Step 1 - Medicine 2019

A young man has come to the genetic consultation. He complains of abnormalities in his physical and reproductive development. Microscopy of his oral mucosa cells shows one Barr body. What karyotype is the most likely in this young man

45, Х 0

47, XY, +18

47, ХYY

47, XY, +21

47, ХХY

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The mother’s karyotype has 45 chromosomes. It was determined that translocation of chromosome 21 to chromosome 14 had occurred. What disorder is likely to be observed in the child of this woman if the father’s karyotype is normal

Edwards syndrome

Klinefelter syndrome

Morris syndrome (androgen insensitivity)

Patau syndrome

Down syndrome

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During regular examination of schoolchildren, a scrape from the perianal folds of a 10-year-old girl shows asymmetrical oval eggs with larvae inside. What diagnosis can be made

Trichuriasis

Amebiasis

Ancylostomiasis

Ascariasis

Enterobiasis

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A young woman, a foreign student from Tehran, has made an appointment with the urologist. She complains of the sensation of heaviness in her lower abdomen and a small amount of blood being excreted with urine at the end of each urination. Microscopy of urine detects the presence of parasite eggs, approximately 140х70 micron in size, with a terminal spike. What diagnosis can be made by the infectious diseases specialist?

Schistosomiasis

Dicroceliasis

Paragonimiasis

Fascioliasis

Opisthorchiasis

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Cells of a person working in the Chornobyl Exclusion Zone have undergone a mutation in DNA molecule. However, with time the damaged interval of DNA molecule restored ist initial structure with a specific enzyme. In this case the following occurred:

Repair

Translation

Replication

Reverse transcription

Transcription

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A man is a carrier of HIV that is an RNA virus. The cells of this patient synthesize viral DNA. This process is based on:

Translation

Repair

Reverse transcription

Replication

Transcription

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The parents with normal hearing have two daughters and a son, who are congenitally deaf. Their other 5 children are healthy. What is the pattern of deafness inheritance in this case

Autosomal dominant

X-linked recessive

Autosomal recessive

Y-linked

X-linked dominant

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Ingestion of plants and mushrooms that grow along highways is dangerous due to risk of lead poisoning. What is the main source of environmental pollution with this chemical element

Exhaust fumes

Chemical fertilizers

Acid rains

Herbicides

Sewage

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Long-term taking of medicines can affect cells of the liver. Particularly, it can cause marked hypertrophy of agranular endoplasmic reticulum due to the following function of this organelle:

Intracellular digestion

Detoxication of harmful substances

Protein synthesis

Nucleic acid synthesis

Formation of maturation spindle

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Dwellers of a village located in the taiga make a living by harvesting berries. Lately the occurrence of alveococcosis in the village population has increased. What is the source of invasion in this case

Sick people

Birds

Rodents

Fish

Foxes

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A patient with severe poisoning was brought into the intensive care unit. In the course of complex treatment the subclavian vein needs to be catheterized for medicine administration. This vein is located in the following topographic structure:

Spatium interscalenum

Trigonum omotrapezoideum

Spatium antesсalenum

Spatium interaрoneuroticum suprasternale

Spatium retrosternocleidomastoideus

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A 52-year-old woman came to the neurologist with complaints of loss of skin sensitivity on the right half of her face in the area of the lower eyelid, nasal arch, and upper lip. What branch of what nerve is damaged in this patient

Ophthalmic branch of the trigeminal nerve

Maxillary branch of the trigeminal nerve

Chorda tympani branching from the facial nerve

Greater petrosal nerve branching from the facial nerve

Mandibular branch of the trigeminal nerve

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A patient with periodontitis of the lower molar came to the doctor. It was determined that the inflammatory process spread to the lymph nodes. What lymph nodes were the first to be affected by the inflammatory process

Facial

Anterior cervical

Submandibular

Submental

Lateral cervical

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After an X-ray examination of the tuberculosis clinic patient, he was diagnosed with tumor of the right lung. During operation the surgeon removed the middle lobe of the patient’s right lung. This lobe includes:

Segmentum basale anterius et posterius

Segmentum anterius et segmentum apicale

Segmentum laterale et segmentum mediale

Segmentum apicale (superius) et segmentum basale mediale

Segmentum lingualare superius et inferius

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A 30-year-old man with an incised wound on the plantar surface of the left foot was brought to the traumatology department. Lifting of the lateral side of the foot is limited. What muscle is likely to be functionally disturbed

Soleus muscle

Anterior tibial muscle

Triceps muscle of calf

Flexor hallucis longus muscle

Peroneus longus muscle

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ovarian tumor was detected in a woman. She is prescribed a surgery. What ligament should be severed by the surgeon to separate the patient’s ovary from the uterus

Broad ligament of the uterus

Round ligament of the uterus

Suspensory ligament of the ovary

Proper ovarian ligament

Lateral umbilical ligament

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A 45-year-old woman presents with breast cancer. Metastases can spread in this case to the following regional lymph nodes:

Cervical, parasternal

Parasternal, bronchomediastinal

Axillary, parasternal

Aortic, bronchomediastinal

Abdominal, cervical

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A 35-year-old man with a hand injury came to the traumatology department. Examination revealed an incised wound on the palmar surface of the left hand; middle phalanges of digits II-IV cannot be flexed. What muscles are damaged

Dorsal interossei

Flexor digitorum profundus

Flexor digitorum superficialis

Lumbrical muscles

Palmar interossei

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Clinical course of urolithiasis was complicated by the passage of a renal calculus. Where in the ureter is it most likely to stop

In the middle of the abdominal segment

In the renal pelvis

At the border between the abdominal and pelvic segments

2 cm above the entrance to the urinary bladder

5 cm above the pelvic segment

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The surgeon noticed aggregated lymphoid nodules (Peyer’s patches) on the intestinal mucosa. What portion of the intestine is it

Jejunum

Cecum

Rectum

Ileum

Duodenum

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An oncology patient is to undergo a surgery on the descending colon. Name the main source of blood supply to this organ:

Superior mesenteric artery

Celiac trunk

Middle colic artery

Inferior mesenteric artery

Splenic artery

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A patient presents with an inner ear inflammation. On examination the doctor states that the 1st neurons of the auditory analyzer are affected. Where are these neurons located

G. spirale

G. geniculi

G. trigeminale

G. vestibulare

G. ciliare

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A victim has received a deep incised stab wound to the upper posterior surface of the shoulder. Extension of elbow, hand, and digits is impaired; skin sensitivity of the posterior surface of the shoulder and forearm is lost. What nerve is damaged in this case

N. musculocutaneus

N. cutaneus brachii medialis

N. radialis

N. ulnaris

N. medianus

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During an invasive operation the surgeon needs to access the omental bursa of the peritoneal cavity via the omental foramen (foramen of Winslow). What anatomical structure makes up the anterior border of this foramen

Visceral surface of liver

Hepatorenal ligament

Superior part of duodenum

Hepatoduodenal ligament

Greater omentum

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Histone protein synthesis is artificially blocked in a cell. What cell structure will be damaged as a result

Cell membrane

Golgi apparatus

Nuclear membrane

Nucleolus

Nuclear chromatin

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Some diseases of large intestine lead to the changes in the quantitative ratio between mucosal epithelial cells. What cell types are normally predominant in the cryptal epithelium of the large intestine

Poorly differentiated cells

Endocrine cells

Ciliated columnar epithelial cells

Cells with acidophilic granules

Goblet cells

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Examination of a surgically excised adrenal gland shows large cells that can be impregnated with a potassium dichromate solution. What hormone is being synthesized by these cells

Aldosterone

Cholecystokinin

Thyroxine

Secretin

Adrenaline

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inflammation can be characterized by hemocapillary dilation in the affected area, decreased blood circulation, and increased vessel wall permeability. What cells play the key role in this process

Plasma cells

Tissue basophils

Fibroblasts

Macrophages

Eosinophils

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A histological specimen demonstrates a vessel with the wall that consists of endothelium, basement membrane, and loose connective tissue. This vessel belongs to the following type:

Non-muscular vein

Hemocapillary

Artery

Lymph capillary

Muscular vein

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Parenchyma of an organ is composed of pseudounipolar neurons localized under the capsule of connective tissue. Central place belongs to nerve fibers. Name this organ:

Intramural ganglion

Sympathetic ganglion

Spinal ganglion

Nerve trunk

Spinal cord

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A histological specimen shows significant amount of mucous connective tissue (Wharton’s jelly), vessels, as well as remnants of yolk sac stalk and allantois. Name this organ:

Umbilical cord

Esophagus

Vermiform appendix

Ureter

Urethra

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A 40-year-old woman on examination presents with intensified basal metabolic rate. What hormone present in excess leads to such condition

Triiodothyronine

Thyrocalcitonin

Aldosterone

Glucagon

Somatostatin

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Toxic damage to hepatic cells resulted in disruption of the patient’s liver function and the patient developed edemas. What changes of blood plasma are the main cause of edema development

Decrease of fibrinogen content

Increase of albumin content

Increase of globulin content

Decrease of globulin content

Decrease of albumin content

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isolated heart was used to study excitation conduction velocity in different areas of the heart. What area had the lowest velocity of excitation conduction

Atrioventricular node

Atrial myocardium

Ventricular myocardium

His bundle

Purkinje fibers

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A 40-year-old person developed elevated blood pressure after an emotional excitement. What is the likely cause of this effect

Hyperpolarization of cardiomyocytes

Increased sympathetic nervous system tone

Increased parasympathetic nervous system tone

Arteriolar dilation

Decreased cardiac contraction frequency

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A patient has elevated blood pressure due to increased vascular tone. To lower the blood pressure in this case it is necessary to prescribe the blockers of:

alpha-adrenoceptors

Histamine H1 receptors

alpha- and beta-adrenoceptors

beta-adrenoceptors

Muscarinic acetylcholine receptors

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ABO blood group is being determined. Erythrocyte agglutination occurred when standard sera of group I and group II were introduced into the blood being analyzed, while group III serum caused no agglutination. What agglutinogens do these erythrocytes have

C

A

D and C

B

A and B

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What changes can be expected to occur in the isolated heart of a toad, if excessive amount of calcium chloride is introduced into its perfusate

Increased cardiac contraction force and frequency

Increased cardiac contraction force

Diastolic cardiac arrest

Increased cardiac contraction frequency

Decreased cardiac contraction force

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After hyperventilation an athlete developed a brief respiratory arrest. It occurred due to the following changes in the blood:

Decrease of CO2 pressure

Decrease of pH

Increase of CO2 pressure

Decrease of O2 pressure

Increase of CO2 and O2 pressure

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A person has increased pulmonary ventilation due to physical exertion. What indicator of external respiration will be significantly increased compared to the resting state

Inspiratory reserve volume

Expiratory reserve volume

Vital lung capacity

Total lung capacity

Respiratory volume

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A patient developed punctate hemorrhages after a tourniquet had been applied. It occurred due to functional disturbance of the following blood corpuscles:

Monocytes

Eosinophils

Lymphocytes

Platelets

Neutrophils

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The dorsal root of the spinal nerve of a test animal was severed. What changes will occur in the innervation area

Increased muscle tone

Loss of motor function

Loss of sensitivity

Loss of sensitivity and motor function

Decreased muscle tone

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After a certain CNS structure had been destroyed in a test animal, this animal lost its orienting reflexes. What structure had been destroyed

Substantia nigra

Lateral vestibular nuclei

Corpora quadrigemina

Red nuclei

Medial reticular nuclei

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On examination the patient was determined to have a strong, balanced, inert type of higher nervous activity according to Pavlov’s classification. What temperament according to Hippocrates is it

Phlegmatic

-

Choleric

Melancholic

Sanguine

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A 45-year-old woman presents with insufficient secretion of enterokinase enzyme. Enterokinase deficiency can cause disturbance of the following digestive function:

Lipid hydrolysis

Vitamin absorption

Carbohydrate hydrolysis

Lipid absorption

Protein hydrolysis

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Systemic blood pressure of a person equals 120/65 mm Hg. Blood ejection into aorta occurs when left ventricular pressure exceeds:

10 mm Hg

90 mm Hg

100 mm Hg

120 mm Hg

65 mm Hg

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Prolonged vomiting resulted in dehydration of the patient’s body. Under these conditons, water retention in the body is ensured primarily due to increased secretion of the following hormone:

Aldosterone

Natriuretic hormone

Adrenaline

Vasopressin

Calcitonin

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KCl concentration in a solution that surrounds an isolated cell was increased. How will resting membrane potential (RMP) and cell excitability change in this case

RMP increases, excitability increases

RMP increases, excitability decreases

RMP decreases, excitability remains unchanged

RMP and excitability remain unchanged

RMP decreases, excitability increases

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Human brain produces endogenous peptides that are similar to morphine and can reduce pain perception. Name these peptides:

Endorphins

Statins

Liberins

Oxytocin

Vasopressin

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I.M. Siechenov has proven that a tired limb restores its working capacity faster if during its period of rest another limb works. It became a basis for the concept of:

Optimum

Pessimum

Active rest

Parabiosis

Fatigue

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Domestic accident has resulted in a significant blood loss in the patient, which was accompanied by a drop in blood pressure. What hormones ensure quick restoration of the blood pressure caused by a blood loss

Aldosterone

Reproductive hormones

Cortisol

Adrenaline, vasopressin

Oxytocin

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An experiment was conducted to measure the skin sensitivity threshold. What patches of skin have the highest sensitivity threshold

Dorsal surface of the hand

Face

Shoulder

Shin

Back

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A student, whose educational achievements throughout the semester were poor, feels emotionally tense during the final test. What is the primary cause that induced the leading mechanism of emotional tension in this case

Lack of time

Lack of energy

Lack of information

Lack of energy and information

Lack of time and energy

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After a trauma the patient has developed right-sided paralyses and disturbed pain sensitivity. On the left side no paralyses are observed, but pain and thermal sensitivity is disturbed. What is the cause of this condition

Unilateral right-side spinal cord injuiry

Motor cortex injury

Midbrain injury

Brainstem injury

Cerebellar injury

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A 3-year-old child with elevated body temperature has taken aspirin and developed increased hemolysis of erythrocytes. In this case hemolytic anemia can be caused by congenital deficiency of the following enzyme:

Gamma-glutamyl transferase

Glucose 6-phosphatase

Glucose 6-phosphate dehydrogenase

Glycogen phosphorylase

Glycerol-phosphate dehydrogenase

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Collagenosis patients typically present with the processes of connective tissue destruction. The presence of these processes can be confirmed by the increase in:

Blood urates

Transaminase activity in the blood

Blood oxyproline and oxylysine

Blood creatine and creatinine

LDH-isoenzyme activity in the blood

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During diabetes mellitus and starvation, the number of acetone bodies in blood increases. These bodies are used as a source of energy and are synthesized from the following substance:

Citrate

Malate

Acetyl-CoA

Succinyl-CoA

Ketoglutarate

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Blood test of the patient revealed albumine content of 20 g/L and increased activity of lactate dehydrogenase isoenzyme 5 (LDH5). These results indicate disorder of the following organ:

Kidneys

Spleen

Liver

Heart

Lungs

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A patient presents with an acute attack of cholelithiasis. Laboratory examination of the patient’s feces will show the following in this case:

Partially digested cellulose

Negative reaction to stercobilin

Connective tissue

Starch granules

Positive reaction to stercobilin

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A patient with diabetes mellitus after an insulin injection lost his consciousness and developed convulsions. What will be the result of a biochemical test for blood glucose level in this case

2.5 mmol/L

8.0 mmol/L

10 mmol/L

3.3 mmol/L

5.5 mmol/L

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A 27-year-old patient presents with pathologic changes in the liver and brain. Blood plasma exhibits acute decrease in copper levels, while urine copper levels are elevated. The patient is diagnosed with Wilson disease. To confirm this diagnosis it is necessary to measure activity of the following enzyme in the patient’s blood serum:

Alcohol dehydrogenase

Xanthine oxidase

Carbonic anhydrase

Ceruloplasmin

Leucine aminopeptidase

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The Gerontology Institute recommends older people to take vitamin complexes that contain vitamin E. What is the main function of this vitamin

Antioxidant

Antihemorrhagic

Antiscorbutic

Antidermatitic

Antineuritic

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Ammonia is extremely toxic for human CNS. What is the main way of ammonia neutralization in the nervous tissue

Transamination

Glutamine synthesis

Formation of paired compounds

Ammonium salts synthesis

Urea synthesis

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People, who for a long time remained in hypodynamic state, develop intense pain in the muscles after a physical exertion. What is the most likely cause of this pain

Accumulation of lactic acid in muscles

Intensive breakdown of muscle proteins

Increased content of ADP in muscles

Accumulation of creatinine in muscles

Decreased content of lipids in muscles

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Human genetic apparatus consists of approximately 30 thousand of genes, while the number of antibody variants can be as high as millions. What mechanism leads to formation of new genes that ensure the synthesis of such a number of antibodies

Genetic recombination

Gene amplification

Formation of Okazaki fragments

DNA replication

DNA repair

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Chronic overdose of glucocorticoids leads to the development of hyperglycemia in a patient. Name the process of carbohydrate metabolism that results in elevated blood glucose levels:

Glycogenolysis

Aerobic glycolysis

Gluconeogenesis

Pentose-phosphate pathway

Glycogenesis

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A patient for a long time was on an imbalanced diet low in proteins, which resulted in hepatic fatty infiltration. This condition is likely to develop if a certain substance is absent in a person’s diet. Name this substance:

Biotin

Alanine

Cholesterol

Acetic acid

Methionine

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A patient, who has been subsisting exclusively on polished rice, has developed polyneuritis due to thiamine deficiency. What substance is an indicator of such avitaminosis, when it is excreted with urine

Methylmalonic acid

Malate

Pyruvic acid

Uric acid

Phenyl pyruvate

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A 40-year-old man with pulmonary tuberculosis was prescribed isoniazid. Prolonged taking of this drug can result in development of the following vitamin deficiency:

Biotin

Folic acid

Pyridoxine

Thiamine

Cobalamin

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Disturbed activity of trypsin and chymotrypsin leads to disturbed protein breakup in the small intestine. Activity of these enzymes depends on the presence of the following factor:

Hydrochloric acid

N a+ salts

Pepsin

Bile acids

Enterokinase

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A newborn presents with weak suckling, frequent vomiting, and hypotonia. Blood and urine citrulline are very high. What metabolic process is disturbed

Ornithine cycle

Glycolysis

Gluconeogenesis

Tricarboxylic acid cycle

Cori cycle

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Patients with ischemic heart disease are usually prescribed small doses of aspirin. This drug inhibits synthesis of platelet aggregation activator, thromboxane A2. What substance is this activator synthesized from

Glutamic acid

Homogentisic acid

Acetic acid

Arachidonic acid

Malonic acid

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A patient with myocardial infarction in the acute phase has been hospitalized into the cardiology unit. To induce platelet lysis in the patient’s coronary vessels during the early hours of infarction, the following enzyme should be used:

Lysozyme

Chymotrypsin

Hyaluronidase

Trypsin

Streptokinase

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In the hematology unit a patient with leukemia was prescribed 5-Fluorouracil. This drug:

Catalyzes replication

Inhibits transcription

Inhibits DNA synthesis

Stimulates DNase

Inhibits translation

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A 7-year-old boy is diagnosed with anemia. Laboratory analysis detects pyruvate kinase deficiency in his erythrocytes. What process is disturbed in this boy, playing the main role in anemia development in this case

Gluconeogenesis

Anaerobic glycogenolysis

Anaerobic glycolysis

Decarboxylation of amino acids

Deaminization of amino acids

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Examination of a patient shows decreased leukocyte and erythrocyte count and low hemoglobin levels in peripheric blood, as well appearance of large cells (megaloblasts). What vitamin deficiency can cause these clinical presentations

Ascorbic acid

Folic acid

Niacin

Riboflavin

Biotin

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Wernicke-Korsakoff syndrome often develops in chronic alcoholics, who have a low-vitamin diet. Decreased transketolase activity can be observed in the course of this disease. What vitamin deficiency causes this development

Cobalamin

Niacin

Retinol

Thiamine

Riboflavin

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A patient was hospitalized in a comatose state. The patient has a 5-yearlong history of diabetes mellitus type 2. Objectively respiration is noisy, deep, with acetone breath odor. Blood glucose is 15.2 mmol/L, ketone bodies - 100 micromol/L. These signs are characteristic of the following diabetes complication:

Ketoacidotic coma

Hyperglycemic coma

Hepatic coma

Hyperosmolar coma

Hypoglycemic coma

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A 63-year-old man suffers from esophageal carcinoma, presents with metastases into the mediastinal lymph nodes and cancerous cachexia. What pathogenetic stage of neoplastic process is observed in the patient

Initiation

Progression

Promotion

Transformation

-

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After a prolonged attack of severe headache the patient lost mobility in his left arm and leg. Muscle tone is decreased in the affected limbs, the muscles are spasmed, spinal tendon reflexes are acutely intensified, reflex zones are increased. What nervous system disorder can be observed in this patient

Peripheral paralysis

Reflex paralysis

Extrapyramidal paralysis

Flaccid paralysis

Central paralysis

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Hematologic study shows the following pattern: erythrocytes - 2, 8 • 1012/L, Нb - 80 g/L, color index - 0.85, reticulocytes - 0,1%, platelets - 160 thousand per microliter, leukocytes - 60 • 109 /L. Basocytes - 2%, eosinophils - 8%, promyelocytes - 5%, myelocytes - 5%, juvenile - 16%, stab neutrophils - 20%, segmented neutrophils - 34%, lymphocytes - 5%, monocytes - 5%. This clinical presentation indicates the following blood pathology:

Chronic myeloleukemia

Hemolytic anemia

Hypoplastic anemia

Undifferentiated leukemia

Acute myeloleukemia

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Antileukocytic antibodies are detected in the blood of a patient with leukopenia. What type of Coombs-Gell hypersensitivity reaction developed in this case

Cytotoxic

Anaphylactic

Stimulating

Delayed-type hypersensitivity

Immune complex-mediated

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A patient with obliterating endarteritis has undergone a ganglionic sympathectomy. Positive therapeutic effect of this surgery is associated with development of arterial hyperemia of the lower limbs, which can be described as:

Metabolic

Neurotonic

Reactive

Neuroparalytic

Working

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In an experiment a laboratory rat was subjected to a stress factor (electric current), which resulted in muscular hypotonia, arterial hypotension, hypothermia, and hypoglycemia in the animal. What period of general adaptation syndrome is it

-

Exhaustion stage

Resistance stage

Antishock phase

Shock phase

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A 14-year-old adolescent has diphtheria. During the peak of the disease against the background of acute drop in body temperature and tachycardia the blood pressure is 70/50 mm Hg. What type of vascular tone disturbance is it

Acute hypotension

-

Chronic hypotension

Somatoform autonomic dysfunction

Essential hypotension

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24 hours after an appendectomy the patient’s blood test shows neutrophilic leukocytosis with a regenerative shift. What is the most likely mechanism of absolute leukocytosis development in the patient’s peripheral blood

Decreased leukocyte disintegration

Intensification of leukopoiesis

Leukocyte redistribution

Immunity activation

Deceleration of leukocyte migration to the tissues

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A 59-year-old man, a business manager, developed intense burning retrosternal pain that irradiates to the left arm. The pain occurred in the evening after the tax audit. 15 minutes later the patient’s condition normalized. What mechanism of angina pectoris development is leading in this patient

Increased level of blood catecholamines

Coronary atherosclerosis

Functional cardiac overload

Coronary artery thrombosis

Intravascular aggregation of blood cells

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A 30-year-old person has been stung by a bee. The stung area exhibits edema, hyperemia, and elevated temperature. What is the initial pathogenetic factor of inflammatory edema in this case

Increase of capillary blood pressure

Increase of osmotic pressure in the inflammation focus

Decrease of oncotic blood pressure

Disturbed lymphatic efflux

Increase of microvascular permeability

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A 30-year-old woman developed facial edemas. Examination detected proteinuria (5.87 g/L), hypoproteinemia, dysproteinemia, and hyperlipidemia. Such combination of signs is characteristic of:

Nephritic syndrome

Chronic kidney failure

Acute kidney failure

Chronic pyelonephritis

Nephrotic syndrome

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An uconscious young man in the state of morphine intoxication has been brought into admission room. The patient’s respiration is slow and shallow due to suppression of the respiratory center. What kind of respiratory failure occurred in this case

Ventilatory disregulation

Ventilatory restriction

Perfusion

Diffusion

Ventilatory obstruction

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A man has been working for a long time in oil processing. What type of carcinogens does he encounter at his workplace

Polycyclic aromatic hydrocarbons

Biological carcinogens

Nitrosamines

Amino-azo compounds

Amines

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A patient has been suffering from bronchial asthma for 15 years. What changes in the patient’s leukogram can be expected in this case

Basophilia

Leukopenia

Leukocytosis

Eosinophilia

Left shift

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A married couple came for a genetic counseling. The husband suffers from insulinindependent diabetes mellitus, while the wife is healthy. What is the probability of their child developing insulin-independent diabetes mellitus

100 %

The same as in the population

Higher than in the population

50 %

Lower than in the population

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A laboratory rat with chronic kidney failure presents with osteoporosis, pathologic calcification of the internal organs, and arterial hypertension. These disturbances are associated with increased activity of the following hormone:

Parathyroid hormone

Adrenaline

Thyroxin

Triiodothyronine

Calcitonin

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A patient is diagnosed with severe B12- deficiency anemia resulting in disturbed hematopoiesis and appearance of atypical erythrocytes in the blood. The patient has a history of total gastric resection. This diagnosis can be confirmed if the following cells are present in the peripheral blood:

Anulocytes

Elliptocytes

Normocytes

Megalocytes

Microcytes

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A patient with asphyxia after a brief respiratory arrest developed single infrequent respirations with passive expiration, after which he stopped breathing completely. What type of respiration was observed in this case

Kussmaul respiration

Cheyne-Stokes respiration

Gasping respiration

Apneustic respiration

Biot respiration

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A 3-year-old child has been brought by ambulance to the intensive care unit of the infectious diseases hospital. On examination the child is in severe condition, skin and mucosa are dry, tissue turgor is reduced. The patient’s history states that profuse diarrhea and recurrent vomiting were observed throughout the previous day after the child had eaten food products of poor quality. What type of salt and water imbalance is likely to have developed in the patient

Isoosmolar hyperhydration

Isoosmolar dehydration

Hypoosmolar dehydration

Hypoosmolar hyperhydration

Hyperosmolar hyperhydration

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A 48-year-old man is unconscious. He has a history of several syncopal episodes with convulsions. ECG shows deformed QRS complexes unconnected with P waves, atrial contractions are approximately 70/min., ventricular contractions - 25-30/min. Name the type of arrhythmia in this case:

Second-degree atrioventricular block

Intraatrial block

Complete atrioventricular block

First-degree atrioventricular block

Intraventricular block

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A 40-year-old man with impaired venous patency in the lower limbs developed edemas. What mechanism plays the main role in the development of this disturbance

Hypoproteinemia

Disturbed humoral regulation of watermineral balance

Elevated filtration pressure

Positive fluid balance

Decreased gradient of osmotic pressure between blood and tissue

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Autopsy of a 60-year-old woman, who for a long time had been suffering from essential hypertension, shows significantly diminished kidneys (weight of both kidneys is 80 g) with finely granular surface. Uniform renal cortical thinning can be observed on section. Name the described changes in the kidneys:

Pyelonephritic contracted kidney

Diabetic nephrosclerosis

Secondary contracted kidney

Primary contracted kidney

Amyloid contracted kidney

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Autopsy of a 3-year-old child shows a tumor in the cerebellum. The tumor has no clear margins separating it from the surrounding tissues. Histologically it is made of small atypical cells with hyperchromic nuclei. This tumor is most likely a:

Medullary sarcoma

Cancer metastasis

Glioblastoma

Medulloblastoma

Sarcoma metastasis

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Autopsy revealed a large wedge-shaped patch of a dense dark red tissue with clear margins in the upper lobe of the right lung. Histological examination detected there necrosis of the alveolar walls; the alveolar lumen is tightly packed with erythrocytes. What process occurred in the lungs

Gangrene

Carneous degeneration

Hemorrhagic infarction

Hemorrhage

Atelectasis

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Regional lymph nodes surrounding an infected wound are enlarged. Histological examination shows increased number of macrophages, lymphocytes, and lymphatic follicles in the cortical layer of the lymph nodes, as well as a large amount of plasma cells. What process in the lymph nodes is indicated by these histological changes

Transplant rejection

Acquired deficiency of lymphoid tissue

Antigen stimulation

Congenital deficiency of lymphoid tissue

Neoplastic aberration

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A patient has gradually developed a skin plaque on his face. In the center of this plaque there are necrotic patch and ulcer. Histopathological analysis of the biopsy material reveals proliferation of atypical epithelial cells with large number of pathologic mitoses. What is the most likely diagnosis

Fibroma

Papilloma

Trophic ulcer

Sarcoma

Skin cancer

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Histological analysis of a biopsy skin sample obtained from a 24-year-old patient detects caseous necrosis surrounded with cellular infiltrate consisting of lymphocytes, among which there are single giant cells; proliferation of connective tissue and endovasculites are observed. Characterize this pathologic process:

Proliferative granulomatous inflammation

Abscess

Ichorous inflammation

Catarrhal inflammation

Proliferative interstitial inflammation

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Autopsy of a man, who had been suffering from mitral stenosis, reveals dense brown lungs. What pathologic process had occurred in the lungs

Hemochromatosis

Jaundice

Hemosiderosis

Hemomelanosis

Lipofuscinosis

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A 63-year-old man, who has been suffering from chronic diffuse obstructive pulmonary emphysema for 15 years, died of progressive heart failure. Autopsy shows nutmeg liver cirrhosis, cyanotic induration of kidneys and spleen, ascites, and edemas of the lower limbs. What type of heart failure can be characterized by such changes in the internal organs

Chronic heart failure

Acute right ventricular failure

Chronic atrial failure

Acute global heart failure

Acute left ventricular failure

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A 6-year-old girl presents with acute onset of a disease. She developed sore throat and high temperature that were later accompanied by a punctate skin rash. Oral examination reveals acute pharyngeal hyperemia, raspberry tongue, and enlarged bright red tonsils with dull gray and yellow foci that spread to the peritonsillar tissues. The submandibular lymph nodes are enlarged. What disease are these changes characteristic of

Laryngeal diphtheria

Pharyngeal diphtheria

Scarlet fever

Measles

Meningococcal nasopharyngitis

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Autopsy of a man, who served on a nuclear submarine, revealed the following pathologies: bone marrow atrophy (panmyelophthisis), anemia, leukopenia, thrombocytopenia, lymphocytic disintegration in the lymph nodes, spleen, gastrointestinal lymphatic system, and hemorrhages into the adrenal glands. What disease had developed in this case

Vibration disease

Acute anemia

Acute leukemia

Acute radiation sickness

Decompression sickness

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A 9-month-old child presents with delayed tooth eruption, improper sequence of tooth eruption, and horizontal maxillary configuration (high-arched palate). Microscopically enamel mineralization pattern is irregular, enamel columns are wrinkled, some of them are vacuolated, predentin zones are widened, single denticles can be observed. What disease is it

Early rickets

Hypervitaminosis D

Late rickets

Gout

Osteomalacia

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Autopsy of a 58-year-old man, who for a long time has been drinking alcohol in large amounts and died at home, is being conducted. Macroscopically the right lung is dense and enlarged, its tissue is gray and homogeneous on section, its pleura is covered with grayish membranous deposits. Microscopically the alveolar cavities contain fibrin threads, neutrophils, and hemolysed erythrocytes. Make the diagnosis:

Croupous pneumonia

Interstitial pneumonia

Focal pneumonia

Primary pulmonary tuberculosis

Caseous pneumonia

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Autopsy of a 49-year-old woman who died of chronic kidney failure shows small dense striated kidneys with areas of hemorrhages. Microscopically nuclei of epithelial channels contain hematoxylin bodies; glomerular capillaries resemble wire loops, have thickened basement membranes, and in places contain hyaline thrombi and foci of fibrinoid necrosis. What is the most likely diagnosis

Rheumatism

Atherosclerotic nephrosclerosis

Amyloidosis

Systemic lupus erythematosus

Arteriolosclerotic nephrosclerosis

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A 34-year-old man died in a comatose state. According to his family after a business trip to an African country he developed periodical jaundice attacks. Autopsy shows the following: dense enlarged spleen with slate-black pulp; enlarged plethoric liver, gray-black on section; cerebral gray matter is brown-gray; cerebral white matter contains numerous small hemorrhages. What infectious disease can be suspected

Generalized cryptococcosis

Prion infection

Generalized herpetic infection

Meningococcemia

Malaria

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A 27-year-old woman has undergone a sector resection of mammary gland tissue. Macroscopy detects a dense white node, 4 cm in diameter, with clear margins in the excised tissue. Immediate histological analysis shows the tumor to consist of a large amount of fibrous stroma with stromal proliferation around the small canaliculi. Canalicular epithelium overlays the basement membrane and retains its polarity. Make the diagnosis:

Adenocarcinoma

Cancer

Sarcoma

Pericanalicular fibroadenoma

Dyshormonal disorders

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In the course of an urgent surgery, the vermiform appendix of the patient was excised. The appendix was acutely distended and gray-black throughout its whole length. In the distal segment a defect of the appendix wall was detected, through which a foul-smelling gray-brown substance was being discharged from the appendix lumen. Histological analysis shows necrotization of the appendix wall with hemorrhagic foci; lumen of the mesenteric artery is filled with a trombus. What type of appendicitis is it

Chronic

Acute superficial

Acute gangrenous

Acute simple

Acute phlegmonous

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A 39-year-old man underwent a surgery for peptic ulcer disease of the stomach. He died 7 days after the surgery. On autopsy the peritoneal layers are plethoric, dull, and covered with massive yellow-green membranous deposits. The peritoneal cavity contains approximately 300 mL of thick yellow-green fluid. What pathologic process was detected in the peritoneal cavity

Serofibrinous peritonitis

Peritoneal commissures

Fibrinohemorrhagic peritonitis

Serous peritonitis

Fibrinopurulent peritonitis

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To test donor blood for hepatitis B antigens, it is necessary to use highly sensitive detection methods. What test should be used for this purpose

Immunoelectrophoresis

Indirect hemagglutination

Complement binding

Indirect immunofluorescence

Solid-phase enzyme-linked immunosorbent assay

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The bacteriological laboratory has received for analysis a sample of dried fish from a focus of food poisoning outbreak. The bacteriologist inoculated the sample into a Kitt-Tarozzi medium, where growth of tennis racquetshaped microorganisms could be observed. These microorganisms are likely to be the causative agents of:

Dysentery

Staphylococcal toxicoinfection

Typhoid fever

Salmonellosis

Botulism

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To determine toxigenicity of diphtheria causative agents obtained from patients, the cultures were inoculated in a Petri dish with nutrient agar, bilaterally to a strip of filter paper spotted with antidiphtheric antitoxic serum and situated in the center of the Petri dish. After incubation of the inoculated cultures in the agar, strip-like areas of medium turbidity formed between some of the cultures and the filter paper. What immunological test was conducted

Ring precipitin test

Agar gel precipitation test

Opsonization test

Coombs test

Agglutination test

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The bacteriological laboratory needs to prepare for analysis of materials that are suspected to be contaminated with spores of anthrax causative agent. What diagnostic preparation allows for quick detection of these spores

Monoclonal antibodies to anthrax causative agent

Standard anthrax antigen

Anti-anthrax fluorescent serum

Anti-anthrax immunoglobulin

Enzyme-tagged immunoglobulin

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A family has two children. The younger child is under a year. The child has developed spastic cough attacks. Similar clinical presentation was observed in the elder preschool child one month ago. The doctor suspects pertussis infection. What method enables retrospective diagnostics of this disease

Serological

Molecular biological

Biological

Microscopy

Bacteriological

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What diagnostic method should be used in industry to test the raw leather for presence of antracis

Bacteriological analysis

Ascoli’s thermo precipitation test

Microscopy with Aujeszky stain

Microscopy with Burry-Gins stain

Serological test

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Urinalysis of a patient with acute cystitis shows leukocytes and a large number of gramnegative bacilli. Inoculation has resulted in the growth of mucous colonies that produce a green soluble pigment. What microorganism is the most likely cause of the patient’s disorder

Escherihia coli

Proteus mirabilis

Klebsiella pneumoniae

Pseudomonas aeruginosa

Salmonella enteritidis

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Pathologic material (mucosal excretion from the nasal passages) obtained from a patient provisionally diagnosed with influenza was sent to the virological laboratory. What quick test allows detecting specific viral antigen in the investigated material

Direct and indirect enzyme-linked immunosorbent assay (ELISA)

Direct and indirect immunofluorescence (IF)

Radioimmunoassay (RIA)

Hemagglutination inhibition assay (HAI)

Reverse indirect hemagglutination (RIHA)

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First-year schoolchildren have received tuberculin skin test (Mantoux test) at the school nurse’s office. The purpose of this test was:

To measure allergization rate against rickettsia

To measure immunity stress due to diphtheria

To determine the children that need to receive BCG vaccination

To preventively vaccinate against tuberculosis

To detect parotitis in the schoolchildren

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A 12-year-old boy with clinical presentation of influenza has developed respiratory mycoplasmosis. What type of infection has developed under these conditions

Iatrogenic infection

Relapse

Mixed infection

Autoinfection

Superinfection

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A patient with peptic ulcer disease was prescribed famotidine. As a result his gastric juice acidity significantly decreased. What is the mechanism of action of this drug

Inhibition of H+, K+-ATPase activity

Histamine H2 receptor blockade

Histamine H1 receptor blockade

Blockade of histamine receptors in the sympathetic ganglia

Muscarinic M1 receptor blockade

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A 33-year-old woman, who for a long time has been treated for chronic polyarthritis, complains of elevated blood pressure, changes in adipose tissue distribution, and disturbed menstrual cycle. What drug does this patient take

Indometacin

Beclometasone

Synaflan (Fluocinolone acetonide)

Prednisolone

Butadion (Phenylbutazone)

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The first-aid center has received a victim of a traffic accident diagnosed with closed displaced fracture of the middle third of the thigh. For repositioning of the bone fragments the patient received 10 mL of 2% dithylinum solution intravenously, which resulted in the prolonged period of apnoea and muscle relaxation. What enzyme is deficient, resulting in such pharmacogenetic enzymopathy

Glucose 6-phosphate dehydrogenase

Uridine diphosphate glucuronyltransferase

N-acetyltransferase

Methemoglobin reductase

Pseudocholinesterase

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A patient with diabetes mellitus and allergic dermatitis was prescribed a certain fluorinated hormone drug in the ointment dosage form. When the patient asked, how this drug was better than the hydrocortisone ointment, the doctor explained that the prescribed medicine:

Had short-term action

Was cheaper

Was less potent

Had practically no resorptive effect

Increased insulin synthesis

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A 45-year-old woman has an attack of cardiac fibrillation. She suffers from stage II essential hypertension. What is the drug of choice for stopping this attack

Potassium chloride

Strophanthin

Sustac forte (Nitroglycerin)

Lidocaine

Anaprilin (Propranolol)

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A patient with inoperable lung cancer accompanied by unbearable pain was prescribed an analgesic. Against the background of analgesic therapy the patient developed signs of intestinal obstruction. What analgesic could have caused this complication

Fentanyl

Omnopon (Papaveretum)

Promedol (Trimeperidine)

Morphine

Analgin (Metamizole)

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A patient has been taking bisacodyl for a long time to treat chronic constipation. However, several weeks later the aperient effect of the drug diminished. What is the possible cause of this

Drug dependence

Functional cumulation

Material cumulation

Sensitization

Acquired tolerance

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A 39-year-old man presents with hyperkeratosis, disturbed twilight vision, and high risk of infectious processes. What vitamin preparation should he be prescribed

Riboflavin

Retinol acetate

Pyridoxine hydrochloride

Tocopherol acetate

Ergocalciferol

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The neurological department received a patient complaining of memory deterioration and loss of mental work capacity that developed after a head trauma. Recommend him a medicine for improvement in cerebral metabolism:

Caffeine

Meridil (Methylphenidate)

Analgin (Metamizole)

Piracetam (Nootropil)

Sydnocarb (Mesocarb)

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A woman with polyarticular rheumatoid arthritis was prescribed a non-steroidal antiinflammatory drug - diclofenac sodium. After the patient has been taking it for some time, her concomitant disease exacerbated, which forced the doctor to cancel the prescription of this drug. What concomitant disease could necessitate cancellation of this drug prescription

Essential hypertension

Ulcer disease

Ischemic heart disease

Diabetes mellitus

Bronchial asthma

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A patient with streptococcal infection of the gingiva was prescribed a drug with beta-lactam ring in its structure. What drug of those listed below belongs to this pharmacological group

Erythromycin

Rifampicin

Benzylpenicillin

Levomycetin (Chloramphenicol)

Streptomycin sulfate

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A patient was administered a certain drug for relief of cardiac rhythm disturbance. This drug can be used as a local anesthetic as well. Name this drug:

Cocaine hydrochloride

Dicain (Tetracaine)

Lidocaine hydrochloride

Anaesthesin (Benzocaine)

Diphenine (Phenytoin)

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A patient with arrhythmia was hospitalized into the cardiology unit. What antiarrhythmic drug should be prescribed

Diclofenac sodium

Amiodarone

Furacilin (Nitrofural)

Drotaverine hydrochloride

Acetylsalicylic acid

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A woman with allergic neurodermatitis was prescribed a second-generation antihistamine without depressing effect on the CNS. Name this drug:

Tavegyl (Clemastine)

Dimedrol (Diphenhydramine)

Ketotifen

Loratadine

Diazolin (Mebhydrolin)

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During gastric resection the patient received mixed anesthesia with tubocurarin chloride muscle relaxant; to restore spontaneous respiration the patient received proserin. What pharmacological group does this drug belong to

Cholinesterase inhibitors

Calcium channel blockers

Angiotensin-converting-enzyme inhibitors

Muscarinic agonists

Muscarinic antagonists

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To treat the burns, a patient was prescribed a drug with antiseptic properties that are based on formation of atomic oxygen in the presence of organic substances. This drug has also an astringent (antiinflammatory) effect due to formation of albuminates. Name this drug:

Sodium bicarbonate

Chlorhexidine digluconate

Potassium permanganate

Hydrogen peroxide

Ethyl alcohol

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Before a surgery the patient was prescribed a synthetic antiprotozoal drug for prevention of wound infection. The prescribed drug is highly effective against Helicobacter pylori. Name this drug:

Metronidazole

Aciclovir

Isoniazid

Chingamin (Chloroquine)

Doxycycline hydrochloride

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A patient with essential hypertension was prescribed a drug that inhibits angiotensinconverting enzyme (ACE). What drug is it

Lisinopril

Nifedipine

Losartan

Carvedilol

Colestyramine

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