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1.

Beta-blockers after myocardial infarction impractical given to patients:


A. With hypertension in the first 4-6 hours after a myocardial infarction and a later date
+ B. with a history of asthma
C. With CHCHS> 80 min. In the absence of heart failure
D. with early post-infarction angina

2. For Stage II status asthmaticus is most characteristic:


A. The development of hypotension and tachycardia
B. appearance of cyanosis
+ C. the beginning of the formation of "silent lung" syndrome
D. The development of respiratory alkalosis

3. The most rational in the treatment of stage II of status asthmaticus are:


A. The purpose of oral prednisolone> 100 mg
B. The appointment of large doses of aminophylline
+ B. administering prednisolone / 90 - 120 mg
D. appointment sympathomimetics and anticholinergics

4. Pain in acute myocardial infarction causes all the following except:


A gain sympathetic-adrenal activity
B. increase in total peripheral vascular resistance
C. cardiac arrhythmias
+ D. reducing myocardial oxygen demand

5. Which method is preferable to the use of diuretics with a steady flow of essential hypertension:
A one-time appointment
+ B. prolonged use
C. treatment short course
D. cardiac arrhythmias

6. What is a diuretic is preferred for long-term use in hypertension:


A. diakarb
B. furosemide
+ B. hydrochlorothiazide
D. veroshpiron

7. The criterion of hypertensive crisis is:


A. increased blood pressure > 159/94 mm Hg
+ B. a sudden rise in blood pressure
C. headaches appearance in combination with elevated blood pressure
D. signs of encephalopathy

8. Which of the following drugs in the first place should be recommended to patients with CHD,
whose voltage stable angina attacks more frequent and require an increasing number of
nitroglycerin, blood pressure rises to 150 - 160/90 - 100 mm Hg and the heart rate is equal to 90 -
100 min
A long-acting nitrates
B. Ca antagonists;
+ C. beta-blockers
D. aspirin

9. The patient with angina should be to stop everything except:


+ A. single monomorphic ventricular premature beats <30 per hour
B. polymorphic ventricular premature beats
C. group politop PVCs short paroxysms of ventricular tachycardia
D. super early PVCs «R» on an upward knee «T» (R on T)

10. The diagnosis of heart failure 2 FC put at:


A. The appearance of signs of heart failure when walking fast on level ground or when climbing the
steep slope
+ B. signs of heart failure at moderate loads (the patient goes on a par with other people his age on
level ground at a normal pace)
C. signs of heart failure at low load, which force to stop when walking on level ground at a normal
pace or non-Run Fast rise to the first floor
D. reducing myocardial oxygen demand

11. The diagnosis of heart failure 4 FC is placed at:


A. The signs of heart failure at moderate loads (the patient goes on a par with other people his age
on level ground at a normal pace)
B. signs of heart failure at low load, which force to stop when walking on level ground at a normal
pace or non-Run Fast rise to the first floor
+ C. signs of heart failure at rest
D. reducing myocardial oxygen demand

12. What changes are detected on auscultation of lungs in patients with congestive (total) heart
failure stage 2A
A. bronchial breathing
+ B. wet finely wheezing in the lower posterior segments of lungs
C. "silent lung"
D. reducing myocardial oxygen demand

13. Which of the following is the most common complication of essential hypertension:
A. myocarditis
B. pericarditis
+ C. hypertensive crisis
D. chronic renal failure

14. AP range, with 1 degree of hypertension:


A. 130/80 - 149/89 mm Hg
B 135/85 - 155/94 mm Hg
+ C. 140/90 - 159/99 mm Hg
D. 145/95 - 165/104 mm Hg

15. The range of blood pressure in grade 2 hypertension:


A. 140/90 - 159/99 mm Hg
B 145/95 - 165/104 mm Hg
C 150/99 - 170/109 mm Hg
+D 160/100 - 179/109 mm Hg

16. What level of blood pressure is diagnosed arterial hypertension grade 3?


A. 170/100 mm hg and above
+ B. 180/110 mm hg and above
C. 190/115 mm hg and above
D. 200/120 mm hg and higher
17. What is the authority of the following does not belong to the target organs in hypertension?
+ A. Liver
B. Heart
C. Vessels
D. eyes

18. What is the authority of the following does not belong to the target organs in hypertension?
A. Heart
+ B. Lungs
C. Vessels
D. kidneys

19. On the basis of what is determined by the stage of hypertension?


A. The degree of increase in blood pressure
B. The duration of the presence of hypertension and the patient's age
C. The presence of target organ damage
+ D. The presence of target organ damage and associated clinical conditions

20. Which of the following is not considered when determining the overall cardiovascular risk in
patients with hypertension?
A. Risk Factors
B. target organ damage
+ C. The presence of concomitant chronic hepatitis
D. The presence of metabolic syndrome

21. Which of the following drugs is a beta-blocker?


A. Perindopril
B. Amlodipine
+ B. bisoprolol
D. indapamide

22. Which of the following drugs is a calcium channel blocker slow?


A. Perindopril
+ B. Amlodipine
C. bisoprolol
D. indapamide

23. Which of the following drugs is an ACE inhibitor?


+ A. perindopril
B. Amlodipine
C. bisoprolol
D. indapamide

24. Which of the following medications is a diuretic?


A. Perindopril
B. Amlodipine
C. bisoprolol
+ D. indapamide

25. For relief of angina attack is used:


A. sustaka
B. Curantil
+ C. Nitroglycerin
D. verapamil

26. The best method of treatment of angina in the defeat of two or more of the coronary arteries by
atherosclerosis is over:
A. Coronary angioplasty
B. Conservative therapy with nitrates + beta-blocker
C. Conservative therapy with amiodarone + calcium antagonist
+ D. coronary artery bypass grafting

27. Connect the electrodes in the registration of the first standard lead:
A. left leg and right arm
B. left leg and left arm
+ C. left hand and right hand
D. reducing myocardial oxygen demand

28. Connect the electrodes in the registration of the second standard lead:
A. left leg and left arm
+ B. left leg and right arm
C. left hand and right hand
D. Coronary angioplasty

29. The mechanism of action of β-blockers:


A. The increase in myocardial oxygen demand
+ B. slowing of heart rate
C. acceleration of heart rate
D. enhancement of myocardial contractility

30. The drug of choice for the treatment of ventricular arrhythmia in myocardial infarction is
+ A. lidocaine
B. Digoxin
C. verapamil
D. quinidine

31. The area of necrosis seen on an ECG:


A. The offset-ST segment above or below the contour
+ B. Pathological Q wave or QS complex
C. various changes shape and polarity of the T wave
D. By increasing the R-wave amplitude

32. Ventricular premature beats electrocardiographic characterized by all except:


A. Absences prior ekstrosistoly P wave
B. Sharp differences complex ventricular premature beats and ventricular complex of the basic
rhythm
+ C. Premature ventricular complex appearance unchanged
D. Lengthening duration QRS complex (more than 0.12 sec.)

33. The most common symptom of exudative pleurisy is:


+ A. The shortening of percussion sound with an upper limit of blunting in the form of an actuate
curve (line Sokolova - Damuazo)
B. Strengthening the head shake
C. Crepitus
D. Dry wheezing

34. The main distinguishing symptoms of dry pleurisy are:


A. Cough connection pain with breathing, swelling of the lower limbs
B. Communication pain with breathing, pleural friction noise, hemoptysis
C. Dyspnea, pleural friction noise, pulse deficit
+ D. Pleural rub, cough, pain with breathing Us

35. The peculiarity of the pain associated with pleurisy:


A. Short
B. Long
+ C. Associated with cough and breathing
D. In conjunction with hemoptysis

36. Exudative pleurisy is characterized by:


+ A. Dullness of percussion sound in the pulmonary area corresponding to the localization of
pleural exudate
B. The appearance of bronchial breathing zone of dullness
C. Offset mediastinal organs in the direction of the affected lung
D. Increased breath sounds on auscultation of the lungs in the area of dullness

37. For dry pleurisy is characterized by:


A. Pain in the chest
B. Dry cough
C. Perspiration
+ D. All of the above

38. Pain in the chest, which developed against the background of a sudden appeared shortness of
breath, the most typical for:
A. Acute pericarditis
B. dissecting aortic aneurysm
C. Break the esophagus
+ D. Pulmonary embolism

39. The following is true for asthma:


+ A. The prevalence of reversible obstructive component
B. The prevalence of irreversible obstruction component
C. Both components are expressed equally
D. Obstructive syndrome absent

