Kr. 2 Medicine 2008 icon

Kr. 2 Medicine 2008




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НазваKr. 2 Medicine 2008
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1. /Krok 2 Med 2008/Keys Krok 2 Medicine 2009.doc
2. /Krok 2 Med 2008/Krok 2 Medicine 2008.doc
Ключі поваріантно Крок Medicine. 2008
Kr. 2 Medicine 2008

Kr.2 Medicine - 2008

1 A 24 year old patient complains about general weakness, dizziness, body temperature rise up to 37,5oC, sore throat, neck edema, enlargement of submaxillary lymph nodes. Objectively: mucous membrane of oropharynx is edematic and cyanotic, tonsils are enlarged and covered with films that spread beyond the tonsils and cannot be easily remove D. What is the leading mechanism of this illness' development?

A. Action of bacterial exotoxin

B. Accumulation of suboxidated products

C. Action of bacterial endotoxin

D. Allergic

E. Bacteriemia


2 A 28 year old woman was admitted to the emergency room with a slightly reddened, painful "knot" 8 cm above the medial malleolus. Examination in the standing position demonstrates a distended vein above and below the mass. There are no other abnormalities on physical examination. The most likely diagnosis is:

A. Early deep vein thrombosis

B. Superficial venous thrombosis

C. Subcutaneous hematoma

D. Cellulitis

E. Insect bite


3 If a child has adherent fingers on his right hand, then what will be your diagnosis?

A. Macrodactyly

B. Ectromelia

C. Syndactyly

D. Ectrodactyly

E. Polydactyly


4 A 19 year old boy was admitted to a hospital with closed abdominal traum A. In course of operation multiple ruptures of spleen and small intestine were reveale D. AP is falling rapidly, it is necessary to perform hemotransfusion. Who can specify the patient's blood group and rhesus compatibility?

A. A traumatologist

B. A laboratory physician

C. A doctor of any speciality

D. A surgeon

E. An anaesthesilogist


5 A 40 year old patient complains of yellowish discharges from the vagin A. Bimanual examination revealed no pathological changes. The smear contains Trichomonas vaginalis and blended flor A. Colposcopy revealed two hazy fields on the frontal labium, with a negative Iodine test. Your tactics:

A. Diathermocoagulation of the cervix of the uterus

B. Specific treatment of Trichomonas colpitis

C. Treatment of specific colpitis and subsequent biopsy

D. Cryolysis of cervix of the uterus

E. Cervix ectomy


6 A patient with acute respiratory viral infection (3rd day of disease) complains of pain in lumbar region, nausea, dysuria, oliguri A. Urinalysis - hematuria (100-200 RBC in eyeshot spot), specific gravity - 1002. The blood creatinin level is 0,18 millimole/l, potassium level - 6,4 millimole/l. Make the diagnosis:

A. Acute interstitial nephritis

B. Acute renal failure

C. Acute renal colic

D. Acute cystitis

E. Acute glomerylonephritis


7 A patient who takes diuretics has developed arrhythmia as a result of cardiac glycoside overdos E. What is the treatment tactics in this case?

A. Increased calcium concentration in blood

B. -

C. Increased potassium concentration in blood

D. Increased sodium consentration in blood

E. Reduced magnesium concentration in blood


8 A 26 year old woman had the second labour within the last 2 years with oxytocin application. The child's weight is 4080 gr. After the placent birth there were massive bleeding, signs of hemorrhagic shock. Despite the introduction of contractive agents, good contraction of the uterus and absence of any cervical and vaginal disorders, the bleeding proceeds. Choose the most probable cause of bleeding:

A. Hysterorrhexis

B. Hypotonia of the uterus

C. Delay of the part of placenta

D. Atony of the uterus

E. Injury of cervix of the uterus


9 A 30 year old patient undergoes treatment because of Werlhof's diseas E. Objectively: the patient is pale, there are petechial haemorrhages on the extension surfaces of forearms. Ps is 92 bpm, AP is 100/60 mm Hg. The lower edge of spleen is at a level with umbilicus. Blood count: erythrocytes: 2,8*1012/l, Hb - 90 g/l, Ht - 0,38, thrombocytes – 30*109/l. The patient is being prepared for splenectomy. What transfusion medium should be chosen in the first place for the preoperational preparation?

A. Washed erythrocytes

B. Stored blood

C. Erythrocytic suspension

D. Thrombocytic mass

E. Native erythrocytic mass


10 A 30 year old man complains of acute pain in his right ear, hearing loss, high temperature for three days. Objectively: right ear whispering language - 0,5 mm, external ear is intact, otoscopically - eardrum protrusion, hyperemia and swelling, loss of landmarks. What disease is it?

A. Eustachian tube disfunction

B. Chronic purulent otitis media

C. Chronic secretory otitis media

D. Acute purulent otitis media

E. Acute mastoiditis


11 A patient has got pain in the axillary area, rise of temperature developed 10 hours ago. On examination: shaky gait is evident, the tongue is coated with white deposit. The pulse is frequent. The painful lymphatic nodes are revealed in the axillary are A. The skin over the lymph nodes is erythematous and glistering. What is the most probable diagnosis?

A. Bubonic plague

B. Anthrax

C. Lymphogranulomatosis

D. Tularemia

E. Acute purulent lymphadenitis


12 A woman complains of having slight dark bloody discharges and mild pains in the lower part of abdomen for several days. Last menses were 7 weeks ago. The pregnancy test is positiv E. Bimanual investigation: the body of the uterus indicates for about 5-6 weeks of pregnancy, it is soft, painless. In the left appendage there is a retort-like formation, 7 х 5 cm large, mobile, painless. What examination is necessary for detection of fetus localization?

A. Ultrasound

B. Colposcopy

C. Cystoscopy

D. Hromohydrotubation

E. Hysteroscopy


13 An 18 year old woman consulted a gynecologist about the pain in the lower part of abdomen, fever up to 37,5oC, considerable mucopurulent discharges from the genital tracts, painful urination. Vaginal and speculum examination results: the urethra is infiltrated, cervix of the uterus is hyperemic, erosiv E. The uterus is painful, ovaries are painful, thickened; fornixes are fre E. Bacterioscopy test revealed diplococcus. What diagnosis is the most probable?

A. Candydomycosis

B. Trichomoniasis

C. Chlamydiosis

D. Chronic gonorrhea

E. Recent acute ascending gonorrhea


14 A patient complained about problems with pain and tactile sensitivity, pain in the nail bones at the end of the working day. He works at a plant with mechanical devices. What pathology can be suspected?

A. Hypovitaminosis of B1

B. Noise disease

C. Vibration disease

D. Caisson disease

E. Overwork symptoms


15 Internal obstetric examination of a parturient woman revealed that the sacrum hollow was totally occupied with fetus head, ischiadic spines couldn't be detecte D. Sagittal suture is in the straight diameter, occipital fontanel is directed towards symphysis. In what plane of small pelvis is the presenting part of the fetus?

A. Over the pelvic inlet

B. Wide pelvic plane

C. Plane of pelvic inlet

D. Plane of pelvic outlet

E. Narrow pelvic plane


16 Clinical and statistical study was devoted to the effect of a new pharmacological medication upon the patients with coronary heart diseas E. What parametric criterion (coefficient) can be used for estimation of results validity?

A. Conformity coefficient

B. Kolmogorov-Smirnov's criterion

C. Wilcoxon's t-criterion

D. Student's coefficient (t)

E. Sign criterion


17 Prophylactic photoroentgenography examination of a 25 year old man revealed focal shadowings of small and medium intensity with irregular contours in the 1st and 2nd segments of the right lung. Which clinical form can be suspected?

A. Fibro-cavernous

B. Disseminated

C. Miliary

D. Focal

E. Tuberculoma


18 A 24 years old primipara was hospitalised with complaints about discharge of the amniotic waters. The uterus is tonic on palpation. The position of the fetus is longitudinal, it is pressed with the head to pelvic outlet. Palpitation of the fetus is rhythmical, 140 bpm, auscultated on the left below the navel. Internal examination: cervix of the uterus is 2,5 cm long, dense, the external os is closed, light amniotic waters out of it. Point a correct component of the diagnosis:

A. Pathological preterm labour

B. The end of the 1st stage of labour

C. Antenatal discharge of the amniotic waters

D. Early discharge of the amniotic waters

E. The beginning of the 1st stage of labour


19 A 50 year old woman with a 2-year history of mild, diffuse, tender thyroid enlargement complains of 10 pound weight gain and fatigu E. What is the most probable diagnosis?

A. Riedel's thyroiditis

B. Subacute thyroiditis

C. Papillary thyroid carcinoma

D. Suppurative thyroiditis

E. Hashimoto's thyroiditis


20 A parturient woman is 27 year old, it was her second labour, delivery was at term, normal cours E. On the 3rd day of postpartum period body temperature is 36,8oC, Ps - 72/min, AP - 120/80 mm Hg. Mammary glands are moderately swollen, nipples are clean. Abdomen is soft and painless. Fundus of uterus is 3 fingers below the umbilicus. Lochia are bloody, moderat E. What is the most probable diagnosis?

A. Physiological course of postpartum period

B. Remnants of placental tissue after labour

C. Postpartum metroendometritis

D. Subinvolution of uterus

E. Lactostasis


21 A pregnant woman may be diagnosed with hepatitis if it is confirmed by the presence of elevated:

A. WBCs

B. SGOT (ALT)

C. Alkaline phosphatase

D. BUN

E. Sedimentation rates


22 A patient complained about general weakness, fever, painful rash on his trunk skin . He has been suffering from this for 3 days. Objectively: lateral surface of trunk on the left is hyperemic and edematic, there are some groups of vesicles with serous and haemorrhagic contents. What is the most probable diagnosis?

A. Herpes zoster

B. Herpetiform Duhring's dermatosis

C. Contact allergic dermatitis

D. Microbial eczema

E. Contact dermatitis simplex


23 A 14 year old patient complains of chest pain, temperature up to 38,5oC, breathlessness. He had acute tonsillitis 2 weeks ago. He is in grave condition. The skin is pal E. Heart borders are dilated, heart sounds are quiet. Above total heart area you can hear pericardium friction soun D. Electrocardiogram: the descent of QRS voltage, the inversion T. The liver is enlarged by 3 cm. ESR - 4 mm/h, ASL - 0 - 1260, C-reactive protein +++. Your diagnosis:

A. Septic endocarditis

B. Rheumatic endocarditis

C. Rheumatic pericarditis

D. Rheumatic pancarditis

E. Rheumatic myocarditis


24 A 3 year old child fell acutely ill, body temperature rose up to 39,5oC, the child became inert, there appeared recurrent vomiting, headach E. Examination revealed positive meningeal symptoms, after this lumbal puncture was performe D. Spinal fluid is turbid, runs out under pressure, protein concentration is 1,8 g/l; Pandy reaction is +++, sugar concentration is 2,2 millimole/l, chloride concentration - 123 millimole/l, cytosis is 2,35*109 (80% of neutrophils, 20% of lymphocytes). What is the most probable diagnosis?

A. Serous tuberculous meningitis

B. Brain tumour

C. Serous viral meningitis

D. Purulent meningitis

E. Subarachnoid haemorrhage


25 An 8 year old child has low-grade fever, arthritis, colicky abdominal pain and a purpuric rash llocalized on the lower extremities. laboratory studies reveal a guaiac-positive stool, urinalysis with red blood cell (RBC) casts and mild proteinuria, and a normal platelet count. The most likely diagnosis is:

A. Poststreptococcal glomerulonephritis

B. Rocky Mountain spotted fever

C. Idiopathic thrombocytopenic purpura

D. Systemic lupus erythematosus (SLE)

E. Henoch-Schonlein's vasculitis


26 A pregnant woman in her 40th week of pregnancy undergoes obstetric examination: the cervix of uterus is undevelope D. The oxytocin test is negativ E. Examination at 32 weeks revealed: AP 140/90 mm Hg, proteinuria 1 g/l, peripheral edemat A. Reflexes are normal. Choose the most correct tactics:

A. Absolute bed rest for 1 month

B. Labour stimulation after preparation

C. Complex therapy of gestosis for 2 days

D. Complex therapy of gestosis for 7 days

E. Caesarian section immediately


27 At year-end hospital administration has obtained the following data: annual number of treated patients and average annual number of beds used for patients' treatment. What index of hospital work can be calculated on the base of this data?

A. Bed turnover

B. Bed resources of the hospital

C. Average bed idle time

D. Average duration of patients' presence in the hospital

E. Average annual bed occupancy


28 A 40 year old woman has a self-detected hard breast mass. The procedure of choice for confirming the diagnosis is:

A. Excision biopsy

B. Thermography

C. Ultrasonography

D. Aspiration biopsy with cytology

E. Mammography


29 A 30 year old patient complains about inability to become pregnant over 3 years of married lif E. The patient is of supernutrition type, she has hair along the median abdominal line, on the internal thigh surface and in the peripapillary are A. Menses started at the age of 16, they are infrequent and non-profus E. US revealed that the uterus was of normal size, ovaries were 4х5х5 cm large and had a lot of cystic inclusions. What is the most probable diagnosis?

A. Chronic oophoritis

B. Polycystic ovaries

C. Menstrual irregularity

D. Ovarian cystoma

E. Bilateral ovarian tumours


30 A 3 year old child has been suffering from fever, cough, coryza, conjunctivitis for 4 days. He has been taking sulfadimethoxin E. Today it has fever up to 39oC and maculopapular rash on its fac E. Except of rash the child's skin has no changes. What is your diagnosis?

A. Scarlet fever

B. Rubella

C. Pseudotuberculosis

D. Measles

E. Allergic rash


31 A 3 year old child with weight defficiency suffers from permanent moist cough. In history there are some pneumonias with obstruction. On examination: distended chest, dullness on percussion over the lower parts of lungs. On auscultation: a great number of different rales. Level of sweat chloride is 80 millimol/l. What is the most probable diagnosis?

A. Pulmonary hypoplasia

B. Recurrent bronchitis

C. Bronchial asthma

D. Mucoviscidosis (cystic fibrosis)

E. Bronchiectasis


32 A 28 year old patient was admitted to the clinic with complaints of the temperature rise up to 39,0oC, headache, weakness, constipation on the 9th day of the diseas E. On examination: single roseolas on the skin of the abdomen are present. The pulse rate is 78 bpm. The liver is enlarged by 2 cm. What is the most probable diagnosis?

A. Typhoid fever

B. Sepsis

C. Leptospirosis

D. Malaria

E. Brucellosis


33 A fitter of a metallurgic factory with occupational exposure to high concentrations of mercury fumes for 16 years presents instability of pulse and blood pressure, general hyperhydrosis, asymmetric innervations of facial muscles and tongue, positive subcortical reflexes, hand tremor on physical examination. A dentist revealed paradontosis and chronic stomatitis. What is the most probable diagnosis?

A. Neuroinfection

B. Parkinson syndrome

C. Mercury encephalopathy

D. Acute mercury intoxication

E. Chronic mercury intoxication


34 A military unit stopped for 3-day's rest in an inhabited locality after a long march. The sanitary-epidemiological reconnaissance found several water sources. It is necessary to choose the source complying with the hygienic standards for drinking water in the field conditions:

A. River water

B. Artesian well water

C. Rain water

D. Spring water

E. Melt snow water


35 A 52 year old woman complains about face distortion. It appeared 2 days ago after supercooling. Objectively: body temperature is 38,2oC. Face asymmetry is present. Frontal folds are flattene D. Left eye is wider than right one and doesn't clos E. Left nasolabial fold is flattened, mouth corner is lowere D. Examination revealed no other pathology. Blood count: leukocytes – 10*109/l, ESR - 20 mm/h. What is the most probable diagnosis?

A. Hemicrania (migraine)

B. Trigeminus neuralgia

C. Brain tumour

D. Ischemic stroke

E. Facial neuritis


36 A patient has a stab wound on his right foot. On the fourth day after injury the patient's body temperature rose up to 38oC, inguinal lymph nodes became enlarged and painful, skin over them reddene D. What complication might be suspected?

A. Phlegmon

B. Lymphangitis

C. Tetanus

D. Erysipelas

E. Lymphadenitis


37 A 9 year old girl with a history of intermittent wheezing for several years is brought to the pediatrician. The child has been taking no medications for some tim E. Physical examination reveals agitation and perioral cyanosis. Intercostal and suprasternal retractions are present. The breath sounds are quiet, and wheezing is audible bilaterally. The child is admitted to the hospital. Appropriate interventions might include all of the following EXCEPT:

A. Prescribe intravenous corticosteroids

B. Prescribe intravenous aminophylline

C. Prescribe nebulized metaproterenol

D. Administer supplemental oxygen

E. Prescribe nebulized cromolyn sodium


38 A woman in her 39th week of pregnancy, the second labour, has regular birth activity. Uterine contractions take place every 3 minutes. What criteria describe the beginning of the II labor stage the most precisely?

A. Duration of uterine contractions over 30 seconds

B. Cervical dilatation by no less than 4 cm

C. Rupture of fetal bladder

D. Presenting part is in the lower region of small pelvis

E. Cervical smoothing over 90\%


39 In order to study impact of microclimate upon the human organism it is necessary to make systematic observation of air temperature over 3 days. Choose a device that will allow to make the most precise temperature records:

A. Thermograph

B. Alcohol thermometer

C. August's psychrometer

D. Mercury thermometer

E. Assmann psychrometer

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