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Question 1 of 200

1. A patient diagnosed with focal tuberculosis of the upper lobe of the right lung had been taking isoniazid as a part of combination therapy. After some time, the patient reported of muscle weakness, decreased skin sensitivity, blurred vision, impaired motor coordination. Which vitamin preparation should be used to address these phenomena?
2. A 60-year-old male patient has a 9-year history of diabetes and takes insulin Semilente for the correction of hyperglycemia.10 days ago he began taking anaprilin for hypertension. One hour after administration of the antihypertensive drug the patient developed hypoglycemic coma. What is the mechanism of hypoglycemia in case of anaprilin use?
3. Pterin derivatives (aminopterin and methotrexate) are the inhibitors of di- hydrofolate reductase, so that they inhibit the regeneration of tetrahydrofolic acid from dihydrofolate. These drugs inhibit the intermolecular tranfer of monocarbon groups, thus suppressing the synthesis of the following polymer:
4. A child with suspected tuberculosis was given Mantoux test. After 24 hours the site of the allergen injection got swollen, hyperemic and painful. What are the main components that determine such response of the body?
5. Hemoglobin catabolism results in release of iron which is transported to the bone marrow by a certain transfer protein and used again for the synthesis of hemoglobin. Specify this transfer protein:
6. A 12-year-old boy has been hospitalized for suspected food poisoning. The fecal samples were inoculated on the Endo agar, which resulted in growth of a large number of colorless colonies. What microorganism is most likely to be EXCLUDED from the list of possible causative agents of the disease?
7. A 23-year-old patient has been admitted to a hospital with a craniocerebral injury. The patient is in a grave condition. Respiration is characterized by prolonged convulsive inspiration followed by a short expiration. What kind of respiration is it typical for?
8. It has been experimentally proven that the excitation of the motor neurons of flexor muscles is accompanied by the inhibition of the motor neurons of extensor muscles. What type of inhibition underlies this phenomenon?
9. A 3-year-old boy with pronounced hemorrhagic syndrome doesn’t have anti-hemophilic globulin A (factor VIII) in the blood plasma. Hemostasis has been impaired at the following stage:
10. A patient got a gunshot wound of hip which damaged the sciatic nerve. Any impact on the affected limb causes severe, excruciating pain. What mechanism of pain is most likely in this case?
11. A 60-year-old patient with a long history of stenocardia takes coronarodilator agents. He has also been administered acetylsalicylic acid to reduce platelet aggregation. What is the mechanism of antiplatelet action of acetylsalicylic acid?
12. A patient with bronchial asthma has developed acute respiratory failure. What kind of respiratory failure occurs in this case?
13. On the fifth day after the acute blood loss a patient has been diagnosed with hypochromic anemia. What is the main mechanism of hypochromia development?
14. A patient with diabetes developed a diabetic coma due to the acid-base imbalance. Specify the kind of this imbalance:
15. A girl receives antibiotics of the penicillin group for acute bronchitis. On the third day of treatment she developed allergic dermatitis. Which drug should be administered?
16. A female patient has been diagnosed with cervical erosion, which is a precancerous pathology. What defense mechanism can prevent the development of a tumor?
17. Microscopy of the coronary artery of a dead 53-year-old patient revealed luminal occlusion due to a fibrous plaque with some lipids. The most likely form of atherosclerosis in this case is:
18. Autopsy of the patient revealed bone marrow hyperplasia of tubular and flat bones (pyoid marrow), splenomegaly (6 kg) and hepatomegaly (5 kg), enlargement of all lymph node groups. What disease are the identified changes typical for?
19. As a result of an injury a patient cannot extend his arm at the elbow. This may cause abnormal functioning of the following muscle:
20. A man sitting with his eyes closed, undergoes electroencephalography. What rhythm will be recorded on the EEG if there is an audible signal?
21. Electrophoretic study of a blood serum sample, taken from the patient with pneumonia, revealed an increase in one of the protein fractions. Specify this fraction:
22. Examination of an 18-year-old girl revealed the following features: hypoplasia of the ovaries, broad shoulders, narrow pelvis, shortening of the lower extremities, \"sphinx neck\". Mental development is normal. The girl was diagnosed with Turner’s syndrome. What kind of chromosome abnormality is it?
23. Hypertrichosis is the Y-linked character. The father has hypertrichosis, and the mother is healthy. In this family, the probability of having a child with hypertrichosis is:
24. A casualty has a fracture in the region of the inner surface of the left ankle. What is the most likely site for the fracture?
25. Some infectious diseases caused by bacteria are treated with sulfanilamides which block the synthesis of bacteria growth factor. What is the mechanism of their action?
26. A 42-year-old male patient with gout has an increased blood uric acid concentration. In order to reduce the level of uric acid the doctor administered him allopurinol. Allopurinol is the competitive inhibitor of the following enzyme:
27. A 40-year-old female patient diagnosed with acute pancreatitis has been delivered to the admission department of a regional hospital. What drug should be administered the patient in the first place?
28. A patient consulted a doctor about being unable to abduct his right arm after a past trauma. Examination revealed that the passive movements were not limited. The patient was found to have the atrophy of the deltoid muscle. What nerve is damaged?
29. After a trauma of the upper third of the anterior forearm a patient exhibits difficult pronation, weakening of palmar flexor muscles and impaired skin sensitivity of 1-3 fingers. Which nerve has been damaged?
30. A 38-year-old female patient complains of general weakness, cardiac pain, increased appetite, no menstruation. Objectively: the height is 166 cm, weight 108 kg, the patient has moon-shaped face, subcutaneous fat is deposited mainly in the upper body, torso and hips. There are also blood-red streaks. Ps- 62/min, AP- 160/105 mm Hg. Which of the following diseases is the described pattern of obesity most typical for?
31. A 60-year-old patient with a long history of atherosclerosis and a previous myocardial infarction developed an attack of retrosternal pain. 3 days later the patient was hospitalized and then died of progressive cardiovascular insufficiency. At autopsy a white fibrous depressed area about 3 cm in diameter with clear boundaries was found in the posterior wall of the left ventricle and interventricular septum. The dissector evaluated these changes as:
32. Measurements of the arterial pCO2 and pO2 during an attack of bronchial asthma revealed hypercapnia and hypoxemia respectively. What kind of hypoxia occurred in this case?
33. A female patient with bronchial asthma had taken prednisolone tablets (1 tablet 3 times a day) for 2 months. Due to a significant improvement of her condition the patient suddenly stopped taking it. What complication is likely to develop in this case?
34. A patient with suspected dysentery has been admitted to the infectious diseases hospital. Which basic method of laboratory diagnosis must be applied in the first place?
35. During a surgery with the use of hygronium the patient had an abrupt fall in blood pressure. Blood pressure can be normalized by the representatives of the following drug group:
36. A patient with respiratory failure has blood pH of 7,35. pCO2 test revealed hypercapnia. Urine pH test revealed an increase in the urine acidity. What form of acid-base imbalance is the case?
37. On examination a patient was found to have medial strabismus, the inward deviation of the eyeball and inability to abduct the eyeball outwards. What nerve is damaged?
38. A patient with a dislocated shoulder had been admitted to a hospital. With the purpose of skeletal muscle relaxation he was given an injection of relaxant dithylinum acting normally 5-7 minutes. However, the effect of dithylinum in this patient lasted up to 8 hours. What is the most likely cause of the prolonged effect of dithylinum in this patient?
39. As a result of an injury of the knee joint a patient shows a drawer sign, that is the anterior and posterior displacement of the tibia relative to the femur. What ligaments are damaged?
40. The neurosurgical department has admitted a 54-year-old male complaining of no sensitivity in the lower eyelid skin, lateral surface of nose, upper lip. On examination the physician revealed the inflammation of the second branch of the trigeminal nerve. This branch comes out of the skull through the following foramen:
41. Bacteriological examination of purulent discharges from the urethra revealed some gram-negative bean- shaped bacteria located in the leukocytes. They can be identified as the causative agent of the following disease:
42. A male patient is 28 years old. Histological study of a cervical lymph node revealed a change of its pattern due to the proliferation of epithelioid, lymphoid cells and macrophages having nuclei in form of a horseshoe. In the center of some cell clusters there were non-structured light- pink areas with fragments of nuclei. What disease are these changes typical for?
43. A 35-year-old male patient has been referred by an andrologist for the genetic counselling for the deviations of physical and mental development. Objectively: the patient is tall, has asthenic constitution, gynecomastia, mental retardation. Microscopy of the oral mucosa cells revealed sex chromatin (single Barr body) in 30% of cells. What is the most likely diagnosis?
44. A patient with jaundice has high total bilirubin that is mainly indirect (unconjugated), high concentration of stercobilin in the stool and urine. The level of direct (conjugated) bilirubin in the blood plasma is normal. What kind of jaundice can you think of?
45. A male with a lesion of one of the CNS parts has asthenia, muscular dystonia, balance disorder. Which CNS part has been affected?
46. A 50-year-old patient has been administered laevomycetin for the treatment of typhoid fever, but on the next day the patient’s condition worsened, the temperature rose to 39, 60C . The deterioration of the patient’s condition can be explained by:
47. A 12-year-old patient has been admitted to a hospital for hemarthrosis of the knee joint. From early childhood he suffers from frequent bleedings. Diagnose the boy’s disease:
48. Examination of a patient with ischemic heart disease revealed the impaired venous blood flow in the territory of the cardiac vein running in the anterior interventricular sulcus of heart. What vein is it?
49. For the direct injection of medications into the liver surgeons use the round ligament of liver. This manipulation involves bougienage (lumen dilatation) of the following vessel:
50. A patient with lobar pneumonia has had body temperature of 39oC with daily temperature fluctuation of no more than 1oC for 9 days. This fever can be characterized by the following temperature curve:
51. The temperature in a production room is 36oC . Relative air humidity is 80%. Under these conditions the human body transfers heat mainly through:
52. A hospitalized patient bitten by a rabid animal has an avulsive wound of shin. What kind of vaccine must be given to prevent rabies?
53. At autopsy the occipital lobe of brain was found to have a cavity 2,5x1,5 cm large filled with a transparent liquid. The cavity had smooth brownish walls. What process had developed in the brain?
54. A child entering the school for the first time was given Mantoux test in order to determine if there was a need for revaccination. The reaction was negative. What is the meaning of this test result?
55. Study of the biopsy material revealed a granuloma consisting of lymphocytes, plasma cells, macrophages with foamy cytoplasm (Mikulicz cells), many hyaline globules. What disease can you think of?
56. Autopsy of a 78-year-old patient revealed that retroperitoneal tissue was soaked with blood, the abdominal aorta had a sacciform protrusion including a defect with irregular edges. The wall of the aorta was here and there of stone-like density. This is the complication of the following disease:
57. Glycogen polysaccharide is synthesized from the active form of glucose. The immediate donor of glucose residues during the glycogenesis is:
58. After the diagnostic tests a 40-year-old male has been referred for the lymphography of the thoracic cavity. The surgeon revealed that the tumor had affected an organ whose lymphatic vessels drain directly into the thoracic duct. Specify this organ:
59. A patient with biliary dyskinesia and constipations has been prescribed a cholagogue having also a laxative effect. What drug has been administered?
60. It is known that individuals with genetically caused deficiency of glucose 6-phosphate dehydrogenase may develop RBC hemolysis in response to the administration of some antimalarial drugs. Manifestation of adverse reactions to drugs is called:
61. A 40-year-old patient with the progressing staphylococcal purulent periodontitis developed purulent inflammation of bone marrow spaces of the alveolar process, and then of the body of mandible. Microscopy revealed thinning of bone trabeculae, foci of necrosis, bone sequesters surrounded by the connective tissue capsule. What is the most likely diagnosis?
62. Curariform substances introduced into a human body cause the relaxation of all skeletal muscles. What changes in the neuromuscular synapse cause this phenomenon?
63. A number of diseases can be diagnosed by evaluating activity of blood transaminases. What vitamin is one of cofactors of these enzymes?
64. After a car accident a 23-year-old male presented to the hospital with a cut wound of the anteromedial region of shoulder and arterial bleeding. Which artery was damaged?
65. During the operation on the small intestine the surgeon revealed an area of the mucous membrane with a single longitudinal fold among the circular folds. Which portion of the small intestine is this structure typical for?
66. 14 days after quinsy a 15-year-old child presented with morning facial swelling, high blood pressure, \"meat slops\"urine. Immunohistological study of a renal biopsy sample revealed deposition of immune complexes on the basement membranes of the capillaries and in the glomerular mesangium. What disease developed in the patient?
67. A diseased child has a high fever, sore throat, swelling of submandibular lymph nodes. Objectively: pharyngeal mucosa is edematous, moderately hyperemic, the tonsils are enlarged, covered with grayish membrane tightly adhering to the tissues above. Attempts to remove the membrane produce the bleeding defects. What di- sease are these presentations typical for?
68. Study of the biopsy material of an embryo revealed a zone of developmental abnormality in a somite. The zone was located close to the endoderm and the notochord. What formations may have abnormal development in case of pregnancy continuation?
69. A smear of sputum from the patient with suspected lobar pneumonia was stained with the use of the following stains and reagents: solution of gentian violet, Lugol’s solution, 96o alcohol, water magenta. What staining method was applied in this case?
70. A patient has normally coloured stool including a large amount of free fatty acids. The reason for this is a disturbance of the following process:
71. Examination of the removed stomach revealed a deep roundish defect with regular edges at the lesser curvature of the antrum. The defect reached the muscular tunic and was 1,5 cm in diameter. Within the defect floor there was a translucent dense area resembling of a hyaline cartilage. What process had developed in the floor of the stomach defect?
72. By the decarboxylation of glutamate in the CNS an inhibitory mediator is formed. Name it:
73. Thermometry revealed that the temperature of the exposed skin is by 1-1,5oC lower than the temperature of the adjacent areas covered with clothing from natural fabrics. The reason for this is that the clothes reduce the heat loss through:
74. A specimen of pia mater includes a vessel whose wall doesn’t have the tunica media, the tunica externa is adherent to the surrounding tissues, the intima is composed of a basement membrane and endothelium. What vessel is it?
75. A patient with extensive burns of torso skin exhibits signs of severe intoxication. What stage of the burn disease is this typical for?
76. As a result of a craniocerebral injury a patient has a decreased skin sensitivity. What area of the cerebral cortex may be damaged?
77. A histological specimen of the eyeball shows a biconvex structure connected to the ciliary body by the fibers of the Zinn’s zonule and covered with a transparent capsule. Name this structure:
78. A comatose patient was taken to the hospital. He has a history of diabetes mellitus. Objectively: Kussmaul breathing, low blood pressure, acetone odor of breath. After the emergency treatment the patient’s condition improved. What drug had been administered to the patient?
79. In order to stimulate breathing in a child born with asphyxia, the doctor gave him a drug injection into the umbilical vein. What drug might have been injected?
80. A patient complains of pain in the right lateral abdomen. Palpation revealed a dense, immobile, tumor-like formation. A tumor is likely to be found in the following part of the digestive tube:
81. A patient underwent biopsy of the soft palate arches for a suspected tumor (macroscopy revealed an ulcer with a dense floor). Study of the biopsy material revealed mucosal necrosis with infiltration of lymphocytes, epithelioid cells, plasma cells, single neutrophils in the submucosa. There were also apparent signs of endovasculitis and perivasculitis. The described changes are typical for:
82. Healthy parents with unremarkable family history have the child with multiple developmental defects. Cytogenetic analysis revealed the trisomy 13 in the somatic cells (Patau syndrome). What phenomenon has caused the defects?
83. A specimen shows an organ covered with the connective tissue capsule with trabeculae radiating inward the organ. There is also cortex containing some lymph nodules, and medullary cords made of lymphoid cells. What organ is under study?
84.

A   25-year-old   patient  consulted a doctor  about  dysmenorrhea and infertility. Examination revealed  that  the patient was 145 cm high and had underdeveloped secondary sex characteristics, alar folds on the  neck.  Cytological  study  didn’t reveal any Barr bodies in the somatic cells. What diagnosis was made?

85. To prevent attacks  of acute  pancreatitis a doctor  prescribed the patient trasylol (contrycal, gordox),  which is an inhibitor of:
86.

A patient died from progressive heart failure.  Autopsy revealed  that  the  heart was enlarged in diameter, flabby. The muscle  section  exhibited  irregular blood supply. Histological  study of myocardium revealed hyperemia, the stroma was found to  have  lymphohistiocytic  infiltrates  with  degeneration of  cardiomyocytes.  The revealed  morphological changes  are indicative of:

87.

A 13-year-old  teenager underwent X-ray examination of the  hip joint.  Examination  revealed  a 3mm wide radiolucent zone  between the  head  and  the  shaft  of femur.  This situation should  be evaluated as:

88.

A surgeon  examined the  patient and found  the injury of the upper  third of the kidney.  Considering  the  syntopy  of  the left kidney, the intactness of the following organ should be checked at the same time:

89.

A patient with urolithiasis has unbearable  spasmodic   pain.  To  prevent pain shock, he has been given an injection of atropine along with a narcotic analgesic having  antispasmodic  effect.  What  drug was it?

90.

Despite the  administration of  cardiotonics   and  a  thiazide   diuretic   a  patient  with  chronic  heart  failure  has  persistent  edemata, there  is a risk  of ascites. What  medication should  be administered in order  to enhance the diuretic  effect of the drugs used?

91.

A   patient   with   a   pathology   of the cardiovascular system developed edemata of the  lower  extremities. What is the mechanism  of cardiac edema development?

92. During  the  fight, a man  had  a cardiac arrest  due  to  the  strong  blow  to  the upper  region  of  the  anterior abdominal  wall. Which of the following mechanisms has led to the cardiac arrest?

93. A  pregnant woman  underwent AB0 blood typing. Red blood cells were agglutinated with  standard sera  of the  I and II blood groups, and were not agglutinated  with the  III  group  serum.  What  is the patient’s blood group?
94.

Amniocentesis   revealed    two    sex chromatin bodies  (Barr  bodies)  in  each cell  of  the  sample.  What  disease  is this character typical for?

95.

A hospital  has admitted a patient complaining  of abdominal bloating, diarrhea,  flatulence   after   eating   protein foods. These signs are indicative of the impaired digestion  of proteins and  their increased  degradation. Which of the following compounds is the product of this process?

96.

An attack of tachycardia that occurred in a patient was stopped by pressing on his eyeballs.  Which  of the  following  reflexes underlies this phenomenon?

97. A    male    patient   has    been    diagnosed with acute post-streptococcal glomerulonephritis. It  is most  likely that the   lesion  of  the   basement  membrane  of  renal   corpuscles   was  caused   by  the following allergic reaction:
98.

An  unconscious  patient was taken  by ambulance  to  the  hospital.   On  objective  examination  the   patient  was  found to  have  no  reflexes,  periodical   convulsions, irregular breathing. After  laboratory examination the patient was diagnosed with   hepatic    coma.   Disorders  of   the central nervous system develop due to the accumulation of the following metabolite:

99.

A  20-year-old  male  patient complains  of  general   weakness,   rapid   fatigability, irritability, decreased performance, bleeding   gums,  petechiae  on  the   skin. What  vitamin  deficiency  may be a cause of these changes?

100.

It   is  known   that   the   monoamine oxidase (MAO) enzyme plays an important part in the metabolism of catecholamine neurotransmitters. In what way does the enzyme inactivate  these neurotransmitters (norepinephrine, epinephrine, dopamine)?

101. The  cellular  composition of exudate largely  depends on the  etiological  factor of inflammation. What leukocytes  are the first to get into the focus of inflammation caused by pyogenic bacteria?
102.

At  the  end  of  the  working  day  a worker  of a hot work shop has been delivered to a hospital. The patient complains of a headache, dizziness, nausea,  general weakness. Objectively: the patient is conscious, his skin is hyperemic, dry, hot to the touch. Heart rate is of 130/min. Respiration  is rapid,  superficial.  What  disorder of thermoregulation is most likely to have occurred in this patient?

103.

Alveolar   space    of    the    acinus was invaded by some bacteria which interacted with  the  surfactant.  This  led to  the   activation   of  the   cells  that   are localized  in the alveolar  walls and on the surface. What cells are these?

104.

A 35-year-old  male developed acute heart  failure  while running  for a long time. What  changes  in the ionic composition can be observed  in the cardiac muscle?

105. Workers of a conveyor  workshop received recommendations for the effective organization of working  time  and  higher  working  efficiency.  What  peculiarity of work in this workshop  causes the greatest stress for the workers?
106.

Mother of  a boy  who  had  recently returned  from   a  summer   camp   found some  small  whitish  insects  up  to  3 mm long  on  the  child’s clothing.  Specify  the parasite:

107.

Histological  examination of the removed skin neoplasm  revealed  clusters and cords of atypical cells of stratified squamous epithelium, growing into the underlying tissue. What  diagnosis  can be assumed?

108.

An 18-year-old male has been diagnosed with Marfan syndrome. Examination    revealed    a   developmental   disorder  of connective tissue  and  eye  lens structure, abnormalities of the cardiovascular  system,  arachnodactylia. What genetic phenomenon has caused the development of this disease?

109.

A patient has severe catarrhal symptoms.  Material growth on Bordet-Gengou   agar    showed    mercury-drop-like  colonies.  Examination of  the  blood smears  revealed  some  small ovoid  gram-positive bacilli sized 1-3 microns. What microorganisms were isolated?

110. A 66-year-old patient with Parkinson’s disease  shows an improvement in locomotor  activity   after   prolonged  use of  a  certain  drug  which  is converted to dopamine by the  decarboxylation. What drug has the patient taken?

111.

Enzymatic  jaundices  are accompanied  by  abnormal activity  of  UDP-glucuronyl   transferase. What  compound is accumulated in blood  serum  in case of these pathologies?

112.

For   the   study   of  serum   proteins various physical and physicochemical methods  can be used. In particular, serum albumins  and  globulins  can be separated by this method:

113. Negative  environmental factors have caused   the   dysfunction   of  myosatellite cells. What  function  of the  whole muscle fibre is likely to be changed  in this case?
114.

The  laboratory  for  especially dangerous infections  conducts  microscopic examination of pathological material from  a  patient  with  suspected plague. The sample was stained  by Burri-Gins technique. What property of the causative  agent  can be  identified  by this technique?

115. Autopsy of a 62-year-old woman revealed  a dense well-circumscribed node of 6 cm in diameter in the  cranial  cavity. The node  was attached to the dura  mater and histologically consisted of clusters and micro-concentric structures of endothelial cells, psammoma bodies.  What  kind of tumor  was found at autopsy?

116.

Inherited diseases, such as mucopolysaccharidoses,   are   manifested in  metabolic disorders   of  connective tissue, bone  and  joint  pathologies. The  sign of this disease  is the excessive urinary excretion of the following substance:

117. An  animal  has  an  increased   tonus of extensor muscles.  This is the  result  of enhanced information transmission to the motoneurons of the  spinal  cord  through the following descending pathways:
118.

A   specimen    of   a   parenchymal organ shows poorly  delineated hexagonal lobules  surrounding a  central  vein,  and the  interlobular connective tissue contains embedded triads (an artery, a vein and an excretory duct). What organ is it?

119.

A   patient  has   been   admitted  to the infectious  diseases department for malaise,  fever  up  to  38oC ,  jaundice.   A few  months  ago,  the  patient underwent blood  transfusion. The  doctor  suspected viral hepatitis B. What  are  the  principal methods of laboratory diagnosis of hepatitis B?

120.

After   resection of  the  middle  third of the  femoral  artery  obliterated by a thrombus the limb is supplied  with blood through the  bypasses.  What  artery  plays the  main  part  in  the  restoration of  the blood flow?

121.

During   the   intravenous  transfusion  of  the   saline   the   patient’s   condition  deteriorated dramatically, and  the patient died  from  asphyxiation. Autopsy revealed  acute  venous  congestion of internal  organs   with   the   dramatic  right heart  dilatation. When the right ventricle     was    punctured   underwater, the bubbles escaped. What pathological process occurred in the patient?

122.

At the post-mortem examination the stomach of a patient with renal failure was found  to have a yellow-brown  coating  on the  thickened mucosa.  The  coating  was firmly adhering to its surface  and  had  significant thickness. Microscopy revealed congestion  and  necrosis  of mucosal  and submucosal  layers,  fibrin presence. What is the most likely diagnosis?

123.

Infectious diseases  are  treated  with antibiotics  (streptomycin, erythromycin, chloramphenicol). They inhibit the following stage of protein synthesis:

124. Diseases  of  the  respiratory  system and  circulatory  disorders  impair  the transport  of   oxygen,   thus   leading   to hypoxia.  Under these  conditions the energy metabolism is carried  out by anaerobic glycolysis. As a result, the following substance  is generated and accumulated in blood:
125.

A patient has been hospitalized for a suspected  tumor  of the  prostate. During the surgery, it was revealed  that the tumor invaded  the  bladder. Which  part  of  the bladder was affected?

126. A casualty with an injury of the temporal region has been  diagnosed  with epidural hematoma. Which of the arteries is most likely to be damaged?
127.

A  19-year-old   male  was  found   to have  an  elevated level  of  potassium   in the  secondary urine.  These  changes  might have  been  caused  by the  increase  in the following hormone level:

128.

Analysis  of  the  ECG   revealed   the missing of several PQRST  cycles. The remaining waves and  complexes  are  not changed. Specify the type of arrhythmia:

129.

ECG  of a patient displays an abnormally  long   R   wave   (up   to   0,18 s).  This  is caused  by  a  decrease in  the conduction velocity of the following heart structures:

130.

6 hours after the myocardial  infarction a patient was found  to have  elevated level  of lactate  dehydrogenase in blood. What  isoenzyme  should  be  expected in this case?

131.

A  46-year-old   female  is  scheduled for  a  maxillofacial   surgery.  It  is  known that  the  patient is prone  to  high  blood coagulation. What  natural anticoagulant can be used to prevent blood clotting?

132.

A 50-year-old  patient with food poisoning is on a drip of 10% glucose solution. It not only provides the body with necessary  energy,  but  also  performs the function of detoxification by the production of a metabolite that participates in the following conjugation reaction:

133. To assess the effectiveness  of breathing in patients, the indicator of functional residual  capacity  is used.  It  includes  the following volumes:
134. It is required to evaluate the level of tissue  excitability.  For  this  purpose one should determine:
135.

Due   to   the   use   of   poor-quality measles  vaccine  for preventive vaccination, a 1-year-old  child developed an autoimmune  renal  injury. The urine  was found to contain macromolecular proteins. What process of urine formation was disturbed?

136. A patient has been  administered an anti-inflammatory drug that blocks the action   of   cyclooxygenase.   Specify   this anti-inflammatory agent:
137.

A pneumonia patient has been administered  acetylcysteine  as   a   part of complex therapy. What principle of therapy  was   taken    into   consideration when applying this drug?

138.

A  26-year-old   female  patient with bronchitis  has been administered a broad spectrum  antibiotic as a causal treatment drug. Specify this drug:

139.

A  65-year-old   male   suddenly   lost the  vision  in  one  eye  due  to  the  retinal  detachment. The  patient underwent enucleation.    Histological     examination of  the  removed eye  retina   and  choroid revealed   clusters   of   atypical   cells  with marked polymorphism of cells and nuclei,  with  a  moderate number   of  mitoses including the pathological ones. The cell  cytoplasm   and   intercellular  medium contained brown pigment giving a positive  DOPA  reaction. Perls’ reaction was negative.  What  is the  most  likely diagnosis?

140.

A  child  cut  his leg with  a piece  of glass while playing and was brought  to the clinic for the  injection  of tetanus toxoid. In   order   to   prevent  the   development of anaphylactic shock the serum was administered by Bezredka method.  What mechanism  underlies this method of desensitization of the body?

141.

Microscopy   of  the  myocardium  of a  patient who  had  died  from  heart  failure revealed foci of fibrinoid necrosis located  diffusely in the interstitial stroma, and    often    around   the    vessels.   Such foci were surrounded by lymphocytes, macrophages,    histiocytes.     Pericardium was found  to have signs of sero-fibrinous pericarditis. What  is the  most  likely  diagnosis?

142.

One  of the factors that  cause obesity is the  inhibition  of  fatty  acids  oxidation due to:

143.

The genetic defect of pyruvate carboxylase deficiency is the cause of delayed physical and mental development and  early  death  in children.  This  defect is characterized by lacticemia,  lactaciduria,  disorder of a number  of metabolic pathways.  In particular, the following process is inhibited:

144.

Deficiency  of  linoleic  and  linolenic acids   in   the   body   leads   to   the   skin damage,  hair  loss, delayed  wound  healing,  thrombocytopenia, low  resistance to infections.  These  changes  are  most likely to be caused by the impaired synthesis of the following substances:

145.

During  ventricular systole, the cardiac muscle does not respond to additional stimulation because  it is in the phase of:

146. A mother had  taken  synthetic hormones  during   pregnancy.   Her daughter was born with hirsutism formally resembling  of adrenal syndrome.  Such manifestation of variability is called:
147. Since a patient has had myocardial infarction, atria and ventricles contract independently from each other  with a frequency of 60-70 and 35-40 per minute. Specify the type of heart block in this case:

148.

A 67-year-old male patient consumes eggs,  pork   fat,  butter,  milk  and   meat. Blood   test   results:   cholesterol  -   12,3 mmol/l, total lipids - 8,2 g/l, increased  low- density lipoprotein fraction  (LDL). What type of hyperlipoproteinemia is observed in the patient?

149.

A 12-year-old child has a viral infection  complicated  by  obstructive  bronchitis. Bronchospasm can  be  eliminated by inhalations of a drug  from  the  following pharmacological group:

150.

In course of an experiment there  has been  an  increase  in the  nerve  conduction velocity. This may be caused by an increase in the concentration of the following ions that are present in the solution around the cell:

151.

A male working  as a blacksmith  has been  tested  for auditory acuity. The  tests revealed 50% hearing loss in the low-frequency range  and a near-normal auditory  acuity  in the  high-frequency range. This condition has been caused by the damage  to the following structures of the auditory system:

152.

In   our   country,   routine  preventive  vaccinations against  poliomyelitis involve  using  live vaccine  that  is administered  orally.  What  immunoglobulins are responsible for the  development of local post-vaccination immunity in this case?

153.

An experiment proved  that UV-irradiated skin cells of patients with xeroderma pigmentosum restore the native structure of DNA  slower than the cells of  healthy   people   due  to  the  defect  in repair  enzyme.  What  enzyme  takes  part in this process?

154.

A  patient  who  has  recently   come from   an   endemic    area   presents  with elevated body temperature, headache, chills, malaise,  that  is with the symptoms which  are   typical  for  a  common   cold. What laboratory tests are necessary to confirm   or   to   refute   the   diagnosis   of malaria?

155.

What  condition may  develop  15-30 minutes after re-administration of the antigen as a result of the increased level of antibodies, mainly IgE, that are adsorbed on the  surface  of target  cells, namely  tissue basophils (mast cells) and blood basophils?

156.

10 days  after  having  quinsy  caused by   beta-hemolytic  streptococcus   a   6- year-old child exhibited symptoms of glomerulonephritis. What  mechanism   of glomerular lesion  is  most  likely  in  this case?

157.

A   22-year-old    woman   ate   some seafood.  5 hours  later  the  trunk  and  the distal  parts   of  limbs  got  covered   with small itchy  papules  which  were  partially fused  together. After   one  day,  the  rash disappeared spontaneously. Specify the hypersensitivity mechanism  underlying these changes:

158.

A hypertensive patient had been keeping    to   a   salt-free   diet   and   taking  antihypertensive drugs  together with hydrochlorothiazide for a long time. This resulted in  electrolyte imbalance.   What disorder  of the internal environment occurred in the patient?

159.

A miner consulted  a physician about the  appearance of body rash followed  by a loss of appetite, bloating, duodenal pain, frequent bowel movements, dizziness. Ovoscopic  probes  of feces and  duodenal contents revealed  some eggs covered with a  transparent  membrane through which 4-8 germinal  cells  could  be  seen.  What disease  is likely  to  have  occurred in the patient?

160. Children with Lesch-Nyhan syndrome have a severe form of hyperuricemia  accompanied by the  formation of tophi,  urate  calculi  in the  urinary  tracts, as well as serious neuro-psychiatric disorders.  The  cause  of this  disease  is the reduced activity of the following enzyme:

161.

In a car accident  a man  got injured and  lost a lot of blood.  What  changes  in peripheral blood  are most likely to occur on the 2nd day after the injury?

162.

In   the   surgical   ward,   the   dressing  material  was  undergoing  sterilization  in  an  autoclave.   Through   an  oversight  of a nurse  the  mode  of sterilization was changed  and  the  temperature in the autoclave  reached only 100oC instead  of the due 120oC . What microorganisms can stay viable under  these conditions?

163.

As  a  result  of  a  mechanical   injury an  over  10  cm  long  portion  of  a  peripheral nerve was damaged.  This led to the impairment of the upper limb activity. The patient was  offered  nerve  transplantation. What glial cells will participate in regeneration and provide  the trophism  of the injured limb?

164. A  26-year-old  woman  at  40 weeks pregnant has been  delivered  to the maternity ward.  Objectively:  the  uterine cervix is opened, but the contractions are absent.  The  doctor  has administered her a hormonal drug  to  stimulate the  labor. Name this drug:
165.

A  patient has  recurrent attacks   of epileptic seizures and stays unconscious between them.  In order  to stop  convulsions   the   drugs   of  the   following   group should be used in the first place:

166.

A patient with arthritis and varicose veins has been taking a non-steroidal anti-inflammatory drug for a long time, which caused  thrombosis of  skin  veins.  Which of the following drugs might have caused this complication?

167.

Students  study the stages of gametogenesis. They  analyze  a cell having  a  haploid   number   of  chromosomes, and each chromosome consists of two chromatids. The chromosomes are located in the equatorial plane of the cell. Such situation is typical for the following stage of meiosis:

168.

A  35-year-old   female  patient underwent biopsy  of the  breast  nodules. Histological  examination revealed enhanced proliferation of the  small duct epithelial  cells  and   acini,  accompanied by the  formation of glandular structures of various  shapes  and  sizes, which  were located  in the fibrous stroma.  What is the most likely diagnosis?

169. Examination of the duodenal contents revealed  some pear-shaped protozoa with  two  nuclei  and  four  pairs  of  flagella.  The   organisms   had   also two  axostyles  between the  nuclei  and  a ventral adhesive disc. What protozoan representative was found in the patient?

170.

A   specimen   of  an   onion   rootlet includes  a  cell  in  which  the  fully condensed  chromosomes are  located   in the equatorial plane making the monaster. What phase of the mitotic cycle is the cell in?

171.

When examining a patient, the doctor revealed  a tumor  of the  bronchus  which borders  on the  aorta.  Which  bronchus  is affected?

172.

A 54-year-old  female was brought to the  casualty  department after  a car accident. A traumatologist diagnosed her with multiple  fractures of the lower extremities. What  kind of embolism  is most likely to develop in this case?

173. Microscopy     of     the     bronchial wall revealed atrophy  of the mucosa, metaplastic change from columnar  to squamous  epithelium,   an   increase    in the number of goblet cells, diffuse infiltration    of   the   bronchial  wall   with     lymphoplasmacytic    elements    with a large number of neutrophilic granulocytes, pronounced sclerosis. Specify the morphological form of bronchitis:
174.

Due  to the blockage  of the common bile duct (which was radiographically confirmed),  the  biliary  flow to  the duodenum was stopped. We should expect the impairment of:

175.

Typical  manifestations of  food  poisoning    caused    by   C.   botulinum   are double   vision,  abnormal  functioning  of the swallowing and breathing. These symptoms develop  as a result of:

176.

At  the  stage  of  translation  in  the rough  endoplasmic reticulum,  the ribosome  moves along the mRNA. Amino acids are joined together by peptide bonds in a specific sequence, and thus polypeptide synthesis takes place. The sequence of amino acids in a polypeptide corresponds to the sequence  of:

177. After  the prolonged vomiting a pregnant 26-year-old  woman  was  found to have  the  reduced volume  of circulating blood.  What  change  in the total  blood volume can be the case?
178.

On allergological  examination a patient has been diagnosed with pollinosis. Specific desensitization can be performed by:

179.

A   patient   consulted    a   physician about chest pain, cough, fever. Roentgenography of lungs revealed  eosinophilic infiltrates which were found to contain  the  larvae.  What  kind  of helminthiasis   are   these   presentations  typical for?

180.

A patient with signs of osteoporosis and urolithiasis has been admitted to the endocrinology department. Blood test revealed  hypercalcemia and hypophosphatemia. These changes are associated  with abnormal synthesis of the following hormone:

181.

Histological  examination of  the  biopsy  material obtained  from  the  lower third  of  the  esophagus of  a  57-year-old male  with  the  symptoms   of  continuous reflux  revealed  the  change  of the  stratified  squamous epithelium to  the  single-layer  columnar glandular epithelium with  signs  of  mucus   production.  Specify the  pathological process  in  the  mucous membrane:

182.

A  30-year-old  female  exhibits  signs of virilism (growth  of body  hair,  balding temples, menstrual disorders). This condition can be caused by the overproduction of the following hormone:

183. A patient with bacterial periodontitis has  been  administered iontophoresis with thuse of iodine  solution.  Specify the mechanism  of  therapeutic action  othis agent:
184.

A  patient with  extensive  myocardial infarction  has developed heart  failure. What pathogenetic mechanism  contributed  to the development of heart  failure in the patient?

185.

A patient who had been continuously taking  drugs  blocking  the  production of angiotensin II developed bradycardia and arrhythmia. A likely cause of these disorders is:

186.

A patient has arterial hypertension. What   long-acting   drug  from  the  group of calcium channel blockers should be prescribed?

187.

Human skin has a high breaking strength. It is known  that  the  skin consists of  epithelial tissue  and  two  kinds  of connective tissue. Which of the following tissues provides the skin strength?

188.

As a result of a home injury, a patient suffered a significant blood loss, which led to  a fall in blood  pressure. Rapid  blood pressure recovery  after  the  blood  loss is provided  by the following hormones:

189.

A  patient with  constant headaches, pain in the occipital region, tinnitus, dizziness has been  admitted to the cardiology department. Objectively: AP- 180/110 mm Hg, heart  rate - 95/min. Radiographically, there   is  a  stenosis  of  one  of  the  renal arteries. Hypertensive condition in this patient has been  caused by the activation of the following system:

190.

A   patient  complains   that   at   the bare   mention  of  the  tragic  events   that once  occurred in his life he  experiences tachycardia, dyspnea  and  an  abrupt rise in blood  pressure. What  structures of the CNS are responsible for these cardiorespiratory  reactions in this patient?

191.

A patient consulted  a dentist  about limited  mouth  opening  (trismus).  He has a history of a stab wound of the lower extremity. What infection may cause these symptoms?

192. Anatomical dead space is the portion of the  air that  is left in the  airways  after expiration. The reduction of the anatomical dead space is typical for the following situation:
193.

Analysis of the experimental spirogram  of a 55-year-old  person  revealed a decrease in tidal volume and respiratory amplitude compared to  the  situation   of ten  years  ago. The  change  in these  indicators is caused by:

194.

A patient underwent a course of treatment for atherosclerosis. Laboratory tests revealed an increase in the anti-atherogenic lipoprotein fraction in the blood  plasma.  The  treatment efficacy  is confirmed by the increase in:

195.

A 65-year-old  female patient has chronic constipations due to the colon hypotonia. What  drug  should  be  chosen in this case?

196.

A   female    patient   complains    of vision    impairment.    On     examination she was found to have obesity, fasting hyperglycemia. What  complication of diabetes  can cause vision impairment?

197.

Analysis of the family history of children with Van der Woude syndrome revealed  that  in their  families one  of the parents had the typical for this syndrome defects   (cleft   lip   and   palate,   lip   pits regardless of  gender). What  is the  type of inheritance of this syndrome?

198.

Administration of doxycycline hydrochloride caused an imbalance of the symbiotic   intestinal  microflora.   Specify the kind of imbalance caused by the antibiotic therapy:

199.

A  3-year-old  child  had  eaten  some strawberries. Soon  he  developed a  rash and itching. What was found in the child’s leukogram?

200. A  12-year-old  patient was found  to have  blood  serum  cholesterol at the  rate of  25 mmol/l.  The  boy  has  a  history  of hereditary familial hypercholesterolemia, which is caused by the impaired  synthesis of the following protein receptors: