krok 1 - 2013 question paper (general medicine)

Krok 1 Medicine 2013 1

1. A patient diagnosed with focaltuberculosis of the upper lobe of the rightlung had been taking isoniazid as a partof combination therapy. After some time,the patient reported of muscle weakness,decreased skin sensitivity, blurred visi-on, impaired motor coordination. Whi-ch vitamin preparation should be used toaddress these phenomena?

A. Vitamin B6

B. Vitamin AC. Vitamin DD. Vitamin B12

E. Vitamin C

2. A 60-year-old male patient has a 9-yearhistory of diabetes and takes insulin Semi-lente for the correction of hyperglycemia.10 days ago he began taking anaprilinfor hypertension. One hour after admini-stration of the antihypertensive drug thepatient developed hypoglycemic coma.What is the mechanism of hypoglycemiain case of anaprilin use?

A. Inhibition of glycogenolysisB. Reduction of glucagon half-lifeC. Increase of insulin Semilente half-lifeD. Increase of bioavailability of insulinSemilenteE. Decrease in glucose absorption

3. Pterin derivatives (aminopterin andmethotrexate) are the inhibitors of di-hydrofolate reductase, so that they inhibitthe regeneration of tetrahydrofolic acidfrom dihydrofolate. These drugs inhibitthe intermolecular tranfer of monocarbongroups, thus suppressing the synthesis ofthe following polymer:

A. DNAB. ProteinC. HomopolysaccharidesD. GangliosidesE. Glycosaminoglycans

4. A child with suspected tuberculosis wasgiven Mantoux test. After 24 hours thesite of the allergen injection got swollen,hyperemic and painful. What are the maincomponents that determine such responseof the body?

A. Mononuclear cells, T-lymphocytes andlymphokinesB. Granulocytes, T-lymphocytes and IgGC. Plasma cells, T-lymphocytes andlymphokinesD. B-lymphocytes, IgME. Macrophages, B-lymphocytes andmonocytes

5. Hemoglobin catabolism results inrelease of iron which is transported tothe bone marrow by a certain transferprotein and used again for the synthesis ofhemoglobin. Specify this transfer protein:

A. Transferrin (siderophilin)B. TranscobalaminC. HaptoglobinD. CeruloplasminE. Albumin

6. A 12-year-old boy has been hospitali-zed for suspected food poisoning. Thefecal samples were inoculated on theEndo agar, which resulted in growth ofa large number of colorless colonies.What microorganism is most likely to beEXCLUDED from the list of possiblecausative agents of the disease?

A. Escherichia coliB. Salmonella enteritidisC. Proteus vulgarisD. Pseudomonas aeruginosaE. Yersinia enterocolitica

7. A 23-year-old patient has been admi-tted to a hospital with a craniocerebralinjury. The patient is in a grave condition.Respiration is characterized by prolongedconvulsive inspiration followed by a shortexpiration. What kind of respiration is ittypical for?

A. ApneusticB. Gasping breathC. Kussmaul’sD. Cheyne-StokesE. Biot’s

8. It has been experimentally proven thatthe excitation of the motor neurons offlexor muscles is accompanied by the inhi-bition of the motor neurons of extensormuscles. What type of inhibition underli-es this phenomenon?

A. ReciprocalB. Inhibition after excitationC. PessimalD. FeedbackE. Lateral


9. A 3-year-old boy with pronouncedhemorrhagic syndrome doesn’t have anti-hemophilic globulin A (factor VIII) inthe blood plasma. Hemostasis has beenimpaired at the following stage:

A. Internal mechanism of prothrombinaseactivationB. External mechanism of prothrombinaseactivationC. Conversion of prothrombin to thrombinD. Conversion of fibrinogen to fibrinE. Blood clot retraction

10. A patient got a gunshot wound ofhip which damaged the sciatic nerve. Anyimpact on the affected limb causes severe,excruciating pain. What mechanism ofpain is most likely in this case?

A. CausalgicB. ReflexC. PhantomD. Endorphin hypofunctionE. Enkephalin hypofunction

11. A 60-year-old patient with a long hi-story of stenocardia takes coronarodilatoragents. He has also been administeredacetylsalicylic acid to reduce plateletaggregation. What is the mechanism ofantiplatelet action of acetylsalicylic acid?

A. It reduces the activity of cyclooxygenaseB. It reduces the activity of phosphodi-esteraseC. It enhances the activity of plateletadenylate cyclaseD. It enhances the synthesis of prostacyclinE. It has membrane stabilizing effect

12. A patient with bronchial asthma hasdeveloped acute respiratory failure. Whatkind of respiratory failure occurs in thiscase?

A. Obstructive disturbance of alveolarventilationB. Restrictive ventilatory defectC. PerfusionD. DiffusionE. Dysregulation of alveolar ventilation

13. On the fifth day after the acuteblood loss a patient has been diagnosedwith hypochromic anemia. What isthe main mechanism of hypochromiadevelopment?

A. Release of immature red blood cellsfrom the bone marrowB. Impaired iron absorption in the intesti-nesC. Increased destruction of red blood cellsin the spleenD. Impaired globin synthesisE. Increased excretion of body iron

14. A patient with diabetes developeda diabetic coma due to the acid-baseimbalance. Specify the kind of thisimbalance:

A. Metabolic acidosisB. Metabolic alkalosisC. Respiratory acidosisD. Gaseous alkalosisE. Non-gaseous alkalosis

15. A girl receives antibiotics of the penici-llin group for acute bronchitis. On the thi-rd day of treatment she developed allergicdermatitis. Which drug should be admini-stered?

A. LoratadineB. Cromolyn sodiumC. BeclomethasoneD. Ephedrine hydrochlorideE. Levamisole

16. A female patient has been di-agnosed with cervical erosion, which isa precancerous pathology. What defensemechanism can prevent the developmentof a tumor?

A. Increase in natural killer level (NK-cells)B. High-dose immunological toleranceC. Increase in the activity of lysosomalenzymesD. Simplification of the antigenic structureof tissuesE. Low-dose immunological tolerance

17. Microscopy of the coronary artery ofa dead 53-year-old patient revealed lumi-nal occlusion due to a fibrous plaque wi-th some lipids. The most likely form ofatherosclerosis in this case is:

A. LiposclerosisB. LipidosisC. Prelipid stageD. AtheromatosisE. Ulceration

18. Autopsy of the patient revealed bonemarrow hyperplasia of tubular and flatbones (pyoid marrow), splenomegaly(6 kg) and hepatomegaly (5 kg),


enlargement of all lymph node groups.What disease are the identified changestypical for?

A. Chronic myelogenous leukemiaB. Chronic lymphocytic leukemiaC. Multiple myelomaD. Polycythemia veraE. Hodgkin’s disease

19. As a result of an injury a patientcannot extend his arm at the elbow. Thismay cause abnormal functioning of thefollowing muscle:

A. Musculus triceps brachiiB. Musculus infraspinatusC. Musculus levator scapulaeD. Musculus teres majorE. Musculus subscapularis

20. A man sitting with his eyes closed,undergoes electroencephalography. Whatrhythm will be recorded on the EEG ifthere is an audible signal?

A. Beta rhythmB. Theta rhythmC. Delta rhythmD. Alpha rhythmE. Gamma rhythm

21. Electrophoretic study of a bloodserum sample, taken from the patient withpneumonia, revealed an increase in one ofthe protein fractions. Specify this fraction:

A. γ-globulinsB. AlbuminsC. α1-globulinsD. α2-globulinsE. β-globulins

22. Examination of an 18-year-old gi-rl revealed the following features:hypoplasia of the ovaries, broadshoulders, narrow pelvis, shortening of thelower extremities, "sphinx neck". Mentaldevelopment is normal. The girl was di-agnosed with Turner’s syndrome. Whatkind of chromosome abnormality is it?

A. Monosomy XB. Trisomy XC. Trisomy 13D. Trisomy 18E. Nullisomy X

23. Hypertrichosis is the Y-linkedcharacter. The father has hypertrichosis,and the mother is healthy. In this fami-ly, the probability of having a child withhypertrichosis is:

A. 0,5B. 0,25C. 0,125D. 0,625E. 1

24. A casualty has a fracture in the regionof the inner surface of the left ankle. Whatis the most likely site for the fracture?

A. Medial malleolusB. Lower third of the fibulaC. AstragalusD. Lateral malleolusE. Calcaneus

25. Some infectious diseases caused bybacteria are treated with sulfanilamideswhich block the synthesis of bacteriagrowth factor. What is the mechanism oftheir action?

