Krok 1 – 2020(Feb) (General Medicine)

In case of inflammation, local anesthetic effect of novocaine decreases in strength. What process in the inflammation focus lead to disturbed hydrolysis of novocaine salt and therefore disturbed release of active anesthetic base?

The laboratory has received a sample of digestive juice for analysis. Its pH is 2.2. Name this digestive juice:

One of the functions of central inhibition is the selection and reduction of the sensory information influx to the cerebral cortex. What type of inhibition performs this function?

A woman was diagnosed with peptic ulcer of the stomach. She has a long history of rheumatoid arthritis. The peptic ulcer in this case is most likely to be caused by a long term taking of the:

A man with chronic constipation was taking daily one tablet of Bisacodyl. After a time, he had to start taking 2 tablets daily to achieve the same effect. This type of change in the action of active substances is called:

The process of collapse progression is associated with nervous system dysfunctions, disturbed pulmonary gas exchange and disturbances in the systems of blood and hemostasis. The signs of the collapse are caused by initial development of the following type of hypoxia:

After partial pancreatic resection the patient developed steatorrhea, which indicates disturbed digestion of fats in the intestine. It is caused by deficiency of the following enzyme:

A 21-year-old patient complains of weakness and elevated temperature upto 38-40⁰C . Objectively the liver and spleen are enlarged. In blood: Hb- 100g/L, erythrocytes – 2.9×10¹²/L, leukocytes- 4.4×10⁹/L, platelets – 48×10⁹/L, segmented neutrophils – 17%, lymphocytes – 15%,blast cells – 68%. All cytochemical reactions of blast cells are negative. What hematologic conclusion can be made?

A 60-year-old man suffered a spontaneous rib fracture. X-ray shows multiple foci of bilateral costal osteoporosis. Biopsy material obtained from the place of the fracture shows uniform proliferation of lymphocytic-plasmacytic cells with signs of cellular atypia. Name this disease:

In an experiment after a prolonged electrical stimulation of the peripheral n.vagus a brief cardiac arrest occurred in the subject. What ion mechanisms in the cardiac cells cause this effect?

Healthy parents gave birth to a son with phenylketonuria. The child presents with normal development due to special diet. What type of variability is associated with the convalescence of this child?

In an experiment a dog was administered a certain hormone, which resulted in increased glomerular filtration due to dilatation of the afferent glomerular arteriole and decreased reabsorption of sodium ions and water in the nephron tubules. What hormone was administered?

A patient has an open facial wound with undermined edges; tissue necrosis with gradually developing partial gangrene that nearly reached the bone tissue is observed. On close examination the wound contains live larvae. the patient is diagnosed with tissue myiasis. What Diptera larvae are the causative agents of this disease?

A 9-month-old baby is on formula-feeding. Formula used to feed the baby us imbalanced in its B6 vitamin content. The child presents with convulsions that are likely to be caused by disturbed formation of:

A 25-year-old woman was hospitalized into the gynecological unit. She needs a surgery for removal of an ovarian tumor. During surgery it is necessary to cut the ligament that connects the ovary to the uterus. Name this ligament:

Human immunodeficiency virus has on its surface antigens gp 41 and gp 120 and interacts with target cells of the body. Specify human lymphocyte antigens, with which viral gp 120 develops complementary bond:

A sick child presents with high content of phenyl pyruvate in urine (normally it is practically absent). Blood phenylalanine level is 350mg/L (norm – 15 mg/L). What disease are these symptoms characteristic of?

Radioactive isotope of phosphorus was introduced into the systems of artificial cell culture. What organic substances can accumulate this isotope?

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:

During removal of the hyperplastic thyroid gland of a 47-year-old woman, the parathyroid gland was damaged. One month after the surgery the patient developed signs of hypoparathyroidism; frequent convulsions, hyperreflexia, laryngospasm. What is the most likely cause of the patient’s condition?

A 65-year-old woman, who had been suffering from deep vein thrombophlebitis of the lower leg, suddenly died when awaiting her appointment with the doctor. Autopsy revealed loose friable red masses with corrugated dull surface in the main pulmonary artery and its bifurcation. What pathologic process was discovered by the pathologist in the pulmonary artery?

After surgical removal of the thyroid gland, a patient developed numbness in the extremities. Laboratory analysis shows hypocalcemia. What hormonal agent should be prescribed in this case?

A patient with an adenoma in the zona glomerulosa of the adrenal gland (Conn’s syndrome) presents with arterial hypertension, convulsive attacks, and polyuria. Name the main link in the pathogenesis of these disorders:

Energy is necessary for the work of cardiac muscle. What substrate is the main source of energy in the working muscle?

A patient with edemas has plasma sodium levels of 160mmol/L. This condition is caused by a change in the levels of a certain hormone. Name this hormone:

A journalist for a long time was stationed in India. After his return from this country he developed a string-like torus on the right leg in subcutaneous tissues of the popliteal area. At the end of this torus a vesicle filled with necrotic masses was formed. What type of helminthiasis can be suspected?

A patient complains of red color of his urine and tears. According to his medical history, he undergoes treatment for pulmonary tuberculosis. What antituberculosis agent can cause this phenomenon?

In a poorly ventilated and overcrowded room an elderly man has developed increased blood pressure. What is the mechanism of this reaction?

Histological microslide of a certain endocrine gland shows epithelial bands that consist of chromophile (acidophilic, basophilic) and chromophobe cells. What organ is it?

A patient came to the dentist with complaints of suppurative inflammation of the gums. What drug will be the most effective if the causative agent is suspected to be anaerobic?

A 64-year-old woman presents with disturbed fine motor function of her fingers, marked muscle rigidity, and tremor. The neurologist diagnosed her with Parkinson’s disease. What brain structure are damaged, resulting in this disease?

A woman giving birth has an increased pain threshold due to activation of the following system:

Due to a bullet wound in the left supraclavicular region, the patient developed motor disturbances in the arm. What nerve structures are damaged in this case?

Autopsy of a patient, who died of bilateral bronchopneumonia, shows in the left lung lower lobe a cavity of 5 cm in diameter, filled with liquid yellowish-white substance. What complication of the patient’s pneumonia had developed?

A 38-year-old pregnant woman with a family history of hereditary disorders underwent test for sex chromatin in the cells of amniotic fluid. This test shows that the fetal cells have two sex chromatin bodies (Barr bodies). What disorder are these signs characteristic of?

Protective function of saliva is based on several mechanisms, including the presence of enzyme that has bactericidal action and causes lysis of complex capsular polysaccharides of staphylococci and streptococci. Name this enzyme:

Investigation of an outbreak of a hospital-acquired infection is being conducted. Pure cultures of staphylococcus aureus were obtained from patients, healthcare workers, and some objects on the premises. It is necessary to determine whether these staphylococci are identical to each other and to find the source of the hospital acquired infection. What test must be conducted for this purpose?

A microslide of the skin sample taken from the finger of a child shows that epidermis is insufficiently developed. What germ layer was damaged in the process of embryo development?

As a result of an abdominal trauma, one of the muscles that form the superior wall of inguinal canal was damaged. Name this muscle:

A patient, who was in the area of radiation exposure, developed increased concentration of malondialdehyde and hydroperoxides in the blood. Name the likely cause of these changes:

A 60-year-old patient with diabetes mellitus was found to have ketoacidosis. Biochemically ketoacidosis in diabetes mellitus leads to decreased acetyl-CoA utilization due to deficiency of:

Histological microslide of the wall of the eyeball shows a structure with no blood vessels. This morphological feature is characteristic of:

Patients with alcoholism receive the bulk of their calories with alcoholic drinks. They may develop a characteristic thiamine deficiency (Wernicke-Korsakoff syndrome) that causes nervous system dysfunction, psychoses and memory loss. This process is associated with decreased activity of the following enzyme:

During practical classes the students were studying a stained smear of mouse blood, where the process of heterophagy occurred. What organelles play the key role in this process?

A patient presents with high blood aldosterone. What physiologically active substance is the likely cause of this development?

A person presents with base metabolism that exceeds normal by 8%. It means that the processes of energy metabolism in this person are:

Due to gamma-radiation a segment of DNA chain rotated 180 ^oC. What mutation occurred in DNA?

