Postmenopause is 12 years.
5. Metastases in bones Vaginal examination revealed that external genital organs
had signs of age involution, uterus cervix was not erosive,
27. A 40 year old patient was bitten by a stray dog for small amount of bloody discharges came from the cervical
about an hour ago. The bite can be seen on the patient’s canal. Uterus was of normal size, uterine appendages
left shin in form of a wound 4х2х0.5 cm large. What kind were unpalpable. Fornices were deep and painless. What
of aid would be recommended in this case? method should be applied for the diagnosis specification?
1. Salve bandage 1. Extensive colposcopy
2. Blind suture 2. Laparoscopy
3. Wound lavage with soapsuds, retension sutures 3. Culdoscopy
4. Aseptic bandage 4. Separated diagnosic curretage
5. Retension sutures 5. Puncture of abdominal cavity through posterior vaginal
fornix
28. A woman is 34 years old, it is her tenth labor at full
term. It is known from the anamnesis that the labor started 32. The amount of ultraviolet radiation dose was
11 hours ago, labor was active, painful contractions measured in minutes. What device was applied for
started after discharge of waters and became continuous. measurement of the biodose?
Suddenly the parturient got knife-like pain in the lower 1. Radiometer
abdomen and labor activity stopped. Examination 2. Actinometer
revealed positive symptoms of peritoneum irritation, ill- 3. Catathermometer
defined uterus outlines. Fetus was easily palpable, 4. Gorbachev’s biodosimeter
movable. Fetal heartbeats wasn’t auscultable. What is the 5. UV-meter
most probable diagnosis?
1. Rupture of uterus 33. A 44 year old man has been working in coke industry
2. Risk of uterus rupture for 16 years. Dust concentration at his workplace is 5-10
3. II labor period times more than maximum permissible concentration.
4. Discoordinated labor activity Roentgenography of lungs revealed changes that are
5. Uterine inertia typical for pneumoconiosis. What is the most probable
type of pneumoconiosis in this case?
29. A 41 year old woman has suffered from nonspecific 1. Anthracosis
ulcerative colitis for 5 years. On rectoromanoscopy: 2. Asbestosis
evident inflammatory process of lower intestinal parts, 3. Silicatosis
pseudopolyposive changes of mucous membrane. In 4. Siderosis
9 12
blood: WBC-9.8×10 /l, RBC- 3.0×10 /l, ESR – 52 5. Anthracosilicosis
mm/hour. What medication provides pathogenetic
treatment of this patient? 34. A 25 year old patient complains of pain in the I finger
1. Motilium on his right hand. On examination: the finger is
2. Sulfosalasine homogeneously hydropic, in bent position. On attempt to
3. Vikasolum unbend the finger the pain is getting worse. Acute pain
4. Linex appears during the probe in ligament projection. What
5. Kreon decease is the most likely?
1. Paronychia
30. A woman of a high-risk group (chronic pyelonephritis 2. Thecal whitlow (ligament panaritium)
in anamnesis) had vaginal delivery. The day after labour 3. Subcutaneous panaritium
she complained of fever and loin pains, frequent urodynia. 4. Articular (joint) panaritium
Specify the most probable complication: 5. Bone panaritium
Krok 2- 2009 (General Medicine) (t.me/krok2GeneralMedicine) - 5

4. Body length and weight, chest circumference

35. A 75 year old man who has been suffering from 5. Annual gain in body length
diabetes for the last six months was found to be
jaundiced. He was asymptomatic except for weight loss at 39. A 36 year old female patient complains about general
the rate of 10 pounds in 6 months. Physical examination weakness, edemata of her face and hands, rapid
revealed a hard, globular, right upper quadrant mass that fatigability during walking, difficult diglutition, cardiac
moves during respiration. A CT scan shows enlargement irregularities. These symptoms turned up 11 days after
of the head of the pancreas, with no filling defects in the holi-day at the seaside. Objectively: face erythema,
liver. The most likely diagnosis is: edema of shin muscles. Heart sounds are muffled, AP is
1. Metastatic disease of liver 100/70 mm Hg. In blood: ASAT activity is 0.95
2. Malignant biliary stricture millimole/h·l, ALAT – 1.3 micromole/h·l, aldolase – 9.2
3. Haemolytic jaundice IU/l, creatine phosphoki-nase – 2.5 micromole Р/g·l. What
4. Infectious hepatitis method of study would be the most specific?
5. Carcinoma of the head of the pancreas 1. Determination of cortisol concentrati-on in blood and
urine
36. A 52 year old patient complains about headache, 2. Electromyography
weakness of his upper left extremity. Neurological 3. Echocardiogram
symptoms become more intense during physical stress of 4. Muscle biopsy
the left extremity. Pulsation on the arteries of the left 5. ECG
extremity is sharply dampened but it remains unchanged
on the carotid arteries. What is the most probable 40. A child is 1 day old. During delivery there had been
diagnosis? problems with extraction of shoulders. Body weight is
1. Occlusion of the left subclavicular artery, steal 4300 g. Right arm hangs down along the body, hand is
syndrome pronated, movement in the arm is absent. “Scarf”symptom
2. Thoracal outlet syndrome is positive. What is the most probable diagnosis?
3. Raynaud’s syndrome 1. Hemiparesis
4. Occlusion of brachiocephalic trunk 2. Distal right-sided obstetric paralysis
5. Takayasu’s disease 3. Total right-sided obstetric paralysis
4. Tetraparesis
37. On the 5th day after labor body temperature of a 5. Proximal right-sided obstetric paralysis
parturient suddenly rose up to 38.7oC. She complains
about weakness, headache, abdominal pain, irritability. 41. A 70 year old man is suffering from coronary heart
Objectively: AP- 120/70 mm Hg, Ps- 92 bpm, to– 38.7oC. disease. His mood is evidently depressed, anxious. As a
Bimanual examination revealed that the uterus was result of continious sleeplessness he has got fears,
enlarged up to 12 weeks of pregnancy, it was dense, suicidal thoughts. He would sit for a long time in the same
slightly painful on palpation. Cervical canal lets in 2 pose, answer after a pause, in a low, monotonous voice.
transverse fingers, discharges are moderate, turbid, with His face has a look of suffering, pain, fear. What is the
foul smell. In blood: skeocytosis, lymphopenia, ESR- 30 main psychopathologic syndrome?
mm/h. What is the most probable diagnosis? 1. Phobic syndrome
1. Metrophlebitis 2. Depressive syndrome
2. Lochiometra 3. Paranoid syndrome
3. Pelviperitonitis 4. Asthenic syndrome
4. Parametritis 5. Obsessive syndrome
5. Endometritis
42. A 52 year old male patient complains about attacks of
38. Estimation of physical development of a child involved asphyxia, pain in his left side during respiration. These
dynamometry and estimation of body weight and length, manifestations turned up all of a sudden. It is known from
annual gain in body length, chest circumference, number his anamnesis that he had been treated for
of permanent teeth, secondary sexual characters, lung thrombophlebitis of the right leg for the last month. In the
vital capacity. Which of the mentioned indices relates to admission ward the patient suddenly lost consciousness,
the physiometric ones? there was a sudden attack of asphyxia and pain in his left
1. Number of permanent teeth side. Objectively: heart rate – 102/min, respiratory rate –
2. Secondary sexual characters 28/min, AP- 90/70 mm Hg. Auscultation revealed diastolic
3. Lung vital capacity, dynamometry shock above the pulmonary artery, gallop rhythm, small
Krok 2- 2009 (General Medicine) (t.me/krok2GeneralMedicine) - 6

bubbling rales above the lungs under the scapula on the 46. A 4 year old girl was playing with her toys and
right, pleural friction rub. What examination method will be suddenly she got an attack of cough, dyspnea.
the most informative for a diagnosis? Objectively: respiration rate – 45/min, heart rate –
1. ECG 130/min. Percussion revealed dullness of percutory sound
2. Study of external respiration function on the right in the lower parts. Auscultation revealed
3. Angiography of pulmonary vessels diminished breath sounds with bronchial resonance on the
4. Coagulogram right. X-ray picture showed shadowing of the lower part of
5. Echocardioscopy lungs on the right. Blood analysis revealed no signs of
inflammation. The child was diagnosed with foreign body
43. A 37 year old male patient was admitted to the in the right bronchus. What compli-cation caused such
resuscitation department because of attacks of tonoclonic clinical presentations?
spasms repeating every half an hour. Between the attacks 1. Emphysema
the patient remains unconscious. AP is 120/90 mm Hg, 2. Bronchitis
Ps- 100 bpm. A day before the patient was at wedding 3. Pneumothorax
and consumed alcohol. 5 years ago he had a closed 4. Pneumonia
craniocerebral trauma and brain contusion that later 5. Atelectasis
caused single convulsive attacks accompanied by loss of
consciousness, but the patient didn’t undergo antiepileptic 47. A 38 year old man, previously in good health,
treatment. What drug should be injected for emergency suddenly develops severe abdominal pain radiating from
aid? the left loin to groin and accompanied by nausea,
1. Aminazine perspiration and the need for frequent urination. He is
2. Magnesium sulfate restless, tossing in bed but has no abnormal findings. The
3. Diazepam most likely diagnosis is:
4. Sodium thiopental 1. Retroperitoneal haemorrhage
5. Sodium oxybutyrate 2. Torsion of the left testicle
3. Sigmoid diverticulitis
44. An infant is full-term. Delivery was pathological, with 4. Leftsided renal colic
breech presentation. Examination of the infant revealed 5. Herpes zoster
limited abduction of the right leg to 50o, positive
“clicking”symptom on the right, asymmetric inguinal folds. 48. In order to study impact of micro climate upon the
What is the most probable diagnosis? human organism it is necessary to make systematic
1. Inborn dislocation of both hips observation of air temperature over 3 days. Choose a
2. Varus deformity of both femoral necks device that will allow to make the most precise
3. Inborn dislocation of the right hip temperature records:
4. Fracture of both femoral necks 1. Mercury thermometer
5. Right hip dysplasia 2. Thermograph
3. Assmann psychrometer
45. A 34 year old patient was delivered to the hospital 4. August’s psychrometer
because of follicular tonsillitis characterized by high 5. Alcohol thermometer
temperature. The patient has been abusing alcohol for 12
years. In the evening on the day of hospitalization he 49. Indicate the registration medical document for the
became anxious, couldn’t stay in bed, left his ward several patient, who 21.02. was addressed to the doctor with
times and applied to the staff on duty with different diagnosis ARVD for the first time in this year:
complaints. He reported about seeing alot of spiders and 1. The statistical coupon is to be filled in, but a sign (+) is
flies in his ward as well as about hearing threats from the not necessary to be put in
corridor. He was exasperated by the fact that other 2. The statistical coupon for registration of final diagnosis
patients didn’t hear them. He lost also spatial orientation. is not necessary
What psychopathological syndrome is it? 3. The statistical coupon is to be filled in and it is
1. Twilight state necessary to deliver on a sign (+)
2. Delirious 4. It is necessary to fill in the emergency notice on a case
3. Asthenic confusion of a contagion
4. Oneiric 5. The necessary registration form is not indicated
5. Amentive
Krok 2- 2009 (General Medicine) (t.me/krok2GeneralMedicine) - 7

