Krok 1 – 2021(Jun 30) (General Medicine)

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

A 3-year-old child has been brought to the paediatrics department with a non-closure of the anterior fontanelle. At what age docs it normally occur?

A man with tetanus developed acute respiratory failure. What type of respiratory failure develops in such cases?

In von Gierke disease, glycogen accumulation can be observed in liver and kidneys. This disease is caused by deficiency of the following enzyme:

A 14-year-old boy was diagnosed with Hutchinson’s triad: barrel-shaped teeth, parenchymatous keratitis, and deafness. These signs are characteristic of:

Oxygen supply of skeletal muscles during their intensive work is often problematic because of compressed vessels and disrupted blood flow. What supplies muscles with oxygen in this case?

Hematologic study shows the following pattern: erythrocytes 2.8 x 10¹²/L, Hb- 80 g/l, color index – 0.85, recylocytes-0.1%, platelets – 160 thousand per microliter, leukocytes 60 x 10⁹/L, basocytes – 2%, eosinophils – 8%, promyelocytes – 5%, myelocytes – 5%, juvenile – 16%, stab neutrophils – 20%, segmented neutrophils – 34%, lymphocytes – 5%, monocytes – 5%. This clinical presentation indicates the following blood pathology

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

Patients with B12-deficiency anaemia develop degenerative processes in the posterior and lateral columns of the spinal cord (funicular myelosis). In this case, the damage to the axons is caused by the disturbed formation of:

During a surgery with application of inhalation narcosis and muscle relaxants, the anaesthesiologist noticed rapid increase of the patient’s body temperature to 43°C. What pathology developed in this patient?

A person has been bitten by a snake, which led to asphyxia and haemoglobin in urine. Erythrocyte hemolysis occurs in blood. Toxic snake venom causes;

Before prescribing a protein parenteral nutrition to an emaciated patient, the doctor has referred the patient for serum protein electrophoresis. This technique is based on the following physicochemical properties of proteins:

A duct must contain fats. What plasticity function do they fulfill in the body?

During analysis a medical laboratory scientist has additionally noted that the blood sample was obtained from a woman. What blood corpuscles have the structural characteristics that allow making such a conclusion?

Autopsy of the body of a person, who died after an abdominal surgery, revealed numerous thrombi in the veins of the lesser pelvis. Clinically, thromboembolism syndrome was registered. Where should the pathologist search for thromboembolas?

Bacteriology testing is one of methods for laboratory diagnostics of diphtheria. To grow the colonies of C. diphtheriae, it is necessary to know the proper conditions for causative agent cultivation. What nutrient media are optimal for Corynebacterium diphtheriae cultivation?

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

Microslide an animal retina shows numerous phagosomes in the cells of its outer pigment layer. What function of pigment cells is the most evident in this case?

The ophthalmologist noticed a purulent discharge from the conjunctiva of a newbom. Microscopy of the smear obtained from the conjunctiva found there a large number of leukocytes, as well as gram negative bean-shaped diplococci located inside the leukocytes. What is the causative agent of this disease?

A child has signs of delayed physical and mental development (cretinism). This condition is caused by deficiency of the following hormone:

What drug is used for treatment of malaria, amoebic dysentery, and autoimmune diseases?

A man with heart failure presents with enlarged liver, leg edema, and ascites. What is the leading mechanism of edema formation in this case?

The patient is suspected to have infectious mononucleosis. What results of laboratory analysis can Sum this diagnosis immediately on the day of the hospitalization?

A woman with chronic hepatitis complains of increased sensitivity to barbiturates that previously she could take without any signs of intoxication. Her condition is mainly associated with disturbance of the following hepatic function:

A person has retained gustatory sensations, but overall sensitivity of the oral structures is lost, which indicates a damage to the:

A 48-year-old woman with diabetes mellitus has been hospitalized in a severe precomatose state. Analysis of her acid-base balance revealed metabolic acidosis. What primary mechanism is the cause of the changes detected in the woman’s acid- base balance?

A long-term taking of potassium preparations has caused hyperkalaemia in the patient. This condition results in the following changes in secretion:

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

In reperfusion syndrome, the processes of free radical oxidation activate, resulting in damage to cell membranes and disturbance of specific cell functions. These changes are associated with excessive i accumulation of the following ions in the cytoplasm:

Autopsy of the body of a 42- year-old man, who had chronic diffuse bronchitis and died of cardiopulmonary failure, shows large hyperinflated lungs that cover the mediastinum with their edges. The lungs do not deflate, are pale gray, emit crackling sound when cut. Pressing a finger to the surface of the lungs leaves an indentation. Bronchial lumen produces mucopurulent exudate. Make the diagnosis:

When a dentist applied hydrogen peroxide to the patient’s oral mucosa, it started frothing excessively. What enzyme breaks down hydrogen peroxide?

On examination a man presents with convergent strabismus, inward deviation of the eyeball and inability to move the eyeball outward. What nerve is damaged?

A patient complains of acute increase in diuresis (up to 5-7 litres of urine per 24 hours). Examination revealed decreased secretion of vasopressin in this patient. What cells have insufficient secretory activity in this case?

A 17-year-old girl is undergoing an examination. She has signs of pharyngitis, lymphadenopathy of neck, and fever and was previously diagnosed with infectious mononucleosis. What test can confirm the diagnosis at the onset of the disease?

After thorough examination, a man, who has returned to Ukraine from the Central Asia, was provisionally diagnosed with spring-summer encephalitis. In such cases, the causative agent is transmitted via the bites of a certain arthropod. Name this arthropod:

Excitation processes in cardiomyocytes have been studied in an experiment. It was determined that during the phase of their rapid depolarization Na+ ions can additionally move through the

Increased resistance to blood ejection from the left ventricle has activated the homeometric compensation mechanism in the patient. In what pathological process can this compensation mechanism develop in the left ventricle?

During a surgery, the surgeon’s manipulations in the area between the stomach and liver were extremely careful, to avoid damaging the hepatoduodenal ligament, because it contains:

A patient with essential hypertension was prescribed hydrochlorothiazide as a part of complex therapy. What mechanism of drug action facilitates a decrease in blood pressure in this case?

An older man with parkinsonism was prescribed a certain drug. Several days later the man developed complaints of dry mouth and rapid heart rate. The prescribed drug is a

During patient examination, the doctor conducts auscultation to assess the functioning of the mitral valve. Where can the tones of this valve be auscultated?

The synthesis rates of DNA. RNA, and necessary proteins are decreased in the cells of a human body and mitotic activity is insignificant. These changes most likely correspond with the following ontogenetic period

To assess their adaptation to physical exertion, the doctor has examined the workers after a severe workload. What changes in the complete blood count can be detected in this case?

To study hypoxia, a test animal was given a potassium cyanide solution. What type of oxygen starvation develops in this case?

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

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

Significant radiation exposure leads to changes in the body resistance, suppression of phagocytosis, reduction of non-specific humoral defense factors, and decreased antibody synthesis. what kind of infection develop as a result of radiation sickness?

During an outbreak of a hospital-acquired infection, pure cultures of S. aureus were obtained upon inoculation from the nasopharynxes of medical personnel and wound discharge of surgical patients. What analysis must be conducted to find the likely source of infection in this case?

What is used as an antidote for poisoning with salts of heavy metals?

A 56-year-old woman with angioneurotic edema was prescribed an Hi blocker with antispasmodic, sedative, and local anaesthetic action. Select this H1blocker from the list:

A man with acute rhinitis has dry and hyperaemic nasal mucosa. What cells of superficial mucosal epithelium normally provide its moisturizing?

During a dry for spleen injury, the surgeon needs to isolate an artery that supplies the spleen with blood. Which branch of the arterial vessel is it?

A patient suffers from disturbed renal function. To check the filtration ability of the kidneys, he was referred for clearance measurement of the following substance:

A woman with ischemic heart disease was prescribed amiodarone. This medicine has antianginal effect. What other effect does it have?

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

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

Synovial fluid is known to reduce the friction between articular surfaces. In rheumatism or arthritis, its viscosity decreases because of depolymerization (destruction) of the following substance:

After a severe case of poliomyelitis, disturbed function of the central nervous system has caused weakening of the movements of all four limbs in the patient. What diagnostic term is used to describe this condition?

A patient has cardiac rhythm disturbance. ECG shows heart rate of 60/min., prolongation of PQ interval, and periodical loss of QRS complex. What cardiac rhythm disturbance is it?

During a fall, a small child has received a trauma of the anterior fontanelle. What type of cranial bone junction was pathologically affected in this case?

An 8-year-old child had an acute onset of the disease. The death occurred two days after the onset. On the basal surface of the brain, autopsy shows acutely plethoric soft meninges that are soaked through with thick and turbid yellow-green exudate. Brain tissues are edematous. Make the diagnosis:

A man complains of itching skin between the fingers of his right hand. He was diagnosed with scabies. Name the preventive measures against this disease:

Histone protein synthesis is inhibited what structure will be affected?

After a myocardial infarction, the morphological intactness of the wall was restored in the patient. In this case, regeneration occurred because of the following tissue:

A man presents with osteoporosis. There are hypercalcemia and hypophosphatemia in his blood. What is the cause of his condition?

Liver diseases usually are accompanied by a marked tendency to bleed. Why is it so?

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?

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?

In experiment on an isolated squid giant axon submerged in a salt solution, the extracellular potassium ion concentration was increased to the level of the intracellular potassium ions concentration. What change in the membrane potential will occur in this case?

A patient, who for a long time was suffering from rheumatism and had mitral stenosis, died of cardiopulmonary failure. Autopsy revealed brown induration of the lungs. What circulatory disorder leads to such changes in the lungs?

Autopsy of the body 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?

A man has undergone a surgery for the removal of one third of his large intestine that was involved in a pathological process. How will water absorption change in this case, if water intake of this man remains as usual?

There is a sensation of tingling in thumb, index and middle finger, earlier pain was resolved using ibuprofen, but now the pain is much worse and wakes her up at night. She works as a typist and the pain often increases after typing all day. Her right wrist and fingers are line. Nerve conduction studies reveal nerve compression. Which of the following nerves is most likely compressed in this patient?

A 1.5-year-old boy, who previously received no regular immunization, was in contact with a measles patient. For urgent specific prevention, the child was administered donor gamma globulin. What type of immunity develops in this case?

What compensatory response occurs in the human body, when external temperature significantly rises?

A man has a node in his thigh that is located within the thigh muscles. On section, the node is whitish, fibrous, bout clear margins. Microscopy shows that the tumour consists of immature polymorphic fibroblast- cells with numerous mitoses and collagen fibres. What tumour is it?

An isolated cell of a human heart automatically generates excitation impulses at the rate of 60/min. This cell was obtained from the

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?

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

When studying section material, the pathologist has noticed folliculi lymphatici aggregati (Peyer’s patches) on the inner surface of an intestinal segment. This segment is a part of:

A man has atrioventricular block of the I degree with a prolonged PQ interval of 0.25 seconds. What cardiac ability is disturbed in this case?

A man has received a hit to the area of the inferior angle of the scapula on the right, which resulted in rib fracture. What ribs were damaged in this case?

When planning a diet, one should observe the correct ratio of nutrients proteins, fats, and carbohydrates. What is the correct ratio?

Watson and Crick determined that the DNA double helix structure is stabilized with the bonds between complementary nitrogenous bases. What type of bond is it?

Blood plasma of a healthy person contains several dozens of protein types. If a person becomes ill, new types of proteins develop in the body. Among them there are acute phase proteins. Name one such protein:

A man has undergone corneal transplantation. What characteristics of corneal structure allow hoping for its retention rather than rejection?

A man complains of a burning pain in the area of his heart. Based on the analysis of his ECG, he has been diagnosed with infarction of the posterior wall of the left ventricle. What artery has damaged branches in this case?

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

After examination, a man, who lived in the Ural region, was diagnosed with taiga encephalitis. The causative agent of this disease could have been transmitted to the patient via a bite of

Feces of a child with an acute intestinal infection were inoculated onto Endo medium, which resulted in growth of numerous raspberry-red colonies with a metallic sheen. It indicates that the colibacillus is the kely causative agent of the disease. What properly of the causative agent was used to distinguish it from other intestinal bacteria?

A man had a case of epidemic typhus 5 years ago. After an acute respiratory viral disease, against the background of weakened immune system, he developed signs of typhus again. The exacerbation occurred because of the causative agents, remaining in his body. What type of infection is it?

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

Name the supramolecular multienzyme complex that is integrated into the lipid layer of inner mitochondrial membrane that creates conditions for redox reactions:

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 gray-yellow substance. The ulcer edges are moderately raised above the mucosa. Widal test is positive. Make the diagnosis:

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

A 35-year-old woman was taking acetylsalicylic acid to relieve the pain in her carious tooth. After a time, she noticed digestive disorders, stomach heaviness, and heartburn. Why does this drug aggravate the gastric condition?

Examination of a patient, who for a long time was taking glucocorticoids, detected lymphopenia. How can the functional State of the patient’s immune- system be characterized?

A man for a long time was suffering from hemoblastosis. Autopsy of the body revealed brown color of the bone marrow, spleen, liver, and lymph nodes. Perl’s histochemical reaction was performed. It was determined that reticular, endothelial, and histiocytic elements of the affected organs contain blue granules. What pigment was detected using the Perl’s histochemical reaction?

An older man developed an acute cerebrovascular accident, followed by coma and death. Autopsy revealed a large blood-filled cavity in the right hemisphere of his brain. What pathological process was detected in the brain?

In the haematology unit a patient with leukaemia was prescribed 5- fluorouracil. This drug:

What differs a sanguinic from a phlegmatic?

A patient was brought by an ambulance to the inpatient department. He was provisionally diagnosed with acute pancreatitis. To confirm this diagnosis, it is necessary to measure the activity of a certain enzyme in the patient’s blood and urine. Name this enzyme:

A man had an acute onset of the disease. He complained of chills, fever of 40°C, headache, cough, and dyspnoea. The man died on the 5 day after the onset. Autopsy shows enlarged lungs with variegated appearance – «large variegated lung”. Such clinical presentation of the lungs is characteristic of the following disease:

A patient with suppurative bronchitis was hospitalized into the pulmonology department. As a part of complex therapy, he was prescribed a medicine that liquefies sputum and facilitates expectoration. Name this medicine:

During mental stress, a hormone- sensitive enzyme triacylglycerol lipase activates in fatty tissues. What secondary messenger takes part in activation of this enzyme?

Albinos are vulnerable to sunlight – instead of developing a suntan, they develop burns. This phenomenon occurs because of disturbed metabolism of a certain amino acid. Name this amino acid:

X-ray has detected multiple foci of osteoporosis and osteolysis in the flat bones of a man. Trephine biopsy material contains high levels of neoplastic plasma cells. Make the diagnosis:

The patient arterial hypertension is caused by renal artery stenosis. The main pathogenetic link of this type of hypertension is the activation of the following system:

A man, who has arrived from Tunisia, has alpha-thalassemia with hemolysis of erythrocytes and jaundice. The disease was diagnosed based on the presence of the following in the patient’s blood:

After a nephrectomy, a 40-year-old man has developed signs of anaemia. Why did these signs appear?

To study inflammations, a test animal was injected with a lethal dose of tetanus toxin into the cavity of a turpentine-induced abscess. However, the test animal did not die. What is the most likely cause of such test result?

Wernicke-Korsakoff syndrome often develops in chronic alcoholics, who have a low-vitamin dict. Decreased transketolase activity can be observed in the course causes this development?

According to the Schade’s physicochemical theory, hyperosmia, hyperonchia and acidosis can be observed in the area of inflammation. The development of hyperosmia is, to an extent, associated with the increasing concentration of K+ in the inflamed area. What causes the hyperkalaemia of the inflammatory exudate?

An 11-year-old girl is brought to the doctor’s office by her mother, who states that her daughter felt weak and had swollen face for 3 days. According to the mother, her daughter had always been healthy and active until the onset of the symptoms. Physical examination reveals generalized swelling of the face and pitting edema of the lower limbs. Upon inquiry, the girl describes a foamy appearance of her urine, but denies blood in urine, nycturia or pain during urination. Laboratory studies show proteinuria and microscopic hematuria. Which of the following is the most likely cause of the findings in the laboratory analysis of urine?

A 45-year-old man complains of dizziness, unsteady gait, and disturbed coordination of movements. Examination shows that he has osteochondrosis of the cervical spine and the vessel that passes through the transverse foramina of the cervical vertebrae is compressed. What vessel is it?

Examination shows that leukocyte count in the patient’s blood is 11 x 10⁹/L, with 80% neutrophils, among which 9% are band neutrophils. Characterize the changes in the cell composition of white blood in this case:

A man with multiple myeloma presents with protein in his urine What type of proteinuria does he have?

A 40-year-old man has died of a pulmonary haemorrhage. In the upper lobe of the right lung, autopsy shows a cavity 4 cm in diameter with dense walls and uneven inner surface. The cavity contains blood clots. Microscopy detects disintegrating leukocytes in the inner layer of the cavity wall and proliferations of epithelioid, lymphoid, and giant multinucleated cells with horseshoe shaped nuclei in the middle layer of the cavity wall. The observed changes in the lung are characteristic of a:

To determine the type of leukaemia, the patient needs to undergo a bone marrow aspiration. What bone is usually punctured for this analysis?

A man, who for many years has been suffering from bronchial asthma, has died of asphyxia. Histology of his lungs shows large amounts of mucus with eosinophilic admixtures in the lumina of the bronchioles and small bronchi, the interalveolar septa are sclerotic, the alveolar lumina are dilated. What mechanism of hypersensitivity reaction development is observed in this case?

An older woman has type 2 diabetes mellitus accompanied by obesity, atherosclerosis, and ischemic heart disease. Basal-state hyperinsulinemia was detected in her condition. What treatment would be adequate for this woman?

The cell surface of pathogenic gram-negative bacteria can be covered in villi and cilia. What function do these structures have?

A man has been hospitalized with a suspected prostate tumor. During the surgery it was found that the tumor has penetrated into the urinary bladder. What part of the bladder was affected?

A man has acute pancreatitis. What medicines must be prescribed in this case, to prevent pancreatic autolysis?

After putting in eye drops, a man with glaucoma developed miosis and myopia. His intraocular pressure decreased. What drugs can have such effect?

In typhoid fever, the necrotized Peyer’s patches in the small intestine color yellow-brown. What pigment permeates the necrotized tissue?

A 50-year-old man has undergone a surgery for gastric cancer. Complex anaesthesia included dithylin (suxa-methonium iodide). After the surgery was over, dithylin effect continued. Why is proserine (neostigmine) contraindicated in case of dithylin overdose?

A child with mushroom (fly agaric) poisoning was brought into a toxicology department. What drug should be administered first as a part of emergency aid?

A new born had seizures that stopped after vitamin B6 was prescribed. This effect was most likely observed, because vitamin B6 takes part in formation of:

A 3-year-old child after a past case of severe viral infection presents with recurrent vomiting, loss of consciousness, and seizures. Blood testing reveals hyperammonemia. What is the likely cause of such changes in the biochemical parameters of the child’s blood?

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:

Lung pathologies stimulate adaptive changes in the human body to ensure better oxygen supply to the tissues. One of these adaptive changes is the increased synthesis of the following in the erythrocytes:

Tyrosine is used as a substrate in thyroxine synthesis. What chemical element takes part in this process?

A 60-year-old man, who has a long history of angina pectoris, was along with coronarolytics prescribed acetylsalicylic acid to decrease the platelet aggregation. What is the mechanism of antiaggregant action of acetylsalicylic acid?

Against the background of digitoxin treatment, a man has developed bigeminy, severe muscle weakness, diarrhoea, vomiting, impaired vision. What medicines can mitigate the signs of poisoning in this

During examination of a man, who was in a car accident, the neurologist has detected dysmetria. This sign characterized by:

In an experiment, electrical stimulation of neurons in the brain of a test animal resulted in hypophagia (refusal to eat). Electrodes were applied to the following area of the brain in this case:

After a cerebral trauma a person has lost the eyesight. What areas of the cerebral cortex are likely to be damaged, causing this condition?

5 weeks after a severe case of streptococcal tonsillitis, a 24-year-old man developed face edema and elevated blood pressure. He presents with hematuria and proteinuria of 1.2 g/L. In the blood, antistreptococcal antibodies and low levels of complement components are detected. In this case, nephropathy has been caused by immune complexes, accumulations of which can most likely be found in the microvasculature of:

After an open scapular fracture, a man suddenly died. Early autopsy detects frothy blood in the right ventricle and pulmonary arteries. What was the cause of death in this case?

Autopsy of the body of a 40-year-old woman, who died of uremia, shows enlarged variegated kidneys. In the kidneys, the glomerular capillary membranes are thickened and resemble “wire loops”; there are foci of fibrinoid necrosis in their walls and hyaline thrombi in their lumina. In the nuclei, there are hematoxylin bodies. In the heart, Libman- Sacks endocarditis is observed. What renal disorder is the most likely in this case?

On the third day after gastric resection, the patient developed intestinal atony. What medicine should be used in the case?

Mitochondrial destruction is observed in some hereditary diseases (for example, Kearns-Sayre syndrome). What processes can be disturbed, as a result, in the cell?

The initiation of transcription process becomes possible when an enzyme DNA dependent RNA polymerase attaches to a certain segment of DNA molecule. Name this DNA segment.

Ventricular myocardium of the examined person exhibits disturbed repolarization processes. It causes disturbances in amplitude, configuration, and duration of the following wave:

A man presents with decreased vasopressin synthesis, which causes polyuria and results in marked dehydration. What is the most likely polyuria mechanism in this case?

A child has been diagnosed with agammaglobulinemia. This genetic disease disrupts the antibody synthesis, leading to:

A urology department has received a 48-year-old man with signs of renal colic. What medicine will be the most advisable in his condition?

What type of disease inheritance results in men being affected by haemophilia, while women are the carriers of this disease?

A measles outbreak has occurred in a maternity clinic. What class of maternal antibodies can provide newborn with immunity to measles virus?