Krok 2_2018

1. A 10-year-old boy with symptoms of arthritis and myocarditis was delivered into a hospital. Based on
clinical examination the preliminary diagnosis of juvenile rheumatoid arthritis was made. What symptom
is the most contributive for the diagnostics of this disease?
A. Regional hyperemia of the joints
B. Reduced mobility of the joints in the morning
C. Affection of the large joints
D. Enlarged heart
E. Increased heart rate

2. A 7-year-old boy has been an inpatient for 1.5 months. He had been delivered to the hospital with
complaints of edemas all over his body, low urine output, and headache. Clinical urinalysis: proteins - 7.1
g/L, leukocytes - 1-2 in the vision field, erythrocytes - 3-4 in the vision fi- eld. During the course of
treatment the edemas gradually dissipated, headache abated, diuresis normalized. Daily urine proteins - 3
g/L. Biochemical blood test: total protein - 43.2 g/L, urea - 5.2 mmol/L, cholesterol - 9.2 mmol/L. What
glomerulonephritis syndrome is the most likely to be present in the patient?
A. Nephritic
B. Nephrotic
C. Isolated urinary
D. Hematuric
E. Mixed

3. The mother of a 3-month-old child came to a family doctor with complaints of her child being
physically underdeveloped and suffering from cough attacks and dyspnea. Anamnesis: the child is the
result of the second full-term pregnancy with the risk of miscarriage (the first child died of pulmonary
pathology at the age of 4 months, according to the mother). Body mass at birth is 2500 g. Cough attacks
were observed from the first days of life, twice the child was treated for bronchitis. Considering the
severity of the child’s condition the doctor made the referral for hospitalization. What diagnosis was most
likely stated in the referral?
A. Pertussis
B. Acute obstructive bronchitis
C. Recurrent obstructive bronchitis
D. Mucoviscidosis (Cystic fibrosis)
E. Acute obstructive pneumonia

4. A 10-year-old girl complains of stomachache that appears and intensifies after she eats rough or spicy
food, sour eructation, heartburn, frequent constipations, headaches, irritability. She has been presenting
with these signs for 12 months. Her meals are irregular and consist of dry food. Objectively her diet is
suffi- cient in calories. The tongue is moist with white coating near the root. The abdomen is soft and
painful in the epigastrium. What method would be optimal for diagnosis-making in this case?
A. Biochemical blood test
B. Intragastric pH-metry
C. Fractional gastric analysis (Fractional test meals)
D. Phase-contrast X-ray imaging
E. Esophagogastroduodenoscopy
5. A 5-year-old child that contacts with viral hepatitis in the kindergarten presents with increased body
temperature up to 38oC, weakness, low appetite, single case of vomiting, dull pain in the subcostal area on
the right. The child is provisionally diagnosed with viral hepatitis. What examination would be the most
informative for diagnosis confirmation?
A. Blood test for bilirubin
B. Urine analysis for bile pigments
C. Feces analysis for stercobilin
D. ALT activity in blood
E. Thymol turbidity test

6. An infant is 2.5 months old. The onset of the disease was gradual, the child had normal body
temperature but presented with slight cough. Within a week the cough intensified, especially at night; on
the 12th day the child developed cough fits occurring up to 20 times per day and followed by vomiting.
There was one instance of respiratory arrest. Make the diagnosis:
A. Pertussis
B. Parainfluenza
C. Congenital stridor
D. Respiratory syncytial infection
E. Adenovirus infection

7. A newborn with gestational age of 31 weeks presents with hypotonia and depressed consciousness.
Hematocrit is 35%, general cerebrospinal fluid analysis shows increased content of erythrocytes and
protein, and low glucose. These data correspond with the clinical presentation of: A. Anemia
B. Meningitis
C. Sepsis
D. Intracranial hemorrhage
E. Prenatal infection