50. A 10 year old boy complains about pain in his left eye 54. A 14 year old girl complains of profuse bloody
and strong photophobia after he had injured his left eye discharges from genital tracts during 10 days after
with a pencil at school. Left eye examination: suppresion of menses for 1.5 month. Similiar bleedings
blepharospasm, ciliary and conjunctival congestion, recur since 12 years on the background of disordered
cornea is transparent, other parts of eyeball have no menstrual cycle. On rectal examination: no pathology of
changes. Visus 0.9. Right eye is healthy, Visus 1.0. What the internal genitalia. In blood: Нb – 70 g/l, RBC-
12
additional method would you choose first of all? 2.3×10 /l, Ht – 20. What is the most probable diagnosis?
1. Gonioscopia 1. Polycyst ovarian syndrome
2. Tonometria 2. Juvenile bleeding, posthemorrhagic anemia
3. Cornea sensation-test 3. Incomplete spontaneous abortion
4. Staining test with 1% fluorescein 4. Werlholf’s disease
5. X-ray examination of orbit 5. Hormonoproductive ovary tumor

51.A woman complains of having slight dark bloody 55. A nine year old child is at a hospital with acute
discharges and mild pains in the lower part of abdomen glomerulonephritis. Clinical and laboratory examinations
for several days. Last menses were 7 weeks ago. The show acute condition. What nutrients must not be limited
pregnancy test is positive. Bimanual investigation: the during the acute period of glomerulonephritis?
body of the uterus indicates for about 5-6 weeks of 1. Salt
pregnancy, it is soft, painless. In the left appendage there 2. Liquid
is a retort-like formation, 7х5 cm large, mobile, painless. 3. Carbohydrates
What examination is necessary for detection of fetus 4. Proteins
localization? 5. Fats
1. Cystoscopy
2. Ultrasound 56. A 22 year old woman complained of right subcostal
3. Hromohydrotubation aching pain, nausea, and decreased appetite. She fell ill 2
4. Colposcopy months after appendectomy when jaundice appeared. She
5. Hysteroscopy was treated in an infectious hospital. 1 year later above
mentioned symptoms developed. On exam: the subicteric
52. A 4 month old child fell seriously ill: body temperature sclerae, enlarged firm liver. Your preliminary diagnosis:
rose up to 38.5oC, the child became inert and had a single 1. Gilbert’s disease
vomiting. 10 hours later there appeared rash over the 2. Acute viral hepatitis
buttocks and lower limbs in form of petechiae, spots and 3. Chronic cholangitis
papules. Some haemorrhagic elements have necrosis in 4. Calculous cholecystitis
the centre. What is the most probable disease? 5. Chronic viral hepatitis
1. Rubella
2. Influenza 57. A 9 year old boy had acute respiratory viral infection.
3. Meningococcemia After it there appeared polydipsia, polyuria, weakness,
4. Haemorrhagic vasculitis nausea. Examination revealed the following symptoms:
5. Scarlet fever mental confusion, dry skin, soft eyeballs, Kussmaul’s
respiration, acetone smell from the mouth, muffled heart
53. A 67 year old female patient complains about edemata sounds, soft and painless abdomen. Blood sugar was 19
of face and legs, pain in the lumbar area that is getting millimole/l. What acute condition is it?
worse at moving; great weakness, sometimes nasal 1. Acute renal insufficiency
haemorrhages, rise of body temperature up to 38.4oC. 2. Hyperosmolar coma
Objecti-vely: painfulness of vertebral column and ribs on 3. Cerebral coma
palpation. Laboratorial study revealed daily proteinuria of 4. Ketoacidotic coma
4.2 g, ESR-52 mm/h. What changes of laboratory indices 5. Hepatic coma
are to be expected?
1. Whole protein of blood serum - 101 g/l 58. A 3 year old child with weight deficiency suffers from
2. γ-globulins - 14% permanent moi-st cough. In history there are some
3. Leukocytes - 15.3 g/l pneumonias with obstruction. On examination: distended
4. Albumins - 65% chest, dullness on percussion over the lower parts of
5. Haemoglobin - 165 g/l lungs. On auscultation: a great number of different rales.
Krok 2- 2009 (General Medicine) (t.me/krok2GeneralMedicine) - 8

Level of sweat chloride is 80 millimol/l. What is the most Frontal folds are flattened. Left eye is wider than right one
probable diagnosis? and doesn’t close. Left nasolabial fold is flattened, mouth
1. Bronchiectasis corner is lowered. Examination revealed no other
9
2. Recurrent bronchitis pathology. Blood count: leukocytes – 10×10 /l, ESR – 20
3. Bronchial asthma mm/h. What is the most probable diagnosis?
4. Mucoviscidosis (cystic fibrosis) 1. Trigeminus neuralgia
5. Pulmonary hypoplasia 2. Hemicrania (migraine)
3. Facial neuritis
59. The most available and informative diagnostic method 4. Ischemic stroke
for closed trauma of the urinary bladder is: 5. Brain tumour
1. Retrograde cystography
2. Sonography of the urinary bladder 64. Examination of a 12 year old child revealed diffuse
3. Cystography thyroid enlargement of the II degree. Heart auscultation
4. Palpation and percussion of abdomen revealed dullness of heart sounds, heart rate was 64/min.
5. Pelvic arteriography The child has frequent constipations, anemia.
Concentration of thyreoglobulin antibodies is increased.
60. Examination of a 26 year old female patient revealed a What disease might have caused such symptoms?
node in the right lobe of thyroid gland. The node appeared 1. Autoimmune thyroiditis
no earlier than 3 months ago. The patient associates this 2. Thyroid hyperplasia
node with stress. She doesn’t complain either about pain 3. Diffuse toxic goiter
or enlargement of the node. Ultrasonic scanning revealed 4. Endemic goiter
a 2×2.5 cm large node in the inferior part of the right lobe 5. Thyroid carcinoma
of thyroid gland. What treatment should be administered?
1. Dynamic observation 65. A healthy 75 year old woman who leads a moderately
2. Conservative therapy active way of life went through a preventive examination
3. Surgical intervention that revealed serum concentration of common cholesterol
4. No need for treatment at the rate of 5.1 millimole/l and HDL (high-density
lipoproteins) cholesterol at the rate of 70 mg/dl. ECG
61. A 47 year old male patient got a flame burn of trunk reveals no pathology. What dietary recommendation is the
and upper extremities and was delivered to the hospital. most adequate?
The patient is in grave condition, confused mental state, 1. Decrease of cholesterol consumption
with fever. AP- 80/50 mm Hg, Ps- 118 bpm. It was locally 2. Decrease of carbohydrates consumption
stated that the patient got III B degree burns with total 3. Increase of cellulose consumption
area of 20%. What medical actions should be taken? 4. Decrease of saturated fats consumption
1. Primary surgical pocessing 5. Any dietary changes are necessary
2. Administration of detoxicating blood substitutes
3. Injection of narcotic analgetics and powdered blood 66. A 62 year old patient complains of rest dyspnea, heart
substitutes pains. 3 years ago he had myocardial infarction. Physical
4. Necrotomy of burn surface, haemotransfusion examination: orthopnea, acrocyanosis, swollen cervical
5. Antibacterial and detoxicating therapy veins. Ps – 92, total heart enlargement, the liver is
enlarged by 7 cm, shin edema. What is the stage of
62. A 14 year old child suffers from vegetovascular chronic heart failure (CHF)?
dystonia of pubertal period. He has got sympathoadrenal 1. CHF- 1
atack. What medicine should be used for attack 2. CHF- 2 А
reduction? 3. CHF- 3
1. No-shpa 4. CHF- 2 B
2. Amysyl 5. CHF- 0
3. Aminophylline
4. Corglicone 67. Which of the methods of examination is the most
5. Obsidan informative in the diagnostics of a tube infertility?
1. Hysterosalpingography
63. A 52 year old woman complains about face distortion. 2. Pertubation
It turned up 2 days ago after supercooling. Objectively: 3. Bicontrast pelviography
body temperature is 38.2oC. Face asymmetry is present. 4. Laparoscopy with chromosalpingoscopy
Krok 2- 2009 (General Medicine) (t.me/krok2GeneralMedicine) - 9

5. Transvaginal echography 1. Hydradenitis

2. Furuncle
68. 25 children at the age of 2-3 years who don’t attend 3. Mycosis
any child welfare institutions should be observed by a 4. Herpes zoster
district pediatrician within the current year. How many 5. Streptococcal impetigo
initial visits of this group of children should be planned?
1. 40 73. In the woman of 24 years about earlier normal
2. 50 menstrual function, cycles became irregular, according to
3. 200 tests of function diagnostics – anovulatory. The contents
4. 100 of prolactin in blood is boosted. Choose the most suitable
5. 20 investigation:
1. Determination of the level of gonadotropins
69. A 28 year old woman has bursting pain in the lower 2. USI of organs of small pelvis
abdomen during menstruation; chocolate-like discharges 3. Progesterone assay
from vagina. It is known from the anamnesis that the 4. Determination of the contents of testosteron-depotum
patient suffers from chronic adnexitis. Bimanual examinati- in blood serum
on revealed a tumour-like formation of heterogenous 5. Computer tomography of the head
consistency 7х7 cm large to the left from the uterus. The
formation is restrictedly movable, painful when moved. 74. After objective clinical examination a 12 year old child
What is the most probable diagnosis? was diagnosed with mitral valve prolapse. What
1. Tumour of sigmoid colon complementary instrumental method of examination
2. Follicular cyst of the left ovary should be applied for the diagnosis confirmation?
3. Exacerbation of chronic adnexitis 1. Veloergometry
4. Endometrioid cyst of the left ovary 2. Roentgenography of chest
5. Fibromatous node 3. Echocardiography
4. ECG
70. A parturient complains about pain in the mammary 5. Phonocardiography
gland. Palpation revealed a 3х4 cm large infiltration, soft in
the centre. Body temperature is 38.5oC. What is the most 75. What guarantees against the preconceived attitude to
probable diagnosis? the physician in cases of professional law violations do
1. Pneumonia you know?
2. Acute purulent mastitis 1. Draw up a statement about forensic medical
3. Birth trauma examination
4. Pleuritis 2. Sanction of public prosecutor, inquiry by preliminary
5. Retention of milk investigator of prosecutor’s office, committee of experts
3. Conduct an inquiry by preliminary investigator of police
71. A 25 year old patient complains about weakness, department
dizziness, haemorrhagic skin rash. She has been suffering 4. Conduct forensic medical examination by district
from this for a month. Blood count: erythrocytes: forensic medicine expert
12
1.0×10 /l, Hb- 37 g/l, colour index – 0.9, leukocytes – 5. Utilisation copy of medical documents
9 9
1.2×10 /l, thrombocytes – 42×10 /l. What diagnostic
method will be the most effective? 76. A 50 year old locksmith was diagnosed with typhoid
1. Spleen biopsy fever. The patient lives in a separate apartment with all
2. Liver biopsy facilities. Apart of him there are also 2 adults in his family.
3. Sternal puncture What actions should be taken about persons
4. Coagulogram communicating with the patient?
5. Abdominal ultrasound 1. Isolation
2. Bacteriological study
72. A 23 year old patient fell ill 3 weeks ago when she 3. Dispensary observation
noticed a very painful induration in her axillary crease. 4-5 4. Vaccination
days later it burst and discharged a lot of pus. After that 5. Antibiotic prophylaxis
some new infiltrations appeared around the affected area.
The patient has never suffered from skin diseases before. 77. A 32 year old patient suffering from chronic viral
What is the most probable diagnosis? hepatitis complains about dull pain in the right subcostal
Krok 2- 2009 (General Medicine) (t.me/krok2GeneralMedicine) - 10

area, nausea, dry mouth. Objectively: liver dimensions are 4. Perforation of abdominal part of esophagus
13-21-11 cm (according to Kurlov), spleen is by 2 cm 5. Thrombosis of mesenteric vessels
enlarged, aspartate ami-notransferase is 3.2
micromole/l·h, alani-ne aminotransferase – 4.8 81. A 25 year old woman complained of edema on her
millimole/l·h. Serological study revealed HBeAg, high face and legs, rise of blood pressure up to 160/100 mm
concentration of DNA HBV . What drug should be chosen Hg and weakness. She fell ill 3 weeks after recovering
for treatment of this patient? from angina. Urinalysis data: protein of 0.5 g/l,
1. Acyclovir erythrocytes of 17-20/field, leukocytes of 2-3/field,
2. α-interferon erythrocyte casts. What treatment should be initiated after
3. Essentiale-forte specifying the diagnosis?
4. Remantadinum 1. Ceftriaxone
5. Arabinoside monophosphate 2. Dipyridamole
3. Penicillin OS
78. Examination of a 22 year old man suffering from 4. Ciprofloxacine
polyarthralgia and high fever revealed right-sided 5. Heparin
exudative pleuritis. X-ray picture showed a homogenous
shadow below the IV rib on the right. In the II segment 82. An outbreak of food poisoning was recorded in an
there were single dense focal shadows. Mantoux test with urban settlement. The illness was diagnosed as botulism
2 TU resulted in formation of a papula 16 mm large. on the grounds of clinical presentations. What foodstuffs
Pleural liquid has increased protein concentration, should be chosen for analysis in the first place in order to
Rivalta’s reaction is positive, there was also increased confirm the diagnosis?
number of leukocytes with prevailing lymphocytes. What is 1. Pasteurized milk
the most probable etiology of pleuritis? 2. Cabbage
1. Viral 3. Tinned food
2. Staphylococcal 4. Potatoes
3. Tuberculous 5. Boiled meat
4. Cancerous
5. Autoimmune 83. A patient has got pain in the axillary area, rise of
temperature developed 10 hours ago. On examination:
79. A sergeant was injured by a shell splinter in the left shaky gait is evident, the tongue is coated with white
subcostal area. He was bandaged with a first-aid pack on deposit. The pulse is frequent. The painful lymphatic
a battlefield. The patient was delivered to the regiment nodes are revealed in the axillary area. The skin over the
medical aid station. He complains about dizziness, lymph nodes is erythematous and glistering. What is the
weakness, thirst, abdominal pain. General condition is most probable diagnosis?
grave, the patient is pale. Ps is 120 bpm. Abdomen is soft, 1. Bubonic plague
painful on palpation. The bandage is well fixed but a little 2. Acute purulent lymphadenitis
bit soaked with blood. The patient should be evacuated to 3. Tularemia
the medical battalion with the following transport and in 4. Lymphogranulomatosis
the following turn: 5. Anthrax
1. With a passing car in the first turn
2. With medical vehicle in the second turn 84. A 36 year old man was delivered to the surgical
3. With a passing car in the third turn department an hour after a road accident. His condition is
4. With medical vehicle in the first turn getting worse: respiratory insufficiency is progressing,
5. With a passing car in the second turn there are cardiac abnormalities. Clinical and
roentgenological investigations revealed mediastinal
80. 1.5 hour after start of gullet bougienage a 48 year old displacement. What process has caused this
patient suffering from corrosive stricture felt acute complication?
abdominal pain. Previously he had been suffering from 1. Subcutaneous emphysema
duodenal ulcer. Examination revealed that abdomen was 2. Open pneumothorax
very tense and painful; Ps- 110 bpm, painful sialophagia, 3. Mediastinitis
skin pallor. What is the most probable diagnosis? 4. Closed pneumothorax
1. Acute myocardium infarction 5. Valvular pneumothorax
2. Strangulation of diaphragmal hernia
3. Perforation of duodenal ulcer
Krok 2- 2009 (General Medicine) (t.me/krok2GeneralMedicine) - 11

85. A patient complained about problems with pain and

tactile sensitivity, pain in the nail bones at the end of the 90. A 23 year old female patient complains about
working day. He works at a plant with mechanical devices. periodical chill and body temperature rise up to 40oC,
What pathology can be suspected? sense of heat taking turns with profuse sweating. The
1. Vibration disease patient has had already 3 attacks that came once in two
2. Overwork symptoms days and lasted 12 hours. She has lived in Africa for the
3. Caisson disease last 2 months. Liver and spleen are enlarged. In blood:
12
4. Noise disease erythrocytes – 2.5×10 /l. What is the most probable
5. Hypovitaminosis of B1 diagnosis?
1. Spotted fever
86. A 52 year old patient has hypervolaemic type of 2. Malaria
essential hypertension. Which of the following medications 3. Haemolytic anaemia
is to be prescribed either as monotherapy or in complex 4. Leptospirosis
with other antihypertensive drugs? 5. Sepsis
1. Hypothiazid
2. Kapoten 91. A 12 year old child has the ulcer disease of stomach.
3. Clonidine What is the etiology of this disease?
4. Dibazol 1. Salmonella
5. Nifedipin 2. Lambliosis
3. Intestinal bacillus
87. Prophylactic photoroentgenography examination of a 4. Helicobacter pylory
25 year old man revealed focal shadowings of small and 5. Influenza
medium intensity with irregular contours in the 1st and 2nd
segments of the right lung. Which clinical form can be 92. A 72 year old female patient has been treated for
suspected? urolithiasis in the urological department. After atropine
1. Tuberculoma injection she got acute pain in her left eye and abrupt
2. Focal vision impairment. Objectively: visual acuity of the left eye
3. Miliary is 0.01, the eye is dense but painful on palpation, cornea
4. Disseminated is opaque, there is cyanotic induration of eyeball vessels.
5. Fibro-cavernous What is the most probable diagnosis?
1. Acute keratitis of the left eye
88. A 5 month old boy was born prematurely, he didn’t 2. Secondary glaucoma of the left eye
suffer from any disease at the infant age and later on. 3. Degeneration of the left eye cornea
Examination at an outpatient’s hospital revealed paleness 4. Acute iridocyclitis of the left eye
of skin, sleepiness. Blood count: Hb – 95 g/l, erythrocytes 5. Acute attack of primary glaucoma of the left eye
12
– 3.5×10 /l, reticulocytes – 90/00, colour index – 0.7,
osmotic stability of erythrocytes – 0.44-0.33%, serum iron 93. A patient has got acute macrofocal myocardial
– 4.9 micromole/l. What is the most probable cause of infarction complicated by cardiogenic shock. The latter is
anemia? progresi-ng under conditions of weak general peripheric
1. Erythrocyte hemolysis resistance and lowered cardiac output. What
2. Iron deficit antihypotensive drug should be injected to the patient in
3. Infectious process the first place?
4. Hemogenesis immaturity 1. Prednisolone
5. B12 deficit 2. Noradrenaline
3. Adrenaline
89. Study of morbidity rate in a city N revealed that 4. Mesatonum
population of different administrative districts differed in 5. Dopamine
age structure. What statistic method allows to eliminate
influence of this factor upon morbidity indices? 94. The man, aged 42, applied to the therapeutist with
1. Standardization complaints of pricking pains in scapulas area, dyspnea on
2. Calculation of average values physical exertion, cough with discharge of small amount of
3. Correlative regressive analysis sputum. During 10 years he works in coal mining. On
4. Analysis of dynamic series percussion-box-note sound in the lower parts, on
5. Wilcoxon’s t-criterion
Krok 2- 2009 (General Medicine) (t.me/krok2GeneralMedicine) - 12

auscultation- a harsh breathing. There were no changes in got pain behind the breastbone and in the lumbar area,
the heart. Possible diagnosis? dyspnea, cold sweat. Objectively: pale skin, heart rate –
1. Tuberculosis of lungs 100/min, AP- 60/40 Hg; oliguria, brown urine. For
2. Silicosis treatment of this complication the following drug should be
3. Silicatosis administered:
4. Bronchiectatic disease 1. Aminophylline
5. Chronic bronchitis 2. Lasix
3. Adrenaline
95. A 27 year old man complains of pains in epigastrium 4. Analgine
which are relieved by food intake. EGDFS shows antral 5. Prednisolone
erosive gastritis, biopsy of antral mucous presents
Hеlicobacter Pylori. Diagnosis is: 100. What is the maximum duration of medical certificate
1. Rigid antral gastritis in case of tuberculosis?
2. Menetrier’s gastritis 1. 10 months
3. Gastritis of type B 2. 2 months
4. Reflux-gastritis 3. Week
5. Gastritis of type A 4. 2 weeks
5. Month
96. An 18 year old patient was admitted to a hospital with
complaints of headache, weakness, high temperature, 101. A patient was delivered to a surgical department after
sore throat. Objectively: enlargement of all groups of a road accident with a closed trauma of chest and right-
lymph nodes was revealed. The liver is enlarged by 3 cm, sided rib fracture. The patient was diagnosed with right-
spleen – by 1 cm. In blood: leukocytosis, atypical sided pneumothorax, it is indicated to perform drainage of
lymphocytes – 15%. What is the most probable diagnosis? pleural cavity. Pleural puncture should be made in:
1. Acute lymphoid leukosis 1. In the 2nd intercostal space along the middle clavicular
2. Diphtheria line
3. Angina 2. In the projection of pleural sinus
4. Infectious mononucleosis 3. In the point of the greatest dullness on percussion
5. Adenoviral infection 4. In the 7th intercostal space along the scapular line
5. In the 6th intercostal space along the posterior axillary
97. A 3 year old boy fell ill abruptly: fever up to 39oC, line
weakness, vomiting. Haemorrhagic rash of various size
appeared on his lower limbs within 5 hours. 102. A 33 year old patient was delivered to the infectious
Meningococcemia with infective – toxic shock of the 1 diseases department on the 7th day of disease. He
degree was diagnosed. What medications should be complained about great weakness, high temperature, pain
administered? in the lumbar area and leg muscles, icteritiousness, dark
1. Chloramphenicol succinate and prednisone colour of urine, headache. The acute disease started with
2. Ampicillin and immunoglobulin chill, body temperature rise up to 40oC, headache, pain in
3. Penicillin and prednisone the lumbar area and sural muscles. Icterus turned up on
4. Penicillin and immunoglobulin the 4th day, nasal and scleral haemorrhages came on the
5. Chloramphenicol succinate and interferon 5th day. Fever has lasted for 6 days. Diuresis – 200 ml.
What is the most probable diagnosis?
98. In the 43rd week of gestation a long, thin infant was 1. Leptospirosis
delivered. He is apneic, limp, pale, and covered with “pea 2. Yersiniosis
soup”amniotic fluid. The first step in the resuscitation of 3. Sepsis
this infant at delivery should be: 4. Virus A hepatitis
1. Catheterization of the umbilical vein 5. Typhoid fever
2. Administration of 100% oxygen by mask
3. Suction of the trachea under direct vision 103. Surgical department admitted a 37 year old patient
4. Artificial ventilation with endotracheal tube with a big crushed wound of his left thigh 4 hours after he
5. Artificial ventilation with bag and mask got this trauma. What is the main provision for successful
prevention of gaseous gangrene?
99. An 8 year old boy suffering from haemophilia was 1. Wound lavage with 6% solution of hydrogen peroxide
undergoing transfusion of packed red cells. Suddenly he
Krok 2- 2009 (General Medicine) (t.me/krok2GeneralMedicine) - 13

2. Infiltration of soft tissues around the wound with osteoporosis, muscle weakness, indisposition. What drug
antibiotic solution has such following effects?
3. Injection of specific serum 30000 U 1. Inhibitor of proton pump
4. Removal of necrotic tissues and timely surgical 2. Metoclopramide
processing of the wound 3. Gastrozepin
5. Injection of specific serum 3000 U 4. Aluminium-bearing antacid
5. 2-blocker
104. A 10 month old boy has been ill for 5 days after
consumption of unboiled milk. Body temperature is 38 − 108. 15 minutes after the second vaccination with
39oC, there is vomiting, liquid stool. The child is pale and diphteria and tetanus toxoids and pertussis vaccine a 4
inert. His tongue is covered with white deposition. Heart month old boy manifested symptoms of Quincke’s edema.
sounds are muffled. Abdomen is swollen, there is What medication should be applied for emergency aid?
borborygmus in the region of ubbilicus, liver is enlarged by 1. Heparin
3 cm. Stool is liquid, dark-green, with admixtures of 2. Prednisolone
mucus, 5 times a day. What is the most probable 3. Adrenalin
diagnosis? 4. Furosemide
1. Staphylococcal enteric infection 5. Seduxen
2. Escherichiosis
3. Acute shigellosis 109. A department chief of an in-patient hospital is going
4. Salmonellosis to examine resident doctors as to observation of medical-
5. Rotaviral infection technological standards of patient service. What
documentation should be checked for this purpose?
105. A prematurely born girl is now 8 months old. She has 1. Health cards of in-patients
dyspnea, tachycardia, hepatosplenomegaly, physical 2. Treatment sheets
developmental lag, limb cyanosis. There is also 3. Statistic cards of discharged patients
parasternal cardiac hump, auscultation revealed 4. Annual report of a patient care institution
systolodiastolic murmur in the II intercostal space on the 5. Registry of operative interventions
left. AP is 90/0 mm Hg. What disease should be
suspected? 110. A female patient has been suffering from pain in the
1. Nonclosure of interventricular septum right subcostal area, bitter taste in the mouth, periodical
2. Stenosis of pulmonary artery bile vomiting for a month. The patient put off 12 kg. Body
3. Patent ductus arteriosus temperature in the evening is 37.6oC. Sonography
4. Stenosis of aortal valve revealed that bile bladder was 5.5х2.7 cm large, its wall –
5. Coarctation of aorta 0.4 cm, choledochus – 0.8 cm in diameter. Anterior liver
segment contains a roundi-sh hypoechoic formation up to
106. A 26 year old woman had the second labour within 5 cm in diameter and another two up to 1.5 cm each, walls
the last 2 years with oxytocin application. The child’s of these formations are up to 0.3 cm thick. What is the
weight is 4080 g. After the placent birth there were most probable diagnosis?
massive bleeding, signs of hemorrhagic shock. Despite 1. Liver cancer
the injection of contractive agents, good contraction of the 2. Liver abscess
uterus and absence of any cervical and vaginal disorders, 3. Cystous liver cancer
the bleeding proceeds. Choose the most probable cause 4. Paravesical liver abscesses
of bleeding: 5. Alveolar echinococcus of liver
1. Delay of the part of placenta
2. Atony of the uterus 111. A 43 year old patient was admitted to the infectious
3. Hysterorrhexis diseases hospital with high body temperature and intense
4. Hypotonia of the uterus headache. The iIlness has lasted for 2 days. Examination
5. Injury of cervix of the uterus revealed a carbuncle on his forearm. The area around it
was apparently edematic and slightly painful. Regional
107. A patient suffering from gastroesophageal reflux has lymphadenitis and hepatoli-enal syndrome were also
taken from time to time a certain drug that “reduces present. It is known from the anamnesis that the patient
acidity”for 5 years. This drug was recommended by a works at a cattle-breeding farm. What disease should be
pharmaceutist. The following side effects are observed: suspected in the first place?
1. Skin cancer
Krok 2- 2009 (General Medicine) (t.me/krok2GeneralMedicine) - 14

2. Anthrax 2. Citrate intoxication

3. Erysipelas 3. Allergic reaction to the donor red blood cells
4. Eczema 4. Cardial shock
5. Erysipeloid 5. Acute renal insufficiency

