Krok 2- 2019 1

Krok 2 – 2019 (General Medicine) food to the child‟s diet. What products should be
introduced to the child‟s diet first? 1. Buckwheat
porridge
1. After a pain attack in the right subcostal area, a 2. Fermented dairy products
58year-old woman with overnutrition developed icteric 3. Grated apple
skin and sclera, light colored feces, and dark urine. 4. Semolina porridge
Her abdomen is distended and painful on palpation in 5. Vegetable puree
the right subcostal area. Palpation detects liver
enlarged by 2-3 cm. Blood test: Total bilirubin – 90 6. A 52-year-old man for the last 3 years has been
mcmol/L, conjugated bilirubic – 60 mcmol/L. What suffering from difficult swallowing of solid food,
method of examination will be most informative for burning retrosternal pain that aggravated during
diagnosis clarification? 1. Infusion cholegraphy eating, loss of body mass and occasional vomiting
2. US of the hepatopancreatobiliary zone with undigested food. Esophageal X-ray shows S-
3. Retrograde cholangiopancreatography shaped deformation of the esophagus and its dilation;
4. Percutaneous transhepatic cholegraphy at the cardiac orifice the esophagus is constricted;
5. Intravenous cholegraphy Esophageal mucosa is smooth, without signs of
peristalsis. Make the provisional diagnosis: 1.
2. A 20-year-old student after failing an exam developed Esophageal diverticulum
complaints of a sensation of a round foreign body in her 2. Diaphragmatic hernia
throat, difficult swallowing. She fixates on her condition, 3. Reflux esophagitis
limits her diet, often cries, seeks attention, exhibits 4. Esophageal achalasia
demonstrative attitude. She is highly susceptible to 5. Esophageal carcinoma
psychotherapeutic suggestion. What psychiatric
diagnosis can be made in this case? 7. Disease onset was acute. A child developed general
1. Hypochondriacal neurosis weakness, pain in the joints and elevated temperature.
2. Hysterical neurosis Later these signs became accompanied by itching skin
3. Paranoid personality disorder rash manifested as erythematous spots 2-5 mm in size.
4. Depressive neurosis The rash gradually turned hemorrhagic. Large joints are
5. Obsessive neurosis painful and swollen; pain attacks periodically occur in the
paraumbilical area; there are signs of intestinal
3. A 32-year-old woman complaints of episodes of haemorrhage. What is the most likely diagnosis?
intense fear that occur without visible cause and last for 1. Scarlet fever
10-20 minutes; the episodes are characterized by 2. Hemorrhagic meningoencephalitis
raped pulse, sweating, labored breathing and vertigo. 3. Streptococcal impetigo
Specify the likely diagnosis: 1. Simple schizophrenia 4. Rheumatism
2. Paranoid syndrome 5. Hemorrhagic vasculitis (Henoch-Schonlein purpura)
3. Panic disorder
4. Manic syndrome 8. 2 hours after a traffic accident a 28 year old man in a
5. Claustrophobia grave condition was brought to a hospital. The patient
complains of abdominal pain. He received a blow to the
4. A 48-year-old woman developed insomnia, depressive abdomen wit the steering wheel. Objective examination
mood, anxiety, fears and suicidal thoughts after the revealed the following: the abdomen does not participate
death of her husband that occurred one month ago. in respiration, is tense and acutely painful on palpation;
During her stay in the hospital she speaks in a low voice, the abdominal muscles are defensively tense, peritoneal
is depressed, anxious, avoids sleeping, refuses to eat. irritation signs are positive, hepatic dullness is absent.
What medications should be prescribed in this case? BP is 90/60 mmHg, heart rate is 120/min. What further
1. Antidepressants treatment tactics should be chosen?
2. Group B vitamins 1. Ultrasound investigation
3. Antipsychotics 2. Laparoscopy
4. Anticonvulsants 3. Laparotomy
5. Nootropics 4. Cold to the abdomen
5. A 6-month-old child on breastfeeding is hospitalized in 5. Laparocentesis
the inpatient department. After the child recovers, the
doctor recommends the mother to start introducing solid
Krok 2- 2019 2

9. Employees work in conditions of high dust 13. A 32-year-old woman complains of body weight loss
concentration. Certain chemical (silicon dioxide content) despite her increased appetite, nervousness, and tremor
and physical properties of dust aerosols contribute to the if the extremities. Objectively: the skin is moist; the
development of occupational dust induced diseases. thyroid gland is diffusely enlarged, painless, soft and
What is the main physical property of dust aerosols? mobile. Blood test: increased level of T3, T4 and
1. Solubility thyroidstimulating hormone(THS). What is the most
2. Ionization likely diagnosis? 1. Thyroid carcinoma
3. Electric charge 2. Diffuse nontoxic goiter 3.
4. Magnetization Autoimmune(Hashimoto‟s) thyroiditis
5. Dispersion 4. Diffuse toxic goiter
5. Thyroid adenoma
10. A 37-year-old patient complains of pain in the spinal
column, reduced mobility. The condition persists for 7 14. A 22-day old infant developed subcutaneous red
years. „Sway back‟ is observed, there is no movement in nodes from 1.0 to 1.5 cm in size on the scalp; later the
all spinal regions. X-ray shows „bamboo spine‟ vertebral nodes suppurated. Temperature increased upto 37.7 oC,
column. What is the most likely diagnosis? intoxication symptoms appeared, regional lymph nodes
1. Osteochondrosis enlarged. Complete blood count: anemia, leucocytosis,
2. Tuberculous spondylitis neutrocytosis, increased ESR. What diagnosis can be
3. Spondylolisthesis made?
4. Spondylitis deformans 1. Vesiculopustulosis
5. Ankylosing spondyloarthritis 2. Pemphigus
3. Pseudofurunculosis
11. During regular medical examination a lyceum student 4. Scalp phlegmon
presents with signs of cheilitis that manifests as epithelial
maceration in the area of lip seal. The lips are bright-red, 15. A man was brought into the admission room after an
with single vertical cracks covered with brown-red scabs. overexposure to cold. He complains of sharp pain in the
These clinical signs are most likely caused by insufficient small of his back and elevated body temperature upto 38
content of the following in this diet: o He took some aspirin. Blood test: leukocyutes – 10.5 x
1. Calciferol 1012/L, eosinophils – 5%, band neutrophils – 8%,
2. Thiamine segmented neutrophils – 51%, lymphocytes – 32%,
3. Retinol monocytes – 4%, erythrocyte sedimentation rate – 28
4. Riboflavin mm/hour. Urinalysis: Protein – 0.6 g/L, leukocytes –
5. Ascorbic acid cover the whole vision field, large amount of mucus.
What is the most likely diagnosis?
12. A 25-year-old woman was brought into gynecological 1. Acute glomerulonephritis
department with profuse bloody discharge from her 2. Chronic pyelonephritis
genital tracts. She is 12 weeks pregnant; the pregnancy 3. Acute pyelonephritis
is planned. Within the last 3 days she was experiencing 4. Subacute malignant glomerulonephritis
pains in her lower abdomen that eventually started 5. Tubulointerstitial nephritis
resembling cramps, she developed bleeding. Her skin is
pale, pulse- 88/min., blood pressure- 100/60 mm Hg, 16. A 47-year-old man developed the signs of
body temperature – 36.8°C . Vaginal examination: the decompensated laryngeal stenosis against the
uterus size corresponds with 11 weeks of pregnancy, the background of acute phlegmonous laryngitis. He
cervical canal allows inserting 1 finger and contains presents with inspiratory dyspnea at rest, forced position,
fragments of the fertilized ovum, the discharge is bloody cyanotic skin covered in cold sweat, tachycardia,
and profuse. What is the most likely diagnosis? deficient pulse, and low blood pressure.
1. 12-week pregnancy, spontaneous abortion in What urgent treatment tactics should be chosen?
progress 1. Oxygen therapy
2. Disturbed menstrual cycle, hyperpoylme-norrhea 2. Oral administration of hypersensitization substances
3. Disturbed menstrual cycle, amenorrhea and broncholytics
4. Full-term pregnancy, term labor
5. 12-week pregnancy, threatened spontaneous 3. Administration of glucocorticoid hormones
abortion 4. Tracheostomy
5. Intravenous administration of dehydrating agents
Krok 2- 2019 3

17. A 45-year-old man underwent a cardiac surgery one 4. Posthemorrhagic anaemia

week ago. His general state has been deteriorating since 5. Dysmenorrhea
then; dyspnea at rest, retrosternal pain that irradiates to
the neck, marked weakness. Objectively his body 21. After eating shrimps, a 25 year old man suddenly
temperature is hectic. His cardiac borders are expanded, developed skin itching, some areas of his skin became
apical beat is weakened. Auscultation detects pericardial hyperemic or erupted into vesicles. Make the diagnosis:
friction rub. What is the most likely diagnosis? 1. Psoriasis
1. Pulmonary embolism 2. Acute urticaria
2. Myocardial infarction 3. Urticaria pigmentosa
3. Acute pericarditis 4. Scabies
4. Acute myogenic dilation of the heart 5. Hemorrhagic vasculitis (Henoch-Schonlein purpura)
5. Acute cardiac aneurysm
22. A 35-year-old man complains of marked dyspnea and
18. An 11 year old boy for a month has been presenting cardiac pain. He describes his disease to the case of
with increasing pain in the right femur. In the painful influenza that he had 2 weeks ago. Objectively he leans
area there is a non mobile painful tumor with unclear forward when sitting. The face is swollen, cyanotic,
margins. The child complains of general indisposition, cervical veins are distended. Heart borders are extended
weakness, increased body temperature up to 39oC. X- on both sides, heart sounds are muffled, heart rate = Ps
ray shows widened medullary cavity, small foci of = 118/min, BP is 90/60 mmHg. Blood test: ESR is 46
cancellous bone destruction, and onion like lamellar mm/hour. ECG shows low voltage. X-ray shows
exfoliation of the cortical layer. What is the most likely trapezoidal cardiac silhouette and signs of pulmonary
pathology resulting in such clinical presentation? 1. congestion. Choose the treatment tactics:
Ewing sarcoma 1. Antibiotics
2. Chondrosarcoma 2. Pericardectomy
3. Juxtacortical sarcoma 3. Pericardial puncture (pericardiocenthesis)
4. Fibrosarcoma 4. Diuretics
5. Osteogenic sarcoma 5. Glucocorticosteriods

19. After a surgery for a left thigh phlegmon the disease 23. A 7-year-old boy has been an inpatient for 1.5
progression was complicate by sepsis. On the 7th day months. He had been brought to the hospital with
after the surgery, there are marked signs of a complaints of edemas all over his body, low urine output
generalized inflammatory reaction, in blood there are and headache. Clinical urinalysis: proteins – 7.1 g/L,
signs of toxic anemia and progressing hypoprotieinemia, leukocytes – 1-2 in the vision field, erythrocytes – 3-4 in
bilirubin levels are 40 mcmol/L, AST and ALT exceed the the vision field. During the course of treatment, the
norm by 2.5 times. Oliguria persists (700 mL of urine per edemas gradually dissipated, headache abated, diuresis
day). Name the phase of sepsis progression: normalized. Daily urine proteins – 3g/L. Biochemical
1. Stress phase blood test; total protein – 43.2 g/L, urea – 5.2 mmol/L,
cholesterol – 9.2 mmol/L. What glomerulonephritis
2. Recovery phase
syndrome is the most likely to be present in the patient?
3. Mixed phase
1. Mixed
4. Catabolic phase
2. Nephritic
5. Anabolic phase
3. Isolated urinary
20. A 14-year-old girl came to the general practitioner 4. Hematuric
with complaints of weakness, loss of appetite, headache, 5. Nephrotic
rapid fatigability. Her last menstruation was profuse and
lasted for 14 days after the previous delay of 2 months. 24. A 3-year-old child has been brought to a hospital with
Objectively; the skin is pale, heart rate is 90/min, BP is complaints of pain in the legs, fever, and loss of appetite.
110/70 mmHg, Hb is 88 g/L. Rectal examination; the Objectively: pale skin and mucosa, haemorrhagic rash.
uterus and its appendages are without changes, no Lymph nodes are enlarged, painless, dense and elastic,
discharge from the genital tracts. What complication not matted together. Bones, joints, and abdomen are
occurred in the patient? painful. The liver and spleen are enlarged. Hemogram:
1. Gastritis Hb- 88 g/L, color index – 1.3, platelets – 80 x 109/L,
leukocytes – 25.8 x 109/L, lymphoblasts – 70% , ESR-
2. Migraine
52mm/hour. Make the provisional diagnosis: 1. Acute
3. Somatoform autonomic dysfunction of hypotonic type
rheumatic fever
Krok 2- 2019 4

2. Thrombocytopenic purpura breathing, dyspnea and dry cough. Ten days ago he
3. Acute leukaemia slipped and fell hitting his right side. On examination: the
4. Infectious mononucleosis patient lies on the left side. The right side of the thorax
5. Haemorrhagic vasculitis( Henoch-Schonlein purpura) lags during breathing. On the right there are crepitation
and pain in the III-IV ribs. Dullness of percussion sound
25. A 43-year-old man complains of a protrusion in the and sharply diminished breath sounds can be observed.
right inguinal region, that enlarges due to strain. He On X-ray; signs of exudate, fracture of the III-IV ribs. On
has been presenting with this condition for 6 months. pleurocentesis; blood is detected. Choose the further
Within this period the protrusion has grown. Objectively tactics:
in the right inguinal region an elastic protrusion 8×5 cm 1. Perform repeated pleural taps
is visible. On palpation it disappears, leaving an empty 2. Transfer to a thoracic surgery department
space 4×4 cm between the pedicles of the Poupart 3. Prescribe conservative therapy
ligament. “Cough push” sign is positive over this 4. Apply a fixation bandage to the rib cage
opening. Make the diagnosis: 1. Cyst of the right 5. Refer to a traumatologist
spermatic cord
2. Right-sided reducible inguinal hernia 29. A woman in her early to mild thirties has lost her
3. Right-sided reducible femoral hernia consciousness 3-5 minutes ago. On examination: the
4. Right-sided reducible arcuate line hernia skin is pale, no pulse over the carotid arteries, no
5. Right-sided inguinal lymphadenitis spontaneous respiration, pupils are dilated; the patient is
nonresponsive, presents with atony. The patient‟s
26. A 32-year-old woman complains of tumor like condition can be determined as:
formation on the anterior surface of her neck that 1. Syncope
appeared 2 year ago. Within the last 3 months the tumor 2. Brain death
has been rapidly growing. It hinders swallowing and 3. Comatose state
impairs speech; the tumor causes a sensation of 4. Natural death
pressure. Objectively the skin moisture is normal. Pulse 5. Clinical death
is 80/min, rhythmic, blood pressure is 130/80 mmHg. In
the right lobe of the thyroid gland there is a dense lumpy 30. A 9-month-old infant presents with delayed tooth
node 3.0×3.5 cm that moves during swallowing. eruption and fontanel closure, weakness and excessive
Scanning image shows a „cold nodule‟ in the thyroid sweating. What type of hypovitaminosis is the most likely
gland. Make the provisional diagnosis: in this child?
1. Thyroid cancer 1. Hypovitaminosis B6
2. Thyroid cyst 2. Hypovitaminosis A
3. Thyroid adenoma 3. Hypovitaminosis D
4. Nodular goiter 4. Hypovitaminosis B1
5. Autoimmune thyroiditis 5. Hypovitaminosis C

27. A 38-year-old woman after physical overexertion 31. A 45-year-old woman complains of intolerable
suddenly developed palpitations, dyspnea and dull pain paroxysmal facial pain on the left with attacks that last for
in the cardiac area. For 10 years she has been 1-2 minutes. Attacks are provoked by chewing. The
registered for regular check-ups due to rheumatism and disease onset was two months ago after the
mitral valve disease with non-distributed blood overexposure to cold. Objectively: pain at the exit points
circulation. Objectively her pulse is 96/min of unequal of the trigeminal nerve on the left. Touching near the
strength. Blood pressure is 110/70 mmHg, heart rate is wing of the nose on the left induces a pain attack with
120/min. ECG registers small unevenly sized waves in tonic spasm of the facial muscles. What is the most likely
place of P waves, R-R intervals are of unequal length.
diagnosis? 1. Facial migraine
What is the most likely diagnosis?
2. Trigeminal neuralgia
1. Atrial flutter
3. Temporomandibular joint arthritis
2. Paroxysmal supraventricular tachycardia
4. Glossopharyngeal neuralgia
3. Respiratory arrhythmia
5. Maxillary sinusitis
4. Atrial fibrillation
5. Paroxysmal ventricular tachycardia 32. During analysis of morbidity in the city, it was
determined that age structure of population is different in
28. A 62-year-old patient has been hospitalized with
complaints of pain in the thorax on the right during
Krok 2- 2019 5

each district. What statistical method allows to exclude difficult breathing, constricting sensation in her chest and
this factor, so that it would not skew the morbidity data? cough attacks. These signs appear on the first day of her
1. Standardization working week and gradually diminish on the following
2. Dynamic time series analysis days. What respiratory disease is likely in this case?
3. Correlation regression analysis 1. Silicosis
4. Wilcoxon signed rank test 2. Bronchial asthma
5. Analysis of average values 3. Allergic rhinopharyngitis
4. Byssinosis
33. A 72-year-old man with pneumonia complains of 5. Asthmatic bronchitis
marked dyspnea, chest pain, severe cough with
expectoration, temperature is 39.5-40.0 oC, no urination 37. A 33-year-old man developed multiple rashes on the
for a whole day. Objectively the patient is conscious. skin of his torso and extensor surfaces of his upper and
Respiratory rate is 36/min. Over the right lower lower limbs. The rashes itch and occasionally fuse
pulmonary lobe percussion sound is dull; on auscultation together and form plaques. The elements of rash are
there is bronchial respiration and numerous moist covered with silver-white fine scales that easily flake off
crackles. BP is 80/60 mmHg. Heart rate is 120/min. when scratched. Grattage test results in three sequential
Heart sounds are muffled, there is tachycardia. What phenomena: Stearin spot, terminal film and punctate
tactics should the family doctor choose in the haemorrhage. What diagnosis can be suspected?
management of this patient? 1. Pyoderma
1. Outpatient treatment 2. Lichen ruber planus
2. Hospitalization into the pulmonology unit 3. Parapsoriasis
3. Hospitalization into the neurology unit 4. Secondary popular syphilid
4. Hospitalization into the intensive care unit 5. Psoriasis
5. Treatment in the day patient facility
38. On the 15th day after a small trauma of the right foot,
34. A 59-year-old woman was brought into the the patient developed indisposition, fatigability, irritability,
rheumatology unit. Extremely severe case of headache, elevated body temperature, and sensation of
scleroderma is suspected. Objectively she presents constriction, tension and twitching in the muscles of the
with malnourishment “mask-like” face, and acro- right shin. What disease can be suspected?
osteolysis. Blood: erythrocytes – 2.2 x 109 /L, 1. Anaerobic gas gangrene
erythrocyte sedimentation rate – 40 mm/hour. Urine: 2. Tetanus
elevated levels of free oxyproline. Name one of the 3. Thrombophlebitis of the popliteal artery
most likely pathogenetic links in this case: 1. Formation 4. Acute thrombophlebitis
of antibodies to collagen 5. Erysipelas
2. Formation of antibodies to blood corpuscles
3. Formation of antibodies to vessel wall 4. 39. A 27-year-old man complains of pain in his leg joints,
Formation of antibodies to transversely striated purulent discharge from the eyes and painful burning
muscles sensations during urination. Disease onset was acute.
5. Formation of antibodies to native DNA He has a history of influenza. The patient smokes and
drinks alcohol in excess. In his line of work he is often
35. After overexposure to cold a 45 year old woman away on business trips. What is the most likely
developed acute pain in her suprapubic and lumbar etiological factor of this disease?
areas during urination, sharp pains at the end of 1. Candida
urination, false urges to urinate. Urine is turbid with blood 2. Adenovirus
streaks. The doctor suspects urinary tract infection. What 3. Staphylococci
results of laboratory analysis would be the most 4. Chlamydia
indicative of such infection? 5. Streptococci
1. Daily proteinuria over 3.0
2. Gross hematuria 40. A 53-year-old man complains of general weakness,
3. Daily proteinuria under 3.0 loss of appetite, a painful vesicles appearing on his skin.
4. Increased blood creatinine and blood urea The disease onset occurred suddenly, after
5. Leukocyturia gross hematuria hyperinsolation one week ago. Examination detects
isolated vesicles with wrinkled opercula and occasional
36. A 38-year-old woman works in flax processing, she painful erosions on the skin of the patient‟s torso and
dries flax. She came to the hospital complaining of
Krok 2- 2019 6

limbs. Nikolsky sign is positive. What is the most likely 1. Urgent report
diagnosis? 1. Toxicodermia 2. Certificate of temporary disability
2. Acantholytic pemphigus 3. Report on a major non-epidemic disease
3. Herpes 4. Statistical report
4. Duhring‟s disease (Dermatitis herpetiformis) 5. Control card of a patient registered for regular
5. Nonacantholytic pemphigus checkups

41. A 40 year old man, a welder, uses manganese 45. A 57-year-old patient complains of dyspnea at rest.
electrodes in his line of work (18 year of experience). He The patient presents with orthopnoea, acrocyanosis,
complains of difficulties with writing, bad mood, bulging cervical veins. On percussion: dull sound over
inertness, gait abnormalities, problems with speech, and the lower lung segments. On auscultation: no respiratory
hand tremors. Objectively the following is observed in sounds. Heart rate is 92/min. Right-sided cardiac
the patient: hypomimia, increased muscle tone of plastic dilatation is observed. The liver is +7cm. Shins are
type, and quiet monotonous speech, tremor of the swollen. Pleural effusion is suspected. What indicator
tongue, pill-rolling tremor of the fingers, and retropulsion. would confirm the presence of transudate in this case?
What syndrome developed in this patient due to 1. Positive Rivalta‟s test
manganese poisoning? 2. Total protein content in the pleural fluid below 25 g/L
1. Polyneuritic syndrome 3. Total protein content in the pleural fluid exceeding
2. Meningism 30g/L
3. Parkinsonism 4. Specific gravity exceeding 1015
4. Vestibular syndrome 5. Presence of atypical cells
5. Hypothalamic syndrome
46. A 40-year man claims that his wife is cheating on
42. A 42 year old man, a dispatcher, suffers from peptic him and presents a „proof‟ of her infidelity. He
ulcer disease of the duodenum. The disease is of repeatedly initiated scandals with his wife at home and
moderate severity. He wants to be assigned a disability at work, demanding that she confess her infidelity,
group. Make the conclusion regarding his working ability: insulted her and threatened to kill her. What preventive
1. Capable of working, non-employable measures should be taken against socially dangerous
2. First group of disability actions on his part? 1. Family counselling
3. Capable of working, employable 2. Consultation with the psychologist
4. Second group of disability 3. Consultation with the psychiatrist
5. Third group of disability 4. Consultation with the general practitioner
5. Outpatient treatment
43. A woman is 40 weeks pregnant. The fetus is in the
longitudinal lie and cephalic presentation. Pelvic size: 47. A woman with the pregnancy term of 8 weeks
26-29-31-20. Expected weight of the fetus is 4800 gram. complains of elevated temperature upto 37.6°C, skin
The labor contractions has been lasting for 12 hours, rash that can be characterized as macular exanthema,
within the last 2 hours they were extremely painful, the enlargement of posterior cervical and occipital lymph
parturient woman is anxious. The waters broke 4 hours nodes, small amount of bloody discharge from the
ago. On external examination the contraction ring is genital tracts. She was examined by the infectious
located 2 finger widths above the navel, Henkel-Vasten diseases specialist and diagnosed with rubella. What
sign is positive. Fetal heart rate is 160/min, muffled. On tactics should the obstetrician-gynaecologist choose?
internal examination the uterine cervix is fully open, the 1. Treatment of incipient abortion
head is engaged and pressed to the entrance into the 2. Prescription of hemostatic therapy
lesser pelvis. What is the most likely diagnosis? 1. 3. Prescription of antiviral therapy
Hyperactive uterine contractions 4. Prescription of antibacterial therapy
2. Abruption of normally positioned placenta 5. Abortion
3. Complete uterine rupture
4. Threatened uterine rupture 48. A 26 year old woman is suspected to suffer from
5. Anatomically contracted pelvis systemic lupus erythematosus due to systemic lesions of
skin, vessels, joints, serous tunics and heart that
44. A district doctor has diagnosed one of his patients developed after photosensitization. The following is
with dysentery. What accounting document reflects this detected: LE cells, antibodies to native DNA, isolated
type of morbidity? anti-centromere antibodies, rheumatoid factor is 1:100,
Krok 2- 2019 7

Wassermann reaction is positive, circulating immune apex and dullness in the lower lobe. What complication
complex is 120 units. What immunological indicators are developed in this patient? 1. Pneumothorax
considered to be specific to this disease? 2. Pyopneumothorax
1. Anti centromere antibodies 3. Pleuropneumonia
2. Immunoglobulin A 4. Esophageal perforation
3. DNA antibodies 5. Acute mediasinitis
4. Increased circulating immune complex
5. Rheumatoid factor 53. A 30-year-old maltigravida has been in labour for 18
hours. 2 hour ago the pushing stage began. Fetal heart
49. A patient has the second and third degree burns of rate is clear, rhythmic, 136/min. Vaginal examination
the 15% of the body surface. On the 20th day after the reveals complete cervical dilation, the fetal head in the
trauma the patient presents with sharp increase of body pelvic outlet plane. Sagittal suture is in line with obstetric
presents with sharp increase of body temperature, conjugate, the occipital fontanel is near the pubis. The
general weakness, rapid vesicular respiration; facial patient has been diagnosed with primary uterine inertia.
features are sharpened, BP is 90/50 mmHg, heart rate is What is the further tactics of labor management?
112/min. What complication is it? 1. Skin head Ivanov‟s forceps
1. Acute intoxication 2. Labour stimulation
2. Pneumonia 3. Outlet forceps
3. Sepsis 4. Cesarean section
4. Purulent bronchitis 5. Vacuum extraction of the fetus
5. Anaerobic infection
54. A 17-year-old girl has made an appointment with
50. A 45 year old woman came to the maternity clinic doctor. She plans to begin her sex life. No signs of
with complaints of periodical pains in her mammary gynecological pathology were detected. In the family
glands that start 1 day before menstruation and stop history the patient‟s grandmother had cervical cancer.
after the menstruation begins. Palpation of the mammary The patient was consulted about the maintenance of her
glands detects diffuse nodes predominantly in the upper reproductive health. What recommendation will be most
outer quadrants. What is the most likely diagnosis? helpful for prevention of invasive cervical cancer?
1. Breast cyst 1. Vitamins, calcium, omega 3
2. Hyperprolactinemia 2. Antiviral and antibacterial drugs
3. Fibrocystic mastopathy 3. Timely treatment of sexually transmitted diseases 4.
4. Breast cancer Immunomodulators
5. Mastitis 5. Vaccination against human papillomavirus (HPV)

51. A 26-year-old man complains of chills, rhinitis, dry 55. A 1-year old child with a case of URTI suddenly
cough and fever up to 38 o Examination shows him to developed noisy respirations with difficult inspiration,
be in a moderately severe condition; there are small intercostal retractions and barking cough on the 2nd
pale pink non-merging spots on the skin of his back, night after the disease onset. What is the most likely
abdomen and extremities. Palpation reveals enlarged diagnosis? 1. Bronchial asthma
occipital and axillary lymph nodes. No information about 2. Acute bronchiolitis
vaccination history could be obtained. What is the likely 3. Acute bronchitis
etiology of this disease? 1. Epstein-barr virus 4. Acute pulmonary inflammation
2. Neisseria meningitis 5. Stenosing laryngotracheobronchitis
3. Mumps virus
4. Streptococcus 56. A 35 year old man complains of rapidly increasing
5. Rubella virus fatigue, palpitations, „visual snow‟, and dizziness. He
has a history of peptic ulcer of the stomach. Objectively
52. A 45-year-old man diagnosed with acute pulmonary the skin is pale. Vesicular respiration is observed in the
abscess suddenly developed sharp pain in his chest on lungs. Systolic murmur is detected over the cardiac
the right and dyspnea upto 30/min. Examination detects apex, heart rate is 100/min., BP is 100/70 mmHg. The
facial cyanosis and shallow rapid respirations. epigastrium is slightly tender on palpation. Blood test:
Auscultation reveals acutely weakened respiration erythrocytes – 3.2 x 1012/L, Hb – 100 g/L, color index –
throughout the whole right lung; percussion reveals a 0.95. What type of anemia is the most likely present in
vesiculotympanititc (bandbox) resonance at the lung this case? 1. Hypoplastic anemia
Krok 2- 2019 8

2. Post-haemorrhagic anemia area, dyspnea at rest. For over 25 years he has been
3. Chronic iron-deficiency anemia suffering from COPD. Objectively: Orthopnea, jugular
4. Hemolytic anemia venous distension, diffuse cyanosis, acrocyanosis. Barrel
5. Sideroblastic anemia chest is observed, on „percussion there is a
vesiculotympanitic (bandbox) resonance, sharply
57. A 40-year-old man with Bekhterev disease weakened vesicular respiration on both sides, moist
(ankylosing spondylitis) complains of elevated body crepitant crackles in the lower segments of the lungs.
temperature upto 37.8°C, back pain and stiffness, Heart sounds are weakened, the II heart sound is
especially observed during the second half of the night. accentuated over the pulmonary artery. The liver is +3
This condition has been lasting for 2 years. Objectively: cm. What complicated the clinical course of COPD in this
reduced spinal mobility, painful sacroiliac joint. patient?
erythrocyte sedimentation rate – 45 mm/hour. X-ray 1. Pulmonary embolism
shows narrowing of the intervertebral disc space and of 2. Community acquired pneumonia
the sacroiliac joint. What eye pathology is often 3. Chronic pulmonary heart
associated with this type of disease progression ? 4. Acute left ventricular failure
1. Cataract 5. Diffuse pneumosclerosis
2. Blepharitis
3. Retinal detachment 61. A woman has been provisionally diagnosed with
4. Optic nerve atrophy pheochromocytoma. At the stage of intermission her BP
5. Iridocyclitis is within norm; there is tendency towards tachycardia.
No urine pathologies. The decision has been made to
58. A child is 1 year old. After solid food was introduced perform a provocative test with histamine. What drug
into the diet, within the last several months the child should be kept close at hand for emergency aid in case
developed loss of appetite, diarrhea with large amount of of positive test result? 1. Phentolamine
feces, and occasional vomiting. Body temperature 2. Prednisolone
remains normal. Body weight is 7 kg. The child is very 3. Pipolphen (Promethazine)
pale, has leg edemas and extremely distended 4. Mesaton (Phenylephrine)
abdomen. Feces analysis detects high levels of fatty 5. Nifedipine
acids and soaps. Diagnosis of celiac disease was made
and gluten free diet was prescribed. What should be 62. Clinical trials have proved the „Lipoflacon‟ drug to be
excluded from the diet in this case? effective for treatment of unstable angina pectoris in the
1. Easily digestible carbohydrates control group and experimental group of patients.
2. Cereals – Wheat, oats Neither patients nor researchers knew who belonged to
3. Animal protein which group. Name this type of study:
4. Fruits 1. Multicenter study
5. Milk and dairy products 2. Simple blind study
3. Triple blind study
59. A 10-year-old boy, who was outdoors in windy and 4. Total blind study
cold weather, developed moderate pain and tingling in 5. Double blind study
his fingers and toes. When he returned home, his
parents noticed that the tips of his fingers and toes were 63. Human body receives from the atmosphere a
white and their sensitivity was lost. As the affected areas number of chemicals. What type of action results in the
were warming up, the fingers and toes developed combined effects that is less than the sum of isolated
tingling and painful sensations. Skin pallor changed into effects of these chemicals on the body?
redness, tingling stopped, mild itching and swelling of 1. Complex action
fingers appeared. Determine the frostbite degree in this 2. Isolated action
child: 3. Synergistic action
1. Frostbite of the III degree 4. Potentiation
2. Frostbite of the I degree 5. Antagonism
3. Frostbite of the II degree
4. Frostbite of the IV degree 64. An 18-year-old young man complains of pain in his
5. Perniosis knee and elbow joints and body temperature upto 39.5 o
One week and a half earlier he developed sore throat.
60. A 72 year old man complains of lower extremity
edema, sensation of heaviness in the right subcostal
Krok 2- 2019 9

On examination his body temperature is 38.5 oC. 68. A 45-year-old man, a farmer, presents with acute
Swelling of the knee and elbow joints is observed. Pulse onset of a disease. He complains of headache, high
is 106/min, rhythmic. Blood pressure is 90/60 mmHg. temperature, pain in the gastrocnemius muscles, icteric
Cardiac borders are unchanged, heart sounds are face, and dark urine. Objectively: body temperature –
weakened, at the cardiac apex there is a soft systolic 38°C, blood pressure – 100/70 mm Hg, conjunctival
murmur. What factors would be the most indicative of haemorrhages, hepatosplenomegaly, and oliguria. What
the likely disease etiology? 1. Creatine kinase is the most likely provisional diagnosis?
2. Rheumatoid factor 1. Trichinosis
3. Anti streptolysin O 2. Pseudotuberculosis
4. C reactive protein 3. Leptospirosis
5. Seromucoid 4. Viral hepatitis
5. Brucellosis
65. A 40-year-old victim of a traffic accident sustained the
following injuries: closed diaphyseal femur fracture, brain 69. In the process of hiring, a prospective employee has
concussion, multiple rib fractures, hemopneumothorax, undergone preventive medical examination and was
degloving shin injuries. What injuries require the most declared fit to work in this manufacturing environment.
urgent attention? What type of preventive medical examination was it?
1. Closed diaphyseal femur fracture 1. Periodical
2. All injuries are equivalent 2. Specific
3. Degloving shin injuries 3. Comprehensive
4. Multiple rib fractures, hemopneumothorax 4. Preliminary
5. Brain concussion 5. Scheduled

66. To assess the effectiveness of medical technologies 70. A 56 year old woman was diagnosed with stage 2
and determine the power and direction of their effect on hypertension of the 2nd She belong to the group of
the public health indicators, the research was conducted moderate risk and has bronchial asthma. What group of
to study the immunization rate of children and measles drugs is CONTRAINDICATED to this patient ?
incidence rate by district. What method of statistical 1. Diuretics
analysis should be applied in this case? 2. Angiotensin converting enzyme inhibitors
1. Calculation of statistical significance of the 3. Calcium antagonist
difference between two estimates 4. Imidazoline receptor antagonists
2. Calculation of correlation coefficient 3. 5. B blockers
Calculation of morbidity index among the
nonvaccinated 71. A 42-year-old man, a worker at the meat processing
4. Calculation of standardized ratio factory, developed an itching spot on his lower jaw, which
5. Calculation of matching factor gradually transformed into a slightly painful carbuncle 3
cm in diameter, surrounded by a painless swelling that
reaches the clavicle. Temperature is subfebrile, under
67. A 20 year old man, a calibrator of dosimetry
37.8 o The doctor suspects anthrax. What drug should
equipment, committed a gross violation of safety
this man be prescribed for treatment?
regulations, when he put two ampoules with cobal-60,
1. Interferon alpha
each with the radioactivity of 7 MCi, in the pockets of his
2. Azidothymidin (Zidovudine)
trousers and jacket. He has been keeping the ampoules
3. Penicillin
in his pocket for 8 hours. The tissue at the distance of
4. Levomycetin (Chloramphenicol)
0.5 cm from the source received the dose of 30 Gy
5. Biseptol (Co-trimoxazole)
(3000 R), while the tissues at the distance of 20 cm – 2
R. Did this man develop radiation sickness?
72. A 28-year-old woman complaining of irregular
1. Yes, he developed a severe form of acute
menstruations and infertility came to gynecological clinic.
radiation syndrome
Menstruations occur since the age of 15, irregular, with
2. Yes, he developed a mild form of acute radiation
delays up to 2 months. On examination she presents
syndrome
with marked hirsutism and excessive body weight. On
3. Yes, he developed chronic radiation syndrome 4.
vaginal examination the uterus is reduced in size and
Yes, he developed a moderate form of acute radiation
painless. The ovaries on the both sides are dense and
syndrome
enlarged. Ultrasound shows microcystic changes in the
5. No, he did not
ovaries, the ovaries are 5×4 cm and 4.5× 4 cm in size
Krok 2- 2019 10

with dense ovarian capsule. Basal body temperature is 1. Phlyctenae, maculae

monophasic . What is the most likely diagnosis? 2. Pustules, papulae
1. Ovarian carcinoma 3. Nodes, nodules
2. Krukenberg tumor 4. Maculae, nodes
3. Endometrioid cysts 5. Pustules, bumps
4. Polycystic ovary syndrome
5. Bilateral adnexitis 77. A woman came to the doctor with complaints of
increased body temperature upto 37.8 oC and
73. In April during the medical examination of various moderately sore throat for the last 3 days. Objectively;
population groups, 27% of individuals presented with mandibular lymph nodes are enlarged upto 3cm.
low working ability and rapid fatigability. The following Palatine tonsils are hypertrophied and covered with gray
symptoms were observed in the affected individuals: coating that spreads to the uvula and anterior pillars of
Swollen friable gingiva that bleeds when pressed, the fauces. What is the most likely diagnosis?
hyperkeratosis follicularis not accompanied by skin 1. Oropharyngeal diphtheria
dryness. These symptoms most likely result from the 2. Agranulocytosis
following pathology: 1. C-hypovitaminosis 3. Oropharyngeal candidiasis
2. A-hypovitaminosis 4. Infectious mononucleosis
3. Polyhypovitaminosis 5. Pseudomembranous (Vincent‟s) tonsillitis
4. B1-hypovitaminosis
5. Parodontosis 78. In the impatient gynecological unit within a year 6500
women underwent treatment. They spent there a total of
74. An 18-year-old patient always obeys others and 102000 bed-days. What indicator of gynecological unit
adapts his needs to the demands of the people on whom work can be calculated based on these data?
he depends. He excessively defers to their wishes and 1. Bed turnover rate
makes them responsible for his well being, cannot 2. Average length of inpatient stay
defend his interests and needs support from other 3. Planned bed occupancy rate per year
people. Such psychic profile has been formed in the 4. Average bed occupancy rate per year
childhood, remains unchanged, and hinders adaptation. 5. Number of beds by hospital department
What psychic disorder is observed in this patient?
1. Anxiety (avoidant) personality disorder 79. A 25-year-old woman complains of fatigue, dizziness,
2. Anankastic personality disorder hemorrhagic rashes on the skin. She has been
3. Psychopathy-like state presenting with these signs for a month. Blood test:
4. Dependent personality disorder erythrocytes – 1.0 x 1012/L, Hb – 37 g/L, color index –
5. Markedly accentuated personality 1.1, leukocytes – 1.2 x 109/L, platelets – 42 x 109/L.
75. A 34 year old man on the 3rd day of ceftriaxone What analysis would be the most advisable for diagnosis
treatment for acute otitis (daily dosage – 2 grams) making in this case? 1. Liver biopsy
developed Diarrhea occurring 5-6 times per day. Feces 2. Coagulation studies
are without mucus or blood admixtures. Temperature is 3. US of the gastrointestinal tract
36.6 o Gregersen reaction (Occult blood in feces) is 4. Sternal puncture (bone marrow biopsy)
negative. Stool culture detected no pathogenic germs. 5. Splenic biopsy
What is the most likely cause of Diarrhea in this case?
1. Antibiotic associated diarrhea 80. A chronic alcoholic was hospitalized into the
2. Ulcerative colitis therapeutic inpatient unit due to pneumonia. On the day
3. Bacterial overgrowth syndrome 5 of his hospitalization he became disoriented in time
4. Crohn‟s disease (Regional enteritis) and space, developed fear-inducing visual hallucinations
and motor agitation. Full body tremor and tremor of the
5. Intestinal dysbiosis
limbs are observed. X-ray and physical examination
76. A young man has made an appointment with the detect the signs of his convalescence from pneumonia.
dermatologist. He complains of a painful facial rash in What tactics should be chosen regarding his patient?
the beard and moustache area. This condition has been 1. Compulsory medical treatment for alcoholism
persisting for several weeks already. After shaving, the 2. Transfer into the inpatient narcology department
patient‟s condition aggravates. The diagnosis of sycosis 3. Continue the treatment in the therapeutic department
is made. What primary morphological elements can be 4. Discharge from the hospital
observed in the rash in this case? 5. Transfer into the neuroresuscitation department
Krok 2- 2019 11

81. A 72 year old man diagnosed with ischemic heart 85. A 58 year old woman came to the gynecological
disease presents with diffuse cardiosclerosis, clinic. She complains of bloody discharge from her
permanent tachysystolic artrial fibrillation, heart failure genital tracts. Menopause is 8 years. Gynecological
IIa, FC III. Objective examination of the vital signs: blood examination: the uterus is slightly enlarged, dense to
pressure is 135/80 mmHg, heart rate is 160/min, pulse touch, with limited mobility; the uterine appendages
is 125/min. Left ventricular ejection fraction is 32%, cannot be detected; parametrium is free. Fractional
What drug is indicated in this case and should be curettage of the uterine cavity yields a significant amount
prescribed to the patient? 1. Ivabradine of medullary substance in the scrape. What is the most
2. Digoxin likely diagnosis?
3. Isadrine (Isoprenaline) 1. Adenomyosis
4. Procainamide (Novocainamide) 2. Uterine corpus cancer
5. Verapamil 3. Hormone producing ovarian tumor
4. Uterine cervix cancer
82. The 5-year-old child has been ill for 2 weeks. Cough 5. Chorioepithelioma
attacks developed first and were then followed by
reprises. During coughing the child‟s face turns red and 86. A newborn has Apgar score of 9. When should this
cervical veins bulge. The cough attacks induce vomiting, infant be put to the breast?
X-ray shows intensified bronchial pattern. Blood test: 1. After 12 hours
leukocytes – 16 x 109/L, lymphocytes – 72%, 2. After 2 hours
3. In the delivery room
erythrocyte sedimentation rate – 4mm/hour. What is the
4. On the 2nd day
most likely diagnosis? 1. Adenovirus infection
5. On the 3rd day
2. Obstructive bronchitis
3. Foreign body
87. A 13-year-old girl for a month has been complaining
4. Pneumonia
of fatigability, dull pain in her right subcostal area,
5. Pertussis
abdominal distension and constipation. Abdominal
palpation reveals positive Kehr, Murphy and Ortner
83. A 45 year old man was brought by an ambulance into
signs, while Desjasrdins and Mayo-Robson points are
the emergency hospital. He complains of sudden pain in
painless. Total bilirubin is 14.7 mcmol/L, predominantly
the lumbar area, frequent painful urination and vomiting.
indirect, ALT – 20 U/L, AST – 40 U/L, amylase – 6.3
Examination detects pain in the lumbar area,
mmol/L. Echocholecytography shows practically no
costovertebral angle tenderness, pain on palpation of
contraction of gallbladder. Make the provisional
kidneys and along the ureter on the right. Urine test:
diagnosis? 1. Chronic pancreatitis
proteins, fresh erythrocytes, leukocytes. Make the
2. Chronic hepatitis
provisional diagnosis: 1. Acute renal failure
3. Acute pancreatitis
2. Acute glomerulonephritis
4. Hyperkinetic biliary dyskinesia
3. Acute pyelonephritis
5. Hypokinetic biliary dyskinesia
4. Urolithiasis, renal colic
5. Polycystic kidney disease
88. A 45 year old woman is registered for regular check
ups due to Werlhof disease (immune thrombocytopenia).
84. A 48-year-old woman complains of disturbed
Complete blood count: Hb – 100 g/L, erythrocytes – 2.8
menstrual cycle: her periods last 7-9 days and are
x 1012/L, platelets – 90.0 x 109/L, leukocytes – 8.4 x
excessively profuse throughout the last half-year. She
109/L, erythrocyte sedimentation rate – 13 mm/hour.
notes occasional hot flashes in her head, insomnia, Examination detects a single small hematoma on the
irritability, and headaches. Her skin is of normal color. anterior surface of the thigh, developed after the patient
Blood pressure- 150/90 mm Hg, pulse – 90/min., accidently stumbled on a table. What treatment tactics
rhythmic. The abdomen is soft and painless. Bimanual should be chosen in this case?
examination shows no uterine enlargement, the 1. Continue the supervision by the hospital
appendages cannot be detected. The vaginal fornices haematologist
are free. What is the most likely diagnosis? 1. 2. Administer thrombolytic mass, continue with
Premenstrual syndrome treatment in the haematology unit
2. Stein- Leventhal syndrome(polycystic ovary 3. Urgent hospitalization into the haematology unit
syndrome) 3. Uterine myoma 4. Urgent hospitalization into the general care unit 5.
4. Climacteric syndrome Urgently start a hemostatic therapy, followed by a
5. Adrenogenital syndrome planned hospitalization into the haematology unit.
Krok 2- 2019 12

89. A 7-year-old boy has severe pulmonary 4. Toxic erythema

mucoviscidosis (cystic fibrosis). He complains of 5. Pemphigus syphiliticus
dyspnea and blood expectoration. Objectively he
presents with lagging physical development, 94. In a rural health care area there is an increasing
acrocyanosis, hepatomegaly, drumstick fingers, and nail cervical cancer morbidity observed. The decision is
plates resembling a “clock face”. Provisional diagnosis made to conduct a medical examination of the women
of chronic examination would be the most informative for living in this locality. What type of medical examination is
diagnosis confirmation? 1. Doppler echocardiography it?
2. Electrocardiography 1. Target
3. Rheography of the pulmonary artery 2. Prelimiary
4. Ultrasound of the liver 3. Screening
5. Chest X-ray 4. Regular
5. Complex
90. A 32-year-old man complains of pain in his legs that
intensifies during walking, intermittent claudication, 95. Clinical statistical investigation was performed to
numbness of his toes, extremity coldness and inability to determine effectiveness of a new pharmacological
walk more than 100 meters. When he sleeps, his leg preparation for patients with ischemic heart disease.
usually hangs down. The patient has been smoking What parametric test (coefficient) can be used to
since he was 16. He drinks alcohol in excess. The left estimate the reliability of the results? 1.
leg is colder than the right one; the skin of the Kolmogorov-Smirnov test
extremities is dry. No pulse can be detected on the pedal 2. Wilcoxon signed rank test
arteries, while pulsation on the femoral arteries is 3. Student‟s t-distribution
retained. What is the most likely diagnosis? 4. Sign test
1. Raynaud disease 5. Matching factor
2. Leriche Syndrome (Aortoiliac occlusive disease)
3. Obliterating endarteritis 96. A 45-year-old man developed constricting
4. Deep thrombophlebitis retrosternal pain that occurs during walks at the distance
5. Diabetic angiopathy of 200m. Objectively: heart rate is 80/min, BP is 160/90
mmHg. During cardiopulmonary exercise test at 50 W
91. A 30-year-old woman made an appointment with the there is a depression of S-T segment by 3 mm below
family doctor for scheduled vaccination of her 2-year-old the isoline in V3-V4. What is the provisional diagnosis?
child. What type of healthcare provide such medical 1. Alcoholic myocardiodystrophy
services? 1. Tertiary healthcare 2. Emergency aid 2. Exertional angina pectoris, functional class II 3.
3. Primary healthcare Somatoform autonomic dysfunction, hypertension
4. Palliative care type
5. Secondary healthcare 4. Exertional angina pectoris, functional class IV
5. Exertional angina pectoris, functional class III
92. A 35-year-old patient developed an epileptic attack
with tonoclonic spasms that lasted for 3 minutes. After 97. A patient has gradually lost consciousness. The skin
the attack the patient fell asleep but in 5 minutes the is pale and dry. There is a smell of ammonia from the
second attack occurred. The first step of emergency aid mouth. Respirations are deep and noisy. Heart sounds
would be to: 1. Ensure patency of airways are muffled, pericardial friction rub is present. Blood
2. Introduce diazepam intravenously pressure is 180/130 mmHg. Blood test: Hb – 80 g/L,
3. Administer chloral hydrate via an enema leukocytes – 12 x 109/L, blood glucose – 6.4 mmol/L,
4. Take blood from the vein for analysis urea – 50 mmol/L, creatinine – 1200 mcmol/L, blood
5. Prescribe antiepileptic drugs osmolarity – 350 mOsmol/L. No urinary excretion. Make
the diagnosis: 1. Acute renal failure
93. A 3-week-old infant developed large, flaccid vesicles 2. Hyperosmolar coma
with purulent contents on the skin of chest and 3. Uremic coma
abdomen. The vesicles rupture quickly. Make the 4. Acute disturbance of cerebral circulation
provisional diagnosis: 5. Hyperglycemic coma
1. Vesiculopustulosis
2. Pemphigus neonatorum 98. A 38-year-old patient has been brought by an
3. Pseudofurunculosis ambulance to the surgical department with complaints of
Krok 2- 2019 13

general weakness, indisposition, black stool. On infraclavicular fossae retract during breathing.
examination the patient is pale, there are dotted Respiration is coarse on auscultation. Heart sounds are
haemorrhages on the skin of his torso and extremities. clear and sonorous, heart rate is 120/min. What
On digital investigation there are black feces on the condition was complicated by the development of the
glove. Blood test: Hb – 108 g/L, thrombocytopenia. upper respiratory tract infection?
Anamnesis states that a similar condition was observed 1. Obstructive bronchitis
1 year ago. Make the diagnosis: 2. Bornchiolitis
1. Non specific ulcerative colitis 3. Airway foreign body
2. Rectal tumor 4. Bronchial asthma
3. Thrombocytopenia purpura 5. Stenosing laryngotracheitis
4. Ulcerative bleeding
5. Hemophilia 103. A 24-year-old woman, a kindergarten teacher, has
been sick for 2 days already. Disease onset was acute.
99. A 65 year old woman on abdominal palpation She presents with elevated body temperature upto
presents with a tumor in the umbilical region and above 38.0°C , pain attacks in her lower left abdomen, liquid
it; the tumor is 13×8 in size, moderately painful, stool in small amounts with blood and mucus admixtures
nonmobile, pulsing. On auscultation systolic murmur can 10 times a day. Pulse – 98/min., blood pressure –
be observed. What is the most likely diagnosis? 110/70mm Hg. Her tongue is moist and coated with white
1. Bicuspid insufficiency deposits. The abdomen is soft, the sigmoid colon
2. Abdominal aortic aneurysm is painful and spastic. Make the provisional diagnosis:
3. Tricuspid insufficiency 1. Yersiniosis
4. Gastric tumor 2. Rotavirus infection
5. Asteriovenous aneurysm 3. Salmonellosis
4. Shigellosis
100. A 3-month-old child with signs of rickets presents 5. Escherichiosis
with positive Chvostek, Trousseau and Maslov signs.
One day ago the parents witnessed a cyanotic attack in 104. In the factory cafeteria there was an outbreak of
their child – the child broke into a cold sweat, the eyes food poisoning. Clinical presentation indicates
bulged and respiratory arrest occurred. One minute later staphylococcal etiology of this disease. 15 people are
the child drew in a loud breath and child‟s condition sick. To confirm the diagnosis of food poisoning, samples
normalized again. What is the cause of the described need to be sent to the laboratory. What samples should
signs of the disease? be obtained for analysis?
1. Decrease of blood phosphorus levels 1. Vomit masses
2. Decrease of blood calcium levels 2. Blood for hemoculture
3. Increase of blood calcium levels 3. Saliva
4. Metabolic acidosis 4. Urine
5. Increase of blood phosphorus levels 5. Blood

101. The burns unit received a patient, who 6 hours ago 105. A 38-year-old woman developed a medical
during a fire received flame burns. On the patient‟s body condition 7 days after her return from Bangladesh.
there is gray-brown area of necrosis that covers ¾ of the Periodical elevation of temperature was accompanied by
body perimeter. Occasionally there are small blisters with chills and excessive sweating. She was diagnosed with
haemorrhagic contents and patches of shredded tropical malaria. Next day her condition further
epidermis. What local therapy is necessary in this case? deteriorated: body temperature – 38 oC, inertness,
1. Necrectomy with xenotransplantation periodical loss of consciousness, generalized seizures,
2. Decompression necrectomy tachycardia, hypotension and icteric skin. What
3. Necrectomy with dermal autograft complication can be suspected in this case?
4. Blister puncture 1. Purulent meningitis
5. Chemical necrolysis 2. Serious meningitis
3. Acute hepatic failure
102. At night a 2-year-old child with upper respiratory 4. Acute heart failure
tract infection suddenly developed dyspnea with labored 5. Cerebral coma
inspiration. Objectively the skin is pale, perioral cyanosis
and slight acrocyanosis are observed. Breathing is loud, 106. A 55-year-old woman complaints of pain and
respiration rate is 32/min. Jugular, supra and popping sounds in her left knee joint, which occur when
Krok 2- 2019 14

she climbs the stairs. Occasionally during movements 1. Acute liver failure
her joint becomes “stuck”, 5 years ago she suffered a 2. Hypoglycemic shock 3. Ischemic
trauma of her left knee. Complete blood count and stroke
biochemical blood analysis show normal results. X- ray 4. Meningoencephalitis
shows marked osteosclerosis and osteophytes. The joint 5. Gastrointestinal haemorrhage
space is narrowed. Make the provisional diagnosis:
1. Osteoarthritis 111. At night a 63-year-old woman suddenly developed
2. Rheumatoid arthritis an asphyxia attack. She has a 15 year long history of
3. Reactive arthritis 4. Gouty arthritis essential hypertension and has a myocardial infarction 2
5. Psoriatic arthritis year ago. Objectively her position in bed is orthopneic,
the skin is pale, the patient is covered with cold sweat,
107. A 25-year-old man was hospitalized with complaints acrocyanosis is observed. Pulse – 10/min. blood
of pain in his lower abdomen and right lumbar area that pressure – 210/130 mmHg, respiration rate – 38/min.
appeared one hour ago. Patient‟s general state is Pulmonary percussion sound is clear, with slight dullness
moderately severe. Body temperature – 38.2 oC, heart in the lower segments; throughout the lungs single dry
rate – 102/min. Tongue is dry. The abdomen is painful on crackles can be heard that become bubbling and non-
deep palpation in the right iliac area and in the petit resonant in the lower segments. What is the most likely
triangle. Aure-Rozanov and Gabay signs are positive. complication in this patient?
Make the provisional diagnosis: 1. Acute left ventricular failure
1. Acute appendicitis 2. Paroxysmal tachycardia
2. Right sided renal colic 3. Pulmonary embolism
3. Intestinal obstruction 4. Acute right ventricular failure
4. Acute cholecystitis 5. Bronchial asthma attack
5. Cecal tumor
112. A 20-year-old man was hospitalized on the 9th day
108. A 23-year-old man has accidentally swallowed of the disease. He attributes his disease to eating of
brake fluid. After that he has been presenting with anuria insufficiently thermally processed pork. At its onset this
for 5 days already; his creatinine levels elevated up to condition manifested as periorbital edemas and fever.
0.569mmol/L . What treatment tactics should be chosen Objectively his body temperature is 38.5°C. The face is
in this case? 1. Detoxication therapy puffy and the eyelids are markedly swollen. Palpation of
2. Hemodialysis gastrocnemius muscles is sharply painful. Blood test
3. Antidotal therapy shows hypereosinophilia. What is the etiology of this
4. Diuretics disease?
5. Plasmapheresis 1. Trichinella
2. Ascarididae
109. A 2 years old child with persisting cough and sub 3. Leptospira
febrile body temperature after a case of URTI developed 4. Trichuris
dyspnea, cyanosis of the nasolabial triangle, percussion 5. Echinococci
dullness and weakened respiration in the lower lobe of
the right lung and a slight mediastinal displacement to 113. For three years a 31-year-old woman has been
the left. What pulmonary pathology is likely to cause this complaining of pain and swelling of her radiocarpal and
clinical presentation? metacarpophalangeal articulations and their reduced
1. Emphysema mobility in the morning, which persisted upto 1.5 hours.
2. Pneumonia Two weeks ago she developed pain, swelling and
3. Pleurisy reddening of her knee joints, her body temperature
4. Bronchitis increased upto 37.5 o The treatment was untimely.
5. Atelectasis Examination of the internal organs revealed no
pathologic alterations. Diagnosis of rheumatoid arthritis
110. A woman undergoing in patient treatment for viral was made. What changes are most likely to be visible on
hepatitis type B developed headache, nausea, recurrent the arthrogram?
vomiting, memory lapses, flapping tremor of her hands 1. Joint space narrowing, usuration
and rapid pulse. Sweet smell from her mouth is detected. 2. Cyst in the subchondral bone
Body temperature is 37.6 oC, heart rate is 89/min. What 3. Joint space narrowing, subchondral osteosclerosis
complication developed in the patient? 4. Numerous marginal osteophytes
5. Epiphyseal osteolysis
Krok 2- 2019 15

114. A 30-year-old man was brought to the neurosurgical 5. Staphylococcus aureus

department with complaints of constant headaches,
nausea, vomiting, fever and weakness of the right-side 118. A newborn girl has apgar score of 7-8 points at the
limbs. Anamnesis states that one month ago the patient 1-5 minutes after birth. During the labor there was a brief
had a surgery for left-sided suppurative otitis and difficulty with extraction of the shoulder girdle. After birth
mastoiditis. He has been undergoing treatment in an the baby presents with disturbed function of the proximal
ENT department. Approximately 2 weeks ago the segment and forced position of the right arm. The
temperature increased, and the patient developed shoulder is rotated inwards, the elbow is extended, the
headaches. Objectively: heart rate – 98/min., BP – forearm is pronated and the whole upper limb resembles
140/90 mm Hg, temperature- 38.3°C. neurologically an arm of a doll. What is the most likely clinical diagnosis
manifested stiff neck: bilateral Kerning‟s symptom, in this case?
unsteadiness during Romberg‟s maneuver. Computer 1. Intracranial haemorrhage
tomography of the brain revealed a three- dimensional 2. Erb-Duchenne palsy
growth with a capsule in the left hemisphere. Make the 3. Soft tissue injury of the right arm
diagnosis: 1. Echinococcus 4. Thoracic spine trauma
2. Arnold-Chiari malformation 5. Osteomyelitis of the right arm
3. Hydrocephalus
4. Hemorrhage 119. 3 hours after a trauma, a young man developed
5. Cerebral abscess bradycardia of 46/min, anisocoria D>S, hemi
hyperreflexia S>D, hemiphypesthesia on the left, and a
115. Having studied the relationship between the convulsive disorder. The character of this process needs
distance from villages to the local outpatient clinics and to be clarified. What method of examination will be most
frequency of visits to the clinics among the rural accurate for this purpose?
population of this area, it was determined that the rank 1. Lumbar puncture
correlation coefficient in this case equals -0.9. how can 2. Skull X-ray
this relationship be characterized? 1. Moderate 3. Echoencephalography
inverse relationship 4. Electroencephalography
2. Strong direct relationship 5. Brain CT
3. Moderate direct relationship
4. Strong inverse relationship 120. During an outdoors school event in hot weather, a
10 year old girl lost her consciousness. Body
116. A newborn with gestational age of 31 weeks temperature – 36.7 o Objectively her skin is pale and
presents with hypotonia and depressed consciousness. cold to touch, her pupils are dilated. Blood pressure –
Hematocrit is 35%, general cerebrospinal fluid analysis 90/50 mmHg. Heart rate – 58/min. What pathology,
shows increased content of erythrocytes and protein, occurred in this case? 1. Syncope
and low glucose. These data correspond with clinical 2. Sympathicotonic collapse
presentation of: 1. Intracranial haemorrhage 3. Sunstroke
2. Meningitis 4. Paralytic collapse
3. Sepsis
4. Intrauterine infection 121. An 18-year-old girl was brought into the
5. Anemia gynaecology department with complaints of elevated
body temperature up to 37.8°C, sharp pain in her lower
117. A 23-year-old man complains of facial edemas, abdomen, more intense on the right and difficult
headache, dizziness, low urinary output and urine defecation. Vaginal examination detected a painful
discoloration (dark red). These complaints arose after a dense elastic formation 5×6 cm in the area of her right
case of acute tonsillitis. On examination there are facial ovary. Pregnancy test is negative. What is the most
edemas, the skin is pale, temperature is 37.4 oC, heart likely diagnosis? 1. Ovarian cyst rupture
rate is 86/min, blood pressure is 170/100 mmHg. Heart 2. Appendicitis
sounds are muffled, the II heart sound is accentuated 3. Ovarian apoplexy
over the aorta. What etiological factor is the most likely in 4. Torsion of ovarian tumor pedicle
this case? 5. Ectopic pregnancy
1. Staphylococcus saprophyticus
2. Streptococcus viridans 122. A 8 year old girl complains of frequent painful
3. Streptococcus pyogenes urination in small amounts and urinary incontinence. The
4. Beta hemolytic streptococcus signs have been present for 2 days already. She
Krok 2- 2019 16

complains her disease by overexposure to cold. examination: the uterine cervix is clear, external orifice
Costovertebral angle tenderness is absent. Complete produces foul smelling discharge. Vaginal examination:
blood count is without pathologies. Urine test: the uterus lies in anteflextion, is mobile, painful, and
leukocytes: 20-30 in the vision field, erythrocytes: 40-50 slightly enlarged. The appendages are without changes.
in the vision field, unchanged, bacteriuria. What is the Make the provisional diagnosis:
most likely diagnosis? 1. Urolithiasis 1. Salpingoophoritis
2. Pyelonephritis 2. Acute respiratory disease
3. Cystitis 3. Enterocolitis
4. Glomerulonephritis 4. Postabortal endometritis
5. Vulvitis 5. Appendicitis

123. After a long drive with the window open a man 127. A 16 year old patient has made an appointment with
developed facial asymmetry. He cannot close his right an otolaryngologist. He complains of elevated body
eye, his right nasolabial fold is smoothed out, temperature and sore throat. Disease onset was 2 days
movements of expression are absent on the right, there ago, after the patient are two portions of ice cream.
is a disturbance of gustatory sensation in the tongue on Pharygoscopy shows hyperemic mucosa of the palatine
the right. No other neurological pathologies were tonsils with purulent exudate in the lucanae. Make the
detected. What disease can be provisionally diagnosed provisional diagnosis:
in this patient? 1. Trigeminal ganglionitis 1. Follicular tonsillitis 2.
2. Ischemic stroke Pseudomembranous (Vincent‟s) tonsillitis
3. Neuropathy of the facial nerve 3. Lacunar tonsillitis
4. Neuropathy of the trigeminal nerve 4. Diphtheria
5. Neuropathy of the oculomotor nerve 5. Acute pharyngitis

124. The body of a 24-year-old woman with suspected 128. A boy had a foreign body removed from under his
poisoning has been found on the street. Forensic nail plate. 3 days later he developed a sharp throbbing
medical examination was requested on the site and the pain at the end of his distal phalanx, which intensifies
body. According to the Criminal Procedure Code when the phalanx is pressed, hyperemia of the nail fold,
currently in force in Ukraine, forensic medical elevated body temperature upto 38.5 oC, and nail plate
examination is required when it is necessary to discoloration. Make the diagnosis:
determine the: 1. Cause of death 1. Erysipelas
2. Mechanism of death 2. Abscess
3. Manner of death 3. Sublingual panaritium
4. Time of death 4. Erysipeloid
5. Mode of death 5. Paronychia

125. During medical examination of high and middle 129. Increased general morbidity of the local population
school students, the doctors were assessing correlation is observed in the area near a factory, where
between biological and calendar age of the school atmosphere is being intensively polluted with sulphurous
students based on the following criteria; height growth gas. What effect does polluted air have on human body
rate per year, ossification of the carpal bones, the in this case? 1. Chronic specific
number of permanent teeth. What additional 2. Acute non specific
development criterion should be assessed at this age? 3. Chronic non specific
1. Chest circumference 4. Acute specific
2. Development of secondary sex characteristics 5. Selective
3. Body mass
4. Hand strength 130. A 46-year-old woman came to the maternity clinic
5. Vital capacity of lungs with complaints of moderate blood discharge from the
vagina, which developed after the menstruation delay of
126. A 27 year old woman complains of foul smelling 1.5 months. On vaginal examination; the cervix is clean;
discharge from her genital tracts, pain in her lower the uterus is not enlarged, mobile, painless; appendages
abdomen and elevated temperature. The complaints without changes. Make the diagnosis: 1. Dysfunctional
arose 2 days ago. She has a history of surgical abortion uterine bleeding
at the term of 8 weeks one week ago. Mirror 2. Submucous uterine myoma
Krok 2- 2019 17

3. Adenomyosis fungi. What effect determines pathogenic properties of

4. Cancer of uterine body the dust? 1. Fibrogenic
5. Ectopic pregnancy 2. Mutagenic
131. At the railroad crossing a passenger train collided 3. Allergenic
with a bus. In this collision 26 bus passengers died, 4. Toxic
another 18 passengers received mechanical injuries of 5. Teratogenic
varying severity. Where will be professional medical aid
provided for the victims of this accident. Who will provide 135. A 13-year-old girl for the last two weeks has been
this aid? complaining of dyspnea and shin and foot edemas that
1. At the site of the accident; specialized second appear after physical exertion. In the morning the
response emergency teams edemas significantly decrease. Clinical examination
2. In medico prophylactic institutions; general revealed enlarged liver and coarse systolic murmur over
physicians and surgeons the heart area. Blood test and urinalysis are without
3. At the site of the accident; first response changes. What is the most likely cause of edemas in this
emergency teams child?
4. In medical institutions; all listed type of 1. Angioneurotic edema
healthcare workers 2. Heart failure
5. In medico-prophylactic institutions; specialized 3. Hepatic cirrhosis
second response emergency teams 4. Acute pyelonephritis
5. Nephrotic syndrome
132. The dermatologist has an appointment with a
30year-old man that complains of severely itching rashes 136. During examination a 4-month-old child with
that especially disturb him at night. The rashes meningococcemia presents with acrocyanosis, cold
developed 2 week ago, after he had returned from a extremities, tachypnea and thread pulse, anuria and
travel. Objectively on the lateral surfaces of his fingers, sopor. What clinical syndrome is it?
hands, writs, elbows, lower abdomen, genitals and 1. Toxic shock syndrome
thighs there are paired papulovesicles, single pustules, 2. Acute renal failure
and scratch marks. What disease can be suspected? 3. Encephalic syndrome
1. Shingles 4. Neurotoxicosis
2. Pyoderma 5. Exicosis
3. Dermatitis
4. Eczema 137. During medical examination a cadet in the naval
5. Scabies college was detected to have a painless dense ulcer
1.5×0.5 in size in his perianal area at the 2 O‟clock
133. A 35 year old pregnant woman with degree 1 position. The ulcer floor resembles „old fat‟. What is the
essential hypertension, developed edemas and provisional diagnosis?
headache at the 33 week of her pregnancy. Objectively 1. Hard syphilitic chancre of the rectum
her general condition is satisfactory, blood pressure – 2. Anal cancer
160/100 mmHg, normal uterine tone. Fetal heart rate is 3. Anal crypt suppuration
140/min and rhythmic. She was diagnosed with daily 4. Rectal fissure
proteinuria – 4 g/L, daily diuresis – 1100 mL. Creatinine – 5. Rectal fistula
80 mcmol/L, urea – 7 mmol/L, platelets – 100 x 109/L.
What complication of pregnancy occurred? 138. A 1.5-month-old child on breastfeeding presents
1. Mild preeclampsia from birth with daily vomiting, irregular liquid foamy feces
2. Hypertensive crisis and meteorism, which are resistant to antibacterial and
3. Moderate preeclampsia probiotic therapy; no increase of body mass is observed.
4. Severe preeclampsia The child‟s condition improved, when breastmilk
5. Renal failure was substituted with „NAN low lactose‟ formula.
What pathology is it? 1. Infectious enteritis
134. In the air of the feed kitchen at the poultry factory, 2. Lactase deficiency
at the area where formula feed is being mixed, the dust 3. Intestinal lambliasis (Giardiasis)
concentration reaches 200 mg/m3. Air microflora is 4. Drug induced enteritis
represented predominantly by Asperquillus and Mucor 5. Functional dyspepsia
Krok 2- 2019 18

139. A 50-year-old patient was brought to a hospital with elective surgery for calculous cholecystitis. What
complaints of blood in urine. Urination is painless and medication adjustment should be made on the day of the
undisturbed. Macrohematuria had been observed for 3 surgery to prevent the development of acute adrenal
days. Objectively: kidneys cannot be palpated, insufficiency?
suprapubic area is without alterations, external genitalia 1. Prescribe a large volume intravenous fluid infusion
are non-pathologic. On rectal investigation: prostate is 2. Add a mineralocorticoid
not enlarged, painless, has normal structure. Cystoscopy 3. Add an antibiotic
revealed no changes. What is the most likely diagnosis? 4. Increase the dosage by 2-3 times
1. Necrotic papillitis 5. Cancel the drug for the day of the surgery
2. Bladder tuberculosis
3. Dystopic kidney 143. A 65-year-old man complains of dyspnea, severe
4. Varicocele cough with expectoration of small amount of blood
5. Renal carcinoma streaked sputum, weight loss, body temperature 37.2
oC, loss of appetite and weakness. He has been
140. A pregnant woman is 28 years old. Anamnesis suffering from this condition for years. The patient‟s
accelerated labor complicated by the II degree cervical condition deteriorated one year ago, dyspnea developed
rupture. The following two pregnancies resulted in 3 weeks ago. The patient is a lifelong smoker. He is a
spontaneous abortions at the terms of 12 and 14 weeks. carpenter by occupation. Objectively he is of normal
On mirror examination: the uterine cervix is scarred from body type but emaciated. Right side of the chest is
previous ruptures at 9 and 3 hours, the cervical canal is retracted, excursions are limited, accessory muscles
gaping. On vaginal examination: the cervix is 2 cm long, take part in the respiration, respiratory rate is 22/min.
the external orifice is open 1 cm wide, the internal orifice Percussion detects dull sound over the right upper
is half open; the uterus is enlarged to the 12th week of segment. Chest X-ray shows shrunken right upper lobe
pregnancy, soft, mobile, painless, the appendages are with homogeneous shadow connected to the root of the
without changes. What diagnosis can be made? 1. lung; the root is deformed; mediastinal organs are
Incipient abortion, habitual non carrying of pregnancy 2. displaced to the right. What is the most likely diagnosis?
Cervical hysteromyoma, habitual non-carrying of 1. Pulmonary sarcoidosis
pregnancy 2. Pulmonary tuberculosis
3. Isthmico-cervical insufficiency, habitual non carrying 3. Complete right-sided pneumothorax
of pregnancy 4. Fibrosing alveolitis
4. Threatened spontaneous abortion 5. Obstructive atelectasis
5. Cervical pregnancy, 12 weeks
144. A 38-year-old woman complains of weakness,
141. A 58-year-old man complains of weakness and sleepiness, pain in the joints, weight gain despite low
tumor like formations that appeared on the anterior appetite, and constipations. She presents with dry and
surface of his neck and in the inguinal region. Palpation thickened skin, puffy and amimic face, narrowed
detects soft painless mobile cervical and inguinal lymph palpebral fissures, thick tongue and deep hoarse voice.
nodes up to 2 cm in diameter. The liver protrudes by 2 Her heart sounds are weak, pulse is 56/min. Low levels
cm from the edge of the costal margin, the lower splenic of free T4 are observed. This patient needs to take the
pole is at the umbilical level. In blood: erythrocytes – 3.5 following on a regular basis: 1. Furosemide
x 1012/L, Hb – 88 g/L, leukocytes – 86 x 109/L, band 2. Calcium gluconate
neutrophils – 1%, segmented neutrophils – 10%, 3. Thyroxine
lymphocytes – 85%, eosinophils – 2%, basocytes – 0%, 4. Lithium carbonate
monocytes – 2%, erythrocyte sedimentation rate – 15 5. Mercazolil (Thiamazole)
mm/hour, Gumprecht shadows. What is the most likely
diagnosis? 1. Chronic myeloleukemia 145. On laboratory investigation of a pork sample there
2. Acute leukemia is 1 dead trichinella detected in 24 sections. This meat
3. Chronic lymphatic leukemia should be:
4. Lymphogranulomatosis 1. Frozen until the temperature of -10 oC is reached in
5. Lymphocytic leukemoid reaction the deep layers, with subsequent exposure to cold for
15 days.
142. A 39-year-old man suffers from chronic adrenal 2. Processed for boiled sausage production
insufficiency and receives replacement glucocorticoid 3. Sent for technical disposal
therapy (hydrocortisone – 15 mg/day). He is to undergo 4. Allowed for sale with no restriction
Krok 2- 2019 19

5. Processed and sold through public catering network 3. Bronchial asthma

146. A 25-year-old woman has been suffering form 4. Acute epiglottitis
diabetes mellitus since she was 9. She was admitted 5. Obstructive bronchitis
into a nephology unit with significant edemas of the
face, arms and legs. BP – 200/110 mmHg, Hb – 90 150. Indicators of work of impatient departments in the
g/L, blood creatinine – 850 mcmol/L, urine proteins – city hospitals for the past year were analysed. After that
1.0 g/L, leukocytes – 10-15 in the vision field. the meeting was held at the central city hospital and
Glomerular filtration rate – 10 mL/min. What tactics based on the results of the analysis, a decision was
should the doctor choose? made to decrease the number of beds in the impatient
1. Transfer into the endocrinology clinic departments and instead open daycare units with partial
2. Transfer into the hemodialysis unit hospitalization in the city polyclinics. What is the main
3. Dietotherapy goal of this decision?
4. Renal transplantation 1. Decreased mortality during impatient treatment 2.
5. Active conservative therapy for diabetic nephropathy Optimization of the average bed occupancy rate per
year
147. On the day 4 after the caesarean section a woman 3. Rational use of the bed fund
developed fever with body temperature upto 39oC and 4. Intensification of the bed fund usage
abdominal pain. Pulse – 104/min. She vomited twice. 5. Decrease of the length of impatient stay
The patient is sluggish, her tongue is dry and has gray
coating. The abdomen is distended. Signs of peritoneal 151. Mother of a 5-year-old child noticed on the head of
irritation are positive in all segments. Peristalsis cannot her child a round „bald‟ spot 3 cm in diameter. All the
be auscultated. No passage of gas occurs. Uterine hairs in the focus are broken off at the lengths of 5-6
fundus is located at the level of the navel. The uterus is mm. The day before the child was petting a stray cat.
painful on palpation. The discharge is moderate and Make the diagnosis:
contains blood and pus. What is the most likely 1. Alopecia areata
diagnosis? 2. Microsporia
1. Diffuse peritonitis 3. Psoriasis
2. Progressive thrombophlebitis 4. Superficial trichophytosis
3. Metroendometritis 5. Deep trichophytosis
4. Pelvic peritonitis
5. Parametritis 152. A 19-year-old young man complains of cough with
expectoration of purulent sputum in the amount of 100
148. Having examined a 52 year old patient, the doctor mL per day, haemoptysis, dyspnea, increased body
diagnosed him with obesity (body mass index- 34 kg/m2, temperature up to 37.8°C, general weakness, weight
waist circumference – 112 cm) and arterial hypertension loss. The patient‟s condition lasts for 4 years.
( 170/105 mm Hg). 2- hour postprandial blood sugar is Exacerbations occur 2-3 times a year. The patient
10.8 mmol/L. What biochemical blood analysis needs to presents with malnutrition, pale skin, cyanosis of the lips,
be conducted to diagnosis the patient with metabolic drumstick (clubbed) fingers. Tympanic percussion sound
syndrome X? in the lungs, weakened repiration, numerous various
1. Lipid profile moist crackles in the lower pulmonary segments on the
2. Calcium and phosphorus left can be observed. In blood: erythrocytes – 3.2 x
3. Electrolytes 1012/L, leukocytes – 8.4 x 109/L, ESR – 56 mm/hour.
4. Bilirubin On X-ray: lung fields are emphysematous, the left
5. Creatinine and urea pulmonary root is deformed and dilated. What is the
most likely diagnosis? 1. Chronic left-sided pneumonia
149. A 15 year old girl complains of dizziness and 2. Multiple bronchiectasis of the left lung
sensation of lack of air that she develops in emotionally 3. Suppuration of the cyst in the left lung
straining situations. Relief occurs after she takes 4. Left-sided pulmonary cystic dysplasia
corvalol. Objectivrly: hyperhidrosis and marble-like 5. Chromic abscess of the left lung
pattern of the skin of her palms and feet. Clinical and
instrumental examination revealed no organic changes 153. A 52-year-old woman has been suffering for 2 years
in the central nervous, cardiovascular, and respiratory from dull, occasionally exacerbating pain in her right
systems. What provisional diagnosis can be made? subcostal area, occurring after eating high-fat foods,
1. Somatoform autonomic dysfunction bitter taste in her mouth in the morning, constipations,
2. Stenosing laryngotracheitis and flatulence. Objectively she has excess weight, her
Krok 2- 2019 20

body temperature is 36.9°C; there is a coating on the 2. Abscess incision, sanation and drainage of the cavity
root of her tongue; the abdomen is moderately distended 3. Antipyretic agents, massage and application of dry
and painful in the area of gallbladder projection. What heat to the right buttock
examination would be the most helpful for diagnosis- 4. Abscess puncture, pus removal followed by
making? application of antiseptics
1. Ultrasound 5. 10-15 minutes of low intensity laser radiation
2. Liver scanning directed at the right buttock
3. Duodenal intubation
4. Cholecystography 157. Heart X-ray of a 31-year-old man has been
5. Duodenoscopy revealed the following: with tightly filled opacified
esophagus there is a marginal filling defect in its middle
154. A 37 year old man suddenly developed acute third on the posterior wall; the defects is 1.8×1.3 cm in
headache accompanied by nausea, vomiting, and size with clear oval border. Mucosal folds are retained
impaired consciousness. Objectively blood pressure is and envelop the defect; wall peristalsis and elasticity are
190/120 mmHg, the face is hyperemic. Patient‟s not affected. There are no complaints regarding the
consciousness is clouded, his answers to the questions condition of the patient‟s alimentary canal. Make the
are short, monosyllabic. Movement and sensory provisional diagnosis: 1. Esophageal tumor
disturbances are absent. Meningeal signs are positive. 2. Achlasia cardiae
Cerebrospinal fluid contains blood. What provisional 3. Diverticulum
diagnosis can be made? 4. Barrett esophagus
1. Meningitis 5. Esophageal burns
2. Ischemic stroke
3. Encephalitis 158. A 51-year-old man complains of vomiting with blood.
4. Subarachnoid haemorrhage He has been drinking alcohol excessively. Health
5. Cerebral vascular embolism disorder has been observed since he was 40, when he
first developed jaundice. On examination the skin and
155. 10 hours after birth a child developed jaundice, visible mucosa are icteric, with a stellate vascular
hypotonia, hyporeflexia and moderate pattern. The patient is malnourished and presents with
hepatosplenomegaly. Feces and urine are of normal abdominal distension, umbilical hernia and ascites. The
color. Umbilical cord blood bilirubin is 51 mcmol/L due to edge of the liver is tapered and painless, +3cm, the
unconjugated bilirubin levels. In venous blood: spleen is +2cm. Blood test: Hb- 80g/L, leukocytes – 3 x
erythrocytes – 3.5 x 1012/L, Hb – 140 g/L, reticulocytes 109/L, platelets – 85 x 109/L. What is the cause of portal
– 1.5%, bilirubin – 111 mcmol/L, conjugated – 11 hypertension in this patient?
mcmol/L, ALT – 40 U/L, AST – 30 U/L. mother‟s blood 1. Constrictive pericarditis
group is A(II) Rh(-), child‟s blood group is A(II) Rh(+). 2. Hepatic cirrhosis
What laboratory test can confirm the diagnosis? 1. 3. Budd-Chiari syndrome
Measurement of glucose 6 phosphate dehydrogenase 4. Thrombosis of the splenic vein
levels in erythrocytes 5. Hemochromatosis
2. Erythrocytometry
3. Coombs test 159. A 13-year-old girl has 30% of excessive body mass,
4. Measurement of erythrocyte osmotic resistance she started to gain weight at the age of 3. She has a
5. Viral hepatitis markers analysis family history of obesity. Her height and sexual
development are normal for her age. The appetite is
156. A 35 year old woman complains of high body excessive. She complains of periodical headaches.
temperature and pain in the upper outer quadrant of her Blood pressure – 120/80 mmHg. Subcutaneous fat is
right buttock, which developed after an injection. She evenly distributed, she has no stretch marks. There is
has been presenting with this condition for 3 days. At the juvenile acne on her face. What type of obesity is it?
site of injection the skin is hyperemic; there is painful 1. Hypothalamic obesity
infiltrate with an area of softening in its center. The 2. Hypothalamic syndrome of puberty
woman is diagnosed with a post injection abscess of the 3. Alimentary constitutive obesity
right buttock. What tactics should the surgeon choose in 4. Hypothyroid obesity
this case 5. Adrenal obesity
160. A 16 year old girl has primary amenorrhea, no pubic
1. Hospitalization, prescription of antibiotics, UHF
hair growth, normally developed mammary glands; her
Krok 2- 2019 21

genotype is 46 XY; uterus and vagina are absent. What 164. A 23-year-old man complains of severe pain in his
is your diagnosis? left knee joint. Objectively the left knee joint is enlarged,
1. Sheehan syndrome with hyperemic skin, painful on palpation. Complete
2. Cushing syndrome blood count: erythrocytes – 3.8 x 1012/L, Hb- 122g/L,
3. Cushing disease leukocytes – 7.4 x 109/L, platelets – 183 x 109/L.
4. Testicular feminization syndrome Erythrocyte sedimentation rate – 10 mm/hour. Bleeding
5. Mayer-Rokitansky-Kuster-hauser syndrome time (Duke method) – 4 min., Lee- White coagulation
time – 24 min. Partial thromboplastin time (activated) –
161. A 24- year-old pregnant woman on her 37th week of 89 seconds. Rheumatoid factor – negative. What is the
pregnancy has been brought to the maternity obstetric most likely diagnosis?
service with complaints of weak fetal movements. Fetal 1. Hemorrhagic vasculitis (Henoch – Schonlein
heartbeats are 95/min. on vaginal examination the purpura), articular form 2. Hemophilia,
uterine cervix is tilted backwards, 2cm long, external hemarthrosis
orifice allows inserting a fingertip. Biophysical profile of 3. Thrombocytopathy
the fetus equals 4 points. What tactics of pregnancy 4. Rheumatoid arthritis
management should be chosen? 5. Werlhof disease (immune thrombocytopenia)
1. Treatment of placental dysfunction and repeated
analysis of the fetal biophysical profile on the next 165. It is the 3rd day after the first normal term labor; the
day infant is rooming in with the mother and is on
2. Urgent delivery via a cesarean section breastfeeding. Objectively; the mother‟s general
3. Urgent preparation of the uterine cervix for delivery 4. condition is satisfactory. Temperature is 36.4 oC, heart
Doppler measurement of blood velocity in the rate is 80/min, BP is 120/80 mmHg. Mammary glands,
umbilical artery are soft and painless; lactation is moderate, unrestricted
5. Treatment of fetal distress; if ineffective, then elective milk flow. The uterus is dense, the uterine fundus is
cesarean section on the next day located 3 finger widths below the navel. Lochia are
sanguine-serous, moderate in volume. Assess the
162. A 45-year-old man with thrombophlebitis of the deep dynamics of uterine involution: 1. Pathologic involution
veins in this legs suddenly after physical exertion 2. Physiological involution
developed sharp pain in his thorax on the right, dyspnea
3. Lochiometra
and hemoptysis. Objectively his condition is severe; he
4. Hematometra
presents with acrocyanosis, shortening of pulmonary
5. Subinvolution
percussion sound on the right and weakened respiration.
Respiration is 30/min, blood pressure is 110/80 mmHg.
166. A 35-year-old man suffers from insulin-dependent
ECg shows sinus tachycardia, heart rate is 120/min,
diabetes mellitus and chronic cholecystitis. He takes
electrical axis of the heart deviates to the right, SI-QIII.
NPH insulin; 20 units in the morning and 12 units in the
What is the most likely diagnosis?
evening. After a meal he developed pain in the right
1. Cancer of the right lung subcostal area, nausea, vomiting, sleepiness and
2. Spontaneous pneumothorax increased polyuria. What prehospital measures will be
3. Community acquired right sided pneumonia the most effective for prevention of crisis within the next
4. Pulmonary embolism several hours?
5. Right sided exudative pleurisy 1. Decrease carbohydrates in the diet
2. Change insulin regimen
163. A 10 year old boy was brought into the hospital with 3. Take cholagogues
complaints of expiratory dyspnea, respiration are 30/min.
4. Exclude fats from the diet
He explains his state by a change in the weather
5. Take analgesics
conditions. For the last 4 years the body has been
registered for regular check-ups due to his diagnosis of
167. A 43-year-old man, a coal face worker with 15 year
third degree persistent bronchial asthma. To provide
long record of work, complains of cough, thoracic pain
emergency aid for this child, first he needs to be given:
and dyspnea. The cough is mild, usually dry, occurs
1. Claritin (Loratadine) mostly in the morning. The pain is localized in the
2. Dexamethasone interscapular region and aggravates during a deep
3. Salbutamol or short acting β2 agonists intake of breath. Dyspnea occurs during physical
4. Euphylline (Aminophylline) exertion. Vesicular respiration in the lungs is weakened.
5. Adrenaline Heart sounds are rhythmic, heart rate is 86/min, blood
Krok 2- 2019 22

pressure is 135/80 mmHg. The abdomen is soft and 171. A 57-year-old woman during a regular ultrasound
painless. X-ray shows micronodular pulmonary fibrosis. examination presented with a space-occupying
Make the provisional diagnosis. heterogeneous lesion in the right kidney. What is the
1. Berylliosis most informative method of renal tumor diagnostic?
2. Siderosis 1. Three glass urine test
3. Metal pneumoconiosis 2. Excretory urography
4. Byssinosis 3. Spiral computed tomography
5. Carboconiosis 4. Radioisotope renography
5. Retrograde pyelography
168. A 22-year-old postparturient woman on the 12th day
after normal child birth informs of elevated body 172. A 10 year old girl exhibits high level of physical
temperature up to 39° C for the last 3 days and pain in development, her body length increased by 10 cm
her right mammary gland. The right mammary gland is within a year (which is double the norm of her age
enlarged, hot to touch, tense, hyperemic, and painful. group), the number of permanent teeth corresponds
Palpation reveals there a dense infiltration 8×8 cm with a with the age norm (20), the development of her
fluctuation in its center. What is the most likely secondary sex characteristics is 3 years ahead of her
diagnosis? age (Ma, P, Ax, menarche). Development rate ahead of
1. Postpartum period, day 12. Right-sided her biological age can occur due to: 1. Deficient
infiltrativepurulent mastitis hygienic education
2. Postpartum period, day 12. Right-sided lactostasis. 2. Certain components of her diet
3. Postpartum period, day 12. Right-sided phlegmonous 3. Acceleration
mastitis 4. Endocrine disorders
4. Postpartum period, day 12. Right-sided serous 5. Sports training
mastitis.
5. Postpartum period, day 12. Right-sided gangrenous 173. A 46-year-old woman has Diarrhea with abdominal
mastitis. distension, loss of body mass, and large amounts of
porridge like foul smelling stool without blood steaks or
169. A 48-year-old woman has arrived to the surgical tenesmus. Objectively examination detects moderate
unit with wounds in her thigh. On examination the tenderness in the mesogastrium and left abdominal
wound surface has dirty-gray coating with unpleasant flank. Feces analysis detects steatorrhea with neutral fat
sweet smell. Wound content resembles raspberry jelly. and creatorrhea. What prescription would be the most
Skin tissues around the wound are glossy and turgid. advisable in this case? 1. Cholinergic antagonists
Palpation reveals moderate crepitation in the tissues. 2. Multi enzyme preparations
What microflora is the most likely to cause such 3. Metronidazole and Loperamide
inflammation? 1. Streptococci 4. Cholinergic antagonists and antibacterial agents
2. Anaerobic clostridial 5. Antacids and antispasmodics
3. Anaerobic non-clostridial
4. Staphylococci 174. A 7 year old girl has been twice treated with
5. Blue push bacillus antibacterial agents for urinary tract infection. US shows
no severe renal defects. The child presents with
170. A 30-year-old man came to the family physician. 2 recurrence of leukocyturia and bacteriuria, elevated body
months ago he underwent a surgery for open fracture of temperature upto 38.5 oC, and pain in her left lumbar
the humerus. On examination the patient‟s condition is area. What examination should be conducted first to
satisfactory; in the area of postoperative wound there is clarify the cause of urinary infection recurrence?
a fistula that discharges a small amount of pus; the area 1. Excretory urography
itself is red; fluctuation is detected. X-ray shows 2. Retrograde pyelography
destruction of the humerus with sequestra. What 3. Radioisotope renography
complication did the patient develop during the 4. Immunogram
postoperative period? 5. Micturating cystourethrography
1. Suture sinus
2. Post traumatic phlegmon 175. A 73-year-old woman came to the family physician
3. Post traumatic osteomyelitis for one of her regular follow–up examinations. Three
4. Hematogenous osteomyelitis months ago, she was found to have type 2 diabetes
5. Wound suppuration mellitus. She was keeping to her diet and exercise plan
Krok 2- 2019 23

and taking phytopreparations. On examination her 3. Acute appendicitis

fasting glucose was within the range of 7.8-8.6 mmol/L, 4. Perforation of gastric ulcer
HbA1c – 7.9%. Height – 164 cm, weight – 83 kg. What 5. Chronic alcoholism
blood sugar controlling medicine should she be
prescribed first in the course of her pharmacological 179. During regular preventive gynaecological
therapy? 1. Glibenclamide examination a 30 year old woman was detected to have
2. Gliclazide dark blue punctulated „perforations‟ on the vaginal
3. Glimepiride portion of the uterine cervix. The doctor suspects
4. Metformin endometriosis of the vaginal portion of the uterine cervix.
5. Insulin What investigation method would be most informative for
diagnosis confirmation? 1. US of the lesser pelvis
176. A 63-year-old man complains of unmotivated 2. Hormone testing
weakness and pressing and bursting sensation in the left 3. Curettage of the uterine cavity
subcostal area. According to him, these signs have been 4. Hysteroscopy
present for a year already. Previously he was healthy. He 5. Colposcopy, target biopsy of the cervix
took part in containment measures during the accident at
the Chornobyl Nuclear power plant. Objectively the skin 180. A middle school teacher with 4 year long record of
is pale, peripheral lymph nodes are not enlarged, the work was issued a medical certificate for pregnancy and
liver is +3cm, the spleen is +10cm . Complete blood childbirth leave. What amount of pay will she receive for
count: erythrocytes – 3.1 x 1012/L, Hb- 100g/L, the duration of her leave in this case?
leukocytes – 46 x 109/L, blasts – 2%, promyclocytes – 1. 60% of average salary
10%, myclocytes – 18%, band neutrophils – 27%, 2. 80% of average salary
segmented neutrophils – 10%, lymphocytes- 12%, 3. 100% of average salary
eosinophils – 6%,basocytes – 3%, monocytes – 2%, 4. 50% of average salary
erythrocyte sedimentation rate – 20 mm/hour. What is 5. 70% of average salary
the most likely diagnosis?
1. Acute leukemia 181. A 28-year-old man complains of skin rash and
2. Chronic myeloleukemia itching on the both of his hands. The condition persists
3. Hemolytic anemia for 1.5 years. The exacerbation of his condition he
4. Chronic lymphatic leukemia ascribes to the occupational contact with
5. Hepatic cirrhosis formaldehyde resins. Objectively the lesion foci are
symmetrically localized on both hands. Against
177. A 10 year old boy with symptoms of arthritis and background of erythema with blurred margins there
myocarditis was brought to a hospital. Based on clinical are papulae, vesicles, erosions, crusts and scales.
examination the provisional diagnosis of juvenile What is the most likely pathology? 1. Idiopathic
rheumatoid arthritis was made. What symptom is the eczema
most contribute for the diagnostics of this disease? 2. Simple contact dermatitis
1. Affection of the large joints 3. Occupational eczema
2. Enlarged heart 4. Allergic dermatitis
3. Regional hyperemia of the joints 5. Erythema multiforme
4. Increased heart rate
5. Reduced mobility of the joints in the morning 182. A 30 year old woman came to the gynaecological
department. She complains of sharp pain in her lower
178. A 39-year-old man, a battery attendant, suddenly abdomen and temperature of 38.8 o She has a history of
developed weakness, loss of appetite, nonlocalized extramarital sexual activity and 2 artificial abortions. On
colicky abdominal pains and nausea. Objectively, his gynaecological examination the uterus is unchanged.
skin is gray; there is a pink-gray stripe on his gums; the The appendages are bilaterally enlarged and painful.
stomach is soft and sharply painful. Blood test detected Profuse purulent discharge is being produced from the
erythrocytes with basophilic stippling and anemia. The vagina. What examination needs to be conducted to
patient has a history of peptic ulcer disease of the clarify the diagnosis?
stomach. Constipation tends to occur every 3-4 days. 1. Colposcopy
What is the most likely provisional diagnosis? 2. Bacteriological and bacterioscopic analysis
1. Saturnism (Lead poisoning) 3. Laparoscopy
2. Acute cholecystitis 4. Curettage of the uterine cavity
Krok 2- 2019 24

5. Hysteroscopy 186. A 23 year old woman came to the gynaecological

clinic. She complains of pain, itching, and burning in her
183. A 59-year-old man complains of pain in his left eye vulva, general weakness, indisposition, elevated body
and left side of his head, significant vision impairment of temperature upto 37.2 oC, and headache. On
the left eye, nausea, and vomiting. Visual acuity of the examination in the vulva there are multiple vesicles upto
right eye is 1.0. Visual acuity of the left eye is 0.03, 2-3 mm in diameter with clear contents against the
attempts at correction bring no improvement. Right eye background of hyperemia and mucosal edema. Make the
intraocular pressure – 21 mm Hg, left eye intraocular provisional diagnosis: 1. Genital herpes infection
pressure – 65 mm Hg. Congestive injection is observed 2. Primary syphilis
on the sclera of the left eye. The cornea is thick and 3. Vulvar cancer
swollen. The anterior chamber is shallow, moist, and 4. Cytomegalovirus infection
clear. The pupil is dilated and unresponsive to the light, 5. Papillomavirus infection
the fundus of the eye is not visible. What is the most
likely diagnosis? 187. A 62-year-old woman was brought into the
1. Acute attack of glaucoma of the left eye admission room with complaints of severe burning
2. Panophthalmitis of the left eye retrosternal pain and asphyxia. She has a 10 year long
3. Endophthalmitis of the left eye history of essential hypertension. Objectively her
4. Stage II intraocular tumor of the left eye condition is moderately severe. She presents with skin
5. Acute iridocyclitis of the left eye pallor, cyanotic lips and vesicular respiration over her
lungs. The II heart sound is accentuated over the aorta.
184. A 39-year-old man suffers from chronic rheumatic Blood pressure – 210/120 mmHg, heart rate (pulse) –
heart disease. He complains of dyspnea during physical 76/min. ECG shows elevation of ST segment in the lead
exertion, cough with expectoration and palpitations. I, AVL and V5-V6. What is the most likely diagnosis?
Auscultation detects intensified I heart sound and 1. Hypertensive crisis complicated with instable angina
diastolic murmur; the sound of opening mitral value can pectoris
be auscultated at the cardiac apex. The II heart sound is 2. Hypertensive crisis complicated with acute left
accentuated over the pulmonary artery. The patient is ventricular failure
cyanotic, X-ray shows dilated pulmonary root and 3. Uncomplicated hypertensive crisis
enlargement of the right ventricle and left atrium. What is 4. Pulmonary embolism
the most likely diagnosis? 1. Patent ductus arteriosus 5. Hypertensive crisis complicated with acute
2. Coarctation of the aorta myocardial infarction
3. Mitral stenosis
4. Pulmonary artery stenosis 188. A surgery unit received a person with an incised
5. Aortic stenosis stab wound on the upper third of the right thigh.
Examination detects an incised stab wound 3.0×0.5×2.0
185. A 5-year-old child was brought to the ENT cm in size on the inner surface of the upper third of the
department by an ambulance. The child presents with right thigh. Bright-red blood flows from deep within the
cough and difficult respiration. From the patient‟s history wound in a pulsing stream. Characterize this type of
it is known that the child was playing with a toy bleeding:
construction set, when suddenly started coughing and 1. Arterial
developed labored breathing. Examination detects 2. Parenchymatous
periodical cough, labored expiration and respiratory lag 3. Venous
in the left side of the child‟s thorax. Auscultation: 4. Capillary
diminished respiration on the left. Percussion: tympanitis. 5. Mixed
X-ray shows a displacement of the mediastinal organs to
the right. Make the diagnosis: 1. A foreign body in the 189. A 48 year old woman has been hospitalized due to
right bronchus, partial bronchostenosis development of tachysystolic atrial fibrillation. She has
2. A foreign body in the left bronchus, complete lost 5 kg of body weight within 2 months. On palpation,
bronchostenosis there is node in the left lobe of the thyroid gland. What
3. A foreign body in the right bronchus, valvular pathology resulted in the development of this condition?
bronchostenosis 1. Non toxic nodular goitre
4. A foreign body in the left bronchus, valvular 2. Autoimmune thyroiditis
bronchostenosis 3. Toxic nodular goitre
5. A foreign body in the trachea 4. Atherosclerotic cardiosclerosis
5. Chronic thyroiditis
Krok 2- 2019 25

190. A woman has been working as a polisher for a year attempt to palpate them they are painless. Blood test:
and half. Her workstation is equipped with a grinding erythrocytes – 3.0 x 1012/L, Hb – 100 g/L, erythrocyte
machine (grinding wheels). She complains of white sedimentation rate – 50 mm/hour. Urinalysis: proteins –
discoloration of her fingers and toes that appears when 3.5 g/L, erythrocytes – 7-10 in the vision field, leukocytes
she is nervous. Objectively there are no changes in the – 5-6 in the vision field. Daily proteinuria – 6 grams.
coloration of the distal segments of her limbs. Grip What analysis should be conducted additionally to verify
strength measured with a dynamometer is 25kg, the diagnosis?
algesimetry findings are 0.1; 0.3; 0.5. Cold stimulus is 1. Radioisotopic examination of kidneys
extremely positive on the upper and lower limbs. Internal 2. Renal ultrasound
organs are without pathogens. Make the diagnosis: 3. Survey and excretory urography
1. Raynaud syndrome 4. Gingival biopsy for the diagnosis of amyloid disease
2. Syringomyelia 5. Urinalysis for Bence-Jones protein
3. Polyneuritis
4. Raynaud disease 194. A 57 year old woman complains of weakness,
5. Vibration disease dyspnea, loss of appetite and liquid feces. She has been
suffering from this condition for 2 years. Objectively she
191. A 26-year-old woman presents with amenorrhea. 10 presents with pale skin, subicteric sclerae and bright red
months ago she gave birth for a second time. In her fissured tongue. Lymph nodes are not enlarged. Pulse –
early postpartum period she developed a massive 100/min. BP – 105/70 mmHg. Liver +3cm, the spleen
hypotonic haemorrhage. No breastfeeding. Lately she cannot be palpated. Blood test: erythrocytes – 1.2 x
has been presenting with loss of weight, loss of hair and 1012/L, Hb – 56 g/L, color index – 1.4, macrocytes,
indisposition. Gynecological examination revealed leukocytes – 2.5 x 109/L, eosinophils – 1%, juvenile –
atrophy of the external genitals, the uterus is abnormally 1%, metamyelocytes – 1%, band neutrophils – 8%,
small, no uterine appendages can be detected. What is segmented neutrophils – 47%, lymphocytes – 38%,
the most likely diagnosis?
monocytes – 4%, reticulocytes – 0.1%, platelets – 100 x
1. Sheehan syndrome (Postpartum pituitary gland
109/L, ESR – 30 mm/hour, indirect bilirubin – 26
necrosis)
mmol/L. What changes can be expected in the bone
2. Stein-Leventhal syndrome (Polycystic ovary
marrow puncture material? 1. Erythtroid hyperplasia
syndrome)
2. Prevalence of megaloblasts
3. Physiological amenorrhea
3. Increased number of sideroblasts
4. Suspected progressing ectopic pregnancy
4. Prevalence of lymphoid tissue
5. Galactorrhea-amenorrhea syndrome
5. Present of blast cells
192. A prurient woman is 30-year-old, stage I of the
195. A patient is being treated in the tuberculosis clinic.
labour is ongoing. The fetus is in the cephalic
Throughout the last 3 weeks he has been suffering from
presentation. Auscultation of the fetal heart sounds
headaches of increasing intensity. Neurological
detects bradycardia. Evaluation of cardiotocogram
examination detects nuchal rigidity without focal signs.
yielded the following date: decreased of basal heart rate
Make the provisional diagnosis:
down to 90/min, variability – monotonous (2 and less);
1. Tuberculous meningitis
late decelerations with amplitude of 50/min. Make the
diagnosis and choose the obstetrical tactics necessary in 2. Myelitis
this case: 3. Chorea minor
1. Fetal distress. Forceps delivery 4. Brain tumor
2. Fetal distress. Vacuum extraction delivery 3. 5. Convexital arachnoiditis
Normal condition of the fetus. Vaginal birth.
196. A 27 year old woman, a teacher in the elementary
4. Fetal distress. Urgent caesarean section delivery
school, complains of frequent stools, upto 3 times per
5. Fetal distress. Stimulation of uterine contraction
day, with lumpy feces and large amount of mucus,
abdominal pain that gradually abates after a defecation,
193. A 34 year old man complains of pale edema of the
irritability. Her skin is pale and icteric. Pulse is 74/min.,
face, feet, shins and lumbar area, elevated BP upto
rhythmic, can be characterized as satisfactory. Blood
160/100 mmHg, and general weakness. He has a clinical
pressure is 115/70 mmHg. The abdomen is soft,
history of nonspecific ulcerative colitis. Objectively: pulse
moderately tender along the colon on palpation.
– 84/min, rhythmic, blood pressure – 165/100 mmHg;
Fiberoptic colonoscopy detects no changes. What
edemas all over the body; the skin is pale and dry, with
disease can be suspected? 1. Irritable bowel syndrome
low turgor. The kidneys cannot be palpated, on an
Krok 2- 2019 26

2. Crohn disease (regional enteritis) 3. Prescribe processing of the postoperative wound with
3. Chronic enteritis UHF field
4. Chronic non-ulcerative colitis 4. Apply cold to the urinary bladder area
5. Whipple disease 5. Bladder catheterization

197. A 3 year old child presents with dyspnea that abates 199. A woman with atopic bronchial asthma was found to
in the sitting position, occasional loss of consciousness have one allergen to dog hair +++. Carpets are removed
and seizures, delayed physical development, cyanosis, from the apartment, the apartment was renovated, and
drumstick fingers. Echocardioscopy detects aortic air conditioner was installed. However, recurrent
dextroposition, ventricular septal defect, pulmonary asphyxia attacks still occurs every night,
artery stenosis, and right ventricular hypertrophy. What is
the most likely diagnosis?
1. Acquired valvular disease 200. 2 hours after eating unknown mushroom‟s, a
2. Tetrad of Fallot 28year-old man sensed a decrease in his mobility and
3. Ventricular septal defect deterioration of his ability to focus. This condition was
4. Coarctation of the aorta then followed by a state a agitated and aggression. On
5. Transposition of the great vessels examination he is disoriented, and his speech is
illegible. 4 hours later he developed fetor hepaticus and
198. A 78 year old man with a prostate adenoma lost his consciousness. What syndrome can be
underwent a herniotomy for a direct inguinal hernia. After observed in this patient?
the surgery he presents with absent urination. Enlarged
urinary bladder is detectable above the patient‟s pubis. 1. Acute hepatic failure
What measures should be taken in this case? 2. Hepatolienal syndrome
1. Prescribe antispasmodics subcutaneously
2. Prescribe proserin (neostigmine) intramuscularly
despite the patient undergoing pathogenetic therapy.
What long term treatment tactics can help this patient to
decrease her sensitivity to the allergen?
1. Buteryko breathing technique
2. Referral for speleotherapy
3. Specific hyposensitization
4. Antihistamine therapy
5. Continuation of prior treatment

01.(3) 31.(2) 61.(1) 91.(3 121.(4 151.(2) 181.(3)

02.(2) 32.(1) 62.(5) 92.(1 122.(3 152.(2) 182.(2)
03.(3) 33.(4) 63.(5) 93.(2 123.(3 153.(1) 183.(1)
04.(1) 34.(1) 64.(3) 94.(1) 124.(1) 154.(4) 184.(3)
05.(5) 35.(5) 65.(4) 95.(3) 125.(2) 155.(3) 185.(4)
06.(5) 36.(4) 66.(2) 96.(5) 126.(4) 156.(2) 186.(1)
07.(5) 37.(5) 67.(5) 97.(3) 127.(3) 157.(1) 187.(5)
08.(3) 38.(2) 68.(3) 98.(3) 128.(3) 158.(2) 188.(1)
09.(5) 39.(4) 69.(4) 99.(2) 129.(3) 159.(3) 189.(3)
Krok 2- 2019 27

10.(5) 40.(2) 70.(5) 100.(2) 130.(1) 160.(4) 190.(5)

11.(4) 41.(3) 71.(3) 101.(2) 131.(2) 161.(2) 191.(1)
12.(1) 42.(3) 72.(4) 102.(5) 132.(5) 162.(4) 192.(4)
13.(4) 43.(4) 73.(1) 103.(4) 133.(3) 163.(3) 193.(4)
14.(3) 44.(1) 74.(4) 104.(1) 134.(3) 164.(2) 194.(2)
15.(3) 45.(2) 75.(1) 105.(5) 135.(2) 165.(2) 195.(1)
16.(4) 46.(3) 76.(2) 106.(1) 136.(1) 166.(2) 196.(1)
17.(3) 47.(5) 77.(1) 137.(1) 167.(5) 197.(2)
18.(1) 48.(3) 78.(2) 108.(2) 138.(2) 168.(1) 198.(5)
19.(4) 49.(3) 79.(4) 109.(3) 139.(5) 169.(2) 199.(3)
20.(4) 50.(3) 80.(2) 110.(1) 140.(3) 170.(3) 200.(1)
21.(2) 51.(5) 81.(2) 111.(1) 141.(3) 171.(3)
22.(3) 52.(2) 82.(5) 112.(1) 142.(4) 172.(4)
23.(5) 53.(3) 83.(4) 113.(1) 143.(5) 173.(2)
24.(3) 54.(5 84.(4) 114.(5) 144.(3) 174.(5)
25.(2) 55.(5) 85.(2) 115.(4) 145.(3) 175.(4)
26.(1) 56.(2) 86.(3) 116.(1) 146.(2) 176.(2)
27.(4) 57.(5) 87.(5) 117.(4) 147.(1) 177.(5)
28.(2) 58.(2) 88.(1) 118.(2) 148.(1) 178.(1)
29.(5) 59.(2) 89.(1) 119.(5) 149.(1) 179.(5)
30.(3) 60.(3) 90.(3) 120.(1) 150.(3) 180.(3)