Practical MCQ Question For 4-Year
Practical MCQ Question For 4-Year
Practical MCQ Question For 4-Year
5. Which method is preferable to the use of diuretics with a steady flow of essential hypertension:
A one-time appointment
+ B. prolonged use
C. treatment short course
D. cardiac arrhythmias
8. Which of the following drugs in the first place should be recommended to patients with CHD,
whose voltage stable angina attacks more frequent and require an increasing number of
nitroglycerin, blood pressure rises to 150 - 160/90 - 100 mm Hg and the heart rate is equal to 90 -
100 min
A long-acting nitrates
B. Ca antagonists;
+ C. beta-blockers
D. aspirin
12. What changes are detected on auscultation of lungs in patients with congestive (total) heart
failure stage 2A
A. bronchial breathing
+ B. wet finely wheezing in the lower posterior segments of lungs
C. "silent lung"
D. reducing myocardial oxygen demand
13. Which of the following is the most common complication of essential hypertension:
A. myocarditis
B. pericarditis
+ C. hypertensive crisis
D. chronic renal failure
18. What is the authority of the following does not belong to the target organs in hypertension?
A. Heart
+ B. Lungs
C. Vessels
D. kidneys
20. Which of the following is not considered when determining the overall cardiovascular risk in
patients with hypertension?
A. Risk Factors
B. target organ damage
+ C. The presence of concomitant chronic hepatitis
D. The presence of metabolic syndrome
26. The best method of treatment of angina in the defeat of two or more of the coronary arteries by
atherosclerosis is over:
A. Coronary angioplasty
B. Conservative therapy with nitrates + beta-blocker
C. Conservative therapy with amiodarone + calcium antagonist
+ D. coronary artery bypass grafting
27. Connect the electrodes in the registration of the first standard lead:
A. left leg and right arm
B. left leg and left arm
+ C. left hand and right hand
D. reducing myocardial oxygen demand
28. Connect the electrodes in the registration of the second standard lead:
A. left leg and left arm
+ B. left leg and right arm
C. left hand and right hand
D. Coronary angioplasty
30. The drug of choice for the treatment of ventricular arrhythmia in myocardial infarction is
+ A. lidocaine
B. Digoxin
C. verapamil
D. quinidine
38. Pain in the chest, which developed against the background of a sudden appeared shortness of
breath, the most typical for:
A. Acute pericarditis
B. dissecting aortic aneurysm
C. Break the esophagus
+ D. Pulmonary embolism
45. What are the antihypertensive drugs are contraindicated in bilateral renal artery stenosis
A. diuretics
+ B. ACE inhibitors
C. ß blockers
D. antagonists Ca
46. What kind of disease you think first and foremost, if the patient shows complaints of pain on the
left, fever, dysuria?
+ A. pyelonephritis
B. amyloidosis
C. acute glomerulonephritis
D. chronic glomerulonephritis
60. Strangulated diaphragmatic hernia in the adult patient has all of the following symptoms are
typical, except:
A. shortness of breath
B. Vomiting
C. cyanosis
+ D. anemia
61. Producing factors that contribute to the formation of hernias include everything except:
A. Heavy physical work
+ B. The presence of the weaknesses of the abdominal wall
C. Constipation
D. difficulty urinating
71. The complaints of the patient after resection of stomach heaviness in the epigastric region,
weakness, up to fainting after receiving a sweet or dairy foods are the signs:
A. insuloma pancreas
B. afferent loop syndrome
+ C. Dumping syndrome
D. Syndrome small stomach
74. The most common complication of ulceration of the front wall 12 duodenal ulcer is:
+ A. Perforation
B. Bleeding
c. Penetration in head of the pancreas
D. All incorrect
77. The operation of choice for a perforated stomach ulcer in conditions of purulent peritonitis is:
A. Gastrectomy
+ B. Closure of perforation
C. SPV suturing perforations
D. True antrumectomy
79. If you suspect a perforated stomach ulcer first study should be:
A. Stomach X-rays with a barium suspension
+ B. Survey abdominal radiography
C. Angiography (selective celiac artery)
D. Laparoscopy
80. The disappearance of the pain and the appearance of "melena" in the duodenal ulcer is typical
for:
A. ulcer perforation
B. malignancy ulcers
+ C. Bleeding
D. Penetration into the pancreas
81. What are the clinical features of patients with diagnosis of combined post cholecystitisektomy
syndrome:
A. Pain in the upper abdomen
B. Diarrheal phenomenon
C. Jaundice
+ D. All of the above
88. In acute intestinal obstruction vomit have all the above features, except: A. Mostly gastric
contents
B. Mostly enteric contents
C. Mostly colonic contents
+ D. The colors of the coffee grounds
93. For the first stage of acute limb ischemia is the main feature:
A. Restriction of active movements in the limbs
B. subfascial muscle swelling
+ C. Paresthesia in the limbs
D. Severe muscle contracture
95. The main feature of the second stage of acute limb ischemia is:
A. Severe muscle contracture
B. limb paresthesia
C. subfascial muscle swelling
+ D. Limiting the active movement of the limbs
96. The most effective means of preventing the progression of varicose veins are:
+ A. Elastic compression of the limb
B. Compliance with the rational regime of work and rest
C. Restriction of heavy physical load
D. Integrated vazoprotektoramy therapy
A. Addisonic crisis
B. Acute gastroenteritis
C. Meningoencephalitis
D. Scleroderma
E. Pellagra
102.
An unconscious patient presents with moist skin, shallow breathing. There are signs of previous
injection on the shoulders and hips. BP- 110/70 mm Hg. Tonus of skeletal muscles and reflexes are
increased. Cramps of muscles of the extremities are seen. What is the most likely disorder?
A. Hypoglycemic coma
B. Hyperglycemic coma
C. Hyperosmolar coma
D. Hyperlactacidotic coma
E. Stroke
103.
A 26 y.o. male patient with postoperative hypothyroidism take thyroxine 100 mg 2 times a day. He
has developed tachycardia, sweating, irritability, sleep disorder. Determine further treatment tactics.
A. To decrease thyroxine dosage
B. To increase thyroxine dosage
C. To administer betablockers
D. To add mercasolil to the treatment
E. To administer sedatives
104.
A 54-year-old patient complains of weakness, weight loss despite the unchanged appetite, frequent
urination, skin itch for six months. Some time ago the patient underwent treatment for furunculosis.
She hasn't been examined recently. Objectively: malnutrition, dry skin with signs of scratching.
Small lymph nodes can be palpated in the axillary regions. Changes in the internal organs are
absent. What testing must be administered in the first place?
A. Blood sugar test on an empty stomach
B. Complete blood count
C. Endoscopy of stomach
D. Lymph node biopsy
E. Blood sterility testing
105.
A 32-year-old female complains of dizziness, headache, palpitation, tremor. For the last several
months she has been under outpatient observation for the increased arterial pressure. Since recently
such attacks have become more frequent and severe. Objectively: skin is covered with clammy
sweat, tremor of the extremities is present. HR- 110/min, AP- 220/140 mm Hg. Heart sounds are
muffled. Blood test results: WBCs - 9,8\10^9/l, ESR - 22 mm/h. Blood glucose - 9,8 mmol/l. What
disease is the most likely cause of this crisis?
A. Pheochromocytoma
B. Essential hypertension
C. Preeclampsia
D. Primary hyperaldosteronism
E. Diabetic glomerulosclerosis
106.
A 47-year-old woman underwent a thyroid gland resection on ccount of nodular euthyroid goiter.
What preparations are most likely to prevent the disease recurrence?
A. Thyroid hormones
B. Mercazolil
C. Thyrotropin
D. Antistruminum (potassium iodide)
E. Radioactive iodine
107.
A 38-year-old woman experiences episodic increases in arterial pressure up to 240/120 mm Hg,
which is accompanied by nausea, vomiting, tachycardia, increased sweating, hyperglycemia. The
attack is usually followed by the excessive urination. Renal sonography reveals an additional
formation adjacent to the upper pole of the right kidney and possibly belonging to the adrenal gland.
What laboratory test will allow to clarify the diagnosis?
A. Determination of urinary excretion of catecholamines and vanillylmandelic acid
B. Blood test for insulin and C-peptide
C. Estimation of glomerular filtration rate by measuring endogenous creatinine clearance
D. Blood test for thyroxine and thyrotrophic hormone
E. Blood test for renin level
108.
A 58-year-old patient has a 3-year history diabetes mellitus type II. He has been keeping to a diet
and regularly taking glyburide. He has been delivered to a hospital on an emergency basis for acute
abdomen. Objectively: the patient is of supernutrition type. The skin is dry. In the lungs vesicular
breathing can be auscultated. Heart sounds are regular, 90/min. AP- 130/70 mm Hg. The symptom
of "wooden belly" is visible. Blood sugar - 9,8 mmol/l. The patients has indication for laparotomy.
What is the most appropriate way of further treatment of diabetes?
A. To administer short insulin
B. To continue taking glyburide
C. To administer Semilong to be taken in the morning and insulin - in the evening
D. To administer 1 tablet of Glurenorm three times a day
E. To administer 1 tablet of Maninil three times a day
109.
A 50-year-old patient was hospitalized in severe condition with complaints of chills, high grade
temperature, dryness in the mouth, multiple vomiting, pain in the epigastrium, frequent watery,
foamy, dirty green color stool of unpleasant odor. The tongue and the skin are dry. BP - 80/40 mm
Hg. What first aid is necessary for the patient?
A. Intravenous injection of sodium solutions
B. Fresh-frozen plasma transfusion
C. To prescribe polyglucin
D. Sympathomimetics
E. Hemosorbtion
110.
A patient had macrofocal myocardial infarction. He is overweight for 36\%, AP is 150/90 mm Hg,
blood sugar- 5,9 mmol/L, general cholesterol- 4,9 mmol/L, uric acid- 0,211 mmol/L. Which risk
factor should be urgently eradicated during the secondary prevention?
A. Obesity
B. Arterial hypertension
C. Hyperglycemia
D. Hypercholesterolemia
E. Hyperuricemia
111.
A 40-year-old female patient complains of headache, dizziness, muscle weakness, occasional
cramps in the extremities. She has been taking antihypertensive medications for 10 years. AP-
180/100 mm Hg. Blood potassium - 1,8 mmol/l, sodium - 4,8 mmol/l. In urine: alkaline reaction,
the relative density - 1012, protein and sugar are not found, WBCs - 3-4 in the field of vision, RBCs
- 1-2 in the field of vision. Conn's syndrome is suspected. Which drug should be chosen for the
treatment of arterial hypertension?
A. Spironolactone
B. Propanolol
C. Enalapril
D. Hydrochlorothiazide
E. Clonidine
112.
A 18-year-old patient had subtotal strumectomy due to malignant capillary cystadenoma of the
thyroid gland. In 2 months there was a suspicion of metastasis presence in the lungs. What
rontgenological method is to be used first?
