1. The infectious diseases department of a hospital admitted a patient with nausea, liquid stool with mucus and blood streaks, fever, weakness. Dysentery was suspected. What method of laboratory diagnostics should be applied to confirm the diagnosis?
2. Malaria is treated with structural analogs of vitamin B2 (riboflavin). These drugs disrupt the synthesis of the following enzymes in plasmodium:
3. A 6-year-old child with suspected active tuberculous process underwent the diagnostic Mantoux test. What immunobiological preparation was injected?
4. In a young man during exercise, the minute oxygen uptake and carbon dioxide emission equalled to 1000 ml. What substrates are oxidized in the cells of his body?
5. A sportsman spontaneously held breath for 40 seconds, which resulted in an increase in heart rate and systemic arterial pressure. Changes of these indicators are due to activation of the following regulatory mechanisms:
6. A 53-year-old male patient is diagnosed with Paget’s disease. The concentration of oxyproline in daily urine is sharply increased, which primarily means intensified disintegration of:
7. A patient has hoarseness of voice. During laryngoscopy a gray-white larynx tumor with papillary surface has been detected. Microscopic investigation has shown the following: growth of connective tissue covered with multi-layer, strongly keratinized pavement epithelium, no cellular atypia. What is the most likely diagnosis?
8. During autopsy approximately 2,0 liters of pus have been found in the abdominal cavity of the corpse. Peritoneum is lustreless and has grayish shade, serous tunic of intestines has grayish-colored coating that is easily removable. Specify the most likely type of peritonitis in the patient:
9. Autopsy of a dead 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?
10. Autopsy of the dead patient who died from pulmonary edema revealed a large yellow-grey nidus in the myocardium, and a fresh thrombus in the coronary artery. What is the most likely diagnosis?
11. An animal experiment is aimed at studying the cardiac cycle. All the heart valves are closed. What phase of the cycle is characterized by this status?
12. Cyanide is a poison that causes instant death of the organism. What enzymes found in mitochondria are affected by cyanide?
13. Increased HDL levels decrease the risk of atherosclerosis. What is the mechanism of HDL anti-atherogenic action?
14. It has been found out that one of a pesticide components is sodium arsenate that blocks lipoic acid. Which enzyme activity is impaired by this pesticide?
15. Stool culture test revealed in a 6-month-old bottle-fed baby the strain of intestinal rod-shaped bacteria of antigen structure 0-111. What diagnosis can be made?
16. A boy referred to a genetics clinic was found to have 1 drumstick in blood neutrophils. The boy is likely to have the following syndrome:
17. A drycleaner’s worker has been found to have hepatic steatosis. This pathology can be caused by the disruption of synthesis of the following substance:
18. Ascarid eggs have been detected during stool analysis. What drug should be prescribed?
19. Bacteriological examination of the urine of the patient with pyelonephritis revealed microorganisms that produced yellow-green pigment and a characteristic odor in meat-peptone agar. What are they called?
20. Feces of a patient contain high amount of undissociated fats and have grayish-white color. Specify the cause of this phenomenon:
21. A 46-year-old female patient consulted a doctor about pain in the small joints of the upper and lower limbs. The joints are enlarged and shaped like thickened nodes. Serum test revealed an increase in urate concentration. This might be caused by a disorder in metabolism of:
22. A 26-year-old female consulted a doctor about having stool with white flat moving organisms resembling noodles. Laboratory analysis revealed proglottids with the following characteristics: long, narrow, with a longitudinal channel of the uterus with 17-35 lateral branches on each side. What kind of intestinal parasite was found?
23. 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?
24. A biochemical urine analysis has been performed for a patient with progressive muscular dystrophy. In the given case muscle disease can be confirmed by the high content of the following substance in urine:
25. While examining foot blood supply a doctor checks the pulsation of a large artery running in the separate fibrous channel in front of articulatio talocruralis between the tendons of long extensor muscles of hallux and toes. What artery is it?
26. A patient with chronic heart failure with edema has increased level of blood aldosterone. What diuretic would be most effective in this case?
27. During autopsy the following has been revealed: the meninges of the upper cerebral hemispheres are extremely plethoric, of yellow-green color and are soaked with purulent effluent. What kind of meningitis is characterised by such clinical presentations?
28. A 41-year-old male patient has a history of recurrent attacks of heartbeats (paroxysms), profuse sweating, headaches. Examination revealed hypertension, hyperglycemia, increased basal metabolic rate, and tachycardia. These clinical presentations are typical for the following adrenal pathology:
29. A comminuted fracture of infraglenoid tubercle caused by shoulder joint injury has been detected during X-ray examination of a patient. What muscle tendon attached at this site has been damaged?
30. A patient has increased thickness of alveolar-capillary membrane caused by a pathologic process. The direct consequence will be reduction of the following value:
31. What drug will be most appropriate for the patient who has chronic gastritis with increased secretion?
32. As a result of careless handling of an iron, a 34-year-old female patient has got acute pain, redness, swelling of her right index finger. A few minutes later, there appeared a blister filled with a transparent liquid of straw-yellow color. The described changes are a manifestation of the following pathological process:
33. A 42-year-old male with a lesion of the ulnar nerve is unable to flex the II and V fingers to the midline. Which muscle function is impaired in this case?
34. A smear from the tonsillar coating of a patient with suspected diphtheria was found to contain blue bacilli with a thickening at the poles. What method of smear staining was used?
35. A child was born asphyxiated. What drug must be administered to the newborn to stimulate breathing?
36. 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?
37. Human red blood cells do not contain mitochondria. What is the main pathway for ATP production in these cells?
38. A 40-year-old female patient has undergone thyroidectomy. Histological study of thyroid gland found the follicles to be of different size and contain foamy colloid, follicle epithelium is high and forms papillae, there is focal lymphocytic infiltration in stroma. Diagnose the thyroid gland disease:
39. A 43-year-old-patient has arterial hypertension caused by an increase in cardiac output and general peripheral resistance. Specify the variant of hemodynamic development of arterial hypertension in the given case:
40. A patient has been hospitalised with provisional diagnosis of virus B hepatitis. Serological reaction based on complementation of antigen with antibody chemically bound to peroxidase or alkaline phosphatase has been used for disease diagnostics. What is the name of the applied serological reaction?
41. A patient has been hospitalised with provisional diagnosis of botulism. What serological reaction should be used to reveal botulinum toxin?
42. Examination of a 52-year-old female patient has revealed a decrease in the amount of red blood cells and an increase in free hemoglobin in the blood plasma (hemoglobinemia). Color index is 0,85. What type of anemia is being observed in the patient?
43. The processes of heat transfer in a naked person at room temperature have been studied. It was revealed that under these conditions the greatest amount of heat is transferred by:
44. Urine analysis has shown high levels of protein and erythrocytes in urine. This can be caused by the following:
45. The development of both immune and allergic reactions is based upon the same mechanisms of the immune system response to an antigen. What is the main difference between the immune and allergic reactions?
46. After a craniocerebral injury a patient is unable to recognize objects by touch. What part of brain has been damaged?
47. A patient complaining of rapid pulse, dyspnea and bluish color of mucosa has been admitted to the cardiological department. The objective symptoms are as follows: edema of lower extremities, ascites. Which of the given medicines should be prescribed for intravenous administration to improve the patient’s general state?
48. As a result of a continuous chronic encephalopathy, a patient has developed spontaneous motions and a disorder of torso muscle tone. These are the symptoms of the disorder of the following conduction tract:
49. A 10-year-old child has painful swallowing, neck edema, temperature rise up to 39, 0oC, the whole body is covered with bright-red petechial rash. Back of the throat and tonsils are hyperemic, the tongue is crimson-colored. Tonsillar surface is covered with isolated grayish-colored necrosis nidi. What disease is it?
50. As a result of a craniocerebral injury, a patient has a decreased skin sensitivity. What area of the cerebral cortex is likely to be damaged?
51.
In a patient elevation of body temperature takes turns with drops down to normal levels during the day. The rise in temperature is observed periodically once in four days. Specify the type of temperature curve:
52. Diabetic nephropathy with uremia has developed in a patient with pancreatic diabetes. The velocity of glomerular filtration is 9 ml/min. What mechanism of a decrease in glomerular filtration velocity and chronic renal failure development is most likely in the case of this patient?
53. A 40-year-old patient has ulcer perforation in the posterior wall of stomach. What anatomical structure will blood and stomach content leak to?
54. A patient is diagnosed with hereditary coagulopathy that is characterised by factor VIII deficiency. Specify the phase of blood clotting during which coagulation will be disrupted in the given case:
55. Angiocardiography of a 60-year-old male patient revealed constriction of a vessel located in the left coronary sulcus of the heart. What is the pathological vessel called?
56. Those organisms which in the process of evolution failed to develop protection from H2O2 can exist only in anaerobic conditions. Which of the following enzymes can break hydrogen peroxide down?
57. 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:
Explanation
Anterolateral abdominal wall has 9 regions and 4 quadrants (RUQ, LUQ, RLQ, LLQ)
· Right lateral abdominal region: Ascending colon (colon ascendens), right kidney, right ureter and loops of small intestine.
· Umbilical region: Transverse colon (colon transversum), head of pancreas, duodenum (except superior part)
· Left lateral abdominal region: Descending colon (colon descendens), left kidney, left ureter and loops of small intestine.
· Left inguinal region: Sigmoid colon (colon sidmoideum), left ureter, left external iliac artery of artery and vein.
· Right Inguinal region: Caecum, vermiform appendix, right ureter
58. A patient complaining of pain in the left shoulder-blade region has been diagnosed with miocardial infarction. What kind of pain does the patient have?
59. A patient has a critical impairment of protein, fat and hydrocarbon digestion. Most likely it has been caused by low secretion of the following digestive juice:
60. A female patient has facial neuritis that has caused mimetic paralysis and hearing impairment. Hearing impairment results from the paralysis of the following muscle:
61. A 22-year-old female student consulted a physician about fever up to 38oC, weakness, sore throat. Objectively: there is white coating of the tongue. What histological structures of the tongue are involved in the formation of this coating?
62. A patient has a traumatic injury of sternocleidomastoid muscle. This has resulted in a decrease in the following value:
63. The receptors under study provide transfer of information to the cortex without thalamic involvement. Specify these receptors:
64. Prolonged fasting causes hypoglycemia which is amplified by alcohol consumption, as the following process is inhibited:
65. A 39-year-old female patient with a history of diabetes was hospitalized in a precomatose state for diabetic ketoacidosis. This condition had been caused by an increase in the following metabolite level:
66. A 37-year-old female patient complains of headache, vertigo, troubled sleep, numbness of limbs. For the last 6 years she has been working at the gas-discharge lamp-producing factory in the lead-processing shop. Blood test findings: low hemoglobin and RBC level, serum iron concentration exceeds the norm by several times. Specify the type of anemia:
67. During an animal experiment, surgical damage of certain brain structures has caused deep prolonged sleep. What structure is most likely to cause such condition, if damaged?
68. A patient takes cholagogues. What other process besides biliary excretion will be stimulated?
69. A 3-year-old child with meningeal symptoms died. Postmortem macroscopy of the pia matter revealed miliary nodules which were microscopically represented by a focus of caseous necrosis with masses of epithelioid and lymphoid cells with some crescent-shaped large cells in between having peripheral nuclei. Specify the type of meningitis in the child:
Explanation
When tubercle bacilli are introduced into the tissue, they are ingested by the alveolar macrophage. Macrophages undergo changes resembling epithelial cells – EPITHELOID cells. Some of the macrophages form MULTINUCLEATED GIANT cells by fusion of adjacent cells (langerhan’s or foreign body type). The giant cells may have 20 or more nuclei. These nuclei may be arranged at the periphery like HORSE-SHOE, RING or clustered at the poles or they may be present centrally (foreign body giant cells). Lymphocytes, plasma cells and fibroblasts surround the epitheloid cells and giant cells (hard tubercle- no central necrosis). Within 10-14 days, the centre of the cellular mass begins to undergo caseation necrosis – soft tubercle. This is the hallmark of tuberculous lesions.
During the hematogenous spreading, the most serious immediate complication is MILIARY tuberculosis. The name miliary derives from its resemblance to millet seeds. Lesions of miliary tuberculosis consist of small granulomas, with a central necrotic portion. Organs often affected are lung, spleen, liver, kidney, meninges and bone marrow.
70. A patient with homogentisuria has signs of arthritis, ochronosis. In this case, the pain in the joints is associated with the deposition of:
71. A patient with hereditary hyperammonemia due to a disorder of ornithine cycle has developed secondary orotaciduria. The increased synthesis of orotic acid is caused by an increase in the following metabolite of ornithine cycle:
72. Amniocentesis revealed two sex chromatin bodies (Barr bodies) in each cell of the sample. What disease is this character typical for?
73. A 49-year-old male patient with acute pancreatitis was likely to develop pancreatic necrosis, while active pancreatic proteases were absorbed into the blood stream and tissue proteins broke up. What protective factors of the body can inhibit these processes?
74. A 16-year-old female patient has fainted after quickly changing her body position from horizontal to vertical one. Which process from the ones listed below has caused the loss of consciousness in the first place?
75. A 53-year-old male patient complains of acute pain in the right hypochondrium. Objective examination revealed scleral icterus. Laboratory tests revealed increased ALT activity, and stercobilin was not detected in the stool. What disease is characterized by these symptoms?
76. A child patient has dry cough. What non-narcotic antitussive drug will relieve the patient’s condition?
77. A patient complains of acute pain attacks in the right lumbar region. During examination the nephrolithic obturation of the right ureter in the region between its abdominal and pelvic segments has been detected. What anatomical boundary exists between those two segments?
78. When measuring total muscle action potential it was revealed that it was subject to the power-law relationship. The reason for this is that individual muscle fibers differ in:
79. A patient has insufficient blood supply to the kidneys, which has caused the development of pressor effect due to the constriction of arterial resistance vessels. This is the result of the vessels being greately affected by the following substance:
80. A patient is diagnosed with iron-deficiency sideroachrestic anemia, progression of which is characterised by skin hyperpigmentation, pigmentary cirrhosis, heart and pancreas affection. Iron level in the blood serum is increased. What disorder of iron metabolism causes this disease?
