Sample test questions Krok 2 Medicine () Терапевтичний профiль 2 1. A patient with Morgagni-Adams-Stokes resonance and absence of respiration.What is syndrome has fainted when walking up the the most likely diagnosis in this case? stairs. The skin is pale, the pupils are dilated, tonoclonic spasms are observed, rib cage is A. Spontaneous pneumothorax immobile. Make the diagnosis: B. Hemothorax C. Lobar pneumonia A. Clinical death D. Pulmonary embolism B. Social death E. Acute pleurisy C. Preagony D. Agony 6. A 34-year-old man on the 3rd day E. Biological death of ceftriaxone treatment for acute otitis (daily dosage - 2 grams) developed diarrhea 2. A 32-year-old welder complains of weakness occurring 5-6 times per day. Feces are without and fever. His illness initially presented as mucus or blood admixtures. Temperature is tonsillitis one month earlier. On examination: 36.6oC. Gregersen reaction (occult blood in o temperature - 38.9 C, respirations - 24/min., feces) is negative. Stool culture detected no pulse - 100/min., blood pressure - 100/70 mm pathogenic germs. What is the most likely Hg, hemorrhages on the legs, enlargement of cause of diarrhea in this case? the lymph nodes. Complete blood count shows Hb- 70 g/L, RBC- 2.2·1012/L, WBC- 3.0·109/L A. Antibiotic-associated diarrhea with 32% of blasts, 1% of eosinophiles, 3% of B. Intestinal dysbiosis bands, 36% of segments, 20% of lymphocytes, C. Bacterial overgrowth syndrome and 8% of monocytes, ESR- 47 mm/hour. D. Ulcerative colitis What is the cause of anemia in this case? E. Crohn’s disease (regional enteritis) A. Acute leukemia 7. A 24-year-old patient visited a doctor B. Chronic lympholeukemia complaining of enlargement of his C. Aplastic anema submaxillary lymph nodes. Objectively: D. B12-deficient anemia submaxillary, axillary and inguinal lymph E. Chronic hemolytic anemia nodes are enlarged. Chest X-ray shows: enlarged lymph nodes of mediastinum. Blood 3. After a 5-day-long celebration of his test: erythrocytes - 3.4 · 1012/L, Hb- 100 g/L, daughter’s wedding a 65-year-old patient blood colour index - 0.88, platelets - 190·109/L, ”saw” in his yard many cats, chickens, and rats. · 9 He tried to chase them away, but was scared leucocytes - 7.5 10 /L, eosinophiles - 8%, band off when the animals started scolding him and neutrophiles - 2%, segmented neutrophiles - tried to harm him. What is the likely diagnosis? 67%, lymphocytes - 23%, ESR - 22 mm/hour. What test must be prescribed to verify the A. Delirium tremens cause of lymphadenopathy? B. Senile psychosis C. Schizophrenia A. Open biopsy of the lymph nodes D. Organic brain syndrome B. Abdominal US E. Reactive hallucinosis C. Mediastinum tomography D. Puncture biopsy of the lymph nodes 4. 5 weeks after hypothermia a 22-year- E. Sternal puncture old patient developed fever, weakness, muscle pain, inability to move independently. 8. A 37-year-old woman complains of Objectively: tenderness, induration of headaches, nausea, vomiting, spasms. The shoulder and shin muscles, restricted active onset of the disease occurred the day before due to her overexposure to cold. Objectively: movements, erythema on the anterior surface o of the chest. There is a periorbital edema with fever up to 40 C; somnolence; rigid neck; heliotropic erythema. Gottron’s sign is present. Kernig’s symptom is positive on the both What investigation is required for the diagnosis sides; general hyperesthesia. Blood test: verification? leucocytosis, increased ESR. Cerebrospinal fluid is turbid, yellow-tinted. What changes of A. Muscle biopsy the cerebrospinal fluid are most likely? B. Aminotransferase activity C. Pneumoarthrography A. Neutrophilic pleocytosis D. ASO titer B. Lymphocytic pleocytosis E. Rheumatoid factor C. Blood in the cerebrospinal fluid D. Xanthochromia in the cerebrospinal fluid 5. During physical exertion a man suddenly E. Albuminocytological dissociation developed acute chest pain on the right and dyspnea. Objectively he assumes forced half- 9. A 44-year-old patient complains of difficult sitting position in the bed, presents with diffuse urination, sensation of incomplete urinary cyanosis, resting tachypnea of 38/min., the bladder emptying. Sonographic examination right side of the thorax is enlarged and does of the urinary bladder near the urethra not participate in the respiratory process; entrance revealed an oval well-defined percussion on the right reveals tympanic hyperechogenic formation 2x3 cm large that was changing its position during the Терапевтичний профiль 3 examination. What conclusion can be made? A. Progressive angina pectoris A. Stone B. First-time angina pectoris B. Malignant tumour of the urinary bladder C. Stable NYHA functional class II angina C. Urinary bladder polyp pectoris D. Prostate adenoma D. Variant angina pectoris E. Primary ureter tumour E. Acute cardiac infarction 10. A 25-year-old woman complains of fatigue, 14. During appointment with the doctor dizziness, hemorrhagic rashes on the skin. She a man complains of painful itching rashes has been presenting with these signs for a that appeared on his skin under the beard month. Blood test: erythrocytes - 1.0 · 1012/L, and moustache one year ago, with frequent Hb- 37 g/L, colour index - 1.1, leukocytes - exacerbations occurring throughout the year. 1.2 · 109/L, platelets - 42 · 109/L. What analysis Objectively the skin of the facial hair growth would be the most advisable for diagnosis- areas is bluish-purple, thickened, with pustules, making in this case? erosions, and scabs covering its moist surface. The fistulous tracts are surrounded by the A. Sternal puncture (bone marrow biopsy) area of loose pink-red granulation and B. Splenic biopsy discharge pus. The skin resembles mulberry C. Liver biopsy in appearance. Make the diagnosis: D. Coagulation studies E. US of the gastrointestinal tract A. Sycosis B. Acne rosacea 11. A 35-year-old man complains of rapidly C. Lupus erythematosus incresing fatigue, palpitations, ”visual snow”, D. Deep trichophytosis dizziness. He has a history of peptic ulcer of the E. Tuberculous lupus stomach. Objectively the skin is pale. Vesicular respiration is observed in the lungs. Systolic 15. A 60-year-old man presents with ischemic murmur is detected over the cardiac apex, heart disease and heart failure of the IV heart rate is 100/min., BP is 100/70 mm Hg. class according to NYHA (New York Heart The epigastrium is slightly tender on palpation. Association) that manifests as dyspnea at Blood test: erythrocytes - 3.2 · 1012/L, Нb- 100 rest. There are moist crackles in the patient’s g/L, color index - 0.94. What type of anemia is lungs. Liver +4 cm, lower limbs are swollen. the most likely present in this case? Ejection fraction is 25%. What sign is the most indicative when determining functional class A. Posthemorrhagic anemia of heart failure according to NYHA? B. Sideroblastic anemia Degree of dyspnea C. Iron-deficiency anemia A. D. Hemolytic anemia B. Moist crackles in the lungs Swollen lower limbs E. Hypoplastic anemia C. D. Decrease of ejection fraction 12. A 35-year-old patient has been suffering E. Extent of liver enlargement from an illness for 3 days. 5 days ago he returned from a trip to Africa. The onset of 16. A patient suffering from infiltrative disease was accompanied by fever up to 40oC, pulmonary tuberculosis was prescribed chills, acute headache, myalgia. In the axillary streptomycin, rifampicin, isoniazid, pyrazinamide, region the lymph node enlarged up to 3x6 cm vitamin C. One month after the beginning of can be palpated. The lymph node is dense, the treatment the patient started complaining intensely painful, slightly mobile, without clear of reduced hearing and tinnitus. What drug has margins; the skin over the node is hyperemic suchasideeffect? and tight. Tachycardia is present. Make the A. Streptomycin preliminary diagnosis: B. Isoniazid A. Plague C. Rifampicin Pyrazinamide B. Sepsis D. Vitamin C C. Tu l a r e m i a E. D. Lymphadenitis 17. A 39-year-old man complains of morning E. Anthrax headaches, appetite loss, nausea, morning vomiting, periodic nasal hemorrhages. The 13. A 52-year-old patient, who has been suffering from angina pectoris, for 2 weeks patient had a case of acute glomerulonephritis has increasingly frequent pain attacks in the at the age of 15. Examination revealed rise area behind his sternum and his need for of arterial pressure up to 220/130 mm Hg, nitroglycerine has increased. Objectively: the skin hemorrhages on his arms and legs, condition is of moderate severity. The skin is pallor of skin and mucous membranes. What pale. Heart sounds are weakened, rhythmic. biochemical parameter is the most important Heart rate is 84/min. ECG shows no signs of for making diagnosis in this case? focal myocardial injury. What is the most likely diagnosis? Терапевтичний профiль 4 A. Blood creatinine center. What disease is most likely in the given B. Blood bilirubin case? C. Blood sodium D. Uric acid A. Pneumonia complicated by an abscess E. Fibrinogen B. Infiltrative tuberculosis C. Peripheral pulmonary cancer 18. The doctor has an appointment with a D. Cystic echinococcosis patient, who 2 days ago developed severe E. Pulmonary cyst chest pain on the left, general weakness, high temperature, and headache. Objectively along 22. A 16-year-old adolescent living in a rural the 4th and 5th intercostal nerves on the left area has been bitten in the shin by a stray dog. the skin is hyperemic and there are tight The wound is superficial. Regular vaccination clusters of small vesicles filled with clear serous against tetanus was received 3 months ago. content. What is the most likely diagnosis? What treatment tactics would be the most advisable in this case? A. Herpes zoster B. Herpes simplex A. Antirabies vaccination C. Streptococcal impetigo B.