40. Asthma typically:


+ A. Mostly dry cough, sputum is scanty, viscous, difficult to cough up at the end of suffocation
attack
B. Cough throughout choking with discharge of a large attack
the amount of muco-purulent sputum
C. The presence of foamy sputum pink
D. Passage of bloody sputum

41. Combined bronchodilators include:


A. Neoteopek
+ B. Flomax
C. Tiatropiya bromide
D. Formoterol

42. Is not typical for status asthmaticus:


A. Reduced efficacy sympathomimetic
B. The prevalence of wheezing remote
C. hypoxemia and hypercapnia
+ D. Sinus bradycardia

43. All components refers to irreversible airflow obstruction in addition to:


A. Metaplasia of bronchial epithelium
B. The development of pulmonary fibrosis
+ C. bronchospasm
D. Formation of emphysema

44. Bronchodilators include all drugs except:


A. Eufillin
B. Salbutamol
C. Flomax
+ D. Lasolvan

45. What are the antihypertensive drugs are contraindicated in bilateral renal artery stenosis
A. diuretics
+ B. ACE inhibitors
C. ß blockers
D. antagonists Ca

46. What kind of disease you think first and foremost, if the patient shows complaints of pain on the
left, fever, dysuria?
+ A. pyelonephritis
B. amyloidosis
C. acute glomerulonephritis
D. chronic glomerulonephritis

47. The main method of diagnosis of cirrhosis of the liver:


A. EGD
B. colonoscopy
C. angiography
+ D. needle biopsy

48. The main method of diagnosis of chronic gastritis:


A. X-ray
B. Laparoscopic
+ C. fibrogastroduodenoscopy with biopsy mucosa
D. reducing myocardial oxygen demand

49. "The Hunger" pain typical:


A chronic atrophic gastritis
+ B. ulcer 12 duodenal ulcer
C. gastric cancer
D. Chronic non-atrophic gastritis
50. Early pain (after 0.5-1 hours after a meal) are typical:
A. ulcer 12 duodenal ulcer
B. chronic atrophic gastritis
+ C. stomach ulcer
D. Chronic non-atrophic gastritis

51. Peritoneal acute appendicitis symptoms include:


A. Resurrection ( "shirt" syndrome)
B. Shchetkina - Bloomberg
C. Razdolsky
+ D. All these symptoms

52. Initially, most of gangrenous appendicitis occurs in:


A. Children
B. Seriously ill
C. Men
+D. Elderly patients

53. For perforated appendicitis is characterized by:


A free gas in the abdominal cavity
B. Increase of clinical peritonitis
C. The sudden increase in abdominal pain
+ D. Muscle tension anterior abdominal wall
.

54. In the diffuse purulent peritonitis appendicular origin shall apply:


A midline laparotomy
B. Appendectomy
C. Drainage of the abdominal cavity
+ D. All of the above

55. Clinically, acute appendicitis can be mistaken for:


A. Salpingitis
B. Acute cholecystitis
C. Meckel diverticulum
+ D. Any of these types of pathologies

56. Wrongful for acute appendicitis is the statement that:


A. The rigidity of the abdominal wall may be missing retrotsekalni location process
B. rigidity may not be in pelvic location
+ C. Vomiting is always preceded by pain
D. The pain may begin around the navel

57. In acute phlegmonous appendicitis symptom is not observed:


A. Shchetkina-Blumberg
B. Bartome - Michelson
+ C. St. George's - Musso
D. Krymov

58. In a typical picture of acute appendicitis is a surgical approach:


A. Midline laparotomy
+ B. Section of Volkovich - Diakonoff
C. adrectal
D. Cross-section

59. The elements of oblique inguinal hernia include everything except:


A hernia gate
B. hernia sac
C. Content hernia sac
+ D. Spermatic cord

60. Strangulated diaphragmatic hernia in the adult patient has all of the following symptoms are
typical, except:
A. shortness of breath
B. Vomiting
C. cyanosis
+ D. anemia

61. Producing factors that contribute to the formation of hernias include everything except:
A. Heavy physical work
+ B. The presence of the weaknesses of the abdominal wall
C. Constipation
D. difficulty urinating

62. The main feature is a sliding hernia:


A. Easy manageability
B. The inherent nature
+ C. One of the walls of the hernia sac is the organ of the abdominal cavity, partially covered by
peritoneum
D. penetration between the muscles and aponeurosis

63. In strangulated hernia in a patient with acute myocardial infarction is shown:


A. Monitoring, cold on the stomach
B. diaplasis hernia
C. Introduction antispasmodics
+ D. emergency surgery

64. Midline laparotomy must be carried out at:


+ A. diffuse peritonitis
B. abscess Douglas space
C. appendiceal infiltrate
D. Acute appendicitis

65. The main method of diagnosis of esophageal diverticulum is:


A. Esophagoscopy
+ B. Contrast X-rays
C. ultrasound
D. Computer tomography

66. The earliest manifestation of esophageal cancer are:

B. Pain in the chest and back


C. Increased salivation
D. Weight Loss
67. Urgent surgery is indicated in gastric ulcer, complicated by:
A stenosis of the output of the stomach
B. penetration
+ C. perforations
D. all of the above

68. Perforated ulcer is characterized by:


+ A. Stabbing pain, board shaped muscle tension anterior abdominal wall, ulcer history,
B. The pain, ulcer history, nausea and vomiting
C. Pain, board shaped muscle tension anterior abdominal wall, abdominal distension
D. Pain, loss of hepatic dullness, nausea and vomiting

69. The main symptoms of acute gastroduodenal bleeding are::


A. Pain, Bloody vomiting
+ B. Symptoms of anemia, bloody vomiting
C. Ulcerative history, pain
D. Dizziness, loss of hepatic dullness

70. The characteristic pathology of the syndrome of Mallory-Weiss:


A. Rupture of the esophagus
B. Break the gastric mucosa
+ C. The gap mucosa at the junction of the esophagus into the stomach
D. Bleeding polyp of the stomach

71. The complaints of the patient after resection of stomach heaviness in the epigastric region,
weakness, up to fainting after receiving a sweet or dairy foods are the signs:
A. insuloma pancreas
B. afferent loop syndrome
+ C. Dumping syndrome
D. Syndrome small stomach

72. The main method of diagnosis of acute gastroduodenal bleeding are:


A. X-ray method
B. Laboratory
+ C. The endoscopic method
D. Functional diagnostics

73. Relapses gastroduodenal bleeding, most likely at:


A callous ulcer
B. penetrating ulcer
c. mucosal surface erosion
+ d. Thrombus vessel diameter greater than 0.1 cm

74. The most common complication of ulceration of the front wall 12 duodenal ulcer is:
+ A. Perforation
B. Bleeding
c. Penetration in head of the pancreas
D. All incorrect

75. Authentic radiological sign of perforation of gastroduodenal ulcer is:


A high standing diaphragm
+ B. The presence of free gas in the abdominal cavity
C. bowel Pneumatization
D. Increased gas bubble stomach

76. Set the source of gastroduodenal bleeding, you can:


A. X-ray examination of the stomach
B. Laparoscopy
+ C. EGD
D. Repeated determination of hemoglobin and hematocrit

77. The operation of choice for a perforated stomach ulcer in conditions of purulent peritonitis is:
A. Gastrectomy
+ B. Closure of perforation
C. SPV suturing perforations
D. True antrumectomy

78. Perforated gastroduodenal ulcer is characterized by:


+ A. Sudden onset of a sharp pain in the epigastric
B. The gradual increase in pain
C. Cramping sharp pains
D. Rapidly increasing weakness, dizziness

79. If you suspect a perforated stomach ulcer first study should be:
A. Stomach X-rays with a barium suspension
+ B. Survey abdominal radiography
C. Angiography (selective celiac artery)
D. Laparoscopy

80. The disappearance of the pain and the appearance of "melena" in the duodenal ulcer is typical
for:
A. ulcer perforation
B. malignancy ulcers
+ C. Bleeding
D. Penetration into the pancreas

81. What are the clinical features of patients with diagnosis of combined post cholecystitisektomy
syndrome:
A. Pain in the upper abdomen
B. Diarrheal phenomenon
C. Jaundice
+ D. All of the above

82. The patient with gangrenous cholecystitis shown:


A. Conservative treatment
B. The decision depends on the age of the patient
C. The operation in the absence of effect of conservative therapy
+ D. emergency surgery

83. Intraoperative cholangiography absolutely shows:


A. In the presence of small stones in the common bile duct
B. The suspected cancer of the major duodenal papilla
C. When extending the common bile duct
+ D. All of the above is true

84. Complications of acute calculous cholecystitis does not include:


+ A. Varicose veins of the esophagus
B. obstructive jaundice
C. cholangitis
D. Peritonitis

85. The stone formation in the gall bladder helps:


A. The stagnation of bile in the bladder
B. metabolic disorders
C. Inflammatory changes in the gallbladder
+ A. All of the above

86. The most characteristic of acute pancreatitis are pain:


A. Aching
+ B. begird
C. Cramping
D. Blunt

87. To stop the bleeding varicose veins of the esophagus is used:


A. Endoscopic electrocoagulation vessel
+ B. Probe Application Blackmore
C. Summary of drugs that promote thrombosis
D. gradual increase in symptoms

88. In acute intestinal obstruction vomit have all the above features, except: A. Mostly gastric
contents
B. Mostly enteric contents
C. Mostly colonic contents
+ D. The colors of the coffee grounds

89. For low colonic obstruction is characterized by all except:


A gradual increase in symptoms
B. bloating
C. The appearance of cups Kloybera
+ D. Quickly (within days), dehydration

90. The most rapid development of bowel necrosis occurs when:


A. obturation iliac colon tumor
B. obturation lumen jejunum gallstone
+ C. nodulation
D. obturation of the lumen of the colon fecal stones

91. For acute high intestinal obstruction is not typical:


A rapid decline in the bcc
+ B. Bloating in the early hours of the disease
C. Rapid dehydration
D. Cramping

92. In Crohn's disease the inflammatory process extends to:


+ A. Throughout the gastrointestinal tract
B. colon
C. the small intestine
D. esophagus

93. For the first stage of acute limb ischemia is the main feature:
A. Restriction of active movements in the limbs
B. subfascial muscle swelling
+ C. Paresthesia in the limbs
D. Severe muscle contracture

94. What sign indicates irreversible ischemic changes limbs?


A. The loss of pain sensitivity
B. Loss of deep sensitivity
C. Cold extremities
+ D. Limb muscle contracture

95. The main feature of the second stage of acute limb ischemia is:
A. Severe muscle contracture
B. limb paresthesia
C. subfascial muscle swelling
+ D. Limiting the active movement of the limbs

96. The most effective means of preventing the progression of varicose veins are:
+ A. Elastic compression of the limb
B. Compliance with the rational regime of work and rest
C. Restriction of heavy physical load
D. Integrated vazoprotektoramy therapy

97. Complications of varicose veins include:


A. Eczema and Dermatitis
B. subcutaneous tissue induration
+ C. thrombophlebitis
D. Elephantiasis

98. In what intercostal pleural puncture is performed with pneumothorax:


A. In the third in the midclavicular line
+ B. In the second in the midclavicular line
B. In the seventh on the anterior axillary line
G. In the eighth on the back axillary line
D. anywhere.

99. The most effective way is to stop pulmonary hemorrhage:


A. Introduction hemostatics
B. Reduce the pressure in the lung vessels
+ C. Bronchoscopic tamponade "bleeding" of the bronchus
D. Surgery

100. The most common cause of spontaneous pneumothorax is:


A. Lung abscess
B. Lung Cancer
+ C. Bullous lung cysts
D. pulmonary atelectasis
101.A 38 y.o. patient was urgently admitted to the hospital with complaints of sudden weakness,
dizziness, loss of consciousness, body weight loss, nausea, vomiting, severe pain in epigastric area,
diarrhea, skin hyperpigmentation. What is the most probable diagnosis?

A. Addisonic crisis
B. Acute gastroenteritis
C. Meningoencephalitis
D. Scleroderma
E. Pellagra

102.
An unconscious patient presents with moist skin, shallow breathing. There are signs of previous
injection on the shoulders and hips. BP- 110/70 mm Hg. Tonus of skeletal muscles and reflexes are
increased. Cramps of muscles of the extremities are seen. What is the most likely disorder?
A. Hypoglycemic coma
B. Hyperglycemic coma
C. Hyperosmolar coma
D. Hyperlactacidotic coma
E. Stroke

103.
A 26 y.o. male patient with postoperative hypothyroidism take thyroxine 100 mg 2 times a day. He
has developed tachycardia, sweating, irritability, sleep disorder. Determine further treatment tactics.
A. To decrease thyroxine dosage
B. To increase thyroxine dosage
C. To administer betablockers
D. To add mercasolil to the treatment
E. To administer sedatives

104.
A 54-year-old patient complains of weakness, weight loss despite the unchanged appetite, frequent
urination, skin itch for six months. Some time ago the patient underwent treatment for furunculosis.
She hasn't been examined recently. Objectively: malnutrition, dry skin with signs of scratching.
Small lymph nodes can be palpated in the axillary regions. Changes in the internal organs are
absent. What testing must be administered in the first place?
A. Blood sugar test on an empty stomach
B. Complete blood count
C. Endoscopy of stomach
D. Lymph node biopsy
E. Blood sterility testing

105.
A 32-year-old female complains of dizziness, headache, palpitation, tremor. For the last several
months she has been under outpatient observation for the increased arterial pressure. Since recently
such attacks have become more frequent and severe. Objectively: skin is covered with clammy
sweat, tremor of the extremities is present. HR- 110/min, AP- 220/140 mm Hg. Heart sounds are
muffled. Blood test results: WBCs - 9,8\10^9/l, ESR - 22 mm/h. Blood glucose - 9,8 mmol/l. What
disease is the most likely cause of this crisis?
A. Pheochromocytoma
B. Essential hypertension
C. Preeclampsia
D. Primary hyperaldosteronism
E. Diabetic glomerulosclerosis

106.
A 47-year-old woman underwent a thyroid gland resection on ccount of nodular euthyroid goiter.
What preparations are most likely to prevent the disease recurrence?
A. Thyroid hormones
B. Mercazolil
C. Thyrotropin
D. Antistruminum (potassium iodide)
E. Radioactive iodine

107.
A 38-year-old woman experiences episodic increases in arterial pressure up to 240/120 mm Hg,
which is accompanied by nausea, vomiting, tachycardia, increased sweating, hyperglycemia. The
attack is usually followed by the excessive urination. Renal sonography reveals an additional
formation adjacent to the upper pole of the right kidney and possibly belonging to the adrenal gland.
What laboratory test will allow to clarify the diagnosis?
A. Determination of urinary excretion of catecholamines and vanillylmandelic acid
B. Blood test for insulin and C-peptide
C. Estimation of glomerular filtration rate by measuring endogenous creatinine clearance
D. Blood test for thyroxine and thyrotrophic hormone
E. Blood test for renin level

108.
A 58-year-old patient has a 3-year history diabetes mellitus type II. He has been keeping to a diet
and regularly taking glyburide. He has been delivered to a hospital on an emergency basis for acute
abdomen. Objectively: the patient is of supernutrition type. The skin is dry. In the lungs vesicular
breathing can be auscultated. Heart sounds are regular, 90/min. AP- 130/70 mm Hg. The symptom
of "wooden belly" is visible. Blood sugar - 9,8 mmol/l. The patients has indication for laparotomy.
What is the most appropriate way of further treatment of diabetes?
A. To administer short insulin
B. To continue taking glyburide
C. To administer Semilong to be taken in the morning and insulin - in the evening
D. To administer 1 tablet of Glurenorm three times a day
E. To administer 1 tablet of Maninil three times a day

109.
A 50-year-old patient was hospitalized in severe condition with complaints of chills, high grade
temperature, dryness in the mouth, multiple vomiting, pain in the epigastrium, frequent watery,
foamy, dirty green color stool of unpleasant odor. The tongue and the skin are dry. BP - 80/40 mm
Hg. What first aid is necessary for the patient?
A. Intravenous injection of sodium solutions
B. Fresh-frozen plasma transfusion
C. To prescribe polyglucin
D. Sympathomimetics
E. Hemosorbtion
110.
A patient had macrofocal myocardial infarction. He is overweight for 36\%, AP is 150/90 mm Hg,
blood sugar- 5,9 mmol/L, general cholesterol- 4,9 mmol/L, uric acid- 0,211 mmol/L. Which risk
factor should be urgently eradicated during the secondary prevention?
A. Obesity
B. Arterial hypertension
C. Hyperglycemia
D. Hypercholesterolemia
E. Hyperuricemia

111.
A 40-year-old female patient complains of headache, dizziness, muscle weakness, occasional
cramps in the extremities. She has been taking antihypertensive medications for 10 years. AP-
180/100 mm Hg. Blood potassium - 1,8 mmol/l, sodium - 4,8 mmol/l. In urine: alkaline reaction,
the relative density - 1012, protein and sugar are not found, WBCs - 3-4 in the field of vision, RBCs
- 1-2 in the field of vision. Conn's syndrome is suspected. Which drug should be chosen for the
treatment of arterial hypertension?
A. Spironolactone
B. Propanolol
C. Enalapril
D. Hydrochlorothiazide
E. Clonidine

112.
A 18-year-old patient had subtotal strumectomy due to malignant capillary cystadenoma of the
thyroid gland. In 2 months there was a suspicion of metastasis presence in the lungs. What
rontgenological method is to be used first?
A. Roentgenography of lungs
B. Roentgenoscopy of lungs
C. Angiopneumonography
D. Bronchography
E. Bronchoscopy

113.A 24-year-old patient complains about putting on weight, limosis. Objectively: the patient's
constitution is of hypersthenic type, body weight index is 33,2 kg/m^2, waist circumference is 100
cm. Correlation of waist circumference to the thigh circumference is 0,95. What is the most likely
diagnosis?