81. In a village, a case of anthrax had been registered. Medical services began epidemiologically indicated specific prophylaxis of population against anthrax. What preparation was used for this purpose?
82. Experimental stimulation of the sympathetic nerve branches that innervate the heart caused an increase in force of heart contractions because the membrane of typical cardiomyocytes permitted an increase in:
83. According to the results of glucose tolerance test, the patient has no disorder of carbohydrate tolerance. Despite that, glucose is detected in the patients’s urine (5 mmol/l). The patient has been diagnosed with renal diabetes. What renal changes cause glucosuria in this case?
84. As a result of past encephalitis, a male patient has developed an increase in cerebrospinal fluid pressure in the right lateral ventricle. What can be the cause of this condition?
85. A 3-year-old child has continuous fever, lymph nodes are enlarged, the amount of lymphocytes in blood is significantly increased. Enzyme-linked immunosorbent assay (ELISA) revealed antigen of Epstein-Barr virus. What diagnosis can be made based on the information given above?
86.
Parents of 5-year-old child report him of having frequent colds that develop into pneumonias, presence of purulent rashes on the skin. Laboratory tests have revealed the following: absence of immunoglobulins of any type, and naked cells are absent from the lymph nodes punctate. What kind of immune disorder is it?
87. A microslide contains the preparation of a gland composed of several secretory saccule-shaped parts that open in the common excretory duct. What gland is it?
88. A patient intending to undergo a gender reassignment surgery has been admitted to a specialised clinic. In the course of examination both male and female gonades have been revealed, with male structure of external genitals. What kind of genital maldevelopment has the patient?
89. 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?
90. In case of alkaptonuria, homogentisic acid is excreted in urine in large amounts. The development of this disease is associated with a disorder of metabolism of the following amino acid:
91. A male patient complains of skin insensitivity of inferior eyelid, external lateral surface of nose and upper lip. A doctor in the course of examination has revealed inflammation of the second branch of trigeminal nerve. What cranial foramen does this branch go through?
92. A patient with insomnia induced by allergic rash and itch has been prescribed the drug that has antihistamine and hypnotic effect. Specify this drug:
93. In a cat with decerebrate rigidity the muscle tone is to be decreased. This can be achieved by:
94. When studying the signs of pulmonary ventilation, reduction of forced expiratory volume has been detected. What is the likely cause of this phenomenon?
95. X-ray examination of a patient allowed to diagnose a tumor in the superior lobe of the right lung. There is a probability of metastases spread to the following lymph nodes:
96. A 55-year-old patient with a characteristic rash, fever, dizziness has been admitted to a hospital. He has been provisionally diagnosed with typhus. No similar cases have been reported. In his youth (15 years old) the patient suffered typhus in a boarding school. What disease is it?
97. A young woman suddenly developed fever up to 39oC accompanied by a strong headache. Examination revealed marked nuchal rigidity. Spinal puncture was performed. Gram-stained smear of cerebrospinal fluid contained many neutrophils and Gram-positive diplococci. What bacteria could be the cause of this disease?
98. In the course of an experiment adenohypophysis of an animal has been removed. The resulting atrophy of thyroid gland and adrenal cortex has been caused by deficiency of the following hormone:
99. Degenerative changes in posterior and lateral columns of spinal cord (funicular myelosis) caused by methylmalonic acid accumulation occur in patients with B12-deficiency anemia. This results in synthesis disruption of the following substance:
100. During local anesthetization the patient has gone into anaphylactic shock. What drug must be administered to the patient?
101. As a result of an injury, the integrity of the anterior spinal cord root was broken. Specify the neurons and their processes that had been damaged:
102. A patient who had been taking diclofenac sodium for arthritis of mandibular joint developed an acute condition of gastric ulcer. Such side effect of this medicine is caused by inhibition of the following enzyme:
103. In one of Polessye regions there was an outbreak of helminthiasis manifested by cramps and facial edemata. The developed preventive measures in particular included ban for eating infested pork even after heat processing. What helminthiasis was the case?
104. A female patient saught medical-genetic consultation. Physical examination revealed pterygium colli deformity (webbed neck), broad chest, underdeveloped breasts. Study of buccal epithelium cells revealed no X-chromatin in the nuclei. This indicates that the patient has the following syndrome:
105. During blood transfusion a patient has developed intravascular erythrocyte hemolysis. What kind of hypersensitivity does the patient have?
Explanation
* Type I: Allergic and atopic disorders (e.g. rhinitis, hay fever, asthma); Anaphylaxis. Presentation – immediate, anaphylactic, atopic
* Type II: Acute hemolytic transfusion reactions, autoimmune hemolytic anemia, Erythroblastosis fetalis, Goodpasture syndrome, Graves disease, Myasthenia gravis. Disease tends to be specific to tissue or site where antigen is found.
* Type III: Arthus reaction; SLE; serum sickness. Can be associated with vasculitis and systemic manifestations.
* Type IV: Contact dermatitis, Graft-versus-host disease, multiple sclerosis. Response is delayed and does not involve antibodies (vs. Type I, II, III)
106. Patients with erythropoietic porphyria (Gunther’s disease) have teeth that fluoresce with bright red color when subjected to ultraviolet radiation; their skin is light-sensitive, urine is red-colored. What enzyme can cause this disease, when it is deficient?
107. During the air and bone conduction tests it was revealed that in the left ear the tones were louder by bone conduction. This might be associated with the disease of:
108. In course of invasive abdominal surgery a surgeon has to locate the origin of the mesenteric root. Where is it normally localized?
109. A 55-year-old male had been delivered to the resuscitation unit unconscious. Relatives reported him to have mistakenly drunk an alcoholic solution of unknown origin. On examination the patient was diagnosed with methanol intoxication. What antidote should be used in this case?
110. Due to the use of poor-quality measles vaccine for preventive vaccination, a 1-year-old child has developed an autoimmune renal injury. The urine was found to contain macromolecular proteins. What process of urine formation has been disturbed?
111. As a result of a road accident a 37-year-old female victim developed urinary incontinence. What segments of the spinal cord had been damaged?
112. An 8-week-pregnant woman with acute respiratory disease and temperature rise up to 39, 0oC has called in a doctor. The doctor insisted on her avoiding taking paracetamol, because in this period of pregnancy there is a risk of its:
113. A pneumonia patient has been administered acetylcysteine as a part of complex therapy. What principle of therapy has been taken into consideration when applying this drug?
114. A 26-year-old female patient with bronchitis has been administered a broad spectrum antibiotic as a causal treatment drug. Specify this drug:
115. When defining blood group according to the AB0 system, using salt solutions of monoclonal antibodies, agglutination didn’t occur with any of the solutions. What blood group is it?
116. Examination of a 56-year-old female patient with a history of type 1 diabetes revealed a disorder of protein metabolism that is manifested by aminoacidemia in the laboratory blood test values, and clinically by the delayed wound healing and decreased synthesis of antibodies. Which of the following mechanisms causes the development of aminoacidemia?
117. Symptoms of pellagra (vitamin PP deficiency) is particularly pronounced in patients with low protein diet, because nicotinamide precursor in humans is one of the essential amino acids, namely:
118. A 68-year-old patient consults a cardiologist, complaining of high arterial blood pressure, pain in the heart region, intermittent pulse. Prescribe the β1-adrenoreceptor blocker for the treatment of the described pathology:
119. A female suffered rubella during pregnancy. The child was born with developmental abnormalities, namely cleft lip and palate. The child’s genotype is normal. These malformations are a manifestation of:
120. An electron micrograph shows a cell-to-cell adhesion consisting, in each cell, of an attachment plaque. The intercellular space is filled with electron-dense substance including transmembrane fibrillar structures. Specify this adhesion:
121.
For biochemical diagnostics of myocardial infarction it is necessary to measure activity of a number of enzymes and their isoenzymes. What enzymatic test is considered to be the best to prove or disprove the diagnosis of infarction in the early period after the chest pain is detected?
122.
A patient complains of pain in the heart area during acute attack of gastric ulcer. What vegetative reflex can cause this painful feeling?
123.
A patient is diagnosed with acute morphine hydrochloride intoxication. Prescribe an oxidizing agent for gastric lavage:
124.
In the course of puncture biopsy of transplanted kidney the following has been revealed: diffuse infiltration of stroma by lymphocytes and plasmocytes and necrotic arteritis. What pathological process has developed in the transplant?
125.
During cell division, DNA replication occurs by a signal from the cytoplasm, and a certain portion of the DNA helix unwinds and splits into two individual strains. What enzyme facilitates this process?
126.
A female patient, having visited the factory premises with lots of dust in the air for the first time, has got cough and burning pain in the throat. What respiratory receptors, when irritated, cause this kind of reaction?
127.
Since a patient has had myocardial infarction, his 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:
128.
A 35-year-old female patient has been hospitalised with acute intoxication caused by salts of high-density metals (lead, most probably). As a part of complex therapy the antidote that contains two active sulfhydric groups has been prescribed. Specify this anti-dote:
129.
A 60-year-old male patient has type II diabetes. A doctor has prescribed him synthetic hypoglycemic long-acting drug that is sulfonylurea derivative. What drug is it?
130.
A patient has been given atropine sulfate for rapid relief of spastic colon symptoms. The use of this drug is contraindicated during the following disease:
131.
As an example of specific human parasites one can name Plasmodium falciparum, human pinworm and some others. The source of parasite invasion is always a human. Such specific human parasites cause the diseases that are called:
132.
In an experiment a dog had been conditioned to salivate at the sight of food and a flash of light. After conditioning the reflex, the light was then paired with the bell. The dog didn’t start to salivate. What type of inhibition was observed?
133. A newborn baby has numerous hemorrhages. Blood coagulation tests reveal increased prothrombin time. The child is most likely to have a disorder of the following biochemical process:
134.
A 63-year-old male patient with bladder atony had been prescribed a medication, which he had been arbitrarily taking at a higher dose. The patient developed hyperhydration, salivation, diarrhea, muscle spasms. The prescribed drug relates to the following group:
Explanation
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.
135.
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?
136.
Tissue sampling of a 37-year-old male patient with chronic renal disease has revealed the following: sclerosis, lymphocytic and plasmocytic infiltration of renal pelvis and calices walls, dystrophy and atrophy of tubules. Remaining tubules are enlarged and stretched with colloid masses, epithelium is flattened out (\"scutiform\" or \"shield-shaped\" kidney). What is the most likely diagnosis?
137.
During the histological study of cortical shaft, basophilic cells with developed synthesis organelles can be seen on the bone surface under the layer of fibers. These cells take part in bone tissue regeneration. What shaft layer are they located in?
138.
Autopsy of a 50-year-old male who had tuberculosis revealed a dense gray-white nidus in form of a nodule 2 cm in diameter in the subpleural portion of the upper right lobe. The pleura in this region was thickened, in the pleural cavity there was a small amount of serous hemorrhagic fluid. Histological study of the region revealed some glandular structures with signs of cellular atypia and abnormal mitoses, which were found within the fibrous connective tissue. What other pathology had developed in the lungs?
139.
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:
140. Hepatitis B is diagnosed through laboratory tests that determine the presence of HBA-DNA in blood serum of the patient. What reference method is applied for this purpose?
141.
On the 24th day since the onset of disease, a male patient diagnosed with typhoid fever and undergoing treatment in an infectious diseases hospital has suddenly developed clinical presentations of acute abdomen leading to the death of the patient. During autopsy peritonitis has been revealed, with numerous ulcers covering the colon mucosa and reaching as deep as muscular and, in places, serous tunic. The ulcers have smooth edges and even floor. The intestinal wall is perforated. What stage of typhoid fever has the lethal complication arisen at?
142.
An HIV-positive patient’s cause of death is acute pulmonary insufficiency resulting from pneumonia. Pathohistological investigation of lungs has revealed interstitial pneumonia, alveolocyte desquamation and their metamorphoses: alveolocyte enlargement, large intranuclear inclusions surrounded by lightly-colored areas. Transformed cells resemble owl’s eye. Name the pneumonia causative agent:
143. The organisms to be identified have a nucleus surrounded by a nuclear membrane. Genetic material is concentrated predominantly in the chromosomes which consist of DNA strands and protein molecules. These cells divide mitotically. Identify these organisms:
144. A 37-year-old male patient developed pseudoarthrosis after a closed fracture of the femur. Specify the type of regeneration in the patient:
145.
Nucleolar organizers of the 13-15, 21, 22 human chromosomes contain about 200 cluster genes that synthesize RNA. These regions of chromosomes bear the information on the following type of RNA:
146.
The resuscitation unit has admitted a patient in grave condition. It is known that he had mistakenly taken sodium fluoride which blocks cytochrome oxidase. What type of hypoxia developed in the patient?
147. Steatosis is caused by the accumulation of triacylglycerols in hepatocytes. One of the mechanisms of this disease development is a decrease in the utilization of VLDL neutral fat. What lipotropics prevent the development of steatosis?
Explanation
Hepatic steatosis can occur when humans are deprived of choline.
Choline + Phosphatidic acid → Phosphatidylcholine (lecithin, PC). In the liver PC can also be synthesized from phosphatidylserine (PS) and phosphatidylethanolamine (PE), when free choline levels are low, because it exports significant amounts of PC in bile and as a component of serum lipoproteins (needed for fat metabolism)
PS → PE →→→ PC. 3 methylation reactions between PE and PC. S-adenosylmethionine is the methyl group donor. If choline, phosphatidylcholine or methionine is deficient, there will be abnormal phospholipid synthesis, oxidative damage caused by mitochondrial dysfunction, lipoprotein secretion (remember, if VLDL cannot be secreted it will be accumulated & cause fatty liver degeneration as seen in hepatic steatosis). PC is also a major lipid component of lung surfactant.
Vitamin B12 is a cofactor for homocysteine methyltransferase and methylmalonyl-CoA mutase. Both vitamin B12 and B6 are needed in fatty acid (FA) metabolism.
148. A 2-year-old boy is diagnosed with Down syndrome. What chromosomal changes may be the cause of this disease?
149.
A patient who has recently arrived 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 prove or to disprove the diagnosis of malaria?
150.
A patient has severe blood loss caused by an injury. What kind of dehydration will be observed in this particular case?
151.
A 30-year-old patient has dyspnea fits, mostly at night. He has been diagnosed with bronchial asthma. What type of allergic reaction according to the Gell-Coombs classification is most likely in this case?
Explanation
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.
152. Decarboxylation of glutamate
induces production of gamma-aminobutyric acid (GABA ) neurotransmitter. After breakdown, GABA is converted into a metabolite of the citric acid cycle, that is:
153.
An outbreak of an intestinal infection occurred in a kindergarten on the eve of New Year holidays. Bacteriological examination of patients’ faeces didn’t reveal any pathogenic bacteria. Electron microscopy revealed roundish structures with clear outer edges and a thick core resembling a wheel. Specify the most likely causative agent of this infection:
154. A smear of streptobacillus preparation stained by Ozheshko method has been studied microscopically with oil immersion. What structural feature of the bacteria has been studied?
155.
After a road accident a victim has tachycardia, arterial blood pressure 130/90 mm Hg, tachypnoe, the skin is pale and dry, excitation of central nervous system is observed. What shock stage is the patient most likely in?
156. Autopsy has revealed shrunken
kidneys weighing 50 mg, with fine-grained surface and uniformly thinned substance. Microscopic investigation has shown the thickening of arteriole walls due to accumulation of homogeneous anhistic pink-coloured masses in them. Glomerules were undersized, sclerotic, with atrophied tubules. What disease are these changes characteristic of?
157.
A fixed-run taxi passenger has a sudden and expressed attack of tachycardia. A doctor travelling by the same taxi has managed to slow down his heart rate by pressing upon the eyeballs and thus causing the following reflex:
158.
Histological examination of biopsy samples taken from the thickened edges of a gastric ulcer revealed small clusters of small, markedly atypical hyperchromatic epithelial cells that were localized in the overdeveloped stroma. Specify the tumor:
159. A 10-year-old child was found to have a congenital hypoplasia of the left kidney. Ultrasound examination revealed that the right kidney was markedly enlarged and had regular shape. No functional disorders were revealed. Specify the process that developed in the right kidney:
160.
In allergic diseases, a dramatic increase in basophilic leukocyte number in patients’ blood is observed. This phenomenon is due to the following basophil function:
161.
A 47-year-old male patient developed intestinal colic against the background of essential hypertension. In this situation it would be most efficient to arrest the colic by using drugs of the following group:
162.
A patient has been admitted to the contagious isolation ward with signs of jaundice caused by hepatitis virus. Which of the symptoms given below is strictly specific for hepatocellular jaundice?
163. An underage patient has signs of achondroplasia (dwarfism). It is known that this is a monogenic disease and the gene that is responsible for the development of such abnormalities is a dominant one. The development of that child’s brother is normal. Specify the genotype of the healthy child:
164. A patient has acute bronchitis.
The fever up to 38
, 5
oC had lasted for a week, presently there is a decrease in temperature down to 37
, 0
oC. Specify the leading mechanism in the 3rd stage of fever:
165. A 35-year-old female patient has undergone biopsy of the breast nodules. Histological examination has revealed enhanced proliferation of the small duct and acini epithelial cells, 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?
166. At a bacteriological laboratory animal skins are analyzed by means of Ascoli precipitation test. What is detected if the reaction is positive?
167.
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?
168. A 36-year-old female patient
has a history of
B2-hypovitaminosis. The most likely cause of specific symptoms (epithelial, mucosal, cutaneous, corneal lesions) is the deficiency of:
169. 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?
170.
A blood drop has been put into a test tube with 0,3% solution of NaCl. What will happen to erythrocytes?
171.
There are cortical and medullary substances separated by connective tissue layer in the endocrine gland specimen. Parenchyma cells make up three zones in cortical substance, with rounded masses in the superficial zone, parallel chords in the middle one, reticular structure of cell chords in the deep one. What gland is it?
172. Histological specimen of a 10-day human embryo represents 2 contacting sacs (amniotic and yolk sacs). Specify the structure that separates the amniotic cavity from the yolk sac:
173.
An electron micrograph shows a cell of neural origin. The terminal portion of the cell dendrite has cylindrical shape and consists of 1000 closed membrane disks. What cell is represented by the micrograph?
174.
Disruption of nerve fiber myelinogenesis causes neurological disorders and mental retardation. These symptoms are typical for hereditary and acquired alterations in the metabolism of:
175.
A patient underwent surgical removal of a cavitary liver lesion 2 cm in diameter. It was revealed that the cavity wall was formed by dense fibrous connective tissue; the cavity contained muddy, thick, yellowish-greenish fluid with an unpleasant odor. Microscopically, the fluid consisted mainly of polymorphonuclear leukocytes. What pathological process are these morphological changes typical for?
176.
A patient complains of photoreception disorder and frequent acute viral diseases. He has been prescribed a vitamin that affects photoreception processes by producing rhodopsin, the photosensitive pigment. What vitamin is it?
177.
A 7-year-old boy got ill with diphtheria. On the third day he died of asphyxiation. At autopsy the mucosa of the larynx, trachea and bronchi had thickened, edematous, lustreless appearance and was covered with gray films which could be easily removed. Specify the type of laryngeal inflammation:
178. A child has a history of hepatomegaly, hypoglycemia, seizures, especially on an empty stomach and in stressful situations. The child is diagnosed with Gierke’s disease. This disease is caused by the genetic defect of the following enzyme:
179.
A public utility specialist went down into a sewer well without protection and after a while lost consciousness. Ambulance doctors diagnosed him with hydrogen sulfide intoxication. What type of hypoxia developed?
180.
A child with a normal karyotype is diagnosed with cleft lip and hard palate, defects of the cardiovascular system, microcephaly. The child’s mother suffered rubella during pregnancy. This pathology in the child may be an example of:
181.
A 28-year-old patient undergoing treatment in the pulmonological department has been diagnosed with pulmonary emphysema caused by splitting of alveolar septum by tissular tripsin. The disease is caused by the congenital deficiency of the following protein:
182.
A patient with signs of osteoporosis and urolithiasis has been admitted to the endocrinology department. Blood test has revealed hypercalcemia and hypophosphatemia. These changes are associated with abnormal synthesis of the following hormone:
183.
During a surgery for femoral hernia a surgeon operates within the boundaries of femoral trigone. What structure makes up its upper margin?
184.
A 19-year-old victim has been delivered to the casualty department with a cut wound of the trapezius muscle. Which of the cervical fasciae forms a sheath for this muscle?
185.
A patient with acne has been prescribed doxycycline hydrochloride. What recommendations should be given to the patient, while he is taking this drug?
186. A 30-year-old patient with a past history of virus B hepatitis complains of prolonged nosebleeds. What drug will be most efficient in remedying this condition?
187. A patient has arterial hypertension. What long-acting drug from the group of calcium channel blockers should be prescribed?
188. A patient has been diagnosed with ARVI. Blood serum contains immunoglobulin M. What is the stage of infection in this case?
189. In a dysentery patient undergoing
treatment in the contagious isolation ward, a significant increase in packed cell volume has been observed (60%). What other value will be affected by this change?
190. A patient complains of palpitation after stress. The pulse is 104 bpm, P-Q=0,12 seconds, there are no changes of QRS complex. What type of arrhythmia does the patient have?
191. A 30-year-old patient has undergone keratoplasty in the transplantation center, cornea has been taken from a donor, who died in a road accident. What kind of transplantation was performed?
192. A 29-year-old male with a knife wound of neck presents with bleeding. During the initial debridement of the wound the surgeon revealed the injury of a vessel found along the lateral edge of the sternocleidomastoid muscle. Specify this vessel:
193. A histologic specimen represents
an organ with walls comprised of mucous, submucous, fibrous-cartilaginous and adventitial membranes. Epithelium is multirowed and ciliated, muscular layer of mucous membrane is absent, submucous membrane contains serous-mucous glands, hyaline cartilage forms open circles. What organ has the described morphological features?
194. In cancer patients who have been continuously receiving methotrexate, the target cells of tumor with time become insensitive to this drug. In this case, gene amplification of the following enzyme is observed:
195. Pancreas is known as a mixed gland. Endocrine functions include production of insulin by beta cells. This hormone affects the metabolism of carbohydrates. What is its effect upon the activity of glycogen phosphorylase (GP) and glycogen synthase (GS)?
196.
A patient has the oxyhemoglobin dissociation curve shifted to the left. What blood changes induce this condition?
Explanation
When the curve shifts to the right, there is decrease affinity of hemoglobin for O2 (this facilitates unloading of O2 to tissues). An increase in all listed factors (including H+) causes a shift of the curve to the right. A decrease in the factors (including H+) causes a shift of the curve to the left. Fetal hemoglobin has higher affinity for O2 than adult hemoglobin, so its dissociation curve is shifted to the left.
Right shift (↑): acidosis(↑H+); CO2; exercise; 2,3-BPG; Altitude; Temperature. Hence left shift will be (↓): alkalosis(↓H+); hypocapnia(↓CO2); temperature decrease. 197.
Administration of doxycycline hydrochloride caused an imbalance of the symbiotic intestinal microflora. Specify the kind of imbalance caused by the antibiotic therapy:
198.
A patient with signs of emotional lability that result in troubled sleep has been prescribed nitrazepam. Specify the sleep-inducing mechanism of this drug:
199.
A patient has been found to have a marked dilatation of saphenous veins in the region of anterior abdominal wall around the navel. This is symptomatic of pressure increase in the following vessel:
200.
A patient with suspected tumor of lung had been admitted to the oncological department. Examination revealed localised pathology in the inferior lobe of the left lung. How many bronchopulmonary segments does this lobe have?
