1. A microslide demonstrates an organ with its wall consisting of three membranes. The inner membrane has tubular glands and undergoes cyclic changes. Name this organ:
2. During examination of a patient a doctor should use anatomical division of anterior abdominal wall into regions for more precise diagnostics. How many regions can abdomen be divided into?
3. A child has a wound located posterior to the mastoid process. Bright red blood flows from the wound. Damaged are the branches of the following artery:
4. When investigating human saliva it is necessary to assess its hydrolytic properties. What substance should be used as a substrate in the process?
5. A person with the fourth blood group (genotype IAIB) has in erythrocytes both antigen A controlled by allele IA and antigen B controlled by allele IB. This phenomenon is an example of the following gene interaction:
6. A patient with diabetes mellitus suffers from persistently nonhealing surgical wound, which is a sign of disrupted tissue trophism. What is the cause of such disorder?
7. A patient with signs of intestinal infection (vomiting, diarrhea, abdominal pain) has been presenting with increasing symptoms of intoxication for three days. Papular rash appeared on the uncovered skin areas and spread to the torso. A doctor suspected pseudotuberculosis. What laboratory test allows confirming this diagnosis within the first week from the onset of disease?
8. A patient with femoral neck fracture, who for a long time had to remain in bed in a forced (supine) position, has developed dark-brown lesions along the backbone; soft tissues are swollen, in the areas of maceration there is a foul-smelling liquid. Name the clinicopathologic type of necrosis:
9. A patient is 20 years old, an athlete. He addressed a doctor with complaints of fatigue, fever up to 38oC - 40oC. Objectively: the liver and spleen are enlarged, lymph nodes on palpation are slightly enlarged, dense, painless. Blood test: Нb- 100 g/l; erythrocytes - 2, 9 · 1012/l; leukocytes - 4, 4 · 109/l. Leukogram: 68% of blast cells. Cytochemical investigation of blast cells revealed negative reactions to glycogen, peroxidase, non-specific esterase, lipids. Name this disease:
10. Impression smear of mucosa biopsy material has been obtained from a patient with peptic ulcer disease of the stomach. Gram-negative arcuate bent microorganisms were detected, urease activity test was positive. What microorganisms were detected in the patient?
11. A patient after disrupted cerebral circulation has developed paralysis. Choose the anticholinesterase drug to be prescribed in this case:
12. 30 minutes after drinking mango juice a child suddenly developed a local swelling in the area of the soft palate, which impeded swallowing and, eventually, respiration. Mucosa of the swollen area was hyperemic and painless. Blood test revealed moderate eosinophilia. Body temperature was normal. Anamnesis states that the elder sister of the child has been suffering from bronchial asthma attacks. What kind of edema has developed in the child?
13. Coenzym A participates in numerous important metabolic reactions. It is a derivative of the following vitamin:
14. A patient diagnosed with acute dysentery has been treated for 3 days in an infectious diseases hospital. On admission there were complaints of high temperature, stomachache and fluid excrements with mucus up to 8-10 times a day. What sample should be taken for analysis?
15. A patient with arthritis has been prescribed an anti-inflammatory selective COX-2 inhibitor. Select this drug among those given below:
16. Parkinson’s disease is caused by disruption of dopamine synthesis. What brain structure synthesizes this neurotransmitter?
17. Name the halogen-containing antiseptic with fungicidal properties, which is used to treat dermatomycosis:
Antimicrobial agents are drugs for the treatment and prevention of infectious diseases. They are divided into disinfectants, antiseptics and chemotherapeutics. Disinfectants realize their antimicrobial properties in the environment outside the body. Antiseptics act on the surface of the body. Chemotherapeutics produce an antimicrobial effect inside the body.
Antiseptics could be inorganic or organic.
· Inorganic substances: halogens, oxidizing agents, metallic salts, acids and alkalis
· Organic substances: aldehydes, alcohols, phenol derivatives, dyes, detergents, nitrofuran derivatives
Halogens: iodine alcohol solution – effects of iodine are based on the interaction between atoms of halogen and proteins resulting in halogenization and oxidation of proteins. It has bactericidal, fungicidal and irritative actions. Indications – processing of small cuts of the skin, dermatomycoses, processing of the surgery skin area and surgeon’s hands.
Other halogens include solution of lugol, iodinol, ioddiccerinum, chlorinated lime, chloramine B, chlorhexidine etc.
18. Due to severe pain syndrome a patient was prescribed a narcotic analgesic. Name this drug:
19. During pathomorphological renal investigation of a patient, who for a long time had been suffering from osteomyelitis and died of progressing renal failure, the following was revealed: deposits of homogeneous eosinophilic masses in glomerular mesangium, arterial and arteriolar walls, and stroma, which colored red when stained with Congo red. What pathological process is this?
20. During experiment a dog has developed conditioned digestive reflex in response to a sound stimulus. This conditioned reflex will not be exhibited anymore after the extirpation of the following areas of the cerebral hemispheres:
21. An athlete (long-distance runner) during a contest developed a case of acute cardiac insufficiency. This pathology resulted from:
22. A man is suffering from diarrhea. In summer he spent his vacation in the south at the sea coast. Bacteria with the following properties were detected in his feces: gram-negative curved mobile monotrichous bacilli that do not produce spores or capsules. Bacilli are undemanding to nutrient medium but require alkaline reaction (рН 8,5- 9,5). Described are the agents of the following enteric infection:
23. When ascending to the top of Elbrus, a mountain climber experiences oxygen starvation, dyspnea, palpitations, and numbness of the extremities. What kind of hypoxia has developed in the mountain climber?
24. A 2-year-old boy is diagnosed with Down syndrome. What chromosomal changes can cause this disease?
25. A 62-year-old patient has been hospitalized due to massive cerebral hemorrhage. Blood pressure is 70/30 mm Hg, heart rate is 120/min., respiratory rate is 4/min., unconscious, no response to external stimuli. Such condition can be determined as:
26. A 3-year-old girl with mental retardation has been diagnosed with sphingomyelin lipidosis (Niemann-Pick disease). In this condition synthesis of the following substance is disrupted:
27. What condition may develop 15-30 minutes after re-administration of an antigen as a result of the increased level of antibodies, mainly IgE, that are adsorbed on the surface of target cells, namely tissue basophils (mast cells) and blood basophils?
Type I Hypersensitivity reaction (HSR); anaphylactic and atopic: free antigen cross-links IgE on presensitized (i.e. exposed to the antigen before) mast cells and basophils, triggering immediate release of vasoactive amines that act at postcapillary venules (i.e. histamine). Reaction develops rapidly after antigen exposure because of preformed antibody from first exposure. IgE is the main immunoglobulin involved in type I HSR. Type I: uses IgE and IgG4
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.
28. Local anesthetics (novocaine, lidocaine and others) decreases pain sensitivity of tissues by blocking Na+ and K+ ions from permeating membranes of nerve fibers and endings. Such mechanism of drug action is called:
29. 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?
30. A woman complaining of sharp pain in her lower abdomen has been delivered into an admission room. A gynecologist on examination makes a provisional diagnosis of extrauterine pregnancy. What anatomical structure should be punctated to confirm diagnosis?
31. A passenger of a fixed-run taxi 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:
32. A patient complains of palpitations after stress. Pulse is 104/min., P-Q=0,12 seconds, there are no changes in QRS complex. What type of arrhythmia does the patient have?
33. The key reaction of fatty acid synthesis is production of malonyl-CoA. What metabolite is the source of malonyl-CoA synthesis?
34. A family of healthy students, who have arrived from Africa, gave birth to a child with signs of anemia. The child has died shortly after. Examination has revealed that the child’s erythrocytes are abnormally crescent-shaped. The disease is characterized by autosomal recessive inheritance. Determine the genotype of the child’s parents:
35. A 35-year-old man has been delivered into a surgical ward with a suppurating wound in the neck, anterior to trachea (previsceral space). If a surgical operation is not performed urgently, there is a risk of infection spreading to:
36. Characteristic sign of glycogenosis is muscle pain during physical work. Blood examination usually reveals hypoglycemia. This pathology is caused by congenital deficiency of the following enzyme:
37. Histologic specimen of a kidney demonstrates cells closely adjoined to the renal corpuscle in the distal convoluted tubule. Their basement membrane is extremely thin and has no folds. These cells sense the changes in sodium content of urine and influence renin secretion occurring in juxtaglomerular cells. Name these cells:
38. Bacteriological analysis of tap water has resulted in the following: total bacterial count in 1,0 ml of water is 80, coli index is 3. What would be the conclusion?
39. The process of metabolism in the human body produces active forms of oxygen, including superoxide anion radical − 2 . This anion is inactivated by the following enzyme:
40. What kind of muscle contraction occurs in an upper limb during an attempt to lift a load beyond one’s strength?
41. A patient suffers from high fever, apnoea, pain in the thorax on the right. Pleurocentesis yielded 700 ml of yellow-green viscous liquid. Make the diagnosis:
42. A patient suffers from disrupted patency of the airways at the level of small and medium-sized bronchial tubes. What changes of acid-base balance can occur in the patient?
43. Upon toxic damage of hepatic cells resulting in disruption of liver function the patient developed edemas. What changes of blood plasma are the main cause of edema development?
44. A 6-year-old child with suspected active tuberculous process has undergone diagnostic Mantoux test. What immunobiological preparation was injected?
45. A 15-year-old boy has been diagnosed with acute viral hepatitis. What blood value should be determined to confirm acute affection of hepatic cells?
46. A 53-year-old man is diagnosed with Paget’s disease. Concentration of oxyproline in daily urine is sharply increased, which primarily means intensified disintegration of:
47. When taking exams students often have dry mouth. The mechanism that causes this state results from the following reflexes:
48. 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 multilayer, strongly keratinized pavement epithelium, no cellular atypia. What is the most likely diagnosis?
49. During autopsy approximately 2,0 liters of pus have been found in the abdominal cavity of the body. Peritoneum is dull and of grayish shade, serous tunic of intestines has grayish-colored coating that is easily removable. Specify the most likely type of peritonitis in the patient:
50. Autopsy of a body 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 of?
51. A bacteriological laboratory has been investigating a sample of homemade dried fish that was the cause of severe food poisoning. Microscopy of the culture inoculated in Kitt-Tarozzi medium revealed microorganisms resembling a tennis racket. What diagnosis can be made?
The causative agent of botulism is Clostridium botulinum.
Morphology. Cl. botulinum is a large pleomorphous rod with rounded ends, 4.4-8.6 mcm in length and 0.3-1.3 mcm in breadth. The organism sometimes occurs in short forms or long threads. Cl. botulinum is slightly motile and produces from 4 to 30 flagella per cell. In the external environment Cl. botulinum produces oval terminal or subterminal spores which give them the appearance of tennis rackets . The organisms are Gram-positive.
Pathogenesis and disease in man. Botulism is contracted by ingesting meat products, canned vegetables, sausages, ham, salted and smoked fish (red fish more frequently), canned fish, chicken and duck flesh, and other products contaminated with Cl. botulinum. The organisms enter the soil in the faeces of animals (horses, cattle, minks, and domes-tic and wild birds) and fish and survive there as spores.
The test specimens are inoculated into Kitt-Tarozzi medium which has previously been held at 100 C for 10-20 minutes.
52. An infant has been diagnosed with microcephaly. Doctors suspect that this brain disorder developed due to the fact that the mother had been taking actinomycin D during her pregnancy. What germinal layers have been affected by this teratogen?
53. A patient demonstrates sharp decrease of pulmonary surfactant activity. This condition can result in:
54. A patient is diagnosed with diabetic coma. Blood sugar is 18,44 mmol/l. What glucose-regulating drug should be prescribed in the given case?
55. Initial inoculation of water in 1% peptone water resulted in growth of a thin film on the medium surface in 6 hours. Such cultural properties are characteristic of causative agent of the following disease:
56. An infant born prematurely 2 days ago presents with yellow coloring of skin and mucosa. Such a condition in the infant is caused by temporary deficiency of the following enzyme:
57. It has been determined that one of a pesticide components is sodium arsenate that blocks lipoic acid. Enzyme activity can be impaired by this pesticide. Name this enzyme:
58. A patient with hypertension has developed headache, tinnitus, vomiting, high BP up to 220/160 mm Hg. On examination: facial asymmetry on the right, volitional mobility is absent, increased tendon reflexes and muscle tone of extremities on the right. What motor disorder of nervous system occurred in this case?
59. A 7-year-old child in the state of allergic shock caused by a bee sting has been delivered into an emergency ward. High concentration of histamine was observed in blood. Production of this amine was the result of the following reaction:
60. A 26-year-old woman 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?
61. A man is 28 years old. Histological investigation of the cervical lymph node revealed a change of its pattern due to proliferation of epithelioid, lymphoid cells and macrophages with horseshoe-shaped nuclei. In the center of some cell clusters there were non-structured light-pink areas with fragments of nuclei. What disease are these changes typical of?
62. Sex chromatin was detected during examination of a man’s buccal epithelium. It is characteristic of the following chromosome disease:
63. A patient, having suffered a thermal burn, developed painful boils filled with turbid liquid in the skin. What morphological type of inflammation has developed in the patient?
64. Autopsy of a man with tuberculosis revealed a 3x2 cm large cavity in the superior lobe of the right lung. The cavity was interconnected with a bronchus, its wall was dense and consisted of three layers: the internal layer was pyogenic, the middle layer was made of tuberculous granulation tissue and the external one was made of connective tissue. What is the most likely diagnosis?
65. A 7-year-old child has acute onset of disease: temperature rise up to 38oC, rhinitis, cough, lacrimation, and large-spot rash on the skin. Pharyngeal mucosa is edematous, hyperemic, with whitish spots in the buccal area. What kind of inflammation caused the changes in the buccal mucosa?
66. A 50-year-old woman diagnosed with cardiac infarction has been delivered into an intensive care ward. What enzyme will be the most active during the first two days?
67. Stool culture test of a 6-month-old bottlefed baby revealed a strain of intestinal rod-shaped bacteria of antigen structure 0-111. What diagnosis can be made?
68. Parents of a sick 5-year-old girl visited a genetic consultation. Karyotype investigation revealed 46 chromosomes. One chromosome of the 15th pair was abnormally long, having a part of the chromosome belonging to the 21st pair attached to it. What mutation occurred in this girl?
69. A patient consulted a doctor with complaints of dyspnea occurring after physical exertion. Physical examination revealed anemia, paraprotein was detected among gamma globulins. What value should be determined in the patient’s urine to confirm the diagnosis of myeloma?
70. A patient complaining of dizziness, thirst, difficult swallowing, and impaired vision of close objects has addressed a doctor. Objectively: respiratory rate is increased, pupils are dilated, general agitation, talkativeness, though the speech is indistinct. BP is 110/70 mm Hg, heart rate is 110/min. Given symptoms can indicate overdosage of the following drug:
71. A dry-cleaner’s worker has been found to have hepatic steatosis. This pathology can be caused by disruption of synthesis of the following substance:
72. A 35-year-old man with peptic ulcer disease has undergone antrectomy. After the surgery secretion of the following gastrointestinal hormone will be disrupted the most:
73. A 16-year-old adolescent is diagnosed with hereditary UDP (uridine diphosphate) glucuronyltransferase deficiency. Laboratory tests revealed hyperbilirubinemia caused mostly by increased blood content of the following substance:
74. A 60-year-old patient with a long history of atherosclerosis and a previous myocardial infarction developed an attack of retrosternal pain. 3 days later the patient was hospitalized and then died of progressive cardiovascular insufficiency. During autopsy a white fibrous depressed area about 3 cm in diameter with clear margins was found within the area of posterior wall of the left ventricle and interventricular septum. The dissector considered these changes to be:
75. After a traffic accident a 36-year-old patient has developed muscle paralysis of the extremities on the right, lost pain and thermal sensitivity on the left, and partially lost tactile sensitivity on both sides. What part of the brain is the most likely to be damaged?
76. A 4-year-old child has been admitted to an orthopaedic department with displaced shin fracture. Bone fragments reposition requires analgesia. What drug should be chosen?
77. 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?
78. Representatives of a certain human population can be characterized by elongated body, height variability, decreased volume of muscle mass, increased length of limbs, decreased size and volume of rib cage, increased perspiration, decreased indices of base metabolism and fat synthesis. What type of adaptive evolution is it?
79. A 59-year-old woman has been hospialized in a surgical ward due to exacerbation of chronic osteomyelitis of the left shin. Blood test: leukocytes - 15, 0 · 109/l. Leukogram: myelocytes - 0%, metamyelocytes - 8%, stab neutrophils - 28%, segmented neutrophils - 32%, lymphocytes - 29%, monocytes - 3%. Such blood count would be called:
80. A 41-year-old man 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 of the following adrenal pathology:
81. During autopsy of a man, who died of acute transmural cardiac infarction, the following has been detected on the pericardium surface: fibrous whitish-brown deposit connecting parietal and visceral pericardial layers. What kind of inflammation occurred in the pericardium?
82. A 12-year-old child developed nephritic syndrome (proteinuria, hematuria, cylindruria) 2 weeks after a case of tonsillitis, which is a sign of affected glomerular basement membrane in the kidneys. What mechanism is the most likely to cause the basement membrane damage?
83. A man arrived into a traumatological department with a trauma of the right shoulder. Examination revealed a displaced humeral shaft fracture on the right in the middle one-third of the humerus; the patient cannot extend the fingers of his right hand. What nerve is damaged?
84. Work in a mine is known to cause inhalation of large amounts of coal dust. Inhaled coal dust can be detected in the following pulmonary cells:
Alveolar macrophages remove inhaled particulate matter from the air spaces and red blood cells (RBCs) from the septum of alveoli. They are unusual in that they function both in the connective tissue of the septum (alveolar wall) and in the air space of the alveolus (surface of alveolar cells). In air spaces they scavenge the surface to remove inhaled particulate matter (e.g. dust, pollen, pathogens), thus giving them one of their alternate names – Dust cells. They also phagocytose infectious organisms such as Mycobacterium tuberculosis. Other macrophages remain in the septal connective tissue, where, filled with accumulated phagocytized material, they may remain for much of an individual’s life. Thus, at autopsy, the lungs of urban dwellers as well as smokers will usually show many alveolar and septal macrophages filled with carbon particles, anthracotic pigment and birefringent needle-like particles of silica.
Type I alveolar cells (type I pneumocytes): the junctions formed between this cells form an effective barrier between the air space and the components of the septal wall. They are not capable of cell division. They make up 95% of the surface of the alveoli.
Type II alveolar cells: secretory cells; have lamellar bodies; progenitor cells for type I alveolar cells.
Clara cells: non-ciliated; low columnar/cuboidal cell with secretory granules. They secrete components of surfactant, degrade toxins and act as reserve cells.
Endothelial cells line blood vessels.
85. What drug will be the most appropriate for a patient suffering from chronic gastritis with increased secretion?
86. A 63-year-old man, who has been suffering from chronic fibrous-cavernous pulmonary tuberculosis for 24 years, has been delivered to a nephrology department with uremia. Intravital diagnostic test for amyloid in the kidneys was positive. What amyloidosis is it in this case?
87. Cells of a healthy liver actively synthesize glycogen and proteins. What organelles are the most developed in them?
88. Immune-enzyme assay has detected HBs antigen in blood serum. What disease is it characteristic of?
89. A patient has been diagnosed with gonorrhea. As fluoroquinolones are the drugs of choce for treatment of gonorrhea the patient should be prescribed:
90. Autopsy of a Middle-Eastern woman, who had been suffering from wasting fever for a long time, revealed enlarged blackened liver and spleen. Bone marrow was hyperplastic and black-colored as well. Cerebral cortex was smoky grey. What disease is it characteristic of?
91. Human red blood cells contain no mitochondria. What is the main pathway for ATP production in these cells?
92. Atria of an experimental animal were superdistended with blood, which resulted in decreased reabsorption of Na+ and water in renal tubules. This can be explained by the influence of the following factor on kidneys:
93. A woman gave birth to a stillborn baby with numerous malformations. What protozoan disease could cause intrauterine death?
94. A 42-year-old patient complains of pain in the epigastral area, vomiting; vomit masses have the color of coffee-grounds; the patient suffers from melena. Anamnesis records gastric ulcer disease. Blood formula: erythrocytes - 2, 8 · 1012/l, leukocytes - 8 · 109/l, Hb- 90 g/l. What complication is it?
95. 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 was used for disease diagnostics. What is the name of the applied serological reaction?
96. A patient with insulin-dependent diabetes mellitus has been administered insulin. After a certain period of time the patient developed fatigue, irritability, excessive sweating. What is the main mechanism of such presentations developing?
97. Examination of a 52-year-old woman 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?
98. Poisoning caused by mercury (II) chloride (corrosive sublimate) occurred in the result of safety rules violation. In 2 days the patient’s diurnal diuresis was 620 ml. The patient developed headache, vomiting, convulsions, dyspnea; moist crackles were observed in the lungs. Name this pathology:
99. For people adapted to high external temperatures profuse sweating is not accompanied by loss of large volumes of sodium chloride. This is caused by the effect the following hormone has on perspiratory glands:
100. 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:
101. Due to destruction of certain structures of the brainstem an animal has lost its orientation reflexes in response to strong light stimuli. What structures were destroyed?
102. Urine analysis has shown high levels of protein and erythrocytes in urine. This can be caused by the following:
103. Along with normal hemoglobin types there can be pathological ones in the organism of an adult. Name one of them:
104. Development of both immune and allergic reactions is based upon the same mechanisms of immune system response to an antigen. What is the main difference between immune and allergic reactions?
105. Histologic preparation stained with orcein demonstrates from 40 to 60 fenestrated elastic membranes within the middle coat of vessel. Name this vessel:
106. Angiocardiography of a 60-year-old man revealed constriction of a vessel located in the left coronary sulcus of the heart. Name this pathological vessel:
107. A comatose patient was taken to the hospital. He has a history of diabetes mellitus. Objectively: Kussmaul breathing, low blood pressure, acetone odor of breath. After the emergency treatment the patient’s condition improved. What drug had been administered?
108. A patient complains of pain in the right lateral abdomen. Palpation revealed a dense, immobile, tumor-like formation. The tumor is likely to be found in the following part of the digestive tube:
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
109. A patient hospitalized due to mercury intoxication presents with the following processes in the kidneys: focal necrotic changes of tubules of major renal regions, edema, leukocyte infiltration and hemorrhages in the interstitial tissue, venous congestion. What condition developed in the patient?
110. According to phenotypic diagnosis a female patient has been provisionally diagnosed with X-chromosome polysomia. This diagnosis can be confirmed by cytogenetic method. What karyotype will confirm the diagnosis?
111. An uconscious young man in the state of morphine intoxication has been delivered into an admission room. The patient’s respiration is slow and shallow due to suppression of the respiratory center. What kind of respiratory failure occurred in this case?
112. On histological examination of uterine mucosa the following is detected: sinuous glands, serratiform and corkscrew-shaped elongated growths of stroma with cell proliferation. Make the diagnosis:
113. 10 minutes after the beginning of heavy physical work a person demonstrates increase of erythrocyte number in blood from 4, 0 · 1012/l to 4, 5 · 1012/l. What is the cause of this phenomenon?
114. A patient has a traumatic injury of sternocleidomastoid muscle. This has resulted in a decrease of the following value:
115. Autopsy of a 40-year-old woman, who died of cerebral hemorrhage during hypertensic crisis, revealed: upperbody obesity, hypertrichosis, hirsutism, stretchmarks on the skin of thighs and abdomen. Pituitary basophil adenoma is detected in the anterior lobe. What diagnosis is the most likely?
Cushing Syndrome: Etiology
*INCREASE Cortisol due to a variety of causes (Glucocorticoids).
*Exogenous corticosteroids: result in DECREASE ACTH (MCC).
*Primary adrenal adenoma, hyperplasia or carcinoma (Cushing’s Syndrome).
*ACTH-secreting pituitary adenoma (Cushing Disease).
Findings: Hypertension, Weight Gain, Moon Facies, Truncal Obesity, Buffalo Hump, Skin Changes (thinning striae), Osteoporosis, Hyperglycemia (Insulin resistance), Amenorrhea, Immunosuppression.
116. A specimen shows an organ covered with the connective tissue capsule with radiating trabeculae. There is also cortex containing lymph nodules, and medullary cords made of lymphoid cells. What organ is under study?
117. After a craniocerebral injury a patient has lost the ability to recognize shapes of objects by touch (stereognosis). What area of cerebral cortex normally contains the relevant center?
118. Monoamine oxidase inhibitors are widely used as psychopharmacological drugs. They change the level of nearly all neurotransmitters in synapses, with the following neurotransmitter being the exception:
119. A worker of an agricultural enterprise had been suffering from an acute disease with aggravating intoxication signs, which resulted in his death. On autopsy: the spleen is enlarged, flaccid, dark cherry-red in the section, yields excessive pulp scrape. Soft meninges of fornix and base of the brain are edematous and saturated with blood (”cardinal’s cap”). Microscopically: seroushemorrhagic inflammation of meninges and cerebral tissues. Make the diagnosis:
ExplanationThere are two medically important Bacillus species: Bacillus anthracis and Bacillus cereus. Bacillus anthracis causes anthrax. Human disease occurs in 3 main forms: cutaneous, pulmonary (inhalation) and gastrointestinal. Humans are most often infected cutaneously at the time of trauma to the skin, which allows the spores on animal products such as hides, bristles and wool to enter. Spores can also be inhaled or when contaminated meat is ingested. After being inhaled, the organism moves rapidly to the mediastinal lymph nodes and causes hemorrhagic mediastinitis. Pathogenesis is based on the production of two exotoxins (Anthrax toxin) – edema factor and lethal factor. Hemorrhagic mediastinitis, septic shock hemorrhagic meningitis and death are severe life-threatening complications. In fatal cases, the organism may affect the spleen, liver, intestines, kidneys, adrenal glands and meninges.
120. Autopsy of an 8-month-old boy, who died of severe pneumonia complicated with sepsis, revealed absence of thymus. Lymph nodes have no lymphoid follicles and cortical substance. In the spleen the follicles are decreased in size and have no light centers. What is the cause of such changes?
121. A patient has been delivered into a surgical ward with an incised wound of the anterior surface of the shoulder in its lower one-third. Flexing function was disrupted in the shoulder and elbow joints, which is caused by the damage to the:
122. A 40-year-old patient suffers from bronchial asthma and prolonged tachycardia. Choose the optimal drug for rapid relief of bronchial spasm in the given case:
123. A patient with urolithiasis has developed severe pain attacks. For pain shock prevention he was administered an antispasmodic narcotic analgesic along with atropine. Name this drug:
124. A patient suffers from acute cardiopulmonary failure with pulmonary edema. What diuretic should be prescribed in the given case?
125. A patient with acute myocardial infarction has been administered heparin as a part of complex therapy. Some time after heparin injection the patient developed hematuria. What heparin antagonist should be injected to remove the complication?
126. At a certain stage of cell cycle chromosomes reach cellular poles, undergo despiralization; nuclear membranes are being formed around them; nucleolus is restored. What stage of mitosis is it?
127. Cardiac arrest occurred in a patient during a surgery of the small intestine. What regulatory mechanisms resulted in the cardiac arrest in this case?
128. Vestibular receptors of semicircular canals of an animal have been destroyed. What reflexes will disappear as a result?
129. A patient working at a pig farm complains of paroxysmal abdominal pain, liquid feces with mucus and blood, headache, weakness, fever. Examination of large intestine revealed ulcers from 1 mm up to several cm in diameter, feces contained oval unicellular organisms with cilia. What disease can be suspected?
130. Blood group of a 30-year-old man has been determined before a surgery. The blood was Rhesus-positive. Agglutination did not occur with standard 0 (I), А (II), and В (III) serums. The blood belongs to the following group:
131. Histological specimen of a hemopoietic organ shows clusters of node- and bandshaped lymphocytes that along with stroma elements compose cortical and medullar substances. Name this organ:
132. It is known that in catecholamine metabolism a special role belongs to monoamine oxidase (MAO). This enzyme inactivates mediators (noradrenalin, adrenalin, dopamine) by:
133. Cellular composition of exudate largely depends on the etiological factor of inflammation. What leukocytes are the first to be involved in the focus of inflammation caused by pyogenic bacteria?
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.
134. A surgeon has detected inflammation of the Meckel’s diverticulum in a patient. During surgical invasion it can be located in the:
135. 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 was detected. What anatomical boundary exists between those two segments?
136. A patient died of cancerous cachexia with primary localization of cancer in the stomach. Autopsy revealed acutely enlarged liver with uneven surface and numerous protruding nodes; the nodes had clear margins in the section, rounded shape, gray-pink color, varying density, sometimes contained necrotic foci. Histologically: there are atypical cells in the nodes. What pathologic process occurred in the liver?
137. A patient has insufficient blood supply to the kidneys, which 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:
138. Experimental stimulation of sympathetic nerve branches that innervate heart caused an increase in force of heart contractions because membrane of typical cardiomyocytes permitted an increase in:
139. Parents of a 5-year-old child report him to have 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; naked cells are absent from the lymph nodes punctate. What kind of immune disorder is it?
140. A microslide contains the specimen of a gland composed of several secretory saccule-shaped parts that open in the common excretory duct. What gland is it?
141. Microelectrode technique allowed to register a potential following ”all-or-none” law and capable of undecremental spreading. Specify this potential:
142. Examination of a patient revealed hypertrophy and inflammation of lymphoid tissue, edema of mucous membrane between palatine arches (acute tonsillitis). What tonsil is normally situated in this area?
143. Histological specimen of an ovary demonstrates a spherical structure composed of large glandular cells containing lutein. What hormone is produced by the cells of this structure?
144. A patient, who has been subsisting exclusively on polished rice, has developed polyneuritis due to thiamine deficiency. What substance is an indicator of such avitaminosis, when it is excreted with urine?
145. When blood circulation in the damaged tissue is restored, lactate accumulation stops and glucose consumption decelerates. These metabolic changes are caused by activation of the following process:
146. A 67-year-old patient complains of periodic heartache, dyspnea during light physical activities. ECG reveals extraordinary contractions of heart ventricles. Such arrhythmia is called:
147. In investigation of serum proteins various physical and physicochemical methods can be used. In particular, serum albumins and globulins can be separated by the method of:
148. Pupil dilation occurs when a person steps from a light room into a dark one. What reflex causes such a reaction?
149. Cells of a person working in the Chornobyl Exclusion Zone have undergone a mutation in DNA molecule. However, with time the damaged interval of DNA molecule has been restored to its initial structure with a specific enzyme. In this case the following occurred:
150. When studying the signs of pulmonary ventilation, reduction of forced expiratory volume has been detected. What is the likely cause of this phenomenon?
151. A specimen of a parenchymal organ shows poorly delineated hexagonal lobules surrounding a central vein, and the interlobular connective tissue contains embedded triads (an artery, a vein and an excretory duct). What organ is it?
152. A patient had a trauma that caused dysfunction of motor centers regulating activity of head muscles. In what parts of cerebral cortex can these centers normally be located?
Primary motor area extends throughout the precentral gyrus and the adjoining lip of central sulcus. Areas 4 and 4S are present here. Muscles of various parts of the body are represented in area 4 in an inverted way from medial to lateral surface. Lower parts of the body are represented in the lateral (upper) surface and upper parts of the body are represented in the lateral (lower) surface. Order of representation from medial (superior, upper) to lateral (inferior, lower) surface: toes, ankle, knee, hip, trunk, shoulder, arm, elbow, wrist, hand, fingers and face. Area 4 is concerned with contraction of discrete muscles.
153. At the post-mortem examination the stomach of a patient with renal failure was found to have a yellow-brown coating on the thickened mucosa. The coating was firmly adhering to its surface and had significant thickness. Microscopy revealed congestion and necrosis of mucosal and submucosal layers, fibrin presence. What is the most likely diagnosis?
154. A 60-year-old man suffering from chronic hepatitis frequently observes nasal and gingival hemorrhages, spontaneous hemorrhagic rashes on the skin and mucosa. Such presentations result from:
155. Leading symptoms of primary hyperparathyroidism are osteoporosis and renal damage resulting in urolithiasis development. What substances are the basis of uroliths in such cases?
156. An oncology department has admitted a patient with suspected pulmonary tumor. On examination a pathology localized within the lower lobe of the right lung was detected. How many bronchopulmonary segments are there in this lobe?
157. Autopsy of a 5-year-old child revealed in the area of the vermis of cerebellum a soft grayish-pink node 2 cm in diameter with blurred margins and areas of haemorrhage. Histologically this tumour consisted of atypical monomorphous small round cells with large polymorphous nuclei. What tumour is it?
158. A 45-year-old woman suffers from arterial hypertension with high blood concentration of angiotensin II. What antihypertensive drug is the most recommended in the given case?
159. An alcoholic suffers from alcoholic psychosis with evident psychomotor agitation. What neuroleptic drug should be administered for emergency aid?
160. In one of Polessia regions there was an outbreak of helminthiasis manifested by cramps and facial edemas. The developed preventive measures in particular included ban for eating infested pork even after heat processing. What helminthiasis was the case?
161. A patient demonstrates functional loss of nasal halves of the retinas. What area of visual pathways is affected?
162. A 26-year-old woman with bronchitis has been administered a broad spectrum antibiotic as a causal treatment drug. Specify this drug:
163. A 16-year-old young man suffering from seasonal allergic rhinitis has been prescribed a highly active second generation H1 blocker, which can be characterized by absence of marked sedative action. Name this drug:
164. Examination of a 56-year-old woman with a history of type 1 diabetes mellitus 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?
165. A patient with injury sustained to a part of the central nervous system demonstrates disrupted coordination and movement amplitude, muscle tremor during volitional movements, poor muscle tone. What part of the central nervous system was injured?
166. A 36-year-old patient has been administered a depolarizing muscle relaxant during a surgery. Name this drug:
167. A man has suffered multiple bone fractures of his lower extremities during a traffic accident. During transportation to a hospital his condition was further aggravated: blood pressure decreased, there were signs of pulmonary artery embolism. What kind of embolism is the most likely in the given case?
168. UN volunteers have arrived in Nigeria to assist the locals in aftermath of earthquakes. What drug should they prescribe for individual chemoprophylaxis of malaria?
169. After an extended treatment with sulfanamides a patient has developed macrocytic anemia. Production of active forms of the following vitamin is disrupted in such a condition:
170. A woman resting in the countryside has been stung by a bee. Immediately after she developed pain in the stung area. In a few minutes there developed a vesicle, erythema and intense itch; later - urticaria and expiratory dyspnea. What factors resulted in the patient developing expiratory dyspnea?
171. Autopsy of a 28-year-old patient, who had been suffering from rheumatism and died of heart failure, revealed pancarditis. Histological investigation of myocardium of the left ventricle posterior wall and interventricular septum detected perivascular cellular focal infiltrates composed of macrophages and creating palisade structures surrounding areas of fibrinoid necrosis. Determine the type of myocarditis:
172. A 47-year-old man developed intestinal colic against the background of essential hypertension. In this situation it would be the most efficient to arrest the colic by administering drugs of the following group:
173. A therapeutist has an appointment with a 40-year-old patient complaining of recurrent pain attacks in his hallux joints and their swelling. Urine analysis revealed its marked acidity and pink color. What substances can cause such changes in urine?
174. Exophthalmus observed during thyrotoxicosis is caused by accumulation of highly water-binding substances within the retrobulbar tissues. Name these substances:
175. A patient presents with dry peeling skin, frequent cases of acute respiratory diseases, xerophthalmia. What vitamin preparation should be prescribed in this case?
176. Parenchyma of an organ is composed of pseudounipolar neurons localized under the capsule of connective tissue. Central place belongs to nerve fibers. Name this organ:
177. A patient consulted a physician about chest pain, cough, fever. Roentgenography of lungs revealed eosinophilic infiltrates that were found to contain larvae. What kind of helminthiasis are these presentations typical of?
178. During appendectomy a patient had the a. appendicularis ligated. This vessel branches from the following artery:
179. A patient with signs of osteoporosis and urolithiasis has been admitted to an endocrinology department. Blood test revealed hypercalcemia and hypophosphatemia. These changes are associated with abnormal synthesis of the following hormone:
180. Prescription of penicillin G sodium salt has caused development of neurotoxic effects (hallucinations, convulsions). Such reaction is the result of antagonism with the following neurotransmitter:
181. A 30-year-old woman exhibits signs of virilism (growth of body hair, balding temples, menstrual disorders). This condition can be caused by overproduction of the following hormone:
182. During a surgery for femoral hernia a surgeon operates within the boundaries of femoral trigone. What structure makes up its upper margin?
183. Activation of a number of hemostatic factors occurs through their joining with calcium ions. What structural component allows for adjoining of calcium ions?
184. A patient has arterial hypertension. What long-acting calcium channel blocker should be prescribed?
185. Material obtained from a patient contains several types of microorganisms (staphylococci and streptococci) causative of the patient’s disease. Name this type of infection:
186. A laboratory has been investigating virulence of a diphtheria agent. In the process of the experiment the infection was introduced intraperitoneally into test animals. The dosage of bacteria resulting in 95% mortality of test animals was found. What unit of virulence measurement was determined?
187. A patient consulted a dentist about restricted mouth opening (trismus). He has a history of a stab wound of the lower extremity. What infection can cause these symptoms?
188. Patient’s systolic blood pressure is 90 mm Hg, diastolic - 70 mm Hg. Such blood pressure is caused by decrease of the following factor:
189. A 29-year-old man with a knife wound of the neck presents with bleeding. During the initial d-bridement of the wound a surgeon revealed the injury of a vessel situated along the lateral edge of the sternocleidomastoid muscle. Specify this vessel:
190. A 6-year-old child suffers from delayed growth, disrupted ossification processes, decalcification of the teeth. What can be the cause?
191. A patient addressed a hospital with complaints of lost sensitivity of the skin of the little finger. What nerve is the most likely to be damaged?
192. A 30-year-old patient’s blood test has revealed the following: erythrocyte count is 6 · 1012/l, hemoglobin is 10,55 mmol/l. Vaquez’s disease was diagnosed. Name the leading part of pathogenesis:
193. Pancreas is known as a mixed gland. Endocrine functions include production of insulin by beta cells. This hormone affects metabolism of carbohydrates. What is its effect on the activity of glycogen phosphorylase (GP) and glycogen synthase (GS)?
194. This year influenza epidemic is characterized by patients’ body temperature varying from 36, 9oC to 37, 9oC. Such fever is called:
195. Fructosuria is known to be connected with inherited deficiency of fructose 1- phosphate aldolase. What product of fructose metabolism will accumulate in the organism resulting in toxic action?
196. A woman complains of visual impairment. Examination revealed obesity in the patient and her fasting plasma glucose level is hyperglycemic. What diabetes complication can cause visual impairment/blindness?
197. Administration of doxycycline hydrochloride has caused an imbalance of the symbiotic intestinal microflora. Specify the kind of imbalance caused by the antibiotic therapy:
198. Cholesterol content in blood serum of a 12-year-old boy is 25 mmol/l. Anamnesis states hereditary familial hypercholesterolemia caused by synthesis disruption of receptor-related proteins for:
199. During recording of a spirogram a patient calmly exhaled. How do we call the volume of air remaining in the lungs?
200. A 40-year-old woman was diagnosed with glomerulonephritis based on her clinical symptoms and the results of urine analysis. Anamnesis states chronic tonsillitis. What microorganisms are the most likely cause for the kidney damage in this case?