Krok 2 – 2014 Surgery Base

1. A 76 y.o. woman complains of progressing swallowing disorder, mostly she

has had problems with solid food for the last 6 weeks. Sometimes she has
regurgitation of solid masses. Swallowing is not painful. She lost 6 kg. 10 years
ago she had myocardiac infarction, she takes constantly aspirine and
prolonged nitrates. She consumes alcochol in moderate proportions, smokes.
Objectively: icteric skin, neck has no pecularities, lymph nodes are not
enlarged. Thorax has no changes, cardiovascular system has no evident
changes. Liver is +3 cm. What is the preliminary diagnosis?
A. Cancer of esophagus
B. Diffuse constriction of esophagus
C. Diaphragmatic hernia
D. Myasthenia
E. Esophageal achalasia

2. A 65 y.o. man who has problems with urination as a result of benign prostate
gland adenoma dveloped fever and chill, hypotension, sinus tachycardia. Skin
is warm and dry. Clinical blood analysis revealed absolute granulocytopenia.
These hemodynamic changes are most likely to be caused by:
A. Endotoxemia with activation of complement system
B. Secondary endothelial changes as a result of bacterial lesion
C. Secondary circulation insufficiency with retained systolic function as a result
of peripheral vasoconstriction
D. Secondary reflex vasodilatation as a result of lowered cardiac output
E. Reflex vagus stimulation with lowered cardiac output

3. A 60 y.o. man complains of sense of heaviness in the region of scrotum.

Objectively: scrotum edema in the left part. Testicle is of normal size, but
there is a soft, scrotum limited edema over it that can be pressed and
disappears when the patient lies down. What is the preliminary diagnosis?
A. Varicocele
B. Ectopic testicle
C. Varicosity of subcutaneous veins
D. Inguinal hernia
E. Inguinal lymphadenopathy

4. A patient was delivered to a surgical department after a road accident with a

closed trauma of chest and right-sided rib fracture. The patient was diagnosed
with right-sided pneumothorax, it is indicated to perform drainage of pleural
cavity. Pleural puncture should be made in:
A. In the 2nd intercostal space along the middle clavicular line
B. In the 7th intercostal space along the scapular line
C. In the point of the greatest dullness on percussion
D. In the projection of pleural sinus
E. In the 6th intercostal space along the posterior axillary line

5. A 40 year old woman has changes of mammary gland. What are the most
often symtomps that precede the malignization?
A. Skin induration with inverted nipple
B. Bloody discharges from the nipple
C. Pure discharges from the nipple
D. Painful movable induration
E. Painless movable induration

6. Name a statistical observation unit for determination of influence amount of

bloodsugar on the healing of wounds surface in a postoperative period:
A. The patient in a postoperative period
B. Blood analysis
C. The patient who was discharged on an after-care
D. The patient who has a wound surface
E. An amount of bloodsugar

7. A 20-year-old patient was delivered to the hospital in summer from the street
with haemorrage from the brachial artery. First medical aid involved
application of a tourniquet for provisional arrest of bleeding. What is the
maximal exposure of the tourniquet?
A. 120 minutes
B. 60 minutes
C. 180 minutes
D. 15 minutes
E. 30 minutes

8. A 9 y.o. child with diagnosis "chronic tonsillitis" stands dispanserization

control. Within 1 year of observation there was one exacerbation of disease.
Physical condition is satisfactory. The general state is not infringed. Define
group of health:
A. III (a)
B. III (c)
C. I-st
D. II-d
E. III (b)

9. A 38 year old man, previously in good health, suddenly develops severe

abdominal pain radiating from the left loin to groin and accompanied by
 nausea, perspiration and the need for frequent urination. He is restless,
tossing in bed but has no abnormal findings. The most likely diagnosis is:
A. Leftsided renal colic
B. Sigmoid diverticulitis
C. Retroperitoneal haemorrhage
D. Torsion of the left testicle
E. Herpes zoster

10. A 40 year old woman has a self-detected hard breast mass. The procedure of
choice for confirming the diagnosis is:
A. Excision biopsy
B. Thermography
C. Aspiration biopsy with cytology
D. Ultrasonography
E. Mammography

11. 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. Sphincterotomy
C. Distal pancreaticojejunostomy
D. Distal pancreatectomy
E. Total pancreatectomy

12. 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. Immediate exploration
C. Tube duodenostomy
D. Retrocolic gastrojejunostomy
E. Duodenojejunostomy

13. An anestesiologist gives narcosis to the patient, he uses a non-reversive

contour. Anesthetic is halothane. Air temperature in the operation room is
21°C, humidity 50%, level of noise 30 dB. What occupational hazard is the
principal one under these conditions?
A. Air pollution with anesthetic
B. Improper occupational microclimate
C. Mental overfatigue
D. Compelled working pose
E. High level of noise

14. A patient suddenly felt an acute chest pain irradiating to the left arm.
Objectively: the patient is excited, with pale skin. Breathing rate - 38/min, AP
- 180/110 mm Hg. Later the patient lost consciousness and fell down. Pulse on
the great vessels was absent, the pupils were equally dilated. What is the most
likely diagnosis?
A. Clinical death
B. Coma
C. Disorder of the cerebral circulation
D. Heart attack
E. Agonal state

15. 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. Aseptic bandage
C. Suture on the wound
D. Drainage of the wound with rubber strip
E. Inspection of the wound with canal probe

16. If a child has adherent fingers on his right hand, then what will be your
diagnosis?
A. Syndactyly
B. Ectrodactyly
C. Ectromelia
D. Polydactyly
E. Macrodactyly

17. A 34-year-old patient was bitten by a dog 3 hours ago.There is a wound by dog
teeth without bleeding in the left arm. What surgical help would you provide
to this patient?
A. Clean wound with detergent water and apply anti-septic
B. Aseptic bandage
C. Complete suture of the wound
D. Incomplete suture of the wound
E. Cream bandage
18. Purulent mediastinitis is diagnosed at a 63-year-old patient. What diseases
from the stated below CANNOT cause the purulent mediastinitis?
A. Cervical lymphadenitis
B. Deep neck phlegmon
C. Perforation of the thoracic part of the easophagus
D. Iatrogenic injury of the trachea
E. Perforation of the cervical part of the easophagus

19. A 63 year old patient was diagnosed with purulent mediastinitis. What of the
below listed diseases are NOT the cause of purulent mediastinitis?
A. Cervical lymphadenitis
B. Perforation of the cervical part of the oesophagus
C. Iatrogenic injury of the trachea
D. Perforation of the thoracic part of the oesophagus
E. Deep neck phlegmon

20.A 36 year old patient was diagnosed with right-sided pneumothorax. What
method of treatment is indicated to the patient?
A. Surgical treatment: drainage of the pleural cavity
B. Symptomatic therapy
C. Thoracotomy
D. Pleural puncture
E. Antiinflammation therapy

21. The diagnosis of a right-sided pneumothorax is made to a 36- year-old

patient. What method of treatment is indicated to the patient?
A. Drainage of the pleural cavity
B. Symptomatic therapy
C. Antiinflammation therapy
D. Pleural puncture
E. Thoracotomy

22. 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
patients mother has an analogous pigmentation and has been often treated for
anemia. What disease is suspected?
A. Peytz-Egerss polyposis
B. Chrons disease
C. Adolescent polyposis
D. Hirschprungs disease
E. Tuberculosis of the intestine
23. 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. Hemostatic therapy
C. Administration of plasma
D. Operation
E. Intravenous administration of pituitrin

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

25. 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 Lekser
C. Herniotomy by Grenov
D. Herniotomy by Mayo
E. Herniotomy by Sapezhko

26. A 52 year old man has recurrent transient ischemic attacks. Auscultation of
the carotid arteries detected murmur. What diagnostic method is to be applied
in the first place?
A. Ultrasound dopplerography
B. MRI of the brain
C. Electroencephalography
D. Cerebral angiography
E. CT of the brain

27. For the persons who live in a hot area after an accident at a nuclear object, the
greatest risk within the first decade is represented by cancer of:
A. Thyroid gland
B. Lungs
C. Reproduction system organs
D. Skin
E. Breast

28.A 10 year old boy complains about pain in his left eye and strong photophobia
after he had injured his left eye with a pencil at school. Left eye examination:
blepharospasm, ciliary and conjunctival congestion, cornea is transparent,
other parts of eyeball have no changes. Visus 0,9. Right eye is healthy, Visus
1,0. What additional method would you choose first of all?
A. Staining test with 1% fluorescein
B. Gonioscopia
C. Cornea sensation-test
D. X-ray examination of orbit
E. Tonometria

29. A patient had disorder of nasal respiration, mucopurulent discharges from

nose, headache for 3 weeks. At anterior rhinoscopy in middle nasal meathus
the stria of pus, edema, hyperemia of the mucosa of the nose have been
determined. What diagnostic method is necessary to administer first of all?
A. An X-ray of paranasal sinuses
B. General blood test
C. Bacteriology analysis of the nasal mucous
D. CT of a skull
E. Punction of the maxillar sinus

30.A patient with acute purulent otitis media complicated by mastoiditis was
admitted to a hospital. Roentgenogram of mastoid processes showed the
shadiowing of the cellular system on the lesion, absence of bone septa was
present. What are the necessary therapeutic actions at the second stage of
mastoiditis?
A. Mastoidotomy
B. Paracentesis of the drum
C. Tympanoplasty
D. Cateterization of the Eustachian tube
E. Radical operation on the middle ear

31. A 35-year-old woman was admitted to resuscitation department in asthmatic

status. What is the most trustworthy criterion of breath effectiveness?
A. PaCO2 and PaO2
B. Respiration rate
C. Respiratory volume
D. Minute respiratory volume
E. Determination of “dead” space
32. During dynamic investigation of a patient the increase of central venous
pressure is combined with the decrease of arterial pressure. What process is
proved by such combination?
A. Developing of cardiac insufficiency
B. Depositing of blood in venous channel
C. Presence of hypervolemia
D. Increase of bleeding speed
E. Shunting

33. A 22 year old patient was admitted to trauma center with complaints of pain
in the left ankle joint that was getting worse during moving and weight
bearing. On the clinical examination it was found that the patient had the
closed fracture of medial malleolus without displacement. In which position
should the foot be fixed in plaster cast?
A. At right angle with varus positioning of the foot
B. In position of planter flexion of foot
C. In position of supination
D. In position of dorsal flexion of foot
E. In position of pronation

34. A 74 y.o. patient has been ill with benign prostate hyperplasy for the last 5
years. 4 days ago, after alcochol consumption, there was an acute retention of
urination. At the pre-admission stage his urinary bladder was catheterized
with metallic catheter. Examination revealed: right epididymis is enlarged,
thick and painful, there are purulent discharges from urethra. What way of
emergency care must be chosen?
A. Trocar or open epicystostomy
B. Placing of intraprostatic stent
C. Introduction of permanent urethral catheter
D. Transuretral resection or prostatectomy
E. Microwave thermotherapy of prostate

35. A rounded well-defined shadow was found in the costo-vertebral angle on the
chest roentgenogram of an otherwise healthy 9 year old girl. Make a
preliminary diagnosis:
A. Ganglioneuroma
B. Ganglioneuroblastoma
C. Sarcoma of the vertebra
D. Sympatogonioma
E. Sympatoblastoma

36. A 4 y.o. child attends the kindergarten. Complains of poor appetite, fatigue.
Objective examination: skin and mucous membrane are pale, child is asthenic.
 In the hemogram: hypochromatic anemia 1st, leucomoide reaction of the
eosinophile type. What pathology must be excluded first of all?
A. Helminthic invasion
B. Hypoplastic anemia
C. Atrophic gastritis
D. Duodenal ulcer
E. Lymphoprolipherative process

37. A 33 year old male patient was brought to Emergency Department with the
signs of cardiovascular collapse: BP - 60/30 mm Hg, Ps - 140 bpm, the skin is
pale and moist, diuresis 20 ml/h, Hb - 80 g/l, red blood cell count -
2,5×1012/l. The reduction of blood volume averages:
A. 30-40%
B. 25-30%
C. 15-20%
D. 10-15%
E. 20-25%

38.A 19 year old girl was admitted to emergency department: unconsciousness,

cyanosis, myotic pupils are present, superficial breathing is 12/min. BP is
90/60 mm Hg, Ps- 78/min. Choose the action necessary in this clinical
situation:
A. Controlled respiration
B. Oxygen inhalation
C. Cordiamine injection
D. Caffeine injection
E. Gastric lavage

39. What preparations are used for prevention of fungal infection?

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

40.What developes most often after accidental intake of Hydrochloric acid?

A. Cardiac insufficiency
B. Deyladss syndrome
C. Acute pancreatitis
D. Cushings syndrome
E. Kutlings syndrome
41. 30 y.o. woman, had mild trauma of 5th finger of the left hand 15 days ago. She
has treated her self at home. She presents to the hospital due to deterioration
of the condition and temperature rise. Objectively: hyperemia and swelling on
the ventral surface of finger. Restricted movements of the finger. X-ray of the
left hand: an early stage of osteomyolitis of the fifth finger could not be
excluded. The diagnosis: panaris of 5th finger of the left hand. What form of
panaris has occurred in the patient?
A. Bony
B. Paronychia
C. Joints type
D. Tendon type
E. Hypodermic

42. A 36 y.o. patient is diagnosed with right sided pneumothorax. What method of
treatment is indicated to the patient?
A. Surgical drainage of the pleural cavity
B. Symptomatic therapy
C. Antiinflammation therapy
D. Pleural puncture
E. Thoracotomy

43. A 28 year old woman was admitted to the emergency room with a slightly
reddened, painful "knot" 8 cm above the medial malleolus. Examination in the
standing position demonstrates a distended vein above and below the mass.
There are no other abnormalities on physical examination. The most likely
diagnosis is:
A. Superficial venous thrombosis
B. Insect bite
C. Early deep vein thrombosis
D. Cellulitis
E. Subcutaneous hematoma

44.A 30 year old man complains of acute pain in his right ear, hearing loss, high
temperature for three days. Objectively: right ear whispering language - 0,5
mm, external ear is intact, otoscopically - eardrum protrusion, hyperemia and
swelling, loss of landmarks. What disease is it?
A. Acute purulent otitis media
B. Chronic purulent otitis media
C. Eustachian tube disfunction
D. Acute mastoiditis
E. Chronic secretory otitis media
45. A 22 y.o. man complains of acute throat pain, increasing upon swallowing
during 3 days. Body temperature 38,3°C, neck lymph nodules are slightly
enlarged and painful. Pharyngoscopically - tonsilar hyperemia, enlargement
and edema, tonsils are covered by round yellow fibrinous patches around
crypts openings. Beta-haemolytic streptococcus in swab analysis. What is the
diagnosis?
A. Acute membranous tonsilitis
B. Pharyngeal diphtheria
C. Acute follicular tonsilitis
D. Infectious mononucleosis
E. Pharyngeal candidosis

46.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. Meningitis
C. Hepatite
D. Nephroso-nephritis
E. Thrombophlebitis

47. 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. Sigmoid diverticulitis
D. Acute pancreatitis
E. Myocardial infarction

48.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. Crohns disease of the terminal ileum
B. Ulcerative colitis
C. Perforated Meckels diverticulum
D. Ileocecal tuberculosis
E. Acute ileitis

49.A 50 year old woman with a 2-year history of mild, diffuse, tender thyroid
enlargement complains of 10 pound weight gain and fatigue. What is the most
probable diagnosis?
A. Hashimotos thyroiditis
B. Riedels thyroiditis
C. Suppurative thyroiditis
D. Papillary thyroid carcinoma
E. Subacute thyroiditis

50.A severely traumatized patient who has been receiving prolonged parenteral
alimentation develops diarrhea, mental depression, alopecia and perioral and
periorbital dermatitis. Administration of which of the following trace elements
is most likely to reverse these complications?
A. Zinc
B. Copper
C. Selenium
D. Iodine
E. Silicon

51. 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. Perforated gastric ulcer
C. Acute appendicitis
D. Renal colic
E. Acute enterocolitis

52. The 67 y.o. patient had 5 recurrent fractures of the lower extremities without
considerable cause within 5 years. O-shaped deformity of the legs in the knee
joints has appeared. The skull, pelvis and lower extremities X-Ray shows the
thickening of flat bones. In the long bones there is a hyperostosis along the
bone axis.The blood test has not revealed any inflammation activity. Serum
calcium is normal. What disease do you consider in this case?
A. Pagets disease
B. Hyperparathyoid dystrophy
C. Myeloma
D. Mottled disease (marble disease)
E. Chronic osteomyelitis
53. A 33 y.o. patient was admitted to the reception room of the Central District
Hospital. He complains of a severely painful swelling localized on posterior
neck, fever up to 38,4°C and general weakness. In anamnesis: diabetes
mellitus within 5 years. On physical examination on the posterior neck surface
there is an infiltrate elevated above surrounding skin. The tissues affected by
swelling are tense and blue reddish discoloration in central area. There are
also several purulent necrotic pustules which are connected with each other
and form a large skin necrosis. A thinned necrotic skin of this swelling has
holes looking like sieve, pus discharges through out. What disease should a
doctor consider first of all?
A. Carbuncle
B. Skin abscess
C. Acute skin cellulitis
D. Furuncle
E. Carbuncle associated with anthrax

54. A 19 y.o. man was admitted to the reception department in 20 minutes after
being wounded with the knife to the left chest. The patient is confused. The
heart rate is 96 bpm and BP- 80/60 mm Hg. There are the dilated neck veins,
sharply diminished apical beat and evident heart enlargement What kind of
penetrative chest wound complications has developed in patient?
A. Pericardium tamponade
B. Valve-likes pneumothorax
C. Open pneumothorax
D. Massive hemothorax
E. Closed pneumothorax

55. A 35 y.o. patient complains of a difficult swallowing, pain behind the

breastbone. He can eat only liquid food. While swallowing sometimes he has
attacks of cough and dyspnea. Above mentioned complaints are progressing.
It is known that the patient has had a chemical burn of esophagus one month
ago. What complication does the patient have?
A. Corrosive esophagitis and stricture
B. Esophageal diverticula
C. Esophagitis
D. Cardiac achalasia
E. Cardiac insufficiency

56. Survey radiograph of chest of a 62 year old smoker who often suffers from
"pneumonias" showed a triangle shadow in the right lung, its vertex is
pointing towards the lung root. It also showed deviation of heart and
mediastinum shadows towards the lesion. What is the most probable
diagnosis?
A. Cenral cancer of lung
B. Lung cyst
C. Lung abscess
D. Peripheral cancer of lung
E. Atelectasis

57. A patient operated for acute paraproctitis undergoes antibacterial and

detoxification therapy, the local course of the disease has the positive
dynamics. Since the operation the patient has had chills, pyrexia, tachycardia,
euphoria for five days. The doctor suspected sepsis. What study will confirm
the diagnosis?
A. Blood culture for a pathogen
B. Determining the rate of average-weight molecules
C. Liver ultrasound
D. X-ray of lungs
E. Determining the rate of microbial contamination of wound

58. A 44-year-old patient has been admitted to a hospital with complaints of dull,
aching pain in the left lumbar region, the admixture of pus in the urine.
Examination revealed a grade II staghorn calculus on the left. What method of
treatment is indicated for this patient?
A. Surgery
B. Distance lithotripsy
C. Ascending litholysis
D. Conservative therapy
E. Contact lithotripsy

59. An emergency team has delivered to a hospital an unconscious patient found

lying in the street in winter. Objectively: the patient is pale, with superficial
respiration; bradycardia with heartrate 54/min, to- 35°C. AP- 100/60 mm Hg.
Palpation of chest and abdomen revealed no peritoneal symptoms. There is a
smell of alcohol from the patients mouth. What is the most likely diagnosis?
A. Hypothermia
B. Apparent death
C. Acute cardiovascular insufficiency
D. Frostbite of trunk and extremities

60.A 48-year-old patient got a job-related injury of a hypodermic varicose vein on

his shin that was accompanied by the intensive phleborrhagia. Choose the
optimal variant of first aid:
A. Pressure bandage and limb strapping
B. Maximal limb flexion in knee joint
C. Application of Esmarchs tourniquet beneath the injury
D. Application of Esmarchs tourniquet above the injury
E. Occlusion of femoral artery in a typical place

61. A 24-year-old patient got a puncture injury below the Pouparts ligament
accompanied by intense arterial bleeding. The best method to temporarily
stop the bleeding in the patient would be:
A. Compression band
B. Maximum limb bending
C. Esmarchs tourniquet
D. Compressing a blood vessel with a clamp
E. Wound suturing

62. While making a round, a doctor had noticed the edema of the right shoulder of
a 26-day-old child with diagnosis of "umbilical sepsis". Active movements in
the shoulder joint were absent, right hand was hanging down. Mother stated
that her childs condition had worsened for the last 24 hours what resulted in
childs refusal to be breast-fed, restlessness, weeping while swaddling, rise in
body temperature up to 38,8°C. What is the most probable preliminary
diagnosis?
A. Epiphysial osteomyelitis of the humerus
B. Fracture of the clavicle
C. Traumatic brachioplexitis
D. Fracture of the humerus
E. Phlegmon of the shoulder

63. 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. Crohns disease
C. Non-specific ulcer colitis
D. Cicatricial stenosis of the rectum
E. Chronic paraproctitis

64.A 52 y.o. patient fell from 3 m height on the flat ground with the right lumbar
area. He complains of pain in this area. There is microhematuria in the urea.
Excretory urography revealed that kidneys functioning is satisfactory. What is
the most probable diagnosis?
A. Kidneys contusion
B. Paranephral hematoma
C. Kidneys abruption
D. Subcapsular kidneys rupture
E. Multiple kidneys ruptures

65. 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°C. Sonography revealed
that bile bladder was 5,5?2,7 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 abscess
C. Paravesical liver abscesses
D. Cystous liver cancer
E. Liver cancer

66.A 36-year-old woman applied to doctor with complaints of the enlargement of

the right mammary gland. On physical exam: the right mammary gland is
enlarged, hardened; nipple with areola is pasty and hydropic, looks like
"lemon peel". There palpates a lymph node in the right axilla, 1,5 cm in
diameter, dense consistence, not mobile. What is the most probable
diagnosis?
A. Hydropic and infiltrative cancer of the mammary gland
B. Diffusive mastopathy
C. Erysipelatouslike cancer of the mammary gland
D. Pagets cancer
E. Acute mastitis

67. A 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 hasnt 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 perform external choledoch drainage
C. To treat conservatively: antibiotics, spasmolytics, antiinflammatory drugs
D. To perform transduodenal papillosphincterotomy
E. To perform choledochoduodenostomy
68.A 49-year-old male patient who had been scheduled for a surgery for gastric
cancer underwent preoperative infusion therapy. Up to 3,0 liters of liquid was
introduced into the right cubital vein. The following day, he felt a dragging
pain in the right shoulder. Objectively: on the inner surface of the shoulder
there is a longitudinal hyperemic zone, edema of skin, a tender cord. What
complication occurred in the patient?
A. Acute thrombophlebitis
B. Venepuncture and edema of paravenous tissue
C. Acute lymphangitis
D. Paravenous tissue phlegmon
E. Paravenous tissue necrosis

69.A 54-year-old patient applied with complaints of acute pain in the shoulder-
joint. 10 minutes earlier he fell in the street with his arms stretched. Doctor of
the traumatological unit noticed an acute deformation of the right shoulder-
joint, the impossibilty of active movement in the right extremity.
Roentgenologically: uncoincidence of articulating surfaces. What is the most
probable diagnosis?
A. Dislocation of the clavicle
B. Contusion of the humerus
C. Dislocation of the humerus
D. Dislocation of the scapula
E. Fracture of the humerus

70. A 62-year-old patient has been delivered to the surgical department with
complaints of sudden pain in the umbilical region irradiating to the back and
groin, which was accompanied by a syncope. Objectively: the patient is in
grave condition, umbilical region is tender on palpation, bowel sounds are
diminished. AP drop is present. USI reveals: free fluid in the abdomen,
thickening of the wall of the abdominal aorta. The most likely diagnosis is:
A. Rupture of abdominal aortic aneurism
B. Acute pancreatitis
C. Stomach ulcer perforation
D. Peritonitis
E. Acute appendicitis

71. Parents of a 2-year-old boy applied to clinic complaining of right testicle

absence in the scrotum of a boy. While examining the boy, hypoplasia of the
right half of the scrotum was revealed, absence of the testicle. Testicle is
miniaturized, it palpitates along the inguinal canal but it could not be moved
down to scrotum. What is the most probable diagnosis?
A. Right-sided cryptorchism, inguinal form
B. Ectopia of the right testicle, pubic form
C. Left-sided monorchism
D. Retraction of the right testicle (pseudocryptorchism)
E. Right-sided cryptorchism, abdominal form

72. A 62-year-old patient complains of the pain behind the sternum, bad passing
of solid and liquid food, bad breath, increased salivation weight, loss of 15 kg
during the period of 2 months. Appetite is retained. On physical exam: face
features are sharpened. The skin is pale, with sallow tint, its turgor is
decreased. The liver is not enlarged. Blood Hb - 86g/L. Gregersen reaction is
positive. What kind of pathology caused the given clinical situation?
A. Esophagus cancer
B. Chronic non-specific esophagitis
C. Cicatricial constriction of esophagus
D. Benign growth of esophagus
E. Achalasia of esophagus

73. A patient suffers from suddenly arising crampy pain in the right loin area. 2
hours after the pain had started, hematuria took place. Loin X-ray: no
pathological shadows. Ultrasound: pyelocaliectasis on the right, the left part is
normal. What is the most probable diagnosis?
A. Stone of the right kidney, renal colic
B. Tumour of the right kidney pelvis
C. Intestine invagination
D. Acute appendicitis
E. Twist of the right ovary cyst

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

75. A 30-year-old patient complains of pain, hyperemia along subcutaneous veins,

rise in body temperature. While examining the large shin subcutaneous vein,
there is hyperemia, pain by pressing. Homanss and Lusess symptoms are
negative. What is the preliminary diagnosis?
A. Acute thrombophlebitis of subcutaneous veins
B. Lymphostasis
C. Acute ileophemoral phlebothrombosis
D. Embolism of aorta
E. Thrombosis of aorta

76. A 30-year-old man has suffered from traffic accident. Consciousness is absent.
Pulse on the carotid artery is undeterminable, no respiration. There is a wide
leather belt on mans waist. What measures are to be taken?
A. Conduct an artificial ventilation of lungs and closed-chest cardiac
massage after having released from the belt
B. Start immediate artificial ventilation of lungs and closed-chest cardiac
massage
C. Do not touch the victim until the arrival of the police
D. Put the victim with his back on the shield
E. Turn the victim to the right side

77. An emergency team deliverd a 83-year-old patient complaining of inability of

her right leg to support the body after falling on her right side. Objectively: the
patient lies on a gurney, her right leg is rotated outwards, the outside edge of
foot touches the bed. There is positive straight leg raising sign. What is your
provisional diagnosis?
A. Femoral neck fracture
B. Femoral diaphysis fracture
C. Hip joint contusion
D. Cotyloid cavity fracture
E. Hip dislocation

78. A 50-year-old patient complains of bursting pain in the left lower limb that is
getting worse on exertion, swelling in the region of shin and foot. Objectively:
left shin and foot are doughy, skin of the lower shin is indurated and has a
bronze tint, subcutaneous veins are dilated, there is an ulcer with necrotic
masses. What is the most likely diagnosis?
A. Postthrombophlebitic syndrome
B. Gangrene of the lower extremity
C. Acute arterial thrombosis
D. Chronic arterial insufficiency
E. Deep vein thrombosis of the lower limbs

79. 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 oclock position. Digital investigation of rectum revealed a
painful infiltration reaching the pectinate line. What is the most likely
diagnosis?
A. Acute periproctitis
B. Acute haemorrhoids
C. Acute prostatitis
D. Rectum tumour
E. Acute anal fissure

80.A 65-year-old patient complains of gradual worsening of the left eye vision
during 10 months. On physical examination: acuty of vision of the left eye is
0,01, not correctable. The eye is quiet, pupil of the eye is grayish, reflex from
the eye-ground is absent. Intraocular pressure is 18 mm/Hg. What is the most
probable preliminary diagnosis?
A. Senile cataract
B. Disorder of blood circulation in retina vessels
C. Open-angle glaucoma
D. Leukoma of the cornea
E. Exfoliation of the retina

81. A 36 y.o. patient was admitted to the hospital with sharp pain in substernal
area following occasional swallowing of a fish bone. On esophagoscopy the
foreign body wasnt revealed. The pain increased and localized between
scapulas. In a day temperature elevated, condition became worse, dysphagia
intensified. What complication has developed?
A. Perforation of esophagus with mediastinitis
B. Obstruction of esophagus
C. Esophageal hemorrhage
D. Pulmonary atelectasis
E. Aspirative pneumonia

82.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. Native plasma
C. Dried plasma
D. Cryoprecipitate
E. Fresh frozen blood

83.On the 4th day after recovering from a cold a patient was hospitalized with
complaints of solitary spittings of mucoid sputum. On the 2nd day there was a
single discharge of about 250 ml of purulent blood-streaked sputum.
Objectively: the patients condition is moderately severe. Respiratory rate - 28-
30/min, Ps- 96 bpm, AP- 110/70 mm Hg. Respiration above the left lung is
vesicular, weak above the right lung. There are moist rales of different types
above the lower lobe and amphoric breath near the angle of scapula. What is
the most likely diagnosis?
A. Acute pulmonary abscess
B. Acute focal pneumonia
C. Pyopneumothorax
D. Pleural empyema
E. Exudative pleuritis

84.A 24 y.o. male patient was transferred to the chest surgery department from
general surgical department with acute post-traumatic empyema of pleura. On
the X-ray: wide level horizontal of fluid on the right. What method of
treatment should be prescribed?
A. Punction and drainage of pleural cavity
B. Pneumoectomy
C. Lobectomy
D. Thoracoplasty
E. Decortication of pleura

85. A patient complains of intense pressing pain in the pharynx, mainly to the
right, impossibility to swallow even liquid food. The illness started 5 days ago.
The patients condition is grave. Body temperature - 38,9°C, speech is difficult,
voice is constrained, difficulties in opening the mouth. Submaxillary glands to
the right are painful, enlarged. What is the most probable diagnosis?
A. Peritonsillar abscess
B. Vincents disease
C. Phlegmonous tonsillitis
D. Diphtheria
E. Pharyngeal tumour

86.In a 65 y.o. female patient a tumor 13x8 cm in size in the umbilical area and
above is palpated, mild tenderness on palpation, unmovable, pulsates. On
ausculation: systolic murmur. What is the most probable diagnosis?
A. Abdominal aortic aneurism
B. Arterio-venous aneurism
C. Stomach tumor
D. Tricuspid valve insufficiency
E. Mitral insufficiency

87. An hour before an elective surgery, a 56-year-old patient of the surgical

department got a dramatic increase in blood pressure, tachycardia, hand
tremor. The patient is confused, anxious, depressed, fearful, is pessimistic
about the operation outcome, refuses the surgery. What tactics should be
chosen by a surgeon?
A. Start the surgery after correction of blood pressure
B. Predict the psychological state of the patient
C. Organize monitoring of the patient by his family members
D. Organize monitoring of the patient by medical personnel and mental health
counselor
E. Isolate the patient

88.A patient with suspicion of pelvic bones fraction is under examination

conducted by the doctor who presses alae ilii in medial direction with his both
hands. What causes painful syndrome of the patient?
A. Disorder of continuity of the pelvic ring
B. Fracture of the sacrum
C. Retroperitoneal hematoma
D. Fracture of sciatic bones
E. Traumatic injury of the intrapelvic organs

89.A 30-year-old man was injured in a fire and got thermic burns of III-A and
III-B degree that affected 20% of the total skin. AP - 110/70 mm Hg, heart rate
-120/min. What transfusion means should be used for blind infusion before
transportation?
A. Saline solutions
B. Albumin
C. 10% glucose solution
D. Polyglycine
E. Fresh frozen plasma

90.A 48-year-old male patient complains of pain in the lower extremities,

especially when walking, intermittent claudication, numbness in the fingers,
cold extremities, inability to walk more than 100 meters. Sleeps with his leg
lowered. The patient has been a smoker since he was 16, abuses alcohol, has a
history of CHD. The left lower extremity is colder than the right one, the skin
of extremities is dry, pedal pulse cannot be palpated, femoral pulse is
preserved. What is the most likely diagnosis?
A. Obliterating endarteritis
B. Raynauds disease
C. Deep thrombophlebitis
D. Diabetic angiopathy
E. Leriche syndrome

91. A 24 y.o. woman consulted a doctor about continued fever, night sweating.
She lost 7 kg within the last 3 months. She had casual sexual contacts.
Objectively: enlargement of all lymph nodes, hepatolienal syndrome. Blood
count: leukocytes - 2,2×109/L. What disease can be suspected?
A. HIV-infection
B. Infectionous mononucleosis
C. Chroniosepsis
D. Lymphogranulomatosis
E. Tuberculosis

92. Development of chronic venous insufficiency of lower extremities depends on

the functional condition of so-called musculovenous pump. This term refers to
the following group of muscles:
A. Shin muscles
B. Abdominal wall muscles
C. Thigh muscles
D. Foot muscles
E. Buttock region muscles

93. A 27-year-old patient was brought to clinic with a crashed wound of the
posterior surface of the right shin in 2 hours after the accident happened.
During surgical treatment pieces of dirty clothes and gravel were removed.
What actions from the given below are the decisive ones to prevent an
anaerobic infection?
A. Radical surgical treatment
B. Introduction of the medical dose of the anti-gangrene serum
C. Hyperbaric oxygenation
D. Rational antibiotic therapy
E. Introduction of the preventive dose of an anti-gangrene serum

94.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. USI
B. Liver scanning
C. Biochemical laboratory examination
D. Survey radiography of abdominal cavity
E. Angiography

95. In morgue there are dead bodies with the following causes of death:
electrotrauma; rupture of the spleen with acute anemia. There is one unknown
person; one ethyl alcohol poisoned person and one drowned man. What dead
body should the blood group be determined for?
A. All dead bodies of the unknown persons
B. Body of person with a sudden death
C. Body of drowned man
D. Body of poisoned person
E. Body of person with internal hemorrhage

96.A 50 y.o. patient was admitted to the hospital with complaints of blood in
urine. There was no pain or urination disorders, hematuria has lasted for 3
days. Objectively: kidneys are not palpable, suprapubic region has no
pecularities, external genitals have no pathology. Rectal examination revealed:
prevesical gland is not enlarged. Cytoscopy revealed no changes. What disease
would you think about first of all?
A. Cancer of kidney
B. Tuberculosis of urinary bladder
C. Kidney dystopy
D. Necrotic papillitis
E. Varicocele

97. A patient complains of nycturia, constant boring pain in perineum and

suprapubic region, weak urine jet, frequent, obstructed and painful urination.
He has been ill for several months, pain in perineum appeared after getting
problems with urination. Rectal examination revealed that prostate is
enlarged (mostly owing to the right lobe), dense, asymmetric, its central
sulcus is flattened, the right lobe is dense, painless, tuberous. What disease
can it be?
A. Cancer of prostate
B. Chronic congestive prostatitis
C. Urolithiasis, stone of the right lobe of prostate
D. Prostate sclerosis
E. Prostate tuberculosis

98.The patient complains of a painful swelling in the chin region, malaise,

headache. Examination reveals an acutely inflamed cone-shaped dense node.
The skin over it is tense, red. In the center of the node there is an ulcer with
overhanging edges and a necrotic core of a dirty-green colour. Submandibular
lymph nodes on the right are enlarged and painful. What is the most likely
diagnosis?
A. Furuncle
B. Parasitic sycosis
C. Carbuncle
D. Tuberculosis
E. Tertiary syphilis (gummatous form)

99.On the 5th day after a surgery for colon injury a patient complains of bursting
pain in the postoperative wound, weakness, drowsiness, headache, fever up to
40°C. Objectively: the skin around the wound is swollen, there is gas
 crepitation. The wound discharges are scarce foul-smelling, of dark-gray
colorl. What is the most likely diagnosis?
A. Anaerobic clostridial wound infection
B. Postoperative wound infection
C. Abscess
D. Erysipelas
E. Phlegmon

100. A childrens surgical unit admitted a 1-month-old boy who had been
prenatally diagnosed with the left-sided pyelectasis. Such studies as drip
infusion urography, cystography and USI allowed to reveal initial
hydronephrosis. There is no information confirming the secondary
pyelonephritis. What tactics of this patient management is most advisable?
A. 6-month surveillance
B. Anderson-Hynes operation
C. Antibacterial therapy
D. There is no need in further surveillance and treatment
E. Urgent nephrostomy

101. A 60 y.o. man complains of significant pain in the right eye,

photophobia, lacrimation, reduced vision of this eye, headache of the right
part of the head. Pain occured 2 days ago. On examination: Vis OD- 0,03,
congested injection of the eye ball, significant cornea edema, front chamber is
deep, pupil is narrow, athrophic iris, there is optic nerve excavation on the eye
fundus, intraocular pressure- 38 mm Hg. Vis OS- 0,8 unadjustable. The eye is
calm, healthy. Intraoccular pressure- 22 mm Hg. What is the most probable
diagnosis?
A. Acute glaucoma attack
B. Eye nerves neuritis
C. Maculodystrophy
D. Right eyes uveitis
E. Right eyes keratitis

102. A 54-year-old female patient has been admitted to a hospital 12 days

after the beginning of acute pancreatitis. Objectively: the patient is in grave
condition. The body temperature is hectic. Ps - 112 bpm. The abdomen is
swollen. Epigastrium palpation reveals a very painful infiltration falling in the
localization of pancreas. Abdominal cavity contains fluid. There is an edema of
the left lumbar region. In blood: WBCs – 18×109/l. What is the required
tactics of the patients treatment?
A. Surgical treatment
B. Massive antibacterial therapy
C. Peritoneal dialysis
D. Further conservative treatment
E. Increase in antienzymes

103. A 37-year-old male patient has a history of diabetes of moderate

severity. On the left side of face the patient has a carbuncle. What severe
complication might have occurred in the patient?
A. Cavernous sinus thrombosis
B. Endarteritis
C. Lymphangitis
D. Thrombophlebitis
E. Thromboembolism

104. To replace the blood loss replacement 1000 ml of the same group of
Rhesus-compatible donated blood was transfused to the patient. The blood
was conserved by sodium citrate. At the end of hemotransfusion there
appeared excitement, pale skin, tachycardia, muscles cramps in the patient.
What complication should be suspected?
A. Citrate intoxication
B. Allergic reaction
C. Citrate shock
D. Anaphylactic shock
E. Pyrogenous reaction

105. 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- 12,2×109/L. What is the most probable
diagnosis?
A. Acute appendicitis
B. Perforated ulcer
C. Acute cholecystitis
D. Rightside kidney colic
E. Acute pancreatitis

106. A patient, aged 58, was fishing in the winter. On return home after
some time felt some pain in the feet. Consulted a doctor. On examination: feet
skin was pale, then after rewarming became red, warm to the touch. Edema is
not significant, limited to the toes. All types of sensitivity are preserved. No
blisters. What degree of frostbite is observed?
A. I degree
B. III degree
C. II degree
D. IV degree
E. V degree
107. 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. Inferoposterior dislocation of hip
D. Pertrochanteric fracture of hip
E. Cotyloid cavity fracture with a central dislocation of hip

108. Three weeks after acute angina the patient is still weak, inert,
subfebrile, his retromaxillary lymph nodes are enlarged. Tonsils are flabby,
stick together with arches, there are purulent plugs in lacunae. What is the
most probable diagnosis?
A. Chronic tonsillitis
B. Paratonsillitis
C. Tonsillar tumour
D. Chronic pharyngitis
E. Acute lacunar tonsillitis

109. A 43 year old patient had right-sided deep vein thrombosis of

iliofemoral segment 3 years ago. Now he is suffering from the sense of
heaviness, edema of the lower right extremity. Objectively: moderate edema of
shin, brown induration of skin in the lower third of shin, varix dilatation of
superficial shin veins are present. What is the most probable diagnosis?
A. Postthrombophlebitic syndrome, varicose form
B. Parkes-Weber syndrome
C. Acute thrombophlebitis of superficial veins
D. Acute thrombosis of right veins
E. Lymphedema of lower right extremity

110. A child undergoes in-patient treatment for acute staphylococcal

destruction of the right lung. Unexpectedly he developed acute chest pain on
the right, dyspnea, cyanosis. The right side of chest lags behind in the
respiratory act. Percussion reveals dullness in the lower parts on the right,
bandbox resonance in the upper parts. Borders of the relative cardiac dullness
are shifted to the left. What complication has most likely developed?
A. Right-sided pyopneumothorax
B. Spontaneous pneumothorax
C. Pleural empyema
D. Exudative pleuritis
E. Right lung abscess

111. A 98 y.o. male patient complains of pain in the left lower limb which
intensifies on walking, feeling of cold and numbness in both feet. He has been
ill for 6 years. On examination: pale dry skin, hyperkeratosis. Hairy covering is
poorly developed on the left shin. "Furrow symptom " is positive on the left.
Pulse on foot arteries and popliteal artery isnt palpated, on the femoral artery
its weak. On the right limb the artery pulsation is reserved. What is the most
probable diagnosis?
A. Arteriosclerosis obliterans
B. Obliterating endarteritis
C. Raynaulds disease
D. Buergers disease (thromboangiitis obliterans)
E. Hemoral arthery thombosis

112. Examination of a dead man who died from hanging revealed that
cadaver spots disappeared when pressed upon and restored after 50 seconds,
rigor mortis was moderately expressed only in the masticatory muscles and
the muscles of neck and fingers. Body temperature was 31°C. Specify the time
of death:
A. 6-7 hours
B. 8-10 hours
C. 10-18 hours
D. 1-2 hours
E. 16-24 hours

113. Examination of the corpse of a man who died from hanging reveals:
death spots disappear when pressed upon and restore after 50 seconds, rigor
mortis is moderately expressed only in the masticatory muscles as well as neck
and finger muscles, body temperature is of 31°C. The time of death:
A. 6-7 hours ago
B. 10-18 hours ago
C. 16-24 hours ago
D. 1-2 hours ago
E. 8-10 hours ago

114. After contusion of the right eye a patient complains of sudden loss of
vision with remaining light perception. Objectively: the eye is not irritated.
The cornea is transparent. Pupil reacts to light. The pupil area is black. The
fundus reflex is absent. What is the most likely cause of vision loss?
A. Hemophthalmia
B. Acute occlusion of retinal vessels
C. Optic nerve avulsion
D. Retinal detachment
E. Traumatic cataract

115. A 65-year-old patient complains of pain in the lumbar spine, moderate

disuria. He has been suffering from these presentations for about half a year.
Prostate volume is 45 cm3 (there are hypoechogenic nodes in both lobes,
capsule invasion). The rate of prostate-specific antigen is 60 ng/l. Prostate
biopsy revealed an adenocarcinoma. Which of the supplemental examination
methods will allow to determine the stage of neoplastic process in this
patient?
A. Computer tomography of pelvis
B. Excretory urography
C. Roentgenography of lumbar spine
D. Bone scintigraphy
E. Roentgenography of chest

116. X-ray picture of chest shows a density and an abrupt decrease in the
upper lobe of the right lung. The middle and lower lobe of the right lung
exhibit significant pneumatization. The right pulmonary hilum comes up to
the dense lobe. In the upper and middle parts of the left pulmonary field there
are multiple focal shadows. In the basal region of the left pulmonary field
there are clear outlines of two annular shadows with quite thick and irregular
walls. What disease is this X-ray pattern typical for?
A. Fibro-cavernous pulmonary tuberculosis
B. Pancoast tumour
C. Abscessing pneumonia
D. Atelectasis of the right upper lobe
E. Peripheral cancer

117. A patient complains of impaired far vision. Previously his eyes often
turned red and hurt. Objectively: the eyes are not irritated, the cornea is
transparent, anterior chambers are median deep, their liquid is transparent.
The iris of the right eye has not changed in colour, its pattern is unchanged.
The pupil is of irregular shape, scalloped. Biomicroscopy of the crystalline lens
reveals the areas of opacity and vacuoles. Make a diagnosis:
A. Complicated cataract of the right eye
B. Diabetic cataract of the right eye
C. Radiation cataract of the right eye
D. Tetanic cataract of the right eye
E. Senile cataract of the right eye
118. A 26-year-old patient complains of experiencing pain in the right hand
for 4 days. The pain arose at the site of corns on the palmar surface at the base
of the II and III fingers. Some time later the dorsum of hand became
edematic. I and III fingers are half-bent in the interphalangeal joints, the hand
looks like "rake". What is the most likely diagnosis?
A. Phlegmon of the second interdigital space of the right hand
B. Tendovaginitis
C. Corn abscess of the right hand
D. Adenophlegmon of the right hand
E. U-shaped phlegmon of the right hand

119. A 30-year-old patient had deep burn covering 30% of body 30 days ago.
Now he presents with continued fever, loss of appetite, night sweats. Burned
surface weakly granulates. What is the stage of burn disease?
A. Septicotoxemia
B. Convalescence
C. Secondary burn shock
D. Primary burn shock
E. Acute burn toxemia

120. 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-Blumbergs symptom. What is the maximal term to make a
diagnosis?
A. In 2 hours
B. In 3 hours
C. In 6 hours
D. In 0.5 hours
E. In 1 hour

121. A surgeon examined a 42-year-old patient and diagnosed him with

right forearm furuncle at the purulo-necrotic stage. The furuncle was lanced.
At the hydration stage the wound dressing should enclose the following
medication:
A. Hypertonic solution
B. Dimexide
C. Ichthyol ointment
D. Vishnevsky ointment
E. Chloramine

122. A 30 year old patient undergoes treatment because of Werlhofs disease.

Objectively: the patient is pale, there are petechial haemorrhages on the
 extension surfaces of forearms. Ps is 92 bpm, AP is 100/60 mm Hg. The lower
edge of spleen is at a level with umbilicus. Blood count: erythrocytes:
2,8×1012/l, Hb - 90 g/l, Ht - 0,38, thrombocytes – 30×109/l. The patient is
being prepared for splenectomy. What transfusion medium should be chosen
in the first place for the preoperational preparation?
A. Thrombocytic mass
B. Erythrocytic suspension
C. Washed erythrocytes
D. Stored blood
E. Native erythrocytic mass

123. A 19 year old boy was admitted to a hospital with closed abdominal
trauma. In course of operation multiple ruptures of spleen and small intestine
were revealed. AP is falling rapidly, it is necessary to perform
hemotransfusion. Who can specify the patients blood group and rhesus
compatibility?
A. A doctor of any speciality
B. A traumatologist
C. An anaesthesilogist
D. A laboratory physician
E. A surgeon

124. A 36-year-old man was delivered to the surgical department an hour

after a road accident. His condition is getting worse: respiratory insufficiency
is progressing, there are cardiac abnormalities. Clinical and roentgenological
investigations revealed mediastinal displacement. What process has caused
this complication?
A. Valvular pneumothorax
B. Closed pneumothorax
C. Open pneumothorax
D. Subcutaneous emphysema
E. Mediastinitis

125. A victim of the car crash was brought to neurosurgery due to

craniocerebral trauma. During examination symptoms of focused injury of the
cerebrum are found, cerebrum contusion is suspected. What method of
examination is to be used?
A. Computed tomography of the cerebrum
B. Eye-ground examination
C. Antiography of vessels of the cerebrum
D. X- ray of cranium bones
E. Ultrasound examination of vessels of the cerebrum
126. A 35 y.o. female patient was admitted to the surgical department with
symptoms of ulcerative gastric hemorrhage. Its been the third hemorrhage for
the last 2 years. After conservative treatment vomiting with blood stopped,
hemoglobin elevated from 60 till 108 g/L. General condition became better.
But profuse vomiting with blood reoccured in 2-3- hours. Hemoglobin
decreased to 93,1 g/L then to 58,1 g/L. What is the tactics of treatment?
A. Urgent surgery
B. Conservative treatment with following surgery
C. Taylors treatment
D. Deferred surgery
E. Conservative treatment

127. A 39-year-old patient complains of a tumour on the anterior surface of

her neck. The tumour has been observed for 2 years. It is nonmobile and has
enlarged recently. The patient has a changed tone of voice, a sense of pressure.
Objectively: in the left lobe of the thyroid gland a 3 cm node is palpable; it is
very dense, tuberous, painless. Cervical lymph nodes are enlarged. Functional
status of the thyroid gland is unchanged. What is the most likely diagnosis?
A. Thyroid gland cancer
B. Nodular hyperthyroid goiter
C. Nodular euthyroid goiter
D. Chronic lymphomatous Hashimotos thyroiditis
E. Chronic fibrous Riedels thyroiditis

128. An unconscious victim in severe condition is brought to clinic. It is

known that the patient touched the bare wire with his hand and during 5
minutes was under the influence of an alternating current with voltage of 220
V. Physical exam: skin is pale, cold by touch. Breath is weakened, BP - 90/50
mm Hg, Ps - 60 bpm, arrhythmical. There are fields of necrosis of the skin on
the right hand and on the right foot. What is the preliminary diagnosis?
A. Electroburn of the right foot and right hand
B. High voltaged electroburn of the right foot and shank
C. Electrotrauma, acute cardiovascular failure
D. Vascular collapse due to electric current lesion

129. A 47-year-old patient complains about cough with purulent sputum,

pain in the lower part of the left chest, periodical body temperature rise. She
has been suffering from these presentations for about 10 years. Objectively:
"drumstick" distal phalanges. What examination would be the most
informative for making a diagnosis?
A. Bronchography
B. Pleural puncture
C. Bacteriological analysis of sputum
D. Bronchoscopy
E. Survey radiograph of lungs

130. Blood typing resulted in positive isohemagglutination reaction with

standard sera of A(II) and B(III) groups and negative reaction with sera of
0(I) and AB(IV) groups. What is this result indicative of?
A. Faulty standard sera
B. The first blood group
C. The third blood group
D. The fourth blood group
E. The second blood group

131. A victim of a road accident, aged 44, is operated on account of

intraperitoneal haemorrhage. In which case can the patients blood from the
abdominal cavity be used for autotransfusion?
A. Stomach rupture
B. Liver rupture
C. Bladder rupture
D. Splenic rupture
E. Small intestines rupture

132. A man with a stab-wound of the right foot applied to doctor. He

stepped on the board with nail two hours ago. In the patient medical chart it is
stated that 3 years ago he passed the whole course of vaccination against
tetanus. What is the tactics of doctor to prevent tetanus in this case?
A. Do not conduct specific prophylaxis
B. Administer 1,0 ml of tetanus toxoid
C. Administer 1 ml tetanus toxoid and 3000 U of anti-tetanic serum
D. Administer 3000 U of anti-tetanic serum
E. Administer 0,5 ml of tetanus toxoid

133. A 42-year-old patient with acute haemorrhage and class III blood loss
underwent blood transfusion and got 1,8 l of preserved blood and erythromass
of the same group and Rh. After the transfusion the patient complained of
unpleasant retrosternal sensations, his arterial pressure dropped to 100/60
mm Hg, there appeared convulsions. Blood serum calcium was at the rate of
1,7 millimole/liter. What is the mechanism of this complication development?
A. Citrate binds calcium ions, hypocalcemia impairs myocardial
function
B. Citrate causes the development of metabolic acidosis
C. Citrate binds potassium causing severe hypokalemia
D. The increased citrate rate causes convulsions
E. Citrate is cardiotoxic and nephrotoxic
134. A 40-year-old woman with acute gastrointestinal hemorrhage was
transfused 400 ml of the preserved blood after having conducted all
compatibility tests. After hemotransfusion the condition of the patient became
worse. She started having headache, muscles pain, her temperature has risen
up to 38,8°C. What is the reason for such condition of the patient?
A. Pyrogenic reaction of medium severity
B. Allergic reaction
C. Air embolism
D. Bacterial and toxic shock development
E. Hemotransfusional shock development

135. A 27-year-old patient with a knife stomach wound has been delivered to
a hospital 4 hours after injury. Objectively: the patient is in grave condition.
Ps- 120 bpm, weak. AP- 70/40 mm Hg. Laparotomy revealed a lot of liquid
blood in the abdominal cavity. The patient has been found to have bleeding
from the mesenteric vessels of the small intestine. Damage to hollow organs
has not been revealed. What is the best way to restore the blood loss?
A. Autoblood reinfusiont
B. Transfusion of washed erythrocytes
C. Rheopolyglucinum transfusion
D. Transfusion of fresh frozen plasma
E. Erythromass transfusion

136. A patient presented to a hospital with a carbuncle of the upper lip. The
body temperature is 39°C. There is a pronounced edema of the upper lip and
eyelids. What is the surgeons tactics of choice?
A. Hospitalize in the surgical unit
B. Disclose the carbuncle and administer out-patient treatment
C. Administer out-patient course of antibiotics
D. Administer physiotherapy
E. Disclose the carbuncle and administer antibiotics

137. A patient, aged 25, suffering from stomach ulcer. Had a course of
treatment in the gastroenterological unit. 2 weeks later developed constant
pain, increasing and resistant to medication. The abdomen is painful in
epigastric area, moderate defence in pyloroduodenal area. Which
complication development aggravated the patients state?
A. Malignisation
B. Stenosis
C. Perforation
D. Penetration
E. Haemorrhage
138. A 62-year-old male patient complains of intense pain in the left leg that
suddenly arose three hours before, leg numbness and coldness. During the
year there has been pain in the leg while walking, hypersensitivity to cooling.
Objectively: the left foot and shin have marbled skin, subcutaneous veins are
collapsed. The foot is cold, active movements of the foot and toes are
preserved. Pulse is present only on the femoral artery. There is rough systolic
murmur above the artery. Make a provisional diagnosis:
A. Acute occlusion of the left femoral artery
B. Stenosis of the left popliteal artery
C. Acute arterial thrombosis ileofemoralny
D. Acute thrombophlebitis
E. Occlusive disease

139. A patient complains about pyrosis and permanent pain behind his
breastbone. When he bends forward after eating there appears regurgitation.
Roentgenological examination revealed extrasaccular cardiofunctional hernia
of esophageal opening of diaphragm. Esophagoscopy revealed signs of reflux-
esophagitis. What is the necessary tretment tactics?
A. Operation in a surgical department
B. Treatment at a health resort
C. Conservative treatment in the therapeutic hospital
D. Conservative treatment in an outpatients clinic
E. Conservative treatment in a surgical department

140. A patient aged 18 with a cranial injury was in comatose state during
several hours. In post-comatose period gets tired quickly, non-productive in
dialog - in the beginning answers 2-3 questions, then gets tired and can not
understand the point of the question. Which psychotropic should be given to
the patient to prevent psychoorganic syndrome?
A. Nootropics
B. Antidepressants
C. Stimulators
D. Neuroleptics
E. Tranquillisers

141. A 45-year-old male patient with acute abscess of the left lung has
suddenly developed acute chest pain and dyspnea while coughing, tachycardia
has increased. The control Ro-gram shows left lung collapse, the air in the left
pleural cavity and a horizontal fluid level. What is the mechanism of this
complication?
A. Abscess burst into the pleural cavity
B. Bullae rupture of the left lung
C. Atelectasis of the left lung
D. Acute cardiovascular insufficiency
E. Inflammation spread to the visceral pleura

142. Examination of a 38-year-old patient who had been hit with a blunt
object on the left side of chest revealed a fracture of the X rib with fragments
displacement, parietal pneumothorax. The patient complains of pain in the
left subcostal area. Objectively: the patient is pale, AP- 80/40 mm Hg, Ps-
138/min, of poor volume. USI reveals fluid in the left abdomen. Splenic
rupture is present. What treatment tactics should be chosen?
A. Drainage of the left pleural cavity followed by laparotomy
B. Immediate laparotomy and alcohol-novocaine block of the X rib
C. Immediate upper median laparotomy followed by drainage of the left pleural
cavity
D. Anti-schock actions followed by laparotomy after the arterial pressure rise
E. Left-sided thoracotomy immediately followed by laparotomy

143. On the 2nd day after a surgery for toxic mixed goiter IV a 35-year-old
patient complains of heart pain. ECG shows prolonged QT intervals.
Chvosteks and Trousseau symptoms cannot be clearly defined. The patient is
provisionally diagnosed with latent tetany. What study will allow to confirm
the diagnosis?
A. Determination of blood calcium and phosphor
B. Determination of potassim
C. Determination of thyroid hormones
D. Determination of sodium
E. Determination of thyrotropic hormone

144. A patient with bilateral hydrothorax has repeatedly undergone pleural

puncture on both sides. After a regular puncture the patients condition has
become worse: he presents with fever, chest pain. The next day, the attending
physician performing pleural puncture revealed some pus on the right. What
is the mechanism of acute right-sided empyema development?
A. Contact-and-aspiration
B. Hematogenous
C. Lymphogenous
D. Implantation
E. Aerial

145. A 25 y.o. patient was admitted with chest trauma. Clinical and X-ray
examination have revealed tense pneumothorax on the left. What emergency
treatment should be undertaken?
A. Pleural cavity drainage
B. Analgetics
C. Oxigenotherapy
D. Intravenous infusions
E. Intubation

146. A 38 y.o. patient lifted a heavy object that resulted in pain in the
lumbar part of spine irradiating to the posterior surface of his left leg. The
pain increases during changing body position and also in the upright position.
Examination revealed positive symptoms of tension. What is the preliminary
diagnosis?
A. Pathology of intercostal disks
B. Myelopathy
C. Arachnomyelitis
D. Spinal cord tumor
E. Polyneuritis

147. Two hours ago a 38-year-old patient got pain in his right shin. He was
diagnosed with popliteal artery embolism, acute arterial insufficiency of grade
I. What is the most appropriate therapeutic tactics?
A. Embolectomy
B. Resection of the popliteal artery
C. Amputation at the middle of shin
D. Bypass grafting
E. Destruction of the embolus by the catheter

148. A 38-year-old patient has suddenly developed pain in the left side of his
chest, suffocation. Objectively: moderately grave condition, Ps- 100/min, AP-
90/60 mm Hg, breath sounds on the left cannot be auscultated. Chest
radiography shows the collapse of the left lung up to 1/2. What kind of
treatment should be administered?
A. Passive thoracostomy
B. Rest, resolution therapy
C. Operative therapy
D. Active thoracostomy
E. Pleural puncture

149. A 47-year-old female patient complains of leg heaviness, fatigue when

standing and walking. This feeling disappears when she takes a horizontal
position. Objectively: dilatation of the superficial veins of the left shin and
thigh with pigmentation and trophic skin disorders. What functional test
should the examination be started with?
A. Trendelenburgs test
B. Pratt test 2
C. Sheinis test
D. Perthes test
E. Pratt test 1

150. A neonatologist examining a full-term mature baby revealed the

shortening and external rotation of the newborns lower extremity. Clinical
examination revealed positive Ortolani sign, symptom of non-vanishing pulse,
additional skin folds on the internal surface of thigh. What is the most likely
diagnosis?
A. Congenital hip dislocation
B. Fracture of the femoral shaft
C. Varus deformity of the femoral neck
D. Dysplasia of the hip joint
E. Femoral neck fracture

151. A child is being discharged from the surgical department after

conservative treatment of invagination. What recommendations should doctor
give to mother to prevent this disease recurrence?
A. Strict following of feeding regimen
B. Hardening of the child
C. Feces observation
D. Common cold prophilaxis
E. Gastro-intestinal disease prevention

152. A 10-year-old child has been admitted to a hospital with a closed

craniocerebral injury with suspected cerebral edema. The patient is in grave
condition, unconscious. The dyspnea, tachycardia, hypertension are present.
Muscle tone is increased, there is nystagmus, pupillary and oculomotor
reactions are disturbed. The mandatory component of intensive care is
dehydration. What diuretic is adequate in this case?
A. Furosemide
B. Spironolactone
C. Moduretic
D. Mannitol
E. Hydrochlorthiazide

153. A 40-year-old patient underwent an operation for a lumbar phlegmon.

Body temparature rose again up to 38°C, he got intoxication symptoms, there
was an increase of leukocyte number in blood. The wound that was nearly free
from necrotic tissues and full of granulations started to discharge pus, the
granulations turned pale. What complication dveloped in this patient?
A. Sepsis
B. Erysipelas
C. Erysipeloid
D. Allergic reaction
E. Putrid phlegmon

154. After a car accident a 37-year-old patient has an acute pain and
bleeding in the middle third of his right thigh. Objectively: there is a wound on
the anterior surface of the right thigh with massive bleeding, abnormal
mobility at the level of the middle third of the thigh. The first aid is to be
started with:
A. Digital occlusion of the femoral artery
B. Venipuncture and intravenous infusion of polyglycine
C. Tourniquet application
D. Injection of pain-killers
E. Immobilization of the extremity with a transportation splint

155. A 42-year-old builder consulted a doctor about a foot injury with a nail
that he got in the morning of the same day. The wound was washed with
water. Three years ago he was vaccinated against tetanus. Examination
established satisfactory condition of the patient. The left foot was slightly
edematic, there was a stab wound on the sole. In order to prevent tetanus it is
primarily required to:
A. Give an intravenous injection of 0,5 ml of tetanus anatoxin
B. Administer a course of antibiotic therapy
C. Give an intravenous injection of 3000 IU of antitetanus serum
D. Give an intravenous injection of 1 ml of tetanus anatoxin, 3000 IU of
antitetanus serum
E. Treat the wound with suds

156. A 9-year-old boy fell from a tree and hit the occipital region, there was
a momentary loss of consciousness. Objectively: the childs condition is
satisfactory, he complains of the headache and dizziness. The X-ray of skull
reveals a comminuted depressed fracture of occipital bone in the region of
inion. What treatment is indicated for the patient?
A. Surgical intervention
B. Hemostatic therapy
C. Anti-inflammatory therapy
D. Therapeutic lumbar punctures
E. Complex conservative treatment

157. A 55-year-old patient complains of severe itching, burning and pain in

the eyes, skin redness in the outer corners of the palpebral fissure. Objectively:
skin around the outer corners of the palpebral fissure is macerated,
eczematous, there are single moist cracks. Palpebral conjunctiva is hyperemic,
 quaggy. There are minor discharges in form of stringing mucus. What is the
most likely diagnosis?
A. Chronic conjunctivitis
B. Blepharitis
C. Atopic eyelid dermatitis
D. Acute conjunctivitis
E. Sty

158. A 40-year-old female patient has a history of rheumatism. She

complains about acute pain in her left eye, especially at night, vision
impairment, photophobia, lacrimation. The patient cannot suggest any
reasons for the disease. Objectively: weak pericorneal injection, flattening of
iris relief, iris discoloration. What is the most likely diagnosis?
A. Iridocyclitis
B. Keratitis
C. Iritis
D. Choroiditis
E. Acute attack of glaucoma

159. 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. Liver abscess
C. Abdominal cavity tumour
D. Left kidney cyst
E. Spleen abscess

160. A patient, aged 81, complains of constant urinary excretion in drops,

feeling of fullness in thelower abdomen. On examination: above pubis there is
a spherical protrusion, over which there is a dullness of percussion sound,
positive suprapubic punch. What symptom is observed in this patient?
A. Paradoxal ischuria
B. Dysuria
C. Urinary incontinence
D. Enuresis
E. Pollakiuria

161. A 67 y.o. patient complains of dyspnea, breast pain, common weakness.

He has been ill for 5 months. Objectively: to- 37,3°C, Ps- 96/min. Vocal
 tremor over the right lung cannot be determined, percussion sound is dull,
breathing cannot be auscultated. In sputum: blood diffusively mixed with
mucus. What is the most probable diagnosis?
A. Lung cancer
B. Bronchoectatic disease
C. Macrofocal pneumonia
D. Focal pulmonary tuberculosis
E. Exudative pleuritis

162. A 52 year old patient complains about pain in the right part of her
chest, dyspnea, cough with a lot of foul-smelling albuminoid sputum in form
of "meat slops". Objectively: the patients condition is grave, cyanosis is
present, breathing rate is 31/min, percussion sound above the right lung is
shortened, auscultation revealed different rales. What is the most probable
diagnosis?
A. Lung gangrene
B. Lung abscess
C. Multiple bronchiectasis
D. Chronic pneumonia
E. Pleura empyema

163. 3 hours ago a 65-year-old female patient felt sharp abdominal pain
irradiating to the right scapula, there was a single vomiting. She has a history
of rheumatoid arthritis. Objectively: pale skin, AP- 100/60 mm Hg, Ps-
60/min. Abdomen is significantly painful and tense in the epigastrium and
right subcostal areat, there are positive symptoms of parietal peritoneum
irritation over the right costal arch, that is tympanitis. What is the tactics of an
emergency doctor?
A. To take the patient to the surgical hospital
B. To perform gastric lavage
C. To take the patient to the rheumatological department
D. To inject spasmolytics
E. To inject pain-killers and watch the dynamics

164. A 15 year old patient suffers from headache, nasal haemorrhages, sense
of lower extremity coldness. Objectively: muscles of shoulder girdle are
developed, lower extremities are hypotrophied. Pulsation on the pedal and
femoral arteries is sharply dampened. AP is 150/90 mm Hg, 90/60 on the
legs. Systolic murmur can be auscultated above carotid arteries. What is the
most probable diagnosis?
A. Aorta coarctation
B. Aorta aneurism
C. Aortal insufficiency
D. Coarctation of pulmonary artery
E. Aortal stenosis

165. A 15 y.o. patient has developmental lag, periodical skin yellowing.

Objectively: spleen is 16?12?10 cm large, holecistolithiasis, skin ulcer on the
lower third of his left crus. Blood count: erythrocytes - 3,0×1012/L, Hb- 90
g/L, C.I.- 1,0, microspherocytosis, reticulocytosis. Blood bilirubin - 56
mmole/L, indirect bilirubin - 38 mmole/L. Choose the way of treatment:
A. Splenectomy
B. Omentohepatopexy
C. Portocaval anastomosis
D. Spleen transplantation
E. Omentosplenopexy

166. A 72-year-old patient complains of pain and bleeding during

defecation. Digital rectal investigation revealed a tumour of the anal canal.
After verification of the diagnosis the patient was diagnosed with squamous
cell carcinoma. The secondary (metastatic) tumour will be most probably
found in:
A. Lungs
B. Brain
C. Pelvic bones
D. Liver
E. Mediastinum

167. A patient with frostbite of both feet was delivered to the admission
ward. What actions should be taken?
A. To apply a bandage, to introduce vasodilating medications
B. To administer cardiac medications
C. To rub feet with snow
D. To apply an alcohol compress
E. To put feet into hot water

168. 10 years ago a patient had a fracture in the middle one-third of his left
femoral bone, and during the last 7 years he has been having acute
inflammation in the area of old fracture accompanied by formation of a fistula
through which some pus with small fragments of bone tissue is discharged.
After a time the fistula closes. What complication of the fracture is it?
A. Chronic osteomyelitis
B. False joint
C. Trophic ulcer
D. Bone tuberculosis
E. Soft tissue phlegmon
169. A 21-year-old male patient got a deep cut wound in his right thigh. In
the emergency room a surgeon on duty performed primary debridement of the
wound and primary wound closure with a suture. After 4 days, there appeared
pain, redness, edema, purulent discharge from the wound gap, body
temperature rose up to 39°C. What kind of wound complication can you think
of and what actions should be taken?
A. Wound abscess, remove the sutures and drain the wound
B. Tetanus, active-passive immunization against tetanus
C. Lymphangitis, apply a hot compress
D. Infiltration, apply a hot compress
E. Erysipelas, prescribe antibiotics

170. A patient has a stab wound on his right foot. On the fourth day after
injury the patients body temperature rose up to 38°C, inguinal lymph nodes
became enlarged and painful, skin over them reddened. What complication
might be suspected?
A. Lymphadenitis
B. Phlegmon
C. Erysipelas
D. Tetanus
E. Lymphangitis

171. During a surgery on a 30-year-old patient a dark ileo-ileal

conglomerate was discovered, the intussusceptum intestine was considered to
be unviable. The intussuscipiens intestine was dilated to 7-8 cm, swollen, full
of intestinal contents and gases. What pathology led to the surgery?
A. Invagination (combined) obstruction
B. Spastic obstruction
C. Obturation obstruction
D. Strangulation obstruction
E. Paralytic obstruction

172. A 52 year old patient complains about headache, weakness of his upper
left extremity. Neurological symptoms become more intense during physical
stress of the left extremity. Pulsation on the arteries of the left extremity is
sharply dampened but it remains unchanged on the carotid arteries. What is
the most probable diagnosis?
A. Occlusion of the left subclavicular artery, steal syndrome
B. Raynauds syndrome
C. Occlusion of brachiocephalic trunk
D. Takayasus disease
E. Thoracal outlet syndrome
173. A 43-year-old patient had been admitted to a hospital with clinical
presentations of ischiorectal periproctitis. On the 12th day of treatment the
patients 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
- 19,6×109/l, RBCs.- 3,0×1012/l, Hb- 98 g/l. What complication was
developed?
A. Liver abscess
B. Pylephlebitis
C. Liver necrosis
D. Budd-Chiari syndrome
E. Hepatic cyst

174. A 57 year old patient abruptly lost the sight of one eye. Examination
revealed that his sight made up 0,02 excentrically, eye fundus has
haemorrhages of different forms and sizes ("squashed tomato" symptom).
Disc of optic nerve is hyperemic. In anamnesis general vascular pathology is
recorded. Direct-acting anticoagulants were administered. What is the most
probable diagnosis?
A. Thrombosis of central vein of retina
B. Hypertensive angiopathy
C. Embolism of central artery of retina
D. Diabetic retinopathy
E. Hypertensive angioneuropathy

175. Half an hour ago a 67-year-old patient with a hernia picked up a heavy
object, which caused acute pain in the region of hernia protrusion, the hernia
couldnt be reduced. Objectively: the hernia in the right inguinal region is
roundish, tight, moderately painful; during palpation it was reduced back to
the cavity, the pain was gone. Specify the further medical tactics:
A. Inpatient surveillance
B. Immediate laparotomy
C. Immediate hernioplasty
D. Planned hernioplasty a month later
E. Planned hernioplasty a year later

176. A 55 year old patient felt suddenly sick in a hospital corridor, he was
immediately examined by a doctor. Examination revealed that the patients
skin was pale, autonomous respiration was absent, pulse on carotid arteries
couldnt be felt, pupils were mydriatic. What action should be taken at the
beginning of cardiac resuscitation?
A. Precordial thump
B. Defibrillation
C. Closed-chest cardiac massage
D. Mouth-to-mouth ventilation
E. Restoration of airway patency

177. A 30-year-old patient has been admitted to the intensive care unit for
multiple bee stings. The skin is covered with cold sweat. The pulse is felt just
on the carotid arteries, 110 bpm, respiration is 24/min, rhythmic, weakened.
Which drug should be given in the first place?
A. Adrenalin hydrochloride intravenously
B. Adrenalin hydrochloride intramuscularly
C. Prednisolone intravenously
D. Dopamine intravenously
E. Tavegil intravenously

178. A 25-year-old victim of a road accient complains of chest pain, dyspnea.

Objectively: the patient is in a grave condition, Ps- 120/min, AP- 90/70 mm
Hg.There is pathological mobility of fragments of III-V ribs on the right.
Percussion reveals a box sound over the right lung, breathing sounds cannot
be auscultated on the right. What examination should be administered in the
first place?
A. X-ray of chest organs
B. Pleural puncture
C. Bronchoscopy
D. USI of chest organs
E. Thoracoscopy

179. After the pneumatic dilatation of oesophageal structure a patient

developed acute retrosternal pain getting worse when throwing the head back
and swallowing. Objectively: dilatation of the neck veins, dropped beat pulse,
signs of purulent intoxication, oliguria, emphysema of the upper portion of
chest. What disease can be suspected?
A. Suppurative mediastinitis
B. Pleural empyema
C. Spontaneous pneumothorax
D. Acute myocardial infarction
E. Thrombosis of the superior vena cava

180. A 6-year-old girl drank some coloured fizzy drink which gave her a
feeling of pressure in the throat. 30 minutes later the childs lips got swollen,
then edema gradually spread over the whole face, laryngeal breathing became
difficult. The child is excited. Ps- 120/min, breathing rate - 28/min, breathing
 is noisy, indrawing of intercostal spaces is observed. What basic aid is most
appropriate for the restoration of laryngeal breathing?
A. Corticosteroids
B. Antibacterial drugs
C. Conicotomy
D. Sedative drugs
E. Tracheostomy

181. An 8-month-old baby has had problems with nasal breathing and
muco-purulent discharge from the nose for a week. Examination reveals a
rhinedema, muco-purulent discharges from the middle nasal meatus as well
as on the back of pharynx. What disease are these symptoms most typical for?
A. Ethmoiditis
B. Sphenoiditis
C. Frontitis
D. Hemisinusitis
E. Maxillary sinusitis

182. A 28-year-old female patient has been admitted to a hospital. She

states to be ill for 12 years. On examination she has been diagnosed with
bronchiectasis with affection of the left lower lobe of lung. What is the optimal
treatment tactics for this patient?
A. Left lower lobectomy
B. Bronchopulmonary lavage
C. Antibiotic therpy
D. Left-sided pneumoectomy
E. Active drainage of the left pleural cavity

183. 4 weeks after myocardial infarction a 56-year-old patient developed

acute heart pain, pronounced dyspnea. Objectively: the patients condition is
extremely grave, there is marked cyanosis of face, swelling and throbbing of
neck veins, peripheral pulse is absent, the carotid artery pulse is rhythmic, 130
bpm, AP is 60/20 mm Hg. Auscultation of heart reveals extremely muffled
sounds, percussion reveals heart border extension in both directions. What is
the optimal treatment tactics for this patient?
A. Pericardiocentesis and immediate thoracotomy
B. Conservative treatment, infusion of adrenomimetics
C. Pleural cavity drainage
D. Oxygen inhalation
E. Puncture of the pleural cavity on the left

184. Esophagus wall of a 72 year old patient with severe concomitant

pathology was injured during urgent fibroesophagogastroscopy. This resulted
 in progressing of acute respiratory failure and collapse of the left lung. What
aid should be rendered?
A. Drainage of pleural cavity by Bullaux method, mediastinum
drainage, antibacterial therapy
B. Endoscopic closure of esophagus wound, drainage
C. Left-sided thoracotomy, closure of esophagus and mediastinum wound
D. Buelaus drainage of pleural cavity, antibacterial therapy
E. Left-sided thoracotomy, closure of esophagus wound

185. A 17-year-old patient complains of pain in the area of the left knee
joint. Soft tissues of thigh in the affected region are infiltrated, joint function
is limited. X-ray picture of the distal metaepiphysis of the left femur shows a
destruction focus with periosteum detachment and Codmans triangle found at
the defect border in the bone cortex. X-ray of chest reveals multiple small
focal metastases. What treatment is indicated?
A. Palliative chemotherapy
B. Radioiodine therapy
C. Disarticulation of the lower extremity
D. Amputation of the lower extremity
E. Distance gamma-ray therapy

186. A 35-year-old victim of a road accident has got an injury of the right
side of his chest. Objectively: respiration rate - 28-30/min, respiration is
shallow, restricted respiratory excursion and acrocyanosis are present. Ps- 110
bpm, AP- 90/60 mm Hg. Respiratory sounds over the right lung cannot be
auscultated. Chest radiograph shows fractures of the VI-VII ribs on the right,
the right pleural cavity contains both air and fluid, with the fluid at about the
level of the V rib, the shadow of the mediastinum is displaced to the left. What
first aid should be provided to the victim?
A. Puncture of the pleural cavity
B. Vagosympathetic blockade
C. Antibiotic administration
D. Artificial ventilation of lungs
E. Urgent thoracotomy

187. On the first day after a surgery for diffuse toxic goiter a patient
developed difficulty breathing, cold sweats, weakness. Objectively: pale skin,
body temperature - 38,5°C, RR - 25/min, Ps- 110/min, AP- 90/60 mm Hg.
What early postoperative complication occurred in the patient?
A. Thyrotoxic crisis
B. Compression of the trachea by the hematoma
C. Postoperative tetany
D. Hypothyroid crisis
E. Acute thyroiditis
188. A 20-year-old patient complains of pain in the left lumbar region,
arterial pressure rise up to 160/110 mm Hg. USI revealed that the structure
and size of the right kidney were within age norms, there were signs of 3
degree hydronephrotic transformation of the left kidney. Doppler examination
revealed an additional artery running to the lower pole of the kidney.
Excretory urogram shows a narrowing in the region of ureteropelvic junction.
Specify the therapeutic tactics:
A. Surgical intervention
B. Kidney catheterization
C. Administration of beta-blockers
D. Administration of spasmolytics
E. Administration of ACE inhibitors

189. A 49-year-old male patient consulted a doctor about difficult

swallowing, voice hoarseness, weight loss. These symptoms have been
gradually progressing for the last 3 months. Objectively: the patient is
exhausted, supraclavicular lymph nodes are enlarged. Esophagoscopy
revealed no esophageal pathology. Which of the following studies is most
appropriate in this case?
A. Computed tomography of chest and mediastinum
B. X-ray of lungs
C. Radioisotope investigation of chest
D. Ultrasound investigation of mediastinum
E. Multiplanar imaging of esophagus

190. A 36-year-old male patient complains of having headache, obstructed

nasal breathing, purulent nasal discharge for 2 weeks. A month before, he had
his right maxillary premolar filled. Radiolography revealed an intense opacity
of the right maxillary sinus. Diagnostic puncture revealed a large amount of
thick malodorous crumbly pus. What is the most likely diagnosis?
A. Chronic suppurative odontogenic sinusitis
B. Chronic purulent sinusitis
C. Tumor of the maxillary sinus
D. Chronic atrophic sinusitis
E. Acute purulent sinusitis

191. A patient with autoimmune thyroiditis accompanied by multinodular

goiter underwent the right lobe ectomy and subtotal resection of the left lobe.
What drug should be administered to prevent postoperative hypothyroidism?
A. L-thyroxine
B. Iodomarin
C. Insulin
D. Lithium drugs
E. Merkazolil

192. A hospital admitted a patient with coarse breathing (obstructed

inspiration), skin cyanosis, tachycardia and arterial hypertension. He has a
histrory of bronchial asthma. An hour ago he was having salbutamol
inhalation and forgot to remove a cap that was aspired while taking a deep
breath. What measures should the doctor take?
A. To perform the Heimlich manoever
B. To use an inhalation of a2-adrenoceptor agonist
C. To make a subcutaneous injection of dexamethasone
D. To perform conicotomy immediately
E. To send for an anesthesiologist and wait for him

193. An emergency physician arrived to provide medical care for a hangman

taken out of the loop by his relatives. The doctor revealed no pulse in the
carotid arteries, lack of consciousness, spontaneous breathing and corneal
reflexes; cadaver spots on the back and posterior parts of extremities. A
person can be declared dead if the following sign is present:
A. Cadaver spots
B. Lack of corneal reflexes
C. Unconsciousness
D. Pulselessness
E. Lack of spontaneous breathing

194. An emergency physician arrived to provide medical care for a hangman

taken out of the loop by his relatives. The doctor revealed no pulse in the
carotid arteries, absence of consciousness, spontaneous breathing and corneal
reflexes; cadaver spots on the back and posterior parts of extremities. A
person can be declared dead if the following sign is present:
A. Cadaver spots
B. Pulselessness
C. Unconsciousness
D. Absence of spontaneous breathing
E. Absence of corneal reflexes

195. A 69-year-old male patient has been hospitalized with hypothermia.

Objectively: the patient is pale, has shallow breathing. AP is 100/60 mm Hg,
Ps is 60/min. Palpation of the abdomen and chest reveals no pathological
signs. The body temperature is of 34,8°C. The patients breath smells of
alcohol. Give treatment recommendations:
A. Warm bath + intravenous administration of warm solutions
B. Antishock therapy
C. Forced diuresis
D. Body warming with hot-water bags
E. Rubbing with alcohol and snow

196. A patient undergoing treatment for the left-sided destructive

pneumonia presents with deterioration of his general condition, progressing
dyspnea, cyanosis. Objectively: the left side of chest is not involved in
respiration, breathing sounds cannot be auscultated. Radiograph shows a
shadow reaching the 5 rib with a horizontal fluid level and a radiolucency
above it, the mediastinum is displaced to the right. What is the medical
tactics?
A. Thoracostomy
B. Infusion and antibacterial therapy
C. Emergency bronchoscopy
D. Open thoracotomy
E. Endotracheal intubation

197. A 26-year-old male patient consulted a doctor abut sore throat, fever up
to 38,2°C. A week before, the patient had quinsy, didnt follow medical
recommendations. On examination, the patient had forced position of his
head, trismus of chewing muscles. Left peritonsillar region is markedly
hyperemic, swollen. What is the provisional diagnosis?
A. Left-sided peritonsillar abscess
B. Phlegmonous tonsillitis
C. Tonsil tumour
D. Pharyngeal diphtheria
E. Meningitis

198. A 26-year-old patient consulted a doctor abut sore throat, fever up to

38,2°C. A week ago, the patient had angina, didnt follow medical
recommendations. On examination, the patient had forced position of his
head, trismus of chewing muscles. Left peritonsillar region is markedly
hyperemic, swollen. What is the provisional diagnosis?
A. Left-sided peritonsillar abscess
B. Phlegmonous angina
C. Tonsil tumour
D. Diphtheria of the pharynx
E. Meningitis

199. A 77-year-old male patient complains of inability to urinate, bursting

pain above the pubis. The patient developed acute condition 12 hours before.
Objectively: full urinary bladder is palpable above the pubis. Rectal prostate is
enlarged, dense and elastic, well-defined, with no nodes. Interlobular sulcus is
 distinct. Ultrasonography results: prostate volume is 120 cm3, it projects into
the bladder cavity, has homogeneous parenchyma. Prostate-specific antigen
rate is of 5 ng/ml. What is the most likely disease that caused acute urinary
retention?
A. Prostatic hyperplasia
B. Sclerosis of the prostate
C. Acute prostatitis
D. Tuberculosis of the prostate
E. Prostate carcinoma

200. A 4 month old child was admitted to a surgical department 8 hours

after the first attack of anxiety. The attacks happen every 10 minutes and last
for 2-3 minutes, there was also one-time vomiting. Objectively: the childs
condition is grave. Abdomen is soft, palpation reveals a tumour-like formation
in the right iliac area. After rectal examination the doctors finger was stained
with blood. What is the most probable diagnosis?
A. Ileocecal invagination
B. Gastrointestinal haemorrhage
C. Helminthic invasion
D. Pylorostenosis
E. Wilms tumour

201. A 3-year-old male patient consulted a family doctor 2 months after he

had been operated for an open fracture of brachial bone. Objectively: the
patients condition is satisfactory, in the region of the operative wound there is
a fistula with some purulent discharge, redness, fluctuation. X-ray picture
shows brachial bone destruction with sequestra. What complication arose in
the postoperative period?
A. Posttraumatic osteomyelitis
B. Wound abscess
C. Hematogenic osteomyelitis
D. Posttraumatic phlegmon
E. Suture sinus

202. A 40-year-old female patient complains of having a bulge on the

anterior surface of neck for 5 years. Objectively: Ps- 72 bpm, arterial pressure
- 110/70 mm Hg, in the right lobe of thyroid gland palpation reveals a mobile
4x2 cm node, the left lobe is not palpable, the basal metabolic rate is 6%. What
is the most likely diagnosis?
A. Nodular euthyroid goiter
B. Mixed euthyroid goiter
C. The median cervical cyst
D. Nodular hyperthyroid goiter
E. Riedels thyroiditis
203. Forensic medical expertise of corpse of a newborn revealed: body
weight 3500 g, body length 50 cm, the umbilical cord was smooth, moist,
glossy, without any signs of drying. Hydrostatic tests were positive. The test
results are the evidence of:
A. Live birth
B. Primary atelectasis
C. Stillbirth
D. Secondary atelectasis
E. Hyaline membrane disease

204. A week ago a 65-year-old patient suffered an acute myocardial

infarction, his general condition deteriorated: he complains of dyspnea at rest,
pronounced weakness. Objectively: edema of the lower extremities, ascites is
present. Heart borders are extended, paradoxical pulse is 2 cm displaced from
the apex beat to the left. What is the most likely diagnosis?
A. Acute cardiac aneurysm
B. Acute pericarditis
C. Recurrent myocardial infarction
D. Cardiosclerotic aneurysm
E. Pulmonary embolism

205. A 36-year-old injured has been taken to the emergency station with
open tibial fractures. Examination reveals bleeding: pulsating blood spurts out
of the wound. What medical manipulations are required at this stage of
medical care?
A. Apply a tourniquet on the thigh proximal to the source of bleeding
and transport the patient to the operating room
B. Transport the patient to the operating room
C. Apply a tourniquet on the thigh distal to the source of bleeding and transport
the patient to the operating room
D. Immobilize the fracture and transport the patient to the operating room
E. Stop the bleeding by a compressive bandage and transport the patient to the
operating room

206. A 75-year-old male patient complains of slight pain in the right iliac
region. The abdominal pain arose 6 days ago and was accompanied by nausea.
Surgical examination revealed moist tongue, Ps- 76 bpm. AP- 130/80 mm Hg.
Abdomen was soft, slightly painful in the right iliac region on deep palpation,
the symptoms of the peritoneum irritation were doubtful. In blood: RBCs -
4,0×1012/l, Hb- 135 g/l, WBCs - 9,5×109/l, stab neutrophils - 5%,
segmentonuclear - 52%, lymphocytes - 38%, monocytes - 5%, ESR - 20 mm/h.
Specify the doctors further tactics:
A. Emergency operation for acute appendicitis
B. Refer the patient to a district therapist
C. Administration of additional examination: abdominal ultrasound, x-ray
contrast study of the gastrointestinal tract
D. Hospitalization, dynamic surveillance
E. Send the patient home

207. A 56-year-old patient was undergoing a surgery for suture repair of

perforated ulcer. During the operation the cardiomonitor registered
ventricular fibrillation. The first-priority measure should be:
A. Electrical defibrillation
B. Injection of calcium chloride
C. Injection of lidocaine
D. Injection of adrenalin
E. Injection of atropine

208. A 78-year-old patient complains of severe pain in the lower abdomen,

perineum and rectum; intense urge to urinate and inability to urinate without
assistance. Abdomen palpation reveals a moderately painful globular
formation above the pubis, there is percussion dullness over the formation.
What is the most likely diagnosis?
A. Acute urinary retention
B. Chronic incomplete urinary retention
C. Cystitis
D. Paradoxical ischuria
E. Chronic urinary retention

209. A 24-year-old patient had been delivered to the thoracic department

with a chest injury, a fracture of the IV, V, VI ribs on the right. Plan
radiography shows the fluid level in the pleural cavity reaching the III rib on
the right. Puncture blood contained clots. What is the optimal treatment
tactics?
A. Emergency thoracotomy
B. Thoracentesis and thoracostomy
C. Pleural puncture
D. Hemostatic therapy
E. Medical thoracoscopy