A. Alimentary constitutional obesity of the I stage, abdominal type


B. Hypothalamic Itsenko-Cushing obesity of the II stage, gynoid type
C. Alimentary constitutional obesity of the III stage, gynoid type
D. Alimentary constitutional obesity of the II stage, abdominal type
E. Hypothalamic Itsenko-Cushing obesity of the I stage, abdominal type

114.
A 45-year-old female patient complaining of general weakness, nausea and vomiting hass been
delivered to a hospital by the ambulance. Recently there has been a lack of appetite, weight loss.
Objectively: hyperpigmentation of skin, blood pressure at the rate of 70/45 mm Hg, bradycardia.
Additional studies revealed the reduced concentration of aldosterone and cortisol in blood,
decreased excretion of 17-ketosteroids and 17-oxyketosteroids in the urine, hyponatremia,
chloropenia, hypokalemia. What therapeutic measures are required?

A. To administer glucocorticoids, mineralocorticoids, and a diet with a high content of cooking


salt
B. To prescribe a diet with a high content of cooking salt
C. To administer prednisolone
D. To administer aldosterone
E. To administer insulin

115.
A 43-year-old female patient was delivered to the hospital in grave condition. She has a history of
Addison's disease. The patient had been regularly taking prednisolone but a week before she
stopped taking this drug. Objectively: sopor, skin and visible mucous membranes are pigmented,
skin and muscle turgor is decreased. Heart sounds are muffled, rapid. AP- 60/40 mm Hg, heart rate -
96/min. In blood: Na - 120 mmol/l, K - 5,8 mmol/l. Development of this complication is primarily
caused by the deficit of the following hormone:

A. Cortisol
B. Corticotropin (ACTH)
C. Adrenaline
D. Noradrenaline
E. Adrostendion

116.
A 38 y.o. man complains of having occasional problems with swallowing of both hard and fluid
food for many months. Sometimes he feels intense pain behind his breast bone, epecially after hot
drinks. There are asphyxia onsets at night. He has not put off weight. Objectively: his general
condition is satisfactory, skin is of usual colour. Examination revealed no changes of
gastrointestinal tract. X-ray picture of thorax organs presents esophagus dilatation with level of
fluid in it. What is the preliminary diagnosis?

A. Esophagus achalasia
B. Myastenia
C. Cancer of esophagus
D. Esophagus candidosis
E. Gastroesophageal reflux

117.
A 35 y.o. woman consulted a doctor about occasional pains in paraumbilical and iliac region that
reduce after defecation or passage of gases. Defecation takes place up to 6 times a day, stool is not
solid, with some mucus in it. Appetite is normal, she has not put off weight. First such symptoms
appeared 1,5 year ago, but colonoscopy data reveals no organic changes. Objectively: abdomen is
soft, a little bit painful in the left iliac region. Blood and urine are normal. What is the preliminary
diagnosis?

A. Irritable bowels syndrome


B. Celiac disease
C. Crohn's disease
D. Pseudomembranous colitis
E. Dispancreatism
118.
A 33 y.o. male patient was admitted to a hospital. A patient is pale, at an attempt to stand up he
complains of strong dizziness. There was vomiting like coffee-grounds approximately hour ago.
BP- 90/60 mm Hg., pulse- 120 b/min. In anamnesis, a patient has suffered from ulcer of the
stomach, painless form during 4 years. An ulcer was exposed at gastrofiberoscopy. Your diagnosis:

A. Ulcer of stomach, complicated with bleeding


B. Ulcer of duodenum, complicated with bleeding
C. Erosive gastritis
D. Acute pleurisy
E. Acute myocardial infarction, abdominal form

119.
A 48-year-old patient complains of heaviness in the right hypochondrium, itching of the skin.He
had been treated in infectious diseases hospital repeatedly due to icterus and itch. On physical
exam: meteorism, ascitis, dilation of abdominal wall veins, protruded umbilicus, spleen
enlargement. What can be diagnosed in this case?

A. Liver cirrhosis
B. Cancer of the liver
C. Cancer of the head of pancreas
D. Gallstones
E. Viral hepatitis B

120.
A 60-year-old woman, mother of 6 children, developed a sudden onset of upper abdominal pain
radiating to the back, accompanied by nausea, vomiting, fever and chills. Subsequently, she noticed
yellow discoloration of her sclera and skin. On physical examination the patient was found to be
febrile with temp of 38,9°C, along with right upper quadrant tenderness. The most likely diagnosis
is:

A. Choledocholithiasis
B. Benign biliary stricture
C. Malignant biliary stricture
D. Carcinoma of the head of the pancreas
E. Choledochal cyst

121.
The complications of acute cholecystitis which require surgical intervention are as follows
EXCEPT:

A. Jaundice
B. Empyema of the gall-bladder
C. Emphysematous gall-bladder
D. Gall-bladder perforation
E. Cholangitis conditioned by the presence of stones in the bile tract

122.
A 44-year-old patient complains about difficult urination, sensation of incomplete urinary bladder
emptying. Sonographic examination of the urinary bladder near the urethra entrance revealed an
oval well-defined hyperechogenic formation 2x3 cm large that was changing its position during the
examination. What conclusion can be made?
A. Concernment
B. Malignant tumor of the urinary bladder
C. Urinary bladder polyp
D. Prostate adenoma
E. Primary ureter tumor

123.
A 40 y.o. patient was admitted to the gasteroenterology with skin itching, jaundice, discomfort in
the right subcostal area, generalized weakness. On examination: skin is jaundice, traces of
scratches, liver is +5 cm, splin is 6x8 cm. In blood: alkaline phosphatase - 2,0 mmol/(hourL),
general bilirubin - 60 mkmol/L, cholesterol - 8,0 mmol/L. What is the leading syndrome in the
patient?

A. Сholestatic
B. Сytolytic
C. Mesenchymal inflammatory
D. Asthenic
E. Liver-cells insufficiency

124.
In autumn a 25-year-old patient developed stomach ache arising 1,5-2 hours after having meals and
at night. He complains of pyrosis and constipation. The pain is getting worse after consuming spicy,
salty and sour food, it can be relieved by means of soda and hot-water bag. The patient has been
suffering from this disease for a year. Objectively: furred moist tongue. Abdomen palpation reveals
epigastrial pain on the right, resistance of abdominal muscles in the same region. What is the most
likely diagnosis?

A. Duodenal ulcer
B. Chronic cholecystitis
C. Diaphragmatic hernia
D. Stomach ulcer
E. Chronic pancreatitis

125.
A 51 y.o. woman complains of dull pain in the right subcostal area and epigastric area, nausea,
appetite decline during 6 months. There is a history of gastric peptic ulcer. On examination: weight
loss, pulse is 70 bpm, AP is 120/70 mm Hg. Diffuse tenderness and resistance of muscles on
palpation. There is a hard lymphatic node 1x1cm in size over the left clavicle. What method of
investigation will be the most useful?
A. Esophagogastroduodenoscopy with biopsy
B. Ultrasound examination of abdomen
C. pH-metry
D. Ureatic test
E. Stomach X-ray

126.
A 37-year-old patient has sudden acute pain in the right epigastric area after having fatty food. What
method of radiological investigation is to be used on the first stage of examining the patient?
A. Ultrasonic
B. Roentgenological
C. Radionuclid
D. Magnetic-resonance
E. Thermographic

127.
A 35-year-old man was operated on peptic ulcer of the stomach. Mass deficit of the body is 10 kg.
The level of glucose after operation in the undiluted cellular blood on an empty stomach is 6,7
mmol. During repeated examination - 11,1 mmol (after meal), level of HbA1c - 10\%. Could you
please make an interpretation of the given data?

A. Diabetes mellitus
B. Disordered tolerance to glucose
C. Diabetes mellitus risk group
D. Norm
E. Postoperative hyperinsulinemia

128.
A 55 y.o. patient complains of distended abdomen and rumbling, increased winds evacuation, liguid
foamy feces with sour smell following the diary products consumption. What is the correct name of
this syndrome?
A. Syndrome of fermentative dyspepsia
B. Syndrome of decayed dyspepsia
C. Syndrome of fatty dyspepsia
D. Dyskinesia syndrome
E. Malabsorption syndrome

129.
A 48-year-old male patient complains of constant pain in the upper abdomen, mostly on the left,
that is getting worse after taking meals; diarrhea, weight loss. The patient is an alcohol abuser. 2
years ago he had acute pancreatitis. Blood amylase is 4 g/h\l. Coprogram shows steatorrhea,
creatorrhea. Blood glucose is 6,0 mmol/l. What treatment is indicated for this patient?
A. Panzinorm forte
B. Insulin
C. Gastrozepin
D. Contrycal
E. No-spa

130.
4 hours after having meals a patient with signs of malnutrition and steatorrhea experiences stomach
pain, especially above navel and to the left of it. Diarrheas take turns with constipation lasting up to
3-5 days. Palpation reveals moderate painfulness in the choledochopancreatic region. The amylase
rate in blood is stable. X-ray reveals some calcifications located above navel. What is the most
likely diagnosis?
A. Chronic pancreatitis
B. Chronic gastroduodenitis
C. Duodenal ulcer
D. Zollinger-Ellison syndrome
E. Chronic calculous cholecystitis

131.
A 43 y.o. woman complains of severe pain in the right abdominal side irradiating in the right
supraclavicular area, fever, dryness and bitterness in the mouth. There were multiple vomiting
without relief. Patient relates the onset of pain to the taking of fat and fried food. Physical
examination: the patient lies on the right side, pale, dry tongue, tachycardia. Right side of abdomen
is painful during palpation and somewhat tense in right hypochondrium. What is the most likely
diagnosis?

A. Perforative ulcer
B. Acute cholecystitis
C. Acute bowel obstruction
D. Acute appendicitis
E. Right-sided renal colic

132.
Gastric juice analysis of a 42-year-old male patient revealed absence of free hydrochloric acid at all
stages. Endoscopy revealed pallor, thinning of gastric mucosa, smoothed folds. Microscopically the
atrophy of glands with intestinal metaplasia was found. What disease is this situation typical for?
A. Chronic type A gastritis
B. Chronic type B gastritis
C. Chronic type C gastritis
D. Menetrier disease
E. Stomach cancer

133.
A 45-year-old female patient complains of frequent liquid stools with a lot of mucus, pus and blood;
pain across the abdomen, loss of 7 kg within 6 months. She has a 1-year history of non-specific
ulcerative colitis. What group of drugs should be preferred for this patient?
A. Corticosteroids
B. Antibacterial
C. Sulfonamides
D. Nitrofurans
E. Polyenzymes

134.
A 51-year-old female patient complains of frequent defecation and liquid blood-streaked stools with
mucus admixtures, diffuse pain in the inferolateral abdomen, 6 kg weight loss over the previous
month. Objectively: body temperature - 37,4^oC, malnutrition, skin is pale and dry. Abdomen is
soft, sigmoid is painful and spasmodic, makes a rumbling sound. Liver is dense, painful, extends 3
cm below the costal margin. What is the most likely diagnosis?

A. Non-specific ulcerative colitis


B. Bacillary dysentery
C. Sprue
D. Intestinal enzymopathy
E. Helminthic invasion

135.
A 43-year-old female patient complains of unstable defecation with frequent constipations,
abdominal swelling, headache, sleep disturbance. Body weight is unchanged. What disease are
these clinical presentations typical for?
A. Irritable colon syndrome
B. Chronic enteritis
C. Chronic pancreatitis
D. Chronic atrophic gastritis
E. Colorectal cancer

136.
A 23-year-old patient complains of a dull ache, sensation of heaviness and distention in the
epigastrium immediately after meals, foul-smelling eructation; dry mouth, empty stomach nausea,
diarrhea. Objectively: the skin is pale, the patient is of thin build. Abdomen is soft on palpation,
there is epigastric pain. The liver does not extend beyond the costal arch. In blood: Hb - 110 g/l,
RBCs - 3,4\10^{12}/l, WBC count is normal. ESR - 16 mm/h. What is the most informative study
that will allow make a diagnosis?
A. Esophageal gastroduodenoscopy
B. X-ray of digestion organs
C. Study of gastric juice
D. pH-metry
E. Duodenal probing

137.
A 49-year-old patient complains of deglutition problems, especially with solid food, hiccups, voice
hoarseness, nausea, regurgitation, significant weight loss (15 kg within 2,5 months). Objectively:
body weight is reduced. Skin is pale and dry. In lungs: vesicular breathing, heart sounds are loud
enough, heart activity is rhythmic. The abdomen is soft, painless on palpation. Liver is not enlarged.
What study is required to make a diagnosis?

A. Esophageal duodenoscopy along with biopsy


B. Clinical blood test
C. X-ray of digestive tract organs
D. X-ray in Trendelenburg's position
E. Study of gastric secretion

138.
A 40-year-old man is ill with autoimmune hepatitis. Blood test: А/G ratio 0,8, bilirubin -
42\ummol/L, transaminase : ALT- 2,3 mmol g/L, АSТ - 1,8 mmol g/L. What is the most effective
means in treatment from the given below?
A. Glucocorticoids, cytostatics
B. Antibacterial medication
C. Hepatoprotectors
D. Antiviral medications
E. Hemosorbtion, vitamin therapy

139.
A 50-year-old patient complains about having pain attacks in the right subcostal area for about a
year. He pain arises mainly after taking fattening food. Over the last week the attacks occurred daily
and became more painful. On the 3rd day of hospitalization the patient presented with
icteritiousness of skin and scleras, light-colored feces and dark urine. In blood: neutrophilic
leukocytosis - 13,1\10^9/l, ESR- 28 mm/h. What is the most likely diagnosis?
A. Chronic calculous cholecystitis
B. Chronic recurrent pancreatitis
C. Fatty degeneration of liver
D. Chronic cholangitis, exacerbation stage
E. Hypertensive dyskinesia of gallbladder
140.
A 56 y.o. man, who has taken alcoholic drinks regularly for 20 years, complains of intensive girdle
pain in the abdomen. Profuse nonformed stool 2-3- times a day has appeared for the last 2 years,
loss of weight for 8 kg for 2 years. On examination: abdomen is soft, painless. Blood amylase -
12g/L. Feces examination-neutral fat 15 g per day, starch grains. What is the most reasonable
treatment at this stage?
A. Pancreatine
B. Contrykal
C. Aminocapron acid
D. Levomicytine
E. Imodium

141
A 43-year-old patient had been admitted to a hospital with clinical presentations of ischiorectal
periproctitis. On the 12th day of treatment the patient's condition deteriorated: there was an
increase in the rate of intoxication and hepatic failure, the body temperature became hectic, AP was
100/60 mm Hg. USI of liver revealed a hydrophilic formation. In blood: WBCs - 19,6\cdot10^9/l,
RBCs.- 3,0 cdot10^{12}/l, Hb- 98 g/l. What complication was developed?
A. Liver abscess
B. Pylephlebitis
C. Hepatic cyst
D. Liver necrosis

142.
A victim of a road accident, aged 44, is operated on account of intraperitoneal haemorrhage. In
which case can the patient's blood from the abdominal cavity be used for autotransfusion?
A. Stomach rupture
B. Bladder rupture
C. Liver rupture
D. Splenic rupture
E. Gallbladder rupture

143.
A 32-year-old patient lives in an area endemic for echinococcosis. In the last 6 months he reports of
pain in the right subcostal area, fever. He is suspected to have liver echinococcosis. What study
would be the most informative in this case?
A. Sonography
B. Survey radiography of abdominal cavity
C. Biochemical laboratory examination
D. Angiography
E. X-ray

144.
3 days ago a 29-year-old patient presented with pulsating pain in the region of rectum, fever,
general weakness. Objectively: local tenderness in the anal region in the 6 o'clock position. Digital
investigation of rectum revealed a painful infiltration reaching the pectinate line. What is the most
likely diagnosis?

A. Acute periproctitis
B. Acute anal fissure
C. Acute haemorrhoids
D. Rectum tumour
E. Acute prostatitis

145.
43 year old patient had cholecystectomy 6 years ago because of chronic calculous cholecystitis.
Lately he has been suffering from pain in the right subcostal area and recurrent jaundice. Jaundice
hasn't gone for the last 2 weeks. Stenosing papillitis 0,5 cm long has been revealed. What is the best
way of treatment?
A. To perform endocsopic papillosphincterotomy
B. To treat conservatively: antibiotics, spasmolytics, antiinflammatory drugs
C. To perform external choledoch drainage
D. To perform transduodenal papillosphincterotomy
E. To perform choledochoduodenostomy

146.
A 65-year-old patient complains of dull pain in the rectum during and after defecation, discharge of
mucus and small amount of blood mixed up with mucus and faeces. The discharged blood is of dark
red color, sometimes with small amount of clots. The patient is sick for 8 months, has lost some
weight. On digital examination, there is a round constriction of the rectum with infiltrate at a height
of 4-5 cm from the anus. What is the most probable diagnosis?

A. Cancer of the medium-ampullar section of the rectum


B. Cicatricial stenosis of the rectum
C. Chronic paraproctitis
D. Crohn's disease
E. Non-specific ulcer colitis

147.
A female patient has been suffering from pain in the right subcostal area, bitter taste in the mouth,
periodical bile vomiting for a month. The patient put off 12 kg. Body temperature in the evening is
$37,6^oC$. Sonography revealed that bile bladder was 5,5х2,7 cm large, its wall - 0,4 cm,
choledochus - 0,8 cm in diameter. Anterior liver segment contains a roundish hypoechoic formation
up to 5 cm in diameter and another two up to 1,5 cm each, walls of these formations are up to 0,3
cm thick. What is the most likely diagnosis?

A. Alveolar echinococcus of liver


B. Liver cancer
C. Liver abscess
D. Cystous liver cancer
E. Paravesical liver abscesses

148.
During an operation for presumed appendicitis the appendix was found to be normal; however, the
terminal ileum is evidently thickened and feels rubbery, its serosa is covered with grayish-white
exudate, and several loops of apparently normal small intestine are adherent to it. The most likely
diagnosis is:
A. Crohn's disease of the terminal ileum
B. Perforated Meckel's diverticulum
C. Ulcerative colitis
D. Ileocecal tuberculosis
E. Acute ileitis
149.
What preparations are used for prevention of fungal infection?

+A.
A. Fluconozol, Orungol, Nisoral
B. Rubomycin, Bleomycin, Mytomycin C
C. Cytosar, Cormyctin, Lomycitin
D. Captopril, Enalapril
E. Isoniazid, Ftibazid, Pyrazinamid

150.
A patient has restrained umbilateral hernia complicated by phlegmon hernia, it is necessary to take
following actions:

A. Herniotomy by Mayo-Sapezhko
B. Herniotomy by Mayo
C. Herniotomy by Sapezhko
D. Herniotomy by Lekser
E. Herniotomy by Grenov

151.
It is suspected that a 34 year old patient has an abscess of Douglas pouches. What diagnostic
method is to be chosen?

A. Digital examination of rectum


B. Rectoromanoscopy
C. Laparoscopy
D. Percussion and auscultation of stomach
E. R-scopy of abdominal cavity

152.
A 16 year old patient with complaints of frequent pain in the abdomen was diagnosed with
melanoma, examination revealed also pigmentation of the mucosa and skin, polyp in the stomach
and large intestine. It is know that the patient's mother has an analogous pigmentation and has been
often treated for anemia. What disease is suspected?

A. Peytz-Egers's polyposis
B. Chron's disease
C. Tuberculosis of the intestine
D. Adolescent polyposis
E. Hirschprung's disease

153.
A 37-year-old patient has come to clinic being wounded in the area of umbilicus an hour ago.On
physical exam, there is a prick and cut painful wound of about 0,5x1 cm around umbilicus on the
abdominal skin with slight bleeding.How would you help this patient?

A. Laparotomy, abdominal cavity organs inspection. Primary surgical processing of the wound
B. Drainage of the wound with rubber strip
C. Inspection of the wound with canal probe
D. Aseptic bandage
E. Suture on the wound

154.
Name a statistical observation unit for determination of influence amount of bloodsugar on the
healing of wound's surface in a postoperative period:
A. The patient in a postoperative period
B. An amount of bloodsugar
C. Blood analysis
D. The patient who has a wound surface
E. The patient who was discharged on an after-care

155.
During investigation for chronic, severe, epigastric pain, a 40 year old alcoholic man is found to
have multiple areas of narrowing alternating with dilatation ("chain of lakes" appearance) of the
main pancreatic duct. The operation of choice is:
A. Lateral pancreaticojejunostomy
B. Distal pancreaticojejunostomy
C. Sphincterotomy
D. Distal pancreatectomy
E. Total pancreatectomy

156.
The treatment of choice for duodenal obstruction caused by secondary duodenal hematoma that
developed a few days after blunt abdominal injury is:
A. Nasogastric decompression and parenteral alimentation
B. Retrocolic gastrojejunostomy
C. Duodenojejunostomy
D. Immediate exploration
E. Tube duodenostomy

157.
A 41 year old patient was admitted to the intensive care unit with haemorrhagic shock due to gastric
bleeding. He has a history of hepatitis B during the last 5 years. The source of bleeding are
esophageal veins. What is the most effective method for control of the bleeding?
A. Introduction of obturator nasogastric tube
B. Intravenous administration of pituitrin
C. Hemostatic therapy
D. Operation
E. Administration of plasma

158.
A patient is staying in the hospital with the diagnosis of abdominal typhus. During the 3-d week
from the beginning of the disease the patient stopped keeping diet and confinement to bed. As a
result the body temperature and rapid pulse decreased and melena appeared. What kind of
complications should we think about first of all?

A. Intestinal haemorrhage
B. Thrombophlebitis
C. Meningitis
D. Nephroso-nephritis
E. Hepatite

159.
A 45-year-old woman, mother of four children, comes to the emergency room complaining of a
sudden onset of the epigastric and right upper quadrant pain, radiating to the back, accompanied by
vomiting. On examination, tenderness is elicited in the right upper quadrant, bowel sounds are
decreased, and laboratory data shows leukocytosis, normal serum levels of amylase, lipase, and
bilirubin. The most likely diagnosis is:

A. Acute cholecystitis
B. Perforated peptic ulcer disease
C. Myocardial infarction
D. Sigmoid diverticulitis
E. Acute pancreatitis

160.
A 38 y.o. woman was hospitalized to the surgical unit with vomiting and acute abdominal pain
irradiating to the spine. On laparocentesis hemmorhagic fluid is obtained. What disease should be
suspected?

A. Acute pancreatitis
B. Renal colic
C. Acute enterocolitis
D. Perforated gastric ulcer
E. Acute appendicitis

161.
A patient complains of an extremely intense pain in epigastrium. He has peptic ulcer disease of
duodenum for 10 years. The patient is in the forced position being on the right side with legs
abducted to stomach. Abdomen has acute tenderness in the epigastrium. Guarding contraction of the
abdominal wall muscles is observed. What is the preliminary diagnosis?

A. Perforation of ulcer
B. Acute pancreatitis
C. Acute condition of peptic ulcer disease
D. Penetration of ulcer into pancreas
E. Thrombosis of mesenteric vessels

162.
A 19 year old patient was admitted to a hospital with acute destructive appendicitis. He suffers from
hemophilia of B type. What antihemophilic medications should be included in pre- and post-
operative treatment plan?
A. Fresh frozen plasma
B. Cryoprecipitate
C. Fresh frozen blood
D. Native plasma
E. Dried plasma

163.
A 20 y.o. patient suddely felt ill 12 hours ago. There was pain in epigactric area, nausea, sporadic
vomiting. He had taken alcohol before. In few hours the pain localized in the right iliac area. On
examination: positive rebound tenderness symptoms. WBC- 12,210^9/L. What is the most
probable diagnosis?
A. Acute appendicitis
B. Acute pancreatitis
C. Perforated ulcer
D. Rightside kidney colic
E. Diphtheria

164.
After an accident a patient complains of pain in the hip joint. Objectively: the leg is in the position
of flexion, adduction and internal rotation, significantly contracted. There is elastic resistance to
passive adduction or abduction of the extremity. Major trochanter is located high above the Roser-
Nelaton line. A significant lordosis is present. What is your provisional diagnosis?
A. Iliac dislocation of hip
B. Femoral neck fracture with a displacement
C. Cotyloid cavity fracture with a central dislocation of hip
D. Inferoposterior dislocation of hip
E. Diphtheria

165.
A 29 y.o. patient was admitted to the hospital with acute girdle pain in epigastric area, vomiting in
1 hour after the meal. On examination: pale, acrocyanosis. Breathing is frequent, shallow.
Abdominal muscles are tensed, positive Schotkin-Blumberg's symptom. What is the maximal term
to make a diagnosis?
A. In 2 hours
B. In 0,5 hours
C. In 1 hour
D. In 3 hours
E. In 4 hours

166.
14 days ago a 49-year-old patient was operated on for perforated appendicitis and disseminated
fibrinopurulent peritonitis. The postoperative period was uneventful. On the 9th day the patient
presented with low-grade fever, abdominal pain, frequent liquid stools. USI of the left
mesogastrium reveals a fluid formation 9x10 cm large. In blood: leukocytosis with the left shift.
What is your provisional diagnosis?
A. Interloop abscess
B. Abdominal cavity tumour
C. Liver abscess
D. Left kidney cyst
E. Acute appendecitatis

167.In the department of pathology of the pregnant woman was hospitalized with second 38 weeks
pregnancy. The first ended in cesarean section due to cephalopelvic disproportion. The estimated
fetal weight - 3200. What method of delivery will choose?
A. Expect spontaneous onset of labor to make a vacuum - the extraction of the fetus
B. Elective caesarean section
C. Excitation of labor at 38 weeks, delivery lead conservative
D. Expect spontaneous onset of labor, eliminate attempts by forceps
E. Plan the delivery can only know the size of the pelvis

168.
An onset of severe preeclampsia at 16 weeks gestation might be caused by:
A. Hydatidiform mole
B. Anencephaly
C. Twin gestation
D. Maternal renal disease
E. Interventricular defect of the fetus

169.
A 26 y.o. woman complains of a mild bloody discharge from the vagina and pain in the lower
abdomen. She has had the last menstruation 3,5 months ago. The pulse is 80 bpm. The blood
pressure (BP) is 110/60 mm Hg and body temperature is 36,6^0C. The abdomen is tender in the
lower parts. The uterus is enlarged up to 12 weeks of gestation. What is your diagnosis?
A. Inevitable abortion
B. Incipient abortion
C. Incomplete abortion
D. Complete abortion
E. Disfunctional bleeding

170.
A pregnant woman was delivered to the gynecological unit with complaints of pain in the lower
abdomen and insignificant bloody discharges from the genital tracts for 3 hours. Last menstruation
was 3 months ago. Vaginal examination showed 10th week of gestation uterus, a fingertip could be
inserted into the external orifice of uterus, bloody discharges were insignificant. USI showed
"snowstorm" appearence. What is the most likely diagnosis?
A. Molar pregnancy
B. Abortion in progress
C. Incipient abortion
D. Threat of spontaneous abortion
E. Incomplete abortion

171.
A 28 y.o. primagravida, pregnancy is 15-16 weaks of gestation, presents to the maternity clinics
with dull pain in the lower part of the abdomen and in lumbar area. On vaginal examination: uterus
cervix is 2,5 cm, external isthmus allows to pass the finger tip. Uterus body is enlarged according to
the pregnancy term. Genital discharges are mucous, mild. What is the diagnosis?
A. Threatened spontaneous abortion
B. Spontaneous abortion which has begun
C. Stopped pregnancy
D. Hydatid molar pregnancy
E. Placenta presentation

172.
A woman in her 39-th week of pregnancy, the second labor, has regular birth activity. Uterine
contractions take place every 3 minutes. All of the below indicate the beginning of the II stage of
labor EXEPT:
A. Cervical dilatation to .4 cm
B. Cervical dilation to 9-10 cm
C. Duration of uterine contractions more than 30 seconds
D. Presenting part is in 0 station
E. Rupture of membranes

173.
A 24 years old primipara was hospitalised with complaints about discharge of the amniotic waters.
The uterus is tonic on palpation. The position of the fetus is longitudinal, it is pressed with the head
to pelvic outlet. Palpitation of the fetus is rhythmical, 140 bpm, auscultated on the left below the
navel. Internal examination: cervix of the uterus is 2,5 cm long, dense, the external os is closed,
light amniotic waters out of it. Point a correct component of the diagnosis:
A. Antenatal discharge of the amniotic waters
B. Early discharge of the amniotic waters
C. The beginning of the 1st stage of labour
D. The end of the 1st stage of labour
E. Pathological preterm labour

174.
A 36-year-old woman with 11-week pregnancy has consulted gynaecologist to make a record in
patient chart. All of the below investigations the woman should pass EXEPT:
A. The blood sugar
B. Determination of the contents of PAPP-protein
C. Bacteriological test of discharge from the vagina
D. Fetal cardiotachography
E. Ultrasound of the fetus

175.
Just after 2 hours after delivery condition of the postpartum woman is good. The uterus is thick,
globe-shaped, its fundus at the umbilicus, bleeding is absent. The clamp put on the umbilical cord
remains at the same level and doesn’t change it length during pressing above the symphysis. Bloody
discharges from the vagina are absent. What is the adequate management?
A. To do manual separation and removal of .placenta
B. To apply Abduladze method
C. To apply Crede's method
D. To do curettage of uterine cavity
E. To introduct oxitocine intravenously

176.
Examination of a placenta after delivery reveals defect 3x5 cm large. Hemorrhage is absent. What
management is the most appropriate?
A. Manual exploration of uterine cavity
B. Prescription of uterotonic medicines
C. External uterus massage
D. Observation for the patient
E. Uterine curretage

177.A woman consulted a doctor on the 10th day after labor about discharge from vagina.
Objectively body temperature is normal. Pulse rate is 72 beats per minute, blood pressure
120/60mm.Hg. What character of the discharge should be normally at this day of postpartum
period?

A.
Bloody
B.
Purulent

C.
Bloody-serous

D.
Serous

E.
Serous-bloody

178.A woman consulted a doctor on the 5th day after labor about discharge from vagina.
Objectively body temperature is normal. Pulse rate is 72 beats per minute, blood pressure
120/60mm.Hg. What character of the discharge should be normally at this day of postpartum
period?

A.
Bloody

B.
Purulent

+C.
Bloody-serous

D.
Serous

E.
Serous-bloody

179.
A woman consulted a doctor on the 21th day after labor about discharge from vagina. Objectively
body temperature is normal. Pulse rate is 72 beats per minute, blood pressure 120/60mm.Hg. What
character of the discharge should be normally at this day of postpartum period?

A.
Bloody

B.
Purulent

C.
Bloody-serous

+D.
Serous

E.
Serous-bloody
180.
A woman consulted a doctor on the 18th day after labor about discharge from vagina. Objectively
body temperature is normal. Pulse rate is 72 beats per minute, blood pressure 120/60mm.Hg. What
character of the discharge should be normally at this day of postpartum period?

A.
Bloody

B.
Purulent

C.
Bloody-serous

D.
Serous

E.
Serous-bloody

181.
21 years old woman consulted a doctor on the 2 day after labor about the examinations which she
should pass at postpartum period. Objectively body temperature is normal. Pulse rate is 72 beats per
minute, blood pressure is 120/60mm.Hg. All of the below examination the woman should pass
before discharge from hospital EXEPT:

A.
Genaral blood analysis

B.
General urine analysis

C.
Bacterioscopic examionation of the vaginal discarge

D.
Analysis of the feces

E.
Ultrasonography of the uterus

182.
22 years old woman consulted after delivery about the examinations which she should pass at
postpartum period. Objectively body temperature is normal. Pulse rate is 84 beats per minute, blood
pressure is 110/60mm.Hg. All of the below examination the woman should pass before discharge
from hospital EXEPT:

A.
Genaral blood analysis
B.
General urine analysis

+C.
ECG

D.
X-ray examination of chest

E.
Ultrasonography of the uterus

183.In 10 min after .delivery by a 32-year-old woman, the placenta was spontaneousely delivered
and 150 ml of blood came out. Woman weight is 90kg, infant weight - 3800 g, length - 52 cm. The
uterus contracted. In 10 minutes the hemorrhage renewed and the total amount of blood loss is 350
ml. What amount of blood loss is physiologic for this woman?

A.
400 ml

B.
1000 ml

C.
450 ml

D.
650 ml

E.
300 ml

184.In 14 min after .delivery by a 22-year-old woman, the placenta was spontaneousely delivered
and 50 ml of blood came out. Woman weight is 60kg, infant weight - 3100g, length - 52 cm. The
uterus contracted. In 15 minutes the hemorrhage renewed and the total amount of blood loss is 250
ml. What amount of blood loss is physiologic for this woman?

A.
400 ml

B.
1000 ml

C.
450 ml

D.
650 ml

E.
300 ml
185.In 18 min after .delivery by a 28-year-old woman, the placenta was spontaneousely delivered
and 80 ml of blood came out. Woman weight is 64kg, infant weight - 03100g, length - 50 cm. The
uterus contracted. In 10 minutes the hemorrhage renewed and the total amount of blood loss is 300
ml. What amount of blood loss is physiologic for this woman?

A.
400 ml

B.
320 ml

C.
450 ml

D.
650 ml

E.
300 ml

186.In 20 min after delivery by a 19-year-old woman, the placenta was spontaneousely delivered
and 60 ml of blood came out. Woman weight is 76kg, infant weight - 3500g, length - 50 cm. The
uterus contracted. In 15 minutes the hemorrhage renewed and the total amount of blood loss is 250
ml. What amount of blood loss is physiologic for this woman?

A.
400 ml

B.
380 ml

C.
450 ml

D.
650 ml

E.
300 ml

187.
Immediately after delivery hemorrhage occurs in 23 years old patient, blood loss exceeded
physiological and was progressing. There were no symptoms of placenta separation. What tactics
should be chosen?

A.
Manual removal of placenta and afterbirth

B.
Uterus tamponade
C.
Instrumental revision of uterine cavity walls

D.
Removal of afterbirth by Crede's method

E.
Intravenous injection of methylergometrine with glucose

188.
Woman with in-time pregnancy. Bears down during 40-45 seconds with intervals 1-2 minutes. The
rupture of the membrane has occurred 10 minutes ago. Vaginal examination: fetal head is on the
pelvic floor. Saggital suture is in anterior-posterior diameter of pelvic outlet. Amniotic sac is absent.
What is the stage of labor?

A.
Cervical

B.
Pelvic

C.
Cranial

D.
Early postpartum

E.
Placental

189.
Immediately after delivery a woman had haemorrhage, blood loss exceeded postpartum
haemorrhage rate and was progressing. There were no symptoms of placenta detachment. What
tactics should be chosen?

A.
Manual removal of placenta and afterbirth

B.
Uterus tamponade

C.
Instrumental revision of uterine cavity walls

D.
Removal of afterbirth by Crede's method

E.
Intravenous injection of methylergometrine with glucose

190.
A 30-year-old gravida consulted a gynecologist about bright red bloody discharges from the vagina
in the 32 week of gestation. She was hospitalized with a suspicion of placental presentation. Under
what conditions is it rational to conduct the internal examination in order to make a diagnosis?

A.
In the operating room prepared for the operation

B.
In the examination room of antenatal clinic

C.
In the admission ward of maternity hospital

D.
In the delivery room keeping to all the aseptics regulations

E.
The examination is not to be conducted because of risk of profuse haemorrhage

191.
A 30 y.o. woman has the 2-nd labour that has been lasting for 14 hours. Hearbeat of fetus is
muffled, arrhythmic, 100/min. Vaginal examination: cervix of uterus is completely opened, fetus
head is level with outlet from small pelvis. Saggital suture is in the straight diameter, small crown is
near symphysis. What is the further tactics of handling the delivery?
A.
Use of obstetrical forceps

B.
Stimulation of labour activity by oxytocin

C.
Cesarean section

D.
Cranio-cutaneous (Ivanov's) forceps

E.
Use of cavity forceps

192.
In10 minutes after delivery a woman discharged placenta with a tissue defect 5х6 cm large.
Discharges from the genital tracts were bloody profuse. Uterus tonus was low, fundus of uterus was
located below the navel. Examination of genital tracts revealed that the uterine cervix, vaginal
walls, perineum were intact. There was uterine bleeding with following blood coagulation. Your
actions to stop the bleeding:

A.
To make manual examination of uterine cavity

B.
To apply hemostatic forceps upon the uterine cervix
C.
To introduce an ether-soaked tampon into the posterior fornix

D.
To put an ice pack on the lower abdomen

E.
To administer uterotonics

193.
Examination of a just born placenta reveals defect 2x3 cm large. Hemorrhage is absent. What tactic
is the most reasonable?

A.
Manual uterine cavity revision

B.
Prescription of uterotonic medicines

C.
External uterus massage

D.
Parturient supervision

E.
Instrumental uterus cavity revision

194.
A 27 y.o. woman suffers from pyelonephritits of the only kidney. She presents to the maternity
welfare centre because of suppresion of menses for 2,5 months. On examination pregnancy 11
weeks of gestation was revealed. In urine: albumine 3,3 g/L, leucocytes cover the field of vision.
What is doctor's tactics in this case?

A.
Immediate pregancy interruption

B.
Pregnancy interruption after urine normalization

C.
Maintenance of pregnancy till 36 weeks

D.
Pregnancy interruption at 24-25 weeks

E.
Maintenance of pregnancy till delivery term

195.
On the tenth day after discharge from the maternity house a 2-year-old patient consulted a doctor
about body temperature rise up to 390C, pain in the right breast. Objectively: the mammary gland is
enlarged, there is a hyperemized area in the upper external quadrant, in the same place there is an
ill-defined induration, lactostasis, fluctuation is absent. Lymph nodes of the right axillary region are
enlarged and painful. What is the most likely diagnosis?

A.
Lactational mastitis

B.
Abscess

C.
Erysipelas

D.
Dermatitis

E.
Tumour
196.
A 28-years-old woman complains of nausea and vomiting about 10 times per day. She has been
found to have body weight loss and xerodermia. The pulse is 100 bpm. Body temperature is 37,2?C.
Diuresis is low. USI shows 5-6 weeks of pregnancy. What is the most likely diagnosis?

A.
Moderate vomiting of pregnancy

B.
Mild vomiting of pregnancy

C.
I degree preeclampsia

D.
Premature abortion

E.
Food poisoning

197.
A 25 y.o. patient complains of body temperature rise up to 37?С, pain at the bottom of her abdomen
and vaginal discharges. Three days ago, when she was in her 11th week of pregnancy, she had an
artificial abortion. Objectibely: cervix of uterus is clean, uterus is a little bit enlarged in size,
painful. Appendages cannot be determined. Fornixes are deep, painless. Vaginal discharges are
sanguinopurulent. What is the most probable diagnosis?

A.
Postabortion endometritis

198.
An ambulance delivered a 21-year-old woman to the gynaecological department with complaints of
colicky abdominal pain and bloody discharges from the genital tracts. Bimanual examination
revealed that uterus was soft, enlarged to the size of 6 weeks of gestation, a gestational sac was
palpated in the cervical canal. Uterine adnexa weren't palpable. Fornices are free, deep and painless.
Discharges from the genital tracts are bloody and profuse. What is the most likely diagnosis?

A.
Abortion inevitable abovtion

B.
Cervical pregnancy

C.
Threat of abortion

D.
Incipient abortion

E.
Interrupted fallopian pregnancy

199.The woman who has delivered twins has early postnatal hypotonic uterine bleeding reached
1,5% of her bodyweight. The bleeding is going on. Conservative methods to arrest the bleeding
have been found ineffective. The conditions of patient are pale skin, acrocyanosis, oliguria. The
woman is confused. The pulse is 130 bpm, BP– 75/50 mm Hg. What is the further treatment?

A.
Total hysterectomy

B.
Subtotal hysterectomy

C.
Uterine vessels ligation

D.
Inner glomal artery ligation

E.
Putting clamps on the uterine cervix

200.
A 37 y.o. primigravida woman has been having labor activity for 10 hours. Labor pains last for 20-
25 seconds every 6-7 minutes. The fetus lies in longitude, presentation is cephalic, head is pressed
upon the entrance to the small pelvis. Vaginal examination results: cervix of uterus is up to 1 cm
long, lets 2 transverse fingers in. Fetal bladder is absent. What is the most probable diagnosis?

A. Primary uterine inertia

B. Secondary uterine inertia


C. Normal labor activity

D. Discoordinated labor activity

E. Pathological preliminary period

I.