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Krok 2
MEDICINE
General Instruction
Every one of these numbered questions or unfinished statements in
this chapter corresponds to answers or statements endings. Choose the
answer (finished statements) that fits best and fill in the circle with the
corresponding Latin letter on the answer sheet.
Authors of items: Ahafonova O.O., Ambrozevych Z.M., Barannyk S.I., Berezniuk V.V., Berezov V.M.,
Bilenko O.A., Bilyk O.V., Bilyk V.D., Blikhar V.Ye., Bolbot Yu.K., Borzova O.Yu., Bukhtieieva E.R.,
Bukhtiyarova O.H., Buriak V.M., Butina L.I., Butvyn I.M., Chaika O.O., Chekanov S.L., Chelpan L.L.,
Chonka I.I., Chuiko Yu.M., Dankyna I.A., Dashchuk A.M., Demchenko T.V., Desiatska Yu.V., Drin T.M.,
Duplenko P.Yu., Dzis N.P., Filippova O.Yu., Franchuk O.A., Hahara V.F., Havrylova L.O., Henyk N.I.,
Herasymenko O.I., Hovalenkova O.L., Hrydasova V.D., Hubka O.V., Hyrla Ya.V., Kalinovska I.V.,
Kaliy V.V., Kalyberdenko V.B., Kandyba V.P., Karliychuk O.O., Kirieieva T.V., Klymenko A.V.,
Koliush O.I., Kompaniyets K.M., Kondratenko P.H., Kondratiev V.O., Konopkina L.I., Konovalova N.V.,
Kopchak O.V., Korovka S.Ya., Kovalchuk P.Ye., Kovalenko S.V., Kovtunenko R.V., Krut Yu.Ya.,
Kryvenko Z.F., Kryvonosov M.V., Kryzhanovsky Yu.M., Kudria V.I., Lavrinchuk I.O., Lakusta N.M.,
Lebediuk M.M., Leshchenko K.A., Liulka O.M., Makieieva N.I., Malovany V.V., Marushko Yu.V.,
Martsynik Ye.M., Melnychuk L.V., Mierkulova N.F., Mitiunina N.I., Miziuk V.V., Moroz I.M.,
Muravska O.M., Murtazin L.M., Mysak A.I., Nadraha O.B., Nechytailo Yu.M., Nerianov K.Yu.,
Nikolaichuk O.M., Nishkumai O.I., Nykoniuk T.R., Olifierovska R.P., Parashchuk Yu.S., Pashchenko I.V.,
Pertseva N.O., Petrynych V.V., Pisotska L.A., Pohorelov O.V., Proniv L.M., Pryshliak O.Ya.,
Radchenko O.M., Reitmaier M.Y., Riapolova T.L., Romanenko V.N., Rudai V.V., Rudenko M.M.,
Rudenko S.M., Ruzhytska O.O., Samardakova H.O., Semeniak A.V., Semenukha K.V., Sennikov I.A.,
Serheta I.V., Shapkin V.Ye., Shkrobanets I.D., Shorikov Ye.I., Shusterman T.Y., Shvyhar L.V.,
Sidykh N.M., Sierkova V.K., Sikorska M.V., Smachylo I.V., Smoliak L.L., Snizhko S.S., Soboleva N.P.,
Sokolov O.B., Soldak I.I., Sonnyk H.T., Sorochan V.V., Sotnik Yu.P., Suk V.H., Svyrydova V.V.,
Svystunov I.V., Sylenko H.Ya., Sychova V.V., Synoverska O.B., Tarasova V.I., Teliushchenko O.D.,
Tiuieva N.V., Todoriko L.D., Tokariev A.V., Tonkohlas O.A., Tretiakevych Z.M., Troian V.I.,
Tykhonova S.A., Ukhal M.I., Vankhanen N.V., Vatanska I.Yu., Volianska A.H., Voloshyna L.O.,
Vorokhta Yu.M., Vykhovanets T.A., Yakovenko I.K., Yermachenko T.P., Yevtushenko V.V.,
Yurchenko I.V., Yutanova A.V., Zakharov V.K., Zheliba M.D., Zoria A.V. and Committees of professional
expertise
Item reviewers. Agafonova O.O., Anisimov Ye.M., Bab’yak T.Ye., Chursina T.Ya., Dyndar O.A.,
Grygorov Yu.B., Grynzovs’ky A.M., Gubka V.O., Gutsalenko O.O., Kalinina S.Yu., Karapetyan K.G.,
Khrapach V.V., Kolesnyk O.M., Kolosovych I.V., Kondratyuk V.Ye., Kopcha V.S., Kravchenko O.V.,
Kutovy O.B., Kuz’mina I.Yu., Malanchuk L.M., Martynyuk L.P., Mishchenko V.P., Muravs’ka O.M.,
Petrushenko V.V., Prokhorova M.P., Pryshlyak O.Ya., Puzanova O.G., Pyptyuk O.V., Shestakova I.V.,
Shevtsova T.I., Stovban I.V., Tsvirenko S.M., Usenko S.G., Vakal’uk I.P., Volyans’ka A.G.
The book includes test items for use at licensing integrated examination “Krok 2. Medicine” and
further use in teaching.
The book has been developed for students of medical, pediatric and medical-and-prophylactic
faculties and academic staff of higher medical educational establishments.
10. A parturient woman complains of pain in A. II degree flame burn of the hands, 4% of
her mammary gland. In the painful area there body surface area
is an infiltration 3x4 cm in size with softened B. II degree flame burn of the hands, 2% of
center. Body temperature is 38,5o C . What is body surface area
the most likely diagnosis? C. IIIa degree flame burn of the hands, 4% of
body surface area
A. Acute suppurative mastitis D. III degree flame burn of the hands, 4% of
B. Pneumonia body surface area
C. Pleurisy E. IIb degree flame burn of the hands, 2% of
D. Milk retention body surface area
E. Birth trauma
15. During the periodic medical examination
11. A 52-year-old patient, who has been an assembly fitter (works on soldering detai-
suffering from angina pectoris, for 2 weeks ls) didn’t report any health problems. Closer
has increasingly frequent pain attacks in the examination revealed signs of asthenic-
area behind his sternum and his need for ni- vegetative syndrome. Blood included red
troglycerine has increased. Objectively: the blood cells with basophilic aggregations
condition is of moderate severity. The skin is and a somewhat higher number of reti-
pale. Heart sounds are weakened, rhythmic. culocytes, urine had a high concentration of
Heart rate is 84/min. ECG shows no signs of delta-aminolevulinic acid. The complex of
focal myocardial injury. What is the most li- symptoms indicates the initial stage of chronic
kely diagnosis? intoxication with:
A. Progressive angina pectoris A. Lead
B. First-time angina pectoris B. Manganese
C. Stable NYHA functional class II angina C. Mercury
pectoris D. Tin
D. Variant angina pectoris E. Ethanol
E. Acute cardiac infarction
16. A 29-year-old woman came to a
12. A 9-year-old boy has been suffering gynecologist with complaints of irritabili-
from multiple bronchiectasis since he was 3 ty, tearfulness, headache, nausea, occasional
years old. Exacerbations occur frequently (3- vomiting, pain in the heart area, tachycardia
4 times a year), after conservative therapy attacks, memory impairment, meteorism.
there are short remission periods. The di- These signs appear 6 days before menstruati-
sease progresses, the child is physically on and disappear the day before menstruation
underdeveloped, presents with pale skin, or during its first 2 days. On vaginal exami-
acrocyanosis, deformed nail plates in the nation: the uterus and uterine appendages
shape of ”clock-face”. Bronchography reveals are without alterations. What diagnosis is the
saccular bronchiectases in the lower lobe of most likely?
the right lung. What further treatment tactics
should be chosen?
Крок 2 Medicine (англомовний варiант, iноземнi студенти) 2017 рiк 3
focus of shadow 3 cm in diameter, low density, A. Risk of late abortion with hemorrhage
with fuzzy smooth margins and a clearing in B. Risk of late abortion without hemorrhage
its center. What disease is most likely in the C. The process of late abortion
given case? D. Incomplete late abortion
E. Attempted late abortion
A. Pneumonia complicated by an abscess
B. Infiltrative tuberculosis 29. A 65-year-old man was diagnosed with
C. Peripheral pulmonary cancer B12 -deficient anemia and the treatment was
D. Cystic echinococcosis prescribed. A week later control blood test
E. Pulmonary cyst was performed. What would be the early indi-
cator of the therapy effectiveness?
25. A 48-year-old patient was found to have
diffuse enlargement of the thyroid gland, A. Increased number of reticulocytes
exophthalmia, weight loss of 4 kg in 2 months, B. Increased hemoglobin level
sweating. Objectively: HR- 105/min, BP- C. Megaloblastic hematopoiesis
140/70 mm Hg. Defecation act is normal. D. Normoblastic hematopoiesis
What kind of therapy is recommended in this E. Increased erythrocyte number
case?
30. A 35-year-old woman complains of heart
A. Mercazolil pain (”aching and drilling”) occurring mai-
B. Radioactive iodine nly in the morning in autumn and spring and
C. Propranolol irradiating to the neck, back and abdomen;
D. Lugol’s solution rapid heartbeat; low vitality. Occurrence of
E. Thyroxine this condition is not associated with physical
activity. In the evening, the patient’s condition
26. A 26-year-old woman is suspected to improves. Study of somatic and neurological
suffer from systemic lupus erythematosus due status and ECG reveal no pathology. What
to systemic lesions of skin, vessels, joints, pathology is most likely to have caused these
serous tunics, and heart that developed after clinical presentations?
photosensitization. The following is detected:
LE cells, antibodies to native DNA, isolated A. Somatization depression
anti-centromere antibodies, rheumatoid B. Resting stenocardia
factor is 1:100, Wassermann reaction is posi- C. Pseudoneurotic schizophrenia
tive, circulating immune complex is 120 uni- D. Neurocirculatory asthenia
ts. What immunological indicators are consi- E. Hypochondriacal depression
dered to be specific to this disease?
31. On the 4th day after recovery from a
A. DNA antibodies cold a patient was hospitalized with complai-
B. Rheumatoid factor nts of solitary spittings of mucoid sputum.
C. Anti-centromere antibodies On the 2nd day there was a single discharge
D. Immunoglobulin A of about 250 ml of purulent blood-streaked
E. Increased circulating immune complex sputum. Objectively: the patient’s conditi-
on is moderately severe. Respiratory rate -
27. A woman came to a doctor with complai- 28-30/min., Ps- 96/min., BP- 110/70 mm Hg.
nts of increased body temperature up to Respiration over the left lung is vesicular,
37,8o C and moderately sore throat for the last over the right lung - weakened. There are
3 days. Objectively: mandibular lymph nodes various moist crackles over the lower lobe
are enlarged up to 3 cm. Palatine tonsils are and amphoric breath sounds near the angle of
hypertrophied, with gray coating that spreads scapula. What is the most likely diagnosis?
to the uvula and anterior pillars of the fauces.
What is the most likely diagnosis? A. Acute pulmonary abscess
B. Exudative pleuritis
A. Oropharyngeal diphtheria C. Acute focal pneumonia
B. Infectious mononucleosis D. Pleural empyema
C. Pseudomembranous (Vincent’s) tonsillitis E. Pyopneumothorax
D. Agranulocytosis
E. Oropharyngeal candidiasis 32. A 65-year-old woman on abdominal
palpation presents with a tumor in the umbi-
28. A primigravida at the term of 20 weeks lical region and above it; the tumor is 13x8 cm
complains of pain in her lower abdomen, in size, moderately painful, non-mobile, pulsi-
smearing blood-streaked discharge from the ng. On auscultation systolic murmur can be
genital tracts. Uterine tone is increased, fetus observed. What is the most likely diagnosis?
is mobile. On vaginal examination: the uterus
is enlarged according to the term, uterine A. Abdominal aneurysm
cervix is shortened to 0,5 cm, external cervical B. Gastric tumor
orifice is open by 2 cm. What is the most likely C. Arteriovenous aneurysm
diagnosis? D. Tricuspid insufficiency
E. Bicuspid insufficiency
Крок 2 Medicine (англомовний варiант, iноземнi студенти) 2017 рiк 5
33. A 45-year-old man complains of cough fi- 37. A patient with suspected pheochromocytoma
ts and tickling in his nasopharynx. He had has normal blood pressure in the periods
been staying for 10 days in the polluted area between the atacks and a tendency towards
created by the Chornobyl nuclear power plant tachycardia. Urine test revealed no pathologi-
accident. Rhinoscopy shows signs of severe es. It was decided to use a provocative test
nasopharynx irritation. What radionuclide is with histamine. What medication should be
the cause of this irritation? prepared to provide emergency care in case
of positive test result?
A. Radioactive iodine
B. Radioactive cesium A. Phentolamine
C. Radioactive strontium B. Pipolphen
D. Radioactive plutonium C. Nifedipine
E. Radioactive cobalt D. Mesatonum
E. Prednisolone
34. A 20-year-old patient complains of severe
headache, double vision, weakness, fever, 38. A 42-year-old woman complains of severe
irritability. Objectively: body temperature is pulsing headache in the frontoparietal area,
38,1o C , the patient is reluctant to contact, vertigo, palpitations. She has been sufferi-
sensitive to stimuli. There are ptosis of ng from hypertension for 3 years. Significant
the left eyelid, exotropia, anisocoria S>D, increase of BP occurs 2-3 times per month
pronounced meningeal syndrome. On lumbar and lasts for 3-8 hours. The left ventricle is
puncture the cerebrospinal fluid flowed out enlarged, heart sounds are clear, heart rate
under a pressure of 300 mm Hg, the fluid - 105/min., BP- 225/115 mm Hg. ECG: signs
is clear, slightly opalescent. 24 hours later of left ventricular hypertrophy. What drug
there appeared fibrin film. Protein - 1,4 g/l, would be the most effective for termination
lymphocytes - 600/3 per mm3 , sugar - 0,3 of cerebral crisis attack?
mmol/l. What is the provisional diagnosis?
A. Labetalol
A. Tuberculous meningitis B. Hydrochlorothiazide (Hypothiazide)
B. Meningococcal meningitis C. Captopril
C. Lymphocytic (Armstrong’s) meningitis D. Losartan
D. Syphilitic meningitis E. Clonidine (Clophelin)
E. Mumps meningitis
39. A 45-year-old patient complains of pain
35. A 37-year-old worker during a fire ended in the epigastric region, left subcostal area,
up in the area of high CO concentration. abdominal distension, diarrhea, loss of wei-
He was delivered to a hospital in unconsci- ght. He has been suffering from this condition
ous state. Objectively: the skin of his face for 5 years. Objectively: the tongue is moist
and hands is crimson. Respiration rate is with white coating near the root; deep palpati-
20/min. ECG: alterations specific for hypoxic on of abdomen reveals slight pain in the epi-
myocardium. Hourly diuresis is 40 ml. Blood gastric region and Мауо-Robson’s point. Li-
test: erythrocytes - 4, 5 · 1012 /l, Нb- 136 ver is painless and protrudes by 1 cm from the
g/l, color index - 0,89, ESR- 3 mm/hour, costal arch. Spleen cannot be palpated. What
carboxyhemoglobin - 5%. What criterion disease can be primarily suspected?
allows determining the severity of the pati- A. Chronic pancreatitis
ent’s condition? B. Atrophic gastritis
A. Carboxyhemoglobin concentration C. Peptic stomach ulcer
B. Respiratory disorders D. Chronic cholecystitis
C. ECG results E. Chronic enteritis
D. Extent of trophic disorders 40. For three years a 31-year-old woman has
E. Development of chronic renal failure been complaining of pain and swelling of
36. After a case of purulent otitis a 1-year-old her radiocarpal and metacarpophalangeal
boy has developed pain in the upper third of articulations, their reduced mobility in the
the left thigh, body temperature up to 39o C . morning, which persisted up to 1,5 hours.
Objectively: swelling of the thigh in its upper Two weeks ago she developed pain, swelli-
third and smoothed out inguinal fold. The li- ng, and reddening of her knee joints, her
mb is in semiflexed position. Active and passi- body temperature increased up to 37,5oC .
ve movements are impossible due to severe The treatment was belated. Examination of
pain. What diagnosis is the most likely? the internal organs revealed no pathologic
alterations. Diagnosis of rheumatoid arthritis
A. Acute hematogenous osteomyelitis was made. What alterations are the most li-
B. Acute coxitis kely to be visible on the arthrogram?
C. Intermuscular phlegmon
D. Osteosarcoma
E. Brodie’s abscess
Крок 2 Medicine (англомовний варiант, iноземнi студенти) 2017 рiк 6
A. Joint space narrowing, usuration resins. Objectively: lesion foci are symmetri-
B. Joint space narrowing, subchondral cally localized on both hands. Against the
osteosclerosis background of erythema with blurred margi-
C. Cysts in the subchondral bone ns there are papulae, vesicles, erosions, crusts,
D. Numerous marginal osteophytes and scales. What is the most likely pathology?
E. Epiphyseal osteolysis
A. Occupational eczema
41. A 58-year-old woman complains of B. Idiopathic eczema
spontaneous bruises, weakness, bleeding C. Allergic dermatitis
gums, dizziness. Objectively: the mucous D. Simple contact dermatitis
membranes and skin are pale with numerous E. Erythema multiforme
hemorrhages of various time of origin. Lymph
nodes are not enlarged. Ps- 100/min, BP- 45. A 10-year-old boy with symptoms of
110/70 mm Hg. There are no alterations of arthritis and myocarditis was delivered into
internal organs. Blood test results: RBC- a hospital. Based on clinical examination the
3, 0 · 1012 /l, Нb- 92 g/l, color index - 0,9, preliminary diagnosis of juvenile rheumatoid
anisocytosis, poikilocytosis, WBC- 10 · 109 /l, arthritis was made. What symptom is the most
eosinophils - 2%, stab neutrophils - 12%, contributive for the diagnostics of this di-
segmented neutrophils - 68%, lymphocytes sease?
- 11%, monocytes - 7%, ESR- 12 mm/h. What A. Reduced mobility of the joints in the
laboratory test should be performed additi- morning
onally to make the diagnosis? B. Regional hyperemia of the joints
A. Platelets C. Affection of the large joints
B. Reticulocytes D. Enlarged heart
C. Clotting time E. Increased heart rate
D. Osmotic resistance of erythrocytes 46. A 25-year-old patient was delivered to
E. Fibrinogen an infectious diseases unit on the 3rd day of
42. After tonsillectomy a woman with illness with complaints of headache, pain in
systemic lupus erythematosus, who has been the lumbar spine and gastrocnemius muscles,
taking prednisolone for a year, developed high fever, chills. Objectively: condition is of
acute weakness, nausea, vomiting, pain in the moderate severity. Scleras are icteric. Pharynx
right iliac area, watery stool up to 5 times is hyperemic. Tongue is dry with dry brown
per day. Ps- 96/min., BP- 80/50 mm Hg. What coating. Abdomen is distended. Liver is
preventive therapy should have been admini- enlarged by 2 cm. Spleen is not enlarged.
stered prior to the surgery? Palpation of muscles, especially gastrocnemi-
us muscles, is painful. Urine is dark in color.
A. Increase of prednisolone dosage Feces are normal in color. What is the most
B. Prescription of desoxycorticosterone likely diagnosis?
acetate
C. Prescription of antibiotics A. Leptospirosis
D. Administration of Ringer’s solution B. Viral hepatitis type A
E. Administration of 10% N aCl solution C. Malaria
D. Infectious mononucleosis
43. A 45-year-old woman complains of E. Yersiniosis
paroxysmal intolerable facial pain on the left
with attacks that last for 1-2 minutes. Attacks 47. A 28-year-old woman complains of
are provoked by chewing. The disease onset skin hemorrhages after minor traumas and
was two month ago after overexposure to spontaneous appearance of hemorrhages on
cold. Objectively: pain at the exit points of the the front of her torso and extremities. On
trigeminal nerve on the left. Touching near examination: the skin is variegated (old and
the wing of nose on the left induces new pain new hemorrhages), bleeding gums. Blood
attack with tonic spasm of the facial muscles. platelets - 20·109 /l; in the bone marrow there is
What is the most likely diagnosis among those increased number of megakaryocytes and no
listed? platelet production. Treatment with steroid
hormones was effective. What disease is it?
A. Trigeminal neuralgia
B. Glossopharyngeal neuralgia A. Idiopathic thrombocytopenic purpura
C. Temporomandibular joint arthritis B. Hemophilia
D. Facial migraine C. Rendu-Osler-Weber disease (Hereditary
E. Maxillary sinusitis hemorrhagic telangiectasia)
D. Disseminated intravascular coagulation
44. A 28-year-old man complains of skin E. Acute vascular purpura
rash and itching on the both of his hands.
The condition persists for 1,5 years. The 48. A 74-year-old patient was delivered into
exacerbation of his condition he ascribes to admission room with clinical presentations of
the occupational contact with formaldehyde acute deep vein thrombosis of the shin. What
Крок 2 Medicine (англомовний варiант, iноземнi студенти) 2017 рiк 7
A. Thoracocentesis on the left at the 7th shoulders, the head is bowed forward, the
intercostal space thorax is flattened, the stomach is bulging.
B. Thoracocentesis at the 2nd intercostal space In the vertebral column there are deepened
C. Repeated puncture of the pleural cavity cervical and lumbar flexures. What posture
D. Intubation of trachea with artificial does the child have?
pulmonary ventilation
E. Alcohol-novocaine block of the fracture A. Kyphosis
area B. Lordosis
C. Stooping
82. A patient complains of suppuration from D. Corrected
the ear and impaired hearing of the left ear, E. Normal
which have been observed for the past 6
years. The patient had periodical headaches, 86. A 46-year-old woman has been hospitali-
general indisposition, fever. Objectively: zed with open fracture of the left thigh in
otoscopy of the external auditory meatus its middle third. She underwent the surgery
revealed mucopurulent odorless substance. - fixation with extraosseous osteosynthesis
The eardrum is of normal color, with central plates. On the 4th day after the surgery
perforation. What is the most likely di- she developed pain in the wound, body
agnosis? temperature rose over 39o C . What measures
should be taken in this case?
A. Chronic mesotympanitis
B. Otosclerosis A. Undo the sutures, drain the wound, and
C. Acute otitis media prescribe antibiotics
D. Chronic epitympanitis B. Prescribe broad spectrum antibiotics and
E. Chronic sensorineural hearing loss hormonal agents
C. Administer antibiotics intraosseously and
83. In 2 hours after a traffic accident a 28-year- hypothermia locally
old man in grave condition was delivered to a D. Inject antibiotics into the area surroundi-
hospital. The patient complains of abdominal ng the wound, prescribe spasmolytics and
pain. He received a blow to the abdomen wi- analgesics
th the steering wheel. Objective examination E. Remove the fixation, prescribe sulfanilami-
revealed the following: the abdomen does not des
participate in respiration, is tense and acutely
painful on palpation; the abdominal muscles 87. A multigravida on the 38th week of her
are defensively tense, peritoneal irritation si- pregnancy complains of increased BP up to
gns are positive, hepatic dullness is absent. BP 140/90 mm Hg, edema of the shins for 2 weeks.
is 90/60 mm Hg, heart rate is 120/min. What In the last month she gained 3,5 kg of weight.
further treatment tactics should be chosen? Urine analysis: protein - 0,033 g/l. Make the
diagnosis:
A. Laparotomy
B. Laparoscopy A. Mild preeclampsia
C. Cold to the abdomen B. Moderate preeclampsia
D. Ultrasound investigation C. Pregnancy hypertension
E. Laparocentesis D. Severe preeclampsia
E. Pregnancy edema
84. A 28-year-old woman complains of
increased intervals between menstruations, 88. A 44-year-old patient with postinfarcti-
up to 2 months, and hirsutism. Gynecological on cardiosclerosis presents with frequent
examination revealed the following: ovaries heart rate disorders and lower extremity
are enlarged, painless, and dense; no alterati- edema. Objectively: Ps- 95/min., irregular,
ons of the uterus. US of the lesser pelvis: 10-12 extrasystoles per minute. BP- 135/90
ovaries are 4-5 cm in diameter, with numerous mm Hg. The 1st heart sound at the apex is
enlarged follicles on the periphery. X-ray of weakened. Pulmonary respiration is rough.
the skull base: sellar region is widened. What The liver is enlarged +2 cm. ECG: irregular
is the most likely diagnosis? sinus rhythm, heart rate - 95/min, frequent
polytopic ventricular extrasystoles. What anti-
A. Stein-Leventhal syndrome (polycystic arrhythmic drug is advisable in this case for
ovarian syndrome) treatment and prevention of extrasystole?
B. Algodismenorrhea
C. Sheehan syndrome (postpartum hypopitui- A. Amiodarone
tarism) B. Lidocaine
D. Premenstrual syndrome C. Mexiletine
E. Morgagni-Stewart-Morel syndrome D. Quinidine
(metabolic craniopathy) E. Novocainamide (Procainamide)
85. Posture of an 11-year-old boy was determi- 89. A 60 year-old woman has been suffering
ned during preventive examination. The chi- from weakness, dizziness, and fatigue over
ld presents with curled forward rounded the last year. Recently she has also developed
Крок 2 Medicine (англомовний варiант, iноземнi студенти) 2017 рiк 12
96. A 47-year-old man is employed at the neck veins, peripheral pulse is absent, the
weaving workshop, has 15-year-long record carotid artery pulse is rhythmic, 130/min., BP
of service at this factory; his work conditi- is 60/20 mm Hg. Auscultation of the heart
ons are associated with high-frequency and reveals extremely muffled sounds, percussion
high-intensity noise. During periodical exami- reveals heart border extension in both directi-
nation he was diagnosed with occupational ons. What is the optimal treatment tactics for
deafness. What are the grounds for making this patient?
such a diagnosis?
A. Pericardiocentesis and immediate
A. Audiometry data and hygienic assessment thoracotomy
of working environment B. Oxygen inhalation
B. Record of service at this factory C. Puncture of the pleural cavity on the left
C. Noise characteristic at this factory D. Conservative treatment, infusion of
D. Central nervous system examination results adrenomimetics
E. Inner ear examination results E. Pleural cavity drainage
97. A 37-year-old woman complains of acute 101. A patient with chronic pancreatitis
pain in the genital area, swelling of the complains of diarrhea occurring up to 5 ti-
labia, pain when walking. Objectively: body mes per day (no blood traces), loss of body
temperature is 38,7o C , Ps- 98/min. In the weight, abdominal distention, dryness of skin,
interior of the right labia there is a dense, loss of hair, thirst, bleeding gums, convulsi-
painful tumor-like formation 5,0x4,5 cm in si- ons. Complete blood count: leukocytes -
ze, the skin and mucous membrane of genitals 5, 8 · 109 /l; Hb- 86 g/l; ESR- 15 mm/g; Blood
are hyperemic, there is profuse foul-smelling protein test: protein - 48 g/l; albumins - 28
discharge. What is the most likely diagnosis? g/l. What indicators of coprological analysis
would accompany this syndrom?
A. Acute bartholinitis
B. Labial furuncle A. Steatorrhea, creatorrhea
C. Acute vulvovaginitis B. Large amount of mucus, amylorrhea
D. Bartholin gland cyst C. Large amount of starch grains and cellulose
E. Carcinoma of vulva D. Gas bubbles, acid reaction
E. Large numbers of iodinophilous microbes
98. A woman undergoing in-patient treatment
for viral hepatitis type B developed headache, 102. A 35-year-old patient complains of
nausea, recurrent vomiting, memory lapses, heartburn, gasseous and sour eructation,
flapping tremor of her hands, rapid pulse. burning constricting pain behind the sternum
Sweet smell from the mouth is detected. Body and along the esophagus, developing when
temperature is 37,6o C , heart rate is 89/min. bowing the torso to the front. No previ-
What complication developed in the patient? ous examination; the patient takes almagel
at his own discretion, after which he notes
A. Acute liver failure improvement of his general state. Make the
B. Ischemic stroke provisional diagnosis:
C. Gastrointestinal hemorrhage
D. Hypoglycemic shock A. Gastroesophageal reflux disease
E. Meningoencephalitis B. Functional dyspepsia
C. Cardiospasm
99. A 42-year-old man was delivered to a D. Ulcer disease of the stomach
surgical in-patient department with complai- E. Ulcer disease of the duodenum
nts of icteric skin, pain in the right subcostal
area. Biochemical blood analysis: total bili- 103. The left hand of a newborn is extended
rubin - 140 mcmol/l, direct bilirubin - 112 in all its joints, stretched along the torso, and
mcmol/l. On US: choledoch duct - 1,4 cm, pronated in the forearm. Active movements
a concrement is detected in the distal area. of the shoulder joint are retained. The hand
Gallbladder is 40 cm, no concrements. What is flattened, atrophied, cold to touch, hangs
treatment tactics should be chosen? passively. Grasping and Babkin’s reflexes are
absent at the affected side. Hemogram indi-
A. Endoscopic papillosphincterotomy cators are normal. Make the most likely di-
B. Laparoscopic cholecystectomy agnosis:
C. Laparotomy with choledoch duct drain
D. Laparotomy with cholecystectomy A. Inferior distal obstetrical paralysis
E. Threatment in an infectious diseases hospi- B. Osteomyelitis
tal C. Proximal obstetrical paralysis
D. Complete obstetrical paralysis
100. 4 weeks after myocardial infarction a 56- E. Hypoxic-ischemic encephalopathy
year-old patient developed acute heart pain,
marked dyspnea. Objectively: the patient’s 104. A 34-year-old man is being treated for
condition is extremely grave, there is marked schizophrenia exacerbation in a psychiatric
cyanosis of face, swelling and throbbing of unit. Objectively: the patient remains in bed,
Крок 2 Medicine (англомовний варiант, iноземнi студенти) 2017 рiк 14
is sluggishly mobile, unresponsive, does not Objectively: the patient is exhausted, there
react to questions. His position is unvari- are enlarged supraclavicular lymph nodes.
ed, hypomimic, snout reflex and Dupre’s Esophagoscopy revealed no esophageal
symptom are present, muscles exhibit waxy pathology. Which of the following investigati-
flexibility. He has been remaining in this ons is the most appropriate in this case?
state for approximately a week. Feeding is
parenteral. Determine the neuromotor di- A. Computed tomography of chest and medi-
sturbance: astinum
B. X-ray of lungs
A. Catatonic stupor C. Multiplanar imaging of esophagus
B. Depressive stupor D. Radioisotope investigation of chest
C. Psychogenic stupor E. Ultrasound investigation of mediastinum
D. Anergic stupor
E. Exogenic stupor 109. A 15-year-old girl complains of dizzi-
ness and sensation of lack of air that she
105. A 14-year-old girl has been delivered to develops in emotionally straining situations.
a gynecological department with complaints Relief occurs after she takes corvalol. Objecti-
of profuse blood discharge from her genital vely: hyperhidrosis and marble-like pattern
tract for 2 weeks. Anamnesis: menstruation si- of the skin of her palms and feet. Clinical
nce 13, irregular, painful, profuse; the last one and instrumental examination revealed no
was 2 months ago. Objectively: pale skin and organic alterations of the central nervous,
mucosa, BP- 100/60 mm Hg, Hb- 108 g/l. The cardiovascular, and respiratory systems. What
abdomen is soft and painless on palpation. provisional diagnosis can be made?
Rectal examination revealed no pathologies
of reproductive organs. What condition is it? A. Somatoform autonomic dysfunction
B. Obstructive bronchitis
A. Juvenile uterine hemorrhage (Dysfuncti- C. Bronchial asthma
onal) D. Stenosing laryngotracheitis
B. Hypomenstrual syndrome E. Acute epiglottitis
C. Inflammation of uterine appendages (Pelvic
110. A 14-year-old patient complains of
inflammatory disease) alopecia foci on his scalp. The patient has
D. Pelviperitonitis been presenting with this condition for 2
E. Endometritis weeks. Objectively: on the scalp there are
106. An infant cries during urination, the several small oval foci with blurred margins.
foreskin swells and urine is excreted in The skin in the foci is pink-red, the hairs are
drops. What approach to treatment should broken off at 4-5 mm length or at skin level.
be chosen? Under Wood’s lamp there are no foci of green
luminescence detected. What disease is it?
A. Create an opening into the foreskin cavity
B. Prescription of α-adrenergic blocking A. Trichophytosis capitis
agents B. Syphilitic alopecia
C. Prescription of antispasmodic agents C. Alopecia areata
D. Urinary bladder catheterization D. Scleroderma
E. Epicystostomy E. Psoriasis
107. A 20-year-old patient complains of pain 111. A 38-year-old patient has been delivered
in the left lumbar region, arterial pressure rise by an ambulance to a surgical department
up to 160/110 mm Hg. US revealed that the with complaints of general weakness, indi-
structure and size of the right kidney were wi- sposition, black stool. On examination the
thin age norms, there were signs of the 3rd patient is pale, there are dotted hemorrhages
degree hydronephrotic transformation of the on the skin of his torso and extremiti-
left kidney. Doppler examination revealed es. On digital investigation there are black
an additional artery running to the lower feces on the glove. Blood test: Hb- 108 g/l,
pole of the kidney. Excretory urogram shows thrombocytopenia. Anamnesis states that si-
a narrowing in the region of ureteropelvic milar condition was observed 1 year ago.
junction. Specify the treatment tactics: Make the diagnosis:
108. A 49-year-old patient consulted a doctor 112. A 35-year-old patient developed an epi-
about difficult swallowing, voice hoarseness, leptic attack with tonoclonic spasms that
weight loss. These symptoms have been lasted for 3 minutes. After the attack the pati-
gradually progressing for the last 3 months. ent fell asleep but in 5 minutes the second
Крок 2 Medicine (англомовний варiант, iноземнi студенти) 2017 рiк 15
attack occurred. The first step of emergency 22. His current condition has changed acutely:
aid would be to: for 3 days the patient has been refusing
to leave his home. He claims that there is
A. Ensure patency of airways a ”telepathy” occurring between him and
B. Take blood from the vein for analysis the other people, through which he receives
C. Introduce diazepam intravenously ”thoughts of strangers” and transmits his own
D. Prescribe antiepileptic drugs thoughts for everyone to hear. He is convi-
E. Administer chloral hydrate via an enema nced that his thoughts and actions are being
manipulated through this ”telepathy”. Make
113. A 23-year-old woman has been suffering the preliminary diagnosis:
from a mental disease since the age of 18,
the course of disease has no remission peri- A. Paranoid schizophrenia
ods. At a hospital the patient mostly presents B. Depressive episode
with non-purposeful foolish excitation: she C. Manic episode
makes stereotypic grimaces, exposes herself, D. Organic delirium
publicly masturbates with a loud laughter, E. Acute reaction to stress
repeates stereotypical abusive shouts. The
patient should be prescribed: 118. A 35-year-old woman has gained 20 kg
weight within a year with the normal diet.
A. Neuroleptics She complains of chills, sleepiness, shortness
B. Antidepressants of breath. The patient’s mother and sister are
C. Tranquilizers corpulent. Objectively: height - 160 cm, wei-
D. Nootropics ght - 92 kg, BMI- 35,9. Obesity is uniform,
E. Mood stabilizers there are no striae. The face is amimic. The
skin is dry. The tongue is thickened. Heart
114. A young woman suffering from sounds are muffled. HR- 56/min, BP- 140/100
seborrhea oleosa has numerous light-brown mm Hg. The patient has been suffering from
and white spots on the skin of her torso amenorrhea for 5 months, has constipations.
and shoulders. The spots have clear margi- TSH- 28 mcIU/l (norm is 0,32-5). Craniogram
ns, branny desquamation, no itching. What shows no pathology. What is the etiology of
provisional diagnosis can be made? obesity?
A. Pityriasis versicolor A. Hypothyroid
B. Torso dermatophytosis B. Hypo-ovarian
C. Seborrheic dermatitis C. Hypothalamic-pituitary
D. Pityriasis rosea D. Alimentary and constitutive
E. Vitiligo E. Hypercorticoid
115. 10 days after birth a newborn developed 119. A patient complains of painless ”sores”
sudden fever up to 38,1o C . Objectively: the on his penis and inguinal lymph nodes
skin in the region of navel, abdomen and enlargement. Synthomycin emulsion that the
chest is erythematous; there are multiple pea- patient have been applying to the ”sores” was
sized blisters with no infiltration at the base; ineffective. Objectively: on the inner leaf of
isolated bright red moist erosions with epi- the foreskin there are three closely situated
dermal fragments are observed on the peri- rounded erosions, 0,5 cm in diameter, with
phery. What is the provisional diagnosis? dense infiltration that can be palpated at their
A. Epidemic pemphigus of newborn bases. Make the preliminary diagnosis:
B. Syphilitic pemphigus A. Primary syphilis
C. Streptococcal impetigo
D. Vulgar impetigo B. Herpes simplex (Herpes pro genitalis)
E. Atopic dermatitis C. Candidiasis of the inner leaf of the foreskin
D. Shingles
116. A man came to an urologist with E. Erythema multiforme
complains of painful urination, discharge
from urethra. The patient has been suffering 120. A 1,5-month-old child on breasfeedi-
from this condition for a week. Objectively: ng presents from birth with daily vomiting,
hyperemic urinary meatus, edema, purulent irregular liquid foamy feces, and meteori-
discharge. Microscopy of smears detected sm, which are resistant to antibacterial and
gram-negative bacteria. Specify the diagnosis: probiotic therapy; no increase of body mass
is observed. The child’s condition improved,
A. Acute gonorrheal urethritis when breastmilk was substituted with ”NAN
B. Trichomonas urethritis low lactose” formula. What pathology is it?
C. Candidal urethritis
D. Chlamydial urethritis
E. Chronic gonorrhea
117. A patient is 28 years old. He has been
suffering from mental disorder since he was
Крок 2 Medicine (англомовний варiант, iноземнi студенти) 2017 рiк 16
and painless. Blood bilirubin is 190 mcmol/l analyses periodically revealed leukocyturia.
(accounting for direct bilirubin). Stool is The child has undergone no further treatment.
acholic. What is the most likely jaundice On examination: increased BP up to 150/100
genesis in this patient? mm Hg. Ultrasound investigation revealed si-
gnificant reduction of the right kidney. What
A. Mechanical jaundice process is leading in arterial hypertension
B. Hepatocellular jaundice pathogenesis in this case?
C. Hemolytic jaundice
D. Caroli syndrome A. Hyperactivity of renin-angiotensin system
E. Gilbert’s syndrome B. Disturbance of water-electrolytic balance
C. Disturbance of renal circulation
144. During hemotransfusion the patient D. Hypersympathicotonia
developed nausea, tremor, lumbar and E. Increased cortisol level
retrosternal pain. On examination the skin
is hyperemic, later developed pallor; the pati- 148. A 3-month-old child presents with
ent presents with hyperhidrosis, labored respi- saffron-yellow coloring of the skin, sclera,
ration, pulse is 110/min., BP is 70/40 mm Hg. and mucous membranes. The abdomen is
Urine is black colored. What complication enlarged, hepatomegaly and splenomegaly
developed in the patient? are observed. In blood there is conjugated
bilirubin-induced hyperbilirubinemia. On
A. Posttransfusion shock intravenous cholangiocholecystography:
B. Acute renal failure opacified bile is discharged into the intesti-
C. Pulmonary embolism ne. Transaminase activity is normal. What is
D. Anaphylactic shock the most likely diagnosis?
E. Hypotonic crisis
A. Biliary atresia
145. A 22-year-old man suddenly developed B. Physiologic jaundice
extreme weakness, nausea, vomiting with C. Hemolytic disease of newborn
traces of blood. The patient is known to D. Crigler-Najjar syndrome
suffer from peptiv ulcer disease of duodenum E. Congenital hepatitis
and hemophilia A. Objectively: heart rate -
102/min., BP- 100/60 mm Hg. Complete blood 149. A 51-year-old woman complains of
count: erythrocytes - 3, 2 · 1012 /l, Hb- 98 g/l, headache, trembling, paresthesiae, palpi-
color index - 0,92, leukocytes - 7, 4 · 109 /l, tations, increased blood pressure up to
280/160 mm Hg. The day before she experi-
platelets - 240 · 109 /l, ESR- 11 mm/hour. What enced exhausting headache, vascular pulsati-
measure would most effectively decrease on, palpitations, asphyxia, stomachache,
hemorrhaging in this case? unbearable fear of coming death. The pati-
A. Cryoprecipitate ent paled and broke out in cold sweat. In
B. Aminocapronic acid urine there is increased content of vani-
C. Native plasma llylmandelic acid. What disease causes such
D. Direct transfusion of donor blood clinical presentation in the patient?
E. Platelet concentrate transfusion A. Pheochromocytoma
146. A 22-year-old woman complains of B. Conn’s syndrome (primary
amenorrhea for 8 months. Anamnesis states hyperaldosteronism)
that menarche occured at the age of 12,5. Si- C. Cushing’s syndrome
nce the age of 18 the patient has a history of D. Primary hypertension
irregular menstruation. The patient is nulli- E. Cushing’s disease
gravida. The mammary glands are developed
properly, nipples discharge drops of milk 150. A 52-year-old patient suffers from
when pressed. Hormone test: prolactin level marked dyspnea during physical exertion,
is 2 times higher than normal. CT reveals a non-productive cough. The patient’s condi-
bulky formation with diameter of 4 mm in tion has been persisting for 8 months. The
the region of sella. What is the most likely di- patient has been a smoker for 30 years. In
agnosis? the lungs there are cellophane-type crackles
auscultated on both sides. Respiration rate is
A. Pituitary tumour 26/min., oxygen saturation of blood is 92%.
B. Lactational amenorrhea On spirometry: moderate restrictive-type di-
C. Stein-Leventhal syndrome (polycystic ovary sturbance of external respiration. What is the
syndrome) most likely diagnosis?
D. Sheehan’s syndrome (postpartum hypopi-
tuitarism)
E. Cushing’s disease
147. A 13-year-old girl complains of fatigabili-
ty, frequent headaches, cardialgia. Eight years
ago she had a case of pyelonephritis. Urine
Крок 2 Medicine (англомовний варiант, iноземнi студенти) 2017 рiк 20
163. A 32-year-old woman complains of 167. A 3-year-old child has been delivered to
Крок 2 Medicine (англомовний варiант, iноземнi студенти) 2017 рiк 22
a hospital with complaints of pain in the legs, 171. Examination of a Rh-negative pregnant
fever, loss of appetite. Objectively: pale skin woman at 32 weeks of gestation revealed
and mucosa, hemorrhagic rash. Lymph nodes a four-time rise of Rh-antibody titer within
are enlarged, painless, dense and elastic, not 2 last weeks; the titer is 1:64. The first two
matted together. Bones, joints, and abdomen pregnancies resulted in antenatal fetal death
are painful. The liver and spleen are enlarged. due to hemolytic disease. What is the optimal
Hemogram: Hb- 88 g/l, color index - 1,3, tactics of pregnancy management?
platelets - 80 · 109 /l, leukocytes - 25, 8 · 109 /l,
lymphoblasts - 70%, ESR- 52 mm/hour. Make A. Early delivery
the provisional diagnosis: B. Delivery at 37 weeks of gestation
C. Screening for Rh-antibodies in 2 weeks and
A. Acute leukemia urgent delivery in case of further increase of
B. Thrombocytopenic purpura antibody titer
C. Acute rheumatic fever D. Introduction of anti-Rh (D)
D. Infectious mononucleosis immunoglobulin
E. Hemorrhagic vasculitis (Henoch-Schonlein E. Ultrasound for signs of hemolytic disease of
purpura) the fetus
168. A 60-year-old man has a diet consisting of 172. During last several weeks an 11-year-
unvaried food staples: mostly cereals, potato, old girl has been complaining of dyspnea and
pasta; few vegetables and little fats (especially edema of shins and feet after physical exerci-
animal fats). During medical examination he se. After a long rest or sleep through the night
complains of deterioration of his twilight visi- her edemas diminish significantly. On clini-
on. This condition can be caused by lack of: cal examination there are enlarged liver and
rasping systolic murmur over the cardiac area.
A. Retinol Blood and urine analyses are without changes.
B. Amino acids What is the most likely cause of the child’s
C. Fats edema?
D. Calcium
E. Carbohydrates A. Heart failure
B. Angioneurotic edema
169. A 14-year-old girl came to a general C. Acute pyelonephritis
practitioner with complaints of weakness, D. Hepatocirrhosis
loss of appetite, headache, rapid fatigabili- E. Nephrotic syndrome
ty. Her last menstruation was profuse and
lasted for 14 days after previous delay of 2 173. A 74-year-old man visited an urologist
months. Objectively: the skin is pale, heart with complaints of pain above the pubis and
rate is 90/min., BP is 110/70 mm Hg, Hb is inability to urinate for 8 hours. At home he
88 g/l. Rectal examination: the uterus and its had taken antispasmodics and had a warm
appendages are without changes, no discharge bath but no improvement occurred. Objecti-
from the genital tracts. What complication vely: the abdomen is soft and painful above
occurred in the patient? the pubis; dullness of percussion sound is
observed above the pubis. Murphy’s punch si-
A. Posthemorrhagic anemia gn (costovertebral angle tenderness) is negati-
B. Somatoform autonomic dysfunction of ve on both sides. What condition does the
hypotonic type patient have?
C. Migraine
D. Gastritis A. Acute urinary retention
E. Dysmenorrhea B. Paradoxal ischuria
C. Chronic urinary retention
170. A postpartum woman on the 12th day D. Anuria
after the normal delivery complains of pain E. Oliguria
localized in her left gastrocnemius muscle.
Body temperature is 37,2o C ; pulse is 85/min, 174. During preventive examination a 58-year-
rhythmic; blood pressure is 128/80 mm Hg. old man on chest X-ray presents with multi-
Mammary glands are soft and painless. The ple globular pale shadows 3 cm in diameter
uterus is behind the pubis. The left leg in the within parenchyma of the both lungs. Exami-
area of gastrocnemius muscle is by 3 cm larger nation in the oncologic hospital: the primary
than the right leg in the diameter. Internal focus is not found; transbronchial biopsy wi-
organs present no pathologies. What compli- th cytologic investigation detected cells of
cation can be suspected? glandular neoplasm. What tactics should the
physician choose?
A. Deep vein thrombosis of the shin
B. Iliofemoral thrombosis
C. Varicose veins of lower extremities
D. Endometritis
E. Myositis
Крок 2 Medicine (англомовний варiант, iноземнi студенти) 2017 рiк 23
orifice allows inserting a fingertip. Biophysi- A. Total protein content in the pleural fluid
cal profile of the fetus equals 4 points. What below 25 g/l
tactics of pregnancy management should be B. Presence of atypical cells
chosen? C. Total protein content in the pleural fluid
above 30 g/l
A. Urgent delivery via a cesarean section D. Specific gravity exceeding 1015
B. Treatment of placental dysfunction and E. Positive Rivalta’s test
repeated analysis of the fetal biophysical
profile on the next day 186. A 28-year-old woman complains of gi-
C. Doppler measurement of blood velocity in rdle pain in her epigastric and left subcostal
the umbilical artery areas with irradiation to the back, nausea,
D. Urgent preparation of the uterine cervix for and vomiting without relief. On examinati-
delivery on a surgeon observes stomach distension
E. Treatment of fetal distress, if ineffective, and meteorism. There are positive Mondor’s,
then elective cesarean section on the next day Mayo-Robson’s, and Cullen’s symptoms.
What is the most likely diagnosis?
183. During regular preventive gynecologi-
cal examination a 30-year-old woman was A. Acute pancreatitis
detected to have dark blue punctulated B. Acute cholecystitis
”perforations” on the vaginal portion of C. Acute intestinal obstruction
the uterine cervix. The doctor suspects D. Aortic dissecting aneurysm
endometriosis of the vaginal portion of the E. Splenic infarction
uterine cervix. What investigation method
would be most informative for diagnosis 187. A 36-year-old woman complains of
confirmation? pain in her lumbar area, which irradiates to
her lower right limb and increases during
A. Colposcopy, target biopsy of the cervix movements, and sensation of numbness in
B. US of small pelvis her limb. Objectively: palpation of the shin
C. Hysteroscopy and thigh muscles is painful, positive stretch
D. Curettage of the uterine cavity symptom on the right. MRI scan: herniati-
E. Hormone testing on of intervertebral disk L5-S1 4 mm in size.
What is the most likely diagnosis?
184. A 26-year-old woman came to a
gynecologist for a regular check-up. She has A. Vertebrogenic lumbago
no complaints. Per vaginum: the uterus lies in B. Vertebrogenic radicular syndrome of L5-S1
anteflexion, not enlarged, dense, mobile, pai- on the right
nless. On the left from the uterus in the area of C. Endarteritis of lower extremities
uterine appendages there is a mobile painless D. Spinal stroke
outgrowth that can be moved independently E. Acute myelitis
from the uterus. On the right the appendages
cannot be detected. What additional investi- 188. During routine medical examinati-
gation would be informative for diagnosis on a 35-year-old woman presents with
clarification? enlarged cervical and mediastinal lymph
nodes. Her overall health is satisfactory.
A. US of lesser pelvis ESR is 30 mm/hour. Cervical node biopsy
B. Metrosalpingography was performed. In the specimen there are
C. Examination for urogenital infection granulomas composed of epithelial and gi-
D. Colposcopy ant cells, no caseous necrosis detected. What
E. Colonoscopy is the most likely diagnosis?
A. Multiple bronchiectasis of the left lung her son with violence. She had opened her
B. Chronic left-sided pneumonia window (on the 8th floor) and tried to jump
C. Chronic abscess of the left lung out, resisted the people, who were holding her
D. Left-sided pulmonary cystic dysplasia back. What drugs should be administered to
E. Suppuration of the cyst in the left lung terminate such condition of the patient?
198. A 37-year-old man working as a A. Antipsychotics
typesetter in a print shop complains of B. Antidepressants
rapid fatigability, paroxysmal attacks of C. Tranquilizers
stomachache, weak drooping hands. Exami- D. Nootropic agents
nation of neurological status revealed E. Antihypertensive drugs
hypotrophy of the forearm muscles.
Carporadial reflexes are sharply weakened. 200. A 43-year-old man, who has been abusi-
Sensitivity is not disturbed. Gums present ng alcohol and suffering from pulmonary
with dark blue border. What neurological tuberculosis, in the course of two weeks
pathology is it? gradually developed general weakness,
headache, diplopia, vomiting. Objectively:
A. Lead polyneuropathy ptosis on the left, anisocoria S>D, exotropia
B. Guillain-Barre syndrome (postinfectious of the left eye, neck stiffness; Kernig’s
polyneuritis) and Brudzinski’s signs are positive. In
C. Shingles cerebrospinal fluid: lymphocytic pleocytosis,
D. Ulnar neuropathy low glucose, precipitation of cerebrospinal
E. Brachial plexitis fluid resulted in production of fibrin film.
What is the most likely diagnosis?
199. A 54-year-old woman takes anti-
hypertensive drugs for hypertension. Havi- A. Tuberculous meningitis
ng discovered that her son was arrested and B. Subarachnoid hemorrhage
is under investigation, became agitated and C. Brainstem encephalitis
extremely anxious. She lost her orientation D. Acute myelitis
in place, stopped recognizing her relatives, E. Basal arachnoiditis
started hearing ”voices” threatening her and
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