Krok 1 – 2018 (General Medicine)

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

Autopsy of a woman revealed the following morphologic changes: stenosis of the atrioventricular opening, mitral insufficiency. Histologically there are focal cardiosclerosis and ”blooming” Aschoff nodules in the myocardium. What is the most likely diagnosis?

After a case of sepsis a 27-year-old woman developed ”bronzed” skin di-scoloration characteristic of Addison’s disease. Hyperpigmentation mechanism in this case is based on increased secretion of:

A 16-year-old girl presents with no hair on the pubis and in the armpits, her mammary glands are underdeveloped, no menstruations. What hormone imbalance can it be indicative of?

From the feces of a patient with acute gastroenteritis a pure culture of microorganisms was obtained. The microorganisms are small mobile slightly curved gram-negative bacilli that within 6 hours grow into a light blue film on the 1% alkaline peptone water. Such properties are characteristic of the following microorganism:

A patient was brought into the infectional diseases hospital on the 8th day since the disease onset. The patient complains of headache, malaise, and weakness. A sample of blood was taken for the serological test. Widal agglutination test results with blood sample diluted 1:200 and typhoid fever O-diagnosticum were positive. What diagnosis can be made based on the results of this test?

Protective function of saliva is based on several mechanisms, including the presence of enzyme that has bactericidal action and causes lysis of complex capsular polysaccharides of staphylococci and streptococci. Name this enzyme:

In the process of hemoglobin catabolism iron is released and then as a part of special transport protein is returned to the bone marrow, to be used again for hemoglobin synthesis. Name this transport protein:

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

An 18-year-old student presents with enlarged thyroid gland accompanied by accelerated metabolism and increased heart rate. These signs can be observed during hypersecretion of thyroxin. What organelles of thyroid cells are primarily responsible for hormone production and secretion?

A patient complains of pain in the upper umbilical region. On palpation there is a mobile painful intestine. What intestine is being palpated by the doctor?

A laboratory experiment on a dog was used to study central parts of auditory system. One of the mesencephalon structures was destroyed. The dog has lost the orienting response to auditory signals. What structure was destroyed?

Histological investigation of the uterine scrape of the 45-year-old woman with disturbed ovarian menstrual cycle revealed increased number of endometrial glands, some of which are serrated, while others are dilated and cyst-like. Make the diagnosis:

A 45-year-old man diagnosed with hepatic cirrhosis and ascites underwent drainage of 5 liters of fluid from his abdominal cavity, which resulted in development of syncopal state due to insufficient blood supply to the brain. What circulatory disorder occurred in the abdominal cavity in this case?

During cholecystectomy besides cystyca another artery was pulled into the ligature. Ligation of this artery resulted in right-sided necrosis of the liver which led to the death of the patient. What artery was mistakenly ligated along with a. cystyca?

Microscopy of the puncture sample obtained from the inflammation focus of the patient with cutaneous abscess revealed numerous blood cells of different types. What cells are the first to transfer from vessels to tissues during inflammation?

During the first year of life an infant presents with disturbed process of breast milk curdling. What cells of the proper gastric glands are functionally disturbed?

A lab rat has subcutaneously received mercury(II) chloride in the amount of 5 mg/kg. 24 hours later the plasma creatinine concentration increased several times. What mechanism of retention azotemia is observed in this case?

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

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

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

A 2-year-old child presents with physical retardation and frequent pneumonias. The child was diagnosed with non-closure of the arterial canal. Hemodynamics disturbance in this case is caused by communication between the:

A child diagnosed with purulent inflammation of the middle ear was brought to the otolaryngology department. The disease started with the inflammation of the nasopharynx. It was determined that the infection had reached the tympanic cavity through the eustachian tube that is located in the:

During the prestart period an athlete develops increased frequency and force of cardiac contractions. These changes are caused by intensification of the following reflex responces:

Due to trauma the patient has lost 25% of circulating blood volume. Name the emergency compensatory mechanism against blood loss:

ECG analysis of the patient shows that the T waves are positive in the second standard limb lead and their amplitude and duration is normal. The conclusion can be made that the following process occurs normally in the patient’s ventricles:

A patient demonstrates sharp decrease of pulmonary surfactant activity. This condition can result in:

After a case of common cold the patient developed numbness of the right side of the face. Examination revealed disturbed pain and thermal sensitivity in the right half of the face. What nerve was damaged?

X-ray examination of a 57-year-old man indicates local areas of hard bone tissue resorption in some of the patient’s bones. These changes can be associated with increased activity of:

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

During autopsy of a 34-year-old man, who died of chronic kidney failure due to renal amyloidosis, in the lungs (mainly in the lower lobes) the pathologist detected multiple bronchial dilations filled with purulent masses accumulated in the bronchial lumen. Surface of the lungs section has fine-meshed pattern and resembles a honeycomb. Histologically there is a chronic inflammation detected in the bronchial wall, muscle fibers are replaced with connective tissue. These changes in the lungs can be defined as:

Initial inoculation of water in 1% peptone water resulted in growth of a thin film on the medium surface in 6 hours. Such cultural properties are characteristic of causative agent of the following disease:

A 30-year-old man complains of suffocation, heaviness in the chest on the right, general weakness. Body temperature is 38.9^oC. Objectively the right side of the chest lags behind the left side during respiration. Pleurocentesis yielded exudate. What is the leading factor of exudation in the patient?

A 42-year-old man with gout presents with high content of uric acid in blood. The patient was prescribed allopurinol to lower the concentration of uric acid. Allopurinol is a competitive inhibitor of the following enzyme:

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

A patient complains of dizziness, thirst, difficult swallowing, and impaired vision of close objects. Objectively: respiratory rate is increased, pupils are dilated, general agitation, talkativeness, though the speech is indistinct. BP is 110/70 mm Hg, heart rate is 110/min. Given symptoms can indicate overdosage of the following drug:

A patient presents with indigestion, stomachaches, and excessive salivation. Similar symptoms had already been observed in this patient previously. Laboratory analysis detected oval eggs covered with lumpy capsules in the patient’s feces. What is the most likely cause of the patient’s disorder?

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

During removal of the hyperplastic thyroid gland of a 47-year-old woman, the parathyroid gland was damaged. One month after the surgery the patient developed signs of hypoparathyroidism: frequent convulsions, hyperreflexia, laryngospasm. What is the most likely cause of the patient’s condition?

On examination the patient presents with hirsutism, moon-shaped face, stretch marks on the abdomen. BP is 190/100 mm Hg, blood glucose is 17.6 mmol/L. What pathology is such clinical presentation characteristic of?

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

A 40-year-old pregnant woman underwent amniocentesis. Examination determined the fetal karyotype to be 47, XY+21. What fetal pathology was detected?

A patient used an indirect-acting adrenergic agonist to treat rhinitis. After the patient has been putting in the nose drops for several days, the vasoconstrictive effect of the drug gradually diminished. Name this phenomenon:

In a township there was registered an outbreak of hepatitis, which had supposedly spread through the water supply. What hepatitis virus could be the cause of the outbreak in this township?

A medical student was hospitalized into the infectious diseases unit on the 2nd day after the disease onset; the patient is suspected to have infectious mononucleosis. What results of laboratory analysis can confirm this diagnosis immediately on the day of the hospitalization?

A 64-year-old woman presents with disturbed fine motor function of her fingers, marked muscle rigidity, and tremor. The neurologist diagnosed her with Parkinson’s disease. What brain structures are damaged resulting in this disease?

A 20-year-old young man with tall stature, asthenic body type, signs of hypogonadism and gynecomastia, and low sperm count (azoospermia) has karyotype 47, XXY. What hereditary syndrome can be characterized by this chromosomal anomaly?

Pathogenic staphylococcus was obtained from the purulent wound of the patient. Its antibiotic sensitivity was determined to be as follows: penicillin growth inhibition zone – 8 mm; oxacillin – 9 mm, ampicillin – 10 mm, gentamicin – 22 mm, lincomycin – 11 mm. What antibiotic should be chosen for treatment in this case?

A patient presents with dilated blood vessels of the anterior medial surface of the lower leg. This condition resulted from the dilation of the following blood vessel:

A patient, who had received a thermal burn, developed painful boils filled with turbid liquid on the skin. What morphological type of inflammation has developed in the patient?

Nitrogen is being excreted from the body mainly as urea. When activity of a certain enzyme in the liver is low, it results in inhibition of urea synthesis and nitrogen accumulation in blood and tissues. Name this enzyme:

Coronary artery thrombosis resulted in development of myocardial infarction. What mechanisms of cell damage are leading in this disease?

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

Histological specimen shows organ parenchyma to consist of lymphoid tissue that forms lymph nodules; the nodules are located diffusely and have a central artery. What anatomical structure has such morphological characteristics?

A 25-year-old woman complains of visual impairment. Examination revealed disturbed eye accommodation, the pupil is dilated and unresponsive to light. What muscles are functionally disturbed in this case?

A patient with hypochromic anemia has hair with split ends and suffers from hair loss. The nails are brittle. Gustatory sensations are affected. What is the mechanism of development of these symptoms?

A patient suffers from hepatic cirrhosis. What substance excreted in urine should be analyzed to characterize the antitoxic function of liver?

A 65-year-old woman, who had been suffering from deep vein thrombophlebitis of the lower leg, suddenly died when awaiting her appointment with the doctor. Autopsy revealed loose friable red masses with corrugated dull surface in the main pulmonary artery and its bifurcation. What pathologic process was discovered by the pathologist in the pulmonary artery?

Blood of the patients with diabetes mellitus shows increased content of free fatty acids. Name the most likely cause of this:

Representatives of a certain human population can be characterized by elongated body, height variability, decreased volume of muscle mass, increased length of limbs, decreased size and volume of rib cage, increased perspiration, decreased indices of base metabolism and fat synthesis. What type of adaptive evolution is it?

A 56-year-old man complains of thirst and frequent urination. The endocrinologist diagnosed this patient with diabetes mellitus and prescribed him glibenclamide. What mechanism of action does this drug have?

Patients with bile duct obstruction typically present with inhibited blood clotting and develop hemorrhages due to insufficient assimilation of vitamin:

A test animal receives electrical impulses that irritate the sympathetic nerve that innervates blood vessels of the skin. What reaction will it cause in the blood vessels?

Examination of the coronary arteries revealed atherosclerotic plaques with calcinosis that narrow the arterial opening by 1/3. In the muscle there are numerous whitish layers of connective tissue. Name the process detected in the myocardium:

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

The carotid bodies on both sides were removed in a test animal. Which of the listed factors WILL NOT be able to cause hyperventilation in the test animal?

Due to prolonged stay in the mountains at the altitude of 3000 m above the sea level, a person developed increased oxygen capacity of blood, which was directly caused by intensified production of:

A woman has been limiting the amount of products in her diet to lose some weight. 3 months later she developed edemas and her diuresis increased. What dietary component deficiency is the cause of this?

A microslide of the lung tissue sample taken from a patient with pneumonia shows damage to the cells that carry out respiratory function. What cells of the alveolar wall are damaged?

After a psychic trauma a woman developed periodical increases in her blood pressure accompanied by headache, palpitations, and general weakness. What mechanism of hypertension development does this woman have?

An electron micrograph of a nephron segment shows cuboidal cells with ciliated lining on their apical surfaces; their basal surfaces have basal striation with mitochondria located between the cytolemma invaginations. Name the described nephron segment:

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

A force generated by the muscle is not enough to lift a load. What type of muscle contraction occurs in this case?

Condition of a patient with diabetes mellitus sharply deteriorated after a regular injection of insulin. The patient became anxious and broke out in cold sweat; tremor of the extremities, general weakness, and dizziness appeared. What medicine can remove these symptoms?

Microscopy of the myocardium of a girl, who died of diphtheria due to heart failure, shows fatty degeneration, multiple foci of cardiomyocytes necrosis, and small foci of cellular infiltrates in the interstitium. What type of myocarditis is it?

A schizophrenia patient was prescribed aminazine. What pharmacodynamic action of this drug is the grounds for its prescription in this case?

A 40-year-old man developed skin redness and swelling in the neck area, where eventually a small abscess appeared. On section the focus is dense and yellow-green colored. In the purulent masses there are white granules. Histologically there are fungal druses, plasma and xanthome cells, and macrophages detected. Specify the most correct etiological name of this pathological process:

A patient was hospitalized into the infectious diseases unit on the 11th day since the disease onset and provisionally diagnosed with typhoid fever. What biological material should be collected from the patient for the analyzes at this stage?

A man with ischemic heart disease has been taking his medicine too often throughout a day, which resulted in poisoning. Examination detects cyanosis of skin and mucosa, sharp drop of blood pressure, tachycardia, and respiratory depression. Blood methemoglobin is high. What type of medicine did the patient overdose on?

General structure of eukaryotic genes is as follows: exon-intron-exon. Such functional structure of a gene leads to certain specifics of the transcription process. What sequence will correspond with precursor mRNA (immature)?

Atria of a test animal were superdistended with blood, which resulted in decreased reabsorption of Na⁺ and water in renal tubules. This can be explained by the effect of the following factor on the kidneys:

A patient with clinical signs of a primary immunodeficiency has functionally disturbed mechanism of antigen-presentation to the immunocompetent cells. What cells are likely to have structural defects?

During intensive muscle work there is a large amount of ammonia produced in the muscles. What amino acid plays the main role in the transportation of ammonia to the liver and participates in gluconeogenesis reactions?

Encephalopathy has developed in a child with hemolytic disease of the newborn. What substance had increased in the child’s blood, resulting in damage to the CNS?

Renal examination shows the kidney to be swollen and plethoric, with easily removable capsule. Renal pelvis and calyces are dilated and filled with turbid urine; their mucosa is dull and has hemorrhagic foci. On section the renal tissue is variegated, there are yellow-gray areas surrounded with plethoric and hemorrhagic zone. What disease can be characterized by such results of macroscopic examination?

A 54-year-old man complains of general weakness, frequent colds, and bruises constantly appearing on his body. Blood test: erythrocytes – 2.5 × 10¹²/L; Hb- 80 g/L; color index – 0.9; reticulocytes – absent; platelets – 50 × 10⁹/L; leukocytes – 58 × 10⁹/L; leukogram: basocytes – 5%, eosinophils – 15%, myeloblasts – 6%, myelocytes – 10%, juvenile – 18%, stab neutrophils – 26%, segmented neutrophils – 10%, lymphocytes – 8%, monocytes – 2%, ESR – 40 mm/hour. What hematologic conclusion can be made?

A mutation has occurred in a cell in the first exon of the structural gene. The number of nucleotide pairs changed from 290 to 250. Name this type of mutation:

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

Due to destruction of certain structures of the brainstem a test animal has lost its orientation reflexes in response to strong light stimuli. What structures were destroyed?

A toxin neutralized with 0.4% formaldehyde under 37-40^oC for 4 weeks is used for vaccination. This preparation was first used by Gaston Ramon for diphtheria prevention. Name this preparation:

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

The right leg of a 40-year-old woman measured at the shin level is by 2 cm smaller in the diameter than the left leg. Ankle-jerk (Achilles) and knee-jerk reflexes are absent on the right. What is the most likely mechanism of hyporeflexia development during peripheral paralysis?

A 38-year-old man, who has been suffering from systemic lupus erythematosus for 3 years, developed diffuse renal lesions accompanied by massive edemas, marked proteinuria, hyperlipidemia, and dysproteinemia. What is the most likely mechanism of proteinuria develoment in this case?

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

A  25-year-old  woman at  her  third  pregnancy with impending miscarriage was brought to the hospital. What combination of Rh-factor of the mother and the fetus can be the cause of this condition?

A specimen of a 10-day-old human embryo shows two interconnected sacs (amniotic and yolk sacs). Name the structure located in the place where these two sacs connect:

A woman with the III (В), Rh (-) blood group gave birth to a child with the II (А) blood group. The child is diagnosed with hemolytic disease of newborn caused by rhesus incompatibility. What blood group and Rh does the father have?

A 40-year-old woman suffers from Cushing’s disease – steroid diabetes. On biochemical examination she has hyperglycemia and hypochloremia. What process activates in the first place in such patients?

A patient with a chemical burn has developed esophageal stenosis. The patient presents with acute weight loss due to problematic food intake. Blood test: erythrocytes – 3.0 × 10¹²/L, Hb- 106 g/L, total protein – 57 g/L. What type of starvation does this patient suffer from?

Autopsy of the body of a man, who for a long time had been working at the  factory with high content of silicon dioxide in the air, revealed enlarged dense lungs with numerous round and oval sclerotic foci. The foci were miliary and larger in size and colored gray or gray-black. What is the most likely diagnosis?

Autopsy of the body of a 50-year-old man, who had been suffering from tuberculosis and died of cardiopulmonary decompensation, shows lobar affection of the lungs: the upper lobe of the right lung is enlarged, dense, yellow on section, crumbling, with pleural fibrin deposition. What type of secondary tuberculosis can be characterized by this pathology?

A woman has come to the hospital with complaints of general weakness, dizziness, and dyspnea. Recently she has been taking levomycetin (chloramphenicol) for prevention of enteric infection. Blood test: erythrocytes – 1.9 × 10 ¹²/L, hemoglobin – 58 g/L, color index – 0.9, leukocytes – 2.2 G/L, reticulocytes – 0.3%. What type of anemia is it indicative of?

Preoperative examination revealed prothrombin deficiency in the blood of the patient. What drug should be preliminarily prescribed to mitigate blood loss in the patient during the surgery?

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

A microslide of the skin sample taken from the finger of a child shows that epidermis is insufficiently developed. What germ layer was damaged in the process of embryo development?

Neutralization of xenobiotics and active endogenous metabolites often occurs via introduction of an oxygen atom into the substrate molecule. What process occurs as the result?

In the process of an experiment, vascular resistance to the blood flow was measured in the different areas of circulatory system. The highest resistance was detected in the:

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

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

A 46-year-old patient suffering from ulcer disease of the stomach is diagnosed with rheumatoid arthritis. What antii-nflammatory drug would be the most advisable in this case?

A patient with myocardial infarction has acute heart failure. Among the drugs that increase the force of heart contractions the least dangerous in this case will be:

During intensive physical exertion, one of the energy sources for the working muscles is glucose produced as the result of gluconeogenesis. This process is the most intensive in the following organ:

During influenza epidemic, morbidity in the schoolchildren, who did not participate in sports, was 40%, while in the schoolchildren, who engaged in regular physical activities, morbidity did not exceed 20%. What adaptation mechanism ensured low morbidity in the physically active schoolchildren?

Monoamine oxidase inhibitors are widely used as psychopharmacological drugs. They change the level of nearly all neurotransmitters in synapses, with the following neurotransmitter being the exception:

A 17-year-old girl suffers from periodical palpitations that last several minutes. Her heart rate is 200/min., rhythmic. What heart rhythm disorder developed in this patient?

Kidney X-ray image obtained by means of pyelography shows that the minor calyces converge to form 2 major calyces that adjoin to the renal pelvis, from which the ureter exits. What type of urinary tract is it?

A patient has been brought into a surgical ward with an incised wound of the anterior surface of the shoulder in its lower one-third. Flexing function was disturbed in the shoulder and elbow joints, which is caused by the damage to the:

A patient suffers from acute cardio-pulmonary failure with pulmonary edema. What diuretic should be prescribed in the given case?

Ketosis develops in the patients with diabetes mellitus, as the result of activation of fatty acids oxidation processes. What acid-base imbalance can result from accumulation of excessive ketone bodies in the blood?

A 5-year-old child is diagnosed with Bruton syndrome (X-linked agammaglobulinemia) that manifests itself as severe clinical course of bacterial infections and absence of B lymphocytes and plasma cells. What changes of immunoglobulin content can be observed in blood serum of the child with immunodeficiency?

During the skill-building session in microbiology the students need to stain the prepared and fixed sputum smears obtained form a tuberculosis patient. What staining technique should be used in this case?

A woman with hypophyseal diabetes insipidus developed a water-mineral imbalance. What type of water-mineral imbalance develops in such cases?

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

In an experiment it is necessary to assess neuromotor and muscle excitability. What value should be measured to make the assessment?

Vestibular  receptors  of  semicircular canals of a test animal have been destroyed. What reflexes will disappear as a result?

Acute renal impairment caused death of a patient with hemorrhage. Autopsy revealed enlarged kidneys with broad pale pink cortical layer expressively demarcated from dark red renal pyramids. Macroscopic examination revealed lack of epithelial nuclei of the convoluted tubules, tubulorrhexis, phlebostasis. The cell nuclei of the choroid glomus and straight tubules were present. What pathology is it?

A boxer had sustained a blow to the left parotid area, after which he developed paralysis of the facial muscles on this side. What nerve had been damaged?

A patient has an open facial wound with undermined edges; tissue necrosis with gradually developing partial gangrene that nearly reaches the bone tissue is observed. On close examination the wound contains live larvae. The patient is diagnosed with tissue myiasis. What Diptera larvae are the causative agents of this disease?

A hereditary disease – homocystinuria – is caused by disturbed transformati-on of homocysteine into methionine. Accumulated homocysteine forms its dimer (homocystine) that can be found in urine. What vitamin preparation can decrease homocysteine production?

During hypersensitivity skin test a patient received an allergen subcutaneously, after which the patient developed skin redness, edema, and pain due to histamine action. This biogenic amine is produced as the result of the following transformation of histidine amino acid:

During the fight a man has received a strong blow to the upper anterior abdominal wall, which resulted in the cardiac arrest. What mechanism has led to the cardiac arrest in this case?

A woman has lost a lot of blood during the childbirth. Her blood group needs to be determined. Erythrocyte agglutination occurred with standard serums 0 (I) and А (II) and did not occur with standard serum B (III). What blood group does this woman have?

A 60-year-old man diagnosed with chronic heart failure was brought to the hospital. After a long course of treatment the patient developed signs of intoxication: dyspnea, extrasystole, nausea, and disturbed perception of colors. What medicine has caused such side-effects?

A patient with exacerbated peptic ulcer disease of the stomach has made an appointment with the doctor. What type of drugs should be included in the complex therapy of this patient?

Autopsy of the body revealed waxy degeneration of the rectus abdominis muscles. In the terminal segment of the small intestine there are ulcers 3-5 cm in diameter. The ulcer walls are covered in a crumbling grayish-white substance. The ulcer edges are markedly raised above the mucosa. Widal test is positive. Make the diagnosis:

Genealogical analysis of a child with myotonic dystrophy determined that this disease is present in every generation, equally presented by the relatives of both genders, the risk of inheriting this disease is equal no matter which parent is affected. If one of the parents is heterozygous for this disease and the other parent is healthy, the risk of them giving birth to a sick child is 50%. What type of disease inheritance is it?

A 30-year-old man has undergone surgical removal of a thyroid tumor. Histologically the tumor is made up of papillary structures varying in size that emerge from the inner surface of dilated cystic follicles and are covered with atypical epithelium. What is the most likely diagnosis?

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

Various biological preparations can be used for poliomyelitis prevention. What drug induces the type of local intestinal mucosal immunity that lasts the longest?

Histological analysis of a removed skin tumor shows clusters and bands composed of atypical stratified squamous epithelium cells that penetrate into the underlying tissue. What preliminary diagnosis can be made?

Autopsy of a patient, who died of bi-lateral bronchopneumonia, shows in the left lung lower lobe a cavity 5 cm in diameter, filled with yellowish-white liquid. What complication of the patient’s pneumonia had developed?

A patient with parkinsonism was prescribed levodopa, which led to rapid improvement of the patient’s condition. What is the mechanism of action of this drug?

A sick child presents with high content of phenyl pyruvate in urine (normally it is practically absent). Blood phenylalanine level is 350 mg/L (norm – 15 mg/L). What disease are these symptoms characteristic of?

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

A patient presents with enlarged cervical lymph nodes. Other lymph nodes and internal organs are without changes. Peripheral blood test results are normal. Histological examination of biopsy material taken from the cervical lymph node shows smoothed-out pattern, absent follicles, homogeneous cell composition represented by lymphoblasts. The cells penetrate into the lymph node capsule. What diagnosis can be made?

When studying the pulmonary ventilation values, the reduction of forced expiratory volume has been detected. What is the likely cause of this phenomenon?

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

Sanitary assessment of a pond, where the children from a recreation summer camp take their swims, detected there oval cysts 50-60 micron in diameter, with 2 nuclei visible in their cytoplasm (macronucleus and micronucleus). What protozoa do these cysts belong to?

A hospital has received a 24-year-old man, who had received a penetrating wound to the eye, which has caused the vitreous body to run out. As the result of this, retinal detachment occurred. What retinal layer was tightly adherent to the vascular tunic of the eye and did not detach?

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

Stool test detects in the patients feces a large amount of undigested fats.This patient is the most likely to have disturbed secretion of the following enzymes:

A 19-year-old young man was examined in the nephrology clinic. High calcium was detected in his secondary urine. What hormone is likely to cause such change, if it is produced in excess?

A young woman presents with a tumor along the auditory nerve. The tumor is node-shaped, 3 cm in diameter, soft and elastic, pink-white colored, and has homogeneous structure. Microscopically the tumor contains bundles of cells with oval nuclei. These cellular fibrous bundles form regular structures made up of parallel rows of regularly oriented cells arranged in the form of a palisade with acellular homogeneous area in between (Verocay bodies). Name this type of tumor:

A patient has undergone surgical removal of the pylorus. Decreased secretion of the following hormone can be expected:

An electron micrograph shows a small vessel with endothelial layer but without basement membrane and pericytes; anchoring fibrils are present. Name this vessel:

One of the causes of pernicious anemia is disturbed synthesis of transcorrin – Castle’s intrinsic factor – by the parietal cells of the stomach. What substance is called Castle’s extrinsic factor?

A patient with contact dermatitis needs to be prescribed an antihistamine drug without somnolescent effect. Select this drug from the list:

Congenital pyruvate carboxylase deficiency causes physical and mental retardation in children and leads to early death. It is characterized by lactic acidemia, lactaciduria, and a number of metabolic disorders. Among others, inhibition of the following occurs:

A woman with enteritis accompanied by severe diarrhea presents with loss of water in the extracellular space, increased water content in the cells, and decreasing blood osmolarity. Name this type of water-electrolyte imbalance:

To stimulate the labor activity a parturient woman was prescribed a drug – a posterior pituitary hormone that does not affect the blood pressure. As the pregnancy progresses, the sensitivity to this hormone increases. Name the prescribed drug:

Cell membrane rest potential changed from -85 to -90 mV. It can be caused by activation of the following cell membrane channels:

Ionizing radiation or vitamin E deficiency affect the cell by increasing lysosome membrane permeability. What are the possible consequences of this pathology?

A patient is diagnosed with glucocerebroside lipidosis (Gaucher’s disease) that manifests as splenomegaly, liver enlargement, affected bone tissue, and neuropathies. What enzyme of complex lipid catabolism is deficient, thus causing this disease?

A 3-year-old girl with mental retardation has been diagnosed with sphingomyelin lipidosis (Niemann-Pick disease). In this condition the synthesis of the following  substance is disturbed:

A traumatology unit has received a patient with a wrist trauma and a clinical presentation of the damage to the nerve that passes through the carpal tunnel. Name this nerve:

A patient, who has been taking β-adrenergic blockers, developed a bronchial spasm. What group of bronchodilators should be chosen to stop the bronchial spasm?

A man has an inguinal hernia. The hernial sac exits through the following opening:

After a nephrectomy the patient developed enteroparesis. What cholinergic agent with anticholinesterase action should be prescribed in this case?

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

An obstetrician-gynecologist measures pelvis size of a pregnant woman. A caliper was used to measure the distance between the two iliac crests. What measurement of large pelvis was made?

Genetic recombination is achieved via several mechanisms. One such mechanism is crossingover. It occurs at the following stage of prophase in the first meiotic division:

ECG of the patient shows increased duration of the QRS complex. What is the most likely cause?

A 50-year-old inpatient during examination presents with glucosuria and blood glucose of 3.0 mmol/L, which are the most likely to be caused by:

A 40-year-old woman was diagnosed with glomerulonephritis based on her clinical symptoms and the results of urine analysis. Anamnesis states chronic tonsillitis. What microorganisms are the most likely cause for her kidney damage?

A 7-year-old child presents with marked signs of hemolytic anemia. Biochemical analysis of erythrocytes determined low concentration of NADPH and reduced glutathione. What enzyme is deficient in this case leading to the biochemical changes and their clinical manifestations?

When examining a biopsy material obtained from the thyroid gland, the pathologist discovered lymphocyte infiltration of the thyroid tissues and destruction of the parenchymal elements. Diffuse lymphocyte infiltration with lymphoid follicles was detected in the stroma. What is the most likely diagnosis?

An 8-year-old girl presents with signs of disturbed twilight vision. This condition is caused by the deficiency of vitamin:

A 25-year-old young man came to the doctor complaining of general weakness, rapid fatigability, irritability, reduced working ability, and bleeding gums. What vitamin is likely to be deficient in this case?

A 52-year-old man presents with fever and pain in the joints. Both of his first metatarsophalangeal articulations are deformed, swollen, and reddened. Blood urea is high. The patient is diagnosed with gout. What is the main developmental factor in the pathogenesis of this disease?

A person with the fourth blood group (genotype IAIB) has in erythrocytes both antigen A controlled by allele IA and antigen B controlled by allele IB. This phenomenon is an example of the following gene interaction:

Vascular endothelium is characterized by high metabolic activity and synthesizes vasoactive substances. Among these substances there is a potent vasodilator synthesized from L-arginine. Name this vasodilator:

A victim of a traffic accident was received by the intensive care unit. The patient is in a grave condition that can be characterized as a severe pathologic process that leads to exhaustion of vital functions and puts the patient into the marginal state between life and death due to critical reduction of capillary circulation in the affected organs. The patient is in the state of:

A person becomes less receptive to pain in physically or emotionally straining situations due to activation of:

A patient suffers from posttraumatic hemorrhage that resulted in development of hemorrhagic shock. What volume of circulating blood was lost by the patient?

A patient with pulmonary tuberculosis is prescribed the most effective anti-tuberculous antibiotic. Name this drug:

During surgery performed in abdominal cavity a surgeon located the ligament of liver stretching from the anterior abdominal wall (navel) to the inferior surface of liver. What ligament is it?

A patient has disturbed blood supply to the anterior papillary muscle of the left ventricle. What cardiac artery supplies this muscle with blood?

Autopsy of the body of an elderly man revealed yellow spots and streaks in the aortic intima and white-yellow protruding plaques in the area of aortic bifurcation. Microscopy (with hematoxylin and eosin staining) shows round cavities in the thickened aortic intima. The cavities color orange when stained with sudan 3 and are surrounded with overgrown connective tissue. What process developed in the aortic intima?

An 18-year-old patient has developed candidiasis after the case of pneumonia treated with β-lactam antibiotic. What anti-mycotic agent should be prescribed?

Preventive vaccination against poliomyelitis is made with inactivated vaccine introduced parenterally. What immunoglobulins create the postvaccinal immunity in this case?

During pregnancy a woman has been taking an antiepileptic drug – sodium valproate. It resulted in her child developing a vertebral column malformation – spina bi-fida. Name the described effect of the drug:

A patient was prescribed atropine sulfate to treat intestinal colic. What concomitant disease can be a contraindication for this drug?

A patient has developed status epilepticus. What medicine should be used in this case to stop the seizures?

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

In human organism significant blood loss leads to decreased blood pressure, tachycardia, and weakness. Eventually the sensation of thirst appears. What hormone participates in the development of this sensation?

After a trauma the man has lost skin sensitivity on the lateral surface of his forearm. What nerve of the brachial plexus  provides sensitivity of the affected area?

Autopsy of a 50-year-old woman, who had been suffering from systemic connective tissue disease, reveals small dense kidneys with lumpy surface. Microscopy of the renal glomeruli detects there foci of fibrinoid necrosis, hyaline thrombi, hematoxylin bodies, and so-called ”wire loop thickening” of the basement membranes. What disease can be characterized by such changes in the kidneys?

A 4-year-old child presents with numerous carious cavities and yellow-colored teeth. The mother has a history of antibiotic treatment during her pregnancy. What antibiotic was the most likely taken by the child’s mother?

A patient developed pyoinflammatory process of periodontal tissues caused by activation of the microorganisms inherent in the body, which are a part of oral mucosal microflora. What type of infection is it?

After a hand fracture the man has lost the ability to touch his little finger with the thumb on the affected hand. Examination of the palmar surface shows one of the palmar muscles to be atrophied. Name the affected muscle: