2014 Krok 1 Explained
For Krok past questions, the answers are usually the first option. We felt this encourages cramming. The answers in this material have been shuffled, and then below each question is an explanation for the correct option. In some explanations, we used elimination method (explaining why all the other options are not the answer).
Also, some frequently occurring concepts are explained so that even if a question is ‘tweaked’, students can still handle them.
- The infectious diseases department of a hospital admitted a patient with nausea, liquid stool with mucus and blood streaks, fever, and weakness. Dysentery was suspected. What method of laboratory diagnostics should be applied to confirm the diagnosis?
EXP: The causative agent of dysentery is Shigella dysenteriae which is a bacteria so the correct answer is C. This involves testing the ‘biologic’ materials i.e stool for the bacteria.
- Malaria is treated with structural analogs of vitamin B2 (riboflavin). These drugs disrupt the synthesis of the following enzymes in plasmodium:
- Cytochrome oxidase
- FAD-dependent dehydrogenase
- NAD-dependent dehydrogenase
EXP: The answer is B because that is the coenzyme of vitamin B2 along with FMN (Flavin-Mononucleotide).
- A 6-year-old child with suspected active tuberculous process underwent the diagnostic Mantoux test. What immunobiological preparation was injected?
- BCG vaccine
- DTP vaccine
- Td vaccine
EXP: Answer is E. Tuberculin is the intradermal injection for mantoux test to confirm tuberculosis because TB is still suspected. BCG vaccine is vaccination against TB.
- 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?
- Carbohydrates and fats
- Carbohydrates and proteins
EXP: Answer is C. During exercise, glucose is used up and it’s a product of carbohydrate
- 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:
- Unconditioned parasympathetic reflexes
- Conditioned sympathetic reflexes
- Conditioned parasympathetic reflexes
- Unconditioned sympathetic reflexes
EXP; Answer is D. Changes of heart rate and blood pressure are unconditioned responses. The ‘increase’ here is due to action of the sympathetic nervous system through production of epinephrine (flight or fight reflex). Parasympathetic NS reduces HR and BP via acetylcholine.
- 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:
HINT: Oxyproline and Hydroxyproline play a key role in stability of Collagen. Increased excretion of Oxyproline will reduce stability of collagen, therefore it leads to Paget’s disease which is a pathology of the bone. Answer is A.
- A patient has hoarseness of voice. During laryngoscopy a gray-white larynx tumor with PAPILLARYsurface 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?
EXP: A papilloma is a benign epithelial tumor. The absence of atypia confirms the tumor as benign. Papillary surface of the epithelial tumor nails it. Answer is D .
- During autopsy approximately 2,0 liters of pus have been found in the abdominal cavity of the corpse. Peritoneum is lusterless 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:
- Hemorrhagic peritonitis
- Fibrinopurulent peritonitis
- Serous peritonitis
- Tuberculous peritonitis
EXP; Grayish shade of peritoneum indicates purulence. The grayish-colored coating points to presence of fibrin. Answer is B
- 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?
- Chronic lymphocytic leukemia
- Multiple myeloma
- Polycythemia Vera
- Hodgkin’s disease
- Chronic myelogenous leukemia
EXP; Pyoid marrow is characteristic for Myelogenous leukemia. Answer is E.
- Autopsy of the dead patient who died from pulmonary edema revealed a large yellow-grey nidus in the myocardium, and a fresh thrombusin the coronary artery. What is the most likely diagnosis?
- Myocardial infarction
REASON; The large yellow-grey area or nidus indicates infarction or death of the myocytes in that area. This is seen to have been caused by the thrombus in the coronary artery that blocked blood flow to that area of the heart. Answer is D.
- 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?
- Isometric contraction
- Asynchronous contraction
- Protodiastolic period
- Rapid filling
- Reduced filling
REASON; Systole is the part of the cardiac cycle when the ventricles contract. In early systole, all the valves are closed, and the ventricles contract without a change in volume, this is known as ‘Isovolumetric/Isometric Contraction’. So the answer is A.
- Cyanideis a poison that causes instant death of the organism. What enzymes found in mitochondria are affected by cyanide?
- Cytochrome oxidase (aa3)
- Flavin enzymes
- Cytochrome 5
- NAD+-dependent dehydrogenase
- Cytochrome P-450
HINT; Answer is A. Cyanide ion stops cellular respiration by inhibiting the enzyme cytochrome c oxidase and disrupting the electron transport chain.
- Increased HDL levels decrease the risk of atherosclerosis. What is the mechanism of HDL anti-atherogenic action?
- They supply tissues with cholesterol
- They are involved in the breakdown of cholesterol
- They activate the conversion of cholesterol to bile acids
- They promote absorption of cholesterol in the intestine
- They remove cholesterol from tissues
HINT; High Density Lipoproteins (HDL) removes cholesterol from tissues so that they do not accumulate in these tissues, therefore preventing process of atherosclerosis. This is why it is known as good cholesterol. Answer is E.
- 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?
- Microsomal oxidation
- Pyruvate dehydrogenase complex
- Methemoglobin reductase
- Glutathione peroxidase
- Glutathione reductase
EXP; Pyruvate dehydrogenase converts pyruvate to acetyl-CoA in the CA cycle. It acts on pyruvate and lipoic acid. So sodium arsenate has to impair this enzyme complex. The answer is B.
- Stool culture test revealed in a 6- month-old bottle-fed baby the strain of intestinal rod-shapedbacteria of antigen structure 0-111. What diagnosis can be made?
- Choleriform disease
- Food poisoning
- Dysentery-like disease
EXP; The antigen strain 0-111 is specific to E.coli which is a rod shaped bacteria and this bacteria affects intestine since it is also a normal flora of the intestine. Hence, it can cause colienteritis, which is inflammation of the intestines. Answer is D
- 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:
- Trisomy X
EXP; Normally, boys should have no barr body. (46XY). Drumstick means ‘barr body’. Klinefelter syndrome has 1 barr body i.e XXY (47XXY). Answer is D
- 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:
- Phosphatidic acid
- Cholic acid
EXP; Steatosis, also called fatty degeneration is the abnormal retention of lipids. Phosphatidylcholine acts as a surfactant that prevents lipid droplets from forming large droplets. So disorder of its synthesis will cause deposition of fats in the liver. Answer is D
- Ascarid eggs have been detected during stool analysis. What drug should be prescribed?
HINT; Ascaris is a helminth and its treated by an anti-helminthic drug. Most of them ends in ‘’dazole’’. Answer is B. Nystatin is antifungal. C, D and E are Antibiotics.
- Bacteriological examination of the urine of the patient with pyelonephritis revealed microorganisms that produced yellow-greenpigment and a characteristic odor in meat-peptoneagar. What are they called?
EXP; Pseudomonas secretes a pigment pyoverdine which is responsible for the yellow-green pigment. Answer is A
- Feces of a patient contain high amount of undissociated fatsand have grayish-white color. Specify the cause of this phenomenon:
- Hypoactivation of pepsin by hydrochloric acid
- Obturation of bile duct
- Irritation of intestinal epithelium
EXP: Obturation or blockage of bile duct prevents bile from being released thereby causing fats to be undigested. Answer is C
- 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:
- Amino acids
EXP; This patient has gout which is caused by disorder of purine metabolism because the end product of this metabolism is uric acid, so its disorder will lead to uric acid increase. Uric acid in the form of urate will deposits in joints forming those nodules (also called “tophi”). Ans = C
- A 26-year-old female consulted a doctor about having stool with white flat moving organisms resembling noodles. Laboratory analysis revealed proglottidswith the following characteristics: long, narrow, with a longitudinal channel of the uterus with 17-35lateral branches on each side. What kind of intestinal parasite was found?
- Taenia solium
- Hymenolepis nana
- Taeniarhynchus saginatus
- Diphyllobothrium latum
- Echinococcus granulosus
HINT; Proglottids are found in tapeworms. T. saginata has uterus of 17-35 while T. solium with uterus of 7-13. Ans = C
- 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 macrophageshaving 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?
- Hodgkin’s disease
- Tumor metastasis
HINT; TB occurs mainly in immunocompromised patients. So these epitheloid cells (granuloma) are immune cells (histiocytes) which are suppose to fight the bacteria but the patient is immunocomprised so they accumulate and form large giant cells which are arranged in horseshoe pattern. Ans = E
- 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:
- Hippuric acid
HINT; In a normal situation, creatine is broken down to creatinine before excretion…but in PMD, the destruction of muscles results in a high quantity of creatine being excreted, so it will be seen in urine. Ans = A
- 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?
- A. tibialis anterior
- A. dorsalis pedis
- A. tarsea medialis
- A. tarsea lateralis
- A. fibularis
HINT: Dorsal pedis is the largest artery in the foot where pulse is able to be checked. Ans = B
- A patient with chronic heart failure with edema has increased level of blood aldosterone. What diuretic would be most effective in this case?
HINT; Retention of sodium & water contributes to development of edema and Aldosterone reabsorbs H2O and Na. So aldosterone levels are increased and have to be blocked thus sparing potassium and excreting Na. Spirinolactone and Triamterene are both K sparing agents but Spirinolactone has direct antagonistic effect on aldosterone but triamterene just affects electrolyte transport but does not block aldosterone. Ans = B
- 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 characterized by such clinical presentations?
- Meningococcal meningitis
- Tuberculous meningitis
- Grippal meningitis
- Epidemic typhus-induced
HINT: Meningococcus is the only causative agent in the options that can cause purulent effluent type of meningitis. Ans = A
- A 41-year-old male patient has a history of recurrent attacks of heartbeats (paroxysms), profuse sweating, and headaches. Examination revealed hypertension hyperglycemia, increased basal metabolic rate, and tachycardia. These clinical presentations are typical for the following adrenal pathology:
- Hyperfunction of the medulla
- Hypofunction of the medulla
- Hyperfunction of the adrenal cortex
- Hypofunction of the adrenal cortex
- Primary aldosteronism
EXP; If it’s C, we’ll see symptoms like moon face. If E, muscle spasm, numbness, and polyuria will be seen. So A is correct because adrenal medulla secretes epinephrine and we know its function.
- A comminuted fracture of infraglenoid tuberclecaused by shoulder joint injury has been detected during X-ray examination of a patient. What muscle tendon attached at this site has been damaged?
- Long head of m. biceps brachii
- Medial head of m. triceps brachii
- Lateral head of m. triceps brachii
- Long head of m. triceps brachii
- Short head of m. biceps brachii
HINT: Infraglenoid tubercle is part of scapula from which long head of triceps brachii originates.
Ans = D.
- A patient has increased thicknessof alveolar-capillary membrane caused by a pathologic process. The direct consequence will be reduction of the following value:
- Diffusing lung capacity
- Oxygen capacity of blood
- Respiratory minute volume
- Alveolar ventilation of lungs
- Expiratory reserve volume
HINT: Alveolar capillary membrane is thin which allows transfer of gases so its thickness will do otherwise. DLC measures the ability of lungs to transfer gas from alveolar space to RBC in pulmonary vessel, so when the alveolar membrane becomes thick, the DLC reduces as gases are not really transferred. Ans = A
- What drug will be most appropriate for the patient who has chronic gastritiswith increased secretion?
HINT; Pepsin is an enzyme produced by stomach. Aproptinin is a pancreatic trypsin inhibitor. Pancreatinine Is produced by exocrine cells of pancreas. Chlorphentermine acts as a selective serotonin releasing agent. So C is correct as it reduces gastric acid secretion.
- 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:
- Traumatic edema
- Exudative inflammation
- Vacuolar degeneration
- Proliferative inflammation
- Alternative inflammation
HINT; First of all, with the signs, its an inflammation. (so A and C are out). Exudate is any fluid produced during an inflammation and here, a fluid was produced. Ans = B
- A 42-year-old male with a lesion of the ulnar nerveis unable to flex the II and V fingers to the midline. Which muscle function is impaired in this case?
- Dorsal interosseous muscle
- Short palmar muscle
- Palmar interosseous muscles
- Abductor muscle of little finger
HINT; All interosseous muscles are innervated by ulnar. The dorsal interosseous muscles control adduction while palmar interosseous control abduction. Ans = D
- A smear from the tonsillar coating of a patient with suspected diphtheriawas found to contain bluebacilli with a thickening at the poles. What method of smear staining was used?
HINT; C. diphtheria, is also known as KLEBS-LEFFLER BACCILUS( the inventors) and leffler stains blue. Ans = A
- A child was born asphyxiated. What drug must be administered to the newborn to stimulate breathing?
HINT; Proserin is a cholinesterase inhibitor, it stimulates muscles by improving nerve impulse transmission. Lobeline acts on nicotinic receptors. Prazosin is an alpha1 blocker. Atropine is an anticholinesterase inhibitor. So E, Aethimizolum is correct because its an ANALEPTIC(it stimulates breathing center.
- A 40-year-oldpatient 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 sequesterssurrounded by the connective tissue capsule. What is the most likely diagnosis?
- Acute osteomyelitis
- Chronic osteomyelitis
- Chronic fibrous periostitis
- Purulent abscess
HINT: The highlighted problems can only occur in Chronic course of Osteomyelitis. Ans = C
- Human red blood cells do not contain mitochondria. What is the main pathway for ATP production in these cells?
- Aerobic glycolysis
- Oxidative phosphorylation
- Creatine kinase reaction
- Cyclase reaction
HINT: Ans = A. Because all the other options require the mitochondria, or oxygen.
- 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:
- Basedow’s disease
- Hashimoto’s thyroiditis
- Riedel’s thyroiditis
- De Quervain’s disease
- Nodular goiter
HINT; Histologically, the different size and amount of follicles will present clinically as diffused goiter which is a clinical symptom of GRAVES DIESEASE(another name is BASEDOW DISEASE). Ans = A
- 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:
HINT: In Eukinetic Arterial Hypertension, both systolic and diastolic BP will be increased i.e there will be increase in cardiac output. Ans = A
- A patient has been hospitalized with provisional diagnosis of virus B hepatitis. Serological reaction based on complementation of antigen with antibodychemically bound to peroxidase or alkaline phosphatasehas been used for disease diagnostics. What is the name of the applied serological reaction?
- A. Immune-enzyme analysis
- Radioimmunoassay technique
- Immunofluorescence test
- Bordet-Gengou test
- Antigen-binding assay
EXP: The binding of the antibody-antigen complement to enzymes makes option A the correct answer.
- A patient has been hospitalized with provisional diagnosis of botulism. What serological reaction should be used to reveal botulinum toxin?
- Agglutination reaction
- Neutralization reaction
- Bordet-Gengou test
- Precipitation reaction
- Immunofluorescence test
HINT: Clostridium botulinum excretes neurotoxin, Neutralization reaction with anti-toxin is the only way to reveal the exotoxin. Answer is B
- 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?
- Acquired hemolytic
- Hereditary hemolytic
- Acute hemorrhagic
- Chronic hemorrhagic
- Anemia due to diminished erythropoiesis
HINT; No history of bleeding (so C and D). No family history of it ( so B is out). E is also out because there is no reticulocytopenia on peripheral smear. So A is correct.
- 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:
- Heat conduction
- Heat radiation
HINT: Heat Radiation doesn’t require body contact or flow of fluid to lose heat unlike Conduction and Convection respectively. So the answer is B.
- Urine analysis has shown high levels of protein and erythrocytes in urine. This can be caused by the following:
- Effective filter pressure
- Hydrostatic blood pressure in glomerular capillaries
- Hydrostatic primary urine pressure in capsule
- Oncotic pressure of blood plasma
- Renal filter permeability
HINT; Normally, protein and RBC in large quantities should not be seen in urine. Proteins are large molecules that cannot normally pass through the glomerular filtration system. Their presence in urine indicates increase in permeability. Ans = E
- 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?
- Amount of released antigen
- Antigen structure
- Development of tissue lesion
- Routes by which antigens are delivered into the body
- Hereditary predisposition
HINT: There’ll be development of lesion in allergic reactions, e.g rashes. Ans = C
- After a craniocerebral injury a patient is unable to recognize objects by touch. What part of brain has been damaged?
- Occipital lobe
- Temporal lobe
- Precentral gyrus
- Postcentral gyrus
HINT; Occipital is mainly for vision. Temporal for memory, speech. Cerebellum for Coordination of limbs and extremity. Precentral gyrus Commands voluntary movements of skeletal muscles. That leaves D, but it is also for touch or tactile sensitivity. So the answer is D.
- 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?
- Adrenalin hydrochloride
EXP: This patient is in Heart Failure. Adrenalin is both an alpha and beta agonist which is contraindicated in heart failure. Cordiamin is an Analeptic (stimulates breathing center) which is not really useful here. Drotaverine is an Antispasmodic drug for childbirth. So Digitoxin and Corglyconum are both cardiac glycosides but corglyconum has rapid action and due to digitoxin’s high level of toxicity, it is hardly used. Hence, the answer is D.
- 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:
- Tractus corticospinalis
- Tractus rubrospinalis
- Tractus corticonuclearis (for muscles of face, head and neck)
- Tractus spinothalamicus (pain, touch)
- Tractus tectospinalis (head and eye)
HINT: Rubrospinal tract (from red nucleus to spinal cord) is responsible for large muscle movements in upper part of body. Corticospinal tract involves lower limbs. So the answer is B
- 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 tongueis crimson colored. Tonsillar surface is covered with isolated grayish-colored necrosis nidi. What disease is it?
- Meningococcal nasopharyngitis
- Scarlet fever
HINT; Tongue is crimson (red) colored (generally, called scarlet fever). And also the age matters (it affects children). It’s a diagnostic for SCARLET FEVER. The answer is B
- 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:
- Febris intermittent
- Febris continua
- Febris recurrent
- Febris hectica
- Febris remittent
HINT; in Febris continua the daily fluctuation does not exceed 1oC. In Febris recurrens, there are periods of rising temp (5-8days), and periods of normal temp. In Febris hectica, there is daily fluctuation of up to 3-4oC. In Febris remittens (indulgence fever), fluctuation between morning and evening temps is 1-2oC.
Ans = A. The temp curve here is the febris quartana type of Febris Intermittens, where temp rises every 4th day and then falls. F. intermittens could also be every 3 days (febris tertiana) or daily (quotidiana).
- 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?
- Posterior central gyrus
- Occipital region
- Cingulate gyrus
- Frontal cortex
- Anterior central gyrus
HINT; Same as 46. ( for skin sensitivity and touch). The answer is A
- 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?
- Tissue acidosis
- Decrease in systemic arterial pressure
- Obstruction of nephron tubules with hyaline casts
- Reduction of active nephron mass
- Arteriolar spasm
HINT; Normal GFR is 90 – 120ml/min. Diabetic nephropathy damages kidney glomeruli, thereby reducing the number of nephrons that is supposed to filter uremia and waste. The answer is D
- A 40-year-old patient has ulcer perforation in the posterior wall of stomach. What anatomical structure will blood and stomach content leak to?
- Bursa hepatica
- Bursa praegastrica
- Right lateral channel (canalis lateralis dexter)
- Left lateral channel (canalis lateralis sinister)
- Bursa omentalis
EXP; The answer is E
- A patient is diagnosed with hereditary coagulopathy that is characterized by factor VIII deficiency. Specify the phase of blood clotting during which coagulation will be disrupted in the given case:
- Fibrin formation
- Thrombin formation
- Thromboplastin formation
- Clot retraction
EXP’; The deficiency of factor VIII (Hemophilia A) makes it impossible to make thromboplastin. Thrombin is factor II. Fribrin is factor 1a. The answer is C
- Angiocardiography of a 60-yearold male patient revealed constriction of a vessel located in the left coronary sulcusof the heart. What is the pathological vessel called?
- Ramus circumflexus
- Ramus interventricularis posterior
- A. coronaria dextra
- V.cordis parva
- Ramus interventricularis anterior
HINT; Left coronary gives rise to A,B,E. but only A, is in sulcus. So, the answer is A
- 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?
- Flavin-dependent oxidase
- Oxygenase and hydroxylase
- Cytochrome oxidase, cytochrome B5
- Oxygenase and catalase
- Peroxidase and catalase
HINT; E is an enzyme that breaks down H2O2 (Hydrogen peroxide) to H2O and O2. So that’s the answer.
- 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:
- Colon sigmoideum
- Colon transversum
- Colon descendens
- Colon ascendens
EXP: The ascending colon is located on the right lateral part of the abdomen so it will be the part of the large intestine. The answer is D
- A patient complaining of pain in the left shoulder-bladeregion has been diagnosed with miocardial infarction. What kind of pain does the patient have?
Exp: When pain felt moves from one location to another it is known to as radiated, Just like question the pain started from the the heart(myocardial infarction) and then radiated to the left shoulder-blade region. The answer is A
- 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:
- Pancreatic juice
- Gastric juice
- Intestinal juice
HINT; B because it contains all the enzymes that breaks down protein, fats and hydrocarbon. So that’s the answer.
- A female patient has facial neuritis that has caused mimetic paralysis and hearing impairment. Hearing impairment results from the paralysis of the following muscle:
- Superior auricular muscle
- Anterior auricular muscle
- Stapedius muscle
- Posterior auricular muscle
- Nasal muscle
HINT; Stapedius muscle is innervated by a branch of facial nerve, so any paralysis of the muscle will cause injury to the nerve. So the answer is C.
- 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?
- Epithelium of the circumvallate papillae
- Epithelium of the foliate papillae
- Epithelium of the fungiform papillae
- Epithelium of the filiform papillae
- Connective-tissue base of all the lingual papillae
HINT: Oral Candidiasis is mostly seen on the filiform papillae. So the answer is D
- A patient has a traumatic injury of sternocleidomastoid muscle. This has resulted in a decrease in the following value:
- Inspiratory reserve volume
- Expiratory reserve volume
- Respiratory volume
- Residual volume
- Functional residual lung capacity
HINT; The sternocleidomastoid muscle (along with the scalene muscle), are accessory muscle for breathing. It increases IRV. So, any injury will decrease IRV. So the answer is A
- The receptors under study provide transfer of information to the cortex without thalamic involvement. Specify these receptors:
HINT; Tactile– 1st and 2nd neuron is in spinal cord and 3rd is VPM (ventral posterior medial nucleus) of thalamus. Gustatory– Terminate in medial half of VPM. Visual- About 90% of axons in optic nerve go to lateral geniculate nucleus of thalamus. Auditory passes through medial geniculate body which is part of the thalamic system. So we are left with OLFACTORY which is the correct answer.
- Prolonged fastingcauses hypoglycemia which is amplified by alcohol consumption, as the following process is inhibited:
EXP; Alcohol consumption causes the accumulation of NADH. Due to this, pyruvate is converted to lactate instead of acetyl CoA which is supposed to be the first enzyme of gluconeogenesis. So this is how the process is impaired. The answer is D
- 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:
HINT; In diabetic ketoacidosis, ketone bodies are increased. But ketone bodies is not here but KB have 3 types- Acetoacetate, Acetone and B- hydroxybutyrate. So the answer is A
- 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:
- Metaplastic anemia
- Iron-deficiency anemia
- Minkowsky-Shauffard disease
- Hypoplastic anemia
- Iron refractory anemia
Exp: iron refractory anemia is an anemia in which the serum iron concentration is increased. In Iron def, Fe is reduced. Minkowsky-shauffard (hereditary spherocytosis) is just when the RBC is spherical in shape. Hypoplastic anemia is a disorder in bone marrow characterized by pancytopenia. Metaplastic is vit B12 def. So the answer is E
- During an animal experiment, surgical damage of certain brain structures has caused deep prolongedsleep. What structure is most likely to cause such condition, if damaged?
- Reticular formation
- Basal ganglion
- Red nuclei
- Cerebral cortex
HINT; B- controls voluntary motor nucleus as eye movement. C- controls muscle of shoulder (such as swinging arms). D- controls formation of memories. E- controls all 4 lobes and their function. A- controls sleep and alertness so injury to it will prolong sleep and possibly coma. So the answer is A.
- A patient takes cholagogues. What other process besides biliary excretion will be stimulated?
- Gastric juice secretion
- Intestinal motility
- Pancreatic juice secretion
- Gastric motor activity
- Water absorption
EXP; Cholagogues is a medicinal agent that promotes the discharge of bile. Bile works in the small intestine. So it will make sense for cholagogues to work due to intestinal mobility. So the answer is B
- 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 inbetween having peripheral nuclei. Specify the type of meningitis in the child:
HINT; Same as 23. So the answer is A
- A patient with homogentisuria has signs of arthritis, ochronosis. In this case, the pain in the joints is associated with the deposition of:
HINT; Homogentisuria is accumulation of homogentisic acid in urine (alkaptonuria) due to homogentisate 1,2 dioxygenase that helps in catabolism of phenylalanine and tyrosine. So the answer is E
- 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:
- Carbamoyl phosphate
HINT; Lack of ornithine carbamoyl transferase that is suppose to covert carbamoyl + ornithine to citrulline gives room for the build up of carbamoyl phosphate which is a substrate for the orotic cycle.( Orotic cycle;- carbamoyl phosphate + aspartate is converted to N- carbamoylaspartate (by ASPARTATE TRANSCARBAMYLASE) which is converted to dihydroorotate (by dihydroorotase) which is converted finally to orotic acid (by dihydroorotate dehydrogenase). Simply put, carbamoyl phosphate is required in both cycle. So the answer is D
- Amniocentesis revealed two sex chromatin bodies (Barr bodies) in each cell of the sample. What disease is this character typical for?
- Trisomy X
- Klinefelter syndrome
- Turner’s syndrome
- Down’s syndrome
- Patau syndrome
HINT; Barr body is the inactive X chromosome. A female has only one barr body, while male has none. So A, is correct.
- A 49-year-old male patient with acute pancreatitis was likely to develop pancreatic necrosis, while active pancreatic proteaseswere absorbed into the blood stream and tissue proteins broke up. What protective factors of the body can inhibit these processes?
- α2-macroglobulin, α1-antitrypsin
- Cryoglobulin, interferon
- Ceruloplasmin, transferrin
- Hemoplexin, haptoglobin
HINT; According to the keyword, we need a protease inhibitor and that happens to be A which is the correct answer. B- are antibodies. Cryoglobulins are abnormal antibody proteins. Interferons acts as defense against viral infections. Ceruloplasmin carries copper. Transferrin transfers Fe. Hemoplexin binds heme with any protein. Haptoglobin carries free Hb back to the liver.
- 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?
- Decreasing oncotic pressure of blood plasma
- Increasing venous return
- Increasing central venous pressure
- Decreasing venous return
- Increasing arterial pressure
HINT: Sudden change of body position vertically decreases venous blood return to the heart due to gravity. The body loses consciousness so that by the fall and consequent return to horizontal position, blood return will be easier. Remember that’s why we get head rushes. ANSWER IS D
- 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?
- Hemolytic jaundice
- Chronic colitis
- Chronic gastritis
HINT; Location of pain removes E. Increased ALT removes D. Age of patient and absence of signs of hemolysis removes B. Absence of stercobilin removes C, so we are left with A, because the gallstone blocks the bile duct hindering the flow of the stercobilin which is the correct answer.
- A child patient has dry cough. What non-narcotic antitussive drugwill relieve the patient’s condition?
- Althaea officinalis root extract
- Potassium iodide
- Morphine hydrochloride
- Codeine phosphate
- Glaucine hydrochloride
HINT; A and B are expectorants. C and D are narcotic (opiods). So we are left with E which is right answer.
- 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 segmentshas been detected. What anatomical boundary exists between those two segments?
- Linea semilunaris
- Linea terminalis
- Linea arcuata
- Linea transversa
- Linea inguinalis
EXP; linea terminalis includes linea arcuta and it lies in abdominal and pelvic segments. Transverse line lies between iliac spines. Semi-lunar line lies on either side of rectus abdominis muscle. Inguinal line lies from pubic tubercle to superior iliac spine. ANSWER IS B
- 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:
- Depolarization threshold
- Conduction velocity
- Resting potential
- Critical level of depolarization
EXP; ANSWER IS A. No comment
- 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:
- Angiotensin II
HINT; The only strong direct vasoconstrictor is angiotensin II. Renin activates the renin-angiostensin system. Angiotensinogen is not active in vessels. Catecholamines has nothing to do with the kidneys. Answer is c
- A patient is diagnosed with iron deficiency sideroachrestic anemia, progression of which is characterized 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?
- Failure to assimilate iron leading to iron accumulation in tissues
- Excessive iron intake with food
- Disorder of iron absorption in bowels
- Increased iron assimilation by body
HINT; A is correct because several organs are affected indicating that Fe is been accumulated in the tissues because its not been used.
- In a village, a case of anthraxhad been registered. Medical services began epidemiologically indicated specific prophylaxis of population against anthrax. What preparation was used for this purpose?
- Genetically engineered vaccine
- Inactivated vaccine
- Chemical vaccine
- Live vaccine
EXP; D is correct because anthrax is a live vaccine.
- 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:
- Calcium ion exit
- Calcium ion entry
- Potassium ion exit
- Potassium ion entry
- Calcium and potassium ion exit
HINT; Ca levels increase HR & contractility (influx of Ca). Potassium does the opposite. ANSWER IS B
- 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?
- Decreased activity of glucose reabsorption enzymes
- Increased activity of glucose reabsorption enzymes
- Exceeded glucose reabsorption threshold
- Increased glucose secretion
- Increased glucose filtration
HINT; The problem here is glucose wasn’t reabsorbed along with Na because Sodium- glucose transport (SGLT) enzymes activity is reduced. ANSWER IS A
- 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?
- Closure of right interventricular foramen
- Closure of left interventricular foramen
- Atresia of tubus medullaris
- Atresia of sylvian aqueduct
- Atresia of the fourth ventricle foramina
EXP; It will make sense for B to be the correct answer. The increased pressure is in the right ventricle due to the closure of the right interventricular foramen
- Parents of 5-year-old child report him o 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, and naked cells are absent from the lymph nodes punctate. What kind of immune disorder is it?
- X-linked hypogammaglobulinemia (Bruton type agammaglobulinemia)
- Autosomal recessive agammaglobulinaemia (Swiss type)
- Hypoplastic anemia
- Louis-Barr syndrome
EXP;- Absence of Ig removes C, D and E. Bruton’s type is just deficiency of humoral immunity (B lymphocytes). So the symptoms are less severe than Swiss type which is deficiency of both humoral and cellular immunity. The patient will start showing symptoms from like 5 months.
- 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?
- Cytomegalovirus infection
- Burkitt’s lymphoma
- Herpetic lymphadenopathy
- Generalized infection caused by herpes-zoster
- Infectious mononucleosis
HINT; Causative agent of infectious mononcleosis is Epstein- Barr which is also HERPES 4. RIGHT ANSWER IS E
- A microslide contains the preparation of a gland composed of several secretory saccule-shapedparts that open in the common excretory duct. What gland is it?
- Simple branched alveolar gland
- Compound branched alveolar gland
- Simple unbranched alveolar gland
- Compound unbranched alveolar gland
- Simple branched tubular gland
HINT; Alveolar glands are sac like (saccule). So E is out. There are several secretory parts which means its BRANCHED (C &D is out), but they empty into ONE duct. Compound (means many) won’t empty into one duct. That leaves A which is the right answer.
- A patient intending to undergo a gender reassignment surgery has been admitted to a specialized clinic. In the course of examination both male and female gonads have been revealed, with malestructure of external genitals. What kind of genital maldevelopment has the patient?
- Female pseudo hermaphroditism
- Male pseudo hermaphroditism
- True hermaphroditism
- Accessory ovary
- Ectopia of testis
HINTS;. Both male and female gonads was revealed so D & E is out. In pseudo hermaphroditism, we won’t be able to differentiate which gentalia is developed. So C, is correct because male genitalia was revealed
- 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?
- Multiple allelism
- Incomplete dominance
HINT: Pleiotropy is when one gene affects multiple systems…different systems are affected in Marfan’s syndrome. So the right answer is D
- 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:
HINT; In alkaptonuria, the enzyme (homogentisate 1,2- dioxygenase) is involved in metabolism of phenylalanine and tyrosine. And also tyrosine is a product of phenylalanine. So, there’s excess tyrosine. So the RIGHT ANSWER IS E
- 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?
- Superior orbital fissure
HINT; Trigeminal nerve- (1st branch is ophthalmic (foramen is superior orbital fissure). 2nd branch is maxillary (foramen rotundum). 3rd branch is mandibular (foramen ovale). ANSWER IS B
- An patient with insomnia induced by allergic rash and itch has been prescribed the drug that has antihistamine and hypnotic effect. Specify this drug:
- Acetylsalicylic acid
HINT; B- is H2 antagonist. C- is an oral, synthetic corticosteroid. D- its also called ASPIRIN which is an NSAID. E- analgesic, antipyretic. That leaves A which is antihistamine and also have hypnotic effect and is correct.
- In a cat with decerebrate rigidity the muscle tone is to be decreased. This can be achieved by:
- Stimulation of the vestibulocochlear nerve
- Stimulation of the otolithic vestibular receptors
- Stimulation of the vestibular nuclei of Deiters
- Destruction of the vestibular nuclei of Deiters
- Stimulation of the ampullar vestibular receptors
HINT: Decerebrate rigidity is caused by lesion on brainstem. Vestibular nuclei of deiters is located on the brainstem. RIGHT ANSWER IS D
- When studying the signs of pulmonary ventilation, reduction of forced expiratory volume has been detected. What is the likely cause of this phenomenon?
- Increase of functional residual lung capacity
- Increase of respiratory volume
- Increase of inspiratory reserve volume
- Increase of pulmonary residual volume
- Obstructive pulmonary disease
HINT: Expiratory Volume is always reduced in all Obstructive Pulmonary disease. E.g Asthma, COPD. ANSWER IS E
- X-ray examination of a patient allowed to diagnose a tumor in the superior lobeof the right lung. There is a probability of metastases spread to the following lymph nodes:
- Inferior mediastinum
- Anterior mediastinum
- Deep lateral cervical
ANSWER IS A. NO HINT
- 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?
- Typhoid fever
- Brill’s disease
HINT; Typhus is caused by RICKETTSIAE PROWAZEKII. This bacteria can remain latent and reactivate after months or even years. When it reactivates, it is known as BRILL’S DISEASE. ANSWER IS D.
- 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?
- Neisseria meningitidis
- Streptococcus pneumonia
- Haemophilus influenzae
- Staphylococcus aureus
- Pseudomonas aeruginosa
HINT; A IS CORRECT and it can cause meningitis and it has 3 signs; Nuchal rigidity, brudzinski and kernig sign.
- 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:
- Thyroid hormones
- Tropic hormones
HINT: All tropic hormones are produced in the Adenohypophysis. Since thyroid gland and adrenal cortex are affected, it removes all other options that focus on only one hormone. RIGHT ANSWER IS C
- 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:
HINT: B12 is responsible for cell regeneration, Therefore deficiency of it causes degeneration of cells. Note that Myelin sheath is the covering of Spinal Cord. ANSWER IS B
- A patient with suspected tumor of lung had been admitted to the oncological department. Examination revealed localized pathology in the inferior lobe of the left lung. How many bronchopulmonary segments does this lobe have?
HINT: Each Lung has 10 bronchopulmonary segments. Right lung has 3 lobes and its segments are upper lobe- 3, middle-2, inferior- 5. For LEFT lung, just 2 lobes are present so 5 segments each in upper and lower lobes. ANSWER IS A
- During local anesthetization the patient has gone into anaphylactic shock. What drug must be administered to the patient?
- Atropine sulfate
- Epinephrine hydrochloride
EXP: Epinephrine hydrochloride (epinephrine is given for anaphylactic reactions) Epinephrine acts quickly to improve breathing, stimulate the heart, raise a dropping blood pressure, reverse hives, and reduce swelling of the face, lips, and throat. ANSWER IS D
- 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:
- Motor neuron dendrites
- Axons of motor neurons
- Axons of sensory neurons
- Dendrites of sensory neurons
- Dendrites of association neurons
EXP: the anterior root of the spinal cord is made up of the axons of motor neurons (posterior is sensory neurons) so a damage of anterior root leads to damage of axons of motor neurons. ANSWER IS B
- 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:
- Monoamine oxidase
Exp: Cyclooxygenase-1 (COX-1) is known to be present in most tissues. In the gastrointestinal tract, COX-1 maintains the normal lining of the stomach so its inhibition could lead to ulcer. ANSWER IS A
- In one of Polessye regions there was an outbreak of helminthias is manifested by cramps and facial edmata. The developed preventive measures in particular included ban for eating infested pork even after heat processing. What helminthiasis was the case?
EXP: Trichinosis and taeniasis are both for pork but length of uterus is not described here for taeniasis. Taeniarhynchosis (taenia saginata) is for pork. Both echinococcosis and alveococcosi is for dog. ANSWER IS A
- A female patient sought medical genetic consultation. Physical examination revealed pterygium coli deformity (webbed-neck), broad chest, under-developed breasts. Study of buccal epithelium cells revealed no X-chromatin in the nuclei. This indicates that the patient has the following syndrome:
EXP: Turner syndrome ( 45 X0 no barr body) is a chromosomal condition that affects development in females. The most common feature of Turner syndrome is an early loss of ovarian function
(ovarian hypofunction or premature ovarian failure) such as broad chest, underdeveloped breasts
ANSWER IS B
- During blood transfusion a patient has developed intravascular erythrocyte hemolysis. What kind of hypersensitivity does the patient have?
- II type (antibody-dependent)
- I type (anaphylactic)
- III type (immune complex)
- IV type (cellular cytotoxicity)
- IV type (granulomatosis)
EXP: type 2 AKA Complement(Antibody) dependent reactions: Antibody is directed against antigen on cells (such as circulating red blood cells) or extracellular materials (basement membrane).
The resulting Ag-Ab complexes activate complement (via the classic pathway), leading to cell lysis or extracellular tissue damage. ANSWER IS A
- Patients with erythropoietic porphyria (Gunther’s disease) have teeth that fluoresce with bright red colour when subjected to ultraviolet radiation; their skin is light-sensitive, urine is red-colored. What enzyme can cause this disease, when it is deficient?
- Uroporphyrinogen I synthase
- Delta-aminolevulinate synthase
- Uroporphyrinogen decarboxylase
- Uroporphyrinogen III cosynthase
Exp: (Gunther’s disease, GD) is a rare autosomal recessive disease. It results from the deficiency of uroporphyrinogen III synthase, the fourth enzyme on the metabolic pathway of heme synthesis. ANSWER IS E
- 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:
- Left middle ear
- Right middle ear
- Left inner ear
- Right inner ear
- Right external ear
Exp : During infection of the middle ear there is accumulation of fluid in the Eustachian tube, this reduces air conduction of sounds. Left because its in the left ear. ANSWER IS A
- In course of invasive abdominal surgery a surgeon has to locate the origin of the mesenteric root. Where is it normally localized?
- Right mesenteric sinus
- Right flexure of colon
- Left flexure of colon
- Sigmoid colon
- Duodenojejunal flexure
Exp: The mesenteric root is located at the duodeno-jejunal flexure anatomically. ANSWER IS E
- 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?
- Protamine sulfate
Exp : Antidote therapy, often using ethanol, is directed towards delaying methanol metabolism until
the methanol is eliminated from the patient’s system either naturally or via dialysis. ANSWER IS C
- 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?
- Reabsorption and secretion
- Secretion and filtration
EXP– Presence of macromolecular (large molecules) proteins shows that filtration process has been distorted. ANSWER IS D
- 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?
- S2 – S4
- T h1 – T h5
- L1 – L2
- T h2 – T h5
- T h1 – L1
EXP; –S2 – S4 nerves have both afferent and efferent fibers, thus they are responsible for part of the sensory perception and their parasympathetic fibers whose electrical potential supply the descending colon and rectum, urinary bladder and genital organs. ANSWER IS A
- 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:
EXP– Teratogenicity is the property or capability of producing congenital malformations.
it usually occurs within the first trimester. ANSWER IS A
- 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?
EXP; Acetylcysteine is used to loosen thick mucus and that’s the effect of pneumonia pathogenically on bronchioles. ANSWER IS C
- A 26-year-old female patient with bronchitis has been administered a broad spectrum antibiotic as a causal treatment drug. Specify this drug:
- BCG vaccine
EXP; Doxycycline is a broad spectrum antibiotic. Interferon is antiviral. BCG vaccine for TB. Ambroxol is a mucolytic agent. Dexamethasone is a corticosteroid. ANSWER IS E
- 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?
- 0 (I)
- ? (II)
- ? (III)
- ?? (IV)
EXP; Group O – has neither A nor B antigens on red cells (but both A and B antibody are in the plasma) so when in contact with monoclonal antibiodies it had no agglutinations because there the absence of antigens on red cells. ANSWER IS A
- 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?
- Increase in low-density lipoprotein level
- Decrease in the concentration of amino acids in blood
- Increase in the oncotic pressure in the blood plasma
- Increased proteolysis
EXP;– Proteolysis is the breakdown of proteins into smaller polypeptides or amino acids. An increased proteolysis results in an increase in amino acids in the blood. ANSWER IS E
- 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:
EXP; Tryptophan is the only nicotiamide precusor present here. Threonine is a homoserine precursor. Arginine is a citrulline precursor. Histidine is a precursor for histamine. Lysine is a precursor for glutamate. ANSWER IS A
- A 68-year-old patient consults a cardiologist, complaining of high arterial blood pressure, pain in the heart egion, intermittent pulse. Prescribe the ß1-adrenoreceptor blocker for the treatment of the described pathology:
- Morphine hydrochloride
EXP;– Metoprolol is a ß1-adrenoreceptor blocker. Morphine is an opiod. Nootropil is a cerebral stimulant. Fenoterol is a ß1 agonist. Benzylpenicillin is an antibiotic. ANSWER IS D
- 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:
- Combinative variability
- Chromosomal mutation
- Modification variability
EXP;–Non-hereditary(phenotype) variability-these are variabilities which can not be inherited.
They are caused by special conditions and environment.They are also called modifications. ANSWER IS E
- 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:
- Tight junction
- Adherens junction
EXP; Desmosomes form links between cells, and provide a connection between intermediate filaments of the cell cytoskeletons of adjacent cells and its intercellular space is filled with electron-dense substances such as transmembrane fibrillar structures. This structure gives strength to tissues. Synapse allows passage of signal to another neuron. Tight junctions are two cells whose membrane join together. Nexus and adherens junctions are cell jnctions. ANSWER IS B
- For biochemical diagnostics of myocardial infarction it is necessary to measure activity of 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?
- Creatine kinase isoenzyme CK-MM
- Creatine kinase isoenzyme CK-MB
- LDH1 lactate dehydrogenase isoenzyme
- LDH2 lactate dehydrogenase isoenzyme
- Aspartate aminotransferase cytoplasmic isoenzyme
EXP– Creatine kinase (CK) is an enzyme found in your muscles. CK-MB, found in the heart and rises when heart muscle is damaged. while CK-MM, found in your skeletal muscle and heart. LDH 1 and 2 is found in the heart only. ANSWER IS B
- A patient complains of pain in the heart area during acute attack of gastric ulcer. What vegetative reflex can cause this painful feeling?
- Viscerovisceral reflex
- Viscerodermal reflex
- Visceromotor reflex
- Dermatovisceral reflex
- Motor-visceral reflex
EXP- Viscerovisceral reflex (heart and gastric [stomach] are both visceral hence 2 visceral). ANSWER IS A
- A patient is diagnosed with acute morphine hydrochloride intoxication. Prescribe an oxidizing agent for gastric lavage:
- Potassium permanganate
- Sulfocamphocainum (Procaine + Sulfocamphoric acid)
- Chlorhexidine (bi) gluconate
EXP; Potassium permanganate is an oxidizing agent.
- 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
- Immune rejection
- Ischemic kidney failure
- Tubular necrosis
EXP– (Diffuse infiltration of stroma by lymphocytes and plasmocytes) this are typical signs for autoimmune disease (i.e. when the body’s immune system attacks and destroys healthy body tissue). Since this occurs after transplantation of kidney. It shows that the body’s immune system rejected the kidney. ANSWER IS A
- 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?
- RNA polymerase
- DNA polymerase
EXP– DNA helicases separates double-stranded DNA into single strands allowing each strand to be copied during replication. RNA polymerase is an enzyme that produces primary transcript RNA. Ligase is an enzyme that join two large molecules. Restrictase is an enzyme that cuts DNA. DNA polymerase is used to synthesize DNA. ANSWER IS D
- 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?
- Irritant receptors
- Juxtacapillary (J) receptors
- Stretch receptors of lungs
- Proprioceptors of respiratorymuscles
EXP– Pulmonary Irritant Receptors are sensors present within the respiratory epithelium which can
sense and respond to a variety of chemical irritants. These sensory cells may initiate coughing in response to a variety of inhaled irritants and might induce bronchoconstriction. ANSWER IS A
- 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:
- Partial atrioventricular
- Complete atrioventricular
EXP; This is a complete atrioventricular block because both atria and ventricles contract independently showing that there’s a block between them. ANSWER IS E
- 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 antidote:
- Nalorphine hydrochloride
- Calcium chloride
EXP– Dimercaprol is a chelating agent that is used to remove a heavy metal (such as lead or mercury) from the blood. Metamizole acts as an antispasmodic and antipyretic. Mannitol is a diuretic. Nalorphine is an opoid. CaCl is used for Mg toxicity. ANSWER IS B
- 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?
- Actrapid (soluble insulin)
EXP– Glibenclamide is an antidiabetic drug in a class of medications known as sulfonylureas.
other sulfonylureas drugs are glipizide (glucotrol), gliclazide etc. ANSWER IS A
- 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:
- Bronchial asthma
- Gastric ulcer
EXP– Moderate doses of atropine sulfate dilate pupils and increase intraocular pressure so its contraindicate for glaucoma. ANSWER IS D
- 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:
- Multifactorial diseases
EXP– Anthroponosis, is an infectious disease in which a disease causing agent carried by humans is transferred to other animals. ANSWER IS E
- 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?
EXP– External inhibition is the sudden decrement of a conditioned response due to the presence of a non important stimulus (change of context). ANSWER IS C
- 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:
- Production of gammacarboxyglutamate
- Conversion of homocysteine to methionine
- Conversion of methylmalonyl CoA to succinyl CoA
- Degradation of glutathione
- Hydroxylation of proline
EXP– Gammacarboxyglutamate is an essential substrate in several proteins, including coagulation
factors X, VII, IX, and XIV, vitamin K-dependent protein S and Z, prothrombin, transthyretin. ANSWER IS D
- 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 hypehydration, salivation diarrhea, muscle spasms. The prescribed drug relates to the following group:
- Cholinesterase reactivators
- Adrenergc blockers
- Ganglionic blockers
EXP– Cholinomimetics aka parasympathomimetic drug, stimulates the parasympathetic nervous system by mimicing the effects of acetylcholine (ACh) as the neurotransmitter. On over administration of the drug the parasympathetic nervous system is over stimulated the clinical signs appear such as; hyperhydration, salivation, diarrhea, muscle spasms. ANSWER IS A
- 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 hyper-lipoproteinemia is observed in the patient?
- Hyperlipoproteinemia type I
- Hyperlipoproteinemia type IIa
- Hyperlipoproteinemia type IIb
- Hyperlipoproteinemia type IV
- Cholesterol, hyperlipoproteinemia
EXP– Hyperlipoproteinemia type IIa is characterized by increased levels of LDL cholesterol in the blood due to the lack of uptake of LDL particles. ANSWER IS B
- 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?
- Chronic pyelonephritis
- Tubular interstitial nephritis
- Acute pyelonephritis
EXP– No haematuria that removes D. No history of drug or anything that could harm the interstitial, that removes B. It is chronic, that removes C. No history of hypertension, so E is out. There was sclerosis, lymphocytic and plasmocytic infiltration on renal (pelvis) suggests pyelonephritis (chronic renal disease) shows the disease is chronic. ANSWER IS A.
- During the hystological 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?
- Osteon layer
- Outer lamellae of compact bone tissue
- Inner lamellae of compact bone tissue
EXP;– The periosteum in one is made up of osteocytes and osteoblasts(all basophilic), they are responsible for bone tissues regeneration. ANSWER IS B
- Autopsy of a 50-year-old male who had tuberculosis revealed a dense grey-white nidus in form of a nodule 2 cm in diameter in the sub pleural portion of the upper right lobe. The pleura in this region was thickened, in the pleural cavity there was a small amount of serous haemorrhagic 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?
- Fibro sarcoma
- Squamous cell carcinoma
EXP;– Adenocarcinoma is the cancer of epithelial tissue that has glandular origin, glandular characteristics, or both. ANSWER IS D
- 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:
- K+ and Cl-
- K+ and Na+
- Ca2+ and Cl-
EXP;– Neurotransmitters interact specifically with sodium channels (or gates). So sodium ions flow into the cell, reducing the voltage across the membrane and increasing their velocity. ANSWER IS E
- 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?
- Ligase chain reaction method
- Hybridization method
- Hybridization signal amplification method
- Polymerase chain reaction
- ELISA diagnostic method
EXP;– Polymerase chain reaction is a tool that you can use to focus in on a segment of DNA and copy it billions of times over. PCR is used every day to diagnose diseases, identify bacteria and viruses, match criminals to crime scenes, and in many other ways. ANSWER IS D
- 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?
- Medullary swelling
- Clean ulcer
- Dirty ulcer
EXP;- The word here is ulcer, so every other option is out. The dilemma is if it’s clean or dirty. The ulcer does not have a bloody discharge covering the grey slough and it’s not swollen. Ulcer has smooth edges, so it’s clean. ANSWER IS C
- 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 coloured areas. Transformed cells resemble owl’s eye. Name the
pneumonia causative agent:
- Candida fungi
- Influenza virus
EXP;– Cytomegalovirus (CMV) produces typical owl’s eye intranuclear inclusion bodies in infected cells. ANSWER IS D
- 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:
EXP;– Eukaryotic cells may contain several other types of organelles such as; mitochondria, nucleus, chloroplasts, the endoplasmic reticulum, the Golgi apparatus, and lysosomes. While other do not have these organelles. DNA is located in the nucleus. ANSWER IS E
- A 37-year-old male patient developed pseudo-arthrosis after a closed fracture of the femur. Specify the type of regeneration in the patient:
- Pathological hypo-regeneration
- Pathological hyper-regeneration
EXP;- In pseudo-arthrosis, the body perceives bone fragments as separate bones and do not attempt to unite them, so the bone would not regenerate. It will make sense to go with A, WHICH IS THE RIGHT ANSWER
- Nuclear 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:
- tRNA + Rrna
EXP;- Genes synthesizing RNA should be rRNA. tRNA transfers information. mRNa serves as messenger between DNA and protein synthesis. SnRNA processes heterogenous nuclear RNA. ANSWER IS D
- 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?
EXP;- An oxidizing enzyme that contains iron and a porphyrin and is found in the mitochondrial membrane of tissue, where it catalyzes the transfer of electrons to oxygen as part of the electron transport chain, ultimately leading to the formation of ATP. ANSWER IS C
- 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?
- Methionine, B6, B12
- Arginine, B2, B3
- Alanine, B1, P P
- Valine, B3, B2
- Isoleucine, B1, B2
EXP;- Steatosis occurs when the breakdown of fats in the liver is disrupted. Methionine, an essential amino acid, is a major lipotropic compound in humans. When estrogen levels are high, the body requires more methionine. Estrogens reduce bile flow through the liver and increase bile cholesterol levels. Methionine helps deactivate estrogens. ANSWER IS A
- A 2-year-old boy is diagnosed with Down syndrome. What chromosomal changes may be the cause of this disease?
- Trisomy 13
- Trisomy 21
- Trisomy X
- Trisomy 18
- Monosomy X
EXP;– Down syndrome is a genetic disorder caused when abnormal cell division results in extra genetic material from chromosome 21. Patau is trisomy 13. Edward is trisomy 18. ANSWER IS B
- 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?
- Study of lymph node punctate
- Microscopy of blood smears
- Study of cerebrospinal fluid
- Microscopy of bone marrow punctate
EXP;– Malaria parasites can be identified by examining under the microscope a drop of the patient’s blood, spread out as a “blood smear” on a microscope slide. ANSWER IS C
- A patient has severe blood loss caused by an injury. What kind of dehydration will be observed in this particular case?
EXP;– Iso-osmolar(isotonic) dehydration is when proportionally the same amount of water and sodium is lost from the body (e.g.; Repeated vomiting, Severe bleeding) the sodium concentration of the extracellular fluid and hence its tonicity will not change. ANSWER IS A
- A 30-year-old patient has dyspnoea 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?
- Immune complex
- Delayed-type hypersensitivity
EXP;– Gell–Coombs conception, disorders, such as hay fever or allergic asthma, are classic examples of Type I hypersensitivity which leads to anaphylatic. ANSWER IS B
- 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:
- Citric acid
EXP;– GABA transaminase enzyme catalyzes the conversion of 4-aminobutanoic acid (GABA) and 2-oxoglutarate (α-ketoglutarate) into succinic semialdehyde and glutamate. Succinic semialdehyde is then oxidized into succinic acid by succinic semialdehyde dehydrogenase and as such enters the citric acid cycle. ANSWER IS D
- 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:
EXP;– On electron microscopy of rotavirus, intact virus particles resemble a wheel, with short spokes and a well-defined rim. ANSWER IS B
- 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?
- Structure of cell wall
EXP;– On examination of bacillus by Ozheshko method it is usually to check for the presence of spores. ANSWER IS D
- 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?
- Preshock (compensation stage)
EXP;– The erectile phase proceeds from several minutes to a half an hour. For it the expressed reaction is characteristic from a CNS and Sympatico adrenal system. During this period, especially if the trauma was preceded by a strong nervous overstrain, sensitivity rising to external stimuli, impellent and speech excitation, fluctuations of arterial and venous pressure, pallor of integuments, increase and quite often arrhythmia of pulse, breath. ANSWER IS E
- 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. Glomerulus were
Undersized, sclerotic, with atrophied tubules. What disease are these changes characteristic of?
- Renal amyloidosis
- Pyelonephritis with kidney shrinkage
- Essential hypertension
- Acute glomerulonephritis
- Membranous nephropathy
EXP;– Essential hypertension causes damages to the artery walls, it makes artery walls thick and stiff and also causes kidney damages. ANSWER IS C
- 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:
- Bainbridge reflex
- Dagnini-Aschner reflex
- Holtz’s reflex
- Hering-Breuer reflex
- Frank-Starling mechanism
-Dagnini-Aschner reflex; Slowing of the heart rate after pressure is applied to the eye or the carotid sinus. It was formerly used to slow the heart in patients with supraventricular tachycardia or angina pectoris. ANSWER IS B
- 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 tumour:
- Scirrhous undifferentiated carcinoma
- Medullary carcinoma
- Undifferentiated sarcoma
EXP;- Scirrhous undifferentiated cancer is of epithelial origin that is atypical and hyperchromatic. ANSWER IS A
- 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:
- Hypertrophic growth
- Working hypertrophy
- Vicarious hypertrophy
EXP;– Vicarious hypertrophy is the hypertrophy of an organ following failure of another organ because of a functional relationship between them. ANSWER IS C
- In allergic diseases, a dramatic increase in basophilic leukocytenumber in patients’ blood is observed. This phenomenon is due to the following basophil function:
- Participation of heparin and histamine in metabolism
- Phagocytosis of microorganisms and small particles
- Immunoglobulin synthesis
- Phagocytosis of immune complexes
- Participation in blood clotting
EXP;– Basophilic leukocytes are phagocytic leukocytes of the blood characterized by numerous basophilic granules containing heparin, histamine, and leukotrienes. ANSWER IS A
- 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:
- Anticholinesterase agents
- Myotropic antispasmodics
EXP;– Intestinal colic occurs due to smooth muscular contractions(spasms) of a hollow tube (intestines, gall bladder or ureter). Best method of treatment is to give antispasmodics. ANSWER IS B
- 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?
- Increase of ALT, AST level
EXP;– The AST:ALT( aspartate aminotransferase /alanine aminotransferase) ratio can be a good indicator because, when the liver cells are damaged or diseased, it releases ALT/AST into the bloodstream, which makes ALT/AST levels go up. ANSWER IS A
- 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:
EXP;-. Achondroplasia is an autosomal dominant disorder, therefore a normal child from parents with achondroplasia will have to get the good recessive gene from both (aa). ANSWER IS D
- A patient has acute bronchitis. The fever up to 38,5oC had lasted for a week, presently there is a decrease in temperature down to 37,0oC. Specify the leading mechanism in the 3rd stage of fever:
- Increased respiratory rate
- Increased heat production
- Development of chill
- Increased diuresis
- Peripheral vasodilation
EXP;– In this stage The hypothalamus detects the blood as being too hot and initiates heat loss (vasodilation). ANSWER IS E
- 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 fibrousstroma. What is the most likely diagnosis?
- Cystic breast
- Invasive ductal carcinoma
EXP;– Fibroadenoma has rounded contour, overgrowth of fibrous and glandular tissue. ANSWER IS B
- Examination of the duodenal contents revealed some pear-shaped protozoa with two nucleiand 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?
- Intestinal trichomonads
EXP– Giardia lamblia is trophozoite which is pear shaped, with a broad anterior and much attenuated posterior. It is 10-12µm long and 5-7µm wide, has 4 flagella, bilaterally symmetrical, and has two nuclei. ANSWER IS D
- 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:
- Cytochrome A1
- Flavin coenzymes
- Cytochrome oxidase
- Cytochrome B
- Cytochrome C
EXP;– Riboflavin (vitamin B2) deficiency is mostly caused by the deficiency of riboflavin coenzymes FAD and FMN. this leads to the symptoms above. ANSWER IS B
- A 54-year-old female was brought to the casualty department after a car accident. Traumatologist diagnosed her with multiple fractures of the lower extremities. What kind of embolism is most likely to develop in this case?
EXP;– A fat embolism is a type of embolism that is often caused by physical trauma such as fracture of long bones, soft tissue trauma, and burns. ANSWER IS E
- A blood drop has been put into a test tube with 0,3% solution of NaCl. What will happen to erythrocytes?
- Osmotic haemolysis
- Mechanical haemolysis
- Any changes will be observed
- Biological haemolysis
EXP;– When the red blood cell has been subjected to a hypotonic solution it undergoes osmosis. this cause stress to the RBC cell wall, making it to rupture. ANSWER IS A
- There are cortical and medullarysubstances 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?
- Pituitary gland
- Thyroid gland
- Adrenal gland
EXP;– Adrenal glands is made up of two layers (cortex, medullar). The adrenal cortex itself is divided into Three zones: zona glomerulosa, the zona fasciculata and the zona reticularis. ANSWER IS C
- 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:
- Embryonic shield
- Amniotic stalk
- Floor of the amniotic sac
- Roof of the yolk sac
- Extraembryonic mesoderm
EXP;– The embryoblast forms an embryonic disc (embryonic shield) which is a bilaminar disc of two layers, an upper layer the epiblast (primitive ectoderm), and a lower layer the hypoblast (primitive endoderm). The disc is stretched between what will become the amniotic cavity and the yolk sac. ANSWER IS A
- An electron micrograph shows a cell of neural origin. The terminal portion of the cell dendrite has cylindrical shapeand consists of 1000 closed membrane disks. What cell is represented by the micrograph?
- Spinal node neuron
- Cone receptor cell
- Rod receptor cell
- Neuron of the cerebral cortex
- Neuron of the anterior horns of the spinal cord
EXP;- It comes down between cone and rod. Rod is cylindrical while cones is conical in shape. ANSWER IS C
- Disruption of nerve fiber myelinogenesis causes neurological disorders and mental retardation. These symptoms are typical for hereditary and acquired alterations in the metabolism of:
- Neutral fats
- Higher fatty acids
- Phosphatidic acid
EXP;– Sphingolipids, a family of membrane lipids, are bioactive molecules that participate in diverse functions controlling fundamental cellular processes such as cell division, differentiation, and cell death. Sphingolipidoses, or disorders of sphingolipid metabolism, have particular impact on neural tissue. ANSWER IS A
- 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 processare these morphological changes typical
- Chronic abscess
- Acute abscess
EXP;– In chronic abscess there are formations of cavity while there is none in acute.
The size and other signs (dense fibrous connective tissue wall) shows it is an abscess(i.e. both empyema and phlegmon are much larger in size). ANSWER IS B
- 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?
- Retinol acetate
- Tocopherol acetate
- Pyridoxine hydrochloride
EXP;– Retinyl Acetate is a naturally-occurring fatty acid ester form of retinol (vitamin A) with potential antineoplastic and chemo preventive activities such as production of rhodopsin. Tocopherol is vit. E. pyridoxine is vit. B6. Cyanocobalamin is vit. B12. Thiamine is vit. B2. ANSWER IS A
- 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:
EXP; In corpus laryngitis, there is exudation of fibranous materials which leads to development of respiratory problems. On autopsy presence of grey films which could be the fibrinous materials produced. ANSWER IS D
- A child has a history of hepatomegaly, hypoglycaemia, seizures, especially on an empty stomach and in stressful situations. The child is diagnosed with Gierke disease. This disease is caused by the genetic defect of the following enzyme:
- Glycogen phosphorylase
EXP;– Gierke’s disease, is the most common of the glycogen storage diseases. This genetic disease results from deficiency of the enzyme glucose-6-phosphatase, it impairs the ability of the liver to produce free glucose from glycogen and from gluconeogenesis. ANSWER IS B
- A public utility specialist went down into a sewer well without protection and after a while lost
Consciousness. Ambulance doctors diagnosed him with hydrogen sulphide intoxication. What type of hypoxia developed?
EXP;– Basis of this hypoxia(hemic) type is decrease of blood oxygen capacity. There are Two variants: anaemic and toxic. Toxic form arises in case of hemic toxins poisoning. The general content of haemoglobin in blood remains normal, but the contents of functionally active haemoglobin decreases. The part of hemoglobin turns into such compounds, which are not capable to execute oxygen transport function. ANSWER IS E
181.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:
EXP;– Genocopy refers to situation when identical phenotype is produced by two different genes / genotypes. ANSWER IS A
- 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 cased by the congenital deficiency of the following protein:
- α1-proteinase inhibitor
EXP;– Alpha 1-antitrypsin is also referred to as alpha-1 proteinase inhibitor (A1PI) because it inhibits a wide variety of proteases. It protects tissues from enzymes of inflammatory cells, especially neutrophil elastase and tripsin. ANSWER IS A
- 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:
- Parathyroid hormone
EXP;– PTH (parathyriod hormone) increases blood calcium levels by stimulating osteoclasts to break down bone and release calcium. It is also an inhibitor of proximal tubular reabsorption of phosphorus. When there is of production of PTH, there hypercalcemia and hypophosphatemia. ANSWER IS D
- During a surgery for femoral hernia a surgeon operates within the boundaries of femoral trigone. What structure makes up its upper margin?
- Arcus iliopectineus
- Lig. pectinale
- Fascia lata
EXP;– Superior border-Formed by the inguinal ligament, a ligament that runs from the anterior superior iliac spine to the pubis tubercle. Lateral border – Formed by the medial border of the sartorius muscle. Medial border – Formed by the medial border of the adductor longus muscle. ANSWER IS A
- 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?
- Muscular part of the pretacheal layer of cervical fascia
- Investing layer of cervical fascia
- Visceral part of the pretracheal layer of cervical fascia
- Prevertebral layer of cervical fascia
- Carotid sheath of cervical fascia
EXP;– The Investing layer of deep cervical fascia is the most superficial part of the deep cervical fascia, and it encloses the whole neck. Where it meets the trapezius and sternocleidomastoid muscles. ANSWER IS B
- A patient with acne has been prescribed doxycycline hydrochloride. What recommendations should be given to the patient, while he is taking this drug?
- Avoid long stay in the sun
- Take with large quantity of liquid, preferably milk
- Take before meal
- The course of treatment should not exceed 1 day
- Do not take with vitamins
EXP;– A IS CORRECT because the sun’s UVrays has direct negative influences on patients with acne.
- 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?
- Folic acid
EXP;– Vicasol is a synthetic, water-soluble analog of vitamin K, which promotes the increase of prothrombin in the blood and improves blood coagulation. ANSWER IS D
- A patient has arterial hypertension. What long-acting drug from the group of calcium channel blockers should be prescribed?
EXP;– Amlodipine is the only long-acting drug of calcium channel blockers present in question.
more long-acting calcium channel blockers are( felodipine). Octadine is a ganglion blocker. Pyrroxanum is an antianxiety drug. Atenolol is beta blocker. Reserpine is a sympatholytic. So, ANSWER IS E
- A patient has been diagnosed with ARVI. Blood serum contains immunoglobulin M. What is the stage of infection in this case?
EXP;– IG and M are found in blood and lymph fluid and are the first type of antibody made in response to an infection. ANSWER IS D
- 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
- Increasing volume of blood circulation
- Increasing blood viscosity
- Increasing erythrocyte sedimentation rate (ESR)
EXP: Increase in PCV shows that there is an abnormal increase in erythrocytes level. This can lead to increased viscosity as there space for RBCs to flow normally. ANSWER IS C
- A patient complains of palpitation after stress. The pulse is 104bpm, P-Q=0,12 seconds, there are no changes of QRS complex. What type of arrhythmia does the patient have?
- Sinus arrhythmia
- Sinus bradycardia
- Sinus tachycardia
- Ciliary arrhythmia
EXP: ECG of sinus tachycardia shows P–R interval: Between 0.12–0.20 seconds and shortens with increasing heart rate. ANSWER IS C
- A 30-year-old patient has undergone keratoplasty in the transplantation center, cornea has been taken fron a donor, who died in a road accident. What kind of transplantation was performed?
EXP;– Allotransplantation is the transplantation of cells, tissues, or organs, to a recipient from a genetically non-identical donor of the same species. Auto is transplantation of tissues from one part of body to another of the same person. Xeno is of different species. Hetero is from one individual to another. ANSWER IS E
- 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 edgeof the sternocleidomastoid muscle. Specify this vessel:
- V. jugularis externa
- V. jugularis anterior
- A. carotis externa
- A. carotis interna
- V. jugularis interna
EXP;– The external jugular vein runs along the lateral edge of the sternocleidomastoid. Anterior jugular runs along the median line and anterior border of sternocleidomastoid. Internal carotid runs vertically upward in carotid sheath and enters the skull. External carotid runs behind the mandible. Internal jugular runs laterally along with internal carotid. ANSWER IS A
- 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, hyalinecartilage forms open circles. What organ has the described morphological features?
- Secondary bronchi (lobar bronchi)
- Tertiary bronchi (segmental bronchi)
- Terminal bronchiole
EXP;– Histology of the trachea show all listed qualities, most especially hyaline cartilages which forms open circles. ANSWER IS C
- 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:
- Dihydrofolate reductase
- Thioredoxin reductase
EXP;– DHFR (dihydrofolate reductase) can be targeted in the treatment of cancer. DHFR is responsible for the levels of tetrahydrofolate in a cell, and the inhibition of DHFR can limit the growth and proliferation of cells that are characteristic of cancer. Methotrexate, a competitive inhibitor of DHFR, is one such anticancer drug that inhibits DHFR. ANSWER IS A
- 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)?
- It inhibits both GP and GS
- It activates both GP and GS
- It inhibits GP and activates GS
- It activates GP and inhibits GS
- It does not affect the activity of GP and GS
EXP;– Glycogen phosphorylase breaks up glycogen into glucose subunits AND glycogen synthase (GS) takes glucose and converts them into long polymers of glycogen. Insulin has a negative effect on GP and a positive effect on GS. ANSWER IS C
- A patient has the oxyhemoglobin dissociation curve shifted to the left. What blood changes induce this condition?
- Alkalosis, hypocapnia, temperature drop
- Acidosis, hypercapnia, temperature rise
- Acidosis, hypercapnia, temperature drop
- Acidosis, hypocapnia, temperature rise
EXP;– A shift to the left implies an increased oxygen affinity and hence, tighter binding due to the higher oxygen saturation in relation to the pO2. This in turn leads to alkalosis, hypercapnia and decrease in temperature. ANSWER IS A
- Administration of doxycycline hydrochloride caused an imbalance of the symbiotic intestinal microflora. Specify the kind of imbalance caused by the antibiotic therapy:
- Superimposed infection
EXP;– Doxycycline hydrochloride is an antibiotic which kills of bacteria in the body, including the essential bacterial in gut system need for digestion. This leads to microbial imbalance on or inside the body (dysbacteriosis). ANSWER IS B
- A patient with signs of emotional lability that result in troubled sleep has been prescribed nitrazepam. Specify the sleep-inducing mechanism of this drug:
- Suppression of serotonergic neurotransmission
- Blockade of opiate receptors
- Inhibition of stimulating amino acids
- H1-histamine receptors stimulation
- GABA- ergic system activation
EXP;– Nitrazepam is a nitro-benzodiazepine. It acts on benzodiazepine receptors in the brain which are associated with the GABA receptors, causing an enhanced binding of GABA to GABAA receptors. GABA is a major inhibitory neurotransmitter in the brain. ANSWER IS E
- 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:
- V. cava inferior
- V. cava superior
- V. portae hepatis
- V. mesenterica inferior
- V. mesenterica superior
EXP;– Probably a mistake(i.e. the saphenous), we should pay more attention to the dilation of veins in anterior abdominal wall, most veins in abdominal region (i.e. Superior mesenteric vein, Splenic vein) drain to the hepatic portal vein. An increase in pressure in H.P.vein would lead to dilation in most veins in anterior abdominal wall. ANSWER IS C