A. They are antivitamins of para-aminobenzoic acidB. They inhibit the absorption of folic acidC. They are allosteric enzyme inhibitorsD. They are involved in redox processesE. They are allosteric enzymes

26. A 42-year-old male patient withgout has an increased blood uric acidconcentration. In order to reduce the levelof uric acid the doctor administered himallopurinol. Allopurinol is the competiti-ve inhibitor of the following enzyme:

A. Xanthine oxidaseB. Adenosine deaminaseC. Adenine phosphoribosyltransferaseD. Hypoxanthine-phosphoribosyltransferaseE. Guanine deaminase

27. A 40-year-old female patient di-agnosed with acute pancreatitis has beendelivered to the admission department ofa regional hospital. What drug should beadministered the patient in the first place?

A. ContrycalB. PlatyphyllinC. AtropineD. MetacinE. Pirenzepine

28. A patient consulted a doctor aboutbeing unable to abduct his right arm aftera past trauma. Examination revealed thatthe passive movements were not limi-ted. The patient was found to have theatrophy of the deltoid muscle. What nerveis damaged?


A. AxillaryB. RadialC. UlnarD. MedianE. Suprascapular

29. After a trauma of the upper third ofthe anterior forearm a patient exhibitsdifficult pronation, weakening of palmarflexor muscles and impaired skin sensiti-vity of 1-3 fingers. Which nerve has beendamaged?

A. n. medianusB. n. musculocutaneusC. n. ulnarisD. n. cutaneus antebrachii medialisE. n. radialis

30. A 38-year-old female patient complai-ns of general weakness, cardiac pain,increased appetite, no menstruation.Objectively: the height is 166 cm, weight108 kg, the patient has moon-shaped face,subcutaneous fat is deposited mainly inthe upper body, torso and hips. There arealso blood-red streaks. Ps- 62/min, AP-160/105 mm Hg. Which of the followingdiseases is the described pattern of obesi-ty most typical for?

A. Cushing pituitary basophilismB. Alimentary obesityC. MyxedemaD. InsulinomaE. Babinski-Frohlich syndrome

31. A 60-year-old patient with a longhistory of atherosclerosis and a previ-ous myocardial infarction developed anattack of retrosternal pain. 3 days laterthe patient was hospitalized and then di-ed of progressive cardiovascular insuffici-ency. At autopsy a white fibrous depressedarea about 3 cm in diameter with clearboundaries was found in the posteriorwall of the left ventricle and interventri-cular septum. The dissector evaluatedthese changes as:

A. Focal cardiosclerosisB. Myocardial ischemiaC. Myocardial infarctionD. MyocarditisE. Myocardial degeneration

32. Measurements of the arterial pCO2

and pO2 during an attack of bronchi-al asthma revealed hypercapnia andhypoxemia respectively. What kind ofhypoxia occurred in this case?

A. RespiratoryB. HemicC. CirculatoryD. TissueE. Histotoxic

33. A female patient with bronchialasthma had taken prednisolone tablets (1tablet 3 times a day) for 2 months. Due toa significant improvement of her conditi-on the patient suddenly stopped taking it.What complication is likely to develop inthis case?

A. Withdrawal syndromeB. Cushing’s syndromeC. GastrorrhagiaD. Upper body obesityE. Hypotension

34. A patient with suspected dysenteryhas been admitted to the infectious di-seases hospital. Which basic method oflaboratory diagnosis must be applied inthe first place?

A. BacteriologicalB. SerologicalC. AllergicD. BiologicalE. Microscopic

35. During a surgery with the use ofhygronium the patient had an abrupt fallin blood pressure. Blood pressure can benormalized by the representatives of thefollowing drug group:

A. α-adrenergic agonistsB. α-blockersC. Ganglionic blockersD. M-cholinergic agentsE. N-cholinergic agents

36. A patient with respiratory failure hasblood pH of 7,35. pCO2 test revealedhypercapnia. Urine pH test revealed anincrease in the urine acidity. What form ofacid-base imbalance is the case?

A. Compensated respiratory acidosisB. Compensated metabolic acidosisC. Decompensated metabolic acidosisD. Compensated respiratory alkalosisE. Decompensated respiratory alkalosis

37. On examination a patient was foundto have medial strabismus, the inwarddeviation of the eyeball and inability toabduct the eyeball outwards. What nerveis damaged?


A. AbducentB. OculomotorC. OcularD. TrochlearE. Visual

38. A patient with a dislocated shoulderhad been admitted to a hospital. Withthe purpose of skeletal muscle relaxati-on he was given an injection of relaxantdithylinum acting normally 5-7 minutes.However, the effect of dithylinum in thispatient lasted up to 8 hours. What is themost likely cause of the prolonged effectof dithylinum in this patient?

A. Genetic deficiency of blood choli-nesteraseB. Reduced activity of microsomal liverenzymesC. Reduced drug excretionD. Material accumulation of the drugE. Potentiation by another drug

39. As a result of an injury of the knee joi-nt a patient shows a drawer sign, that isthe anterior and posterior displacementof the tibia relative to the femur. What li-gaments are damaged?

A. Cruciate ligamentsB. Arcuate popliteal ligamentsC. Oblique popliteal ligamentD. Interosseous membraneE. Collateral ligaments

40. The neurosurgical department hasadmitted a 54-year-old male complaini-ng of no sensitivity in the lower eyelidskin, lateral surface of nose, upper lip.On examination the physician revealedthe inflammation of the second branch ofthe trigeminal nerve. This branch comesout of the skull through the followingforamen:

A. Round foramenB. Lacerated foramenC. Oval foramenD. Spinous foramenE. Superior orbital fissure

41. Bacteriological examination ofpurulent discharges from the urethrarevealed some gram-negative bean-shaped bacteria located in the leukocytes.They can be identified as the causativeagent of the following disease:

A. GonorrheaB. SyphilisC. Venereal lymphogranulomatosisD. ChancroidE. Trichomoniasis

42. A male patient is 28 years old. Hi-stological study of a cervical lymph noderevealed a change of its pattern due to theproliferation of epithelioid, lymphoid cellsand macrophages having nuclei in form ofa horseshoe. In the center of some cellclusters there were non-structured light-pink areas with fragments of nuclei. Whatdisease are these changes typical for?

A. TuberculosisB. Hodgkin’s diseaseC. ActinomycosisD. Tumor metastasisE. Syphilis

43. A 35-year-old male patient has beenreferred by an andrologist for the geneticcounselling for the deviations of physi-cal and mental development. Objectively:the patient is tall, has asthenic constituti-on, gynecomastia, mental retardation. Mi-croscopy of the oral mucosa cells revealedsex chromatin (single Barr body) in 30%of cells. What is the most likely diagnosis?

A. Klinefelter syndromeB. DiGeorge syndromeC. Down syndromeD. Recklinghausen’s diseaseE. Cushing pituitary basophilism

44. A patient with jaundice has hightotal bilirubin that is mainly indirect(unconjugated), high concentration ofstercobilin in the stool and urine. Thelevel of direct (conjugated) bilirubin inthe blood plasma is normal. What kind ofjaundice can you think of?

A. HemolyticB. Parenchymal (hepatic)C. MechanicalD. Neonatal jaundiceE. Gilbert’s disease

45. A male with a lesion of one of the CNSparts has asthenia, muscular dystonia,balance disorder. Which CNS part hasbeen affected?

A. CerebellumB. Black substanceC. Reticular formationD. Red nucleiE. Vestibular nuclei


46. A 50-year-old patient has been admi-nistered laevomycetin for the treatment oftyphoid fever, but on the next day the pati-ent’s condition worsened, the temperaturerose to 39, 60C. The deterioration of thepatient’s condition can be explained by:

A. Effects of endotoxins of the causativeagentB. Allergic reactionC. Insensitivity of the pathogen tolaevomycetinD. Secondary infectionE. Re-infection

47. A 12-year-old patient has been admi-tted to a hospital for hemarthrosis ofthe knee joint. From early childhood hesuffers from frequent bleedings. Diagnosethe boy’s disease:

A. HemophiliaB. Hemorrhagic vasculitisC. Hemolytic anemiaD. B12 (folic acid)-deficiency anemiaE. Thrombocytopenic purpura

48. Examination of a patient with ischemicheart disease revealed the impairedvenous blood flow in the territory ofthe cardiac vein running in the anteriorinterventricular sulcus of heart. What veinis it?

A. V. cordis magnaB. V. cordis mediaC. V. cordis parvaD. V. posterior ventriculi sinistriE. V. obliqua atrii sinistri

49. For the direct injection of medi-cations into the liver surgeons use theround ligament of liver. This manipulationinvolves bougienage (lumen dilatation) ofthe following vessel:

A. V. umbilicalisB. A. umbilicalisC. Ductus venosusD. V. portaE. A. hepatica propria

50. A patient with lobar pneumoniahas had body temperature of 39oC wi-th daily temperature fluctuation of nomore than 1oC for 9 days. This fevercan be characterized by the followingtemperature curve:

A. PersistentB. HecticC. RemittentD. HyperpyreticE. Recurrent

51. The temperature in a production roomis 36oC. Relative air humidity is 80%.Under these conditions the human bodytransfers heat mainly through:

A. Sweat evaporationB. Heat conductionC. RadiationD. ConvectionE. -

52. A hospitalized patient bitten by a rabidanimal has an avulsive wound of shin.What kind of vaccine must be given toprevent rabies?

A. Anti-rabies vaccineB. DTaPC. TdD. BCGE. TABte

53. At autopsy the occipital lobe of brainwas found to have a cavity 2,5x1,5 cmlarge filled with a transparent liquid. Thecavity had smooth brownish walls. Whatprocess had developed in the brain?

A. Cyst on the site of a hemorrhageB. Softening of the cerebrocortical greymatterC. Brain abscessD. ParacephaliaE. A cyst on the site of the softening of thecerebrocortical grey matter

54. A child entering the school for the firsttime was given Mantoux test in order todetermine if there was a need for revacci-nation. The reaction was negative. Whatis the meaning of this test result?

A. No cell-mediated immunity totuberculosisB. Availability of cell-mediated immunityto tuberculosisC. No antibodies to the tuberculosisbacteriaD. No anti-toxic immunity to tuberculosisE. Presence of antibodies to thetuberculosis bacteria

55. Study of the biopsy material revealeda granuloma consisting of lymphocytes,plasma cells, macrophages with foamycytoplasm (Mikulicz cells), many hyalineglobules. What disease can you think of?


A. RhinoscleromaB. LeprosyC. SyphilisD. TuberculosisE. Actinomycosis

56. Autopsy of a 78-year-old patientrevealed that retroperitoneal tissue wassoaked with blood, the abdominal aortahad a sacciform protrusion including adefect with irregular edges. The wall ofthe aorta was here and there of stone-likedensity. This is the complication of thefollowing disease:

A. AtherosclerosisB. Essential hypertensionC. Systemic vasculitisD. Visceral syphilisE. Marfan syndrome

57. Glycogen polysaccharide is synthesi-zed from the active form of glucose. Theimmediate donor of glucose residues duri-ng the glycogenesis is:

A. UDP-glucoseB. Glucose-1-phosphateC. ADP-glucoseD. Glucose-6-phosphateE. Glucose-3-phosphate

58. After the diagnostic tests a 40-year-old male has been referred for thelymphography of the thoracic cavity. Thesurgeon revealed that the tumor hadaffected an organ whose lymphatic vesselsdrain directly into the thoracic duct. Speci-fy this organ:

A. EsophagusB. TracheaC. Left main bronchusD. HeartE. Pericardium

59. A patient with biliary dyskinesiaand constipations has been prescribed acholagogue having also a laxative effect.What drug has been administered?

A. Magnesium sulfateB. AllocholC. CholosasD. CholenzymeE. Nicodinum

60. It is known that individuals withgenetically caused deficiency of glucose-6-phosphate dehydrogenase may developRBC hemolysis in response to the admini-stration of some antimalarial drugs. Mani-

festation of adverse reactions to drugs iscalled:

A. IdiosyncrasyB. AllergyC. SensibilizationD. TachyphylaxisE. Tolerance

61. A 40-year-old patient with theprogressing staphylococcal purulent peri-odontitis developed purulent inflammati-on of bone marrow spaces of the alveolarprocess, and then of the body of mandi-ble. Microscopy revealed thinning ofbone trabeculae, foci of necrosis, bonesequesters surrounded by the connecti-ve tissue capsule. What is the most likelydiagnosis?

A. Chronic osteomyelitisB. Acute osteomyelitisC. ParodontomeD. Chronic fibrous periostitisE. Purulent abscess

62. Curariform substances introducedinto a human body cause the relaxati-on of all skeletal muscles. What changesin the neuromuscular synapse cause thisphenomenon?

A. Blockade of N-cholinergic receptors ofthe synaptic membraneB. Impaired acetylcholine releaseC. Blockade of Ca2+ channels of thepresynaptic membraneD. Impaired cholinesterase synthesisE. Depolarization of the postsynapticmembrane

63. A number of diseases can be di-agnosed by evaluating activity of bloodtransaminases. What vitamin is one ofcofactors of these enzymes?

A. B6

B. B2

C. B1

D. B8

E. B5

64. After a car accident a 23-year-old malepresented to the hospital with a cut woundof the anteromedial region of shoulderand arterial bleeding. Which artery wasdamaged?


A. A. brachialisB. A. radialisC. A. axillarisD. A. subscapularisE. A. profunda brachii

65. During the operation on the smallintestine the surgeon revealed an areaof the mucous membrane with a singlelongitudinal fold among the circular folds.Which portion of the small intestine is thisstructure typical for?

A. Pars descendens duodeniB. Pars horizontalis duodeniC. Pars ascendens duodeniD. jejunumE. Distal ileum

66. 14 days after quinsy a 15-year-old chi-ld presented with morning facial swelling,high blood pressure, "meat slops"urine.Immunohistological study of a renalbiopsy sample revealed deposition ofimmune complexes on the basementmembranes of the capillaries and in theglomerular mesangium. What diseasedeveloped in the patient?

A. Acute glomerulonephritisB. Acute interstitial nephritisC. Lipoid nephrosisD. Acute pyelonephritisE. Necrotizing nephrosis

67. A diseased child has a high fever, sorethroat, swelling of submandibular lymphnodes. Objectively: pharyngeal mucosais edematous, moderately hyperemic, thetonsils are enlarged, covered with grayishmembrane tightly adhering to the tissuesabove. Attempts to remove the membraneproduce the bleeding defects. What di-sease are these presentations typical for?

A. DiphtheriaB. Catarrhal tonsillitisC. Scarlet feverD. Meningococcal diseaseE. Measles

68. Study of the biopsy material of anembryo revealed a zone of developmentalabnormality in a somite. The zone waslocated close to the endoderm andthe notochord. What formations mayhave abnormal development in case ofpregnancy continuation?

A. Skeletal tissuesB. Genito-urinary systemC. Skeletal striated muscle tissueD. Cardiac striated muscle tissueE. Fibrous connective tissue of skin

69. A smear of sputum from the pati-ent with suspected lobar pneumonia wasstained with the use of the followingstains and reagents: solution of genti-an violet, Lugol’s solution, 96o alcohol,water magenta. What staining method wasapplied in this case?

A. GramB. Ziehl-NielsenC. RomanovskyD. NeisserE. Leffler

70. A patient has normally coloured stoolincluding a large amount of free fatty aci-ds. The reason for this is a disturbance ofthe following process:

A. Fat absorptionB. Fat hydrolysisC. Biliary excretionD. CholeresisE. Lipase secretion

71. Examination of the removed stomachrevealed a deep roundish defect withregular edges at the lesser curvature of theantrum. The defect reached the musculartunic and was 1,5 cm in diameter. Withinthe defect floor there was a translucentdense area resembling of a hyaline carti-lage. What process had developed in thefloor of the stomach defect?

A. Local hyalinosisB. AmyloidosisC. Mucoid swellingD. Fibrinoid alterationsE. General hyalinosis

72. By the decarboxylation of glutamate inthe CNS an inhibitory mediator is formed.Name it:

A. GABAB. GlutathioneC. HistamineD. SerotoninE. Asparagine

73. Thermometry revealed that thetemperature of the exposed skin is by 1-1,5o lower than the temperature of theadjacent areas covered with clothing fromnatural fabrics. The reason for this is thatthe clothes reduce the heat loss through:


A. ConvectionB. RadiationC. ConductionD. EvaporationE. -

74. A specimen of pia mater includes avessel whose wall doesn’t have the tuni-ca media, the tunica externa is adherentto the surrounding tissues, the intima iscomposed of a basement membrane andendothelium. What vessel is it?

A. Nonmuscular veinB. Muscular vein with underdevelopedmuscular elementsC. Muscular arteryD. ArterioleE. Artery of mixed type

75. A patient with extensive burns of torsoskin exhibits signs of severe intoxication.What stage of the burn disease is this typi-cal for?

A. Burn toxemiaB. Burn shockC. Burn infectionD. Burn emaciationE. Terminal

76. As a result of a craniocerebral injurya patient has a decreased skin sensitivity.What area of the cerebral cortex may bedamaged?

A. Posterior central gyrusB. Occipital regionC. Cingulate gyrusD. Frontal cortexE. Anterior central gyrus

77. A histological specimen of the eyeballshows a biconvex structure connected tothe ciliary body by the fibers of the Zinn’szonule and covered with a transparentcapsule. Name this structure:

A. Crystalline lensB. Vitreous bodyC. Ciliary bodyD. CorneaE. Sclera

78. A comatose patient was taken to thehospital. He has a history of diabetesmellitus. Objectively: Kussmaul breathi-ng, low blood pressure, acetone odor ofbreath. After the emergency treatmentthe patient’s condition improved. Whatdrug had been administered to the pati-ent?

A. InsulinB. AdrenalineC. IsadrinumD. GlibenclamideE. Furosemide

79. In order to stimulate breathing in a chi-ld born with asphyxia, the doctor gave hima drug injection into the umbilical vein.What drug might have been injected?

A. AethimizolumB. CorazolumC. CordiaminumD. SulfocamphocainumE. Coffeinum

80. A patient complains of pain in the ri-ght lateral abdomen. Palpation revealed adense, immobile, tumor-like formation. Atumor is likely to be found in the followi-ng part of the digestive tube:

A. Colon ascendensB. Colon transversumC. Colon descendensD. Colon sigmoideumE. Caecum

81. A patient underwent biopsy of thesoft palate arches for a suspected tumor(macroscopy revealed an ulcer with adense floor). Study of the biopsy materi-al revealed mucosal necrosis with infi-ltration of lymphocytes, epithelioid cells,plasma cells, single neutrophils in thesubmucosa. There were also apparent si-gns of endovasculitis and perivasculitis.The described changes are typical for:

A. Primary syphilisB. Aphthous stomatitisC. Ulcerative stomatitisD. Necrotizing ulcerative Vincent stomati-tisE. Pharyngeal diphtheria

82. Healthy parents with unremarkablefamily history have the child with multi-ple developmental defects. Cytogeneticanalysis revealed the trisomy 13 in thesomatic cells (Patau syndrome). Whatphenomenon has caused the defects?

A. Abnormal gametogenesisB. Somatic mutationC. Recessive mutationD. Dominant mutationE. Chromosomal mutation

83. A specimen shows an organ coveredwith the connective tissue capsule with


trabeculae radiating inward the organ.There is also cortex containing somelymph nodules, and medullary cords madeof lymphoid cells. What organ is understudy?

A. Lymph nodeB. ThymusC. SpleenD. Red bone marrowE. Tonsils

84. A 25-year-old patient consulted adoctor about dysmenorrhea and infertili-ty. Examination revealed that the patientwas 145 cm high and had underdevelopedsecondary sex characteristics, alar folds onthe neck. Cytological study didn’t revealany Barr bodies in the somatic cells. Whatdiagnosis was made?

A. Turner’s syndromeB. Klinefelter syndromeC. Morris syndromeD. Trisomy X syndromeE. -

85. To prevent attacks of acute pancreati-tis a doctor prescribed the patient trasylol(contrycal, gordox), which is an inhibitorof:

A. TrypsinB. ElastaseC. CarboxypeptidaseD. ChymotrypsinE. Gastricsin

86. A patient died from progressive heartfailure. Autopsy revealed that the heartwas enlarged in diameter, flabby. Themuscle section exhibited irregular bloodsupply. Histological study of myocardiumrevealed hyperemia, the stroma was foundto have lymphohistiocytic infiltrates wi-th degeneration of cardiomyocytes. Therevealed morphological changes are indi-cative of:

A. Non-purulent interstitial myocarditisB. Venous plethoraC. CardiomyoliposisD. CardiosclerosisE. Myocardial infarction

87. A 13-year-old teenager underwent X-ray examination of the hip joint. Exami-nation revealed a 3 mm wide radiolucentzone between the head and the shaft offemur. This situation should be evaluatedas:

A. Normal (incomplete process of ossifi-cation)B. Fracture of the femoral neckC. Fissured fracture of the femoral neckD. Dislocation of the femoral headE. Radiographic film artifact

88. A surgeon examined the patient andfound the injury of the upper third of thekidney. Considering the syntopy of theleft kidney, the intactness of the followingorgan should be checked at the same time:

A. StomachB. LiverC. Small intestineD. Transverse colonE. Descending colon

89. A patient with urolithiasis hasunbearable spasmodic pain. To preventpain shock, he has been given an injectionof atropine along with a narcotic analgesichaving antispasmodic effect. What drugwas it?

A. PromedolB. NalorphineC. TramadolD. Ethylmorphine hydrochlorideE. Morphine hydrochloride

90. Despite the administration of cardi-otonics and a thiazide diuretic a pati-ent with chronic heart failure has persi-stent edemata, there is a risk of ascites.What medication should be administeredin order to enhance the diuretic effect ofthe drugs used?

A. SpironolactoneB. FurosemideC. AmilorideD. ClopamideE. Manithol

91. A patient with a pathology ofthe cardiovascular system developededemata of the lower extremities. Whatis the mechanism of cardiac edemadevelopment?

A. Increased hydrostatic pressure at thevenous end of the capillaryB. Increased oncotic pressureC. Increased hydrostatic pressure at thearterial end of the capillaryD. Reduced osmotic pressureE. Lymph efflux disorder

92. During the fight, a man had a cardi-ac arrest due to the strong blow to theupper region of the anterior abdominal


wall. Which of the following mechanismshas led to the cardiac arrest?

A. Parasympathetic unconditioned reflexesB. Sympathetic unconditioned reflexesC. Parasympathetic conditioned reflexesD. Sympathetic conditioned reflexesE. Peripheral reflexes

93. A pregnant woman underwent AB0blood typing. Red blood cells wereagglutinated with standard sera of the Iand II blood groups, and were not aggluti-nated with the III group serum. What isthe patient’s blood group?

A. B(III)B. 0(I)C. A(II)D. AB(IV)E. -

94. Amniocentesis revealed two sexchromatin bodies (Barr bodies) in eachcell of the sample. What disease is thischaracter typical for?

A. Trisomy XB. Klinefelter syndromeC. Turner’s syndromeD. Down’s syndromeE. Patau syndrome

95. A hospital has admitetd a patientcomplaining of abdominal bloating, di-arrhea, flatulence after eating proteinfoods. These signs are indicative of theimpaired digestion of proteins and theirincreased degradation. Which of thefollowing compounds is the product of thisprocess?

A. IndoleB. BilirubinC. CadaverineD. AgmatineE. Putrescine

96. An attack of tachycardia that occurredin a patient was stopped by pressing on hiseyeballs. Which of the following reflexesunderlies this phenomenon?

A. AschnerB. GoltzC. BainbridgeD. HeringE. Bernard’s

97. A male patient has been di-agnosed with acute post-streptococcalglomerulonephritis. It is most likely thatthe lesion of the basement membrane

of renal corpuscles was caused by thefollowing allergic reaction:

A. Immune complexB. AnaphylacticC. CytotoxicD. DelayedE. Stimulating

98. An unconscious patient was taken byambulance to the hospital. On objecti-ve examination the patient was foundto have no reflexes, periodical convulsi-ons, irregular breathing. After laboratoryexamination the patient was diagnosedwith hepatic coma. Disorders of thecentral nervous system develop due to theaccumulation of the following metabolite:

A. AmmoniaB. UreaC. GlutamineD. BilirubinE. Histamine

99. A 20-year-old male patient complai-ns of general weakness, rapid fatigabi-lity, irritability, decreased performance,bleeding gums, petechiae on the skin.What vitamin deficiency may be a causeof these changes?

A. Ascorbic acidB. RiboflavinC. ThiamineD. RetinolE. Folic acid

100. It is known that the monoami-ne oxidase (MAO) enzyme plays animportant part in the metabolism ofcatecholamine neurotransmitters. In whatway does the enzyme inactivate theseneurotransmitters (norepinephrine, epi-nephrine, dopamine)?

A. Oxidative deaminationB. Addition of an amino groupC. Removal of a methyl groupD. CarboxylationE. Hydrolysis

101. The cellular composition of exudatelargely depends on the etiological factorof inflammation. What leukocytes are thefirst to get into the focus of inflammationcaused by pyogenic bacteria?


A. Neutrophil granulocytesB. MonocytesC. MyelocytesD. Eosinophilic granulocytesE. Basophils

102. At the end of the working day aworker of a hot work shop has been deli-vered to a hospital. The patient complainsof a headache, dizziness, nausea, generalweakness. Objectively: the patient isconscious, his skin is hyperemic, dry, hot tothe touch. Heart rate is of 130/min. Respi-ration is rapid, superficial. What disorderof thermoregulation is most likely to haveoccurred in this patient?

A. Reduced heat transferB. Increased heat transfer and reducedheat productionC. Increased heat transfer and heatproductionD. Increased heat production with nochanges to the heat transferE. Reduced heat production with nochanges to the heat transfer

103. Alveolar space of the acinuswas invaded by some bacteria whichinteracted with the surfactant. This ledto the activation of the cells that arelocalized in the alveolar walls and on thesurface. What cells are these?

A. Alveolar macrophagesB. Alveolocytes type IC. Endothelial cellsD. Clara cellsE. Alveolocytes type II

104. A 35-year-old male developed acuteheart failure while running for a long ti-me. What changes in the ionic compositi-on can be observed in the cardiac muscle?

A. Accumulation of Na+ and Ca2+ ions inthe myocardium cellsB. Accumulation of K+ and Mg2+ ions inthe myocardium cellsC. Reduction of Na+ and Ca2+ ions in themyocardium cellsD. Reduction of K+ and Mg2+ ions in theextracellular spaceE. Reduction of Na+ and Ca2+ ions in theextracellular space

105. Workers of a conveyor workshopreceived recommendations for the effecti-ve organization of working time and hi-gher working efficiency. What peculiari-ty of work in this workshop causes thegreatest stress for the workers?

A. Monotony of workB. State of "operating rest"C. Increased intellectual componentD. Increased responsibilityE. Social inefficiency of labor

106. Mother of a boy who had recentlyreturned from a summer camp foundsome small whitish insects up to 3 mmlong on the child’s clothing. Specify theparasite:

A. Pediculus humanus humanusB. Phtirus pubisC. Pulex irritansD. Cimex lectulariusE. Blattella germanica

107. Histological examination of theremoved skin neoplasm revealed clustersand cords of atypical cells of stratifiedsquamous epithelium, growing into theunderlying tissue. What diagnosis can beassumed?

A. Non-keratinizing squamous cell carci-nomaB. Keratinizing squamous cell carcinomaC. Carcinoma in situD. PapillomaE. Adenoma

108. An 18-year-old male has been di-agnosed with Marfan syndrome. Exami-nation revealed a developmental di-sorder of connective tissue and eye lensstructure, abnormalities of the cardi-ovascular system, arachnodactylia. Whatgenetic phenomenon has caused thedevelopment of this disease?

A. PleiotropyB. ComplementarityC. CodominanceD. Multiple allelismE. Incomplete dominance

109. A patient has severe catarrhalsymptoms. Material growth on Bordet-Gengou agar showed mercury-drop-like colonies. Examination of the bloodsmears revealed some small ovoid gram-positive bacilli sized 1-3 microns. What mi-croorganisms were isolated?

A. BordetellaB. CorynebacteriaC. MycobacteriaD. MeningococcusE. Brucella

110. A 66-year-old patient with Parki-


nson’s disease shows an improvement inlocomotor activity after prolonged useof a certain drug which is converted todopamine by the decarboxylation. Whatdrug has the patient taken?

A. LevodopaB. NaloxoneC. CelecoxibD. DroperidolE. Chlorpromazine

111. Enzymatic jaundices are accompani-ed by abnormal activity of UDP-glucuronyl transferase. What compoundis accumulated in blood serum in case ofthese pathologies?

A. Unconjugated bilirubinB. Conjugated bilrubinC. DehydrobilirubinD. HydrobilirubinE. Choleglobin

112. For the study of serum proteinsvarious physical and physicochemicalmethods can be used. In particular, serumalbumins and globulins can be separatedby this method:

A. ElectrophoresisB. PolarographyC. DialysisD. SpectrographyE. Refractometry

113. Negative environmental factors havecaused the dysfunction of myosatellitecells. What function of the whole musclefibre is likely to be changed in this case?

A. RegenerationB. ContractionC. TrophismD. Contractile thermogenesisE. Relaxation

114. The laboratory for especiallydangerous infections conducts mi-croscopic examination of pathologicalmaterial from a patient with suspectedplague. The sample was stained by Burri-Gins technique. What property of thecausative agent can be identified by thistechnique?

A. Capsule formationB. Spore formationC. Acid resistanceD. Alkali resistanceE. Presence of volutin granules

115. Autopsy of a 62-year-old woman

revealed a dense well-circumscribed nodeof 6 cm in diameter in the cranial cavity.The node was attached to the dura materand histologically consisted of clusters andmicro-concentric structures of endotheli-al cells, psammoma bodies. What kind oftumor was found at autopsy?

A. MeningiomaB. GlioblastomaC. MedulloblastomaD. MelanomaE. Cancer metastasis

116. Inherited diseases, such asmucopolysaccharidoses, are manifestedin metabolic disorders of connective ti-ssue, bone and joint pathologies. The si-gn of this disease is the excessive urinaryexcretion of the following substance:

A. GlycosaminoglycansB. Amino acidsC. GlucoseD. LipidsE. Urea

117. An animal has an increased tonusof extensor muscles. This is the result ofenhanced information transmission to themotoneurons of the spinal cord throughthe following descending pathways:

A. VestibulospinalB. Medial corticospinalC. ReticulospinalD. RubrospinalE. Lateral corticospinal

118. A specimen of a parenchymalorgan shows poorly delineated hexagonallobules surrounding a central vein, andthe interlobular connective tissue contai-ns embedded triads (an 0artery, a vein andan excretory duct). What organ is it?

A. LiverB. PancreasC. ThymusD. SpleenE. Thyroid

119. A patient has been admitted tothe infectious diseases department formalaise, fever up to 38oC, jaundice. Afew months ago, the patient underwentblood transfusion. The doctor suspectedviral hepatitis B. What are the principalmethods of laboratory diagnosis of hepati-tis B?


A. Serological and gene diagnosticsB. Virus isolation in cell culture and itsidentification by the cytopathic effectsC. Detection of virions in blood by electronmicroscopyD. Isolation of the virus in laboratoryanimals (neutralization reaction)E. Isolation of the virus in chicken embryos

120. After resection of the middle thi-rd of the femoral artery obliterated by athrombus the limb is supplied with bloodthrough the bypasses. What artery playsthe main part in the restoration of theblood flow?

A. Deep femoral arteryB. Superficial iliac circumflex arteryC. Descending genicular arteryD. Superficial epigastric arteryE. External pudendal artery

121. During the intravenous transfusi-on of the saline the patient’s conditi-on deteriorated dramatically, and thepatient died from asphyxiation. Autopsyrevealed acute venous congestion ofinternal organs with the dramatic ri-ght heart dilatation. When the rightventricle was punctured underwater,the bubbles escaped. What pathologicalprocess occurred in the patient?

A. Air embolismB. Gaseous embolismC. Adipose embolismD. Tissue embolismE. Thromboembolism

122. At the post-mortem examination thestomach of a patient with renal failure wasfound to have a yellow-brown coating onthe thickened mucosa. The coating wasfirmly adhering to its surface and had si-gnificant thickness. Microscopy revealedcongestion and necrosis of mucosal andsubmucosal layers, fibrin presence. Whatis the most likely diagnosis?

A. Fibrinous gastritisB. Croupous gastritisC. Gastric abscessD. EsogastritisE. Corrosive gastritis

123. Infectious diseases are treated withantibiotics (streptomycin, erythromycin,chloramphenicol). They inhibit thefollowing stage of protein synthesis:

A. TranslationB. TranscriptionC. ReplicationD. ProcessingE. Splicing

124. Diseases of the respiratory systemand circulatory disorders impair thetransport of oxygen, thus leading tohypoxia. Under these conditions theenergy metabolism is carried out byanaerobic glycolysis. As a result, thefollowing substance is generated andaccumulated in blood:

A. Lactic acidB. Pyruvic acidC. Glutamic acidD. Citric acidE. Fumaric acid

125. A patient has been hospitalized for asuspected tumor of the prostate. Duringthe surgery, it was revealed that the tumorinvaded the bladder. Which part of thebladder was affected?

A. CervixB. ApexC. BottomD. BodyE. -

126. A casualty with an injury of thetemporal region has been diagnosed withepidural hematoma. Which of the arteriesis most likely to be damaged?

A. Medial membranous arteryB. Medial cerebral arteryC. Superficial temporal arteryD. Anterior membranous arteryE. Posterior auricular artery

127. A 19-year-old male was found tohave an elevated level of potassium inthe secondary urine. These changes mi-ght have been caused by the increase inthe following hormone level:

A. AldosteroneB. OxytocinC. AdrenalineD. GlucagonE. Testosterone

128. Analysis of the ECG revealed themissing of several PQRST cycles. Theremaining waves and complexes are notchanged. Specify the type of arrhythmia:


A. Sinoatrial blockB. Atrial fibrillationC. Atrioventricular blockD. Atrial premature beatE. Intra-atrial block

129. ECG of a patient displays anabnormally long R wave (up to 0,18s). This is caused by a decrease in theconduction velocity of the following heartstructures:

A. VentriclesB. AtriaC. Atrio-ventricular nodeD. Right ventricleE. Left ventricle

130. 6 hours after the myocardial infarcti-on a patient was found to have elevatedlevel of lactate dehydrogenase in blood.What isoenzyme should be expected inthis case?

A. LDH1

B. LDH2

C. LDH3

D. LDH4

E. LDH5

131. A 46-year-old female is scheduledfor a maxillofacial surgery. It is knownthat the patient is prone to high bloodcoagulation. What natural anticoagulantcan be used to prevent blood clotting?

A. HeparinB. HirudinC. Sodium citrateD. FibrinolysinE. None of the above-listed substances

132. A 50-year-old patient with food poi-soning is on a drip of 10% glucose soluti-on. It not only provides the body withnecessary energy, but also performs thefunction of detoxification by the producti-on of a metabolite that participates in thefollowing conjugation reaction:

A. GlucuronidationB. SulfationC. MethylationD. GlycosylationE. Hydroxylation

133. To assess the effectiveness of breathi-ng in patients, the indicator of functionalresidual capacity is used. It includes thefollowing volumes:

A. Expiratory reserve volume and residualvolumeB. Inspiratory reserve volume and residualvolumeC. Inspiratory reserve volume, tidalvolume, residual volumeD. Expiratory reserve volume and tidalvolumeE. Inspiratory reserve volume and tidalvolume

134. It is required to evaluate the level oftissue excitability. For this purpose oneshould determine:

A. Depolarization thresholdB. Resting potentialC. Critical level of depolarizationD. Action potential amplitudeE. Action potential duration

135. Due to the use of poor-qualitymeasles vaccine for preventive vaccinati-on, a 1-year-old child developed an autoi-mmune renal injury. The urine was foundto contain macromolecular proteins. Whatprocess of urine formation was disturbed?

A. FiltrationB. ReabsorptionC. SecretionD. Reabsorption and secretionE. Secretion and filtration

136. A patient has been administered ananti-inflammatory drug that blocks theaction of cyclooxygenase. Specify thisanti-inflammatory agent:

A. AspirinB. AnalgeneC. AllopurinolD. ThiaminE. Creatine

137. A pneumonia patient has beenadministered acetylcysteine as a partof complex therapy. What principle oftherapy was taken into considerationwhen applying this drug?

A. PathogeneticB. SymptomaticC. EtiotropicD. AntimicrobialE. Immunomodulatory

138. A 26-year-old female patient withbronchitis has been administered a broadspectrum antibiotic as a causal treatmentdrug. Specify this drug:


A. DoxycyclineB. InterferonC. BCG vaccineD. AmbroxolE. Dexamethasone

139. A 65-year-old male suddenly lostthe vision in one eye due to the reti-nal detachment. The patient underwentenucleation. Histological examinationof the removed eye retina and choroidrevealed clusters of atypical cells wi-th marked polymorphism of cells andnuclei, with a moderate number of mi-toses including the pathological ones. Thecell cytoplasm and intercellular medi-um contained brown pigment giving apositive DOPA reaction. Perls’ reactionwas negative. What is the most likely di-agnosis?

A. MelanomaB. Pigmented moleC. HemorrhageD. CysticercosisE. Wilson’s disease

140. A child cut his leg with a piece ofglass while playing and was brought to theclinic for the injection of tetanus toxoid.In order to prevent the developmentof anaphylactic shock the serum wasadministered by Bezredka method. Whatmechanism underlies this method ofdesensitization of the body?

A. Binding of IgE fixed to the mast cellsB. Blocking the mediator synthesis in themast cellsC. Stimulation of immune tolerance to theantigenD. Stimulation of the synthesis of antigen-specific IgGE. Binding of IgE receptors to the mastcells

141. Microscopy of the myocardium ofa patient who had died from heart fai-lure revealed foci of fibrinoid necrosislocated diffusely in the interstitial stroma,and often around the vessels. Suchfoci were surrounded by lymphocytes,macrophages, histiocytes. Pericardiumwas found to have signs of sero-fibrinouspericarditis. What is the most likely di-agnosis?

A. Rheumatic heart diseaseB. Myocardial infarctionC. CardiomyopathyD. CardiosclerosisE. -

142. One of the factors that cause obesityis the inhibition of fatty acids oxidationdue to:

A. Low level of carnitineB. Impaired phospholipid synthesisC. Excessive consumption of fatty foodsD. Choline deficiencyE. Lack of carbohydrates in the diet

143. The genetic defect of pyruvatecarboxylase deficiency is the cause ofdelayed physical and mental developmentand early death in children. This defectis characterized by lacticemia, lactaci-duria, disorder of a number of metabolicpathways. In particular, the followingprocess is inhibited:

A. Citric acid cycle and gluconeogenesisB. Glycolysis and glycogenolysisC. Glycogenesis and glycogenolysisD. Lipolysis and lipogenesisE. Pentose phosphate pathway andglycolysis

144. Deficiency of linoleic and linolenicacids in the body leads to the skindamage, hair loss, delayed wound heali-ng, thrombocytopenia, low resistance toinfections. These changes are most likelyto be caused by the impaired synthesis ofthe following substances:

A. EicosanoidsB. InterleukinsC. InterferonsD. CatecholaminesE. Corticosteroids

145. During ventricular systole, the cardi-ac muscle does not respond to additionalstimulation because it is in the phase of:

A. Absolute refractorinessB. Relational refractorinessC. HyperexcitabilityD. Subnormal excitabilityE. There is no correct answer

146. A mother had taken synthetichormones during pregnancy. Herdaughter was born with hirsutism formallyresembling of adrenal syndrome. Suchmanifestation of variability is called:

A. PhenocopyB. MutationC. RecombinationD. HeterosisE. Replication

147. Since a patient has had myocardial


infarction, atria and ventricles contractindependently from each other with afrequency of 60-70 and 35-40 per minute.Specify the type of heart block in this case:

A. Complete atrioventricularB. Partial atrioventricularC. Sino-atrialD. Intra-atrialE. Intraventricular

148. A 67-year-old male patient consumeseggs, pork fat, butter, milk and meat.Blood test results: cholesterol - 12,3mmol/l, total lipids - 8,2 g/l, increased low-density lipoprotein fraction (LDL). Whattype of hyperlipoproteinemia is observedin the patient?

A. Hyperlipoproteinemia type IIaB. Hyperlipoproteinemia type IC. Hyperlipoproteinemia type IIbD. Hyperlipoproteinemia type IVE. Cholesterol, hyperlipoproteinemia

149. A 12-year-old child has a viral infecti-on complicated by obstructive bronchi-tis. Bronchospasm can be eliminated byinhalations of a drug from the followingpharmacological group:

A. β2-agonistsB. M-anticholinergicsC. N-cholinomimeticsD. β2-adrenergic blockersE. Analeptics

150. In course of an experiment there hasbeen an increase in the nerve conducti-on velocity. This may be caused by anincrease in the concentration of thefollowing ions that are present in thesolution around the cell:

A. Na+

B. K+ and Cl−

C. K+ and Na+

D. Ca2+ and Cl−

E. Ca2+

151. A male working as a blacksmith hasbeen tested for auditory acuity. The testsrevealed 50% hearing loss in the low-frequency range and a near-normal audi-tory acuity in the high-frequency range.This condition has been caused by thedamage to the following structures of theauditory system:

A. Corti’s organ - closer to helicotremaB. Corti’s organ - closer to the ovalforamenC. Median part of the Corti’s organD. Muscles of the middle earE. Eardrum

152. In our country, routine preventi-ve vaccinations against poliomyelitisivolve using live vaccine that is admini-stered orally. What immunoglobulins areresponsible for the development of localpost-vaccination immunity in this case?

A. Secretory IgAB. IgMC. IgGD. Serum IgAE. IgE

153. An experiment proved that UV-irradiated skin cells of patients withxeroderma pigmentosum restore the nati-ve structure of DNA slower than the cellsof healthy people due to the defect inrepair enzyme. What enzyme takes partin this process?

A. EndonucleaseB. RNA ligaseC. PrimaseD. DNA polymeraseE. DNA gyrase

154. A patient who has recently comefrom an endemic area presents withelevated body temperature, headache,chills, malaise, that is with the symptomswhich are typical for a common cold.What laboratory tests are necessary toconfirm or to refute the diagnosis ofmalaria?

A. Microscopy of blood smearsB. Study of lymph node punctateC. UrinalysisD. Study of cerebrospinal fluidE. Microscopy of bone marrow punctate

155. What condition may develop 15-30minutes after re-administration of theantigen as a result of the increased level ofantibodies, mainly IgE, that are adsorbedon the surface of target cells, namely ti-ssue basophils (mast cells) and bloodbasophils?

A. AnaphylaxisB. Antibody-dependent cytotoxicityC. Delayed-type hypersensitivityD. Immune complex hyperresponsivenessE. Serum sickness


156. 10 days after having quinsy causedby beta-hemolytic streptococcus a 6-year-old child exhibited symptoms ofglomerulonephritis. What mechanism ofglomerular lesion is most likely in thiscase?

A. ImmunocomplexB. Cellular cytotoxicityC. AnaphylaxisD. AtopyE. Antibody-dependent cell-mediatedcytolysis

157. A 22-year-old woman ate someseafood. 5 hours later the trunk and thedistal parts of limbs got covered withsmall itchy papules which were partiallyfused together. After one day, the rashdisappeared spontaneously. Specify thehypersensitivity mechanism underlyingthese changes:

A. Atopy (local anaphylaxis)B. Systemic anaphylaxisC. Cellular cytotoxicityD. Immune complex hypersensitivityE. Antibody-dependent cell-mediatedcytolysis

158. A hypertensive patient had beenkeeping to a salt-free diet and taki-ng antihypertensive drugs together withhydrochlorothiazide for a long time. Thisresulted in electrolyte imbalance. Whatdisorder of the internal environmentoccurred in the patient?

A. Hypochloremic alkalosisB. Metabolic acidosisC. HyperkalemiaD. HypermagnesemiaE. Increase in circulating blood volume

159. A miner consulted a physician aboutthe appearance of body rash followed bya loss of appetite, bloating, duodenal pain,frequent bowel movements, dizziness.Ovoscopic probes of feces and duodenalcontents revealed some eggs covered witha transparent membrane through which4-8 germinal cells could be seen. Whatdisease is likely to have occurred in thepatient?

A. AncylostomiasisB. StrongyloidiasisC. TrichocephaliasisD. HymenolepiasisE. Enterobiasis

160. Children with Lesch-Nyhansyndrome have a severe form of hyperuri-

cemia accompanied by the formation oftophi, urate calculi in the urinary tracts,as well as serious neuro-psychiatric di-sorders. The cause of this disease is thereduced activity of the following enzyme:

A. Hypoxanthine-guanine phosphori-bosyltransferaseB. Xanthine oxidaseC. Dihydrofolate reductaseD. Thymidylate synthaseE. Karbamoyl phosphate synthetase

161. In a car accident a man got injuredand lost a lot of blood. What changes inperipheral blood are most likely to occuron the 2nd day after the injury?

A. ErythropeniaB. HypochromiaC. AnisocytosisD. MicroplaniaE. Significant reticulocytosis

162. In the surgical ward, the dressi-ng material was undergoing sterilizati-on in an autoclave. Through an oversi-ght of a nurse the mode of sterilizationwas changed and the temperature in theautoclave reached only 100oC instead ofthe due 120OC. What microorganisms canstay viable under these conditions?

A. Bacilli and clostridiaB. Staphylococci and streptococciC. Mold and yeast fungiD. Salmonella and klebsiellaE. Corynebacteria and mycobacteria

163. As a result of a mechanical injuryan over 10 cm long portion of a peri-pheral nerve was damaged. This led to theimpairment of the upper limb activity. Thepatient was offered nerve transplantati-on. What glial cells will participate inregeneration and provide the trophism ofthe injured limb?

A. Schwann cellsB. Fibrous cellsC. Protoplasmic cellsD. MicrogliaE. Ependymal cells

164. A 26-year-old woman at 40 weekspregnant has been delivered to thematernity ward. Objectively: the uterinecervix is opened, but the contractions areabsent. The doctor has administered hera hormonal drug to stimulate the labor.Name this drug:


A. OxytocinB. HydrocortisoneC. EstroneD. TestosteroneE. ACTH

165. A patient has recurrent attacks ofepileptic seizures and stays unconsciousbetween them. In order to stop convulsi-ons the drugs of the following groupshould be used in the first place:

A. TranquilizersB. NeurolepticsC. Muscle relaxantsD. SedativesE. Analeptics

166. A patient with arthritis and varicoseveins has been taking a non-steroidal anti-inflammatory drug for a long time, whichcaused thrombosis of skin veins. Whichof the following drugs might have causedthis complication?

A. CelecoxibB. IndomethacinC. AspirinD. PhenylbutazoneE. Ibuprofen

167. Students study the stages ofgametogenesis. They analyze a cell havi-ng a haploid number of chromosomes,and each chromosome consists of twochromatids. The chromosomes are locatedin the equatorial plane of the cell. Such si-tuation is typical for the following stage ofmeiosis:

A. Metaphase of the second divisionB. Metaphase of the first divisionC. Anaphase of the first divisionD. Anaphase of the second divisionE. Prophase of the first division

168. A 35-year-old female patientunderwent biopsy of the breast nodules.Histological examination revealedenhanced proliferation of the small ductepithelial cells and acini, accompaniedby the formation of glandular structuresof various shapes and sizes, which werelocated in the fibrous stroma. What is themost likely diagnosis?

A. FibroadenomaB. AdenocarcinomaC. Cystic breastD. Invasive ductal carcinomaE. Mastitis

169. Examination of the duodenal

contents revealed some pear-shapedprotozoa with two nuclei and four pai-rs of flagella. The organisms had alsotwo axostyles between the nuclei and aventral adhesive disc. What protozoanrepresentative was found in the patient?

A. LambliaB. ToxoplasmaC. LeishmaniaD. Intestinal trichomonadE. Trypanosome

170. A specimen of an onion rootletincludes a cell in which the fullycondensed chromosomes are located inthe equatorial plane making the monaster.What phase of the mitotic cycle is the cellin?

A. MetaphaseB. Early telophaseC. ProphaseD. InterphaseE. Late telophase

171. When examining a patient, the doctorrevealed a tumor of the bronchus whichborders on the aorta. Which bronchus isaffected?

A. Left principalB. Right principalC. Right upper lobarD. Left upper lobarE. Middle lobar

172. A 54-year-old female was brought tothe casualty department after a car acci-dent. A traumatologist diagnosed her withmultiple fractures of the lower extremiti-es. What kind of embolism is most likelyto develop in this case?

A. AdiposeB. TissueC. ThromboembolismD. GaseousE. Air

173. Microscopy of the bronchialwall revealed atrophy of the mucosa,metaplastic change from columnar tosquamous epithelium, an increase inthe number of goblet cells, diffuseinfiltration of the bronchial wall wi-th lymphoplasmacytic elements wi-th a large number of neutrophilicgranulocytes, pronounced sclerosis. Spesi-fy the morphological form of bronchitis:


A. Chronic purulent bronchitisB. Acute bronchitisC. Polypoid chronic bronchitisD. Acute purulent bronchitisE. Chronic bronchitis

174. Due to the blockage of the commonbile duct (which was radiographicallyconfirmed), the biliary flow to theduodenum was stopped. We should expectthe impairment of:

A. Fat emulsificationB. Protein absorptionC. Carbohydrate hydrolysisD. Secretion of hydrochloric acidE. Salivation inhibition

175. Typical manifestations of food poi-soning caused by C. botulinum aredouble vision, abnormal functioning ofthe swallowing and breathing. Thesesymptoms develop as a result of:

A. Exotoxin effectsB. Enterotoxin effectsC. Enterotoxic shock developmentD. Activation of adenylate cyclaseE. Pathogen adhesion to the enterocytereceptors

176. At the stage of translation in therough endoplasmic reticulum, the ri-bosome moves along the mRNA. Aminoacids are joined together by peptide bondsin a specific sequence, and thus polypepti-de synthesis takes place. The sequence ofamino acids in a polypeptide correspondsto the sequence of:

A. mRNA codonsB. tRNA nucleotidesC. tRNA anticodonsD. rRNA nucleotidesE. rRNA anticodons

177. After the prolonged vomiting apregnant 26-year-old woman was foundto have the reduced volume of circulati-ng blood. What change in the total bloodvolume can be the case?

A. Polycythemic hypovolemiaB. Simple hypovolemiaC. Oligocythemic hypovolemiaD. Polycythemic hypervolemiaE. Oligocythemic hypervolemia

178. On allergological examination a pati-ent has been diagnosed with pollinosis.Specific desensitization can be performedby:

A. Intermittent administration of allergenB. AntihistaminesC. GlucocorticoidsD. Administration of salineE. -

179. A patient consulted a physici-an about chest pain, cough, fever.Roentgenography of lungs revealed eosi-nophilic infiltrates which were found tocontain the larvae. What kind of helmi-nthiasis are these presentations typicalfor?

A. AscariasisB. EchinococcosisC. FascioliasisD. CysticercosisE. Trichinosis

180. A patient with signs of osteoporosisand urolithiasis has been admittedto the endocrinology department.Blood test revealed hypercalcemia andhypophosphatemia. These changes areassociated with abnormal synthesis of thefollowing hormone:

A. Parathyroid hormoneB. CalcitoninC. CortisolD. AldosteroneE. Calcitriol

181. Histological examination of the bi-opsy material obtained from the lowerthird of the esophagus of a 57-year-oldmale with the symptoms of continuousreflux revealed the change of the strati-fied squamous epithelium to the single-layer columnar glandular epithelium wi-th signs of mucus production. Specifythe pathological process in the mucousmembrane:

A. MetaplasiaB. HyperplasiaC. HypertrophyD. OrganizationE. Regeneration

182. A 30-year-old female exhibits signsof virilism (growth of body hair, baldingtemples, menstrual disorders). This condi-tion can be caused by the overproductionof the following hormone:

A. TestosteroneB. OestriolC. RelaxinD. OxytocinE. Prolactin


183. A patient with bacterial periodontitishas been administered iontophoresis wi-th the use of iodine solution. Specify themechanism of therapeutic action of thisagent:

A. Substitution of hydrogen atoms whenthe protein amino group contains a ni-trogen atomB. Reduction of the nitro group under theeffect of nitroreductaseC. Albumin formationD. Changing the surface tension of thebacterial cell membraneE. Inhibition of the cell wall formation

184. A patient with extensive myocardi-al infarction has developed heart failure.What pathogenetic mechanism contri-buted to the development of heart failurein the patient?

A. Reduction in the mass of functioningmyocardiocytesB. Pressure overloadC. Volume overloadD. Acute cardiac tamponadeE. Myocardial reperfusion injury

185. A patient who had been continuouslytaking drugs blocking the production ofangiotensin II developed bradycardia andarrhythmia. A likely cause of these di-sorders is:

A. HyperkalemiaB. HypokalemiaC. HypernatremiaD. HypocalcemiaE. Hypercalcemia

186. A patient has arterial hypertension.What long-acting drug from the groupof calcium channel blockers should beprescribed?

A. AmlodipineB. OctadineC. PyrroxanumD. AtenololE. Reserpine

187. Human skin has a high breakingstrength. It is known that the skin consi-sts of epithelial tissue and two kinds ofconnective tissue. Which of the followingtissues provides the skin strength?

A. Unformed dense connective tissueB. Stratified squamous epitheliumC. Loose connective tissueD. Single-layer epitheliumE. Transitional epithelium

188. As a result of a home injury, a patientsuffered a significant blood loss, which ledto a fall in blood pressure. Rapid bloodpressure recovery after the blood loss isprovided by the following hormones:

A. Adrenaline, vasopressinB. CortisolC. Sex hormonesD. OxytocinE. Aldosterone

189. A patient with constant headaches,pain in the occipital region, tinnitus, dizzi-ness has been admitted to the cardiologydepartment. Objectively: AP- 180/110 mmHg, heart rate - 95/min. Radiographically,there is a stenosis of one of the renalarteries. Hypertensive condition in thispatient has been caused by the activationof the following system:

A. Renin-angiotensinB. HemostaticC. SympathoadrenalD. KininE. Immune

190. A patient complains that at thebare mention of the tragic events thatonce occurred in his life he experiencestachycardia, dyspnea and an abrupt risein blood pressure. What structures of theCNS are responsible for these cardiorespi-ratory reactions in this patient?

A. Cerebral cortexB. CerebellumC. Lateral hypothalamic nucleiD. Specific thalamic nucleiE. Quadrigemina of mesencephalon

191. A patient consulted a dentist aboutlimited mouth opening (trismus). He hasa history of a stab wound of the lowerextremity. What infection may cause thesesymptoms?

A. TetanusB. BrucellosisC. Whooping coughD. Wound anaerobic infectionE. Tularemia

192. Anatomical dead space is the portionof the air that is left in the airways afterexpiration. The reduction of the anatomi-cal dead space is typical for the followingsituation:


A. TracheostomyB. Forward flexion of headC. Turning the lying patient on his left sideD. Turning the lying patient on his rightsideE. Breathing through the mouth

193. Analysis of the experimental spi-rogram of a 55-year-old person revealeda decrease in tidal volume and respiratoryamplitude compared to the situation often years ago. The change in these indi-cators is caused by:

A. Decreased force of respiratory musclecontractionB. Gas composition of the airC. Physical build of a personD. Height of a personE. Body mass of a person

194. A patient underwent a course oftreatment for atherosclerosis. Laboratorytests revealed an increase in the anti-atherogenic lipoprotein fraction in theblood plasma. The treatment efficacy isconfirmed by the increase in:

A. HDLB. VLDLC. IDLD. LDLE. Chylomicrons

195. A 65-year-old female patient haschronic constipations due to the colonhypotonia. What drug should be chosenin this case?

A. BisacodylB. Castor oilC. Magnesium sulfateD. Neostigmine methylsulfateE. Metoclopramide

196. A female patient complains ofvision impairment. On examinationshe was found to have obesity, fastinghyperglycemia. What complication of di-abetes can cause vision impairment?

A. MicroangiopathyB. MacroangiopathyC. AtherosclerosisD. NeuropathyE. Glomerulopathy

197. Analysis of the family history ofchildren with Van der Woude syndromerevealed that in their families one of theparents had the typical for this syndromedefects (cleft lip and palate, lip pitsregardless of gender). What is the typeof inheritance of this syndrome?

A. Autosomal dominantB. X-linked recessiveC. X-linked dominantD. Autosomal recessiveE. Multifactorial

198. Administration of doxycyclinehydrochloride caused an imbalance of thesymbiotic intestinal microflora. Specifythe kind of imbalance caused by the anti-biotic therapy:

A. DysbacteriosisB. SensibilizationC. IdiosyncrasyD. Superimposed infectionE. Bacteriosis

199. A 3-year-old child had eaten somestrawberries. Soon he developed a rashand itching. What was found in the child’sleukogram?

A. EosinophiliaB. HypolymphemiaC. Neutrophilic leukocytosisD. MonocytosisE. Lymphocytosis

200. A 12-year-old patient was found tohave blood serum cholesterol at the rateof 25 mmol/l. The boy has a history ofhereditary familial hypercholesterolemia,which is caused by the impaired synthesisof the following protein receptors:

A. Low density lipoproteinsB. High density lipoproteinsC. ChylomicronsD. Very low density lipoproteinsE. Intermediate density lipoproteins

krok 1 - 2013 question paper (general medicine)

Health & Medicine