A. Roentgenography of lungs
B. Roentgenoscopy of lungs
C. Angiopneumonography
D. Bronchography
E. Bronchoscopy
113.A 24-year-old patient complains about putting on weight, limosis. Objectively: the patient's
constitution is of hypersthenic type, body weight index is 33,2 kg/m^2, waist circumference is 100
cm. Correlation of waist circumference to the thigh circumference is 0,95. What is the most likely
diagnosis?
114.
A 45-year-old female patient complaining of general weakness, nausea and vomiting hass been
delivered to a hospital by the ambulance. Recently there has been a lack of appetite, weight loss.
Objectively: hyperpigmentation of skin, blood pressure at the rate of 70/45 mm Hg, bradycardia.
Additional studies revealed the reduced concentration of aldosterone and cortisol in blood,
decreased excretion of 17-ketosteroids and 17-oxyketosteroids in the urine, hyponatremia,
chloropenia, hypokalemia. What therapeutic measures are required?
115.
A 43-year-old female patient was delivered to the hospital in grave condition. She has a history of
Addison's disease. The patient had been regularly taking prednisolone but a week before she
stopped taking this drug. Objectively: sopor, skin and visible mucous membranes are pigmented,
skin and muscle turgor is decreased. Heart sounds are muffled, rapid. AP- 60/40 mm Hg, heart rate -
96/min. In blood: Na - 120 mmol/l, K - 5,8 mmol/l. Development of this complication is primarily
caused by the deficit of the following hormone:
A. Cortisol
B. Corticotropin (ACTH)
C. Adrenaline
D. Noradrenaline
E. Adrostendion
116.
A 38 y.o. man complains of having occasional problems with swallowing of both hard and fluid
food for many months. Sometimes he feels intense pain behind his breast bone, epecially after hot
drinks. There are asphyxia onsets at night. He has not put off weight. Objectively: his general
condition is satisfactory, skin is of usual colour. Examination revealed no changes of
gastrointestinal tract. X-ray picture of thorax organs presents esophagus dilatation with level of
fluid in it. What is the preliminary diagnosis?
A. Esophagus achalasia
B. Myastenia
C. Cancer of esophagus
D. Esophagus candidosis
E. Gastroesophageal reflux
117.
A 35 y.o. woman consulted a doctor about occasional pains in paraumbilical and iliac region that
reduce after defecation or passage of gases. Defecation takes place up to 6 times a day, stool is not
solid, with some mucus in it. Appetite is normal, she has not put off weight. First such symptoms
appeared 1,5 year ago, but colonoscopy data reveals no organic changes. Objectively: abdomen is
soft, a little bit painful in the left iliac region. Blood and urine are normal. What is the preliminary
diagnosis?
119.
A 48-year-old patient complains of heaviness in the right hypochondrium, itching of the skin.He
had been treated in infectious diseases hospital repeatedly due to icterus and itch. On physical
exam: meteorism, ascitis, dilation of abdominal wall veins, protruded umbilicus, spleen
enlargement. What can be diagnosed in this case?
A. Liver cirrhosis
B. Cancer of the liver
C. Cancer of the head of pancreas
D. Gallstones
E. Viral hepatitis B
120.
A 60-year-old woman, mother of 6 children, developed a sudden onset of upper abdominal pain
radiating to the back, accompanied by nausea, vomiting, fever and chills. Subsequently, she noticed
yellow discoloration of her sclera and skin. On physical examination the patient was found to be
febrile with temp of 38,9°C, along with right upper quadrant tenderness. The most likely diagnosis
is:
A. Choledocholithiasis
B. Benign biliary stricture
C. Malignant biliary stricture
D. Carcinoma of the head of the pancreas
E. Choledochal cyst
121.
The complications of acute cholecystitis which require surgical intervention are as follows
EXCEPT:
A. Jaundice
B. Empyema of the gall-bladder
C. Emphysematous gall-bladder
D. Gall-bladder perforation
E. Cholangitis conditioned by the presence of stones in the bile tract
122.
A 44-year-old patient complains about difficult urination, sensation of incomplete urinary bladder
emptying. Sonographic examination of the urinary bladder near the urethra entrance revealed an
oval well-defined hyperechogenic formation 2x3 cm large that was changing its position during the
examination. What conclusion can be made?
A. Concernment
B. Malignant tumor of the urinary bladder
C. Urinary bladder polyp
D. Prostate adenoma
E. Primary ureter tumor
123.
A 40 y.o. patient was admitted to the gasteroenterology with skin itching, jaundice, discomfort in
the right subcostal area, generalized weakness. On examination: skin is jaundice, traces of
scratches, liver is +5 cm, splin is 6x8 cm. In blood: alkaline phosphatase - 2,0 mmol/(hourL),
general bilirubin - 60 mkmol/L, cholesterol - 8,0 mmol/L. What is the leading syndrome in the
patient?
A. Сholestatic
B. Сytolytic
C. Mesenchymal inflammatory
D. Asthenic
E. Liver-cells insufficiency
124.
In autumn a 25-year-old patient developed stomach ache arising 1,5-2 hours after having meals and
at night. He complains of pyrosis and constipation. The pain is getting worse after consuming spicy,
salty and sour food, it can be relieved by means of soda and hot-water bag. The patient has been
suffering from this disease for a year. Objectively: furred moist tongue. Abdomen palpation reveals
epigastrial pain on the right, resistance of abdominal muscles in the same region. What is the most
likely diagnosis?
A. Duodenal ulcer
B. Chronic cholecystitis
C. Diaphragmatic hernia
D. Stomach ulcer
E. Chronic pancreatitis
125.
A 51 y.o. woman complains of dull pain in the right subcostal area and epigastric area, nausea,
appetite decline during 6 months. There is a history of gastric peptic ulcer. On examination: weight
loss, pulse is 70 bpm, AP is 120/70 mm Hg. Diffuse tenderness and resistance of muscles on
palpation. There is a hard lymphatic node 1x1cm in size over the left clavicle. What method of
investigation will be the most useful?
A. Esophagogastroduodenoscopy with biopsy
B. Ultrasound examination of abdomen
C. pH-metry
D. Ureatic test
E. Stomach X-ray
126.
A 37-year-old patient has sudden acute pain in the right epigastric area after having fatty food. What
method of radiological investigation is to be used on the first stage of examining the patient?
A. Ultrasonic
B. Roentgenological
C. Radionuclid
D. Magnetic-resonance
E. Thermographic
127.
A 35-year-old man was operated on peptic ulcer of the stomach. Mass deficit of the body is 10 kg.
The level of glucose after operation in the undiluted cellular blood on an empty stomach is 6,7
mmol. During repeated examination - 11,1 mmol (after meal), level of HbA1c - 10\%. Could you
please make an interpretation of the given data?
A. Diabetes mellitus
B. Disordered tolerance to glucose
C. Diabetes mellitus risk group
D. Norm
E. Postoperative hyperinsulinemia
128.
A 55 y.o. patient complains of distended abdomen and rumbling, increased winds evacuation, liguid
foamy feces with sour smell following the diary products consumption. What is the correct name of
this syndrome?
A. Syndrome of fermentative dyspepsia
B. Syndrome of decayed dyspepsia
C. Syndrome of fatty dyspepsia
D. Dyskinesia syndrome
E. Malabsorption syndrome
129.
A 48-year-old male patient complains of constant pain in the upper abdomen, mostly on the left,
that is getting worse after taking meals; diarrhea, weight loss. The patient is an alcohol abuser. 2
years ago he had acute pancreatitis. Blood amylase is 4 g/h\l. Coprogram shows steatorrhea,
creatorrhea. Blood glucose is 6,0 mmol/l. What treatment is indicated for this patient?
A. Panzinorm forte
B. Insulin
C. Gastrozepin
D. Contrycal
E. No-spa
130.
4 hours after having meals a patient with signs of malnutrition and steatorrhea experiences stomach
pain, especially above navel and to the left of it. Diarrheas take turns with constipation lasting up to
3-5 days. Palpation reveals moderate painfulness in the choledochopancreatic region. The amylase
rate in blood is stable. X-ray reveals some calcifications located above navel. What is the most
likely diagnosis?
A. Chronic pancreatitis
B. Chronic gastroduodenitis
C. Duodenal ulcer
D. Zollinger-Ellison syndrome
E. Chronic calculous cholecystitis
131.
A 43 y.o. woman complains of severe pain in the right abdominal side irradiating in the right
supraclavicular area, fever, dryness and bitterness in the mouth. There were multiple vomiting
without relief. Patient relates the onset of pain to the taking of fat and fried food. Physical
examination: the patient lies on the right side, pale, dry tongue, tachycardia. Right side of abdomen
is painful during palpation and somewhat tense in right hypochondrium. What is the most likely
diagnosis?
A. Perforative ulcer
B. Acute cholecystitis
C. Acute bowel obstruction
D. Acute appendicitis
E. Right-sided renal colic
132.
Gastric juice analysis of a 42-year-old male patient revealed absence of free hydrochloric acid at all
stages. Endoscopy revealed pallor, thinning of gastric mucosa, smoothed folds. Microscopically the
atrophy of glands with intestinal metaplasia was found. What disease is this situation typical for?
A. Chronic type A gastritis
B. Chronic type B gastritis
C. Chronic type C gastritis
D. Menetrier disease
E. Stomach cancer
133.
A 45-year-old female patient complains of frequent liquid stools with a lot of mucus, pus and blood;
pain across the abdomen, loss of 7 kg within 6 months. She has a 1-year history of non-specific
ulcerative colitis. What group of drugs should be preferred for this patient?
A. Corticosteroids
B. Antibacterial
C. Sulfonamides
D. Nitrofurans
E. Polyenzymes
134.
A 51-year-old female patient complains of frequent defecation and liquid blood-streaked stools with
mucus admixtures, diffuse pain in the inferolateral abdomen, 6 kg weight loss over the previous
month. Objectively: body temperature - 37,4^oC, malnutrition, skin is pale and dry. Abdomen is
soft, sigmoid is painful and spasmodic, makes a rumbling sound. Liver is dense, painful, extends 3
cm below the costal margin. What is the most likely diagnosis?
135.
A 43-year-old female patient complains of unstable defecation with frequent constipations,
abdominal swelling, headache, sleep disturbance. Body weight is unchanged. What disease are
these clinical presentations typical for?
A. Irritable colon syndrome
B. Chronic enteritis
C. Chronic pancreatitis
D. Chronic atrophic gastritis
E. Colorectal cancer
136.
A 23-year-old patient complains of a dull ache, sensation of heaviness and distention in the
epigastrium immediately after meals, foul-smelling eructation; dry mouth, empty stomach nausea,
diarrhea. Objectively: the skin is pale, the patient is of thin build. Abdomen is soft on palpation,
there is epigastric pain. The liver does not extend beyond the costal arch. In blood: Hb - 110 g/l,
RBCs - 3,4\10^{12}/l, WBC count is normal. ESR - 16 mm/h. What is the most informative study
that will allow make a diagnosis?
A. Esophageal gastroduodenoscopy
B. X-ray of digestion organs
C. Study of gastric juice
D. pH-metry
E. Duodenal probing
137.
A 49-year-old patient complains of deglutition problems, especially with solid food, hiccups, voice
hoarseness, nausea, regurgitation, significant weight loss (15 kg within 2,5 months). Objectively:
body weight is reduced. Skin is pale and dry. In lungs: vesicular breathing, heart sounds are loud
enough, heart activity is rhythmic. The abdomen is soft, painless on palpation. Liver is not enlarged.
What study is required to make a diagnosis?
138.
A 40-year-old man is ill with autoimmune hepatitis. Blood test: А/G ratio 0,8, bilirubin -
42\ummol/L, transaminase : ALT- 2,3 mmol g/L, АSТ - 1,8 mmol g/L. What is the most effective
means in treatment from the given below?
A. Glucocorticoids, cytostatics
B. Antibacterial medication
C. Hepatoprotectors
D. Antiviral medications
E. Hemosorbtion, vitamin therapy
139.
A 50-year-old patient complains about having pain attacks in the right subcostal area for about a
year. He pain arises mainly after taking fattening food. Over the last week the attacks occurred daily
and became more painful. On the 3rd day of hospitalization the patient presented with
icteritiousness of skin and scleras, light-colored feces and dark urine. In blood: neutrophilic
leukocytosis - 13,1\10^9/l, ESR- 28 mm/h. What is the most likely diagnosis?
A. Chronic calculous cholecystitis
B. Chronic recurrent pancreatitis
C. Fatty degeneration of liver
D. Chronic cholangitis, exacerbation stage
E. Hypertensive dyskinesia of gallbladder
140.
A 56 y.o. man, who has taken alcoholic drinks regularly for 20 years, complains of intensive girdle
pain in the abdomen. Profuse nonformed stool 2-3- times a day has appeared for the last 2 years,
loss of weight for 8 kg for 2 years. On examination: abdomen is soft, painless. Blood amylase -
12g/L. Feces examination-neutral fat 15 g per day, starch grains. What is the most reasonable
treatment at this stage?
A. Pancreatine
B. Contrykal
C. Aminocapron acid
D. Levomicytine
E. Imodium
141
A 43-year-old patient had been admitted to a hospital with clinical presentations of ischiorectal
periproctitis. On the 12th day of treatment the patient's 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\cdot10^9/l,
RBCs.- 3,0 cdot10^{12}/l, Hb- 98 g/l. What complication was developed?
A. Liver abscess
B. Pylephlebitis
C. Hepatic cyst
D. Liver necrosis
142.
A victim of a road accident, aged 44, is operated on account of intraperitoneal haemorrhage. In
which case can the patient's blood from the abdominal cavity be used for autotransfusion?
A. Stomach rupture
B. Bladder rupture
C. Liver rupture
D. Splenic rupture
E. Gallbladder rupture
143.
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. Sonography
B. Survey radiography of abdominal cavity
C. Biochemical laboratory examination
D. Angiography
E. X-ray
144.
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 o'clock position. Digital
investigation of rectum revealed a painful infiltration reaching the pectinate line. What is the most
likely diagnosis?
A. Acute periproctitis
B. Acute anal fissure
C. Acute haemorrhoids
D. Rectum tumour
E. Acute prostatitis
145.
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
hasn't 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 treat conservatively: antibiotics, spasmolytics, antiinflammatory drugs
C. To perform external choledoch drainage
D. To perform transduodenal papillosphincterotomy
E. To perform choledochoduodenostomy
146.
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?
147.
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
$37,6^oC$. Sonography revealed that bile bladder was 5,5х2,7 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?
148.
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. Crohn's disease of the terminal ileum
B. Perforated Meckel's diverticulum
C. Ulcerative colitis
D. Ileocecal tuberculosis
E. Acute ileitis
149.
What preparations are used for prevention of fungal infection?
+A.
A. Fluconozol, Orungol, Nisoral
B. Rubomycin, Bleomycin, Mytomycin C
C. Cytosar, Cormyctin, Lomycitin
D. Captopril, Enalapril
E. Isoniazid, Ftibazid, Pyrazinamid
150.
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 Mayo
C. Herniotomy by Sapezhko
D. Herniotomy by Lekser
E. Herniotomy by Grenov
151.
It is suspected that a 34 year old patient has an abscess of Douglas pouches. What diagnostic
method is to be chosen?
152.
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 patient's mother has an analogous pigmentation and has been
often treated for anemia. What disease is suspected?
A. Peytz-Egers's polyposis
B. Chron's disease
C. Tuberculosis of the intestine
D. Adolescent polyposis
E. Hirschprung's disease
153.
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. Drainage of the wound with rubber strip
C. Inspection of the wound with canal probe
D. Aseptic bandage
E. Suture on the wound
154.
Name a statistical observation unit for determination of influence amount of bloodsugar on the
healing of wound's surface in a postoperative period:
A. The patient in a postoperative period
B. An amount of bloodsugar
C. Blood analysis
D. The patient who has a wound surface
E. The patient who was discharged on an after-care
155.
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. Distal pancreaticojejunostomy
C. Sphincterotomy
D. Distal pancreatectomy
E. Total pancreatectomy
156.
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. Retrocolic gastrojejunostomy
C. Duodenojejunostomy
D. Immediate exploration
E. Tube duodenostomy
157.
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. Intravenous administration of pituitrin
C. Hemostatic therapy
D. Operation
E. Administration of plasma
158.
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. Thrombophlebitis
C. Meningitis
D. Nephroso-nephritis
E. Hepatite
159.
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. Myocardial infarction
D. Sigmoid diverticulitis
E. Acute pancreatitis
160.
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. Renal colic
C. Acute enterocolitis
D. Perforated gastric ulcer
E. Acute appendicitis
161.
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. Acute pancreatitis
C. Acute condition of peptic ulcer disease
D. Penetration of ulcer into pancreas
E. Thrombosis of mesenteric vessels
162.
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. Cryoprecipitate
C. Fresh frozen blood
D. Native plasma
E. Dried plasma
163.
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- 12,210^9/L. What is the most
probable diagnosis?
A. Acute appendicitis
B. Acute pancreatitis
C. Perforated ulcer
D. Rightside kidney colic
E. Diphtheria
164.
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. Cotyloid cavity fracture with a central dislocation of hip
D. Inferoposterior dislocation of hip
E. Diphtheria
165.
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-Blumberg's symptom. What is the maximal term
to make a diagnosis?
A. In 2 hours
B. In 0,5 hours
C. In 1 hour
D. In 3 hours
E. In 4 hours
166.
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. Abdominal cavity tumour
C. Liver abscess
D. Left kidney cyst
E. Acute appendecitatis
167.In the department of pathology of the pregnant woman was hospitalized with second 38 weeks
pregnancy. The first ended in cesarean section due to cephalopelvic disproportion. The estimated
fetal weight - 3200. What method of delivery will choose?
A. Expect spontaneous onset of labor to make a vacuum - the extraction of the fetus
B. Elective caesarean section
C. Excitation of labor at 38 weeks, delivery lead conservative
D. Expect spontaneous onset of labor, eliminate attempts by forceps
E. Plan the delivery can only know the size of the pelvis
168.
An onset of severe preeclampsia at 16 weeks gestation might be caused by:
A. Hydatidiform mole
B. Anencephaly
C. Twin gestation
D. Maternal renal disease
E. Interventricular defect of the fetus
169.
A 26 y.o. woman complains of a mild bloody discharge from the vagina and pain in the lower
abdomen. She has had the last menstruation 3,5 months ago. The pulse is 80 bpm. The blood
pressure (BP) is 110/60 mm Hg and body temperature is 36,6^0C. The abdomen is tender in the
lower parts. The uterus is enlarged up to 12 weeks of gestation. What is your diagnosis?
A. Inevitable abortion
B. Incipient abortion
C. Incomplete abortion
D. Complete abortion
E. Disfunctional bleeding
170.
A pregnant woman was delivered to the gynecological unit with complaints of pain in the lower
abdomen and insignificant bloody discharges from the genital tracts for 3 hours. Last menstruation
was 3 months ago. Vaginal examination showed 10th week of gestation uterus, a fingertip could be
inserted into the external orifice of uterus, bloody discharges were insignificant. USI showed
"snowstorm" appearence. What is the most likely diagnosis?
A. Molar pregnancy
B. Abortion in progress
C. Incipient abortion
D. Threat of spontaneous abortion
E. Incomplete abortion
171.
A 28 y.o. primagravida, pregnancy is 15-16 weaks of gestation, presents to the maternity clinics
with dull pain in the lower part of the abdomen and in lumbar area. On vaginal examination: uterus
cervix is 2,5 cm, external isthmus allows to pass the finger tip. Uterus body is enlarged according to
the pregnancy term. Genital discharges are mucous, mild. What is the diagnosis?
A. Threatened spontaneous abortion
B. Spontaneous abortion which has begun
C. Stopped pregnancy
D. Hydatid molar pregnancy
E. Placenta presentation
172.
A woman in her 39-th week of pregnancy, the second labor, has regular birth activity. Uterine
contractions take place every 3 minutes. All of the below indicate the beginning of the II stage of
labor EXEPT:
A. Cervical dilatation to .4 cm
B. Cervical dilation to 9-10 cm
C. Duration of uterine contractions more than 30 seconds
D. Presenting part is in 0 station
E. Rupture of membranes
173.
A 24 years old primipara was hospitalised with complaints about discharge of the amniotic waters.
The uterus is tonic on palpation. The position of the fetus is longitudinal, it is pressed with the head
to pelvic outlet. Palpitation of the fetus is rhythmical, 140 bpm, auscultated on the left below the
navel. Internal examination: cervix of the uterus is 2,5 cm long, dense, the external os is closed,
light amniotic waters out of it. Point a correct component of the diagnosis:
A. Antenatal discharge of the amniotic waters
B. Early discharge of the amniotic waters
C. The beginning of the 1st stage of labour
D. The end of the 1st stage of labour
E. Pathological preterm labour
174.
A 36-year-old woman with 11-week pregnancy has consulted gynaecologist to make a record in
patient chart. All of the below investigations the woman should pass EXEPT:
A. The blood sugar
B. Determination of the contents of PAPP-protein
C. Bacteriological test of discharge from the vagina
D. Fetal cardiotachography
E. Ultrasound of the fetus
175.
Just after 2 hours after delivery condition of the postpartum woman is good. The uterus is thick,
globe-shaped, its fundus at the umbilicus, bleeding is absent. The clamp put on the umbilical cord
remains at the same level and doesn’t change it length during pressing above the symphysis. Bloody
discharges from the vagina are absent. What is the adequate management?
A. To do manual separation and removal of .placenta
B. To apply Abduladze method
C. To apply Crede's method
D. To do curettage of uterine cavity
E. To introduct oxitocine intravenously
176.
Examination of a placenta after delivery reveals defect 3x5 cm large. Hemorrhage is absent. What
management is the most appropriate?
A. Manual exploration of uterine cavity
B. Prescription of uterotonic medicines
C. External uterus massage
D. Observation for the patient
E. Uterine curretage
177.A woman consulted a doctor on the 10th day after labor about discharge from vagina.
Objectively body temperature is normal. Pulse rate is 72 beats per minute, blood pressure
120/60mm.Hg. What character of the discharge should be normally at this day of postpartum
period?
A.
Bloody
B.
Purulent
C.
Bloody-serous
D.
Serous
E.
Serous-bloody
178.A woman consulted a doctor on the 5th day after labor about discharge from vagina.
Objectively body temperature is normal. Pulse rate is 72 beats per minute, blood pressure
120/60mm.Hg. What character of the discharge should be normally at this day of postpartum
period?
A.
Bloody
B.
Purulent
+C.
Bloody-serous
D.
Serous
E.
Serous-bloody
179.
A woman consulted a doctor on the 21th day after labor about discharge from vagina. Objectively
body temperature is normal. Pulse rate is 72 beats per minute, blood pressure 120/60mm.Hg. What
character of the discharge should be normally at this day of postpartum period?
A.
Bloody
B.
Purulent
C.
Bloody-serous
+D.
Serous
E.
Serous-bloody
180.
A woman consulted a doctor on the 18th day after labor about discharge from vagina. Objectively
body temperature is normal. Pulse rate is 72 beats per minute, blood pressure 120/60mm.Hg. What
character of the discharge should be normally at this day of postpartum period?
A.
Bloody
B.
Purulent
C.
Bloody-serous
D.
Serous
E.
Serous-bloody
181.
21 years old woman consulted a doctor on the 2 day after labor about the examinations which she
should pass at postpartum period. Objectively body temperature is normal. Pulse rate is 72 beats per
minute, blood pressure is 120/60mm.Hg. All of the below examination the woman should pass
before discharge from hospital EXEPT:
A.
Genaral blood analysis
B.
General urine analysis
C.
Bacterioscopic examionation of the vaginal discarge
D.
Analysis of the feces
E.
Ultrasonography of the uterus
182.
22 years old woman consulted after delivery about the examinations which she should pass at
postpartum period. Objectively body temperature is normal. Pulse rate is 84 beats per minute, blood
pressure is 110/60mm.Hg. All of the below examination the woman should pass before discharge
from hospital EXEPT:
A.
Genaral blood analysis
B.
General urine analysis
+C.
ECG
D.
X-ray examination of chest
E.
Ultrasonography of the uterus
183.In 10 min after .delivery by a 32-year-old woman, the placenta was spontaneousely delivered
and 150 ml of blood came out. Woman weight is 90kg, infant weight - 3800 g, length - 52 cm. The
uterus contracted. In 10 minutes the hemorrhage renewed and the total amount of blood loss is 350
ml. What amount of blood loss is physiologic for this woman?
A.
400 ml
B.
1000 ml
C.
450 ml
D.
650 ml
E.
300 ml
184.In 14 min after .delivery by a 22-year-old woman, the placenta was spontaneousely delivered
and 50 ml of blood came out. Woman weight is 60kg, infant weight - 3100g, length - 52 cm. The
uterus contracted. In 15 minutes the hemorrhage renewed and the total amount of blood loss is 250
ml. What amount of blood loss is physiologic for this woman?
A.
400 ml
B.
1000 ml
C.
450 ml
D.
650 ml
E.
300 ml
185.In 18 min after .delivery by a 28-year-old woman, the placenta was spontaneousely delivered
and 80 ml of blood came out. Woman weight is 64kg, infant weight - 03100g, length - 50 cm. The
uterus contracted. In 10 minutes the hemorrhage renewed and the total amount of blood loss is 300
ml. What amount of blood loss is physiologic for this woman?
A.
400 ml
B.
320 ml
C.
450 ml
D.
650 ml
E.
300 ml
186.In 20 min after delivery by a 19-year-old woman, the placenta was spontaneousely delivered
and 60 ml of blood came out. Woman weight is 76kg, infant weight - 3500g, length - 50 cm. The
uterus contracted. In 15 minutes the hemorrhage renewed and the total amount of blood loss is 250
ml. What amount of blood loss is physiologic for this woman?
A.
400 ml
B.
380 ml
C.
450 ml
D.
650 ml
E.
300 ml
187.
Immediately after delivery hemorrhage occurs in 23 years old patient, blood loss exceeded
physiological and was progressing. There were no symptoms of placenta separation. What tactics
should be chosen?
A.
Manual removal of placenta and afterbirth
B.
Uterus tamponade
C.
Instrumental revision of uterine cavity walls
D.
Removal of afterbirth by Crede's method
E.
Intravenous injection of methylergometrine with glucose
188.
Woman with in-time pregnancy. Bears down during 40-45 seconds with intervals 1-2 minutes. The
rupture of the membrane has occurred 10 minutes ago. Vaginal examination: fetal head is on the
pelvic floor. Saggital suture is in anterior-posterior diameter of pelvic outlet. Amniotic sac is absent.
What is the stage of labor?
A.
Cervical
B.
Pelvic
C.
Cranial
D.
Early postpartum
E.
Placental
189.
Immediately after delivery a woman had haemorrhage, blood loss exceeded postpartum
haemorrhage rate and was progressing. There were no symptoms of placenta detachment. What
tactics should be chosen?
A.
Manual removal of placenta and afterbirth
B.
Uterus tamponade
C.
Instrumental revision of uterine cavity walls
D.
Removal of afterbirth by Crede's method
E.
Intravenous injection of methylergometrine with glucose
190.
A 30-year-old gravida consulted a gynecologist about bright red bloody discharges from the vagina
in the 32 week of gestation. She was hospitalized with a suspicion of placental presentation. Under
what conditions is it rational to conduct the internal examination in order to make a diagnosis?
A.
In the operating room prepared for the operation
B.
In the examination room of antenatal clinic
C.
In the admission ward of maternity hospital
D.
In the delivery room keeping to all the aseptics regulations
E.
The examination is not to be conducted because of risk of profuse haemorrhage
191.
A 30 y.o. woman has the 2-nd labour that has been lasting for 14 hours. Hearbeat of fetus is
muffled, arrhythmic, 100/min. Vaginal examination: cervix of uterus is completely opened, fetus
head is level with outlet from small pelvis. Saggital suture is in the straight diameter, small crown is
near symphysis. What is the further tactics of handling the delivery?
A.
Use of obstetrical forceps
B.
Stimulation of labour activity by oxytocin
C.
Cesarean section
D.
Cranio-cutaneous (Ivanov's) forceps
E.
Use of cavity forceps
192.
In10 minutes after delivery a woman discharged placenta with a tissue defect 5х6 cm large.
Discharges from the genital tracts were bloody profuse. Uterus tonus was low, fundus of uterus was
located below the navel. Examination of genital tracts revealed that the uterine cervix, vaginal
walls, perineum were intact. There was uterine bleeding with following blood coagulation. Your
actions to stop the bleeding:
A.
To make manual examination of uterine cavity
B.
To apply hemostatic forceps upon the uterine cervix
C.
To introduce an ether-soaked tampon into the posterior fornix
D.
To put an ice pack on the lower abdomen
E.
To administer uterotonics
193.
Examination of a just born placenta reveals defect 2x3 cm large. Hemorrhage is absent. What tactic
is the most reasonable?
A.
Manual uterine cavity revision
B.
Prescription of uterotonic medicines
C.
External uterus massage
D.
Parturient supervision
E.
Instrumental uterus cavity revision
194.
A 27 y.o. woman suffers from pyelonephritits of the only kidney. She presents to the maternity
welfare centre because of suppresion of menses for 2,5 months. On examination pregnancy 11
weeks of gestation was revealed. In urine: albumine 3,3 g/L, leucocytes cover the field of vision.
What is doctor's tactics in this case?
A.
Immediate pregancy interruption
B.
Pregnancy interruption after urine normalization
C.
Maintenance of pregnancy till 36 weeks
D.
Pregnancy interruption at 24-25 weeks
E.
Maintenance of pregnancy till delivery term
195.
On the tenth day after discharge from the maternity house a 2-year-old patient consulted a doctor
about body temperature rise up to 390C, pain in the right breast. Objectively: the mammary gland is
enlarged, there is a hyperemized area in the upper external quadrant, in the same place there is an
ill-defined induration, lactostasis, fluctuation is absent. Lymph nodes of the right axillary region are
enlarged and painful. What is the most likely diagnosis?
A.
Lactational mastitis
B.
Abscess
C.
Erysipelas
D.
Dermatitis
E.
Tumour
196.
A 28-years-old woman complains of nausea and vomiting about 10 times per day. She has been
found to have body weight loss and xerodermia. The pulse is 100 bpm. Body temperature is 37,2?C.
Diuresis is low. USI shows 5-6 weeks of pregnancy. What is the most likely diagnosis?
A.
Moderate vomiting of pregnancy
B.
Mild vomiting of pregnancy
C.
I degree preeclampsia
D.
Premature abortion
E.
Food poisoning
197.
A 25 y.o. patient complains of body temperature rise up to 37?С, pain at the bottom of her abdomen
and vaginal discharges. Three days ago, when she was in her 11th week of pregnancy, she had an
artificial abortion. Objectibely: cervix of uterus is clean, uterus is a little bit enlarged in size,
painful. Appendages cannot be determined. Fornixes are deep, painless. Vaginal discharges are
sanguinopurulent. What is the most probable diagnosis?
A.
Postabortion endometritis
198.
An ambulance delivered a 21-year-old woman to the gynaecological department with complaints of
colicky abdominal pain and bloody discharges from the genital tracts. Bimanual examination
revealed that uterus was soft, enlarged to the size of 6 weeks of gestation, a gestational sac was
palpated in the cervical canal. Uterine adnexa weren't palpable. Fornices are free, deep and painless.
Discharges from the genital tracts are bloody and profuse. What is the most likely diagnosis?
A.
Abortion inevitable abovtion
B.
Cervical pregnancy
C.
Threat of abortion
D.
Incipient abortion
E.
Interrupted fallopian pregnancy
199.The woman who has delivered twins has early postnatal hypotonic uterine bleeding reached
1,5% of her bodyweight. The bleeding is going on. Conservative methods to arrest the bleeding
have been found ineffective. The conditions of patient are pale skin, acrocyanosis, oliguria. The
woman is confused. The pulse is 130 bpm, BP– 75/50 mm Hg. What is the further treatment?
A.
Total hysterectomy
B.
Subtotal hysterectomy
C.
Uterine vessels ligation
D.
Inner glomal artery ligation
E.
Putting clamps on the uterine cervix
200.
A 37 y.o. primigravida woman has been having labor activity for 10 hours. Labor pains last for 20-
25 seconds every 6-7 minutes. The fetus lies in longitude, presentation is cephalic, head is pressed
upon the entrance to the small pelvis. Vaginal examination results: cervix of uterus is up to 1 cm
long, lets 2 transverse fingers in. Fetal bladder is absent. What is the most probable diagnosis?
I.