When playing, a child received a hit to the presternum region. As a result of this trauma an organ located behind the presternum was damaged. Name this organ:

As the result of a trauma, the semicircular canals in the patient’s inner ear were damaged. This person will be unable to respond adequately to the following stimuli:

In the pulmonological unit a patient with obstructive bronchitis with spastic component was prescribed a broncholytic agent. Therapeutic effect of this drug is based on stimulation of β2 adrenergic receptors in the bronchial smooth muscles. Name this drug:

A patient with severe poisoning caused by an unknown substance was brought into the intensive care unit. What drug should be used to induce forced diuresis in the patient?

A woman has clinical diagnosis of gonorrhea. What type of analysis can be used to confirm this diagnosis?

A 63-year-old man suffers from esophageal carcinoma, presents with metastases into the mediastinal lymph nodes and cancerous cachexia. What pathogenetic stage of neoplastic process is observed in the patient?

A patient is being prepared for a cardiac surgery. Pressure in the heart chambers was measured. In one of these chambers throughout the cardiac cycle this pressure changes from 0 to 120 mmHg. What heart chamber is it?

A patient with an occipital head injury was brought into the neurosurgical unit. During the surgery the doctor dissected a part of the dura mater that separates the occipital lobes from the posterior cranial fossa. What anatomical structure was dissected?

In a traffic accident a man suffered a trauma with massive blood loss. What changes in the peripheral blood are the most likely on the 2nd day after the trauma?

Autopsy of the patient, who died of diffuse peritonitis, shows numerous small oval ulcers located along the intestine in the distal portion of the small intestine. Ulcer floor is clear and smooth, formed by muscular or serous layer. Ulcer margins are even and rounded. Two of the ulcers are perforated, with perforations upto 0.5cm in diameter. What disease can be suspected?

A microslide shows an organ of cardiovascular system. One of its layers consists f anastomosing fibers. These fibers are made of cells connected by intercalated discs. What organ of cardiovascular system is it?

Bacteriological analysis of the feces of a 4-month-old child with signs of acute enteric infection was conducted. Inoculation in Endo medium resulted in the growth of a large number of red colonies. What microorganisms are the most likely in this case?

A patient, who lives in a specific geochemical territory, was diagnosed with endemic goiter. What type of post-translational modification of thyreoglobulin is disturbed in this patient?

A 43-year-old woman against the background of septic shock developed thrombocytopenia; her blood fibrinogen levels are low; fibrin degradation products appeared. The patient developed petechial hemorrhages. What is the cause of these changes?

A man presents with disturbed circulation in the myocardium of the right atrium. The disturbances occurred in the system of the following artery:

During experiment a skeletal muscle is being stimulated with a series of electrical impulses. What type of muscular contraction will develop, if each of the following impulse occurs within the relaxation period after the previous single contraction of the muscle?

A patient complaining of nausea and heartburn after meals and steatorrhea came to the gastroenterologist. What is the likely cause of the patient’s condition?

After a week of starvation, blood glucose levels maintain stability due to the following process:

In an experiment, an extracellular potassium concentration was increased until it became equal to the intracellular potassium concentration, which resulted in the loss of cellular excitability. What electrophysiological process occurred in this case?

A certain syndrome manifests as damage to the teeth, hair and bones. Each generation has affected persons. Men and women are affected with equal frequency. What is the type of inheritance of this syndrome?

A 27-year-old patient with injury to the neck has lost approximately 30% of the blood volume. The patient’s condition is severe: blood pressure is 60/40 mmHg, heart rate is 140/min., respiratory rate is 30/min., conscious. Characterize the condition of the patient’s circulatory system:

During hypersensitivity skin test a patient received an allergen subcutaneously, after which the patient developed skin redness, edema and pain due to histamine action. This biogenic amine is produced as the result of the following transformation of the histidine amino acid:

A patient with clinical signs of a primary immunodeficiency has functionally disturbed mechanism of antigen-presentation to the immunocompetent cells. What cells are likely to have structural defects?

