MINISTRY OF PUBLIC HEALTH OF UKRAINE Department of human resources policy, education and science Testing Board Student ID Last name Variant ___________________ Test items for licensing examination 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: Andrusiak O.V., Andrusha A.B., Artyshchenko V.A., Baburіna O.A., Babyn Yu.F., Badogіna L.P., Balabuieva S.V., Berezov V.M., Boiko M.І., Bondarenko V.V., Borovkova S.O., Borzova O.Yu., Bukhtieieva E.R., Buriak V.M., Burka O.A., Butvyn І.M., Bіlenko O.A., Bіlonko O.F., Bіlyk O.V., Bіlyk V.D., Chekanov S.L., Chonka І.І., Chuiko A.P., Demchenko T.V., Derkach V.G., Desiatska Yu.V., Detsyk O.Z., Dobrovolska L.M., Dziuba G.A., Dzіs N.P., Emіralіieva Z.R., Galagan S.І., Genyk N.І., Gerasymenko O.І., Golubovska N.M., Goriachev V.V., Grygorova І.A., Gryshchenko V.I., Gutsalenko O.O., Іvaniuta S.O., Kabeliuzhenko S.B., Karlіichuk O.O., Kelmanska S.І., Kolesnyk O.M., Kolesnіkova O.V., Koltsova N.І., Kondratiev V.O., Konopkіna L.І., Korobko O.A., Koval І.І., Kovaliova O.M., Kovtunenko R.V., Kozhushko M.Yu., Kravchenko T.Yu., Kriachkova L.V., Krut Yu.Ya., Krylova V.Yu., Kudrevych O.M., Kudria V.I., Kudіievskyi A.V., Kutuzov І.M., Kuzmenko S.A., Kvasnytska O.B., Kyrylenko V.A., Lakusta N.M., Lazar A.P., Lotysh N.G., Lymar L.Ye., Lysenko D.A., Maliovanyi V.V., Martychnuk O.A., Marushko Iu.V., Melnychuk L.V., Miakіnkova L.O., Moroz І.M., Mostovoi V.P., Mostovyi Yu.M., Murtazіn L.M., Mysak A.І., Mіtiunіna N.І., Mіziuk V.V., Nykoniuk T.R., Nіshkumai O.І., Nіtsovych R.M., Okhrіmenko G.І., Olіfierovska R.P., Orel Yu.G., Orlova N.M., Ostropolets M.S., Parashchuk Iu.S., Paustovskyi Yu.O., Plastunov B.A., Pogorelov O.V., Pokydko M.І., Prokhoda A.F., Prokhorov Ye.V., Prus L.O., Pshuk Ya.І., Pіsotska L.A., Radchenko O.M., Reva V.B., Riapolova T.L., Romanenko V.N., Rudenko M.M., Sander S.V., Selska O.V., Semenukha K.V., Sergeta І.V., Shehovtseva T.G., Sheremeta R.Z., Shiutiev M.M., Shkurba A.V., Shkvarkovskyi І.V., Shumko G.І., Shusterman T.Y., Shutka V.Ya., Shvygar L.V., Sierkova V.K., Sliepіchko Yu.M., Slyva V.І., Smoliak L.L., Snіzhko S.S., Soldak І.І., Sopov G.O., Sotnik Yu.P., Spіrіna І.D., Stefaniuk V.D., Stepanov Yu.І., Strechen S.B., Svyrydova V.V., Sytnyk M.M., Sіnchuk N.І., Talalaienko Yu.O., Tarallo V.L., Teliushchenko O.D., Tkach V.Ye., Tkachenko M.M., Tomash O.V., Tomkіv V.M., Trefanenko І.V., Tsertіi V.P., Tsyvenko O.І., Uryvaieva M.K., Vanhanen N.V., Vereshchagіna N.Ia., Volianska A.G., Voloshyn O.M., Vorokhta Yu.M., Yakovenko І.K., Yartseva D.O., Yasnіtska M.Ya., Yermachenko T.P., Yevtushenko V.V., Yudіna T.V., Yurchenko І.V., Zadorozhnyi V.V., Zaiats Z.Ye., Zaitsev V.S., Zeliak M.V., Zhelіba M.D., Zorіna S.M., Zvierieva O.A. 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. Approved by Ministry of Public Health of Ukraine as examination and teaching publication based on expert conclusions (Orders of MPH of Ukraine of 14.08.1998 №251, of 27.12.1999 №303, of 16.10.2002 №374, of 29.05.2003 №233). © Copyright Testing Board. Крок 2 Medicine (англомовний варiант, iноземнi студенти) 2016 рiк 1 1. You are a doctor on duty. A patient after Common blood analysis: erythrocytes - 2,8 a successful resuscitation (drowning) was deli- Т/l, Hb- 80 g/l, color index - 0,78, anisocytosis, vered to an admission room. BP is 90/60 mm poikilocythemia, serum iron - 10 mcmol/l. Hg, heart rate is 120/min., respiration rate is What diagnosis is most likely? 26/min. The patient is unconscious, pupils are moderately dilated, general clonic and tonic A. Iron-deficiency anemia convulsions are observed. Make the diagnosis: B. B12-deficient anemia C. Autoimmune hemolytic anemia A. Postresuscitation disease D. Aplastic anemia B. Apparent death E. Hypoplastic anemia C. Coma of unknown origin D. Unconsciousness 6. A 24-year-old patient visited a doctor E. Vegetative state complaining of enlargement of his submaxi- llary lymph nodes. Objectively: submaxi- 2. A 32-year-old welder complains of llary, axillary and inguinal lymph nodes weakness and fever. His illness initially are enlarged. Chest X-ray shows: enlarged presented as tonsillitis one month earlier. On