1. A patient had to go through an operation. Doctors introduced him dithylinum (listenone) and performed intubation. After the end of operation and cessation of anesthesia the independent respiration wasn’t restored. Which enzyme deficit prolongs the action of muscle relaxant?
A patient is ill with diabetes mellitus that is accompanied by hyperglycemia of over 7,2 millimole/l on an empty stomach. The level of what blood plasma protein allows to estimate the glycemia rate retrospectively (4-8 weeks before examination)?
3. A 60 y.o. patient has a reduced perception of high-frequency sounds. What structures’ disorder of auditory analyzer caused these changes?
A patient ill with diabetes mellitus felt acute pain in his right foot. Objectively: foot thumb is black, foot tissues are edematous, there are foci of epidermis desquamation, stinking discharges. What clinicopathological form of necrosis is it?
5. A patient with a stab wound of the anterior stomach wall is in surgical care. What formation of abdominal cavity did the stomach contents get into?
A 4 y.o. child with signs of durative proteinic starvation was admitted to the hospital. The signs were as follows: growth inhibition, anemia, edemata, mental deficiency. Choose a cause of edemata development:
7. Autopsy of a patient who suffered from croupous pneumonia and died from pneumococcal sepsis revealed 900 ml of turbid greenish-yellow liquid in the right pleural cavity. Pleural leaves are dull, plephoric. Name the clinicopathological form of inflammation in the pleural cavity:
Examination of a patient revealed reduced contents of magnesium ions that are necessary for attachment of ribosomes to the granular endoplasmatic reticulum. It is known that it causes disturbance of protein biosynthesis. What stage of protein biosynthesis will be disturbed?
Analysis of blood serum of a patient revealed increase of alanine aminotransferase and aspartate aminotransferase level. What cytological changes can cause such a situation?
10. Power inputs of a boy increased from
500 to 2000 kJ pro hour. What can be the cause of it?
11. A patient presents high activity of LDH1,2, aspartate aminotransferase, creatine phosphokinase. In what organ (organs) is the development of a pathological process the most probable?
12. According to the data of WHO, for about 250 mln of Earth population fall ill with malaria. This disease is mostly spread in tropical and subtropical regions. Range of its spread falls into the areal of the following mosquitoes:
Autopsy of a 58 y.o. man revealed that bicuspid valve was deformed, thickened and unclosed. Microscopically: foci of collagen fibrilla are eosinophilic, react positively to fibrin. The most probably it is:
Labeled amino acids alanine and tryptophane were introduced to a mouse in order to study localization of protein biosynthesis in its cells. Around what organellas will the accumulation of labeled amino acids be observed?
15. In some regions of South Africa there is a spread sickle-shaped cell anemia, in which erythrocytes have shape of a sickle as a result of substitution of glutamin by valine in the hemoglobin molecule. What is the cause of this disease?
A patient died under conditions of cardiovascular insufficiency. Autopsy results: postinfarction cardiosclerosis, myocardium hypertrophy and dilatation of its cavities, especially of its right ventricle. Liver is enlarged, its surface is smooth, incision revealed that it was plethoric, with dark-red specks against the background of brownish tissue. Histologically: plethora of central parts of lobules; peripheral parts around portal tracts contain hepatocytes in a state of adipose degeneration. How are these liver changes called?
17. Autopsy of a man who died from chronic cardiovascular collapse revealed \\\"tiger heart\\\". Sidewards of endocardium a yellowish-white banding can be seen; myocardium is dull, dark-yellow. What process caused this pathology?
18. In course of an experiment a skeletal muscle is being stimulated by a series of electric impulses. What type of muscle contraction will arise, if every subsequent impulse comes in the period of shortening of the previous single muscle contraction?
19. Ammonia is a very toxic substance, especially for nervous system. What substance takes the most active part in ammonia detoxification in brain tissues?
A man was admitted to the hospital on the 5th day of disease that manifested itself by jaundice, muscle aching, chill, nose bleedings. In course of laboratory diagnostics a bacteriologist performed dark-field microscopy of the patient’s blood drop. Name a causative agent of this disease:
A patient has a transverse disruption of spinal cord below the IV thoracic segment. What changes of respiration will it cause?
22. 12 hours after an acute attack of retrosternal pain a patient presented a jump of aspartate aminotransferase activity in blood serum. What pathology is this deviation typical for?
A lightly dressed man is standing in a room, air temperature is +140C, windows and doors are closed. In what way does he emit heat the most actively?
24. A 30 y.o. woman had been ill for a year when she felt pain in the area of joints for the first time, they got swollen and skin above them became reddened. Provisional diagnosis is rheumatoid arthritis. One of the most probable causes of this disease is a structure alteration of a connective tissue protein:
A patient with infectious mononucleosis has been taking glucocorticoids for two weeks. He was brought into remission, but he fell ill with acute attack of chronic tonsillitis. What action of glucocorticoids caused this complication?
A peripheral segment of vagus nerve on a dog’s neck was being stimulated in course of an experiment. The following changes of cardiac activity could be meanwhile observed:
27. As a result of exhausting muscular work a worker has largely reduced buffer capacity of blood. What acidic substance that came to blood caused this phenomenon?
A patient was delivered to the hospital by an emergency team. Objectively: grave condition, unconscious, adynamy. Cutaneous surfaces are dry, eyes are sunken, face is cyanotic. There is tachycardia and smell of acetone from the mouth. Analysis results: blood glucose - 20,1 micromole/l (standard is 3,3-5,5 micromole/l), urine glucose - 3,5% (standard is - 0). What is the most probable diagnosis?
A 62 y.o. woman complains of frequent pains in the area of her chest and backbone, rib fractures. A doctor assumed myelomatosis (plasmocytoma). What of the following laboratory characteristics will be of the greatest diagnostical importance?
30. Nappies of a newborn have dark spots that witness of formation of homogentisic acid. Metabolic imbalance of which substance is it connected with?
Having helped to eliminate consequences of a failure at a nuclear power plant, a worker got an irradiation doze of 500 roentgen. He complains of headache, nausea, dizziness. What changes in leukocytes quantity can be expected 10 hours after irradiation?
The nuclear radiation this patient was exposed to can produce inflammatory reaction in the patient. Within the first 24hours, the first leukocyte to get into any inflammatory focus are the neutrophils, followed by the monocytes (macrophages) and then lymphocytes.
Neutrophils are the first leukocytes that cross the blood vessel wall to enter inflammatory sites. Under normal conditions, leukocytes are restricted to the center of small blood vessels, where the flow is fastest. In inflammatory sites, where the vessels are dilated, the slower blood flow allows the leukocytes to move out of the center of the blood vessel and interact with the vascular endothelium. Even in the absence of infection, monocytes migrate continuously into the tissues, where they differentiate into macrophages; meanwhile, during an inflammatory response, the induction of adhesion molecules on the endothelial cells, as well as induced changes in the adhesion molecules expressed on leukocytes recruit large numbers of circulating leukocytes, initially Neutrophils and later monocytes, into the site of an infection (inflammatory focus).
First –Neutrophils; second –monocytes and macrophages; third –lymphocytes.
32. A 12 y.o. boy who suffers from bronchial asthma has an acute attack of asthma: evident expiratory dyspnea, skin pallor. What type of alveolar ventilation disturbance is it?
A woman who has been keeping to a clean-rice diet for a long time was diagnosed with polyneuritis (beri-beri). What vitamin deficit results in development of this disease?
Removal of gall bladder of a patient has disturbed processes of Ca absorption through the intestinal wall. What vitamin will stimulate this process?
A hepatitis outbreak was registered in a settlement. This episode is connected with water factor. What hepatitis virus could have caused the infective outbreak in this settlement?
Examination of a 43 y.o. patient revealed that his stomach has difficulties with digestion of protein food. Gastric juice analysis revealed low acidity. Function of which gastric cells is disturbed in this case?
A 16 y.o. boy from a countryside entered an educational establishment. Scheduled Manteux test revealed that the boy had negative reaction. What are the most reasonable actions in this case?
38. A patient complains of frequent diarrheas, especially after consumption of fattening food, and of body weight loss. Laboratory examination revealed steatorrhea; hypocholic feces. What can be the cause of this condition?
A patient consulted a doctor about bowels dysfunction. The doctor established symptoms of duodenitis and enteritis. Laboratory examination helped to make the following diagnosis: lambliosis. What medication should be administered?
40. A group of mountain climbers went through the blood analysis at the height of 3000 m. It revealed decrease of HCO3 to 15 micromole/l (standard is 22-26 micromole/l). What is the mechanism of HCO3 decrease?
Introduction of a pharmaceutical substance to an experimental animal resulted in reduction of salivation, pupil mydriasis. Next intravenous introduction of acetylcholine didn’t lead to any significant changes of heart rate. Name this substance:
Acetylcholine is a neurotransmitter. It increases salivary secretion and stimulates intestinal secretions and motility. It increases bronchial secretions, increases tone of detrusor urinae muscle, causing expulsion of urine, stimulates ciliary muscle contraction (accommodation). It increases exocrine gland secretions (e.g. lacrimal, salivary, gastric acid); gut peristalsis, bladder contraction, bronchoconstriction, papillary sphincter muscle contraction (miosis). Poisoning by cholinomimetics causes diarrhea, urination, miosis, bronchospasm, bradycardia, excitation of skeletal muscle and central nervous system, lacrimation, sweating and salivation. Cholinomimetics are cholinergic agonists which produce analogous effects of acetylcholine.
Atropine sulfate (M-cholinoblocker) blocks the acetylcholine response, so that
intravenous introduction of acetylcholine didn’t lead to any significant changes.
Continuous taking of a drug can result in osteoporosis, erosion of stomach mucous membrane, hypokaliemia, retention of sodium and water, reduced content of corticotropin in blood. Name this drug:
43. A child is languid, apathetic. Liver
is enlarged and liver biopsy revealed a significant excess of glycogen. Glucose concentration in the blood stream is below normal. What is the cause of low glucose concentration?
44. A 63 y.o. man with collapse symptoms was delivered to the emergency hospital. A doctor chose noradrenaline in order to prevent hypotension. What is the action mechanism of this medication?
From pharynx of a child with suspected diphtheria a pure culture of microorganisms was isolated. Their morphological, tinctorial, cultural and biochemical properties appeared to be typical for diphtheria causative agents. What study should be conducted in order to draw a conclusion that this is a pathogenic diphtheria bacillus?
Examination of a child revealed some whitish spots looking like coagulated milk on the mucous membrane of his cheeks and tongue. Analysis of smears revealed gram-positive oval yeast-like cells. What causative agents are they?
47. A 35 y.o. patient who often consumes
alcohol was treated with diuretics. There appeared serious muscle and heart weakness, vomiting, diarrhea, AP- 100/60 mm Hg, depression. This condition is caused by intensified excretion with urine of:
After intake of rich food a patient feels nausea and sluggishness; with time there appeared signs of steatorrhea. Blood cholesterine concentration is 9,2 micromole/l. This condition was caused by lack of:
Examination of a man who hadn’t been consuming fats but had been getting enough carbohydrates and proteins for a long time revealed dermatitis, poor wound healing, vision impairment. What is the probable cause of metabolic disorder?
50. An experimental animal has been given excessive amount of carbon-labeled glucose for a week. What compound can the label be found in?
RNA that contains AIDS virus penetrated into a leukocyte and by means of reverse transcriptase forced a cell to synthesize a viral DNA. This process is based upon:
52. Examination of a patient with frequent
hemorrhages from internals and mucous membranes revealed proline and lysine being a part of collagen fibers. What vitamin absence caused disturbance of their hydroxylation?
Vitamin C (ascorbic acid): found in fruits and vegetables; an antioxidant; also facilitates iron absorption by reducing it to Fe2+ state. It is necessary for hydroxylation of proline and lysine in collagen synthesis; necessary for dopamine β-hydroxylase, which converts dopamine to norepinephrine. Deficiency leads to: scurvy – swollen gums, bruising, petechiae, hemarthrosis, anemia, poor wound healing, perifollicular and subperiosteal hemorrhages, “corkscrew” hair; Weakened immune response.
Type III collagen is found in blood vessels; Type IV collagen is found in basement membrane. Deficiency in Vitamin C disrupts the second stage of collagen synthesis in fibroblasts (hydroxylation of collagen) which results in petechiae, bruising, hemarthrosis.
Vitamin B2 (riboflavin) deficiency – growth retardation, glossitis, conjunctivitis
Vitamin B1 (thiamine) deficiency – Beri-Beri (polyneuritis)
Vitamin A (retinol) deficiency – Night blindness
53. A patient who suffers from pneumonia has high body temperature. What biologically active substance plays the leading part in origin of this phenomenon?
A 27 y.o. patient put eye drops that contain penicillin. After a few minutes she felt itching and burning of her body, there appeared lip and eye-lid edemata; arterial pressure began to drop. What immunoglobulins took part in the development of this allergic reaction?
55. A patient suffers from hepatic cirrhosis. Examination of which of the following substances excreted by urine can characterize the state of antitoxic function of liver?
A 2 y.o. child has convulsions as a result of lowered concentration of calcium ions in blood plasma. It is caused by reduced function of:
Inflammation of a patient’s eye was accompanied by accumulation of turbid liquid with high protein at the bottom of anterior chamber that was called hypopyon. What process underlies the changes under observation?
58. Heart rate of a man permanently equals 40 beats pro minute. What is the pacemaker?
A 48 y.o. patient was admitted to the hospital with complaints about weakness, irritability, sleep disturbance. Objectively: skin and scleras are yellow. In blood: conjugated bilirubin, cholalemia. Feces are acholic. Urine is of dark colour (bilirubin). What jaundice is it?
Indirect; Hemolytic; Prehepatic
Mixed; Parenchymal; Hepatic
Direct; Obstructive; Mechanic; Posthepatic
Decreases (pale faces)
Absent (clay coloured faeces)
Type of bilirubin in blood
Conjugated and Unconjugated
Obturation (obstruction, to close) of bile duct – it can be:
* Intrahepatic – blockage of intrahepatic bile ducts
* Extrahepatic – blockage of common bile duct (ductus choledochus).
* malabsorption: bile salts do not enter the Small Intestine; no emulsification of fat.
*light coloured stool: due to lack of urobilin (which leads to lack of stercobilin).
*Jaundice (posthepatic, mechanic, obstructive): increased conjugated Bilirubin.
The findings are specific for obstruction of bile duct and bile acid deficiency.
Bacteriological examination of a patient with food poisoning required inoculation of a pure culture of bacteria with the following properties: gram-negative movable bacillus that grows in the Endo’s medium in form of colourless colonies. A representative of which species caused this disease?
A patient was diagnosed with active focal pulmonary tuberculosis. What drug should be prescribed in the first place?
Examination of a young man in the AIDS centre produced a positive result of immune-enzyme assay with HIV antigens. Patient’s complaints about state of his health were absent. What can the positive result of immune-enzyme assay be evidence of?
Parents of a 10 y.o. boy consulted a doctor about extension of hair-covering, growth of beard and moustache, low voice. Intensified secretion of which hormone must be assumed?
64. A patient who suffers from severe disorder of water-salt metabolism experienced cardiac arrest in diastole. What is the most probable mechanism of cardiac arrest in diastole?
Examination of coronary arteries revealed atherosclerotic calcific plaques that close vessel lumen by 1/3. The muscle has multiple whitish layers of connective tissue. What process was revealed in myocardium?
66. Reaction of passive hemagglutination conducted with erythrocytic typhoid Vi-diagnosticum helped to reveal some antibodies in the dilution of the patient’s serum at a ratio of 1:80 that exceeds the diagnostic titer. Such result witnesses of:
67. A teenager was irradiated with high radiation dose that resulted in serious damages of lymphoid system, lysis of many lymphocytes. Restoration of normal hemogram is possible due to the functioning of the following gland:
68. A man with cut wound of his right foot sole was admitted to the hospital ward. The patient has limited elevation of the lateral foot edge. In course of wound management the injury of a muscle tendon was revealed. What muscle is injured?
69. A patient who suffers from heart failure has enlarged liver, edemata of lower extremities, ascites. What is the leading mechanism in the development of this edema?
70. A 32 y.o. man is tall, he has gynecomastia, adult woman pattern of hair distribution, high voice, mental deficiency, sterility. Provisional diagnosis is Klinefelter’s syndrome. In order to specify diagnosis it is necessary to analyze:
71. Examination of a miner revealed pulmonary fibrosis accompanied by disturbance of alveolar ventilation. What is the main mechanism of this disturbance?
72. A man took a quiet expiration. Name an air volume that is meanwhile contained in his lungs:
73. Examination of an isolated cardiomyocyte revealed that it didn’t generate excitation impulses automatically. This cardiomyocyte was obtained from:
74. Examination of a man established that cardiac output equaled 3500 ml, systolic output - 50 ml. What is the man’s heart rate pro minute?
75. A man who went for a ride on a roundabout had amplification of heart rate, sweating and nausea. What receptors stimulation is it primarily connected with?
76. In order to estimate toxigenity of diphtheria agents obtained from patients the cultures were inoculated on Petri dish with nutrient agar on either side of a filter paper strip that was put into the centre and moistened with antidiphtheric anti-toxic serum. After incubation of inoculations in agar the strip-like areas of medium turbidity were found between separate cultures and the strip of filter paper. What immunological reaction was conducted?
77. A man’s intrapleural pressure is being measured. In what phase did the man hold his breath, if his pressure is 7,5 cm Hg?
78. A 49 y.o. woman consulted a doctor about heightened fatigue and dyspnea during physical activity. ECG: heart rate is 50/min, PQ is extended, QRS is unchanged, P wave quantity exceeds quantity of QRS complexes. What type of arrhythmia does the patient have?
79. A patient with neuritis of femoral nerve has disturbed flexion of thigh as well as disturbed crus extension in the knee joint. What muscle’s function is disturbed?
80. Autopsy of a newborn boy revealed polydactylia, microcephalia, cheiloschisis and uranoschisis as well as hypertrophy of parenchymatous organs. These defects correspond with the description of Patau’s syndrome. What is the most probable cause of this pathology?
81. An ovary specimen stained by hematoxylin-eosin presents a follicle, where cells of follicular epithelium are placed in 1-2 layers and have cubic form, there is a bright-red membrane around the ovocyte. What follicle is it?
82. A woman has been applying a new cosmetic preparation for a week that resulted in eye-lid inflammation accompanied by hyperemia, infiltration and painfulness. What type of allergic reaction was developed?
83. Examination of a patient revealed extremely myotic pupils, sleepiness, infrequent Chain-Stoke’s respiration, urinary retention, slowing-down of heart rate, enhancement of spinal reflexes. What substance caused the poisoning?
84. A patient is followed up in an endocrinological dispensary on account of hyperthyreosis. Weight loss, tachycardia, finger tremor are accompanied by hypoxia symptoms - headache, fatigue, eye flicker. What mechanism of thyroid hormones action underlies the development of hypoxia?
85. A doctor administered a patient with allergic dermatitis a H1-histamine blocker as a part of complex treatment. Name this medication:
86. An injured man has bleeding from branches of carotid artery. For a temporary arrest of bleeding it is necessary to press the carotid artery to the tubercle of a cervical vertebra. Which vertebra is it?
87. As a result of an accident a patient has intense painfullness and edema of the anterior crus surface; dorsal flexion of foot is hindered. Function of which crus muscle is most likely to be disturbed?
88. The first grade pupils were examined in order to sort out children for tuberculosis revacination. What test was applied for this purpose?
89. The permeability of the irritable cell membrane has been increased for potassium ions during an experiment. What changes of membrane electric status can occur?
90. A patient with II stage hypertension has been taking one of hypotensive medications for the purpose of treatment. After a time arterial pressure decreased, but the patient started complaining of flaccidity, sleepiness, indifference. A bit later he felt stomach pain. He was diagnosed with ulcer. What hypotensive medication has the patient been taking?
91. 6 months after delivery a woman had uterine bleeding. Gynecological examination revealed in the uterine cavity a dark-red tissue with multiple cavities that resembled of \\\\\\\"sponge\\\\\\\". Microscopic examination of the tumour revealed some atypic light epithelial Langhans cells and giant cells of syncytiotrophoblast in blood lacunas. What tumour is it?
92. A 40 y.o. patient complains of intensive heartbeats, sweating, nausea, vision impairment, arm tremor, hypertension. From his anamnesis: 2 years ago he was diagnosed with pheochromocytoma. Hyperproduction of what hormones causes the given pathology?
93. A 56 y.o. patient has been suffering from thyreotoxicosis for a long time. What type of hypoxia can be developed?
94. A sportsman was recommended to take a medication that contains carnitine in order to improve his results. What process is activated by carnitine the most?
95. A patient has symptoms of inflammation of urogenital tracts. Examination of a vaginal smear revealed big monocellular, pear-shaped organisms with the pointed spike at the posterior end of body, big nucleus and undulating membrane. What protozoa were found in the smear?
96. A patient has extrasystole. ECG shows no P wave, QRS complex is deformed, there is a full compensatory pause. What extrasystoles are these?
97. A patient who suffers from cancer of back of tongue has an intense bleeding as a result of affection of dorsal lingual artery by the tumour. What vessel should be ligated to stop bleeding?
98. In course of an experiment a big number of stem cells of red bone marrow was in some way destructed. Regeneration of which cell populations in the loose connective tissue will be inhibited?
99. Histological examination of a 40 y.o. man’s thymus revealed decreased share of parenchymatous gland elements, increased share of adipose and loose connective tissue, its enrichment with thymus bodies. The organ’s mass was unchanged. What phenomenon is it?
100. Mucous membrane of the right palatine tonsil has a painless ulcer with smooth lacquer fundus and regular cartilagenous edges. Microscopically: inflammatory infiltration that consists of lymphocytes, plasmocytes, a small number of neutrophils and epithelioid cells; endovasculitis and perivasculitis. What disease is it?
101. Bacteriological laboratory examines canned meat whether it contains botulinum toxin. For this purpose an extract of test specimen and antitoxic antibotulinic serum of A, B, E types were introducted to a group of mice under examination; a control group of mice got the extract without antibotulinic serum. What serological reaction was applied?
102. To prevent postoperative bleeding a 6 y.o. child was administered vicasol that is a synthetic analogue of vitamin K. Name post-translational changes of blood coagulation factors that will be activated by vicasol:
103. As a result of spinal-cord trauma a 33 y.o. man has a disturbed pain and temperature sensitivity that is caused by damage of the following tract:
104. For the preparation of a patient’s burn skin surface a certain medication was used. Its antiseptic action is provided by free oxygen that segregates in presence of organic substances. Choose the right answer:
105. After a 2 y.o. child has had flu, there appeared complaints about ear ache. A doctor revealed hearing impairment and inflammation of the middle ear. How did the infection penetrate into the middle ear?
106. A 50 y.o. patient with chronic cardiac insufficiency and tachyarrhythmia was prescribed a cardiotonic drug. What drug was prescribed?
107. Microscopical examination of a removed appendix revealed an edema, diffuse neutrophilic infiltration of appendix wall along with necrosis and defect of mucous membrane with affection of its muscle plate. What appendicitis form was developed?
108. A 39 y.o. woman went through an operation in course of which surgeons removed her uterine tube that was enlarged and a part of an ovary with a big cyst. Histological examination of a tube wall revealed decidual cells, chorion villi. What was the most probable diagnosis made after examination of the uterine tube?
109. A 4 y.o. boy has had recently serious viral hepatitis. Now there are such clinical presentations as vomiting, loss of consciousness, convulsions. Blood analysis revealed hyperammoniemia. Disturbance of which biochemical process caused such pathological condition of the patient?
110. Examination of a patient revealed hyperkaliemia and hyponatremia. Low secretion of which hormone may cause such changes?
111. In course of indirect histogenesis of tubular bone tissue a plate is formed between epiphyseal and diaphyseal ossification centres that provides further lengthwise growth of bones. What structure is it?
112. A 40 y.o. woman was admitted to the infectious diseases department with high body temperature. Objectively: evident meningeal symptoms. A spinal cord punction was made. What anatomic formation was punctured?
113. After resection of the middle third of femoral artery obliterated by a thrombi the lower extremity is supplied with blood due to the surgical bypass. Name an artery that plays the main role in reestablishment of blood flow:
114. A patient’s knee joint doesn’t extend, there is no knee-jerk reflex, skin sensitivity of the anterior femoral surface is disturbed. What nerve structures are damaged?
115. An electron micrograph of a kidney fragment presents an afferent arteriole. Under its endothelium some big cells can be seen that contain secretory granules. What type of cells is it?
116. For the purpose of retrospective diagnostics of recent bacterial dysentery it was decided to perform serological examination of blood serum in order to determine antibody titer towards Shiga bacilli. What of the following reactions should be applied?
117. Examination of a 43 y.o. anephric patient revealed anemia symptoms. What is the cause of these symptoms?
118. A 50 y.o. patient was admitted to the hospital with complaints about pain behind his breastbone, asphyxia during physical activity. Angiography revealed pathological changes in the posterior interventricular branch of the right coronary artery. What heart parts are affected?
119. 48 hours after performing tuberculin test (Mantoux test) to a child a 10 mm papule appeared on the spot of tuberculin introduction. What hypersensitivity mechanism underlies these changes?
120. Examination of a newborn boy’s genitals revealed a cleft of urethra that opens on the inferior surface of his penis. What developmental anomaly is it?
121. A patient has a disturbed absorption of fat hydrolysates. It might have been caused by a deficit in the small intestine cavity:
122. Inhabitants of territories with cold climate have high content of an adaptive thermoregulatory hormone. What hormone is meant?
123. Violation of safety rules resulted in calomel intoxication. Two days later the daily diuresis was 620 ml. A patient experienced headache, vomiting, convulsions, dyspnea, moist rales in lungs. What pathology is it?
124. A newborn child with pylorostenosis has often repeating vomiting accompanied by apathy, weakness, hypertonicity, sometimes convulsions. What disorder form of acid-base balance is it?
125. Glutamate decarboxylation results in formation of inhibitory transmitter in CNS. Name it:
126. In course of histidine catabolism a biogenic amine is formed that has powerful vasodilating effect. Name it:
127. Utilization of arachidonic acid via cyclooxigenase pathway results in formation of some bioactive substances. Name them:
128. As a result of damage to certain structures of brainstem an animal lost orientation reflexes. What structures were damaged?
129. Osmotic pressure of a man’s blood plasma is 350 mosmole/l (standard pressure is 300 mosmole/l). First of all it will result in high secretion of the following hormone:
130. A young man consulted a doctor about disturbed urination. Examination of his external genitals revealed that urethra is split on top and urine runs out of this opening. What anomaly of external genitals development is the case?
131. A patient complains of pain in the area of his liver. Duodenal intubation revealed yellowish, oval, narrowed at the poles eggs with an operculum at the end. Size of these eggs is the smallest among all helminth eggs. What is the most probable diagnosis?
132. Colonoscopy of a patient ill with dysentery revealed that mucous membrane of his large intestine is hyperemic, edematic, its surface was covered with grey-and-green coats. Name the morphological form of dysenteric collitis:
133. 24 hours after appendectomy blood of a patient presents neutrophilic leukocytosis with regenerative shift. What is the most probable mechanism of leukocytosis development?
134. Arterial pressure of a surgeon who performed a long operation rised up to 140/110 mm Hg. What changes of humoral regulation could have caused the rise of arterial pressure in this case?
135. A hypertensive glucose solution was introduced to a patient. It will intensify water movement:
136. A 36 y.o. man has a craniocerebral trauma. Objectively: diminished breath sounds, thready pulse, no reflexes. What way of pyracetam introduction will be the most appropriate in this case?
137. A child complains of general weakness, loss of appetite, a troubled sleep, itching in the perianal area. The provisional diagnosis is enterobiasis. In order to specify this diagnosis it is necessary to perform:
138. A patient was ill with burn disease that was complicated by DIC syndrome. What stage of DIC syndrome can be suspected if it is known that the patient’s blood coagulates in less than 3 minutes?
139. In course of practical training students studied a stained blood smear of a mouse with bacteria phagocyted by leukocytes. What cell organella completes digestion of these bacteria?
Lysosomes are small organelles containing digestive enzymes, their derivatives include phagosomes, phagolysosomes, autophagosomes and autophagolysosomes. Lysosomes are digestive organelles rich in hydrolytic enzymes such as proteases, nucleases, glucosidases, lipases and phospholipases. 3 pathways for digestion exist:
· Extracellular large particles such as bacteria, cell debris and other foreign materials are engulfed in the process of phagocytosis. A phagosome, formed as the material is internalized within the cytoplasm, subsequently fuses with a lysosome to create a phagolysosome.
· Extracellular small particles such as extracellular proteins, plasma membrane proteins and ligand-receptor complexes are internalized by endocytosis and receptor mediated endocytosis.
· Intracellular particles such as entire organelles, cytoplasmic proteins and other cellular components – autophagy.
140. A 55 y.o. woman consulted a doctor about having continuous cyclic uterine hemorrhages for a year, weakness, dizziness. Examination revealed skin pallor. Hemogram: Hb- 70 g/l, erythrocytes - 3, 2 · 1012/l, color index - 0,6, leukocytes - 6, 0 · 109/l, reticulocytes - 1%; erythrocyte hypochromia. What anemia is it?
141. According to audiometry data a patient has a disturbed perception of medium-frequency sounds. It might have been caused by a damage of:
142. A patient diagnosed with carcinoid of bowels was admitted to the hospital. Analysis revealed high production of serotonin. It is known that this substance is formed of tryptophane amino acid. What biochemical mechanism underlies this process?
143. A 23 y.o. patient complains of weakness, temperature rise up to 38 − 40oC. Objectively: liver and spleen are enlarged. Hemogram: Hb- 100 g/l, erythrocytes - 2, 9 · 1012/l, leukocytes - 4, 4 · 109/l, thrombocytes - 48 · 109/l, segmentonuclear neutrophils - 17%, lymphocytes - 15%, blast cells - 68%. All cytochemical reactions are negative. Make a hematological conclusion:
A patient ill with bronchial asthma didn’t inform his doctor that he had attacks of stenocardia. Doctor administered him a medication, which taking resulted in less frequent attacks of bronchial asthma, but stenocardia attacks became more frequent. What medication was administered?
A patient who has been suffering from cardiac insufficiency for several months has been taking digoxin on an outpatient basis. At a certain stage of treatment there appeared symptoms of drug overdose. What phenomenon underlies the development of this complication?
146. A patient who has been treated with diazepam on account of neurosis complains of toothache. Doctor administered him an analgetic, but its dose was lower than average therapeutic dose. What phenomenon did the doctor take into account while prescribing the patient an underdose?
A child’s blood presents high content of galactose, glucose concentration is low. There are such presentations as cataract, mental deficiency, adipose degeneration of liver. What disease is it?
148. According to clinical indications a patient was administered pyridoxal phosphate. What processes is this medication intended to correct?
Vitamin B6 (pyridoxine): converted to pyridoxal phosphate (PLP), a cofactor used in transamination (e.g. in ALT and AST), decarboxylation reactions, glycogen phosphorylase. Synthesis of cystathione, heme, niacin (Vit. B3), histamine and neurotransmitters including serotonin, epinephrine, norepinephrine, dopamine and GABA. Deficiency produces convulsions, hyperirritability, peripheral neuropathy (deficiency inducible by isoniazid and oral contraceptives), sideroblastic anemia due to impaired hemoglobin synthesis and iron excess.
149. In course of an operation surgeon removed a part of a lung that was ventilated by a tertiary bronchus accompanied by branches of pulmonary artery and other vessels. What part of a lung was removed?
150. A patient with clinical presentations of immunodeficiency went through immunological examinations. They revealed significant loss of cells that form rosettes with erythrocytes of a ram. What conclusion can be made according to the analysis data?
151. A woman with (B), Rh− blood group born a child with (A) blood group. The child is diagnosed with hemolytic disease of newborn as a result of rhesus incompatibility. What blood group is the child’s father likely to have?
152. A 45 y.o. woman suffers from Cushing’s syndrome - steroid diabetes. Biochemical examination revealed: hyperglycemia, hypochloremia. Which of the under-mentioned processes is the first to be activated?
Histological specimen presents a vessel the wall of which consists of endothelium, basal membrane and loose connective tissue. What type of vessel is it?
154. Autopsy of a 48 y.o. man revealed a round formation 5 cm in diameter with clear-cut outlines in the region of the 1st segment of his right lung. This formation was encircled with a thin layer of connective tissue full of white brittle masses. Make a diagnosis of the secondary tuberculosis form:
On the 6th day of treatment a patient with acute renal insufficiency developed polyuria. Diuresis intensification at the beginning of polyuria stage of acute renal insufficiency is caused by:
Long-term starvation cure of a patient resulted in diminished ratio of albumines and globulines in plasma. What of the following will be result of these changes?
157. An experimental animal was first sensibilized whereupon an antigen dose was introduced subcutaneously. This injection resulted in the development of a fibrinous inflammation with alteration of vessel walls, basal substance and fibrous structures of connective tissue in form of mucoid and fibrinoid swelling and necrosis. What immunological reaction took place?
Type I (Immediate, Anaphylaxis, Reagin): IgE (immunoglobulin E)-dependent activation of mast cells/basophils, usually accompanied by eosinophilia e.g. urticaria (hives), hay fever, asthma (wheezing), rhinitis and conjunctivitis (stuffy nose and itchy eyes; usually seasonal)
Type II (cytotoxic): antibody dependent reactions e.g. Goodpasture syndrome, Myasthenia gravis, Graves disease, ABO hemolytic disease of newborn etc.
Type III (immune-complex): deposition of antigen-antibody complexes e.g. systemic lupus erythromatous (SLE), Arthus reaction, serum sickness, poststreptococcal glomerulonephritis etc.
Type IV (cell mediated, delayed): antibody-independent T-cell mediated reactions e.g. positive mantoux reaction (tuberculin test), hashimoto’s thyroiditis or transplant rejection etc.
A patient suffers from vision impairment - hemeralopy (night blindness). What vitamin preparation should be administered the patient in order to restore his vision?
A 1 y.o. child with symptoms of muscle affection was admitted to the hospital. Examination revealed carnitine deficit in muscles. Biochemical base of this pathology is disturbed process of:
A patient suffers from severe postoperative pseudomonadous infection. What of the following antibiotics should be administered in this case?
A 9 m.o. child has delayed dentition, it is also out of order. Upper jaw configuration is horizontal (\"high\" palate); microscopically - irregular mineralization of tooth enamel, wrinkled enamel prisms, some of them are vacuolized. Predentin zone is extended; there are solitary denticles. What disease is it?
Examination of a patient revealed an abscess of pterygopalatine fossa. Where can the infection spread to unless the disease is managed in time?
Microscopical renal examination of a 36 y.o. woman who died from renal insufficiency revealed in the glomerules proliferation of capsule nephrothelium as well as of podocytes and phagocytes accompanied by formation of \\\"crescents\\\", capillary loop necrosis, fibrinous thrombs in their lumens; sclerosis and hyalinosis of glomerules, atrophy of tubules and fibrosis of renal stroma. What is the most probable diagnosis?
A forensic medical expert examines the body of a 58 y.o. man who had been consuming large amounts of alcohol for a long time and died at home. Microscopically: the right lung is dense and enlarged, its incision revealed that the tissue is greyish and homogenous, pleura is covered with greyish layers. Microscopically - alveolar cavities contain fibrin, hemolyzed erythrocytes. Make a diagnosis:
165. Two days after consumption of
smoked pork a patient got face and eyelid edemata, gastrointestinal disturbances, abrupt temperature rise, muscle pain. Blood analysis showed full-blown eosinophilia. What helminth could the patient be infected with?
After a tooth extraction a patient felt persistent pain behind his breast bone. After sublingual intake of an antianginal drug the pain behind the breast bone disappeared, but the patient complained of headache and dizziness. What drug are these properties typical for?
A patient with fracture of his lower jaw was admitted to the maxillofacial department. It was decided to fix his bones surgically under anaesthetic. After intravenous introduction of muscle relaxant there arose short fibrillar contractions of the patient’s facial muscles. What muscle relaxant was applied?
Autopsy of a 56 y.o. man revealed in the right temporal part of brain a big focus of softened grey matter that was semi-liquid and light grey. Arteries of cerebral tela contain multiple whitish-yellow thickenings of intima that abruptly narrow the lumen. What is your diagnosis?
169. Vitamin A deficit results in the impairment of twilight vision. Name the cells that have the above-mentioned photoreceptor function:
Neurological examination of a 65 y.o. patient revealed a haemorrhage within the superior temporal gyrus. In the blood supply area of which artery is it?
A 70 y.o. man has cut an abscess off in the area of mammiform process during shaving. Two days later he was admitted to the hospital with inflammation of arachnoid membranes. How did the infection penetrate into the cavity of skull?
172. A 22 y.o. woman has enlarged lymph nodes. Histologically: a lymph node contains lymphocytes, histiocytes, reticular cells, small and big Hodgkin’s cells, multinucleated Sternberg cells, isolated foci of caseous necrosis. What disease are these changes typical for?
A lymph node punctate of a patient with suspected protozoal disease was examined. Examination of the stained specimen (Romanovsky’s stain) revealed some crescent bodies with pointed end, blue cytoplasm and red nucleus. What protozoan were revealed in the smears?
174. During pubescence the cells of
male sexual glands begin to produce male sex hormone testosterone that calls forth secondary sexual characters. What cells of male sexual glands produce this hormone?
An isolated cell of human heart automatically generates excitation impulses with frequency 60 times pro minute. What heart structure was this cell obtained from?
176. Examination of a patient revealed a strong, balanced, inert type of higher nervous activity according to Pavlov. What temperament type does the patient have (according to Hippocrates classification)?
Hippocrates classification due to temperament and social behavior: choleric, phlegmatic; sanguine; melancholic.
· Choleric: egocentric and extroverts, excitable, impulsive and restless (dry and hot).
· Phlegmatic: reasonable, calm, patient, caring and tolerant (moist and cold)
· Sanguine: lively, sociable, carefree, talkative and pleasure seeking (hot and moist)
· Melancholic: serious, introvert, cautious or even suspicious (cold and dry)
A patient has a haemorrhage into the posterior central gyrus. What type of sensitivity on the opposite side will be disturbed?
Analysis of a punction biopsy material of liver revealed hepatocyte dystrophy with necroses as well as sclerosis with disorder of beam and lobulous structure, with formation of pseudolobules and regenerative nodes. What is the most probable diagnosis:
179. Examination of a 60 y.o. patient revealed hyperglycemia and glucosuria. A doctor administered him a medication for internal use. What medication is it?
A patient who had been working hard under conditions of elevated temperature of the environment has now a changed quantity of blood plasma proteins. What phenomenon is the case?
An experimental rat with extremity paralysis has no tendon and cutaneous reflexes, muscle tone is decreased, but muscles of the affected extremity maintain their ability to react with excitation to the direct action of continuous current. What type of paralysis is it?
A liquidator of a breakdown at a nuclear power plant who was irradiated complained about vomiting that occurs all of a sudden. What medication should be prescribed?
183. Urine examination of a patient with acute cystitis revealed leukocytes and a lot of gram-negative bacilli. Inoculation resulted in growth of colonies of mucous nature that formed green soluble pigment. What microorganism is the most probable cause of the disease?
184. A 45 y.o. patient consulted a doctor
about plaque-shaped formation on his neck. Histological examination of biopsy skin material revealed tumourous cells of round and oval form with thin ring of basophilic cytoplasma that resemble of cells of basal epidermal layer. What tumour is it?
185. A patient has pain, edema and reddening of his skin in the anterosuperior area of his thigh and his foot’s thumb. What lymph nodes of his lower extremity responded to the inflammatory process?
A laboratory received a material from a patient’s wound. Preliminary diagnosis is gaseous gangrene. What microbiological method should be applied to determine species of causative agent?
Examination of cell culture got from a patient with lysosomal pathology revealed accumulation of great quantity of lipids in the lysosomes. What of the following diseases is this disturbance typical for?
A patient got a craniocerebral trauma that resulted in right-side convergent strabismus. Damage of which craniocerebral nerve caused such consequences?
189. In case of a penetrating wound of
the anterior abdominal wall the wound tract went above the lesser curvature of stomach. What peritoneum formation is most likely to be injured?
A rabbit’s nerve that innervates the right ear was cut and its right superior cervical ganglion was removed. Immediately after operation the temperature of ear skin was measured. It was revealed that the temperature of the rabbit’s ear skin on the side of denervation was by 1, 50C higher than on the opposite intact side. What of the following is the most probable explanation of the above-mentioned effects?
191. A 63 y.o. man fell ill with acute tracheitis and bronchitis accompanied by bronchial pneumonia. On the 10th day the patient died from cardiopulmonary insufficiency. Autopsy revealed fibrinous hemorrhagic laryngotracheobronchitis; lungs were enlarged, their incision revealed the \\\"coal-miner’s\\\" effect caused by interlacing of sections of bronchial pneumonia, hemorrhages into the pulmonary parenchyma, acute abscesses and atelectases. Internal organs have discirculatory and dystrophic changes. What is the most probable diagnosis?
Autopsy of a man who died from influenza revealed that his heart was slightly enlarged, pastous, myocardium was dull and had specks. Microscopical examination of myocardium revealed signs of parenchymatous adipose and hydropic dystrophy; stroma was edematic with poor macrophagal and lymphocytic infiltration, vessels were plethoric; perivascular analysis revealed petechial hemorrhages. What type of myocarditis was developed in this case?
A patient with chronic cardiac insufficiency has been treated with cardiotonic drugs and a thiazide diuretic, but in spite of it there are still edemata and risk of ascites. What medication should be prescribed to amplify diuretic effect of the applied drugs?
194. A patient ill with collagenesis has been taking prednisolone for a long time. Hypokaliemia development caused spastic pain of skeletal muscles. What medication should be used in order to correct potassium exchange?
A boy is 7 y.o. Objectively: against the background of hyperemic skin there is knobby bright-pink rash on his forehead, neck, at the bottom of abdomen, in the popliteal spaces; nasolabial triangle is pale. Examination of oropharyngeal surface revealed localized bright-red hyperemia; tonsils are swollen, soft, lacunas contain pus, tongue is crimson. Cervical lymph nodes are enlarged, dense and painful. What is the most probable diagnosis?
A patient complains of dryness of head skin, itching, fragility and loss of hair. After examination he was diagnosed with seborrhea. Disturbed activity of which cells caused this condition?
In the surgical department of a hospital there was an outbreak of hospital infection that showed itself in often postoperative wound abscesses. Bacteriological examination of pus revealed aurococcus. What examination shall be conducted to find out the source of this causative agent among the department personnel?
198. Short-term physical activity resulted in reflex amplification of heart rate and raise of systemic arterial pressure. What receptors activation was the main cause of pressor reflex realization?
In course of an experiment a skeletal muscle is being stimulated by a series of electric impulses. What type of muscle contraction will arise, if every subsequent impulse comes in the period of relaxation of single muscle contraction?
200. A patient who suffers from acute myocarditis has clinical signs of cardiogenic shock. What of the under-mentioned pathogenetic mechanisms play the main part in shock development?