112. A 26 year old woman who delivered a child 7 months 116. As a result of prophylactic medical examination a 35
ago has been suffering from nausea, morning vomiting, year old woman was diagnosed with alimentary and
sleepiness for the last 2 weeks. She suckles the child, constitutive obesity of the III degree. It is known from her
menstruation is absent. She hasn’t applied any anamnesis that the patient doesn’t observe rules of
contraceptives. What method should be applied in order to rational nutrition: she often overeats, the last food intake is
specify her diagnosis? usually 10-15 minutes before going to bed, prefers
1. Roentgenography of small pelvis organs fattening and rich in carbohydrates food. What is the main
2. Palpation of mammary glands and pressing-out of alimentary risk factor of obesity development?
colostrum 1. Excess of fats
3. Speculum examination 2. Violation of dietary pattern
4. Bimanual vaginal examination 3. Energetic unprofitableness of nutrition
5. Ultrasonic examination 4. Lack of cellulose
5. Excess of carbohydrates
113.A 48 year old female patient complains about contact
haemorrhage. Speculum examination revealed 117. A 58 year old female patient complains about
hypertrophy of uterus cervix. It resembles of cauliflower, it periodical headache, dizziness and ear noise. She has
is dense and can be easily injured. Bi-manual examination been suffering from diabetes mellitus for 15 years.
revealed that fornices were shortened, uterine body was Objectively: heart sounds are rhythmic, heart rate is
nonmobile. What is the most probable diagnosis? 76/min, there is diastolic shock above aorta, AP is
1. Endometriosis 180/110 mm Hg. In urine: OD- 1.014. Daily loss of protein
2. Metrofibroma with urine is 1.5 g. What drug should be chosen for
3. Cervical pregnancy treatment of arterial hypertension?
4. Cervical papillomatosis 1. Inhibitor of angiotensin converting enzyme
5. Cervical carcinoma 2. β-blocker
3. Calcium channel antagonist
114. A woman delivered a child. It was her fifth pregnancy 4. Thiazide diuretic
but the first delivery. Mother’s blood group is A(II )Rh−, 5. α-blocker
newborn’s – A(II )Rh+. The level of indirect bilirubin in
umbilical blood was 58 micromole/l, haemoglobin – 140 118.A 52 year old patient was admitted to a hospital
12
g/l, RBC-3.8×10 /l. In 2 hours the level of indirect bilirubin because of high hemorrhagic diathesis of mucous
turned 82 micromole/l. The hemolytic disease of newborn membranes, massive skin haemorrhages in form of
(icteric-anemic type, Rh-incompatibility) was diagnosed. ecchymoses and spots, nasal and stomachal
Choose the therapeutic tactics: haemorrhages. After clinical examinations her illness was
1. Replacement blood transfusion (conservative therapy) diagnosed as thrombocytopenic purpura. What is the most
2. Symptomatic therapy probable cause of this disease?
3. Antibiotics 1. Disturbed hemostasis
4. Conservative therapy 2. Deficit of the VIII factor of blood coagulation
5. Blood transfusion (conservative therapy) 3. Inherited insufficiency of plasma factors of blood
coagulation
115.A 33 year old patient has acute blood loss 4. Iron deficit in blood serum, bone marrow and depot
12
(erythrocytes – 2, 2·10 /l, Hb- 55 g/l), blood group is A(II 5. Generation of antithrombocytic anti-bodies
)Rh+. Accidentally the patient got transfusion of donor
packed red blood cells of AB(IV )Rh+ group. An hour later 119. Female 45 year old patient was admitted to the
the patient became anxious, got abdominal and lumbar traumatological ward with the closed fracture of the medial
pain. Ps- 134 bpm, AP- 100/65 mm Hg, body temperature malleolus with its displacement up to 3 mm. The foot is to
– 38.6oC. After catheterization of urinary bladder 12 ml/h be fixed with a plaster cast in the following position:
of dark-brown urine were obtained. What complication is 1. In position of supination
it? 2. In position of planter flexion of foot
1. Toxic infectious shock 3. In position of dorsal flexion of foot
Krok 2- 2009 (General Medicine) (t.me/krok2GeneralMedicine) - 15

4. At right angle with varus positioning of the foot standing on the other leg, the patient can stay in such a
5. In position of pronation position for quite a long time. Name the probable disorder:
1. Catatonic stupor, schizophrenia
120. A 38 year old man was delivered to the hospital in 2. Depressive stupor, bipolar disorder
unconscious state. The symptoms of illness turned up a 3. Apathetic stupor, schizophrenia
day before: headache, nausea, vomiting, to-38.5oC, 4. Psychogenic stupor, stress disorder
dizziness, delusion. For the last 4 days he had been 5. Dissociative stupor, dissociative psychosis
complaining of pain and hearing loss in the left ear.
Objectively: sopor, rigidity of occipital muscles, bilateral 125. A 40 year old female patient has been observing
Kernig’s symptom, general hyperesthesia, purulent excessive menstruation accompanied by spasmodic pain
discharges from the left ear. What is the most probable in the lower abdomen for a year. Bi-manual examination
diagnosis? performed during menstruation revealed a dense
1. Subarachnoidal haemorrhage formation up to 5 cm in diameter in the cervical canal.
2. Primary purulent meningitis Uterus is enlarged up to 5-6 weeks of pregnancy,
3. Secondary purulent meningitis movable, painful, of normal consistency. Appendages are
4. Parenchymatous subarachnoidal haemorrhage not palpable. Bloody discharges are profuse. What is the
5. Tuberculous meningitis most probable diagnosis?
1. Algodismenorrhea
121. A 40 year old woman has a self-detected hard breast 2. Nascent submucous fibromatous node
mass. The procedure of choice for confirming the 3. Cervical myoma
diagnosis is: 4. Cervical carcinoma
1. Ultrasonography 5. Abortion in progress
2. Mammography
3. Aspiration biopsy with cytology 126. Infant is 6.5 months now and is given natural feeding
4. Thermography since birth. Body mass was 3.5 kg, with length 52 cm at
5. Excision biopsy birth. How many times per day the supplement (up
feeding) should be given?
122. A patient who takes diuretics has developed 1. 0
arrhythmia as a result of cardiac glycoside overdose. 2. 3
What is the treatment tactics in this case? 3. 1
1. Increased sodium consentration in blood 4. 2
2. Reduced magnesium concentration in blood 5. 4
3. Increased calcium concentration in blood
4. Increased potassium concentration in blood 127. A 42 year old man applied to a hospital 10 minutes
after he got stung by a bee and complained about face
123. A woman 26 years old has abused alcohol for 7 edema and difficult respiration. Objectively: Ps- 98 bpm,
years. She has psychological dependence on alcohol, but AP- 130/80 mm Hg. A doctor on duty injected him 1 ml of
no withdrawal syndrome. Drinks almost every day 1% dimedrol solution intramuscularly and recommended
approximately 50-100 g of wine. She is in her 4th week of to apply to his local therapeutist on the next day. What
pregnancy. Primary prevention of fetal alcohol syndrome tactics of treatment should be chosen for this patient?
requires: 1. Intravenous introduction of calcium chloride
1. Treatment of alcoholism and full abstinance from 2. The patient needs no further medical aid
alcohol during all the period of pregnancy 3. Hospitalization for observation
2. Medical abortion 4. Intravenous introduction of calcium chloride and
3. Decrease of alcohol use hospitalization
4. Participation in the A-ANON group 5. Intravenous introduction of prednisolone and
5. Gyneacological observation hospitalization

124. The observed patient’s movements are retarded, she 128. The results of 5 year monitoring allowed to estimate
answers no questions. Sometimes she spontaneously the level of environmental influence upon health indices of
stiffens in strange postures. It is possible to set her body population. What statistic method should be chosen?
and limbs into different positions artificially. If the 1. Calculation of correlation coefficient
psychiatrist lifts her arm or leg, so that she remains 2. Calculation of conformity coefficient
3. Calculation of coefficient of difference validity
Krok 2- 2009 (General Medicine) (t.me/krok2GeneralMedicine) - 16

4. Calculation of regression coefficient 133. A 10 year old boy suffers from chronic viral hepatitis
5. Calculation of dynamic indices type B with maximal activity. What laboratory test can give
the most precise characteristic of cytolysis degree?
129. Examination of a 9 month old girl revealed skin 1. Weltman’s coagulation test
pallor, cyanosis during excitement. Percussion revealed 2. Takata-Ara test
transverse dilatation of cardiac borders. Auscultation 3. Prothrombin test
revealed continuous systolic murmur on the left from the 4. Test for whole protein
breastbone in the 3-4 intercostal space. This murmur is 5. Transaminase test
conducted above the whole cardiac region to the back.
What congenital cardiac pathology can be suspected? 134. A 34 year old patient complains of profuse sweating
1. Defect of interventricular septum at night, skin itching, weight loss (9 kg within the last 3
2. Pulmonary artery stenosis months). Examination revealed malnutrition, skin pallor.
3. Fallot’s tetrad Palpation of neck and inguinal areas revealed dense
4. Coarctation of aorta elastic lymph nodes for about 1 cm in diameter,
5. Defect of interatrial septum nonmobile, non-adhering to skin. What is the most
probable diagnosis?
130. Three weeks after acute angina the patient is still 1. Cancer metastases
weak, inert, subfebrile, his retromaxillary lymph nodes are 2. Burkitt’s lymphoma
enlarged. Tonsils are flabby, stick together with arches, 3. Lymphogranulomatosis
there are purulent plugs in lacunae. What is the most 4. Lymphosarcoma
probable diagnosis? 5. Chronic lymphadenitis
1. Tonsillar tumour
2. Paratonsillitis 135. A 39 year old patient complained about morning
3. Acute lacunar tonsillitis headache, appetite loss, nausea, morning vomiting,
4. Chronic pharyngitis periodic nasal haemorrhages. The patient had acute
5. Chronic tonsillitis glomerulonephritis at the age of 15. Examination revealed
rise of arterial pressure up to 220/130 mm Hg, skin
131. It is planned to make complete isolation boxes in the haemorrhages on his arms and legs, pallor of skin and
infectious department in order to prevent nosocomial mucous membranes. What biochemical index has the
airborne infections. The boxes consist of a tambour, a greatest diagnostic importance in this case?
ward and a lock chamber. What structure should be also 1. Uric acid
included in a complete isolation box? 2. Blood creatinine
1. Bathroom unit 3. Blood sodium
2. Manipulation room 4. Blood bilirubin
3. Nursing room 5. Fibrinogen
4. Patient’s examination room
5. Doctor’s consulting room 136. The average body lenth of newborn boys is 50.9 cm
at a sigma 1.66; and average mass – 3432 at a sigma
132. On the second day after preventive vaccination a 2 5.00. What criterion is necessary in order to compare
year old boy got abdominal pain without clear localization, degree of variability of these signs?
body temperature rose up to 38oC. On the third day the 1. Coefficient of association
child got red papular haemorrhagic eruption on the 2. Amplitude
extensor surfaces of limbs and around the joints. Knee 3. Limit
joints were edematic and slightly painful. Examination of 4. Sigma
other organs and systems revealed no pathological 5. Coefficient of variation
changes. What is the most probable diagnosis?
1. DIC syndrome 137. A 46 year old patient is to be prepared to the
2. Meningococcemia operation on account of stomach cancer. Preoperative
3. Urticaria preparation involves infusion therapy. It was injected up to
4. Haemorrhagic vesiculitis 3 l of solutions into his right lunar vein. On the next day he
5. Thrombocytopenic purpura got tensive pain in the region of his right shoulder.
Examination of interior brachial surface revealed an
oblong area of hyperemia, skin edema and painful cord.
What complication is it?
Krok 2- 2009 (General Medicine) (t.me/krok2GeneralMedicine) - 17

1. Necrosis of paravenous cellular tissue 142. Examination of a 3-month-old child revealed scrotum
2. Acute lymphangitis growth on the right. This formation has elastic
3. Acute thrombophlebitis consistency, its size decreases during sleep and
4. Phlegmon of paravenous cellular tissue increases when the child is crying. What examination will
5. Vein puncture and edema of paravenous cellular tissue be helpful for making a correct diagnosis?
1. Diaphanoscоpy
138. A pediatrician talked to a mother of a 7 month old 2. Examination of the formation in Trendelenburg’s
breast-fed boy and found out that the child was fed 7 position
times a day. How many times should the child of such age 3. Palpation of the thickened cord crossing the pubical
be fed? tubercule (sign of the silk glove)
1. 5 times 4. Punction of the scrotum
2. 7 times 5. Palpation of the external inguinal ring
3. 6 times
4. 4 times 143. Administration of a plant producing red lead paint
5. 3 times intends to form a group of medical specialists for
periodical medical examinations. What specialist must be
139. A woman consulted a doctor on the 14th day after obligatory included into this group?
labour about sudden pain, hyperemy and induration of the 1. Psychiatrist
left mammary gland, body temperature rise up to 39oC, 2. Neuropathologist
headache, indisposition. Objectively: fissure of nipple, 3. Gynaecologist
enlargement of the left mammary gland, pain on palpation. 4. Otolaryngologyst
What pathology would you think about in this case? 5. Dermatologist
1. Phlegmon of mammary gland
2. Lacteal cyst with suppuration 144. During preventive examination a 16 year old patient
3. Lactational mastitis presented no problems. Objectively: the patient has signs
4. Breast cancer of malnutrition, he is asthenic, AP is 110/70 mm Hg, Ps is
5. Fibrous adenoma of the left mammary gland 80 bpm, cardiac border is normal, auscultation above the
cardiac apex reveals three sounds, cardiac murmur is
140. A boy is 1 year old. Previously he had purulent otitis. absent. ECG shows no pathological changes,
After that he started complaining about pain in the upper phonocardiogram shows that the third sound comes 0.15
third of his left thigh, body temperature rose up to 39oC. s after the second one above the apex. How are these
Objectively: the thigh is swollen in its upper third, inguinal changes called?
fold is smoothed. Extremity is in half-bent position. Active 1. Atrial gallop rhythm
and passive movements are impossible because of acute 2. IV physiological sound
pain. What is the most probable diagnosis? 3. III physiological sound
1. Acute coxitis 4. Protodiastolic gallop rhythm
2. Intermuscular phlegmon 5. Fout-ta-ta-rou (reduplication of the 2nd sound)
3. Osteosarcoma
4. Acute haematogenic osteomyelitis 145. The 25 year old patient was admitted on the 1st day
5. Brodie’s abscess of the disease with complaints of double vision in the
eyes, difficult respiration. The day before the patient ate
141. A patient has been in a hospital. The beginning of the home-made mushrooms. On objective examination:
disease was gradual: nausea, vomiting, dark urine, аcholic paleness, widened pupils, disorder of swallowing,
stools, yellowness of the skin and scleras. The liver is bradycardia, constipation are marked. What is the
protruded by 3 cm. Jaundice progressed on the 14th day diagnosis?
of the disease. The liver diminished in size. What 1. Salmonellosis, gastrointestinal form
complication of viral hepatitis caused deterioration of the 2. Yersiniosis
patient’s condition? 3. Leptospirosis
1. Infectious-toxic shock 4. Lambliasis
2. Cholangitis 5. Botulism
3. Relapse of viral hepatitis
4. Meningitis 146. A 60 year old man with unstable angina pectoris fails
5. Hepatic encephlopathy to respond to heparin, nitroglycerin, beta adrenegic
Krok 2- 2009 (General Medicine) (t.me/krok2GeneralMedicine) - 18

blockers and calcium channel antagonist. The best period. What index allows the most precise estimation of
management includes: this situation?
1. Coronary artery bypass grafting 1. Crude mortality rate
2. Antihypertensive therapy 2. Perinatal mortality
3. Intravenous streptokinase 3. Natality
4. Excercise testing 4. Neonatal mortality
5. Oral aspirin 5. Natural increase

147. A 32 year old welder complains of weakness and 152. A 38 year old man worked at roofing and drain pipes
fever. His illness started as tonsillitis a month before. On production for 15 years. He seeks medical help for
exam, BT of 38.9oC, RR of 24/min, HR of 100/min, BP of expiratory breathlessness on exertion, and dry cough. On
100/70 mm Hg, hemorrhages on the legs, enlargement of exam, wheezes above both lungs, grayish warts on
the lymph nodes. CBC shows Hb of 70 g/l, RBC of 2.2×10 fingers are seen. Factory physician has diagnosed
9
12/l, WBC of 3.0×10 /l with 32% of blasts, 1% of asbestosis. What method is the most important for this
eosinophiles, 3% of bands, 36% of segments, 20% of diagnosis?
lymphocytes, and 8% of monocytes, ESR of 47 mm/h. 1. Bronchoscopy
What is the cause of anemia? 2. Blood gas analysis
1. Aplastic anema 3. Spirography
2. Chronic lympholeukemia 4. Chest X-ray
3. Vitamin B12 deficiency anemia 5. Electrocardiography
4. Chronic hemolytic anemia
5. Acute leukemia 153. A patient applied to the traumatology centre and
complained about a trauma of the lower third of the volar
148. The student has the following devices: Geiger forearm surface caused by cut on a piece of glass.
counter, Ebert counter, Krotov’s apparatus, Mischuk Objectively: flexion of the IV and V fingers is impaired,
device, Ebert device. What device can he use to assess sensitivity of the interior dorsal and palmar surface of hand
air germ pollution? as well as of the IV finger is reduced. What nerve is
1. Geiger’s counter damaged?
2. Ebert’s device 1. Radial
3. Ebert’s counter 2. Musculoskeletal
4. Mischuk’s device 3. Ulnar
5. Krotov’s apparatus 4. Median
5. Axillary
149. A 2 month old full-term child was born with weight
3500 g and was on the mixed feeding. Current weight is 154. A 29 year old female patient complains about
4900 g. Evaluate the current weight of the child: periodical right-sided headache that is usually provoked
1. 150 g less than necessary by strong smells or excitement. The patient’s mother
2. Hypotrophy of the I grade suffers from the same disease. Objectively: examination of
3. Corresponding to the age internal organs revealed no pathology. During the attack
4. Hypotrophy of the II grade there are general hyperesthesia and nausea, at the end of
5. Paratrophy of the I grade the attack polyuria is observed. Palpation of the right
temporal artery during the attack revealed tension and
150. Estimation of community health level involved painfulness of the artery. Complete blood count and urine
analysis of a report on diseases registered among the analysis reveale dno pecularities. What is the most
population of district under charge (reporting form 12). probable diagnosis?
What index is calculated on the grounds of this report? 1. Neuritis of the facial nerve
1. Index of morbidity with temporary disability 2. Epilepsy
2. Index of basic non-epidemic morbidity 3. Meniere’s syndrome
3. Index of pathological affection 4. Migraine
4. Index of hospitalized morbidity 5. Neuralgia of trigeminus
5. Common sickness rate
155. At year-end hospital administration has obtained the
151. A maternity hospital registered 616 live births, 1 following data: annual number of treated patients and
stillbirth, 1 death on the 5th day of life over a 1 year average annual number of beds used for patients’
Krok 2- 2009 (General Medicine) (t.me/krok2GeneralMedicine) - 19

treatment. What index of hospital work can be calculated progressing. Vesicular respiration is absent, X-ray picture
on the base of this data? shows a shadow on the left. What pathology might be
1. Bed resources of the hospital suspected?
2. Average bed idle time 1. Pleuritis
3. Bed turnover 2. Pulmonary abscess
4. Average annual bed occupancy 3. Left-sided pneumonia
5. Average duration of patients’ presence in the hospital 4. Spontaneous left-sided pneumothorax
5. Pulmonary infarction
156. A 34 year old female patient has been suffering from
anxious depression accompanied by panic attacks for 2 160. A 15 year old girl suddenly got arthralgia, headache,
years. She has been a patient of a psychotherapist. nausea, vomiting; pain and muscle tension in the lumbar
Treatment resulted in incomplete remission. The patient area; body temperature rose up to 38 − 39oC.
had to break off psychotherapy because of moving to a Pasternatsky’s symptom was distinctly positive on the
new place of residence. Soon after this her condition grew right. In the urine: bacteriuria, pyuria. What is the most
significantly worse, she was almost permanently anxious, probable diagnosis?
panic attacks turned up 5-6 times a day and were 1. Cystitis
accompanied by palpitation, dyspnea, cold sweat, 2. Pararenal abscess
thanatophobia. What drug group is the most appropriate 3. Renal colic
for medicamental therapy? 4. Acute pyelonephritis
1. Antidepressants 5. Acute glomerulonephritis
2. Cardiotonics, respiratory analeptics
3. Lithium drugs 161. On the third day of life an infant’s skin got icteric
4. Antipsychotic neuroleptics colouring. The child was born with body weight of 3200 g,
5. Sedative neuroleptics body length of 52 cm. The child is active. There is puerile
respiration above the lungs. Respiratory rate is 36/min,
157. A 45 year old woman complains about unbearable heart sounds are rhythmic, heart rate is 130/min.
pain attacks in the left part of face lasting 1-2 minutes. Abdomen is soft, liver comes out from the edge of costal
Such attacks are provoked by mastication. These arch by 2 cm, spleen is not palpable. Feces are in form of
symptoms appeared 2 months ago after exposure to cold. meconium. What is the most probable diagnosis?
Objectively:the pain is localized in the ending points of 1. Physiologic jaundice
trigeminus on the left. A touch near nose wing provokes 2. Biliary tracts atresia
another pain attack and tonic spasm of face muscles. 3. Minkowsky-Shauffard disease
What is the most probable diagnosis? 4. Neonatal sepsis
1. Arthritis of mandibular joint 5. Hemolytic disease of newborn
2. Neuralgia of trigeminus
3. Maxillary sinusitis 162. A 42 year old man works in a boiler room. He
4. Neuralgia of glossopharyngeal nerve complains about girdle headache and recurring vomiting.
5. Facial migraine There was also short-term consciousness loss.
Objectively: increase of tendon reflexes, spontaneous
158. Study of morbidity with temporary disability among myofibrillations. AP is 150/80 mm Hg, Ps- 104 bpm.
workers of a machine building plant revealed that average Visible mucous membranes and cutaneous surfaces have
duration of a case was 20 days. What diseases influenced crimson colouring. What is the most probable diagnosis?
upon the index value? 1. Poisoning with anilin colouring agents
1. Preexisting diseases 2. Poisoning with carbon monooxide
2. Chronic 3. Poisoning with benzine
3. Acute 4. Poisoning with methane
4. Subacute 5. Poisoning with hydrocyanic acid
5. Hard to determine
163. A 13 year old patient is suffering from an acute
159. A patient complains about strong dyspnea that is disease with the following symptoms: thirst, polyuria,
getting worse during physical activity. Presentations weakness. Objectively: his general condition is
appeared suddenly 2 hours ago at work: acute chest pain satisfactory, there is no smell of acetone. Glucose
on the left, cough. The pain was abating, but dyspnea, concentration in blood on an empty stomach is 32
dizziness, pallor, cold sweat and cyanosis were
Krok 2- 2009 (General Medicine) (t.me/krok2GeneralMedicine) - 20

micromole/l, in urine – 6%, acetone +. What treatment retrosternal pains, decreased exercise tolerance for 5
should be administered? days. Angina is less responsive to nitroglycerine. What is
1. Biguanides the most probable diagnosis?
2. Diet 1. Cardialgia due to spine problem
3. Short-acting insulin 2. IHD. Functional Class II angina
4. Long-acting insulin 3. IHD. Unstable angina
5. Sulfonylurea 4. Myocarditis
5. Myocardial dystrophy
164. A 63 year old patient was diagnosed with purulent
mediastinitis. What of the below listed diseases are NOT 169. A 35 year old female patient suffering from
the cause of purulent mediastinitis? cholelithiasis has broken her diet, and this caused an
1. Deep neck phlegmon acute pain attack in the right subcostal are. The pain
2. Perforation of the cervical part of the oesophagus eased off on the third day, but the patient got progressing
3. Perforation of the thoracic part of the oesophagus jaundice. What non-invasive diagnostic method should be
4. Cervical lymphadenitis applied?
5. Iatrogenic injury of the trachea 1. Duodenal probing
2. Test for bilirubin
165. It was noticed that a 7 year old pupil had been 3. Endoscopic retrograde cholangiopancreatography
innattentive several times during the lessons. The teacher 4. Infusive cholecystocholangiography
also noticed that the child had been smacking his lips and 5. Survey radiography of abdominal organs
had vacant look. There were no falls and convulsions.
During such short periods of absence the child didn’t react 170. A patient with acute purulent otitis media complicated
to calling his name. His mother notic such phenomena by mastoiditis was admitted to a hospital. Roentgenogram
before but didn’t pay much attention to them thinking that of mastoid processes showed the shadiowing of the
the child was deep in thought. What type of epileptic cellular system on the lesion, absence of bone septa was
attack (according to the standard classification) is it? present. What are the necessary therapeutic actions at the
1. Generalized tonoclonic epilepsy second stage of mastoiditis?
2. Absentia 1. Mastoidotomy
3. Complex partial epilepsy 2. Radical operation on the middle ear
4. Simple partial epilepsy 3. Tympanoplasty
5. Jacksonian partial epilepsy 4. Cateterization of the Eustachian tube
5. Paracentesis of the drum
166. Examination of placenta revealed a defect. An
obstetrician performed manual investigation of uterine 171. A plot of land with total area of 2.0 hectare was
cavity, uterine massage. Prophylaxis of endometritis in the intended for building of a hospital. The maximal capacity
postpartum period should involve following actions: of the hospital will be:
1. Antibacterial therapy 1. 200 beds
2. Instrumental revision of uterine cavity 2. 400 beds
3. Haemostatic therapy 3. 800 beds
4. Intrauterine instillation of dioxine 4. Over 1000 beds
5. Contracting agents 5. 100 beds

167. Indices that characterize population health include 172. A patient complains about evaginations in the region
demographic indices. What environment is used for of anus that appear during defecation and need to be
calculation of these indices? replaced. Examination with anoscope revealed 1×1 cm
1. Number of patients large evaginations of mucosa above the pectineal line.
2. Number of hospitalized people What is the most probable diagnosis?
3. Employment number 1. Acute paraproctitis
4. Number of population being liable to preventive 2. Anal fissure
examination 3. Internal hemorrhoids
5. Population number 4. External hemorrhoids

168. A 52 year old patient with history of functional Class 173. A 4 month old child was admitted to a surgical
II angina complains of having intense and prolonged department 8 hours after the first attack of anxiety. The
Krok 2- 2009 (General Medicine) (t.me/krok2GeneralMedicine) - 21

attacks happen every 10 minutes and last for 2-3 minutes, 2. Rubella
there was also one-time vomiting. Objectively: the child’s 3. Measles
condition is grave. Abdomen is soft, palpation reveals a 4. Allergic rash
tumour-like formation in the right iliac area. After rectal 5. Pseudotuberculosis
examination the doctor’s finger was stained with blood.
What is the most probable diagnosis? 178. A 28 year old patient was admitted to the clinic with
1. Helminthic invasion complaints of the temperature rise up to 39.0oC,
2. Ileocecal invagination headache, weakness, constipation on the 9th day of the
3. Pylorostenosis disease. On examination: single roseolas on the skin of
4. Wilm’s tumour the abdomen are present. The pulse rate is 78 bpm. The
5. Gastrointestinal haemorrhage liver is enlarged by 2 cm. What is the most probable
diagnosis?
174. A 27 year old patient suffers from haemophilia. He 1. Leptospirosis
was admitted to the hospital with melena and skin pallor. 2. Malaria
Objectively: Ps- 110 bpm, AP- 100/60 mm Hg. In blood: 3. Typhoid fever
12
Hb- 80 g/l, erythrocytes – 2.8×10 /l. What medication 4. Brucellosis
should be administered in the first place? 5. Sepsis
1. Stored blood
2. Packed red blood cells 179. A 68 year old patient complains about acute pain in
3. Epsilon-aminocapronic acid his right foot, toe edema and darkening of skin of the IV
4. Cryoprecipitate toe. He has been suffering from diabetes mellitus for 15
5. Dicinone years, doesn’t receive regular treatment. What
complication of diabetes mellitus is it?
175. A 2 year old girl has been ill for 3 days. Today she 1. Panaritium
has low grade fever, severe catarrhal presentations, slight 2. Haematoma
maculopapular rash on her buttocks and enlarged occipital 3. Erysipelas
lymph nodes. What is your diagnosis? 4. Gangrene of the IV toe on the right foot
1. Rubella 5. Fracture of the IV toe on the right foot
2. Measles
3. Adenoviral infection 180. A man, aged 37, working on the collective farm on
4. Pseudotuberculosis sowing, was admitted to the infectious hospital with the
5. Scarlet fever clinical symptoms: miosis, labored breathing,
sweating.What kind of poisoning is it and what is the first
176. A 37 year old patient applied to a local therapeutist. aid?
As a result of exacerbation of chronic obstructive 1. Poisoning by lead. Treatment: tetacine Calcii
bronchitis the patient had been temporarily disabled for 2. Poisoning by the methylic alcohol. Treatment: ethylic
117 days within 1 year. What tactics will be legally alcohol
correct? 3. Poisoning by POC. Treatment: atropine
1. The patient should be referred to the medical 4. Poisoning by vapours of mercury. Treatment: unithiol
consultation commission for extension of medical
certificate 181. Five days after a total hip joint replacement a 72 year
2. The therapist should issue a new medical certificate old woman becomes acutely short of breath, diaphoretic
3. The therapist should extend a medical certificate and hypotensive. Both lung fields are clear to auscultation
4. The patient should be referred to the medicosocial and percussion, but examination of the neck reveals mild
expertise jugular venous distension with prominent A waves. Heart
5. The patient should be referred to the sanatorium-and- sounds are normal. ECG shows sinus tachycardia with a
spa treatment new right bundle branch block and minor nonspecific ST −
T wave changes. The most likely diagnosis is:
177. A 3 year old child has been suffering from fever, 1. Aortic dissection
cough, coryza, conjunctivitis for 4 days. He has been 2. Pulmonary thromboembolism
taking sulfadimethoxine. Today it has fever up to 39oC 3. Acute myocardial infarction
and maculopapular rash on its face. Except of rash the 4. Aspiration
child’s skin has no changes. What is your diagnosis? 5. Pericarditis
1. Scarlet fever
Krok 2- 2009 (General Medicine) (t.me/krok2GeneralMedicine) - 22

182. A patient consulted a venereologist about painful 1. Respiratory failure of II degree

urination, reddening of the external opening of urethra, 2. Respiratory failure of I degree
profuse purulent discharges from the urethra. He 3. Respiratory failure of III degree
considers himself to be ill for 3 days. He also associates 4. Congenital heart malformation
the disease with a casual sexual contact that took place 5. Myocarditis
for about a week ago. If provisional diagnosis “acute
gonorrheal urethritis”will be confirmed, then bacteriological 187. A 30 year old patient complains about inability to
study of urethral discharges will reveal: become pregnant over 3 years of married life. The patient
1. Gram-positive diplococci is of supernutrition type, she has hair along the median
2. Gram-negative diplococci abdominal line, on the internal thigh surface and in the
3. Spirochaete peripapillary area. Menses started at the age of 16, they
4. Proteus vulgaris are infrequent and non-profuse. US revealed that the
5. Mycoplasma uterus was of normal size, ovaries were 4х5х5 cm large
and had a lot of cystic inclusions. What is the most
183. A 20 year old patient was delivered to the hospital in probable diagnosis?
summer from the street with haemorrage from the brachial 1. Menstrual irregularity
artery. First medical aid involved application of a 2. Bilateral ovarian tumours
tourniquet for provisional arrest of bleeding. What is the 3. Chronic oophoritis
maximal exposure of the tourniquet? 4. Polycystic ovaries
1. 15 minutes 5. Ovarian cystoma
2. 120 minutes
3. 30 minutes 188. A patient has restrained umbilateral hernia
4. 180 minutes complicated by phlegmon hernia, it is necessary to take
5. 60 minutes following actions:
1. Herniotomy by Sapezhko
184. A 72 year old patient complains about pain and 2. Herniotomy by Lekser
bleeding during defecation. Digital rectal investigation 3. Herniotomy by Mayo
revealed a tumour of anal canal. After verification of the 4. Herniotomy by Grenov
diagnosis the patient was diagnosed with squamous cell 5. Herniotomy by Mayo-Sapezhko
carcinoma. The secondary (metastatic) tumour will be
most probably found in: 189. A 54 year old male patient complains about
1. Mediastinum permanent dull pain in the mesogastral region, weight
2. Lungs loss, dark blood admixtures in the feces, constipations. He
3. Liver put off 10 kg within a year. In blood: erythrocytes:
12 9
4. Pelvic bones 3.5×10 /l, Hb- 87 g/l, leukocytes – 12.6×10 /l, stab
5. Brain neutrophil shift, ESR- 43 mm/h. What is the most probable
diagnosis?
185. A 16 year old female patient underwent an operation 1. Gastric ulcer
on account of diffuse toxic goiter of the III-IV degree 12 2. Chronic pancreatitis
years ago. Now she has recurrence of thyrotoxicosis. The 3. Stomach cancer
patient was offered operative intervention, but it is 4. Cancer of transverse colon
necessary first to localize the functioning gland tissue. 5. Chronic colitis
What method should be applied for this purpose?
1. Gland scanning 190. A 26 year old manual worker complained of 3 weeks
2. USI history of fevers and fatigue, weight loss with no other
3. Puncture aspiration biopsy symptoms. Physical findings: Temperature 37.6oC, Ps- 88
4. Roentgenography of esophagus bpm, blood pressure 115/70 mm Hg, superficial lymph
5. Roentgenography of neck nodes (occipital, submental, cervical, axillary) are
enlarged, neither tender nor painful. Rubella-like rash on
186. A 3 month old infant suffering from acute segmental the trunk and extremities. Herpes simplex lesions on the
pneumonia has dyspnea (respiration rate – 80 per lips. Candidosis of oral cavi-ty. What infectious disease
minute), paradoxical breathing, tachycardia, total would you suspect?
cyanosis. Respiration and pulse – ratio is 1:2. The heart 1. HIV infection
dullness under normal size. Such signs characterise: 2. Influenza
Krok 2- 2009 (General Medicine) (t.me/krok2GeneralMedicine) - 23

3. Rubella 3. Rectoromanoscopy
4. Infectious mononucleosis 4. Laparoscopy
5. Tuberculosis 5. R-scopy of abdominal cavity

191. A male patient, 60 years old, tobacco smoker for 30 196. A 36 year old patient was diagnosed with right-sided
years, alcoholic, has dysphagia and weight loss since 4 pneumothorax. What method of treatment is indicated to
months. Suggested diagnosis? the patient?
1. Esophageal achalasia 1. Anti-inflammation therapy
2. Hanter’s disease 2. Pleural puncture
3. Esophagitis 3. Surgical treatment: drainage of the pleural cavity
4. Esophageal diverticulum 4. Symptomatic therapy
5. Cancer of the esophagus 5. Thoracotomy

192. Which of the following symptoms would occur only if 197. A parturient woman is 27 year old, it was her second
a total-body acute radiation exposure exceeded 5.000 rad labour, delivery was at term, normal course. On the 3rd
(50 Gy) day of postpartum period body temperature is 36.8oC, Ps
1. Nausea and vomiting – 72/min, AP – 120/80 mm Hg. Mammary glands are
2. Epilation (hair loss) moderately swollen, nipples are clean. Abdomen is soft
3. Hallucinations and impairment of vision and painless. Fundus of uterus is 3 fingers below the
4. Diarrhea umbilicus. Lochia are bloody, moderate. What is the most
5. Bleeding gums probable diagnosis?
1. Subinvolution of uterus
193. A 28 year old parturient complains about headache, 2. Postpartum metroendometritis
vision impairment, psychic inhibition. Objectively: AP- 3. Remnants of placental tissue after labour
200/110 mm Hg, evident edemata of legs and anterior 4. Lactostasis
abdominal wall. Fetus head is in the area of small pelvis. 5. Physiological course of postpartum period
Fetal heartbeats is clear, rhythmic, 190/min. Internal
investigation revealed complete cervical dilatation, fetus 198. A 32 year old patient complains about cardiac
head was in the area of small pelvis. What tactics of labor irregularities, dizziness, dyspnea at physical stress. He
management should be chosen? has never suffered from this before. Objectively: Ps- 74
1. Stimulation of labor activity bpm, rhythmic. AP- 130/80 mm Hg. Auscultation revealed
2. Conservative labor management with episiotomy systolic murmur above aorta, the first heart sound was
3. Embryotomy normal. ECG showed hypertrophy of the left ventricle,
4. Cesarean signs of repolarization disturbance in the I , V5 and V6
5. Forceps operation leads. Echocardiogram revealed that interventricular
septum was 2 cm. What is the most probable di-agnosis?
194. During examination a patient is unconscious, his skin 1. Essential hypertension
is dry and hot, face hyperemia is present. The patient has 2. Aortic stenosis
Kussmaul’s respiration, there is also smell of acetone in 3. Hypertrophic cardiomyopathy
the air. Symptoms of peritoneum irritation are positive. 4. Coarctation of aorta
Blood sugar is at the rate of 33 millimole/l. What 5. Myocardium infarction
emergency actions should be taken?
1. Intravenous infusion of glucose along with insulin 199. A 3 year old boy has petechial eruption. Examination
2. Intravenous infusion of short-acting insulin revealed no other pathological changes. Thrombocyte
9
3. Intravenous infusion of sodium chloride saline number is 20×10 g/l; haemoglobin and leukocyte
4. Intravenous infusion of neohaemodesum along with concentration is normal. What is the most probable
glutamic acid diagnosis?
5. Introduction of long-acting insulin 1. Immune thrombocytopenic purpura
2. Schonlein-Henoch disease
195. It is suspected that a 34 year old patient has an 3. Disseminated intravascular coagulopathy
abscess of Douglas pouches. What diagnostic method is 4. Systemic lupus erythematosus
to be chosen? 5. Acute lymphoblastic leukemia
1. Percussion and auscultation of stomach
2. Digital examination of rectum
Krok 2- 2009 (General Medicine) (t.me/krok2GeneralMedicine) - 24

200. A 39 year old patient suffering from hypertension

suddenly got intense headache in the region of occiput;
there appeared recurrent vomiting. These presentations
has been lasting for 5 hours. Objectively: Ps – 88 bpm, AP
– 205/100 mm Hg, painfulness of occipital points, rigidity
of occipital muscles are present. Kernig’s symptom is
bilaterally positive. Subarachnoid haemorrhage is also
suspected. What diagnostic method will be of the greatest
importance for confirmation of provisional diagnosis?
1. ECG
2. Lumbar puncture
3. Ultrasonic dopplerography
4. Examination of eye fundus
5. Computer tomography
Krok 2- 2009 (General Medicine) (t.me/krok2GeneralMedicine) - 25

Krok 2- 2009 (General Medicine) Answer Key

01.(1) 31.(4) 61.(3) 91.(3) 121.(5) 151.(2) 181.(2)
02.(4) 32.(4) 62.(5) 92.(5) 122.(4) 152.(4) 182.(2)
03.(1) 33.(1) 63.(3) 93.(5) 123.(1) 153.(3) 183.(2)
04.(4) 34.(2) 64.(1) 94.(2) 124.(1) 154.(4) 184.(2)
05.(2) 35.(5) 65.(5) 95.(3) 125.(2) 155.(3) 185.(1)
06.(4) 36.(1) 66.(4) 96.(4) 126.(4) 156.(1) 186.(3)
07.(5) 37.(5) 67.(4) 97.(1) 127.(5) 157.(2) 187.(4)
08.(1) 38.(3) 68.(2) 98.(3) 128.(1) 158.(2) 188.(5)
09.(4) 39.(4) 69.(4) 99.(5) 129.(1) 159.(4) 189.(4)
10.(5) 40.(3) 70.(2) 100.(2) 130.(5) 160.(4) 190.(1)
11.(4) 41.(2) 71.(3) 101.(1) 131.(1) 161.(1) 191.(5)
12.(5) 42.(3) 72.(1) 102.(1) 132.(4) 162.(2) 192.(3)
13.(3) 43.(3) 73.(5) 103.(4) 133.(5) 163.(3) 193.(5)
14.(5) 44.(3) 74.(3) 104.(4) 134.(3) 164.(4) 194.(2)
15.(5) 45.(2) 75.(2) 105.(3) 135.(2) 165.(2) 195.(2)
16.(1) 46.(5) 76.(2) 106.(2) 136.(5) 166.(1) 196.(3)
17.(1) 47.(4) 77.(2) 107.(4) 137.(3) 167.(5) 197.(5)
18.(4) 48.(2) 78.(3) 108.(2) 138.(1) 168.(3) 198.(3)
19.(4) 49.(3) 79.(4) 109.(1) 139.(3) 169.(3) 199.(1)
20.(2) 50.(4) 80.(4) 110.(5) 140.(4) 170.(1) 200.(2)
21.(3) 51.(2) 81.(3) 111.(2) 141.(5) 171.(5)
22.(5) 52.(3) 82.(3) 112.(5) 142.(3) 172.(3)
23.(2) 53.(1) 83.(1) 113.(5) 143.(2) 173.(2)
24.(2) 54.(2) 84.(5) 114.(1) 144.(3) 174.(4)
25.(4) 55.(3) 85.(1) 115.(5) 145.(5) 175.(1)
26.(4) 56.(5) 86.(1) 116.(3) 146.(1) 176.(4)
27.(3) 57.(4) 87.(2) 117.(1) 147.(5) 177.(3)
28.(1) 58.(4) 88.(2) 118.(5) 148.(5) 178.(3)
29.(2) 59.(1) 89.(1) 119.(4) 149.(3) 179.(4)
30.(4) 60.(3) 90.(2) 120.(3) 150.(5) 180.(3)