8. A 16-year-old girl has primary amenorrhea, no pubic hair growth, normally developed mammary
glands; her genotype is 46 ХY; uterus and vagina are absent. What is your diagnosis?
A. Testicular feminization syndrome
B. Mayer-Rokitansky-Kuster-Hauser syndrome
C. Cushing syndrome
D. Sheehan syndrome
E. Cushing disease

9. Mother of an 8-year-old girl complains that the child is too short and has excessive body weight.
Objectively: obesity with fat deposits on the torso and face (round moon-like face), acne, striae on the
thighs and lower abdomen, hirsutism. What hormone can cause such symptoms, when in excess? A.
Thyroxin
B. Cortisol
C. Testosterone
D. Insulin
E. Glucagon

10. A 9-year-old girl complains of fever up to 38.5oC, headache, inertness, weakness, loss of appetite,
stomachache, and frequent painful urination. Provisional diagnosis of acute pyelonephritis is made.
Clinical urine analysis: specific gravity - 1016, no protein, leukocytes - 10-15 in the vision field. What
investigation method can verify the diagnosis of urinary tract infection?
A. Bacteriological inoculation of urine
B. Rehberg test (creatinine clearance test)
C. Zymnytsky test (density measurement of daily diuresis)
D. Complete blood count
E. Clinical urine analyses, dynamic testing

11. A 14-year-old patient visited a doctor complaining of enlargement of his submaxillary lymph nodes.
Objectively: submaxillary, axillary and inguinal lymph nodes are enlarged. Chest X-ray shows: enlarged
lymph nodes of mediastinum. Blood test: erythrocytes - 3.4 · 1012/L, Hb- 100 g/L, blood colour index -
0.88, platelets - 190 · 109/L, leucocytes - 7.5 · 109/L, eosinophiles - 8%, band neutrophiles - 2%,
segmented neutrophiles - 67%, lymphocytes - 23%, ESR - 22 mm/hour. What test must be prescribed to
verify the cause of lymphadenopathy?
A. Abdominal US
B. Open biopsy of the lymph nodes
C. Mediastinum tomography
D. Puncture biopsy of the lymph nodes
E. Sternal puncture

12. A 10-year-old boy, who was outdoors in windy and cold weather, developed moderate pain and
tingling in his fingers and toes. When he had returned home, his parents noticed that the tips of his fingers
and toes were white and their sensitivity was lost. The affected areas are warming up, the fingers are
tingling and in pain. Skin pallor changed into redness, tingling stopped, slight itching and swelling of the
fingers appeared. Determine the frostbite degree in this child:
A. Perniosis
B. Frostbite of the I degree
C. Frostbite of the II degree
D. Frostbite of the III degree
E. Frostbite of the IV degree

13. A 12-year-old boy with hypertrophic cardiomyopathy complains of dyspnea caused by the slightest
physical exertion. Echocardiography detected asymmetrical left ventricular hypertrophy, signs of
pulmonary hypertension, and left ventricular dilatation, its ejection fraction is 59%. These developments
are indicative of:
A. Heart failure with preserved ejection fraction
B. Heart failure with reduced ejection fraction
C. Primary pulmonary hypertension
D. Essential hypertension
E. Symptomatic arterial hypertension

14. A 9-month-old infant presents with delayed tooth eruption and fontanel closure, weakness, and
excessive sweating. What type of hypovitaminosis is the most likely in this child?
A. Hypovitaminosis A
B. Hypovitaminosis C
C. Hypovitaminosis B1
D. Hypovitaminosis B6
E. Hypovitaminosis D

15. A 10-year-old girl exhibits high level of physical development ( + 3σ), her body length increased by
10 cm within a year (which is double the norm for her age group), the number of permanent teeth
corresponds with the age norm (20), the development of her secondary sex characteristics is three years
ahead of her age (Ма, Р, Ах, Menarche). Development rate ahead of her biological age can occur due to:
A. Endocrine disorders
B. Acceleration
C. Certain components of her diet
D. Sports training
E. Deficient hygienic education

16. A 16-year-old adolescent living in a rural area has been bitten in the shin by a stray dog. The wound is
superficial. Regular vaccination against tetanus was received 3 months ago. What treatment tactics would
be the most advisable in this case?
A. Antirabies immunoglobulin
B. Antirabies vaccination
C. Tetanus toxoid adsorbed
D. Antitetanus serum
E. Antitetanus immunoglobulin

17. During examination a 4-month-old child with meningococcemia presents with acrocyanosis, cold
extremities, tachypnea, and thready pulse, blood pressure of 30/0 mm Hg, anuria, and sopor. What clinical
syndrome is it?
A. Acute renal failure
B. Neurotoxicosis
C. Exicosis
D. Encephalic syndrome
E. Septic shock

18. The pregnancy is full term. The body weight of the parturient woman is 62 kg. Fetus is in a
longitudinal lie, the head is engaged to the pelvic inlet. Belly circumference is 100 cm. Uterine fundus
height is 35 cm. What body weight of the fetus can be expected?
A. 2.5 kg
B. 4 kg
C. 3.5 kg
D. 3 kg
E. 4.5 kg

19. An 18-year-old young man complains of pain in his knee and elbow joints and body temperature up to
39.5oC. One week and a half earlier developed sore throat. On examination his body temperature is
38.5oC. Swelling of the knee and elbow joints is observed. Pulse is 106/min., rhythmic. Blood pressure is
90/60 mm Hg. Cardiac borders are unchanged, heart sounds are weakened, at the cardiac apex there is soft
systolic murmur. What factor would be the most indicative of the likely disease etiology?
A. Anti-streptolysin O
B. C-reactive protein
C. Creatine kinase
D. Rheumatoid factor
E. Seromucoid
20. The right arm of a newborn is stretched along the torso with all its joints extended; the shoulder is
rotated inwards, while the forearm is pronated, the hand is in the position of palmar flexion. Spontaneous
movements are absent in the shoulder and elbow joints, passive movements are painless. What is the most
likely diagnosis?
A. Duchenne-Erb palsy, superior proximal type
B. Dejerine-Klumpke palsy, inferior distal type
C. Total obstetric palsy
D. Osteomyelitis of the right humerus
E. Poliomyelitis

21. A newborn has Apgar score of 9. When should the infant be put to the breast?
A. In the delivery room
B. After 12 hours
C. After 2 hours
D. On the 2nd day
E. On the 3rd day

22. A 3-day-old infant with hyperbilirubinemia (428 mcmol/L) developed disturbances manifesting as
periodical excitation and convulsions against the background of inertness, hypotension, hypodynamia, and
inhibition of unconditioned reflexes, convergent strabismus, rotational nystagmus, and settingsun eye
phenomenon. What is the most likely cause of such symptoms?
A. Infantile cerebral paralysis
B. Craniocerebral injury
C. Brain tumor
D. Hydrocephalus
E. Bilirubin encephalopathy

23. A 15-year-old adolescent girl came the the gynecologist with complaints of painful menstruations that
are accompanied by nausea, vomiting, and dizziness. Her menarche was at 12. Menstruations became
painful since she was 14, remain regular. What treatment should be prescribed in this case?
A. Analgesics, antispasmodics, antiprostaglandine therapy
B. Antiinflammatory treatment only
C. Antihemorrhagic agents
D. Antiandrogen therapy
E. Vitamin supplements

24. A 3-year-old child presents with sharp deterioration of his general condition. He has a history of
purulent otitis. His temperature is now 38.5oC. The left leg is pressed to the torso, active movements are
absent, the lower third of the thigh and knee joint are thickened, hyperemic, with localized fever. Axial
load leads to acute discomfort of the patient. What is the most likely diagnosis?
A. Osteogenic sarcoma
B. Left hip fracture
C. Rheumatoid arthritis
D. Epiphyseal osteomyelitis on the left
E. Hygroma of the knee

25. A 1.5-month-old child on breastfeeding presents from birth with daily vomiting, irregular liquid foamy
feces, and flatulence, which are resistant to antibacterial and probiotic therapy; no increase of body mass
is observed. The child’s condition improved, when breastmilk was substituted. What pathology is it?
A. Infectious enteritis
B. Intestinal lambliasis (Giardiasis)
C. Lactase deficiency
D. Drug-induced enteritis
E. Functional dyspepsia

26. It is the 3rd day after the normal term labor; the infant is rooming-in with the mother and is on
breastfeeding. Objectively: the mother’s general condition is satisfactory. Temperature is 36.4oC, heart
rate is 80/min., BP is 120/80 mm Hg. Mammary glands are soft and painless; lactation is moderate,
unrestricted milk flow. The uterus is dense, the uterine fundus is located by 3 fingers width below the
navel. Lochia are sanguino-serous, moderate in volume. Assess the dynamics of uterine involution:
A. Physiological involution
B. Subinvolution
C. Lochiometra
D. Pathologic involution
E. Hematometra

27. During regular examination of a 2-yearold boy, he presents with enlarged left kidney, painless on
palpation. The right kidney was undetectable on palpation. Excretory urography shows no contrast on the
right. Cytoscopy detected hemiatrophy of the urinary bladder trigone, the right ureteral orifice is not
detected. What pathology is it?
A. Hypoplasia of the right kidney
B. Dystopia of the right kidney
C. Agenesis of the right kidney
D. Agenesis of the right ureter
E. Ectopic right ureteral orifice

28. A 5-year-old child has body temperature risen up to febrile numbers, suffers from inertness, weakness.
Examination revealed hemorrhage on the skin of limbs and torso. Enlargement of cervical and axillary
lymph nodes can be detected. The liver is 4 cm below the costal arch; the spleen is 6 cm below the costal
arch. Blood test: erythrocytes - 2.3 · 1012/L, Hb- 60 g/L, platelets - 40 · 109/L, leukocytes - 32.8 · 109/L,
eosinophiles - 1%, band neutrophiles - 1%, segmented neutrophiles - 12%, lymphocytes - 46%, monocytes
- 1%, blasts - 40%, Duke’s bleeding time test result is 9 min. What examination is necessary to make the
diagnosis?
A. Abdominal US
B. Lymph nodes biopsy
C. Myelogram (bone marrow biopsy)
D. Detection of hepatitis markers
E. Analysis of dynamic platelet function

29. An 8-year-old girl with complaints of painful urination, frequent low-volume urination, and
leukocyturia was diagnosed with acute cystitis. 10 days before the disease onset she was treated by the
gynecologist for acute vulvitis. 5 days ago she presented with mild catarrhal symptoms. Her mother
ascribes the child’s disease to her overexposure to cold. Specify the most likely infection route:
A. Ascending
B. Descending
C. Hematogenic
D. Contact
E. Lymphogenic

30. A 17-year-old girl has made an appointment with the doctor. She plans to begin her sex life. No signs
of gynecological pathology Krok 2 Medicine (англомовний варiант, iноземнi студенти) 2018 рiк 24
were detected. In the family history there was a case of cervical cancer that occurred to the patient’s
grandmother. The patient was consulted about the maintenance of her reproductive health. What
recommendation will be the most helpful for prevention of invasive cervical cancer?
A. Immunomodulators
B. Vitamins, calcium, omega-3
C. Vaccination against human papillomavirus (HPV)
D. Antiviral and antibacterial drugs
E. Timely treatment of sexually transmitted diseases

31. A 6-month-old infant is not vaccinated. The physician recommends a DPT (diphtheria, pertussis,
tetanus) vaccination but the mother is absolutely against this procedure. Choose the most substantial
argument in favor of vaccination:
A. Epidemic risk for the others
B. -
C. Personal professional experience
D. High quality of vaccines
E. Risk of lethal consequences

32. A 5-year-old boy complains of severe dyspnea and sensation of lack of air. Objectively the child
assumes orthopneic position, presents with marked peripheral cyanosis, drumstick fingers, nail plates
resembling a ”clock face”, the borders of cardiac dullness are bilaterally extended; coarse systolic murmur
can be detected over the whole surface of the heart and is especially pronounced in the II intercostal area
on the left near the sternum. What disease can be characterized by such presentations?
A. Primary bacterial endocarditis
B. Dilated cardiomyopathy
C. Defect of the interventricular septum
D. Fallot’s tetrad
E. Defect of the interatrial septum

33. A 10-year-old boy is delivered into a polytrauma unit after he received a blunt trauma of the thorax,
having fallen from the bicycle. Upon hospitalization his blood pressure is 110/80 mm Hg, heart rate is
96/min. Chest X-ray is noncontributive to the diagnosis. Echocardiogram shows free liquid in the
pericardial cavity, in the amount of up to 100 ml. In an hour after the hospitalization the patient started to
develop increasing signs of heart failure: jugular venous distention, decreased blood pressure down to
90/70 mm Hg, tachycardia up to 120/min. On auscultation muffled heart sounds. What would be the
primary tactics of a physician?
A. Pericardiocentesis (pericardial puncture)
B. Cardiac glycosides intravenously
C. Constant oxygenotherapy
D. Diuretics intravenously
E. Antibiotics intravenously

34. An 18-year-old patient complains of skin rash. The patient has been suffering from this condition for 5
years. The first instance of this disease occurred after a car accident. Objectively: the patient presents with
papular rash covered in silvery scales, ”thimble” symptom (small pits on the nails), affected joints. What
is the most likely diagnosis?
A. Rheumatism
B. Panaritium
C. Onychomycosis
D. Lupus erythematosus
E. Psoriasis

35. An 8-year-old child presents with blood pressure up to 180/100 mm Hg in the upper limbs
accompanied by headaches, tinnitus, occasional nosebleeds, and high fatigability. On examination there is
no pulse over the leg arteries. ECG shows left ventricular hypertrophy. MRI-scan shows aortic narrowing
to 5 mm in the typical place. Coarctation of aorta is diagnosed. What kind of treatment should be
prescribed in this case?
A. Conservative
B. Surgical
C. Physical therapy
D. Case monitoring
E. Abstain from surgery in favor of complex conservative therapy
36. A 6-year-old girl arrived to the in-patient unit with complaints of enlargement of the lower third of her
right thigh. According to the case history, she has been stepping carefully on her right leg and limping for
6 months. Blood test detected anemia. X-ray of the right thigh shows a round bone defect with clear
margins resembling melting sugar in the distal metaphysis. What provisional diagnosis can be made in this
case?
A. Osteogenic sarcoma of the right femur
B. Rheumatoid arthritis of the right knee joint
C. Acute hematogenous osteomyelitis of the distal femoral metaphysis on the right
D. Tuberculous osteitis of the distal femoral metaphysis on the right
E. Giant cell tumor of the right femur

37. A 15-year-old girl suffers from systemic lupus erythematosus and has been receiving prednisolone
therapy in the daily dosage of 2 mg/kg for the last 6 weeks. The plans are made to gradually lower the
dosage of the medicine. No clinical signs of her disease are observed. Previously she has received no
immunization against measles. Due to measles outbreak it is necessary to develop the immunity against
this infection in the patient. When can she be vaccinated?
A. At the present time
B. After 2 weeks of prednisolone therapy in the dosage lower than 2 mg/kg/24 hours
C. 1 month after the prednisolone therapy is complete
D. Immediately after the prednisolone therapy is complete
E. Never due to medical contraindications

38. A healthy child 1 year and 5 months of age is being vaccinated against hepatitis B. The child did not
receive the first dose of the vaccine previously, while in the maternity hospital. The doctor makes an
individual vaccination schedule for this child and plans the administration of the next dose of the vaccine.
What is the minimum interval between doses of vaccine in this case?
A. 1 month
B. 2 months
C. 3 months
D. 6 months
E. 12 months