A patient with urolithiasis has developed severe pain attacks. For pain shock prevention he was administered an antispasmodic narcotic analgesic along with atropine. Name the drug:

Due to early taking of antibiotics by a patient with typical clinical presentation of dysentery, bacteriological analysis of the patient’s feces detected no Shigellae in the samples. Passive hemagglutination reaction shows a four time increase in the titer of anti shigella antibodies in the patients’s paried sera. What does it indicate?

A 45-year-old man, who had been taking large doses of paracetamol to treat a cold, developed oliguria and azotemia.5 days later he died with signs of acute renal failure. Renal histology show diffuse edema of the medullary interstitium infiltrated with lymphocytes,eosinophils and single neutrophilis;renal tubular epithelium is destroyed; glomerular changes are mild. What is the most likely type of kidney damage in this case?

After a case of severe infectious disease, the patient developed signs of diabetes insipidus, which was indicated by daily urine output increased upto 10 liters. What mechanism of dehydration development is leading in this case?

A patient is in a state of anaphylactic shock. What drug should be used for urgent treatment of this condition?

Floor of the crypts in the small intestine mucosa contains cells with acidophilic secretory granules and basophilic cytoplasm. These cells function as a part of the antibacterial defense of the body. Name these cells:

After eating homemade canned meat, a student developed signs of food poisoning caused by Clostridium botulinum: Diplopia, speech disturbance, and respiratory paralysis. What causes these signs in botulism?

A 67-year-old patient with clinical diagnosis of chronic bronchitis, pneumosclerosis and cardiopulmonary decompensation has the biopsy material taken from the suspicious area in his right bronchus mucosa. Cellular and tissue atypism along with pearly bodies can be histologically detected. What pathological process is characterized by the described histological changes?

For preventive immunization against poliomyelitis, inactivated vaccine was introduced parenterally. What immunoglobulins induce postvaccinal immunity in this case?

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?

A 5-year-old girl for diagnostic purpose underwent Mantoux tuberculin skin test. 48 hours later in the place of tuberculin injection developed a dense papule 1.5cm in diameter with signs of hyperemia and necrosis. What is the mechanism of hypersensitivity that resulted in these changes?

A patient with obliterating endarteritis underwent ganglionic sympathectomy. What type of arterial hyperemia developed as a result of the surgery in this patient?

A 45-year-old man complains of a plaque-like formation on his neck. Histology of the skin biopsy material detected clusters of round and solid tumor cells with thin layer of basophilic cytoplasm. These cells resemble the cells of basal layer of epidermis. Specify the name of this tumor:

On the 3rd day after giving birth, a 29-year-old postparturient woman developed diffuse edema of the right mammary gland with pain on palpation, hyperemic skin in the affected area and elevated body temperature up to 38 C. Histology of the gland tissue revealed a diffuse cellular infiltration in to stroma, which consisted of a large amount of neutrophilic leukocytes, interstitial edema, and vascular hyperemia. Make the diagnosis:

A patient suffers from peptic ulcer disease with ulcer localization in the duodenum. He complains of heartburn, nausea and periodic vomiting? What H2-blocker should be prescribed in this case:

During diabetes mellitus, the content of ketone bodies in the blood is increased, which leads to metabolic acidosis. Ketone bodies are synthesized from:

Preoperative examination revealed prothrombin deficiency in the blood of the patient. What drug should be preliminarily prescribed to mitigate blood loss in the patient during the surgery?

A boxer had sustained a blow to the left parotid area, after which he developed paralysis of the facial muscles on this side. What nerve had been damaged?

Postmortem examination of the body of a man, who died of heart failure, shows the following: mitral valve cusps are deformed, thickened and fused together at the edges; myocardial connective tissue contains diffusely scattered nodules with patches of fibrinoid necrosis surrounded by accumulations of macrophages that resemble multinucleated giant cells. These nodules are surrounded by lymphocytes and single plasma cells. What type of granuloma is it?

A patient with pollinosis after a travel to the countryside developed edemas of lips and eyelids, lacrimation, nasal discharge and a burning sensation in the eyes. What is the main mechanism of edema development in this case?

A 57-year-old woman died of acute cardiopulmonary failure. On autopsy the pathologist suspects fat embolism of the pulmonary artery. What stain should be applied to microslides to confirm this diagnosis?

A woman came to the ophthalmologist with complaints of deteriorating vision. Examination revealed disturbed process of accommodation of the eye. What anatomical structure is functionally disturbed in this patient?

A man was hospitalized with a hemorrhage from a knife wound in the carotid triangle. The blood flowing out of the wound is dark. What vessel us damaged?

A patient simultaneously present with high levels of conjugated(direct) and unconjugated(indirect) bilirubin in the blood plasma, while stercobilinogen levels in feces and urine are sharply decreased. What type of jaundice does the patient have?

A patient presents with absence of T-lymphocytes, facial defects, defects if thyroid and parathyroid glands, heart disease. Cellular immune responses do not develop. The patient was diagnosed with DiGeorge syndrome. This syndrome is caused by :

Ionizing radiation or vitamin E deficiency affects the cell by increasing lysosome membrane permeability. What are the possible consequences of this pathology?

Condition of a patient with diabetes mellitus sharply deteriorated after a regular injection of insulin. The patient become anxious and broke out in cold sweat; tremor of the extermities, general weakness and dizziness appeared. What drug can remove these symptoms?

A patient came to the dentist with complaints of pain and redness of oral mucosa and swollen gums. The patient was diagnosed with herpetic gingivostomatitis. This disease is likely to be caused by:

A 71-year-old man with atherosclerosis developed pain in the left floor. He requested no medical assistance. At the time of examination the foot is enlarged in volume, the tissues are flaccid, black and macerated. Demarcation area is unclear. Make the diagnosis:

During appointment with the dentist, patients often develop anxiety, fear and depression. These psych emotional disturbances can be reduced if secretion of a certain mediator is intensified in the central nervous system. Name this mediator:

A patient with neurologic disorders was diagnosed with a brain tumor. The tumor was removed surgically. It looks like dense node attached to the dura mater. Histologically this tumor consists of tightly packed endothelium-like cells. Make the diagnosis:

A 36-year-old man was brought into the infectious diseases hospital with profuse diarrhea, signs of exsiccosis and acute decrease of body temperature. He died of uremia. Autopsy detects a colorless liquid resembling rice water in the lumen of the small intestine; mucosa is hyperemic. Microscopy of the small intestine shows vascular plethora, focalhemorrhages , desquammation of enterocytes, goblet cell hypersecretion, and lymphocyticc and leukocytic infiltration of mucosal stroma. What is the most likely diagnosis?

A patient with an eye trauma was prescribed a substance that induces a long-term (upto 10days) relaxation of the accommodation muscles. Name this substance:

A patient presents with signs of exudative pleurisy. The liquid will accumulate predominantly in the following anatomical structure:

A 38-year-old man who has been suffering from systemic lupus erythematosus for 3 years, developed diffuse renal lesions accompanied by massive edemas, marked proteinuria, hyperlipidemia and dysproteinemia. What is the most likely mechanism of the proteinuria development in this case?

Electronic microphotograph of a renal corpuscle shows certain cells with processes between the capillaries of the vascular glomerulus. There is a large number of filaments in their cytoplasm. Name these cells:

A 32-year-old man from the rural area came to the doctor with complaints of a painful swelling in the submandibular region with formation of a fistula. Examination showed an infiltration; in the center of this infiltration there was a fistula with thick purulent discharge that contained white granules. The infiltration was lanced, which revealed dense yellow-green tissues with a honeycomb structure due to numerous small abscesses. What disease can be suspected?

During periodic medical examination, a person with no health complaints presents with leukocytosis. This sign can be detected if blood sample for the analysis was obtained after:

During recording of a spirogram a patient calmly exhaled. How do we call the volume of air remaining in the lungs?

During the skill-building session in microbiology the students need to stain the prepared and fixed sputum smears obtained from a tuberculosis patient. What staining technique should be used in this case?

A patient suffers from disturbed patency of the airways at the level of small and medium-sized bronchial tubes. What changes in the patient’s acid-base balance can occur in this case?

A young man with a history of gonorrhea that was completely treated presents with a case of gonorrhea again. This case can be classified as:

To prevent coagulation of a blood sample obtained from a patient for analysis, it was mixed with heparin solution. By its chemical structure this anticoagulant belongs to:

7 days after eating a smoked pork, the patient developed periorbital edemas, myalgia, gastrointestinal disorders and sharp increase in body temperature. Blood test shows marked eosinophilia. What helminth was transmitted to this patient through the pork?

For infectious disease prevention, a person preparing to travel to Africa was prescribed chingamin (chloroquine). This drug belongs to the following pharmacological group:

In stress conditions an elderly person developed elevated blood pressure. It is caused by activation of:

After a prolonged fasting therapy, the patient presents with decreased ratio of albumins and globulins in the blood plasma. What will be the result of this changed ratio?

To lose some weight a woman has been limiting the amount of products in her diet. 3 months later she developed edemas and her diuresis increased. What dietary component is deficient, causing this condition in the patient?

A person with the fourth blood group (genotype I_AI_B) has in erythrocytes both antigen A controlled by allele I_A and antigen B controlled by allele I_B. This phenomenon is an example of the following gene interaction:

ECG of the patient shows increased duration of the QRS complex. What is the most likely cause?

Spirogram analysis shows decreased depth and frequency of respirations in the person, which in turn leads to decrease in the :

In a township there was registered an outbreak of hepatitis, which was attributed to contaminated water supply. What hepatitis virus could be the cause of the outbreak in this township?

During a surgery performed in the abdominal cavity the surgeon located a ligament of the liver stretching from the anterior abdominal wall(navel) to the inferior surface of the liver. What ligament is it?

What enzymatic system uses the energy of electrochemical potential for ATP synthesis in mitochondria?

In the process of protein conversion into the active form after biosynthesis, the proteins undergo certain post modification changes. What change occurs when proinsulin transforms into insulin?

A 40-year-old pregnant woman underwent amniocentesis. Examination determined the fetal karyotype to be 47, XY+21. What fetal pathology was detected?

A patient with a tumor in his large intestine complains of abdominal pain, feces with blood, general weakness. In blood: hemoglobin – 97 mmol/L, erythrocytes -2.8 x 10¹²/L, color index – 0.66, microcytosis, piokilocytosis, moderate number of polychromatocytes. What type of anemia is it?

Histological analysis of a biopsy material obtained from a tuberculosis patient shows a focus of caseous necrosis with irregularly arranged small chromatin granules. These visible changes are a result of:

During intensive physical exertion, one of the energy sources for the working muscles is glucose produced as the result of gluconeogenesis. This process is the most intensive in the following organ:

A patient is diagnosed with herpetic stomatitis. What should be prescribed for the treatment in this case?

A 2-year-old child on examination presents with hepatosplenomegaly, cataract and delayed mental development. Blood galactose levels are high. What hereditary pathology is likely in this child?

A patient diagnosed with downward displacement of the right kidney (nephroptosis) was brought into the nephrology department. Where is the right kidney located normally in relation to the 12^th rib?

During cholecystectomy besides a.cystyca another artery was pulled into the ligature. Ligation of this artery resulted in the right-sided necrosis of the liver which led to the death of the patient . What artery was mistakenly ligated along the a. cystyca?

A 7-year-old child has acute onset of a disease: temperature upto 38^o C, rhinitis, cough, lacrimation and a large spot rash on the skin. Pharyngeal mucosa is edematous, hyperemic, with whitish spots in the buccal area. What kind of inflammation causes the changes in the buccal mucosa?

A woman with enteritis accompanied by severe diarrhea presents with loss of water in the extracellular space, increased water content in the cells and decreasing blood osmolarity. Name this type of water-electrolyte imbalance:

A person with a heatstroke was brought into an admission room. What defensive and compensatory mechanism develops in this condition?

Autopsy of a 9-year-old child shows numerous irregular defects of varying depth with uneven margins and gray-white films tightly attached to the underlying tissue on the rectal mucosa of the body . What disease can be suspected?

A tuberculosis patient was prescribed a complex treatment. Isoniazid is a part of this treatment. By its chemical composition this drug can be classified as:

After a trauma the patient cannot extend his arm in the elbow joint. This condition is likely to be caused by functional disturbance of the following muscle: