Dr Ashiq TuToriAls

KroK-2 BAse

surgery
2021-2022
upDATeD
1. An 83-year-old bedbound man presents with a shallow open ulcer over his
sacrum, with a red wound bed. Upon further examination, he also has areas of
non-blanching redness on hnis lateral malleoli. Which of the following
interventions would most likely have prevented his condition?
A. Frequent repositioning
B. Nutritional supplementation
C. Topical antibiotics
D. Anti-coagulants
E. Elevating the head of the bed to 45 degrees

2. A 69-year-old female presents to the emergency department with crampy

abdominal pain. She has a past medical history of hypertension, dyslipidemia,
and cholelithiasis status post cholecystectomy. The patient states she has not
passed stool or gas for 48 hrs. On physical exam vitals are T 98.4 F HR 105
bpm BP 155/101 mmHg RR 16 SpO2 96%, abdominal exam is notable for
distension, tympany to percussion, and tenderness to palpation without
rebound or guarding. Which of the following
3. findings are most likely on radiograph?
A. Ladder-like series of distended bowel loops with air-fluid levels on
abdominal radiograph
B. Apple core defect after lower GI series
C. Multiple punctate mucosal outpouchings through the serosa on lower GI
series
D. Free air under the diaphragm on upright abdominal radiograph
E. Loss of haustral markings and "lead pipe" appearance to the descending
colon on lower GI series

4. A 53-year-old farmer presents to the clinic for evaluation of a pigmented

lesion on his arm. He states that he first noticed the lesion last year, but he
believes that it has been slowly growing in size. He otherwise does not have
any complaints and is generally healthy. Which of the following findings on
physical exam would suggest a malignant diagnosis?
A. Different pigmentation throughout the lesion
B. Flat lesion with symmetric hyperpigmentation
C. Hyperpigmented lesion with smooth borders
D. Symmetrical ovoid lesion
E. Tenderness to palpation

5. An 11-year-old girl presents to her pediatrician with complaints of headache

and rapid leg fatigue with exercise. Her vital signs are: HR 77, BP in left arm
155/100, RR 14, SpO2 100%, T 37.0 C. On palpation, her left dorsalis pedis
pulse is delayed as compared to her left radial pulse. Her lower extremities
feel slightly cool. Blood pressure obtained on the left lower extremity is
120/80. Which of the following is the most likely underlying pathology?
A. Coarctation of the aorta
B. Vasospasm
C. Peripheral arterial disease
 D. Tetralogy of Fallot
E. Aortic stenosis

6. A 40-year-old victim of a traffic accident sustained the following injuries:

closed diaphyseal femur fracture, brain concussion, multiple rib fractures,
hemopneumothorax, degloving shin injuries. What injuries require the most
urgent attention?
A. Multiple rib fractures, hemopneumothorax
B. Closed diaphyseal femur fracture
C. Brain concussion
D. Degloving shin injuries
E. All injuries are equivalent

7. The burns unit received a patient, who 6 hours ago during a fire received
flame burns. On the patient’s body there is gray-brown area of necrosis that
covers ¾ of the body perimeter. Occasionally there are small blisters with
hemorrhagic contents and patches of shredded epidermis. What local therapy
is necessary in this case?
A. Decompression necrectomy
B. Chemical necrolysis
C. Blister puncture
D. Necrectomy with xenotransplantation
E. Necrectomy with dermalautograft

8. A 25-year-old man was hospitalized with complaints of pain in his lower

abdomen and right lumbar area that appeared one hour ago. Patient’s general
state is moderately severe. Body temperature-38.2oC, heartrate - 102/min.
The tongue is dry. The abdomen is painful on deep palpation in the right iliac
area and in the Petittriangle. Aure-Rozanov and Gabay signs are positive.
Make the provisional diagnosis:
A. Acute appendicitis
B. Right-sided renalcolic
C. Cecal tumor
D. Intestinal obstruction
E. Acute cholecystitis

9. A 65-year-old woman on abdominal palpation presents with a tumor in the

umbilical region and aboveit; the tumor is 13x8 cm in size, moderately painful,
non-mobile, pulsing. On auscultation systolic murmur can be observed. What
is the most likely diagnosis?
A. Abdominalaorticaneurysm
B. Gastric tumor
C. Arteriovenousaneurysm
D. Tricuspidinsufficiency