lymph nodes of mediastinum. Blood test: examination: BT- 38, 9oC, RR- 24/min., HR- erythrocytes - 3, 4 · 1012/l, Hb- 100 g/l, blood 100/min., BP- 100/70 mm Hg, hemorrhages colour index - 0,88, platelets - 190 · 109/l, on the legs, enlargement of the lymph nodes. · 9 12 leucocytes - 7, 5 10 /l, eosinophiles - 8%, band CBC shows Hb- 70 g/l, RBC- 2, 2 · 10 /l, neutrophiles - 2%, segmented neutrophiles - WBC- 3, 0 · 109/l with 32% of blasts, 1% of 67%, lymphocytes - 23%, ESR- 22 mm/hour. eosinophiles, 3% of bands, 36% of segments, What test must be prescribed to verify the 20% of lymphocytes, and 8% of monocytes, cause of lymphadenopathy? ESR- 47 mm/hour. What is the cause of anemia? A. Open biopsy of lymph nodes B. Ultrasonography of abdominal cavity A. Acute leukemia C. Mediastinum tomography B. Chronic lympholeukemia D. Puncture biopsy of lymph nodes C. Aplastic anema E. Sternal puncture D. B12-deficient anemia E. Chronic hemolytic anemia 7. A 32 year old patient complains of cardiac irregularities, dizziness, dyspnea at physical 3. A regional cardiologist is tasked with the exertion. He has never suffered from such development of a plan for medioprophylactic condition before. Objectively: Ps- 74/min., measures aimed at decrease of cardiovascular rhythmic. BP- 130/80 mm Hg. Auscultati- mortality. What measures should be planned on revealed systolic murmur above aorta, for secondary prevention? the first heart sound was normal. ECG showed hypertrophy of the left ventricle, si- A. Prevention of recurrences and complicati- gns of repolarization disturbance in the I, V5 ons and V6 leads. Echocardiogram revealed that B. Referring patients for sanatorium-and-spa interventricular septum was 2 cm. What is the treatment most probable diagnosis? C. Prevention of diseases D. Referring patients for in-patient treatment A. Hypertrophic cardiomyopathy E. Optimization of life style and living conditi- B. Aortic stenosis ons C. Essential hypertension D. Myocardium infarction 4. An 8-year-old boy developed a temperature E. Coarctation of aorta of 37, 5oC two days after his recovery from the case of URTI. He complains of suffocati- 8. A 35-year-old patient’s wound with on, heart pain. Objectively: the skin is pale, suppurative focus was surgically cleaned. tachycardia, the I heart sound is weakened, On the 8th day after the surgery the wound short systolyc murmur in the 4th intercostal cleared from its purulo-necrotic content and area near the left edge of the breastbone. granulations appeared. However, against the What heart disorder such clincal presentati- bacground of antibacterial therapy the body on is characteristic of? temperature keeps at 38,5-39,5oC.Thereare chills, excessive sweating, euphoria, heart rate A. Nonrheumatic myocarditis is 120/min. What complication of local pyoi- B. Primary rheumatic carditis nflammatory process can it be? C. Myocardiodystrophy D. Fallot’s tetrad A. Sepsis E. Cardiomyopathy B. Purulent absorption fever C. Trombophlebitis 5. A woman complains of muscle weakness D. Meningitis and general fatigue, dyspnea, vertigo, bri- E. Pneumonia ttleness of her hair and nails, an urge to eat chalk. Anamnesis states uterine fibroid. 9. A 60-year-old woman has been sufferi- Крок 2 Medicine (англомовний варiант, iноземнi студенти) 2016 рiк 2 ng from arterial hypertension for 15 years. A. Tuberculous spondylitis of the thoracic After recurrent stroke she started complaini- spine ng of unmotivated bad mood, problems with B. Spinal tumor attention concentration; she forgets to close C. Multiple sclerosis the entrance door, cannot recall events of D. Metastases into the spine the past day. Computer tomography shows E. Osteochondrosis areas of postinfarction changes in the cortical postfrontal areas. What is the most probable 13. A pregnant woman is 28 years old. diagnosis? Anamnesis: accelerated labor complicated by the II degree cervical rupture. The followi- A. Vascular dementia ng two pregnancies resulted in spontaneous B. Alzheimer’s disease abortions at the terms of 12 and 14 weeks. C. Huntington’s disease On mirror examination: the uterine cervix D.