Krok 2 Medicine 2012 1 1. Routine examination of a child with A. Developing of cardiac insufficiency a history of bronchial asthma reveals AP B. Depositing of blood in venous channel of 140/90 mm Hg. The most likely cause of C. Shunting the hypertension is: D. Presence of hypervolemia E. Increase of bleeding speed A. Renal disease B. Theophylline overdose 6. A neonate was born from the 1st C. Chronic lung disease gestation on term. The jaundice was D. Coarctation of the aorta revealed on the 2nd day of life, then it E. Obesity became more acute. The adynamia, vomi- ting and hepatomegaly were observed. 2. Head of a department and a trade- Indirect bilirubin level was 275µmol/L, union group have appealed to the head direct bilirubin level - 5µmol/L, Hb- 150 of a hospital about dismissal of the seni- g/l. Mother’s blood group - 0(I), Rh+,chi- or nurse who has 17 year record of servi- ld’s blood group - A(II), Rh+. What is the ce. The facts of charge were confirmed most probable diagnosis? and recognized by the nurse herself. This nurse lives with a daughter (who is di- A. Hemolytic disease of the neonate (АВ0 vorced and unemployed) and a 9-month- incompatibility), icteric type old grandson. Make an administrative B. Jaundice due to conjugation disorder decision: C. Hepatitis D. Physiological jaundice A. To continue the worker in office with E. Hemolytic disease of the neonate (Rh - a warning of dismissal in case of repeated incompatibility) violation of labor discipline B. To discharge the worker, i.e. to satisfy 7. An infant was born with body mass 3 kg demands of the collective and body length 50 cm. Now he is 3 years C. To issue the sick list old. His brother is 7 years old, suffers from D. To shift the solution of this problem on rheumatic fever. Mother asked the doctor other officials or public organizations for a cardiac check up of the 3-year-old E. - son. Where is the left relative heart border located? 3. Purulent mediastinitis is diagnosed at a 63-year-old patient. What diseases from A. 1 cm left from the left medioclavicular the stated below CANNOT cause the line purulent mediastinitis? B. 1 cm right from the left medioclavicular line A. Cervical lymphadenitis C. Along the left medioclavicular line B. Deep neck phlegmon D. 1 cm left from he left parasternal line C. Perforation of the cervical part of the E. 1 cm right from the left parasternal line easophagus D. Perforation of the thoracic part of the 8. A neonate is 5 days old. What vacci- easophagus nation dose of BCG vaccine (in mg) is E. Iatrogenic injury of the trachea necessary for vaccination of this child? 4. For the persons who live in a hot area A. 0,05 mg after an accident at a nuclear object, the B. 0,025 mg greatest risk within the first decade is C. 0,075 mg represented by cancer of: D. 0,1 mg E. 0,2 mg A. Thyroid gland B. Skin 9. A 60-year-old woman, mother of 6 C. Reproduction system organs children, developed a sudden onset of D. Breast upper abdominal pain radiating to the E. Lungs back, accompanied by nausea, vomiting, fever and chills. Subsequently, she noti- 5. During dynamic investigation of a pati- ced yellow discoloration of her sclera and ent the increase of central venous pressure skin. On physical examination the pati- is combined with the decrease of arterial ent was found to be febrile with temp of pressure. What process is proved by such 38, 9oC, along with right upper quadrant combination? tenderness. The most likely diagnosis is: Krok 2 Medicine 2012 2 A. Choledocholithiasis g/L, WBC- 20-25 in f/vis, RBC- 1-2 in f/vis. B. Benign biliary stricture What diagnosis is the most probable? C. Malignant biliary stricture D. Carcinoma of the head of the pancreas A. Acute cystitis E. Choledochal cyst B. Dysmetabolic nephropathy C. Acute glomerulonephritis 10. 4 days ago a 32-year-old patient D. Acute pyelonephritis caught a cold: he presented with sore E. Urolithiasis throat, fatigue. The next morning he felt worse, developed dry cough, body 14. A woman, primagravida, consults temperature rose up to 38, 2oC,there a gynecologist on 05.03.2012. A week appeared muco-purulent expectoration. ago she felt the fetus movements for Percussion revealed vesicular resonance the first time. Last menstruation was on over lungs, vesicular breathing weakened 10.01.2012. When should she be given below the angle of the right scapula, fi- maternity leave? ne sonorous and sibilant wheezes. What is the most likely diagnosis? A. 8 August B. 25 July A. Focal right-sided pneumonia C. 22 August B. Bronchial asthma D. 11 July C. Acute bronchitis E. 5 September D. Pulmonary carcinoma E. Pulmonary gangrene 15. A 40-year-old female patient has been hospitalized for attacks of asphyxia, cough 11. A 45-year-old woman, mother of four with phlegm. She has a 4-year history of children, comes to the emergency room the disease. The first attack of asphyxia complaining of a sudden onset of the epi- occurred during her stay in the countrysi- gastric and right upper quadrant pain, de. Further attacks occurred while cleani- radiating to the back, accompanied by ng the room. After 3 days of inpatient vomiting. On examination, tenderness is treatment the patient’s condition has si- elicited in the right upper quadrant, bowel gnificantly improved. What is the most sounds are decreased, and laboratory data likely etiological factor? shows leukocytosis, normal serum levels of amylase, lipase, and bilirubin. The most A. Household allergens likely diagnosis is: B. Pollen C. Infectious A. Acute cholecystitis D. Chemicals B. Perforated peptic ulcer disease E. Psychogenic C. Myocardial infarction D. Sigmoid diverticulitis 16. A 3-year-old child has been admi- E. Acute pancreatitis tted to a hospital because of ostealgia and body temperature rise up to 39oC. 12. During an operation for presumed Objectively: the patient is in grave condi- appendicitis the appendix was found to tion, unable to stand for ostealgia, there be normal; however, the terminal ileum is apparent intoxication, lymph nodesare is evidently thickened and feels rubbery, enlarged up to 1,5 cm. Liver can be its serosa is covered with grayish-white palpated 3 cm below the costal margin, exudate, and several loops of apparently spleen - 2 cm below the costal margin. In normal small intestine are adherent to it. blood: RBCs - 3, 0·1012/l, Hb- 87 g/l, colour The most likely diagnosis is: index - 0,9, thrombocytes - 190 · 109/l, WBCs - 3, 2 · 109/l, eosinophils - 1, stab A. Crohn’s disease of the terminal ileum neutrophils - 1, segmented neutrophils - B. Perforated Meckel’s diverticulum 0, lymphocytes - 87, monocytes - 2, ESR C. Ulcerative colitis - 36 mm/h. What examination should D. Ileocecal tuberculosis be conducted in order to specify the di- E. Acute ileitis agnosis? 13. A girl is 12-year-old. Yesterday she was A. Sternal puncture overcooled. Now she is complaining on B. Ultrasound pain in suprapubic area, frequent painful C. Lymph node puncture urination by small portions, temperature Lymph node biopsy 37, 8oC D. is . Pasternatsky symptom is E. Computer tomography negative. Urine analysis: protein - 0,033 Krok 2 Medicine 2012 3 17. A 22-year-old girl has been complai- A. Hypothermia ning of having itching rash on her face B. Acute cardiovascular insufficiency for 2 days. She associates this disease wi- C. Apparent death th application of cosmetic face cream. D. Frostbite of trunk and extremities Objectively: apparent reddening and E. - edema of skin in the region of cheeks, chin and forehead; fine papulovesicular 21. A 28-year-old parturient complai- rash. What is the most likely diagnosis? ns about headache, vision impairment, psychic inhibition. Objectively: AP- A. Allergic dermatitis 200/110 mm Hg, evident edemata of B. Dermatitis simplex legs and anterior abdominal wall. Fetus C. Eczema head is in the area of small pelvis. Fetal D. Erysipelas heartbeats is clear, rhythmic, 190/min. E. Neurodermatitis Internal examination revealed complete cervical dilatation, fetus head was in the 18. A 16-year-old patient who has a hi- area of small pelvis. What tactics of labor story of intense bleedings from minor management should be chosen? cuts and sores needs to have the roots of teeth extracted. Examination reveals A. Forceps operation an increase in volume of the right knee B. Cesarean joint, limitation of its mobility. There are C. Embryotomy no other changes. Blood analysis shows D. Conservative labor management with an inclination to anaemia (Hb- 120 g/l). episiotomy Before the dental intervention it is requi- E. Stimulation of labor activity red to prevent the bleeding by means of: 22. A 35-year-old patient complains about A. Cryoprecipitate pain and morning stiffness of hand joi- B. Epsilon-aminocapronic acid nts and temporomandibular joints that C. Fibrinogen lasts over 30 minutes. She has had these D. Dried blood plasma symptoms for 2 years. Objectively: edema E. Calcium chloride of proximal interphalangeal digital joi- nts and limited motions of joints. What 19. A 44-year-old patient complai- examination should be administered? ns about difficult urination, sensati- on of incomplete urinary bladder A. Roentgenography of hands emptying. Sonographic examination of B. Complete blood count the urinary bladder near the urethra C. Rose-Waaler reaction entrance revealed an oval well-defined D. Immunogram hyperechogenic formation 2x3 cm large E. Proteinogram that was changing its position during the examination. What conclusion can be 23.