10. A 50-year-old patient was brought to a hospital with complaints of blood in

urine. Urination is painless and undisturbed. Macro hematuria had been
 observed for 3 days. Objectively: kidney scan not be palpated, suprapubic area
is without alterations, external genitalia are non- pathologic. On rectal
investigation: prostate is not enlarged, painless, has normal structure.
Cystoscopy revealed no changes. What is the most likely diagnosis?
A. Renalcarcinoma
B. Bladdertuberculosis
C. Varicocele
D. Dystopickidney
E. Necroticpapillitis

11. A 45-year-old man was brought by an ambulance into the emergency hospital.
He complains of sudden pain in the lumbar area, frequent painful urination,
and vomiting. Examination detects pain in the lumbar area, costovertebral
angle tenderness , pain on palpation of kidneys and along the ureter on the
right. Urine test: proteins, fresher throcytes, leukocytes. Make the provisional
diagnosis:
A. Urolithiasis,renalcolic
B. Acutepyelonephritis
C. Acuteglomerulonephritis
D. Acuterenalfailure
E. Polycystickidneydisease

12. A patient has the second and third degree burns of the 15%of the body surface.
On the 20th day after the trauma the patient presents with sharp increase of
body temperature, general weakness, rapid vesicular respiration; facial
features are sharpened, BP is 90/50mm Hg,heart rate is 112/min. What
complication is it?
A. Sepsis
B. Pneumonia
C. Acuteintoxication
D. Purulentbronchitis
E. Anaerobicinfection

13. A 32-year-old woman complains of tumor like formation on the anterior

surface of her neck that appeared 2 years ago. Within the last 3months the
tumor has been rapidly growing. It hinders swallowing and impairs speech;
the tumor causes a sensation of pressure. Objectively the skin moisture is
normal, pulse is 80/min., rhythmic, blood pressure is 130/80mm Hg. In the
right lobe of the thyroid gland there is a dense lumpy node 3.0x3.5 cm that
moves during swallowing. Scanning image shows a ”cold nodule” in the
thyroid gland. Make the provisional diagnosis:
A. Thyroid cancer
B. Thyroid adenoma
C. Thyroid cyst
D. Nodular goiter
E. Auto immune thyroiditis
14. During medical examination a cadet in the naval college was detected to have
a painless dense ulcer 1.5x0.5 in size in his perianal area at the 2 o’clock
position. The ulcer floor resembles ”old fat”. What is the provisional
diagnosis?
A. Hard syphilitic chancre of the rectum
B. Rectal fissure
C. Rectal fistula
D. Anal cancer
E. Anal crypt suppuration

15. After a surgery for a left thigh phlegmon the disease progression was
complicated by sepsis. On the 7th day after the surgery there are marked signs
of a generalized inflammatory reaction, in blood there are signs of toxic
anemia and progressing hypoproteinemia, bilirubin levels are 40 mcmol/L,
AST and ALT exceed the norm by 2.5 times. Oliguria persists (700 mL of urine
per day). Name the phase of sepsis progression:
A. Catabolic phase
B. Stress phase
C. Anabolic phase
D. Recovery phase
E. Mixed phase

16. 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 returned home,
his parents noticed that the tips of his fingers and toes were white and their
sensitivity was lost. As the affected areas were warming up, the fingers and
toes developed tingling and painful sensations. Skin pallor changed into
redness, tingling stopped, mild itching and swelling of the fingers appeared.
Determine the frostbite degree in this child:
A. Frostbite of the I degree
B. Perniosis
C. Frostbite of the II degree
D. Frostbite of the III degree
E. Frostbite of the IV degree

17. A 16-year-old patient has made an appointment with an otolaryngologist. He

complains of elevated body temperature and sore throat. Disease onset was 2
days ago, after the patient ate two portions of ice-cream. Pharyngoscopy
shows hyperemic mucosa of the palatine tonsils, with purulent exudate in the
lacunae. Make the provisional diagnosis:
A. Lacunar tonsillitis
B. Follicular tonsillitis
C. Diphtheria
D. Acute pharyngitis
E. Pseudomembranous (Vincent’s) tonsillitis
18. A 35-year-old woman complains of high body temperature and pain in the
upper outer quadrant of her right buttock, which developed after an injection.
She has been presenting with this condition for 3 days. At the site of injection
the skin is hyperemic; there is a painful infiltrate with an area of softening in
its center. The woman is diagnosed with a postinjection abscess of the right
buttock. What tactics should the surgeon choose in this case?
A. Abscess incision, sanation and drainage of the cavity
B. Hospitalization, prescription of antibiotics, UHF
C. Abscess puncture, pus removal followed by application of antiseptics
D. 10-15 minutes of low-intensity laser radiation directed at the right buttock
E. Antipyretic agents, massage, and application of dry heat to the right buttock

19. A 32-year-old man complains of pain in his legs that intensifies during
walking, intermittent claudication, numbness of his toes, extremity coldness,
and inability to walk more that 100 meters. When he sleeps, his leg usually
hangs down. The patient has been smoking since he was 16. He drinks alcohol
in excess. The left leg is colder than the right one; the skin of the extremities is
dry. No pulse can be detected on the pedal arteries, while pulsation of the
femoral arteries is retained. What is the most likely diagnosis?
A. Obliterating endarteritis
B. Diabetic angiopathy
C. Leriche syndrome (aortoiliac occlusive disease)
D. Raynaud disease
E. Deep thrombophlebitis

20. A 59-year-old man complains of pain in his left eye and left side of his head,
significant vision impairment of the left eye, nausea, and vomiting. Visual
acuity of the right eye is 1.0. Visual acuity of the left eye is 0.03, attempts at
correction bring no improvement. Right eye intraocular pressure - 21 mm Hg,
left eye intraocular pressure - 65 mm Hg. Congestive injection is observed on
the sclera of the left eye. The cornea is thick and swollen. The anterior
chamber is shallow, moist, and clear. The pupil is dilated and unresponsive to
the light, the fundus of the eye is not visible. What is the most likely diagnosis?
A. Acute attack of glaucoma of the left eye
B. Acute iridocyclitis of the left eye
C. Stage II intraocular tumor of the left eye
D. Endophthalmitis of the left eye
E. Panophthalmitis of the left eye

21. On the 15th day after a small trauma of the right foot, the patient developed
indisposition, fatigability, irritability, headache, elevated body temperature,
and sensation of constriction, tension, and twitching in the muscles of the
right shin. What disease can be suspected?
A. Tetanus
B. Anaerobic gas gangrene
C. Erysipelas
D. Acute thrombophlebitis
 E. Thrombophlebitis of the popliteal artery

22. 2 hours after a traffic accident a 28-yearold man in a grave condition was
brought to a hospital. The patient complains of abdominal pain. He received a
blow to the abdomen with the steering wheel. Objective examination revealed
the following: the abdomen does not participate in respiration, is tense and
acutely painful on palpation; the abdominal muscles are defensively tense,
peritoneal irritation signs are positive, hepatic dullness is absent. BP is 90/60
mm Hg, heart rate is 120/min. What further treatment tactics should be
chosen?
A. Laparotomy
B. Laparoscopy
C. Cold to the abdomen
D. Ultrasound investigation
E. Laparocentesis

23. A 48-year-old woman has arrived to the surgical unit with wounds in her
thigh. On examination the wound surface has dirty-gray coating with
unpleasant sweet smell. Wound content resembles raspberry jelly. Skin tissues
around the wound are glossy and turgid. Palpation reveals moderate
crepitation in the tissues. What microflora is the most likely to cause such
inflammation?
A. Anaerobic clostridial
B. Anaerobic non-clostridial
C. Streptococci
D. Staphylococci
E. Blue pus bacillus

24. After a pain attack in the right subcostal area, a 58-year-old woman with
overnutrition developed icteric skin and sclera, lightcolored feces, and dark
urine. Her abdomen is distended and painful on palpation in the right
subcostal area. Palpation detects liver enlargement by 2-3 cm. Blood test: total
bilirubin - 90 mcmol/L, conjugated bilirubin - 60 mcmol/L. What method of
examination will be the most informative for diagnosis clarification?
A. Retrograde cholangiopancreatography
B. Intravenous cholegraphy
C. Infusion cholegraphy
D. Percutaneous transhepatic cholegraphy
E. US of the hepatopancreatobiliary zone

25. An 11-year-old boy for a month has been presenting with increasing pain in
the right femur. In the painful area there is a nonmobile painful tumor with
unclear margins. The child complains of general indisposition, weakness,
increased body temperature up to 39oC. X-ray shows widened medullary
cavity, small foci of cancellous bone destruction, and onion-like lamellar
exfoliation of the cortical layer. What is the most likely pathology resulting in
such clinical presentation?
 A. Ewing sarcoma
B. Osteogenic sarcoma
C. Fibrosarcoma
D. Chondrosarcoma
E. Juxtacortical sarcoma

26. A 43-year-old man complains of a protrusion in the right inguinal region, that
enlarges due to strain. He has been presenting with this condition for 6
months. Within this period the protrusion has grown. Objectively in the right
inguinal region an elastic protrusion 8x5 cm is visible. On palpation it
disappears, leaving an empty space 4x4 cm between the pedicles of the
Poupart ligament. ”Cough push” sign is positive over this opening. Make the
diagnosis:
A. Right-sided reducible inguinal hernia
B. Right-sided reducible femoral hernia
C. Cyst of the right spermatic cord
D. Right-sided inguinal lymphadenitis
E. Right-sided reducible arcuate line hernia
27. A 78-year-old man with a prostate adenoma underwent a herniotomy for a
direct inguinal hernia. After the surgery he presents with absent urination.
Enlarged urinary bladder is detectable above the patient’s pubis. What
measures should be taken in this case?
A. Bladder catheterization
B. Apply cold to the urinary bladder area
C. Prescribe processing of the postoperative wound with UHF field
D. Prescribe proserin (neostigmine) intramuscularly
E. Prescribe antispasmodics subcutaneously
28. A 38-year-old patient has been brought by an ambulance to the surgical
department with complaints of general weakness, indisposition, black stool.
On examination the patient is pale, there are dotted hemorrhages on the skin
of his torso and extremities. On digital investigation there are black feces on
the glove. Blood test: Hb- 108 g/L, thrombocytopenia. Anamnesis states that a
similar condition was observed 1 year ago. Make the diagnosis:
A. Thrombocytopenic purpura
B. Hemophilia
C. Ulcerative bleeding
D. Rectal tumor
E. Nonspecific ulcerative colitis
29. A 30-year-old man came to the family physician. 2 months ago he underwent
a surgery for open fracture of the humerus. On examination the patient’s
condition is satisfactory; in the area of the postoperative wound there is a
fistula that discharges a small amount of pus; the area itself is red; fluctuation
is detected. X-ray shows destruction of the humerus with sequestra. What
complication did the patient develop during the postoperative period?
A. Posttraumatic osteomyelitis
B. Hematogenous osteomyelitis
C. Wound suppuration
 D. Posttraumatic phlegmon
E. Suture sinus
30. 3 hours after a trauma, a young man developed bradycardia of 46/min.,
anisocoria D>S, hemi-hyperreflexia S>D, hemihypesthesia on the left, and a
convulsive disorder. The character of this process needs to be clarified. What
method of examination will be the most accurate for this purpose?
A. Brain CT
B. Skull X-ray
C. Electroencephalography
D. Echoencephalography
E. Lumbar puncture
31. The body of a 24-year-old woman with suspected poisoning has been found on
the street. Forensic medical examination was requested by an investigator
during examination of the site and the body. According to the Criminal
Procedure Code currently in force in Ukraine, forensic medical examination is
required when it is necessary to determine the:
A. Cause of death
B. Manner of death
C. Time of death
D. Mode of death
E. Mechanism of death
32. A 37-year-old patient complains of pain in the spinal column, reduced
mobility. The condition persists for 7 years. ”Sway back” is observed, there is
no movement in all spinal regions. X-ray shows ”bamboo spine” vertebral
column. What is the most likely diagnosis?
A. Ankylosing spondyloarthritis
B. Osteochondrosis
C. Spondylitis deformans
D. Tuberculous spondylitis
E. Spondylolisthesis
33. A surgery unit received a person with an incised stab wound on the upper
third of the right thigh. Examination detects an incised stab wound
3.0x0.5x2.0 cm in size on the inner surface of the upper third of the right
thigh. Bright-red blood flows from deep within the wound in a pulsing stream.
Characterize this type of bleeding:
A. Arterial
B. Venous
C. Parenchimatous
D. Capillary
E. Mixed
34. A 47-year-old man developed the signs of decompensated laryngeal stenosis
against the background of acute flegmonous laryngitis. He presents with
inspiratory dyspnea at rest, forced position, cyanotic skin covered in cold
sweat, tachycardia, deficient pulse, and low blood pressure. What urgent
treatment tactics should be chosen?
A. Tracheostomy
B. Oral administration of hyposensitization substances and broncholytics
 C. Intravenous administration of dehydrating agents
D. Administration of glucocorticoid hormones
E. Oxygen therapy
35. Heart X-ray of a 31-year-old man has revealed the following: with tightly filled
opacified esophagus there is a marginal filling defect in its middle third on the
posterior wall; the defect is 1.8x1.3 cm in size with clear oval border. Mucosal
folds are retained and envelop the defect; wall peristalsis and elasticity are not
affected. There are no complaints regarding the condition of the patient’s
alimentary canal. Make the provisional diagnosis:
A. Esophageal tumor
B. Achalasia cardiae
C. Esophageal burns
D. Diverticulum
E. Barrett esophagus
36. A 45-year-old man diagnosed with acute pulmonary abscess suddenly
developed sharp pain in his chest on the right and dyspnea up to 30/min.
Examination detects facial cyanosis and shallow rapid respirations.
Auscultation reveals acutely weakened respiration throughout the whole right
lung; percussion reveals a vesiculotympanitic (bandbox) resonance at the lung
apex and dullness in the lower lobe. What complication developed in this
patient?
A. Pyopneumothorax
B. Pleuropneumonia
C. Pneumothorax
D. Acute mediastinitis
E. Esophageal perforation
37. A 5-year-old child was brought to the ENT department by an ambulance. The
child presents with cough and difficult respiration. From the patient’s history
it is known that the child was playing with a toy construction set, when
suddenly started coughing and developed labored breathing. Examination
detects periodical cough, labored expiration, and respiratory lag in the left
side of the child’s thorax. Auscultation: diminished respiration on the left.
Percussion: tympanitis. X-ray shows a displacement of the mediastinal organs
to the right. Make the diagnosis:
A. A foreign body in the left bronchus, valvular bronchostenosis
B. A foreign body in the right bronchus, valvular bronchostenosis
C. A foreign body in the trachea
D. A foreign body in the left bronchus, complete bronchostenosis
E. A foreign body in the right bronchus, partial bronchostenosis
38. A 30-year-old man was brought to the neurosurgical department with
complaints of constant headaches, nausea, vomiting, fever, and weakness of
the right-side limbs. Anamnesis states that one month ago the patient had a
surgery for left-sided suppurative otitis and mastoiditis. He has been
undergoing treatment in an ENT department. Approximately 2 weeks ago the
temperature increased, and the patient developed headaches. Objectively:
heart rate - 98/min., BP- 140/90 mm Hg, temperature -38.3oC.
Neurologically manifested stiff neck: bilateral Kernig’s symptom, unsteadiness
 during the Romberg’s maneuver. Computer tomography of the brain revealed
a three dimensional growth with a capsule in the left hemisphere. Make the
diagnosis:
A. Cerebral abscess
B. Echinococcus
C. Hemorrhage
D. Hydrocephalus
E. Arnold-Chiari malformation
39. A woman in her early- to mid-thirties has lost her consciousness 3-5 minutes
ago. On examination: the skin is pale, no pulse over the carotid arteries, no
spontaneous respiration, pupils are dilated; the patient is nonresponsive,
presents with atony. The patient’s condition can be determined as:
A. Clinical death
B. Natural death
C. Syncope
D. Brain death
E. Comatose state
40. A boy had a foreign body removed from under his nail plate. 3 days later he
developed a sharp throbbing pain at the end of his distal phalanx, which
intensifies when the phalanx is pressed, hyperemia of the nail fold, elevated
body temperature up to 38.5oC, and nail plate discoloration. Make the
diagnosis:
A. Subungual panaritium
B. Erysipelas
C. Paronychia
D. Erysipeloid
E. Abscess
41. A 32-year-old woman complains of body weight loss despite her increased
appetite, nervousness, and tremor of the extremities. Objectively: the skin is
moist; the thyroid gland is diffusely enlarged, painless, soft, and mobile. Blood
test: increased level of T3, T4, and thyroid-stimulating hormone (THS). What
is the most likely diagnosis?
A. Diffuse toxic goiter
B. Thyroid carcinoma
C. Autoimmune (Hashimoto’s) thyroiditis
D. Thyroid adenoma
E. Diffuse nontoxic goiter
42. A 19-year-old young man complains of cough with expectoration of purulent
putum in the amount of 100 mL per day, hemoptysis, dyspnea, increased body
temperature up to 37.8oC, general weakness, weight loss. The patient’s
condition lasts for 4 years. Exacerbations occur 2-3 times a year. The patient
presents with malnutrition, pale skin, cyanosis of the lips, drumstick
(clubbed) fingers. Tympanic percussion sound in the lungs, weakened
respiration, numerous various moist crackles in the lower pulmonary
segments on the left can be observed. In blood: erythrocytes - 3.2·1012/L,
leukocytes - 8.4·109/L, ESR- 56 mm/hour. On X-ray: lung fields are
 emphysematous, the left pulmonary root is deformed and dilated. What is the
most likely diagnosis?
A. Multiple bronchiectasis of the left lung
B. Chronic left-sided pneumonia
C. Chronic abscess of the left lung
D. Left-sided pulmonary cystic dysplasia
E. Suppuration of the cyst in the left lung
43. A 57-year-old woman during a regular ultrasound examination presented with
a space-occupying heterogeneous lesion in the right kidney. What is the most
informative method of renal tumor diagnostics?
A. Spiral computed tomography
B. Excretory urography
C. Retrograde pyelography
D. Radioisotope renography
E. Three glass urine test
44. At the railroad crossing a passenger train collided with a bus. In this collision
26 bus passenges died, another 18 passengers received mechanical injuries of
varying severity. Where will be professional medical aid provided for the
victims of this accident? Who will provide this aid?
A. In medico-prophylactic institutions; general physicians and surgeons
B. At the site of the accident; first-response emergency teams
C. At the site of the accident; specialized second-response emergency teams
D. In medico-prophylactic institutions; specialized second-response
emergency teams
E. In medical institutions; all listed types of healthcare workers
45. A 45-year-old man underwent a cardiac surgery one week ago. His general
state has been deteriorating since then: dyspnea at rest, retrosternal pain that
irradiates to the neck, marked weakness. Objectively his body temperature is
hectic. His cardiac borders are expanded, apical beat is weakened.
Auscultation detects pericardial friction rub. What is the most likely
diagnosis?
A. Acute pericarditis
B. Acute cardiac aneurysm
C. Myocardial infarction
D. Acute myogenic dilatation of the heart
E. Pulmonary embolism

46. 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
47. 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

48. 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

49. 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

50. 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

51. 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
52. 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

53. 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

54. 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
55. 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

56. 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

57. 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

58. 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

59. 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

60. 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

61. 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

62. 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

63. 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

64. 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

65. 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
66. 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

67. 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

68. 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

69. 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

70. 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

71. 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

72. 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

73. 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

74. 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

75. 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

76. 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

77. 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

78. 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
79. 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

80.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%

81. 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

82. 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

83. 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

84. 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
85. 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

86. 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

87. 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

88. 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

89. 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

90. 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

91. 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

92. 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

93. 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

94. 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

95. 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

96. 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
97. 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

98. 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

99. 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

100. 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

101. 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

102. 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

103. 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

104. 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
105. 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

106. 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

107. 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

108. 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

109. 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

110. 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

111. 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
112. 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

113. 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

114. 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

115. 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

116. 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

117. 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

118. 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

119. 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

120. 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

121. 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

122. 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)

123. 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
124. 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

125. 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

126. 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

127. 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

128. 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

129. 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

130. 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

131. 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

132. 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
133. 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

134. 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

135. 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

136. 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
137. 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

138. 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

139. 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

140. 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
141. 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

142. 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

143. 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

144. 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

145. 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

146. 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

147. 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

148. 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

149. 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

150. 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

151. 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

152. 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
153. 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

154. 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

155. 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

156. 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
157. 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

158. 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

159. 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)

160. 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

161. 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

162. 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

163. 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
164. 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

165. 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

166. 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

167. 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
168. 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

169. 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

170. 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

171. 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
172. 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

173. 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

174. 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

175. 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

176. 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

177. 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

178. 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

179. 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

180. 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

181. 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

182. 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

183. 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

184. 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

185. 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

186. 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

187. 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

188. 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

189. 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

190. 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

191. 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

192. 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

193. 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

194. 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

195. 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

196. 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

197. 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

198. 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
199. 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

200. 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

201. 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

202. 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
203. 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

204. 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

205. 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

206. 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
207. 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

208. 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

209. 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

210. 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

211. 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

212. 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

213. 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

214. 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

215. 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

216. 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

217. 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

218. 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

219. 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

220. 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

221. 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
222. 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

223. 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

224. 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

225. 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
226. 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

227. 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

228. 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

229. 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

230. 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

231. 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

232. 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

233. 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

234. 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

235. 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

236. 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

237. 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

238. 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

239. 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

240. 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
241. 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

242. 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

243. 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

244. 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

245. 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

246. 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

247. 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

248. 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

249. 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

250. 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

251. 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

252. 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

253. 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

254. 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